Monday, December 24, 2012

Cameroonian Christmas


So, Christmas at Mbingo. It doesn’t feel like Christmas in the typical, American sense. It’s 80 degrees, the Christmas carols have not been going since Thanksgiving, I haven’t bought a single gift in the past month. And yet there are a couple of things that remind me of “home” this Christmas.

I asked Ben, the guy who works in most of the gardens around here, if he could get me a couple sticks of evergreen off of one of the trees. I was just going to stick them in a vase for my “Christmas tree”. But here came Ben, dragging the entire top of an evergreen. Now it’s no Frasier Fir or Cedar, in fact it has thorns all up and down the branches, but it is green and works well for a Christmas tree look-alike. Since I’ve nothing to put it in (aka – tree stand), I keep it propped up against the wall in an old oatmeal can to keep its water in. I also have no ornaments or lights to decorate with. I considered making a popcorn strand, but then thought that it may draw rodents. So, it is just a naked tree, but it stands (or leans as the case may be) as a reminder of Christmas to me.


The next thing is Christmas carols. They’ve been doing carols in the chapel in the mornings, but I am always rounding during that time and so have not been involved in that. However, last night the missionaries all got together to sing. And this evening, the plan is to carol in the patient wards. That is kind of fun.

Leg after leg coming out of that door - how many legs can a cow have?


But otherwise, Christmas celebrating is just a bit different. Take feasting for instance, it happens all over the world, but this is unlike any Christmas dinner preparation I have ever done. The first thing is the Christmas slaughtering of cows. Some of the hospital cows are butchered and sold. This meat is better than the ordinary beef you can find. Each ward sends around a sign up sheet to tell how much meat you want and which cut (cut meaning first cut, second cut, etc – not like you can order T-bones or ribeyes). Then you go stand in line on your assigned day during the days before Chrstmas. Everyone is gathered and pushing in on one another. They carry the very, very fresh cut meat from the slaughter site over to the next door down, the selling site. There are small piles of meat, with little papers saying who has ordered them. Turns out, you are supposed to bring your own bag. But how was I to know this? So, they were gracious and squeezed a big bunch of meat into a tiny, thin little bag for me. As I walked back toward the house, I cradled the meat to keep the bag from breaking. The blood squished into my shirt.
Now that is fresh meat


Next animal to be killed was the pig. There’s no bacon for sale in Cameroon. No one knows what bacon is. So, when they said they were slaughtering a pig, I thought, “hey, that pigs gotta have some bacon part somewhere on it”. So, I turned in my order, 2 kilograms of bacon. We looked up a diagram of pork parts, and I had to show the man where the bacon part comes from on a diagram. I am learning so much about livestock during all this Christmas celebration.

Now the gross part of this picture is the pig head. The interesting thing is that the man who bought and is now carrying it is a doctor, complete with white coat and stethescope.



And lastly, the chicken. As tomorrow is Christmas Day, I am the supplier of the main course for the missionary dinner. So, a chicken had to die today. I have been wanting to learn to kill one. I mean, you can’t live in Africa and be too wimpy to kill a chicken. So, I asked Ben (the above tree-provider) if he would show me. He agreed. So this morning, we went to the chicken coop, he rounded up a good fat one, and brought it out of the cage. He showed me how you have to hold the feet under your one foot and the wings under the other so that you can use your hands to slice the neck. As he held the chicken down, he started to pray. I found this odd, wondering why in the world he was praying, and wondering if it was for sure to the same God I knew (I’ve seen chickens sacrificed in witchcraft before). So, a bit later I asked him. “Why were you praying before we killed the chicken?” He replied with what I thought was hilarious, “The same reason that you pray before you operate”. That took my mind in a thousand funny places. I’m not hoping for a successful kill with my patients, I’m actually praying for a good outcome. But it made total sense to him. Anyhow, he helped hold the chicken, while I slit its throat. He explained how you must keep holding it down after you kill it so that it doesn’t sling blood all over the yard. I thought that was a good tip. Then came the boiling water. You’ve gotta pour it on the chicken before plucking it to make the feathers come out easily. Then pluck, and pluck, and pluck. Rinse and pluck any small feathers you missed before. Then cut off the head and feet, eviscerate it, and voila – just like a chicken that comes from the grocery store!



Pluck, pluck, pluck
Ready for the oven





So, feasting is part of Christmas in both American and Cameroonian culture. I may be missing out on eggnog and cheesecake and stuffed mushrooms, but as a perk I’m eating the freshest, most hormone-free meat I think I’ve ever had. There are so many differences all around the world in the way we celebrate. But no matter what the celebration looks like, from near and far, we join as God’s children to celebrate His amazing gift of Christ Jesus.  

Thursday, December 20, 2012

The Greatest Story Yet


None of the plans that God had come up with seemed, from a human perspective, to be working out so well. Made man and woman in the midst of the wonders filling creation –only to watch them find greater pleasures in something else. Led His huge hoard of people along, generation after generation, only to be truly honored and loved by a few rare ones. Offered forgiveness over and over to those who turned away from Him. I mean, what kind of God would keep chasing after people so foolish, obstinate, and self-willed?

And then the culmination of it all was found in God putting on flesh to pursue His people. No longer just to guide them from afar or welcome them back with open arms, but to become “God with us”. A strange plan, seemingly full of flaws. He had everything to lose, they had everything to gain. Too risky for people who have failed time and again. Why give so much for them?

And again it looked like few followed, another plan destined to fail. At first a few wise men. Years later a few fishermen, a couple tax collectors. Sometimes crowds would come to see what this Flesh would awe them with, but most would return home without bearing the name of disciples.

And, as in the past, the plan fails again. They turn on Him, turn from Him. He is mocked, beaten, killed. Was this the amazing Promise? But wait a few days… And beyond our comprehension, life comes out of death. Hope comes out of despair. We stand here justified, when we were condemned before. And then we see, that this Flesh changed everything. We look at the baby, lying beneath that bright star. He no longer is just a glimmer of hope, now He is confirmed as the hope of the nations. We look at the man teaching the crowds and realize that he was not just a great moral character, but was fulfilling righteousness for those who could not achieve it. We look at the torn body, sagging on the cross, and realize that He was saving those who He had been pursuing since time began. We look at the empty tomb and see Him as the conqueror and king. It looks like the plan may be working out.

As the plan continues, it starts to get confusing again. These same people, full of failures, who now He has had to give His life to save, He makes as the ones that will carry His message out. They will image Him into the world. Again, He chooses to make Himself known through flesh, but now the flesh of men. Once again, it appears destined to fail. But He sends His Spirit as a guide, comfort, strength. They go, not as perfect men, strong and wise and composed, but frail, broken, and humbled as they take His name wherever they walk along the course of their lives.

You or I wouldn’t have done it this way. We would’ve quit at the garden. Man wasn’t worth pursuing anyhow. A total let-down. At every step of the way we could have found a hundred reasons to stop loving mankind. And if we had gotten all the way down to a Messiah, he wouldn’t have come as a weak, fussy baby. No, he would have been a fearsome warrior. And then, we certainly wouldn’t have made the people who had let us down over and over and over again our representatives. Nope. But God did. He has been glorified by plans beyond human comprehension. He has been and will be glorified by strange things. Strangely, even by your flesh and mine, against all odds. Praise His name for all that He has done. Give glory to God in the highest, from the broken, frail, and tired down here with our feet still dirty on this dust. And thank Him that He became broken, frail, and tired with dirty feet for us. 

Tuesday, December 18, 2012

The noise

I am a good sleeper. Its one of a handful of things that I am just naturally good at. So, why am I lying here in the dark, finally resorting to grabbing my computer off the floor to type? Well, just like last night, I woke after a few hours of sleep with a strange combination of water pouring out of my nose and the inability to breathe from nasal congestion. Why is that always the combination that comes with upper respiratory illness, clogged up and pouring over? So I blew my nose, rolled over, tried it again. Oh, and then the nurse calls to make sure I knew about a patient (who I had known about since it was very much light outside). The nasal cycle continued until I was having to get up, turn on the light, and go to the bathroom regularly to get more tissue. Finally I just crammed some up my left nostril and laid with that side down so the snot would drain effectively in one direction.

