Bear Scare

No, not a "real" bear. Not in Kenya.

But we do have a large, matted, much-loved (and very unhygienic) stuffed bear at Maseno Mission Hospital. He has served long and well as a comforting pillow for our patients. He arrived here several years ago, the gift (after $62 "duty"/ransom was paid) of U.S. church friends. His seams have been re-sewn countless times, and his fur has been rubbed off in several places. The bear disappeared awhile ago from the wards. He had been relegated to an ignominious existence in a storage room. When we found him, his stitched-on smile had frayed to threads, and his once-shiny nose was dulled by dust.

His eyes were still bright, however, so over the weekend I brought him home to Rotary House for a bath.

First, however, he and I spent a few hours in storage-room "surgery." The bear's head was flopping, his seams were split, and his stuffing was well over half-gone. Fortunately, the somewhat powdery remnant of a foam rubber mattress was folded next to him. After a few hours with bandage scissors, my knuckles were blistered and my sinuses were clogged. But the mattress was recycled, and the bear had new "muscle mass." Most importantly, he also had a respectable bear-belly once again.

Before his Omo bubblebath, I stitched up seams, embroidered a new mouth and added an unfortunately lascivious-looking felt tongue. After his sun-dried air-freshening, I polished his nose with magic marker. Sawa! Our good-old Bear is now as real as the Velveteen Rabbit. And for the moment, at least, he shuffles again between Wards I and II. This is as close as I'll ever get to being a surgical nurse, and it's not much of a mission legacy. But "we can do only small things with great love..."

And with great apologies to our visiting infection control nurses.

Come and See

Today was graduation day at St. Philip's Theological College. Twenty students received diplomas, and two special certificates were awarded. The festive occasion was opened, however, with silent prayer for the family of a graduate who was unable to be present. The mother and sister of Festus Wakula were murdered in their home last week. All of the students and their families (and faculty, as well) have struggled more than most of us can even imagine to simply arrive at this moment in time after three years of study. They understand full well the struggles of their parishioners as they "go into the world" of rural Kenya to love and serve the Lord.

In her moving speech of welcome, Principal Nan Hardison addressed the graduates and visitors. Padre Richard, our college chaplain, then reminded the students about St. Philip's own response to Nathaniel's doubt: "Can any good come out of Nazareth?" -- Philip wisely invited him to "Come and see" (John 1:46). The guest speaker next described the graduates as God's own salt of the earth (Psalm 38:4), called to season the world and be agents of change for the good. As bishop congratulated our students, it was a blessing, indeed, to see all the good that is coming out of a small Bible college, now an accredited theological diploma program in Western Province.

As the graduation ceremony continued, the Mothers' Union members of 31 parishes throughout Maseno North were simultaneously feeding and teaching thousands of children in their Saturday orphan programs. Those tireless efforts bear witness to the lay leadership of this diocese, also inspired by Nan's tutelage.

Meanwhile, back at the hospital... A popular young piki-piki (motorcycle taxi) driver was admitted late yesterday, badly wounded by pangas/machetes. Elphas is stable and will recover from his head wounds, but his severed wrist ligaments will require more surgery. His badly-beaten body was discovered at 6 AM, following an all-night rain and the brutal theft of his motorbike by a midnight customer. Elphas is the sole support of his family, and this is the second time he's been robbed of his livelihood. He cannot replace either of the leased vehicles now, and his family is worried. His body will heal, but will his spirit?

Elizabeth, four years old, was brought to us last night by friends at a nearby Swiss orphanage. They had admitted the child the previous day. Her father is dead, her mother is physically disabled, and Elizabeth is suffering from kwashiorkor. She weighs 10 kgs. and has a profoundly flat affect. Neither touch nor balloons, nor stickers nor stuffed animals, can elicit even a flicker of expression in Elizabeth's dark eyes. Fortunately, her kidneys are still functioning well, so Dr. Hardison believes her facial swelling and pitting extremities will improve with a week or so of improved nutrition. Elizabeth now has a nurturing place to live, but when will she be able to trust like other children?

Come and see... In the face of fear and frustration, pain and poverty, small miracles are happening every day. Asante sana, Mungu God.

