Asante Sana (Thank You)

This is St. Andrew's Day. I thought gratefully of Susan leading Morning Prayer in English in Edgartown while I was worshipping in Swahili in Maseno. And I delighted in the little "Forward Day by Day" message which focused on the immediacy of Andrew's reply to Jesus' invitation. I'm not Andrew, and I'm certainly no saint, but the opportunity to come to Maseno in November -- and, for that matter, to go to El Salvador in June -- just plunked themselves into my lap.

It took less than seconds, each time, for me to say "Yes!" To my amazement, every one of the "How's" fell promptly into place. So while many of you may have wondered at my judgment, or lack thereof, I am grateful to all of you in my family, at St. Andrew's and throughout the world. You have supported those "Yeses" in so many ways for so many years, including your tolerance of my blogging! Asante sana.

Two days ago, another Andrew, a 23-year-old from Nairobi -- which is seven hours away by matatu -- was admitted to the hospital with a recent history of inexplicable vomiting. Dr. Hardison's endoscopy revealed a pyloric mass, a tumor in his stomach. Frustration began anew, since the scrapings must be examined at a distant, more sophisticated lab before appropriate treatment (surgery vs. chemotherapy) can be determined. Either will need to be provided at another site, since we have no qualified surgeon and no chemo department here. It may be two weeks before we receive the lab results, so we can only keep Andrew as comfortable and as hydrated as possible for now. Delays like this make the Vineyard's MVH/MGH connections appear nothing short of miraculous.

Emmah's six-year-old niece ("Diana, your namesake," she smiled) was admitted yesterday with a very high fever and convulsions. We hope that her elevated temperature and white count might be related to a small abscess on her hip, not to malaria. A wound culture is being done at our own hospital lab. Meanwhile, Diana's temperature is subsiding, and she has had a good night's rest.

Evelyn died last night, two hours after she was admitted with acute cryptococcus meningitis. She had been followed by a distant CCC and referred to us too late, in a coma, with a fixed and dilated left pupil and apparent left hemi-paresis. Although she was gravely ill upon arrival, it felt like a truly unnecessary loss.

My amateur PT efforts continue with Jessica and Ruth, each of whom is struggling to regain the ability to walk. I glimpsed the smallest of smiles today on Jessica's face when I used her stuffed rabbit, "Maureen," as incentive to get Jessica to raise her legs a little higher. Ruth seems much less depressed and much more motivated than her counterpart; she actually took three small steps with the only walker on the ward this morning. "Three small steps for womankind," I told Ruth; but I could only say it with a smile -- not in Swahili, nor in her native Luhya.

A 17-year-old girl was admitted this afternoon in a coma. She is recovering after attempting suicide by ingesting rat poison/ warfarin, following an altercation with her sister. Another new admission was a hypoglycemic male, 49, with a known history of alcohol abuse. His condition is complicated, however, by a severe aortic insufficiency; this is the first time I have palpated classic "gunshot" femoral pulses. He has both systolic and diastolic murmurs, and his EKG shows marked deviations at V6, V5 and V4. He has no fever and is negative for VD and HIV. Among other things, we are concerned about renal shutdown. I wish we could just pick up a phone and call Steve Miller.

People come to Maseno Mission Hospital from all over Western Province, Nyanza and beyond. When admitted before the end stages of life (and sometimes even then), they get well here. The word has spread. Please hold Andrew, Diana, Evelyn, Jessica, Ruth, their families and the hospital itself in your prayers. Please also hold Nico, my three-year old grandson who is again struggling with asthma, and his family in your hearts. "Keep watch, dear Lord, with those who work or watch or weep this night, and give thine angels charge over those who sleep... Amen."

The university's cybercafe is closed on weekends, so I'll try to write again Monday. It is the only way my feeble brain will ever begin to remember and share the countless blessings of this time and place. Asante sana, dearly beloved friends.

Mothers' Union

I fell asleep, grateful, last night for all of your comments, especially for words from and about my own family. I awakened, grateful, this morning for yet another day in Maseno. By 5:30 AM, our industrious rooster was scouting his lunch while unflappable Emmah was preparing our breakfast.

