At some point in 2004, I walked out of the Univeristy of New Mexico Hospital with a smile on my face. I had just completed my last day on the trauma service. No longer would I be up in the middle of the night taking care of labor-intensive injured patients. No longer would I sit for hours in the ICU taking care of the sickest of sick patients while others operated on the “interesting cases.” My career path was taking me towards the aspect of surgery that I loved the most- operating, operating, operating. I was happy to be in the OR all day while critical care specialists helped take care of the sicker patients whose care I was involved in.
I spent the first decade of my career as a busy, private practice surgeon which meant I spent a lot of time in the operating room. I loved it. But as our family transitioned to Kenya it became very apparent that good outcomes in complex surgical patients at Tenwek were hard earned. Yes, a technically perfect operation is imperative, however, a good outcome depends on much more than just a good operation. Technically difficult operations could be completed, however, patients who became sick after these procedures or who were admitted to the ICU after life threatening trauma often times died when they shouldn’t have. Was it my care? Was it the residents’ lack of knowledge of critical care medicine? Was it our monitoring capabilities? Was it nursing? Was it specific problems in our rural Kenyan population? The answer to all of these questions was yes. And there are many more problems. The bottom line is that it is largely a systems issue. We as physicians like to tackle specific diseases and problems, but we often times neglect the development of a system of care that can be applied to a broad range of patients. It became clear to me that we can teach our residents how to be expert operators- even at advanced techniques such as laparoscopy that are rare in rural Africa. However, until we develop a better system for caring for the critically ill, outcomes in our sickest patients are not likely to change.
As our first term in Kenya was coming to an end in June of 2016, we began to think about how we would spend our time in the U.S. Angela and I had decided that we wanted the girls back in school for a complete school year. Angela wanted to mainly focus on helping the girls transition back to the U.S., and I hoped to be able to work. But as I thought about working, I felt like my time would be best spent by trying to learn things that I could take back to Kenya. We discussed the possibility of me doing a fellowship in surgical critical care and ultimately decided to ask around to see if there were any available fellowships spots. Fellowships are additional training programs that physicians can do once they have completed a residency. To be a cardiologist, one does a fellowship after a medicine residency. To be a heart surgeon, surgeons will do a 2 or 3 year fellowship after their general surgery residency. Surgeons can do a year of specialized training in surgical critical care which prepares one to care for the sickest of sick surgery patients. In practice, most surgical critical care specialists are also trauma surgeons due to the fact that traumatized patients often make up a large percentage of patients in a surgical ICU. In the current era, the evolving specialty of acute care surgery has emerged, which encompasses surgical critical care, emergency general surgery, and trauma surgery (which makes up a huge chunk of what we do at Tenwek). Most practitioners of this specialty in teaching facilities are board certified in surgical critical care. And so, my hope was to find a fellowship which would allow me to do this.
After sending out multiple inquiries, we were delighted to hear that the program at the Univerisity of Tennessee in Knoxville was willing to allow me to join them for a year as one of their surgical critical care fellows. I couldn’t be more grateful to the trauma and critical care faculty at UT who helped create a spot for me. They allowed me the freedom to spend time learning skills would be beneficial to the work at Tenwek. I was even able to spend a month at Parkwest Hospital (the hospital were I worked prior to going overseas) working with the cardiac anasthesiologists learning how to take care of cardiac surgery patients. However, the year of training had its struggles. I felt all of my 43 years of age during the busy call nights. Recovery after these busy call nights took an extra day or two more than it used to. Time with our family was more limited than we had hoped after being away for a couple of years. However, it was a privilege to have the opportunity to sink my teeth into learning the nuances of trauma and critical care surgery.
