Shop talk

Daktari here.  Checking in after the first couple of weeks on the wards at Tenwek.  Grateful for a rainy season Sunday afternoon off from work, and the mental space to sit for a minute to reflect.

Being a member of the medicine ward service is a great privilege.  I am continuously amazed at the passion and curiosity of the Kenyan interns, their eagerness to learn, it's a heady drug to a professorial type.  Their humility when approaching uncertainty in clinical decision-making (and there is a great deal of uncertainty) inspires and challenges me.  This time around I get to spend my afternoons with a Family Medicine resident from Congo, learning the ways of the intensive care unit, and the mathematics of pulmonology and nephrology; the light coming on as: CO = 2 x NA + 1.15 * GLU/18 + BUN/2.8 starts to make sense in light of a patient with toxic alcohol poisoning = bad home brew.

A couple of clinical stories from the ward: We have a young healthy 18-year-old who stepped on an acacia tree thorn.  He does not have his bottom two adult teeth pulled like many of the older generation Kenyans.  They used to pull those teeth to secure a way for delivering nutrition in case of illness such as this: lockjaw, tetanus.  The man who stepped on a thorn contracted bacteria from the soil called Clostridium tetani that releases the toxin tetanospasmin.   The toxin makes muscle fibers contract irreversibly, causing a terrible contortion of an arching back and every muscle of the body is contracted until the nerve endings that were killed by the toxin can regrow.  Thank God for the treatment: source control (wound debridement), immune globulin to bind circulating toxin, antibiotics to kill remaining bacteria, and sedatives and magnesium to counteract and relax the spasms. Also because his original dose of toxin was low enough, his reaction was not fatal.  Sometimes the spasms of tetanus can break one’s own bones.   He has been moved out of ICU and is now stabilized in a regular ward bed.  Working on loosening, stretching, strengthening those muscles once again.  Daktari loves vaccines, they are a gift

A 20-year-old young man with a congenital heart disease died last week.  Tetralogy of Fallot it's called. He had received a bridge procedure 10 years before as a sort of stop-gap that wouldn't fix the right-left shunt, but allow him to live for a few years.  His father was by his side throughout this time, and as he passed, said these words, "I thank God that He has given us the life of my son, and that He gives life to my son, even now, with a new heart in a resurrected body."  

I leave you with his words, and ask for you to pray today for healing specifically in a young man called Kevin, with what I believe to be kala-azar (visceral leishmaniasis): a parasite from the bite of a sand fly that causes liver, spleen, kidney, and bone marrow failure. The treatment is quite toxic and we don't know if it is going to work yet.  

Until next time, Daktari.

The Hunt: Week 2

The Hunt

At night, we hear mosquitos whining in the air.  We don’t see them in the darkness but we know they are present.  Like a prison camp search light sweeping the walls, our cell phone light seeks out whom to destroy.  The little pests are hard to see though.  Daktari and Man Cub have an electric tennis racket that they hunt with at night to zap the mosquitos in the house.  It’s a fun game while we are awake.  When we are asleep however, we are under mosquito nets, imagining it to be a force field holding them at bay.  Who is hunting whom really?

In the morning, choir practice of song birds begins quite early.  I love their gentle early morning blessing that sings to us “Get up, get up, the sun is about to rise and it will be a hot and very busy day.  Get up while it is lovely and peaceful with us!”  We can’t see the birds too easily from our ground level apartment with one window.  But I do know they are there.  There is a 10 lb. book of The Birds of East Africa that I’ve been toting around for years now.  It shows me what they look like on paper.  Yet experience shows a real bird in in the tree is worth 25 in the book!  The illustrations of a Lilac Breasted Roller pale in comparison to the real life one.  A Variable Sunbird far surpasses its species name and drawing in the astonishing beauty of reality.  I renamed it the “Birthday Bird” because of its birthday party like colors and date of apparition.

We stay on the lookout, ready for the beautiful surprise that is the True Life version: iridescent flash of fruit loop blue as the wings take to flight.  The birds are there but my eyes can’t quite find them in the dim light of dawn…

Last weekend we got to go camping at Lake Naivasha with our Tenwek friends to recreate and relax together and celebrate the birthdays of a few of our Man-Cubs together.  There were not one but TWO Lilac Breasted Rollers perched in some dead trees at the shore!  I had one in my binoculars and lost the other.  Where did he go?  Then, the flash of wings was right beside me where he had landed and taken off again.  Blue and purple and white flash, opening my eyes to what was right there beside me as I looked out in the distant dead tree.  So close

There is an old Rabbinical joke George once told us about a day that God wanted to play a game of hide and seek and He wondered where to hide and the Holy Spirit told God to hide in the human heart because “no one will ever look for you there”!

