Heartbreak at Tenwek

Greetings friends,

Our time here is again coming to a close, and it is always bittersweet to review the joys and sorrows of our time at Tenwek.  One particularly heartbreaking case this year involved a young mother who was on the medical service most of the month.  Her name was Jacqueline R., and she was 23 years old.  She had given birth to a son at the end of 2020, and was about 2 months post-partum.  After delivery, she had developed a post-partum cardiomyopathy and congestive heart failure (a weak heart muscle and inability to generate a normal cardiac output, which usually resolves over time).  She also had developed a deep vein thrombosis in her leg (blood clot), and was on our service receiving treatment for these two problems.  When I would make rounds to check on her, she always had her infant son with her and was often breast feeding when we would arrive.  Additionally, her husband or mother was often present to help her with her needs while she cared for her son.  Her young son would always be wrapped in his shuka (a traditional Maasai blanket with its bright red/yellow/blue plaid pattern unique to each tribe) and always looked so peaceful and content.  His mother always expressed her gratitude to us for caring for her and on several occasions asked us to pray for her and her son (which we did – sometimes in Swahili, sometimes in English).  She was making steady progress and I was expecting that she would be ready for discharge in 1-2 days (after adjustments to her anticoagulation regimen).  On the last day of her expected hospital stay, we went in to visit her and noted that she had developed a peculiar affect and seemed to be having some confusion and anxiety.  Her vital signs, examination, and oxygen levels were all unchanged, and we thought that she might be developing a post-partum depression with anxiety, or perhaps some post-partum psychosis?  Her discharge was delayed while we attempted to address these issues.   In her confusion, she was again oriented enough to ask for prayer – which I provided for her.  I recall asking that God would comfort her, give her peace, and heal her body.  I also asked for wisdom and discernment in making medical decisions for her care.  We started her on some anti-depressants and returned to see her the next day.  At that time, she was more clearly psychotic, but still stable- appearing.  We changed her medications to include some low dose anti-psychotics, and my intern briefly prayed over her again in Swahili.  During this time of her mental decline, her mother had started to come in daily to provide childcare, since the Kenyan culture does not permit husbands to physically care for their children (feeding, diaper changes, etc.).  On Thursday morning of this past week, her mother had come into the room and found her daughter unresponsive and not breathing.  The nurses were notified, a code was called, and CPR efforts were begun.  I just happened to be walking up to the ward to begin rounds, when I saw the activity outside her room and went in to find her in the middle of resuscitative efforts.  Jacqueline was lifeless, not breathing and CPR was in progress.  She received 12 vials of epinephrine, 10 vials of bicarbonate, and was being bagged with 100% oxygen.  She had a cardiac rhythm on the monitor, but only had a pulse with chest compressions.  While these resuscitative efforts were in progress, my eyes were continually drawn to the small bundle, wrapped in his shuka, and sleeping peacefully in the bed adjacent to his mother’s bed.  While her life was ebbing away, he was warm, snug, and blissfully unaware.  The resuscitative efforts were continued for about an hour, and as we were getting ready to stop efforts, we noted that she was making some gasping respiratory efforts, and had visible chest movements corresponding to her heart rhythm.  Despite this, she had no palpable pulse or discernible blood pressure.  At this point, we were in a quandary…we had already called for the chaplain to help notify the family of the patient’s demise, and yet she had not technically “died”.  While discussing whether or not to make additional, seemingly futile efforts on her behalf, my eyes were again drawn to her infant son.  “Let’s make every possible effort…for her sake, and for his…” was the final decision.  We bolused her with IV fluids, and her pulse became faintly palpable.  She was intubated and arrangements were made to transfer her to the ICU where she was placed on an epinephrine drip and a bicarbonate drip.  Despite escalating doses of fluids and epinephrine, she was never able to generate a measurable blood pressure and continued to remain very hypoxemic (low oxygen levels in her blood).  It appeared that she had probably had a massive pulmonary embolus (blood clot in the lung), despite being adequately anticoagulated.  She survived for another 4-5 hours during which time we were able to counsel the mother about her prognosis and the likelihood that she would die sometime later that day.  We were told that the patient’s husband had fled the hospital when it appeared that his wife was dying, and the mother was not sure if he would return.  She informed us that she was a poor woman, but would find family to care for her daughter’s son if need be.  Her only request to us was that we again pray for her daughter, her grandson, and her family…which we did with great sorrow and heartbreak.  Too often, such is the case here at Tenwek…great poverty, great hardship, and great sorrow…. but also great faith and trust in a loving God.  I have continued to silently grieve these past few days for Jacqueline and her infant son and family.  Please join me in praying for protection, comfort, and provision in their time of need.

