Conversation on faith, work-life balance, parenting, stewardship, leading through the pandemic,

Friends of Kijabe

Faith Leilei

Elizabeth Drum Interview:  David: You started a new position a little while ago, is that correct?   Elizabeth: I have a couple different responsibilities.  I became chair of a committee within the American Society of Anesthesiologists.  They have a committee, the Global Humanitarian Outreach, within the American Society of Anesthesiologists  that was originally envisioned as a way to send US anesthesiologists to other countries to help in educational efforts around anesthesiology.  Over time some of those programs grew/changed/morphed.  Eventually that committee developed into the GHO.  I have been on that committee for years and just became the chair.   There are a number of things that committee does within the ASA.  We support two programs, one is in Rwanda, one is in Guyana.  The goal is to help with anesthesiology efforts in those countries.   The program in Rwanda was originally a partnership with the Canadian Anesthesiologists’ Society.  So, the two societies went and taught residents in Rwanda.  Over time the Rwandan Anesthesia Society has grown stronger, more robust, there’s now graduates who are leading the teaching efforts.  The ASA and CAS efforts have changed more into supporting the faculty, helping them learn to become educators and leaders, and not so much providing hands on teaching, but supporting the leaders in that country.  It’s an amazing testament to the value of education and training local anesthesiologists who then can become leaders in their country.  The efforts in Guyana are similar, they’re not quite as far along, but there is now a Guyanese anesthesiologist who is in a position over all the graduate medical education in the country and another anesthesiologist who is now head of the Guyana anesthesia society and training program.  Again, similar thing, they started with not too much and are slowly growing.  Those are really exciting things that our committee has done.  Another thing, 5 of 6 years ago, I started a program within the GHO committee where we send senior-year U.S. anesthesiology residents to a low-income country for a month to get to experience what it’s like to live and deliver anesthesia care in another country.  Not so much as a mission model, you go for a month and do work, you start to understand what the educational needs and systems are.  Each year we send 6 or 8 residents, we have now sent 50.  Started in Ethiopia, and now Uganda and Malawi.  We also sponsor visiting scholars to come to the ASA meeting every year, to spend a little bit of time as an observer, to hopefully build some long-term relationships to help them in their development as leaders of anesthesiology programs in their home countries.  One of my goals is to gain visibility within the ASA about the importance of this work.  Believe it or not, is not universally understood with U.S. anesthesiologists that there is need or value for working with others around the world.  There are definitely people who want to make some humanitarian contributions but don’t really know how to go about it.  I have a couple of other things I’m working on.  There is an organization called the World Federation of Societies of Anaesthesiologists.  Basically, a society of societies.  Any country that has a society of anesthesiology can be a member of this.  They have separate committees.  Some provide educational opportunities.  There is one in Nairobi, in pediatric anesthesiology, those travel and spend time at Kijabe.  There are other programs around the world in pain medicine, and other stuff.   WFSA does a lot of advocacy work.  They do work preparing statements in line with WHO guidelines, helping member societies advocate for and navigate local politics.  I just became part of the larger board of directors.  David: That’s lovely.  I have met several of the visiting pediatric anesthesiologists.  That work is what makes a program like this PAACS thing possible.  It’s not only a matter of education; it’s creating an environment where people can succeed after they have that education.  Good on you, thank you!Elizabeth: It’s true in our US hospitals and training programs, so why would we not think it’s important in the rest of the world?  It’s one thing to train people, it’s another to sustain them, maintain them, help support them in their career growth.  In many parts of the world, anesthesiologists might be the only one in a community or in a large geographic area.  We need to find ways to support them – simple things like continuing education, how to learn new techniques, how to have collaboration/cooperation when you have a difficult case, how to work together to improve not only educational systems, but care systems, how to lobby ministers of health and education.  These are difficult things, even for those with a lot of resources.   David:  I don’t know how big you want to go, but you are definitely familiar with Africa. . .what is the picture of the need for anesthesia in Africa?  Elizabeth:  I think it’s safe to say, the need is probably overwhelming and staggering.  If you could actually think what the need is, you could get depressed, thinking how would we ever meet the need?  The standards that organizations like the WFSA advocate for are in terms of how many providers you need per population.  In terms of a place like the US, we’re way above recommended minimum which might be 10-20 surgeons, anesthesiologists, obstetricians per 100,000 population.  In many countries in Africa, those are in single digits.  For example, Ethiopia, which has more than 100 million population has a couple dozen anesthesiologists.  On any given day, there are more than that at my one hospital in the United States.  Kenyan and Uganda are a little better, but not a lot.  Most of Sub-Saharan Africa, which is what I’m most familiar with, has such a lack of anesthesiologists.  Even if you look at other anesthesia providers, whether they are nurse anesthetists or KRNAs or different names that are given to non-physician anesthesia providers. . .even when you count those, they are not enough to care of the population. First and foremost, we have got to find ways to increase the numbers of providers.  But that in itself is not sufficient.  You need numbers, but you need quality care.  In addition to that, you need the support systems.  You need a hospital that has water and electricity and understands the basic concepts of sterile technique and infection prevention and control, and quality & safety systems that support surgical care.  Then you have to have pre-op and post-op care.  You need nurses and you need ways for patients to get to a hospital.  You need to figure out which hospitals should be doing which types of surgical procedures.  Each country has its own political and governmental ways that’s organized.  There are certainly limitations in what is available.  There is a never-ending need.  You can easily get overwhelmed with thinking about the need.  When that gets too overwhelming to me, I like to back off and think, what can we do and how can we make an impact? Taking care of one patient is one thing.  Teaching someone else to take care of that patient is a secondary thing.  Then teaching people how to teach other people to take care of that patient has a magnifying effect.  And then helping anesthesiologists, among others, understand what it takes to make that whole system is important.  A surgeon can’t do it alone.  Anesthesiologists are an important part of the whole team that needs to provide excellent peri-operative care.  In too many situations, anesthesiologists and others are an afterthought.  David:  This is something I was ignorant about.  What is the role of an anesthesiologist in a developing country?  It’s a lot broader sometimes than what it is in America, right? Elizabeth: The American medical education system is a little different from many other countries in the world, even Western countries.  The length of education, the responsibilities, how it’s organized and paid for.  It’s a different system of how care is delivered.  In the United States, in academic medical centers with trainees, there is always an anesthesiologist available, so a resident who is a trainee is never caring for a patient without supervision of a fully trained anesthesiologist.  Our medical education hierarchies are pretty well described.  And the delivery of care is pretty well structured and organized.  That is not necessarily true in most LMICs.  There are different levels of anesthesia providers who are doing the best they can with the education they have and the tools, equipment, medications that are available to them.  But in a place like rural Ethiopia, for a population of 1 million in one area, there might be one physician, and that’s not an anesthesiologist, that’s a general practitioner.  In the way that a physician cannot be responsible for all the medical care, there is certainly no way an anesthesiologist cannot be responsible for all anesthesia care.  The same is true for surgeons.  So, you have rural hospitals, whether they’re called district hospitals, or whatever, you can get basic medical care.  If you show up with a broken leg or an infection, you may get some level of care.  You might get some antibiotics, or your infection cleared out, or a cast for your broken leg.  If you need something more sophisticated, you have to go somewhere else.  Anesthesia care is the same way, the most highly trained anesthesia professionals are usually in the big cities and in big hospitals, which means the rural areas are less well-served, not only by anesthesia providers, but by surgeons and nurses and equipment.  One of the challenges is One of the challenges is finding a way to provide the needed care in the rural areas and matching all the needs together.  It doesn’t do you any good to have a surgeon but no anesthesia provider, or the other way around, an anesthesia provider with nothing to do because there is no surgeon. One of the things that has become evident over the last decade or so is - what is the bare essential minimum?  The Lancet commission describes Bellwether procedures.  They have a list of procedures that are the minimal procedures you want to be able to do in a district hospital, not a tertiary care hospital.  Things like treatment of abscess, putting a tube in if someone has a collapsed lung.  If your hospital can do these three things, you can probably meet the basic needs of your community.  These are emergency c-section, fixing a leg fracture that requires operative intervention, and doing emergency surgery for an abdominal issue.  If you can do those three things, and have the anesthesia team, you can meet the surgical needs of the community at a basic level.  None of that is necessary glamorous.  It’s not plastic surgery.  It’s not elective.  It’s basic surgical needs, and if you can meet those, you can meet the needs of the community.  Those are the goals that governments and institutions are working towards – how can we provide those basic needs?  David: In Kijabe, for the developing world, we are a pretty advanced setting.  What does somewhere like Kijabe make it worth investing in for these training programs?  We are in the in-between space.  We are rural, but not super-rural, you can get to Kijabe in an hour-and-a-half from Nairobi.  Is Kijabe an ideal set-up, in some ways, as you look at the training sites you have been involved with.  What makes you happy about what we are starting out with?  Elizabeth: A couple of things.  Clearly, the basic infrastructure exists at Kijabe to provide comprehensive care to a whole population.  That’s from birth to adulthood.  That’s from basic outpatient needs to complex surgical intervention that requires intensive care afterwards to survive and get back to health.  In that sense, it’s not a rural, remote place that does a few things, but it has comprehensive care.  It doesn’t offer everything to everybody that a bigger city might, but you don’t need everything, everywhere.  From that sense, it’s really a good way to look at what does a population need in order to not only meet the basic minimum, but to try to use the advances in medical and surgical care to improve someone’s health, not just react to when you fall and break your leg or infection, but how can we try to promote health among a population.  Kijabe allows people who are learning and training, and people who are more advanced in their career, to see the value of working together in teams and partnerships.  For too much of medical history and training in America and many Western countries, there are hierarchies and traditions of who is in charge, and who has the power, and who gets to make the decisions which may or may not be in the patient’s best interest – a culture of education and training which is not necessarily supportive and positive.  Those things are slowly coming to light and being addressed in American medical education, although we have a long way to go, IMO.  I think, in a place like Kijabe, the camaraderie people develop by living and working together in a small community and over a long period of time shows the value and benefit of partnerships and collaborations and working together to try to improve the health of your community. . . In a place like Kijabe, having anesthesiologist training will help show that physician anesthesiologists and non-physician anesthesia providers can work together collaboratively.  There are too many examples around the world where relationships of different providers are antagonistic.  It happens among anesthesiologists. It happens among another health care professionals.  In a place like America, where there are other factors at play, politics and finances, it detracts from the care that patients need.  There is value in people seeing the benefit of collaborative relationships.  For much of medical history, surgeons and anesthesiologist haven’t always been collaborative and working together.  Some hospitals have better cultures than others, and it’s clearly beneficial for patients if they work together, but that’s not always the case, so that has to be modeled.  Same between specialists.  If an EM physician asks for help from a urologist or general surgeon and the attitude is “why are you bothering me?” nobody benefits from that.  In a place where everyone is in it together, people learn this attitude.  Another thing that Kijabe is working towards is finding ways to train people to go into communities where there is not the level of care that Kijabe offers.  That’s a tricky thing to teach someone to do.  You want them to have every benefit, but you want to train them, “what happens when you to go into an area where you don’t have all this stuff?”  That’s true in America, that’s true in Africa.  It’s difficult, it’s not a simple formula.  It does help remind you to learn the basics, and how to do no harm, how to prepare and advocate for what you need.  If we train these people and they all end up in Nairobi, it doesn’t do any good for the rest of the country necessarily.  Finding that balance is difficult, and it’s going to take thoughtful dialogue among leaders about how to meet those needs.  One of the things that some of the training programs have in Kijabe have worked on is to train people to go to other places in Kenya and other places in Africa where there are not so many.  If you can provide a team, a surgeon and anesthesiologist and other support staff, for an operating room at a hospital, that’s what you need.  David:  Your answers made me really happy.  It’s easy for someone like me to overlook the culture of collaboration.  When I had surgery a few years ago, Mark [Newton] did the anesthesia.  Mark called Mike [Mara], the orthopaedic surgeon, and Mike called Rich [Davis], and they’re all together working with me, and they’re all friends, together working on me.  I haven’t thought, until you said this, what it means to be living together in this community as neighbors.  It’s fun.  It will be interesting to see who are the first residents in the class.  We go to their kid’s birthday parties.  It’s a special place to get to know each other on many and deep levels. Anything we should talk about to wrap up? Elizabeth: We just had a series of interviews for applications in the first class of trainees.  Hopefully in the next weeks and months, we’ll be able to move ahead with selecting our first two trainees.  Our initial goal was to start this month, but because of COVID, government regulations, we’re not there, but hopefully this year we’ll be able to start with the first two.  We have to balance the needs, to train those two well, and make sure we support them.  It’s a beginning of the journey, not the end, many more trainees who can train other people, who can go out and provide care that needs to happen around the world.  David:  I speak on behalf of Kijabe when I say this, we are grateful to you for your support and advocacy in getting this program to where it can take off.  Thank you. 

