Catching up!

By Ann:

I can hardly believe that we are almost entering the month of April!  The short rains, which should have arrived in February, have still not made an appearance and the earth is arid and dusty.  Cows and other livestock are emaciated looking as there is no green grass to graze upon.  The farmers shrug their shoulders and lift their hands in the air, baffled by the once predictable climate patterns.  Dust storms abound, looking like tornadoes from a distance.  And still the parched ground waits for life and vitality to be restored once again.

Despite the crazy weather for this time of the year, life continues to be busy around Kijabe.  I recently transitioned out of my role as consultant with the Resource Mobilization Department.  I felt as if I had taken the department as far as I could, and there are others who have arrived in Kijabe, and who are coming, that have a lot more diversified skills to pour into the role.  And so, like the parched ground, I wait to see what God would have me do here next.  In the meantime, I am preparing a grant application to USAID/ASHA, for the third consecutive year!  It involves a colossal amount of work as USAID change the parameters and specific format each and every year. This year, as in years past, Kijabe Hospital (KH) is applying for money to build additional housing for medical trainees.  KH is one of the leading medical training centers in Africa. It has 35 full-time specialty consultants, all of whom are passionate about training the future Christian healthcare leaders of medicine in East Africa and beyond.  In 2013, KH was selected as the 25th case study in Harvard Medical School’s Global Health Delivery series. Trainees in the past have not only included Kenyans but also individuals from Cameroon, Senegal, South Sudan, Madagascar, Tanzania, Botswana, and Uganda.  The various licensed training programs offered at KH have grown exponentially in recent years and new programs are being added every year. However, KH’s ability to expand these training programs is severely hampered by the lack of available housing for medical trainees.  It is quite phenomenal what this small rural hospital has accomplished over the last few decades with extremely limited resources and little or no external funding.  The only explanation is that God’s hand is all over this ministry, creating miracles on a daily basis, enabling this place to do much with so very little.  Would you please join me in praying for the success of this grant application, which would result in US$500,000 to build a hostel type building with 30 single bedrooms, shared bathrooms, kitchens and lounge areas?

Some of the highlights in our lives over the past few months have involved animals!  Anyone who knows me, even vaguely, is probably aware of my adoration of giraffes. There is no other animal on the planet as paradoxically graceful yet gangly (have you ever seen these beasts run?), serene yet feisty (using their necks as batting weapons on very rare occasions)…and their eyes!  They have deepest brown eyes and the longest eyelashes you are likely to ever see.  Pure, unadulterated beauty and strength!  So, as a surprise for my birthday this past January (oh yeah, and Mike’s birthday too), our friends, the Zirschky’s (who come to Kijabe every year to serve at the hospital) presented us (kids and all) with a night at Giraffe Manor, in Nairobi!  The.  Best.  Gift.  Ever!  I cannot tell you how fantastic this experience was.  We arrived at the manor in time for lunch on Saturday afternoon, which is a little over an hour’s drive from our house.  From the moment you step across the threshold of the manor, everything you see if giraffe-themed, from the paintings on the walls, to the water jugs, to the candle holders, to the crockery.  I was in heaven!  After an amazing lunch of gourmet food, we took in the grounds.  By 5pm, completely on schedule, the giraffes started to amble up towards the manor house.  On every window sill (including the bedrooms), ledge and table, there are small pots of molasses-covered, dried grass pellets – the equivalent of dog treats for giraffes.  They approach you, in all their majesty, looking for treats and love and kisses.  I obliged them in all of these ways!  They come back in the morning, eager to share breakfast with the guests, and stick their long necks in through the slated windows waiting to be fed some molasses treats.  I could go on and on, but these photos can tell a thousand words of love instead… DSC_0047DSC_0057 copyDSC_0051DSC_0178DSC_0176DSC_0194DSC_0086 copyDSC_0069 Shortly thereafter, upon arrival home from being away with my parents who had come to visit us for three weeks, Jane made a startling discovery!  To our complete horror and confusion, Jane had noticed that one of her beloved bunnies had made a nest.  “Simba” had gathered together some dry grass and plucked white fur from her breast to make a snug and warm environment for her new babies.  I was convinced she was having a phantom pregnancy and explained to Jane that new baby bunnies were highly unlikely.  Simba and Carrot (who we suspected was a male) had had a 30-second chance encounter one solitary day, and from what I witnessed, Carrot was a little confused with the direction in which he was aiming.  I was quietly confident that Simba was just imagining the “pregnancy”, and the fact that she was still acting hyper and not looking large, made me prepare Jane for the inevitable disappointment.  Jane went to bed that night and prayed earnestly that God would send some baby bunnies – she wanted to raise baby bunnies so badly!  The next morning, after the sun had barely risen, Jane ran out to the cage and gently stretched her hand into the nest.  What happened next was nothing short of bedlam!  She had felt multiple warm, naked, babies!!!  9, 12 , 15, she couldn’t be sure!  God has answered her prayers!  But alas, not mine.  We now have 10 rabbits, 7 of whom are adorable, white and fluffy babies.  Jane is adamant on keeping the runt of the pack, who she would move to the front of the nest every morning so that she would get milk from her mother without being bullied by her siblings.  She’s still small, but cute, and has been aptly named, Runt.  As for the other 6?  Please, someone, take them off our hands before they approach the copulation age of 6 short months! IMG_9037IMG_9056IMG_9083 (1)IMG_9237 (1) IMG_9241 IMG_9248 IMG_9269 IMG_9279 IMG_9298 The kids are off school for the entire month of April (in between terms) and we are headed to the Kenyan coast for our Serge Regional Retreat.  Serge teams from Kenya, South Sudan, Burundi, and Uganda, will join together for a time of reflection, fellowship, encouragement, and of course, sundowners!  We cannot wait! Thanks for keeping up with our news and for your continued support, emails, cards and love!  We wouldn’t be here without you.  And, please pray for the success of the ASHA grant, which would be a huge blessing to the hospital.

