Mont Ste Michel

Chartres Cathedral

Plaque in Chartres

Rainbow from our balcony 30-Nov-2012

To those who received a message that the blog had been updated--apparently there was a hiccup in the ether and to some it doesn't appear (it appears to others--are we all in the same world?)  So, I will try again.

Habari yako, jamaa na rafiki,

(Greetings, family and friends)

“I __________, will pay all bill after I have harvested my maize and had a fund raising.”

This letter was attached to the hospital file (chart) for one of our patients.  The hospital bill for this patient was Ksh 37,791.65—a huge sum for most of our patients who are subsistence farmers.  In US dollars, it is $447.24—which is the entire bill for a typical hospitalization and surgery for a child with hydrocephalus who has insertion of a shunt.  These letters are often signed with a thumbprint—many of our families cannot write/sign their names.  How often do the people who have signed these letters default on the bill?  We don’t know—many families pay in installments as money is available.  However, this woman, perhaps a single mother (more and more of our patients are babies of single moms), has to feed and clothe her family and pay rent out of the proceeds of her harvest.  So she may need to make a decision to pay the bill or eat.

Another hospital story: because of severe (actually excruciating) episodic abdominal pain, on our recent “vacation” in the States, I saw a physician for sphincter of Oddi dysfunction.  (As best I understand it, this is a sphincter coming from the bile duct).  The spasms of the sphincter were causing the pain—this physician said that during a procedure called an ERCP, he could cut the sphincter so that it no longer had spasms.  The risk of the procedure was a 10-40% chance of pancreatitis—usually mild, requiring a couple days of IV fluids and pain meds.  I had the procedure as an outpatient the following day—and about 18 hours later awoke with really awful abdominal pain.  I was admitted to the hospital for 5 days—had ascites (fluid in the abdomen), pleural effusions (fluid in the chest cavity) on both sides, required a CT of my abdomen and another of my chest to make sure I hadn’t developed a pulmonary embolism.  I gained 11 pounds in 3 days (fluid), and then lost 22 pounds.  (The upside to this story—weight loss!)  I had to pay $250 just to see the doctor and $12,500 to have the procedure.  I have yet to have an accounting from the hospital as to the total bill, but it will run into the tens of thousands of dollars. 

What a contrast in care between the two countries!  Yes, I was able to have a complex medical procedure because of the resources in the US.  However, I never again saw the physician who did the procedure—apparently he has no interest in his patients who develop a complication.  In Kenya, I would have had the team pray together before the procedure; my physician would have been at my bedside not only directing my care but also praying for me.  I cannot adequately explain to you how important prayer was to me before the ERCP—in the OR, I thought about asking the team to stop so I could pray—but they had given me meds and sprayed the back of my throat, so I was a bit dopey and couldn’t talk well by the time I thought of it.  And, to be honest, I figured they’d think I was nuts.  I am not suggesting that prayer would have prevented complications.  But having a team that cares deeply about patients and asks for God’s help in caring for them—I saw that difference—and wished I were in Kijabe with my pancreatitis. (I had a great nurse, Lora, and a great doctor, Dr. Day—so I want to make sure I give credit where credit is due).

While we were in the States, Leland and I were able to see our children and our grandchildren.  We see Tusk and Evelyn only in “snapshots” because of the great distance between us.  That is hard—for our children to understand, for us, maybe as well for our grandchildren.  My dad prayed for my sister and me every day of his life since our births—for many years that meant nothing to me.  It wasn’t until he was old and nearing death that I realized how much he loved me and how his daily prayers were his highest way of loving me. 

I was sprung from the hospital on the day we were supposed to have left for 2 weeks in France.  No one was comfortable with my flying overseas that day, so we postponed the flight for 24 hours.  We arrived in Paris and drove to Honfleur—a beautiful coastal town in Normandy.  After seeing the Boudin museum and praying in the chapel where Champlain’s exploration of Canada was blessed, we drove to Vimoutiers, also in Normandy, where we rented a cottage.  The town was lovely, the cottage was incredibly cold—stone floor, no central heat.  After a week of wearing two coats and being wrapped in a quilt, we decided warmth trumped quaintness and cut our stay there short by 4 days.  Having read about the Channel Islands, I had the brilliant idea of visiting them for a day trip.  We left the cottage at 6 am for what we thought would be a 2-hour drive to the coast to catch the ferry to Jersey.  However, the drive took 2.5 hours, and we had some fear that we’d miss the ferry.  Oh, how I wish we had!  It was several days after Sandy hit the East Coast of the US, and its effects were being felt in the Channel—the ferry had been cancelled the day before.  We made the ferry, and had the worst case of mal de mer (sea sickness) I can imagine.  Fully two thirds of the people vomited repeatedly on the 70 minute cruise—including us.  We could barely shuffle off the ferry—then had 6 hours until we had to get back on.  First stop—buy Dramamine. On Jersey, our credit cards didn’t work, we had only Euros (Jersey is in Britain so they take pounds), there was sun, then driving rain, then hail—repeat that sequence---not a fun day.  We limped back on the ferry, heavily medicated, sat in the middle of the back and made it back to France with intact gastric contents. 

After that, the trip was lovely.  We toured Mont Ste. Michel on a Sunday morning, entering the cathedral just as mass was beginning—the nuns and monks were singing ethereally a cappella.  The fragrance of incense hung lightly in the air; the sun streamed through the windows; we took communion from the priest and prayed with tourists, the congregation, the nuns and monks.  We toured the medieval city of Dinan and hiked down to the gorge below the town walls, then drove to the westernmost point of France to stay in Le Conquet, an old fishing village.  From there we drove in the direction of Paris through Chartres to see that great cathedral and pray in the light of the stained glass windows.  Along the way, we communicated in my broken high-school French and ate wonderful meals.  Despite my rather severe dietary restrictions (no red meat, no alcohol, low fat, bland foods), I enjoyed poulet (chicken), salades (salads) and the most delicious jus de pomme (apple juice) all across France.  And of course, le pain (bread)--the best in the world—even without butter.

