Monday, May 19, 2014

If you struggle with contentment, please read this....

I'd like to introduce you to a woman, who is also named Sarah, who helps in our house 3 days a week.  In Kenya, it is culturally expected to have someone work in your house (and outside, too)....and it helps a lot with food prep and cleaning.  The first person who worked for us was a super hard worker, but she ended up stealing from us after a few weeks.  We were a little reluctant to try again, but a family left last October who had employed Sarah and loved her.  She has worked at RVA for over 20 years, and she has an unspoiled reputation.  She has been working for us since the first October that we were here, and she has become a part of our family. :)

She is hard working, pleasant, honest, a great baker,  smart, helpful to us about matters of culture, and so generous.  She is also a woman of great faith who has taught me a lot about contentment.  Last week, she asked me if I had any old clothes from my girls, because there is a women in her community who has 4 little girls, no husband, and no money.  She said the girls only have tattered clothes because whatever money they can scrape together goes towards food.  Sarah had already given them all the clothes that she had that would fit, but it wasn't very much.  When you learn more about her, you will see how amazingly generous this act was.  I probed a bit further and discovered that the woman in her neighborhood does laundry to earn some money, and Sarah has her do her laundry.  I'm sure that Sarah could use that money for her own family's needs, but she chooses to help this woman in a dignified way through employment.  She told me that the woman buys cheap corn flour to make ugali and serves it with sikuma wiki (kale) - a traditional Kenyan meal that is very inexpensive but also very low in protein.  I was horrified to learn that the only protein this woman can give her children is milk in their chai everyday - she buys milk by the cupful.  Don't miss that - about a 5 ounce cup!!  And, she splits it between 5 cups of chai!  We are so worried about those little girls that we went to the duka and bought a bunch of beans and powdered milk and cooking fat to help them get by for a while - not a perfect solution, but that will help, along with the clothes. 

One day a few months ago, I asked Sarah to tell me her story over a cup of chai.  She told me that she is the third born child among 10 children.  The first born is a girl, who was able to finish high school and get married before their father died.  The older sister got a job as a houseworker for a family at RVA.  The second born was a boy, and he and Sarah were in the same grade in school when their father died.  Her mother told her that she could not afford to pay high school fees for both Sarah and her brother, so she would need to get a job to pay for her brother's school fees.  She ended up taking her sister's job at RVA, because her sister began to have children and stayed home with them.  Meanwhile, her uncle put 2 of the younger brothers (ages between 5 and 10) OUT OF THE HOUSE to become street kids because they couldn't afford to feed everyone.  They stayed on the street for 2 years before being absorbed back into the family.  So, the years passed and she put 8 of her siblings through high school and she never had the opportunity to go.  Through her connections, she also was able to get each of them a job in Kijabe - no small thing in a country with 40% unemployment. 

She and her mother had turned away several would-be suitors and, when the last sibling was through high school, she was looking forward to getting married and starting a family of her own.  After all, she was getting pretty old by Kenyan standards!  However, her mother kept saying "no" because she wanted her to stay at home and help her.  Finally, Sarah "ran away" to get married.  She laughed when she recalled that she told her employer "Please don't fire me, but I am going to get married."  She came back to ask her mother's forgiveness, but she had to miss out on a church wedding.  I am amazed that she tells all of this story with no trace of bitterness in her voice or eyes.  She will tell you that God has blessed her family and she has everything she needs.  God has indeed blessed her with a loving, hardworking husband and 2 sweet kids...and siblings that all support themselves and look out for each other.  She is content - honestly, she is content.

Now, Sarah does not live on the edge of starvation - she and her husband both have steady jobs, and I have made sure she has another job when we leave.  But, they do not have a lot.  She makes just under a dollar an hour - a rate set by station management here, according to the norms of the area.  Between her husband and her, they probably make just above the $2 per person per day that the majority of the world lives on.  She lives in a community of squatters about a 45 minute walk from here, in the direction of the top of the escarpment.  It is cold and misty there, so she tends to cough a lot - I'm not sure if it is from the charcoal smoke from cooking food in the house or from the weather.   It is also very steep in the area - the children that died in the mudslides last year were her neighbors.  In fact, the government announced then that the area was not fit for habitation, but no one can afford to buy land and move to a safe area, so they are still there. 

Path to her home

Outhouse, and neighbors homes "stacked" on top of each other on the misty hill

She borrowed money to pay for water to come to her house, but the pipes were washed away in the mudslides last year only 3 or 4 months after installation.

Sarah and her children in front of their home.

While I would love for her to have an education or a church wedding, what she really needs is a safe place for her family to live.  She and her husband have looked at land that is safe and still a reasonable walk to work for them and to school for the kids - I think they must be using an hour's walk as their criterion of reasonable.  They would plan to dismantle their modest wooden house and rebuild it on the land, but there is no way they can afford the $3000-4000 that it costs to buy the land.  So, I am humbly asking for some of you to prayerfully consider joining us in helping her....and you can help the Needy Children's Fund at the hospital at the same time. 

Here is my idea:  she has borrowed large amounts ($200-300) of money from us 2 times...and paid them both back on schedule or ahead of schedule.  She is willing to pay back this money for the land, as long as people understand that it will take a few years.  If anyone reading this is willing to help donate to her land, she will pay back a set amount each month into the Needy Children's Fund at the hospital.  In this way, you will be helping her family escape an unsafe environment AND help needy families who can't pay for their children's hospital bills.  If you'd like to help, please message me on the FB  page or email me directly.  Thanks for considering helping this amazing family escape an unsafe home! 


