Posts Tagged With: kenya

Difficult Discussions: Flunking Sainthood Day 24

Busy day in surgery today, as well as seeing consults between cases.  The surgeries went fine, but what was really hanging over the orthopaedic resident and I today was a discussion we needed to have with a patient and his family.  Last week, we worked hard to save the life of the man who had a terrible injury to his pelvis and leg.  You might remember a photograph of a mangled leg accompanied by warnings not to look if you would find it disturbing.

Thankfully, he has stabilized.  He has gone from the intensive care unit, to the intermediate care unit, and today was able to transfer to the regular men’s ward.  His blood pressure has stabilized, and we have been taking him to surgery every two or three days to clean out his wounds, and remove damaged tissue.

The leg is teetering on the edge of being salvageable.  The bones and muscles are so damaged that he has little hope of a well-functioning limb.  Though his hip, knee, and ankle are fine, the areas in between are mostly devoid of functioning muscle, and severely fractured.  We have had discussions with him over the last days, but wanted to have a family care conference today so everyone was on the same page.

His social situation is far more complex than I could have imagined.  He is an orphan.  Both his mother and father have died, but we did not discuss how they died.  His father had three wives, two of whom are still living, so we had the discussion with a dizzying array of uncles, in addition to his brother and older sister.  Decision making authority rests with the patient, as he is lucid and capable of making his own choices.  Kenya has a strongly family-oriented culture, however, so group discussions and consensus building are vital.

The relatives strongly recognize that they may be held accountable by other family members for medical decisions, so they made it clear that they would abide by “whatever the doctors decide.”  This puts a little too much authority in our hands, however, as the final decision needs to be up to the patient.

Thankfully, the family had outstanding English skills, and communication skills in general, and the Kenyan resident I’m working with filled in my language and cultural blind spots.  We had a long and intricate discussion, and each person voiced his perspective and concerns.  I’ve been in discussions like this a number of times, and I’m often struck by the patience, careful listening, and gentle pace of the dialogue.  It is vital for the health care providers to understand the depth and breadth of implications of decisions like this.  In the end, we met privately with the patient, who was markedly comforted by the group consensus.  We discussed his options again, prayed with him, and he expressed his decision.

The plan is to do everything we can to save his leg, regardless of cost, number of surgeries, or length of treatment.  If at any point we feel like the endeavor is hopeless, or is putting his life at risk, we will communicate this with the patient and with the family.

For this man, I think this is the best decision.  If things go well, his leg will work a little better than a prosthesis would.  Moreover, his psychological and social situation would make amputation an unusually devastating blow.  He and his extended family realize that this is a real possibility, but they would all rest easier with this decision knowing that every effort had been made.  Remarkably, one of the uncles present is on a disability awareness council, and repeated the mantra that “disability doesn’t mean no ability.”  He is encouraging his nephew that, regardless if he winds up with an amputation or not, he can continue with a productive life.

I feel privileged, if also saddened, to be part of discussions like this.  Kenya is a country with a high incidence of motor vehicle violence, and few doctors to treat the suffering.  We may or may not succeed in saving this man’s leg, but I am pleased that he knows he is cared for by his family and by the staff here at Kijabe.

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French Toast and Trauma: Warning, Disturbing Image

Weekends are hard to predict around here.

I’m on trauma call for the hospital, so I need to stay close to home and close to my phone.  But beyond that, life goes on as usual.  Saturdays and Sunday are great family days, we try to sleep in, make coffee, and I’m on breakfast duty.

Saturday morning French Toast, Bacon, and Hot Coffee

Saturday morning French Toast, Bacon, and Hot Coffee

The kids get “screen time”:  Finding Nemo for Jane, Minecraft or reading books for Michael.  It’s the cold and rainy season, so a roaring fire and fuzzy PJ’s are mandatory.

Contented and Cozy

Content and Cozy

It’s great not having to rush off somewhere or have anything to do.  I make my way down to the hospital storage room to organize some donated equipment and get rid of a huge pile of useless junk.

The kids have friends within walking distance, RVA has high school rugby games to go watch, and dinner plans with great friends round out a perfect Saturday.  A peaceful start to the weekend.

Organizing the Store Room

Organizing the Store Room

Sunday is another story.  My phone jars me out of a sound sleep, the screen tells me it is the ortho resident calling.  I don’t really know what time it is, I just know it’s dark.

