Ten Year Challenge

 Many people on Facebook are posting a "ten year challenge", a look back on the last ten years. It's been interesting to see the growth in most peoples lives. Often times there is a different physique. Some of my younger friends it's interesting as they've had Facebook since a young teen and now they are in their early 20's. Others have young children and now nearly grown children. Often their family size is different.

But for me, like other widows, there is a sense of bittersweetness to the thought. Ten years ago I was living in Congo and often wondering if I would ever be married, and who that would be, and what my married life would be like. Would I ever have children of my own or would I always be another mother figure to niece, nephews and other children I was around? I had no idea that five years ago I would meet a man 9 years my younger, bald, with a beard, and covered in tattoos, who would steal my heart. It took him quite a bit of work, but I think I was worth it. :-)  Four years ago we were preparing for our wedding-my bachelorette party was 4 years ago this last week. It was lots of fun and I was surrounded by sisters and friends from high school, college, residency and work. So much of my life was represented at that party. To be honest I was a little nervous about getting married. It was a big life change, something I had waited for my whole life. He wasn't exactly the image of the man I had dreamed of marrying (I mean what woman doesn't dream of a tall, strong, muscular man), and he had some rough edges, but I saw his heart. I saw it in ways that many others didn't see because he sometimes kept a tough exterior. I know he wasn't the man many people had thought I would marry, either. There were friends who questioned him for me, and his ability to lead. I think some were concerned about how loud and vocal he was with his opinions, if he would roll over me. But what they didn't count on was how strong he helped me to voice my own opinions (even if he didn't agree) and that my experience with my previous boyfriend to him actually made me stronger to not allow it to happen again. Personally I think Luigi loved that I gave him my opinion, that I didn't just cater to his every whim. I had no problem telling him when I thought he was wrong, and he did the same to me. It made us a good balance, as I know I can be quite bossy and headstrong, and needed a man who would stand up to me. I wanted someone to lead, and he did a good job of it. 

Many have heard about our disagreement on the practice of headcovering when we first married. He didn't tell me he really wanted me to practice it as he knew I wouldn't marry him if he demanded it (and I wouldn't have). It was a source of myriad arguments in our first 6 months of marriage. It wasn't until I decided to approach it scientifically (what if what I had been taught was wrong, and what if there is something lost in the translation from the Greek to English...I had to start with a null hypothesis and be open to another idea). Then the Holy Spirit did His work as well. I'm sure Luigi prayed a lot about it.  

The last post I made on this blog was on the due date of our firstborn, Dale. I am remiss that I have not posted more since then. Three years ago was his due date. He would be about three now. If we had him I don't know what life would be like. Would we be living in this house (we moved about the time I was due), would we have Esther? 

I remember when I started bleeding with Dale, I prayed so much that he would live. But I also knew Luigi wasn't quite where he needed to be with God. He knew a lot, and his heart wanted to be close to him, but some of his past life was holding him up. I don't think I ever told anyone other than perhaps my counselor, but I believe I had prayed that if losing Dale would bring Luigi closer to Christ, then so be it.  I don't know if that's why I lost him, and I try not to think about it. The grief is so profound, but at the same time I believe Dale is in Heaven with Luigi, so if losing Dale meant saving Luigi, I take some solace in that. I still wish I had both of them.  I do think he became closer with God after that. We changed churches several times to find one he felt fit us best, and we ended up staying at Berea Christian Fellowship. I resisted finding a new church for a while as I had had a lot of life changes in a short time, but I’m so glad we changed. They have been such a source of support and friendship to Luigi and I. 

I remember at times prior to the loss of Dale, I doubted Luigi's love for me at times. He made enough jokes about "marrying a rich doctor so he didn't have to work" that I had doubts, likely fueled by well meaning friends. But I distinctly remember Luigi holding me so tenderly and lovingly, and seeing the look of love in his eyes, that from that moment on I had absolutely no doubts of his fierce love for me. He handled cancelling my trip to Gabon, planning on short notice a trip to Tennessee and visiting family along the way, so that I didn't have to handle it. He was with me when I got my first tattoo of Dale's feet, and I cried, not because of the pain of the tattoo needle, but because of the sharp and acute loss of our son. Now, I plan to get another tattoo, hopefully at the same place by the same artist, in memory of Luigi when I am in the area in April. I haven't decided what to do yet...it's a hard decision. 

Three years ago (well it was Feb 2019) we moved to our current house. It was a hard move for me as I loved the previous house, but he never felt it was "our home", only "my home" he was living in. When I had bought it I realized the man I marry may not want to live there, but I could imagine raising children there, with the neighborhood of kids that could run back and forth, and a nice little back yard. 

It was something I didn't have growing up-only a few neighbors and often had to be driven to a friends for play. He loved our current house-it was his dream home that he had envisioned 10 years before. A main living level and a finished basement that was kind of like an apartment with a separate kitchen, so we could have friends and family there to entertain. I have grown to love it, through I still wish for laminate tile floors that are easier to clean with two dogs and a toddler. (There is always something we long for, right?)

Two years ago, I was finally expecting again, this time around 24 weeks pregnant. I had lost another baby in April 2019, and became pregnant with Esther around July of 2019. We prayed all the time for her. He was so ecstatic to finally have another one of his dreams fulfilled, to have a child. He wanted to be a dad so much. When she was born he beamed with joy and pride. A life long wish fulfilled. He loved being a dad, and was such a great father to Esther. He doted on her, and took such delight in all she did. I miss having him here for this time in her life, because he would enjoy it so much. I'm sure he would give her little challenges of things to do to see her mind at work. 

One year ago, we were enjoying our lives as new parents, anticipating Esther turning 1 in a few months. She was growing well, and looked more like her father every day. She still does, and for that I am thankful (though I still pray against her getting his unibrow and acne as she gets older. ha ha).

And now, I am a widow. I never thought I'd be a widow at 41 years of age. I miss him every. single. day, in different ways and for different reasons. I miss our inside jokes, I miss texting him throughout the day with updates. I miss hearing about a call he was on, or a discussion he had with friends while patrolling in Bourbon. I miss getting photos of he and Esther during "daddy daughter" time while I was at work, urging me to come home as soon as I could to be with them. 

I realized Thursday morning that he would have woken up and said "you know what we haven't had since last year?" and then name some restaurant we likely have been to in the last month, but it was surely last year that we went to it, and want to go there for breakfast. Then I would have protested about all the things I wanted to get done that day, but likely still have gone anyway, because I know how much he enjoyed it. I don't take Esther out to eat much by myself, mostly because mealtimes aren't quite as enjoyable as they used to be since I don't really have someone to talk over the events of the day.

