Dr. Knife

We met on a dirt road in front of a vegetable market. He was lean (maybe underfed), well over 6 feet tall, and wearing a tattered suit. He was straddling a bicycle seat spinning his pedals faster and faster but not going anyhere. Looking closer, I saw his back wheel hoisted off the ground several inches by a heavy kickstand. Rising above his handle-bars was a cylindrical stone-wheel spinning at a revolution matching his back wheel. Attached to this stone was a rubber “chain” threaded to his back spokes. I approached the man. He stopped pedaling and we greeted each other.



I asked curiously, “What is this?”

“I will show you what I do,“ he replied.

He pressed down on the pedals, his back wheel began to rotate, and the stone wheel at his hands started to turn. He pulled out a butchering knife and placed the edge at a 45 degree angle to the stone. As he forced the knife against the stone, it screeched and red sparks filtered off like a sprinkler. He flipped the knife over and under like a game of hand-slap, paused.... then placed the sharpened edged against the pad of his thumb.



“Una Itwa Nani?” I said (what is your name?)

“Mimi Samuel, but they call me Dr. Knife. This is my steel sharpening charger. I have been doing this since 1984. ” I smiled (Who doesn’t enjoy a good nickname....Magic, Sweetness, Chocolate Thunder came to mind).

“I like your invention. Do you have a name for your bicycle?” I asked fishing for another great line.

Without a pause, Dr. Knife said, “Welcome to my clinic.”

Yes, I could tell I was going to like Dr. Knife right away. You see I like bikes (especially those that are retrofitted...I brought my own break-away bike to Africa but that is another story) and I greatly respect people who make a go with whatever they have to create a business. I immediately invited Dr. Knife to our house to sharpen our entire set of kitchenware (Sara happened to be gone for the weekend). Dr. Knife came over and set up “clinic” in our back yard taking one knife at a time to his stone.



“You see I have this problem..” he said as he picked up our paring knife. “I have a Shamba (Garden) but the rains have stopped. I have dug a boar hole 8 meters down and found water. But you see I have no way to lift the water to my Shamba. I have no..what you call pump. I want to grow onions, tomatoes, and potatoes..they are already beginning to die. Even my family needs food. I am looking for.....well...a donor?”

We continued to talk. I asked Dr. Knife about his family, “I have 6 kids... 3 boys and 3 girls.” I asked him, “WaChristo? (are you a Christian)”?

“My family attends Mass on Sunday but I do not yet attend.”

I said “Mungo (God) would be pleased to see you in church.”

As he removed the last knife from the rotating stone I began slicing through cactus leaves Japanese style to check out his work. “I’d like to come visit your house...meet your family, see your Shamba. I have a bicycle. We can ride down to Old Kijabe Town together.”

I paid Dr. Knife for his Clinic and we exchanged mobile numbers (common occurence in Kenya). “Una Itwa Nane?” Dr. Knife looked at me ready to program my name into his mobile.

“Mimi Dr. Meno (Tooth).” Dr. Knife grinned, released his kickstand, took down his clinic, and coasted out of our yard.

Big Bibles

If our internet connection was better I could paste this enjoyable youtube clip directly to this post, but the best I can do is give you the link...

http://www.youtube.com/watch?v=tTYr3JuueF4&feature=fvst

It's less than 5 minutes long, viewed by over 1 million, creative, funny, slightly irreverent, satirical, and connects to the youth group generation I grew up in the late 80's and early 90's. If we can't laugh at ourselves a little bit, who can we laugh at?

God & Mammon

A friend and I have been reading the book “Money, Greed & God...Why capitalism is the solution and not the problem.” The author Richards believes we are presented with two competing messages,
1) wealth is bad and causes much of the world’s suffering
2) wealth is good and God wants you to prosper and be rich
Can we find a middle path between guilt and prosperity? Is there another way?
You may find our following e-mail conversation interesting...

I just finished reading the intro....I find myself pushing back, not because capitalism is evil (all economic models fail, because we are sinners), but just because capitalism does seem to be built on greed, which Jesus talks a lot about.

Perhaps, capitalism rather than being motivated by greed; encourages creativity, risk, imagination and hard work to invent things we rely on...blackberry phone, cat litter, cars with good gas mileage.  Countries that are mired in poverty struggle because capitalism has been squelched (think Haiti). Many of these countries have convoluted private property laws, high income taxes, and complicated regulations to start a business. Many westerners are able to be generous because of the freedom their economic systems allow. (Americans give 1.67 of their GDP to donations, twice that of any other country.)