Who is hunting whom?

First night in country:
We arrive in Nairobi at the "Midnight Guest House" in what felt like midnight.
Wake up in the morning to the happiest kid anywhere. "Ahhhh, when I look out the window and see that (green tropical garden and trees full of birds),  it just makes me so happy!" says the Man-Cub.

First drive through the valley:
We have a 4th year med student and a senior resident on a global health elective rotation with us.  It's a great job that we get to be doing this and call it work. Kenya is changing.  There is a new section of railway being built.  And Kenya is much the same; now in a new segment of an old story.

First Call:
Daktari on call on the first weekend here.
The hospital has open one ward for males and another open ward for females.  20 beds in a room and lots of very sick people sharing space with family members and each other.  There is a 35 yr old man who had a bleeding ulcer.  He was stable but he suddenly coded and died in the night.  35. Ulcer.
Directly across from him our friend was coding a 1 yr old child.  She also died last night. 1 year old. Next morning before church, found out a second man in his 30's also died unexpectedly before the code team could even be notified.  How it happens like an angel of death sweeping over the place, I don't know.

First weekend:
We were invited to lunch at our friend's house in the village over the river.  It was lovely to be out there again.  Real people doing real life:  growing banana trees, sugar cane, grass to feed the milk cow.  Eating real Kenyan food: chapati, greens, rice, beans, beef, and steaming hot sweet chai. Thankful for these nourishing relationships that keep pulling us back to this place.

First meals:
We were also invited to dinner with a missionary family who recounted the traumatic events of last weekend, just a week before we arrived.  Tenwek had a terrible fire at night.  Around 8 pm the kitchen caught fire and burned up an entire building of offices and the kitchen.  They community was really dramatically impacted. It was like a story of Gideon in the Old Testament and how he took his tiny army and some flash lights to defeat the enormous Midianite army.  Here in Kenya there is no EMS.  The closest thing to a fire engine was a water tank truck in town and the wheels were off for repair.  One missionary drove for an hour to the next town to look for a fire engine.  Meanwhile the missionaries and staff and local folks were tossing buckets of tap water onto the huge flames.  One man we know who is a master builder, climbed on the roof of the building to knock off all the wood trim that would spread the fire to other buildings.  The boiler room and back up generator with tons of diesel fuel were directly next door to the burning building.  The patient wards were all around being evacuated.  The Lord directly protected and contained the fire to that one building and we are all full of thanks and praise!  Not a single person was even hurt.  It was miraculous.

First impressions:
The daktari kids noticed that some of the ground rules in the community have changed for how they are allowed/expected to play.  However, they still ask if we can stay here for years and years.  It is their glory days all over again.  At least, that's their first impressions.

More that rises in the morning...

    My would-have-been friend, Rich Mullins wrote a song when I was 9 yrs old about how "there's more that rises in the morning than the sun".  He listened and reported like a prophet on the deeper things that call out to the human soul, the Spirit that sustains all our humanity and creation.
   When I walk out on the back porch before dawn, I look east and see glowing lights on the horizon.  It is not a sunrise at all.  It is led and sulfur lights that have twinkled all night to report human activity of airport and shopping mall and franchises that eat off the cell wall of the city.
   What I hear is a few cars cruising up the main road and a few robins, all us early birds up to get something accomplished this Saturday before dawn.  Listen harder.  Listen longer.  I hear a distant train, an airplane, my children upstairs waking to play nerf war.  Listen more, hear the Spirit of God.  Become aware of His presence even in a suburb.  Even here and now.  Yes.  God is still within her she will not fall. God will help her at the break of day. (Psalm 46:5)
    Think through the day with gratitude, opening the porch doors for the fresh, crisp air of grace.  thankful for breath.
   Reflecting on the day, realize there is a battle to be fought and if I merely ignore it, I am therein defeated.  Blind and deaf to the beauty of God's heart would be our default and my defeat. I would simply believe that all we can see is all there really is, or worse yet, all we can feel is all that is real. Lord, keep us truly alive to the Life that is Abundant.  Keep us sharp and quick to Truth, Love, and gratitude. 
  The sky is getting lighter and it is overcast this morning. I don't see a sunrise still in the east.  But I do know that it is rising.  We are like campers in a tent waking to the light, the sun isn't visible.  But we cannot go on sleeping because the sun is making everything else visible and I know that it is time to get going.  Time to get going. 

