Christmas through a child's eyes

My grandparents had two nativity "sets" that I remember playing with as a child. One was a set of small figurines, copper-colored and (in my opinion many years ago) fragile and very beautiful. The other was a wooden puzzle - all the characters fit back into the stable-shaped tray but only if you could arrange them just so. 

This year, I pulled out our two nativity sets and did something I've never done before...I asked our son Dominic (6 years) to set them both up. He did so enthusiastically and willingly. And looking at his setup, to my shame, the first thing I did was reach out my hand to fix them.

You see what's wrong with them, right? In a nativity scene, you're supposed to be able to see the faces and all their intricate little details. You should see the shepherd's grubby face and the dirty little lamb. You should see what gifts the magi have brought to the baby King. And instead, all the characters in Dominic's nativity setup have their faces turned AWAY from the audience and toward...oh.

Just as I grabbed the first figurine and started to flip him around to face the "correct" direction, I got it. I was milliseconds away from correcting Dominic by turning the figures' faces AWAY from Jesus. Wow. I have a lot to learn, and my 6-year-old probably taught me the most important lesson. In this holiday season, in this crazy season that covid and politicians and social media have produced, in this horrible season when families and churches and neighbors are torn apart, please take a moment and consider a 6-year-old's nativity. For a moment, let's turn our eyes away from the audience, from each other, from the world and all its troubles. Let's consider this story, of a creator God who came to be born as one of His created, who came to show us a new way to be human, the right way to love God and neighbor and self and creation, who established a new covenant between us and God by taking the brokenness of creation and created into His body and blood. Let's just, for a moment, consider what this world could be like, if we followed His example of love.

Merry Christmas. Peace and love be with you all.

OB/Gyn Outreach

In late October and early November, I was able to leave the OB/Gyn department in the very capable hands of a short-term volunteer, Dr. Allan, and finally visit many of the hospitals and dispensaries that refer patients to me on a daily basis. Since our arrival in Kapsowar over 2 years ago, I had not stepped foot into another clinic, health center, or hospital in Kenya (except for a brief meeting at the regional referral hospital). Our hospital administrators helped me set up some visits for a little meet-and-greet, some brief education, and promotion for the hospital.

The health care system in Kenya, as in many other countries, is a tiered system. What I've described below is just my understanding of how things work and is NOT an official guide to health care in Kenya!

Lowest level - Dispensaries, where nurses see and treat common ailments and often perform maternal and child healthcare including vaccinations, antenatal (pregnancy) care, and routine deliveries. 

Health centers - May have beds for inpatient care, again perform maternal care including deliveries, possibly some laboratory tests beyond the basics.  A clinical officer (a little like a nurse practitioner) is  likely the highest trained provider in a health center.

Sub-district hospital - Inpatient care and possibly c-sections or other emergency surgeries if staffing is available. Fully trained medical doctors may or may not be available; sub-district hospitals may be staffed by medical officers (more training than a clinical officer, but not a full Medical Doctor; somewhat like a General Practitioner in the US long ago before residency training became the norm).

District hospitals - Provide more comprehensive medical and surgical care and may have specialists either full time or on a visiting basis.

National or Referral Hospitals - Larger referral centers with multiple specialists.

Our hospital is a Faith-Based Hospital and therefore doesn't neatly fit into any of the above designations. We currently have 3 surgeons (1 US-trained and 2 Kenyan-trained), 1 medical officer (Kenyan-trained), 1 family-medicine doctor (US trained), 1 OB/Gyn (that's me), 1 dentist (US-trained) and 4 family-medicine residents providing care full time in our hospital, plus whatever short-term volunteers are around. We receive referrals directly from dispensaries and health centers, and we refer patients on to the regional referral hospital if they need a higher level of care than we can provide. Reasons for referral may include need for ventilation, a surgery we couldn't provide (neurosurgery, some cancer surgeries), medical care such as dialysis or chemotherapy, even blood transfusions if our supply is low.

Our team for the OB/Gyn outreaches included myself, a chaplain, a nurse who runs our antenatal clinic, a finance/insurance person from the hospital, and of course our driver. We invited nurses, clinical officers, hospital administration, regional chiefs and anyone who has a stake in women's healthcare to attend, and we were overall pleased with the responses we received. 

