Window (Part II)

   

The Window Part II-

     Our family came to Kenya again this summer to serve and to be on mission with what God is already doing in the world.  Specifically where our strengths and gifting meet together with what God is doing amidst the needs of the world.  We have been working with Tenwek Mission Hospital like this more or less over the past 12 years.  The opportunity this year is to meet a huge need for Rheumatic Heart Disease early detection through a screening program for RHD that is boldly pushing back against the Darkness of this disease that affects 40 million people world wide. 

      Most folks in the US won't know what RHD is unless they've talked with me lately and then they definitely have heard about it.  RHD is a very preventable disease of the heart valves that is caused by an auto-immune response to recurrent Strep-A bacterial infections.  These can be infections like strep throat or minor skin infections, which are both common in childhood. Those who get recurrent infections with no treatment of antibiotics become susceptible to Rheumatic  [Scarlet] Fever.  We don't often hear of this in the US because we have access to advanced health care providers and penicillin and even more primary prevention like basic hand hygiene.  In many low and middle income countries however, many children will not have adequate access to care, or even the primordial prevention of disease like basic water supply for hand washing and adequately clean and safe housing.  Not all will get RHD, but 300,000 people die every year from it needlessly. As with almost all infectious diseases, the social drivers of health disproportionately push the burden of disease in Africa.  

   This summer we are not just pushing back against this disease, but also we are bringing 2 communities together across 3 cultures- ours, the Kipsigis people at Tenwek, and the Masai people at Talek.  The Masai group of Community Health Partners has a fantastic little hospital out at the edge of Masai Mara.  They specialize in Maternal and Child Health as that is a major concern for that community's needs.  Many people in this community live with very traditional worldviews and practices that result in poor health outcomes.  Maternal mortality and infant mortality or traumatic birth outcomes are not uncommon.  This little hospital is an outpost of the Kingdom of God where they bring hope, healing, life and light in the Name of Jesus where there was none previously.  

This is the progress chart of the hospital at Talek, a window into lives saved through the provision of maternal health services in this remote corner of Kenya.

 

This is the amazing Dr. Angel Meipuki beside me (I'm in green)

This is our amazing son volunteering his heart for training purposes.  A pediatric cardiologist came 3 hours out here to teach the local clinic staff about RHD screening.

Dr. Angela will be able to continue heart screenings by looking at the valves for stenosis (meaning the door does not close tightly)  Thankful for this guy's good, strong heart!  The ultrasound makes a pie shaped black and white window into the heart.  The inner workings of the heart valve can go unseen and unknown until it is too late for a child or a young pregnant woman.  This little window of seeing inside the valves will provide hope for treatment. When they add color to the image, they can even watch the blood flow in and out to know it is working properly or not. This window in the ultrasound image gives a new point of view.  It is like a little outpost of the Kingdom of God bringing life where death wanted to reign.  

This is the 2 teams together, one Tenwek, the other Talek.  Praise God for bringing all things together under Christ, even different tribes and people groups for His glory and our good! Again, I am thankful for this little window on heaven!

Would you consider encouraging this project through making a World Gospel Mission RHD screening? 

https://wgm.org/project/tenwek-rheumatic-heart-disease

Lastly,

I remember what my dear friend, Effie recently told me about how some portions of Scripture are told from the point of view from Heaven.  In particular, Revelation 5 was what she referred to.  We can get a tiny glimpse of reality down here as if a window from the heavens is rolling open and we see it from a new angle.

What would heaven's point of view be on our life?  What if there were a window or skylight looking down from Heaven on our life where we could get a new POV on our daily situations?

For instance, when Jesus rebuked his good friend Peter for trying to prevent his suffering in the "Get the behind me, Satan" incident,  was he actually fighting for a heavenly POV while the earthly view was so tempting, the way of avoiding the cross?  

We are tempted in so many ways to avoid carrying our cross or doing what the Lord asked us to do.  But when we ask Jesus to meet us there in the midst of the difficulty, walk us down the road, we find that he does meet us right there so faithfully.  He even lets us "take his easy yoke" and thereby Christ bears the burden of the weight from our shoulders onto His own.

  I wonder how I can keep the Kingdom of God outpost mentality?  We may not see into heart valves, but we can see others as beloved of God.  The POV from heaven on this person, particular to your sphere of influence, opens a window for light to shine and the Kingdom of God to be seen right there among you.

