Wiki moja (Kiswahili for Week 1)

 Wiki Moja-  I hope to post 3 weeks of Dakatari Life for the first time back online for the first time since, well, a long time ago.  

    We are so blessed to have this opportunity to be back in Kenya serving at Tenwek Mission Hospital again.  Daktari was allowed to bring a UT medicine resident for an away rotation.  Kenya has general elections in August and it is recommended that visitors make their way out beforehand, so we are only able to work in the hospital for a week.  Therefore, he hit the ground running at 7 a.m. for ICU rounds on Friday and is covering call for the medical ward this weekend.

    Here is a very dry little take on the medicine rounds so far:

ICU patient 1- Rheumatic Heart Disease, atrial fabulation, history of stroke.

patient 2- Lady with probable Lupus, very sick, respiratory failure, on vasopressor, chest tube for fluid on lungs.  She coded Sunday morning.

patient 3- Old mad with diabetes, hypertension, DKA, new renal failure, needs dialysis.

patient 4-  heart failure, getting a little better.

Medical ward, 40 patients to see, a noticeable lack of HIV this time.  There's more non-communicable diseases and a handful of Covid patients (which is a communicable disease) in a cohort isolation unit.

Highlights: There are now 2 Kenyan full-time doctors on the ward.  One was a med student in our 1st year here, then he was an intern in our 2nd year, and now he is the consultant on staff!  The other is a Kenyan medical officer and affords the consultant a partner in the work.  These are major developments from 2014 and a big reason for doing what we do.

Another highlight: teaching at rounds and patient bedside with the team of medical staff. Teaching them about rate control for RHD, ID concepts on diagnosis and treatment of neutropenic fever (which is like the guards of the immune system all going on leave of absence at once).

There is an overwhelming volume of very sick people but it is a little bit like "Cheers" in that everybody knows his name, and they're always glad he came.  Lots of happy, warm welcomes in the community so we are encouraged.  That is the daktari update wiki moja, part 1.

The Great Rift Valley is still there. 

 In 2019 we witnessed its rifting in an earth splitting fracture of the  road.

Typical town along the 3 hour journey from Nairobi to Tenwek.  

The roads are remarkably smooth these days!

The most beautiful tree along the way

Oh, wow, that's a big pointer finger.

Our friend, Gideon is completing his 6 years of medical school now. Pray for his exam on Monday!

How to tame your dragon/ Great Dane

We get to dog sit for 3 different missionary dogs this week!

The day Josiah prayed for friends to play with, a 13 yr old named Josiah appeared and remembered him from summer camp at the gaga ball pit.  They got to rematch on the trampoline this time. God had planned to answer that prayer before it was even prayed I do believe!

The "Place of Songs": Tenwek 

Our little friend's 2nd birthday party

Christmas 2021

 Christmas Letter 2021

“This child is destined to cause the falling and rising of many in Israel, and to be a sign that will be spoken against, so that the thoughts of many hearts will be revealed.  And a sword will pierce your own soul too.” Luke 2:34-35

  Simeon was always on the lookout for God’s salvation.  He was looking for Redemption and to be a part of it in Israel. He was vigilant in watching for God.  Waiting and watching. The Bible doesn’t say how old he was, but surely he had white hair!  Ok, maybe he had white hair and stooped over in his walk.  But he never gave up trusting that the Christ would come to him.  And when he did, it must have been so shocking that he was a baby! Imagine when he held that 1 week old newborn high in the air, lifting up a light for revelation to the non-Jews and a glory to Israel.  Then he turned to Mary, and said those strange words to her about a sword piercing her own soul.  

Merry Christmas, Mary and Joseph?  It could be that this is referring to a Roman soldier at the foot of the cross trying to hasten the Christ’s death by piercing his heart right there in front of his mother.  Kind of a “do not be surprised at the fiery trials you go through” type of situation. Creepy baby dedication, right?

But today, a light has dawned on me and the thoughts of my heart have been revealed in his light to show me joy and beauty.  Have you ever experienced a joy, a beauty so deep that it penetrates the soul?  There’s a rare beauty that can access something inside so deep and tender that whenever it is tapped it wells up in tears.  

