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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The Maasai Mara

The countdown is on!  We leave Kijabe in 4 weeks time for the first of our home leave breaks.  Next month marks the 2 year date when we left Bend, Oregon, and started on this amazing adventure.  The kids were only 7 and 5 then – those of you who we will be fortunate enough to see this summer will notice a BIG change in them both!

Kenya truly is one of the most beautiful countries and if you visit here, you must visit the Maasai Mara.  We took our first trip there last weekend.  The Mara is situated in the middle of Maasai territory, which extends throughout the southern part of Kenya and the northern part of Tanzania. The Maasai people are semi-nomadic and have continued to this day, their age-old customs. The young warriors (the Morani) are known for their strength and fierceness, having learned at a young age to conquer one of the most dangerous animals of all, the lion. They make the best security guards all over East Africa and armed with little more than a bow and some poisoned arrows, they strike fear into all those who dare to confront them!

Masaidance

(The fact that my maiden name is Moran and my married name is Mara continues to astound most Tanzanians and Kenyans, and convinces me that this is one part of the world where I most definitely belong.)

Mike and I have been on many safaris together, mostly in Tanzania. It is such a thrill to introduce your kids to the majesty of the scenery and the wild animals.  For those of you who have not yet visited…karibuni sana!

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And here’s what we saw…

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And the sunsets!!!

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Sad News from Kijabe, a reason for hope, and a way to help

If you’ve followed this blog over time (October and November 2013), you’ll remember a desperately ill boy, named Jonah.  Jonah was flown from a remote region of Samburu to Kijabe with end stage tuberculosis.

Jonah in his hut in Samburu

Jonah in his hut in Samburu

The infection had eroded through his spine, causing complete paralysis from the waist down.  He went through a very difficult hospitalization, including three surgeries, one of which was complicated by cardiac arrest.  Miraculously, he survived this ordeal, and was able to return to his village and the loving arms of his mother.  He never recovered from the lack of oxygen to his brain during his cardiac arrest, however, and required assistance for feeding and all his activities.  Sadly, I received an email last week that Jonah had died in his home in Samburu.

Jonah’s short and difficult life reflects the daily struggles of so many in Africa.  In reality, Jonah died from poverty, which led to malnutrition, which weakened his immune system, which allowed the devastating infection to take over his precious little body.

And so this is the struggle….an adversary so large and powerful that it’s easy to lose hope.  Easy to think that our puny effort is too small, that children starve and die of infections, and wars break out, and relationships fracture, no matter how hard we try.

But this would miss the point entirely.  The point was never that what you or I do is enough, or sufficient, or even begins to scratch the surface.  We are small, we are broken, we can make little difference, no matter how hard we try.  The point, I think, is this:  we live in a broken, fallen world, where this type of suffering and loss is a constant reality.  Our choice is to succumb to the darkness, or numb ourselves to it, or, on the other hand, to embrace and be the light the world so desperately needs.

Through a long searching journey, I’ve come to believe that the outlandish story told in the bible is true:  that there is a God, that He created and loves us, and took on earthly existence so He could enter history and redeem this world.  His entrance into space and time set up an irreconcilable conflict, between darkness and light.

The Bible says “the whole world lies in the power of evil” (1 John 5:19).  That’s a dismal thought.  We live in a world ruled by evil, so what’s the point of striving for goodness, for light, for an end to suffering?  If we live in North Korea, what is the point of resisting Kim Jong Un?  If we live in a world dominated by materialism, what is the point in living simply?  If children get sick and die before they can enjoy life, what is the point in expending tremendous time, energy, and money to try to save just one child?

The point is this:  the battle is a worthy one, and we don’t fight alone.

The Gospel of John begins with this poem:

“In the beginning was the Word, and the Word was with God, and the Word was God.

He was in the beginning with God.

All things were made through him, and without him was not anything made that was made.

In him was life, and the life was the light of men.

