Tuesday, February 25, 2014

updates: inpatient in Nairobi, miracles, free Michael, severe malaria, never alone

I'm sitting here in our shared room at the Karen Hospital in Nairoibi, Kenya.  Mike is awake and reading Calvin and Hobbes while sitting in his hospital bed with his feet propped up.  He has large blisters covering his heels so can't put pressure on them.  We are waiting for the doctors to round and then we will take our slow and shuffling walk outside.  The Weaver birds are singing for us; we have a front row seat to their next building and baby feeding.  They enter their nests from the bottom side and the nests are swaying in the breeze.  The birds are bright fluffy yellow bits of energy and life.  Karen is a beautiful part of Nairobi, full of trees and flowering plants.  The staff at the hospital are incredibly kind and often telling us that God is with us and that they are praying for us.  We are thankful to be here for his treatment.

Mike is recovering from complications due to severe malaria.  He first got sick 17 days ago with a fever. We did two rapid malaria tests at home which were both negative so we didn't treat him (which of course, I deeply regret now) until day nine.  That day (Tuesday) found us in the emergency department of Bugando hospital in Mwanza, Tanzania.  He was very ill and his blood smear was positive for malaria with a large parasite count. He was also hypotensive (low blood pressure) and prone to fainting when upright.  He was given IVF right away and when an abdominal ultrasound showed free fluid in his abdomen we made arrangements to be medically evacuated to Nairobi, Kenya.  One day later he was taken to emergency surgery for a ruptured spleen (it was a very large laceration in a spleen that was 4-6 times the size it was supposed to be).  He was transfused with 7 units of blood due to severe abdominal bleeding.

The miracle happened the night before we headed to the Bugando hospital, Monday night, over one week ago.  As we look back now, we realize that Mike's spleen ruptured on the Friday (valentines day), 3 days before that Monday.  On that day, he has sudden acute onset upper left shoulder pain and left upper abdominal pain (which now I know is called Kehr's sign a classic sign of a ruptured spleen).  He also got much worse in terms of his symptoms at home.  But, because every morning he would be fever free and would seem to be a little better, we waited to take him to the hospital (again, something I regret now).  On Monday evening, he seemed worse and at one point I walked into our bedroom to find him collapsed on the floor.  The rest of that night will remain one of the scariest I have walked through with him.

After Mike "came to" after collapsing he was disoriented, covered in sweat, very pale, and extremely weak.  He couldn't sit up without almost passing out again. His blood pressure was low. After some time we were able to get him into the bed.  A doctor came to see him and he was stable in bed, much calmer.  Later that night, Mike got worse again and started to almost faint every time he sat up.  At one point I found him again on the floor and disoriented.  It was late by this time and when I took his vital signs they were unstable.  His blood pressure was 80/40 but as the night wore on it dropped further and at one point I couldn't even find it very well.  His heart rate was up and he was breathing fast.  His color was greyish and he was covered in sweat.  And he was fairly out of it.

Looking back now I can see he was in hypovolemic shock from the rupture of his spleen and the internal bleeding. That night I spent next to him in bed sobbing and begging God to keep him alive.  I knew in my gut that he was very very ill and I was so worried he would die right then and there.  I didn't have "911" to call, so I prayed and prayed.  At about 4 am, all of a sudden his vital signs stabilized, he was still hypotensive (low blood pressure) but I could find the blood pressure and he was conscious and alert, though he still couldn't walk on his own.  That was our miracle.  In talking with our surgeon here, she told us that there is no explanation for why he stabilized like that (and stayed stable until he had surgery on Thursday) but for God.  That for whatever reason, we were shown mercy and his life was spared.  It is still completely overwhelming and brings me to tears even now writing this.

He may not have a spleen today, which complicates our life living in a malaria endemic area, but he has his life and I will be forever grateful for this gift.  When I wrote that poem that I posted here I was sitting in the ICU.  After he had surgery and I was again sitting in the ICU next to him, it hit me that he should have died and what happened.  Sitting there, I read medical articles about splenic rupture in severe malaria and his symptoms and I cried again.