Philippians 4:11  "Not that I speak from want, for I have learned to be content in whatever circumstances I am."

Monday, May 12, 2014

Immeasurably more than all we ask or imagine...

Kijabe is blessed with a wonderful group of chaplains that work throughout the hospital, ministering to the patients and families and sharing Jesus with them.  I have previously mentioned Mercy in this blog, and she has come in during the middle of the night on many occasions to help a family struggling with loss.  Also, many of our visiting teams have worked with her and been welcomed by her.

April 2014

July 2013

Another young chaplain is named Steven.  We have gotten to know him during our time here, and he invited us to preach at his church in Kambaland (sort of near where ABO was - about 4 hours away).  After many attempts to find a weekend that worked, we settled on last Sunday.  Because of call issues, I couldn't go, so Rick and Steven set out about 5:30am together.  As an aside, Rick and I have made a policy not to drive here when the sun is not up, but this was a tricky situation due to the distance.  Being at the equator, the sun rises and sets at roughly 6:30 everyday.  Remember that.

Their journey took them towards Nairobi, then around the Nairobi bypass, and north for a few miles to a town called Thika.  Thika is the center of the pineapple industry in Kenya, and Del Monte has a large presence there.  After passing through Thika, they took a series of smaller roads through the pineapple plantations and dry, scrubby acacia forests until they reached the area around Mwingi.  Mwingi is in the traditional home area of the Kamba people, who are the fifth-largest tribe in Kenya.  It was a real treat for Rick to visit with Steven’s family and have chai with them before they all headed over to the local church.

Some time before the trip, Rick had asked Steven about how long he should plan to preach.  Steven nonchalantly replied, “about one hour.”  Sermons are, by modern American standards, long - but probably similar to sermons in early America.  Kenyans do not get too uptight about schedules and, although the service was scheduled to start at 10am, the fact Rick and Steven arrived at the church after 11am, was "hakuna shida" or "no problem.In fact, Kenyan friends have told us that as long as you arrive at an event before it is over, you are not late!  Most of the service was in the Kamba language, but Rick preached his message on Acts 1:8 in English, with Steven translating for him.  After the service they enjoyed a traditional lunch of rice and a meat and potato stew with the church elders.
On the way home, they stopped to visit Steven’s sister-in-law in a local hospital, who was recovering from wounds suffered in an accident with a pikipiki (motorcycle) all-too-common event here.  Rick texted me to let me know they would be leaving "soon," already past the time that they could hope to make it before dark.  We had previously talked about Rick staying the night in Nairobi to avoid driving in darkness, but he felt obligated to get Steven, Steven's father (who also works at Kijabe Hospital), and Steven’s son home to Kijabe that night, since they were all riding together.

Speed bumps (and sometimes rumble strips) are very common along the highways in Kenya - not well marked, but common.  They can be found in pretty much every small village, and sometimes open highway, and serve to bring traffic down to a reasonably safe speed through the town (either by causing you to brake - if you see them in time - or by taking off several important metal things that hang down under the car).  Rick actually reported no surprise speed bumps that day but, about halfway home and before they got back to Thika, Rick started to notice a disturbing noise coming from the front end of the car whenever he slowed down for one of those bumps.  Given that trained mechanics are hard to find in the rural areas and there is no AAA 24 hour service here, he decided to press on and try to get the car home.

So, at 6:10pm, I got a call from Steven's phone (Rick's wasn't working!):  it was Rick saying the car was broken down on the far side of Nairobi, maybe near Thika.  It was a very short conversation that involved some quick brainstorming and that was all.  I wasn't really sure where they were or what the problem with the car was.  At 6:30pm, I got an emergency text from the US Embassy, saying that there had been 2 bombings of buses in Thika and to avoid that area.  Let me summarize:

-Car broken down
-Phone not working
-Pretty much dark now
-In an unfamiliar area
-And, maybe near bombings

Cool, now we pray and watch God at work!  (Ok, honestly, I wasn't exactly excited about this scenario, but it turned out to be a pretty neat way to see God at work.)  I tried to get in touch with Rick again, but his phone still wasn't working and no one was answering Steven's phone.  I called our Kenyan friend, John, who went to pick them up, but we knew that the car would be gone if we left it there overnight.  So, after everyone is safe, what to do about the car?  

I found out about an hour or so later (When John got there, we could communicate via his phone.), that they were past the bombings and the issue with the car prevented the front wheels from turning at all.  A real problem, without a tow truck.  I suggested lifting the car and putting the front end on the back of a pikipiki - I mean, if they can be used to transport goats, cows, and large furniture like sofas, then why not?!  

