Flash Me!

It's not what you're thinking... That's just the ingenious way my Kenyan friends get me (and one another) to pay for their local phone calls. They call a number, let the phone ring once, and then hang up. The recipient of the call (especially I) can't move fast enough to answer it before the disconnection, recognizes the number on the cell phone screen, and then obligingly returns the call. The original caller does not pay. Clever.

There are few land lines here anymore since most of the copper wiring in Kenya has been vandalized, "harvested" and sold. Every time I wear my 150 KSH ($2) handcrafted earrings, I wonder whose telephone wires were sacrificed. The truth is, though, that the infrastructure is so fragile that cell phones are a boon in underdeveloped countries. They are inexpensive tools that enable callers to prepay for calls via computerized Safaricom, Zain or Orange-brand cards, purchased in increments of 10 KSH, or 12 cents, and loaded into a phone. (Ten KSH will probably buy about ten minutes of local air time for the caller.)

Communication means a lot in Kenya, where family, tribe and "connections" provide much-needed support. Ubiquitous cell phones ring from boda-bodas in the countryside, church pews in the city and even hospital beds on our wards. The phones come in handy, too, when it comes time to pay a bill. People can "MPesa" money to one another via cell phone much more efficiently (and much less expensively) than Western Union ever did. "Clever" redux. Fortunately, no one here has yet instructed, "MPesa me!"

Esther

Esther is almost four, and her parents are both dead.

Her grandmother brought her to the hospital in a coma late Wednesday evening. Esther was feverish and had been vomiting for three days, one of the all-too-many dehydrated children admitted to our pediatrics ward. She had "3-plus" malaria and needed a blood transfusion as well as IV quinine. The nurse on duty was finally able to access a scalp vein, but we weren't sure Esther would survive. However, Esther went home with her granny this morning, the first Sunday in Lent -- wearing a "new" smocked dress from someone's mission box .

Thanks to the generous donors who fund our Orphan Health Initiative, Esther's three-day hospitalization will be covered in full. It cost exactly $25 to save her life. There are so many more lives that need to be saved... Please consider making a donation to Maseno Missions or to a charity of your choice during Lent. (See "Donate" on the sidebar of my blog.) And please remember that we can all afford to pray. As Father Rich Simpson at St. Francis Episcopal Church in Holden, MA, wrote on Ash Wednesday: "The point of these next forty days is not to feel bad, but to do good."

Laughter Really is the Best Medicine

We were wisely informed, during our mission training, that a sense of humor might come in handy. It seems especially useful these days... I stifle many a tear on the ward, but I chuckle through many a moment in Maseno.

I was thinking, for example, that "African time" has all sorts of permutations, from two-hour-"late" meetings that phase absolutely no one, to ten-minute exchanges of pleasantries that are prerequisite to every conversation. Contrasts in culture are perhaps funniest, though, in the other ways we pace ourselves (or don't). I was recently told by the town drunk/character that he had never seen "an old mzungu go so fast." He was weaving his way alongside me on a rusty, twined-together bicycle before I jogged off -- almost late again -- to chapel. We were both left in the dust, however, by the Maseno Boys' School track team that day. This is, after all, the land of marathon winners.

Our little conversation got me thinking (again) about my age and laughing even more, in the context of my life in Kenya:

You know you're old...

When kids call you "Mzee" (Old One) instead of "Mzungu" (White One).

When you revert to your childhood, slap "Blue Band" (hydrogenated palm oil) and sugar on white bread, and call it lunch.

When the neighbors ask if you have daughters that their sons might marry.

When you're too tired at the end of a day to stitch up the holes in your mosquito net.

And when you go to bed (at missionary midnight - 9 PM) with your laptop.

Lala salaama, Everyone. Good night from my ASUS PC and me.

Too Wet for Walking

It's Ash Wednesday, and I couldn't get to morning chapel. An all-night rain (after Emmah's Shrove Tuesday chapatis) turned the road to St. Philip's into 3 kilometers of sticky red mud.

Heartened by the current company at Rotary House -- and undaunted by the "showers of blessing" -- I suggested we share a Compline service at home. While Jessica, Steven, Anna and I prayed together in Maseno, a refrain emailed to me by a dear friend in Massachusetts echoed in my heart:

"Fill us with your love that knows no bounds, no limits, that can only hope and cannot despair."

On Ash Wednesday, and on every day, I feel blessed to be "in the company of all faithful (and hopeful!) people" -- company that extends around the world. Thank you, Father Chip, for sharing your words of wisdom with us tonight, too.

In a homily given at noon in Edgartown (just about the time we were praying here in Maseno, eight hours "later"), he spoke about our need to do the interior work of Lent, remembering that the light of Christ, the love that can only hope, is always with us.

"...we must take on that hard work, risking true terror. We are all called to go through it, and to understand we can’t get around it. There are no shortcuts to the very recesses of our hearts. As the writer Gustave Thibon wrote, 'You feel you are hedged in; you dream of escape; but beware of mirages. Do not run or fly away in order to get free; rather dig in the narrow place which has been given you; you will find God there and in everything. God does not float on our horizon, he sleeps in your substance. Vanity runs, love digs. If you fly away from yourself, your prison will run with you and will close in because of the wind of your flight; if you go deep down into yourself it will disappear in paradise.' "

Fr. Chip concluded: "What might we become if we dig in that wilderness of our hearts these forty days?"