We were so happy to get back to Kijabe—but not well rested as we had planned.  There was a lull in patient census for 2 days—since then we have had up to 8 admissions/day with very sick children.  We’ve had a few “Mercy consults”—those children in whom our best efforts have not helped.  Mercy and I have counseled, wept, and prayed with the moms.  The whole team rejoices with good news—a negative culture, an infection successfully treated.  One Somali mom insisted on our continuing a very expensive antibiotic to treat her son’s meningitis—and when I told Thomas Renner, the pastor and Somali interpreter, that after 7 days of treatment, the infection appeared to be much better, his first response was, “Praise God.”  In fact, as I walk along the hospital corridors, I see evidence of God everywhere—in the fruits of the Spirit posted between the hallway windows—love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control.  As I walk, in my unkind, ungracious, turmoil-filled mind, I daily am convicted—yes, that is the correct word—and my mind is turned toward God.  As another Somali woman said, Kijabe is a place where God is present.  The people who work here give thanks and praise to God for the healing that goes on—they lay their frustrations and defeats and failings at God’s feet.  I find it hard to describe just how alive I feel to work here.  We are becoming real—just as in The Velveteen Rabbit—a bit shabby and worn, threadbare, but alive.  Thanks and praise to God.

BKKH needs your help.  Leland has started a fund for neurosurgical equipment—just about everything we use is donated.  When equipment breaks, we have no replacements.  We need to have a fund for replacements and upkeep—he has written to about 100 neurosurgeons to ask for their help.  The patients need help in paying their bills—most families here work very hard, most in physical labor.  Most want to pay their bills but simply cannot raise the money—fundraisers in their communities help—but these are poor people giving money—so the whole community becomes impoverished.  We need donations of the antibiotics that we have to use to treat multi-drug resistant infections—some infections require 2-3 weeks of meropenam, which costs Ksh 3000/day.  If the families cannot pay for the medicine, we are not supposed to treat the children with it.  I must confess that sometimes I go ahead and order a trial of the medicine.  We need an ongoing source of vancomycin, ceftazidime, and meropenam.  We need funds so that salaries to the employees can be raised—many people working for BKKH could make 4x their current salary by working for an NGO.  They work for BKKH because of their commitment to God—but it becomes difficult for them to pay their children’s school fees, or put anything aside for retirement.  I challenge any nurses in the US to give even a small amount monthly to improve the working conditions for the nurses here—we need better equipment, more continuing education opportunities. 

As I read through this posting, I realize how many times I’ve mentioned prayer--talking with God, presenting to Him our requests, our joys, our failures, asking for His forgiveness and help to turn in the right direction, praying for our children, grandchildren, colleagues, enemies…sometimes being so overcome that the only prayer is “the Spirit himself [interceding] for us with groans that words cannot express.” (Romans 8:26b)

I’ll end with this passage from Galatians 2: 4-10:

But because of his great love for us, God, who is rich in mercy, made us alive with Christ even when we were dead in transgressions—it is by grace you have been saved.  And God raised us up with Christ and seated us with him in the heavenly realms in Christ Jesus in order that in the coming ages he might show the incomparable riches of his grace, expressed in his kindness to us in Christ Jesus.  For it is by grace you have been saved, through faith—and this not from yourselves, it is the gift of God—not of works, so that no one can boast.  For we are God’s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.

Take care, God bless.

Susan

Contact: www.bethanykids.org

Dear Friends and Family,

We have come to Malu, our retreat, to celebrate the end of our second year in Kenya—and the beginning of our third year here.  It has been an opportunity for reflection on all that we’ve experienced over the past two years.  We’ve also looked ahead and realized how much needs to be accomplished over the next years to see that pediatric neurosurgery is established in East Africa.

For both of us, I think, the chief benefit in coming to Kijabe has been the opportunity to deepen our faith, to draw nearer to God, to feel the peace that has come with following where He has led.  Leland’s work on his sermons this Winter (June, July, August in the Southern hemisphere) and his weekly meditations that he sends to the church members via email have nourished his faith.  My participation in our weekly Bible Study has given me insights into Scripture as well as relationships with the other Bible study members.  Our morning times of prayer and study are precious to us; we awaken with a real thirst for God’s Word.

It is often said that Africans excel in relationships.  I have discovered over the past two years that that is true.  I cherish the relationships that are slowly building here in Kijabe; I feel a part of the staff now, and we have a wonderful time talking, teasing, swapping Swahili. They teach me a word, I teach them a word—like ukungu (fog) which none of the OPD staff knew.  It is probably because we have been told so often that relationships are cherished in Kenya that we have been so shocked to see women disowned by their families, abandoned at the hospital.  One lady recently had a newborn child with a myelomeningocele that was repaired.   She was from the IDP camp (Internally displaced persons) down in the valley and had been transferred to Kijabe from Naivasha Hospital.  She had a husband and two older children.  When it was time for discharge, her husband never came; Purity, our excellent social worker, learned that the husband had taken the two older children back to his home in Western Kenya saying that he would not have a disabled child.  Not only did this lady have no family, she had no money nor clothes.  Purity arranged that the bill be paid by BKKH; she found clothes for the mum and took up a collection among the staff so that the mum and baby could be transported back to the IDP camp—on a piki-piki—a motorbike transport for hire.  These heart-rending stories of abandonment are balanced by those like Nelly, another baby girl with a repaired myelomeningocele.  She is the first baby of a very poor older man.  When she was readmitted with a wound breakdown, he was distraught—not only because his precious daughter was ill, but also because he did not know how he would pay the bill.  He offered to mop floors in exchange for his daughter’s hospital bill.  He came to visit nearly every day (that is unusual) and always asked how she was doing after shaking my hand.  I saw him again just the other day—about a week after her discharge.  He told me she was doing well.  I suspect he was back to pay some of the balance on her bill.  It is families like his that impress me the most.

