Sunday, September 25, 2011

Take my yoke upon thee, for I am meek and humble in heart

Two weeks ago I left Congo for the first time in 6 months to go to Kenya for a retreat with Samaritan’s Purse. As some of you know, this came at an opportune time for me, as I was at a point of burnout. I was going through the motions, trying to get through each day, biding my time until I could get away, to be able to reflect, to spend time alone with God, with no distractions, to be able to hear Him. In the several days just before I left, it became harder and harder to speak french, and by the day before my departure, I could barely do it at all. Thanks be to God, I had an intern with me who speaks English, French, and Lingala, so he was of great assistance to me, especially that last day. 
         When I left, I was angry. Angry because of all the frustrations, angry because the insufficiencies of our hospital in equipment and staff to save lives,  angry at all the deaths that occur on such a regular basis. Angry. Angry. Angry. There is no better way to describe it. And yes, I was angry at God because of all this. Why does he allow it all? Why do we continually struggle just to keep power, let alone enough supplies and nursing staff to care for our patients? Why does it all have to be so frustrating? God knew how I felt, and let me be angry for a time. I didn’t want to let go of my anger. I was a bit proud, like I knew better than He what to do, and He just needed to do it. He just needed to fix the problems. He can heal the sick. He can provide us with consistent electricity. But He doesn’t always work that way, and He needed me to know and accept that.
To me, the main theme from the conference was rest. There were several sessions in which this was the theme, each using a different way of demonstrating rest. The first comes from Matthew 11:28-30
“Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke on you and learn from me, because I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy to bear, and my load is not hard to carry.”
I must admit whenever I’ve thought of a yoke, I thought of it as something for just one animal, But I was reminded a yoke is often used to join two animals together to make pulling a heavy load easier on both. So when Jesus is saying to take his yoke upon us, he’s not giving us all the work-he’s sharing it with us, making our burdens lighter and easier. He can take care of all our worries, fears and frustrations. We can rest in him. If there is anything I’ve needed more at this time, it’s to rest, and most importantly, to rest in HIM. I’ve been a bit like a fussy child who knows they need a nap but resists it, even by throwing temper-tantrums. Fortunately, God does not give up on fussy children, but gently tries to calm them until they rest comfortably in His arms. And in this last two weeks, I’ve been able to quiet myself until I could rest in Him, almost feeling His arms around me, comforting me. It’s not all the time I feel that way, but it’s enough to start to bring some healing to my hurting, broken heart. 
The second was a session entitled “Even God Rested.” The speaker used several passages to show that Jesus often rested. Among these, Luke 5:15-16 sums it up best: 
“But the news about him spread even more, and large crowds were gathering together to hear him and to be healed of their illnesses. Yet Jesus himself frequently withdrew to the wilderness and prayed.”
Jesus could have taken up all his time caring for the sick and healing them, but he made a point to withdraw, to be alone before God. There was certainly no end to the number of people needing healing, be it physical or spiritual, yet he didn’t heal them all. His goal was to spread the kingdom of God, not to heal every sick person on earth. But to spread the Good News, the forgiveness of sins, sometimes this included miracles of physical healing. Sometimes it included casting out of demons. But despite these wondrous things, he still withdrew frequently to pray. He often rested in the arms of his Father. I am sure it gave him strength and guidance to continue on.
The speaker also shared three powerful truths that sum up his talk:
“The deadly scheme is this: keep them running and wear them out, that way they can never protect their hearts.”
“Peaceful and humble reliance on the Lord prepares us to minimize the frequency of stress in our lives.”
And most importantly:
“As a part of a well-balanced life of peacefulness, he slept. He left needs unmet. He took time away from busyness for reflection, solitude, and prayer.”
We will do well to follow His example!!
How am I now, one week following this conference? Better. No longer angry. Better able to accept His ways, and admit they are so much better than my ways. I am able to realize that my purpose in being here is not to be a physician, to heal every person who walks through the hospital doors, but to be a light for Christ. I cannot heal them all, nor should I kill myself trying. In fact, it is not me who heals them, I merely provide a means for them to be healed. Only God can heal. There will always be ill people waiting to be healed. I take comfort in two truths: 
  1. It is ultimately not I who decides who will be healed and who will not. I can give the best care possible but God decides the outcome. 
  2. I need to follow the example of Christ to frequently withdraw and pray.  I need to rest in Him.

Saturday, September 10, 2011

Safu Pie

There are many types of fruit here I've never encountered before. So far, most of them are very tart. (When I eat them I make those faces like when one bites into a lemon). Some are much better with sugar, others are just still too tart for me. Right now, it's Safu season. 
Safu is a fruit that turns a purple color when ripe. You need to cook it first, as it's rather firm. Then you can eat it with salt or with sugar. I decided after the first time I tasted it, it was similar to rhubarb, and thus perhaps one could make a rhubarb pie with it. So I did. The result: Safu pie

My pie crust didn't really roll out too well, so I improvised.

The final verdict: A congolese liked and asked for the recipe. Success!

