“So I said to the Lord, ‘You promised me Lord, that if I
followed you, you would walk with me always.
But I have noticed that during the most trying periods of my life there
have only been one set of footprints in the sand. Why, when I needed you most, you have not
been there for me?” The Lord replied,
‘The times when you have seen only one set of footprints is when I carried you.’”
–
Mary Stevenson, Footprints in the Sand
Another eventful week at In Step has
come and gone; I can’t believe how fast the days and weeks fly here. This wraps up my fourth week,
practically. I’ll have been here a full
month on the seventeenth.
So much has been going on, it’s
hard to keep track. This morning we said
goodbye to a very special group of people, the eight-member team from
Canada. They spent two weeks here at In
Step sharing their hearts and talents with us.
We were profoundly blessed to have them with us and I hope to welcome
them back to the compound in the future.
We had a great time, and their contributions to the home – physical and
spiritual – will remain here, with us and with the children, indefinitely. I feel so grateful to have met such a kind
and thoughtful group of folks, wholehearted in their efforts to love these
children, and diligently successful in their accomplishment of physical goals
(like building shelves in the new dorm for all of the boys). God blessed their time with us, and I trust
that many of them will return, as God may continue to use them to demonstrate
His Love. Also, yesterday we had the
monthly “Happy Birthday” celebration, involving a morning of cake, ice cream,
and fun. The visitors brought special
blessings for each of the children, and they were so pleased to have stickers
and trinkets to play with, each with something special all their own. It has been a typically blessed time.
This past week, however, I have
been especially distracted. Early in the
week one of our babies, Ayub, nine-months-old or so, came down with another bout
of malaria. As a matter of fact, many of
the babies have been ill with the parasite, with their cases in the majority,
compared to the rest of the population of children. Even though we were able to treat Ayub with
powerful antimalarial injections, he quickly became dehydrated from the
combination of stomach and bowel symptoms characteristic of the illness. I’m not Ayub’s mother, or anyone’s mother for
that matter, but I can only begin to describe the terror and horror I felt in
the pit of my gut as I stared into his eyes, seemingly sunken into his head.
The missionary staff and the
visitors were watching him continuously during our waking hours – giving him a
combination of standard formula, and what we call “ORS” (World Health
Organization standard issue Oral Rehydration Salts), an orange-flavored
electrolyte and glucose mixture especially designed to treat acute
dehydration. The main problem with
administration of the ORS for poor Ayub was that he vomited absolutely
everything we offered him – at least ten times in a few hours. I eventually knelt on the floor of the
medical room, over the bed we use as an examination table, with a 24-gauge IV
catheter in hand, normal saline bag spiked and tubing primed, ready to put a
line in this baby after brief period when it was hard to wake him. Of course, having a tourniquet on each of his
tiny, chunky limbs woke him up swiftly, but to the point that even with another
adult holding him, we couldn’t stabilize the limb to the extent that an
intravenous line would have remained in for very long.
It was a challenge – I knew he was
dehydrated and I knew how to fix him, and even found a vein or two I believed I
could cannulate, but I knew that even if we could hold him down long enough to
get the line in, there was no way it would stay in – he was still too strong,
thank God. We prayed over him and fed
him small amounts of the ORS, with his head up (just in case he did vomit), and
eventually he started to keep some of the fluids in. I wondered if I should have been doing more,
or if I was being too alarmist. When I
looked into his eyes, he looked like a different baby, a sick baby; his sunken anterior fontanelle (the soft spot on the top
of his head) reminded me I was not overreacting too much.
That night a few of us stayed up
late with him – past midnight – to try and rehydrate him. He was so cranky, undoubtedly feeling awfully
ill, we could barely get him to stop crying.
