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!

Goodbye to 2009

"Please Help Meredith" by Amelia

Because Amelia is on a year round school calendar she has been out of school since before Thanksgiving. Meredith and Amelia have done everything together including sand-box, peanut-butter spoon snacks, matching game, taking Luthien for walks, playing in the Hammock, coloring, etc. Sometimes they are happy sisters together like above.



Sometimes they can't go 1 minute without "Meredith did this, Amelia did that" conversation. If you can read the sign Amelia wrote on the ladder to her bunk-bed you can see that "little kids are not allowed." (I wonder who?)



Amelia wrote this sign on her own (we only helped her spell nicer). We reacted first maybe the way you are with a pleasant smirk, but then thought maybe we should take this a little more seriously. Amelia and Meredith together can be a combustible mix of incredibly sensitive 6 year-old and a rambunctious, loud, carefree 3-year old. The one usually in tears is the 6 year old.

So I did ask Amelia what Meredith had done to not be nice? "Daddy, like the time Meredith bit my pinkie, or wrecked my legos, or wripped my drawing, or pulled by hair, or hit my face in the bath-tub, or pushed me in the hammock, or stepped on my feet in the sand-box, or worst of all hurt my feelings."

Sisters, everyone says SOMEDAY they will be best friends!

Precious

Christmas Eve delivered a special blessing for my dear patient, Leah. She had seen me numerous times during this pregnancy and I had been doing weekly dopplers, BPPs, and exams because previously she delivered a baby that died 1 hour after birth and had a stillbirth at 38 weeks. After much worry about when I should do a repeat C/S to deliver her 3rd girl, she started complaining of decreased fetal movement. And so at 36 weeks I decided it was time. Leah sobbed seeing a live, crying little girl and of course that made me start to cry for joy as well. Her daughter had the cord wrapped around her neck twice, but did great with Apgars of 9, 10 (no baby ever gets a 10 in the States, but they do here all the time!). How we prayed for this outcome and God graciously gave Leah what she desired most this Christmas.

As you may also see in the picture, more hats from arrived from the States on Christmas Eve. Thanks Laurel for sending them and for those who made them. It was wonderful to give them out Christmas Eve as a reminder of Jesus' coming to earth in the form of a baby.

Crashing Rain, Baking @ High Elevation, & Arriving at Church 5 Minutes Early

It seemed nearly a miracle that all the Friess Family including our bible books, crayons, boots, jackets, etc arrived at AIC Kijabe Church at 8:25 AM 5 minutes before church was to begin. The pews were empty as we entered the sanctuary and for an instant we thought we had come at the wrong time. But indeed we must have been blessed because we were early. "Please come sit on the front row," the worship leader said. "

And you (pointing to Sara), you must sing well. Please pick up a microphone and sing with our worship leaders." Sara joined the worship team and led our congregation in "Shine, Jesus Shine."



The results of baking a cake at High Elevation of Kijabe (6,545 ft). Maybe some of you in Colorado can relate.



We do not underestimate the power of your prayers. As you can see the rains have come again in abundance like they never have in the past 3 years! This area of Kenya will be blessed to have crops grow again and food on the table.

Merry Christmas

After 13 months I still don't grasp Kenyan Culture. We as a family had the strangest Christmas Eve on record. It started out typical as we attended a Christmas party with snacks, kid's dressed as angels and wisemen, and the reading of the Christmas story. Then Sara was paged to the hospital (which is also quite typical).

But then it all changed. The rains came, thunder roared, the roads turned to red mud, the clouds covered Kijabe Station. Sara returned from the hospital to inform us that a pregnant patient was very sick and HIV+ but the nursing staff deemed it best to wait until the day after Christmas to inform her of her status, because no one should find out such information on Christmas Eve.

We settled into our home hoping to spend some time as a family, a cup of hot chocolate, maybe one Christmas Eve present. Knock, Knock, Knock on the door at 8:45 PM. We were surprised to see our friend Sarah K. with a very large bag in hand. The time before Sara came with a bag in it was a live chicken (for us to butcher and cook). And the time before that she came with two parakeets and two bunnies for us to watch.

"Greetings, I am here. I told you I would come and I have come!" In the bag was a Twister (a wicked Kenyan blender), 6 conconuts, and Kenyan Cheetos for the girls. Sarah K. had come to make us coconut milk on Christmas Eve at 9:00 PM. "Well thank-you Sarah. I don't know what to say."

