Monday, December 3, 2012


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