Giving thanks

This thanksgiving I thought I’d write about how I’m thankful for the way in which God has orchestrated my life to prepare me for the mission field. I’ll try to put them in chronological order, but some are rather nebulous in time.

Second-born child, but first-born daughter-This took some of the pressures off being the oldest, but as the oldest daughter, I was often given responsibilities my sisters did not have until I left for college-much later than I started. This allowed me to develop some leadership skills (sitting on your sister when she doesn’t do her chores is appropriate leadership, right?). 

He put it in my heart from an early age. When I was little, adults used to ask what I wanted to do when I grew up. I often answered I wanted to be a doctor or a missionary. I don’t know exactly where this response came from, but it’s what I would say. 

Since my mom worked second shift, and my dad worked late in the winter months (tax season), I often had to make the meals for the family. It first started as ‘heat up the leftovers in the fridge’, and gradually developed to ‘make spaghetti and sauce’, etc. We often also baked together, especially around the holidays. This cooking knowledge has been helpful since most things I eat are made from scratch. Had I not learned to cook, I would struggle more.

We often traveled during the summers. I can remember camping, peeing in the woods, using pit-toilets (and that was at the rest area!), and other interesting places to relieve ourselves. Since most places I’ve visited in Africa have pit toilets, it wasn’t a big deal to me to use them, nor the ‘squatty potty’ so very common there. It may seem an odd thing to be thankful for, but I’ve seen some missionaries who had a hard time with this. For them, I’d suggest to invest in a ‘Go Girl’. Mom also taught me an important lesson when it comes to bathroom breaks: You can always at least try. You never know when your next chance is going to be, or if it will be among biting ants (been there, done that.)

Growing up, I enjoyed reading books based in the 18^th and 19^th centuries, pioneering, traveling and working in the old west. It may seem odd, but this has actually helped me, as living in Impfondo is like a strange mix of 19^th and 21^st century mixed together. Women still go to get water, most often from a pump well. Most things are made by hand, and from scratch-no Lean Cuisine dinners there. I had read about killing and plucking chickens, killing goats, farming (with a hoe, not a tractor), and many other things that have helped me be more aware of how things are done, and not be too surprised. There are sometimes certain words, or items that I know, only because I read those books. 

He also placed people in my life to influence my desires to be a missionary. My own family doctor used to take missions trips to haiti each year. In college I met other missions minded people, which expanded my horizons of possibilities in the mission field. College afforded me my first trip to Africa, where I fell in love with the continent. Medical school allowed me to return, and spend two months there. In residency I was able to make several short term trips to Kenya, Uganda, and Ecuador. Each of these gave me insights into different ways of doing missionary medicine, in different settings. 

The process which brought me to be a post-residency fellow with Samaritan’s Purse is quite a long and strange route. I met some people while on my medical school rotation in Kenya. A year after I returned, the wife of the couple died suddenly. I went to the funeral. At the meal afterwards, I met a resident at IU who did an internship at Kijabe Hospital in Kenya. He stated that there was a need for doctors, especially surgeons, at that hospital. Just a month or two prior, my attending for my surgery rotation mentioned he’d like to take a trip to Africa with his daughter in the summer of 2008. We had discussed combining forces to work in a hospital in Kenya. I contacted Kijabe hospital, who stated they could use both of us, but we needed to complete an application through World Medical Mission. This is the first I’d heard of them. The next fall, I went to the Medical Missions conference in Louisville, KY. There I met Scott Reichenbach, then the director of the Post-Residency Program. I wasn’t really planning on stopping at that booth, but I noticed the photo of a resident who had been at my program the year before I started residency.  I asked about her, and soon we were talking about the program. From my time in Kenya in medical school, I knew I wanted to do long term missions, but was a little hesitant/unsure how to go about it. This program seemed like a nice way to bridge the gap between residency and full-time missions. It’s a wonderful program!

There are myriad other ways in which He’s prepared me that are not listed here. Friendships, other events, professors, courses, familial encouragement have all played a part. 

Thank you, Lord, for how you have guided me, and how you will continue to guide me. Help me keep my ears and eyes open to your will for my life. 

“For I know the plans I have for you,” declares the Lord. “Plans to prosper you and not to harm you, plans for a hope and a future.”

