Peace at the Last

My mother died last night at Hartford Hospital, as I was en route to visit her. Caregivers were kind as she went from my sister's loving arms to God's. Mama knew you were all praying for her comfort, and that meant as much to her as it does to me. Asante sana.

I am writing from Heathrow and will be with family in New England for a couple of weeks, doing whatever I can to help. Meanwhile, please know that this Christmas, especially, I am grateful for your friendship and for all of God's blessings.

Krismas Njema.

"O, Lord, support us all the day long, until the shadows lengthen and the evening comes, and the busy world is hushed, and the fever of life is over, and our work is done. Then, in thy mercy, grant us a safe lodging and a holy rest, and peace at the last." (Book of Common Prayer)

Our Town

Five funerals and a wedding... and two pending births. In just two months, Maseno has become like Martha's Vineyard, or maybe even like Cheers, "where everyone knows your name" -- especially if you're the only mzungu living on the hospital grounds.

Shared losses, common anxieties and mutual delight bring us all closer in community. I mourn for them the deaths of Christopher's wife, Kenneth's father, Eunice's son, Margaret's sister-in-law, and Okinye's father. I feel honored to be invited to Peter's and Rosa's wedding. I worry about the price of medicine and maize. I celebrate Christine's and Maureen's pregnancies. I give thanks for the companionship of Gerry and Nan and Linet and Emmah. And they all pray for my mother in her current health crisis.

Our Town. Thornton Wilder and Eddie Coogan would have been at home here. So am I.

Yes, I miss the other "characters" in my life, too! I thank God and all of you every day for supporting and sharing this chapter with me. Thank you for inviting me to be your eyes and ears and hands and hearts as we walk together with the people of Maseno, Kenya. You are the reason I am here. You are also the reason many of the people in Our Town are even alive.

We read in I John 3:17, "How does God's love abide in anyone who has the world's goods and sees a brother or sister in need and yet refuses help?" You have not refused. You have given them (and me) help and hope in countless ways. Asante sana.

Senseless Violence

Five shots in the dark... Emmah and I heard them at 2:15 AM. We later learned that the local constabulary was shooting at five "thugs" who had robbed a nearby home -- on the other side of the hospital fence. One man was injured and caught; he is now in jail.

Violence seems to again be increasing in Kenya, although it's not an election year. Today riots broke out in Nairobi at President Kibaki's Independence Day speech. According to the local newspapers, people are unhappy about a new gag rule for the press, disproportional tax-free salaries for the parliament, and inflation run amok. The price of maize meal is out of control, this in a country where maize is a staple.

There are other kinds of violence, more personal and perhaps even more disturbing. Rogers, our pharmacist, was attacked last night on his way home from Maseno Stores. He's recovering from a head wound inflicted by a rock thrown by drunken revelers. And, sadly, we admitted two RTA (Road Traffic Accident) patients yesterday. One was a young pregnant pedestrian who had been hit by a piki-piki; the fetal skull was fractured in utero.The other patient was a two-year-old child who had fallen off the back of his own father's moving piki-piki. Little Michael has head wounds and facial lacerations but will recover.

Senseless violence, all.

"Almighty God, kindle, we pray, in every heart the true love of peace, and guide with your wisdom those who take counsel for the nations of the earth..." (Prayer for Peace, The Book of Common Prayer)

Mama-Gram

Asante sana, dear ones, for your love and prayers.

My mother has survived a heart attack and major abdominal surgery, which the doctors did not think would be possible, given her pre-existing conditions. It was also challenging for them to wean her from the post-op respirator because of her fragile heart.

Last night I was awakened by a phone call from Connecticut and expected the worst. Instead, my sister put my mother on the phone. "I love you," we cried, simultaneously -- she in delight, me in astonishment.

As my friends in Kenya say, "God is good. All the time." Mama still has significant pain and faces many unknowns ahead, but God IS good all the time. And I am grateful -- this time, especially.

Prayer Request

My mother has been admitted to Hartford (CT) Hospital for emergency surgery. She is 83 and blessed with four children, seven grandchildren and seven great-grandchildren who love her. But I cannot get to her bedside in time from half a world away.

You have all been so generous in response to my prayer requests for the people of Maseno, Kenya. This one is for my mother. Please pray for Laura and for the people who are tirelessly and skillfully caring for her. Asante sana.

"Almighty God, we entrust all who are dear to us to thy never-failing care and love, for this life and the life to come, knowing that thou art doing for them better things than we can desire or pray for, through Jesus Christ our Lord. Amen." (For those we Love, The Book of Common Prayer)

Language Barrier?

Technically, there is none. Since English is the official language of Kenya, I do not need -- but I definitely want -- to learn to speak Kiswahili, which is the national (common) language.

It is a matter of honoring my hosts. It is also matter of personal and national embarrassment that most Americans speak only English. Even the the children who cannot go to secondary school here speak two languages -- and often one or two tribal languages, as well. I just hope I can learn half as much Kiswahili in Kenya in one year as my young friend Elizabeth learned in one month in Tanzania. (See her wonderful blog: "Here I Am -- in Tanzania!" at www.elizabethboe.blogspot.com)

But there are regional and cultural terms and idioms, even in the English language, that are fascinating to me. Some of those fall within the realm of medical jargon, and a few of you may be interested in them, as well. If not, just skip this blog entry! I will add to the list from time to time because I don't want to forget...

At the moment, however, I am confined to quarters by Montezuma's -- or is it Kenyatta's? -- Revenge, and I need to distract myself. (I am reminded of another wonderful blog. Fellow missioner Jeremy Lucas survived a similar experience. He and his wife Penny write at www.missiontonamibia.blogspot.com)

So, just FYI, dear readers: in Kenya, a bar is called a "beer pot." (Perfect, hm? I only know because the SIGN says so; honest, Bishop Oketch!) When a piece of equipment is lost or misplaced, the equipment is simply labeled "spoilt"; little effort is expended in finding the missing part. The action by a crowd of witnesses who catch and unmercifully beat a cell phone thief is referred to as "mob justice." And the political clash that killed 1,500 people last January was known as "a fracas." (Is that some vestige of colonial British understatement, Father Copley?)

The medical acronyms are another story. In addition to learning how to read Centigrade thermometers, I have discovered:

PTO = Please Turn Over (a page! - vs. Parent Teacher Organization)
NB = No Blood (available for transfusion - vs. nota bene)
RTA = Road Traffic Accident (vs. MVA/Motor Vehicle Accident)
DIB = Difficulty in Breathing (vs. SOB/Shortness of Breath)
FHG = Full Hemogram (vs. CBC/Complete Blood Count)
HOB = Hotness of Body (vs. Head of Bed)
GBW = General Body Weakness
FGC = Fair General Condition
ORS = Oral Rehydration Solution (a poor person's Gatorade)
DOA = Date of Admission (an alarming cover note on every chart)

My own HOB, GBW and FGC are being successfully managed with ORS, tea, toast and proximity to the long drop. Dr. Hardison added Cipro. It's the same treatment in any language. (I'm avoiding DOA as long as possible.)

Sophie's Choice -- and Ours

Today is the 20th commemoration of World AIDS Day. Yes, there are many health problems the world over (quite a number of them at Maseno Hospital, in fact), and "AIDS is just one of them." But 22 million of the 33 million people infected with HIV live in sub-Saharan Africa, and they are my neighbors. Some of the remaining 11 million are yours. Perhaps most sadly, there are 11.5 million AIDS orphans in the world, and all of these numbers continue to climb. Every single one of them is much more than a statistic, however. This is Sophie's story...

Sophie is ten years old, and she is choosing to "live positively." The doctors and nurses at Maseno Hospital saved her life in July, and a CCC caseworker named Praxedes adopted and breathed love back into her. Sophie's parents had both died of AIDS-related illnesses, and she was suffering from a variety of HIV complications, herself. Sick and wasted, Sophie was brought to the hospital by a relative who didn't think she would live -- and who didn't want to take her home when she did.

Then a miracle happened. A remarkable community health worker at Maseno Hospital's Comprehensive Care Center invited Sophie into her home and family. Praxedes, 42, is a vibrant single mother with two children of her own. She is living with HIV and spends her life teaching others to live as positively as she does. In just a few short months, Sophie has blossomed into a happy child whose remaining immediate health concern is a problem with her vision. Praxedes works extra hard for extra income to help her family, and she dreams of opening an orphanage for children like Sophie someday. Her heart has room for every one of them.

This is the poem (translated from Kiswahili) that Sophie recited as she lit the "HOPE" candle on World AIDS Day 2008 at Maseno Mission Hospital:

AIDS is a killer disease.

