MPEC

MPEC (pronounced "empeck") is an acronym that I've come to know and fear.  It stands for "Meilleur prise en charge" (better care).  This is the most common reason for transfer to Nyankunde from another hospital.  What MPEC means is basically that the referring physicians have no idea what to do, that they've performed a number of detrimental operations and that they're afraid that the patient will die on them.  This week I've dealt with a number of MPEC cases.  A note to the squeamish; each of these cases involves stool leaking.  An alternative for you would be to skip the text and look at some of these nice, happy pictures.  

The first is a young healthy man who was shot.  The bullet went in one hip and out the other buttock.  It shattered his hip and blew a hole in his rectum.  This is a devastating injury and generally requires diversion (creation of a colostomy) to prevent further contamination.  This was not done and they patient underwent a "non-therapeutic" abdominal operation.  He came to us a week later.  We did a colostomy and drained the wounds.  We eventually ended up doing a very high amputation of the left leg.  He is septic, anemic and malnourished.  It's a bad combination.  He smells like rotting flesh.  We're doing the best we can, but I doubt he will survive.  

Patient two is a lady who underwent a c-section.  Unfortunately they left a surgical sponge in her.  A week later they figured it out and reoperated on her.  It's a bit unclear how, but they left her with three or four holes in her bowels.  She was sent here for MPEC.  We have operated on her once, but she's still leaking stool from the wound.  Her intestines are all stuck together, and the more you try to free things up, the more they tear.  

Another patient we treated this week had been operated on three times for an intestinal perforation from Typhoid fever.  We've operated on him twice, finally doing a diverting ileostomy.  I am not optimistic for his survival. 

The other patient came in today, a week after being shot in the abdomen.  He was operated on in another hospital, but they failed to find the hole in his intestines.  He is now (guess what?) leaking stool out the bullet hole.  

These cases are so frustrating.  They illustrate the desperate situation of surgical care in Eastern Congo.  The problem is not the lack of surgical care, but simply poor care.  I can't really blame these folks.  They are inadequately trained, they work in facilities with poor anesthesia and lighting.  They do the best they can, but it's not enough.  After a couple of unsuccessful operations, they transfer them here.  MPEC.  It's discouraging to have to deal with the complications of others.  It's painful when they die.  I wish they got here a bit faster.  They have usually been deteriorating for a week or so before they arrive here.  My hope is that our doctors in training will pick up the skills necessary to avoid some of these complications.  That is also a challenge.  I get these trainees for two months.  It's not enough time.  

Lindsey has spent her days doing battle with malaria.  It's now the rainy season and malaria stalks these kids like a lion.  A healthy child can deteriorate and die with shocking speed.  I believe they have around 70 kids in the hospital now, and many of them have malaria.  Hardly a day goes by when she doesn't lose one.  The deaths are mainly due to cerebral malaria with severe anemia.  She deals with these tragic cases, them comes home and hugs Emmanuel with a strange intensity.  We struggle with giving him malaria prophylaxis, but come hell or high-water she manages to disguise the bitter taste of Mefloquine and get it down.  They say that deaths from malaria are decreasing.  We're still waiting for that magical anti-malarial vaccine.  Bill and Melinda have poured plenty of money into it...  In the meantime we continue to treat and transfuse.  We continue to see those sad little bundles carried out of the hospital by wailing moms.  This kind of stuff takes a toll on you.

 

Our life, however, isn't all death and disasters.  The climate is pleasant and the landscape is incredibly green.  We've had some of the most amazing sunsets ever.  We take a walk in the evenings and the clouds are magnificent. I've been working on various projects. My latest one has been to make a trailer out of an old Land Rover chassis that I found hidden in tall grass. It's a bit funny looking, but it's going to be great.  I can at least tow it behind the tractor and takes the kids on a hayride. This week I actually took a day off from medical work to concentrate on some administrative challenges and technical problems. A day with no surgery!  It was kind of nice. The highlight of our days is simply watching Emmanuel grow. He is starting to talk a bit. He knows a lot of words and it is a relief to actually be able to communicate a bit. All parents think this, but he is such a pleasant, fun little guy!  It is amazing to think that God gave us such a gift. 

Thanks to those who have prayed for us and supported us in various ways.  Without your help we couldn't be here.  Please do pray for this desperate country. 

Warren Cooper

Mangoes in May

May 16, 2016

I love the month of May.  I love flowers blooming, trees budding, celebration of Mother’s Day, mangoes in abundance, memories of our wedding day.  Everything is quite green here at Nyankunde!  Sunsets are stunning through the rainy season cloud formations.  I am reminded again that we live in the beautiful place and of the many things God has blessed us with.

