Leland and Kenyan celery

Habari rafiki,

15, 17, 63, 14, 13, 16, 61, 65, 66….that is not a series of random numbers.  That is the “order” in which I found the medication sheets in the binder for Team A (beds 13-18 to the right of the nurses station, beds 61-66 to the left).  Among those patients, there was a baby who had been moved to isolation for a multi-drug-resistant Klebsiella pneumonia ventriculitis (cerebrospinal fluid infection in the head). Two doses of the only two antibiotics to which his organism was sensitive had not been charted as given—whether or not they were given will never be known.  I become quite discouraged when I see this lack of order in the nursing care—after I discuss the problem with the supervisors, the care improves for about two weeks and then reverts to the same inconsistent level.  I refuse to accept the common belief among some here—that here in Kijabe we are incapable of delivering excellent care.  I know that my fellow nurses here are highly intelligent people and ARE capable of excellence.

I think nearly every day of things to tell you; yet I find it hard to describe our lives here.  We work hard—but so do many people all over the world.  We have days of drudgery and days of excitement, days of sadness and feelings of failure over a child’s death, and days of joy and satisfaction over a child’s operation and recovery.  Believe it or not, I wrote 2 blogs over the past month—never finished either one.  I looked at the first and thought it was a lot of whining.  As my children will tell you, I never tolerated whining from them, so I think it patently unfair for you to receive it from me.  The second just wasn’t very interesting.  So, I’ll try again.

I traveled to the US in February to greet my newest grandchild—Joseph Alexander Schulter (called Alex), born on February 5.  I had the joy of spending his first three weeks with him, his Big Sister Evelyn, Kelly, and Joe.  During the time there, I also saw my son Michael, and daughter-in-law Marisa, my sister Ginni, Joe’s Dad and step-mother, and my very good friends Bud and Linda.  I savored the great food, hot showers, smooth roads, great signage, restaurants.  I didn’t see one person leaping over the median barrier, one donkey being beaten, one chicken crossing the road (why DO they do that, anyway)?  Life there was orderly and predictable—every single time I turned on the hot water tap, hot water came out—never cold, never steam, never mud, and certainly never nothing.  On either side of the median barrier, traffic flowed IN THE SAME DIRECTION—never once was a minivan or bus traveling on the sidewalk.  I found it truly amazing.

Joseph Alexander Schulter

Marisa, Michael, Alex and Evelyn

 

The 3 week break did me a world of good—Leland subsequently had a harried and exhausting short trip to India where he gave 2 of 3 prepared lectures, used pedicabs through traffic even worse than Nairobi’s, dodging roaming people, bicycles, cars, and cows.  The red tape he encountered getting the Indian visa was even worse than that which we met renewing our alien registrations—and his reentry into Kenya was made difficult when the Kenyan customs agents failed to recognize the temporary visa he had obtained in February so he had to get US dollars to pay the $50 single entry visa fee.  I had just entered 1 week before using the exact same temporary visa and had had no trouble. 

My adventure with health care insurers finally came to an end.  My “health insurance company” twice denied payment of my hospital bill from my admission for pancreatitis last October—they claimed it was a preexisting condition about which I had not informed them on my application.  I learned a number of important things from this experience; that if an insurance company wants to deny, they will find any number of reasons to do so—and that Danish insurance companies have no appeal process.  I also learned not to call my credit card company to have the credit limit increased because in doing so, one’s card is cancelled—permanently.  I also learned how to ask for discounts in the hospital bill and receive them (ask and you shall receive worked quite well in this instance).  So, the end of the story came with my cashing in an annuity and paying the hospital “only” $44,000 instead of the $72,000 on the initial bill.  The good news is that we will have a very nice tax deduction on our 2013 taxes. 

Life here brings us daily reminders that we live in a different culture.  For instance, when we go out to eat, Leland is served first.  Men go through doorways first.  Occasionally one of the Kenyan residents will hold the door open for me—I laugh and tell them to go ahead of me—“We are in Kenya, you know.”  If a group of people is coming down the hallway toward me, they don’t move aside to allow me a path through—generally I flatten against the wall—or if I’m feeling out of sorts, I’ll push my way through them—it is not considered rude here.  People who precede you through doors will pull the door closed without looking to see if someone is behind them.  People will often just stride out in front of oncoming traffic without looking to see that the way is clear.  If people don’t hear what you say, they answer with a sharp high pitched “HUH?”  None of those things are considered rude here.  And our directness in speaking is considered quite rude.  Fortunately for me, my Kenyan friends kindly overlook my directness—in fact, a few have come to me with direct questions (without the preliminary handshake and greeting) and I’ve teased them that they are becoming American.  One of the biggest compliments to me is when someone tells me I am becoming a white Kenyan.

