We also wanted to invite you again to adopt an orphan to pray for, or add one if you are already praying.  If you are already praying, we say THANK YOU!  The difference in some of the kids from past years is obvious, and you should see their faces light up when we tell them they each have someone in the USA praying for them! I think it is very powerful to them that someone across the oceans knows their name and what they look like. We have about 30 kids that we still need to connect with people for prayer. 

There was a recent article in Christianity Today about how effective child sponsorship is.  Kids that are sponsored do better in life.  We certainly aren't a well oiled machine here at the Kettler house as far as communication and organization over this goes, but we would love to send you a picture of a child or two (OR a sibling group), along with whatever info we have on them, and have you pray.  If monetary sponsorship helps kids, IMAGINE what prayer sponsorship does!!  

And... of course.... If you would like to support Kitoben Vision Children's Home financially, that would be great!  Financial support can be sent to Nations to Nations, 5101 Lake Jackson, Waco, TX  76710.  Put a note with your check that designates it for Kitoben.  Every penny you send goes directly to pay for education, food, and clothing for the children, none is used for administration.  Some of you generously gave last year, and we have enough to get everyone through 2013.  Hallelujah!  Love to all,  Tom and Anne

We have been back for over a week now. I am at work full time and the business of life has returned. Unfortunately I have been sick for the past week and a half, When your illness originates in Africa it causes you to pause and reflect, but I think it was just a bad cold. I continue to have coughing fits, usually at night but they are decreasing. Anne also came down with a similar virus so we have been slowed but not stopped. I wanted to try and fill in a few of the gaps during our time in Kenya. I have enjoyed the blog because it allows everyone to see many of the places and people we have written about through the years. It has also been nice to direct some of my long time patients and friends to the site. During the first leg of our journey home I went through my journal and a lot of my old notes concerning our times in Africa. It is always good to reflect on the past, the good and the bad. Now that years have gone by, it is more like the perceived good and the perceived bad. Not quite so black and white. I have come to appreciate that sticking with things and enduring together brings about a deeper understanding and satisfaction. It also promotes a deep rooted thankfulness for God and our utter dependence on His "big picture and larger story" way of doing things. Our first trip to Kenya was 1998 and we stayed for three months, followed by two month stints in 1999 and 2000. We then had a hiatus, but worked in Rwanda in 2005. From that time on we have always returned to Kenya; in 2006, 2008, twice in 2010, 2012 and 2013. We have combined our medical work with our work at Kitoben Children's Home. Much has changed in the past 15 years, but amazingly most of the people have stayed the same. One thing that has not changed is that the ride back to Nairobi is always an adventure and the line of cars and trucks that have to be negotiated at the end will cause your prayer life to instantly blossom.

Morning Report occurs almost every day at Tenwek. It begins at 8 am in a large conference room. There are sometimes over 50 people with the majority being doctors and doctors in training. If you show up at 8:00 you might be alone but by 10 after everyone is there. No early bird sayings here. Some speak very softly and you may never be able to pick up what they are saying. Asking someone to speak up does not, under any circumstance work, so I usually smile and watch the new people struggle with thinking they are missing something. I can now confidently say I can understand the majority of morning report. 51% is a majority. One day a week, on Tuesday we have M and M rounds. That is mortality and morbidity rounds. Usually it is morbidity that leads to mortality and the presentations and discussions can be quite lively. That is usually thanks to the surgeons who drill down on what happened fairly quickly, exposing what went wrong and how the care could have been improved. There is no thin skin allowed. It is all about learning and growing and is sometimes painful. I have been on the receiving side of M and M., but not this time. It was most entertaining this year, as instead of the patients dying, they lived, and were even discharged and went home. I was on the edge of my seat as I kept thinking any minute they were going to give us the bad news.