“28 year old guy on a piki (motorcycle), hit by a bus about 4 o’clock this morning.  Pelvic fracture, bad open floating knee.  Has had 4 units of blood, his BP is 100/50, and we’re on our way to theatre. His Hemoglobin level is 5 after the third unit of blood”  To translate, this man is bleeding to death, he has already lost at least two thirds of his blood volume.  Only healthy young people survive such blood loss, but they can die very quickly once their ability to compensate is overwhelmed.

Okay, I’m awake now.  I volley back some questions:  is the pelvic fracture stabilized with a binder, does he have two IV’s flowing wide open,  is more blood available, is he alert, can you feel a pulse in his leg, have antibiotics been started, has he gotten a tetanus shot, any chest or abdominal trauma, has his c-spine been cleared?

Yes, yes, yes, yes….The systems have worked, protocols have been followed, and this young man is going to have the best chance he can at survival and keeping his leg.  I’d like to repeat that sentence 10 more times, because it is amazing.  At this little hospital clinging to a muddy hillside in rural Kenya, this patient is receiving world class trauma care.  This is all down to the excellent work of the junior residents who met this man in the emergency department.  We don’t have a sophisticated lab to know his acid-base balance, we don’t have invasive monitoring to know his exact fluid resuscitation status, but within our abilities, every possible thing has been done, and is being done, to save this man’s life and limb.  In medical parlance, we move into “damage control” surgery.

The goal of damage control surgery is to stabilize the patient, quickly clean wounds, stop bleeding, and  get him into the expert hands of the intensive care unit doctors.  Damage control does not involve meticulous repair of wounds or fractures, just quickly trying to move him out of a life-threatening situation.

I gulp down a cup of instant coffee to clear my head and walk into the pink sky of the breaking dawn and down to the operating room.  The patient is just being wheeled into theatre, and I introduce myself and talk to him, in as reassuring tones as I can, about his injuries.  I’ve had more than one patient here with these same injuries never wake up from surgery, but he doesn’t need to know that right now.  “Your blood pressure has stabilized, things are looking good, we’re going to clean up your wounds and begin stabilizing your broken bones.”

With that, the nurse anesthetist gets him off to sleep while we stabilize his neck.  He hasn’t yet gotten an Xray of his neck, and has no pain there, but could easily have a broken neck and not know it.  The pelvic and limb fractures are painful enough to mask the pain of other injuries, so we always assume the spine is broken until proven otherwise.

The leg looks bad.  The thigh bone (femur) is broken and sticking out the front.  A large segment of the tibia bone is missing beneath the knee, and there is a clot of blood behind the knee.  Through my gloves, I can feel a pulse behind his knee, so we know the main artery to his leg is intact.  With a doppler probe, we can see that he has good blood supply to his foot.  So the leg is probably salvageable. But that clot behind the knee looks ominous.  We leave it alone, to be looked at more carefully a bit later.   Before he went to sleep, we had tested his ability to move and feel his toes, and this was normal.  Some reasons for optimism.  But the clot worries me.

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Floating Knee:  Open Fractures of the Femur and Tibia

Floating Knee: Open Fractures of the Femur and Tibia

We wash debris, paint chips, gravel, sand, and pieces of his trousers out of the wounds.  The fractured ends of the bones are tattooed blue from the paint on the bumper of the bus.  We meticulously clean everything, excising dead tissue, until the wounds look clean.  The residents and I install an external fixator, a stabilizing device which uses pins inserted into the bone to attach to a carbon graphite frame.  This can be applied in a matter of minutes, from his upper thigh to just above the ankle, to provide some stability to the leg.

The patient is getting cold.  Hypothermia, or below normal body temperature, is a common and ominous sign in severe trauma.  We get hot water bottles and blankets to cover every square inch of the patient that is not being operated on.  A cold patient can have severe metabolic disruption, including losing the ability to clot his blood.  This can be irreversible and fatal in a severely injured patient.  We turn the room temperature up to 86 degrees Fahrenheit.  While garbed in hats, masks, gowns, and lead vests, this becomes very uncomfortable, but is standard trauma protocol.

