Trip to Epulu & Coffee Harvest

September 20, 2015

Mapenzi’s Story

She was breathing quickly and was too weary to sit.  Her mother's brow was furrowed.  I kept looking at Mapenzi’s body and her date of birth on the intake, thinking to myself  “There is no way she is 7 years old.  She looks to be about 3.”  But the mother insisted that she was indeed 7 years old.  A few questions later we learned that Mapenzi’s grandfather had just died of tuberculosis.  My first concern was that Mapenzi also had tuberculosis.  However the mother's first concern was, "how will we eat in the hospital?  I have no one.  I have no husband and my parents are dead and my other child is sick at home with the neighbor."  The family had not eaten in over a day since arriving to the hospital. 

This story illustrates is a fairly common occurrence.  The children who enter our nutrition program have multiple social problems and are often in great need.  The children are weak.  The families are stressed.  What was uncommon about this story was the degree of this woman’s loss.  Most people have someone to look after them.  This mother was truly alone.  You could just see the stress melt from the mother’s face as we told her Mama Ruth, the nutrition program cook, would look after her needs.

In the days that followed we learned more of her story. At the urging of friends and neighbors this mother brought Mapenzi to the hospital after three days of mourning of her father’s passing.  The villagers insisted that she would be taken care of at Nyankunde.  This warmed my heart, "They will take care of you."  We learned that the woman's whole family had been killed during the war.  Her two children had been attending a local heath center for nutritional supplements, but Mapenzi in particular was not doing well.  Mapenzi has received blood transfusions to correct severe anemia. She has started on tuberculosis treatment and in the therapeutic feeding program and is gaining the strength to sit and stand again. Her cough is decreasing.  She is on the road to recovery, with her mother and brother at her side.

I feel blessed to be part of something I KNOW makes a difference.  The causes of poverty and malnutrition are deep and complex.  There is no simple

solution.  But we can carry people through really difficult times and we watch

them pick their lives back up again.  I have lost hope in some parents for their

situations to change, but I can say that I am often wrong.  Often it is the

person you least expect to change who will.  People need someone to believe in

them and to experience the love of Christ through us. 

A Trip to Epulu

We were fortunate enough to take a short trip to Epulu Nature Preserve last week.  This is a very special place dedicated to the preservation of local species including a native endangered species of DRC in the giraffe family called the okapi.  The preserve plans to re-establish a select number of okapi in captivity in the next few months so the world can see this unique animal.  We woke up to the sound of African grey parrots and monkeys in the trees.  We went on a few nature hikes and actually saw the traces of a recent troup of elephants.  There is a kind of mystique to knowing the animal been there but not actually seeing it.

Checking everybody out, looking for a friend

  

Found a buddy!

Such confidence...I don't think he knows why he is different than them

Emmanuel loved splashing in the shallow pools around the riverside.  We spent some time with our friends Jon and Cher Cadd and Rosie a Swiss woman who helps to operate the reserve.  Rosie was a wonderful host, showing us around and spoiling us with wonderful evening meals.  Jon is a MAF pilot and was doing some wildlife surveys in the area as well as looking for encroachment on the park by poaching or logging.  Conservation in this part of the world means protecting the land from misuse and attempting to re-establish populations of rare species.  The local pygmees have such a dependent relationship on what the rainforest provides…from how to extract water from plants to harvesting honey from hives high up in trees.  It is really nice to be able to get away from time-to-time in country.  We look forward to seeing more wildlife and conservation efforts in DRC. 

A Recent Visitor

We were fortunate to welcome Dr. Kimiko Sugimoto, an American surgeon, to Nyankunde Hospital this past month.  She grew up in DRC and even lived here in this village for a short time.  This was

Dr. Kimiko (front left)

her second visit to our hospital and it was a blessing to have her with us again.  The staff of the hospital is encouraged by visitors as this allows them to learn new things.  Her presence allowed Warren to work on some projects and even build a chicken coop.  She even helped him remove a cyst from our dog Cocoa.  She really looked for ways to be helpful and relieve the surgical load.  Thank you Kimiko.  We will miss you.

Chickens and Coffee

The newest addition to our household are three hens named Kim Jun, Plastic, and Flower (named by various children).  Warren designed and built a chicken coop, which looks like a treehouse about 6

This sweet boy Jebel Miller climbed up into the chicken coop thinking it was a treehouse...then got stuck

feet off the ground.  For the first few days the chickens kept flying into the surrounding trees at night to roost….then we clipped their wings.  Since clipping their wings they are sleeping in their chicken coop.  We are hoping for eggs soon.  It remains to be seen if a male chicken is needed for the females to lay eggs.  It is a learning process.  I am glad that Warren likes to experiment with new animals…a cow might be next.

