Safe Home

We never walk alone, and I am profoundly grateful to have been able to share "our" mission to Maseno... Eucharistic living at its best. Thank you for walking, working, loving and praying with me.

Asante sana, Bwana asifiwe, and please forgive me if it takes a little while to reconnect with each of you personally. I need to try to catch up on five weeks of missed work. Meanwhile, please keep the people of Maseno in your prayers, now and always.

God bless us, every one... and Happy New Year!

Krismas Njema!

Just a few moments ago, the Christ candle was lit at St. Andrew's in Edgartown. It shines in my still-singing heart here in Kenya: "Joy to the world... " And just a few days ago, this evergreen branch was decorated at the CCC Kids' Club.

We shared a lovely Christmas Eve at the Hardisons' home on the compound at St. Philip's. Nan prepared a delicious ham dinner with all the trimmings, and Padre Zach performed a miracle (with garlic, of course) on the mashed potatoes. Everyone enjoyed Nan's rum cake with ice cream for dessert, while the family dogs, Simba, Chewi and Little Brown, gobbled up the leftovers. Hymns played quietly in the background, a wooden giraffe was decorated as a Charlie Brown tree, Liz orchestrated a hilarious gift exchange, Lori and Don bequeathed a furry Santa cap to our hosts, and Nadia and I loved every minute. Christmas in Kenya was a delight, in great part because I knew you were with us in spirit.

Everyone went to bed around 10 PM and "slept fast" since I needed to be taken to the Kisumu Airport at 6:30 this morning. The flight to Nairobi was stunning, and my plane to Boston via Amsterdam will leave tonight at 11:10 PM. Meanwhile, I am enjoying the company and diversity of my fellow travelers: planeloads of passengers returning from the Hajj; Susan, an American embassy nurse in Yemen en route to visit family; and Krista, a Canadian epidemiologist returning to her home in California after a photographic safari with the World Wildlife Fund. Destinations scrolling overhead on the airport monitors include Zanzibar, Dar es Salaam, Kilimanjaro, Bombay, Dubai, Mombasa, Cairo, Entebbe, Addis Ababa -- and, oh, yes, Paris, London and Rome. This sure isn't Kansas (or even Kenya) anymore!

But the Anglican Church of Kenya has a Christmas collect for all the world: "Eternal God, who made this most holy night to shine with the brightness of your one true light; bring us, who have known the revelation of that light on earth, to see the radiance of your heavenly glory through Jesus Christ your Son our Lord..."

Morning, Noon and Night

James, the evangelist, led our small Morning Prayer service at the hospital. "Hark the Herald Angels Sing" is beautiful in Swahili. I felt both surprised and honored to be invited to read the Christmas narrative from the Gospel of Luke, and, later, to be invited to offer the closing prayer. It was hard to hold back my tears. After hospital rounds, I succumbed.

Two patients died last night: Rose had been in a meningitis-induced coma for three weeks, and a newly-admitted baby never recovered come to understand that it might help to be tested, for her own sake as well as for the sake of any possible future pregnancy/ baby. If a woman is known to be HIV-positive, the risk of maternal-child transmission can be significantly reduced.

It was a very full day. Gerry never got home for lunch, but he managed to do morning and afternoon rounds, two endoscopies and a colonoscopy; then he discharged every patient possible home for Christmas. And, yes, Ruth was finally transported, too. At midday, Nadia and I took boda-bodas to the Maseno Stores' cybercafe a couple of miles away. Time was at a premium, and we wanted to let our families and friends know we are thinking of them this Christmas Eve. Nadia received her own Christmas gift, in the process: a photograph of herself with a Masaai -- at no charge! -- whom we met on the road. The only thing missing from the photo is his cell phone.

Lala salama (Sleep safe/well), dear ones... and to all a good night.

Fourth Sunday in Advent

The Anglican Cycle of Prayer focused on the annunciation story today, although The Episcopal Church lectionary focused on Joseph. Nan's meditation at St. Philip's was a blessing. She did not soft-peddle the story of a young woman's acceptance of an angel's news. "Mary's 'Yes' was not the end of a sweet sentimental story. Nor was it the beginning of an easy life, just because she said 'Yes' to God... Neither is it an easy life for us if we say 'Yes' to God," Nan continued. "But the same passage reminds us that 'All things are possible with God.'" Amen.