Sofa on piki - courtesy of Jullie Taubitz

Here's where God provides when you've got no viable options:  an orthopedic resident from Kijabe Hospital and his wife, who is a nutritionist on the pediatric floor "happened" to pass by.  Rick wasn't sure if they were driving or walking, but the wife recognized him and they came to help.  As it turns out, her cousin "happens" to be a competent mechanic, and she offered to call him.  He came within a few minutes and saved Rick from all the wannabee mechanics that were surrounding the car and trying to offer solutions.   This all happened in sort of a sketchy area with lots of bars, and it was impossible to know if any these guys were actually mechanics or just trying to finagle some money.  This sweet couple stayed with them for 2 or 3 hours - with an 18 month old!  They provided WAY more than moral support and a contact with a good mechanic - it really wasn't a safe area and having Kenyan advocates there who knew the area and dangers in the situation was a huge factor in their safety.  We are so very thankful for their presence and generosity - they could've passed by without stopping, and no one would have ever known.  They could've come and called the cousin and left, which would have been totally reasonable.  They are busy, had a young child, and needed to get home themselves, but they chose to stay until the end.  What an example of God's generous love!  I am pretty convinced that God sent them to help Rick, in a time of need when there were no other options.

So, how did it turn out?  Well, the problem was too great for the cousin mechanic to fix on the side of the road, and the problem was that the front wheels HAD to turn in order to move the car.  No one else liked the piki idea and, evidently, there were no tow trucks available.  The best idea was to take big pieces of metal from under the car until the wheels moved, and then drive it home.  One-and-a-half hours on very poor roads, in the dark, and down a steep hill into Kijabe.  Seriously!  Obviously, I am not a mechanic, but that sounded weird enough that I had to AGAIN bother our next door neighbor - who knows a lot about cars - and ask him if that sounded safe.  He said he thought it was fine.  Here are the pieces in the backseat:

Did you know these car parts are optional?!  Sort of like your appendix...
I called John after another hour or so to find out the status.  When I asked if I could speak with Rick, he said, "No, because he is driving the other car."  John followed them home, which made everyone feel so much better, and they arrived home before 11pm.  In another selfless move, John (whose business is being a driver for hire) wouldn't accept any money for his time and effort.  We are surrounded by generous, loving Kenyans and expats here!

Here is a takeaway from this experience:  Don't ever doubt that God is able.  And He may not pick from one of the neat little choices that you have laid out for Him - you may be out of options, like Rick was.  I have to admit that I was able to relax after I found out about this couple that stopped to help them - I knew that God was a part of this situation, so I didn't need to worry.  I am ashamed that I don't always behave with such confidence.


Ephesians 3:14-21
For this reason I kneel before the Father,  from whom every family in heaven and on earth derives its name.  I pray that out of his glorious riches he may strengthen you with power through his Spirit in your inner being,  so that Christ may dwell in your hearts through faith. And I pray that you, being rooted and established in love, may have power, together with all the Lord’s holy people, to grasp how wide and long and high and deep is the love of Christ,  and to know this love that surpasses knowledge—that you may be filled to the measure of all the fullness of God.
Now to him who is able to do immeasurably more than all we ask or imagine, according to his power that is at work within us, to him be glory in the church and in Christ Jesus throughout all generations, for ever and ever! Amen.

Monday, May 5, 2014

The Lord is my shepherd, I shall not want

Everyone has days that feel like an emotional roller coaster.  Join me on one of my own recently....

This happened a few weeks ago, while Rift Valley Academy was on it's month-long term break.  The fact that the expat population in Kijabe drops dramatically doesn't affect the patient volume or workings at the hospital, but it feels different here.  Rick and Ted both had birthdays that month, but we had decided to celebrate them together and early this year, since Ted was away for most of the month and over both the birthdays.  (This is sort of relevant.)  So, Tuesday was Rick's ### birthday - gosh, there was some static when I tried to tell you how old he is.  Anyway, Emily had been invited to a birthday party that day at a place in Naivasha (about an hour away) that has a pool.  Well, Tuesday is Rick's usual day to work, but I offered to work so that he could go to Naivasha and swim and hang out with folks on his birthday.  So, that is the background...

The day started off like any other day.  I met a visiting nurse about 8:45 to show her around and let her shadow on ward rounds.  On the ward, I checked in with the visiting US peds resident and was found by one of the chaplains who needed to talk about a patient's bill - this patient had actually been discharged a week prior, but no one on the team knew that he had been moved to a different bed and had stayed because he couldn't pay his bill.  Another patient needed help clearing his bill, so that took a little time to sort out.  I checked in with nursery, which was remarkably calm and less full than I have seen it in almost 2 years of being here...only 20 patients!  I went to round on the patient in the ICU - a very sick 14 month old with continued fevers and terrible lungs, despite adequate TB meds, meropenem, vancomycin, flagyl, and fluconazole.  Nothing had seemed to work for about 3 or 4 weeks, but the baby had finally seemed to turn a corner - it was time to try to extubate him and get him off the ventilator.

His chest xray at its worst.
So, we talked to the mom and got everything ready (including everything needed to RE-intubate him, should it go poorly), and I pulled out the breathing tube.  It felt tight coming out, which worried me that he may have so much swelling in his airway that he wouldn't tolerate breathing on his own...and, even worse, that he would be very difficult to re-intubate.  We hooked him up to CPAP and watched his oxygen saturation slowly fall on the monitor.  He had a good respiratory effort but terrible stridor - another sign of upper airway swelling - and had some wheezing (bronchoconstriction).  Finally, I decided to bag him (breath for him with a bag and mask) and asked for an albuterol neb to help relax the smooth muscle in his airways.  He bagged up immediately to 98% oxygen saturation...a factoid that will come into play later.  After the neb treatment, he looked pretty good.  He remained in good shape on face mask oxygen all day!  What a wonderful step for him; his mom was thrilled!