Now as we transition back to Tenwek I am looking forward to putting new knowledge to work. Like many other areas of medicine, modern critical care capabilities are lagging in the developing world. In Kenya, there are nicely developed critical care units in some of the larger hospitals in Nairobi, however, distance, money, and transportation issues limit access to these facilities for a large percentage of the population. Fortunately, the need for surgical ICU development in low and middle-income countries is increasingly recognized. A nice article by Drs. MacLeod, Kirton, and Maerz was published in 2016 highlighting the incredible need for critical care development as well as possibilities for a way forward in development. Here is the link to this article for all of you as nerdy as me: Surgical Intensivist and global critical care: is there a role? The authors point out staggering statistics such as the fact that 90% of deaths due to trauma world-wide occur in low and middle-income countries. Each year, 8 to 10 million children under the age of 5 die, however, 90% of these deaths occur in the 42 poorest countries. Many of these deaths could be prevented by access to critical care services. Although ICU’s in the west are often thought of has being high-tech, expensive, sophisticated units, the authors correctly point out that major improvements in patient outcomes can be achieved by implementing basic tenets of critical care. It is my hope to continue to make improvements in the way we deliver surgical critical care in our relatively rural setting at Tenwek, but more importantly, to educate our residents so that when they leave our program they are capable of ministering to the sickest of sick.
God has answered SO many prayers of our hearts during our time in the U.S. this year! We want to share some amazing follow up on my wishes from “My Grown Up Christmas List”…
A TEACHER!… We have a teacher preparing to join us in Kenya! Grace Williams graduated from Johnson University in Knoxville in 2016 in Early Education. She heard of our need for a teacher through our video shared by her Education Department. Realizing that she had the skill set, desire, and ability to help meet this need, God worked through her heart and circumstances to bring her to a willingness to serve with our team. She will be teaching 3rd and 4th grade missionary kids and working with children’s ministries at our Kenyan church. I know she will be a huge blessing to our family and the rest of our team! Please pray for Grace as she takes this step in faith to live and work in Kenya. Grace will be raising her own support for this year. If you would like to contribute to her financial support, click here.
An ULTRASOUND machine!… Thanks to the generous donations of several couples, a matching gift from Friends of Tenwek, and a discount given by Sonosite, we were able to purchase a new Ultrasound machine for Tenwek for use in the surgery department. This is a new machine with fantastic imaging capabilities that will add immensely to our patient services and resident education. The machine has arrived and is already in use at Tenwek!
EDUCATION for an orphan… This is always an ongoing need! As I have shared before, education is one of the BEST investments in helping vulnerable children rise above poverty and other risks. We have had many friends and church groups invest money toward our Tenwek orphan scholarship fund. Thank you! This week, Mary Taylor’s grade at school held a “Coins for Kenya” walk to raise money for a child’s school fees. They learned about the difficulties that many children face in going to school and brought in their coins to help pay for a year of schooling for a child in Kenya. I pray that God will move in these young hearts to know that they are a part of His story, and that even they can be used to show His love to others around the world! If you feel led to help sponsor a child’s schooling, click here.
Tis the season! No better day than “Giving Tuesday” to roll out my 2nd annual Grown up Christmas List! Even though this year we will have the joy of celebrating Christmas in America, our hearts and minds are still with our Kenyan friends and neighbors. Throughout the past few years, our vision has grown bigger, our passion deeper, and our excitement greater about what God is doing in East Africa through Tenwek Hospital, our PAACS graduates, and our local Kenyan church. Although it has been humbling and challenging to live and work in an area of the world with such great need, it has also been rewarding beyond measure. I know that our blog has been silent since our return to the US this past summer. We have found it difficult to express in words the ups and downs of living between two “homes.” Returning to the US with fresh eyes has been interesting! Maybe we will share more in a future post about the good, the bad, and the ugly of this fresh perspective. But one surprising outcome of our experience so far in serving as “missionaries” is the amazing way that God has allowed us to connect so many people within our circle (and even beyond) to His work in the world. Ironically, even though we have “less” by the world’s standards now, we have been able to GIVE even MORE…by being conduits of your blessings which have been given so generously. We have been continually amazed at how God has used YOU (our community in America) to bless our community in Kenya! So in this season of giving, we wanted to again highlight some needs near to our hearts. If you are hoping to make a real difference with your dollars this Christmas season, instead of more online shopping for more “stuff”…consider one of our wish-list items below!
1. EDUCATION for an orphan..
Schooling in Kenya is not free…One year of tuition and required school fees (books, uniforms, food, etc.) costs about $500 per child. Orphans are especially at risk for not progressing through school due to lack of financial support among other factors. Access to education for orphans and vulnerable children has been directly linked to improved health, wellbeing, and long-term outcomes. Our local children’s homes care for about 350 orphans who rely on donations to provide this critical opportunity for education. Could you give a child the gift of knowledge and opportunity this year? If you can’t give $500, any amount does help! If this need speaks deeply to you and you have interest in a commitment each year to sponsor a child’s schooling, please contact me for more information.
