A Round for the New Year

"Make new friends, but keep the old: one is silver, and the other gold." Remember that little gem? Our families and friends are such blessings. It is their love that makes room in our hearts for more.

After rounds last Sunday, I climbed the mountain behind the hospital again, this time with two new friends -- Zoe, a medical student from New Zealand, and Leah, a university student from Mercy Home, the orphanage where Zoe volunteers. We scrambled up rocks, enjoyed a sunny view of Lake Victoria, explored the fish farm cooperative, rested at the oldest Anglican church in Maseno, and were accompanied by animated children all along the path. We reached our destination after half an hour, only to learn that our friend Alex had been unexpectedly called away by the bishop to serve in a distant parish.

True to Kenya's Karibuni (welcoming) tradition, however, Alex's elderly parents promptly invited us into their house next door -- with broad smiles, cold sodas and tasty biscuits served by assorted grandchildren. Proclaiming our visit as a gift from God, the patriarch and his family told us tales of his children, asked about our families, and shared our delight in the gala Christmas balloons and streamers hanging from the ceiling of their immaculate home. "God has blessed me today... all of us, from all over His world, are right here in this room!" Baba Alex marveled.

I couldn't help but wonder how our experience might have played out in any other place: three hot, sweaty foreigners arriving at 5 PM on one's doorstep, unbidden and unannounced? What a perfect example of "welcoming the stranger as the Christ." After a lovely visit, amidst hugs all 'round, we exchanged asantes (thanks) and kwaheris (goodbyes) and were urged to return.

Twice now I have been asked by well-intentioned Americans "what demons are driving" me to live and work in East Africa. How can I explain that I don't believe demons are driving any of us -- that, instead, I believe God is calling all of us "wherever we may be" dancing. I'm a very poor rock climber and an even worse dancer, but I am grateful to be around for the new year, to hope and to celebrate with new friends, and to very much cherish the "g/old."

Paul wrote to the Ephesians, "I, therefore, beg you to lead a life worthy of the calling to which you have been called, with all humility and gentleness, with patience, bearing with one another in love, making every effort to maintain the Spirit in that bond of peace." We have seven more new friends visiting Maseno Missions right now, student nurses from Wisconsin, who are also making every effort in the bond of peace.

My heart is overflowing with love from and for you all as we dance, sing and pray together, wherever we may be. Asante, Mungu/ Heri za Mwaka Mpya! (Thanks be to God/ Happy New Year!)

P is for Pneumonia -- and for Prayer

It has been an especially prayerful Christmas at Maseno Hospital.

Festus, 19, died of PCP (pneumocystis carini pneumonia) in Ward I on Christmas Eve in his weeping brother's arms.

Felix, 13, died before he even made it to the hospital on Christmas night, after enjoying his first holiday party ever -- in spite of a cough and high fever.

And Phoebe Leah, 26, is back on Ward II with pneumonia. You remember "Mama Zedekiah." (It is her 3-year-old son's arm that I am holding in the "Hands to Work" photo.) The family that cast Phoebe out because of her HIV status has now quite literally dug her grave. Although Phoebe is still struggling to breathe, she is slowly improving on antibiotics and oxygen. We do not know, however, who is looking after Zedekiah in her absence.

Unthinkable Christmas stories are our patients' everyday realities. Unfortunately, too many people come too late for medical help -- for financial, social and personal reasons. Sometimes it is merely that the cost of transportation is too high. A 20 KSH matatu ride to the hospital is simply too much for someone who is trying to support a family on less than 75 KSH ($1.00) a day.

How can we keep from praying? (For some help and hope, click on and listen to Brother Curtis Almquist, SSJE's "Twelve Days of Christmas" at http://ssje.org/twelvedays/?p=17)

Krismasi Njema

Nan's meatloaf was scrumptuous, and my chocolate chip cookies were a success. We listened to a delightful recording of Harvard University's Christmas Revels last night, Christmas Eve. "Dance, dance wherever you may be... " sings on in my heart. Simba (the dog, not the lion) awakened me with a slurpy kiss this morning, and now we're off to hospital rounds. The banana leaf creche is finally complete, with baby Jesus in his crib. Although our traditional holiday balloons have popped, the "flowers" (tinsel leis) live on in Maseno. So does the spirit of Christmas. Krismasi Njema, love to you all, and God bless us, every one.

Silent Night, Holy Night

And God was a child,
curled up, who slept in her.

And her veins were flooded
with His wisdom,
which is night,
which is starlight,
which is silence.

And her whole being
was embraced in Him
whom she embraced.

And they became
tremendous silence.

-- Thomas Merton

Three Small Miracles

(1) Last night Prince Charming arrived at my door and declared: "Madam, I am here to save you." He was handsome, earnest and about 25 years old. I was somewhat nonplussed before I realized he was the night guard assigned to Rotary House during Emmah's absence. Some things that are lost in translation ("save/protect"/whatever!) can be found in cross-cultural chivalry.

(2) Even more miraculous is the experience of having had 96 -- count them! -- consecutive hours, to date, of electrical power on the hospital grounds.

(3) The most wonderful miracle of all is that my grandson turns 16 today. (How did that happen?) Happy Birthday, Huck!

December Tridium

Every day is a holy day, but my first three back in Maseno seem holier than usual. It's often quieter at the hospital in December because family time takes precedence over inconvenient, even life-threatening, illness in Kenya.

Unless, of course, you're Phoebe Leah, who has no food at all and prefers to stay in the hospital with 3-year-old Zedekiah so her son can eat, thanks to our donors' feeding program. (The hospital census is also down during the three planting seasons of the year. Seeds must go into the ground to feed the living, even when some family members are dying.) With fewer patients, we are even more intimately privy to their life stories...

