Saturday, December 24, 2011



Habari yako,

I am sitting in “our” cottage in Malu (#6) in the mid-morning of our last day here. 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. There is silence except for the occasional birdsong. We have found restorative peace here—as always when we come.

The past month was almost overwhelming—Humphrey Okechi, our pediatric neurosurgery fellow, took a much needed two week break. 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.

We had a truly “other-worldly” experience for Thanksgiving this year. Pastor Sam and Cindy Wolff, our new but already dear friends from Nairobi International Lutheran Congregation, invited us to dinner on Thanksgiving. We drove from Kijabe in the afternoon, arriving at their apartment just at dusk. 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. I remarked that I’d never sat outside for appetizers on Thanksgiving in my entire life—it is a different world here. Then, Sam and Cindy served a real American Thanksgiving feast—complete with stuffing, gravy, cornbread, sweet potato casserole and a delicious turkey from Naivasha. My contribution to the meal was a pumpkin pie—made from a Kenyan pumpkin. Not quite Libby’s but it worked all the same!

The week after Thanksgiving, a friend at church had an amazing experience. He is a vibrant 81 year old man from Eritrea (he jumps rope 100 times each day) who works fulltime in business. He has been quite successful and lives in Nairobi. He came home in the evening to find three heavily armed men robbing his apartment. They demanded money, which he gave them, then asked him to open his safe. He told them he doesn’t have a safe; he keeps his money in the bank. They then stole all of his jewelry, his TV and everything else they could carry—loading everything in three trips into his car. Before they left, he reminded them to take the TV remote with them. 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. He knew that God was present with him. It is very common to read that people are killed during these robberies; we were overjoyed that he was spared.

My health has not been spectacular since we came back from the States. 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. I feel like the aging Queen Victoria with my personal surgeon, Peter Bird. The spider bite, more than 2 months later, is finally scarring over—at least it is no longer painful. 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. Then a hacking cough appeared—which is just now resolving. 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). 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). We went to Nairobi to get a special MRI but the MRI machine broke while we were enroute. 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. 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.

The bimonthly audit was due last Friday—reviewing the numbers from September and October. I enjoy preparing and presenting the audit, though it entails a phenomenal amount of data review and analysis. 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. Three were related to myelomeningoceles, two were related to hydrocephalus, and three to brain tumors (one in an adult and two in children). It is possible that, had we had a CT scanner here, at least one death in the children with tumors could have been prevented. Plans are underway to ship a good quality CT scanner here in January—though it will be months before it is installed and operational. 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.

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. 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). 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. 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. 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. Several have died while waiting to go home—on two occasions, they were unsuccessfully resuscitated. 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. 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. 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. We were proud of them.

Each morning here in Malu we’ve taken a walk—the air is chilly but the sun is hot. The first day, Leland and I walked up to the airstrip—and looked north at the rugged eastern escarpment of the Rift Valley. 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. 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. After about 30 long seconds, she shied again, then abruptly turned around and briskly walked back up the trail. We never did know what she heard or smelled but were grateful that she was with us on that walk. 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. 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. In fact, because of baboons and leopards, dogs in Malu are locked up at night.

Christmas—what memories does that invoke for you? 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. I think that is what makes Christmas here hard—we have to make new memories. This year, we will have a 2’ tree; next year we will have an Advent wreath. We have appreciated the Advent services and sermons this year—calling us to wait upon the Lord. 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. 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. Some of those books are:

A Generous Orthodoxy, Brian McLaren

Radical, David Platt

Love Wins, Rob Bell

Blue Like Jazz

Surprised by Hope, N.T. Wright

Yearning: Living Between How It Is & How It Ought to Be, M. Craig Barnes

Your God is Too Safe, Mark Buchanan

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. Pray for all the nurses as they care for and comfort the children and families. 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.

If anyone has access to intravenous vancomycin, ciprofloxacin, or meropenam, please contact us. 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. We have nearly used our supplies of vancomycin and ciprofloxacin; meropenam costs about $40-50/day—far exceeding what our families can afford.

We wish you a very joyful Christmas and safe and happy New Year. May your minds and hearts be overflowing with the love of God.

“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)

Take care, God bless.

Susan

Friday, November 4, 2011













Habari Rafiki (friends),

It has been quite a long time since I last posted a blog. Many reasons—travel, lack of a working, reliable internet connection, sheer busyness. I will try to convey some of the adventures of the past few months.

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. 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). Our first evening game drive was highlighted by a halfhearted chase of a zebra by an obviously well-fed cheetah. Our guide, Stephen, laughed—the zebra was far too big for the cheetah to bring down alone. It was as if the cheetah thought she should put on a show for her 7-vehicle audience.

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. 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. The baby kept approaching the carcass—the smell was overpowering. Stephen predicted that the same lion that killed the mother would be back for the baby that night. I was glad Kelly was not with us—those are the kinds of stories that broke her heart when she was little.

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. And all along, I thought hippos were strict vegetarians.