Elizabeth Drum

Olakunle Idowu – Anesthesiologist, MD Anderson David: I know you said it’s a long story, but I’d love to hear the short version of the long story.  I’m Nigerian, I was actually born in Nigeria.  I’m the last of four children.  My siblings were born in Boston, but my father, who is a math professor took a position at the university of Dos.  We were living there when I was born.  I came to the United States when I was 3 years old.   I grew up in Maryland, went to University of Maryland, I’m a Terrapin.  I went to the Virginia Commonwealth University for medical school, SUNY Downstate in Brooklyn, NY for Anesthesia Residency, and Critical Care here in Houston, which is what brought me to Houston.   Since then I’ve spent time in private practice and in academics.   Initially I left private practice and came MD Anderson for 3 years, then my wife was recruited to Yale in New Haven CT, we went there for a year, decided to come back, and here I am!  (Laughter) There’s been some moving and shifting, but I think along the way that God has revealed things to us.  We feel Houston is home even though our families are in the northeast.   My wife is a pediatric anesthesiologist, she works at MD Anderson as well.   David: When you say critical care, is that anesthesia or normal medicine.   Kunle: The track is critical care through anesthesia, it’s a one-year internship after training, I spent a year at UT Houston, and during part of that time I was at MD Anderson, which is how I connected to the institution.   David: What do you love about your work?  Why anesthesia?  Aside from talking to me, what gets you out of bed in the morning? Kunle: (audio drops briefly) Learning includes lessons about life, about vulnerability, about faith, about spirituality, about strength, perseverance, about conflict.  I think working both in the operating room and also having experiences in critical care. . .they’re very different environments.   In the operating room, most people walk into the hospital, most procedures tend to be elective, the intent is that things end well.  That is always the expected outcome, or what people perceive as a good outcome – to get through surgery or whatever procedure they are having.   In the ICU the dynamic is very different.  Expectations and goals change daily, hourly, by the minute depending on the patient situation.  Sometimes you find yourself healing not through intervention but through support and prayer and walking side-by-side with patients.  That is where my energy comes from, that’s what wakes me up.   You know, I drink coffee like most people, to get me going.  But somehow when I get in front of a patient I’m up, I’m there, I’m present.  David: Have you done any overseas work lately?  What you describe sounds like the role of somewhere like Kijabe.  When an anesthesiologist comes, they are everywhere, they’re in the operating room, they’re in the ICU, they’re in the emergency department if something goes strange. . .they’re everywhere.   Kunle: Compared to some of the other people involved in this project, I’m fairly new.  I’ll tell you that story.   In coming back to MD Anderson, I pivoted in terms of focus.  There’s something in me, and there’s something that’s always been in me.  I have relatives or people who are Nigerian, who came here as immigrants who for training with the intent of going back.  My father came to the States for post-graduate training, but never returned to Nigeria permanently.  So, I’ve understood that there has always been this void, not only in Nigeria, but across the continent, in terms of people who receive opportunities who receive opportunities overseas whether in the States or across the world, and never return.  It’s almost like there’s a resource that’s been taken away. . .people don’t go back to even plant seeds to grow.  I think people are realizing this, and that itch. . .I’ve always had that itch to be involved in this work.   I was initially looking to do things in Nigeria and I was looking to start projects I was looking to start a symposium and looking for schools/teaching hospitals in Nigeria to connect with.  I connected with HBO.  They have a site at Kat Karmasi, Ghana.  My wife and I were set up to go this April for a two-week trip.  She was going to help with Pediatric Anesthesia education and I was going to teach a fundamentals critical-care support course, because critical care mortality is extremely high across the continent.  That is one thing that is very clear.  The contact I have there is very concerned about obstetric mortality, the availability of resources and ventilators is limited.  I work with Louis Pisters, a urologist at MD Anderson, and he’s connected with PAACS.  He said, “you know, I work with a great organization.”  He’s a person of strong faith and conviction.  I attended a meeting with PAACS and learned that there was an Anesthesia task force.  Everything about the project aligns with my personal goals and how I see myself.  It brings my faith, it aligns my faith, my practice, and this internal feeling – this urge – to start doing more global outreach.  The timing couldn’t be better, and I have support from my institution to do this.   That’s how I got involved.  Long story, but I’m extremely excited because at the center of it is God, and my love for Christ.   Through medicine, I’ve affirmed the idea that only God can perform miracles.  We are tools that he has put here to carry out his will and to be blessings upon others.  You know, blessed to be a blessing in a sense.  That’s how I practice and that’s how I see this project.  Everything that I’ve come to understand about Kijabe, that’s my understanding of the center, of the people there, of you and your work.  I’m just excited and so very thankful and grateful.   David: That’s awesome Have you ever heard of Howard Thurman?  He was an African American pastor.  He was Martin Luther King’s spiritual mentor.  I went down the rabbit trail this weekend and I ended up with a book of his sermons that I got on Amazon for a dollar – that’s the best dollar I’ll ever spend – he’s got this amazing passage about medicine as ministry.  It’s so, so good and reminds me of what you just said. He goes through the entire passage and ends up with the statement that “every hospital, every clinic, every consultation room should be an altar for the burning heart of God.”   Kunle: Absolutely.  You can almost draw a parallel to the pandemic.  You see how limited our understanding of the human body and where is this virus coming from?  All these resources focused on one thing. Right? Its human will that we are going to control this, yet every day we are reminded that we are not in control. There is only one person in control of all of this.    These are the same interactions that happen on a daily basis in the hospital.  When it comes to cancer care you realize it.  People often want to treat the numbers, or they see a CT scan. “I have to fix this.”  That’s the human instinct.   You learn how limited you are, in the sense that you could do everything and not change the outcome.  You could do nothing, and the outcome can be favorable for the patient.  It’s because God is in the center of it.  He has a masterplan.  You have to step back, realize your place, that you are just a tool.  You cannot fix the situation. You just have to trust God.   That’s why I bring spirituality and I bring faith.  MD Anderson is obviously not known per se as a Christian institution.  I always ask people, are you a person of faith?  Regardless of their background, most other religions or people who consider themselves as being spiritual, they are open to prayer.  Prayer is universal, for everyone.  I pray for them.  I know my father, but I pray for them.  I love that aspect of medicine.   David: If we get you over here, you’ll meet Jack Barasa, our head of surgery.  Whenever you talk to him, he says a similar thing about Kijabe “this is God’s hospital.”  He says, “We do these things, and somehow a patient gets better.  We do the exact right thing and they don’t get better.  Or we make a mistake and somehow, they walk out the door three days later.  It’s very clear that we are not the ones in control of the situation.”  My wife had this awesome mentor in Alabama.  When she was in residency, she had a really low moment.  Her program director called her into her office, and she said, “Arianna, you need to trust God. You do not hold the keys to life and death.  A patient could walk in the door, and they could walk out even if you do everything wrong.  This is ultimately not about you.” That’s the big challenge of what you do in medicine, how to work with all your skill and all your power yet know your limitations and to be at peace with that at the end of the day.  Kunle: I think about these things every day.  I reflect on the day and the lessons learned.   Even for me, as I’m caring for patients in stressful situations, that He is my quiet in the middle of the storm.  I can only trust Him to give me the thoughts, wisdom, understanding, compassion.  It has made me a better person, ultimately.  David: What do you say to a family member, say you’re in ICU and you have a patient who is not doing well. How does it go?  What is running through your head and what are you trying to convey to them?  Kunle: It’s tricky, a lot of it depends on their background.  It depends on their knowledge of medicine.  It depends on the conversations they have had prior to the moment.  In critical care, you tend to have limited access to the patient’s perspective.  Either because people are too ill to communicate, or because they are on mechanical ventilation and have a breathing tube and they just can’t talk.  So, you have to rely on surrogates.   I take a few days, when a patient isn’t doing how I would expect.  I take a few days and really try to understand the situation, before I jump in and try to give a perspective.  I want the family or the caregivers to know I am taking my time to reflect, to comb through things, and make sure we have explored all options.  I ensure through communication and bedside manner that I am there to support them in any way that I can, whether that is moving around hospital resources and so forth.  I remain objective about the data points.   “This is what this shows, this is where we are, this is where we were yesterday.  Your loved one (the patient) doesn’t have control of the situation, I don’t have control of that situation, and you don’t have control of the situation.  So, we must take it one day at a time, using God-given tools every single day to apply.  He will show and reveal to us how your loved-one responds.  In the meantime, the tool that we have, the most powerful one, is prayer.”   I remind them, I pray with them, and I offer the hospital chaplains for support.  Sometimes in situations when there is no family around, we still bring chaplains in to pray, or I will pray.  That’s typically how it goes.   I’ve seen a difference from when I first started practicing, because people trust you more, they understand you can’t fix the situation, and they know that you’re on their side.  It also reminds them that in the middle of all storms, you must stand firm and rest in your faith. . .in God, in Christ, and he will see you through.   I don’t have to go too far to know how blessed I am in a cancer hospital. I’m reminded every day.  It’s a topic that really hits home, and I spend a lot of time in this area because of how important it is to me.   David: That was an amazing answer actually.  Always when I’m doing these things, I’m thinking what is a universal concept?  Beyond we are trying to put this (anesthesiology) program together.  When someone is going to connect with on a personal level, whether they do medical work, but I think it applies to any area of our lives.   Anything you would like to add in closing?   Kunle:  I would like to say I think it’s exciting to be involved in something like this.  My hope for this project is that it expands – on God’s time – to different parts of Africa, because the need is there.  Not just in anesthesia, but in emergency medicine, in surgery.  There are so many specialties and there is so much expertise needed.  You have people there who want the knowledge, who want the help, who need the resources.  And you also have people who are unfortunately dying from very preventable illnesses, diseases.  We want to use God’s given tools to help.  Those tools are knowledge.  Those tools are prayer, that’s the best one in the box.  Community support.  The resources that we can pull together from our institutions in the United States.  The great resource in having the Christian community at the soul of all this, that unites us, and I’m very excited about the future.   David: Kunle, this is fantastic.  I would talk to you all day if you were not going to work.   Kunle:  Thank you so much.  

