Embassies and Immigration

One of the interesting things about living abroad is your status as a resident alien. In fact, we all have little cards that have our beaming faces beneath the words "Alien Certificate". Also, you get the "pleasure" of visiting embassies and immigration offices, which gives you a new appreciation for immigrants living in the US.

In the past, these thoughts (especially those involving embassies) sounded a little glamorous. A little piece of American soil that I can visit right here in Kenya! I think most of this misconception comes from too many Jason Bourne movies, but I still think it would be cool to have a second passport.

So, when John and I realized our passports were going to expire in just over 6 months (the period of time needed for travel), we trekked into Nairobi to see what this embassy was all about. Now, some of you may remember that the US Embassy in Kenya was bombed by Bin Laden et al back in the 1990's. Thus, the new embassy (pictured here) has some pretty beefy security. And no place to park. But once you get through security, it's really pretty smooth. The reality, though, is that it's more like a little piece of American bureaucracy rather than American soil, but even that can be heartwarming. I haven't yet met any Americans there. Most of the people in the "American Citizen Services" section (which is open just a couple hours in the morning) appear to have originally come from Somalia, and the chosen television programming in the little lobby is Al Jazeera, which is, at the very least, ironic.

I do give them some credit for efficiency. John and I's passports had to be flown to DC, renewed, and flown back. How long did this take (without being expedited)? 7 business days. Whoa. 2 years ago, Rachel got hers renewed stateside, and it took 12 weeks. Thus the moral: if you want your passport renewed quickly, fly to a foreign embassy for the deed.

After getting the passport (which by the way, has more than twice as many pages as my old one), I had to head to Kenyan immigration in order to get the work permit and re-entry pass from my old passport transferred to the new one. This is always a bit intimidating, but thankfully there's a very friendly Kenyan guy in Nairobi named Johanna who met up with me and saw me through the snares.

Now that all that was done, it was time for the biggest challenge. Rachel and I are trying to arrange a visit in September to the little nation of Burundi, in order to check out some possible future McCropder options. Since Burundi has virtually no tourism, they won't issue a visa at the border, and you have to get one before leaving from... the Embassy! Thankfully, they do have one in Nairobi.

But where? During our internet research, we found 2 addresses and no less than 6 phone numbers, none of which worked. We asked a ton of knowledgeable people, and no one knew. So, we stopped by the post office today, and asked if they knew. They looked it up and gave us an answer that matched one of our addresses, so we headed out. Five gridlocked roundabouts later, we discovered that it had moved, and five more roundabouts later, we discovered that they were open Monday through Thursday 11am-1pm. Since it was precisely at Thursday 1pm that we learned this, along with learning that we were missing about 4 essential items for a visa application, we headed back to the guesthouse, satisfied that at least we were the very first people in Kenya to learn where this elusive embassy is currently located.

Situations like this make us ask: Why don't they have a website? Why don't they have a reliable phone? Why are their hours so limited? The answer lies in the observation that the Embassy of Burundi in Kenya appears to be a single individual sitting behind a single table, and if there was a phone in the office, we didn't see it. Considering that this tiny nation is the 2nd poorest in the world, I guess we should just be thankful that they are there at all.

We keep learning.

REFERENDUM

Kenya does not typically make international news. A major exception to this was in 2007 when the presidential election took place. Most of you remember the violence and rioting that broke out when the election results were released, sparking intertribal conflicts between many of Kenya's 40+ tribal groups. Over 1,000 people died and many more became homeless during this time. A power sharing deal was eventually brokered, and peace was restored, but many worry that the same thing could happen again in subsequent elections.

Well, the time has come for Kenya to adopt a new constitution. Unlike the US, where we have a set constitution with amendments and vote to add amendments as necessary, in Kenya the entire constitution gets voted on. Out with the old, in with the new. On August 4, Kenyans will vote on this new constitution (referendum). I don't pretend to be an expert on it, but there seem to be some controversial points to it, like a move towards legalizing abortion, and Muslims being able to try their legal cases in a Muslim court, as well as a portion on land reform (personal vs. govt ownership of some key areas of land in Kenya).

We would ask for your prayers in these next several weeks. Pray that the Kenyans would be sensitive to the Lord's will regarding a yes or no vote on this constitution. Pray the voting would not be corruptible in any way. Pray all would be done peacefully, that no harm would come to the Kenyans or to ex-pats (like us) living in Kenya, and that everyone would accept the decision. I am fairly confident that we are safe here at Tenwek Hospital, and there won't be any problems, but some extra prayers never hurt! Thanks, and we'll keep you updated in the weeks to come.

