Birthday Njema!

I miss you, dear Nadia. I wish I could share your second birthday with you today, but Kenya is a little too far away... I have an idea, though: let's make an UN-birthday cake together when I get home next fall. We can have a big "grandchildren" party with Nico, and with Nell & Huck and Maisie & Gwendolyn; OK? We will celebrate all of the birthdays I am missing! Shall we have a chocolate cake? What color balloons would you like? Shall we invite parents? We can have lots of fun just planning our un-birthday party until then.

Meanwhile, I want you to know how much I love and miss you all. Every day I see lots and lots of kids here in Africa. It makes me sad sometimes to see so many sick children, but many of them get well and play together, just like you do. Then it makes me happy to see them playing because they remind me of you, your brother and your cousins! Here in Maseno, kids play with soccer balls made of wadded-up plastic bags, tied with a string. They share a bicycle that's a little bit rusty and a lot too big for them. They jump rope with sisal they've cut and braided together. And they spin hoops (old bicycle tires or plastic tub lids, actually) with a stick. They play hide & seek and sing songs and laugh together, just like you do. They help their parents, too, just like you do.

Your big brother asked me what the kids here eat for dessert. I told Nico they have no dessert, at least not the kind you have. They don't have birthday cakes or cookies or ice cream or popsicles after their meals. But they can pick bananas and guavas right off the trees, and they can suck sugar cane right out of the fields. They can also dig fresh peanuts to shell, right out of the ground, as long as the monkeys don't beat them to the harvest. Peanuts are called "ground nuts" here -- because they come from the ground, of course! Once in awhile, visitors do bring candy, so the kids have now learned to ask "mzungus" (visitors) for "sweets." It's a good thing visitors bring toothbrushes and toothpaste, too.

Many children in Kenya sleep on the floor (sometimes that's just the bare ground, smeared with dung) because they don't have beds. They don't have sheets or blankets or sleeping bags, either. They sleep in their clothes, and they snuggle close together on cool nights. Some of the grown-ups that Granny knows are saving their money to buy washable blankets for those kids. There are thousands of children in our orphan program in Maseno North. That's a lot of blankets, but they cost only $7 each. We are hoping that the blankets will add up, "bit by bit" -- just like Mama Panya's pancakes did in the story book about Kenya that we read together. That way, one day, all the kids here will be warm at night.

Be warm, yourself, dear Nadia, this and every night. Have a very special, very happy birthday; and, don't forget, we'll have an extra party when I get home! Please know how much I love and miss you and Nico and your mama and your daddy; how much I love and miss Nell & Huck and Aunt Jen & Uncle Joe; how much I love and miss Maisie & Baby Gwendolyn and Aunt Scarlet & Uncle Rex. "Night night, sleep tight, don't let the bedbugs bite." (And, as your brother says, "If they do... " well, you know what to do: "Hit 'em with a shoe!" Right, Nico?)

God bless you all, children and grandchildren of the world,
Granny Smith

Home Visits

Marcella, 12, and Dorene, 6, are orphans. Their parents died several years ago from AIDS-related illnesses. The sisters share a thatch-roofed, windowless, mud-walled two-room home with three other relatives. We met them, and nine other families living with HIV, on a warm day-long walk into the community, through forests, fields and sunny shambas (small farms). Praxedes, Salome and Teresa, three committed CCC staff members, were my guides.

The Comprehensive Care Clinic is one of the hospital-affiliated programs in Maseno. Separately-staffed and funded by NGO monies, it provides daily counseling, testing, outpatient services and support programs to people living with HIV/AIDS. The CCC operates from a building located between our Women's Ward and the Xray Department. It also operates in the community by sending trained health workers, many of them living with HIV/AIDS themselves, into homes to provide follow-up care to adults and children alike.

Marcella and Dorene ushered us into their simple home, invited us to sit on the only bench in the house, and shyly counted out their anti-retroviral drugs on a spotless, pressed tablecloth. A neighbor's cow grazed in the dooryard, chickens wandered in and out, and fringed homework papers decorated the ceiling.


