We have again reached that point in our trip when it is time
to say goodbye. This is always such a bittersweet time for us…we are tired and
ready to come home, but simultaneously realize that some our recent acquaintances
will not be seen again. One thing has become apparent to us over the years however: our circle of “Tenwek friends” is ever
enlarging, and one never knows when these connections may someday “intersect.” For example, we first met Jonathon and
Chelsea Swanson when Jonathon was an emergency medicine physician doing a
fellowship in ultrasound in 2019. Three years later, we unexpectedly meet up
again at Tenwek where they are now serving a 2-year commitment through the
Samaritan’s Purse postgraduate program…such a sweet reunion it was! Many of the
Kenyan doctors that we are now working with, we first met when they were medical
students rotating through Tenwek Hospital. Dr Mike Chupp who is now the head of
CMDA in the US, we first met while he
was serving as a surgeon/orthopedist at Tenwek. We recently had the pleasure of
reconnecting with an old acquaintance from many years ago – Dilley (see photo
below), who is a lifelong missionary to Kenya (along with his wife Ruth). Dilley
has now become a patient at Tenwek and is travelling 8-9 hours from his home to
receive regular care in the eye clinic. In the past, we have spent many hours
listening with pleasure to Dilley recount stories of his time in Kenya, but
never expected to see him or Ruth again. On our last night at the guesthouse
this year, Dilley turned up to have dinner with us, and the reunion time was an
unexpected joyous occasion! Of course, no trip to Kenya would be complete without
a visit to our dear sister-in-Christ, Matilda Ongondi (see photos). I met
Matilda on my first trip to Tenwek when she was serving as the head of the
medical team that I was assigned to. She was my “lifeline” to the foreign world
of Kenyan medicine, and was so sweet, faith-filled, and kind, that she has
since become a forever friend. As many of you know, we also had the pleasure of
hosting her at our home in San Antonio some years later when she just happened
to being going there to study hematology/oncology at the UT Health Science Center
SA. She is now a part of our extended Tenwek Family. Lastly, we are now headed
out to reconnect with our dear friends – Peter and Petra Axt. We first
connected with the Axts when they were serving together on a medical/surgical
team in Guatemala. At that time, they were living in the Netherlands, and we
never anticipated seeing them again. As Marilyn and I began making annual trips
to Kenya, our journey often took us via connecting flights through Amsterdam. On
one of these occasions, we decided to attempt to meet up with Peter and Petra
on our way home. We met in Amsterdam and had a lovely reunion with them. Subsequently,
we have tried to meet up with them annually on our way home from Tenwek. We
have had some memorable times together in Prague, Bruges, Athens, and Lisbon…this
year we are planning to visit them in their new retirement residence in Faro,
Portugal. As we make plans to depart for Portugal this evening, we reflect back
on all the wonderful blessings that we have encountered on our various times of
service in Central America, and more recently in Kenya. Some of the biggest
blessings have been the friendships that we have made along the way!
Kwaheri Kenya and Tenwek…till we meet again!
Jonathon and Chelsea Swanson
With Joshua - a medical student from Ghana, serving on the pediatric team
The OB Team - Sharon, Gideon, Brian, Cheryl, Albert, Jackie, Zapporah, Patricia, Marilyn, Monique, and Tabitha
The medical team 2022 - Dr. Obala, CO Joram, CO Wanyonyi, MO Lily, Dr Rwamba, CO Hillary, MO Rachel, and me.
Game night with the Cowles - Dean Cowles, Dr. Amanda McCoy, Dr. Monique Wubbenhorst, Marilyn, Me, and Dr. Cheryl Cowles
Reconnecting with old friends - Marilyn, Dilley, and Me. Dilley and wife Ruth are lifelong missionaries to Kenya.
A visit with Dr. Matilda Ongondi in Nairobi.
Matilda and Marilyn
Such a sweet long-term friendship - Dr. Matilda Ongondi 💞💞
We usually travel to Tenwek in September. COVID altered that
schedule, and we are experiencing the benefits of this trip at a different
season.
This Thanksgiving is coupled with the start of Advent.