It happens to me when I am alone and listening to African music sometimes.  I feel so drawn in, like a portal opens above the kitchen sink, or wherever I am,  and I am not just doing dishes anymore but like some other realm is beckoning.  It is a beautiful aching sensation from beyond ourselves.  Maybe it’s like a memory of a loved one who has gone on ahead of us.  It’s an aching beauty that is not sad to be here at port but longing to set sail.  There’s a sense of “how brief and beautiful this life was” and “how I long for it again” and also “How blessed am I that the Mighty One has done such great things for me?” 

Today, Simeon’s word became clearer to me that the sword is also Beauty, Joy, and Grace that maybe a mother feels when remembering her babies in her arms, now at her side, soon to fly away.  It is a piercing joy of beauty.

Just when washing dishes with the African Children’s Choir Christmas music  I find myself in tears saying with Mary’s old cousin Elizabeth “But who am I that the mother of my Lord should come to me?”  Who am I that this blessed life would be given to me?  How wonderful that we got to experience this kind of life and love and octaves and intervals of a capella harmony in the voices of children and friends and singing voices deep and sweet and melodious.  How much He has loved us!  The aching beauty sword pierces my soul too.

Will he send us back to Kenya this coming year?  We don’t know yet.   Will he take away the Pandemic? and make life easier? Hmm.  Will we keep trusting him either way?  Yes.

 Will you be open to receiving the Joy of Jesus even if it comes like a sword?  In the words of Old Cousin Elizabeth again “ Blessed is she [or he] who has believed that what the Lord has said to her [or him] will be accomplished”!

 Merry Christmas and a very Happy New Year!  May you and your children feel the Joy of Jesus calling you onward in 2022.

Our family Christmas letter update 2020

Bless the LORD, O my soul, and all that is within me.  

Bless his holy name.

Bless the LORD, O my soul, and FORGET NOT ALL HIS BENEFITS

Psalm 103

Our family memorized this Psalm in October. We can look back now and gratefully say hindsight is truly 2020.  “Pivot” became a trendy word this year as paradigms shifted and the whole world was forced into new adaptations for survival.  As we pivot this Christmas, let’s look back and see  “how mightily the hand of the LORD was with us and we knew it not”.  Maybe we did see a few glimpses of his glory around us as we were led through a sort of Red Sea crossing type of year.  We haven’t yet reached the other side still, as the pandemic rages.  But we know that God is still good and he hasn't left us now, nor will he ever leave us.   Let us tell you a few of his blessings to our family this year so you may be encouraged to look back too and tell your family his salvation history in your own recent memory.

1. Michael’s work as Infectious Disease doctor really has been providentially timed for such a year as 2020.  He has charted new territory in hospital leadership and influencing decisions for a COVID-19 response to the tide rising since March.  He has become more dependent upon the LORD this year and has been blessed by a peace that surpasses understanding as the situation worsens.  There are so many terribly sick and sad people he sees every day.  Yet he has been blessed with protection for what he is called to do too.  We are so thankful to God for all he has done!  We are so excited too for the vaccines that are being wondrously produced like a Christmas present to the whole world!  Wow!

While plans were changed, postponed, cancelled, etc. (no trip to Kenya this year sadly), we are people of the cross and will go where he leads.  Looking back at February 2020, we vaguely remember that Michael went to a medical conference in Ecuador with a veteran missionary to teach in his specialty about a new upper respiratory infection called “the coronavirus”. The attendees were willing to receive that message of precaution and with great faithfulness and they were spared the worst of the outbreak that really impacted other parts of Ecuador tremendously.  Praise the Lord! Now at home in Chattanooga we are relying on the LORD to be "Another in the fire standing next to me" as Michael works double the usual load of patients this Christmas week and Christmas Day. Your prayers and your caution (mask wearing and 6' distancing) are personally appreciated!!!

