My First Call Weekend

This past weekend, I was on call for the Pediatric wards, which means that myself and the intern on call had to see all 60 or so of the children on the wards and in the NICU each day, and cover any neonatal resuscitations after delivery. A couple of weeks ago, this seemed incredibly daunting, but at the end of last week, I was feeling up to the task.

I had it all planned out. The intern would see the Peds ward patients, while I came in early to start seeing the NICU babies. I would leave the NICU at 9am (to leave the ladies alone during the 8th day of Christmas) and go and see the floor patients with the intern, have some chai, and head back to finish NICU. All in all, I should be done by noon.

It went well for about 10 minutes. I got to the NICU, and the overnight nurse wanted to draw my attention to some "sick" babies. One was a preemie in obvious respiratory distress despite our most aggressive assistance. The other was a full-term baby brought in from home for severe jaundice, leading to a brain problem called kernicterus (which, in this case, was due to mom not getting that little Rhogam shot that some pregnant ladies need based on their blood type). The baby was getting light therapy and I thought that was all we had to offer. The nurse asked about "exchange transfusion". We do that here? (And by "we", I guess I meant "me")

The next several hours, I had to consult a total of 7 of my colleagues, despite my ardent desire that my efforts would enable them to have a well-deserved weekend off. During this time, the other baby died. I finally made it to the general ward, where I learned that my tardiness was not minded, given that they had been busy trying to save a little girl, whom we had been treating for HIV and TB. She also had just died. So, it was lunchtime, no work was done, a bunch of my colleagues had helped out from home, and two kids had died.

For the sake of at least facade of brevity, I won't tell the whole saga. Five children died during my 48 hour watch. Each time I watched one die, I would pray for God to receive his small child, and each time it got harder and harder to trust in the subtle, yet powerful, albeit mysterious, goodness of God.

It doesn't break my faith, but it creates a tension inside me, one that is greatly complicated by my feelings of helplessness, despite many years of my life, gone into training that is seemingly not nearly enough for the need around me. This tension makes me want to run, but I don't deny its presence. And I would assert that I have the Psalmists and a chunk of biblical prophets who would back me up.

God, how can you let this happen?

God, I can't do this.

God, I still believe that you're good. Please, please, show me.

There's so much death. How can I just keep going?

Rachel wraps her arms around me, and softly says that God's strength is made perfect in my weakness. Later, Alyssa empathizes with the simple retelling of her own first call weekend, and reiterates that I can always call her at home. And late Sunday night, we gather in the Cropsey's living room and listen to an old sermon from Knox, where Chuck preaches a characteristically somber sermon on joy from Habakkuk, asserting that we must decide whether we will view God in terms of what we see in the world, or view the world in terms of what we see in God.

This is only one part of life here, as our lighthearted exploits into pet squashes, milking moms, and dead geckos surely show. But it is significant. It is expected. It is incredibly hard. And by God's grace, I pray it be fruitful.

"Give me an undivided heart, that I may fear your name."

On the Procurement of Water

Wow!  We had heard the water was a bit bitter here at Tenwek, but when Jessica and I drank our first glass (post-boiling, post-filtration) we could barely get it down.  Dehydration appeared to be preferable until the primal urge to drink became irresistible.  After about a week, I couldn't take it any longer.  


You see, the procurement of water has been of primary importance since creation. God put Adam and Eve in Eden with a fantastic water supply: "A river watering the garden flowed from Eden; from there it was separated into four headwaters...Pishon...Gihon...the Euphrates...the Tigris." Every would-be settler since has first procured a water source before settling any new civilization. Well, the McCropders weren't going to buck the system.

Let me explain how things work here.  The water coming to our indoor plumbing originates from this waterfall, which also happens to be the source of our electricity.  It works great for flushing toilets, washing dishes and even taking a bath if you don't mind some exfoliatives (river bed sand).  

The drinking water, on the other hand, comes from our roof gutters and is stored in a big plastic water tank.  Rain water is really clean.  So why the wretched taste?  

I decided it was time to inspect the water procurement system.  On first observation. the pipe connecting the roof gutters to the tank was disconnected.  That would explain observation number two:  the water level in the tank was only knee high despite it being rainy season.  Perhaps we had stagnant water of unknown duration sitting in our tank?  I climbed up and began to open the lid.  Fumes began to emanate.  I peered into a primordial cesspool.  There was vibrant life in very dark water.  This would explain the little worms swimming in our water when collecting a bucket of drinking water.  We decided to drain the tank and have it cleaned with bleach.  The quality of the water that began to collect was of significantly higher quality, with just a bit of a kick still.  