After introductions, I led a brief discussion on common reasons for referral and encouraged the providers who do the most basic care and history-taking to be on alert for common diseases or red-flags in pregnancy history that should result in early referral to try to prevent some of the more common bad outcomes in pregnancy. 

[A common example - someone with three prior c-sections is advised at her antenatal visit at 38 weeks to return to the hospital "when in labor." This mother risks uterine rupture and both maternal and fetal death if she lives far from the hospital and goes into labor during the night or during a bad storm. Instead, she should come to see me for a consultation - ideally before 38 weeks - and have her c-section scheduled before labor begins. Another common example - a first-time mom at her 41-week visit is told to go home and return when she has labor. This mom risks returning with fetal distress or stillbirth, or at the very least obstructed labor as baby becomes bigger and her placenta ages and is less able to supply her baby with the oxygen it needs to be healthy. This patient should be referred to me for evaluation and safe induction of labor.] 

After the education portion, we ended with many, MANY photos of the groups. I'm the one wearing the white coat... 

Wishing you a happy (belated) Thanksgiving, blessed Advent, and Merry Christmas! See you again in the New Year!

Kim

Safiri Salama

 If you read our blog post last month, you know that after a LONG delay, my parents and grandma were finally able to visit our home in Kapsowar. Their visit came in the middle of a long and somewhat difficult season for us due to yet more transitions within our small missionary community. We were SO grateful for the help of some short-term volunteers who made it possible to take time away from our jobs and responsibilities in Kapsowar and get some much-needed rest. AND, we were finally able to see some more of this beautiful country. 

When my dad left off writing, we were getting ready for our safari. What he didn't mention was that we were also preparing to meet Kris' parents in Nairobi. So Dominic got to travel to Masai Mara for the first time, with BOTH sets of grandparents and one of his two great-grandmas. I don't know if I've ever met such a lucky (or overindulged) six-year-old! We really cherished that time together and created lots of fun memories. 

So without further introduction, some pictures from our time together.

Among the first animals we saw at Masai Mara - a pair of brother cheetahs! These were Kris' favorite.

A pair of lions relaxing in the hot afternoon sun

Mama cheetah with one of her two cubs

Beautiful landscapes

A pride of lions feasting on the morning's kill - a baby giraffe

Studying up on Kenyan wildlife

Cape buffalo

Last safari drive - beautiful rainbows and animals on parade

Elephants

Ostrich

Hyena

Twin baby hippos outside our lodging

Grandma and Dominic taking selfies with Queen Elizabeth the Rhino

Hyrax babies (relative of the elephant)

Dominic with 5 of his 6 grandparents/great-grandparents

The pictures just don't do justice to the beauty of the country, or the wonderful visit we had with our families. Thanks again to them for visiting, to the short-termers who made our trip possible, and to our community for supporting us and encouraging us to take a vacation!

Note from a dad

This blog post comes to you from the same place as always, Kenya, but from a different author. Hello readers! This is Kim’s father, Clarence, writing to you during my/our visit to this beautiful country. Accompanying me on this “finally” trip are Kim’s mother, Lois, and her grandmother, Vonnie. Covid devastated our plans to visit in April of 2020, so this visit with Kim, Kris and Dominic has been an answer to a long time of prayer. 

Arriving in Nairobi. Apparently plaid is the preferred clothing for travel in our family!

This is a first time in Kenya for the three of us. Recently we discussed our strongest impressions of Kapsowar and the life Kris, Kim and Dominic are living here and want to share them with you, hoping to give you a perspective from newcomers. We have all been blown away by the beauty and geography of this area; it is so verdant and lush. Plants grow everywhere, easily. Not so easy is the planting, tending, and harvesting of crops due to the steepness of the terrain. There are no tractors hauling plows, cultivators or harvesting equipment here. We’ve seen acres and acres of maize/corn, but all that we’ve seen are managed through hard manual labor. Maize is the predominant crop due to its dominance as a staple food source for people.

Taking a walk around Kapsowar

Livestock, again very abundant, seem to subsist quite well on grasses found on hilly pastures and roadsides. Cows, sheep, goats and occasional pigs and donkeys we saw all appear to be quite healthy, not to mention well practiced at slowing down traffic whenever they feel it appropriate. 

