Wednesday, December 4, 2013

Thankfulness, an attitude of the heart

December 4, 2013

My joyous rafiki (friend) named Anto
Happy Post-Thanksgiving from the Congo!   The theme of this post will be ‘thankfulness.’

Do you ever struggle to see the bright side of a situation, especially when you see a lot of suffering?  I know I do.  Sometimes I think being thankful is a choice.  Every day is a gift from God.  Simply having breath is no guarantee.  This past Sunday I started to see the Genesis account of creation of the world with new eyes.  Everyday that there is light in the morning, there will be new growth on the earth to give us food.  God also created water to fill the earth, filling our cup.  It is with this same water that keeps us clean and therefore healthy.  This water feeds the earth and the plants therein.
 Let us not forget the
My other little "rafiki" who greets me on the way to church
animals that walk the earth, birds that fill the sky, and fish that swim the seas (including our fuzzy, fun-loving African grey parrots).  Perhaps the greatest gift of all is that of each other, our abundant family and friends.  We are extremely blessed.  No matter the circumstances, or suffering there is something to give thanks for.  I have more of a keen awareness of how precious life really is (and so fragile) since coming to Congo.  When I see someone going through suffering/trials, I try to say ‘thank you God’ for this precious person made in your image.  A joyful heart is good medicine. 

Cultural Things
Indeed, it was National Cicadia Day in Congo last Friday.  Who knew?  Kids were excused from classes and scoured the surrounded hillsides looking for bugs.  It was absolutely a show!  I came home for lunch only to find a few hundred kids hooting and hollering on the hill by our house, scurrying around lighting fires in the tall grass.  Apparently, fire gets the cicadas out of hiding.  It was pure chaos and felt a bit dangerous!  Maybe this is equivalent to our snow days in America!  There were no injuries that we were aware of.

It is also the beginning of dry season here in Congo.  This means that everyone (not only the kids) is burning the fields in preparation for the next growing season.  It is a little unnerving to be out on a hike and come across a spontaneous fire with no one around, or to hear the cracking of fire all night long through our open windows.

Did you know that bathtubs are useful for more than bathing?  Here in Congo bathtubs are also useful for cooking.  Foo-foo is a staple food made from manioc flour.  Manioc (otherwise known as cassava) is a food that really fills your stomach, but is not so rich in nutritional value.  I was walking home the other day when I encountered a group of girls carrying a bathtub in which they would cook foo-foo over a 3-day period.   Who knew?

Burning the hillsides in preparation for the next growing season

Home in Wisconsin
I (Lindsey) had the privilege this past month of traveling back to Wisconsin to be in my dear friends’ wedding, Josh and Kristine Hoiland.  It was such an honor to be part of seeing two friends make these promises to one another before God and man.  I had the real sense of heaven rejoicing with them, almost transcending the moment.  A foretaste of heaven perhaps?  It was so clear that God had brought these two together and had designed this day.  I look forward to seeing what they will be doing in 5 years.  My trip back to the US was quite short, taking advantage of frequent flyer miles.  Still it was great to spend time with my family, visit with my grandma, see my friends’ expecting babies, shop at Target, buy new sheets.  I carried back to Congo lot of fun toys for Warren …even a couple of small Christmas trees and curtain rods.  You would be surprised how difficult it is to find curtain rods…you end up making them out of rebar around here.  Rebar isn’t quite as elegant.

Hospital Work
These last few weeks have been difficult at the hospital.  We continue to receive more and more
patients for care and surgical consultation.  They are coming from farther and father away and are quite sick.  We recently received a woman from Chad!  Pediatrics has seen the passing of so many lives from malnutrition and other causes…I would rather not say how many.  Suffice it to say that we the degree of malnutrition is on the level of a crisis by world standards.  We have supplemental milk (F75), the means to resuscitate, give blood transfusions, etc.  Sometimes it is just too late to go back and the energy deficit is just too great.  I have never seen anything like this.  If there is one area of medicine here I feel most passionate about, it is nutrition and all the medical sequelae.  Pray for our work and us.  Pray for the Congo.  Pray for the broken families.  Pray for Godly leadership of families.  Pray for hope and spiritual awakening.  Pray for people to work the land.  Pray for people to know Jesus.