Kunle Idowu

Greg Sund

Pastor Benjamin

David - What is your name and what do you do at KijabeLilian - I’m Lilian and I’m an Ob-Gyn in Kijabe, for the last four years, but been here a lot longer.David - When did you start?Lilian - 2007, internship for two months, elective term, 2009 internship for one year. I left for 8 months and came back in October 2010. Then residency, and I came back fully in 2015.David - Who is your husband and when did you meet?Lilian - He’s George (Otieno) – we met in undergraduate in our third year of medicine and surgery. When we came to Kijabe from the first time we were already dating.David - Lilian is head of Ob-Gyn at Kijabe, here you say obs/gyn, is that right? George was head of internal medicine, but now he’s promoted right? He’s inpatient subdivision head. Both do so much for the hospital, they’re amazing.What we’ve been talking about lately, and working on, are some of your needs for the OB department. Some we’ve gotten sorted and some are in process. Two years ago, we were having a big problem with the delivery room. And now that’s done.Lilian – Thank God. Now we can walk in and smile and not be embarrassed. That used to be my nightmare. For example, patients come, they don’t know where the delivery room is, and they walk into this ugly room. That used to be a very big problem for me, it was nothing for a woman delivering her first child. I’m happy.David – And now it’s really nice.Lilian – Thank you for spearheading that process for renovation.David – It’s night and day different. I think there is a process we are going through, not just in Kijabe, but in Kenya, where the bare minimum is not acceptable anymore.Lilian – No it’s not. We have to give the best to our women. . .and to any patient who walks into any hospital. I think we have gotten used to the poverty mentality to the point that we are not willing to go the extra mile to make things better, as opposed to just living today.David – We were just talking with a doctor who wanted to come visit a clinic doing more open surgeries than laparoscopy. Which is reality for a lot of places. But here in Kijabe, I feel like we have the option to do things with excellence. That’s why you’re here!Lilian – That’s why we are here. To make a difference, and to live our purpose too, which is to do everything with excellence.David – What we’ve been talking about is how as Friends of Kijabe, we can help with the Obs/gyn department – what is feasible to do, and in some ways, what is the Christian thing to do.Why don’t you tell me about the patients or populations/demographics that have been the most stressful, and that we agree these might be able to most easily address their needs?Lilian – Among the patient populations we’ve been concerned or have special interest about have been cancer patients who come and need urgent care, yet they’re not able to pay for the services offered. These are patients who are coming and don’t have National Insurance Cover. National cover requires three months to mature, even if someone was to apply as soon as the diagnosis is made, but that is too long to wait.David – Because with cancer, usually they’ve waited too long anyway right?Lilian – Yeah, so by the time they are coming, we need to make radical decisions at that point. As much as it may be a small population, we feel like the care they deserve should be accorded to them, regardless of their financial status. That’s why we feel they need support.David – So for gynecology-oncology patients, do they require surgery and chemotherapy or sometimes just surgery?Lilian – It depends on the type of cancer and the stage or the spread. Early cervical cancer patients might require only surgery and that is it, unless they have evidence of spread, like in the lymph nodes in which case they need chemo-radiation. In case of radiation-therapy they have to be referred out of Kijabe.David – Chemo, you can usually do here now?Lilian – Ovarian cancer, most of those cases will go through surgery, then eventually will require chemotherapy after, which can be given to them in Kijabe.Some cases are strict referrals, for example, advanced cases, which are not operable. We will refer for the combined chemotherapy/radiation therapy. The few we are able to handle here require chemotherapy and surgery.David – This is becoming a big issue in Kenya, it’s all over the news.Lilian – It’s all over the news. I think, partly because of improved diagnostics. There is more advocacy for screening and early detection. There are over 3,000 deaths from cervical cancer every year.Our joy has been able to sort patients at an affordable cost compared to what they would have to pay in Nairobi.In 2016, we had 11 cancer surgeries for gyne. In 2017, we rose to 31, in 2018, we had 41. We hope this year we can have an even higher number that are detected early to get surgical management. There is more awareness and people are coming through referrals and we are doing aggressive screening for cervical cancer.David – I don’t know if it would directly relate to your patient population in Kijabe, but life expectancy in Kenya has grown 1 year every year for the last 15 years. Fifteen years ago, life expectancy was 48 and now its 63.Lilian – Yes, it’s 63 now.  It’s an improvement. As much as we know many are still dying, I really think there is something positive happening as far as improving primary health care and advocacy for many things, with health being a big agenda for the president. We are seeing a lot happening even in the country places. We appreciate that they are doing something.David – That’s gynecology/oncology, what’s your other patient demographic that you personally stress over? This isn’t something out there, it’s something very close to your heart.Lilian – For gyne-onc, I’ve also lost family through cancer and I think there is so much we can do in terms of primary prevention and early detection, which is not really emphasized so much. I think for Kijabe that’s one area we could do well in.A second type of population we see are young pregnant women who need emergency care and they can’t access to the point of saying “don’t admit me.” We know that whatever happens on the other side, the care they will get is substandard.For example, a patient who comes with preeclampsia in the 7th month of pregnancy, the baby requires newborn ICU admission and the mom require HDU or ICU care, clearly you can’t refer those patients because of finances.There are teenage girls with unplanned pregnancies coming with no insurance cover, who require emergency, comprehensive obstetric care. That population is at very high risk for mortality and morbidity for both mothers and babies. They may be few, but those few deserve to live.David – you’re concerned specifically about abortion or if the baby does come, what happens to the baby afterwards.Lilian – We’ve had different encounters with primary school, high school girls coming and wanting a termination, and we’ve said no. But even if we say no, we are supposed to be giving them solutions, alternatives. Who is going to help with the clinics? They are already high-risk by virtue of age, by virtue of them wanting to terminate. Who takes care of the clinic bills, who takes care of the delivery, who takes care of the child afterward in postpartum clinic reviews? If baby requires specialized care, what happens? These are young girls who are prone to depression, psychosis, suicide, and I feel like they deserve better because that’s a point of ministering to them. I think those few hours we spend with them are enough to actually change their lives, not just because of their condition, but even in terms of eternity.These high-risk patients that come to us and they don’t have better options, I think they deserve more. Especially those who come with unplanned or what you call crisis pregnancy.David – There is precious-few resources for things like that.Lilian – One, young people are condemned by society for making wrong choices. Two, there are no options given to them. If they are given, they are poor options, like terminations, which means going to the backstreets to terminate. It is cheaper of course and it won’t be known. That has resulted in high mortality for girls.Among the top 5 [maternal] killers in our country, we still have abortion. Beyond hemorrhage and hypertension, have abortion topping because of girls going to the back streets for termination of pregnancies.As we take care of them and do abstinence and user protection, when all those steps have been bypassed, we need solutions for these girls.David – I’ve seen Kijabe babies be placed in homes.Lilian – There are many options, it’s just I think we don’t take that time that has to be spent walking with such, there is the financial aspect that must be considered from way before, during pregnancy, delivery and thereafter. We have a few rescue homes that do a job for these girls, but not all go to the rescue homes. So, can we be a sort of rescue home in terms of the medical care that we’re giving.David – And we can make sure that they are not making bad decision for lack of finance. A delivery in Kijabe is $250 or $300.Lilian – That could be all it takes for them to actually see there is hope.David – Who is the one you were telling me about that came with the grandmother.Lilian – At least a happy one. This was a sixteen year-old, who got pregnant while in form 2.  For you guys, that would be 10th grade. Every time she would come for a clinic, she would be accompanied by the grandmom who would pay the bills for the clinic. And the grandmother would make sure she was okay.This was a grandmother who lost her daughter, and her daughter left her with a grandchild who became pregnant. She was taking care of the great grand-child after the delivery.I think what really made my heart feel warm was the love, and the fact that she was there to support her and tell her, I’m here, I will pay your bills, and I’ll take care of my great grandchild, and you’ll go back to school after the first few months.That love shown to this young girl who may have opted for termination if there was no other option.The grandmother was able to afford some coins to walk through the journey. No fancy clothes for the babies, but maybe, some coins to buy a packet of chips, to say, “I’m here for you.”David – One other one that was very special for several of us and for me personally, the first time I walked through this process, was a teenager who came in with a pregnancy, I think it was twins and they lost the first twin. I think it was 30 or 32 weeks. I heard about it from Dr. Mary Adam, “Hey, there’s this little baby and the mom has gone, she has abandoned.” All the nurses and the doctors at the hospital, said, “this is our baby.” That was the first person we ever crowdfunded for individually. The way it happened was amazing. I walked through the NICU one day with a camera. She raised her hands up to me. "You want this picture don’t you? You want people to take care of you!" In that picture she was wearing a diaper that came up to her neck, and now when you see her, she is two years old, she is round and chubby.For what it takes to do the right thing, in my mind, it’s such a tiny amount of money, to take care of the mother and the baby.We do have some general funding coming in toward this. We hope that can increase over time, as some of our obgyn’s become involved. Also, any of you guys who might be listening to this, anyone who gives to the Friends Fund, a portion of that goes to vulnerable patients. Basically we want to say yes when someone needs something. That’s the goal.Anything you would like to add?Lilian – Just requesting humbly for support wherever it comes from. Of course we are very grateful for those who have had Kijabe in their minds, and for whichever way they support, whether by been human resource, whether it’s financial, whether it’s prayers, whether it’s encouragement.David - AbsolutelyThe Estimated Incidence of Induced Abortion in Kenya: A cross-sectional study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546129/