One of the long term doctors has had it with all of the abbreviations used in the meetings. I have talked about this before, but it is worth repeating. SL = sick looking. BM = body malaise, or bowel movement, or bone marrow, or bacterial meningitis, just depends. GBM = general body malaise. HOB = hotness of body. CAP = community acquired pneumonia. NTB = not too bad. MAEW = moves all extremities well. PTB = pulmonary tuberculosis. P*, J*, C*, and O*, with those asterisks signs being the power symbol 0. That means patient with no pallor, no jaundice, no cyanosis and no oedema (british). Then there is also P+ and P++. He went on about how no one understands all of these abbreviations, but I was sure the majority did. The very next day he said that a DPL should have been done on a patient, that is a diagnostic peritoneal lavage. I just smiled.

Follow the ladders...

Some of my favorite signs in Africa are: The Toe Jam Inn, The Lazarus Funeral Home, The Anointed Candy Shoppe, The God Almighty School Bus, Flush Thrice with Vigor, Beware of Low Height Mind Your Head, and one of my all time favorites from the great state of Arkansas, that being a waste removal business, with a sign saying something like, "Our business stinks, but it's pickin up."

We have begun our journey home. We left Tenwek a few hours ago and just passed the "Annointed Candy Shop." I am wondering why in the world we didn't stop there, but now it is too late. What could be better than Annointed Candy!? There are always mixed feelings leaving. This time we made some closer relationships with the other Americans in the guest house because we ate there everyday and played games together at night:)) Hannah is an intern with Tenwek this year, and as I mentioned before, just graduated from Wheaton. She's just Katy's age and I would like to adopt her as my fourth child.  Trouble is she has a family already. Anyway, she was so much fun. I will miss her. Also, Jerry, the guy who helped build the first dam at Tenwek. He was from North Carolina and his deep southern accent and personality stole our hearts. So it was a little hard to leave them, and of course the Kitoben crew.

We visited Kitoben for the last time on Monday. Alot of the older kids have left for school, but those in grade 3 and lower are there and are attending the newly opened "Ketcasa School" right there on the property. I have tried to make an effort to hug each child each time we visited this time around. They were sometimes a little reluctant, but Monday they had warmed up and all gathered around. They approached shyly with chin a little low, one arm outstretched to touch my shoulder and waited for me to hug them. I guess you can imagine that I was trying not to boo hoo loudly. We know the older kids pretty well by now, but there are so many new young ones that I can't keep them straight. I will try to study their pictures when I get home. I need some more people to pray for kids if you are interested. No other obligation and no shame, no guilt, just a picture and a breath prayer when you see it or think of them. One or two prayers a year would be better than none. Alice gave me a complete list of sibling groups this time, so that's been kind of helpful. For some reason, I really want to "see and know" each child, and I want someone else to "see and know" them too. Kind of like with Hagar, God is the God who sees, so I think He wants us to see people too. Some of you are praying for older kids that have grown up, so if you want to add a younger one, let me know.

If you remember, we were thinking about starting a college fund for the kids to take out loans and pay half of back. We pondered it, and decided to just go ahead and open it at Kitoben's bank and let Alice and Samwel administrate it. I went to the bank with Alice this time. Tommy usually does stuff like that because he is better at it, but after some intense discussions with several bankers I think we walked out with an understanding of the difference between dollar accounts, which we opened, and KSh accounts. We wanted her to get the best possible exchange rate. They will write some bylaws for the account, and have the people who borrow sign a document which they will keep at the bank. Someone gave us a gift before we left thru Nations to Nations to do whatever with, so that's what we chose to do. It's kind of exciting really, and Mercy, the clinical officer student, will be one of the first beneficiaries. Right now she owes a lot of money and they won't grade her tests from her first year until she pays.

Tommy hasn't had much of a chance to write, but is planning to do some when he gets home.  Thanks so much for reading along.

Tommy found our first chameleon yesterday.  He is taking a nap on our curtain rods.

Tom led a D group in the endoscopy suite this morning and I got to attend. Afterward, he told them all how much he appreciated their compassion, kindness, humility and team work. They also expressed their appreciation to him, for his help, his wisdom and perspective, his willingness to come and just his presence. It was very cool.