In the midst of this miserable time, longing for rest that would not come, I heard the noise. I knew it. There is something that comes up my shower drain in the night, flips the drain cover off, and then enters freely to enjoy my home. I heard the noise of the plastic cover flipping off. I always liked to imagine it was a lizard. You know, they are kind of solitary, interesting creatures. They aren't really thought of as nasty or germy, though of course they probably are. But as I lay in my bed, it occurred to me that I don't think lizards are nocturnal. I then heard the creature knock over some small item in the kitchen. I couldn't just lay there anymore. Lights on again. Robe on (just in case something jumped on me, I wanted to have an extra layer). I couldn't find him, so I made sure all the cabinets were closed and headed back to bed. On the way, I put the drain cover back on with a heavy bottle of  cleaning solution on top of it so that if it made it out already it would be trapped outside.

But, no such luck. It was trapped inside. I heard it again in the bathroom, this time trying to get out of the drain. Up again. Robe on. Lights on. Aaaaahhh, a rat! Sick, nasty, disease laden creature. I felt very vulnerable to attack with my bare legs there on the same floor as him. But there was nothing else to do but trap him or kill him. So, with all the wisdom that comes in a groggy, foggy state, I went for the heaviest thing I could find. Someone left a broken hand churn ice cream maker bowl here before I moved in. Those things are stout. Since it was already broken and useless, I grabbed it as a double use instrument of war. I could trap him in the bowl, or if that didn't work, I could bludgeon him to death with the weight of the bowl. But as I timidly approached, he knocked the bottle of cleaning solution off the drain, flipped it off, and was down it once again.

I have complained multiple times to the juvenile appearing plumber at the hospital regarding this now known rat (prior lizard). He looks at me like I'm stupid, says something nice that translated into what he means says "you're stupid", and then turns away to talk to his friends. Well, in my current multi-night sleep deprived state I have come up with some other options. First, between cases today I will go and talk to the maintenance departments boss. If that fails to get some kind of non-removable drain cover, I will change directions and head toward the administration building to see if they can get something done. If this too fails, I am going to find some bush-hunter type Cameroonian man, let him stay in my guest room and eat at my house for free, in exchange for his willingness to be woken up by me whenever I hear that rat start to mess with the drain cover. He will be responsible for killing any creature that crosses the limit of that plastic piece. I saw a man who works in the OR walking down the road just the other day with a gun, heading out to get some bushmeat. Perhaps I will introduce the idea to him when I  get to the OR today. He may be the one.

Saturday, December 15, 2012

The Christmas Party

The nurses from clinic came to me, excited because they wanted to put on a Christmas party for all the staff at the clinic. I'm okay with that, I can go to a party, sounds good. Only as the plot was further revealed in the days to come did I realize what that actually meant. I was the one putting on the party. My house, which is big enough for me, but not big enough to entertain more than 3 or 4 others, was going to be the spot. So I cleaned the floors and bathroom, went home from work each day to cook and bake, and finally it was party time.

Now, it was at my house, but I wasn't the one coming up with the "program". It is hillarious to me to see how Cameroonians need a program for everything. And how it needs to be read aloud to transition from one activity to the other. This one went something like the following:
1. Opening prayer, 5 minutes - John
2. Greetings and purpose of the meeting, 10 minutes - Christy Lee
3. Worship songs, 5 minutes - Mercy
4. Prayer time, 10 minutes - Elizabeth
5. Christmas carols, 10 minutes - John
6. Eating food, 15 minutes
7. Dance, dance, dance, 10 minutes
8. Closing remarks and prayer, 5 minutes - Mercy
My part only lasted about a minute and a half, which helped get us back on the mandatory schedule. And thankfully during the "dance, dance, dance" portion I was washing dishes. Cameroon isn't ready for my dancing, in fact almost no where in the world is ready for that. It is a rare event.

I've never been to a choreographed party. Nor do most parties I have gone to have so much prayer time scattered throughout. I thought it was going to be sort of corny, but actually it was pretty neat. Though totally written out step by step, we had good, and spontaneous worship together. And as we sang local worship choruses, one person would pray with all of their might for the prayer requests. I've been part of lots of prayer times with all sorts of believers joining together, solemn Baptists throwing in extra "wherefores" and "hithertos", Pentecostals breathing heavily and sweating, folks praying in tongues, children seemingly listing out thanks for every creature and person God ever made. But never have I experienced it like that. It was powerful and moving in a refreshing way. You couldn't actually hear what anyone was praying, but it was like a sweet sounding praise lifting up their prayers all around.

And then finally came the food. There was a bunch, but there could never be enough in Africa. Plenty was left, but then came the napkins. Napkins aren't used to wipe your hands with here, they are instead used to wrap any extra food in to stuff in your purse for later. "For my kids" I kept hearing. One of the guys giving that excuse has kids that live 3 hours away, and he won't see them for another week. I finally broke out the all too valuable ziploc bags to help them shove in more cookies, peanuts, cakes, etc. As they jammed them down into their bags, they said, "We have had dinner in America, we have visited America, and now we will take America back to our families". I had to hide a couple cookies in the kitchen to keep them for myself.

They left to their houses. Surprisingly, I was refreshed, rather than tired. And I was happy to have brought a little "Merry" to their Christmas.

I left in the darkness after the dishes were washed to head back up to the hospital. Pus was waiting to be cleared out of a belly. Sick patients were needing to be checked on one more time. The party is over, back to the grunge of daily life. But that is what Jesus did. There were bright stars, and angels in chorus, and wise men coming from far - spectacular things. But then, after a short-lived celebration of the newborn King, here came Herod, and fleeing to Egypt, and leaving the makeshift home that the stable had been. Back to the paths that shaped His early life, that made His little feet dirty, and left Him sweaty and tired as He grew into a young man. These are the paths that formed Him and shaped Him into what was well-pleasing to the Father.


Saturday, December 8, 2012

Frustrations

It's been a frustrating couple weeks. I wouldn't call myself a "control freak", I mean, especially compared to people with "real" control issues. But I do get annoyed, mostly about the things beyond my ability to change. Seems pretty constant for the past little while. Circumstances let me down. Things I thought would be awesome turned out to really stink. And then the little things. They turn into big things when they keep coming one after the other. It's like an ant bite - one is bothersome, but if you accidentally find your foot in the ant hill, 25 of them are almost all consuming. The small things add up.

Like the OR. No appropriate instruments. I keep asking for them. But nobody is moving to even look for them. I had a small tantrum this week, broke sterility, untied my gown, dropped it, and went to look for the instruments myself. Did I find them? No. Technically it was a useless moment, but somehow it made me feel like something was actually happening.

And the same day, I asked the staff to call the last case of the day in for her surgery. It was 2 pm. But, no, anesthesia says they can't take the case back because it just passed 2 o'clock and the staff will soon be low. Really? I told them to go tell the patient that because I was too ashamed to tell her something that sounded so dumb. They just laughed and said no. So, I have to walk into the ward to give her the news. "You'll have to wait another day." She wants to know why, but heck, I don't know - I don't understand it a bit. She's got to pile onto the next day, so make that six cases tomorrow instead of five.

Oh, and just as I was closing the belly of the patient before her, frustrated by the news that they wouldn't bring the next patient, I see a spot bleeding. I want to use the instrument called the bovie to make the bleeding stop. It kind of makes a small burn in order to stop little areas of bleeding. I look, but it's already been thrown off onto the floor. I always ask to keep it on until I'm finished, but its gone every time. So, I ask for another one to be put out. It's plugged in, I push the button, here the "neeeeeeeee" that means its working. A millisecond of feeling less frustrated, at least I have another one ready to use now. Then I feel the intense burning through my gloved hand. Yep, its on fire. Not just a little touch of heat, an actual full blaze in my hand. I threw it on the floor and removed my glove. Turns out that the "cleaning solution" that they are soaking those in is alcohol, which is highly flammable, of course. Coupling the fierce burn in my right pinky finger with the now mountain-like mound of frustrations, I held back the tear that wanted to come. It wasn't a sad tear, it was anger and lack of control and a unmet hope for things that could, and should, be different.

