Hit Hard, and Hopeful

If October was a month filled with uncertainty and constantly wondering what new changes the new healthcare system would bring here in Kapsowar, November turned into a month with no time to stop and think at all. As we anticipated, mothers who decided just to "wait and see" at home eventually had to show up for healthcare - and with doctors at the public hospitals in our region on strike, there is only one place for them to come. We're so happy to provide care, and so overwhelmed with the task of explaining the new system to them, getting them enrolled, helping them figure out how much and where to pay to access their government healthcare benefits - all added to the routine task of providing "catch up" care. At this point it time, the hospital is running on promises from the government that we will eventually receive back pay for all the care we've provided. Obviously my salary doesn't depend on the government making good on that promise - but promises aren't keeping food on the table for healthcare workers and support staff at our hospital, in our county, or around the country. It's been a stressful month at the hospital.

On top of work stress, this month we dealt with our washing machine motor going out (we got it replaced), our solar panels dying (got them replaced too), more days of rain that I care to count, and increasingly frequent power outages which seem to only sometimes be related to the weather. November weather patterns (alternate high and low pressure) often trigger migraines for me (Kim), and that's been true in the last few weeks. Also, some type of allergic or exposure-related reaction would make you think that someone is using my face as a model for a horror movie - blisters, bruises, and rashes all around my eyes and a few other places on my face. Yuck.

Nonetheless, we've had a lot of reasons to be thankful this past month. On November 23, we celebrated the five year anniversary of our move to Kapsowar! Dominic has been cruising through his school year, and is scheduled to finish his SonLight Grade 4 curriculum this week! Kris celebrated the graduation of 12 students from the School of Theology, and we also celebrated the graduation of about 30 students from Serge's Chronologic Bible Storying course. 

And, we're getting ready for a visit to the US. For the first time since 2019, we'll be spending the holidays with our families in Washington and Montana. We would LOVE to get to visit with all of our friends, family, and supporters, but the reality is that this trip is too short to see everyone. However, we do have some needs while we're in the US, including for winter clothes and maybe a vehicle. If you think you would like to help, please visit this website (www.sokindregistry.org/30486) to see when/where we need help. Thanks so much! Looking forward to seeing you soon!

All in a Day's Work

October is a "special" month in our household. It's special, because every year in October, Gladys (our housekeeper) takes her annual, month-long leave. So every October, our family picks up all the routine household chores like doing laundry, washing dishes, baking bread, preparing all the meals. I know, I know - we're really suffering :)

But before you judge us TOO hard, please remember - we live in rural Kenya, where our incoming power and water are unreliable, so laundry (although we have a clothes washer) has to be done on those auspicious days when both power and water are available. Our laundry is hung on a line, and when rains come in the daytime, it has to be rescued from the line or left out to dry another day. We can buy something like Wonderbread at the local shops, but for a less highly processed loaf we make our own. Our milk comes from our neighbor's cow, so it has to be boiled, cooled, and put in the refrigerator. Again with our unreliable power, meal making may involve using the InstantPot or pulling food out of the fridge to microwave it, but we always need to have a backup (non-refrigerated, non-power operated) option in case the power is out. Of course, we do have a dishwasher. His name is Kris ;)

Our local "Wonderbread" came in a pumpkin shape this week! I assume this was a coincidence, but it made for a fun school lunch!

Gladys helps keep everything running smoothly in our household - food on the table, clean clothes in the cupboards, dishes washed and floors cleaned, milk properly processed and refrigerated, fruit, veg and eggs "sanitized" before we eat them. She makes it much easier to host visitors and meetings, because she can help us prepare food, and we can feel confident that the house will be clean and there won't be underwear hanging on the clothes line outside our front door when we welcome strangers into our home and community for the first time. When Gladys is away for the month, we miss her, and when she comes back from her leave, we are very grateful.

Before you think I'm really pitying myself, let me count our blessings. Kaylea, our intern through Serge, has been helping us with teaching Dominic since August. Having someone outside our family to help with education has really been life changing for us. Kaylea has also been helping another family with their curriculum for part of the day, so Dominic has time to sit in a classroom with other kids and has been learning a lot from the way other kids approach school.