Karin (one of the visitors), Ray (one of the other five missionaries)
and I took turns consoling him and keeping him comfortable. We brought him out onto the veranda (the
colorful room with the long tables), away from the other babies and the hallway
where everyone else was sleeping, so to try and let them sleep. The night-shift Aunties were awake, of
course, but they are responsible for the care of all the other children
(changing diapers, escorting kids to the toilet, making sure everyone is
sleeping) and Ayub’s malaria was enough to keep one person totally tied up for
the night. Not every child becomes this
ill from malaria. I felt for the poor
baby – we followed the doctor’s orders as closely as possible and did what we
could – he still had to suffer through the process while the medication did it’s
job to destroy the parasites which had invaded his liver and bloodstream. It was a time when I knew that my experience
and knowledge were inadequate, and yet, I had to trust that we were making a
difference for the baby boy.
In each of our turns we sat and
rocked little Ayub, back and forth or up and down, talking to him and offering
him comforting “shushing” sounds like white noise, but eventually we realized
that we were not being very effective. I
stood with him and started walking back and forth for a few feet, which are
available in abundance in the long veranda, and he stopped crying. A few times he fell asleep, and I sat back
down, only to notice that he would awaken suddenly and begin again with his
abnormal, prolonged, high-pitched cry, that which is characteristic of the
ill. Again, I stood up, and paced back
and forth, rocking him with each step, and he calmed down. Sometimes he didn’t even need me to make any
sound or rock him at all, but he seemed comforted just enough by the sensation
of me walking.
Earlier
that night in the hospitality room (what we call the area where we have a
kitchen and living-room setup) we were all gathered for our nightly
devotion. We had then begun taking turns
attempting to rehydrate Ayub, and we kept him with us during this time. Some of the visitors were curious about his
history and asked Carla about his story.
She told us how (if I remember correctly; my memory may be unreliable
this week, as I will mention later) due to his mother’s death or absence, he
may have been taken care of by his eight-year-old sister. Carla mentioned how she suspected that the
young girl would most likely have carried Ayub around on her back for most of
his life, as is traditional among Kenyan women.
I can just
marginally appreciate what this looks like, as in the past two weeks the local
women employed here have been teaching me how to carry a child on my own back
in their traditional manner. I had
approached one of them asking how to do so, amazed at the reliability of such a
makeshift infant carrier. One morning, when
one of the babies was being fussy, they put him on my back, and the next thing
I knew, I was walking around asking, “He’s not going to fall out, is he?” They
laughed, spoke to me in Swahili, and told me that he was safe. For a few mornings in a row I got to
practice, and carried a few of the baby boys on my back (one-at-a-time, of
course). Speaking of it, actually, Ayub
was one of those babies.
It’s very
simple, really: take a “shawl” (a rectangular scarf, approximately three or
four feet long) made of a lightweight fabric (I’d think of it as a “head
scarf”, the thickness of a thin bed sheet) and lay it down in front of you,
flat, with the long-edge up. Hold the
baby on your side as much as possible, then lean forward (bend so your torso
and legs make a forty-five to ninety-degree angle), and twist your arm over the
baby while pushing them toward the center of your back, then grabbing hold of
them behind your back with the opposite arm.
Once you are holding them centered on your back, like giving a low-piggyback
ride, skooch them up so they are closer to your shoulders, still centered with
your back, on their abdomen. Letting go
of the infant with one arm, grasp the two corners of one side with one hand,
and pinching the opposite corner or two with your thumb and index finger. Reach around behind your back and feed the
pinched corners to the opposite arm, which has been holding the baby
steady. Outstretch the shawl so that
the long-edge is still on the top.
Maneuver the piece of fabric so that the baby is covered by it – all
except their head. The baby’s legs will
straddle your back, and their arms will be tucked in to the shawl. The key is this: their bottom must be completely
hammocked by the shawl – this is how they are kept stable. Their little rear-end sits in the fabric,
which is then gathered into two ends, on the left and the right. The left end goes over the left shoulder,
close to the neck, and is brought down across the chest; the right end goes
under the right arm, and is brought up across the chest to meet the left
end. The fabric is then pulled tight,
and tied in a simple double-knot. The
child usually needs some straightening, and their head can then be repositioned
for comfort. At the end another women
usually verifies that the harness is not too tight or too loosely tied, nor too
constricting for the baby. The Aunties
assisted me with this – even when I started doing it myself, I let them make
sure the little one was okay.