We lunched together, then attended the CCC Kids' Club Christmas party which began at 2 PM. It was initially billed as an overnight celebration, and we were encouraged to stay. Although "all things are possible..." at least some of us were relieved to learn that plans had changed and that the party would be over by 9 PM, a/k/a Missionary Midnight. It was also a relief to see Goodrick at the gathering. He still has two black eyes, but he is recovering from last week's assault.

Together We Make A Difference was the theme of the evening, and 200 children provided a lot of togetherness! First, a goat was slaughtered (yes, we all watched) and charcoal-roasted in a pit for the special occasion. The nyama choma was delicious. Then a teenage DJ played American Christmas carols on an old boombox while a lively Lordy distributed a toy to each child. Next a "street theatre" troupe from Kisumu presented an AIDS/HIV-prevention skit. Even in Swahili, it seemed pretty sexually graphic for an audience of young children. But life and death are graphic, and these kids know more about both, unfortunately, than most adults in the States. Later, Lori and Don brightened up the afternoon by teaching everyone the hokey-pokey. And later still, "Golden Diana," a 10-year-old with an amazing voice and presence performed for us; she is clearly a Caller in the making! Small faces were wreathed in big smiles for seven full hours, as were our own. Children bring holidays to life.

... And that reminds me: Happy Birthday Season, Huck and Kas!

Have fun celebrating with the children in your beloved families!

Hapa Hapa Syndrome

"Hapa hapa" means "Here and here..." That's where it hurts, we heard several times today at Ebwali Parish, from the kids and guardians alike. "How long?" "Two weeks," was invariably the answer. The orphan feeding program was busy, githeri notwithstanding, but most of the clinical problems presented were generalized aches and pains -- and jiggers, of course. We worked until about 1:30 PM, then loaded up the van and waved kwa heri ('bye) to everyone. David Mabenda asked to have his photo snapped with Dr. Hardison before we pulled away.

Returning for hospital rounds , we encountered a classic country "traffic jam." Meanwhile, a new patient had been admitted to Ward I: he was recovering from a minor assault and a major hangover. A new patient had also been admitted to Ward II: Millicent came through the CCC via the outpatient department. She appeared to be about seven months pregnant. After a negative pregnancy test and a thorough ultrasound, however, it was determined that she had ascites. Millicent then agreed to be tested for HIV and learned she was positive, not pregnant.

Ironically, Brigit, another new patient, was discharged today after lengthy HIV testing and counseling. She had been admitted with non-specific complaints, and several family members had died from AIDS-related illnesses. Brigit had been so surrounded by disease and death that she simply could not believe she was HIV-negative. I wish I had a picture of her smile when she finally accepted the doctor's reassurances.

Ruth's daughters came to visit today. She was able to walk outside with their help and sit in the hospital garden. Ruth, too, was smiling. She will be taken home to Luanda by ambulance as soon as one is available. Patients usually walk or take a matatu home from the hospital; but crutches in a matatu would just not work.

Emmah and her family left this morning for the long holiday trip to their home -- eight hours from Maseno. How empty it seems here without them, and how much we miss them already! "Traveling mercies," dear friends, and Christmas blessings to all.

Perspective

The hospital ran out of surgical gloves today, and it ran out of blood a few days ago; fortunately, we only had to delay elective procedures each time. At Rotary House last week, we never had to resort to "the long drop"/hole-in-the ground toilet, and Emmah (who refused to let us help; honest!) only had to lug buckets for a short while before our water pipe was repaired. The electricity is erratic, but it seems to be functional now; as a result, the oxygen tank is working on the ward, and I can read by the light of the overhead bulb in my room. It is sufficient.

And "sufficient" is enough. There is neither running water nor electricity in traditional homes both on and off the hospital grounds. We feel truly blessed to be safe, healthy, comfortable and happy here; I pray that all of you are, too. "It's beginning to feel a lot like Christmas..." There's an evergreen swag on Mary's door, and Emmah has decorated the sitting room with balloons. Best of all, Ruth will indeed be going home. She has been practicing with crutches that Gerry found for her and now, with encouragement, negotiates the length of Ward II. What a gift!

No More Rice

At today's Mothers' Union meeting, Nan again congratulated the guardians on their tireless volunteer efforts throughout the year. The mamas sang goodbye to me and hello to new visitors from San Diego: Lori and Don, delightful California Rotary friends of the Hardisons, will be at St. Philip's for a week.

