We need more Oxygen

The basics:

So, this post includes some medical info. If you want to skip all the reading, here are the basics. 

Tenwek needs to buy another Oxygen concentrator to support our patients. We need to move quickly to purchase and install it so we are ready for patients. I am asking for help to raise these needed funds. Through supporters and organizations, some funds have already been given/pledged, and we are moving forward to purchase the machine, THANK YOU. Funds are still needed to fulfill this commitment and for piping, installation, and renovations. 

Americans -give to WGM, Tenwek Covid Project.  OR Friends Of Tenwek. 

Canadians- Donate through Into All The World, Go to https://app.etapestry.com/onlineforms/IntoAlltheWorldInc/shortterm.html

Please send me a message via e-mail (annette.lievaart@wgm.org) or Facebook of the amount you have donated so I can direct the funds. Also, you can write Covid in the comments box. 

The Story:

Everywhere you turn these days is talk about COVID-19. Whether it be affected numbers, a salute to health care workers, the need for hospital beds, or the need for ventilators. As a Respiratory Therapist, I have never seen my profession and the work we do highlighted so much. 

Kenya is gearing up for this disease, our current count is 126 cases. The government here has put in place many measures to reduce the spread. Yet, hospitals are preparing for an influx. Tenwek is working together with the County who will care for many of these patients. At Tenwek in the last few weeks, we have been saying, “We are not scared. We are prepared.” So, we are working hard on those preparations. 

Tenwek wants to focus on the basics with OXYGEN. Not all patients who develop COVID-19 need hospital care. In fact, many will have mild symptoms. But of the ones who do need hospital care, not all need ICU care. This group of patients need oxygen to support them until they can recover, which can be provided by a mask connected to a flow meter that delivers the oxygen. 

The challenge is where does oxygen come from? This is a question I never asked when working in Canada - the answer was the wall - you plug in the flow meter and oxygen comes out. Here in Kenya, I have learned a little more about the process. Tenwek uses something called an oxygen concentrator - maybe you have seen a small one in someone’s home who is on home oxygen. The one we want to purchase is similar but on a much larger scale. This will work continually to produce oxygen for many patients. We can serve many patients with one concentrator. The hospital currently uses a few concentrators to provide for the hospital but they are at near capacity. A few weeks ago when we had many sick patients they could barely keep up. So we have decided we could really use another one as we expand. We are doing some renovations and will be increasing the number of beds in the hospital. There is a machine already in the country - we just need the funds to purchase it - will you help give funds to help us help these patients? Giving information is above. 

A few years ago we bought a new compressor to work with the Oxygen conentrator. 

Giving Oxygen can sometimes be added to by creating a simple CPAP device for babies. 

I hope socks are in this box and why is the money orange?

So I started this blog post two months ago, forgive me that it has taken so long for me to finish, life got busy.

I am enjoying life back in Kenya. I left Alberta in a bit of a snowstorm and am glad Dad's truck has snow tires - and that he is more experienced driving on snow and ice than I am. Although, I did get some practice this past year. I also left before the arctic chill moved in. I am happy to have left Alberta before it got below -25C.

My flights went well. I was able to catch up on some movies and even got some sleep. Despite landing in Nairobi many times I always am a little nervous. Will the passport line be long? - will my luggage come? Will my large bag come out at the normal carousel or at the oversize section. This time I got lucky the bags, all three, came out quite quickly. Then the next hurdle: Customs. Will they open every bag? Will they x-ray every bag? Will I have to unload my carefully balanced cart? Will they charge me fees? With a prayer and a push of the cart, I went through Customs with only one bag going through x-ray. I was thankful to be out of the plane and in the taxi after only 40 min.

Kenya is a large cash society. So a quick stop at the ATM, had me in my sleep-deprived, jet-lagged state surprised. While I was away Kenya changed their currency so instead of the normal 100oshilling notes I was used to, I got orangey/pink ones. It took a bit for me to recognize what it was and then take my money and go.

After a few days in Nairobi getting a new cell phone sim card, buying groceries for the next few weeks and renewing my physiotherapy license. From there it was the 4 hour trip to Tenwek and settling back into my place. I moved back into the same house as before. While I was away some short term visitors stayed in my house. Some things were packed away and so the unpacking began.

Every time I move (or pack into or out of storage) I am amazed about how much space everything takes up. I had left myself a list of some of what I had in storage. I had left a note - telling myself to not bring back socks from Canada. 95% of the time I wear sandals anyway. However, while I was unpacking, I was a little worried, as I did not find my socks until the very end. A few were in the slow cooker, wrapped around kitchen stuff - boy, am I glad I looked inside before I put it on the shelf. It took only a week to get settled and after being back at work for two months, it feels like I never left. I have settled back into the routine of work being patient care and education, answering e-mails for visitors who want to come and everything else that is part of life here. Below are some pictures to give you a taste of the last two months.

When it rains here it pours, we have gotten a few days of rain every week since I got back even though it is supposed to be dry season. 

A shift change lecture to the nurses on Arterial line management

So driving home from Nairobi last month I was following this truck down the escarpment, part of this road has steep drop-offs and I am nervous in my SUV, glad I was not driving this wide load. 

Last week we did a 2 day ICU crash course for nurses who are new to ICU. Was busy but fun. 

We receive many short term visitors, these medical students and residents asked for teaching on ventilators. I never say no to the option of teaching. Especially as the residents take overnight call, and if they learn how to do it, they don't page me at 2am. 

Preparing to Go Back, WHY?

The Lord willing in three months, I will be back on Kenyan soil. I have enjoyed the last 6+ months in Canada. I have a comfortable apartment, a convenient LRT (subway) ride to work, I am enjoying being able to visit with my family often, go for coffee and supper with friends. I have a job where I am challenged but not stressed. I work with a fun group of people. I get paid well, and I don't need to raise support for it. So why would I want to leave?