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.

In late September, we flew to the US for a much needed break. 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. I know that people sometimes disparage the people in the US, but we consistently met wonderful people. One lady couldn’t make change for my dollar for our parking meter so just gave me 3 quarters. 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. Our spirits were uplifted and encouraged by those and other similar interactions.

Our destination was a small island in Sawyer Bay—an indentation along Green Bay. We took the pontoon boat over, ferrying our luggage and groceries. My sister Ginni drove from Lancaster to join us a few days later. 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. 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. 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. It was a dramatic illustration of how important it is to have deep roots.

After a worker held up the downed (and dead) electric lines behind Ginni’s car, she was able to leave. 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. 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). We all decided that the Viking Tour would be a once in a lifetime experience that we need never suffer again. On Monday, Leland’s sister Mary arrived—fortunately overlapping with Julie and Art so the family had time to reconnect. It was so good to spend time with our family—we miss them.

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. I miss the energy of the people in Wisconsin, the forthrightness.

We had an adventure (ok, so we got really lost—this time I’ll admit it) two weeks ago. We were invited to a reception at the US ambassador’s home for those who work with people with disabilities. 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. Toward the end of the evening, though, all the lights went out. As we left in complete darkness, I mentioned to Judy my surprise at the lack of emergency generators. She said they have emergency generators but that those hadn’t kicked on—the first time that had happened. Of course, I’m looking in the bushes for the terrorists. 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. We found out something very interesting—one can get on the road to Thika but there are no exits. 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. 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. 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). 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. We are blessed to find wonderful people in Kenya as well as in the US.

Leland and I have spent some time reflecting on this past year. We expected it to be hard to make the transition from living in the US to making our home here. The ways in which it has been hard, though, have surprised us. We thrive on the long hours and complex cases, we so enjoy the interactions with the patients and families. We are encouraged by working with many nurses and support staff—we often feel that we are working together as a team. 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. We love learning a new language and look forward to each lesson with Edward. 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. I find that the simplicity of life (no TV, no radio, no easily accessible stores) helps me focus on my spiritual growth.

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. We find that the bureaucracy of this hospital is little different from that of those in the States. 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. 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). 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. 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.

Some people have asked about the safety here since the Kenyan army entered Somalia in search of Al Shaabab. 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. Many westerners are avoiding shopping malls and restaurants entirely—we have decided to just be more vigilant and to not sit in outside cafes. 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. People throughout Kenya are becoming more desperate as inflation skyrockets and more people are going hungry. The hospital recently added an armed guard (the AK47 is pretty prominently displayed) at the main gate. But we have not felt at all unsafe here.

We have specific requests: Almost none of the nurses own a stethoscope. We would like to make sure that each nurse has one. I am making arrangements for shipment—if anyone would like to contribute toward that, please contact me. There are about 30 nurses, only about 2 have stethoscopes.

We continue to need help for our patients who have no money to pay for scans. 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. Contributions to the BKKH Pediatric Neurosurgery Patient Subsidy Fund go toward those kinds of costs.

Leland is still looking for funding for a second Pediatric Neurosurgery Fellow. We have an excellent candidate but have no funding for his position. Leland has made contacts with pediatric neurosurgery associations in the US and with medical equipment companies but so far has found no funds. 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.

BKKH continues to struggle with ongoing funding of care to the children who need surgery. 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.

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.

Well, the short rains are here. The winds at night have returned. We have come full circle in this year—death and new life, brutality and incomparable beauty. What a wonderful place this is—the place God has brought us, sustained us. Wherever we are, it is the place God has put us to serve him.

“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.

Take care, God bless.

Susan


Sunday, August 21, 2011




Habari yako,

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.

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.

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.

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.

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.

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.

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.

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.

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 avidly 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!"

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.

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.

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.

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.

I leave you with another of Paul’s writings from Romans that seems particularly appropriate:

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

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.

Take care, God bless.

Susan

A SERMON ABOUT NOTHING


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.

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.

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.

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.

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 love 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 loved 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 love of God in Christ Jesus our Lord.

There you have it: Nothing can separate us from the love of God in Christ Jesus our Lord.

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.

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.

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?

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.”


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.


And He reminds us of his love with verses from the Psalms:


Ps 34:18: The Lord is near to the broken hearted and saves the crushed in spirit.


Ps 55:22: Cast your burden on the Lord, and he will sustain you.


And of course the most frequent statement in all the Psalms: “The steadfast love of the Lord endures forever.


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.”

B. Paul’s second point was that life (with its sufferings) is not able to separate us from the love of God.

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.

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 are, 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.

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.” Sometimes, what we cannot feel is more essential to sustaining us than what we can feel.

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.

C. 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, and thirdly ( I am not a preacher but I know that sermons are supposed to have three points), the suffering we bring on ourselves cannot separate us from the love of God.

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.

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.

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.

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.

Where else can we find a God like that? Where else can we find a love like that? Nothing can separate us from the love of God in Christ Jesus our Lord. Nothing. Amen.


