Posts Tagged With: kijabe

Neil Young, Papal Yogaphobia, and the Power of Prayer

As I intimated in my last couple of post, I’ve been going through a down patch, experiencing some discouragement and burnout.  In our pre-deployment training, we had lectures and sessions on this, and they were helpful, but when you’re in the middle of it, it’s a little tough to see an obvious escape route.

One belief in Christianity is that we often get in the way of our own relationship with God.  The image is one of a door, with you on one side and Christ on the other.  He’s knocking to come in, but the door only has a handle on your side: God’s side of the door is blank.  We often shut the door, and then complain bitterly that God is absent, or doesn’t exist, or doesn’t care.  God is always present, waiting for us to open the door, but it doesn’t work if we close the door, close off the relationship.

Slightly cheesy Bible picture

Reaching for that handle, opening the door, re-establishing relationship with our creator, can be difficult.  Difficult not because it requires knowledge of a certain denomination, or sacrificial practice of an esoteric spiritual discipline.  Difficult not because the key to that door belongs to a certain sect, and not because one needs a mantra or wisdom from a gnome-like guru sitting cross legged in his mountain cave, or in his palace in Rome.

The opening of that door is difficult, because to grasp the handle, we must let go of what we’re holding on to.

From the Gospel of Mark:

As Jesus started on his way, a man ran up to him and fell on his knees before him. “Good teacher,” he asked, “what must I do to inherit eternal life?”…

 Jesus looked at him and loved him. “One thing you lack,” he said. “Go, sell everything you have and give to the poor, and you will have treasure in heaven. Then come, follow me.”

 At this the man’s face fell. He went away sad, because he had great wealth.”

I don’t think this passage was meant to say that everyone is supposed to go out and sell everything and give it to the poor.  If you look carefully, an unusual sentence is inserted into the passage:  “Jesus looked at him, and loved him.”  In his day, Jesus was a hugely popular and controversial figure.  He attracted crowds of thousands wherever he went.  But over and over again in the Gospels, we see Jesus as very “one on one.”  On only a few occasions does he address large groups of people.  Rather, he spent three years wandering around from town to town, engaging individuals deeply.  Touching lepers, dining with people we might despise, confronting the possessed, really “hands on”.

And in this particular circumstance, he stops, looks at this rich young man, looks into his soul,and sees what is preventing this particular person from experiencing God.  In this particular instance, this man cannot reach up and open the latch on the door because he is clinging tightly to his wealth.

The current Roman Catholic Pope Francis is a rock star.  The press loves him, mainly because he embraces humility, poverty, and authenticity, over the trappings of his office.  There was a recent flurry of concern over his comments on yoga!  Is the Pope yogaphobic?  Is he prohibiting Christians from using yoga for core strength or to get those six pack abs? If you take the time to look at what he said, you’ll find this non-controversial statement: “You can take a million catechetical courses, a million courses in spirituality, a million courses in yoga, Zen and all these things. But all of this will never be able to give you freedom”.  The Pope tells us that only the Holy Spirit can “move the heart” and make it “docile to the Lord, docile to the freedom of love”. If we are seeking a zen-like peace from yoga meditation, or wealth, or security, then we are seeking peace from the wrong source.

So the supposed papal statement on yogaphobia also includes a warning that Catholic theology classes (catechetical courses) aren’t the way to go!  It turns out that the path to peace in your heart is just letting that door open, and experiencing God directly.  But again, to do that, you have to put down what you’re grasping.

One of the great poet-sages of our time, Neil Young, captures this pretty well:

Workin’ hard every day
Never notice how
the time slips away
People come, seasons go
We got something
that’ll never grow old.

I don’t care
if the sun don’t shine
And the rain keeps pouring
down on me and mine
‘Cause our kind of love
never seems to get old
It’s better than silver and gold.

I used to have a treasure chest
Got so heavy that I had to rest
I let it slip away from me
Didn’t need it anyway
so I let it slip away.