     

Window part 1

     Daktari life is back online in Kenya at Tenwek Mission Hospital for a limited time only.

    Have you ever watched a sunrise from inside a window? Have you ever seen a sky tear open the dawn like a Christmas present?  At 7,000 feet it seems so close the heart inside me longs for its nearness.  Here it comes, not like the Beatles song "doo da doo doo"- not that at all.  This is a majestic triumph sun that starts in the dark with a cold wind blowing the tree branches like clapping hands and banana leaves bobbing and bowing their heads.  Then comes the first blush of rose gold, then the shining golden moment with the sun climbs up above the far away mountain and takes off to fly above the clouds suddenly like a jet plane, or a champion running his course as the psalmist says.  It leaves a trail of light all along the path of the sky.  It is a Truth Teller, lighting the day.

    From here looking out my thin glass window pane, the metal frame and wishbone shaped handle, I feel so limited and wishful to experience more of this beauty.  The sense of sight is so awesome and such a valued gift, but there is more to experience than to simply seeing.  My whole self wants to be immersed in the sunrise- to get outside beyond this veil, this barrier, this tiny window pane.  I want to get out of my pjs and go plant my feet in the soft grass to actually feel it warming, to open my ears to the sounds of sunrise, before little songbirds defer to cawing crows. There is surely even a smell and taste to sunrise here.  It may be wood fire and a little grass hint of rosemary, fresh life.  The 5 senses give us but a sample of the significance of life.

    Oh it's a cold 50 degrees though and the pjs are a sluggish force to the furniture of cozy indoor complacency.  So I watch from here as the banana leaves reduce their jubilee to mild finger snaps or maybe spirit fingers. The wind dies down and the show today has begun. Here I sit seeing through a glass dimly.  One day we will know in full what it means to be out there in the fully alive, realized and actualized life above the top of Maslow's pyramid- when faith becomes sight. Have you too felt like Life to the Fullest is so much more than what we settle for day in and out? Lord, haste the day and let it be well in my soul.

The Safari Post

 Psalm 50: 10,11 

"every animal of the forest is mine and the cattle on a thousand hills. 

I know every bird in the mountains and the creatures of the field are mine."

    "Safari" is a word that means to journey in Swahili.  We usually mean going on a journey into the game parks of Africa, where we ride around and catch beauty, shoot memories, and hunt wonder and amazement.  It is one of my favorite things to do in all the world.  I am pleased to give you a glimpse into a few of the things I love about going on safari.

    We are riding out from a small developing town from the pavement on to a stone and dirt road.  We are in a big tan Land Rover with no windows and a pop-top roof that rattles around until it can be released.  The group of volunteer physicians and spouses have exited the mission hospital setting and are entering the beauty and calm of the wild in these wide open spaces on the African Savannah.  A human can feel the unfettering of creativity and curiosity as we journey further up and further into the Narnian like landscape.  We are entering lion country. It's a land of all kinds of creatures that I would love to write home about, but it takes so long to unpack this enclave of inspiration that I typically well up with life and joy and beauty and praise but fear confining the experience with something so mundane as a text, especially in Times New Roman. 

    There is something about being saturated and engulfed in the whole created order that reminds us; it re-collects our memory that we are also created beings, and that our Creator takes delight in the wellbeing of his servants too. (Psalm 35:27). Going on safari is such a life-giving experience for us, for 24 hours every year after we spend a few weeks working in the mission station.  It's a refreshment, yes, and more.  It's a re-creation, a time to name creation and delight in the unpredictable, the extravagant nature of God's goodness.  