See Matthew Chapter 6:24:
"No one can serve two masters. Either he will hate the one and love the other, or he will be devoted to the one and despise the other. You cannot serve both God and Money.”

I'm beginning to believe more and more that Jesus' teachings don't fit into any economic model and that is the point.  We are called to stand amidst all the political and economic realities as points of light that shine because we live differently.


In the book we read that Adam Smith said, “It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.” Capitalism is grounded in looking after yourself. The Bible is clear that we cannot serve God and Money. Does capitalism present an unresolvable conflict for Christians when God wants “our everything?” Indeed we have to ask at what cost, but does God give us another way. In God’s plan we have ample opportunity to give generously, use our talents to help those in need, to be the Good Samaritan to someone else.
 

One of the troubles with capitalism is it is built on the premise that accumulation is good for you...and your soul.  Jesus seems to say the opposite. Of all the 'systems' capitalism may be the best at elevating the standard of living, but at what cost...if it is hard for a rich man to enter the kingdom of heaven, perhaps making people 'better off' draws them away from a relationship with God...the Father who longs to supply our every need. 


Is it possible to confuse accumulation with hoarding. Consider the parable of the talents (Matthew 25). The master commends the servants to whom he doubles his original 5 talents. But the master reserves the harshest rebuke for the servant who dug a hole and hid his talent in the ground. Clearly this parable has greater implications than investment strategies, but the economic insight should not be overlooked. Hoarding is discouraged as it says, “Do not store up for yourselves treasures on earth, where moth and rust destroy, and where thieves break in and steal.” Matthew 6:19 But accumulation and then voluntary effective distribution can can help many (Gate’s Foundation).

The conversation ended at that point..and finished with Niebuhr’s Serenity Prayer,
Lord, grant us the serenity to accept the things we cannot change, the courage to change the things we can, and the wisdom to know the difference.

Practicing Medicine from Afar

I am now taking care of several pregnancies via e-mail and text messaging. These women live far from a hospital (or don't have access to a safe hospital) and while they plan to come to Kijabe to deliver, I'm trying to provide their prenatal care from a distance. Sometimes the questions are easy: can I take this medication? Sometimes harder: is this pain normal? Medicine typically involves a physical exam and testing, but the first thing you learn in medical school "How to take a patient history" has become the most critical in caring for these women. It also allows these families to stay on the mission field while expecting.

The care via communication-only reached a new level 2 weeks ago when I provided management for an obstructed labor via radio. The nurse caring for the patient lives in a remote area of Kenya and as she described the patient I was worried because they were more than 2 hours from a hospital (a hospital which may or may not have a doctor available to assist). Thankfully, the mother and baby did well, but knowing the situation and being aware of all that could go wrong, it was hard to know in the end there was little I could do... but we did pray together for the patient.

There are still many places in Kenya, on the continent of Africa and in the world where access to healthcare remains poor. In the end, radio, e-mail and text messaging can't substitute for an available doctor.

Your Generosity....Part II

This is a picture of Nancy our helper. We appreciate her so much and there is no way Sara and I could both work at the hospital without her at our house.

Nancy at first can come across as quiet, aloof, and difficult to read. It has taken months to find out who she really is and see her loving character. We have come to realize that once you ask her a question, you just have to wait and wait and then pause and then she will open up. Nancy is a mother of 3 little girls (is well adapted to helping with Amelia and Meredith). Her husband is a tailor at the hospital.

Around Christmas time we asked Nancy how her family was getting along. She told us "it has been difficult to cook. Dry firewood is hard to find with all the rains, We can walk over a 2 km just to find some sticks to burn. Also, they are clearing the forests and buying firewood or charcoal is getting very expensive, I have electricity at my house and it would be so nice to have a stove."

Nancy cooks for her family over a Jicho (like a mini grill) and I have seen her start a fire with just one log and keep it slowly burning for hours (much more efficient than my Eagle Scout Bonfires).

With your generous donations we were able to find Nancy this used stove, a regulator, a gas tank, and a refill of butane. Sara watched as Nancy and her husband proudly tied the Stove to the back of a Taxi. She had it installed that very day. I have asked her what she thinks. She writes....