It continues to be hard when medications are not charted, when dressings aren’t changed, when vital signs on very sick babies are not recorded for 12 hour stretches.  It is devastating when, as happened two nights ago, one of our patients dies during the night and not one of our team is notified—finding out the next morning on rounds when he was not in his bed.  Over the past two years, I have found myself becoming less angry about these situations—more bemused than anything else.  I have adopted a “smile” that I put on my face when these things happen—I am not smiling with my eyes, just my mouth.  However, I find that it helps me cope.  It does no good to get angry here—what we need to do in these situations is discover the underlying problem (it is never just one nurse, or one ward—these problems are systemic) and try to find a solution in which everyone can invest.  I believe that most of the staff here want very much to do well, to take good care of patients.  As in every place, there are those few who really don’t care.  We all need to identify the barriers to good care and arrive at reasonable solutions.

I have said several times that I have used every experience and skill gained throughout my career since I’ve come to Kijabe.  I started out in nursing working for a short time at a psychiatric hospital; recently we had two mothers with severe post-partum psychosis.  One went from bed to bed blessing each mother; the other came into the nursing station and started opening cupboards.  Because of my remote past experience, I was able to tell the nurses how to speak to and direct these ladies to keep them, their children, and the other children safe.  See, nothing is wasted.

One of the most important lessons that I have learned since coming to Kijabe is to keep in mind who I am trying to please.  Am I trying to be liked, accepted, or am I here to be obedient to and please God?  There are many times, the happiest ones, when those are one and the same.  But, every once in a while, I have to make a decision or take a stance that makes me quite unpopular with people—but I feel that God is leading me in that direction.  We continue to think about that discussion we had 18 months ago with one of the surgeons who reported great discontent among “all the nurses” with our way of giving neurosurgical care to the children.  That discussion was instrumental in making me look at our practice here.  There are areas where I can bend—organization of supplies in clinic drawers no longer is my issue.  Other areas—giving the right medication to the right child via the right route at the right time and recording it—I will continue to be a real pain in the neck about that.

There are things about Kenya that still make me smile (with my eyes) and shake my head.  The fluidity of spelling and names—we had a child admitted on 2-JUL-2012 under the name of Mary who had 4 surgical procedures and was discharged in early August—at discharge, the national insurance fund refused to pay their portion of her bill because her birth certificate name was Madeline.  Her mother never bothered to “inform” us that we had the wrong name.  After going to Limuru to straighten out the paperwork, Madeline was readmitted for a wound breakdown—and during the course of that hospitalization was called Mary or Madeline—changing from day to day.  Her mother often called her Mary—and the child, 8 years old, answered to either.  One child is admitted as Denton or Danton—no one seems to be concerned which it is.  One child was admitted as “Baby of Lydiah”—when he was 7 years old; the original admission was under that name and so all subsequent admissions and clinic visits continued as “Baby of Lydiah.”

In early August, we moved back into our third floor apartment after the repairs to the roof and ceilings were completed.  We have had a few driving rainstorms and have seen no new wet spots in the ceiling or walls, for which we are very grateful.  However, the new crown molding is beginning to crack as it shrinks, and plaster (caulk being an unknown entity here) is drifting down on the furniture.  I have spent the Saturdays since moving back scraping dried oil-based paint splotches from the floor (dropcloths are also “unknown unknowns”).

As some of you may have heard, there is rioting in Mombasa since a Muslim cleric, accused by Kenya, the UN, and the US of raising money and men for Al-Shabaab, was gunned down (shot dead in Kenyanese).  We heard that some clerics in Nairobi were encouraging their followers to go and do likewise in Nairobi.  The election is nearing, and I would say that the underlying problems (corruption, tribalism, impunity) that led to violence after the 2007 election have not been addressed—in fact, if anything, have worsened.  Several of the men charged by the ICC for crimes against humanity are running for President.  So, I ask for your prayers for Kenya.  It is a country of incredible beauty not only in its mountains, plains, valleys, lakes, but especially among its people.  They deserve better leaders.

We tremendously enjoyed the month-long visit of Wendell Lake, a neurosurgery resident from University of Wisconsin.  We had worked with Wendell at UW before we came here.  He is not the first UW resident to visit Kijabe, but he is the first to visit for a month and receive credit for his time here.  During the month of August, he participated in 60 cases—he saw more children die than he had in his career to date.  He saw the full spectrum of cases—myelomeningoceles, hydrocephalus (he saw one child with a 78 cm head circumference), spinal cord tumors (including a tuberculoma in the spinal cord—only the 9^th known case in the world), head injuries, brain tumors—both adult and pediatric.  One of the more unusual cases was a man, admitted to another service, who had been mauled by a hippo.  I told Wendell, “Now you know you aren’t in Kansas anymore.”  He said he was very impressed that the missionaries here didn’t fit his stereotype of missionaries.  I would have to say that I agree wholeheartedly with that.  The Poisonwood Bible sort of missionary doesn’t exist here in Kijabe—the missionaries, both short and long term, that I have met are dynamic, fun-loving, joyful, contemplative, complex people.  Despite differences in theological backgrounds and practices, they are among the least judgmental people I have met.  Becoming part of that community has been another highlight of our stay here.

