The good and and bad news,,.. or skylines

Los Angeles,... Chicago,.... perhaps New York. Could be anyone of these cities. But this, ladies and gentlemen is beautiful, downtown Nairobi Kenya. Makes you wonder doesn't it. How such a modern skyline in the capitol city of Kenya can exist adjacent to some of the most desperate poverty we know. And the progress of this city doesn't stop with its high rise office buildings and hotels.. Everyone is excited about the construction of modern "super highways". Literally, the boasting and expectation of relieving some of the worst traffic nightmares in the world is heard from many corners,... from drivers who are truly skilled at maneuvering tight spaces without traffic accidents, to pedestrians who narrowly escape death by crossing through these tight spaces, especially on the round-abouts. It has to be seen to be believed. But this is modern Nairobi. Its still building. The new highways are actively under construction with a target completion date of sometime in 2012. The excitement here is palpable. The scenes are far from the poverty ladened pictures that routinely are seen in media outlet.

Much has changed since our first visit, some 17 years ago. In those days, cell phones were far in the future, in fact, communication more often took place through unstable and unreliable phone connections and then more often than not infrequently. Now through fiber optic lines its inexpensive and reliable. The skyline certainly wasn't what it is today. The attitude of Kenya's citizens was largely one of despair. Changes over the years have brought vitality to this metropolis and with continuous renewal of hope, fostered in large part, I'm told, by it current leadership. There are mis-steps by the government to be sure, at the parliamentary level mostly. But the excitement of Nairobi is truly a good sign of a properous present and future. Congratulations are certainly in order.

That's the good news.

Meanwhile, back at the ranch, as they used to say (showing my age maybe?:-), even within this capitol city of Nairobi, within Kibera or Mathare Valley for example, each with at least 1 million desperate inhabitants, starvation, lack of cleanwater, illness and despair remain the order of the day. That's the bad news. But it can be even worse in the "upcountry" or places where the concept of a downtown Nairobi or Los Angeles, or New York is as unreal as traveling to another galaxy. Dreams of Nairobi are hard to find when their dreaming instead of feeding their children or having access to basic health care or clean water without traveling for one day to the nearest "borehole". This is a different skyline. That's,.... the very bad,... and sad news.

There's an obvious disconnect. Recognized by all, many stating grand plans to eliminate it, but the task to bridge the gap is huge.

Consider health care. There is a 6.3% prevalence of HIV/AIDS in Kenya, a nation of 40 million citizens. Of those with known HIV, the highest estimate of those receiving treatment is approximately 400,000. The most commonly heard figure is 200,000. So approximately 20% of those needing treatment are actually receiving treatment, at best. The enormity of this problem is probably felt strongest in the rural areas,.. not in city center Nairobi. And we don't even know what's happening at the cross borders at the juncture with neighboring countries, where mobility between countries combined with an enormous sex trade, provides the ingredients for explosive HIV prevalence. What to do? How can the gap be filled?,.. if only in this one example.

We all have the power to heal... if not physically, then emotionally, spiritually and socially. The gap can be filled through simply caring about and fixing the systems that produce the gaps in the first place. But Jesus made it even simpler than that. He healed through touching people. People were healed through touching him... and sometimes, by touching only his clothing (...If I can only touch the hem of His garment,.. remember that one?). Healing happens when we enter and touch each others' lives, or maybe even by coming a little closer than we are accustomed. Maybe someone needs only to touch our clothing to be healed. Gaps can be bridged, ... health can be restored and healing can take place.

The disconnect we feel is real. Fixing or lobbying for fixing systems that explode this disconnect either in Nairobi or in Philadelphia can heal and fill the gap, ..... bridge the disconnect,.... help us to touch people's lives. Maybe this will allow all of us to scrape the sky,... sort of like the skyline of beautiful downtown Nairobi.....Maybe.

Simon: "I want to serve"

Simon is a Pharmaceutical Technologist in Kilifi Kenya. Kilifi is in the Coast Province of Kenya, just on the Indian Ocean. Overall, it’s an apparently quiet place,.. nothing like the capitol city of Nairobi.. The traffic jams are non-existent, but people go about their daily lives just the same, albeit in a less frenzied pace. Simon is the chief pharmacist at the Kilifi District Hospital,.. the hospital responsible for the health matters of almost 5000 square miles (about 12,500 sq Km) of kilifi district.. So his job is to facilitate delivery of medications to hospital inpatients as well as those in close proximity to the hospital.

