Father's Day Projects, Gorilla Adventures, and a Loss

June 21, 2020 

Happy Father's Day 

Wishing you all a very Happy Father's Day to all the dads out there!  Warren is a great father to Emmanuel.  They are always making something together.  Today Warren made him a little treehouse and showed Emmanuel his handmade crossbow.  It is a blessing to have a handy husband who likes to try new things!  He invests in his son.  Thanks for being a great dad and husband!  We love you!

Building a mini-treehouse

A handmade crossbow

Virunga National Park

Last week we had the opportunity to visit Virunga National Park, the oldest national park in Africa. We had been hoping to do this for years and we jumped at the chance.  We needed desperately to get out of the village for a short time.  The national park is officially “closed” due to Covid restrictions to protect the gorillas.  The park headquarters has a gorilla sanctuary for orphan gorillas whose parents died prematurely.  There are currently 4 orphans: 3 females and 1 male.  They have one guardian who cares for all of their needs and has learned to communicate with them.  We were told that there are 15 gorilla sounds/calls that they have mastered.  I tried to imagine spending most of my time with gorillas instead of people and what a commitment that really is.  

It seems that the gorillas have learned how to escape from their enclosure, climbing over

the electric wire without being electrocuted!  While we were there with their guardian, two of the gorillas were very interested in us and jumped the fence!  No sooner had this happened that it was peering over the observation deck with its’ big hands scaling the wall between us!  Then the second female came to join us.  They wanted to take turns approaching us.  At this point Emmanuel got a little nervous and the guardian was between us at all times.  They were not aggressive just very curious.  I am sure they would have come up and touched our hair, etc.  IT was enough excitement for one day!

It is amazing to watch these creatures scale trees with such agility and size, to see the size of their hands, etc.  Their eyes are so inquisitive, as if they want to know what we are thinking about them. They are very deeply respected by the Congolese, almost hallowed.  In fact when a gorilla dies they hold a funeral procession and give them a proper burial.  It felt like such an honor to spend part of the morning together.

Virunga NP has become increasingly a difficult place to protect.  In Africa conservation is akin to actively protecting animals from poaching and land from exploitation for natural resources.  It is not an easy job.  Our pilot friend wears a bullet proof jacket when we flies doing surveys. Much of this is done from the sky. Our hospital has cared first hand for many rangers who have suffered accidents from national parks.  I have great respect for those who work to protect these rare habitats.  It often comes at great cost.

Perhaps someday we will have the opportunity to visit gorillas in the wild as Emmanuel gets older. We take any chance we get to expose him to these wonderful wild animals.  He is becoming a bird watcher and  loves chameleons.  He just loves animals and is learning that animals have limits and get tired too.  

The descent to the Semliki Valley

Close to Boga

Loss

This past week one of our nurses died of complications of a stroke.  His name was Bara and

Bara's family

CME Colleagues, Friends, and Family

he was chief of the pharmacy.  He worked at Nyankunde before the war and was one of the few who came back to re-start the work afterwards.  It affected our staff deeply.  I was very touched to hear of many staff members who came to sleep in the hospital chapel alongside the family the night of his death.  It is very cultural for family members to “veuil” (night guard) alongside the body of their loved one.  The following day there was a large procession to attend the funeral in a neighboring village.

Today the hospital held a prayer meeting for his family,  friends, and co-workers.  One of the Swahili songs was about how there is only one way to get to God and we need to know Jesus to inherit heaven.  We need to prepare ourselves for this reality.  Death has a way of exposing what is really important: knowing and following God in this life and helping others to do so.  I was reminded of the passage in John 14: 6: “I am the way and the truth and the life. No one comes to the Father except through me.”  

I could almost hear Bara’s chuckle and see his dry smile as we sang and prayed over his family.  

An Update on Security

Many of you have expressed concern for how we are doing, given the recent event of insecurity in our village.  Thank you for contacting us.  We are doing all right.  There has been continued movement of the population-many women and children have left, most shops have closed, etc.    The governor of our province visited a couple of weeks back in an attempt to promote peace and the laying down of arms. There is military presence here which isn’t always reassuring, but they are here to protect against any insurgences. We have taken more frequent breaks out of the village to breathe which has been good.

We appreciate your prayers and support.

Blessings,

Lindsey for the Coopers

Our new baby goat Jackson

Emmanuel climbing the cell phone tower with his dad (Level 1)!

A Miraculous Recovery & Pictures from Everyday Life

May 3, 2020

Kid in the bucket!