Christine, 37, was admitted to the hospital because of weight loss, abdominal distention and pain. Physical examination revealed a hard tender mass in her abdomen, and ultrasound showed a coarsened liver. Cirrhosis, malignancy or TB? Regardless, she faces a difficult time ahead as a widow with five children to feed.

Phanice is suffering from cryptococcal meningitis. She's been on Amphotericin B, a toxic medication but our best recourse, for 12 days and is improving, but she still needs almost-daily spinal taps to relieve the painful headaches associated with her illness. Her CD4 count is 25. Soon Phanice will be able to go home to her elderly parents, who are struggling to find a way to pay for even a portion of her hospital expenses.

Zablon, 44, is still combative, but his cryptoccal meningitis is also improving on medication. His creatinine is climbing, however, so we will soon be unable to administer more Ampho B. At that point, we will send him home on high-dose Fluconazole and pray.

Peter, 25, was admitted with multiple compound fractures after a piki-piki (motorcycle) accident. We cannot reduce the fractures here and have referred him to the district hospital in Kisumu, but his family doesn't have the money for transport and wants to take him home instead. If they do that, Peter will never walk again.

Over on "Peds," Joash, 4, is recovering from cerebral malaria. He was in a coma when he arrived but is recovering after two blood transfusions and IV quinine. Precious is 14 months old; she, too, is making a dramatic recovery from malaria. Fortunately, their mamas brought them to the hospital (barely) in time. Sharon, 3, is suffering from cutaneous anthrax. The surface of her hard, swollen jaw is covered in pustules which erode into blackened craters. When Dr. Hardison asked, "Are there any sick cows in the village?" Sharon's mama nodded: "The chief sent a man to give all the cows some medicine." Sharon, too, will recover, but it will take two months of antibiotic medication. We pray her mama will be able to purchase it and remember to administer it. She has three other children at home and is the sole support of her family.

Some of you have already heard the story of 9-year-old Silas. While I was in the U.S., he came to Maseno Mission Hospital's outpatient department complaining of a sore throat. Silas and his family live "inside," away from towns and villages. They drink unfiltered river water, and a leech had attached itself to Silas' tonsils. Harvard Medical School didn't teach "leech-ectomies," but Dr. Hardison dealt proficiently with the situation. Silas went home the same day, with simple instructions for clean water techniques.

Same stuff, different (three) day(s). And so we pray.

Meanwhile, back at Rotary House, I'm settling in and "batching" it for awhile. Emmah is home for the holidays, herself, so I'm trying to live up to my most hilarious high school award: "Betty Crocker Homemaker of Tomorrow." That, dear friends, was 45 years ago, and burnout has definitely occurred. I can foresee lots more PBJ. However, PBJ is more nutritious than the ugali and greens many Kenyan families will share for Christmas dinner. There may be little food and no presents, but, oh, there will be music! ("If you listened...the words would break your heart. Silence, darkness, Jesus, angels. Better, I suppose, to sing than to listen." --John Updike in "The Carol Sing")

Fortunately, Nan and Gerry have invited me to their house to quietly celebrate -- and both are excellent cooks.

Sunrise over Mt. Kenya

Sorry, everyone. My camera was stowed in the overhead bin... But take my word for it: 'twas a glorious sight when I glanced eastward this morning, out the window of Kenya Airways Flight 101, prior to landing in Nairobi. The view almost compensated for the angst I felt listening to Bing Crosby sing his old Christmas chestnuts for hours, over Logan Airport's PA system, prior to leaving Boston.

It's a long way to Tipperary, and it's an even longer way to Kenya via my twelve-hour layover in England. But the two-hour trip from Nairobi to Kisumu via Eldoret was a delight. I sat next to a beautiful six-month-old and her granny, all the while remembering my own six beautiful grandchildren at home. When we deplaned in Kisumu, Nan rushed up to enfold me in her welcoming arms, in spite of her busier-than-ever morning. The harrowing ride to Maseno (thank you, God, and thank you, Kenneth, for safe transport!) was downright nostalgic. After two months of "missionary leave" (not exactly R and R), it seemed to me that very little had changed here. Sunny skies were warming the land and people, tattered laundry was drying on bushes, kids were waving and chanting staccato "How are YEW's?" along the way. (Thank you, Regina, for the photo!)

Fields were fallow after the harvest, but perhaps a little greener following the season of the short rains. Children and livestock were grazing -- sugar cane and grass, respectively -- on the roadside, but they were perhaps a little thinner as a result of Kenya's escalating inflation. (Corn, our staple food, is three times the price it was two years ago.) The hills we climbed in "Private" were perhaps a little more decimated by deforestation, and the air was perhaps a little more polluted by the acrid smoke of burning trash and spilled diesel. But the mosquitoes were as tiny and voracious as ever. (Yes, I'm taking my malaria pills.) When we pulled into the hospital compound, it was equally obvious from the mutual smiles and hugs that "the company of all faithful people" had not changed one bit. "You came back! You said you would, and you did. Karibu and Bwana asifiwe!"

Bing sang, "I'll be home for Christmas, if only in my dreams." Dreams are powerful gifts, thank God... My mother died one year ago tonight, but she, too, lives on in my dreams. And so I send hugs and misses and sweet dreams to you all -- with heartfelt gratitude for your love and prayers as we begin another assignment at Maseno Mission Hospital together.

Annual Letter

Some folks have asked for a copy of the holiday letter we mailed to those of you who kindly made donations during the past mission year. Here you are!