There are a few answers to this question:

- I have a great place to live in Kenya too, it's comfortable, I have great neighbours, and I can walk to work, and home for lunch too.

- Family is farther away (and that is hard) but I have great community, kids who call me Aunt Annette, friends who I can call at any time. I am thankful for technology that helps me to keep in touch with the family that is far away.

- Work is the same in Kenya, in some ways, but different in others.  I am working in a Pediatric Intensive Care Unit in Alberta. On weekdays when I show up to work here there are two pediatric intensivists working, a few peds residents and one pediatric fellow (finished residency and getting more training in ICU care). Each critical patient has a nurse assigned to them with specific training in pediatric critical care. For our 16 bed ICU, we have three respiratory therapists assigned each shift.
When needed, the pediatric team of physicians can consult pediatric pulmonology, or infectious disease, or endocrine or oncology or...

-Contrast this to Tenwek: when I show up at work there are one or two pediatricians for all the pediatric patients (20-30 on the wards, ~30 in the nursery, a line up in outpatient and a few in the ICU). We have interns working who are with us for one year of training in adult medicine, pediatrics, obstetrics, and surgery. At the end of their training year, they are helpful but at the beginning they need a lot of guidance. We have one or two family residence on the pediatrics service helping out. When the service gets stuck they can talk to the pediatric surgeons, they can talk to the adult intensivist, they can talk to a smattering of other staff or they can send an e-mail home with questions.

-For respiratory therapists at Tenwek - there is one, and I am not just caring for the pediatric patients, I am helping out wherever I can.  When I go back to Kenya, the hope is to do more formal teaching so one day, hopefully soon, there will be more than just me.

So all this comes together to show need but there is more.

Eric Liddel, an Olympic Gold medal winner in running,  said: "God made me fast and when I run I feel His pleasure".

Frederich Buechner said, "The place God calls you to is the place where your deep gladness and the world's deep hunger meet."

Together both of these bring me to Kenya. At risk of sounding proud I will say I am a good respiratory therapist, when I work in respiratory caring for patients or teaching others I feel God's pleasure. When I look around I see the need in Kenya. Pulling this all together, Kenya fits for me.

So I will go back, this next term will be three or four years. I am excited for what this term will look like. I am looking forward to greeting old friends and meeting new ones. I am nervous about what will be waiting for me, how will things have fared while I was away. I am hoping I am prepared.

I ask for your help. This can be done in a few ways:

1.  Prayers, Tenwek is great but hard. To give some perspective in the last six months working in the PICU and floors, I have seen 2-3 deaths of children. In Tenwek, I sometimes see that many in a week. Including adults in my count (I don't keep track as that is too depressing) 2-3 deaths a day is normal. So pray for God to encourage me. If you want some perspective of this I recommend you read a book called "Promises in the Dark" by friend and fellow missionary Eric Mclaughlin.

2. I also need financial support. The hospital does not pay me so my salary and other expenses must be raised. Donations are easy just follow the instructions in the post below this one.

There are a few more reasons to go back to Kenya. The weather is lovely all the time and it is beautiful. Below are some favourite pictures. If you ever find yourself in Kenya send me a message and maybe we can meet up.

What A Strange Bird

2 of my Favourite animals together in the wild

I took this picture just outside my door. 

Colubus monkey (4 hours away in the rainforest)

Giving 2019

Thank You for supporting this ministry. You will receive a tax receipt for donations, just follow the instructions below. 
I ask you to consider regular scheduled giving, it is easy to do and will help sustain the ministry. 

Canadians - Give via Into All the World

Ministry vs Personal - When you donate there is an option between Project and support. Both are tax-deductible. Project covers expenses beyond my salary ie travel, materials, equipment, fees etc. Support is my monthly salary. You may choose whichever you like. If needed I can transfer between funds. 

Electronic Funds Transfer, Credit card, Cheque, E-transfer
Use this IATW Form.

Web:
https://app.etapestry.com/onlineforms/IntoAlltheWorldInc/donate.html
Select my name from the drop-down list and fill in the information.


Americans - Give via World Gospel Mission


Check, credit Card
Use this WGM Form

Web:
https://www.wgm.org/lievaart.


Thank you for your prayers and support

All I want for Christmas is...

So Christmas is coming and while I am away from a lot of the commercialization that surrounds the North American Christmas season the thoughts of what I want for Christmas is on my mind. This year I am asking for something big and I am asking for your help.

This year all I want for Christmas is New Ventilators. 


These are not for me personally although I do have a collection of medical supplies in my house. Currently my desk is covered with Laryngoscope blades, I tripped over my spirometer that I store under my bed and this bag of CPAP masks is getting in the way. (Don't worry all this stuff will be used by the hospital). The new ventilators I am asking for will be utilized well. We have already ordered two and plans are to order four more.

Since I arrived in 2010 Tenwek has managed to get by with a collection of donated machines, over time some of these machines would break in a way neither I nor Bio-Med could fix and they would join the broken pile. Since I have arrived we have gotten four 'new to us' machines. Three of these were already 15+years old and one quickly became extra parts for the other two.

We still have a few machines with us that have been here for (way) too long. Two of them always alarm "check diagnostics", one no longer delivers PEEP which is needed for 90% of patients. (Yes my fellow RT's: really 100% need PEEP but head injuries and overdoses do OK with no PEEP.) Now if this was your family member would you want them on a machine made in 1981 and is also found in museums (not a lie) or would you want them on a machine that alarms and no one knows why? DO you want them on a machine that says "No PEEP must keep at 0". While we have been able to provide safe care to the patients a change is needed. So we are working with a distributor to purchase six 'new to us' machines. Two are going to the cardiac surgery area and have already been paid for but the other four will be used in our general population.