Then, since it was the visiting peds resident's last day of a 5 week rotation, I went over all of the patients on the ward with her - both so that I would know them for rounding the rest of the week and because I was taking call that night.  There were 3 very fragile patients in the HDU (high dependency unit = step down unit), including one that I had fully expected not to pull through 2 weeks before in the ICU.  The other 2 were new admissions and so sick - one with probable urosepsis and severe malnutrition; the other with Down's syndrome, severe malnutrition, and heart defects/heart failure.  All three patients were on high flow oxygen, either by CPAP or nonrebreather face mask.

 After that, it was off to the Maternal and Child Clinic to see a couple of patients.  One patient with constipation - a blessedly "normal" problem that is not life threatening.  Another with some developmental delay and neurologic findings after a fall a few months ago that the intern wanted me to see.  This patient turned out to have a huge dark patch over her left neck and shoulder and a mass in the left upper lobe of her lung on xray.  It turned out that her mother and maternal grandfather brought her and, when I asked them if anyone else in the family had dark patches like hers, they both started showing me their skin findings.  This little girl has a particularly severe presentation of something called Neurofibromatosis-1 and will be having surgery here in a week or so to debulk some of the neurofibroma that has invaded her spinal column and upper chest.  Please pray for her.

The discolored skin is evidence of a large neurofibroma underneath
 We admitted an infant with respiratory distress who has previously been diagnosed with an interrupted aortic arch vs. tight coarctation of the aorta (usually not repairable in this country, but we are working on getting him signed up with a visiting team of heart surgeons).  We admitted another child a few months old with probable TB - this was his NINTH admission for respiratory issues!

Then, I headed over to check on the patient in the ICU and the ones in HDU - 2 of which were needing somewhat higher oxygen flows.  They didn't look great, and I expected it to be a long call night.  I made some adjustments to their medications with the intern and headed home to make dinner. 

At home, Rick and the girls had returned from a fun day at the pool.  :)  We got dinner ready and ate a very casual birthday dinner, since we had already celebrated and I never know how much time I'll have on call....a casual completed dinner is more satisfying than an interrupted elaborate dinner.  It was turning into one of those nights where the pager is going off at the same time as the house phone is ringing, and the intern is calling on your cell phone while you are on the phone with the ICU or casualty.  While I was answering a call from casualty, the pager went off and then the intern called my cell phone - one of the children in HDU had arrested.  I ran up to the hospital and jumped in after the first dose of epi - the nurses and one of the outgoing medical interns (the new ones had recently arrived) were doing a fabulous job.  About 25 minutes into that resuscitation (that wasn't going well), I was called emergently to ICU because the baby up there had suddenly crashed. Really wishing that I could clone myself, I gave quick instructions to the intern and ran upstairs.  Why was that baby suddenly crashing after such a stable day??  When I arrived, the sats were in the 60s, so I started bagging the baby (breathing with a bag and mask).  The sats continued to fall - but, this baby had responded so quickly to bagging earlier in the day.  As I asked for the equipment and medications that I needed to reintubate this baby, I looked around at the 3 adult  patients in the big, open room.  I realized with a pit in my stomach that all of their monitors had red numbers for their oxygen saturations, and it suddenly struck me what was happening - the oxygen had failed.  The nurses ran to the patients' bedsides and began to bag them, while I sent one nurse on a hunt for any available oxygen cylinders.  I knew this baby would respond to oxygen and didn't need intubation.  He found one amazingly quickly in casualty, hooked it up, and the baby's oxygen saturations immediately rose to the 90s.

Running back down to HDU, I found all 3 infants being resuscitated at the same time.  This is one of those times where you know you are woefully inadequate and cannot handle everything that needs to happen at the same time, but you jump in and take one step at a time.  The nurses and available interns did a wonderful job, and they deserved a lot of commendation.  Keeping your wits about yourself in that sort of a situation is not something that comes naturally, but panic causes a spiral.  I won't go into the remaining details, but order and function was restored in under an eternity plus some.  Talking and praying with parents that night, discussing the events with the medical director, teaching the interns so they could learn from what they had seen and was draining, and on the walk home in the dark, I couldn't keep back the flood of tears.  I was so thankful that the kids were already asleep when I returned home. 

The rest of the night was mercifully light, with only a few phone calls.  God kept bringing Psalm 23 to my mind, and I prayed it each time I was awakened.  I prayed it for the children and families in the hospital, and for myself.  In the morning, I went in the talk to the chaplain of the children's ward to fill her in and met some visitors that were with her.

We ended up praying for the children affected by the events, and the visitors each spontaneously prayed parts of Psalm 23.  I feel like God was, once again, sending reassurance that he can and will be my/our Comforter...He will comfort his children, even in the deepest, darkest valley.  I am learning how to be comforted in the midst of sadness and even grief.  It is not the same kind of comfort as when all things are made right again - it is a comfort that comes despite the sadness, despite the wrongs, despite the loss....and it is real and good.

