tag:blogger.com,1999:blog-82389621616185270902024-02-19T09:11:15.863-08:00Susan and Leland in KijabeUpdates on the work of Susan Ferson and Leland Albright to develop pediatric neurosurgery in KenyaSusan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.comBlogger25125tag:blogger.com,1999:blog-8238962161618527090.post-75076236962932947302015-02-03T07:51:00.000-08:002015-02-03T07:51:12.872-08:00<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">Habari
rafiki,<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">Leland
often says that life does not go in a straight line.<span style="mso-spacerun: yes;"> </span>When we left for Kenya on August 31, 2010, we
thought we would stay 2-3 years.<span style="mso-spacerun: yes;"> </span>Once
there, we realized that establishing a functioning pediatric neurosurgery
service, one that gave excellent care to the children, provided teaching to
residents and fellows, and was an expression of the love of God, might take 6
years.<span style="mso-spacerun: yes;"> </span>That time frame was our basis for
saying we planned to leave Kenya on September 1, 2016.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: Arial;"><span style="font-size: x-small;">Instead,
life happened. Leland’s chronic fatigue syndrome, more accurately referred to
as myalgic encephalomyelitis, has made it impossible for us to continue our
work in Kenya. We returned to Kijabe on
November 1, 2014 to provide coverage for Humphrey during his month-long vacation
(during which he was married) and for Veronicah, our clinical officer, during
her annual leave, train another person to fill my role, and say goodbye to so
many cherished co-workers. </span></span></div>
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<span style="font-size: x-small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq-3Cs-lZv4SUofPUtbnF8nZ4EqlfGq0b41pKN_FNh6K9Z_ziZyr7TiJ8mM1DpMFH85D98XJbBz33FBAT4mmQ1yfQXtYurq11FBFau-3XHlfqP_A9fcF9IZzvgk-oykiBH3w2BOXugTopd/s1600/Elizabeth+Njoroge.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq-3Cs-lZv4SUofPUtbnF8nZ4EqlfGq0b41pKN_FNh6K9Z_ziZyr7TiJ8mM1DpMFH85D98XJbBz33FBAT4mmQ1yfQXtYurq11FBFau-3XHlfqP_A9fcF9IZzvgk-oykiBH3w2BOXugTopd/s1600/Elizabeth+Njoroge.jpg" height="200" width="150" /></a></span></div>
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<span style="font-size: x-small;">Even that did
not go as we had expected; Veronicah, who had worked with us for 18 months,
went on her annual leave in December as expected—but during her annual leave,
applied for and was accepted as clinical officer for the women’s ward. So, she never returned to pediatric neurosurgery. Fortunately, a highly motivated nurse,
Elizabeth Njoroge, became a phenomenal addition to our team. She has amazing initiative—she went home each
night and read a chapter from the Neurosurgical Nursing book sent to her by
Andrea Strayer, a nurse practitioner at UW with whom we worked at U.W.. It would have been ideal for Veronicah to
have mentored Elizabeth after I left—but as we all know, life is not
ideal. I have full confidence that
Elizabeth will shine in her new role.<o:p></o:p></span><br />
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<br /></div>
<!--EndFragment--><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">Our last
2.5 months in Kijabe were full ones—we worked harder than ever (did not take
our usual Wednesday half-day breaks).<span style="mso-spacerun: yes;">
</span>Leland was on-call over Christmas and New Year’s Day.<span style="mso-spacerun: yes;"> </span>I think everyone in Kenya who had a shunt
malfunction had it over Christmas—on Christmas day and the day after (Boxing
Day in Kenya), he did three emergency shunt revisions.<span style="mso-spacerun: yes;"> </span>We had great help during Humphrey’s absence
in November when Dan Curry from Texas Children’s Hospital came for 3
weeks.<span style="mso-spacerun: yes;"> </span>His service allowed Leland to
rest between rounds and the operations he performed.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">Leland and
I had time last summer to think objectively about the provision of neurosurgery
to children in Kenya.<span style="mso-spacerun: yes;"> </span>After careful
review of our data concerning outcomes and with the help of Ivan Stewart, the
former executive director of Bethany Kids and a palliative care physician, we developed
guidelines for care.<span style="mso-spacerun: yes;"> </span>Upon returning to
Kenya and facing the impossibility of one neurosurgeon caring for up to 40
children, we prayerfully and thoughtfully refined those guidelines and
presented them to the medical staff in our last audit.<span style="mso-spacerun: yes;"> </span>These are developed as guidelines, not as
rigid rules.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">--the
census will be limited to 20 patients, including adults<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">--non-urgent
cases will be housed in the BKKH guest house until a bedspace becomes
available.<span style="mso-spacerun: yes;"> </span>Elective cases will be
scheduled as time allows.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">--patients
whose care would be futile will not be admitted.<span style="mso-spacerun: yes;"> </span>Instead, counseling will be provided to the
family.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">--patients
with severe malnutrition will have nutritional counseling and be discharged
until a target weight is achieved.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">--for
children who arrive with pus in their ventricles, the family will be counseled
and sent home.<span style="mso-spacerun: yes;"> </span>The chaplain will be
involved with the family discussions.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">--children
with multiloculated hydrocephalus will be offered a transverse shunt with or
without endoscopy as a one-time treatment.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">--use of
antibiotics will be driven by culture results; the use of meropenam should be
exceptional and requires approval by the team as a whole.<span style="mso-spacerun: yes;"> </span>Vancomycin should be used sparingly.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">--for
children with hydranencephaly, the options of no treatment, choroid plexectomy
or shunt will be offered.<span style="mso-spacerun: yes;"> </span>If any
surgical intervention fails, no further treatment will be offered. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">--consideration
of the prognosis should be part of the admission process, daily treatment plan,
and be revisited as the status changes.<span style="mso-spacerun: yes;">
</span>The chaplain should be involved as early as possible to counsel mums of
patients with grim prognoses.<o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 4.5pt;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><br /></span></div>
<div class="MsoNormal" style="tab-stops: 4.5pt;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small; mso-bidi-font-family: Arial;">It is hard in any setting to
ration care.<span style="mso-spacerun: yes;"> </span>We believe that it is God’s
will that we continue to offer care to children who are poor and to those who
have disabilities.<span style="mso-spacerun: yes;"> </span>But we also believe
that offering care in cases of futility is not merciful or just; we need to be
more mindful of our staff and the sustainability of our practice.<span style="mso-spacerun: yes;"> </span>What Humphrey, Leland, and I have done over
the past 4 years is not sustainable—not for two neurosurgeons and certainly not
for one.<span style="mso-spacerun: yes;"> </span>We were encouraged that we
found great support for these changes from most of our colleagues.<o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 4.5pt;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><br /></span></div>
<div class="MsoNormal" style="tab-stops: 4.5pt;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small; mso-bidi-font-family: Arial;">We look forward to the completion
of Dan and Naomi Ochieng’s residency in Cape Town, SA and their arrival in
Kijabe to carry on the work, probably in 2018.<span style="mso-spacerun: yes;">
</span>In the interim, Humphrey Okechi will be the sole neurosurgery consultant,
and we ask for your prayers for him.<span style="mso-spacerun: yes;">
</span>Although we have many visiting neurosurgeons scheduled to come over the
next 6 months, the responsibility of the provision of care will be Humphrey’s.<o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 4.5pt;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">After the
holidays, we had two visitors from UW Madison. Emily Meyer, the nurse
practitioner who I mentored in her final term as a student, and Marcella Andrews,
the pediatric physical therapist with the Spasticity and Movement Disorders
Clinic, came just after Christmas and stayed for nearly 2 weeks.<span style="mso-spacerun: yes;"> </span>Most of our visitors have come to help
Leland; I was thrilled to have two people who were with me much of the
time.<span style="mso-spacerun: yes;"> </span>Emily saw a very different
practice of pediatric neurosurgery from what she has experienced in the
States—she tapped ventricles and myelomeningoceles, taught Elizabeth
recognition of heart sounds, and helped keep track of our infections.<span style="mso-spacerun: yes;"> </span>Marcella gave us a glimpse of what could be
done with pre and postop physiotherapy for our children with hydrocephalus,
spina bifida, and brain tumors.<span style="mso-spacerun: yes;"> </span>The
teaching she provided to the mums was so needed.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><br /></span></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXqlR95IWWipCESc9oF5MvCKKqoSMHZYg4jlqAAPSIOpqaDZSkMiyEIapqZuChc3bDPsMOvxKFudYM1NqpOpj5nZOS-vCw3TRyQbuQjSmN9olIbo07DxNcTWQTB2p_d1c6dixUjf_cWlst/s1600/summit.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXqlR95IWWipCESc9oF5MvCKKqoSMHZYg4jlqAAPSIOpqaDZSkMiyEIapqZuChc3bDPsMOvxKFudYM1NqpOpj5nZOS-vCw3TRyQbuQjSmN9olIbo07DxNcTWQTB2p_d1c6dixUjf_cWlst/s1600/summit.jpg" height="133" width="200" /></span></a><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFOZnY4FXofh6qvCjpw9QZDbGTEHvqw9_c6ehDNiWL9lMeNQazAm2jk0x5ydQxAVxo5nVktuMKlaLi0PZlq2AO1-SOF6u0a1670be2wgA7CE_PoL5NorF-gGeBoF8vGadapLpG20DtNk09/s1600/hard+climb.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFOZnY4FXofh6qvCjpw9QZDbGTEHvqw9_c6ehDNiWL9lMeNQazAm2jk0x5ydQxAVxo5nVktuMKlaLi0PZlq2AO1-SOF6u0a1670be2wgA7CE_PoL5NorF-gGeBoF8vGadapLpG20DtNk09/s1600/hard+climb.jpg" height="133" width="200" /></span></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">With Emily
and Marcella providing needed encouragement, I climbed Mt. Longonot, the
volcano near Kijabe.<span style="mso-spacerun: yes;"> </span>We also went, with
Mercy, to Maasai Mara for a safari.<span style="mso-spacerun: yes;"> </span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLWdqJFVXiJi8PWt9SXs5HrGLbK1N0YSkRJEAHEvUF5figtApeFDPnfnp58siXO6pnd-HD0CbHNwlQsi7OqHuY4qJn8knTTp0fDnnlkpQt0_VuEID-aUVpqXlPxkzXQLhht4QOepJKL_vZ/s1600/shooting+on+safari.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNkMNx68f1Aj0EWIOCHPg2RnTC9cO88R7INHONRFYHpj9XB4nf6R_LDk_3qOQ2uKPCLeh6FHO000UTpUjiAfZ-MiJyyBeB4yHK32LVSYUNUFYAHrHN_rWLDOes9aH_-ryBCfpUd6Va9ns9/s1600/giraffes.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNkMNx68f1Aj0EWIOCHPg2RnTC9cO88R7INHONRFYHpj9XB4nf6R_LDk_3qOQ2uKPCLeh6FHO000UTpUjiAfZ-MiJyyBeB4yHK32LVSYUNUFYAHrHN_rWLDOes9aH_-ryBCfpUd6Va9ns9/s1600/giraffes.jpg" height="212" width="320" /></span></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLWdqJFVXiJi8PWt9SXs5HrGLbK1N0YSkRJEAHEvUF5figtApeFDPnfnp58siXO6pnd-HD0CbHNwlQsi7OqHuY4qJn8knTTp0fDnnlkpQt0_VuEID-aUVpqXlPxkzXQLhht4QOepJKL_vZ/s1600/shooting+on+safari.jpg" height="133" width="200" /></span></div>
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPU1aYgqAyHCXoUMmS7zJDSWsi7tD2sR0rJcHWQmN_BXCcM3VDVZzrnLWAqGHA8bZw6CStPNtm5K4MDKzBmdzky1ZMYGnsT4xZDwunuKu5XWJjeRcTO9BksMPEct9MrU2adVAvXgMe3kOi/s1600/sleeping+lion.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPU1aYgqAyHCXoUMmS7zJDSWsi7tD2sR0rJcHWQmN_BXCcM3VDVZzrnLWAqGHA8bZw6CStPNtm5K4MDKzBmdzky1ZMYGnsT4xZDwunuKu5XWJjeRcTO9BksMPEct9MrU2adVAvXgMe3kOi/s1600/sleeping+lion.jpg" height="133" width="200" /></span></a><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><br /></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: x-small;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: x-small;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgG1d0D3CUBSLvnrlA-b7CWQcmIJYdH9Y6qRUJW1hWvZuS6o0cFumf4pNIphSbdjrddE3WXtda3D_pxv8d0dyc1pHy2Za6hfbrBe2ncTK0BOliqBNTM5fvwrpgv5DSPSIuFLIwHq42BUNQI/s1600/elephants.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgG1d0D3CUBSLvnrlA-b7CWQcmIJYdH9Y6qRUJW1hWvZuS6o0cFumf4pNIphSbdjrddE3WXtda3D_pxv8d0dyc1pHy2Za6hfbrBe2ncTK0BOliqBNTM5fvwrpgv5DSPSIuFLIwHq42BUNQI/s1600/elephants.jpg" height="213" width="320" /></a></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: x-small;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJg70w7vpH-WCfD1_jud6GhZIjC9T1jcoLUPwC_bgYPUMQo8GWBEO3CH7CQY7ZdFFGZYQfmKY5rr8VzqOp5jvrNrsiDVtftIA8h3D4XAgR1mICnpVmJBJDEsILMe7hNP__YcCKiFXOjVGH/s1600/IMG_0121.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJg70w7vpH-WCfD1_jud6GhZIjC9T1jcoLUPwC_bgYPUMQo8GWBEO3CH7CQY7ZdFFGZYQfmKY5rr8VzqOp5jvrNrsiDVtftIA8h3D4XAgR1mICnpVmJBJDEsILMe7hNP__YcCKiFXOjVGH/s1600/IMG_0121.jpg" height="133" width="200" /></a>Emily and Marcella enjoyed “shopping” for beaded jewelry with Samuel,
the Maasai guard from the Rift Valley Academy.<span style="mso-spacerun: yes;">
</span>He was in despair after losing 8 out of 12 cows to lions in the forest
near his home in Suswa.<span style="mso-spacerun: yes;"> </span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: x-small; mso-spacerun: yes;"></span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><br /></span></div>
<div class="MsoNormal" style="tab-stops: 4.5pt;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small; mso-bidi-font-family: Arial;">In our last weeks in Kijabe, we
had two other visitors; Dan Hansen, a junior faculty neurosurgeon from
University of Iowa, and Ross Green, a medical student from the University of
Arizona.<span style="mso-spacerun: yes;"> <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpQBaEsax8b1SlTwXwP8ET_BM4mpHj73Dvzwn3TvG4GdsBrFurzDhgM6av4v_dACRR2HGZ44z7Er9I1tfT9OSUm-sEEUYXfEdWi4S-AKNyrx-ObZ2rPkVYJGB9oUtX-xreL8aZJDetWY0z/s1600/IMG_1253.jpeg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpQBaEsax8b1SlTwXwP8ET_BM4mpHj73Dvzwn3TvG4GdsBrFurzDhgM6av4v_dACRR2HGZ44z7Er9I1tfT9OSUm-sEEUYXfEdWi4S-AKNyrx-ObZ2rPkVYJGB9oUtX-xreL8aZJDetWY0z/s1600/IMG_1253.jpeg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Peter Kitunguu, Ross Green, Leland, Dan Hansen, Addisaleam Belete</td></tr>
</tbody></table>
</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small; mso-bidi-font-family: Arial;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small; mso-bidi-font-family: Arial;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small; mso-bidi-font-family: Arial;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small; mso-bidi-font-family: Arial;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small; mso-bidi-font-family: Arial;">I love having visitors—not only
because it makes rounds much more academic (the mums’ eyes got very big when 9
people, 7 of whom were wazungu, gathered around their beds each morning) but
also because their reflections give us “fresh eyes” with which to see the
impact of our service.<span style="mso-spacerun: yes;"> </span>I want to quote
from Marcella’s reflections. <o:p></o:p></span></div>
<div class="MsoNormal" style="tab-stops: 4.5pt;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><br /></span></div>
<div class="MsoNormal" style="tab-stops: 4.5pt;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small; mso-bidi-font-family: Arial;">“This is
what Dr. Leland Albright and Susan Ferson have done for the mums with children
who have spina bifida, hydrocephalus and tumors. They have given them a
reason to be thankful. Of course, I don’t believe the mum’s are cursed
because of the birth of this child and I don’t believe it is God’s will
either. The only answers that I could provide for why this has happened
to them would be looking at the science of why (folic acid?) and how (lack of
neural tube closure) but it feels a little too late for these mums right in
front of you. But what I did feel in their presence is enormous
gratitude, not that their child has a disability but that there is a place for
them to come. They did not have to hide or be shunned from their
community but could be together and see they were not alone. During
morning rounds, I watched the mum’s faces and what I saw behind their eyes was
gratitude. They appeared thankful for anything that was offered.
They appeared thankful that this group of people stopped by the bed of their
child and talked about them. Their child mattered. They would point
out certain changes in their child and their opinion mattered. We were
validating them and giving them a voice. They could be thankful for the care
that was provided to them at Kijabe Hospital. One mum asked quietly, “I’m
so thankful my child doesn’t have a big head like that, what is that from
something they eat?” She was thankful even though her child just had a
cancerous tumor removed from his brain. Here at Kijabe hospital they were
encouraged to love their child which is what all mothers want to do.
No matter the surgical outcome or the challenges their child with a
disability may face in an unaccepting culture, these mothers had a place to be
thankful and a child to love. Without Kijabe hospital many of these mums
would have been encouraged by African culture to love their child only in
secrecy, that their child is a curse and it is God’s will. Here these
mums found a place to be thankful, a place of community, a place where they
were heard and where they and their child mattered.” <o:p></o:p></span></i></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">I want to
say clearly here that Leland and I, Humphrey, Erik Hansen, Ken Muma, and all of
us who work at BKKH are just contributors to what has become the mission.<span style="mso-spacerun: yes;"> </span>Dick Bransford started operating on children
with hydrocephalus and spina bifida—that wasn’t done in Kenya before him.<span style="mso-spacerun: yes;"> </span>Dan Poenaru started the academic mission—to
train African physicians to care for these children.<span style="mso-spacerun: yes;"> </span>We have made our contributions.<span style="mso-spacerun: yes;"> </span>But, it is important to know that this is not
Dick’s program; it is not Dan’s, or Leland’s or Humphrey’s or Erik’s or
Ken’s.<span style="mso-spacerun: yes;"> </span>It is God’s program and we are
merely the servants who carry it out.<o:p></o:p></span></div>
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<div class="MsoNormal">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">In my last
few days in Kijabe, I had a lot of “lasts”—last dawn over the rim, last sighting
of the Southern Cross, last sunset over the Rift Valley, last presentation of
the quarterly audit (it was my 16<sup>th</sup> presentation).<span style="mso-spacerun: yes;"> </span>I will never again have such a beautiful view
outside my window.<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0aJAVQi3k6_JdjFpGRH4nrhHXvhxS8bS7JlbVLabt9tn2yCqIfAjxS_nrzwRq7UMukql4bRHmq7MrRbBCrYXPsu2z-tXcyAAsPkTA_gFUnY9e06tUboapr7ac5EwOLW8miWY_nmii6e2y/s1600/dawn+over+the+rim.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0aJAVQi3k6_JdjFpGRH4nrhHXvhxS8bS7JlbVLabt9tn2yCqIfAjxS_nrzwRq7UMukql4bRHmq7MrRbBCrYXPsu2z-tXcyAAsPkTA_gFUnY9e06tUboapr7ac5EwOLW8miWY_nmii6e2y/s1600/dawn+over+the+rim.jpg" height="133" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">dawn in Kijabe</td></tr>
</tbody></table>
<span style="mso-spacerun: yes;"> </span>I doubt I will ever
find the daily challenges and fulfillment I found there, either.<span style="mso-spacerun: yes;"> </span>It is rare in life to find a vocation that
uses every bit of knowledge, skill, and preparation one ever has had—I don’t
expect to find that again.<span style="mso-spacerun: yes;"> </span>What was
hardest was saying goodbye to so many Kenyan colleagues—Musyoka (my Kenyan
“son”) and his wife and baby daughter, all the nurses, Elizabeth, Mercy.<span style="mso-spacerun: yes;"> </span>Mercy was the hardest—she is my Kenyan
sister-in-Christ, my comfort in hard and sad times, my encourager, my
friend.<span style="mso-spacerun: yes;"> </span>We both shed tears during that
goodbye.<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTwU7DD-9MeXUFdvtE7qdF0mlsS9ieZng7ip_aKLO6Yvl8TWLYEydSxtKAh-NquqRsYdl-084-WvuvfYK5sxmtH8yN2WweSvVWoppNB6Z7ux5PCe8US3wg3W-NKLv3-Zq5iLpwcO3Gy-R2/s1600/Mercy+and+me.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTwU7DD-9MeXUFdvtE7qdF0mlsS9ieZng7ip_aKLO6Yvl8TWLYEydSxtKAh-NquqRsYdl-084-WvuvfYK5sxmtH8yN2WweSvVWoppNB6Z7ux5PCe8US3wg3W-NKLv3-Zq5iLpwcO3Gy-R2/s1600/Mercy+and+me.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Mercy and me</td></tr>
</tbody></table>
<o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_mvR3_CrKdAX9_6ztR4qnoOh9hbCAeeyqQGrDCaiQh_5Dn8KxvjTwYmjYlW8U3bzv1sgsk3rtg2-PvgWq5KkZuS2uBRv-EisjEEo3MjqDqA_EH3xkR4m5xqZtvIi0V5BaDuYiU8ksyM8X/s1600/Baby+Joy.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_mvR3_CrKdAX9_6ztR4qnoOh9hbCAeeyqQGrDCaiQh_5Dn8KxvjTwYmjYlW8U3bzv1sgsk3rtg2-PvgWq5KkZuS2uBRv-EisjEEo3MjqDqA_EH3xkR4m5xqZtvIi0V5BaDuYiU8ksyM8X/s1600/Baby+Joy.jpg" height="212" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;">Musyoka, Gladys, and Baby Joy</span></td></tr>
</tbody></table>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><br /></span></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">During my
last days in Kijabe, the new executive director for BK International
visited.<span style="mso-spacerun: yes;"> </span>He asked me what was the most
important thing I had done—something that may have made a difference.<span style="mso-spacerun: yes;"> </span>It took me some moments to think about
that—but finally I realized that the most profound moments in my life in Kijabe
had been during those times when Mercy or Pastor Agnes and I had counseled mums
of children whose care was medically futile.<span style="mso-spacerun: yes;">
</span>There was no medicine or surgery that would benefit their child.<span style="mso-spacerun: yes;"> </span>Elizabeth Njoroge and I remarked that we are
so grateful that God called us to be nurses—because unlike surgeons or even
medical doctors, nurses always have something to offer.<span style="mso-spacerun: yes;"> </span>Even when no medicine or surgery can help,
the family can be comforted; the child’s pain can be eased, the hope that we
have in Christ can be shared.<span style="mso-spacerun: yes;"> </span>As nurses,
we are able to be with the patients and families—not to cure, but to
comfort.<span style="mso-spacerun: yes;"> </span>My time in Kijabe was filled
with those opportunities.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">Leland
returned to the US on January 16, 2015; I returned on January 20.<span style="mso-spacerun: yes;"> </span>We now live in our beautifully renovated
bunglalow in La Grange Park, IL.<span style="mso-spacerun: yes;">
</span>Sparkling clear water comes out of the tap EVERY TIME it is turned
on.<span style="mso-spacerun: yes;"> </span>Our oven actually gets hot enough to
bake my home-baked pizza.<span style="mso-spacerun: yes;"> </span>It is a wonder
living here, and we give thanks every day for all of our blessings.<span style="mso-spacerun: yes;"> </span>But, I think, a part of me will always remain
in Kijabe.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">We don’t
know what God has in His plans for us—Leland has entered a year-long online
course in Theology and Ministry with Princeton Theological Seminary.<span style="mso-spacerun: yes;"> </span>I have started working on my trains—my Dad
had a train set which he gave to me; I have spent much of my adult life
planning to set up the trains.<span style="mso-spacerun: yes;"> </span>But, I
know God has something set aside for each of us to do—we are looking forward to
the next chapter in our lives.<span style="mso-spacerun: yes;"> </span>He has
promised great things:<o:p></o:p></span></div>
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<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: .5in; margin-top: 0in;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">From you comes the theme of my
praise in the great assembly; before those who fear you will I fulfill my vows.<span style="mso-spacerun: yes;"> </span>The poor will eat and be satisfied; they who
see the Lord will praise him---may your hearts live forever!<o:p></o:p></span></i></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">All the ends of the earth will
remember and turn to the Lord, and all the families of the nations will bow
down before him, for dominion belongs to the Lord and he rules over the
nations.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></i></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">All the rich of the earth will feast
and worship; all who go down to the dust will kneel before him—those who cannot
keep themselves alive.<span style="mso-spacerun: yes;"> </span>Posterity will
serve him; future generations will be told about the Lord.<span style="mso-spacerun: yes;"> </span>They will proclaim his righteousness to a
people yet unborn—for he has done it.<o:p></o:p></span></i></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">Psalm 22: 25-31<o:p></o:p></span></i></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><br /></span></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">And we know that in all things God
works for the good of those who love him, who have been called according to his
purpose.<span style="mso-spacerun: yes;"> </span>Romans 8: 28<o:p></o:p></span></i></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">Take care, God bless, <o:p></o:p>Asante sana (thank you very much), Kwaheri (goodbye), </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">Susan<o:p></o:p></span><br />
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Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com6tag:blogger.com,1999:blog-8238962161618527090.post-26340430299692826442014-11-22T04:24:00.000-08:002014-11-22T04:24:07.031-08:00<div align="center" class="MsoNormal" style="text-align: center;">
<i style="mso-bidi-font-style: normal;">You will keep in perfect peace<o:p></o:p></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i style="mso-bidi-font-style: normal;">Him whose mind is steadfast<o:p></o:p></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i style="mso-bidi-font-style: normal;">Because he trusts in you.<o:p></o:p></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i style="mso-bidi-font-style: normal;">Trust in the Lord forever, <o:p></o:p></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i style="mso-bidi-font-style: normal;">For the Lord God is the Rock Everlasting.<o:p></o:p></i></div>
<div align="right" class="MsoNormal" style="text-align: right;">
<i style="mso-bidi-font-style: normal;">Isaiah 26: 3-4<span style="mso-tab-count: 3;"> </span><o:p></o:p></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">Habari yako, rafiki.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial;">As I sat this August and
September on our lovely front porch in La Grange Park, I read those</span></div>
<div class="MsoNormal">
<span style="font-family: Arial;"><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
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<tr><td class="tr-caption" style="text-align: center;">Autumn in La Grange Park, IL</td></tr>
</tbody></table>
words from
Isaiah again and again.<span style="mso-spacerun: yes;"> </span>Over the past 6
months, Leland and I have made many decisions that will change our lives and
move us in a path that we didn’t foresee 6 months ago.<span style="mso-spacerun: yes;"> </span>We have felt incredible peace about these
unexpected changes.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">In 2008, we each felt a
strong call from God to come to Kijabe, to do and teach pediatric
neurosurgery.<span style="mso-spacerun: yes;"> </span>We initially thought we
might spend 2-3 years here but soon after arriving in September 2010, we
realized that it might take up to 6 years to train enough people to carry on
the work.<span style="mso-spacerun: yes;"> </span>We even joked about staying
longer—saying that we may not want to leave.<span style="mso-spacerun: yes;">
</span>My personal view has always been that God would just as clearly show us
when our time at Kijabe should end as He had in leading us here. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">Soon after arriving in the
USA on April 30, 2014, Leland experience debilitating exhaustion and muscle
weakness.<span style="mso-spacerun: yes;"> </span>We decided to extend our stay
in the States in order to obtain a definite diagnosis and allow him to rest.<span style="mso-spacerun: yes;"> </span>After 4 trips to Madison to see specialists
in neuromuscular medicine and infectious disease, 76 blood tests,
electromyography, nerve conduction studies, and a total body CT/PET scan, the
doctors have determined that Leland has Chronic Fatigue Syndrome of unknown
origin.<span style="mso-spacerun: yes;"> </span>Over the time Leland was in the
US, he really never improved—he would have good days and bad days with his
weakness and fatigue, but we saw no real improvement.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">On November 1, 2014, we
returned to Kenya in order to train another person to take my place. <span style="mso-spacerun: yes;"> </span>We have tickets to return to the States in
mid-January 2015.<span style="mso-spacerun: yes;"> </span>Although this is not
the way we had planned or hoped to end our service in Kijabe, we see God’s hand
in this, as in each stage in our lives.<span style="mso-spacerun: yes;"> </span>We
are sad to leave our friends and colleagues here in Kijabe—but are looking
forward to our lives in the US.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">My cochlear implant in
February has exceeded my expectations and even my dreams.<span style="mso-spacerun: yes;"> </span>In conversation, even in noise, I understand
almost everything that is said.<span style="mso-spacerun: yes;"> </span>I can
now close my eyes and bow my head during corporate prayers and hear nearly
every petition and praise.<span style="mso-spacerun: yes;"> </span>I have been
able to carry on conversation with my co-workers here in Kenya—even to chat
with the nurses and understand the mums’ English and some Swahili.<span style="mso-spacerun: yes;"> </span>The ability to hear has been life-changing
and, to me, miraculous.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">Our first night back in
Kijabe, we had a huge storm that knocked out the electricity for about 10
hours—getting ready for work in the dark wasn’t a problem since the battery
powered alarm decided to quit at 5:10 am—the alarm had been set for 5:15
am.<span style="mso-spacerun: yes;"> </span>So, we awoke (after a fitful
sleep—jet lag was terrible this time) at about 6 am (first light) and were at
the hospital at 6:30 am.<span style="mso-spacerun: yes;"> </span>And, mshungao
(surprise in Swahili), there was no hot water (or any water) from the hot tap,
so we really felt we were back at home.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">The plumbers fixed the hot
water by our third day here, so we now have hot and cold running water.<span style="mso-spacerun: yes;"> </span>Our new neighbor across the hall (a long-term
missionary formerly in India) gave me some tips on handling the washing machine
(I now add several buckets of water to the drum) so that it no longer takes 2.5
hours to wash one load.<span style="mso-spacerun: yes;"> </span>I am back using
my<span style="mso-spacerun: yes;"> </span>“solar dryer” (the sun) and hanging
the clothes outside—I really missed doing that while I was in the US.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">After being here for three
weeks, it is obvious that Leland cannot maintain even the slower pace that he
has adopted in response to his illness.<span style="mso-spacerun: yes;">
</span>After we make rounds each morning (which takes about 2 hours), he comes
back to the apartment and sleeps for up to 2 hours, then rests until he is
called up to help in the theatre.<span style="mso-spacerun: yes;"> </span>His
exhaustion is visible in his face.<span style="mso-spacerun: yes;">
</span>People stop him and tell him how glad they are to have him back—even just
for rounds, or teaching.<span style="mso-spacerun: yes;"> </span>But I can see
that he has worsened a bit since our arrival.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">One of the big unanswered
questions in regard to our leaving Kijabe earlier than we had anticipated is:
will pediatric neurosurgery continue at BKKH/Kijabe Hospital?<span style="mso-spacerun: yes;"> </span>Humphrey Okechi was married November 8 to
Ruth Muthoni, a nurse at BKKH in Entebbe Uganda.<span style="mso-spacerun: yes;"> </span>They will be on leave for the month of
November.<span style="mso-spacerun: yes;"> </span>In Humphrey’s place, we have a
visiting neurosurgeon, Dan Curry, from Texas Children’s Hospital.<span style="mso-spacerun: yes;"> </span>He is a great clinician and teacher, and the
resident and fellow have appreciated his lectures.<span style="mso-spacerun: yes;"> </span>We also have a visiting neurosurgery resident
from the University of Wisconsin, Carolina Sandoval-Garcia, who has been a
great encouragement to our Kenyan neurosurgical resident, Grace Muthoni.<span style="mso-spacerun: yes;"> </span>Leland has arranged for visiting chief residents
to come in January, February, March, and April 15-May 15.<span style="mso-spacerun: yes;"> </span>Dr. Veeti Li, a pediatric neurosurgeon from
Buffalo, will make his 3<sup>rd</sup> trip to Kijabe in July.<span style="mso-spacerun: yes;"> </span>However, we will have great need of more
pediatric neurosurgeons to provide help for Humphrey over the next year.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">The new wing construction
has been halted because of legal problems, and we do not know when it will be completed and opened.<span style="mso-spacerun: yes;"> </span>It
certainly will not be in our Kijabe lifetimes.<span style="mso-spacerun: yes;">
</span>The nursing staff is being led by acting in-charge nurses (acting head
nurses), and no one has been identified to direct the nursing care.<span style="mso-spacerun: yes;"> </span>However, Elizabeth Njoroge has been chosen to
start training with Veronicah and me to take care of the neurosurgical
patients.<span style="mso-spacerun: yes;"> </span>Elizabeth came to me about a
year ago and said, “I want to be you.”<span style="mso-spacerun: yes;">
</span>She has a passion for taking care of our children, and has wonderful
initiative and organizational skills.<span style="mso-spacerun: yes;"> </span>It
will be a delight to have her take my place along with Veronicah.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">This week, Veronicah, Pastor
Mercy, and I talked with two mums about ending treatment of their
children.<span style="mso-spacerun: yes;"> </span>One was the mum of a 6 year
old boy with a recurrent brain cancer—after the second operation to remove the
recurrent tumor, and radiation therapy, his tumor recurred.<span style="mso-spacerun: yes;"> </span>He is the third child, and only son.<span style="mso-spacerun: yes;"> </span>His mother expressed gratitude for the care
he had received over the past 2 years here at BKKH.<span style="mso-spacerun: yes;"> </span>The second child is 5 months old, was born
with no brain above the brainstem (hydranencephaly), had a surgical procedure
to control the growth of her head, and now weighs her birth weight.<span style="mso-spacerun: yes;"> </span>Both conversations were heart-breaking—these
children are greatly loved.<span style="mso-spacerun: yes;"> </span>We saw three
additional babies this week with hydranencephaly.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Two other
babies passed away on Thursday.<span style="mso-spacerun: yes;"> </span>There
are days when I come home feeling stunned by the sadness here.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial;"><br /></span></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUUNNVlRCx65oBQZRTJKcbjQGacMdTq4cc-Xua0u1WKWJBf-H1Pt8URSqlLIxat4z4CG_gI_TRXEElanyyDPKO2NW9LFV8jM7FCnfVmT_UqzmvRDZxtSDOSqjDhioUljz-Gs1nvwTbQGXY/s1600/hydranencephaly.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUUNNVlRCx65oBQZRTJKcbjQGacMdTq4cc-Xua0u1WKWJBf-H1Pt8URSqlLIxat4z4CG_gI_TRXEElanyyDPKO2NW9LFV8jM7FCnfVmT_UqzmvRDZxtSDOSqjDhioUljz-Gs1nvwTbQGXY/s1600/hydranencephaly.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">hydranencephaly</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLXPJPKhmwFQ4uF8HJFmBdyYa2GwD8J5xdcvVp9dcupMxaRz32CiIPG3W1IvTaL99lGnZbDdrEtBh2EEfD2ceOAlu8FCvlZuLoep5hp3E8pFC9mZF1DeUw-z1gqBQ5tj3HkXAiwY3wwAxz/s1600/Traditional+healing.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto; text-align: center;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLXPJPKhmwFQ4uF8HJFmBdyYa2GwD8J5xdcvVp9dcupMxaRz32CiIPG3W1IvTaL99lGnZbDdrEtBh2EEfD2ceOAlu8FCvlZuLoep5hp3E8pFC9mZF1DeUw-z1gqBQ5tj3HkXAiwY3wwAxz/s1600/Traditional+healing.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Traditional healing scars</td></tr>
</tbody></table>
<br />
<span style="font-family: Arial;">Leland’s sister Mary sent us
handpainted tote bags for the mums that her garden club had made—Mercy and I
spent time one morning handing them out.</span><span style="font-family: Arial;">
</span><span style="font-family: Arial;">It means so much to the mums to hear that people in the US, Canada, Great
Britain, Australia think about them, pray for them, and want to help them.</span><br />
<span style="font-family: Arial;"><br /></span>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVmNJ1jDRb3hHhtf7ZxZCduO1WOqqgTgam-3lnsBCKRaycEGkHKK_sFUwislfkBZGH2TgGPX2aN6aCOPkmzCDWIGNcCfLIzx82NytxElF1vQHsiSqOBTr8B-JMBILUa5VlyJ5zNgc8B6W0/s1600/Mercy+1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVmNJ1jDRb3hHhtf7ZxZCduO1WOqqgTgam-3lnsBCKRaycEGkHKK_sFUwislfkBZGH2TgGPX2aN6aCOPkmzCDWIGNcCfLIzx82NytxElF1vQHsiSqOBTr8B-JMBILUa5VlyJ5zNgc8B6W0/s1600/Mercy+1.jpg" height="213" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9ve4Fhov7r_2eqC4KnjQtmfjkiJm859CF8Hi0-Xhw8FD9UyvGbK2umSF8qFkMZ_gVsowKM6d-GdslOP3ifY_BJ0E1ziglMLtI-1kTURVfr4zvc7QcoxFeMMGWDKiPO4KEH0KvOf2GIMoL/s1600/Mercy+2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9ve4Fhov7r_2eqC4KnjQtmfjkiJm859CF8Hi0-Xhw8FD9UyvGbK2umSF8qFkMZ_gVsowKM6d-GdslOP3ifY_BJ0E1ziglMLtI-1kTURVfr4zvc7QcoxFeMMGWDKiPO4KEH0KvOf2GIMoL/s1600/Mercy+2.jpg" height="213" width="320" /></a></div>
<span style="font-family: Arial;"><br /></span>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">I ask for your prayers for
the following:<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial;">-For Leland to have the
strength to maintain the pace here in Kijabe over the next 2 months.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial;">-For Veronicah Njaramba, our
clinical officer, who has worked heroically in my absence.<span style="mso-spacerun: yes;"> </span>She needs encouragement and support to
continue her vital role on the service.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial;">-For Mercy Nganga, my Kenyan
sister, who, like me, is approaching the end of one chapter of service to Jesus
Christ—and is looking for direction for the next opportunity to serve.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial;">-For BKKH and Kijabe
Hospital, to determine the long-term commitment to pediatric neurosurgery and
how each organization can support the care of the children with neurosurgical
problems.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial;">-That the legal problems
encountered by BKKH in the completion of the new building be resolved so that
the wing can be opened soon.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial;">-For Humphrey and Ruth
Okechi, that they may be strengthened and supported during the time that Humphrey
is without a permanent colleague in neurosurgery.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial;">-For BKKH as the
organization transitions from one Executive Director to the next.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial;">-And always, for the
children with spina bifida, hydrocephalus, brain tumors, spine problems and
their families—that they will know God’s love and care through us.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial;">Take care, God bless.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial;">Susan<o:p></o:p></span></div>
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Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com4tag:blogger.com,1999:blog-8238962161618527090.post-89846976328982379082014-08-06T15:51:00.000-07:002014-08-06T15:51:14.579-07:00<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Dear Friends and family,<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">It has been 8 months since I
posted a blog.<span style="mso-spacerun: yes;"> </span>Many have written Leland
to ask in a round-about way if we are still alive.<span style="mso-spacerun: yes;"> </span>I have started many blogs, finished none.<span style="mso-spacerun: yes;"> </span>I intend to post this today….!<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">On December 21, 2013,
Geoffrey Musyoka and Gladys were married in Machakos.<span style="mso-spacerun: yes;"> </span>It was a beautiful Kambaa wedding with
processions (about 3), flower girls strewing rose petals and blowing bubbles,
one lady spraying artificial snow (December is summer in Kenya), all of which
we enjoyed tremendously.<span style="mso-spacerun: yes;"> </span>Gladys was
beautiful in her white dress; Geoffrey looked a bit nervous but very handsome
in his suit.<span style="mso-spacerun: yes;"> </span>Although the wedding was to
have begun at 10 am, the processions began about 1:15 pm and the vows were
exchanged around 3:15 pm.<span style="mso-spacerun: yes;"> </span>Leland and I
were the only wazungu there; several other staff from BKKH attended.<span style="mso-spacerun: yes;"> </span>Leland and I had to get back to Nairobi
before dark since we have decided to limit our travel on the roads to daylight
hours (dark comes about 6:30 pm in the summer), so we missed the reception (in
fact, left just after the exchange of vows—I think there were about 45 more
minutes to the ceremony).<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">I mention that day because,
by the latter part of December, I realized that my hearing was so poor that I
could no longer work safely and effectively in Kijabe.<span style="mso-spacerun: yes;"> </span>By October, I had stopped participating in
rounds—I could not hear what was discussed and found it very exasperating for
me and all the others to have everything repeated.<span style="mso-spacerun: yes;"> </span>I tried following the team and reading the
notes in the medical record to get the plan for the day—but as in the US, the
notes often did not reflect the extent of the discussion.<span style="mso-spacerun: yes;"> </span>On the drive to Machakos, Leland suggested
that I reconsider having a cochlear implant—by the drive home from the wedding,
I had decided to do just that.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Because of the new health
care requirements, I was able to enroll in an insurance plan that covered
pre-existing conditions—including my hearing loss.<span style="mso-spacerun: yes;"> </span>Before the ACA, I could not get coverage for
an implant—at least not until I qualified for Medicare.<span style="mso-spacerun: yes;"> </span>I was able to make appointments with two
implanting surgeons and acquire a PCP via the internet while still in
Kenya.<span style="mso-spacerun: yes;"> </span>I left Kijabe on January 9, had
my left cochlear implant on February 13, and had my first programming session
on February 24.<span style="mso-spacerun: yes;"> </span>After my implant was
“activated,” the audiologist went behind me and said three colors.<span style="mso-spacerun: yes;"> </span>She asked me to tell her what I heard—I
replied, “Orange, yellow, purple.”<span style="mso-spacerun: yes;"> </span>We
all burst into tears—even the surgeon had tears in his eyes.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">It is truly life-changing to
be able to hear again.<span style="mso-spacerun: yes;"> </span>At first, sound
was very electronic; people sounded like Munchkins in the Wizard of Oz.<span style="mso-spacerun: yes;"> </span>I heard noises that I could not identify—one
day I heard a strange sound all day; then that evening realized that what I had
heard was two plastic bags flapping against each other in the breeze through
the window.<span style="mso-spacerun: yes;"> </span>After 5 months and several
programming sessions, I can hear and understand almost all speech, even at very
low volumes.<span style="mso-spacerun: yes;"> </span>I hear birds chirp, rain
patter, water splash, doorbells and phones ring.<span style="mso-spacerun: yes;"> </span>For several months, I practiced daily
listening exercises on-line—after Leland came home on April 30, I have simply
engaged in daily conversation.<span style="mso-spacerun: yes;"> </span>He still
is amazed at how much I can hear and understand.<span style="mso-spacerun: yes;"> </span>My kids joke that they can no longer talk
about me when I am present.<span style="mso-spacerun: yes;"> </span>My daughter
says the biggest change is that I now can stay up late and talk—before the
implant I would be exhausted by 8 pm.<span style="mso-spacerun: yes;"> </span>My
son-in-law thinks it is fantastic that I can now talk with him in the car.<span style="mso-spacerun: yes;"> </span>For the first time in 5 years, I can engage
in conversation with my 5-year-old granddaughter.<span style="mso-spacerun: yes;"> </span>It is truly an amazing, almost miraculous
experience.<span style="mso-spacerun: yes;"> </span>Every day, I realize what a
gift I have been given.<o:p></o:p></span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6je3DVgnCP1GEEt3oIHAuVkz8PPWmmBiAT6yjxA_QxhjEbIntquxJ1fK98f8Wxx8CZSRt003HUnHo0w91ixYzlKoPkIzBoIoGTT3xi3X1Pt24m-LDuem5bu-vc_BBJap0lucWQVHFY_jq/s1600/Reading+time.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6je3DVgnCP1GEEt3oIHAuVkz8PPWmmBiAT6yjxA_QxhjEbIntquxJ1fK98f8Wxx8CZSRt003HUnHo0w91ixYzlKoPkIzBoIoGTT3xi3X1Pt24m-LDuem5bu-vc_BBJap0lucWQVHFY_jq/s1600/Reading+time.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Evelyn and Alex reading together</td></tr>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Leland came home to be with
me for the implant, then returned to Kijabe.<span style="mso-spacerun: yes;">
</span>Although he had many visiting neurosurgeons to help since his partner
left in September for a 6-month fellowship in Germany, Leland was the only BKKH
consultant who was continuously there until early April.<span style="mso-spacerun: yes;"> </span>During that time, he became exhausted and had
several episodes of illness.<span style="mso-spacerun: yes;"> </span>So, it
didn’t take too much encouragement from me for him to agree to come to the
States for a 4-month break from May through August. <o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">In the weeks after Leland’s
arrival in the Chicago area, he had increasing exhaustion and proximal muscle
weakness (upper arms and upper legs).<span style="mso-spacerun: yes;"> </span>He
was evaluated in Madison and was found to have chronic fatigue syndrome as a
result of an Epstein Barr viral infection he had in Kijabe in March.<span style="mso-spacerun: yes;"> </span>Over the past 3 months, he has had a few
weeks when it seemed that he was slowly improving but over the past week, his
muscle weakness has again worsened.<span style="mso-spacerun: yes;"> </span>We
really don’t know if he will be strong enough to return to Kijabe.<span style="mso-spacerun: yes;"> </span>For that reason, we have deferred our departure
to Kenya until late October.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">We have tremendously enjoyed
being back in the USA.<span style="mso-spacerun: yes;"> </span>We continue to
marvel at the roads, the signage, the running water (hot <b style="mso-bidi-font-weight: normal;">and</b> cold, and without sediment).<span style="mso-spacerun: yes;">
</span>I found an apartment in La Grange Park and moved in there on February
1—within walking distance to my son’s house, restaurants, the bike shop, a drug
store, a hardware store—and most importantly, 0.7 miles from Grace Lutheran
Church and 0.1 miles from the grocery store.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">For the first 2-3 years in
Kijabe, I felt comfortable and happy about not having a home in the US—I would
joke about being homeless and unemployed.<span style="mso-spacerun: yes;">
</span>After 3 years though, I missed having a place to call home—our furniture
and clothes that we had not given away or sold were in storage, we had no
address that was ours.<span style="mso-spacerun: yes;"> </span>So when Leland
became ill, we thought seriously about where to settle in the US if we couldn’t
go back to Kijabe.<span style="mso-spacerun: yes;"> </span>Since both of us like
the walkable communities here in La Grange/La Grange Park and love being near
to Michael and Marisa, we started to look at houses and neighborhoods.<span style="mso-spacerun: yes;"> </span>On May 30, we saw the house where we want to
“age-in-place.”<span style="mso-spacerun: yes;"> </span>We closed on our
bungalow on July 15, moved in on July 18, and will start the renovations that
will allow us to live completely on the first floor in mid-late August.<span style="mso-spacerun: yes;"> </span>Both of us have a real sense of peace about
this decision and are very grateful to have this house as our own.<o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgYxvi1rmLbv6JHj2o1co3NU_i8rwelG5J6cRa_RdTvmjBetesSaFV6jAXqWxY-zcOiBNJE7XDxjyuJo7l742OGvu7HYl55LnTQNryz-PhXVgA7A_0xltMj6RMRSqamAKz3N6KrWEiwUTA/s1600/IMG_20140727_101751340.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgYxvi1rmLbv6JHj2o1co3NU_i8rwelG5J6cRa_RdTvmjBetesSaFV6jAXqWxY-zcOiBNJE7XDxjyuJo7l742OGvu7HYl55LnTQNryz-PhXVgA7A_0xltMj6RMRSqamAKz3N6KrWEiwUTA/s1600/IMG_20140727_101751340.jpeg" height="320" width="316" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Our little house</td></tr>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">We spoke of our work in
Kijabe in Charlotte NC at a BKKH board meeting and twice at our church here in
La Grange. Leland was a keynote speaker at the Bethune Conference in Hamilton,
ON in June and a visiting professor in Charleston SC in August. <span style="mso-spacerun: yes;"> </span>I continue to work on the BKKH database;
Leland has made revisions to several papers and submitted them for
publication.<span style="mso-spacerun: yes;"> </span>He continues to work hard
to recruit visiting neurosurgeons to go to Kijabe for 2-week commitments to
help his partner, Humphrey Okechi.<span style="mso-spacerun: yes;"> </span>We
hope that we both will return in late October—but if Leland is not able to do
so, I will return for 2-3 months in order to train someone to take my place
there, and to pack up and say goodbye to the many people who are our community
in Kenya.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">The summer months are usually
lean ones for NGO’s.<span style="mso-spacerun: yes;"> </span>This summer is no
different.<span style="mso-spacerun: yes;"> </span>There is consideration of
limiting admissions at BKKH; this will require hard decisions not only by BKKH
administration but also by all the Kenyan staff.<span style="mso-spacerun: yes;"> </span>For that reason, I ask for your prayers for
wisdom and guidance, your donations to provide for care of the children, and
your efforts to tell others about the work that God is doing through BKKH in
Africa.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">I’d like to close with some
thoughts on poverty and poor people.<span style="mso-spacerun: yes;">
</span>Most of us here in the US have little appreciation for how deeply
poverty impacts every facet of life for many people in the world.<span style="mso-spacerun: yes;"> </span>Herman Melville said, </span><span style="font-family: Arial; font-size: 11.0pt;">“Of all the preposterous assumptions
of humanity over humanity, nothing exceeds most of the criticisms made on the
habits of the poor by the well-housed, well-warmed, and well-fed.” Leland’s
sister Mary said, “I just watched and listened to your talk at the Bethune
round table conference. Wow. What an eye opener. I am afraid you ‘hit the nail
on the head’ about most PNS's [pediatric neurosurgeons] not being committed to
treating the poorest of the poor because they are or will be disabled.
