A day in the Life of a Visiting doc in Rwanda March 2005

Kibogora Pediatrics, PC

This is a ‘day in the life’ at Kibogora for a visiting American pediatrician.

6:10 AM: Another day in paradise. It is daylight. It is always daylight after 6AM and before 6PM. Kibogora is somewhat south of the equator but the days are almost identical in length. One can and does set one’s clock by the sun.
Step One: is there electricity? Most days there is and that makes life easier.
Step Two: is there water? Better by far to learn that the water is off before you flush the toilet (for what may be the last time is hours.)
Step Three: Unlock kitchen door for Simeone (pronounced Sim-e-OH-nee), our kitchen help. He will work most of the day but leaves in the early afternoon and will lock up, pushing the key under the door.
Step Four: A quick wash up before breakfast is on the table: Rwandan coffee (dark roasted and pungent), toast, local fruit (small bananas, pineapple and papaya) with yogurt and water (I never seem to be able to drink enough).
7:20AM Leave my laundry (to be done in a venerable Maytag complete with electric mangle) for the muganda, the outside worker cum launderer.

Start my commute to the hospital. The front gate of the hospital is within sight from the front of the house but actually getting there requires a walk over the ‘hump,’ up and down a hill that is the spine of the Kibogora peninsula. I lock the front door and keep the key to let myself back in after Simeone leaves. (Africa: the land of keys). As I go I see the small flock of greenbuls, robin-like birds with the attitude of blue jays. They have started their bickering at dawn and will continue except during the hottest time after noon. It is important to watch one’s step as the fallen guava or grenadilla (passion fruit) make the brick walkway hazardous for the unwary. I unbolt the gate as I go through. Our zamu (guards) have been up all night making their rounds among the several houses which make up the compound. The missionaries, their families and single female nurses live in housing within the compound. An attempted armed break-in at Dr. Belindwa’s home 2 weeks ago has people scandalized. His mother used this as an excuse to come from Congo to visit her son…and daughter-in-law of 2 weeks duration. At the hospital gate I will greet the guard with a “Muramutse”, as it is morning.

7:30AM Morning Prayers: At least one song (sung in Kinyarwanda) and a homily by one of the hospital chaplains or a visitor. This may be translated but usually not.
“Morning report” amounts to a reading of the admissions from a log…in French. There is no discussion.

8:00AM Rounds start. We have a full team today: Dr Thompson, a family practice resident from Orlando; Dr Archippes Belindwa, a recent graduate from Congo, a staff nurse, Martin, and myself. I usually start in Maternity, which is where they keep the premature infants, my major interest. I have been following a set of twins born 2 months early and weighing about 3 Ibs a piece. At two weeks old, they are doing well with their tube feedings every 2 hours. Mother is there to provide. There is no storage refrigerator. They are replaced into a wooden incubator powered by 2 lightbulbs (that is to say NOW 2 lightbulbs, as when I arrived there was only one working. Who knows for how long.) Since there has been electricity I believe they have been warm enough but I have yet to be sure that the idea has been accepted that these babies need to be warm EVEN IF the electricity goes out. It seems absurd that I am worried about temperature in the tropics but indeed that lesson is probably the most important one given.

I was asked to keep an eye on an adult patient who I have been feeding through a jejunal tube. He has been so poorly nourished that he does not heal his wounds after surgery. A feeding tube was placed directly into his intestine and I have been tasked with getting him nourished enough to heal some of his massive surgical wounds. We have been going at it a week and are just now getting into target range or 3000 calories a day. He is skin and bones, every rib standing out and looking like a scarecrow. He is complaining that he wants to walk around a little. I write the order.