Jeremiah 29:11

Doing it all in high heels and backwards

As I’ve been discussing some of my frustrations and stresses of work in Congo with fellow missionaries, I’ve gained some perspective. One asked “Would you have the same sort of responsibilities if you practiced in the US?” Let’s make a comparison:

US physician responsibilities:

See patients-inpatient and outpatient

Fill out miles of paperwork for insurance companies 

Complete Gigabytes of electronic medical records

Collaborate with others within the practice (business stuff)

Take call-medicine and obstetrics

Other things I’m sure I’ve forgotten

My responsibilities as a physician here:

See patients-inpatients and outpatients

Fill out small booklets as the patients medical record, which they usually carry with them

Fill out the minimalistic chart we use on inpatients

Perform cesarian sections

Perform exploratory laparotomies

Perform other random surgeries ranging from urological procedures (repaired a man’s ruptured bladder last week), to orthopedics (I have amputated fingers, toes, done larger amputations), neurosurgery (assisted to elevate a depressed skull fracture), general surgery (bowel resection, repair of gastric ulcers), to plastics (repair of lip which was bitten off in a fight).

Assist with ordering medications, keeping stock in pharmacy

Be the social worker, discharge planner, nutritionist, physical therapist, occupational therapist, and perform patient education

Know how the electrical system at the hospital works, know how to turn on the generator, and trouble shoot minor electrical problems

Over see ‘wound clinic’

Manage financial issues such as encouraging people to pay their bill, and sometimes reducing the bill so they can go home.

Assist with deliveries

Perform and interpret ultrasounds

Deal with the preoccupations of medical and non-medical staff

Read x-rays

Now, do all these things in French and/or Lingala

So why am I stressed?

You know you've lived in rural Africa when...

You know you’ve lived in rural Africa when:

1. You know how to knock ants out of bread.
2. The 10 second rule becomes the 30 second rule, which quickly becomes, ‘if it’s not growing something on it and no cockroach is standing on it, you can eat it.’
3. You can’t throw any bottle or container away because:
1. You can use it to store food.
2. You can use it to provide containers for nutritional milk to feed malnourished children
3. You can use them to give away food to people who might not bring back your plastic containers.
4. Chocolate is priceless, even if it’s been melted and cooled several times. 
5. You’re willing to pay $16/gallon ($2 per ½ liter) for liquid, irradiated milk because 
1. It’s not powdered
2. It tastes closer to real milk than anything else you can get
6. Instead of throwing out food the cat or dog got into, you either 
1. Eat it anyway
2. Scoop out where the animal ate from it, and eat the rest
7. All your clothes are either 
1. Faded (from drying in the sun)
2. Stretched (from being stretched on the clothes line)
3. Stained 
4. All of the above
8. “I’m traveling on such and such a day” really means you may be traveling the day before, the day of, the day after, or not at all. That's just you-your luggage may or may not come with you.
9. You know what sounds termites make, especially before the flying ones are about to leave the mound.  (Shiver!)
10. Lizards and geckos in the house don’t really bother you, because they eat flies, termites and mosquitos.
11. You have two types of seasons:
1. By weather
1. Rainy
2. Dry
2. By produce
1. Mango
2. Avacado
3. Papaya
4. Caterpillars
12. You know how to make pizza from Laughing Cow cheese.
13. Having granola and yogurt for breakfast means:
1. making your own yogurt
2. buying honey from a local pygmy
3. making your own granola, which involves
1. Buying, opening, and grating fresh coconut (if desired)
2. Buying and roasting peanuts (if desired)
3. Buying oatmeal 
14. You know how to 'candle' eggs to tell if they are good or not.

The Sound of Silence

After recently talking with a friend back home, I realized I had not updated my blog since the end of June. Being as a few months have passed since then, I thought I should take the time to update what’s been going on here. 

For those of you who know me well, you know that if I’m not communicating very much, by phone, email, or other forms of communication, I’m likely not doing so well. I tend to hide away when feeling down or stressed. With all the changes that have happened here, I have been both, and thus most of my communication has come to a grinding halt. So, should you be one who checks my blog regularly and finds there is no recent update, take it as a sign to send some more prayers my way. 

It’s been a challenge to balance my life with having call every other week. Sometimes there are not too many emergencies and not to many calls during the night, which makes for easier times, but other times I have several nights of interrupted sleep. I’m thankful to Stephen and Anna, who look out for me, provide cold water and meals, as well as my Congolese neighbors, the Ngalipe’s, who also look out to be sure I’m eating and resting when possible. Without them, it would be that much harder. 

Suzy, the pharmacist came for a month in August and helped with payroll and some other pharmacy things. It was nice to have another addition to the team, even if it was for a short while. I enjoyed having a housemate again. 

In September I left to go to Kenya for a conference with Samaritan’s Purse. It was good to get away from the hospital, but still not as relaxing as I would have liked it to be. It took quite a while to be able to relax, and then it was time to leave again. The travel there and back was stressful at best, which left me tired and worn out upon my return. (Mostly due to travels to and from Impfondo.)

