Hello, folks!

As of today, we are 2 days shy of being in Kenya for 3 months. Time being time, it seems like anywhere between 1 and 9 months—depending on the day, my mood, etc. I’m afraid that I “hit the wall” recently; until about 2 weeks ago, I felt upbeat, content, patient, kind, really inspired to be here. Well, I have to confess that those feelings have vanished over these past two weeks. Despite knowing in my head that change takes time—that is true anywhere—I guess I had hoped that the small changes we have tried to make in taking care of patients would be well-received. What I saw as “small changes” are quantum leaps here—and so, understandably, we’ve met resistance. In return, I can say that my response to the resistance hasn’t been particularly productive—I tend to become quiet and remote—and that isn’t well understood here. So, I’d say that I have a lot of work to do on my attitude.

Leland has a gift of good timing and incredible intuition—he arranged for us to take this weekend (Friday after rounds until Sunday afternoon) at Malu, a sort of bed-and-breakfast-lunch-and-dinner place in the hills north of Lake Naivasha. The food was outstanding (African interpretation of rustic Italian—absolutely delicious), the cottage was heated by a crackling cedar wood fire lit each night by Biden (pronounced Beedin) or Njeri. We rode beautiful and responsive horses in the forest above the camp, and read and rested, refreshing our souls and spirits. The birds were spectacular—large and loud ibis feeding in the pastures, sparrow sized black birds with iridescent heads, robin sized birds in shimmering emerald/turquoise hues, African eagles soaring silently overhead. What impressed us most was the quiet—the absence of the ubiquitous Kijabe winds. Getting away from Kijabe is, we’ve found, absolutely necessary to maintain our perspective and emotional, psychological, and spiritual health.

We continue to see patients die—four babies last weekend. Because there are no autopsies, we most often don’t know what caused the death. We don’t have ability to do EEGs so we can’t always tell if children are having seizures. The lab is unreliable, so we can’t count that the calcium level is really low (one child had a calcium level of 5.6—very low—and 4 hours later, without any treatment, the level was 9.6). We have checked sodium levels and have gotten results of 101 and 194 (both are probably incompatible with life—or nearly so) in children who really didn’t look too bad. There are no tallies of intake and output—the children for the most part don’t have diapers (in US hospitals, disposable diapers can be weighed before and after use, and calculations of urine output can be made)—they urinate in cloths which are then washed by the moms and hung out on the line. So determining fluid and electrolyte balance—something fairly simple in the US becomes quite complicated.

We also see incisions that won’t heal; 10-14 days after surgery, many just fall apart. After watching the nutritional status of the moms, seeing the diet they are served in the hospital (which is probably in many cases better than what they might receive at home) and seeing two month old breast-fed babies with rickets, I am convinced that some of the wound healing problems are nutritional. We talked about supplementing the mom’s and the babies with vitamins—sounds simple, huh? Except, that is an expensive undertaking, we don’t know for sure if that will translate into better wound healing, we don’t know how long to supplement, and that won’t address the problem after discharge. One missionary who has been a midwife in Uganda (and has been quite encouraging to me in my recent funk) suggested that we start having “food parties” to teach the moms how to prepare nutritious food from readily available sources—like cooking and eating the greens of the sweet potatoes to enrich their diet. So, I am on the lookout for an available person to coordinate that undertaking—but we’ll need a Kenyan to take charge of the actual teaching.

Despite the above complaints, we do continue to feel led to be here—and grateful for the opportunity to serve here. There are so many opportunites to show God’s love—last week, we had a 2 month old baby boy, Victor, with a large myelomeningocele (open spinal cord) that caused him to have no leg function. His head was 53 cm (about 5 cms larger than my granddaughter’s head at 16 months). We obtained a head ultrasound and there was very little brain tissue—mostly spinal fluid. So, we recommended that he be taken home without surgical intervention. Pastor Mercy and I talked with the mother—she was a young single mom who came from the displaced person’s refugee camp and had no family supports at all. After I explained that even with surgical intervention (which would cause him pain), he would not be able to think, play, walk, even urinate or empty his bowels normally, we prayed together, thanking God for the gift of this child and asking God’s strength for his mother, to care for him and love him as long as he lived. These are not easy decisions or discussions or prayers—and we don’t presume to know what is best or “right” to do in cases like these. But we occasionally see children for whom it seems most appropriate to not intervene surgically but provide love and emotional support to their moms. Whenever it has been possible in these situations, we’ve asked that the bill be paid through our indigent patient fund so that the mom does not have the added burden of a bill that she can’t pay.

It is sobering to see so many women who have waited to get treatment for their babies’ hydrocephalus because they can’t pay for treatment—they have waited so long that the heads are the size of basketballs—and they don’t understand that we can’t make those heads normal—ever. So much here is related to lack of basic resources—food, transportation, adequate shelter, family support, basic medical care including prenatal visits, immunizations.

Some of you have written asking what you can contribute. We have not answered these questions—not because we haven’t appreciated your asking, but because we have not known how you can best help. While sending toys or clothes for the children for Christmas is appealing, it is probably not what they most need. We have thought about asking for donations toward supplying disposable diapers for the babies after surgery—to better keep incisions clean, aid in keeping track of urine output. However, we will need to address the problem of waste disposal, storage of diapers, and how to fairly supply each mom with a daily allotment. We need more information about how to best enrich the nutritional status of the moms and babies before we can ask for your help in that effort. So, we would appreciate your patience while we gather more information. Any contributions to the indigent patient fund go toward paying the bills of those who otherwise would not be able to afford treatment. We also pay for CT or MRI scans on those patients who otherwise would not be able to afford them and in whom Leland would not be able to operate without a scan. Contributions toward those endeavors can be directed to:

The Neurosurgery Patient Subsidy Fund

Bethany Kids at Kijabe Hospital

PO Box 1297

Abingdon, VA 24212-1297

Another need just recently arose: an operating microscope, so desperately needed for tumor cases, has been acquired and is sitting in a crate in Madison, Wisconsin, awaiting shipment. Our usual means of shipping, through Africa Inland Mission (AIM), is no longer available (they are no longer shipping equipment overseas) and so, we will need to establish new means of having equipment shipped to Africa. Ideas and/or contributions toward that are welcome.

Please continue to keep us in your prayers—that we not become so discouraged by setbacks that we fail to care for the children, their moms, the hospital staff. Thank you also for your words of encouragement through email. They mean more than you can imagine.

Take care, God bless.

Susan