Hello, folks!

As of today, we are 2 days shy of being in Kenya for 3 months. Time being time, it seems like anywhere between 1 and 9 months—depending on the day, my mood, etc. 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. Well, I have to confess that those feelings have vanished over these past two weeks. 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. What I saw as “small changes” are quantum leaps here—and so, understandably, we’ve met resistance. 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. So, I’d say that I have a lot of work to do on my attitude.

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. 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. We rode beautiful and responsive horses in the forest above the camp, and read and rested, refreshing our souls and spirits. 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.

We continue to see patients die—four babies last weekend. Because there are no autopsies, we most often don’t know what caused the death. We don’t have ability to do EEGs so we can’t always tell if children are having seizures. 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). 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. 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. So determining fluid and electrolyte balance—something fairly simple in the US becomes quite complicated.

We also see incisions that won’t heal; 10-14 days after surgery, many just fall apart. 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. We talked about supplementing the mom’s and the babies with vitamins—sounds simple, huh? 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. 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. 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.

Despite the above complaints, we do continue to feel led to be here—and grateful for the opportunity to serve here. 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. His head was 53 cm (about 5 cms larger than my granddaughter’s head at 16 months). We obtained a head ultrasound and there was very little brain tissue—mostly spinal fluid. So, we recommended that he be taken home without surgical intervention. 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. 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. 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. But we occasionally see children for whom it seems most appropriate to not intervene surgically but provide love and emotional support to their moms. 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.

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. So much here is related to lack of basic resources—food, transportation, adequate shelter, family support, basic medical care including prenatal visits, immunizations.

Some of you have written asking what you can contribute. 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. While sending toys or clothes for the children for Christmas is appealing, it is probably not what they most need. 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. 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. 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. So, we would appreciate your patience while we gather more information. Any contributions to the indigent patient fund go toward paying the bills of those who otherwise would not be able to afford treatment. 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. Contributions toward those endeavors can be directed to:

The Neurosurgery Patient Subsidy Fund

Bethany Kids at Kijabe Hospital

PO Box 1297

Abingdon, VA 24212-1297

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. 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. Ideas and/or contributions toward that are welcome.

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. Thank you also for your words of encouragement through email. They mean more than you can imagine.

Take care, God bless.

Susan

Habari friends, family, others who have stumbled across the blog,

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.

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.

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.)

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.

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?

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).

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.

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.

Till next time…
The Lord bless you and keep you.
The Lord make his face shine on you and be gracious to you.
The Lord look upon you with favor and give you peace.

Susan