Never have I felt so covered by the mercy and love of God as that moment. Immanuel. We are never alone.

Malaria can be divided into uncomplicated malaria and severe malaria.  Severe malaria can come with high parasite counts, decreased levels of consciousness, weakness to the point of not being able to walk, collapsing, convulsions, difficulty eating, kidney failure, low blood pressure, acute respiratory distress syndrome, jaundice, pulmonary edema, and more.  Mike showed not all of these symptoms, but many of them and now he is improving in every way.

He is now doing much better, though still has a long recovery ahead of him.  He has had two rounds of malaria treatment (specific for severe malaria) but still has scant malaria in his blood. We began the third treatment two days ago and are waiting for the blood results today to make sure all the parasites are gone.  Because has has not spleen right now, he has to get special vaccines and go on permanent (while living in Africa) prophylaxis to prevent malaria.  We hope we will get discharged from the hospital in the next day or two and head to a friends house so that he can do outpatient rehab.  He will need to get vaccines in about 10 days before we travel.  We are grateful to Mike's sister who is flying to TZ now to help watch the kids until we get back in a couple of weeks.

We have been overwhelmed and grateful for all the love, support and prayer sent our way over the last week or two.  Here are some of the many ways we have been supported:  prayer from around the world, friends sitting the the waiting room of the ICU for days to support us, a good friend coming from Bujumbura to support me, someone I had never me bringing my a computer so I could have internet, another friend running errands for us like buying ice and helping me get a phone and internet and shampoo (I packed in a huge hurry!), picking up friends/family from the airport, friends in Mwanza picking up and living at our house and taking care of the girls on a moments notice, encouraging emails, places to go to take a shower and rest, calls and words of encouragement and on and on.  We were stunned by the support we received from Mike's "Malaria free Michael" fund over the last day.  Overall, the biggest blessing has been the support and love of all our friends and family.  Thank you so much.

I'm sure Mike would not appreciate me sharing the "before" photos given how extremely ill (and yellow) he looked with tubes coming out all over his body and multiple IV lines, just know that this photo from yesterday is a gift and a testimony to God's mercy and love.  

Saturday, February 22, 2014

The fear I hide.

(The following post was written three nights ago, as I was sitting in the dark ICU in Nairobi, Kenya, next to my very sick husband.)

Do you see the fear in my eyes, my love?

Do not be afraid.

But I am afraid, love, I am.
There are moments I'm terrified
when  I consider
I cannot tell four little girls they no longer have you
this moment
our last.
Sometimes I flee
out of the room full of sick and dying patients
to cry in a corner
to hang my head out of the window and gulp in cool air
with the breeze on my face
Today a young man died next to you
we could not hide
beating on his chest, trying to pump life into his heart
over and over
heart wrenching wails and screams
Not us, love, not us
I will not say goodbye yet
His story
will not be yours tonight

Do not be discouraged

Yes, love, I admit
there are times when I am filled with bottom thoughts
when I wonder what we are doing in the middle 
of Africa
that brought us to this pass
while your blood swims with small deadly parasites
and your organs swell

For I am with you.

I whisper my prayers in the darkness
while life giving machines breath into still bodies next to you
I whisper thanks as you take your own breath

For I am your God

The pleas of my heart I cannot utter
others utter them for me
from around the world
whispered words of love
and supplication
but not from me
for I am too tired, my love
you want me close by
you are brave, husband
so very brave

I am your strength and shield

These moments I wish
were a nightmare 
we could wake from
but also ones I want 
never to forget
the days when my eyes would never leave yours
memorizing the lines of your body
when I would beg for more days
more hours.
You hold my heart in your hands.