It killed my mother.
It killed my father.
It killed my grandmother.
It killed my grandfather.

Why are we so ashamed?
We cannot hide in the forest.
We need to fight this killer disease.
We need to live with hope.

Once an orphan, Sophie is now the daughter of Praxedes; but she has always been a child of God. It is Sophie's choice to live fully and joyously. It is ours to continue to help her and Praxedes and others like them, as well as the hospital that serves them all.

Maseno Hospital is struggling. Your financial and prayer support are not just appreciated; they are vital. Mission hospitals provide 48% of the medical services in Kenya, and they depend upon our donations to survive. Please consider sharing your Christmas offering plate or contributing a holiday check. We need medicine, equipment and supplies. Please note "MASENO HOSPITAL" on the memo line of your check to St. Andrew's Episcopal Church, PO Box 1287, Edgartown, MA 02539. Asante sana!

Two Kenyas and a Collect

We hear in America about "two Maines" and "two Vineyards." In Kenya, we also hear about disparate (some would say desperate) economies. Nairobi appears to be bustling, but we are told the safari business is still struggling and crime is increasing. The price of food has more than doubled here since last winter, but no one in Maseno has seen an increase in income, very few are employed, and many of those have not been paid for two months. The bean and corn fields look lush from the road, but the harvest is both late and disappointing. For the first time in years, there are not enough beans, and there is talk of importing corn.

Emmah explains it simply, "The long rains made it hard to grow good beans, and we did not have enough money this year to buy fertilizer for the corn." On Monday, after a long hot day walking through corn fields to make home visits, we stopped in nearby Luanda. It was market day. Our two volunteer HIV/AIDS community health workers, both single mothers, came back empty-handed: "The tomatoes and beans were too expensive. There is no corn. We'll have ugali (boiled cornmeal) again tonight." Yet Kenya is not Zimbabwe, not Thailand, not Mumbai.

Kyrie eleison, Christe eleison, Kyrie eleison.

"Almighty and gracious Father, we give thee thanks for the fruits of the earth in their season and for the labors of those who harvest them. Make us, we beseech thee, faithful stewards of thy great bounty, for the provision of our necessities and the relief of all who are in need... Amen." (Thanksgiving Collect, The Book of Common Prayer)

Silence

...is not always golden.

Sometimes it is a reflection of a high fever, like the 106F/41.1C recorded for Jesca, a sweet three-year-old who looks a lot like my granddaughter. Fortunately, her mother brought her to the hospital in time for us to put her on IV fluids and quinine for malaria. Mama Jesca's once-convulsing child is recovering and will go home tomorrow.

Sometimes it is an expression of pain. Joab, 9, was dropped off at the outpatient department yesterday after he had all but severed his baby finger with a panga while cutting grass. Showing no physical signs of shock, he walked quietly to our minor (operating) theatre for a tetanus shot, amputation and discharge.

Sometimes it precedes (and follows) the death rattles we witnessed in a two-year-old admitted yesterday. "She was perfect when God gave her to us," explained her father. "Now God wants to take her back." He then described a year of Nora's recurrent "boils," fevers, weakness -- and her intermittent treatment with herbal remedies. Three weeks ago, he said, Nora developed another fever, plus a stiff neck, but no boils. She died an hour after admission.

Silence is a time to pray. We didn't make it to church yesterday, but we certainly prayed.

Careful what you wish for...

According to the neighbors, we have had intermittent power and water for almost a year in Maseno. One of my assignments at the hospital is to "help improve nursing standards." The nurses and I have met several times. In an effort to better understand their roles before presuming to help them "improve" anything, I invited the charge nurses to share their own concerns and suggestions. "Better staffing" was answer number one, a response we'd hear from nurses at any hospital, at any place in the world. After that, the answers became more particular to Maseno:

Jik/bleach, gloves, rubber aprons and boots for infection control. (Back-ordered Jik. Can't afford the other items.)

Electricity. (It was out for 72 consecutive hours last week.)

Water. (None on the wards since July, it began flowing from the spigots again today. Yes, Mama, this, too shall pass.)

Foreskin Follies

That's what the doctor calls the current "occupation" of Maseno Hospital. Eighty 13-year-old boys are here for five days of education and circumcision, a pilot project funded by NGO's and facilitated by the CCC, in a well-documented effort to reduce the spread of HIV/ AIDS in Kenya. Three more waves of eighty adolescents each are scheduled to come during the next three weeks. A gaily-striped tent has been erected on the hospital lawn, and colorful plastic mattresses have been spread, wall-to-wall, on the floor of Pediatrics.

Fortunately, the hospital census is down, but the patients we have are sicker than ever. Among others, 80-year-old Truphena was admitted today. Her daughter brought her in after a young mentally-ill grandson had stabbed Truphena twice in the chest and tried to strangle her.

Phoebe Leah, 28, has been here for three days with her two-year-old son. Both are weak and listless, wasted by AIDS. Mama weights 35 kg, and Zedekiah weighs 7 kg. (A kilogram is 2.2 pounds; you can do the calculations.) Phoebe suffers from oral thrush and Kaposi's sarcoma; she also has KS lesions on her swollen right leg. The only treatment we have for KS is vincristine IV. She needs to be stronger before we administer it. Zedekiah is not walking, not talking and not smiling. His healthy 7-year old brother is being cared for by a grandmother. A middle child died three years ago. Because Zedekiah and his mother have AIDS, they were turned out of the house by his grandmother and his (HIV-positive) father -- who has another wife. Phoebe Leah and her youngest live in a shed on the edge of the property. She is too sick to work; whatever Phoebe is given to eat, she gives to her son. It isn't enough.
Benson, 10 years old, presented almost two weeks ago with a fever and pancytopenia. He cannot hear or speak, and his father is dead, so his mama spends most of her days at the hospital with him. She agreed to have her son tested for HIV since Benson had had a transfusion as a baby. He is HIV-positive. Since he is the middle child of three and his father had died, we needed to err on the side of caution: Mama and her other children were advised they should be tested. Sadly, all of them are HIV-positive. Fortunately, the CCC here offers excellent counseling and free anti-retroviral medications. But Benson is still spiking temperatures, and we cannot determine the cause. Pneumonias, aplastic anemia and malaria have been ruled out; he has been started on anti-TB meds. Perhaps he has an empyema?

Philip, 17, was brought by his mother to the Outpatient Department in the middle of the morning. He had fallen, hard, two days ago on a playing field at school and was complaining of abdominal pain. Ultrasound examination revealed a lacerated liver; we sent him by ambulance to Provincial Hospital in Kisumu where there is a surgeon.

Grace, 26, was admitted via the CCC this afternoon in a psychotic state. After 200 mg. of Thorazine and an injection of Valium, she was still combative. I foolishly forgot I was wearing my glasses while assisting with her examination. Grace managed to yank them off my face and crumple them with one bare hand. That's not quite the reason I anticipated I'd need a second pair, but I'm glad I packed both. Grace will be transferred to a psychiatric hospital tomorrow.

Tomorrow Kwan Kew Lai, an infectious disease physician from Boston, and I will go with Dr. Hardison and the mobile medical van to Ekwanda between morning and afternoon rounds. Our housemates Ralph (a UConn medical student) and Sue (a Boston EMT) will be leaving the hospital early to go on safari to the Maasai Mara. We may find our rambunctious pediatrics unit is somewhat more subdued by the time we all return.

Sweet Spirit

If it's Wednesday, it must be... Chapel. I am always grateful to walk to St. Philip's in the early morning sunshine. Primary school students, hospital staff members and farmers alike call out, "Habari, Mama/Daktari/Sister!" as we pass one another along the road. I crossed the theological college campus a few minutes late today and heard the now-familiar rhythmic a capella rumble of the first hymn through the open windows: "There's a sweet, sweet spirit in this place." Dorcas gave the homily, a moving message about empowerment, encouraging us to fully use the gifts/talents God gives us. Eucharist is always both personal and corporate, and it is a joy to sink into the comfort and company of all faithful people in the tiny red brick chapel that reminds me of home.

One week from tomorrow most of my family will gather together for Thanksgiving. Half a world away, I will be working at the hospital and missing, but thinking gratefully of, them all. We've scheduled our own holiday dinner (chicken, mashed potatoes, gravy, sukuma wiki/greens, baked pumpkin and mango pie) for Sunday, four days ahead of America's. The Pilgrims never landed on Kenya's shores, of course, but the authorities here seem to routinely invent new national holidays. The Hardisons and I decided we could be just as arbitrary and moved Thanksgiving up a few days to suit our patients' (OK, and our own) needs.

