Easter weekend

We've enjoyed a beautiful Easter weekend here at Tenwek - and long, too, as Good Friday and Easter Monday are Kenyan holidays. I love four day weekends! Those of you who read my most recent email update (message me your email address if you want to be added to that list) may think a lot of what we do here is sad and depressing, but that's not true. There is a lot of joy in our day to day lives, too, as we participate in the beginnings of God's new creation. Because Christ has risen and conquered death, we see victory, sometimes clearly visible in this life, sometimes in the hope of eternity. Below are some pictures of joy and fun and beauty this weekend:

Ariel view of Tenwek hospital - green roofs in the center of the picture

My friend Agneta and I climbed Mt. Motigo on a truly Good Friday

We met a few friends at the top

Easter egg hunt on Saturday

Abi showing me her eggs

An impromptu biology class - turtle autopsy - note Peter's shirt :)

Future medical students

Most everyone came to watch - even though "Baringo the Turtle" didn't smell so great

Cause of death: Metastatic Cancer
Primary source: unknown

After the turtle dissection, Abi & Anna came over to paint pictures

Sunrise service bright and early Easter morning. Everyone brought flowers to place on the cross.

Abi and Maggie with "Aunt Sasa" on Easter morning

Elise and Micah with patient station dog Emma

Easter dinner at the McLaughlins - me, McLaughlin family, Fader family, Brown family, Carrie

It truly has been a wonderful weekend and it's not over yet as we still have plans for Ultimate Frisbee today. But I did miss something special back in Nashville - my whole family together except me. Pictured left to right: Lauren, Wei Chi, Grandma Pfister, Leslie, Bud, Emma, Dad, Samuel, Mom. And I haven't even met my niece Emma yet!

Emma (pictured with Gigi - my mom) was welcomed into the covenant family at her baptism on Palm Sunday

Do you ever wish you could be in two places at once or have everyone you love in one place? I'm thankful to know that will happen in eternity and it will be more beautiful than we can even imagine. Christ is Risen!

Middle schoolers, power outages, board meeting

For the last three months, I've been meeting with this small group of middle schoolers as they study the book of Luke. Three of the students memorized 75 verses from Luke! All of them studied hard and hopefully learned truths from God's word that will be applied in their lives for years to come.

At the end of each month, the students were quizzed on what they learned. Our team came in second place! But hopefully through the competition, the Word of God was made real and active to all the kids. I'm thankful for the opportunities I had as a child to hide God's word in my heart - I still remember those verses today and hope these children will as well.

As we walked home from the last quiz, we discovered power outages (again) but for a good reason this time - several huge trees fallen during a storm on our power lines.

As 2 year old Abi said when she came to my dark house a couple days ago, "Sasa house, [no] whoo hoo?" Whoo hoo is power as that's what we say when the power comes back on!

Maggie says, "No Bob?" Meaning she can't listen to her favorite Veggie Tales music when there's no power!

We're all getting used to the frequent power outages, though. With no power, I can still: read outside while it's daylight, play with the kids, go running with friends, eat dinner by candlelight - frequently scrambled eggs as the stove is gas but the oven is electric, use my cell phone, make a list of all the things to do when the power comes back on - like write this blog and lots of emails, & go to work as the hospital runs on a generator. The unpredictability is frustrating, though, as we never know when the power will go out or if it will be out for 30 minutes or 3 hours.

The Myrhes, pictured here with the McCropders, are used to power outages, though, having lived for many years in rural Uganda. We likely will be, too, in Burundi, though maybe we'll bring a generator with us! We loved having the Myrhe family visit us at Tenwek a couple weeks ago and were thrilled to hear that their proposal to the World Harvest Mission board to open the new site of Burundi was unanimously approved! Scott and Jennifer Myrhe, currently working at Kijabe hospital, will be our Africa field directors with World Harvest Mission as we head to Burundi long term. Our official individual approval won't come from WHM until our interviews and orientation in Philadelphia in September, but things are moving forward and we're excited!

