Cristo Rei....overlooking the city of Lisbon.

Friends,

As Marilyn and I jet back home to resume our usual lives, we pause once more to review our time in Kenya, and finally, our time in Lisbon.   We are rested and hopefully ready to tackle our upcoming move into a new home, and a return to work, a return to our volunteer activities, and our small group activities.  Service at Tenwek has become increasing difficult as we continue to age and move further away from fulltime active practice in hospital medicine (for me) and obstetrics (in Marilyn’s case).  Time marches on, medicine advances at an astounding rate, and protocols and treatments continue to change.  Each time we go to Tenwek, it takes a little more time to “shake off the rust” and to get back into the practice of Kenyan medicine.  Nevertheless, it continues to feel “right” to us, and we are always rewarded for having practiced obedience to our perceived call.  The Kenyans that we serve are unfailingly appreciative, gentle, patient, and long-suffering.  The long-term medical staff that we partner with are likewise unfailingly supportive, gracious, and appreciative.  The Spirit of God is definitely at work in that place.  As a result, we plan to continue going to serve in Kenya until we feel that we are no longer helpful, or until it becomes clear that we are no longer called to short-term medical missions.  Alternatively, we would likely be more proficient if we were there for longer periods of time, or on a more frequent basis?...yikes!!…God only knows what He has in store for us?!  If this happens, we may need to continue shedding houses and possessions!!...not an unpleasant thought at this point in time!  As has become our routine, we met up with our friends Peter and Petra Axt from the Netherlands for a brief period of exploration, leisure, and renewal of old bonds of friendship after our departure from Kenya.  This year we visited the lovely city of Lisbon and enjoyed outstanding weather, outstanding food and companionship, a sunset sailing expedition, some E-biking around the city, and finally a day trip to the magical city of Sintra.  Here we visited the incredible remains of a Moorish castle (from the time of the Crusades), and an additional castle (the palace of Pena) that was used by the Kings and Queens of Portugal as a summer retreat during their monarchy period.  It’s difficult to imagine how these structures were ever successfully assaulted/captured given the difficulty we had in just reaching them (with roads and buses no less!!).  They were quite spectacular and pictures don’t quite do them justice.  I would encourage you to go visit if you ever have the opportunity!  After all of the above “leisure”, we find ourselves somewhat physically spent and thankful to be sitting again (at least for the time it takes us to return home).  Then the next leg of our “sprint” begins anew!!  We hope to see, and reconnect with each one of you in the weeks ahead, though please be patient…it may take some time for us to “catch our breath”!  For now, we will be signing off from our blog till next year…in the meantime Marilyn and I wish each of you the peace and love of Christ in your everyday lives and families.

God bless,

Randy and Marilyn.

Meeting up with old friends...Peter and Petra Axt.

A toast to a tradition...

Caipirinhas...I like Brazil's better!!

Pastéis de Nata in Lisbon...a must try treat!

View of a miniature replica of the Golden Gate Bridge, as viewed from Cristo Rei, a miniature replica of Christ the Redeemer statue in Rio de Janeiro...

Roof top dining at our hotel in Lisbon...

Rooftop view of the city....

Castelo dos Mouros...an incredible site in Sintra, Portugal

View of Sintra from Castelo dos Mouros

Last night in Lisbon...dessert of course!!

Kwaheri Tenwek!

