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! 

Love,
Sarah

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

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)...an 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.

Love,

Sarah

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.

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 hour...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 done.....it 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.

Love,

Sarah