"Thank you for helping me have a stove, I'm happy for you made my kitchen work easier. I won't waste most of my time looking for firewood. I'll use it for cooking most Kenyan food like: chipati, rice, ugali, stew. My husband Joseph and my kids Martha, Joy, and Anna also said thanks for having it even to bake their birthday cakes. They are very happy and highly appreciative. Thank-you so much, may God bless you."

Nancy & Joseph & Kids

Winter Fun in Kenya (January Water Field-Day)

Tug-O-War on a slip-and-slide with soap.


Make shift water slide (I think Meredith is squeezed 3rd in the train).


Sisters.


A form of musical chairs (musical buckets) and Meredith found her bucket when the music stopped.

Your Generosity Has Done This...Part 1

We have enjoyed having Daniel around our house. We could not do what we need to do at the hospital without his help gardening, planting, pruning, raking, watering etc. He is trying to raise money to build a house (which he has started) and also to save for a dowry. Daniel is engaged to be married..but can not marry until he has his own house and a dowry to pay his future father-in-law (generally about 2 cows he told me depending upon the level of education she has).

One month ago Daniel came as usual with 2 liters of fresh milk, but was visibly upset. He told us that his dairy cow had gotten loose and fell into a ditch and broken its leg. He asked us for a small loan to have the animal inspected by a veterinarian. As expected the dairy cow was not salvageable and was slaughtered the next day for meat.

Daniel's dairy cow was producing with 2 milkings about 20-24 liters per day. All in all after selling the milk minus the cost of the feed he nets about 8 dollars per day which is a great business for a young man like Daniel. As you can imagine losing his dairy cow left him heart-broken, as it would delay the building of his house and savings for a dowry and consequently delay his marriage.

Just last week your generosity purchased Daniel a new dairy cow. Meredith and I were able to visit Daniel at his house and see the new cow (no name yet) milking. Daniel is very pleased as the cow is healthy, feeding well, about 4 years old (has already birthed 2 calves), and producing about 30 liters of milk per day.



Daniel wrote the following thank-you note,

"Thank-you so much for your generous heart to help me buy a cow after I lost my first one. I was much stressed but you enlightened my life in the most wonderful way. God bless you and gives you more. It's a big step that you have made me go because I am in the middle of my house project and I know the sell of milk will help me make progress. I may not be able to show much how I appreciate through writing, but inside my heart I thank-you and pray for you."

thank-you & God bless you all
yours, Daniel Gochie

Psalm 23

The LORD is my shepherd, I shall not be in want.
He makes me lie down in green pastures,
he leads me beside quiet waters,

he restores my soul.
He guides me in paths of righteousness
for his name's sake.

Even though I walk
through the valley of the shadow of death,
I will fear no evil,
for you are with me;
your rod and your staff,
they comfort me.

You prepare a table before me
in the presence of my enemies.
You anoint my head with oil;
my cup overflows.

Surely goodness and love will follow me
all the days of my life,
and I will dwell in the house of the LORD
forever.

To how many people has recitation of Psalm 23 given the weary rest, given the distracted peace, given the sinner restoration, given the fearful hope, given the sick comfort, or given the stranger a home?

Amelia surprised me this morning as she recited Psalm 23 from memory (they have been memorizing at school). It was meaningful as Amelia's Dad to hear her recite such a long text from memory. She spoke sometimes with cadence, sometimes rushed, sometimes decelerating as her memory caught-up, sometimes mispronouncing words, and sometimes omitting a phrase.

I don't know if Amelia understand all of Psalm 23. Yet, I do know God has now written His word in Amelia's heart...where no one can take it away.

Doing Green in Kenya (with a touch of humor)

I’m (Malin writing) really the last one to ask about going “green”, environmentalism, or global warming. To be honest I always really really wanted to be “green” (kind of like I always wanted to be a morning person), but it never clicked (or maybe I never committed to what it required).

I never mastered recycling; can I recycle magazines, do I need to clean out the milk jug first, what color container for disposables? I prefer Costco and Wendy’s to Trader Joe’s and Whole Foods. I like making a camp fire and burning wood even when there is no point. I take long hot showers in the morning. I love red meat and would eat it 3 meals a day if I could. Don’t ask me what my carbon footprint is, all I know is I wear a size 8, (40 UK).

