Seasons. Seasons in life. Seasons in nature. Seasons equal change.

We have now experienced two natural seasons here in Burlington, summer and fall. In that time we have experienced a change in temperature, a change in surroundings, and a change in recreational activities. Work stays the same, church stay the same, friends stay the same, but the surroundings change, our clothes change, and we have an added factor to consider when we go anywhere, the cold.

We are currently experiencing a couple of new seasons of life. One, home ownership. As I write this Josh is unhooking a thermostat from the wall to start a project to build me a pantry. He's awesome. We have made decisions about tearing down walls, replacing windows, and tiling our bathroom floor. We have never had to make decisions like this before.

The other season that we are embarking upon is parenthood. As I type this, a 12 week little baby is growing inside my belly. That is also awesome. We are excited about growing our family. We are making decisions about what will be best for the baby both while I carry him or her and also after we are able to meet our child. We have never had to think about many of these things before either, and we know that there will be many more factors that we will have to consider each time we leave the house. The prospect of parenthood is overwhelming but there is definitely a peace that comes with knowing that this is the Lord's child more than it is ours, and He loves it more than we ever could. We pray that the Lord is already working in its little heart and that we would be well equipped and ready to show our child Jesus.

Several times we've been asked, "Why Vermont?" and though we could always give them some canned answers (that it's beautiful, that we wanted to see a different part of the country, that Josh really liked the residency program, or simply - why not?), the true answer was always, we don't know, but we have a feeling that God is going to use this place to shape us for use in His Kingdom. Well, the Lord has definitely been blessing us with our time here, and we have the distinct comfort that He has sovereignly placed us here. Prior to coming to Vermont we asked many of you to pray for three specific things: a good church, a good home, and good friends. We'd like to share of how the Lord has displayed his goodness to us.

Request #1: Good church. Have you ever browsed the web looking for churches to attend? Quite interesting. You try to look at their doctrine and theology, the different ministries they have, a sense of their overall direction, and whether they seem to have free coffee in the foyer. Well, Josh was doing a web search prior to our first Sunday, and suddenly I heard an excited call come from the study. I went to the computer monitor to see what he was so pumped about, and I saw two words that always thrill Josh's heart. "Ulitmate Frisbee". Yes, the church had an ultimate frisbee ministry. So, with that said, we had no choice but to try Christ Memorial Church first. We also knew that is was one of the only reformed doctrine churches in the area. We attended the church and were amazed by the true feeling of the Body, the delivery of the Word, and evidence of active praise and repentence through their sharing time. We were immediately invited to dinner by a couple our own age, which have become fast friends. We have attended other churches in the area, but it has been incredible how we feel like part of the body of Christ Memorial Church after such limited contact. We have continued to attend CMC and are starting to get involved with their young adults ministry, women's ministry, and hope to be in a home group this fall.

Request #2: Good home. After being here 3 months we are starting to get the feeling of being settled in. It was a bit of a wake up call to see the prices on housing here, but the Lord provided in a way that we did not expect. We purchased a condo very similar to our Lexington townhouse, but one that could use a few home improvements. We are situated in a great location, in a crux between the busyness of Burlington, access to the "box stores" of Walmart, Home Depot, etc., and still on the the border of the open country. The Lord provided the home, the funds, and the relationships in our neighbors which we have been able to form so quickly. It is not the cute little single family home that I dreamed of, but it is perfect for us at this time, stage of life, and resources.

Our new address is:

4 Hayes Avenue

South Burlington,VT 05403

Request #3: Good friends. The Church has been amazing in its provision of friendships. It continues to astound me at how the bond of Christ enables you to form relationships so quickly. We have met an incredible group of people who are teaching us a lot about what it means to serve and strive after holiness. We also have made friends with our neighbors and people at work. Josh really enjoys his other Orthopedic colleagues. Our social life has not been boring and that is a great thing.

Josh and I are both enjoying the jobs that the Lord has provided also. Josh's residency demands a lot of him, but he truly has been able to enjoy it. He's more tired than usual, but he has continued to be the man of God that you all know him to be and an incredible husband to me during this transition. I am working part-time at an orthopedic outpatient clinic and per diem with a home health agency. The combination is suiting me well, giving me a great mix of job and time to get our house in working order.

We have also had a blast enjoying the beauty of Vermont. We have done lots of hiking, biking, and a little sailing! We are looking forward to the beauty of the fall and the new sports of the winter. I have my eyes on some snowshoes :). We are trying to mentally prepare ourselves for the cold of the winter, since I am freezing in the mornings right now, but we know thar it will be fine.