Psalm 34:18   “The Lord is near to the brokenhearted and saves the crushed in spirit.”

2 Corinthians 1: 3-5   “Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted by God.”

COVID-19 at Tenwek Hospital

 

Greetings friends,

We are now about 2 weeks into our time here at Tenwek and are finally getting acclimated to the elevation  (about 8400 ft above sea level), and the time change (9 hrs ahead of CST). It also takes me (Randy) about this same amount of time to change my thinking and mindset from western outpatient medicine, to Kenyan inpatient medicine – 2 ENTIRELY different worlds.  My typical patients here might have any combination of:  severe hypertension;  thrombotic events like deep vein thrombophlebitis, pulmonary emboli, or strokes; esophageal cancer (very common in this community for unknown reasons); tuberculosis; HIV; meningitis (bacterial, tuberculous, or cryptococcal); poisonings (suicide attempts); severe anemia;  any number of different masses or malignancies; or rheumatic heart disease and congestive heart failure.  What I am not seeing much of is COVID-19?  This has been very surprising to me.  I had visions of rampant disease in the major populated areas of Kenya (like Nairobi), but that seems not to have been the case.  I thought perhaps the low levels of COVID-19 might have to do with the absence of adequate testing, but I am not seeing many patients with COVID-like symptoms to make me think it is going undiagnosed.  Additionally, Tenwek hospital is now able to do rapid antigen testing (which takes about 15 minutes) as well as PCR testing which is sent out to a local lab, and takes about 4-5 days for results.  I did see one of the local missionaries last week with an illness which sounded very much like it might be COVID related.  Fortunately (for him and me, since I did not have PPE on during his evaluation) it turned out to be some other type of viral syndrome.  He reported that he had been feeling achy and having some neck and back pain for a few days prior to being seen.  On the day that I saw him, he had been walking up to the hospital and noted some dizziness, lightheadedness, shortness of breath, and headache with nausea.  He nearly collapsed, but was caught by another long-term missionary, and assisted up to the hospital where I was called to come and see him.  He reported that his daughter had been ill about 8 days prior with an unexplained illness associated with fevers to 103, body aches, nausea, and abdominal pain with diarrhea.  She had been evaluated by the pediatric team, and no cause had been found, though she had not been tested for COVID-19.   She recovered uneventfully, and then the patient (her father) began to feel ill some days later.  At the time that I saw him, he was extremely lightheaded when sitting, and would complain of feeling “out of it” and like he was going to pass out.  He also had nausea, some severe left flank pain, but no fever, chills, or urinary tract symptoms.  He did not have any nasal congestion or sore throat.  He was complaining of a “funny metallic taste” in his mouth, but no cough or chest symptoms other than shortness of breath.  He had a prior history of kidney stones on the right side, but a very different type of pain with these stones.  Because of this history, and his left flank tenderness, he had an evaluation looking for possible recurrent stones on the left.  His chest x-ray, renal ultrasound, and abdominal CT scan were all unremarkable.  His lab work revealed a mild elevation of his white blood count (11.5) as well as a predominance of certain types of white cells usually associated with bacterial infection (85% segs).  Other than that, everything was within normal limits.  He had rapid antigen testing for COVID 19, but this was also neg. (False negatives, and false positives can occur). He received 2 liters of IV fluids, and felt a bit better, but was still very weak, dizzy, and lightheaded.  There were no beds available in the hospital (not an unusual situation – some patients wait 2-3 days in the emergency area before a bed becomes available for them), so the decision was made to try and treat him at home in his apartment.  He was given a dose of IV antibiotics, and assisted home to his wife and family where he was instructed to isolate, wear a mask around other family members and to push oral fluids and high sodium containing foods (soups, or broths) to help maintain his hydration orally.  