WOODS IN THE WORLD

Hymns in the Hallway

2009-10-26T12:36:00.007-06:00

This morning, we woke up to a particularly strong, cold wind bending the trees, as though Kijabe was sending us off in style, with a fierce display of force and beauty. I wrapped myself in my white coat and shuffled down to the hospital through a near dust-storm for my last morning rounds.

Workng at Kijabe has helped to more solidly confirm my desire to do additional training in pediatric surgery after finishing surgery residency. I love taking care of these children, and during the past six weeks at Kijabe, there have been a few to whom I was particularly attached. One of those children is named Paul. Paul is a twelve year old who had spina bifida and scoliosis. He is paraplegic and has come to us because of pressure ulcers on his buttocks, thighs, and knees. When he arrived, he was anemic and malnourished, and his wounds were infected. With a lot of wound care and (more importantly) a cow-ful of milk, he has gained strength and his wounds are clean. He has been in the hospital almost the entire time I was in Kijabe, and on Friday we grafted his wounds. I am hopeful that they may heal.

This morning, I stopped by to see Paul on my way out of the hospital—to say goodbye. He and his brother, John, listened as I told them that I was leaving and that I wanted them to stay strong—Kaa ngumu!, I told them. Paul’s brother, John, is eighteen years old and has been at his brother’s bedside, caring for all of his needs, every day for the last month or more. He tends Paul’s wounds, plays games with him, carries him outside on a cart, and cleans him when he soils himself. I told John that he is a good brother—and a good man. I told them both to continue working at getting an education. I told them I was leaving today. John asked me when I would be back, and I told him that it would be a long time. ‘A long time?’ he asked. Like 5 years, I told him. 'Like 5 years' he said, somewhat bewildered and questioning. I explained to him that I was going home-- or back to the States rather-- and that I didn't know when I would be back in Kijabe. We talked for a little while longer; I prayed for them both and left.

In the Western world, we spend thousands of dollars on sound equipment for music in our churches, and we worry about whether the music is just right. But there is no sweeter sound than hymns filling the hallways of a hospital. Perhaps it is just the acoustics, but I think it’s the juxtaposition of faithful praises and deep suffering that is so profound. We sing, for the most part, when we are joyful and satisfied. Here, the songs of satisfaction come from the mouths of the suffering and oppressed and those who are caring for them. The hymns insist that their singers' satisfaction is elsewhere, that their thirst is slaked by a different spring of hope and rest.

Sunday morning, the hymns had a slightly different message for me: I was sitting at the nurses' station writing a frustrated note about an ultrasound that had not been done despite multiple calls, repeated orders, etc. The only reason for the omission was laziness, and I was angry about it. Unfortunately, some of my frustration was finding its way into the chart in a somewhat masked way-- inside I was fuming. Half-way through my scribblings, I heard angelic music coming from the doors. In burst Mercy and about 30 of her 'disciples', a group of women whose children have been treated at Bethany Kids Kijabe and now come back on occassion to minister to the parents of children in the hospital. They were happily singing "We are soldiers, we are soldiers. We are soldiers in the army of the Lord," as they marched right up to the nurses desk, where I sat in my frustrations, letting the vitriole spill on the page. They might as well have been singing "You're a sinner; You're a sinner. You're a sinner in the middle of the ward." I smiled and waited for them to leave, although I was a little less eager to let the radiographer know he was a lazy sluggard.

This morning, as I walked from Paul's bedside to the theatre to say goodbye to the OR staff, the voices of nurses at their morning devotions filled the resonant halls. What was conviction and accusation yesterday had become sweet again, and it added to the sense that this was a significant moment in my life.

In the OR, I told the staff and other residents goodbye, shaking hands around the room, then made my way back to the Sitaplex, where Amelia had finished packing our bags. We said a few more goodbyes, including to Helen, Josiah's nanny, whom we will deeply miss.

When our driver arrived, we loaded the van and began the long, dusty journey toward home.

"Henceforth, simply the nappy."

2009-10-25T02:47:00.000-06:00

One of the most delightful things about being in Kenya is participating in the odd mix of African bush culture and English propriety. It’s what remains of the colonization of this land by the British, I guess. And it is quite nice.