Donate directly at Tenwek Orphan Scholarship Fund
2. An ULTRASOUND machine for surgical use…
Ultrasound is a vital tool for patient care at Tenwek Hospital. Our radiology department does about 50 patient scans per day, leaving little availability for ultrasound use in surgery, in evaluating trauma and critical care patients, or in teaching residents these important skills. We are in dire need of an additional ultrasound machine devoted to these purposes. We are raising funds to purchase a Sonosite M-turbo portable machine. Sonosite has offered a generous discount, and Friends of Tenwek organization is contributing 50% of the needed funds! Could you help us in raising the additional 50% needed to acquire this important tool for improving patient care and training?
Donate directly to this need at Surgery Dept. US Project
3. A TEACHER!
OK, so this isn’t something that money can buy at all, but it is my biggest wish! Our Tenwek community is in need of two teachers committed to helping with educating our missionary kids. This important job impacts our ministry in such a big way! If you or someone you know is a teacher licensed for elementary or middle school with a heart for missions and a willingness to consider serving with us in Kenya, please contact us! Help spread the word!
Thank you for considering supporting our Kenyan community and our work at Tenwek Hospital. We look forward to returning to Kenya in 2017. Thanks to our amazing partners, we have 95% of our needed monthly funds for our return already committed! Are you interested in joining our support team? If so, contact us to learn more, or donate directly toward our ministry . We are in currently Knoxville, where Heath is doing additional training in critical care at UT Hospital, and Angela is working to juggle our family’s transition. If you would like to connect, please contact us!
All of this is for your benefit. And as God’s grace reaches more and more people, there will be great thanksgiving, and God will receive more and more glory.” ~2 Corinthians 4:15 NLT
It was early Sunday morning and our team had been up late the night before operating on a premature infant with an intestinal blockage. I am usually grateful when there is just one big problem to handle during a weekend of call, but that was not to be this weekend. At about 4:00 am, I was informed by the senior surgical resident that a woman with extensive burns had just arrived to Casualty (our ER). I briefly contemplated taking a shower, but instead prioritized coffee intake, then walked up the hill to the hospital. It was easy to find the patient…her burns extended onto her face which was not hidden by the white sheet which covered the rest of her body. The resident, Valentine, filled me in on the story: The woman lying in the bed was a mother to two young children who were playing inside of their house around an open fire. An open fire is a common enough occurrence in Kenya since it provides the means of cooking in most homes, but what evolved into an uncommon situation was that the two children began playing around the fire with a container of kerosene. Fortunately, the mother quickly recognized this and took the container from them. Unfortunately, the kerosene spilled onto her shirt, soaking it thoroughly which was then ignited by the fire. The fire was quickly extinguished, but not before burning the majority of the skin on her body. She travelled to a nearby hospital and then was sent on to Tenwek, now some 8 hours after her injury.
Together, our team examined her. She was completely awake and alert and was able to have a normal conversation with us. As expected, she was in some pain, but it was reasonably well controlled. Her burns were extensive…her back, chest, arms, and face were covered in second and third degree burns. In total, just over 60% of her skin was burned.
In the U.S., a patient with a 60% body surface area burn is a challenge…so much so that these patients are usually transferred to a specialized burn center to be cared for by burn specialists. Surviving a burn that involves 60% of the skin is possible in the U.S., but even with specialized care about half of these patients (depending on age) will ultimately die from their injury. In western Kenya, where there are no burn specialists and where hospitals are not equipped to take care of a patient of this complexity, the chance of survival is close to zero. And so, as we are assessing Mary, the extent of her burns and the reality that she will almost certainly die from these burns becomes clear.
