Bonjour, mes amis et famille,

Do you have any clue as to where we are right now?  Not in Kijabe—definitely not in Kenya.

Allow me to explain.

Humphrey informed us (that is the way it is said in Kenya—everyone becomes informed…) that he would take a 6-month fellowship in Tübingen Germany starting on September 1 to March 1, 2014.  His vacation begins on August 15.  So, we decided in late May that we needed a rest before Humphrey’s leave.  As of September 1, we will have been in Kenya 3 years.  For us, the first two years flew by—the third year has been the hardest and longest yet of our stay in Kenya.  We wanted a place to vacation where it was warm and the time zone was near Kenya’s (the jet lag problem in going to the States really makes resting and relaxing hard).  So, Provence became our destination.  We are 6 days into our 10-day stay.  Having just completed The Rise and Fall of The Third Reich, I decided to take a break and write the blog.  Many people have hinted that a posting is long overdue.

Lavender

Sunflowers

Lac D'Allos in Haute-Provence

  

Three years in Kenya is long enough to have made some observations—not so long that one fails to be amazed.

God’s Power.  Only By Prayer.  For We Go By Faith, Not By Sight.  These are nice sentiments—but a cause for some alarm when found on the back bumpers of matatus plying the roads between Kijabe and Nairobi.  The number of matatu accidents and resulting fatalities have been a concern in the newspapers—one investigative reporter obtained 6 driving licenses without having any proof of ability to drive—mostly by paying bribes.  His licenses allowed him not only to drive a car, but also operate commercial vehicles such as trucks, buses, and matatus. Many matatu drivers are illiterate—though to be honest that is less of a problem in a country where road signage is at a minimum.

We see a lot of death in Kijabe—I have mentioned before that the number of children and adults that I’ve seen die here in 3 years far exceeds the number I saw in 35 years of nursing in the US.  I thought I’d explain what happens after a patient dies.  First, the body is taken to the mortuary of the hospital.  Only after the bill is cleared can the body be released for burial.  In Nairobi, some bodies have stayed in the mortuary for years because the family has been unable to pay the hospital bill.  We are fortunate that BKKH sometimes covers the bill so that the families are able to take the body home for burial.  There are funeral homes here—with interesting names: Destiny Funeral Home…Exodus Funeral Service….or my personal favorite: Hidden Treasures Funeral Home.  Most times, the extended family and the entire community will converge in private cars and matatus hired just for the purpose of meeting at the mortuary, sometimes conducting an outside service there.  It is not uncommon to see 10 to 20 vehicles and over a hundred people who have come to accompany the body home.  Some families are so poor that they cannot take the body home (one cannot transport a dead body in a public matatu—so the matatu has to be rented for that purpose).  Those children are sometimes buried in the Kijabe Hospital cemetery.  There are times when the child’s death is imminent and the parents beg us to discharge the child so he or she can die at home—most times those requests are made because of financial constraints rather than simply wanting the child to be surrounded by family at the time of death.

Ascaris (intestinal worm)

We sometimes have to be detectives to diagnose our patients.  One boy with shunted hydrocephalus arrived with a massively distended abdomen.  Although that usually means a low-grade chronic infection in the abdomen which prevents absorption of the shunted cerebrospinal fluid, in this case, no evidence of infection was found.  He did later vomit some worms—and had mildly elevated venous pressure associated with his liver.  We all learned a lot about ascaris infestation through caring for him.

Kimberly and Joseph

I want to highlight one of our patients, Joseph, a boy of 10 years who developed brain abcesses.  They were drained and treated in February of this year but recurred.  He returned in May with pus draining from his head.  Because he had undergone weeks of antibiotic coverage in February-March, we began using our strongest antibiotic, meropenam.  He required 6 weeks of treatment with meropenam at a cost of about $50/day.  During his stay, his cucu (pronounced Shosho which is Kikuyu for grandmother) developed severe diabetes and was hospitalized on the women’s ward twice—thereby incurring her own bill. Joseph required 3 operations during his stay—his bill reached nearly 400,000 shillings (about $4,800).   To put that into perspective, my hospital bill for one procedure and 5 days of hospitalization last October was $72,000. However, his family will never have any hope of paying his bill.  Joseph and his family are desperately poor—so his bill was covered by BKKH; his grandmother’s bill was paid by an anonymous donor.

   

We see children with medulloblastomas—cancer in the cerebellum.  Most of the time, the tumor can be fully resected; however, to achieve a cure the children need to undergo radiation and chemotherapy. Leland and I decided to pay for the adjuvant therapy for one of our 11 year old patients.  She was also desperately poor; her father, who accompanied her and took excellent care of her, was from a very remote region of Kenya.  Until his stay with her in Kijabe, he had never been more than several miles from his home. Chemo and radiation therapy is available only in Nairobi; since both take place over weeks, it was necessary to find a place for them to stay while in Nairobi.  Leland made a request during a Sunday NILC church service; by the next week, the ladies of the church had furnished a room on the church grounds and had arranged meals and transportation to and from the hospital. During Sheila’s treatment, they even provided clothes for Sheila and her father. We were amazed and so impressed with their servanthood.  THIS is what community is. 

Unfortunately, that does not seem to be the end of the story—after her therapy was “completed,” we learned from the oncologist that Sheila had not received the appropriate chemotherapy.  Although we ended up paying nearly double ($2300) the original quote, the costs to complete her therapy will be another $1600 plus the amount needed for her father to make the trip to and from Transnzoia.  We are in the process of praying for God’s guidance.  Even if the money for therapy is provided, we are not certain that her father will be able to arrange transportation to Nairobi every 3 weeks for eight visits.  This is always so difficult for us; the cost of the entire therapy is about what I paid for 2 CT scans during my hospitalization.

