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"


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  4. Here's an important Swahili phrase for you to remember "chai na mandazi"! During my stint in Kenya, this little snack always lifted my spirits! Yeah, I gained 10 lbs after spending 6 weeks in Kenya. Anyone hear of DIET soda, hello!

    Thanks for your blog post - always helps to bring me back down to earth. You and Warren are truly doing God's work there in the Congo. I pray for you whenever I hear of unrest in the Lake Region.

    Love your milk frothing technique - I bet Warren serves the best cappuccino and lattes this side of Kampala. Has Starbuck's come to East Africa yet?

    Love, Mark Maroko "amuka twende", "mwana na chapati" Dombrofski (my full Kenyan name!)