The wounds are clean, the fractures stabilized, and now it is time to go back and look at that clot.  I carefully place retractors to hold the surrounding tissues out of the way, and gently remove the clotted blood.  Before the case started, I had insisted that everyone in the room was wearing eye protection.  And this was why.  As I removed the clot, bright red blood began spraying out of the wound.  We had found the reason his hemoglobin blood levels were so low.  As the bumper of the bus hit his leg, one of the bone fragments had torn a hole in an artery in the back of his leg.  Gentle fingertip pressure stopped the bleeding, and we called for the talented general surgeon, Dr. Jack Baraza.

Jack was waiting in the wings, and quickly arrived to calmly explore the vascular injury.  There are three vessels which supply blood to the lower leg, and two were still intact.  So the repair was a simple matter of isolating and tying sutures around the offending blood vessel.  We rechecked the blood supply to the foot, and after a few tense moments, were rewarded with pink toes and a visible pulse on the doppler ultrasound screen.

Dr. Baraza checking the blood supply to the foot

Dr. Baraza checking the blood supply to the foot

Thick dressings are applied, a plaster splint reinforces the external fixator, some other wounds are quickly sutured, and the patient is ready for transport to the ICU.  He has a long and difficult struggle ahead of him.  The next 48 hours will show us how much reserve he has left.  As he stabilizes, we can begin to plan reconstructive surgeries to fix his pelvic and femur fractures, and restore the bone missing from his leg.

I walk back home to an empty house.  Ann and the kids are enjoying Mother’s Day by going on a hike at Crescent Island with some friends, so I have some breakfast and get ready for a nap.

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Of Fibonacci, Logos, and Chaos: a Theology of Surgery

I believe our world is broken.

I believe our reality includes suffering, chaos, loss, and death.

I believe it wasn’t meant to be this way.

Turning and turning in the widening gyre
    The falcon cannot hear the falconer;
    Things fall apart; the centre cannot hold;
    Mere anarchy is loosed upon the world,
    The blood-dimmed tide is loosed, and everywhere
    The ceremony of innocence is drowned;
    The best lack all conviction, while the worst
    Are full of passionate intensity.

WB Yeats “The Second Coming”

Anarchy is loosed upon the world.  As in every age, this age seems ruled by the headlines.  ISIS, Leukemia, divorce, war.

Partisan hatred, global warming, spiraling health costs, corrupt institutions.

Young men so devoid of purpose they grasp at fundamentalist straws.  Crowded cities conceal suicidal loneliness.  Young women defined by ad agencies, dying to be thin.

Those south of the equator dying from too little food, those north of it from too much.

I believe it wasn’t meant to be this way.

The falcon spins away from the falconer in the widening gyre.  Society, decency, kindness, gentleness, overwhelmed by division, violence, hatred, ignorance.

But I believe it wasn’t meant to be this way, and Yeats catches himself in a contradiction.  The falcon turns away in an ever widening gyre.  Let’s back up a bit.  A gyre is a spiral, extended into space in three dimensions.  A gyre has structure, mathematical perfection, elegance.  A gyre is the opposite of anarchy.

If we look at the falcons’s gyre, or the arrangement of petals on a flower, or the shell of a chambered nautilus, we find a numerically perfect order, or logic, which in mathematics is called the Golden Proportions.Fibona52  Fibona50 Fibona51

The golden proportions are defined by a simple series of numbers:  0 1 1 2 3 5 8 13 21 34 55 89…..  Add two numbers together, and it creates the next number in the sequence.  This series of numbers is called the Fibonacci sequence.  Divide any number by the number before it, and the result comes out approximating an infinitely long number that starts with 1.618033988749894848204586834.  This number is the golden proportion.  The further out you go in the sequence, the closer the ratio comes to the golden proportion.

What does the golden proportion have to do with chaos, a broken world, and surgery?

It turns out, the Fibonacci sequence and resulting golden proportion are more than a mathematical curiosity.  If we look to nature, we find this order, this organizing principle, everywhere.  Subatomic particles arrange themselves according to the golden ratio.  Galaxies rotate in values proportional to the Fibonacci sequence.  Plant leaves arrange themselves, nautilus shells spiral, pine cones, roses and sunflowers all dance to the music of tFibona48he golden proportion.  Computer programs and search engines rely on the Fibonacci sequence.  Most remarkably for me, the length of the bones in our hands follows a Fibonacci sequence, so as we make a fist, we echo the grace of the spiraling nautilus shell.