The big question to most of the PNS's re treating the African kids is, ‘why
bother’? That makes them uncomfortable and squirm in their chairs. Answer
being, ‘I'm comfortable where I am, and to commit to that would take me out of
my comfort zone, salary income, etc, etc.’ Unfortunately, it takes a Christian
commitment that is missing in most of them. Why would anyone want to work in
such conditions as no funding, used/broken equipment, strained living
conditions, and lack of support? That's because they are looking at the big
picture. You have to look at, and really see, the soul of the little person
inside that disabled body. Then, how can you say no?”<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Take care,
God bless.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Susan<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Links:</span></div>
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<o:p></o:p><br />
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<span style="color: #14560d; font-family: Arial; font-size: 11.0pt;"><a href="http://www.bethanykids.org/">www.<b>bethanykids</b>.org/</a><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;"><u><span style="color: blue;">fhs.mcmaster.ca/surgery/isd/brt<b>2014</b>.html</span></u><span style="color: #14560d;"> </span>(Bethune
Conference, Leland’s presentation)</span><b><span style="color: #6d6d6d; font-family: Arial; font-size: 11.0pt;"><o:p></o:p></span></b></div>
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Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com1tag:blogger.com,1999:blog-8238962161618527090.post-5550514626435685762013-12-04T08:19:00.005-08:002013-12-04T08:19:32.884-08:00Cultural Exhaustion
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<span style="font-family: Arial; font-size: 11.0pt;">Habari yako,<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Happy
Advent!<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt;">It has been
quite a while since I posted a blog. For
several months now, I’ve had mixed feelings about being here in Kenya. Though I have felt useful, I haven’t felt
enthusiastic about working and living here.
Friends of ours call it “cultural exhaustion.” Some of the things that we found charming or
amusing the first few years are now just wearing. The road that leads out of Kijabe to
Gichiengo and the high road is much worse than when we arrived. I used to think it was an adventure to be
jolted for the 15-minute ride; now it is incredibly—well, jolting. Seeing matatus and buses heading at a high
rate of speed directly toward us in our lane has ceased to be amusing. One Sunday on the drive home from Nairobi, a
man leaped the barrier and stooped beside our car so that we ran over the stick
he held in our path—not sure what that was about but it was a bit unnerving.
Another Sunday a lady led her 4 year old child directly into the path of our
car on the main highway from Nairobi—she strolled as if taking a leisurely
Sunday walk (which, I guess, is what she was doing). We had to slam on the brakes and swerve to
avoid hitting them.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Not knowing
if there will be water each morning (hot or cold) used to be exciting; now it
is aggravating. The plumber came earlier
this week to fix a leak in the apartment on the first floor; for several days
the water pressure has been awful and today, again, we had no hot water at
all. Turns out, to fix the leak, he
turned off the water to the entire building and didn’t bother to turn it back
on. Two weeks ago, while Leland was
speaking at a conference in Australia, there was a deluge through his study
ceiling onto the floor (through the light fixture). On investigation, it appears there had been a
leaky valve in our non-functioning solar water system—in fact, a container was
placed under the valve. Unfortunately it
was a very small container and a very large leak (gallons). So, the ceilings are again trashed and moldy
(the same ceilings that were replaced last July). We’ve given up on having them replaced or
repainted—my suspicion is that this was not the last leak. It was a good “opportunity” to give the room
a good Spring cleaning.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt;">The service
has been quite busy most of the time since Humphrey Okechi stopped operating in
September. We have had three pediatric
neurosurgeons visit from the US to give Leland a break (Howard Silberstein and
Doug Cochrane in October) and to help out with the caseload (Cathy Mazzola in
November). With 5-7 cases per day Monday
through Friday, it is too much for one neurosurgeon to handle, even with
residents helping. Humphrey was to have
started a 6-month fellowship in Germany on September 1; however, there were
many problems obtaining a visa, and he left Kijabe for Uganda just last week. We hope he will be back by May when we plan a
month-long break. Leland is physically
exhausted most days (as well as culturally…).<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt;">I’ve said
before that we have many Toto moments (“Toto, we’re not in Kansas
anymore). This morning is a very good
example of that. At 6:20 am Leland was
called about a baby who had stopped breathing in the annex on post-operative
day 1 after a shunt. We ran up to find
the baby in the procedure room. The baby still had a good pulse but was not
breathing. She is 2 weeks old now, and
the preoperative head ultrasound showed complete absence of the brain above the
brainstem—a condition called hydranencephaly.
I saw two cases of this in the States in 12 years of neurosurgical
nursing practice and have documented about 40 Kenyan cases in 3 years. The care of children with hydranencephaly is
a moral dilemma. Western data suggest
that 70% will die within 2 years; however, the heads are filled with cerebrospinal
fluid and keep expanding, causing pressure sores, difficulty in caring for the
child, and a huge stigma here in Kenya.
The children never develop beyond the level of a newborn despite the
growth of their bodies—they suck, swallow, cry, and their eyes move, but they
don’t ever see, hear, or experience pain at a cognitive level. They never develop a social smile, speak or
interact, feed themselves, walk or play. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt;">After that,
we continued rounds on our 25 other patients.
One mum complained that she’d not been given a blanket and wanted to
leave. Her baby had surgery for a
meningocele yesterday, so ideally we would have liked to observe him another
day. He had been admitted with a
terrible eye infection (probably chlamydia or gonococcus) and was on oral
antibiotics for his infection. Following
rounds, she tried to abscond with the baby.
That means she tried to sneak out without being discharged (or paying
the bill). Pastor Mercy saw her, went
after her, and brought the baby and the mom back to the annex. Our social worker called the Chief of her
village in western Kenya and learned that the baby’s grandmother and uncle are
psychotic (as probably is this young woman); that prior to her being sent to
BKKH, she had seen the swelling on his back and tried to squeeze it off, then
asked for a knife so she could cut it off.
There is doubt as to whether she is capable of caring for either him or
his older sibling. The Chief will arrive
tomorrow to help sort out the problem.
It would be nice to refer her for psychiatric treatment but in most
places in Kenya, including this lady’s home, that is non-existent.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt;">We continue
to be awed by the beauty of the sky and the valley seen every day from our
living room window—and also by the beauty of the Kenyan people. It is the time of year (the start of our
summer) when the wind is a fierce roar at night, the valley is visible to the
western ridge, and on particularly clear days we can see a distant volcano on
the horizon. It is fantastic laundry
drying weather if one can keep the clothes on the line.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt;">We flew to
the States in October to visit our children—Leland flew to Pittsburgh and LA to
see Julie, Art, Todd, Lisa, and Tusk; I stayed in La Grange with Michael and
Marisa while Kelly drove with Evelyn and Alex to meet us there. Joe wasn’t able to take his vacation because
of the government shut-down (he is considered a critical employee). I cannot tell you how much we miss our families. I used to miss a garbage disposal, going out
to restaurants, taking a bike ride, walking the dog. Now, I just miss my family and friends. It is getting harder, not easier, to be so
far from them.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt;">The news
from the Kenyan government is concerning.
The Ministers of Parliament (MPs) have passed a bill with draconian
restrictions on the media—fines and imprisonment for reporting opinions, facts,
with which the government takes issue.
They have also created an inquisition of the judiciary—which is the
least corrupted institution in Kenya since Willy Mutunga became Chief Justice. On a closer level, because NGO’s in Kenya
have been accused of fomenting the charges against Uhuru Kenyatta (President)
and William Ruto (Deputy President) for crimes against humanity, all donations
coming into Kenya are now subject to 20% duty on the value of the
donations. What this means for us is
that BKKH or Kijabe Hospital has to pay thousands of shillings for donated
supplies. What that means for the people
of Kenya is that chemotherapy medications donated for people with cancer are
sitting in Mombasa port because no one can afford the duty to free them for
use. If President Kenyatta signs these
bills, then I could be arrested for saying what is in this paragraph. If that happens, please send someone to visit
me in prison…</span><span style="font-family: Wingdings; font-size: 11.0pt; mso-ascii-font-family: Arial; mso-char-type: symbol; mso-hansi-font-family: Arial; mso-symbol-font-family: Wingdings;">J</span><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">We honestly don’t know what
God’s will is for us. We had thought
when we came that we’d spend 6 years here.
We still feel God’s call to be here—but are not sure we can physically
or emotionally do 3 more years. My
hearing is deteriorating to the point where it is excruciatingly difficult for
me to understand people—and that is very isolating. I often wonder what Kenya
would be like for me if I could hear, understand, and interact more easily with
people here. I bought new hearing aids
while in the States; unfortunately the programming for them has made hearing
more difficult rather than easier. So, I
will need to make another trip to the States early next year to get them
reprogrammed. A cochlear implant (or
two) is in my future—but I’ll need to wait for Medicare to get that done. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">I take great comfort in what
Paul says in II Corinthians 4: 7-10,16: <o:p></o:p></span></div>
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<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">But we have this treasure in jars of clay, to
show that the surpassing power belongs to God and not to us. We are afflicted
in every way, but not crushed; perplexed, but not driven to despair;
persecuted, but not forsaken; struck down, but not destroyed; always carrying
in the body the death of Jesus, so that the life of Jesus may also be
manifested in our bodies….So we do not lose heart.” <o:p></o:p></span></i></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Please continue to hold us in
your prayers. Pray for the parents of
the babies who are born so damaged. Pray
for Pastor Mercy—she maintains a joy despite all the sorrow she sees. Pray for
the completion of the new building—about $400,000 more is needed to complete
it. Pray for Jim and Jullie Taubitz who
have overseen the building, and who are our strongest encouragers here. Pray for the government of Kenya, that it may
serve the Kenyan people with wisdom and compassion.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">It has been easy to
concentrate on the negative things about being here. But, we also have much for which to be
grateful. We have loving and caring
family and friends; we live in a safe place.
We lack for nothing. When I was a
child, I memorized scripture. In my
attempt to “rewire” my thinking, I’ve started to memorize psalms of
praise. My first attempt is Psalm 103:<o:p></o:p></span></div>
<div class="MsoNormal">
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<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Bless the Lord, O my soul, and all that is
within me, bless His holy name.<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Bless the Lord, O my soul, and forget not all
his benefits.<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Who forgives all your iniquity, who heals all
your diseases,<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Who redeems your life from the pit, who crowns
you with steadfast love and mercy,<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Who satisfies you with good so that your youth
is renewed like the eagle’s. <o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">The Lord works righteousness and justice for
all the oppressed.<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">He made known his ways to Moses, his acts to
the people of Israel. <o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">The Lord is merciful and gracious, slow to
anger, and abounding in steadfast love.<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">He will not always chide, nor will he keep his
anger forever. <o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">He does not deal with us according to our sins,
nor repay us according to our iniquities.<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">For as high as the heavens are above the earth,
so great is his steadfast love toward those who fear him;<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">As far as the east is from the west, so far
does he remove our transgressions from us.
As a father shows compassion to his children, so the Lord shows
compassion to those who fear him. <o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">For he knows our frame; he remembers that we
are dust. <o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">As for man, his days are like grass; he
flourishes like a flower of the field; for the wind passes over it, and it is gone,
and its place knows it no more.<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">But the steadfast love of the Lord is from
everlasting to everlasting on those who fear him, and his righteousness to
children’s children, to those who keep his covenant and remember to do his
commandments.<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">The Lord has established his throne in the
heavens, and his kingdom rules over all.<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Bless the Lord, O you his angels, you mighty
ones who do his word, obeying the voice of his word.<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Bless the Lord, all his hosts, his ministers,
who do his will!<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Bless the Lord, all his works, in all places of
his dominion.<o:p></o:p></span></i></div>
<div class="MsoNormal">
<i><span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Bless the Lord, O my soul.<o:p></o:p></span></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Take care, God bless.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Susan<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
<!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com4tag:blogger.com,1999:blog-8238962161618527090.post-81141484977712859902013-08-06T07:54:00.001-07:002013-08-06T07:54:47.720-07:00
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<span style="font-family: Arial; font-size: 11.0pt;">Bonjour, mes
amis et famille,<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Do you have
any clue as to where we are right now?<span style="mso-spacerun: yes;">
</span>Not in Kijabe—definitely not in Kenya.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Allow me to
explain.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt;">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.<span style="mso-spacerun: yes;"> </span>His
vacation begins on August 15.<span style="mso-spacerun: yes;"> </span>So, we
decided in late May that we needed a rest before Humphrey’s leave.<span style="mso-spacerun: yes;"> </span>As of September 1, we will have been in Kenya
3 years.<span style="mso-spacerun: yes;"> </span>For us, the first two years
flew by—the third year has been the hardest and longest yet of our stay in
Kenya.<span style="mso-spacerun: yes;"> </span>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).<span style="mso-spacerun: yes;"> </span>So, Provence became our destination.<span style="mso-spacerun: yes;"> </span>We are 6 days into our 10-day stay.<span style="mso-spacerun: yes;"> </span>Having just completed The Rise and Fall of
The Third Reich, I decided to take a break and write the blog.<span style="mso-spacerun: yes;"> </span>Many people have hinted that a posting is
long overdue.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;"><br /></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijNvwjlvMYD55iQS66gsf0PCBgM7xEF7wSE27mFvnI52ReJVuZLnU7Q2xf0h0Bj0qM0BVGov8gS4VGknGk-8NpEIzDMcwviISbXURhs_NE3EhH5cLH94DrXUO202T6Kv76JAHyYJmBUNQN/s1600/Lavender+at+Abbaye.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijNvwjlvMYD55iQS66gsf0PCBgM7xEF7wSE27mFvnI52ReJVuZLnU7Q2xf0h0Bj0qM0BVGov8gS4VGknGk-8NpEIzDMcwviISbXURhs_NE3EhH5cLH94DrXUO202T6Kv76JAHyYJmBUNQN/s320/Lavender+at+Abbaye.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Lavender</td></tr>
</tbody></table>
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghk4pZpe9bHjUCmb1Zsq_tM4SAEvAfsdQdftUVJqBVhipt7gAonRMKdOuDdyd78PsQ-1LCu_PcYd-r-T4e3qpl_EfhWR9Sfroz8ZH3KwyT6bVQB2Omk42dwogq7V2CzB31YmIm59anChqy/s1600/sunflowers.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghk4pZpe9bHjUCmb1Zsq_tM4SAEvAfsdQdftUVJqBVhipt7gAonRMKdOuDdyd78PsQ-1LCu_PcYd-r-T4e3qpl_EfhWR9Sfroz8ZH3KwyT6bVQB2Omk42dwogq7V2CzB31YmIm59anChqy/s320/sunflowers.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Sunflowers</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdDX-qjnfm-zponmK59e3ONDQfOInR3GxUUWYOBLe5iXI2nQtCuZsOiDK3aF0Z03r_CvXoYmWmy_W3g2bmiSZ019BQx7crWnjehsthbkhnckFfuAX_8ndZpJly_t5CSzK822v4eMmPPwhn/s1600/Lac+D'Allos.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdDX-qjnfm-zponmK59e3ONDQfOInR3GxUUWYOBLe5iXI2nQtCuZsOiDK3aF0Z03r_CvXoYmWmy_W3g2bmiSZ019BQx7crWnjehsthbkhnckFfuAX_8ndZpJly_t5CSzK822v4eMmPPwhn/s320/Lac+D'Allos.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Lac D'Allos in Haute-Provence</td></tr>
</tbody></table>
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<span style="font-family: Arial; font-size: 11.0pt;">Three years
in Kenya is long enough to have made some observations—not so long that one
fails to be amazed.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Copperplate Gothic Bold"; font-size: 11.0pt; mso-bidi-font-family: Arial;">God’s Power</span></b><span style="font-family: Arial; font-size: 11.0pt;">.<span style="mso-spacerun: yes;"> </span></span><span style="font-family: Braggadocio; font-size: 11.0pt; mso-bidi-font-family: Arial;">Only By Prayer</span><span style="font-family: Arial; font-size: 11.0pt;">.<span style="mso-spacerun: yes;">
</span></span><span style="font-family: "Snell Roundhand Black"; font-size: 11.0pt; mso-bidi-font-family: Arial;">For We Go By Faith, Not By Sight</span><span style="font-family: Arial; font-size: 11.0pt;">.<span style="mso-spacerun: yes;">
</span>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. <span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>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.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">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.<span style="mso-spacerun: yes;"> </span>I thought
I’d explain what happens after a patient dies.<span style="mso-spacerun: yes;">
</span>First, the body is taken to the mortuary of the hospital.<span style="mso-spacerun: yes;"> </span>Only after the bill is cleared can the body
be released for burial.<span style="mso-spacerun: yes;"> </span>In Nairobi, some
bodies have stayed in the mortuary for years because the family has been unable
to pay the hospital bill.<span style="mso-spacerun: yes;"> </span>We are
fortunate that BKKH sometimes covers the bill so that the families are able to
take the body home for burial.<span style="mso-spacerun: yes;"> </span>There are
funeral homes here—with interesting names: </span><span style="font-family: "Copperplate Gothic Bold"; font-size: 11.0pt; mso-bidi-font-family: Arial;">Destiny
Funeral Home</span><span style="font-family: Arial; font-size: 11.0pt;">…</span><span style="font-family: Capitals; font-size: 11.0pt; mso-bidi-font-family: Arial;">Exodus
Funeral Service</span><span style="font-family: Arial; font-size: 11.0pt;">….or my
personal favorite: <b><i><span style="text-transform: uppercase;">Hidden
Treasures Funeral Home.</span></i></b></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Apple Chancery"; font-size: 11.0pt;"><span style="mso-spacerun: yes;"> </span></span></b><span style="font-family: Arial; font-size: 11.0pt;">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.<span style="mso-spacerun: yes;"> </span>It is not uncommon to see 10 to 20 vehicles
and over a hundred people who have come to accompany the body home.<span style="mso-spacerun: yes;"> </span>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).<span style="mso-spacerun: yes;">
</span>Those children are sometimes buried in the Kijabe Hospital
cemetery.<span style="mso-spacerun: yes;"> </span>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.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;"><o:p><br /></o:p></span></div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiM1US7Uc3G7mlWRxmHgtRZJ9eaT4mZZhoZvtBex75bV2KFAfpZXNFvBnjqTxRxiTKycuKhDifWHKnPCMqc7srTEs_8byj1Ou_ua5aSc_gGeBShhXJb8XdcVsM5804UE5Fx1CIDnTJWrlwI/s1600/Ascaris.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiM1US7Uc3G7mlWRxmHgtRZJ9eaT4mZZhoZvtBex75bV2KFAfpZXNFvBnjqTxRxiTKycuKhDifWHKnPCMqc7srTEs_8byj1Ou_ua5aSc_gGeBShhXJb8XdcVsM5804UE5Fx1CIDnTJWrlwI/s200/Ascaris.jpg" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Ascaris (intestinal worm)</td></tr>
</tbody></table>
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<span style="font-family: Arial; font-size: 11.0pt;">We
sometimes have to be detectives to diagnose our patients.<span style="mso-spacerun: yes;"> </span>One boy with shunted hydrocephalus arrived
with a massively distended abdomen.<span style="mso-spacerun: yes;">
</span>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.<span style="mso-spacerun: yes;"> </span>He did
later vomit some worms—and had mildly elevated venous pressure associated with
his liver.<span style="mso-spacerun: yes;"> </span>We all learned a lot about
ascaris infestation through caring for him.<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEij3wLVeqxNvJ6csKZWO_YH08RDd6UqTFo-bUDCHPQOMEo2cQqc_SWxOtLA3qMBSh4-tXYPgzKukI_YRceJg68hGRvRIbic796EXBe7eu3s1u_Fq6U01z1A6zcvJrhweftEWvebMCF3TnWg/s1600/Kim+and+Joseph.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEij3wLVeqxNvJ6csKZWO_YH08RDd6UqTFo-bUDCHPQOMEo2cQqc_SWxOtLA3qMBSh4-tXYPgzKukI_YRceJg68hGRvRIbic796EXBe7eu3s1u_Fq6U01z1A6zcvJrhweftEWvebMCF3TnWg/s320/Kim+and+Joseph.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Kimberly and Joseph</td></tr>
</tbody></table>
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<span style="font-family: Arial; font-size: 11.0pt;">I want to
highlight one of our patients, Joseph, a boy of 10 years who developed brain
abcesses.<span style="mso-spacerun: yes;"> </span>They were drained and treated
in February of this year but recurred.<span style="mso-spacerun: yes;">
</span>He returned in May with pus draining from his head.<span style="mso-spacerun: yes;"> </span>Because he had undergone weeks of antibiotic
coverage in February-March, we began using our strongest antibiotic,
meropenam.<span style="mso-spacerun: yes;"> </span>He required 6 weeks of
treatment with meropenam at a cost of about $50/day.<span style="mso-spacerun: yes;"> </span>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).<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>Joseph and his family are
desperately poor—so his bill was covered by BKKH; his grandmother’s bill was
paid by an anonymous donor.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: Arial; font-size: 11.0pt;"><span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">We see
children with medulloblastomas—cancer in the cerebellum.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>She was also
desperately poor; her father, who accompanied her and took excellent care of her,
was from a very remote region of Kenya.<span style="mso-spacerun: yes;">
</span>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. <span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>THIS
is what community is.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">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.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>We are
in the process of praying for God’s guidance.<span style="mso-spacerun: yes;">
</span>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.<span style="mso-spacerun: yes;"> </span>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.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">I mentioned
earlier that this past year has been the hardest.<span style="mso-spacerun: yes;"> </span>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.”<span style="mso-spacerun: yes;"> </span>Leland and
I have not accepted that and will not.<span style="mso-spacerun: yes;">
</span>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).<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">And we </span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">believe that God doesn’t delight in mediocrity.<span style="mso-spacerun: yes;">
</span>We want to “give of our best to the Master,” and we try to encourage our
colleagues to do the same.</span></div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrdfp1siwTUMHh7cLhseOrZseUTmn0X7QP2OAvTJuaAFsRb4zCVc2gQtpp0VCQD-3j9yzPfpJcPQ7xd6eSTBCFzq1EJEeYVqX-uM6d5Ci00-QbxYDmt7xCBFW7f_Lnr6BvdIFB26ABwrIA/s1600/%2522organization%2522.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrdfp1siwTUMHh7cLhseOrZseUTmn0X7QP2OAvTJuaAFsRb4zCVc2gQtpp0VCQD-3j9yzPfpJcPQ7xd6eSTBCFzq1EJEeYVqX-uM6d5Ci00-QbxYDmt7xCBFW7f_Lnr6BvdIFB26ABwrIA/s320/%2522organization%2522.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Requisition cabinet</td></tr>
</tbody></table>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh26XokatIbJnhOp6Por_ABl-S7YoYAxJ9WRpan2ObZIGu134v6rPenyECWIvgKZdZQ_1htI4rpcj2gkdWucA4OH5CGGQOxi6ixxGpFqULDM72qsLkQPpZWAITkDj4j5h_GrKlPQ8RPBLGB/s1600/order+box.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh26XokatIbJnhOp6Por_ABl-S7YoYAxJ9WRpan2ObZIGu134v6rPenyECWIvgKZdZQ_1htI4rpcj2gkdWucA4OH5CGGQOxi6ixxGpFqULDM72qsLkQPpZWAITkDj4j5h_GrKlPQ8RPBLGB/s320/order+box.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Box for charts with new orders</td></tr>
</tbody></table>
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<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt;">It takes
many people to support this work.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>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).<span style="mso-spacerun: yes;"> </span>We were pleased that Lianna
Ben-Adani, an Israeli neurosurgeon, could spend two days with us.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>Leland continues to search for candidates for
the neurosurgical fellowship next year.<span style="mso-spacerun: yes;"> </span>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.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">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.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>The destruction was impressive—just as
impressive was the local community’s response.<span style="mso-spacerun: yes;">
</span>Within several hours, the tunnel was cleared.<span style="mso-spacerun: yes;"> </span>The government is responsible for the bridge
which has just this week been replaced.<span style="mso-spacerun: yes;">
</span>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.<o:p></o:p></span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtdT0zYvwvhBEL85fL3MvCRaru5nQ0cabfkV94C8Vova5MXnE0G7cAgwNk0HTq7tLmUhxNRTtALzb4zEh_slhm4l14u33bxc_r4vu4ik9wj1zOQwoHgnK_n5RAvaIgLusXFeAOvMzpyLMq/s1600/mud.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtdT0zYvwvhBEL85fL3MvCRaru5nQ0cabfkV94C8Vova5MXnE0G7cAgwNk0HTq7tLmUhxNRTtALzb4zEh_slhm4l14u33bxc_r4vu4ik9wj1zOQwoHgnK_n5RAvaIgLusXFeAOvMzpyLMq/s1600/mud.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Lower road in Kijabe after landslides</td></tr>
</tbody></table>
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<span style="font-family: Arial; font-size: 11.0pt;">I always am
struck, when I reenter the Western world, of how much people take for
granted.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>When we go to Nairobi, we see walled
compounds with barbed wire topping the wall.<span style="mso-spacerun: yes;">
</span>There are armed security guards in every shopping area.<span style="mso-spacerun: yes;"> </span>People in our Nairobi church have been
ambushed and shot just outside their homes.<span style="mso-spacerun: yes;">
</span>Carjackings are frequent—being mugged after use of an ATM is
common.<span style="mso-spacerun: yes;"> </span>In Kijabe we are somewhat
protected, yet even there home break-ins have occurred recently.<span style="mso-spacerun: yes;"> </span>I believe that income inequality is largely a
factor in the insecurity—in Africa and even in places in the US.<span style="mso-spacerun: yes;"> </span>The more people acquire, the more they feel
compelled to defend their possessions—especially when those around them are
desperately poor.<span style="mso-spacerun: yes;"> </span>I continue to struggle
with Jesus’ words in Luke 6: 29-31: <i style="mso-bidi-font-style: normal;">“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.<span style="mso-spacerun: yes;"> </span>Give to everyone who begs from you; and if
anyone takes away your goods, do not ask for them again.<span style="mso-spacerun: yes;"> </span>Do to others as you would have them do to
you.”</i><span style="mso-spacerun: yes;"> </span>To be honest, I no longer feel
guilty when I say “no” to those asking for money.<span style="mso-spacerun: yes;"> </span>I believe that I am giving not only my money,
but also my time, and myself.<span style="mso-spacerun: yes;"> </span>Over the
past 3 years, we feel “poured out” to a great degree for the children at
BKKH.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>Yet, there is always so much more we want to
do.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt;">A good
friend just wrote this: “Am feeling like there is more I could be doing with my
life.”<span style="mso-spacerun: yes;"> </span>I believe that all of us, if we
are truly honest with ourselves, could say the same.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>There is no need to sell everything and be an
itinerant preacher, or to move to Ecuador and start a school.<span style="mso-spacerun: yes;"> </span>Everyone has been given a pulpit—everyone has
the opportunity to be the hands, feet, mouth, arms, eyes, ears, heart of
Jesus.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>But where is Jesus needed most?<span style="mso-spacerun: yes;"> </span>In those very places.<span style="mso-spacerun: yes;"> </span>Yes, I encourage you to give of your money
and possessions—those are needed everywhere.<span style="mso-spacerun: yes;">
</span>But more than that I encourage you to give of yourself, wherever you
are—because Jesus’ presence is needed far more than your money.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt;">Thank you
all for your prayers of support for us; they become more precious and needed as
time goes on.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;">
</span>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.<span style="mso-spacerun: yes;"> </span>Because of that we have lost experienced and
valuable staff nurses.<span style="mso-spacerun: yes;"> </span>We ask you for
your continued support in prayer and money for BKKH.<span style="mso-spacerun: yes;"> </span>Many children’s bills are paid through your
contributions.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt;">Take care,
God bless.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Arial; font-size: 11.0pt;">Susan<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com3tag:blogger.com,1999:blog-8238962161618527090.post-66055638009642075282013-04-25T01:51:00.000-07:002013-04-25T01:51:01.147-07:00
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlcYhf7aDhQIFKkrgi2w0loRzkMegHVdv6Zv5vyb-s25Ndqg4f_LhYPlKiIgfMsXql_u4BLDwtGvEYr1ahghJ9JFMHO8yO9N2X7Op1FhEGIFZMqB4rjBk5597oHLy1Q66i0fCXnXvLKwaR/s1600/Leland+with+celery.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlcYhf7aDhQIFKkrgi2w0loRzkMegHVdv6Zv5vyb-s25Ndqg4f_LhYPlKiIgfMsXql_u4BLDwtGvEYr1ahghJ9JFMHO8yO9N2X7Op1FhEGIFZMqB4rjBk5597oHLy1Q66i0fCXnXvLKwaR/s320/Leland+with+celery.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Leland and Kenyan celery</td></tr>
</tbody></table>
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<span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">Habari
rafiki,</span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">15, 17, 63,
14, 13, 16, 61, 65, 66….that is not a series of random numbers.<span style="mso-spacerun: yes;"> </span>That is the “order” in which I found the
medication sheets in the binder for Team A (beds 13-18 to the right of the
nurses station, beds 61-66 to the left).<span style="mso-spacerun: yes;">
</span>Among those patients, there was a baby who had been moved to isolation
for a multi-drug-resistant Klebsiella pneumonia ventriculitis (cerebrospinal
fluid infection in the head). Two doses of the only two antibiotics to which
his organism was sensitive had not been charted as given—whether or not they
were given will never be known.<span style="mso-spacerun: yes;"> </span>I become
quite discouraged when I see this lack of order in the nursing care—after I
discuss the problem with the supervisors, the care improves for about two weeks
and then reverts to the same inconsistent level.<span style="mso-spacerun: yes;"> </span>I refuse to accept the common belief among
some here—that here in Kijabe we are incapable of delivering excellent
care.<span style="mso-spacerun: yes;"> </span>I know that my fellow nurses here
are highly intelligent people and ARE capable of excellence.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">I think
nearly every day of things to tell you; yet I find it hard to describe our
lives here.<span style="mso-spacerun: yes;"> </span>We work hard—but so do many
people all over the world.<span style="mso-spacerun: yes;"> </span>We have days
of drudgery and days of excitement, days of sadness and feelings of failure
over a child’s death, and days of joy and satisfaction over a child’s operation
and recovery.<span style="mso-spacerun: yes;"> </span>Believe it or not, I wrote
2 blogs over the past month—never finished either one.<span style="mso-spacerun: yes;"> </span>I looked at the first and thought it was a
lot of whining.<span style="mso-spacerun: yes;"> </span>As my children will tell
you, I never tolerated whining from them, so I think it patently unfair for you
to receive it from me.<span style="mso-spacerun: yes;"> </span>The second just
wasn’t very interesting.<span style="mso-spacerun: yes;"> </span>So, I’ll try
again.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">I traveled
to the US in February to greet my newest grandchild—Joseph Alexander Schulter
(called Alex), born on February 5.<span style="mso-spacerun: yes;"> </span>I had
the joy of spending his first three weeks with him, his Big Sister Evelyn,
Kelly, and Joe.<span style="mso-spacerun: yes;"> </span>During the time there, I
also saw my son Michael, and daughter-in-law Marisa, my sister Ginni, Joe’s Dad
and step-mother, and my very good friends Bud and Linda.<span style="mso-spacerun: yes;"> </span>I savored the great food, hot showers, smooth
roads, great signage, restaurants.<span style="mso-spacerun: yes;"> </span>I
didn’t see one person leaping over the median barrier, one donkey being beaten,
one chicken crossing the road (why DO they do that, anyway)?<span style="mso-spacerun: yes;"> </span>Life there was orderly and predictable—every
single time I turned on the hot water tap, hot water came out—never cold, never
steam, never mud, and certainly never nothing.<span style="mso-spacerun: yes;">
</span>On either side of the median barrier, traffic flowed IN THE SAME
DIRECTION—never once was a minivan or bus traveling on the sidewalk.<span style="mso-spacerun: yes;"> </span>I found it truly amazing.<o:p></o:p></span></div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXWYrjEFiPySf0I7LRQq2lTT0QF3xRD1GOKE5YbEdKobuoQNJMQad8YxcUd1f2vt_o6zMU3gWfMinmqJXU9YEvGhIQsnpTVJZxg5zQQjdRTtZsLKyZ44Qf_e7E30G7zVauXwWg9vyE8XBW/s1600/Alex+awake.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXWYrjEFiPySf0I7LRQq2lTT0QF3xRD1GOKE5YbEdKobuoQNJMQad8YxcUd1f2vt_o6zMU3gWfMinmqJXU9YEvGhIQsnpTVJZxg5zQQjdRTtZsLKyZ44Qf_e7E30G7zVauXwWg9vyE8XBW/s200/Alex+awake.jpg" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Joseph Alexander Schulter</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLZbJMLtTZDnPTlZGI7ZjKgLyQI7HC57I1Vdzosw7nJtNiZZsthacov54DjSCUwYCOLoFm1gG4WX44Mpwf9dechnaltWTHlrmLWJAuokZzvmJEMDZdi9DcY6b43cq3dUqaXK6GE7j3gVQr/s1600/on+the+sofa.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLZbJMLtTZDnPTlZGI7ZjKgLyQI7HC57I1Vdzosw7nJtNiZZsthacov54DjSCUwYCOLoFm1gG4WX44Mpwf9dechnaltWTHlrmLWJAuokZzvmJEMDZdi9DcY6b43cq3dUqaXK6GE7j3gVQr/s320/on+the+sofa.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Marisa, Michael, Alex and Evelyn</td></tr>
</tbody></table>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdfSVf4uV-sAfVqx-p1aUuLJh0sJAfg1oFoRdKJYxBONbbxa5-sdcQmHT1UexlQNIm5CLFqC9MqZVb9hapuxOwJejaQSLDvMvBZQPjQHW8qFHmdMz7764_Pg_OWmjhn25h0fjMt2ubSwfl/s1600/together+in+DC.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdfSVf4uV-sAfVqx-p1aUuLJh0sJAfg1oFoRdKJYxBONbbxa5-sdcQmHT1UexlQNIm5CLFqC9MqZVb9hapuxOwJejaQSLDvMvBZQPjQHW8qFHmdMz7764_Pg_OWmjhn25h0fjMt2ubSwfl/s320/together+in+DC.jpg" width="320" /></a></div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioqywMTIjX6-Mi43N4gcya-4bIqqdLUIBcGjEvP-1b1NQjV4g-5-LW-GXjpmcH7g_OuySL-DMxLekIoM98YlKY6g3MNdzmqaXqcPyytXtBAfqkHWOHCNzIlMokTjBIqeqRsjnxPbcp3IGp/s1600/Shosho+and+Evelyn.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioqywMTIjX6-Mi43N4gcya-4bIqqdLUIBcGjEvP-1b1NQjV4g-5-LW-GXjpmcH7g_OuySL-DMxLekIoM98YlKY6g3MNdzmqaXqcPyytXtBAfqkHWOHCNzIlMokTjBIqeqRsjnxPbcp3IGp/s200/Shosho+and+Evelyn.jpg" width="200" /></a><br />
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<span style="font-family: Arial; font-size: 11.0pt;">The 3 week
break did me a world of good—Leland subsequently had a harried and exhausting
short trip to India where he gave 2 of 3 prepared lectures, used pedicabs
through traffic even worse than Nairobi’s, dodging roaming people, bicycles,
cars, and cows.<span style="mso-spacerun: yes;"> </span>The red tape he encountered
getting the Indian visa was even worse than that which we met renewing our
alien registrations—and his reentry into Kenya was made difficult when the
Kenyan customs agents failed to recognize the temporary visa he had obtained in
February so he had to get US dollars to pay the $50 single entry visa fee.<span style="mso-spacerun: yes;"> </span>I had just entered 1 week before using the
exact same temporary visa and had had no trouble.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">My
adventure with health care insurers finally came to an end.<span style="mso-spacerun: yes;"> </span>My “health insurance company” twice denied payment
of my hospital bill from my admission for pancreatitis last October—they
claimed it was a preexisting condition about which I had not informed them on
my application.<span style="mso-spacerun: yes;"> </span>I learned a number of
important things from this experience; that if an insurance company wants to
deny, they will find any number of reasons to do so—and that Danish insurance
companies have no appeal process.<span style="mso-spacerun: yes;"> </span>I also
learned not to call my credit card company to have the credit limit increased
because in doing so, one’s card is cancelled—permanently.<span style="mso-spacerun: yes;"> </span>I also learned how to ask for discounts in
the hospital bill and receive them (ask and you shall receive worked quite well
in this instance).<span style="mso-spacerun: yes;"> </span>So, the end of the
story came with my cashing in an annuity and paying the hospital “only” $44,000
instead of the $72,000 on the initial bill.<span style="mso-spacerun: yes;">
</span>The good news is that we will have a very nice tax deduction on our 2013
taxes.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Life here
brings us daily reminders that we live in a different culture.<span style="mso-spacerun: yes;"> </span>For instance, when we go out to eat, Leland
is served first.<span style="mso-spacerun: yes;"> </span>Men go through doorways
first.<span style="mso-spacerun: yes;"> </span>Occasionally one of the Kenyan
residents will hold the door open for me—I laugh and tell them to go ahead of
me—“We are in Kenya, you know.”<span style="mso-spacerun: yes;"> </span>If a
group of people is coming down the hallway toward me, they don’t move aside to
allow me a path through—generally I flatten against the wall—or if I’m feeling
out of sorts, I’ll push my way through them—it is not considered rude
here.<span style="mso-spacerun: yes;"> </span>People who precede you through
doors will pull the door closed without looking to see if someone is behind
them.<span style="mso-spacerun: yes;"> </span>People will often just stride out
in front of oncoming traffic without looking to see that the way is clear.<span style="mso-spacerun: yes;"> </span>If people don’t hear what you say, they
answer with a sharp high pitched “HUH?”<span style="mso-spacerun: yes;">
</span>None of those things are considered rude here.<span style="mso-spacerun: yes;"> </span>And our directness in speaking is considered
quite rude.<span style="mso-spacerun: yes;"> </span>Fortunately for me, my
Kenyan friends kindly overlook my directness—in fact, a few have come to me
with direct questions (without the preliminary handshake and greeting) and I’ve
teased them that they are becoming American.<span style="mso-spacerun: yes;">
</span>One of the biggest compliments to me is when someone tells me I am
becoming a white Kenyan.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">We’ve
entered the rainy season and that means wadudu (pleural for insect).<span style="mso-spacerun: yes;"> </span>We have mayflies (a variety of termite) that
pour out of holes in the ground at dusk—they mass around light so our porch is
covered with wings in the morning.<span style="mso-spacerun: yes;"> </span>Some
Africans catch and fry the bodies—I am told they are quite tasty (I have no
personal experience of this fact).<span style="mso-spacerun: yes;"> </span>As I
was sitting on the couch last night, a small object dropped beside me from the
ceiling—it was a Nairobi ant.<span style="mso-spacerun: yes;"> </span>They are
quite small, writhe like shrimp when they are sprayed with Morten’s Doom, and
need to be “flicked” not swatted if they land on you—their bodies release a
toxin when they are crushed that causes an impressive and, I’m told, painful welt.<span style="mso-spacerun: yes;"> </span>On rounds one morning, I saw “living wall
art”—a cockroach running up the wall beside one of the babies’ beds.<span style="mso-spacerun: yes;"> </span>I motioned to Leland who took my writing pad
and mashed it.<span style="mso-spacerun: yes;"> </span>That left cockroach juice
all over my writing pad—having no towels, paper or otherwise, I wiped it on
Leland’s lab coat to the immense glee of every single mum in the annex.<span style="mso-spacerun: yes;"> </span>We hadn’t realized how closely we are
watched! <o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjI3dvHmsJ19uNKBRTceWD-Yd0U1imZH7YADfaFsAhIUW-RTqja4Yo9w0x1ITi090ENFEcRHeHDyK4aDlZqYPBsNUY_QQM0lbHfMT6Npil6x_MY094fff7cCer_GV6K1cLPBRl_B4PicCbD/s1600/African+Hornbill.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjI3dvHmsJ19uNKBRTceWD-Yd0U1imZH7YADfaFsAhIUW-RTqja4Yo9w0x1ITi090ENFEcRHeHDyK4aDlZqYPBsNUY_QQM0lbHfMT6Npil6x_MY094fff7cCer_GV6K1cLPBRl_B4PicCbD/s320/African+Hornbill.jpg" width="320" /></a></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Three weeks
ago, Leland and I were home all day on a Sunday—he was on call so we spent 3
hours making rounds and were not able to get to Nairobi for church.<span style="mso-spacerun: yes;"> </span>Most of the day I heard a terrible racket in
the attic—as though someone were banging on the roof with a hammer.<span style="mso-spacerun: yes;"> </span>Leland went outside to see if workers were on
the roof—no one was seen.<span style="mso-spacerun: yes;"> </span>He finally
went up into the attic and came face to face with an African Hornbill who had
gotten into the attic but then could not find his way out.<span style="mso-spacerun: yes;"> </span>Leland made a quick retreat and called Elisha
who brought 3 men.<span style="mso-spacerun: yes;"> </span>Using a board as a
shield, they cornered the bird and one grabbed his beak; another his feet.<span style="mso-spacerun: yes;"> </span>He was taken outside and released. <o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">One of our
best known patients died this past weekend.<span style="mso-spacerun: yes;">
</span>Abigael just turned 2 years old and had a myelomeningocele repair and
shunt soon after birth.<span style="mso-spacerun: yes;"> </span>She had many
complications related to her shunt—over the course of her life she had three
different kinds of shunts (ventriculoperitoneal, ventriculcholecystal,
ventriculatrial) but all had complications—either malfunction or
infection.<span style="mso-spacerun: yes;"> </span>Her 7<sup>th</sup> admission
resulted in an infection that was resistant to all antibiotics we have
available.<span style="mso-spacerun: yes;"> </span>We talked with her mom and
she decided to take Abigael home—but before she could clear her bill, Abigael
suddenly died.<span style="mso-spacerun: yes;"> </span>I wrote a letter for her
mom today listing her hospitalizations and calculated that out of 753 days that
she was alive, Abigael spent 127 in the hospital—17% of her life.<span style="mso-spacerun: yes;"> </span>We will all miss Abigael—she cried whenever
she would see me so I tried to make games of hiding from her and playing
peek-a-boo.<span style="mso-spacerun: yes;"> </span>I never did get her to
laugh, though.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">A young
Somali mum brought her very delayed, lethargic baby to OPD with a CT scan she
had obtained at Kenyatta National Hospital.<span style="mso-spacerun: yes;">
</span>We see many children who have had scans there and have had nothing else
done for them.<span style="mso-spacerun: yes;"> </span>This child had a scan
showing severe brain atrophy from meningitis soon after birth.<span style="mso-spacerun: yes;"> </span>When I told her through the interpreter that
her child’s brain was terribly damaged from infection and that there was no
medicine or surgery that could “fix” his problem, she collapsed onto the exam
table, wailing in despair.<span style="mso-spacerun: yes;"> </span>I put my arm
around her, but really had very little else to offer but my sorrow that we
couldn’t make her child whole.<span style="mso-spacerun: yes;"> </span>The
interpreter then explained that this mother’s first baby had died soon after
birth.<span style="mso-spacerun: yes;"> </span>What is very hard is that not
only is this mother grieving for her two babies, but she also has to worry
about being discarded as a wife because she hasn’t produced healthy children.<span style="mso-spacerun: yes;"> </span>There are many levels to the grief we see
here—some that we never encounter in our practices in the US.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">One of the
frustrations here is that we don’t have antibiotics that treat our multidrug
resistant organisms—or that the antibiotics that are available are financially
out of reach of the patients’ ability to pay.<span style="mso-spacerun: yes;">
</span>We also really need a pediatric infectious disease specialist to come
either short-term or long-term to help us make decisions regarding which
antibiotic to choose, duration of treatment, and to help the lab improve the
identification of organisms.<span style="mso-spacerun: yes;"> </span>We need all
