Heart Reconstruction

Welcome back to Daktari Cases.  It’s been a few weeks since I’ve posted a case; not because there has been a dearth of interesting medicine, but really because there has been a surplus.  In addition to the usual holiday busyness (and we do have a less commercialized version of that here), there was a nationwide strike of healthcare workers in government institutions.  The details and causes of which I’ll omit (because I’m sure I don’t understand them).  The result was a very full hospital and outpatient department at Tenwek, which always runs at full capacity, over the past few weeks has approached “two-to-a-bed.”  With the New Year has come a settlement, and the reopening of the government hospitals, good for the patients and a breath of air for Tenwek.

So, I’ll start 2014 with a story.  The young lady’s name is Soi.  She is a 20 year-old woman from a village about 15 kilometers away who was married last year and is expecting her first child.  She finds herself getting tired and short of breath as she enters her 4th month, and when she asks her mother, she learns that this is a part of bearing a child.  Reassured, she continues to go about her day as a young wife and mother-to-be, working in the garden, carrying firewood, cooking and cleaning.  She lives beyond the reach of the electrical lines and water system, and beyond the reach of our prenatal care.  She carries on with life in the cool lush dirt-floor equatorial sun until one day she can’t walk to the river.  Then everyone notices that something is really wrong.  And they find a driver with a car and take her to Tenwek.

I meet her in casualty (the ER), and she is clearly in distress.  Her initial vital signs are a heart rate of 164, BP 94/68, RR 30, pulse oximetry 82% on room air.  These are her initial chest x-ray and electrocardiogram.  Her heart is beating faster than it can fill up with blood and she is going into heart failure.  We have to slow her heart down or this downward spiral will get out of control.  We have to decide to try to use medicine to slow her rate down, or to cardiovert her with the electric shock of a defibrillator (it’s not a good idea to shock a patient when you don’t know how long she’s been in this rhythm (foreshadowing: it could cause a stroke), not to mention that I don’t want to shock a mom and baby).  After some calling around, we locate some drugs that were left from the last cardiac surgery team at Tenwek that will ease her heart rate down, and give her some diuretics to pull off some of the fluid that has collected in her lungs.  This happens over the course of the first night, and so as the beautiful African equatorial sun rises on the next morning, we start to ask “Why?”

Nothing in my medical education to date gave me an explanation of why an otherwise healthy 20-year-old woman would have this tachyarrhythmia as she enters her second trimester.  But the first storm has passed, and it’s time to get to the thinking part.  As I repeat her exam, and now that her heart rate is down around 100, I can hear new sounds: the “whoosh-thump-whoo” of a mixed systolic and diastolic heart murmur.  We are blessed at Tenwek to have echocardiography capability and this is what her echo looked like.  It shows an extraordinarily scarred and narrowed mitral valve with just a teeny jet of blood flowing through it, along with a very large blood clot in her left atrium.  This is a picture of severe mitral valve stenosis from longstanding rheumatic heart disease.  RHD is a disease of poverty from repetitive bouts of untreated strep throat.  She has been living, miraculously, with this severe heart disease, likely since her childhood.  Yet in pregnancy, her blood volume increases by about 50%, to accommodate the baby.  The way her body changes to nurture the baby has overwhelmed her damaged heart.  And the strain on her body will accelerate over the next few weeks; she won’t survive pregnancy without open heart surgery, and having that large clot in her left atrium gives her the added risk of a major stroke.

This is one of those times when I’m thinking about what it would be like to work in a walk-in clinic in Tennessee: “Oh, you have a backache, I’m sorry; here are some painkillers.” or “Is that a sniffly nose?  Should I give you some antibiotics (editorial note: NO!)” 

Anyway, I snap out of that daydream after about 1.4 seconds and call in a lifeline: Dr. Russ White, cardiothoracic surgeon extraordinaire.  I am SO thankful to work in a place like Tenwek with such awesome colleagues.  Yes, he’s seen this before. Yes, it’s a tough case with a lot of risks no matter what we do.  And Yes, we can do open heart surgery, replace her valve, remove that dastardly blood clot, and give her a chance to live.  The downsides: there’s very little or no chance that the baby will survive being on cardiopulmonary bypass, and there’s a fair chance that clot will travel up into her brain during the operation and cause a stroke, and the family will likely have to go bankrupt to pay for the operation and ICU care (even though it’s the cheapest open heart surgery in Africa).  We have a few days to weigh the risks/benefits while we try to optimize her health, and the family involves their community in a fundraising drive and all-night prayer meetings. 

