"Millennium Development Goal #4 Reduce Child Mortality" -- by John G. Miers

"Thus says the Lord: A voice is heard in Ramah, lamentation and bitter weeping. Rachel is weeping for her children; she refuses to be comforted for her children, because they are no more." -Jeremiah 31:15

Rachel is weeping. I would be, too. There is a special bond between a parent and child. This also extends beyond parents, however. It includes grandparents, too. It also goes to Godparents, Aunts and Uncles, and then to Cousins and just regular friends. People see potential and hope in these children, (whatever their relationship may be). People see the future. Each child is seen uniquely and separately, a gift from God, and treasure to be cherished and prized. Each is special.

Several weeks ago, I went to a local hospital, to visit the Pediatric Intensive Care Unit, known as “the PICU.” There were many sick kids there, some very ill. There were family members there trying to soothe each other, trying to be there for each other, trying to be there for the sick child. There were subdued voices and frightened faces. There was not much weeping; there was a lot of hope. People were there hoping for healing, expecting healing, assuming that healing would come and come soon. The doctors and nurses and technicians were all bustling around. But there was hope. Always.

This was here in the US. But what about “over there?” What about places where there is not so much technology as we have here? There are places where supplies are short or non-existent. Stethoscopes, maybe; monitors, no way. But there are children there who are sick, many of whom are quite sick, and have been sick for a long time. Each is special, and each is prized. But is there hope? Sometimes. How can we ensure that “sometimes” will increase to “most of the time,” and that “most of the time” will increase to “always?”

This is the key to having MDG #4 – to “Reduce Child Mortality.” This is a goal that everyone can identify with. People see sick children everywhere, and we must remind them that things are more drastic “over there.” In order to “Reduce Child Mortality,” it has to be done there, too. It is harder to do it there, for several reasons. First, more children are sick, and there are fewer resources to care for them expertly.

This is where this MDG comes in. Through various arms and agencies, it encourages and allows us all to help. Those of us “over here” are encouraged to help those who are “over there.” Funds and resources are needed. We can donate time, resources, and funds, the ‘Time, Talent, and Treasure’ about which we have learned. We have so much “over here” that it is obvious where it is needed – and needed desperately. How can we ensure that Child Mortality will be reduced? How can we ensure that Rachel will weep less? Find an agency with international ties. Find a foreign hospital. Support them, and help Rachel stop weeping.

John Miers is from Bethesda, Maryland, where he was employed at the National Institutes of Health from 1968 to 2005. He serves on the board of St. Luke’s House, a halfway house for persons recovering from mental illness and also serves as Jubilee Officer for the Diocese of Washington. He was a member of National Commission on Science, Technology and Faith for the Episcopal Church and is active in his local church, where he is in the choir, worship committee, pastoral care committee, and the prayer team, and he also visits patients in a local hospital on behalf of the Chaplain.

"Reflection of an Image" -- by Craig Cole

It is Advent and we await the coming of Jesus as a child born into a dirty, smelly manger. It is hard to grasp what that might have been like. I sometimes wonder as a parent of two small children what it might have been like to be Joseph. Would he have been scared about Mary actually delivering the baby without her life being threatened?

Even to this day, mothers in many countries die from complications associated with childbirth. Years ago, I walked into a maternity ward in Haiti and I noticed a few flies hovering above a mother in the corner. As I approached I realized she had recently died. I called the doctor over and he quickly checked her pulse, and then had the nurse cover her face with the sheet and he moved on. I was stunned by his nonchalant attitude. In the states we would have done everything possible to save the mother using the latest in technology. When questioned, the doctor told me that postoperative death is common and he had to tend to the living. Moments later, still in the maternity ward, a nurse in our group came running out with a baby who was turning blue. She raced toward another room where the only available oxygen tank in the whole building could be found. It was 1960s vintage but it worked and the baby lived.

That very night at the hotel, I watched an episode of ER, the television show that depicts an emergency room at a hospital in Chicago. The tragic irony was not lost on me as the doctors raced from room to room trying to save lives.

Childbirth was far from easy in the time of Jesus. And in some places it still is and that’s why to reduce child mortality and improve maternal health are the fourth and fifth Millennium Development Goals. I can imagine Joseph breathing a sigh of relief as the baby Jesus cried out for the first time and Mary had not suffered any ill effects. Even with all the medical facilities we had available at the hospital, I know I breathed easier when the doctors gave the thumbs up!

