Epilogue 2011

"What will they do now?" people ask about our friends in Maseno.

"God only knows" is once again the answer.

Nan and Gerry Hardison have just returned to the U.S. Their final "Communique" is reprinted below. Hard and faithfully as they tried, over ten years of committed service, to foster sustainability in their corner of Kenya, that was an enormous challenge in a community that has far too little with which to sustain itself. And so we continue to pray. We pray in thanksgiving for Nan's and Gerry's lives of faith and service, and we pray in petition for the future of our brothers and sisters in Maseno. 

Down through the years, there have been hundreds of good-bye songs, both popular and classic. As we draft this, the last of our Communiqués from Kenya, the song that best expresses our emotions is the one adapted from one of Woody Guthrie’s Dust Bowl ballads by Pete Seeger and the Weavers in the late 40's or early 50's. It goes like this:

         I've sung this song, and I'll sing it again
         Of the people I’ve met and the places I’ve been
         ‘Bout some of the troubles that bothered my mind
         And lots of good people that I left behind 
         So long, it’s been good to know you  (x3)
         It’s a long time since I’ve been home
         And I’ve got to be movin’ along.

And so it is with us. We have met lots of people, some good and some bad; a few happy, but more sad. We’ve seen life and death and too much of the latter. We have seen high spirits in the face of poverty and adversity but despair and hopelessness as well. Our 10 years in Kenya have planted lots of troubles that bother our minds, troubles which will continue to bother our minds until our dying days. We are changed persons. What we remember most are the “lots of good people that we left behind.” We cannot take them with us. Nonetheless, “we’ve got to be movin’ along.” It was a blessing to have known them and a grief to leave them. Who would have thought, when Nan and I were young college students, that, in our “twilight years,” we would forge close bonds of friendship with persons half a globe away? The fact is, it was not hard. They are just like us. The same desires, the same aspirations, the same struggles and the same tragedies. Unlike us, however, their desires are less often realized, their aspirations less often achieved, their struggles more unremitting and their tragedies more profound and unexpected than ours will ever be. With the help of all the good people we shall be rejoining on our return, however, we have changed for the better the lives of many. We are eternally grateful for the help and support that our friends and donors have given us. We just wish that we could have boasted more sustainable changes. But, as we implied in our “next to last” communiqué, any batting average more than zero for sustainability is good in this business. I think we have achieved that.

Does it sound like we are really leaving them behind? Of course we cannot. I was once told that in certain Asian countries, if you saved a life, you were obliged to support it thereafter. If that is true, then we have quite a burden to shoulder. Get real; it is too big to shoulder. But we can continue to help so long as we are selective. Therein lies the future. We would like to revive the Orphan Health Initiative which had such a beneficial effect on orphan and caregiver well-being when it was active. The cost was modest, about $2,000 per month; the yield in healthcare was tremendous. Over a two-year period, jiggers and scalp fungus virtually disappeared in the orphans of parishes served by the program. As the program progressed, fewer and fewer patients with formidable acute disease required hospitalization. Where can we find $24,000 per year? I think it can be raised even in the face of the Western Financial meltdown. If it is possible, we know of a very committed and honest Clinical Officer whose main interest is in community health. He would be a great leader of such a program. The program would have dual benefits. It would improve the health of orphans and caregivers and would provide income for the Hospital which will need much help to stay afloat, as Kenyan inflation soars and as the healthcare system remains in turmoil. A Mission Hospital without donor support, supported only by patient income, is no longer a “Mission” Hospital. It has lost its soul.

There is another project which we deem extremely worthy. More importantly, it is a program which the community conceived and for which they and we have identified an honest, smart and committed person. It would be run from Phoebe House. We have mentioned Phoebe House in earlier communiqués. Often when women are diagnosed with AIDS, they are thrown out by their husbands as well as by their own families. Phoebe House was started by a group of women in Luanda township (4 km. from Maseno Hospital) to provide shelter and food for such women. Maseno Hospital has traditionally provided free health care to residents of Phoebe house. It has been successful. The new initiative, proposed by one of the ladies, is aimed at “child-headed households.” Imagine a 12-year-old girl trying to raise and provide for her younger siblings, ages 4 and 7, because both parents are dead and there is no willing “Granny” to take over. The proposal would extend the shelter of Phoebe House to those families. It is not clear what the ultimate costs will be, but start-up costs should be modest. Nancy and I want to help this program to become successful.

