Daktari wife: on getting ready

I wrote this entry in my trusty ol' paper and leather journal while sitting at the DMV.  It felt closer to "nature" that way I suppose.  This is the Daktari's wife entry into the Blogosfear.
 

Blogging is looking at me like a big rumbling yella school bus looks at a 5 year old.  Who knows that one day it will be coming for him too.
Do I want to get on the bus and party with a make-believe identity, indulgent in self-expression and independence? Or do I fear getting on completely unnoticed and totally insecure in bearing me wee little soul to the big wide world, like a kindergartner in with 4th graders? Yes!

The truth is, I fear not measuring up to the blogger mommies who write such pithy and literary accounts of life.   I fear not measuring up to insta-gramming enough documentation of my beautiful life.  Moving to East Africa in 4 months with our pre-schoolers, living at a hospital amidst infectious tropical diseases, sharing our family in community with strangers, crossing the cultural divide of east/ west, all these things thrill me!  But writing about it for the www makes me quake!
Not that other people's children don't make demands on their time or that other people aren't struggling to process their life as it is lived too.  But I still have trouble getting dirty dishes out of the sink every night.  Let alone contemplative journal writing.  Online.

But the fact is, we are moving to Kenya in 4 months and like getting ready for the first day of school, I've got a lot of preparation to do before we get on the bus and go (or 747, actually). First, we've got to get freed up from much of our belongings.  (anybody want baby toys?) Moreover, I need to figure out how homeschooling or MK schooling works for my real kindergartner this fall.  No actual big yella bus is going to take him into academia out there in Bomet. There's some "supply" shopping to be done: long skirts, rain boots, learning apps for the kid's devices.  One more things is, I need to start blogging to build a bridge between our family and the ones we have to leave behind.  I desire to build understanding of what Africa is like, what our kids are like, what God is doing in our lives.

Mostly though, getting ready to go for me means trying to listen for the rumbling sound of troops marching in the top of the balsam trees- for the God of Angel Armies who goes before me.  Listen for the rhythm of the Good News that pounds down everyday saying "You'll never measure up to my requirements."  You aren't good enough.  (what?!) And THAT is why Jesus came for you.  THAT is where Jesus brings life, drives out fear, gives His Very Self to bring little ole you and me through battles of life.  It's Good News because it's not up to me.  It's Good News because it's about Jesus taking care of all my fears.  Because His love is stronger than the power of death- what have I to fear?  Fear is about death.  I will not fear being unnoticed, unliked, unfollowed, unpinned.  Listen, Katie.  Listen for the sound of the Gospel.  For without that engine rumble, it is all in vain. 

Malaria for Grandview Kids

This is a talk I gave to the 4-12 year-olds at Grandview Christian Church, who are doing an awesome project: collecting money to buy insecticide-treated bed nets.

Miss Anna told me about this awesome project that you were doing to collect money to buy bed nets for poor children in Africa, and I was so excited that I asked her for the opportunity to talk about one of my worst enemies…

-Which do you think is the most dangerous animal in Africa? 

-The answer is…the mosquito.  He looks scary here, but this little guy is almost microscopic; you’ve heard him, buzzing in your ears on a summer night, leaving those tiny welps on your exposed arms or legs.  The mosquito, fairly harmless and annoying to us, but in much of the world it holds this even tinier, truly microscopic killer: malaria.  The malaria parasite invades your own red blood cells, just like it’s doing here, and keeps them from doing their job of carrying oxygen and nutrients to your body’s cells. 

-Malaria kills about one million people per year, which averages out to about 2 people per minute.  Most of the people who die from malaria are kids under 5 years old, and it is the leading infectious cause of death.  In Kenya, where we’re moving, almost 1 in 10 children die before their 5^th birthday, in Sierra Leone, it’s 1 in 5.  Josiah turned 5 years old today, and we celebrated. 

-So what can we do about this?