On my return, I started back to work right away, taking call, jumping back into things. That first week back was a bear...unfortunately not well rested from my trip, along with a busy week of call resulted in quite a few tears. The second week was better as I was able to catch up on some much needed sleep. I’m now into the 4^th week back, and things are okay, much of the time.  

There are several things on my mind which I think are provoking the stress. One big one is the departure of the Wegner family in January of 2013. Not only am I losing Stephen as a fellow physician at the hospital, but I am also losing two good friends, and the Interim Medical Director. Currently we do not have anyone to take the place as Interim Medical Director, and so the duties are likely to be split between me and another missionary here, a nurse ophthalmologist. This leaves big questions in my mind: Can I handle the responsibilities? Will I become too worn out with only short-term physicians helping out with hospital rounds and call? Will God provide a medical director to help out, or is this a task I am to learn to perform? 

Then comes questions for the future: what will I do when I finish my time here? I’d like to continue as a missionary, but with what sending agency, and where? Return to Impfondo? Or elsewhere? Take some time to practice back home before heading out again? I think it could be beneficial to get more experience under my belt back home. Now that I know more of the types of things I need to know on the field, I can work to learn more in areas where I am deficient. 

Don’t get me wrong, I do love my work here. I enjoy the challenges (but sometimes get tired of them). I love the people (though I may not understand them, or understand their culture). I love doing what I’ve dreamed of doing since childhood, though it’s not quite as utopian as my dreams. ;-) But no one ever said being an adult was easy. Fortunately, I have a Guide to help me know what to do next, to whisper encouragement to me (if only I’ll take the time to listen), to walk with me and support me along the way. In all my busyness of ‘working for the Lord’, sometimes it’s easy to forget to spend time with Him, to listen, and be content in Him. So please pray that I make time for Him each day, that He will show me the way I am to go, and to take comfort in Him. 

And Then There were None OR The Gideon Experience

And Then There Were None

OR

The Gideon Experience

The LORD said to Gideon,“You have too many men for me to deliver Midian into their hands in order that Israel may not boast against me that her own strength has saved her, announce now to the people, ‘Anyone who trembles with fear may turn back and leave Mount Gilead.” So 22,000 men left, while 10,000 remained. But the LORD said to Gideon, “There are still too many men. Take them down to the water, and I will sift them for you there. If I say, ‘This one shall go with you,’ he shall go; but if I say, ‘This one shall not go with you,’ he shall not go.” So Gideon took the men down to the water. There the LORD told him, “Separate those who lap the water with their tongues like a dog from those who kneel down to drink.” Three hundred men lapped with their hands to their mouths. All the rest got down on their knees to drink. The LORD said to Gideon, “With the 300 men that lapped I will save you and give the Midianites into your hands. Let all the other men go, each to his own place.” So Gideon sent the rest of the Israelites to their tents but kept the 300, who took over the provisions and trumpets of the others. Now the camp of Midian lay below him in the valley. During that night the LORD said to Gideon, “Get up, go down against the camp, because I am going to give it into your hands.”

...Thus Midian was subdued before the Israelites and did not raise its head again. During Gideon’s lifetime, the land enjoyed peace forty years. 

Judges 7:2-9, 8:28

In the last month, our team here has had some major changes, and will continue to have some more in the next month. The Harvey family left for their one year home assignment in mid-June. Dr Harvey is the medical director of the hospital, and one among three physicians here (the other two being myself and Stephen Wegner). His wife Becky has done quite a bit of administrative tasks for the mission as well. With their leaving, there were a number of tasks to be divided up among the remaining team members. With this comes the stumbling of figuring out how to do tasks we’ve never done before, even with the instructions left us by the Harvey’s. Prior to this, Sarah, one of our long-term missionaries broke her arm back in March in a bike accident. She runs a leprosy program and is working on building a new center for them. Her fracture didn’t heal properly, and she left a few months ago to return to Canada for further surgery and physical therapy. The tasks she performs were largely assumed by some Congolese, but also by another missionary family, the Marshes. Our pharmacist finished her term here in May, and returned to the US, and thus we’ve taken on some of the tasks she had been doing. She continues to do some of the work from the US. 

This Tuesday, the Marsh family is returning to the US before their anticipated time due to a medical problem that we are not able to treat here. They were assuming a number of tasks previously done by Becky Harvey, as well as tasks done by Sarah, which now need to be reassigned to someone else. This last Wednesday we spent our team meeting defining the tasks that need to be done, and clarifying who is doing each task. I think we all felt the weight of additional responsibilities to an already full plate. Being as I will soon be the only missionary at the mission (the rest live on the hospital compound), I have assumed many of the responsibilities the Marshes were carrying. Thursday, we spent about 5 hours going over everything. Nonetheless, I don’t feel too very stressed about it yet. I think I have a peace about it from God that He’ll help me get things done. But I would appreciate your prayers that I have time and energy to get the monthly and weekly tasks done. They aren’t hard, but some just take time. 