I wrote these few words soon after my daughter was born almost six years ago. I found them while writing this essay and I thought they might be appropriate at this time of the year.

“I looked into the mirror and it was you who smiled back at me – a smile so wide I almost cried.

The father finds a reflection of himself as he holds his first-born daughter. Only, instead of a tired, unshaven face at 4 a.m., she has wide, innocent eyes that sparkle happiness and joy. What will she become? I ask under the glow of the bathroom light.

It won’t be long until she is standing and looking into the mirror with no one to hold her. Will she see my reflection in herself just like I sometimes see my parents reflected in me?

More importantly, will she know that she is made in God’s image and the beauty she radiates comes from Him?”

Have a blessed Advent and Christmas!

"Aiden's Story: Not 'Just Another Death'" -- by Meredith Bowen

The past few days have been some of the most joyous and the most painful of my life. And although the recent events are personal, and not work related, I have decided to share them anyway. I have decided to blog about the past few days with the hope that sharing will help me to heal.

Last Wednesday I received a call from a Tanzanian friend of mine in Arusha. He is a social worker and a village leader. People often seek him out for advice. A young couple had come to him in need of help. Both are HIV positive. Although they are not married, they are in a serious relationship. Despite their best efforts, they had become pregnant. Pregnancies are incredibly difficult on HIV positive women. In addition, this couple had no intentions of starting a family.

This is where I came in. I got the phone call asking if I would be interested in adopting their baby. As many of you know, I am planning to adopt in the coming year. So, I said that I would love to meet them and make sure that they fully understood what an adoption really meant.

I drove to Arusha and was informed that the mother – Stella – had been admitted to a local hospital with contractions. I went to the hospital and spoke with the couple. I had my Tanzanian lawyer join us and asses the situation. The couple was already incredibly informed and their decision was a conscious one.

I asked if she would be willing to transfer to another hospital in town – the “best” option - and undergo a c-section in order to reduce the risk of HIV transmission. She agreed.

I took her to this hospital’s “best” ob-gyn in Arusha and had her checked out. He said the contractions were Braxton Hicks and that he would do the c-section on Monday the 13th.

Unprepared for a newborn, I spent the weekend with friends shopping for supplies, thinking about names, celebrating the immanent arrival. I visited the mother each day and we spoke about the future of her little boy or girl.

Monday finally arrived. I drove to the hospital first thing and invited myself into the surgical room but missed the actual birth by a few minutes. It was a boy. He was born at 10am on Monday the 13th of October 2008. I named him Aiden.

Unfortunately, he came out covered in meconium. As all mothers know, that is the first stool after the baby is born. Releasing the meconium in utero is a sign of stress on the baby. He weighed 3.0kg – 6 ½ pounds – a great weight for an African baby born to a mother with HIV. The mother made it through the surgery well.

Everyone said that the baby was doing fine and that meconium is not a big deal. He was seen by Tanzanian doctors and nurses, as well as two American doctors who are doing a visiting rotation at this hospital.

The baby spent most of the day in an incubator – with oxygen – and iv antibiotics. Around 5pm I finally got to hold him. I never expected to adopt a new born. It was a blessing I thought was too rare a miracle. Holding him was one of the most joyous moments of my life – imagining our lives together.

But I had been coming down with a head cold all weekend and decided that I would return to where I had been staying with friends for the night – get some sleep and some cold meds – and head back to the hospital in the morning. I wasn’t going to be any good with a cold.

I returned to the hospital Tuesday morning. The baby’s father was waiting.

The baby had died.

The hospital form said that he died of respitory arrest at 6:40pm. Just moments after I left.

It was one of the saddest days of my life.

I have faith that I will survive this and that all of this was meant to happen - that one day I will realize why and for what purpose. In the mean time I am simply trying to breath.

In the midst of my grief, it has been incredibly obvious to me that had this baby been in the US he might have survived. There is no way to know for sure. But I am positive that the medical care in Arusha where we went was some of the worst I have ever seen. In addition to terrible facilities, the staff had nothing invested in their jobs. At 7pm when the baby died, there were NO doctors on the entire medical campus. They had all gone home for dinner. The nurses were basically useless. Even the morning I was told that the baby had died, no one seemed to care. Just another death. Just another expendable life.