Looking ahead to the next four years, we see many challenges.  We need another pediatric neurosurgery fellow; the caseload is too high for 2 neurosurgeons, and more people need to be trained.  We realize also that we need to develop an ongoing, lasting means of support for neurosurgery here at Kijabe.  The neurosurgery service, like most of the surgical services at Kijabe, depends entirely on donations.  Equipment is donated; suture, dressings, and medications are donated.  Leland’s and my services are donated.  It is exciting that Humphrey has been hired by Kijabe Hospital as a consultant (attending doctor) as of September 1.  We need to identify and train a person who can fill my position when I leave. 

I started out this blog talking about relationships—that the Kenyans excel at them.  But one thing I’ve learned is how important relationships are to all people—not only Kenyans.  Leland and I have missed our families more this year than the first.  We are fortunate to be living in an age of Skype and email—I think often of my cousins who were missionaries in Japan in the 1950’s when it took a month to get a letter from home.  They returned home every 5 years for furlough—I’ll make 4 trips to see my children this year.  We can look forward to visits from our families—my sister and her friend Diane are planning a trip in 2013; Leland’s sister Mary plans her second trip to Kijabe next year, Michael and Marisa visited us in 2011.  A visiting short-termer asked us if we ever get homesick—and we looked at each other and said “no, we feel like this is home.”  However, ever since he asked, I’ve thought about that—and I am often “homesick” in a way—we would really like to see our kids, our daughters-in-law and sons-in-law, our grandchildren, our sisters and nieces and nephews, our friends far more often than we can now.  It isn’t the place; it is the people that we miss.

We continue to treasure your prayers for us and for the ministry in Kijabe.  We ask that you lift up the moms and babies in your prayers.  We ask you to pray for our health—I am battling a sinus infection and some residual difficulties related to my gall bladder operation.  Pray for those visiting us this month—Goong, a pediatric neurosurgeon from Thailand, Jim Trosen, our financial advisor and friend who will visit with his wife, members of the CDC who are gathering data on Spina bifida in Kenya, and members of the International Federation for Research in Hydrocephalus and Spina Bifida.

Though I am not a particular fan of the Apostle Paul, as some of you are aware, I do find great encouragement in some of his writings.

Therefore, my dear brothers [and sisters!], stand firm.  Let nothing move you.  Always give yourself fully to the work of the Lord, because you know that your labor in the Lord is not in vain. I Corinthians 15: 58

Take care, God bless.

Susan

6 July 2012

Habari Yako,

Have you ever spent about two hours writing a letter on a computer only to hit the delete button instead of the save button?  Well, I have--and just did.  Sigh.  So, on my new word-processing program, I will try to rewrite my blog entry (quite honestly, it was an amazing piece of work!).  

We’ve developed a baboon problem here at Kijabe--one was found inside a worker’s house yesterday.  They aren’t the cute furry creatures that one might think--they are strong, intelligent, dangerous animals--particularly in groups.  A Kenyan safari guide told me that a troop of baboons is capable of killing a leopard.  So, the Kenyan Wildlife Service was called to take care of the situation.  Unfortunately, the baboons obviously had notice of their arrival and disappeared--so the KWS decided we don’t have a baboon problem.  The administration is asking KWS to come back before a human is attacked--plans to enclose the garbage bins are also underway.

It is mid winter now in Kijabe--cloudy, misty, cool days and nights.  I used to tease the nurses for feeling so cold when the temperature is 59-65.  Well, right now as I write, I am wearing a long-sleeved cotton ribbed sweater, quilted vest, heavy wool sweater, long pants, shearling lined slippers and am sitting with a knitted wool-covered hot water bottle (thank you Michael and Marisa) on my lap to avoid icy fingers.  I’ve become quite Kenyan in my cold-intolerance.

Our census has been either feast or famine--we’ve had from 9-40 patients over the past few months.  Even with that, Leland and Humphrey have had 4-9 cases scheduled 5 days/week.  In April, we  enjoyed a 10-day visit from a neurosurgery fellow who is completing his training at St. Jude’s.  He came while Humphrey took a well-deserved and much needed vacation.  We also had two neurosurgery residents from the US join us for 2 weeks each in April and June.  It was really an enriching experience to work with new people; the residents even enjoyed seeing patients in OPD (most residents avoid clinic like the plague).  We are looking forward to having a resident from University of Wisconsin join us for a month in August.  He will see more children with spina bifida and hydrocephalus in one month than he will in 7 years of residency.  But he will also see complex brain tumors, spinal cord tumors, brain infections, and other neurosurgical problems--we “have it all” here.

Many “long-termers” at Kijabe seem to resent the visits of “short-termers.”  They believe that the visitors don’t know any tropical medicine, don’t understand the limitations of practice at Kijabe, hold unreasonable expectations, and have difficulty adjusting to non-developed-world medicine.  Usually, but not always, the first is true--and learning about malnutrition, anemia, malaria, Burkitt’s lymphoma, parasitic diseases, and TB among other things is an ongoing challenge.  But, I hope that we never disdain the enthusiasm, experience, problem solving, new ideas and practices, and suggestions brought by our visitors.  It is very easy to adopt an attitude that says, “That’s the way we’ve always done it,” “That won’t work in Kijabe/Kenya,” “We’ve never done that before.”  It will be increasingly important, the longer that Leland and I are here, to have infusions of new ideas, new eyes through which we see our patients and new ways of doing things.  As we near our 2 year anniversary of coming to Kenya, we feel neither “short-term” nor “long-term.”  Perhaps that’s a very good thing.

