Wednesday, December 4, 2013

Cultural Exhaustion


Habari yako,

Happy Advent!

It has been quite a while since I posted a blog.  For several months now, I’ve had mixed feelings about being here in Kenya.  Though I have felt useful, I haven’t felt enthusiastic about working and living here.  Friends of ours call it “cultural exhaustion.”  Some of the things that we found charming or amusing the first few years are now just wearing.  The road that leads out of Kijabe to Gichiengo and the high road is much worse than when we arrived.  I used to think it was an adventure to be jolted for the 15-minute ride; now it is incredibly—well, jolting.  Seeing matatus and buses heading at a high rate of speed directly toward us in our lane has ceased to be amusing.  One Sunday on the drive home from Nairobi, a man leaped the barrier and stooped beside our car so that we ran over the stick he held in our path—not sure what that was about but it was a bit unnerving. Another Sunday a lady led her 4 year old child directly into the path of our car on the main highway from Nairobi—she strolled as if taking a leisurely Sunday walk (which, I guess, is what she was doing).  We had to slam on the brakes and swerve to avoid hitting them.

Not knowing if there will be water each morning (hot or cold) used to be exciting; now it is aggravating.  The plumber came earlier this week to fix a leak in the apartment on the first floor; for several days the water pressure has been awful and today, again, we had no hot water at all.  Turns out, to fix the leak, he turned off the water to the entire building and didn’t bother to turn it back on.  Two weeks ago, while Leland was speaking at a conference in Australia, there was a deluge through his study ceiling onto the floor (through the light fixture).  On investigation, it appears there had been a leaky valve in our non-functioning solar water system—in fact, a container was placed under the valve.  Unfortunately it was a very small container and a very large leak (gallons).  So, the ceilings are again trashed and moldy (the same ceilings that were replaced last July).  We’ve given up on having them replaced or repainted—my suspicion is that this was not the last leak.  It was a good “opportunity” to give the room a good Spring cleaning.

The service has been quite busy most of the time since Humphrey Okechi stopped operating in September.  We have had three pediatric neurosurgeons visit from the US to give Leland a break (Howard Silberstein and Doug Cochrane in October) and to help out with the caseload (Cathy Mazzola in November).  With 5-7 cases per day Monday through Friday, it is too much for one neurosurgeon to handle, even with residents helping.  Humphrey was to have started a 6-month fellowship in Germany on September 1; however, there were many problems obtaining a visa, and he left Kijabe for Uganda just last week.  We hope he will be back by May when we plan a month-long break.  Leland is physically exhausted most days (as well as culturally…).

I’ve said before that we have many Toto moments (“Toto, we’re not in Kansas anymore).  This morning is a very good example of that.  At 6:20 am Leland was called about a baby who had stopped breathing in the annex on post-operative day 1 after a shunt.  We ran up to find the baby in the procedure room. The baby still had a good pulse but was not breathing.  She is 2 weeks old now, and the preoperative head ultrasound showed complete absence of the brain above the brainstem—a condition called hydranencephaly.  I saw two cases of this in the States in 12 years of neurosurgical nursing practice and have documented about 40 Kenyan cases in 3 years.  The care of children with hydranencephaly is a moral dilemma.  Western data suggest that 70% will die within 2 years; however, the heads are filled with cerebrospinal fluid and keep expanding, causing pressure sores, difficulty in caring for the child, and a huge stigma here in Kenya.  The children never develop beyond the level of a newborn despite the growth of their bodies—they suck, swallow, cry, and their eyes move, but they don’t ever see, hear, or experience pain at a cognitive level.  They never develop a social smile, speak or interact, feed themselves, walk or play.   

After that, we continued rounds on our 25 other patients.  One mum complained that she’d not been given a blanket and wanted to leave.  Her baby had surgery for a meningocele yesterday, so ideally we would have liked to observe him another day.  He had been admitted with a terrible eye infection (probably chlamydia or gonococcus) and was on oral antibiotics for his infection.  Following rounds, she tried to abscond with the baby.  That means she tried to sneak out without being discharged (or paying the bill).  Pastor Mercy saw her, went after her, and brought the baby and the mom back to the annex.  Our social worker called the Chief of her village in western Kenya and learned that the baby’s grandmother and uncle are psychotic (as probably is this young woman); that prior to her being sent to BKKH, she had seen the swelling on his back and tried to squeeze it off, then asked for a knife so she could cut it off.  There is doubt as to whether she is capable of caring for either him or his older sibling.  The Chief will arrive tomorrow to help sort out the problem.  It would be nice to refer her for psychiatric treatment but in most places in Kenya, including this lady’s home, that is non-existent.

We continue to be awed by the beauty of the sky and the valley seen every day from our living room window—and also by the beauty of the Kenyan people.  It is the time of year (the start of our summer) when the wind is a fierce roar at night, the valley is visible to the western ridge, and on particularly clear days we can see a distant volcano on the horizon.  It is fantastic laundry drying weather if one can keep the clothes on the line.