For those of you who are worried that I’m the only missionary at the mission, don’t worry. There is another family here with whom I am very close, who are Congolese. They are my Congolese family, and are a great help to me here. There are still guards here 24/7 (not that it’s not safe, but they help deter theft and provide a buffer between me and people knocking at my door.) So I’m not alone, there is a truck here for me to use, and I’m only 3 miles from the hospital. And God is here.

In December, the Wegner family leaves for their 1 year home assignment, leaving me as the sole acting physician at the hospital. (There is an internist here, but her main focus right now is helping to open the Eye Center and care for her three young children. Two full time jobs in and of themselves.) God has blessed us with several volunteers who have expressed interest in coming in the months of January-June. This should help me unload some clinical responsibilities so that I’m able to do more administrative duties once Stephen is gone. Currently I am not sure who will become acting medical director in January. 

The Marsh family hopes to come back in September, should their funding allow it, to finish their term here. Sarah hopes to come back near September as well. Suzy, the pharmacist, is planning on returning for a month in August. So, we are not without hope. 

Is God doing this so that we know the hospital continues to function not because of our own doing but because of His power? Quite possibly. It certainly requires more faith and reliance on Him when it seems we can’t provide things for ourselves. (Though in reality it is God who provides all, we just think we provide for ourselves.) It certainly forces us to work together as a team, to ask for help, to communicate well so that we do not become angry, bitter, and resentful towards one another. Be praying for the former, so that the latter does not occur. 

Father's Day

I remember writing my post last year for Father’s Day. It’s hard to believe an entire year has gone by already. But, it has, and this time it’s only been 3 months since I’ve seen him last, instead of 6 months as it was before. 

I miss my dad. I miss his hugs, I miss his corny puns (if you don’t get them at first, don’t worry. It’s like the sun, it will dawn on you.)  I miss getting to talk to him regularly. I miss him coming down to my bedroom to say good morning or goodnight. In April, shortly after I returned from my visit home, I woke up to the sound of what sounded like my dad’s footsteps coming towards me. My first thought was, ‘my dad is coming to give me a hug and a kiss good morning’. Then I realized I was back in Africa and it would be over a year before I got to hug him again. I was SO disappointed. I cried. And I’m crying again as I write this. 

I know it was hard for my dad while I was at home this last time because he was so busy with tax season, and even busier than usual since his partner had just passed away. He usually left fairly early in the morning, and arrived home late in the evening, not leaving us a lot of time together. So, he made time for me by taking time out to eat lunch with me several times while I was home. I know it wasn’t much, but it was wonderful to get to spend some one-on-one time with my dad. 

Today, I hope to get to talk with him on Skype, to personally wish him a Happy Father’s Day. I know that if by chance we don’t get to talk, he still knows I love him very much, and I know he loves me and supports me, even though this work takes his little girl so very far from him. 

Thanks dad, for loving me so much!

Fellowship of the suffeRing

I started call on Friday. I had been enjoying two weeks of not being on call. Whatever did I do with my time? I rested as much as possible, in preparation for call. So far, this week of call has been one of the worst ever. 

It started with doing two wound debridements on Friday afternoon. One was for a 20 year old with a chronic wound on his leg that we grafted last November, and now almost done of that graft is left. I saw It back in January and prescribed some antibiotics as I think it is a tropical ulcer, and sometimes they respond to bactrim and ethambutol. He never got the ethambutol. I don’t know why. I continued to see him from time to time, but didn’t realize he was still getting dressings, and that his wound continued to get worse. Neither did the guy doing wound care have me see him or his wound, to give direction on what to do. I’m working on seeing wounds on a more regular basis, as I’ve found some people keep getting dressings even when their wound isn’t getting any better, and never see a doctor until it’s really late. Anyway, I had to do this massive debridement on him, and it stunk. I hope and pray his leg will heal, but there wasn’t alot of bleeding with the debridement, which isn’t a good sign. Neither does he really have much skin to be able to do another skin graft if his wound gets clean enough to do another, because he has already had two. Next I did a debridement on a lady with some form of chronic ulcer-I suspect she had an infection, but not sure how it all started. It stunk too. Then I got to go home for a little bit, saw the missionary kids art show, and returned home in time to eat a little something before being called back into the hospital.