The endoscopy team

 For the bible story, we read and discussed the story of Jesus calming the sea in Mark 4:35-41. I love the differences in how we all look at things, and I learn so much from the Kenyan people every time we come here. Today I was struck by a couple of things. First, when you ask what they are thankful for, no matter the age, a good percentage (1/4th to 1/3rd) will say, "The gift of life." Every time I hear someone say that, there is something about it that really captures me. I have to confess, sometimes I think it would be easier just to go on to heaven. But, I do simply want to be thankful for the gift of life.

Also, as we discussed the story, I asked whether they thought the disciples should have awakened Jesus when they were afraid. They all immediately said "Yes! Absolutely! They had too! Their unified response kind of took me back. I had actually been considering whether they just should have kept a stiff upper lip, tried to have faith, and waited for Jesus to wake up. He knows everything, can do anything, and even though the boat was filling up with water He would have gotten them to the other side, right? Maybe, but I think they grasp something about needing Jesus and the interaction between God and man that I forget. In the story, Jesus points out their fear and lack of faith. I was trying to think what the disciples could have done to demonstrate that they did have faith. But after reading this many times, I think the lack of faith was shown in their question, "Don't you care about us?" and not by their need of His help.  Another thought is that maybe He wanted THEM to believe and rebuke the wind? Anyway, Jesus's stories are so multifaceted; so deep and wide in their application and stimulation of thought. I'm sure that's why He used them. I want to try to think about them more.

I'm on call today. (Tom) It began with a patient dying in casualty before we really got started. He was a young man that I really never figured out. Probably a mixture of trauma, alcohol, and being in the wrong place at the wrong time. So far today was a busy day of hard cases. Five admissions, one consult on an OB patient with oligouric acute renal failure, hyperkalemia, hyponatremia, severe anemia with pancytopenia, probable sepsis, and she delivered a baby that died 2 days ago. I had to read about that one with many trips to the unit. We had no blood to give her as the hospital was out, and she was O positive. It didn't take me long to remember my own blood type is O pos. She needs dialysis as well, and her potassium was 6.3 on last check. I had an unfortunate poisoning patient who tried to take her life by ingesting Triatix. She was really sick and we had to intubate her and put her on a ventilator. But prior to getting the ventilator, I had to take another patient off a ventilator. Hopefully they will do ok. We only have so many. It's nine in the evening now and I think there are only 4 more left in casualty that are coming in, hopefully none too bad. I have another day of call tomorrow and then I am finished with call. Anyway, I'm getting my money's worth. It takes me back to when I was young. Way back. Things continue to go well here and I am looking forward to this next week. We leave for home Wednesday afternoon, so plenty of time for more adventures. We went to tour the hydro plant and the beginning construction of the new hydro-electric project this morning. We are here with Jerry who is working on this new project.  He was one of the original team that built the dam back in 1986. What a story.

Tom giving blood for his patient

Anne and Jerry walking up the construction site on the side of the dam.
As Jerry said, 'It is sturdier than it looks"

I do have to say, this has been the most encouraging visit we have ever had concerning Kitoben Vision Children's Home. Lots of times, I mean LOTS, we have questioned and wrestled with this thing. We have known that God tells us to take care of orphans, and that our involvement with Kitoben was His idea and not ours, (the thought of an orphanage in our future had not EVER entered our mind before the first time we came here in 1998), but the question of how to go about it has been ever looming and even agonizing at times. We are clueless. How and when does helping REALLY help? I know many of you have asked the exact same questions, and I have no answers. I do know that God asks us to be dependent on Him, humble and repentant, and to persevere through struggles. This may be over dramatic, but I feel that we have been flat on our faces begging for His help and wisdom, and He has been pulling us along by outstretched arms. God HAS been so very faithful to Alice, Samwel and the kids. So many of you have been used irreplaceably in council, prayer, and financial support along the way. It is really like a refreshing cup of cool water this time to see things seemingly going along so well!