Everyone was in a festive holiday mood, even when "Professor Nancy" had to announce that rice could no longer be served at the orphan feeding programs -- for awhile, at least. The price of rice, imported from Indonesia, has doubled since the inception of the program. During the same period of time, the value of the U.S. dollar has declined dramatically. The guardians understood and expressed their gratitude to Nan, to God and to the churches in Massachusetts, Pennsylvania and Vermont that continue to support the orphan feeding program in the face of rising costs. And the children will come to understand one more stark reality: only githeri will be served on Saturdays. Stark realities are facts of life in the Diocese of Maseno North, where most families live on less than 62 KSh ($1.00) a day.

Economic disparities abound. A chest xray at Maseno Hospital costs the equivalent of $6.00; so does a gallon of gas. (Very few people own cars, of course.) Unfortunate, if understandable, expectations also abound. Not every American is wealthy, but even the poorest of us is better off than a Maseno mama. Economies of scale are difficult to explain in the face of global inequities. It is neither uncommon nor unreasonable for me to be approached discreetly: "Sister, I have a problem; perhaps you could help..." Nor is it easy for me to say that I cannot buy a new laptop for a student clinician or a new car for a struggling young couple to start a taxi business. I cannot even pay for a month's rent-and-household furnishings for an abused wife or for the secondary education of an evangelist's grandniece.

"Pole" (which means "Sorry" in Kiswahili, when it is used only once -- "Slowly-Slowly," when it is repeated), I have to say. But I am beyond sorry; I am in tears. I can offer only small donations and large prayers.

Impromptu Holiday

A national holiday was unexpectedly declared this morning, apparently in an effort by the ruling PNU party to curry favor in the upcoming elections. There are no hospital holidays, of course, and we admitted three new patients, all victims of random assault: one a boda-boda driver, one a matatu passenger and another a pedestrian. Violence seems to be increasing in Maseno; Gerry says it has been increasing in the entire Western Province. Last weekend a Church of God missionary in nearby Kima was attacked and robbed in his home. Goodrick is 79 years old and has spent 50 years serving his church and people here. He and his wife retired in Kenya because she had a stroke several years ago, and home care for her in the U.S. is too expensive.

It was not the best night for our Nadia to go missing. She did not know she was missing, of course, but we were all worried when she didn't return home by dark at 6:30 PM ... or at 7:30 PM ... or even at 8 PM. We slowly pieced together the story: she had asked a boda-boda driver to take her to Kisumu -- 30 minutes away by van, remember -- in order to cash her traveler's checks. They left Maseno about 1 PM. Although Nadia has a cell phone, we did not know the number, and no one had heard from her. There was "no point in calling the police," nor was there any point in sending out a search party and risking others' lives on the dark rutted road to Kisumu. All we could do, quite literally, was pray.

Nadia arrived home safely about 8:20 PM, innocently exhilarated by her "beautiful ride" but disappointed that the country's banks had been closed for the uncharted holiday. "That is probably what saved your life," a very relieved Emmah told her, amidst hugs all around. Thanks be to God.

Son of Kenya

"Hodi!" ("Hi! Anyone here?") we called into the dark recesses of Alex's duka. His handsome smile instantly appeared. A student at St. Philip's Theological School, as well as a young entrepreneur, Alex had kindly invited us to climb to the other side of Mount Maseno after hospital rounds today. Everyone we met along the winding path greeted him affectionately. Alex had grown up on the mountain. He opened his shop on the street below the hospital entrance five years ago, when he was only 15. Burned out once and robbed twice, he remains undaunted -- and a gentleman. As Nadia and I talked and trudged, Alex slowed his pace to accommodate us and even produced bottled water and chewing gum for us halfway up the mountain.

We lingered for a long while at the peak, silently taking in God's own views. They were as breathtaking as before, and Alex's hospitality was even more so. He invited us into the home he had built last year. Opposite his father's house and next to his brother's, the two-bedroom dwelling was spotless and neatly furnished, with matching curtains at the windows. Alex explained that he looks after one brother's orphaned children, Nancy and Nellie -- "for Nelson Mandela." They all take meals with Alex's father, who lives just a few yards away. The youngest of eight, himself, Alex said his mother and four sisters live nearby in Luanda. (A third brother also died a few years ago.) Nancy and Nellie shyly brought us Cokes and ground nuts, followed by grilled corn and lollipops, before disappearing to feed the family's three cows and small goat.