What, indeed?

Too Hot for Monkeys, Too Sad for Words

In view of the wintry weather that has recently swept across the U.S., we cannot complain about our 90-degree heat in Kenya. But when the water is short, the day is long... We still have no maji/water on the hospital compound, a frustrating situation that we hope will be remedied when the Engineers without Borders return in July. Meanwhile, water is trucked in jerry cans (1o ksh each, a bargain compared to Nairobi's 70 ksh each) from the river, then boiled and filtered.

Last evening, three new visitors went out with cameras to cool off and capture some pix of our marauding monkeys -- who were nowhere to be found. "It's too hot for monkeys," a neighbor explained.

About the same time, Robert, 25, was discharged from the hospital after eight days of treatment for PCP, TB and generalized wasting. It was nothing short of a miracle that he had survived. We carefully tucked Robert into the Christ's Hope van that was to take him to his family in Bondo for further recovery. Sadly, I received a text message this morning from Desmond, the director of Christ's Hope: "Robert was turned away by his father. He told him to go somewhere else to die." Desmond said that seven wooden crosses in the family's front yard mark the graves of Robert's seven brothers.

Please pray with us for water, for Robert and his father, and for all the people in the world who have no place to live or die.

Health Care Reform?

"The system is broken" in many ways in Kenya -- from the top down.

That is reflected in the quiet pleas of the impoverished, the angry voices of the disenfranchised, the wasted bodies of the HIV-infected, the sunken eyes and swollen bellies of hungry children. Still, people cope, and Americans might consider some options (and/or adjust some expectations) vis a vis our frail-but-still-functional medical mission hospital here...

Where there are no outpatient appointments, but where people come when they are truly ill and wait patiently for attentive care. Where the hospitalized bring their own water, plates, utensils, wash basins and toilet tissue. Where family members (who are charged room and board at $4.50 pp, half the daily hospital rate) provide personal patient care and save paraprofessional salary expenses. Where IV antibiotics are limited in scope but remarkably effective when/if we have them. Where oxygen tubing and bedpans are cleaned with Jik/chlorine bleach and re-used, of necessity. (Note: needles are NOT.)

Where water and electricity are erratic, but where methylated spirits and kerosene lamps can suffice. Where chickens may wander the wards, but where sunshine, fresh air and simple foods are plentiful. Where major surgery is unavailable because we have no surgeon, but where simple fractures are set, C-sections are performed and healthy babies are delivered daily. Where no one can afford the one insurance policy available in Kenya -- which just covers hospitalization (but not surgery), anyhow. Where the ambulance fee ($2.50 to/from the nearest town) is often averted by transporting patients on piggyback, wheelbarrow, and piki-piki, but where the majority of them still arrive and leave on foot. Where a family's cow may be sold to pay a hospital bill, but where invoices are issued if necessary.Where people live who would otherwise have died.

The system is not ideal, but it is far worse in Kenya's government hospitals, where outpatients are frequently prescribed expensive, often inappropriate, lab tests and medications but are rarely given physical exams. Where inpatients must bring the same personal care essentials to the hospital but are admitted two to a bed -- and are seen twice a week by poorly trained medical officers, vs. twice a day by Dr. Hardison. Where surgery is not performed unless "kito kidogo" -- "a little (more often a lot!) extra" -- crosses palms. And where discharged patients are literally locked in a crowded back ward until their bills are paid.

Perspective is all?

Thanks be to God and to all of you who support and pray for us and those we serve.

Showers of Blessing

A gospel hymn frequently sung in sun-parched Africa (sorry, freezing friends and family in America!) reminds us to pray, to be grateful and to trust God -- lessons I am re-learning here every day: "Showers of blessing, showers of blessing we need. Mercy drops round us are falling, but for the showers we plead."

I've recently asked you for prayers for the sick and prayers for the dead. Today I invite your prayers for the living, as we thank God for three patients whose lives have been saved this week at Maseno Mission Hospital. We are grateful for the drops of mercy and the abundance of love that we share. Most especially, we give thanks for the lives of:

Phoebe, about whom I've written before... HIV-positive and the mother of two, Phoebe was abandoned by her husband when she developed opportunistic infections and her status became known. She and her youngest child, also positive, were put out of the house and left to starve. Phoebe was brought to the hospital in January for the fifth time, shortly after her husband's family had quite literally dug her grave in their yard. We treated her for PCP and TB, fed, comforted and encouraged her. Phoebe is now living with her son in a new women's shelter in nearby Luanda, created by some of the remarkable ladies of the Mothers' Union in the Diocese of Maseno North.