I don’t know what Neil Young’s spiritual beliefs are, but his song “Silver and Gold” captures exactly the same point.  Holding on to wealth, pride, security, pain, whatever is in our “treasure chest”, gets very tiring.  It’s okay to rest, put down whatever you’re holding on to so tightly, and reach up for the handle on the door.

So I think the Pope and Neil Young would agree:  if what you seek is peace, no amount of striving can get you there.  If you’re burned out and discouraged, trying harder, working harder, wishing people would just see your vision and fall in line, just isn’t going to put you on your zen mountaintop.

One of the advantages of living in a village in Africa is that you can get away from people pretty quickly.  Yesterday afternoon, I was in such a black hole that I couldn’t stand myself.  I put on my running shoes, and within five minutes of old man shuffle, was on a muddy twisty mountain road with dense bush on all sides.

This is a great place to talk with God without looking like a crazy person.  No one to judge you but baboons.  I shouted, I pleaded, I got angry, I let Him know exactly what I thought about my current situation.  But the door was firmly shut.  He was nowhere to be found.  Great.

Just when I need Him, He’s either not paying attention, doesn’t care, or doesn’t exist.

The only thing listening were the baboons, and they had nothing helpful to contribute.

I expected to come back from that run rejuvenated and energized.  After all, I had done my part, I had “gone to the mountaintop”, spent some quality time with God.  It was time for him to do his part.  So why did I still feel so black?

Last evening, we had a dinner engagement at our house with some of my favorite people in Kijabe.  Chege is one of our senior trainees, and his wife Evalyn is a nurse in the operating theatres.  They have a beautiful four year old boy named Nimwell.  They are gentle, loving, kind, amazing people.  Chege is in the middle of a spine surgery fellowship in Egypt, and so hasn’t seen his family in a couple of months.  He’s spending a short break back here in Kijabe, and they were good enough to agree to have dinner with us.

We had a great dinner of Irish stew and mashed potatoes, which, it turns out, is very similar to Kikuyu cooking.  No surprise that mashed potatoes and beef with gravy are everyone’s comfort food.  Great conversation, hilarious stories, just one of those nights of fun and relaxing relationship.  As we stood up to say our good-byes, Chege asked if he could pray briefly.

I’ve heard Chege pray and preach before, and he is a gifted speaker.  But he was moved at this moment to pray for me, to encourage me, to lift me up, to allow me to let go of my treasure chest of pride and insult.

As he prayed, I could feel the anger, resentment, burnout, begin to melt.  I went to bed, and woke up this morning, with the blackness gone, and the enthusiasm and energy returning.

I don’t pretend to understand how prayer works.  I don’t know how Chege knew that I needed prayer to help me let go of my treasure chest.  Theologians could debate paradoxes and mysteries for lifetimes.  But like this laptop, I don’t need to know how it works.  I’m just glad that it does.

I’m heading off on an outreach trip tomorrow, and I wasn’t sure how that was going to work.  The travel, cross-cultural setting, and security measures are all exhausting.  To head into that week depleted looked like a recipe for disaster, and I had contemplated a last-minute cancellation, knowing how disruptive that would be.

But I think that all had to do with what I was holding on to.  And I think my friend Chege saw how firmly I was holding that door closed.  His prayer helped me to just let go of what was bothering me, quit taking myself so seriously, and see the beauty around me.  We hold on so tightly to the chains that bind us, hold on so tightly to what we treasure.  Too often, the peace we seek is right in front of us, but we refuse to accept it.  If you think that might be true in your current setting, I encourage you to pray, find someone to pray for you, let go of your treasure chest, and see what happens when that door opens.

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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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Day 4….Some days are better than others

As I sat down to write this, my phone rang.  It was the excellent resident I’m currently working with, calling with bad news.  He had brought our patient from Sunday, the one with the terrible leg infection, back to theatre to wash out the infection again.  Instead of finding the leg improving, he found toes turning black, and the muscles dying.  We got to Kamau too late.  The infection had gone too far.  This young man is going to need an amputation.