December 1, 2009

Dear Family and Friends,

This is the season of Advent on the church calendar. It is World AIDS Day on the secular calendar. Both are times of quiet remembrance, hope and gratitude. In two weeks’ time, I will return to Maseno Mission Hospital to resume work as your missionary with that same quiet remembrance, hope and gratitude. It has been a joy to be home with you, my children and grandchildren, and to tell the story of Maseno Missions – which fortunately tells itself. The people of Kenya send their greetings and love; I will take yours back!

Archbishop Rowan Williams reminded folks at Lambeth in June that mission is God’s work, not ours, and Archbishop Desmond Tutu declared years ago, “We are all missionaries, or we are nothing.” So we are all doing God’s work in Maseno: we are all walking in our flip-flops together. I hope you have checked my blog occasionally over the past year to learn more about our ongoing efforts at the hospital, HIV/AIDS clinic, orphan programs and theological college. I hope you have seen the photographs of the beautiful, faithful people whom – and with whom – we serve. Above all, I hope you have prayed with us and will continue to do so.

As I reflect on the year gone by, I remember the faces of our patients and our orphaned children. I hope for a healthier future for them and their families. And I am grateful for the opportunity to return to serve in God’s name and in yours. Together, we have truly made a difference; and of course, we will always have more to do. We are excited about the current renovation of the hospital maternity wing, where we will have a functioning incubator; about the imminent visit from Engineers without Borders, who will address our community’s ongoing problems with power and water; and about the possibility of building a roadside outpatient clinic that will reach more people, more effectively, more of the time.

Tax-deductible donations to facilitate these efforts may be made via PayPal on my blog site or by check to St. Andrew’s Episcopal Church, PO Box 1287, Edgartown, MA 02539. (Please note “Kenya Mission” on the memo line.) Thank you for your generosity all year ’round and especially in this season of hope.

Advent blessings,
Dianne

A Song, Two Lists, an Aha

Life is beautiful... but it sure is full! A missionary's "leave" is not exactly R and R, but it is a joy to be able to squeeze my visits with family and friends between the requisite medical and dental appointments, continuing education (RN) credits and -- oh, yes -- fund raising. Today I watched my one-year-old granddaughter select and name her crayon colors. Today I also received a very generous donation from my eleven-year-old granddaughter for the orphans of Maseno: $210, the proceeds from her summer lemonade stand sales. I am so proud of both of them and so grateful to their parents. It will be a delight to see my four "off-island" grandchildren this weekend, at last. "How can I keep from singing?"

Just for fun (and because I miss everyone, everywhere), I have comprised some"miss lists." They are works in progress, of course:

"Kenyana" That I Miss in the U.S.

Patients and friends

Sights: smiling faces; kids chasing/chomping termites; mamas balancing baskets on their heads and babies on their backs; lush green forests, cascading bougainvillea, hevetia peruviana (lemon-yellow “trumpet trees"), sunsets blazing through the windows

Sounds: Emmah singing as she works, peepers peeping, cockroaches skittering, hadada ibis squawking, mosquitoes whining (outside my bed net, thank you very much), monkeys bickering in the trees, rains teeming/“laughter on the roof” -- and Gary-isms, like "DC the egg."

Smells: frangipani/plumeria in the daytime, charcoal/Jiko cooking fires in the evening

Tastes: Weetabix, Stony, Tusker, fresh avocados & tomatoes & mangoes & papayas, Emmah’s nurturing meals

Feels: perfect 75-degree sunshine every day

"Americana" That I Miss in Maseno

Family and friends

Electricity and water (especially in the hospital)

Thermometers, pulse oximeters, routine meds

Safe public transport

Broadband internet

Haircuts

Chocolate chips

Parmesan Cheese

Friends ask, "So what's it like to re-enter?" I'm not sure how to answer that question since I am not really re-entering: I expect to return to Maseno in early December. But I am reminded of a missionary friend who said, after a visit to the U.S., "I feel like I don't fit anywhere anymore." Perhaps things will change, but I actually feel quite the opposite -- and I am grateful to the people in every corner of the world who make me feel that way. Is this a glimmer of grace, a taste of being "in, but not of, the world"?

Thanks be to God.

Kwaheri, Mzee!

It must be my scraggly and ever-whitening hair... In any case, I was twice addressed as "Mzee," or "Old One," yesterday. Fortunately, that is a term of honor in Kenya, as in: "Mzee, my mother/father won't listen to me, but he'll listen to you because of your age. Please tell him he needs surgery."

Women run their hands through my hair in amazement, men nod deferentially, and last week three kids ditched the bundles of kindling on their own heads so they could run and tousle mine. Since the local beauty "saloon" stylists are intimidated by mzungu hair, I'm quite the white-haired wonder by now.

I'm also a mixture of anxiety and excitement -- admittedly a year older and perhaps a day or two wiser at the close of my first mission term here in Maseno. Heartfelt welcomes and equally heartfelt goodbyes are genuine blessings in Kenya. It's not easy to say "kwaheri" to so many wonderful people this week, uncertain if/when I'll return. But I am also eager to see family and friends in the U.S. and to give my six grandchildren very big hugs!

Linet says I need to be back in Maseno by December 13th, her 26th birthday. Now there's a goal! If my youngest daughter is willing to celebrate her 40th two days early, maybe it's even a possibility. My flip-flops are flapping...

Meanwhile, we continue to pray, from and for this and every corner of the world: for food and water, for integrity and leadership, for joy and compassion, for grace and gratitude, for peace in our time. (Linet and I created our own version of "Praying Hands," above.)

Musings on Mission

Fair warning, Friends... This is essentially my annual report.

One of the greatest joys in my life is learning to walk in someone else's moccasins – or flip-flops, more accurately, here in Kenya – through whatever conditions we may share on God's not-always-green earth. (We would have happily shared New England's soggy June!) The harvest has been sparse in Maseno, and the infrastructure is more fragile than ever. But life does goes on and hope does spring eternal, thanks in great part to all of you.