I wasn't quite sure if Coconut Milk was a tradition on Christmas Eve. "I need a hammer," Sarah K. said. Minutes later she was driving the hammer into the blunt edge of a knife and cracking open 6 coconuts brought from the coast. The banging went on and then the roar of the Twister as Sarah K. fed this machine bits of coconuts and out came a chunky milky substance.

Hospitality is valued in Kenya over privacy. Not making time for friendships is condemned. Unannounced visits are to be expected. It is Christmas..and the greatest gift of all was an unexpected birth of child in an unexpected place who came to redeem the world. And that is how God would intend it to be.



Merry Christmas from the Friess family.

COHOs

COHO is the acronym for Community Oral Health Officer and I could not do my job without them. This is Naomi (COHO employee at Tenwek for the past 2 years) and Sylvester (COHO intern for the past 4 months). COHO's go through a 3 year training at Kenya Medical Training College in all aspects of dentistry. Just as Dental Hygienists fit the need of patient's in America (we all need regular cleanings) COHO's fit the need in Kenya (many Kenyans need multiple and regular extractions of diseased teeth).

Well over half of our patients come to Kijabe Dental in pain, with oral infection, oral pathology, or advanced periodontal conditions. The COHO's (we have 4) triage these patients and take x-rays as necessary, extract diseased teeth, counsel regarding oral hygiene, and provide full mouth scaling for those with calculus. I am available as a 'consultant' which frees me up for elective care, unknown pathology, teaching restorative, difficult diagnosis, molar rct, crowns, orthodontics, etc.

Naomi is a product of Kijabe born and raised just a few Kilometers from the Hospital. She is part of the Africa Inland Church Choir and a teacher in the youth group.

Sylvester stays in Northwest Kenya. He is 1 of 13 children and has invited me to his home to eat Mangoes and meet each of his siblings. When asked about the size of his family he told me his parents did not understand or know about birth control. He is currently dating but say's, "I am leaving a lot open to change."

Luthien

Luthien is the the fairest of the elves in Lord of the Rings. Luthien as we know her is the above 8 week-old Cocker-Spaniel Puppy we have been watching for the last 2 weeks. Amelia loves cuddling sweet Luthien and takes her on morning walks. Meredith likes to pick Luphien (the 'th' is hard to say) and drag her up and down the stairs as Meredith finally has someone around she is bigger than and can boss around. Luthien has developed several endearing nicknames including La Diablo, Dorcian, and Lucifer. Luthian will stay with us one more week and then return to her owner.

For over 4 years we lived in Ohio with no pets, but in the last week we have at one time in our house 2 gold fish, 2 birds, 1 dog (Mocha), 1 puppy (Luthian), 2 tadpoles, and 2 bunny rabbits.

Theatre Christmas Party

We celebrated the OR staff today and the work that they do. Food was prepared for 80 people and thankfully there is a caterer so I only made the desserts and organized the party.

Before the party was about to start I went to check on a critical post-partum patient who I was trying to get a CT scan and referral to neurosurgery in Nairobi. My best potential diagnosis's were a ruptured aneurysm or stroke that led her to present with a GSC (coma scale) of 4. She had previously been admitted for eclampsia and aspiration pneumonia and had survived and gone home well. I can't even describe the sadness of seeing her return in such poor condition. Well, as I was checking on her, her BP began to drop quickly and I called for the crash cart and began CPR. Our resuscitation was not successful and so I had to tell her husband. The baby had died 3 weeks earlier and he collapsed in grief over his wife. Please pray for Michael; he has lost so much and yet somehow he was able to profess to me, "Thank you Daktari, we know God knows what He is doing."

Favorite Hymn

What is a dentist's favorite hymn? Crown Him With Many Crowns.
It's certainly corny dental humor..but it has been nice at Kijabe to be able to provide this level care for our patients. Maybe you have a few crowns in your mouth and nobody I know enjoys the process of getting a crown including the injection of long lasting anesthetic, prepping the teeth, packing cord in your gums, multiple impressions, making of temporary, and returning in a couple weeks to cement on the final crown, and then of course opening up your pocketbook for the final bill.
Much of the technique for fixed prosthodontics is the same as we would do back in America, except at least the final bill is only about 20% of that in America.




Light and Medium Body PVS impression of Bridge Prep.