We’ve entered the rainy season and that means wadudu (pleural for insect).  We have mayflies (a variety of termite) that pour out of holes in the ground at dusk—they mass around light so our porch is covered with wings in the morning.  Some Africans catch and fry the bodies—I am told they are quite tasty (I have no personal experience of this fact).  As I was sitting on the couch last night, a small object dropped beside me from the ceiling—it was a Nairobi ant.  They are quite small, writhe like shrimp when they are sprayed with Morten’s Doom, and need to be “flicked” not swatted if they land on you—their bodies release a toxin when they are crushed that causes an impressive and, I’m told, painful welt.  On rounds one morning, I saw “living wall art”—a cockroach running up the wall beside one of the babies’ beds.  I motioned to Leland who took my writing pad and mashed it.  That left cockroach juice all over my writing pad—having no towels, paper or otherwise, I wiped it on Leland’s lab coat to the immense glee of every single mum in the annex.  We hadn’t realized how closely we are watched!

Three weeks ago, Leland and I were home all day on a Sunday—he was on call so we spent 3 hours making rounds and were not able to get to Nairobi for church.  Most of the day I heard a terrible racket in the attic—as though someone were banging on the roof with a hammer.  Leland went outside to see if workers were on the roof—no one was seen.  He finally went up into the attic and came face to face with an African Hornbill who had gotten into the attic but then could not find his way out.  Leland made a quick retreat and called Elisha who brought 3 men.  Using a board as a shield, they cornered the bird and one grabbed his beak; another his feet.  He was taken outside and released.

One of our best known patients died this past weekend.  Abigael just turned 2 years old and had a myelomeningocele repair and shunt soon after birth.  She had many complications related to her shunt—over the course of her life she had three different kinds of shunts (ventriculoperitoneal, ventriculcholecystal, ventriculatrial) but all had complications—either malfunction or infection.  Her 7^th admission resulted in an infection that was resistant to all antibiotics we have available.  We talked with her mom and she decided to take Abigael home—but before she could clear her bill, Abigael suddenly died.  I wrote a letter for her mom today listing her hospitalizations and calculated that out of 753 days that she was alive, Abigael spent 127 in the hospital—17% of her life.  We will all miss Abigael—she cried whenever she would see me so I tried to make games of hiding from her and playing peek-a-boo.  I never did get her to laugh, though.

A young Somali mum brought her very delayed, lethargic baby to OPD with a CT scan she had obtained at Kenyatta National Hospital.  We see many children who have had scans there and have had nothing else done for them.  This child had a scan showing severe brain atrophy from meningitis soon after birth.  When I told her through the interpreter that her child’s brain was terribly damaged from infection and that there was no medicine or surgery that could “fix” his problem, she collapsed onto the exam table, wailing in despair.  I put my arm around her, but really had very little else to offer but my sorrow that we couldn’t make her child whole.  The interpreter then explained that this mother’s first baby had died soon after birth.  What is very hard is that not only is this mother grieving for her two babies, but she also has to worry about being discarded as a wife because she hasn’t produced healthy children.  There are many levels to the grief we see here—some that we never encounter in our practices in the US.

One of the frustrations here is that we don’t have antibiotics that treat our multidrug resistant organisms—or that the antibiotics that are available are financially out of reach of the patients’ ability to pay.  We also really need a pediatric infectious disease specialist to come either short-term or long-term to help us make decisions regarding which antibiotic to choose, duration of treatment, and to help the lab improve the identification of organisms.  We need all kinds of pediatric preparations of common oral drugs—like phenobarb, diazepam, cephalosporins for urinary tract infections.  There are times when we have to hospitalize infants because the only antibiotics we have available are intravenous preparations.

Some medicines are not available here in Kenya; some are available in Kenya but not in Kijabe Hospital.  We have recently had 3 patients with diabetes insipidus after brain surgery—DDAVP, the medicine to control the huge urine output is not available at Kijabe Hospital pharmacy.  The MD in the ICU had a family member who had used that same drug several years ago for another problem—he found the medicine under his sink and we used it for two of the patients—fortunately, though it had expired, it was still effective.  When the third patient needed the medicine, we borrowed a tablet from the ICU and sent the mother to Nairobi to a pharmacy that stocked the medicine—she came back later that day with a month’s supply.  Other times, when we need hormone assays, we have to have the family pay the fee for an outside lab; the blood is then drawn and sent to the lab.  If the family cannot pay, the blood is not drawn or sent.  We are fortunate to be part of BKKH—we can often have BKKH pay the lab and get the assays done.  If the patient is an adult, though, they have to pay out of pocket.  The same is true for using our new CT scanner—the fee for the scan ($71) has to be paid before the scan is done.  You can see that there is a great advantage to being a patient in BKKH—but all of these new procedures are costly—and if the family is unable to pay the bill, BKKH picks up the tab. 

Frequently seen problems among babies and younger children are severe malnutrition and rickets.  My grandson gained 2.66 pounds in the first month—some of the children we see are 2-7 months old and are still at or near their birth weights.  Many of the malnourished children require supplemental formula which is incredibly expensive (about $10 for 3-4 days).  One 5 month baby was given a prescription for infant formula—his mother brought him back for admission, and I discovered that he had been given chocolate Ensure instead of infant formula!!  Treatment of rickets requires about 6 months of Calcium and Vitamin D supplementation.  The packets cost 24 Ksh/day—about $0.28, or about $51 for the 6-month course.  But most of our families cannot afford that—so the babies often get incomplete or no treatment.

