Oral Histology

Kijabe is fortunate to have a pathology lab here at the hospital that serves Kijabe as well as at least 20 other mission hospitals all over Africa. Samaritan's Purse/World Medical Mission keep a cycling group of retired and semi-retired pathologists staffing the path lab here from month to month. Furthermore Kijabe pathology has the capability to capture pictures from their microscopes and digitally send them to a pathology specialist when needed. A recent pathologist (Dr. Gray) took a particular interest in my patient.



Patient was diagnosed clinically and radiographically with complex odontoma and lack of eruption. Complex odontoma is tumor characterized by the formation of calcified enamel and dentin in an abnormal arrangement because of lack of morphodifferentiation. Often times they look like a miniature ball of malformed teeth.



Dr. Gray was kind enough to e-mail me the microscopic viewpoint of the complex odontoma (I'll never quite know how they section this hard tissue thin enough to see under a microscope). If I remember my oral histology correctly I think the pink is dentin tubules and darker purple the pulp complex.

What's that on the window sill?

At least 6 of these had been sitting in the window sill of the dental clinic for the last 4 weeks. They were always directed toward the window, "basking in the sun" as they might say in Kenya. What was this little device with the name Comcare.

After some snooping around, I soon found out from the ENT's wife (dental and ENT share a building) that this device basking in the sun is a solar powered hearing aid designed specifically for the third world. They are made by Comcare (http://www.comcareinternational.org/) About 15 were brought over from the States via a donation from Kiwanis (each hearing aid costs just over 100 USD).


With just a couple hours of sunlight this device can provide hearing for a child throughout an entire day. Solar-power, of course makes sense as the sun is nearly always shining in Africa, and batteries are too expensive. Imagine watching a child put the I-POD like ear phone into their ear and see the smile on his face as he hears his voice for the first time.
And do you know what the motto is for Comcare... Matthew 11:15...He who has ears, Let Him Hear! (We can all praise God for that!)

Why again do we celebrate Easter?

Last week I asked Amelia why we celebrate Easter, "I think Daddy, it's Jesus' Birthday," she said. Dooohhh! I know we have been through this before and explained Jesus' death on the cross, the empty tomb, the stone that had been rolled away, and that Jesus is alive. Why had Amelia forgotten? What were we doing wrong as parents?

But Amelia's theology must have come back to her this morning at AIC church Sunday School in the picture she drew (she was proud to tell us her picture had the nails and blood) for us. But I think I often forget the reason we celebrate easter just as easily as Amelia does. Why did the Son of God take this path towards redeeming his creation? And what did the crucifixion, resurrection, and ascension settle?


Borrowing some thoughts from a great mind, John Piper lists 50 different reasons (with scripture reference) that Jesus' death and resurrection settled...

1) To Absorb the Wrath of God

Galatians 3:13 – Christ redeemed us from the curse of the law by becoming a curse for us — for it is written, “Cursed is everyone who is hanged u on a tree”

Romans 3:25 – whom God put forward as a propitiation by his blood, to be received by faith. This was to show God’s righteousness, because in his divine forbearance he had passed over former sins.

1 John 4:10 – In this is love, not that we have loved God but that he loved us and sent his Son to be the propitiation for our sins.

2) To Please His Heavenly Father

Isaiah 53:10 – Yet it was the will of the Lord to crush him; he has put him to grief; when his soul makes an offering for guilt, he shall see his offspring; he shall prolong his days;the will of the Lord shall prosper in his hand.

Ephesians 5:2 – And walk in love, as Christ loved us and gave himself up for us, a fragrant offering and sacrifice to God.

3) To Learn Obedience and Be Perfected

Hebrews 5:8 – Although he was a son, he learned obedience through what he suffered.

Hebrews 2:10 – For it was fitting that he, for whom and by whom all things exist, in bringing many sons to glory, should make the founder of their salvation perfect through suffering.

4) To Achieve His Own Resurrection from the Dead

Hebrews 13:20-21 - Now may the God of peace who brought again from the dead our Lord Jesus, the great shepherd of the sheep, by the blood of the eternal covenant, (21) equip you with everything good that you may do his will, working in us that which is pleasing in his sight, through Jesus Christ, to whom be glory forever and ever. Amen.

5) To Show the Wealth of God’s Love and Grace

Romans 5:7-8 – For one will scarcely die for a righteous person — though perhaps for a good person one would dare even to die — (8) but God shows his love for us in that while we were still sinners, Christ died for us.

John 3:16 – “For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life.

Ephesians 1:7 – In him we have redemption through his blood, the forgiveness of our trespasses, according to the riches of his grace,

6) To Show His Own Love for Us

Ephesians 5:2 – And walk in love, as Christ loved us and gave himself up for us, a fragrant offering and sacrifice to God.

Ephesians 5:25 – Husbands, love your wives, as Christ loved the church and gave himself up for her,

Galatians 2:20 – I have been crucified with Christ. It is no longer I who live, but Christ who lives in me. And the life I now live in the flesh I live by faith in the Son of God, who loved me and gave himself for me.

7) To Cancel the Legal Demands of the Law Against Us

Colossians 2:13 – And you, who were dead in your trespasses and the uncircumcision of your flesh, God made alive together with him, having forgiven us all our trespasses,

Eight) To Become a Ransom for Many

Mark 10:45 – For even the Son of Man came not to be served but to serve, and to give his life as a ransom for many.”