At this point, we decide to go ahead with the surgery, and this is the point in the story where you come in.  Because many of you are our supporters, and I told the hospital finance department that we will pay to make this surgery happen.  The community in their village gave, the family sacrificed greatly, and we filled in what was lacking.  To the Operating Room…

The procedure was long and complicated.  The valve was deeply scarred into the surround heart muscle, the clot was hardened and calcified, making it difficult to remove (but able to be removed intact).  The baby didn’t make it through the procedure, and there were times when the survival of the mother was in doubt.  But this time when they shocked her to restart her heart, it beat in a smooth, healthy, regular 88 beats per minute.  Several days of recovery later, she walked out of the hospital and caught a ride back to her village, with a story of a miracle.  Reminds me of a story that the prophet Ezekiel told
-->: “I will give you a new heart and put a new spirit in you; I will remove from you your heart of stone and give you a heart of flesh.” (Ezekiel 26:36).  And to those of you who are our supporters, this is your story too.  Thank you for giving and praying, so that we can be here, and giving so that people like Soi can be healed.  A piece of her new heart comes from you.

Life is a Gas

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We used to say in our family that our stuff was like a gas.  When we travel and have a suitcase of tiny condensed proportions, upon opening it combusts and takes up as much space as is available.  Since moving to Tenwek we have certainly reduced our stuff and the amount of traveling we do too.  But even in a house one may find that stuff will expand to take up any available space.

In Africa, time is like that.  Time is in fact, one of the most valuable natural resources in Africa.  You may have stereotyped Africa as a place where people pay no attention to time.  But in fact, I am learning that people actually place a very high value on time but they expend it much more generously than we Westerners typically could fathom.  Now being from the South does modify a little bit of that shock and awe of unscheduled life.  Southerners have some deep commonalities with Africa that helps me feel so comfortable here.

In Africa, time sharing is how a person gives friendship, respect, and honor.  It’s not my friend’s condo on the coast, but it is my friend who will sit for an hour on a bench waiting for a word from the surgeon.  It’s time shared by having a cup of tea together- hot with milk and sugar, but still if there’s no sugar there’s no tea.  That’s Southern too.  And time shared just to “chew the news” and exchange greetings. 

I’m finding that not having an agenda on paper (or a screen) daily frees me up to be available.  I’m available for favors, errands, stories with my kids, toy sharing with neighborhood kids, or like today, available to be a walking blood bank. 

There was a 28 year old lady today needing emergency brain surgery so I went to donate for her very messy situation.  We call it the walking blood bank.  Anyway, my veins are so very thin that lab techs always have difficulty getting a needle in my arm nicely.  My blood is good, but the vessels are weak.  And my pulse rate is slow. And bp low.  First stab and no blood came out.  It’s supposed to fill that tube and flow down into the little baggy for transfusion.  But it was a collapsed vein (so said the lab tech) and he’d have to get someone else to try.  Great.  Other arm, another stabber, and bingo the blood trickled down in triumph.  At long last, it filled the bag for one unit of blood.

Time will expand to take up whatever space you give it.  Erma Bombeck said “going to the store for a loaf of bread and coming out with just a loaf of bread can happen.  But the odds are 3 billion: 1”.  Life is like that.  It was just going to be a simple day at home with my mom and dad here visiting.  We were just going to do one outing to have dinner with someone in the village.  But because there was space available and the right blood type, boom!  Time has taken over my day.  African time. 

This thought actually occurred to me after the blood donation while I was waiting for the ATM to work.  It takes about 10 minutes per transaction.  Apparently there is some software problem inside but can you imagine the panic if your ATM held your card for 10 minutes?  Here, it’s normal.  Perhaps I should think the machine is trying to honor me by keeping me company for a while. Hardly the case, but just an example of life in Africa.