I will never leave you or forsake you

Tonight I sit in the quiet
only so because you are finally in a deep sleep
in an ICU 
in Africa
with malaria, racing
filling organs
and cavities with fluid
monitor lights reflecting on your face

For I am your God

Numbers mark my days
eleven days of fever
two days apart from our children
two CT scans
two ultrasounds
three hospitals
one medical evacuation plane

Slow to anger

life giving 
carrying death

Abounding in love and compassion

Your finger glows as oxygen is enumerated
we couldn't count the numbers of yelled
"I love you daddy!"
on the phone tonight
by four little girls
bewildered again by another parent
sick and absent

Be certain of what you do not see, what you hope for

Warm faces
caring hands
reassuring you
and me
you will be okay
it will be okay
God is here

perhaps we did catch this one on the edge, the cusp.  too much longer we would have spilled over.  your life moving on.  but tonight.  courage. hope. prayers of love and encouragement sent up for you around the world.  you are loved.  you are loved. measuring progress by numbers on blinking monitor lights in an ICU. by sleep, deep and quiet.  tonight. God. Immanuel. Is with us.

My love, you and I, we are not alone.

we are not alone.  

(After emergency surgery the next day for a ruptured spleen secondary to complications of severe malaria, and intensive malaria treatment, he is on the slow road to recovery. I will share more in the future about the testimony of what has happened in the past two weeks and the miracle of his survival. We have humbled by the outpouring of love and support we have received and the amazing amount of prayer said on his behalf on people around the world. We appreciate continued prayer for complete healing and recovery. Thank you.)

Friday, February 14, 2014

Small steps mean big changes

Reeds of Hope is a small organization.  We do small work in eastern DRC with overwhelming challenges.  We have big dreams though.  Dreams that are intertwined with the hearts of parents facing insurmountable odds.  We support two project, one has been ongoing for four years and one is a new partnership.  Both support children who have been separated from their families because of maternal mortality, death or illness of surviving parents, abandonment, moments of crisis in their family in a place where there is no social safety net beyond local church and community members who are often living in extreme poverty as well. 

After a visit to DRC, I am always left humbled beyond belief at the strength, resilience, and determination of the people I have been honored to spend time with during my brief stays.  I love the recent campaign by Panzi and Channel Initiative named Rise.  They are "changing the narrative of congolese women. From victim to victory."  Check out the link and be encouraged! 

On a recent trip to DRC, I was told by a social worker, "Give money and support to our families, not just to our children. Because when you give money to our families then they can care for our children and eventually they will not need help anymore.  Children will always need your help.  Please, help our families here in Congo have the strength and ability to care for their children."  This is our vision.  Children living with their families. 

Because we are a small organization, we don't have big overhead costs.  We send about $2200 to $2500 to the field every month.  Three times a year we send about $2000 for school fees for 82 children.  We support more and more babies every month that need formula (their mothers have died in birth) and often all our donations are used for the needs of the babies so we are left waiting until we find extra funds for our bigger projects.  Those bigger projects are the ones that will move us forward in our dreams of children in families.  Over the past four years I have learned we can do so much with so little. 

We are excited about this year.  We know God can do big things, even with little resources. 

Thank you for all the support you have given us over the past four years and we look forward to what this year will bring in our work in DRC. 

One of the many little ones we support.  Our dreams mean we want to support her beyond just making sure she has milk to drink and staff to care for her.  Our dreams for her are that she would be reunited with her family and not spend her days in an orphanage, because even if it gives excellent care, is not enough.

For those that are interested in ways to support Reeds of Hope, there is an auction that is happening today which will benefit one of four charities (Reeds of Hope is one of them).  Please consider sharing the link.  It is found here.  Most of all, I feel encouraged by this group of artists who have decided to share and give of their amazing talents to those in need.  Thank you!

Friday, February 7, 2014

Orphanage donations, child finder fees, social services fees, and referral fees in international adoption in DRC

When we first decided to adopt, I searched for all the information I could find about international adoption.  Some of my own journey as I found this information and what I learned I have already written about.  Over the past few years I have been writing about ethics and corruption in IA in DRC frequently.  I feel like I am throwing pebbles at a moving train.  But because I hear back from adoptive parents that what I write is important and it has helped them make good decisions about their adoptions (and even whether to adopt from DRC or not), I continue to write.

International adoption has impacted me on many levels, but the biggest two are in a personal way when we adopted our twins and on a professional level with our work at Reeds of Hope.  It is impossible to not have to wrestle with the impact of international adoption if you work with orphanages in a country that allows IA.  I am still looking to find an orphanage where there is a good working relationship between organizations that are committed to family reunification and ones that facilitate international adoptions.  One is trying to reunite children with their families and the other is trying provide waiting families with children (often babies or toddlers under 2 years old). I don't think a good working relationship between two such parties at the same baby home exists because at their basic mission/focus level they differ fundamentally. 