Sunday, July 3, 2011





Habari rafiki,

June 26, 2011

Leland assures me that the pleural of rafiki (friend in Swahili) is rafiki (friends). I asked if he was sure like a neurosurgeon (sometimes wrong but never in doubt) or sure like Leland. He assured me that it was the latter. I’ll confirm it with our Swahili teacher, Edward Amalu, at tomorrow’s lesson—not that I doubt Leland or anything….

We decided we both needed help in talking with the patients more effectively, so Leland arranged for private lessons 2 evenings per week. Each time, we start with Leland’s questions—how do we ask if the child is vomiting, passing stool, etc. For that reason, we don’t have the ability to have pleasant dinner conversation—but we can find out important information about the patients. We’ll work on the more socially acceptable dialogue later. In the process, Edward tells us fascinating things about the Kenyan culture and customs. It is fun to pick up a few recognizable words as the patients or staff talk around us. 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.

An amazing thing happened at our church this past week. Four years ago, the church started a construction project on the existing church building and moved into a tent. The tent was to have been used for 6-9 months. 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. 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. Late last evening, a ferocious storm moved through Nairobi and shredded the tent roof, making it an even “hole-ier” place. 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. 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.”

Work at the hospital has been emotionally draining this past month. 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. 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. 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. Now, I do appreciate that they recognized the need for organization—but I had to seriously question their timing and prioritization. I decided that we wouldn’t get very far in OPD so carried the baby to the nursery where he was stabilized. 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. The baby’s temperature was 41, and a nauseating smell permeated the room when she arrived. She was covered with dried birth fluids and stool. I quickly cleaned her and drew fluid from her head for analysis—it was pure pus. She had the most horribly infected myelomeningocele that I’ve yet seen—leaking foul-smelling fluid. It was obvious that she could not survive. After Pastor Mercy and I told the baby’s mother, she disappeared. A little later, the OPD nurse came to me and said that the baby was gasping. I went down to find this baby girl alone in the exam room. I could not stand the thought of this child dying alone, so I held her in my arms until she died. Afterward, my lab coat was saturated with the infected spinal fluid. 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. By bringing the baby to us, we had the child buried in our church cemetery in Kijabe.

Several days later, a 6 year old very malnourished boy was brought to OPD with pus draining from a hole in his scalp. It had been draining for over a year. 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. The child will be on 4 antibiotics for at least a month—if he survives. 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. So, if we can heal this boy, he will return to his home. So, what is the right thing to do? These are the questions we face every day.

Habari again—it is one week later—this week I had little time or energy to complete the posting I began above. Another eventful week—the 6 year old boy mentioned above developed very severe pneumonia despite 4 antibiotics. 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). The IV access was poor so he didn’t get all the doses no matter when they would have been given. His white blood count was 31,000 (normal is 4.5-11,000). 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. So, we took off the oxygen and removed his IVs and sent him home on a matatu (about a 12 hour journey). 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.

I very often have trouble deciding what to share in the blog. 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. But it is hard to see poor quality nursing care given and to not address the issues with those responsible. We have routinely had orders not carried out, medications not given or given incorrectly, dressings not done properly. To be fair, though, each nurse takes care of 8-15 patients; these are very sick children. I’m not sure how well I’d be able to do under those circumstances.

Two vignettes:

A baby with spina bifida and hydrocephalus spent a month in BKKH having various complications. Finally she was ready to go home. 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. The day after the baby was discharged, she was still in the bed and her mother was in tears. 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. Unfortunately, this is not a rare circumstance. 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). Your donations go toward paying the bills of these babies.

You may remember the saga of the disappearing infrared thermometer. 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. I was overjoyed and said something about rejoicing for what was lost had been found. 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. 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. 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. After she had continued to work for 2 more weeks, she finally refused to resign so was dismissed. As painful as this incident was, it was very important for the nursing staff to see that there are consequences to theft, lying, etc. 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. 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.

We are enjoying the winter here—July is like January in Wisconsin (well, relatively speaking). Even though we are just 2 degrees south of the equator, we see a real difference in weather. The afternoon sun no longer streams in the living room window; when we sit out on the balcony we almost always need sweaters. The long rains are past; we still have rain occasionally but it is often cloudy and foggy. Since there is no heat in the hospital, the staff wear parkas, hats, and scarfs. 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.

Last Friday marked the beginning of our eleventh month here—time has flown. We feel much more settled here—and are feeling that we belong here in Kijabe. 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. Leland has been asked to preach two sermons during the pastor’s leave. We were “greeters” this morning and both of us have been scheduled to read the scripture.

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 http://gallery.me.com/leeapowell#100069

Here is a link to a BKKH newsletter: https://app.e2ma.net/app/view:Join/signupId:1418122/accId:1408519

Thank you all for your prayers. It has been so good to hear from friends—some who were “lost to follow up” for many years. 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. 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.

Take care, God bless.

Susan