We look forward to a few physician friends who plan to visit soon, including an orthopedist.  There are so many opportunities for teaching and for specialty surgeries.  Warren is currently studying up on how to perform a total laryngectomy for a man with cancer of the larynx.  More and more complicated cases are coming.  Currently there is a professor of internal medicine from Kinshasa with his entourage of physicians.  “Nyankunde village” is becoming more and more known for the work that is going on here. 

I have been caring for a very special girl named Anifa on and off for the past 6-months.  She has a
Anifa watching Barney& Friends on an iphone
skin condition called Pemphigus Vulgaris which has required strong doses of steroids, an antibiotic called Dapsone (usually used for leprosy), and special steroid creams.  She has basically moved to our village for medical treatment, as it is very difficult to follow a home regimen.  It is my hope to get her off steroids eventually, but so many of the medications that are typically used to control this condition are not available here.  I also have been caring for a young boy with a cyanotic heart condition which would require a curative surgery.  I have been learning how to do echocardiograms.  We are hoping he can been evaluated by cardiologists in Uganda in February.  He is a very special young boy and reminds me of Anifa, in that he also lives with a serious disease.

Thank you to all of you that have contributed to the hospital mattress project.  We were able to purchase 150 new mattresses for the hospital that are sorely needed.  We don’t currently have 150 beds, but anticipate that they will be needed eventually.  I will post photos soon.

Other things
Our days here are full of visitors, cooking, shopping in the market playing with Peterson, our dog, being
Julia, visitor from the UK buying an escabo (local chair)
entertained by our parrots, gardening, local friends…Warren is always adapting something around the house to be more functional or fun.  I (Lindsey) am making new duvet covers for the beds and decorating for Christmas.  Warren recently overhauled a fancy ice-cream maker, so now we are living large and making ice cream and passion fruit sorbet.  We plan to try out coffee ice cream soon.  We are roasting our own coffee and making our own peanut butter.  I can honestly say that I know where all my food comes from.  Life is full and quite fulfilling.  
Any guesses on how many kilos Peterson weighs?
Chaco trying to steal from the horse's mouth

We need your prayers for our work here.  We are becoming quite well known for our medical work.  Pray that even before our medical care, that Nyankunde would be a place where Jesus lives, heals, and walks with people in suffering.  Pray that the staff would be known by their love.  Pray that we would not be discouraged as we witness the passing of many lives. 

Thank you for loving us and your interest in our lives.

Lindsey and Warren

A packed market

Buying local

Monday, October 21, 2013

October: A few more pictures from our vacation to Uganda and everyday life

October 20, 2013
It is October.  A time of leaves changing color, apple cider, hay rides, carving pumpkins.  Here we are in the jungles of eastern Uganda.  Here a walk in the forest (something I love to do), is a less pleasant experience that involves trudging through knee-high mud at times, tall grass, and prickly plants with the hopes of seeing a horned chameleon or a chimpanzee (if you're lucky).  We had a great time and necessary diversion.  We spent our time between Rwenzori National Park, Queen Elizabeth National Park, and Kampala for some necessary errands.

The Rwenzori mountains, "mountains of the moon" in eastern Uganda
A 7-day hike round-trip, up and down glaciers...maybe next time!

Our campsite overlooking the high peaks of the Rwenzoris

Thick jungle, pre-alpine

A serious hike, about a 1000m ascent

The horned chameleon
A bridge over glacial waters from the Rwenzoris
The roads of eastern DRC

Glacial waters

Buying 50kg of local coffee beans in the Rwenzoris...
this is farming cooperative for fair pricing and representation of farmers.
They don't normally sell to locals (or white folks).

                                                                                                      Buying local charcoal

This really is a beautiful part of the world.   I am so thankful to have this opportunity to explore it!
Thanks for your interest in our lives.
Blessings of Jesus from our house to yours,

Lindsey and Warren

It is nice to be back in Nyankunde again!