We marveled at Alex's schedule: "When do you sleep?" He acknowledged he gets about three hours a night when school is in session. "But I love my family and my business and my school work, so I am not tired." He explained that he had applied three times before getting accepted into his program of studies and then showed us the exam questions he had recently completed for his Intro to Psych and Old Testament classes. We were duly impressed. Alex also spoke of his fiancee, Rhoda, who works as a CCC nurse some distance away. They hope to marry in April, but Alex still has two more years of theological studies, and a wedding is expensive: 10,000 KSh, plus 4-5 cows (@ 10,0000-20,000 KSh each), in dowry payment to the bride's family, in addition to the "wedding clothes and food for 1000. We will invite 500, but 1000 will come." They will also need to eventually build another house on land of their own.

It was almost dark when we left Alex's home, waved goodbye to the children, and worked our way down the mountain by the half-moon's light. Croaking frogs and flickering fireflies ("star children," Alex called them) accompanied us. Our host lent an occasional hand, as we scrambled past goats and their kids settling in for the evening. It was an unforgettable afternoon with an unforgettable person -- child of the mountain, man of God, son of Kenya.

CCC, Church and State

Vigina Parish, near Vihiga, is the CCC's largest and most distant satellite clinic. We traveled through familiar savannahs with acacia trees, past Luanda and into more rolling countryside, thick with banana trees and rock outcroppings.

There we once again met with clients, filled prescriptions, assisted with HIV counseling and testing, and distributed supplemental food to clients who qualified, based on body weight. It was a full day: 89 clients were seen, and 38 others were anonymously tested for HIV antibodies. Only two were reactive/ positive, TG, in a province where 9.7% of the entire population is infected. More statistics: 15% of the men and 20% of the women aged 15-35 are HIV-positive. But countless have died. Knowing the names makes the numbers even more distressing.

At midday, we were served large portions of chai and a hot mash of bananas and sweet potatoes, a dish that Emmah told us is sometimes served on banana leaves. (She softly explained that everything is served on banana leaves when people do not own dishes.) It was disconcerting to see several white cars with orange placards and loudspeakers come roaring into the church-and-school yard after lunch. The ODM party proceeded to hold an impromptu rally outside as we treated patients inside. Separation of church and state is specified in Kenya's constitution, but laws and lines seem to blur at election time. Church service announcements -- except at St. Philip's! -- have frequently included long speeches by PNU or ODM party members after descriptions of their respective "gifts" for the church: choir robes, electricity or even a new roof.

It was also disconcerting for me to be approached at the CCC clinic by James, the evangelist, who had accompanied us to Vigina: "I brought my grand-niece to meet you, " he said. "She needs help. Her mother died in November, and her father died last year. She is in Form 2 and is a good student. She has no one to look after her." My heart sank as I extended a hand in greeting. "Habari, Elizabeth?" "Nzuri, sana," she replied. But she was clearly not well, and her eyes reflected great sadness. I was dismayed to realize that the evangelist was asking me to help support her -- and even more dismayed to have to gently explain that I could not. There is no orphan feeding program or clinic in Elizabeth's parish. (Only 15 of the 41 parishes in the diocese have orphan feeding programs thus far, and only 5 of those parishes have medical clinics.) All I could do was make certain she was registered with the CCC, encourage her in her studies and pray for her.

Two Kenyan nurses gave up their seats in the CCC van and walked to the main road's matatu stop, to enable two sick mamas and their babies to ride home with us in the heat of the day. We returned to Maseno in time for afternoon rounds at the hospital and very good news: Ruth has graduated to crutches and may be able to go home soon!

Hope... and Hippo Point

I lit three candles in the darkness before dawn today and prayed for the souls of all our fathers -- and for all of our families everywhere. It brought me comfort to know that, within hours, the Advent wreath at St. Andrew's would be lowered and the pink "Hope" candle would be lit.

We have no Advent wreaths in Kenya, but families here are anticipating holiday gatherings, just as they are around the world. There seems to be very little commercialization of Christmas in Kenya's countryside. (I refuse to count the three skinny Santas, one in a purple suit promoting Cadbury candy bars, that we saw at Kisumu's Nakumatt last week.) The economy is undoubtedly a factor, but the cultural emphasis seems to remain blessedly on family and faith in a country that is 75% Christian and 15% Muslim. Kenya is a country of both beauty and pain, clinging to hope against many odds.