Are you willing to help me with this Christmas present? Four machines and shipping will be expensive but will help sustain the ICU and HDU in Tenwek for many more years. Some funds are already in my account but I am giving you the opportunity to help. To give you an idea of cost - I was thinking of buying a car but since I am borrowing another family's car while they are in the States for a year I figured this would be a better use of the funds. So if you want to help - it's easy click the "to donate" button on the side and follow the directions, you will even get a tax receipt. Then send me an e-mail or Facebook message letting me know that the donation is for this purpose. If by chance (that would really be a miracle) I raise more than needed the extra funds will go to preventative maintenance of these machines.

I have also added some pictures to show the new machine and old machines.

The New Machine - We already have one,  it will be great to have more. Isn't it beautiful?

Old machine from 1981, we actually have two of these, this one with some trouble but the other actually works well. You may notice this is the same brand as the new ones we are buying hopefully they will also hold up for 30+ years

another older machine, notice the 0.00 in the top middle. That is supposed to read the amount of air the patient is breathing. A helpful value, however it does not work (despite replacing the sensor). 

Unique Talents one learns on the mission field

So living in Kenya has taught me a few things that I probably would not have learned back in Canada.  I thought I would share a few of them here.

• Ability to look at the gas burning in the bottom of my oven and know if the temp is set to 350F or 450F necessary as the temperature regulation looks identical to the ones on the stove, no numbers.
• Able to drive (a standard) while dodging motor bikes, potholes, people, cows, donkeys and other cars.
• Can now distinguish the difference between Thompson Gazelles, Impala, and Grants Gazelles. 
• Can give a speech with a few minutes notice, although my 4-H days taught me this.
• Can hear a ventilator alarm from a different part of the hospital or through the phone line and know what the problem is.
• Able to go shopping only every 6 weeks, with the exception of a few staples and veggies and not starve.
• Complete a recipe with multiple substitutions, see why above, and it still tastes good. 
• Speak to patients in various languages. My Swahili is coming along well, but some patients only speak a local tribal language - Kipsigis, interestingly my 15-20 kipsigis words include cough, don't bite, breathe, breathe by yourself and lie down (relax). I guess you learn what you need to. 
• How long it takes for me to get cabin fever - 6 -7 weeks. With elections happening we were told to sit tight. So here I am, after not leaving Tenwek for 7 weeks and I am going a little crazy. I guess I know my limit.
• Able to quickly get to know and work with a new phsyician, dancing the line between advising them what do do and telling them what to do. We have about 150 medical visitors a year so a lot of hello's and good-byes
• I'm sure the list is longer but that's all that comes to mind right now. 

Ghana, Non-Medical missions

So I am a little behind but I thought I should write a bit about my time in Ghana. I am serving with an organisation called Reach Beyond.  Missions are full of confusion so they second me to the organisation known as World Gospel Mission (WGM) that I work with at Tenwek. Anyway, Reach Beyond divides up the world into regions and I am part of the Sub Saharan Africa region. A few times a month I have been meeting via Skype with the other missionaries in the region. It was time to meet in person and with visitors from the American HQ coming out to Ghana it was a good time to go. So beginning of January I took off for a few days.

I enjoyed my time in Ghana. I got to meet the rest of the team and their families, the children who had previously been annoying shrieks over voice Skype were now fun to play with. I also enjoy visiting other parts of Africa. Africa is a huge continent with diverse cultures. When travelling across the continent it is interesting to see what is similar and different. Nairobi has much more western malls and fast food than Accra, Ghana but in Accra you can safely walk after dark.

While meeting the rest of the team in person was the best part of the trip, I really enjoyed seeing the non-medical side of missions. The rest of the Reach Beyond group on the team are not medical but do radio. It was really great to see the work going on. Christian broadcasts going out in local language, spreading the good news of the Gospel, another group who has recorded audio bibles in 300+ languages, visits to a community where the water source was a puddle and with some help from reach beyond and a visiting team, a well was put in. Changing the health of a community. The medical side of missions is great, however I enjoyed the exposure to another side, which is also great.
Rather than say more I will share a few photos

I did do some medical work, assisted a nurse in putting a dressing on the finger of one of the boys in the village.

Just like Kenya the kids love photos and strange looking people with white skin and red hair.

Recording live for the radio, we all were in the room trying to be quiet. 

It's a jungle

The DJ at work.

Cocoa beans -yum.

Village's old water source.

New water source, tastes good I drank it fresh from the tap.

Rain

So I have become someone who always annoys me - people who have a blog and don't keep it updated. So sorry, I have a good reason and I will use this reason to write a blog post.

Life here in Kenya has become normal, when I arrived in Kenya years ago everything was different and exciting. From new language, a different culture, a different hospital and different responsibilities. All of this gave plenty of material to blog about. I have not blogged about it all but it now seems normal. When visitors come and get excited about the baboons on the side of the road or are dismayed by the high number of suicide attempts or I explain to a guest what we should and don't have to use filtered water for, it is all just normal life now.

Writing about normal life is boring. I keep reminding myself that even though I find my life boring (as in normal) it may still be interesting to you. So I will write about something so normal here but it still makes me shake my head. That is RAIN.

When you read about Kenya in guide books or online you will read about the rainy season and the dry season. How the rains come March through  June and August through October, or maybe about the December short rains. That the rest is dry. However this is crazy in my experience - it rains most weeks, except January, January is dry unless it rains. Why you may ask?  Two reasons: first Tenwek is at a high altitude and therefore gets more rains, second is climate change, now I don't want to get in to an argument about global warming but in Kenya the weather has gone from predictable to unpredictable. The locals tell me they used to be able to say what day the rains would start, now it's just confusing.