Rose, 26, who was admitted with puerpural sepsis, a systemic (and often fatal) post-partum infection. The second of three "co-wives," Rose delivered a stillborn child at home three weeks ago, was found near-death and brought to the hospital on Monday by Desmond from Christ's Hope, an aid organization that provides home-based care. [Three months prior, Rose's husband had strangled wife number one and run off with wife number three when the neighbors turned out in force with their pangas/machetes. "Mob justice," it's called.] Rose has lost two other children, both prepubescent girls. A neighbor in Nyahera murdered, then decapitated, her daughters and drained their blood. The blood of a virgin brings a high price in secret rituals. "Mob justice" in that case was responsible for burning down the home of the murderer.

Jonhes, 16, who was admitted with a deep laceration and fractured skull after a panga (machete) blow sliced into his head. Jonhes was clearly in the wrong place at the wrong time. He is lucky to be alive.

We also give thanks for the families of two patients who died last night of "blackwater fever," a complication of malaria which is believed to be an autoimmune reaction. We recognized the hemolytic crises, severe jaundice, fever, anemia and dark red/black urine, but we could not stop, in either case, the rapid progression to death. Catherine, 25, suffered from sickle cell anemia but had graduated from college and was working as a social worker. When I held Mama Catherine's hands to express my sorrow during rounds today, she smiled radiantly and said simply, "It was God's plan."

Her words were more than echoed by the father of Elijah, a 3-year-old who arrived in a hepatic coma as we were finishing rounds yesterday. We immediately checked Elijah's oxygen saturation (thank you, St. Andrew's, for the pulse oximeter), put him on oxygen (thank you, St. Barnabas, for the oxygenator), administered blood (thank you, God, for the matching blood type, miraculously the only unit available at the time), IV fluids and quinine. But hemolysis had already done too much damage. The child died at 2 AM. "The Lord has called him home, and we say thank you for everything," Baba Elijah said.

"Happy are those who mourn; God will comfort them," Padre Betty reminded me this morning. I am still shaking but grateful for the faith of people who experience such painful losses, yet sing with such profound conviction: "There shall be showers of blessing. This is the promise of love."

A Little Night Music

Drums were beating all night again. Voices raised in song were accompanied by clanging cowbells and shouts of encouragement as another soul was "sung to heaven." There are too many funerals these days. As Linet would say, "It's just too sad, Granny."

Friends at St. Andrew's, Edgartown, recently invited our intercessory prayers from Maseno, Kenya. The first list I sent included prayers for the sick. The second was a list of the dead (abridged below).

Please join us in prayer for a little less night music.

"We celebrated 'All Saints' and 'All Souls' Days three months ago, but I ask your prayers again today for people who have died. During the past week alone, we lost several patients before they were helped into beds on our wards.

Roselyne, 16, suffered a probable heart attack as a result of CHF and untreated thyrotoxicosis. Although she was accurately diagnosed four months ago in Mombasa, she was given no meds, just a follow-up appointment for March 4th.

Rhoda, 22, severely anemic and obviously septic, died before we could transfuse or treat her. We don't know why -- a ruptured appendix or ectopic pregnancy? We only know she had internal bleeding and a massive infection. No autopsies are performed here.

James, 41, died from rabies. He was bitten by a dog in October and went to a local healer at the time. He was admitted last week with only a localized "numbness" on his calf at the site of the injury. While I was still looking up "rabies" in Harrison's text, James died -- probably of the "paralytic" variety that I had never even seen. (The more familiar "furious" rabies accounts for 80% of the cases in the world. Both are fatal unless treated within days of the bite.)

Lastly, and most unnecessarily, two babies died of malaria. They simply arrived too late. Loice was 9 months old, Dishon, two years. Both had "three-plus" malaria and were severely anemic and dehydrated by the time they were admitted. If only they had had bed nets and/or had come to the hospital sooner…

When a patient dies at Maseno Mission Hospital, the nurse draws a cross on the front of the chart/file folder, then enters an initial in each quadrant around the cross. Left to right and top to bottom, the initials read 'RIPF' for 'Rest In Peace Forever.'

Thank you for praying with us -- for the living and for the dead. May families, friends and caregivers, as well as the deceased, know the comfort of God's loving arms. And may you know it, too."

Sounds of Silence

I pray en route to chapel. There's nothing quite like a brain-jarring boda-boda ride over the washboard roads of Maseno. All anyone can do is pray.

There's also nothing quite like the recent soul-scarring earthquake in Haiti. All we can do is pray. And we do, hands and hearts together.

Poverty and disaster are no strangers to Kenya. We are on our knees for and with our brothers and sisters on the other side of the world. To paraphrase President Obama, "That's just what (Christians) do."

Have you noticed, though, that while the press makes increasingly futile attempts to describe the indescribable, the people of Haiti simply refer to the earthquake as "the event"?

I am reminded of the reaction here to the crisis that killed 1,500 in politically-instigated tribal violence. The people of Kenya simply refer to that unspeakable sorrow as "the fracas."

And when we are informed on the ward, "The patient collapsed," it simply means, "The patient died." I used to go running until I realized there is no "Code Blue" here.

There are no words... Try as we might to re-frame our pain by cloaking it in labels, terminology cannot tame tribulation. We simply need to pray in silence.

I wonder... If the whole world prays together, will the sounds of silence be heard?