The bones of the hand describe a Fibonacci sequence

The bones of the hand describe a Fibonacci sequence

So the falcon, even as he ascends away from the falconer, even as things fall apart, describes an arc which betrays the underlying grace and structure of his being.

How can this be?  How can this world of chaos reveal an underlying structure, an underlying organizing principle?

I believe a clue to this mathematical marvel can be found in the Bible:

In the beginning was the Word, and the Word was with God, and the Word was God.  He was with God in the beginning.  Through him all things were made; without him nothing was made that has been made.  In him was life, and that life was the light of all mankind.  The light shines in the darkness, and the darkness has not overcome it.

This beautiful poem was originally written in Greek, and is the opening verse of the Gospel of John.  The word “word” was originally written as the Greek word “logos.”  We don’t have an exact translation of “logos” into English, but it is the word from which we get logic.  The idea of logos is structure, order, the premise upon which everything else follows.

You’ll notice that the opening verse of this poem is identical to the opening of the Hebrew book of Genesis, the opening words of the Bible:  “In the beginning…”

This puts us intentionally at the beginning of time, the beginning of existence, physicists would say at the moment of the big bang.  And the author of the Gospel of John tells us that God was there, in the form of order, in the form of an organizing principle, in the vibration and spin of the subatomic particles that would give rise to galaxies, stars, planets, earth, and life.

The Logos was there at the beginning, and the darkness has not overcome it.  The falcon’s gyre is ever widening, he cannot hear the falconer, but even in his betrayal, he cannot escape the inherent order of his being as he ascends in a graceful spiral.  This world was created, by whatever means you may believe, but I believe it was created for order.

The Jewish and Christian faiths share what anthropologists call their “creation myth.”  Myth in this sense is a technical term which means a story of ancient and important truth.  We tend to use the term to mean untrue, mythical, like bigfoot.  But anthropologist recognize that creation myths hold great truth for their culture.

The Judeo-Christian creation myth began as an oral tradition, and was eventually written down as the book of Genesis.  Christians believe it is inspired revelation, and there are various interpretations as to how it should be read.  Regardless of interpretation, we see a world created in Logos, in order, in perfection.  Only when mankind chose pride, knowledge, and power over kinship with the Logos did things fall apart, and mere anarchy was loosed upon the world. 

So I believe our world is broken.  It was created for logos, for order, for perfection, for shalom.  But separation from the Logos, the creator, leaves us with mere anarchy.

This would all seem a bit dark, but for one thing.  Christians also believe that the Logos, the organizing principle of the universe, returned, and entered human history, entered time and space, as a human being.  He entered this world of anarchy, and by perfect Logos, perfect order entering this world, he redeemed it.  He began the process of restoring it to its rightful state.  He didn’t come only to save souls, to redeem individuals, but to redeem creation itself.

What would this look like, a redeemed creation?  I can’t begin to imagine.  It’s easier for me to imagine what it is not: it is not suffering, it is not loss, it is not loneliness or death, it is not painful separation from our creator.

From the standpoint of a surgeon, a redeemed creation does not include broken femurs, shattered pelvis’, or children with bone infections or incurable tumors.

There is no doubt in my mind that we live in a dark world, but I take hope in the fact that “the light shines in the darkness, and the darkness has not overcome it.”

Yeats stumbles again when he declares that “the best lack all conviction.”  I believe this is precisely where he was wrong, and I believe this is precisely how the darkness cannot overcome the light.  God calls us to be that light, to work with and be part of the Logos, the redemption of this broken world.  He calls us not to lack conviction, but to stand convicted.  To struggle in the chaos,to lose our way, but in our efforts describe the breathtaking spiral of love, compassion and beauty we were created for.

For a surgeon this means working to restore the order of the human body, approximating the way the Logos intended it to be.  It means healing those who can be healed, and comforting those who cannot.  It means teaching others to view their job as their calling, as a priesthood, as a privileged servant-hood allowing us to shine the light of God’s love into the darkness of suffering.  It means being the light to those overcome by the darkness as we cling to the hope of the redeemer, the centre that will always hold.

