Friday, July 6, 2012

6 July 2012


Habari Yako,
Have you ever spent about two hours writing a letter on a computer only to hit the delete button instead of the save button?  Well, I have--and just did.  Sigh.  So, on my new word-processing program, I will try to rewrite my blog entry (quite honestly, it was an amazing piece of work!).  
We’ve developed a baboon problem here at Kijabe--one was found inside a worker’s house yesterday.  They aren’t the cute furry creatures that one might think--they are strong, intelligent, dangerous animals--particularly in groups.  A Kenyan safari guide told me that a troop of baboons is capable of killing a leopard.  So, the Kenyan Wildlife Service was called to take care of the situation.  Unfortunately, the baboons obviously had notice of their arrival and disappeared--so the KWS decided we don’t have a baboon problem.  The administration is asking KWS to come back before a human is attacked--plans to enclose the garbage bins are also underway.
It is mid winter now in Kijabe--cloudy, misty, cool days and nights.  I used to tease the nurses for feeling so cold when the temperature is 59-65.  Well, right now as I write, I am wearing a long-sleeved cotton ribbed sweater, quilted vest, heavy wool sweater, long pants, shearling lined slippers and am sitting with a knitted wool-covered hot water bottle (thank you Michael and Marisa) on my lap to avoid icy fingers.  I’ve become quite Kenyan in my cold-intolerance.
Our census has been either feast or famine--we’ve had from 9-40 patients over the past few months.  Even with that, Leland and Humphrey have had 4-9 cases scheduled 5 days/week.  In April, we  enjoyed a 10-day visit from a neurosurgery fellow who is completing his training at St. Jude’s.  He came while Humphrey took a well-deserved and much needed vacation.  We also had two neurosurgery residents from the US join us for 2 weeks each in April and June.  It was really an enriching experience to work with new people; the residents even enjoyed seeing patients in OPD (most residents avoid clinic like the plague).  We are looking forward to having a resident from University of Wisconsin join us for a month in August.  He will see more children with spina bifida and hydrocephalus in one month than he will in 7 years of residency.  But he will also see complex brain tumors, spinal cord tumors, brain infections, and other neurosurgical problems--we “have it all” here.
Many “long-termers” at Kijabe seem to resent the visits of “short-termers.”  They believe that the visitors don’t know any tropical medicine, don’t understand the limitations of practice at Kijabe, hold unreasonable expectations, and have difficulty adjusting to non-developed-world medicine.  Usually, but not always, the first is true--and learning about malnutrition, anemia, malaria, Burkitt’s lymphoma, parasitic diseases, and TB among other things is an ongoing challenge.  But, I hope that we never disdain the enthusiasm, experience, problem solving, new ideas and practices, and suggestions brought by our visitors.  It is very easy to adopt an attitude that says, “That’s the way we’ve always done it,” “That won’t work in Kijabe/Kenya,” “We’ve never done that before.”  It will be increasingly important, the longer that Leland and I are here, to have infusions of new ideas, new eyes through which we see our patients and new ways of doing things.  As we near our 2 year anniversary of coming to Kenya, we feel neither “short-term” nor “long-term.”  Perhaps that’s a very good thing.
I think I may have mentioned that we’ve had a leaky roof....well, about 3 weeks ago, Leland and I moved the contents of our apartment from the third floor to the second floor.  It was a good opportunity to develop upper body muscles and work on hamstring/quad strength.  We’ve come to really appreciate our third floor apartment; the view from our balcony, the light because of the open floor plan.  The second floor is much darker, much noisier, and less private.  We expect to be here for about another month.  The roofers have an amazing work ethic--start early, work till dark 6-7 days/week.  They are living in one of the rooms on the third floor and cooking dinner on a Kenyan stove (jiko--much like a habachi).  When the roof was off and it rained, they got soaked--they said it was more incentive to hurry with the repairs.  Because the solar water heaters are disabled, they installed a “widow-maker” in our shower.  For those who are unfamiliar with this devices, it electronically heats the water as it comes out of the showerhead.  It is so named because when it malfunctions, the shower-er gets electrocuted.  I’m assuming they think it is always a man.  Our friends in Nairobi who had a “widow-maker” always showered in rubber flip-flops.