I miss the middle of the night baths when he wasn't feeling well (I would wake to find him gone from the bed, and often heard the water refilling the tub with hot water). I miss hearing the radio in the night with calls (and even my annoyance when he had it set to all the area townships). I miss chastising him about how much Easy Cheese to eat in a day (one can is NOT a serving). I miss complaining about the trash he would leave on the counter, ten feet from the trash can. I miss his loud singing, whether it was at church, in the car, or as we were getting ready in the morning. I miss him complaining about all the pagan practices of Christmas but still having no problem with Halloween (don't worry I called him out on that). I'm sure he would complain about Esther wanting to read the SAME book OVER and OVER, and I would remind him that reading the same book is good for speech and language acquisition. I miss that he won't be able to teach her Italian or Spanish, with a very good accent as well. I still have some books with Italian in them but I can't bring myself to get them out yet. 

I'd like to put Esther's crib into a toddler bed with the hopes of getting her to sleep by herself, but right now I can't bring myself to do it as Luigi and I put the crib together when we moved to this house. I moved one of her toys she got for her 1st birthday, and would like to take it apart and build a different shape for her to climb, but I can't quite bring myself to do it yet as we put it together the week before he died. I cried just thinking about it.  I cried when I sat on the floor of her room this week, putting 12 month clothes away and putting away other clothes. I remembered the week before he died, he sat on the bed as I put away her 9 month clothes and got out her 12 month clothes. I tried on shoes on her to see if they fit while she played with his phone-she managed to record a video and you can hear him complain about it in the background. 

I miss having someone to cuddle with at night (even though he hated cuddling). I miss having him to vent to about things at work or with patients, or with friends or family. I couldn't have asked for a richer 4.5 years together from time of meeting to his death, and just a little over 3 years of marriage. I wouldn't give it up for anything, but I would much rather that he were here. 

What will the next ten years bring? Will I be remarried?  Will I have other children?  It’s hard to think about, because I long for Luigi, but yet we talked about if something happened to one of us, we would want the other to remarry if they met the right person. I had such a wonderful time with him that I long for that relationship again. I do have confidence that if I am to marry again, God will bring that man into my life at the right time, and he will be the right person for Esther and I. I will always be a widow, even when remarried. He will always be Esther’s dad. We will always mourn his loss and talk about him so she knows her dad.

Photos from ten years ago: 

Photos from the last few years: 

 

 

Due date

Dale Michael Both

That is the name of my first born son. I haven't talked a lot about him, as sometimes it is quite painful. He was born at 14 weeks and 3 days gestation, far too small and early to survive on his own. He was due on January 8th, 2019. It has now been almost 6 months since his death, and I have been preparing for this day ever since.

    I knew I wanted to post something about it. I wanted to be able to post the video from when we first told my family I was pregnant on Mother's Day. I had hoped to share it in late July, after a planned trip to Gabon, but by then he was gone, and so I never posted it. But the joy and excitement were there, and I wanted to be able to share it in some fashion. I wanted to be able to share his story and mine, with the hopes that it may help other women who have lost children due to miscarriage to know they are not alone. Initially I thought I would write just about the announcements to family and then what I found helpful or not helpful after I miscarried. However, this turned into a much longer post, but I think I needed to write it. 

     I first discovered I was pregnant in April. I just knew something was different, and that I was pregnant, but it seemed forever for me to have a positive test. When I did, it was faintly positive. Luigi had me take a few more tests just to be sure. I did so over the course of the next week, and they were all positive. At about 6 weeks gestation I started to have some morning sickness. Most of it was tolerable with some ginger or crackers. On the rare occasion it caused horrible stomach pain, but it resolved with some Zofran. We discussed about when to tell family, but since my parents were leaving on a 3 week trip to Europe, we thought we would tell them before they left (just in case something happened). My grandma and my dad's siblings/spouse and all my siblings and nieces and nephews were there as well, so we enjoyed getting to share the news with them as well. I still remember the tears of joy in my aunts eyes. Here is the video: 

Shortly after that, we told Luigi's family. Here's the video of Juliana learning about it:

First glimpse at our little one

     We had my first ultrasound when I was 8 weeks along. We could see his heart beat flickering on the screen. Things continued to go well, and I managed to keep my nausea from affecting work (all though at times waves came at me and I had to step outside a room). My staff at work kept asking me if I was pregnant or had taken a pregnancy test (I'm not sure why, but they did). I didn't tell them it was because I was already pregnant that I didn't take any more tests. When I was a little over 9 weeks, I told them. Mae about fell out of her chair with excitement. 

     We had a family reunion (for my mom's side) in June last summer, and though I was only about 10-11 weeks, I wanted to share the excitement with my family, and I told them as well. They were all quite excited! Some may argue that we told people too early and should have waited until the 2nd trimester. In my opinion, it was easier for me to go through everything knowing I had their support and prayers than to smile and nod and pretend nothing happened. I want people to know I have a son and I love him very much. 

     I had an ultrasound shortly after the reunion, I would have been about 11 weeks here. You can see him putting his hand to his face. He had been moving around a lot before I started recording, but then slowed down. 

     On June 30th, I went to Michigan to visit some college friends. I awoke July 1st to some bleeding. I called my doctor about it, because even though I answer those phone calls for my patients, sometimes it is just better to hear the same words from someone else. I had little bleeding the rest of the day, but was sure to check to hear heart tones when I got home that day-he was still alive, with a heart rate of 150's. I saw my doctor the next day, and he did a short ultrasound and checked to see if there was any reason for the bleeding. He diagnosed BV (an overgrowth of bacteria, common in pregnancy) and treated it accordingly. I still had bleeding during the night after that, but it did improve and was gone for several days. I did some gardening July 4th and had some heavier bleeding. I ran upstairs as I could feel the blood, and after cleaning myself up, laid on the floor crying, almost hysterically, as I was so afraid I might lose the pregnancy. The bleeding stopped and we checked his heart rate again-150's, still alive. I called my doctor and we did a more formal ultrasound to evaluate for signs of bleeding around the placenta. There was none, and he was moving around and active. I was amazed to see him and how much development there was already (even though I know it mentally, it's still amazing to see) and also just in awe that this baby was inside me-those pictures on the screen were of my baby, not someone else's. It's been 16 years of caring for other women and their pregnancy, and finally I was getting to experience it myself. I was so thankful. 