So it seems that Nan and I cannot really leave Maseno and the people there. The Hospital, College and the Orphan Feeding Program are perpetually in need of support. Nancy and I shall continue to seek donations on their behalf and will continue to ensure they reach the right places. We shall continue to be accountable to all donors we might be fortunate enough to attract. The conduit through All Souls’ Church will remain to enable donations to be tax deductible.

Many thanks for all your help, encouragement and support.

Nan and Gerry Hardison

Message from Christ's Hope

The following email and accompanying photos were sent to me by the devout Irish missioner who works for an organization called "Christ's Hope." You've read about him in several of my blog entries. Desmond Marshall's sole assignment is to go into remote villages and pray with people who are dying in Kenya. But he also brought many of those people out to our little mission hospital in Maseno. He knows that, unfortunately, in the government hospitals, two or three people share a bed, and medical rounds are held once a week.

Dr. Hardison called him "St. Desmond." And he called Dr. Hardison a miracle-worker. 


You will notice, if you look closely at the photo below, that Gerry Hardison is holding a live chicken in his lap. That is a gift of the highest honor in a country where many people are able to eat meat once a month, at best. (I couldn't resist asking Gerry how he was going to get that critter through Customs!) 

Dianne, this was a very special day for us here at Christ's Hope. We held a "Appreciation Lunch" for Prof and Nan. We had a wonderful day with about 85 former patients attending. I trust it was an encouragement to Prof to see just how many lives he has touched, just in the few years I’ve been taking patients to Maseno. Mama Joshua was there also and spoke of how Prof had cared for Joshua. There were many testimonies of how God used Prof. You may not remember, but many of these people you cared for also. Thank you for coming to Kenya and serving with such a loving heart. Linnet was also there, along with a few others from Maseno.

I will miss him so very much and the patients will also miss him. Many of the people were at death's door, but we thank God today they are doing well. I wish you could have been here…We held it in Kisumu at our office. I trust you are doing well. I hope you are still enjoying your Hospice nursing position? I’ll be in touch again with my Christmas letter! Just want to let you know that we had a blessed day.

Much love,

Dessie

Epilogue 2010

"What will you do now?" people ask.

Always we begin again," was St. Benedict's answer.

"God only knows," is mine.

That is perhaps more unsettling to friends and family than it is to me. But planning my life has always been illusory, and I have been surprised by joy. Perhaps I am learning at last to listen and to wait -- with a song of hope in my heart. Yes, I will hug loved ones; yes, I will work; and yes, I will have shoulder surgery. How, when and where are simply details to be determined.

Our friends in Maseno taught me the real meaning of hope. Robin, the young missioner who mentored me through TEC's training in New York, has mentored me home to Martha's Vineyard -- this time with a passage from Praying Our Days by The Rt. Rev. Frank T. Griswold, 25th Presiding Bishop of the Episcopal Church:

A Prayer for Availability to God's Will
O God, I do not know what to ask of you.
You alone know my true needs
and love me more than I know how to love.
I ask neither for cross nor consolation,
but only that I may discern and do your will.
Teach me to wait in patience with an open heart,
knowing that your ways are not our ways,
and your thoughts are not our thoughts.
Help me to see where I have erected idols of certitude
to defend myself from the demands of your
ever-unfolding truth:
Truth you have made known to us in the one
who is the truth,
Our Savior Jesus Christ. Amen.

(After Metropolitan Philaret of Moscow, 1867)

Postscript: South Sudan

This isn't Kenya anymore, Watoto/Children...

Central Equatoria

Juba is a busy port on the banks of the White Nile, located at the river's southernmost navigable point in Sudan. During the dry season, it is a bustling place of shimmering heat and swirling dust. Round mud tukels, iron-sheeted lean-to's and a few remaining colonial (English) era buildings are being rapidly replaced by square cement shops and startling glass-and-steel offices. Street vendors line the congested marketplace, and returning residents fill Jubatown. Bus- and barge-loads of people from IDP camps are also arriving. Everyone queues patiently at official tent-sites cordoned off by red-and-white striped tape. It is the final week for the Sudanese to register to vote before the January 9th Referendum. Meanwhile, convoys of white Land Rovers, ubiquitous symbols of western aid and oversight, appear and disappear like mirages out of the clouds of their own dust.