We were joined yesterday by four unexpected guests for three days, officials from the Kenyan AIDS Ministry, who came to visit our Comprehensive Care Clinic. They arrived in a spiffy new white 4WD vehicle and will need to gather their data quickly since our CCC workers will be out in the community on Saturday for World AIDS Day. Last evening's meal included lentils, rice and ugali, a maize staple in Kenya that is something akin to finely-ground grits. Yesterday I was introduced to Emmah's chapati, a lightly-seasoned flatbread, and her sukuma wiki, chard-like greens. She fixes beans, rice, bread and cabbage a thousand different delicious ways, and small, sweet bananas are always on our table for a snack.

Our day began with morning prayer on the hospital grounds, worshiping with staff and patients at their Kiswahili service. The homily was based on John 3:16 -- a particularly moving choice, since that was the confirmation verse given to me 48 years ago by Pastor Braughler. "Yesu Bwana," the 23rd Psalm, the Lord's Prayer and a closing circle are familiar in every language. God so loved the world, indeed.

I then played hooky from medical rounds to attend a weekly ACK Mothers' Union meeting with Nan, Mary and Liz. In nearby Luanda, we met with Carolyn, the current leader of the group, and approximately 40 additional mothers/grandmothers/caregivers from the various local parishes.

Our little gathering was punctuated by prayer and song as the distributions of the day were meted out: small amounts of cash for the respective orphan feeding programs; amaranth flour, a high-protein grain to mix with the orphans' food; and encouragement ("You go, Girls!") for the women to "be tough" even with their own religious leaders, who sometimes schedule church meetings meetings that conflict with Saturday feeding programs and mobile medical clinics -- all of which use the same furniture and space. "Remember, it hurts our daughter orphans." They were also reminded that the next meeting would include a "Clean Water" review; our sponsored students will help.

At the end of the morning, tee shirts were distributed to every woman present. In an effort to promote non-partisanship and peaceful elections, the church ladies were discouraged from wearing shirts or hats or even colors with political messages. Singing "Asante, Mungu" ("Thank You, God"), the mamas happily donned their new shirts which read: "Mother to Mother, Together We Are One." And so we are.

Price of Success?

No rain for 48 hours. Could "the season of the short rains" be ending? Nan affectionately describes the climate here as "two seasons: mud and dust." I left the house early today to walk to the 7:30 AM communion service at St. Philip's (sermon: to those whom much is given, much is expected...) and then hitch a ride back for hospital rounds with Dr. Hardison. The Eucharist was made even more meaningful by the accompaniment of low, rhythmic voices and traditional instruments. It was a good morning to pray.

Yesterday afternoon was discouraging. A 13-year-old boy was brought to the hospital in acute cardiac distress and renal failure. He had been misdiagnosed and discharged from a nearby public hospital days ago and will probably not survive. Gerry quickly identified the child's condition but could not treat it here. The only alternative was to return send him and his family back to the admitting hospital with the proper diagnosis and pray that he could be diuresed before he died.

Another patient was happily discharged this morning after successfully meeting his TB challenge. Yet another new admission, a shivering man with an O2 sat of 88%, had to wait in bed, third in line (behind a 75-year-old woman with a 54% sat and four-month-old Peter with pneumonia) for the one portable oxygen tank we have.

This morning after rounds I resumed the PT I'd begun yesterday with two HIV-positive women. Their wasted quad muscles left them too weak to stand or walk, and walk they must before they can go home. Quite simply, no one else will be there to care for them. So this mzungu's (white person's) personal PT regime of last summer is being "passed on" from Martha's Vineyard to Maseno Missions. Thank you, Judy Athearn!

So many stories, so many successes -- and so many frustrations for Dr. Hardison and his staff. At chai/ tea (mostly hot water, sugar and milk -- no wonder it is popular!) in the matron's office, Gerry began to explain the scope of the hospital's programs. Much has been accomplished in just a few short years. He also explained some of the difficulties, ranging from lack of surgical staff to inadequate community services, from NGO and Anglican Church intersections with the Kenyan government to just plain poverty.