Finally to Pediatrics, all the way at the bottom of the hill near the garbage fires and the latrine. Children are always give short shrift, even in third world countries. The ward consists of five rooms with about six beds placed down each side. There is a three feet clearance down the middle and 4-6 inches between the beds. This however can represent about 15-18 patients, as sometimes there are two patients (meaning 4 people) per bed. A parent and usually at least one sibling accompany each patient. Fortunately, at Kibogora there are no beds on the floor; unfortunately this is because there is not enough floor. The windows are unscreened but every bed has a mosquito net suspended above it, giving the appearance of a flock of blue hammocks roosting, suspended about 3 feet off the ground when “up” for rounds. Each room exits onto a wide, covered walkway with a view down the hill to the hospital gardens. Patients or their families may pay off some of the fees by working in the garden, which in turn supplies some of the food for the patients.

Rounds are conducted in an Anglo-Franco- kiSwahili-Kinyarwanda pidgin, which is a hoot. It can take a long time to get ideas exchanged. The ‘educated’ language is French and only occasional individuals have even a little schoolbook English. I find that if I am careful to use very precise English medical terms, they are frequently recognizably good French medical terms. When we each slip into slang, the troubles begin. I have learned to read enough medical French to get through a typical admission note, bad writing and all. The frustration levels were lowered once I learned to use the French terms. (Thank you Agatha Christie and Hercule Poirot.)

Most patients have malaria or have had it within the last six months. Quinine is the most common treatment for resistant “P. falciparum” malaria, the bad kind. I haven’t seen any of the good kind (P. ovale, P. malaria, or P. vivax) since arriving however. Most are therefore anemic. We don’t transfuse for any hemoglobin above 7 gm%. We have no blood available about 4 of 7 days on average. Last night a woman died because of its unavailability. Occasionally cerebral malaria is encountered. Very discouraging work, that. A six-year-old with convulsions was brought in. When I saw her 2 days later, the quinine had dropped the fever but she was comatose and rigid. I was more startled when I went to examine her. Every area of her body from head to legs was covered in cuts varying from 3-12 CMS. They are administered by a healer (what in less politically correct times we might have described as a witch doctor). He is obviously quite skilled. None of the cuts goes all the way through the dermis. By now I have seen any number of these wounds and they all seem to heal without infection. Since she has gotten over her malaria she has been unable to walk or talk or follow directions. Over last weekend she started eating, the day after we prayed with the family for her healing.

The pediatric wards have a huge variety of diseases once one gets beyond the malaria, intestinal parasites (of several persuasions) and occasion miocrofilariasis. Some of the severity of illness harkens back to my internship. A 12-year old has a cough, weight loss and night sweats and the consumptive demeanor to make a Mimi jealous. On exam she has all the auscultory signs of cavitary tuberculosis including egophony. Three days on quadruple therapy and her fever is gone, she is gaining weight and a smile has returned. She has 5 more weeks of isolation before she can go home. Another 11 year-old comes in with a mother who tells in voluminous detail how her cough keeps her up at night. She is blue, dyspneic and her hands are cold. She has a thready pulse and ascites, which throws her off balance as she walks. She has pneumonia of course but also rheumatic heart valve disease (PS, PI, MS). After 3 days of digoxin and amoxicillin she has lost about 9lbs (15% of her entire weight), reduced ascites, has opened up her right middle lobe and sleeps through the night.

Other diseases are familiar from my previous assignments to mission hospitals. Kwashiorkor, severe malnutrition causing red hair swelling, fluid retention, apathy and susceptibility to infection is sort of an old friend. I lost about 3 children a week to it when I was in Zambia in 2001. So far I haven’t lost any of my kwashiorkor patients. It is indeed nice to work in an affluent country. We haven’t run out of milk powder since I’ve been here.

