Wednesday, April 29, 2009


No one spoke a word about it yesterday, but eyes were anxious and hearts were heavy. We all knew the Speaker of the House had a decision to make at 2 PM. Two powerful opponents were vying for a critical post in Parliament. Either way Mr. Marende made his ruling, people feared that riots (a/k/a "a fracas") would erupt again all over the country. It is no secret to the world that Kenya's power-sharing pact, brokered by Kofi Annan after the political violence of one year ago, has been crumbling.

To everyone's surprise and enormous relief, the Speaker refused to take a stand, instead referring the decision to the entire body of Parliament. We will now return to the usual routine of "elephants trampling the grass," but at least people won't get killed if they stay out from underfoot. En route to Kisumu this morning, Kenneth said, "Yesterday at this time, I didn't believe we would be making this market safari. There were no vehicles on the road, and everyone was seriously worried."

Indeed. Could you hear us exhale in unison last night? We recalled Solomon's wisdom today at chapel and gave thanks for Marende's decision to return the onus to the people responsible.

Friday, April 24, 2009

Visitors and Other Blessings

Remember the first line of that old chestnut, "Zilivyo baraka zihesabu tu..."? It is perhaps more familiarly known as "Count your blessings..." Well, it is always a blessing to have visitors come to Maseno.

We are grateful for the compassion, commitment and generosity of so many wonderful people, as well as for the time and skills they offer in their visits of every duration. Just since my own arrival in October, we have welcomed nurses and doctors, students and EMT's, researchers and computer gurus, current and former missionaries alike.

Asante sana, Doug and Sue, Ralph and Kwan Kew; asante sana, Wisconsin nursing students, Judith and Boston-area nursing students. Asante sana, Marie and Meera, Richard and Kristy, Leopold and John. Asante sana, Ann, Amanda and Chantal. Asante sana, Douglas, Lauren and Jordan.

We love and thank and miss you all. (I'm only sorry I don't have photos of everyone.) Please know our doors in Maseno remain open to visitors. Hospitality is Kenya's middle name!

Among the other blessings of this day... During chapel, Padre Betty kindly translated for me; afterward, we processed to our "new" laboratory for a prayer. During patient rounds, I met the garrulous grandson of a founder of Maseno Mission Hospital. And no one died today. After rounds, I delivered photos to Alex at his duka/shop, where we re-lived the joy of his daughter's Sunday christening.This afternoon, a neighbor said, "Sister, I am happy that you are 'feet' (fit) and went up the mountain again" -- to said ceremony, of course. I am happy, too.

Meanwhile, friends and family stay in touch frequently. We have had water and electricity at Rotary House for 36 consecutive hours, and only one section of our roof leaks. Emmah and I had delicious rice and beans for supper. Our hearts and our bellies are full.

So, yes, I am counting my many blessings, one by one... "See what God has done!" ("Mungo aliyofanya ndiyo makuu!")

Wednesday, April 15, 2009

His Name is Legion

A thin, dirty, bloodied 15-year-old was brought to the hospital by his parents last evening, just after the Outpatient Department had closed and just as the Pharmacy was wrapping up. The clinical officer on duty was leaving, and the night call officer was not immediately available. Fortunately, Jordan, a friend and visiting paramedic from the U.S., was up to the challenge.

The young man had been running from a group of older kids when he fell into a ditch and suffered a gaping compound tib/fib fracture. In acute pain, he was nonetheless stoic. So were the subdued and anxious parents who stood quietly by their son.

Jordan expertly assessed the situation, established IV access and administered fluids, pethidine (the only thing we have for pain besides aspirin and ibuprofen) and tetanus toxoid. We irrigated the wound with normal saline, gently wrapped it in sterile gauze and carefully immobilized the limb. Although a pedal pulse was miraculously still intact, time was of the essence to save the boy's right foot.

But TIA: This is Africa. Time is not often of the essence here. That is a disconcerting but reasonable reality in a country where death has become sadly commonplace. The few remaining staff members on duty at 5 PM were shaking their heads at the wazungu racing around to find the requisite supplies from four different buildings on the hospital campus. One of them said, "All this commotion for 'just' a broken bone?"

What Jordan and I were thinking, however, was, "We have to save his foot. No, traction is not appropriate in this case. We have to save his foot. PLEASE don't move anything. We have to save his foot. He can't sever any more vessels. We have to save his foot. He needs surgery. We have to save his foot. He is just 15, dear God..."

He could be my grandson, my own heart added, when I finally had time to look into his frightened eyes. We had to save his foot.