Lilian Mameti

Mardi Steere

FoK - How long have you been in Kijabe? You delivered on what date? Dorine - I delivered on the 2nd of May 2019. I came in a week before, the 27th of April. FoK - And today is July 9th? Dorine - No, it’s the 8th, it’s our monthiversary, we got married on the 8th of February. Happy monthiversary! I think the baby’s charts say 65 days of life or something like that. 72 days, I’ve been here. FoK – So this is your home? (laughter) Dorine - But I look forward to going to my real home. FoK – Why did you come to Kijabe? Were you in labor, were you concerned? Dorine - I went into labor two days before the 27th when I was at home, it was a Friday evening. Prior to that I was on two months bedrest. I was already working from home, my office was kind enough to let me do that work from home. On that Friday evening I went into labor. I called my doctor, I was seeing a gyna. She gave me some prescriptions to take to stop the labor, but in about two hours if it didn’t stop I would meet her at the hospital. called her and she gave me some prescriptions to take to stop the labor to delay the labor, if it doesn’t ease off in two hours we could proceed to the hospital. In two hours, I would meet her at the hospital. We had planned to deliver at Coptic hospital, so that’s where we headed. We got there, but the labor kept progressing so we started off on steroids and all the other things. That was around midnight, along with the meds to stop contractions. By 3:30 am, we were sure we were going to deliver. The issue was at the hospital, there was no neonatal doctor or nurse. Advanced as we were in labor. The doctor told me, "here, we can see the head, do your thing." But as God would have it, she told me on the next contraction, "You push," but the next contraction never came, it just subsided. It subsided enough for me to get off the table and walk back to the waiting area. I proceeded with the meds, I even slept. By that time, we needed a transfer because the hospital didn’t have a neonatal ICU, which we really needed. We check the hospitals in Nairobi or it was crazy the amounts they wanted, 300,000 deposit. Kenyatta told us they had, but as soon we were discharged, they called back and said it’s gone. In the height of that pressure my husband remembers, "I don’t know why we didn’t think about Kijabe Hospital." We’ve interacted with Kijabe Hospital before, there as a time my mother needed a surgery. We called through some people we know, confirmed they did have a NICU bed available, and that’s how we made our trip here. FoK – That’s really important, even though they didn’t have the full resources, that they gave you steroids, they did the right things so that when Gabriel came, he was healthy. How big was he, how much did he weigh at that time? Dorine - Gabriel was born at 1040 grams, but he dropped weight to 840 in the following days. So we began our climb from 840. He was tiny then, I didn’t know where to touch or hold. His current weight is 2350 grams as of this morning. FoK - When he was like that, when he was little and you were scared to touch and scared to hold, what did the doctors and nurses advise you at that time? Did they coach you on how to interact with him? Dorine - Okay, my husband saw him first, then I saw him shortly after. He was delivered about 2 pm. I saw him about 7 pm, I think they were working on him somehow on the resuscitation table. I stretched out my hand and thought, where? Where would that be. But they were encouraging, encouraging you to come to terms, this is your baby, he is absolutely tiny, but he’s in the best of hands. Actually that reassurance came before I got to Kijabe. They said, we have an ICU bed for you, and once we know you are coming, we will keep it for you. Because when I was coming it wasn’t obvious that I was going to deliver on the same day. But they were very reassuring all along. In terms of the many questions I had, statistics for what’s the survival rate and all those things. The stats were really good. As much as they were careful to alert me to risks the baby will face, we also have a lot of success. Compared to Mr. Google which told me a lot of scary information. They answered many of my questions. It has been a reassuring journey that the doctors are available to walk with you. FoK - What would you say to a mom who is in the situation you were in several months ago, what would you say to her as far as encouragement or hope, how to face what’s ahead. Doreen - The journey is very scary, it is tough. There is a room where we go to express milk for the baby. That’s where you meet everyone who is going to pursue the nursery. The first few days they walk in, and I think I was the same, they are very scared. I remember a woman, who walked in, not even a 26 weeker, maybe a 30 weeker, but still tiny. One of the things I told her, is you need to change your mindset, your expectation. You will not be here for two days, you will be here for a longer time, much longer but it will be doable. Every day will be better than yesterday. It’s been an interesting position. I didn’t know that’s what I was coming to do here. In fact, they call me the welcome-er. Everyone who comes new, they come to fetch me. D, come, there’s someone new, she has a tiny baby, come talk to her. FoK – That’s amazing, though. We see that so often around here. You’re here having care for your baby, but it’s a ministry you’re engaged in. Dorine - It absolutely is. FoK - It’s not just the Kijabe staff doing ministry, it’s also you guys as moms caring for each other. Dorine – It’s one of those things I didn’t think was going to be part of my ministry. I’m a singer, worship ministry I’m familiar with. This one is a new ministry. But God has been gracious. And it’s been tough, some days it’s tough, when the baby is not doing well, the first couple of weeks, those are really low. Those were very tough. The baby had all sorts of things, one after the other. If it’s not respiratory, an infection. It was tough. In that toughness, God somehow managed to make me tougher, in the toughest way possible. Lack of sleep, every two hours, it’s not even two hours, it’s more like 30 minutes the most sleep I ever got was 30 minutes. But the next week there is someone in your shoes, they need you to say that one thing that will encourage them to come back the next day, to toughen up beyond what you yourself can do. It’s been a serious growth opportunity. FoK - Are there any bible verses or quotes or sayings, or songs even that come to mind as you are trying to toughen or persevere? Dorine - I will not remember where it come from, but there is a verse it says, “the Lord will perfect everything that concerns me.” (Psalm 138:8) That’s what I keep repeating to Gabriel, I will stand by his incubator and pray over him and remind him that, “Dude, the Lord is perfecting everything that concerns you.” So, if it’s respiratory issues that week, The Lord is sorting this respiratory issue, not just sorting, perfecting. That’s what I’ve been believing, even now as I wait for him to get off of oxygen. He is going to perfect that. We’ve come a long way I’ve seen perfection in all those ways. Then the wall of the nursery, has that beautiful verse, “I knew you were formed in your mother’s womb.” Me, I was surprised by Gabriel’s arrival at 26 weeks, but God wasn’t. One of us needed not to be surprised. What you cannot control. What I, as D. cannot control, God can control. I sort what I can. I can express milk for the baby, fine. I can stand by his incubator and pray for him, I will do that. I will stand with a fellow mum, or just sit there and let them cry, if that’s what they need. But what I cannot control, just let it be. The doctors are sorting it. God has put them there, he’s using them to sort out whatever it is. It will be fine. It’s easier said now that I have walked the path. (laughter) FoK – It’s not so easy in the moment. Dorine - In the moment, you will yourself to remember those things. I’m glad I have been spending time in the bible before now, cause you need to remind yourself those things. Ultimately, God is the one who knows how this is going to play out, and it’s played out well. FoK – How has this been for you and your husband to do together? I still want to meet him, I haven’t met him yet, but I’ve heard stories that he’s really tall. Dorine - He’s 6’3, not only tall, really huge, big boned. I think Gabriel is following suit. He’s been absolutely supportive, absolutely awesome. We don’t live near Kijabe, maybe an hour or so from Nairobi, but he’s made every effort to come by. In the beginning he would come, maybe 3 or 4 times a week. On the weekends he’ll always be here. Even with the traffic, he would come after 7 and leave again to get home by after 9. Every weekend when he comes by, he will bring a cooked meal, a hot one. He will take his time and cook. He’ll ask what do will you want to eat this weekend. He’s been awesome, but it’s been a strain for him as well. The commute. The uncertainty. You know I’m here, when I’m called to nursery I’m there to see. He has to wait for relayed information, especially in the beginning, he’d worry. I never took my phone to the nursery, and already we knew there had been a slight issue. I was waiting for the doctors to do their rounds, and it was a couple hours before I came back. He had looked for me frantically, he had called everyone, he even called Kijabe Hospital. It's been strenuous on him, but he’s also really prayerful. I thank God it’s him I’m doing this with. He’s more patient. He tends to take his time in a situation. He won’t react spontaneously as much as I would. This has taught me a lot of patience as well. We talk often, we spend the little time we have well. It’s been tough, but good. FoK – Anything else I should ask or you would like to say? Dorine - This experience for me has been multifacted. In the beginning there was lots of uncertainty, lots of worry, anxiety. All those things you are told, “don’t be anxious.’ We were anxious. We prayed yes, with thanksgiving, but in the moment, it’s absolutely all these emotions. You are worried. I didn’t get any sleep after he was born. I couldn’t sleep, and even when I slept I feared to wake up. “Dorine, you’re being called for the nursery.” That was the worst, you know. Maybe, it was not even for the baby, maybe it was just to go and express milk. But that in itself was enough to send panic. Initially it was a lot of high-stress condition. I think God that He gave me the strength to still hold on. As much as we want to know is everything okay, the strength (is) to be optimistic, I’m going to walk in there and the baby is going to be fine. And even if he’s not right now, he will be shortly. And it always came to pass. It’s made me more prayerful as well. Pray at all times, more prayerful. This idea of “have faith”. . .I think sometimes when you say it, when you’re not in the situation, it’s more of “I have faith,” and you know full well there’s food somewhere to eat. No, no, no, this brings the meaning of faith. You have no idea how it’s going to play out, but you have faith. It’s also been tough. Kijabe Hospital is really great in terms of the facilities, the doctors, the nursing staff. But on the other hand, things like the food. (laughter) FoK – I’m sure, for three months. Dorine - There are many other things that you cannot compare with home or that could really be improved upon. But for us the facilities were the main thing that we needed. I absolutely miss home every day. . .you know these small things. But the main reason we were here, I’m glad were here. Especially in light of the debate that has been going on in Kenya about abortion rights. . .you know we want to legalize it in Kenya. I wish some of those people could be here to see life does not begin at birth when the baby is born at full term. They should see life at 26 weeks. Life begun when these two human beings mate, that’s when we should start protecting a life. I felt strongly about it now, I don’t know what word is stronger than strongly. Dorine - Yes, Kijabe has been home. I’ve made friends, lots of friends. Patients. . .they come and go, you say goodbye, escort them to the gate. I’ve escorted so many, carrying their luggage, say goodbye. Goodbye, see you. You welcome many others. The staff here become familiar, most on name basis. The doctors, the nurses, the support staff, the canteen, the askaris, pretty much everyone. I think I’m really an outgoing person, so I like to know people. FoK – Last fall we had a celebration and invited back some of our NICU moms. The oldest baby who came is 19 years old, she’s tall! It’s amazing to watch what happens afterwards, how these children are growing and doing. I’ll say to you, you’ve been wonderful to my wife and to Dr. Ima. I don’t know the nurses as well, but I know you’ve been wonderful to them. That’s a really big deal because it is stressful and it is hard, but you have handled it gracefully. We appreciate you for that.

