Christmas newsletter

Fair warning

I am grateful for a gracious reminder.

I work part-time in the emergency department of a hospital nearby, to cover our expenses so that everything donated to our WGM account will only be used when we're en route to Chogoria.  I was working in that local ER a few days ago, taking care of a fellow who was quite sick and becoming sicker.  He had a whole-body infection, termed 'sepsis,' and his blood pressure was dropping.  He needed a large IV in his jugular vein to give fluids and check internal pressures and give powerful blood-pressure-supporting medications.  This IV procedure isn't surgical, but is somewhat complex, requiring multiple needles, a scalpel, wires, sutures, and other devices.  Because the procedure carries some increased risk to the patient, including collapsing a lung, injury to the carotid artery and infection, we took extra precautions.  We prepared the area carefully and used large sterile drapes, and I suited up with sterile gown, mask, and gloves.  I also used ultrasound to visualize the vein and artery during the procedure, and was glad to have ultrasound available, because this patient's anatomy was somewhat different and I would have to insert the needles at an atypical angle.

I found his vein with the ultrasound, injected anesthetic, used the large-bore needle to enter the vein, threaded a wire through the needle, removed the needle, used a scalpel to open the skin around the wire, inserted a dilator and removed it, and threaded the IV catheter over the wire.  Then I pulled out the wire and used a syringe to pull out some blood to confirm placement.  All was going well.  Then, while holding the catheter and reaching for the suture needle, I felt a prick on my finger.  The bloody scalpel had fallen into a cavity of the tray and was lying blade-up.  I had cut my finger with the scalpel.

I paused to consider risk of contagion.  And my thoughts were not reassuring.  This fellow's medical record included many past visits to treat STDs.  And his white blood cell count had been low for the last couple of years, which could be a sign of HIV infection.

I finished the procedure, suturing the catheter in place, and cleaning up my mess, including policing up the needles and scalpel and other 'sharps' so our superb nurses and technicians wouldn't be injured by them.  Then off to the sink to wash as best I could, and then I reported the 'needle stick' to the charge nurse.  She and the rest of the staff were very good, completing lots of paperwork and drawing lots of blood from me and from our patient to check for hepatitis and HIV and other concerns. All of this is routine procedure for a 'needle stick.'

The more difficult part followed - waiting the few days for the test results, and ruminating about my foolishness.  The stick had occurred at about 1:00 in the morning.  I was tired and was sloppy with my 'sharps.'  I should have been much more deliberate with every piece of equipment that had touched my patient's skin.  What if he had HIV?  And what if he had hepatitis C?  That was actually the main risk, based on his history.  Hepatitis C could be very debilitating, even fatal.  Surely the Lord would not allow those infections, especially as we're preparing to go to the mission field.

On the other hand, we recently had the profound privilege to hear the story of a friend already on the field who had been raped and subsequently had a positive HIV test.  This friend's story of faith and deliverance is truly remarkable and miraculous.  Perhaps we can tell it someday.  But I could hardly claim some sort of right to protect me from those infections when I knew our friend's story.

Isn't blood interesting?  Life-giving.  The Bible says life is in the blood.  Lose too much and you die.  Astoundingly complex, containing proteins, clotting factors, antibodies, inflammatory mediators, infection-fighting and cancer-fighting cells, electrolytes, hormones, cellular fuels, buffers, and cells that carry oxygen and carbon dioxide, among hundreds of other things.  And sometimes infectious viruses.  When it carries those, blood can be death-giving.  What is profoundly good by design can be exceptionally dangerous when tainted.  Symbolic of all creation, I suppose.

Martha took the news well.  She prayed and I prayed.  I might have lost a little sleep about it, but not much.  My favorite verse is Isaiah 26:3.  "You will keep in perfect peace him whose mind is steadfast, for he trusts in you.  Trust the Lord forever, for the Lord, the Lord is the rock eternal."  I am very grateful for that peace.

And then came the phone calls from the very kind Occupational Health nurse.  First, about HIV.  Our patient's test was negative.  (So was mine, in case you were wondering.)  And, last night, the second phone call.  His hepatitis tests were negative, too.  Hallelujah.

I am very grateful for this event.  In prayer, I feel that I have received fair warning.  Or at least an important reminder to be much more careful.  We're going to a place with a very high incidence of HIV and hepatitis and parasites and other dangers.  I cannot be sloppy with my 'sharps' or with similar procedures, and must insist on my students' diligence as well, for their protection.  We can go with the best of intentions and unfortunately still make a mess of it, both for ourselves and others.  But we desperately don't want to do that.  We will still engage as best we can, but we will make ourselves diligent.  As innocent as doves and as shrewd as serpents.  Thank you, Lord, for the very kind reminder.

Proud of Meredith

Meredith is our just-turned-12 daughter.  She is a trooper.  Upbeat, always willing, looking for a way to help in a meaningful way.  Sometimes, she hides her worries.