It can be internet, facebook time, a job, or a thinking pattern, but things tend to expand to the amount of space allowed.  For our kids, it’s play time.  They seriously play outside for 4 or 5 hours a day.  It’s awesome.  They are so happy with the freedom to be children in a very pure way here.  And our little man-cub would extend his play hours to be 24-7 if his biological machine would allow for that.  The kid burns so much energy he even sweats in his sleep.  He wakes up like a rocket every day ready to take on the world with questions, ideas, adventures, and a bowl of cereal right away.  Even my children would take up as much space in my life as I’d allow them.  And while they are the most precious gift we have in flesh, I can’t obsess so much over them that no one else crosses my line of vision.  That would be a disservice to them as well. 

Life comes at us here in a new pace.  It’s a bit like jet-lag for the soul.  The days can be so incredibly full of microscopic interactions that it could seem trivial, but never ever banal. All these small things take up all our extra time and create a culture of relationship over time value.  Where I am now is where I’m supposed to be.  What happens in this moment is more valuable because we are together than what I want to do in a few minutes apart from you.  It’s hard for a couple of introverts to recharge in this context.  But we can’t find our energy and source of strength from our internal meager reserves anyway, that psycho-babble-hog wash.  My Source is not my anemic self.  Pray for us to be filled to overflowing with Life that comes from the Giver of Life in Abundance. 

The Daktari is working hard and fighting uphill battles on most patients.  He has watched too many tragedies in the last 4 months.  Too much dying of babies, pregnant ladies, bright young men, beloved parents.  Death is coming at us here in a new pace too.  Survival is never taken for granted on the local level.  Have you ever been to a staff Christmas party and heard in the speech “none of us has died this year, so let’s thank God for that”?  (!) 

Writing could take as much space as I will give it too.  Let me stop abruptly.  Life is a gas on a good day, a vapor on others.   

Dichotomy: one thing definitively cut in two

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Going on safari with our happy healthy children, who have learned to be so much happier with so much less stuff.

 

Then the sheer splendor of entering Eden at the Sekenani Gate. 

But first the Maasai ladies rush up like angels with flaming swords and stretched earlobes, selling their beads, tapping the windows, crowding the doors, but they are not there to keep me out, they are there to survive their family.  Josiah asks “why does everyone want to sell you something”?  He doesn’t understand yet that people are forced to work for a living outside of Eden.

If I were in America today I’d be asking the same question.

Effie used to tell us “the joy of overflow comes quicker when the cup of need is smaller”. What do I need? Consider these:

Then we enter.  Bam! 1. Giraffe 2. Zebra  3.Thomson Gazelles 4. Wart Hogs   5.Cape Buffaloes  6. Wildebeest  7.Grant’s Gazelle  8. Topi  9. Impala 10. Elephants 11. Ostrich 12.  Maribu Stork 13. Secretary Bird  14. Waterbuck 15. Lion 16. Serval Cat 17. Mongoose 18. Stoney Eagle 19. Guinea Fowl 20. Hot Air Ballon!  21.Spotted Hyeana 22. Plover Bird 23. Cheetah 24. Jackal 25. Elephant (worth listing again) 26. Lilac Breasted Roller (most beautiful bird in the world) 27.Black Eagle 28. Mouse 29. Eland 30. Ruppell’s Long tailed starling 31. BLACK RHINO 32. Black Bellied Bustard 33.Wattle Plover 34. Egyptian Goose 35. Superb Starling 36. Crocodile 37.Hippopotomus 38.Reedbok 39. Tiny white Butterfly 40.Hartebeest   

God I love Africa!  Thank you for this!

And the adventure of game drives and broken down vehicles after sunset, did I mention the lions? 

And the Maasai guides named Jacob and John who weren’t afraid of lions but worked relentlessly and selflessly to get us out of our broke-down place.  Then they found out we had a missionary doctor. 

So John went there.  He took us out of our ethereal vacation and into the heart of life after the fall.  But he had to try.  This is Africa.  He has been trying for the past 3 years to get help for his little boy, Anderson.  Anderson had a loss of oxygen at birth.  There is no help that will cure him except the mom dripping milk into a nasal tube for him as he lies in bed, unable to walk, stand, sit, or grasp.  And the dad guides tourists through Eden.  Once he guided 10 cows up through the Great Rift Valley to Kijabe mission hospital to exchange for any help he could get for his little boy.  All his stock in it.  But nobody can do anything more.  I do grasp it. But.