Its not an easy job. Dealing with the medication needs of the hospital is one thing. Dealing with the needs of the surrounding community is yet another. You see, the way it works is that, although the hospital takes care of some of the community medication needs, the majority of these needs are managed by dispensaries and health centers “closer” to those. Closer, is in fact, a relative term. There’s a phrase in Kenya used often when talking about distances, especially on the coast. That phrase is: "just here". When asked “are we there yet”,.. the usual response is” its just here”, which could me we have another 10 Km to go,.. but its “just here” in Kenyan terms. So the community health centers of Matsongoni, Ganze and Msumarini, are “just here”.

On this particular day, we’re driving between health centers and dispensaries, on not so smooth “off” roads to places where the villages and homesteads are disbursed some distances from each other. We’re driving and the time seems endless. Can’t imagine how it feels when you’re walking. And that’s what they do…. Walk. To “just here”.

Some of the places have only nurses and maybe a clinical officer, but certainly no physician and no pharmacist. Simon explains that there is an acute shortage of pharmacists and physicians in the medical system of Kenya, especially in the rural areas. When asked why, he further explains that the pay is low and the circumstances are cruel and demanding, the hours, grueling. Many health professional go the private sector, where pay is much more than when working for the governmental health system, as Simon does. So I asked Simon,… Why do you do it? His response: I want to serve.

Simon is a rarity, even here. If you had to go to work every day to provide a service to those who might night be able to pay, whom you might contract a respiratory disease from, where you might hear babies crying in anguish all day…. Would you do it? Many here won’t,.. But many will. And the truth is that most of us serve, in one way or another. But because Simon serves here, one more child will live. Because he is planted here, a mother will receive medication so that she can look for work, or, work on her farm, or, sell goods in the market place…..because Simon serves,… and inspires others to serve. In this, there is hope.

But that can happen anywhere, it can certainly happen in the U.S. where the needs are as great as they are in Kenya or anywhere, ...the difference is that we have systems that, arguably, could work and should work on our behalf. But similar to Kenya though or anywhere else for that matter, if systems don’t work on behalf of the poor, the rest of us are called to serve,.. like Simon, and with intention,.. not the intention of being recognized for service, but with the intention of lifting someone up. With the intention of being an instrument of justice, not charity. With the intention of “leveling the playing field”, which may not happen immediately, but over time, it happens. Simon knows this, and so he serves.

So, in our lives and travels to “just here”. What intentional service will we render today? We're all thinking about this, but going beyond thinking and into action is yet another matter. As we go beyond action in our own lives, one more child will live.

So Simon "toils" on, ...with joy, sometimes frustration, yes,.. but always with intention. Can we join him?

They're coming from everywhere

They came from everywhere,… as far as 20 Km from their village or homestead to this place called Ganze Health Center. It was small, had services like laboratory evaluations pharmacy distribution, HIV/AIDS counseling, but it was literally “in the middle of nowhere”. But it rendered service. Service to many who had no alternative, because they were sick or dying, because they knew no remedy,.. not even the herbal medications extracted from the field worked any more. The pain just wouldn’t go away. Or, maybe the skin infection from which their small child suffered was more than the young Mother could bear to see.

They came from everywhere, to this place with no Doctor, no Pharmacist and sometime no medicines, at least not the ones they needed. Frequently, they were told that the medicine wasn’t there. That they needed to go to the “local” chemist. But there they knew that the cost would be high, the distance sometimes far. Yet the clinical officers and nurses offered the care they could, providing the medicines they had, despite frequent “stock-outs” rendered by delivery shortages from government distributors.

Imagine your medical center that you traveled 20 Km to reach. Imagine not having an automobile or even public transit to reach it. Worse yet, imagine not having the money to travel by public transport, if it was available. Imagine no water, little food and insufficient strength to travel the long journeys, by foot, to receive some semblance of health care. Yet they come, because there is no alternative, because death stands close by, watching to intervene, if they don't come.

Global healthcare is in crisis. Obvious?... perhaps.. but we sometimes do not recognize and why people are so sick, nor why they remain so sick. Environmental reasons are surely present. There are places experiencing drought. Climate warming has taken a heavy toll. In places where mosquitoes and other insects prevail, malaria, denque fever and river blindness are similar in their prevalence as the common cold is in our world. The planet is large, and so there are still places yet unreached by roads and other symbols of infrastructure. Cities, towns and villages remain separated by huge distances. Although this separation has been mitigated somewhat by communication amenities such as cell phones and the internet, the east does indeed remain far from the West.