•  The Zebra-His name in Swahili is "Pundamilia". It means "striped donkey".  Can you hear Shrek calling his name in your imagination? They are much like the donkey but will never be domesticated because their back is not designed for strength to carry burdens. These are a beast of beauty.  To me they all look the same, but they each have a distinct stripe pattern because each one is in fact, a unique being.  I think about Balaam in the Bible and his talking donkey,  These ones are almost talking too- "Look! Listen! Live, knowing the Creator's generosity". They never bathe but somehow maintain such clean black and white lines, I'm constantly amazed.
• The giant giraffe, so regal and silent, appears on the landscape like a slanting cell phone tower that is broadcasting beauty in 5G- "Can you hear me?" When they move they amble. Few 4-legged animals do this funny trick of walking with both right legs together and both left legs together.  The Tennessee Walking Horse is another one that can master this gait.    The giraffe in a traveling line are called a "journey".  They seem to enjoy the safari too!
• Warthogs are endearingly familial.  They root and rummage and run together with their tails popped straight up like an antenna.  They used to be called "Radio Africa" back when people used radios.
• The Topi is another peculiar beauty.  Sometimes drivers like to call them the "Spare parts" animal due to their coloration and shape.  I don't think it's body shaming to say they are an oddly built antelope.  Their skull and eyes and height allow them to also serve all the plains animals as a watchman on alert for predators.  We owe a bit more gratitude to this one.
• Two elephants jostling each other with a little small charge of energy was enough to electrify my sense of smallness and danger.  They are so amazing and the closest thing to Jurassic Park we may ever encounter.
• 2 male lions meet like a couple brothers that pile on each other and lazily wrestle for control of the room.  
  
  
  
• A Silverback Jackal is over there in the grass.  What's he doing?  Is he eating?  Yes!  He is standing proud over his baby gazelle kill.  We watch him pick at it trying to carry it over to his family.  He decides to lighten the load by disemboweling the prey first.  It's like he's slurping up long red Ramen noodles.  It's too graphic to video this part.  But when we see his little wifey and 2 pups waiting for their dinner, we understand that this is part of the circle of life as it is for us post-diluvian omnivores.
  
  
  
  
  
  
  
  
  
  
• Last but not least, is the humble little "Waste Paper Flower".  These white- petunia-like blooms pop up all over the low grass after the rains and after the grazers have mown the lawn.  They remind me of the lavishness of creation that is just for pleasure sometimes, whether or not anyone ever sees them, they bloom in triumph.  They encourage us to be what we are meant to be whether or not anyone notices.  I love to consider these flowers of the field.
• We sleep in tents on safari.  I hear lions at night.  They could be 7 kilometers away, but when you hear lions, no matter how far away, you sleep like a rabbit.  Of course I'm telling myself we have electric fencing around the camp... but sometimes the power is off.  And I've seen the movie "The Ghost and the Darkness"... It's all part of the adventure.

I could go on for years like this.  I suppose I do though, as it has been 21 years since I have started missionary work in Kenya.  The secret is out though, and the journey we take (almost) every year is such a delightful blessing that we just want to share how great us our Creator God.  As we are now back in our "regular" work life of brick and mortar buildings with artificial fluorescent lights and tile or concrete floors, I long more and more to be out of doors.  The big blue sky has grown in its value to me.  The vault of the sky and the tent of creation are overwhelming.  On this lovely Sunday afternoon at home, I am praying a Hebrew Sabbath prayer for us all "Embrace us with a tent of thy peace".  

The medical post

Patient 1- 20 yr old female from somewhere far away was able to get to the hospital barely whispering in English "Please help me".  She presents with a blood pressure of 70/40, much to low to keep the body working. Heart rate 140 bpm, meaning the heart is working very hard and hardly pumping any blood.  

Ultrasound and ECHO reveals aortic stenosis (tightening of the valve through which the heart delivers the blood to the body).  The tightness of the aortic valve is so tight, that the blood squirts through it in a weak little squirt gun manner.  The valve is the problem.  It has been bad for such a long time that the muscle of the left ventricle has grown incredibly large.  It has been striving so hard to push blood out of this bad valve that it is now constricting the ventricle further.  The blood is now partially moving up through the mitral valve back into the left atrium. 

The patient has too much fluid gathering in some places and not enough in others.  The lack of blood supply to the rest of the body is causing the liver and kidneys damage, which means she is in the end stages of heart failure.  

The cause of this terrible situation is called RHD.  Rheumatic Heart Disease is a preventable illness of poverty.  It affects far too many people who are now hospitalized for their condition, about 10% maybe.

Back in the medical ward, it is now a matter of fine tuning the treatment for the patient with heart rate control and volume of fluid as a bridge to try and get her renal and liver function back.  She needs valve replacement surgery rather soon. That could cost about 11,000 USD that a family has to come up with.  The outcomes are bleak.  Thankfully, a new RHD screening program has started early treatment and prevention education in area schools.  The simple solution of penicillin for strep throat infections and even for infected heart valves will save so many lives in the future.

