Back from Nepal

I’ve been back in DRC for almost a week.  I spent a couple of week in Nepal, assisting with the earthquake relief effort.  It was a good experience.  Nepal is a fascinating, bewildering, bizarre experience, even without an eartquake.  The earthquake has devastated this poor country and it was my privilege to go and try to help. 

Preparing for surgery

I would like to make a couple of observations.  Firstly, the “news” does not present an accurate picture.  I before arriving in Kathmandu, I had read about the situation.  It sounded like the city of Kathmandu had been flattened, the hospitals completely overwhelmed and the infrastructure totally destroyed.  This was not the case.  I landed in the airport with the other medical teams and the search and rescue squads.  There were cracks here and there, but things were functioning ok.  I was met outside of the airport by a van from the hotel.  On the trip to the hotel I looked for signs of destruction but I didn’t see much.  There were houses here and there which were damaged.  Some of the buildings looked a little crooked, but in Kathmandu a lot of things look crooked.  Most of the destroyed structures were older building make out of brick.  The more modern buildings seemed ok.  I’m not trying to make light of the situation; what happened was terrible.  Don’t believe the news, however.  The stories always make the situation sound worse and more dramatic than the reality.  A dramatic story captivates us, it grabs our attention.  It sells newspapers (do they still exist?).  Anyway, I think it is helpful to view the news as a product and not a completely accurate reflection of the situation.

Lance (R), fearless leader of medical team

The country of Nepal was certainly inundated with foreign medical teams.  Did they have needs for supplies and assistance?  Certainly, but they didn’t need all the doctors who showed up.  As a matter of fact, the Ministry of Health had a big job trying to coordinate and direct the foreign medical teams.  The military was quite effective in evacuating wounded patients to hospitals in Kathmandu.  These hospitals were quite adamant about not needing the assistance of foreign doctors.  Was there pride involved?  Was there a degree of posturing?  I believe there was.  Were there patients whose care was delayed due to inadequacies of the medical system?  Certainly.  Nevertheless, I confess that I was impressed by the general competence and efficiency of the Nepali medical system.  Many of the foreign medical teams ended up in more remote areas, vying to stake their claim and struggling to find something useful to do.  There are huge medical needs in Nepal and there is much that needs to be done to rebuild the health sector, especially in outlying rural areas.  There are incredibly remote areas which are cut off and need basic medical care. 

A typical scene of destruction

Anandaban OR

Did they need me there?  Not really.  It’s hard to say this, but I did not feel especially useful.  I mostly worked at Anandaban Hospital.  This is a smallish hospital on the outskirts of Kathmandu.  It functions as a center for the care for patients with leprosy, but they also do a fair amount of orthopedic surgery.  Obviously the leprosy work was on hold for the two weeks following the earthquake.  There was a steady, but not overwhelming caseload of orthopedic cases.  The cases were what you would generally expect in an earthquake: crush wounds, lacertations, open and closed fractures.  Most of the injuries involved the lower extremities.  We put a lot of bits of metal to fix broken bones.  It was actually a good learning experience for me, as I was able to work with some very competent orthopedic surgeons.  I learned a lot, and this felt like a real luxury.  In Congo I am forced to muddle through on my own, with inadequate materials.  In Nepal I worked with three orthopedic surgeons.  We had access to decent materials, we had good x-rays, a c-arm, good anesthesia, adequate supplies, etc.  I didn’t quite succeed in saving the world, but I learned a lot, and I enjoyed my time.  In these situations, you really don’t know what you’re going to find until you get there.

Dr. Tul, an old friend from Tansen

As always, the stories are heartbreaking.  I spoke with people who had lost half of their family in a matter of seconds.  They lost lifestock and posessions.  I spoke to one man who was in his late 90’s.  He had survived the last big earthquake in Nepal, the one in 1934.  In this earthquake he lost his wife, a son and two grandchildren.  He lost his buffalo and several goats.  I think that it is a privilege to offer help to people who have suffered so much.  When you multiply this level of several of suffering by the number of people who were affected it can be truly overwhelming.  The wonderful thing about medicine is that you have the ability to provide tangible physical care to individual people.  One woman with a fractured femur is a drop in the bucket in one sense, but in another it is the most important thing.  We put a rod in that broken bone.  It helped her pain and it got her up walking and back home to what remained of her family.   