But I tell you I have really tried to “go green.” I even saw Al Gore’s “Inconvenient Truth,” and although it was nifty to watch our former Vice-President raised into the sky by a construction lift next to his life-size global warming graph, but I’m skeptical when provocative claims (New York will be under water in a decade) are used to motivate change. The last time I was at a trendy coffee shop in Oregon, I went green and ordered a fois grass latte and couldn’t down the first swallow. I saw the McDonald’s documentary “Super-size It” and even though my mind was greatly convinced, my stomach can’t resist a large order of french fries. I even tried Namaste Yoga at a spiffy spa- but in the midst of ohming..I realized I couldn’t touch my toes. For goodness sakes, I have lived in both uber-green cities Portland and Seattle and have never set foot inside a vegetarian restaurant.

Regardless, it is clear that God asks us to be Stewards of the world he has given to us: “The Earth is the Lord’s and all that is in it, the world, and those who live in it” (Ps. 24:1).

So here in Africa (even though for the vast majority of Kenyans the task of simply living does not afford the luxury of environmental concerns) we as a family I think are making many good “green” decisions. I guess I call them decisions, even if most are decisions out of necessity (Hey, I’m doing my best).

We walk to work, school, church, friend’s houses, and the local dukas.
We are partial locavores (we buy and eat year-round available fresh produce from the “vegetable ladies.”)
Our milk we drink for lunch was probably in the udder of Daniel’s Cow just a few hours ago.
We have a Shamba and grow our own lettuce, potatoes, thyme, carrots, and onions.
We are a 1 car family. I think we drive perhaps one of the most fuel efficient Missionary cars in Kenya. Our Toyota Corolla often gets strange looks from police when they see our family in tow...as these vehicles here are frequently used as taxis.
We have solar panels on our roof that reliably (as long as we have a couple hours of sun) provide the majority of our hot water needs.
Lastly, perhaps to your surprise my hair-care needs do not require aersol hairsprays. Don’t worry I stay far away from BPP’s, DVT’s, HDL’s and all those other nasty acronyms.

And please help me out. If there are any green trends that have caught-on back in the States in the last 14 months, keep me in the loop. I’m behind as it is and need all the help I can get.

Every Day Life in Kenya

Cars in Kenya are run into the ground, and then after that loaded up with bricks, chickens, grass, cabbage, passengers and forced up hills much too steep for their transmission. This vehicle unloaded some bricks half-way up a hill and recruited some passengers to finish the job, then reloaded the bricks at the top of the hill.



Kenyan Traffic Jam on Old Kijabe Road (picture taken from car).



Jonathan our friend insisted on taking us to Kimende on our way back from Nairobi to his favorite butchery. We order 2 kg of their best cut of meat. We enjoyed a VERY WELL BOILED Kenyan Stew the next day.



The Local Black Mamba (the only type of bike available here) Bike Gang.

"Thou shall not operate on the day of the patient's death."

In other words, avoid an operation that will kill the patient. I don't always know about this advice as certain surgeries require some risk to result in saving a patient's life, but today Sharon and I found ourselves very near exsanguinating a patient. The surgery was to remove a pelvis abscess (or so we thought) that had occurred 4 weeks after the patient had a D&C at another hospital. What had really happened was the the entire uterus had become a necrotic, actively bleeding, purulent mess. This patient initially presented with septic shock and after 48 hours seemed stable enough for surgery to drain/remove this mass that was about 20 centimeters. A visiting family practice doctor happened to walk into our room during the surgery and Sharon asked, "What's your name and can you scrub?" Thankfully he answered yes and was told to hold pressure on the aorta while we began to try to control the hemorrhaging. In the end, the patient lost 2.5 liters of blood, got 4 liters of fluid and 4 units of blood (plus some more units were being freshly donated from visiting staff) and she did leave the OR alive, but intubated and transferred to the ICU. This is particularly remarkable when you know her starting Hg was 6.5 and after 2 units pre-op only 8.2, Reflecting on her surgery, I am amazed her life was spared. Yet, I'm seeing over and over God does amazing things sometimes in a very simple way. We had the right people in the room: 2 skilled OB/GYNs, 2 anesthetists, 3 nurses, an intern to get more blood, a visiting pathology resident willing to donate with the right blood group, an FP who just happened to come in when we needed pressure, and a general surgeon (who was thankfully in between cases) to review the necrosis on the rectum. We work in a hospital that has visitors coming and going all the time, is short on nursing staff and sometimes the theater staff disappear from the room, but for this case ALL the personnel we needed was graciously provided. God is always faithful.