So those of you who think I live in a dreary wet drizzly climate couldn't be farther from the truth. Here when it rains - it pours, maybe for 5 min maybe for an hour but then the sun comes out again. I am sure there is a five degree difference between rain and no rain.

SO how does rain affect life here:

Because when it rains it pours - never, ok rarely, a little drizzle - no one goes anywhere. You wait. I have come home for lunch and had my lunch extended by 20 min waiting for the rain to stop, it never rains for long. A walk to the hospital even with an umbrella and I could get drenched.
Some days at the hospital it may be slow for me and I think one more thing and then I will work on things at home, then it starts to pour so I work longer or vice versa, if it has been an on and off rainy afternoon I may go home early if there is a break in the rain. Or there are days like yesterday where I decide to run home in the rain and get completely soaked. You know the type of soaked where you don't even walk through the house but are thankful you live alone and the curtains are closed so you leave the wet clothes in the entrance.

I don't complain about the rain, it's normal and as a farm girl I know about the importance of rain. Much of Kenya right now is experiencing a drought. So while the rains have started here at Tenwek (it's no longer January) parts of the country remain dry. So join me in praying for rain for those suffering from drought.

How's that I don't write for months and then all I talk about is rain? Pathetic, I know.

life update and why you should get your tetanus shot

So my plan has been to write a post once a month. I have failed again. Sorry. Since I last wrote I made a quick trip to Canada to attend a friend's wedding and see family. It was great to see everyone there again, if I missed connection with you I am sorry. I have joked that I am the missionary that never leaves as since arriving in Kenya in January I have made 2 trips back to Canada. The February trip, as you know was unexpected. This trip that I just took was planned already in January, and I am so thankful for that. I don't have any further trips planned so it will probably be a year before I am back in Canada. It was hard to be home without mom but also good to connect with my family. I have found since coming back I have progressed further out of the grief. The other day at work I was singing. I used to do that often but not in the last few months. It is good to feel more normal although I am sure there are times when it will seem to bog me down again. 

Work at the hospital continues and I would like to share a challenge that does not exist in Canada but is one of the hardest things about working here. Healthcare at Tenwek and many mission hospitals is often referred to as working in a resource limited setting. That limitation of resources vary vastly on the spectrum and Tenwek is a better equipped resource limited hospital. However we still have to be judicious concerning our use of this equipment. For me a weekly question is the use of our ventilators. We currently have 5 working ventilators (1 broke while away and I still can’t find a replacement part). When a patient is placed on a ventilator that means we can not use that machine for someone else so decisions need to be made about how appropriate this is. 

Let me share a story about this. A few weeks ago I got to work to discover a child with Tetanus had deteriorated over night and was placed on a ventilator. Tetanus is an ugly disease - so please get your vaccine. If it progresses to the point of needing a ventilator the chance of survival is poor, but there is still a chance and without the ventilator in this case the child would have died. So the decision was made and we continued to care for this child. Tetanus means the child may need a machine for 2-3 weeks. Therefore we are unable to use the machine to care for other patients with this machine (although I have 4 more) meaning other patients may die or may not. There are weeks when I only have 1-2 patients on a machine and some when all are in use. 

So here we were with this child on the machine. Praying, treating and hoping he will recover. 

However there is a second resource limitation here - the families resource. Staying in the ICU is an expensive treatment. About $100/day or more. That is cheap by western standards but if you only make 5$/day this is a lot. With all your funds going to pay the hospital bill still not being enough some families have to sell their land to pay the bill. Yes, Tenwek is a mission hospital and does provide care to all patients and we have a fund to help patients when needed but a large amount still falls onto the family and their community. So back to my patient after 2 weeks on the machine he died. Now not only is the family grieving a loss their savings have also been depleted. Limited resource is hard. 

Now a few weeks later I get a page, another child also with Tetanus, not doing well. Now what do we do. We have a ventilator available - do we use it? Is this a good choice? Again the family has no money? Transferring to another hospital is not an option as the government hospitals will also charge and require a large deposit up front. These decisions I hate. A colleague of mine once said “don’t make a decision based on what happened to your last patient” not sure if he was quoting someone else but we took this advice. We decided to put the child on the ventilator and 24 hours she is doing a little better and she came off the veniltator, not on purpose the tube fell out but momentarily stable. So we observe. She may need the ventilator again she may not. She may live or she may not. 

In closing - a public service announcement: this is the 3rd child with tetanus in a few weeks, 2 have died and the 3rd we still don't know. Please, wherever you live, ensure you have your tetanus shot. 

Back to work, life and rest

Since coming back to Tenwek I have not yet shared with you what's been going on. I have felt like a bit of a yo-yo as I was in Kenya for 3 weeks than back in Canada for 4 (for Mom's funeral) then back at Tenwek for 4 weeks and then off I went again for a week of retreat. By the time you read this I will be back to work at Tenwek again.

I love the work I do at Tenwek and did not really know what to expect when I got back in January. After being gone for 11 months would I still be remembered, would the nurses I invested time in teaching still remember what I taught them? would they still be there? Would the physicians welcome me back allowing me to run my machines and care for patients?  Would my equipment still work? The answers to these questions was vastly positive. My first few days back at work were busy greeting everyone. Many of the nurses wishing me a Merry Christmas - a bit of a joke as they had not seen me for so long and I missed Christmas. I was happy to see many nurses still there and still remembering much of what I taught, however other nurses have gone to other departments, hospitals or for further training. The physicians were happy to have me back and let me know by paging me for something almost every day for the first two weeks (including nights and weekends). As for my equipment that was a different story - I came back to every single ventilator not working or "working" with multiple problems. I spent the first two weeks hurriedly trying to fix the machines. I was happy to have the help of a bio-med from Samaritans Purse who had come to help out the cardiac team. We took machines apart, swapped parts, put them back together and said lots of prayers. Some machines were just broken from normal wear and tear, others had just missed out on some routine maintenance, and one had been put back together wrong and fried a piece - when it smells burnt you know you have a problem. So fixing machines has been a priority. I can not care for patients if equipment does not work, nor can patients benefit from a life support machine that is not working. Two weeks ago I had six functioning vents and each one was in use. We were turning away patients and unable to provide the care we would have liked to for others. In Canada, this happens but a well equipped ambulance is there and able to take the patient to another hospital also well equipped. However Tenwek is the only hospital in a large area that has ventilators so so if we say no.... This is hard so I am hoping to fix another ventilator when I am back next week - I have one that is more broken so current plan is keep swapping parts until it works.