Dear friends,

Our time here at Tenwek is coming to a close for another year.  It is always a bittersweet time as we say goodbye to new friends and old, and reflect back on the patients that we have helped care for while here.  It is with much joy that I can report back on a patient that I wrote about earlier this month (see posting 9/16/19, “Why am I here?”).  Her initials are E.O., and she is a 29-year-old mother of 4 young children.  She initially came in with severe mitral valve stenosis, tachycardia, severe right heart failure, hypotension, and respiratory failure.  I fully expected her to die within the first 24 hrs. of her presentation, but she miraculously survived with aggressive efforts at supportive care.  I wrote to you about how I felt that God had His hand upon her during that critical period, and how I was awed to be able to participate in His plan for her survival and care.  She remained very tenuous during the subsequent days while in the intensive care unit, and gradually was able to be weaned off of ventilatory support.  We were very pessimistic that once extubated, she would be able to support her own respiratory needs, but again she miraculously surpassed expectations, and was able to breathe on her own.  Despite this, she remained dependent on IV medication to support her blood pressure, due to the severity of her rheumatic valvular disease.  We were never able to stabilize her BP adequately, so that she could be moved out of the ICU.  In desperation, we reached out to the Cardiovascular team and informed them that we thought E.O. was as stable as we could get her with medication, and that she would likely die in the hospital, or shortly thereafter without surgical intervention for her valvular heart disease.  The long-term missionary in charge of the cardiovascular team here (Dr. Russ White), evaluated her with his team, and agreed that she had essentially no detectable blood flow past her severely narrowed mitral valve, and his statement to me was: “I don’t know how she is still alive”!  He was planning to operate on another patient the next day, but would then have a period of one week during which no surgeries were planned due to shortages of personnel, and vacation time for some of his critical staff.  He was willing to try to replace her diseased valve the following day, but reported that the patient was declining surgery because she was convinced that she had been placed under a curse, and would die if she sought medical help or hospitalization.  It was her belief that she would survive only if she left the hospital and abandoned efforts at medical care.  Many members of our team spent time with E.O. and her family explaining her disease and what was needed to help her.  They also prayed with her, and over her and informed her that our God was bigger and more powerful than any curse that might have been placed on her.  The hospital chaplain also came by and counseled her, and prayed with her and her family.  E.O. remained very ambivalent and indecisive.  She gave consent to proceed with surgery, then again revoked consent.  This pattern repeated itself several times, before her family finally intervened and gave consent on her behalf, claiming that she was not able to rationally make a decision for herself.  Finally, as she was being prepped for surgery on the afternoon of 9/25, with the consent of family, and ultimately of the patient herself, she was taken to the operating room for mitral valve replacement.  Dr. White had confided in me that he was uncertain what to expect.  He did not know if her right ventricle would recover from being chronically overstretched and dilated, or whether it would recover once the mitral valve obstruction was relieved.  He thought that there was a relatively high risk of death intraoperatively, or shortly thereafter.  E.O. was covered in prayer by our team and myself as she went through surgery.  On the last day of our time here at Tenwek (9/26/19), I awoke with some trepidation and anxiety.  I had not been called about E.O. overnight and presumed that this meant that she had survived the night, but was uncertain about her status.  Marilyn and I walked up to see her in the recovery room this morning, and I was greatly relieved to see E.O. sitting up in bed, extubated, and alert!  She looked as stable as I have seen her over the course of her hospital stay!!  I silently thanked God for bringing her through her ordeal safely, and expressed to E.O. my joy at seeing her on the road to recovery and wished her and her family a happy and blessed life.  I told her that I would be returning home later today, and asked permission to have my picture taken with her.  Once again, she refused,…then consented…  I am confident that one day she will be able to smile again, and will come to believe that the curse that she has believed to be her destiny has been lifted by the grace of our great God!!  Glory be to God on high…. and thank you for the life of E.O.  May she have a long and joy- filled life, and may she be a living testimony to the love and grace of God…both to her family, and to her community.

To our Tenwek family ….Kwaheri!  To our U.S. family and friends…see you soon!  To Peter and Petra…see you in Lisbon!!

E.O. in recovery following mitral valve replacement!

A message from Marilyn

Dear Blog Aficionados,

Randy has again offered me an opportunity to post on our blog. One of the many blessings that Tenwek offers to us as a couple is the time to share deeply our joys and concerns from our daily experiences  (limited access to the distractions of TV, the internet,  and our phones help immensely). He senses perhaps an opportunity for me to understand better, and to share with you, what Tenwek has come to mean to me.