I don’t want your pain.  I don’t want your tears.  I don’t want your tragedy to touch me.  Not now.  Please I’m on vacation. Please.  God please.  And I’m underwater in the grief and love of this man for his child. 

God I hate Africa.  And yet, thank you for this Father’s love.

But here is the Beauty.  It is an invitation to the reality that we live on Earth.  This is not some middle kingdom in between heaven up high and hell down below.  This is the battle ground of 2 kingdoms at war and they are actively interpenetrating right here daily.  The Kingdom of God is at hand!  That is Good News.  But the kingdom of man is actively building gates to keep me out.  The boundary line is inside my own heart, this Rifted Valley.  My vacation please, your suffering no thank you.  I think my vacation should get me back to Eden.  Or my home as close as possible.  Or my daily existence can be my own little graven image of Eden.  If only you won’t contaminate my pleasure with your suffering.

Dichotomy.  I can’t hide from you in Africa.  You are there looking in on me day and night.

I feel like a bird trying to snorkle.  This world is so different.  I can’t breath sometimes.  The smells of a different eco-system fill my lungs and I need gills.  Or a pipe to breathe.  Or a cigarette. God help me. It’s hard here.  It’s so real here.

And I stay on the surface peering into the world I came to serve.  But in crossing culture and worldview and systems I am like a flapping bird, not viable in this habitat.  The food is hard on my stomach. Beans, bland rice, beef fat. (You all should ask Michael about his special missionary food experience)  I tell myself “5 more bites, you can do it Katie”. . A bird trying to swim.  An albatross at worst, a loon at best. 

Dr. Doolittle's Pushmi-pullyu embodies the feeling.

Some Days Are Harder Than Others

Greetings from the Daktari Cases blog (we've decided to marry the clinical cases with the family life and missions blog, beware medical images and descriptions.  Previous cases: www.daktaricases.wordpress.com).  One of my goals in writing is to introduce you to and connect you to our work here.  And that includes the tragedies, as well as the victories and the comedies.  Our patients come to the hospital desperately sick, often on the brink of death; and our inpatient medicine mortality rate averages 10%.  Of the 40-50 patients that I see every day, 4-5 of them will die in the hospital.  These are a couple of their stories.

Joan was a 37-year-old woman who came to the hospital after having a septic abortion.  All abortion in Kenya is illegal, and when it is done by the hands of a non-medical practitioner it is called a “criminal abortion.”  When I was asked to see her in the ICU, she was unable to speak, and I will never know why this happened.  I was asked to see her in the ICU for multi-organ failure and sepsis.  

 The source of her infection was a necrotic uterus, an all-to-common complication of these illegal “procedures.”  As we attempted to resuscitate her with IV fluids and antibiotics, there was an ongoing discussion with the obstetricians about whether or not she would have to have a hysterectomy to remove her uterus, her womb, and the source of her overwhelming infection.  Through the course of the day, a repeated CBC showed that her hemoglobin and platelet counts were dropping precipitously.  Her body was consuming her own blood products (a condition called DIC: disseminated intravascular coagulation).  The treatment for this condition is with replacement of those blood products; ideally with FFP (fresh frozen plasma) or cryoprecipitate, neither of which are available at Tenwek.   

What we can give is fresh blood, straight out of the donor, through the screening process (to insure against transmission of HIV, hepatitis etc) and into the patient.  And there was no fresh blood.  Her blood was typed: A-positive.  Do you know who else is A-positive?  I am.  By this time, it’s getting late in the day, and I was on-call the night before, and I’m tired.  The only chance this woman has to live is to receive fresh blood during the night and then have surgery to remove her necrotic uterus after the transfusion.  So we come up with a plan: I go to the blood bank, give my blood for the transfusion, and then we set-up the OR for the moment the transfusion is accomplished.  After the blood bank, I go home, pretty well spent.  That night, during her second transfusion, her heart stops beating, the code team comes to resuscitate her, and is ultimately unsuccessful.  And in one week last month 3 pregnant women died: one of AIDS complications, one of status epilepticus, and one of a stroke from a rheumatic mitral valve.  Prior to moving here, I had never seen a pregnant woman die in the hospital.