 I have enjoyed being back at work it has challenges but also many rewards - being able to see patients get better after a severe illness. We had a young man who was quite sick after a road traffic accident. On top of multiple fractures his lungs were affected (Fat emboli/PE/ARDS) he spent a good week on the ventilator and it was great to see him get better and leave the ward smiling.

Life at Tenwek is always a changing landscape - I have found myself missing friends from last time who were only here for a 2 year term and staying busy meeting new people. I dove back in facilitating bible studies Wednesday nights and helping with youth group when the Kenyan youth are home from boarding school. After retreat, I plan to soon restart pizza parties with the interns; a  fun way to get to know each other and relax. I practiced my rusty pizza making skills a few weeks ago as there is a couple from Edmonton now at Tenwek so I had to catch up with them. I see so few Canadians. As I am now a long term missionary at Tenwek instead of a visitor that does not leave I am now responsible for furnishing my house. I have borrowed furniture for a few more months but have done a fair amount of shopping - this weekend was expensive as I bought a fridge and washing machine. I am having a bed frame built and will also buy some furniture from a family that is leaving this summer. It is fun to set up house. 

As I mentioned earlier, I also just had a week of rest. Every year all the missionaries with the organization I am with here in Kenya (World Gospel Mission) take a few days of retreat. About 100 (including children) of us headed to the hot and humid coast. It was exactly what I needed, as you can see from above it has been a busy few weeks - this has not given me a lot of time to grieve the loss of my mom. This retreat gave me a chance to talk with my colleagues who are also so busy at Tenwek, we worshiped together -  most times of worship had me singing with tears running down my face. I hate crying in public but this was a safe and good place to do so. God also sent us a great speaker. A christian counselor and psychiatrist who has worked with missionaries all over the world. He led a session on grief that reminded me I was normal and reminded my colleagues that I will need time. The session wasn't just for me - most missionaries are grieving something whether something big like a death or a collection of smaller things - being away from family, not knowing if you are doing what's best for your children or the cumulative loss of too many patients etc. Anyway, this was a well needed break, a reminder that I have a missionary family that loves me and even more a God who loves me.
So this post has been long I will end with some pictures of the beautiful coast.

Woke up early to watch the sunrise

A weaver bird - so beautiful

upside down

I had started a few blog posts in the last few weeks but have never finished one. I had one started about coming home to Kenya, and one about two weeks back at work but again not finished. You see, I wanted to spend some time getting it right, to share a post about how excited I was about being back in Kenya. Settling back into life and work with the people I love. However, before I could finish these posts my life turned upside down. My mom has battled a disease called scleroderma for eight years and about a week after I arrived in Kenya I heard from her and the rest of my siblings that she was not doing well. Scleroderma is an ugly disease and she has done not well before but how could I sit down and write a blogpost about how excited I was to be back when 13 570km away my mom was quite ill? How could I write when I was worried about her and time was spent talking on the phone as well as the busyness of being back at work? So I did not finish a post.
Then, I heard news that further turned my life upside down. On Feb 18, I learned my mom was transported to Calgary and was in the ICU. I was happy when my family gave the phone to the ICU doctor so I could hear what was going on in language I could understand. I thought I heard him wrong when he said cardiac arrest (I didn't). Then I began to hear more - liver failure, dialysis/prisma, unable to ventilate - only when we bag, inotropes, this doctor was painting a picture that I knew too well. I have been in that ICU as caregiver many times. The doctor said we will not do CPR again and I agreed completely. My family put the phone to my mom's ear and I said some words that barring a miracle would be my last to her.
Less than 30 minutes later I got another call. She was gone. So I was 13 570km away in my living room crying. Now what?- I called a missionary lady who lived next door and she came over. She notified the rest of the community and we did the next thing - looked at flight. It was 10 at night and driving to Nairobi was not an option until the nest morning so the earliest flight would be 24 hours away.
I was thankful to be surrounded by my Tenwek family with their hugs, tears, stories and bunnies (yes one of the missionaries brought over a baby bunny for me to cuddle). I sent people away with food from my fridge as I was told to go back to Canada for one month. Some of the ladies tidied my house and I gave them stacks of things that needed to be taken care of before I left. The next began the trip home, 24 hours after I got The News I was on a flight back to Canada, 48 hours after The News I was hugging my dad at the Calgary Airport.  However, there was some joy among all of this. The day after we lost my Mom, my brother and sister-in-law had a baby girl. A new niece.
Those of you who have lost a family member before knows what was next, tears, hugs, stories and doing the things needed to plan a funeral. My dad has been surrounded by wonderful friends, family and neighbours. The fridge and freezer were filled with soup, buns and casseroles that quickly disappeared when my mom's family from Ontario arrived.
So here I am a week later after the funeral, the house is currently quiet although visitors and food keep coming, Dad and I put a big dent in the paperwork and life continues. Part of me feels guilty about continuing life I know.  I must continue to take the next step and by God's grace I can.
In two weeks, I will return to Tenwek, Tenwek is home now and I love the life that I have there and I know that is where God wants me to be. I am glad my parents were able to visit me at Tenwek, twice, and have seen that part of my life and my Mom and Dad could see that Tenwek is my home.
I ask for your continued prayers. The acute grief of losing my mom is passing however the chronic grief of living life without my mom has just begun.  A few days before she died my mom shared some scripture with me and I will share it here with you.