     Rocco (Luigi's brother) and his family came to visit the weekend after that (July 7-8). We went swimming in our neighbor's pool. Gianni shouted to us across the pool that he "had a 'gina" (His parents have been teaching him proper names of body parts, but he was a little confused at who had which part). We all laughed quite a bit at his remark. 

    July 12th was my 38th birthday. My friend Melissa Raymond had come the night before to pick up a trumpet for her daughter (long story but it was too broke to fix for use) and hang out for a while. She sat while I finished my packing for my planned two week trip to Gabon. I had been quite nervous about this trip with the recent bleeding, and had conveyed to the team that if there were any complications that came up, I wouldn't come. I kept praying about it, and had discussed it several times with Luigi. My biggest concern was if something happened while I was there, how he would respond (he was not going with me this time). In retrospect, he should have been coming with me, and I won't go without him in the future. I awoke that morning feeling so thankful: my dreams had come true. I had a loving husband, and a baby growing in my belly. I have wonderful friends, a great place to work, and a wonderful home to live in. I had everything. I even had one of my closets friends here to visit me. It was a wonderful birthday! I don't recall what gifts I was given by my husband, but I do recall laying in bed trying to see if I could feel our baby move. (I'm still not sure if it was him or just me moving from breathing). 

    Then I awoke July 13th to more bleeding. It was still about the same as usual, but a little more cramping with it than previously. We had a staff meeting that morning, so I left early while Luigi was still sleeping. I had awoken him to tell him of the bleeding and cramping, and we prayed together. I had had some mild cramping before with the bleeding but it always went away. Today, however, I noticed the cramping was worse as I drove to the hospital for the meeting. It was enough to put me in tears from the pain and fear. I still believed the cramping would go away. Rather than going to the staff meeting, I went to the OB floor. Sue Bettcher was there and I told her everything that was going on. She helped me to the triage room, we checked fetal heart tones, still 150's, got me a hot pack and some Tylenol, and I called Luigi, and then my doctor. He said the same thing I knew: either the cramping would stop and go away, or it would get worse and I would miscarriage. I still believed it would go away. I couldn't possibly have a miscarriage. It's not supposed to happen that way. Not when I've waited all this time. Not when I've already made plans-I've not added any OB patients due near me, and told a few that were due while I would be on maternity leave. I started making plans at work for how patients would be cared for while I was gone. So the cramps were going to go away. Lindy stopped by as she noted I wasn't at the med staff meeting and had asked where I was. She did a bedside ultrasound, and there he was, moving all around! No signs of bleeding around him, all looked good. I wasn't having any more bleeding either. The cramps seemed to improve and so I went home for the day, and the office took care of rescheduling my patients or having Lindy see them if needed.      On the way home the cramping increased. I kept using the word cramp because contraction would mean something more serious. I was crying on the way home as it hurt and I was scared. Luigi made me breakfast and a hot pack from rice and a pair of his socks. He had never made one before so it took a bit of explaining (including NOT to cook the rice) but we got them made. They helped for a while, but then the pain went from tolerable to intolerable in about 3 minutes. From that point on it was excruciating pain. I could tell my blood pressure had dropped by the way I felt. I tried to stand but almost passed out. Luigi was a bit frozen as to what to do: does he follow his instincts as an EMT, or listen to his physician wife? I didn't know what the best thing was at that point. I wanted to melt through the floor, or pass out, or die. Anything that would tale away the pain. I knew I needed medical care but I wasn't sure the fastest way to get it, or get relief.  It turns out the best way was to have Luigi take me. We have since found out the local EMT's have a BLS ambulance, and wouldn't have been able to provide any relief to me. Luigi called the ER on the way to the hospital to inform them we were on our way and why.  

     On arrival, my blood pressure was extremely low (70/50 or so) so I got a large IV in my arm and fluids. I begged for pain medicine. It turns out Dilaudid IS a wonderful pain medication and helped tremendously. Within ten minutes of arriving, Dale was born. He was born en cul, meaning the amniotic sac was still intact. It was also attached to the placenta. As soon as he was born, the physical pain subsided, but the emotional pain really began. I moved him around first to see if he was still alive. There was no movement. I opened the sac and you could see he was a boy. His little hands, his tiny feet-they were all there, all fingers and toes. His eyes were still fused shut but he was able to open his mouth. He was likely sucking his thumb or fingers in the ultrasound I saw previously. Luigi was there the whole time, I think in shock too. The nurse put Dale in a little washcloth with a little lace thing beneath him. Luigi held him while I got cleaned up. I held him again and took pictures. I wish I had taken more. I wish I had one of his hand in mine (or on my hand). I wish I had him up near my face, or of me holding him. I have ones of his feet-those are precious to me. I have a few of his whole body. His umbilical cord was so interesting as it had three vessels, but they looked like old typewriter ribbons (where there were black and red ribbons), without all the wharton's jelly or twists and turns a term umbilical cord has (the wharton's jelly is the rubbery/jelly like substance around the vessels). I remember looking at him and the placenta both as a physician looking for a cause, and a mother, looking at every detail of her child. 

     Besides taking more photos, there are other things I wish I had done differently. I wish we would have buried him. At the time, I didn't want him buried as I don't usually visit graves and I think the thought of having a tombstone to visit with my son's name on it was too much. I know some of that came from my own perceptions about how far along I was and how "real" he was (it might not make sense, and I know he was very real, but just not as developed. It seemed strange to me to bury a baby that was such an early gestational age. Now I wish I had buried him. I wish I would have held him longer. In all, we were in the ER less than 4 hours. However, I wish we had stayed and I had held him longer. I was at such a loss, and I felt like holding his body wasn't going to bring him back, so I might as well go. I still wish I stayed and held him longer. I do not regret the last thing I did before leaving the hospital-I kissed his head good bye. 

      Based on everything I know now, we believe it was some sort of infection around the amniotic sac (called chorioamnionitis), but we don't know the particular bacteria that caused it. I was septic when we arrived to the ER and though my vital signs improved after delivery, having those IV fluids helped significantly. The infection also resulted in abruption (separation of the placenta from the uterus)  as it came out with him and the sac.

      As we left that day, it was sunny. I wanted it to be anything by sunny. I wanted rainclouds and thunderstorms. I wanted something that matched my heartbreak inside. We went home and napped that afternoon. Then we had to start making phone calls-telling friends and family, canceling the travel plans, etc. I am thankful for friends and family willing to pass the word along so I didn't have to make all of those phone calls myself. It was important to me to call my immediate family. I called my Grandma, too. She had just called me the week before and told me she wanted me to name my child after someone on "her side of the family" (as opposed to my mom's side). I think she was happy to know he was named after her late husband, my grandfather. 