Dreams

Amelia came in our bed last night crying, shaking, cuddled close and calmed down. In the morning when asked what about her dream had scared her, she replied, "Mommy, it's too scary to talk about." Which reminded me of my dream. Somehow while still working in Kenya I dreamt there had been a gyn-oncologist I could've referred patients too this entire time. In my dream I panicked looking at the patient I was presently operating on for cervical cancer and thinking to all the patients on my board list that would've been better served by a gyn-oncologist. I don't think I've worked one week here without performing some type of cancer related surgery--in fact I'm even getting referrals because most ob/gyns trained in Kenya have no gyn-oncology training. So, if you know or are a gyn-oncologist and would be willing to come, you truly would be an answer to my dreams. But even more so an answer to my prayer for further training as I work here from specialists! So far I've had the privilege of learning more from urologists, plastic surgeons, and a colorectal surgeon.

False Extremes

When thinking about God's Kingdom here on earth Jay Richards in his book 'Money, Greed, And God' argues that Christians must avoid two tempting but false extremes.

"The first temptation is to quarantine God's Kingdom safely in the distant future up in the clouds...sealed off away from the blood, sweat, and tears of the present. In this view we should expect the world to be beyond repair. There is nothing we can do about it. Don't bother polishing the brass on a sinking ship. The best we can hope for is to be that in the end we'll be saved, maybe raptured before it goes really bad, and perhaps we'll be able to to bring a few converts with us. In this telling, Christian faith is at worst a story about me-and-Jesus, about saving my soul and little else, and at best it's about a gospel message that can save souls but has little power to transform the larger world for good. On this model God's kingdom has little to do with worries about poverty, injustice, and the physical struggles that mark our earthly lives."

The second extreme we must also avoid Richards titles the 'Nirvana Myth.'

"The Nirvana Myth is not simply the belief that good will triumph in the end (here on earth) or the belief that the kingdom of God is already present in history. It's the delusion that we can build utopia if we try hard enough and that every real society is intolerably wicked because it doesn't measure up to utopia."

We must jettison both of these "false extremes."

To seal off God's Kingdom in an air-tight distant future is dangerous because it encourages us to forget about the needs of those here and now (think crisis in Haiti). This type of theology creeps into our world frequently. Have you seen it? Perhaps a conversation in a Christian group, "This life is just a test. What really matters in the end? Joy is the answer, period." as a member who just had a parent die of cancer draws away. Or an individual infatuated with the end times and the precise moment of the rapture. Not only do Christians lose credibility when another end times prophecy fails to be fulfilled (think Y2K), we become so obsessed with the future that we forget about loving our neighbor (who needs a friend, lost a job, or struggling with an addiction) as ourselves (God's second greatest commandment). Maybe we recall a sermon declaring a natural disaster or pandemic disease a curse on an unrepentant culture. This theology fans the flames of blame and fear rather than encourage the needed response of help, love, and relief.

Even more tempting and perhaps more dangerous is the ‘Nirvana Myth’ If we come to belief that if we try hard enough our society can have heaven on earth (think John Lennon) we are sorely misinformed. Do we think that the right politician, party (republican or democrat), or government can bring complete justice to our world? Can the rock star, talk-show host, self-help guru, or prominent author bring ultimate Joy?

Even despite our best efforts, free clinics, and mission hospitals...medical needs will be unmet. Despite the excellent work of micro-loans, charitable aid, and relief agencies poverty will exist. Despite social programs and better police force we will still see violence on our streets. Even though we have hard working teachers in the inner cities, school vouchers, and after school programs kids will still fall behind.

Let’s not stop trying to reach these noble goals, but if we endorse the ‘Nirvana Myth’, who will need God? If we don’t need God then we certainly don’t need his son Jesus of Nazareth either.

This line of thinking can also happen in our presence. If so, the crosses come down from the church. Prayer will cease. Ministers become organizers. Phrases like sin, forgiveness, salvation are replaced with social justice (an ambiguous phrase anyway) fair trade and protest. Evangelism becomes an outdated and unattractive idea, instead replaced by the modern and fashionable notion of inclusiveness. Perhaps most tragic in this delusion is that if we think we can do it all by ourselves. We will fail. When we do fail, we will have already rejected our need for God’s grace, when we need it most.

Samaritan's Purse Response to the Crisis in Haiti

I know I am likely several days late with this information as many of you have already made generous donations to excellent relief agencies to help with the crisis in Haiti. But if you still feel inclined to help out through financial donations to a relief agency I think Samaritan's Purse is a superb choice. Because of these 10 reasons listed below we have donated to SP for relief to the crisis in Haiti.