Other times, children are diagnosed with rickets and malnutrition when they have regression of developmental milestones because of brain tumors.  One such 23-month-old girl was readmitted this week; her medulloblastoma had been emergently resected in January, she had been discharged in February in an almost vegetative state.  Her parents took amazing care of her and saw her regain some speech, the ability to feed herself finger foods and sit on a chair.  However, over the past 2 weeks, she regressed and was somnolent on admission.  After talking with her parents, we all decided to not intervene with further testing, scans, etc.  She died two nights after admission, with her mum at her side.  We all grieved and yet shared a peace that she was surrounded with love at her death—and that she was now in the arms of God.

Please pray that we have the physical, mental, and emotional strength to continue our work here.  We are tired and know that we need to take more breaks.  That means that we need more short-term neurosurgeons to help with coverage.  Right now, Sandi Lam and John Collins are visiting Kijabe to give us coverage while we go for a week to a conference in the States, and Humphrey takes a quick trip home to visit family in Uganda.  Humphrey has been accepted to a 6 month fellowship in Germany beginning in September so we will need A LOT of help this Fall (to you in the Northern hemisphere), Spring to us in the Southern hemisphere.  Thank you to those who continue to support us in prayer and contributions to BKKH.  We are very grateful for your faithfulness.

Erik Hansen and his family are on leave in the US for the next 5 months—so Leland is serving as temporary BKKH medical director until Erik returns.  I ask for your prayers for the Hansen family as they spend time with family and in raising funds to support their ongoing work here in Kijabe.  They, like us, consider Kijabe home.  And while we all love seeing our families and living in an orderly world, our home and our hearts are here in Kenya.  I ask for your prayers for the Hansens, and for Leland as he represents BKKH in meetings with the medical staff at Kijabe Hospital. 

I strongly recommend Kingdom, Grace, Judgment by Robert Farrar Capon.  It is a trilogy on the parables of Jesus.  What I find striking is that all through the gospels, the disciples just didn’t get it.  Christ continually told them about God’s grace, the Kingdom of God, and what God’s judgment means.  He told them of his death—over and over again, and yet, they just didn’t get it.  I’ve come to realize that I am no different from them—that my understanding of grace, the kingdom of God and judgment is probably just as flawed and incomplete as theirs. 

For now we see in a mirror dimly, but then face to face.  Now I know in part; then I shall know fully, even as I have been fully known.

I Corinthians 13: 12

Take care, God bless,

Susan

Gladys, RN

 Patient and mum

  

 Patient and mum

Elizabeth, OT

Susan with patients 

Agnes & Eunice, RNs

Habari Yako,                                                                                       31/01/2013

I am sitting in the BKKH Land Rover in Machakos Town while the nurses and staff of our Mobile Clinic here today are shopping.  We had a wonderful clinic—saw one young infant with Apert’s syndrome who will need surgery to enlarge the skull—she was born with fused sutures and fused fingers.  Fortunately, Del Mount, the craniofacial surgeon will arrive on Sunday—we have about 11 cases already scheduled and will likely add a few more. We shared the open air clinic with two goats—who had left visible (and odiferous) proof of their presence on the ground under our feet.

I want to share with you some “Toto” moments.  The Swahili word for child is “mtoto” (plural watoto) but I am not referring to children here.  These are Wizard of Oz moments when one realizes, “Toto, we aren’t in Kansas anymore.”

A 7 month old girl from Mombasa was admitted in mid-December; the history was a bit sketchy since the mother of six had no idea why the father told her to take the baby to the hospital at 5 months—nor did she understand when the grandmother told her the head was getting big and she should come to Kijabe.  The morning of surgery, she refused to thumbprint (sign) the consent for surgery.  Later that evening, the mum attacked another child and tried to bite her.  Mum was carted off to Casualty and heavily medicated while calls were made to the father in Mombasa to bring someone with him to stay with the child while he took Mum home.  He came alone, so we had to discharge the baby without surgery.  He brought her in mid January for a successful operation.

A baby was admitted sometime last Monday evening; it wasn’t until Thursday of this week that we were notified that no one had seen the baby since admission.

We began enrolling patients into our new shunt study—a single blind randomized study of the regular Chhabra shunt versus an antibiotic impregnated one.  After consenting three mums, we were told that the standard pre and post op antibiotic we were to give intravenously was “out of stock.”

A 2-month-old boy was admitted with a high fever and seizures—he had recently had a shunt.  On his back was what appeared to be a pustule/boil.  I tried to express the pus to get a culture, and out popped a live larva.  I have to say it was a first for me.  I put the wriggling creature in a test tube—one of the pediatricians identified it as a tumba fly larva. The flies lay their eggs on drying clothes, then the eggs hatch and burrow into the skin until the fly is ready to “fly.”  Think of it as a subcutaneous cocoon.  By the way, the fever and seizures had nothing to do with the larva.  He also had a urinary tract infection.

A lady lacked 10 shillings (about $0.12) of her 30-shilling matatu fare; the tout (conductor) threw her out of a moving matatu into the path of a bus.  She was killed.  The mob that gathered torched the bus and carted off the salvageable parts. The police are holding the bus driver in custody.  The matatu driver and tout have not yet been identified or arrested.