But this I call to mind, and therefore I have hope: The steadfast love of the Lord never ceases, his mercies never come to an end; they are new every morning; great is your faithfulness. “The Lord is my portion,” says my soul, “therefore I will hope in him.” The Lord is good to those who wait for him, to the soul that seeks him. It is good that one should wait quietly for the salvation of the Lord. Lamentations 3:21-26

For those of you interested my Mom's obituary is here and the funeral can be viewed here, just look for memorial service for Marie.

My mom and me this past summer

Baridi Sana, Sio mbaya

So for all you non Kenyans reading this post the title has probably thrown you off. Why? Because this post is a little different. Often I write in Kenya for my North American friends about what life is like in Kenya as a missionary. This post is for my Kenyan friends about life in Canada, particularly Canada in the winter. So you North Americans are welcome to keep reading, don't worry most of it will be english. The title translated is: very cold, but not bad. 
The last few years at Tenwek when I walked to work at 7am in my sandals, scrubs and lab coat, I would run into others walking or riding to work or school dressed in thick coats, scarves and hats - in Canada we call them toques. When I would greet people I would often hear baridi sang (very cold), my reply was often hakuna baridi hapa (there is no cold here) and further explain that I am from Canada and it can be very cold there. So now I am in Canada and the last few weeks have been very cold so I will share a little about that here.
A few days before Christmas I decided to go downhill skiing with my brothers. Yes, I intentionally got up early and headed into the cold. We dressed warm: 3 layers of trousers, a thick sweater, a thick jacket, scarf and a toque. To ski you need to put these big plastic boots on your feet so I had big thick socks as well. We headed to the mountains and sat on a movable chair that carried us all the way up the mountain and then with our skis on the feet went down. The trick is to turn so you don't go straight down and lose control and fall. At the top of the mountain, where the most snow falls, there was so much powdery snow that when you fell it was just a poof and felt like you fell into a pile of feathers. It was so deep that I would put my poles down to get up again and they would sink in about a meter. While we skied it was snowing so my scarf was  white (instead of black) and very icy. It was a beautiful day a little cold at ~ -12C but lovely.

A few days later was the day of my brothers wedding it was a very cold day -25C. My parents house was full with family and we were very thankful for the furnace that burns all day and night and sends warm air into the house. The morning of the wedding I had to go to the store to get some foods for the meal that night. So despite the cold I took the car to the store and picked up various things. We all met at the church in the afternoon. Everyone was there, and on time. People mentioned the cold mostly along the lines of what a beautiful day - as it was a lovely day with fresh snow and it really was lovely. The wedding party took pictures outside, they were a little cold, the ladies in their dresses and the men in their suits but I am sure the pictures will be lovely. I went skiing another day, a different type: cross-country instead of downhill, still cold but beautiful.

When you live here life goes on in the cold and rather than suffer through it we enjoy it. So in a few weeks when am I back in Kenya and you tell me "dada, leo ni baridi sana" (sister today is very cold) you will have to let me argue.

Getting ready

So the countdown is on in a month and a half I will be taking off. Due to the craziness of the next few weeks which I will explain lower down I am already packing. One of three suitcases is already packed at 45lbs (I don't completely trust my scale). This suitcase may be unpacked and repacked the next few weeks. I have made numerous trips to the store to stock up on things. What kind of things does one pack? After a few trips to Kenya, my Kenya list is getting more defined. So I have packed things like Allen keys - needed to fix the ventilators, random donated medical equipment, sticky hooks for the walls, a utility knife for making spacers, ink cartridges, random kitchen stuff etc. Packing is fun. So I pray it will all fit into 3 suitcases and an overloaded carry-on.

So why am I packing now? - I am planning on bringing everything to my parents next week. I will be in southern Alberta for 3 weeks catching up with family, celebrating Christmas and going to the wedding of my little brother. So it will be a fun 3 weeks but as I will be busy with nieces and nephews - current count has increased to 4 nieces and 5 nephews - just got another niece last week :). So busy with little people, catching up with siblings, chatting with aunts, uncles and cousins, and helping Mom keep everyone happy and fed. I am excited, it will be fun. But not much time will be left for preparing to go to Kenya. Which is why I am packing now.

So after 3 weeks at home I will be back up in Edmonton for a few days to work a few shifts, say a few more good-byes, and have a commissioning service at church. Than its back to southern Alberta for a few days so I can pack a small suitcase and hop on a plane to Colorado. I have a training there for Reach Beyond for a week - a little ironic is this training is a lot of fundraising training, and  my fundraising is at 100%. Yes praise the Lord all the needed support is raised. Also on a belated note the Reach Beyond website is now fully working  if you still want to donate - its easier to do now, read below about what happens if more than 100% is raised.
Back to my plans: after a week in Colorado, I fly back to Canada for 3 days before I hop on a plane for Kenya.

So I ask for your prayers as I spend the last few weeks preparing, saying good-byes, and surviving the cold dry weather.

Questions

So this post is a little trivial and a little serious. There are some questions as missionaries that may seem normal to the rest of the world but to me are much more complicated. Here is a sampling and some answers

When are you leaving? 

I have gotten this question frequently while on the road trip that finished a week or 2 ago. Do you mean leaving Ohio? Tennessee? Ontario? Or what ever place I am currently in or when am I leaving to go to home to Kenya. Asking when I am coming home is the same. Do you mean my Kenyan Home, my southern Alberta home, or my Edmonton home. Not easy.
So to answer this question: I will be in southern Alberta over Christmas, and say good-bye to Edmonton before then.
My flights to Kenya departs Jan 27. 