That's a few moments in one day. And some days there are similar moments one after the next after the next. I could write a book on technologic frustrations. Nobody wants to read about that, so I won't. Or I could show you the chapters in my specialty books, that no matter how many times I read, I just cannot get everything out of that I should be able to. But, since I can't understand them and think they are boring, you wouldn't like to hear any more about them either. The list goes on...

And then once in a while something awesome will happen. Like the day following the one described above. I knew that there were more cases than I could do. I knew that there wouldn't be much help. I knew from the moment I awoke that the day had lots of potential to be frustrating and overwhelming. But then, the general surgery attending just showed up. I mean, it was wonderful. He sent all of his available residents to help get the C-sections done, and he even helped assist me on a hysterectomy himself. During the case I asked, "Don't you guys have two cases today? Don't you need to be doing those?" That actually triggered his mind that yes, they did have cases, and he had forgotten them because he was trying hard to help get mine done. I was, and still am, suspicious. See, he is my neighbor. Like the kind of neighbor that I can hear talking in their house. Don't know what they are saying, but its close enough to hear something. I wondered if he heard me praying the night before or that morning. Had he heard me so frustrated and sad before the Lord. Or, had he been peeking in my window the night before? Because that was the only time since I've been here that I have shed a self-pity tear. But I talked to my family and it pushed me over the edge. I had to let a few tears fall as I was drifting off to sleep. I mean the man is a nice fellow, but something must have pushed his compassion button a little harder to help so much that day.

Or maybe, it is just that God sometimes reminds us of how much He loves us. When we get so consumed by the frustrations - often real, valid things that should frustrate us - it is so easy to lose our sight of Him. Carrying burdens so heavy often leaves me feeling restrained in my worship, and even my love toward Him. My prayers are pitiful. I'm too tired to invest in Him. Too mentally drained to focus. My spirit just wants to rest. He doesn't get my best. But He loves us even then. Sometimes He relieves the burdens, sometimes he refreshes us while we carry them. But He never leaves us. We never walk the paths alone.


Monday, November 26, 2012

Things I Think are Funny


Someone noted that my blog was depressing, so here are some things that I think are funny in Cameroon. Maybe they will cheer you up. Sometimes people don't understand my humor, but I think I it usually quite good.  



If you've ever seen a newborn baby under the blue lights in the US, it's just a bit pitiful. But here, its much more pitiful. Poor thing is closed up in a wooden box with blue bili lights shining down, eyes blindfolded by a bandana type cloth to protect them from the light. For some reason, it is always funny to me though - looks like a tiny abduction victim. Its probably not funny to you, but maybe.




This one is what "you're having twins" indicates in Cameroon. One on each arm while you ride the motorcycle. 






This one came on a bad day. Everything seemed to be a struggle. I had to do a procedure in the OR. As I bent down to take the broken bed apart, I saw this sign mounted on the underside of the OR table. I thought, "well, I guess this is encouraging on a bad day, at least the table won't blow up". 







The female bathroom sign is normal, a little girl in a triangle type dress. And then you see the male sign. I mean, I never thought the normal, general sign was flattering to the male figure, until I saw this one. Wierd. Where in the world did they get this? Oh yeah,  Africa. 





The flash distorted the photo a bit, but this is a box of tea in the store. There's tea for everything, sex, fat, etc. But this is my favorite. "The de la defication" - Defecation tea (for those who speak country - tea to help you poop). Note the cool picture with the woman reading on the toilet. 





This one isn't really funny, its kind of gross. What's for dinner? Fish heads. I didn't eat these.




Now, this one seems funny to me every time I come to town. It never gets old for me. The sign below says "At your own risk WILD DOGS". If you don't get why this one is funny, I can't help. 


Wednesday, November 21, 2012

Hope in Despair


Two children died coming into this world before, and now the next was at stake. The 20 year old couple had lost too many for so few years. In fact, they only had losses, no living children. They were offered a C-section, as the child was breech, but declined. Labor ensued. Hope mixed with pain, the intensity of which worsened after the water broke and trickled onto the floor. The young man was obviously concerned as he watched his wife. Awkward and young, he didn’t know what to do or say, but he kept coming to check on her. She called to him as she began to push, and obediently, he came. The nurse told him that he could rub her back to help with the pain. Massage isn’t really practiced here, but he tried to do what he imagined she was telling him to. The child came, a bit closer, and closer. But the pushing continued. Joy came closer with each millimeter of progress. No electronic monitors available, so the nurse listened every few minutes.

Oh I love that sound of the fetal heartbeat. That rhythm brings a slight nod of my head and pulse of my fingers that ensures me that everything is okay. I miss the continuous rhythm of electronic monitoring, the transmitted beats written on the page, and delighting my ears. Fetal monitoring in the developed world comforts me, but here, there is no fetal monitor. Only an occasional, momentary check to make sure the heartbeat is still there. No soothing, continuous “da-dum, da-dum” to nod my head with.

And then the nurse went to check again, and it was gone. She could hear nothing but the swish of the maternal pulse. Had the child shifted, or was it there, but hard to hear? I imagined hearing some faint sound, but I could tell it was only an imagination of my mind. I called ultrasound to come. But with no ultrasound immediately available on maternity, there was nothing to do but wait for them to bring the machine. The worst thing would be to do emergent surgery on an already deceased baby. That would bring higher risk to mother, but no reward in a child. So we waited, and anxiously searched for the heartbeat with the fetoscope until the ultrasound finally came. It confirmed there was no heartbeat.

Our hearts sunk, as now there was only one course of action. She couldn’t push anymore, and the fit was tight through those young bones. Terrible, terrible delivery it was. Intentional, forceful removal of the fragile infant’s body is one hardest things for an obstetrician to feel beneath our hands. It brings me a wave of nausea to have to deliver intentional harm like that. We, who love to bring life, also have the job when outcomes are at their worst. And this was certainly worst. All of the prior impending joy was lost as we struggled to complete this delivery.

A hundred backward glances over the days to follow. Wishing for more resources outside, more wisdom inside. Every morning I rounded on the woman. My uncomfortable eyes meeting with hers, another reminder to me of the failures that can occur with our best skill and intention. I knew it was not truly my fault, but there was a constant twinge of guilt. I fought against the thoughts that came –“I am the one who is supposed to be able to help”, “I’m supposed to give them a live baby when the past ones all died in the village”, “They’ve come to the hospital because I am a specialist here”. I could think of nothing else I could have done or offered though. The course was reasonable right up until the difficult delivery. If I knew the future, knew the outcome, we could have changed the course. But only God can know these things. I pray for wisdom to choose smooth paths, compassion to walk patients through rough ones.

In spite of circumstance, the young woman and her husband were continually gracious and appreciative. Was it their humble state in life, filled with poverty and loss, that left them numb?  Had it not sunk in? Was this culturally appropriate external action, while brokenness or anger lay concealed inside?

My greatest hope was that it was something more. I hoped that God had given peace, surpassing circumstance. He speaks of it as a “peace that passes understanding”. It is what lets the soul rest in Him, while storms rage all around. It is not ignorance, or numbness, or a false mask of joy. It knows great pain, acknowledges brokenness, it feels disappointment – but it knows the gentle and comforting hands of the Father hold them in the midst of it all. We come to know this peace most often when we find ourselves beyond our limits, during times when life gives us more than we can bear. It is then that self-sufficiency is lost, and we recognize our need for God’s sufficiency. And thankfully, when we realize our need, He comes to fill it. We have mountaintop experiences with God dotted throughout life, but these experiences in the darkness and hopelessness of the depths are where we come to know and trust Him most. I hope and pray that this young couple has found Him as a comforting guide to walk them through these hard times. 