After several weeks of hard rain, our tank still only rose to knee height and the Faders and McLaughlins would soon be drawing from the tank too.  On Jason's arrival, we agreed the gutter system was in disrepair.  It was collecting little run-off from the roof and was not running downhill toward our tank.  We summated the roof.  What we found explained the remaining aftertaste in our water.

A layer of foul, black muck lined the gutters.  Some poor lizard had fallen to its miry grave in the deadly goo.  Umm, nice to think all of the water we had been drinking had been brewed in gutter stew.  The vile muck was removed with our hands and a mop that has since been retired from indoor service.  The gutters were adjusted and repaired to collect the rain and to send it downhill to our clean tank.  After only a few days with several hard rains, our tank was running over with water (see the picture at the bottom with water shooting out of the overflow hole at the top right of the tank). 

We thank God for our renewed water source and a full tank as we approach  the dry season. 

The Eighth Day of Christmas

Much of what we encounter here is tragic. Much is beautiful. Sometimes our experiences are instructive. Some are perplexing. And some, like the unpublished story of John and the creepy Nepalese guy clinging for dear life to the roof of their Himalayan van, are purely snapshots that are best appreciated by stepping back and laughing as the absurdity of it. And I'd like to use today's position in the liturgical calendar to share just a moment.

Against all my expectations, one of my major roles here at Tenwek thus far has been in the NICU (or the "nursery"), where we care for little 2 pound babies, as well as bigger newborns who are sick for one reason or another. Given that my training included a total of zero days working in such an environment, I've been scrambling to learn how to function there.

How does one provide food for the 30ish babies pictured above? Especially when many are too young or sick to breastfeed? And without making them dependent on formula, which most families can't afford after discharge? Well, the answer can be seen every three hours on the dot, as a parade of moms make their way into the nursery wearing matching green gowns (for infection control reasons). They wash their hands, and then sit on these short floor stools in front of their baby's incubator or cot. They then grab a couple very small plastic cups and begin to manually express their milk into the cups, which is then fed to their infant.

There is nothing particularly humorous about this, but now imagine the tall skinny white male doctor, confused enough by learning the ropes of neonatal care, trying to awkwardly weave his way through the crowded milking hour, in order to see a few babies. Every one in a while, he tries out his fledging Swahili skills and meets with about 25% success and 75% loud silence. Welcome to my world.

So, the Tenwek nursery is indeed a special place, for the 8th Day of Christmas visits the rest of the world only once a year, but in this one room, it comes every 3 hours on the dot.

Christmas Highlights

The McCropders’ first Christmas at Tenwek included:

- A festive church celebration of Jesus’s birth
- Christmas carols in the hospital wards after rounds
- Party hats for Micah’s 1st birthday (Christmas Day)- Skype calls with our families- Gifts from the Grandparents- Cookies and gatherings and good food- A Boxing Day picnic- Time with friends- Giving thanks to God for many blessings


Christmas in Kenya did not include:
- Visiting our families and friends in the USA. We really missed you.
- Eggnog
- Ice skating
- Sweaters, jackets, or mittens
- Inflatable yard decorations
- After Christmas sales
- Santa
- Snow
- A dramatization of the nativity stable scene. So Anna came up with her own re-enactment.

Merry Christmas from Kenya

Christmas Eve at Tenwek

530p 24.12.09 -

I'm finishing up in the NICU, seeing just a few more crazy small babies before heading home. We've got plans for Micah Cropsey's 1 year old birthday, and a McCropder dinner and caroling session at 600p. It looks like I should have plenty of time.

"Mass casualty," the nurse says, all too calmly.

I look at the pediatrician "Again?" he says. Again?

Now, I don't want to appear ignorant, but sometimes the truth is hard to hide. "Um, what's going on?"

"Come on, were going to Casualty (i.e. the ER). There's been a big bus accident."

What followed was, at the very least, instructive. Apparently what happens when a "mass casualty" occurs in our cachement area of Kenya is that they pretty much call every doctor, and we all meet in Casualty. I arrived to find the Family Practice docs, the pediatrician, a few surgeons, some OBGYNs, some orthopods, and a slew of interns, residents, and PAs. I also found the first and most severe victim of the accident, who was likely the most mutilated human I've ever seen that was still sitting up, talking, and even flailing around. (Details upon request only)

And then everyone set to work. Xrays were ordered, pupils checked, antibiotics hung, wounds cleaned, and the worst of them taken to theatre (OR). Being as green as I am, I chipped in, but wasn't as busy (or useful) as the veterans, so I had a moment to observe.

I know these professionals, and I know that they want desperately to be with their families on Christmas Eve. But they and their families have been changed by the incarnation of the Son of God, by a baby who caused Mary a good bit of inconvenience, but who bore much much more. There was great need, and so at great cost, God has come and brought salvation. And so do his followers. Regardless of whether they were on call, they were here to meet need, and they bore it with joy. As it turned out, many of the patients went off to another hospital, so our influx was somewhat shortened, and most everyone got home within a few hours. However, no one knew that at the beginning, and yet there was no grumbling, just a desire to make sure that care was delivered, and needs met, as best as could be.