Sisters

Violet, 17, was readmitted today, the fourth time in two months. Our friends from Christ's Hope brought her to Maseno Mission Hospital. Dr. Hardison tapped 1800 mls of fluid from her chest and will probably need to repeat the procedure tomorrow. Violet's nine-year-old sister Elyse (at right) remains with us as her caregiver to help with meals, meds and personal care. Wide-eyed and serious, Elyse tends to Violet's needs with consummate attention and affection. Orphaned by AIDS, they now have only one another -- and y/our prayers.

Heigh-ho, Heigh-ho

Off to work we go... and went. The Monday "holiday" turned out to be a lengthy service of celebration that simply delayed the start of (everyone else's) shift, rather than provided a whole day off. Our morning and afternoon rounds were punctuated by three endoscopies instead of lunch, and we admitted several new patients. Two are beaten wives -- with head and rib wounds, respectively. We also treated a child who had been raped, and we admitted a 77-year-old self-described "peasant" who had cut her toenail too short last May. Hellen continued to work in her shamba/garden and neglected the developing infection for five months before coming for care. She will lose much of her left foot, as a result. At least she was spared a grisly death from tetanus. But who will feed her grandchildren?

A 12-year-old boarding school student was admitted late Sunday night after mixing a cup of Omo laundry detergent in water and ingesting it. He was discharged Monday afternoon in the care of his teacher who had insisted (without success) that we treat Samson for "cerebral malaria" because of his "bizarre behavior." The child had no fever and no malarial parasites. He did have a problem, however. In a private conversation, he told me that he'd been studying when some older students threatened to beat him. We talked quietly for awhile, and I asked his permission to explain his problem to the teacher. Samson agreed, so I invited Sister Aloys to talk with us.

She instantly scolded the student about how his hospitalization would incur financial expense for his mama. I explained that bullying was a serious problem all over the world, and that some schools now have curricula to address the problem. She did not respond. I reminded her that we see adults who have attempted suicide -- usually after domestic disturbances -- as often as once a week in our hospital. "We need to help Samson find another way to resolve this problem." Our three-way conversation concluded with her verbal assurance that he could report to his hostel supervisor's office if further difficulties should arise. In her heart of hearts, though, I know she still believes that Samson has untreated malaria.

A thunderstorm (still the season of the short-but-violent rains here) trapped us in the ward after rounds -- a "shower of blessing," indeed, since I was invited to comfort a beautiful healthy baby whose very sick mama was trapped by the same storm in our hospital lab just a few hundred yards away. It was lovely to hold a substitute grandie in my arms! And it was lovely to eventually get home to Rotary House to the company of Emmah and Jessica, our new YASC volunteer at St. Philip's. We shared a delicious dinner and mango pie. "God is good all the time, and all the time, God is good," as our Kenyan friends so faithfully chant.

St. Luke's Day

A hospital holiday has been declared for tomorrow, apparently to compensate for the removal of last week's "Moi Day" from the country's holiday calendar -- one of the smaller items addressed by Kenya's new political constitution.

Luke, the Physician... a reasonable icon for a mission hospital. Except sickness and death take no holidays, and we will be even more short-staffed than usual. Patients like little Norah, who needs a chest tube, and patients like Kennedy, who needs an MRI, and patients like Joan, who needs more debridement of her burns, will suffer because of administrative decisions that may pacify hospital employees but will make no sense whatsoever for hospital patients.

We have a plethora here of western-inspired mission statements, vision statements and computerized forms. We have a dearth of money, medications and functional computers -- much less trained, motivated clinical and clerical staff. It is a challenge to provide even marginal patient care. And Wednesday will be Mashujaa/Heroes' Day, formerly Kenyatta Day, which remains a national holiday.

Let us pray.

African Arachnid (for my grandchildren)

An eensy-weensy spider
Went up your Granny's skirt.
Down smacked her hand
To prevent the spider's hurt.

Out came red welts
And a fair amount of pain --
Granny's hand too slow
To avoid two bites, 'twas plain.

Down fell the spider,
He landed on the ground.
He thought he'd have a taste again,
Not knowing he'd been found.

The eensy-weensy spider
Then tried just one more time.
"Stomp" went Granny's foot
To halt another climb.

An "ouch!" was heard from Granny,
A tiny "crunch" then came.
That eensy-weensy spider won't
Go up a skirt again.