Today however, was a red-letter day. I sent home “Mother Teresa.” She is a twelve year old girl who weighs about 15kg (33lbs). She was already in hospital since before I arrived. I would find her all over the hospital (climbing up and down the equivalent of 3-4 flights) dressed in the same dress with a shawl over her head. She kept losing weight. It developed into a bit of a cat and mouse game between us. I would forbid, coax, cajole, make funny faces, and pretend to cry when I directed her to squeeze my hands. She would reply that I was a grown man and she didn’t believe I should cry. I bribed her with toy balloons, bread from one of the waduka (shops), and when all else failed threatened her with a “sonde,” a naso-gastric tube. It took one experience and she knew she could not count on the crazy umuzungu to act civilized…so she started to eat. She has gained a kilo and a half since the showdown and smiles at me, walks with me and gives me hugs when I am near her rather diminutive height. I learned that her mother had abandoned her in hospital at the beginning of her stay. Mother showed up today. Teresa is to return in two weeks. I presented her with a throwaway camera to bring back with her. I have arranged with one of the national doctors to forward the film on to me.

AIDS is alive and well in Rwanda. The prevalence is about 30% and of my patients, about 10% are affected at any one time. Many are merely dwindling down and admitted for malnutrition. One little 6 month old has what I think to be a fungal infection. He was deteriorating daily before we took the potentially dangerous step of using Amphotericin even without a culture (not available here). He has been afebrile for the first time in a week and has started eating again.

We see each patient, discharge the willing and listen to the new admissions and to their mothers; the air is hot and moist, the children are all dressed for Michigan in February. After the two acute wards we do the gastroenteritis wards and finally Isolation. We averaged 65 patients/ day last week. This week the load is less and about half the time I can finish by noon. Some of the time rounds are interrupted by the huge rainstorms that sweep up from Burundi. It is impossible to hear enough to continue until the storm passes. At noon the resident and I are expected to have lunch at one of the houses. This is the major meal of the day and usually well worth the 7-8 flights of stairs to get to it. Today talapia, potatoes, carrots and green beans, carrot cake and tea. (“Go to Africa, Treat Malnutrition, Get Fat!”).

We will not restart rounds “until 14;” 2pm. I return to the house and try to be cool. The house is about 85F and the humidity is 60-70% until a storm comes by to cool things off briefly. I spend my time usually reading Manson’s Tropical Medicine or learning a little Kinyarwanda. Frank Ogden usually takes a siesta. Very civilized. By “14” the air is no cooler but lunch is well digested and we start again. We are almost always finished by 5PM in time for a short breather, shower and time to appreciate the sunset before dinner at 6:15PM.

Tonight I am to have supper at the Sudell’s, a family that has come for a year from Lancashire, UK. From thence they have brought a love of football (soccer) and table tennis as well as a profound distrust of things Scottish (at least on David’s part this having much to do with a disputed football match some years ago). It was he and his youngest, Emily (Ems) who picked me up in Kigali and got me here. The Sudell’s are tall and unrelentingly blond: John 16, Phillip 14, Ems (10) and Mary, the mother of them all. David has been involved with setting the “station to rights” and a building project among the Ba-Twa, the pygmy-oid indigenous people of the area.

Supper is light: soup & salad. After dinner we gamble…for who does the dishes. My losing streak is finally broken and David is elected. He has the good grace to grumble about it, which grumbling makes us all feel well out of it. Sunday and Thursday night we have a Bible study. Once or twice a week we will see (again) one of the recorded movies available. Tonight however, I must go back to the house.

The paths among the houses are quite dark and one of these announces “N’amakuru.” I call back to the zamu, “N’ mesa.” (“What’s the news?”… “It is good.”) There are a few fireflies in the grass and rather more toads of impressive dimensions trying to have them down for “light” dinner. I hear out over the lake the fishermen “singing to the fish” as the three-hulled fishing boats slowly seine Lake Kivu. There are drums on Ijwa tonight. The clouds over Congo are lit every few seconds with lightning but no thunder. Overhead the sky is clear. Jupiter is climbing, Orion is falling and the Southern Cross wheels about the Milky Way. I come in and sit down to write: “This is a ‘day in the life’ at Kibogora…”

Traveling home from Rwanda April 2005

The major problem with travelling home is the mindset one can get into. It is one thing to be ready to leave and quite another to have already left, except for the body, which lingers until your ride comes. It is best to ‘discover’ that you are scheduled to leave on the morrow and only then to bend your thoughts in that direction. The decisions regarding ‘what goes and what stays’ are probably only marginally poorer than that provided by deep deliberation.