Yesterday was a full day. Hannah, Tommy and I went to Kitoben in the morning and did the last part of the key chain. I reviewed the previous three concepts and then Tommy talked about the last verse, Matt 28:18, "Go into all the earth..." He talked about revival and how it could start with them right there at Kitoben. They were listening intently. We also talked about the many people that have never heard about Jesus in Africa. They actually broke into applause when we told them that we pray that some of them will be the ones to go into those areas and share about Him someday. It was quite exciting! I was glad there wasn't a theologian present over the last week as we tried to get these ideas across with word pictures and examples in the face of language challenges.  At one point, as we were tying to discuss putting all our hope in our divine inheritance, heaven moved from being the "City of Gold" to the "City of Cake." Cake is universally their favorite food. Oh well, maybe there will be something like cake there?

We left Kitoben late morning with Mercy (a different Mercy), Jackline and Alice so that the two of them could be seen at the hospital. We got to see what the hospital is like coming in from the other side. As visitors, the challenge was trying to balance not being too demanding of the consultant physicians with getting good care and some questions answered. They were both difficult cases. Everyone was very gracious, and we came away with a fairly clear diagnosis for each of them, and a plan to move forward. We were very pleased, but it took all day and was pretty exhausting.  Once again, we got a small glimpse into Alice's life with 80 kids, and are so thankful and appreciative of all she does. We capped off our day with a slightly cool Coke Zero from the local duka.



The kids waving their key chains and chanting "Everyday! Everyday!" after we
had talked about reading the verses everyday.

The hospital visit, Alice, Mercy and Jackline.

Enoch (center) is Alice and Samwel's oldest son and is
in pharmacy school.  Check out the keychain on the belt.

This is a (sorry) picture of a swarm of bees that came to "rest" in one of the nearby
trees.  Apparently they come to the same tree about this time every year.
The guards tried to burn them out last night, but they moved and made this swarm on the lawn,
and then by the end of the day had moved on.  I tried to take this picture from a distance:)

I have been on call a few times now at Tenwek.. My first patient to see late last night was a man who had been in a motor cycle accident 6 days before. He had some chest pain and an open fracture of his ankle. He was in the O.R. but the ortho folks wanted him to be seen due to his chest x-ray and low PO2. He initially had an O2 in the 50s but had come up to the 70s. He looked pretty good in person, but his chest x-ray did not, and the dilemma of how to manage him began. I remember little sayings in medicine, and one is, always treat the patient, not the x-ray, or whatever else might be confusing you, such as a monitor or such. I treated him with an non rebreather and increased his oxygen, held off on the ARDS dx, and intubation, and we both made it through the night. This morning I did talk to an American radiologist, Shane from Birmingham, and he said the chest x-ray looked like non cardiac pulmonary edema. Anyway he made it through the night.

What's your diagnosis?

One of the many things we do in endoscopy is put in esophageal stents. Here is how a lot of them go: Joyce is a 73yo here for an EGD to rule out esophageal cancer and have a possible stent placement. She has come from far away and has severe dysphagia. We pray prior to her EGD and someone signs a consent. We pass the scope under no anesthesia, and she does have a tumor at 25 cm. A wire is placed beyond the tumor because the scope cannot be advanced, and the esophagus is serially dilated to 36 French. She is re-scoped and her tumor is measured from 25-30 cm. Biopsies are taken, The remainder of her stomach and duodenum are normal. Her EG junction is at 37 cm. Her UES is at 15 cm. A 12 cm Chinese nickel-titanium alloy stent is marked at 20 cm, in order to deploy 5 cm proximal to the lesion, and is placed without difficulty or complication. The scope is re-inserted to check the placement of the stent, the wire is removed, and she is given the ceremonial cup of water to drink. No perforation is noted and she is discharged home with a hospice consult and a chaplain consult. This is all done with a total cost of 30,000 shillings. The shilling is 85 to one dollar, so it's around 350.00. The stent helps with swallowing and the average life expectancy of a patient after stent placement is I believe nine months. I have seen one patient that had a stent placed 17 months ago and we re-stented her last week. Tenwek is now well known for their work and are conducting research studies searching for the reason why this is a world wide hot spot for esophageal ca.