I can feel the resentment build:  why did this have to happen?  It wasn’t a complex problem: with some basic surgical care from the outset, he could be planning his recovery, this episode soon relegated to a painful memory and tales to tell his children and grandchildren.  Instead, he will be an amputee, in a country which doesn’t look kindly on disability.  Here we have no “Kenyans with Disabilities Act” to put in sidewalk ramps, require accessible public transport, or prevent employment discrimination.  Disability is sometimes viewed as a curse, creating fear, suspicion.  He will have some difficulty finding and affording a good prosthesis.  This is a huge setback for his life.

If this were an isolated instance, it would be simply frustrating.  But it is a regular occurrence, even here in Kenya, one of the more developed countries in sub-Saharan Africa.  I’ve been to countries where things are much worse, where there is simply no hope for patients with significant injuries.  The suffering across this continent is unimaginable.

There’s a lot of people working on this problem.  My Notre Dame classmate and roommate from medical school, John Meara, has risen to the highest echelons of the academic world, and is spearheading the Lancet Commission.  The Lancet, one of the oldest and most prestigious medical journals in the world, has decided to undertake a major project, looking at the effect of this severe lack of surgical capacity in the developing world.  The governing body of the World Health Organization meets in May and will pass a resolution declaring basic surgical care a right, much like access to clean water, food, security, and vaccines.  This is a watershed moment for the billions of people suffering worldwide from lack of access to adequate surgical care.

In our lifetimes, this problem will be reversed, and severe lack of surgical capacity will go the way of smallpox and polio.  But that doesn’t help Kamau today.

Our first patient for the day, a young man in a car wreck, was due to have his hip socket reconstructed after a fracture-dislocation of his hip.  Unfortunately, due to a scheduling error, we had to re-schedule his surgery for Thursday.

Our next patient was due for wrist reconstruction after a mangling injury a year ago when his van rolled over as his arm was out the window.  As we were preparing him for surgery, I pressed gently on a little opening in his arm.   To my surprise, a 3/4 inch seed pod popped out, followed by pus.  Apparently, despite multiple surgeries at two excellent hospitals in Tanzania and Nairobi, this remnant from his roadside injury had hidden inside his arm for a year.  It decided to work its way out on the day this patient was finally scheduled for his reconstructive surgery.  We cleaned out the infection and took him to the ward for intravenous antibiotics.

The third patient today was a middle aged lady who had fallen down some stairs, shattering her wrist.  She was scheduled for a combination of plating and external fixation today.  Though she has a history of hypertension (high blood pressure), she has been well controlled by medications.  Until she got onto the operating table.  Her blood pressure shot up to a dangerous 200/100, and persisted despite intravenous anxiety and blood pressure medications.  Surgery cancelled.

Next up, a two year old boy who fell down some stairs, hyper-extending his elbow to the point where the elbow broke just above the joint.  Jane had this same injury just last November.  The treatment is a surgery where the bones are manipulated back into position, and then held there with two pins introduced through the skin into the bone using video xray.  This went flawlessly, all the equipment worked perfectly, and he should be fine.  Finally, we accomplished something for the day.

Our last patient was the disastrous Kamau, wrapping up an all-too-typical day in the battle against trauma in Africa.  When he wakes up, we’ll need to give him the bad news and obtain consent for amputation.

In the big picture, I know progress is being made, systems are being formed, surgeons are being trained, the John Meara’s of the world are pushing global organizations to wake up to this unseen epidemic.  But day to day, my picture isn’t that big.  My picture is the men, women, and children in my clinics and theatres who suffer agony and disability from lack of safe roads, safe drivers, and access to safe surgical care.  Though we’re too late for Kamau, my prayer is that his children will live in a world with less suffering.

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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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Managing Surgical Emergencies

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

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

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

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

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

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

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

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

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

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

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

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

 

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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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