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 9th 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
