dawn: adventures of a journeywoman

A snap of me painted as a "Massai princess" after conquering a 2 hour hike and between a 20 km bike ride through Hell's Gate national park last weekend.

There are portions of each of our lifetimes where we are able to step back and marvel at the present. I often find it easy to look back and see times of growth, pain, sweetness, or joy with an ability to appreciate each quality (and if I’m lucky enough, I can see how it fits into the larger picture of life). And trying to anticipate the future can either be stimulating or dreadful. But to be able to step outside the day-to-day humdrum, headaches, and ordinaries of the present and realize the significance of what is taking place is something completely different.

Lately I have been fortunate enough to be able to experience this feeling. Several times a day this week, I have felt like pinching myself. After the adjustment to new expectations, new culture, and new normalities, I am realizing the depth of my daily experiences in Kenya. I realize I am not living through each day, but trying to savor and stretch each moment. I can almost feel the growth happening, it has been so quick. And as in a child, rapid growth is often painful.

I had to sit down with one of my patients last week to discuss the case of cancer vs. her body. The limited chemotherapy available had been briefly attempted, but convenience, cost, and her body’s tolerance had halted any attempt by medicine to defend her body months before. I spent an afternoon with her as we uncovered and faced the reality of medicine’s limits and plotted the next few steps to manage symptoms and provide comfort. Afterwards as I prayed with her, I felt a strong sense of my limits but a reassurance of God’s limitlessness. Later that afternoon, a physician came around with a few English bibles. As one of my select patients who was very educated and proficient in English, her face lit up as her cupped hands contained the small Bible like the last drops of water in a dessert. And I suppose in a way it was. I smiled as she insisted I write an inscription for her in the front cover. I was amazed at how full I felt being used in small ways in this place.

Though I am far from perfect in my performance, it feels good to be used by the conductor. To be offered a chance to play a part. I was acutely aware of this as I ran between two floors attempting to resuscitate two patients with the help of a senior physician. I knew I was living deeper as I carefully palpated the hearts of HIV positive death row inmates in prison. I could feel my own heart stretching as I held a screaming mother after telling her that her child would not live through the night. I knew I was in a growing moment as I lay on a gurney next to a patient I had been treating just moments before (strange stomach bugs can suddenly affect even healthcare providers).

Where does this present fullness come from? The only way I can comprehend it is that I feel I am doing what I was made for. For a moment in time, I see my Father letting me work with Him. Like a young child who loves to “help pump gas” with their father (who is doing 95% of the powerful squeezing), it is thrilling just to feel the rush of power escape just under my hands. Beth Moore words this feeling best:
God could grant us victory and maturity without an ounce of participation on our parts, but He created us with a need to contribute to and participate in the harvest. God made sure…that much of our fulfillment would involve the glorious pursuit of God and His goals so that our souls would be filled and thrilled in the constant discoveries [that] God is sovereign. When all is said and done, He knows what thrills us most.

Thank you again for all your support as I continue to serve and grow in Kenya.

Photos: walking among baby giraffes on Cresent Island; the children receiving de-worming medicine in church

I must apologize for the despairing tone of my last blog. Although the initial days of re-adjustment to life in Kenya were not easy, I have been able to feel more settled in the last week. God is a God of answered prayers and I was privileged enough to see His hand in the midst of suffering.

Last week a young patient recently paralyzed and blinded from meningitis was thought to have a rectal-vaginal fistula. As I gently questioned her about risk factors, she revealed a painful story of being molested as a 5 year old girl. I wasn't able to hold back all the tears as I prayed for healing of body and spirit over her. I was so relieved when no fistula found on further examination, and I was happy to see her go home today under the care of her mother. Yet I am reminded that just 2 months ago, she was an active, studious young woman. What a different life she returns to now: tube feedings, diapers, and lying in darkness.

As other patients I care for struggle to breathe with tuberculosis, to walk with debilitating and neglected leg sores, and to think clearly after being assaulted by a unprovoked head injury or a bout with malaria I find myself rejecting the bitterness of disease. Though it may seem I play a part, I recognize how small and limited this is. Yes, it has been exciting to see patients regain some function after being treated with medicine. And some of these changes have been dramatic and exciting. One patient progressed from labored, distressful breathing to practically skipping down the hall (without oxygen) a few days later. I saw another patient today who could barely move without excruciating pain from meningitis a week ago, embrace her husband and comfortably smile and laugh.

I have (and do) question why pain exists, especially when I witness what seems like enough for multiple lifetimes be manifested in one person. I find myself increasingly drawn to what will ultimately relieve all the exhausted cries that I witness. I attach myself firmly in agreement with Paul when he says, “We grow weary in our present bodies, and we long to put on our heavenly bodies like new clothing…while we live in these earthly bodies we groan and sigh, but it’s not that we want to die and get rid of these bodies that clothe us. Rather, we want to put on our new bodies so that these dying bodies will be swallowed up by life.” 2 Corinthians 5: 2, 4 How amazing that we don't have to be swallowed by the tendrils of pain and death but instead can look toward being engulfed by deep, true, and infinite life. So even as I prayed with a mother after telling her the pregnancy she had longed for had ended, I did not despair. It would be hard to survive without being reminded that there is more than this life.

I was encouraged by a friend before I left that we can seek pleasure in all earthly things (which is different than simply living with the ultimate goal of earthly pleasure). And my creative Father has given me some surprises of pleasure. On Saturday, I traveled with a family across Lake Naivasha to Cresent Island where many wild animals were deposited for the filming of "Out of Africa." Apparently no one remembered to return these animals to their homes after the shooting was complete. Upon arriving on the island, I was greeted by a giraffe as I stepped out of the boat. We hiked for a few hours getting as close as we dared to wildebeasts, gazelles, and zebras. It was breathtaking to walk among these bizarre creations and realize I likely looked just as strange to them.