As a missionary surgeon, I am charged with displaying Christ in both word and deed to my patients. The deed part comes naturally to us as surgeons. We like to fix things. We like using our hands and minds to correct a problem so that we can see a person healed. This paves the way for us to sometimes share, by word, who Christ is. Often times at Tenwek this is done by our Kenyan chaplaincy staff who can speak into spiritual matters with better cultural and language insights that I can. I am always grateful for our chaplains because, quite frankly, I am at times uncomfortable doing their job. I do not want the patient or family to think that the only way that I, the white guy, will provide care for them is if they agree to my religion. The reality is that there is an imbalance of power between us as physicians and our patients. We have knowledge, skills, ability, and resources that a desperate patient needs. Does my sharing of Christ in word coheres a patient? Possibly. Therefore, my approach is to display Christ primarily in deed by taking care of a patient’s physical needs. But on this morning, I have little to offer this patient this patient medically.
We explained to the patient and her family the extent of her injuries and the likely outcome. We give them the option of not doing any treatment, of just keeping her comfortable, but they refuse and ask us to do everything we can, to which we agree. We will need to intubate her- place a breathing tube- for which she will be sedated and communication will be difficult. Valentine, in Kiswahili, asked the patient about her faith. “Do you know Christ?” She does not, but after Valentine spends time telling her about who Christ is, she decides to give her life to him. We all pray together: the patient, her family, and our team. We prayed for healing and for comfort in the midst of a lot of pain. Tears flowed from her husband. After this we wheeled her to surgery…it was the last time she would talk to her family.
Skeptics might say that her faith was not genuine. They might say that she was scared for her life, or rather, her coming death. Some might even say we took advantage of this to achieve our own desires to “win people for Jesus.” However, the only place where we can fully see Christ is when we are stripped of everything. Only when we realize the frailties of our flesh, the briefness of this world, and the passing of material possessions can we truly see our need for the cross. And so, very likely, this lady came to know Christ in deeper ways than many of us who have followed Christ for years. But my role is not to be a judge. Instead, I am called to be a witness in a time of great need- a need that cannot always be met by modern medicine or years of training.
All things considered, our patient did well over the next 3 days. We worked hard to replace liter upon liter of fluid that she was losing because of her burns. She remained on a ventilator. We kept her pain controlled with IV pain medication. On what would have been her fourth day in the hospital, I arrived to ICU rounds to find her bed empty. She had died during the night.
Generally, as a missionary, I want to tell of stories of success, stories of great healing where God used me as his instrument to bring someone back from the brink of death. I want people to applaud the medical work that is done at Tenwek. This is a human mindset- and one that is self-glorifying. While there are truly amazing things that happen here, I have come to understand more completely that not all acts of healing are physical. Not all great interventions involve the use of sterile instruments and suture. For Mary, healing was achieved apart from these things.
As we sang Christmas carols at our Christmas Eve church service, a familiar and heart-wrenching wailing began in the background, coming from the direction of the hospital. We all know what this sound means…Someone has just lost a dearly loved one. You see, it is rarely a “silent night” at a hospital.
We have just celebrated our second Christmas season in Kenya. It has truly been filled with such joy! But amid the joyful celebrations and rewarding service opportunities, we are surrounded here by constant reminders that we still live in the “messy middle.” This term, “messy middle,” has been used by different people in different ways, sometimes to describe the timeframe between the starting and completion of a goal. But here, I mean the time between the arrival of Christ in human form as the promised redeemer of mankind…and His anticipated return to restore harmony, true PEACE, to His creation.
The struggles of this “messy middle” are not unique to Africa…they are just more intense here… more “in your face” so to speak. The pain of disease, illness, loss, grief…it touches us all at some point. In America, we tend to hide it away if possible. But in this place, a stone’s throw from a hospital in a region where most people live on less than two dollars a day, there is no hiding it. And so we hear wailing while singing carols. Or there’s the Christmas party, interrupted by an urgent request for blood donation for a patient undergoing emergent surgery after a trauma. And there were hundreds of families displaced on Christmas Day in a neighboring county, their homes burned down due to fires set from inter-tribal conflicts. And men with arrow wounds presenting to Tenwek from these same conflicts. And there are daily knocks on our door, asking for help due to these and other struggles. Life is messy.
So, yes, we celebrate Christmas with deeply grateful hearts…as this miraculous coming of Christ to earth gives us hope and promise of things made right and new…and we also longingly yearn for His rule as the true Prince of Peace. This promise gives us true JOY and HOPE even in the midst of pain and suffering. So we strive to LOVE as He taught us…seek PEACE where we can…DEFEND those with no defender…and build God’s kingdom here on earth until He comes to complete the task.