Parked in the wrong place!

Dr.s McClusky and Tul

Nepal will continue to have overwhelming needs.  They need food, clean water, adequate sanitation and shelter.  This need for shelter will become even more pressing as the monsoon approaches.  It was my privilege to work with the Samaritan’s Purse team and I was impressed to see the level of competence and compassion that they manifested.  It was also great to see the commitment to sharing the gospel and working alongside the local Church in a culturally appropriate manner.  In a disaster situation, people need physical help, but I believe that even in this situation, people have a spiritual need.  They have questions, doubts and fears.  They need prayer, kindness and the good news.  It makes me proud to see that Samaritan’s Purse acknowledges these spiritual needs, even in the acute disaster situation. 

I’m back at Nyankunde, and truth be told, I’m far busier here.  Today we had a conference (topic: sickle cell disease), operated on a ectopic pregnancy, a prostatectomy, removed a fish bone from the esophagus of a lady (that was my most challenging case), chiseled away the outer part of the skull on a girl with a huge scalp wound, did three c-sections, an umbilical hernia on a child, several major debridements,  and treated a soldier who had been shot through the femur.  There may have been a couple of other case I forgot about.  We saw a bunch of outpatients as well.  This is my ongoing chronic disaster situation.  It may not be in the news, there may not be relief organizations rushing to help, money pouring in…but it keeps me busy.

Mostly I’m happy to be back home with my family.  I missed Lindsey and Emmanuel.  I love it all: our evening walk, my struggle to feed an active little boy, our evening winding-down rituals.  I love to see the new things he is doing, to feel his little tooth which is coming in.  All these things are valuable to me.  Yesterday was our 5 year anniversary, and our first as a family.   It gives me pause to consider the incredible blessings of this life.  I have a beautiful wife who loves me despite all the ways I drive her crazy, we have a child who is an incredible gift and a joy to us.  We have work that is challenging and meaningful.  We feel that God has called us to be here in this time. 

Thanks so much to everyone who has supported us and prayed for us.  I was especially touched by so many who prayed for us during the time we were apart.   You are an integral part of our ministry here and we can’t thank you enough.

Warren

Happy Boy

My coffee plantation- expecting a bumper crop!

Nyankunde from a drone

Circumstances force us to spend some time apart...

April 27, 2015

From Warren

 I am writing this from Entebbe airport, in Uganda. On Saturday I received an email asking whether or not I would be willing and available to travel to Nepal to assist with the earthquake relief efforts. Now, here I am, waiting for a flight which will take me to Doha tonight and then to Kathmandu tomorrow. 

I have been in Kathmandu a number of times and it is disturbing to see the images of devastation. Having seen the aftermath of the earthquakes in Pakistan and Haiti, I have an idea of what to expect, but there is really no way to prepare yourself. 

I have no idea where I will be working, or precisely what I will be doing. I only wish to help in whatever way I can. 

Please pray for me as I continue my journey and start working. Pray for Lindsey and Emmanuel as they stay behind at Nyankunde. There was a time when I would be very excited about such an opportunity, but I have to confess that I would rather stay at home with my family, carrying out the demanding work at Nyankunde Hospital. There are times, however, when I am needed elsewhere, and this is one of those times. 

The rest is from Lindsey

April 25, 2015

For the first time this week we were able to see our village from the air!  We welcomed a communications team from Samaritan's Purse (SP) who did some interviews and videoing of active SP projects in the area.  They took aerial shots with a drone which attracted all the neighborhood children.  Emmanuel was fascinated to watch its' flashing lights go higher and higher and finally pass out of sight.  He seemed a bit more intimidated as the drone descended coming towards him.  It is the first time I remember seeing him "cling" to me in fear.  We were happy to share our lives a bit with the communications team and pray that they will find  a story to tell here.

I have been archiving topics in my mind to blog about this past week, some medical and others non-medical.  The first is that of fuel economy.