Thanksgiving at Tenwek is not a recognized event. The long-term missionaries
here had a Thanksgiving prayer time Thursday evening after a ‘business as
usual’ busy day at the hospital. I (Marilyn) was on-call but was able to
participate in the shared prayers of thankfulness before I was called away to
an emergency cesarean section (he is a beautiful, healthy, baby boy). One of
the thanks lifted up was for the progressive availability of technologies here
to keep us in closer contact with our families at home: facetime, ZOOM,
texting, etc. These were not available to us so readily when we started coming
here 10 years ago. These allow us to communicate on those special family times
when we are separated by many miles and time zones.
The first day of Advent is symbolized by the lighting of the
candle of Hope. Tenwek Hospital is fueled by the Hope that as “We Treat…”, we
know and believe, that it is “…Jesus (that) Heals”.
Thanksgiving gratitude leads to hope for the future.
This visit has allowed us to witness a new expression of
community. In the long-term missionary population here, community is defined by
the “common characteristics or interests, especially professional interests,
living together within, or scattered through, a larger society”. So Tenwek
Hospital is a multi-national (English, German, American, Kenyan) group of
physicians caring for and participating in the local Kenyan population (or even
international populations) who come here for care. A general surgeon/missionary
and his wife from Guinea have been staying with us at the guesthouse as he
underwent neurosurgery for a large pituitary tumor, and then postoperatively
convalesced here.
The Tenwek Missionary community celebrated Thanksgiving on
Saturday (rather than Thursday). It was a unique blend between American
traditions and their own. There was a 5 K run at 7 AM, then a Turkey Trot for
the four and under age group at 8 AM. Randy and I served as cheerleaders as
they navigated the course. At noon, a Feast was served in an outdoor community
space. Approximately fifty people attended. We were hosted at the table of a
German family (he is an ophthalmologist, she is a generalist MD, and their three
children). There were four baked turkeys, many styles of dressing, gravy,
mashed potatoes, sweet potatoes, green beans, creamed corn, carrots, home-made
rolls, various jellos, devilled eggs, cranberry dishes, etc. It looked just
like home! An Australian construction contractor described it as “all weird
food, but all delicious”. At 3:30, a
football game was ‘played’…. Team pink vs Team yellow.Participants wore “pink bubble gum” or “yellow
sweet potato” jerseys. The ages ranged from 18 mos- 60+years. Who cares who won
or lost? ..It was a hoot!Have you ever
seen a football player carrying his 18-month-old daughter during play? God
protected them all from injury! Then at 5:30 came pie-time!...pumpkin pies, apple
pies, rhubarb pies, ice cream---oh my! At 8:00 PM we gathered for the UofM vs
Ohio State football game---the winner of that game DID matter a little bit more!
(There were a few who chose to watch International Rugby or the World Cup
soccer…imagine!!). Throughout these 17 hours I saw scores of children- none of
whom were ever looking at a cell phone or other digital device…what a blessing
to witness!
When we visited Israel in 2011, we learned about the concept
of community called “Insula”. It was a style of living that involved a
collection of units (homes, tents, apartments) around an open courtyard.In this community, one would share meals,
childrearing, and various other aspects of daily life. In a broader sense,
“insula” can be extended to mean families that live, work, and interact with
each other on a daily basis. Young people learn from the stories and actions of
the older members and all the “aunts” and “uncles” participate in the lives of
all the youngsters. Life at Tenwek is very much like this… it provides a living
example of “insula” and is, I believe, a picture of heaven (God’s housing
complex).
Today, on the Sabbath and the first day of Advent, my heart
is filled with hope. I have so many expectations for the ‘tomorrows’ of our
lives. Sometimes the road ahead is filled with loss and stress that weighs one
down- we all need HOPE. I was blessed with re-connecting with a former patient,
Beatrice, that I had cared for back in 2015. She is employed at Tenwek
Hospital. She approached me one day and asked me if I had been at Tenwek in
September of 2015 and if I was Dr Vanover. She then proceeded to remind me that I had
delivered her stillborn daughter. We discussed how the years since then had
been for her. She has great peace about that time and now has two other
children. I pray that she remembered me as a compassionate doctor who helped
her through that trial. We both recognized that God was in the midst of it all
then, and still is today. We need Jesus… the Jesus of Christmas. He is the
‘anchor of our souls’ that secures us all through the storms of life.