We are harvesting the first coffee from Warren's coffee plants from two years ago.  He is learning all about the growing, drying, shelling, roasting process.  How fun that we will be drinking our own home grown coffee!  

Playing in the new sandbox with friends

Harvesting coffee with nanny Maziga

Fresh Milk for Pediatrics

This past week the pediatric department ran out of therapeutic milk for the re-feeding program.  We completely ran out!  For the Congolese this is a common occurrence to run out of things, but for me this is not at all normal.  This milk rupture was anticipated, as we are still waiting for the importation of more therapeutic milk through UNICEF and other organizations.  Since mid-week we are making our own F75 milk with a combination of fresh milk, sugar, oil, electrolyte solution, and water.  I am thankful that we live in a farming area where cows are in abundance.  During wartime the hospital was often lacked therapeutic milk and had to come up with local solutions.  Pray for our hospital and continued management of children with malnutrition.  Our census has decreased these past weeks which is a blessing.

Thanks for your interest in our lives and for praying for us.  As you can see by all the kid photos, this is a busy and full season.  We enjoying our life here in DRC.  

If you want to be more involved in our work here, drop us an email.

Lindsey (for the Coopers)

Community Life in a Village

August 2015

Greetings from Nyankunde!  It is a peaceful and rainy Sunday morning.  Our baby is sleeping,  Warren is roasting coffee, and I am catching up on correspondence.  We have found our lives to be very full with a very active little boy.  Emmanuel is starting to walk and is gaining strength and agility.  He is very curious about everything and seems to be decoding his world.  Here is a list of his top daily activities:

1) Open and close doors.  

2) Drop everything and then pick it up.  

3) Hide and then "pop out." 

4) Climb over and go under.

5) Eat and then spit it out (or gag oneself).  

6) Play with puppy and crawl all over her.  

7) Unplug the nightlight.

8) Turn on all the buttons on the fan.

9) Take a bath and then roll in the dirt.

10) Hide under the hamper with a flashlight
11) Splashing in the outdoor puddle pool

12) Hugs!!!  

It is a real joy to see him learning and growing everyday,  He hears Swahili everyday and has learned to wave when he hears “tutuanana” which means “we’ll see each other later.”  Now if we can only coordinate our nap times so I can get some rest too.

We have welcomed a new family, the Larochelles, and an obstetrician to Nyankunde.   They are integrating and learning about life in the village.  It has been been pause for me to think about “village life” and real community as we talk about realities of life.

Village Community Life

First in a village everyone knows everything.  It is hard (impossible even) to keep secrets and private life just looks different.  This was a reality when Emmanuel was born…everyone knew I had gone into labor and that I was having some health problems.  I could be lying in bed and hear people in the fields outside talking about my son and how I was doing.  One of the single doctors who lives alone was sick recently.  People came to her house daily to check on her, as they were genuinely concerned for her especially with her living alone.  It is nice to know that people really care and want to be involved in your life, but it can be hard to rest at times.

In a village your identity is in relation to others.  No one lives in isolation.  I am known as “Mama Emmanuel,” Warren’s wife, just as much I am known as “Doctor Lindsey.”  And it’s true- my child and my husband very much define who I am.  My relation to others is more important than what “I do.”  In a tribal society like the one in which I live, you really are who you are (customs, language, values) based on your relatives. There are a lot of orphaned children in the hospital right now so I have been thinking a lot about how their sense of identity must change.  Who do these children become?  Do they marry?

Interestingly, The Bible says that we are all orphans and aliens in this world.  So our identity in the earthly sense is less important.  Scripture tells us that there is “one body and one Spirit-just as you were called to one hope when you were called-one Lord, one faith, one baptism; one God and Father of all” (Ephesians 4:4-5).  We belong to God the Father, to the body of Christ, and to the Spirit.  Someone could refer to me as “Lindsey, child of God and sister in Christ.”  This fact is even more important than that I am a mother, wife, or doctor. 

In a village you really need to find a way to get along with others.  In a village you rub elbows with everyone everyday.  There are people you get along well with and people you have differences of opinion with.  Sometimes in the west I think we become good at avoiding people and situations that we don’t want to deal with.  We probably also avoid conflict whenever we can.  Extended family may be estranged to one another.  In a village this does not work and is not good for the health of the community.  Paul says, “Make every effort to keep the unity of the Spirit through the bond of peace” (Ephesians 4:3).   It is important to work on relationships and work through differences…this is to the benefit of the entire body. 