For example, we all have dusty feet peering out of rubbery ‘flip-flop’ like sandals in the operating area, yet we refer to the OR’s as ‘theatres’, and we adjourn to ‘take tea’ at the proper intervals throughout the day. The Kenyans put every coffee house in the developed world to shame with their ‘chai’: a creamy, sweet cup of goodness scooped from a boiling pot of tea leaves and milk, fresh from the cow, brought to the hospital that morning in a plastic bucket. It is just so very civilized and so very African. And it is mandatory, I am beginning to understand. In this picture, you can see me having tea with some of the nursery and maternity nurses. I had just given them a lecture about neonatal warning signs in the delivery room, and I was prepared to whisk away to the days doctoring tasks. They insisted that I sit and have tea. It’s the proper, Kenyan way.

The influences of the Queen’s English and Kiswahili also manage to trip me up on a daily basis. Example 1: intern says to Dr. Amy, “this preterm is receiving 8ml feeds, two hourly, and is retaining.” Dr. Amy blinks thinking, “retaining? Is retaining good or bad?” Example 2: same intern pouts over a squeaking, stridorous baby. “Oh, he is lamenting,” she says. And I think, “man, I wish I used the word lamenting.” Example 3: A few days ago I noticed that there was an odd pile of gauze taped around baby Hawa’s ostomy which was causing the liquid stool output to severely irritate his skin. So I asked one of the nurses, “could we stop using the dry gauze and only use a diaper from now on?” The nurse replied, “So, henceforth, simply the nappy?” “Uh, yeah, simply the nappy. Thanks.”

Perhaps my favorite experience yet should have a photo but I must try words instead. I was chatting with Dr. Gary in the hospital corrider, and as we were talking, a Masai grandmom walked past with her infant grandson in a sling on her back. The little guy was healing from a chemical burn of his head, and he had even lost most of his left ear. After multiple skin grafts he still had bright pink under-flesh covering most of his head. It was a patchwork that looked like freshly groomed farm land: little squares of different soils in pinks and browns. His grandmom was covered in beads, ear lobes hanging low from a piercing type process, dark black feet flat against the hospital floor and the little guy, peering up to catch our eyes… then he giggled and hid from us in the folds of his grandmother’s clothes. His happiness took over the air around us. I could not understand how such a little boy (two years old) could have so much pain-- so much to cry about -- and yet so much joy! Later I found out that this patient, Ralian, is Jim’s patient. Jim is his surgeon, and he is Jim’s favorite. Ralian’s grandmother has said that she wants to return to visit us before we leave so she can give Jim a reward for taking care of her grandson.

So far, I have been blessed to enjoy my time here in ways I could not have foreseen. It is simply “well with my soul,” as the old hymn says. And still, I am a creature of luxury, and I miss all the lavishness of my home in Colorado. Gary Finke, the pediatrician of the past 2 years, leaves roughly the same time we do. So as the days march forward and we get closer to hugging our families, our friend Stephany gets closer to being the sole pediatrician at this busy children’s hospital. Her fear of taking on this mighty task is always behind the scenes. She is weary, and it is hard to leave her behind. I am asking now, reader: please pray for reinforcements for Stephany. Pray for courage and joy and wisdom and sleep for her. If you are a pediatrician – consider coming to help her. Even just a few weeks would lessen the load and give little lily pads of rest during her 2 year commitment. You will be a blessing and you will be blessed!

I have a tendency to count down days until the end of different periods of life. A physician in Nashville once advised a group of us not to wish away our lives during residency, and I hate to admit that I sometimes have that tendency, although not just in residency. Recently I have been simultaneously struggling to not count down the days until I return to my own indulgences (warm bath, constant electricity, reliable phone line to call mom and dad) and dreaming of returning to live out my days here.

I said in a previous post—my first post from Kijabe in fact—that life here is simple, hard and lovely. It is simple, and it is hard in many ways. That is true. But in the end and above all, life here is lovely.

Mommas, Fleas, and Interns

2009-10-07T12:30:00.001-06:00

Pretty sure I have fleas. Jim found these two little guys buried deep in my hair and wriggling up itches everywhere. Now I learn that the previous neonatologist had also acquired some type of stow-away and so would not sit on the mom’s beds or wear his white coat through maternity. But what am I to do? The moms wait longingly as I speak to the woman in front of them. The want attention for their babies and for their concerns. They delight when the blond mazungu doctor hugs them and stops to visit. Maybe if I were here long term it would be different, but for just six weeks, though its not very lady like – I guess I’ll have fleas.