Patient 2-  18 yr old male presents in emergency room with upper GI bleeding, vomiting blood.  History of sickle cell anemia (meaning his red blood cells are sickle shaped instead of round).  Faster than he can make the misshapen blood cells which are pouring into his stomach, he is throwing them up.  The source is a stomach ulcer due to bacteria called H. Pylori which is common in any low- middle income country.  Again, another disease of poverty is unfurling.

Hemoglobin was 4, bp 80/40, heart rate 120 bpm.  He was first given 3 units of blood, then sent to endoscopy and the ulcers were not actively bleeding.  He intermittently bled and stopped for several days from the deterioration of the stomach lining.  Medical team decided to give transfusions, acid suppression, and treatment for the bacterial infection.  The sickle cell disease got worse due to the lack of available blood flowing in his body, developed what is called acute chest syndrome.  

Acute chest syndrome is when the sickle shaped blood cells clog up the alveoli (part of the lungs where oxygen is attached to the blood cell).   This causes severe chest pain, hypoxia, loss of oxygen to the body overall. It is a pretty bad state to be in.  Treatment needed is called exchange transfusion, meaning all the blood in the body needs to be replaced.  Then he started bleeding profusely in the ulcers again. 

60/30bp, Hgb 2

He is sent to emergency surgery for resecting the section of his duodenum where the bleeding is coming from. The blood bank in the hospital gives 12 units of blood to him over 24 hours.  (An average person might contain 12 units in a normal healthy body)  The gift of the new and normal shaped blood cells in all of these donated pints was that they flowed properly and cleared the clogged up alveoli in his chest, opening oxygenation to the blood stream again.  It is called an exchange transfusion but was done in a very unconventional manner.

He was recovering in ICU today. Pray for Boniface when you read this, please!

The medical ward nowadays is being run by some very fine Kenyan team members.  They have a good dynamic and genuinely want to help people.  Michael is enjoying working with them and seeing their growth and development as medical professionals not only over these 3 weeks, but also over the past 11 years since he's been coming here.  They see about 60 patients a day but it is divided up quite well among the team so no one is overwhelmed.

We are also hosting 2 residents (and their dear spouses) from UT with us this time at Tenwek.  We eat lunch and dinner together in a guest house with lots of other volunteer physicians and spouses.  They show each other x-rays and pictures of things like a black lung that they helped remove earlier in the day.  The table talk can get colorful you might say.  This is a typical day in the typical life here.  

                                                    blood donation center inside the hospital

                                                        Katie's type 0+ matches our patient!

                                                        into the blood fridge it goes for Boniface

This day. 7/22/24

I remember arriving here in a cloud of unknowing and alone late last night.  The journey was long and complicated.  It started on Friday, driving the kids south to Georgia and then in driving rain, driving home to pack alone.  Then it was driving the doggie to her boarder early Saturday and nearly missing a turn due to a big selfish driver in the other lane, and bounding through a pothole in the little triangle between I-24 and I-59, splashing water all over the windshield like my adrenaline, thankful for my Jeep and those angels watching over me. There is not a minute to lose on a travel day.  

I remember my dear neighbor, Ellen, showing up to help me out the door Saturday morning and she even took out the garbage for me while I gathered my alleged wits and forgot my actual hairbrush, hand sanitizer, and phone charger.  (It’s surprising how poorly I pack for someone who has done this trip as much as I have)

I remember the macro-chaos of the micro-software malfunction Friday that caused 1,000’s of flight cancellations across the country.  My travel companions had to rebook on Saturday, for a flight Sunday, for which I would spend a day in Nairobi to await them.  I remember today, Monday, is that gift of time. (Michael has already been in Kenya for a week now, working his Daktari life at Tenwek Mission Hospital again. We will catch up with his interesting stories soon.)

I remember flying solo Saturday night across the Atlantic like Beryl Markham or Amelia Earheart, or Katie Christian, the 24 year old.  There were also 550 other souls on board the Boeing 777. But without my 2 kids and 1 husband sitting in the 4 across seats of the middle row, I was alone.  I remember trying to watch mindless entertainment and not enjoying it.  So I read a bit of poetry and the Silver Chair by CS Lewis in which I felt like Jill Pole getting blown by Aslan’s breath in silence and solitude over our world into Narnia.