Sunday is market day in Kisumu, however; Massachusetts blue laws do not apply. Linet escorted Nadia and me via matatu to Kenya's "second largest city." Actually, Kisumu is the third largest, but Mombasa is not labeled a city. Our Nissan van legally held 15 passengers; people hopped on and off and paid the tout (conductor), who hung precariously by one arm onto the open door frame throughout. I counted 26 of us, all sizes and shapes, at one point during the half-hour ride. Shortly after that we were stopped by a police roadblock, and kitu kidogo (a little something) exchanged hands before we were permitted past the meter-high metal teeth that criss-crossed the highway.

In Kisumu, we resisted the street vendors, met Linet's husband Collins and traveled together to Kiboko (Hippo) Point on Lake Victoria via piki-piki, or motorized boda-boda (bicycle). Getting there was definitely half the fun! Vehicles here travel on the left side of the road; careening through the roundabouts with cows, pedestrians, goats, cars and other boda-bodas made for an exciting ride, to say the least. A mzungu can be an expensive liability for her African friends, however. I made a relatively futile effort to disappear into the crowds whenever they were arranging transport, since every price is negotiable in Kenya.

It was a most amazing day. Lake Victoria, although shallow and congested by encroaching water hyacinths, is the source of the Nile River, and it is enormous. Lake Superior is the only larger freshwater lake in the world. Linet and Collins introduced us to a young boatman who had poled his slender wooden matatu- (engine-) boat through the hyacinths to meet us at Hippo Point. He took the four of us out for two hours on the lake where, yes, we saw hippos -- from a very safe distance, thank you. They travel in matriarchal groups, with the bulls maintaining solitary watch some distance away from their pods.

We both drifted and motored through the murky water, which is unfortunately full of bilharzia-causing schistosomiasis, while taking in the astonishing scenery. Uganda was in the distance on one horizon, Tanzania on another, and Kenya was behind us. We could only imagine Rwanda on the far western shore. Families were bathing and laundering in the marsh, while nearby fishermen were casting their nets by hand. Catfish are caught in the hyacinth tangles to use as bait for the tilapia found in the open water; the delicious tilapia is then sold to the local markets. We also saw geese, egrets, kingfishers and bright yellow "riverbirds," along with a few boats, one of them a dhow with a single striking triangular sail.

It was surreal to be lolling about on a bucolic lake in 85-degree sunshine, especially knowing many of you have already had a foot of snow. I expected Humphrey Bogart and Katharine Hepburn to appear around the next bend.

Soon, however, we returned to reality, knowing we still had hospital patients to see. But first we treated our hosts to lunch -- fresh tilapia, of course -- for 350 KSh, or about $5.50 each, at the Kiboko Club. We were surrounded by throngs of people in bright orange garb; it was obviously a meeting of the ODM (a/k/a/Orange Democratic Movement) party elite. We then traveled back via three-wheeled motorized tuk-tuk to Kisumu and saw gracefully leaping impala en route. Another hair-raising matatu ride brought us back to Maseno and a walk up the long red road home.

Birth, Life and Death

Nadia and I stopped by the maternity department this morning to check on Laban, the baby boy born yesterday to the laboring mama I'd met on the road to Maseno. He and his mother are "nzuri, sana" ("fine, thanks").

I smiled. Thirty-eight years ago today my own youngest child was born. Birthday blessings, Kate!

We then took off to Emukasa for this week's orphan clinic and feeding program. A few kids were playing when we arrived at the parish church to set up. Their soccer ball was made of wadded-up plastic bags, tightly tied with string. It was moving to see how the older ones looked out for the younger. I waved and was immediately surrounded by children from every direction. One of the student nurses explained that my routine hand wave -- a forward, vertical flapping motion -- is a gesture interpreted in Kenya as "Come here." No wonder I've found myself trailed by beautiful children these past many weeks! They must have all been trying to figure out what in the world the crazy mzungu wanted. I need to remember to wave in a sideways motion from now on.