I was
amazed at how well-tolerated this was for the baby, and for me. I got all sorts of stuff done with the baby
on my back, mopping the floor, cleaning up the med room, taking care of other
kids. Even when I sat down, I could just
rock back and forth when the tot got fussy and it was usually all he needed. Of course, eventually the baby gets fussy, or
needs to be changed or fed, and the knot is untied with one hand while the
other supports their bottom from behind; then the shawl itself can be grabbed
with one hand while the baby is supported with the other, and the child can be
grabbed around the side, from the back.
That night
on the veranda, noticing how comfortable Ayub was being walked around, even
though he was rocked less than when we were seated, I wondered if he had become
accustomed to being carried; I wondered if being walked was a comforting
sensation for him from earlier in his life.
I was surprised, though: I could pay more attention to him seated,
making more comforting sounds and even rocking him more diligently, than I was
when I was walking, during which time I could make no noise, or even have a
conversation with one of the other adults, and he still preferred to be
walked. Obviously I understand only a
little about the physiological or psychological underpinnings of his
preference, but I have my hunch. He was
sick and wanted to be comforted, and we were going to do what seemed to keep
him most comfortable. We didn’t tie him
to ourselves that night, but the phrase rang through my head for the rest of
the week…
Carry me on your back.
How
comforting it must have been to him, feeling securely strapped to his
caregiver. He was able to look out at
the surroundings, or sleep, being gently rocked all the while. He could feel his sister’s warmth, her
breathing, and the vibration of her body as she spoke. I’d imagine it would feel like the closest
thing to being in-utero, though outside the body, as possible. If it’s quiet enough, and the baby is
positioned low enough on the back, with their ear turned in the proper
orientation, I wonder if he could have even heard her young heart beating.
So, we
walked him, and eventually Karin (Canadian team) volunteered to stay up with
him later – she eventually helped him take a few cc’s of ORS in at a time so
that he would not vomit. That woman really
has a gift – God used her in a very obvious way to care for that baby. Over the next couple of days, with a few
setbacks in convalescence, he recovered from his bout of acute dehydration: his
eyes aren’t sunken, his fontanelle has been restored to its proper volume, and
he is eating and drinking almost totally normally. He’s not exactly himself yet, but apparently
it takes a little while to recover from malaria, so I find…
It was
actually the second or third day of Ayub’s illness, after I thought he was “all
better”, that I noticed he was still not looking well. Still dehydrated, I thought. I felt an urgency surge through my chest and
I knew I was not doing enough for this baby.
Fluid and electrolyte status in an infant can be so sensitive and critical
– how did I not realize he wasn’t fully improving? Turns out he had some more diarrhea and
needed more rehydration. I took him to
the med room, believing he needed intravenous rehydration, but again, even if I
had wanted to, he wouldn’t tolerate getting an IV in one of his squirmy,
thrashing little arms or feet. His
dehydration, and his Kenyan skin color, frustrated the situation and I wondered
if we would have to bring him to one of the local hospitals. It was then that I sat on the floor, rocking
him, and felt my head pounding, feeling like all the lights were too bright and
like Ayub’s crying was too much for me.
Was he crying louder than usual?
Why was I so irritated by it?
I had felt this way on and off for
a few days but figured that I had not been sleeping enough, or drinking enough
water. A few of the missionary staff had
suggested I be tested for malaria, which I had been once before during this
stay (but it was negative) but I refused, figuring I did not feel “sick
enough”. Within a matter of hours after
the episode sitting on the med room floor, after a discussion with the other
staff, I was taking medication for malaria and was in my bed, sleeping. I had easily identifiable symptoms –
exhaustion, persistent and uncharacteristic headache, fever and chills, and
irritability; all had been gradually worsening for the past few days. Looks like I had been bitten.