Night before last, after being tucked into bed, she appeared again at our bedroom door, in tears.  Earlier in the week, she had heard about the terrorist attack at the Westgate Mall in Nairobi.  She knew about the killings and explosions and woundings and all.  And she knows that we will be living in or near Nairobi when we're in language training, which is scheduled to occur a few months from now.  Hence the worry and the tears.

We talked for quite a while about the dangers of Nairobi and how we will deal with them.  We talked about the earthly issues (Nairobi is a city of 3 million people, and the terrorist attack last week hurt fewer than 300 (we think).  We will be following Embassy warnings and avoiding risky places.  Etc.)

But more importantly, we talked about the heavenly issues.  Jesus has all authority over heaven and earth (Mt 28).  We are told not to worry but to bring our requests to God, with the promise of His peace (Phil 4, Mt 6).

Also, this journey isn't a vacation.  We're 'deploying' on God's orders to help some magnificent people.  The mission is important.  And important work is rarely accomplished from the couch, free of risk.

Sometimes people tell us, "The safest place is in the middle of God's hands." And sometimes they're really wrong, and sometimes they're really correct.

When they mean "No bodily harm will befall you when you're a servant of God,"  they're quite wrong.  Anyone who knows the history of the biblical Apostles knows that.  They lived lives of shipwreck, imprisonment, torture, and violent death.  Those risks did not end with those Apostles, as we know from the stories of Jim Elliot and so many contemporary Saints who are tortured and killed for their faith.

But they're correct if they mean, "Even in physical peril and death, the Child of God is secure and safe in knowing his or her destination."  We hope and expect to hear, "Enter into the joy of your master."

Meredith heard this very difficult lesson, smiled, gave us a hug, and went back to bed.

The very next day (yesterday) she and James studied Swahili (Kiswahili, for you purists).  They made post-it notes for their vocabulary words, attaching them to representative objects or drawing illustrative pictures.

Despite the very real concerns of the World, Meredith trusts in the Most Powerful, and is doing her best to prepare for her new life in Kenya.  She sings as she studies.  She makes the learning fun for her brother.  I am very proud of my Meredith.

There are dangers.  But God has all authority.  And in the midst of difficulty and pain and risk and loss and cost and even death, we can look forward to His overwhelming lovingkindness.  How blessed indeed we are to be Children of God!

By the way, today (Oct 1) is Meredith's 12th birthday.  I know she would love to hear your encouragement.  Feel free to leave a comment for her.

I love this painting, the Good Samaritan by Vincent Van Gogh.  He painted it in 1850, while a patient in an asylum.  He was struggling, and found solace and direction in his artistic meditations. 

The painting is dense with meaning.  The Samaritan is himself struggling, awkwardly pushing the ambushed and injured Jewish man onto his donkey.  The Samaritan has given up his place of relative comfort on the donkey and has emptied his chest treating the man with oil, wine, dressings, and clothes. But the Samaritan man isn’t glorified.  His face is in shadow, and his leg serves as a step-stool for the Jewish man. 

The injured man doesn’t even appear to be particularly grateful to the Samaritan.  His countenance is heavenward, which is more appropriate.  The priest and the Levite, who should have stopped to help a fellow Jew, pass by on the road, ignoring the need and the struggle. 

Jesus told the story of the Good Samaritan after a Jewish lawyer asked,  “Who is my neighbor?”  After telling the Parable, Jesus asked “Which of these three proved to be a neighbor…?”  The answer was, “The one who showed compassion toward him.”

Let us be compassionate toward our neighbors, regardless of where they are and regardless of their acknowledgement and regardless of the attention of others.  The One who sees and remembers our compassion is He who taught us about compassion and showed the greatest compassion of all.  

Partners Joining in the Program

While we're going through all of our preparations here in the States, sometimes we tend to lose visibility of all the preparations going on in Kenya.  Then we receive very encouraging updates like the one below, which is an introductory letter to potential partners over there.  

Information about Chogoria’s involvement with Kabarak U. Family Medicine Residency and the coming of Dr. Jim and Martha Ritchie

In July 2013, PCEA Chogoria hospital, along with AIC Kijabe Hospital and Tenwek Hospital, signed Memoranda of Understanding with Kabarak University to become the core collaborating teaching hospitals for the new  Family Medicine residency program. This four-year, M.Med- Family Medicine post-graduate degree will prepare Kenyan medical officers to become the “primary care team consultants” for both church and Ministry of Health, county-sized hospitals and health centres.  Traditionally these have  been staffed by posted internship-trained Medical Officers who aspire to ongoing post-graduate training. 

In 2005, the same hospitals, with the assistance and collaboration of the Nairobi-based Institute of Family Medicine, partnered with Moi University, Eldoret Kenya, to begin Kenya’s first family medicine residency program.   To date the residency has trained 18 graduate family doctors with another 12 currently enrolled.   Chogoria’s initial registrar, Dr. Patrick Chege, started his training at Chogoria, finished at AIC Kijabe and has now gone on to become the first Kenyan Chair of Family Medicine at Moi University.