Friday, October 11, 2013

Nyankunde to Kampala

We made it. We are in Kampala, Uganda!  Getting here by road was an adventure. It is pretty much a given that driving anywhere in Africa will be an adventure. Some of the highlights have been the following. 

1.  On the way out, I stopped by the OR to pick up my wedding ring. I take it off for surgery and sometimes I just forget it for a few days. Lindsey wanted to make sure that no one would take me for an eligible young bachelor.  Closing the door behind me, I wondered if the place would survive without me. Guess what?  Places always survive without us.  Sometimes our absence can even be a positive thing, as everyone realizes how much they need us. 
2. On the road to Beni, we enjoyed immensely the 30 km or so of paved road in Eastern Congo.  It seems like a miracle!  Anything was possible!  From Beni to Kasindi, the paved road is only a distant memory.  Replacing it is the jarring, bone-crunching experience that we have come to know and love.  Nope, we're still in Congo.
3.  We passed through Virunga park, home to gorillas and guerrillas alike.  Both remained elusive.  We saw only the great walls of vegetation that comprise the rain forest. 
4.  At Kasindi, the border crossing, we experienced a momentary panic.  Did we have all the necessary papers to cross in a vehicle?  There was some debate on the matter, but we emerged victorious into Uganda!
5.  ...only to find that we entered too late and the man who was to process our papers was in a surly mood.  He eventually hustled us out of his office.  We discovered soon afterwards that we were unable to leave the police barrier without a letter from said individual. Much discussion ensued, including assurances that someone "under the mango tree" might be able to help.  Much apologizing and shmoozing and a few shillings for "tea" we emerged with the necessary paper.
6.  Lindsey had made arrangements for a stay in a lodge near the Rwenzori mountains, but it was too late to make it.  I made an executive decision and we stayed the night at the "Hard Rock Hotel" in Bwera.  It is my practice to conscientously avoid any establishment with "Hard Rock" in any part of its name, but there didn't seem to be many other options.  It actually wasn't too bad. We had the standard village chicken and fries and were lulled to sleep by the thumping of "club music" in the adjacent bar.  
7.  The next morning we drove back to the border and after a mere two hours waiting, we got our papers. Lindsey made friends with a woman begging for alms whose strategy seemed to be trying to embarrass us into giving money. She made a variety of funny faces, took off her ring and offered it to us (not necessary, see 1.) and even stretched herself out of the floor and stared at us.  
8.  We made it to the Ruboni Community Camp ("Where all the profits go back to the community!"), took a long nap and a late walk.  We celebrated our combined Birthday at the Equator Snow Lodge.  It was a bit eery as we were the only guests.  Me:  "Guess what?  I didn't get you a birthday gift."  Lindsey: "Me neither."  Lindsey is getting older and wiser, by the way.  I'm staying as immature as ever.
9.  The next day we did the "Hill Walk" with overnight camping.  It sounds pretty innocuous, but as it turns out, it was a brutal uphill climb of some very difficult terrain and it about did me in.  There are some spectacular views of the Rwenzori Mountains.  We didn't actually see them for the heavy fog, but they're out there!  It was actually very beautiful.  We pitched a tent at the top and enjoyed a relaxing night under the constant heavy rain.  We awoke in a large swarm of ants, and enjoyed a breakfast of white bread soaked in rainwater.  On the way down we combined the trek with the "Forest Walk". Again, it sounds innocuous, but the word "forest" really means mud, swamp, rotting vegetation and the crossing of treacherous streams.  Still, it was all great fun and we survived somehow.  
10.  That evening we made a pilgrimage to buy coffee.  We've had a hard time finding decent coffee in DRC and the stuff seemed to be growing everywhere.  After a couple of dead ends we found ourselves in a sort of warehouse with large sacks of coffee beans.  I examined the beans, sniffing their aroma and chewing on them.  I tried to appear to be a connoisseur and very knowledgable about the going price for bulk coffee. After some brief haggling, we bought 50 kilos of the stuff. I really hope it's good because we're going to be drinking it for a long time!
11.  The following day we "did" Queen Elizabeth National Park.  I'm not a big safari guy.  Mostly it just seems like a lot of driving around.  All the animals can be easily seen at the zoo, and you don't have to chase them around to find them.  Still it was very beautiful and a wonderful time was had by all.  
12.  We left the park and I decided (probably foolishly) that we should make a run for Fort Portal ( or Port Fortal, as I like to call it) where we would spend the night. The combination of windy roads, rain, poor visibility, potholes, motorcycles and pedestrians with varying level of death-wish, made for a more potent adventure.  We arrived somehow and Lindsey deftly maneuvered us to a decent hotel, where we enjoyed a good meal and a nice night.  I probably would have found the nearest "Hard Rock Hotel" but sometimes women know better.  
13.  The road to Kampala was not bad.  Lindsey is a wonderful navigator, but she does have a panic response that is characterized by a quick intake of breath.  I have encouraged her to try to distinguish between interesting sights (such as three men and a full-sized pig on a motorcycle) and bona-fide threats to our life (such as a huge truck barreling down on us in the only remaining lane).  Kampala itself, is another story!  I feel like I'm taking our lives in my hands every time we venture out.  After a brief and harrowing experience this evening, we made the decision to only venture out in the light of day.  My night vision is terrible.  Also, a Toyota Landcruiser has a wide turning radius and fairly sluggish acceleration.  Still, we made it and we're glad to be here.