kinds of pediatric preparations of common oral drugs—like phenobarb, diazepam, cephalosporins
for urinary tract infections.<span style="mso-spacerun: yes;"> </span>There are
times when we have to hospitalize infants because the only antibiotics we have
available are intravenous preparations.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Some
medicines are not available here in Kenya; some are available in Kenya but not
in Kijabe Hospital.<span style="mso-spacerun: yes;"> </span>We have recently had
3 patients with diabetes insipidus after brain surgery—DDAVP, the medicine to
control the huge urine output is not available at Kijabe Hospital
pharmacy.<span style="mso-spacerun: yes;"> </span>The MD in the ICU had a family
member who had used that same drug several years ago for another problem—he
found the medicine under his sink and we used it for two of the patients—fortunately,
though it had expired, it was still effective.<span style="mso-spacerun: yes;">
</span>When the third patient needed the medicine, we borrowed a tablet from
the ICU and sent the mother to Nairobi to a pharmacy that stocked the
medicine—she came back later that day with a month’s supply.<span style="mso-spacerun: yes;"> </span>Other times, when we need hormone assays, we
have to have the family pay the fee for an outside lab; the blood is then drawn
and sent to the lab.<span style="mso-spacerun: yes;"> </span>If the family
cannot pay, the blood is not drawn or sent.<span style="mso-spacerun: yes;">
</span>We are fortunate to be part of BKKH—we can often have BKKH pay the lab
and get the assays done.<span style="mso-spacerun: yes;"> </span>If the patient
is an adult, though, they have to pay out of pocket.<span style="mso-spacerun: yes;"> </span>The same is true for using our new CT
scanner—the fee for the scan ($71) has to be paid before the scan is done.<span style="mso-spacerun: yes;"> </span>You can see that there is a great advantage
to being a patient in BKKH—but all of these new procedures are costly—and if
the family is unable to pay the bill, BKKH picks up the tab.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Frequently
seen problems among babies and younger children are severe malnutrition and
rickets.<span style="mso-spacerun: yes;"> </span>My grandson gained 2.66 pounds in
the first month—some of the children we see are 2-7 months old and are still at
or near their birth weights.<span style="mso-spacerun: yes;"> </span>Many of the
malnourished children require supplemental formula which is incredibly
expensive (about $10 for 3-4 days).<span style="mso-spacerun: yes;"> </span>One
5 month baby was given a prescription for infant formula—his mother brought him
back for admission, and I discovered that he had been given chocolate Ensure
instead of infant formula!!<span style="mso-spacerun: yes;"> </span>Treatment of
rickets requires about 6 months of Calcium and Vitamin D supplementation.<span style="mso-spacerun: yes;"> </span>The packets cost 24 Ksh/day—about $0.28, or
about $51 for the 6-month course.<span style="mso-spacerun: yes;"> </span>But
most of our families cannot afford that—so the babies often get incomplete or
no treatment. <o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Other
times, children are diagnosed with rickets and malnutrition when they have
regression of developmental milestones because of brain tumors.<span style="mso-spacerun: yes;"> </span>One such 23-month-old girl was readmitted
this week; her medulloblastoma had been emergently resected in January, she had
been discharged in February in an almost vegetative state.<span style="mso-spacerun: yes;"> </span>Her parents took amazing care of her and saw
her regain some speech, the ability to feed herself finger foods and sit on a
chair.<span style="mso-spacerun: yes;"> </span>However, over the past 2 weeks,
she regressed and was somnolent on admission.<span style="mso-spacerun: yes;">
</span>After talking with her parents, we all decided to not intervene with
further testing, scans, etc.<span style="mso-spacerun: yes;"> </span>She died
two nights after admission, with her mum at her side.<span style="mso-spacerun: yes;"> </span>We all grieved and yet shared a peace that
she was surrounded with love at her death—and that she was now in the arms of
God.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Please pray
that we have the physical, mental, and emotional strength to continue our work
here.<span style="mso-spacerun: yes;"> </span>We are tired and know that we need
to take more breaks.<span style="mso-spacerun: yes;"> </span>That means that we
need more short-term neurosurgeons to help with coverage.<span style="mso-spacerun: yes;"> </span>Right now, Sandi Lam and John Collins are visiting
Kijabe to give us coverage while we go for a week to a conference in the
States, and Humphrey takes a quick trip home to visit family in Uganda.<span style="mso-spacerun: yes;"> </span>Humphrey has been accepted to a 6 month
fellowship in Germany beginning in September so we will need A LOT of help this
Fall (to you in the Northern hemisphere), Spring to us in the Southern
hemisphere. Thank you to those who continue to support us in prayer and contributions to BKKH. We are very grateful for your faithfulness.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Erik Hansen
and his family are on leave in the US for the next 5 months—so Leland is
serving as temporary BKKH medical director until Erik returns.<span style="mso-spacerun: yes;"> </span>I ask for your prayers for the Hansen family
as they spend time with family and in raising funds to support their ongoing
work here in Kijabe.<span style="mso-spacerun: yes;"> </span>They, like us,
consider Kijabe home.<span style="mso-spacerun: yes;"> </span>And while we all
love seeing our families and living in an orderly world, our home and our
hearts are here in Kenya.<span style="mso-spacerun: yes;"> </span>I ask for your
prayers for the Hansens, and for Leland as he represents BKKH in meetings with
the medical staff at Kijabe Hospital.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">I strongly
recommend <u>Kingdom, Grace, Judgment</u> by Robert Farrar Capon.<span style="mso-spacerun: yes;"> </span>It is a trilogy on the parables of
Jesus.<span style="mso-spacerun: yes;"> </span>What I find striking is that all
through the gospels, the disciples <i style="mso-bidi-font-style: normal;">just
didn’t get it.</i><span style="mso-spacerun: yes;"> </span>Christ continually
told them about God’s grace, the Kingdom of God, and what God’s judgment
means.<span style="mso-spacerun: yes;"> </span>He told them of his death—over
and over again, and yet, they <i style="mso-bidi-font-style: normal;">just didn’t
get it.<span style="mso-spacerun: yes;"> </span></i>I’ve come to realize that I
am no different from them—that my understanding of grace, the kingdom of God
and judgment is probably just as flawed and incomplete as theirs.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: Arial; font-size: 11.0pt;">For now we see in a mirror dimly, but then face to face.<span style="mso-spacerun: yes;"> </span>Now I know in part; then I shall know fully,
even as I have been fully known. <o:p></o:p></span></i></b></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: Arial; font-size: 11.0pt;">I Corinthians 13: 12</span></i></b></div>
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<span class="Apple-style-span" style="font-family: Arial;"><span class="Apple-style-span" style="font-size: 15px;">Take care, God bless,</span></span></div>
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<span class="Apple-style-span" style="font-family: Arial;"><span class="Apple-style-span" style="font-size: 15px;">Susan</span></span></div>
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<!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com0tag:blogger.com,1999:blog-8238962161618527090.post-74229576646969514952013-02-04T01:29:00.001-08:002013-02-04T01:29:36.725-08:00<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGs-FjuF-KoMWNQ1KT07mUazsJI5hij-VzT9Nz_hcQVe79xrSizzv3cROdkLL2tJpJhK3BTLny1Gpy9luy9YvcxORpknu3PPjEEWELk-2U56bNUxJ86MS3nGWZ_vCt8j_zxB2ryI7dJSj8/s1600/IMG_0325.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGs-FjuF-KoMWNQ1KT07mUazsJI5hij-VzT9Nz_hcQVe79xrSizzv3cROdkLL2tJpJhK3BTLny1Gpy9luy9YvcxORpknu3PPjEEWELk-2U56bNUxJ86MS3nGWZ_vCt8j_zxB2ryI7dJSj8/s200/IMG_0325.jpg" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Gladys, RN</span></td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4HIG3vxAZHg-qNHcDrknMWcszH0LExjmXSdZllzuwm9mmPSHkGzpmtA4jmjk9BM4jaTMkTsVZpJxHazYQ5UBa1vESIf-soYm2flhbuFr1HsLfWBVUosyk-BeLmB4XVwuMaYjrHJm_Anek/s1600/IMG_0323.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4HIG3vxAZHg-qNHcDrknMWcszH0LExjmXSdZllzuwm9mmPSHkGzpmtA4jmjk9BM4jaTMkTsVZpJxHazYQ5UBa1vESIf-soYm2flhbuFr1HsLfWBVUosyk-BeLmB4XVwuMaYjrHJm_Anek/s200/IMG_0323.jpg" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-family: Arial; font-size: 12px;"><span> </span>Patient and mum</span></td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe4vNPGekmZR8uHfIKYLZDd5M8VT9laltvQwpnTp0uAX2WW0hLwHw9k32unqG63KYcNY3QZRY5J8tX_TgR7Ey0wsAPTPBozreqzWGFCocgoiC1LEq2EKlWqXpeJxsU7Dwfyzw9JucvCfC5/s1600/IMG_0331.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe4vNPGekmZR8uHfIKYLZDd5M8VT9laltvQwpnTp0uAX2WW0hLwHw9k32unqG63KYcNY3QZRY5J8tX_TgR7Ey0wsAPTPBozreqzWGFCocgoiC1LEq2EKlWqXpeJxsU7Dwfyzw9JucvCfC5/s200/IMG_0331.jpg" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-family: Arial; font-size: 12px;"><span> </span>Patient and mum</span></td></tr>
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<tr><td style="text-align: center;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYyPXQdVSokTS_2UoJaeenqvixSPhlXFMCR-xufMXMDzPeQB37r-cazWsDMhEJQeDjeV0Kx-_nbhLFk5B7EDKX_od9iz2_3mIrPyV16yGo5jKy9lAEstmyp75iCOltvH66GXds8aVlbrdg/s200/IMG_0326.jpg" style="margin-left: auto; margin-right: auto;" width="150" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Elizabeth, OT</span></td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNGjK1p79yaGAZDUScrfNZXaR4aUTlP5feCG0N1kpbjjYXsRnLYJjinvEDf3RrZ8SYpY31uvH1R5cyRQUP6WY-rv3d-rdXZ4Ew6sQQSZjCLTIXVXFtA4au3V26AWZfiHMCw0wk8MR-LxXV/s1600/IMG_0322.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNGjK1p79yaGAZDUScrfNZXaR4aUTlP5feCG0N1kpbjjYXsRnLYJjinvEDf3RrZ8SYpY31uvH1R5cyRQUP6WY-rv3d-rdXZ4Ew6sQQSZjCLTIXVXFtA4au3V26AWZfiHMCw0wk8MR-LxXV/s200/IMG_0322.jpg" width="150" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-size: 12px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Susan with patients<span> </span></span></span></td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYmjp90gBfCHZWPqdoqS3nJceSuKiQjsAVGAL2pAcAlTHTdQ6oPkD2jSCr2GK91Jpd0-2YLw9yRlyEpb7oUN46oS0PXhj9JxB7P4crMwaFM2LnHQTCXpFVgkr3GnSjmKJ5P7-q1Qgg3fAK/s1600/IMG_0335.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYmjp90gBfCHZWPqdoqS3nJceSuKiQjsAVGAL2pAcAlTHTdQ6oPkD2jSCr2GK91Jpd0-2YLw9yRlyEpb7oUN46oS0PXhj9JxB7P4crMwaFM2LnHQTCXpFVgkr3GnSjmKJ5P7-q1Qgg3fAK/s200/IMG_0335.jpg" width="150" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Agnes & Eunice, RNs</span></td></tr>
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<span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">Habari <span class="SpellE">Yako</span>,<span> </span>31/01/2013</span></div>
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<span style="font-family: Arial; font-size: 11pt;">I am sitting in the BKKH Land Rover in Machakos Town while the nurses and <span class="GramE">staff of our Mobile Clinic here today are</span> shopping.<span> </span>We had a wonderful clinic—saw one young infant with Apert’s syndrome who will need surgery to enlarge the skull—she was born with fused sutures and fused fingers.<span> </span>Fortunately, Del Mount, the craniofacial surgeon will arrive on Sunday—we have about 11 cases already scheduled and will likely add a few more. We shared the <span class="GramE">open air</span> clinic with two goats—who had left visible (and odiferous) proof of their presence on the ground under our feet.</span></div>
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<span style="font-family: Arial; font-size: 11pt;">I want to share with you some “Toto” moments.<span> </span>The Swahili word for child is “mtoto” (plural watoto) but I am not referring to children here.<span> </span>These are Wizard of Oz moments when one realizes, “Toto, we aren’t in Kansas anymore.”<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;">A 7 month old girl from Mombasa was admitted in mid-December; the history was a bit sketchy since the mother of six had no idea why the father told her to take the baby to the hospital at 5 months—nor did she understand when the grandmother told her the head was getting big and she should come to Kijabe.<span> </span>The morning of surgery, she refused to thumbprint (sign) the consent for surgery.<span> </span>Later that evening, the mum attacked another child and tried to bite her.<span> </span>Mum was carted off to Casualty and heavily medicated while calls were made to the father in Mombasa to bring someone with him to stay with the child while he took Mum home.<span> </span>He came alone, so we had to discharge the baby without surgery.<span> </span>He brought her in mid January for a successful operation.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;">A baby was admitted sometime last Monday evening; it wasn’t until Thursday of this week that we were notified that no one had seen the baby since admission.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;">We began enrolling patients into our new shunt study—a single blind randomized study of the regular Chhabra shunt versus an antibiotic impregnated one.<span> </span>After consenting three mums, we were told that the standard pre and post op antibiotic we were to give intravenously was “out of stock.”<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;">A 2-month-old boy was admitted with a high fever and seizures—he had recently had a shunt.<span> </span>On his back was what appeared to be a pustule/boil.<span> </span>I tried to express the pus to get a culture, and out popped a live larva.<span> </span>I have to say it was a first for me.<span> </span>I put the wriggling creature in a test tube—one of the pediatricians identified it as a tumba fly larva.<span> </span>The flies lay their eggs on drying clothes, then the eggs hatch and burrow into the skin until the fly is ready to “fly.”<span> </span>Think of it as a subcutaneous cocoon.<span> </span>By the way, the fever and seizures had nothing to do with the larva.<span> </span>He also had a urinary tract infection.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;">A lady lacked 10 shillings (about $0.12) of her 30-shilling matatu fare; the tout (conductor) threw her out of a moving matatu into the path of a bus.<span> </span>She was killed.<span> </span>The mob that gathered torched the bus and carted off the salvageable parts. The police are holding the bus driver in custody.<span> </span>The matatu driver and tout have not yet been identified or arrested.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;">I could go on, but I think you get the picture.<span> </span>It is usual for very unusual things to happen here.<span> </span>Not Kansas---or Madison—or Pittsburgh—or even Portland, as wonderfully unusual as that city can be.<o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy2SRzpz5mudfI4rLMZGDSXX7cIzn9uLZV6aKdy8DWyiA8NdLqi6cvsOUfJe7ymg7szLmHcksXCXbqTdhDDOUajZnN9-zf11C5udt6Jrg8rY_1OWI9x9L98LCAgrrIMkJjFIsBEjLkOrEL/s1600/IMG_0305.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy2SRzpz5mudfI4rLMZGDSXX7cIzn9uLZV6aKdy8DWyiA8NdLqi6cvsOUfJe7ymg7szLmHcksXCXbqTdhDDOUajZnN9-zf11C5udt6Jrg8rY_1OWI9x9L98LCAgrrIMkJjFIsBEjLkOrEL/s200/IMG_0305.jpg" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-family: Cambria; font-size: 16px;"><span style="font-family: Arial; font-size: 11pt;"><span> </span></span><span style="font-family: Arial; font-size: 9pt;">Children’s sermon<span> </span></span></span></td></tr>
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<span style="font-family: Arial; font-size: 11pt;"><span> </span><span> </span><o:p></o:p></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">A few Sundays ago, I saw something in church that took my breath away.</span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"><span> </span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">Pastor Mike was beginning the children’s sermon and had invited the children to come forward.</span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"><span> </span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">A little 3-year-old boy very reluctantly approached, lagging behind the other children.</span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"><span> </span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">The sermon was about the baptism of Jesus, so Pastor Mike shepherded the children to the baptismal font.</span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"><span> </span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">The little boy stood back and didn’t move with the group.</span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"><span> </span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">Another </span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"><span class="GramE">boy,</span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"> about 10 years old, came and took the hand of the three year old and stepped toward the group, but the little one planted his feet firmly and didn’t move.</span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"><span> </span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">I expected to see the older boy yank or pull the child but he didn’t.</span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"><span> </span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">Instead, he just held his hand and waited.</span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"><span> </span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">Finally, the older boy took a small step forward and then the small one followed him to the font.</span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"><span> </span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">To me, this was a revelation of how God works in our lives.</span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"><span> </span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">He is present, always beside us, holding our hand, ready to lead us.</span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;"><span> </span></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">But He doesn’t yank—He waits until we follow.</span></div>
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<span style="font-family: Arial; font-size: 11pt;">We had a group of visitors this week—they are involved with this ministry through BKKH.<span> </span>Erik Hansen, Leland, and I gave 30-minute talks at the luncheon in Kijabe last Saturday.<span> </span>I told them about being inspired when I was about 10 years old by Miss Emma Snyder, the missionary nurse who worked in a leprosarium in Nigeria.<span> </span>I talked about having given my heart to Jesus when I was eight—and then realizing my dream of being a missionary nurse in Africa 50 years later.<span> </span>As Leland often says, our <span class="GramE">lives are not lived in a straight line—so many twists and turns</span> and detours off the main road.<span> </span>But the truest joy and most amazing peace come when we follow where He is leading us.<span> </span>Most times, that is not to another country—it can be to a new church, a new job, a new city, a new relationship—but we need to keep following Him along the path.<span> </span><o:p></o:p></span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Christmas poinsettia, Kijabe</span></td></tr>
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<span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">Living here in Kenya is an experience in extremes--exciting, exasperating, exhilarating, exhausting, hilarious, <span class="GramE">heart</span>-breaking.<span> </span>We see the rosy blush of dawn on the Valley, the curtains of rain on the horizon, the sparkling of the Milky Way at night, the incredible ever-changing sunsets over the far ridge of the Valley.<span> </span>We see so many children cherished by their families—babies who are born with terrible anomalies yet are deeply loved.<span> </span>We see so many children die—5 over the week between Christmas and New Years.<span> </span>Children with brain tumors are misdiagnosed as having rickets—and we see them when they are finally having brain herniation, too late to save them.<span> </span>One 7-year-old girl was admitted two weeks ago—and died during the night; her operation had been scheduled for first case that morning.<span> </span>Often these children have been to many other health facilities before they reach us; one had been seen at Kenyatta National Hospital (KNH) in mid–December and had a CT showing a large brain tumor and severe hydrocephalus.<span> </span>The doctors at KNH gave him a return appointment for Jan 28, 2013.<span> </span>Despite his parents bringing him to BKKH 5 days after the CT, he stopped breathing right before his surgery the morning after admission.</span></div>
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<span style="font-family: Arial; font-size: 11pt;">Through a united effort among pediatric physicians, surgeons, nurses, BKKH engineers, and administration, our 3-bed HDU (high density unit) is operational.<span> </span>We have monitoring for the sickest children and a <span class="SpellE">patient<span class="GramE">:nurse</span></span> ratio of 1-3:1 instead of the usual 8-12:1.<span> </span>We still do not have the capability of monitoring those children who may have shunt malfunction or severe hydrocephalus pre-operatively—who seem stable now but could deteriorate quickly.<span> </span>The nursing staff has been under a great deal of stress—the nurses in the national hospitals have been on strike for 3 months.<span> </span>That means that both our census and our acuity <span class="GramE">is</span> higher than normal.<span> </span>I think the nursing care has never been better than it is right now—and many nurses are taking an active role in improving it even more.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;">We continue to have water problems—and I will never again take for granted turning on the hot water tap and actually having hot water come out!<span> </span>Our solar water has been non-existent since the roof repair last July.<span> </span>This week we have no water at all from the hot tap.<span> </span>However, we do have cold water (which can be heated in a pot for an “African bath”)—which is more than I can say many mornings in the hospital.<span> </span><span class="SpellE">Musyoka</span>, our infection prevention and control technician, frequently announces with some exasperation that there is no water in the hospital today.<span> </span>It is hard to give the babies their <span class="SpellE">preop</span> antiseptic baths without water.<span> </span>And after examining a newborn with <span class="SpellE">spina</span> bifida and feces all over the legs, it is particularly unpleasant to learn there is no running water—hand gel just doesn’t cut it.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;">Please continue to pray that we find someone to help Leland and Humphrey with the heavy numbers of operations.<span> </span>Leland thinks he has found a neurosurgery fellow who can start next January, but we need help from now until then.<span> </span>Please also pray that we find a helper for me—there is a clinical officer who will join us for the month of April—if she likes the work with our kids (and with us), there is the hope she will join our team.<span> </span>I would love to go to more of the mobile clinics where there is a need for someone to look at scans and identify children who need neurosurgery.<span> </span>But traveling to mobile clinics leaves the OPD and wards without daily support for the nurses.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;">If you have interest in helping with this ministry, I encourage you to go to the Bethany Kids website </span><a href="http://www.bethanykids.org/" style="color: blue; text-decoration: underline;"><span style="color: windowtext; font-family: Arial; font-size: 11pt;">www.<b>bethanykids</b>.org</span></a><span style="font-family: Arial; font-size: 11pt;">. While it is tempting to give to special funds, I will tell you that BKKH needs donations to the general fund in order to support all the ministries.<span> </span>We have dire need of funds to finish the sewage system updates that must be in place before the new hospital building can continue. This isn’t a glamorous use of donations, but if the sewage system isn’t funded, then all construction for the new hospital ends—and the government could shut down the entire hospital.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;">Throughout scripture, God is very clear about His priorities.<span> </span>We are to be the face, hands, feet of Jesus to the poor, the oppressed, the lonely, the sick, the hungry, naked, imprisoned.<span> </span>I once sang a solo in <span class="SpellE">Bellefield</span> Presbyterian Church—from Micah 6. <span> </span>It is one of my favorite scriptures.<span> </span>I will leave you with that….<o:p></o:p></span></div>
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<b><i><span style="font-family: Arial; font-size: 11pt;">The word of the Lord came to Micah, and he said,<o:p></o:p></span></i></b></div>
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<b><i><span style="font-family: Arial; font-size: 11pt;">Wherewith shall I come before the Lord, and bow myself before God on high?<o:p></o:p></span></i></b></div>
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<b><i><span style="font-family: Arial; font-size: 11pt;">Shall I come before him with burnt offerings, with calves of a year old?<o:p></o:p></span></i></b></div>
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<b><i><span style="font-family: Arial; font-size: 11pt;">Shall the Lord be pleased with thousands of rams, with ten thousands of rivers of oil?<o:p></o:p></span></i></b></div>
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<b><i><span style="font-family: Arial; font-size: 11pt;">Shall I give my first-born for my transgression, the fruit of my body for the sin of my soul?<o:p></o:p></span></i></b></div>
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<b><i><span style="font-family: Arial; font-size: 11pt;">It hath been told thee, oh man, what is good.<span> </span>And what doth the Lord require of thee, but to do justice, and to love mercy, and to walk humbly with thy God.<o:p></o:p></span></i></b></div>
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<span style="font-family: Arial; font-size: 11pt;">Take care, God bless.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11pt;">Susan<o:p></o:p></span></div>
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Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com1tag:blogger.com,1999:blog-8238962161618527090.post-12928491749252446842012-12-03T01:01:00.001-08:002012-12-03T01:01:19.021-08:00<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqPgg1C5kRCzcdO9cWbcJa9VSJKSDVWxkOEFkPTogGtNlfekTa-yx2XFxy0bcNatGN_UxNXcY7cR2U-XdB6K6S-iv8djsIZNuo4y3-xuBK8nkRo34y5EstGUDQW-KDwXm0kTk_WqHoDRKr/s1600/Mt+Ste+Michelle.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqPgg1C5kRCzcdO9cWbcJa9VSJKSDVWxkOEFkPTogGtNlfekTa-yx2XFxy0bcNatGN_UxNXcY7cR2U-XdB6K6S-iv8djsIZNuo4y3-xuBK8nkRo34y5EstGUDQW-KDwXm0kTk_WqHoDRKr/s320/Mt+Ste+Michelle.jpg" style="cursor: move;" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 13px; padding-top: 4px; text-align: center;">Mont Ste Michel</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgr4uX3JZPMvqUwZwThdRp_64s3wncZIJBfV9QlmDazri7snGEj_Kifiu1J0QXy9tLQRAlXYIirVd5albKFTvYwAxtLuddxRt80WVfNBaY4CLKaQjoxoYjHfDPowL6mzs6alKwlfejESvQo/s1600/Chartres+stained+glass.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="" border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgr4uX3JZPMvqUwZwThdRp_64s3wncZIJBfV9QlmDazri7snGEj_Kifiu1J0QXy9tLQRAlXYIirVd5albKFTvYwAxtLuddxRt80WVfNBaY4CLKaQjoxoYjHfDPowL6mzs6alKwlfejESvQo/s320/Chartres+stained+glass.jpg" style="cursor: move;" title="" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 13px; padding-top: 4px; text-align: center;">Chartres Cathedral</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUu6X-5Ju_ctaJicUWiw_cBrNnFlXVqQB1dUl9gTfQa2EKOYUenG4XKZxhclNF14nAh9uf0qasmkmr-2IvD_leGOs2y-DgLy8D0kDw9ShAQiH8akrWumCq0TJrb2mpx15pxou_8y-ilgq6/s1600/Chartres+plaque.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUu6X-5Ju_ctaJicUWiw_cBrNnFlXVqQB1dUl9gTfQa2EKOYUenG4XKZxhclNF14nAh9uf0qasmkmr-2IvD_leGOs2y-DgLy8D0kDw9ShAQiH8akrWumCq0TJrb2mpx15pxou_8y-ilgq6/s320/Chartres+plaque.jpg" style="cursor: move;" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 13px; padding-top: 4px; text-align: center;">Plaque in Chartres</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-x29Xtgw1sSSeuxgG5HYWz-_UeJ3NZ-Cvq-vpwyNsSb6ejjhUNnr7sAP8l9phjga290R443imWy-i2zbocJEY-UDF3yTAGabWgFJ0GWQiYTAMAzTlatlfHJw7Rpw8y5qVaZnxMworqI2O/s1600/Rainbow+11-30-12.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-x29Xtgw1sSSeuxgG5HYWz-_UeJ3NZ-Cvq-vpwyNsSb6ejjhUNnr7sAP8l9phjga290R443imWy-i2zbocJEY-UDF3yTAGabWgFJ0GWQiYTAMAzTlatlfHJw7Rpw8y5qVaZnxMworqI2O/s320/Rainbow+11-30-12.jpg" style="cursor: move;" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 13px; padding-top: 4px; text-align: center;">Rainbow from our balcony 30-Nov-2012</td></tr>
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<span style="font-family: Arial;">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.</span></div>
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<span style="font-family: Arial;">Habari yako, jamaa na rafiki,<o:p></o:p></span></div>
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<span style="font-family: Arial;">“I __________, will pay all bill after I have harvested my maize and had a fund raising.”<o:p></o:p></span></div>
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<span style="font-family: Arial;">This letter was attached to the hospital file (chart) for one of our patients.<span> </span>The hospital bill for this patient was Ksh 37,791.65—a huge sum for most of our patients who are subsistence farmers.<span> </span>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.<span> </span>These letters are often signed with a thumbprint—many of our families cannot write/sign their names.<span> </span>How often do the people who have signed these letters default on the bill?<span> </span>We don’t know—many families pay in installments as money is available.<span> </span>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.<span> </span>So she may need to make a decision to pay the bill or eat.<o:p></o:p></span></div>
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<span style="font-family: Arial;">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.<span> </span>(As best I understand it, this is a sphincter coming from the bile duct).<span> </span>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.<span> </span>The risk of the procedure was a 10-40% chance of pancreatitis—usually mild, requiring a couple days of IV fluids and pain meds.<span> </span>I had the procedure as an outpatient the following day—and about 18 hours later awoke with really awful abdominal pain.<span> </span>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.<span> </span>I gained 11 pounds in 3 days (fluid), and then lost 22 pounds.<span> </span>(The upside to this story—weight loss!)<span> </span>I had to pay $250 just to see the doctor and $12,500 to have the procedure.<span> </span>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.<span> </span><o:p></o:p></span></div>
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<span style="font-family: Arial;">What a contrast in care between the two countries!<span> </span>Yes, I was able to have a complex medical procedure because of the resources in the US.<span> </span>However, I never again saw the physician who did the procedure—apparently he has no interest in his patients who develop a complication.<span> </span>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.<span> </span>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.<span> </span>And, to be honest, I figured they’d think I was nuts.<span> </span>I am not suggesting that prayer would have prevented complications.<span> </span>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).<o:p></o:p></span></div>
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<span style="font-family: Arial;">While we were in the States, Leland and I were able to see our children and our grandchildren.<span> </span>We see Tusk and Evelyn only in “snapshots” because of the great distance between us.<span> </span>That is hard—for our children to understand, for us, maybe as well for our grandchildren.<span> </span>My dad prayed for my sister and me every day of his life since our births—for many years that meant nothing to me.<span> </span>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.<span> </span><o:p></o:p></span></div>
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<span style="font-family: Arial;">I was sprung from the hospital on the day we were supposed to have left for 2 weeks in France.<span> </span>No one was comfortable with my flying overseas that day, so we postponed the flight for 24 hours.<span> </span>We arrived in Paris and drove to Honfleur—a beautiful coastal town in Normandy.<span> </span>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.<span> </span>The town was lovely, the cottage was incredibly cold—stone floor, no central heat.<span> </span>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.<span> </span>Having read about the Channel Islands, I had the brilliant idea of visiting them for a day trip.<span> </span>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.<span> </span>However, the drive took 2.5 hours, and we had some fear that we’d miss the ferry.<span> </span>Oh, how I wish we had!<span> </span>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.<span> </span>We made the ferry, and had the worst case of mal de mer (sea sickness) I can imagine.<span> </span>Fully two thirds of the people vomited repeatedly on the 70 minute cruise—including us.<span> </span>We could barely shuffle off the ferry—then had 6 hours until we had to get back on.<span> </span>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.<span> </span>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.<span> </span><o:p></o:p></span></div>
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<span style="font-family: Arial;">After that, the trip was lovely.<span> </span>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.<span> </span>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.<span> </span>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.<span> </span>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.<span> </span>Along the way, we communicated in my broken high-school French and ate wonderful meals.<span> </span>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.<span> </span>And of course, le pain (bread)--the best in the world—even without butter.<o:p></o:p></span></div>
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<span style="font-family: Arial;">We were so happy to get back to Kijabe—but not well rested as we had planned.<span> </span>There was a lull in patient census for 2 days—since then we have had up to 8 admissions/day with very sick children.<span> </span>We’ve had a few “Mercy consults”—those children in whom our best efforts have not helped.<span> </span>Mercy and I have counseled, wept, and prayed with the moms.<span> </span>The whole team rejoices with good news—a negative culture, an infection successfully treated.<span> </span>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.”<span> </span>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.<span> </span>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.<span> </span>As another Somali woman said, Kijabe is a place where God is present.<span> </span>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.<span> </span>I find it hard to describe just how alive I feel to work here.<span> </span>We are becoming real—just as in The Velveteen Rabbit—a bit shabby and worn, threadbare, but alive.<span> </span>Thanks and praise to God.<o:p></o:p></span></div>
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<span style="font-family: Arial;">BKKH needs your help.<span> </span>Leland has started a fund for neurosurgical equipment—just about everything we use is donated.<span> </span>When equipment breaks, we have no replacements.<span> </span>We need to have a fund for replacements and upkeep—he has written to about 100 neurosurgeons to ask for their help.<span> </span>The patients need help in paying their bills—most families here work very hard, most in physical labor.<span> </span>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.<span> </span>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.<span> </span>If the families cannot pay for the medicine, we are not supposed to treat the children with it.<span> </span>I must confess that sometimes I go ahead and order a trial of the medicine.<span> </span>We need an ongoing source of vancomycin, ceftazidime, and meropenam.<span> </span>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.<span> </span>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.<span> </span>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.<span> </span><o:p></o:p></span></div>
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<span style="font-family: Arial;">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)<o:p></o:p></span></div>
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<span style="font-family: Arial;">I’ll end with this passage from Galatians 2: 4-10:<o:p></o:p></span></div>
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<b><i><span style="font-family: Arial;">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.<span> </span>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.<span> </span>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.<span> </span>For we are God’s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.<o:p></o:p></span></i></b></div>
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<span style="font-family: Arial;">Take care, God bless.<o:p></o:p></span></div>
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<span style="font-family: Arial;">Susan<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 12pt;">Contact: </span><span style="font-family: Cambria; font-size: 12pt;"><span style="font-family: Arial;">www.bethanykids.org</span></span><br />
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Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com1tag:blogger.com,1999:blog-8238962161618527090.post-9853705066601013342012-09-02T09:04:00.000-07:002012-09-02T09:04:11.208-07:00
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<br />
<div class="MsoNormal">
<span style="font-family: Helvetica; font-size: 11.0pt;">Dear
Friends and Family,<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Helvetica; font-size: 11.0pt;">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.<span style="mso-spacerun: yes;"> </span>It
has been an opportunity for reflection on all that we’ve experienced over the
past two years.<span style="mso-spacerun: yes;"> </span>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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Helvetica; font-size: 11.0pt;">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.<span style="mso-spacerun: yes;">
</span>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.<span style="mso-spacerun: yes;">
</span>My participation in our weekly Bible Study has given me insights into
Scripture as well as relationships with the other Bible study members.<span style="mso-spacerun: yes;"> </span>Our morning times of prayer and study are
precious to us; we awaken with a real thirst for God’s Word.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Helvetica; font-size: 11.0pt;">It is
often said that Africans excel in relationships.<span style="mso-spacerun: yes;"> </span>I have discovered over the past two years
that that is true.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>One lady recently had a
newborn child with a myelomeningocele that was repaired.<span style="mso-spacerun: yes;"> </span>She was from the IDP camp (Internally
displaced persons) down in the valley and had been transferred to Kijabe from
Naivasha Hospital.<span style="mso-spacerun: yes;"> </span>She had a husband and
two older children.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>Not only did this lady have no family, she
had no money nor clothes.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>These heart-rending stories of abandonment
are balanced by those like Nelly, another baby girl with a repaired
myelomeningocele.<span style="mso-spacerun: yes;"> </span>She is the first baby
of a very poor older man.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>He offered to mop floors in
exchange for his daughter’s hospital bill.<span style="mso-spacerun: yes;">
</span>He came to visit nearly every day (that is unusual) and always asked how
she was doing after shaking my hand.<span style="mso-spacerun: yes;"> </span>I
saw him again just the other day—about a week after her discharge.<span style="mso-spacerun: yes;"> </span>He told me she was doing well.<span style="mso-spacerun: yes;"> </span>I suspect he was back to pay some of the
balance on her bill.<span style="mso-spacerun: yes;"> </span>It is families like
his that impress me the most.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Helvetica; font-size: 11.0pt;">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.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>Over the past two years, I
have found myself becoming less angry about these situations—more bemused than
anything else.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>However, I find that it
helps me cope.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>I believe that most of the staff here want
very much to do well, to take good care of patients.<span style="mso-spacerun: yes;"> </span>As in every place, there are those few who
really don’t care.<span style="mso-spacerun: yes;"> </span>We all need to
identify the barriers to good care and arrive at reasonable solutions. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Helvetica; font-size: 11.0pt;">I have
said several times that I have used every experience and skill gained
throughout my career since I’ve come to Kijabe.<span style="mso-spacerun: yes;">
</span>I started out in nursing working for a short time at a psychiatric
hospital; recently we had two mothers with severe post-partum psychosis.<span style="mso-spacerun: yes;"> </span>One went from bed to bed blessing each
mother; the other came into the nursing station and started opening
cupboards.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>See, nothing is wasted.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Helvetica; font-size: 11.0pt;">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.<span style="mso-spacerun: yes;">
</span>Am I trying to be liked, accepted, or am I here to be obedient to and
please God?<span style="mso-spacerun: yes;"> </span>There are many times, the
happiest ones, when those are one and the same.<span style="mso-spacerun: yes;">
</span>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.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>That
discussion was instrumental in making me look at our practice here.<span style="mso-spacerun: yes;"> </span>There are areas where I can bend—organization
of supplies in clinic drawers no longer is my issue.<span style="mso-spacerun: yes;"> </span>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.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Helvetica; font-size: 11.0pt;">There
are things about Kenya that still make me smile (with my eyes) and shake my
head.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>Her
mother never bothered to “inform” us that we had the wrong name.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>Her mother often called her Mary—and
the child, 8 years old, answered to either.<span style="mso-spacerun: yes;">
</span>One child is admitted as Denton or Danton—no one seems to be concerned
which it is.<span style="mso-spacerun: yes;"> </span>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.”<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Helvetica; font-size: 11.0pt;">In
early August, we moved back into our third floor apartment after the repairs to
the roof and ceilings were completed.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;">
</span>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.<span style="mso-spacerun: yes;"> </span>I have spent the Saturdays
since moving back scraping dried oil-based paint splotches from the floor
(dropcloths are also “unknown unknowns”).<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Helvetica; font-size: 11.0pt;">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).<span style="mso-spacerun: yes;">
</span>We heard that some clerics in Nairobi were encouraging their followers
to go and do likewise in Nairobi.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;">
</span>Several of the men charged by the ICC for crimes against humanity are
running for President.<span style="mso-spacerun: yes;"> </span>So, I ask for
your prayers for Kenya.<span style="mso-spacerun: yes;"> </span>It is a country
of incredible beauty not only in its mountains, plains, valleys, lakes, but
especially among its people.<span style="mso-spacerun: yes;"> </span>They
deserve better leaders.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Helvetica; font-size: 11.0pt;">We
tremendously enjoyed the month-long visit of Wendell Lake, a neurosurgery
resident from University of Wisconsin.<span style="mso-spacerun: yes;">
</span>We had worked with Wendell at UW before we came here.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>During the month of August,
he participated in 60 cases—he saw more children die than he had in his career
to date.<span style="mso-spacerun: yes;"> </span>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<sup>th</sup> known case in the world), head injuries, brain
tumors—both adult and pediatric.<span style="mso-spacerun: yes;"> </span>One of
the more unusual cases was a man, admitted to another service, who had been
mauled by a hippo.<span style="mso-spacerun: yes;"> </span>I told Wendell, “Now
you know you aren’t in Kansas anymore.”<span style="mso-spacerun: yes;"> </span>He
said he was very impressed that the missionaries here didn’t fit his stereotype
of missionaries.<span style="mso-spacerun: yes;"> </span>I would have to say
that I agree wholeheartedly with that.<span style="mso-spacerun: yes;">
</span>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.<span style="mso-spacerun: yes;"> </span>Despite differences in theological
backgrounds and practices, they are among the least judgmental people I have
met.<span style="mso-spacerun: yes;"> </span>Becoming part of that community has
been another highlight of our stay here.<o:p></o:p></span></div>
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<span style="font-family: Helvetica; font-size: 11.0pt;">Looking
ahead to the next four years, we see many challenges.<span style="mso-spacerun: yes;"> </span>We need another pediatric neurosurgery
fellow; the caseload is too high for 2 neurosurgeons, and more people need to
be trained.<span style="mso-spacerun: yes;"> </span>We realize also that we need
to develop an ongoing, lasting means of support for neurosurgery here at
Kijabe.<span style="mso-spacerun: yes;"> </span>The neurosurgery service, like
most of the surgical services at Kijabe, depends entirely on donations.<span style="mso-spacerun: yes;"> </span>Equipment is donated; suture, dressings, and
medications are donated.<span style="mso-spacerun: yes;"> </span>Leland’s and my
services are donated.<span style="mso-spacerun: yes;"> </span>It is exciting that
Humphrey has been hired by Kijabe Hospital as a consultant (attending doctor)
as of September 1.<span style="mso-spacerun: yes;"> </span>We need to identify
and train a person who can fill my position when I leave.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: Helvetica; font-size: 11.0pt;">I
started out this blog talking about relationships—that the Kenyans excel at
them.<span style="mso-spacerun: yes;"> </span>But one thing I’ve learned is how
important relationships are to all people—not only Kenyans.<span style="mso-spacerun: yes;"> </span>Leland and I have missed our families more
this year than the first.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>They returned home