I would like to summarize a devotion that I read for Day 1
of Advent:
Hope for Help: Tofind grace in times of need.
Hope to Overcome: To overcome great obstacles and to
have faith in Jesus who gives us hope. This is the victory that overcomes the
world (1 John 5:4).
Hope for Power: To help us when we feel overwhelmed.
Our weakness is the entry point for God’s strength.
Hope of Eternity: He gives us help, strength and
power for today, but more importantly, hope for life after death: the ultimate
tomorrow.
May this advent season be especially blessed for you all,
But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me.
I awaken and check the time on my phone…It’s again 2 a.m. and I am wide awake. It has now been one week since our arrival in Nairobi and the jet lag remains very much a part of my daily routine. Outside it remains quiet…. only an occasional bird is singing, and the sound of rain on our metal roof is again noted. It has been raining daily since our arrival, though usually in the early afternoon, and usually lasting only 30-60 minutes. The noise of boda bodas struggling up the dirt road outside our bedroom window has not yet begun. I struggle to get back to sleep, but my mind is racing, and I can’t help but think about all the challenges that lay ahead for the day. Around 5 a.m. I again awaken to hear an occasional cow beginning to awaken. Outside, a few adults are walking by with yellow plastic containers which look like they should contain some sort of toxic chemical, but which have been repurposed for carrying milk for their families. Groups of nursing students, and other young Kenyans are heard laughing as they climb the hill outside our window, headed to school or work. Next comes the distant crowing of the rooster(s), then finally the boda bodas (motorcycles). I finally give up trying to sleep and get up before my alarm which is set for 5:45. As daylight approaches, the distinct raucous call of the hadeda ibis begins (see below). The workday has begun. I perform my morning ritual…shaving, brushing teeth, showering, preparing breakfast. Here the choice is always one of the following: 1. eggs (which are never refrigerated, since the protective coating which the hen provides is not washed away as in the U.S.) 2. Corn flakes 3. White oats. 4. Muesli with yogurt. 5. Toast with “medium fat” (margarine). 6. Coffee or tea. Kenya is particularly famous for their excellent black teas (they are the largest supplier to the U.K. and Europe), but their coffee is excellent as well. On my first day here, I head up to the hospital at 7 a.m. to meet up with my medical team. I approach the nurse’s station for the medicine ward and see a young Kenyan male in a long white coat with scrubs and no other identification (not unusual…here one cannot tell who is who by appearance or dress). I approach and say “Good morning. I am just arriving today; can you help me find my team?”. He answers, “I am Naas”. I reply “good morning Naas, do you know where I might find them (I have never heard this name here before, but see that my team includes Drs. Ndaro, Waruguru, Obala, Ochala, Chebii, Gakuya, Wanyonyi, and Rawambi Simei, so Dr Naas does not seem too surprising). He peers at me a moment too long with a flicker of frustration crossing his face and replies “No I am not Naas, I am Naas….N-U-R-S-E”. Embarrassed and humbled, I apologize profusely and find that his real name is Jacob…thus begins the always vertiginous, disorienting, chaotic experience of serving at Tenwek. For much of the first week I struggle to hear what is being said on rounds. With their naturally soft voices, muffled and obscured by facemasks, and their beautiful Kenyan accents, I catch only about one half to two thirds of what is being said. When I DO hear what is said, much of it is non-sensical to my western ears. Many lab results here are reported in units of millimoles per liter, rather than milligrams per deciliter as in the U.S. Therefore, blood glucoses, serum creatinines, bilirubin levels, calcium and magnesium levels, and lactate levels all must be converted to understandable U.S. units while I am struggling to understand the rest of the patient’s history. Often, I end up not really knowing why the patient came in, nor what was found to be normal and abnormal on their workup. The effect is total disorientation, and a sense of furiously treading water to avoid drowning…a sense of barely keeping my face above water. I have experienced this many times now, so I know to expect it, and I know that after a few weeks’ time, I will finally be able to comprehend most of what is being reported to me, and MAY finally be able to be an asset to the team…but definitely not in the beginning. In the beginning, I am slowing everyone down, and constantly asking them to