Despite making two trips to the Western hemisphere this year to see family, I got an acute case of “missing the kids.”  So, on June 14 (my granddaughter’s 3rd birthday), I left Nairobi to fly through Paris (love Charles de Gaulle airport!) to Dulles in VA.  Joe is in Afghanistan for 6-8 weeks, so Kelly and Evelyn met me at the airport; later that evening, Michael flew in from his job in Boston.  We had a wonderful weekend, mostly talking and eating.  I spent the next two weeks talking with Kelly, attending Kelly’s award ceremony at work, playing/dancing with Evelyn, painting walls, and shopping.  Never was much of a shopper before--but love those window displays at Restoration Hardware (new color scheme), Pottery Barn, made a boatload of trips to Home Depot.  I loved the clothes dryer, bagels, paved roads, road construction signs like “Bump,” “Uneven Pavement”--they never give you warning here in Kenya and would run out of signs in about a mile if they did.  I didn’t love the GPS (it told me to make a U-turn on an interstate), or the confusing roads (one wrong turn and the only options are Washington, Baltimore, or Richmond), or the 106 degree temperature and extreme humidity that makes your hair cry.  I saw close friends who live in Purcellville--the kind of friends I hadn’t seen for years yet we talked as though we’d seen each other yesterday.  It was a soul-satisfying visit, and I really enjoyed the States.  But I was very glad to come back home to Kijabe.
The first morning back at work, the team asked me to talk with a mum whose baby’s care was futile.  As Mercy translated my words, I became very aware of what a privilege it is to share these hard times with the patients and families.  There has been no accusation of blame by the parents; they express deep appreciation for our care of their children and belief that whatever happens is God’s will.  When I first came here, I really resisted the idea that a child’s death could be God’s will.  I still grapple with that concept--yet, what I have come to learn is that God is very present in everything that happens, that we have the privilege of being God’s arms holding the people in grief and loss.  The lack of blame does not make us less careful in giving care; in fact, I believe we are often closer and more attentive to the patients and families because we share in the grief when one of the children dies.
Leland continues his diligent study of Swahili; I’ve taken a hiatus from the oral lessons and, as a primarily visual learner, am studying from a book (though not diligently).  Since our pastor at NILC (Nairobi International Lutheran Congregation left at the end of May, Leland has preached twice and is responsible for the Weekly Meditation sent via email to most of the congregation.  Since I haven’t figured out attachments to the blog, I’ll copy both sermons at the end of this posting.
Both Leland and I miss our children and families and being more involved with our grandchildren; in a way they are sacrificing for us to be here.  I really appreciated what my son said to me on a walk we took together, “Mom, I’m really proud of what you and Leland are doing in Kenya, I want you to know that.  But, I really miss having you here, and I’ll be glad when you come home.”  Leland and I want to be in Kijabe right now--even as much as we miss our family.  In this time and place, we have a profound sense of peace and closeness with God.
I ask for your continued prayers that we find a pediatric neurosurgery fellow to start in October--not only will that fill the position and train another pediatric neurosurgeon for East African, but it will significantly lighten Leland and Humphrey’s surgical load.
Thank you all for your prayers, notes, care packages, gifts to the neurosurgical patient subsidy fund--we appreciate your thoughtfulness and faithfulness. 
As we say at the end of each church service,
Go in peace. Serve the Lord. Thanks be to God.
Take care, God bless.
Susan and Leland
June 17 Sermon
The Holy Gospel according to St. Mark the fourth chapter, verses 26-34
He also said to them, “The kingdom of God is as if someone scattered seed on the ground, and would sleep and rise night and day, and the seed would sprout and grow—he does not know how.  The earth produces of itself, first the stalk, then the head, then the full grain in the head.  But when the grain is ripe, at once he goes in with his sickle, because the harvest has come.”
He also said, “With what can we compare the kingdom of God, or what parable will we use for it?  It is like a mustard seed, which when sown upon the ground, is the smallest of all the seeds on earth; yet when it is sown it grows up and becomes the greatest of all shrubs, and puts forth large branches, so that the birds of the air can make nests in its shade.”
With many such parables he spoke the word to them, as they were able to hear it; he did not speak to them except in parables, but he explained everything in private to his disciples.  