Psalm 23
The Lord is my shepherd,
I shall not want.
He makes me lie down in green pastures;
He leads me beside quiet waters.
He restores my soul;
He guides me in the paths of righteousness
For His name’s sake.
Even though I walk through the valley of the shadow of death,
I fear no evil, for You are with me;
Your rod and Your staff, they comfort me.
You prepare a table before me in the presence of my enemies;
You have anointed my head with oil;
My cup overflows.
Surely goodness and lovingkindness will follow me all the days of my life,
And I will dwell in the house of the Lord forever.

We all will experience various hardships in this fallen world, but I am learning more about the comfort that can only come from God in difficult situations that we must still walk through.  No taking another path, no running away - we just have to walk straight through it, but we are not alone.  I hope this will be an encouragement to some of you in those difficult situations right now.


Tuesday, April 29, 2014

A long way from civilization

I have so many half-finished blogs that I didn't think were "good enough."  It is time that I just send them.  Please forgive my misplaced perfectionism/self-criticism/something - here goes!

Over Easter weekend, we were able to travel to Lake Bogoria.  We have lived here for almost 2 years now and thought we were up for the challenge - it is about 4 and a half hours from Kijabe...away from the more urban areas.  We stayed the night on a farm about halfway there and drove up the next morning.  Since we recently had to invest in a major engine overhaul for our car (ouch!), we figured we were in as good of shape (from a mechanical standpoint) as we could be.

The farm we stayed was delightful - just about 30 minutes past Nakuru, which is the fourth largest urban center in Kenya.  The best part of the cottage was the fireplace - definitely the coolest fireplace I have ever seen!  You could put the fireplace at the Grove Park Inn in Asheville as a close second; I mean, 4 or 5 adults or all of the Duggar's children could fit into that one. ;)  I'll post a photo and let you decide; you'll have to go to Asheville, NC to experience the one at Grove Park!

Triangular fireplace

Saturday morning, we set out after breakfast. 

I'll have you know that not all upgrades for electronic contraptions (I chose that word to solidify in my children's minds that I am, in fact, it just sounds fun!) are positive.  I upgraded the operating system on my iphone 4S in December and it deleted all useful maps of East Africa.  Last year, I could actually use the maps to drive through Nakuru National Park! (Although, it didn't tell me not to let my children ride on the roof of the car because of leopards!  I guess it is a good thing after all that we haven't seen a leopard yet in Kenya.)  Currently, this is how it depicts one of the roads just north of Nakuru.

We really were on a tarmac road!

You'll notice on this screenshot, that the road below us is an "A" road.  There are about 3600 km (2200mi) of A roads in Kenya, and about 77% of those are paved - they are Kenyan interstates.  We traveled for the first hour on a "B" road: there are about 2600 km of these, and 56% of them are paved.  Ours was paved, and it was a good road with not too many potholes on our stretch.  So, after about an hour, we turned onto a "D" road and things got more interesting.  There are about 10,700 km of D roads in Kenya, and only about 11% of them are paved.  Yeah. 

This was near the beginning of the "D" road - a fork that likely had to do with the nearby sisal farm.  You know that poem by Robert Frost?

   Two roads diverged {in a wood}, and I—
   I took the one less traveled by,
   And that has made all the difference.
Okay, so I thought of that here.  Do you also remember the preceding stanza?
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.
Doubting if I should ever come back??  You know I like to be a little dramatic - these roads actually just came back together after a while.

Farther on, this is what the road looked like.  I noticed that the path on the right was functionally a bike lane - we passed maybe 10 piki pikis (motorcycles) during that hour or so, and only about 4 cars.  By the way, we were on the "wrong" side of the road here, but you just try to find the smoothest path.  There are a lot of roads here that give you a "full body massage," as the safari drivers like to say.  Did I mention that it was pretty hot and dusty, and somehow the air-conditioner had been disconnected during the recent repair work on the car? 

This was one of 2 road signs during the entire drive, and we were very thankful for it!  One of my friends that came recently remarked as we drove to the Masai Mara, "It feels like we are a long way from civilization."  To which I replied, "You are."  But, we were with a driver who knew the way, and on Saturday, we were alone.  Except for 2 roadsigns, it felt really, very remote.

At times, it was hard to tell if there was a road!

This is one of the dry creek beds that we drove through:

And, this one is the wettest:

Sorry for the angle - it was hard to keep the camera straight!  If you notice in most of these photos, there are no for an occasional village:

Termite mound:

And tortoise:

When we finally reached the lake, it was beautiful.  There were about 10 other cars there - I have no idea how they got there, because they weren't on our road.  The other road in is an "E" road, so they must be even more adventuresome (or better informed) than we were!  The girls boiled eggs in socks in the hot springs that were around the edges of the lake - pretty cool!  We saw nary a park ranger of any kind while we were there, except at the gate...where they had no money of any kind and couldn't make change for us.  The attendant was going to go to someone's house for change, if we couldn't come up with it! 