Celebrated our 6th wedding anniversary this May

Malaria Season & An Unusual Case

Malaria season has completely EXPLODED!  Our pediatric service has over 70 patients at the moment.  It is a challenge to see every child every day.  Most of the children are recovering nicely, but some are not and it is really necessary to see even the straightforward cases.  I am thankful for the help of Dr. Patrick LaRochelle who is a med/peds doctor who is helping with the increased patient load.  He was looking to be more involved in pediatrics and now he has his wish! 

I continue to be amazed at the interesting cases and complicated pathology we see everyday.  I am caring for a young boy with a complicated heart condition called Ebstein’s anomaly (malformed tricuspid valve) that results in very small ventricles.Over time children experience profound symptoms of heart failure.  This young boy also happens to have signs of abdominal tuberculosis with a huge abdomen such that he looks 9-months pregnant.  On admission he was having a lot of abdominal pain and difficulty eating.  He essentially was not able to walk due to his large abdomen.  Now he is able to eat, is gaining weight, and is not having abdominal pain.  We are really hoping for good recovery and for him to return home soon.  He will have to live with his symptoms of heart failure, given the risks of cardiac surgery which are far too great.  Pray for his recovery.

Running on Solar Electricity

In rainy season we test our solar system capacity to the limit.  We are at the limit!  Warren is quite adept at finding solutions to our power shortages.  I appreciate how handy he is and am learning a lot myself.  Our home shares electricity with the guesthouse next door and facilitates a VSAT for three households so it really is important that we have consistent power.  The hospital recently installed 20 new solar batteries, gifted by a church in Switzerland.  This should significantly improve our power problems.  In the US most of us simply switch on the light switch and don’t give a thought to how many watts we are using.  A few years ago Warren was shocked at how many Christmas lights I had installed on our Christmas tree (exceeding 1200 watts).  It was the equivalent of running a high-powered mixer for hours.  In Congo we use low wattage bulbs and try to conserve appliance use as much as possible (..I still have low wattage Christmas tree).

Emmanuel Minute

Emmanuel continues to advance in his language skills.  I think he understands much more than he speaks in English, French, and Swahili.  Now when we look at books he points out the sun, moon, bears, bunnies, water, twiga (giraffe), tembo (elephant), simba (lion), babies, mommas, daddies, fish.  It is quite entertaining.  We sing a lot of songs to learn words.  It will be really interesting which language he masters first and then how he will choose to use the other languages surrounding him.  We are really enjoying this chapter of parenting.  I will keep working on “I love you Momma.”

I am often reminded that every day is a gift.  Sometimes simply preparing food for the evening and taking care of Emmanuel can be time consuming.  It can feel like  a stretch to get everything done and the laundry put away.  Yet despite the busy work, having a child forces you to take a step back and smell the roses.  Some days Emmanuel literally pulls up my meticulously planted herbs to smell them.  I can’t get too upset with him when I see his cute grin.  I love that he is discovering his world, even my herbs!

Projects & Ministry Support

We have a lot of projects going on around the house and guesthouse.  We are completing a foundation behind our house to be used as a play area and gazebo.  We plan to plant additional fruit trees and flowers in the surrounding lawn.  We are planning to design a nice outdoor wooden table with stools.  One of Warren’s gifts is adapting his environment for greater functionality.  I love this and am a direct beneficiary. 

If you would like to be a ministry partner, we would love to hear from you.  We anticipate some significant costs to replace a set of solar batteries in addition to a recently repaired water line to the   These are all necessary maintenance costs to continue living here.  We are hoping to raise funds to buy a vehicle over the course of 2016.  We continue to pray about these things and let our support base know.  You can contact us at: warrenandlindsey@gmail.com or through Christian Health Service Corps at:  http://www.healthservicecorps.org/moto/dr-warren-and-dr-lindsey-cooper-

Blessings and love,

Lindsey (Warren & Emmanuel)

Bridges are a huge problem, trucks actually go through!

Emmanuel with Lukas Folmer

A Safari and Stories of Patience and Hope

April 20, 2016

Greetings friends and family!  It has been a long time since we have written.  We just returned from a trip to Greece for a Christian Medical and Dental Association medical conference and a visit with Warren’s family in Switzerland.  We were so grateful to be able to attend again and re-connect with our friends around the world.  

