The New Normal

A little less than three years ago, the Mara family drove away from our house in Bend, Oregon, with a mixture of excitement, fear, sadness, and anticipation.  Ann and I had lived there our entire married lives, brought our newborn babies in through the front door, and we shared a little fear that we would never feel quite as “at home” again.  As I walked to work this morning, however, I realized we now have a new normal.  Things which would have seemed bizarre, exotic, or even frightening three years ago now simply add to the richness of life here.  Over the last three years, we have experienced close encounters of the best kind:

Murit, Jane's adopted baby elephant.

Murit, Jane’s adopted baby elephant.

Michael and Jane with two new friends

Michael and Jane with two new friends

Simba and her litter

Simba and her litter

We have become patients ourselves:

Prayers for Jane with her surgeon and anesthesiologist

Prayers for Jane with her surgeon/dad  and anesthesiologist Dr. Newton

Ann, very stoic as she gets an IV in casualty.

Ann, very stoic as she gets an IV in casualty.

Mike going in for the first of his two surgeries at Kijabe.

Mike going in for the first of his two surgeries at Kijabe.

My friends and I have had multiple bike wrecks:

My friend Andy:

My friend Andy: “I feel cold. Tell my wife I love her” (He had sprained his shoulder)

Adam attracts a crowd after his bike disintegrated beneath him.

Adam attracts a crowd after his bike disintegrated beneath him.

We’ve gotten used to driving three hours round trip for groceries, not being able to understand most conversations around us, and sometimes feeling like a novelty or curiosity.  Happily, we also feel embraced by a culture which values time spent face to face, gentle suggestions over confrontation, and family life over consumerism.  I’m slowly learning that relationship is more important than achievement, love more important than efficiency, and compassion more important than titles or degrees.

Sadly, the most constant rhythm of life at Kijabe is the incessant flow of very sick and badly injured patients.  Some of these patients are too injured, or come to the hospital too late, for us to be able to give them a good outcome.  But the thing that amazes me the most about Kijabe Hospital, is how miracles happen on a weekly basis.  I’d like to tell you about two recent patients that demonstrate this.

Ahmed broke his leg when he was struck by a passing “piki piki” (motorcycle) in a remote and lawless area of Kenya.  With no access to health care, Ahmed’s family did the best they could, taking him to a local bonesetter.  He was quite malnourished at the time of injury, and the forced bedrest in his hut led to huge ulcers, bedsores, which covered his back side and injured leg.

When Ahmed was finally brought to Kijabe, he was semi-conscious, with foul smelling pus and bodily fluids contaminating his wounds.  He was in marked pain, with his unstable fracture allowing his damaged leg to flop around during the long car ride over bumpy roads.

I must admit, when I first saw Ahmed, I wasn’t sure he would survive, and I even wondered briefly if the most merciful thing would be if he passed away quickly.  But of course, that’s not why we’re here.  A team of compassionate nurses, pediatricians, pediatric surgeons, plastic surgeon, and orthopaedics took him under their wing.  Intensive nursing care helped heal his wounds and improve his nutrition.  Hospital chaplains came and poured love and prayers over Ahmed and his family.  The paediatric surgeons performed a colostomy to avoid his wounds being soiled by bodily fluids.  And our talented plastic surgeon managed finally to close the gaping wounds in his leg and buttocks.

Due to the gross contamination of Ahmed’s wounds, we could not risk operating to fix his fracture.  But due to his huge wounds, treating him in traction would worsen his life-threatening bed sores.  The solution was unusual, but we placed him in traction after rolling him onto his stomach.  For four weeks, he had to lie on his stomach while his femur and wounds slowly improved.

And then, remarkably, he was healed.  And several weeks later, he walked into clinic!

Ahmed, gravely ill, and now walking under his own power!

Ahmed, gravely ill, and now walking under his own power!

I didn’t recognize him.  He wasn’t even limping.  Instead of the poor, dying, semiconscious, badly infected patient, he was a happy, energetic, funny young man.

