home away from homesick

"Although the world is full of suffering, it is also full of the overcoming of it."        - Helen Keller

            I feel like taking a big sigh of relief.  ::sigh:: Phew. Glad that’s over.  What? Oh, I was sick again. Yeah, I guess I can talk about that.

            I didn’t write this past week at all.  This time I was not too busy, I was just beat down by the apparently bi-weekly dose of Strange African Illness. I know some of you back in the States have been concerned about my health over here and I want to tell you first and foremost that I am better, that I am alright, and that as a medical professional I am not seriously concerned about being ill the handful of times I have already been since I arrived.   Really, I'm okay! Today I'd like to tell you why.

            In my daily practice with the children and staff, I encounter one illness above all the others.  Malaria, obviously, is endemic in this area, with tenacious strains requiring high-powered anti-malarials to clear the parasites from my patients’ blood.  Some people, especially babies, can become seriously ill.  Others, especially those who have been exposed to the parasite since birth, usually don’t become more ill than the “flu” makes us back in the states, at worst.  For some, it’s just like having a mild bug, even.

            Malaria is caused by the parasite species Plasmodia; the most prevalent strain here is one of the most severe, Plasmodium falciparum.  We call this “falciparum malaria”.  The “eggs” (gametocytes) of the parasite are carried in the body of the female anopheles mosquito, which bites between dusk and dawn.  After it bites you, the “eggs” travel to your liver, where they invade some of your liver cells and set up camp.  They mobilize some of your liver cells’ resources against you to make early forms of the parasites themselves.  Your liver becomes a kind of “home base” for the disease.  At some point, at the end of the incubation period of the illness (usually five or six days up to weeks or even months), a special type of parasite cell leaves your liver and enters your bloodstream.  As many of them do this at once, now entering the “erythrocyte phase”, the red blood cells are attacked and the parasites feed on the hemoglobin (iron) to thrive.  Someone with malaria would now experience clinical signs and symptoms of the illness such as headache, lack of energy, nausea, vomiting, diarrhea, body aches, and fever.  The red blood cells then become like satellite hubs where more parasites can be made.  The parasite bodies, known as schizonts, can stick to each other and then get themselves deliberately stuck in capillary beds (areas where blood vessels decrease in size to the microscopic level) and impair organ function.  Complications arise from this feature of the illness especially, as parasites can even cross the blood-brain barrier (protects your brain from certain things in your blood) sometimes and cause serious damage to brain tissue.  “Cerebral malaria” can cause anxiety, paranoia, hallucinations, psychosis and coma, eventually leading to death.  Without treatment with antimalarial medication, thousands of people in Africa die every day from malaria.  There is no vaccine for malaria (though some of you may heard in the past few weeks about a promising vaccine) and the only treatment is with oral or injectable drugs.

            So, I’ve had malaria a few times.  With that description, you might wonder why I tell you not to worry.  There are a few more things that you should know.

            Although malaria is not like a disease you can get once and then be immune to, like the chicken-pox, in most cases, the body does seem to mount some kind of immune response to the parasite.  Adults who have lived in Kenya all their lives don’t get nearly as sick as adults who are infected for the first time.  Babies here, after the residual immune effect from their mom wears off, can get rapidly and critically ill from malaria.  I’ve seen adults here become suddenly and violently ill who have never previously been exposed to malaria.  I’ll generalize the demographic to say that the more times, and the more severe, you’ve had malaria, the better your body should be able to do at least some of the work.  As this happens, people here seem to just recognize a few symptoms that are unique to when they have malaria, recognize it, and seek treatment early, avoiding the complications.  I’ve never seen an adult or baby die from malaria here so far, thank God.

            The reason I am made well from this illness is because we are blessed to be in an area, and in a position, to have access to a reliable supply of antimalarial drugs.  The government doesn’t give them out – they have to be purchased at the pharmacy.  Most of them that really get the job done are not cheap, but they’re worth the money to the sufferer and their loved ones.  I feel extremely grateful to serve in an area where I don’t have to fear for my life, like countless children in Africa do, because of this illness.  Sometimes I wonder how many of our own children here at In Step would have died from malaria if they weren’t with us.  After that I usually wonder how many more children would be here, who died after being abandoned outdoors, who we’ll never have the chance to love.

