COVID WARD

I am working in the COVID / Respiratory Ward this week. It is a great place to be, but it can be hard. In the past 24 hours we have lost two patients . . . one from COVID, the other from renal failure. On the other hand, the chance to be in the midst of suffering as a source of compassion is a great privilege. I would likely feel different if I was the one going through the suffering. Being amidst suffering is definitely different than suffering itself.

I really enjoy my work. I like teaching, and I like serving the sick patients in the hospital. I like my Kenyan colleagues from whom I learn so much. Every day is a challenge, but (almost) every day is good.

Thanks for supporting us in our work. I believe that God is doing good things in Kijabe!

Visit to the USA

We will be visiting home this summer. David will start at Abilene Christian University in the fall as a freshman student. We are sad to see him go, but at the same time we are happy to drop him off in Texas to start the next independent phase of his life. To say he is ready to go is an understatement. We feel like we just left the US, which is true. After being in the US for 7 months during COVID, we are barely settled back in to life in Kijabe, and now we go back to Texas again. However, this visit will be much shorter. We arrive in mid July, and we go back to Kenya toward the end of August. During this time we believe we can see more people than we did last time home despite the brevity since laxer COVID restrictions should be more visit friendly. We hope to have at least 2 gatherings to share about the work in Kenya. We are eager to meet in person in smaller groups and even one on one. If you have a church or friend group that would be interested in helping to support us, would you please let us know. We are trying to increase our monthly support by around 1500 each month. That is not an insignificant amount, but with David now a university student our expenses have gone up. And because of the pandemic, the cost of living has gone up in Kenya. Finances are tight. We also have to renew everyone’s passports before we can fly back to Kijabe. We are hoping there is no delay in that process, as we have heard it can take longer than usual. It has been impossible to schedule an appointment in the US embassy in Nairobi due to the pandemic, and so we are hoping to fast track the renewals in the US. We also plan to take one last family vacation together before David leaves, and so it will be a busy time. Please keep us in your prayers as we also keep many of you in our own. These are challenging times for many, and our thoughts are with you.

To Whom Is God Faithful?

This is a thought, not well conceived, but in process. When God is faithful to us, is it as individuals or as a people, specifically Christians. God blessed Abraham to form a new nation that would be a blessing to the world, and God was faithful to Abraham on behalf of the world. Are we blessed just so we have goodness from God, or is God working through us to be a blessing so that our own personal well-being is secondary to that greater goal. Or are both realities the truth Is God only faithful to us individually to the point that it allows us to bless others.

I think it is both. We experience God’s blessing personally (how can we not?), but that blessing is to be used for the blessing of the world, both Christian and non-Christian. God’s generosity toward us is not just for ourselves, but is for the display of his love and faithfulness to the world.

And so everything good that comes our way, we can enjoy, but we should also look to how it could be used for the good of others. We are God’s conduits of faithfulness and love.

As an aside, been listening to John Mark Comer preach recently, and I have been listening to the book below on Audible. Allison and I enjoy him and find him edifying. Also, he has a cool Portland vibe! See below for a link to his church’s sermons as well as to the book.

This Bugs Me

A New York Times article explaining how the CDC is misrepresenting the statistical risk of COVID transmission demonstrates my frustration with the COVID messaging. You cannot get good information. The news does not understand what they are reporting on, and often do not seem like they are trying. They are sensational without nuance. And then the governmental organization are so scared of being wrong that they will not share what they know to be true. That causes more confusion because what people see with their eyes and experience does not match up to what an entity like the CDC or municipal government says is occurring. And that breaks down trust. Regarding the CDC saying that less than 10 percent of transmission was occurring outdoors . . . “That benchmark “seems to be a huge exaggeration,” as Dr. Muge Cevik, a virologist at the University of St. Andrews, said. In truth, the share of transmission that has occurred outdoors seems to be below 1 percent and may be below 0.1 percent, multiple epidemiologists told me. The rare outdoor transmission that has happened almost all seems to have involved crowded places or close conversation. Saying that less than 10 percent of Covid transmission occurs outdoors is akin to saying that sharks attack fewer than 20,000 swimmers a year. (The actual worldwide number is around 150.) It’s both true and deceiving.” . . . Which gets me to the idea that we need to get back to being brave with truth. I tell my kids that when you tell the truth, there may be some consequences, but you have nothing to fear. Living a lie is hard, and telling a lie leads to fear. Read the article for an interesting analysis of the data.

Love This Show

Everybody seems to know about this show and watch it. We are big fans in our house. The episode below is when Nicodemus comes to Jesus at night. It is best watched after seeing the previous episodes, as you see that Nicodemus really wants to know God and wants to see his kingdom come. He cares about the things of God. And so when he meets Jesus at night, it is very powerful. So if you are one of the few who have not heard of this show or think it is not worth your time . . . give it a try.

Medical Education – How Does it Work

What does medical education look like? Let me describe today.

I was up early for some reason, eyes open at 4:30 AM. I have been getting up early this week . . . but 4:30 is about an hour earlier than usual. So after showering and some reflective time and Bible reading, I started reviewing my notes for today’s lecture on shock and sepsis. This review was an ongoing process while waking up the kids multiple times until they are out of bed, and then seeing them off to school. I went into the hospital around 8:30 AM, quickly walked through the ER and the two step down ICU units, finally ending my walk in the ICU. I wanted to see who had been admitted overnight. Around 9:00 AM as I was reviewing my patient’s labs and x-rays while also updating our audit sheets, I was called by the ER doctor that he had just intubated a young woman in the ER and was sending her to the COVID ward. He wondered if I was covering COVID. I told him I was in ICU, but that I could help in the COVID ICU if needed. One of our medical officers is covering the COVID ward this week, and I am her back up for complicated patients. I decide to run down to the COVID ward to meet the patient on arrival. Unfortunately, the patient was not there yet, but I spent the opportunity to review antibiotics, ventilator settings, and plan of care with the care team in the ward. This was an unplanned teaching moment, but it was a typical educational opportunity at Kijabe. We teach at the moment of giving care or preparing to give care. Not all the interns or medical officers are comfortable with the ventilator, and reviewing the machine is a good chance to teach about how the lungs work, how the body balances acid and base levels, how circulation functions in different pressure scenarios, and how to think logically about the process.