Sudan is a huge country, approximately the size of the entire eastern United States. (Kenya, by comparison, is approximately the size of Texas. Yet each country is home to an estimated 40 million people.) Burgeoning Juba, in southern Sudan, may be a small town compared to Khartoum, its sky-scrapered counterpart in the north, but it is still the regional hub of commerce and politics. There is no way that one of even my most lugubrious "postcripts" could justly describe any place or its people. Do read Robin's beautiful blog (robin-mission.blogspot.com) for a full picture of her life here. I can only share glimpses of my week -- including a lovely lunch on the Nile! -- as her grateful guest.

Travel to Juba, en route to Boston, was an experience unto itself, from the moment I checked in at Nairobi's airport to the moment we landed in southern Sudan. An authoritative ticket agent at the Jetlink counter introduced me to Sister Mary Amorajok and promptly charged me with shepherding her through Kenya's International Departures, onto the plane and off it in Sudan.

Sister Mary identified herself as a Dinka nurse and an ECS (Episcopal Church of Sudan) priest. Very tall, very thin and frankly fragile, her age alone commanded respect. She was further distinguished by her clerical collar, bright blue shirt and personal demeanor. With slender fluttering arms outstretched, Sister Mary blessed everyone and everything in sight. She was grateful to be alive and returning to workat Jonglei Hospital after her own extensive medical care in Kenya.

In spite of some residual unsteadiness, Sister Mary maintained great dignity as she negotiated her first-ever escalator ride with a large pocketbook in one hand and a twine-tied carton in the other. She was understandably anxious, however, about being plunked in a plastic chair and essentially deserted after I offered (in clumsy sign language) to get her a Coke. When she heard an announcement for a departing Juba flight -- although it was not ours -- Sister Mary panicked. By the time I had returned with two sodas, she had bolted and disappeared into the crowd.

Cokes in hand and and carry-ons in tow, I raced toward the announced gate, praying that my own short legs might carry me fast enough to find her. Fortunately, Sister Mary had stopped to rest; even bent over a baggage cart, she still towered over almost everyone in the airport. "My girl!" she beamed when she saw me. We were inseparable for the rest of the trip. I'm not sure which of us was more relieved when her grandson met her (and Robin welcomed me) in southern Sudan.

The Juba airport is strangely reminiscent of its Vineyard counterpart, half a world away. Long and low, but not as new (no presidential retreat here -- yet), the building stretches out adjacent to its recently-extended tarmac. A few of the city's streets, most of them unnamed, have also now been paved. But Juba is a mini-metropolis, and larger-than-usual crowds are here, both because schools are closed for the holidays and because of the historic opportunity to register to vote. Joyous parades and rallies were held on Thursday to celebrate the close of that largely peaceful, month-long process.

One of our fellow plane passengers was a young mother traveling home to Yei from Uganda. Her excited three-year-old was looking forward to meeting his grandparents for the first time. She was looking forward to an opportunity to vote "for separation," as she shyly informed me. Another passenger was a well-dressed Kenyan traveling to Juba for her monthly appointment with a Chinese herbalist; China has an ever-increasing presence on the continent. A few days later, at the same airport, we "welcomed home" Dr. Daniel Deng Bul, Archbishop, Primate of Sudan and Bishop of Juba, and his entourage. They had been in Khartoum, on travel permits that are becoming increasingly difficult to obtain, for the consecration of a bishop in the north. Robin's housemate, Rebecca, is the international coordinator for His Grace.

On Saturday, we were kindly invited to brunch with MAF/Mission Aviation Fellowship and SIL/Wycliffe Bible Translator associates. Most of them plan to be out of the country for the Christmas holidays, well past the referendum vote. Robin will remain in Juba. The Episcopal Church of Sudan has worked hard to promote a peaceful referendum vote, reminding everyone on billboards and in homilies to "trust and obey." (Note: some also send the Exodus message of "Let my people go.") A nearby mosque's daily call to prayer awakened me on Sunday, and Al Jazeera's TV cameramen appeared, unannounced, to film the 8 AM service at the ECS cathedral. We hope, pray and, yes, trust that the overarching message of peace and justice will reach all of Sudan's viewing (and non-viewing) public during the course of this month and in the years to come.

