Michael & Marisa

Mt. Kenya at dawn

Dear Friends,

It has been over 4 months since I’ve posted a blog.  In that time, we have flown thousands of miles to various events.  In January, Michael and Marisa were married in a beautiful ceremony in Jamaica.  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.  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.  He found it difficult to pay $23 for a hamburger and drink—prices here, while high by Kenyan standards, are much more reasonable.

Since the last blog, we’ve gone from the height of summer to late Fall here.  In early April, the long rains started—late—which was the source of some anxiety for the farmers.  I hesitate to call this “rain;” we have deluges about every 12 hours.  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.  Our trickle of water today is a bit dirty—but it is quite possible that there is no water today in the hospital.  It can be, um, disconcerting to have hands full of body fluids of various sources, turn on the tap, and have NO water.  Makes infection control challenging….

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.  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.  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.  It is hard to imagine that the roof will be replaced during the long rains…no sign of scaffolding yet.

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.  Edward, our Swahili teacher, tells us that he hasn’t seen rains like these in over 12 years.  In western Kenya, erosion has swept away acres of land.  In the valley, the nearest town, Maai Mahiu, was flooded as was the IDP (internally displaced persons) camp near Mt. Longonot.  We just read that a geologist in Nairobi is predicting that Mt. Longonot will erupt in the near future.  So, these are definitely interesting times here in Kenya.

Crossing the moat

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.  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.  It is unfortunate that the levee/trench lies directly in front of our steps—in the US it would definitely be a legal nightmare.  Here, one knows to look out for randomly appearing trenches.  But, not only do we live in a gated community, when it rains we now have our very own moat!

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?  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.  Death is more common here; one lady whose baby was seen this week has had 12 children, 5 of whom died.  However, each child is deeply cherished, and the death of each child cause extreme grief.  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.  Here, it is frequent.  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.  Many times we never know the “cause of death.”  That makes it difficult to identify and address system problems that contribute to bad outcomes.  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.  Since our new matron, Ann Mulwa, joined us, I have seen a tremendous improvement in accountability and professionalism among the nurses.  Working here with the nurses has become a real joy.

Rainbow over the valley (from our window)

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.  But as we drive along the slums in Nairobi, we are struck by the ugliness that surrounds so many homes.  It would be hard for me to live there—maybe I, too, would surround myself with my beautiful children.

We’ve been blessed with many visitors.  In early March, Jim Trosen, the former pastor-turned-financial advisor, visited us and found Kijabe to be “a life-changing experience.”  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.  After he left, Sandi Lam, a pediatric neurosurgeon working in Chicago, spent nearly 2 weeks here, covering for Leland during his trip to Israel.  On my way back from Lousiana, I met Leland’s sister Mary in Atlanta, and we flew together to Nairobi.  We were met at the airport after dark by our driver.  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.  Mary’s eyes were quite large by the time we finally arrived.

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).  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.  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.  She was asked to give a class to the OR nurses, which was well received (they asked her to teach again the next day).  We joked that this visit was her “fact-finding mission” and that her next visit will be filled with classes.  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.

We’ve had a real decrease in the number of patients—not only in neurosurgery, but all over the hospital.  At times we’ve had more than 40 pediatric neurosurgical patients on our service; today we had 8.  It is probably partly attributable to the rains—some places are inaccessible until the roads dry out.  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.  Two of those babies were seen too late in the course of their disease (hydrocephalus) to be able to help them.  One was 11 weeks old and weighed less than his birth weight.  The other was 9 months and weighs 9 pounds—most of which is in her head.  The number of children with severe malnutrition seems to be increasing; those children also often have severe anemia.  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. 

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.  Leland and I will miss them tremendously; we grew to know and love them in a very short time.  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.  I’ll attach Leland’s latest sermon, preached last Sunday.

We ask for your prayers for the following:

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

Ann Mulwa and the BKKH nurses: that they would continue to work toward improving nursing care of our very needy population

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

Jim and Julie Taubitz: an engineering team who have provided leadership in planning infrastructure and the ten year plan for Kijabe Hospital and BKKH

Mardi Steer, Jennifer Myrhe, and Sarah Muma, the pediatricians who provide expert pediatric medical care as well as consultations on our sickest children

Wisdom for Leland and Humphrey as they search for a candidate for the pediatric neurosurgical fellowship

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…?”

Garbage Disposal system

Thanks for your emails, prayers, and encouragement.

Susan and Leland