Cultural Lessons

Here are some cultural lessons lately....

*Our missionary neighbors were hosting a large going-away party in which many people were supposed to come. Our homes are not large, especially not to hold the 60 people that were expected, so the plan was to have it in the yard. Unfortunately, the afternoon of the party it started raining (hard) and did not let up throughout the party. Someone commented about what a bummer it was that it was raining and our Kenyan neighbor made a statement that stuck with me.  She said, “rain is a blessing”. I am so “American” in my thinking sometimes. I think of rain mostly as an inconvenience, but to our Kenyan friends, their livelihood, their food supply depends on rain.

*We went to visit and share a meal with some of our Kenyan friends. They used to live right near us but in the past months have been able to move to a different home with electricity and more than 2 tiny rooms. Along with this electricity, they got a TV! They seem to have it on all the time when we are there. Near the end of our visit with them, I found it very ironic that the show that they had on was a home remodeling show. They were taking a studio apartment and giving it a make-over. As we watched about 5 minutes of it, they asked me if I understood what was happening. I tried to explain to my friends that don’t have running water, just got electricity, and eat with no “dining room table” why these folks needed their very functional apartment “remodeled”.

*For many years in Kenya, a way to discourage crime in the village is a process called mob justice.  When a criminal is caught, a mob of locals will severely injure or even kill the offender.  Mob justice is supposed to be a thing of the past, but we realized this week that it is alive and happening in Kenya.  Just yesterday Eric had a patient that was burned over 40% of his body as a result of mob justice. This man was known to be a thief and so a group of people set a trap for him to catch him in the act. When he fell for the trap and went to steal the item, the mob grabbed him, doused him in gasoline and set him on fire. He was burned badly but is still alive. In modern day Kenya the ideal mob justice would be a mob catching a criminal and taking this person to the authorities, but as you can see, it doesn’t always work that way. I have also heard of mobs stoning criminals.   

*When in Ethiopia we had a househelper that worked for the people whose house we were staying in. She was good at what she did, but she spoke very little English and cooked virtually no American food. As we were talking with some other missionaries we learned an interesting characteristic about some Ethiopians. If you compliment them too much about what a good job they are doing, they stop doing a good job and slack off. They may even be found taking a nap on your bed! So strange.

*We have some Kenyan friends who recently asked us for a significant amount of money to finance a business venture they wanted to persue. It is such a cultural difference, and we were very uncomfortable with this at first. Americans don’t ask their friends for money! We were unsure how to respond to such an “awkward” request.  However upon asking around, we learned that it is not at all uncomfortable for Africans to make requests like this to friends and family. In fact, by giving our friends money (but not giving to just any person who asks at our door, we have a relationship with these people) it strengthens our relationship in their mind. A really good and informative book on this topic is African Friends and Money Matters. Talk about  different ways of thinking!

*We’ve had a situation that is perfectly illustrated in the book When Helping Hurts (I HIGHLY recommend this book if you work with people in poverty, in the US or abroad).  There is a young man (around age 16) who comes around selling vegetables to make money for his family. He walk 1 ½ hours to come sell to the missionaries. When we first met him, we felt compassion toward him and his story and wanted to buy his wares to help him out (his father has died and his mother has many children including a special needs child to take care of). We admired his hard work to try to take care of his family.  However, over time (and with the help of Tenwek social workers and more veteran missionaries) we’ve learned more about his story and realized that our act of kindness might be hurting him and his family more than we were helping.  We realized that we may have been creating a dependence on “missionary money” and preventing his family from having a stable, independent livlihood.  When this young man goes away to school in a few months, he will not be able to sell vegetables to us and will leave his non-working mom alone to take care of his younger siblings.  We realized that right now, we needed to change how we invest in this family.  Our goal now is to assist his handicapped sibling to free up his mom, help his mom start a small business, and assist the local church in helping the family.  This will allow our young man to concentrate on his studies. It is a long complicated story, but a great example that you need to invest deeply in people and their entire situation, not just throw money at them.