Trust and Real Estate - Part 4

Today, we have special reason to celebrate. Here's the story. After delay and more delay, our real estate saga finished unexpectedly quickly, and with way better terms than we had hoped. We are thankful for this, and thankful to those of you who supported us through this, and thankful to God. We may or may not learn reasons for this saga.

Also, possibly of interest, some shopping tales and a video home tour of our apartment here at Tenwek (in 3 parts).

Tenwek FAQ - Part 2

FAQ #3: What types of animal wildlife live near Tenwek?

Well, I now feel qualified to answer this question, because Anna has already been the proud owner of no less than four small pets. Luckily our apartment does not allow pet monkeys, zebras, or elephants.

First, Anna brought home Sluggie the slug.

When Sluggie perished, she found Snailie the snail.

When Mommy released Snailie the snail, Anna talked her friends into catching her a frog.

Another kid offered to trade Froggie for a cool bug. Thus she was given Deedee the bug, who is still in captivity in the living room.

She is pretty excited about trapping bugs.

Little does Anna know, we also have geckos who roam our walls at night feasting on the mosquitos who like to feast on us.

We also have beautiful butterflies, like this one that we noticed last week while taking a walk.

What Anna really wants is a chameleon like the ones that our neighbors found in their yard.

For now, thankfully, she seems to have changed her focus. Today the object of her affection was a squash.

Pretending to be Mary with her squash named baby Jesus, she insisted upon carrying him around in modified Kenyan baby-carrying style.

Tenwek FAQ – Part 1

Here on the McCropder blogspot, we will attempt to answer our readership’s Frequently Asked Questions. We’ll tackle a few at a time.

FAQ #1: How are the McCropder apartments furnished?
You will note several apartment amenities in this picture of the Fader living room. Couch, chairs, dining room table with rose bouquet. The door to the left center leads to a small hallway, through which you can see a yellow bedspread, a blue mosquito net, and a bedroom window. The door to the right center is to the kitchen, in which you see a refrigerator. That’s right, we have a refrigerator, an oven, and even a washing machine (for which we are especially grateful, since 4 of the 5 McCropder children wear cloth diapers). We do not have dryers or dishwashers, as you can see.



























Running water is a nice feature of these apartments as well. The water comes out of the tap in a murky shade of dirt color. Not good for drinking. So we collect rain water, boil it, and then filter it in a water filter as seen here.


FAQ #2: How do letters, Christmas cards, and packages arrive at Tenwek?

The US Postal system can be used to send mail to Tenwek. Letters and cards usually take approximately two weeks in transit. The McCropders are not opposed to post-holiday arrival of Christmas cards. Bubble-type package mailing envelopes usually arrive within a few weeks as well. The mailing address here is:

(Name)
Tenwek Hospital
PO Box 39
Bomet, Kenya 20400
East Africa

Surprised?

In a transition like this, one of course builds up more expectations that one realizes, some of which may be totally unfounded. ("I don't know why I thought it would be like that, but I did...") These expectations can lead to surprises, some pleasant, and some less so. A few surprises from our first few days:

Pleasant: Vines growing in through our shower window in Nairobi.

Less-than-pleasant: Our first shower at Tenwek being ice cold and filled with enough sand to make the bathtub floor look like we just returned from the beach.

Pleasant: Each apartment has both 110 and 220 electrical outlets

Less-than-pleasant: We left one appliances' AC adapter in Nashville, Tennessee.

Pleasant: The Rift Valley escarpment is more beautiful than we imagined, and our wildlife viewing began on the road to Tenwek, where we saw about 100 gazelles and 100 zebras.

Pleasant: Our second shower having nice warm water, and less silt than the first.

Pleasant: Our "shamba" (garden) is growing some cilantro.

Less-than-pleasant: Unthinking, I discovered it was really cilantro by chewing down on it, without washing, before remembering that many neighborhood pets relieve themselves in our shamba.

Pleasant: My favorite carbonated beverage, Bitter Lemon, is here in abundance

Less-than-pleasant: Mosquitoes are even more abundant, though apparently malaria is still rare.

Not surprising: Cows on the street by the dukas (shops).

Not surprising: Anna Fader takes to Tenwek like a fish to water.

Not surprising: Two nights ago, when the Cropseys hosted us for a McCropder dinner, John demonstrated how well he is adapting to "Africa Time".

Team McCropder Reunited

The three-part migration is complete. The McLaughlins are settling in. The adventure is underway.