Stanley Rotich was a Good Samaritan.  He was 28-years-old and had cared for his brother dying of AIDS complicated by tuberculosis in their 10x10 foot one-room home.  It only takes one deep breath in the right circumstances to acquire TB, and when  Stanley was brought to our hospital, he was in respiratory failure, requiring high flow oxygen to keep him alive. This was his chest x-ray, which showed miliary TB, one of the most aggressive and advanced forms of TB, spread through the bloodstream.  He remained in our ward for 5 days, and this image is copied from the clinician and chaplain notes of his last 18 hours of life before he passed.  This is one of the cases that are so hard to understand that challenges my clinical judgment, and my faith.  Is this a tragedy?

These are some of the cases of note from the past few weeks.  The stakes are very high here; the acuity of these patients once they get to the hospital is almost always a matter of life and death.  There are no cases here of indigestion in an 85-year-old great-grandmother that undergoes a nuclear stress test to insure that it’s not a subclinical heart attack.  Sometimes I miss those cases.  But this is my dream job- to be living out my true vocation (calling).  Thank you for being interested enough to read these stories, to pray for us, and to support us.

All Saint's Day

All Saints Day

Looking back to September, I am recording from my paper and leather journal today.  We are transcribing from earthy stories to internet stories, perhaps adding small glosses, but striving for authentic interpretation of this amazing life in Africa.

(9/15)

Yesterday we ventured out to Narok town to visit some friends where I lived in 2003 and 2004.  Tim Mantai drove out to Tenwek to pick us up in his car.  It is a 1 hour drive, then he took us 1 hour back to his house. He told us that we can use his vehicle any time we want to, any distance to drive is not too far.  We ate lunch with Tim and Lorna and felt so welcomed and refreshed by their friendship and hospitality to us.  Then we met Edith in town.  She had been waiting for us there all day in the hot dust-bowl town without a drop to drink.  She just was happy to spend some time with us and helped us navigate around town a bit.

Josiah got a real Masai bow from an old old man with long stretched earlobes, selling on the side of the dusty dusty road.  The arrows in the quiver were real hunting arrows, designed to lodge and kill.  We only bought the bow.

Then, we went to find Wambugu’s house.  He was my car mechanic before.  His family wanted us to have dinner with them.  We were so tired and ready to go home by then but I knew that in Kikuyu culture (and other tribes as well but that is his tribe), one is required to feed visitors and to reject that offer is a sincere insult.  They had been counting on us coming for some time.  They had cooked cabbage, peas, chapattis (like a tortilla), and goat stew and chai and bananas with cleaned and cut peelings. The bananas that you buy in North America have been cleaned before you get them.  Nothing that grows outdoors south of the equator is naturally that sterile.  Their two girls who are named Karen and Katie were waiting for us all day in beautiful little satin Kenyan princess dresses.  I don’t know how they kept them clean outside in their rocks and dust courtyard.  They wanted to meet the white Katie and our kids.  They were so kind and polite to total strangers among them.  Annie and Josiah really enjoyed being there without even recognizing my inner impatience with wanting to go home, they didn’t seem to mind at all.  It took a few hours.  I kept reminding myself what they told us at Mission Training International “How flexible are you willing to be for the sake of the Gospel”? 

And the Gospel is more than a piece of information, a statement or a point of view.  It is in relationship as we learn to LOVE AS GOD HAS LOVED.  And we let go of self preservation, we are free to have faith in the Resurrection of Jesus who will raise us with Him in the End.  If we have died with Christ, what more can we loose?  If we are resurrected with Him, why do I still cling to my mortal flesh and personal preferences?  If I let go, I find freedom in Christ to stay the long hours in uncomfortable places, to go the long distance for reaching out in relationships. 

But yesterday it was our Kenyan friends who were showing me the Gospel.  They were the ones acting like the Kingdom of God more than me.   