The larger tragedy is perhaps we haven’t considered what we can do about all of this. But its hard to even think about how we can take care of our neighbor, especially when the neighbor is on the other side of the globe. But what about our neighbor around the corner or next door. Its hard work. Given all that we must contend with to take care of our own lives, and now we’re asked to care of someone else’s life. I don’t think so. Its easier to just look away. Maybe when I look back, it won’t be there, or maybe it’ll take care of itself. Isn’t God watching out for this? Doesn’t He care?

Suffering is everywhere. They do come from everywhere,.. next door, around the corner, around the world, …and it doesn’t go away, if we pretend its not there, or if we simply look away or close our eyes.

A thought. Maybe God is watching, but watching to see what we’re going to do about the suffering, the pain our neighbor is experiencing. Maybe God is watching to see if we’re going to build a clinic 10 Km or 5Km closer to the village so that our neighbor doesn’t have to walk 20Km. Maybe God is watching to see if we’ll drill a well to a level where we can access water in areas where clean water, or just water is needed, or creatively devise other methods of water access on a planet where, despite drought, 75% of the surface is water. Maybe through creative research we can develop vaccines that will combat malaria or HIV. Or maybe we can enact a truly comprehensive health care law that will insure everyone. Maybe God is watching out,.. to see what how His creation will take care of each other.

Cain’s response to God,” Am I my brother’s Keeper?” has not been diluted across the ages. We’re still asking “Am I my brother’s keeper. And we’re still trying to avoid the obvious answer.

Not 25 anymore

Well, I'm not 25 anymore,.. or even 30 or 40. I've crossed over.. Crossed over to what you say? To the senior class,.... elderly if you will, those who are close to collecting medicare,.. or maybe we should already be collecting it.

I came by this startling revelation, when there I was, trekking through Kibera with my student team who are 25. Of course, I went through the paces, the hills, the rough terrain, the valleys, and the the hills again, as if I do this every day. The pretense was, I must admit, impressive, but so was the shortness of breath. Of course, I didn't dare let them see it,.. carrying on a conversation while at the same time drawing huge gulps of air. My alternating timing was perfect. No one knew, I think, that with each syllable was an equal and silent gasp. But in the end, I made it. Not 25 anymore.

So if you're inclined to hangout with those who are 1/2 your age (or maybe more?), fess-up, admit the disparity, or,.. if you don't, and you happen to keep up, the alternating breaths will do wonders for your sense of rhythm. But it may be easier to take up the bass guitar.

From peace at St. Mary's Guest House to using outrage as an expression of love

We’re staying at St. Mary’s Missions Hospital Guest house. Both hospital and guest house are within a gated compound on the outskirts of Nairobi (Langata). It’s quite secure with a bustling shopping area of small establishments just beyond the gate. By the way, the U.S. has no monopoly on three hair salons in one block. The local CVS and Rite could best be described as a small chemist shop in one block and Duka la Dawa (drug store) in another. Its not clear who owns these drug emporiums, by the way. Regulations are that only pharmacists or pharmaceutical technologists can operate such businesses,.. but when asked specifically about this, there’s lots of throat clearing and uncertain answers,.. so who knows. Let’s just say, I might be inclined to purchase my Advil somewhere else J. There are “real” pharmacies in Nairobi. Kibera, probably the largest slum on the continent, is within walking distance, and getting there, literally, can be done within 5 minutes (but the hills are steep, and if you’re over 30, you’re body doesn’t lie). The people are as congenial as you would want them to be with greetings of Jambo (hello) or Habari yako (How are you?) exchanged commonly, and it is quite uncommon to find anyone, particularly at the shops, who doesn’t end a conversation with asante (thank you) or karibu (you’re welcome). These are gentle surroundings.

Its educational as well. This past week, the guest house was host to a medical missions team, two physicians and 6 medical students, from Korea. This group was on its way to Tenwik Hospital, another missions hospital in Kenya. Frequently, travelers pass through here for volunteer work, study, or other activity that requires a temporary stay in Kenya. Next week another group is visiting from Korea. Last year, I shared this space with a group from Australia who operates a school in Kibera, and a missions pilot who regularly brings supplies from Russia. The stories the staff could recount, as well as those of us who are blessed with their hospitality, are numerous. There are those who return to St. Mary’s Guest House repeatedly as well as those who live here year round. Its easy to see why.