I could go on, but I think you get the picture.  It is usual for very unusual things to happen here.  Not Kansas---or Madison—or Pittsburgh—or even Portland, as wonderfully unusual as that city can be.

 Children’s sermon 

  A few Sundays ago, I saw something in church that took my breath away.  Pastor Mike was beginning the children’s sermon and had invited the children to come forward.  A little 3-year-old boy very reluctantly approached, lagging behind the other children.  The sermon was about the baptism of Jesus, so Pastor Mike shepherded the children to the baptismal font.  The little boy stood back and didn’t move with the group.  Another boy, about 10 years old, came and took the hand of the three year old and stepped toward the group, but the little one planted his feet firmly and didn’t move.  I expected to see the older boy yank or pull the child but he didn’t.  Instead, he just held his hand and waited. Finally, the older boy took a small step forward and then the small one followed him to the font.  To me, this was a revelation of how God works in our lives.  He is present, always beside us, holding our hand, ready to lead us.  But He doesn’t yank—He waits until we follow.

We had a group of visitors this week—they are involved with this ministry through BKKH.  Erik Hansen, Leland, and I gave 30-minute talks at the luncheon in Kijabe last Saturday. I told them about being inspired when I was about 10 years old by Miss Emma Snyder, the missionary nurse who worked in a leprosarium in Nigeria.  I talked about having given my heart to Jesus when I was eight—and then realizing my dream of being a missionary nurse in Africa 50 years later.  As Leland often says, our lives are not lived in a straight line—so many twists and turns and detours off the main road.  But the truest joy and most amazing peace come when we follow where He is leading us.  Most times, that is not to another country—it can be to a new church, a new job, a new city, a new relationship—but we need to keep following Him along the path. 

Christmas poinsettia, Kijabe

Living here in Kenya is an experience in extremes--exciting, exasperating, exhilarating, exhausting, hilarious, heart-breaking.  We see the rosy blush of dawn on the Valley, the curtains of rain on the horizon, the sparkling of the Milky Way at night, the incredible ever-changing sunsets over the far ridge of the Valley.  We see so many children cherished by their families—babies who are born with terrible anomalies yet are deeply loved.  We see so many children die—5 over the week between Christmas and New Years.  Children with brain tumors are misdiagnosed as having rickets—and we see them when they are finally having brain herniation, too late to save them.  One 7-year-old girl was admitted two weeks ago—and died during the night; her operation had been scheduled for first case that morning.  Often these children have been to many other health facilities before they reach us; one had been seen at Kenyatta National Hospital (KNH) in mid–December and had a CT showing a large brain tumor and severe hydrocephalus.  The doctors at KNH gave him a return appointment for Jan 28, 2013.  Despite his parents bringing him to BKKH 5 days after the CT, he stopped breathing right before his surgery the morning after admission.

Through a united effort among pediatric physicians, surgeons, nurses, BKKH engineers, and administration, our 3-bed HDU (high density unit) is operational.  We have monitoring for the sickest children and a patient:nurse ratio of 1-3:1 instead of the usual 8-12:1.  We still do not have the capability of monitoring those children who may have shunt malfunction or severe hydrocephalus pre-operatively—who seem stable now but could deteriorate quickly.  The nursing staff has been under a great deal of stress—the nurses in the national hospitals have been on strike for 3 months.  That means that both our census and our acuity is higher than normal.  I think the nursing care has never been better than it is right now—and many nurses are taking an active role in improving it even more.

We continue to have water problems—and I will never again take for granted turning on the hot water tap and actually having hot water come out!  Our solar water has been non-existent since the roof repair last July.  This week we have no water at all from the hot tap.  However, we do have cold water (which can be heated in a pot for an “African bath”)—which is more than I can say many mornings in the hospital.  Musyoka, our infection prevention and control technician, frequently announces with some exasperation that there is no water in the hospital today.  It is hard to give the babies their preop antiseptic baths without water.  And after examining a newborn with spina bifida and feces all over the legs, it is particularly unpleasant to learn there is no running water—hand gel just doesn’t cut it.

Please continue to pray that we find someone to help Leland and Humphrey with the heavy numbers of operations.  Leland thinks he has found a neurosurgery fellow who can start next January, but we need help from now until then.  Please also pray that we find a helper for me—there is a clinical officer who will join us for the month of April—if she likes the work with our kids (and with us), there is the hope she will join our team.  I would love to go to more of the mobile clinics where there is a need for someone to look at scans and identify children who need neurosurgery.  But traveling to mobile clinics leaves the OPD and wards without daily support for the nurses.

If you have interest in helping with this ministry, I encourage you to go to the Bethany Kids website www.bethanykids.org. While it is tempting to give to special funds, I will tell you that BKKH needs donations to the general fund in order to support all the ministries.  We have dire need of funds to finish the sewage system updates that must be in place before the new hospital building can continue. This isn’t a glamorous use of donations, but if the sewage system isn’t funded, then all construction for the new hospital ends—and the government could shut down the entire hospital.