Thursday, September 8, 2011

Lessons from Job

Why do the sickest patients always end up being the last to be seen in outpatient clinic? I had noticed the emaciated man earlier, waiting outside to be seen. I thought perhaps he was waiting to see our nurse who sees HIV and TB patients. But no, he was there to see me. I get the history: seven months of weight loss, night sweats, fevers. Appetite is good, he actually eats a lot of food, according to him. This belies his emaciated state-his temples are sunken in, as are his cheeks. The boney prominences of his face are clearly visible. His arms and legs are wasted, making the joints look unusually large in comparison. I can see each rib on his chest rise and fall as he breathes. If he’s truly eating well, then something is using up more calories than he can eat. There are three major things that will cause that here: HIV, TB, and cancer. Finally I moved to the abdominal exam. Rather than the concave shape I would expect to see given his malnourished state, I notice it is a bit distended. One touch of his abdomen, and I inwardly groan: his abdomen is firm, with a large mass in the middle. His ultrasound had revealed a pancreatic mass, and multiple metastatic looking lesions in the liver as well as in the abdomen. “Oh, papa,’” I think. “You’re so late in coming. Oh that I had a means of treating you, making you better.”  But I do not say this out loud.
Breaking bad news is difficult in English, in my own culture, let alone in French or Lingala, in a culture I do not fully understand. Do you tell the patient he is dying? Do you tell the family? Who is the head of the family? Are they present? Do you have to wait for them to be present to explain what is going on? Some of these are readily answered by the situation, others are less clear. I discussed it with a Congolese intern who was working with me. He recommends it best not to tell the patient at this time. I have asked for some tests, and we can wait until the results come back to discuss it further. 
He is admitted to the hospital because he is so weak. His HIV and TB test are negative. The metastases in his liver appear to be calcified, which is more consistent with a malignant (cancerous) process. He becomes weaker and weaker. Sunday the doctor on call talks with the family about taking him home to die. It’s must cheaper to transport a mostly-dead person than an already dead person, and these patients don’t have much money to begin with. There is nothing further we can do medically. The family searches for a ride, and asks the wife of one of the other physicians if they can put him in the back of the truck. She agrees.
The family gathered all their belongings, putting them on top of the cab of the truck. They placed a straw mat on the truck bed, and gently placed their loved one on it, his mother sitting at the front, so she could hold his head on her lap. He’s still alive, but barely. I can see his slow respirations through the thin jacket covering him. “Any time now,” I think. You can’t survive long breathing 4-6 times per minute. The rest of the family gathered round him-about 8 people all together-for the ride home. I’ll never forget the mother’s solemn face, the silent tears falling down her cheeks as she held her son one last time. We arrive at their home. Before taking him out of the truck, they prepare a ‘bed’ of sorts for him-a low frame with several sticks across it for support. One man takes the front door (which was not attached to the house) and places it on the sticks to provide a flat surface. He is then gently transported to this ‘bed’, no doubt his death bed, the very place he will lay while they mourn him. He’s still alive at this time, but barely. The tears fall more freely from the mothers face. Soon, no doubt, the cries and wailing will start. They will mourn him loudly, crying out in their sadness and grief.
I have heard the sound of wailing many times at the hospital. Sometimes, I wish to join in. I wish to cry out to God “Why are you letting this happen? Why are these children dying? What did they do to you? Have you no mercy?” My heart breaks for these people. Through my sadness I can see that God loves these people even more than I can ever dream. His mercy is far more than I can imagine. When my heart breaks, His breaks more. His heart breaks for the sadness of the parents as they lose their child. His heart breaks for the sin that so encompasses the people-idolatry, infidelity, stealing, lying, sorcery. Oh that they could know Him, and He would set them free! 
God, to Job:
“Would you discredit my justice? Would you condemn me to justify yourself? Do you have an arm like God’s, and can your voice thunder like his? Then adorn yourself with glory and splendor, and clothe yourself in honor and majesty. Unleash the fury of your wrath, look at every proud man and bring him low, look at every proud man and humble him, crush the wicked where they stand. Bury them all in the dust together; shroud their faces in the grave. Then I myself will admit to you that your own right hand can save you.”  

Job’s response:
“My ears had heard of you but now my eyes have seen you. Therefore I despise myself and repent in dust and ashes. “
Job 40:8-14
Job 42:5-6

Tuesday, September 6, 2011


three days after admission
He came in at the end of a long, hot day. Nestor sat in his mother’s lap, eyes distant, vacant. At 22 months, he should have been around 20 lbs. However, he weighed a measly 14 lbs. His mother states she weaned him from the breast at 18 months, and he refused to eat after that. He lost a significant amount of weight in that time. Now, likely after trying multiple ‘traditional’ treatments, including sorcery, she brought him to the hospital. I admitted him and started him on treatment for severe malnutrition. 
Three days later I saw him-or at least I thought I saw him. This kid looked a little different-he had fat cheeks! 
Three more days went by. I saw him on rounds. I had to double check the chart to be sure it was the same child. Avimbi! He’s grown!! Now not only did he have cheeks, but a found face, and his belly was starting to fill out. His eyes were still a little distant, but more attentive than before. 
10 days after admission
A week later he is a different child. He’s a normal child! He laughs, plays, smiles, talks, and walks. Now just catch-up growth until he can be discharged. 
2.5 weeks after admission
He’s not the only child to come in like that. We have had others, and seemingly more lately than usual. Some struggle to gain weight, others fatten up quite quickly. For me the most amazing part is when they lose that vacant stare for a healthy, attentive and curious look. It gives me hope, and I pray that once they go home, they will continue to grow happy and healthy.  

Day of discharge, 4 weeks after admission

Nestor and his mother, day of discharge.
Yes, he has an umbilical hernia.  It does not need repaired yet.