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The Big Fig

Saturday, a break in the rain, blue skies with serrated clouds, brilliant sunshine.  Time for a hike!  The Big Fig is a famous tree near Kijabe, with huge roots winding through boulders, perched on the edge of a 200 foot drop into a small canyon.  The tree is about an hour’s hike through the bush from Kijabe.  We gather our friends the Heins and Higgins families, load back packs with snacks and water bottles, and head out.  Our first stop is at our friends the Davis’ house, where Rich bluetooths the path from his gps to mine.  Once you’re in the bush, it’s difficult to follow the correct twists and turns to the Big Fig, so now we have satellite navigation!  The Davis’ dog Radar decides to abandon his family and join us on the hike.

The hike down is a little muddy, but the footing is good.  Monkeys stalk us in the trees, giant centipedes wiggle across the trail, black ibis, hawks, and colorful song birds punctuate the walk.  An animal skin on the trail is animated with a lacy white fungus.  The gps takes us straight to the big fig, where we take a welcome break in its  cool shade.

The tree is remarkably large, and precariously set.  Roots more than a foot in diameter snake their way through 10 foot boulders, leaving the trunk hanging out over a precipitous drop.  We herd the kids, all kindergarten to fourth grade, away from the edge so the adults can relax.  Michael and his friend Noah impress each other by getting ever closer to the edge, pretending to slip.  Somehow we don’t find it as funny as they do.

The tree’s rocky home provides comfortable seating as we take our break.

Mara family, On the Edge!

Mara family, On the Edge!

The canyon opens up to farmers fields planted with maize and kale, and lazy cows drift from one field to the next in the valley below.  Red-garbed Masai herders dramatically decorate the lush green vegetation.  Rock hyrax duck in and out, resenting our invasion, and Jane finds an 8 inch lizard.

Heading back up, the heat kicks in, but we make good time and relax in the cool of the house.  Jane heads up to a friend’s house, I make grilled cheese sandwiches for Michael and Noah, and Ann takes Bosco out for a walk.  He’s getting a bit old, and we don’t take him on big steep hikes anymore, but he hates to be left behind.

Tonight, we’re looking forward to having the Higgins family over for dinner.  Meghan is cooking, which is a sure sign of Ann’s friendship with her.  Normally, it takes years before an Irish “mammy” will allow another woman to lift a finger in her kitchen, so they must be tight.  Either that, or Ann is just really sick of cooking dinner every night.

I had the pleasure of running into my good friend, Dan Galat, today.  Dan is my doppelganger at Tenwek hospital, about three hours west of here in Bomet, Kenya.  Dan is an orthopaedic surgeon from the US, who came to Kenya straight out of his residency at the Mayo clinic.  We are twin brothers, both sharing a passion for providing orthopaedic care and teaching Kenyan surgeons.  Dan recently started an orthopaedic surgery residency at Tenwek, and we are finding ways to collaborate for better care and training.

It’s nothing short of miraculous that I can sit here in a muddy little village in Kenya, and be working alongside talented Kenyan surgeons such as Dr.’s Muchiri and Wamae, as well as surgeons from the US.  If defies logic, but you have to get used to that once you quit living on your own power and trust that God will provide what you need, and when you need it.  You might not know what tomorrow will bring, but you can have confidence that God has it covered.  And He never fails!

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What Protestants think about Catholics (Flunking Sainthood: Day 3)

St-Benedict-Ornate-Wall-Crucifix_37949.xjpg

Please share this post as widely as possible, because it relies on audience participation.  At the end, I want you to “comment” and give me some of your thoughts.  Protestants only please:  Catholics, you’ll have your turn.  Please re-blog, post on FB, share anyway you can.  I’m really interested in the feedback.

Growing up in a devout Roman Catholic family, I think it is unlikely that I draw a breath or have a thought in my head not seasoned by my rich upbringing in the Church.  A family of eight, Irish Catholic, all six children’s names from the mother land (Maureen, Shannon, Michael, Sheila, Kathleen, Colleen), all six children attended Catholic grade school and Catholic universities.  Dad was president of the parish council and church historian, mom with a masters degree in theology and another one in adult spiritual development.

The rhythm of our life was mass, the sacraments, prayer, and study.

It’s been years since I attended mass regularly or participated in the sacraments, but the reasons for this are  pragmatic as well as theological.  As a result of our upbringing, Ann and I have both had the opportunity to feel loved and loving, accepted and accepting, in both Catholic and Protestant settings.