Around 8pm, I was called to come in to assist with a vaginal breech delivery-there was one food in the vagina. It takes at least 1 hour to get a patient to the OR from the time a decision is made to do a surgery, if it’s not during normal weekday hours. Sometimes it’s difficult to get ahold of people, and you have to go find them, or send someone to go find them. So, when I found the patient just had one foot in the vagina, I decided to see if I could get the other one to come down. I did. The woman was able to push the baby out the rest of the way, but as is the risk with breech deliveries, the head got stuck on the cervix because it wasn’t quite dilated enough. By this time, there was impingement of the cord (it was compressed) and so the baby wasn’t getting much blood flow. I tried all I could to get the baby out-hyperextension of the neck, episiotomy to make more room for me to get my hands in, and attempted to cut the cervix as a last resort, but found it difficult to reach with the short scissors I had. We struggled and struggled. Her aunt yelled at her that she wasn’t doing enough and tried pushing on the fundus to help get the baby out. I yelled at her to stop. End of story, the baby died in the course of giving birth. Drenched in sweat, I went home, showered, and went to bed.

The next day, I was awoken by a phone call that there was a lady who was 4 months pregnant with placenta previa who was bleeding significantly. I rushed into the hospital but by the time I arrived, she had delivered a stillborn, still in the sac. According to the nurse it appeared the baby had been dead for a few days. I started rounding, and discovered the patient admitted by a colleague the day before for post-abortive endometritis had retained products of conception, which were now infected. She also complained of a lot of pain in her right buttock, where she received an injection at a different hospital a few days ago. I took her to the OR to perform a D&C, and ended up also doing an incision and drainage on a large abscess in her buttock (which smelled HORRIBLE, and the OR still smelled the next day. Not a lot of air circulation in there). 

I continued rounding and was asked to come evaluate a woman with abdominal pain. She’s in her sixty’s, I’d guess, and has a distended abdomen. It’s been that way for several months, getting worse. She’s losing weight, and has blood in her urine. On physical exam, her liver tip comes down to the level of her belly button, and her spleen does too. I did an ultrasound of her belly-large liver, spleen, and lots of masses in her abdomen-likely metastatic cancer. Oh fun, I love giving news like this to families. I explain to the family what I saw, what the likely diagnosis is, and that I had no way of treating it. It’s already very advanced, and I don’t know what the primary source is. And then they say ‘but what are you going to do to treat her?’. This invariably happens just after I’ve explained what I’m going to do for the patient, especially if there isn’t much I can do. It’s like they don’t accept that the white doctors don’t have any medicine to treat it. Or perhaps denial of the illness itself. I don’t know, but it’s tiring. So I explain again. And again. Finally, I think it starts to sink in.

  Once finished rounding, I then was presented with a patient who complained of right thigh swelling for one year, then for the last three months, pus has been coming out a site in his thigh where someone from a clinic lanced it. Now, for at least the last month, when he’s walked on his leg, he says it feels like his femur is broken. Noting how his upper thigh is rotated differently than his distal thigh, kneed, and foot, I believe him. So I took him to the OR to drain the pus out of his thigh, but got interrupted before I could start (but after the nurse had given ketamine, unfortunately).

Before I had started, the OB nurse called to say a woman 30 weeks pregnant came in for evaluation. Her water broke yesterday at home and she’s now having contractions. And there’s a foot in the vagina. Nice.  So I debate between trying for a c/s and letting her deliver vaginally (though there is higher risks, but the baby is small, so might be ok). I call in the team to do a cesarian, but can’t get ahold of people. I end up sending someone to find them. In the meantime, I planned to drain the pus out of the guy’s thigh, but was interrupted by the OB nurse calling to say the patient wanted to push. So I take off to maternity, get there in time to help deliver the infant. This time, the right foot came out first, but the left food stayed up by her head as she delivered. I was able to sweep it down. I was trying to sweep the arms down (Williams Obstetrics and all other books make it sound so easy. Liars.), and was successful with the first one, but as I was ‘sweeping’ the other one down, I felt a snap. I broke the humerus. Great. Thank the Lord, the head didn’t get stuck this time. I took the baby to the warmer and started rescusitation. She still had a heart beat when she delivered, and it was a relatively short time for the delivery itself. She wasn’t breathing at first, and so I used the ambu-bag to give her some air and oxygen. (I will say I’m proud the nurses got the right things out ahead of time for the delivery, except for connecting the ambu bag to the oxygen concentrator. But still, the fact that they had it out is a good thing. And both the incubator  and the warmer turned on.) She started breathing, but required oxygen, and was still mildly hypoxic. I used an adult cannula to create a little more pressure for her (they tend to fill the nose, creating a sort of CPAP). She stabilized, I started antibiotics, I swathed her arm across her chest to stabilize the fracture, and put her in the incubator. 