An esophageal stent

 

 

 

 

Alice had a day off from the hospital today, so I went for a couple of hours over to Kitoben to try to take some pictures of individual kids, and go through our files to review where all the kids are with school and life. It was fun being with Alice, just the two of us, and it seemed kind of like old times. Things have been a little strained between us off and on, I think because of the huge need before her. Today I felt like we were pulling in the same direction. That was very refreshing.

If I were an orphan, I would absolutely want Alice to be my adopted mom. She knows pretty much every detail about all 100 kids. She has a list of all the kids with their birthdays  When they come home for break, she has someone bake a cake and then they have a birthday party for everyone who had a birthday when they were away at school. Over and over she said, this or that was happening in their lives... single mother died, slave to relatives in different ways, only parent mentally ill, relatives not feeding them... So we took them in. It is just matter of fact, there is a need, and we met it. I believe this passion for the kids is totally God given, because no one could do this in their own strength.



Saying goodbye from the back of a hatchback

Also, she is doing individual fund raisers for each of the ones in college to meet their tuition. The money that some of us send through Nations to Nations is barely enough to get them through high school. One friend of ours and Alice's, Karen Tanksley, has talked about an idea where we could figure out financing for college loans. She had thought about trying to get sponsors, have the kids take out a loan for college, and pay half of it back. If anyone knows of any microfinance organization or other way to go about doing this, please let us know. It is a big need now and will get much bigger in the years to come. It would be great if we could do this college stuff thru another organization that was set up for loans.

When I first arrived today, Alice wasn't there. She was out sharing about Jesus door to door. She said "You said tell others, so I went to tell others. I went on this side (she pointed) this morning, and will go to this side this afternoon. A friend is gathering some people on the corner at noon for me to share with them. This Saturday we will have a children's rally on the lawn for all the kids on the airstrip. I will buy them something small and share with them, then our children will do D groups with them." WOW. Somehow in America I have made things more complicated than they need to be.

Our attempt to do D groups with the kids way surpassed whatever we had pictured in our minds. Tommy and I took the oldest 6 kids and did a group and then the older kids each took several younger kids and repeated the process.  I think I'm always a little shocked when kids do what I suggest! Our verse card for yesterday was about God having a wonderful plan for each of them, and that He would never fail or abandon them. The story we did was about Jesus calming the sea. We gave the kids in standard 4 and up each one of the little red booklets (parts of which are shown below) with their name on the front.  They were treasuring them.  The sight of the kids spread over the lawn doing the groups with each other was pretty cool.  Tommy was quite the inspirer.  He was talking to the boys about revival starting at Kitoben, and was drawing pictures of how multiplication can reach the world! They love the verse keychains too.  Right when we pulled up yesterday, they greeted us and immediately ran to the meeting room, waiting to get their next verse addition.  I guess you and I can really do this stuff, because we feel pretty clueless.

The boys doing D groups

The girls praying over the C for commit portions in twos

Today we are going again and have several visitors that want to go with us.  Should be fun. Thanks again for praying for us and for Tommy's call, it went good.  One down 3 or 4 to go. We continue to be so very grateful for our friends!!