Doreen, Mama Gabriel

Pastor Helmers: Grace be to you from God our Father and our Lord Jesus Christ. Acts 10:34 34 Then Peter began to speak: “I now realize how true it is that God does not show favoritism 35 but accepts from every nation the one who fears him and does what is right. 36 You know the message God sent to the people of Israel, announcing the good news of peace through Jesus Christ, who is Lord of all. 37 You know what has happened throughout the province of Judea, beginning in Galilee after the baptism that John preached— 38 how God anointed Jesus of Nazareth with the Holy Spirit and power, and how he went around doing good and healing all who were under the power of the devil, because God was with him. 39 “We are witnesses of everything he did in the country of the Jews and in Jerusalem. They killed him by hanging him on a cross, 40 but God raised him from the dead on the third day In the name of Jesus, my dear friends, it is truly an honor to be here with you this morning. This is my second visit to Kijabe Hospital. I was here in 2017, and was honored to witness the ministry of Kijabe hospital. I was able to walk to you and see what you do for Jesus and his people in Kenya. When I left Kenya and went back to the United States, and I can honestly tell you. I couldn’t stop talking about this place. I was impressed with your motto, everywhere I turned staring at me, healthcare to God’s glory. I was impressed with the commitment of all of you, the commitment providing quality healthcare for the people of Kenya. The commitment to providing training for future healthcare workers in Kenya. The commitment to minister to the spiritual needs of patients in this hospital. I’ve never witnessed a hospital in the US that had healthcare to God’s glory. I see it everywhere here, and it struck me so deeply. And your commitment to the three pillars of your ministry. I was also deeply impressed by your commitment to Jesus. He’s our savior isn’t he? But he’s also our Lord. Lord of the church and Lord of our lives. See what you are doing here in Kijabe Hospital, I would say in simple, plain English is a downright good thing. That’s what Peter is trying to say as he describes Jesus’ ministry in his sermon. Peter talks about Jesus’ death – a death on on the cross that atoned for the sins of the world, so that everyone regardless of their race, their nationality, their language – all might live with God forever. He talks about Jesus’ resurrection, a sign that the power of sin and death over us has been destroyed by Jesus of Nazareth, the son of God. And that because he lives, we too shall live and join that great throng mentioned in the book of revelation, that throng from every tribe and nation and language offering praise to God forever. I made special emphasis in reading of one line, that always grabs my attention, “he went about doing good, and healing all who were oppressed by the devil.” One simple line, isn’t it, “he went about doing good.” What better thing could be said about a person at the end of their earthly journey, “he went about doing good.” What better thing to be engraved on a headstone in a cemetery, “this person went about doing good?” You’re doing good at Kijabe Hospital, you are doing what Jesus did – going about doing good. Why did Jesus do this? Go about doing good even to the extent of dying on the cross. Very simply put, Jesus was filled with compassion. Several times in the gospel it says Jesus met this person, Jesus met that person, and he is filled with compassion. In the Greek language it says, his gut was moved by what he saw. Compassion is a Jesus word, isn’t it? It’s what Jesus is all about. Compassion is his nature. It’s his words and his works as he shows his love for people. I think there are three things that encompass compassion. (every good sermon has to have three parts!) Compassion means having eyes that see It’s easy to look away sometimes. Some situation are so tragic that it’s downright hard to look at them. I’ve been going to Uganda once or twice a year since 2005. the first time that I went I saw thousands of children, protruding stomachs, children who were hungry, who were sick, who were dying. I remember being overwhelmed by it. I had seen it on television in the united states, but to see it up close with my own eyes, that was something else. Jesus had two good eyes. He saw people who were hungry, lame, deaf, blind. He saw people who were grieving over the loss of loved ones. Jesus was not afraid to see hurting people with his two good eyes, and that’s where compassion begins. Compassion means having hearts that can be moved. Sometimes we get hardhearted don’t we? We may see a tragic situation and say, well, that’s not my problem. Or we may see someone in need and say, well, they brought it upon themselves. But Jesus, this son of God, son of Mary, he’s an emotional guy. He has a heart that can be moved. We are told in the gospels that Jesus looked out over the city of Jerusalem and he cried, because they rejected them as messiah. When his friend Lazarus died, Jesus wasn’t afraid to show his emotions. He wept. Jesus is not afraid to let his feelings be known. He’s not afraid to be vulnerable. He sees and hears and his heart is moved. Compassion is having eyes that see, hearts that can be moved, and willingness to do something about it. We see and feel sorry for someone, sometimes it’s difficult to take the next step. Maybe it’s too costly, maybe it’s too dangerous. We’re not willing to give God what God has first given to us. But Jesus, he’s not only able, Jesus is willing. A man with leprosy came up to Jesus one day and said, “Lord, if you want to, you can make me clean.” Jesus says, well, I want to! And he touched him. Jesus is able and willing. Jesus fulfills those words in Isaiah that talk about the messiah coming and about restoring creation and restoring human beings. Jesus speaks these words of Isaiah about himself. The spirit of the Lord is upon me because he has anointed me to preach the good news to the poor. He has sent me to proclaim release to the captives and recovery of sight to the blind, to let the oppressed go free, to proclaim the year of the Lord’s favor. That’s Jesus, with eyes that see, a heart that is overflowing love, deeply moved as Jesus willing to do something about it. Jesus willing to give what he has a son of God – to give his power, to give his grace, to make people whole again. To go about ministry to the whole person, soul and body. Because he has eyes that see, a heart can be moved, and he wants to do something about it. Jesus gives and he gives and he gives, almost until he has nothing left to give, when he dies on the cross to pay the price of our sinfulness, hat we might be set free from a guilty conscience, that we might be set free from the power of the devil, that we might be set free to go into the world and be Jesus to others, to be his hearts and to be his hands. In the US we have an expression, he’s preaching to the choir. What that means is that the preacher is talking to people who already know what he is talking about, and that they are doing what he says they ought to do. I feel this morning like I am preaching to the choir: People who are already the heart and hands of Jesus. People who have eyes to see, hearts that can be moved, overflowing with love. People who are willing to give what they have first been given – knowledge, wisdom, skill to make bodies whole, to uplift souls and spirits. To give people the peace of Jesus, peace the world cannot give. I feel like I’m preaching at the choir, but I’m going to pray for you, but I’m going to go a little bit farther. I’m going to pray that you may continue to do this good work. I’m going to pray that God will pour out an extra measure of his holy spirit so that you may increase in what you are already doing, the existing hospital, future operating theatres, whatever happens in this place, that you may do it all for Jesus for the glory of all. Prayer: I thank you that you have given me the opportunity twice now to see a spectacular place, to see a downright good thing that is happening at this hospital. I pray for each one gathered here today, I thank you for the faith you have planted in their hearts. I thank you for the commitment you have given them. I thank you for their willingness to use their gifts for the welfare of your people, for your glory alone. Be with everyone here, deliver them from evil, be with them from the hour of temptation to be less than what God has created them to be. Pour our your spirit on them so that they may have courage, faith, and can continue your good work in this place. In the name of Jesus, amen.” Ken Muma I would like to thank Friends of Kijabe Two years ago we had a retreat to brainstorm about how efficiently and how best to partner together. We came up with a raft of things that looked so impossible them, but they are coming to fruition. I’d like to thank David Shirk, we’ve been walking this journey together. I’d like to thank your church members from Lutheran, we are forever grateful. I’d like to thank this boy, Joe Lehman, who started a crowdfunding campaign and the person who raised the most money would have a mention of their university and their university football team for who they love the most. That is why today I am wearing an Ohio State Jersey, because the ones who gave the most amount is from Ohio State. I want to thank this boy very much, and the family and the parents. Asante sana, wherever he may be, I hope this message reaches him. I was just comparing him to my boy – while he is doing crowd funding, my boy is chasing after baboons. (laughter) Africans, where did we go wrong? Thank you to all. And thank you to a core team that has been instrumental in delivering this project. I saw Dr. Bird somewhere. He has been instrumental in providing the wisdom and experience of how the project was done in the past and bringing that experience to this final concept. I’d like to thank Dr. Barasa who has been the lead of the project as the head of surgery. I’d like to thank and acknowledge Dr. Hansen in abstentia. He has been instrumental, he did the original mathematics about the needs and future needs based on the number of surgeons and the trajectory of the growth of training. I’d like to thank Grace Kamau and the infection control team and the peri-operative nurses and everyone who participated in giving information for the Archeterion team. . .and the people who developed (the design). Thank you very much, even the education team with Dr. Evelyn Mbugua. This is an example of when everything comes together in perfect harmony. But above all, I’d like to thank God for making this a possibility. Asenteni sana.