Judging by the eclectic assemblage of clothes that adorn the population, many people appear to lighten their load by giving away t-shirts and sweatpants. A nice shirt I saw in church read “I’m too sexy for my hair …That’s why it’s not there.” I’m not sure she could read English. T-shirts with commercial appeals are the most common of course, followed closely by European football clubs and American supermarkets.

I was able to pack all that I had left in one of the two suitcases with which I had come primarily because I dropped off donated and requested items in Kibogora: blood pressure cuffs, used eyeglasses, drugs, DVD’s, ketchup and brown sugar.

I was scheduled to be taken to Butara from Kibogora the morning of the 26th April. This was done to allow me to catch a ride with the Ogden’s (Dr. Frank and Carol) who were coming up from Burundi on their way to Kigali to swap cars with David Sudell and bring back some building supplies and a Burundian surgeon, Dr. Kaganga, to work at Kibogora for a while. If this sounds complicated, it pales in comparison to the actuality. Travel in Africa is typically complicated enough to tax your logical capacities. In addition someone is always coming up with a last minute request or problem to add to your ‘to do’ list on arrival. I was to be ‘on the porch’ at the Hotel Ibis in Butara at 5:30PM. There was no plan “B.”

I was driven by the hospital’s driver, Innocent, the three hours from Kibogora to Butara, the old capitol of Rwana-Urundi colony prior to the 1963 independence. He speaks little English but we get by with an argot of several languages. We worked our way out of the Kiva Lake area, past Gataca Church (which has it’s new roof) up the road to N’amasheka and to the paved highway in about 45 minutes. From there we started to climb. This is the tea-growing area. Huge farms are seen with the typical green “cushions” of tea plants, row upon row, going up impossible hillsides. A man from N’amesheka was brought in Saturday after a tea branch he was pruning with his ‘ponga’ snapped back into his eye. He noted that his vision deteriorated for two days before coming in. He has a well-developed cataract now and is blind in that eye.

We rapidly enter the jungle at the top of the grade and run into several military patrols. They are said to be there to prevent poaching in the jungle. Rwanda has published the plan that they will turn the entire area into a tourist destination, limit access by road (thus adding about two hours to the six that it now takes to get to Kibogora), and build some tourist hotels. The reason most people think that they are there is to prevent infiltration from Hutu rebels in Congo. Whatever the reason, we enjoy it while we may. The temperature drops about twenty degrees and we stop for several troops of colobus monkeys, black and white along the road but not much taken with becoming photographic subjects. The two hours consists of good roads winding up to impressive overlooks before descending into a liana-choked forest. Gangs of men pile logs along the road. None of the logs shows the marks of anything but a ponga. We do see a couple of men gleaming with sweat in the morning coolness, at a makeshift saw-pit using the deep gully at the side of the road to take planks off a 3 foot wide mookwa log.

We still see people with huge head loads. Very different from rural Zambia or Kenya, both men and women carry on their heads. This leaves their hands free for other loads and balance. Some of these loads are huge bulky bundles of leaves or lumber. Some are just silly: a single umbrella or hoe. They are most usually carried on a head ring made by each person out of banana leaves. They are quick and easy to construct and frequently discarded on the road at the end of a trip. Not surprisingly, posture here is excellent. The next step-up in mass transportation is the wheelbarrow. This vehicle bears no relation to any similarly named item from Lowe’s. It is of home manufacture, with a solid wooden tire on a wheel scavenged from some vehicle. The bed is made of sticks, roughly shaped to make a platform that is canted slightly at the front end by about 10 degrees. It is used by typically two-men to carry wood, potatoes, charcoal or produce. One pulls and the other pushes. I saw a gang resting on the long hill going up to Tyavo last week and motioned that I would like to try to move it. The pusher, a very muscular young guy who was streaming in sweat and heaving huge breathes, gladly realized the “Tom Sawyer” potential and let me have at it. The handles are widely spaced and sturdy. With the help of the puller, I was able to get it up to trotting speed fairly quickly but it was quite unstable even so. I was able to get another hundred feet up the hill before quitting (to my own credit without tipping the poor thing over). We took pictures of each other to good-natured laughter from the spectators. (What will these bazungu do next?)