I am not oblivious to the fact that some on each side of this divide have strong feelings about the heathens on the far shore, but I have also had the opportunity to see loving, humble servants in each camp.  My gut feeling is that “God”, whatever we make of him, is having a good chuckle at any party that thinks they have Him completely contained in their particular box.

About six times a year, our team here at Kijabe gets together to have a discussion on a Friday night.  One member leads a discussion on a topic of personal interest.  We’ve talked about Islam, spiritual disciplines, and Biblical justice.  The evenings are social, low-key, fun, and interesting.  This Friday, I’ve volunteered to talk about my upbringing in the Catholic church.

My reasons for this are several.  I have fond memories of spiritual mentors, the comfort of liturgy, and unforgettable direct experiences of the divine.  But perhaps more than this, I’ve come to understand that most Protestants’ understanding of Catholicism comes from their Protestant pastors.  These pastors, in turn, get their understanding of Catholicism from their reformation history classes in seminary or bible school.  These classes, in turn, are taught from the perspective of 16th century Church corruption and scandal.  Missing are the counter-reformation, the Council of Trent, true Catholic theology, Vatican I, Vatican II, and the fact that billions of Catholics over the last two millennia have served Christ humbly in the best way they knew how.  Once the cobwebs of the last 500 years are cleared away, the two camps look very much like earnest, truth-seeking followers of Christ.

Here’s where you come in:

I’m looking for open, honest, uncensored, thoughts, questions, opinions, conclusions, and vitriolic diatribes regarding Protestants’ views of Catholics or Catholicism.  Here’s your chance!  If it’s too nasty or profane, I won’t “approve” it to be read on the blog, but my intent is to find out what people are thinking.

To get you started:

Catholics worship Mary, pray to dead people, the Pope is perfect, and you can party all you want on Friday as long as you go to have your sins forgiven by a priest on Saturday.  The whore of Babylon, the Pope as antichrist….

Many, but not all of these ideas have kernels of truth which give them credence, and are great starting points for discussion of commonalities and differences.

Please respond, engage, participate.  And remember Catholics, you’ll have your turn!

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Flunking Sainthood: Day 1….make that Day 2

I just finished reading “Flunking Sainthood”, by Jana Riess.  It’s a pretty light read, documenting this spiritual tourist’s attempt to reproduce one ancient “spiritual discipline” per month, for a year.  Things don’t go as planned, as she tries to emulate a strict Jewish sabbath, practice Benedictine hospitality, tithe, and sit in contemplative prayer. flunkingsainthood But the sum is greater than its parts, as she finishes the year with some wisdom, and humility at how difficult even simple disciplines can be.  I give it two thumbs up, but I’m into this sort of thing.

Her book got me thinking about a practice I used to embrace.  In grade school, we were taught a simple prayer, traced back to the fourth century mystic “desert fathers” of Egypt.  This prayer is still practiced in Eastern Orthodox Christianity, and has recently regained a toe hold in contemplative Christian practice in the west.  How and why a Redemptorist Catholic priest in Midland, Michigan was teaching this powerful practice to 11 year olds in 1975, I can’t imagine.  But it’s stuck with me:  Breathing in: “Lord Jesus Christ;” Breathing Out: “Son of God;” in again: “Have Mercy On;”, final exhalation: “Me a sinner.”  Lather, Rinse, Repeat.  The desert fathers prayed this ceaselessly throughout the day, and some even prayed it in their sleep.  It was felt that this powerful mantra invoked the name of Jesus in his relationship as King and Son, and then placed the servant humbly in his place in the universe, in need of grace, mercy, and forgiveness.  I dare you to try it:  it’s remarkably powerful, and also a great sleep aid.

The has me considering spiritual disciplines, setting a challenge that will center me on what’s important and making time for something just because it is worth doing.

Here’s my plan: my spiritual discipline will be to write a brief blog, every day, for four weeks. At the end of four weeks, I’m going to be traveling to a country with little internet access, and zero tolerance for Christian bloggers, so that will be that.  And I wrote a blog yesterday, so this counts as day 2.  My spiritual discipline, my rules.

