Artificial nose

How does one go about creating a new nose for someone who is lacking one?  This young man was attacked by a hyena while he was sleeping. The hyena bit off his nose and chewed on his face. The horror of such an event really cannot be imagined. He survived, but spent the next five years healing the wounds. The MSF team found him and asked me if I would be willing to try something. Normally I get exited about a challenge but I found myself dreading this case. There is a lot to lose. It is possible that the flap will die and then you have burned bridges and mutilated the patient even further. I would have preferred to send the boy to see a real Plastic Surgeon. Unfortunately there aren't any around here, and there were no funds to send him elsewhere. In these cases, you just bite the bullet and do the best you can. 

When in doubt, read. After investigating the options, I decided to go with the "Converse scalping flap". I actually saw one of these on the Mercy Ship, some years ago. It looks nice and neat on paper.  The reality is really quite different. 

Nasal reconstruction was one of the pioneering procedures in plastic surgery. This is partly due to the fact that amputation of the nose was a common punishment in India and other countries. This case was going to be tough because the whole nose was missing. I had to recreate both layers, the inside and outside. As the septum was gone, I would have to make do with a single common nasal chamber. 

This was the first step; to fashion a forehead flap which could be turned down and constitute the inside of the nose. 

The nose itself was created from a forehead flap.  This involves basically scalping the patient so the flap  will have sufficient blood supply. This leaves a big defect behind.  The area of the nasal flap is covered with a full thickness skin graft from the groin. 

The completed first phase is not pretty, by any means, but there is at least tissue over the hole. You're supposed to wait three weeks before cutting the bridge. You need blood supply to grow in from the wound edges. This kid had a some breakdown of the wound edges and an infection, so I waited an extra week. 

This is after the second phase of the operation. The bridge of the flap has been divided, the scalp has been put back in a place and another skin graft from the groin has been used to over the defect that remains.  Again, it's not pretty, but the gaping hole has been covered by something that vaguely resembles a nose.  It lacks any real support and it will need some work in the future. 

Throughout the whole ordeal this child has remained remarkably stoic. No emotion at all!  Is he happy about the procedure?  I have absolutely no idea!

The nose is a beautiful thing. You don't realize this until you see a person who lacks one. The expression "cutting off one's nose to spite one's face" is an illustration. This expression originated from an event which took place in 867 AD. Vikings attacked a convent in Scotland. The Mother Superior chose to disfigure herself by cutting off her nose and upper lip in order to preserve her chastity from the marauders. She urged other nuns to do the same. The attackers were so disgusted that they burned the building to the ground, with the nuns inside. Not sure if this strategy would be considered a success or a failure. 

These cases are hard on me. I work so hard, and in the end, the final result is something like, "well, he doesn't look quite as horrible as before!"  My prayer is that he will return home, glorying God for what has been done. We have shown him compassion and have done our very best for him. 

Things are going well here. I've been ill for the past two weeks or so. This has made me irritable and hard to get along with. I feel like I'm pulling through and hope to soon be back to my good-natured self. 

My apologies for a fairly technical post. It may not be everyone's cup of tea, but this is what I do. 

Warren

Koinonia in October

October 17, 2015

Greetings from rainy Congo!  Every morning for the past week we wake up to the sound of rain.  Although we love the rain, it does become tiresome,,,especially on a night like tonight when we got stuck in it on an evening walk.  

The Fein Family and Samaritan's Purse Family

Maternity Ward Opening

This last week we had some very special visitors to Nyankunde from the US to commemorate the opening of the newly renovated maternity building.  Congo is one of the countries with the highest maternal-child mortality rates in the world.  We see this reality on a regular basis.  A young man by the name of Gabe Fein, affectionately known as the “Cakeman” and his sister Livvy have been raising money through Samaritan’s Purse by making and decorating cakes for the last year or so.  They really wanted to use their gifts to benefit others, in particular women and children.  Their story has inspired us to serve for the glory of God with whatever gifts we have.  No one is too young to be used by God.  They even were able to bake cupcakes in our wood-burning oven, which was a first.  This was an opportunity to talk about the fact that most household do not have ovens and that firewood and charcoal are commodities that are reserved for cooking meals.  Bread, and definitely cupcakes, are a bit of a luxury.  To read more about Gabe and Livvy check out their facebook page or Samaritan's Purse website:  http://www.samaritanspurse.org/gift-catalog/sweet-giving/?&utm_source=SPFacebook&utm_medium=referral&utm_campaign=m_Y000-SOCM_SocialMedia&utm_content=10-02-GabeLandingPage#main-story.   

Vicky, Livvy, and Gabe Fein

Baking cupcakes in a wood burning oven

opening of the newly renovated maternity building.