Travelling on Rwandan roads is enlivened by taxis…of the two-wheeled persuasion. Even very poor roads will have a bicycle or two with a plank seat behind the driver. These affairs may be quite gaudy with reflectors and whip-antennae. They are reminiscent of a Schwinn I lusted after in third grade. Paying passengers are expected to help push the taxi to get it up to speed before hopping on (sidesaddle in the case of women…how do they do that?).

All travel in Rwanda will bring you to a genocide memorial or three. These may be simple cross-marked slabs of concrete at ground level like in Kibogora or large affairs such as at Kigali. The most chilling I saw was up towards Kibuyi north of Kirambo. It consists of a concrete mausoleum built into the hillside and extended perhaps 50 feet. The front is about 15 feet wide and is glazed and barred. It is lined with shelves and skulls. The shelves behind the front recede into the darkness gleaming with stacks of femurs and an occasionally naturally preserved mummy. No accurate account has been made but the best estimate has been that about 1.4 million of the 8.3 million people of Rwanda died in the period from 1994-1998.

Eventually we got to Butare and I got a tour of the National Hospital, a typical rambling affair of covered walkways and ramps. I visited their Newborn Intensive Care and was interested to find a two-month-old who looked pretty good. She was however suffering from a narrowing of her aorta that will in time make her heart fail. There is no cardiac surgeon in Rwanda; much less a pediatric cardiac surgeon nor any of the infrastructure needed to accomplish the surgery.

I spent the rest of the afternoon walking the main street after going to the national museum. This however was a bit of a disappointment. As the power was off, the tour was thus by flashlight and the legends were in French. I had gotten a room at the Hotel Ibis, quite plush actually. Screens on the windows and electricity (at least from 6AM until 11PM) and everything. Frank, Carole and company showed up on time and we went to dinner. Carol observed to me that “TIA,” “This is Africa” and that in ordering food one needs to “ask for what you want and eat what you get.” We have a quite nice dinner of talapia and retire at about 9:30PM.

We start at 6AM sharp to get to Kigali. Frank has to pick up another doctor coming in, drop off two of us and swap cars with David Sudell. I catch the plane on time at 4PM. It will be 28 hours before I am in Atlanta, 22 hours of that in the air. My travelling companion is Nathan Thompson, the son of a Congolese / Rwandan/ Burundian missionary (depending on which country had not evicted him at the time). Nate is a senior med student at U. Washington and will be graduating in June after spending a six-week surgery rotation with Frank. He had been in Burundi for the week. We are able to share a flight to Nairobi and Amsterdam. We part after a prayer session in the airport. He still has a 12-hour flight leaving an hour after mine.

The rest of the trip is lot in sleep, reading and contemplation; this was a good trip indeed.