So Happy Holidays, Everyone! In spite of pain and poverty, illness and anxiety, we have much to be thankful for, the world over. I am especially grateful for your love and your prayers, and so are the people of Maseno. There truly is a sweet, sweet spirit in this place. We feel blessed to be able share it, and we send our love and prayers to you, as well. Asante sana.

All I Really Need to Know I'm Learning in Kenya

(with apologies and thanks to Robert Fulghum)

(1) Share everything. Some people may take advantage of you, but others may not starve tonight if you simply share your last bananas. (This applies to people. The monkeys are doing fine.)

(2) Play fair. Although "African time" is often two hours later than "American time," continue to show up for your appointments as scheduled. You'll meet some fascinating folks while you wait.

(3) Don't hit people. Their pangas are likely to be bigger than yours.

(4) Put things back where you found them. Especially the slug you found crawling out of the sink drain. He needs water, too, and you don't want to find him in your drinking glass.

(5) Clean up your own mess. Scraps go to the kukus, and absolutely everything else gets recycled.

(6) Speaking of kukus, jog cautiously. It is easy to trample a baby chick -- or trip over a rut, for that matter -- by dawn's early light.

(7) Don't take things that are not yours. Someone else probably will, and you won't want to be blamed for it. (Remember the pangas.)

(8) Say you're sorry when you hurt somebody, even if it's a patient whose limb you really had to manipulate to determine mobility. And especially if you asked a foolish question like, "Are you the patient's mama?" and were told, "No. I'm the co-wife."

(9) Wash your hands before you eat -- and afterward, too. There are often no utensils. It is also polite to pour the water and hold the bowl for the next person.

(10) Flush only when necessary. Water is precious. Flushing does not apply, however, in the "long drop." (Remember recycling.)

(11) Piki-pikis kill. Since no one wears a helmet here, piki-piki and panga victims are vying for beds in the hospital and morgue. Perhaps someone could send me some "Ban Mopeds" bumper stickers from the Vineyard...

(12) A little goes a long way, and it's remarkable what we can do without. A latex glove makes a perfectly good tourniquet, stones in plastic bags make reasonable ankle weights, a dried up Bic pen makes an excellent thermometer case, and empty toilet paper rolls make perfect drapery tiebacks.

(13) You don't need to speak Kiswahili to understand the universal language of love. Just watch a mama nursing her child.

(14) Warm cookies and milk are good for you. But Emmah's homemade maandazis are even better.

(15) Don't hog space. There's room for all of us. Even mosquitoes and termites and cockroaches have their places in the world. Preferably outside.

(16) Live a balanced life. Learn and think and work and play and sing and dance at least a little every day. Especially if you can sing with a Kenyan caller and dance to a Luhya drumbeat.

(17) Take an afternoon nap on your mat (OK, I'm still struggling with this one), preferably not in the equatorial sun.

(18) Watch out for matatus, boda-bodas and piki-pikis. They all hurtle along carrying 3-4 more times their authorized number of passengers -- and usually a few chickens and goats, besides.

(19) Hold hands (just with the same sex, please, in East Africa), and stick together. We can get along without electricity, but we can't get along without one another.

(20) A highway is not necessarily paved. Nor is it even two marked lanes. Nor would anyone notice if it were. So remember #19: hold hands and stick together -- and cross quickly.

(21) Don't believe everything you hear. Especially patient histories. The reasons are perfectly innocent and perfectly clear: (a) patients want to please medical professionals, and (b) the concept of time is not the same where different where people don't know their birth dates, where 9 AM means noon (at best), and where pain is tolerated until it's intolerable... i.e., "How long have you had chest pain?" Two weeks. "How long have you had vomiting?" Two weeks. "How long have you had fever?" Ayup: two weeks.

(22) Peepers and geese and antimalarial drugs can keep you awake all night. So can one pesky mosquito... Nets are good. Doom is better.

(23) Be aware of wonder. Wherever we are in God's world, from South Beach to Lake Victoria, there is great beauty to behold -- particularly in the eyes of children.

(24) Goldfish and hamsters and gerbils and white mice all die. So do we. But we die a whole lot faster if we are poor and hungry and unable to get medical care.

(25) God loves me and Y-E-W! (Thank you, Archbishop Tutu!)

Monkey See, Monkey Do

Well, we wondered when it would happen...

Yesterday we finished eating lunch between rounds and took our dishes to the kitchen. Just as we returned, we caught a vervet in the act of stealing a banana right off the dining room table! He had come in through the open window, perched on the top rung of a chair, and brazenly stretched out his long arm to neatly swipe one banana from the bunch. He started to peel it in front of our eyes before housemate Ralph shouted "NO!" and chased him out of the house (banana and all) with a rolled up newspaper.

The monkey obviously wasn't properly trained because he was unfazed by the chase. He leapt to the railing of our porch, cocked his head, finished peeling his prize, and smugly chomped it down, bite by happy bite. We watched in astonishment as his friends began gathering on the front lawn. The word was obviously out, and they were lining up for a chance to snitch our remaining bananas!

It's about 85 degrees here in the afternoon, but we're either going to have to close the dining room windows or else hide the bananas if we want to have any left for ourselves!

Snail Mail

My sainted father rued the day "real" correspondence began to be replaced by email. The longer I live in East Africa with dial-up internet, the more I concur with his assessment. On the other hand, snail mail takes 2-3 weeks to get to Kenya, and our packages are intercepted at Customs, never to be seen again.

But instant gratification isn't everything, and I am thankful to have received two pieces of snail mail in the month since my arrival in Maseno: an absentee ballot (alas, too late to be counted) and a wonderful letter from The Rev. John T. Braughler in Pittsburgh, PA -- the person perhaps most responsible for my being here.

Fifty years ago, Pastor Braughler was minister, teacher and role model to about 25 of us who met as preteens for two full years of Catechism classes at Good Shepherd Church in Monroeville, PA. He made Saturday mornings come alive, and he somehow got us through those painful, but formative, junior high years.

My faith life began to develop when I was a little girl in Vacation Bible School, but it blossomed when I was a gawky adolescent in Good Shepherd's Catechism class. To my delight, a friend and retired Lutheran minister found John Braughler's address for me just a few years ago. (Thank you, Richard!)

I had longed to thank Pastor Braughler personally for all he had done, all those years ago. Now I can thank him publicly, as well, for sending me the first snail mail I've received as an Episcopal missionary in Kenya. How appropriate that it came from a man who fostered the faith that has sustained me for 50 years!

Asante sana, Pastor Braughler. God's eternal peace to you and your family, and my eternal thanks for all you gave us... Amen.

P.S. In case anyone else remembers the Palmer method and still owns a (not necessarily quill) pen, the address here is Maseno Hospital, PO Box 116, Maseno 40105, Kenya. My email address is dianne.smith.rn@gmail.com. It is a gift to hear from everyone, by every means, and I will make every effort to reply.

Together, "Yes, we can!"

The hospital is full. Yesterday's morning and afternoon rounds simply merged into a somewhat chaotic 12-hour shift. I'm sure Dr. Hardison went home and worked some more. Although I brought a couple of texts back to Rotary House, my own research into the diseases-of-the-day didn't last; I quickly fell asleep.

The usual cries of roosters and hadada ibis roused us at dawn, however, so I've been reading this morning about some of our current patients' problems: cutaneous anthrax (contracted by a farmer with a sick cow), a medullary tumor (defined by CT scan in Kisumu and attributed -- incorrectly, per LP results -- to cryptococcal meningitis), lumbar TB and pyelonephritis, to name a few. Other patients are suffering from perhaps more-familiar, but equally debilitating, malaria, bacterial infections, cancer and CVA.

Our housemate Abraham returned last night from a week-long HIV seminar in Kisumu, bringing tales of the Obama election celebrations there. Kisumu is the third-largest city (behind Nairobi and Mombasa) in Kenya. Abraham said a huge TV screen was set up outside in the city center, traffic was blocked off, and thousands of people watched and sang and danced and hugged for hours, as the election returns came in. He also reported that there was no beer left in the city, but that it was a joyous, peaceful (no-panga!) time.

Here in Western Province, home of the Luo tribe, the daily greeting is no longer the perfunctory "Jambo; habariacu?" ("Hello; how are you?") It is now, simply, "Yes, we can!" as people clasp hands and smile. Barack Obama's father attended the nearby Maseno School (until he was kicked out, per our President-elect's first book). We frequently walk by it, en route to St. Philip's.