What is your Address?

See above. My home is multiple places. Why do you want my address? If it is for junk mail I will tell you I live in Africa and watch your baffled look. If you are a bank or someone who needs my address you get my parents place. If you want to visit me - it depends where do you want to visit me. If you're Amazon or sending me presents, it's wherever I will be next that charges the least shipping. 

What if you raise too much money?

I am now at 95% of needed funds, which is a huge blessing. Some of you may have been thinking of giving and wondering if you should still give. 

So this question is a little more serious. If too much money is raised - I do not get a raise, nor do I get a trip to Hawaii. What I do get is a little more financial security. My budget is in Canadian dollars, but when I am in Kenya I am spending Kenyan shillings and American Dollars. So with changing economies the amount needed for rent could change. Second if there are extra funds I have more with which to help others. Whether it be helping a patient with their hospital fees, buying bibles for youth group, helping the hospital with supplies or helping other missionaries who are short for a month - others will be helped by the money. Third 70% of my funds are pledged monthly or yearly. Peoples financial situations can change and I may lose supporters over the four years I am in Kenya. 

The decision to give and where to give is between you and God. There are many good causes out there so please pray about your giving.

How long are you going for?
I think it will be a long time until I live a "normal" life in Canada, maybe when I retire. As I am a missionary and funds are raised during my time in Canada. I will be back for a year in 4 years.The next 4 years will be in Kenya. However, I will be using my vacation time to fly to Canada to see family once or twice a year. So you may see me after I leave. 

Thanksgiving and Roadtrip

This past Monday was Thanksgiving day here in Canada. No, we don't call it "Canadian Thanksgiving". It is just Thanksgiving. We know our neighbours to the south celebrate a month later with shopping but here we are a little more simple. A meal with friends and family, being thankful for the harvest (for farmers, and others who like to eat food) and the blessings of the year.
Ok, sarcastic marks now put aside. I have a lot to be thankful for this year. Over the last few years my life has gone a direction that I did not expect. I am now becoming more and more comfortable stating that I am a missionary. I receive compliments for sacrificing and risking so much to do what I do but really I don't see it that way. I am so thankful to be doing something I love. To be able to interact regularly with other, sometimes multiple cultures. To be able to teach others so health care in Kenya is improved. To be able to join/lead a bible study where we can encourage and challenge one another.
This year at home in Canada, I also have a lot to be thankful for. God has provided a place for me to live, a car to drive, a job to go to, friends to visit with, babies to cuddle, siblings to chat with, nieces and nephews to play with, parents to converse with and so much more. One of the tasks of the year was raising financial support - something I was not super excited about but again I am thankful. God calls people to give to his work. I am encouraged when I meet with people and share and we can encourage each other. Support raising is still a lot of work but every week I am excited to see my support thermometer (see side of the post) go up a few percentage points. God is faithful. I am confident and trusting that the remaining support will come in the next few months I have booked my flights and Jan 27, the Lord willing, I will be off to Kenya.

Before I take off to Kenya I have some adventures here yet.  Next week, I am taking off in my car and heading East. My Aunt J. is joining me for the trip to Ontario and then I will be on my own. Please pray for me as I travel. I am going to visit with friends and family, and attend a conference. I have listed my tentative itinerary below and would love to see you. If you are in or close to one of these places let me know as I love catching up with people - the whole point of this trip.
So my tentative, slightly vague itinerary is below and remember I am driving so if you live between point a and b I can stop by.
Oct 21-24 - Travel from Alberta to Southern Ontario.
Oct 25-31 Southern Ontario
Nov 1-4 Ohio and Michigan
Nov 5-7 Global Mission Health Conference Louisville Ky
Nov 8 - Southern Tennessee
Nov 9-10 Travel from Tennessee to NW Iowa
Nov 11-15 North west Iowa
Nov 16-17 Travel back to Alberta.

Homesick

I have been back in my Canadian home for 6 months now, the shine is wearing off and I now miss my Kenyan home. Culture shock, or what happens when you come back, reverse culture shock, has its ups and downs. The first few months back I had some challenges but then I settled into normal. One thing that I do miss while in Kenya and have enjoyed here is time with family and friends. Getting to know my nieces and nephews again is wonderful. For the last few months I have enjoyed the shine of normal. The conveniences of North American life are great. I don't think twice before I hop in the car, do some groceries and stop at Subway or Dairy Queen for bite on the way home. The same is true for work at the hospital, I am surrounded by very well trained nurses, physicians, pharmacists, dietitians, therapists and others. Lab tests are ordered without a thought. TPN is automatic. We don't debate whether a patient really needs a CT or what a MRI might tell us if we could get one. Instead everything is at our fingertips. I throw away so many supplies that are hardly used that I would reuse many times at Tenwek.

So you may be thinking this sounds great, what's the problem. The truth is I miss my Kenyan home. I miss the simplicity of stopping at one of the many shops to buy my fruits (yes we say fruits there), vegetables and other staples. I miss holding her baby as the shopkeeper puts my groceries on the counter and puts my eggs in a small flimsy plastic bag. I miss showing up at work and greeting my co-workers before we get to work - although I often miss this, but they call me on it. I miss walking to and from work, sometimes multiple times a day to get something. I miss coming home at noon to a meal cooked by a lovely lady who helps me out 2 days a week (who wouldn't miss this). I miss the surprises when I get to work in the morning. Quickly trying to figure out who I need to see with the teams of doctors and trainees and trying to round with 3 teams at once. I miss being a part of the team called for advice at all hours. I miss the challenge of fixing a machine when I have no one to ask for advice. Taking the whole machine apart and then realizing I could have just undone 2 little screws. I miss putting that machine back together again and having  it work better than it did before. I miss teaching the nurses, physicians in training and anyone who would listen so someday I am not needed. I miss the bible study with my interns where the conversation is always interesting and I am challenged. I miss stepping out the front door of my house and encountering multiple kids on scooters circling my house. I miss going for a walk and encountering another missionary and we can chat about life, and pray for one another. There is so much more that I could add to this list: the fun of trying to speak and understand swahili, going to church and singing song of praise together; it could just go on.