Why am I telling you this story?  Well, there are so, so many parts of it that just scream Kenya - more than I can fully explain in this setting, but it gives you a flavor of life here at any rate.  The other reason is that, while we felt really alone, we were not alone.  That is how it is in the Christian walk - we may feel alone at times and we may not even be able to see the evidence of God at work, but God is there.  He knows where we are - he knows where the road is and isn't, where the riverbeds are, and what dangers do or don't exist along the way.  He knows whether we "should ever come back" that way or any other way.  God is providing for us whether we see it or not.  Sure, we will have difficult times and bad things happen, but that doesn't negate the power or the presence of God.  We don't know how God uses those struggles and difficulties for our good or for purposes beyond us - that is a really hard part of faith.  But, God has proven himself faithful time and again, so we know that he is present and able, and we cannot doubt his love for the people he created.
I also want to tell you how very thankful we are for all of you who have walked this journey with us for the last 2 years (and even longer, as God prepared our hearts to go).  I think of y'all so often and have been a poor communicator recently - please know that you are all such an important part of us being over here.  When I had some cell service on our adventure (the part closer to Nakuru), I got a few texts from some of you back home - what a joy that is for me to be able to communicate over almost 8000 miles, while we are driving around trying to find a big lake among the hot, dusty, rocky roads of rural East Africa!  So, thank you and may God bless you for continuing to uphold and support our work over here in countless ways!

With much love,

Romans 8:28
And we know that God causes all things to work together for good to those who love God, to those who are called according to His purpose.

Thursday, November 7, 2013

God of Wonders

Look around you and you will see the fingerprints of God everywhere!  It's pretty exciting.  :)

On Sunday, I experienced my first solar eclipse, and it was amazing.  Thanks to a friend at RVA and some donations of leftover solar eclipse viewing glasses from the Australian eclipse in 2012, we and our neighbors were treated to an amazing view of the eclipse over the Rift Valley in the late afternoon.  We served "eclipse food" - sort of.  In Kijabe, the moon eclipsed about 90-95% of the sun...which fit right in with my off-center deviled eggs.  Why were all of the yolks at the ends of the eggs??  Must be the way the eggs are stored.  In Northern Kenya, the eclipse was total - but they unfortunately did not experience the best weather for viewing.

Not-quite-total-eclipse deviled egg

Two cool dudes ;)  They look like they are at some sort of 1960's scifi drive-in!


Our neighbors made a pinhole projector to watch the eclipse safely.
This is what it looked like through the "projector."
Emily and her friend Sallie even painted their faces for the occasion. :)

We borrowed a welder's helmet from another friend at RVA, so that we could take photos without frying our cameras.  I didn't know your camera could be damaged from photographing the sun, but it makes sense.  The protective glass made all my photos turn out green, but no matter. 

Early on

Near maximum eclipse

I love events like this that show off the majesty of God in this giant universe - to see the moon cross in front of the sun in real time like that is almost breath-taking to me.  I mean, the moon and sun are both mind-boggling enormous and so far away,  and I watched them cross in front of each other.  Wow.  Our God is a big, mind-boggling amazing God!

At the time of maximal eclipse, an eerie dusk settled over the area.  It was noticeably darker...but not a normal change in light as during a storm or evening.  And it became cold.  Our dog, Mak, who is terrified of our steep stairs (because he can't get back down them), appeared on the upstairs porch.  I don't know if he sensed something strange, or if he just wanted to join the party, but he really wasn't himself the rest of the night.  Very subdued and quiet.  This change in light only lasted about 5 or 10 minutes, and then the sun began to become stronger and warmer again as the moon moved past the sun. 
Mak watching the sun descend in the sky after the eclipse ended.

I'll share another photo of the full moon that I took while up near Mount Kenya last June.  Amazing that it turned out so well, since I know almost nothing about photography.  It doesn't do it justice, of course, but look at all the detail on the surface of the moon even so.  I wish I could photograph the night sky here in Kijabe - one of the perks of getting called into the hospital in the middle of the night is walking back and seeing a bajillion stars and the Milky Way stretched across the sky.  Truly more than my mind can comprehend!  I can identify with the words of the David in Psalm 8: 3-4 "When I look at your heavens, the work of your fingers, the moon and the stars, which you have set in place, what is man that you are mindful of him, and the son of man that you care for him?"
Yet, He loves us like a father loves his child.

Sunset over Mt. Longonot on another night.  God is certainly a God of Wonders!

Lord of all creation
Of water, earth, and sky
The heavens are Your tabernacle
Glory to the Lord on High

God of wonders, beyond our galaxy
You are holy, holy
The universe declares Your majesty
You are holy, holy

Lord of heaven and earth

Early in the morning
I will celebrate the light
And as I stumble through the darkness
I will call Your name by night

God of wonders, beyond our galaxy
You are holy, holy                           
The universe declares Your majesty
You are holy, holy

Lord of heaven and earth

Hallelujah to the Lord of heaven and earth

God of wonders, beyond our galaxy
You are holy, holy
Precious Lord, reveal Your heart to me
Father holy, holy
The universe declares Your majesty
You are holy, holy, holy, holy

Hallelujah to the Lord of heaven and earth
(Lyrics by S. Hildalong and M. Byrd)

Lots of love,

Isaiah 40:11-13
He tends his flock like a shepherd:
He gathers the lambs in his arms
and carries them close to his heart;
he gently leads those that have young.
Who has measured the waters in the hollow of his hand,
or with the breadth of his hand marked off the heavens?
Who has held the dust of the earth in a basket,
or weighed the mountains on the scales
and the hills in a balance?
Who can fathom the Spirit of the Lord,
or instruct the Lord as his counselor?

Tuesday, November 5, 2013

Hateful Tb

Tuberculosis.  Even the word sounds bad. 