Pastor Hellmers

PAACS Part 1 Good morning and welcome to the first PAACS episode. PAACS stands for the Pan-African Academy of Christian Surgeons and on the next two episodes I’ll be sharing conversations with graduates and faculty in the PAACS training programs at mission hospitals in Kijabe and around Africa. Nothing done at Kijabe Hospital is in isolation. Surgeons have been training under the PAACS program at Kijabe for more than a decade, and I think the PAACS program develops some of the best Christian leaders on the planet – not just surgeons, but Christian leaders. Friends of Kijabe is a support organization – we support the work of Kijabe Hospital in general and we support the work of PAACS at Kijabe through infrastructure projects like the Operating Theatre Expansion or through needy patient funding. I’m excited to share these conversations because they paint a vision of what is possible. Dr. Jacques in Malawi describes the blessing PAACS is in African Healthcare The second interviewee is anonymous because of a sensitive location, but he articulates the intersection of mission, medicine and the gospel perhaps better than anyone I’ve ever interviewed. Dr. Beryl Akinyi, associate director of PAACS at Kijabe, talks about paying it forward – giving young surgeons the time and effort that was given her, to help them succeed. Please enjoy! David – You’ve been these multiple different places, you’ve seen PAACS working all over the continent, what is your impression on the work? Jacques – The work of PAACS? This is incredible, incredible work. As an African I can say clearly, without doubt, PAACS has been, and it is, and it will be a blessing for Africa. A real blessing for Africa. My real joy is, I come from nowhere, God allowed me to be a general surgeon, then on top of that, God allowed to become an educator with PAACS. I’m so happy to train others, just as Paul trained Timothy. This is my real joy, to train others. PAACS is a real blessing for us. David – Where is nowhere? Jacques – DRC is a huge country, blessed by several resources. But when you go to DRC, you will say what I am saying. People live in poverty, people die of simple health issues, people are not really educated. With all the conflicts that are happening in DRC, I really pray for my country. David – Where do you see yourself 5 or 10 years from now? The ways of God are sometimes difficult to understand. I don’t know why God didn’t allow me to find a suitable hospital in DRC to work and serve my people. He sent me instead to Cameroon to Mbingo hospital. I don’t know know why God has allowed the instability in Cameroon and sent me way down to Malawi. I don’t really understand, but I know as long as I’m on the path of our Lord Jesus Christ, I’m content with His plan for my life. But one day, if He allowed me to return to DRC, I would only say, “Thank You!” Y Interview David: One of the unique benefits of PAACS, you’re training not only surgeons, you are training Christian leaders. When you look at these wide-ranging systemic problems, that’s what you are teaching them to address. What does that look like in how you work with your students and how you are teaching them? Y: It’s really interesting to see how our residents are growing academically, but also spiritually. We recruit residents that are believers, they love the Lord, they want to share what the Lord has given to them. Some of them, they want to be missionaries, to go to remote places to help the needy people. But when they come to the training environment, they get more. We are trying to fit into the curriculum Bible studies, discussions that are related to what they are doing. How can you show the love of Christ to a sick patient? You might heal somebody with medication, but the way you touch the patient, the way you speak to the patient, the way you care for his well-being and the well-being of his family. This in our context, is very important. These are some of the things we try to emphasize, not just to look at the patient as a sick person, but as a person who has spiritual needs. Those spiritual needs need to come up so you will have the opportunity to talk to them. There are various ways we help our residents by demonstrating. As a teacher, I do all I can to help my resident understand why I am so compassionate to my patients. Why should I come and greet my patient? Why should I come and sit at his side and talk to him in a gentle way? Most of our patients are Muslims. It’s so amazing that when you offer prayers to them, they will always say “Yes, pray for me, pray for me so that I will get well.” And if we pray, we pray in the name of Jesus. We will tell them we are praying in the name of Jesus. And if they are healed, Jesus healed, not us. So, we integrate that into the system. We also help our residents to be residents that are telling the truth. That sheds light not only on the patients but on other workers. Did this thing happen? Did you do this test? No teacher, I did not. It helps to know we are not there only for the surgery, for the pathology, but we are saying to our resident, “Be honest in your deeds.” “Did you examine this patient?” No teacher, I did not. When we grow and understand honesty is part of the thing that reflects Christ’s life, it changes things. David: What’s interesting about that, is it shows the trust they have in you as a teacher. Y: One of the things I see in residents or workers, if they see the teacher saying, “I’m sorry, I think I should have done this thing differently.” That changes a lot in the life of the resident, the nurses, the team. For the teacher to say, “I think I made the wrong choice here. It was my fault.” It makes a lot of difference. This type of training I like so much because it carries me, because of who I am, and I should show respect and be honest to myself. If I am wrong, and I know that I am wrong, and I refuse to confess that, my resident will not do that. We know as a teacher, we do things, not intentionally, but if we make mistakes we must come back and confess them. And if we do that, the resident will train in the perspective that, if you are wrong, you have to say that you are wrong. It doesn’t have to be a hidden thing. It is a be a normal thing to say that you are wrong. “I’m sorry for doing that. I will not do this next time.” David: That’s so profound. Sometimes the hardest things to do are the ones that even a little child should know. This is an issue for every medical provider everywhere in the world. Am I willing to own the truth and speak the truth? Y: Really, we have a lot of opportunities. (Our country) is 99% Muslim. Most people who come to our hospital come for their health problems and this gives us opportunities to share Christ with them. It’s sometimes very easy to engage into a discussion with somebody. A few weeks ago, we got a gunshot injury. Somebody went to another country, bought a car, thieves pursued him to his house, and in his sleep, they shot him. The bullet went through the left side of his abdomen toward the right side. It passed in between two vertebrae, did not go into the spinal cord, just passing near. We took him into surgery, repaired about 4 bowel perforations, his ureter was cut, some of the vertebral vessels were so destroyed. But his function was not affected. Looking at the x-ray, “Is he really moving his legs, this man?” Looking at the entry, he narrowly escaped being paralyzed for his life, but it didn’t happen. That really gave us the opportunity to open the discussion, how God was merciful on him. We took the x-ray, showed him what could have happened to him. We opened that discussion, shared the love of Christ with. We are engaging in communication to lead him to Christ. So, trauma, getting into training, if I didn’t know how to repair these things, I wouldn’t have the opportunity to do that, to share Christ with someone. We see such scenarios in our hospitals most of the time. I’m really happy with the vision that PAACS has. We are going to change the way we do medical mission, because the Lord is in the process of changing the way we do medical mission. Why am I saying this? I used to be the only doctor in my hospital. When I came back I spent about 9 months being the only surgeon. I would be on call almost every night. That was the situation of each mission hospital about 20 years ago. Missionaries would come from overseas, they would go to the place where the need is overwhelming, and they would be the only doctor or surgeon in that place until they burned out. Do they have time with the patients, to share? If you look at the workload, you say “No, they probably do not have.” I’m proud to say, today we have 8 residents and we are planning to go up to 10. So, we will train and we will send. We are multiplying ourselves, instead of the past idea of just doing it. And we are multiplying with the local people, who understand the language, the politics, the places they need to go to. Medical mission is changing, it’s spreading, and I think now we are getting it right. Jesus started with 12 disciples, he concentrated on those 12, and taught them, and after that, they went all over. That’s how Christianity came to us, Christianity came to Africa. If they did not teach and also send, it would never happen. I think that PAACS is taking that hope. We are teaching, we are training, we are making disciples, and we are sending them to go spread the word. That is the positive thing to me in this situation. David – What motivates you as a surgeon, what gets you out of bed at three in the morning? Beryl – I’d say in Kenya there is a big surgical need, the fact that I can meet that and later they come back and they’re smiling, that motivates me. The other thing that gets me out of bed, is I’m heavily involved in training of residents. When I see someone comes in so green, and they graduate as a surgeon, to me that’s a very big motivation - we’ve added someone to the workforce, meeting the need within the country and Africa in general. How do you think about, and how do you talk about the surgical need in Kenya? Is there an easy way to describe it? Beryl – That’s one burden of having poor patients coming in late. The other problem comes in terms of workforce, when people are not properly trained to offer the service that is needed. Those who are trained or skilled, especially in subspecialties are very, very few. That means we have increased waiting time for anyone to get their treatment, and that just makes the burden heavier and heavier. That’s what I’d say currently. David – You were talking about how there is very limited sub-specialization, but a lot of you as general surgeons choose an area of expertise a little bit, even if it’s not on a diploma. What is that for you, what do you love doing? Beryl – Two things, I like doing breast surgery and surgical education. Breast surgery is a little bit individualized, direct to one patient. Surgical education, you are multiplying yourself, I’m not just one person doing this, I’m teaching many people at different levels. David – I have watched you in theatre, and you are a very good surgical teacher. You are very patient, very gentle, you are willing to take longer on a procedure so the person you are working with can learn to do it right. How, practically, do you think about surgical education? What are the things you do on a daily basis in your teaching role? Beryl – Currently, because Kijabe is a training site, we have general surgery, orthopaedic surgery, and pediatric surgery fellowship. I am the assistant program director for the general surgery program, but I coordinate the learning for all basic sciences for all these specialties. That has made me read more, but has also made me focus more on the bigger picture, what’s the need for all these individual students? I’m trying to organize, so that in the five-year-time that all these trainees are here, they get what they need to get to make them a better surgeon. As an individual, I’ve had people who invested time in me, so I could be a better surgeon. That drives me, because if they didn’t invest this time and energy in me, I don’t think I’d be what I am today. So, as an individual, I try to use those good qualities, to make me a better teacher for my residents. David – How does faith play into what you do with your teaching and even with patients? Beryl – God has called us to be good stewards with whatever talent he has given us. To me, being a surgeon is what God has given me, and that is what drives me. God has called me to be a good steward with this talent or this gift. Each time I go to the hospital to work, to teach, I do it for God, not necessarily for the patient or for somebody else to see me. If I do it for my own glory, or for the patients or everyone else to see me, at some point in time I will be tired if I don’t get any good feedback. Knowing I’m doing this for God, drives me to be better and better each day, because that’s what He requires of me. I’d say I’m very grateful to Kijabe and over all to the PAACS program for offering an opportunity for me to learn as a surgeon, to do what I love most, and for all the people who invested their time and energy to help me grow. I’m grateful to Kijabe as a hospital and to PAACS as an organization.