            In the past week I was on treatment for malaria, but also for some “other” illness that caused fever, severe (and I mean severe, like the worst in my whole life) abdominal pain and its consequences, and left me in my bed for several days, wondering if I’d ever be able to do my work again.  I’m a bit of a baby when it comes to these things.  I too my medication as directed, however begrudgingly.  Here, the primary site of intramuscular injection is the “dorsal gluteal” (the upper lateral quadrant of the buttocks) but is known in the developed world to be associated with sciatic nerve damage and chronic pain, so I don’t get my injections from the clinic here (it works for them, I respect that, I just want something different) and I just do it myself at home, in the “vastus lateralus” (the anterior thigh, where the “Epi-pen” goes).  This is where the kids and staff at home here get it too.

            I guess there’s a lot that goes into being sick.  I guess there’s a lot that goes into being well, too.

            I have to say, though I really wish I could not, that my physical illness was not the only one that surfaced since I last wrote to you.  I had been warned that homesickness was an inevitable part of my experience here, and I had wondered what that would feel like and how it would affect me.  I was starting to understand how it felt before I came down with this last bout of “whatever”, but when I was in my bed not feeling well, just thinking, I couldn’t help but notice my mind wandering to some truths which I only reluctantly acknowledged.

            “If I were back in the States, I probably wouldn’t be sick right now.”

            “When I get better, I can’t wait to go to Wegman’s and get some of that ice cream I lo--… oh, wait.”

            “The toilet paper is nicer over there.”

            “This would be a great time to just vegetate in front of my Netflix Instant Queue.”

            “I want my mommy.”

            It’s alright, I am laughing about this now, but I don’t mind acknowledging these things in this forum.  Even when I’m not sick, there are things that I am really starting to miss from “back there”, and it’s requiring me to look deeper into myself, toward God, and toward the people that love me, to be reminded of not just how but why I got here.

            A day or two ago I asked Mama Carla, “Mama Carla, did you ever ask God why He had to send you to a place where there was so much personal sickness?”  She replied something like, “Not really.  I knew [Jeff and I] were called here, that this was where God wanted us, and we were just willing to deal with whatever came along with it.”  I had asked her expecting a laugh, and her saying something like, “of course, but you get used to it,” or “don’t worry, we all go through that,” but instead I got a real answer that I apparently needed to hear.  Now as I write, I realize that I never actually asked God that question myself.  I did wonder for a second – “God called me here and now I’m sick. Does that mean He wants me to suffer?” I answered that question myself quickly: absolutely not.  That would be like a child saying, “my mother gave birth to me and brought me into the world, and now I am experiencing a challenge.  Does she want me to struggle?”  As a pseudo-mom to the kids here, giving them love but having to discipline them too, I know that’s not true.  I even heard myself ask, “God didn’t call me here to be sick, so maybe since I have been so much (every two weeks) that means I’m not supposed to be here.”  God probably didn’t call me here to hang out with Ray and watch Star Trek once in a while either, just as an example, but just because it happens doesn’t mean that it I’m not supposed to be here to take care of the kids. 

            I’d say that I came here for the sickness, but it’s not true.  I came here to try and do a few little things that would make it easier to keep everyone well, and then be more able to do what God calls them to do.  For example, Beth Ann is called to teach and take care of the big girls, and when she’s sick I am happy to take care of her, knowing it will help her to get back to the kids’ wing of the main house faster, as she feels better and gets better.  When the kids are brought down by malaria again I am glad to give them their medicine and comfort them, believing that what I’m doing will help them to get back to what God calls them to do – learn, play, and grow. 

I’m just now considering for the first time (literally, as I write this) that I never thought to approach taking care of my own illnesses the same way.  I hate being sick.  I spend most of the time whining to everyone about how I should be doing my work, how I have no motivation, and then apologizing for not accomplishing my tasks and then asking for help.  I usually feel guilty most of the time when I’m resting up, even when the doctor explicitly tells me that I have to rest.  I often think, “I came here to take care of the sick, not be the sick.”  Based on what I said in the last paragraph, I’m now seeing that this simply isn’t a fair perspective to take on myself. I knew I was going to get sick.  It’s totally natural that when we’re uncomfortable and are actually feeling what the challenge really entails that we can get scared and angry, losing perspective from to time.  Apparently, for this chick who spent most of her years living on Long Island with life handed to her, losing perspective means feeling sorry for herself and fantasizing about the comforts of “home”.  It’s okay.