every 5 years for furlough—I’ll make 4 trips to see my children this year.<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>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.”<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>It isn’t the place; it
is the people that we miss.<o:p></o:p></span></div>
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<span style="font-family: Helvetica; font-size: 11.0pt;">We
continue to treasure your prayers for us and for the ministry in Kijabe.<span style="mso-spacerun: yes;"> </span>We ask that you lift up the moms and babies
in your prayers.<span style="mso-spacerun: yes;"> </span>We ask you to pray for
our health—I am battling a sinus infection and some residual difficulties
related to my gall bladder operation.<span style="mso-spacerun: yes;">
</span>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.<o:p></o:p></span></div>
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<span style="font-family: Helvetica; font-size: 11.0pt;">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.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: Helvetica; font-size: 11.0pt;">Therefore, my dear
brothers [and sisters!], stand firm.<span style="mso-spacerun: yes;"> </span>Let
nothing move you.<span style="mso-spacerun: yes;"> </span>Always give yourself
fully to the work of the Lord, because you know that your labor in the Lord is
not in vain.</span></i></b><span style="font-family: Helvetica; font-size: 11.0pt;">
I Corinthians 15: 58<o:p></o:p></span></div>
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<span style="font-family: Helvetica; font-size: 11.0pt;">Take
care, God bless.<o:p></o:p></span></div>
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<span style="font-family: Helvetica; font-size: 11.0pt;">Susan<o:p></o:p></span></div>
<!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com1tag:blogger.com,1999:blog-8238962161618527090.post-37757751727602642392012-07-06T07:47:00.000-07:002012-07-06T07:47:54.761-07:006 July 2012<br />
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<span class="Apple-style-span" style="font-size: small;">Habari Yako,</span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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!). </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">Thank you all for your prayers, notes, care packages, gifts to the neurosurgical patient subsidy fund--we appreciate your thoughtfulness and faithfulness. </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">As we say at the end of each church service,</span></span></div>
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<span style="letter-spacing: 0.0px;"><i><span class="Apple-style-span" style="font-size: small;">Go in peace. Serve the Lord. Thanks be to God.</span></i></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">Take care, God bless.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">Susan and Leland</span></span></div>
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<span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0.0px;"><i></i></span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;"><b>June 17 Sermon</b></span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">The Holy Gospel according to St. Mark the fourth chapter, verses 26-34</span></span></div>
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<span style="letter-spacing: 0.0px;"><i><span class="Apple-style-span" style="font-size: small;">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.”</span></i></span></div>
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<span style="letter-spacing: 0.0px;"><i><span class="Apple-style-span" style="font-size: small;">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.”</span></i></span></div>
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<span style="letter-spacing: 0.0px;"><i><span class="Apple-style-span" style="font-size: small;">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. </span></i></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;"><b>The Seed of the Kingdom of God</b></span></span></div>
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<span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0.0px;">Jesus was such a disappointment. Think of all the ways he disappointed the Jews. They expected a messianic <i>king</i> to restore Israel into a <i>kingdom</i> 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</span><span style="font: 7.3px Helvetica; letter-spacing: 0.0px;"><sup>th</sup></span><span style="letter-spacing: 0.0px;"> 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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;"> 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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;"> 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?</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">So Jesus always talked about the kingdom of God in parables. The Greek word for “parable” comes from two Greek words, <i>para</i>, which means beside, or alongside, and <i>ballo, </i>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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;"> 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? </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">A sower planted seed in four different kinds of soil.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">A sower planted seed and weeds came up with the wheat.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">A sower planted seed and then just waited for the crop to grow.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">A sower planted a small mustard seed and it grew into a large plant.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">A woman put yeast put into a large amount of flour and it worked its way through all the dough.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;"> 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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;"> Our first parable today is found only in the gospel of Mark. </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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) </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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. </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;"> The second parable today, the parable of the mustard seed, is also found in Matthew and Luke.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.” </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;"> 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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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 </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;"><b>June 24 Sermon</b></span></span></div>
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<span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0.0px;">The Holy Gospel according to St. Mark, the 4</span><span style="font: 7.3px Helvetica; letter-spacing: 0.0px;"><sup>th</sup></span><span style="letter-spacing: 0.0px;"> chapter, 35-41</span></span></div>
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<span style="letter-spacing: 0.0px;"><i><span class="Apple-style-span" style="font-size: small;">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?</span></i></span></div>
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<span class="Apple-style-span" style="font-size: small;"><b>Is Jesus’ Presence Sufficient?</b></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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. </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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. </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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. </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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, <i>epitimao</i>, 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”</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">The wind stopped, the waves ceased, and there was a dead calm. Can you imagine that? </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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 <i>phobos</i> —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 <i>phobeomai, </i>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:</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-tab-span" style="white-space: pre;"> </span><i>God himself is with us, Let us now adore him</i></span></span></div>
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<span style="letter-spacing: 0.0px;"><i><span class="Apple-style-span" style="font-size: small;"><span class="Apple-tab-span" style="white-space: pre;"> </span>And with awe appear before him!</span></i></span></div>
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<span style="letter-spacing: 0.0px;"><i><span class="Apple-style-span" style="font-size: small;"><span class="Apple-tab-span" style="white-space: pre;"> </span>God is in his temple; All within keep silence,</span></i></span></div>
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<span style="letter-spacing: 0.0px;"><i><span class="Apple-style-span" style="font-size: small;"><span class="Apple-tab-span" style="white-space: pre;"> </span>Prostrate lie with deepest reverence.</span></i></span></div>
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<span style="letter-spacing: 0.0px;"><i><span class="Apple-style-span" style="font-size: small;"><span class="Apple-tab-span" style="white-space: pre;"> </span>Him alone God we own,</span></i></span></div>
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<span style="letter-spacing: 0.0px;"><i><span class="Apple-style-span" style="font-size: small;"><span class="Apple-tab-span" style="white-space: pre;"> </span>Him, our God and Savior; Praise his name forever!</span></i></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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”</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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. </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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?</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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. </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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.</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">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?</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">We need to remember two verses: </span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">Mt 28:20: “And remember I am with you always, to the end of the age</span></span></div>
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<span style="letter-spacing: 0.0px;"><span class="Apple-style-span" style="font-size: small;">Romans 8:39: “Nothing will be able to separate us from the love of God in Christ Jesus our Lord.” Amen.</span></span></div>
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<span style="letter-spacing: 0.0px;"><br /></span></div>Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com0tag:blogger.com,1999:blog-8238962161618527090.post-25203247118484867662012-05-08T09:36:00.000-07:002012-05-08T09:36:23.149-07:00<!--[if gte mso 9]><xml>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDT6qIsdtPOc3pOnAKYSUN6_uORHtEM_HNHYTSt1NG6ujeOp4tq2EULlk4eWXiUzfGtY2X-Z8efWxyBPdSEqwAtWfoThkhBaH6wUFwR-ENLRKaRAb4HBrHvW9Gfr4SYqhjh51Ku-AUUVZT/s1600/wedding.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDT6qIsdtPOc3pOnAKYSUN6_uORHtEM_HNHYTSt1NG6ujeOp4tq2EULlk4eWXiUzfGtY2X-Z8efWxyBPdSEqwAtWfoThkhBaH6wUFwR-ENLRKaRAb4HBrHvW9Gfr4SYqhjh51Ku-AUUVZT/s320/wedding.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Michael & Marisa</td></tr>
</tbody></table>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOoh0ZYYoluawseRtgzlItL7sXgqXbOmwQj-lSmkTILjk6N24HKGw-No2-fd0GAPTz95jPYrDyuiZZQd53Ju2u9_f6VpiRhN5zfsP5qNbq39lgdtDUFTg-vn0OE6yR1kiHSX4Ty2PnNO4I/s1600/Mt.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOoh0ZYYoluawseRtgzlItL7sXgqXbOmwQj-lSmkTILjk6N24HKGw-No2-fd0GAPTz95jPYrDyuiZZQd53Ju2u9_f6VpiRhN5zfsP5qNbq39lgdtDUFTg-vn0OE6yR1kiHSX4Ty2PnNO4I/s320/Mt.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Mt. Kenya at dawn</td></tr>
</tbody></table>
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<span class="Apple-style-span" style="font-family: Arial; font-size: 15px;">Dear
Friends,</span></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Arial; font-size: 11.0pt;">It has been
over 4 months since I’ve posted a blog.<span style="mso-spacerun: yes;">
</span>In that time, we have flown thousands of miles to various events.<span style="mso-spacerun: yes;"> </span>In January, Michael and Marisa were
married in a beautiful ceremony in Jamaica.<span style="mso-spacerun: yes;"> </span>All of our family attended so it was a great reunion. In
March, Leland and I flew to Israel for a neurology conference at the Dead Sea
where he gave two lectures on the neurosurgical treatment of movement
disorders. From there, we had a Palestinian Christian guide who took us first
to Jericho, then Galilee, then the Jerusalem/Bethlehem area. Now when I read
the scriptures, I can visualize places—the passages have become much more
meaningful for me. I left Tel Aviv for DC to meet Kelly, Joe, and Evelyn for a
few days together until we all flew to Louisiana for my niece’s wedding in St.
Francisville.<span style="mso-spacerun: yes;"> </span>Leland flew back to
Nairobi from Tel Aviv, but he had a quick 6-day trip to Miami Beach where he
was given the Humanitarian of the Year Award by the American Association of
Neurological Surgeons.<span style="mso-spacerun: yes;"> </span>He found it
difficult to pay $23 for a hamburger and drink—prices here, while high by
Kenyan standards, are much more reasonable.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Since the
last blog, we’ve gone from the height of summer to late Fall here.<span style="mso-spacerun: yes;"> </span>In early April, the long rains
started—late—which was the source of some anxiety for the farmers.<span style="mso-spacerun: yes;"> </span>I hesitate to call this “rain;” we have
deluges about every 12 hours.<span style="mso-spacerun: yes;"> </span>Just
today, we received an email saying that the latest water shortage (only one of
many) is due to a landslide that wiped out the main water supply to
Kijabe.<span style="mso-spacerun: yes;"> </span>Our trickle of water today
is a bit dirty—but it is quite possible that there is no water today in the
hospital.<span style="mso-spacerun: yes;"> </span>It can be, um,
disconcerting to have hands full of body fluids of various sources, turn on the
tap, and have NO water. <span style="mso-spacerun: yes;"> </span>Makes
infection control challenging….<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Our roof
leaks every time it rains—I am not talking about a few drips. Our bucket is in
use in the closet, we have papers under the leaks in the hallway and firebox
pipe, and we spend a lot of time using flannel sheets to sop up the water that
leaks behind the paint and seeps out from under the baseboards. With each
deluge, we collect about 4-5 liters of water.<span style="mso-spacerun: yes;"> </span>We have been in contact with the department responsible for
the housing since last March (2011) about the leaks—last Thursday we were
informed that last Saturday we were to move everything because the roof
replacement was to begin yesterday.<span style="mso-spacerun: yes;">
</span>I recently read Jeff Shaara’s book Rise to Rebellion about the Lexington
Green altercation (“Don’t fire until you see the whites of their eyes”) and we
decided that when we see the scaffolding reach the third floor, then we’ll
move.<span style="mso-spacerun: yes;"> </span>It is hard to imagine that
the roof will be replaced during the long rains…no sign of scaffolding yet.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Despite the
aggravation of the leaking roof, we really must keep in mind how many people
have lost houses, farms, cattle, goats, sheep, even family members in these
incredible rains.<span style="mso-spacerun: yes;"> </span>Edward, our
Swahili teacher, tells us that he hasn’t seen rains like these in over 12
years.<span style="mso-spacerun: yes;"> </span>In western Kenya, erosion
has swept away acres of land.<span style="mso-spacerun: yes;"> </span>In
the valley, the nearest town, Maai Mahiu, was flooded as was the IDP
(internally displaced persons) camp near Mt. Longonot.<span style="mso-spacerun: yes;"> </span>We just read that a geologist in
Nairobi is predicting that Mt. Longonot will erupt in the near future.<span style="mso-spacerun: yes;"> </span>So, these are definitely interesting
times here in Kenya.<o:p></o:p></span></div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEgem9yxnrhjX8cgrJ2DpazHX72G6FL3n3dhauH1VB9CTtpf9ugkI3GkVTHKYLrGt9zaQNJxPRpmr10wNLE-DL7nvFb1thgjm6SOF9cYY-2NA7wokmpoXirXReFzydHpsJLML-iiofhYGX/s1600/stepping+over+the+moat.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEgem9yxnrhjX8cgrJ2DpazHX72G6FL3n3dhauH1VB9CTtpf9ugkI3GkVTHKYLrGt9zaQNJxPRpmr10wNLE-DL7nvFb1thgjm6SOF9cYY-2NA7wokmpoXirXReFzydHpsJLML-iiofhYGX/s320/stepping+over+the+moat.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Crossing the moat</td></tr>
</tbody></table>
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<span style="font-family: Arial; font-size: 11.0pt;">Speaking of
erosion—every time it rains a torrent cascades down the hill, splashing into
the steps to our building, sweeping around the building and rushing down the
“driveway”, depositing mounds of red soil down on the lower slopes.<span style="mso-spacerun: yes;"> </span>A few days ago, a young man cleaned the
dirt off the steps and dug a mini-levee and a trench meant to divert the water.<span style="mso-spacerun: yes;"> </span>It is unfortunate that the levee/trench
lies directly in front of our steps—in the US it would definitely be a legal
nightmare.<span style="mso-spacerun: yes;"> </span>Here, one knows to look
out for randomly appearing trenches.<span style="mso-spacerun: yes;">
</span>But, not only do we live in a gated community, when it rains we now have
our very own moat!<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">Some people
have asked me how the people here feel about their children….do they grieve as
we do in the West when a child dies?<span style="mso-spacerun: yes;">
</span>Let me try to give you a feeling for how the parents here cherish their
children…Wonderful, Marvelous, Blessing, Gracious, Hope, Joy, Gift, Precious,
Lucky…these are some of the names of our children at BKKH.<span style="mso-spacerun: yes;"> </span>Death is more common here; one lady
whose baby was seen this week has had 12 children, 5 of whom died.<span style="mso-spacerun: yes;"> </span>However, each child is deeply cherished,
and the death of each child cause extreme grief.<span style="mso-spacerun: yes;"> </span>Some mothers seem quite stoic and don’t cry at all, others
sob, wail, fall on the floor—the same spectrum of responses that I’ve seen in
the US—only there I saw it rarely.<span style="mso-spacerun: yes;">
</span>Here, it is frequent.<span style="mso-spacerun: yes;"> </span>Each
death is hard for all of us—but I want it to keep being hard; I never want to
get used to a child dying.<span style="mso-spacerun: yes;"> </span>Many
times we never know the “cause of death.”<span style="mso-spacerun: yes;">
</span>That makes it difficult to identify and address system problems that
contribute to bad outcomes.<span style="mso-spacerun: yes;"> </span>The
whole team—pediatricians Mardi Steere and Jennifer Myrhe, peds surgeons Erik
Hansen and Ruth Mayforth, and Humphrey Okechi and Leland have worked hard to
support reviews of each death.<span style="mso-spacerun: yes;">
</span>Since our new matron, Ann Mulwa, joined us, I have seen a tremendous
improvement in accountability and professionalism among the nurses.<span style="mso-spacerun: yes;"> </span>Working here with the nurses has become
a real joy.<o:p></o:p></span></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaskec5P5ngMMEFoegyJ1d0YSnPhnf49CwtnbTI6TtFQGVdzyg2SqCEXdeVwgAtZKyT4yr_m4rsFCyesu_6En4K-DQuDQKMP-wIHrgwADSzXeMWds_W9a-szRRns2FbBjnqWHSF4eyaMvh/s1600/rainbow.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaskec5P5ngMMEFoegyJ1d0YSnPhnf49CwtnbTI6TtFQGVdzyg2SqCEXdeVwgAtZKyT4yr_m4rsFCyesu_6En4K-DQuDQKMP-wIHrgwADSzXeMWds_W9a-szRRns2FbBjnqWHSF4eyaMvh/s320/rainbow.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Rainbow over the valley (from our window)</td></tr>
</tbody></table>
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<span style="font-family: Arial; font-size: 11.0pt;">There is
much beauty in Kenya—our picture window overlooking the valley gives an
everchanging view—no evening sky is quite like another, every rainstorm over
the valley has its own pattern, each rainbow is unique.<span style="mso-spacerun: yes;"> </span>But as we drive along the slums in
Nairobi, we are struck by the ugliness that surrounds so many homes.<span style="mso-spacerun: yes;"> </span>It would be hard for me to live
there—maybe I, too, would surround myself with my beautiful children.<o:p></o:p></span></div>
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<span style="font-family: Arial; font-size: 11.0pt;">We’ve been
blessed with many visitors.<span style="mso-spacerun: yes;"> </span>In
early March, Jim Trosen, the former pastor-turned-financial advisor, visited us
and found Kijabe to be “a life-changing experience.”<span style="mso-spacerun: yes;"> </span>He spent the time when he didn’t have to monitor the markets
praying with patients with Pastor Mercy, meeting and talking with other missionaries
and the administrative staff of BKKH.<span style="mso-spacerun: yes;">
</span>After he left, Sandi Lam, a pediatric neurosurgeon working in Chicago,
spent nearly 2 weeks here, covering for Leland during his trip to Israel.<span style="mso-spacerun: yes;"> </span>On my way back from Lousiana, I met
Leland’s sister Mary in Atlanta, and we flew together to Nairobi.<span style="mso-spacerun: yes;"> </span>We were met at the airport after dark
by our driver.<span style="mso-spacerun: yes;"> </span>Mary had her first
encounter with a roundabout (not a good experience for her); the driver didn’t
know the way to the guest house, and I could not give him directions because
every window was completely fogged—either the defroster didn’t work or he
didn’t know about its existence.<span style="mso-spacerun: yes;">
</span>Mary’s eyes were quite large by the time we finally arrived.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Arial; font-size: 11.0pt;">It was a
real help to me to have Mary here—she is a nurse educator so she could identify
needs and think about tactful ways to suggest changes (she is much more tactful
than I).<span style="mso-spacerun: yes;"> </span>Even more important to me
was her ability to see things here through a nurse’s eye—all the other visitors
have been physicians or OR nurses.<span style="mso-spacerun: yes;">
</span>While I’ve enjoyed all their visits, there wasn’t anyone who came with
me on my daily activities and saw the challenges, humor, blessings, and
frustrations that I see every day.<span style="mso-spacerun: yes;">
</span>She was asked to give a class to the OR nurses, which was well received
(they asked her to teach again the next day).<span style="mso-spacerun: yes;"> </span>We joked that this visit was her “fact-finding mission” and
that her next visit will be filled with classes.<span style="mso-spacerun: yes;"> </span>I think Mary also found Kijabe to be “life-changing”—she has
said since returning home that her heart remains here. That is what is striking about Kijabe--it doesn't get into your blood; it gets into your heart.<o:p></o:p></span></div>
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<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Arial; font-size: 11.0pt;">We’ve had a
real decrease in the number of patients—not only in neurosurgery, but all over
the hospital.<span style="mso-spacerun: yes;"> </span>At times we’ve had
more than 40 pediatric neurosurgical patients on our service; today we had 8.<span style="mso-spacerun: yes;"> </span>It is probably partly attributable to
the rains—some places are inaccessible until the roads dry out.<span style="mso-spacerun: yes;"> </span>But, I fear that it is also because of
economic hardships—we’ve admitted a few babies lately whose parents said they
waited to come because they had no money.<span style="mso-spacerun: yes;">
</span>Two of those babies were seen too late in the course of their disease
(hydrocephalus) to be able to help them.<span style="mso-spacerun: yes;">
</span>One was 11 weeks old and weighed less than his birth weight.<span style="mso-spacerun: yes;"> </span>The other was 9 months and weighs 9
pounds—most of which is in her head.<span style="mso-spacerun: yes;">
</span>The number of children with severe malnutrition seems to be increasing;
those children also often have severe anemia.<span style="mso-spacerun: yes;"> </span>My nursing practice here extends far beyond neurosurgical
care—treatment of malaria, malnutrition, anemia, seizure disorders, parasite
infestations, and neonatal sepsis is now part of my repertoire.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Arial; font-size: 11.0pt;">Our beloved
friend and Pastor, Sam Wolff, is leaving Kenya at the end of this month after
30 years in mission work. Cindy,
his wife, left while we were away in March.<span style="mso-spacerun: yes;"> </span>Leland and I will miss them tremendously; we grew to know
and love them in a very short time.<span style="mso-spacerun: yes;">
</span>Leland will have an opportunity to preach from time to time in Sam’s
absence until the new pastor and his wife arrive in August.<span style="mso-spacerun: yes;"> </span>I’ll attach Leland’s latest sermon,
preached last Sunday.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial; font-size: 11.0pt;">We ask for
your prayers for the following:<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Arial; font-size: 11.0pt;">BKKH
administration and Board: that they would make wise decisions regarding the
future of BKKH—the proposed new hospital wing, extension into other African
countries, use of resources in difficult financial times<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Arial; font-size: 11.0pt;">Ann Mulwa
and the BKKH nurses: that they would continue to work toward improving nursing
care of our very needy population<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Arial; font-size: 11.0pt;">Pastor
Mercy Nganga: that she find encouragement to continue her ministry not only in
Kijabe but also throughout Kenya as she trains disciples who support and encourage
our patients in outlying areas<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Arial; font-size: 11.0pt;">Jim and
Julie Taubitz: an engineering team who have provided leadership in planning
infrastructure and the ten year plan for Kijabe Hospital and BKKH<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Arial; font-size: 11.0pt;">Mardi
Steer, Jennifer Myrhe, and Sarah Muma, the pediatricians who provide expert
pediatric medical care as well as consultations on our sickest children<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Arial; font-size: 11.0pt;">Wisdom for
Leland and Humphrey as they search for a candidate for the pediatric
neurosurgical fellowship<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Arial; font-size: 11.0pt;">Patience
and humor for us as we struggle with our very Western reactions in dealing with
very African living conditions—and for the wisdom to stop asking “Why…?”<o:p></o:p></span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgscv8FbK0hBvb8YDCkA9QNZvTYNqiASiyBFSll8OsmtUkKazwXmIeiel_bhYJWysXoLD5ROMkcpuQFF8By4mWofkT21E5CakMkV1V6Og8ulb5RFD3as_DdqBrAnvF5PZTDZdZK7Ue4Cjoz/s1600/Garbage+disposal+system.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgscv8FbK0hBvb8YDCkA9QNZvTYNqiASiyBFSll8OsmtUkKazwXmIeiel_bhYJWysXoLD5ROMkcpuQFF8By4mWofkT21E5CakMkV1V6Og8ulb5RFD3as_DdqBrAnvF5PZTDZdZK7Ue4Cjoz/s320/Garbage+disposal+system.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Garbage Disposal system</td></tr>
</tbody></table>
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<span style="font-family: Arial; font-size: 11.0pt;">Thanks for
your emails, prayers, and encouragement.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: Arial; font-size: 11.0pt;">Susan and
Leland<o:p></o:p></span></div>
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<!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com2tag:blogger.com,1999:blog-8238962161618527090.post-36635973088954228812011-12-24T00:43:00.000-08:002011-12-24T00:47:23.209-08:00<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilpdpuQFdFbVGvtViK9am5EK_amwNu5yKvW_nGFHHtVjNkMOtu1bIO_WWGacIzr1tOljH3FR8m3gKT4HPVU0EhNF0jc2g53Z_1PH100Dgg9IB1JIybfZbHnbgDKbwqHcd3plBk2vbwYZ7l/s1600/Leland+and+Susan.JPG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilpdpuQFdFbVGvtViK9am5EK_amwNu5yKvW_nGFHHtVjNkMOtu1bIO_WWGacIzr1tOljH3FR8m3gKT4HPVU0EhNF0jc2g53Z_1PH100Dgg9IB1JIybfZbHnbgDKbwqHcd3plBk2vbwYZ7l/s320/Leland+and+Susan.JPG" border="0" alt="" id="BLOGGER_PHOTO_ID_5689613712044611762" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkydcHsycRwYh8Xku7qETJnDncU7eNElUwp9cXpO-WLGmT0NoEsTN6PbroSm6DS9_Vk4aZ3IbE9V1y44wVcIp2UiuzzJe2BdJfd7uAKgUXYl6800Ec6re_1Z0XeoCT-cTAe14dCL1ggQ7X/s1600/Tree.JPG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkydcHsycRwYh8Xku7qETJnDncU7eNElUwp9cXpO-WLGmT0NoEsTN6PbroSm6DS9_Vk4aZ3IbE9V1y44wVcIp2UiuzzJe2BdJfd7uAKgUXYl6800Ec6re_1Z0XeoCT-cTAe14dCL1ggQ7X/s320/Tree.JPG" border="0" alt="" id="BLOGGER_PHOTO_ID_5689613701482409890" /></a><br /> <!--[if gte mso 9]><xml> <o:officedocumentsettings> <o:allowpng/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:worddocument> <w:zoom>0</w:Zoom> <w:trackmoves>false</w:TrackMoves> <w:trackformatting/> <w:punctuationkerning/> <w:drawinggridhorizontalspacing>18 pt</w:DrawingGridHorizontalSpacing> <w:drawinggridverticalspacing>18 pt</w:DrawingGridVerticalSpacing> <w:displayhorizontaldrawinggridevery>0</w:DisplayHorizontalDrawingGridEvery> <w:displayverticaldrawinggridevery>0</w:DisplayVerticalDrawingGridEvery> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:dontgrowautofit/> <w:dontautofitconstrainedtables/> <w:dontvertalignintxbx/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="276"> </w:LatentStyles> </xml><![endif]--> <!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} </style> <![endif]--> <!--StartFragment--> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">Habari yako,<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">I am sitting in “our” cottage in Malu (#6) in the mid-morning of our last day here.<span style="mso-spacerun: yes"> </span>The cedar wood fire is crackling in the fireplace, the sun is shining through pillow clouds, a gray, white and yellow bird is hurriedly eating the seed in the feeder before flying off. Mt. Longonot is a hazy blue silhouette beyond the silver outline of Lake Naivasha.<span style="mso-spacerun: yes"> </span>There is silence except for the occasional birdsong. We have found restorative peace here—as always when we come.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">The past month was almost overwhelming—Humphrey Okechi, our pediatric neurosurgery fellow, took a much needed two week break.<span style="mso-spacerun: yes"> </span>Since patients keep coming despite physician vacations, that meant making rounds for 19 days in a row at 6:30 am (7:30 on Saturday), operating 5 days a week with a full schedule, and having no extra hands to see patients in OPD. With God’s grace we made it through, but we needed a few days rest afterward.<span style="mso-spacerun: yes"> </span></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">We had a truly “other-worldly” experience for Thanksgiving this year.<span style="mso-spacerun: yes"> </span>Pastor Sam and Cindy Wolff, our new but already dear friends from Nairobi International Lutheran Congregation, invited us to dinner on Thanksgiving.<span style="mso-spacerun: yes"> </span>We drove from Kijabe in the afternoon, arriving at their apartment just at dusk.<span style="mso-spacerun: yes"> </span>For the next 2 hours, we sat out on the balcony eating samosas and sipping wine with two other congregants—Grace, a Tanzanian professor of sociology, and Tekye, a businessman from Eritrea.<span style="mso-spacerun: yes"> </span>I remarked that I’d never sat outside for appetizers on Thanksgiving in my entire life—it is a different world here.<span style="mso-spacerun: yes"> </span>Then, Sam and Cindy served a real American Thanksgiving feast—complete with stuffing, gravy, cornbread, sweet potato casserole and a delicious turkey from Naivasha.<span style="mso-spacerun: yes"> </span>My contribution to the meal was a pumpkin pie—made from a Kenyan pumpkin.<span style="mso-spacerun: yes"> </span>Not quite Libby’s but it worked all the same!</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">The week after Thanksgiving, a friend at church had an amazing experience.<span style="mso-spacerun: yes"> </span>He is a vibrant 81 year old man from Eritrea (he jumps rope 100 times each day) who works fulltime in business.<span style="mso-spacerun: yes"> </span>He has been quite successful and lives in Nairobi.<span style="mso-spacerun: yes"> </span>He came home in the evening to find three heavily armed men robbing his apartment.<span style="mso-spacerun: yes"> </span>They demanded money, which he gave them, then asked him to open his safe.<span style="mso-spacerun: yes"> </span>He told them he doesn’t have a safe; he keeps his money in the bank.<span style="mso-spacerun: yes"> </span>They then stole all of his jewelry, his TV and everything else they could carry—loading everything in three trips into his car. <span style="mso-spacerun: yes"> </span>Before they left, he reminded them to take the TV remote with them.<span style="mso-spacerun: yes"> </span>As he told this story, he had what can only be described as a beautific countenance—he said that as the men were robbing him, he felt a sense of complete peace—even happiness.<span style="mso-spacerun: yes"> </span>He knew that God was present with him.<span style="mso-spacerun: yes"> </span>It is very common to read that people are killed during these robberies; we were overjoyed that he was spared.</span><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;"> </span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">My health has not been spectacular since we came back from the States.<span style="mso-spacerun: yes"> </span>I had a brown recluse spider bite that morphed into an abcess that needed to be surgically drained—my second time of going under the knife this year.<span style="mso-spacerun: yes"> </span>I feel like the aging Queen Victoria with my personal surgeon, Peter Bird.<span style="mso-spacerun: yes"> </span>The spider bite, more than 2 months later, is finally scarring over—at least it is no longer painful.<span style="mso-spacerun: yes"> </span>I had a terrible bout of gastroenteritis that kept me in bed for 3 days (quite unlike me) and washed me out for about 2 weeks.<span style="mso-spacerun: yes"> </span>Then a hacking cough appeared—which is just now resolving.<span style="mso-spacerun: yes"> </span>But the latest assault to my misperception of health has been the recurrence of severe biliary colic (pain due to spasms of my common bile duct—I no longer have a gallbladder to blame).<span style="mso-spacerun: yes"> </span>It was so severe last week that Leland ran up to Casualty to get me some IM pethidine (Demerol) for the pain (I gave myself the injection).<span style="mso-spacerun: yes"> </span>We went to Nairobi to get a special MRI but the MRI machine broke while we were enroute.<span style="mso-spacerun: yes"> </span>After waiting 5 hours while technicians hurried in and out of the scanning room, we gave up, had a really nice dinner at an Italian restaurant in Nairobi, and returned to Kijabe.<span style="mso-spacerun: yes"> </span>Fortunately since then, I’ve had only occasional twinges of pain—and I think my liver enzymes are back to normal—I feel energetic again.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">The bimonthly audit was due last Friday—reviewing the numbers from September and October.<span style="mso-spacerun: yes"> </span>I enjoy preparing and presenting the audit, though it entails a phenomenal amount of data review and analysis.<span style="mso-spacerun: yes"> </span>We usually find some surprising facts—for instance, our number of deaths over those two months was the highest for any two months over the past year—8.<span style="mso-spacerun: yes"> </span>Three were related to myelomeningoceles, two were related to hydrocephalus, and three to brain tumors (one in an adult and two in children).<span style="mso-spacerun: yes"> </span>It is possible that, had we had a CT scanner here, at least one death in the children with tumors could have been prevented.<span style="mso-spacerun: yes"> </span>Plans are underway to ship a good quality CT scanner here in January—though it will be months before it is installed and operational.<span style="mso-spacerun: yes"> </span>But, our ability to treat postoperative complications in people who undergo craniotomy and in those with trauma will be markedly improved once we have a CT scanner on site.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">In preparing the audit, we identify ways to improve our care—we had several children who were either discharged or ready to be discharged on palliative care status.<span style="mso-spacerun: yes"> </span>That means that we believe that futher medical treatment is futile (either because of non-response of severe gram negative CSF infection to antibiotics or because of multiple congenital anomalies in addition to spina bifida that make the likelihood of life grim).<span style="mso-spacerun: yes"> </span>In those situations, we talk with parent and other family members if they are available, tell them what we believe the prognosis to be (acknowledging that God alone knows the outcome), and ask what they would like to do.<span style="mso-spacerun: yes"> </span>Circumstances differ, but almost all women will tell us that they would like to take the baby home—often they want to leave that very day.<span style="mso-spacerun: yes"> </span>However, many cannot leave that day (they are unable to get a pass to leave the gate until the bill has been paid), so the babies are still in the annex but discharged.<span style="mso-spacerun: yes"> </span>Several have died while waiting to go home—on two occasions, they were unsuccessfully resuscitated.<span style="mso-spacerun: yes"> </span>If the hospital interns are called, they almost always fully resuscitate—their spiritual belief is that God needs and expects their full intervention to prevent death.<span style="mso-spacerun: yes"> </span>Because this is so upsetting to all involved, the pediatricians have become quite involved in helping us to improve communication and update our resuscitation efforts.<span style="mso-spacerun: yes"> </span>This has resulted in clearer communication in the patient file regarding the discussion held with the mother and in orders that not only convey the palliative care status (do-not-resuscitate) but also what the nurses are to do if the baby is apneic and pulseless (put the baby in the procedure room with oxygen, keep it warm, take the mum to a quiet place and console her, call the neurosurgery resident on call to inform him/her). In addition, the nurses now feel empowered to begin resuscitation before a doctor arrives—and they successfully resuscitated a baby in annex who aspirated and arrested last week.<span style="mso-spacerun: yes"> </span>We were proud of them.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">Each morning here in Malu we’ve taken a walk—the air is chilly but the sun is hot.<span style="mso-spacerun: yes"> </span>The first day, Leland and I walked up to the airstrip—and looked north at the rugged eastern escarpment of the Rift Valley.<span style="mso-spacerun: yes"> </span>Yesterday, Tanga, the Rhodesian Ridgeback, accompanied us on our way to the Plunge Pool—a warm water spring that we’ve visited on past stays here.<span style="mso-spacerun: yes"> </span>We were approaching an area where buffalo wallow in the mud (only at night—they withdraw to the forest during the day) when suddenly Tanga stopped in her tracks, shied, and then listened intently to something neither Leland nor I could hear.<span style="mso-spacerun: yes"> </span>After about 30 long seconds, she shied again, then abruptly turned around and briskly walked back up the trail.<span style="mso-spacerun: yes"> </span>We never did know what she heard or smelled but were grateful that she was with us on that walk.<span style="mso-spacerun: yes"> </span>Tanga, like most of her breed, is a very courageous dog—they were bred to hunt lions—so whatever it was out there, it wasn’t nice.<span style="mso-spacerun: yes"> </span>Back in the cottage, I read that leopards are numerous here—and though they hunt at night, I wouldn’t want to inadvertently stumble upon one.<span style="mso-spacerun: yes"> </span>In fact, because of baboons and leopards, dogs in Malu are locked up at night.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">Christmas—what memories does that invoke for you?<span style="mso-spacerun: yes"> </span>Snowflakes silently carpeting the sidewalks with sparkles, seeing your breath in the cold air, the scent of pine needles as you decorate the tree, steamed pudding with hard sauce, driving through the neighborhood to see the Christmas lights, welcoming your family home for the holidays.<span style="mso-spacerun: yes"> </span>I think that is what makes Christmas here hard—we have to make new memories.<span style="mso-spacerun: yes"> </span>This year, we will have a 2’ tree; next year we will have an Advent wreath.<span style="mso-spacerun: yes"> </span>We have appreciated the Advent services and sermons this year—calling us to wait upon the Lord.<span style="mso-spacerun: yes"> </span>Both Leland and I have been reading and praying about the Kingdom of God—what that means here and now; what our contribution to bringing God’s Kingdom has been, is, and should be.<span style="mso-spacerun: yes"> </span>We find that reading somewhat controversial books on Christian theology and rereading scripture challenges us to define our beliefs, allows God to speak to us in new ways with new ideas—we are quite thankful, at this point in our lives, to have our minds stretch instead of stagnate.<span style="mso-spacerun: yes"> </span>Some of those books are:</span></p> <p class="MsoNormal" style="text-indent:.5in"><span style="font-size:11.0pt; mso-bidi-font-family:Arial;font-size:10.0pt;">A Generous Orthodoxy, Brian McLaren<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:.5in"><span style="font-size:11.0pt; mso-bidi-font-family:Arial;font-size:10.0pt;">Radical, David Platt<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:.5in"><span style="font-size:11.0pt; mso-bidi-font-family:Arial;font-size:10.0pt;">Love Wins, Rob Bell<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:.5in"><span style="font-size:11.0pt; mso-bidi-font-family:Arial;font-size:10.0pt;">Blue Like Jazz<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:.5in"><span style="font-size:11.0pt; mso-bidi-font-family:Arial;font-size:10.0pt;">Surprised by Hope, N.T. Wright<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:.5in"><span style="font-size:11.0pt; mso-bidi-font-family:Arial;font-size:10.0pt;">Yearning: Living Between How It Is & How It Ought to Be, M. Craig Barnes<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:.5in"><span style="font-size:11.0pt; mso-bidi-font-family:Arial;font-size:10.0pt;">Your God is Too Safe, Mark Buchanan</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">Thank you for your continued prayers for us—we need those. Please pray for our new Nursing Matron, Ann Mulwa, as she begins her leadership in the pediatric section of Kijabe Hospital and BKKH.<span style="mso-spacerun: yes"> </span>Pray for all the nurses as they care for and comfort the children and families.<span style="mso-spacerun: yes"> </span>Keep Pastor Mercy in your prayers—she is a tireless presence on the ward, and she has an emotionally exhausting job in counseling the mothers of very ill children.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">If anyone has access to intravenous vancomycin, ciprofloxacin, or meropenam, please contact us.<span style="mso-spacerun: yes"> </span>We use those drugs to treat CSF infections—they are quite expensive to buy here so using donated drug makes a world of difference to our families.<span style="mso-spacerun: yes"> </span>We have nearly used our supplies of vancomycin and ciprofloxacin; meropenam costs about $40-50/day—far exceeding what our families can afford.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">We wish you a very joyful Christmas and safe and happy New Year.<span style="mso-spacerun: yes"> </span>May your minds and hearts be overflowing with the love of God.</span></p> <p class="MsoBodyText"><i><b>“The people living in darkness have seen a great light; on those living in the land of the shadow of death a light has dawned.” (Isaiah 9:2)….”You are the light of the world…let your light so shine before men that they may see your good deeds and praise your Father in heaven.” (Matthew 5: 14, 16)….”therefore…shine like stars in the universe as you hold out the word of life.” (Philippians 2: 12, 14)</b></i></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">Take care, God bless.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;">Susan<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:10.0pt;"><o:p> </o:p></span></p> <!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com2tag:blogger.com,1999:blog-8238962161618527090.post-70704266089197687272011-11-04T09:57:00.000-07:002011-11-04T10:14:20.169-07:00<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgb6oVL1giNhAgiQxCsa9H3PMAnsP3LxNfo9yAFaNW4glowNSTjK_u147ZCvkFlDC8Q6QeQttqVDkLezZpCNkn3Qa2cAsbMGF1XovNfkEynKJKWyvUZ-9wP6HLO0g-UuD8ZfBTlvobnuQCt/s1600/the+big+blow.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; 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mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} </style> <![endif]--> <!--StartFragment--> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;font-size:100%;">Habari Rafiki (friends),<o:p></o:p></span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">It has been quite a long time since I last posted a blog.<span style="mso-spacerun: yes"> </span>Many reasons—travel, lack of a working, reliable internet connection, sheer busyness.<span style="mso-spacerun: yes"> </span>I will try to convey some of the adventures of the past few months.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">On September 1, we celebrated our first year in Africa on safari with Michael and Marisa in Masai Mara—probably the best-known game park in Kenya.<span style="mso-spacerun: yes"> </span>We caught the last weeks of the wildebeest migration—by the time we were there, the long grassland had been cropped short by thousands of wildebeests (also known as gnus).<span style="mso-spacerun: yes"> </span>Our first evening game drive was highlighted by a halfhearted chase of a zebra by an obviously well-fed cheetah.<span style="mso-spacerun: yes"> </span>Our guide, Stephen, laughed—the zebra was far too big for the cheetah to bring down alone.<span style="mso-spacerun: yes"> </span>It was as if the cheetah thought she should put on a show for her 7-vehicle audience.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">Parts of the game drive were wondrous—seeing the beauty of the sunrise over the eastern hills, being the lone car to see a herd of elephants silently emerge from a thicket of scrub trees, following the single file migration of thousands of wildebeests on the horizon, watching four giraffes feed on acacia trees in the morning mist—their almost prehensile tongues curling gently around the leaves among the thorns.<span style="mso-spacerun: yes"> </span>Other stories were sad—a baby wildebeest wandering aimlessly alone far from any herd, the remains of his mother’s body being devoured by vultures and maribou storks.<span style="mso-spacerun: yes"> </span>The baby kept approaching the carcass—the smell was overpowering.<span style="mso-spacerun: yes"> </span>Stephen predicted that the same lion that killed the mother would be back for the baby that night.<span style="mso-spacerun: yes"> </span>I was glad Kelly was not with us—those are the kinds of stories that broke her heart when she was little.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">We drove down the Mara river valley to one of the crossing points for the famous wildebeest migration—we saw just a few stragglers crossing but found scores of dead wildebeest bodies floating in the river, bloating on the gravel beneath the rapids, one hippo eating a dead wildebeest in the river—plunging up and down with the body in its mouth.