A Greater Love


The woman was quite upset when I told her about the cancer. The most outward display of emotion I have seen here with delivery of such news. Obviously afraid, she begged me not to leave her. Clinging tightly to my hand, she didn’t even give me the option to leave. She was overwhelmed by confusion, fear, vulnerability, and despair. One moment of bad news brought out every insecurity. I prayed with her, but she was too overwhelmed by her emotions to find comfort there. She called her husband on the phone and spoke to him with a scared, cracking voice. He was her husband of many years, and she begged him to come to the hospital, with deep hope that he would somehow make it better. She yearned for his presence. I had to go on with my work for the day, so I gently freed my hand from her firm grasp. I ensured her that I would return to discuss the cancer with her husband when he arrived. It took hours for him to get there, all the while her fears and needs grew deeper. When he came, he made me even ashamed. I tried to break the news to him gently, since I saw that his wife was banking so much on him. I imagined that his deep love for her would make the news hard to hear. But he never seemed to care about her. His only questions, deeply concerned as he asked them, were about how to protect himself from getting cancer. He understood that it was associated with sex. He understood that it had been working in her for years. And so, logically, he knew that he must have been exposed. Was he at risk? Did he need vaccines, or testing, or screening??? He was willing to do anything to make sure it wasn’t eating him up inside too. But it didn’t bother him at all that he had likely given the infection to her, or that his wife’s burden was far too heavy for her to bear. She bent her shoulders forward sitting in that ward full of women, broken by the despair of disease and the lack of concern from those she loved. I wondered if she was as ashamed of him as I was. I felt sorry for her. She was not a love, or partner, but only a risk to him. However, he had been everything to her.

It reminded me of how much we need to know the love of God. It is a love that does not fail, better than the best any person on earth could provide. There is no one who can fill every need you have except Him. To place our every hope, our every dream, our everything, on another, only gives them a heavier load than they can carry. No one can fill us up except the One who is meant to “fill all in all”. He can always be trusted, he always cares, and he never leaves His people. I wish that lady knew that there was a far surpassing Love available. She was made for more than her miserable husband could provide. 

Thursday, November 15, 2012

Fundraising, ugh


I am not much of a fundraiser. People always ask me what I need. I usually tell them that I have enough to eat and a house to stay in, but that I treasure their prayers most. And all that is true. However, there are many other expenses along the way. I will say that what I, and people like me around the world, am doing is really important. As we work to provide medical care and teach others to do the same, we are able to alleviate disease not only in the here and now, but with fingers reaching into more distant areas and even future generations. As we recognize and minister to the needs of peoples’ hearts in the name of Christ, we are able to bring healing that far outlasts the ever present weaknesses of these temporary bodies. So, I’m not going to try to give you an exhaustive list of why you should give. I do believe it enriches one’s life as they learn generosity toward others. If you and your family do decide to ever support me financially, I am truly thankful. I really do appreciate every person who gives, every person who prays, and even every person who just cares. Thanks to those of you who do.

If anyone does need my information for my Samaritan's Purse account, it is:

World Medical Mission
Christy Lee, Acct #004394
PO Box 3000
Boone, NC 29607

or online
https://www.samaritanspurse.org/index.php/giving/wmm_doctors/

Wednesday, November 14, 2012

Not this one!


I’ve written in brief about my cervical cancer patients previously. The problem with cervical cancer is that usually by the time you have any symptoms, it has gone to far to be able to offer any good treatment. In the states, pap smears are  so engrained and routine, we often catch the cancer early. Here, they always come in advanced. I diagnose it as they walk in the door. The smell of rotting flesh has no obvious source as they walk in, so that tells me exactly where the source is. I don’t even shy away anymore from the smell, don’t grimace during the exam. That seems degrading to someone who you are about to give very bad news to. The exam is the same, black and gray flesh where pink should be, overtakingly malodorous discharge pouring out, and dull eyes peering over the pelvic bones wondering what I am seeing down there. I finish, and cover their legs again. I keep them lying flat to help taper the trickle of bleeding that ensues after the most gentle exam I can perform. And I draw my chair up beside them to talk face to face. I tell them that the cancer is too big, and that I have no way to cure it. No one has any way to cure it. I have some “special x-rays” (an old cobalt radiation machine) available 6 hours away, but it won’t cure the cancer. It can help with the pain or the bleeding, but that is all. But she can’t afford it anyways. It may as well not exist as a false hope in her world. I tell her that no matter what we do, this cancer is eventually going to take her life. I answer any questions, and then I ask if I can pray with her. I pray to a God who can be trusted in the best of circumstance, and the worst of circumstance. She usually cries a little. I tear up too, but have it under control by the time she opens her eyes at the finish of the prayer. Then I send her to the chaplaincy to continue her counseling (they also do much of the psychology here), and palliative care, who will supply her morphine until she dies.

But not this week. Yesterday someone came in with the biopsy results, “invasive cancer” it read. She had been screened at an outside screening progam. She didn’t smell bad. And the cervix was still visible. In fact, the area was small. I knew it was small enough. Small enough to give another talk, instead of the usual one. I finished the exam, all of it was clear otherwise. I cursed the cancer to myself, “you can’t have this one”.

But that isn’t the really amazing part. In just a few hours I knew that walking into my clinic would be the doctor from Canada with whom I will learn for the next week. I know of no one else who has done so many cancer surgeries here. Next week, we are doing cervical cancer surgery together so that I can learn the procedure better. I assisted on a few in residency, but not enough to feel like my patients would really get the best surgery if I tried to do it alone. But he has done this many times. And he has travelled the country over the past days, from one screening center to the next, rounding up only the handful of women who are eligible for surgery amongst the swarms of inoperable. Only a few drops of hope in the midst of a sea of despair, but a few beautiful drops.

This lady was the only one from our hospital region who qualified for the surgery. She came in randomly on that day. This doctor came randomly on that day too. Apparently, others have been waiting on him for months. And now, she is to meet us next week for surgery. Seemingly random events, but actually very amazing. Why do so many die, and yet the paths have come together so well for her? I don’t know. But still, I pray to a God who can be trusted in every circumstance. And I pray that the hope I have seen in her will be lived out in life instead of death this time. That her children will get to keep her. And she will die at some ripe old age, filled up with days. But more, that she will understand, at least as I see it, that there is some divine hand working for her good. And that her life lived will be lived for His glory.


About Sex


People are always talking about sex. I’m an ob/gyn doctor, so my job is highly dependent on sex. I have to talk about it all the time. I really do enjoy educating young people about it. I always like to discuss what sex was meant for. I mean, the world is full of answers and tips, but mostly it offers a bunch of lies. Sex, as portrayed by the world around us, seems so glamorous, but really it is a far less amazing thing that it was meant to be. It was meant to be great. But the twisted nature of it leaves it beautiful on the outside, but rotten on the inside. Distortion of it seems to span the globe, like an unacknowledged plague. Very literally bringing problems which, when combined, are like a plague. I see it here so much. The effects of the twisted, adulterated version are seen in the patients lined up for clinic. Sex was designed by God to be enjoyable, and there isn’t anything wrong with it – that is unless somebody uses it incorrectly. But when used in different ways than God originally planned, mercy, does it go bad.
-She comes to sit in my office at the age of 39 and have a conversation about how her cervical cancer (the only known sexually transmitted cancer) is inoperable. Then we will talk about what “inoperable” means. It means that this is what is going to take her life. Tears fill her eyes as she asks me what she will do with the children she is raising. How will they make it without her?
-She comes to the office and talk about how she’s been trying to have children for 12 years. She has had medications, and surgery, and healing prayer services, and witchcraft. But the baby won’t come. And I’ll tell her how the tubes are scarred. She wonders why. I respond it is from a sexual infection, often many years ago. Most of the time, she didn’t even know that it was waging war inside of her, but it irreversibly damaged her tubes. Now the egg cannot make it into the place where it should sit in the uterus.
-Or she comes in with an ectopic pregnancy. I open her belly to save her life. It’s tensely filled with blood. We are giving IV fluids, but her heart has a hard time keeping up with the active loss. That scarred tube caught the pregnancy, and it grew inside there until finally the tube could stretch no more. It ruptured open, began spewing blood, and  is now endangering the mother’s life. The next morning, I tell her that we had to take out the fallopian tube. She wants to know what made the scars. I have the STD talk again.
-Or, she really hasn’t done anything. But her husband is with 3 other women. She lives in fear of HIV. But there’s nothing she can do. Why not leave? Well, because the poverty around her is swallowing her up. She doesn’t have any way to make enough to support herself and her kids. He beats her. And she doesn’t get to choose whether she will have sex since she has little power as a woman.
-Or,  one of the prostitutes who usually don’t make it to my office. She wishes she could have a better life, but can’t get out. Her family needs money. Everybody needs money. There’s no other work. So, she decides to just try to be careful. But its only gonna make $2 with a condom, and $10 without one. I mean, $10 could really help…
-And I could list a thousand others with other sexually related problems, but I'll spare you.