Fortunately, his wife had a digital thermometer, a BP cuff, and a pulse oximeter to help monitor him while at home.  He remained very ill- appearing for several days thereafter, and decision was made to repeat his COVID testing by PCR, and to repeat his white blood cell count.  His repeat white cell count had fallen to the low normal range (3.4) and his white cells had become mainly lymphocytes (50% lymphs) – a change which suggested a viral infection rather than a bacterial infection.  He continued to complain of this same “funny taste in the mouth”, but did not lose his sense of smell.  He never had any cough or drop in his oxygen levels, but continued to have borderline low blood pressures and lightheadedness (BP’s 85/50 – 90/60) with normal heart rates.  I continued to monitor him at home for several days, and he gradually began to feel more and more normal.  Yesterday, I received word that his PCR testing for COVID-19 was negative as well.  After the first encounter at the hospital, where I evaluated him wearing only a mask), the decision was made that only one person would physically check on him at home, and would use more PPE (personal protective equipment – gloves, gowns, face shields, masks, etc.) during these encounters.  This was undertaken to minimize the risk of possible COVID- 19 exposure to others.  The hospital has also taken extraordinary measures over a short period of time to deal with a possible outbreak of COVID-19 in the community.  They have developed 2 new units consisting of about 25 beds total.  They have developed safety measures to protect staff and other patients including what are designated green zones (access by anyone allowed- patients and family are typically here to register or check the status of a loved one), yellow zones for “donning and doffing” PPE (limited staff- only access areas), and the red zone which consists of COVID, or suspected COVID patients and staff.  No one other than designated staff is allowed in these areas.  Tenwek has developed a policy that only staff under the age of 60 can access the red zone and care for COVID patients.  These designated staff are only rotated through the COVID unit (CHACU unit), and not rotated through the general patient wards or ICU’s.  Consequently, there are 2 MO’s (medical officers) and 2 CO’s (clinical officers – equivalent to a PA in the states) who staff the unit.  They work 12 hour shifts, and are on call every fourth night and every fourth weekend).  There are also nursing staff who are confined to the CHACU unit (COVID holding and care unit) and not circulated through the general hospital population.  They have had about 25 staff members (including some missionary staff) who have come down with COVID over this past 6 months – fortunately all have survived and recovered uneventfully.  Bomet County, which is where Tenwek is located, has only had about 250 confirmed cases.  The entire country of Kenya has reported ~99,000 cases and 1,726 deaths thus far.  Recent case numbers have been declining and about 100-200 new cases are now reported each day (country wide).  At the peak in November, they were seeing about 1500 new cases per day.  I don’t really understand why Kenya has been relatively spared compared with the US, but fortunately this seems to have been the case.  At Tenwek, the population is mostly rural and spread out, so case numbers are relatively low.  The CHACU unit now has about 8-10 patients on any given day.  I feel so fortunate to have received my first dose of vaccine shortly before departure from  the US…this was very comforting to me after my potential exposure as described above, and was one of the reasons I was allowed to continue to monitor and care for him (being over 60 myself!).  I thank God that I (we) remain under His protection and have continued to be healthy.  While Tenwek Hospital has made great strides in becoming a center of high technologic, as well as holistic care, it remains very limited by US standards, and would be a frightening place to become seriously ill.  Hopefully, by God’s grace, we will never have to find out what that would be like.  Thank you for all your prayers and well wishes.  We look forward to being home again soon….though perhaps we are safer here?!  May God bless you and all your loved ones.

