Sunday, May 31, 2009

Pentecost and Other Celebrations

Our parents taught us to always write thank-you notes. At Mom's graveside service last weekend, we celebrated a life well-lived and well-loved. I read aloud a Mother's Day litany of thanks I'd sent to her in 1965. It had been tucked inside the family Bible for safekeeping.

Today is Whitsunday, or Pentecost, traditionally celebrated as the birthday of the church. "Birthday gifts" abound, and my thank-you note to God is almost a carbon copy (remember those?) of my thank-you note to Mom. It's been tucked inside my heart forever. Whether in self-conscious script or computerized calligraphy, in adolescent angst or geriatric joy, in Kiswahili/English or any other other tongue, the message is simple and very much the same:

Thank you for loving us, the world over, just as we are, often in spite of ourselves. Thank you for teaching us to try to do the same.

Birthday Njema/Happy Birthday today, Church. Madaraka Njema /Happy Self-Governing Day tomorrow, Kenya. Amani/Peace every day, World. Asante Sana/Thank You forever, Mama/Mom and Mungu/God.

Friday, May 29, 2009

Tempus Fugit

Time really does fly; and, sometimes, so do we. During the two weeks after my computer died, I traveled to Lamu, an island off the northeast coast (of Kenya this time), for a few blessed days of respite with missionary friends Robin and Zach. En route home to Maseno, we spent a half day at Crescent Island in Lake Naivasha, where we walked on the wild side... with the animal extras who have made their homes there since the filming of "Out of Africa." (See my picasaweb link.)

I also made an utterly unplanned five-day round trip to Connecticut for my mother's memorial service last weekend. I am grateful to be old and foolish enough to have gone. Family and friends mean so much to me -- and to everyone here in Maseno, as well. Apologies to those I couldn't see in the limited time I was in the U.S. We'll get together in October. And sincere thanks to those I could see in the few hours allotted. It was a genuine gift to be with you. Very special thanks to Helen Gordon, patron saint of computer crises... She resurrected my laptop and programmed a new notebook in short order, so I am emailing and blogging again!

Nan and Gerry Hardison and I were on the same London-Nairobi-Kisumu return flights, and we hit the ground running upon arrival. We have much to do, including moving Gerry's office. The hospital complex is being redesigned with the planned "integration" of HIV/AIDS services. The Hardisons were royally Welcomed Home/Karibu'd Kenya, and we are all glad to be back.

The photo above, taken at the Swahili Takwa Ruins off Lamu Island, shows a centuries-old baobab trunk. Known as "the tree under which man was born," it is a symbol of strength and survival. Tribal elders traditionally sit beneath the majestic baobab on their three-legged stools to mete out justice and impart wisdom.

Tuesday, May 12, 2009

Computer Crashing, Prayers Unceasing

God made us long before we made inconveniently-malfunctioning computers. But "blessed be the tie that binds," however fragile fiber-optics may be.

We are grateful for your prayers, dear family and friends the world over, and we send ours back to you -- the old-fashioned way, for a little while!

Saturday, May 9, 2009

Karibu Maseno (Again)

What a difference a day makes! It is not quite noon, but I am already counting my blessings:

(1) Florence smiled for me after her PT tears; (2) only three of the seven kids from Maseno School (alma mater of Baba/Papa Barack Obama) presenting at the OPD had malaria serious enough to warrant admission; and (3) one of our staff nurses, after morning rounds, presented me with a healthy, live chicken. "Karibu Maseno," she said shyly. "I like you." 

Maybe that's a sign that it's okay for me to complete the second half of my mission assignment here? It was an honor to be given such a generous gift, especially in the midst of such uncertain times. Many families here feel fortunate to eat meat (and rarely anything but chicken) once a month. Emmah and I would be happy to share the feast with all of you, but it may be a little far to travel for chicken dinner. In deference to my vegetarian and vegan family members and friends, I will post only the "before" photo on this page.

Asante sana, Mungu God. Asante sana, Sister Harrison. Asante sana and Happy Mothers' Day Eve to all of you!

Friday, May 8, 2009


She is ten years old, and she is beautiful. But Florence is hiding beneath a kanga because her chest and neck are a mass of painful raw pink and white flesh. She was admitted to the hospital three days ago, reportedly with "porridge" burns. The site of her injury was somewhat unusual. After a few days of gentle treatment, we learned that Florence lives with ten other orphans and a woman (not an ACK Mothers' Union guardian!) who brews changaa. The children help her in the business, in exchange for room and board. Somehow a pot of boiling changaa "spilled" onto Florence's upper torso. We are now beginning some rudimentary physical therapy; otherwise, Florence might never move her head or neck again. Child neglect/abuse occurs in every country of the world, but there are no social workers here. Twombe/Let us pray... for Florence and for children like her everywhere.

Wednesday, May 6, 2009

Long Day, Short Night

Yesterday was the first of our marathon weigh-ins at the hospital. Kids were brought in from nearby Ekwanda by the van load until our pharmacy was closed and we could weigh no more.

You've read and seen enough about hunger here. Not long ago, we learned that children between 2 and 17 years of age who meet specific criteria can receive some of the USAID food supplements that are delivered to our CCC pharmacy. If they are severely malnourished, they do not need to be HIV-positive to qualify.

Our Mothers' Union volunteers are helping us identify the neediest kids from the surrounding villages. I weighed, measured and did the requisite paperwork for 60 children on the first day: 14 of those qualified for USAID food supplements; 9 were sick and referred to the clinical officer for treatment without charge. (No one required admission, TG.) Near the end of the afternoon, our pharmacist approached me anxiously: "We're running out of food, and we won't have any more until the end of the month."

