One of the buzz words in the US over the past decade has been "sustainable." I have heard it used to describe everything from food packaging to shopping center development. I suspect that for sellers of almost any product in the US, having a label that promotes the "sustainable" virtues of the company or product is worth a 10-20% markup on the price. So, what does "sustainable" have to do with Kenya?
Monday, March 18, 2013
Saturday, March 16, 2013
The value of a life
The value of a life - wow, that will set your mind working. How does one place a value on another life? As a parent, I understand the value of my children's lives intimately. I do not value my children for what they can do or what they look like or even because they love me - I value them because they are mine. Flesh of my flesh, bone of my bone. I will do anything it takes to protect them, and I will never turn away from them. This is how our heavenly father, Abba God, views us. He has adopted us and redeemed us - we are His.
As a doctor, I value the children's lives that I care for many reasons. I have knowledge and training that allows me to care for them - that could be construed as almost duty driven. More importantly, I value them because they also have value to God, and to their families. So I value them as human beings, fellow children of their Maker, and because I understand the value of a person to someone who loves them. It is very hard not to put myself into the shoes of the parent, when a sick child is brought to see me. It doesn't matter the color of their skin, the language they speak, or the life experiences they have had - the parent is a parent, the same as I am - and that sick child could be my child.
On Wednesday morning of this week, fellow missionaries brought their 13 month old little girl to Kijabe from Tenwek (another missionary hospital in Kenya) because she had just been diagnosed with a very aggressive brain tumor. She had stopped breathing and her heart had stopped several times that morning, and she was taken emergently to surgery by our excellent neurosurgeon here within an hour and a half of arrival. Rick and I were involved in her care because we are working in the ICU this month, but only minimally. While the surgery went well, she did quite poorly through the night and died the following morning. I witnessed the grief of these parents and their humble and steadfast faith, and it was very hard not to put myself in their position. I found myself stroking the little girl's hair while we moved her to the stretcher to go to the OR - trying to comfort her as her mom would, since her own mother couldn't reach her. When she died and the parents left, I wanted to run up to the school and hug my own children. The value of a life is so obvious when it is struggled for and lost. Please pray of this family of Hannah. They have only been in Kenya for about 5 weeks and have 3 little boys. You can follow their amazing story at http://www.aaroninkenya.com/
The next night, I was on call. I got my hopes up that the pediatric floor, ICU, and nursery were pretty stable - I have to stop doing that! I had gotten called in 4 times by midnight. The call to come at midnight was for a reportedly 25 week baby that was about to be delivered by a woman who had just shown up to the hospital, fully dilated and bleeding for a week. 25 weekers can live in the US, with a struggle, but they will only rarely live in East Africa. So, the first thing to do after initial resuscitation is to determine if the baby is really 25 weeks. A younger baby really has no chance of survival, and an older baby would be given more aggressive treatment because of their higher chance of survival based on maturity. This baby was 24 weeks by dates, 25 weeks by ultrasound, 25.5 weeks by Ballard scale (a maturity rating, based on physical and neurologic development) - but was larger than expected for a 25 weeker. After a resuscitation requiring breathing for the baby and chest compressions, his heart began to beat and he showed some respiratory effort. I placed him on CPAP to help him breath, and we began the task of getting an IV line in this tiny little guy, in order to give him fluids, dextrose, and medications. After a couple of hours and 15 tries or so, we could not get a peripheral IV. I decided to place an umbilical venous catheter - not really so hard to do, but our portable xray machine has been broken for some time, so I was reluctant initially since I couldn't confirm where the line was (in the liver, in the heart, in the vena cava?). After gathering the supplies from theater (operating room), casualty (emergency room), and the "store," I taught the intern how to place a UVC. We gave fluids, sugar, and medications to help him breath and fight infection, but he was becoming increasingly apneic (not breathing). I was back and forth to talk to the mom several times, and I was able to bring her to the nursery to pray with and for the baby - but, I finally had to tell the mom that I could not do anymore, since he would not breath on his own. We were resuscitating him every 5-10 minutes at that point. I invited her to come hold him, but she declined. I do not pretend to understand all the cultural differences here even now, and I cannot judge her.