I remember reading in Time magazine a few years ago about the resurgence of tuberculosis and the development of resistance to the medications that we have to treat it.  In the developing world and the HIV population, it is a very real problem - and those two worlds intersect here in Kenya.  Our HIV population is smaller than you might imagine - about 6 percent of our pediatric inpatient population.  Many of them have tuberculosis or have been treated for it in the past.  But, it is not just a problem of HIV infected patients - many of our patients come in with chronic coughs which make us suspect Tb.  I say suspect, because it is actually difficult to confirm Tb in children here.  All children get the BCG vaccine for tuberculosis as infants, and that can muddy the waters when interpreting the skin test that you are all probably familiar with.  That skin test is not even available to us here in Kijabe.  Chest xrays are standard in the work-up of cough/shortness of breath/oxygen requirement, but CXRs are only shadows and cannot confirm the diagnosis of Tb.  Sputums are difficult to obtain on infants and young children.  Gastric aspirates are possible here, but they end up being difficult in practice and are often not confirmatory.  We can occasionally pursue other testing in Nairobi, but those sources are not routine. 

I am just setting the stage for you about how difficult it can be to actually diagnose this common and potentially devastating infection.  Is it treatable?  Yes, very often.  Is it a simple treatment?  No, definitely not.  The standard regimen is to begin on 4 drug therapy (plus pyridoxine, to prevent some side effects of the medications).  This must be taken daily for 2 months, and then you can back down to 2 medications.  Tuberculosis is a tricky germ and, if you use only 1 or 2 or even 3 drugs, it can easily develop resistance.  If the children are infected, often you need to test the parents to see if they need to be treated also.  Taking medications for this long can be difficult for a family (it is difficult for us to remember medications in our family!), and these medications are hard on one's body.  So, you don't want to start someone on the medications, if you don't really think they have Tb....but it is difficult to confirm and you don't want to miss it and have it spread in the body and worsen.

Students learn in medical school that Tb can be anywhere in the body.  Here, we have most often seen it in the lungs, meninges around the brain, and bone.  We use the abbreviations PTb (pulmonary Tb) and TbM (Tb Meningitis) commonly.  We admitted an 8 month old child last week with a 5 month history of cough and a suspicious chest xray.  Mom denied any exposures to people with known Tb/chronic cough, but you have to take that with a grain of salt.  After 2-3 days of "regular" antibiotics for a possible bacterial pneumonia, I started him on the 4 drug Tb regimen (RHZE) because everything about him pointed to Tb.  That one was a pretty easy decision, and I am hopeful that he will do well.

Two other boys with Tb (or probable Tb) have been heavy on my heart this week.  One is a little boy named Jonah, who has Pott's Disease or Tb of the spine.  He is about 8 years old and was brought here from northern Kenya.  He is from the Samburu tribe and does not speak English or Kiswahili, so verbal communication is difficult.  However, he is a sweet little boy who would smile and wave through the window of his hospital room when he saw me and many others coming down the hall.  Tb of the spine will eat away the bones and cause collapse of the vertebrae, resulting in a gibbus formation and "hunchback."  Jonah's condition was advanced and he could not walk.  I have learned, though, that once the infection is treated and the spine is stabilized, these kids often heal well and the overwhelming majority are neurologically normal - walking!  The goal with him has been to treat with Tb meds, debride the abscess around the spine, and stabilize the spine with rods/bone grafts. 

His surgery was difficult due to hypotension (very low blood pressure) and an episode of circulatory collapse but, after 3 trips to the OR, his infection was drained and the spinal cord fused.  We are all waiting and praying that he will wake up and be neurologically normal - first, his brain after the cardiac arrest that he experienced during his second surgery, and secondly, that his lower extremities will function.  For the full, eloquently written story, see Mike Mara's blog (orthopedic surgeon) at

The second boy is named Vincent.  There are some things in life that just don't have an explanation.  We see many things here in Kijabe that just "shouldn't happen,"  and this is one of them.  He is a 15 year old boy - about Ted's age - who has been having weakness for a few years, and has not been ambulatory since January.  He is from a large family without resources, and he did not receive proper treatment.  He may have Pott's Disease too - many elements of his presentation are similar to Jonah's:  hunchback on exam, vertebral collapse on MRI, etc.

The big difference is that, because he lay in bed without proper cushioning or rotation, he has developed enormous pressure sores on his buttocks.  I can't post photos of this, because it is just too horrifying.  It is horrifying to me.  I held it together while examining the wounds Saturday morning, but couldn't control my emotions when I got home.  The left ulcer shows the ball of the femur totally exposed and is some 10 inches or more across.  He is depressed, weak, paralyzed, and in pain.  If only I could turn back the clock to before these pressure sores developed and treat him....if only I could stretch new healthy skin and tissue over these gaping wounds....if only Jesus could touch him.  Jesus can heal him - with one touch or slowly over time.  But I feel helpful to care for him - he cannot have spinal surgery until his pressure sores heal, and really that is secondary now.  His wounds are growing a multi-drug-resistant bacteria called Klebsiella, and he is terribly malnourished which prevents wound healing. 

He should be in high school and playing sports with his friends, like my son.  I can offer no logical explanation of his situation, and it grieves me to even think of him.  Please pray that his infections will respond to the many costly medications and that he will eat and gain weight.  Please pray that his pain is tolerable and that he truly has the will to live and cooperate with his wound care and conditioning.  Please pray that he truly knows Jesus.