Election day and the ensuing national holiday were quiet on the hospital compound, but joy continues to show on the faces of Maseno. We all pray for Barack Obama, his family and advisors, our countries and the world. And we give thanks for the hope that is now in the hearts of many for the first time in their adult lives.

"Together we can!" was the theme of the CCC orphans' Christmas party here last year. I blogged about it at the time, and then again in the aftermath of Kenya's elections in December. TOGETHER, "Yes, we can..." Hm. Isn't that the concept of community Jesus was talking about awhile ago, too? Inside the hospital and outside in the world, renewed hope inspires all of us -- sick and well -- as we begin another day.

Ward IV/Pediatrics

Many of the kids admitted to Maseno Hospital have malaria and/or bacterial infections; most of them survive after we administer appropriate fluids, blood transfusions, anti-malarials and/or antibiotics. It's a miracle that we don't see more injured children here. The neighbors' kids play with real pangas (machetes) as four- and five-year-olds, chopping away at trees and stumps in our yard. They also use sticks as guns, just like kids do in the U.S., shrieking loud staccato "bam-bam-bam-bams" -- usually outside an open window as I futilely try to read. Fortunately, at least, they don't play with real guns.

We admitted a four-month-old baby yesterday, but he was quickly transferred to PGH, the public hospital in Kisumu, with extensive burns on his face and trunk. Jeremiah's five-year-old sister had been carrying him, to help her mama, but Rose wasn't strong enough. She accidentally dropped her brother into a vat of hot uggi (porridge) that was boiling over an open fire. It was a sadder-than-usual moment at Maseno Hospital. The baby was wailing in pain; his brown skin had been burned off, revealing pink and white second and third degree burns; the mama's tears were streaming down her face; and I could only imagine how upset (and splash-burned, too) Rose herself was.

Shortly before I arrived in Maseno, several children were admitted from an orphanage in Kakamega. Brought in by alert and caring guardians, the kids were treated here for salmonella and released. A major outbreak was averted. In the process, though, we heard a few of the kids' stories. One infant had been buried alive by her distraught mother; she was rescued by a neighbor and delivered to the orphanage for safety. Another was stunted in growth, due to lack of food and medical care as he grew up alone, without adult supervision. But it was heartwarming to learn that those kids have a safe place to live now, a place where they are cherished, as all children deserve.

Leah

Her mother brought her to the hospital three days ago. Leah's chief complaint was a headache. She said her husband had died in 1996, and she asked us to let her die, too. Leah, 36, was thin and somewhat listless, but her conversations (in Kiswahili) were animated. She had no pain except the headache, her vital signs were normal, and her chest and abdomen were clear. HIV positive with a CD4 count of 238, her malaria smear was negative, and her FHG (full hemogram/CBC) was normal; there are no chem screen panels in Maseno. With not much to go on, but given the host of infectious possibilities here, Dr. Hardison started her on the antibiotic Ceftriaxone. We watched and waited.

Yesterday her mother reported that Leah had diarrhea. Her chest was still clear. At the same time, her temperature began to spike, and she quickly became unresponsive. Within two hours, she was comatose. We weren't sure why, but Leah was slipping away in front of our eyes. Ralph, a visiting med student from U.Conn, performed his first lumbar puncture to perfection; Leah's spinal fluid came out clear and without undue pressure -- although we have no gauge here. It was sent to our lab and the results were returned quickly: no cryptococcus, but Leah's glucose level was less than 1/4 of normal. With no previous history, she had lapsed into a hypoglycemic coma!

I sat next to Leah's mama while Dr. Hardison administered a bolus of IV dextrose and ordered D50. Leah roused and was responsive within minutes. Her previously frightened mother hugged and kissed me: "Thank you, thank you, thank you, Sister." Equally joyous, I replied, "We need to thank Dr. Hardison. And God." Since Leah is still febrile, there is certainly more going on than "just" hypoglycemia -- which Dr. Hardison says he sees surprisingly often here. But at least we can now begin to tackle that problem... and then head for the weekly orphan feeding program and mobile medical clinic in Esiandumba.

Hymn 593 (ACK Songbook)

"Let us rejoice and be glad..." we sang at St. Philip's Chapel this morning, not long after the dawn of a new day in Kenya and, indeed, around the world. But we first sang, "Softly and tenderly Jesus is calling." Too soon and too sadly, I learned the reason.

We have no television or radio here at Rotary House; the internet was overloaded with traffic and inaccessible all night. As a result, I awakened happily to the sound of two cows lowing outside my window, rather than to the blaring blue light and cacophony of TV newscasts. The coffee was on before 6 AM since Emmah knows my Wednesday morning routine.

"Morning has broken," I hummed to myself as I walked down the long red road to St. Philip's. Maseno mamas were out early, gathering sticks for firewood; the men were lounging by their boda-boda's (bicycles), disappointed that I chose to walk the distance; and a few fortunate children were setting off for school in their distinctively-colored uniforms. Periodic outbursts of applause erupted from some of the houses along the road, hinting at the excitement in Luo-land as the US votes were being tallied. Today is a very special day, indeed, and even Kenya's Kikuyu president has astutely declared tomorrow a national holiday.

But for many people here, the days are much the same. They are days of serious struggle. Western Province is the second-poorest province in the country, and life is hard -- not just for our hospital patients. In the past nine months, since the post-election violence in Kenya, corn has doubled in price, rice has tripled, and the current crops won't be harvested until December. The cost of petrol/gasoline has skyrocketed, we are in the midst of yet another inexplicable water shortage (a municipal financial issue, definitely not a water table problem), and power outages are increasing.

Today was especially hard for Florence, a 25-year-old HIV-positive woman whose suckling third child was born eight months ago. Afterward, she went to the Maternal Child Health Center for family planning assistance, but she was eight weeks too late. Florence learned today that she is 24 weeks pregnant. She spent the morning in tears, anxious about how she'll be able to provide for her young family. Her husband is too sick to work.

Today was harder still for Christopher Ruto. A theological school student at St. Philip's, he is the father of twin toddlers and three older children. His beloved wife Rhoda died last night in a Nairobi hospital. She had been in a coma there for several weeks, after suffering a brain aneurysm. The whole school is in mourning, and so are we. Please pray for Rhoda's family.

The bishop's entourage arrived at a Mothers' Union meeting this afternoon. Bp. Simon Oketch came to congratulate the ladies on their participation in a new micro-lending program being provided by the Jubilee ministry of the Diocese of Massachusetts. "Let us rejoice and be glad," we sang again, between spontaneous "Obama" chants and Nan's "You go, Girls!" refrain.

After the meeting, a crowd of happily shrieking children drew my attention. They were hunkered down in the dirt together; I thought they might be playing marbles. Instead, I found them trapping termites beneath a plastic-bag anchored by rocks over a small patch of earth. When the bag was lifted, dozens of hands dove wildly into the pile of termites that had collected. The live afternoon snacks, wiggly wings and all, immediately disappeared into hungry mouths. (The wings were quickly spat out.)

Padre Richard's homily this morning was from I Peter 2:21. "Life is difficult," he said. "But Christ suffered, too, and He suffered for us. The cross of Christ shapes and sharpens us. It draws us closer to Him and to one another. Yes, 'softly and tenderly, Jesus is calling, calling for you and for me.'" For Rhoda and Florence and the kids eating crunchy live protein. For the new American president and his family, for the United States, for Kenya and for the world. Let us all draw closer together. "This is the day the Lord has made. Let us rejoice and be glad."

Birthday Present

Major celebrations are planned around the globe this month, the most important of which is my mother's birthday.

Your gift is online, Mama. Just click on www.picasaweb.google.com/dianne.smith.rn. (I'm sure she'll share with everyone. My mother is the kindest woman in the world.)

Birthday blessings, hugs and kisses -- from me and the giraffes! I love you.

Starfish Story

Philip was admitted last evening, just as we were finishing rounds. A shy, stunted young man, just a boy, really, he looked both younger, and somehow far older, than his 20 years. He was brought to us by a teacher in the community, a Rotarian who helped to organize the Jiggers Treatment Program at a school in Kwilhiba Parish. The teacher had learned about Philip from his neighbors. She went to his village to find and bring him to Maseno Hospital.

Philip's eyes were downcast. He was encrusted with layers of clay, and he smelled like sour dirt. Every centimeter of his malnourished body was disfigured by ichthyosis and by the swollen masses of lesions that are produced by "jiggers." Jiggers are caused by fleas in the soil. Their larvae infest and infect the skin, turning it to lumpy, painful shreds over time. We usually see the condition in patients' extremities, not enveloping their entire bodies. But Philip had been sleeping for years on the dirt floor, where jiggers dwell, of his one-room mud house. His legs were also swollen bilaterally -- perhaps by infected lesions, perhaps by elephantiasis. We will know after the lab results come in today.