A young Maseno pharmacy student posed a question to me about the orphan formulary during a break in our patient schedule: "Do you prescribe different amounts of medication?" "Yes," I responded, misunderstanding his query. "Based on weight in kilograms. We use a smaller dose for children, for example." "No," he persisted. "I mean do you prescribe different amounts for wazungus (plural of mzungu)?" Uncertain about the nature of his concern, I reassured Eric that the same amounts are prescribed in America as in Africa for the same conditions; that our bodies are all created equal, regardless of nationality and regardless of skin color; and that no one is shortchanged on dosage. We both fully understood, however, that many second, third and fourth generation drugs are simply not stocked here.

Availability, not dosage, is a very real issue in Kenya.

[CORRECTION: Unfortunately, upon my return to the States, I read a new JAMA study about pain control medications within the US: "Whites More Likely to get Narcotics in ER," the headlines trumpeted. I owe Eric and his brothers an apology. We all do.]

Another student reported, during our ride back to the hospital, that the December 27th national elections may need to be postponed because a large number of ballots had been misprinted. People throughout the country are anxiously awaiting the government's decision.

We returned to the hospital for afternoon rounds and were just finishing up when an elderly man was admitted with severe dehydration and anorexia, suffering from an apparent intestinal blockage. An NG tube was inserted, he was put on IV's and sent for diagnostic xrays. I helped his son and a staff nurse wheel the gurney to the xray department, three buildings and a few thousand yards away, through the hospital grounds. The films were completed, but the patient went into agonal breathing on the xray table and died on our way back to the ward.

As the nurse prepared his body for the mortuary, the doctor spoke to the son. It was a cultural faux pas, but I reached out and touched Francis' shoulders to express my own sorrow. "You and your family will be in my prayers." "Asante, Sister," he graciously replied. Nadia and I spoke quietly with the young man for a few moments. "Do you have a way to contact your family members?" He nodded and began to call them, as we sadly returned to Rotary House for the evening.

"...Give rest to the weary, peace to the dying, and all for Thy love's sake. Amen."

Sawa (Okay)

En route to communion at St. Philip's early this morning, I stopped to comfort a woman in labor walking the opposite direction. She was bent over double in the middle of the long dirt road to the hospital grounds, a good 15 minutes from her destination. I had no idea how far she had already traveled, but it was another 10 minutes to the highway that she must have come from. Dorcas spoke Luhya and I, English; but we both understood labor pains.

I tried sign language to explain that I would accompany her back to the hospital. She nodded gratefully, but at that point her husband appeared, running to catch up with her. "Shall I walk with you?" I motioned, to ask him, too; he shook his head and indicated he would take care of his wife. I looked worriedly from one to the other and asked in Swahili, "Sawa?" "Sawa, sawa," they both responded. I hope it really is okay... I will visit the maternity ward later, hoping to see them and a healthy newborn.

This morning's service, the last of the semester, was lovely. Padre Richard, long the chaplain at the theological college, spoke about Isaiah's words. "The Israelites were asking in Lamentations, 'Have you forgotten us?' Then come the words of comfort, followed by the admonishment to 'Prepare the way for the Lord.'" Combining Advent's theme with that of graduation, Richard reminded us, "God made a people of priests out of nothing. He kept faith with them even when they did not keep faith with Him." Richard went on to say that we all have a responsibility to continue to work for liberty and justice, a theme especially appropriate in a country that just celebrated its hard-won independence. "God's message was not about pleasing people in power, but about liberating the people of the land," Richard closed, in an obvious reference to the upcoming elections. Simba, the Hardisons' oldest dog, joined us in the chapel to sing a rousing recessional, "Marching to Zion."

I caught a ride with Dr. Hardison back to the hospital for morning rounds. We arrived as an ambulance pulled in with a female patient suffering a gaping head wound -- the result of a serious altercation with her mother-in-law. The government's temporary five-panga limit is apparently not helping much. It only takes one machete to wreak havoc on a skull.

A young man presented at our outpatient department today with a seven-year history of abdominal pain and diarrhea. Dr. Hardison's sigmoidoscopy confirmed the obvious: ulcerative colitis. Had it been colon cancer, the patient would not still be alive, of course; but it is sad to know that he has been so inappropriately treated at so many other hospitals for so long. He was never even scoped until he got to Maseno. A short-term steroid regimen (also never before prescribed for him) will help to calm the inflammation, but there is no medication in all of Kenya that compares to the ones we have in the U.S. to treat the long-term condition.

Some things are just not sawa.