Although a qualified surgeon happened, surprisingly, to be on site (to supervise this week's public circumcision program), his professional fees for performing the "private" service far exceeded what the boy's family could pay. We knew we needed to transfer our patient to Kisumu's Provincial General Hospital, about 40 minutes away. There surgery and hospitalization would cost only 5000 KES (about $63) total, still an exorbitant sum to a family that earns less than $1/day.

We requested the hospital ambulance and were told that it had just left the grounds -- without a patient and for an errand. "Get it back," Jordan and I simultaneously urged. At that point, the dickering began. "The family has no money. We can't take the boy to Kisumu tonight. Just admit him and talk to Administration tomorrow to see about adjusting the fees."

"No," we insisted. "He must go tonight." "Surgery needs to happen sooner than later."

In fact, the boy's parents could not even afford the 500 KES ($6.25) for the emergency services just performed, much less the 2000 KES ($25) for the ambulance. They had no time to beg for money from relatives, and we had no time to be polite. The boy's right foot and entire future were at stake. "Please bring the ambulance NOW. We need to get this kid to Kisumu."

"They must pay first," we were again told by people who understandably had no choice.

And for that we would have further risked the loss of a young man's foot and future? OK. You know what we did. It was undoubtedly culturally inappropriate and fostered dependency, besides. But what would you have done? And, yes, I should have worn latex gloves, but the Outpatient door was locked when I arrived at the scene, and I got lucky. Again, what would you have done? (See miniscule video clip: click on Picasa link at left.)

We don't even know the boy's name. But we do know "his name is Legion..."

Monday, April 13, 2009

Good News - John 3:16

It is the day after Easter and already a challenge... a good day to remember that the MDG's fit perfectly on the empty cross.

Dr. Hardison is in the U.S., and Dr. Morrison left this morning; Silus will be leaving for advanced medical training in less than a week. He and I made rounds today and found 6-year-old Whitney suffering from repetitive seizures. She was admitted yesterday after having received outpatient treatment at another clinic two weeks prior, following an unwitnessed "fall from a height."

Whitney's thigh wound, a nasty 10 cm slice, ended in a 3 cm hole which had been (sorry) inappropriately sutured closed. We opened, drained and wicked the wound, then prescribed IV fluids and antibiotics -- after we removed a 5 cm stick from the incision. Whitney was listless, and her verbal responses were limited, but her pupils were equal and reactive to light.

We kept her overnight for observation, in the hope that infection and fever were the causes. When she began suffering seizures this morning, however, we transferred Whitney to Kisumu's Provincial General Hospital. We can only pray she will be properly evaluated via CT scan for a subdural hematoma. There is no follow-up between hospitals, however, so we will never know.

In the midst of rounds, we were called to Maternity, where we determined that a 23-year-old multipara also needed to be transferred. Millicent was 28 weeks pregnant, bleeding and in pain. She had expelled a 13 cm "clot" after admission. We have no surgeon at Maseno Hospital, and Millicent's pregnancy is too advanced for a manual vacuum extraction.

On Ward II, 25-year-old HIV-positive Alice is tolerating IV Amphotericin B for cryptococcal meningitis remarkably well. However, she is weak and has begun spiking fevers, although she has also been on anti-TB medications for several months. Alice may not be able to withstand the necessary course of treatment; her caregivers are worried, and so are we.

Charles, 28, is still languishing on Ward I as a "discharge in," pending payment. He was ready to go home four days ago after recovering remarkably well from PCP pneumonia, but he could not afford the (minimal) mission hospital costs. Charles' employer agreed to lend his family the money. Charles' brother promptly disappeared with it -- a sad, but not uncommon, problem in a country where too many people are too hungry.

The good news? When we stopped by his bed, Charles was reading a small, well-worn Bible, open to the Gospel according to St. John. Silus asked Charles if that was his favorite book. "Yes," he nodded. Reminiscent of yesterday's ruminations, I exclaimed, "My confirmation verse was John 3:16!" Charles began to recite it in unison with me: "For God so loved the world that He gave his only begotten son, that whosoever believeth in Him shall not perish, but shall have everlasting life."It is Easter Monday, after all.

And it is my own beloved son's birthday, besides. Blessings, Rex! (There's that candle again...)

Sunday, April 12, 2009

Seven Stanzas for Easter

This poem has been one of my favorites ever since it was written by John Updike -- the year I was confirmed by Pastor John Braughler at Good Shepherd Lutheran Church, Monroeville, Pennsylvania. The faith of my childhood has since been sustained, renewed and shared by gifted and generous writers, artists, friends and family members over the years. I am grateful.