THANK YOU to all who gave toward my “Grown up Christmas list” and to those who give to our ministry year-round. You enabled us to love well this Christmas, and you blessed our community with your gifts. Since a picture is worth a thousand words, here are some pics that describe our Christmas:
We were able to “take” Christmas to one of the local orphanages, Kinduiwa home. It was a fun and humbling experience. We have such respect for the Kenyan pastor and his wife who are committed to the challenging task of raising these children in a safe and loving environment despite very limited resources.
This year we were thrilled to be on the giving side of Operation Christmas Child. After packing boxes in the US for years, this was very special! Tenwek Hospital received boxes to give all of the pediatric patients on Christmas Day.
We had parties at the hospital, with fellow Kenya missionaries, and with the surgery residents. Below are pictures of our chief surgical residents as “living Christmas trees.” This is the closest we will get to a Living Christmas Tree in rural Kenya!
The girls and I continued our now annual tradition of homemade gingerbread houses (more like a village!). This is an anticipated event for the MKs at Tenwek, and one we have come to enjoy. I was much less intimidated this year by the lack of the “kit” and work involved to DIY!
“Truly He taught us to love one another; His law is LOVE and His gospel is PEACE. Chains shall he break, for the slave is our brother, and in His name all oppression shall cease. Sweet hymns of JOY in grateful chorus raise we; Let all within us PRAISE His holy name. Christ is the Lord! O praise His name forever! His power and glory evermore proclaim!” ~O Holy Night, verse 3
Although there have been more recent releases, this song will always carry me back to the 1990’s and Amy Grant and a time when I thought I was much more grown-up than I really was! I am not as optimistic or naive as I was then, but now that I really am a grown-up, I do have a Christmas list that can’t be bought in stores. And these wishes don’t come from song lyrics, but from the backdrop of my daily life. Would you like to give a gift that really matters to someone this Christmas? If so, read on, because you can! …This is my grown up Christmas list:
1. Needed SURGICAL CARE for our poorest patients
Tenwek Hospital has become a referral center for the sickest and most complicated patients in the region. While our physician services are free through the support of our donor-team, the hospital operates by patient fees. The Tenwek Compassionate Surgical Fund lets us give free or discounted services to the most needy of our patients, and is critical in allowing us to offer quality care to the poor in our community. Most surgeries here can be covered with $400.
2. TEA PLANTS for our sustainable tea farming project
This sustainable project implemented with our national partners is designed to help support the daily needs of our local orphans. One acre of tea plants costs $250. Help plant fields of hope through the Tenwek Orphan Outreach Fund.
3. FOOD for our orphans
One 45 pound sack of corn costs $50. One 45 pound sack of rice costs $50. Each of these sacks can feed 50 children for 1 month! Invest in a healthy future for our community through the Tenwek Orphan Outreach Fund.
4. CLOTHES for our orphans
One pair of shoes costs $10. One school uniform costs $20. Invest in the practical needs of our kids through the Tenwek Orphan Outreach Fund
5. One year of EDUCATION for an orphan
Unfortunately schooling here is not free. One child’s preschool fees costs $75; One child’s elementary school fees costs $125; One child’s high school fees costs $500. Invest in opportunity through the Tenwek Orphan Scholarship Fund.
Thank you for considering a gift to support our Kenyan community in meaningful and lasting ways. Let us each seek to share the great great love of our Savior this season!
“For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me… Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.” ~Matthew 25:36, 40
“Summer afternoon- summer afternoon; to me those have always been the two most beautiful words in the English language.” ~Henry James
I’m feeling a bit nostalgic today and thought I would reflect on our recent summer. I love summer. I have never been one of those moms who is ready for school to start. I love the late warm nights and slow lazy mornings of summer. I might live in an eternal summer if I could. For my past ten years of parenting, thoughts of summer have conjured words like sun, beach, peaches, cook-outs, cousins, grandma’s house, lake, camp. This year however, my summer memories hold words like goats, mud, and babies. Thankfully, it still also holds memories of cousins and beach and sun!