Being sick is a part of being human.  Not one of us has ever been, is now, or will ever be, exempt from illness, whether it be physical, mental, emotional, or spiritual.  Sometimes illness is a necessary barometer to indicate that something is out-of-balance in our lives or that something has to change.  Sometimes it is a result of choices we’ve made, and other times it happens just because we are vulnerable to another life form, substance, or force.  Regardless of the illness,or its consequences, I’ve seen God act in all forms of illness to do everything from cure chronic diseases with statistically dismal outcomes, to allow the traumatically injured to function in a way never before imagined, to bringing the mentally ill back to life from a real hell of psychotic torture, to mend a broken heart and give it new life.  I experience His healing power every day – I see it all around me as He keeps our kids well (I am astonished at how few kids have malaria here, actually) and protects them from injury and disease.  I learn about His incredible love through stories of how He enabled His servants to overcome unbelievable circumstances – like when Mama Carla told me about those three months, years ago, when she had malaria seventeen times in three months before becoming well.  The power of God in healing disease is real.  I believe it, I trust it, and I depend on it, as much as I depend on Quinine, the most powerful and last-resort antimalarial I have to fight the parasite.  I prayed through my illness and immediately after I got ideas about what I needed to take and what I needed to do to get better.  I prayed through the pain - and remembered that if anyone knows anything about pain it’s Jesus Christ – and it was so much easier to tolerate.  As I pray about feeling homesick, missing my friends and family and even my grocery store, I feel the Lord allowing me to take a new perspective, grateful that I have had the opportunity to experience so many luxuries in life, and still having all my needs – and ninety-percent of my wants - met here every day.  I’ll get sick again and I’ll take meds and pray and He’ll heal me again and put a smile back on my face.  I trust Him with my life.  I trust Him with the lives of the babies I love.  I even say this knowing that some have died here.  He was there and taking care of them too, and Knew something we can’t.   Medication is critical, but God is the Real Healer.  He works when we pray.  

You don’t have to take my word for any of this.  In fact, I’d wish you wouldn’t.  If you’re not sure, and you’d like to know more, I know Who you can ask about it.

After all, when I was sick in the States and the doctor told me that I “would regret it for the rest of my life” if I went to Kenya, I prayed.  I took the meds too.  I asked God all about whether or not He could heal me, and asked Him to not even being totally sure He could.  I waited for His answer in my heart – I wanted Him to tell me whether or not He would heal me.  I was getting discouraged, not being told the answer.

Until He showed me.

This is why I tell you that I’m okay.  This is why I tell you that I’m not concerned and that you shouldn’t worry.   Trust me: I’ve got powerful medications and a Great Doctor.  

Bonnie chowing down

Dorcas - I asked them, "show me how you eat." I was tempted to say, "show mommy how the little piggies eat!" (A Christmas Story) She did this all on her own.

Ayub after "eating" his mashed potatoes

Chris has literally doubled in size since we got him two months ago, now here 8 months old.

Sunset

Ray's "Bathday Party" - he turned 29 on the 8th.  It's a tradition here to unexpectedly douse the celebrant with buckets of cold water.  He had fun.

Little Beth (18 mos old) drinking a smoothie. She's the tyke who isn't even rolling over yet.

Rebecca, Marrion and Rehema all playing

Sheri and Marrion

Evening Suncast over town, filtered

Mural above the shoe rack, with effect

Ray teaching Jason how to drive the Land Cruiser. I told Ray I thought he was a little young, but he insists that the boy is a natural.

Beautiful Esther love

Jason - not too messy for me to kiss!

Sammy, 7, laid down next to me on the veranda as a whole lot of us watched Charlie and the Chocolate Factory (the original) on a Friday afternoon

Brian, age 11

Philip, 6, didn't cry or need to be held for his final injection for malaria treatment. He's showing off his new sticker.

Apparently someone is running a special on babies! We've got a few new ones... anyone looking to sponsor a child? :) Brings our count to 135.

Jenny

Elvis, 6, rests while waiting in the car at the clinic. He had a temperature of 103.5 in this pic.