Maseno has become a model mission for the Episcopal Church; but even with the support of the national church, the Dioceses of San Diego and Massachusetts (and many other individuals), the Hardisons remain both hopeful and concerned about the future. Please keep them and this community of caring people in your prayers.

Morning Sounds and Rounds

They come like clockwork: the rooster's early crows, the children's lilting laughs as they walk by our house to school, then another child's screams as his burns are debrided in the nearby pediatric ward. We hear music, in stark relief, at 8 AM as a Prayer and Praise service begins on the portico near the hospital lab. I said goodbye for the day to Emmah and Douglas, a medical officer who has returned to Rotary House, and then made my way to morning rounds, waving "Jambo! Habari?" to the cows and their milkers along the path. Judy, our neighbor and a Maseno Hospital aide, greeted me with her beautiful smile, en route -- the beginning of a blessed friendship.

As always, mixed blessings awaited us: another HIV-positive toddler was discharged, a newly-admitted female with chest pain had an unremarkable EKG, a stalwart male underwent a colonoscopy (negative for polyps; hurrah) and a 36-weeks-pregnant 16-year-old had a normal ultrasound. Everywhere Dr. Hardison goes, Linet, his Kenyan assistant and translator, accompanies him. And everywhere they go together, respect and gratitude follow them. The people they are, as well as the people they see, provide living examples for me of the power of faith, hope and love, "these three."

We so often hear the words, "We cannot save the world." It is true. We cannot even save ourselves; that is up to God. But together we can -- and must -- do something. "Can't" is a four-letter word in both English and Swahili. I pray as I write, and I risk sentimentality, because I want you to come to know and walk with the people of Maseno. Their (only first) "real" names are used with great respect. Patient confidentiality is important; but, half a world away, it is not as important as Christian love.

And Work and Pray (and Play) Some More

Most of our household left early this morning. Christiana and I joined Dr. Hardison for rounds at 8:30 AM, which included three young women with advanced AIDS -- and, even more sadly, for a visit to Maternity where we learned that a premature baby, delivered by C-section on Saturday and in respiratory distress from birth, had died.

Christiana also saw a nine-year-old boy with severe eczema in the outpatient department; he had been suffering for eight years. We returned "home" to work on the final data entries for her de-worming program on Christiana's laptop. Now she, too, is leaving (but will return in February, TG), as I write from the cybercafe at nearby Maseno University. The afternoon rains will soon come to cool off the heat of the day and to dampen the ever-present smells of burning rubbish and human sweat.

Emmah and I will be alone at Rotary House for a few days before new visitors arrive. Meanwhile, please be aware that it may be awhile before I can get to a computer again. Please also know that when the university closes in mid-December, the cybercafe will close. My thoughts and prayers are with you and will remain with you all. They are very much here, as well. I am so thankful to be a very small participant in a very great Plan, and to witness the work of the people in Maseno. As others have said before, "Surely Nan and Gerry Hardison were hand-picked by God."

... and Hands to Pray

The roosters began crowing at 4:30, but dawn arrived at 6 AM. Birds, dogs and kukus (chickens) congregated on the red dirt path in our neat green yard, all knowing they might be fed before we ate breakfast ourselves. Bena and I walked 1/2 hour to church, while Christiana traveled by boda-boda (bicycle propelled by a local driver) in order to meet Nan before she left the campus with Gerry for a harambee, an hours-long confirmation service and fundraising party, held at a neighboring parish. Eight of us gathered at St. Philip's chapel for Morning Prayer -- with music. There is rarely a service here without music; I think Kenyans must be born singing. The excellent homily was about servanthood, and even the sheep in the doorway chimed in on the Alleluias.

We shopped for fresh avocados and pineapples (135 Kenyan shillings, about $2 total, to complement dinner for ten) at the dukas en route home, then joined about 50 children at the Sunday Kids' Club back at Maseno Missions. I was introduced by Lordy, the group's leader, as "Princess Diana," to the giggles of the children, while Josh and Tilo taught them the gestures and lyrics for "He's Got the Whole World in His Hands." In a sweet tribute to the departing docs, several of those same kids came later to our front porch for a farewell serenade: "He's got Josh and Tilo in His hands, He's got Josh and Tilo..."