Easter Celebration
We hosted a Samaritan's Purse Easter meal, Easter egg hunt for missionary kids.  A community has really formed here, in contrast with our first Easter here when we were the only missionary family at Nyankunde.  It is a joy to share life together.

Greece

The Mediterranean coast of Greece is quite cold this time of year, but this did not stop us from swimming in it!  At the conference childcare was provided so Emmanuel was able to play with other kids all day allowing us to attend educational sessions.  I feel better equipped to read a peripheral blood smear, to expand my screening for HIV, and incorporate more medical resources into my practice.  It is inspiring to hear about people’s ministries around the world.  It was fun to meet the other folks working in different parts of Congo, in particular from Vanga Hospital.  Plus we enjoyed hanging out with our fellow colleagues from Nyankunde out of the work context.  Our kids really love each other and are so close in age.

The Folmer & Larochelle family

Can we say future trouble?

I knew that our child was very ACTIVE but this conference confirmed this fact, as there were many children his age that he ran circles around!  We met lots of new people due to our curly haired, busy, little boy.  I love how outgoing he is.  Whenever he walks into a room he is instantly looking for a friend to play with….whether the child he pursues likes it or not.  He really has a charming smile and friendly nature.  They had a children’s program at the end of the conference.  Emmanuel simply went up on   It is fun to watch.  My biggest scare was his running away from me in the lobby of the hotel down to the ocean with our friend Joe Harvey chasing him.  As good as it is to be away, it is so nice to be home.  Emmanuel instantly reconnected with his nanny Maziga and our house crew.  He embraced his dog Cocoa and has been running all over the place.  We did not make any weekend trips to historical sites, maybe in the next couple of years when Emmanuel can be better directed.

Joanna and Lukas Folmer

stage and joined along with all the older kids during their singing and dancing.

Switzerland

A highlight of our trip to Europe was the opportunity to visit Warren’s parents in Basel, Switzerland. 

We enjoyed wonderful meals and conversation as always.  Emmanuel laughed so much with his grandmother Anita.  We rode many trams all over the city, went shopping and to the zoo, the pool, and out to eat.  We have never seen the national animal of Congo, the okapi, a cross between a giraffe and a zebra...but we

The elusive okapi, that prefers to always show its backside

Emmanuel said "shh" for "fish"

saw this animal at the zoo in Basel!  And Emmanuel was very excited about seeing a fish for the first time.  Our friend Mike Upio, a physician from Nyankunde, is completing his advanced degree in Basel and we were able to re-connect with him.  We were able to speak at a supporting church in Basel, which was a blessing.  We bought Emmanuel a new scooter that he rode all over the place.

The Value of Patience and Hope

Do you find that the best lessons in life are learned through experience?  Not from a book, a TEDTalk, counselor, etc.  Although all these things are great, there is nothing quite like learning something firsthand.  I have been learning profound lessons from God about enduring hope and patience through my patients.  I shared these stories with Basel Christian Fellowship during our time in Switzerland.  I was tempted to give up on both of these situations and send the children home on palliative care, but I really believe that the Holy Spirit prevented me from doing so.  I hope these stories will be a blessing to you too.

The first is regarding a toddler named James (name protected) who had been in the hospital for the past 4months with HIV and its’ infectious complications.  He was losing weight, had daily fevers, was not developing, had general irritability, and had signs of tuberculosis.  He typified almost ALL of the bad complications I see in children.  Like so many other pediatric patients, the disclosure of a diagnosis of HIV is complicated and can fracture families.  In the end we diagnosed the mother with HIV, but sadly she did not want further discussion or treatment.  Over the following months the child showed steady improvement on anti-retrovirals and antibiotics.  I did not have peace to send him home, wanting the mother to accept her own condition and pursue treatment.  I knew that the health of the child and the mother were intimately linked.  All we could do was pray and wait.  I am not sure how many times we asked the mother if she was willing to talk.  The answer was always no.  Finally one day she accepted our proposal and attended a counseling session.  Today she is on treatment with her son.  This is HUGE victory. 

What changed this mother’s heart?  I don’t know, but I do know that she experienced transformation.  I think the Holy Spirit was involved and that she was learning through experience.  These are powerful things.  She witnessed her child steadily improving-starting to walk, smiling, gaining weight, and experiencing life again.  This gave her HOPE and COURAGE for her own life.  All the glory goes to God for this.  It is hard to wait sometimes when it seems like you are constantly hitting a wall, but the Lord is always faithful to answer.