I have learned and am still learning that there is no greater gift to another human being than giving compassion. Moses and Leah, the staff at St. Mary’s, are hospitable, gracious and kind, providing a quiet, warm and required respite for those who extend compassion to others or who are in need of compassion themselves.

Children are abundant on the grounds of St. Mary’s. This is because the compound is also home to an educational center which contains a school for orphans. Even under these circumstances, children have the most delightful way of affecting our lives. Saturday morning, we were awakened by singing. Yes, literally awakened by singing, unintentional, yet deliberate. You see, the Educational Center is located within 25 feet of the guest house and the children were celebrating mass at 6:30 in the morning. There is no more beautiful sound than children singing in Kiswahili. And to be awakened by that sound on a Saturday morning, in Nairobi Kenya, is a statement from God, that at that moment, in that space, all is right with the world and that there is indeed hope. I remain convinced, that this is one of the many ways God extends compassion to us.

But compassion doesn’t stop there. We are called to multiply that compassion to, and in, others …, and if we are to link that compassion with hope, we must multiply compassion, especially to our children. But the multitude of children at St. Mary’s is only a microcosm of the children in Kenya, or in Africa in general. We can also see children in St. Mary’s Hospital. We see them at Carolina Clinic in Kibera,... and then, of course, there's Good Samaritan orphanage in Mathare Valley, another large slum in Nairobi. These children are heard too, and although surprisingly, these children sing, there are also tears.

A recent quote I’ve read states:

"Let us be the ones who say we do not accept that a child dies every three seconds simply because he does not have the drugs you and I have. Let us be the ones to say we are not satisfied that your place of birth determines your right to life. Let us be outraged, let us be loud, let us be bold." —Brad Pitt.

I could be wrong, but I think Jesus would have been outraged. His quote was: “I have loved you with an everlasting love.” I think he meant that, and I think that he meant for us to love each other with an everlasting love. Never to allow our neighbors to suffer for want of a clean glass of water,.. or even a hug. In overturning the tables in the Temple, Jesus showed outrage and anger at the prevailing culture. In our time, given our circumstances,..perhaps our call, simply, is to overturn our tables.

Let's talk about traffic jams,.. or, finding the real story

Traffic jams, .... not moving,....summer heat, ..... in meetings,...... out of meetings,...... what are they saying?... I don't believe it, ... but maybe its true,...... let's think about this some more. Whew,.. what a blur of information, and in just two days in Kenya, .. looking for answers,.. finding none,.......only more questions to matters pertaining to their health care crisis. Is it pharmaceutical manufacturing?..medication distribution?...insurance access?....governmental funding?..., all or none of the above? This is like the automobile traffic jam we're in,..... not moving (especially the round-abouts,... are we going in circles?... again?) The initial confusion is astounding. But isn't this what research is about?

Two days in Kenya,... traveling with M.I.T. students who are doing a marvelous job at digging beneath the surface to look for answers about addressing health access in this country of 40 million. The scope of the mission has broadened immensely, and, unexpectedly from the initial premise of how to improve the quality of pharmaceutical manufacturing in Kenya.

But issues have been revealed that are begging for closer examination. Such examination isn't easy: Discussions are being held with experts who claim to know the system. Endless meetings and opinions are expressed on how this confusing health care system actually works and how it can be improved (sound familiar?). Those in the know will say that twenty-five percent of Kenyans have health insurance (and we thought we were in trouble). But who are these people? Others may state that the HIV prevalence in Nairobi is in the vicinity of 4%, but in other areas, as high as 18%. In a country where 75% of the population lives rurally, with no transportation, no access roads, little infra-structure, except in urban areas, it seems that it may not be easy to determine who is insured and who is not, who has specific diseases and who doesn't, when most of the country can't be reached (at least easily). So how do we really know? What are the "real" figures? The opinions expressed are from people who claim to know how things work in Kenya. But do they really? Are they really familiar with the faceless uninsured, the unreached, the uncounted 30 million who live without voices? Can't help but wonder who is the keeper of the truth, or, is there only mass denial that people are grossly under served and that we, the "keepers of the truth", have failed to respond to the needs of our neighbors, to facilitate equity and the entry of justice in health care. We all bear responsibility and accountability for these disparities. But, the question looms: are we even talking to right "experts"?