Throughout scripture, God is very clear about His priorities.  We are to be the face, hands, feet of Jesus to the poor, the oppressed, the lonely, the sick, the hungry, naked, imprisoned.  I once sang a solo in Bellefield Presbyterian Church—from Micah 6.  It is one of my favorite scriptures.  I will leave you with that….

The word of the Lord came to Micah, and he said,

Wherewith shall I come before the Lord, and bow myself before God on high?

Shall I come before him with burnt offerings, with calves of a year old?

Shall the Lord be pleased with thousands of rams, with ten thousands of rivers of oil?

Shall I give my first-born for my transgression, the fruit of my body for the sin of my soul?

It hath been told thee, oh man, what is good.  And what doth the Lord require of thee, but to do justice, and to love mercy, and to walk humbly with thy God.

Take care, God bless.

Susan

Mont Ste Michel

Chartres Cathedral

Plaque in Chartres

Rainbow from our balcony 30-Nov-2012

To those who received a message that the blog had been updated--apparently there was a hiccup in the ether and to some it doesn't appear (it appears to others--are we all in the same world?)  So, I will try again.

Habari yako, jamaa na rafiki,

(Greetings, family and friends)

“I __________, will pay all bill after I have harvested my maize and had a fund raising.”

This letter was attached to the hospital file (chart) for one of our patients.  The hospital bill for this patient was Ksh 37,791.65—a huge sum for most of our patients who are subsistence farmers.  In US dollars, it is $447.24—which is the entire bill for a typical hospitalization and surgery for a child with hydrocephalus who has insertion of a shunt.  These letters are often signed with a thumbprint—many of our families cannot write/sign their names.  How often do the people who have signed these letters default on the bill?  We don’t know—many families pay in installments as money is available.  However, this woman, perhaps a single mother (more and more of our patients are babies of single moms), has to feed and clothe her family and pay rent out of the proceeds of her harvest.  So she may need to make a decision to pay the bill or eat.

Another hospital story: because of severe (actually excruciating) episodic abdominal pain, on our recent “vacation” in the States, I saw a physician for sphincter of Oddi dysfunction.  (As best I understand it, this is a sphincter coming from the bile duct).  The spasms of the sphincter were causing the pain—this physician said that during a procedure called an ERCP, he could cut the sphincter so that it no longer had spasms.  The risk of the procedure was a 10-40% chance of pancreatitis—usually mild, requiring a couple days of IV fluids and pain meds.  I had the procedure as an outpatient the following day—and about 18 hours later awoke with really awful abdominal pain.  I was admitted to the hospital for 5 days—had ascites (fluid in the abdomen), pleural effusions (fluid in the chest cavity) on both sides, required a CT of my abdomen and another of my chest to make sure I hadn’t developed a pulmonary embolism.  I gained 11 pounds in 3 days (fluid), and then lost 22 pounds.  (The upside to this story—weight loss!)  I had to pay $250 just to see the doctor and $12,500 to have the procedure.  I have yet to have an accounting from the hospital as to the total bill, but it will run into the tens of thousands of dollars. 

What a contrast in care between the two countries!  Yes, I was able to have a complex medical procedure because of the resources in the US.  However, I never again saw the physician who did the procedure—apparently he has no interest in his patients who develop a complication.  In Kenya, I would have had the team pray together before the procedure; my physician would have been at my bedside not only directing my care but also praying for me.  I cannot adequately explain to you how important prayer was to me before the ERCP—in the OR, I thought about asking the team to stop so I could pray—but they had given me meds and sprayed the back of my throat, so I was a bit dopey and couldn’t talk well by the time I thought of it.  And, to be honest, I figured they’d think I was nuts.  I am not suggesting that prayer would have prevented complications.  But having a team that cares deeply about patients and asks for God’s help in caring for them—I saw that difference—and wished I were in Kijabe with my pancreatitis. (I had a great nurse, Lora, and a great doctor, Dr. Day—so I want to make sure I give credit where credit is due).

While we were in the States, Leland and I were able to see our children and our grandchildren.  We see Tusk and Evelyn only in “snapshots” because of the great distance between us.  That is hard—for our children to understand, for us, maybe as well for our grandchildren.  My dad prayed for my sister and me every day of his life since our births—for many years that meant nothing to me.  It wasn’t until he was old and nearing death that I realized how much he loved me and how his daily prayers were his highest way of loving me. 