9) For the Forgiveness of Our Sins

Ephesians 1:7 – In him we have redemption through his blood, the forgiveness of our trespasses, according to the riches of his grace,

Matthew 26:28 – for this is my blood of the covenant, which is poured out for many for the forgiveness of sins.

10) To Provide the Basis for Our Justification

Romans 5:9 – Since, therefore, we have now been justified by his blood, much more shall we be saved by him from the wrath of God.

Romans 3:24 – and are justified by his grace as a gift, through the redemption that is in Christ Jesus,

Romans 3:28 – For we hold that one is justified by faith apart from works of the law.

11) To Complete the Obedience That Becomes Our Righteousness

Philippians 2:8 – And being found in human form, he humbled himself by becoming obedient to the point of death, even death on a cross.

Romans 5:19 – For as by the one man’s disobedience the many were made sinners, so by the one man’s obedience the many will be made righteous.

2 Corinthians 5:21 – For our sake he made him to be sin who knew no sin, so that in him we might become the righteousness of God.

Philippians 3:9 – and be found in him, not having a righteousness of my own that comes from the law, but that which comes through faith in Christ, the righteousness from God that depends on faith —

12) To Take Away Our Condemnation

Romans 8:34 – Who is to condemn? Christ Jesus is the one who died — more than that, who was raised — who is at the right hand of God, who indeed is interceding for us.

13) To Abolish Circumcision and All Rituals as the Basis of Salvation

Galatians 5:11 – But if I, brothers, still preach circumcision, why am I still being persecuted? In that case the offense of the cross has been removed.

Galatians 6:12 – It is those who want to make a good showing in the flesh who would force you to be circumcised, and only in order that they may not be persecuted for the cross of Christ.

14) To Bring Us to Faith and Keep Us Faithful

Mark 14:24 – And he said to them, “This is my h blood of the covenant, which is poured out for many.

Jeremiah 32:40 – I will make with them an everlasting covenant, that I will not turn away from doing good to them. And I will put the fear of me in their hearts, that they may not turn from me.

15) To Make Us Holy, Blameless, and Perfect

Hebrews 10:14 – For by a single offering he has perfected for all time those who are being sanctified.

Colossians 1:22 – he has now reconciled in his body of flesh by his death, in order to present you holy and blameless and above reproach before him,

1 Corinthians 5:7 – Cleanse out the old leaven that you may be a new lump, as you really are unleavened. For Christ, our Passover lamb, has been sacrificed.

16) To Give Us a Clear Conscience

Hebrews 9:14 – how much more will the blood of Christ, who through the eternal Spirit offered himself without blemish to God, purify our conscience from dead works to serve the living God.

17) To Obtain for Us All Things That Are Good for Us

Romans 8:32 – He who did not spare his own Son but gave him up for us all, how will he not also with him graciously give us all things?

18) To Heal Us from Moral and Physical Sickness

Isaiah 53:5 – But he was wounded for our transgressions; he was crushed for our iniquities; upon him was the chastisement that brought us peace, and with his stripes we are healed.

Matthew 8:16-17 – That evening they brought to him many who were oppressed by demons, and he cast out the spirits with a word and healed all who were sick. (17) This was to fulfill what was spoken by the prophet Isaiah: “He took our illnesses and bore our diseases.”

19) To Give Eternal Life to All Who Believe on Him

John 3:16 – “For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life.

20) To Deliver Us from the Present Evil Age

Galatians 1:4 – who gave himself for our sins to deliver us from the present evil age, according to the will of our God and Father,

21) To Reconcile Us to God

Romans 5:10 – For if while we were enemies we were reconciled to God by the death of his Son, much more, now that we are reconciled, shall we be saved by his life.

22) To Bring Us to God

1 Peter 3:18 – For Christ also suffered once for sins, the righteous for the unrighteous, that he might bring us to God, being put to death in the flesh but made alive in the spirit,

Ephesians 2:13 – But now in Christ Jesus you who once were far off have been brought near by the blood of Christ.

23) So That We Might Belong to Him

Romans 7:4 – Likewise, my brothers, you also have died to the law through the body of Christ, so that you may belong to another, to him who has been raised from the dead, in order that we may bear fruit for God.

1 Corinthians 6:19-20 – Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, (20) for you were bought with a price. So glorify God in your body.

Acts 20:28 – Pay careful attention to yourselves and to all the flock, in which the Holy Spirit has made you overseers, to care for the church of God, which he obtained with his own blood.

24) To Give Us Confident Access to the Holiest Place

Hebrews 10:19 - Therefore, brothers, since we have confidence to enter the holy places by the blood of Jesus,

25) To Become for Us the Place Where We Meet God

John 2:19-21 – And this is the testimony of John, when the Jews sent priests and Levites from Jerusalem to ask him, “Who are you?” (20) He confessed, and did not deny, but confessed, “I am not the Christ.” (21) And they asked him, “What then? Are you Elijah?” He said, “I am not.” “Are you the Prophet?” And he answered, “No.”