Randy and Marilyn

The COVID Holding and Care Unit, Tenwek Hospital

Patients waiting outside the Green zone, CHACU

The yellow zone - Donning and Doffing Area, CHACU

Thoughts on despair and loss of hope

 

Greetings friends,

Perhaps many of you will not read past the title this week…who needs more despair in their life…I certainly don’t, and I bet you don’t either.  Nonetheless, it’s a theme that I have become aware of this first week here at Tenwek.  Just a little background for perspective… when we arrived here about a week ago, a national doctors strike and nurses strike was just ending…it had apparently been going on for about a month prior to our arrival.  The back story is that one of the national Kenyan physicians, about 25 yrs or age, had not been paid for 4-5 months prior to coming down with COVID 19.  He became very ill, and ultimately died at one of the large national hospitals.  The hospital (with Kenyan government backing) decided to charge the doctor’s family his entire hospital bill, despite not having paid him his salary for many months prior.  This apparently was the final straw… a national doctor’s strike followed over pay concerns, inadequate facilities, and inadequate PPE (personal protective equipment). Since Tenwek Hospital is a private, faith-based facility, and the medical staff and nurses are not paid by the Kenyan government, it was one of the few facilities in the country still open for business.  Consequently, Tenwek had been severely stressed with an influx of patients above and beyond their norm.  For example, the OB service would sometimes have more than one laboring patient in a single bed (2-3 patients per bed at times depending on the need).  The medical service has had all ICU and HDU (critical care) beds full, and an additional 6-10 critical patients backed up in casualty (the emergency department) waiting for a bed to become available (which either means someone dies and the bed becomes empty, or someone improves and can be moved out to the floor…sadly, the former occurs almost as often as the latter).  In addition to the unusually heavy patient load, there has been a relative paucity of short term volunteers since the onset of the pandemic.  We have been some of the earliest “returnees” this past year, and as expected many of the long term staff appear to be experiencing various levels of “burnout”.  I expected to see this among the long term staff, but was not expecting to see an overall increase in apparent despair among the patient population?  After all, their individual situations are already quite dire for the most part, so I did not think that there would be much distress about the pandemic.  I expected that they would perceive this as just another potential infection to avoid…and not even a particularly scary one compared with HIV, TB, Bacterial meningitis, etc (which are much more common and more deadly).  But something IS different among the patients this year…it was even brought to my attention by the long term attending medical staff.  They reported seeing many more suicide attempts than in past years (usually by way of ingesting a poison of various types).  The patients around Tenwek are mostly farmers and have livestock, and as a result have access to many pesticides and herbicides.  A common poisoning might consist of an organophosphate (an herbicide) or triatix (an anti- tick medication for their farm animals), or some home- brew alcohol… most times, some combination of the above.  If they survive the poisoning attempt, we would then typically question them about what brought them to the point of wanting to end their lives.  Invariably, their answer has been some sort of conflict within their interpersonal relations with family or loved ones or inability to work.  So why the increase this year?  Similar to what we are seeing in the U.S. this past year, the Kenyans have also been masking, attempting to socially distance themselves from others, avoiding large gatherings like worship services.  We walked by the Thursday night worship service up at the hospital chapel last evening and noted less than half the usual attendance compared with previous visits. As in the US, the holiday times are also particularly bad for depression, despair, and suicide attempts.  In addition to the above, I see signs that some of most steadfast long term missionaries are suffering as well.  For example, the chief of my medical service who has been in Kenya for many years recently posted a long essay on Facebook about his disillusionment with the “goodness” of America – particularly from the Vietnam era forward.  