In a village, people need each other to survive and men and women fall into more “traditional roles.”  In this culture as a woman, you really need a man to do the hard work of field preparation for crop planting.  As a woman your role is to work in the fields, harvest, prepare food for your family, and support your husband.  Can these gender roles change?  Yes, they can adapt to the situational needs.  I fall much more into these traditional roles here.  But the fact that Warren helps me cook sometimes or that I have a Congolese man helping me in the house is unusual and definitely makes me more “western.”

In a city, you can hide easier from others, associate with whom you like, and not need to depend on  

Our growing ex-pat medical community at Nyankunde

Don’t get me wrong.  I am not saying that village life is better.  In fact sometimes I wish I could hide out a little.  But village life does illustrate life in close community which is a positive thing and very Biblical.   It takes intentional effort to create community and foster relationships.  May the Lord awaken our spirits to living in close relationships with others.

others. You might not even realize that there may be another way to live.

News from Pediatrics

Have you ever struggled to be in the “in crowd,” to feel like you are understood and belong?  Living overseas puts you out of your element on a daily basis.  But I can honestly say that I “fit in” here now.  I am a foreigner and will always be a foreigner, but I feel like I am part of the family.  As I walked into the pediatrics building the other night to check on a patient I was greeted warmly by everyone in the room with waves and “Hi Doc.”  It warmed my heart.  The room was full of people sitting on the floor, the beds, and kids walking to-and-fro.  There was a lot of interest over the patient I had come to see on a Sunday night. 

Recently I felt very appreciated by a mother for taking care of her 1year old daughter named Zawadi. She was hospitalized in May with “failure to thrive,” in other words malnutrition.  After a month of increasing her calories I could not get her to gain weight.  Then she developed pneumonia.  This led me to believe that she had tuberculosis.  After weeks and weeks of treatment for tuberculosis she began gaining weight, playing, and doing developmentally normal things.  This is why I do my job.  There are daily frustrations.  There are families that disappear from the hospital during treatment.  There are patients that continue to get so sick despite everything you do.  There are patients that you can not diagnose precisely.  There are people who simply don’t believe they have the disease and don’t follow your advice….or maybe start to believe it after the third hospital admission for the same problem.  But then there are kids like Zawadi who achieve a cure.  We give God all the glory for these victories.

A New Addition

Building a fire together

I am not sure if I announced the completion of one of Warren’s projects, a wood-burning oven.  It is outside off our back patio.  It is perfect for baking breads and pizza and would be absolutely perfect for cooking a turkey.  I like it better than my wimpy indoor oven.  This one gets so hot that it cracks the thermometer and singes the hair on your arms if you reach in too far.  There is always a new project underway for my husband.  He also just completed a geodesic dome out of metal for Emmanuel to play in.  

Warren's geodesic dome and homemade swing

That’s all for now. 

Thank you for your prayers and interest in our lives. 

Love,

Lindsey (for the Coopers)

Just having fun

  

Rehabilitation of the old maternity building at Nyankunde is underway!

Lazy Days of Summer

Nyankunde Hospital

Nyankunde airstrip

July 2015

Greetings family and friends!  We just returned from some much needed time to relax in Uganda.  The DRC and Uganda are neighboring countries but are different in many ways.  The roads in eastern DRC are for the most part rugged and the most common vehicle one meets on the road is a motorcycle or an overloaded truck.  We passed several overturned, overloaded semi trucks.  In DRC woman carry mostly everything on their heads, however in Uganda weight is often carried on the back.  Attire is different too.  Clothing is very colorful and patterned in Congo, whereas in Uganda the colors and styles are more neutral and western.  Congolese eat lots of foo-foo (ground cassava) and dried fish whereas Ugandans eat lots of chapatis and bananas.

Vacation in Uganda

Murchison Falls National Park is a national park situated right on the Nile River with lots of wildlife to

behold.  Going on safari with a baby is interesting to say the least.  Emmanuel wanted to hold the steering wheel and stand up to see out of the windows the whole time.  He was not able to see the elephants and giraffe in the distance like we were, but spotted an antelope up close.  I think he thought it was a big goat.  We slept in a safari tent, enjoyed great food while watching the monkeys play in the trees and hippos surface on the water.  Emmanuel enjoyed swimming for the first time (in a pool, not the Nile).  He liked getting his face wet and drinking the water, as well as floating on his back.  It will be fun teaching him how to swim.  For me just being outside and seeing wildlife was so relaxing.  Uganda is a great place to go on safari.