I then returned to the OR, drained the pus that was there, and am sure he has a fracture by the way his leg bends abnormally in the middle of his thigh. The question is if he has osteomyelitis or a sequestrium that needs to be drained. Will have to get an xray on Tuesday. For now, he’s getting antibiotics. 

Sunday morning, I am awakened by a phone call from the OB nurse that the preemie’s oxygen saturation is low-30%. I’m trying to verify that the concentrator is working and all tubing connected properly (as that is a common cause of hypoxia while ‘on oxygen’ at our hospital) when she tells me ‘now there is no heartbeat’. Perhaps there was no heartbeat for a minute or two, and that’s why the kid was hypoxic. Not sure exactly what happened-if there was an apneic spell, or bradycardia due to prematurity, or something else. I gave the baby caffeine (in the form of instant coffee) the night before to decrease risk of such spells, but it doesn’t eliminate them completely.  So we lost another preemie.

I arrive to do rounds this (Sunday) morning. The lady I worked on the day before is now afebrile, awake, and talking a little. Looking a little better. Praise the Lord. But now there’s a 13 year old with right lower quadrant pain. She is moody and doesn’t respond to questions, but sometimes flops around like a fish on the bed. So I suspect her pain may be more ‘supratentorial’ than in her abdomen. I do an ultrasound and don’t see the appendix, or any mass in her pelvis. So she’s on antibiotics and treatment for malaria, as she had a test done elsewhere that was positive. While evaluating her, a 20 year old girl is brought in from a town about 45 minutes away. She drank caustic soda (lye) in an effort to commit suicide. Sounds like she drank a significant amount. She started vomiting blood, and her lungs are all junky sounding from a pneumonitis. She became hypoxic so we had to start oxygen. She has a high risk of death. 

I leave the ‘ER’ area and sit down outside the church and cry. Angry about the two babies deaths. Angry over this girl drinking caustic soda because of something her dad said to her, who now might die a painful, horrible death. Tired, and hurting because of the suffering of these four women I’ve cared for in the last few days. 

A colleague of mine sat down next to me and was praying for me. As he stood up to leave, he said the Lord told him I’m ‘enjoying the fellowship of the suffering’. I’ll tell you what, it’s not so enjoyable. But it makes me more empathetic, and it brings me closer to God. So I guess it’s not so bad. 

Mother’s Day (May 13^th, 2012)

I’d like to pay tribute to my mother today. This is the second mother’s day I’ve been in Africa (technically, the third, but the first one was eleven years ago, but I digress). Though at times we’ve had our differences, more often than not, we’ve gotten along. My mom is among those who inspired me to go into the medical field. I remember being fascinated with her stories about naked pregnant women dancing on the bed while in labor, delivering babies, helping moms learn how to breast feed, teaching them what’s normal and not normal for a newborn. Hearing stories about afterbirth at the dinner table while eating spaghetti and meatballs never really phased me, but it did skew my perception of what appropriate dinner conversation is supposed to entail. My college friends were kind enough to inform me when I had crossed some imaginary boundary of conversation etiquette. Why can’t you talk about diarrhea while eating chocolate pudding? Again, I digress.

Mom has been there to support me through the years, praying for me, cheering me up when I needed it. She also tries to do little things to make me feel loved or thought of. For example, when I returned home this last March, she brought my winter coat, a scarf, and gloves with her to the airport to receive me, despite everyone else saying it was ‘so warm’ outside. (It was SO COLD!)

Knowing my love of flowers, she bought a bouquet before coming to the airport and had each person of my family give me one as they greeted me.  I think my niece Addy was the only one who decided she needed it more than me.

Addy gives me the rose, and then takes it back.

In preparation for my arrival to my parents house, she cleaned some clothes out of the closet to make space for my clothes. She knew I’d lost weight since living in Congo and purchased some wintery clothing in smaller sizes so I had something to wear that fit and was warm. She also found an electric blanket to help keep me warm at night, put extra layers underneath the futon so it was nice and comfy, and left me some warm pajamas, a thick robe, and a small bag of Lindt chocolate on my bed. 

        While home, we spent time together here and there. Sometimes going shopping, sometimes just being at home together. While I was packing up to leave, she helped by writing down the things I was putting into the trunks as I went, which made packing so much easier. 

Since I’ve been back to Congo, I know she’s thought about me alot. I know she’s praying for me, and loves me and all my siblings no matter what. 

Thanks mom, for making me feel so loved.

My parents and I before I left to return to Congo

Wish List

Several of you have asked what kinds of things I’d like, or need, or want, for me or for the hospital. Since you only know if I tell you, I decided to make a list, of things I’d like, and things the hospital would like. If you can help in providing some of them, please let me know! If I’m going to see you while home, you can give it to me then. If not, I can send you my parents home address, and you can send it there. Also, for ideas of things to send in a package to me (via other short term missionaries who are coming), see things with a star.