We all notice how comparatively more time-consuming everyday activities are here. Food preparation, milk procurement and boiling, having consistent electrical power, shopping, getting clean drinking water—things that are quite easy and automated for most of us—these things all take more effort and time. I was counting out scoops of coffee grounds for the coffee maker yesterday morning and “bleep!” -the power went off. (The “bleep!” represents the sound the microwave makes when the power goes off, not the word the grumpy grandpa says when he doesn’t get his morning coffee.) In full disclosure, they have a house helper at times throughout the week, but Kim or Kris would have to discontinue or severely reduce their workloads to perform these basic tasks were it not for Gladys’s cheerful assistance. 

We made some special family recipes including popcorn cake and stroopwaffel

And that work they do is so vital! We were able to join Kris at the theology school. The majority of Kris’s students are farmer/pastors. We joined them for worship at their chapel service and for chai afterward. We attended a class on sermon preparation. We witnessed eagerness for learning as well as joy in song and worship and earnestness in prayer. We had delightful conversations with students and felt very welcomed by them. Kris deals with some challenges at the school, most caused by scheduling issues, but those who are eager to learn are faithful and want to improve their mission to their home churches. Another task Kris took up is sorting and shelving books to create a sizeable, workable library on the campus. We’d heard about this work, but were all impressed by the number of volumes there—all or most of which have been donated to the school. 

Trying on new gifts from Beppe (Dominic's other great-grandma) in the morning

One of the reasons we were able to finally visit Kapsowar is that an ob/gyn doctor from Phoenix stepped up and arrived recently to provide help and relief to Kim for a total of 8 weeks. During the first half of our visit, Kim still had a fairly “normal” hospital schedule and was also on call for part of it. Therefore, we’ve been able to witness a number of things firsthand: 

 1. Wow! She’s busy. 

 2. Babies and their laboring mothers and/or women in pregnancy-related distress do not “schedule” their times of need. *See #1 above 

3. We’ve been aware, but now have first-hand knowledge that our daughter really is a doctor! We saw her at her work. Together, we witnessed her perform an ultrasound on a woman expecting triplets. Each of us were able to witness Kim performing some sort of surgery. What a fantastic and humbling opportunity for us, and what a strong confirmation that the work done by Kim and others at the Kapsowar hospital is so important and life-changing.

Getting ready to watch surgery

Kim has written in past blog posts about the need for more doctors in this hospital community. The pandemic has changed a lot of things and it is evident that the talent resource is stretched. But also very evident is the loving and caring community of doctors and staff who ARE there, working together despite limited human and physical resources. They draw on their community of faith and encourage one another in times of worship, study, and prayer. As Kim and Kris’s family, we want to humbly and thankfully offer words of gratitude to Dr. Allan from Phoenix, whose selfless gift of time and talent made it possible for Kim to ease up on her schedule and allow us to visit. Thank you, Dr. Allan! 

Our next adventure begins. Since Kim is free to take a break and the theology school has a one-week recess, we are about to head out on safari. We expect this will be an awesome conclusion to this visit and a special time for our family. 

Four generations in Kenya

For those of you who faithfully read this blog—Thank you! Kris, Kim, and Dominic, their mission community, and their families appreciate your prayers and support more than you can ever imagine. Asante-Thank you. Asante sana-Thank you very much!

Reality Check

Every 4-6 weeks, we have a zoom meeting with our friends at the Post-Residency Program (PRP) and the other Post-Residents working in East Africa.* Like all organizations, I think the PRP realized that we're not going to be able to see each other in person as often as we used to, so these regular zoom meetings are a great chance to check in, give updates, provide encouragement and share tips, and remind each-other that we are part of a bigger team. We had one such meeting earlier this week, and I'll be honest, it was a struggle. Having to summarize the condition and concerns of your hospital, your family, and your community in a 5-minute update can be difficult. Especially when your updates become consistently more bleak from month to month. 

