My Father's Eulogy

Below is the text to the eulogy I gave at my father's funeral, Dec 28, 2012. I ad-libbed just a bit, but the text is pretty close to the actual eulogy. My father was a blessing to me and my hope is that this short synopsis gives some glimpse into a great man who taught me so much. 

Dad spent a day seeing what I do, first handFirst, on behalf of my mother and our family, thank you all so much for coming today. The love and support that you’ve shown us over these last 3 years and especially these last few weeks has meant so much to us. There are some who couldn’t be here today, and so we’re videotaping this message, so that they might hear - provided I don’t become a blubbering idiot - I do reserve the right to edit or delete that tape! Thank you, all so much. 

I don’t think many of you realize the real reason you are here today. In fact, I feel lucky that I happened on it myself. Just the other day, I stumbled across an unusual Twitter feed. It was from God - I bet you didn’t know God had a twitter account! It seems that God had tweeted that heaven was having a bit of a problem -that nearly all of the projects in heaven were nearing completion. So the following message was sent down: Needed, an ambitious worker to start projects that seemingly have no end, hashtag heaven help us. Now, the angel Gabriel responded quickly saying he had the ideal candidate and his name was Donald Joseph Forwith. But God, probed saying how do you know this is the right man for the job? Gabriel responded that he had visited in a dream the person who knows him best, who’d been his high school sweetheart, who’d been his best friend, lover, and life long companion. Someone who’d he’d laughed with, teased, yelled at, and worried over. In fact, he’d dedicated his whole life to her - 52 years of marriage! So, who would know him better than Carol Baker Forwith? So, Gabriel asked her in a dream, could Don be our man? She responded with confidence, “Lord, he’ll start so many projects it will take an eternity to finish them all.” And the Lord said, then it’s time to call him home. 

My name is Keith, and I’m Don and Carol’s oldest son. I live in Louisville KY where i practice medicine and with my wife of 24 years have raised four daughters. A few weeks ago, I discussed with my Dad the content of this eulogy. It may seem an odd thing to do, but it turns out that Dad had a few things he wanted you to know. So, what you are about to hear is a little bit of me, and a whole lot of Dad. Some of you may not like what you’ll hear, but Dad always told it like it was, whether you wanted to hear it or not. I will talk about some matters that involved me, in fact, in a little while,  I’m going to read you a short letter that he wrote to me just a few years ago, before he even knew he had cancer. I want you to focus on what kind of man would write these things and what it says about him. 

My father was not a highly educated man, he pretty much went to work after high school and set about the business of providing for a family. Because he didn’t pursue higher education, he often would comment that he wasn’t an intelligent man. But make no mistake, Don was very smart - especially when it came to that not so common characteristic of common sense. Dad could fix anything or at least start to. I was inspired and pushed by my Dad to do a bit better in the education department. For those that don’t know, I have a Bachelor’s in chemistry, a PhD in biochemistry and a medical degree. But, after all that - if I thought myself a wiser man than my Dad, well - I would be a fool! So, I’d ask - or warn - each each of you. Don’t dismiss what this wise man thought to be important.

Dad realized that his time was near four days before he passed. He knew his time was limited and his doctors had warned him he’d finish life in a coma. So, what does a man say when he realizes his remaining words are few? Dad talked about love and family. He said the most important thing in this life was to love one another and not to let anything stand in the way of that. Dad had faithfully read his bible, especially over the last three years. In the gospel of John,  Jesus states “My command is this: Love each other as I have loved you. Greater love has no one than this, that he lay down his life for his friends.” Laying down one’s life for those he loved is something Dad did on a daily basis. I remember a good portion of his life, he’d head off to General Electric where he knew his work didn’t provide the kind of challenge and fulfillment he’d dreamed of, but that job and his dedication to it provided for his family. His work ethic was unquestioned, something that I learned a bit of and it’s served me well. 

Many of you recall that Dad nearly lost his life in a horrific chainsaw accident. What he suffered in that event, has shaped my life perhaps more than any other moment. Dad’s pain, his recovery, my mom’s courage through it all and her dedication to him shaped my life in so many ways - we wouldn’t really have time to scratch the surface on this one. But, while Dad took pride in what he did, he was a humble man. He allowed a seeming tragedy in his life to change and shape him. And I noticed as a young man that his change was for the better. Life was more cherished after that, and Dad’s love for us was more evident. In his suffering, we all benefited. 

I would like to read an excerpt from a letter he wrote me about five years ago. I attended a retreat at my church and Dad, in an unusual moment of openness, wrote me the following letter. Let me warn you, I couldn’t get through this letter when he was alive and healthy, so I may struggle now but here’s my best effort:

Don wrote: “While pondering on what I could talk about it came to me to tell you how my life as a young man became part of your life. 

I was around 18 to 19 years old when I got my first job. My job centered around a lot of other people, both men and women. I started studying everyone’s personality and picking out their good and bad points. I thought if I could develop their good and avoid the bad I could grow into a good man. While this sounds easy, it certainly isn’t. It seems as good comes some bad tags along. I learned each of us has to struggle with their own life and pray to God for help. In my studies of people, one particular man stood out from the rest. He was an engineer that seemed to overlook everything at the factory when he walked through the door. A happiness was about him. He would speak to everyone no matter what their job was or where they came from. He wore regular clothes and never showed off his above average intelligence. I noticed how everyone liked him and enjoyed being around him. His name was Keith. 

I prayed to God asking him that if he ever blessed me with a son that he would be very intelligent and yet be modest, respect others and being respected himself. He would have high morals, love life and respect it. I prayed he would be blessed with a family and love them with all his heart, to always love his wife and respect her, to be true to her, to have God at the center of his life and others would see this godliness in him and thank God for him and that everyone would enjoy his company and his intelligence and he would never degrade them. This was my prayer to God. 

Well, as I was developing from a boy into manhood, my thoughts were what I’d like to be. An engineer or a doctor would be my dream. As time passed I knew that I didn’t have the intelligence or finances for this to ever happen, so once again I prayed to God. I asked that if I couldn’t be a servant to his people that he would let my son do his work through him. I asked if I wasn’t chosen to be his servant that my son would be. I asked God to bless this son and teach him to heal the sick. Before you were even conceived your destiny was prayed for. When you were born a prayer was answered and now I know I can look back and remember that God listens to our prayers and answers us with his blessings. 

Before you draw a drop of blood from God’s people stop for a moment and ask God to be with you, to fill your mind with knowledge and to guide your hands. God will give many rewards and blessings for being a servant to his people. 