I think I may have mentioned that we’ve had a leaky roof....well, about 3 weeks ago, Leland and I moved the contents of our apartment from the third floor to the second floor.  It was a good opportunity to develop upper body muscles and work on hamstring/quad strength.  We’ve come to really appreciate our third floor apartment; the view from our balcony, the light because of the open floor plan.  The second floor is much darker, much noisier, and less private.  We expect to be here for about another month.  The roofers have an amazing work ethic--start early, work till dark 6-7 days/week.  They are living in one of the rooms on the third floor and cooking dinner on a Kenyan stove (jiko--much like a habachi).  When the roof was off and it rained, they got soaked--they said it was more incentive to hurry with the repairs.  Because the solar water heaters are disabled, they installed a “widow-maker” in our shower.  For those who are unfamiliar with this devices, it electronically heats the water as it comes out of the showerhead.  It is so named because when it malfunctions, the shower-er gets electrocuted.  I’m assuming they think it is always a man.  Our friends in Nairobi who had a “widow-maker” always showered in rubber flip-flops.

Despite making two trips to the Western hemisphere this year to see family, I got an acute case of “missing the kids.”  So, on June 14 (my granddaughter’s 3rd birthday), I left Nairobi to fly through Paris (love Charles de Gaulle airport!) to Dulles in VA.  Joe is in Afghanistan for 6-8 weeks, so Kelly and Evelyn met me at the airport; later that evening, Michael flew in from his job in Boston.  We had a wonderful weekend, mostly talking and eating.  I spent the next two weeks talking with Kelly, attending Kelly’s award ceremony at work, playing/dancing with Evelyn, painting walls, and shopping.  Never was much of a shopper before--but love those window displays at Restoration Hardware (new color scheme), Pottery Barn, made a boatload of trips to Home Depot.  I loved the clothes dryer, bagels, paved roads, road construction signs like “Bump,” “Uneven Pavement”--they never give you warning here in Kenya and would run out of signs in about a mile if they did.  I didn’t love the GPS (it told me to make a U-turn on an interstate), or the confusing roads (one wrong turn and the only options are Washington, Baltimore, or Richmond), or the 106 degree temperature and extreme humidity that makes your hair cry.  I saw close friends who live in Purcellville--the kind of friends I hadn’t seen for years yet we talked as though we’d seen each other yesterday.  It was a soul-satisfying visit, and I really enjoyed the States.  But I was very glad to come back home to Kijabe.

The first morning back at work, the team asked me to talk with a mum whose baby’s care was futile.  As Mercy translated my words, I became very aware of what a privilege it is to share these hard times with the patients and families.  There has been no accusation of blame by the parents; they express deep appreciation for our care of their children and belief that whatever happens is God’s will.  When I first came here, I really resisted the idea that a child’s death could be God’s will.  I still grapple with that concept--yet, what I have come to learn is that God is very present in everything that happens, that we have the privilege of being God’s arms holding the people in grief and loss.  The lack of blame does not make us less careful in giving care; in fact, I believe we are often closer and more attentive to the patients and families because we share in the grief when one of the children dies.

Leland continues his diligent study of Swahili; I’ve taken a hiatus from the oral lessons and, as a primarily visual learner, am studying from a book (though not diligently).  Since our pastor at NILC (Nairobi International Lutheran Congregation left at the end of May, Leland has preached twice and is responsible for the Weekly Meditation sent via email to most of the congregation.  Since I haven’t figured out attachments to the blog, I’ll copy both sermons at the end of this posting.

Both Leland and I miss our children and families and being more involved with our grandchildren; in a way they are sacrificing for us to be here.  I really appreciated what my son said to me on a walk we took together, “Mom, I’m really proud of what you and Leland are doing in Kenya, I want you to know that.  But, I really miss having you here, and I’ll be glad when you come home.”  Leland and I want to be in Kijabe right now--even as much as we miss our family.  In this time and place, we have a profound sense of peace and closeness with God.

I ask for your continued prayers that we find a pediatric neurosurgery fellow to start in October--not only will that fill the position and train another pediatric neurosurgeon for East African, but it will significantly lighten Leland and Humphrey’s surgical load.

Thank you all for your prayers, notes, care packages, gifts to the neurosurgical patient subsidy fund--we appreciate your thoughtfulness and faithfulness. 

As we say at the end of each church service,

Go in peace. Serve the Lord. Thanks be to God.

Take care, God bless.

Susan and Leland

June 17 Sermon

The Holy Gospel according to St. Mark the fourth chapter, verses 26-34

He also said to them, “The kingdom of God is as if someone scattered seed on the ground, and would sleep and rise night and day, and the seed would sprout and grow—he does not know how.  The earth produces of itself, first the stalk, then the head, then the full grain in the head.  But when the grain is ripe, at once he goes in with his sickle, because the harvest has come.”

He also said, “With what can we compare the kingdom of God, or what parable will we use for it?  It is like a mustard seed, which when sown upon the ground, is the smallest of all the seeds on earth; yet when it is sown it grows up and becomes the greatest of all shrubs, and puts forth large branches, so that the birds of the air can make nests in its shade.”

With many such parables he spoke the word to them, as they were able to hear it; he did not speak to them except in parables, but he explained everything in private to his disciples.  

The Seed of the Kingdom of God

Jesus was such a disappointment.  Think of all the ways he disappointed the Jews.  They expected a messianic king to restore Israel into a kingdom like it had been under King David, a king who would free them from Roman rule.  The ancient Jews said: “He prays not at all, in whose prayers there is no mention of the kingdom of God”, so their everyday prayer would be “Let God cause his kingdom to reign, and his redemption to flourish: and let the Messiah speedily come and deliver his people.” After all, the 7^th chapter of Daniel said the Messiah “..was given dominion and glory and kingship, that all peoples, nations, and languages should serve him.  His dominion is an everlasting dominion that shall not pass away, and his kingship is one that shall never be destroyed.” But Jesus, son of a carpenter, born in a stable, going around with fishermen and tax collectors and prostitutes, caring nothing about the Roman occupation, criticizing the most religious people of the day, breaking the sacred commandments and teaching that he was greater than the commandments.  What a disappointment he was.  Good thing he died, they thought.  That was the only correct thing they ever thought about him.