PAACS Part 1

Read the full transcript with graphics at: https://friendsofkijabe.org/blog/a-response-to-cured-into-destitution/

Cured Into Destitution

Watson: For you specifically, I want to get a sense of how that transition was. You said you were very successful as a wedding photographer. I know for me, I only do photography as a hobby, but I get that feeling of joy when I get the perfect picture, and edit it, and I’ve given a few people some of my productions, and I’m so happy. And to go from that, where that doesn’t directly translate. For Arianna, her medicine translates directly. But you, there was a time of trying to fit into this huge jigsaw puzzle that is Kijabe, there was a lot of faith and trusting in God, how was that like? How did you end up where you are and in what you are doing. David: Wow, you are so good at this, that is a great question. For me, photography was not an end, it was a means to an end. I love creating things, I love exploring, and doing things that I’ve never done before. That’s the part of photography I loved, creating something out of nothing. This was not here before, and now it is, you’re bringing something new into the world. That was the part I enjoyed most about photography. That definitely translates into the work I do with Friends of Kijabe now. There is not a definite map, a definite script. There are concepts. Watson: Like a framework. David: There is a framework, that’s a good way to phrase it. There is a framework for my job, it’s very people-focused, it’s relationship-focused, a big part that I enjoy is it is creativity-focused. How do I call people into the work that is happening here, how to I let them feel engaged with that, how do I give them something that resonates with their hearts? It’s really interesting and challenging. Most days, I wake up and what I do during the day, I did not know existed when I woke up. An email comes through and there is a new challenge or problem to solve, that aspect is really fun. But finding that place was a challenge. What realistically happened is, I never found it on my own. When Ann Mara - she had been working to start Friends of Kijabe for several years - when she and Mike were transitioning to Ireland, she said “Hey, here’s this thing, can you make something of it?” And my answer was, “I have no idea.” (Laughter) But I called Arianna’s uncle, John Richter, and he was the exact right person. He said, “Let me go down the hall and talk to my friend.” And six weeks later Friends of Kijabe existed, and the next question became, now what do we do with it? Watson: Now we have a non-profit. David: A little bit like photography, it is a season, in the back of my mind, I’m always aware of that. How do I build something where I’m both completely in the center of it, outside of me. Watson: Self sustaining. David: It (Friends of Kijabe) won’t ever be self-sustaining in the sense where it can run on its own, but how do I give other people the tools where they can carry it. It’s a really fun, interesting challenge. Watson: I see. I like how you started by saying you were somehow able to boil down to the core reason of why you like photography so much. Once you said that statement, it clicked in my head that as a creator, a content creator or as a creative, you definitely had a place to plug in. Even if it didn’t exist before, or it wasn’t clear in the beginning. It’s something that God worked behind the scenes, to get Ann Mara to approach you, and then you had the exact right person to call, and the exact right processes that went through, and Friends of Kijabe is now existing and is functioning in such a way. Sometimes I look at the beginnings of something like this, and then I imagine ten years down the line how those people will be looking back and wondering, “How did this begin. How did they go through the initial teething problems? And how did they get the first tens and hundreds, and millions?” because I believe it will be millions. David: It really is interesting and that journey. . . I feel like, at least in our family, there are two kinds of people, the Arianna’s and the David’s And Arianna is the one who knew, from the time she was 5 years old that she wanted to be a doctor in Africa. Intellectually she had no idea what that meant, but she literally wrote down on paper, “I’m going to Africa.” For me it was the total opposite, where I’ll wake up and not know exactly where I want to go during a day. So, we balance each other out very well in that sense. That leading, and continual doors opening, and the orchestration. . . You hear people sometimes talk about God’s tapestry, like weaving of a tapestry. That is so unbelievably evident in my life. I can look back and say, Wow! This led to that, this led to that, this led to that. It’s nothing I would have imagined 15, 20 years ago, that I would be in these places. But it’s amazing, it’s really good. Watson: For a creative like you, whose 9-5 is creating content, and you find out in the morning what you need to do that day, how do you keep on top of your to-do list? How do you stay productive? David: The biggest challenge is being productive in the right direction. And even with work there are lot of things like that, there are things that take a lot of time that don’t yield results and there are some that are simple that are the most important. Trying to remember to make the most important thing the most important, that’s the biggest deal. Watson: Prioritizing your tasks, and like you said, it’s an 80-20 principle. 20% of your work is what ends up achieving 80% of your outcomes. Now, at the beginning of your week, Monday through Friday or for you, Monday through Monday. How does your day look like, how does your week look like? How do you project and know I’ll spend these days doing this project and these days doing another project? David: I do like the way you phrased that, because that’s the way I view my work, project by project. Even making a podcast or doing my emails, I still see those as an individual thing. Sometimes I can spend 8, 10, 12 hours on one email, putting it together. That’s not phrased exactly right, that’s not phrased right. I need better picture, I need another story. It can take significant time to put those together. The best weeks for me are the weeks where I start out and I have nothing planed. Or maybe only one or two things, so when interesting things come up I can pursue them. I’m not a naturally organized person. I don’t know if you’ve met Ree’L, but she and her husband Jason moved to Kijabe a few months ago. She’s super-super organized, loves spreadsheets, and she’s been helping me with the hardest part of my work, which is accounting. I can do it, but it’s just not my skill set. I’m glad I worked on it for the last year-and-a-half because I understand what’s happening. But to have somebody else who loves that to say hey, “here’s my numbers, let’s look at and discuss it.” Being able to hand off things that are life-draining, offloading some of those things, that’s been really helpful. I’ve done that to Salome also. One of the temptations for me is to be in the hospital, doing things that don’t move Friends of Kijabe forward. Not that they’re not important, but do they have strategic purpose. Are they moving us toward big goals? Watson: Are they high-yield? David: Exactly. One of the things that has changed for me is because of John Richter, our board chair, our board guys and Ken Muma – sitting together and saying, “What is the purpose of Friends of Kijabe?” And we decided I should be doing the one biggest thing that there is. This year we decided that is fundraising for operating theatres. So instead of me having 27 jobs and trying to juggle all of them, I have one job and then multiple ways to accomplish that. That has been unbelievably freeing, because when someone comes up to me in the hallway and says, “Can you come up with money for this little thing,” I can say, “no that’s not my job this year.” Not that it’s not important, if I can, I’ll try to help them think about how to succeed. But I’ll try not to take it on to myself as my responsibility. My responsibility is, “What does the Director General say, what does my Board Chair say?” Watson: I think it’s really important for creatives to have clarity about the big picture and the big goal so that you don’t end up getting lost in your own mind. You can have so many ideas and so many projects that you begin and reach half-way and another great idea comes in and you want to start. But the really big goal reigns you in, but gives you more freedom do really dive deep, to your heart’s content. David: That is a fantastic way to phrase it. It’s been really fun, and a big mental shift for me. Arianna’s family - I keep mentioning them, but they are all amazing - I was talking to her aunt a little while ago, and she said, “When you’re really going to see success is when you get crystal-clear about your message and the change you are making.” I feel like I’m on the verge of that, it’s in my head but I don’t fully know how to articulate it. But keeping the main thing the main thing is a part of that. We’re 103 years into Kijabe, and what does it take to make another hundred years possible? What steps do we have to do today to get to forever? Kijabe Forever, how do we get there? The answer to that a lot of times is not another blood pressure cuff. Really, it’s getting people to work as a team on the most important things, then moving to the next most important thing. Ken Muma said, “David, why are you fundraising for that over there?” “Well, because it’s a need.” “Yeah, of course it’s a need, there are so many needs. But if you do this one big thing, it can do many. It can fund, maybe not all the things, but thirty of them instead of one need.” That’s the difference between meeting needs and actually being strategic. Watson: I see, it’s like synergism. When you pool all your energies together, they multiply, don’t just add up, they multiply on top of each other, and you have a bigger impact together than alone. Wow, that must have been a really interesting meeting. David: That’s the big change that I hope will continue in the coming years. That’s why we’re doing work as a hospital on culture change. To get people to view each other as part of a team, working together, for the good of everybody. It takes a lot of time and a lot of repetition, a lot of meetings, but it’s really, really valuable. It’s fun to watch happen, and fun in my little way, to be a part of it. Watson: You mentioned doing stories, and the accounting part of your job. As far as what you were given from the DG, are there several ways of meeting that goal as a department or Friends of Kijabe, under which you can have little projects? Like stories, part of that is podcasts, photos, and something else. Do they all fall under something big, like a main three or four? David: The core of it is how to build a team, a wide, diverse team who is very engaged. I’ve thought a lot about different stakeholders this year, there’s expat missionary doctors, Kenyan missionary doctors, partner organizations like Samaritan’s Purse and Bethany Kids, our Friends of Kijabe board, and donors who have either served as doctors here or are connected to doctors here. That’s more how I think of it. How do I serve them, how do I give them what they need? The way I think of it, this is God’s ministry, this is God’s mission in Kijabe. We get to partake in that, we are stewards of it in some sense. How do I enable people to participate in what God is doing here? That is the core of my job. What do I need to give them to be involved, to come along on that journey? This was a big turning point last year, I read some book, it was terrible, but the title was amazing: Who Do You Want Your Customers to Become? Instantly, I thought, “Who do I want the people around me to become?” There are donors, my kids – who do I want my kids to grow up to be? Who do I want my wife to be, how do I want her to succeed? Thinking of people not as static, but as we’re all on this journey, and how do we build the journey together, how do we go together? That was a really powerful image to me. It’s different for the different groups, but there are a lot of overlaps, but at the core of that is what you said, it’s stories. The reason we do what we do is because of stories, right? It’s our motivation. What story do we tell ourselves about the world we live in and our place in it? From you talking, a big part of your story is the opportunity to help people, to make communities better, to give people wholeness and life. That’s a really big value to you. It’s way more valuable to you than money or having a really nice car. Reinforcing that for people, giving them vocabulary, ways to think about that, ways to speak about that is a gift, it’s a really big gift. Here’s the most important thing that’s happening in the world, this is a significant part of God’s work. Both, “here’s how you can be a part of it,” and “wow, you are a part of it, look at what that means, look at the significance of it.” For another doctor listening to you talk, they realize, “oh, this is why I went into medicine.” It’s a reminder that this is what the essence of following Jesus is all about. And we have to constantly be reminded of those things. Watson: That’s true, that’s true. I like that approach. Stories. The stories we tell ourselves affirm and confirm our reasons for doing the things we do. And hearing it come from someone else reminds you of why you started and why you are going on. I do envy you, it’s an amazing job you do. David: But you’re a part of it, that’s the big thing. It’s not me alone. That’s the fun part of it now, being able to connect people like you to some who you will meet and others you may never meet this side of heaven. But that you can still somehow have an impact on their lives, I think that’s phenomenal. Watson: Have you talked to the neurosurgeon, Dr. Kim? I got to hear behind the scenes how Kijabe hospital is able to over a 1.2 million shilling surgery at 100,000, surgeries in Nairobi that cost ten times what they do in Kijabe. How much he has given of his time, resources, mobilizing friends and mission agencies. Those stories remind me of why I fell in love with Kijabe, and why I want to stay. They give me drive to do more, achieve more and be more. People are doing it and it’s possible. You know every one person who is helped, that’s a family who is represented, that’s a community, a village, an estate. It spreads out. All the negativity in the world, in the country. I like to think of myself as a focal point of good. Like in the perspective of God knows if Watson is there, something good is going to happen there. I don’t need to send legions of angels, I just put that guy there, and I know he’s going to change the area. And I put this other person there and this other person there. And the country will change because it’s beginning in those points. David: One of the next people I want to talk with is Ima Barasa. She said when she talks to Interns, it is in terms of light and dark. We did this today, this is light. We beat the darkness with this specific action, it was a victory for the light. Watson: I was listening to an audiobook recently called Atomic Habits. He says every action we do is like we are casting a vote. You want to have as many votes as possible for your good habits and few as possible for your bad habits. Imagine every time you do something you are in a polling booth casting a vote. If every time I’m doing something for a patient, I do my best. If I’m called at three in the morning, I wake up, I take the call, I give my advice, I do what I am supposed to. I am casting a vote to the good. Eventually we’ll have enough votes to turn the tide. If we lose, we lose by the one vote I didn’t cast. If we win, we win by the vote I did cast. David: I like that, turning the tide. It’s an interesting aspect of being in Kijabe and Kenya right now. In your lifetime, it’s gone from a mostly impoverished nation to now a developing nation and it’s on this upward trajectory. These decisions you’re making and these things that you’re doing have not necessarily been done here before. There is a template and a road map for them, they have been done in other hospitals in other countries. But it’s the first time it’s been done in Kijabe. These little steps you take will influence far, far downstream. When you talk about, “how do we set up the 24-hour trauma service?” It’s never been done here before. You know it can be done, but you get to be the first to do it. Watson: I don’t want to hold out, to be negative for the many months It has not yet happen. But instead I want to contribute to the push to make it happen. Another example he gives, if there is a block of ice on the table and it’s 15 degrees, then the temperature starts to rise, but the moment it goes from 28-29 and you begin to see it melt, it’s not the one degree change that melted the ice, but the increment of all the small changes. Every day I go to work, we talk about it, we engage people about an improvement in theatre, the time when it happens the atmosphere will be right, everyone will be ripened. And it will be all the more successful because of the small gains we’ve that been getting all this time. Improving efficiency, training the scrub techs so that the ones at night are just as good as during the day, the equipment at night is just as good as during the day. David: I like that. I had this moment over the summer, we were in the woods camping by the river. There had been a rainstorm, and there was this one drop on at tree. And I’m picturing that falling to the ground and then making its way to the river and where it joins all these other drops. It’s this huge river, but it’s really one drop plus one drop plus one drop, and all moving in this direction together. Watson: And all together they are so powerful David: That’s the beautiful thing about Kijabe, there are so many people actively doing that. We do fight, there are differences, usually not of whether something is good or not good, but differences of priority. Watson: It’s more trying to, as you said, but it’s never “you shouldn’t even be doing that.” It is different angles heading forward. David: Thank you Watson!