Even if you are far away, you are in our hearts and our love. I’m very proud of you, Keith and the life you lead.

Love, Dad

That, in a nutshell, is Donald Joseph Forwith. A man who laid his dreams aside to provide a path for his son to reach his dreams. A man who suffered in quiet dignity and taught his son and family lessons even to his very last day. I thought it fitting that at the moment he died, I was seeing patients in the clinic - carrying out his dream and mine.  

My family at our last holiday with Dad, Thanksgiving 2012Today is a joyous day. Dad is in heaven with Jesus and no longer in pain. He has already heard the words “well done, my good and faithful servant.” He is happy. But, he wanted me to tell you something. Don’t think of him as in a better place - he’s in the best place! The only sad part of today, is that some of you may never see him again. To see him, you’ll have to go to heaven because that’s where he is. I say that with certainty because I can. You see, we’ve slipped into this false idea that good people go to heaven. Especially at funerals, we like to think of the good in people. Today, that should be easy as my Dad was a very good man. But, that is not why he’s in heaven. He wanted you to know, he wasn’t good enough for heaven. I joked with him that I could make a long list of why he shouldn’t go to heaven - but of course, today is not about Dad’s weaknesses or sins. Dad is in heaven because he was forgiven. Good people don’t go to heaven, forgiven people do. 

Dad was forgiven because he accepted the sacrifice of Jesus Christ.  His trust was in the Son of God who gave himself up so that our sins may be forgiven. Jesus suffered so that we all would benefit. It is by God’s grace that Dad was welcomed home. Dad wanted you to know, each and every one, that he wants to see you again. He wants to welcome you home. He told me at Thanksgiving that the only fear he had of dying was that he didn’t feel he’d talked to the people he loved enough about the saving grace of Jesus. So, I would like to close by asking you - are you one of Dad’s unfinished projects? Would you rather believe that this man of wisdom was a fool? Would you set aside the very foundation on which he based his life? I promised Dad I would continue to work on this project - to tell you in no uncertain terms, that heaven is real, that God loves you, and that Jesus has paid the price for your admission ticket. Don is waiting there to rejoice if and when you come. Don tried to not die so that you would know this message - that Jesus willingly died to give you eternal life if you would only accept it.  I thank God for giving me an earthly father who showed me a glimpse of my heavenly Father’s endless love.  I pray that each of you will know that same love. God Bless you all. 

He is with his Savior!

My Dad passed at 9:43 am this morning after a three year battle with prostated cancer. He suffered quietly and privately (with the exception of his son blabbing about it on his blog and on Facebook). His pain is no more and by the grace of our Lord, Jesus Christ he is in heaven. Praise be to God!

I find it fitting that I was seeing patients in the office while he passed. I saw him last night and he wouldn't have wanted me to not be there for my patients on his account. Guaranteed, he'd see it that way - that's how he saw the world. I know he was proud of me for becoming the man I am, and the doctor that I strive to be. He would have been happy that I was trying to help others as he departed. He told us all -  "no tears for me, I'll be in a better place and relief will finally come." He said he knew he'd see me again - so long, Dad! Enjoy your journey - see you in God's time! 

He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away. Rev 21:4

Near Death, Near Christmas

My father has drifted into a deep sleep. His last meaningful communication was Tuesday when he told my mom goodbye. He was so sweet - telling her that he has always loved her. It's unusual these days to see a man die in the loving care of his high school sweetheart. He will moan a bit when getting turned or moved to bathe him, but otherwise rests comfortably in his bed. His pain seems to be controlled and our family has been gathered around, ensuring that he is not alone when that final moment comes. I believe it will be soon, I pray that will be so. 

For all the negatives we hear about modern communications, I must say that Facebook and the responses to this blog have been so helpful to me. It has been so comforting to know that people are praying for my father and family. I can't thank everyone enough for their kindness.  On Tuesday as he was drifting off, I read from the Bible - starting with some selected Psalms. I ended up consulting my FB page as so many had suggested great verses that were comforting. So, thanks for your prayers and I hope everyone has a blessed Christmas. I know my family will, as all this is part of God's plan. The joy of Christ's coming into the world is celebrated at Christmas - we will celebrate because His coming has granted my father salvation and eternal peace. That we know, and we can be sure of! Merry Christmas!

"I'm ready to go...if the Lord will take me"

Dad, 71, with his wife, Carol, of 52 years!Those were Dad's words when our family was called to his bedside yesterday. After three years with metastatic prostate cancer that is beyond hope of treatment, my father finally says that his time has come. Just two weeks ago, we talked and he said then that he wasn't ready to die, that he still had some things to take care of. But, last week he was stricken with blood clots in both legs - perhaps the worst I've ever seen. He can't walk 15 feet to the bathroom without extreme pain and as he says, "this is no way to live." So, when he began getting short of breath yesterday he said for the first time, that he was dying. He is in pain and suffering, and he says that it will be a relief when he dies - so we're not to be upset. Growing up, Dad was my baseball coach and I can remember him telling his very competitive son (that's me, of course) not to be upset - that losing was part of playing the game. That there will be victories and there will be defeats - that the game wouldn't be the same without them. So too, is life. We've had so many blessings to remember and cherish; cancer is a defeat but only a temporary one. 

Another victory came just last night. Dad's parish priest came to administer last rites. We crowded around his bed and prayed as the priest gave Dad his final blessing. We prayed and thanked the priest for his kindness. Then, my wife - who still suprises me with the depth of her goodness, began to sing. She started Silent Night with a few reluctant family members joining in at first. But then came the deep, weak, slightly out of tune, voice of my Dad. The rest of us joined in and soon had gone through every carol we could think of. When we ran out of meaningful ones, we resorted to Rudolph, Frosty and the like. We were searching for song suggestions and lyrics on our smartphones and ipads. The music proved to be therapeutic for all of us. My Dad loved it!- he'd join in on random lines here and there. The music ended with my wife and daughters singing Breath of Heaven as Dad drifted off to a temporary sleep.  We soon said our goodbyes, perhaps for the last time. 

As hard as it may be, I try to follow his counsel not to be sad.  Afterall, he's suffering - his pain is constant and his quality of life is poor. I know that I will see him again as he knows Jesus and trusts in His saving grace. He knows where's he's headed and now says he's ready to go. So, now we're waiting to see not if, but when the Lord will take him. I pray it is soon, as Dad wants to go. He has run with perserverence the race marked out for him. He is in the Lord's hands - in that we can trust and be thankful.

