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.

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

Habari Friends,

It is Saturday; I am taking a few minutes to write while the clothes are drying. We have a renewable energy clothes dryer—it is called a clothesline. Because it is so windy today, the clothes dry in about 75 minutes. I have discovered that “permanent press” doesn’t work well without an automatic dryer…amazing the things we Westerners take for granted.

Although it is still “the rainy season,” we have mostly sunny days with rain sometimes at night. There is great concern in Kenya because the “long rains” during April and May have not delivered the rainfall that was expected. Many are predicting continued food shortages and rising prices for food and gas. Food prices for Kenyan staples (maize flour, milk, rice, potatoes) have risen between 15 and 33% since January. Many of our patients live on the edge of starvation in the best of times; we fear that we’ll see even more malnourished children and mums.

The rise in the cost of living is causing anxiety among the Kenyan politicians; they fear that people will become desperate—and politicians aren’t very good at controlling desperate people. Here in Kijabe we are not isolated from this—two weeks ago an armed gang of men invaded the Casualty (Emergency) Department, beat the security guard, and robbed the people there (staff and patients). All the hospital staff were quite shaken by that—it has never happened before at Kijabe Hospital. Here in our Quadplex, the contractors have installed security gates at the two entrances to the building. However, there is no lock on either gate as yet—and from the way the gates are constructed, I’m not sure anything other than a padlock will work—so we’ll either be locked in or out. Not ideal. Maybe the appearance of the gates will be a deterrent. It will also deter visitors—there is no intercom to alert us that someone wants to come up. So some yelling may be in order.

In April, we started worshiping at Nairobi International Lutheran Church. It is a wonderful group of people—most are from countries in Africa. Sam Wolfe, a pastor who worked for 30 years in Tanzania and 7 years in Frankfurt, was called to minister to the church. On Good Friday, he preached about the Last Supper, when Jesus told the disciples that one of them would betray him—and each one asked, “Is it I, Lord?” Pastor Wolfe then applied that to us today—am I the one who passes by a hungry child, am I the one who fails to visit the sick and those in prison, am I the one who doesn’t clothe the poor? His Easter sermon was from Mark 16: 1-8 where the women discovered the empty tomb and left “trembling and bewildered.” We tend to see the joy of the Easter story and forget how terrifying the empty tomb was to the women and the disciples. While we are in the midst of circumstances, they can cause us to tremble. In hindsight, we can see God’s hand leading us through those times.

Whenever my kids were little, if we were lost or if things were a little unsettling, I’d tell them we were having an adventure. Well, we had an adventure this month. On two occasions the week before Palm Sunday, I’d awakened during the night with a gripping (really excruciating) pain that almost made me pass out both nights—but the pain lasted only 10-15 minutes, so I just went back to sleep. On Palm Sunday, I awoke with right upper quadrant abdominal aching pain that grew during the day—by midnight, we decided to go to Casualty where the Australian surgeon, Peter Bird, met me, diagnosed cholecystitis (gall bladder attack) and gave me a shot of pethidine (Demerol in the States) that caused me to not remember the walk back to the Quadplex (LOVELY medicine). Early the next morning I had an ultrasound confirming the diagnosis and by 10:30 am was in theatre (alas, not acting) having a laparascopic cholecystectomy. Much to the nurses’ amazement, I went home that evening (Kenyans aren’t acquainted with same day surgery). The bill for the entire adventure was $500. Paying the bill was yet another adventure; they lost my “file” (medical record) twice in the same day.

Avoiding an “open” operation allowed us to leave for the States on 4/27/11 as planned. We spent 2 days of rest with our dear friends, Deb and Barry McLeish in Madison, then worshipped on Cantata Sunday at Luther Memorial (fantastic music with organ, strings, brass, and tympany). Leland and I gave a presentation in the adult Sunday school—I realized afterward that I’d just given a missionary talk at my church just like the lady who inspired me as a child--Miss Emma Snyder, a missionary nurse who worked in the 1950’s with lepers in Nigeria! That was a “wow” for me. The rest of the week was spent in Chicago—we rested and visited with my family, all of whom were present for Michael and Marisa’s engagement party hosted by her parents.

Leland spent some time reviewing the operations done since we have come to Kijabe and BKKH. In the first 7 months, 869 pediatric neurosurgical cases were done with an average of 124/month. Two thirds of the cases are related to spina bifida and hydrocephalus; the other third is a mixture of tumors (brain and spinal cord), encephaloceles, lipomyelomeningoceles and others. Our work is exceeding the amount budgeted by BKKH by about $10,000/month. While in Chicago, we met with Scott Ward of the Medtronic Foundation who visited us in Kijabe in November and has been instrumental in arranging funding of a wireless internet system to be installed in Kijabe in June as well as that for our neurosurgery fellow, Humphrey Okechi. Scott calculated that each operation and hospitalization costs an average of $228. Remarkably, the Sunday School children of Luther Memorial Church dedicated their weekly offerings for this past year to the children of BKKH—they raised $228.42. Others who have been incredibly generous have been nurses and staff of American Family Children’s Hospital OR who have donated proceeds from “Dog Bones For CAT Scans”, gathered outdated medical supplies, and given sacrificially from personal funds. Luther Memorial Foundation awarded the Neurosurgery Patient Subsidy Fund of BKKH a generous grant. We feel quite grateful to all who support the children and are praying for God’s guidance in finding ways to make up the monthly deficit.