Happy Birthday, Desmond Tutu

--and peace to you and your family in retirement. You are a gift and an inspiration to this broken-but-still-beautiful world. "We thank God continually for you."

Miracle Children

Frida, 18 months old, had a high fever and was unresponsive when she was admitted to the hospital. Diagnosed with streptococcal pneumonia and meningitis, we were not sure she would survive intact, if she survived at all. Frida was in a coma for five days, her worried mother at her side. Pole, pole (slowly, slowly), she began to respond to IV antibiotics and fluids. A week later, her smiling mama was able to take Frida home.

Three-year-old Eunice came in the same week with oral thrush and an erratic heartbeat. HIV-positive at birth, she weighed 7 kgs (15.4 pounds) on admission. She is dressed in a voluminous 18-month-sized going-home sweatsuit in the photo above. She was severely dehydrated, cachectic and lethargic. Her mother told us that Eunice had been eating only 2 T of barley water every day for two months. It is difficult to access veins in dehydrated patients, especially in dehydrated children, but we were fortunate. We taught Eunice's mama to administer anti-fungal Clotrimazole drops for the thrush, and our nurses slowly administered IV fluids, ORS (oral rehydration salts) and eventually high-protein eggnog through a feeding tube. Thankfully, we had no power outages during Eunice's admission; the "Kangaroo pumps" that our Boston friends brought us last year saved her life. Within a week, Eunice, too, was able to go home, once again able to eat and take her medications orally. She and Frida are our miracle children.

Violet, 17, was brought to the hospital by our friends at Christ's Hope. It was her third admission in six weeks. She is HIV-positive and takes her drugs faithfully but suffers from CHF and micronodular hepatomegaly. When she arrived, Violet had severe dyspnea and distended neck veins. She was struggling to breathe. We administered aldactone and IV lasix, but she diuresed only 2 kgs. Over the course of seven days, Dr. Hardison removed 4000 mls. of fluid from her chest via thoracentesis. She is more comfortable now and will soon be discharged. But the harsh reality is that she would be on a heart transplant list in the U.S. That is not an option for her in Kenya. Violet needs a miracle.

Cornell, 18, also needs a miracle. His older sister brought him to the hospital. He was admitted with a severe headache, papilledema, 3+ proteinuria and a blood pressure of 200/130. His malignant hypertension is a longstanding condition, and he is now in full-blown renal failure. Cornell needs dialysis and a kidney transplant to survive. That cannot happen here. Please pray for these children and their families.

One Father's/Family's Grief

James, 34, was admitted to the hospital a few days ago, complaining of chills and lethargy. Actually, he was carried in by his three brothers; their anxious father followed close behind. They told us that James was recently diagnosed as HIV-positive and went on a drinking spree. When he suffered seizures two days later in our hospital, we thought the seizures might be alcohol-induced. He was negative for both malaria and cryptococcal meningitis.

His intermittent seizures (of 15 minutes' duration) continued, and James began vomiting blood. His hemoglobin dropped dramatically, so we typed his blood in preparation for a transfusion. Dr. Hardison performed an endoscopy and discovered that James has a pyloric obstruction. As a result, he cannot absorb oral medications. We have no IV anti-convulsants.

Neither do we have any available blood, so we asked his brothers if they might be willing to donate two units for James before we transfer him to an ICU/surgical unit in Kisumu. They willingly agreed and were typed by our lab. In the process, however, we learned more sad news.

One brother had a different blood type, and the other two were unable to donate: Kennedy was HIV-positive himself, and Francis had hepatitis B. We needed to inform them. They, in turn, needed to inform their father. In his private grief, Baba James initially bolted, then returned to his son's bedside. There the family watches and waits together. Free counseling and HIV medications are available, but the stigma of AIDS is great. Many people still don't go for help until the disease has progressed and they are symptomatic.

Please pray for us all.

View from Maseno

Olivia, a wise woman friend now retired in the U.S., asked me not very long ago, "We so often hear about the differences between cultures. What are some of the similarities you see?"

There are many, but my instantaneous response was "love for children": children in the hospital, children in the community, children around the world. Their health, well-being and education are valued by us all.

Cynthia, a wise woman friend now teaching in Maseno, recently wrote about a children's program fostered by "Dr. Gerry's" wife, "Dr. Nan," whose primary role is Administrator of St. Philip's Theological College. Cynthia has kindly given me permission to share her story...