But you, man of God, flee from all this, and pursue righteousness, godliness, faith, love, endurance and gentleness. Fight the good fight of the faith. Take Hold of eternal life to which you were called when you made your good confession in the presence of many witnesses. 1Timothy 6:11-12 NIV

An answered prayer

Radiologist and friend, John Hutchinson MD in the conference roomI've been trying to stay upbeat these last several days. Things here have not been going as I'd like. Certainly, I'm not in control of this situation over here! I've seen so many people that I could have helped - if they had presented 6 months ago instead of now. I've lost track of the number of patients that are too advanced for any hope of a surgical cure. For these impoverished areas, it is rare that patients have the money to travel to Nairobi and pay for radiation therapy - something even the uninsured in America would get. So, if there is not a surgical cure, most cases there's not a cure at all. I've spent too much time helping the surgery residents explain that there's nothing that can be done for them. Their life is in God's hands and they will be healed, but maybe not on this earth. I believe that God can cure any of them, if it be His will. Ironically, my tea bag at dinner tonight had a verse on it: For my thoughts are not your thoughts, Nor are your ways My ways. Isaiah 55:8 If I were God I'd cure every last one of them! But, certainly I am not and I don't understand His plans. But, I know that He has plans for each one of these people.  

So, I have prayed the last several nights for just one victory. One patient who we can save. Just one, please! Well, today God gave me what I prayed for, but not exactly as I thought it would come. The man came to us with difficulty swallowing for over a month. I was working with a family practice resident, Dr. Castro Mugala, whom I admire very much. Unfortunately, I had been able to show him several types of head and neck cancer - all unresectable (too far advanced for surgical removal). This patient was actually no different. His tumor started at the back of his tongue and came all the way forward to just behind his teeth. He couldn't lift or move his tongue on the right side because of the cancer growing just under it. His neck was full of metastatic nodes and the tumor had invaded his mandible (jaw bone). He was having pain which radiated to his right ear. Cerainly, he was not a surgical candidate and even radiation would not work on this advanced disease, even if he could afford it. So, how was my prayer answered by this man? Dr. Mugala and I planned for hospice, discussed tracheostomy and a feeding tube for him. But, we also discussed the need to talk to him about Jesus Christ. I believe that the sacrifice of Jesus on the cross atoned for all of my sins and this man's sins. It is a free gift of grace that we need only accept. This patient, whose days are few in number on this earth, accepted Christ right there in the clinic. He got on his knees and prayed with Dr. Mugala in swahili - oh, how I wish I could speak swahili! Later, a chaplain came to follow up with him and he left just after getting a bible - in his own language! 

So, my prayer for victory was answered. Not through surgery, but through the saving grace of my Lord and Savior Jesus Christ. Yes, he will die - as we all will. But this man came to Christ today! I smiled all morning because what he recieved today is more precious than any surgery or cure. His life will now be eternal! God, indeed does have His ways.

I know the plans I have for you, declares the Lord, plans to prosper you and not to harm you, plans to give you hope and a future! Jeremiah 29:11

It's Midnight in Kenya

It's midnight in Kenya and I'm wide awake! I've had trouble sleeping these last few nights so I'm short on sleep, fatigued,  but somehow not tired. Perhaps the half cup of chai at the Men's bible study tonight was not such a great idea! But, I've only a few days left and chai is such a special part of this place. Perhaps their tea fetish is remnant of the British colonial days. The altitude here is above 6,000 feet and I typically sleep fitfully at higher elevations. My bed is exactly 6 feet long and I'm exactly 5 foot 10 inches so there's not room to spare before Im kicking the footboard. The mosquito net makes a cozy little nest but sometimes I wake up with it on my face or tangled in the blankets. Ok, so I'm rambling... but it's midnight and I'd rather not think about the fact that I'm loosing way too many battles over here. But, that's a post for another day. Time to pray, think of my wife and girls, pray again, read, and perhaps dream. God Bless, everyone! Goodnight!

Wedding Day!

After my last post, I had resolved not to let my impatience get the best of me. So, on Friday I was calm and not concerned that we were more than two hours behind schedule. I was enjoying operating with a young resident who was eager to learn. I love to share with students and residents who are hungry for knowledge and wisdom! I think that they bring out the best in me. As we were close to finishing, a wedding invitation was delivered in to the OR. Two residents who I had known from previous visits to Tenwek saw me arrive Tuesday and had sent an invitation to me. If we had been running on time, I would have missed the delivery! I was honored to be invited and certainly wasn't going to miss my first opportunity to attend an African wedding! 

Earlier this year as I was preparing for a mission trip to Nicaragua, our team leader recommended the book Foreign to Familiar: A Guide to Understanding Hot -and Cold -Climate Cultures. Turns out the book was exactly correct in its descriptions of cultural differences. The invitation states the wedding begins at 10:00 am. So, being the cold climate creature that I am, I showed up exactly at 9:00 to catch a ride with the White family to Kericho - one hour drive away. The Whites are long term missionaries here and they knew better. Beth White was still feeding children breakfast and hadn't started getting ready yet. She informed me that the bride's mother was still in Nairobi and that it would be at least a couple of hours! I returned to my room to do some reading and remembered the book's description of this very situation. We left three hours later and arrived just on time to the wedding. A full four hours past the stated start time. According to the book, this was typical because hot climate cultures regard the start of the wedding as when preparations begin - the arrival at the church comes later - well after the start of the event! I spoke with a few residents who confirmed that it's always a guessing game as to when the bride will show for the wedding. Four hours late was not out of line! TIA!

Mike and Liz are both first year surgical residents who have centered their life around serving the Lord and His people. Their day and their ceremony were likewise God centered. The wedding was outdoors and began with the typical bride processional. The biggest difference was the women who did this high pitched trill that is unlike anything we do in America! The groom awaited at the front of a small tent which was lined with about 50 chairs that formed a small aisle. The tent provided an intimate setting for the ceremony. The bride's mother then gave her away with a short speech that was heartfelt and moving. She described Liz as her only jewel and asked for God's blessing on her new home with Mike.  A worship team offered two Swahili songs which found everyone in strong voice - except the English only speakers like me. One thing that's been abundantly clear is that culturally, Americans have a hang up about singing and dancing. These Kenyans sing with an abandon which I envy. Most have good voices, but the quality of the voice doesn't determine a person's volume as it does back home. Singing is for celebrations and enjoyment is for everyone. Wish we were like that! 