Walking in someone else's flip-flops is also one of my greatest concerns, as I try to be accountable to "people back home." My missionary heart still leaps in response to the plea I heard from Central America's Primate, Bishop Martin Barahona: "Walk with us, mano en mano (hand in hand) and side by side. Don't forget us!" I loved walking and working with the people of El Salvador in 2007, and I love walking and working with the people of Kenya today. I can't – and don't and won't – forget any one of them. At the same time I can't – and don't and won't – forget any one of you.

I am painfully aware of my own culture's pressure to be "cost-effective," to "accomplish things" and to "create self-sustaining projects." I have been frugal, but is that the same as cost-effective? I have not "accomplished" any great things in the almost-year I've been in Maseno, but I take comfort in Mother Teresa's words, "We can only do small things with great love." I have not created any yet-proven self-sustaining projects, but I've been quietly working with our Kenyan brothers and sisters to facilitate several of them.

At the request of Bishop Simon Oketch, Diocese of Maseno North, I have tried to help support a weary hospital staff and nurture its wearier-still patients. I've also tried to be of support to Nan and Gerry Hardison, our deeply committed Episcopal Church missionaries who have been serving in Kenya for 10 years. Through my hands, you have given 160 chickens to Esiamboko AIDS orphans for school fees and sustenance; helped to establish fledgling community pharmacies in both Ebwali and Ekwanda; and created a scholarship fund - via its choir's CD sales – for St. Philip's Theological College. You have also contributed money for 650 orphan blankets for kids who sleep on cold, jiggers-infested ground. And you have generously donated four x-ray view boxes, two suction machines and two life-sustaining oxygenators to Maseno Hospital, plus $8,000 for pharmacy supplies.

I am grateful for those opportunities because, in every case, we were specifically invited to help. And I remain convinced that it is presumptuous for us to impose our best-intentioned ideas upon another culture without being asked. No one is going to save, or even change, the world, but together we really can make a difference, especially if we let go of our own definitions of "change" and listen to the people who are in need. After a year in Maseno, I have renewed respect for the realities of poverty and for the efforts of the men, women and children who "keep on keeping on," in spite of those realities.

People can and do live with dignity in poverty, to paraphrase a remarkable missionary who works in Tanzania. It seems as important, to me, to honor that dignity as it is to work alongside people to help them alleviate it. It is a holy thing to step out in faith, to walk mano en mano and side by side, in one another's flip-flops. Mission is about this kind of relationship. Asante/thank you for stepping out and walking with us in Maseno.

Ours is a ministry of presence and praxis (diakonia: practical service in the name of the gospel) as much as, or even more than, it is a ministry of accomplishment. Yes, that creates a conundrum, a moral dilemma of sorts, as we continue to support and LIVE mission in the world, especially during our currently "interesting times." Times probably weren't any less interesting 2000 years ago, however, when Jesus said, "Love one another." He didn't say, "Love one another when you can comfortably afford it." Jesus also said, "Feed my sheep." He didn't say "Count them."

As I near the end of my first term as a Volunteer in Mission for The Episcopal Church to the Anglican Church of Kenya, I am especially grateful for the love and support you have given me, the hospital staff and patients, and the community of Maseno. Together we have made a difference. Together we may even have dispelled a few stereotypes about North Americans: "Wazungu (Europeans/white people) all look alike." "Wazungu are all rich." And "a shangazi (old lady – especially a mzungu old lady!) doesn't climb mountains." I trust that, together, we have dispelled a few stereotypes about our African neighbors, as well.

Above all, I pray that, together, we will continue to work toward a more healthy, hopeful and loving world... "with God's help," as we say every time we reaffirm our baptismal covenant. Archbishop Tutu more succinctly says, "We are all missionaries, or we are nothing." Because of you and people like you, I have been working alongside others who are serving the needs of kids and adults alike in a small, impoverished community in East Africa, where HIV/AIDS is rampant and where two out of ten children die of malaria before the age of five. There is reason for grief in our world, but there is also reason for hope. You are helping to provide that hope.

The people of Maseno know that I am here because you care about them. I know I am here because you care about me, too. We have been working together in body and spirit at the hospital, orphan clinics and in the community, treating everything from AIDS and anthrax to typhoid and TB. Poverty, disease and, sadly, corruption are devastating Kenya. People are struggling to simply survive. Forty-eight percent of medical care in the country is provided by mission hospitals which get no support from Kenya's government, nor from the NGO's. The hospitals are struggling to survive, as well. This hospital and its patients are surviving because of you who are sharing so fully, in so many ways – walking in our flip-flops! – in a ministry of healing and hope and love.

Loving one another, as I recently wrote to friends at St. Andrew's, is the first and great – but by no means the easiest – commandment. Mission is just one way to love, of course, and mission is "done" in our own back yards, as well, so these next few months will be a time of discernment for us all. I feel honored to be invited to return to Maseno, on your behalf, after a few weeks at home in the fall. We have a very good start on fund-raising, but I will need your prayerful support. If I am to be a continuing presence here, we will all need to consider some significant personal, family and financial matters. Perhaps we will also need to consider what my/our absence would mean.

In my admittedly anxious dotage, I go "back to basics" and revert to my Midwestern childhood. I turn to prayer, to morality tales (The Little Engine that Could) and even to nursery rhymes. Do you remember "Deedle deedle dumpling... One shoe (flip-flop) off and one shoe (flip-flop) on"? Well, at the moment, one of my flip-flops is in Kenya, and one is in the U.S. I am waiting for one or the other to drop, wondering where it will land, as we discern together. And I am praying. Where is God in all of this? Where are we? And how "will we seek to serve Christ in all persons, loving our neighbors as ourselves?"