26) To Bring the Old Testament Priesthood to an End and Become the Eternal High Priest

Hebrews 7:23-27 – The former priests were many in number, because they were prevented by death from continuing in office, (24) but he holds his priesthood permanently, because he continues forever. (25) Consequently, he is able to save to the uttermost those who draw near to God through him, since he always lives m to make intercession for them. (26) For it was indeed fitting that we should have such a high priest, holy, innocent, unstained, separated from sinners, and exalted above the heavens. (27) He has no need, like those high priests, to offer sacrifices daily, first for his own sins and then for those of the people, since he did this once for all when he offered up himself.

Hebrews 9:24-26 – For Christ has entered, not into holy places made with hands, which are copies of the true things, but into heaven itself, now to appear in the presence of God on our behalf. (25) Nor was it to offer himself repeatedly, as the high priest enters the holy places every year with blood not his own, (26) for then he would have had to suffer repeatedly since the foundation of the world. But as it is, he has appeared once for all at the end of the ages to put away sin by the sacrifice of himself.

Hebrews 10:11-12 - And every priest stands daily at his service, offering repeatedly the same sacrifices, which can never take away sins. (12) But when Christ had offered for all time a single sacrifice for sins, he sat down at the right hand of God,

27) To Become a Sympathetic and Helpful Priest

Hebrews 4:15-16 – For we do not have a high priest who is unable to sympathize with our weaknesses, but one who in every respect has been tempted as we are, yet without sin. (16) Let us then with confidence draw near to the throne of grace, that we may receive mercy and find grace to help in time of need.

28) To Free Us from the Futility of Our Ancestry

1 Peter 1:18-19 – knowing that you were ransomed from the futile ways inherited from your forefathers, not with perishable things such as silver or gold, (19) but with the precious blood of Christ, like that of a lamb without blemish or spot.

29) To Free Us from the Slavery of Sin

Revelation 1:5-6 – and from Jesus Christ the faithful witness, the firstborn of the dead, and the ruler of kings on earth. To him who loves us and has freed us from our sins by his blood (6) and made us a kingdom, priests to his God and Father, to him be glory and dominion forever and ever. Amen.

Hebrews 13:12 – So Jesus also suffered outside the gate in order to sanctify the people through his own blood.

30) That We Might Die to Sin and Live to Righteousness

1 Peter 2:24 – He himself bore our sins in his body on the tree, that we might die to sin and live to righteousness. By his wounds you have been healed.

31) So That We Would Die to the Law and Bear Fruit for God

Romans 7:4 – Likewise, my brothers, you also have died to the law through the body of Christ, so that you may belong to another, to him who has been raised from the dead, in order that we may bear fruit for God.

32) To Enable Us to Live for Christ and Not Ourselves

2 Corinthians 5:15 – and he died for all, that those who live might no longer live for themselves but for him who for their sake died and was raised.

33) To Make His Cross the Ground of All Our Boasting

Galatians 6:14 – But far be it from me to boast except in the cross of our Lord Jesus Christ, by which the world has been crucified to me, and I to the world.

34) To Enable Us to Live by Faith in Him

Galatians 2:20 – I have been crucified with Christ. It is no longer I who live, but Christ who lives in me. And the life I now live in the flesh I live by faith in the Son of God, who loved me and gave himself for me.

35) To Give Marriage Its Deepest Meaning

Ephesians 5:25 – Husbands, love your wives, as Christ loved the church and gave himself up for her,

36) To Create a People Passionate for Good Works

Titus 2:14 – who gave himself for us to redeem us from all lawlessness and to purify for himself a people for his own possession who are zealous for good works.

37) To Call Us to Follow His Example of Lowliness and Costly Love

1 Peter 2:19-21 – For this is a gracious thing, when, mindful of God, one endures sorrows while suffering unjustly. (20) For what credit is it if, when you sin and are beaten for it, you endure? But if when you do good and suffer for it you endure, this is a gracious thing in the sight of God. (21) For to this you have been called, because Christ also suffered for you, a leaving you an example, so that you might follow in his steps.

Hebrews 12:3-4 – Consider him who endured from sinners such hostility against himself, so that you may not grow weary or fainthearted. (4) In your struggle against sin you have not yet resisted to the point of shedding your blood.

Philippians 2:5-8 – Have this mind among yourselves, which is yours in Christ Jesus, (6) who, though he was in the form of God, did not count equality with God a thing to be grasped, (7) but made himself nothing, taking the form of a servant, being born in the likeness of men. (8) And being found in human form, he humbled himself by becoming obedient to the point of death, even death on a cross.

38) To Create a Band of Crucified Followers

Luke 9:23 – And he said to all, “If anyone would come after me, let him deny himself and take up his cross daily and follow me.Matthew 10:38 – And whoever does not take his cross and follow me is not worthy of me.

39) To Free Us from Bondage to the Fear of Death

Hebrews 2:14-15 – Since therefore the children share in flesh and blood, he himself likewise partook of the same things, that through death he might destroy the one who has the power of death, that is, the devil, (15) and deliver all those who through fear of death were subject to lifelong slavery.

40) So That We Would Be with Him Immediately After Death

1 Thessalonians 5:10 - who died for us so that whether we are awake or asleep we might live with him.

Philippians 1:21, 23 – For to me to live is Christ, and to die is gain… I am hard pressed between the two. My desire is to depart and be with Christ, for that is far better.