Robin hosted an impromptu coffee hour at her house in the church compound after the early service. A lively gathering of Swiss, Americans, and Brits working for the church and various NGO's, it also included a trio of volunteers from England who had shown up at our door the day prior. Jerry, Jason and Conrad were en route home. They had been building school desks and benches for a month in rural Sudan, and they offered to do some carpentry in exchange for a safe place to sleep before flying back to London. After a night's rest at the now-vacant Bishop Gwynne College on the ECS compound, they returned and repaired the broken lock on Robin's and Rebecca's front door.

Cathy, the director of Juba's "Confident Children out of Conflict" center, was also invited for coffee, but "her" girls had met her at church, so she needed to leave to prepare breakfast for them at the site. We joined them later at the CCC, where Robin and Rebecca are frequent volunteers, and spent the afternoon with about a dozen girls, ages 8-16. Street children, all, they share horrific stories of abuse and survival. Juba is a "boom town," as Robin says, but forty years of civil war have taken a traumatic toll on its people, especially on its children.

"Sunday," a bright-eyed girl with a recently-repaired cleft palate, has become especially dear to the volunteers. Abandoned months ago in a remote village by her parents, she walked 52 miles from Terakeka, alone, to find them in Juba. She was rejected once again, even after the corrective surgery that Sunday had hoped, in vain, might make her acceptable in their sight. She has become a frequent visitor at the ECS compound. (See her photo below with Robin, Rebecca, and missioner neighbor Larry.) A highlight of our week was teaching her "Away in the Manger" in English. The CCC girls will be singing at the cathedral's Service of Lessons and Carols.

Eastern Equatoria

It was a gift to accompany Robin, mid-week, on an agricultural site visit to Panyikwara, not far from the Ugandan border. Three hours away by very bumpy, but apparently much-improved, road, it is an oasis of green in a brown land and dry season. This now-blossoming community (also called Abara) in Magwi was literally wiped out over the course of 40 years of civil war by deadly, sweeping strikes of both the LRA and SPLM. Any surviving residents were forced to flee to even more rural areas or to IDP camps in neighboring countries.

Two years ago, at the end of a growing season, USAID "repatriated" people to the region. Each adult was given a hoe, a shovel, a pail and some seeds. Tukels/mud-and-thatch huts were built, and land and lives were reclaimed. Although farming was once their "heritage," however, this whole new generation needed to learn to grow crops, work in community and create small agri-businesses in order to survive.

With vision (the archbishop's, in great part), support (Robin's, in great part) and hard work (by the people of Panyikwara, in every way) trees were cut, land was tilled and crops were planted. Where once only scrub forest existed, sorghum, sim-sim (sesame) and families now thrive.

As honored visitors, we were invited to sit under a large shade tree with the village elders. After polite conversation and with their assistance, Robin composed two formal letters on her laptop, then stamped and printed them (via battery) for local signatures. The letters, requisite filings for land usage, were promptly hand-carried on foot to the sub-district officials for approval.

Also as honored visitors, while the women worked and children played, we were fed two generous and delicious dinners within an hour. One was smoked wart hog, the other a more traditional beef; both were delicious and complemented by a mound of maize meal.

Food accompanies relationship in almost every part of the world. The mutuality of the relationship under that big shade tree in Panyikwara was clearly God's work, as well as (wo)man's. It was a joy to witness the progress made in just two short years there, and it was a very special treat to meet "Robinsida," the little namesake of Robin Denney.

Read, Pray, Love

Throughout our travels, I've read, prayed and loved. This has been a blessed time of transition for me, from the grief of goodbyes to the joy of hellos. In just one week, I've seen only a small part of a very different country, and I've met only a few of its very welcoming people. But there are powerful parallels of hope between Sudan, where violence has devastated much of the country for two generations, and Kenya, where HIV/AIDS has done the same.

Listening to Morning Prayer in Arabic and to evening Christmas carols in English (in 100-degree heat with people of many cultures but one faith) already seems perfectly normal. Ours are prayers and carols of hope in a season of hope. It is difficult to imagine that in only a few days, I'll be walking in muk-luks on Martha's Vineyard, rather than in flip-flops in East Africa. But I'll be singing the same songs, however off-key...