<span style="mso-spacerun: yes"> </span>And all along, I thought hippos were strict vegetarians.<span style="mso-spacerun: yes"> </span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">Oddly enough, for me, the safari was spiritual as well—as we watched lions feeding on a freshly killed carcass, the words from Matthew 26 came to me, “Take and eat, this is my body…Drink…this is my blood…” I became intensely aware of the brutality of Christ’s death—and how we are made alive because of his death and resurrection.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">In late September, we flew to the US for a much needed break.<span style="mso-spacerun: yes"> </span>Michael met us at O’Hare in Chicago; we borrowed his car for the two weeks and drove to Door County, Wisconsin, stopping on our first day just north of Milwaukee at a shopping mall.<span style="mso-spacerun: yes"> </span>I know that people sometimes disparage the people in the US, but we consistently met wonderful people.<span style="mso-spacerun: yes"> </span>One lady couldn’t make change for my dollar for our parking meter so just gave me 3 quarters.<span style="mso-spacerun: yes"> </span>I bought some cosmetics and ended up spending about 45 minutes talking with the 27 year old single mom who wanted so much to raise her son with good values and a serious work ethic.<span style="mso-spacerun: yes"> </span>Our spirits were uplifted and encouraged by those and other similar interactions.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">Our destination was a small island in Sawyer Bay—an indentation along Green Bay.<span style="mso-spacerun: yes"> </span>We took the pontoon boat over, ferrying our luggage and groceries.<span style="mso-spacerun: yes"> </span>My sister Ginni drove from Lancaster to join us a few days later.<span style="mso-spacerun: yes"> </span>We had one glorious early fall day to tour the peninsula before the storm hit—70 mph winds, multiple leaks in the cottage roof, loss of electricity and water—and no cell phone or internet access.<span style="mso-spacerun: yes"> </span>By the time the winds ceased and we were able to return to the mainland (minus the canopy for the pontoon boat which had been torn off in the gale), we found that the road out was blocked by a large fallen tree—other trees had been uprooted (they call it tipping) but amazingly had fallen in between the closely grouped cabins—no cabin had sustained more than minor damage and no person had been hurt.<span style="mso-spacerun: yes"> </span>We learned that the reason that trees “tip” there is that the soil is only a few feet deep—below it is rock—so the trees cannot put down deep roots and thus are vulnerable to being blown over.<span style="mso-spacerun: yes"> </span>It was a dramatic illustration of how important it is to have deep roots.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">After a worker held up the downed (and dead) electric lines behind Ginni’s car, she was able to leave.<span style="mso-spacerun: yes"> </span>Julie and Art were to have arrived that night, but the flights had been cancelled because of widespread storms. The next day, Saturday, Leland and I moved over to a cottage on the mainland (where we had electricity and water) and Julie and Art arrived later that evening.<span style="mso-spacerun: yes"> </span>We again toured the peninsula and even took a ferry to Washington Island, the “highlight” of that trip being a tour on the “Viking Train” where we stopped at an Ostrich farm (Leland and I declined the tour since we had just seen ostriches in the wild in Kenya).<span style="mso-spacerun: yes"> </span>We all decided that the Viking Tour would be a once in a lifetime experience that we need never suffer again.<span style="mso-spacerun: yes"> </span>On Monday, Leland’s sister Mary arrived—fortunately overlapping with Julie and Art so the family had time to reconnect.<span style="mso-spacerun: yes"> </span>It was so good to spend time with our family—we miss them.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">We also found renewed and deep appreciation for so many things we used to take for granted—wide, well-paved, smooth roads, good signage, going out to restaurants, laundromattes, toilet paper and paper towels in restrooms, work crews to fix downed power lines.<span style="mso-spacerun: yes"> </span>I miss the energy of the people in Wisconsin, the forthrightness.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">We had an adventure (ok, so we got really lost—this time I’ll admit it) two weeks ago.<span style="mso-spacerun: yes"> </span>We were invited to a reception at the US ambassador’s home for those who work with people with disabilities.<span style="mso-spacerun: yes"> </span>US citizens’ tax money has gone to excellent use; the residence is tasteful without being ostentatious; the food was delicious but not excessive, and Judy and Scott Gration are excellent hosts and represent our country beautifully.<span style="mso-spacerun: yes"> </span>Toward the end of the evening, though, all the lights went out.<span style="mso-spacerun: yes"> </span>As we left in complete darkness, I mentioned to Judy my surprise at the lack of emergency generators.<span style="mso-spacerun: yes"> </span>She said they have emergency generators but that those hadn’t kicked on—the first time that had happened.<span style="mso-spacerun: yes"> </span>Of course, I’m looking in the bushes for the terrorists.<span style="mso-spacerun: yes"> </span>The whole area was without power, so as we drove away, we made a few wrong turns—we finally reached a familiar road—the new Thika road (built by the Chinese government)—but apparently went north in the direction of Thika instead of south in the direction of town.<span style="mso-spacerun: yes"> </span>We found out something very interesting—one can get on the road to Thika but there are no exits.<span style="mso-spacerun: yes"> </span>Ninety minutes later, we found ourselves far north of the city in the worst jumble of cars going in every direction (a bus was coming toward us in our “lane” --I use that term loosely--leaning ominously at a 45 degree angle.<span style="mso-spacerun: yes"> </span>Three hours after leaving the ambassador’s residence, as we were back in Nairobi and were approaching the Mennonite House where we were to spend the night, we hit a pothole and felt/heard the whump-whump of a flat tire.<span style="mso-spacerun: yes"> </span>It was nearly midnight, it was raining, it was on a less than wondrously safe road in Nairobi (the police shoot people dead there with some regularity).<span style="mso-spacerun: yes"> </span>Leland pulled over at a matatu pick up point (deserted) and Charles, a security guard, stepped out of the shadows, saluted us smartly, and proceeded to help us change the tire—in fact, he did the bulk of the work.<span style="mso-spacerun: yes"> </span>We are blessed to find wonderful people in Kenya as well as in the US.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">Leland and I have spent some time reflecting on this past year.<span style="mso-spacerun: yes"> </span>We expected it to be hard to make the transition from living in the US to making our home here.<span style="mso-spacerun: yes"> </span>The ways in which it has been hard, though, have surprised us.<span style="mso-spacerun: yes"> </span>We thrive on the long hours and complex cases, we so enjoy the interactions with the patients and families.<span style="mso-spacerun: yes"> </span>We are encouraged by working with many nurses and support staff—we often feel that we are working together as a team.<span style="mso-spacerun: yes"> </span>Our Swahili is improving polepole (slowly) so that we can carry on rudimentary conversations—at least can ask questions; sometimes if the patient is garrulous, we don’t completely understand the answers.<span style="mso-spacerun: yes"> </span>We love learning a new language and look forward to each lesson with Edward.<span style="mso-spacerun: yes"> </span>We are so inspired by the vista out of our apartment window—and now that the weather has changed, the mountain range on the western rim of the Rift valley is again in view.<span style="mso-spacerun: yes"> </span>I find that the simplicity of life (no TV, no radio, no easily accessible stores) helps me focus on my spiritual growth.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">What we find hard is having few close friends of our age with whom we can share problems—though we are becoming close to our pastor and his wife, Sam and Cindy.Wolff in Nairobi.<span style="mso-spacerun: yes"> </span>We find that the bureaucracy of this hospital is little different from that of those in the States.<span style="mso-spacerun: yes"> </span>We are often surprised by the lack of good communication among the administrators so that decisions that have been made have not been communicated; other longstanding problems have not been addressed, problems that are of significant importance are not shared with us until it is nearly too late to resolve them.<span style="mso-spacerun: yes"> </span>We still are surprised with the “disappearances” of items—my stethoscope (which was later found), my infrared thermometer, our umbrella (which was mysteriously returned three days later).<span style="mso-spacerun: yes"> </span>Some of the things are small, some are hard to replace—it is discouraging to not be able to trust that if something is put in a particular place it will be there later. It continues to be hard that poverty prevents access to care that is taken for granted in the US.<span style="mso-spacerun: yes"> </span>The sheer number of deaths continues to stun us—I have seen more babies die in the past year than in my previous 38 years of nursing.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">Some people have asked about the safety here since the Kenyan army entered Somalia in search of Al Shaabab.<span style="mso-spacerun: yes"> </span>We have seen definite improvements in security in Nairobi—the mall where we grocery shop has installed gates so that every car is searched (boot [trunk] opened, mirrors under the car, etc), there are more visible security personnel patrolling.<span style="mso-spacerun: yes"> </span>Many westerners are avoiding shopping malls and restaurants entirely—we have decided to just be more vigilant and to not sit in outside cafes.<span style="mso-spacerun: yes"> </span>Here in Kijabe, we see trouble of a different sort—there was a carjacking recently, a young Kijabe Village resident is on drugs and has been harassing some of the missionaries and RVA female students.<span style="mso-spacerun: yes"> </span>People throughout Kenya are becoming more desperate as inflation skyrockets and more people are going hungry.<span style="mso-spacerun: yes"> </span>The hospital recently added an armed guard (the AK47 is pretty prominently displayed) at the main gate.<span style="mso-spacerun: yes"> </span>But we have not felt at all unsafe here.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">We have specific requests: Almost none of the nurses own a stethoscope.<span style="mso-spacerun: yes"> </span>We would like to make sure that each nurse has one.<span style="mso-spacerun: yes"> </span>I am making arrangements for shipment—if anyone would like to contribute toward that, please contact me.<span style="mso-spacerun: yes"> </span>There are about 30 nurses, only about 2 have stethoscopes.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">We continue to need help for our patients who have no money to pay for scans.<span style="mso-spacerun: yes"> </span>We also have a few children who need radiation or chemotherapy after brain tumor resection—with that they could be cured, without it, they will probably die from recurrence of the tumor.<span style="mso-spacerun: yes"> </span>Contributions to the BKKH Pediatric Neurosurgery Patient Subsidy Fund go toward those kinds of costs.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;font-size:100%;">Leland is still looking for funding for a second Pediatric Neurosurgery Fellow.<span style="mso-spacerun: yes"> </span>We have an excellent candidate but have no funding for his position.<span style="mso-spacerun: yes"> </span>Leland has made contacts with pediatric neurosurgery associations in the US and with medical equipment companies but so far has found no funds.<span style="mso-spacerun: yes"> </span>Medtronic continues to fund Humphrey Okechi’s fellowship which will extend another year. We know that Humphrey was and continues to be an answer to prayer.<o:p></o:p></span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">BKKH continues to struggle with ongoing funding of care to the children who need surgery.<span style="mso-spacerun: yes"> </span>We need creative ideas to provide funding long-term to support surgery here—both general pediatric surgery and pediatric neurosurgery--so that the children of Kenya have access to basic care.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">Most of all we need your continued prayers—for health, patience, love for those with whom we work, wisdom in the choices we face every day, the administration of BKKH, the new Nursing Matron, the nurses and staff.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;">Well, the short rains are here.<span style="mso-spacerun: yes"> </span>The winds at night have returned.<span style="mso-spacerun: yes"> </span>We have come full circle in this year—death and new life, brutality and incomparable beauty.<span style="mso-spacerun: yes"> </span>What a wonderful place this is—the place God has brought us, sustained us.<span style="mso-spacerun: yes"> </span>Wherever we are, it is the place God has put us to serve him.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:medium;"><i>“To him who is able to keep you from falling and to present you before his glorious presence without fault and with great joy—to the only God our Saviour be glory, majesty, power and authority, through Jesus Christ our Lord, before all ages, now and for evermore! Amen." Jude 24-25.</i></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;font-size:100%;">Take care, God bless.<o:p></o:p></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;font-size:100%;">Susan</span><span class="Apple-style-span" style="font-size: 11pt; font-family:Arial;"><o:p></o:p></span></p><p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;font-size:100%;"><br /></span></p> <!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com2tag:blogger.com,1999:blog-8238962161618527090.post-619926494101400092011-08-21T06:37:00.000-07:002011-08-21T07:03:23.356-07:00<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdeOc54XlkpcskAqb7MMWSdLhL8dmXr-TI3wqQ6VqRYCvDap7xggR7lTSNGPM3peVb87SJKcQ_-GCC5uoNYwWvkBxh1W97VEJfPbaG4TBZFOh510X5hNYlqh0VfIVJnKOYcxCgwi_xaxta/s1600/after+church+crowd.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdeOc54XlkpcskAqb7MMWSdLhL8dmXr-TI3wqQ6VqRYCvDap7xggR7lTSNGPM3peVb87SJKcQ_-GCC5uoNYwWvkBxh1W97VEJfPbaG4TBZFOh510X5hNYlqh0VfIVJnKOYcxCgwi_xaxta/s320/after+church+crowd.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5643304773899132018" /></a>
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<br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_VXmG_VqfzrkCiTm2V7dNPKuD9AknvGvxUId-7V5BJjsLbRiccSEEtvGQMw6Y3duI7qgw_o6ZQTrRCg6e5tOiCYc7ARET2Gm59JIo4tOG-65XCjhCE3msnga2Bn8qBWv77u-sEVqV2213/s1600/Pastor+Mercy.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_VXmG_VqfzrkCiTm2V7dNPKuD9AknvGvxUId-7V5BJjsLbRiccSEEtvGQMw6Y3duI7qgw_o6ZQTrRCg6e5tOiCYc7ARET2Gm59JIo4tOG-65XCjhCE3msnga2Bn8qBWv77u-sEVqV2213/s320/Pastor+Mercy.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5643304767885404242" /></a>
<br /><!--StartFragment--> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Habari yako,</span></span></p><p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">The two pictures at the top of the posting are what we saw coming out of church one Sunday--the cows crossed right in front of our car--on a major road in Nairobi--on their way to a pasture in the forest sanctuary. To the left of the text is a picture of one of my favorite people in Kenya--Pastor Mercy, who has been a tremendous source of comfort, affirmation, and encouragement.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">In the blog, I’ve tried to convey some of our impressions of life in Kijabe to you in the West. Leland and I obviously see life here in light of our own experiences, biases, world views, philosophies. The African culture is quite different from ours—some things are mutually hard to understand—our directness is seen as rudeness; our pursuit of excellence is seen as being critical and “nitpicking.” When nurses or patients tell us what they think we want to hear instead of what really happened, we interpret that as untruthfulness instead of politeness; we see the lack of pursuit of excellence as “wrong.” There is a cultural tension in living here that we may never resolve—yet we need to find ways to work together that affirm each other. Lately, I’ve found that harder to do.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Leland and I have been learning Swahili. Our teacher, Edward Amalu, has a vast knowledge not only of the grammar and vocabulary but also of the origins of the language and the different groups in Kenya who influenced the development of Swahili. There are many sounds in Swahili that are not part of American English speech—the n’g as in n’gombe (cow) in which one does something weird at the back of the throat, the ny as in nyanya (either grandmother or tomato—go figure that one) which has the same sound as a child’s taunting, or the ubiquitous m or n beginning a word with the next letter being a consonant. With my hearing loss, it is a bit harder to know if I am saying something correctly—so I tend to overemphasize some of the beginning m’s or n’s. While many of the patients and staff seem to appreciate that we are trying to learn the language, the staff’s laughter, bordering on ridicule, of our pronunciation can be hurtful. At least the patients are a bit kinder. Edward said that is just the African way and it isn’t meant to be harsh. But it is hard for us to imagine a group of nurses in the US who would do the same.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Do you know that there is no word in Swahili for “excellence?” The closest is nzuri (or mzuri) sana sana which means very very good. We see the poor quality of construction of our quadplex and the workers’ complete inability to understand why these wazungu are so upset about panes of glass that fall out of windows, ceilings and toilets that leak onto the floor, doors that are so warped that one cannot lock them. It is apparent that “excellence” was not a pursuit during construction. </span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">One of our missionaries recently participated in fighting a fire. A Kenyan living nearby had been given a house—apparently some of her neighbors greatly resented that. When the house was burning, it was learned that the fire truck from the town was disabled, so the truck from Rift Valley Academy was finally called for—but ran out of water. By the time the missionary arrived at the scene, many neighbors were standing around watching, with only about 5 people fighting the fire with buckets. The missionary saw some men looking through tools at the scene and was heartened, thinking they were arming themselves to join the firefighting effort. But, what they were doing was stealing the tools. We hear many wonderful things about the sense of community in Africa and how people support each other. And, we see that in the way some share their food, housing, clothing. But we also see these other things—the women who have been disowned, the reports in the newspaper of the 90 year old man who was accused of witchcraft, burned and lynched by his “neighbors.” It is amazing how often reports of mob “justice” are in the paper. Leland and I see such contrasts every Sunday when we go from the poverty of most of the patients in Kijabe to the relative affluence of many in Nairobi.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">We have been in Kenya now for nearly a year. I feel sometimes like I am on an emotional rollercoaster. Lately, that coaster has been going downhill. We have been told that we have to cut back because of lack of funds—our census over the past two months has been lower than usual yet I think I am better emotionally when things are too busy—then I don’t have time to ruminate on missing my kids, my friends, the little things of life in the US (like a garbage disposal and a clothes dryer). However, we have been incredibly blessed with good health—and considering the environment, that is remarkable. One excellent young nurse recently cared for a sick baby and pricked herself with a needle used on the child. She had the baby tested for HIV—the test came back positive. It is not unusual to take care of children with HIV and/or tuberculosis (two of the latter this past month). So, we don’t take our good health for granted here. One of the long-term missionaries, a general surgeon, has developed a very serious debilitating illness which has not been able to be diagnosed in Kijabe—or probably anywhere in Kenya. He has failed treatment for a host of infectious diseases including TB—and has returned to the US so that he can have more diagnostic studies. We just learned today that his wife’s father in the US has been diagnosed with terminal pancreatic cancer. Our difficulties pale in comparison.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Since we both felt the need for a break from Kijabe, we drove down to Nairobi last weekend and were ensconced in the Mennonite Guest House. It is a wonderful place—relatively low cost with meals included, a spacious and clean room with two balconies overlooking the beautifully tended grounds. At night, we heard the call to prayer at a mosque nearby—since it is Ramadan, there tends to be more activity after dark in the Muslim areas. We each read a book—mine, The Appeal, by John Grisham, and Leland’s, Cry the Beloved Country, were found in the Guest House Library—each of us finished our book in one day. One of the best things about staying there are the people we’ve met. Meals are family style, so we met new people at each meal. Saturday night at dinner and again on Sunday morning at breakfast, we talked with a lady born in South Sudan who now lives in Canada. She was a refugee in Northern Kenya earlier in her life; she attempted to obtain an American visa but was turned away because her children didn’t have documents (they were refugees, so didn’t have legal “papers”). She then went to the Canadian Embassy where she was told that if she emigrated without the children, she would be able to get papers for them later. That is what she did—her son stayed in Kenya and completed high school before emigrating to Canada where he is enrolled in a master’s program. However, her daughter became pregnant and now has three children and is dying of AIDS. The lady is in Kenya to take her nephews back to Canada—her brother, their father, recently died and they were abandoned by their mother. The boys are 14 and 7 years—and are the saddest looking children I have seen in a while. She said that about 8 months before her brother’s death, she had a premonition that God wanted her to adopt two children from Kenya—but at that time she had no idea that those children would be her nephews. She has a tremendous faith and spirit; it was humbling and a privilege to eat with her and listen to her story.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Relationships are said to be incredibly important here. I, in particular, have been criticized for not spending more time chatting with the nurses. I’ve been criticized for my lack of chatting just about everywhere I’ve ever worked—and especially with my hearing loss, I tend not to spend much time in chatting. But, as I explained to the Deputy Matron who brought this to my attention, in the West, relationships are based on mutual trust. I find it hard to build a meaningful relationship with those who may or may not tell the truth about whether or not a medicine was given or who take little responsibility for carrying out orders. I had a retractable tape measure for measuring the babies’ head circumferences—they are hard to find in Kenya—that disappeared one day while I was resuscitating a baby—a pediatric resident helping me had her pen disappear. While these things are not huge or costly, it is hard to replace them here—the hospital does not stock pens and I’ve brought mine from the States. And it is very discouraging to have that kind of thing happen. There is a different culture regarding relationships and money as well. Leland was interested in getting to know the security guards by name; he introduced himself to one guard who told Leland his name and then said, “Now that we are friends, can you give me money?” There are many needs here—many people with whom we work are advancing themselves by going to school part-time; we try to help those with whom we have a real relationship. But the constant request for money makes it hard to be a cheerful giver. Last Sunday, two children knocked on the door asking for money to pay a relative’s hospital bill. We have very little way of knowing when these are legitimate requests.</span></span><span class="Apple-style-span" style=" ;font-family:Arial;font-size:small;"> </span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Another facet of life here in Kijabe is the constant feeling of being on display. It is understandable that some, even many, of the patients have seen very few white people—so when the babies look at me and their eyes become like saucers, I understand and can laugh about that. Often children will walk or run by me and hit me or try to touch me. The stares that accompany every move through the hospital are not unfriendly—but neither are they friendly. They are the same stares that are given to animals in a zoo. What is harder is that, despite the many decade presence of white missionaries in Kijabe, the Kenyan population of the town also tend to stare in the same way. Once I was shaking out my mop and saw five men </span></span><span class="Apple-style-span" style=" ;font-family:Arial;font-size:small;">avidly </span><span class="Apple-style-span" style=" ;font-family:Arial;font-size:small;">watching me from behind a tree. I wondered, had they never before seen a white woman shake out a mop? And then I thought, "Perhaps not!"</span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">One of the things we are most looking forward to is Michael and Marisa’s visit to Kenya at the end of this month. We will meet them in Nairobi, then spend a couple days in Kijabe where they can rest and acclimate to the time change—then we plan a safari to Maasai Mara to see the end of the wildebeest migration. We will end our stay in Nairobi—hope to do the sightseeing there that we’ve not had the time to do as yet—the animal orphanage, the giraffe feeding center, the Museum complex with a world renowned early hominid collection.<o:p></o:p></span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">I hesitate sometimes in relaying these less cheerful and upbeat facets of our lives here—yet I need to be genuine. This life is incredibly challenging; it can be exciting, fulfilling, enriching—yet parts are terribly hard as well.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Despite all that I’ve relayed, we continue to be convinced and feel deeply that God has called us here. I would ask for your prayers that I can be more forgiving, less critical, more welcoming of differences in philosophy and custom. We ask your prayers for BKKH and the financial difficulties that are impacting the care we give children. We need some creative ideas for raising funds to support continuing care so that no child is turned away for lack of ability to pay.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Leland often says that though he wanted to be a preacher, God never called him to that vocation. But, because our pastor is on his biannual leave, he asked Leland to fill in for him—so two weeks ago, Leland was in the pulpit. I’ll attach the sermon to the blog; I invite you to read it. The passage on which it was based, Romans 8: 26-39, is a favorite of mine—and also of my daughter Kelly.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">I leave you with another of Paul’s writings from Romans that seems particularly appropriate:<o:p></o:p></span></span></p> <p class="MsoNormal"><b><i><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;"><span class="Apple-tab-span" style="white-space:pre"><span class="Apple-style-span" style="font-style: normal; font-weight: normal;"> </span></span>Therefore, since we have been justified through faith, we have peace with God through our Lord Jesus Christ, through whom we have gained access by faith into this grace in which we now stand. And we rejoice in the hope of the glory of God. Not only so, but we also rejoice in our sufferings because we know that suffering produces perseverance, perseverance, character; and character, hope. And hope does not disappoint us, because God has poured out his love into our hearts by the Holy Spirit, whom he has given us. Romans 5: 1-5</span></span></i></b></p> <p class="MsoNormal"><b><i><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;"><span class="Apple-tab-span" style="white-space:pre"> </span>To him who is able to keep you from falling and to present you before his glorious presence without fault and with great joy—to the only God our Saviour be glory, majesty, power and authority, through Jesus Christ our Lord, before all ages, now and for evermore! Amen. Jude verses 24-25.</span></span></i></b></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:small;">Take care, God bless.</span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Susan</span></span></p><p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;"> </span></span></p><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;"><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"> <span class="Apple-style-span" style="font-size: medium;"> </span><b><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">A SERMON ABOUT NOTHING</span></span></b></p><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><b><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">
<br /></span></span></b></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">My wife, Susan, and I moved to Kijabe last September. She is a pediatric neurosurgery (brain surgery) nurse practitioner and I am a pediatric neurosurgeon. We take care of children who need operations to treat problems with their brain or spinal cord. We felt God calling us to come to Kijabe, to do and to teach pediatric neurosurgery, and we are blessed to be here. We have also been blessed by this church—by the liturgy, by the hymns, by the preaching. You have been an answer to our prayers for a church where we can worship. Asante sana.</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">All my life, I wanted to be a preacher, but God in his wisdom never called me to preach. Is there any greater calling than to be a preacher, to share the word of God with people? Preachers get into your heads with their words, and if their sermon is a good one, the words come back into our minds time and time again in the coming week. It would have been great to be a preacher…although neurosurgeons can get into your head in other ways.</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">The sermon this morning is about nothing. When you hear that, you may think God was wise when he did not call me to preach, but please hold your judgement for a few minutes. </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">In the world, nothing can be quite successful. Did any of you ever see the television series, Seinfeld? It was a show about nothing, and yet, it was one of the most successful television series in the last 20 years. Every week it brought in millions of viewers and millions of dollars. That is the value of nothing in the world.</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">What is the value of nothing from a Christian’s perspective? In the second reading this morning, we heard Paul’s question in Romans 8: “Who will separate us from the </span></span><i><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">love</span></span></i><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> of Christ? Will hardship or distress or persecution or famine or nakedness or peril or sword? NO, in all these things, we are more than conquerors through him who </span></span><i><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">loved</span></span></i><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> us. For I am convinced that neither death, nor life, nor angels nor rulers, nor things present, nor things to come, nor powers nor height nor depth, nor anything else in all creation will be able to separate us from the </span></span><i><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">love</span></span></i><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> of God in Christ Jesus our Lord.</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><b><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">There you have it: Nothing can separate us from the love of God in Christ Jesus our Lord. </span></span></b></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">A. Of the things on Paul’s list, I think the most important is the statement that death is not able to separate us from the love of Christ-- neither the death of our loved ones nor our own death. </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">The deepest sorrow in all of life is probably the death of one’s child, but the death of a loved husband or wife can tear our hearts apart. I do not know the wife and children of °©°©°©°©°© Evan Michael, who was killed in that tragic accident recently, and I hope you will forgive me for using an example so near, but if it is not true for their family that death cannot separate them from the love of God, it is not true for any of us. When she came back to church that first Sunday after his death, we could see pain and sorrow about as deep as they get on her face. She probably could not feel the love of God through the pain of her loss. It is near impossible to praise God in the depths of grief.</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">In our sorrow, we cry with the Psalmists. One cried, “How long, O Lord? Will you forget me forever? How long will you hide your face from me? How long must I bear pain in my soul, and have sorrow in my heart all day long?” Another cried, “Why are you so far from helping me, from the words of my groaning? O my God, I cry to you by day but you do not answer, and by night, but find no rest.” In our sorrow we cry, as Jesus did, “My God, my God, why have you forsaken me?</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">That is what we feel, but what is happening on God’s side? God’s love was, and is, there for Evan Michael’s family. God showed it partly by our prayers for them, partly by the visits people made, partly by the donations we gave, and partly by the prayers of the Holy Spirit. You remember Paul’s words, “God helps us in our weakness; for we do not know how to pray but that very Spirit intercedes with groans too deep for words.”</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva; min-height: 21.0px"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">
<br /></span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">In our grief, God helps with Christian friends, who sometimes just listen and sometimes just sit there silently with us, just like God, sometimes being with us and listening and sometimes just being silently with us, somehow being God with us. </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva; min-height: 21.0px"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">
<br /></span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">And He reminds us of his love with verses from the Psalms:</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva; min-height: 21.0px"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">
<br /></span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">Ps 34:18: The Lord is near to the broken hearted and saves the crushed in spirit. </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva; min-height: 21.0px"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">
<br /></span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">Ps 55:22: Cast your burden on the Lord, and he will sustain you. </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva; min-height: 21.0px"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">
<br /></span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">And of course the most frequent statement in all the Psalms: “The steadfast love of the Lord endures forever.</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva; min-height: 21.0px"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">
<br /></span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">The death of a loved one cannot separate us from the love of God in Christ, and, perhaps most importantly, our death will not separate us from His love. Only one thing needs to be said about that-- Paul’s words, which are our words: “For me to live is Christ but to die is gain.”</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><b><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">B. Paul’s second point was that life (with its sufferings) is not able to separate us from the love of God.</span></span></b></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">Susan and I work every day with parents, usually mothers, whose babies are born malformed with hydrocephalus and spina bifida and the mothers ask “why”? But is that what they need, an answer to “Why?’ If I told the mother, “When you conceived this baby, you ate some maize that was contaminated with fumonisin, a toxin made by fungus in maize that has mold. The fumonisin inhibited the enzyme that was needed for the DNA to form your baby’s nervous system.” Do you think she would say, “Oh thank you, I feel so much better? What she needs is not an answer to the “why” question.</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">But her question is why and her complaint is for justice. She thinks it is unfair for her to have an abnormal baby when her friend’s baby is normal. Life certainly is not fair. We all know that. As Oswald Chambers says, “Sin and sorrow and suffering </span></span><i><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">are, </span></span></i><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">and it is not for us to say that God has made a mistake in allowing them.” Suffering does not always make people better. I know a man whose wife died from cancer although the church had prayed for her for months. He was so angry with God that he never entered the door of their church again as long as he lived. He only came into the church again when he was brought in in his casket. Suffering is like a fire within us that can destroy us so we pray that God will preserve through the fire of sorrow the self that He created us to be. </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">The mother’s question is “why” and her complaint is for justice, but what she needs most is to remember--that God is here in it, with us--even though we cannot feel it and we may not believe it. Sometimes things are true even though we do not believe them or feel them to be true. When I take out a tumor from the spinal cord, sometimes the patient cannot move their legs the day after surgery. I tell them “Your strength will slowly get better-- over the next weeks and months.” That is true, but they may not believe it or feel it because of their weakness. It is true that God is there with us in our pain and sorrow even though we cannot feel His presence. You remember the words in Hebrews 13:5, “I will never leave you nor forsake you.” </span></span><span style="font: 16.0px Helvetica"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">Sometimes, what we cannot feel is more essential to sustaining us than what we can feel.</span></span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">And although we have to be careful how we use these words of Paul, “God works to bring good out of all situations”, good often does seem to come out of even the most painful ones—not in them—but out of them. When I talk to the parents of a child who has just been diagnosed with a brain tumor, there is no one who is better able to talk to them, to comfort them, than the parents of a child who has had a brain tumor. God has brought good out of their suffering such that they can then comfort other parents.</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><b><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">C.</span></span></b><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> </span></span><b><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">Death cannot separate us from the love of God, suffering that comes upon us because we are human cannot separate us from the love of God,</span></span></b><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> </span></span><b><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">and thirdly </span></span></b><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">( I am not a preacher but I know that sermons are supposed to have three points), the</span></span><b><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> suffering we bring on ourselves cannot separate us from the love of God.</span></span></b><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">You remember the story of the prodigal son, who took half his father’s estate and squandered it and ended up feeding pigs? Luke 15 says, “ But when he came to his senses, he said to himself, ‘How many of my father’s hired hands have bread enough and to spare, but here I am dying of hunger. I will get up and go to my father and I will say to him “Father, I have sinned against heaven and before you. I am no longer worthy to be called your son. Treat me like one of your servants. So he set off and went to his father. But while he was still far off, his father saw him and was filled with compassion; he ran and put his arms around him and kissed him.” The boy does not even get to finish his speech—he never makes it to the part about being taken back as a hired servant before his father interrupts him. The father says to his servants, “Quick, bring a robe—the best one—and put it on him; put a ring on his finger and sandals on his feet. And get the fatted calf and kill it, and let us eat and celebrate, for this son of mine was dead and is alive again; he was lost and is found. “ Such is the love of God our Father as Jesus described him. </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">That scene-- of the prodigal son on his knees in his father’s arms-- has been drawn by many artists. The most famous painting, from 1773, is by the Dutch painter Rembrandt. In it, the son is in rags, kneeling at the father’s feet, his head on the father’s chest. The father’s arms are around the boy, holding him. But what art critics comment on most about the painting are the hands of the father. The left hand is a large masculine strong hand, on the boy’s shoulder; the muscles are flexed, keeping the son in the embrace. The right hand is smaller, almost feminine, and is on the boy’s back, almost like a mother stroking andcomforting her child. </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">Fifteen hundred years before that painting, the early church father Irenaeus in the second century claimed that Jesus and the Holy Spirit were the two outstretched arms of the Father, who uses both of them to pull us and hold us into his heart. With one hand God holds us secure by the work of Jesus; with the other hand the Father comforts us through the Holy Spirit.</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">That is the love of God in Jesus, and neither the death of our loved one, nor our own death, nor suffering that comes because we are human, nor suffering that comes because we sin so badly, are able to separate us from that love.</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">Where else can we find a God like that? Where else can we find a love like that? </span></span><i><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;">Nothing</span></span></i><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> can separate us from the love of God in Christ Jesus our Lord. Nothing. Amen.</span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Times New Roman"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family:arial;"> </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 16.0px Geneva; min-height: 21.0px">