Favourite Signs of Kenya

One of the simple joys of life in Africa is the wonderful storefronts and signs that you meet everywhere. I have been keeping a photo file of some of my favorites, and they are here for your enjoyment. I plan to keep this as a link on the sidebar, and update it whenever I feel I have found another hall-of-famer. Hopefully John will soon post his similar collections of matatu decals.

Vote for your favorite!

Wal-Mart Complex Shopping

For the record, "Moran" is a feared Maasai warrior. But still...

What exactly do you think goes on at this place?

Hilarious Mascot General Stores

Awesome African school names.

Excellent Obama Fashions

Click to enlarge. The fine print is "The Best Nyama Choma (grilled meat) in East & Central Africa & Asia."

Beware the Baboon Menace.

Bipartisanship. McCain's state and Obama's mug.

If they had spelled it "Candy Shoppe", it would have been perfect.

How would you define "Anti-Natal"?

On the Tenwek Hospital grounds

If we only we had his skills, think of the impact!

For sale in the same town as the Lazarus Funeral Home. The misspelling of "arthritis" is maybe my favorite part.

A chicken coop just down the hill

What We Do and Do Not Sacrifice

Yesterday, I walked out onto an outdoor second story landing. The sky was clear, and I was surrounded by green hills full of maize and tea trees. There was a nice breeze. It wasn't blistering hot like Tennessee currently is, or bone-chilling cold like Michigan inevitably will be. And it's been pretty much this way for the last seven months. I could be lulled into a sense of "I haven't given anything up. Look at this great life!" And it is a great life, but there are counter moments, when I feel quite the opposite. My primary conclusion, though, is that we do sacrifice, but not necessarily the expected sacrifices.

What we don't give up:

1. Nice weather. This is not the Sahara desert. I'm beginning to forget what cold feels like. And hot, for that matter. I don't have AC, heat, or a coat.

2. Food. Yeah, there are a few things that we pine for, and Pacific Rim is at the top of the McLaughlin list, but it's not really that big of a deal. Today, my lunch was a choice of leftovers, muttar paneer or pad thai.

3. Work lifestyle. Yes, I take more call than I would in almost any family practice job in the US. But, I go home for lunch everday, and almost everyday I get a tea break. I work with people I really enjoy, and almost all of my schedule requests get honored.

4. US Medicine. You can keep your billing and coding regulations, and continue to order your CT scans for no other reason that you're afraid of future lawsuits. There are things we give up, but there are also things I don't miss at all.

What we do give up:

1. Friends and family. This is expected and it is correct. It's quite difficult sometimes, and for those whom we left in the US, it may be even harder, since this was not their choice.

2. Education. Not a big deal for the McCropders currently, but as Anna is heading to kindergarten next year, Heather would deem this list incomplete otherwise. Homeschooling can be phenomenal education, but it seems like a lot of work.

3. Feeling at home. Partly this heals with time, but I don't think I will ever feel as comfortable in Africa, as I do in the country where I spent the first 28 years of my life. In the US, I know how people generally think and conduct everyday affairs. I know what it's like to be from there. Not so now.

4. Assurance at work. There is no confirmatory test. There is no letter from the specialist to confirm or correct your initial impression. To be here is to endure a very expanded feeling of not quite knowing if your diagnosis or treatment is correct. I always wish I could see the answer key at the end. I think I would provide better care in the future. Alas.

5. Good outcomes. It comes to this. If you want to be where you can make a big impact, you have to be there in the times when you couldn't. Hands have to get dirty. And it can be very very hard.

And so it was that Saturday was a tough morning. Overnight call had brought patient disasters, some of which we should have been able to handle, but for a variety of reasons didn't. Those are the moments of doubt, not the inability to drink the tap water or sleeping under the mosquito nets (which is actually kind of fun, if you ask me).

In other words, I have given your our requests for prayer. If you are willing, pray for us along the lines of the issues above, that we would persevere and be willing to sacrifice these things as we need to, in order to glorify God through bringing health to the needy.

The Glory Days

This past weekend was one I had been looking forward to for a long time – Alumni Weekend at my high school, Rift Valley Academy. I attended RVA for all or part of 2nd, 5th – 10th, and 12th grades, graduating in 1995.