It's cold, but nice!

So, here we are in Vermont. Wow, there have been a lot of changes in the last three weeks. Josh and I feel like we have been on a "highs" and "lows" rollercoaster with lots of excitements and a few disappointments. This rollercoaster is easily explained by the necessity of the ride we have been taking.

Getting on the ride- We had a great move here with only one major hiccup. We accidentally left our laptop in the hotel at Lexington and it was stolen. But otherwise we really enjoyed the drive up here with my parents and getting to do a few Burlingtony things with them. We were definitely geared up for what was ahead of us.

Hill #1- Finding a place to live. Well, things are a lot more expensive up here than in KY. That combined with not having an income over the last 3 months can tend to complicate things. But, in the end after lots of looking, making offers, experiencing competing offers, and praying we are very excited about the little townhouse that we signed a contract on and hope to close on by the end of July. If you were wondering what it looks like, well, just imagine where we lived in Lexington and change the number by one and paint the outside brown (Josh's description). Our new address will be 4-Hayes Ave, South Burlington, VT. It will be close enough for Josh to bike to work (in the summer) and far away enough to escape the busyness of downtown Burlington. The lake is about 5 minutes from our house and the mountains are about 25. Beautiful views abound.

Downhill #1- The blast of exploring Burlington and the surrounding areas. I have posted many of our pictures on Facebook, I will try to figure out how to post an album on here. Simply said, it is gorgeous. I am already looking forward to the beauty of the fall colors. We have hiked the highest and 3rd highest mountains in Vermont. We have seen waterfalls, we have been on bikepaths, we have ran the neighborhood hiking trails, we have ridden the ferry, we have savored the Ben & Jerry's Factory Tour, and enjoyed a delightful B&B, we even splurged and got the 99 cent upgrade of Pure VT Maple Syrup at Denny's.


Hill #2- Logistical transitions (aka Headaches): Getting my PT license transferred, registering our cars, joining a bank, getting new licenses, figuring out how all this home buying stuff works. Its hard to get a lot of things done because we do not have a permanent address and will not have one until the end of July (we hope). For example the DMV wants a signed lease or a bank statement sent to our VT address before issuing a license. The bank wants proof of permanent residence before opening an account. We finally got it all figured out but it was a headache.

Downhill #2- Church hunting. The first Sunday that we were here we went to a church that we both got very excited about. Withing the first 15 minutes of being there we were already invited for dinner by a couple our own age. We enjoyed the praise, the message, the fellowship, and the vision of the church. We have had our new friends Jonathan and Heather over for a good game of Settlers since then and feel very blessed that the Lord has placed them in our lives.

Well, my imaginary rollercoaster is only going to have 2 hills. Partly because that encompasses a lot of what we have done and also because I need to figure out dinner. Josh started his residency on Wednesday and I have a PRN job with a home health agency and am also investigating some other part-time options. The reality that- this is it, we are here, what is the next 5 years going to look like- is hitting. We continue to strive to rest in the Sovereignty and Salvation of our Lord and pray for patience and perseverance.

Packing madness.

Our house looks downright chaotic right now. I mean, it's really impressive. We have stuff strewn everywhere. Bombshells, twisters, and freshmen college students could be described as neat and orderly in comparison with our upstairs hallway. I'm not joking. For me to make it to the bathroom, for example, I have to dodge the precarious stack of sweatshirts, maneuver around my barricaded closet door, pick my way past the imposing pile for Goodwill, and squeeze through two enormous boxes brimming over with clothes. All this without slipping on the growing mountain of trash.

It's really interesting the things you throw away when its time to move. Yesterday I chucked a massive folder that had housed my elementary school awards for the last 2 decades. Somehow, you just don't quite feel right throwing out such an archive of ancient commemorative stuff, you know? Now granted, no one is ever going to care that I was student of the month in October of my fourth grade, or that I received a certificate for most original poem in Mr. Frank's writing class, but still, my hand hesitated to throw that pile of fading papers away. Lots of fun memories came rushing back to mind, and it was good. Yet just as I was admiring myself for how accomplished and mature I was for ditching all of these petty, insignificant, outdated relics, I broke down when I saw my middle school basketball team picture. I just couldn't part with that photo of the impressively tiny, skinny kid with the comb-over and braces who had a vague resemblance to a beardless me. That portrait got tucked into the trunk right next to my 5th grade report on the Apache indians, which was fully illustrated, I will have you know. Everyone has their weakness, I guess.