"September 2010: View from Maseno

Most of you have heard about the Mothers' Union activities, especially their orphan feeding program, in the Maseno area. Yesterday I had the pleasure of seeing a special program to honor several hundred Mothers' Union members who volunteer their time and labor to bring help and support to the orphans in this program. Many of these women are only barely less poor than the orphans themselves. All struggle to keep their families adequately fed. Many have little or no schooling. Some are HIV-positive or have other serious health conditions. But they work in their local orphan-feeding program one day a week, hauling water and food sacks, standing over hot smoky cookfires for hours, making mixtures of maize and beans that are not only filling but palatable. (I've eaten the results.) They give the orphans one day a week in which they are looked after by mothers, taught songs and prayers, and given a supervised place to play, be cared for and comforted.

You can always tell which children have most recently joined the orphan program. They're the ones with the glassy look of malnutrition, the generally unkempt appearance, the sadness, and often the lameness that comes from feet infested with sandflies [a/k/a "jiggers"], for which the orphan feeding program will put them in footbaths that eventually eradicate the problem (subject, sadly, to re-infestation). The ones who have been coming to the programs for some time are visibly healthier, more alert, and, in a well-behaved way, more like the children you might know at home: ready, in a shy kind of a way, to have fun.

The program yesterday, unlike the other programs, was mainly for the women themselves, to honor the volunteers who have done so much. Around 350 volunteers attended. It was held at a local Anglican church compound. The Anglican Bishop of Maseno North presided. Bishop Oketch has an imposing presence, great familiarity with ceremonial situations; best of all, he is a strong supporter of the Mothers' Union orphan program. The Maseno Orphan Feeding Program has attracted attention and respect in other parts of Kenya [indeed, around the world], so he gets some reflected glory from it -- a clear case of positive feedback.

American Episcopal missionary Dr. Nan Hardison, the Principal of St. Philip's Anglican Seminary (where I teach), gave a history of the orphan-feeding program. Eight years ago, in discussions with Mrs. Oketch and with women in the local churches, she realized that there were more orphans and otherwise uncared-for children in the vicinity than anyone had calculated. Nan asked women from four local parishes to count up such children, and the results ran from 300 to 700 children per parish –- children whose parents had died of AIDS or other illnesses, children who had been left behind when one parent died and the other went away to the city to look for work and a new partner, etc.

All of the women were shocked at the magnitude of the need in their midst. Dr. Hardison asked them to think about what the children needed most and what the Mothers' Union could do for them. The women thought it over and decided that nourishment was the most immediate and acute need. They planned, calculated and thought they could manage one good feeding a month for these children, so that is what they originally organized and began running. Then Dr. Hardison contacted friends on the Jubilee Committee of the Diocese of Massachusetts who provided funding for supplemental food supplies so that the children could have one day of care and feeding every week, and the program shifted from a once-a-month to a once-a-week care-and-feeding day.

Other Anglican parishes in the Diocese of Maseno North gradually took up the idea and agreed to make the commitment to work and care that it takes. There are 31 such programs in the district. Churches, schools, and one or two better-off individuals have donated the use of their grounds for the program. (If they have a cook shed, that's wonderful. If not, rain is fortunately not usually at midday.) In a couple of cases, a farm field has been loaned as a farm school for some of the children to learn basic farming techniques. They can take home whatever they raise, which gives them an important supplement to the little they have.

Increasingly, there are some male volunteers supplementing the females; one of them is a graduate of the orphan program. He had received a scholarship to high school (not free in Kenya), completed it successfully, and now works on St. Philip's grounds. He volunteers his spare time to help other children orphaned as he was.

Anyway, back to the ceremony. The groups of women from the different parishes sang or gave dramatic performances; one group did its own dramatization of how Dr. Hardison had presented the original program proposal to Bishop Oketch. The largest woman in the group gave a spot-on performance as the bishop (a big, robust man), both humorous and charming, and his party acknowledged with chuckles that the portrait was right on target. Bishop Oketch had another appointment that afternoon, but he called ahead to say he would be delayed, so that he could present a certificate of appreciation individually to each one of the volunteers, a mark of honor much appreciated by all of them, especially as many of the women had little or no schooling and this was the first certificate of any kind they had ever been awarded.