Why?  Because the money that is brought into orphanages (or into the social service system) for adoption makes children become commodities.  Let's look at the definition of commodity: "Something that is bought and sold. Something or someone that is useful or valued.  One that is subject to ready exchange or exploitation within a market." (source). It is clear by looking at best practices documents, law around the world, and resources in international adoption, that separating the money from those that are responsible for the children on the ground is one very important part of protecting children from exploitation.

Yet, in DRC I haven't found a single case where adoptive parents are not required to do one or more of the following:  sign a contract that says they must fund raise for their organization/agency and give a certain amount in donations (which usually ends up in the hands of those that are finding children for referrals) for every child they adopt, give a fee to an on-ground staff member that then finds a referral for the AP (child finder fees), give a donation to the orphanage that cares for the child to "compensate" for the cost that they incurred while caring for that child (usually this is required to take the child out of the orphanage), pay monthly foster care fees to the orphanage directly as soon as the referral is in place, give a one time humanitarian donation to the orphanage where their child came from, pay a "referral" fee or other unlabeled designated amount to social services when the referral is made available (some agencies and organizations work directly with social services for their referrals and not through orphanages). 

This places pressure on a very weak system to find children for international adoption.  The weaker the infrastructure of a country, the more unchecked pressure is placed on those caring for vulnerable children in the country.  Children become commodities and are easily exploited for gain.  There is a huge lack of infrastructure and systems in place to protect these same children from the harm of being exploited and possibly trafficked in DRC.  Everyone plays a part in this.  The ones who care for the children as well as the government officials (including social services) who call on ground contacts when a child is found and money is exchanged.

Imagine this scenario.  A adoptive parent gets a call.  A 2 week old baby was found on the street three days ago.  Social services has called the organization or agency contact on the ground that there is a baby available for adoption.  No one has come forward for the baby and they can't find the family (remember, the baby was found 3 days ago).  The on-ground contact calls the organization or agency in the states.  Who then call the AP.  "There is a baby available, we have no photo or other information, if you want this referral you have to decide in 24 hours or we may lose the baby to another agency or I will call the next family on my list.  If you want this referral, please wire $500 immediately to our on ground contact in DRC so they can pay the referral fee.  We are so excited to find a family for this little one." 

I feel like this must be a very obvious post.  We cannot "pay" anyone to find us a child.  We should not "pay" anyone in exchange for a child.  We should not "pay" the government officials when they hand over a child to us for referral.  We don't pay for children (or in other words, we shouldn't "buy" children) and neither should anyone accept payment for a child (or in other words, no one should "sell" a child). 

It should be clear that the money from adoptive parents should not have any influence on the decision whether or not a child is made available for adoption.  That is a clear incentive to traffic children.  Yet, this is routinely done in DRC.  And what happens when this is being done on such a routine basis?  It falls apart.  Children are taken from families that are lied to about what adoption means and where there child is going.  Children are taken from families that don't knowingly consent to them being adopted internationally.  Children are taken from families and then the same families are coerced and threatened when they question where their children went.  (All of these actions would be called "child trafficking" in any other developed country but the U.S.A.  The U.S. doesn't believe that the definition of child trafficking includes those children bought or taken for international adoption.)  Siblings are split apart.  When siblings are split apart more money is collected overall.  Children are referred to one agency or organization and then referred instead to another one because they can get two referral fees or the other agency gives them more money.

For orphanages and government organizations like social services that do not have a lot of funds and support, the money that funnels in because of international adoption becomes the way they support the children.  Even those that don't have nefarious motives, this regular income must be sustained if they are to support their work, their own families, and keep themselves afloat.  And often those that are accepting funds on a regular basis from the organizations and agencies are the ones doing the consenting and counseling of birth parents.  Even those that may be doing this with the best motives, if they or the orphanage they support (if their livelihood) is dependent (or partly dependent) on those same donations then it puts pressure on that person to find children for international adoption.  So, even those with the best motives need to continue to find children for adoption.