The most recent McCropder team photo including our newest member: Baby Benjamin! Pictured from left to right: Fader family, me, McLaughlin family, Cropsey family.

Quadruplets Going Home!

"Your kingdom come, your will be done, on earth as it is in heaven." Matthew 6:10

It's unsettling to live daily in the visible tension between Kingdom here and Kingdom to come. Through the life, death, and resurrection of Jesus, His kingdom came to earth. I see evidence daily of lives changed as a result, brokenness repaired, healing provided, needs met. But I also see many areas and lives where the fabric of Shalom - the peace and wholeness that God intended and desires - is broken, evidence that the kingdom is not yet fully here. A new mother with congestive heart failure and atrial fibrillation suffered a stroke two weeks ago and lost the ability to move her right side. Her mother assisted her in caring for her newborn infant. She became stable clinically and was discharged home but did not actually leave the hospital as the family was unable to pay the bill. Last night, she died. Maybe she had another stroke. Maybe she had an arrhythmia from her heart condition. We'll never know. Now there is a mother-less baby who will need to drink cow's milk in order to survive as formula is unaffordable for the family. In addition to the emotional pain he will experience from growing up without a mother, he'll be at risk of anemia and diarrheal disease and malnutrition as a result of not having breastmilk.

This is just one example of the extremes of life and death that we face literally on a daily basis here as we strive to bring the hope of the Gospel to a broken world that does not know of Christ's triumph over sin and death in the resurrection. "For now we see in a mirror dimly, but then face to face. Now I know in part; then I shall know fully, even as I have been fully known. So now faith, hope, and love abide, these three; but the greatest of these is love" 1 Corinthians 13:12-13. In the dimness, we catch glimpses here and there of our bright eternal future in the new heaven and the new earth, when faith, hope, and love remain forever and when death and suffering will be no more. I happily rejoiced in one of those glimpses today:

Quadruplets - extremely unlikely to occur spontaneously (incidence of 1: 571,787), and, in this setting, unlikely to occur in a mother who actually had prenatal care and was able to deliver at a hospital with one of the biggest neonatal nurseries in the country. Even so, without continuous fetal heart rate or contraction monitoring, the boy baby slipped out and delivered vaginally before adequate preparations could be made. Mom was quickly wheeled to the OR for a cesarean section to deliver the three remaining babies - amazingly, all born quite vigorous. But at 1kg each (2lbs) and 29 weeks gestation, their chances were slim in our setup without TPN (IV nutrition) or ventilators or continuous vital sign monitors. They certainly suffered from complications of prematurity - respiratory distress syndrome, hyperbilirubinemia, anemia requiring blood transfusions, apnea of prematurity, feeding intolerance, even bronchiolitis, and, by far worst of all, the dreaded necrotizing enterocolitis. All four babies had serious signs of nec and we unfortunately lost one of them as a result. The other three became quite wasted as we were unable to provide them with adequate nutrition through their long periods of feeding intolerance. We tried multiple courses of antibiotics as well as other meds and, eventually, very slowly and haltingly with frequent setbacks, they began to feed better and gain weight. Now, the three quadruplets are three months old and 2kg (>4 lbs) each, feeding well, and going home today! Truly a miracle to celebrate! Bwana asifiye, as we say here (praise the Lord)!

Kipchumba (name means boy born in the presence of a white person) looks curiously at this mzungu (white person) as I help get him ready to go home today. Incidentally, one of his sisters is Chepchumba - can you guess what that means?

Proud father

The family bought these nice, new, "smart" clothes to go home. The babies will grow into them eventually! They even bought diapers - I've only seen a handful of Kenyan babies with disposable diapers in my 1 1/2 years here. I had to show the nursery nurse how to put the diaper on the baby! It certainly is a special occasion!