<br /></p></span></span><p></p> <p class="MsoNormal"><b><i><span style="font-family:Arial;"><o:p><span class="Apple-style-span" style="font-size:small;"> </span></o:p></span></i></b></p> <p class="MsoNormal"><o:p><span class="Apple-style-span" style="font-size:small;"> </span></o:p></p> <!--EndFragment--> Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com3tag:blogger.com,1999:blog-8238962161618527090.post-5561362287525789322011-07-03T08:30:00.000-07:002011-07-03T08:52:18.136-07:00<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPAaHcnc9hSQNhVkBs1sR_DL099pesPWfRe-uLVmVKb_zjWh0aMsAm3i2fv3aWV4mEQRXLUOtPJ3QxJo_wVdLrq-im2AV-si-bpI6SMo0-RNWSkZvnNMMFYpPLSCIIw6lg3-ILle0iSMrO/s1600/tent+inside.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 150px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPAaHcnc9hSQNhVkBs1sR_DL099pesPWfRe-uLVmVKb_zjWh0aMsAm3i2fv3aWV4mEQRXLUOtPJ3QxJo_wVdLrq-im2AV-si-bpI6SMo0-RNWSkZvnNMMFYpPLSCIIw6lg3-ILle0iSMrO/s200/tent+inside.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5625154237403447154" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-Cy_ITiiGREzO35TRKckd-iYcvoPJYMv-rOgzscVniPyTaKcw8VAaK1Wv7xVelThTdWkU5nnXC4wDkawxxEVp8pVN5K6TSYtsgPmq0cgK0Q7VXoayu1fmCQBvyNGshv3tKZA58e8lNjlF/s1600/tent+outside.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-Cy_ITiiGREzO35TRKckd-iYcvoPJYMv-rOgzscVniPyTaKcw8VAaK1Wv7xVelThTdWkU5nnXC4wDkawxxEVp8pVN5K6TSYtsgPmq0cgK0Q7VXoayu1fmCQBvyNGshv3tKZA58e8lNjlF/s200/tent+outside.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5625154070764398690" /></a><br /><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 154px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFYQHwRLfdyujm9uF7VeR8nZcouUlFFcuapT_I3f59QrvJ1H4W-QkiPf_nTkEhCKyqiINRwiqXIQdOeOSBmudSooDsXbYP3TO3abqua-VXgtBTnXKag2EiUYnqGQNnQx3Xa_qNXsbZm2bS/s200/Mama+Winfred+and+Susan.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5625152089808253794" /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiotQ7mA476HLpBo0FeBDIGd7jeVGQLbIdxpiuo0jmycFSs3i3WuL03LUp40p7UZNzwqltF2OpenTIQzDU_dyFS72MFyO-aiymni1h767GB63WjoHrBIvEbf9CjK048FkZZPuc8DjX1oPAW/s1600/new+church.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiotQ7mA476HLpBo0FeBDIGd7jeVGQLbIdxpiuo0jmycFSs3i3WuL03LUp40p7UZNzwqltF2OpenTIQzDU_dyFS72MFyO-aiymni1h767GB63WjoHrBIvEbf9CjK048FkZZPuc8DjX1oPAW/s200/new+church.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5625153159493030962" /></a><br /><br /><!--StartFragment--> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Habari rafiki,<o:p></o:p></span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">June 26, 2011<o:p></o:p></span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Leland assures me that the pleural of rafiki (friend in Swahili) is rafiki (friends).</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">I asked if he was sure like a neurosurgeon (sometimes wrong but never in doubt) or sure like Leland.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">He assured me that it was the latter.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">I’ll confirm it with our Swahili teacher, Edward Amalu, at tomorrow’s lesson—not that I doubt Leland or anything….<o:p></o:p></span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">We decided we both needed help in talking with the patients more effectively, so Leland arranged for private lessons 2 evenings per week. </span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Each time, we start with Leland’s questions—how do we ask if the child is vomiting, passing stool, etc.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">For that reason, we don’t have the ability to have pleasant dinner conversation—but we can find out important information about the patients.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">We’ll work on the more socially acceptable dialogue later.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">In the process, Edward tells us fascinating things about the Kenyan culture and customs.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">It is fun to pick up a few recognizable words as the patients or staff talk around us.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">And the staff seem to be very appreciative of our efforts to learn Swahili—though my pitiful attempts at pronunciation still send them into peals of laughter.</span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">An amazing thing happened at our church this past week.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Four years ago, the church started a construction project on the existing church building and moved into a tent.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">The tent was to have been used for 6-9 months.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">As I explained in an earlier post, some renegade council members not only stopped construction but bribed the authorities to rescind the construction permit and had the caretaker arrested at gunpoint.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">On this past Thursday, the pastor was told he could finish construction—many church members worked feverishly until the early hours this morning (Sunday) to ready the church for worship today.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Late last evening, a ferocious storm moved through Nairobi and shredded the tent roof, making it an even “hole-ier” place.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">We worshiped this morning for the first time in the new building—but Pastor Sam led us into the tent at the close of the service, and with tears in his eyes, thanked God for providing a dry place of worship, not for 9 months, but for 4 years.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">He spoke about Elijah and the widow of Sidon during the famine—who had flour and oil for only one cake—but God made it last “until the rain came.”</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Work at the hospital has been emotionally draining this past month.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Thursday a week ago, we had a week old baby boy brought to OPD with a temperature of 35.4 degrees (normal is 37), a slow heart beat, abnormal respirations, a high myelomeningocele and severe hydrocephalus.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">I asked the nurses to quickly get a heater and start an IV so that we could stabilize this baby who probably had a neonatal infection.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">After 10 minutes and no heater and no IV, I looked to see what they were doing and they were cleaning out the infamous supply drawer that has been the bane of my existence since we arrived last September.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Now, I do appreciate that they recognized the need for organization—but I had to seriously question their timing and prioritization.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">I decided that we wouldn’t get very far in OPD so carried the baby to the nursery where he was stabilized.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Later that very afternoon, another baby, 9 day old Agnes, was brought by her mother from Lodwar (“veddy far”) which is in northwestern Kenya and is quite remote.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">The baby’s temperature was 41, and a nauseating smell permeated the room when she arrived.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">She was covered with dried birth fluids and stool.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">I quickly cleaned her and drew fluid from her head for analysis—it was pure pus.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">She had the most horribly infected myelomeningocele that I’ve yet seen—leaking foul-smelling fluid.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">It was obvious that she could not survive.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">After Pastor Mercy and I told the baby’s mother, she disappeared.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">A little later, the OPD nurse came to me and said that the baby was gasping.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">I went down to find this baby girl alone in the exam room.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">I could not stand the thought of this child dying alone, so I held her in my arms until she died.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Afterward, my lab coat was saturated with the infected spinal fluid.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Mercy saw great benefit in having the baby brought to us to die—the custom of the people of this baby’s tribe is to put dead bodies out in the bush for the hyenas.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">By bringing the baby to us, we had the child buried in our church cemetery in Kijabe.</span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Several days later, a 6 year old very malnourished boy was brought to OPD with pus draining from a hole in his scalp.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">It had been draining for over a year.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Humphrey, our pediatric neurosurgery fellow, took the boy to theatre to drain the abcess—and it grew every kind of bacteria as well as amoebas.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">The child will be on 4 antibiotics for at least a month—if he survives.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Unlike the US, there is no Child Protection Service to call—the most that might be done is to have his mother put in jail for a few days—which would accomplish nothing.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">So, if we can heal this boy, he will return to his home.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">So, what is the right thing to do?</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">These are the questions we face every day.</span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Habari again—it is one week later—this week I had little time or energy to complete the posting I began above.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Another eventful week—the 6 year old boy mentioned above developed very severe pneumonia despite 4 antibiotics.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Of course, we had the usual problems of having the nurses change times that the antibiotics were given (one was supposed to be every 6 hours; they didn’t like that so they gave it at 6am, 10 am, 6 pm and 10 pm).</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">The IV access was poor so he didn’t get all the doses no matter when they would have been given.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">His white blood count was 31,000 (normal is 4.5-11,000).</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">When Mercy and I talked with his aunt, she called his father who said to bring the boy home immediately so he would die at home.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">So, we took off the oxygen and removed his IVs and sent him home on a matatu (about a 12 hour journey).</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">It was hard for me to remove the oxygen, though after talking with our pediatrician, Dan Entwhistle, I agreed with him that the child was not likely to suffer more off the oxygen than he was with it.</span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">I very often have trouble deciding what to share in the blog.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">I don’t mean to demean or denigrate the Kenyan staff—many are quite dedicated to their professions and really feel that their work is a ministry.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">But it is hard to see poor quality nursing care given and to not address the issues with those responsible.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">We have routinely had orders not carried out, medications not given or given incorrectly, dressings not done properly.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">To be fair, though, each nurse takes care of 8-15 patients; these are very sick children.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">I’m not sure how well I’d be able to do under those circumstances.</span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Two vignettes:</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span></span></p> <p class="MsoNormal" style="text-indent:.5in"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">A baby with spina bifida and hydrocephalus spent a month in BKKH having various complications.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Finally she was ready to go home.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">During the hospitalization, I remarked about how many visitors her mum had—often several friends/relatives per day—it was unusual because many of the mums have no visitors until they are ready to go home—many have no visitors at all.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">The day after the baby was discharged, she was still in the bed and her mother was in tears.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">The mum and baby had been disowned by her entire family—they did not want a disabled child in the house—and not one of her relatives wanted to take responsibility for paying her bill.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Unfortunately, this is not a rare circumstance.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Leland and I paid part of her bill; BKKH forgave part of it (though BKKH will pay the amount of the entire bill to Kijabe Hospital).</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Your donations go toward paying the bills of these babies.<o:p></o:p></span></span></p> <p class="MsoNormal" style="text-indent:.5in"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">You may remember the saga of the disappearing infrared thermometer.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">One morning last month, a security guard and one of the experienced neuro nurses appeared in front of me—the guard was holding the missing infrared thermometer.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">I was overjoyed and said something about rejoicing for what was lost had been found.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">It took me a few minutes to realize that he had found it in her purse—the guards routinely search the belongings of staff members of the hospital as they leave work because there is so much theft of hospital property.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">The nurse said she had used it for mobile clinics—in later versions, she said that the in-charge nurse had given it to her (clearly not true), that each nurse had one—her testimony changed even during her disciplinary hearing.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">The committee was unconvinced—or rather, they were convinced of her guilt so gave her the option of resigning (and retaining her benefits) or being discharged.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">After she had continued to work for 2 more weeks, she finally refused to resign so was dismissed.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">As painful as this incident was, it was very important for the nursing staff to see that there are consequences to theft, lying, etc.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">What was particularly upsetting, though, was learning that most if not all of the other nurses knew that she had it for the two months that it was missing.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Not only did no one turn it in, or report her, but also no one thought enough of the nurse to encourage her to return it anonymously so that she could retain her job. <o:p></o:p></span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">We are enjoying the winter here—July is like January in Wisconsin (well, relatively speaking).</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Even though we are just 2 degrees south of the equator, we see a real difference in weather.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">The afternoon sun no longer streams in the living room window; when we sit out on the balcony we almost always need sweaters.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">The long rains are past; we still have rain occasionally but it is often cloudy and foggy.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Since there is no heat in the hospital, the staff wear parkas, hats, and scarfs.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Being from Wisconsin most recently, we wear regular clothes under our labcoats, but I do have to admit that on foggy days, my hands never get warm.</span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Last Friday marked the beginning of our eleventh month here—time has flown.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">We feel much more settled here—and are feeling that we belong here in Kijabe.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Making friends is still a slow process but our growing involvement with the Nairobi International Lutheran Church has helped us feel at home in Kenya.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">Leland has been asked to preach two sermons during the pastor’s leave.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">We were “greeters” this morning and both of us have been scheduled to read the scripture.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">If anyone would like to see a presentation of a video about our work in Kijabe that Leland and I made at Luther Memorial Churchon May 1, please go to </span><a href="http://gallery.me.com/leeapowell#100069"><span class="Apple-style-span" style="font-size:small;">http://gallery.me.com/leeapowell#100069</span></a></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Here is a link to a BKKH newsletter: </span><a href="https://app.e2ma.net/app/view:Join/signupId:1418122/accId:1408519"><span class="Apple-style-span" style="font-size:small;">https://app.e2ma.net/app/view:Join/signupId:1418122/accId:1408519</span></a></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Thank you all for your prayers.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">It has been so good to hear from friends—some who were “lost to follow up” for many years.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">We pray that God will be glorified in all that we do—I am not just talking about our work here in Kijabe, but in the lives that all of you lead as well.</span><span><span class="Apple-style-span" style="font-size:small;"> </span></span><span class="Apple-style-span" style="font-size:small;">I am increasingly convinced that it is not so important what work we do; what is important is that we follow our Savior so that His work is done here on earth.</span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Take care, God bless.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size:small;">Susan</span><o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:12.0pt;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:12.0pt;"><o:p> </o:p></span></p> <!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com2tag:blogger.com,1999:blog-8238962161618527090.post-76819704303787735732011-05-17T10:59:00.000-07:002011-05-17T11:18:48.778-07:00<img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnIM5RK7zUksCgs5BJPTSuf-47hHJIYhKJOOS2dbB4CxVykUuxgGNoAXfR28yM6uccgMBFIEa4LhCiu8NIIrogi9RTGIch9ECLUWTbj4MNMd6XdXl6YNvtGE5M5QjLVFLtk_JaUhhB7B0C/s200/end+of+day.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5607747969402786978" /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvFAu_cNpWdq1yPwR2tghB_Lv3LhZ18x30rK2730xODGQkzNSLjNCCifVqz0RDsNs49Q04waeDdGJgdimPexMQ1hdwdjRTgXG_GrZKfGSe5jGJgvC5U7HzOfuq8iAaxZnQg3Io8w_sTi-t/s1600/Sandi+and+Leland.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvFAu_cNpWdq1yPwR2tghB_Lv3LhZ18x30rK2730xODGQkzNSLjNCCifVqz0RDsNs49Q04waeDdGJgdimPexMQ1hdwdjRTgXG_GrZKfGSe5jGJgvC5U7HzOfuq8iAaxZnQg3Io8w_sTi-t/s200/Sandi+and+Leland.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5607747996499649618" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguWdWYbOv3Z0aAYv9_24wBIiiUSJ2gpfo3ipuyZnmbTYsAmIHN1jBmDv9Nc0XVEhYfrhoErrmTDU8keI7xWJnCfKAK0OkD3hFVV6aCGG4kGJb7aTvwQYd773f8RykkGCJ5z3_GBHgxG8OW/s1600/Family.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEguWdWYbOv3Z0aAYv9_24wBIiiUSJ2gpfo3ipuyZnmbTYsAmIHN1jBmDv9Nc0XVEhYfrhoErrmTDU8keI7xWJnCfKAK0OkD3hFVV6aCGG4kGJb7aTvwQYd773f8RykkGCJ5z3_GBHgxG8OW/s200/Family.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5607747988555272882" /></a><br /><br /><!--StartFragment--> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;"><br /></span></span></p><p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;"><br /></span></span></p><p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;"><br /></span></span></p><p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;"><br /></span></span></p><p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;">Habari Friends,<o:p></o:p></span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:small;">It is Saturday; I am taking a few minutes to write while the clothes are drying. We have a renewable energy clothes dryer—it is called a clothesline. Because it is so windy today, the clothes dry in about 75 minutes. I have discovered that “permanent press” doesn’t work well without an automatic dryer…amazing the things we Westerners take for granted.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:small;">Although it is still “the rainy season,” we have mostly sunny days with rain sometimes at night. There is great concern in Kenya because the “long rains” during April and May have not delivered the rainfall that was expected. Many are predicting continued food shortages and rising prices for food and gas. Food prices for Kenyan staples (maize flour, milk, rice, potatoes) have risen between 15 and 33% since January. Many of our patients live on the edge of starvation in the best of times; we fear that we’ll see even more malnourished children and mums.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:small;">The rise in the cost of living is causing anxiety among the Kenyan politicians; they fear that people will become desperate—and politicians aren’t very good at controlling desperate people. Here in Kijabe we are not isolated from this—two weeks ago an armed gang of men invaded the Casualty (Emergency) Department, beat the security guard, and robbed the people there (staff and patients). All the hospital staff were quite shaken by that—it has never happened before at Kijabe Hospital. Here in our Quadplex, the contractors have installed security gates at the two entrances to the building. However, there is no lock on either gate as yet—and from the way the gates are constructed, I’m not sure anything other than a padlock will work—so we’ll either be locked in or out. Not ideal. Maybe the appearance of the gates will be a deterrent. It will also deter visitors—there is no intercom to alert us that someone wants to come up. So some yelling may be in order.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:small;">In April, we started worshiping at Nairobi International Lutheran Church. It is a wonderful group of people—most are from countries in Africa. Sam Wolfe, a pastor who worked for 30 years in Tanzania and 7 years in Frankfurt, was called to minister to the church. On Good Friday, he preached about the Last Supper, when Jesus told the disciples that one of them would betray him—and each one asked, “Is it I, Lord?” Pastor Wolfe then applied that to us today—am I the one who passes by a hungry child, am I the one who fails to visit the sick and those in prison, am I the one who doesn’t clothe the poor? His Easter sermon was from Mark 16: 1-8 where the women discovered the empty tomb and left “trembling and bewildered.” We tend to see the joy of the Easter story and forget how terrifying the empty tomb was to the women and the disciples. While we are in the midst of circumstances, they can cause us to tremble. In hindsight, we can see God’s hand leading us through those times.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:small;">Whenever my kids were little, if we were lost or if things were a little unsettling, I’d tell them we were having an adventure. Well, we had an adventure this month. On two occasions the week before Palm Sunday, I’d awakened during the night with a gripping (really excruciating) pain that almost made me pass out both nights—but the pain lasted only 10-15 minutes, so I just went back to sleep. On Palm Sunday, I awoke with right upper quadrant abdominal aching pain that grew during the day—by midnight, we decided to go to Casualty where the Australian surgeon, Peter Bird, met me, diagnosed cholecystitis (gall bladder attack) and gave me a shot of pethidine (Demerol in the States) that caused me to not remember the walk back to the Quadplex (LOVELY medicine). Early the next morning I had an ultrasound confirming the diagnosis and by 10:30 am was in theatre (alas, not acting) having a laparascopic cholecystectomy. Much to the nurses’ amazement, I went home that evening (Kenyans aren’t acquainted with same day surgery). The bill for the entire adventure was $500. Paying the bill was yet another adventure; they lost my “file” (medical record) twice in the same day.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:small;">Avoiding an “open” operation allowed us to leave for the States on 4/27/11 as planned. We spent 2 days of rest with our dear friends, Deb and Barry McLeish in Madison, then worshipped on Cantata Sunday at Luther Memorial (fantastic music with organ, strings, brass, and tympany). Leland and I gave a presentation in the adult Sunday school—I realized afterward that I’d just given a missionary talk at my church just like the lady who inspired me as a child--Miss Emma Snyder, a missionary nurse who worked in the 1950’s with lepers in Nigeria! That was a “wow” for me. The rest of the week was spent in Chicago—we rested and visited with my family, all of whom were present for Michael and Marisa’s engagement party hosted by her parents.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:arial;font-size:small;">Leland spent some time reviewing the operations done since we have come to Kijabe and BKKH. In the first 7 months, 869 pediatric neurosurgical cases were done with an average of 124/month. Two thirds of the cases are related to spina bifida and hydrocephalus; the other third is a mixture of tumors (brain and spinal cord), encephaloceles, lipomyelomeningoceles and others. Our work is exceeding the amount budgeted by BKKH by about $10,000/month. While in Chicago, we met with Scott Ward of the Medtronic Foundation who visited us in Kijabe in November and has been instrumental in arranging funding of a wireless internet system to be installed in Kijabe in June as well as that for our neurosurgery fellow, Humphrey Okechi. Scott calculated that each operation and hospitalization costs an average of $228. Remarkably, the Sunday School children of Luther Memorial Church dedicated their weekly offerings for this past year to the children of BKKH—they raised $228.42. Others who have been incredibly generous have been nurses and staff of American Family Children’s Hospital OR who have donated proceeds from “Dog Bones For CAT Scans”, gathered outdated medical supplies, and given sacrificially from personal funds. Luther Memorial Foundation awarded the Neurosurgery Patient Subsidy Fund of BKKH a generous grant. We feel quite grateful to all who support the children and are praying for God’s guidance in finding ways to make up the monthly deficit.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;">We were blessed with visitors this past month. Sandi Lam, who just completed her pediatric neurosurgery fellowship at Children’s in Pittsburgh, spent 4 days here and did 17 operations. John and Maggie Tarpley, close longtime friends of Leland’s, visited Kijabe to facilitate an international outreach option for general surgery residents at Vanderbilt. Tom Steineke and the physican’s assistant who works with him, Peter Parcells, covered for us during our absence—though we were able to visit with them briefly the day they arrived (the same day we left). We cannot describe how wonderful it is for us visit here with people from the States. I have come to realize how important it is for people to come here and see for themselves not only what we do here, but the patients and families that we treat. Most people who visit and see the needs have described that their lives have been changed by what they see here. So, we invite people to come visit us—but, expect your life to be changed.</span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;">People have asked if it was hard to come back—and, yes, it was hard for me to leave my children. My granddaughter really doesn’t understand who IS this lady who looks a little like her mom and is called “Shosho”? But when we arrived back in Kijabe, both Leland and I felt that we had come home. We are energized by our work here. We feel that we are exactly where God has led us. In my devotions each morning, I read a portion of M. Craig Barnes’ </span></span><u><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;">An Extravagant Mercy</span></span></u><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;">. In his essay on Mark 1: 16-20, he talks about how the story of the Bible has been about people on the move—whether that means a change in relationships, job, aging, or relocating. He says, “…the point of following Jesus [is] not to get to a new place. The point of following Jesus is to follow Jesus. Along the way, we come to understand that our identity is found not in where we are but in the Savior who is leading the way.”<o:p></o:p></span></span></p> <p class="MsoNormal"><o:p><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;"> </span></span></o:p><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;">Thank you for your prayers, your support, your friendship. </span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;">Susan<o:p></o:p></span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;"> <o:p></o:p></span></span></p> <p class="MsoNormal"><o:p><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;"> </span></span></o:p></p> <p class="MsoNormal"><o:p><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size:small;"> </span></span></o:p></p> <!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com0tag:blogger.com,1999:blog-8238962161618527090.post-15413423369213506972011-03-31T05:07:00.000-07:002011-03-31T05:18:33.182-07:00<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNW2lJ48j_aGA85xfdFj3sN1btwfkkNE8ACz3CHVvY-4rW22S8RynD2f00BXCYgBZuFQX2SnQLmHdSVTtePZhF8ua3rPWf2RiUWoU3tD_uqHiKqVoascVdPoYwnynY28lJJCaLpSfcZjrB/s1600/P1000931.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 150px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNW2lJ48j_aGA85xfdFj3sN1btwfkkNE8ACz3CHVvY-4rW22S8RynD2f00BXCYgBZuFQX2SnQLmHdSVTtePZhF8ua3rPWf2RiUWoU3tD_uqHiKqVoascVdPoYwnynY28lJJCaLpSfcZjrB/s200/P1000931.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5590216786604560722" /></a><span class="Apple-style-span" style="font-size: medium;"><br /></span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4OIFEOZKr67bYJLvtrdBNdB2xmo8HRraIB6IbmQBe4Q5UnLmjgwUG8HwiBykVpTqgJEMaPAm1ccdt0MBXE6srPdCgKRAf5dHmOo31ViUUnzY_o5AVtHi17oGOxNiMh_3lxn4sIzslb-SQ/s1600/P1000926.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 150px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4OIFEOZKr67bYJLvtrdBNdB2xmo8HRraIB6IbmQBe4Q5UnLmjgwUG8HwiBykVpTqgJEMaPAm1ccdt0MBXE6srPdCgKRAf5dHmOo31ViUUnzY_o5AVtHi17oGOxNiMh_3lxn4sIzslb-SQ/s200/P1000926.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5590216784011055954" /></a><span class="Apple-style-span" style="font-size: medium;"><br /></span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhELbobWGsaXpdsqvL21qhXzKcO78TdGSbp9bNl_ZTf6yej-Zv0tvIPMwN_o2G980cDjySA_4_ra6YIU5blFAxu-Oj7ciSsyPD3N-J73fVWQNyNbwRp0iTvOGJFW_fZv0vNmg2IBTGnbD14/s1600/P1000921.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 150px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhELbobWGsaXpdsqvL21qhXzKcO78TdGSbp9bNl_ZTf6yej-Zv0tvIPMwN_o2G980cDjySA_4_ra6YIU5blFAxu-Oj7ciSsyPD3N-J73fVWQNyNbwRp0iTvOGJFW_fZv0vNmg2IBTGnbD14/s200/P1000921.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5590216780009209586" /></a><span class="Apple-style-span" style="font-size: medium;"><br /></span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjljtkRIzznXyw0BHiXEpYyIDVucRrRhPqgqDHD6cKIgJDdam6_OzXXf3IVdbMlyTNrJOolrmIftLGDW-aXVarSVfK84wwy7sHdjR5HwWKXiYQBtzcCfA-bzXGnbzsi6TN66tOhXJnyycml/s1600/Road+crew.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 150px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjljtkRIzznXyw0BHiXEpYyIDVucRrRhPqgqDHD6cKIgJDdam6_OzXXf3IVdbMlyTNrJOolrmIftLGDW-aXVarSVfK84wwy7sHdjR5HwWKXiYQBtzcCfA-bzXGnbzsi6TN66tOhXJnyycml/s200/Road+crew.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5590216775235920322" /></a><span class="Apple-style-span" style="font-size: medium;"><br /></span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvAqyqTCTLOFD1jlp3f9kbfQ6QfzuRAbU4SIHa7ciZP-p6H5ND7HDslHcCYrZ1499_io-Hnwnet04mkLCv31lTNrPQ4L-rJ6okkg9NXmhDOCe6DbdPgMMMVZZffMNTv0ZudcxH3wTTv43i/s1600/P1000930.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvAqyqTCTLOFD1jlp3f9kbfQ6QfzuRAbU4SIHa7ciZP-p6H5ND7HDslHcCYrZ1499_io-Hnwnet04mkLCv31lTNrPQ4L-rJ6okkg9NXmhDOCe6DbdPgMMMVZZffMNTv0ZudcxH3wTTv43i/s200/P1000930.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5590216775316625794" /></a><span class="Apple-style-span" style="font-size: medium;"><br /></span><!--StartFragment--> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">Jambo! (yet another way of saying hello)</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">On St. Patrick’s Day, March 17, 2011, the Long Rains began.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">It was a day of tremendous excitement among the hospital staff because it meant that the crops just planted will survive.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">There were torrential downpours (which meant soggy ceilings in our third floor apartment—but that’s another story)—5” in 2 hours…dirt rivers the color of Burnt Sienna (always my favorite crayon) flowing downhill.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">The silence that night—the complete ABSENCE of wind—was stunning.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">We could hardly sleep for the silence. </span></span><span style="font-family:Wingdings;"><span style="font-family:Wingdings;"><span class="Apple-style-span" style="font-size: medium;">J</span></span></span><span style="font-family:Arial;"><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">I had expected that the long rains would be like living in Portland in January—rain all day every day.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">That isn’t the case at all—there have been days with an hour or two of rather light rain, sunny days without any rain, and days like today which are overcast most of the day with occasional showers.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">But, my, how green is our valley!</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">The tan/brown parched earth has been transformed to lush green.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">I hope the pictures I’ve included give you some idea of the beauty.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">It is hard to convey how different life is here.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Take road construction, for instance.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">You all know what that means in the US—heavy machinery, hard hats, safety signs.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Here, everything is done by hand—men push wheelbarrows up and down the hill to bring the medium sized rocks that form the base covering for the old dirt road.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Then, they cover that layer with load after load of red dirt.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Finally, the cars driving over the road pack it down—which means that now that the rains have come, the middle of the one lane is a muddy mire—we have some missionaries who cannot negotiate the new road even with 4-wheel drive SUVs.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">Another group of workers dug deep trenches (about 3 feet deep) so that telephone wire could be laid to the houses further down the hill from the hospital—the physicians living there had to rely on cell phones to call the hospital.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">The reason that the lines couldn’t be strung on the existing telephone poles is that the wire had repeatedly been stolen for the copper.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">In the course of digging the trench, rocks and other assorted things were unearthed.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">One day we saw an ovoid “rock”—which on closer inspection was a human skull.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">We named him Yorick and were a bit concerned until the medical director informed us that we live on a former cemetery so that bones were always being discovered during the course of construction of the Quadplex.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">He suggested we just rebury the skull.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Alas, poor Yorick disappeared before we could reinter him.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Gone too soon to have known him well….<o:p></o:p></span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">I’ve mentioned before about some of the hard ethical dilemmas that we have here—Leland asked that I give you several vignettes:</span></span></p> <p class="MsoListParagraphCxSpFirst" style="text-indent:-.25in;mso-list:l0 level1 lfo1"><span style="font-family:Arial;"><span><span class="Apple-style-span" style="font-size: medium;">1.</span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size: medium;"> </span></span></span></span><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">A 6 day old boy came to OPD yesterday from East Pokot—a very poor area in northwest Kenya.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">His father was older and had moderate tremor—one side worse than the other.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">The baby was the eleventh child and had had no medical attention since birth.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">I don’t think I’ve ever seen a dirtier baby in my life—the clothes were covered with dried stool and urine, he had never been bathed since birth.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">He had a huge myelomeningocele that was infected.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">He had no movement below his hips and had a very small head.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">As I examined him and tried cleaning his back, I realized that he had significant apneas—pauses in breathing—during which his heart rate dropped precipitously and he became ashen.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">After a pause, he would gasp and then start to cry.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Leland examined the baby and saw that his prognosis was rather grim—if his breathing and heart rate could be stabilized, he could have an operation to close the spina bifida, then probably a shunt to treat the developing hydrocephalus.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">However, the chance that he had the beginning of a bad infection because of the open spinal cord was huge—which would be likely to infect his brain.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Also, treating the spina bifida would require that the family do good wound care, observe him for complications (shunt malfunction, skin ulcers) as well as do catheterization to help him urinate regularly.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">We consulted with Pastor Mercy and she had real concerns that this family would not be able to handle all these medical issues.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">She recommended though that we give the family the choice of treating the baby or taking him home.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">That discussion (always a hard one) took place with translation from English to Swahili to the local language of the Pokot.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">The father seemed to vacillate—but the mother said that if the baby couldn’t be normal, she wanted to take him home without surgery—and that is what they did.</span></span></p> <p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1"><span style="font-family:Arial;"><span><span class="Apple-style-span" style="font-size: medium;">2.</span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size: medium;"> </span></span></span></span><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">A 50 year old man rode via matatu for several hours and presented to Casualty (Emergency Department in British/Kenyan English) with a chronic subdural hematoma causing severe headaches and an impressive right-sided weakness.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">He had no money to pay for an operation.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">There were no beds available in the hospital.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">With a simple operation, he could resume a normal life—without one he would be incapacitated.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">The operation and hospitalization would cost 26,400 Kenyan shillings--$330 in American dollars (can you imagine how far $330 would go in the US?).</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">One of our wonderful OPD nurses, Jane Mutinda, offered to house him and his wife with her family overnight until a bed became available.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Leland paid for his operation and hospitalization—he had a remarkable recovery and is a very happy and grateful man.</span></span></p> <p class="MsoListParagraphCxSpLast" style="text-indent:-.25in;mso-list:l0 level1 lfo1"><span style="font-family:Arial;"><span><span class="Apple-style-span" style="font-size: medium;">3.</span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-size: medium;"> </span></span></span></span><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">In December, an 18 year old young man had resection of a medulloblastoma—a brain cancer.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">His family was able to pay for his surgery and hospitalization.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Afterward, he needed an MRI of his spine to make sure he had no sign of cancer there.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">He could afford only the cervical MRI—we made arrangements to pay for the rest of the spine MRI through funds from BKKH.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">The MRI was clear of any signs of cancer.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">But, he needed radiation therapy to make sure the cancer cells were killed.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Arrangements were begun to send him to the University of Wisconsin—but then we became aware of a facility in Nairobi which could do the radiation therapy (the usual place, Kenyatta National Hospital has a waiting list of 400 patients—people usually die before they can start therapy).</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">The cost for 6 weeks of daily radiation treatments for this bright young man was KSh 200,000 or $2500.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Leland and I felt so strongly that he should have the therapy (which is potentially curative) that we split the cost from our personal funds.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">The young man just completed the 6 week course and has started back to school.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">These are just a few of the many dilemmas we encounter here—whether to treat babies with severe brain damage with expensive medicines and long hospitalizations, whether we should try treating children with massive hydrocephalus, malnutrition, and scalp bedsores, whether children with brain tumors should undergo the risk of surgery (with no ability to do scans here at Kijabe) or face death from the tumor without surgery.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">Added to these often heart-wrenching concerns, we daily have incidents where ordered meds (including antibiotics for severe spinal fluid infections) are not given—or are charted as given but have not been, lab tests are not done or the results have been lost, equipment goes “missing” (the donated infrared thermometer that I brought from UW “walked off” last Friday).</span><span><span class="Apple-style-span" style="font-size: medium;"> From time to time we have no running water anywhere in the hospital--washing hands between procedures on patients can be an adventure. </span></span><span class="Apple-style-span" style="font-size: medium;">It can sometimes be difficult to maintain a cheerful demeanor during the course of the day. <o:p></o:p></span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">Last month we were informed that the “nurses” were very upset with us; we were given a list of our infractions. Both Leland and I were a bit surprised—we had seen some real improvements in our relationships with the nurses on morning rounds. Many of the formerly reticent nurses had started to actively participate in sharing information about the mums and babies—some had started to ask good questions and were showing interest in learning new techniques. So, we did some reality checking—talked to several Kenyans, other missionaries, and each other—also spent a good amount of time in prayer. We each decided that, despite what had been shared with us, we felt like we were heading in the right direction with our relationships with nurses and other staff in the hospital. We realize that building relationships takes time, and we are committed to doing that over the next 4-5 years. We also realize that cultural differences interfere with understanding—my doing the ventricular taps to be more efficient was seen as being critical of the nurses’ abilities. Our writing daily progress notes was seen as critical of the nurses’ charting. There is real reluctance among some (but not all) Kenyans to directly share information and concerns—we tend to be direct which is seen as quite rude. I feel very confident that we will sort these difficulties out—already the discussions that we’ve initiated with the unhappy nurses have soothed some of the hurt feelings. But, I also became aware of a very important truth. We did not come here to please people. We came because we both felt called by God—we not only want to be obedient to that call, but out of the gratitude we have for God’s love and mercy toward us, we want others to see Christ through us. We are here to bring glory to God, so that through us, people see, come to know and love God.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">So, I want you all to know that we are very happy here; we feel an incredible sense of peace.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">We don’t downplay the difficulties but also don’t dwell on them.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">We are not discouraged.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">We look forward to continuing to get to know the Kenyan staff; we love working with the patients and families.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Most of all, it is supreme joy to be serving God in this place every day.<o:p></o:p></span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">We ask that you continue to pray for us—for wisdom, patience, cheerfulness, discernment.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">Thank you for your prayers and encouragement.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">We have confirmation from Paul Buford, the bookkeeper for Bethany Kids, that the </span><b><span class="Apple-style-span" style="font-size: medium;">Neurosurgery Patient Subsidy Fund</span></b><span class="Apple-style-span" style="font-size: medium;"> has been established.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">To access the website, go to </span><a href="http://www.bethanykids.org/"><span class="Apple-style-span" style="font-size: medium;">www.bethanykids.org</span></a><span class="Apple-style-span" style="font-size: medium;">.</span><span><span class="Apple-style-span" style="font-size: medium;"> </span></span><span class="Apple-style-span" style="font-size: medium;">If anyone feels led to contribute specifically toward care of indigent patients, you can designate gifts to that fund under “Other.”</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">Take care, God bless.<o:p></o:p></span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: medium;">Susan</span><o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:12.0pt;"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:12.0pt;"><o:p> </o:p></span></p> <!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com0tag:blogger.com,1999:blog-8238962161618527090.post-12651007403115272132011-02-13T10:24:00.000-08:002011-02-13T10:31:47.212-08:00<!--StartFragment--> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">Habari Friends,</span></span></p> <p class="MsoNormal"><b><i><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">Impunity:</span></span></i></b><i><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;"> exemption from punishment or loss or escape from fines…the impossibility of bringing the perpetrators of violations to account—whether in criminal, civil, administrative or disciplinary proceedings. </span></span></i><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">(Wikipedia) In other words, No Consequences.</span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">Impunity…a central word here in Kenya. One sees that word on nearly every page in the daily newspaper; impunity is rampant not only in high administrative circles but also among interactions with nurses on the ward. Several weeks ago, the Kenyan public was bombarded with the video of policemen summarily executing alleged criminals lying in surrender on Lang’ata Road in Nairobi (just hours before we drove along the same road). Just this week, a child in respiratory distress was ordered to have a chest xray at 11:45 am. The order was not “noted and handed over” until 9pm that day—the child did not have the xray until the next morning. Neither of these incidents is unusual. Neither provokes sustained or generalized outrage among the people here. It was very disturbing, in fact, to read so many letters to the editor praising the action of the police who shot the men lying face down on the tarmac through the head. I’m told that so many people have been brutalized by gangs of men who have broken into their homes, raped their wives and daughters and have escaped—with impunity. So people accept the brutality of the police, having no confidence in the justice of the courts. What they don’t think about is the possibility that one of them will be judged and executed by the police in a circumstance of mistaken identity. There is a move afoot to arm the traffic police—which also has prompted supportive letters to the editor. Yet nearly every time we drive, we see or hear of people who have been pulled over by the traffic police who have demanded bribes to avoid fines. One nurse anesthetist described refusing twice to pay bribes—she and her husband lost two days of work going to court to fight the tickets they were given (for speeding or not having the appropriate paperwork in the car)—both times having to pay a fine imposed by a court that supports the police. I drove to Nairobi on Thursday while Leland operated at Kijabe—though driving here is daunting, I am much more afraid of being stopped by the police checkpoints than of having a matatu plow into me—at least I have some control of where my car is on the road—I have no control over those policemen and their nightsticks. But God heard my cry, and spared me from being stopped. Quite honestly, that was serious prayer being sent up for two hours.