For the hospital:

Rewetting eye drops (either in little bottles or in individual bullet packs) 

Reading glasses, strengths -1.5, -1, +1, +1.5

Anti-biotic eye drops (for any of my optho friends who can hook me up with some samples)

Sharp mayo or metzenbaum scissors (ours are rather dull)

Alice clamps that clamp

Bladders for blood pressure cuffs (the rubber breaks down quickly in the heat)

Mesher (for skin grafts)

Colored electrical tape (I’d like to label our instrument sets so our ladies organize them better, and things get into the right set.)

Gynecologic surgery atlas

Suture, size 0, chromic, vicryl, or prolene, on either taper or cutting needles

For me:

Molasses*

Powdered sugar*

M&M’s*

Chocolate chips*

Drink flavorings (such as Crystal Light)* (my favorite is grape)*

Cake decorations (sprinkles, etc)*

Silicone baking sheets (the things you put in the bottom of the cookie pan to keep it from sticking) (I have two small ones someone left me in Impfondo, but I’d like two for my large sheet pans, because they are most useful for baking)

Two medium sized rubbermaid food storage containers (for storing cookies or muffins; they don’t have to be rubbermaid, but they do need to seal well because ants can get into the tiniest places, and we have some really tiny ants.)

Ziploc baggies*

Benedryl cream or spray*

Thread of various colors (you can buy it there, but the quality isn’t great)*

Ribbon (for sewing and making cards)*

Stamping and jewelry making supplies*

Fingernail polish (esp the ones with small tips for making designs)*

Thread (for sewing, all-purpose is fine. they sell thread there but it breaks easily in the machine)

Walnuts*

Pecans*

Dried fruits*

I'm sure there are other things. Perhaps others from the hospital will post if there are other supplies we'd like. I know there are, just can't think of them off-hand.

A long time coming...

So I realized it's been almost two months since I've posted something to my blog. In order that you know I'm still alive, and I'm still here, I thought I better update the site. Here's the news:

1. I'm returning to the US for about 5 weeks, arriving March 9th, leaving April 10th. If we haven't already arranged a time to get together, and you'd like to get to see me, please respond and let me know. I don't really plan on leaving the tri-state area, so visits outside of IN-MI-OH are less likely to occur.  I'm excited about this chance to see my family, meet my two nieces who have been born in my absence, and reconnecting with family and friends. Please be praying for me during this time, as there will be sure to be some reverse culture shock. If you see me and really want to know how things are going, please try to ask some specific questions, such as 'what's the hardest part about being there?', 'what's your favorite thing about being there?', 'what's the weirdest thing you've seen or heard?', etc, and more than just, 'How is it?'. For those who just want a general answer, you can ask the latter question. Please try and be supportive as I may have times I'm a little moody, or tired or reclusive. My life here is quite different than my life I had back home, and so it will take some adjusting. 

2. I've been doing more surgeries in the absence of a trained surgeon. There are still quite a few skills I would like to learn, and really could use some more help with clinical decision making with who to operate on, when, and how to handle some of the post-op complications. (Hint hint, Dr Noveroske-come help!) Some things I learned while a resident, some I'm learning by experience, and some I learn from books. If any of you surgeons I know want to come for two weeks, a month, a few months, I'd love it! (and so would the other docs here) We had a surgeon with Samaritan's Purse come in Nov-Dec of this last year and I learned quite a bit from him. I finally was able to see the hernia sac in repairing inguinal hernias (to that date I thought they just made it up...). He also taught quite a bit with ultrasound, and help us acquire a new portable machine through Samaritan's Purse and money we received from UNHCR (United Nations High Commissioner for Refugees). It is SWEET, and allows a clarity we never had before. There are three probes that we purchased with it-abdominal, small parts, and cardiac. Now I'm only wishing for an intracavitary probe so that I can do vaginal ultrasounds on early pregnancies. But since most women here are really thin, I can usually get a good enough image with the abdominal probe. 

3. We are almost always in an energy crisis here at the hospital. I haven't talked about it much in the past, but we have three systems for power. 

1)A generator, which costs $14/hour to run, and depends on diesel that comes up from Brazzaville on boats, which is dependent on sufficient rain to bring the level of the river high enough for the boats to come through. We are at the end of dry season, which means there is little diesel left in town, and it will be a few months before the river is high enough for the boats to come up. 