 For some of us, Jesus is a disappointment.  He told us to pray “Thy kingdom come” and Sunday after Sunday we pray it in the Lord’s prayer. At the end of the prayer we say, “For thine is the kingdom, the power and the glory.” What do we think when we pray, “Thy kingdom come”? Many of us think of the kingdom of God in terms of power and glory. Many of us are praying that God will reign, will rule, over all the earth, that his laws will be obeyed by everyone.  Many of us think of the kingdom in terms of the second coming, when Jesus will bring in a new heaven and a new earth.  We almost always think of the kingdom in terms of power and glory and justice and Jesus finally making things right.  And we are disappointed that we see nothing like that kingdom.  Nothing like it.

 When Jesus talked about the kingdom of God to the crowds and to his disciples, his main objective, his main goal, was to reveal himself as the king of the new spiritual kingdom being inaugurated by his presence, a kingdom completely different from the expectations of the Jews.  He did not talk about power or glory and he never gave a clear definition of the kingdom, maybe because it is hard to define, like, how would you define the universe?

So Jesus always talked about the kingdom of God in parables.  The Greek word for “parable” comes from two Greek words, para, which means beside, or alongside, and ballo, which means to throw.  So a parable is a story that is thrown alongside or placed beside, another idea or concept, to clarify it. Jesus told many parables about the kingdom of God, in fact, more parables about the kingdom of God than anything else he told parables about, and each of the parables looked at the kingdom from a different viewpoint.

 Now you know I am not a preacher; I am a teacher, a professor, so let me teach for just a moment and you be the students.  Here is the question for you:  When I read the following list of parables, do you see a common theme in them, a common idea? Do they have anything in common? 

A sower planted seed in four different kinds of soil.

A sower planted seed and weeds came up with the wheat.

A sower planted seed and then just waited for the crop to grow.

A sower planted a small mustard seed and it grew into a large plant.

A woman put yeast put into a large amount of flour and it worked its way through all the dough.

 Did you see any common idea in those parables?  Did you see anything about power or glory?  No, the parables compared the kingdom of God to something small that was put into the world, something not obvious but, like a seed, having power within itself to grew into something great, as in our two parables for today.

 Our first parable today is found only in the gospel of Mark. 

The Kingdom of God is as if someone should cast seed on the earth.   But who casts the seed and what seed is sown?  Is Jesus saying that he, himself, casts seed on the earth?  Is he talking about people evangelizing?  No, the someone, the sower, is God himself.  What seed does God sow into the earth? According to this parable in Matthew, the seed was the word—“anyone who hears the word of the kingdom”. So what was “the word?” How does the gospel of John begins? “In the beginning was the word.” What word was John talking about? Jesus, who was the good news of the kingdom of God and who brought the good news of the kingdom of God was the seed God cast on the earth.

And should sleep and rise night and day and the seed should spring up and grow, he (the farmer) doesn’t know how. For the earth bears fruit of itself, automatically: first the blade, then the ear, then the full grain in the ear.

God is at work in the soil of mankind.  The success of the kingdom does not depend on the efforts of mankind, trying to bring it into being.  No, the active work of God’s grace will make it happen and the reign of Christ in the lives of people who receive him will bring forth the fruit of God’s character in their behavior.

The point of this verse is the work of the seed. Think of the parallels between a seed and Jesus:  both enter the earth inconspicuously, both contain within themselves everything needed for the work they are made to do, both die and are mysteriously transformed from what was planted into something dramatically greater.  As Jesus said, “Unless a grain of wheat falls into the earth and dies, it remains a single grain; but if it dies, it bears much fruit.” (Jn 12:24) 

The kingdom of God is like that—mysteriously growing from the seed of Jesus, people unexplainably choosing to follow him.  A teenage boy with a history of bad behavior decides one Sunday he wants to be baptized; a scientist who denounced God and religion all his career remembers a Bible story he heard as a child and it brings tears to his eyes; a rich, corrupt, businessman who had swindled many clients is invited to church by a business colleague and hears that he is forgiven and believes it and begins to follow Jesus.  No explanation for those.  And yet teenagers who are raised in Christian homes stop believing anything about God, adults who have gone to church all their lives stop believing because God did not heal their wife who was dying of cancer. 

The growth of the kingdom is mysterious, and we have far less influence on its growth than we would like to have.  I have prayed for several years that a dear friend who is a neurologist would say yes to Jesus.  I sent him emails telling him about Jesus.  No response.  Its frustrating, isn’t it?  We love these people, we want so badly for them to know Jesus, to follow him, but they choose not to.   The growth of the kingdom, like the growth of a seed, is mysterious.  But it grows nevertheless. Somehow, that seems fitting for God.  Do we want a God we can figure out? A god who does things the way we think he should?  That would not be god, but an extension of ourselves.

But when the fruit is ripe, immediately he puts forth the sickle, because the harvest has come. Just as we can count on the earth to produce great plants from small seeds, so we can also count on God to bring about the harvest of a great kingdom. The point of this parable is not so much the mystery of the kingdom of God, but its dependability.

 The second parable today, the parable of the mustard seed, is also found in Matthew and Luke.

The kingdom of God is like a mustard seed, which, when sown upon the ground is the smallest of all the seeds on earth.  Once again, Jesus disappoints.  Instead of him starting the kingdom as a mighty warrior or a great king, he starts it as an illegitimate infant.  Instead of choosing the best and the brightest to be his disciples, he chooses fishermen and a despised tax collector.  Instead of comparing the kingdom of God to a giant sycamore tree or a magnificent cedar, he compares it to a mustard seed, the smallest seed they knew of then.  The point here is that the work of God is not done by human methods nor by the ways people think it should be done.