The other thing about packing is that you realize you've been keeping some pretty crazy stuff for who knows how long. This can be eye-opening and mind-boggling. I'm giving a stack of clothes to Goodwill that is two feet high. Why the heck do I have two feet of extra clothes? Where in the heck did they come from? Why do I still have a stack of receipts from 2005? And why is that expensive silk tie hiding underneath my muddy workboots? What do I do with a Discman CD player these days? Since when did I think that a fourth pair of jean shorts would be a good idea - like I just couldn't stand having only three to sit unworn in my closet? Why do I literally have nine different types of socks that have no match? Nine! It is baffling to see the bizarre items that are hiding in the cracks and corners of your home.

The most ironic thing about it is that we are going to box up all of these items, cram them into a 16 foot long truck, haul them over 17 hours of interstate, and eventually pull them all out in a reverse sort of mayhem where instead of too much excess, we will be unable to find this or that, we go buy more items, and wish we hadn't sold that extra George Foreman grill. Mayhem. Madness. For the moment, however, these cramped passageways that we used to call "halls" are still mocking us. There is more packing to be done, more package tape to fight with, more trips out to the dumpster, more bubble wrap, more dust bunnies...

...and less time remaining in this good home.

So much to tell...

So we are back in Lexington now but there is still so much to write about with the closing of our trip. So this is my attempt to not let the last two weeks disappear without letting you know some of the things that went on. There were definitely some very exciting things at the end of our trip.

Exciting event #1- The most adventurous weekend of my life! Josh and I and 5 other friends travelled to Jinja, Uganda to white water raft the Nile. This trip came about because of our good friend Joe Stone very excitedly told me before we left that we "had to do it." The combination of my own love for adventure, Joe's excitement, and the chance to have a lifetime experience were pretty much irresistible. So, the planning began. Two goals of the trip were- to do it as cheaply as possible and have a blast. This combination is what made it an adventure. We used the busing route from Kenya to Uganda, which involved a 7 hour bus ride, in a huge bus, on a little road. To say the least I was very tense about 80% of those 7 hours. The place that we rafted was definitely a hippie/ place for young people to hang out while they figure out what they want to do with our lives. Don't get me wrong it was a good establishment, just interesting. Then rafting.... WOW, crazy, huge, large, rapids that were very powerful. Josh and I felt that power first hand. On the first rapid Josh was thrown out of the boat (along with the rest of us) but then proceeded to be pushed to the bottom, scraping and bruising his back and ankle on some very mean rocks. He came up dazed, shaken up, and hurting /bleeding a bit... but he was ok. The last rapid was my turn to feel the power. We were all thrown out of the boat again as it flipped, but this time the rapids wanted to hang on to me a little longer than I and my lungs were comfortable with. I got stuck in a "washing machine" of sorts where I got sucked back into the rapid 3x before by the grace of God it finally spit me out and let me see the light of day. I came out very shaken up, coughing, and scared.... but ok. Oh yeah, my helmet and pants got ripped off too, I hope my pants are of good use to some Ugandan out there right now. After our rafting and another "exciting" bus ride we finally returned safely with quite a story to tell.


Exciting event #2- So way back in my first or second blog I told you about how my "project" for the trip was to build the rehab dept a standing frame. In the first two weeks I brainstormed, planned and tried to recall what I had worked with at Cardinal Hill. A standing frame is used by people who have difficulty standing on their own- whether they are completely paralyzed from a spinal cord injury, partially paralyzed from a stroke or brain injury, or just have other medical conditions that make standing difficult. So the plans were turned in and on the day before we were to leave the standing frame was completed and started to be put into use. It was so exciting to see plans come together and a tool be created that will greatly benefit the rehab team. The plans were definitely from the Lord.

I had been working with a patient who had been attacked in his home and almost beaten to death. He had a brain injury and we had been working with him gradually from initiating range of motion, to holding his head up, to sitting up in a wheelchair. The entire time I was working with him I knew that the standing frame would be perfect for his condition and was hoping that it would be done in time for me to demonstrate to the team the benefits behind this therapy. The Lord fulfilled that desire. I brought David to the PT room and he stood up in the frame wonderfully! We had to help him of course, but in the time that he stood we saw him become more responsive to commands, more intentional with his actions, and even got a smile out of him.