We will never know what really happened, what was really wrong with Aiden, or what could have been done to save him.

I realize what a blessing it is to work here in Karatu with doctors and nurses who actually care and are properly trained. They are a rare commodity.

Please pray for Aiden. That he is resting comfortably with the angels.

Please pray for Aiden’s mother, Stella, that she fully recovers from the surgery and this tragedy.

Read Meredith's update on Stella's health on The African Orphan Education Fund blog.

Meredith Bowen is an Episcopal young adult living in Tanzania. She has volunteered in Tanzania with the Rift Valley Childrens Village (an orphanage) as well as with the Anglican Diocese of Mount Kilimanjaro and the Diocese of Tanga. Started the African Orphan Education Fund to award scholarships for secondary school and university.

Baby Jean (or Why Fee For Service Medical Care Doesn't Work in Poor Communities).

by Dr. Christiana Russ

I work as a pediatrician at Maseno Hospital, an Anglican Mission Hospital in Maseno, Kenya. It sits high up on a hill over the university, and consists of several cream colored buildings with bright blue trim and red roofs. We have a pediatric ward, a male ward, a female ward, maternity, an operating theater, and an outpatient clinic. There is also the Comprehensive Care Center for HIV/AIDS where antiretrovirals are distributed. We have a decent pharmacy and lab, x-ray services and even an ultrasound machine.

Maseno Hospital originally was designed to have approximately 160 beds. During my tenure here, our maximum inpatient census has been approximately 25 patients. This isn't because the communities around Maseno are healthy and well – in fact HIV infection rates are estimated to be approximately 15% for men and over 20% for women aged 15-35. Of all the children born here, approximately 125 out of 1000 won't reach their first birthday and over 200 out of 1000 won't reach their 5th birthday. These numbers used to be much lower, but the HIV pandemic has devastated the young adult population taking away employers and employees and thus further impoverishing the region. HIV has also been taking away mamas and papas, leaving children behind hopefully with extended family, sometimes only older siblings to care for them. The children who die, die mostly of the same diseases that have always killed children who grow up with not enough food and unsanitary conditions. Malaria followed by pneumonia and diarrhea are the primary culprits, all of which are treatable conditions. These children do not receive care for these conditions in this particular area of the world because their families cannot pay for it.

The example of this failed system of care that sits heaviest in my heart is baby Jean – a one month old baby girl seen at Maseno Hospital outpatient clinic one Monday with fevers up to 39 ºC (102 ºF). A lab test revealed elevated white blood cell count; she was fighting an infection. Any small infant with a fever needs to be taken seriously. They often have only subtle signs of bacterial infection and can develop sepsis and die with extraordinary speed if not treated. Baby Jean's mother, however, did not have the deposit for her to be admitted to the hospital so despite the clinical officer's advice that she be admitted, she went home. She was brought back two days later in the evening with difficulty breathing, and was admitted on IV antibiotics and IV fluids.

The following morning she was dead.

This story makes me SO ANGRY. It is an affront to us as human beings that in this day and age it is still possible for a child to not receive appropriate medical care, especially when her mother sought it out. It is an affront to the Anglican church – the entire communion – that we have a cross hanging on the front gate of this hospital and that we don't fund it well enough to take adequate care of those who enter here, even the small children. It is even more damning for us that other organizations are able to find the funds to provide free or highly subsidized care, and we are still operating in a hopelessly un-Christian fee-for-service system. When people don't get basic health care because they can't pay for it, it's a travesty. It's disgusting. It wounds us all.

I am sick at heart today for the children who die due to lack of care, who die within a few miles of institutions such as this hospital which have the capacity to care for them but somehow don't. I am sick at heart for the mothers and fathers, grandparents, and siblings who bury their little ones and know this is not the way it is meant to be. This is not God's plan.

Dr. Christiana Russ is a pediatrician on faculty at Boston Children's Hospital. She is currently working (and spends half the year) at an Anglican mission hospital in Kenya through a joint arrangement with Children's and the Diocese of Massachusetts. Christiana is chair of the Executive Council Standing Commission on HIV/AIDS.

Tomorrow: Josephine Mujawiyera