repeat themselves, and to raise the volume of their voices. Despite this, my Kenyan colleagues are uniformly gracious, and patient, and kind. I begin to feel every one of my 67 years on this earth – the fading hearing, the fading visual acuity, the slowed mental processing, as well as the aches and pains associated with this damp and cool climate. In addition, I am breathless as I climb numerous stairs (since there are no elevators here) at 6900 feet elevation. It’s about this point that I again find myself asking “Why God…Why am I here? Have you indeed called me to be here, or have I come of my own doing, without your blessing?” At the low point of this first week, amidst the struggle, the chaos, and the feeling of inadequacy, I am called to lead the morning rounds as the most “senior” (in years only) member of the team (as the actual leader will be out all day in meetings)…it’s at this point that I recall the scripture above (2 Corinthians 12:9), where the apostle Paul states “I will boast all the more gladly of my weakness, so that the power of Christ may rest upon me.” While making rounds, I am presented with a young woman who has been treated at an outside facility for the past 5-6 days for complaints of abdominal pain, increased abdominal swelling, bloody diarrhea, and weakness and dizziness. She is 29 yrs old and has been previously healthy. She has been on Depo-Provera for birth control. She has had no history of alcohol abuse or known liver disease. She is profoundly anemic with a hemoglobin level of 5 and a hematocrit of 15. Her heart rate is 130, and she is in distress. My intern has also reported that her coagulation parameters are abnormal and that her INR is 6. (not clotting normally). She has normal liver enzymes, and no other evidence of abnormal bleeding. No diarrhea or rectal bleeding has been witnessed. Her other coagulation tests are normal and there is no evidence of DIC (abnormal consumption of coagulation factors). She (the intern) has performed an ultrasound of her abdomen and sees a large amount of intra-abdominal fluid. A paracentesis is performed, and bloody fluid is obtained. A CT scan of the abdomen has been done, but the official reading from the U.S. radiology group will not be available till the next day. We review the CT together and decide that something does not look normal in the pelvis…there appears to be an abnormality in the right side of the pelvis, but no evidence of a bowel perforation, or other free air in the abdomen. I ask about her pregnancy test, and am told that it was ordered, but not yet done, because the patient had not been given a cup to provide a urine specimen. I am reminded that she should not be pregnant, because she has been using birth control as mentioned earlier. The one thing that 41 yrs of medical practice has taught me is that one should never place complete trust in any one piece of information or data…thus, the accuracy of the history of “bloody diarrhea” (rather than blood from an adjacent area) was questioned, the accuracy of the prolonged INR with other normal coagulation tests was questioned (repeat was normal), and the infallibility of birth control was questioned (urine pregnancy test came back positive). The patient was seen urgently by the OB service (Marilyn) and was determined to have a ruptured ectopic pregnancy which had gone undetected, with resultant bleeding into her abdomen, profound anemia, and impending hemorrhagic shock. She was taken to the operating room and her bleeding was controlled, and her ectopic pregnancy removed. She was given blood and stabilized. I am confident that the medical team would have ultimately arrived at the correct diagnosis, though it may have taken another 24 hrs to get back the CT report, and to follow through on the pregnancy test which had been requested. It seems like my part (and Marilyn’s part) in this drama was small, but perhaps very significant to the survival of this young lady. I believe that her diagnosis was made at least 12 hrs earlier than it might have been, had I accepted as accurate the information provided (Occasionally my naturally skeptical nature is of some value...though Marilyn might disagree!) Once again, I am humbled. I feel that my questioning and my prayers have been answered. God has shown me that He is faithful; that He has a purpose for my (our) service here, and that His power is made perfect in my weakness. This weekend I will rest. Today is my birthday and Marilyn has planned cake and fellowship time with our fellow volunteers. Tomorrow (Saturday) she has made plans to take me out to dinner in the town of Bomet. The struggle of the first week here is behind me (us). Let’s see what the new week has in store…
Warning: Longer than usual content follows! Hope you find it worthwhile.