We'll be here for a couple of days.  We have some repair work to be done on the vehicle.  We need to do some shopping and to buy some medicines for the hospital. Also, Lindsey needs to swim in a pool. We both need to be somewhere away from a hospital for a few days.  It is nice to be in a big city, but I'd much rather be in Nyankunde. Stay tuned!  More adventures on the way back.

Pictures to follow soon.


Friday, September 20, 2013

Everyday life at Nyankunde

September 20. 2013

This month I thought I would post pictures from everyday life.  Sometimes I forget that even this can be interesting to people.  Where do we live?  What do we eat?  What do the streets look like?  What do we enjoy doing in the evenings? 

So….we got a second African grey parrot.  He kept repeating the word “chacu,” so we decided that this was his name.  He is quite young and scrappy.  He jumps off his perch and mimics lots of birds he hears.  He likes to try anything you might be eating (loves beans and passion fruit sorbet) and even nestles under Warren’s chin.  He even like his head scratched.  Who knew that birds could be so personable?  Our first parrot Bubu is socializing more now that she has a comrade.

I love colorful African fabric prints.  Someone told me that it is rare to see straight, symmetric designs and more common to see complex, natural themes.  Within the designs are often flowers, vines, trees, water, and fruit.  Some of the designs are rather abstract.  Here is a taste of some of the designs I have seen recently.

We live in a beautiful, renovated house up the hill from the hospital.  It’s about 1/4mile walk to the hospital which also means a 1/4mile home uphill.  So just making a couple of trips everyday is a workout.  As I walked to the hospital today I stopped to pet two baby goats born last night, sunning themselves on the road.  Our water comes from a fresh water source off the mountain in back of our house.  The water undergoes an underground purification process in a series of aquifers before it arrives to our tap (designed by Swiss engineers back in the old days).
Series of aquifers at the top of the hill behind our house

Do you see our TV?

Our 9-foot long dining table

Peterson trying to come in the house

Most people do not have running water in their homes.  Most carry it from water sources set up throughout the neighborhood surrounding the hospital.  The water has been tested and shown to be good to drink-we still filter especially after hard rains.  We have a solar water heater for showering and exist almost solely off solar power. 

Solar water heater and my favorite crazy Congolese flowerI (Lindsey) even have an outdoor bathtub Warren installed for me off the garden which is wonderful on warm evenings.

Farming is a way of life in Nyankunde, yet it is a lot of work.  For many Congolese this requires hiking long distances with heavy loads on their heads, hiking up steep inclines, and terrace farming.  It is not for the faint of heart.  We have a new appreciation for how people live off what they are able to grow.  This is actually really hard to do!  We have a large garden and we have not managed to come close to doing this! We have a gardener named Soborabo who helps us cultivate the basics to put vegetables on the table every night.