Trip to Narok July 2002

I had to fold my shoulders and duck my head to get through the door. Unfortunately, like a cork in a bottle, I now had no light to navigate. I had spent the day with the Kejeri family and their church, returning to Namunchka late in the day and had been invited for ‘chai,’ hot, sweet milk and tea. . I followed the instructions of my amused host, turned right and then immediately left into a slightly higher room and found my seat by touch on the “mens” side of the room. The atmosphere was hot, smoky, claustrophobic and somehow cozy. A small fire burned in a grate on the floor without benefit of a chimney. The only light and ventilation came through an irregular 4” X 8” hole high in the cow-dung and mud plastered wall of Jackson and Elizabeth Wejeri’s home. I tried to forget about breathing. It had been a long day.
Last week, I was invited to go along with a maternal-child clinic trip to Suswa, a Great Rift Valley town that on a clear day is actually in sight of Kijabe, about 8-10 miles by road. Suswa is a collection of stick and clapboard buildings placed at random sites generally around a large corral.
The clinic used to meet in the most substantial edifice in the town, the tavern, which by all reports made a tidy profit on “rufi” (Maasi moonshine). This despite several instances of blindness among the patrons thereof. The clinic was now meeting in a small clapboard building, The Suswa Baptist Church. We cleared the unpainted wooden pews and lectern and set to work. Four hours later, 150 babies had been weighed and immunized.
Saturday, I was talking with Drs. Gary Rourke and Bruce Dahlman and their wives Corrine and Kate. I asked the source of the baptist presence in Suswa. The story they shared made me again marvel at the working of the Holy Spirit in people’s lives. In 1990 a widowed Maasi matron came to a roadside preaching crusade, went in to listen, was saved and left with a Maasi Bible. She went home, read her Bible and, following the Word, brought her grown children to the Lord. They in turn evangelized their neighbors and started a church. This one group has gone on to start new churches all over the valley since 1993.
As it turned out the Rourkes and Dahlmans were helping another Maasi church in Namuncha, “out there past the pumping station.” The pastor of the church, Simon Wajeri, was graduating the next day from the Narok Bible College. They were taking two cars to transport the church choir which was performing. I was asked if I’d like to come along. I did.
The Maasi have been resistant, as a rule, to evangelical efforts since these started in the latter part of the 19th century. The Maasi were primarily nomadic warriors and herdsmen, holding a dominant position not only in the Great Rift Valley but south across the border to Tanzania and up to the highlands of Kenya well north of Kijabe.
The British occupation of the highlands of Kenya would most likely have been a rather bloody affair had not the Maasi suffered twin disasters just before the British arrived: a huge reduction in their herds due to rinderpest and bloody internecine warfare which reduced their numbers further. Due to this they were pushed out of the highlands into the Rift Valley floor where it is hotter and drier. They speak their own language and are much less likely to know Swahili. Martin, a Christian Kykuyu artist with whom I talked, commented that the Kikuyu and Maasi now intermarry frequently, “But we still don’t understand the Maasi.” Why he thought that husbands and wives necessarily understood each other was not explained.
The Maasi therefore have been isolated by geography, politics, language and religion for over a hundred years. Many continue a traditional life of herding cattle and goats. Their dress is colorful and distinctive. The men frequently wear kilts and a red plaid shawl and carry long sticks for herding and defense. They have no horses and only an occasional donkey. The women wear elaborate beaded necklaces and earrings. Both men and women have pierced ears that can be as long as 6 inches. (Some men, I note, must find this annoying and wear their redundant ear lobes wound over the top giving them a resemblance to Shrek).
The Maasi are looked upon by many Kenyans as quaint, backward, recalcitrant and not overly bright. “Hillbilly” comes to mind. The Maasi, on the other hand, think of themselves as the “real” people: brave, honorable but harsh if challenged.
We set out at 7:30 the next morning, drove down through Suswa again and then turned south until we came to a petroleum pumping station and forded a small stream. Navigation immediately became one of compass directions and distances. Imagine scrubland crossed by any number of cattle trails making foot deep dust, fine a talc. We came up on a small clapboard building and a rock pile (the building fund) and heard singing. After a few minutes of the inevitable greetings, introductions, and involved interrogation regarding the whereabouts and health of my family, we piled 13 people into each car and left. More would have boarded if we had allowed it. The trip out to Narok took about 2 hours but was made memorable by the presence of the Kenya International Safari Rally. We went out alternating between marveling at the zebra, gazelle and giraffe and being terrorized by racecars, dodging around trucks and cars on the pot-holed two-lane road. Half way there, Bruce’s land cruiser overheated and blew the radiator cap into hiding. Another 25 minutes were taken up with refilling the radiator and finding the cap.
When we arrived in Narok we were however only slightly late. The choir was able to sing and dance . The graduation ceremony itself was more reserved and quietly joyful than any I’ve seen lately in the USA. Simon received his divinity certificate, an associate degree. He expects to get his bachelor's in about a year. As anywhere in the world, the ceremony was followed by photos with the various relatives. Simon’s mother, all 4’ 11” of her, and brother, Jackson were wreathed in smiles. Dr. Bruce Dahlman presented a bible commentary from the mission group. After a celebratory meal at a local restaurant (we wazungu got silverware) we started back with now 14 in our Land Rover; Simon was now sharing the front seat with Gary, the stick shift and me.
The entire return trip was rather more exciting than the trip out. It became an evangelical travel-log by Simon. He would point to a little building and tell us that that was where he had done a week-long crusade the previous year. Twenty-six people were saved. The building holds 40. There was the road that takes you to Dukuleli where he spoke for 3 days and started a new church last month. Here was the house of one of the people whom he had led to the Lord…
On arriving back at Namunchka, we were invited into his brother’s home and listened to Simon as he gave an impromptu seminar in evangelism. He felt that the Maasi were now being brought to Christ for two reasons. One, that these days are the endtimes and the success among the Maasi is part of the final incoming harvest. Secondly, he believes that the Maasi needed only to be presented with the gospel in the right format, by Maasi in Maasi. He sees himself in the great traditions of evangelical efforts from Pentecost on. He is bringing an update to Paul’s assertions that to Jew he is a jew and to Greeks, a greek. We left, the cars laboring to climb out of the Valley. I felt it had been a mountaintop day nevertheless.