The Seed of the Kingdom of God
Jesus was such a disappointment.  Think of all the ways he disappointed the Jews.  They expected a messianic king to restore Israel into a kingdom like it had been under King David, a king who would free them from Roman rule.  The ancient Jews said: “He prays not at all, in whose prayers there is no mention of the kingdom of God”, so their everyday prayer would be “Let God cause his kingdom to reign, and his redemption to flourish: and let the Messiah speedily come and deliver his people.” After all, the 7th chapter of Daniel said the Messiah “..was given dominion and glory and kingship, that all peoples, nations, and languages should serve him.  His dominion is an everlasting dominion that shall not pass away, and his kingship is one that shall never be destroyed.” But Jesus, son of a carpenter, born in a stable, going around with fishermen and tax collectors and prostitutes, caring nothing about the Roman occupation, criticizing the most religious people of the day, breaking the sacred commandments and teaching that he was greater than the commandments.  What a disappointment he was.  Good thing he died, they thought.  That was the only correct thing they ever thought about him.
 For some of us, Jesus is a disappointment.  He told us to pray “Thy kingdom come” and Sunday after Sunday we pray it in the Lord’s prayer. At the end of the prayer we say, “For thine is the kingdom, the power and the glory.” What do we think when we pray, “Thy kingdom come”? Many of us think of the kingdom of God in terms of power and glory. Many of us are praying that God will reign, will rule, over all the earth, that his laws will be obeyed by everyone.  Many of us think of the kingdom in terms of the second coming, when Jesus will bring in a new heaven and a new earth.  We almost always think of the kingdom in terms of power and glory and justice and Jesus finally making things right.  And we are disappointed that we see nothing like that kingdom.  Nothing like it.
 When Jesus talked about the kingdom of God to the crowds and to his disciples, his main objective, his main goal, was to reveal himself as the king of the new spiritual kingdom being inaugurated by his presence, a kingdom completely different from the expectations of the Jews.  He did not talk about power or glory and he never gave a clear definition of the kingdom, maybe because it is hard to define, like, how would you define the universe?
So Jesus always talked about the kingdom of God in parables.  The Greek word for “parable” comes from two Greek words, para, which means beside, or alongside, and ballo, which means to throw.  So a parable is a story that is thrown alongside or placed beside, another idea or concept, to clarify it. Jesus told many parables about the kingdom of God, in fact, more parables about the kingdom of God than anything else he told parables about, and each of the parables looked at the kingdom from a different viewpoint.
 Now you know I am not a preacher; I am a teacher, a professor, so let me teach for just a moment and you be the students.  Here is the question for you:  When I read the following list of parables, do you see a common theme in them, a common idea? Do they have anything in common? 
A sower planted seed in four different kinds of soil.
A sower planted seed and weeds came up with the wheat.
A sower planted seed and then just waited for the crop to grow.
A sower planted a small mustard seed and it grew into a large plant.
A woman put yeast put into a large amount of flour and it worked its way through all the dough.
 Did you see any common idea in those parables?  Did you see anything about power or glory?  No, the parables compared the kingdom of God to something small that was put into the world, something not obvious but, like a seed, having power within itself to grew into something great, as in our two parables for today.
 Our first parable today is found only in the gospel of Mark. 
The Kingdom of God is as if someone should cast seed on the earth.   But who casts the seed and what seed is sown?  Is Jesus saying that he, himself, casts seed on the earth?  Is he talking about people evangelizing?  No, the someone, the sower, is God himself.  What seed does God sow into the earth? According to this parable in Matthew, the seed was the word—“anyone who hears the word of the kingdom”. So what was “the word?” How does the gospel of John begins? “In the beginning was the word.” What word was John talking about? Jesus, who was the good news of the kingdom of God and who brought the good news of the kingdom of God was the seed God cast on the earth.
And should sleep and rise night and day and the seed should spring up and grow, he (the farmer) doesn’t know how. For the earth bears fruit of itself, automatically: first the blade, then the ear, then the full grain in the ear.
God is at work in the soil of mankind.  The success of the kingdom does not depend on the efforts of mankind, trying to bring it into being.  No, the active work of God’s grace will make it happen and the reign of Christ in the lives of people who receive him will bring forth the fruit of God’s character in their behavior.
The point of this verse is the work of the seed. Think of the parallels between a seed and Jesus:  both enter the earth inconspicuously, both contain within themselves everything needed for the work they are made to do, both die and are mysteriously transformed from what was planted into something dramatically greater.  As Jesus said, “Unless a grain of wheat falls into the earth and dies, it remains a single grain; but if it dies, it bears much fruit.” (Jn 12:24) 
The kingdom of God is like that—mysteriously growing from the seed of Jesus, people unexplainably choosing to follow him.  A teenage boy with a history of bad behavior decides one Sunday he wants to be baptized; a scientist who denounced God and religion all his career remembers a Bible story he heard as a child and it brings tears to his eyes; a rich, corrupt, businessman who had swindled many clients is invited to church by a business colleague and hears that he is forgiven and believes it and begins to follow Jesus.  No explanation for those.  And yet teenagers who are raised in Christian homes stop believing anything about God, adults who have gone to church all their lives stop believing because God did not heal their wife who was dying of cancer. 