With a heavy heart, I went back to the nursery where the intern and nurses were again breathing for him and doing chest compressions. I decided we needed to stop and let him be at peace. Since his mom was not there, I wrapped him in some cloths and held him while his heart slowed and stopped. A holy and heartbreaking time. And one that took longer than I expected - giving me plenty of time to doubt my decision. Someone asked me recently what the most challenging part of being here is - I don't remember how I responded then, but this is it. To have to make decisions of life and death without all the training or backup services that I really need - to have to stop working on a baby that 2 hours before had held onto my finger with his tiny hand - to provide the only cuddling this baby will ever know. This is the hardest part of being here. I committed this little guy to God while I held him, to join Hannah who had gone before him just the day before. All these lives have value.
I had barely put that little baby down, when I was called to the delivery room for another baby in distress. This one a huge term baby (by my now-biased standards) who had been born stressed and had passed meconium before birth. This baby had taken his first breath in the meconium stained fluid instead of after delivery, and had a large amount of it in his lungs. The intern on for OB (they do all of the deliveries by themselves during the night here - difficult vaginal births and c-sections alike) had done a great job of suctioning a lot of the meconium from his lungs before bagging/breathing for the baby. But the baby was still not breathing. So we ran down the hall with the baby to the nursery, laying him on the same resuscitaire that I had stood over most of the previous 4-5 hours. After some time of bagging, this young one began to breathe, and he stabilized even better than I expected, given his initial presentation. A few minutes later, the mom came into the nursery - wanting to see the baby before anyone had a chance to go speak to her. She sobbed on my shoulder, imploring me to help her baby. I hugged her with one hand and attended to the baby with the other, not willing or able to ignore either of these people who have intrinsic value and needs.
So, hug your children, parents, friends and treat them with the value that they inherently have. Please pray for these families that I have mentioned, and countless others that are like them. And please pray for all of us who struggle to care for these little ones, making difficult decisions not based on their value - which they all have - but on whether continued care is helping or hurting.
Love,
Sarah
Psalm 139
1 You have searched me, Lord,
and you know me.
2 You know when I sit and when I rise;
you perceive my thoughts from afar.
3 You discern my going out and my lying down;
you are familiar with all my ways.
4 Before a word is on my tongue
you, Lord, know it completely.
5 You hem me in behind and before,
and you lay your hand upon me.
6 Such knowledge is too wonderful for me,
too lofty for me to attain.
and you know me.
2 You know when I sit and when I rise;
you perceive my thoughts from afar.
3 You discern my going out and my lying down;
you are familiar with all my ways.
4 Before a word is on my tongue
you, Lord, know it completely.
5 You hem me in behind and before,
and you lay your hand upon me.
6 Such knowledge is too wonderful for me,
too lofty for me to attain.
7 Where can I go from your Spirit?
Where can I flee from your presence?
8 If I go up to the heavens, you are there;
if I make my bed in the depths, you are there.
9 If I rise on the wings of the dawn,
if I settle on the far side of the sea,
10 even there your hand will guide me,
your right hand will hold me fast.
11 If I say, “Surely the darkness will hide me
and the light become night around me,”
12 even the darkness will not be dark to you;
the night will shine like the day,
for darkness is as light to you.
Where can I flee from your presence?
8 If I go up to the heavens, you are there;
if I make my bed in the depths, you are there.
9 If I rise on the wings of the dawn,
if I settle on the far side of the sea,
10 even there your hand will guide me,
your right hand will hold me fast.
11 If I say, “Surely the darkness will hide me
and the light become night around me,”
12 even the darkness will not be dark to you;
the night will shine like the day,
for darkness is as light to you.
13 For you created my inmost being;
you knit me together in my mother’s womb.
14 I praise you because I am fearfully and wonderfully made;
your works are wonderful,
I know that full well.
15 My frame was not hidden from you
when I was made in the secret place,
when I was woven together in the depths of the earth.
16 Your eyes saw my unformed body;
all the days ordained for me were written in your book
before one of them came to be.
17 How precious to me are your thoughts,[a] God!
How vast is the sum of them!
18 Were I to count them,
they would outnumber the grains of sand—
when I awake, I am still with you.
you knit me together in my mother’s womb.
14 I praise you because I am fearfully and wonderfully made;
your works are wonderful,
I know that full well.