1) They have already 21 team members on the ground.
2) By the end of the week they will have materials to build 6000 temporary shelter.
3) They have cargo planes coming and going daily.
4) Samaritan's Purse receives a 4 star rating (highest possible) from Charity Navigator (a charity rating service). Their efficiency rating surpasses American Red Cross and World Vision. 89% of their donations go directly to program expenses (in this case relief efforts to Haiti if so designated). Less than 5% go to administration.
5) We have been to their headquarters in Boone, NC and were astounded by their organization, professionalism, expertise, humility, and Christ focused attitude.
6) SP will have the ability in the next week to produce half-a-million gallons of fresh water daily in the capital city of Haiti.
7) Scott Reichenbach our Post-Resident Coordinator with Samaritan's Purse who we communicate with weekly has been put in charge of coordinating the medical response team to the crisis in Haiti.
8) SP's donor services often call their donor's directly to thank them for their donation (I found this out from several of our donors). They really care about their donors. Easy online donations are available at www.samaritan'spurse.org
9) World Medical Mission (SP's medical arm) has a medical team of 7 going in on Monday and WMM already has relationships with Haitian Christian Mission Hospitals in which to coordinate medical care.
10) The aid (bottled water, shelter, flash lights, food, medicine, hygiene kits, medical care) all comes wrapped in the Gospel message of a God who despite the horror of this tragedy cares for you.

A Solar Eclipse & Lip Gloss

On Friday Morning at 8:30 AM a once in a lifetime astronomical event occurred better viewed in Kenya near the equator than any other place in the world, a full Solar Eclipse (you know one of those events where the next one won't be until year 2537, except it seems like they happen about every 7 months). We were told the the day would turn to darkness, security lights would turn on, and when the blackness occurred it would cause some to think it was the second coming.

Amelia enjoyed the event at school with science teachers facilitating telescopes, filtered cameras, and projectors to view the eclipse (but she told me it was not as cool as she thought it would be). Meredith (pictured above) and I used the dental low tech approach of just gazing at the sun through a dental x-ray. At precisely 8:30 AM the moon passed in front of the sun making the appearance of a black circle with a glaring halo around it. But much to our disappointment there was no panic, no darkness, and just a lot of people gazing at the sun with a hand above their eyebrow.




As you can see Meredith found the Lip Gloss. And with Lip Gloss the more the better.

"Grandma Jean"

Grandma Jean as she likes to be called has been coming to Kijabe to serve with her husband a physician for 1-3 month intervals for the past 15 years. Grandma Jean ministers to the sick patients in the wards by singing hymns and praise songs with her accordion. Meredith found Grandma Jean on the way back from the hospital and invited her to our house for some songs and dancing.

A nice note

“Hi Doctor, I want to sincerely say thank-you for the treatment you gave me. You really showed a lot of concern. I appreciate your good work. May God bless you as you treat many more people. My teeth are now OK. The way you worked really challenged my life and I pray that one day I will also be a dentist like you, maybe working with the Red Cross. It is my desire that I help other people. That is why I am so grateful for the work you did for me. May God grant you with more energy than the number of those you treat.”

-note received at Dental Clinic from 9-year-old girl (2009).

Mud Box

Meredith, Amelia, & Ben enjoying our new sandbox, or perhaps better named "African Mud Box."



The dirty aftermath.

Graduation

2 weeks ago, I went with the graduating intern class to Nairobi for a lunch celebrating the end of internship. Kenyan interns start and end with the New Year. It was a honor to be asked to attend and also relaxing to enjoy a good meal at the local Holiday Inn Nairobi. During the interns speeches there was a proposal from George to Lillian (the couple pictured above)! George thoughtful asked Lillian to marry him and with a beautiful ring as well.

These young doctors will be posted by the government to various hospital and after only 1 year of training, in some cases, will be expected to run the hospitals. Sometimes the task of teaching them C-sections, D&Cs, tubal ligation and surgical treatment of ectopic pregnancy as well as how to manage labors and common GYN problems during 3 months of their intern year overwhelms me. And yet that is all the time I'm allowed. But it will never be easy to pare down what I learned/experienced in 4 years to a 3 month "only the essentials" crash course.