I was sprung from the hospital on the day we were supposed to have left for 2 weeks in France.  No one was comfortable with my flying overseas that day, so we postponed the flight for 24 hours.  We arrived in Paris and drove to Honfleur—a beautiful coastal town in Normandy.  After seeing the Boudin museum and praying in the chapel where Champlain’s exploration of Canada was blessed, we drove to Vimoutiers, also in Normandy, where we rented a cottage.  The town was lovely, the cottage was incredibly cold—stone floor, no central heat.  After a week of wearing two coats and being wrapped in a quilt, we decided warmth trumped quaintness and cut our stay there short by 4 days.  Having read about the Channel Islands, I had the brilliant idea of visiting them for a day trip.  We left the cottage at 6 am for what we thought would be a 2-hour drive to the coast to catch the ferry to Jersey.  However, the drive took 2.5 hours, and we had some fear that we’d miss the ferry.  Oh, how I wish we had!  It was several days after Sandy hit the East Coast of the US, and its effects were being felt in the Channel—the ferry had been cancelled the day before.  We made the ferry, and had the worst case of mal de mer (sea sickness) I can imagine.  Fully two thirds of the people vomited repeatedly on the 70 minute cruise—including us.  We could barely shuffle off the ferry—then had 6 hours until we had to get back on.  First stop—buy Dramamine. On Jersey, our credit cards didn’t work, we had only Euros (Jersey is in Britain so they take pounds), there was sun, then driving rain, then hail—repeat that sequence---not a fun day.  We limped back on the ferry, heavily medicated, sat in the middle of the back and made it back to France with intact gastric contents. 

After that, the trip was lovely.  We toured Mont Ste. Michel on a Sunday morning, entering the cathedral just as mass was beginning—the nuns and monks were singing ethereally a cappella.  The fragrance of incense hung lightly in the air; the sun streamed through the windows; we took communion from the priest and prayed with tourists, the congregation, the nuns and monks.  We toured the medieval city of Dinan and hiked down to the gorge below the town walls, then drove to the westernmost point of France to stay in Le Conquet, an old fishing village.  From there we drove in the direction of Paris through Chartres to see that great cathedral and pray in the light of the stained glass windows.  Along the way, we communicated in my broken high-school French and ate wonderful meals.  Despite my rather severe dietary restrictions (no red meat, no alcohol, low fat, bland foods), I enjoyed poulet (chicken), salades (salads) and the most delicious jus de pomme (apple juice) all across France.  And of course, le pain (bread)--the best in the world—even without butter.

We were so happy to get back to Kijabe—but not well rested as we had planned.  There was a lull in patient census for 2 days—since then we have had up to 8 admissions/day with very sick children.  We’ve had a few “Mercy consults”—those children in whom our best efforts have not helped.  Mercy and I have counseled, wept, and prayed with the moms.  The whole team rejoices with good news—a negative culture, an infection successfully treated.  One Somali mom insisted on our continuing a very expensive antibiotic to treat her son’s meningitis—and when I told Thomas Renner, the pastor and Somali interpreter, that after 7 days of treatment, the infection appeared to be much better, his first response was, “Praise God.”  In fact, as I walk along the hospital corridors, I see evidence of God everywhere—in the fruits of the Spirit posted between the hallway windows—love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control.  As I walk, in my unkind, ungracious, turmoil-filled mind, I daily am convicted—yes, that is the correct word—and my mind is turned toward God.  As another Somali woman said, Kijabe is a place where God is present.  The people who work here give thanks and praise to God for the healing that goes on—they lay their frustrations and defeats and failings at God’s feet.  I find it hard to describe just how alive I feel to work here.  We are becoming real—just as in The Velveteen Rabbit—a bit shabby and worn, threadbare, but alive.  Thanks and praise to God.

BKKH needs your help.  Leland has started a fund for neurosurgical equipment—just about everything we use is donated.  When equipment breaks, we have no replacements.  We need to have a fund for replacements and upkeep—he has written to about 100 neurosurgeons to ask for their help.  The patients need help in paying their bills—most families here work very hard, most in physical labor.  Most want to pay their bills but simply cannot raise the money—fundraisers in their communities help—but these are poor people giving money—so the whole community becomes impoverished.  We need donations of the antibiotics that we have to use to treat multi-drug resistant infections—some infections require 2-3 weeks of meropenam, which costs Ksh 3000/day.  If the families cannot pay for the medicine, we are not supposed to treat the children with it.  I must confess that sometimes I go ahead and order a trial of the medicine.  We need an ongoing source of vancomycin, ceftazidime, and meropenam.  We need funds so that salaries to the employees can be raised—many people working for BKKH could make 4x their current salary by working for an NGO.  They work for BKKH because of their commitment to God—but it becomes difficult for them to pay their children’s school fees, or put anything aside for retirement.  I challenge any nurses in the US to give even a small amount monthly to improve the working conditions for the nurses here—we need better equipment, more continuing education opportunities. 

As I read through this posting, I realize how many times I’ve mentioned prayer--talking with God, presenting to Him our requests, our joys, our failures, asking for His forgiveness and help to turn in the right direction, praying for our children, grandchildren, colleagues, enemies…sometimes being so overcome that the only prayer is “the Spirit himself [interceding] for us with groans that words cannot express.” (Romans 8:26b)

I’ll end with this passage from Galatians 2: 4-10:

But because of his great love for us, God, who is rich in mercy, made us alive with Christ even when we were dead in transgressions—it is by grace you have been saved.  And God raised us up with Christ and seated us with him in the heavenly realms in Christ Jesus in order that in the coming ages he might show the incomparable riches of his grace, expressed in his kindness to us in Christ Jesus.  For it is by grace you have been saved, through faith—and this not from yourselves, it is the gift of God—not of works, so that no one can boast.  For we are God’s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.