Don’t be mislead…I am not that cool about having fleas. The first night we discovered them I must have combed 1 pound of Ultrathon repellent through my hair. I then got three “999” pages to maternity for worrisome deliveries. Yup, there I was resuscitating babies with my DEET drenched head. I can’t wait to hear what the Samali women have named me, something like “sour smelling doctor.”

Most of the on call pediatric emergencies are in the delivery room which has verified my decision to specialize in neonatology. For the most part, a sick newborn in the delivery room does not stress me out in the same way that it bothers non-neonatal physicians. I am working hard to teach the general interns here how to be calm and act even when the babies are tiny or need to be intubated. My soap box has been intubating babies who need to have meconium (first baby stool) removed from their tracheas prior to resuscitation. The interns know tracheal suctioning needs to be done, but they are terrified. So if a baby is floppy, not breathing, and covered in meconium the interns have been STAT paging the pediatrician and then just waiting: intern shaking, child dying. Now we review the steps at every delivery that I go to with them, and we prepare. If the child needs suctioning it is up to the intern to be the baby’s doctor, and I am there for support. It is hard to stand by and watch; I am praying for the baby in front of us and hoping that the intern is learning skills that will help him care for babies in the future.

During the night of the three STAT delivery pages, I had my first death in the delivery room. The hospital is downhill from our apartment so I was pretty swift to respond to the call, but the baby was a stillbirth. The intern briefly tried to resuscitate him, but then made the decision that the child was truly gone. When I walked in there was a blue baby on the bed warmer with the leg of scrub bottoms covering his face. His mom was silent, stretched out toward him, blinking in disbelief. It was awful. I went to console her but quickly realized this was not the time for a rich white woman whose fat, healthy baby was asleep at home to become involved. I left quietly.

I remember passing the guard on the walk home. My mind was busy trying to figure out what I am doing here. I am suppose to be a teacher. I didn’t teach anything. Of course, that would have been inappropriate, but why was I supposed to be there at all?

At home where my family slept, I wondered and waited for the next page. I did finally realize my intern had made the decision to let the baby “go” on his own – How advanced? How intimidating? So I called him and told him he did the right thing. I told him that in my country we frequently get babies who didn’t have a heart rate for 30 minutes but no physician was brave enough to stop attempting resuscitation. I reminded him that saving the body once the person has gone is not triumphant. Learning when to stop is not easy and is almost never clear, but it is essential. I told Jeremy I was proud of him and he was grateful (quiet and Kenyan, but grateful).

The Place of Winds

2009-10-05T11:42:00.004-06:00

The word Kijabe means ‘place of winds.’ Every afternoon, the trees begin to bend gently in a breeze, as the sun moves to the other side of the Great Rift Valley. The day passes slowly here, and sunsets can seemingly last for an hour. Last night, we sat on our porch with our neighbors, Gary and Lee Anne Finke, watching a brilliant sunset behind a purple-gray rainstorm on the Valley. As always, by the time the light was gone, the wind was at full-force, filling the night air with its roaring, stirring through the tall trees.

The night of our arrival, we walked through the cool night winds down to the Poenaru’s house for dinner. Traveling from London to Kijabe via Nairobi had been exhausting. We left the Mitre House Hotel early in the morning and walked to Paddington station where Josiah posed (asleep) next to Paddington Bear. He and Amelia were only half awake on the train ride to Heathrow, but we made it to our plane without too many problems.

Josiah and his monkey slept for much of the flight. We spent a night in Nairobi, and then drove to Kijabe the next day. After all of that traveling, a nice home-cooked meal with the Poenarus was just what we needed, and we watched the sun go down behind Mount Longonot from their back porch before dinner.

The couple of weeks since then have been busy. Our arrival coincided with that of an American pediatric urologist, Ron Sutherland, who comes to Kijabe twice each year. Dr Poenaru had patients stacked up for him, so we really hit the ground running—operating long days and seeing fifteen or more urological consults in clinic each day. It was sort of a rude awakening after being in the lab for the past year, but it was also very gratifying to help so many young boys with major problems that are attended by social as well as medical difficulties. The bright smiles of the children make the long hours and busy days well worth it.

As expected, the medical and surgical diseases here are fascinating. In my first two weeks, I saw four prune belly patients (3 newborns and one teenager), a multitude of hypospadius patients, and several children with bladder extrophy and epispadius. These problems exist in the States, but there seems to be a higher incidence of several congenital diseases, which may be attributable to environmental factors. For example, the overwhelming number of patients with spina bifida here is a testament to the importance of ‘simple’ interventions like adding folate to the grain supply. As Dr Bransford pointed out, though, that is a much more difficult task in Africa than we Westerners might imagine.