The price of success? Hardly. Success will be when there are no children anywhere who "qualify" for food supplements.

Needless to say, it was a very full day, and this granny is out of practice. I collapsed into bed at 7:30 PM and enjoyed 90 minutes of sleep before a nearby funeral got underway. Funerals in Kenya, you may remember, are often several-night, all-night affairs. They feature throngs of guests and perpetual music, with speaker volume at the max. It is important to sing the dearly departed's soul into heaven. Changaa, the local moonshine, usually flows in abundance, further increasing the decibel level -- and sometimes our patient population. Funerals are notorious places to settle family feuds. With pangas. In any case, even I couldn't "sleep fast" enough to feel very civilized today.The good news is that the neighborhood burial took place this afternoon.

But the best news is that twelve children had a little more to eat last night. Lala salama, dear family and friends. Thank you, as always, for your love, support and prayers. I could not be here without you, and your presence is very much felt by us all.

Friday, May 1, 2009

Third Time's the Charm?

One of the joys of our work at Maseno Missions is facilitating sustainable community-based projects. In the process, it is a gift to be able to encourage Kenyan women to believe in themselves and in their futures. Frequently the sole supporters of their families as well as their neighbors' child-headed families, they braid sisal into rope, roll paper into beads and work the land-- if they have land.

They cook uggi/porridge over open fires, hand wash laundry in a bucket or a stream, and sweep dirt floors with tied-twig brooms. Kenyan "mamas" work from sun up until sun down with little, if any, recompense and little, if any, complaint. All they have left at the end of the day are weary muscles and bent or broken bodies -- and not just their own. Life expectancy in Kenya is 25 years lower than in the U.S. Many of these women are so busy coping with the sick, the dying and the orphaned that they are unable to braid, or bead, or work anyone's land, although the season of the long rains has finally begun.

Nan Hardison has done an incredible job of empowering women and children with the ACK Mothers' Union and the Orphan Feeding Programs. Those programs are now micro-lending operations and are expanding to all 41 parishes in the Diocese of Maseno North. With her encouragement and Gerry Hardison's professional assistance, I've been helping four Kenyan nurses establish community pharmacies in Ebwali and Ekwanda. These pilot projects were funded by Boston pediatrician Christiana Russ, who has visited Maseno on several occasions.We have all been concerned about our patients' inability to comply with their prescribed medications. Our hospital and pharmacy are some distance from the highway, but more convenient suppliers are expensive and/or inconsistent, at best.

We want our neighbors to be able to buy affordable medications without wasting money on either dangerous matatus (taxi vans) or counterfeit drugs. The local chemists and dukas/shops currently sell "treatments" of all sorts. Prescriptions are not required for antibiotics, and there are no guarantees as to the quality or the appropriateness of the items dispensed. (It doesn't help to take one dose of quinine for malaria or two doses of Septrim for a bacterial infection. If that's all folks can afford, though, that's all they buy. And that's how drug resistance is born.)

Our satellite pharmacies are fully subsidized at start-up so the nurses can provide good drugs at good prices. The drugs are purchased through the hospital pharmacy and MEDS, its reliable supplier. The nurses will sell only full-dose packets of medication. They will base the pharmacies at their respective churches, and they will, together, determine the business hours appropriate for their own communities.They will earn 10% percent of their sales, the Orphan Programs 10% of the sales, and the remaining 80% will be reinvested in medications and supplies. They know that their pharmacies must be self-supporting after the initial investment.

The original funds were used to purchase a quantity of 50 separate items for sale, bandaging materials and syringes for professional use, and four locking chests. The nurses have met several times over several months to brainstorm together and to establish protocols. They will provide limited clinical services (dressing changes, for example), as well as medications. They themselves priced the drugs for sale, and they themselves have determined what would sell in their markets. The nurses requested a large supply of Triatix poison for treating jigger infestations and an even larger supply of Formalin for embalming bodies. Death confronts us daily.

Community pharmacies are not new to aid-based efforts in Africa. They are not new to Kenya, either -- dating back to 1978 and the well-intentioned Declaration of Alma-Ata in the USSR. The concept was revisited in Mali in 1987 and called "The Bamako Initiative." According to a local clinical officer, many of those efforts failed for many reasons, in part financial and in part cultural. A major problem, he says, is that, throughout Africa, loyalty to one's family/tribe is paramount. At its best, that fosters the loving concern we see shown by the Mothers' Union volunteers in Maseno. At its worst, it fosters the violence the world witnessed in early 2008. Regardless, one of the difficulties with which every Kenyan must contend is the sometimes desperate need within his or her "family."

It is simply not OK to turn a family/tribal member away. The pressures are great upon anyone-with-anything to give it to members in need. The reality of that need is intense, so if things aren't given, things are sometimes taken. It is not about theft as much as it is about starvation. Because our nurses are Mothers' Union volunteers who support orphans of their own and have some experience with micro-enterprise, we hope these fledgling pharmacy initiatives will work for them and for their communities this time. Please give thanks with us for Christiana's support; and please keep Magi, Noel, Rosemary and Elizabeth in your prayers.

Today is Labor Day, a holiday in Kenya. These beautiful women won't get one, but they deserve a holiday -- and so much more. Meet Noel (L) and Rosemary (R)... and Magi (center), Jane (R) and Kwendo (far left), their first customer!