I have been reading about this
malaria business for months – the parasite is only eradicated by antimalarial
medication. When the other staff have
malaria (Ray and Adam) I nag them relentlessly about staying well-hydrated and
resting enough. I can say that I
legitimately tried to do this for myself, but there’s a lot to do here and
figured that I was doing enough for myself, but maybe not. Malaria is a funny illness, unlike anything
I’ve ever encountered first-hand. It
doesn’t exactly follow the classic linear pattern of convalescence – some of
its symptoms are renowned to be “relapsing, remitting”, or “on-again,
off-again”. In other words, just when
you think you’re all better and it’s time to get out of bed and get moving
again, you realize your head feels like it’s going to explode and that it’s
time to have a seat… and just when you think the episode has passed, when you’re
bored enough from resting that you just have
to get up and do something, you realize it’s time to go back to bed. Apparently I struggle to rest myself in this
manner, especially when kids are being brought to my door with injuries, and I
know that there are other children I could be tending to.
So, for the past few days I have
been laid-out, on and off, taught a lesson in self-care by the faithfully
virulent parasite Plasmodium falciparum. I thought I could have avoided it with my
mosquito net and organic insect repellent, but when all is said and done, I
suppose those nefarious Star Trek villains could have been speaking for the
female anopheles mosquito when they
touted ominously, “You will be assimilated, resistance is futile.”
When I walked with that baby on the
veranda, staring down at his eyes, half-open, half rolled-back in his head
during the most frightening moments, I wondered, “where’s God in all this? Jesus, why malaria?” I wondered why I was willing to trust my
“Awesome God” who takes care of orphans and “lets them get malaria”. I wondered why He would allow millions of the
most vulnerable and already-suffering human beings to suffer from the
illness. When I found myself afflicted,
I asked “why” again. Then I asked once
more then I realized how fortunate I am to have life-saving medication at the
ready, available to me within hours, if not immediately. Where is the loving God that is “good all the
time” that we pray to and talk about daily?
Maybe the parasites were knocking on the membranous defenses of my
neurological system, the blood-brain barrier, and my faith took a hit. Or maybe I wasn’t even that sick at all, and
was just being my typical self-of-little-faith.
For whatever reason, I was asking questions again. This time, though, the answer came before the
question.
Her name is Lavendar Karin. I mentioned her last week – she’s the new
little peanut we got from the local hospital in Kitale. Two months old, teeny-tiny, with the
“whites-of-her-eyes” a shade of pale yellow.
It was the fourth of July when Mama Carla picked her up; we were at a
missionary barbecue when I peeked into her oversized pink-flowered fleece
blanket to see her wide-set eyes, and then scoured the few discharge papers she
had been sent to the Children’s Office with.
I was troubled by her diagnosis, “biliary atresia”. A listing of lab values, indicating elevated
liver enzymes, among others, skirted my gaze on the pages. I had a vague memory of what this meant –
something about a duct problem with bile? My internet searches the next day
reminded me about her prognosis.
Biliary atresia is the absence, or
incompetence, of the small tube that connects the part of the liver that makes
bile with the portion of the small intestine into which the bile must drain
(the common bile duct). When this
doesn’t exist, or fails, two problems main problems occur: the inability of
bile to reach the small intestine and do it’s job of digesting fats, and the inability
of bile to drain from the liver, which results in damage. This problem occurs in one out of ten or
fifteen thousand babies, is a congenital defect, and requires surgery. From what I could tell, and from the
much-appreciated consultation of a few folks with more medical expertise than I
from back in the states, I knew that this problem doesn’t go away on its
own. You might be thinking, “What’s the
problem? You know the problem, and the solution. Can’t be that hard to fix, right?”
Wrong.
Let’s just say that Little Lavendar
may not have been thriving from birth, for whatever reason. Her body hadn’t been able to absorb nutrients
very well, and we considered her to be malnourished. Surgical candidacy even in the first-world is
conservative and investigated thoroughly.
We knew she wouldn’t be a candidate for surgery for a little while, and
the longer the procedure is delayed (especially past two months of age), the
less of a chance that bile outflow can be adequately restored. Carla and Jeff decided they would take her
another pediatrician they trusted, at a facility an hour-and-a-half away, for
some more lab work and consultation. We
were praying that the Lord would heal her completely. Holding her, we prayed over her, asking God
to guide the doctors to do what they could, and asking God to do all He would,
if it was in His will, to heal little Lavendar Karin. I had seen God’s healing power in my own life
and prayed believing in the possibility, but still holding medical facts and
lab values in my mind.