</span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">The nurses at Kijabe Hospital are very upset because the pay scale has been reconfigured to make it more “equitable.” Those nurses who have been working the longest have seen a decrease in their base pay with “allowances” for housing, education, etc that at least equal what the pay had been before restructuring. However, many of the longterm nurses are threatening to quit because they say they have taken a substantial cut in pay. It was explained to me by the Matron that the base pay is what banks consider when a person applies for a loan; it is also the basis for calculation of the pensions. Until this week, I had no idea how many Kenyans live on loaned money—the debts they accumulate are astounding—and are spread among family, friends, the hospital, and banks. It is also remarkable how freely hospital workers and patients ask us for loans—about two weeks ago, a patient’s mom stopped me in the hallway saying that her child had a cardiac defect and needed Ksh 14,000 for surgery—and could I give her that. When I said I could not give her the money, she looked incredulous and, laughing, asked, “Why not?” Quite honestly, the verse: “Ask and you shall receive” came to mind. There is a totally different philosophy here about asking for money, help, etc—and I’m coming to understand that people often don’t expect someone to give all that they’ve asked for—but the asker feels that he/she has nothing to lose by asking. Quite honestly, it takes a good deal of cultural awareness, understanding and wisdom to know what to do with all the requests for money, loans. Leland and I have responded to several requests—but obviously cannot help everyone who asks. It also can be quite disruptive to the local economy if missionaries overpay their help—it was explained that when that occurs, the Kenyans can’t afford to hire people to clean, cook, watch their children while they work.</span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">We are again at Malu—the place of refuge and rest that we have found east of Lake Naivasha. There was a lull in workload following the holidays but the past two weeks we have again been inundated with patients—we had three mattresses on the floor in OPD and took out beds in one area so that more mattresses could be placed on the floor (we had one patient in “bed 11X” meaning 11 Extra). We had 8 emergency admissions last Friday and 4 new babies with spina bifida admitted on Tuesday. For the past two weeks, every patient who has arrived and is not emergent has been sent home (sometimes a 6-8 hour matatu ride) and rescheduled as an elective admission —including babies with hydrocephalus who are symptomatic but still feeding well. We had wondered if we had scheduled our R&R a bit too early, but after the past two weeks, we both needed the break. So here I sit on the wooden porch floor, writing and looking up at Tanga, the Rhodesian Ridgeback who alternates sleeping on the floor with chomping noisily on her toenails. The herd of horses just grazed through the “front yard.”</span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">For the first time since we have been here, I have seen Leland grow angry with circumstances in the hospital as well as concerning the new apartment. Last week, during a craniotomy, he requested the microscissors to cut the arachnoid lining of the brain. Each of the three pairs of scissors that he brought had bent tips (from mishandling) and could not be used. Two of three cautery wires had damaged insulation, causing them to short out. The endoscope camera also malfunctioned and several cases of endoscopic third ventriculotomies had to be converted to shunts. Then, in our new apartment, an inspection by the architect, the contractor, the BKKH administrator (who will take “ownership” of the building once it is officially “done”) and the inhabitants revealed some deficiencies—like electric plugs that did not work, wet spots in the ceiling from defective roofing, pipes under the sink that leaked, windows with huge gaps allowing red dust to blow through the apartment). I’m afraid that our priorities (leaks, plugs,) are quite different from theirs (painting, smooth doors); I think this is one of those times where we will look at each other, shrug, and say, “TIA.” (This is Africa). We have requested that the resident from Vanderbilt who arrives next week </span></span><span class="Apple-style-span" style="font-family: arial; font-size: medium; ">bring more duct tape and weatherstripping to keep out the wind and dust.</span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">In our work here, we continue to struggle with how best to treat the children with complex congenital brain deformities or those children who arrive at the OPD barely clinging to life. A 2 year old girl, Jebet, arrived in OPD from northwestern Kenya about a month ago with a history of one week of vomiting and diarrhea. She was severely dehydrated with a temperature of 41.7 C (107 F), heart rate of 200, respiratory rate of 68 and having a seizure of undetermined duration. She was blue; I left her to get oxygen (there was no one in OPD to help me); the tubing wasn’t available—once it was found, it wouldn’t fit on the adapter to the oxygen tank—which turned out to be empty anyway. Because she had had a shunt operation in November, I quickly aspirated fluid from her shunt for analysis and to prove that her shunt was working (her pupils were pinpoint so it didn’t look like a shunt malfunction problem). Then I called the pediatric service and they assumed management. However, because of her severe and prolonged dehydration, she clotted a major vein in her brain and sustained substantial brain damage. Leland examined her a few days later; she was still febrile and her condition was very grave. He recommended not aggressively treating her. However, she was aggressively treated and just yesterday, I was asked to explain to her very young and very poor mother why we could not “fix” Jebet. Once again, Pastor Mercy and I talked with her, explained that Jebet could not see, probably would never walk and talk. After the explanation, the mother asked if the paperwork could be completed that day so that she could pay the bill and take Jebet home—the complicating factor is that Jebet’s father told his wife, “Don’t bring her home; I don’t want a disabled child in my home.” So, now that we have salvaged this very ill child, she and her mother have no home to which to return. So, when Pastor Mercy asked me to lead the prayer, my request was for God to provide a home for Mama Jebet and Jebet. I am not sure that Jebet wouldn’t be better off now if she were in the arms of Jesus. We have at least two babies right now with very severe brain deformities in addition to severe spina bifida and hydrocephalus. It is hard to have the family spend precious resources on these babies who are unlikely to see their first birthdays with the best, most aggressive care.</span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">We were told on Thursday that we are ordering “too many scans” on the children. Since we treat children with brain tumors, complex hydrocephalus, severe spinal deformities, it is exasperating to hear that we have ordered “too many scans”—especially when the vast majority of children go to surgery with only an ultrasound, not a CT or MRI. Ultrasound is readily available at Kijabe and is relatively inexpensive. CTs and MRIs are available only in Nairobi. Often, we order a CT without contrast when in the US, the child would get an MRI with contrast. The concern about “too many scans” reflects a lack of understanding of the kinds of abnormalities we are treating. However the concern also reflects the limited budget for the neurosurgical program</span></span><span class="Apple-style-span" style="font-family: arial; font-size: medium; "> </span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">So that brings me to my requests. I’ll list them in no special order but I’ll ask you to prayerfully consider how you might be able to help. I think of that mama asking me for money—if she keeps asking, someone may feel led to help.</span></span></p> <p class="MsoBodyText" style="margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo1;tab-stops:list .5in"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">1.</span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;"> </span></span></span><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">We ask that you pray for us to have strength, compassion, and wisdom so that we make good decisions in giving care in a place of very limited resources.<o:p></o:p></span></span></p> <p class="MsoBodyText" style="margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo1;tab-stops:list .5in"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">2.</span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;"> </span></span></span><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">Pray for us to maintain a good sense of humor, flexibility, and reasonable expectations so that we are better at rolling with the punches.<o:p></o:p></span></span></p> <p class="MsoBodyText" style="margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo1;tab-stops:list .5in"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">3.</span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;"> </span></span></span><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">Please prayerfully consider contributing to the BKKH fund that is established to pay for scans that children need for surgical planning. Many parents cannot afford the $200-400 cost of a scan here.<o:p></o:p></span></span></p> <p class="MsoBodyText" style="margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo1;tab-stops:list .5in"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">4.</span></span><span style="font:7.0pt "Times New Roman""><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;"> </span></span></span><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">Pray for the leadership of Kijabe Hospital and BKKH. There have been and are soon to be complete changes of leadership at both entities. Change is always difficult and threatening—even when it is positive.</span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">We thank you for your prayers, your monetary support of the neurosurgical program through BKKH, and for keeping in touch through email. We are grateful for each one of you—you sustain us.</span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">As I’ve written this sitting on a chair under a tree in the open area in front of the cottage, I’ve watched several birds come to drink out of a concrete bird bath on the ground. The water level is quite low; each bird has perched on the side and carefully, tentatively tried to dip down to reach the water—but each has been unable to drink. It has been fascinating to watch each one finally “take the plunge” and get its feet wet by hopping off the the side to the floor—there drinking deeply and being refreshed. It teaches me that we all will come up dry unless we commit our entire beings to God’s purpose—that committing to the unknown can refresh us and give us sustenance. As Craig Barnes says in </span></span><u><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">An Extravagant Mercy</span></span></u><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">, “Receiving God’s grace shakes the very foundation of our carefully constructed lives…We even have to lose our interest in carefully constructed lives because, well, that may be the greatest sin of all.”</span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">Take care, God bless.<o:p></o:p></span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">Susan</span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">Neurosurgery Patient Subsidy Fund<o:p></o:p></span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">Bethany Kids @ Kijabe Hospital<o:p></o:p></span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">PO Box 1297<o:p></o:p></span></span></p> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">Abingdon VA 24212-1297</span></span><o:p></o:p></p> <!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com0tag:blogger.com,1999:blog-8238962161618527090.post-88703563515720197312010-12-29T02:18:00.000-08:002010-12-29T02:43:54.456-08:00Christmas in Kijabe<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhc7s24dvvmxjTmgA11GJJlnyHGZ1HHwjy_NRXRemaMcDIeo7aQxTMdD1YJH-SSRZc-k-J_cHkiNksbhFGy81oRSOGMnwCk9rrzGMA60K6ILlUage_nX51qxE-v_KiqxopuB6ZWUi97-chs/s1600/Aden+and+mum.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhc7s24dvvmxjTmgA11GJJlnyHGZ1HHwjy_NRXRemaMcDIeo7aQxTMdD1YJH-SSRZc-k-J_cHkiNksbhFGy81oRSOGMnwCk9rrzGMA60K6ILlUage_nX51qxE-v_KiqxopuB6ZWUi97-chs/s200/Aden+and+mum.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5556052853768754034" /></a><span class="Apple-style-span" style="font-size: small;"><br /></span><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTlAAwhQnJuo_A5QIYmp7QT9tBEh6ViwV1rSVWADTfzOeXxq-fBac58v_RlafraWIWbiM5BX318hqCJMehqYjx916RlSJSpr-0ZKm6rmbGrM0aEjrcNkAh1RQJSd0Bn6VIGMW_vIeIQOkP/s1600/Patience+and+mum.jpg"><img style="float:right; margin:0 0 10px 10px;cursor:pointer; cursor:hand;width: 150px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTlAAwhQnJuo_A5QIYmp7QT9tBEh6ViwV1rSVWADTfzOeXxq-fBac58v_RlafraWIWbiM5BX318hqCJMehqYjx916RlSJSpr-0ZKm6rmbGrM0aEjrcNkAh1RQJSd0Bn6VIGMW_vIeIQOkP/s200/Patience+and+mum.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5556051339503266354" /></a><span class="Apple-style-span" style="font-size: small;"><br /></span><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSInlUASJp6aCxxIyrs_15EGhJu7cjeyF7KfX_QnNl7sLQE0Gbowjdn9JP9DDEz67tpJZLofjpFCqfumPxc2DStp1kgJJh11mc_nv5FXHy-84s8pdnh6Xi192lg1Y6qiDFKjfjFcxSRLhk/s1600/John+and+mum.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSInlUASJp6aCxxIyrs_15EGhJu7cjeyF7KfX_QnNl7sLQE0Gbowjdn9JP9DDEz67tpJZLofjpFCqfumPxc2DStp1kgJJh11mc_nv5FXHy-84s8pdnh6Xi192lg1Y6qiDFKjfjFcxSRLhk/s200/John+and+mum.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5556051033245839474" /></a><span class="Apple-style-span" style="font-size: small;"><br /></span><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgM9K8A3bpV_Zw6qshePoFGnQ4SUnnM2ZypM1bi_pQNTCRJi8UAjx23NJWJgCZiw4I5vtWrJOIkQhg3XDj4jmB_o_siEz6Tj19d16looXZ39an_LRWj0ihvfX_Jc-mLEOnaVV7Z8CM7PQ9P/s1600/Monicah+and+mum.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 150px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgM9K8A3bpV_Zw6qshePoFGnQ4SUnnM2ZypM1bi_pQNTCRJi8UAjx23NJWJgCZiw4I5vtWrJOIkQhg3XDj4jmB_o_siEz6Tj19d16looXZ39an_LRWj0ihvfX_Jc-mLEOnaVV7Z8CM7PQ9P/s200/Monicah+and+mum.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5556049591536146338" /></a><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuJ7GG4BlCDfmvXGk5mFKO3WT2uOjQXKmZ5lq0cO1C_s2ISe-PdeLbMX7Mo9mOScFRQSCGTxrp2ic2NtunJmU630k5sv_WQx2CD5xXiJBmktYpYbquAA4QR-8WK7zQlB4o-15hal5lDz1_/s1600/Bevan+and+mum.jpg"><img style="float:right; margin:0 0 10px 10px;cursor:pointer; cursor:hand;width: 150px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuJ7GG4BlCDfmvXGk5mFKO3WT2uOjQXKmZ5lq0cO1C_s2ISe-PdeLbMX7Mo9mOScFRQSCGTxrp2ic2NtunJmU630k5sv_WQx2CD5xXiJBmktYpYbquAA4QR-8WK7zQlB4o-15hal5lDz1_/s200/Bevan+and+mum.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5556049329458674738" /></a><span class="Apple-style-span" style="font-size: small;"><br /></span><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfh6j5apznTzt6HVMWI0Nnj1-cd0XnfaTN5vZ5va5LQNBbNIKvAw_2N5z3GGckm3ZbZR9q3l2BYSKA7HZceiFv7F_6HPF7ATRZY09z-qlxpYef4xiRLwXcM4Pc-kZmbY2aN5RAl_RsWsmT/s1600/Christmas+in+the+Annex.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 150px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfh6j5apznTzt6HVMWI0Nnj1-cd0XnfaTN5vZ5va5LQNBbNIKvAw_2N5z3GGckm3ZbZR9q3l2BYSKA7HZceiFv7F_6HPF7ATRZY09z-qlxpYef4xiRLwXcM4Pc-kZmbY2aN5RAl_RsWsmT/s200/Christmas+in+the+Annex.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5556049098395530818" /></a><span class="Apple-style-span" style="font-size: small;"><br /><br /></span><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: small;">Dear Friends and Family,<br /><br />I wrote a blog posting on 12/13/10 but an electrical surge blew my surge protector strip for the American plugs on the computers. The battery on my computer died and could not be resurrected until we had purchased new strips. Then, the internet connection failed so I could not post the blog even with a fully charged computer. Perhaps that is “providential” as my Dad would have said—the blog I wrote then was a bit d</span><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 150px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6enlC4A4Oay33EYFbE5MBTtiFyJOd_o0Q0CX5gj2kBiG_837EATcD_FDff2pgv82gYLO5xLMDN_XM-Ot-vHPJHrF09b75BlMnudp2RXo9MwAjcUDrh_XFvfyudsiAwDB1WifM-8dc07Ly/s200/Jane+at+entrance+to+BKKH.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5556048887945647922" /><span class="Apple-style-span" style="font-size: small;">own.<br /><br />As I explained in the last blog, I had reached the end of my rope so I flew to Vienna on 12/2/10 (at 12:25 am) to meet Kelly, Joe, and my granddaughter Evelyn. My temporary Kenyan visa expired on 12/1/10 which was duly noted by the customs agent in Nairobi; he said it is fairly easy to renew—I told him, No! I HAD to leave Kenya!! Upon reaching Vienna I found a winter wonderland—it snowed for two days. It was good to be back where traffic signals are strictly obeyed, no one leaps from barriers between lanes and matatus are not heading directly toward you at breakneck speeds IN YOUR LANE! Crossing the street was so...pedestrian—no suspense at all. I gained 4 pounds in 5 days (schnitzel will do that). What was really helpful (besides playing with my granddaughter) was to talk with Joe and Kelly about their experiences in Syria. Joe has spent a good deal of time working with the Syrian guards who patrol the outside of the embassy. Over his 15 months there, he has significantly improved morale among them—mostly by treating them with respect and having clear directives about performance. Although his and my roles are dissimilar, he had some ideas that I will try since morale and performance are important issues here in Kijabe.<br /><br />I have to admit that I had trouble returning--not simply because I missed my connecting flight to Nairobi in Zurich, had to detour through Istanbul arriving in Nairobi at 02:10 am—and did not find the driver hired to meet my plane until 05:45 am. The sidetrip gave me the opportunity to see Istanbul from the air and to cross off another country on my mental map of the world. My attitude remained less than stellar—until one of the moms approached me for help—then my heart melted with love for these women and their babies. I realized then that it has always been the patients that have saved me, fed me, ministered to me at least as much as I have to them. It is the Erics and Megans and Chanons, and Mr. Moseleys, and Sarahs and Marks and Davids, and Danelles of Madison, Portland, Pittsburgh who have been my best teachers, my strongest supports, and sources of greatest joy in my work. So, as in the past, these Kenyans ladies and their babies drew me back to the place where God has most certainly brought me.<br /><br />We’ve continued to be busy at work. In November, Leland did 72 operations (his previous all time high was 30/month in Pittsburgh; so far in December he has done 81). Our Pediatric Neurosurgery fellow, Humphrey Okechi, has been a wonderful addition to our team. Humphrey has a gift for organization as well as technical skill in the operating room, so our rounds are concise and mercifully shorter each morning. He also has learned a good deal of Swahili during his first 6 weeks (I guess if one can learn Chinese, as he did in a year, one can learn any language) so is able to have more than rudimentary conversations with the moms. Leland and I are consigned to saying “nyumbani, kesho” which means “home, tomorrow.” We do cause some giggles among the moms as we try to properly pronounce words—asking the staff to spell the word causes some consternation, as the spelling is fluid and depends on one’s native tribal language. Babies admitted as Fatih Jepkemoi become Faith Chepkemoi sometime during the hospitalization. Athan becomes Aden, Iynoam becomes Ahinoam. Also, people don’t get caught up in such things as spelling: our clinic secretary Veronicah sometimes leaves the “h” off her name—she says she doesn’t much care how it is spelled. It reminds me of Ellis Island where names of immigrants were changed because the staff processing them didn’t understand the language and assigned phonetic spelling.<br /><br />Leland and I spent one afternoon reviewing the complications of the past 20 children treated for myelomeningocele. We are dismayed at the number of spinal fluid leaks, wound infections, instances of incisions falling apart (up to 20 days after surgery). We talked recently with two of the pediatric surgeons here—there are so many factors that impede healing here—intraoperative temperature (the babies get cold during surgery), nutritional status and vitamin/mineral deficiency, skin preparation (we don’t have chlorhexidine prep here—it has been shown to significantly decrease surgical site infections), even oxygen supply to the tissues. At altitude, the air is “thinner.” Most people here increase their hemoglobin levels in compensation—that happens within 120 days of acclimating. However, so many of our babies are significantly anemic—they arrive preoperatively with hemoglobins of 7-9 (normal at sea level is 11-16). We have decided on some interventions that we can fairly easily institute; Leland will change the way he prepares the skin before surgery; we will start each child on multivitamins when they are admitted and send them home with a one month supply. Intraoperatively, the temperature will be monitored and recorded every 15 minutes. I need to talk with a nutritionist in the States of ways to supplement the mom’s nutrition so that the breastmilk is of better quality. Long term, we’ll need to work with the Kenyan staff to teach moms to cook more nutritious foods, refrain from feeding cows milk before the age of one year (one 3 week old baby was being fed cow’s milk last week).<br /><br />We have so many discouraging stories—Leland asked that I tell you about a different outcome. Early this week, he saw a 26 year old Somali lady who had been struck by a stray bullet—which lodged at the end of her spinal cord causing complete paralysis of her legs. She had sustained the wound December 2nd; Leland told her that he thought there was a 20% chance of improvement after surgery. The surgical procedure went well; the following day, she had movement in one leg. Two days later, she had normal movement of her right leg and antigravity movement of some muscles in her left leg. We have seen many Somali patients; Dick Bransford says that arguments will never sway them, but caring for them compassionately in Christ’s name is the best way to minister to them. One Somali mom told the translator that she wanted to hear about this Jesus because she saw Him in Leland and me. That, quite honestly, is why we are here.<br /><br />Two weeks ago I gave a 15 minute talk to the nursing staff on how to do wet to dry dressings—despite our telling and showing many of the nurses, we found every morning that the dressings were done incorrectly. After the talk, we were astounded to find that the dressings were correctly done….for the next 5 days—then a lapse back to the old way. When I asked about that, the nurse said that they’d been doing the dressings their way for years and she didn’t understand why we should change. Another thing I’ve recently discovered is that the nurses have as much trouble understanding our accents as we do theirs. So, they “seem” to understand what we say but really don’t. Other nurses are really not fluent in either spoken or written English—so once again, they say they understand but don’t follow the order that has been written. Today a very sick child was not given antibiotics for 24 hours--the nurses didn't see the new order until during the night (it was written yesterday at 0645 am) and then the antibiotics were locked in a cupboard, so could not be given until the person with the keys arrived for work this morning.<br /><br />We are thrilled to report that we moved into our new home—a 768 square foot apartment on the third (gasp!!) floor of the new building on the downside of the mountain from the hospital. We have the furniture that we ordered (delivered 5 days early—that’s when they were delivering to Kijabe—take it or leave it). We have drapes that I chose and were made to order on Biashara Street in Nairobi—they were done in two days!! I finally have a stove that doesn’t make bread into nuclear waste—we feel like we are in heaven. There are a few glitches—they made ventilation screens at the top of each window—so each night a roof rattling gale blows through our apartment, flapping the draperies, showering that wonderful red dust on everything. Believe it or not, the wind wakes ME up at night!! (I’m deaf!!) The showers are remarkable—we love them; but in every other tap the water comes out in a pitiful trickle. And we have solar hot water—which so far has been solar tepid water. Every time I think about complaining, though, I remember that most of the staff at the hospital—and nearly all the patients—bathe in basins with cold water or water heated over a charcoal stove. Even with the imperfections, we both feel like we are now at home.<br /><br />It was a strange Christmas in Kenya. The chaplain decorated the ward 3 days before Christmas. By Christmas day, each area had a small tree. But, there was no celebration of Advent (the sermons were from the book of Esther), and other than in mid-November, no carols or advent songs were sung. Leland and I finally went to the Uhuru Highway Lutheran Cathedral in Nairobi on the Sunday before Christmas—both of us remarked that we were able to worship for the first time since leaving Madison. We had dearly missed the liturgy, the readings, the recitation of the Creed, the Lord’s Prayer—as well as the hymns. I think that we will try hard to drive to Nairobi each Sunday to worship there. Despite the identification as a “cathedral”, the church is small so should allow us to get to know the members. It has a good mix of Kenyans and wuzunga—and has both a German and a Kenyan pastor. Otherwise, Christmas was quite low key here—a few of the staff exchanged gifts—like cabbage, etc. In a way, it was good to see a lack of commercialism and greed. It is a little disorienting to see life-sized replicas of Frosty the snowman and Rudolph in the Nairobi mall—2 degrees south of the equator.<br /><br />In the last blog, we asked for ideas for how to ship the operating microscope. Eric Hanson, the new pediatric surgeon who arrived, told us he has room in his crate in Boone, NC for the microscope. So, we will need to ship it to Boone, but then the problem is solved. We hear that people are passing the blog along to fellow coworkers, etc, and welcome any new followers. If anyone has thoughts about ways we can improve nutrition, please send them.<br /><br />Most of all, we ask for and thank you for your prayers for us. Even when we have very hard days, we remember that so many people are lifting us up to the Lord in prayer. We are part of a very large community—not just here in Kijabe but extending all over the world—people who care deeply about the poor, the sick, the helpless. “..for I was hungry and you gave me food, I was thirsty and you gave me something to drink, I was a stranger and you welcomed me, I was naked and you gave me clothing, I was sick and you took care of me, I was in prison and you visited me. Then the righteous will answer him, “Lord, when was it that we saw you hungry and gave you food, or thirsty and gave you something to drink? And when was it that we saw you a stranger and welcomed you, or naked and gave you clothing? And when was it that we saw you sick or in prison and visited you.” And the king will answer them, ‘Truly I tell you, just as you did it to one of the least of these who are members of my family, you did it to me.’”<br /><br />Take care, God bless.<br />We wish you a Merry Christmas and a new year full of joy, peace, and health.<br />Susan</span></span>Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com5tag:blogger.com,1999:blog-8238962161618527090.post-67080791708527041582010-11-28T09:38:00.000-08:002010-11-28T10:00:34.046-08:00<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrIaMzFWF-2-0iqlUogkemrBEK4FjKoMhOkfndhWoBUyCJktQHnIU_14Hve2DZUZeygWo-kSqrK2fMvTBE07CehjXO-Gg8_DtyK5ozgvOlnkzVi2Sb0txmcL2M6NncIthwostRY4cMN61d/s1600/baboon.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrIaMzFWF-2-0iqlUogkemrBEK4FjKoMhOkfndhWoBUyCJktQHnIU_14Hve2DZUZeygWo-kSqrK2fMvTBE07CehjXO-Gg8_DtyK5ozgvOlnkzVi2Sb0txmcL2M6NncIthwostRY4cMN61d/s200/baboon.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5544661292451109778" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3mDoGEGD1IKKPtX42cLFdBjbV9ZA5fi37Zz8gJ3slwOm5sAg3XZJ9RFdYUweeX6Eix5Yk3RQ1LDqntRKD6LdiXupFhRkwqfwkyXLhDUO6-1w02CLEMyAt4LHpRQ_lPb2xbkhjG2szrxMi/s1600/crossing+the+road.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3mDoGEGD1IKKPtX42cLFdBjbV9ZA5fi37Zz8gJ3slwOm5sAg3XZJ9RFdYUweeX6Eix5Yk3RQ1LDqntRKD6LdiXupFhRkwqfwkyXLhDUO6-1w02CLEMyAt4LHpRQ_lPb2xbkhjG2szrxMi/s200/crossing+the+road.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5544661284173760914" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFk0wJyFbjp9JyVfpRZYU1ipFIzwd7_8huh9kn-65QSP5oVeUACWyjnw7i0Ybd9pguUgSFItx-OK2q1OToC-9SWKemZHaTK7-GYzGAlzgblekL9C6vy0EwqnDSWDpq7XkxEvtUZBNHEyAD/s1600/old+and+new.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFk0wJyFbjp9JyVfpRZYU1ipFIzwd7_8huh9kn-65QSP5oVeUACWyjnw7i0Ybd9pguUgSFItx-OK2q1OToC-9SWKemZHaTK7-GYzGAlzgblekL9C6vy0EwqnDSWDpq7XkxEvtUZBNHEyAD/s200/old+and+new.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5544661278963378946" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCFVRE_N5a4otHI_Q9g889skwns_1kadqEmZG1NnvBz9GwX9xsKDd1eNsY8XZSGmkDgLUorEA6vwpxOrcIkKpe9FHwa-hMxXar8G6wKP_C-M0g49GUUN4VGnWciN7Lt0soeHE4I80kDzxu/s1600/general+store.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCFVRE_N5a4otHI_Q9g889skwns_1kadqEmZG1NnvBz9GwX9xsKDd1eNsY8XZSGmkDgLUorEA6vwpxOrcIkKpe9FHwa-hMxXar8G6wKP_C-M0g49GUUN4VGnWciN7Lt0soeHE4I80kDzxu/s200/general+store.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5544661277048120738" /></a><br /><!--StartFragment--> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;"><br /></span></span></p><p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;"><br /></span></span></p><p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;"><br /></span></span></p><p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;"><br /></span></span></p><p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">Hello, folks!<o:p></o:p></span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">As of today, we are 2 days shy of being in Kenya for 3 months.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Time being time, it seems like anywhere between 1 and 9 months—depending on the day, my mood, etc.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">I’m afraid that I “hit the wall” recently; until about 2 weeks ago, I felt upbeat, content, patient, kind, really inspired to be here.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Well, I have to confess that those feelings have vanished over these past two weeks.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Despite knowing in my head that change takes time—that is true anywhere—I guess I had hoped that the small changes we have tried to make in taking care of patients would be well-received.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">What I saw as “small changes” are quantum leaps here—and so, understandably, we’ve met resistance.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">In return, I can say that my response to the resistance hasn’t been particularly productive—I tend to become quiet and remote—and that isn’t well understood here.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">So, I’d say that I have a lot of work to do on my attitude.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">Leland has a gift of good timing and incredible intuition—he arranged for us to take this weekend (Friday after rounds until Sunday afternoon) at Malu, a sort of bed-and-breakfast-lunch-and-dinner place in the hills north of Lake Naivasha.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">The food was outstanding (African interpretation of rustic Italian—absolutely delicious), the cottage was heated by a crackling cedar wood fire lit each night by Biden (pronounced Beedin) or Njeri.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">We rode beautiful and responsive horses in the forest above the camp, and read and rested, refreshing our souls and spirits.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">The birds were spectacular—large and loud ibis feeding in the pastures, sparrow sized black birds with iridescent heads, robin sized birds in shimmering emerald/turquoise hues, African eagles soaring silently overhead. What impressed us most was the quiet—the absence of the ubiquitous Kijabe winds. Getting away from Kijabe is, we’ve found, absolutely necessary to maintain our perspective and emotional, psychological, and spiritual health.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">We continue to see patients die—four babies last weekend.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Because there are no autopsies, we most often don’t know what caused the death.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">We don’t have ability to do EEGs so we can’t always tell if children are having seizures.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">The lab is unreliable, so we can’t count that the calcium level is really low (one child had a calcium level of 5.6—very low—and 4 hours later, without any treatment, the level was 9.6).</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">We have checked sodium levels and have gotten results of 101 and 194 (both are probably incompatible with life—or nearly so) in children who really didn’t look too bad.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">There are no tallies of intake and output—the children for the most part don’t have diapers (in US hospitals, disposable diapers can be weighed before and after use, and calculations of urine output can be made)—they urinate in cloths which are then washed by the moms and hung out on the line.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">So determining fluid and electrolyte balance—something fairly simple in the US becomes quite complicated.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">We also see incisions that won’t heal; 10-14 days after surgery, many just fall apart.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">After watching the nutritional status of the moms, seeing the diet they are served in the hospital (which is probably in many cases better than what they might receive at home) and seeing two month old breast-fed babies with rickets, I am convinced that some of the wound healing problems are nutritional.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">We talked about supplementing the mom’s and the babies with vitamins—sounds simple, huh?</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Except, that is an expensive undertaking, we don’t know for sure if that will translate into better wound healing, we don’t know how long to supplement, and that won’t address the problem after discharge.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">One missionary who has been a midwife in Uganda (and has been quite encouraging to me in my recent funk) suggested that we start having “food parties” to teach the moms how to prepare nutritious food from readily available sources—like cooking and eating the greens of the sweet potatoes to enrich their diet.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">So, I am on the lookout for an available person to coordinate that undertaking—but we’ll need a Kenyan to take charge of the actual teaching.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">Despite the above complaints, we do continue to feel led to be here—and grateful for the opportunity to serve here.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">There are so many opportunites to show God’s love—last week, we had a 2 month old baby boy, Victor, with a large myelomeningocele (open spinal cord) that caused him to have no leg function.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">His head was 53 cm (about 5 cms larger than my granddaughter’s head at 16 months).</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">We obtained a head ultrasound and there was very little brain tissue—mostly spinal fluid.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">So, we recommended that he be taken home without surgical intervention.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Pastor Mercy and I talked with the mother—she was a young single mom who came from the displaced person’s refugee camp and had no family supports at all.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">After I explained that even with surgical intervention (which would cause him pain), he would not be able to think, play, walk, even urinate or empty his bowels normally, we prayed together, thanking God for the gift of this child and asking God’s strength for his mother, to care for him and love him as long as he lived.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">These are not easy decisions or discussions or prayers—and we don’t presume to know what is best or “right” to do in cases like these.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">But we occasionally see children for whom it seems most appropriate to not intervene surgically but provide love and emotional support to their moms.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Whenever it has been possible in these situations, we’ve asked that the bill be paid through our indigent patient fund so that the mom does not have the added burden of a bill that she can’t pay.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">It is sobering to see so many women who have waited to get treatment for their babies’ hydrocephalus because they can’t pay for treatment—they have waited so long that the heads are the size of basketballs—and they don’t understand that we can’t make those heads normal—ever.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">So much here is related to lack of basic resources—food, transportation, adequate shelter, family support, basic medical care including prenatal visits, immunizations.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">Some of you have written asking what you can contribute.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">We have not answered these questions—not because we haven’t appreciated your asking, but because we have not known how you can best help.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">While sending toys or clothes for the children for Christmas is appealing, it is probably not what they most need.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">We have thought about asking for donations toward supplying disposable diapers for the babies after surgery—to better keep incisions clean, aid in keeping track of urine output.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">However, we will need to address the problem of waste disposal, storage of diapers, and how to fairly supply each mom with a daily allotment.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">We need more information about how to best enrich the nutritional status of the moms and babies before we can ask for your help in that effort.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">So, we would appreciate your patience while we gather more information.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Any contributions to the indigent patient fund go toward paying the bills of those who otherwise would not be able to afford treatment.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">We also pay for CT or MRI scans on those patients who otherwise would not be able to afford them and in whom Leland would not be able to operate without a scan.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Contributions toward those endeavors can be directed to:</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">The Neurosurgery Patient Subsidy Fund</span></span></p><p class="MsoNormal"><span class="Apple-style-span" style="font-size: small;"><span style="font-family:Arial;"></span></span><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">Bethany Kids at Kijabe Hospital</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">PO Box 1297<o:p></o:p></span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">Abingdon, VA 24212-1297</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">Another need just recently arose: an operating microscope, so desperately needed for tumor cases, has been acquired and is sitting in a crate in Madison, Wisconsin, awaiting shipment.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Our usual means of shipping, through Africa Inland Mission (AIM), is no longer available (they are no longer shipping equipment overseas) and so, we will need to establish new means of having equipment shipped to Africa.</span><span><span class="Apple-style-span" style="font-size: small;"> </span></span><span class="Apple-style-span" style="font-size: small;">Ideas and/or contributions toward that are welcome.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">Please continue to keep us in your prayers—that we not become so discouraged by setbacks that we fail to care for the children, their moms, the hospital staff.</span><span><span class="Apple-style-span" style="font-size: small;"> Thank you also for your words of encouragement through email. They mean more than you can imagine.</span></span><span class="Apple-style-span" style="font-size: small;"><o:p></o:p></span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">Take care, God bless.</span></span></p> <p class="MsoNormal"><span style="font-family:Arial;"><span class="Apple-style-span" style="font-size: small;">Susan</span><o:p></o:p></span></p> <!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com0tag:blogger.com,1999:blog-8238962161618527090.post-91385652447051294862010-11-14T09:39:00.000-08:002010-11-15T09:32:09.366-08:00<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE1dOdZVNp5_xVXKuh2yp3Ftw_p2XM-UQBdYo5by2mPeK9MPLYgTqRMvjg_w2lzwkXRYBzmefJGaZV2vpobQH_OCrWwgVDGNo8RK-lswyOBY3OtA0VDx3iH_Cb-mDLXHF8wpZ_yRvWfMbq/s1600/P1000745.JPG"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE1dOdZVNp5_xVXKuh2yp3Ftw_p2XM-UQBdYo5by2mPeK9MPLYgTqRMvjg_w2lzwkXRYBzmefJGaZV2vpobQH_OCrWwgVDGNo8RK-lswyOBY3OtA0VDx3iH_Cb-mDLXHF8wpZ_yRvWfMbq/s200/P1000745.JPG" border="0" alt="" id="BLOGGER_PHOTO_ID_5539470614519288578"></a><br /><font class="Apple-style-span" face="arial">Habari friends, family, others who have stumbled across the blog,<br /><br />Two weeks have flown by since the last blog post. It is hard for us to fathom that we’ve been in Kenya two and a half months. We’ve been too busy to be homesick, yet we’ve missed the color change and fall of the leaves in Wisconsin, we’ve missed the first snow fall. Last week in church, I had an acute attack of longing for Luther Memorial—for the worshipful, quiet, reverent awe-filled liturgy, the familiar (and formal) hymns, the wonderful complex harmonies of the choir and Bruce Bengtson’s masterful leadership. I cried silently while the prayer was hollered (definitely not a Lutheran pray-er). After the service (and a thoughtful sermon by Pastor Muhota), we had our communion of bread cubes and grape juice—and yet—yet God was there in that service and in that communion every bit as much as at Luther Memorial.<br /><br />Over the past two weeks, we’ve seen about 4 children who have big heads and essentially no brain tissue—it is so hard to make decisions about treatment for them when so many other children need operations—and will have benefit from them. We have been inundated with sick children—there are beds lining the corridor; still Bethany Kids at Kijabe Hospital (BKKH) has had to turn away hypoxic children because of lack of bed space. Probably 2/3 of the children are on the neurosurgery service, the rest are on the paediatric or general surgery service. On Monday, a child came in to OPD pulseless and not breathing---we started CPR but we had no working oxygen or suction—not to mention any medications; it was unsuccessful. The baby’s name was Pollyanne and she was 4 days younger than my granddaughter Evelyn. She had hydrocephalus and spina bifida—we will never know why she died—maybe seizures, maybe a shunt malfunction, maybe something else. I sat with the RN, Chaplain Mercy, and Pollyanne’s mum while we told her that the baby had died. It’s hard for me because Mercy believes fervently that spina bifida, death, illness, all are part of God’s will and we need to accept that. I sit silently through these explanations—I admire and respect Mercy but I adamantly disagree—I don’t believe any of this is God’s will. Later, I stood with the baby’s father while he held Pollyanne’s hand and wept. He finally said something—Agnes the RN translated it for me. “He says, ‘Why did God let this happen?’” Then everyone waited for my response. Finally, I said, “I don’t know why God allows these things to happen. I do know that God stays with us through every terrible time.” I had nothing more to say—I still don’t know the answer to his question.<br /><br />We were blessed this week by a visit from Scott Ward and David Etzwiler, two gentlemen (and I mean that literally) who are leaders of Medtronic Foundation, the charitable arm of a medical device company that is very generously supporting our work here. Through them, Medtronic Foundation has donated funds for wireless/highspeed internet to be developed at Kijabe Hospital. The company has also been instrumental in funding the pediatric neurosurgery fellowship that Leland is offering here. It was good to talk with people whose accent I can easily “read.” (They are from Min-ne-soh-ta). They spent 3 days in the OR with Leland—and were a bit blown away when they arrived in the OPD—the cacophony of languages, babies crying, the SHEER NOISE just amazed them. On Wednesday, we drove with them to Mary and Stephen Njenga’s ministry in Ebburu north of Naivasha. There they have established a school for 125 children—most of whom are “functional” orphans with little effective parenting. As soon as we got out of the car, we were overrun with little hands reaching out for us—most of the children had never touched a muzungu before—I had about 5 children on each arm (some of whom were trying hard to see if my white color would rub off). Leland made the mistake of putting a small child on the roof of the car and suddenly had about 30 children to lift up and down. Scott acquired instant friends by taking everyone’s picture; David made a great hit with the kids by using a rugby ball as a missile to shoot the well-ensconced soccer ball out of a tree (made more exciting by the presence of a very active beehive in said tree.)<br /><br />Mary and Stephen have a dream--to have a ministry to the children and families in that small town on a mountaintop. They have bought some acreage and have built the school. A dormitory for boarding students is nearing completion. Mary works 6 days a week at Kijabe Hospital (she is head nurse of the OR) and then goes up to cook for the children—they realized early on that the children needed nutritious food in order to learn in school. Mary also has a clinic nearby—and they are farming on the land—planning to add 997 more goats to the 3 that they already have. Their vision is to be self-sustaining in 9 more years. The land formerly belonged to a British “Baron” who used Italian POWs to build a Tuscan villa overlooking the Abedere mountains and Lake Naivasha. As we toured the ruins of the house, Stephen reminded us of how futile it is to build treasures on earth, where rust and moth decay—instead of building treasure in heaven. It isn’t often one has such a stark reminder of that.<br /><br />That is the impressive quality of so many of the Kenyans we have met here in Kijabe—they not only have dreams but they use the few resources they have to follow their dreams. If we look at the needs of Kenya with human eyes, we are tempted to throw up our hands and say the needs are too vast to even begin to address. Yet so many people are taking a small piece and saying, “yes, with God’s help, we CAN.” They are answering the call they hear. Can you imagine what the world would be like if we all did that?<br /><br />Well, the electricity has just gone off for the third time in about 10 minutes—again reminding me of the quirks of living here. I drove for the first time yesterday—white knuckles all the way (for both me and Leland—he kept muttering something about falling off the side of the road). It was exhilarating (though we appreciated that more after getting home). The weather is downright Portlandesque—it changes from misty moisty morning to brilliant sunshine to driving rain to spectacular sunset. (The weather is the only thing that could remotely be called Portlandesque).