The ceremony had the typical elements of sermon, vows, ring exchange and candle lighting. The newlyweds were announced by the pastor and the emcee took over right there in the church tent. He had them dance, not walk, down the aisle followed by the wedding party and family. It sounds like a stereotype, but there is no doubt that Africans are blessed with rhythm. I could have watched them process all day! Age is no barrier, kids and elderly all dance with ease and grace. The only awkwardness I saw were the white folks whose attempts were, to be kind... lame! I was safely behind my camera which was probably best for everyone! 

A buffett was served while the wedding party disappeared for pictures. One of the coolest parts was when the couple returned to the festivities. The women went out to escort them in. A Swahili song was sung by the crowd as they danced their way in a parade that encircled the grounds for the next half hour or so. Two or three songs were sung, with never the need for any instruments other than the voices. Harmonies, rhythms, and melodies blended together as the party danced it's way around in no particular hurry. The bridal party nestled under a tent with the head table. Their meal would be followed by gifts, toasts and more dancing. Unfortunately for me, we had to hit the road back to Tenwek. Missionaries are not permitted to drive after dark (for safety reasons) and the late started meant we'd miss some of the festivities. We arrived back just before dark at Tenwek.

I feel so honored to have been invited. The love of family and friends was so abundantly clear to me, even though I understood none of the Swahili that made up most of the conversations. Africans are really good at relationships and family. They celebrate without reservation and take joy in the simple act of spending time together. Time is not their master. Life is often hard in Africa, but days like today are for celebrating the love of friends, family and God. Their remaining surgical training will be difficult and once finished, their lives will be taxed by the overwhelming need of their community. I pray for God's blessings and protection of their marriage. I know that they will be a blessing to so many in their lives and surgical careers. 

A painful withdrawal from my addiction

I love efficiency! I crave it! I spend a good deal of my normal days figuring out how to be more efficient. When I operate I have everything planned out. Like a chess match, I know my next moves and am planning for all the variations that may thwart my plans. I even have figured out how to hold my open hand in certain unique positions so that my scrub tech can tell what instrument I want without me saying it. Afterall, an extra 2.3 seconds of me speaking the word and her hearing the word means inefficiency. So, I get a great feeling when an operation flows smoothly. When every detail goes as planned and everthing flows it gives me an indescribable feeling of satisfaction and accomplishment. Efficiency means less anesthesia time and less risk to the patient. Efficiency means protecting critical structures and operating strategically. Mistakes slow you down, so I've honed my technique knowing that efficiency is surely a Godly attribute! 

Kenya is not the place for me! I nearly went into convulsions today over efficiency withdrawal! I spent too much time thinking of all that needs to be done while realizing all the obstacles that are standing in the way. I did three operations today that consumed most of the day! Three 45 minute cases in an entire day! I felt like crawling out of my skin! In one case, I walked into the room to see the nurse sitting on a chair, seemingly content. The instruments I needed weren't in the room and opened. The injection wasn't drawn up. No gloves were pulled for the case. The Mayo stand wasn't prepared. In fact, she had done absolutely nothing - nothing to prepare the room, nothing to help the surgeon or anesthetist, and nothing to help the patient. I then recalled that I remember her pretty much doing the same thing last year; so why was I surprised? In fact, I've spent enough time here that I should have expected all this! 

But that is the intellectual side of my brain reasoning over the situation. My heart and my ambition were screaming "let's get to work! let's help some people! I didn't come half way around the world to relax! I only have two weeks here and my time is valuable!" Funny, I had a similar feeling three weeks into my stay last year - when I only had a week or so left. I remember telling myself that "this is a waste, I'm never coming back, these people don't appreciate me, these people aren't helping themselves!" But, this is Kenya. Kenyans don't see things my way. They are in no hurry; they don't understand why I would rush by and not visit. They don't seem to compile checklists each day. Their culture is not mine and I'm called to honor theirs - and that is not always easy! So, I returned to my room late afternoon and succumbed to the jet lag and took a nap! Those of you that know me well, know that I don't nap! Fortunately, the ER had an emergency and I was paged out of my nap. Yes, I'm still tired, but now there's a need - a chance to get something done! A chance to feed my addiction! Turns out, it was just a simple nosebleed that was well managed before I got there. No excitement, but I think I'm ok now. 

Just had to get that off my chest. I'll pick up tomorrow trying to work within the system and help where I can. I just have to take it a Kenyan pace. I have to shred the mental checklist; I have to stop the mental comparisions (if my OR team at home...) I have to trust that God put me here to serve, not to dictate. So, when frustration comes, I'll just shrug my shoulders and say "TIA!" (This is Africa!) and I'm glad to be here. 

Not all surgeons are created equal

The familiar smells of Kenya hit me the moment I deboarded from the plane in Nairobi. Everything on this trip so far is very familiar to me - in a back home again, comforting sort of way. The trip to Tenwek took about 4 hours; friendly faces welcomed me back with a number of "karibu(welcome) Dr. Keith" refrains. After a quick lunch I headed to clinic where it took less than an hour for me to be shaking my head in disbelief. This afternoon I saw 4 cancer cases - two of which had incomplete operations recently at government hospitals. 

One patient had a vocal cord paralysis from a botched thyroid operation. She had several extra scars from where the previous surgeons had carelessly cut through the skin as they were raising the subplatysmal flaps. Ironically, this is one of the easier parts of the operation! Not surprising that the most delicate part of the procedure was not performed well. 

I want to emphasize that these were not Tenwek surgeons. The surgical residents I've worked with here are outstanding. It mainly motivated me to keep coming back to help train these young physicians so that disasters like this aren't inflicted on these poor people. The worst part of this is that her thyroid cancer has spread into the lateral neck. God willing, we will be doing a much bigger operation to save her next week. 

This 26 year old gentleman was told that they completely removed this tumor - just over a month ago! Obviously, that was not the case. He had two different nerves paralyzed by the poor surgery. The ending on this one may not be so happy. We need a CT scan - which he says he can't afford - to determine if there is a chance of a life-saving operation - which he can't afford. 

Each year I come, I bring extra money to help patients get the care they need. Each year I get here and realize that I haven't brought nearly enough! This year the exchange rate changed dramatically so I have 37% less than I anticipated. Even so, it is always challenging to know when to offer and when to hold back. The culture here is much more communal and most patients have to rely on their relatives or village for surgical funds. And this is not neccessarily a bad thing. So, when to offer help is a tough decision. I especially worry that a more heartbreaking story or situation may present tomorrow. Triage with your funds is a painful process! Wisdom in this area is something I will pray for tonight.