Last night, we simply bathed Philip. Shocked into silence by disbelief and galvanized into action by grief, I lugged buckets of water to Ward I. We washed and rinsed Philip, sponged him for 15 minutes with a chemical treatment that will -- after repeated applications -- suffocate the jiggers, rinsed him again and helped him dry. Philip was quiet, compliant and understandably embarrassed. We then applied petroleum jelly to his entire body, in an effort to address the scaly skin around the shreds. Before finishing rounds, Dr. Hardison gave Philip clean clothing, beans and ugali (finely-ground cooked cornmeal) for supper, and gently tucked him into the first bed he may have ever slept in.

Philip's story is still piecing itself together, but he was orphaned at an early age. His father died before he was born, his mother soon thereafter, and he was raised by a grandmother who suffered from a progressive dementia. Philip tried to provide for her and for himself by cutting and selling firewood. His grandmother's condition deteriorated to the point that she was incontinent. They reportedly lived in squalor, their mud house caving in around them, their clay floor infested with bacteria and jiggers. His grandmother died before receiving any treatment, and Philip was left alone.

He is safe now, but frightened and overwhelmed. We pray that Philip will stay with us long enough to fully recover. He has been promised housing and a job in his village, guarding a kiosk/shop with a cement floor (hence, no jiggers). There's that Hope again, "that thing with feathers that never stops at all." But we have to wonder how many more Philips there are in the world... As Gerry reminded me last night, "He is our starfish."

[Please look it up if you don't remember the wonderful starfish allegory. I can't retell it now; thanks to your love and support, I will be leaving soon with the mobile medical team for the Saturday Orphan Program in Ebwali.]

Mothers' Union

Many of you know how important the Mothers' Union is to the welfare of the children in the 38 parishes in the Diocese of Maseno North. Nan Hardison has helped the neighbor ladies assume responsibility for the orphans in their communities. Their programs teach and feed about 500 kids per site per Saturday. The food, crunchy hot corn and beans, or githeri, has traditionally been supplied through outright grants from individual churches in the U.S. It costs about $4000/year per site. The mobile medical clinics that Dr. Hardison and the hospital staff provide cost an additional $5000/year per site to provide. Because of limited resources, only sixteen feeding programs and five medical clinics currently exist. Bishop Oketch and the Mothers' Union have suggested micro-lending as an alternative means of funding, in an effort to resolve the inequities and ultimately make the feeding programs available to all 38 parishes in the diocese.

I accompanied Nan this morning to the weekly Mothers' Union meeting, where she helped seven more parishes complete their applications for micro-loans ranging from 20,000 KSh ($250) to 50,000 KSh ($625). One program has already been funded, and Nan expects that an additional eight parishes, totaling sixteen, will be in process by the end of November. That's almost half of the parishes in Maseno North, so the caregivers were quite excited. Several business projects are planned, including farming of grains (using the labor of the women and older children, not hired help), sales of "paraffin"/kerosene for cooking within the community (short-cutting the long walk to the paraffin businesses located many kilometers away along the highway), and sewing (purchasing more fabric for parishes with machines).

Nan also announced that donors were sending money to provide rice, instead of corn, to go with the beans for the orphan program at Christmas time -- a real treat for the kids! Much hand-clapping, hymn-singing, "Bwana Asifiwe's" ("Praise God's") and "Ai-yi-yeee's" ensued. As always, Nan encouraged them, "You go, Girls!"

Diwali and Other Celebrations

Luminaria line the streets of nearby Kisumu, marking the five-day "Festival of Lights," or Hindu New Year. Kenya is a multi-ethnic country; although the Hindu population is a minority, it is well-represented in the business community here. Rich traditions reflect Kenya's 42 tribes, and a fragile peace has returned to this beautiful land.

Although controversy reigns around implementation of the Waki Report and corruption scandals are reported regularly in the local press, all headlines now focus on the upcoming U.S. presidential race. I asked a matatu driver in Nairobi last week, "Will it invite more conflict between Luos and Kikuyus if Barack Obama wins?" His answer was swift and incisive: "Obama is an American." But here in Western Province, the local populace is reading the news as avidly as the expats.

While the world awaits the outcome of the elections, my grandchildren are getting excited about Hallowe'en at home, and I am grateful to receive the Eucharist at St. Philip's. It is a lovely early-morning walk across the equator to chapel services.

Time to Feed the Chickens

That is Dr. Hardison's euphemism for "Let's break for lunch." But our days are full, and yesterday there was time to feed only the patients. Gerry diagnosed and treated everything from aplastic anemia in a pregnant mama to Potts' disease, r/t HIV, in one 25-year-old male and CIDP (chronic inflammatory demyelinating polyneuropathy) in another. Samuel has died, and Eunice is barely alive, but Rose has miraculously recovered from cryptococcal meningitis. Our Medical Officer admitted a Maseno School student with a fever and a large mass on his neck. Silus also treated a mama, who was compulsively eating dirt, for geophagia/pica and removed a cockroach from a toddler's ear. We were interrupted during afternoon rounds by a fracas outside Ward I when roaming chickens took exception to marauding monkeys. The vervets were considering lunch, themselves: baby chicks (kukus) are apparently quite a delicacy.

Borrowed by the Baptists

A funny thing happened on the way to the ACK (Anglican) services this morning... A patient's relative, the wife of the pastor of the local Maseno Bible Church, appeared at the hospital gate to recruit Doug for a church service near the Busia Road. "May we borrow you, too?" she asked, so Sue and I joined them, walking through lush green fields of corn and passing a couple of inebriated university students en route. We soon found ourselves singing "Stand up, Stand up for Jesus" and listening to a lay leader's passionate message, generously interspersed with Bible references, about hope -- our theme for the week, the month and the years to come.

Yesterday another young child was admitted, feverish, convulsing and unconscious, to the hospital. His mama had no money so she had waited almost too long to bring him in. After IV quinine and copious fluids, little Ibrahim is responding to malaria treatment, TG. Eunice and Samuel, however, with more complicated conditions, are still teetering on the brink of death, and we are running out of treatment options. But we still have hope.

Meanwhile, two Swiss journalists brought their driver, in distress, to the Outpatient Department. Suffering acute abdominal pain, the patient was treated and referred for possible surgery. He was not well enough to transport the reporters to their intended destination: the home of Barack Obama's grandmother, 15 km down the highway. The poor woman was spared these two, but she must feel as besieged by the legions of international journalists camped out in Siaya as she is proud of her grandson campaigning in America.

Hope springs eternal on many fronts. Amen.

Best-Laid Plans

Reality check #9999: We tried to order the oxygenator this morning, only to discover that the local catalog price has almost doubled (to $1,500) with Kenya's rampant inflation. Since there is no reliable way for medical equipment to be securely shipped from elsewhere and retrieved at Customs, we have ordered two suction machines from the catalog, instead. It is of some comfort to know that Dr. Hardison says the need for suction equipment is even greater than the need for oxygen equipment. Again, the list and the prayers go on...

Near the top of my own wish list for Maseno Hospital is an incubator. Although the infant mortality rate in sub-Saharan Africa is extraordinarily high, the incubator we have is pitiful. A new one would cost the equivalent of $7,000. But how many more babies must die unnecessarily?

Triage Redux

It's "deja vu all over again!" Last year I wrote from Maseno about the oxygen problem here. It's not about altitude; it's about allocation of resources. We had a desperately ill child who needed oxygenation, but that meant removing the only equipment we had in the hospital from a mama who also needed it. Triage, Kenya style... Thankfully, both patients survived.

This week Eunice, with probable PCP pneumonia, TB and an 02 sat of 84% on room air, has been dependent upon oxygen for her slow road to seemingly miraculous recovery. Carol, however, with widespread consolidation in her lungs and a similar saturation level (normal is high 90's), also needs help breathing. We moved a large, unwieldy tank over from the surgical suite three days ago, but it ran out of oxygen yesterday. Dr. Hardison said it may be weeks before it will be refilled. Meanwhile, Samuel presented in acute respiratory distress. His O2 sat was a startling 67% (which we hope might also be r/t impaired circulation and finger-clubbing), so last evening we moved the equipment from Eunice's bedside to Samuel's. Then we had to wait for the electrical power to come back on in Western Province.

All three patients survived the night, TG, and today we are going to order three xray view boxes, two new suction machines and an oxygenator from Nairobi, thanks to the generosity of the Rotary Club of Martha's Vineyard and St. Barnabas Episcopal Church in Falmouth, MA. Thank you/asante sana, Everyone!