So, in the interest of being honest and keeping you in the loop, read on for the reality on the ground in Kapsowar. But before you do, consider reading this article by someone who actually has long-term experience in the field of medical missions and can speak more clearly to the challenges in medical missions in the age of COVID. 

https://www.medicalmissions.com/resources/32921/what-is-the-future-of-medical-missions 

Now for the situation in Kapsowar. In the interest of not sugar-coating it for this blog, I've take excerpts of an email I recently wrote to a mission organization, removing details to protect the privacy of our colleagues: 

When our family arrived, there were 2 graduates of the Post-Residency Program serving in Kapsowar as long-termers (11 years in Kapsowar and 6 years respectively). They were both family medicine docs who were trained to do OB care also. Their families have both relocated back to the US. One of those families would love to return to Kapsowar, but the reason they left is that one of their family members is suffering from long-COVID syndrome and currently cannot live at high elevation (we're about 8000 ft here). 

The other physicians here include a plastic surgeon and his wife (US-based). They are a rock in the missionary community here, but also do a lot of international travel to places even less-served than Kenya. When they are out of town, I am the longest-serving physician in Kapsowar. We also have 2 Kenyan surgeons. One arrived 18 months ago and the other, about 2 months ago, when our longest serving Kenyan surgeon left for another mission hospital. 

A new PRP family medicine doc started here in February 2021. He is not trained for OB care and is busy directing our year-old family medicine residency program and helping manage the housing/station with his wife, who also homeschools their 3 kids. They are extremely busy and I think it's fair to say, overworked. We have a dentist, who is also in the PRP and has been here almost a year. 

SO, in summary - in the course of about a year we went from a community with multiple different specialties, lots of experience, and tons of knowledge, to a community of brand new residency graduates, brand new to Kapsowar, (many brand new to Kenya) and many different responsibilities that we weren't anticipating like running a residency program or being responsible for housing. We have two more short-termers scheduled to come this year, and then we're not sure what help will come and from where. Welcome to medical missions, right? 

Despite all the challenges here, our family loves Kapsowar. We know that we'll find challenges anywhere, but there are a lot of things that excite us about this community and about our opportunities here. Kristopher teaches theology at the seminary located immediately adjacent to our hospital, and has really enjoyed building relationships with his students, most of whom are already pastors in the Africa Inland Church but have no or limited formal training. I am crazy busy at work but also have opportunities to train residents and hope to be able to start some community outreach programs in the future. Dominic has a ton of freedom to explore, play, and just love being a kid within our beautiful community. Ideally, if we can figure out a solution to educating Dominic, we would be happy to stay in Kapsowar and continue our work here.

We also know that we're not the only people undergoing challenges during the COVID pandemic. So many peoples' jobs and careers have been interrupted or lost, and so many others have lost their lives or been affected, possibly irreversibly, by the disease. I feel especially for those healthcare workers in the US and other developed countries where vaccines are readily available. The work of caring for critically-ill people who had an opportunity to vaccinate but didn't, and the trauma of watching resources diverted to a now-avoidable pandemic, is doubly-traumatizing and I truthfully don't know if I could continue to work in that situation. 

I'm not really sure how to wrap us this post...if you've stuck with me this far, all I can say is (1) thank you for caring, and (2) please continue to pray for us, and so many other workers who are trying to stick it out in difficult places, whether that's an ICU in Mississippi, doing disaster response in Haiti, responding to violence, war, and famine worldwide, or in a tiny hospital in a small corner of Kenya.

 

*For those of you who are unfamiliar, the Post-Residency Program is a program run by World Medical Mission, the medical arm of Samaritan's Purse. Physicians who have completed their residency training recently (about 5 years or less prior to applying) and are interested in long-term medical missions are hired into the Post-Residency Program and then sent to work in a mission hospital, ideally under the supervision of a mentor within their field. We are fully trained physicians who could be working at any hospital in the US - but we've chosen to work in low and middle income countries instead, where access to medical care or specialty care might be a problem. The great thing about the PRP is that they provide a salary, health insurance, language training, and an amazing amount of support to their physicians, so we don't have to fund-raise for those things...but only for a limited time (about 2 years). During the last year of our time with them, we need to start transitioning to another organization or "sending agency" that can keep us in the field long-term.

What will you do on your "S-Days"?