Yet, when it grows up, it becomes greater than all the herbs, so that the birds of the sky can lodge under its shadow.  The kingdom is the thing sown in/on earth.  It does not refer to heaven. This tiny seed of the kingdom of God becomes so great that birds can rest in its branches.  This is a parable.  It is not talking about mustard seeds and birds.  It is talking about the kingdom of God and people, and it hints at something the Jews hated, the idea that Gentiles could be included in the kingdom, like quotation from the OT, “under it shall dwell all birds of every wing” “All great nations lived under its shadow” “all flesh was fed from it” and “in it was food for all.” 

The parable makes clear the dependability of his kingdom in the earth.  It says nothing about the hostility people might have to the kingdom, nor to the various responses people might make to it.  Only that once the kingdom is sown, it will continue to grow into something magnificent.  Our role in that growth in that kingdom is to abide in Christ, to be receptive to what God has gifted us to do and leads us to do, to demonstrate the life and character of Jesus in our worlds.

 With many such parables he spoke to them—the crowd-- as they were able to hear it. Without a parable he did not speak to them. But privately, to his own disciples, he explained everything.  His disciples did not understand the parables either.  They asked him what the parables meant, and he said “The knowledge of the secrets of the KoG has been given to you, but to others I speak in parables, so that “Though seeing, they may not see, though hearing, they may not understand”—a quotation from Isaiah 6.   You remember Isaiah heard the Lord ask, “Whom shall I send? And who will go for me?” And Isaiah said, “Here am I, Send me!” But do you remember what God said next? “Go and tell this people: Be ever hearing, but never understanding; be ever seeing, but never perceiving.  Make the heart of this people calloused and their ears dull and close their eyes, otherwise, they might see with their eyes, hear with their ears, understand with their hearts and turn and be healed.” Then Isaiah said, “For how long, O Lord?”, and God answered, “Until the cities lie ruined, until the houses are deserted, until the Lord has sent everyone far away, and the land is laid waste.  But as the terabinth and oak leave stumps when they are cut down, so the holy seed will be in the stump in the land.” In other words, until Jesus, the holy seed, was planted in the land and grew and was cut down and resurrected.”   The mystery of Christ would finally be revealed by the Spirit of God at Pentecost.

With Jesus’ birth and life and death and burial and resurrection and ascension, the Kingdom of God was planted, in a way that, as Luther said, “can neither be known nor felt, but only believed and trusted”, and praise God, it is growing and will one day become the harvest God wants. And that is nothing to be disappointed about.  Amen 

June 24 Sermon

The Holy Gospel according to St. Mark, the 4^th chapter, 35-41

On that day, when evening had come, he said to them, “Let us go across to the other side”.  And leaving the crowd behind, they took him with them in the boat, just as he was.  Other boats were with him.  A great windstorm arose, and the waves came into the boat, so that the boat was being swamped.  But he was in the stern, asleep on a cushion; and they woke him up and said to him, Teacher, do you not care that we are perishing?”  He woke up and rebuked the wind, and said to the sea, “Peace! Be still.” Then the wind ceased, and there was a great calm.  He said to them, “Why are you afraid? Have you still no faith?  And they were filled with great awe and said to one another, “Who is this, that even the wind and the sea obey him?

Is Jesus’ Presence Sufficient?

The fourth chapter of Mark begins with these words: “ Again he began to teach beside the sea.  Such a very large crowd gathered around him that he got into a boat on the sea and sat there, while the whole crowd was beside the sea on the land.  He began to teach them many things in parables.”  In that fourth chapter, Jesus told them the parable about the sower who planted seed in four different kinds of soil, about a lamp not being put under a basket, and he finished with the two parables we read last week, about someone scattering seed on the ground and waiting for the harvest to come and about the kingdom of God being like a mustard seed growing into a great plant, parables about the kingdom of God.  With that, Mark ended this group of parables and began to tell us about Jesus’ miracles, the first of which is in our gospel reading for today.Jesus had taught from the boat all day long and when evening came he said to his disciples, “Let us go across to the other side”, to cross the Sea of Galilee, which is 21 km long, 11km wide and 46 meters deep.  Fishermen then often fished at night—they still do—but why Jesus wanted to cross to the other side that night, we have no idea.  But he did.  It must have been a clear night so they could tell their direction by the stars, at least it was clear when they left. On the other side of the Sea of Galilee was mainly Gentile territory, the country of the Gerasenes, where the man possessed by demons lived—you remember the story of the pigs running off the cliff into the sea.  It was a place they had never been before and would not go again.

So they left the crowd on the shore and the disciples took Jesus just as he was, presumably meaning that he had been sitting down teaching all day and they began the journey with him sitting where he had been teaching.  Teaching or preaching all day is tiring and Jesus naturally went to sleep with his head on a cushion in the stern, the back, of the boat.  That is the only reference in the Gospels to Jesus sleeping.

They were probably in a fishing boat like the one from the first century that was discovered in 1986 when a drought lowered the level of the Sea of Galilee.  The boat was covered in mud but people realized that it was ancient and it was carefully restored.  If Jesus and his disciples were in a boat similar to that one, it was about 8 meters long, 2 meters wide, and 1.3 meters high.  

So Jesus is in the back of the boat asleep and the disciples are rowing or more probably sailing and a storm comes up.  They were at the northern end of the Sea of Galilee and on its western coast there is a canyon between two mountains where strong winds from the Mediterranean Sea come sweeping down to cause sudden violent winds and waves.  In 1992, a late winter storm produced waves three meters high that slammed into the town of Tiberias, approximately where Jesus had been teaching. 

Our text says, “the waves came into the boat, so that the boat was being swamped.”   There was not only great wind but big waves coming over the sides of the boat filling it and these experienced fishermen thought they were going to drown.  This was no ordinary storm.  