"Half a Hospital"

It is sometimes frustrating to practice medicine in a developing country because the resources are so limited. "Routine" chem screens are not routine and are, in fact, very difficult (and very expensive) to come by. Third and fourth generation antibiotics do not exist. Without a surgeon, we cannot do more than the most basic procedures in Maseno. Dr. Hardison shakes his head and mutters, "We'll never be more than half a hospital."

But half a hospital is better than none if you are Eunice or Otima or Daniel or Fillister or Margaret. To our great, albeit guarded, joy, Eunice is still alive, apparently responding to the aggressive, if limited, treatments that Dr. Hardison prescribed. Her fever is subsiding and her respirations are easing. She is still gravely ill, but we pray with her Mama that she will continue to improve. Otima's broken bone has been set, and Ibuprofen has been dispensed. She will be discharged in time to go to her granddaughter's funeral today. Daniel was seen in the Outpatient Department this morning and referred immediately to Kisumu for surgery. Had he waited any longer or gone somewhere else, a delayed diagnosis of his inguinal hernia might have created the necessity for major surgery/bowel resection.

Fillister, accompanied by her three-year-old daughter, Doracilla, was admitted with the classic symptoms of TB. Severely scarred and disfigured by burns from a stove explosion two years ago, she was then abandoned by her HIV-positive husband. Fillister may well be positive, herself. In addition to testing and treatment for probable TB, she needs to be tested for HIV, and so does her little girl. HIV infection, resulting in a depressed immune system, is of course the primary reason people contract the countless opportunistic infections we see here. (Later NB: Fillister is HIV-negative; hurrah!)

Margaret was admitted after being run over by a piki-piki (motorized boda-boda). We tended her injuries, did a chest xray because she complained of a one-year history of coughing, and discovered that she, too, has TB. Margaret was then tested for HIV and was found to be positive. She will recover from her injuries and will be referred, with her husband, for VCT (Voluntary Counseling and Testing).

Both of these women should be able to live long and productive lives, thanks to anti-TB treatment and free anti-retroviral medications. But Margaret's marriage, also, may well dissolve through no fault of her own. The rate of HIV infection in females in Africa is much greater than that for males. Polygamy is legal in Kenya. For men. If a male is infected... well, we can all figure the odds for infection, as well as for abandonment.

As afternoon rounds are about to begin at our "half-hospital," though, I remember that even in America, the other half of getting well is always hope.

PS

Thank you all for your responses and your prayers. The mud hut tragedy is just the tip of the iceberg/mountainside, of course, but it is no worse here than in Haiti or Sudan or anywhere else in the world. Perhaps the real tragedy is that things like this happen every day, multiplied ad infinitum, and that we get complacent enough to forget them or else distressed enough to "shut down." One of my assigned tasks in Maseno is to help bring order-out-of-chaos to the medical supplies. We need ready access to oxygen tubing and nebulizers to keep people alive. One of my unspoken responsibilities, though, is to help tell the stories. We need ready reminders of one another's needs to keep human hope alive. Please don't forget that every one of us really can do "something" -- from prayer to participation. And every one of you is participating -- by reading and by caring. Asante sana and God bless us, every one.

Karibu Maseno!

It was wonderful to be "welcomed back" by the people of Maseno. Emmah had prepared a lovely room for me, replete with bookshelves for a year's supply of bug dope, vitamins and Kindle books -- TY, All! I am at home at Rotary House and happy to have the company of Sue, a premed student from Massachusetts, and Doug, a young doctor from San Diego. Drs. Nan and Gerry Hardison are fine and send their best to everyone, as do I. We celebrated their "birthday month" with visitors from Rome over a delicious dinner at St. Philip's on Sunday evening.

Yesterday's three-hour humdinger of a storm will guarantee that we'll have no electrical power in Maseno for awhile, so I'm working off the laptop's battery and typing (vs. dancing) as fast as I can, hoping to save and post this entry whenever we have "air time" again. We cannot complain; a drought and water rationing in Nairobi put our own mere power outages in perspective. We even had a 13" TV in the living room until it fried last night. It was quite a luxury -- although the local (Kiswahili) channel seemed to provide the only reliable reception. We could sometimes find Al Jazeera, however, and could occasionally even get BBC. Perhaps needless to say, every station in Maseno reports regularly on US politics. It will be interesting to be here on election day!

Meanwhile, we are celebrating the fresh morning air and sunshine, enjoying Emma's oatmeal, and readying for morning rounds at Maseno Hospital. The census was down when I arrived Sunday morning, but we had five new admissions before the day was out. Monday was Kenyatta Day, a national holiday; however, as always, there is no respite from illness and poverty in rural Kenya. In the Outpatient Department, a young mama presented with bilateral lactorrhea. She stopped nursing her youngest child two years ago, but lactation spontaneously recurred shortly thereafter. Two weeks ago, it stopped; her breasts are swollen and painful but not abscessed. She is being evaluated for a possible tumor of the pituitary gland and will return Friday.

On Ward I, we saw Washington, who came in too late for treatment for testicular torsion; he will be referred for an orchiectomy since we have no anesthetist here at present. John presented with severe headaches and has been referred to the CCC for VCT (voluntary counseling and testing for HIV) after Dr. Hardison ruled out cryptococcal meningitis. Another patient came in with gastric distress after attempting suicide; he had swallowed a liter of Formalin following an argument with his employer.

On Ward II, three-week old Abigail was admitted with possible malaria and has now spiked a temperature. Eunice, who had a stillborn baby two weeks ago, was transferred from Ward III/Maternity with recently-diagnosed HIV, probable TB and and a possible pulmonary embolism. She is 28 years old, in acute respiratory distress, and will probably not survive the day. Evelyne is recovering well after treatment for a Bartholins cyst. Two young HIV+ women are suffering acute pain with herpes zoster (shingles) -- one, involving the classic T-9/T-10 dermatomes, presented with one-sided pain and coalescing pustules around her right side; the other, with T-3 and C-8 involvement, has granulating tissue in a wide swath across her chest and back. She was misdiagnosed three weeks ago at another hospital as suffering from "spider bites." It is probably too late for antivirals to help either patient; we are limited to treating their symptoms -- codeine for pain, since there are no morphine drips and no Fentanyl patches here -- and encouraging both women to continue their ARV's. The majority of our patients are HIV-positive, with the accompanying immune suppression that invites a variety of complications.

Margaret, 43, however, is HIV-negative; she has nine children and will, sadly, be transferred to a hospital in Busia, her home town, for potential amputation. Her gaping "septic foot wound" -- which we had almost hoped was "just" gangrenous -- turned out to be malignant melanoma, and her lymph nodes are enlarged. Helen, 17, is suffering from unilateral swelling; she has been diagnosed with microphilia (elephantiasis) and will be treated with steroids. Kezia, a blind and deaf 81-year-old woman, came in with a fractured femur and will be transferred for surgery; she is fortunate to have a family that can afford it. And Otisa was admitted last night: after yesterday's heavy rains, the corrugated iron roof of her mud house had collapsed on her, broken her ankle and killed her one-year-old grandchild.

The list goes on... as do the prayers. Asante sana, dear friends.

The Lord God Made Us All

It's spent an inspiring few days in Nairobi. I've met with amazing Jane Muriuki of the Tabitha Project (please do find her story online), kissed giraffes (yes, there's a picture), admired women at work at Kazuri Beads, viewed cheetahs and zebras and warthogs (but no lions or tigers or bears) in the Nairobi Game Park, practiced my pitiful Kiswhahili and shared a meal with Rose and Ndungu Ikenye, our remarkable TEC volunteers in Thika... It's also been a frustrating few days, way too many hours during which I've done battle with my laptop and lost. In the process, however, I've met countless kind and helpful folks, from driver Jonhes Mulusya to the staffs at the ACK Guest House and the Safaricom Customer Care Center. Thank you all for your own wonderful messages and prayers. I'll be on the early-morning flight to Maseno tomorrow, hoping to be of some use at the hospital by Monday -- which is actually Jomo Kenyatta Day, a very special holiday here in Kenya. Lala salama (Sleep safe), everyone.

Safe (Almost-) Home

After a lovely Logan send-off (TY, Lori, Dianne, Helen and Barbara!), I enjoyed perfect connections and flights (TY, British Airways), great accommodations in Nairobi (TY, ACK Guest House), and no swollen legs this time (TY, Beth)... God is good; yes, all the time!