We were blessed with visitors this past month. Sandi Lam, who just completed her pediatric neurosurgery fellowship at Children’s in Pittsburgh, spent 4 days here and did 17 operations. John and Maggie Tarpley, close longtime friends of Leland’s, visited Kijabe to facilitate an international outreach option for general surgery residents at Vanderbilt. Tom Steineke and the physican’s assistant who works with him, Peter Parcells, covered for us during our absence—though we were able to visit with them briefly the day they arrived (the same day we left). We cannot describe how wonderful it is for us visit here with people from the States. I have come to realize how important it is for people to come here and see for themselves not only what we do here, but the patients and families that we treat. Most people who visit and see the needs have described that their lives have been changed by what they see here. So, we invite people to come visit us—but, expect your life to be changed.

People have asked if it was hard to come back—and, yes, it was hard for me to leave my children. My granddaughter really doesn’t understand who IS this lady who looks a little like her mom and is called “Shosho”? But when we arrived back in Kijabe, both Leland and I felt that we had come home. We are energized by our work here. We feel that we are exactly where God has led us. In my devotions each morning, I read a portion of M. Craig Barnes’ An Extravagant Mercy. In his essay on Mark 1: 16-20, he talks about how the story of the Bible has been about people on the move—whether that means a change in relationships, job, aging, or relocating. He says, “…the point of following Jesus [is] not to get to a new place. The point of following Jesus is to follow Jesus. Along the way, we come to understand that our identity is found not in where we are but in the Savior who is leading the way.”

Thank you for your prayers, your support, your friendship.

Susan

Jambo! (yet another way of saying hello)

On St. Patrick’s Day, March 17, 2011, the Long Rains began. It was a day of tremendous excitement among the hospital staff because it meant that the crops just planted will survive. There were torrential downpours (which meant soggy ceilings in our third floor apartment—but that’s another story)—5” in 2 hours…dirt rivers the color of Burnt Sienna (always my favorite crayon) flowing downhill. The silence that night—the complete ABSENCE of wind—was stunning. We could hardly sleep for the silence. J I had expected that the long rains would be like living in Portland in January—rain all day every day. That isn’t the case at all—there have been days with an hour or two of rather light rain, sunny days without any rain, and days like today which are overcast most of the day with occasional showers. But, my, how green is our valley! The tan/brown parched earth has been transformed to lush green. I hope the pictures I’ve included give you some idea of the beauty.

It is hard to convey how different life is here. Take road construction, for instance. You all know what that means in the US—heavy machinery, hard hats, safety signs. Here, everything is done by hand—men push wheelbarrows up and down the hill to bring the medium sized rocks that form the base covering for the old dirt road. Then, they cover that layer with load after load of red dirt. Finally, the cars driving over the road pack it down—which means that now that the rains have come, the middle of the one lane is a muddy mire—we have some missionaries who cannot negotiate the new road even with 4-wheel drive SUVs.

Another group of workers dug deep trenches (about 3 feet deep) so that telephone wire could be laid to the houses further down the hill from the hospital—the physicians living there had to rely on cell phones to call the hospital. The reason that the lines couldn’t be strung on the existing telephone poles is that the wire had repeatedly been stolen for the copper. In the course of digging the trench, rocks and other assorted things were unearthed. One day we saw an ovoid “rock”—which on closer inspection was a human skull. We named him Yorick and were a bit concerned until the medical director informed us that we live on a former cemetery so that bones were always being discovered during the course of construction of the Quadplex. He suggested we just rebury the skull. Alas, poor Yorick disappeared before we could reinter him. Gone too soon to have known him well….

I’ve mentioned before about some of the hard ethical dilemmas that we have here—Leland asked that I give you several vignettes:

1. A 6 day old boy came to OPD yesterday from East Pokot—a very poor area in northwest Kenya. His father was older and had moderate tremor—one side worse than the other. The baby was the eleventh child and had had no medical attention since birth. I don’t think I’ve ever seen a dirtier baby in my life—the clothes were covered with dried stool and urine, he had never been bathed since birth. He had a huge myelomeningocele that was infected. He had no movement below his hips and had a very small head. As I examined him and tried cleaning his back, I realized that he had significant apneas—pauses in breathing—during which his heart rate dropped precipitously and he became ashen. After a pause, he would gasp and then start to cry. Leland examined the baby and saw that his prognosis was rather grim—if his breathing and heart rate could be stabilized, he could have an operation to close the spina bifida, then probably a shunt to treat the developing hydrocephalus. However, the chance that he had the beginning of a bad infection because of the open spinal cord was huge—which would be likely to infect his brain. Also, treating the spina bifida would require that the family do good wound care, observe him for complications (shunt malfunction, skin ulcers) as well as do catheterization to help him urinate regularly. We consulted with Pastor Mercy and she had real concerns that this family would not be able to handle all these medical issues. She recommended though that we give the family the choice of treating the baby or taking him home. That discussion (always a hard one) took place with translation from English to Swahili to the local language of the Pokot. The father seemed to vacillate—but the mother said that if the baby couldn’t be normal, she wanted to take him home without surgery—and that is what they did.