* Kenyans love ugali! (their staple food, made of cornmeal, the consistency of mashed potatoes) It cracks me up because they could come to our house and have a meal, but if we didn’t serve ugali, they consider it a snack, no matter how big of a meal it was. Our neighbor went to Ethiopia for 6 days and she said by the 6^th day she was feeling weak and tired because she hadn’t had ugali! She came home and had it for every meal for days till her son said he was leaving if he had to eat it one more time! Ha! 

My kids love Sakuma Wiki and Ugali too!

*Church this past Sunday was Children’s Sunday. The local children had VBS this week and they used the service to share what they had learned. It was precious. There was even a sermon by a 12ish year old boy! I was quite impressed. Children shared verses, sang songs and led prayer. One thing that really hit home to me was when a small boy stood up and asked prayer for the mothers of their country because many die in childbirth. I really imagine that coming out of my child’s mouth, but that is not a huge reality for Americans. (though it was almost my story!)

First Days of School!

          Well, school has officially started for the Tenwek MK community. Wednesday was our first day! We have a LOT of MK’s this year, so we have set our homeschooling co-op up to look more like a “school”. There is a pre-school class, 1^st grade, 2/3^rd grade, 4/5^th grade and middle school class.

The MK school 2014-2015

Whose kids are these?

        Cole is in 3^rd grade this year. We had hoped to have a teacher come to teach this grade but that didn’t happen, so we have four different moms teaching different subjects! Way to go, moms. These kids should learn some flexibility! They will be learning about Creation to Egyptians in history, anatomy in science and studying a few novels like Stuart Little, Charlotte’s Web and Misty of Chincoteague. Cole has always loved school, so he’s all on board!

      Cooper is in 1^st grade this year! He has the best teacher of all- me! I am commited to teaching the 4 first graders this year. They are hard lookin bunch of kids, let me tell you! 

My classroom

Since we don’t have an actual school, the different classes meet wherever we can find a place- which usually means an extra room in someone’s house! (Cole’s class meets in our actual “school room”)

      There are certain challenges and advantages that come with teaching in someone’s house. (the people’s who’s house it is have been super gracious-they are great!)

*We can walk to school

*We have a “class dog” Bailey, that occasionally joins us

*We hear the washing machine and vacuum a various times in the day

*We have sometimes have to yell at the kids playing outside our window to be quiet (they happen to be our siblings as well)

*The power goes out on certain days and we have to get creative about light sources

*If one of my students forgets something, she can just run upstairs and get it!

       Nothing we can’t handle! I am a few days into it and already enjoying being back to teaching- and it’s all done in 3 hours a day!

We are learning about world history this year, improving our beginning reading skills, having our first spelling tests (!), and doing lots of different science.

     Alex is doing a little pre-school class 3 mornings a week! He loves it! 

We're very thankful to be part of this community and have help in schooling our kids!

Soddo Summary

   
   We returned earlier this week from Soddo Hospital in Ethiopia, where we spent two weeks filling in, as they are without a surgeon right now. I know many are interested in knowing if this is where we will end up after our ministry in Kenya, but we don't know yet! It had pros and cons and is still on our potential list. Our last blog entry was some of Eric's experiences at the hospital, so I'll share a little of what I did for the two weeks.
    Soddo's missionary community is much smaller than Tenwek's. There was one family there during our stay, with a 6 year old and a 3 year old. We were very happy they were there! They were very kind and hospitable to us.

The boys with their friend Taylor

    The boys and I mainly did 3 things during out two weeks: jumped on an in-the-ground trampoline, climbed trees, and read lots of books.

The boys with their friend Nate (upside down)

Other than that we:
-discovered that our kids now get carsick. Two pukers= gross.
-ran into a fellow Cedarville graduate at a guest house in Addis Ababa
- learned that Ethiopians riot when their plane has been delayed for 8 hours
-discovered that Ethiopia doesn't have piki-piki's (motorbikes) like Kenya, instead they have tuk-tuks!

A tuk-tuk!