Updates

Well, now I know... Worse than seeing faces is not seeing them. Susan's bed was empty when I arrived for morning rounds yesterday. She died on Thursday, following a massive GI bleed. Her medical record had not yet been filed away: "RIPF" (Rest In Peace Forever) was printed on the cover of the chart, those initials carefully placed in the quadrants created by a hand-drawn Christian cross.

Noticing my obvious distress, Linet tried to console me, "Ni shauri ya Mungu/It is the will of God." "Not my God," I snapped back -- and then apologized. I'm afraid I still have much to learn from our African friends.

When I saw that Pamela's bed, too, was empty, my heart sank. Then I was told that she had been discharged on Friday. A student nurse reported that Pamela had promised to eat and rest and exercise and take her meds -- and that her co-wife had promised to encourage her.

We next rounded on Pediatrics, where I was dismayed to see that Gastone, 7, was also missing. The dazed little boy, in shock and pain, had been brought to the hospital one week ago by his frantic parents. He had picked up a fallen live electrical wire while playing with a friend. The voltage had shot through Gastone's body, creating first and second degree burns on his face, neck, upper and lower limbs. The deepest wound was a hole beneath his jaw.

We were also worried about the child's heart because he complained of chest pain on admission. He explained, though, that he had fallen "hard" on the ground, on his chest, when the electricity had raced through his body. His cardiac status was fine, but Gastone developed severe edema on his face the next day. The potential for a constricted airway was real, but it never materialized, TG. And Gastone never stopped playing with the Matchbox tow truck we gave him on admission -- a very hopeful sign. (Thank you, Church of the Advent, for the toys!) We administered Pethedine for pain, tetanus toxoid, IV Ceftriaxone and fluids. His burns were cleansed and debrided, and Dermazene was generously applied.

I was relieved to learn that Gastone, too, had been discharged over the weekend. He may never pick up even a dead electrical wire again, but his wounds will heal. Thanks be to God.

Faces

I ran away from home on Wednesday -- at my own, not our donors', expense. Actually, I convinced myself that I really wanted to take the "Lunatic Express" (the old British night train from Nairobi to the coast, replete with sleeping berths and dining cars) before returning to the Vineyard at the end of my first mission year in October. My beloved grandmother took me via train across the U.S. fifty years ago, and I've never forgotten the experience. Nor will I forget this one.

The truth is, I am tired. I needed to take a break for a few days from the frustrations of a hospital with no water and little electricity and minimal medications and late employee paychecks. Again.I needed to take a break from the faces of the Pamelas and the Susans who separately looked into my eyes on Monday and asked me to let them die. "We're not giving up on you. Don't you give up on you, either," I responded, with a squeeze. (They both have TB and can survive, with time and food and medication. And they're getting all of the above at Maseno Mission Hospital, TG.)

So when a neighbor told me she'd soon be taking the bus to visit her daughter in Mombasa, my heart skipped a beat. I asked Judy, "Would you consider traveling by bus to Nairobi with me, and then going by train, as my guest, to the coast?" (It's not safe to travel alone at night in Kenya.) She was delighted, and so was I. We made our plans quickly, secure in the knowledge that a Boston medical resident would accompany Dr. Hardison on rounds in my absence.

In all candor, we were probably the only "lunatics" around on Wednesday, and there was nothing "express" about that train. But Judy and I shared an amazing experience, and I am grateful for her companionship. We took the morning Easy Coach bus from Maseno to Nairobi, and it was a thrill to see the sights, en route -- all eight hours of them. Sugar cane fields in the rolling dark earth of Nyanza Province merged into tea plantations in the lush green hills of Kericho, where we saw the tenderest tea leaves being harvested by hand. But that lovely land gave way to increasingly parched tan earth as we approached Molo in the Rift Valley. Familiar acacia trees dotting the countryside of the west were replaced by desperate cacti, reaching their withered arms to a merciless sky.

And there, in Molo, the faces appeared again... Faces of illness and hunger and despair and poverty. Mostly the faces of children this time. Children who were too tired to play and who simply stood at the station on spindly legs, arms out, eyes wide and sunken with hunger. Beginning in Molo, in fact, children began to routinely line our route. At the Nakuru stop, we saw the menacing sight of older kids, armed with hand-hewn clubs, stealthily approaching a private vehicle. We soon realized, with great relief, that they were unleashing their own venom onto a black mamba that had wrapped itself around the car's axle.

Our bus made its way through the more prosperous town of Nakuru, where we saw the pink sands of the lake in the distance. The sand wasn't really pink, of course: it was chockablock full of flamingos! Further along, at Gilgil, we narrowly averted a collision with a zebra. Children's faces temporarily faded in the dust of the Kiligo Wildlife Conservancy, as ill-advised baboons bounced in the roadside ditches, while warthogs and oribi antelope played chicken with the bus. Shortly thereafter, we encountered a vast eucalyptus forest ("Emmah's trees," as Judy called them) being laboriously logged by donkey carts.

Approaching Nakuru, goats and sheep grazed the meager fields and rocky roadsides. Then we saw the faces again. This time the smallest of the faces were bundled in the hoods of mission-box snowsuits. It was cool (70 degrees F) and rainy near the lake. Nearing Nairobi, the scene changed as buildings began to dot the skyline. A large sign posted at the entrance of the parking lot for the Communication Commission of Kenya announced, "You are now entering a corruption-free area." The lot was filled with gleaming new black and silver BMWs.