“Summer” in Kenya is very different. For starters, there isn’t really a seasonal summer. Being in the southern hemisphere, the months of June through August are actually our cooler months. Now “cool” is relative, as we almost always have sunny days with warm temperatures reaching near 80 degrees. In this way, our weather here is kind of like a perpetual enjoyable summer, without the sticky humidity of my US summers. So here, we define “summer” in terms of our break from school. And we did take a break from school. On our first day after finishing school, we greeted Heath’s sister and family for a visit. This started a summer of experiencing Kenya with and through a stream of visitors…family, friends, pastors, and short-term medical staff. We helped mud houses, colored and painted with orphans, held babies, took walks through the countryside, visited with Kenyan friends, and took safaris. We were so fortunate and blessed to be able to share bits and pieces of our lives here with friends, family, and visitors. I am thankful that we have memories with these special people in our new home. We hope that their visits here let them connect more with us in our new life, and even more so, than it will give a bigger and fuller and more real picture of God…as God of the universe and God of all people.
I read a quote somewhere, “Some of the best memories are made in flip-flops.” I would have to agree, especially since in Kenya, flip-flops are year-round! (Although my girls might argue that the best memories are made in bare feet!) So even though our carefree days of no school and many visitors have ended for now, our flip-flop-memory-making days continue…
In previous posts and through other media forms I have tried to give a picture of the need for access to surgical care in rural Africa. Recently, this need was highlighted in a paper that was published in the Lancet and was subsequently reported on in the BBC. Please see this link to read more- No Access to Safe Surgery . The conclusion is that most of the world’s poor do not have access to adequate surgical care. This growing awareness of the worldwide surgial need has prompted brainstorming from various health organizations on how to meet this need. Certainly, training surgeons is one of the methods to help pave the way for better surgical care. This is what has drawn our family to Kenya. However, there are other ways. Surgical “camps” are one of the ways that various groups have used to try to relieve the surgical disease burden in one locality. The idea is to do as many surgeries as possible over a few days while providing this care for free or at a significantly reduced rate. Typically these camps are done in areas where there is not immediate access to to surgical facilities, and, often times, it is professionals from other countries who are coming to donate their time and expertise.
Last week, I travelled to far western Kenya along with one of our third year residents, Dr. Valentine Mbithi, for a 3 day surgical camp. This well-organized camp is at a small clinic which is run by Kenya Reflief. At least monthly, teams (usually from the U.S.) come to do as many surgeries as possible over 3 days. However, for July, the team travelling from the U.S. was lacking surgeons… which of course is a key ingredient in providing surgery. We were asked to help fill the gap and we gladly accepted. I felt like this would be a great opportunity for Dr. Mbithi and I to participate in mission outreach, plus it would allow her to operate a little more independently as we would both be running OR rooms.
We arrived on a Sunday afternoon after travelling about 3 hours from Tenwek to an area that I had not been before. The last hour was on a narrow road that twisted and turned through sugar cane farms. I felt grateful to arrive in one piece- we were run off the road twice by high speed buses who were out of control on the narrow roads. After settling in, we met the team who we would be serving with. There were four CRNA’s from various locations in the U.S., as well as a recovery room nurse. We quickly made our way to the screening clinic were we evaluated and scheduled patients for the next 3 days. The most common diagnosis was thyroid goiter. These huge goiters are often times caused by iodine deficiency and can grow so large that they cause problems with swallowing or even breathing. However, we also saw patients with hernias and other lumps and bumps. We worked into the evening, ate a big dinner, and then crashed.
By 6:30 the next morning, we were back to the clinic and ready to start surgeries. We worked out of one OR which had two surgery tables, so Dr. Mbithi and I were in close proximity. If she had a question or concern, I could quickly provide guidance. In the morning we did smaller cases independently, and as the afternoon started, we began thyroid-fest. Our team was incredibly efficient. We had almost no break between surgeries, which as surgeons, we love. Thyroidectomies are more complex cases, so Dr. Mbithi and I would work togther during the key parts of the operations, and then one of us would close the wound while the other headed to the next table to start the next case. Our team worked until 9:00 or 10:00 at night for the next two days. In two and a half days of operating, we did 24 operations. In total, we removed 9 thyroids, fixed 5 hernias, and did several other smaller operations including a lip reconstruction from a poorly healed tramatic injury. We also performed the first cytoscopy (looking into the bladder with a camera) that had been done at the clinic.