Jet lag is such a real thing for me. We arrived at the Nairobi airport at 8pm, noon KC time. It was as I had expected with the international terminal burning down a few weeks ago. Ramp off the plane to the tarmac, bus to the makeshift tent for immigration, and of course a free for all when they finally let us into the tent with our luggage. That was fun. Grab a bag, grab a cart, lose Anne, find another bag far away, one more bag that is of course black, find it, find Anne. Perfect. Head out to the mob of people waiting with little signs that have names in all sizes written on them. I took the short cut and yelled out Samaritan's Purse, Kettler family very loud and out came our driver smiling and happy that I had made it easier. There were no mishaps on the plane as I did not hit Anne in the nose with falling luggage this year. They, whoever they are, reassigned our seats to Nairobi from Amsterdam and Anne sat next to a fairly large man who looked like a bad guy in a movie. Anne said animated movie. He drank no less than 7 bottles of wine on the trip and said less than 10 words. He was of course the aisle seat so I not only felt trapped but was. We made it, and we made it to Tenwek, no harm done. The first night we woke up very early. Anne said it seems like we just went to sleep, but it's 5:30. I said, you didn't change your watch, it's 1:30. We talked and laughed for a couple of hours. That's how jet lag starts. Then when you need to stay awake there is no way to do it. We have been here for 6 days now and it's a lot better. No more afraid to look at the clock for fear it will be 12:30.

I like the way Anne put the pictures in so I will try and take you along my journey at the hospital at times. I am in the endoscopy unit filling in for one of the long term missionaries, Dr. Steve Burgert. He is a gastroenterologist and has things really running smoothly. I go back 15 years here at Tenwek, to a time of overhead paging, like M.A.S.H., and scopes that worked not so well. I did them when I could get away from my work in the wards, and became more proficient as the demand for more complicated things arose. I have now done almost everything except ERCP's. It's challenging and the team in endoscopy is fun and good at what they do. I brought over a scope that was repaired by a Kansas City company, that we have had a relationship with through College Park for years. A small world. The service they have provided Tenwek is amazing, repairing scope after scope. Anyway, the patients receive probably the best care in East Africa, with scopes and equipment that are top quality, and a team of providers that really care about serving. Since a lot of the care centers around esophageal cancer I am happy to say the men and women who work here have not grown cold and cynical, but continue to treat people with dignity and love, praying before each case and showing concern over small details. Many patients cannot swallow and are in pain, so it makes a difference.

I was on call last night and before I went over to casualty (the ER) to evaluate the five or six admissions I had waiting for me I wrote the following in my journal.  The air here is cool with a mild breeze and I can catch a glimpse of a rolling hill several hours walk from here. A lot of people are milling around: visiting family members, staff, patients that can walk. Tenwek has 300 beds so it can be quite action packed at times. I just finished a full day of endoscopy. Lots of cases, all different. It was peaceful out here until just a few minutes ago. An older woman and two younger women tore through here screaming and wailing. Tearing at their clothes and being restrained, they came from the vicinity of the intensive care unit. I could only assume that a family member had died. Grieving here is loud and out in front of anyone and everyone. Death is so in your face here. It seems that very few escape the untimely death of someone in the extended family. Dealing with the endoscopy unit this week has brought me back to "life isn't fair." Cancer, complications, chronic illness, unmet potential, it goes on and on and comes in the door over and over. Being here allows me to be exposed. I cannot hide. I don't want to hide. I draw near to God as they do that suffer. Asking questions that cannot be answered and praying for strength and faith. I pray a lot here.

On the lighter side I made rounds this morning after a pretty good night on call. The two interns I made rounds with were Paul and Barnabas, go figure. The charts are sometimes entertaining to me.
Sick looking = ill
Elderly = anyone over 30
HOB = hotness of body = elevated temp
Loss of pulses = the best I can tell is that the patient has died.

It says pull in this direction, but there is no arrow

This is the staff toilet in endoscopy. The reading material is well, think about it.

 

I will leave you with this. You do not want to be an elderly sick looking mother with HOB just prior to loss of pulses. 

Fun group of International medicine fellows from
 David Platt's church in Birmingham.  They were "Radical!"

Good news!  Today the two ladies with pemphigus were both sitting up having chai and ndazis and watching an African worship video!  A remarkable improvement from the day before.  Their skin still looks pretty bad, but they obviously feel much better.  Thanks for praying for them.