In the USA or in Africa, surgical residency is a demanding 5 year process that truly matters. Residency is the process where doctors become surgeons. It is not overdramatic to say that lives are on the line. Poor training leads to unneccessary suffering and poor outcomes. Life here is tough and both these patients deserved better. The surgical training that PAACS offers these African surgeons rivals the quality of American programs. As more PAACS surgeons graduate and begin working in their communities there will be fewer of these tragic cases. That is a reason for hope and the reason I continue to return. 

Return to Africa

Several years ago I realized that life was quickly sailing by and some of my longstanding intentions were sitting passively on the sidelines. So, after a particularly convicting message from Dave Stone at Southeast Christian Church on the second chapter of James, I decided to make a change. I started by attending the Global Health Missions conference which is held every November at SECC. To make a long story very short, I truly was urged by the Holy Spirit to do something I thought I had no heart for - take a mission trip to Africa! So, now I sit in the Detroit airport just moments away from my seventh mission trip and fifth one to Africa. I am anxious, but not nervous. I've done this before, afterall. But, each time the people are different and the circumstances are different. It is always challenging both medically and spiritually. I hope to make a few entries while there and probably some after I return. As always, I will try to be brutally honest in the hopes that my experiences can inform, inspire, or even convict those who join me in caring about these people. My mission is simply to do what God asks me to do, knowing that he has equipped me for the challenges ahead. In everything I write, I hope you can see that God is at the center of this and His purposes will be fulfilled. I am honored that He has allowed me to be a small part of His story. Now, it's time to board so I'll close by asking for your prayers in the days ahead. Peace and Blessings!

 What good is it my brothers, if a man claims to have faith but has no deeds? Can such faith save him? In the same way, faith by itself, if it is not accompanied by action is dead. James 2:14, 17

From weddings to funerals

It doesn't seem that long ago that Sue and I were spending our summer days traveling to attend weddings. We had to mark the calendar carefully so we didn't miss anyone's big day. Weddings are happy, joyful and forward looking - reasons to celebrate! But as time has passed, the wedding season of our lives diminished. Now, a new season seems to be upon us - and it's not one I welcome in any way. Seems we're at the age where funerals have come to clutter our calendar. I've recently lost an uncle on each side of my family. 

Most recently, our family vacation was interupted with a 7 hour trip to my uncle Harold's unexpected funeral. Unlike the politeness of weddings, funerals give you no warning and demand you drop everything. They quickly shake you to remind you that we are not in control and that life can't be fully planned. Our days are numbered, but none of us actually know what that number is. Funerals are rude, impolite, backward looking and reasons to mourn. I think I really prefer weddings!

But, I've decided to try a new outlook on funerals. My friend, Bob Myles, passed away last week. I met his stepson and explained that Bob and I were friends from Rough River. Bob was the kind of guy who was your friend if you've spent more than a week and a half or so at Rough River. His smile was both infectious and mischevious. He was either making you laugh or planning to make you laugh. At his funeral we got to see some pictures from his childhood. To our amazement, his warm smile was seemingly identical as a toddler. At 55, Bob died way too young. Bob was the kind of guy who admits his mistakes. As he puti it, he was a smoker who quit too late. Lung cancer took his body, but not his spirit. So my new outlook on funerals is to go back to the basics. Trust God in all things - and learn from those that I've been blessed to know. I'm glad I knew Bob Myles and feel blessed to have called him a friend. 

No empty chairs at dinner!

For so many years, the six chairs around our kitchen table were filled. First, with little girls spilling, making messes and needing their meat cut up. Next thing I know, we're paying college tuition bills and a chair is empty most of the time. But the other five were filled and life goes on. Then, a second chair became empty as another daughter venrured off into the world. Suddenly, the girls filling the chairs didn't outnumber the girls missing from the chairs, and the time passing begins to seem accelerated! Removing a leaf from the table still didn't bring back the complete feeling of a family. 

Allegra returned Wednesday night and her Mom and little sister returned from a school DC trip last night. So, for the first time in a long time every chair was full and there were no empty spots. We prayed and thanked God for his loving care and protection. A lot has happened and safety wasn't guaranteed. It truly is a blessing to have them all home, even if it's just for a little while. I realize these days too, will become shorter and shorter as the next girl already considers where her next chapter will take place. So, for now I'm just enjoying the crowded table - realizing that some parents don't have their kids come back. Some fall to illness or tragedy and the chair remains empty. God's grace has spared me from that kind of pain and I thank him for his goodness. Nothing in this life is certain, so I'm focusing on this day and the abundance of blessings God has given me. 

Nicaragua becomes a family affair!

In just a few days, my oldest daughter Megan will journey with me to the southern part of Nicaragua as part of a large medical team. Megan is a sophomore at Xavier and will serve as a translator; two years ago she lived in Spain where she had a tremendous cross cultural experience and learned Spanish while living with a loving family.Megan with her 'Spanish sister', Sylvia

As for me, I'm not quite sure what to expect. This trip, organized through Global Health Outreach (part of the Christian Medical and Dental Association) will have 15 MD's, 5 dentists, a bunch of nurses and support personel and many students. A total of 68 people will arrive on Saturday in Managua to form the team that will venture south to near the Costa Rican border.  This is not a surgical trip, so I'll mostlly be using my medical side. I'm taking a small surgical set with me, just to be prepared! Hopefully, I'll get a chance to share some of that experience. 

Allegra in Chinandega, NicaraguaMy second daughter, Allegra, is spending the spring semester in the northern part of Nicaragua.She keeps a blog at the Adventures in Missions site.  She turned 19 yesterday and reflected on her 18th year of life. I am amazed at the work that God has done in her life. Much like last fall, I will likely find myself in the same foreign country as her, but unable to connect. Seems to bother dear old Dad more than daughter!

 So, please pray for our family and the work God has planned for us in Nicaragua. So many times, I set out on an adventure such as this hoping to bring a positive change, only to discover that the real change occurs in me. I pray that Megan will have that transformational experience through our encounters with the people of Nicaragua. I humbly ask for your prayers for our team and Allegra's team that our talents and efforts can bring the love of Christ to people in need. Please pray for the many medical and dental students that will be part of our team; pray that their lives will be molded by this encounter into lives of service and thankfulness.

One more day...