The light shines in the darkness, and the darkness has not overcome it.”

“The Word”, in Greek, Logos, refers to Christ, and is the root word of logic, or order.  So you could paraphrase this poem to read, “In the beginning was order…”  So the Christian world view is that this world is meant for order, not chaos.  Health, not suffering.  Peace, not violence.  Relationship, not isolation.  Christ came into the world as the light, and the darkness cannot, and will not, overcome it.

The good news is that we get to choose sides, choose our commanding officer.  As the great Canadian sage (and lead singer of Rush) Geddy Lee said, “If you choose not to decide, you still have made a choice.”  CS Lewis, former atheist and one of the great theologians of the twentieth century, described it as “Enemy-occupied territory—that is what this world is. Christianity is the story of how the rightful king has landed, you might say landed in disguise, and is calling us to take part in a great campaign of sabotage.”

By choosing the light, by choosing to be servants of “the rightful king”, our puny efforts become part of a larger effort to make this suffering world a little more like the kingdom of order it was created to be.

So how does Jonah fit into all of this?  Is it God’s will that innocent children suffer and die?

I don’t believe so.   I don’t think I’d much like a father who’s plan included the suffering of his children.  Rather, I believe our Father loves us so much he gave us choice, allows us to reject Him, allows the human race to choose pride and this broken world over servant-hood in His kingdom.  But like any loving father, he looks for opportunities to intervene in our suffering to spread His light despite the darkness of this world.

So if I am to believe in this God, I have to believe that He suffered with Jonah, and with Jonah’s mother, as Jonah became sick and died.  That he loves us so much he came into our world to suffer with us.  Compassion:  com-with, passio-suffer:  to suffer with.  I believe God suffers with us, shows compassion for us, as the darkness descends.  And one of the ways He shows compassion is to find ways to shine light in the darkest of moments.

Jonah’s life touched thousands of lives.  So many people have themselves responded with compassion, with prayers, with support, and with donations so generous that many others have been able to be treated at Kijabe.  Here is a statement of some of the very poor patients who came to Kijabe for care, and had their bills simply written off by compassionate donations to the vulnerable orthopedic patient fund, all because of one six year old boy.

A list of patients helped by the vulnerable patient fund:  over one million shillings!

A list of patients helped by the vulnerable patient fund: over one million shillings!

 

One of those being helped by the Vulnerable Patient Fund is Ben Moyie.  “Moyie” (moy-yeah) is Ben’s name, but also a swahili outcry of grief.  I don’t know why he was named this, but it sadly portrays his life.  Ben grew up in an area well known for demonic practices, with an alcoholic father, in abject poverty.  He noticed a mass on his left thigh when he was about 12 years old. His family background made it very difficult to get to a doctor.  He was eventually seen, and had a biopsy, which showed a benign tumor of his femur, or thigh bone.  This continued to grow, and he again had a biopsy done two years ago.  The tumor was very large now, but again the biopsy was benign, or non-cancerous.  Because of the size of the tumor, he was advised to have it removed.  This was far beyond the means of his family, so he did not have the surgery.  When the pain became intolerable at age 18, he finally appeared at Kijabe, alone, ten hours bus ride from his home near the Indian Ocean.  The tumor was shockingly large, making removal very difficult.

Ben's leg with large tumor

Ben’s leg with large tumor

Tragically, by this time, it had transformed into a highly malignant tumor known as osteosarcoma.  The only hope for a cure was amputation, through the hip joint.

Understandably, Ben fell into despair at this news.  He asked to be sent home to die.  He withdrew, refused to speak.  The team of doctors and chaplains came again and again to his bedside to pray with him, to talk with him, to suffer with him.

Ann noticed that he had only one light shirt, with holes all over it.  The nights at Kijabe are cold, and the hospital has no heating.  Ann gave him one of her sweatshirts from the Justice Conference to keep him warm at night.