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Happy St. Patrick’s Day!

As missionaries, we have to celebrate in a special way one of the most amazing missionaries of all time.  Only two hundred years after the Gospels were written, this Scottish slave converted a nation from druidic paganism to Christianity.  “St. Patrick’s Breastplate” is a fourth century Christian prayer, which pulls from the ancient Celtic spirituality of Ireland.  An incantation as much as a prayer, it is said to convey God’s protection on those who pray it:

 

I arise today
Through a mighty strength, the invocation of the Trinity,
Through belief in the Threeness,
Through confession of the Oneness
of the Creator of creation.

I arise today
Through the strength of Christ’s birth with His baptism,
Through the strength of His crucifixion with His burial,
Through the strength of His resurrection with His ascension,
Through the strength of His descent for the judgment of doom.

I arise today
Through the strength of the love of cherubim,
In the obedience of angels,
In the service of archangels,
In the hope of resurrection to meet with reward,
In the prayers of patriarchs,
In the predictions of prophets,
In the preaching of apostles,
In the faith of confessors,
In the innocence of holy virgins,
In the deeds of righteous men.

I arise today, through
The strength of heaven,
The light of the sun,
The radiance of the moon,
The splendor of fire,
The speed of lightning,
The swiftness of wind,
The depth of the sea,
The stability of the earth,
The firmness of rock.

I arise today, through
God’s strength to pilot me,
God’s might to uphold me,
God’s wisdom to guide me,
God’s eye to look before me,
God’s ear to hear me,
God’s word to speak for me,
God’s hand to guard me,
God’s shield to protect me,
God’s host to save me
From snares of devils,
From temptation of vices,
From everyone who shall wish me ill,
afar and near.

I summon today
All these powers between me and those evils,
Against every cruel and merciless power
that may oppose my body and soul,
Against incantations of false prophets,
Against black laws of pagandom,
Against false laws of heretics,
Against craft of idolatry,
Against spells of witches and smiths and wizards,
Against every knowledge that corrupts man’s body and soul;
Christ to shield me today
Against poison, against burning,
Against drowning, against wounding,
So that there may come to me an abundance of reward.

Christ with me,
Christ before me,
Christ behind me,
Christ in me,
Christ beneath me,
Christ above me,
Christ on my right,
Christ on my left,
Christ when I lie down,
Christ when I sit down,
Christ when I arise,
Christ in the heart of every man who thinks of me,
Christ in the mouth of everyone who speaks of me,
Christ in every eye that sees me,
Christ in every ear that hears me.

I arise today
Through a mighty strength, the invocation of the Trinity,
Through belief in the Threeness,
Through confession of the Oneness
of the Creator of creation.

 

May this be a blessed Patrick’s Day for you!

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Managing Surgical Emergencies

One of the greatest blessings of living and working in Kenya is getting to be a teacher of surgery.  My work at Kijabe Hospital involves working daily with trainees.  Some are senior level orthopaedic surgery trainees, honing their skills before embarking on their new career.  Some are clinical officers, like a physician’s assistant, who don’t do major surgeries but will be on the front lines of diagnosing and providing crucial early treatment to the injured.  Almost every patient we see, and every surgery we do, involves teaching young Kenyan professionals.  In a country and a continent with a heart- breaking shortage of trained medical personnel, it is incredibly exciting to watch young trainees grow into confident, and competent, professionals.

Much of the teaching we do here falls under the auspices of the College of Surgeons of Eastern, Central, and Southern Africa (COSECSA).  Through COSECSA, I have the privilege of working with and training young surgeons from Burundi, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe.  South Sudan and Somalia have also applied for membership in the college.  This is a college without walls, a huge group of surgeons from Africa, Europe, the UK, US, and Australia, who come together to teach the next generation of African surgeons.  Thought leaders in surgical education from around the globe strive to provide advanced training and assessment.  The testing and assessment process is in some ways more thorough than the board examinations I went through in the US.

Amazingly, much of the funding and intellectual firepower behind COSECSA has come from the Royal College of Surgeons in Ireland (RCSI).  Visiting faculty from both Ireland and the UK come regularly to conduct courses and administer examinations.  In accordance with ideal development practices, the European influence lessens each year while the African surgeons take authority over this African college.

Beginning last year,  I’ve been privileged to participate in a course called “Managing Surgical Emergencies” (MSE).   This is a week long course, aimed at teaching a core set of surgeries that can save life and limb using low technology and limited resources.  The course is intricate, and extremely fast paced.  The orthopaedic surgery module was designed by my great friend Dr. Yogesh Nathdwaralawa, an orthopaedic surgeon from Wales.  The longest lecture is 12 minutes, followed immediately by hands on application of the surgeries taught.  A very large pig is euthanized so junior surgeons can learn how to drain blood from a bleeding brain, save the life of a baby and a mother with a rapid C-section, stop bleeding in an abdomen traumatized by a car wreck, recognize life threatening infections and fractures, and other vital procedures.

The course is set in a remarkable surgical skills laboratory located on the University of Nairobi campus.  Professors from England, Wales, Scotland, the US, and Kenya teach the different modules.  To date, most of the funding and teachers have been from the UK, but with the class we held last week, this ends, and the African staff take over completely.  This is an historic and exciting moment in African surgical training.

One of the most remarkable things about this course is its practicality.  The students return to their hospitals and immediately start performing these life and limb saving procedures on a daily basis.  I feel if only one surgical course could be taught to medical students and interns in Africa, it should be this one.

In the few days since we finished the last course, I have had two patients who demonstrate the vital nature of the MSE course.  The first is tragic, the second encouraging.