2016 some back stories

The songs inside dried up for a while.  Over the course of a year I wrote this once and it's like an episode 4 or something that falls in the middle of stories already told. I'm back pedaling to 2016 on my stories.  Hoping to prime the pump again.

Oh Lord, I want to write again.  I want a song to sing again.

Help me find the music in this land where my forefathers died and this land of the pilgrim’s bride. Let freedom ring in my heart again too.

March 30 Great Rift Valley picture

Daktari and I were out on a date in the scenic city at a fancy schmancy aquarium that journeys you experientially from Appalachia down the Tennessee River to the Gulf of Mexico.  It’s lovely and serene and so very local.  But they juxtaposed a picture of the Great Rift Valley there in the peaceful places of Tennessee with the bluegrass music.  I don’t know why they put that picture there, but it was like a magic porthole that the Narnia kids fell into.  The gravitational force pulled my heart out and left me wondering- how can this even be the same world?  How can I be way over here in this skin and have that big beautiful prairie life so long gone? 

Thankful to have both.  Heart brokenly thankful.

Monday April 4

Cherry blossom petals blowing down over a swarm of happy 2^nd graders.  Little Miss calls them the “tooth graders”.  The playground time on these sunny spring days when he doesn’t know I’m watching is magic.  Little boy, let your heart be alive!  I can’t keep you in with me forever like that cherry blossom branch in the jar.  You must thrive in this season and be brave enough to be kind to the weak and be kind enough to be brave for them.  Tell them about Jesus- the best thing they’ll ever learn.  Tell them how they are loved enough God let His Son die for them so they can live this abundant spring blossoms blowing over the playground life in the fullness of His presence. 

Friday April 9

At home folding laundry.  Enjoying the new almost found rhythm of life with just my preschooler and me.

 I sang “Born Free” to her today and I cried.  It just overcame me.  The vision of that life in Kenya, the savannah, the exotic freedom of childhood in a mission compound, the life on the edge of adventure, as free as the grass grows. Her little body and big big spirit that longs to be there again- it overwhelms me.  It has dominated these past 9 months for her and feels like a beautiful memory that is so warm and so intensely beautiful and difficult to manage.  I don’t like to lift that band-aid up too often because the feelings are still tender.  Hers and mine.

Wednesday April 13

He did it.  He told them the truth today.

The 2^nd grade teacher said “What’s the most important thing on the One Dollar bill?” and Man-cub said “In God We Trust”. 

“Why?”  They wanted to know-

And he says: “Well because God is like, way more important than money”.

This public school thing might work.

Monday April 18

In this wilderness of material pleasures, my soul desperately needs my Savior.  I wither under the vacancy sign in my heart as it flits to and fro from vanity to vanity.  Little Miss tells me we go to too many shops in America and don’t see enough people.  Ouch. 

When we first moved back I listened to a lot of Rich Mullins and Andrew Peterson music because they sound like home, they felt/feel the spiritual homesickness that I felt so intensely as a sojourner.  But now we have bought a house. 

She says “Kenya is my home.” And he says “No, America is our home”. 

But can a person truly buy a home? 

No. 

The Lord is our home I tell them.

And she adamantly joins the ancient faith declaring aloud in the carpool line “Heaven is my home.  I’m a Heavener!”

Wednesday April 20

Chattanooga is in the middle of a gang war.  The tooth graders are being kept indoors for recess all week it looks like because of that.  No outside play?  But the weather is so lovely and their hearts are so alive with the wiggles and the earth is so beautiful, right there on the playground that is overlooked by Look Out Mountain. 

Dr. King even said “From Look Out Mountain Tennessee, Let freedom ring!

From every mountainside, let freedom ring.”

And here we are, trying to do this American life again/ for the first time and trying to seek first the Kingdom of God, and not be caught up in the fear and consumerism and frenetic and lonely pace of life. 