This is very out of character from what I know of him.  He has always been a very upbeat, spiritual person…. very trusting in the goodness and sovereignty of God, and yet he seems to be feeling some sense of hopeless despair at the state of our nation, and the diminishing “goodness” among our leaders and our people.  Marilyn and I have also been discussing the despair and sense of hopelessness that we feel about our nation and our citizenry.  We have been progressively concerned that many of our fellow citizens feel the same …a sense that all civility and decency are disappearing; a concern that justice and fairness are no longer goals of too many Americans; a sense that our leaders and our political parties will do anything to accomplish their goals regardless of the harm that it does to the nation.  I personally no longer trust our political parties, or our news media.  I find that I am likewise losing faith in our courts and justice system.  I no longer trust my fellow man to pursue, or even to desire to know objective truth or justice if it does not serve their own purpose.  I even find myself questioning some medical science and research, since everything seems to have become politicized…we are beginning to see reports of some medical research being falsified and corrupted by apparently preconceived desires for certain outcomes.  I know from talking with Kenyans that many of them are also distrustful of their corrupt leaders and institutions.  Perhaps what we are witnessing both here in Kenya, and also at home in the U.S. are the very real and harmful effects of isolation, fractured relationships with friends and loved ones, a sense of distrust and betrayal by our institutions, our media, and our fellow man… and a progressive distancing of ourselves from God.  After all who is truly “good” (Mark 10:18  “And Jesus said to him, “why do you call me good?  No one is good except God alone.”)?  How did we get here?  How do we get out of this?  How do we regain trust that has been broken or lost?  How do we avoid despair in the face of all this?  Unfortunately, I think the answer is that we don’t “get out of this” in this lifetime…we live in a fallen, broken world with fallen broken people and institutions.  If our trust is in these things, we are bound to be disappointed and hurt.  Our only hope is to place our faith in the One who IS good… “…God alone”.  And yet in the midst of all that there is to be sad about, every now and then we catch a glimpse of a spark of light in the darkness.  On Wednesday of this week I was asked to give a talk to the medical students for their noon luncheon.  In preparation for this, I attempted to charge up my laptop the night before…as I plugged in my charging cable, there was a sudden spark and a burning smell which spelled doom for my efforts.  Facing the possibility that I might not have enough battery power to complete my talk, I went into what I thought was the IT office at the hospital, hoping that they might have a spare cable for an Apple computer.  What I actually did, was walk into the finance department and begin to tell my sad tale to the office worker there.  He listened politely, and then informed me I was in the wrong office.  Instead of sending me on my way, he offered to take my charger and “ask around” to see what could be done.  He promised to call me back that evening.  Needless to say I was skeptical that I would hear from him again, and even less skeptical that there would be any “asking around”.  To my amazement, he called me back at about 7:30 PM to tell me that he had located a receptionist in the Eye clinic, who had such a cable, and would be willing to loan it to me!...who would have believed that a random individual in the “wrong department” would go out of his way to help me with my inconsequential problem.  Additionally, who would be willing to trust a random stranger with a critical piece of such equipment – Winnie, the Eye clinic receptionist, informed me that she would need her charging cable back for her own use the next day…she had an upcoming test that she needed to access by computer!  What a world we live in… what “goodness” we still encounter in the strangest places!  Perhaps that’s the answer to our human condition: take personal action and responsibility where we can; be kind in the smallest of encounters; be honest with others; help where you can; keep your promises; trust in God and His goodness.  I find that small encounters like this keep me encouraged in spite of all that is wrong with our fallen world...what about you?