On Fuel Economy

Did you ever stop to think about the cost to bake bread versus make chapatis/tortillas?  What goes into it?  An oven is an unusual resource here and something most people don't have.  Ovens are costly to run whether by gas, charcoal, or wood.  Imagine if everything you cooked depended on your ability to find enough wood to cook with, not just for fun like a bonfire, but seriously cooking every meal this way?  Would you burn all your wood to bake bread?  What if you had to hike up and down a steep hill to harvest this wood everyday?  I can tell you that I would probably not cook more than once/day and I would not be baking bread very often!

 It is much less expensive to use a burner to prepare a flat bread like chapatis.  This is much of the world's bread, probably for all these reasons.  People here choose the type of bean they prepare based on fuel economy (what cooks fastest).  By the way, white beans cook the fastest).  I now think about the cost of the foods I am preparing, but I am able to afford to operate an oven and a gas stove.  I have enjoyed reading the introduction of the cookbook "More with Less" that discusses the responsible use of food resources.  I recommend it as a great take-off point for cooking from scratch.

On Contagious Diseases

This week I have helped to care for a boy with probably Hepatitis A and a malnourished child with likely pertussis.  I am exposed to a host of diseases daily.  I am grateful to have some level of immunity for most of these diseases.  I do my best to wash my hands and even change my clothing when I come home to care for Emmanuel. I believe in vaccinating children and I really want my little boy to be healthy.  I struggle to understand the vaccine debacle in the United States.  It seems like a "luxury" almost to choose to vaccinate or not vaccinate.  This can't be a positive thing in the bigger social picture for those at higher risk among us.  

A Typical Day for Lindsey

My day started getting Emmanuel ready for the day and giving instructions for vegetable preparation to one of our workers.  I then made my way down to the hospital.  On any given day there are on average 30-50 pediatric patients that I am responsible for.

I first visit a sweet 1year old boy in the ER who is dying from AIDS, so beautifully cared for by his mother for the past two months.  It is heartbreaking to see that no matter what we do, anti-retrovirals, antibiotics, therapeutic milk, etc he just was too sick to come back.  I organize a care conference to talk about his condition and recommend the family to return home.  We pray together and the mother shares some deep concerns on her heart.  I have never seen such devotion by a parent in the hospital.  I am grateful for the time they have had and the healing they have experienced as a family.

My next patient is an 8mo with tetanus.  The nurses rightfully noticed that the child had less "contractions" in the calm of the night.  I talk the family into a feeding tube and know the child will lose vascular access soon.

A few other kids with malaria and the like and I am off the the regular pediatric wards.  I pass by hoards of people and children sitting and talking outside the pediatrics ward.  Many onlookers are eating morning beans and rice.

Where is our 1year old with miliary tuberculosis and complications of pneumonia?  It seems the mother has left the hospital to care for her other children as the father, a military man, is called out to the field.  I inform the health center so that they can search for her.

I see a 9year old girl with a nephrotic syndrome, still in need of high dose steroids and not tolerating an outpatient drug taper.  I don't think her kidney function is completely normally so I limit her water intake, place her on diuretics and steroids, and tell her to keep her urine over 24hours.  The lab tells me they can do a creatinine so this is helpful.

I see the other children with malnutrition...one little boy has been waiting >1 week for a transfusion with a hemoglobin of 5 (normal >12).  He looks so unwell with his big belly (ascites) and swollen extremities.  I can't wait anymore and make plans to donate blood later in the afternoon.

I see another 1year old with his first sickle cell crisis and meet with the family about how to best care for him.  We try to explain the genetics of this disease and write a prescription for long-acting monthly penicillin.  We discuss how to avoid anemia (not contract malaria and parasite) and which foods are high in iron content.

There are two children with hydrocephalous, one also has spina bifida with a spinal fluid leak from the back mass.  We discuss how surgery is a major stress to the body and how the child needs better nutrition and to be cleared of his current infection.

I make a trip to the health center to discuss two tuberculosis patients and their outpatient follow-up and to report the case of tetanus.

Then I go back to the ER to discharge a patient and I see a new mother who just gave birth with likely severe eclampsia.  She is unable to see anything and is very confused.  It is 1pm and it is time for me to get back to take care of Emmanuel.  The patient with an abdominal tumor will have to wait until tomorrow.