Next onto Kampala for some supplies shopping and good food.  We were able to meet up with a couple of Warren’s old friends and have fellowship together.  In some ways all big cities are alike, lots of people, traffic, and noise.  It was so convenient to walk into a store and buy many things all in one place.  What might take a day of searching around multiple shops here in DRC, we were able to do in just a couple of hours.  I was encouraged by our visit to Ambrosoli International Church.  I told Warren that hearing the message on Sunday morning was the most important reason we were in Kampala.  The pastor started out by asking when the last time was that we had had a serious discussion or thought about heaven.  Our lives on earth account for such a small percentage of God’s plans for us, so how is it that we never talk or think about eternity?  This is a very poignant question.  He went to challenge us to keep our perspective on eternity and not get lost in our daily trials.  He posed the question, if you catch a fish and take a photo to show it off will people appreciate its’ magnitude?  Probably not.  But if you take a picture of the same fish relative to your body, will people then appreciate its’ size?  Definitely.  Just as it is difficult to appreciate the size of a fish alone, our lives in isolation don’t make a lot of sense.  We may find ourselves discouraged by daily frustrations and fail to see the larger picture.  If however we see our lives relative to eternity as God has made us to live with him, our lives make a lot more sense.   He does not want us to lose heart by our daily experiences and troubles, but to be renewed on the inside in our relationship and knowledge of Jesus Christ.  It is this relationship with Christ that we need to cling to in this life.  Our lives do matter for eternity so we must fix our eyes as Corinthians says on “not what is seen, but on what is unseen.”    We must not lose heart and lose this perspective.   

2 Corinthians 4:6; 16-18

For God, who said, “Let light shine out of darkness,” made his light shine in our hearts to give us the light of the knowledge of the glory of God in the face of Christ…Therefore we do not lose heart.  Though outwardly we are wasting away, yet inwardly we are being renewed day by day.  For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all.  So we fix our eyes not on what is seen, but on what is unseen.  For what is seen is temporary, but what is unseen is eternal. 

An Interesting Anecdote

Today the local radio station announcer came to our house to talk to Warren.  He and Warren are good friends and help each other out from time-to-time.  Warren advertised a reward for anyone who could help him capture a swarm of bees.  For days we had people stopping in with a bee sighting.  Next we announced our escaped goat and sure enough we were able to recover him.  So tonight our friend came by to see if Warren could help him find “hidden treasure”.  He had been told that a certain rocky hillside contained treasure and wondered if Warren had any “machines” that might help him.  I had to smile because my husband does know a lot about a variety of things AND has plenty of “machines.”  Therefore he was a reasonable consult for such an endeavor.  Life is always interesting here.

Our Baby is Growing Up

Our little baby is officially crawling and walking with assistance.  We alternate adjectives between busy,

active, and trouble!  Our house has undergone a progressive childproofing.  Warren removed the handles on the lower cupboards in the kitchen.  The bird cage as been elevated.  Electrical cords are concealed.  Our kerosene refrigerator has tape blocking the flame adjusting knob.  He opens every door and cupboard just because he can.  He loves to play outside with his puppy and goat.  My handy husband welded him a swing out of rebar today.  He is making so many sounds and waving “hi” and “bye.”  He loves people and often extends his hands to everyone.  As you can imagine everyone loves

this.  I can’t make a trip to the local market without multiple people asking me about Emmanuel or being called “Mama Emmanuel.”  In this culture you are who you are because of your relationships to others.  Warren and I hope that we will be able to handle him once he starts walking! 

Thanks again for your interest in our lives.  Pray that we would be encouraged in our daily work and have more opportunities to share the hope we have in Christ.

Blessings,
Lindsey, Warren and Emmanuel

The 4 M's

These days we've seen a lot of trauma at the hospital. As a young surgeon, trauma seems really exciting.  As you get older, it just seems annoying.  It is so stupid, so avoidable, but it takes so much effort to treat. In the setting of trauma, I have four enemies. 

The first is the motorcycle. There is a Chinese-made motorcycle called the "Senkhe" (or some variant). A Senkhe can be purchased for about 500$. They drive these motorcycles like madmen. Scarcely a day goes by when I don't see several two or three Senkhe victims. Mastaki is a 15 year old who was on a motorcycle with two buddies. He has a skull fracture with a major leak of cerebrospinal fluid from his nose. He has a fracture of the humerus, which required a plate and screws, and a fracture of the radius which we treated with a cast. He has now awakened from a coma, but I suspect he has a major contusion of the frontal lobe of his brain. He knows who he is, and where he is, but he has a serious brain injury. He sounds pretty bad off, until you learn that both of his friends on the motorcycle died. I could tell you many stories of patients who have horrible orthopedic injuries. As a motorcycle rider, these injuries do give me cause to ponder.  I have a Honda, however, so I should be ok. 