School Lunch

In the last month, we've had multiple OB/Gyn visitors as well as multiple requests from others to come to Kapsowar. In fact, we've had so many requests that I've had to ask people to adjust their requests because we have too much help! As I said to them, after being in Kapsowar through "the Covid years," I never anticipated having so many volunteers that we wouldn't have enough work for them all! What a huge change in perspective!

OB Team

So, with all that in mind, our day on Monday looked SIGNIFICANTLY different than it would have looked in October 2020. Here's how the day went:

6:30am: Kris and Dominic left the house for basketball club

6:30am: I (Kim) woke up to a power outage, so I put coffee on the stove in the Moka pot

7:00am: Breakfast

7:30am: Washing dishes, putting clothes out on the line (washed in the machine the night before). The weather was looking pretty suspicious, so I hung everything that would fit on the back porch under our awning - it dries much slower in the shade, but doesn't risk getting a "bonus rinse" from the rain.

8:00am: Hosting Psalms and Prayers at our house. Kim led the reflection on Psalm 123, including a couple of songs on our new piano

9:00am: Kaylea takes over school with Dominic at our house. Kim - Walking into the hospital with two new visiting physicians. Quick meeting with the OB team (currently 3 OBs including myself plus our clinical officer) before running up to theatre to do a c-section. I wouldn't normally do a c-section when we have two other visiting OBs - but this is actually my third delivery of this specific patient in my nearly 5 years in Kapsowar, and so I wanted to deliver this baby (her fourth and final) myself. Kris - heading into the School of Theology to prepare for class.

11:00am: Guiding the two new physicians on a tour of the hospital and Kapsowar. It's always fun to see the hospital through a first-time visitor's perspective.

12:30pm: Run home to put on lunch (soup and homemade bread) for the "school kids" - Kaylea and Dominic, plus four other kids who Kaylea is also helping during the days. While I'm home, wash dishes and put away what laundry has dried. The power is back on, so I can boil water in the electric kettle to do the dishes, and move the fresh milk from the stove (where Kris boiled it earlier in the day and left it to cool) to the refrigerator.

1:30-6pm: Back to the hospital for afternoon clinic, answering phone calls and emails, and meetings. I'm still working on the call schedule for November - with multiple visiting doctors for the first half of the month, as well as some learners, it is pretty complex. Kaylea and I also meet to go through her work permit application again - we're still waiting on a response from Nairobi about what type of permit she qualifies for.

6-8pm: Homework with Dominic, supper (leftovers), and bedtime.

8-10pm: Walk in to the hospital to check on a patient - the "remote access" link for the hospital is down, so I can't check her lab results or nursing notes from home. Check in with the night-time nurses before heading home. The water supply is low, so we alert our neighbors to be on water conservation efforts and don't put in a load of laundry tonight.

As we always tell people who ask about our life in Kenya - the only thing that's predictable is that things are always changing. We're entering some new territory in our daily rhythms here, but one thing is sure - we'll be glad to have Gladys back at work tomorrow!

A few of our favorite things

Meal preparation in Kapsowar is a little different than meal preparation in North America. When the power goes out, plans for using ingredients out of the refrigerator, or using kitchen tools like an InstantPot or blender are also out the window. Basic ingredients are available in Kapsowar, but most "easy" or "ready-made" groceries have to be purchased in Eldoret. Add that to the unpredictability of an OB/Gyn's schedule, and you start realizing that a lot of flexibility and contingency planning are required. On the other hand, because our housework is labor-intensive, we have Gladys working in our home 5 days a week to help us with all of that work. She does a lot of our baking, some cooking, and a lot of meal prep and shopping for us.

Over the past five years, I've been building up a small repertoire of recipes for these various occasions. Chances are if you have joined us for a meal, you've sampled Bean and Cheese Enchiladas (with homemade enchilada sauce and guacamole), Pumpkin or Potato Curry with Jeera Rice and Gladys' Chapati, or Vegan Sloppy Joes with biscuits and coleslaw.