Yesterday, two new friends and I went to Kitoben to visit, share and hand out the first of part of a keychain thing that we brought with bible promises and verses on it.  Mikelan made them for us at the last minute :))))  There are two things we are aiming to do this time with the kids at Kitoben.  The first is to give out these verse keychains, and try to give a story or word picture with each portion that helps it stick. The second is to start D groups with the older kids and encourage them to do the same at school and with the younger kids.  D group is a term I think coined by All Nations and it is just an easily reproducible kind of discipleship group/church with three ABC elements:  A for ask (thanksgivings and prayer requests), B for bible ( a passage read and discussed in a very specific and simple way) and C for commit (stating who you will pray for and tell this story to, and practicing how to tell it).  Its funny, but somehow doing these things  make me pretty nervous and are surely out of my comfort zone. I struggle to teach and communicate in that environment, and wish I had Julie or Kathy in my back pocket.  Anyway, the first one went great I think.  Whitney and Hannah helped and shared with the kids; they were amazing.  Whitney shared about God having a special plan for each kid and that we are all one big family in Jesus.  Their eyes and smiles were so expressive as she shared.  Hannah shared about how important it is to work hard in school and finish.  I think if I would have asked Alice and Samwel to script two talks, they would have been exactly right on!  We will try to do the D groups this weekend sometime.  We are praying that God's promises stay in their heart forever, and help get them through the rough times ahead.



Alice's sister Sharon (Brian's mom) and brother Benard who both care for the kids.  Hannah (middle)
just graduated from Wheaton and is working for Tenwek.  Whitney is an international adoption counselor
from Birmingham.  Whitney and Hannah were awesome sharing with the kids.

When we visit, we will  hand out the card for that time, share about it, and then the children
 bring them up for us to write their name in the space.  Hopefully the promise will become very personal to them. 

Last year we sat around the dinner table and talked about happies and crappies for the day. This is actually a great way to stay in touch with each other.  My happy yesterday was that Samwel told us that he and Alice took all the kids third grade and under out of school 3 months ago and hired 3 teachers to teach them at home.  They divided the building that Michael, Big Mike, Colin and Roy built last year into 3 classrooms and are using that as a school house.  They realized that this was financially wise and I think it will be great for the kids as well.  It is always gut wrenching to put a ceiling on how much you will give because the needs are endless, but this was very encouraging for us.  They are wisely making the best of what they have.  My crappy was that Mercy, a different Mercy, has developed a disease called scleroderma and is starting to have joint contractures, trouble swallowing, and some bad skin changes.  She is so quiet and timid anyway, so my heart breaks for her.  I will try to see if I can get her started on some treatment, find someone to follow her here, and get some braces made for her arms back in the US.


The Kitoben kids yesterday. Many home for break and 20-25 are there year round.  The high school  kids that are able have begun going to their home villages for breaks to reconnect so they have a place to go when they graduate.

I walked in to say Hi to Tommy today in the endoscopy lab, and he was helping Lando Justice (yes, that is his most awesome real name) were removing a piece of goat rib bone from someone's esophagus.  It was quite a struggle because it was lodged horizontally, but Lando triumphed and got it loose.  The man ended up spitting it out, so we were all happy to know it wouldn't get stuck again.  Apparently meat is considered more fresh here if it has bones in it...maybe not a good thing. Tommy is on call Friday and Monday, which is actually a real reason to be nervous.  Please pray for the mind of Christ and strength for him.




The funniest carrot I have ever seen!

Hello from Kenya! We made it. Communication has been challenging, but wanted to let you know that we are here and have begun work at the hospital. We also got to drop by the children's home the first day we got here and everything looks great! The buildings and playground are being put to full use, the crops are growing, two of the cows are giving milk, the water tanks are full, there is some electricity, and a lot of life! About 50 of the kids were there and it was so much fun to see them, the place was buzzing. We would appreciate your prayers for our work at the hospital, and especially pray for our time with the kids. We plan to talk to them about discipleship and living out their faith in Jesus. We will write more when we are less jet- lagged. Thank you for your prayers and support, Love Tom and Anne


Playground built by Mike Kokinos

Beans and other crops in the distance





The newest building in the distance and the retaining wall
that Michael Gromer, Colin and Roy worked on last fall



Some of you remember Brian.  He has grown!