Three hours later I am back to give blood and look at the peripheral blood smear of a patient with suspected lymphoma.  I think I can confirm the presence of lymphoblasts.  The family will go home on palliative care as chemotherapy and advanced diagnostics are not available.  I will have that discussion tomorrow.

This is a typical day.  I am a western pediatrician working on the equator in a country where people are surviving day by day and wanting the best for their children.  As a mother now I feel things more deeply.

Pray for:

1) The injured and missing in Nepal following the recent earthquake.  Pray for Warren's safe journey to Kathmandu and that he would be a blessing and help to many in his care.  Pray for Emmanuel and I in Warren's absence as we continue on here in Congo.  He will be in Nepal for 3 weeks.

2) Pray for the ministry of Nyankunde Hospital, that we would declare the Gospel boldly as we should.


Love and blessings,


Lindsey, Warren, and Emmanuel

Never too young to start!

Momma Back to Work

March 2015

Back to Work

This Momma is back to work!  It feels good, even refreshing, to be working again, speaking Swahili, and using my medical knowledge.  I feel renewed to try new things and have had some time to think about improvements to the pediatrics service.

Some weeks the diversity of the practice of medicine here astounds me.  As a pediatrician you manage things that children would see specialists for in the US.  I use my clinical knowledge much more than any lab test….but isn’t that how it should be? Last week I diagnosed a 3month-old baby with congenital syphilis.  I see contagious diseases like tuberculosis, meningitis, and whooping cough, even diphtheria regularly.  There are always cases of malaria, intestinal parasites, schistosomiasis, pneumonias, osteomyelitis, and new cases of HIV.  I take pictures of unusual rashes.  I am not sure why children get pancreatitis here and are left with pseudocysts.  I follow our kids in the malnutrition program very closely as their conditions can change rapidly.  Most days I go home with several clinical questions to look up.  My question of the day is, how does one diagnoses tubercular osteomyelitis (infection of the bone) in this setting?  It is not as simple as obtaining a specimen for pathology, rather a clinical decision.  Medicine is humbling and often rewarding.

I recently started two children with HIV on anti-retroviral (ARVs) medications, a first for Nyankunde Hospital.  We seem to be doing HIV counseling on a weekly basis of late.  It is my hope that we can get these children feeling better, gaining weight, and resolve of their infections with the help of ARVs.  It is an unfortunate reality and one I hope we can improve with public health measures over time, such as prenatal testing.

Being a mom is making me more sensitive to hospitalized babies and the worries of parents.  This last week Emmanuel has been fighting a viral infection with fevers making him feel miserable.  I have been giving him plenty of warm baths, Tylenol, and lots of love.  Parents everywhere want their children to feel well, eat and sleep and not suffer from fever.  I am constantly reminded to care for others with the same compassion I would want someone to show my son.

Emmanuel loves his new nanny Maziga and really looks for her to feed him in the morning.  I taught   I realized when I went to explain that a baby monitor was like a kind of telephone…that maybe I had given her information overload.  She seems very comfortable in our home and enjoys singing and playing with our little boy in her language.  This means so much to me.  There are so many things that transcend culture and love for children is one of them.  It is fun to see Emmanuel’s face light up when I get home.  Most days I work about 5hours, allowing me to follow the inpatient pediatrics service and see a few consults.

her how to light a gas stove, to sterilize dishes and bottles, to make baby food, how to use safety devices such as seatbelts, etc.

Rainy Season Begins

Wet season is starting here in Congo.  We woke up last week to the sound of thunder and the sudden crack of a cedar tree branch falling on the road just outside.  It took the better part of three days for our garden staff to cut the branches and store the wood.  It gave us pause to consider how powerful the wind can be!  Wind seems immaterial, but can cause major alterations in the natural landscape!  It is interesting that Scripture talks about the Holy Spirit coming with the sound of a mighty wind, without shape or form, but in power.  Just as quickly as the wind comes, it also goes away.  Like the wind the Holy Spirit has incredible power to change both us and those around us.  In an instant God can show up and transform things drastically.  I love that God is totally in control of our lives and the physical world.  Storms are a reminder of God’s sovereignty. 