Working Models that are trimmed, pindexed, dye lube, and articulated. Our fixed lab work is completed in Nairobi. Years back the impressions were sent back to America for crown fabrication. As you can imagine it took a long time.



Final FPD (bridge) in place two weeks later.

Advent

This will be our second Christmas in Kenya. This year we happened upon a Christmas Tree. It took some tinkering, some duck-tape, and my two helpers (Amelia & Meredith) to get our tree up. Amelia made the star with some paper and tinfoil, Meredith hung a few ornaments on the tree, and we found some baby wrapping paper to wrap a few presents.




And although in particular we feel the distance from family and friends during Advent we in Africa celebrate with you the anticipation of the birth of our Messiah, Jesus Christ. Merry Christmas.

For to us a child is born,
to us a son is given,
and the government will be on his shoulders.
And he will be called
Wonderful Counselor, Mighty God,
Everlasting Father, Prince of Peace.

Isaiah 9:6

Signs

Funny Kenyan signs always catch my attention. We have seen signs that say "Moron Driving School" which is a motor vehicle education school in Narok. I have seen signs that say "No Way" when a road has been marked for detour. As a dentist this sign below caught my attention.



You may ask where was this sign located? No, it was not in our dental clinic (even though my life would be rosier if my patients were to do a pre-exam Listerine rinse). This sign was found above the sink in the eating area of the hospital cafeteria. Why the sign was strategically placed at that location...that is left up to our imagination. But the sign seems to be working...after I washed my hands in the sink and as I ate lunch not even one person rinsed their mouth in that sink.

Iron Women

Kenyan women have to be the strongest, fiercest, most durable, formidable, courageous women I have ever met (except for my wife). These women don't do Pilates, run triathlons, or hold Yoga positions; but these women are Africa's version of Iron Women.

I don't think I could get this load of fire sticks on my back let alone carry them up from the forest to the top of the Rift Valley escarpment which is easily 1500 vertical feet. Then after completing this chore it's time to fetch water which is likely at the bottom of a boar hole 2 km away. After that get the cooking fire going (but you can only use a few sticks to preserve firewood) to heat up milk and water for chai. If you are lucky you may have some charcoal to cook with.

Then its time to wash the clothes by hand and hang them on the line. You may have another job on the side like sewing, cleaning, or being a casual for someone else to earn an extra 50 KSH. Did I forget managing the kids (Kenya's birth rate average 5 kids per family), feeding them, cleaning them (no tubs, diapers, bibs, napkins available). Then you can't forget the Shamba (garden) that needs tending to grow potatoes, carrots, cabbage..that is if their is a decent rainy season this year. As dinner time comes (most Kenyans only eat one big meal at dinner) it becomes time to cook the Ugali, make the chipates, and boil chai over the jicho. Then cleaning up and washing all the dishes by hand with a bucket.

You won't hear a word of complaint from these Kenyan women. But I wonder... Is this lifestyle a product of corruption, marginalization, and chauvinism? Or is it just the way of life in Kenya?

Happy Birthday Meredith!

She's 3. Loves to talk, shout her ABCs, climb onto anything, play with her sister, and gives the best hugs and kisses. We celebrated a little early last week with 4 other families and while Grammie and Grampie were still here. Meredith blew out her candles with gusto and in general does everything emphatically. We love having her in our family. Sometimes I still can't believe she started life 6 weeks in the NICU surviving RDS, RSV, necrotizing enterocolitis, and a patent PDA. Truly, how great is our God.

Thanks Auntie Jennifer for making her the "3" shirt!

Frozen Sections

I'm so grateful for our pathology department here. Although we only have basic staining the experience brought here through the visiting pathologists is better than any fancy stain. Still, I can't help but wish for frozen sections. Frozen sections are done during the surgery and give preliminary results. For me this would help most when I'm looking at a mass and trying to decide if it's cancer and if I need to do a bigger surgery. Last week a 24 yo presented with what appeared to be ovarian cancer or pelvic tuberculosis. Hoping it was TB we just took biopsies and closed knowing if it was cancer it would mean more surgery. Well early this am the pathology came back cancer. The previous 3 patients we had done this on did turn out to have pelvic TB. But before I re-operate I'll have to make sure she'll actually be able to get chemotherapy. I don't think I'll ever get used to having to treat patients differently based on what they can afford. Although I try to maintain the highest standard of care, the care is still usually influenced by the finances of the patient.