Over the past year or so, we've also had several members of our long-term community join us or be diagnosed with gluten and dairy allergies. Now I'm adding vegan and gluten free recipes to my mental cookbook. I've realized that cooking vegan or gluten free isn't actually as difficult as it sounds, but I had to adjust my approach. Instead of thinking of my favorite thing to eat (maybe pasta with alfredo sauce) and then trying to adjust the recipe to suit a gluten- or dairy- free diet, I've started making note of recipes that I cook that happen to be gluten- or dairy- free (or close to it) already. For example - making a chocolate cake gluten free is tricky using local or pantry ingredients. But making Monster Cookies or Oatmeal Bars gluten free is super easy, requiring no adjustment at all, or just a small amount of gluten-free flour. Most curries are already gluten free, and a lot can be made dairy free just by cooking in oil instead of butter.

Another note about meal prep in Kapsowar. In North America, I used to spend a lot of time running to the grocery store for missing ingredients while trying to prepare a meal. In Kapsowar, I've learned a lot about substitutions and eliminating ingredients. It's been really freeing to just cook with what's available, instead of making sure that I have every single ingredient and spice. I'm not saying my cooking tastes good all the time, but I hope that I'm improving over time!

After all that preamble...a few of my favorite recipes for dietary restrictions (adjusted to Kapsowar ingredients, etc) 

Paneer Makhani (Gluten free, serve with rice; freezes well)

3 T butter, divided

1 large onion, chopped

2 tsp ginger (I use the prepared refrigerated minced ginger and garlic to save time and washing dishes)

3 garlic cloves

3-4 roma size tomatoes

1 tsp salt

1/4 tsp cayenne pepper (increase to 1 tsp if your family tolerates spice)

1/2 tsp tumeric

3/4 c water, divided

1/4 c whipping cream

1 tsp garam masala

1/2 tsp sugar

2 cups cubed paneer - I fry this in oil to give it a little more texture. Paneer is pretty simple to make, but I usually buy it and freeze it, then pull it out as needed. The paneer can also be replaced with rehydrated soy chunks (called meal maker in Indian grocery stores) or probably some type of meat :)

Fresh cilantro to top

In an instant pot, saute the onion in 2 T butter for 3-4 min, then add the garlic and ginger. Add tomato paste, fresh tomatoes, salt, cayenne, tumeric, and 1/2 c water. Cook on high pressure for 3 min, natural pressure release for 5 min, then quick release the remainder of the pressure. Add 1/4 c water and blend with an immersion blender. (I often double the recipe, and remove half at this point to freeze for later.)

Add 1T butter, cream, garam masala, sugar, and paneer, then heat to simmering (I use the saute function for this). Serve with rice, cilantro to top.

Layered Refrigerator Salad (Can be made dairy free or gluten free by adjusting the ingredients, but I wouldn't attempt to eliminate the eggs. Mayo is dairy free, so eliminating the dairy is actually pretty easy)

Layer 1: 3c green leaf or romaine lettuce, washed and shredded (I use 2 heads of romaine or salinova(

Layer 2: 1.5 c small pasta, cooked, rinsed, and drained

Layer 3: 3 hard boiled eggs, sliced, sprinkles with salt and pepper

Layer 4: Red and/or green pepper, diced, one total (I've also used cucumber or shopped snap peas in this layer)

Layer 5: 16 oz frozen peas, thawed

Layer 6: 1c mayo plus 1/4c sour cream (I substitute an ingredient called Mala, which is basically plain yogurt) plus 1/4 c chopped green onion plus 2 tsp Dijon mustard

Layer 7: 1c cheese, shredded (I use gouda, cheddar, or something called "everyday")

Cover with plastic wrap and refrigerate several hours, up to overnight

Pineapple-Star Anise Sorbet (Gluten Free, Dairy Free)

(An ice cream maker makes this recipe much more convenient, but isn't strictly necessary. You can do a freeze/mix/freeze/mix process if you don't have an ice cream maker. The star anise in this recipe adds a nice contrast to the pineapple, which can otherwise be overly sweet.)