2.  Katie in 2020 is full of thanksgiving for the pleasant places that the stay at home days allowed.  The Lord led us in green pastures and quiet waters quite literally.  The experiences He gave us from life overseas really helped so much in our “pivoting” to virtual school for 3 months and not going anywhere but here.  The bountiful generosity of the Lord has been staggering to me this year- a family, a house, a yard, neighbors to pray with on porches, gardening, swimming, running, music, beauty in the sky every day, college friends virtual book clubs, it goes on and on.  It has been so good to watch and search for what God wants to show us in all this pandemic.  We have read Matthew, Mark, Luke, and John 3x each this year to see if we can get to know Jesus a little better.  He is no stranger to suffering and he is near.  At least we’ve got that part.

A few fun ministries I’ve been allowed to pick up this year, much to my surprise have been: 1) Hosting 3 marriage retreats (with COVID precautions) through WinShape Marriage.  Super- duper- gracious goodness of God there!  Check them out: marriage.winshape.org

2) I took my first [part time] job outside of the home in who knows how many years!  I got recruited to help at our kid’s school as an assistant in the student health office.  The Lord has definitely satisfied the desires of my heart with good things! 3) A wonderful adventure came up for me in August to join in the Moderna Covid-19 Vaccine Trial!  I think I got the real deal, though it is a blind experiment.  I am confident this will be the best Christmas present for everyone to get for their families as soon as possible!

3. Now for the fun people: Josiah (12) and Annie (suddenly, she's 10).  These kids have rocked the pandemic with resilience they may have acquired in Africa.  They’ve been blessed with awesome neighborhood friends and an empty lot of woodland wonderland just behind our fence.  They played outside almost non-stop and pray for the end of the pandemic daily.  

1. Josiah has become a real sailor this year and competed in several youth regattas with the joy of a boy on a boat in the wind on his own.  He’s pretty good at it and still plays piano and trombone too.  Mainly he just likes playing with friends outside.  

2. Annie is our little equestrian now.  She was able to compete in her first Hunter/Jumper show and baby brought home 3 blue ribbons! Her violin/fiddle music has now sprung to a life of its own and she can play Christmas carols by ear and worship music together with her brother and dad when we have home church nights. She also was gifted some great neighbor friendships this year. A real answered prayer.

Finally, I was encouraged by George McDonald to share this quote which I saw come true in 2020: “Everything that God makes in a man is an obligation under which God lays himself to supply the need.”

4. What about you?  What are the ways that you have seen the Lord carrying you through this year?  Who will you tell about that? Tell us!                                                                                         

Psalm 78:1. O my people, hear my teaching; listen to the words of my mouth.

2. I will open my mouth in parables, I will utter hidden things, things from of old-

3. What we have heard and known, what our fathers have told us.

4. We will not hide them from their children; we will tell the next generation the praiseworthy deeds of the Lord, his power, and the wonders he has done.

On Vaccines and Trials

On Vaccines and Trials…

Somehow I've found myself in the middle of a new epic adventure of scientific proportions that are so tiny no one can see it, and so large the whole world is watching. Daktari is recruiting participants for the Moderna trial for COVID-19 vaccine which is now in phase III. We like to do things together, so I called the phone number to see if I qualified to join as a trial participant.

First there was the labyrinth of office “park” parking lots.  I missed the first entrance and the second entrance only had a small walk through connection to the offices on the first entrance.  Then there was a maze of corridors inside the office called “Clin-Search”.  Are you seeing the theme here of searching?

Then came the litany of questions, measurements, marking, charting, sticking, drawing blood for antibody screening, and then the nasal “swab”, (Covid-19 test) which was perhaps really checking if any brain cells were even thinking about Covid-19.  I accidentally yelped out loud at that part.

They had me sit for 30 minutes while I got randomized and suddenly I, like Jean Valjean was just a number like 24601.  Of 30,000 participants, half of us will receive a vaccine and half of us will receive a placebo.  The reason is to compare 15,000 people over 25 months with another set of 15,000 people to see if the vaccine group has less Covid-19 infection than the placebo group. It’s a double blind study, meaning neither we nor the doctors performing the study will know who is in which group.

But I wasn’t blind to the big red BIOHAZARD sign on the door that I walked through to sit in the chair.  The nice lady with the needles in the N95 mask had a tat on her arm which says “neither reckless nor afraid” (in Latin, no less).  I asked her about it and she said it’s because she is also a paramedic who must be neither reckless nor afraid on the job. Maybe we all should take that approach to life.  Maybe I will use a Bic pen and put that on my hand. 