As a matter of fact, many things are more difficult in Africa than they are back home, especially when it comes to caring for patients. One of the limitations is technology—a CT scan can only be gotten by sending a patient to Nairobi, and the radiological interpretations are sometimes suspect. Saturday night, Amelia admitted a three year old girl with new, progressive hemiplegia (one-sided paralysis). She came with a CT scan from Nairobi that had been read as stroke. We were having dinner with friends when she got the call, so Josiah and I walked with her to the pediatrics ward to look at the CT scan. It didn’t look like a stroke to us, so we decided to pursue other possibilities. While Amelia did a lumbar puncture (spinal tap) and ordered tests, I rigged up my computer as a light box for the CT scan. I took several pictures of the scan and sent them off the formidable Clarence Edwin Smith IV. CE is doing a fellowship in neuro-radiology, and I knew that if anyone could give us some help it would be him. I was right. He fired back a thorough read of the CT scan that was much more helpful than what we had previously. It was a lot of fun to collaborate on a patient with CE—especially when we were so far from each other. His input helped guide the treatment plan, and we are hoping to get the girl back to Nairobi for an MRI sometime soon, at CE’s suggestion.

One of the highlights of my trip so far has been getting to work with and operate with Dr Dick Bransford. Dr Bransford is a general surgeon in the truest sense of the word. Over the years, he has done a little bit of everything. In the past 10 years or more, he has invested most of his time and energy creating a surgical program for children with hydrocephalus and spina bifida. Kijabe is now the regional center of excellence for these diseases, and the case load is astounding (I think he did 9 cases today and postponed another 3). I have enjoyed learning how to do VP shunts and spina bifida closures, but the real privilege has been to spend time with Dr Bransford, whom Dr Tarpley calls one of his heroes. That makes Dr Bransford a hero of a hero, whom I greatly admire and enjoy.

The operating room experience here is a little different than back home. It’s not just the reused bovie pads and attention to conserving suture. There’s just a feel to it that is different—perhaps it is primarily Mary’s ‘chai’. Every day, Mary brings a large white bucket full of fresh milk (straight from the cow), which she mixes with strong Kenyan tea. A little sugar and you have chai. We all huddle into the ‘tea room’ and sit shoulder to shoulder on the couches drinking our tea. This is one of the more enjoyable times of the day, when things slow down a little. Everyone sits and talks about whatever comes to mind. Then it’s back to work.

Each day, at the end of the day, I make my way back home to the Sitaplex, the apartment guest house where we live. It’s the best part of the day, coming home to Amelia and Josiah and another Kenyan sunset over the Valley.

At Home in Kijabe (with pictures)

2009-10-01T11:32:00.021-06:00

We have now been in Kijabe a full week. We arrived to homemade zucchini bread and an invitation to watch “So you think you can dance” from the wonderful Davis family (our neighbors just below in the Sitaplex guest house). Not having a TV at home, we were way less in the know than some of the long term missionaries here. Kijabe is like summer camp for doctors. And although there may be some sacrifices in being in Africa (like broccoli free of aphids) our overwhelming sentiment is, “man, don’t we feel at home!”

We have made many good friends in the short time since we arrived, including a missionary couple who are living our dream. Mark and Sue Newton have been in Kijabe for 12 years and they are so authentic and enjoyable that they make missionary life seem easy. Mark is a pediatric anesthesiologist who spends 10 weeks working at Vanderbilt every year and the rest of their time is at Kijabe. They have a welcoming home, wonderful children, and a black lab named Moshi. Their lives are busy, but they have graciously had us over twice in the first week – of course, one of those times we arrived un-invited! But they didn’t seem to mind. It has been great to listen to them and realize that some of our hopes could in fact become realities.

PRAISE THE LORD, Jim and I found an angelic nanny named Helen who I will cry to leave. She makes it possible to work in peace knowing that our sweet Josiah is cheerfully smacking around our home under her watch. I am only working until lunch time (plus taking call) which is good because everything takes longer in Africa. It is a slow walk with Josiah on my hip to the dukkas (pronounced doo-kus = produce vendors); then bleaching the vegetables is another considerable speed bump once we get home! I actually really love hanging my own laundry out on the line (although it does mean you can’t leave the job unfinished until tomorrow).