-housesat 2 dogs (I am the biggest dog-NOT-lover that ever lived)
-were woken throughout the night by said dogs and calls to prayer over the town's loudspeaker
-burned/destroyed half the things I tried to make while figuring out (another!) new oven
-went to a local church and were ushered to the very front (think 2000 people) to sit right next to the stage. We also understood nothing b/c it was in Amharic. We made it for over an hour with 4 kids though= success. That hour included the longest choir song I have ever heard and a very interesting drama including a huge gun and a sword.
-we had high-speed internet= awesome
-had meals at two missionaries' homes
-Alex fell 6 feet off a slide platform. Good thing that one's tough!
-we had a first- we got on the wrong airplane! We just followed the people in front of us who led us astray. To their credit, you would think our plane would be the closest to the gate we just came out of. You would be wrong.
- we read Willy Wonka and the Chocolate factory and had chocolate day!

Chocolate designs in syrup!

-I went to the local market to buy fruit and got mobbed by street children :(
-we jumped and jumped and jumped on the trampoline

There you have it! It was a nice two weeks but we are glad to be home! School will start in just a few weeks! 

Rainy Season

East African countries like Kenya and Ethiopia (where we are visiting for two weeks) don’t have seasons like we are used to in the U.S.  The mention of summer, fall, winter or spring to a Kenyan or Ethiopian only brings blank stares of confusion.   There is no snow here; no fall colors on the trees, and the flowers just keep blooming.  However, we do have some variation in weather patterns manifested by two seasons, rainy season and dry season.  Rainy season reminds me of late spring in Michigan, just not as cold.  Weeks of overcast gray go by with a mixture of thunderstorms and drizzle.  Everything is wet and muddy.  Then, just when you think you can’t take it anymore, the clouds will break and you will get a few rays of warm sunshine before the next storm rolls in. 

It’s rainy season in Ethiopia now, and today was a rainy season at the hospital.  Overall our family has had an enjoyable time here and have gotten a good snapshot of what Soddo Christian Hospital is all about.  However, some days are cloudier than others.

I sloshed my way down the wet path to the hospital this morning to meet the Ethiopian PAACS surgery residents for morning rounds. I knew there would be at least two patients near death in the ICU; we had admitted them yesterday.  I asked my post call resident how the rest of his night went and he responded in a tired despondent voice, “It was a rough night.  Let me show you.”  We commenced with rounds.

Bed 1:  empty.  Our patient who had been assaulted and robbed a few days back died in the night.  He was a normal guy employed as a guard when he was attacked and robbed.  His head injury, bilateral pneumothorax (dropped lung) and rib fractures were a bad combo for a place with no ventilators. 

Bed 2:  22-year-old man who had gotten into a fight with his brother (not sure why) and had just arrived a few hours prior to rounds.  His pupils were fixed and dilated, and I could tell by the way he was breathing that the tall guy dressed in black waiting in the corner holding a scythe was there for him.  He died 5 minutes later and the 20 family members outside the ICU began their mourning process with wailing and screaming audible throughout the whole hospital. 

Bed 3:  55 year old male I had admitted the previous day with another bad head injury due to a motorbike accident.  I was surprised to see that he was still alive, as he showed signs of brainstem herniation yesterday.  I spoke to his family, and updated them on his grave prognosis

Bed 4: 14 year old girl brought in by her family overnight from 3 hours away.  She too was a victim of the transportation system here in East Africa, where cars, motorbikes, pedestrians, and donkey’s share the newly paved roads.  She had been hit by a motorbike and sustained an intracerebral hemorrhage (bleeding on the brain) that put her in a coma (GCS 5).  After ensuring that she was getting our best supportive care, I told her family not to go anywhere today or tonight.

Bed 5-9 were made up of orthopedic patients with open fractures of various long bones.  Most were polytrauma from road traffic accidents and most were younger than I. 

Road traffic accidents are maiming a generation in the developing world.  Over 1.2 million people die each year from road traffic accidents, and an estimated 50-60 million people worldwide suffer disabling injuries.  Over 90% of these injuries happen in low to middle income countries like Kenya and Ethiopia.   A careful analysis of current trends yields the prediction that road traffic will be the third leading cause of death and disability worldwide by 2030, up from ninth place today (WHO 2009 Global status report on road traffic safety).

