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.

Warren 

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!

Blessings,

Lindsey

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,

Lindsey

Our friend Lisa frothing milk "Warren style"

Lap Choley

Should a laparoscopic cholecystectomy be attempted in eastern Congo?  That is a question that I am still asking myself.  It can be done.  We did one yesterday, but it nearly killed me.  There are a lot of machines to coordinate.  The patient has to be under general anesthesia, a challenge in itself.  There are video monitors on either side of the table.  You need an insufflator, a light source, a camera module, suction, cautery, trocars, specialized instruments, a gas source, clip appliers, endo-loops, etc.    In short, there are lots of moving parts, and whatever can go wrong, will go wrong.  I couldn't find the special cautery cord and I had to make one with a wire.  Burned/shocked myself in the process.  Most of the equipment runs off of 110V and our transformer can't quite handle the load.  What usually happens is that the ladies in the sterilization room turn on the washing machine and then the whole system shuts off.  It is unsettling to have instruments inside the patient and have no idea where they might be.  In the US we use carbon dioxide to blow the abdomen up with air.  No CO2 available around here, so I use a medical air compressor, which seems to work...except when it doesn't.  

I am the only one around who actually knows how to manipulate laparoscopic instruments, and I'm not all that good at it.  It's kind of like operating with chopsticks and doing it in a mirror, as all the directions are reversed.  I selected the person who I thought would make the best assistant.  It didn't work out so well.  I asked him to grab the top of the gallbladder.  He could see it, know what he wanted to do, but simply could not make it happen.  Every time I needed him to do something, I had to reach across the table, put the instruments where I needed them, and then return to my instruments.  I also had to hold the camera, as no one else could manage to show me what I needed to see.  

Anyway, we struggled and sweated through it, and finally managed to get the gallbladder out.  We lost power a couple of times.  I poked a hole in the gallbladder and spilled some bile.  Not such a big deal.  The clip applier did not function well and I had to get a tie around the cystic duct.  I finished the case with a splitting headache.  It left me wondering if it was worth all the effort.  On one level it was.  The patient left the hospital the following day.  I know we'll get better at it.  I'll teach someone to assist me.  We'll work through the technical challenges.  This is not a new operation, and I believe with all my heart that I should do the very best I can for the people I treat.  The young doctors working here deserve to learn about laparoscopic surgery.  In the meantime, however, it is so, so, so hard!

Most of what we do is really, really hard.  It demands a lot from me and I leave the hospital feeling spent.  We are pushing the envelope here.  Nearly every day I end up doing something and wondering if I should.  I am also finding that it becomes a vicious circle.  The more you do, the more you have to do.  Yesterday we did a laparoscopic cholecystectomy, and today another one showed up to be scheduled.  We have started doing more ortho cases.  The more we do, the more patients are referred to us.  We have started doing procedures such as cystoscopy and endoscopic banding of esophageal varices here.  No one else around here is doing this stuff, so we get more and more referrals.  The more you do, the more you do.  Eventually you arrive at a balance, I suppose.  We have yet to do so.  At some point I will need help.  Maybe even (dare I say it?) another surgeon!  I'm doing what I can to train the folks here, but it is a process and they simply aren't there yet.  Last I checked there wasn't a backlog of trained surgeons wanting to go to Congo...  Who knows.  God might have someone in mind.  It would be wonderful to share the burden.  

In the meantime, we do what we can.

Warren Cooper