     I still had the two weeks of vacation time scheduled because of my trip. Lindy wouldn't let me come back to work early, and insisted I take the full time off. I am glad we did. I needed that time. We went to visit my family, then to Pigeon Forge for a few days just for ourselves, and then to Chicago to visit his family, and then home for a week. I remember noticing when we got to Pigeon Forge, I could feel an emptiness in my abdomen. I hadn't really noticed the fullness as it had been gradual as he had grown. I had been able to feel my uterus and knew where the top of it was before I miscarried. I could feel the difference without him, and I cried. Luigi held me so tenderly and lovingly during that time. He mourned the loss of his son, but he was also so grateful his wife was still alive. While I was in agony during the miscarriage, he feared I was dying before him. I can't imagine the fear and worry in his heart during that time. 

       I remember during those two weeks I thought for a while that I had to get through all my grief in that two week period before I returned to work. Then, in that second week, I realized that wasn't realistic, and actually harmful. That gave me a bit more freedom and relief. It was still hard to return to work, and there were many days I arrived crying, as the 15 minute drive gave me too much time to think. 

    There are things people did after I lost him that really helped: people brought us food and care packages. I had a few neighbors stop by as soon as they heard (Luigi had gone out to get something and she heard I was alone and came over immediately). At that time, sometimes the best thing to hear was "I'm sorry" followed by "there are no words".  I still think it is one of the best things I have heard. In that time of grief, I just needed people to be with me. I needed them to let me tell the story of what had happened. I needed them to be able to laugh and joke at times because I couldn't be in sorrow all the time. I am so thankful that I have friends and family that were able to provide that for me. 

     One of the hardest things to hear was "God has a plan." I do believe God is Sovereign, that He directs our paths, and that sometimes, he allows things to happen that are bad or sad. We don't always understand it, and sometimes we get mad when things don't go the way we planned it, but it doesn't change his Sovereignty nor his great love for us. We live in a fallen world, and therefore bad things will happen until this world is made anew. Knowing all of this didn't change the fact that I was mad at God for a while. I knew He could handle my anger, and still loved me, and knew I still loved him even though I was angry. I am no longer angry, though I will admit that I still have days or moments when I am mad or angry, but they are shorter, and I admit it to God when I feel angry, so that I can work past the anger. 

     One of my patients has had multiple miscarriages between two full term pregnancies, and is now expecting again. She has been a comfort to me during this time, as she has gone through struggling with the loss of her children, and the "Why?" questions. One thing that she found to be frustrating is people's expectation for your time of grieving. They expect it to be done and over with, but don't always allow it to be a process that can take months, or even years. Each person mourns differently and in different lengths of time. So to those of you supporting women who have lost a child, be it through miscarriage or stillborn or after their birth, remember that grief comes at different times, in different ways. Sometimes it can be a seemingly innocent comment, sometimes it's just a thought, sometimes a reminder of what was supposed to be but isn't. Those times are sometimes managed with just a twinge of the heart, but other times with tears. My encouragement to you who are supporting such women or couples is to be there and support them no matter what. That could mean a hug or a listening ear. It doesn't always require a verbal response. 

     At her last visit, she reminded me that our days our numbered, and only God knows how long each one is. As she approaches her due date, she has her own fears about labor, delivery, and how the baby will do after delivery. We have all had friends or family have a child die near those times, and so it is scary. She takes comfort in knowing God is in control, and we are to be thankful for the time He gives us with each person on Earth. I am so thankful for the short 14 weeks I had with my son. But I'll be honest, I am also jealous to have had more time with him, to know his hair color and eye color, to know the sound of his cry and his laugh. It is something I won't know until Heaven.

      This year, the holidays were really rough for me. Luigi can tell you how much I cried as Thanksgiving and Christmas and the New Year approached. Each one was a reminder of where I thought I'd be in pregnancy-34 weeks, 38 weeks, and possibly delivered. I had imagined being with family at those holidays and they would get to feel the baby move. We would have his name picked out and a bedroom set up for him. There would be a baby shower somewhere in there too. But none of those were to be, not at least this year. 

     There are moments that Facebook is really hard for me to see. Friends posting photos of their babies, friends who had babies or are having babies around the time I was due are sometimes reminders of what I do not have. While I am so happy for them, there is at times a bit of grief for me. I do not want them to stop posting, I don't want them to stop being happy and loving their little one. But I hope they hug and kiss and snuggle their little one a little extra just for me. 

     Despite my sadness and grief, I have found things for which to be thankful. We bought a new house and haven't moved yet, and I would be stressed to have the baby's room ready or a place for him. I now have time to pack and move and not recover from a delivery. I was able to cover my office partner being gone for a month with some stress but not as much as if I was 34 weeks pregnant. I changed jobs at the end of December. Had I been pregnant, I probably would have just started my maternity leave then, and not returned to work for 3 months. Since I changed practice locations, this may have left some of my patients feeling at a loss of where to be seen or who would take care of them. I am thankful I can still see them and care for them, and help them in transitioning to a new office location. I have several patients who are due in February and March that I would not have gotten to deliver. They are dear to my heart and I'm so thankful I get to be a part of both their pregnancy, but also their labor and delivery. With the change in jobs comes a change in insurance, and my delivery would not have been covered by the new insurance. While we would have done a self-pay package, it is still a relief to know a future pregnancy will be covered by the new insurance. I am thankful for the additional time with Luigi just as husband and wife, to know each other deeper during this time. With all the changes in the last two months, I've been a bit irritable (to say the least) and he has loved me through it. 

    I was hoping by the time I wrote this I would be expecting again. However, it was not to be. It has been six months since I was pregnant. I still long for children, but will take whatever God has in store for me. It may be another pregnancy, it may be adoption, it may mean no children of our own. (Though I secretly pray it is not the latter). 

     As I close this long post, I will end it with these verses: a hope we are promised in Christ:

"Look! God's dwelling place is now among the people, and he will dwell with them. They will be his people, and God himself will be with them and be their God. 'He will wipe every tear from their eyes. There will be no more death' or mourning or crying or pain, for the old order of things has passed away." He who was seated on the throne said, "I am making everything new!"  

Revelation 21:3-5

PS I have started reading a book called 'It's Not Supposed To Be This Way".  I highly recommend it!