2 Corinthians 5:8 – Yes, we are of good courage, and we would rather be away from the body and at home with the Lord.

41) To Secure Our Resurrection from the Dead

Romans 6:5 – For if we have been united with him in a death like his, we shall certainly be united with him in a resurrection like his.

Romans 8:11 – If the Spirit of him who raised Jesus from the dead dwells in you, he who raised Christ Jesus from the dead will also give life to your mortal bodies through his Spirit who dwells in you.

2 Timothy 2:11 – The saying is trustworthy, for: If we have died with him, we will also live with him;

42) To Disarm the Rulers and Authorities

Colossians 2:14-15 – by canceling the record of debt that stood against us with its legal demands. This he set aside, nailing it to the cross. (15) He disarmed the rulers and authorities and put them to open shame, by triumphing over them in him.

1 John 3:8 - Whoever makes a practice of sinning is of the devil, for the devil has been sinning from the beginning. The reason the Son of God appeared was to destroy the works of the devil.

43) To Unleash the Power of God in the Gospel

1 Corinthians 1:18 – For the word of the cross is folly to those who are perishing, but to us who are being saved it is the power of God.

Romans 1:16 – For I am not ashamed of the gospel, for it is the power of God for salvation to everyone who believes, to the Jew first and also to the Greek.

44) To Destroy the Hostility Between Races

Ephesians 2:14-16 – For he himself is our peace, who has made us both one and has broken down in his flesh the dividing wall of hostility (15) by abolishing the law of commandments expressed in ordinances, that he might create in himself one new man in place of the two, so making peace, (16) and might reconcile us both to God in one body through the cross, thereby killing the hostility.

45) To Ransom People from Every Tribe and Language and People and Nation

Revelation 5:9 – And they sang a new song, saying, “Worthy are you to take the scroll and to open its seals, for you were slain, and by your blood you ransomed people for God from every tribe and language and people and nation,

46) To Gather All His Sheep from Around the World

John 11:51-52 – He did not say this of his own accord, but being high priest that year he prophesied that Jesus would die for the nation, (52) and not for the nation only, but also to gather into one the children of God who are scattered abroad.

John 10:16 - And I have other sheep that are not of this fold. I must bring them also, and they will listen to my voice. So there will be one flock, one shepherd.

47) To Rescue Us from Final Judgment

Hebrews 9:28 – so Christ, having been offered once to bear the sins of many, will appear a second time, not to deal with sin but to save those who are eagerly waiting for him.

48) To Gain His Joy and Ours

Hebrews 12:2 – looking to Jesus, the founder and perfecter of our faith, who for the joy that was set before him endured the cross, despising the shame, and is seated at the right hand of the throne of God.

49) So That He Would Be Crowned with Glory and Honor

Hebrews 2:9 - But we see him who for a little while was made lower than the angels, namely Jesus, crowned with glory and honor because of the suffering of death, so that by the grace of God he might taste death for everyone.

Philippians 2:7-9 – but made himself nothing, taking the form of a servant, being born in the likeness of men. (8) And being found in human form, he humbled himself by becoming obedient to the point of death, even death on a cross. (9) Therefore God has highly exalted him and bestowed on him the name that is above every name,

Revelation 5:12 - saying with a loud voice, a “Worthy is the Lamb who was slain, to receive power and wealth and wisdom and might and honor and glory and blessing!”

50) To Show That the Worst Evil Is Meant by God for Good

Acts 4:27-28 – for truly in this city there were gathered together against your holy servant Jesus, whom you anointed, both Herod and Pontius Pilate, along with the Gentiles and the peoples of Israel, (28) to do whatever your hand and your plan had predestined to take place.

Psalm 100

Psalm 100.

Shout for joy to the LORD, all the earth.
Worship the LORD with gladness;
come before him with joyful songs.

Know that the LORD is God.
It is he who made us, and we are his
we are his people, the sheep of his pasture.

Enter his gates with thanksgiving
and his courts with praise;
give thanks to him and praise his name.

For the LORD is good and his love endures forever;
his faithfulness continues through all generations

As we approach the most important day in the Christian Calendar; Easter Sunday I was reminded by Amelia in her recent recitation of Psalm 100 that on Easter we can shout for joy, worship with gladness, approach Him in song, have confidence that God is God, declare our Thankfulness, and above all celebrate that He has conquered death such that His love and His faithfulness will continue forever.

Spice Island

Jumping on the 540 plane on our way to the island of Zanzibar (just off the coast of Tanzania) with a not very direct route through Dar Es Salam and Mt. Kilimanjaro airports.



A nice view of the Mt. Kilimanjaro (highest peak in Africa at 19,340 feet). I was standing at the summit of Kilimanjaro a little over a year ago in pitch black and I was very very cold!



Our Spice Girls!








Dressed for the spice tour with hats, purses, and ties! (This may be the closest this family gets to Fancy Nancy)



Digging in the sand.



A needed nap is a sign of a great vacation for kids or adults!



Thanks Nana and Papa (Mom & Dad) for great time with you on Spice Island! As Meredith would say, "we will miss Nana and Papa when they are gone!"