Victor is 10 years old, the same age as my son Michael.  He has been an orphan since a very young age.  About four years ago, he developed swelling and then pus coming from his ankles.  One of the things we teach in the MSE course is how to recognize and treat osteomyelitis, a common, dangerous, and crippling bone infection.  Osteomyelitis strikes the most vulnerable:  the very young and old, the malnourished, those with AIDS.  Likely because of malnutrition and sickle cell disease, Victor had osteomyelitis in both feet and ankles.  The bones of his foot were destroyed by infection, to the point where his tibia, or leg bone, was protruding through the skin.  He is a social outcast, unable to go to school, due to the smelly pus and disturbing appearance of his ankles.  Xrays showed complete destruction of the bones of the foot.  Despite multiple consultations looking for a better answer, the only way for him to survive, go to school, and one day work and have a family, is to amputate both legs below the knee.  With prosthetic legs, paid for by our vulnerable patient fund, he will be able to walk, run, go to school, and rejoin society.  We met with him, prayed with him, and performed the surgeries this past Monday.  Within several weeks, we’ll begin the process of getting him new prosthetic legs.  The silver lining of this awful tale, is that he has discovered his faith while in Kijabe Hospital.  He is reading a Bible, and wants to commit his life to following God’s will for his life.  This has given him a purpose and hope as he faces life with prosthetic legs.  Amazing how God can work through even the most miserable of circumstances.

This could have all been prevented with some simple training in recognition and treatment of osteomyelitis in children.

Our second patient yesterday could be diagnosed from the hallway.  A 45 year old man had been hit by a motorcycle on Sunday, suffering a moderately severe wrist fracture.  A local hospital had put on a full tight cast, something we teach never to do in the MSE course.  Overnight, the swelling had progressed to the point of cutting off the circulation to the arm, a condition called compartment syndrome.  The excruciating pain and numbness brought him to our casualty department (ER).  The astute clinical officers rapidly removed the offending cast, but the cascade of events had progressed too far.  As the arm lost circulation, the pain became intractable, and we could hear the poor man screaming from the hallways by the operating room.

Thankfully, the well trained clinical officers recognized the urgency of the situation, contacted the orthopaedic team, and we rushed to casualty.  Cases were cancelled, we pushed the trolley rapidly through the halls to Operating Theatre 1.  One of our recent junior trainees from the MSE course was by my side, and I asked him to do the surgery he had just learned.  He completed the job beautifully with little guidance, saving the man’s arm.  Though he will have some scarring, he can plan on having normal function once he heals.  I was so proud of our junior clinical officers and doctors, rapidly recognizing and treating this surgical emergency.

These types of disasters and near disasters are a daily occurrence in most of Africa.  So much more work needs to be done, but we can already start to see the benefit of basic surgical training.  If we could take the MSE course to every corner of this continent, many many thousands of lives would be saved, and even more people saved from a life of crippling pain or disability.   It is a great privilege to be part of this process, and we thank God every day for bringing us here.

 

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Elephants and Awards

By Ann:

Being back in Dublin for a couple of weeks at the beginning of December was wonderful…but as always, far too short.  We had Christmas celebrations early and our whole family was together for the first time in ages.  We got back to Kijabe the week before Christmas, in time for Mike to relieve the 2 Kenyan Ortho Doctors so that they could travel home for the holidays.  Christmas day arrived, the turkey was cooked, friends (old and new) gathered, gifts were opened, and the sun was blistering!  I’ll never quite get used to a hot Christmas; it’s just not right!

All Jane wanted for Christmas was to adopt an elephant from the David Sheldrick Elephant Orphanage, in Nairobi.  She picked out a 7-month old orphan, named Murit, who had been found stuck down a deep well.  Some local tribesmen had alerted the orphanage and a plane was soon dispatched with a team to go and rescue him.  When the team arrived, there was no sign of Murit’s family.  No-one knew how long he had been in the well but he had a raging bacterial infection due to ingesting infected water. He was flown back to the orphanage, put on antibiotics, and Jane got to visit him for the first time, last weekend.  When we arrived, he has just had his bed-time bottle and promptly fell into a deep slumber, under his blanket, snoring quietly.  It was about the cutest thing I had ever seen and Jane was beside herself with excitement!

Murit

Murit

Sleeping with a full belly

Sleeping with a full belly

photo 1 (16)

Jane, in her element!

Jane, in her element!

photo 3 (12)

photo 4 (3)

As for the awards part of this blog…now I get to brag a little on Mike!  Back in 8th or 9th grade, Mike happened across the writings of Dr. Thomas Dooley.  Thomas Dooley was a medical doctor, from the US, who spent many years in South East Asia, providing medical care to those most in need.  This captured Mike’s attention as a young child and inspired him to pursue a career in medicine.  Dr. Dooley was a graduate from Notre Dame (where Mike attended and got his under-graduate degree) and is memorialized at the University of Notre Dame’s Grotto of Our Lady, with a statue as well as an engraved copy of a letter he wrote to former Notre Dame president Ted Hesburgh.  In his memory, every year, the Dr. Thomas A. Dooley Award is conferred by Notre Dame on an alumnus/alumna (living or deceased) who has exhibited outstanding service to humankind.  Mike’s name was put forward last year as a proposed recipient and he was chosen by the committee to receive the award for 2014.

Besides this being a huge honor for him, it is truly significant to Mike and his family.  Not only is this the individual who inspired Mike to become a doctor in the first place, but Notre Dame is near and dear to the entire Mara clan!  Mike’s own father graduated from Notre Dame and he and Sue practically made it their full-time jobs to ensure that all of their children would go to college also.  Mike flew out to the US on Sunday and this week, his five sisters are all traveling to see him receive this award, to help him celebrate, and to honor their parents for making such sacrifices on their behalf.  How Lee and Sue would have been so very proud, not only of Mike, but of all their kids.  All six Mara kids are hard-working professionals, each with drive and perseverance, and big personalties to match…gifts, I believe, bestowed upon them by their parents.