15 My frame was not hidden from you
when I was made in the secret place,
when I was woven together in the depths of the earth.
16 Your eyes saw my unformed body;
all the days ordained for me were written in your book
before one of them came to be.
17 How precious to me are your thoughts,[a] God!
How vast is the sum of them!
18 Were I to count them,
they would outnumber the grains of sand—
when I awake, I am still with you.
Wednesday, March 6, 2013
Kenya Decides 2013
As I write this blog, all of Kenya is waiting to hear election results to learn who will be the next president. This election has been so complicated and there are so many facets to and implications of the outcome. This election will totally redivide the country into new areas of local government, thereby fully executing the new constitution that was passed in 2010.
In terms of the presidential arm, there are 8 candidates running for president but, all along, only 2 have been serious contenders: Uhuru Kenyatta and Raila Odinga. Kenyatta is the son of the first president of Kenya - he ran and lost in 2002, and he (and his running mate) are both charged with crimes against humanity by the International Criminal Court (ICC) for their part in the post-election violence of 2007/8. He is currently leading in the popular vote, but it is so hard to know who will win. To win, a candidate must garner at least 25% of the votes in at least 24 of the 47 counties AND they must win 50% +1 of the popular vote. Both of the top two candidates have more than 25% in more than 24 counties...so it comes down to the popular vote. Only about 1/3 of the constituencies have counted and verified the votes, due to problems with the electronic machines and sending in the results electronically. Officials have had to hand carry the results to the IEBC at the Bomas of Kenya(Independent Electoral and Boundaries Commission). These are being verified now - the process is taking some time, which seems to be causing some growing anxiety.
So, you may wonder if people have factored the 2007/8 fiasco into election preparations this time. The answer is most certainly "yes." Kenya has gone to great pains to orchestrate an election process that Kenyans and the world can have confidence in, and one that is well-organized and peaceful. Remaining peaceful has been a constant prayer in the hearts of most Kenyans, and the words on their lips have reflected that. On one of the main news websites on Monday, here was a public service announcement that I love. It reads "Choose Kenya. Choose Peace. SMS (ie, text) 108 to report any threats to peace."
And, from the newspaper, a more heart-wrenching reminder of the destruction and grief of 2007/8 and a plea to not repeat it.
The citizens of Kenya have seemed very invested in these elections. Of the 40 million citizens, 14 million registered to vote (keep in mind, that over 40% of the population is under 15 years of age). Of those, 11 million actually voted. Monday was Election Day - the day of casting votes. For the week prior, patients were trying to be discharged from the hospital and no one was scheduling elective surgery. Some of this was due to fear of violence and wanting to be home, but some of it was from the desire to go to their places of registration and vote. Monday was a national holiday, and the hospital was like a ghost town....except in the nursery. Newborn babies wait for no one and nothing! I discharged 3 patients on Monday morning, and they were so excited to be able to go vote on the way home! Here are ads from the paper the weekend before the election-everything was closed on Monday!
The queues (I'm becoming British here, but my British accent is lost in print!) at the polling centers were impressive! There was no violence, and I think most citizens felt that the process was smooth. I did see in the news that a young woman delivered a premature baby in line (only 1 kg~2 pounds), and PROCEEDED TO VOTE before going with her baby to the hospital! I think that is a little excessive - I don't know how that baby is doing. :(
In hospital chapel this morning, we had a time of corporate prayer. I heard people placing the elections and their country at their Lord's feet. I heard someone say "we are a country of 42 tribes," and it struck me how the citizens struggle with those divisions. We have heard much about tribalism here - it is not something that the young people hold fast to, and I think Kenya will be much more cohesive in 30-50 years, when this generation and the next is in leadership (my opinion)....but for now, it drives a lot of decision making. Please pray with me as the election results come in - that the process and the results are accepted as trustworthy, and that peace reigns in the land. Our Lord is Lord of all the nations!