Some things can never be the “new normal.”  Joyce’s story is one of those situations.  Last week, in the midst of our busy orthopaedic clinic, with 90 patients waiting to be seen, one of the clinical officers came over from “casualty” (the emergency department).  “Dr. Mara, could I show you an MRI scan”  This is a common request, usually patients with back pain who have gotten a scan done in Nairobi and want someone to look at it.  I always ask the clinical officer to describe the patients history and physical exam before we go over the scan, to emphasize that careful history taking and examination are really more important than expensive tests.

“This is a 7 year old girl.  She was healthy until 10 months ago, when her legs became clumsy.  Then she became paralyzed.  She hasn’t been able to walk for five months.  Now she can’t move her arms or legs.  And since this morning, she’s having trouble breathing.”  A quick glance at the MRI scan in the CO’s hand showed an extremely rare condition which is fatal if not treated.  Due to a birth defect in her upper spine, her head was not properly attached to her neck.

Joyce's MRI, showing severe compression of the spinal cord

Joyce’s MRI, showing severe compression of the spinal cord

This creates instability which had progressed to the point where her spinal cord was severely compressed at the base of her skull, at the junction between her spinal cord and her brain stem.  We ran over to casualty.

Over the last months, the spinal cord damage had progressed to paralyze her legs, then her arms, and finally, that morning, was beginning to paralyze the muscles which allowed her to breathe.  She was within hours of dying from respiratory arrest.  We put her on oxygen, and I ran back to clinic to get Dr. Muchiri, our spine specialist.

We left 90 patients waiting in clinic, to quickly put Joyce in traction.

Joyce lying comfortably with the life-saving traction applied to her head.

Joyce lying comfortably with the life-saving traction applied to her head.

Michael and Jane on their way to visit Joyce.

Michael and Jane on their way to visit Joyce.

This is a medieval-looking but painless procedure, done under local anesthetic, which pulls the skull away from the damaged spinal cord and allows healing to begin.  Within minutes, her breathing improved, and she required less oxygen.  Dr. Muchiri and I were breathing a little easier too.

I came home from work that night and shared Joyce’s story with Michael and Jane.  Without hesitation, they adopted her, and decided they needed me to take them to the hospital that night.  Michael went and got a favorite blanket he’s had since he was an infant, and Jane collected a stuffed bunny, an embroidered pillow, a story book, and another blanket.  We went to the children’s ward, prayed for Joyce and her mother, and delivered the gifts.

Joyce, a little scared, but comfortable, and awaiting her life-changing surgery.

Joyce, a little scared, but comfortable, and awaiting her life-changing surgery.

This past Monday, Dr. Muchiri and our neurosurgeon combined their considerable skills to decompress and stabilize Joyce’s spine.  This involved removing some of the bone from the upper spine, and base of the skull, and then using metal plates and screws to fix her skull solidly to her neck.

Joyce is now able to move her arms and legs!  She has a long way to go, but there is every chance she will be able to walk and use her arms normally again.  Children have such amazing powers of healing, and the care she got at Kijabe Hospital has given her the best chance possible for a full life.

Our new normal involves some challenges, but also allows us to witness miracles like Ahmed and Joyce on a regular basis.  As a family, we feel incredibly fortunate to be part of showing God’s love to the thousands of people who come to Kijabe.


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5 thoughts on “The New Normal

  1. Colleen

    You got me crying on this one. Joy. Been a challenging, rough week here in safe, privileged southern Oregon, and your stories are so uplifting to hear of God working miracles for these beautiful people through you and the Kijabe team. And it swells my heart to be able to picture Michael’s and Jane’s hearts bursting with love and compassion, and putting it into action for others. God bless each of you in Kijabe, and especially, you, Ann, Monkey and Jumps. xoxo

  2. Kern Reynolds

    You’re doing great work Mike…..very proud of you.

  3. Lynda Corbin

    Mike, you and your team just amaze me. We think we have some hellish feats with which to deal, but what you’re doing puts everything in prospective. Much love and many blessings to you and yours. Lynda

  4. Andrea Walker

    Golly, I love this. I’m grateful for your hard work and compassion, which you have so blessedly passed on to your beautiful children. Thank you for sharing. 🙂

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