2 Peter 3:9 says, “ The Lord is not slow to fulfill his promise as some count slowness, but is patient toward you, not wishing that any should perish, but that all should reach repentance.”

Yes, Lord you are not slow to fulfill your promises.  Your timing is perfect.

The second story is about a child named Demetrius, aged 7years.  He came in from another hospital with arthritis and long-standing fevers and what looked like clinical typhoid.  We treated him like typhoid but the fevers continued, the pain became so debilitating that he could no longer walk, and he started developing bony abscesses everywhere.  He started on treatment for tuberculosis and we started painfully draining abscesses every other day.  Every day it seemed like he had a new problem and the pain continued to worsen.  Every service in the hospital knew Demetrius-physical therapy, nutrition, surgery, pediatrics, the chaplains, and the local health center.  We kept doing ultrasounds on his painful bones.  We added a fifth drug to cover tuberculosis of the bone and he started to get better.  The fevers went away and he had less pain.  Finally we were able to transfer him out of the ICU.

Several times I felt like I was failing this young boy.  It is really hard to see a child suffering , to feel helpless to change things, and to feel like you are missing something.  I told Warren that Demetrius would either get better or die while we are doing everything for him.  I was not willing to give up.  A few weeks ago the family thanked me for loving him and not giving up.  In essence they said, “You listened to us when there were daily problems and he was getting worse.  You just kept going.”  I simply said that God never gives up on us.  He sees all of our situations and wishes all of us to come to Him.  Our God’s patience and steadfast love is unending, no matter what the circumstance.  I told them that I was simply His representative.

I am so humbled to have participated in the care of these two children.  I count it a privilege to participate in the Lord’s work.  I learned so much from these two boys.  I have a long way to go in learning the virtues of patience, hope, and steadfast love.  Paul says, “ Therefore as God’s chosen people, holy and dearly love, clothe yourselves with compassion, kindness, humility, gentleness, and patience”  (Colossians 3:12).  I think these virtues are so important and a good check for our spirits as we work together with friends, colleagues, and patients.  I hope that these stories will be a blessing to you too.

Longevity on the Missions Field
I ran across an article the other day about longevity on the mission field by a pioneer missionary with YWAM named Tom Bloomer.  It struck a chord and I encourage those interested to read the article at: http://missionsmanual.com/2014/02.  In essence he says that missionaries need to learn how to do three things:  maintain hope, grow faith, and do spiritual warfare over their mind and relationships.  Hope is sustained though the reading of Scripture, prayer, and hearing and giving testimony of God's faithfulness in the community of believers.  The enemies of hope include "passivity, disappointments and complaining."  Faith is maintained through obedience and is seen by its results.
Finally spiritaul warfare over mind and relationships involves dealing with conflict, avoiding gossip and critical talk of others.  He says we must not be afraid of differences, but see them as a pathway to maturity and intimacy.

Here are some prayer requests:
Pray for the staff of our hospital who need to be paid and for wisdom for the administration in dealing with financial issues.  
Pray for us to hold hope for others and to live out the Gospel in our own transformed lives.
Pray for two recently abandoned children (one a recent graduate of our malnutrition program) who are in the custody of hospital staff on the pediatric ward.  We need wisdom along with our village chief as to what action should be taken.
Pray for new financial and prayer partners for our ministry in Congo.

Blessings to all of you,

Lindsey

Transferring food from spoon to spoon (fine motor skills: A+)

Monkey see, monkey do

Campsite of explorer Stanley in Eastern Congo in 1880

Incident

Greetings from Nyankunde!

We're long overdue for a little update of life in our little village.  We are doing well and rejoicing, despite the various trials we endure.

The most recent of these trials was a security incident which took place a few days ago.  We were enjoying dinner with a doctor who was departing the following day.  I heard in the distance the unmistakeable sound..."pop..pop...pop."  I was pretty sure that the gunfire was coming from the center of Nyankunde town.  Over the next 15 minutes we heard more gunshots.  I made a few phone calls and discovered that bandits had broken into the shop of a well-known businessman here at Nyankunde, and killed him.  The gunshots continued for a couple of hours.  They came from different locations and were accompanied by shouting and clanging bells.  At one point, after a hiatus the shots rang out closer.  We turned off all the lights and got on the floor.  The hardest thing was that we didn't know what was happening or why.  Thankfully we were able to communicate by phone with the medical director of the hospital who provided some details and assured us that we were not in danger.