RVA is a unique school that caters primarily to missionaries' kids from all over Africa. The diversity is therefore stunning - back when I graduated, over 40 countries were represented at the school of 500 kids. 90% of the students are boarding students and the other 10% are like my siblings and me, whose parents worked in Kijabe, the town in which the school is located. For those interested, there is a biography written about RVA called “A School in the Clouds.” It is even possible that some of the McCropder kids might end up attending this great school for some of their education.

Last weekend, in addition to reminiscing about the glory days, I competed in the alumni vs. varsity rugby game. This was certainly one of the highlights of the weekend for me. I got to play for the first time with my youngest brother, Caleb, who is in the black shirt below and I am right behind him. I did come away with the predictable realization that I am not as young as I used to be, and I am thankful that I didn’t break my neck in the scrums (but probably fractured a rib).

As you can partially see in the picture below, the field is perched on the edge of The Rift Valley and has a spectacular view of about 80 miles – probably the most beautiful location for a field in all the world, but then I might be biased.

Life in Community

I find that people often comment on what we as the McCropders are doing. It's different, and unique. It catches attention and piques interest, and it's fun for us to get to share our story with so many who are interested. Most of you reading this post already know our story, so I won't elaborate more. But I did want to talk a bit about what it means for all of us to be pursuing God's calling as a community instead of individuals.

There are plusses and minuses to community, a chance to get to know the good parts and bad parts of each other. Some silly things: you've heard of the term “airing out our dirty laundry,” I'm sure. Well, we all air out our clean laundry on the line together. I know exactly what kind of underwear every McCropder wears, which is a little more than I know about most people! When one kid gets sick, there's a good chance the other 4 will get sick. Abi and Maggie most days would rather spend time in each others' house than their own, and we are constantly chasing them down to bring them to the proper home.

The best parts of community are, well, the community. Adjusting to life at Tenwek has not been as difficult as most of us anticipated, and that's primarily due to the fact that there are three families—we all know each other, we're friends, we're sharing similar experiences coming from similar cultures, and we can talk about our triumphs and failures and frustrations with people who know exactly where we're coming from. We can talk about people and places back home with others who know what we're talking about. We can worship together, pray together, listen to Knox sermons together. And we feel that as a community of 6 adults, we can accomplish more than if we were 6 separate adults. Jess and Heather are fantastic at watching Maggie if I have to go in emergently for work. If I'm in the middle of a surgery and get “stuck,” Jason is there to help. When Eric and I get terrible pinkeye, John comes down and gives us eye drops. :)

When we first started talking about the McCropder concept, some people warned us about the downsides to community. One man warned about the “ideal” of community, the desire to have everything work out perfectly, destroying the members of the community. Many warned about being “exclusive” or clique-y and not reaching outside our group to get to know other missionaries, or other people we serve and interact with on a daily basis. Decisions get made much slower when 6 people have to agree. We can split the cost of a van between 3 families, but what happens when we want to go to 3 different destinations on the same day?

But I have to say, so far, our McCropder community has been a total blessing to me, and has been better than I could have hoped for. On days like today, when the only McCropders left at Tenwek are Maggie and me, I miss the community that we share! We thank all of you for your prayers in helping us grow together in community. Please keep praying as we have big decisions coming up on where to go next, trying to make our decision as the McCropders and not as individuals. We'll keep you updated!

COTW: Heroes in Training

Let me explain. One of the unfortunate realities we live with here is that if someone is sick enough to get intubated (a tube in the throat and a machine to help breathing), the odds that they will recover is slim. Very slim. This even goes for the previously healthy. It may be because our ventilator is from the 1970's and looks remarkably like a stereo receiver that my parents had when I was growing up. Truth be told, the answer is more complex than just old technology, but suffice to say the prognosis for such patients is poor.

Which is part of what makes the story of Ernest so remarkable. He was eight months old, and came in with bad bronchiolitis. You may have heard of this in the US, and it's often a mild viral infection, but sometimes it can be deadly if you can't support their breathing through to the other side. This was the case with Ernest, and so after a few days in the hospital, he was put on the ventilator.

One night on call, I am paged urgently to the ICU, because Ernest has crashed. It's about 3 or 4 minutes from my apartment to the ICU, and I arrive to find that my intern and my family practice resident have resuscitated Ernest successfully.

Let me explain. Another unfortunate reality worldwide is that, if your heart stops beating, your odds of survival are poor, despite what the television dramas show. It's better for kids, but when the heart totally flatlines ("asystole"), it's tough even in the best of circumstances. Here at Tenwek, where our staff is limited and simple things like not having the little plastic connector to the oxygen supply often get in our way, it's even more complicated.