 

Psalm 42:5  “Why are you cast down, O my soul, and why are you in turmoil within me?  Hope in God: for I shall again praise him, my salvation.”

Romans 15: 13  “May the God of hope fill you with all joy and peace in believing, so that by the power or the Holy Spirit you may abound in hope.”

Render unto Caesar...

Dear friends,

After 25 hours of travel time we have safely arrived at Tenwek Hospital in Bomet, Kenya.  Our travel was pretty uneventful, though never have we encountered more obstacles along the way.  The flights out of the U. S. were on Delta airlines, and they were still blocking the middle seats to allow for more distancing between travellers.  This was a nice benefit to the new world of travel in the time of COVID 19…perhaps one of the only benefits!  Our flights all left on time, and we had basically smooth air travel along the way.  With all that is happening in Europe, and the emergence of a new strain of COVID 19, they have implemented some new requirements and protocols for travellers to their airports.  Amsterdam, (our intermediate destination in Europe before flying on to Nairobi) has begun to require proof of a neg. PCR COVID test taken within 72 hours of arrival (even for those in transit to another destination).  Fortunately, Nairobi had already instituted such a policy months ago. Consequently, we were already prepared, and had scheduled our COVID PCR testing the day before we left San Antonio.  We were able to get our results back that same day, so much of the anxiety about flying toward our destination without knowing our COVID results was alleviated.  There were numerous checks on our test results before leaving SA, before allowing us to board our flight in Amsterdam, and on arrival in Nairobi.  Along the way, we were required to wear our masks at all times while in the airports and aboard the planes…this had been one of my major worries about travel this year…how was I going to survive the uninterrupted sense of suffocation associated with masking, and was it going to produce recurrent problems with claustrophobia and flight anxiety?  Fortunately, I had tried out some neck gators which could be pulled up and used as a face covering, and found these to be much more tolerable.  The masking went well, and I had no unhinged psychiatric episodes…thanks be to God!  

“Render unto Caesar…”

The airline “COVID meals” were another story…prepackaged, plastic wrapped, and handed out by masked, gloved, and sometimes gowned flight attendants?...truly other worldly, but surprisingly “not bad”!  In Amsterdam, we encountered some “over the top”, mostly Asian? (hard to tell under all that gear), travellers in full Hazmat gear…Hazmat suits covering head to toe, goggles, masks, and gloves.  Again, other worldly!  We felt relatively “naked” with our simple face coverings.  In spite of all the COVID insanity, I was shocked (and relieved) to find that my Amsterdam “rent-a-shower” was operational and open for business!...30 minutes later I was a new man, and ready to face the next leg of our journey.  After another long line to check our COVID documents, our E-visas, our health questionnaires (both written and  online!), our passports and boarding passes, we made it onto our last aircraft headed for Nairobi!  Again we found that the flight was relatively empty… over 100 seats in economy class were unoccupied, allowing Marilyn to locate an entire 4 seat row which she claimed as her “bed” for the next 8 hours.  I had 2 seats to myself, so I was quite comfortable as well.

“Render unto Caesar…”

Our flight arrived on time, and all of our bags arrived with us…great news!...at least until I saw the large green “X” on 2 of our five bags…the 2 bags that I knew to contain medical supplies for Tenwek.  On each of our prior trips to Kenya, we had been warned to make an inventory list of all supplies being brought into the country, and an estimated value of each item, in case of questions by customs.  Consequently, we had again compiled a list as requested, even though we had never been stopped or questioned by customs…even when bringing in 8 - 50# bags on one occasion!!   This time, we were not to be so lucky…I suspect that with the volume of travellers and tourists being so low, the customs officials had very little to do, and the Kenyan government coffers were probably getting a bit low.  Whatever the reason, we were pulled aside and our marked bags were opened and searched.  Unfortunately, these 2 bags contained some high dollar medical equipment which was being donated, and/or returned after repairs in the U.S. – 2 ultrasound machines, a colposcope, some vacuum devices for OB, some costly pharmaceuticals for OB, etc, etc… Real value probably in excess of $15,000.  The Kenyan government, never wanting to let good deeds go unpunished, has decided that a 16% tax on donated goods for charitable use is appropriate…this on top of the ever –expanding list of licenses, and permits that are required to donate one’s time to work in their faith based charitable institutions!!  We were able to convince the customs officials that all the goods were used, and significantly depreciated, so we were able to finally  gain access to the country for a mere $450 more…

“ Render unto Caesar…”

This whole process added another hour to our already exhausting “day” of travel, and we were able to get to our hotel at around midnight.  Needless to say, we were angry, disheartened, and not a little cynical…not a good way to start our time of service to the Kenyan people.  It was difficult to fall asleep after all of this, but we were able to distract ourselves a bit by watching some live coverage of the Rose Bowl being played in ….DALLAS??!  Again, other worldly.   Sometime later, in the early hours of the morning, I was awakened from sleep with the above-mentioned scripture repeatedly running through my mind.  So persist was the thought, that I pulled out my phone in the dark and looked up the rest of the passage:

Matthew 22: 19-22 ESV  “”Show me the coin for the tax”.  And they brought him a denarius.  And Jesus said to them, “Whose likeness and inscription is this?”  They said, “Caesar’s”  Then he said to them, “ Therefore render to Caesar the things that are Caesar’s, and to God the things that are God’s”  When they heard it, they marveled.  And they left him and went away.”