Ben Moyie after surgery, warm in his Justice Conference hoodie

Ben Moyie after surgery, warm in his Justice Conference hoodie

Amazingly, this somehow turned a switch in Ben.  He felt loved, he knew he mattered, he saw a ray of light.  He decided he was through with being sick, being in pain, being hopeless, and asked that we go ahead with the amputation.

Ben has been in the hospital since January, is now healed from his amputation and hoping he can be fit with a prosthesis.  He’s now 19 years old and hopes for as normal a life as possible.  Despite the size of the tumor, there is no sign that it has spread outside of the leg, so we pray for a complete healing.

To be able to walk, Ben will need a very special prosthesis, one rarely made in sub-Saharan Africa.  A prosthesis  that fits onto his pelvis, with two artificial joints.  I’ve talked to the prosthetic specialists here at Kijabe, and they are up for the challenge.  With donated artificial joints, the leg can be made for about $3,000, a fraction of what it would cost in the US.  Even this reduced amount, however, would represent about four years income to Ben’s family.  They would have to sell their ancestral land to buy the leg.

I would like to invite you to donate to the Kijabe Orthopaedic Vulnerable Patients’ Fund.  Our church has created a secure giving platform which allows you to make a US tax-deductible donation to help Ben and others like him.  There’s no middle man, no administrative cost, your donation goes into an account, and then directly to the patient’s bill.  If you are moved to help Ben, you can use the link below to make your donation.  You can “Pay as a guest”, and select “Orthopaedic Vulnerable Patient’s Fund”, and we’ll put your donation to work immediately.

 

https://public.serviceu.com/PaymentForm/9555/?OrgKey=a55524e4-734a-4e10-beb4-66cc087f7988&RN=1559016137&SGUID=cc96ee30-a730-4ba5-8c41-acb32faa4d15&RN=1926419137

 

Thanks for showing compassion, for “suffering with” these most vulnerable men, women, and children.

 

 

 

 

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Save The Date!

No, we are NOT renewing our wedding vows (!!), rather we are returning to the US for a few weeks this summer!  Our organization (now called Serge) encourages us to take this time as ‘Home Leave Assignment’…to catch up with family, friends and supporters…to talk about the work we are doing here…to cultivate relationships…to re-energize…to spend quality time with loved ones…to be filled up…

I would add to that list, to eat out in nice restaurants…grab a take away coffee at any point during the day…go to the cinema…and of course, partake in happy hours!

It has kind of crept up on us, to be honest.  It’s hard to believe that we left Bend, Oregon, almost two years ago.  In ways, it feels as if we have been here for years!

We leave Kenya towards the end of the last school term (June 29th) and fly directly to Michigan.  Not only is this Mike’s home, but it continues to be closely linked with Kijabe, Kenya.  We had dinner last night with the Meads, who lived here for almost 15 years, and worked at the CURE hospital, in Kijabe. Tim and Jana are both from Michigan, and Tim’s brother, Dale, was one of Mike’s teachers in his residency program.  Most of the short-term ortho doctors who have come to Kijabe in the last 2 years have been from Michigan too.  So, we get to have a “Kijabe reunion” in Michigan this summer, visit Mike’s home town of Midland where he grew up, reconnect with Mike’s old friends (none of whom I have ever met and have a hard time believing that they actually exist!) and Mike gets to give a lecture on Global Surgery at his old residency.

From there, we head to New Buffalo for a week of chaotic, brilliant, fun-filled ‘Marapolooza’ family time!  Mike has five sisters (no brothers) all of whom are married with kids.  Every three years we try to get together as each family is spread out over the US, and now Kenya.  There is nothing quite like that time together… the cousins have a ball, the adults catch up, reminisce  and laugh, and dinners are made and served to the masses!  We love it!