Arrival

(Written 7/2/16…there is internet but it’s slow and I’ve not had much time to connect between visiting and working)

Changes

I’ve been away for as long as I was here. So much has changed, yet almost nothing has changed. I’ve changed in many ways-physically, emotionally, spiritually) and people here have changed in similar ways. The climate and the culture are still the same, which doesn’t surprise me. Things still run on “African Time” (what we time oriented people would call “late”). This can range from the expected time of arrival to an event to how long it takes to run errands. I have to remind myself when I make a “to do” list that I should keep it very short, and be happy if I get just one thing on it done each day, because errands and other tasks just take longer here. 

The last 2-3 hours of my flight from Paris to Brazzaville seemed to take FOR-E-VER. I was so eager to see my Congolese family that I could no longer rest. We finally landed in Brazzaville. All the sights and sounds of the airport were so familiar, except for the nurses handing out health questionnaires (a result of the recent Ebola epidemic, but the screening is now rather lax). The heat and humidity of the immigration area closed in on us as we joined the line to have our yellow cards checked and passports stamped. Once through, we waited with all the others for our luggage. This takes some time as though there are fully functioning belts that look quite nice and remain in working condition, the luggage is unloaded from the plane into large carts and then pushed/pulled by airport personnel to the airport, then manually unloaded. 

As we left the baggage area to proceed through customs, I dreaded taking off our 8 pieces of luggage and passing them through the x-ray scanner (a procedure I’ve found to be hit or miss-sometimes requested, sometimes not). This time, a somewhat familiar face greeted me and read my letter of invitation. He was familiar with Impfondo as his brother works at our hospital. I know his brother well, he works in the workshop, with the chaplains, and has made multiple dresses for me in the past. He resembled his brother very much! He let us through without requiring they go through the x-ray machine. 

Finally, I saw them-my “other” family-Yvonne, Octavie, and Guylvi. They had been waiting for about an hour and half by the time we got everything and saw them. Oh, it was so wonderful to see them! I had tears in my eyes! We chatted a bit and then soon were off to Hotel Bravo together, where we got to visit a bit more before they had to take off. We had some time together on Sunday, but still not as much as I would like. I will have more time to visit with Guylvi and his parents as he is coming back to Impfondo on our flight. I realized after we left that I did not get a picture of all of us together. I am sad for that. 

Myths about missionaries

There are some commonly held beliefs about missionaries that I've noticed both before, during, and after living overseas. Some are true, some are not. I''d like to dispell some commonly held beliefs...

1. Missionaries are spiritual giants.

While we may feel called to go overseas, it doesn't mean the calling is any more meaningful than being called to work in the US, or wherever you currently call home. It also doesn't mean our theology is perfect. Often, it isn't, and we can learn alot about God from those around us, regardless of what culture we are in, if only we'd open our eyes. 

2. Missionaries have it all together.

This, in fact, is one of the biggest myths out there. Sure, it takes a lot to give up your home and familiar surroundings and go overseas. But we all have baggage, including missionaries, and it doesn't stay at the airport when you leave. Often, living overseas can exaggerate or worsen whatever baggage you have...but I think God often uses that as a way of calling attention to those sharp edges we have that He'd like to smooth over. Often, it seems God calls the most stubborn to be missionaries because there are things He knows you have to be taken out of your comfort zone in order for you to see all your glaring faults, so he can prune those unhealthy parts of you so you can grow back healthier and stronger. 

3. Working overseas is glamorous.

Sure, those of us who have worked overseas have our stories..."one time someone brought me a boa constrictor in a jerry can and wanted to sell it to me as a pet"..."I was once monkey-slapped by my neighbors pet monkey"..."we went on a jungle walk and ate fresh cacao fruit".

These stories seem great, but it's just a small part of life overseas. It's still life, just not in one's home culture. There are still ups and downs, joys and pains. Sometimes, the pains seem to come more frequently than the joys. There is conflict, more often with other missionaries than with the nationals you live among. This conflict can seriously impact the ministry you are trying to build. There are cultural misunderstandings, which at times can lead to broken relationships with those among whom you are trying to build relationships. 

If you're a medical missionary, there is much sickness and death, frustration at diseases that could be treated easily in your passport culture (where you were born and raised) but are not so easily treated in your host culture. This could be due to late presentation (coming in for care too late in the disease process to be able to treat), lack of resources/equipment to treat the disease, or lack of financial ability to pay for the needed treatment. 

There are joys as well, such as a malnourished child being nursed back to health-watching the fog in their eyes lift as their body gets proper nutrition, and then seeing them continue to do well after hospital discharge. Or the woman you admitted whom you thought would die over the weekend, and miraculously not only survives to hospital discharge, but thrives afterwards from accepting Christ as her Lord and Savior. Or the joy of seeing 1.4 kg preemie gaining weight, and discharged to home and doing well in follow-up...if only it was easier to remember the joyous occasions rather than the sad ones! 

Interesting cases part one

For those of you a bit queasy, this post is not for you. This is for those either a)medical or b)interested in medical stories.

This is a photo depicting the leg of a young girl, I believe she is 11 years old. The probe is in her femoral vein, if I remember correctly. She presented with a swollen, painful right calf. Two weeks prior she had cut her foot on a piece of a tin can. The cut on her foot had healed, and did not look infected. We did an ultrasound to look for DVT, but unfortunately did not look high enough in her leg (only looked from about the calf down, since that is where the swelling was). The next day she was admitted to the ICU with tachycardia, hypoxia, and right heart strain. She also developed high fevers. We did a more thorough ultrasound and found a large thrombus in her femoral vein. With all her signs and symptoms, we suspected a septic thrombus. We put her on heparin, but without thrombolytics, there wasn't much else we could do except amputate the leg above the thrombus. We did an amputation of her right leg, and this photo shows the amputated portion. When we cut into the vein, there was pus that came out. She improved dramatically in the days following the amputation. Clearly the surgery saved her life. She did fairly well emotionally too. Her father has some form of deformity in his legs (I can't recall what), so the idea of a person walking with crutches for their whole life wasn't foreign to her or her family. I think this helped her to cope, and had it not been the case, I'm not sure her parents would have agreed to the surgery. Dr Lindsey is looking to see if it will be possible to obtain a prosthesis for her.

This next photo is the leg of a sweet little girl who fell at least a year prior, and sustained an open tibial fracture. Obviously it wasn't well reduced (often a result of traditional treatment), and resulted in part of the tibia sticking out of the leg. We gave her anesthesia and pulled out the dead bone you see here, then put her in a cast to stabilize the leg as the remaining healthy bone heals in. I suspect her fibula will tibialize to support her weight. 