So, I marveled…what are the things that are God’s?...only our entire selves… our very lives and our health, our talents, skills, gifts, time, and resources…. So next morning with renewed commitment, we boarded our bus for the next 4 hour drive to Tenwek…and began again to move forward.  I pray that we will be able to maintain this focus…to give to God that which is already His, and to be open to what God has in store for us this time around…

With love,

Randy and Marilyn

Who knew a neck gator had so many uses?!

Fear in the time of COVID-19

 

Friends, as Marilyn and I ready ourselves for another trip to Kenya in January, we are again confronted with an old familiar enemy...and his favorite tool...FEAR.  Beginning with our first mission experiences in Guatemala, El Salvador, Nicaragua,  Mexico, Dominican Republic, and later with our trips to Kenya, we have experienced fears of one type or another on each and every occasion.  When we first ventured out into the medical mission field of Guatemala, my main fears had to do with illness and personal safety.  On every prior occasion that I had the opportunity to travel into Mexico or Central America (for tourism), I would regularly experience “tourista”...sometimes quite severe... including high fevers, and sometimes bloody diarrhea.  My main fear at that time, was getting out into the mountains of Guatemala, and being unable to access medical care if needed.  At that time, Guatemala was also being threatened by Narco-terrorists, as well as gangs engaged in the kidnapping of wealthy Americans and others.  Our mission teams had Guatemalan soldiers assigned to our team to ensure our personal safety, and we were confined to a hospital “compound” within the area that we were serving.  It was with great fear and trepidation that we reluctantly followed the call that we had felt on our lives to begin using our medical skills and our significant resources to help others in the name of Jesus.  I had heard all the assurances of scripture that God would provide and enable those He had called, but this did NOT alleviate my anxiety and fear...this was “head knowledge”, rather than “heart knowledge”.  Only after stepping out in faith (though admittedly a somewhat miniscule faith...), did God show me that He would indeed provide for my health and welfare...I did NOT get sick ( and have not gotten sick on MULTIPLE trips thereafter) and did NOT feel unsafe or threatened.  As a result, my faith began to grow, bit by bit, with each new mission experience and with the absence of significant illness or safety issues on each occasion.  As these fears began to subside, I developed an intense claustrophobic fear of flying, and would become nearly ill when merely thinking about being trapped inside a gigantic aluminum cylinder at 30,000 feet!  We were scheduled to make another trip to Guatemala in the summer months of that year, but I could not imagine boarding a plane to get there.  Around that time, I became aware of the Christ Healing Center (Now called “One”). During a fact- finding meeting,  whose purpose was to explore coordination of clinical medicine with spiritual wellness, we attendees were extended an offer to try out a prayer session with the staff .  I was very reluctant and skeptical (as is my default position on most things), but decided to give it a chance anyway.   I went in for my session, and while being prayed over, was asked to speak the first thing to enter my mind.  I did so, but noted that my thoughts were of childhood experiences and sins, that seemingly had nothing to do with flying, claustrophobia, etc.  I was asked to speak what I thought I heard God saying to me in response to these confessions, and was then asked to describe what images, if any, I might have had in my mind.  I remember describing an image of myself being held in the palm of God’s hands...like an Allstate insurance commercial!  The team then asked God to give me a tangible sign upon leaving the center that He had indeed been communicating with me.  I remember going home, opening the mailbox, and seeing in the stack of mail, an advertisement from a dentist friend from church.  The mailing piece showed a family being cradled in the palms of their overly large dentist (!) with the message that, “your family is in good hands with Dr. ______!!  Needless to say I was profoundly impacted, and speechless...the memory continues to bring me chills.  I made that flight to Guatemala, though with much discomfort...I remember calling on this mental image frequently to get me through.  It has been many years, and with repeated successful episodes of overcoming flight anxiety, I no longer think much about flying...or  health or safety issues for that matter.  