Exciting event #3- Kijabe hospital. On Wed of our last week we packed up all our things and travelled to Kijabe hospital to meet Dr. Bransford and his wife Millie. Kijabe hospital is where many of Josh's aunt's and uncles have served as missionaries. There is a long heritage of Schuits (Josh's mom's family) there and Josh's grandparents were very good friends with Dr. and Mrs. Bransford. Rift Valley Academy- a 6-12 grade private school for missionary kids, was also on our list of things to see there. We were very impressed by facility and were able to see where Josh's mom and several of his cousins went to school. Josh had visited Kijabe hospital in '94 with his family so he had lots of reminiscing and fun memories. Dr. and Mrs. Bransford were incredible hosts and it was great to see their ministry there and the joy of the Lord in them as they continued to expand his kingdom. Dr. Bransford has been an inspiration and role model for Josh for some time now as we have been able to follow his ministry through his email updates. Josh spent one day with Dr. Bransford on the ward and OR and I spent the day with one of the therapists in the hospital and then with another one at Rift Valley Academy. It was a great time to see a different setting for a mission hospital, gain some new friends, and for Josh and I to debrief and reflect on our time in Africa as a whole before we returned to all the decisions that now need to be made.


So now we are home. We had a wonderful greeting from our great friends the Lindemann's that has been just one of the many, many, things that we have been able to praise God for and marvel at the blessings he has placed in our lives. It has been incredible to have our eyes opened to how much the Lord has given us and how he has poured so much grace on us as we have appreciated his blessings so little.
I just finished running with my good friend Leslie, and I have a day ahead of me of preparation for our big move to Vermont. The next adventure. We will be moving on May 31st. The Lord's faithfulness will continue, we are so grateful for that promise, and we plan on attempting to continue to blog about all that He is doing in our lives. So, stay tuned!

Isabellah

For the past three weeks I have been seeing a patient named Isabellah. Isabellah came into the hospital after being treated by another hospital following a car accident. She had a broken femur and deep lacerations down her right leg. At the other hospital she had been sown up and then she transferred to Tenwek. Dr. Galat and Josh performed her surgery repairing her broken femur and also opening up her laceration to get it clean. Under the sutures they found that her tissue was barely alive. She had to go back to the operating room 2 additional times for cleaning and skin grafts before she as released for rehab. I met her on rounds and she immediately took to me. When ever I would walk past her room she would yell out "Jesska." Then I would go in, say hello, pray with her, and let her know that I was looking forward to working with her. She has been a patient that expects me to pray with her and definitely keeps me accountable to that.
Isabellah is a confessed believer. She attends an African Gospel Church- the predominant denomination here. She speaks of the Lord freely. She also comes from a family that seems to be well off. She has given me gifts often of bananas and sugar cane. She has pedicured toe nails and has been well fed.
In a previous post I mentioned that Isabellah has been the source of some of my greatest joys and frustrations on this trip. She has brought me joy in the fellowship I have with her as a sister in Christ. It is a blessing to pray with her and to be able to encourage her in her faith throughout her recovery.
Unfortunately though, Isabellah is spoiled. Her pain tolerance is incredibly low. She does not take ownership of her own body but rather expects others to do everything for her, including make her better. I feel like I have been trying to instill work ethic and determination into her for the entire time I have treated her. I have become very frustrated with her because she just will not move her leg. Trust me, she can. I have nicknamed her Drama Queen. Frequently when we first started to get her out of bed she would act like she was fainting so that we would let her sit down. Her screams can be heard in the next building when I even start to move her leg. She is afraid of pain- she is not actually hurting (because I am not actually moving it) she is just afraid of it hurting. I do believe there is a Biblical principle here. Isabellah is paralyzed because of fear. She continually tells me that "this isn't my fault." My reply is "the fact that you won't be able to walk later will be your fault." Isabellah believes that she didn't deserve what happened to her so therefore she shouldn't have to endure the pain of recovery.
So often I feel like my sinful nature isn't my fault- I can't help that I sin, I'm a victim. Therefore it should just be taken away supernaturally. The reality is that I must endure sanctification and be grateful that the Lord wants to make me better. But I must trust in the Lord that the pain of sanctification is making me better- even though it hurts.
"Our fathers disciplined us for a little while as they thought best; but God disciplines us for our good, that we may share in his holiness. No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it. Hebrews 12: 10-11
My time with Isabellah has also tested my ability to truly love her. Loving Isabellah doesn't mean that I am always nice to her. Often I have been stern, real, and called her out on her laziness and excuses. It is amazing to see how the bond of Christ remains strong and we can always laugh and "be friends again" at the end of a session. Often she has said she misses the "old Jesska," meaning the nice one that spent 2 hours with her just to convince her to get out of bed. The great thing is that she understands that I have changed strategies to cultivate independence in her. In the course of our three weeks together she has cried, her father has cried because of her screaming, her roommate has cried because she thought I was torturing the poor girl, she has threatened to sue me, and her mother has realized how spoiled her daughter really is. Her mom greets me each day outside the ortho ward with cheek to cheek kisses (which we have head butted several times b/c of my unfamiliarity with the custom) and a smile, she understands that I am truly there to help no matter how much it may look otherwise.