Empty Benches

A strange thing happened this past monday at Kijabe Hospital. As one walked through out-patient and specialty clinics instead of seeing 200-300 patients waiting to see a doctor, all that could be seen were empty benches. It was strangely quiet without the sounds of the babies, the intercom of the next patient's name being announced, and the chatter of conversation. Where was everyone?



This picture above is not a Matatu (just imagine similar quality and appearance but more the size of a 11 seat van, yet with 15-20 people inside and some passengers hanging out the door) it might as well be. I found out from my coworkers that the entire country of Kenya had experienced a Matatu Driver Strike.

Matatus are private vehicles that provide the vast majority of transportation all over Kenya. The cost for a ride can be as little as 40 schillings (about 30 cents) and take you from the coast to Lake Victoria or just up the road to the highway. They have no schedule, little regulation, constantly break-down, and drive at ridiculous speeds on treacherous roads. But somehow the system works and people are able to get where they need to go.

Because of the strike the country was paralyzed. Goods could not be transported, students could not get to school, new intern doctors at Kijabe could not make it to their first day of work, and patients could not make it to the hospital.

I soon asked what was the cause of the strike. (I had assumed that the matatu drivers were striking against the passengers to demand they pay better fares.) I was wrong. No, the drivers were striking against the Kenyan government.

You see police officers do not drive around in cars giving tickets like in America. They remain at designated or undesignated road blocks (marked by large spike barricades) and direct vehicles to stop as they choose. The reasons for being stopped, depending who you talk with, can be legitimate (speeding, too many passengers, no license plates, no seat belts) or questionable (no flashers, no triangle reflectors, a flat tire, no fire-extinguisher).

Once stopped by a police officer an interesting exchange or dance exists between the two. After a couple of minutes, some negotiation, some dialogue, no paperwork, and a discreet handshake with cuffed money the Matatu will be on its way. This can happen 3 times in the matter or a hour drive. The Matatus were striking against the apparent police corruption and frequent stops by police officers for negligible offenses.

Three days later with negotiations between the president and Matatu Drivers Union (?) the strike was called off. Matatus were back on the road, doctors came to work, students made it to school, patients returned to Kijabe, and the benches were full.

2010 New Year's Parade at Kijabe

Little Lambs is an orphanage just up the road from Kijabe.



Kijabe Primary School "Shining for Jesus."



Meredith watching the parade. She enjoyed most of the parade until some candy was thrown her way and she was nearly tackled by other kids in search of "Sweets."

The Princess Who Couldn't Kiss

The Princess Who Couldn't Kiss (A kind-of-long story for a first-grader)

-by Amelia Kate Friess (Age 6) January 7, 2010
(artwork not included)

Once upon a time there was a princess and a frog. They were friends but the princess didn't no how to kiss. The frog knew how. The frog was trying to help the princess learn how to kiss. It was hard to learn how to kiss. The frog kept trying to teach her.

Chapter 2

The princess kept trying....The princess was sad because she couldn't kiss. The frog helped her and finally she learned how.
THE END!

Aid to Africa...Is it working?

In the book 'Dead Aid,' Dambisa Moyo claims that aid to Africa has done nothing to alleviate poverty on the continent and should be shut off in five years.
It's a provocative book with relevant points that makes a case to determine if AID to Africa is working. As a missionary health care worker sometimes I wonder are we making a difference. Some statistics would indicate that despite decades of foreign Aid to the continent of Africa things are no better.

Sixty years ago roughly 10% of the continent lived on a dollar a day and today over 70% live on a dollar a day.
Average annual GDP per capita in Sub-Sahara Africa is less than $2,000 (lowest in the world) and more than half of that comes from two countries (Nigeria & South Africa). To increase the income of the world's poorest 1.4 billion (the bottom billion as they have been called) to just $2,000 per year would require a budget 14 times the size of the current world aid budget.
Most African governments remain 70% to 80% dependent on foreign aid.

But these statistics do not tell the whole story.

PEPFAR has been remarkably successful is slowing the spread of HIV and treating AIDS. In 2002 only 50,000 were receiving life-saving AIDS treatment and in 2007 that number has increased to 2 million.
Between 2005 and 2007 in Ethiopia and Rwanda deaths due to malaria were cut in half due to increase availability to bed nets and anti-malarial medications.
In the last 10 years 34 million African children went to school for the first time.