650g fresh pineapple

50mL water

200g sugar

1.5 - 2 pieces star anise

3T Lime Juice

Zest of 3 limes (if you're using fresh)

1 Tbsp Vodka (optional, prevents crystallizing)

Combine fresh pineapple, water, sugar and blend. Place blended "juice" and star anise in a pot and heat until the sugar dissolves, stirring occasionally. Turn off the heat, and place the lid on the pot. Leave for 40 minutes to cool and for the star anise to infuse the liquid. Remove the star anise, add the lime and zest if using. Place in the fridge until chilled (I usually do this overnight). Once chilled, churn in an ice cream maker or using your favorite method (I put mine in the KitchenAid ice cream maker attachment for 25 minutes). Freeze for at least six hours, overnight if possible.

New Things!

 August has been an extremely busy but fun month.

We went to Eldoret and stayed at an AirBNB to do some shopping, and to watch the Olympics!

I (Kim) flew to Nairobi for a day. I arrived at 8:30am, met my driver (friend of a friend) who took me around the city to visit two used piano stores, and then back to the airport by 2pm (see below). After trying out about 20 pianos, I put in an offer on one, and it was delivered to our house, installed, and tuned just 5 days later!

Picking up Kaylea, our new intern, at the airport in Nairobi

First Day of School with Miss Kaylea!

Thankful that Dr. Allan is here helping with OB/Gyn while we get Kaylea settled!

Our hospital laundry has been "benefitting" from extra rinse cycles during a particularly wet rainy season. We're grateful that the sun has come out the last three days, and we've had dry laundry AND hot showers.

Meanwhile, work at the hospital is ramping up, as it usually does this time of year. We're grateful for the short-termers who help relieve some of the work load and call responsibility. Kris is getting ready to start a new school term, and Dominic is now doing most of his school work with Miss Kaylea (just a few subjects to add back into the schedule next week). As a new school year begins in N America, we hope your Septembers are full of new, fun things too!

Moving on

 

My mom bought me a new pair of clogs when I entered residency in 2019. These shoes have seen a LOT - of birth and bodily fluids, running for emergencies and standing for hours, the happiest and saddest days of women's lives. 

After resoling them twice, holding them together with tape, and generally causing embarrassment to all my coworkers based on the poor condition of my footwear, it's time to move on. I have a replacement pair - in good condition, but not yet molded perfectly to my feet. They feel strange and new - not bad, just not comfortable yet.

It's a fitting (pun intended) metaphor for some changes we're getting ready to embrace. Recently, another member of our community volunteered to take over housing and transportation coordinating, a job that I had reluctantly done for a couple of years. Next month, we will be welcoming our first intern from Serge, who will be helping us with some of our education on station. And in December, the number of long-term OB/Gyns at our hospital will double, as we welcome Abby, coming to work with us through to Post-Residency Program (the same program that brought us to Kapsowar)! 

These changes are SO exciting! Just like my old worn out clogs, we're ready to say goodbye to the responsibilities of coordinating visitors arrivals, departures and housing; of being the primary educators for Dominic; of being the only OB/Gyn at the hospital. But at the same time, we're saying goodbye to something known and entering another time of change and adjustment. Some things are a little uncomfortable or don't feel quite right yet. But we know the old way just wasn't working best, and we're praying that we'll learn, grow, and adapt until the new "shoes" become even better than the old.

(Financial) Year End

We just reached the end of Serge's financial year. Now that all of our receipts are submitted (I hope!) it feels like a good time to let you know about some special projects that we have been able to support due to your generosity (through our accounts at Serge, World Medical Mission, and Great Commission Fund). The hospital and school of Theology have MANY other projects going on, these are just a few small areas that we've gotten involved in thanks to a surplus from you all!

School of Theology: Student assistance fund. Many of Kris' students have a difficult time raising money for their own school fees while also paying for their children's education. We don't want tuition to be a barrier to keep adults from furthering their own education, or providing for their families. Thanks to those of you who have donated specifically toward this student assistance fund.

Kapsowar Hospital: Infrastructure is vital to safe patient care. Our hospital's generator was receiving somewhat routine maintenance, but was struggling to keep up with the growing demands of the hospital. A generator is absolutely critical given the unreliable nature of our "grid" power. As Kris often says, the grid power goes out about once a day here on average. Usually, it's out for a couple of minutes. Sometimes, though, it's out for hours - and we have no way of predicting when that will be. Even a minute-long power outage can be really dangerous for a patient who happens to be undergoing surgery during that time! So the hospital generator needs to run smoothly and reliably for our patients' safety. 