Instead of staying at the compound on Sunday, I squeezed into a crowded landrover headed into a slum of Nairobi. After carefully stepping over waste of all sorts and passing unrecognizable slabs of meat roasting on the same ground, we arrived at a shanty just barely bigger than my bedroom (which, by the way, is not spacious). There a few parishoners were already interceding for the upcoming 4 hour long service (putting my own church to shame). There was a dance team who led us through moving to an hour of call and response singing. And of course, the other white people and I had to share some wazungu songs in exchange. The move of the spirit among people who had so little, yet gave so much was undeniable. The surgeon in our group was asked to bless a new purple satin covering some members had pooled together to provide (which was a nice contrast to the dirt floors and sacs making up the roof). Instead of passing out communion, one by one each member came forward to receive a de-worming medicine. It was truly a place where I could feel an affirming presence of the longing of something beyond this world.

Thank you again for your thoughts, prayers, and e-mails as I continue my service in Kenya.

I have officially begun work at Kijabe Hospital as part of the team caring for the patients on the women's ward, alongside a visiting physician and a Kenyan clinical officer (similar role as a physician assistant in the U.S.) I have my own room in a duplex with a fluctuating number of other single women from all over the world who have come to volunteer. I have many luxuries including a very hot shower (very neccessary in this 50 degree climate), a stash of diet coke that I bought in Nairobi, and electricity that works more than 90% of the time (although it went out about 3 times in the middle of a procedure using ultrasound last week, causing the team to have to repeatedly start over).
As I have been contemplating my experiences so far in Kenya, the word that keeps repeating itself in my mind over and over is overwhelmed. My thesaurus is trying to help me find other words to express this emotion: to overpower, overcome, engulf, devastate, beat (down), and crush. So much of my first few days at Kijabe Hospital I have felt overpowered by the awareness of my insufficiencies. And they are many.
I do not understand enough Swahili to grasp the symptoms my patients are describing. (I must humbly and constantly ask the nurses and nursing students for help with translation). I finally looked up nini today, which I had thought meant “you” as this word was often directed toward me. Sadly, I realized that it means “what?”; quite fitting as even my American accent limits full understanding even when both parties are fluent in English.

I don’t know enough about how the hospital works here: where to go, whom to talk to, which tests and medicines are too expensive, and even what the lab values mean. The units are quite different even for simple values I know in the U.S. such as blood glucose (I have to multiply by 18 to convert to mg/dL). The acronyms are strange to me (An RTA refers to a road traffic accident instead of the what I use to in the US, MVA=motor vehicle accident).

I constantly recognize that my medical knowledge and skills are also insufficient. I was called in the middle of the night to evaluate a young child who appeared to be in distress in the middle of a blood transfusion. Was she reacting to the transfusion (which can be fatal, but she desperately needed) or was it the three other serious illnesses that were causing this? I decided to wake a physician to ask for help after temporarily halting the transfusion in hopes that this was the safest measure. I could tell at least 25 similar stories and I’m sure by the time I leave I will have hundreds more to tell where I am lost by my limited expertise.

The amount of suffering engulfs me several times a day. Far from a romantic notion of saving lives, I see so many lives that are cut short before my eyes. I declared my first patient dead two nights ago. The nurse called and explained, “Dawn, we have a patient here with decubitus ulcers and he’s passed. We need you to examine him.” My first thought was, “what did he pass out of his ulcers?” I started imagining all sorts of fluids until she explained, “Daktari, he has no pulse.” I dutifully reported to the patient’s bedside and started to look for indications of life. My medical school gave me several lessons on examining live patients, but never dead ones. So I got out my stethoscope and went through the ritual of listening for a heartbeat, breathsounds, examining his eyes, and feeling for a pulse on the young man. I tried to finish my exam without reflecting on the chasm between life and death that separated the two of us. In the last few days, this chasm has appeared smaller.

Much of the time I have felt overwhelmed, it is because I am not living up to my own expectations of what I feel my abilities should be. My inadequacies are discouraging and make me wonder if my presence is helpful at all. Yet, God cut through to me this week through his word through the psalmist. “I look up to the mountains-does my help come from there? My help comes from the LORD, who made heaven and earth!” Psalm 121:1-2 I was struck today how Paul writes to the people of Corinth about carrying around Christ’s death. “Through suffering, our bodies continue to share in the death of Jesus so that the life of Jesus may also be seen in our bodies.”

What does it mean to carry and share in death? As I read the word, “death”, I am assaulted by the smells of death stuck in my memory. And I also carry that stench of imperfection, of not caring enough, not knowing enough, not trying to understand enough. I now have an increased awareness of how much I fall short. And this is what led the One I love to die. I have tried to cover up this ugly smell of reality with the cheap perfumes of puffed-up knowledge, confident appearances, and false competence. But this cannot hide the truth that my humanness stinks and isn’t enough to save lives or souls. I am in desperate need of lifting my eyes up to the LORD, who is my help. His truth washes away the ugly odor of my weakness and replaces it with His strength, His life. “So now I am glad to boast about my weaknesses, so that the power of Christ can work through me.” 2 Corinthians 12:9b. My prayer this week is to see evidences of God's work in this place. May that be answered in whatever place this finds you, as well.

Grace and Peace,
Dawn ;)

Just a quick post to say thank you for all your prayers- I arrived (with all of my luggage) safely in Nairobi yesterday. I will share more stories later this week.