Malaria

This post will blend our two writers, Daktari and his wife.  One is more scientific, the other more theological
 (the lecture and the sermon).

I like to hunt mosquitoes at night around our house.  I think it’s a part of my service as an infectious disease doctor; I call it “vector reduction.”  And it’s something of a sport, and it’s part of living in Africa.  Sometimes we live in a FarSide cartoon where I can imagine that it’s a big  coup de tat for the mosquito if it can get an ID doc to hit himself in the forehead.  Or the wife of the doc to smack him and say “Mosquito!”

That’s the light part.  You can stop here. Or proceed with caution into the harsher realities.

In terms of malaria transmission, we live in a “hypoendemic” area.  That means there is some around, but not a lot.  We historically would have a case come to my attention once every couple of months.  For those of you who might wonder why, it’s a matter of temperature.  Our weather at Tenwek is too cold for the parasite that dwells within the mosquito to go through its lifecycle.  It’s as though there are zillions of mosquitos buzzing around here that just can’t complete sporogenesis which activates the parasite.

Anyhow, then these past few weeks it’s been unseasonably warm and there has been some more standing water around after the rains, and all of the sudden there’s an epidemic of malaria going on around us.  We’ve had an epidemic of epidemics the last few months: cholera and typhoid for the most part.   

And the richest targets in the world for malaria infection are pregnant women and children under 5 years-old.  86% of malaria mortality is in these two groups, and I’ve seen a few bad cases in the past two weeks.  Women with kids that are just a few days old have been coming into our ICU because a mother’s immune system changes late in pregnancy, to protect the baby from TH2 helper cells.  That is, the security guard of the immune system that tells the body what is self and what is other.  This makes the mom’s health vulnerable so that the baby, who is other than self, will be sustained.  And unfortunately, these are the same defenders that are needed to respond to the malaria parasite.  It is an act of perfect coordination with the Fall of Creation.  The serpent still acts to kill steal and destroy the children of Eve. 

We had a lady who was hanging on by a thread last week in the ICU.  7 days post-partum with a bad case of malaria.  So in the middle of the night last week when the pager went off, I went up to the hospital in the dark and ran the code for resuscitation.  Pounding and pounding and pounding 10 rounds of chest compressions on her- more than any regular patient would ever get in a code.  But her baby needed her to live.  We tried.  And we tried.  And I did not want to let go. But she died.  7 days after giving birth.  And the blood of Abel would cry out again from the ground-

But the blood of Christ speaks a better word than the blood of Abel (Hebrews 12:24).  I do believe that the One Child of Eve has already come to crush the head of that serpent and his parasitical sin-death relationship. The One Child of Eve came that we might have Life.  

The child of the woman in the hospital survived.  He faces tremendous odds in life, but he has a heart beating own it’s own in his chest to praise God.

A few days later, a local gardener, who also had a 7 day-old baby and a post-partum wife, came to our door asking for help because his wife was having terrible headaches.  We brought her in for a malaria smear.  She was unwittingly hosting that parasite that would destroy her if given free reign. But thank God, there is a cure! And she will be fine.   

We may not exude a happy happy happy kind of hopefulness in writing the truth about this work running a hospital’s medical ward and ICU in Sub-Saharan Africa where little to no preventative care is routinely given for patients.  The suffering of humanity is intensely heavy and overwhelming numbers of deaths are encountered weekly. Seven patients died in one day last week.  Seven.  Mind numbing.

How can this be remotely connected to hope?

Then today in church I heard the pastor say, “Hope is the great grandchild of suffering.” 

(Suffering produces perseverance and perseverance produces character and character- hope. Romans 5:3,4). 

Herein lies the Gospel. It must be that the suffering of Christ will do these things, not me, because if it were up to me, the end result of my suffering would be-hardness- bitterness- despair and we’ve been pretty close to it.   Only when we remember the suffering of our Savior will we persevere, and when we recall His perseverance of three days in Hell that broke the power of death then character is formed, and when we see His character in doing all this for love, then only will true deep hope in our hearts amount to anything.  The Gospel encounters suffering with open arms of love. Hope can only live if it’s connected to the Resurrection.  That hope will not disappoint.

The Lord is close to the broken hearted and saves those who are crushed in spirit. Psalm 34:18

Rescued!

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Our friends who are in Bulgaria helped us to see that the kids of missionaries are also missionaries.  We have prayed for our kids to be good missionaries in whatever way they can because the call is for all of us to be caught up in the Story of a God Who Rescues.  Last week I saw part of that answered.

So, Man Cub gets incentives for doing some extra work ($$).  He also gets fined as penalties on work undone.  So one day I looked in his little rock-star wallet to dig out 50 shillings.  And I was surprised to see 2000 shillings (about $20)!  So I asked where it came from and he answered that his little friend, Kip gave it to him.  Well Kip is a local boy and in the local economy 2000 shillings is about 1/3 of his school fees, no laughing matter. So I, together with Kip’s mom and dad, had to investigate as to how that money came around.

“How did you get 2000 shillings?” The dad of Kip interrogated.  He proceeded to explain to us that a stranger had given it to him with the instructions “take this money to your best friend and say let’s go to Nairobi together”.  The stranger was another boy with a man and a car and a woman standing down the road.   