The following is an excerpt from the letter that Thomas Dooley wrote to the former president of Notre Dame, on his deathbed…

“It has become pretty definite that the cancer has spread to the lumbar vertebrae, accounting for all of the back problems over the last two months. I have monstrous phantoms . . . as all men do. But I try to exorcise them with all the fury of the middle ages. And inside and outside the wind blows.

But when the time comes, like now, then the storm around me does not matter. The winds within do not matter. Nothing human or earthly can touch me. A wilder storm of peace gathers in my heart. What seems unpossessable I can possess. What seems unfathomable, I fathom. What is unutterable, I utter. Because I can pray. I can communicate. How do people endure anything on earth if they cannot have God?”

That is certainly the kind of faith I aspire to having…a wilder storm of peace within…available to all who ask…freely given…light and sustenance…an anchor to cling to in good times and in bad.

This is the first time in 14 years that Mike and I have not celebrated our birthdays together, but in my opinion, there could not be a better reason for us to be apart today…

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New Perspectives & The Wounded Healer!

By: Ann

So, I confess…

I have complained a lot since returning to Kijabe, after our home assignment in the US this past summer. My role here at the hospital, working in Resource Mobilization (Communications and Fundraising), is one that I struggle with. I mostly work from home, writing grants, updating the website and FB page, managing donations, sending out funding appeals for urgent equipment needs and capital projects, and communicating with our donors and friends of Kijabe. I find the isolation that this role brings, difficult. I have always worked as part of a team, which is what I enjoy most. I have gone back and forth, wondering if this is really my purpose here in Kijabe, and whether there is some other role that would best suit my skills.

I often envy Mike (this is a true confession!), who performs a surgery and immediately sees the tangible results of his efforts and skills. He might be having a bad day or week, but then he will come home with a story about a patient that can now use his/her hand, a child who will be able to walk again, a father who will, once again, be able to provide for his family. And I despair. What impact am I really having in this place?

I warned you at the beginning. I have been grumbling a lot!

…and then, this past week happened…

I developed an infection under my toenail and could barely walk. The infection was starting to creep up my foot and into the lower part of my leg. Mike said that the toenail would have to be removed. I said, absolutely no way! Luckily, my husband knows me very well and the extent to which I am completely unable to handle anything with the mere sight of blood. He told me to sit out the back of our house in the sun, soaking my toe in a basin of warm water, while he got some pain medications and antibiotics at the hospital. I knew I was in trouble when he arrived back with surgical gloves, injections, lidocaine, and implements! He promised that he would numb me up and simply clip off the corner of my nail, to release the infection. Jane was his surgical assistant and official photographer of the entire operation. She zoomed in on every movement that Mike made, while I hid my face in a cushion! Before I knew it, Mike was holding up my entire toenail at the end of a tweezers and I just about passed out! Suffice to say, despite his barefaced lies to me, my toe was healed and I quickly recovered just in time to become a full-time nurse in my own home.

Mike noticed a hernia on his lower abdomen a few weeks ago and it started to get progressively more painful over time. He was scheduled for surgery last Friday. As I sat in the waiting room, crowded together with other family members also waiting on narrow wooden benches, I was overcome with gratitude. Gratitude for this amazing hospital in rural Kenya…for the doctors and surgeons who could be making 4 times their salary in Nairobi or elsewhere, but who have chosen to be part of this powerful ministry to serve the most vulnerable…for the brand new surgical equipment that had been recently purchased as a result of incredibly generous donations from across the globe…for the competent and caring nurses, surgical techs and anesthetists, who treat with compassion and joy. Mike’s surgeon was Dr. Rich Davis. Rich, his wife Stacy, and their three kids moved here to Kijabe right after Rich qualified as a General Surgeon in the US. They have been serving at Kijabe Hospital for the past 8 years. Mike’s anesthesiologist, Dr. Mark Newton, has worked here for the past 17 years and began the first ever nurse anesthetist training program in East Africa. He came to Kijabe with his wife, Sue, and their three children, and they later adopted two Kenyan children. To date, this nurse anesthetist-training program has graduated over 80 anesthesia nurses. Last year’s class graduated 14 South Sudanese nurse anesthetists and they returned to South Sudan a couple of months ago, bringing with them much-needed skills, which will literally save countless lives of mothers and babies, trauma victims and many others. (For more information on this, read here: http://kijabehospital.org/education-training-programs/nurse-anesthetist-training-programs)

I sat there in awe of the entire team helping Mike, from the admission nurse, to the surgical team and the recovery nurses. Mike came out of his surgery proclaiming that he had experienced the smoothest IV and anesthesia in his entire life! So many of his colleagues gathered around his bedside before he went to sleep, and prayed for him, just as they do for every other patient here at Kijabe Hospital.

All gowned up and ready for surgery!

All gowned up and ready for surgery!

So, if that wasn’t enough to provide me with some fresh perspective, we had another casualty in our family. I went up to the school to collect Jane on Friday. As I was chatting to another parent, I heard a blood-curdling scream from Jane and knew that she had either split her head open or broken a bone. I held my breath waiting to see blood as she screamed, “My arm bent the wrong way! My arm bent the wrong way!” All I could think of at that moment was the fact that Mike was lying in bed at home, recovering from his surgery – of all the days for one of our kids to get injured! I drove her back to the house and Mike took one look at it and knew that she had broken her elbow.

The main entrance of the hospital sits close to the end of our driveway. We piled into the car and drove slowly and carefully over the rocks and the bumps. Both my patients were in agony. As the ‘Ambliance’ driver (Jane’s pronunciation!), I dropped them off at the front gate. We headed straight for the x-ray department, which eventually confirmed Mike’s diagnosis. Jane would need surgery to pin the broken bone.