There is solidarity in journey and in song. Some call it pilgrimage. I am comforted by the knowledge that while I am going home, people in Sudan and in Kenya are also going home. In my bags are token gifts. On their heads are bundles of food. We will all be celebrating Christmas with family and friends.

Emmah, for one, will leave Maseno on Monday to travel several hours north. There she will prepare her family home for the holidays by smearing the floor with a fresh layer of cow dung ("decorated" with scrolled flowers and seasonal stars) to protect against jiggers; gather with relatives who will have also come from great distances; and cook a feast for them on a holiday fire built over three smooth stones.

My travel time will be much longer, and my preparations will be much simpler. But on Christmas Eve Emmah will attend an outdoor prayer vigil in her rural African parish while I attend midnight mass at my rural North American church. We will be continents apart, but our lives (and the lives of our families, friends and neighbors) have been forever touched and changed. We now share the journey -- and "walk one another Home" -- with song and prayer, with love and hope.

Wana Baraka

A traditional Swahili spiritual, the title of this song is translated, "They are blessed, those who pray. "

And so we are, the world over, regardless of language, color or creed. But we don't pray in order to be rewarded with blessings. We are blessed because we pray. It is the act of praying itself that connects us to one another and to God, the greatest blessing of all.

Today is World AIDS Day, a time to remember our blessings and renew our commitment to fight disease and discrimination. Every day my friend Mary awakens singing, "This is the day the Lord hath made..." I am trying to rejoice and be glad in it, even though this is also the day I must return to Massachusetts for probable shoulder surgery. It will be good to be closer to family and friends in the U.S. But it's been three years since I first arrived in Maseno, so I have family and friends in Kenya, as well. And I will miss them.

The people of rural Western Province have taken me in. And, as always, a missioner receives much more than s/he ever gives. There are no words to describe the generosity of people here -- as well as the generosity of all of you, our family "there" -- who have made this time and this work possible. And who will enable it to continue, however God may see fit.

Because I am returning early for medical reasons, the Kenya mission funds remaining in our church treasury will be set aside for a special project. We hope to be able to build an outpatient clinic on church property on the highway below Maseno Mission Hospital. We need to provide better access and care for the sick, as well as to improve the economic stability of the hospital. It is a big hope and a small legacy, but it is a legacy of great love. It is your legacy of love.

I have only been able to serve here because of your individual, corporate, church and diocesan donations. I am also here because Drs. Nan & Gerry Hardison, who have been serving faithfully in Kenya for ten years, kindly invited me to "come and see" -- and because the Mission Personnel staff of The Episcopal Church graciously accepted my application and "sent me forth." It is a blessing to be able to hold one another in prayer as our years increase and our missions evolve.

I will be returning home via Southern Sudan, yet another blessing. It is an honor to be invited to walk for a week in the flip-flops of our friends in Juba and beyond, thanks to the warm welcome of fellow missioner Robin Denney. (See her remarkable blog at http://robin-mission.blogspot.com) These are fragile times in Sudan. Please pray for Robin and for the people she serves.

Wana baraka. We are blessed. I am grateful that we can remain connected to one another in prayerful presence, enveloped by a cloud of witnesses and the blessed company of all faithful people. Asante sana, Mungu God. Asante sana, all of you.

Barikiwa!

That's not Kiswahili for "Turkeys!" Barikiwa means "Blessings!/ Thanksgivings!" (to you all).

One of my brilliant nieces maintains three amazing blogs, as well as a beautiful "gratitude list." I seriously considered doing the latter but quickly gave up. I'm a whole lot older than she is, so my list was too long before I could even begin to write.

I can only tell you that I am thankful every day for every one of you who cares about me and the people I love -- including the people of Maseno. Be assured that we cherish you, too, and that we hope you'll have a blessed Thanksgiving Day/Week/Year!

When I was very young, I was grateful, at this season of the year, for the turkey stickers posted on the pages of my homework. Nowadays I am grateful, at every season of the year, for the prayers posted on the tablet of my heart. Asante sana.