The disciples woke Jesus and said, “Teacher, do you not care that we are perishing?”  They did not use the term Master or Lord, but only Teacher—as if to say, “You teach all this stuff but can you do anything to keep us from drowning?”  In Mark’s gospel, the only people who called Jesus “teacher” were his opponents and his own disciples. We do not know if they believed that he could do something but they were rebuking him that he did not care.

Jesus woke up—I doubt he stood up in the boat in those waves—he probably just sat up and spoke: “Nyamaza utulie”, perhaps “Quiet” to the wind and “be still” to the waves.  The text says he rebuked the storm.  The greek work, epitimao, to rebuke, to sternly warn, to give orders, is the same word used when Jesus rebuked demons, when the disciples rebuked people who wanted to bring little children to Jesus, when Jesus rebuked Peter and said “Get thee behind me Satan”

The wind stopped, the waves ceased, and there was a dead calm. Can you imagine that?  

Then Jesus asked them, “Have you no faith? (the Greek more correctly says, “Why are you cowards?  Do you still have no faith?”)  I think he was saying, “After all you have seen, do you still doubt me?  Do you doubt that I care for you and your needs?”  He may have been angry that they thought he did not care but his reply could also have been one of sadness that they were so slow to learn.  They had seen Jesus cure the fever of Simon’s mother-in-law, cure lepers, heal a man’s paralyzed legs and another’s paralyzed hand but had never seen him rule over nature.  They had no faith that they would be okay just because Jesus was with them.

The disciples were terrified.  The Greek translation is “they feared a great fear.”  The disciples had two fears:  their first fear was their terror that they might drown in the storm.  The Greek word for that kind of terror is phobos —the feeling we get when we see a matatu out of control coming toward us.  But after they saw what Jesus did to the storm and to the sea, they had a different kind of fear.  The Greek word for that kind of fear is phobeomai, an awe, a deep reverence, the kind of fear the Bible means when it says “The fear of the Lord is the beginning of wisdom”.  The kind of feeling we have when we sing:

God himself is with us, Let us now adore him

And with awe appear before him!

God is in his temple; All within keep silence,

Prostrate lie with deepest reverence.

Him alone God we own,

Him, our God and Savior; Praise his name forever!

They “were saying to one another”…over and over, “Who then is this?” because the Jews believed that only God had power over the winds and the seas:  Ps 89:8.9, “O Lord God of Hosts, who is like Thee, O mighty Lord?  Thou dost rule the swelling of the sea; when its waves rise, Thou dost still them.” Ps 107:29  “He maketh the storm a calm, so that the waves thereof are still.”  But the disciples kept saying, “Who then is this?  The miracle did not seem to have led to faith.  In fact, in spite of all Jesus’ miracles, in Mark’s gospel the disciples are never described as having faith.

This gospel text is so often used as a children’s sermon with the point that “Jesus calms the storms of life.”  Good people, you know that is a half-truth.  How many times have we asked God the same thing the disciples asked Jesus, “Do you not care?  Do you not care that I lost my job, that my husband left me, that my child was killed by a drunk driver?  Where are you God?  Asleep in the back of the boat?” And we say it in anger. The most common thing we say to God is “Do you not care?”  What is the most common thing God says to us in the Bible, 89 times?   “Do not be afraid”

Having Jesus with us does not keep us from storms. (In fact it was Jesus suggestion that they go across the sea that night)  Last Sunday I quoted the words of the gospel song, King Jesus will roll my burdens away.  That is not true for the storms of life.  One minute we are fine, the next minute, a phone call, an email, a conversation and everything changes, the storm has come.  

A few years ago I operated on a five-year old girl with a brain tumor.  Her father had died of lung cancer six weeks before.  Her tumor was large and deep and she needed two operations to remove it.  The first operation went very well she was normal when she woke up.  In the second operation a week later, the tumor went deeper and deeper into the brain.   When we do operations like that, under an operating microscope, the only thing that tells us what is tumor and what is normal is what the tissue looks like.  I had done hundreds of tumor operations like that before but as I continued her operation, I realized that her tumor had blended into her normal brainstem so gradually that I had removed some of her normal brainstem—the part of the brain that makes you conscious.  Fear that I had caused great damage came over me; sweat rolled down my back.  After surgery, she was in a coma. I prayed day after day for that little girl to wake up but she died a few months later.  It was the most stressful, most painful experience of my neurosurgical career. The pain lasted for months. There was no miracle, no “rolling my burden away.”  So where was Jesus, asleep in the back of the boat?

Many of you have had storms that entered your life suddenly.  Some storms we cause ourselves, some are caused by other people—sometimes people in the congregation--, some are caused by the evil one.  It seems to be part of maturing in our relationship with Christ, to come to realize that 1) he usually will not do a miracle to solve our problem, to calm our storm, and 2) this is harder— to accept that what he gives us is his presence with us in the storm. 

I know we sometimes say, “So what if Jesus is with me?  The pain is just as bad.  The loss is just as bad.”  There is no easy answer to that question.  I only know that I would much rather go through loss and grief and pain knowing that Jesus is with me than to go through it alone.  I suspect the reason He tells us “Do not be afraid” is because his presence with us is sufficient to get us through the storms.  It did get me through the storm of that little girl’s coma and then her death.

In those hard times of life when we ask Jesus the question, “Do you not care?,” Jesus asks us the same question he asked the disciples in the boat with him, “Have you no faith?”  I think he means, “Is my presence not sufficient?

We need to remember two verses: 

Mt 28:20: “And remember I am with you always, to the end of the age

Romans 8:39: “Nothing will be able to separate us from the love of God in Christ Jesus our Lord.”  Amen.