Friday, July 6, 2012
6 July 2012
Tuesday, May 8, 2012
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| Michael & Marisa |
| Mt. Kenya at dawn |
| Crossing the moat |
| Rainbow over the valley (from our window) |
| Garbage Disposal system |
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