It was humbling to begin Holy Week this year at Rondo Retreat's Good Shepherd Chapel in Kakamega, Kenya, and to read inspired sermons while there: "Suffering, Celebration and The Rest of the Story" by Father Rob Hensley of Grace Episcopal Church, Vineyard Haven, Massachusetts. My life came full circle, somehow, just halfway around the world.

Asante sana, John, John and Rob, and to all of you (especially Bob, Donnel and Steve) between!

Make no mistake: if He rose at all
it was as His body;
if the cells’ dissolution did not reverse, the molecules
reknit, the amino acids rekindle,
the Church will fall.

It was not as the flowers,
each soft Spring recurrent;
it was not as His Spirit in the mouths and fuddled
eyes of the eleven apostles;
it was as His flesh: ours.

The same hinged thumbs and toes,
the same valved heart
that-pierced-died, withered, paused, and then
regathered out of enduring Might
new strength to enclose.

Let us not mock God with metaphor,
analogy, sidestepping, transcendence;
making of the event a parable, a sign painted in the
faded credulity of earlier ages:
let us walk through the door.

The stone is rolled back, not papier-mâché,
not a stone in a story,
but the vast rock of materiality that in the slow
grinding of time will eclipse for each of us
the wide light of day.

And if we will have an angel at the tomb,
make it a real angel,
weighty with Max Planck’s quanta, vivid with hair,
opaque in the dawn light, robed in real linen
spun on a definite loom.

Let us not seek to make it less monstrous,
for our own convenience, our own sense of beauty,
lest, awakened in one unthinkable hour, we are
embarrassed by the miracle,
and crushed by remonstrance.

(from Telephone Poles and Other Poems)

Friday, April 10, 2009


(This is Good Friday, and This is Africa.)

And this is a hospital. Although ours is a mission hospital, we did not get to church this morning, best intentions notwithstanding. Most of Kenya celebrates a four-day Easter weekend, but our patients don't have the privilege of determining when to be sick.

After rounds last night, we admitted a three-year-old with a snake bite. Dettrick's mama had killed the snake, but she hadn't brought it with her to the hospital. That was worrisome since we couldn't be sure it was non-poisonous, based upon description alone, and since we have no (expensive) anti-venoms at Maseno Hospital. "It was a green snake, about a meter long," Mama reported. That was somewhat reassuring, since the only poisonous green snake in Kenya is the green mamba.

Frankly, Dettrick would not be alive two hours after a green mamba strike. (It was a long walk to the hospital for Mama with a three-year-old on her back.) Since the boy was not in obvious distress, we decided to simply keep him for observation. A banana leaf had been tied as a tourniquet above his swollen ankle. The bite marks on his heel were visible. We removed the tourniquet, cleansed the wound, administered an antibiotic, then paracetamol for pain and a precautionary tetanus shot. Dettrick was discharged today. (Travel at night, via foot or vehicle, is dangerous in Kenya. Our patients sometimes stay 12 hours just for safety's sake if they present in the evening.)

This morning, we were greeted by several new admissions, a second crop (sorry) of kids for circumcision, and a skeleton crew of staff members. On Ward I we saw Mark, an underdeveloped 15-year-old who was described by his mother as "sickly all his life." Diagnosed with "malaria" multiple times at multiple clinics over the years, Mark arrived at Maseno Hospital feverish, in a coma and in respiratory distress. We began treatment and tested him for HIV in the process. Mark is positive.

Sadly, "Mama Mark" has since been tested and is also positive. She has been counseled and is heartsick because her son needs a blood transfusion, but she cannot donate. Four other patients are currently awaiting blood transfusions, as well, and we have no supply. There was none to be had in Kisumu all week, and the relatives of our patients are often sick or unavailable. Because of the holiday weekend, the blood bank will not re-open until Tuesday, and there is no guarantee anything will be available then.

Rotary House residents made Easter donations today. Five pints of blood seemed more sensible than a dozen marshmallow peeps.

Monday, April 6, 2009

Ants in Her Pants

From the ridiculous to the sublime...

It wasn't exactly the highlight of our Palm Sunday trip to Rondo Retreat in the Kakamega Rain Forest, but housemate Amanda's brief (no pun intended) encounter with voracious safari ants was certainly memorable. Our veteran guide was pointing out the ants' determined trail on the earth beneath us, explaining their innate ability to rapidly ascend a tree, a human leg, or whatever else happened to cross their paths, when we were suddenly alarmed by two yelps in a row. Amanda raced past us to the nearby Yala River and stripped to her skivvies, flailing as she fled. (She very wisely averted diving in; schistosomiasis would have been worse.)