2. A 50 year old man rode via matatu for several hours and presented to Casualty (Emergency Department in British/Kenyan English) with a chronic subdural hematoma causing severe headaches and an impressive right-sided weakness. He had no money to pay for an operation. There were no beds available in the hospital. With a simple operation, he could resume a normal life—without one he would be incapacitated. The operation and hospitalization would cost 26,400 Kenyan shillings--$330 in American dollars (can you imagine how far $330 would go in the US?). One of our wonderful OPD nurses, Jane Mutinda, offered to house him and his wife with her family overnight until a bed became available. Leland paid for his operation and hospitalization—he had a remarkable recovery and is a very happy and grateful man.

3. In December, an 18 year old young man had resection of a medulloblastoma—a brain cancer. His family was able to pay for his surgery and hospitalization. Afterward, he needed an MRI of his spine to make sure he had no sign of cancer there. He could afford only the cervical MRI—we made arrangements to pay for the rest of the spine MRI through funds from BKKH. The MRI was clear of any signs of cancer. But, he needed radiation therapy to make sure the cancer cells were killed. Arrangements were begun to send him to the University of Wisconsin—but then we became aware of a facility in Nairobi which could do the radiation therapy (the usual place, Kenyatta National Hospital has a waiting list of 400 patients—people usually die before they can start therapy). The cost for 6 weeks of daily radiation treatments for this bright young man was KSh 200,000 or $2500. Leland and I felt so strongly that he should have the therapy (which is potentially curative) that we split the cost from our personal funds. The young man just completed the 6 week course and has started back to school.

These are just a few of the many dilemmas we encounter here—whether to treat babies with severe brain damage with expensive medicines and long hospitalizations, whether we should try treating children with massive hydrocephalus, malnutrition, and scalp bedsores, whether children with brain tumors should undergo the risk of surgery (with no ability to do scans here at Kijabe) or face death from the tumor without surgery.

Added to these often heart-wrenching concerns, we daily have incidents where ordered meds (including antibiotics for severe spinal fluid infections) are not given—or are charted as given but have not been, lab tests are not done or the results have been lost, equipment goes “missing” (the donated infrared thermometer that I brought from UW “walked off” last Friday). From time to time we have no running water anywhere in the hospital--washing hands between procedures on patients can be an adventure. It can sometimes be difficult to maintain a cheerful demeanor during the course of the day.

Last month we were informed that the “nurses” were very upset with us; we were given a list of our infractions. Both Leland and I were a bit surprised—we had seen some real improvements in our relationships with the nurses on morning rounds. Many of the formerly reticent nurses had started to actively participate in sharing information about the mums and babies—some had started to ask good questions and were showing interest in learning new techniques. So, we did some reality checking—talked to several Kenyans, other missionaries, and each other—also spent a good amount of time in prayer. We each decided that, despite what had been shared with us, we felt like we were heading in the right direction with our relationships with nurses and other staff in the hospital. We realize that building relationships takes time, and we are committed to doing that over the next 4-5 years. We also realize that cultural differences interfere with understanding—my doing the ventricular taps to be more efficient was seen as being critical of the nurses’ abilities. Our writing daily progress notes was seen as critical of the nurses’ charting. There is real reluctance among some (but not all) Kenyans to directly share information and concerns—we tend to be direct which is seen as quite rude. I feel very confident that we will sort these difficulties out—already the discussions that we’ve initiated with the unhappy nurses have soothed some of the hurt feelings. But, I also became aware of a very important truth. We did not come here to please people. We came because we both felt called by God—we not only want to be obedient to that call, but out of the gratitude we have for God’s love and mercy toward us, we want others to see Christ through us. We are here to bring glory to God, so that through us, people see, come to know and love God.

So, I want you all to know that we are very happy here; we feel an incredible sense of peace. We don’t downplay the difficulties but also don’t dwell on them. We are not discouraged. We look forward to continuing to get to know the Kenyan staff; we love working with the patients and families. Most of all, it is supreme joy to be serving God in this place every day.

We ask that you continue to pray for us—for wisdom, patience, cheerfulness, discernment. Thank you for your prayers and encouragement.

We have confirmation from Paul Buford, the bookkeeper for Bethany Kids, that the Neurosurgery Patient Subsidy Fund has been established. To access the website, go to www.bethanykids.org. If anyone feels led to contribute specifically toward care of indigent patients, you can designate gifts to that fund under “Other.”

Take care, God bless.

Susan