And you read about them and think that they are people a world away. And yes, they are. Fewer resources, less opportunity. But many of the problems are still the same in my hometown and in this new town. Sexuality is idolized all over the world it seems. Perverted, and with the safety of the protective walls of marriage taken away, it leaves physical scars, emotional scars. It was meant to be unifying between two people, freeing them to a level of vulnerability within commitment that was unparalleled. It doesn’t make marriage perfect, or easy. But it is a symbol of the commitment within relationship. How far less it is to settle for a few moments of pleasure, when so much greater was the original offer. And how devastating to find that the easier road had so many unrecognized, painful consequences. God offers more to His people. He demands more from them. And His ways are infinitely better than this world can offer. We need to work to redeem the generations coming up. They are taught by the world that sex is ultimate. But Christ is ultimate. And thankfully, He has made a wonderful place for sex, but it is not going to satisfy outside of His intention for it. 

Wednesday, November 7, 2012

Guava Mania

It was a good day at work, topped off by finishing up with patients a bit early. One of the short term volunteers had asked me to take her riding horses, so I gave her a call and said to get ready. But, why perform one task when you could multi-task. I had been wanting to go find the guava grove so I could pick fruit and make juice from it. So, that's where we headed. The people in the village laughed at me on the way up. I had my market/farming basket on my back as I rode. They think it is very funny when I use mine, though theirs all are exactly the same. Everyone along the way stated, "You are going to farm", somewhat as a question, partly a joke.

We arrived at the hill where scattered trees hold green and yellow guavas. You could see the trees shaking as we bent their boughs to lean in and grab ahold of the ripe fruit. Little by little the basket on my back filled almost to the top. Satisfied, we headed back to the horses. I tilted my body a bit to lift up to the saddle, finding a showering of guavas from my basket hitting me on the head and then rolling on the ground. Stopped to pick those up, then tried again to mount the horse a smarter way. Finally we were off. This time the people along the road didn't make fun, they all said, "You have gotten oranges!" (they couldn't tell what fruit they were, only that they were piled high in that basket, and they did look a bit like the yellow oranges they have here). I was proud of our load. It must have been 40 or 50 pounds on my back, with the little straps of my basket digging in to the crevice they had made in my shoulders. But I was thankful to not be walking while carrying the burden, at least the horse was doing most of the work.

Or I thought he was doing most of the work. But then after I got home I realized that a good portion of it was yet to come. I brought out my biggest pots and boiled the water, sliced the fruit, and waited. Then to the sieve, squashing the pulp through to keep the seeds out. Over and over again. So many guavas, so many twists of the wrist. On and on, until finally it was done. It had been dark for hours, and now, late in the night, it was time to clean up. A little while longer and I got to fall asleep, satisfied somehow by harvesting and preparing. And in the morning, how lovely to wake up and get a big glass of fresh guava juice! Mmmm, mmmm, mmmm. It was so worth all that effort.


 Only a few of the many guavas beside my market basket





Cook em up, squash em up.


Tuesday, November 6, 2012

Pigeon GYN

No, I have not begun performing aviary medicine. Pigeon english is the language that they speak here. You'd never know there was any english in it, except for when they really slow it down for you. Even then, many of the words aren't in any dictionary. So, gynecology can be a bit interesting. Here are some of the daily phrases we say. Some are only my version of pigeon, but the patients understand what I am asking or saying, so it works. Some are what my nurse translate when I ask the question.

To the one who comes for infertility, but is 46 years old:
"Yo ovary done grow old"

To the couple after I've explained the most fertile time of the month to concieve, who are now finished consulting: 
"Now yu and yo man go make pikin"

The explanation of a hysterectomy (pikin=child/children):
"We gon move yo house fo pikin"

Do you have abnormal vaginal discharge?:
"Yu done got bad water from de woman skin"

Have you been to the witch doctor/traditional healer?:
"Yo done drink country mercy?"

Have you had a period/menses?:
"Ya done see ya time fine? It de come fine?"

Have all of your prior deliveries been vaginal, or any c-sections (pikin=child/children)?:
"All yo pikin dun come tru de woman skin?"

Have you ever had a miscarriage?
"Some belly be dun spoiled?"

Have you ever had a D&C?:
"De be done wash yo belly?"

We need to do a semen analysis (pickin=child/children): 
"We be check yo man pikin water"

The ovary:
"Dat place where de egg done come from"

The cervix: 
"Dat door fo house for pikin"

You have male factor infertility, the semen analysis is abnormal:
"If dem sperms no swim, ya no get pikin"

How many wives does your husband have? (husband=master/owner - hey, I didn't come up with it):
Un a de how many fo yo masseh?

Is the relationship monogomous?:
Yo masseh got noder woman fo outside?



Uggghh!

I prepared for a c-section today. Standing, looking at the pile of green rain boots that are shared by all the staff, I cringed. I hate to put my foot down in that deep dark hole. Once I found an old, dirty sock inside. Today I found an old rag. I told the OR staff member standing in the room, "Judy, I hate to put these boots on, I imagine there are critters inside". I turned away to go in my plain shoes, but she stopped me. She said I had to wear them, that she didn't want me to get blood all on my feet, and that I knew c-sections always had plenty of blood dripping down. So, I grabbed them up and put them on. It seemed the responsible course. Those oversized boots clunked off my heels as I walked into the OR.

The case went fine, baby out, uterus back together, beginning to close the skin... and ouch! I jumped as behind  my right knee stung. I looked beneath the drape of my sterile gown to see a gigantic cockroach on my pant leg. Uggghhh! I broke sterile technique, jerked my foot out of that gross boot, and knocked the roach of my leg. It was Charleston sized, big enough to eat my toe if it wanted. Oh it was disgusting. I kicked the other boot off, considering that maybe he had a brother or cousin hiding out in there, leaving me in my socks to finish surgery.

As he ran for the door, my outburst demanded someone follow him for the kill. You can't let him get away with assaulting me like that. The circulating nurse went after him. And sure enough, when I came out after the case was safely completed, there he was flipped on his back, injured, but with legs still wiggling in the air. I left him to die a painful death. My compassion doesn't extend to roaches.

I can manage with limited suture choice, or bendable needles made in China, or power outages in the middle of a case. But I don't do cockroaches. Not on me. Who knew roaches could bite, or sting, or whatever it did to me. If my right leg gets infected and I die off over here, you'll know what started it all. Nasty little thing! I am still feeling crawly all over. I keep trying to brush away non-existent bugs as the sensations tickle my skin every few minutes. 


photo.JPG

Sunday, October 28, 2012

Recent Photos


A child, happy to offer a photo




The break room, with all of the staff asleep in it





Hiking the whole way up and feeling like you are on top of the world, until you look the other way and see more above you




That little red dot is a beautiful little girl, sneaking a peak around the corner of the house





Ready for action in the operating room!

Church

Sunday, October 21, 2012

video


This is a view from where we call half-dome. Who knows what the real name is. The last thing in the video is a view of the hospital compound, way off down in the valley.