This little boy presented with abdominal pain, fever, and a distended abdomen. While the first concern from the history was for peritonitis, further physical exam and ultrasound confirmed a large abscess between his abdominal muscles and skin, which extended down into his scrotum. It required a very large incision to drain. This photo is after several dressing changes, when it was starting to heal. Soon after, we were able to close the skin secondarily, and he was able to go home.

This young lady, in her mid 20's, sustained this ankle fracture in a motorcycle accident.  (Which is where most of our Ortho cases come from.) She presented several months after the accident. This was beyond our ability to treat, as ankle/foot fracture of this nature are a challenge even to orthopods and podiatrists. When we told her we wouldn't operate, she fell to the ground, crying and pleading that we would do something for her. Then we called in her mother to console her, and when we informed her the same news we told her daughter, she also fell to the floor and did the same. They weren't without hope, as there is a doctor in a nearby town who was willing to operate, but they were hoping they would have something done at Nyankunde.

I came in one morning to see two of the Congolese doctors attempting a D&C for a retained placenta. They were using ultrasound guidance, and found the placenta seemed to be oddly placed...very superior in the fundus, and no plane of separation. This is because she had placenta increta, where the placenta has grown into not just the endometrium, but the myometrium (uterine wall) as well. Thankfully it wasn't through the serosa (which would make it placenta percreta), as that is more difficult to treat. Kimiko and I are doing a hysterectomy in this photo.

This young 40 something year old presented with early satiety and an abdominal mass. She was also anemic and appeared mildly malnourished. The mass you see in her abdomen is her spleen. The following photo is her spleen after we removed it. I believe it weighed at least 5 lbs! It was heavy, at any rate! It's not often we do a splenectomy for splenomegaly, but in her case, it was definitely warranted.

This x-ray is from a young man who presented with shortness of breath. Diagnosis? 

He felt much better after we placed a chest tube. 

This 30-something year old man came in with a leg mass that he had for at least 2 years. It has progressively increased in size. We offered to do surgery to remove the mass (it appeared well-circumscribed, no boney involvement) but he never returned for surgery. I'm not sure if he was still looking for money to have the surgery done or he decided to go elsehwere.

Transitions

Endure hardship as discipline; God is treating you as his children. For what children are not disciplined by their father? If you are not disciplined--and everyone undergoes discipline--then you are not legitimate, not true sons and daughters at all. Moreover, we have all had human fathers who disciplined us and we respected them for it. How much more should we submit to the Father of spirits and live! They disciplined us for a little while as they thought best; but God disciplines us for our good, in order 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. Therefore, strengthen your feeble arms and weak knees. "Make level paths for your feet," so that the lame may not be disabled, but rather healed.
Hebrews 12:7-13

     This 33rd year of my life has been a challenging one. It has been a year full of transitions, and there are more transitions yet to come. I've transitioned from living and working in a hot, humid environment in Impfondo, Congo to living in cooler, less humid Indiana. I've transitioned from working in a culture not my own, speaking daily in a second or third language, and struggling with finding the right words, to working in the US, in my own language, but in a job less fulfilling. I've transitioned back to another culture, similar to the one in Impfondo, but yet different, in Nyankunde. I could at least speak French and some Lingala, but now limited by lack of speaking Swahili, and struggling with another language barrier.
     During all these transitions, my faith has been challenged. I've been forced to re-evaluate many things.  I feel as though God has been breaking down certain barriers I have built up over the years so He could either create new doors, or rebuild the wall in a structurally sound manner, rather than my feeble human-erred attempts.  He's calling me to draw closer to him, to put aside any distractions I've had in the past, and step out in faith.
    The question remains-step out where? I am not yet sure. I have some ideas, but I am not yet ready to share them with the world, and they require much more prayer before things are clear. I was hoping that during my three months in Nyankunde, I would have a clear direction as to the next steps in my life. However, the only thing that is clear is that I must trust God and depend fully on him. Jennie Allen, author of the book Restless, writes "He likes his kids completely hanging on to him for dear life more than he cares about the perfect plan being executed. He is after us, and uncertainty is usually what keeps us glued to his side. He is in the trenches with us. In the fear. In the uncertainty. He is in the unknown-knowing and leading and working. What we don't know yet is meant to lead us to dependence."
     Every time I read that last sentence, my mind wants to read "What we don't know yet is meant to lead us to independence. Which is exactly the opposite of what she is saying. Learning to be dependent is very difficult for this independent woman (ask my mom, I've wanted to do things myself since I was a baby. I wouldn't even take solid food until I could feed it to myself). But through these last three years, God has been asking me and teaching me to be dependent on Him and others, rather than trying to do it all myself. I've found through many mistakes and cultural faux pas that being independent often hurts ourselves and others-it deprives us of community and the ability to truly bear one another's burdens, and it causes undue fatigue and stress on ourselves.
  There are no words to thoroughly express the thankfulness and joy I have for my friends and family who have been by my side during this time. There has been some laughter, and many, many tears in the last year. I'm so thankful to have them nearby to wrap their arms around me (literally or virtually) and love me without condition. It's been exactly what I've needed.    
  So I ask you to gather round, pray for me as I pray for you, that we may bear one another's burdens. Pray for guidance for my future, and that I rest comfortably in the Savior's love for me. I will be praying the same for you.

Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles. And let us run with perseverance the race marked out for us, fixing our eyes on Jesus, the pioneer and perfecter of faith. For the joy set before him he endured the cross, scorning its shame, and sat down at the right hand of the throne of God. Consider him who endured such opposition from sinners, so that you will not grow weary and lose heart. 
Hebrews 12:1-3

It's about Redemption

 When they had finished eating, Jesus said to Simon Peter, “Simon son of John, do you love me more than these?”

“Yes, Lord,” he said, “you know that I love you.”

Jesus said, “Feed my lambs.”

Again Jesus said, “Simon son of John, do you love me?”

He answered, “Yes, Lord, you know that I love you.”

Jesus said, “Take care of my sheep.”

The third time he said to him, “Simon son of John, do you love me?”

Peter was hurt because Jesus asked him the third time, “Do you love me?” He said, “Lord, you know all things; you know that I love you.”

Jesus said, “Feed my sheep. 

John 21:15-17

Godly sorrow brings repentance that leads to salvation and leaves no regret, but worldly sorrow brings death.