I remember Sunday night landing in the foreign-familiar dark night city where stars shine on the ground and we disembark the giant “ndege” (Swahili for bird and airplane), onto the tarmac like those cavalier women pilots of the early 20th century.  But I was corralled into a bus then a building that bottlenecks the 550 souls into 3 tiny passport control portals for an hour or so.  I listened to a podcast on “Practicing the Presence of God” there. And I connected to wifi for messaging my husband, the Daktari, because we certainly know how to practice the presence of wifi don’t we?

I remember riding out to the hotel Sunday night with a British family “on holiday”.  Their teenage sons were excited to share the latest update on American election news with me.  I checked into my room alone with the confidence that The Lord is my Shepherd.  I remember acutely missing my family and how my mind gives them so much occupation.  But there is art on the wall of some lilies.  

And I remember the Mary Oliver poems I just read “How Everything Adores Being Alive” and “The Lily” and also Jesus on “consider the lilies”.  My call now is to live life fully alive with Him in the present, to see it, appreciate it, and remember it.  I will both lie down and sleep in peace for He alone makes me dwell in safety.  I realize it even if I cried a little silent tear.

And this Monday, this penultimate Monday in July, this serene day of waiting here on the terrace rooftop by a beautiful blue pool with the 4 horizons I can count-  spending this day alone with Jesus has restored my soul.  He has brought me into a spacious place today.  I looked way up and saw a graceful white and black winged crane silently, secretly flying overhead. Everyone else is looking down. They are missing all the delight of just being here, practicing His Presence.  How can I be so blessed as to be here amidst all this splendor? (Luke 17:21) It is because I am secured by the strength of God’s own deep and complete love for me.  That is why I am here today.  So are you.  Do you realize it? Look up, look around, look back. Remember.

Effie wrote to me today “There is no stronger faith builder than remembering”.

Look who came to Nairobi for dinner with me on Monday! 

Generations Part 1

    Returning to Kenya year after year has been such an interesting blessing.  My first trip was in 1992 with my parents, sister, and her future husband.  It was as far out of my comfort zone that 13 year old me had ever been.  I didn't particularly "enjoy" it at the time, yet upon arriving back home, I was keenly aware that I missed it already.  It was as though the first little bit of my heart was divided and deposited for future interest.  In a beautiful coming-around saga, the now 18-year-old daughter of my sister and her husband was able to join us for her first visit to Kenya this summer.  She did much better getting out of her comfort zone than I did on my first round.  She brought her guitar and led us all in singing praises to God (and a little Taylor Swift sometimes too). 

    We also were honored with the gift of another family member on this trip- Michael's dad! Someone graciously pointed out the unique situation of us having 3 generations together.  We are grateful and encouraged by his willingness to go and endure with us.  

    The first 2 weeks, Michael and his medical resident were working at several rural Maasai clinics he had never been to before.  The director of these clinics is a wonderful Maasai friend named John Sankok. He told us that they were able to serve 334 people in that time.  One patient in particular stands out as a case to share.  She was a girl with Rheumatic Heart Disease.  The early diagnosis at the rural clinic will afford her the opportunity to treat this disease with medicine monthly.  The treatment does not just affect her heart for now, but Lord willing, it will allow her heart to function properly when it is time for her to have children of her own.  Too many young women go untreated for RHD in Sub-Saharan Africa and the loss of life is often doubled in pregnancy.  Simple penicillin might allow this girl and a future generation of her future family to praise God too.

                                        below: the clinic staff at Mara Rianta CMF health clinic

                                

              below: a realistic danger for the clinic staff walking home from work here- a resident elephant is the evening traffic jam you don't want to get caught in

(she makes it very difficult for farms and gardens to keep fresh vegetables growing)

The Mara River:

 

 Below:: Daktari's one medical lecture if he could give just one to the Tenwek trainees-         Antibiotic Stewardship

   I arrived in Narok with the family for one week and then we migrated to the next county to visit Tenwek Mission Hospital for only a few days of inpatient hospital rounding and teaching.  Mainly we just wanted to reconnect and visit.  In just a few short days, we felt so very blessed by the old friends there who welcomed us back "home" and made us feel so much seen and loved.  Someone once said, "We all enter the world looking for someone who is looking for us".  Here at Tenwek we feel very much "looked at" by our community ("seen" is a better way of saying that, but it depends on the day if we feel looked at or seen) Sometimes we wish that nobody was looking at us or for us, for that matter.  But for this time it was a big blessing.  We not only felt seen but felt like we can also see things more clearly here.  