Touching Worlds Apart

My world is small. I live life between a couple dirt roads surrounding the hospital here. Once in a while I branch out on a hiking trail, or rarely take a taxi to town (a very high risk ride). I have no TV, don't get much news. If there's a catastrophe or great event, I never knew it happened. I only know when someone emails me an update.

It makes me think of how far away worlds can be.  As the fall comes at home, I have no idea if my family is breaking out their jackets. When winter sets in, who knows if the snow comes and the children get out of school to play.

Here the rains start, and then the rains end, and then harmattan sets in. None of it usually means anything to another unless they are walking through the rain or dust on this side of the world.

That is the way it is. We are almost always consumed by whatever we see around us. Our circumstances dictate reality for us. If it is raining on us, then it is raining. No one considers that in some other place it is snowing, and in another people are bathing in the sun. That is, unless we love someone who is apart from us. Then, we wonder, "what are they doing now?", "what's the weather like there?", "are they sleeping or awake?". Our mind wanders to something beyond ourselves, to try to grasp what another's life may be. Once in a while it happens in terrible circumstances - tsunamis, earthquakes, famine, war. Our hearts are touched by the position and circumstance of others. But it is much easier to forget about all that is beyond our sight, and so we most often don't consider what is beyond our front door, or work area, or circle of friends.

But for those who follow Christ, He calls us to remember. We reach out across those miles through a God who is outside of and beyond the limitations of space and distance. He has called us to intercede on behalf of others, even those on the other side of the earth. It still can be hard to imagine, sometimes hard to know exactly what to pray. But God is always listening to the cares and pleadings of His people, and He is changing circumstance on account of the prayers of His saints. I am so thankful for those who lift me up before the Father regularly. The people who don't really understand what life is like here, or exactly what the needs are, but who keep praying anyways. I see God move on behalf of your prayers. I see better outcomes than I should have in my daily work. People who should have died walk out of the hospital alive, as if nothing was ever wrong. So, thank you for praying.

To those who don't pray much, I would ask why not. When there is Someone who is all powerful, and who  cares so much about all the things that you care about, why not ask Him to move. We are like idiots with the things we chose to pray for. You feel your stomach start churning, and begin to pray with all of your might, "Lord please help me make it to the bathroom, please let me make it, help me hold out, oh please.." We come closer to Him in our GI upset than in the actual greatest needs of our souls. He isn't expecting eloquent speeches and persuading words, He is just wanting hearts that long to know and trust Him more. His heart is already inclined toward those who seek Him.

Better Hands

Here a handshake can last forever. Offering a hand to greet is constant. Over and over and over again. It is deep in the culture. And the hand holding. So different than what I am used to. Though I have spent a good deal of time in Africa, this has never been natural for me. Walking to the market, someone grabs my hand. It would be okay if it were just for a moment, but no, they keep holding on. If it were up to me, I would pull away after a gentle touch that made sure they knew that I cared. But it's not up to me. So hand in hand we walk swinging our arms together. Men do it even more frequently. I laugh to think of what my male friends at home would do when another man slipped his hand into a firm grasp and held on tight. Young fellows in their twenties, old men with grey hair,  all with hands clasped together in friendship. It is awkward for me. When their hand tangle in mine, I always consider which way to break free - a fake cough, or pretend a sneeze is coming, or act as if I have to move my hand to shift the load I carry... There are just precious few people with whom I want to hold hands.

But His hands are wonderful to me. His hands are perfect to rest in. Perfect to hide in. They hold us up when we are weak, and guide us when the path is rough. So often we are found wringing our own hands, not realizing that He offers His. We get busy with our own lives, our own walk, our own stumbling, and forget that we can hold the hand of someone who can steady us through life. Like a toddler, we pull away to go on our own, only to land on our tush shortly thereafter. Oh to remember His presence and to slip my small hand into His large one. I want to instinctively cling to His hand, just as a small child does to the Father she adores.




The steps of a man are established by the Lord, and he delights in his way. When he falls, he will not be hurled headlong, because the Lord is the One who holds his hand. Psalm 37: 23, 24

Sunday, October 14, 2012

Poorly Fitted to be a Missionary



I’m not such a good missionary. I mean, I’ve never really fit the mold for the missionary woman. Number one, missionary women are supposed to be kind of reserved, sweet, mild ladies, and I’m not too much of that stuff. And they really do wear missionary woman dresses. I wear scrubs because it is like getting to wear pajamas out in public. I don’t have a husband, while almost every other woman is a “missionary wife” (perhaps that’s due to my constant pajama wearing in public, or some of my other similar attributes). I don’t like playing card or board games, and all the real missionaries love some of that. Who even knew that there were so many of these crazy games? They keep thinking they can teach me how to play and I’ll like it, but it holds no pleasure for me. I just go to “game night” for the snacks and fellowship. Thankfully, those missionary wives do make good snacks.

I’m not even a very good missionary doctor. I find myself often frustrated by all the stuff around me, sometimes consumed by it. I teach the general surgery residents and think, “surely I was not this hard to teach, surely not”. I try to have patience with the nursing staff, but this week one of my nurse midwives thought that preterm pregnancy was anything before 40 weeks. Huh? Every day it is something. Sometimes it feels like every moment is something. Patient care sometimes has huge mistakes and I find myself overwhelmed by waves of irritation by near misses, and often complete failures. I’m fine with seeing patients in clinic, but what about when they show up at the door of my house and I don’t know what to do with them. Today one came wanting me to do a vaginal exam. Really??? Do I need to clarify that I don’t do those at my house on Sundays? And those things are all outside of me. Inside, I find inadequacies of knowledge, skill that is lacking compared to the cases before me, and a restless spirit that gets consumed by all of the circumstances around me.

The other day I had been grumpy inside for quite some time. I realized the pattern of frequent frustration and I thought to myself, I am going to start every introduction to a new person with an apology – “I’m sorry I didn’t meet you earlier in life when I was really fun…sorry you only got to know the new me that is not really much fun at all”.  And that got me thinking about who I want to be and how I want to see life around me. I can’t fix all the knowledge deficits in myself or the staff. I can’t be the perfect doctor to every patient who comes in. I can’t know what the right thing is to do for every person who shows up at my house. But somehow I have to learn to rely on God through every success and every failure. I can see how He is glorified by success, but so often I can’t imagine that he can be gloried even by our brokenness and  mistakes.

One day last week I finally saw a glimpse of it in a tangible way. I was operating, just about to open the last layers of the belly wall, when I thought, "that looks like a big full bladder poking out at me". Hiding the frustration inside me, I asked if the patient had a catheter in. I mean, every patient, every case needs that catheter. I knew that someone had forgotten, just like they had forgotten the antibiotics until I asked just before beginning the case. I could feel the irritation rising inside me. But then I realized, had that bladder not been bulging out at me, tremendously full, I would probably have damaged it entering the abdomen. Only with it so distended could I really see how amazingly high up it was stuck to the underlying structures. Their error actually helped me. So instead of feeling my heart beat fast from yet another irritation, I thanked God for providing for me through it.
 
In 2 Corinthians it speaks of how we carry about the treasure of the gospel in “earthen vessels” so that the power will be seen to be from God and not from ourselves. He could've chosen golden vessels, or fine crystal vessels, but He chose earthen vessels so that the glory that was displayed by them would not be due to their own attributes. And in multiple places within the Word, God speaks of His people being like clay, and He like the potter molding them just as He desires. To think on it makes me wonder at the goodness of God. If I was making something and it kept having a defect in it, I would just say “well, that’s a defective clump of clay, throw it out and get another”. But God so often shows His patience and kindness to us, even when we are grumpy or irritated or imperfect in a thousand other ways. He keeps shaping and molding us, He keeps His hands on us. He is making us to be vessels that can carry great treasures. But we don’t carry our own precious cargo, we carry the greatest of worth – the gospel of Christ. Who would have thought that God would trust that to be carried by the flesh of marred men? And yet, that is how He has seen fit to make Himself known. Not through perfect, strong, wise specimens of humanity, but through the broken, weak, and weary who follow after Him. All He requires is that they be His. He is big enough to mold them into what He wants them to be from there. 