We arrive in Bend on July 19th!  Our good friend, Laura Wytsma, has graciously offered us the use of her house and car, for the duration of our stay there.  What a huge blessing!  Amidst all the chaos of meeting up with family and friends, it will be good to have some ‘family space’ for ourselves also.  We will be sharing at Antioch on July 27th, and have rented Aspen Hall (where we also had our farewell) on August 8th.  We wanted a time whereby all of our friends, family and supporters could come and mingle, learn more about our work at Kijabe, and be made aware of the incredible community of people that have supported us on this crazy adventure.  It’s a time for Mike and I to be able to thank each and everyone of this community for their invaluable love, prayers, and support.  We can pretty much guarantee that we would have never made it this far without their encouragement and belief in the work we are doing.  We also want to be able to show people photos of Kijabe, tell stories about patients, and communicate the triumphs and the struggles we have experienced along the way.

So, if you are in Central Oregon, please come and join us on August 8th – we’ll provide drinks and meat and ask that you bring a side dish or dessert to share.  Come along after work, bring the kids, grab some food, and have an opportunity to learn about our work, ask questions, and give us hugs!

We cannot wait to see you all.

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Hope

As we’re closing in on the end of the second year since we left Bend, some things are starting to seem normal which probably shouldn’t.  While many Kenyans in and around Nairobi or other large cities lead lives similar to people in the US or Europe, far more live in rural areas with little access to health care.  As a result, we see things at Kijabe that are unimaginable in the western world.  And sometimes I forget what a shining star, what a ray of hope, Kijabe represents.  There are times when I feel overwhelmed by the need, and feel hopeless myself.  But what always brings me back to enthusiasm are meeting patients whose lives are changed by this little hospital.

Yesterday, we operated on one patient, all day.  The main road to Kijabe is called the Nairobi-Nakuru highway.  It was recently listed by a British firm as one of the 22 deadliest stretches of road in the world. 

Poor road conditions, insane passing maneuvers, huge trucks, overcrowded buses,  motorcycles, pedestrians, goats, cattle, donkeys, and the occasional baboon all combine for an experience that would be comical if it weren’t so deadly.

There’s a surprisingly sharp turn on this highway, near the city of Nakuru, about 80 miles north of here.  About two years ago, a large fuel tanker lost its breaks, slammed into oncoming traffic, killing many.  The truck then began leaking fuel.  As local villagers rushed to gather the valuable fuel, it burst into flame, incinerating many more.  Unbelievably, this just happened again.  This time the truck exploded immediately, so no crowd had gathered, so I guess that’s a horrible silver lining.  Fewer people were burned this time.  The local hospitals were quickly overwhelmed, both by the number and seriousness of the injuries, so Kijabe received some of the most severely injured.

The first patient we treated was a 46 year old woman, Jane, who’s legs were severely crushed.  She was awake and alert, but in incredible pain.  Examination of her legs showed they were both dead, and her crashing vital signs showed that the acid and potassium leaking into her body from the dead legs was quickly causing her heart and other organs to fail.  As she was on a ventilator, with a breathing tube, she couldn’t give informed consent for surgery.  I phoned her brother on his mobile, letting him know the gravity of the situation.   We rushed her to surgery for emergency amputation of both legs, but to no avail.  She succumbed to her overwhelming injuries a few hours later in our humble intensive care unit.

Another victim, Jacob, had injuries which seemed incompatible with life.  He had shattered all four of his limbs, including both femurs (thigh bones).

Both Femurs Fractured

Both Femurs Fractured

His forearm bones on the right were sticking out through the skin.  His left wrist was broken.  His right ankle was dislocated and crushed, and most of the bones in both feet were crushed.  He had second degree burns from the mid-shin down to the toes.  His rib cage had been crushed, with fractured ribs on both sides and a chest xray that showed his lungs were bruised and filling with fluid.