This was attempted kidnapping.

Kip was totally naïve about strangers and he took the money and ran to our house to bring it to his buddy.  Thank God that we were at home and the boys were able to just stay and play here together.  I don’t know what happened to the strangers that day.  I didn’t even know what was happening at that time.  Man Cub certainly didn’t know that he was playing a pivotal role in saving Kip’s life!  We were pretty passive players in the story.  But sometimes, perhaps all times, who a person is and who he has been, is much more important than anything he does. A little micro-story of rescue, inside a bigger Story of the God Who Rescues by sheer relationship to His Son.

Passover

8a.m.Good Friday.

They were out of school because it is Good Friday.  Man-Cub would say “It’s Good Friday because we are outta school”.  So they played to their hearts content in the glorious freedom of MK’s in Africa. 

5p.m.Passover. 

Tonight we got to participate in our first Passover dinner.  The kids watched Prince of Egypt and we are reading in a story bible about the Exodus.  It’s a different emphasis on the meaning of this day, but one I am glad to be connecting in the synapses of their heart and heads.  Freedom.  Deliverance.

7:30p.m.Two little kids falling asleep all over me at the church service tonight.  How am I going to get them home? Daktari was here with us a minute ago, but he was paged up to help a lady with pulmonary embolism who isn’t going to make it through the night.  Now the lights of the meeting room are dimming and the candles being extinguished and it’s raining- the blessed rain that makes such sweet melodies on these tin roofs.  How am I going to get these children home?

“I’m carrying you home baby”, I say as she feels the cold water from the sky hit her sweet little legs.  Two Kenyan defense forces security guards are patrolling the night with great big guns hanging around their necks.  They ask me “habari mtoto?”- How’s the child?  I tell them she’s just sleeping and thank them for their work here.  We appreciate them. 

I think about the Roman soldiers patrolling the night in Jerusalem, Mary and Jesus, the Pieta. We sang O Sacred Head Now Wounded up there in the meeting room on the hill, just inside the staff gate of the hospital. 

I think about Garissa, Kenya.  147 mothers wanting more than anything to carry their sons or daughters home from there. 147 fathers waiting more than watchmen wait for the morning to hear from a son or daughter that they will still be coming home.  These were the valedictorians, the top students in high school.  They have to work so, so hard to get to a university in Kenya.  Their families have worked unbelievably hard at raising funds to get a student through university in Kenya.  Now the families will be carrying them home for burial.

I cannot process this event.  I cannot fathom the shock and grief and outrage.  Writing helps.  But really I can only carry my babies home and be so thankful for their sleepies that keep them needing me.  Their little requests for water at night, for one more story and the contented sigh of well-entered rest inside the mosquito net keep my heart so thankful for them.  They have no idea.

10a.m.Tomorrow- we will get up and scramble around like crazy candy addicts searching for bright plastic eggs and try to connect it all somehow to Jesus. 

6a.m. Sunday- We will watch the sunrise over a big wooden cross and stand in its shadow to decorate it with flowers.  147 mothers and 147 fathers will stand in the shadow of the cross somewhere all over Kenya with their shock and grief and outrage, and they will be able to look up at the Father who saw His Son die for them.  And He will say “I’m carrying your baby home too”.  Lord, please.  Let them see that you are there.

Seasons

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Cattle being herded through the capital city streets, mountains of mangos for sale on tables piled high with big black avocados. A thin layer of dirt is veiling everything and a sun radiating brilliantly into the pollution of a city bursting at the seams.  Nairobi.  They are zooming past the industrial age and into technology and Chinese investments shaped like enormous concrete monoliths of Babel as they scrape skywards out of poverty. 

We go to the city once in a while to be away from the weight and nearness of tragedy in the hospital.  We go to buy chicken and cheese and coffee (mostly to buy coffee really).  Nairobi is exhausting in a different way so it relocates the normal stress and that is good enough to call it a “break”.  It is a changing place and gives us a change of pace.

Daktari is hard at work this Saturday morning where 50% of his patients live with HIV or die with AIDS, and the other 50% have heartbreaking illnesses too but are just more complicated to understand and impossible to deal with.   Sometimes all a person can do is to be there as the face of Love to the dying.  He doesn’t pretend anymore to be the face of hope.  But the Love of God is constant.

  In the cool dark of this morning, tropical birds call me to rise and get to the day’s work before the day gets to me, and a beautiful African song echoes up the hill from a nearby school.  This may be what it was like for Eve or Lucy or whoever at the dawn of time in Africa. Pure and perfect for a moment.

But today I’d rather listen to Alan Jackson.  He reminds me of where I come from.  Country music is a still life in a swirling world of changes.  It’s good to remember where you come from when you come from somewhere like my home.   The constant of home is in moms and dads and sisters and cousins who love us and in the churches who sent us out with love and generous prayers for our journey.  It is the strength of deep roots allowing us to branch out so far into this unexplainable, unpredictable and ruggedly beautiful place.