So, what should we do?  Stop paying the money!  Again, we can blame the on ground staff, we can blame the problems in the government of DRC, we can blame our agencies and organizations (all are culpable in this problem, some more than others), but in the end where we can actually make change happen is with us.  We are the ones that fund the whole system.  We send our $30,000 or more to the agencies and organizations.  We send our $500/month to the orphanages or care homes.  We pay child finder fees.  We pay referral fees and social services fees and humanitarian donations to those that are finding or providing the children to be referred.

We put pressure on a weak system (please see this post) where there is nothing in place to protect vulnerable children from exploitation.

Do something about it.  You can make a difference.  Don't accept any new referrals from DRC until reform happens on the ground that can protect children from exploitation.   I assume no one wants to adopt a trafficked child.  Demand accountability from your agency and organization now.  Do an investigation.  Ask hard questions. Find out how your money is being used on the ground.  Don't give up.  Don't be intimidated.  Contact a lawyer if you need representation.  Speak out.  Don't be silent. All of us say we want to help orphans in DRC.  So, help orphans in DRC.  Protect them from becoming commodities in international adoption.  Protect vulnerable mothers who are preyed upon because their children are valuable to on ground staff.  Stand up for those that more powerless and have no one to protect them.  Do the right thing.

"Silence in the face of evil is itself evil: God will not hold us guiltless.  
Not to speak, is to speak.  Not to act, is to act."  Dietrich Bonhoeffer 


What is happening in DRC by agencies and organizations facilitating adoption is not what should be happening and is clearly not what is uniformly the accepted practices to ensure ethical and corruption free adoptions.  For further reading:

Children's Act Uganda.  Part VII:  "The applicant or any person on behalf of the applicant has not paid or agreed to pay money or anything in place of money to the parent, guardian or any person in charge of the child in consideration of the adoption of the child."  What is interesting about this is the Children's Act is very easily found on line and is publicly accessible, yet similar to DRC, most agencies, lawyers, orphanages, and APs also are perpetuating a cycle of fueling a system which makes a pipeline creating commodities from children for international adoption. 

A great series of posts about ethics in IA.  Grab a cup of tea and start here.

Thursday, February 6, 2014

It is not enough.

It has been 4 years this month that I first visited and started supporting the orphanage we support in eastern DRC.  From the first day we were very alarmed by the condition of the children.  We were thankful that the mamas loved the children so much but there was little they could do caring for almost 40 babies and toddlers when there were only two women on a shift.  We saw all the signs of neglect, malnourishment, nutritional deficiencies, developmental delays, extreme sensory issues, lots of rocking back and forth and self soothing behaviors.  Babies were practically untouched all day and there was little interaction or human touch for those that were out of their cribs.  You can read all about the harm institutions can do to babies and children, but when you hold a 14 month old that weighs the same as a newborn, can't lift her head up and shudders when you touch her, your heart is forever changed.

So, we (with the help of other, like some of you reading this right now) helped to bring change.  We brought high quality formula.  And we promised we wouldn't stop when we realized on later visits that it was still being watered down because they didn't know if we would be back.  The mamas wanted to make sure what they had would last so that they didn't run out of milk for the babies.  We did training after training on mixing formula correctly, on safe water standards, on how much and how often to feed babies.  We consistently weighed the babies.  We hired a nurse to work in the orphanage and monitor formula and that babies.  We still do this work.

It is not enough. 

We hired more women to care for the babies and toddlers.  We did training after training on the importance of touch and holding babies.  We talked about how in Congo mamas wrap their babies close to their babies from birth until they are walking and beyond.  We talked about how that is so very important for babies hearts and minds.  We talked about how we knew they loved these babies and we promised more help for them.  We told them they are the hands of God holding the babies, that they are their mamas.  We still do this work.

It is not enough.

We talked about the importance of play for the older children, they they needed to be outside in the sunshine and playing in the grass.  We talked about how talking and interacting to toddlers, touching them and hugging them, is as important as the food they are given.  We still do this work.