The second enemy is (predictably) the machine gun. The fact of the matter is that Eastern Congo is a violent place, and my old friend the AK-47 is alive and well. In the area east of here there has been fighting between the Congolese army, the UN "Peacekeepers" and a rebel group known as the FRPI. This is, of course, the Force for Patriotic Resistance in Ituri.  This conflict has been heating up as of late, and we've received some horrible injuries. One man had his jaw shattered. Several young combatants were shot through various limbs. Beside the conflict victims, we have the civilians who are injured by bandits, or from stray bullets. I have a 10 year old girl and a 60 year old women who were shot. In this business, one learns to hate guns. Still, in this line of work, they do offer some job security.  

The third is the gold mine. As it turns out, there is a lot of gold in this area. I wish there was no gold here. The lure of easy money drives families apart and results in a lot of vices. It also entices able-bodies young men to dig down and tunnel, like rats into the depths of the earth. These tunnels cave in, killing many and resulting in terrible injuries. At the present time we have five patients who are paralyzed, and two who have severe pelvic fractures. One man had a stone fall on him, rupturing his urinary bladder. On a good day, these miners will show up at the local store to buy beer and cigarettes. They weigh out the gold on little scales. A matchstick's weight of gold is worth about three dollars. Some people are making a killing on gold. Not these guys. They're just getting killed. 

The fourth enemy, particularly in this season, is the mango. So far I've only seen a couple of kids with broken bones. This is because the season is in full swing and the mangoes are dropping like manna from heaven. It gets dangerous later on the season as those ripe mangoes are high up in the tree. Mango trees are notoriously weak. Some days it seems like there are as many kids dropping out of the trees as mangoes. Every year I see a few that die. I like a good mango as much as the next guy, but I haven't yet tasted one I was willing to die for. 

Today I had a good one. I suppose it fits under the "motorcycle" category, but perhaps I could make an additional category called "moo". It is a guy in his 30's, who seems intelligent enough. He got up early in the morning and headed out on his Senkhe. Either his headlight was not working, or it malfunctioned, and he found himself in a large herd of cattle which was on the road. He managed to crash into a large cow and basically impaled himself on its horn. Now that I write this, it seems implausible, but that was his story. The horn entered his chest, barely missing his heart. He presented with what we call an "open pneumothorax" or, more colorfully, a "sucking chest wound."  This is a hole in the chest wall. If it is large enough, the air will preferentially go through the chest wall, rather than through the airway. I found him breathing with some difficulty. Nobody seemed to know what to do.  Lesson of the day: if there is a hole in the chest wall, try to seal it with something. The general dictum is that you put a piece of plastic over the hole and tape it on three sides. That permits air to leave the chest cavity, but not to enter it. When we got him a bit stabilized, we brought him to the OR. He had a gaping hole, through which the heart and right lung were visible. The horn had passed to the side of his heart, but had torn through the internal mammary artery, which runs down the inside of the chest well. After we ligated the bleeding artery, fixed the hole and gave him some blood, he felt much better. I've replayed the scene in my mind a couple of times, and it still seems bizarre.  Is it really possible to drive a motorcycle with no headlight and impale yourself on the horn of a cow?  It seems that it is. 

So, those are my major challenges: motorcycles, machine guns, mines and mangoes. My real challenge is to share the love of God to people who are suffering here.  Many of them, one must concede, are suffering because of stupid things.  I continue to work closely with the trainees that pass under my tutelage. Teaching Congolese doctors is the only way I can hope to have a greater impact on healthcare in this area. It is challenging, infuriating, frustrating, maddening, but never boring. 

Two days ago we had another motorcycle incident. There were three big guys on a Senkhe. This blows my mind.  The story is stil hazy, but the crashed into a bus (or vise versa). One had an open fracture of the tibia and severed his patellar tendon. One had a femur fracture, which we treated by placement of a steel rod with interlocking screws. The last had a dislocated hip and a fractured pelvis.

It's time for us to get out of Nyankunde for a bit. We've been here for six months without a break and it's time for a change of scenery. We are going to take a little road trip to Uganda. We'll see some animals, eat at a restaurant, do a little shopping. Most importantly, we will be spared from patient care for a bit. We love our job, really we do, but it takes a toll and sometimes we just need to get away!

Warren