Many things on this list are the same thing I may have complained about 2 years ago. Life is strange is that way. So now I am continuing in this life here in Canada, working towards going back. I have gotten multiple e-mails from friends back in Kenya with a repeating question:  when are you coming back? The plan is January. Will you help me get there? I need to raise support to get there. Check out the thermometer on the side of the post. I still have a ways to go. So why am I going back? Not just because I miss it. I miss it because that is where God wants me to be.

Weather, water, power, houses

So now that I am back in Canada I get all sorts of questions and I would like to answer some now.

So this month in Alberta it has been hot 30+ C hot (86F). That much warmth is not common here, so over the past few days I have had comments of "boy it's hot, but you must to be used to it as you have lived in Africa". The truth is while I have been in parts of Kenya and other parts of Africa that have been quite warm. The area I call home, Tenwek, is quite comfortable. It a high altitude, about 6000 ft, and therefore is quite temperate. The days are lovely in the mid to low 20s. At nights it cools down to the teens. During the rainy season it's a little cooler, with clouds and rain. But it does not rain all day during the rains, just a few hours in the afternoon and then again in the evening and rains on and off overnight. So really its great weather all the time.

I have had other people concerned about my water situation. Honestly, the water situation was fairly normal. I had flush toilets and a hot water heater. Some of it was different. I filtered my water in a big filter before I drank it. The hot water heater was part solar and part electric. I would flip it on 30-40min before hopping in the shower, and the water would be hot. The water was hard and sometimes brown but really it was all fairly easy and OK.

Power. We had power most of the time. There were periods of time when we would have no power for more days than we would but it was ok - I got used to it. The stove was gas so it still worked, I would read books or play games by candlelight and battery powered lights. Recently I have moved close to downtown and have learned to think of rush hour timing when going somewhere. However, still I am occasionally stuck in traffic. You get used to it fairly quick. You learn what works and what doesn't and sometimes you just sit and wait. Having no power is like that. You quickly get used to it and complain at times but really it is just part of life you roll with.

So lastly people are curious about what my house is like. It's really quite normal. I lived in a two bedroom place that was part of a three-plex . It was a 5 minute walk to the hospital and my neighbors were other missionaries and hospital staff. It was a decent size house and for bible studies or pizza nights 15+ people would fit in there.

So there you have a little about my life. Feel free to ask more questions in the comments and I will work them into my next post

Big News, Moving forward

As I mentioned in my last post, I had traveled to Ontario to interview with a new mission organization. I am excited to share that  I have been accepted by the group, Reach Beyond. Reach Beyond,  formerly called HCJB, has been sending missionaries around the world for a long time. They started with mission radio stations in Ecuador and have since spread around the globe doing radio, health care and other ministries.

I am very excited about working with this great organization. I have had a few questions so I will try answer them here. 

Why the change? What about Samaritans Purse?

This is a change that I knew would probably have to happen for me to stay in missions long term. Samaritans Purse was great to work with, however, they do not send medical missionaries long term. Going long term requires more support like health insurance, retirement savings, and support of mental and spiritual well-being. These are things that Samaritans Purse was not able to offer me and Reach Beyond can. All that being said I was very happy with Samaritans Purse. 

Are you going to the same place now that your with a new group?

Yes, I am returning to Tenwek hospital in Kenya. The work God has me doing there is still not done.

Are you going to be paid now?

With Samaritans purse I did not receive a salary but got reimbursed for expenses. Now I will receive a monthly stipend which I will be required to allocate where needed.

So you still have to raise money?

YES. Reach Beyond functions like many mission organizations. I will need to raise funds to cover all my costs. This will need to be more than I raised last time as funding is needed for the things I mentioned above like health insurance. I ask that you prayerfully consider partnering with this.  Giving is easy to do just follow directions on the post below.  

So how long are you in Canada for?

I am planning to move back to Kenya to serve a term of 3-4 years in January 2016. I will not be released by Reach Beyond until 100% of the funds are raised or pledged, but I am hopeful that I will not be delayed. 

What are you doing until then?

I am living in Edmonton reconnecting with my church here, working close to full-time at the hospital, doing some online bible college courses (requirement of Reach Beyond), and most importantly catching up with family and friends. I would also like to connect with you, if you would like to hear more about the work God is doing in Kenya please let me know. I would love to meet with you, your family, your bible study or church. 

How to Give - Update

Thank You for supporting this ministry. You will receive a tax receipt for donations. I ask you to consider regular scheduled giving, it is easy to do online and will help sustain the ministry. 

Canadians

Electronic Funds transfer;
Print off this form fill it out and mail it to the address below. (you can just click the X in the top right corner - no need to join dropbox). 

Web:
http://reachbeyond.ca/donate
Select donate to a specific missionary
Please place my name in the message box.
When donating a pop-up may pop-up, please ensure pop-up are enabled.

Call:
1-888-354-4252, Reference Annette Lievaart account #4110579

Mail:
Please notate Annette account #4110579 in the memo line. 
Reach Beyond
3-44 Saltsman Drive,
Cambridge, ON, N3H 4R7

Americans


Print off this form fill it out and mail it to the address below. (you can just click the X in the top right corner - no need to join dropbox). 

Web:
https://reachbeyond.org/missionaries/read/annette-lievaart

Call:
1-800-545-9394 Reference Annette Lievaart account #110579

Mail:

Please notate Annette account #110579 in the memo line. 

Reach Beyond

PO Box 39800

Colorado Springs CO 80949