We flew to the States in October to visit our children—Leland flew to Pittsburgh and LA to see Julie, Art, Todd, Lisa, and Tusk; I stayed in La Grange with Michael and Marisa while Kelly drove with Evelyn and Alex to meet us there.  Joe wasn’t able to take his vacation because of the government shut-down (he is considered a critical employee).  I cannot tell you how much we miss our families.  I used to miss a garbage disposal, going out to restaurants, taking a bike ride, walking the dog.  Now, I just miss my family and friends.  It is getting harder, not easier, to be so far from them.

The news from the Kenyan government is concerning.  The Ministers of Parliament (MPs) have passed a bill with draconian restrictions on the media—fines and imprisonment for reporting opinions, facts, with which the government takes issue.  They have also created an inquisition of the judiciary—which is the least corrupted institution in Kenya since Willy Mutunga became Chief Justice.  On a closer level, because NGO’s in Kenya have been accused of fomenting the charges against Uhuru Kenyatta (President) and William Ruto (Deputy President) for crimes against humanity, all donations coming into Kenya are now subject to 20% duty on the value of the donations.  What this means for us is that BKKH or Kijabe Hospital has to pay thousands of shillings for donated supplies.  What that means for the people of Kenya is that chemotherapy medications donated for people with cancer are sitting in Mombasa port because no one can afford the duty to free them for use.  If President Kenyatta signs these bills, then I could be arrested for saying what is in this paragraph.  If that happens, please send someone to visit me in prison…J

We honestly don’t know what God’s will is for us.  We had thought when we came that we’d spend 6 years here.  We still feel God’s call to be here—but are not sure we can physically or emotionally do 3 more years.  My hearing is deteriorating to the point where it is excruciatingly difficult for me to understand people—and that is very isolating. I often wonder what Kenya would be like for me if I could hear, understand, and interact more easily with people here.  I bought new hearing aids while in the States; unfortunately the programming for them has made hearing more difficult rather than easier.  So, I will need to make another trip to the States early next year to get them reprogrammed.  A cochlear implant (or two) is in my future—but I’ll need to wait for Medicare to get that done. 

I take great comfort in what Paul says in II Corinthians 4: 7-10,16:
But we have this treasure in jars of clay, to show that the surpassing power belongs to God and not to us. We are afflicted in every way, but not crushed; perplexed, but not driven to despair; persecuted, but not forsaken; struck down, but not destroyed; always carrying in the body the death of Jesus, so that the life of Jesus may also be manifested in our bodies….So we do not lose heart.” 

Please continue to hold us in your prayers.  Pray for the parents of the babies who are born so damaged.  Pray for Pastor Mercy—she maintains a joy despite all the sorrow she sees. Pray for the completion of the new building—about $400,000 more is needed to complete it.  Pray for Jim and Jullie Taubitz who have overseen the building, and who are our strongest encouragers here.  Pray for the government of Kenya, that it may serve the Kenyan people with wisdom and compassion.

It has been easy to concentrate on the negative things about being here.  But, we also have much for which to be grateful.  We have loving and caring family and friends; we live in a safe place.  We lack for nothing.  When I was a child, I memorized scripture.  In my attempt to “rewire” my thinking, I’ve started to memorize psalms of praise.  My first attempt is Psalm 103:

Bless the Lord, O my soul, and all that is within me, bless His holy name.
Bless the Lord, O my soul, and forget not all his benefits.
Who forgives all your iniquity, who heals all your diseases,
Who redeems your life from the pit, who crowns you with steadfast love and mercy,
Who satisfies you with good so that your youth is renewed like the eagle’s.
The Lord works righteousness and justice for all the oppressed.
He made known his ways to Moses, his acts to the people of Israel.
The Lord is merciful and gracious, slow to anger, and abounding in steadfast love.
He will not always chide, nor will he keep his anger forever.
He does not deal with us according to our sins, nor repay us according to our iniquities.
For as high as the heavens are above the earth, so great is his steadfast love toward those who fear him;
As far as the east is from the west, so far does he remove our transgressions from us.  As a father shows compassion to his children, so the Lord shows compassion to those who fear him.
For he knows our frame; he remembers that we are dust. 
As for man, his days are like grass; he flourishes like a flower of the field; for the wind passes over it, and it is gone, and its place knows it no more.
But the steadfast love of the Lord is from everlasting to everlasting on those who fear him, and his righteousness to children’s children, to those who keep his covenant and remember to do his commandments.
The Lord has established his throne in the heavens, and his kingdom rules over all.
Bless the Lord, O you his angels, you mighty ones who do his word, obeying the voice of his word.
Bless the Lord, all his hosts, his ministers, who do his will!
Bless the Lord, all his works, in all places of his dominion.
Bless the Lord, O my soul.

Take care, God bless.
Susan