While there, I got a call from the gynecological team for help with a patient. I was just across the courtyard, and so I ran over and gave a mini-lesson how to manage inpatient blood sugar levels and how to start insulin on a new diabetic patient. That was my second unplanned teaching moment of this still early day. Since the patient had still not arrived to the COVID ward, I ran upstairs to round with the ICU team. My trainees are muslim and Christian, and it is a good chance to try and model Christian medical ethics to all of them. This was my first scheduled teaching time. We had several new patients admitted overnight to meet and several previously admitted patients to review. With each patient there is a new topic to cover. Diabetic Ketoacidosis, tuberculosis, meningitis and renal failure in one bed. An epidural hematoma in the next. A hemothorax and multiple trauma injuries suffered by our next patient. The fourth bed is an HIV patient with a cheek tumor. Then we went on to the two HDU’s to discuss hyponatremia, seizure disorder, stomach hemorrhage, and stroke among many other things. After rounds, I ran down again to the COVID ward to discuss the new admission. We reviewed her chest x-ray, the possibilities diagnosis that she might have and how we were going to sort them out. Again I did a quick review of ventilators. This is another great chance to try and teach. I went back up to the ICU, and as I was reviewing some other patients I get a call that the woman in COVID ward is needing resuscitation. So we spent 40 minutes trying to save this patient, and through it all we are reviewing the rules of Advanced Cardiac Life Support and Basic Life Support. We got some labs back that show she is in complete renal failure, and so we spoke a bit about that. We teach while treating patients. Then I was tasked with informing her husband about her passing, and I did that with one of our interns. This is different, but it another form of education. It is a chance to model Christian compassion while breaking bad news.

I quickly ran home for some lunch, then, as there was a small break in the rain, I ran back to the hospital. Now it was a formal teaching time, and I reviewed for one hour sepsis and shock with the interns assigned to the ICU. Afterward, I received two calls from my medical officers, reviewing patients with them. More informal teaching. The afternoon exit rounds were spent reviewing a man who had been in a car accident in whom we found a diaphragmatic rupture on CT that we ordered in the morning. I spent another 30 minutes going over all of his x–rays and CTs trying to see if there was a way it could have been found earlier. That was a learning time for me, trying to get better. And I hope it models a certain humility and need to always try and get better to our interns.

That is how teaching works in a teaching hospital, and specifically at Kijabe Mission Hospital. Formal times mixed in with many random opportunities. I learn each day, and I try and pass on how I learn and what I learn to those interns who entrust their education to us.

Small Conveniences

The important things are available, even if not everything is convenient. However it is nice to have a plastic surgeon as a next door neighbor when your son slices open his hand opening a can of tomatoes. And did it really happen if it is not documented? Both David and I have the need to photo record our lives.

Thoughts on Faith

I had a discussion with a more experienced physician of whom I was asking for advice. I call Steve with medical questions because he can help me sort out the balance of taking good care of patients in a resource limited situation and how to weigh futility against aggressive hope. But our conversation this time was more about interpersonal relationships in a pandemic when opinions can be so varied. We drifted into discussions of the role of missions in Kenya versus other parts of the world, how do we deal with people dying who would never die in a developed nation. We acknowledged that we deny the trauma of watching people die compartmentalizing it into some sort of work related box disconnected from our emotions. Finally we ended up in theology. Later, I was emailing with another friend Matt, and shared some thoughts that came out of that conversation which I have posted below copied from our email. This thought has been stuck in my brain since talking with Steve, and I am trying hard to sort whether it is true.

I have been thinking a lot about how as Christians we are called to die, not called to live. Also wondering about affluent Christianity, and how it affects my own thinking. Kenya Christians and Peruvian Christians think about God as suffering with them, not taking care of them. A subtle difference, but I know I pray for God’s provision probably as much as his presence (or I am thinking more of his care of me instead of just being with me). I am afraid that is cultural baggage and not the true message of Christ. Our truly poor brothers probably have it more correct.

Steve mentioned that he had been studying the story of Jesus in the boat with his disciples. Jesus slept, the storm came and threatened to sink their boat. The disciples woke Jesus and he calmed the storm saving the boat and his followers. We often read this story as Jesus protection and power over even the storm. And I agree with that. But Steve pointed out that God does not always save the boat. We see Jesus followers die all the time. Within the last week I have watched two mothers die leaving widowed husbands and motherless children. Jesus own disciples (except John) were all killed for the gospel’s sake. But Jesus is always in the boat with us, whether it stays afloat or goes down. So he may not rescue us in our times of struggle, but for sure he is with us, and that is good news too.

Baboons

They are my favorite and my least favorite. Of the animals that come through our yard, I think they are the most interesting. However they are a menace. They drive our dog crazy, and she will bark for hours. They go in peoples houses if they have not locked their doors. They threaten kids and women. But they are so interesting . . . dog like apes. This video is from a few years ago, when two troops of baboons had a turf war in front of our neighbors house just around the corner from ours. Lots of bluff with little damage, but still scary to be in the middle of it.