Looking at the Malnutrition Program

Many people have shown interest in our ongoing work and support of the hospital malnutrition  For those of you who have supported this work, “THANK YOU SO MUCH!”  This past year we have seen >50% increase in the number of admissions (about 150 in 2014), an older population of children being served, yet still a high mortality rate (12%).  Samaritan’s Purse has been able to refer many children to our hospital for care and follow-up with families in their homes.  I know that many children’s lives have been saved on re-admissions.  I am thankful to have had this partnership.  We have a long ways to go!

Inpatient Nutrition Program

program.

Some children come in critically ill, many irreversibly.  Malnourishment affects children’s abilities to respond to vaccines and many get diseases they should have immunity against.  I struggle to read about the “anti-vaccine revolution” in the United States when I see the realities of these diseases in the vulnerable population here.  There is so much meningitis here that leads to hydrocephalous.  It is sad.  We have less meningitis in the US due to the H. flu and Pneumovax vaccines.  An outbreak of measles would be fatal to so many in this at-risk malnourished population.  Diphtheria is such a scary disease.  One case of tetanus is one case too many.  I couldn’t imagine living here without my child having the basic vaccines, as the exposures are great.      

We are trying to improve the supplemental nutrition received by our children after discharge from the  Children receive a ration of corn and soy flour on a weekly basis.  People will often walk many kilometers for this small ration.  It is our hope to keep these children out of the hospital and to be able to identify those who are sickest and re-hospitalize them. 

hospital.

It feels like an uphill climb as we seek to improve the overall nutritional status of this at-risk population.  I am reminded that even as we climb this cliff, there is respite on small ledges.  The poor will always be among us, but it really is a testimony to Jesus as we care for the poorest of the poor.  We hope that families are receiving spiritual nourishment and hope to continue.  I know that the causes of malnutrition are deep and are rooted in the breakdown of the family.  We serve a population affected by displacement by war and insecurity, where many fathers are non-existent and women raise their children with the help of their extended families.  Without a head of household to prepare the fields for planting and to assist in harvest, many families fall onto hard times.  We want people to feel supported and cared for by their hospital family. 

The “Lent Project”

A great resource for Lent is an online devotional called the “Lent Project” from Biola University.  I recommend checking it out.  The webpage is found at: ccca.biola.edu.  I enjoy the posts everyday, and really enjoyed a recent post about the women disciples.  Often we neglect to discuss the many women who followed Jesus and showed him hospitality.  Many of these women followed him to the cross and cared for his physical needs both before and after death.  I really like the meditation from March 15^th:

A Day in the Life of Warren

So...what did you do today?

Today, I got up to discover that the power was out last night. We have the luxury of fairly consistent solar power, but the rainy season has begun and the sun has not been making an appearance. No photons in, no electrons out. That is the economics of solar power.

I did a little tour of the gardens. The tomatoes have been planted. If we can keep the goats out we might have a chance. The cucumbers are coming along. The cabbages are failing miserably.  My coffee plantation (23 bushes) shows promise. They are flowering and looking healthy. Not sure we will ever get consumable coffee, but these little projects keep me from being bored.

Feed the dog, put out the cat before Lindsey gets up. We aren't "cat-people" and Lindsey is allergic, but without a cat we have mice.  Then it's time to get Emmanuel up and dressed. He is a happy guy in the morning and it lights up my day to see him smile and laugh. Lindsey gets up and we share coffee and a time of reading and prayer before we leave. By this time Maziga has arrived. This is Emmanuel's nanny.  He is always excited to see her.

I arrive at the hospital to be confronted by the director of the nursing school who is wondering if I might have forgotten that I had committed to give a lecture to the nursing students about endoscopy. Oops!  It might have slipped my mind. Luckily, I am able to give this lecture with no preparation. Despite my lack of preparedness, it went fairly well.

I was hoping to round today, but never quite got  Fortunately I have a pretty good team covering surgery and they can let me know if there are any critical cases. I stop in the ICU to see a few cases and then I go to the OR. The first case is a boy with osteomyelitis (a chronic infection of the bone). He needs an operation called a "sequestectomy". I scrub in for the critical part, and then see a few outpatients. This is how my days go. I run back and forth between the OR and my office. I am always in a hurry, always two steps behind.

around to it.