So as for our “test run” here at Kijabe….I’d say we love it. Where else could a country-boy practice pediatric surgery and his wife practice academic neonatology while their children run through the country-side?

The people here are smiley and energetic. The children are beautiful, just like everywhere. I work in the “nursery” which is an absurd understatement for the degree of illnesses managed in the small, overly heated room crammed with sick infants. We pile in as one big mass of white coats to begin rounds while the nurses sing praise songs in the next room for morning devotionals. Their singing sounds like a dream or the soundtrack to a Francis Ford Coppola film. In the nursery, the mothers all gather round to listen to our discussions as we move from baby to baby. There is no HIPPA so they support each other when things aren’t going well and consol one another’s babies when they are crying. Mostly, it is a type of sweet interdependence and community lost in the ultra-private and sterile US. Sometimes however, it is a cacophony of cultures—a yelling match in varied languages with beeping incubator alarms and empty infusion pumps filling in any moments of silence. The Somali women are particularly prone to finger wagging and loud refusals to suggested medical plans. I sometimes struggle to teach amidst all the hot commotion.

I usually round with my friend Stephany Hawk, who was my co-resident at Vanderbilt and is now doing a two-year stint as the pediatrician at Kijabe. Together we are training African residents in pediatrics during our daily discussions of patients in the nursery. I have also been asked to lecture at Grand Rounds for the missionary physicians -- pediatricians and family docs. Because I have had the privilege to train under Susan Niermeyer, an international expert in the care of newborns at high-altitude (Kijabe is 2000 feet higher than Denver), I plan to teach about the special challenges of caring for infants transitioning from fetal to post-natal circulation at high altitude. I will also be giving lectures in basic neonatology to the nurses who do much of the bedside care and are pivotal to keeping these babies alive. I am already attached to them, and I often need their hugs on the way out the door each day—neonatology in rural Kenya is sometimes very difficult.

Our biggest limitation to sick newborn care is the lack of total parenteral nutrition. We have many pre-term babies as well as several infants with inadequate intestinal length due to operations, who would all receive TPN in the States. At Kijabe we manage them by feeding at the earliest opportunity and praying for a miracle. It is the best thing available. We can sometimes get lipids (a component of TPN) to add to their IV fluids, and there are rumors of amino-acids, but I have yet to see any—I don’t really believe they exist in Kenya. So we do the best we can with what we have.

We see a lot of death and pray that we are communicating Christ’s love to these moms by caring for their children who would otherwise be forgotten. This morning, I barely left the bedside of a dying child, whose mother insisted that he was already dead—as evidenced by the ventilator breathing for the baby. The baby is not dead, but he probably will be soon. With all of the challenges and obstacles, it can be difficult to persevere at times.

Still, we do see some miracles. We have two former 29-week preterm infants who are thriving and have graduated into what American neonatologists call “feeder-growers”. My favorite is baby James. He is almost ready to ‘hatch’ from his incubator. Another baby I love is baby Joseph—a term newborn we admitted for sepsis. I told his father (‘Babba Joseph’ as the Kenyans refer to a child’s father) that he should expect Joseph not just to survive but to be a normal child. I told him that Joseph will play football (soccer) with his brothers one day. Babba Jospeh smiled broadly and declared “This is a good prophecy.” Indeed, I agree.

Life is simple, hard, and lovely.

At home in Kijabe

2009-09-28T13:11:00.002-06:00

This has been re-posted above with pictures.

September in London

2009-09-16T16:40:00.000-06:00

Our journey has officially begun, and we are feeling the jet lag on our layover in London.

The flight from Denver to London went off without a hitch. Josiah slept almost the entire way, and we arrived at Heathrow in time to reach the hotel and out to a pub for dinner before dark.

It rained most of the night, but jet lag apparently has a gastric component, so we made our way through the rain back to Paddington station for a late night snack, then sloshed home to the hotel in wet shoes and pants legs.

Autumn is beginning in England. Today, the air is cool and wet, and the skies are mostly grey. There is a steady wind, and ochre colored leaves are piling up on the green lawns of the city parks.

This morning, we took the Southern line train into Sussex county, rolling past green fields separated by thick hedges and spotted with white sheep and white cows. It bordered on cliche, it was so picturesque.