Currently Isabellah is on the upswing. Her skin grafts are healing and she is slowly starting to achieve some muscle contractions. She still has one skin graft remaining to be completed then she will be discharged to go home. She is walking on her own for about 50 ft. She continues to want to lay in bed all day and complains the entire time she is sitting up, but she is making progress. She has taught me a new kind of patience and love. With her progress I have seen glimpses of a new strength in her, my prayer is that the source of that strength grows in the power of Christ.

Therapy

My work here at Tenwek has mainly been acute care inpatient rehab. My typical day has matured to now I see the patients in the wards of the hospital while the other therapists handle the outpatient visits and any casting needs there are in the hospital. This can be a lot of work. My days are generally longer than what I would put in at the US and they are definitely more varied. I've mentioned some aspects of care in my previous posts, but I thought an 'end of our time here' reflection is now appropriate.
Differences between therapy in the US and Kenya:
1.) Casting- Here therapists are expected to be expert casters. I have only applied one cast by myself but I have helped the other therapists apply on average 2 casts each day. I have gotten a lot of experience with the cast saw.

2.) Prescriptions- The therapists can prescribe pain medicine and anti-inflammatories. I have been handing those responsibilities over to the other therapists.
3.)Traction Pins- Therapists play a big role in inserting traction pins into the limbs of children and adults for setting up traction to heal their fractures.
4.)Spica casts- They are everywhere. These casts position the patient with their leg out to their side and externally rotated. The casts typically go up the leg around the waist and part way down the other leg. Many are modified here to only include one leg to allow the patient to walk. Sitting is very difficult for these patients.
5.) Exercise- The majority of people I work with have no concept of exercise. Which makes sense, because they perform manual labor as their exercise. But the concept of continuing to bend your leg to make it be able to bend like normal seems to be a foreign strategy. They just say "it won't bend" and then don't work on it the rest of the day, despite my instruction. Then they get pretty aggravated at me at times when I make it bend, yes it hurts, but it is always the young men who get the most mad, I think it is a control issue. A huge issue with non-compliancy with exercise is my inability to speak their language. Most of the time I can get my point across with motions, broken Swahili and their broken English. Then I ask the nurse to translate the frequency of exercises, but often I wonder if the nurse understands how they really do need to do it as many times as I am telling them. The national therapist's default for frequency here is "do it 100 times a day." I'm not sure that strategy works either.
6.) Families- The families here seek me out to work with their beloved ones. After I do my initial evaluation the caregivers keep an eye out for me all day and are sure to remind me when I walk by that their child or mother or father needs to be seen. Another difference is the gratfulness the families display. It is definitely apparent. I seem to be able to bond quickly with patients and their families here. Whether it is from the guys on ortho giving me a hard time because I don't speak their language or the children beaming when I poke my head into the room, there are definitely relationships being built. I plan on blogging about Isabellah soon- she has been one of my biggest frustrations and joys on this trip.
7.) Assistive devices- They have to pay for them before they can get them. This creates a huge dilemma for me. I will train someone on crutches (which are used a lot more here than in the US) then I have to take them away until they can pay for them. Then I see my patient either laying in bed all the time when they could be walking, or walking on the limb that they are not supposed to be letting touch the ground. This is a frustration with the system.
8.) Diseases- There have been many times when the diagnosis for a patient reads malaria vs. typhoid or cva vs seizure or just plain unknown origin. Often you have to assume the patient has the worst to protect yourself from contamination. They do not have a CT scan or MRI here which makes definitive diagnoses very difficult in many cases. It doesn't effect my treatment much, just how carefully I wash my hands afterwards.
8.) The freedom to pray- There is such a joy and comfort brought to the patients by speaking the Lord's name and praying with them as they recover. Both the freedom and how comfortable it is to pray with the patients is different from the US. It has also shown me how many opportunities to pray with my patients in the US I have let pass by.

Despite the many differences between the US and here I am amazed at how God continually shows me evidence of the fact that we are all created in his image. People seem to be the same here versus America. We are all either sinners living in sin or saved by grace. There are strong, weak, tough, whiny, joyful, sad, excuse makers, and overcomers on my case load. Personalities seem to be evenly distributed, very similar to the personalities that I see in the US. I am able to bond quickly to fellow believers and have barriers to overcome with angry or resentful patients, but they all appreciate and seem to recognize genuine care.