We took two little friends out to play after school this week.  They understood about shootings.  One of them said “My uncle got shot behind Food City” like it was as normal as driving in a car.  Her reality accepts that as normal.  Her world is being built in the projects.  My kids have seen poverty in Africa, but they have not known poverty with violence before. 

But like Dr. King also said “…their destiny is tied up with our destiny. And they have come to realize that their freedom is inextricably bound to our freedom.

We cannot walk alone.”

So they sit indoors looking out the porthole at the beauty and feel that longing too.

Oh Lord, from every mountainside, let freedom ring.  Let us work for it here too.  Bring your Kingdom Lord, so we can have our Home at last.

Pleasant places

Smooth white shiny mug of hot brown Kenyan coffee and many many little 2 wheeled taxis going piki piki piki piki under my window across the dirt road to start the Kenyan morning. So many school children with smooth brown heads and gingham uniforms are riding to school at 6:30 a.m.  Our children tried to hike with me a fraction of the distance over the river, but by the end of the day everyone is too tired to make that commute- the walk to school, the walk to work, the walk to water for the dry season is bearing down too.  But life in the village across the river still reminds me of the goodness of Africa and the traditions of community and respect and the beauty of bright colored paint and fabric over rustic frames.   We are refreshed by the friendships and camp style mugs of hot creamy chai full to the brim and we are too full to eat again until the next morning. 

It all seems so normal, natural, and right to my brain.  Even the things I see as glaring injustices are still predictable and understandable somewhat here.  I love life here.  Even when it’s awful and unendurable and frightening I love it and hate it and love it again.  The Man-cub and Little-miss are playing so hard  with so many kids every day here that any remaining baby fat has melted off in the hot equatorial sun.  Their hearts are more than happy doing this life here.  Man-cub asks if we can live here again for another 2 years, or 5. Oh, what about our wonderful puppy back home, the Golden Dog? She at least has a staying power of fidelity and cute and cuddliness that they are willing to board a plane to America for.

Africa has an incredible staying power that undergirds many vulnerabilities.  People come and go and come and go and seasons change, technology and development change but Africa remains.  I read that or a line like that in a Maya Angelou book called “All God’s Children Need Travelling Shoes”.  I love wearing my travelling shoes to come back and witness what she meant. If I didn't have the freedom to come and go, I think I would love it less both here and there.

I am impacted by gratitude for the awesome privilege of living a life here in the rich beauty of community and the harsh ugliness of community and also in the safe and sanguine picket fenced yard of my America life.  How did I get so lucky as to have it both ways?!  I can tell you the secret.  It’s because My Father really loves me and He listened to my prayer for a home on earth and then yet for the wings to fly into His wild and wonderful world, refreshed and filled up to overflowing.  The boundary lines have fallen for me in pleasant places.  Psalm 16

strike

strike:

What would you do?

The over simplified version of the situation at hand: the doctors nation wide have been on strike for more than 50 days now due to deplorable working conditions and pitiful salaries at public hospitals.  We arrived on the tails of a crisis gone bad to worse.  5,000 Kenyan physicians nationwide serve 45 million people.  They are worn out beyond what can be paid.  The government agreed to a collective bargaining agreement several years ago to increase the salaries and provide better working conditions in hospitals where it is not uncommon to have less equipment than one thermometer.  The agreement has not been kept so now the doctors have called a strike until it is implemented.  The government has threatened to sack 4,000 doctors this Friday if they do not return to work. 

Meanwhile the private hospitals are open for the few who can afford to pay.  Tenwek is a private mission hospital so we are carrying on under the pressure of bloated capacity and standing room only, triaging the patients according to their likelihood to recover. 

One might be tempted to get depressed or worse, despair.  Some might be tempted to do more and try harder until one is burst at the seams from a particularly western disease called the God-complex.

 It's a complex situation too.  

But we are not the Hero who is competent to defeat any of the systemic evils of this world save for the power of the Risen Christ at work in our hearts.  We don't have to solve this.  We only have to be faithful.  Only by staring through certain death to the back door that was blasted out there by His Resurrection, can we find the strength to endure for even another day.  So while some trust in collective bargaining, some trust in better equipment, some trust in democratic systems or scientific materialism, we trust in the Name of the Lord Our God and that’s how we continue.