So, when I arrived in the middle of the night to find that my team had already successfully brought back Ernest's heart in just such a scenario, I was stunned. And blessed. Back on the ventilator he went, and day after day we continued to struggle for him.

Let me explain. Tenwek Hospital is a teaching facility. Currently, we have at least 25 Kenyan docs (or P.A. equivalents) that are here to be trained for anywhere from one to five years. And we the McCropders didn't fully realize this when we decided to come to Tenwek, but it's been a happy "coincidence", since we have since decided that medical education is where we want to invest ourselves, and here we get a chance to learn how to be educators.

So, this was not just an amazing victory for Ernest, but it represents our trainees' ability and accomplishments for a whole future career of patients they will care for. It shows timely response and heroic effort, and it gives me great hope.

"Ernest" battled in the ICU for several more days. He finally started to improve, and I took this picture of him and his mom, on the day of his discharge, with the two heroes in training who saved his life. He went home, as far as I can tell, as healthy as any other little 8-month old boy.

Board Eligible

We've spent many blogs elaborating on the practice of medicine in Kenya, quite different than our US training. However, I would venture to speak for all four doctors to say that we are very grateful for our US education none the less. Perhaps we never learned how to manage malaria and typhoid, pull worms out of bowel, or laser parasites growing on the retina, but we learned a lot about critical thinking, surgical skills, etc. And a US medical license will open many doors for us in the future, as it is recognized in almost all countries (not true for the reverse--Kenyan doctors, for example, need to take 3 expensive and difficult tests, then redo an entire residency before practicing in the US). So. Now the issue is...getting or maintaining that US medical license. Harder than it sounds for four doctors living in Kenya.

Every medical field has a different way of "board certifying" their doctors. Eric took a written test when he finished residency, passed it, and voila. Board certified. Jason took a written and oral exam before leaving the US. John has already needed to fly back to the US once for his written exam, and will likely need to fly home one more time next year for the oral exam. Me? I took a written exam prior to our departure for OB-GYN, but then comes part II. I'll take my oral exam in front of a panel of examiners winter of 2011-2012, but in the meantime I have to collect something called a case list. Basically, I need to record every surgical case and every hospital admission I take care of for 12 months. I think most OB-GYN's case lists would look something like this:

Normal delivery

Normal delivery

C/S for failure to progress

Normal delivery

Endometrial ablation

Normal delivery

So far, my case list looks like this (after 10 days):

Failed VBAC, repeat C/S

C/S for fetal distress

Hospital admission for abnormal uterine bleeding w/ Hgb of 4

PPROM at 28 weeks, chorio, induction

Hospital admission for metastatic choriocarcinoma and likely brain metastases

Cervical cerclage for 3 2nd trimester losses

Repeat C/S

I could go on, but basically what this means is that my stuff is weird, rare, and there's a lot more of it than an average OB in her first or second year of practice. I'm a little wary of this oral exam.

So once we're all board certified and such, then we need to be RE-certified. This means that every few years we need to prove to our respective boards that we are not just a bunch of hacks, and we've maintained all our medical knowledge, and we are safe to take care of patients. Alright, admittedly, this is not a bad idea. But for Jason, for example, he needs to log on the internet all the surgical cases he's doing. Because he's in a supervisory role, he does probably in excess of 5 cases per day, far more than the average general surgeon in the US. And because the cases are all weird (removing sacrococcygeal teratomas from babies and ex laps for bowel obstructions due to worms and the like) and our internet is slow, it takes about 20 min per case to log these procedures. Sigh.

All this to just give a glimpse into the other side of medicine, just in case you were curious.

4th of July

As it starts to sink in that my children will probably spend the majority of their childhood in a country other than America, it has become more important to me to make a big deal out of American holidays and family traditions.  I’m grateful for the many unique experiences that my children will have overseas, but I also want them to love their native country and American heritage. 

We had a great 4^th of July celebration at Tenwek!  The festivities began with some games for the kids -- water balloon toss, watermelon-eating contest, 3-leg race, wheelbarrow race, and the electric trash can game.  

The kids also enjoyed face tattoos and popsicles.  There were approximately 75 Americans at Tenwek that day, about half of those being visitors!  We began our meal with “The Star-Spangled Banner” and then chowed down on grilled hamburgers & hot dogs, potato salad, coleslaw, and other goodies.

Just after dark, we were treated to some fireworks.  (Anna seemed a little concerned about those.)  We ended the day with s’mores, courtesy of my Aunt Tonya.  It took some doing to get the fire going with our damp wood, but John was successful in the end.

Happy birthday, America!