Broken elbow

Broken elbow

Of both my patients, Jane is the strongest (she gets this from her mother, of course!). From that first evening, she never asked for any pain medication and remained pleasant and agreeable, as always. Mike, on the other hand, moaned incessantly and took every pain pill he could get his hands on! I drew the line at him wanting a bell to ring for assistance by the side of his bed! Male patients, and ones that are in the medical profession = the worst kind of patient! ;-)

So, this morning, Mike got to perform surgery on Jane. She did so very well and is currently reclining on the couch; arm elevated, movies on the go, snacks at the ready, and she couldn’t be happier! She will need to wear a cast for about 6 weeks. Michael, you might be inclined to wonder about, has not escaped a casualty either – his mouth is full of canker sores and he is also on pain medications…he’s never one to be left out!

As for me, I’m hobbling around on my recovering toe, and looking after everyone else! The next time I sit down at my computer to complete a mundane grant application, or tally up the number of donations that have come in, I won’t quite be so quick to grumble. I am thankful to God for showing me a fresh perspective and for revealing to me firsthand, the connection between my work here and the incredible healthcare that is delivered at this rural hospital on a daily basis. “And though my heart is torn, I’ll praise YOU in this storm…”

The silver lining in all of this is that myself and the kids are heading home to Ireland, this Thursday, for 3 weeks! Mike will follow us over after a week. We are celebrating Christmas early, together as a family. Paul and Amanda will be home from San Francisco, and Stephen, Anna and Aria live two minutes down the road from my parents! So, this Florence Nightingale is looking forward to being pampered by HER Mammy and Daddy! :-)

And there goes the little bedside bell, once again…

Enjoy the photos!

Heading off to the hospital this morning

Heading off to the hospital this morning

Walking down our driveway

Walking down our driveway

In waiting room

In waiting room

In capable hands

In capable hands

Prayers for Jane with her surgeon and anesthesiologist

Prayers for Jane with her surgeon and anesthesiologist

In surgery

In surgery

theatre 2

theatre 1

rec 1

rec 2

All over!!

All over!!

In recovery

In recovery

leaving 1

surgeon

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World Diabetes Day

Michael was diagnosed with Type 1 Diabetes, in April 2011, at the age of 6.  It came as a complete shock to our whole family who had no prior knowledge of, or experience with this disease.  Since then, there is not an hour that goes by without it occupying our thoughts and actions.  Managing diabetes is a 24/7 job, and one which Michael does with such responsibility.  I remember, on the night that he was admitted to hospital, my heart breaking as I watched needle after needle being poked into his delicate skin.  He was and is the bravest boy I know.  Never once has he cried over yet another jab; very, very seldom does he ever complain.  He is a warrior, aptly named after the Archangel, Michael, who leads armies of angels, while wielding a flaming sword.  He is courageous in this battle and is never defeated by the disease.  On day two in the hospital, I was still crying uncontrollably, devastated by what Michael would have to face in his life.  He looked at me at said: “It’s ok Mom.  God is going to use this diabetes for good in my life.”  Out of the mouths of babes…

Last week in school, Michael had to write an essay on a topic that he knew a lot about, but which his class mates might not be aware of.  This is what he wrote…

Diabetes.  By: Michael Mara, 7 November 2014

“I have type one diabetes. Living beings can have two types of diabetes. Type two diabetes is when your body still produces insulin but your body can’t use it. Type one diabetes is when your pancreas stops producing insulin. Usually Type one diabetes occurs in little children. Anybody can get diabetes, at any age or anywhere. There’s no reason why you get type one diabetes. I got type one diabetes when I was 6.

Diabetics must take care of their disease. I have to check my blood sugar about 10 times a day! I check my blood sugar by poking a needle into my finger and putting it on a strip that’s inside an electronic device. This tells me how much sugar is in my blood. My body can’t produce insulin on it’s own. I had to have 4 shots a day (snacks not included) for a year after my diagnosis. Now I have a pump, which gives me insulin. It’s only 1 shot every three days.

Diabetics have to control their blood sugar. I can’t have too much or too little sugar in my blood. If I have too much sugar in my blood, I get really thirsty because water breaks down sugar. When I have too little sugar, I get really dizzy. It feels like you’re about to go on stage, or you feel really embarrassed. Sometimes you can forget your name or faint or forget where you are. When this happens I need too take 4 pure sugar tablets.

Diabetes is a life long disease. There’s no cure yet. I can still have every food there is, I just need to manage my blood sugar levels. I can also do every sport. My hope for diabetes is that researchers would find a good cure.”

Screen shot 2014-11-14 at 7.43.25 PM

 

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Coming up in the world

By Ann

Early one morning this week, I set out for a quick run.  It was a gorgeous, sunny morning, as Bosco (my four-legged firstborn) and I made our way through the village of Kijabe.  There was nothing but blue skies as we ran along the dirt road on the escarpment, overlooking the Great Rift Valley.  You can literally see for miles and miles – the view is dominated by Mount Longonot, towering above the otherwise flat landscape.  There I was, running along, feeling strong and full of energy, enjoying the early morning sounds of cocks crowing and birds singing, when my foot caught on a small protruding rock and I fell flat on my face!  You know one of those falls, which feel like they are happening in slow motion?  I was fully aware for the whole entire 3 seconds that I was sailing through the air that my fall was going to be a bad one.  And it was!  I ended up with my face in the dirt, having slid along the ground on my left side.  I was a sight to behold!  My immediate reaction was, “I hope no-one saw that,” as I quickly got up, shook myself off, and attempted to keep running!  I didn’t get very far as the adrenaline coursed through my body, forcing me to walk…and maybe even cry a little!