The dung floor was swept clean, and an old calendar brightened the wall near the door. The sisters are fortunate: their aunt took them in and raised them alongside her own children, in spite of the lingering stigma of AIDS. We did not see Deenah because she works all day, every day, as a domestic to support her family. The kids work, too, on the house and in the garden. They do not attend the "free" district primary school because they do not have enough money for the requisite uniforms and books. However, they do attend our Saturday orphan feeding programs, where they participate in classes, as well. They also walk seven miles round trip, twice a month, to attend the Kids' Club at Maseno Hospital's CCC -- one more program that is keeping hope alive.

We wore neither lab coats nor uniforms on our home visits. Although guests are warmly welcomed, even the children did not want their neighbors to know why we were there. There is a poignant hand-lettered sign on the wall of a makeshift clinic in the village where Marcella and Dorene live: "In the end, we will not remember the words of our enemies. We will remember the silence of our friends."

Keeping Hope -- and Kids -- Alive

Some of you listened patiently to my Epiphany sermon at St. Andrew's a few weeks ago. The theme was Joy and Justice, and it closed with the prayer: "Let us light one candle for hope, and may 'the work of Christmas' begin."

Barack Obama's inauguration reinforced my prayer. Neighbors in Kenya are still marveling at the peaceful transition of power we simply took for granted in America. In 45 years of independence, that has never happened here -- nor has it yet happened in a number of other developing countries. Sometimes, in spite of ourselves, we are role models for other nations. In his speech on Tuesday, our new president reminded us that our forebears had rolled up their sleeves and worked together during hard times in the past. "We can do it (yes, we can!) again." Hope and responsibility go hand in hand. The future of the world, not just the United States, is up to every single one of us -- not merely to the individuals we may install, peacefully or otherwise, as our respective leaders.

We have seen inspiring images from around the world this week. I am grateful to be able to share a few more from Kenya. These are photos of kids and kukus (chickens), not of flags and buildings. Two hundred more Kenyan children will be able to save egg money for school, thanks to donations from the Vineyard. These are also photos of hospitalized toddlers whose mamas entrust them to our care. We are working hard to help Zedekiah and some other very sick kids survive, thanks to donations from Cape Cod and, in fact, from all over America. Mine are pictures of joy and justice in action -- thanks to your hope and your responsibility, the Maseno North Mothers' Union and the Maseno Missions staff.

Thank you for lighting one candle and for keeping hope alive, both at home and around the world. To see more photos of "Kids and Kukus!" and "Zedekiah and Friends," please click this link: www.picasaweb.google.com/dianne.smith.rn

Asante sana.

What, Me Homesick/ Happy/ Hopeful?

A resounding YES to all of the above.

It's been a busy morning at Maseno Mission Hospital. After rounds, Dr. Hardison worked up a very sick new patient: a 28-year-old emaciated male with multiple abdominal masses. Rabson has lost 15 pounds in the past three weeks and is too weak to stand. Fortunately, he was also too weak to refuse admission for very long and ultimately allowed us to put him into a bed. We await with concern the test results that should determine his diagnosis: TB vs. lymphoma -- hopefully the former so he can more effectively be treated.

En route to the ward with our patient at noon, I caught a glimpse of the small black and white TV high on the wall of the waiting room/covered portico. To my surprise, I began to choke up. A fuzzy aerial view of the White House was pictured on the screen, and local news broadcasters were beginning to cover America's Inauguration Day in Kiswhahili. (We are eight hours "ahead" of D.C. here, so it was precisely eight hours prior to President Barack Hussein Obama's swearing-in ceremony.) Spirits are as high in our small rural Kenyan hospital compound as they could be in any massive urban American inaugural ballroom.

We are wearing Obama stickers today; they were kindly provided by our visitor, Marie Williams, from Chatham, MA. I am also wearing a hand-me-down Obama t-shirt from daughter Kate beneath my lab coat. In honor of the occasion, Dr. Hardison bought ground nuts (peanuts) for everyone to share with morning chai in Matron's office. And Linet and her mother Mary have generously invited me to their house after dinner to watch the swearing-in ceremony on their TV. (Outpatient's screen will be locked up long before 8 PM.) I've warned them that I will probably spend the evening in tears.