What do we make of these statistics as a Christian and also Health Care provider in Kenya. On one hand as a health-care worker must be responsible and effective with funding that is entrusted to us and the hospital. I think health-care (one of the 3 pillars of reducing poverty in Africa along with education and agriculture) is an effective means of AID. Personally, we can see the difference care in a mission hospital makes in the lives of our patients each day. Furthermore, at Kijabe and numerous other mission hospitals the care given is not just by addition (missionary doctor to patient) but also by multiplication (missionary doctor to doctors in training who then go out to touch many patients).

But this isn't the entire story. Kijabe Hospital and other mission hospitals are evaluated beyond the means of annual patients visits (over 100,000), major surgeries annually (over 8,000), or number of patients enrolled in the AIDS RELIEF program (over 5000). Patient's come to mission hospitals and many find the right diagnosis, a life-changing surgery, a healthy new baby, AIDS medicine to keep them alive.

But to some the prognosis is not good, the treatment not available, the medicine too expensive. Where is God at those times? There may be no silver lining. Things really may not "turn out for the good." It seems that God is responsible and "on the hook." Peter Kreeft points out that no amount of philosophizing will get God "off the hook". God sent his Son Jesus to intentionally put himself on the hook. Through Jesus Christ, God experienced the greatest human humiliation, the greatest human suffering, but also the greatest human redemption. Therefore, Christianity by putting God on the hook (doesn't try to give a reason) yet seeks to provide the resources to the hurting to have the courage to conquer uncertainty, discouragement, bitterness, and even death with security, hope, love and salvation in Him.

Flash Floods in Narok, Kenya

While we on the edge of the Rift Valley have been blessed by the rain (crops are growing) you can see that those in the valley in Narok (Narok is half-way between Nairobi and Tenwek) have seen the flash flooding cause massive damage.

http://www.youtube.com/watch?v=X3fpYa3LAgU

Oral Diagnosis

When I tell people I am working as a missionary dentist in Africa the first response I receive is, "you must see some crazy things." The answer straightforward answer is 'yes'. Kijabe Hospital casts a broad net even beyond Kenya and we see numerous patients who have been referred to our clinic due to the rarity of their condition and/or because they have found no treatment at the various other clinics they have previously seen.

Although their pathologies are fascinating... they come attached to a person who is often scared, confused, and desperate for help. We try to keep in mind that are African patients are more than a puzzle (size of lesion, color, radiographic characteristics, and duration) to be solved (coming up with a differential diagnosis). No they are a child of God to be loved, valued, and treated with the highest level of professionalism.



Five-year old girl that has bean deaf since birth and came to our clinic for underdeveloped mandible.

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Most likely a fibroma of the hard palate.

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At first glance a hyper-extruded incisor. But after looking in the mouth just a poorly made denture.



Aggressive oral tumor called Ameloblastoma (positive dx from biopsy).



Swelling isolated to the upper lip. The patient had no history of allergies (cinnamon), no medications (Ca+ Channel Blockers), no trauma (he is not a boxer), no signs of oral infection, and is otherwise healthy. We were baffled.

Looking through our pictures from 2009 I found some of the more materialistic things we're grateful for:
Ballet Lessons
Nakamatt in Nairobi for all your grocery needs
Icecream bars at our local duka (store) for bribes after the girls walk the 3/4 mile there
Fresh fruit and vegetables readily available






Looking at this list I've started I see already 3 of the items relate to food and eating. Perhaps that's because I often feel that the time I'm home is consumed with organizing meals for the week, making sure we have the ingredients for the meals, cooking the meals on the days Sarah doesn't come to help, getting Amelia's lunch ready for school, and finding new recipes with available ingredients on an internet connection that is slow. We are eating well, but it's time-consuming. On the other hand, both Amelia and Meredith are learning how to cook. Meredith is learning words like whip, beat, cool, frothy, and Amelia is understanding what things are needed to make things different flavors and textures. Tonight we made sugar cookies and painted them with a mixture of egg yolk and food coloring. I guess someday my girls might be amazed that soup comes in a can, cookie dough can be bought, not all vegetables need bleaching, soaking and meticulous washing and that sometimes mommy just likes to go out for dinner!

Kazooing in the New Year

It was a magnificent sound as Meredith filled her Kazoo and brought in the New Year of 2010 with a countdown at 8PM (midnight is far too late for a 3-year old). It's hard to believe it is 2010 and we came to Kenya in 2008. We look forward to school resuming, the beginnings of a new families bible study, upcoming visits by family, and the adventures that we do not even yet know of that await. Happy New Year!