Emmah, our beloved housekeeper is off on Sundays, so we prepared homemade guacamole and chips, pasta and pesto for a "last supper" at our house with the Hardisons, neighbors Mary, a Peace Corps volunteer, and Liz, a Young Adult Service Corps (YASC/The Episcopal Church) teacher. A pleasant dinner was followed by a bedtime movie on Christiana's laptop computer. Six of us lined up in hard-backed chairs to watch "Zorro." It was a quiet night in Lake Wobegon.

Hands to Work

Dr. Nan Hardison met me at Kisumu Airport in the "new" Maseno Missions van, after triumphing over a recalcitrant second gear. We delivered my bags to Rotary House, the hospital dorm, just in time for me to be able to join Dr. Gerry Hardison and his mobile medical team on a visit to Esiandumba, about a half hour's drive from Maseno. There, in a country churchyard, hundreds of children and their caregivers were gathering for weekly lessons on a propped-up chalkboard, a medical clinic and an orphan feeding program.

"Listen," Gerry said, handing me his stethoscope. "Left upper and lower lobe crackles, " I responded, as he wrote a prescription for an eight-year-old with pneumonia. There is surely hope for the child, but his mother's vacant eyes told another story. Of her six children, only two are still living. They clung to her as she was examined and treated -- young, pregnant and with no ID card to access prenatal care elsewhere. "Poorest of the poor" was written on one page of the patient's chart. "Saddest of the sad" was written all over her face.

Kids and their caregivers quietly responded to the gentle probings of the doctor and his staff. Busy chickens and pint-sized cats scurried in and out of the examining room, oblivious to our human intrusion. An axillary thermometer (along with Gerry's "magic stick," a Centrigrade/ Fahrenheit cheat sheet pasted on a tongue depressor), a stethoscope and a listening heart are the primary diagnostic tools in evidence.

Malaria, TB, HIV, meningitis, pneumonia, sepsis, tinnea, diabetes, hypertension and fever are among the many conditions seen, treated and followed, along with the chronic aches and pains of arthritis and bursitis, related to patients' years of carrying heavy loads. Malaria alone kills one million children a year, most of them under five and most of them in Africa; it is estimated that 200 out of 1000 children here will not reach their fifth birthday. Malnutrition, dehydration and AIDS-related opportunistic infections kill countless others. Patients are seen until there are no more at any given Saturday clinic.

Meanwhile, the "Mothers' Union" guardians (most of whom are elderly neighbors, aunts and grandmothers; the mothers, too, are dead), who had been cooking all night over open fires, were teaching and playing all morning with the youngsters of the parish as they awaited a hot meal which was, in many cases, the best or perhaps the only one of the week. The children lined up silently to wash their hands, then lined up again to receive their food. There was surprisingly little sound except coughing; the kids were sick. We prayed together before sharing a meal of rice and beans -- some of us without utensils and all of us without napkins. The custom in Kenya is to use the right hand to eat food, before and after which everyone's hands are graciously washed with water pitcher and bowl. Following lunch, we departed for afternoon rounds at the hospital. There, two new admissions were awaiting, and several other people needed follow-up care.

Panga (machete) wounds, burns, salmonella, post-matatu (-taxi) accident fractures, suspected TB and infections secondary to HIV/AIDS were among the presenting problems. Happily, however, one five-year-old child was being discharged. HIV-positive, he will soon begin antiretroviral treatment after his two weeks of successful anti-TB treatment. A grateful mama was so relieved that leukemia had been ruled out, she joyfully exclaimed to the doctor, "I will bring you a goat the next time."

Bedtime came early Saturday night. I crawled under the mosquito netting about 8 PM, the third time the electricity went out. My housemates, three medical students from Germany, a college student from Nebraska, and a pediatrician from Children's Hospital (and the Diocese of Massachusetts' Jubilee Committee), stayed up to exchange photos by candlelight since they'll all be leaving Monday after several months here at Maseno. Four, plus a visiting priest from Pittsburgh, will climb Mt. Kenya before returning to their respective homes. Please keep Bena, Rhiannen, Tilo, Josh, Christiana and Zach in your prayers as they travel.