This unfortunate incident got me thinking.  It’s a lot like living life here in Kenya.  There are days when we are sailing along, full of passion for the work we are doing, wondering why we didn’t do this a decade ago, and relishing in the small but significant victories.  And then, bang!  We are knocked down on our faces, in the dirt…a bad patient outcome, some seemingly insurmountable obstacle that cannot be moved, a weariness in trying to navigate a different culture, and the frustrations that come with cross-cultural misunderstandings.  We pick ourselves back up again, brush off the dirt, and continue on at our previous pace…and hope that no-one has seen us make a fool of ourselves.  There is no buffer.  There is no inoculation.  Life here, at least for Mike and I, is either absolutely wonderful or debilitatingly difficult.  Personally speaking, I’ve experienced some of my lowest lows, here in Kijabe.  However, I’ve also had moments, which have surpassed my wildest dreams and expectations.  There’s something about living here that makes everything feel raw…poverty and desperation are never far away, pain and suffering reveal themselves on a daily basis, and life and death are never more evident.  On the other end of the spectrum, I’ve witnessed the closeness of the body of Christ like never before, seen miracles happen before my eyes, heard stories of incredible hope and redemption, and have truly felt God’s divine purposes being worked out in my life.

If you read our last blog entry this past week, that was most definitely a “face in the dirt” moment.  We both agonized about writing it.  We felt somewhat hopeless, wondering how we could possibly be vulnerable with our situation and ask for financial support, while at the same time not wanting to reveal our disillusionment.  We really wanted to pick ourselves up and hope that no-one had seen us fall so hard…but, it doesn’t work like that.  It’s not meant to work like that.  This is the very reason why our sending agency requires that we have a community of supporters standing behind and with us.  The constant swing from exuberant to desolate, is exhausting.  Some days, a perfect latte, a trip to the cinema, or a nice meal out, seem like the only solution – which, unfortunately, cannot be found in Kijabe.

So, we wrote an honest post, requesting help, and we were blown away by the response.  Those few emails, encouraging words, pledges of financial support, and prayers, picked us up and set us on our feet again.  Thanks to all of you who responded so sacrificially, and so lovingly.  Words cannot adequately express our gratitude at how supported we really feel.  If we didn’t fail or fall, we wouldn’t have asked for help, and we would never have been blessed in such an incredible way.  Knowing that there are  literally hundreds of you who have committed to this crazy adventure together with us, who believe in our calling, and who are willing to give beyond your means so that we can be here, is truly one of the most humbling and significant experiences of both our lives.  Thank you for cheering us on from afar, for holding us up in prayer when we cannot even stand, and for believing so relentlessly in God’s purposes and plans for us, here at Kijabe.  It helps tremendously both when we are face down in the dirt, but also when we are prevailing in our ministries.

We have also “come up in the world” this week in a very tangible way, here in Kijabe.  All of the bumpy roads and dusty pathways were assigned names!  We can now tell people that we live on “lane 4.”  That’s our house in the top left-hand corner!

lane 4

And some other highways and byways…look out for Bosco, my constant companion, in the second last photo.  If you don’t know the story already, we got Bosco as a tiny puppy the day before we found out I was pregnant with Michael.  He has been with our family through thick and thin, he has watched Michael and Jane grow up, and he made the horrendous journey from Bend to Nairobi in the belly of a plane!  He is our hero and loyal defender!

academy st

 

residential lane

 

lane 9

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We need your help

One of the great joys of this life adventure, living and serving in Africa, is being part of a community that stands with us as we work at Kijabe Hospital.   Each month we receive emails from supporters, asking for prayer requests, staying in touch, and reminding us that we are the boots on the ground for an amazing group of people that cares about suffering here in Kenya.  When times are difficult, when futility and chaos seem to have the upper hand, we are lifted and encouraged by your prayers, and by knowing that you join us in advocating for the most vulnerable.

We have written blog posts before asking for help with a sick child whose family is devastated by medical costs, and you have responded.  We have been able to pay for hospital bills and a prosthetic leg for a teenager with cancer.  You have enabled us to travel into the most bleak, unstable regions of Africa, to provide medical care and compassion, to let those on the margins know that they are not, indeed, God-forsaken.  The monthly support provided by our dedicated community of supporters has sustained us over the last two and a half years. You have allowed us to serve at Kijabe Hospital, to train doctors, to pray with gravely ill patients and their families, to quietly pay a hospital bill for a dedicated pastor who’s leg was lost to infection, to try, in our imperfect way, to tell people, in word and deed, that God loves them.

But now, it is our turn to ask for help.  As part of our work here, we are sustained through one-time and monthly contributions from over 100 individuals, families, and churches, who allow us to serve here by supporting us financially and prayerfully.  There is a natural attrition rate as supporters’ situations change, and over the last 6 months, we have fallen behind in our financial support.  For the past two months, our account has been “in the red,” requiring us to urgently seek additional financial support.

The very responsible policy of Serge, our sending agency, is that if we carry a negative balance for three consecutive months, our “salary” is reduced, and if the situation is not remedied, we must temporarily return to our home country to increase financial support.  A good friend of ours, also working in Kenya, is currently in the US, not able to do his work here, for just this reason.  As a faith-based non-profit, Serge is responsible to both their donors and the IRS.

Due to this shortfall, we need $7,800 in one-time contributions, to bring our account balance even.   We also need 17 new supporters of $100 per month, to bring our budget into balance.   We are reaching out to you, to see if you, your family, your church, or your organization can come alongside us in our work here.  Please know that any financial support is put to immediate and hard work here at Kijabe hospital.

Here are the practicalities of how to provide support to our ministry.   All donations are tax deductible.

1) Go to the link: https://www.whm.org/give/missionary?ID=51553

2) This will take you to the Serge/World Harvest Mission page for donations to our work here in Kenya.

3) In the box, enter how much you would like to donate, and make sure you use the menu right below that to indicate whether this is  a one time donation, monthly, or annual donation.

4) After you click “Add to Donation Cart”, you’ll be taken to a registration page to checkout.