Friday, October 5, 2012

More Odd Things


I took communion for the first time this week. The church in America could learn a thing or two about the Lord’s supper from these guys. They use the equivalent to graham crackers and orange kool-aid. I felt like I wanted to keep going back through the line. It was like kindergarten snack time. I was reverent and somber until I put those things in my mouth, then I started feeling a like I was living on some more thrilling fringe of Christianity. It was just a big surprise I guess compared to choking down that dull cracker (which I do adore and always look forward to, but only because it represents the body and blood of Christ). Much more exciting taste to it than at home. I'm not sure if communion should be so thrilling. :)

My house is not far from market. It is always a bustling place. So if I am home from work, I hear somewhat annoying music blaring from the speakers there for most of the day. And then once in a while Dolly Parton comes on. Where in the world did she come from? It’s always the same song. I can’t hear the words well enough to know which one, but I know for sure it is her. Always amuses me.

Something else amusing was my patient today. I was kind of excited about getting to treat a nun. You know, it’s something about that thing on her head. That is what sets her apart. There are many of us who follow God with all of our lives (though certainly ours are different), but the rest of us don’t get to wear that. Anyhow, while treating her I was having a good rolling laugh inside. I had to give her birth control pills – not for the purpose of birth control, but for other gynecologic problems. I told her while chuckling, “You are going to have some explaining to do to the sisters at the convent as to why you are on these”. 

And the last thing I've found funny - circumcision. Three mornings a week I see them abducting the boy babies out of their mothers arms and lining them up on a stretcher. Their mothers wrap them like it is deep winter in the frigid north all the time, so they look like fat little rolled baby tortillas. They are all lined up right alongside one another. Most are crying - I would be too, had I the same parts and destined for the same purpose. They seem to know that they are in danger. I heard the nurse today gently say to one, "Stop crying baby". I told her, "You'd cry too if someone did to you what you are doing to him!" And then they were off, rolling down the hall to surgery clinic. 




The Broken


The world is full of brokenness. I see it every day in my clinic. Advanced cervical cancer again and again. It’s getting young women with children and families, older women widowed and raising grandhchildren. The cancer doesn’t care who they are. It just grows and consumes them. I’ve gotta look them in the eyes and give them “the talk”. Infertility again and again. Didn’t know that those times of pleasure then would cause them so much pain now. But sexual diseases have scarred the tubes shut and I can’t fix them. I can’t give them a baby. I’ve gotta look her in the eyes too, and give her “the talk”. Mothers, or women who want to be mothers, pregnant so many times, but lost them all. Stillborn twice, three died within a week of birth, the only one that lived died at age of five. I’ve gotta look her in the eyes, and here comes “the talk”. It varies a bit to fit the need of the moment, but the beginning of the talk is always starting from the same point – hopelessness. And the end of it is leading to something that often seems out of grasp – hope. Maybe circumstances haven’t led you to that point of having been drained of expectation of any good, or of any joy. But they likely will. So let me tell you the introduction for what you are going to need to know on that day. Maybe you can remember and reflect. I don’t know why bad things happen like this. I mean, theologically, I do know. But sometimes you just can’t make sense of it. This is a hard day. You are hearing hard things. And it seems like there is no hope left. But I want to tell you that on the very best days and on the very worst days, there is hope. There is a God who can be trusted no matter what the circumstance is. He is able to be trusted with the circumstances of this world, and with all that is to come when this life is over. He sent His Son down to show us who He is, and to bring hope to the desperate. He Himself lived a life of sorrow, and He can comfort you in your sorrow. You need to understand who Christ is, He is the only hope…

Really, that is the most important conversation that I have. And sometimes it feels so helpless, like you wish you could do something more, but you can’t. Ultimately we all need a bigger, better hope than this limited world has to offer. Life is going to let us down. It’s going to ask us for more than we want to give, take more than we ever would have allowed, and sometimes pour on more than we can bear. But there’s something better to come. Where brokenness is made whole, healing is complete, joy comes without sorrow, and life does not end in death. In fact, life there does not end at all. There we will see for the first time since generations and generations ago, what creation looks like without the mar of sin. The worries of this life will be but distant memories, wisps too small to be remembered in light of the One who will satisfy and sustain us in full. Let every broken moment make us long and yearn for that day. 

The clucking box









I’m officially a chicken farmer. Just got my chicken house finished up at the carpentry workshop. All the Africans chuckled to watch me walking down the road with a loud, big, fluttering cardboard box full of feathered friends. Well, I guess they are friends, at least for a while. I’ve named them – Breakfast, Lunch, Dinner, Snacky, Noodle Soup, Carolina BBQ Chick, Tender Clucker, Finger-lickin Chicken, Roasty Toasty, and Kentucky Fried. There are some problems, like that fact that I don’t really know much about chickens. I mean, our family had chickens when I was growing up, but I don’t remember any of the important stuff. I do remember that chicken coop smelled so bad. It was eerie and dark. Sometimes snakes would get in and eat the eggs. I hated having to shoo those chickens away to collect the eggs, they would try to peck at me as I did it. But here there aren’t many snakes, and I put the chickens somewhat far away so I can’t smell them. They are for meat, so won’t be around long enough to make eggs. Plus, they are going to serve multiple purposes. Chicken poop is supposed to be awesome fertilizer, so my garden is about to be amazing. And they are going to eat all my leftover vegetable scraps so I have less trash to throw away. The more I think of this, it is a great idea! Actually, I initially decided to get the chickens because I am cheap. Anyone who knows me would say that. My sister prefers the term “tightwad”. I’m not cheap toward others, just myself. I don’t waste money. So, when I wanted a chicken and it was going to cost over $10, I said, “heck no, I’ll raise my own darn chickens!”. And so, that’s where it started. Within an hour or so I had found someone to make my chicken house. And now they are all snuggled up together holding out until morning when I will feed them again. 

Saturday, September 29, 2012

Synopsis of a day

Today I rounded early, then went to the OR for a couple of cases lasting until almost lunch. Then Moumadou called to see if I wanted to go ride horses. I had a bunch of other things to do, but I went anyways. Moumadou is an 18 year old boy who keeps the horses around the hospital. His age is given away by the way he rides. I'll be running through the dirt and mud, and here he comes passing me by like a flash of lightning. Doesn't matter to him if its uphill or down, slippery or rocky, he is always wanting to go fast. Since he is usually a bit faster than me, and thus ahead of me, it leaves me splattered with dirt and mud from the top of my head the whole way down. It's okay though, I've always enjoyed dirt and mud. We went to a Fulani (a people group who mostly are associated with raising cattle) compound way up on a mountain. We went to greet and they invited us in. They always are kind to me, I think they are amused that I am a woman who can ride a horse. We were in a little square house with a smaller house on each side. We sat in the man's house, and each of the other houses was for one of his wives. They brought tea with milk from their cows, yams, and bread. I sat with the men and took the tea in a circle on the floor. They were so gracious and kind. It reminded me of so long ago when I spent time in Africa. That was the way that we took every meal, from the same plate sitting on hard dirt. Of course back then I didn't get to sit with the men. And in that culture we all had to drink from the same bowl. Being a girl and young put me right at the bottom of the totem pole, and having to drink from the bowl after everyone else had already drunk and left their spittle. Ugghh. Getting older has some perks. Thankfully they don't do that here. We visited probably too long, because the rains then began coming heavily. They offered for us to stay, but we moved along. So off we went into the mud back toward the hospital. It was the best mud splattering thus far on my clothes. I was really glad to get to go meet with that family. It was a bright spot in the day. The Fulani have always caught my attention. They often live far out from everyone else so that they can raise their cattle. Almost all of the are Muslim. They are often not concerned about education, so many do not send their children to school. It is neat to see how easy it seems to connect with them in spite of being worlds apart in many ways. Like I said, they're always impressed by a white woman who can ride, so that gives me a foot up I suppose. Who would have thought that God would use something like that to start relationships. I don't know what will come, but I love meeting them and getting to know them. I hope that I will be able to continue to build relationships, eventually connecting regarding eternal things. But for now, I guess horses will have to do.