left femur fracture

left femur fracture

open forearm fracture

open forearm fracture

skull, wrist, and foot xrays

skull, wrist, and foot xrays

Burned and Broken Ankle

Burned and Broken Ankle

crushed and burned ankle

crushed and burned ankle

right femur fracture

right femur fracture

Keeping Jacob alive would be a challenge at the best university hospital in the US or Europe.  And this is where Kijabe is beyond belief.  Using patched together instruments, donated ventilators and surgical equipment, patients like Jacob are routinely given state of the art trauma care.  We were allowed a brief surgery to stabilize the most urgent problems, and the patient was then whisked to the ICU to support his breathing, blood pressure, receive transfusions, and pain control.  Several days later, we were given the go-ahead to complete his trauma surgery.  He entered the operating room at 8 am as a shattered person, and was wheeled out at five pm, ready to get out of bed.

Everything fixed, ready to get up out of bed!

Everything fixed, ready to get up out of bed!

The amount of teamwork this requires is beyond description.  I’ve seen shows on TV where surgical teams rehearse complicated surgeries ahead of time.  None of that happens here.  When the situation calls for it, everyone just shows up, does her or his job without fanfare, and gives the patient hope for a decent life.

Amazing Anesthesia Team

Amazing Anesthesia Team

Today in clinic, one of the clinical officers from the outpatient department came in with an xray, to ask us about a child she was seeing.  Eight year old Samuel and his mother had been sent to Kijabe to have his leg amputated.  He’d been seen at a large national hospital a few months ago with leg pain, and sent away with pain killers.  A few weeks later, the main bone between the knee and ankle protruded out of his skin.  He’d been living like this for several months, before being seen at another hospital, which referred him to Kijabe for amputation.

I reviewed the xray with a junior orthopaedic resident,

Protruding bone due to osteomyelitis

Protruding bone due to osteomyelitis

who I asked to describe the findings and make the diagnosis from the xray.  He did well, answering correctly that this was chronic osteomyelitis, a deep infection of the bone frequently seen in malnourished children.  As the infection worsens, parts of the bone die, and then migrate out of the skin until they fall out.

I was grinning from ear to ear, both because the resident was doing well, and because I knew that Samuel did not need an amputation.  We rushed over to the outpatient department to meet Samuel and his mother.  As we entered the room, we were greeted by the familiar stench of infected, dead tissue.

I carefully explained to Samuel and his mother that, though he would not need an amputation, he had a long road ahead of him.  With good nutrition, several surgeries,  and months of antibiotics, this can almost always be cured or brought under excellent control.  Children who have been ostracized and unable to attend school can have a decent life, can have hope.

I then asked the resident to perform a “sequestrectomy”, or remove the dead bone.  This is usually a large surgery, done under general anesthetic.  However, with Samuel’s bone sticking out through the skin, there was no reason not to remove this part of it immediately.  As the tissue is dead, there is no sensation.  With some hesitation, the resident put on gloves, and tentatively gave the exposed bone a pull and a twist.

protruding dead bone

protruding dead bone

Dr. Nyambati's first sequestrectomy!

Dr. Nyambati’s first sequestrectomy!

Bone Removed

Bone Removed

To his, and Samuel’s amazement, the dead bone eased out of the infected leg.  It took a bit of convincing, but Samuel eventually understood that he was going to keep his leg!

Samuel after "sequestrectomy"

Samuel after “sequestrectomy”

Hope.

For Jane and her family, we failed.  But they know, and they told us, that we did everything we could for her.  In Kenya, that means a lot.  They know we really cared about her, talked to her before surgery, suffered a little with her.  They are grateful for what we did, even though we feel we failed.  I guess that gives me hope.  For Jacob and Samuel, conditions which would frequently be crippling or fatal can be treated.   They can both have hope for a good life.  And all of these people come to Kijabe because this rather small, nondescript building on the side of a muddy escarpment means hope.  Probably the hardest part of living and working here, both for Ann and myself, is swinging between despair at the overwhelming suffering, and gratefulness to be a part of something so amazing.  As always, thank you for being here with us, supporting us and praying for us.

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