5) Your options are to donate by credit card, or by Electronic Funds Transfer (EFT).  EFT is the most simple and secure way to donate.  Setting up EFT allows Serge/World Harvest Mission to transfer your donation directly from your checking account to our mission account at Serge/WHM.

To do this you’ll need to look at one of your checks, to get the routing number and your account number.

Image

The routing number is the nine digit number to the left, and your account number is the next set of digits, after the colon.

Follow along the rest of the registration page, and you’re done!

We consider ourselves amazingly fortunate and blessed to be serving in Kenya, and we hope and pray you will join us in our work.  If you have any questions about our work here, or about financially supporting us, please email Mike at michael_mara@hotmail.com or Ann at annmoran2002@yahoo.co.uk.

Mike, Ann, Michael, and Jane

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Two Happy Stories

Sometimes, things seem really hard at Kijabe Hospital.  We see a constant stream of really sick and badly injured patients.  We talk and pray with them, give them the best medical care we can, and hope for the best.  Most patients thrive, heal up well, and go on with their lives.  Others suffer greatly, and not all of them survive.  Kijabe can be an intense place to work.

 

Which is why it is so important to celebrate victories.  We have had two small children with really unusual problems this week, but both should go on to have normal lives.

The first patient is Ahmed.  You wouldn’t know that this child lives in a famine plagued corner of Kenya, in the largest refugee camp in the world.  Dadaab is known as an arid, hostile, often violent place where Somalis flee to escape the war and terrorism in their home country.

Happy little Ahmed

Happy little Ahmed

So imagine our delight when this fat, happy, funny baby arrived from that awful place.  Ahmed is six months old, and born with an unusual condition.  He was born with his urinary bladder incompletely formed and outside of his body.  A part of this problem is that the bones of the pelvis don’t form completely, and so don’t come around to meet in the front.  Thus, there is nothing to “hold his insides, in.”  So I got to work with my good friend, Erik Hansen, a paediatric surgeon, and our amazing anesthesia team,

Ahmed safely undergoes anesthesia

Ahmed safely undergoes anesthesia

to fix this problem.  Erik’s assignment was a long and difficult process of forming a new bladder from the tissue available, and placing the new structure inside of the pelvis.  My smaller part was to cut the bones of the pelvis on each side so we could fold them inward, containing the structures on the inside.  I hadn’t done this exact procedure before, so it took a little longer than it should, but it seemed to turn out alright in the end.  Ahmed is doing well, recovering comfortably in his new turtle shell of a cast.

Ahmed, done with surgery, and in his new home, a body cast for six weeks.

Ahmed, done with surgery, and in his new home, a body cast for six weeks.

We’ll plan on removing the cast in about six weeks, and Ahmed can go on his way.

 

Today, I saw a beautiful two day old girl named Elizabeth.  She is a health, happy, peaceful little thing, but has a couple of problems with her legs.   The right knee has a fairly rare problem called “congenital dislocation of the knee.”  For reasons not fully understood, occasionally a child is born with their knee joint dislocated, bending the wrong way, with the foot up near the face.

Congenital Dislocation of the Knee

Congenital Dislocation of the Knee

Though this seems like it should be painful, it isn’t.  Her other foot has a common condition called calcaneovalgus foot deformity, which resolves over time, sometimes with a bit of gentle stretching from the parents.

The treatment for congenital knee dislocation usually requires some manipulation and casting, once a week, for six or eight weeks.  Most babies then develop normally.

gently stretching the dislocated knee back into position

gently stretching the dislocated knee back into position

Elizabeth’s mom was delighted and relieved to know the treatment was so simple, for a condition which looks strange and potentially disabling.

A baby sized cast holds the leg in good position

A baby sized cast holds the leg in good position

Thankfully, the family lives in a village not far from Kijabe, so it shouldn’t be too much of a burden for them to come once a week.  It’s really nice to be able to help these babies, hopefully give them a normal life, instead of one of shame, poverty, and disability.  Patients like these help remind me of the ministry of Kijabe, to show God’s love to people in this part of Africa.

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20 Beds in 60 Days

Whew!  We have just finished our first “home assignment.”  As long term missionaries, we spend about 10 months of each five-year term outside of our host country.  This time is spent resting and recuperating, praying about the direction of our lives, visiting with friends, families, prayer and financial supporters, and spreading the word about Kijabe Hospital.  The last two months have been some of the most amazing of our lives:  we’ve been overwhelmed with the kindness, love, and generosity extended to the Mara family.

The first leg of our trip took us from Kijabe to Michigan, where I grew up.  The flights were seamless, and somehow Michael’s blood sugars stayed stable through ten time zone changes.  We enjoyed a fun family reunion with all five of my sisters’  families, including no less than fourteen cousins!

Crazy Family Dinners

Crazy Family Dinners

Kid heaven, we walked to the beach every day, rode bikes, ate and drank together, and generally put the “fun” back in dysfunction.

Zen Moment on Lake Michigan

Zen Moment on Lake Michigan

We took a quick trip to my home town, Midland, and to my alma mater, Notre Dame.

Sacred Heart Cathedral, Notre Dame

Sacred Heart Cathedral, Notre Dame

We had a great visit with our friends from Kijabe, Norm and Carolyn Boeve.  They treated us to beautiful dinners, great conversations, lots of rest, and even took the kids out tubing behind their boat!  They introduced us to Harvest Bible Chapel in Spring Lake, and Pastor David Wisen and his wife Kristen.  Before we departed, Norm and Carolyn blessed us with prayer and sent us on our way.

From there, we re-united with my classmates from residency, Steve Kimberly and Jeff Recknagle and their families.  Jeff lives on a beautiful lake which connects with Lake Michigan.