When Marilyn and I first felt drawn to serve in Kenya, we discovered a whole new set of issues and fears to be dealt with.  We again felt “under attack”...I began to worry about whether I could be effective (medically) in a world where nothing is as it is the West...the diseases are not the same, the lab values are reported in different units than those used in the US, and the cultural issues are definitely not the same (think tribal warfare, bows and arrows, etc)!  I was told to expect to see a lot of TB, TB meningitis, bacterial meningitis, and AIDs- related problems, as well as malaria, tropical diseases, and many other things I had only read about, but rarely seen or cared for in 30 yrs of private practice.  Once again, taking a step in faith was the first challenge, but we found this a little easier given our past experiences with a providential God.  Needless to say, we survived that first immersion into Kenyan medicine, but each time has truly been “otherworldly”...each time we have been enabled and provided for...each time, just the right specialist from Kenya or the US has been present to help us when we feel lost or clueless about what we are dealing with.  We come away each time convinced that God has been present in the experience.  We have now been to Kenya each of the last 7 years, and on each occasion, a new “attack” involving one type of fear or another has been thrust upon us.  We were there in 2013 when Al Shebab, a terrorist group operating out of Somalia, attacked the Westgate Mall in Nairobi.  A couple  of our fellow missionaries had just been at that very mall, shopping, and “stocking up” for their time in Tenwek.  They had left the mall 30 minutes prior to the attack.  During that attack, 148 civilians were murdered before the Kenyan military were able to restore order.  We were in Bomet, (a rural area, 4 hrs drive from Nairobi) at the time, but had been in Nairobi one week earlier.  During the Ebola outbreak of 2014-2016 we continued to make our annual September trip to Tenwek Hospital in Bomet...each time, anxious about the outbreak possibly spreading to Kenya, and “trapping” us in a quarantine situation, or worse....possibly exposing us to an illness associated with >90% mortality.  In addition to Islamic terrorism, equally terrifying diseases, and isolation from the comforts of the Western world, we also have been in Kenya during presidential election years.  In 2007, more than 1000 civilians were killed in election violence, and 600,000 fled the city for safety,  In 2017, we flew into Nairobi just ahead of a presidential election which was scheduled to take place later that month.  On that occasion, only 24 violence-related deaths occured, but we definitely experienced anxiety and fear that things might again spiral out of control.  So with that background, 2020 feels very much like more of the same….a new virus, but an old and familiar enemy...Fear.  As we have been preparing for this upcoming trip, we have again trusted in God to make clear to us whether we should be going or not.  As the time approaches, we have watched “doors begin to open” for us.... The mandatory quarantine of 14 days following entry into Kenya from certain U.S. territories (including TX), has now been lifted.  The COVID -19 vaccines have been making remarkable progress, and will potentially be available literally days before our scheduled departure, and we will be considered among the first in line for access (health care workers, AND  over age 65!).  Once again, we will be trusting God to keep us “in the palm of His hands”, and trusting in His promises from scripture….

2 Timothy 1:7, ESV  “for God gave us a spirit not of fear, but of power and love and self control.”

Philippians 4:6-7 ESV  “do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God.  And the peace of God, which surpasses all understanding, will guard your hearts and minds in Christ Jesus.

Mark 8:35 ESV  “For whoever would save his life will lose it, but whoever loses his life for my sake and the gospel’s will save it.”

Daniel 3:17-18 NIV  “If we are thrown into the blazing furnace, the God we serve is able to deliver us from it, and he will deliver us from your majesty’s hand.  But even if he does not, we want you to know, your majesty, that we will not serve your gods or worship the image of gold you have set up.”

Friends, please be in prayer for us...pray that we will again be protected from illness, violence, and terrorism...pray that our fears will be assuaged, pray that we will be enabled to care for those individuals that we encounter, and pray that we will be good ambassadors of Chist’s love and compassion.

With love,

Randy and Marilyn 

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!!