The strength of constant love at home is allowing our children to exhilarate in their free-range lifestyle here.  They climb to breathtaking heights in trees.  They soar in the green meadows.  Like Kenya, they too are zooming through developmental years, growing taller and more angular with each new morning.   Their dirty feet signify a good day’s work and the thorns remind them of their vulnerability.  They are learning what it means to be at the mercy of the rains and the Maker of the Rains.  We take them to the river to watch the water levels fall and rise.  And to pray.

Like Kenya and our kids, our seasons are changing.  Rains have come like an Amazing Grace on a tin roof.  We are in the 4^th quarter of our 2 year term. Hope is perched mid-summer on the calendar for that mythical land called home.  But changes come to us all and home will be changed, as we will be changed.  Yet Love remains the constant.  And since it’s Saturday, I’ll just sit still and listen to Alan Jackson for a while.

A Little Journey to Rwanda

 It has been long since we last wrote an update, and I wanted to write a short story to reconnect us.

The first week in February I (Mike) took a trip to Rwanda to visit some Australian friends, the Walkers, who work in an Internal Medicine residency training program, and to teach a few lectures at the University of Rwanda Medical School.

It was a deeply refreshing and stimulating experience, the family hosting me was extraordinarily hospitable and gracious.  The training program is taught at a very high level of medical expertise.  And I didn't have to make any life or death decisions for a whole week.  It was something of a nerd's vacation.

Pictured here are some images from a hiking trip into the surrounding volcanic mountain ranges (no gorillas, we were on the southern end of Rwanda).  And below are some still shots of an immunology drama which I dreamed up to illustrate the cellular immune response to infection.  It's a 4 part drama of cellular warfare, good guys (immune cells) vs. bad guys (bacteria/viruses), with various weaponry (antibiotics).  These residents have knowledge and curiosity at a deep level of medicine.  They challenged my teaching ability and encouraged me deeply that they are the bright hope of medicine in Africa.

Born Free

Sometimes it's no wonder that missionaries end up a little awkward after enduring so many awkward moments in this life uncommon.  But I really do love how my own quirks jive so (seemingly) well in Kenyan culture.  For instance, I will never be accused of being type A but that's okay here.  Because if I make plans, things fall apart.  If I just roll with it as it happens, my creativity breathes and things tend to happen that we never expected but are grateful for by the end of the day.  I deeply love that aspect of our life in Kenya. 

Last week we were honored guests (read: token white people) at a passing out party. What the heck is a passing out party you ask? It is when a boy goes through initiation rites and passes out of childhood and into young manhood and then he comes back home for a celebration.   There was a party tent and a sound system and we were asked to make several speeches.  Fortunately for us, our kids love to hear themselves on a microphone and they even sang 2 solos as part of the circus act (Please consider paying for their therapy when we reintegrate into mainstream society).  If you know the Man-Cub, you may have guessed that he sang his favorite song "Go Tell it on the Mountain".  But the Little Miss, she sings her own music. 

Today Little Miss has left "free" and graduated to four.  She can actually pronounce "three" now that it comes to a close all too soon.  But she will always be free.  Her spirit is singing her own song- passionate- imaginative- and free as the wind blows.  She loves the original Elsa- the lioness that was "Born Free".  

Four years ago Little Miss was born as the darkest night in some 600 years ended and turned into light.  It was a full moon that was totally eclipsed on the winter solstice.  And she tore into this world like a rocket ablaze with love and joy and strong feelings whichever way they go. Never did a baby scream as loud as that child on the beautiful marvelous night she was born.  I remember how strangely empty inside I felt after her entry into the world.  Though I held her in my arms it was already an act of separation.  She came as a gift that I couldn't keep to myself.  

A wise person once said that we know God best in our missing Him.  

Beautiful, surprising, passionate zeal for life.  She has helped us to know God better from day one.

 

Advent

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I usually do my best thinking on scraps of worthless paper.  This faded folded piece of red construction paper was tucked in my purse one day a while back when I was taking a lady to the hospital.  Jotting down my observations back then, this is what I pull out today:

A 2^nd hand McDonalds uniform shirt delights and even entices me in the emergency room (called “casualty” here).  A Maasai woman in spectacular bling bling of beads and shiny silver on age old stretched out ear lobes, shaven head, black wrinkled skin like tar-pits swallowing an old dinosaur.  Who will save us from this body of death?

Crowded, quiet, curious, stares at the white lady.  Yes, even I have a body of death too.  We are bound by corruption inherited through our cells and genes and traditions and systemic oppressions. 

Daktari has been blazing bright in his work.  He is alone now.  And the suffering of his patients day after day after day has taken a toll.  He calls them the 20-20-20 club.  The 20 yr old woman with a CD-4 count of 20 (advanced AIDS) and she is typically 20 weeks pregnant: they come in frequently and do poorly.

Who will save us from this soul crushing fatalism that is life in Africa?

Mama said there’d be days like this.

And even Jesus said in this world we’d have trouble.  But here’s one thing that’s True too:  He will never leave us.  So we don’t give up on Him.

Now you know how to pray for us I hope.   I promise to be more merry and bright in the next post.  Watch for it.  Wait for it.  Don’t give up on me either.