We arrived in bustling downtown Nairobi and walked quickly from the bus to the train depot, where we awaited the arrival of our assigned "Coach Number 1223, Chumba/Compartment C." The history of the British Railway/Kenya Railway/now Rift Valley Railway is the history of colonial East Africa. As Judy kept remarking during our trip, "Those men who built it, they were strong." They were also essentially slaves, brought from India, and many died on the job -- of heat, hunger and lions even hungrier than they.

After a series of zany misadventures (who knew that a receipt was not a ticket, that a ticket was not a boarding pass, and that askari/guards would challenge our anxious comings and goings?), we boarded at 6 PM for our 7 PM departure. Miracle of miracles, the train actually departed on time. We settled in to enjoy the ride -- and soon the dining car, where the starched white tablecloths and mismatched silver and stainless tableware provided an elegant counterpoint to the hot and rumpled passengers (just like us).

But then the faces returned in earnest. Faces of every age, lining the tracks, vying for slices of bread from the kitchen crew tossed out railroad car doorways, and coins from the passengers tossed out dining car windows. The scene bore no resemblance to Oak Bluffs harbor, where kids dive for coins tossed off the ferry for fun.

After a decent, but disconcerting, meal, we "retired to our cabin," which had been neatly made up in our abseAfter a decent, but disconcerting, meal, we "retired to our cabin," which had been neatly made up in our absence into very comfortable bunk beds. (Yes, I got the top, Maisie and Nico and Nell and Nadia!) Although I was up once -- n.b., a stationary long drop is nothing compared to a rolling choo -- I saw no sign of the infamous Tsavo lions during the night. And when we stopped at various stations along the way, it was blissfully dark. No faces could be seen, just scattered cooking fires in the distant bomas/settlements.

Dawn over Tsavo brought a startlingly different landscape. Ubiquitous plastic bags and the skeletal remains of a variety of livestock littered the arid pasture land between us and parallel MacKinnon Road. The drought in Kenya is real. A pungent stench, that of not-quite-rotted flesh, made breakfast unappetizing enough. But hungry faces peering in the dining car while we were sidelined at Taru Station made it impossible. The flat red earth of Taru was criss-crossed by narrow trails, down which children in oversized shirts (and nothing else) came running. Gesticulating hand-to-mouth, their needs were all too apparent. Judy and I waved and retreated. There was, sadly, no way to give anything to anyone without starting a stampede of children.

The train moved on. As we passed Samburu Station, we saw toddlers and mamas fetching firewood, with babies tied on their respective backs. Then came a surprising stretch of stately green sisal, as far as the eye could see -- a blessed relief from the haunting realities reflected in the faces of poverty. Clusters of coconut palms began to dot the horizon as we approached Mombasa. Clusters of kids again began to dot the tracks. More faces.

The train arrived two hours late, right on schedule (TIA). Judy's beautiful daughter, her husband and two-year-old Deborah met us at the station and led us through Biashara Street, Old Town, and stalls of sticky dates -- a great delicacy imported especially during Ramadan. They then kindly delivered me, via tuk-tuk, matatu and ferry, to the ACK Guest House in Likoni, just south of Mombasa. I can personally attest to the fact that there is something wilder than Vineyard Haven's Steamship Authority dock in August. That pales by comparison to Likoni's ferry terminal! On the other hand, the Mombasa-Likoni ferry is, ahem, FREE.

It is now a quiet evening in a quiet place. The calls to prayer from the mosques of Mombasa are somehow soothing. They remind me to pray, too. Even as I remember the faces that I so foolishly tried to forget in Maseno (and all along the Way), I am remembering again to breathe and to pray. Thank you, dear friends, for the reminders! I'll be homeward bound tomorrow -- by plane to Kisumu, then car to Maseno this time. And I will be ready, once again, to see the face of God, as well as the faces of pain, in Pamela and Susan. Please pray for us all at Maseno Mission Hospital?

Market Day

Monday is market day in nearby Luanda. We went shopping for papayas/popos and pineapple and came back with a broom, a goat rope and kitenge/fabric, as well. (The ladies in our HIV/AIDS crafts group want to sew "a smart Kenyan dress" for me.) I'm just sorry I can't bring any fresh fruits home in October to share!

Market day always leaves me on overload. There are so many amazing things to see, hear, taste, smell and do -- including, today, diving into a crowd of shoppers to avoid being trampled by bulls. Six of them, in fact. The critters had been startled by a passing lorry, broke loose from their tether, and thundered in a red cloud of dust straight for Emmah and me.

Upon our escape, amidst much relieved laughter ("Aiyeee, Mzungu!"), we resumed shopping. Actually, Emmah resumed shopping. I was too distracted by the myriad of stalls selling everything from beautiful beans and millet, to fresh fruits and aromatic spices, to mahindi/grilled corn, to pilipili-hoho (green peppers-haha/no heat), to used Goodyear tires, to cheap Chinese hardware, to kukus/chickens and wabuzi/goats -- both "before" and "after" (edible) varieties -- to be of any help to her.

Carlos, a visiting physician from Peru, via the University of Tennessee, is now busy making guacamole with the fresh avocados (7 cents each) and tomatoes (half of that) he bought this morning. His recipe rivals even the Hardisons'. A mission hospital in rural Kenya can be a very cosmopolitan place! Soon it will be back to our simple, but no less stimulating, world of afternoon rounds. If this is Monday, it must be Maseno...

Someone's Son

Dickson was a private man. He died yesterday, an hour after I had quietly reassured him, "You're safe here. We'll take care of you." His core body temperature was 33 degrees Celsius (91.4 Fahrenheit). Dickson looked at me and smiled as I covered him with another blanket. We both knew he would die soon.