Recently
Marilyn and I have begun the process of planning for our final days on earth
(though hopefully that will not be anytime soon!).As part of the process, we have been
following a checklist which assists with decision-making about the type of
memorial service, favorite scripture passages, favorite music, etc. that one
would choose to include in one’s final service (and thereby help prepare, (and
spare) one’s survivors for the difficult task of having to make those
decisions.)The last item on the
checklist was this: “One year after I’m gone, I’d love it if you’d celebrate
my memory by doing this:”.After
some thoughtful consideration, my personal answer was to read my blog postings
regarding our mission experiences over the last several years of our
lives.I believe that these experiences
represent the culmination of all that has gone before…the summation of our
lifetime of preparation and purpose.It
has been difficult to convey to our family and loved ones just how impactful and
formative these experiences have been.In the case of some unbelieving loved ones, it has even become a
divisive issue…there is the perception that we have become “blind” to the
realities of the world and the risks of our volunteering as a result of our
faith. Consequently, I am reminded of the warnings of the “cost” of
discipleship… what one can expect when one chooses to follow Jesus.
Matthew 10:34-36:34 “Do
not suppose that I have come to bring peace to the earth. I did not come to
bring peace, but a sword.35 For
I have come to turn ‘a man against his father,a daughter against her
mother, a daughter-in-law against her mother-in-law—36a man’s
enemies will be the members of his own household.’[c]
In other words, one can
expect strife and turmoil as a result of following Jesus…even within one’s
family.So why follow Him?How does one come to believe so strongly that
God exists, that Jesus was who He said He was, and that God does call us, equip
us, and lead us into various types of Kingdom work?My own story of faith, many of you already
know…but perhaps many of those closest to me do not?Perhaps you are reading this in real-time?Perhaps you are reading this after my
death?In any event, let me try to explain.I was born into a family with one believing
parent (my mother), and one agnostic parent (my father).My mother was a member or the Church of Latter-Day
Saints (LDS, or Mormonism).I was raised
in this tradition and baptized at age 8.As a child, I embraced the concept that God existed, but did not have
much else in the way of a personal testimony as I was growing up.I attended church more out of a sense of duty
to my mother, and maternal grandparents, than anything else.As I approached adulthood, and the age at
which I would need to decide about going on a “mission” with the LDS church, I
was confronted with the fact that I did not feel any personal conviction to do
so.I felt like I would be an
“imposter” if I chose that route.In fact, as I had progressed
through school and through my pre-medical curriculum, I had begun to "worship
at the altar of science".I had begun to
believe that there was no God, and that I did not see how anyone could become
objectively convinced of His existence.Perhaps you have been in this place…or still are?I remained a non-believer through most of my
early adult years.After Marilyn and I
had children, we would occasionally take them to church with the goal of
providing moral instruction.One year
when my daughter was about 10 years of age, she attended a summer sports camp
at T-Bar-M (a Christian sports camp in New Braunfels, TX).She returned home from that experience “on
fire for God” – she was reading her bible, praying, and questioning why we were
not going to church more regularly.I
felt a piercing conviction in my heart that she was right…we DID need to expose
our children to Christianity, and then let them come to their own conclusions
about their faith, or lack of faith.We
made a commitment to take them to Sunday School each week, and while they were
in Sunday School, Marilyn and I also enrolled in an adult class.It was here that I was encouraged to commit
to reading the entire bible over the course of one year in a course called
Disciple Bible Study.I had zero
interest in doing so but was strongly encouraged by Marilyn to participate…and in
the end, I decided to read this book that I professed not to believe (though
had never read).I entered the study as
a strong skeptic, believing that nothing could answer my questions, my doubts,
and my unbelief.I was now about 39-40 years old and had experienced enough of the practice of medicine to
realize that the god known as "Science” was anything but infallible.As I read the Old Testament, I came upon the
following Psalm of David:
Psalm 19:1-5:
1The heavens declare the glory of God; the skies proclaim the work of his hands. 2 Day after day they pour forth speech; night after night they reveal knowledge. 3 They have no speech, they use no words; no sound is heard from them. 4 Yet their voice[b] goes
out into all the earth, their words to the ends of the world. In the heavens God has pitched a tent for
the sun.
and later in the New
Testament, I came upon the following statement from the Apostle Paul: Romans
1:18-23, 1: 25.