Take care, God bless.

Susan

Contact: www.bethanykids.org

Dear Friends and Family,

We have come to Malu, our retreat, to celebrate the end of our second year in Kenya—and the beginning of our third year here.  It has been an opportunity for reflection on all that we’ve experienced over the past two years.  We’ve also looked ahead and realized how much needs to be accomplished over the next years to see that pediatric neurosurgery is established in East Africa.

For both of us, I think, the chief benefit in coming to Kijabe has been the opportunity to deepen our faith, to draw nearer to God, to feel the peace that has come with following where He has led.  Leland’s work on his sermons this Winter (June, July, August in the Southern hemisphere) and his weekly meditations that he sends to the church members via email have nourished his faith.  My participation in our weekly Bible Study has given me insights into Scripture as well as relationships with the other Bible study members.  Our morning times of prayer and study are precious to us; we awaken with a real thirst for God’s Word.

It is often said that Africans excel in relationships.  I have discovered over the past two years that that is true.  I cherish the relationships that are slowly building here in Kijabe; I feel a part of the staff now, and we have a wonderful time talking, teasing, swapping Swahili. They teach me a word, I teach them a word—like ukungu (fog) which none of the OPD staff knew.  It is probably because we have been told so often that relationships are cherished in Kenya that we have been so shocked to see women disowned by their families, abandoned at the hospital.  One lady recently had a newborn child with a myelomeningocele that was repaired.   She was from the IDP camp (Internally displaced persons) down in the valley and had been transferred to Kijabe from Naivasha Hospital.  She had a husband and two older children.  When it was time for discharge, her husband never came; Purity, our excellent social worker, learned that the husband had taken the two older children back to his home in Western Kenya saying that he would not have a disabled child.  Not only did this lady have no family, she had no money nor clothes.  Purity arranged that the bill be paid by BKKH; she found clothes for the mum and took up a collection among the staff so that the mum and baby could be transported back to the IDP camp—on a piki-piki—a motorbike transport for hire.  These heart-rending stories of abandonment are balanced by those like Nelly, another baby girl with a repaired myelomeningocele.  She is the first baby of a very poor older man.  When she was readmitted with a wound breakdown, he was distraught—not only because his precious daughter was ill, but also because he did not know how he would pay the bill.  He offered to mop floors in exchange for his daughter’s hospital bill.  He came to visit nearly every day (that is unusual) and always asked how she was doing after shaking my hand.  I saw him again just the other day—about a week after her discharge.  He told me she was doing well.  I suspect he was back to pay some of the balance on her bill.  It is families like his that impress me the most.

It continues to be hard when medications are not charted, when dressings aren’t changed, when vital signs on very sick babies are not recorded for 12 hour stretches.  It is devastating when, as happened two nights ago, one of our patients dies during the night and not one of our team is notified—finding out the next morning on rounds when he was not in his bed.  Over the past two years, I have found myself becoming less angry about these situations—more bemused than anything else.  I have adopted a “smile” that I put on my face when these things happen—I am not smiling with my eyes, just my mouth.  However, I find that it helps me cope.  It does no good to get angry here—what we need to do in these situations is discover the underlying problem (it is never just one nurse, or one ward—these problems are systemic) and try to find a solution in which everyone can invest.  I believe that most of the staff here want very much to do well, to take good care of patients.  As in every place, there are those few who really don’t care.  We all need to identify the barriers to good care and arrive at reasonable solutions.

I have said several times that I have used every experience and skill gained throughout my career since I’ve come to Kijabe.  I started out in nursing working for a short time at a psychiatric hospital; recently we had two mothers with severe post-partum psychosis.  One went from bed to bed blessing each mother; the other came into the nursing station and started opening cupboards.  Because of my remote past experience, I was able to tell the nurses how to speak to and direct these ladies to keep them, their children, and the other children safe.  See, nothing is wasted.

One of the most important lessons that I have learned since coming to Kijabe is to keep in mind who I am trying to please.  Am I trying to be liked, accepted, or am I here to be obedient to and please God?  There are many times, the happiest ones, when those are one and the same.  But, every once in a while, I have to make a decision or take a stance that makes me quite unpopular with people—but I feel that God is leading me in that direction.  We continue to think about that discussion we had 18 months ago with one of the surgeons who reported great discontent among “all the nurses” with our way of giving neurosurgical care to the children.  That discussion was instrumental in making me look at our practice here.  There are areas where I can bend—organization of supplies in clinic drawers no longer is my issue.  Other areas—giving the right medication to the right child via the right route at the right time and recording it—I will continue to be a real pain in the neck about that.

There are things about Kenya that still make me smile (with my eyes) and shake my head.  The fluidity of spelling and names—we had a child admitted on 2-JUL-2012 under the name of Mary who had 4 surgical procedures and was discharged in early August—at discharge, the national insurance fund refused to pay their portion of her bill because her birth certificate name was Madeline.  Her mother never bothered to “inform” us that we had the wrong name.  After going to Limuru to straighten out the paperwork, Madeline was readmitted for a wound breakdown—and during the course of that hospitalization was called Mary or Madeline—changing from day to day.  Her mother often called her Mary—and the child, 8 years old, answered to either.  One child is admitted as Denton or Danton—no one seems to be concerned which it is.  One child was admitted as “Baby of Lydiah”—when he was 7 years old; the original admission was under that name and so all subsequent admissions and clinic visits continued as “Baby of Lydiah.”

