Monday, January 25, 2010

Lost in Laughter, not in Translation

Nurses have no formal training in hieroglyphics, but most of us learn how to decipher doctors' handwriting before graduation. Even after all these years, however, some doctors' notes still give me pause. They're a little trickier, perhaps, in a different culture, although our clinical officers write in English. That is the official language of Kenya.

I have been temporarily stymied here by sentences like, "The patient was stoned by rugs." (Try "rogues.") Speaking of rogues, I had visions of an Indian snake charmer run amok in East Africa after reading in two separate charts, "The patient was beaten by a snake." (Maybe "bitten"?) Most recently, I was startled to see an "NPO after midnight" order written as "Starve the patient after midnight."

Even oral communication has its moments, and that's always a two-way street. Today our medical officer asked me to consult in the Outpatient Department. Francis instructed the patient, who was lying face down on the examining table, to remove his trousers. "Boils?" I anticipated. "No," Francis replied without hesitation. "His balls are in front."

Fortunately, calligraphy, spelling and the nuances of vowels are not necessarily required to communicate effectively and give conscientious care at Maseno Mission Hospital. The ability to laugh at ourselves, though, is a prerequisite.

Sunday, January 24, 2010

Through a Glass Darkly

"It's not our job to change people. It's our job to love them," Emmah sighed.

Our nurses have been distressed about well-intentioned people trying to effect change without first asking what change might actually be needed or wanted. Without careful communication, "systemic" change can be perceived as imposed "personal" change, and perception is all. Thanks to Emmah's gentle reminder, I realized that we have expectations of the change agents, just as they have expectations of us. Therein lay the problem: unmet needs related to unmatched reflections of "them" and "us."

The list is growing, but my recurrent life lessons include: (1) "It's not "either/or." It's "both/and." (2) It's not about "them and us." It's about "all of us." (3) It's not our job to change people -- wazungu, African or anyone else. It's our job to listen to and love one another.

Even in the bright Kenyan sun, seeing face-to-face is not easy. And it is certainly humbling. Thank you, Emmah, and thank you, God. It is time for morning rounds again, time to put one flip-flop in front of the other. It is time to listen and time to love.

Friday, January 8, 2010


Yesterday a visitor from Wisconsin was enjoying the company of a young neighbor. As they played, she was taught the Kenyan version of a familiar nursery rhyme:

This little piggy went to market,
This little piggy stayed home,
This little piggy had water,
This little piggy had none.
And THIS little piggy cried
"Wee-wee-wee" all the way home to America.

Today more visitors will arrive. A group of Engineers without Borders is coming to assess, and hopefully help us address, our local water and power problems.

Please pray for them and for children everywhere that one day soon "pigs will fly..." (all the way home to Africa), water will flow and reliable energy will be harnessed.

Wednesday, January 6, 2010

Feast of the Epiphany

In the gospel reading for today (Matthew 2:1-12), we hear how the Magi came, not without difficulty, to offer homage to the infant Jesus, realizing they were seeing God made manifest. In many ways, in homes and hospitals around the world, small epiphanies occur every day as we witness the miracles in the lives we share.

This week in Kenya, the matatus (taxi vans) are on strike, creating great difficulty for travelers -- whether they are students returning to school, employees returning to work, or patients trying to reach medical care here at Maseno Hospital. We could use a few good old-fashioned camels about now. The local matatu drivers complain about police extortion, the local police complain about unsafe vehicles (and, admittedly, their own delayed paychecks), and the litany goes on... But, as always, it is the poor and the sick who suffer the most.

For them, getting here is definitely not "half the fun." It is a tribute to the hospital's reputation that people walk countless kilometers to be seen and treated by Dr. Hardison. Two days ago, a farmer from the interior came to us with a chunk of his badly-infected left calf missing. "A donkey bite," he explained, as he sank to a bench in pain and exhaustion. The same day, a laboring mama made it to our maternity ward in time to deliver a nonviable fetus, her second "twin," after giving birth to a live infant at home.

Today we saw Francis, a 16-year-old, who was brought in after being struck by lightning. Andrew, 63, in the adjacent hospital bed on Ward I, is suffering from gangrenous toes and diabetic retinopathy. With no popliteal pulse and gaping ulcers on his right leg, he will be referred to the district hospital for a probable BKA (below-the-knee-amputation). Floice, on Ward II, is recovering from pharmacologic toxicity. (A nearby clinic misread her "Tylenol" prescription as "Tegretol," an anti-seizure medication.) And oxygen-dependent Phoebe suffered a setback last night because of a 4-hour power outage. Her O2 sat is now 88%, but she continues to improve. With the help of the Mothers' Union, we hope to establish a sort of "halfway house" for her and other single mamas who are too ill to provide for their children.

Although underlying HIV compromises many of our patients, especially those with TB, PCP and cryptococcal meningitis, some diagnoses are "straightforward" panga/machete wounds, diabetes, malaria, enteric fever, hypertension, ashtma, cellulitis (often r/t boda-boda or piki-piki injuries), etc. Because Dr. Hardison is a gastroenterologist, we also seem to diagnose an unusual number of esophageal cancers at Maseno Hospital. We can't help but wonder if those cancers (and the asthmas, too) may directly correlate with our patients' years of cooking over indoor fires.

Against many odds (often economic), our patients find their way here. Against many other odds (also often economic), we try to care for them. We are sometimes asked by well-intentioned Western friends, "But can the hospital become 'sustainable'?" In a word, and in my humble opinion, no. Not for quite some time and not without quite a bit more initial support and reorganization, at least. As Dr. Hardison says, "I guess it wouldn't be a mission then; would it?" I have to wonder, myself, "Is any hospital in any depressed economy 'sustainable' without loans, grants, and the equivalent of Medicaid/Medicare?"

The poor are always with us, and they may always need our help. It is ours to share and celebrate the small epiphanies that happen every day, in spite of great difficulties -- and, yes, to offer our own homage, wherever we may be.

Friday, January 1, 2010

Holy Name Day

My beloved grandchildren have distinctive names (Gwendolyn, Huckleberry, Maisie, Nell, Nadia and Nico), so I take particular delight in learning the names of the children of Maseno. Currently we have Charity, Dorcas, Mercy and Precious in the hospital, as well as Philemon, Shadrack and Zedekiah. Most are recovering from malaria and will soon be able to go home. You've read about the influx of our newborn Baracks and Michelles after the 2008 inauguration in the U.S., of course -- nary a Tom, Dick (and Jane) or Harry in the bunch. There are, however, a lot of little "Nans" and "Gerrys" running around, children named in loving honor of the Hardisons, whose eight years of unstinting efforts at Maseno Missions are deeply appreciated here. (We even have a little "Professor"!) From the time of Joseph and Mary, parents all over the world have named their babies with joy, hope and gratitude... "All God's children got names!"

Heri za Mwaka Mpya!

Many Christians throughout Kenya spent last night at church vigils, praying in the new year. At midnight, communion wine and bread were shared; where there was no wine, communion sodas and biscuits (cookies) were distributed.

Although I fell asleep at "missionary midnight" (9 PM), I awakened at 11:55 PM to hear the sounds of celebration a few moments later from our little town of Maseno: drums beating, pots and pipes clanking, and the joyous shouts of people hoping for peace and prosperity (or at least for enough water and maize) in 2010.

I am told that "Happy New Year" greetings will be exchanged here during all of January, much as "Yes We Can's!" were exchanged during all of January last year, following President Barack Obama's inauguration... It is now midnight on the east coast of the US, so I send my own month-long wishes for a Happy New Year to you!