He came to us too late, suffering from end-stage AIDS. A kindly outreach worker in Homa Bay, two hours away, had brought Dickson to Maseno because he felt we would give him better care than the several district hospitals in between. But we couldn't do very much.

"Dickson has no one," Desmond told us. "We're his family. He's from the 'interior' -- a region with few roads, isolated from other villages. We know he's in bad shape, but we couldn't leave him there. He's only 28. He says he's been sick for a long time."

Wasted, weak, gaunt and cold, Dickson spent only four days on Ward I before he died. We fed him, bathed him, changed him, talked and prayed with him. It was too late for anything else -- ARV's, anti-TB's, even steroids. He never complained, and he always smiled.

"Whose son, whose friend, whose lover, whose brother was Dickson?" I wondered, as "Sister Helen" and I closed his eyes and wrote his name on the "strapping" (adhesive tape) that would bind his limbs together. "And how could he die alone?"

"But he didn't die alone," Desmond reminded me today. "You were with him, Dianne. "

God's peace, Dickson.

Uniforms?

Yes, uniforms. They're important symbols of community belonging and pride. They're undoubtedly a vestige of colonial order, as well. School children of all ages are required to wear uniforms, making Kenya's "free" public schools even more expensive. (It's not just the desk fee, the blackboard fee, and the hockey stick fee...) Years ago, at the inception of the Mothers' Union Orphan Program, one of Nan's earliest orders of business was prioritizing children's needs. "Uniforms" ranked right up there with food and potable water, according to the local church women. Thanks to California and Wisconsin donors, sewing machines were purchased, and volunteer "mamas" went to work making hundreds of uniforms so kids could go to school.

Uniforms became a hot topic at the hospital last month,when two staff nurses asked me, "Could you help us, Sister, with our leadership project?" As an outgrowth of their continuing education course, Salunia and Dinah had already carefully created, laminated and posted "mission" and "vision" statements on each ward. Now they needed to implement a project "to improve the standards of the hospital." The concept of uniforms as a project initially mystified me, since our nurses already wear uniforms. But they laughed and explained they meant "patient uniforms" -- a/k/a hospital johnnies.

Salunia and Dinah had done their homework and knew how much fabric would be required for 90 wraparound gowns, 30 per adult ward. They produced completed samples and then asked for "sponsorship," since the shamba they had planted on the hospital grounds, in the hope of selling sukuma wiki/greens to help purchase the material, was not yet ready for harvest. Dr. Hardison, grateful for an opportunity to more efficiently examine patients on daily rounds, generously donated 46,500 shillings (about $6.50/gown) for the project. Patients routinely wear several layers of their own clothing to bed at Maseno Hospital, creating unnecessary delays in administering care. The clothes might otherwise be stolen, however, if left at home.

Within a remarkably short time (TIA, remember), the ladies of our HIV/AIDS support group had sewn the gowns and earned a few shillings in the process.The seamstresses were pleased. Our nurses were pleased. Dr. Hardison was pleased. Now we just need to coax our patients into being pleased. The current promotion for compliance is, "Everyone at Aga Khan -- a private, exclusive hospital in Kisumu and Nairobi -- wears them." It remains to be seen how effective our "patient education" efforts will be. Meanwhile, though, the project earned Salunia and Dinah kudos in their leadership class. As Nan would say, "You go, Girls!"

Frangipani

Bad stuff happens. When I was a child, I would turn, in tears, to my parents for explanations. Life isn't fair, Dad would snap -- then bow his head to hide his emotions. Mom would simply purse her lips. Even they couldn't protect us from harsh realities, but they kept on keeping on. Together. Years later, I learned they would sometimes hold one another and cry themselves to sleep. In private. But in public -- even in family -- they seemed indomitable. They were our own personal blend of regional art and literature: "American Gothic" and "Portraits (sic) in Courage." Our parents.

Bad stuff still happens. Mom and Dad are gone now, so I am even more grateful for faith, family and friends. I am grateful, too, for the prayer and cyberspace that connect us. (Yes, it's a frustrating connection, but dial-up from Kenya is better than none!) I remember an old friend's remark, "Life works, if we just remember to take turns needing." It is hard to take turns in the midst of poverty, but I witness it every day. And I give thanks for new friends who, by example, ever-so-kindly remind me to notice. To -- as Dad would have said and Mom would have nodded -- "wake up and smell the roses."

Or, more accurately, the frangipani. It is heavenly here. So are you, Robin and Zach, Finley and Elizabeth. Asante sana for "frangipana." (Pole/Sorry. I'm ever the corny Midwesterner.)

Smiling from the Inside, Out

"Inside jokes" and funny familiarities are too good to keep inside. We have to laugh (or at least exchange smiles) -- sometimes at our patient files, often at our idealism and always at ourselves. A few recent file entries:

"Patient reports being bitten by a snake. The assailant was brown in color."

"Patient absconded when his pants were returned." (A drunk piki-piki driver sneaked out without paying after we stitched him up. It would be funnier if he hadn't also left two unrelated 15-year-old passengers -- with related wounds -- on Ward II.)

"Oxygen administered when meter read '0.'" (For all of our non-clinical friends, a pulse oximeter measures oxygen saturation in the bloodstream via clamp-on finger probe. We get pretty worried when the meter goes below 90%. At 0, a patient would be long-since dead. Fortunately, ours was alive; only the oximeter's battery was dead. And a little extra O2 probably gave 85-year-old Tom a temporary lift.)

My personal favorite, however, is a photocopied sketch of "The Ideal Nurse" that is posted on Ward II's bulletin board. In case this picture is too blurry, the labels read: "Head: full of knowledge of nursing and the Bible. Eyes: to say 'I care.' Ears: alert and listening. Mouth: to smile for Jesus. Heart: warm with love... for others. Hands: gentle to soothe and comfort patients. Feet: quick to respond to calls."