By Wednesday afternoon, we were beat. Our team members were incredible to work with and I give a big “hats-off” to Kenya Relief and the missionaries who are there on the ground making these camps happen. In addition to doing surgeries, we referred many patients who were too complex to operate on at the camp to follow up with us at Tenwek. In this manner, we were able to extend care and continuity that many short camps are unable to provide. As we drove home to Tenwek, Valentine asked me if we could bypass letting one of the other 13 residents come on the next trip so that she could return. This is what I am most thankful for… seeing our trainees develop a vision for service and outreach to those who are in desparate need.
“It’s such an honor,” we are told, “for wazugu (white people) to be invited do the final layer of the house.” We are preparing for “mudding” a house. Traditional houses here are fashioned from simple scaffolding made of sticks which are then filled in with several layers of mud. A local women’s ministry (Tabitha Ministry) works with village churches to help provide money for roofing supplies (rafters and a corrugated metal sheet) so that these simple houses can be built for widows and orphans who often find themselves without a home.
My nephews, Ryan and Eli, raised money for a house. Motivated by their upcoming trip to Kenya and wanting to contribute to our community here, they worked extra jobs around their school helping teachers clean and pack up their classrooms for summer break. They were able to earn almost $250, the amount needed to complete a house with roofing. Now, during their visit, we are going to help finish Betty’s house.
Betty, a 21-year-old orphan, has never had a house of her own. Her mother, Anna, spent much of her adult life doing anything she could to provide for her seven children…selling illegal brew and even her body. She rented rooms for her and her children in an area of town called “Satan’s Den.” In her last years of struggling with HIV/AIDS, Anna came to know Jesus. She grew in her faith through the Tabitha ministry’s Bible studies. She spread news of Jesus’ love throughout Satan’s Den, and began sharing Him with her children. Anna lost her battle with HIV/AIDS in 2010. Betty turned from God for a time in the aftermath of her mother’s death. Now, Betty is striving to follow Jesus and trying to create a home for her younger siblings.
“The final layer is special,” we are told, “because it is a mixture of clay and animal dung, which provides a protective layer to the walls.” (Yes, animal dung…a nicer way of saying “cow poop”). So we scooped up large, dripping, smelling handfuls of the thick liquid and “painted” the walls with our hands. The ladies show us the proper technique…both hands, large sweeping motions, smoothing it into all the cracks. There’s no halfway effort to this. Doing it right means that the warm liquid runs down your arms, dripping onto your legs and toes. Throughout the day, as our “paint” mixture gets low, the ladies disappear and return with large buckets filled with fresh dung to replenish our supply. Nature’s supply shop…
A thicker gloppy mud is also made to fill in the space between the roof and the upper edge of the wall. This mixture is made by digging up dirt in a hole, adding water, then stomping on the mud until it is just the right consistency. Our kids all love this part!
After finishing the inside and outside walls of the house, we wash up (in buckets because there is no running water) and share a meal in the new home with Betty and her family. Neighbors and friends keep squeezing into the freshly mudded room, unhindered by the flies or the odor. Scriptures were read and songs were sung…giving thanks to God for His provision and praying His blessings on the home. What a beautiful picture surrounded us of God providing through the body of Christ not just for Betty’s practical needs, but restoring hope and joy and family.
Yesterday, while celebrating the admirable earthly fathers in my own life, I couldn’t help but think of Betty. I pray that she knows more strongly each day the love and security of our Heavenly Father who adopts us all as His own into His eternal family.
Rejoice before him – His name is the LORD.
A father to the fatherless, a defender of widows, is God in his holy dwelling. God sets the lonely in families, he leads out the prisoners with singing!
“Let us pray for our Mothers… Because sometimes they die giving birth.”
This. A simple prayer request. Jolting in it’s content. But even more so because it was spoken by a 10-year-old boy, in his clear and crisp Kenyan-English accent, standing up bravely before a large church congregation.
It was our first Sunday to attend church at Tenwek after we arrived last fall. Inquiring later, I learned that this young boy is not an orphan, not motherless… Just a child growing up in a place where pregnancy holds as much risk as promise.