-That brings us to this campaign:  this girl Esther is a Maasai girl living in the Rift Valley, an area in Kenya where there is a lot of malaria.  She lives in a hut next to a slow-moving river.  They need the water to survive, but having stagnant water standing in the rainy season is a perfect breeding ground for mosquitoes, and subsequently for epidemic malaria.  Having this bed net that she’s peeking out from under gives her a much higher chance of surviving to adulthood, and to living without malaria.

-Another extremely high-risk group is pregnant women.  This woman: Mma Makutsi is protecting from that same village, and she is protecting herself, her current children, and her future children from malaria.  Pregnant women get sicker, and even get more mosquito bites than other adults.  And protecting them protects the baby, and gives the baby its best chance to be healthy.

 

-So, why should the church do something about malaria?  Here are two maps of the world.  On the top map in red are the places in the world where there is malaria.  The green places in the world have no malaria transmission.  On the blue map at the bottom, the darker blue places are the places in the world where there are the most Christians.  You can see that there is a lot of overlap between these red areas and dark blue areas.  These are our brothers and sisters in Christ who suffer from this deadly disease.  They need our help.  Also, if you look at Asia, and where the red area of malaria covers, it’s the area of the world where there is almost no Christians.  This is the unreached mission field of the church.  And because God has been so good to us, we can be good to others. 

-And when we are being good to others in need, it’s as though we are being good to Jesus himself.  Here’s how he tells the story:

More of the Equation: need (n)

Here are some pictures that demonstrate the need for trained healthcare workers.

  This article was published in December 2011 in the New England Journal of Medicine highlighting the disparities in the distribution of healthcare workers worldwide.  These areas of purple shading are the places of the most critical shortages of healthcare workers, including Kenya.  

 In the figure, there is a graph plotting percentage of global health workforce, and disease burden.  The size of the dot represents the percentage of healthcare expenditures.  Sub-Saharan Africa bears 24% of the world’s disease burden but has only 3% of the global health workforce.

I = nP^er   .......    Impact = need (Patient Care) ^ (education x research)

An Equation for "Why move to Africa?"

I wanted to give you an introduction to our medical mission vision.  A mentor once advised me to formulate an equation to measure my values, and thus give me a litmus test for decision making for our future.  This is it, the impact of our work is equal to need times patient care to the exponents of education and research.

 

 The first variable is that impact is proportional to need.  And this is a snapshot of the world in terms of mortality.  It compares mortality rates among adults by cause and region.  Your eyes are drawn to this bottom row, where the overall mortality for Africa more than doubles the rate of high-income countries, and the cause-specific mortality encompassed in these grey bars: HIV/AIDS and other infectious/parasitic diseases causes more death than all of the combined mortality in the high-income countries.  This is why I am an infectious disease doctor moving to Africa.

And here in the blog, I get to dive a little deeper into global health statistics.  And I think that these statistics have an important message.  I promise only one new acronym from the alphabet soup of the World Health Organization statistics set: Disability Adjusted Life Years.   It is the accepted way of quantifying years of life lost due to early mortality and years of healthy life lost due to disability, and gives a more holistic view than total mortality rates.  Because though more people in the world may die from ischemic heart disease, more disability and early death are actually due to lower respiratory infection, diarrheal disease and surprisingly to me: depression.

And these people, suffering and dying from these preventable and treatable diseases cannot be reduced to numbers on a bar graph.  I can see their faces, with their hollow sunken eyes, overcome and hopeless by the wasting disease of HIV/AIDS.  I can hear their labored breathing as they struggle to get enough air through their lungs, thick with tuberculosis and bacterial pneumonia.  And I can see the children, their unnaturally swollen potbellies from malnutrition.  These are real people, who Christ lived and died for.