Carla and Jeff returned with little
Lavendar, with a fresh page of lab values and a good report. Apparently her liver enzymes were trending down,
much closer to normal than they were (down from the 400s into the lower 100s,
for you medical folks), and the doctor’s physical findings did not alarm him
enough to push for any imaging work-up (which, we trust, he would have
pursued). She was anemic, which we will
treat with medication, but his recommendations were for standard care and
nutrition support, with a follow-up in a few weeks. It wasn’t what I expected. It was more like what we prayed.
It’s not the last medical problem
she’ll have – in a malaria-endemic area, having a liver condition isn’t exactly
ideal - the parasites make the liver their home base before deploying
themselves into the bloodstream to consume and utilize the resources in the red
blood cells. Maybe she still does have
this problem that needs surgery; maybe not.
Maybe she’ll grow up fine and lead a healthy life; maybe not. I can tell you that today she looks ten times
healthier, with better color and less jaundice, observable in the sclerae and
mucous membranes, than when she got here.
She’s putting on weight, becoming stronger everyday, and even showing a
little bit of personality. She cries
when she’s hungry, which is a major improvement, and has output of normal
color, consistency, and amount. Her
abdomen appears benign and she has no obvious signs of a fat-soluble vitamin
deficiency. Who knows?
God.
Here I was, questioning God about
how he could let little Ayub be sick, and all the while I had lost sight of a
little miracle weighing just a few kilos.
I was asking God where He was in all this, and He was obviously working
right along, all the while. I don’t
doubt for a second that He kept those sick kids, along with each and every well
child on this compound, as close to Him as the Kenyan women keep their young,
on His back. Safe and secure, tied tight
to the Power of the Almighty, I am convicted with the sense that He’s got those
babies fastened tightly to His loving mercy twenty-four hours a day.
And what about the rest of
them? That veranda we paced through at
twenty-three-hundred-hours, in the cool of night, was filled in the morning by
more than one-hundred-and-twenty children that I believe God picked-up and
dropped-off into the lap of this Children’s Home. I go about my days, even here, worrying about
this or that, whatever problem weighs on my mind or my heart; I find myself in
moments with indecision, punctuating busy days which demand more of me than I
suspect I can supply. But just look at
these children! He takes care of them,
each and every one. He uses this
organization, our directors, our local employees, our missionary staff, and
especially our financial supporters, to feed, clothe, and shelter His babies
who were abused, neglected, abandoned, or simply disregarded by those who were
physically, emotionally, mentally, or spiritually unable to care for these
babies. I pray with tears in my eyes,
asking God for answers, and there are more than one-hundred-and-twenty answers
to those prayers in my face every day – many of whom have learned my name, by
now.
Do I think God has some of them at
a distance, with some in sight, and some out of sight? Do I think that some of these kids are more
favored than others? Where do I think He
keeps them? What do I think each one of
them wants from their caretaker, on Earth and in Heaven? They probably all want what they obviously
all need – to be cared for – in heart, mind, body, and spirit. God meets their needs with food, clothing,
and shelter. What about in the
meantime? Are they chillin’ out in
limbo, these Kenyan babies? Or those Somalian babies? Or those Chinese babies?
Or those Mongolian, Ethiopian, Peruvian, or Sudanese babies? Or those American
or Canadian babies? How close would they
want to be to this God? And what would
they want from Him? Probably what baby Ayub got from his sister, and wanted
from us.
Carry
me on your back.
Here’s the thing – it’s easy to
lose faith and question God when we are suffering, or when we see others
suffering. It’s easy to blame God when
we see the apparently innocent suffer, or the apparently guilty go free. I’m quick to ask God where He is in someone’s
life, or in my own. I’m so grateful that
He is so patient with me, and that He blesses me with a change in perspective,
in a loving and gentle shift, to realize that He has been carrying those babies
all the time.