Many have asked me, “What about OB? How is your work?” I haven’t shared about my experiences in “Maternity” because, frankly, I don’t even know where to start. How is it possible that my previous and current worlds of obstetrics and gynecology even exist on the same planet? How did a trip across the ocean take me from a practice where I discussed with my patients the risks and benefits of epidurals, explained the evidence behind prenatal screening tests and childhood vaccines, reviewed the merits of personal birth plans, met with privately hired doulas, and even assisted in planning gender-reveal parties…to a place where the children in my community literally fear for the lives of their mothers.
I knew the statistics…I had shared maps and numbers and percentages with many of you in our days of preparations to help flesh out the “whys” that motivated our move to Africa.
Statistics like this:
- 800 women die EVERY DAY in the world due to pregnancy complications
- Almost 2/3 of these deaths are in Sub Saharan Africa
- The lifetime risk of dying due to pregnancy for a woman in Sub Saharan Africa is 100 times greater than for a woman in America (100 times!!!!)
And maps like this:
But beyond the staggering statistics and dramatic maps are real people. These numbers now have names to me. Dorcas. Mercy. Nellie. Faith. Evelyn.
And they have families. Children left without a mother… sometimes newborns who I brought into the world on the brink of their mother’s departure from it.
Most maternal deaths are preventable, which makes the stark contrast between my two OB worlds even more difficult to reconcile. But too often, by the time mothers arrive to our facility, they have crossed a critical threshold beyond which our medical interventions have little chance of changing their outcome. Hemorrhage starting 24 hours prior to arrival with cardiovascular collapse already progressing too quickly. Infection setting in days ago, unrecognized or ignored, with septic shock already taking over. Advanced stage cancer, untreated, with severe malnutrition, in a body unable to withstand the strains of pregnancy any longer. Preeclampsia, unrecognized in a village clinic, with convulsions and loss of consciousness beginning several hours before arriving to our facility.
The reasons behind this unacceptably high death rate in mothers worldwide are complex and multi-faceted… Inadequate numbers of skilled health workers (trained nurses, midwives, or doctors), long distances to health care centers, poverty, cultural practices, and lack of information. Improving maternal health was 1 of the 8 Millennial Development Goals adopted by the international community in 2000. Improvements worldwide are being made. Maternal death rates are decreasing, but much too slowly to reach the proposed benchmarks by the goal of 2015. And there are still huge discrepancies between the rich and poor, and between those in urban and rural areas.
But my purpose here is not to fully expound on these reasons, or even to explore the many possible solutions, but rather to share about the beautiful and strong and brave women of my new home. They are remarkable…bearing incredible difficulties and sufferings with stoic grace. They love their children fiercely, dream expectantly, and persevere in amazing ways to care for their families. Their “barriers” to adequate health care are now the backdrop of my life. And it’s not OK.
Frustrated. Perplexed. Discouraged. Heartbroken. Indignant. These emotions co-exist within me on a regular basis in my new “normal.” In 9 years of private practice in America, I never lost a patient. Our team here lost 9 mothers in the month of January alone…4 more in February. And it’s not OK.
God does not ignore these strong and conflicting emotions. He has much to say about death and discouragement and earthly pain in His Word, because these elements surround us in this world if we are willing to see them. He uses words like “groan” and “burdened” and “grieved” and “afflicted” to describe our time on earth. But He also gives us the assurance that this is not how He intends for things to be. Yes, we protest against death with every fiber in our bodies; because we are created for eternity, not for these weak and temporary earthly bodies. And while I may not be able to save the life of every mother brought into my care, I am given promises to which to cling.
…Promise of death defeated… “He will swallow up death forever; and the Lord God will wipe away tears from all faces,” (Isaiah 25:8)
…Promise of light overcoming darkness… “The light shines in the darkness, and the darkness has not overcome it.” (John 1:5)
…Promise of GOD with us… “For it is God who works in you,” (Philippians 2:13)
…Promise of eternity… “But our citizenship is in heaven, and from it we await a Savior, the Lord Jesus Christ, who will transform our lowly body to be like his glorious body,” (Philippians 3:20)
So let us pray for our mothers, and for us all, that we not lose heart.
“So we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day. For this light and momentary affliction is preparing us for an eternal weight of glory beyond all comparison, as we look not to the things that are seen but to the things that are unseen. For the things that are seen are transient, but the things that are unseen are eternal.” (2 Corinthians 4:16-18)