18 The
wrath of God is being revealed from heaven against all the godlessness and
wickedness of people, who suppress the truth by their wickedness,19 since
what may be known about God is plain to them, because God has made it plain
to them.20 For since the
creation of the world God’s invisible qualities—his eternal power and divine
nature—have been clearly seen, being understood from what has been
made, so that people are without excuse.
21 For
although they knew God, they neither glorified him as God nor gave thanks to
him, but their thinking became futile and their foolish hearts were darkened.22 Although
they claimed to be wise, they became fools23 and
exchanged the glory of the immortal God for images made to look like a
mortal human being and birds and animals and reptiles....
25 They
exchanged the truth about God for a lie, and worshiped and served
created things rather than the Creator—who is forever
praised. Amen.
I once again felt pierced to my soul; convinced that the truth of
the existence of the Creator, had always been right in front of me….as
evidenced by what had been made.
As a biology major, and later a medical doctor, I was intimately
familiar with what science had made known to us about the inner workings of the
simplest of living structures, the cell.
I had spent many years learning about the organelles, their chemical
make-up, their function, their structures, and their interdependence. Watch the following video representation of
cellular function and try to see it as a scientist sees it…the culmination of
millions of years of evolutionary pressures brought to bear on non-living,
inorganic materials such that through random chance each component evolves, one
after the other, with hundreds of thousands to millions of years between each component, till they all,
by random chance assimilate, somehow become living organic materials, and begin to function. Is that not an incredible “faith” of
a different sort?!
Or is it easier to believe
that there is design, structure, purpose, and intelligence beyond our wildest
ability to imagine? Which takes more
“faith”?
Or look at the night sky
and the universe as we know it…is there not also design, structure, beauty, and
“speech” testifying to the same Creator?
I had much the same experience while hiking in the Maroon Bells
wilderness of Colorado…I recall sitting down to eat lunch, looking around me
and saying to myself “No way this is all random chance….” I recalled what I had
read…”His eternal power and divine nature has been clearly seen, being
understood from what has been made”.
By the end of my one year
of bible study, I could no longer believe that there was NOT a God. Once I became convinced that God indeed exists,
my next dilemma was to decide if Jesus was who He claimed to be, and if so, how
could I be sure? Once again, the answer
came to me through scripture, the book of Acts, chapter 9, written by Luke the
physician, a travelling companion of the apostle Paul. In it, Luke describes from first- hand
descriptions, Paul’s encounter with the risen Jesus. Prior to this encounter, Paul might have been
me (or I might have been Paul!) …a non-believing skeptic of the highest
order… to the point of pursuing, persecuting, and even killing Jesus
followers! The stories of what happens
to Paul after this encounter convinced me that something powerful and
overwhelmingly convincing had happened to him…something which caused him to
completely change course and fearlessly follow and proclaim the Lordship of
Jesus as the Christ. I identify strongly
with Paul…I often say that I am another of Paul’s converts, some 2000+ years
later. I believe that he was one of the
greatest evangelists of all time…read him and see if you don’t agree. In some of my previous blog entries I have
written about what came next…how I came to feel the tug on my heart towards
missions, and how I reluctantly came to respond to that leading. As I have responded to that perceived call,
my faith has been strengthened, and has grown exponentially. I/we (I believe I speak for Marilyn as well)
have been incredibly blessed to be able to join God where He is at work around
the world…to “see” with new eyes his “eternal power, divine nature” and His
incredible love for mankind. I do not
pretend to have the degree of faith that Paul exhibited. I still have periods of doubt; spells where I
do not feel God’s presence; events which make me question His control, and His
purposes. Nevertheless, I can no longer
believe that He does not exist. I now must
trust that He is good; that His purposes and plans are higher than my
understanding, and that I simply must strive to be transformed in my thoughts
and deeds…to become as much like Christ as possible in the years that remain. If you have not already done so, I strongly
encourage you to study God’s word…the bible.
You may find that it changes your life, as it has mine.
Numbers 6:24-26
24 “‘“The Lord bless you and keep you; 25 the Lord make his face shine on you and be gracious to you; 26 the Lord turn his face toward you and give you peace.”’