It's been exactly a month since I returned from my last mission trip. It was my third trip to Africa, the first being two weeks duration, the second was three, and most recently a month. But, despite my increasing time spent there, it was just not enough. Throughout my last day there, people kept coming for evaluation. Most were routine problems, but one lingered in my mind. A lady showed up with a tracheostomy (a breathing tube in the low neck) that had been placed earlier. She had fairly extensive larynx cancer that had not yet spread into her neck but was progressively blocking her airway. The tracheostomy allowed her to breathe below the blockage. Larynx cancer often will not metastasize (spread) until late in the disease. She needed a laryngectomy - which given that she had no evidence of disease spread in the neck, would save her life. But, she had already eaten when she showed up in the afternoon, the OR schedule was full, and  I was scheduled to leave early the next morning. A laryngectomy is not within the skill set of general surgeons. The next ENT to visit Tenwek will likely be in February. The only treatment alternative for larynx cancer is radiation therapy, which is available in Nairobi.  But the costs of travel, lodging, and treatments far exceed this woman's financial resources. If she had only shown up one day earlier, we could have offered her a life saving operation. Instead, she'll return in February with the hopes that her cancer is still surgically curable. 

While this was not as devastating as last year's final day at Tenwek (chronicled below), it serves as a painful reminder of how desperately needed surgical care is in Africa. The mission of PAACS to train and disciple surgeons to serve the poor in Africa becomes dearer to my heart with every day spent there. The long plane rides home gave me plenty of time to reflect - and to begin  planning for my next trip. God continues to open my eyes to see both the need and the ways in which I can help. Your prayers for the people, the young African surgeons in training, and their American mentors are so needed!

Cars, Cats, Kittens, and Kids

Well, I had quite the adventurous weekend. I had no clinical duties Saturday or Sunday so I jumped in with some The first of two flat tires!visitors who just arrived and went to Masai Mara for a Saturday evening and a Sunday morning game drive.  In the morning, we arose early to go to a remote area, hoping to see some lion cubs. Before departure the driver had the hood open looking for a sound that he thought was a cat. Sure, enough I soon heard the same meow sound, but we couldn't find a cat anywhere. Perhaps a bird, an engine squeak? We proceeded along without finding the answer.  Half way there it becomes apparent we have a flat tire. No big deal, except when we went to change the tire I noticed a hissing, air leaking sort of sound coming from the rear tire. This was intermixed with more meows that seemed now to becoming from behind the dash board. So, there we sat in the middle of a road, in the middle of nowwhere with two flat tires, one spare, and a hidden cat in or under the vehicle. About 45 minutes later another safari vehicle came and we were able to get two very old tires with little tread to replace the two very old treadless tires that had leaked. Yes, we were now heading further out with no spare and two flats strapped to the back of the Land Rover. This is not the cat that induced fear.

As we get into the area where the lions were known to be, our driver suddenly hears the cat next to his door. The driver radios another driver and the two of them are outside the vehicle, in lion country, looking for a cat. Then, the drivers see a tail - but it turns out these big, burly safari drivers are afrad of cats! No, not the big carnivores we were hoping to see. No, they were afraid of a domestic cat! Wanting to get on with it, I get out and crawl partially under the vehicle, as I am only afraid of the big cats - you know the kind that would feed on a pair of legs hanging out from under a safari vehicle. I see the tail, reach up and grab the rear of the cat and pull - it's a kitten. My size 8 hands cover nearly the entire body of his cute little kitten. 

Crisis averted, I'm anxious to get back into the safety of the vehicle and not become some lion's breakfast. The driver wants me to set the cat in back of vehicle while we drive off! Leave, a poor helpless kitten to become snack food! Now, I'm no cat lover, but even I can't do that! So, I casually walk around the vehicle and set the kitten in the back of the vehicle for safekeeping until the safari is over. Crisis strikes again! One of our traveling companions sets a land speed record for evacuation from the third row of a safari vehicle. Before I was even to my door, she had bolted through the middle of the seats and jumped out of the window! Now, she's wide eyed, petrified, and standing 15 feet from the vehicle! Who knew so many people were afraid of kittens! Now, there's a driver and a passanger standing in the savannaugh, refusing to reenter the vehicle because of the kitten! So, I have to retrieve the now frightened kitten from under a seat. So, a brief standoff occured where I decided it was better to leave a kitten for lion food than a pediatrician and safari driver. So, I tossed the kitten out of the car and it retreated behind a bush. Before we could reload, the kitten was back into the undercarriage of the truck and the meows continued.  So, the rest of the morning was spent looking at wild animals, including lions while the kitten purred in fright under our vehicle.  

Back safely at camp! Unharmed by the fierce kitten!

We arrived safely back to the camp and later departed for Tenwek. Our vehicle troubles were not over! About a third of the way back our vehicle begins to smoke - mostly out of the exhaust. First signs of trouble! It would get worse!

We stop and the driver says that the engine had just been serviced and that too much oil was put in. No problem, it will burn off and we reloaded for the remainder of the trip. So, we thought. The optimist in the bunch pointed out that at least it wasn't raining nor was it dark.

Not 10 minutes later the driver tries to shift to a lower gear and the engine suddenly revs to it's maximum rpm's. The vehicle begins to smoke and one of my companions starts yelling "turn it off, turn it off!"l 

But, the engine is not interested in shutting down and continues to roar at maximum rpm like a child throwing a temper tantrum. The next yell was "everybody out!"Naturally, I can't leave my camera gear behind in an emergency so as soon as my friends and I are out of the jeep, I snapped this picture! The driver finally gets the car to shut down by popping the clutch. Our vehicle is officially dead! 

Our entertainment arrives!We debated walking to the main road with our luggage - one of the locals said it was "not far", only about 10 km. Luckily, we had cell phone service and made a call to Tenwek for help. Word was we'd have help in only 5 minutes! Wow! we must be closer than I thought. We decided not to walk, and just wait it out. Then, it started to rain! Well, turns out time and distance estimation are not Kenyan strong suits. The rain let up and we got back out of the burnt smelling vehicle to find several spectators. Several local men began offering opinions on the problem with the jeep. A motorcyle appeared with some tools. We all agreed we were not risking another ride in the big green smoke bomb, even if they fixed it - which they did not!

Kenyan men of GodSo, five minutes was now twenty and we decided to have some fun with the local kids. We started with pictures, moved to videos of them dancing, then to games. We taught them duck, duck, cow because no one here knows what a goose is. A group from a church walked by and we talked with the men and the pastor for a while. We then got back to the kids and traded songs.