Finally just after dusk Wambugu asked Tim if he could drive us home using Tim’s car (remember 2 hour round trip).  Of course Tim allowed it and would not accept any money for fuel.  Wambugu explained to us that they have a phrase “Friendship has a price”.  In Kenya, people show friendship with others by material and tangible sacrifice for the other person.  Solidarity.  It’s a way they exhibit honor and the other’s value in their heart.  I think that is a lot like the Gospel.

Now we come to October.

Last week, a beautiful sunshiney day in the low 70’s here on the equator.  Our kids did their morning schooling and their afternoon playing with wild abandon.  As usual, we have people stop by on their way to the hospital to ask for funds. 

Aside: Tenwek is a unique case of mission hospital that is fully supported by patient fees.  Now, that would exclude the missionary salaries because we raise our own and basically volunteer to be here as staff.  But the Kenyan staff is paid and the hospital run not by outsiders or grants or taxes, but patient fees. It’s supposed to make the system “sustainable”, but it also makes it complex when people are destitute and asked to pay their bills before they are discharged.  Each day they wait for their family to have fund raisers for collecting their medical fees, the daily rate of staying in a hospital bed piles up.  Can you imagine paying cash on delivery when you go to have a baby or appendectomy or meningitis treatment at your local hospital?  But a physician cannot deny helping someone who comes with an emergency.  So there is a needy patient fund to help cover some of these people.

Back to the sunny day.  A mama and small child were there on the back porch waiting for me so they could ask for her money for medicine.  The child was tiny but her face seemed old.  She could not stand or sit on her own but leaned into her mother’s arms from her lap.  They said she was 6 years old.  She appeared to me to have something like cerebral palsy.  Her name is Chelangat and her mouth didn’t function properly enough to keep from drooling a little bit out of the corners.  But she had a smile that could light up like those florescent tube lights that flicker wildly as they light up the dark (that’s what my kitchen light is like). 

Chelangat didn’t speak with her voice to me, but boy did she speak to my heart that day.  I asked her mama to have chai with us before they went to the clinic for her appointment, but the mom wanted to be there on time.  So I gave them something for buying medicine and then the mama heaved her up on her back and tied her with clothe into the place she has been carried for these six years now.  They came back in the afternoon with a receipt (because Westerners and agencies from the west rely heavily on receipts for proof).  I gave them lunch and my house helper Peris got them some clothes from the clothing bin that is used for local orphans.  The mama and the little girl who could really smile.  I was struck by how little support that mom must have and how few resources they have available to help.  They are hoping to get a wheel chair soon (for limited use on roads that are never easy here), but for how long can she carry a six year old? Tiny frame that she is, she still requires a constant arm of support.  So I brought a living room arm chair to the kitchen that the girl might rest on it while the mama ate with two free hands.  She fell asleep and peed in the chair.  Now which of these characters is the hero?  Certainly not me, I’m just a bleeding heart.  But I saw that mama in her unwavering commitment to care and support a girl for her whole life though it cost her everything.  And I saw Jesus.  She heaved her up on her back again and tied her in place as they headed down the road.   I am Chelangat.

We are weak but he is strong. 

Have a blessed All Saint’s Day.

Prettier pictures of life this month

Is it a result of shut-down?  No, it's public transport.

 We are not gifted in graphic design, photography, or things that will delight your eyes.  I am realizing that Kenya's beauty is like that too.  Not always aesthetically pleasing, but something that delights the deeper senses. Friendliness matters more than font style here. Relationships are more valued than organization  (I think I'm gonna like it here)! Disclaimer: This is more of a sloppy collage than a fancy scrap-booker page. In defiance of the generationY tendency to self-inflate online, enjoy!  Also, Michael has some more "realistic" Africa pictures of medical cases at: www.daktaricases.wordpress.com

A journey: Some of the beauties of Kenya from our first month.

"Wait for me"

some great wonders in the yard: bouganvillia, daisies, Nile lilies, and children playing so happily.

banana tree in our yard

Little Miss likes to stand on the porch and sing. real loud.

view of the hills and tea farms across the river

the backyard and our house

our sweet potatoes

 Some other sweet potatoes:

Annie and her buddy Levi making mud pies after school

Man-cub and his first chameleon.  So elated for the hour.

little chameleon escaped and he plunged into the depths of loss the next hour.