Rehema, 7, fell asleep snuggling baby Lavendar

She just snuggled up right next to her and snoozed!

mrembo (beautiful)

“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern. Beautiful people do not just happen.” 
― Elisabeth Kübler-Ross

The longer I am here at In Step, the more that the days seem to blend together.  The more I get used to the day-to-day routine, the harder it is to pick out what, in the past week, stands out to me.  The reality of my awareness is that very little of it stands out, but not because it is mundane or boring or ordinary.   I felt myself sit back in awe this week and, again, recognize how much beauty is living here on this compound.  It’s overwhelming when I actually think about it, and it’s almost easier not to think about it at all because of the emotional load it bears, however positive it is.  It’s almost easier sometimes to just pretend that these are all “regular kids” here for something like a summer camp.  I know, it’s ridiculous, and it’s not true.  These kids are not regular kids.   Whatever that means.

            This week I went to Eldoret with Jeff (one of the directors) to take one of the tykes to see a doctor there.  One of our sweet babies, seventeen months old, has been having a lot of tummy trouble – bloating and distention, diapers that could very well clear the veranda, reluctance to eat solid food, and severe failure to thrive.  She’s been with us for months and still hasn’t been putting on much weight, and continues to fall behind in milestones of physical development.  She can sit up but doesn’t roll over or crawl at all.  I can only imagine that she hasn’t rolled over onto that belly of hers because it’s causing her pain.  She has the biggest brown eyes I’ve ever seen, with long black eyelashes that curve outward – women all over the world would kill for what this little one has!  She’s got tiny little arms and legs, with a rotund abdomen.  We have her nicknamed “CTE”, or “Cutest Thing Ever”.

In Eldoret she was examined and a high-quality (digital) x-ray was taken that showed an abnormal gas pattern and retention of fecal matter high into the bowel.  She’ll was taken back for a barium enema this week to better visualize whether or not there was a narrowing of the bowel that’s preventing stool from passing.  As if she didn’t have it hard enough to begin with, right?

            Before we went to the hospital in Eldoret to see the pediatrician, we stopped at the airport to drop off Rachele, the visitor from Pennsylvania who was with us for most of July.  I’ve hoped to write about my experiences with this woman in this blog and I’ve really struggled to.  She touched my heart in a gentle and deep way and we got to know each other on a level I did not expect.  I feel like she adopted me as her little sister.

            Rachele is a mom – apparently an awesome one – of two boys, ages fourteen and seventeen.  She’s married to Mark, the love of her life, of whom she speaks with great devotion and admiration.  She’s a veteran, too, and served our country with passion for as long as she was able.  This was her first time to Africa, and she came by herself!  This lady has some serious guts.

            As soon as she got here, Rachele felt like part of the team.  I was sick when she first arrived and I was occupied with my own illness for the most part.  We also still had our team from Canada here, and so there were many people among whom to divide the time.  Just after the Canada team left, Carla, Jeff and Beth Ann all left for a missionary conference in Mombasa (in southeastern Kenya, past Nairobi, on the coast of the Indian Ocean) and it was just the four of us – Rachele, Adam, Ray, and me.  There were tasks that needed doing and issues that needed handling and she stepped right up from the word “go” to be as much help as possible.  The woman brought willingness, courage, and love to all of her interactions with the kids.  She brought her heart with her and formed strong relationships with each of us as we shared our life stories and testimonies.  She and I shared almost as many laughs as we did tears.  She left a tremendously lasting impact on my heart.

            What I admire most about Rachele is her ability to see the best in people – especially in children.  Now, let me remind you – this woman is not exactly the stereotypical all-American church girl.  She hasn’t had life handed to her on a silver platter by a long-shot.  She’s a tough cookie with a heart of gold who has seen and experienced some really challenging life experiences; she has made lemonade out of some hard and bitter lemons.  The lemonade she has made out of difficulties life has handed her is sweet and attractive – it is her warmth, her friendship, her compassion, and her faith.  I’ve seen many people who have experienced great challenges become hardened and closed off, or on the opposite end, openly apathetic and lackadaisical about life.  On the contrary, Rachele seems to live in an envious balance of sharing her heart and being reserved.  Interacting with her, and watching her interact with the kids, was a privilege I miss already.