We sang Our God is an Awesome God, and they sang the hip bone connected to the thigh bone song - about 5 times. We sang Jesus loves the little children, they sang some Kipsigi song whose title translated to God is a Lion. Literally, two hours passed and we were still playing with the kids when a Tenwek vehicle showed up! 

Kipsigi girls were happy to see us!the crowd steadily grew as our wait approached 2 hours!

So, it turned out that our vehicle breakdown was the best part of our trip. Our misfortune turned into a true blessing from God. We shared what we could with the locals, and they in turn blessed up with smiles, laughter and lifelong memories. The six of us and our luggage then crammed ourselves into a Honda CRV - yes, seven adults of in a small passenger car.  

The sunset as we were nearing Tenwek

But we were happy to be moving as darkness was setting in. Turns out we were 31 km from the main road. That's over 18 miles we would have hiked with luggage and darkness setting in! Not to mention, there were two forks in the road and I would have definitely taken the wrong road at the first divergence point.

Our friend from Tenwek, upon hearing of our vehicle troubles throughout the day, asked which one of us was the Jonah? I love a man who knows his bible! So, in the end, we were all happy to have broken down and partaken in God's clever plans! 

Back home again

This is Sue, Keith's wife, writing now. Returned this past Sunday and still waking at 4 in the morning. Don't know how others shift so quickly back to local time!

I wanted to also blog during our stay but internet was just so spotty. Then, grand hopes of sharing pictures and stories upon our my return only to find that in all our camera swoping/sharing with others, I didn't come home with the right camera card. So, pictures of my outings will have to wait.

This picture was taken in the church on the hospital grounds. Keith had run up to check on a patient at night and quickly came back to get me. Being the only white people sitting in the back of the church experiencing the praise and worship music and then the preaching in both English and Kipsigis was awesome. This little girl kept running back to me.

This is my second trip to Africa with Keith. Our first one in Feb of 2010 we visited 3 different hospitals in Kenya and Ethiopia. While I loved that, we didn't get an intimate look at any given place. This trip was a bit different. While I was only there for two weeks, I got to know the surroundings and some of the locals more. Not being medical and confined to the hospital, I sought after experiences that Keith never got to experience....

....helping to weigh babies in a village from a scale hung from a tree

....being in a vehicle that is constantly dodging donkeys, cows and people along the rough roads

....going on followup bio sand filtration visits into mud and stick constructed homes

....being serenaded by little preschools singing Jesus songs

....visiting 2 orphanges and witnessing the love the caretakers extend to these kids who have nothing

....seeing the scared look of little ones who had never seen a white person before, let alone a blond

....testing the drinking water from several sources with a testing kit I obtained from Edge Outreach http://www.edgeoutreach.com/  before going . Most disturbing was a spring that the locals said was "clean water" only to find it has all kinds of bad things in it

....going into some of the local churches with dirt floors, rough wooden benches, & open windows

....being invited as the first white person into a teachers home (by our standards a shack really) who insisted on having us talk via cell phone to her father, mother, fiance' and friend

I found these people who have materially practically nothing, live to survive, but many have the faith as big as the plant from a mustard seed. A great challenge to my faith.

Hope to share more upon Keith's return.

Overwhelming need

Since returning from Safari, I've been extremely busy. I gave 4 lectures in three days. Since Tenwek now has a CT scanner (just opened 4 days ago) I taught a session on reading head and neck CT scans. Tuesday I taught on Head and Neck disorders - a topic that covers most of my specialty, but I thinned it down to 45 minutes by skipping nearly everything! Also Tuesday I taught a lunch session with clinical officers on handling nosebleeds. Wednesday morning was a session on Approach to Neck Masses. Again, a huge topic boiled down to 30 minutes. 

I was relieved that they went well and I could focus on patient care the rest of the week. Wednesday after lecturing I repaired this baby's cleft lip. The result wasn't perfect - which is the only thing I'm not happy with, but the family was pleased and this kid won't grow up as an outcast.

It's a national holiday here in Kenya. Heroes day it is called. But, I've been working all day but at a more casual pace than most days. Only one trip so far today to the OR (or theatre as it's called here). A young lady who presented to casualty (their name for an ER) with 5 days of lockjaw. This wasn't the tetanus variety, but the kind that comes from a persistent open bite deformity. Her pterygoid muscles were in chronic spasm, so we had to put her under anesthesia to reduce her jaw dislocation. She really needs a good orthodontist as this is going to keep happening over and over again. Since that will never happen, a surgery where the jaw is essentially broken and reset to give her proper alignment may do the job. Problem is, I have no room on my remaining OR schedule for it. So, we put an elastic bandage on and will see if she can get some banding and elastics from dental clinic after the holiday.

Being the holiday, I'm working without residents. So, I'm using nurses and nursing students as translators. In many ways, it made things easier as my words are getting translated directly, instead of being filtered by another doctor. They call me "daktari" which I believe is Swahili for "funny looking pale man." Some of the real young kids are genuinely frightened by my white skin. They sometimes cry just when they see me, then really wail in fear if I look right at them! I try to smile but maybe that appears like an animal bearing it's teeth. Come to think of it, my very presence used to frighten my nieces so maybe it's not just the white skin?

Finally, I want to close with the story of this young lady who we are desperately hoping to help. She has an aggressive tumor, called rhabdomyosarcoma. It's pushed her eye aside, is flling her sinuses and is growing near her brain. We're working her up today to determine if it has metastasized. If it has not, then we'll be operating on Monday to remove the tumor. 

It seems that God has put all the right people in place to help her. I was worried about whether this tumor was into the brain, but a neurosurgeon arrives on Saturday. So, even if it has, we might be able to remove it with a craniofacial resection - an operation not possible without this unique combination of visitors. We have a radiologist here, who has been valuable in studying the films to make sure we can accomplish a resection. Amazingly, we also have a pediatric oncologist here who is assisting in her work up. I am praying that this tumor hasn't spread. If we an remove it, she'll still need chemotherapy and possibly radiation, but she'll have a fighting chance. Without surgery, her prognosis is dismal at best. Your prayers for her are needed!

I still feel so blessed to be here! My energy levels remain high as I realize my time here is approaching a rapid end. My surgery schedule is full, but patients continue to come who need surgery. I wish there was a way to even things out. My first two weeks, when there were two ENT's here, we weren't overly busy. Now, Im wishing I had more time to help some of these very unique patients. I miss my family, but I know that they understand my call to be here and try to help. Thanks to all who continue to pray for these people and my ministry here.

Safari time!