There’s a goofy big picture of her little dog on the wall and she tells me to look at it.  I smile while she jabs me in the shoulder with either saline solution or mRNA-1273. 

The mRNA1273 makes me think of Screwtape Letters.  It’s a new way of thinking about vaccines and it is not a live virus.  It is a playbook, so to speak, of the virus’s strategy.  They inject it so that the body will know what kind of immune response to produce when the actual virus comes in.  If you haven’t read CS Lewis' Screwtape Letters, you may want to do so now.  In it, he is showing us the playbook of the demons that would harass and depress and destroy the human soul but for being found out.  You get a peek from the opposite point of view and insight to the real enemy's tactics. Spiritual and Viral jujitsu maybe? 

I went back through the Matrix (with purple sunglasses on top of my head, not all black like Keanu Reeves) to read my little 75 page paper book by NT Wright called “God and the Pandemic”.  I had to wait 30 more minutes for observation.  I hope to be observed not on my phone every time I must wait.  Wait.  What are they observing me for anyway? I don’t know...

Professor Wright tells us in his book that whatever the Christian response to pandemic is, it should be one in which all Christians of the world can join.  Can all Christians join the vaccine trial?  No, very few can. I want to encourage more people, especially those who represent minority populations in the trial. The reason we need more representation is that there are certain populations that are much more at risk in this pandemic. Those populations need to be included in the trial so that the efficacy will be more visible and how it effects different populations must be studied. We don't want to produce a lop-sided vaccine that isn't effective among the people who need it most.

So what can all Christians do? We can all pray to end Covid-19. Pray for a vaccine. Pray for the vulnerable. We can lay down our own will, and self-determination in order to take up the cross of Christ and bear one another’s burdens in this hour, or year, or generation, for as long as it takes. As we wander through global pandemic “together apart”, let us keep our eyes up!  Look to Jesus.  Look up!  The god of Economy won’t save us.  The god of the Academy won’t save us.  The god of Your Opinion certainly won’t save you (but you may get a good buzz from it for a while). The God and Father of our Lord, Jesus Christ, is the only one to actually save, and he calls us to be with him even through suffering and unto glory. Pray for the vaccine to be available to the vulnerable, that they don't get lost from the search.

“Dear friends, do not be surprised at the painful trial you are suffering, as though something strange were happening to you.  But rejoice that you participate in the sufferings of Christ, so that you may be overjoyed when his glory is revealed.” I Peter 4:12,13

Testing busybodies and antibodies

Daktari has a saying he likes to give his internal medicine residents.  “Ordering a test is like picking your nose.  You gotta know what you’re gonna do with the results.”

Recently there has been such a stillness and loss of traction for the world that geologists say the earth’s crust is literally more still during the pandemic. They say it’s like a stillness they’d measure on Christmas day.  Could it be a geological Sabbath?  Psalm 46 says “Be still AND know that I am God”. We are now 5 weeks into being still(er) and might have started knowing that God is still God (or at least detecting that we are not actually God- nor is the CDC, the WHO, the scientists, or even- gasp-the economy).

Here in America, most people do well in the shallows of busy, busy, busy living but not really Life.  Back in our Kenya life we learned that the Swahili word for foreigner is “Mzungu”, meaning “one who moves around a lot”.  Our time in Kenya really was preparing us in so many ways. Now we are all brought to a standstill- a bizarre world-wide standstill!  And we can pause to listen. What is God saying to us in his word?  Can you stop and listen? Are we still so busy even home-bound and sitting around, paying homage to glowing rectangle gods? Or might we actually kneel in awestruck wonder before the One True God and plead for his deliverance from this dread disease, his direction out of chaos into a place of peace?  Are we too busy to pray even when the things of earth are growing strangely dim?  This is busybody-testing time.  What will your test results show?

Frank Laubach, in the precarious post WWII era of 1946, wrote a tiny book called "Prayer: The Mightiest Force in the World".  In it he says on p.17 "So this is not a time for confidence, not is it a time for despair; it is the time to turn to God.  It is the time for humility, penitence, desperate resolve, rectitude, obedience to the will of God, all-out sincerity!"  That is where I got inspiration in the middle of March when I realized this could possibly be the fight of our lifetime for our family.