It was a gift to meet John and Ann from "Other Sheep" this morning, and I look forward to seeing the Ikenyes, TEC missioners in Thika, and Jane Muriuki, from the Tabitha Orphans Project, later today. I also look forward to meeting baby elephants, giraffes and a few more of the "big five" tomorrow (TY, Ann!). I'll fly to Kisumu early Sunday, then go to Maseno, at last!

Last Sunday in church in the US, we read the 23rd psalm together. Today under my mosquito net in Nairobi, I re-member "Thy rod and thy staff, they comfort me." And I know that "Your prayers and your love, they sustain me." Asante sana/thank you all!

The First Day of the Rest of Our Lives

Yes, every day is the first day. This, the first day of October, 2008, also marks the first week in 50 years that I have been officially unemployed. (In the "olden days," twelve-year old babysitters were paid 25 cents an hour for taking care of five kids, BTW.)

In the midst of packing and preparation for work in Kenya, I am also praying the words below. Often attributed to "Monsenor" (as the Archbishop preferred to be called) Oscar Romero, they were actually written by The Rev. Ken Untener:

"It helps, now and then, to step back and take a long view. The kingdom is not only beyond our efforts, it is even beyond our vision. We accomplish in our lifetime only a tiny fraction of the magnificent enterprise that is God's work. Nothing we do is complete, which is a way of saying that the kingdom always lies beyond us...

This is what we are about. We plant the seeds that one day will grow. We water seeds already planted, knowing that they hold future promise. We lay foundations that will need further development. We provide yeast that produces far beyond our capabilities.

We cannot do everything, and there is a sense of liberation in realizing that. This enables us to do something, and to do it very well. It may be incomplete, but it is a beginning, a step along the way, an opportunity for the Lord's grace to enter and do the rest. We may never see the end results, but that is the difference between the master builder and the worker.

We are workers, not master builders; ministers, not messiahs. We are prophets of a future not our own. Amen."

Blue Ribbons and Humble Pie

Ribbons were awarded for the many remarkable exhibits at the MV Agricultural Fair this, as every, year. I wish I could award a blue ribbon to each of you who stopped by our nonprofit "Mission to Maseno" table to share your own experiences and to ask about mine. As the world's most reluctant fundraiser, I am sincerely humbled by your generosity of spirit.

Thanks to every one of you who has made a contribution over these past months, we are "over the top." My mission expenses for one year are covered, and I will be leaving for Kenya October 14th. The people of Western Province will know that I am able to be there only because you have made it possible. Asante!

One of our many surprised-by-joy experiences at the Fair was sharing the stories of the children of Maseno with the children of Martha's Vineyard. American kids who could have been riding a ferris wheel instead of looking at posters came up to ask about pictures of Kenyan kids -- kids who are now getting well and growing stronger in a small village in East Africa. It gives me hope for the future; I trust it will give hope to children everywhere and hope to all of you, too.

One by one, reaching out in love and holding hands across the world, "Together we CAN make a difference!" That was the theme of the Maseno CCC Kids' Club party last December, and that is the theme of mission everywhere.

Come to the Fair - or Our Virtual Harambe!

Harambe. - N. [Kiswahili] a "pulling together," or a working together in unity. The harambe concept is used throughout Kenya to initiate projects that require people to work together and pool their resources. In true African style, a harambe is also one big party, uniting a community while working together toward a chosen common cause.

The annual Martha's Vineyard Agricultural Fair will begin tomorrow -- our island version of the harambe, a four-day tradition that draws hundreds of people together to create a party for thousands of others, this one in celebration of the harvest year. Come to the fair, stop by our mission fund-raising table and share America's bountiful harvest... Learn more about kids in Kenya while you register for a Red Sox raffle! (Shameless hint: if you can't make it to the fair, you can still visit the PayPal button on this site's sidebar. Your donation will be deposited directly into St. Andrew's Church mission account.)

We are 3/4 toward our goal for this mission year. I will be departing from Logan Airport for Nairobi, Kenya, on October 14th. Please come to the fair or else join our "virtual harambe." Please continue to support our Mission to Maseno. And please continue to pray for us, as we do you. Asante sana, one and all!

Girl Scout Cookies and S'Mores

Like many of my childhood friends, I became a good Girl Scout by memorizing the Brownie Promise, putting on that great big smile and weaving a bright yellow oilcloth sit-upon. But when I was a child, I earned no merit badge for selling Girl Scout cookies. My parents were concerned that our neighbors might find that intrusive. When I became a woman, I still hadn't learned how to ask for support, even for very good reasons. (And Girl Scout cookies, in my humble opinion, remain among some of life's very good reasons.)

I was taught to be supportive, of course, to share my time and treasure, to commit myself to a myriad of volunteer activities, to almost always say "Yes" to almost everyone and everything, and to follow through with love and determination. But I was taught to never, ever ask for anything. Well, dear family and friends, I am living proof that even retired Girl Scouts are not too old to learn. During these past few weeks, I have needed to follow through on my "Yes" to God. I have had to ask for both prayers and financial support in order to commit the next year/s of my life to working with people who have also had to ask -- for a whole lot more.

The children of Maseno thank you, and I thank you, for teaching me some valuable lessons, even in my dotage. Hm... Perhaps I should say thank you for teaching me "s'more"! I have learned to receive your amazing gifts of time and friendship, as well as your remarkable donations of dollars and cents. You have opened your hearts as well as your pocketbooks to join me in mission, and I am thankful. Times are not easy for some of us right now, but times are much worse for many others.

I am grateful to you who have been to Kenya, who know its people and understand their needs. I am grateful to you who have never been to Africa, who know its people through story alone, and who sincerely want to help. I am grateful to you who could decide to cope with local and global crises by simply "shutting down" -- but who don't. I am grateful to you who have great means and generously share it, as well as to those of you who have little means and still manage to share what you have. I am grateful...

To my mother, siblings, children, grandchildren and friends, all of whom will be sharing my life with the people of Maseno. To the people who pray me into confidence (yes, I feel it) and email me into strength. To my beloved employers and co-workers who understand "call." To a cherished soul who pledged "$10 a week -- that's just two suppers, Dianne; I can drink millk those nights, instead." To the couple who volunteered to sit at a nonprofit table for three days in the August sun to raise AIDS-in-Africa awareness, as well as money. To church friends collecting baseball memorabilia and family friends offering a quilt to raffle...

To Diomass companeros who inspired and informed my mission heart; to Jubilee, Samaritans Now and the many organizations already serving our sisters and brothers in need; and to those who are still finding ways to serve more.To the good cook who suggested a bake sale and the Fair Trade coffee buyers who support mission at St. Andrew's. To the committed couple who invited me to an "Africa Sunday" celebration, the Cape neighbor who drove me to Chatham, and everyone who welcomed me at the service. To the friends who gave me the perfect Tilley and the attorney's office that prepared my legal documents pro bono. To a nursing school classmate who miraculously found white uniforms (the requisite dresses, not scrubs!) in her attic for me to wear in Maseno...

To a struggling shopkeeper who wrote, "I sell African jewelry and would be happy to promote it as a fundraiser for your mission trip. My own mission is more spiritual than financial." To the parish priests who provide forums and the parishioners who sit through them. To the neighbors who shake their heads and love me anyway. To the niece who supports a young son and supports me, too. To the friends who are confronting cancer and still reaching out to others in need. To the missionaries everywhere (including you!) who live out their faith, step by step and day by day. To people who are praying with us and for us and the children of Maseno, all over the world.

We are over halfway toward our $27,000 mission budget for the first year, with $17,000 donated and another $400 pledged. I promised the Hardisons that I'd be in Kenya in October. Thank you for teaching me to ask and teaching me to receive. Thank you for helping me keep my promise. Girl Scout cookies are good, but your "s'mores" are the best! They are giving every one of us the energy to keep on fund-raising for our mission to Maseno.

"We are all missionaries," Archbishop Tutu reminds us. Bwana Asifiwe (Praise God) and Amen!

Assignment Maseno

Women Who Love Too Much is the title of a pop-psych book that was published several years ago. I didn't believe then that it was possible to love too much, and I don't believe it now. God asks us to love unconditionally; God's own unconditional love for us is the reason we can -- and must -- continue to try to do the same.

We have all been invited to love some more. The Episcopal Church has commissioned me to return to Kenya to work as your missionary and their nurse with Dr. Gerry Hardison at Maseno Hospital in the fall of 2008. It is an unexpected privilege and an amazing gift.

It is also a significant effort -- for my cherished family, friends, parish, diocese and employers, as well. I ask, and I am grateful to, every one of you for your support. It will not be easy to be away from you all, nor to leave "the best job I have ever had." It is a genuine leap of faith; I ask for your love and understanding, as well as your support.