"Tubing" at Norm and Carolyn Boeve's house

“Tubing” at Norm and Carolyn Boeve’s house

The kids had a riot, learning how to water ski and drive a jet ski.  Michael terrified me by going full throttle on Lake Michigan in six foot swells, screaming “big air!!!!”  I think he gets it from his mother.  It meant a lot to me for Ann to meet two guys and their families who have meant so much to me.  There were a few uncomfortable moments when my old friends related stories from my “B.A” (before Ann) era, but grace was extended all around!

One of the highlights of the trip for me has been the opportunity to speak at Orthopaedic Surgery Grand Rounds in Michigan and Oregon.

Orthopedic Grand Rounds in Portland, Oregon

Orthopedic Grand Rounds in Portland, Oregon

Antique Orthopaedic Surgeons

Antique Orthopaedic Surgeons

My good friend from medical school, John Anderson, both made the arrangements for me to speak, and invited us to spend time with us at his cottage, also in west Michigan.  The kids couldn’t believe their luck, three different lakes with boats for inner tubing and water skiing in one summer!

We said our sad good-byes to my sisters and friends in Michigan, and got back on the plane, now destined for Bend, Oregon.  Here, we were extended the incredible gift of a beautiful home and car by Laura Wytsma.  The house was our home from mid-July to late August.  It is truly a sanctuary of peace and relaxation.  The Wytsma family has taken us under their wing, spoiling us with their generosity and kindness.

In Central Oregon, we got to connect with almost all of our close friends from the time we were first married.

Jane Kayaking on Elk Lake, with Mt. Bachelor looming behind.

Jane Kayaking on Elk Lake, with Mt. Bachelor looming behind.

True friends are the ones where it feels as if you’ve only been apart for a few days.  I got to go on a three day mountain bike adventure, punctuated by an emergency room visit for an emergency epinephrine injection and IV steroids when my airway began to close up.  It’s a great idea to mountain bike with your personal physician!  The really fun part of that is no one really knows why it happened.  So I get to travel with two epi pens from now on.  Hmmmm…  We got to have some great dinners and outings with my sister Shannon, her husband David, and my nephews Will and Ian.  Michael and Jane love their cousins, so it was great to see them get to spend time together.

Our great friend and gifted photographer Benjamin Edwards invited us to speak at Redmond Church of God Seventh Day, and Pastor Sean Mills and the entire congregation immediately made us feel right at home.  They blessed us with kindness, generosity, and prayer, and really started the Oregon leg of this journey out on the right foot.  Paradoxically, Ben was in East Africa, climbing Mt Kilimanjaro while we were in his home church in Oregon.  Ben is shooting a video for the Elisha foundation, and climbed Kili with Eli, a boy with Down’s Syndrome who has also been to Everest Base Camp.  If you want to get rid of any self-pity in your life, check this out further at Ben’s website,

http://www.benjaminedwardsphotography.com/blog/travel/mountains-documentary-film-on-disabilitykilimanjaro-trek/

A really surprising highlight of the Summer was our visit to Emmanuel Bible Church in Salem.  Dr. Bob and Sally Zirschky have been over to work at Kijabe, and they put their church to work praying for us, and then supporting us financially, before we had ever visited the church!  We had the most amazing weekend with the Zirschky’s and EBC, and they invited us to speak the message from the pulpit for both services on the Sunday.  So exciting (and a little nerve-wracking) to be able to tell stories of how God works at Kijabe and in our lives.  The Zirschky’s again showered us with their amazing generosity, and Bob even drove up to Portland to support me as I spoke to the ortho residency there.

We took a pause from public speaking engagements to attend the joyful wedding of Ann’s great friend Erin Lytle to Jay Jones.  Ann co-officiated the ceremony with our friend Pastor Brandon Reynolds, who we know from his time at Antioch.  What an amazing and blessed celebration.  A great bonus of being in Ashland for the wedding was getting to spend more time with my sister Colleen and her family.  Returning to Bend, Ann’s brother

Paul, Amanda, Michael and Jane

Paul, Amanda, Michael and Jane

Paul and incredible chef Amanda came up from San Francisco and prepared us an amazing feast.

Back in Bend, God blessed us with an amazing evening with our dedicated supporters at Aspen Hall.

Supporter Evening in Aspen Hall, Bend, Oregon

Supporter Evening in Aspen Hall, Bend, Oregon

So many people made the effort to come out, we had great conversations, and got to catch up with many of our friends, prayer partners, and financial supporters.  The time was too short, but we are grateful that we at least got to say hello to many of the people who allow us to do our work in Kenya.

In the midst of all this crazy travel, we carved out three days of real vacation.   We dropped Michael

Adam Duritz of Counting Crows, as seen from the front row!

Adam Duritz of Counting Crows, as seen from the front row!

Hard to tell if he's excited about camp!

Hard to tell if he’s excited about camp!

at the first ever Type 1 Diabetes Camp in central Oregon, and dropped Jane with her best friends in Portland.

Ann and I relished three days of rare treats like sleeping in, spare time, lazy breakfasts, sushi, and uninterrupted conversation.

We even spoiled ourselves with concert tickets to see Counting Crows in Portland!!

We then returned to Bend to speak at Antioch Church on August 17th, some shopping for last minute essentials, and then departed Oregon on the 21st.  We enjoyed a quick lay-over with Ann’s parents in Dublin, enjoying their amazing hospitality, and spending some good family time.  All too quickly, we were back on the plane to Nairobi, where our friend John was waiting at the airport to drive us back to Kijabe.

Kijabe really feels like home, seeing our little house, getting a feverish tail wagging greeting from Bosco, and seeing our good friends here.  I’ve been back to work for a little over a week, with renewed energy and enthusiasm.  Ann has jumped right back in to trying to find funds to keep the place running, and the kids are overjoyed to be back in school.  Overall, an amazing, somewhat exhausting two months.  We can’t thank you all enough for standing with us in so many ways.

 

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