In early August, we moved back into our third floor apartment after the repairs to the roof and ceilings were completed.  We have had a few driving rainstorms and have seen no new wet spots in the ceiling or walls, for which we are very grateful.  However, the new crown molding is beginning to crack as it shrinks, and plaster (caulk being an unknown entity here) is drifting down on the furniture.  I have spent the Saturdays since moving back scraping dried oil-based paint splotches from the floor (dropcloths are also “unknown unknowns”).

As some of you may have heard, there is rioting in Mombasa since a Muslim cleric, accused by Kenya, the UN, and the US of raising money and men for Al-Shabaab, was gunned down (shot dead in Kenyanese).  We heard that some clerics in Nairobi were encouraging their followers to go and do likewise in Nairobi.  The election is nearing, and I would say that the underlying problems (corruption, tribalism, impunity) that led to violence after the 2007 election have not been addressed—in fact, if anything, have worsened.  Several of the men charged by the ICC for crimes against humanity are running for President.  So, I ask for your prayers for Kenya.  It is a country of incredible beauty not only in its mountains, plains, valleys, lakes, but especially among its people.  They deserve better leaders.

We tremendously enjoyed the month-long visit of Wendell Lake, a neurosurgery resident from University of Wisconsin.  We had worked with Wendell at UW before we came here.  He is not the first UW resident to visit Kijabe, but he is the first to visit for a month and receive credit for his time here.  During the month of August, he participated in 60 cases—he saw more children die than he had in his career to date.  He saw the full spectrum of cases—myelomeningoceles, hydrocephalus (he saw one child with a 78 cm head circumference), spinal cord tumors (including a tuberculoma in the spinal cord—only the 9^th known case in the world), head injuries, brain tumors—both adult and pediatric.  One of the more unusual cases was a man, admitted to another service, who had been mauled by a hippo.  I told Wendell, “Now you know you aren’t in Kansas anymore.”  He said he was very impressed that the missionaries here didn’t fit his stereotype of missionaries.  I would have to say that I agree wholeheartedly with that.  The Poisonwood Bible sort of missionary doesn’t exist here in Kijabe—the missionaries, both short and long term, that I have met are dynamic, fun-loving, joyful, contemplative, complex people.  Despite differences in theological backgrounds and practices, they are among the least judgmental people I have met.  Becoming part of that community has been another highlight of our stay here.

Looking ahead to the next four years, we see many challenges.  We need another pediatric neurosurgery fellow; the caseload is too high for 2 neurosurgeons, and more people need to be trained.  We realize also that we need to develop an ongoing, lasting means of support for neurosurgery here at Kijabe.  The neurosurgery service, like most of the surgical services at Kijabe, depends entirely on donations.  Equipment is donated; suture, dressings, and medications are donated.  Leland’s and my services are donated.  It is exciting that Humphrey has been hired by Kijabe Hospital as a consultant (attending doctor) as of September 1.  We need to identify and train a person who can fill my position when I leave. 

I started out this blog talking about relationships—that the Kenyans excel at them.  But one thing I’ve learned is how important relationships are to all people—not only Kenyans.  Leland and I have missed our families more this year than the first.  We are fortunate to be living in an age of Skype and email—I think often of my cousins who were missionaries in Japan in the 1950’s when it took a month to get a letter from home.  They returned home every 5 years for furlough—I’ll make 4 trips to see my children this year.  We can look forward to visits from our families—my sister and her friend Diane are planning a trip in 2013; Leland’s sister Mary plans her second trip to Kijabe next year, Michael and Marisa visited us in 2011.  A visiting short-termer asked us if we ever get homesick—and we looked at each other and said “no, we feel like this is home.”  However, ever since he asked, I’ve thought about that—and I am often “homesick” in a way—we would really like to see our kids, our daughters-in-law and sons-in-law, our grandchildren, our sisters and nieces and nephews, our friends far more often than we can now.  It isn’t the place; it is the people that we miss.

We continue to treasure your prayers for us and for the ministry in Kijabe.  We ask that you lift up the moms and babies in your prayers.  We ask you to pray for our health—I am battling a sinus infection and some residual difficulties related to my gall bladder operation.  Pray for those visiting us this month—Goong, a pediatric neurosurgeon from Thailand, Jim Trosen, our financial advisor and friend who will visit with his wife, members of the CDC who are gathering data on Spina bifida in Kenya, and members of the International Federation for Research in Hydrocephalus and Spina Bifida.

Though I am not a particular fan of the Apostle Paul, as some of you are aware, I do find great encouragement in some of his writings.

Therefore, my dear brothers [and sisters!], stand firm.  Let nothing move you.  Always give yourself fully to the work of the Lord, because you know that your labor in the Lord is not in vain. I Corinthians 15: 58

Take care, God bless.

Susan