Smile, everyone!

More Good-byes

"So long, farewell, auf wiedersehen, kwaheri... And please come back!" we tell our visitors. It is always a gift for us to receive them, and their presence means perhaps even more to the people of Maseno. Visitors bring hope and health (and, yes, grated Parmesan cheese!) to us all, and we hold them in our hearts forever. Lauren, Jordan and Brandon recently left the St. Philip's compound to return to the U.S., and five Children's Hospital, Boston, nurses left Rotary House on Sunday. Asante sana, Elizabeth, Gail, Kathy, Patti and Regina. Oh, how we shall miss you all! God bless you, every one.

RIP

Do you remember my previous blah-blah-blogs about our neighborhood mbwa? She was the sweet young Mama Dog that Emmah nursed back to health, even as the dog (a/k/a Kate Moss) was nursing her own six puppies -- who all eventually died, apparently from distemper. Mama Mbwa then devotedly followed Emmah and Rotary House residents everywhere, even on hospital rounds. Two weeks ago we had to reluctantly ask her "real" owner to please keep her tied in the daytime because hospital employees were complaining (read threatening to poison her) -- although no one complains about the chickens who freely wander in and out of the wards.

The owner agreed, of course, and Dr. Hardison also began to carry a collar and leash in his medical bag so we could take the dog home if she did get loose and find us. Yesterday we learned that Mbwa had been poisoned, however, in spite of all our precautions. I am horrified as well as saddened. People die here every day, but they die because of disease, not because of malice. Yes, dogs can be rabid; yes, they are used primarily for protection, not for companionship, in Kenya; and, yes, the same owner lost two previous dogs to poisoning. But I have to wonder how much our own misbegotten friendship contributed to Mama Mbwa's death.

Is this another cultural lesson? How many more do I need to learn? Rest in peace, dear friend.

The Road to Amagoro

... is paved with faulty material. A recent adventure took us over several kilometers of tarmac which looked more like railroad tracks than road. In addition to the usual potholes, humps of asphalt, running parallel to the roadside ditches, delineated the route. The ruts were a hazardous diversion from the usual matatus, lorries, boda-bodas, goats, cows, chickens and pedestrians that we hurtled past in Missionary/Padre Zach Drennan's refurbished Land Rover. Brandon, a young Diomass visitor, and I were recently Padre Zach's guests -- and the guests of "Bishop Zach" Epusi and his wife, "Mama Catherine," for two days in the Katakwa Diocese.

"A Big Man probably built a Big House with the money he made from skimming the materials list," two of our Kenyan companions chuckled. "And then someone else probably made kitu kidogo (a small 'appreciation') by allowing big lorries on the new road too soon." Barack Obama and The New York Times are right about political corruption here. It's not a new problem, however. That road was built seven years ago. The sad thing is that only the rich get richer. 'Twas ever thus?

Brandon and I both appreciated the generous hospitality of "the two Zachs" and the bishop's household. We also thoroughly enjoyed our visits to Elewana sites (see Zach's blog @ www.elewana.org) and watching "the great tire race" at Amagoro Junior School; walking across the Uganda border to shop in Malaba; and climbing (in my skirt and flip-flops) to the top of the rocks at Kakapel Monument, where cave paintings date to 3000 BCE. 

Along the way, Zach stopped to introduce me to his English class at the Teachers' College, and I suddenly found myself teaching "Health Ed in the Age of AIDS" (a/k/a "safer sex") to bright young Kenyan adults. Took me back a few years... The highlight of our visit, for me, at least, was sharing quiet evenings with the bishop-in-Bermudas, his family and the assorted friends who gathered in the living room to pray.

We returned home to Maseno just in time to say goodbye to University of Wisconsin med students Ali and Holly, and to say hello to five nurses from Children's Hospital in Boston. It is a blessing to be able to share this amazing place with so many wonderful visitors! And it is a blessing that they share their countless gifts with us...

Mistaken Identity

We had a population explosion yesterday when nine Maseno School students and one faculty member, all with similar symptoms, were admitted to the hospital. Some were "clinically febrile," with low-grade fevers. Most were suffering from headaches, "GBP" and "GBW" (generalized body pain and weakness), mild diarrhea and occasional coughs. Eight have recovered and will be discharged today; the ninth is on the mend.

It's a good thing, since 30 more sick students are currently lining the long portico of our beleaguered Outpatient Department and are sprawling onto the lawn. The hospital matron has phoned the district medical officer to report an "outbreak" of some kind. Fortunately, no one is seriously ill, and we are methodically working our way through diagnoses and symptomatic treatments. It could be anything from malaria to salmonella to shigella to a virus of some sort. "This is winter," said my friend Floice matter-of-factly. "We get sick in cold weather." The temperature recently dipped to 68F at night.

In the midst of it all, two doctors from Kisumu arrived to "investigate 20 (apparently healthy) new foreign visitors" reportedly at Maseno Hospital -- who are not. After some initial confusion, the doctors determined they were supposed to be investigating the "foreigners" down the road at Coptic Hospital -- not here. They went on their way after blandly suggesting, "It could be that your students have malaria." Ayup. But so far no malaria parasites have been seen in our lab samples.

I privately wondered, equally unhelpfully, if perhaps it could be swine flu hysteria (vs. H1N1 itself). Photocopied CDC pamphlets were dropped by helicopter last week and are fluttering about the countryside, listing the symptoms for every anxious child to imagine he has. Or could it be that the students' national exams will start on Monday? I know, I know; I sound like my/a mother... After last week, though, we are grateful that the "outbreak," whatever it may be, is thus far mild.