<br /><br />The most striking and wonderful facet of our lives here is the opportunity to minister to the mums and children—we have opportunities every day to show the love of Christ, to be his hands, voice. I talked with one young single mom whose baby has hydranencephaly—absence of the brain above the level of the brainstem. With Mercy’s help, I explained that the child (about 16 months) would never see or hear, would never speak, would always be like a newborn baby—and no surgery would change that fact. She cried—then on her way out of the hospital with her baby strapped to her back, she came to OPD—to thank me; we hugged. Those are the moments when I hope the people feel God’s arms, not mine, holding them.<br /><br />Please continue to pray that we do the work that God wants done here—that we follow and not go our own way. We also pray for you—that God will lead you in your corner of his world—to be his hands, voice, feet, mind to the people to whom you minister.<br /><br />Till next time…<br /><i>The Lord bless you and keep you.<br />The Lord make his face shine on you and be gracious to you.<br />The Lord look upon you with favor and give you peace.</i></font><div><font class="Apple-style-span" face="arial"><i><br /></i></font><div><font class="Apple-style-span" face="arial">Susan</font></div></div>Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com1tag:blogger.com,1999:blog-8238962161618527090.post-91560374646761593902010-10-31T12:08:00.000-07:002010-10-31T12:21:59.818-07:00<!--StartFragment--> <p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">Habari! </span></span></p><p class="MsoBodyText"><span class="Apple-style-span" style="font-family:arial;"><span class="Apple-style-span" style="font-size: medium;">I have tried to give you some idea of our lives here—and have shared some humorous anecdotes. Leland reminded me that I haven’t given you much information about how hard working here can be. So, with this installment of Updates from Kijabe, I’ll try to do that.</span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">These past two weeks, we have seen two children die, and have had 4 intraoperative cardiac arrests.<span style="mso-spacerun: yes"> </span>The old saying, the operation was a success and the patient died unfortunately applies.<span style="mso-spacerun: yes"> </span>The first boy, Said, was 4 years old—he had a very large tumor in his cerebellum—much larger than his scan from July indicated.<span style="mso-spacerun: yes"> </span>Toward the end of the 3 hour operation, Leland noticed that his blood was thin and asked that he be transfused.<span style="mso-spacerun: yes"> </span>There was no blood available; despite Leland’s emergency donation directly from his vein to Said’s, the boy’s heart stopped, and he could not be revived.<span style="mso-spacerun: yes"> </span>The tumor resection, though difficult, was complete—and Said died of a completely preventable cause.<span style="mso-spacerun: yes"> </span>Two days later, a 15 year old girl, Lilian, had what we thought was an unusual and very serious reaction to anesthesia (malignant hyperthermia)—this was after a successful resection of an extensive spinal cord tumor.<span style="mso-spacerun: yes"> </span>She also arrested on the operating table—and despite being resuscitated, later died in the ICU of brain damage.<span style="mso-spacerun: yes"> </span>This Friday, a 3 year old girl with hydrocephalus had a cardiac arrest after being given anesthesia—even before her operation had started.<span style="mso-spacerun: yes"> </span>Just afterward, a 73 year old man with an acute bleed in his brain also arrested just after Leland had successfully evacuated the blood from his brain.<span style="mso-spacerun: yes"> </span>Both of these patients were successfully resuscitated and appear to have had no damage from their arrests.<span style="mso-spacerun: yes"> </span>Because of these problems the anesthesia equipment was examined; it now appears that three of the four arrests may have been related to malfunction of the anesthesia equipment.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">There are cultural differences that make working here hard.<span style="mso-spacerun:yes"> </span>In the West, organization and planning ahead for potential problems are part of everyday life in hospitals.<span style="mso-spacerun:yes"> </span>Here, they are, in many ways, foreign concepts.<span style="mso-spacerun: yes"> </span>Little things like organizing supplies so that they are readily available when needed---don’t happen.<span style="mso-spacerun: yes"> </span>Everyday, I spend valuable time searching for tape, going to the Central supply office for packs of gauze (none were available on Friday), locating scissors to cut bandages, finding sterile gloves for procedures.<span style="mso-spacerun: yes"> </span>Something as simple as a dressing change becomes an hour-long process (hard when we have 30 children on the service).<span style="mso-spacerun: yes"> </span>In the same way, staff here don’t plan for potential problems—like children having respiratory difficulties.<span style="mso-spacerun: yes"> </span>I disagree with some missionaries who have said the staff doesn’t care—I really believe that many staff don’t recognize when children are in trouble and are at risk of dying.<span style="mso-spacerun: yes"> </span>This is true not only on the ward but also in the ICU—intubated patients on ventilators have died with plugged endotracheal tubes.<span style="mso-spacerun: yes"> </span>It can be difficult to get people to respond quickly when a child is unstable.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">And we have so many very sick babies and children.<span style="mso-spacerun: yes"> </span>I have never seen so many with severe anemia, such complex and extensive congenital defects.<span style="mso-spacerun: yes"> </span>On Friday alone, we admitted four children with myelomeningoceles—a day old baby with both a cervical and lumbar defect, a three day old baby with a lumbar defect, a day old baby with a large, leaking thoracic defect, and an 11 month old boy with a bleeding and leaking cervical defect.<span style="mso-spacerun:yes"> </span>This is unheard of in First World countries.<span style="mso-spacerun: yes"> </span>Another one month old baby admitted this week has hydrocephalus, bilateral cleft lip and palate, a congenital absence of her left arm, and bilateral club feet.<span style="mso-spacerun:yes"> </span>Her name is Rahama—her mother died when Rahama was 13 days old.<span style="mso-spacerun: yes"> </span>Her older sister also has spina bifida that has never been repaired.<span style="mso-spacerun:yes"> </span>Because of malaria, anemia, and other congenital anomalies, the risk of surgery is greater in these children.<span style="mso-spacerun:yes"> </span>I am continually challenged to use every bit of my past education and experience as a pediatric nurse practitioner, former pediatric ICU nurse, as well as my neurosurgical experience in ministering to these children.<span style="mso-spacerun: yes"> </span>Leland also acts as much more than a neurosurgeon—he evaluates abdomens, listens to chests—it takes everything we have ever learned to take good care of these children—and yet, some die.<span style="mso-spacerun: yes"> </span>That is a very hard thing.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">We know that we need to pace ourselves—and have tried to do that by taking breaks.<span style="mso-spacerun: yes"> </span>Last Wednesday was one of the two Kenyan Independence Days (the other is in June).<span style="mso-spacerun:yes"> </span>We drove down the worst road I have ever seen (worse than the one in Monument Valley, kids) and over to Mt. Longonot, a volcano in the valley.<span style="mso-spacerun: yes"> </span>We spent about an hour climbing up to the rim (no switchbacks here—just straight up the side!).<span style="mso-spacerun: yes"> </span>Unlike parks in the US, there are no guardrails, fences, or even rangers at the rim—just a sheer drop into the crater with a path along the rim.<span style="mso-spacerun: yes"> </span>Unfortunately for us, a large group had arrived before us—they were having a loud prayer meeting along the rim.<span style="mso-spacerun:yes"> </span>People were praying in Swahili (eyes shut), arms raised to God, walking around—it was terrifying to us because we had very little room to walk without fear of falling into the crater if one of them bumped into us.<span style="mso-spacerun: yes"> </span>Obviously, that didn’t happen—we loped down (the dust was so slippery it was easier to lope than climb) and then drove into the valley to celebrate the climb the Kenyan way—by having roast goat.<span style="mso-spacerun: yes"> </span>Then we tested our little car by driving back up the worst road I have ever seen—which entails an extensive ab workout just by maintaining an upright position, not to mention working off those calories.<span style="mso-spacerun: yes"> </span>These excursions help us maintain perspective as well as refresh our spirits.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">This morning we heard a wonderful sermon from Romans 14:1-23 by Pastor Muhota of the AIC church.<span style="mso-spacerun: yes"> </span>He spoke of Paul’s exhortation that we not be critical of differences—in what we eat, in the way we worship, in whether we dance or stay rock still during songs.<span style="mso-spacerun: yes"> </span>Yet on the walk home, another missionary criticized us quite severely for making rounds to see the children scheduled for tomorrow’s surgery instead of “honoring the Lord’s Day.”<span style="mso-spacerun: yes"> </span>I wondered what she thinks of the nurses who work on Sunday taking care of the children.<span style="mso-spacerun: yes"> </span>It is hard not to respond sharply (I appreciated having just read Craig Barnes’ sermon from 10/10/10 on not using our weapons (my sharp tongue) but trusting in God—thank you Craig).</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">Then there are the peculiarly Kenyan inconveniences that make our lives less predictable—some would say more humorous.<span style="mso-spacerun: yes"> </span>This morning the electricity went out---about 6 times.<span style="mso-spacerun: yes"> </span>It was interesting to have the lights and sound system go on and off during the church service—and getting a shower can be downright suspenseful since we have an electric showerhead that heats the water—or doesn’t as the case may be.<span style="mso-spacerun: yes"> </span>Shampoos are especially tricky; I think I’ve gotten the shampoo/conditioner segment of the shower down to less than a minute.<span style="mso-spacerun:yes"> </span>And cold water rinses are supposed to make hair shinier, right?</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">Whenever we feel discouraged, it seems that God sends us a gift.<span style="mso-spacerun:yes"> </span>One morning it was the end of a rainbow over the valley; one evening a spectacular sunset over the Mau range.<span style="mso-spacerun:yes"> </span>Last night, we were both too tired to cook; we had just checked on the progress on our new apartment being built (and to our dismay, found that it will have an electric stove—reread the above paragraph) and so we stopped by the hospital “cafeteria” for some mukimo, beef stew (Leland), and beans/maize and rice (Susan)—only to find they didn’t have most of that.<span style="mso-spacerun: yes"> </span>However—Pastor Mercy was leading about 30 ladies to the wards—they were a women’s choir and they gave us an impromptu concert, including dancing and ululations.<span style="mso-spacerun:yes"> </span>Those are the moments that feed our souls—and make us so grateful to God that He brought us here.<span style="mso-spacerun: yes"> </span>It is a privilege to be here, to use what gifts God has given us to serve him.<span style="mso-spacerun: yes"> </span>We have much joy here.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">Until next time, take care, God bless.<span style="mso-spacerun: yes"> </span>Please continue to pray that God will use us for his glory.<span style="mso-spacerun:yes"> </span>Thank you for your prayers—we feel supported—and we need your prayers.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">Susan</span></p><p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">PS: I am having a lot of trouble importing photos--will try to solve the problem with the next post.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;font-family:Arial"> <o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;font-family:Arial"> <o:p></o:p></span></p> <!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com0tag:blogger.com,1999:blog-8238962161618527090.post-62060658506345841032010-10-17T09:17:00.001-07:002010-10-17T09:20:03.708-07:00<!--StartFragment--> <h1><span style="font-size:11.0pt;mso-bidi-font-size:10.0pt">17 October 2010</span></h1> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:10.0pt; font-family:Arial">Dear Friends,<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:10.0pt; font-family:Arial">Habari.<span style="mso-spacerun: yes"> </span>So much has happened since the last update from Kijabe.<span style="mso-spacerun: yes"> </span>The President, Mwai Kibaki, dedicated the new operating room suite at Kijabe Hospital on Friday, 8 October.<span style="mso-spacerun: yes"> </span>Our hospital was given 4 days notice that he would attend, so in that time, the hospital was painted inside and out, the road from the highway was repaved, new curtains were hung in the wards, all the hedges and gardens were trimmed!<span style="mso-spacerun: yes"> </span>We should have him visit more often.<span style="mso-spacerun: yes"> </span>The hospital employees were so proud—at the ceremony the Maasai murans (warriors) danced, there was a brass band that curiously played The Star Spangled Banner along with God Save the Queen and the Kenyan anthem, and there were many speeches.<span style="mso-spacerun: yes"> </span>I missed the dancing because ALL of the nursing staff left the wards to see the spectacle—leaving the patients with no staff.<span style="mso-spacerun: yes"> </span>Ah, things are different here….<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:10.0pt; font-family:Arial"><o:p> </o:p></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">I am struck with the fluidity of things…time, dates, spelling, rules.<span style="mso-spacerun: yes"> </span>Time is an approximation; if one starts rounds at 0630, that really means sometime between 0640 and 0715.<span style="mso-spacerun: yes"> </span>Leland and I joke that church has a rolling start here—although the published<span style="mso-spacerun: yes"> </span>“start” time is 0830, things are really underway in earnest by about 0850.<span style="mso-spacerun: yes"> </span>Birthdays: in the US, one of the patient identifiers is the birthdate.<span style="mso-spacerun: yes"> </span>In Kenya, most Muslim children have a birthdate of January 1 of the year in which they were born.<span style="mso-spacerun: yes"> </span>Non-Muslim children may have a recorded birthdate that is somewhere in the month in which they were born—but that date may differ on successive admissions.<span style="mso-spacerun: yes"> </span>Names also are fluid—sometimes Stacy is spelled Steicy, Josaphat morphs to Josphat and back again—last names also change spelling from day to day (Muthamni becomes Mutharimi)—making sure what patient is being discussed can be challenging.<span style="mso-spacerun: yes"> </span>The nurses also switch patients from bed to bed—so that one day bed 71 is Maxwel, but later that day it is Hosea—Maxwel is now in Hosea’s former bed 81.<span style="mso-spacerun: yes"> </span>If you are confused, imagine how we feel making rounds—especially when the staff insists on using only the bed number as the identifier—not the patient’s name. Rules: although there are traffic lights that turn red and green (only in Nairobi), no one pays the least bit of attention; if you see an opening you take it—or someone else will. On our death-defying drive to Nairobi yesterday we were a bit taken back when, on a divided 4 lane highway, we swerved violently to avoid a head-on collision with a matatu (almost always a Toyota van that carries people from town to town) driving in the wrong direction.<span style="mso-spacerun: yes"> </span>On the way home, a huge traffic jam caused us to follow everyone else to the other side of the median barrier, so all four lanes were traveling in the outbound direction.<span style="mso-spacerun: yes"> </span>It worked surprisingly well until we met the traffic headed toward Nairobi.<span style="mso-spacerun: yes"> </span>I’m actually not entirely sure how we got out of that mess, but I do remember it involved frantic arm waving and driving over curbs.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:10.0pt; font-family:Arial"><o:p> </o:p></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">I’ve wanted to share with you more about the children and moms here.<span style="mso-spacerun: yes"> </span>You cannot imagine how dearly these children are loved by their moms.<span style="mso-spacerun: yes"> </span>Despite having very damaged babies with devastating neurological problems, these moms play with, sing to, kiss, caress, and really delight in their babies.<span style="mso-spacerun: yes"> </span>We have an annex with two large rooms containing 19 cots—the moms and babies sleep together (no Kenyan mom would think of using a crib).<span style="mso-spacerun: yes"> </span>Although most of the children have had surgery, there is surprisingly little crying—if the baby fusses, he/she is nursed immediately.<span style="mso-spacerun: yes"> </span>When a mom needs to use the toilet, another mom watches her baby—in fact, the older children in the ward, if not too sick, play with the younger ones.<span style="mso-spacerun: yes"> </span>All the moms talk together and provide support to each other—it is quite different from the US where we are so concerned about privacy and confidentiality.<span style="mso-spacerun: yes"> </span>I’m not sure but I think this system works better—at least in providing mutual support. I wish you could hear the moms sing; the chaplain, Mercy Nganga, led the moms in singing the other day—they broke into harmony; the beauty of it brought tears to my eyes.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:10.0pt; font-family:Arial">We do find that we need to get away from Kijabe weekly for a few hours—last week we drove to Naivasha, seeing Maasai herding their cows and goats along the highway.<span style="mso-spacerun: yes"> </span>Once there, we had lunch outside and then walked to the edge of the lake—where we saw a bird standing on a rock—which ascended until ears and eye were visible.<span style="mso-spacerun: yes"> </span>Then a little farther out along the shore, we saw a group baptism with the hippo submerged about 50 yards away. <span style="mso-spacerun: yes"> </span>Gives the term “trusting in Jesus” a new slant.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:10.0pt; font-family:Arial">Kenya is also a study in contrasts—the almost indescribable beauty from the ridge at 8000 ft overlooking the Great Rift Valley with the volcano crater, Mt Longonot in the distance in a blue haze, the rich terra cotta color of the earth, the jacaranda trees covered in periwinkle blue blossoms…the abject poverty of the rural people living amid trash and scraps of plastic bags fluttering in the wind, the donkeys grazing by the highway (giving literal meaning to the term “being at the end of one’s rope”), the tin roofed shacks advertising Blessings Butchery, Susan’s Saloon, God’s Promise Tailoring and Beauty Shop, Gichiengo Omuja Hotel and Butchery, the men pulling carts heavily laden with 10 gallon water containers, women carrying huge bundles of wood on their backs, men handshaping the building stones for the new construction here at the hospital complex.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:10.0pt; font-family:Arial"><o:p> </o:p></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">Some short stories:</span></p> <p class="MsoNormal" style="text-indent:.5in"><span style="font-size:11.0pt; mso-bidi-font-size:10.0pt;font-family:Arial">Each patient, before surgery, is led in prayer by a surgical team member—sometimes Leland, sometimes Mary, the nurse anesthetist.<span style="mso-spacerun: yes"> </span>On Friday, a 14 year old Muslim girl was ready to be put asleep for surgery and she agreed to a prayer.<span style="mso-spacerun: yes"> </span>After Mary had prayed, the girl asked, “Why do you pray to your father?”<span style="mso-spacerun: yes"> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:.5in"><span style="font-size:11.0pt; mso-bidi-font-size:10.0pt;font-family:Arial">I traveled to Embu for a mobile clinic, a 3 hour drive (4.5 hour return—turns out Kenyan nurses like to shop too—though this was no mall; who knew people could get such joy out of vegetable shopping?).<span style="mso-spacerun: yes"> </span>There I saw a 3 month old girl with a temperature of 42.9 C(it equals 109 F).<span style="mso-spacerun: yes"> </span>She was limp, rolling her eyes.<span style="mso-spacerun: yes"> </span>She had an unrepaired myelomeningocele and most likely end-stage meningitis.<span style="mso-spacerun: yes"> </span>I felt quite helpless—her mother hadn’t money to take her earlier for care, and she would not survive a trip to Kijabe.<span style="mso-spacerun: yes"> </span>I doubt she lived through the night.<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent:.5in"><span style="font-size:11.0pt; mso-bidi-font-size:10.0pt;font-family:Arial">We saw one boy in clinic—a 12 year old with a complex spinal deformity.<span style="mso-spacerun: yes"> </span>Leland needed an MRI to safely plan surgery, and his mom agreed to get one.<span style="mso-spacerun: yes"> </span>Fortunately she told a nurse that before she could pay for the MRI, she would have to sell her only goat.<span style="mso-spacerun: yes"> </span>We were able to arrange for BKKH to pay for the scan out of the fund we established for just that reason.</span></p><p class="MsoNormal" style="text-indent:.5in"><span style="font-size:11.0pt; mso-bidi-font-size:10.0pt;font-family:Arial"><br /></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:10.0pt; font-family:Arial">We continue to be humbled, challenged, stretched, molded by our days here.<span style="mso-spacerun: yes"> </span>We ask for your prayers that God will be glorified through the work of our minds and hands, that He will guide us each moment and give us wisdom, patience, cheerfulness, graciousness in our relationships with staff and patients.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:10.0pt; font-family:Arial">Take care, God bless.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:10.0pt; font-family:Arial">Susan and Leland<o:p></o:p></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family:Arial;font-size:130%;"><span class="Apple-style-span" style="font-size: 15px;"><br /></span></span></p> <!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com0tag:blogger.com,1999:blog-8238962161618527090.post-18964316086624018272010-09-29T04:06:00.000-07:002010-09-29T04:09:28.948-07:00<!--StartFragment--> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt; font-family:Arial">29/09/2010<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt; font-family:Arial"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt; font-family:Arial">Dear Friends,<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt; font-family:Arial">Karibu! It is time for an update from Kijabe.<o:p></o:p></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">We are learning some Swahili words.<span style="mso-spacerun: yes"> </span>Karibu means welcome—to which the polite response is Asante (thank you).<span style="mso-spacerun: yes"> </span>Habari means hello/how are you; in Tanzania, the response is nzuri, but in Kenya (at least in this area), one responds mzuri.<span style="mso-spacerun: yes"> </span>I was taught the phrase/response by a Tanzanian nurse who is visiting here (and who obviously believes I need to acclimate myself better to the community)—so when I replied nzuri, the Kenyans had a good chuckle.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt; font-family:Arial">Our weather here is quite unlike the common “picture” of Africa.<span style="mso-spacerun: yes"> </span>Though we are just south of the equator, our altitude (7200 feet at Kijabe) causes cool nights—blanket weather (sometimes socks as well!)<span style="mso-spacerun: yes"> </span>The days have been partly cloudy to brilliantly sunny.<span style="mso-spacerun: yes"> </span>What is most amazing to me here is the wind—each late afternoon as the valley cools, the wind from the highlands at the top of our ridge sweeps down to the valley.<span style="mso-spacerun: yes"> </span>It begins as a rustling of the trees; by dusk and for a few hours afterward it strengthens until at times it has the sound of a jet engine or continuous rumbling thunder.<span style="mso-spacerun: yes"> </span>I am reminded of I Samuel 19 when Elijah looked for God in the wind, then the earthquake, then fire, but finally heard God in the silence.<span style="mso-spacerun: yes"> </span>Perhaps my relative deafness is a blessing. </span><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt; font-family:Wingdings;mso-ascii-font-family:Arial;mso-hansi-font-family:Arial; mso-char-type:symbol;mso-symbol-font-family:Wingdings"><span style="mso-char-type: symbol;mso-symbol-font-family:Wingdings">J</span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">Leland returned to the US for Julie and Art’s wedding on September 18.<span style="mso-spacerun: yes"> </span>He had a wonderful time with family and long-time friends (we are careful not to use the term “old” at our ages).<span style="mso-spacerun: yes"> </span>He loved seeing both the bride and groom so obviously cherishing each other and all the people who attended.<span style="mso-spacerun: yes"> </span>After he left Pittsburgh, he flew to South Africa for lectures in Johannesburg and Cape Town, returning to Nairobi on 23/9/2010.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt; font-family:Arial"><o:p> </o:p></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">The matron of the hospital, Ann Ndungu, graciously hand carried my application for my Kenyan nursing license to the Nursing Council on 23/9/2010.<span style="mso-spacerun: yes"> </span>She met with the committee members (having formerly been a Council member herself) and pled my case.<span style="mso-spacerun: yes"> </span>She reported to me on Monday 27/9/10 that they wanted to meet with me for an interview—on Tuesday (28/9/10)!<span style="mso-spacerun: yes"> </span>So, Leland and I made the trip to Nairobi yesterday morning, arriving at the Council building at 09:20.<span style="mso-spacerun: yes"> </span>I was #20 on the list for interviews.<span style="mso-spacerun: yes"> </span>I completed another application and paid an interview fee. At 12:40, they asked that I go upstairs—where there was another waiting room full of people.<span style="mso-spacerun: yes"> </span>A lady waiting there said she was #10 on the list (having arrived at 07:50).<span style="mso-spacerun: yes"> </span>So, it looked pretty bleak that we would be called before they went to lunch from 12:45 to 2 pm.<span style="mso-spacerun: yes"> </span>They break for the day at 3:30, so I was envisioning having to drive back to Kijabe and come another day.<span style="mso-spacerun: yes"> </span>However, soon after that lady was called, they called my name; Leland came in with me as my interpreter and we had a 30 minute interview, at the end of which I was given a registration number, allowed to pay $400 USD (that, I am told, is a month’s salary for a nurse), and given another application to get my actual license (after I pay yet another fee).<span style="mso-spacerun: yes"> </span>From what we could gather, I will not need to do any supervised bedside nursing.<span style="mso-spacerun: yes"> </span>So, I thank all of you who prayed about this—the results certainly exceeded my expectations and met my wildest hopes.<span style="mso-spacerun: yes"> </span>There is no doubt to me (and to the Kijabe nurses) that God’s hand directed this process.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">Humphrey Okechi, the hoped for pediatric neurosurgery fellow, is a step closer to starting—his medical papers have been received and forwarded to the National medical board for review and approval.<span style="mso-spacerun: yes"> </span>We hope that he will be able to start in late October.<span style="mso-spacerun: yes"> </span>Having had a taste of Kenyan bureaucracy, the word “hope” is chosen carefully.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt; font-family:Arial"><o:p> </o:p></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">Leland has started his full operating schedule this week; most children have some variant of spina bifida—but with much more complex features and infections of the open spinal cord and/or cerebrospinal fluid as well.<span style="mso-spacerun: yes"> </span>One 2 month old baby has a completely formed finger and remnants of toes within the folds of a large mass covering her back.<span style="mso-spacerun: yes"> </span>She has excellent leg function however, so with the needed operation, there is some risk of loss of function.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt; font-family:Arial">We have a growing Somali patient population who present language barriers but also some lack of trust in the providers here.<span style="mso-spacerun: yes"> </span>One lady claims that her child’s kidney was removed and sold for profit (the child had a burn and so had a graft of skin taken from the lower abdomen).<span style="mso-spacerun: yes"> </span>It is sad that there is almost no way to convince her otherwise—and there is some concern about her going back and reporting her beliefs in her community.<o:p></o:p></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">We have eaten well so far—many vegetables! <span style="mso-spacerun: yes"> </span>However, buying vegetables here can be an incredibly intimidating experience; one has to deal with The Vegetable Ladies.<span style="mso-spacerun: yes"> </span>They are a group of about 10 ladies, each of whom sits behind a card table in a concrete block building in the village and sells exactly the same vegetables.<span style="mso-spacerun: yes"> </span>Fortunately, only 5 were there the day I shopped—but one has to buy about the same amount from each lady or some will seem angry.<span style="mso-spacerun: yes"> </span>I announced loudly when I arrived that I was “just one” that week. <span style="mso-spacerun: yes"> </span>I bought carrots, onions, tomatoes, broccoli, cucumber, and potatoes--and when one lady couldn’t make change, she just handed me another zucchini (making 5).<span style="mso-spacerun: yes"> </span>I said, “I’m going to turn green!”—to which they all laughed. I hope to be friendly enough with them to get their picture by the time I post the next blog.<span style="mso-spacerun: yes"> </span>Most of their vegetables are not home-grown as we had thought; we learned that they all go to the high road on Tuesdays and Saturdays to meet the trucks from Mombassa/Nairobi.<span style="mso-spacerun: yes"> </span>It is no wonder then that all the produce is the same.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">The new operating theatres are nearing completion; a formal dedication is scheduled for 8 October.<span style="mso-spacerun: yes"> </span>Rumor has it that either the President or Prime Minister of Kenya is expected to attend.<span style="mso-spacerun: yes"> </span>When the new theatres open, Leland will sometimes have 2 operating rooms, so should be able to accomplish more cases with much better efficiency than can be accommodated now.<span style="mso-spacerun: yes"> </span>Construction of our apartment building is also progressing well—we climbed up again last Saturday to measure the rooms.<span style="mso-spacerun: yes"> </span>On our way back from Nairobi last week, we bought some living room and dining room furniture which will be made over the next month and then held until we move into the new apartment.<span style="mso-spacerun: yes"> </span>We are thrilled with the views overlooking the Rift Valley and will be happy to move to a quieter and less dusty location within the complex.</span></p><p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt; font-family:Arial"></span><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">We appreciate the responses we’ve received from many of you—and are very thankful for your prayers.<span style="mso-spacerun: yes"> </span>I cannot explain how much it means to us to know that you are praying for us.<span style="mso-spacerun: yes"> </span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial; font-size: 15px; ">Take care, God bless.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi-font-size:12.0pt; font-family:Arial">Susan and Leland<o:p></o:p></span></p> <!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com1tag:blogger.com,1999:blog-8238962161618527090.post-2641770769953165712010-09-16T00:19:00.000-07:002010-09-16T01:35:06.145-07:00Arrival in Kijabe<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtsx-87D139Mq-sCC6_XtNo_H7NPJ_fmtaHF2tuu-q0eQUlFS_RDQidbc4nrE1WjDZmQjJmYPZMh7vUl_xqf3JwBmgVndsGEzCOEm6wnJFMV8D3UfIJ6nt2x2KwssumrmxRq8eaNjL-z39/s1600/Kijabe+road.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 180px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtsx-87D139Mq-sCC6_XtNo_H7NPJ_fmtaHF2tuu-q0eQUlFS_RDQidbc4nrE1WjDZmQjJmYPZMh7vUl_xqf3JwBmgVndsGEzCOEm6wnJFMV8D3UfIJ6nt2x2KwssumrmxRq8eaNjL-z39/s200/Kijabe+road.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5517426851620558450" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh53gFztOerlIkKIPWm7a78TGZxsi0SMsy0b-97D6TwKphwnpT3DzUnJKB5OA2eaCkj1qlCoJ9Q0xuNe-YCwTR3FmLEqpwWmmXJZ0BghhlT4gT0vTMH6Bq4Dz_b4lQAu1_eLYgpUA1WU7XH/s1600/New+car.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 150px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh53gFztOerlIkKIPWm7a78TGZxsi0SMsy0b-97D6TwKphwnpT3DzUnJKB5OA2eaCkj1qlCoJ9Q0xuNe-YCwTR3FmLEqpwWmmXJZ0BghhlT4gT0vTMH6Bq4Dz_b4lQAu1_eLYgpUA1WU7XH/s200/New+car.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5517426850426803410" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaORd8qvpv0pQvlKDlNbcc1sVoQSX-tOUqNHPiieC35WKgqwYrzYNGsCvIOJ4sar6ogm0vVVxwc5XA2Pul8A8re6HP4-OSJcvwevZWVr7zR5ZqPzEg_xPU6oIxPaXtg6VD4uBmIOeqdCz9/s1600/kijabe+sunset.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 150px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaORd8qvpv0pQvlKDlNbcc1sVoQSX-tOUqNHPiieC35WKgqwYrzYNGsCvIOJ4sar6ogm0vVVxwc5XA2Pul8A8re6HP4-OSJcvwevZWVr7zR5ZqPzEg_xPU6oIxPaXtg6VD4uBmIOeqdCz9/s200/kijabe+sunset.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5517426839426286834" /></a><br /><!--StartFragment--> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:12.0pt;">11/9/2010 (Kenyans use the European date configuration—it really is September)<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:12.0pt;"><o:p> </o:p></span><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">Dear Friends,</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">I am not a faithful correspondent, but will attempt to improve on my past record.<span style="mso-spacerun: yes"> </span>I wanted to share with you what has happened since our departure from Madison.<span style="mso-spacerun: yes"> </span>It is hard to believe that we have been here just over a week.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">The summer in Madison was quite hard—we worked well over 50 hour weeks every week at the hospital, then kept busy with cleaning/keeping the yard/clearing out the house in the hours we were home.<span style="mso-spacerun: yes"> </span>Despite all of our efforts toward making the house saleable, we were not able to find either a buyer or renter for the house.<span style="mso-spacerun: yes"> </span>We seriously misjudged on the day we left and were so grateful for the help of Deb McLeish, a dear friend and colleague at UW, who came to help drive us and our things to the airport.<span style="mso-spacerun: yes"> </span>She ended up helping to clean out the refrigerator, wipe off the kitchen counter, run to Home Depot for more rope, and take our mail to the post office.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">We left Madison on 31/8/2010 after a 50 minute delay because of a serious thunderstorm (no, Madison was not weeping for us).<span style="mso-spacerun: yes"> </span>The departure was also somewhat complicated because the ticket agent inadvertently tore up the receipts for the 10 additional checked boxes (each just under the allowed weight of 50 pounds—our home scale <u>is</u> correct).<span style="mso-spacerun: yes"> </span>It took him about 15 minutes to retrieve the pieces from the trash and tape them together. Our connection in Detroit was already tight; we did a variation on the OJ/Hertz theme and found our seats 2 minutes before they closed the doors of the plane.<span style="mso-spacerun: yes"> </span>The flight landed in Amsterdam; once again, the connection was fairly tight, and I was pretty convinced that we would be separated from most if not all of the checked baggage (14 pieces in all).<span style="mso-spacerun: yes"> </span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">We arrived in Nairobi around 8 pm on 1/9/2010 with ALL of our baggage.<span style="mso-spacerun: yes"> </span>I figure that was pretty miraculous.<span style="mso-spacerun: yes"> </span>As we came toward the customs agents, with 3 carts stacked Susan-high with baggage, a lady waved to us to come to her station.<span style="mso-spacerun: yes"> </span>She thought she recognized Leland from previous visits and started praising God that Leland was back to do God’s work.<span style="mso-spacerun: yes"> </span>She said, “Go take care of the children, then tell them about Jesus”.<span style="mso-spacerun: yes"> </span>It took about a minute to get through customs, and she never even asked what was in the baggage.<span style="mso-spacerun: yes"> </span>Since we had bought some new things as well as brought some expensive medical equipment, we had not looked forward to the customs inspection—so this was another amazing event for us.<span style="mso-spacerun: yes"> </span>Leland doesn’t think he ever saw the woman before.<span style="mso-spacerun: yes"> </span>We were met at the airport by John Githii, a Kenyan driver who has driven us many times before—it was so good to see his familiar face in the mass of people waiting for travelers at the airport.<span style="mso-spacerun: yes"> </span>We spent the first 2 nights at the Mayfield House, a very welcoming and spare place where missionaries and others stay while in Nairobi.<span style="mso-spacerun: yes"> </span>At dinner, we sat with a lady who had just brought her two older children from their home in Benin to the Rift Valley Academy (RVA) for the opening of the school year.<span style="mso-spacerun: yes"> </span>Whenever she spoke of them, she’d tear up and hold her heart.<span style="mso-spacerun: yes"> </span>I realized how fortunate I was to have had my kids home with me while they went to school.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">During those two days, we set up an account at the Forex and exchanged US dollars for Kenyan shillings (80 Ksh = $1).<span style="mso-spacerun: yes"> </span>We spent several hours trying to arrange phone service for my cell phone (waiting in lines graciously is a skill that will be called upon frequently over the next 3-4 years).<span style="mso-spacerun: yes"> </span>Surprisingly, the easiest part of those two days in Nairobi was finding a car—Kamal Jabez, a man who converted to Christianity 22 years ago, arranges car leasing and purchasing for expats and missionaries.<span style="mso-spacerun: yes"> </span>We learned quite a lot from him (and others) about buying cars in Kenya.<span style="mso-spacerun: yes"> </span>First, if you want to buy a car that is less than 7 years old, expect to pay at least $60K (American)—to cover the cost of importing a car and all the customs/tax fees.<span style="mso-spacerun: yes"> </span>Secondly, insurance costs about 7.5% of the purchase price/year.<span style="mso-spacerun: yes"> </span>Kamal is able to arrange 7% with creditable insurance companies.<span style="mso-spacerun: yes"> </span>There is lower cost insurance available, but that is through independent agents who are notoriously unreliable.<span style="mso-spacerun: yes"> </span>Kamal brought two cars to the Mayfield House—our plan was to lease a car for a month, then buy a car.<span style="mso-spacerun: yes"> </span>We leased a 2002 Honda CR-V—no money was exchanged, no papers were signed.<span style="mso-spacerun: yes"> </span>He said that if we decided to keep that car, the monthly leasing fee would be waived.<span style="mso-spacerun: yes"> </span>Kamal also applied for the taxpayer PIN number for Leland that is a necessary item for almost any sizeable transaction in Kenya.<span style="mso-spacerun: yes"> </span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">Having been daunted by the Nairobi traffic (as well as the thought of driving on the wrong side of the road—Kenya being a former British colony), we called John Githii to lead us to the Nakumatt/Westgate Mall to do our grocery shopping before driving to Kijabe on Friday.<span style="mso-spacerun: yes"> </span>He waited while we did our shopping (and ate a wonderful lunch on the patio of the Art Café—an Italian restaurant in the mall).<span style="mso-spacerun: yes"> </span>Then he led us to a gas station and explained how to get to the road to Kijabe.<span style="mso-spacerun: yes"> </span>Leland was masterful in his driving (using a driving style I’ll term cautious aggression) and we arrived in Kijabe around 4 pm on Friday 3/9/2010.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">It is funny how long it took to pack our 14 suitcases/boxes/containers; it took exactly 75 minutes to unpack everything.<span style="mso-spacerun: yes"> </span>By 6 pm, our clothes were hung in closets, our dishes were washed and placed on shelves, and the groceries were put away.<span style="mso-spacerun: yes"> </span>Kijabe missionaries have a wonderful way of welcoming new arrivals—they supply a dinner for you in your home the first night, then a family has you to dinner the second night.<span style="mso-spacerun: yes"> </span>Millie Bransford had us to dinner on Saturday—with homemade pizza and fruit salad.<span style="mso-spacerun: yes"> </span>She also offered a desk and a sewing machine for me to have (not to use—to keep).<span style="mso-spacerun: yes"> </span>We picked those up on Sunday afternoon after church.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">There are two options for church here: the AIC (African Inland Church) which has an English service at 8:30 am and a Kiswahili/English service at 10:30 am) or the RVA service (not sure when it starts—we’ve always arrived too late to get a seat, so have to find out the time it starts and get there earlier). <span style="mso-spacerun: yes"> </span>RVA does not meet the first Sunday of each month—so that Sunday, everyone goes to the AIC; Holy Communion is available that Sunday AFTER the service.<span style="mso-spacerun: yes"> </span>Since it was the first Sunday of the month, we went to AIC for a nearly 2 hour service (including communion).<span style="mso-spacerun: yes"> </span>The service was packed—they brought in plastic lawn chairs to set in the aisles for the overflow.<span style="mso-spacerun: yes"> </span>As in any service, I could not hear the sermon (because of my hearing loss), but I really appreciated the singing—especially the choir’s presentation (dancing/singing to a Swahili song—with Swahili and English words projected in the front of the church).</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">Although Leland had planned to have meetings and establish relationships this week rather than see patients and operate, that plan was not communicated to the nursing staff who arrange patient appointments.<span style="mso-spacerun: yes"> </span>So, there were full clinics with people who had waited months to see Dr. Albright.<span style="mso-spacerun: yes"> </span>Needless to say, he did operate this week—and is operating this morning (Saturday) on two patients who came yesterday and need urgent operations.<span style="mso-spacerun: yes"> </span>One is a girl who suddenly went blind 3 days ago (after having a severe headache 5 days ago) and the other is a boy with severe hydrocephalus from a large tumor in his cerebellum.<span style="mso-spacerun: yes"> </span></span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">I had been led to believe that I’d have to apply for a Kenyan nursing license before I could see patients, so I waited until I could talk to the Matron (Director of Nursing).<span style="mso-spacerun: yes"> </span>That appointment never quite got arranged, so yesterday I went down to see the nurses in OPD (outpatient department) with whom I’d worked the past 2 times I’ve been in Kijabe.<span style="mso-spacerun: yes"> </span>Janet Otieno made a call for me; I will know Monday if I can work under Leland’s license (if so, I could start working immediately).<span style="mso-spacerun: yes"> </span>If I have to apply for a Kenyan RN license, Leland learned from the hospital administrator that it is a 1-2 year process to obtain an RN license (not the 3-6 month ordeal I’d expected)!<span style="mso-spacerun: yes"> </span>He also learned that his emigration papers had been applied for 3 months ago, so he can expect to receive them in the next 1-3 months.<span style="mso-spacerun: yes"> </span>I cannot apply as his dependent until after he receives his; if I do not receive my E papers within 3 months (the time on my entrance visitor’s visa), then I have to leave the country—in fact have to leave East Africa and then reenter on another visitor’s visa.<span style="mso-spacerun: yes"> </span>If I want to apply for emigration papers on my own, then I’d first have to obtain the Kenyan RN license (remember, that is a 1-2 year process), then apply for E papers.<span style="mso-spacerun: yes"> </span>So, the bottom line here is that it pays to marry well.</span></p> <p class="MsoNormal"><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">Spiritually, it has been a meaningful week for me.<span style="mso-spacerun: yes"> </span>It is so helpful to be removed from the distractions that inundate our days in the US.<span style="mso-spacerun: yes"> </span>We continue to subscribe to the New York Times—which ironically enough was the source of one of the most provocative Christian books I have read recently.<span style="mso-spacerun: yes"> </span>David Brooks (not noted for his Christian spiritual musings) wrote an editorial on 7 September about a book by David Platt, a megachurch pastor from Birmingham Alabama.<span style="mso-spacerun: yes"> </span>Dr. Platt writes that the “American Dream” that so many in the US pursue relentlessly is completely unbiblical and antithetical to what Christ taught.<span style="mso-spacerun: yes"> </span>Because of that editorial, I downloaded and read the book <b style="mso-bidi-font-weight:normal"><u>Radical:</u></b><u> Taking Back Your Faith from the American Dream.</u><span style="mso-spacerun: yes"> </span>I’d discourage anyone who wants to remain comfortable in life and faith from reading this book.<span style="mso-spacerun: yes"> </span>However, if you want to be challenged, please read the book.</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:12.0pt;">Finally, I ask for your prayers for this mission and ministry.<span style="mso-spacerun: yes"> </span>We are surrounded by Christians here in Kijabe, both Kenyan and expat missionaries who are trying to carry out what Christ commanded: to go into the world, preach the Word, make disciples.<span style="mso-spacerun: yes"> </span>Please pray that we will become part of a community that continues to reach out and minister to the poor, the sick, the hungry.<span style="mso-spacerun: yes"> </span>We have been here too short a time to really know the needs; but we take on the following charge: <i style="mso-bidi-font-style:normal">And whatever you do, in word or deed, do everything in the name of the Lord Jesus, giving thanks to God the Father through him.</i></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:12.0pt;">Take care, God bless.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:12.0pt;"><o:p> </o:p></span><span class="Apple-style-span" style=" ;font-family:Arial;font-size:15px;">Susan</span></p> <p class="MsoNormal"><span style="font-size:11.0pt;mso-bidi- font-family:Arial;font-size:12.0pt;"><o:p> </o:p></span></p> <!--EndFragment-->Susan and Lelandhttp://www.blogger.com/profile/01291918433126469355noreply@blogger.com1