When I left Tenwek last year in October 2018, I entered into an incredibly tumultuous year. I retired from my Ob/Gyn practice which had enriched my life for 33 years. I had anticipated an upheaval of emotions and had put into place the chance to thank so many people for the joys and blessings of those years. God presented an idea to me (thru a casual conversation with a patient’s husband) to develop an outward and visible sign to those people who shaped those years. Rob Grimes used his Godly hands to create Women Partners mugs, and also a special set of mugs with a heart logo on them. I spent the year leading up to retirement handing out those mugs to the people who had become symbolic of what I loved. Those cups overflow with love and gratitude to so many patients and peers and co-workers who graced me with their trust. So many of my patients have become life-long friends and essentially have become extended family. You know who you are and how you have enriched my life. My partners, and the new young doctors who have joined our growing practice, know the depth of my commitment to those relationships. I learned from them, and was humbled by all of them.  I am eternally grateful to God for these people and years.

And now He has blessed me again with a similar opportunity at Tenwek.  He sent such an obvious sign when, on my first day of retirement, I was invited to help with the development of an accredited Ob/Gyn Residency program at Tenwek.  PAACS (Pan-African  Academy  of Christian Surgeons) is our governing body.  My retirement date had been set long before this opportunity presented itself. Only God could have orchestrated my transition from retirement directly into an effort to help further the development of the Ob/Gyn program at Tenwek. It was wonderful to meet up with other Tenwek Ob/Gyn ‘addicts’! Now I have a new cache of co-workers that I have the opportunity to learn from, be humbled by, blessed by,  and hopefully,  to help. What I didn’t anticipate was the joy of recurrent encounters with former patients here at Tenwek!  This year I was performing ultrasound studies one morning.   One of the many women that came in looked familiar –I said to her: “Don’t I know you from last year”?  She said:  “No, you delivered my child in 2015”.  Her husband even breached Kenyan etiquette by giving me a hug when he saw me! (Kenyans do not typically show open expressions of affection between men and women). She is now in her 4^th pregnancy, and only one of her children is still alive and well---the one born in 2015!  She is now 7 months pregnant with twins, has had 3 previous cesarean sections, currently has a placenta previa, as well as chronic hypertension (every Ob/Gyn doctor reading that has now undoubtedly broken into a cold sweat). At present her babies are starting to lag in their growth and her placenta previa is starting to be problematic. Selfishly, I would love to participate in the ultimate birth of these babies, but they will benefit from staying in the womb far more than the 4 days that I have left on this trip. God will set their delivery date and my role with them.  My love and prayers will be with Rehema and her care-givers whether I am here, or 9,000 miles away in San Antonio.

I now have a new group of peers, co-workers, and relationships here in Kenya. They will never replace my previous practice family. I no longer have the freedom of a single spoken  language, but have the opportunity to expand my means of communicating-God is SO big-I pray that His Holy Spirit is manifested  through me by eye contact, a gentle touch, a smile of encouragement, or shared tears of sadness.  I witness depths of compassion deeper than I have ever seen from the people who have chosen to dedicate their professional lives to caring for patients here at Tenwek.  I participate in prayers in other languages without knowing, or needing to know,  the meaning of the words themselves.  It is obvious when the corporate “AMEN” comes from all participants at exactly the same time that the words themselves are unimportant…that what IS important, is the corporate talking with God on the patient’s behalf. It is a sweet, repetitive occurrence shared many times throughout the day. The Christian music and singing that fills the halls during morning shift change throughout the hospital is also language independent.

I thank each and every one of you who read our missives about Tenwek, and God’s work here, and in our lives.  I write this while looking at birthday cards from friends and family in America, and from Kenya as well. Words seem to jump off the page… Joy, Hope, Peace, Love, Faith, Smiles, Laughter, Hugs and Surprises. May those words also resonate in your lives.

….and from my sister:  “Most of all, may your (birth)day be the beginning of a beautiful year…the kind you (and ALL OF YOU as well) deserve”.

I pray it is so until I return to Tenwek in September 2020.

Love to you all,

Marilyn