I am the wife of an infectious disease physician.  He is certainly a health care worker for whom many prayers have been prayed.  We had a neighbor who had a dream of praying over Michael as the Lord was anointing him!  We are so thankful for the force field of prayer and protection of the Lord over this city during the pandemic.  We can almost see the Mighty Fortress holding back a tsunami of Covid-19.  Prayer is a powerful weapon against darkness!  We are not testing God.  We are trusting.

The daktari is a man of few words.  He has no good words for Covid-19 antibody testing.  While it seems to be the next craze for a world gone mad, it is a test that produces no good results. Nobody really understands it yet.  It is possible that in the future studies will tell us if positive people are still positive and if they have had re-infections or not. But nobody knows if it means they will stay healthy and for how long or if they are dread virus shedders and for how long.  It seems to be a lateral motion test for the sake of motion and for our busybodies to chase after.  Beware. The results are a bit of a booger. 

If you want to rush out and stockpile on some supplies this Covid -April 19, try looking for faith.  Run to God, run to the Word of God, run to prayer.  Run to your reservoir of faith and see if there’s anything left, even a tiny seed. Dive into your emergency savings tank of faith. When scarcity abounds, faith can even be borrowed from others to kickstart something for your own.  Get out of the shallows, dig down deep and find faith that actually multiplies when the global supply chain starts using it.  These test results can clearly produce seeds of faith for another generation, or not.

the storm

April 14, 2020

Chattanooga endured some pretty severe weather this past weekend.  It was significant enough to rip off roofs and destroy homes and schools and it took seven souls with its midnight fury.   My morning after started too early with some chirps of the cell phone, which I took off of the usual “do not disturb” mode incase of overnight emergencies from my neighbors.  They waited until dawn after a sleepless night to start checking in on each other.  Chirp: “Everybody ok over there?” Chirp: “yes”. Chirp: “Power’s out. Boil water for coffee”.  Chirp: “like” chirp chirp chirp. 

Out side though, all’s quiet on the eastern ridge. 

We have been quietly waiting here for a month now.  There’s nowhere to go, except Daktari who goes to the hospital every day.  And that is even a miraculous calm, a tense and anxious calm, a quiet waiting- not yet after the storm. 

Easter, Resurrection Sunday, rather was so unusual this year.  We worshipped the Risen Lord in a tiny woodland cemetery and sang the songs to remind each other that Death is Ended.  Now here on Easter Monday, we are left reeling from the storm of the reckless raging fury.  I came to look for my Lord, where IS HE? 

Giant willow oaks lay uprooted like tipped over wine glasses in the park.  Big old beauties, belly up and broken, took with them a Celtic knot of power lines.  They leave us in the dark, "powerless" or so we think. We go survey the damages.  Let us also survey the wondrous cross and consider the work done on that tree.  My richest gain I count but loss...

My baby girl, now nine years old came barreling in boundless and free, like the deep, deep love of Jesus.  She came to announce with all joy and truth what she’d just discovered. “LIFE!” In her woodland fort she found a robin nest.  And in the nest, she found baby birds!  There on the day after the storm, they haven’t even opened their eyes yet, all blue and skinny.  But they sense the shadow of her presence and they open their mouths to receive whatever grace is given to them.

Baby birds in a tiny nest after an oak turning power passed over them.  Indeed His eye is on the sparrow, and the robin. And our eyes will stay fixed on Him.  We pray for the end of the pandemic.  God is able.  Psalm 105:4"Look to the LORD and his strength; seek his face always"

Anatomy of a broken heart

A classic Tenwek Mission Hospital case is a young expectant mother who comes in with Rheumatic Heart Disease late in pregnancy and slips into a coma to never recover. Bam. It hits like that.  No soft intro, just all up in your face when you start.