    The girls called their experiences "eye opening".  I was delighted to have open eyes for some of the generations of new medical staff that have risen up in the past 10 years.  We had Kenyan medical students and interns in 2013 and 2014 who are now bearing so much fruit at Tenwek by heading up the new oncology department, now practicing daktaris, training in surgical residency, neuro-surgery even, and carrying on as the attending medicine consultant for the inpatient medical wards.  We have no words but thanksgiving and praise to God for all the evidence of His faithfulness to all generations, especially to our 3 generations this summer.         

                                               

       

Generations part 2

    The Maasai people have been fiercely traditional for centuries.  They are noble and unique among African tribes, an iconic symbol of Kenyan culture and vitality. They resisted colonization by the British and continued their way of life in nomadic pastoring of cattle, sheep and goats.  We just learned at a campfire culture talk this week that the word "Maasai" comes from Maa meaning the people and sai  meaning to pray to Enkai (their name for God).  So they are "the people who pray to Enkai".   In the late 1970's and early 80's a young Maasai man named Timothy heard a word from the Bible which said "Whoever has the Son of God has life and whoever does not have the Son of God does not have life" (I John 5:12).  He began to ask himself "Am I not alive? Then, what does this mean?" and he went to find someone who would teach him what the Word of God meant.  He heard of a missionary with a big beard that hid his mouth and white skin and was widely feared. He was also known as one who taught the Words of God.  So Timothy walked about 30 kilometers to sit under the meeting tree with him and hear about the Son of God who offers life.

   God is moving in big ways among the Maasai today.  From the seeds that were planted in the hard dry ground of Maasailand in the '80s up until today, the number of believers is really growing.  They are communal people and like to make community decisions.  The Good News of the Kingdom of God is for communities too.  God wants us to be in community with Himself.  That is why the Son of God became one of us, to bring us back to God.  

    The missionaries of just one or two generations ago shared the Word of God with today's Maasai elders who are continuing the work of the Kingdom of God.  Today, our friend Timothy has a Masters degree in Disaster Management and is director of the ministries at Africa Hope.  They are pushing back the edges of extreme poverty through holistic outreach with water security and sanitation, children's camps and family sponsorship, all in the name of Jesus.  The same bearded white missionary recruited me to be part of the work back when I was a college student and I came to Kenya to help with the start of Africa Hope in 2003. A year later, we broke ground on a conference center for Africa Hope and my mom and dad came to help mix concrete and lay blocks for that building.

     This year, our kids and our sweet niece came and mixed concrete to help make some sidewalks that people use when coming for training and programs. The center is so big now.  I was asked to do some staff development this time and it was marvelous to see a whole new generation of community health workers and pastors growing in their understanding of the Word of God!  I and they together told the story of the whole Bible about 7 times over with a different theme each time. It offers a 35,000 foot view on how much God relentlessly loves and pursues His children to bring them back into his family through restoring life, rest, rule, friendship, and salvation.  It was 3 days of Bible stories that weave together like an epic movie trilogy.  Most people read one verse or passage at a time and miss the big picture.  Imagine watching your favorite movie in 5- 10 minute increments over a period of a year versus a binging the whole story at once and getting swept up in the drama!  The staff was so encouraging in their joy at the Word of God!  It was like medicine to my soul to be part of this.  As we left from Africa Hope, they offered a beautiful send off with prayers, singing and adorning us with Maasai blankets and beads.  The girls and I were wrapped in Kenyan flags and I felt like a marathon winner!  Then it came to me "I have fought the good fight, I have finished the race, I have kept the faith".  

    

     Girls fetching water from a secure source- a bore hole that Africa Hope helped to bring the community:

below: Some Maasai grandmothers worshipping God in the church 

A new generation paving the way:

The AH staff development learning Seven Streams of Grace Bible study:

Campfire cultural talk

Tim and Michael at the AH dormitories

AH staff and send-off time:

So much to give thanks for!  God has brought us a long, long way from where we started.