At Tenwek, our orthopedic service is overrun with fractures due to careless and untrained motorbike drivers, and devastating head injuries are far too common in our ICU.  Now, I’m at a different hospital, in a different developing country, and I’m seeing the same thing; another busy orthopedic service trying to keep up with the constant stream of open fractures, more head injuries with minimal supportive care options, and young people in the prime of their lives being robbed of their mobility and mental capacity.   What about the hundreds, perhaps thousands who never even make it to the level of care provided by Tenwek and Soddo? 

And what about the patient’s ability to hear the gospel...their only hope of eternal life?  Head injury patients are especially tough for me.  We can treat their body, but due to their mental status changes they aren’t able to hear and comprehend the eternal healing message of the gospel. 

Later in the day I was in the OR lounge when I heard the familiar sound of a family screaming and wailing, mourning yet another death.  I made my way over to the ICU thinking it was one of my patients, but it was a patient from a different service.  More gray skies, and the rain kept falling.  I checked on my head injury patients, and both were still hanging on. 

After the day was over, I began the walk home.  The path was dry now, as the literal rain had held off for the day.  I walked past the hospital’s pet sheep, (that are kept for phlebotomy to make blood agar in the lab) and around the corner toward our house.  In the distance Alex was playing, and when he saw me he screamed for joy, “Daddy’s home!!” and it echoed throughout the compound.  He ran over and gave me a big hug.  Tucker trailed behind, and Cooper materialized from a tree to welcome me home.  Cole came running out from the house and said he had been waiting for me.  The clouds from my day had broken and a few rays of warm sunshine were holding onto my legs.  I enjoyed the evening in the sun, not sure when the next storm will roll in. 

Two Dr. Mitchells?

I had my 2^nd OR experience the other day. I got to watch a C-section! I have wanted to do this for a long time, but every time my friend the OB calls, it’s never been a good time. Every time I am available... there are no scheduled C-sections. You get the idea. But it finally happened.  Free babysitting from my parents, and a pregnant Kenyan lady with a scheduled C-section. 

I went intending to watch, just as I did when I went in with Eric during surgery, but this time, they let me scrub in! I don’t know if I was really supposed to, but someone offered, and I jumped on it.  

The actual scrubbing process went fine.  I had watched Eric do it a couple times. I was fitting well with the mantra of surgery training... see one, do one, teach one. I then had to figure out how to stay sterile and get on all the other paraphernalia. (They must teach you that in med school. I skipped med school. I’m taking the learn-on-the-job route.) One of the doctors gave me a quick lesson on what NOT to touch, and where NOT stand, and who NOT to let walk in front of you. (So much to remember.  On second thought, maybe I should have gone to med school!) After all that preparation, the fun started! 

I got to stand right up at the table, and watch them make the first incision.  The doctors then continued by cutting, yanking, pulling, and cauterizing. I can’t believe how tough the body is; how it can handle being yanked and pulled apart. How small an incision it takes to yank those babies out. Yep, you read correctly, babies.  I got a two for one- it was twins!!

              I was a legit, people.  I held the bladder blade retractor, was squirted with some bodily fluid, they passed me the babies and I even got to squeeze the uterus. 

The babies were a boy and a girl. The mom spoke a little English, so I learned that her previous two children were girls, so one of these twins being a boy was a big deal! (they never know what they are having ahead of time) It is very important in this culture to have boys, so that your family line continues. When girls get married, they essentially leave their family for good. They don’t even see their family for years usually. (that is why the bride’s father is paid a dowry, they are losing a family member) The family land is also passed on to the sons, not the daughters. So, the first twin out was a girl, but shwooo, the second was a boy! That mama was happy.

I stuck around to watch the uterus be shoved back in, and to see her being sewn up. Then I decided I should go back to my day job.