The growth of the kingdom is mysterious, and we have far less influence on its growth than we would like to have.  I have prayed for several years that a dear friend who is a neurologist would say yes to Jesus.  I sent him emails telling him about Jesus.  No response.  Its frustrating, isn’t it?  We love these people, we want so badly for them to know Jesus, to follow him, but they choose not to.   The growth of the kingdom, like the growth of a seed, is mysterious.  But it grows nevertheless. Somehow, that seems fitting for God.  Do we want a God we can figure out? A god who does things the way we think he should?  That would not be god, but an extension of ourselves.
But when the fruit is ripe, immediately he puts forth the sickle, because the harvest has come. Just as we can count on the earth to produce great plants from small seeds, so we can also count on God to bring about the harvest of a great kingdom. The point of this parable is not so much the mystery of the kingdom of God, but its dependability.
 The second parable today, the parable of the mustard seed, is also found in Matthew and Luke.
The kingdom of God is like a mustard seed, which, when sown upon the ground is the smallest of all the seeds on earth.  Once again, Jesus disappoints.  Instead of him starting the kingdom as a mighty warrior or a great king, he starts it as an illegitimate infant.  Instead of choosing the best and the brightest to be his disciples, he chooses fishermen and a despised tax collector.  Instead of comparing the kingdom of God to a giant sycamore tree or a magnificent cedar, he compares it to a mustard seed, the smallest seed they knew of then.  The point here is that the work of God is not done by human methods nor by the ways people think it should be done.
Yet, when it grows up, it becomes greater than all the herbs, so that the birds of the sky can lodge under its shadow.  The kingdom is the thing sown in/on earth.  It does not refer to heaven. This tiny seed of the kingdom of God becomes so great that birds can rest in its branches.  This is a parable.  It is not talking about mustard seeds and birds.  It is talking about the kingdom of God and people, and it hints at something the Jews hated, the idea that Gentiles could be included in the kingdom, like quotation from the OT, “under it shall dwell all birds of every wing” “All great nations lived under its shadow” “all flesh was fed from it” and “in it was food for all.” 
The parable makes clear the dependability of his kingdom in the earth.  It says nothing about the hostility people might have to the kingdom, nor to the various responses people might make to it.  Only that once the kingdom is sown, it will continue to grow into something magnificent.  Our role in that growth in that kingdom is to abide in Christ, to be receptive to what God has gifted us to do and leads us to do, to demonstrate the life and character of Jesus in our worlds.
 With many such parables he spoke to them—the crowd-- as they were able to hear it. Without a parable he did not speak to them. But privately, to his own disciples, he explained everything.  His disciples did not understand the parables either.  They asked him what the parables meant, and he said “The knowledge of the secrets of the KoG has been given to you, but to others I speak in parables, so that “Though seeing, they may not see, though hearing, they may not understand”—a quotation from Isaiah 6.   You remember Isaiah heard the Lord ask, “Whom shall I send? And who will go for me?” And Isaiah said, “Here am I, Send me!” But do you remember what God said next? “Go and tell this people: Be ever hearing, but never understanding; be ever seeing, but never perceiving.  Make the heart of this people calloused and their ears dull and close their eyes, otherwise, they might see with their eyes, hear with their ears, understand with their hearts and turn and be healed.” Then Isaiah said, “For how long, O Lord?”, and God answered, “Until the cities lie ruined, until the houses are deserted, until the Lord has sent everyone far away, and the land is laid waste.  But as the terabinth and oak leave stumps when they are cut down, so the holy seed will be in the stump in the land.” In other words, until Jesus, the holy seed, was planted in the land and grew and was cut down and resurrected.”   The mystery of Christ would finally be revealed by the Spirit of God at Pentecost.