This week, please pray for Simon Wajeri, the Namuncha Church and unsaved Maasi in Maasiland.

Graves of Kijabe July 2002

Graves in Kenya
In America, I guess, it would be considered, at the very least, bad advertising to have a cemetery in close proximity to a hospital. Nevertheless, at Kijabe there is a quiet little burial ground about a 100 yards from the “business” entrance. I made a small detour to see it on my way back to my house last week. The whole area has been planted with orderly rows of trees that shade the entire cemetery. A dirt path lined with Poinsettia runs down the middle. The grass grows a bit rank in places despite the workers hacking back the weeds and bushes from time to time. It is a quiet place through which many of the hospital staff walk on their way to and from work.
I found the oldest grave with a readable stone back at a corner. It was quite a thing, covering the grave with a Mansard stone top. The inscription read that Reginald Singyng So-and-So had died here at Kijabe while hunting and that he was really from India and it almost seemed he was a bit embarrassed to be here. He died in 1922, a few years after the mission opened.
The next group of stones was several men and women in their thirties and forties who also died in the early 1920’s. These were some of the early missionaries who came out to Kenya to serve at Kijabe. They died at their station, bringing the news of Jesus to the Kykuyu.
Mixed in with these were small markers, level with the ground and taking up hardly any space at all. They all had dates of birth and death in the same year; some in the same month; some on the same day. One had the inscription: “The first face he saw was Jesus.” A stone nearby bore a woman’s name. It had the same name and date as one of the babies.
The next group of graves was a little more recent. These people died in their 60’s and seventies even. The stones frequently noted service at Kijabe for 10, 20 and even forty years. One stated: “Born in Kenya, Died at Kijabe, Will meet the Lord from Kijabe.”
I walked along a little further past a jumble of weathered wooden crosses and rock-bordered but marker-less graves. Some of these showed signs of recent visitation with faded flowers laid on the ground. As I moved along to the end of the path, I saw graves with stones in Swahili and Kykuyu. Here there were whitewashed crosses and Bible verses on the stones.
I met Joaichim Techand, a 52 y/o German missionary to Congo, on his deathbed. I never had the opportunity to talk to him; we were trying to get his heart started at the time. We failed. All the doctors on call at Kijabe had been paged to the hospital in the small hours of Saturday, the 13th. We worked on him for most of the next hour before we had his family come into the room, said a prayer committing him to his Lord and called the code. It was his first heart attack. He, his wife and 3 of their six kids were in Kijabe for the week to see Ruth, their oldest girl, graduate from high school. Graduation was at 10AM that day.
I don’t know where he will be buried but I’m sure he would be welcomed to spend the brief time from now until the rapture in the company of believers among Kijabe’s quiet rows of trees and tombstones.