The upshot of the event, as I now understand it, was that there was a planned hit on the businessman.  It is still sad to think about this, as we all knew him and liked him.  Two days before the incident, I bought a few supplies from his shop.  I took Emmanuel with me and we chatted a bit.  Strange to think he's now dead.  Anyway, following the hit, the assailants fled.  The local youth then turned on the military, angered that they had witnessed the event, and had done nothing to stop it.  Two soldiers and a policeman were killed.  The military then arrived from Marabo and they fired into the air to disperse the crowd.  One civilian was killed, bringing the death toll to 5.  The next day I went to the hospital and sorted out the aftermath.  There were six or seven injured individuals, mostly from stray bullets.  Two of them had bled profusely, and would likely have died without care.  There was a rather disturbing trail of blood leading up the walkway to the OR building.

I'm not going to dwell on this event, but it does remind us that we live in an uncertain and dangerous world.  The local population knows what it is to live in fear.  Still, this is a chance for us to trust in God in a practical way.  Are we crazy to live in a place like this?  I don't think so.  The safest place we can ever be is in the hand of the Father, even in the midst of confusion, violence and evil.  "Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me..."

The debatable positive of this incident is that the number of patients coming to the hospital has dropped off.  This has given us some time to work on other projects.  I've spent a couple of hours trying to move a 40 foot shipping container.  This was accomplished with the help of a tractor, chains, jacks and two courageous helpers.  We finally got it done, and we didn't injure anyone in the process.  I have found that driving a tractor is pretty good therapy for me.  I have a very old Romanian-made tractor.  I move dirt, push things and pull things.  Lindsey thinks I'm crazy, but it does help me unwind.  Emmanuel loves to sit on my lap as we bounce around.

Last weekend we went to Garamba National Park.  This is a game reserve north of here.  A group of us chartered a MAF plane and we flew up there.  It was a wonderful chance to relax and see some animals.  The park isn't exactly teeming with wildlife, or tourists.  The staff have struggled greatly to keep the poaching at bay.  Conservation in Africa, especially Congo, is a huge challenge.  This park was the site of an African Elephant domestication project, which was the crazy brainchild of King Leopold II.  Mostly it was great to just get away for a bit and spend some time together.  Emmanuel had a ball.  He fears nothing and we had a little scare when he went charging toward the hippo pool.

Emmanuel is a year and a half.  He is on the cusp of using language.  This has probably been delayed by constant exposure to English, Swahili and French.  He is probably going to end up speaking "Swafranglais" but that's ok with us.  He'll figure it out.  He is such a wonderful little guy and sometimes we look at him with amazement.  He is quite independent and strong willed.  We are trying to figure out how to work the whole discipline issue.  If anyone knows how to do this the right way, please let us know.  I was sure I know how until I had a kid!  On the whole he has been an unspeakable joy.  It is a reminder of just how much God loves us.

The hospital has been busy, with the exception of the past couple of days.  Not a day goes by when we don't face some new challenge.  The hospital has become well known.  I have a patient now who has been to Kisangani, Nairobi and Kinshasa for care, and now has come to our little village.  We continue to see lots of trauma, mostly from motorcycle accidents.  Lindsey has enjoyed a little reprieve from malaria, as it is now the dry season.  She continues to deal with malnutrition, AIDS, tuberculosis, meningitis, etc.  It can be so hard to take care of sick kids.  We have been treating one poor little guy who is so sick, but we haven't quite figured out why.  He has had problems with almost every major organ system.  Now he has developed abscesses all over his body.  He family has almost given up hope, but we continue to encourage them and help this poor little brave guy.

We are so grateful for the many people who have supported us, prayed for us and encouraged us.  Without this support, we wouldn't be able to live and work here.  The hospital continues to have needs.  We are supporting the malnutrition program and helping to feed destitute patients.  Other missionary staff here have begun rehabilitating a facility for the care of patients with tuberculosis.  We are looking at a project to increase the electrical capacity of the solar system of the hospital.  This might lack glamour, but it is so important to have power at night for patient care and oxygen.  It continues to be a dream to renovate the hospital chapel.  In each of these endeavors, it has been our concern to work alongside the Congolese hospital management, and not undertake some independent project.  We firmly believe that this is Congolese hospital and we work alongside of them.

We are looking forward to taking a little trip later on this month.  We will be traveling to Greece to attend the CMDA medical conference.  It will be great to get away for a bit.  We're going to take the opportunity to travel through Switzerland on the way, to visit my folks.

Please pray for peace in this little corner of the world.  So many things take place that are just incomprehensible to us.  All we can do is trust God.

Warren