Dominic attended preschool for about 12 weeks in Nairobi, where he had two lovely women caring for and teaching him: Teacher Dorinah and Teacher Esther. He learned many important lessons, most of which had nothing to do with academics. One song he learned has stuck with him - a little diddy to remember the days of the week.

Sunday, Monday, Tuesday, Wednesday,

Thursday, Friday, Saturday.

Seven days are in a week,

What will you do on your "S-Days"?

Dominic saying goodbye to Teacher Esther - obviously pre-COVID!

Our "S-Days" have varied a lot in the past year. During the peaks of COVID, while our hospital was not yet receiving volunteers or visitors and the country was under lockdown, our weekends were pretty quiet. Being busy at the hospital, and being a pretty strong introvert, I have to say that I didn't mind that too much. I had lots of time to cook, bake, knit sweaters (four in the last 12 months) and prepare Dominic's homeschool lessons. Kris liked to use the weekends to workout, read, chop firewood, and play with Dominic. For Dominic, of course, every day is pretty much a weekend - the only difference is no school in the morning and maybe a chance to watch a movie or play a board game at night. We have decided not to take Dominic to in-person worship services on Sundays as we know COVID is still making its way around our community and we don't know which variant it is, so we have been participating virtually in worship services from Vancouver First CRC, where Kris and I attended church over a decade ago!

I had several opportunities to attempt pie-baking during lockdown. So happy to have rhubarb in Kapsowar!

Now that travel restrictions have eased somewhat, and we have more visitors coming in and out of Kapsowar (and fewer "permanent" households to welcome them), our weekends look different. More socializing, coordinating trips to different hikes or tourist attractions, figuring out who is coming and going in the week ahead, worship services at station, campfires, and recently, shopping trips to try to furnish our "new" (previously unfurnished) house. I may not be the biggest fan of Ikea, but I can tell you that after two months without a dining table, even Ikea is starting to sound pretty good! 

Enjoying a meal at a new restaurant in Eldoret with our new friend Anna

Dominic after a long hike

An outdoor potluck/worship service. I'll never figure out how the four little boys got chairs while the grown-ups are sitting on the ground!

After nearly 12 months of routine, it has been nice to see some new (and old - I mean familiar!) faces, to experience Kenya through their eyes, and to be encouraged by them. Now that the North American summer is drawing to a close, it looks like our weekends will be settling back into the old routine for a while. During those quiet times, we're thankful for memories with new friends, and looking forward to future visits!

A rainy day

 I'm sitting at my bedroom window at 3:30pm, so grateful for the short-term doc and my clinical officer who are covering clinic so I can take a late lunch break. This blog post is late for many reasons...mostly because I am waiting for a replacement part for my laptop, but also because every free moment I've been working on uploading cases into the computer for my oral board exam. The final patient is in, and the totals are about 100 gyne admissions (some who underwent surgery, most did not), about 400 OB surgeries or deliveries, and the required 30 outpatient clinic visits. Someday I'll count up how many babies, c-sections, and surgeries those numbers represent but for now, I'm just happy to be at the next step...some significant editing to get the list "submission-ready."

Our family has also been focused on other matters in the last week or so. Kris' niece, Samantha, became ill with e. coli at a family reunion, and is now in the ICU in Salt Lake City. We're grateful for technology that allows us to be in close contact with Kris' family, and for regular updates on CaringBridge. But it's times like these when we recognize that living in Africa means not being physically available to our families every time we want to be. Please join us in prayer that Samantha will wake up without seizures or ongoing neurologic problems, and that her kidneys and the rest of her small body will have a complete recovery. 

Those of you who receive our newsletters have already read this request OR will read it in the next month, but it bears repeating here. We are seeking help with education in Kapsowar. Dominic has significantly benefited from some short-term volunteers who have helped out with his homeschooling during their time in Kapsowar. Actually, I should say that our whole family has benefitted. Kris and I are therefore very seriously seeking someone (or some 2 or 3) who is willing to come and help us with the very important, but sometimes neglected or poorly-implemented, task of educating our child. If only one kid sounds boring to you, there are other kids around who would also be available for shared classroom learning opportunities! If you or someone you know is seeking adventure, loves kids and education, and is willing to commit to 3 or more months in Kenya,  PLEASE send me a message! 