I cook entirely from scratch and am continually learning new twists on things.  Eggplant curry, coconut rice, chiapatis, chili with local beans, fried plantain…etc.  Now I realized how so much of the food I was accustomed to in the US was highly processed and maybe not the healthiest.  Eating out is really a rare occasion, but we try to organize ourselves to have pizza on Saturdays and do something special.  We really do live in a “petite village.”  I wouldn’t trade our village life for city life for anything (even if there was fast food)!  We have an outdoor charcoal oven (which Warren designed) that we are trying to use more and more for baking bread and pizza.  Most Congolese are not accustomed to baking, as they are more used to eating foo-foo (manioc) and rice.  The nurses at the hospital love my banana bread as it really is novel.

Many evenings Warren and I walk or run with our dog Peterson on the nearby airstrip.  It is really quite
pleasant.  We have a chance to catch up on the day’s events are process through things together.  I am very thankful for Warren and the opportunity to work together.  When Peterson comes running it is like the parting of the Red Sea, as people scatter in either direction.  People find it amusing to watch us running with our dog and are quite intimidated by her size.  We have the airstrip mostly to ourselves!

Life is full and exciting most days, also fairly routine.  Wow, did I manage to write an update without any talk of m*d*c*n*?  Speaking of this, Warren and I are headed to Uganda in the next couple of weeks for some necessary down time and acquisition of supplies.

Thank you for your interest in our lives.  We need your prayers and look forward to hearing from you!

Thursday, September 5, 2013

Already 8 months in DRC!

September 5, 2013
Warren and I dressed up for a wedding in front of our house.
(notice the upside-downlamp fixture in the background?) 

It is my turn to write a blog update of recent events.  It is hard to believe we have been here already 8 months!  It is amazing how a place so different than anything you have ever experienced becomes home.  I wake up to the sounds of the red-eyed dove and sights of ancient green volcanic hills.  I then sit down to drink a cup of home-roasted coffee and homemade bread covered hand-churned peanut-butter….maybe even some local passion fruit juice.  Wearing my qiquembe (wrap skirt), I walk to the hospital with a bag of our very own avocados in hand for the kids in the hospital.  I start the morning in the ICU and ER to see the new admissions and sick kids and then continue onto the pediatric wards to see the nutrition cases.  At any given time 25-50% of our hospital cases are in the supplemental re-feeding program.  My eyes are becoming skilled at picking out subtle signs of nutritional deficiencies.  One common theme is that the malnourished children take MUCH LONGER to recover from any illness and illness unmasks their deficiencies.  I continue to learn a lot.

On Doctoring
In memory of Sammy
I feel that I have become a better doctor since coming here…and hopefully grown in compassion.  I have seen so many conditions for the first-time.  I am the dermatologist who has learned to distinguish various bullous lesions.  I am the cardiologist who gets to diagnose atrial/ventricular septal defects for the first-time with cardiac echo.  I am the neurologist who tells a family their child has muscular dystrophy or has had a stroke.  I am the neonatologist baffled over how a newborn can be born with severe meningitis or tetanus.  I have been truly enriched to have the opportunity to see and manage these children’s medical conditions.  It really is fun (most of the time)!

These last couple of months Warren has reminded me several times that I work in a developing world hospital and that it is not easy.  We have had some major problems with having essential medications and sometimes you have to wait for several days for the medication needed.  It is hard to see a boy that you have spent so much time managing his heart failure (over weeks) return to the hospital in a worsened state due to inability of the family to buy medications.  My response is, if I had only known we could have come up with a solution.  The reality is that this boy will live with his weak heart for the rest of his life and require these medications.  How do I maintain accessibility to medications?  Do I need to make home visits? How long should I keep another child with HIV before transferring to another facility where ARVs are available? 