With Jesus’ birth and life and death and burial and resurrection and ascension, the Kingdom of God was planted, in a way that, as Luther said, “can neither be known nor felt, but only believed and trusted”, and praise God, it is growing and will one day become the harvest God wants. And that is nothing to be disappointed about.  Amen 
June 24 Sermon
The Holy Gospel according to St. Mark, the 4th chapter, 35-41
On that day, when evening had come, he said to them, “Let us go across to the other side”.  And leaving the crowd behind, they took him with them in the boat, just as he was.  Other boats were with him.  A great windstorm arose, and the waves came into the boat, so that the boat was being swamped.  But he was in the stern, asleep on a cushion; and they woke him up and said to him, Teacher, do you not care that we are perishing?”  He woke up and rebuked the wind, and said to the sea, “Peace! Be still.” Then the wind ceased, and there was a great calm.  He said to them, “Why are you afraid? Have you still no faith?  And they were filled with great awe and said to one another, “Who is this, that even the wind and the sea obey him?
Is Jesus’ Presence Sufficient?
The fourth chapter of Mark begins with these words: “ Again he began to teach beside the sea.  Such a very large crowd gathered around him that he got into a boat on the sea and sat there, while the whole crowd was beside the sea on the land.  He began to teach them many things in parables.”  In that fourth chapter, Jesus told them the parable about the sower who planted seed in four different kinds of soil, about a lamp not being put under a basket, and he finished with the two parables we read last week, about someone scattering seed on the ground and waiting for the harvest to come and about the kingdom of God being like a mustard seed growing into a great plant, parables about the kingdom of God.  With that, Mark ended this group of parables and began to tell us about Jesus’ miracles, the first of which is in our gospel reading for today.Jesus had taught from the boat all day long and when evening came he said to his disciples, “Let us go across to the other side”, to cross the Sea of Galilee, which is 21 km long, 11km wide and 46 meters deep.  Fishermen then often fished at night—they still do—but why Jesus wanted to cross to the other side that night, we have no idea.  But he did.  It must have been a clear night so they could tell their direction by the stars, at least it was clear when they left. On the other side of the Sea of Galilee was mainly Gentile territory, the country of the Gerasenes, where the man possessed by demons lived—you remember the story of the pigs running off the cliff into the sea.  It was a place they had never been before and would not go again.
So they left the crowd on the shore and the disciples took Jesus just as he was, presumably meaning that he had been sitting down teaching all day and they began the journey with him sitting where he had been teaching.  Teaching or preaching all day is tiring and Jesus naturally went to sleep with his head on a cushion in the stern, the back, of the boat.  That is the only reference in the Gospels to Jesus sleeping.
They were probably in a fishing boat like the one from the first century that was discovered in 1986 when a drought lowered the level of the Sea of Galilee.  The boat was covered in mud but people realized that it was ancient and it was carefully restored.  If Jesus and his disciples were in a boat similar to that one, it was about 8 meters long, 2 meters wide, and 1.3 meters high.  
So Jesus is in the back of the boat asleep and the disciples are rowing or more probably sailing and a storm comes up.  They were at the northern end of the Sea of Galilee and on its western coast there is a canyon between two mountains where strong winds from the Mediterranean Sea come sweeping down to cause sudden violent winds and waves.  In 1992, a late winter storm produced waves three meters high that slammed into the town of Tiberias, approximately where Jesus had been teaching. 
Our text says, “the waves came into the boat, so that the boat was being swamped.”   There was not only great wind but big waves coming over the sides of the boat filling it and these experienced fishermen thought they were going to drown.  This was no ordinary storm.  
The disciples woke Jesus and said, “Teacher, do you not care that we are perishing?”  They did not use the term Master or Lord, but only Teacher—as if to say, “You teach all this stuff but can you do anything to keep us from drowning?”  In Mark’s gospel, the only people who called Jesus “teacher” were his opponents and his own disciples. We do not know if they believed that he could do something but they were rebuking him that he did not care.
Jesus woke up—I doubt he stood up in the boat in those waves—he probably just sat up and spoke: “Nyamaza utulie”, perhaps “Quiet” to the wind and “be still” to the waves.  The text says he rebuked the storm.  The greek work, epitimao, to rebuke, to sternly warn, to give orders, is the same word used when Jesus rebuked demons, when the disciples rebuked people who wanted to bring little children to Jesus, when Jesus rebuked Peter and said “Get thee behind me Satan”
The wind stopped, the waves ceased, and there was a dead calm. Can you imagine that?  
Then Jesus asked them, “Have you no faith? (the Greek more correctly says, “Why are you cowards?  Do you still have no faith?”)  I think he was saying, “After all you have seen, do you still doubt me?  Do you doubt that I care for you and your needs?”  He may have been angry that they thought he did not care but his reply could also have been one of sadness that they were so slow to learn.  They had seen Jesus cure the fever of Simon’s mother-in-law, cure lepers, heal a man’s paralyzed legs and another’s paralyzed hand but had never seen him rule over nature.  They had no faith that they would be okay just because Jesus was with them.