Well, I think I've overstayed my lunchbreak and should get back to work. Thanks as always for your thoughts, prayers and messages!

Answers to Prayer

In the past 14-plus months, there have been a lot of things to complain about, and believe me...I have done a LOT of complaining. If you don't believe me, just ask my husband...or mom...or coworkers. But we have also had a LOT to be thankful for. Some things that come to mind are: - living in a community where Dominic could go outside and play with his friends every day, while many kids (and parents) around the world were restricted to their own homes - Kristopher and I received both doses of a well-studied vaccine in Kenya, although we had initially thought that we would have to travel back to the US to receive it

- a short-term visitor who came despite the pandemic to give me a vacation last November

- despite many of our family members contracting COVID, no one has become critically ill 

Two major things have been weighing on me in the last year, and some of you can probably guess what they are. The first is the OB/Gyn oral board exam, which I have been preparing for by collecting "cases" since July 2020. The exams happen every year between November and January, after a candidate's case list is reviewed and approved. Last year (the 2019-2020 cycle) the oral exams were cancelled and candidates took a computerized exam instead. Let's be honest here...oral exams are intimidating, and I've been praying that the same change would happen for the 2020-21 cycle. Last month, I started getting pretty serious about trying to find someone to cover OB at our hospital while I return to the US in the late fall to study for and sit the exams. Well, sometimes prayers are answered in ways we don't expect. Through a series of miscommunications, it turns out that I am not eligible to take the exams this cycle.

Thankfully, my case list can still be submitted for review, and I'll be able to transfer my application to the 2021-22 cycle. As much as I just want to get this exam over with, the barriers to getting coverage at the hospital this year have been pretty huge. In the long run, although this isn't the solution I would have chosen, I think it will end up working better for everyone. 

 The second big weight for me and our family has been homeschooling. It becomes more obvious with each passing week that trying to squeeze Dominic's education into the two hour window between waking up and me getting to the hospital is not a healthy situation for any of us. We've been praying for a solution, and haven't found any solutions for the long term, but for the next two weeks, our answer to prayer has come in the form of Anna and Caleb, a mom-son team who came as short-term volunteers through SP. While their other family members are working at the hospital, Anna and Caleb have taken on the homeschooling responsibilities and are doing a MUCH better job than I could ever do. Dominic loves them, and we have time to just be a family in the morning.

We have NOT been praying for a new house (especially as an open house means the departure of more good friends from our community) but we are nonetheless thankful to have moved to a larger, quieter, and WARMER house this past weekend. Again we were so thankful to have help from friends and neighbors as we quickly got all our things moved over. We have a lot of organizing to do, and furniture to buy, but we're so excited about the change!

Things we got in the mail

One thing I have not yet become comfortable with in Kenya is the mail. Yes, there is a Kenyan postal system. And yes, it does deliver mail to us via the hospital. In fact, for an insanely high fee, we could even receive parcels. I just haven't taken the time to actually mail anything myself. Maybe that's a goal for next month... 

Despite not knowing how it works, we have received some fun things in the mail while living in Kenya. Our first piece of mail was a lovely homemade card from my Aunt Catherine in Canada. I think she sent it (or at least it was still in the postal system) during the early days of COVID, because it arrived looking as though the envelope had been drenched in either hand sanitizer or bleach likely courtesy of Kenya Post (although I guess it could have happened in Canada also). Regardless, it was really nice to receive a handwritten note! 

 Here's a picture of something my very talented brother and sister-in-law sent to Dominic (we assembled it) for his birthday this year. They have gotten into designing and laser cutting wood crafts. They also sent a lovely Christmas ornament which I can't find a picture of.

A while back we signed up for the Adventures in Odyssey app, and checked a box to receive their free magazine. We assumed it would be delivered to our billing address, which is my parents' house in Seattle. Imagine our suprise when this came to the hospital! Dominic read these magazines over and over, and brought them over to show all our neighbors.

This didn't arrive by Kenyan Post, but was sent to my mom last February for her to bring along to us in March. Obviously that trip got canceled due to COVID, but after a few delays, we finally received this painting from my cousin's daughter, a birthday card for Dominic's 5th birthday, plus several other letters and small items this past week.