"We pray for all who govern and hold authority in the nations of the world; that there may be justice and peace on the earth" (from "Prayers of the People," Form III, The Book of Common Prayer).

Medical and Moral Dilemmas

Two youngsters in our pediatric unit spiked fevers of 40.1C (104+F) within one hour yesterday, shortly after they had received blood transfusions for anemia. Since they've responded to IV quinine, the probable cause was malaria-infected blood -- a classic question of the cure being worse than the disease. In this case, as Dr. Hardison explained, "We could screen for malaria in the donated blood, but we'd probably eliminate half of our supply" -- which is obviously at a premium. Instead, we will be prepared to treat with quinine before transfusing anyone. Adults experience malaria as a flu-type misery; young children experience it as a life-threatening illness.

Two mamas on Ward II, both of whom tested HIV-positive, were admitted this week with serious opportunistic infections. After they agreed to be tested and were then informed of their status, both separately refused counseling and registration at a Comprehensive Care Clinic -- ours or anyone else's. Although they could qualify for and receive free anti-retroviral drugs and medical care, Diana and Ritah cannot cope with the social stigma of their diagnosis. This is a recurring problem. Women in rural Kenya are afraid to be seen going to a CCC because their husbands may discover their status and dismiss them -- and quite possibly their children.

We cannot force them to get treatment, of course. We can only encourage them to go with their husbands to get (re-) tested together. In almost every situation, the husband has infected his wife/wives, but the female is the first to get sick. If a wife is diagnosed as HIV-positive, however, the husband will often refuse to be tested and will conveniently blame and abandon her. He will continue to infect other women while his wife and his children may die. PEPFAR funding and HIV/AIDS education have made great inroads in Africa, but social stigma is the same the world over.

Return to Maseno

Christmas in New England was both unplanned and bittersweet... But my mother's final gift to me was precious time with family and friends. Thank you all, from North America to Africa and points between, for your love and support these past painful weeks.

Thanks to Nan & Gerry, Emmah and Linet, re-entry in Maseno felt seamless after a classic Vineyard departure, fraught with high winds and canceled ferryboats. "Pole sana" ("I'm so sorry") neighbors kindly offer with extended hands, here just as there, about my mama's recent death. I returned one week ago to warm sunshine, welcoming hugs and the usual unusual array of presenting problems in our little mission hospital.

A 9-year-old boy suffering from severe malnutrition, jiggers and phimosis (look it up) needed circumcision. We kept Stephen an extra few days to feed him. A 36-year-old HIV-positive female presented with herpetic lesions involving the trigeminal nerve. Mary's left cornea was damaged; she has permanently lost her sight in that eye. A 14-year-old was admitted after an attempted abortion, a 21-year-old after an attempted suicide. Two wasted, almost skeletal, young women, one with TB and one with probable HIV encephalopathy, are not doing well. [Note: Jesca died the day after I wrote this entry.] And 7-year-old Beryl is suffering from the worst case of chickenpox I have ever seen; she is febrile, immuno-suppressed and perfectly miserable. Margaret, 14, was discharged after successful treatment for osteomyelitis in her left femur -- a condition that had gone undiagnosed for over a year at other medical facilities. Grace is a beautiful 12-year-old with severe red-cell aplasia/anemia; her prognosis is not good. Several babies with malaria have come for treatment and gone home. A young HIV-positive male was admitted two days ago with ascending bilateral neuropathy -- probable AIDP (acute inflammatory demyelinating polyneuropathy). And five drunken young men suffered a variety of hand, skull and clavicle fractures in a two-piki-piki RTA (motorized bicycle road traffic accident) last night. Life and death and time march on...

Speaking of time, January 20th is almost here, and all eyes in predominately-Luo/Luhya Maseno are on the U.S. presidential inauguration. Five babies named "Barack" were born in our small maternity wing this week, and fraternal twins named "Obama" and "Michelle" arrived two days ago. Michelle and her mama are pictured above. (Her brother is resting up for the big event.)

Epiphany blessings, Everyone. "Light one candle for hope," as our St. Andrew's, Edgartown, children recently and beautifully sang.