I see a boy with a painful hip, probably TB. I see a man with a rectal cancer. He needs a big operation. I see a child with a big abdominal tumor. I was supposed to operate on him a month ago, but he disappeared. The tumor is, predictably, larger. It is unlikely that we will be able to cure him with surgery, but we need to at least try.

I run back to the operating room. I amputate a person's hand. It was turning black, possibly a complication of a treatment at another hospital. My Congolese colleagues are doing a hernia in the other room. The clock on the wall has stopped, but I know that time is ticking away. No lunch, but I am revived by a cup of black coffee and some "glucose biscuits".

I see more patients. Several of them have advanced cancers. Two of the liver and one poor skeletal woman with cervical cancer. It has already spread. I am sick of cancer, sick of telling people that they are going to die. I try to explain things simply and clearly. We talk about spiritual matters, end-of-life stuff. It is always a tough conversation. Strangely enough, people always thank me for being honest with them. Thanks for what?  They news that you are going to die?  Death is no stranger here and people accept it. Maybe they just don't get it. We pray together and they leave.

I run to the ICU to see a boy whose head was hit by a falling tree branch. I operated on him yesterday to remove a blood clot which was compressing his brain. He is still in a coma. Will he make it?  Hard to say. I see a lady whom I operated on yesterday. She was an obstetrical disaster. She had a vesicovaginal fistula and a rectovaginal fistula. I operated on her to repair her colostomy and to deal with the urine leak. It was a tough operation. She is in pain, but there seems to be no leak for the moment.

I run back to the OR to stick a drain in a man with a chronic infection of the kidney. He has seen all the traditional healers, and his flank is marred by the tiny cuts that they make. I tell the OR staff that I do the same thing. I just make a deeper cut. He will need this kidney removed, but for the moment I need to drain the half-liter of pus that is trapped in his kidney.

More outpatients.  A kid with hydrocephalus. He needs surgery but I am all out of the tubes that we use to shunt he fluid from the brain to the abdomen. It seems like every patient is a disaster of one sort or another. Where are the nice simple cases?  I try to stop between cases to do a little teaching with the junior resident.

I leave without seeing all the cases. Some of them can wait. The work is never done, and at some point I just have to go home.

I rush home to write a few emails. I am way behind. People who sit at their computers sometimes don't understand the delay, but I'm kind of busy during the day.

I have a little time with Emmanuel. We take a family walk. The soccer game is finishing up and there is chaos on the road. Everyone stops to marvel at a chubby, white baby with deep blue eyes. He is a mystery and a source of much discussion.

The evening passes peacefully. Dinner with a friend, dishes, some bonding time with the dog. There are a few calls to make. Then it's time for bed.

Lindsey kept asking me if I was ok. I am ok, I think. It's just that we see a lot of misery. It takes a toll. It weighs upon the soul. Still, I can't think of anything that I would rather be doing. I guess that is something like job satisfaction. I never come home wondering what I'm doing with my life.

Our Prayer Requests

1) Pray for Warren as he is dealing with some really difficult orthopedics and general surgical cases.  The work weighs on the soul.  Today he told four patients that they had terminal, inoperable cancer.

2) Pray for the upcoming arrival of the post-residents, the Dr. Patrick & Anna LaRochelle and their family and Dr. Michelle Doran.  Pray also for the work being done to rehabilitate a duplex for their arrival.

3) Pray that we would be able to identify another source of therapeutic milk for our nutrition program.  We anticipate the supply to run out by September.

4) Pray for the fields to produce a great harvest to feed the local population.

5) Pray that the Lord would be glorified in our work and give us strength, hope, and daily bread.