Full Circle: Starting Point

This is a picture of us from 10 years ago.  It makes me smile.  There we are, 20 years old, our first adventure in Kenya together.  It’s set in a village called Maji Moto, a little outpost of civilization, rising out of the dust of Massailand around a geothermal vent (maji moto = hot water).  You can see a lot about these two characters by this picture.  They are young and browned by the African sun.  They like to stand close together, despite the heat and the dust.  They wear the beadwork handicrafts given to them by their friends, and rest in the shade of an mbati (tin) roof in the equatorial sun.  He wears around his neck a stethoscope, just taking a lunch break from a busy clinic.  It’s a symbol, of his dreams to be a healer, of the revelation in the human body; he is just beginning to hear the voice of God through it.  And it rests atop a thrift-store polyester button-up, uniform of the bohemian to match the afro that blends into the shade of the building.  I like this guy.  And there she is; the golden one that he’s pursued across the world.  The Peachtree Road Race t-shirt reminds her of the races she’s run and calls her to the ones before her.  Sunglasses and twin braids.  And you can see it in their eyes and in their posture: the passion and the idealism.  This is where it truly began for us; the opening act of this chapter of the story of Yahweh, in which our parts are set in Africa.

How was Haiti?

Last month I spent a week in Cap Haitien with a short-term medical team.  It was a powerful experience, deeply refreshing and challenging.  I am no expert, but here are some thoughts from that time:

                  The first thing that struck me stepping off the plane was the heat.  It has a force behind it from latitude, backed up by mountains behind the city that block the wind off the sea to create heat under pressure.  I heard it described as “walking through peanut butter that was warmed up in the microwave.”  This heat under pressure seems to affect many things: the musical, slurred French vowels of Creole, the tropical sense of “island time,” and the occasional bursts of frustration and protest.

                  There were the sights, smells, and the sense of desperation from absolute poverty.  The recent storms during hurricane season had led to an overflow of the sewage system, and a subsequent resurgence in cholera and intestinal worms.  The landscape around the city is brown and barren, and there is a sadness, hopelessness in the eyes of so many that you meet.  It reminds me that poverty is so much deeper than a lack of resources; it is a social, biological, spiritual disease/evil.

                  And in life on the ragged edge of survival, everything has meaning and purpose.  Food, water, shelter, medicine, security are not guaranteed.  I am humbled by the realization of the artificial dramas in which I play the leading role here at home: inconveniences and inefficiency in my work as an American physician, exercise as my right to relieve stress, artificial war/conflict through sports and television drama to fill a vacuum of meaning.  It is a reminder that these places on the edge are where I belong, not because I am noble, but because I am called, and perhaps because I am so easily distracted.

                  I have been taught that “It takes a whole world to know a whole Christ.”  Haitian Christians opened my eyes to a sense of spiritual reality that pervades all of life.  Speaking to pastors at each stop along the way, I would ask about the opportunities and challenges they and their churches face.  Each one of them turned to me, even standing amidst absolute poverty, disease, riots, and hopelessness, and they would speak of the spiritual forces of good and evil.  They could see clearly a deeper reality of which I have only glanced dimly, and have shuddered.  And their prayers sprang from a well of experience, their fellowship an honor I will hold proudly all my days.   

“But thanks be to God, who always leads us as captives in Christ’s triumphal procession and uses us to spread the aroma of the knowledge of him everywhere.” (2 Corinthians 2:14).

Living Between Two Worlds

This is the first post on the blog for Daktari Life. The idea to do this comes from a friend that I respect very much who read my update emails from our time in Kenya in January. I posted the pics of the Rift Valley and the Sequatchie Valley because it seems our life remains centered between these two. Just this afternoon I have finished the research abstract from our January's work in Kenya. The men and women who work in that clinic system do work that changes the world. My job is to tell their story. And it is a great story. Their success treating HIV amidst the greatest challenges to survival is a story that should be shouted to the mountaintops. And while we look to the future of medicine in America, and focus ourselves on the patient-centered medical home, we would do well to learn from some of the most unusual and difficult places in the world.

Our dreams still put us in both valleys, and bringing them together is the Gordian knot, the risk and uncertainty that drives us to faith. The next set of decisions for us are about ID fellowship, where and under what circumstances to pursue it. What is most in line with our core values and mission? The mystery is what leads to growth. "Don't ask yourself what the world needs. Ask yourself what makes you come alive. Because what the world needs is men who have come alive."