Matthew 9:36-37
And Jesus went throughout all the cities and villages, teaching in their synagogues and proclaiming the gospel of the kingdom and healing every disease and every affliction. When he saw the crowds, he had compassion for them, because they were harassed and helpless, like sheep without a shepherd.

Sunday, September 22, 2013


As I write today, I am touched by the many, many folks who have written and even called to make sure we are safe, in light of the ongoing hostage situation in Nairobi.  We sincerely appreciate your concern and your prayers for us and the victims.

We are safe here in Kijabe and we, like you, await more information.  The worldwide news sites, such as CNN and BBC, are as informative and up-to-date as any of the local news sites in Kenya.  In church this morning, it felt a little like attending church after 9/11...except without the incredulity that something like that could happen nearby.  Everyone here understands that something like this can and does happen here sporadically - we are briefed on it before we come and are constantly reminded that we need to be aware in public situations, avoid demonstrations, etc.  Also, we are the outsiders here - we stand out naturally and don't need to do a lot to draw attention to ourselves.

I generally avoid Nairobi on the weekends:  not just from a safety standpoint - I don't like crowds and traffic.  However, I did take Anna and some friends into town last Saturday.  We were pulled over twice by the Kenyan army.  I had no idea why and no one was coming to my car to ask for my license or a tissue to wipe the dirt out of my wheelwell to read a sticker (this has really happened!).  The army was pulling everyone heading in my direction off of the road, but the first time it seemed like they were directing everyone down a "frontage road" (and I use that term very loosely).  Assuming they were directing everyone around an accident, I followed the crowd down this rutted path paralleling the highway and eventually found my way back to the highway.  A few minutes later, I was pulled off the road again.  This time, I asked the officer why and he replied "a state function."  The girls were convinced that the president would be passing by in a convoy, and that seemed reasonable.  As the minutes passed, it dawned on me that I was sitting in the middle of a large Kenyan crowd of vehicles and pedestrians with something related to the government about to happen/pass by....and all the warnings started to come back to me.  Unable to find anything on the local news sites on my phone (have I ever mentioned how our phones are really lifelines here?), I looked around for a way to leave.  When another car pulled out onto the highway, I followed and so did many of the other cars.  Of course, about 3 or 4 minutes later, the president's convoy did actually pass us!!

The Presidential/government convoy.

We speculated that this was the President's car.

I only mention that story to illustrate what life is like here.  You cannot assume that your grocery shopping or birthday party or sporting event will be routine - even returning from a trip to town without being involved in a road traffic accident makes us so thankful.  One of my interns in the nursery right now wanted me to email a lecture to him last week, and he mentioned that he would get it from a friend's computer because his laptop was "lost."  That seemed strange to be nonchalant about losing a laptop, so I asked him about it.  It turns out that he was knocked unconscious leaving a friend's house in Nairobi a week or so ago, and his laptop was stolen.  Indignant, I asked if he reported it to the police, and the other interns smirked ruefully.  They explained their opinion that it wouldn't make a difference and he will never get the stolen items back. 

Things like this can happen anywhere - in any city or small town across the world, including in the US.  But, we don't assume that they will happen in the US.  We live in a privileged world of assumed safety - our infrastructure is maintained, our police force has cars, we have a 911 system for emergencies, we can drink water straight from the tap.  Honestly, it is mind-boggling!  Twice on the cul-de-sac where we were living before moving here, different families called 911 for an ambulance, and they arrived in less than 5 minutes.  FIVE MINUTES!!  It took the airport in Nairobi 2 and a half hours to get the firefighters back to fight the huge blaze last month - it wouldn't even have made the news if they had been there to put it out or had arrived in only five minutes.  

The issues here in Kenya are complex and I can't begin to offer an easy solution, but I do want us to both appreciate the luxury that we live in and not let it corrupt us or make us apathetic about the world others live in.  If we take our privilege for granted, it will corrupt us - we will become haughty and proud...and ungrateful.  If we become apethetic (ex, "It's their problem, not mine."), we will not reach out to help others with our time, skills, and wealth.  The simple interaction I had with the young Kenyans about the stolen laptop belies some of the fatalism that exists here, even among the well-educated that will carry the next generation.  While I am convinced that we cannot help by just giving out money and directing change, we can come alongside our Kenyan (and other areas of the world's) brothers and sisters and offer them hope.  The hope of Christ offers love that does not end and is not based on race, socioeconomic status, or even worth.  Hope gives a reason to enact change and reach out to others, crossing tribal and political lines in a way that nothing else can.  

So, as the world waits for the standoff in Nairobi to end and for more answers, please pray for the victims and their families.  Please pray that this is not the beginning of more attacks in Kenya or around the world.  And please pray for hope to come to this land and the world - to all places where hope is squelched by fatalism.


Romans 5:1-5
Therefore, having been justified by faith, we have peace with God through our Lord Jesus Christ, through whom also we have obtained our introduction by faith into this grace in which we stand; and we exult in hope of the glory of God. And not only this, but we also exult in our tribulations, knowing that tribulation brings about perseverance; and perseverance, proven character; and proven character, hope; and hope does not disappoint, because the love of God has been poured out within our hearts through the Holy Spirit who was given to us. [emphasis mine]

Luke 12:48
...From everyone who has been given much, much will be demanded; and from the one who has been entrusted with much, much more will be asked.