Next on the docket, assisting Eric with a case! ;)

Fear and Comfort

I was in surgery clinic last week when I had a thought provoking interaction with a patient.  A 47 year old Kipsigis lady had come to see me for enlarging masses in her neck.  As soon as I walked in the room it was evident that these masses had been there for a while and were quite advanced.  Her entire left neck was filled with lumps and bumps.  After a few minutes of questioning and a physical exam I diagnosed her with metastatic squamous cell cancer of the tongue.  Her cancer had begun on her tongue but had metastasized to the lymph nodes of her neck.  Some of these bumps were mobile, but some were fixed, likely attached to important structures like nerves and blood vessels.  Through the aid of a translator, I had to give her the disappointing news that I had no surgical options for treatment.  An aggressive resection wouldn't give her any survival benefit in the absence of radiation treatment, and I would likely severely disfigure her in the process.  We talked a little about the availability of radiation in Nairobi, but like so many others before her, cost was a prohibitive factor.  I had to tell her that without treatment, the cancer would take her life.  Regardless of cultural background, telling someone they have a terminal illness is never easy.   As we had this discussion, my patient's response to my terminal prognosis was encouraging and thought provoking. She told all of us in the room that because of her relationship with Jesus she was not afraid to die.  She understood that she couldn't pay for the treatment needed in Nairobi and she was OK with that.  She would not run from death but instead would enjoy what time she has on earth, and embrace death without fear.  We all held hands and prayed together.  I prayed for my patient and her family, she prayed for me and my resident.  Then she calmly left.
It was true.  With Jesus awaiting her on the other side of life, what was there to fear in death?  I was struck by the deep faith of this rural Kenyan lady that I am supposed to be here to minister to.  I thought to myself, "This lady needs to be a missionary to the U.S.  We Americans need to hear her message."

In other news, a lot has been going on here at Tenwek.  Some of the missionary families are away at language school, which leaves our kids void of a few friends.  However, Erin's parents have been here for the past month and it has been great.  Also, our good friends Joel and Paula Green will be coming to visit for a few weeks.  It will be fun to hang out with them, but more importantly, they will be bringing Levi, Anna, and Lauren...the Mitchell boys' long lost friends.  With all of our visitors, we have had good excuses to go on safari...which is a nice perk to living in rural Kenya.

Safari!! 

Cooper and Mimi with a Buffalo, one of the "Big Five" animals to find on a safari

Cheetah chilling in the wild, not afraid of us and our cameras. 

We also had a nice time hosting Amie Ecker, a general surgery resident from Michigan State in Grand Rapids.  She did a wonderful job in and out of the OR, and got along well with the residents here.  In good Kenyan fashion, I told her to "take my greetings back to Grand Rapids."

Amie in the OR at Tenwek

Some of you have asked us how you can pray for us and for Kenya.  Currently, you can pray for peace here in Kenya.  There has been some rhetoric from various political parties that are not currently in power, and they are planning on having some rallies on Monday July 7th.  They call it "Saba Saba" day (7/7 in Swahili)  and we are hoping it doesn't set off any tribal violence here in Kenya.
Also, we will be traveling to Ethiopia soon to visit a hospital that might be a place we serve after Tenwek.  Pray for God to show us the best place to go for our next step.

Thanks for praying for us and being a part of the ministry here in Kenya and beyond.

We got a girl!

We got a girl! 

But only for a day.
Last Saturday we had the privilege of caring for a newborn little girl whose mother was sick in the hospital. Our friend Amy is in charge of these matters and she is caring for the little girl until her mother gets better. I offered to take her for the day on Saturday and so we had fun caring for her for a little while!
The boys really loved having her around, Tucker especially! They all fought over who got to hold her and who got to feed her a bottle. Tucker loved, loved holding her and asked about her when she was lying down for her nap. 

It gave me great encouragement that when we eventually get our daughter through adoption, the boys will be onboard and love her too! 

Also...my parents are here visiting!! Their visit is 3/4 over and we have loved them here!! We've all settled into a nice routine and are enjoying our days, mainly doing our regular life with a few extra fun things thrown in!! I'll leave you with one picture (and more to come soon!)

Here they are with the wild rhinos!