I mentioned earlier that this past year has been the hardest.  We struggle against developing a mindset that we see in some people here—one that says, “this is Africa, we can’t have excellent medical care here.”  Leland and I have not accepted that and will not.  We do realize every day that we are in Africa and understand the challenges of limited resources, lack of consistent electricity (the lights went out 3 times during Leland’s last brain tumor resection), broken equipment (the drill bits for the saw used to open the skull broke) and lack of organization that makes even writing a requisition for bloodwork an exercise (both in patience and in a physical sense—having had to run to two different wards to find the paper).  But we believe that throwing up one’s hands in resignation is insulting to the Kenyans with whom we work—most of whom are intelligent, caring, hardworking people who want to be practitioners of excellence.  And we believe that God doesn’t delight in mediocrity.  We want to “give of our best to the Master,” and we try to encourage our colleagues to do the same.

Requisition cabinet

Box for charts with new orders

It takes many people to support this work.  This year we have welcomed several neurosurgeons from the developed world who have come for periods of time to help. Sandi Lam and John Collins made their second trip to Kijabe while we made a quick trip to a conference in New Orleans.  Mark van Poppel, Kimberly Foster, Nunthasiri Wittayanakorn, and Alireza Mansouri are neurosurgery residents from the US, Thailand, and Canada who donated their time and had a surgical experience here that cannot be replicated in their home programs (Kimberly listed 98 cases in 3 weeks—including not only shunts and myelomeningocele repairs but also treatment of traumatic brain injuries, infections, and brain and spinal cord tumor resections).  We were pleased that Lianna Ben-Adani, an Israeli neurosurgeon, could spend two days with us.  Del Mount, a pediatric craniofacial surgeon came for 2 weeks with her colleague Lisa David to operate on some of the more complex encephaloceles that we see often here in Kijabe.  Leland continues to search for candidates for the neurosurgical fellowship next year.  We look forward to the next 6 months when many visiting neurosurgeons will work with us, helping us with the caseload, teaching the residents other techniques and practices, elevating the care of children with neurosurgical problems.

Back in April, while we were in the States for the conference, there were terrible landslides in Kijabe which temporarily blocked access to or from the hospital.  Three children were killed in the mudslides. The railroad tunnel was blocked; a bridge over which all the construction equipment and supplies were brought in was washed away.  The destruction was impressive—just as impressive was the local community’s response.  Within several hours, the tunnel was cleared.  The government is responsible for the bridge which has just this week been replaced.  The road from the valley had been the only access for the large construction vehicles; this caused delay of the construction of the new BKKH hospital wing and an increase in costs.

Lower road in Kijabe after landslides

I always am struck, when I reenter the Western world, of how much people take for granted.  It isn’t simply excellent roads with clear signage, or phenomenal food and great bread, or dependable electricity, or running water and clean public bathrooms.  When we go to Nairobi, we see walled compounds with barbed wire topping the wall.  There are armed security guards in every shopping area.  People in our Nairobi church have been ambushed and shot just outside their homes.  Carjackings are frequent—being mugged after use of an ATM is common.  In Kijabe we are somewhat protected, yet even there home break-ins have occurred recently.  I believe that income inequality is largely a factor in the insecurity—in Africa and even in places in the US.  The more people acquire, the more they feel compelled to defend their possessions—especially when those around them are desperately poor.  I continue to struggle with Jesus’ words in Luke 6: 29-31: “If anyone strikes you on the cheek, offer the other also; and from anyone who takes away your coat do not withhold even your shirt.  Give to everyone who begs from you; and if anyone takes away your goods, do not ask for them again.  Do to others as you would have them do to you.”  To be honest, I no longer feel guilty when I say “no” to those asking for money.  I believe that I am giving not only my money, but also my time, and myself.  Over the past 3 years, we feel “poured out” to a great degree for the children at BKKH.  We have had several patients to whose bills we have contributed or for whom we have paid the fee for adjuvant therapy after tumor resection for brain cancers.  Yet, there is always so much more we want to do.

A good friend just wrote this: “Am feeling like there is more I could be doing with my life.”  I believe that all of us, if we are truly honest with ourselves, could say the same.  As I grow older (which is another thing that has become much more apparent over the last 3 years…) I become more firmly convinced that everyone has a ministry wherever he/she is RIGHT NOW.  There is no need to sell everything and be an itinerant preacher, or to move to Ecuador and start a school.  Everyone has been given a pulpit—everyone has the opportunity to be the hands, feet, mouth, arms, eyes, ears, heart of Jesus.  In fact, I would say it is much more challenging to be Jesus in an insurance company, as a financial advisor, in a grocery store, government agency, or a public school.  But where is Jesus needed most?  In those very places.  Yes, I encourage you to give of your money and possessions—those are needed everywhere.  But more than that I encourage you to give of yourself, wherever you are—because Jesus’ presence is needed far more than your money.

Thank you all for your prayers of support for us; they become more precious and needed as time goes on.  Please pray for the parents of the children at BKKH—so many of their decisions are influenced by their ability (or lack of it) to pay the bill.  We ask your prayers for Kijabe Hospital administration, for the BKKH nursing staff which has been decimated because we cannot pay salaries commensurate with those paid by government hospitals.  Because of that we have lost experienced and valuable staff nurses.  We ask you for your continued support in prayer and money for BKKH.  Many children’s bills are paid through your contributions.

Take care, God bless.

Susan