Prior to that misadventure, all four of us had thoroughly enjoyed the beauty of the birds and beetles, flowers and trees, butterflies and three varieties of chattering monkeys in Kenya's precious rain forest -- only 10% of which remains, after years of human encroachment and recent global warming. Two of us had also happily ascended Lirhanda Hill at 5:30 AM (and alarmed hundreds of swarming fruit bats when we explored their secluded cave, en route). At the summit, we watched in silent wonder as the sun rose over the Nandi escarpments and tea plantations to the east. Mt. Elgon loomed on the horizon to the north, Uganda in the distance to the west, Lake Victoria and the hills of home/Maseno to the south. Wisps of ground fog looked like rivers of holy water meandering through the deep green canopy below. We basked in the color-streaked skies above and prayed with gratitude in God's own cathedral.

I was reminded of an equally-moving sunrise service years ago at a Dominican convent. And I remembered the late Dean Frank Sayre, commenting after his retirement from the National Cathedral: "God knows I am worshiping in His church when I am surf casting on Martha's Vineyard." I think God also knew we were worshiping in Her church when we were walking in Kakamega Forest. May the blessings of this Holy Week be reminders for us all to breathe deeply, love unconditionally and become (misadventures included) everything God wants us to be.

P.S. Amanda is fine!

Friday, April 3, 2009


The cycle continues. Rain is providing much-needed hope for another harvest. It is also providing a breeding ground for mosquito-borne malaria, as well as another cholera outbreak. Eight hundred sixty cases of cholera have been reported in Kenya since November. A recent "alert" went out for (our) Western and (nearby) Nyanza provinces, after several cases cropped up in Kakamega and Kisumu. Once-dry creek beds are now running with contaminated wastewater from the nearby submerged latrines. Mothers and children fill their bright plastic buckets, balance them on their heads, and patiently walk the dirty water home for household consumption.

Not everyone has had the benefit of our Mothers' Union "Waterguard" training, and not everyone has the pennies to buy the requisite Jik (bleach) to purify the water. Boiling works only if the water is filtered and boiled long enough. Deforestation threatens many areas, firewood is at a premium, and open fires are usually reserved for cooking dietary staples like uggi/porridge and ugali/maize meal.

In a recent survey, most of our Mothers' Union mamas reported that the orphans in their own communities are receiving just "strong (plain, no milk) tea" for breakfast, plus ugali for dinner 3-4 nights a week. Water is on the menu the other nights. Beans and corn are now too expensive for most people to buy in the Luanda market. Many families haven't been able to plant their shambas because, to prevent starvation, they fed their children the beans and corn that had been stored from last season to propagate this one. Fruits and meats are out of the question. We are seeing kwashiorkor routinely. Our Saturday morning Mothers' Union feeding programs are more important now than ever.

Meanwhile, babies and toddlers with malaria are filling our pediatrics ward. "Malaria continues and poverty deepens in a truly vicious circle," writes economist Jeffrey Sachs. Sick and well kids are currently crammed bed-to-bed at Maseno Hospital because the school holiday is also the occasion for another round of circumcisions. We are inundated with temporarily-rambunctious adolescent boys. In an effort to help battle the transmission of HIV/AIDS, NGO's are sponsoring week-long surgery-plus-education programs throughout sub-Saharan Africa. "As always," Sachs writes in his book The End of Poverty, "these battles are never won, just pushed forward to new terrain. Still, after years of extreme neglect, the battle against AIDS, malaria and TB has finally been joined."

Sachs closes his book by quoting Robert Kennedy: "Let no one be discouraged by the belief there is nothing one man or one woman can do against the enormous array of the world's ills -- against misery and ignorance, injustice and violence... Few will have the greatness to bend history itself; but each of us can work to change a small portion of events , and in the total of all those acts will be written the history of this [or any] generation."

Wednesday, April 1, 2009

Mud-Luscious and Puddle-Wonderful

Bwana asifiwe, and asante sana, ee cummings! "The rains (finally) came" to Maseno Missions, two evenings in a row, and we listened all last night to laughter on the roof.

Thank you, everyone, for your prayers -- and thank you, Nell, for sending the wet weather in western Massachusetts to the parched people in western Kenya!

Relief is palpable as people begin to plant. This photo of our neighbor's shamba may not look like much to you, but it literally means life to us.

"... I will send down the showers in their season; they shall be showers of blessing. The trees of the field shall yield their fruit, and the earth shall yield its increase. They shall be secure on their soil..." (Ezekiel 34: 26, 27 - NRSV)