In preparation for Chogoria’s new start as a family medicine teaching site in 2014, Dr. Franklin Ikunda has come as its first  family physician.   In the new year Dr. Ikunda will be joined by  Dr. Jim Ritchie and his family from Virginia USA, who will come to assist in the teaching as Chogoria begins family medicine teaching again with the new Kabarak program.  Dr. Ritchie has had many years of experience in residency educational  administration while serving in the US Navy medical services.

The Ritchie family with Jim’s wife, Martha, and three of their younger children, will be relocating to Chogoria in early 2014.  You can follow their blog at http://www.chogoriastories.blogspot.com/   They will be sponsored by World Gospel Mission who are beginning their 81^st  year of service in Kenya, much of which has been concentrated at Tenwek Hospital..   Housing on the Chogoria campus for the Ritchies will be rehabilitated with a generous grant from the Medical Benevolence Fund. 

We are inspired to be part of a much larger work of the Lord!  As we plan for upcoming events, like the Comprehensive Advanced Life Support class in December, the COMPASS course in Colorado during the entire month of January, and our upcoming support-building trips, we're grateful for the work and support of so many in the US and Kenya as our nest is feathered and the work is prepared.  

This semester, the kids are learning more about Africa as part of their formal school curriculum, and we're adding Kiswahili language training.  

Onward, upward...

Drs. Brown who served at Chogoria

We are very grateful to have met Drs. Richard and Judith Brown, who served at Chogoria Hospital for three years, ending around 2001.  He is a physician and she is a cultural anthropologist.

We  were introduced by Jim Wood, Senior Pastor of First Presbyterian Church in Norfolk.

The Browns are wonderful saints who served on the mission field for 38 years.  They shared an abundance of advice with us.  They described the ministry at the hospital, how to avoid social and cultural missteps, how to navigate the countryside, what to expect about daily life, what sort of car to buy, and so much more.

Dr. Brown (Richard) helped set up the Casualty (ER) at the hospital and started the HIV program there.

We are honored to follow in their footsteps.

Our house at Chogoria

Our hosts at Chogoria have picked out a nice house for us on the hospital compound.  Here are a few photos.

 Entrance gate

 The front garden

 Attached chicken coop - Helen is especially happy about this!

 Living room

 Rear garden

 Kids' bedroom with mosquito net

 Jim and Martha's bedroom

We are grateful to our advocates!

Where is Chogoria?

Chogoria is located in the Central Kenyan Highlands, just east of Mount Kenya.  The town is on the shoulders of Mount Kenya, at an altitude of approximately 6,000 feet.  Chogoria is a popular route of entry for climbers of the mountain, and is a couple of hours drive from Meru Game Preserve.  It is a rural very small town in the middle of a very fertile agricultural region known for its excellent tea.

We are excited to be part of God's plan of redemption in a magnificent land.  Back in the 1920's, the Lord brought Scottish Presbyterian missionaries to the Central Kenyan Highlands, just east of Mount Kenya.  They started a medical outpost there.  Over the next 80 years, they and the Kenyans built a 300-bed hospital and two fine boarding schools.  All were very effective in spreading the Gospel throughout the area.  After 80 years, the Scots moved their Mission to a different country, and the Kenyans have been running the hospital and schools themselves.  PCEA Chogoria Hospital is a well-run facility with a very good reputation, but very few fully-trained mission-minded doctors remain there.
We are convinced that the Lord would have us move to Chogoria to assist the Medical Missions Ministry there, and especially to help start an advanced medical training program.  This program will function in partnership with Kabarak University and Tenwek Missions Hospital, and will train East African medical professionals for medical missions service throughout the continent.
We strongly believe that the Lord has been preparing us for this role.  Jim has been training medical students, interns, and residents for over 15 years, and he was the Program Director of an Emergency Medicine residency for seven years.  He earned three national teaching awards as well as many local teaching awards.  Jim's trainees have also won many national competitions and serve in positions of leadership and service nationally and internationally.  He has served and taught in Kenya, Cameroon, and Afghanistan.   A recognized speaker, he has lectured on international medical ethics to many groups including national medical meetings, high school and college groups, and the Pentagon.
Martha has homeschooled our six children for seventeen years, served in leadership in many local ministries such as Awanas, homeschool co-ops, and Venture Crew.  She has lived in Puerto Rico, Korea, Holland, and Italy, and has a deep love of service.
Helen, though only 15 year old, has completed all required credits for High School, and is very excited about moving to Chogoria. She has an interest in medicine, and will be an apprentice with Jim at the hospital.
Meredith and James are also very excited about the move to Africa.  Though they are sad about leaving their friends (and dog and cats) here, they anticipate meeting new friends in Kenya.