            One of the special gifts Rachele shared with us when she was here was her talent with the special needs kids.  We have a handful of children with needs that are different than the other children: six have some degree of profound developmental delay.  One of the six is relatively high-functioning, two function moderately, and two are wheelchair-bound.  Rachele played and worked with each of the kids in such a dedicated and focused way that she could tell us (or at least tell me) things I didn’t even know about any of them (but what do I know? I’ve been here for two minutes).  One of the children, who only “walks” on her knees, Rachele had standing and taking a few steps; she worked with the child regularly while she was here, and now it’s easier to continue the walking practice almost daily.  Another one, who occasionally has outbursts as he struggles to express himself, was kept calm by new games Rachele implemented involving therapeutic touch and sound – games we are still using today.  So many other little gifts she left – from playing “Little Bunny Foo Foo” and “Where’s Thumpkin?” to letting the kids use her scented antibacterial hand sanitizer (they call it sabuni, meaning “soap”; they’d try to eat it and she’s deter them saying, “don’t eat it or you’ll poop bubbles!”) to playing songs from the radio with their names in it (like Benny and the Jets)… Rachele’s attentiveness and wholehearted presence with our kids makes her name one they won’t quickly forget.

            Rachele and I had the type of intense conversations that I can’t even have with some of my close friends: one of those gut-churning, heart-wrenching, tear-jerking, rib-aching-from-hyperventilating-from-crying-and-laughing-at-the-same-time conversations.  How could I have become so close to a woman who was only here for three and a half weeks?!  I guess she was just one of those people in my life.  You know what I mean by “one of those people”, too: someone who comes into your life unexpectedly, sees you for exactly who you are, knows that you have walked in each others’ shoes from time to time, and tells you exactly what you need to hear exactly when you need to hear it.  It’s likely that I won’t see her again for almost a year, in person… but I’ll see her here everyday each time a kid asks for some of the sabuni  she left me, or sings “Little bunny foo-foo, hopping through the shamba…” or makes a joke about shaking their “booty” (okay, in her defense, it is better than the Swahili word for the rear-end, tako, pronounced like the Mexican food).  I’ll see her everytime I hear the word mrembo, a word she flung around at every little girl and boy, for practically any and every reason, describing how she viewed them.  “Joshua mrembo!” and “Marrion mrembo!” and “Brenda mrembo!”

            Mrembo is the Swahili word for “beautiful.”

            I won’t just see Rachele around here in those seemingly small or silly things, though.  If I can hope and pray for one way to continue seeing her here I hope that I see as she saw.  I hope that I continue to see what Rachele left here by looking at this place with her eyes.  No doubt: I love this place, I love the kids, and I love the mission… but there’s an particular vantage point that Rachele took as she gazed over what we do here that added a color and a depth to it that, perhaps, a few bouts of malaria had dulled for me.  She saw – and undoubtedly sees – the beauty in even the most challenged of our children, the positive opportunities for change in even the most difficult situations. 

I’ll see Rachele when I know that I can ask some of our older boys, who have been struggling to obey Ray and Adam, whether or not they are bad boys.  She gave a few of them some “talking-to’s” (as they were called when I received them twenty years ago), that turned into motivational speeches that would put Tony Robbins to shame.  I know I can ask them, “What did Miss Rachele remind you of?”  I know I will the response, “I’m a good boy,” and I’ll ask, “Why’s that? Because what’s in your heart?”  I bet they’ll say what they said to her, about which she reminded them.

            “God.”

            Maybe that’s why it is so easy for her to see the beauty in the struggle, in the traumatized or handicapped child, in the tough situation.  She looks for the beauty in people and she finds it.  She sees God in the faces and stories of our kids here, and that’s where she sees the beauty.  I’ve heard it said that we often see in others what we ourselves project; if we project negativity we will see it everywhere, but if we project positivity we will see the glass always half-full.  I also wonder if the reason Rachele sees beauty in the world so easily is because she herself embodies so much of this same beauty she seeks to discover and accentuate in others.

            When we were driving to Eldoret, the sweet baby had a serious diaper-related wardrobe malfunction all over Rachele, who was about to travel for a day and a half.  Obviously this happens often with kids, and especially with kids with tummy issues.  Rachele took it in stride, laughing about it all the way – good thing she didn’t leave all her scented sabuni with me, wink wink.  I got a voice message from her a day or so ago and she talked about how adorable and sweet the little tyke is to her.  I’m not surprised, but it made me laugh thinking about the situation, and how it’s just another little example of my new friend’s loving outlook.

            There’s an interesting tradition here.  When new babies arrive without names, they are typically named after visitors, interns, or special people who support or love In Step.   While Rachele was here we got two new baby boys, one who needed a name.  He was named Noel, as I mentioned last week.  Some of the Aunties told Rachele that when a girl baby comes that she should be named after her.  They said,

            “She should be named Rachele Mrembo.”

            Amen, sister.  Amen.