Three Babies, Three Days

No, not joyous births. Needless deaths. Kelvin had cerebral malaria, Juliet had enteric fever/gastroenteritis, and Mika arrived in end-stage renal failure. All three babies had been previously misdiagnosed and given inappropriate medications at other, more accessible area clinics. When they were finally brought to our outpatient department, they were promptly admitted to the hospital. But it was too late. Kelvin and Juliet were so dehydrated and anemic when they arrived that we could not help them -- not even with "cutdowns" to get IV fluids (and in Kelvin's case, blood) into them. Mika had been anuric for two weeks. His body was swollen, and he was dyspneic by the time we saw him. Although his lungs were perfectly clear, Mika had been misdiagnosed with "pneumonia" and given ineffective antibiotics at two previous clinics. If we were in a major pediatrics ward in Boston, three deaths might sound terribly sad but perhaps not unexpected. However, our small hospital only had seven pediatrics patients when three of them died.

Maseno Mission Hospital is located at the end of a long, rutted, uphill road. In the past several years, small public/private medical stations and government "sub-district hospitals" have sprung up along the highway below us. Most are sparsely-staffed by poorly-trained employees who have even fewer available medications than we do. But they call themselves clinics, and they are more accessible than our outpatient department. Sick people cannot easily walk to MMH for care, and poor sick people cannot get to us by any other means -- although some do try by boda-boda, piki-piki and even wheelbarrow. As a result, we are seeing increasing numbers of patients (most often, children, because they get dehydrated so easily) who are too sick to save. We have neither ICU equipment nor staff. Yes, I am upset; and, yes, I am angry. Above all, I am saddened by the broken "system" that provides an inadequate education for clinicians, zero funding for mission hospitals or even road repair, and absolutely no safety net for people of little means.

Keep watch, dear Lord...

Rusinga

I confess I've been island-hopping for two days on Lake Victoria. Friend and neighbor Judy kindly invited me to Rusinga to meet her family, visit the fishing village of Leanda/Olugi, and pay my respects at Tom Mboya's grave.

We traveled to and from Mbiti via matatu, ferry, piki-piki and a hearse named "Beauty for Ashes." (Honest. Replete with casket and recorded gospel music.) Then we spent two wonderful days with two wonderful people. Veronica and Mike welcomed us into their home and their lives -- and into the lives of their extended family.

We walked their large, lush, hippo-holed shamba by day and ate delicious kuku, tilapia and Nile perch by kerosene lamp at night. We met morning preacher-birds and evening drunkard-birds, helped put the cows out and the chickens in, played with Baby Cornell and made friends with "watchdog" Elsa.

We bathed in water carried up from the lake, then heated over an open fire. We watched the twinkling lamps of the lake fishermen after dark, and we mourned with the community when ten of its members died. All had been passengers in a small, overloaded boat that capsized on a windy night last week.

We also prayed. We prayed together before meals, before bed and at Tom Mboya's mausoleum. Veronica brushed away tears as she told us a painful and unexpected story at the serene gravesite.

In 1968, at the age of 18, she became Mboya's junior secretary in Nairobi. It was her first job. One year later, on a quiet Saturday morning in July, Mboya returned from an economic development meeting in Ethiopia, opened his briefcase and presented his small secretarial staff with token gifts. A few hours later, he left the office to do an errand and never returned. Tom Mboya was murdered on Moi Avenue, a major thoroughfare in downtown Nairobi. (Note the bullet-shaped mausoleum roof.) Veronica's quiet words were triggered by the sight of bloodstains on that same briefcase in the memorial hall the site. Her grace, grief and powerful memories deeply moved us all.

It was a blessing to be on Rusinga with Judy. From the moment we were welcomed with prayer, to the moments we grieved together in prayer, to the moment we bade farewell after prayer, we felt surrounded by the love of God and the love of our host family.

Now We Are Six

Rotary House is a remarkable place, as any of our former or current guests can attest -- and Emmah is a remarkable hostess! She is now "mothering" six of us with equilibrium: Andrea from Tennessee via Kentucky, Charlotte and Elke from Amsterdam, Sarah from Colorado via Florida, and Jessie (our YASC volunteer) and me from "all over."

We've had fun celebrating a spate of birthdays together recently -- starting with Nan's and Gerry's in October, and "finishing" soon (only because most of us will depart in December) with Jessie's and Charlotte's. Along the way, we've shared a few Kenyan birthday balloons, too. I'm afraid our neighbors are beginning to adopt some of our decadent western ways...
It was Carolyn from the Comprehensive Care Center who first shyly hinted, "I'll be 22 next week, and I've never had a birthday cake." Then Jessie had a small party for Ruth, who cooks at St. Philip's, after which Doracas -- who teaches at the college -- had a party for her own two children. (It was actually Christian's 8th birthday, but 4-year-old Nema needed a celebration, too!)