Blessings to all of you,

Lindsey, Warren, and Emmanuel

Back Home in DRC

February 21, 2015

Blessings from our home to yours!  We made it back to Nyankunde at long last.  We were able to spend a week with Warren’s folks in Basel, Switzerland, on our return to the US.  A wonderful time was had by all!  Emmanuel loved finally meeting his grandparents.  Our little boy has been so loved by everyone he meets!  We experienced the European life of riding train and trams.  It was a challenge carrying all our luggage and Emmanuel in a backpack but somehow we did it.   We are really blessed with a baby that travels well and loves meeting new people.  It was great to visit Basel Christian Fellowship where we have several friends and supporters. We are blessed by their prayers and interest in our lives.

Love those Swiss fairytales

We spent a day in Istanbul, Turkey, on the way back to Congo.  We toured some of the historical sites such as the Blue Mosque, Basilica Cistern, and the Hippodrome.  This is a very interesting historical place because of its’ location between the Black Sea and the Mediterranean-at the junction between Europe and Asia.  Istanbul was the capital of two major empires-both the Ottoman and Roman empires.  We enjoyed wandering around the city a bit and eating shwarmas.  Emmanuel charmed all the airplane stewards on Turkish Airlines and even got a free teddy bear.  Sometimes it felt like we were invisible while traveling...it was as if we didn't exist at airport counters when people just wanted pinch the cheeks of our little boy or take his picture.  I guess he is pretty cute.

Always looking up

We are adjusting to life again here.  I have been teasing Warren that the last two months have been like a paternity leave. He comes back to long lines of patients for consultation each day and a full surgical load.  Emmanuel loves the warmth, bathing outside, and taking a nap in his diaper.  He also loves playing with his new puppy Cocoa, a 9-week old boerboel.  Cocoa has a very sweet demeanor and is getting plenty of exposure to children.  I have been working with a Congolese nanny who will be caring for Emmanuel in the mornings when I go back to work next week.  Living the rural life is more involved and requires making your own baby food, cooking from scratch, gardening, and getting some goods into the country.  I am looking forward to returning to the hospital part-time.  It has been a wonderful 6-month maternity leave.  I have been so fortunate to have spent this time with our son.  I am thankful that I can work part-time and still spend a lot of the day with him.

Rainy season is approaching which everyone looks forward to with anticipation.    This means it is time to plant for the next season.  In our recent newsletter we reflected on the hidden action of God, being like planting a seed in the ground.  These analogies make so much more sense now because we try to grow our own food. 

Jesus said, “The Kingdom of God is like a farmer who scatters seed on the ground.  Night and day, while he’s asleep or awake, the seed sprouts and grows, but he does not understand how it happens.  The earth produces crops on his own.  First a leaf blade pushes through, then the heads of wheat are formed, and finally the grain ripens.  And as soon as the grain is ready, the farmer comes and harvests it with a sickle, for the harvest time has come.”  Mark 4: 26-29. 

The plants that become our food start out as tiny seeds and grow into seedlings. Growth requires

many factors such as good soil, water, protection and sunlight.  It also requires time. Gardening is difficult for the impatient person. We have planted corn, beans, cabbage, onions, tomatoes, greens, melons, carrots, peanuts, etc.  We love to see those little shoots push up out of the ground, but it takes SOOOO LONG before you actually have something you can eat. For trees, it's even worse!  We have planted coffee, oranges, lemons, papaya, bananas and even pomegranate trees.  We look forward to the day when we will enjoy these fruits, but it won't be any time soon.  It takes patience.  You need to forget about things a bit and trust the process. Thomas Merton put it this way. "How does an apple ripen?  It just sits in the sun.  A small green apple can't ripen in one night...We must wait for God, we must be awake, we must trust in his hidden action within us."

This is our prayer for all of you, that you would be like an apple in the sun, waiting on God and His purposes for your life.  May you recognize His blessings all around you and recognize that He has done great things.

Prayer Requests:

-For Lindsey as she resumes hospital work in the pediatric wards and for Emmanuel to enjoy his new nanny.

-For us to treasure each day God gives us and find joy in our medical work.

-For the outpatient malnutrition program and a source of supplemental food for the children.

-For spiritual vision at Nyankunde Hospital and for our patients to hear the Gospel clearly with open hearts.

Blessings and love,

Lindsey (for all of us)

Airline entertainment

Meeting Puppy Cocoa

 

Flying with MAF to Nyankunde