2)Solar power-we have multiple panels that pull in solar energy (which works well as it is so sunny here), except it requires a)good batteries to store the energy and b)an inverter to convert the stored power into usable power (from DC to AC). Being as our energy requirements are pretty high, this requires two large inverters. Between the batteries and the inverters, we haven't been able to keep a good charge in the batteries in a few months, which means sometimes the power goes out during the night. When there is no electricity, the portable oxygen concentrators don't work, and the incubaters for the preemies don't keep heat. Some of the problem has been ameliorated by a grant from the US to install a large oxygen concentrator with 6 bottles for storing oxygen, which we place strategically throughout the hospital for use when there is no current. We are the only place within the whole Likouala region with oxygen and incubators. We put the preemies on the mom's chests to keep them warm when we have no current for them. However, the concentrator relies on generator power for use, and can take 1-2 days for the bottles to fill (they hold 2000L of oxygen, which goes fast at 2L/min). So there are benefits and downsides. This last year we received the same grant again, and now we are working to purchase the materials to redo our electrical system with larger solar panels, better batteries and inverters, with enough current that we should not outgrow this system for the next 10 years, despite any improvements/expansions we may make. There are two people stateside who have planned and designed this system, and they are working to order the parts. There is a team coming this spring to build a new power building. Also, this new system can automatically switch back and forth between the three electric systems depending on the current needs of the hospital. 

3) SNE, or the national power company, also supplies power. They turn the power on for 1/3 of the city almost every day, for usually 2-4 hours at a time. Currently we are not getting all the current possible because someone stole the cable that connects us to the power. To replace it is very expensive. We think either someone working at the hospital stole it and sold it, or someone working with the power company took it and sold it. So, we have a temporary cable which doesn't bring as much current as usual. In addition, during rainy season, we have many lightening storms, which have a predilection for striking the hospital or the mission. So during rainy season the power problem is confounded by almost weekly repairs to the system due to lightening strikes. So, please be praying for our current, for the people planning the new system, and for protection that it is not struck by lightening and lasts as long or longer than we hope.

4. There is currently a Cholera epidemic in our region. There have not been many cases in Impfondo, but there have been around 100 cases in several outlying villages. Be praying that this will be controlled soon, and the messages about good hand-hygiene, safe food handling, and clean water get out to all the region. Not only these things decrease the risk of cholera, but also other diarrheal diseases.

5. I've been working on learning Lingala in the last few months. It took a good 7-8 months here before I could get to the point that I had room in my head to learn Lingala along with everything else I was learning. It's coming along slowly but surely. Most of what I know only works in the hospital, so get me out in town, and I'm lost if I can't ask you 

1)if you've had a fever, 

2)if you are eating and drinking ok, 

3)if you are having diarrhea or vomiting, 

4)if you are peeing and pooping, and 

5)if you are standing and walking.

6)I can tell you to come, go, stop, wait, and be quiet. All of which I think are rather important. ;-)

7)I can say 'take off your clothes' in three languages now. Never thought I would be able to say that...or need to use it. 

Alouette, gentil alouette, alouette, je te plumerai

     Those of you who don't know french may not know the translation of the song 'Alouette' that many of us sang when we were little. I was a little surprised to realize the song is about plucking the feathers off of a lark. (Alouette is lark in French, plumer is the verb 'to pluck', plumerai is the future tense)

     What does that have to do with this blog post? Well, it has nothing to do with larks, but it does have to do with plucking.

     Here, it is much like olden days-gifts are not always bought with money, but are sometimes produce grown in one's garden, or animals one has raised, captured, or bought. And in order to keep animals fresh until eaten, they are given while still living. I was party to such gifts at Christmas this year. I was given several papaya, plantains, and a rooster. Since roosters don't lay eggs, and I already have a functioning alarm clock, the only thing left to do with him was make a meal of him. Here's how it went down...

So excited-can't you tell?

Isn't he lovely? 

"What am I going to do with you?"

We became fast friends...I even gave him a name...Dinner. And I may have sung 'Alouette' to him before he was killed...

Papa Serge helped show me what to do.
Had chicken at Cedar Bend Farm in college, but I didn't kill it.
Just skinned and gutted it. Here he's showing me to hold it like that over
the hole so the blood can drain out after I've chopped it's head off.

So once you have the legs and wings held back, you rest it's
neck on the banana leaf, which is placed over a small log.
You use the back of the machete to rub the neck, to calm the
chicken, and stretch it's neck out so it's easier to cut.

1...2...3...and off with his head! I was afraid I wouldn't hit it hard enough
to kill it in one blow...so I did it twice.

See, I did it!!! Not too much blood either. But he did
move quite a bit after I cut his neck...

Then I put him in hot water to loosen the feathers.

Pa Serge and I worked together to pluck all the feathers off.

He's looking tastier by the minute.

Don't forget to take the innards out! Fortunately my recent surgical training helped with that...but I still didn't find the nuggets.

At last...Dinner is served.