Please, take some time over the next few weeks to prayer for Joachim’s family.

Broadcast letter from Kijabe, Kenya July 2002

Greetings from Kijabe Hospital, Kenya.
I arrived into Kenyatta International Airport on Tuesday July 2 without difficulty. I was collected and brought to Kijabe with two other doctors who will be working here during July also. We are staying in a house overlooking the Great Rift Valley, the other side of which I haven’t clearly seen yet. The area’s most notable landmark is Mt Longonot, and inactive (NOT dormant) volcano. The climate is quite cool as the elevation is 7000 feet. This is the beginning of the dry season and reminds me a good deal of Northern California in the fall. Those of you who are admiring my fortitude in braving the rigors of Equatorial Africa may now move on to other matters.
The hospital serves people from all over Kenya but primarily the Kykuyu and the Maasai. The Kykuyu a rather prominent in government as they are a large fraction of the country’s population and the first president, Jomo Kenyatta, was Kykuyu. The Maasi are more rural and isolated generally and thus more traditional. Most people speak a usable amount of Kiswahili (i.e. the language of the Swahili). Contrary to my stay in Zambia last year, there is very little malaria Burkett’s lymphoma or shistosomiasis. There is however a good deal of tuberculosis and AIDS (the local population has a prevalence of about 35% since it is on a heavily traveled truck route).
The medical supplies which I brought were fallen upon with glad cries! Children in this hospital, as in most general hospitals, are at the back of the queue as far as getting supplies. In a country which has limited resources, children frequently do without, medically.
This week a mother of a boy on the ward asked about Jesus and was led to Jesus by a Kykuyu layman. A mother in the next bed listened in and was also saved. Last night the 12 year-old boy was saved while his mother looked on. We serve a truly amazing God. His care is sufficient. I saw a sign today at the local school which said something like: “Our highest goal is not to do good works, succeed in accomplishments or even to see the working of God’s will in His creation but rather in the furtherance of our communion with God as his children in imitation of His Son.”

Sincerely yours,
Walt Boutwell

letter from Mukinge to a friend

Dear Jim (DiPisa a psychologist friend and fellow climber/ backpacker),

I remain alive and well! Some of my patients can also say the same. Today is Easter and it is something else to celebrate it in Africa. I was on call all night & finished a delivery (my 1st in 28 yrs) and then got up to go to a sunrise service. The nursing students singing going up the hill behind the hospital in the dark. On the horizon bright Venus, overhead the Moon and Mars and to the right the milky way and southern cross. Several of us stayed to have a bit of breakfast in the beautiful weather. I had a tour thru the Tb (read AIDS) ward this pm. So little I could do except ask what was bothering them, how well they ate and whether they slept or not. Leprosy, snake bites (spitting cobra, which are the short (4' vs 8') brown ones---> eye injuries.
I think your comments about being open with the experiences of faith is on the money. It is one thing to believe something; it is another to put all your weight on the one anchor. If you really don't weight that single anchor, it really wasn't there to begin with.

I'm tired. Me go bed.
Mesanta Awhanni (thanks and good bye)