We're grateful for a donor who responded to this specific (and perhaps not very glamorous) need and provided funds for a professional evaluation and overhaul of the generator. 

The hospital relies on a lot of donated equipment to reduce costs. We have anywhere from 4-6 ultrasounds in the hospital, all in various states of disrepair. In our radiology "suite" (two rooms, one for xray and one for ultrasound) we were using three ultrasound machines - only one was able to export files to the computer system which is needed for health insurance "prior authorization" but the pictures were not great quality, (another) one was capable of measuring color flow (needed to diagnose blood clots in the legs, characterize various tumors, and evaluate hearts), and a third gave pretty good images, but the lid was cracking off and every time we opened the machine, we were afraid it might be the last time before the lid falls completely off! During a trip to Nairobi, our hospital's medical director found a used ultrasound for sale that would take on the work of all three of the partially-working machines! The price was exactly what we had agreed to contribute as a surplus from our Serge fund toward upgrading hospital equipment, and we were able to get the machine to Kapsowar within about 2 weeks!

As we've mentioned before, your contributions help us with a lot of big and small expenses of life on the mission field. We're so grateful every day for the ways that you give, to help us serve the people in our community. Thank you!

The Storm is Passing Over

Recently I've found myself humming this song at various points in my day. We sang this in choir sometime in high school (a shocking number of years ago) and it came back to me one day as I watched the clouds rolling out of our valley and the sun breaking out over our town. 

The Storm is Passing Over - Detroit Mass Choir

(If you're interested in the history of this song - or at least, the original composition and composer, you can find it here: https://hymnary.org/text/courage_my_soul_and_let_us_journey_on)

"Stormy" is a good way to describe the last month, both literally and figuratively. Kenya has received more rain that in can safely handle, and flooding has displaced many people, taken lives, and swept away planted crops. Kids were unable to return to school when originally scheduled. Meanwhile, the doctors who work at government hospitals went on strike, followed closely by the clinical officers (mid-level providers). Last week, the nurses announced that they would also join the strike from Monday May 13. For those who can afford to pay, private hospitals remained open. For those who cannot afford to pay a huge deposit to enter a private hospital, or who have an emergency, mission hospitals like ours remain an option - so we've been absorbing a lot of extra work. Last week in the course of about 36 hours, I did 11 surgeries - not an terribly unusual number for me, but the majority were gynecologic emergencies (ruptured ectopic, ovarian torsion, tubo-ovarian abscess to name a few), rather than c-sections which usually make up 80-90% of my surgical cases.

On Tuesday afternoon, the government announced that they had reached a deal with the government-employed doctors who are now returning to work. From what I can tell, the nurses have therefore called off their strike. The last few days have been dry and sunny, with only a small amount of rain at night, and though the ground is still boggy ("squelchy" is the word that always comes to mind), the kids will be returning to school next week. 

During the busiest days of the strike, though tired and worn, it was easy to remember to lean of God's grace - to get through a day (and night), to pray for a healthy outcome for a mom and baby, to remember that my continuous efforts will never be enough to pull a patient through a life-threatening illness - but that God can do all that, and more. 

The storm might be passing over. Or, as our 4-year-old neighbor keeps reminding us, this might just be the calm at the eye of the storm. We may be facing a lighter and easier week ahead - or maybe not. For now, we're basking in the sunlight, thankful for the respite, and joining in singing "Hallelujah" - praise be to God!

Inspiration

Sometimes, I need a little inspiration in my work, home life, and faith. This month, I want to share two sources of inspiration and encouragement. Enjoy!

The first is an article written by Dr. Eric McLaughlin, a graduate of the Post-Residency Program (World Medical Mission) and a physician at Kibuye Hope Hospital in Burundi - he and his wife Rachel are also our team leaders through Serge. He's also written an excellent book, Promises In the Dark: Walking with Those in Need Without Losing Heart. 

https://www.christianitytoday.com/ct/2023/november/i-stumbled-in-steps-of-good-samaritan.html?utm_medium=widgetsocial

The second is a new video from our local videographer and teammate, Regan, featuring our two plastic surgeons who have been doing facial reconstruction surgery for patients from outside of Kenya with limited access to healthcare and no access to specialized surgeons. These patients stay in Kapsowar for months at a time to have multistage surgeries performed.