So the students have begun using an alternative and novel approach,..asking questions on these issues of other experts: residents in Nairobi,..patients at pharmacies, health care workers, people in the system rather than above and overseeing the system. People who also have opinions on how this system can better serve,... them. People who are frustrated with being witness to a system that can work but doesn't. People who have grown weary of hearing opinions from other experts who only claim to know the system... those who operate under the pretense of managing health care systems on their neighbor's behalf. So the questions being asked of these "experts" are only in the preliminary stages of inquiry. Yes, we're in the mystery of not knowing where the questions will lead. But there is little mystery in the fact that interesting yet troubling stories are beginning to emerge,.... a disconnect between what is supposed to happen and what actually happens.. in this metropolitan area of Nairobi. So, I suppose that we can add to the traffic jams, mismanaged health care systems and low allocation of funds that continue to frustrate residents, and perplex outsiders asking questions of "experts", ..those that are in the system and those that are responsible and accountable for it. One supposes that this may be another traffic jam,..of sorts. We're speculating further that somewhere in the questions posed to these disparate groups of experts, lie honest answers. But,.. if we're finding these types of challenges in the metropolis of Nairobi, one can only imagine what stories will be told when questions are asked in Mtwapa, and Majengo, where we're headed next week. The story will evolve further and the "plot will thicken". So stay tuned. These are stories that we should all hear. Stories that may provide light so that Kenyans will find the way out of their health care traffic jam.

Back to Kenya

Well, here we go again,... back to Kenya, back to Nairobi, maybe Mombasa, back on the road to talk to men and women who are so desperately in need of hope....in need of a hug, hand-holding, a smile,.. you get the picture. And those are just the needs for human contact. Taking that out of the equation, what about the need for clean water, for food, for medicial care, for justice? Not that we can provide all of these aspects of daily living,.. but we can try. We can try, as best we can, to bring hope to hold someone's hand, to facilitate access to clean water, to food and all the rest. But in the end the challenges are enormous. But Jesus wanted us to start somewhere, with the hope that one candle lit would allow others to envision and light their candles,... as people see, not only what is, but what could be, that lives would be changed.

The young man with whom I'm traveling from the Philadelphia area, wants to experience the vision,.. but more than that, he wants to feel the vision. How can people in need be given the chance for life that most of us in the western world experience? What' s necessary for justice to be given to those who are left wanting by colonial systems, long gone, but present, still? This young man seems to want to find out if we can make a difference simply by going, simply by showing up, because in that, and in that alone, there is inspiration for others to do the same. Inspiration,... especially if you are a young man with the fortitude to travel 8,000 miles to ask "How can I help?", of those who are in desperate need. This young man is becoming a man of vision.

Nehemiah would have been proud. Nehemiah knew that Jerusalem had been destroyed, that there were challenges in the re-building of Israel's capitol. In the distress this caused him, he knew something must be done. In his distress, he envisioned a new Jerusalem. In his distress over the destruction of Jerusalem, his home region, Nehemiah knew he had to go to see how he could help,.. how he could allow his vision to become reality,.. in His home region. Nehemiah would have been proud of the young men and women who ask "How can I help?", and then actually show up. What an extraordinary thing.

But when people suffer, when they need the very basics,,, in Africa, in South America, in the Ukraine, in Haiti,...(isn't there need everywhere?)...shouldn't all of us ask "How can I help?". Isn't this planet our home region. When people suffer, when we travel 8,000 miles to show up, aren't we traveling around the corner in our own neighborhoods? When Nehemiah shows up, when others shows up, when you, or I just show up, the vision of how Jerusalem can be rebuilt inches just a little further toward reality.

So, we're leaving for Nairobi Kenya tomorrow. We're meeting four M.I.T. students, my colleagues Steve Praissman and Titus Kahiga, and staying at St. Mary's Guest House on the grounds of St. Mary's Missions Hospital. We're leaving with the hope,....the prayer,... that we'll come just a little closer to rebuilding this part of Jerusalem and inspiring others to come to the feast,.. to join the construction effort.

From time-to-time, we'll post some observations on this blog. I believe that as you read, as we explore, how we can help,.. that we're co-travelers. Thanks for being part of this journey.