Up, Up and away

The vacation begins tomorrow at 5 am. Meredith has prayed diligently for a safe trip to Zanzibar, good time with Nana and Papa, and good swimming. Amelia has made a list of all the fun things she hopes to do like build sand castles, bury papa in the sand, catch a fish, swim before breakfast, try looking at fish in the ocean and collecting sea shells. I hope the kids tolerate the flight stopping at Kilimanjaro, Dar salem and then Zanzibar. Malin's already dreaming of sail boarding. But mostly we're eager for a great time with my parents and fun on the beach... thanks Mom and Dad. More blogging in 1 week when sadly the vacation will all be over!

Fried Flying Ants

Amelia and Abby brought flying ants home from school (just two) with idea that they could be fried and eaten. Apparently some tribes in Kenya eat flying ants on a regular basis. First Amelia and Abby removed the wings.



Two flying ants being fried with butter. How do you really know when a flying ant is completely fried?



Flying ants ready to eat.



On the fork and into the mouth!



The surprisingly positive reaction to the taste of fried flying ants.




Well, the pictures about say it all. I don't know if I should be more surprised that Amelia wanted to try eating a flying ant, that she said it tasted, "good, like bacon," or that Malin knew enough about cooking to fry it in butter.

Intrusion

This 8 year old boy was scared to see me after falling on his face on the way home from school. Believe me, I'm often just as scared of these little patients as they are of me.



Intra-oral x-ray shows intrusion of both central incisors (note discrepancy in position of central incisor edge to lateral incisor edge). Apices seem 90 to 100% formed so repositioning, splinting with composite and SS wire, Ca-OH pulpotomies, and eventually RCT was our planned treatment (96% of teeth with intrusion injuries will become necrotic). Note tooth #9 seemingly with its apex pushed into the nasal space. No root fracture is seen.



You can see the aftermath of the accident. There should be as you know be two teeth nicely with their natural crowns exposed. You can see both teeth intruded well into the gingival tissue. Diagnosis of intrusion greater than 6 mm indicates surgical repositioning.



After a lot of tears, some screaming, and a very unhappy little boy the teeth were repositioned and splinted. Next up the pulpotomies in a few weeks. I hope we become friends by then.

Eiffel Tower

No we are not in Paris. We are still in Kenya. I've never visited the Eiffel Tower on the Champs de Mars but according to Amelia this is what the 19th century iron lattice tower looks like if it were made of string.

How to create "Killer Community" anywhere!

Maybe some of you have been involved in some "killer community" small groups within your church, college, or circle of friends? When a small group has good chemistry the results can be remarkable. Weekly time together is anticipated, strong friendships develop, healthy community prayer practices emerge, corporate faith grows, and ultimately in a gathering as such I believe God is glorified.

Maybe you also have been involved in a small group community that was far from “killer” and just needed to be killed. If you are lucky these groups quietly and hopefully rapidly disperse and disintegrate. If you are not so fortunate these groups painfully endure week after week. Meetings are avoided, conversation is awkward and forced, and the whole thing seems like work instead of spiritual refreshment.

It is clear that God calls us to gather together in community (Zep 2:1). Something special (including prayer, companionship, vulnerability, accountability, God’s word is opened, to name a few) occurs when people make time for God by making time for each other.

Within Kijabe Hospital, Moffat Bible College, and Rift Valley Academy (all three within walking distance) there are probably upwards of 150 Missionary Units (families, couples, or singles). A missionary community this size brings with it the blessings of diverse resources, a dynamic atmosphere, a school for our children, and a strong corporate community. The downside of a community this size is the real possibility of feeling lost. Maybe you have been in community without having community in your church, workplace, or school?

Community rarely just occurs spontaneously. It seems to take a mix of commitment, time, intentionality, and simply making meeting with others a priority. We have been blessed by a gathering of five families that started at the beginning of the year. We find childcare while the adults gather for prayer and study. Shortly after that, the kids return and we conclude with music and dinner together. Is it working? I think so. The attendance is consistent, the meetings are anticipated, and most importantly I think we acknowledge our reliance on God and each other.

I don’t know what makes one small group “killer” (which is uplifting) and another small group “needing to be killed” (that’s OK also..many things God has a season for). But I know God would believe it is worth trying.

The following short humorous video clip is well worth seeing!

http://www.ignitermedia.com/products/iv/singles/1379/Killer-Community-Tips

It is Jonny and Chachi’s invaluable “advice” on how to experience community at its finest. Let me know what you think.

"The World's Worst Country"

Have you read the awards for best city in America to live in and they come out with towns like Kalispell, Montana, Ft. Collins, Colorado, or Amelia Island, Florida. I've never seen the opposite list of most down-and=out towns in America (Detroit, Michigan, Youngstown, Ohio, etc). But recently the Economist came out with an award for the world's worst country in the year ahead (2010).

They say, "calling this country is a stretch. It has a president, prime minister, and a parliament but with little power outside their capital city. Even their presidential palace requires an outside peacekeeping force to protect the president. In this country more than 40% of the population need food aid to survive and one in every 5 children is malnourished. 1.5 million people live in dire, temporary camps. The future of this country is bleak. The country has a meager economy, and the aid that has been promised often can not get to the people who need it because security can not be guaranteed."

Residents of this country come to Kijabe Hospital frequently for care. I am told this people group is amazed at how quiet the hospital is without the noise of any gunshots or explosions that they are accustomed to hearing back home. Their greeting I have learned is Nabut Mia. This translates to 'is their peace'...that being the first thing they ask anyone they meet. The only history they know is instability, fighting, violence, and civil war for the past 20 years.