"O LORD, you hear the desire of the afflicted; you will strengthen their heart; you will incline your ear to do justice to the fatherless and the oppressed." Psalm 10:17-18

OB, continued

I continue to enjoy my work as a full service physician - adults, kids, pregnant women, phone consults, email consults (from my sister :)), house calls, ICU, clinic, multiple specialties. I even gave antibiotic shots last week to a staff member's child with pneumonia at their home. Praise the Lord; the little one is much better now. I love the variety present each day (though I do at times get frustrated with the interruptions) and am so grateful for my thorough training in internal medicine and pediatrics. And now I'm enjoying adding new obstetric skills to my repertoire. I'm thankful visiting doctors came at the right time to help on the medicine and pediatric services so that I can learn some obstetrics and hopefully help women down the road in Burundi with this knowledge. Here are some photos from this week on the OB service:

Suturing the C section incision

A very young mother with her newborn

The three remaining quadruplets (pictured above and below) continue to grow slowly but surely. Their mother (pictured here on the left) doesn't have sufficient milk for all three so we are working out an alternative plan with formula for now (very expensive, though) and likely cow's milk later. Hopefully the babies, now three months old and at their due date, will go home soon.

This young mother had eclampsia with seizures and very high blood pressure. She unfortunately lost the baby but needed to have a C section as delivery of the infant was the only thing that would improve her medical situation and potentially save her life. After the C section, though, she developed kidney failure (Creatinine 12.2 and minimal urine output) and we referred her for dialysis (not available here at Tenwek but available 3-4 hours away). She never went for dialysis, though, due to the family's inability to pay for it. We thought it likely that she would not survive and transferred her out of the ICU so that another patient with a better chance could have that bed. Amazingly, though, slowly but surely, she began to wake up and her kidney function began to return. Her recovery did not happen overnight, but in the course of a week or so, it was clear that she was recovering. She was discharged last week after almost a month in the hospital with a creatinine of 2.4, normal mental status, and regained strength. We praise God for her miraculous healing.

One of three C sections I assisted with on Friday (I'm on the left)

A monumental event: my first cesarean section without an OB attending scrubbed in. Intern Githiomi and I delivered these healthy twins, both girls, the first one breech. Our attending was in the room to ensure the babies came out ok, but we did all the cutting and sewing and delivering!

The OB/Gyn team

Anesthetist Jackson displaying a visitor to the OB ward

"For I resolved to know nothing while I was with you except Jesus Christ and him crucified." 2 Corinthians 2:2
As we continue in this Easter season and as I learn these new skills, I pray that all my knowledge would be overshadowed by the surpassing greatness of knowing Christ Jesus my Lord (Philippians 3:8).

Med/Peds/OB??!

So, in making plans to head to Burundi long term after Tenwek (for more details about that upcoming adventure, click here), I suddenly realized that, though we have an amazing team with six doctors (compared to no full time doctors currently at Kibuye mission hospital where we're going), we each represent different specialties (surgery, OB/gyn, family practice, ophthalmology, med/peds, emergency medicine). If we're going to avoid being on call every night, we're going to need to learn a bit about the other specialties in order to help each other out. So, as there are sufficient visiting doctors to cover medicine and peds this month at Tenwek, I'm learning obstetrics! I have no illusions that I can learn what OB residents learn in 4 years in one month, but I'm hoping I can learn enough of the basics to give Rachel (our OB/Gyn) a few extra hours of sleep in Burundi. The first baby (girl) I delivered by C section (with assistance, of course!)

Now, though I haven't held a scalpel in an operating room since my third year of medical school (and even then, rarely do they let the medical student hold the scalpel!), I have seen quite a few C sections as a pediatric resident at a busy women and infants hospital. But I obviously didn't see what happened after they handed me the baby! And still, as those kind enough to teach me here will testify, my allegiance still lies with the baby. The OB interns are getting tired of hearing me ask if the mom got dexamethasone (to help premature infant lungs mature) and if the baby is feeding well. And on several occasions in the operating room (or theatre as they call it here), I have been a little too intent on suctioning and resuscitating the baby when I should have been concentrating on stopping the mother's uterus from bleeding! But I'm learning, slowly but surely.