Love,
Sarah
Revelation 7:9-10
After this I looked, and there before me was a great multitude that no one could count, from every nation, tribe, people and language, standing before the throne and before the Lamb. They were wearing white robes and were holding palm branches in their hands. And they cried out in a loud voice:
In terms of the presidential arm, there are 8 candidates running for president but, all along, only 2 have been serious contenders: Uhuru Kenyatta and Raila Odinga. Kenyatta is the son of the first president of Kenya - he ran and lost in 2002, and he (and his running mate) are both charged with crimes against humanity by the International Criminal Court (ICC) for their part in the post-election violence of 2007/8. He is currently leading in the popular vote, but it is so hard to know who will win. To win, a candidate must garner at least 25% of the votes in at least 24 of the 47 counties AND they must win 50% +1 of the popular vote. Both of the top two candidates have more than 25% in more than 24 counties...so it comes down to the popular vote. Only about 1/3 of the constituencies have counted and verified the votes, due to problems with the electronic machines and sending in the results electronically. Officials have had to hand carry the results to the IEBC at the Bomas of Kenya(Independent Electoral and Boundaries Commission). These are being verified now - the process is taking some time, which seems to be causing some growing anxiety.
So, you may wonder if people have factored the 2007/8 fiasco into election preparations this time. The answer is most certainly "yes." Kenya has gone to great pains to orchestrate an election process that Kenyans and the world can have confidence in, and one that is well-organized and peaceful. Remaining peaceful has been a constant prayer in the hearts of most Kenyans, and the words on their lips have reflected that. On one of the main news websites on Monday, here was a public service announcement that I love. It reads "Choose Kenya. Choose Peace. SMS (ie, text) 108 to report any threats to peace."
And, from the newspaper, a more heart-wrenching reminder of the destruction and grief of 2007/8 and a plea to not repeat it.
The citizens of Kenya have seemed very invested in these elections. Of the 40 million citizens, 14 million registered to vote (keep in mind, that over 40% of the population is under 15 years of age). Of those, 11 million actually voted. Monday was Election Day - the day of casting votes. For the week prior, patients were trying to be discharged from the hospital and no one was scheduling elective surgery. Some of this was due to fear of violence and wanting to be home, but some of it was from the desire to go to their places of registration and vote. Monday was a national holiday, and the hospital was like a ghost town....except in the nursery. Newborn babies wait for no one and nothing! I discharged 3 patients on Monday morning, and they were so excited to be able to go vote on the way home! Here are ads from the paper the weekend before the election-everything was closed on Monday!
The queues (I'm becoming British here, but my British accent is lost in print!) at the polling centers were impressive! There was no violence, and I think most citizens felt that the process was smooth. I did see in the news that a young woman delivered a premature baby in line (only 1 kg~2 pounds), and PROCEEDED TO VOTE before going with her baby to the hospital! I think that is a little excessive - I don't know how that baby is doing. :(
Here is a screenshot from the online news page from earlier today. Not much has changed, as they continue to verify the votes brought from the surrounding countryside. There will be some issues, as there are in many elections (remember the "hanging chads" in the US a few years ago?). The biggest issue that I see as a serious concern is if Kenyatta wins and then faces international charges at The Hague in April. How will Kenya and the world react, if he is convicted? The fact that Kenya has allowed someone on the ballot with pending charges is a whole other issue.
In hospital chapel this morning, we had a time of corporate prayer. I heard people placing the elections and their country at their Lord's feet. I heard someone say "we are a country of 42 tribes," and it struck me how the citizens struggle with those divisions. We have heard much about tribalism here - it is not something that the young people hold fast to, and I think Kenya will be much more cohesive in 30-50 years, when this generation and the next is in leadership (my opinion)....but for now, it drives a lot of decision making. Please pray with me as the election results come in - that the process and the results are accepted as trustworthy, and that peace reigns in the land. Our Lord is Lord of all the nations!
Love,
Sarah
Revelation 7:9-10
After this I looked, and there before me was a great multitude that no one could count, from every nation, tribe, people and language, standing before the throne and before the Lamb. They were wearing white robes and were holding palm branches in their hands. And they cried out in a loud voice:
“Salvation belongs to our God,
who sits on the throne,
and to the Lamb.”
who sits on the throne,
and to the Lamb.”
Saturday, March 2, 2013
Suswa Nights
Sleeping under the stars, roasted meat, visiting with Masai elders, dung beetles, sledge hammers, beautiful Rift Valley scenery, hanging out with friends, pocket knives, slingshots...what better way for teenage boys to spend a weekend?
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