I don't write this to knock them down...but to recognize what an opportunity we have at Kijabe to have them come to our hospital. Inside they are likely broken, fearful, and uncertain about their future. If you have not guessed which country this is...the dubious honor of world's worst country goes to our neighbors occupying the Horn of Africa...Somalia.

Do I look different?

It wiggled for days and days and even though Daddy is a dentist..this 6 year old patient would not let him extract her front tooth. It finally came out at school and was brought home in an envelope. I think Amelia looks like a Hockey Player.

If you ever listened to Marv Albert the announcer for the New York Knicks NBA team you would have heard his emphatic, extended trademark phrase of "Yessssssssss!" Meredith has picked up that phrase in her everday life.
"Daddy can I have Rice Krispies? Yesssssssss!"
"Mommy, can I sit in the front seat of the car? Yessssss!"
"Sister, can I use the pink crayon? Yessssssss!"

Florence

We (myself and my father) operated on Florence in December to remove a low grade mucoepidermoid carcinoma (minor salivary gland tumor) of the hard palate.



The tumor covered 75% of the hard palate and to remove it we stripped the mucosa off leaving raw palatal bone. After seeing her 1 months later I was concerned that the tumor had reoccurred. There was bleeding, raw palatal bone exposed, and very slow healing. You can see the original excisional biopsy specimen above.



When I heard Florence was here at Kijabe Dental again for her reevaluation I was dreading seeing what her mouth would look like. I was expecting bleeding, poor healing, and the necessity of a rebiopsy to check for reoccurrence or her cancer. But to my surprise the palate was now covered with healthy, pink, firm, stippled gingiva, and no signs of cancer.

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Florence as you can see was pleased as was I.

10 Things We Miss About Home

I like lists. I’ve written a list of 50 things I want to do before I turn 50. I’m currently reading a book about lists (Checklist Manifesto by Atul Gwande) and how lists insure things are done right (maintaining safety in take-off of a Boeing 757, building a 80 floor skyscraper so it won’t fall over during high winds, placing central lines with low infection rates). I put lists around our dental clinic to remind our staff where things go, when things are to happen, and who is coming.

But I hesitate to write a list about missing...because it quickly transforms from what I miss (family, church, etc) to a pity story and/or complaint machine (bad African roads, inferior medical instruments breaking down, developing nation infrastructure, etc). Woe is me! I also wanted to wait until we lived in Kenya a substantial length of time (now 17 months) to figure out what I really missed (family) and things I could live without (Cinnamon Toast Crunch). I hope this list will share what we miss (because they are important parts of our life) and not come across as critical to Kenya, its people, or culture (We are blessed to be here with these good people). So here are the 10 things we miss about home in no particular order.

10- We miss the freedom to travel at night. Roads are not marked and cars often have one working headlight...that single headlight approaching may not be a motorcycle but a Lori (I also saw a motorcycle driving by flashlight), and bandits are about... it’s just not safe to drive at night. Where would we go if we could? Maybe a movie, a coffee shop, a book store, or out to dinner..with the girls falling asleep in the back in the dark on the way home and Sara and I talking.

9- We miss the seasons. The weather is 50-75 degrees daily, usually sunny, probably a lot like San Diego. The sun rises EVERYDAY (along with Meredith) at 6:15 AM and sets EVERYDAY at 7:15 PM (we are within driving distance of the equator). I could not tell you when the best month to harvest corn or plant tomatoes is and they may be the same month for all I know! The weather is so regular around Kijabe it can get a bit monotononous! What seasons do I miss?

We miss the authentic Autumn of Ohio with school resuming, the excitement of College Football, pumpkins on the porches, piles of leaves blowing down our sidewalk, the reds, yellows and orange of the Cuyahooga Valley National Park blurring together.

We miss the winter of Central Oregon with white snow, x-country skiing to Tumalo Falls, Christmas Lights, a warm fire at home, nice turns on the Outback lift at Bachelor, and a Fir Christmas trees that smells everything like Christmas should.

We miss the Spring in Portland and Seattle as the Crocus peak through even in late February, the blooming house size Rhododendrums, the scent of NW coffee (even though I don’t drink coffee), hiking in the Old Growth Forests, and wearing a Gortex coat in lieu of a umbrella like any proud Northwestener would do.

We miss the summer of the Puget Sound as the Ferries are passing by, the lakes are prime for water skiing and swimming, the ocean is alive, the daylight that extends just when you need it most to get in that last bike ride, jump shot, or walk to get ice-cream with the girls.

8- We miss our country. I didn’t expect this at all until we were at a conference about reverse culture shock and it was suggested that when repatriating strong emotions, tears, and love for your home country can emerge; and I realized I hadn’t seen our flag or sang our national anthem in over 16 months (this also coincided with the Winter Olympics). I became sad and proud of the USA at the same time. I wanted to pledge allegiance, sing the star-spangled banner, and read the Declaration of Independence all at once. Without being ethnocentric, jingoistic, or any other ‘ic’ I have become even more aware that the United States is strong, generous, honest, free, and amazing country to call home. I’m more proud to be and American citizen living in Africa than I ever have been before. I’ll leave it at that.