Second C section - healthy baby boy (mother below)

Though it's a bit intimidating to be back at the beginning again not knowing what I'm doing (though I certainly still feel that way at times on medicine or peds), I've realized that my med/peds knowledge still is beneficial on the OB service as we discuss medical complications with the mothers or answer their questions about their babies. And it's so fun to see all these healthy babies! What a blessing!

Twins I helped deliver - a boy and a girl

I'm enjoying a bit of a break from the peds and medicine services as well. Peds has been particularly rough lately as Kenya is in the midst of a drought now. My first week back from Thailand, peds had a child die from severe malnutrition every day. We're hoping the rain is coming soon. OB is not without its complications, though. We have a mother with eclampsia (seizures and high blood pressure during pregnancy) who lost her baby and then developed kidney failure. Her kidney function was slightly better yesterday (creatinine down to 9.5 from 12.2), so we're hoping her kidneys will recover on their own as we don't have dialysis and the family can't afford to take her to a place that does have dialysis. Another mother with rheumatic heart disease (relatively common here) is now paralyzed on one side due to a stroke caused by her irregular heart rhythm. A 16 year old girl delivered a healthy baby at home but tore all the way and required surgical repair to regain continence of stool. Another 16 year old was raped. Please pray for these patients and also pray for me that I would learn what I need to in order to help obstetric patients in the future.

I did get the privilege of being the pediatrician for a very special birth on March 7 at 2:36am. My friends Eric and Rachel McLaughlin (previously mentioned OB) requested I be present at the birth of their son Benjamin Kenneth Kipruto as the pediatrician. I was so honored to be part of that special event - and so thankful that my skills were not needed! Praise the Lord Benjamin is perfectly healthy and was able to be held immediately by mom and dad. We welcome him joyfully as the youngest missionary kid on the McCropder team and in the Tenwek community.

Jessica, Rachel, and I with Baby Benjamin at his surprise baby shower

Thailand fun

Our days at the conference began at 6:30am and continued until 9pm each night with many fascinating lectures on relevant medical topics (translating into 45 hours of CME credit for me!), spiritual renewal sessions with Os Guinness (Christian author), field reports from missionaries in vastly different settings - from a special needs orphanage to a government clinic to a mission hospital, worship time together with the ~500 conference attendees (including families), and sharing struggles and triumphs with each other over meals and in small groups. I thoroughly enjoyed each aspect of the conference, but, as you can imagine, the schedule was exhausting - especially by the end of the second week! So I'm thankful for the fun interludes with friends on the two weekends:

Zip lining through the rain forest

Exploring the city of Chiang Mai

Buddhist temple

Traditional dancers

Feeding elephants

Starbucks at the Chiang Mai wall

I wouldn't believe the elephant painted this landscape if I hadn't seen it with my own eyes!

Or that elephants could play soccer!

We ate lunch at a tiger exhibit

And viewed an orchid farm

I loved so many aspects of this cross cultural experience in Thailand. But it was so much bigger than just Thailand. This year's conference attendees serve in 35 different countries, mostly in Asia, many in very difficult living conditions. Quite a few have served for several decades. I sought out every opportunity to learn from their wisdom and experience as I head down this road in medical missions. I heard excellent advice on transitioning back to the U.S., navigating cross cultural communication, managing conflict, helping third culture kids thrive, caring for those Stateside as well as those in the developing world, cultivating a ministry of listening, dealing with family challenges, etc. I also was so encouraged to share together with friends of mine in the same situation I am as newer medical missionaries looking ahead to an uncertain future. I look forward to crossing paths with these friends and colleagues for years to come.

Though I enjoy traveling, it's also really nice to come back to welcoming friends and routine in my own familiar surroundings. I'm happy to be back at Tenwek!