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."