2 Corinthians 7:10

When I first felt called to come to Nyankunde over a year ago, I knew that God had something special in mind for me while here. I knew that I would have direction for the next steps to take in my life. Little did I know what else He had in store for me. 

When I first arrived here, I found it strange at first to hear a mixture of Swahili and French, rather than Swahili and English that I've heard when in Kenya. Hearing the Swahili brought back memories of the two months I spent in Eldoret, Kenya while in medical school. Memories that were good, yet also painful. 

I remember having a good walk with the Lord when I arrived in Kenya. I remember that I read my Bible daily, and was comfortable in prayer. It was while there that I felt called to long term missions. Yet at the same time, it is also when I feel I started to drift away a little...I wanted control in one area of my life...one area in that I wanted to direct and do as I pleased. I could tell this was not pleasing to God, but it's easy to start talking yourself into things once you've started.  I have struggled to turn this area back over to God in the nine years that have followed. I have come to realize in the last few months (perhaps a year, but the realization and acceptance has been growing) that the real problem has been a lack of true repentance. 

And so, it was in hearing the Swahili again that these memories came to mind. Painful reminders of my sinful thoughts and behavior which cried out for repentance. God wants me, and ALL of me, all parts of my life, and I needed to give that back over to Him. I felt shameful of my actions, of trying to keep this part of my life from Him. I felt shame in seeing and remembering the hurt relationships as a result of my actions, perhaps causing others to stumble in their walk with God. 

Then one day in February, while laying on the floor, crying my heart out to God, I heard God respond: (not in an audible voice, but in my thoughts)

"Laura, do you love me?"

"God, you know I love you."

"Feed my lambs."

"Laura, do you love me?"

"Lord, yes, I love you."

"Take care of my sheep."

"Laura, do you love me?"

"Yes Lord, I do love you!"

"Feed my sheep."

Just as Jesus restored Peter after he had denied Him three times, he was restoring me. He was letting me know that I'm forgiven, I'm redeemed, and set free. Those things I've done in the past that weren't healthy for my walk with Him? Forgiven. Totally, unequivocally, and irrevocably forgiven. 

Dont' get me wrong, I've asked for forgiveness before, and I know I've received it. But one thing I had lacked was the one thing He desired-true, utter repentance. That is the difference. That is what finally occurred in both my mind and heart, bringing me to my knees before God. And that I where I received Grace. It is where Jesus redeemed me from my past, so I can go on living a different future. I know it won't be perfect. I'll have to keep giving this area of my life back to God over and over again. But I no longer live with guilt. 

So this Easter I'm especially thankful for the events that happened so long ago in Jerusalem. I'm thankful for his sacrifice on the cross, and rising from the dead. I'm thankful that we are no longer dead in sin, but alive in Christ. I'm redeemed, I'm redeemed, praise the Lord!

A long week

Some of you may know the maxim "All bleeding stops eventually". The phrase came to mind this week as we dealt with multiple difficult cases. (This may be too graphic of descriptions for some, so I'm giving you fair warning to stop reading now if this is the case. I'm also going to use medical terms and not explain everything. Suffice it to say, we had a difficult week with one emergency after another. Not many survived.)

Monday was a busy day. There are often cases that have been admitted during the weekend that aren't urgent enough to require us to come in during the weekend, but do need to be handled that day. We had several procedures already scheduled, plus the usual outpatients. Around 1pm we heard some vague rumors about a patient with hemoptysis and severe melena. But it wasn't clear where this patient was, and what exactly was happening with him. Then about 2:30 pm or so, we found there were several endoscopies which the medicine team wanted us to do. These patients had presented during the weekend with hemoptysis, but had been otherwise stable and could wait until monday for endoscopy (we look for esophageal varices, which are common here due to high incidence of infection of schistosomia, which causes peri-portal fibrosis, portal hypertension, etc). We did the endoscopies (I got to do two of them-and made it through the pylorus both times!), and even banded a few varices (which I did not do). Then we heard more about the patient with hemoptysis and melena, around 4pm. Turn out he was hypotensive and while blood transfusions had been ordered, donors had not yet been found. We got a line in him (he had had a 22G in the wrist), and about that time a friend of his and a passing nursing student were able to give blood. We did an endoscopy and found a large duodenal ulcer. We thought we could cauterize it, but when we did, then it started bleeding heavily. We rushed him back to the OR, and had him open and pressure on the site of bleeding in no time. Fortunately we had a case earlier in the day that we had cancelled, but the drapes, instruments, and gowns were all still in the room, which allowed us to start the case that much faster. He had lost so much blood that his organs were white, and nothing was bleeding. We managed to stop the bleeding, do a vagotomy, and close. He got two units of blood intra-operatively, and another post-operatively.
He remained stable overnight, but the next morning he developed tachycardia and hypotension and was transfused another two units. He was awake and talking to us, but you could tell he had this sense of doom about him. We tried to encourage him, to get him to fight, but I think he had lost hope. By thursday he had passed away.

Then tuesday we a fairly average day...two prostatectomies, removal of an ovarian cyst, etc. But Wednesday was another matter. We had a 2 year old present with hemoptysis. It is very unusual for such a young child to present with hemoptysis, even in an area with schistosomiasis. He was transfused and an endoscopy performed. It was found he had some form of vascular malformation in his duodenum, but no longer actively bleeding. It was decided to give fluids, blood, and observe him. He was doing fairly well the next morning when around 10am, he vomited again, copious amounts of blood. We rushed to the OR and found the site of bleeding and were able to stop it. However, his extremities remained cool and clammy throughout the procedure, and we weren't able to get a good oxygen saturation the whole time. After returning back to the ICU, we were called because he was noted to have dyspnea. He had an IV in his external jugular vein which infiltrated, and was causing respiratory compromise. It's unknown how long this had gone on before it was noticed. His breathing was rather Kussmaul-ish. We checked his pupils-fixed and dilated. My suspicion is he was hypoxic for a significant amount of time, whether during the OR case or after the IV infiltrated. He died not long after.

Thursday we had another man present with bleeding-this time a large amount of melena, but no hemoptysis. His hemoglobin was stable at 13, and no further melena, and his vitals were stable. In light of the long day of events on thursday and him being stable, we decided to wait until friday to do his endoscopy. But around midnight, he became agitated and was given tramadol and diclofenac by one of the other docs. Then at 7:30 am, he had acute onset of abdominal pain, tachycardia, hypoxia and hypotension. He was found to have free fluid in his abdomen. He did not follow the axiom that "Bleeders don't perforate and perforators don't bleed." We needed to resuscitate him with fluids before we could take him to the OR, so a central line was placed, we tanked him up with fluids, and blood was ordered. However, he remained too unstable to operate, and he passed away.