It is perhaps the archetypal patient that conquered our own youthful ambition and countless others along with their unborn lives.  Perhaps it stems back from the old Serpent in the Garden who has been consistently threatening the offspring of Eve.  So fraught with danger and vulnerability, the pregnant and the laboring mother is easy target for destruction.  But we come as citizens of the Kingdom of God, bringing Good News, fighting off Darkness, exhausting every last resource we can muster in the Name of Jesus to rescue the perishing.  We are not the Savior, and He has graciously broken that delusion for us.  We are simply the servants of the King and we try to follow His way, even all the way to the Cross and onward.  We do have to ask occasionally though, “What is God wanting to make out of what we are going through here and now?”

In a rare at home medical lecture, Daktari explained to us how RHD (or as our kids hear it “Drumatic Hear Disease”) works its evil:

In the West, when you get a sore throat and fever (with no coughing especially) as a child, you should have gone to the doctor.  They gag you with a giant q-tip and then grow strep cultures in a Petri dish, which is amazing.  And then they give you yummy bubblegum flavored penicillin for a week.  Bad guy (Strep bacteria) dies and good guys (immune system/ human life) win. End of story.

In Africa, if you get a sore throat and fever, no cough as a kid, you probably wait until it goes away on its own or take some herbal medicine.  The bacteria however aren’t killed so they begin to play tricks on the immune system.  Year after year of untreated simple strep throat, a protein on the HEART VALVES start to resemble the protein that caused the infection of the sore throat- fever- no cough, and the human immune system produces a response to attack its own member, hence it is “auto-immune”, meaning against itself.  The auto immune response will even attack its own heart, leaving little scars on the tissue of the heart valves and making a poorly sealed ventricle muscle.  (example: I was baking in our tiny Kenyan oven and the regular American sized cookie sheet would not fit in properly so the door didn’t seal properly and the heat escaped and the cookies were at least unburned, and that was good!) But if the door that won’t fully close is inside a chamber that needs to seal in order to pump blood to your lungs and brain and body that is not good. 

When that muscle of the heart can’t squeeze hard enough to force the blood through and seal it shut to keep it from regurgitating backwards, then the volume of blood is not pumping per heartbeat as it should.  This is the anatomy of a Rheumatic heart.

Now when you add pregnancy into the equation, the blood volume, oxygen usage, and heart rate of the woman is required to increase to care for the growth of new life.  That’s why pregnant ladies get tired so easily.  When a lady has RHD, she usually is young and late in pregnancy when things get really bad.  Her heart simply can’t meet the demands for blood volume and she can easily be left without blood to her own brain. That means severe trauma if not death.

A smart doctor named Starling mapped out the diagram of cardiac output and optimum blood volume.  It’s called the Starling curve.  Daktari Davis has a graph here to show the RHD spike.  It has no forgiving curve but rather a sharp drop where the heart either has too much volume or not enough volume to maintain function.  There is a teeny tiny happy place for the patient to live.  I think there is a way to solve for that equation one day, but for now all he can do is ask our Cardio-Thoracic surgeon how to get that, and she says the only option is to operate (typical surgeon response).  It’s an impossible and impractical approach.  What can be done?  Where can we go from here?  Maybe one day someone will solve this medicinally and mathematically.  Maybe one day strep throat will not cause the loss of so many lives in Africa.

3 young ladies in as many weeks were claimed by this fate just in our medical ward alone.  We try to process meaning out of these experiences.  We follow Christ in taking up our cross, and we believe in the resurrection of the dead and Life Everlasting.  We can only trust that He is Savior and we are not.  

*Regarding the anatomy of a broken heart closer to home, Mother Teresa said this in my August 12 daily reading from "Thirsting for God":

"Our sisters are working in New York with the shut-ins.  What they see- the terrible pain of our people, that loneliness, that fear, that feeling of being alone, unwanted, unloved.  I think that it is much greater than even cancer and AIDS.  The sisters have met people like that very often- completely brokenhearted, desperate with big feelings of hurt.  You may meet people like that and you must come to know them.  You must come to know your children, and very often we find this in our own communities- brothers and sisters who feel that kind of feeling.  Do we know the pain and poverty of our people with whom we come in contact?"

You may come in contact with someone today who has a breaking heart of loneliness, fear, and unknowing the great Love of God. Our mission is not to be their savior, but to light their path to the Savior of the World. Only His heart can heal our brokenness.