A Miraculous Recovery

Yesterday I saw a woman in the clinic named Dora.  She had a terrible dental infection that she had been hoping would get better. It did not and by the time she came she had a large abscess under the chin.  It was pushing up her tongue and she was very ill.  We did an emergency drainage of the abscess and she seemed to be much better.  

I was called to the hospital several hours later to see her.  She had been having more and more difficulty breathing.  I think that she may have had bleeding into the abscess cavity and her tongue was obstructing her airway.  We had an inexperienced doctor on call who did not appreciate the extent of her symptoms. By the time I arrived, she had stopped breathing and her pupils were dilated.  This is a sign of profound anoxic brain injury. We rushed her into the OR hallway and I went to the supply room.  In front of me I found a cricothyroidostomy kit.  It was 4 years expired, but I had been keeping it around just in case.  There was no need for anesthesia as the patient was virtually dead.  I got the tube in her trachea and we began ventilating her.  Her oxygen saturation came up with ventilation but she was making no spontaneous respirations.  After bagging her for an hour or so, I was about to give up.  I remembered that we had received two old ventilators on a container from WMM.  I hooked her up to one of them and it worked fine.  It was an old and very basic ventilator, but it did the trick.  

At midnight, the power went out and the ventilator stopped. The nurses bagged her for a while and then she started breathing spontaneously. This was about 6 hours after she stopped breathing.  I had fully expected her to die, but she basically woke up, started breathing  and responded appropriately. 

This morning, I found her breathing on her own, communicating and asking for food and water.  I had utterly given up hope, but here she was alive and neurologically intact.  She may have lost a few brain cells, but she seems ok.  

The airway kit and the ventilator were both gifts from Samaritan's Purse, stored on a shelf. They were procured, packed and shipped by people who care.  The ventilator was checked out by the biomed team. Even the OR is here because of Samaritan’s Purse. 

This morning Dora and her husband are praising God for his mercy.  Her four children will hear the story of how her life was spared.  She is by no means out of the woods, but she has come back to life.  In the days to come we will continue to speak with her and her family about God's goodness.  

 Few Photographs of Life

We want to share a few photographs depicting life in Congo.  This is an agricultural society.  People's ability to provide for their families depends on what they are able to grow with their own two hands.  Here are some photos showing a traditional wheelbarrow, hoe, and a mix of soybeans/corn going to the mill.  We mill our own soybeans and corn to make nutritional porridge for our outpatient malnutrition programs.

Corn and soy mix prior to milling

There is nothing quite like freshly ground peanut butter!  It is a process to harvest, shell, decorticate, and roast peanuts.  Then you pass it through this mill to make peanut butter...or you grind it by hand.  The natural oils are pressed out of the nut giving the peanut butter a very smooth texture.  There is no need to add sugar or any preservatives!

We have been growing Arabica coffee for a few years now and have had several harvests.  The berries turn pinkish/red on the vine indicating that it is time to pick them.  Then you float the berries in water to determine which ones are good and which ones are not.  Then either you can de-pulp them by hand or run them through a manual mill like this one.  Next you are left with the bean covered in parchment to be dried in the sun and then stored.  The parchment protects the bean until it is ready to be removed and beans roasted.

There is not a Home Depot around the corner to purchase tree and shrub seedlings.  We start our trees from grafts.  This takes a bit of time.  Here is a pomegranate tree which was started from a graft years ago.  Now it is producing beautiful fruit!

This is a vanilla vine growing up a tree seedling.  We planted 4 vanilla vines within 2 meters (social distancing) of each other.  This is the way it is done in the forest.  Eventually, the vines will cover the trees and cross-pollinate one to another.  It takes years to harvest vanilla pods and at least initially cross-pollination is done by hand.  I have no idea what this involves, but it is fun to learn these things!

Vanilla vine

The rainy season has begun!  Rain is a blessing and waters the plants to provide food we desperately need.  It is my prayer that we will feel more connected to creation as we tend and water the fields and animals around us.  

Psalm 104:13-15 says, "You send rain on the mountains from your heavenly home, and you fill the earth with the fruit of your labor.  You cause grass to grow for the livestock and plants for people to use.  You allow them to produce food from the earth-wine to make them glad, olive oil to soothe their skin, and bread to give them strength."  

Blessings and love,

Lindsey and Warren Cooper

A traditional hoe

A critical time

WARNING!  This blog will contain nothing about the Coronavirus. I know that in these times, there can be no other topic of concern or information which more important,  but I am going to take the bold step of actually talking about something else.  Feel free to stop reading now. 