The concept seems a little self-indulgent, like posting on Facebook a picture of what you’ve eaten for lunch that day.  But Jana Riess wrote a whole book about her pursuit of spiritual disciplines, so I feel enabled to write a blog.  I love writing blogs, and kind of feel like it’s a chance to give a glimpse into our life for all of the people who support us emotionally, in prayer, and financially.  But too often, I’m exhausted at the end of the day, and a bowl of popcorn and episode of “Prison Break” take the place of sharing my day.  I can’t promise any profound insights, but I’ll try to just give a fair representation of the day to day here at Kijabe.

So, here we go…

Today is Sunday, and we’re deep into the rainy season.  Our cement-block house has a sheet metal roof, and the only heat is from a log-burning fireplace in the living room.  African rain can feel primordial:  it comes down so hard, so suddenly, so loudly, that it saturates the senses.  We cocoon in front of the fire, secure that our little house has stood for half a century against such tropical torrents.

Duty calls, and I’m up at 8 am to get coffee, french toast, and sausages ready for the troops.  Kenya produces dark, rich coffee beans, the sausages come from Nairobi, and the eggs are laid here in Kijabe. The kids have been on school break for a month, but go back to school tomorrow.  Ann and the kids get ready to go to the chapel up at Rift Valley Academy, but I am on call and have to go in to the hospital.

The northern parts of Kenya, bordering South Sudan, Ethiopia, and Somalia, are very remote and largely outside the rule of law.  Sadly, a wedding party was ambushed by bandits in Marsabit yesterday, on their way to the ceremony.  Multiple members of the wedding party, in traditional garments and face paint, were gunned down.  The survivors were swept up by a missionary pilot in a bush plane, and deposited at our gravel airstrip.  The victims have been undergoing surgery, one after the other, since yesterday afternoon.  Only one of the patients had a fracture, so that waits until this morning.

The surgery goes well, the bone is shattered, but the nerves and blood vessels are okay.

Gunshot wound to the humerus.

Gunshot wound to the humerus.

I just clean out the wounds, apply a splint, and we’ll come back later in the week to put a SIGN nail down the humerus to let it heal.  He should be fine.

Next up, a disaster.  Kenya has one of the deadliest road systems in the world.  14-passenger vans, often dilapidated wrecks, serve as share taxis:  Uber taxis on drugs.  The drivers are often lawless, pulling out into oncoming traffic to pass, forcing drivers to the shoulder of the road or be hit head on.  Eventually, the Pauli exclusion principle prevails, and people are horribly injured.

Kamau was a passenger in such a vehicle, and survived with a relatively simple tibia (leg) fracture, which had protruded through the skin.  He was taken to a rural hospital, where antibiotics were started, and surgery performed to clean out his wounds.  Perfect care, up until this point.  Unfortunately, at the end of the surgery, they tightly sutured his wounds, trapping any residual infection inside.  Over the next week, huge amounts of pus built up, eventually stretching the surrounding skin to the point where it died.

Kamau came to us with fevers, a horrible smell, and whitish green pus dripping through his bandages.  After his spinal anesthetic was placed, we peeled back his splint and dressings.  Seasoned operating room tech’s fought the urge to gag from the stench.  The skin of the leg was dead from knee to ankle.  Pus dripped from his leg, onto the operating room table, and pooled on the floor. We spent the next two hours excising dead skin and muscle, finding yet another pocket of pus, cleaning the infected bones, and applying an external fixator to stabilize the fractures and allow access for wound care.  At the end of the surgery, the wounds looked much cleaner, but he will need several more surgeries to eradicate the infection.

Leg cleaned out, external fixation applied.

Leg cleaned out, external fixation applied.

Once the infection is under control, we can swing muscle flaps to cover the exposed bone, and then skin graft over the muscle flaps.  He’ll probably be in the hospital for a month or so.

As I finished the surgery, the heavens open again.  I walk home grateful for the cool, cleansing shower, the scent of wet grass and mud replacing the terrible stench of infection.  Surgical scrubs go into a bucket filled with bleach and water, and I climb straight into the shower, fearful that I could bring these aggressive drug resistant bacteria into the house. Ann has been hanging out with our new friends the Higgins family, who are here for three months from Utah.  The kids are off playing somewhere, and we start organizing for dinner.  The night gets chilly, we light the fire, and get ready for another week at Kijabe.

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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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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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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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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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