Emmah explained to me a few years ago, "We don't celebrate birthdays here." Many Kenyans don't know when they were born. Dates of all kinds weren't especially important until NGO funding and computerized forms arrived on the continent. Until recently, most people simply had to invent their birth dates, as I learned firsthand when I tried to document children's heights and weights for a USAID supplemental food program.

A new law in Kenya this year makes birth registration a requirement. The legislation created a real problem for folks born before 2010 who now need birth certificates to enter secondary schools, universities, etc. Implementation of any new law is a challenge, at best, here -- especially in a rural hospital with only three functioning (but as yet un-networked) computers.

Perhaps we can rationalize birthday parties as being the flip side of that "challenge"? In any case, we're saving our biggest and best party for Emmah. Wish her a happy birthday in your hearts on November 9th! (Photo in her birthday kanga and "flowers" were added post-party.)

Love, Medicine and Miracles - from MV to Maseno

Asante sana, St. Andrew's, for your "hands across the sea." We will now be able to purchase more lifesaving antibiotics and painkillers for our hospital patients, thanks to your generous donations!

Prayer

To me, that's always meant "talking (and listening) to God." In private, of course. To my Kenyan friends, that means "talking (and listening) to God everywhere." Even, gasp, in public.

I'm almost as old and almost as shy as Garrison Keillor. I'd venture to say he would wholeheartedly agree that shy persons from the midwest -- perhaps especially those who are transplanted to New England -- do not pray in public.

Except in Kenya. When in Kenya... even shy persons are asked to pray impromptu prayers and preach impromptu sermons. Life and death and love and hate and faith and doubt are so tangible here, there is little privacy about anything.

So I found myself praying aloud at little Joshua's grave site last Saturday afternoon in Darajambili. The simple cross on his burial mound was made of sticks, tied together with a vine. (Sometimes a grave in the family's yard is marked by a wooden cross; sometimes -- but rarely, and only at much more affluent homes -- it is marked by a cement one.) We stood silently in the sunshine for a few moments afterward, bound together by our love for a very special child.

You may remember Joshua. He was a beautiful boy who was brought to the hospital by our friend "Saint Desmond" from Christ's Hope. Dr. Hardison treated him over the course of many months. (See photo.) We came to know Joshua and his family well. When his massive skin infections began to heal, he was taken to another hospital for surgery to address his contractures because we have no surgeon in Maseno. Joshua survived the operation but died soon afterward. We do not know why. We rarely get any follow-up on patients. The whole community grieved with Joshua's family, and hundreds of people attended his funeral in July.

Since I was on home leave at the time, Linet and I traveled together last weekend by matatu to Darajambili (and many more kilometers past the junction, on foot) to pay our respects to Mama Joshua. We were greeted warmly and spent an hour reminiscing about Joshua, amidst tears and smiles. Just as I thought we were about to depart, several neighbors appeared to help Mama Joshua serve us a very large, very traditional, very delicious meal of ugali, sukumawiki, curried eggs, cabbage, salad, beef, "soup" (broth) and chicken. And oh, yes, some rice for the mzungu. But first we prayed.

Afterward, everyone (neighbors and family alike) moved to a large mat made of reeds that was placed beneath the shade of acacia trees. We shared even more stories about Joshua -- in Luo, Kiswahili and English. His young life was an all-too-brief blessing to everyone who knew him. Linet and I watched children and chickens and puppies and kittens play at the Luo homestead for another hour before we apologized for needing to get back to the hospital. Mama Joshua put her arms around me: "Asante sana," she said. "You came all the way from the U.S. to pray with us." (I really just came from Maseno.) Neighbors gathered to bid us farewell. But first we prayed together again.

We may sometimes be surrounded by grief, but we are always surrounded by prayer. It is I who must say and pray (both silently and aloud), "Asante sana." Especially on All Saints' Day. Thank you, God, for giving us Joshua as long as you did. Thank you for holding him, the saints who have gone before -- as well as those who live among us still -- and every one of us in your loving arms.

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.