There are a lot of things beyond my control.  Sometimes I see a child in clinic and see clearly that they have lymphoma/leukemia and have to tell them how serious this is.  I am not able to confirm the diagnosis, but I have a good idea what it is.  I refer them to Kampala, our closest specialty/advanced care facility.  Sometimes discouragement gets the best of me.  I diagnose a child with an advanced heart condition on echocardiogram with no means of surgery in the country.  I can give advice for her to live as long as she can, but I am limited.  There are a limited number of things that I can do something about.  Sometimes it is hard to practice medicine in a way that I feel good about when essential medications are lacking.  How do I deal with disappointment and discouragement in a healthy way?  Am I talking to Jesus about these things?  It is too much for me.  He has to help me in my weakness, assure me that He is sovereign over it all.  I am learning to accept that even giving someone a diagnosis is a gift and prevents them from searching everywhere for answers.  At times I can really relate to Paul yearning for something more, redemption of the body. 
“For the creation was subjected to frustration…in hope that the creation itself will be liberated from its bondage to decay and brought into the glorious freedom of the children of God.  We know that the whole creation has been groaning as in the pains of childbirth right up to the present time.  Not only so, but we ourselves, who have the firstfruits of the Spirit, groan inwardly as we wait eagerly for our adoption as sons, the redemption of our bodies. For in this hope we are saved.”  (Romans 8:23-24)

Free Time
Taming Bubu is not as easy as it looks!  

Warren and I are learning more about the balance between work and life, the importance of taking time off.  I am thankful that we live in such a pretty place and not behind tall walls and barbed wire of a city.  Hiking, watching the sunset, growing our own food, picking fresh guavas/avocados/mangoes from the trees surrounding us, and running anywhere with the dog are regular activities.  We go the market and cook up a storm on Saturdays and freeze homemade pizzas for the rest of the weekend.  We don’t have to cook on Sunday, so it really is a day to rest.  Then there is the occasional motorcycle ride.   My Swahili is improving slowly, such that I can say for example…”I’m amazed, so much rain is coming!”  People smile and wave.  I probably still say a lot of silly things. Ndege, ndizi, ndazi, ngazi all sound very alike to me.  As do many other words!

We are looking forward to exploring more the DRC.  About 35km from us are a series of famous caverns and waterfalls called Mt Hoyo.  We are waiting for more stability and accessibility in the area to visit this beautiful place.  Hopefully we will have a chance to see the gorillas soon too.  Pray for this country which has experienced so much war and instability…brokenness is even reflected in the natural world.  I know that God has a plan for the DRC-it must be one of the prettiest places on earth.  Have you ever thought about what the new creation will look like?  How will the world be redeemed?  I look forward to this as well.

Lindsey and Peterson on Nyankunde mountain
Warren continues his efforts to train our bird Bubu to stand on his arm.  She has been a tough bird to crack...and he is very persistent.  She is very beautiful.  We'll figure her out yet.  I am hoping to start some house plants she can climb.  Our dog Peterson continues to grow by leaps and bounds!  Most recently she has been jumping over the mop or an extended arm for fish.  She pretty much terrifies everyone who crosses paths with her, unless they know her and how she wants to befriend everyone.  We are hoping to take a short holiday to Uganda in early October to celebrate our birthdays...maybe watch some elephants.

Congolese Culture
Each day is an adventure.  Here are a few of my questions this past week.
-What does it mean when someone says they will go the market today and bring cabbage back for you?  Does this mean they will really bring it back today or tomorrow? 
-When someone says they will come over at 2pm, how long should you wait for them? 
-Does our friend Victor really want to sell us a crocodile? 
-When asked to be a witness in a wedding, what exactly does this mean?
-What is in traditional remedies?
-Why do women laugh when I seem baffled over the many types of bananas?

On Cooking
This Saturday I have invited the pediatric nurses over to our house to learn how to make banana bread in our traditional oven.  Outdoor ovens are a bit of a rarity here, as is baking bread.  Have you ever thought about why some cultures eat chiapatis or tortillas?  It is usually a bread substitute, made over a hot stone or skillet over a flame.  I will keep you updated on how the nurses enjoy bread-making.…I have a feeling this will become a bit of a tradition!

Thanks for your interest in our lives!  Drop a line.  Stay in touch.  Come out and visit!
May the Lord bless and keep you close to Him,

Our friend Lisa frothing milk "Warren style"