Watson & David

During internship I came to Kijabe, I scrubbed in theatre, I had excellent teachers, and I fell in love with surgery. I totally fell in love with surgery. The ability to take someone who is broken, and someone who has been taken out of society because of one issue or another, and then you go into theatre and fix the problem, and they can plug back in. Especially in orthopaedics, they’re not walking, you fix the fracture, and the next day they’re walking and able to go back to work. I fell in love with that, I fell in love with the impact on every patient that comes our way. You see, I believe it’s the bad outcomes and the negative things in your workplace that really flesh out your character. You don’t escape complications, you don’t hide it from the family members, you don’t cover up anything. But you do your best, and you make sure the patient is getting the best possible care, and that’s what I saw from him. It shook me because, wow, these patient’s lives are in our hands, but sometimes they come very sick. I also saw that it’s possible for you do the best you can, and trust God for the outcome. Families will appreciate the human element of a doctor. You are scientist, but they need a human being to explain to them what is going on, to make them feel comfortable and confident in what you have done, that there is nothing that you’ve done wrong and what is going on is even something you are burdened by, you don’t just brush it off and go on to the next patient. Friends of Kijabe – That’s a good answer. Are there certain surgeries that are your favorite? Watson – I like to do trauma. Trauma has the highest (patient) satisfaction rating, and also the highest need. It is quickly becoming one of the top-five causes of mortality and morbidity in Sub-Saharan Africa. Surgical disease is overtaking Malaria, HIV, all these communicable diseases combined. And there are so few trauma surgeons. Of course, I love doing arthroplasty, it is the second most satisfactory surgery in the whole world after cataract surgery. Friends of Kijabe – You mean satisfactory in the way it changes a patient’s life. Watson – The kind of impact it has on people’s life is significant. It changes life on the patient side. Cataract surgery is number one, you can blind and now you can see. Hip surgery is number two, you could not walk and now you can walk. Friends of Kijabe: What do you feel like are your biggest motivations as a physician? Watson: What I feel really drives me is that I believe I was put in Kijabe for a reason. I believe very heavily in God’s direction and in God’s calling. I believe I’m called to be a doctor, and not just that, I believe I’m called to be a doctor specifically in Kijabe. Every time I interact with a patient, and every time I discharge somewhere home, in my mind and in my heart, I get the confirmation that this is where I’m supposed to be, this is what I’m supposed to be doing. Second after that is the satisfaction of helping people, I love helping people in an area that I’m skilled and knowledgeable in. That gets me out of bed in the morning; I know there is someone in need and I know how I can help, so I go and do it. Having an impact in the community and in the nation is also part of my motivation.

Watson Maina

Nolen - It’s a lot of fun trying to learn new things and culture. One of the things I love is how (Kenyan) families take care of each other. That’s something I think the U.S. system should adopt. It’s so endearing to see how much patient families show up and are just there, take care of things, rally around each other. It’s something I love to see. There’s times when I see a patient in clinic and I’ll tell them you have a very complex problem. I can always fall back on, “Hey, why don’t come next time with your family?” And we’ll have a group discussion. Shirk - One of your big challenges is how to take care of Needy Patients, it sounds like many of your patients do have good family and support networks. But some don’t, and that can be hard, how to get them the care they need. Nolen - That touches on issues within this sphere of global health. We are on the fringe of healthcare with ENT otolaryngology. When people think of healthcare, most people think about maternal health, communicable diseases, cardiovascular disease. Here in east Africa, there are big minds thinking about how to take care of populations. And ENT isn’t a central focus of that nor should it be the central focus. But if you are dying of head and neck cancer, it’s important to you. If you are child with right-heart from adenotonsil hypertrophy, it’s important to you. And that’s true in any field of medicine. It a bit challenging because ministries of health, the surgeon general back home isn’t thinking “how can we alleviate nasal obstructions around the world?” But for patients having problems in our area, we want to help and treat them. I tell everyone back home when they ask what it’s like over there (In Kenya), it’s great, it’s really wonderful. The challenges are missing friends, family and Mexican food. . .and maybe college football. The not being close to family when kids are so little is the hardest part. The desire for them to know their grandparents, their aunts, uncles, cousins. When we are home they look at relatives like a stranger. We hope to help them know their roots, where they come from, and how loved they are. If God came down and said, " David, I’ll grant you one wish," knee jerk response is to be able to tele-transport. To teletransport friends and family here. On Sunday afternoons to have the kids be around their grandparents, their aunts and uncles. That would relieve 99% of the internal conflict in living away from the US. Shirk - Why is it worth the stress of being away from family, the financial sacrifice, to be here? Nolen - I think it’s seeing God. I see and experience God in real, tangible ways here. I don’t think I had to leave the US to experience that, but it is making an intentional choice to follow where you think God is leading. It’s hard sometimes and easy to think of physical and tangible things you "sacrificed." Seeing what He is doing in Kijabe. Hearing the stories of where this hospital started over a hundred years ago, the improbabilities of it being what it is today, seeing so many of my colleagues, what they are doing. . .witnessing these miraculous outcomes. Even yesterday I was giving exposure to an orthopaedic surgeon and neurosurgeon to the top of the spine through the mouth. The patient comes in barely able to move and he’s going to leave being able to walk. To me that’s just miraculous. Being part of that is really, really fun. It’s really compelling. It’s what draws me in and keeps me here. You see God move, you taste what God is about with his redemptive work.

David Nolen

Conversations about life, work, and faith with Kijabe Hospital heroes.

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Friends of Kijabe

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