Well after we got back, maternity immediately called. Back to the OR. And then to labor and delivery, again. Then finally back home. A patient at the hospital followed me home. That is always a bit sketchy. She wanted something, seemed like she was trying to get money to put minutes on her phone so she could call her family. I told her where to go at the hospital to get help. I was tired of being chased down by everyone at the hospital and just wanted time alone. People are always trying to get me to see just one more. Nurses always calling me to come see someone else. It wasn't that sending her away was wrong, but the spirit in which I sent her was one of not wanting to be bothered. As soon as she left I began thinking of how Jesus never was really bothered by people. Maybe He was tired, but He kept ministering to others. I then thought of how the Word talks of kindness to others, and how it states that sometimes people have even entertained angels without knowing it. I hoped she hadn't been one. Seems worse to turn away an angel than a person. Of course, that is exactly the point. I wished I had just let her use my phone. Not because I was truly changed into a giving heart, but so I didn't have to think of it anymore. I've been running her through my mind ever since. And yet I really am tired. It's been 5 weeks I think without a real day off from the hospital. I've had hours here and there, but not an actual day off.  How did Christ make his eyes see the eternal value of each person in the midst of the frustrations and weariness caused by desperate crowds and endless work?

Thursday, September 27, 2012

Patients this week


I diagnosed my first case of meningitis in a pregnant patient this week. It was kind of obvious by her symptoms, but still I was happy that I knew what it was. As for what to do about it, I read that line by line out of a book to make sure I didn’t get anything wrong. I stuck a needle into her spinal column to get some fluid immediately to confirm the diagnosis. I was proud of myself for remembering how to do that. It wasn’t hard, but I don’t think I had done it since medical school. So, now she is lying in a little room by herself getting antibiotics for a week. She is far from better, but so many die from this by now. I think (and hope) that we got to her in time.

 I opened up another patient’s belly who had undergone a cesarean section a little time back. She was full of pus all in her abdomen. I’d never seen such after a C-section. I was so angry at the medical decisions that put her in this position. I was on fire inside at so many management errors that were made during her hospital course. But I went by this morning to see her and she had her new baby at her breast, resting in bed. Now, she’s not recovered yet, she still has pus draining out of the tube coming from her side, but when I saw her I stopped being consumed so much by anger. I began having hope for her healing and joy at the life she does have.
 
I have a patient with HIV and tuberculosis on whom I recently delivered a baby emergently. She was so sick and had to be delivered in order to get the treatment that she needed for her disease. She was so sick that I had to do her cesarean section with her sitting up and with local anesthesia to help numb the surgical site because she couldn't have the usual type. The study I got on her heart had less than half of the work-ability that it should have had. She was gasping on admission, and had been ever since. Mothers in the US die from what she has going on in her heart, they have heart transplants and such due to it. Plus, then you add on AIDS and very active tuberculosis, and medically there’s just not much hope. But this morning I walked in to check on her and there she was, lying flat on her back (she has been unable to sleep for days due to difficulty catching her breath unless she is sitting upright), sleeping soundly. She still was breathing a bit fast, but she looked so peaceful and, well, I’m not sure how to describe it, better. Just last night I had given her a little card with a couple verses from Psalm 73 written on it-
Whom have I in heaven but You? And besides You, I desire nothing on earth.
My flesh and my heart may fail, But God is the strength of my heart and my portion forever.
I don’t know if she will even make it. She looks better for the moment, though the road ahead is likely a hard one. But I loved to see her resting there this morning. And I loved to see her smile when I awakened her, not smothering any more. Indeed, for her and for each of who follow after Him, our bodies and hearts may let us down, but God is our strength and forever our portion. 

Sunday, September 23, 2012

Oddities


The funny things that are so different are scattered randomly through life here. Like, I helped push a patient from one ward to another the other day, and there were so many hills. My burning thighs felt like I was doing a massive exercise routine. Up one hill like huffing and puffing, and then down another holding the stretcher back. I wondered how far would it go if one of those stretchers got loose from the person who was supposed to be driving it during the downhill slopes? In US hospitals there are no slopes. Maybe a little bump or a slight little ramp, but elevators do all the hill climbing. Here, people do all the climbing. 

Another thing – we officially ran out of disposable surgical masks a week ago. So we went back to the MASH type green cloth ones. Everything takes a long time to dry here because it rains every day. They don’t have dryers, etc. The masks often have a funky mildew odor to them. So, this morning I went to go get one and there weren’t any in the bin. So sweet little spunky Judy, the circulating nurse, took me to show me where to find them. She then walked away with it. I followed and asked what she was doing. “Ironing it”, she said. Well, I don’t iron even for special occasions, so I didn’t get it. Ironing is just not one of my gifts. J  So I asked why. She said “Cause its wet. And to kill some bacterias”. I thought, “You just go ahead and iron it all you want then, kill all those bacterias”. I turned around and laughed as I walked off.  She ironed that mask for what must have been 5 minutes. I bet it was sterile, though still damp.

And then, there is death. Death usually isn’t funny. But this morning after rounds I walked past a taxi that was just getting ready to pull off down the road. “Taxi” doesn’t mean the same thing here that you may be used to. It means a 1970 or 1980 compact car that somehow got shipped over here to live out its final days. It also indicates enormous levels of pollution from the thick black smoke trailing behind the car. Anyhow, this little tiny blue Toyota hatchback had a well-made wooden coffin tied in under the hatch. About 2/3 of it was hanging out the back, with the back door tied onto the top of it. Well, unless that person was shoved down there wadded up at the bottom, it was way top-heavy out the back. Plus the whole car was bogged down with the load (in addition to the 6 people inside with their own loads). One little bump and that poor fellow hanging out the back was a goner. I guess he was already gone, but the thought of it just got me tickled on the walk home. I rushed to get my camera to take a discrete picture, but someone stopped me along the way, making me miss an awesome photo. I don’t care who you are, how holy, or serious, or sensitive, or whatever, you would have thought it was funny too. 

Wednesday, September 19, 2012

Tuberculosis Ward Lessons


Had to go to TB ward today and see a patient. This one was really sick. And the room was little and cramped with no real ventilation. It already made me feel claustrophobic, and then since she was a super sick immunocompromised TB patient, I started to concentrate on my breathing the whole time and it made me feel like I might pass out. We don’t have special respirator masks here. Actually we are out of all masks except the cloth ones we use in the OR. Anyhow, I didn’t have a mask on. So, it probably doesn’t make any sense, but I thought to myself that if I just breathed shallowly maybe the TB would just get in my nostrils or the very top of my upper respiratory tract and then be able to be blown out when I got back outside. Well, at least that thought gave me some comfort while I was in the room, even though it is pretty dumb. So there she was breathing about 60 times per minute, and since I was trying to breathe really shallowly I was probably just beneath her rate. I was praying the whole time, “Lord please don’t let my TB test convert to positive”. As I left that hazy dark room and came out into the light, I realized how weird my perspective had just been. I laughed at how consumed I had been by my breathing, like I was in a modified lamaze class or something. And I remembered how going where God has called us takes us often to very uncomfortable places. I regained perspective that He had called me to go in there and care for that poor woman. I was overtaken for a moment by thoughts related to my own mortality, but ultimately He has already numbered all of my days. I don’t want to be foolish and risk unnecessary exposures, etc. I am not advocating that. And yet, I am glad that God doesn’t sit up in heaven consumed by what we are consumed by. What a small and useless God would He be if He were looking down, biting his fingernails, wondering if I would get TB, not knowing what to do if I did. But that isn’t our God. He is not consumed by these facts, indeed He is consuming. He is bigger, fiercer, stronger, more dangerous, more passionate, more loving, more full of kindness than anything that we can imagine. And when circumstances are beyond our understanding and we fear that they have gone beyond His control, we remember that He is sovereign and able to be trusted even then. So of course He can be trusted in the TB ward. Stop breathing funny, thinking you can keep those particles in your nostrils, silly child.