The ceremony was followed by a luncheon of rice and beef and the excellent local tomatoes, a big event for women for whom meat is a very rare luxury, and a meal prepared for them by someone else an almost unknown privilege. Friends of Dr. Hardison's in the U.S. had designed and printed up badges with "Mother's Union Orphan Program" and "You go, Girl!" (the program's unofficial motto – for the rarer male volunteers, there were also some "You go, Guy!" badges) for the volunteers, which were greatly appreciated. Everyone had a wonderful time. Everyone felt pleased and honored, from the bishop down to the lowliest visitor (me), and it was one of the very few occasions I have ever attended in my life from which everyone took away the right messages.

This morning Dr. Hardison and I and Jessica, the newly-arrived Young Adult Service Corps missionary, went to the weekly orphan-feeding volunteers' meeting in the nearby market town of Luanda. It was chaired by the wonderful woman who had organized yesterday's regional program. We all greeted each other enthusiastically and reminisced happily about yesterday's great event. The women sighed with pleasure: there had been enough food to go around, rare in a subsistence economy. Indeed, more than enough; one woman said shyly she had actually gone back for a second helping of meat. Several said that they had not needed any evening meal, they were so well fed at the luncheon. Several women also mentioned the certificates, which clearly meant a great deal to them. Everyone agreed this had been a wonderful occasion and hoped it would not be the last of its kind. Second the motion."

Asante, Cynthia!

Amazing Grace

"Karibu/Welcome... You were so LOST, Sister Diana!"

"Sema/How goes it?" ("What's your news?")

"Ah, you are finally beginning to look like a traditional African woman." [I gained 10 kgs in four months, working in the U.S. at a sedentary job -- which prompted Henry, our ambulance driver, to wonder if I'd had a face lift!]

"Ndiyo/Yes" to all of the above greetings -- but no to the face lift. In short, it "goes" busily, or else I would have blogged sooner. Fortunately, we have had medical visitors here to help. Unfortunately, Dr. Diana (Vancouver, Canada, via the University of Tennessee) and Dr. George and Sister Karen (San Diego, California) left yesterday. We -- and every one of our patients -- will be forever grateful for their medical expertise and human kindness.

Many things have changed at Maseno Missions over the past few months. Sadly, both Phoebe and Joshua -- old patients and dear friends -- have died. Happily, a new hospital manager is in training, the renovation of our maternity ward is almost finished, and the water project has been completed! Thanks to the Engineers without Borders, our little hospital and the mountain community "above" us now have consistent access to water.

Many other things have not changed. We still have erratic electricity, insufficient staff, and limited equipment and medications. We still have patients who come to us too late, in part because they've been misdiagnosed or inadequately treated at more convenient, but less professional, roadside clinics.

However...

Not long ago, Shadrack, 54, was admitted with painful pemphigus vulgaris -- raw and weeping wounds that had covered his trunk and limbs for months. After aggressive treatment with IV steroids and vaseline gauze, he was well enough to be discharged yesterday. But there is no guarantee that his remission will last.

While Shadrack was here, we admitted a 10-year-old child with second and third degree burns over her entire body. Jenipher's burns were caused by a kerosene lamp that had "exploded," a not-uncommon occurrence in rural Kenya. She wept in pain, even when we pre-medicated her with Pethedine for requisite dressing changes. And we ran out of Pethedine.

The very next day, Joan, 35, was also admitted with second and third degree burns. A large kettle of boiling porridge had splattered over her arms, trunk and thighs when she suffered a seizure at home. Joan simply hadn't had enough money to refill her previously-prescribed Dilantin.

At the time our patients needed it for pain, we had no codeine, just a mild NSAID, in our hospital pharmacy. We still have none. The order cannot be sent until we have enough money. (Thankfully, we had enough IV Ceftriaxone/antibiotic in stock.) We also had only four small bed cradles in the hospital to protect their raw wounds from irritation by bed linens, so we improvised: another cradle was crafted from a cardboard carton.


Thanks be to God and to good medical care, all three patients averted infection and were able to be discharged home with Silvadene ointment, Diclofenac tablets and prayers.

Ndiyo. I once was "lost" but now am found, was blind but now I see. It is humbling to witness, support and celebrate the tenacity of the human body and spirit. Amazing grace.