Pole, Pole

"Pole, pole" -- pronounced "poly-poly," it means "slowly, slowly" -- we laughed and cried, as our driver Kenneth negotiated winding roads this morning. The potholes between here and Esihoola are only slightly less death-defying than those between here and Kisumu. The difference is that ambitious kids who are unable to pay for secondary school put their shovels and their shoulders to the task. They twist makeshift flags into the middle of the highway to indicate "road construction ahead," dig up the red roadside earth and fill as many holes as possible on a given day. Grateful drivers reward their labors by reaching out car windows to contribute much-needed and much-appreciated coins. Meanwhile, along a different stretch of road, the kids' older counterparts cut and bake bricks from the same ochre clay, or else they sit and break large roadside rocks into stone chips for potential sale. It is all backbreaking labor for meager potential income.

Nancy and Liz invited me to join them and three Maseno mamas/grandmas to travel to the weekly Mothers' Union meeting today. Afterward, we stopped for supplies in Luanda in the Maseno Missions' one (mostly) functioning vehicle. The women's gathering itself was, as always, a remarkable combination of business meeting, prayer and powerful support group. Discussion today focused on their own elections in January, with the explanation that the Mothers' Union officers would change -- not because of dissatisfaction with anyone's work, but because it is important to develop leadership skills in every woman "to make ours a strong country of strong women."

Bwana Asifiwe

Warm rains came again in earnest last night. Someone (who is it?) describes the sound as "laughter on the roof." Laughter becomes a chorus of delight on a corrugated tin roof in Kenya.

Nadia and I slid our way through the raw, red mud to St. Philip's this morning. It took a little longer than the usual half hour; but, once there, the intimacy of prayer and the immediacy of music made my own heart laugh and sing anew. "Bwana Asifiwe" ("Praise God") is both a call to worship and a Christian greeting. It is repeated during services, in word or song, with increasing intensity until a resounding "Amen!" is heard in response. Tambourines, drums and kayambas -- flat wooden boxes that, shaken, sound like rain sticks -- provide spontaneous accompaniment for the voices raised in praise.

"I thank God continually for you" is my heart's refrain this Advent. Today we heard a different translation of that familiar Philippians 1:3 passage: "I thank my God upon every remembrance of you." Listening to the reading, a flood of tears caught me by the same surprise as last night's rain. I love this place and these people; I love and miss you all even more. It is a joy to hear about your families and holiday preparations. Thank you for sharing them.

We returned to the hospital for morning rounds after chapel, then walked miles into the community with Theresa, a CCC outreach worker, to visit HIV/AIDS clients in their homes. There are 1850 clients in the Maseno cachement area, approximately 500 of whom receive home visits. We met seven of those clients and their families, admired the amaranth and moringe (nutritional supplements) growing in their gardens, checked on their health and counted out their pills. One elderly man was suffering a variety of opportunistic infections, including a painful outbreak of herpes zoster; his CD4 count was 4. "Stress," commented the outreach worker succinctly: "He has two wives." I judiciously refrained from comment.

Tonight as we scrubbed the clay off our sneakers, the kids next Tonight as we scrubbed the clay off our sneakers, the kids next door brought us fistsful of purloined posies. They proceeded to sing, "He's got the whole world in His hands" in perfect harmony, little realizing the comfort they brought to my momentarily-homesick heart. It is good to remember we are all held in the same loving hands. Bwana Asifiwe and Amen!

Politics as Usual

Today the political campaigns have begun in ominous earnest. We were unable to hear Dr. Hardison several times during rounds because of the truckloads of people going by on the street below with their loudspeakers blaring. December 12 is the anniversary of Kenya's independence (1963), but voting won't take place until the end of the month. Fortunately, we only have to tolerate the campaign noise for two weeks, not two years. In the meantime, no more than five pangas (machetes) can be purchased at one time, in an apparent effort to curtail election-time violence.
More importantly, the beautiful colors of the Kenyan flag -- black spears crossed behind red shields against a green background -- will brighten the countryside tomorrow. Their colors will remind us of Christmas as much as the poinsettia trees in bloom on the hospital grounds!

P.S. Speaking of color, I have tried to add a few photos to the blog. It takes an inordinate amount of time to upload the images, so they are yet few and far between. I am also spasmodically trying to correct my abysmal spelling of Swahili words. Apologies to all!