The inauguration consisted of a big celebration with lots of speeches, tours, and a big feast.  It felt a bit like a wedding.  The renovations included installing better lighting and an independent solar system, plumbing for several hand-washing stations, and private rooms.  There is a new sanitary block with toilets and shower facilities, as well as a new place for women to wash their clothing.  It is very timely that these changes are taking place as we are hoping that it improves our infection rates and ultimately reduces maternal-child mortality.  It is our hope that we become more and more of a   Ultimately we want to communicate to women and children that they are greatly loved by God and

Maternity nurses in matching celebratory outfits

provide a nice environment for them.

referral center for at risk pregnancies and gynecologic care.

We are becoming quite a referral center for chronic health problems, gynecologic problems included.  It amazes us to see how long people stay at home with obviously debilitating tumors, difficulty urinating, broken bones, and infections.    I think sometimes people are hoping for a miracle, a magic pill, or simply that you use a machine on them and they are suddenly healed.  Sometimes people look at us backwards when we say that there are no medical treatments to cure their condition.  This is one of the more difficult aspects of our job here.

A Book Recommendation

I would like to recommend an excellent book written by a friend of ours named, Justin Wren, called “Fight for the Forgotten.”  He is affectionately named the “Big Pygmy.”  Over the last few years he has worked in partnership with a local university in Bunia called Shalom to acquire land and drill wells for pygmy tribes in the area.  He humbly tells his life story from how he goes from a life of addiction and professional fighting to real “fighting” for one of the most oppressed people in this country.  There are people who do not believe that pygmees are humans.  Justin’s life was transformed by Jesus, or as he says God “loved the hell out of him.”  It is an excellent book.  I was reminded that God sees and advocates for these people and asks us to participate in His work.  “Is not this the kind of fasting I have chosen:  to loose the chains of injustice and untie the cords of the yoke, to set the oppressed free and break every yoke”  (Isaiah 58: 6).  He see the injustice and suffering of the pygmees and has used this man, Justin Wren and his Congolese team, to transform what is unjust.  Take a look at this book!

Our Growing Child

It is such a joy watching Emmanuel grow.  He seems to be figuring out his world more and more.  He   Occasionally I hear what sounds like a French word like, “bien.”  Most of the time I am not sure what he is saying, but he really likes to participate in the conversation.  He will grow up speaking two and probably three languages (English, French, and Swahili) as we have Congolese people in our home daily.  We anticipate that he will learn the same number of words developmentally as other kids, but that he will not know as many in one language and perhaps seem delayed.  It will be really interesting how he sorts it all out.  Here are some of his favorite activities:

makes a lot of varied sounds and says, “Momma, Daddy, and Cocoa” most consistently.

1)   Putting his toys in the oven, closing the door, and opening it again (trying to curb this one)

2)   Throwing balls for his dog Cocoa

3)   Running after Daddy around the house…or following Daddy anywhere

4)   Chasing the chickens

5)   Attempting to climb the fence

6)   Drinking out of everyone’s cups

7)   Imitating bird calls (his favorite is the crow)

8)   Taking everything out of his crib

9)   Walking to Jazira’s house wanting to play

10) Dancing to any and all music (even the chickens clucking)

Thoughts on Koinonia

What is true fellowship?  What does it mean to truly connect with another human being?  Is it simply sharing common interests (like a soccer club), hobbies, or professions?  Have you ever joined a club and still felt like an outsider after a considerable amount of time? We have been thinking a lot and struggling to build community.  Biblical fellowship is different than other fellowship.  Fellowship between fellow Christians is often referred to as Koinonia and refers to a deep connectedness.  It is a Greek word that occurs some 20 times in Scripture…so it appears to be very important to the Christian life. 

What we receive from our relationship with Christ should naturally spill over into our relationships with others.   As Paul says in Philippians 2: 1-2, “If you have any encouragement from being united with Christ, if any comfort from his love, if any fellowship with the Spirit, if any tenderness and compassion, then make my joy likeminded, having the same love, being one in spirit and purpose.” It is very clear that if we say that we have fellowship with God the Father we can have true fellowship with one another.  If we do not stay connected to God we cannot have true fellowship with another.  “If we walk in the light as He is in the light, we have fellowship with one another, and the blood of Jesus Christ cleanses us from all sin.” 

Characteristics of this koinonia are: devotion, honor, living in harmony, acceptance, service, kindness and compassion, admonishment, encouragement, spurring on one another, hospitality, and loving one another.  We really want to work on these characteristics as we relate to our fellow missionaries and serve the Congolese.  We realize that it is difficult to have true koinonia and just how easy it is for bitter roots to develop within a fellowship.  Please pray with us that as a team we will grow in our love and devotion for Christ, and thus our love and devotion to one another.  Pray that these characteristics of koinonia would permeate our missionary community.  Thank you!

We appreciate your interest in our lives and ministry.  Enjoy these last pictures of several birthdays and a picture of community life.

Blessings,

Lindsey Cooper

Another shared birthday celebrated together

Miriam's birthday party

The Larochelle Family, celebrating Miriam's first birthday

Crossing a river to the Samaritan's Purse community gardens

Emmanuel and Lukas Folmer

Jazira's second birthday

A typical night at our house in the baby tent

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)