What about the rest of us? Yesterday the local doctor told me that the
reason I’m still feeling ill even after finishing my course of treatment with
the “best antimalarial drugs we have” is because I have been doing too much –
in the brain and in the body. He told me
to rest, and drink water, and to do something I didn’t expect. He told me to take a walk.
What is it about walking that’s so
relaxing and calming? There’s a soft rocking
of it – the beat of the pace in moving forward can stir even the most
uncomfortable, welcome or unwelcome, fluttering of my heart. The gentle undulation of the pattern of
movement is soothing; the passing scenery allows for a refreshing of the images
of my mind. The quietness of the breeze
around me is cleansing as the physical change of perspective can often afford
me a similar change in my spiritual-point-of-view. It’s the rhythm of my own footsteps that
reminds me of where I have been, where I am now, and where I may travel in the
future.
Sometimes I can get so caught up
asking God questions and listening for responses that I treat our lines of
communication as though they were the local cell networks (intermittent,
temperamental, sometimes unreliable, but only compared to the consistency of
what I’m used to; they are actually pretty good compared to what used to be
available here, and they are bound to improve).
I forget that I am never far from God.
I forget that “just to the extent” that I am willing to open my eyes
more to travel paths He will show me, He will so lead me on such paths. I forget so quickly, when distressed or ill,
that He has never left me, even when I suspected He has. I forget – and I dare say, so conservatively
and quietly – that He may not be the only force trying to direct the lives of
us humans here on Earth – and that still,
He is the Maker, the Keeper of all Power, and the True Spirit in All
Things. I forget that He’s got me, just
like He’s got each and every child out there on that veranda eating supper at
this moment, as I type. And isn’t that
what I want?
I’ve traveled many paths in this
brief quarter-decade of my time here so far.
I’ve made many mistakes and I’ll make many more. In the past twenty-five years I’ve been
confused and angry; I’ve been frustrated and fed-up; I’ve been lost and
heartbroken. But more than that, I’ve
been joyful and calm; I’ve found resolution and peace; I’ve known healing and
forgiveness. I’ve discovered these
things and many more along paths God has shown me, and on paths I’ve led myself
down. He has used every single mistake I’ve been willing to commit to Him to bring me
into a freedom that I’ve never known. I
didn’t have to denigrate myself or beat myself dead first for Him to pick me up
either – His freedom has been one of opportunity and hope, completely devoid of
shame and guilt. He has provided for me
when I thought it impossible. If I could
make one request of the Lord today it would be this:
Carry
me on Your back.
I have a feeling He would tell me
that He has been doing so all along, as much as I have allowed and invited Him
to.
As an aside, I must note that these
paths upon which He has guided me are obviously those which have brought me
here to this Children’s Home – exactly one year ago today I was in Nairobi,
just having arrived in Africa for the first time, less than twenty-four hours
away from encountering destiny, about which I would pray and dream for every
day following, here at In Step.
I want to go wherever He wants me
to go today. This desire has never led me astray. It has always led me to greater happiness,
greater usefulness, and greater hope.
Asking God in prayer where He wants me, for the ability to follow His plan,
and the ever-renewed willingness to carry out whatever He has for me to do has
always carried me further away from boredom, depression, anxiety, and confusion. While I know not the scope of His purpose for
me, I am satisfied even if it is as small as the Plasmodia seen in our babies’ blood slides. For it is God who makes the most astronomical
changes in the lives of those on Earth, by using us each individually, even in
ways that seem the most mysterious, or microscopic.
 |
| Churchill |
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| The Dorm |
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| Plants on the Compound |
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| Evening Storm |
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| Ayub |
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| Amos |
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| Amos, Joshua, Job, Eliza |
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| Brenda |
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| Beverly after cake and ice cream |
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| Abraham after birthday stickers |
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| Sidewalk Chalk |
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| Shadrach and Job at Happy Birthday |
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| Joy |
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| Pendo (Love) |
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| Brighton being silly |
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| Wellington |
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| Karin with Ayub |