Immigration at the Nairobi airport temporary tent.  The international portion was destroyed by fire recently.  Baggage claim was a ZOO!

 

 

Blogging is all new for us, but we decided it was the best way to get some pictures mixed in since Michael, the facebook whiz, is sadly not with us this time. We have had a packed full few days. I just have to start out with the highlight so far, and I can't really imagine anything else taking over its place as #1. This morning we were sitting in morning report at the hospital when a young woman caught my eye. She smiled and waved shyly at me, and my brain said "Is that... no it can't be... maybe??..." And indeed it was!!! Mercy, one of the many Mercys at Kitoben Childrens Home, graduated from high school and started Clinical Officer training (like a PA at home) almost a year ago, and is doing a clinical rotation at Tenwek!!! She is one of a sibling group of three that Alice and Samwel welcomed in 12 years ago. You can imagine our sense of joy in seeing her there and realizing again how much she has overcome with God's help! 

The brightest moments always seem to come after discouragement, maybe that's what makes them so bright.Last night was kind of a low point, the usual thoughts and questions flooded in: "What in the world are we doing here?" "Can we even think straight any more, much less remember the name of a disease process or a person that we know?"  "How in the world do we communicate the immensity of your love and trustworthiness to these kids? "Will I ever get to sleep and can I just throw all technology away once and for all?"  "How does anything we do really make a dent in problems this big?" and of course, "There is no way we have what it takes!?" And surely we don't, but we do have to arrive at that very point by a different road every time we serve. And we all do. The bright spots are awesome, but God's movement is so very often underground or over our heads, out of our sight and recognition. Our only hope is to just keep walking along by faith, one foot in front of another. As we do that, He is working in ways we can't even dream up. He describes it in Ephesians as " beyond, beyond what we can imagine or think." So once again we set our minds and hearts like flint to believe God, and "look not to the things that are seen but to the things that are unseen; for the things that are visible are temporal, brief and fleeting, but the things that are invisible are deathless and everlasting" (2 corinth 4:18).

On the hospital front, The dermatology consult business has been busier than ever. I have seen some really challenging and unusual cases already, even life-threatening, which is not my standard fare for the US of A. There are two ladies in the hospital with pemphigus vulgaris, a serious blistering disease that is somewhat like being a burn victim. Please pray for their rapid healing and that they would feel God's presence as they endure this awful condition. Another woman has a blistering diesease of pregnancy which we are treating, but she needs prayer for the health of her unborn child. This morning a man was admitted with a tumor on his head almost the size of another head. He was humiliated and I don't know whether they will try to operate or not. I pray that they all experience the love of Jesus here, and I am thankful that there are chaplains here that share Good News with the patients in their own heart language.  Tommy is enjoying endoscopy and has great people to work with.. They are a fun group, and he keeps them laughing. He is gathering stories to write about, so he will be keeping us all laughing too:)) As always, the residents and interns are so much fun to work with and most of them love to learn.  This year there are so many young visiting doctors and their families, and that always keeps things lively.  Yesterday we had lunch at A-Aron's house.  Tomorrow morning I have four young women going to Kitoben with me. Two of them asked me if I would take them there and then the group kept growing. One of them was on the track team at Wheaton with Ian McGregor, and one is interestingly an international adoption counselor with Lifeline Children's Services. Please pray that we can love well, present truth in a way that lasts, and that faith would be increased all around. 

With much love and gratitude, Anne

Old friends Eliud and Julius.  We DID remember their names.



Mercy Chepngeno at Tenwek now in Clinical Officer training.  Came to Kitoben with her
brother and sister in 2001 after the death of her single
 mother due to HIV