(I'm not very familiar with Vimeo and can't figure out how to embed the video, so you'll just have to follow the link or search for "Becoming Whole: Facial Reconstructive Surgery at Kapsowar Mission Hospital" on the Vimeo website. https://vimeo.com/932169521 )

Fat Tuesday

This week, we celebrated our FIFTH "Fat Tuesday" in Kapsowar. We started with pancakes in 2020, quickly realized that pancakes are entirely too time consuming to make, require a lot of cleanup, and are difficult to eat outside (as necessitated by Covid in 2021), so we switched to doughnuts and haven't looked back! 

The idea of Fat Tuesday (Mardi Gras, in French) was - traditionally - to use up the last of the fat and sugar stores before starting a Lenten fast. Doughnuts definitely meet that criteria! (I'm not going to write about the WHY of a Lenten fast here, but I did find a really nice article about Christian fasting at this blog: https://gravitycommons.com/how-to-fast-for-lent/  - I'm not endorsing the whole website, I don't know anything about their organization, but I really liked their explanations of why and how to fast.)

Fat Tuesday gives us an opportunity to meet with our community, talk about our experiences with Lent and Easter (some of us grew up in very "high church" backgrounds, others grew up very evangelical and have never been exposed to the church or "liturgical" calendar, many of us fall somewhere in the middle), and discuss why or how or if it is important to prepare for Holy Week and Easter. 

Here are some photos of Fat Tuesday, and Dominic's favorite doughnut recipe, inspired by reading Farmer Boy and adapted from a recipe we found online:

African Twisted Doughnuts (adapted from www.preciouscore.com)

Makes: 24 doughnuts

12 oz evaporated milk (see recipe)

2-1/2 tsp active dry yeast

3 T sugar

3 T melted butter

1 tsp salt

1 egg

4 c all-purpose flour

Cinnamon sugar, powdered sugar, or glaze of your choice

1. Make evaporated milk: Boil 3-1/4 cups whole milk or shelf milk until it is reduced to 1-1/2 cups (12 oz) OR warm up 12 oz of evaporated milk (from a can) 

2. Let evaporated milk cool until it is just warm to touch. Stir in yeast, let rest for 5 minutes

3. Whisk in sugar, butter, salt and egg

4. Stir in flour with wooden spoon, then knead dough for 5-7 minutes, adding flour as needed

5. Cover and let rise for 1 hour or until doubled in size

6. Roll dough out into a rectangle, then cut into 24 strips (I do mine as 2x12)

7. Create twists by rolling into "snakes" with hands moving in opposite directions. Keep twisting the dough until it twists up, then pinch off the ends (this takes a little practice the first time but it gets easier!)

8. Fry in oil at approximately 350 degrees (I just get the oil hot until it forms bubbles around a small piece of dough when dropped in), turning after about 1-2 minutes

9. Roll in cinnamon sugar immediately, or sprinkle with powdered sugar after cooled, or try a glaze

Photo Dump!

 In no particular order, without explanation or excuse - photos from the last 6 weeks.

Chameleon hunting is a popular sport in our neighborhood. As far as I know, all the moms have a same-day capture and release policy. Chameleons don't thrive in captivity.

Heading to school with Dad and Nala

We love guest teachers, especially those with special skills!

Heading to Nairobi for passport renewal meant a great opportunity to check out some new restaurants! Dominic chose (no surprise) a chocolate croissant and vanilla milkshake for lunch. What was a surprise was the size of the croissant!

Some mornings can be a little chilly in Kapsowar.

First day of Grade 4! Finally learning some keyboarding!

Olie bollen for New Years Day

Obviously I'm not a food blogger - We made Indian food for Christmas lunch

No, this is not a flashback - Christmas Eve Potluck was cancelled last-minute due to a Covid outbreak at our station! We collected and redistributed food from the unaffected households, and then had an outdoor meal with what remained with a couple of our neighbors

Kapsowar's first (I think) Christmas Cookie Exchange was a great success! So many yummy treats to enjoy!