No photoshop here, we were this close to this white rhino!The internet connection here has been nearly non-existent but I met with the hospital IT department today and I think they've found a way for me to blog! So, hopefully more stories coming soon. The weekend was a time to forget clinical duties and relax. What better way than a safari! So, our group of five headed to the Fairmount Mari Safari Club for an unforgettable weekend. We took game drives Friday evening, Saturday  morning and evening and Sunday morning. Friday evening we took a "walking safari" led by some National Park rangers. They carry AK-47's and guard these rhinos 24/7/365 from poachers. Legend has it that the horn contains a powerful aphrodesiac. Shame that they have to guard them so closely, but tourism is a huge industry in Kenya. These magnificent creatures are one of the big 5 that people always ask if you saw on safari. Our first night was magical - we saw 4 of the big five!

Not one of the big five but I never tire of these beauties! Zebras are like bison in Yellowstone - the first one you see you stop and take tons of pictures, then by the end of your stay your hardly paying attention to them. Unfair, because each has a unique striping pattern - like our fingerprints . These two were first scratching each others backs, then it turned into this neck biting activity. I learned from our driver that their spines are not sturdy enough for carrying water or packs like mules do. Probably why they've never been domesticated - but they sure are prettier to look at than mules!

The most elusive of the big five is the leopard. We saw this one on our first night! Our waiter at the hotel told us that some people stay for a week and don't spot one. I'd love to see one in a tree someday, but felt lucky to see this one so clearly. What a thrill! 

The greatest part of the safari was sharing it with my wife, Sue. Last year, I had a great safari but kept thinking - I wish Sue could see this. Well, this year she was here and got to experience it first hand. Despite the fact that I talked her head off about what I saw, she still didn't get it. You just have to see the beauty for yourself. The pictures just don't do it justice!

All good things must come to an end, and in this case it was bittersweet. I returned to Tenwek on Sunday, but my wife, the Murphys and Stephanie all returned to the airport to go home. Sad to say goodbye, even if it's only for two weeks. After great food and fellowship on safari, I spent Sunday dinner alone in the guesthouse. There are other guests here but I they were all scattered. I heated up leftovers and considered the stark contrast. My loneliness was brief though. I worked out, spent some extra time in prayer and realized that despite saying goodbye, I'm glad I'm still here. There is so much work to be done and I'm am blessed to have the ability to do it. God is so alive in this place - from the beautiful creatures to the desperate poverty. It is easy to be a believer here.  

Somewhere else in this vast country, my daughter Allegra continues her mission. Seems unfair to both be so far from home, in the same country, but not able to talk or communicate. I hope during her time she gets to see the magnificent wildlife. 

I hope to load more photos from our safari onto the Gallery section of this website. Tomorrow I'll be back to telling more clinical stories. Thanks for all the encouragement from those following along, it sure makes home feel less far away!

Hopefully, Sue will put some posts on this site. She spent some time in the villages and people's homes. So if you see Sue, encourage her to tell her stories, and tell her there's still two people in Kenya who love her and can't wait to see her. God Bless!

the Maasai baby

Shortly after arriving at Tenwek, the head of pediatrics showed up in the specialty clinic to see me. Seems he had an urgent case to run by me. In fact, so urgent that he didn’t page me, he just walked over to find me. The child had some swelling around the left eye that started the day before. The baby was brought to Tenwek, admitted and begun on treatment of IV antibiotics for infection. By the next morning the baby had severe swelling of the neck that was rising to just under the ears. 

Now, if Dr. Chuck Bemm walks from pediatrics to consult me, I’m certainly going to see the patient immediately.  I examined the child and found the worst swelling I’ve ever seen in an infant neck. I quickly passed a fiberoptic laryngoscope  to examine the baby’s airway. What I saw in the baby’s airway was shocking! The baby had a severe case of epiglottitis. That’s swelling and infection in the epiglottis - the flapper that keeps food out of your airway. Although rare, I’ve seen enough of these before. 

One of the advantages of doing mission work in the same place is that the locals get to know you. This paid off, as when I approached the OR charge nurse, my call for an immediate OR was taken seriously. They knew I wasn’t one to hit the panic button and quickly bumped a case to accommodate this baby. It was a struggle to get a breathing tube in, as the swelling was massive. In the OR I noted an odd, purple color of the epiglottis as well as some fibrous debris along the baby’s base of tongue. I collected it for culture and got the baby to the ICU. Later that day, I learned that the baby had anthrax! Yes, anthrax! I’ve never seen anthrax before, but I’ll know it now! Turns out, the baby had either played with or eaten part of a dead goat. Not he kind of history I usually get on my Louisville patients! 

Having a diagnosis, we started appropriate antibiotics but the baby began to decline. A day later, the swelling now consumed the baby’s whole head, but no other part of the body. After consultation with Dr. Bemm, we started the baby on high dose steroids. The next day, my exam showed that the baby’s neck was starting to improve. The antibiotics were working! Praise, God! But, this was not to be a happy ending. Three hours after rounds, during mid morning, the baby had an acute event in the ICU. The ventilator alarm either didn’t go off, or was not noticed. The baby didn’t have a cardiac monitor - something that would never take place in the U.S. The baby’s breathing tube plugged and then he had a cardiac arrest. He was not noticed for about 5 minutes. I was called stat to the bedside where we performed CPR for the next 30 minutes. During our attempted resuscitation, I removed and replace the breathing tube. The epiglottis and larynx had dramatically improved! But, the baby was dead. My resident, Phillip, informed the family while I tried to remain calm as I discussed the events with the ICU nurses. 

In the end, this baby didn’t die of anthrax, but of poor ICU care. In the US, this would never have happened. We have so far to go in training these people how to care for critically ill patients. They are good hearted people, but training to the degree of US standards comes very slowly. In the meantime, patients die, sometimes unnecessarily.  I’ve been grieving over this baby. More Kenyans have died since then and these people just move on. Death is so much a part of their culture - but not mine. A single death like this one lingers with me and I wonder why it had to happen. There are no simple answers. Some seem obvious, like train the nurses better! But once you learn the details of it, the simplicity goes away. Culture permeates everywhere, even the ICU and culture is slow to change. My prayer is for that sweet baby’s soul, the grieving parents, and those nurses who don’t even realize what they failed to do. I’m not bitter toward them, but just sad that they don’t realize what great things are possible and that fewer have to die. This hospital needs an ICU specialist to come here full time and change their work culture. Short term trips like mine, aren’t enough to change things. I pray that God will call someone here soon to fill this critical need.