Karibu Kenya

"Welcome to Kenya," Jonhes beamed when he met our plane in Nairobi and took me to the ACK (Anglican Church of Kenya) Guest House. Palm trees were backlit by nearby city lights, and the scent of bougainvillea was in the air. After a short night's rest, my early morning flight circled over Lake Victoria before landing in Kisumu an hour later. I chatted en route with a young mother of three. Lori had a sleepy son (9) and two daughters (7 and 3) remarkably in tow. An American ex-pat living in Paris with her engineer husband, she was introducing Joshua, Elyse and Sophie to Africa. They will spend three weeks at two orphanages in Oyugis, not far from Kisumu. Lori's father, a Cleveland architect, and her mother, a nurse, have been volunteering in Kenya for many years. Here, as on America's beleaguered Gulf Coast, communities of faith are providing the primary relief to communities in crisis. 'Twas ever thus... Amen and amen.

Traveling Mercies and Angels Unawares

Dark-eyed Anya, 18 months, provided the in-flight entertainment on the BOS-AMS overnight leg of my trip. NW Airlines served a delicious vegetarian Thanksgiving dinner on board, and little Anya shyly hugged me goodbye eight hours later, before we went our separate ways: she to New Delhi with her parents, me to Nairobi with your prayers. Echoes of a family holiday...

The nine-hour flight to Nairobi took us south over astonishing views of the Alps and Italy's "boot," then over the vast sands of the Sahara before darkness fell at 6:30 PM. Darkness always falls at the same time at the equator, just as daylight always dawns at 6:30 AM. I'd forgotten that. Joachim, a young German soldier recently returned from his second tour of duty in Kosovo, sat on my left.

He was en route to Nairobi to meet his (German) wife of seven years. It was Joachim's 5th visit since June, when the couple had first begun legal adoption proceedings for Samuel, their infant Kenyan son. "We wanted to do more than just send donations to help children here," he explained. Joachim told me that Samuel was abandoned near the public toilets in Thika. He was taken by police to an orphanage. Joachim's wife has been renting a room in Nairobi since June, and little Samuel is now living with her under the watchful eyes of the adoption authorities. Their final hearing is scheduled for November 27th; Joachim hopes to take his family home to Bavaria in time for Christmas. Please keep them in your prayers.

A young Kenyan economist who lives in Stockholm and works in Sweden and Denmark sat on my right. Jacqueline ("My mother admired Jacqueline Kennedy Onassis") was returning home for the national elections and for a traditional up-country holiday with her family. Originally from Kisumu, she smiled when I told her I was going to Maseno. "That's where my (Luo) tribe is from." Jacqueline described the days around the December 27th elections as "chaotic, with lots of drinking and lots of corruption. I came home to vote for change." Please pray for continuing peace in this beautiful land where 42 tribes currently live in peace.

Thanks-Giving

In North America, we often use the terms "family" and "extended family" to differentiate close relationships. I am grateful for the love and support of every one of you, family and friends alike, as I prepare for a month in Maseno.

In Africa, I am told, there is no such differentiation. There is only "family," or tribe. Perhaps that is how neighbors and grandparents and even nine-year-old siblings manage to care for children who have lost a whole generation of parents to disease.

We can help in both word and deed. "Hands and hearts," we remind ourselves. "Help us to walk in the footsteps of Christ," we pray. Your hands will be working, your hearts will be loving, and your footsteps will be walking beside mine.

We all have much to learn from, as well as give to, our brothers and sisters in Kenya. With the hope that we might learn together, I will try to send messages from Maseno. There is no computer access at the hospital, but there is a university cybercafe  nearby.

Many of us will be with family or extended family for the holidays. You will be in my prayers as I travel, in response to Nan and Gerry Hardison's generous invitation to "come and see." Please keep me -- and God's one beloved family throughout the world -- in yours. Thank you.