It is not enough.

What have I learned after 4 years of this work?  I have learned that I did it all wrong.  I have learned that if you don't begin the work with a plan for every single child that considers how to make their time there as short as safely possible, then you are doing great harm to the children you are trying to help.  I have learned that a child is a part of their family and that the family is just as important as that child.  I have learned that the nicer you make the orphanage, the more the babies will come.  I have learned that if you only focus on meeting the acute needs of the children living in the orphanage, and not also on family reunification and support, you will miss out on what those children really need most of all to survive: their families.  

For the past two we have been focused on changing our mission at Reeds of Hope to one that prioritizes the alternative care framework, family reunification and support.  We are committed to making sure our on-ground work fits with our mission: children belong with their families whenever possible, not in an orphanage. 

If you are supporting an orphanage or thinking about supporting one, or, if you are the director of an organization that supports an orphanage or someone who is just helping from of the goodness of their heart, please consider the kind of work you are doing.  Consider that if you are only meeting the acute physical needs of the children in the orphanage you may be doing more harm than good (because even the best orphanages harm children).  If you are not working harder to help them return to their families (please see this post) than you are to meet their acute physical needs, then you are not meeting their greatest need.  They have a fundamental human right to be with their families and we have a responsibility in DRC to come along families who are in vulnerable situations and need support so that they can care for their children.   

I'm so excited about 2014 and the changes that are coming.  We have the funds for a motorcycle as well as the funds to hire a social worker.  I can't tell you how much this means to me.  We are starting a second partnership that you can read about here.  

We have done some good things in the past four years, some very good things.  But, it is not enough.  We want to do our best for the children we support.  

Thank you for supporting the children and families of eastern DRC and partnering with us in this work.

(This post is not about International Adoption, please see this resource if you would like to know how IA fits into the alternative care framework.  And please visit (and consider supporting) the work of these two groups in Uganda for a better picture of what this work would look like in DRC:  The Abide Family Center and Child's i Foundation.) 

All photos copyright of Reeds of Hope and not to be used without permission. 

Tuesday, February 4, 2014

Grasping the gifts of beauty and joy.

My yard is full of the color green.  We are fortunate to have a grassy yard and many trees.  We also have fruit trees, bushes, and flowering plants.  When I first moved here I didn't think we had many flowering plants.  It was lovely in green, but there wasn't a lot of color other than green.  When we lived in DRC, we were fortunate to have a large compound full of flowering plants that were tended carefully by the gardener and our good friend Pocolo (our oldest couldn't say "Uncle Bill" so he became "Pocolo").  I missed our flowers in DRC. 

Then, I realized that many of the plants and bushes in our yard did flower.  I would find myself surprised when I saw a gorgeous flower on a plant that I thought for sure was just leaves.  The next day I would grab my camera and the flower would be gone.  This kept happening.  I finally figured out we have a magical yard.  Beauty in the form of flowers, comes briefly and then disappears just as fast.

I've learned that if I'm not looking, I miss the gift.  If I am walking fast, I often notice a blooming flower.  But if I am too busy and I don't take the time to stop, it is gone by the next time I pass by the same plant.  I don't understand it.  Likely, if I was a botanist, it would make perfect sense. But since I'm not I instead am learning to slow down, stop, pull my kids over and soak in the beauty of an unexpected flower.

I'm trying to learn about these gifts.  I feel like the natural world is teaching my about life.  Our lives have been so busy and fast for the past 2 years.  Getting sick forced me to slow down.  Moving to Tanzania and not working also changed the pace of my life.  My oldest turned 7 years old last week.  I don't want to miss the beauty of these years in her life.  I don't want to be walking so fast that when I finally do slow down they are gone.  Like these flowers, I want to soak up the joy and beauty of the gift I have been given today.

The magic is the in the gifts God gives us that we often miss.  The gifts of beauty and deep joy.  I don't want to look back and feel regret that I didn't even see them when they were right in front of me, and I was too busy to notice.  

(All the flowers in this post are from my yard from days when I slowed down and grabbed my camera.  They are not blooming in my yard today.)