Not to mention the other cases we did this week: three cesarian sections added on to the schedule on either wednesday or thursday, I can't recall. Two with good indications, a third that was thought to be term by her last menstrual period with a hand presentation but was actually 28 weeks with twins (no ultrasound had been done, and apparently no one had figured it out by Leopold's maneuvers). The twins did not make it.  We also found out that another patient we had operated on a few weeks ago (menigocele repair) had died.  It seemed that death was all around us, despite our best intentions or best efforts. Perhaps we should have intervened sooner in some cases. Perhaps there are things we could have done differently, and the outcome would have been different. There are many what if's, but we have to live with what was. 

Then friday, I noticed one of the doctors had posted this to Facebook:
Dans un bon nombre de situation difficile,Dieu nous demande simplement d'avoir confiance en son plan et de continuer a avancer jour apres jour,sans baisser les bras.Alors quel que soit votre vie a un moment donne,prenez courage Dieu reste Dieu,il est assurement avec vous et il vous aidera quel que soit le defis devant vous. Philipien 4:6

Which means: "In many difficult situations, God asks us simply to have confidence in his plan and continue forward day after day, without giving up. When this comes to your life, take courage that God is always God, and he is surely with you and will help you no matter what the challenges before you. Philippians 4:6"

Philippians 4:6 says "Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God."

It gave me courage to read his post, and to remember that as he said, God is always God, no matter the circumstances. 

That's not what you want

Recently I've had some experiences of where the person I was interacting with had a different idea of what I wanted or needed than what I thought I wanted or needed. Examples:

A month or so ago I was at the market and asked for 150 francs worth of lentils. She told me no, I wanted 300 francs worth. I accepted, mostly because I probably could do something with them, and I understood she wanted to sell the last of what she had (which was 300 F worth).

Last week I had a little bit of hot water in with some coffee grounds in the French press to make a second cup of coffee. I hadn't filled it all the way because I wanted to add more hot water before I left the house, so it would be hot at work. Esperance, the Congolese woman who helps at my house, saw it as a dirty dish and washed it. Guess I really only needed one cup that day. 

Last weekend we went to the market and I wanted just 200 F worth of dried kidney beans. The lady gave me a look as if to say "are you crazy? That's not enough to for a meal."  I still only bought the 150 F. And by the way, it's plenty.

I made bread this morning and asked Esperance to put the bread into loaf pans. I got home and have two dozen rolls. I really wanted loafs. I wanted to have slices of bread. I can't really explain why, but it was important to me.

It got me thinking, I wonder how often we do something like that to God. He says "I want you to do this..." and we say "no, you really want me to do this." Sometimes we're like Jonah, who flees God's direction, or try to 'one up' what God wants. Sometimes he just wants us to be satisfied with Him. To take time to be in His presence. We try to 'one up' things, to do something 'better', but it really distracts us from what He really wants-our heart. And it distracts us from seeing and hearing Him.

Teach me your ways, O LORD, 
that I may live according to your truth!
Grant me purity of heart, so that I may honor you.
Psalms 86:11

First week at Nyankunde

     I'm sure many of you are wondering how things are going here. Well, on the whole, pretty good. I arrived Monday after a short flight from Entebbe to Bunia, then a 1.5 hr drive the last 20 km from Bunia to Nyankunde. I remember most of it, but there are things coming back to me that I realized I was a little too dazed and jet lagged to remember well at the time.
    At the airport in Entebbe I met up with Kimiko Sugimoto, a surgeon from the US who lived at Nyankunde for a few years as a child (her dad is a missionary surgeon). Kimiko is about the same age as me, and we are sharing a house here in Nyankunde. It's been fun getting to know her and share the work load at the hospital, and learn from her as we work. She's also been sharing with us what various buildings here once were, as we walk around some of the empty shells of houses that are here.
     CME Nyankunde used to be a very large, thriving mission hospital. However, in September 2002, the surrounding tribal warfare came to the hospital grounds of Nyankunde itself. (read more here) Many were killed, and hospital was ransacked and destroyed. About 10 years ago, a few returned to the hospital and found the place buried in thick grass and brush. Slowly, they cleared things out and the hospital was re-opened in 2005. Work has continued ever since to slowly re-establish what was lost. Samaritan's Purse has helped tremendously with rebuilding the hospital, including the construction of a new surgical suite and ICU. The hospital is staffed mainly by Congolese doctors and nurses. Drs Warren and Lindsey Cooper are the only ex-patriot (foreign) doctors here long term.
     Tuesday we jumped right in to work. I've been able to assist on a few contracture releases/skin grafts (all were people who developed these after suffering from burns), a post-hysterectomy following complications of a c-section done elsewhere (she needs prayers!), and a few other cases. I've also been brushing up on my ultrasound knowledge.
      The weather here has been nice and warm-in the 70's most days, but cool in the evening and early am. Much better than the -15 degrees we've been having in the US! While the snow is fun for sledding, I much prefer to be able to get out and walk around in short sleeves! The hospital is situated on side of a 'mountain' (not sure if it is technically a mountain, or just a large hill), so I've been getting some exercise going to and from work, as well as exploring the hospital compound. The guest house here is quite nice. There are three bedrooms and a nice living area and kitchen. I can even get a hot shower!! What a blessing!!
     A few things I could use some prayer on:

• Going to bed at a decent time so I get enough sleep. I tend to be a night owl, which doesn't work well when one has to get up early. 
• Humility to state what I do and don't know.
• To be able to deal properly with feelings of insufficiency. There is so much to learn, and so many times I don't and won't be able to know the answers. It's easy to feel one isn't enough, doesn't know enough, can't do enough. 

Here are a few pictures from my first week here:

View of Lake Victoria as we left Entebbe

Lake Albert (on the border between Uganda and DR Congo)

Where I'm staying. See all the flowers? I'm so happy!

One of the houses that is being renovated. The house I'm in used to be like this.

The swimming pool. Anyone want to jump in?

The soccer field and some of the housing for staff. Notice the fields on the hill in the background.
How would you like to farm that? 

Warren, Lindsey and Kimiko.

At the market

Some of the legumes one can purchase at the market.

Kimiko buying green coffee beans for us to roast.

Fabric I bought at the market.

Another piece of fabric I purchased.

The nursing school.