7- We miss the American health care system. I know the system in America has faults. I know health insurance is expensive. I realize too many people that want to be insured are not. But once you have a condition that requires surgery in a third world setting...you will yearn for any City Hospital in America compared to the best hospitals here (no criticism intended) in Africa. We have missed the nursing care, specialization, privacy, competency, compassion, cleanliness, and excellence that the American Health care system provides.

6- We miss not being with family and friends when they need us. We are sorry! We feel helpless here when back home someone we know has open heart surgery, misses out on job sorely desired, is working things out in a new relationship, faces an unknown future of transition, has health problems, is in the hospital for pre-term labor, is redefining family, is fired from a job, has a big test, is being scrutinized, has lost their house, lost a family member, has problems with their children, isn’t being heard, wonders where God is right now. All of this and more has happened to family and friends since we have been gone. Skyping, e-mail, blogging, and mobile phones are great inventions but vastly poor substitutes for a hug, prayer, shared tear, a word of encouragement, or a cup of coffee together. We are still praying for you. Thankfully, there are no physical boundaries that prevent God’s ability to answer prayers.

5- We miss being with family and friends during the great times. The other day Meredith said, “Daddy I miss my cousins.” I wondered which cousins she was talking about as she now has 7 cousins (two new since we have left) and two other we have met just twice. The little ones (cousins and friends) are growing and we have missed countless birthdays, 2 Christmases, wedding, new births, Summer Reunions, graduations, and much more. I have heard of missionaries that have prayed that “God would take their longing for their families and friends away, to help them better serve without distraction.” Hey, we have been blessed with great friends at Kijabe and Tenwek...but our thinking is not in that camp! Our friends and family back home (YOU) are irreplaceable. And though we know the party must go on without us...we think it would be a much better party with the Friess Family present!

4- We miss being connected. They say a missionary is at best at least a season behind and at worst forever stuck in the year they went out on the mission field. That either means we are still living in 2008 (I think ‘W’ is no longer President) or at best somewhere in the spring of 2009. Occasionally I see Western visitors coming wearing rolled-up pants, big sunglasses, loafers, v-neck sweaters, collars up, and bigger hair than I am used to (is this the 80’s again)....and I wonder why are they dressed so differently? But it happened so consistently I finally realized no Malin...you are the one that is out of style (which is no big suprise). If I could just find my pegged pants, hairspray, and Izod shirts from 8th grade!
We missed celebrating together as Americans the Winter Olympics Gold Medals and Inauguration of our new President. Just the same coming together for the Relief in Haiti and even the downturn in the economy and just trying to understand the implications of the health care reform.

3- Can we each have a few superficial things we miss? Chipotle Burrito (black beans, cilantro, white rice, beef), a smooth road (for driving or cycling), street lights, pop tarts, Philadelphia Cream Cheese, Cosco, March Madness, Borders Books, Nightly News, NBA Playoffs, and reliable internet.

2- And for Sara (a bit more refined)? Starbucks Coffee with friends, the convenience of Target, Panera Bread, a flat trail in which to run, NW Seafood, a great salad, and the Fine Arts (Broadway Musicals).

1- We miss our home churches? We miss worshiping with you through good music, engaging bible study, challenging sermons (Our home pastors are great and most any sermon they give could satisfy the 3AM phone call rule..Pastor what is your sermon about?...and they could give you the answer in one concise sentence!), and most of all your friendship. You are indeed glorifying God in how you worship. And also glorifying Him in your support of our family in Kenya.

Being called to be in Kenya now feels right, different, and far away from home all at once.

Why we do what we do...

There are many bad reasons to be a missionary; the desire to hide-away from Western Culture, because my parents were missionaries, I don’t know what else to do, I don’t get along with my family, I don’t fit in back in my home country, I want to be known as a missionary, I want to own a big safari truck and drive fast on dirt roads, I want to be a minority, or because it is legal here to have more than one wife.

There are many good reasons to be a missionary; the desire to travel to new countries, to experience other cultures, to identify with people different from one’s self, to give back to the poor, to build churches and houses, to bring clean water to the thirsty, to provide healthcare to the poor, to teach a language are just a few good reasons that come to mind.

But I am convinced there is only one great reason to do missions. This reason looks at the motivation behind why any missionary does what they do. In the book ‘When Helping Hurts’ authors Corbert and Fikkert write...

“What truly motivates you? Do you really love poor people and want to serve them? Or do you have other motives? I confess to you that part of what motivates me to help the poor is my felt need to accomplish something worthwhile with my life, to be a person of significance, to feel like I have pursued a noble cause...and in the process, I sometimes unintentionally reduce poor people to objects that I use to fulfill my own need to accomplish something.”

I know myself am guilty of motivations that are not particularly wrong (I want to live a meaningful purposeful life)....but also are not as pure as I would want them to be (I help because I care). Can I turn my motivations away from fulfilling my own needs to accomplish (not a terrible thing) to loving the people I am serving (a much better thing) on my own?

Paul writes to the Church of Corinth...

If I speak in the tongues of men and of angels, but have not love, I am only a resounding gong or a clanging cymbal. If I have the gift of prophecy and can fathom all mysteries and all knowledge, and if I have a faith that can move mountains, but have not love, I am nothing. If I give all I possess to the poor and surrender my body to the flames, but have not love, I gain nothing.

