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