Isaiah 6:8 reads: "Then I heard the voice of the Lord saying, 'Whom shall I send? And who will go for us?' And I said, 'Here am I. Send me.'" God's call is clear, and it became clearer still when Kenya erupted into violence last winter, gravely affecting the lives of people there whose stories you have read here. The poor really have gotten poorer, the sick really have gotten sicker, and together we really can make a difference.

I invite you to join me in serving the people of Maseno in word and in deed. Please pray for our mission, and please help me return. The Episcopal Church has 70 missionaries throughout the world. We are provided with medical insurance, but the rest is up to each of us -- and, frankly, to all of us. Please see the Donation Information at left.

With your help and God's grace, I will be living and working in a region where HIV/AIDS, malaria and poverty have wiped out an entire generation. The children of Maseno must not be forgotten. Your donations are needed and most thankfully accepted.

With Every Heart and Voice

"Can't" really is a four-letter word in both English and Swahili ("Wezi"). Now, more than ever, we must cry out in the universal language of the heart: "Together we can! (Tunaweza!)"

"Together We Make a Difference" was the theme two months ago for the children's Christmas party at Maseno's CCC. It is also the theme for today and for the future of Kenya. Together people can survive and surmount even weeks of chaos. Gerry and Nan have safely returned to work at the hospital and theological college. Their love and commitment maintain the many vital programs of Maseno Missions, in spite of a reduced and anxious staff. The Episcopal Dioceses of Massachusetts and San Diego continue to support their multi-faceted efforts. And Kofi Annan continues to try to reason with two political "leaders" who now have an opportunity to live into their titles.

We have an opportunity to help. Erratic transportation, food supplies and health care have compromised good people who were already in great need. Lives, homes and businesses have been lost. Medications and educations have been interrupted by the recent instability. The people of Kenya are struggling, but they are surviving, by God's grace and with emergency aid.

Yes, our friends in Maseno are living in peace, but in now-difficult times and in sometimes-desperate conditions. Please continue to keep them in your prayers, and please contribute whatever you can to help them re-establish the mobile clinics and orphan feeding programs that serve many thousands of vulnerable children each week. Nan and Gerry are working hard with the Mothers' Union mamas (and sisters and grannies and neighbors and aunts) to expand the services and make them sustainable.

Donations may be made payable to the Jubilee Ministry and sent to The Rev. Maggie Geller, c/o The Episcopal Diocese of Massachusetts, 138 Tremont Street, Boston, MA 02111. Please indicate "Maseno Emergency Relief" on the memo line. Thank you very much (Asante sana)!

Postscript: Kenya's Kesho

Kesho means tomorrow in Swahili. It is heartbreaking to imagine right now just what Kenya's tomorrows will bring. Time, prayer and integrity are needed to heal its recent yesterdays.

The country is still burning, its people are still dying, and its rival "leaders" are still playing power politics with innocent lives. Nan reports that criminal gangs, not tribal vengeance, are responsible for the looting and violence in Western Province. Just as in our own country, they take full advantage of unstable political and economic conditions. Yesterday the U.S. Peace Corps was forced to decide, for security reasons, to withdraw all of its volunteers from western Kenya. Will our missionaries be next? Kenya's sick are getting sicker and its poor, even poorer.

"Grant, O God, that your holy and life-giving Spirit may so move every human heart, that barriers which divide us may crumble, suspicions disappear and hatreds cease; that, our divisions being healed, we may live in justice and peace... "


And bless, dear Lord, all those who have given so generously of their lives for so many years. Let them not be discouraged, help them hold fast to that which is good, and keep them safe in your loving arms... all for thy love's sake. Amen.



[Drs. Nan and Gerry Hardison, Christmas Eve 2007, Maseno]

Elephants in the Grass

Archbishop Tutu Asifiwe, Bwana Asifiwe... Praise them both! This morning's email brings a more hopeful message from Maseno:

Dear Dianne,

Things seem to be getting back to normal. Troops are patrolling the highway Busia-Kisumu and escorting fuel trucks to the border. So that is good news. Archbishop Tutu has apparently managed to persuade the two elephants to stop trampling the grass. We'll see.

Much love,
Nan

----- Original Message -----
From: Dianne Smith
To: hardison
Sent: Friday, January 04, 2008 6:14 AM
Subject: Prayers Apace

Dear Nan & All,

We continue to pray for peace in Kenya, safe travel for all, and for food and gasoline to become available. I know I could be of very little use if I were still there, but I wish I were... All I can do from here is obsess over the BBC online news and console myself with two thoughts: (1) Desmond Tutu is in Kenya now, and (2) mine is at least one less mouth for Emmah to feed.

Love,
Dianne

Cradle of Humanity

What a difference a day makes... Many of you are aware of the tragedies unfolding in the wake of Kenya's national elections on December 27. Our friends at Maseno Missions are safe at the moment, but they -- and their beautiful, beleaguered country -- desperately need our prayers.

It is difficult to say, or even to think, "Happy New Year" today, with so many lives at stake in so many places. Maseno is west of the Rift Valley, where the Leakeys discovered evidence of the first forms of human life. May God help us all restore and preserve the best of our collective humanity this day and in the year to come.

With Nan Hardison's permission, I am posting our most recent email exchange (in "reverse order"):

Dear Dianne,

Gerry is spending his usual full day at the hospital, now complete with bullet wounds. No one bothering the hospital right now, or St. P's. Emmah is safe and taking care of the nursing students.

Love,
Nan

----- Original Message -----
From: Dianne Smith
To: hardison
Sent: Tuesday, January 01, 2008 5:06 AM
Subject: Re: Prayers

Oh, dear God, Nan... Gerry is not trying to make rounds, is he? But what is happening w/the hospital patients?

----- Original Message -----
From: hardison
To: Dianne Smith
Sent: Tuesday, January 01, 2008 4:46 AM
Subject: Re: Prayers

Dear Dianne,

Many thanks again. And of course you may share the email. We are quiet here this afternoon after some shots were fired in Maseno to disperse a mob trying to torch the Total (gas) station, owned by a Kikuyu. We are all waiting tensely. Zach and Liz are still in Amagoro with Bishop Epusi, no way to get here, and Zachary was due in Tanzania.

Much love,
Nan

----- Original Message -----
From: Dianne Smith
To: hardison
Sent: Tuesday, January 01, 2008 4:17 AM
Subject: Re: Prayers

Thank you (and God) for your message, Nan! I have been frantic about Nadia, especially, and I am so relieved to know she's with you. We will certainly be keeping you all in the forefront of our prayers and in the center of our hearts.

So many people have asked me about your safety... May I share your email with them? The other side of the world seems very far away to people unless they have a powerful reminder like your personal words and witness.

If there is anything else we can do, please tell me.

In Him,
Dianne

----- Original Message -----
From: hardison
To: Dianne Smith
Sent: Tuesday, January 01, 2008 1:48 AM
Subject: Re: Prayers

Dear Dianne,

Many thanks for your prayers. Don and Lori got off o.k. but the nurses were delayed to an afternoon flight. We got them back to Maseno after a hairy trip through many barricades with burning tires, etc. and mobs. The ambulance had some damage. I freely and shamelessly bribed at each barricade. Now we are all safe in Maseno, but there is no way to get out. All roads are blocked, no fuel anyway. So keep us in prayer.

Fortunately Nadia was willing to stay in Maseno, not that there was really any choice. She is here now, and, I am sure, hoping that she can get out on Sunday. Right now Nairobi and Kisumu airports are closed.

The email has been on-again off again, but so far we have power from 9:00 am to 8:00 pm two days now so we can charge phones and laptops. No airtime is available for purchase however, so we are being careful with the phones. What a mess. The ethnic cleansing aspect of this is the most worrying. It shows the most ugly side of human nature.

Love,
Nan

----- Original Message -----
From: Dianne Smith
To: hardison
Sent: Monday, December 31, 2007 2:32 PM
Subject: Prayers
Dear Nan & Gerry, Liz & Zach,

Habariacu/How are you? Did Lori & Don and Nadia get off okay? I sincerely hope Nadia decided to climb Mt. Kenya, not wander around Nairobi for a week... And did your 15 Wisconsin nursing students arrive safely?

The BBC website news about Kenya -- especially about Kisumu -- is more than worrisome. You must be very busy answering other friends' and families' concerned queries, but I couldn't keep still any longer.

Please know we are all thinking of you and praying for the violence to end.

Love in Christ,
Dianne