Only the love and forgiveness of our Redeemer Jesus Christ can transform my sinful heart (which even when helping those in need is misdirected by selfish ambitions) to something new and pure (simply loving those I am with).

SORRY

Amelia's favorite game. We play over and over and over. And while the game teaches to say, "Sorry," it does so while you are intentionally making the other person lose. There's something sort of wrong about tritely saying, "Sorry," and making the person start over time and time again. But wait the opponent also gets to smile and say, "Sorry," as your player goes back to start. Has anyone else ever been bothered by the lesson taught in this game? It seems to teach: say "sorry" and you can do anything you want to the other player!

Alright maybe I'm taking the game to seriously or just trying to find an excuse not to have to play again!

The encourager

Whenever I've taken a spiritual gifts assessment, the gift of encouragement is always on the list, but never by my name. I admit I find it hard to "encourage." It's much easier for me to be analyze, try to improve, critique and yes sometimes be critical. But I see in Meredith the very thing I find hard to do. At dinner, "You make the best soup ever mommy." At bedtime, "You're the best mommy ever and you're mine." At breakfast, "I love to wake-up and see you mommy." During the day, "You're my favorite mommy, when I grow-up I'm going to be a mommy like you." "Mommy you look pretty." "Mommy, I like how you painted your toenails purple." And it continues talking on the phone with Nana and Papa, "Nana, you're the best Nana ever. I really miss you." To her sister after falling, "Sweetie you'll be okay. Let me help you." Okay, you get the point. She gives more encouragement in 24 hours than I usually give out in a month. Hebrews 3:13, "Encourage one another daily, as long as it is called today, so that none of you may be hardened by sin's deceitfulness." I pray Meredith will always be quick to encourage and that I will be quick to encourage others as well.

Growing

This is the mother I wrote about in December who finally gave birth to a live little girl after losing 2 babies at term. She called me to show-off her now 5 kilo girl. I had been praying that this child was growing well after she had come in with a sodium of 218
10 days after birth. For those of you that don't know much about sodiums this level means severe dehydration and high risk of neurological impairment not to mention the possibility of imminent death. But God was gracious and it was a joy to see them both!

Enjoying my daughters.

What can you say?


Too much fun!

RPC

Our patient I will call 'M' has lived with the defect of unilateral cleft lip and palate since he was born 10 years ago. It is disfiguring, causes difficulty chewing, makes pronunciation of words nearly impossible, and forces M to live with a chronic sinusitis and runny nose as the nasal turbinates are directly exposed to the mouth. Despite this M is seen on the playground adjacent to the pediatric ward with a gigantic grin as he comes down the slide.

M was referred to dental after an unsuccessful surgical attempt was made to close the lip and palate (the wound dehisced and separated). A second surgical opinion thought the distance (probably 10-15 mm) was just to severe to achieve a successful union of the lips and covering of the palate.



Winnie taking an impression on M for a perhaps a newly invented appliance we are calling a rapid palatal condenser (RPC).



You may know about the traditional appliance the Rapid Palatal Expander (RPE) or better known as Hyrax if you had orthodontics as a child and suffered from a posterior cross bite. The RPE consists of a screw attached to the posterior teeth. The device is designed to break the palatal suture of the developing child in a short time period. With each twist of the screw over a two week period the device separates .25 mm and the teeth begin to move laterally into their correct position. Some feel the RPE is more of torture device because it causes pain (even a sound as the boney palatal midline suture breaks), headache, and gap in between the upper central incisors with each twist of the screw by their parents.

We reasoned that if you can use a RPE to expand the palate, why not use a RPC to bring a cleft palate and lip together.



You can see the appliance above cemented in place. We are giving it a few turns of the screw each day to see if we can achieve sufficient closure that M can go for surgical repair.

Your Generosity Has Done This...Part III

Rose works as a unit clerk for ENT and became a good friend in the past 4 months.



In October a gas burner caught fire in her home. In less than 5 minutes this was all that was left of her timber house and the homes of eight others. Rose and her husband got out safely but lost everything they had.



The hospital set up a fund to rebuild Rose a temporary house which you can see above that she moved into last week. I told Rose that we had many generous people back in America who were supporting God's work in Kenya. These people wanted to help someone who is in need and trying to rebuild, I asked her if there was anything she needed. Rose told me that they needed a simple bed and mattress.



Because of your generosity funds were used such that Rose and her husband have a place to sleep at night. Asante Sana!

A mini safari

Just a couple pictures from our visit to Lake Naivasha yesterday. We saw lots of birds, water buck, giraffe, hippo and zebra. Only a 40 minute drive from Kijabe. It was good to see all the rain had raised the level of the lake; although more is still needed. Meredith has enjoyed all the attention. Amelia wanted to skip school yesterday "so I can be with Nana and Papa," tempting offer, but in the end decided it was best for her to go! So she called at lunch to say she had a "bad headache" and needed to come home. I told her we were at Naivasha and that she should go to student health. Her headache improved as she remembered it was computer class in the afternoon.

Mom and Dad arrived

We were glad to see Nana and Papa at the airport Sunday morning. After sorting out the luggage that didn't arrive, we went to Java House for breakfast and then headed back to Kijabe. They managed to mostly stay awake until dark (7pm)! It's good to have them here.