The disciples were terrified.  The Greek translation is “they feared a great fear.”  The disciples had two fears:  their first fear was their terror that they might drown in the storm.  The Greek word for that kind of terror is phobos —the feeling we get when we see a matatu out of control coming toward us.  But after they saw what Jesus did to the storm and to the sea, they had a different kind of fear.  The Greek word for that kind of fear is phobeomai, an awe, a deep reverence, the kind of fear the Bible means when it says “The fear of the Lord is the beginning of wisdom”.  The kind of feeling we have when we sing:
God himself is with us, Let us now adore him
And with awe appear before him!
God is in his temple; All within keep silence,
Prostrate lie with deepest reverence.
Him alone God we own,
Him, our God and Savior; Praise his name forever!
They “were saying to one another”…over and over, “Who then is this?” because the Jews believed that only God had power over the winds and the seas:  Ps 89:8.9, “O Lord God of Hosts, who is like Thee, O mighty Lord?  Thou dost rule the swelling of the sea; when its waves rise, Thou dost still them.” Ps 107:29  “He maketh the storm a calm, so that the waves thereof are still.”  But the disciples kept saying, “Who then is this?  The miracle did not seem to have led to faith.  In fact, in spite of all Jesus’ miracles, in Mark’s gospel the disciples are never described as having faith.
This gospel text is so often used as a children’s sermon with the point that “Jesus calms the storms of life.”  Good people, you know that is a half-truth.  How many times have we asked God the same thing the disciples asked Jesus, “Do you not care?  Do you not care that I lost my job, that my husband left me, that my child was killed by a drunk driver?  Where are you God?  Asleep in the back of the boat?” And we say it in anger. The most common thing we say to God is “Do you not care?”  What is the most common thing God says to us in the Bible, 89 times?   “Do not be afraid”
Having Jesus with us does not keep us from storms. (In fact it was Jesus suggestion that they go across the sea that night)  Last Sunday I quoted the words of the gospel song, King Jesus will roll my burdens away.  That is not true for the storms of life.  One minute we are fine, the next minute, a phone call, an email, a conversation and everything changes, the storm has come.  
A few years ago I operated on a five-year old girl with a brain tumor.  Her father had died of lung cancer six weeks before.  Her tumor was large and deep and she needed two operations to remove it.  The first operation went very well she was normal when she woke up.  In the second operation a week later, the tumor went deeper and deeper into the brain.   When we do operations like that, under an operating microscope, the only thing that tells us what is tumor and what is normal is what the tissue looks like.  I had done hundreds of tumor operations like that before but as I continued her operation, I realized that her tumor had blended into her normal brainstem so gradually that I had removed some of her normal brainstem—the part of the brain that makes you conscious.  Fear that I had caused great damage came over me; sweat rolled down my back.  After surgery, she was in a coma. I prayed day after day for that little girl to wake up but she died a few months later.  It was the most stressful, most painful experience of my neurosurgical career. The pain lasted for months. There was no miracle, no “rolling my burden away.”  So where was Jesus, asleep in the back of the boat?
Many of you have had storms that entered your life suddenly.  Some storms we cause ourselves, some are caused by other people—sometimes people in the congregation--, some are caused by the evil one.  It seems to be part of maturing in our relationship with Christ, to come to realize that 1) he usually will not do a miracle to solve our problem, to calm our storm, and 2) this is harder— to accept that what he gives us is his presence with us in the storm. 
I know we sometimes say, “So what if Jesus is with me?  The pain is just as bad.  The loss is just as bad.”  There is no easy answer to that question.  I only know that I would much rather go through loss and grief and pain knowing that Jesus is with me than to go through it alone.  I suspect the reason He tells us “Do not be afraid” is because his presence with us is sufficient to get us through the storms.  It did get me through the storm of that little girl’s coma and then her death.
In those hard times of life when we ask Jesus the question, “Do you not care?,” Jesus asks us the same question he asked the disciples in the boat with him, “Have you no faith?”  I think he means, “Is my presence not sufficient?
We need to remember two verses: 
Mt 28:20: “And remember I am with you always, to the end of the age
Romans 8:39: “Nothing will be able to separate us from the love of God in Christ Jesus our Lord.”  Amen.

Tuesday, May 8, 2012


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

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