If I had a hammer, I'd hammer in the morning.

built himself a bench

Michael's blessed hiking time on Saturday.


Thank you for remembering us in prayer!  Thanks for your friendships with us!  We miss home, and we are having the time of our life too.  Love, Katie 

An Almost Perfect Weekend (We are Ok)

This weekend was almost perfect.  It was warm and sunny, we had a full family day hiking to the river, seeing the hydro-electric dam that generates power for Tenwek, meeting some Kenyan kids to play with, a skype call with Michael's sister.  And then a notification from the US Embassy: Do not go to Westgate Mall. Shooting. Al-Shabab. Sheer terror.

If that notification went unnoticed, the weekend could have been so nice. For us in isolation.  

But we don't live in isolation.  Bad news really does affect us.  We were in that shopping mall and the Nakumatt supermarket that is under siege exactly two weeks ago stocking all our supplies.  When I lay my children down to sleep at night, it's on pillows purchased in that holed up terror hideout. I cover them with blankets bought in the upper isolated back corner of that store, where I don't know if I saw an emergency exit or not. 

I wish that image were not in my head. We were trained for this in pre-field so I feel even the simulated surge of panic rush my veins. I wish it were just daisies and roses and not really happening.  This is the third day of it. 

We are pushed to examine our motives for being here again.  God, is this where you want us? 

But Sunday came and I had a commitment to go to church with our house-helper, Peris.  Peris has been leading Bible studies for women together with another missionary for 8 years now.  They train women to teach other women the Scriptures and when they have memorized 18 verses, they are given their own Kipsigis language Bible.  I knew it was important day for them, but I had no idea how important.  So yesterday I got to go to a Kipsigis church service that lasted 5 hours for these 83 women to receive their first Bible.  That was why I was here.

They put a graduation gown on us and all 83 women had sashes and uniform for graduation.  We marched in singing and processing.  I wanted to duck into the first empty seat possible, but being dubbed “line leader” they had me sit on the dirt floor platform with the other leaders for the ceremony.  Thankfully I knew a little bit of what to expect from a Kenyan church ceremony event.  I needed to make an official greeting and short word to the congregation so I told them I also just graduated from my Bible study at Emmanuel Christian Seminary in the USA and my professor was a Kenyan, even a member of their tribal family the Kalenjin. And I needed to sit there for five hours.  The hundred or so children would stand outside quiet and still too as they waited to see their mamas awarded.  And there was singing. Oh there was singing and singing and singing.  These folks got their praise on yesterday.  They sang “I know that Jesus has loved me” over and over in Kipsigis language.

If my Internet was able, I’d upload a video of the singing.   They got their names called up and I handed the Bible to them with two hands because a gift is given and received with two thankful hands in Kenya.  Then I shook hands just like President Sweeney did for me at Emmanuel Christian Seminary graduation a few months ago. And then the families put garlands of shiny tinsel around their necks and the paparazzi took phone photos with intensity. And then they sang some more.  They sang in Kipsigis “Thank you Linda, God sent you from America to bring us this Bible”.  (Linda is the missionary whose home we are residing in this year while she is on furlough, and who gives me the honor of hosting the women’s Bible study training in the home too)

It was intense, and it was real.  They were so grateful to receive their own Bible, like you wouldn’t believe.  But we do believe.  We do believe that the Word became flesh and resided among us so that we could receive His Life that is truly Life.  And it is an awesome thing to consider.  So that when terror strikes, I can recite over and over and over again “I know that Jesus has loved me” and that is where my life is.  Even if I’m holed up in my deepest fear of dying in Wal-mart, a senseless death or tragic waste, that Jesus has loved me and given his death defeating Life to me is enough.  I have to remember that.

In truth, my heart and flesh cry out for the safety and comforts of an easy peaceful life.  And he answers back to me that I have already died with Christ and my life is hid with Him.  Is there anything safer or more comforting than those Mighty Outstretched Arms that reached down to rescue me already?

Even if I made my bed in Hell, still there He would find me. (Ps. 139)

So we press on, living by faith and not by fear.