We traveled south to visit Uncle John at the College of St Barnabas, where he has retired. It occurred to me afterwards, that it was twenty-five years ago that Uncle John first became a part of our family. I was 8 and and he was 62. It was quite a pleasure to see him again and to introduce him to Amelia and Josiah. Josi gave him several kisses before we left.

Josi continues to enjoy travel, primarily because there are always new people to see. He likes the sights but it's the people that he seems to enjoy the most, and he manages to entertain a handful of new friends on every leg of our journey.

He is also quite entertaining to us. We stopped in Westminster Abbey after our trip south (the extent of our sightseeing I am afraid), and Josiah was well pleased with the sound of his voice echoing off the high ceilings and ancient stone.

Tomorrow morning, we'll make our way back to Heathrow via Paddington Station, collect our bags at the 'left luggage' storage, and be on our way to Kenya. I suspect the flight to Nairobi will be a little more adventuresome, considering that it will not occur during Josiah's normal sleep hours. Indeed, it might be quite painful.

But, Lord-willing and creek-don't-rise, we'll be in Nairobi this time tomorrow night.

Heading to Kenya…

2009-08-18T14:32:00.011-06:00

Two years ago, Amelia and I had the privilege of meeting Dan Poenaru, a soft-spoken missionary pediatric surgeon serving long-term with his family in Kenya. We had traveled from Denver to Louisville for the Global Missions Health Conference, with the specific purpose of meeting Dr Poenaru. The cross-country trek proved to be well-invested. We talked for quite a while, we prayed together, and he invited us to join him at Kijabe Hospital for a short-term mission as a warm-up to a longer stint once my residency is complete.

With that in mind, Amelia decided to take six weeks ‘off’ between finishing fellowship and starting her new job here in Denver so that we could go to Kenya during my final year of research. We are leaving in just under a month. And we can’t wait. (You can see our travel schedule below).

We are excited to serve at Kijabe Hospital. The first hospital at Kijabe mission station was established in 1915, twenty years after the first missionaries landed in Kenya, and there has been continuous medical care at Kijabe ever since. The hospital is run by the African Inland Church, which arose from the work of African Inland Mission. Today, Kijabe is a thriving hospital complex, with 250 beds and over 800 staff serving in inpatient, outpatient, maternity and pediatric units.

As I understand it, I will be working primarily alongside Dr Poenaru and Dr Dick Bransford, both career missionary surgeons who specialize in the surgical care of children. I expect my role at Kijabe to be very similar to that of a chief resident in the States, and I hope to be helpful to the pediatric surgery service in that role. Extra hands are always useful on a surgical service.

It sounds as though Amelia will be taking a more front-line role. She will likely be ‘running’ the NICU while we are there, and we are under the impression that she may be the only pediatrician at the hospital during our stay. That should be exciting.

We don’t really know exactly what we are getting ourselves (and Josi) into, but we are eager to serve in whatever capacity is most needed and in whatever way we can make the most impactful contribution. We are extremely thankful to be working alongside a team of career missionaries who are committed to the twin calling of medical missions: disciple-making (Mark 16:15) and mercy ministry (Matthew 25:34-40). It is our privilege to serve them and support their stated mission: “Health care to GOD’S Glory.”

Some of you have asked for a support letter to be sent so that you could join us financially in this work. For others this is the first time you have heard about the trip. We greatly appreciate any support that any of you can give. The total cost of the 6 week mission for the three of us will be somewhere around $6,000. The budget outline is attached below.

We will be serving as short term missionaries with World Medical Mission (WMM), the medical arm of Samaritan’s Purse, and they are handling all of the financial/logistic aspects of the trip. If you are interested in helping us finance this work, you can send donations to WMM at PO Box 3000 Boone, NC 28607. Our account number is #003875. You can also call WMM (Sandra Shupe 828-278-1373) if you would like to make a credit card donation.

Whether you are able to support us financially or not, we do hope that you will pray for us and keep in touch. We will try to keep the blog updated frequently so that you all know what is happening with us and so that you can share in the adventure.

Grace and peace to you all—

Jim, Amelia, and Josiah

Preliminary Budget

2009-08-17T22:06:00.004-06:00

There will certainly be some expenses not accounted for in this budget, but it gives us a rough starting place. We will update it as more costs become definite. [Click on the image to see a larger version]

Travel Itinerary

2009-08-17T21:59:00.003-06:00

This is our basic trip itinerary. At this point, we have no plans besides working at the hospital between our arrival in Kenya on the 17 and our departure on October 28. [Click on the image below for a larger view].