What I would like to mention first is that our little village of Nyankunde is in a state of conflict. I won’t say the word “war”,  but the security situation is at a low point. There have been rumblings for several months. The local tribe here is Bira.  For reasons that we do not fully comprehend, a local Bira militia has been formed.  Their purpose was ostensibly to protect the local population, but whenever you mix tribal issues and bands of enthusiastic armed youth, things are liable to go astray. Go astray, they did.  There have been a number of “incidents” over the preceding months.  There were some attacks of people in the community. There were a number of murders which took place. It was difficult to get an accurate account of what was going on and why. It was hard, and still is, to understand whether this movement was supported by the local population or not.  

Anyway, things came to a head last night.  The militia had openly come into Nyankunde town for the first time, brandishing arms.  There was some incident regarding a shopkeeper who was accused by the Congolese army of supplying the militia.  The army moved in, and last night, we heard shooting in town. One Congolese soldier was seriously injured and several bodies were found around the town this morning. 

They called me to the hospital last night to see the injured soldier.  He had a thoracoabdominal wound appeared to have injured his lung and liver.  He was in shock from bleeding into his abdomen. Everyone was convinced that he had been shot. The patient himself asserted this.  There was an entrance wound, but no exit wound.  Trauma surgery is pretty simple stuff.  The question is, “where did the bullet pass and what did it injure en route.”  I got an X-ray and discovered a bullet in the left lower quadrant.  This meant that the bullet had passed all the way thought the abdomen, from side to side and top to bottom.  There was a potential for devastating injury and we took him immediately to the operating room. I opened him up and discovered that there was a wound to the diaphragm and the right lobe of the liver, which was bleeding, ...but nothing else.  I just could not figure out how the bullet ended up where it was, without injuring something else.  After some head-scratching, I ended up packing around the liver to control the bleeding, and closed.  After closing, it hit me that this was not a gunshot wounds all, but a stab wound.  The knife had cut cleanly into the diaphragm and liver.  The bullet I discovered on X-ray, had been there for years, and he had forgotten about it.  This morning he admitted that there had been a lot going on, and that yes, it might be possible that he was stabbed instead of shot.  He needs more blood, but seems to be doing fine, for now.  

Excuse the medical diversion. Our peaceful little town is now in a state of fear and confusion.  The majority of the population left. The Congolese army is firmly established in town.  The militia have reported pulled back, but it is uncertain whether or not they will attack again.  We do not know what the future holds.  For the moment we do not feel personally threatened. I feel that my presence here is needed at the hospital and it is my desire to continue to demonstrate that I wish to stay.  There is always a tendency for all expatriates to run away in time of need.  This obviously is a decision which must be carefully weighed.  There is a time when non-essential personnel should be evacuated. We are discussing what we should do as a family.  It is hard to contemplate evacuation in a time when the world seems be a on lock-down and any other place may be scarier or more dangerous.  

On a less dramatic note, I have been waging another war, against dust.  We have been embroiled in a project to redo the floors in the OR/ICU in terrazzo.  Our floors had deteriorated to a point where we could not properly clean them.  We got some funding and we have had them redone in terrazzo.  This is a durable and beautiful option, though very expensive.  It involves pouring a mixture of cement and small stones.  When it hardens the surface is ground down, leaving a beautiful surface with small colored stones.  The process of grinding down the floor puts out a fine dust powder which is EVERYWHERE!  I’ve spent the last week cleaning every surface, every window, every piece of equipment and moving them back into the rooms.  It has been an massive job and it has nearly done me in.  We are finally nearing the end, and we actually operated in the our “new” OR on the stabbed patient who though he was shot, see above. 

On the homefront we have offered shelter to two large extended Congolese families in our guesthouse.  This is a record for the number of people we have lodged.  We have 21 people in a 3 bedroom house!  There is plenty of room for cooking outdoors and a bit of a yard which is helpful for the kids to play.  Many Congolese families have sought shelter in other villages, but since the hospital side of the village is more peaceful, we are lodging these people here.

So that’s the news from Nyankunde.  It is disturbing and unsettling. All over the world, we are coming to terms with the reality that this world can be a scary place, and none of us can think that we are somehow “safe” in the bubble we have created. Here, in our troubled little village, as you are wherever you may be, we assert that we are in God’s hands and we can rest in that calm assurance of his peace.  

We appreciate your prayers and support.

Warren, for the Coopers

Riding the epidemic wave AGAIN

March 24, 2020

A funny sight... chickens perching on the parrot perch in the house.  They came in through the aviary window.

Riding the Wave

I have pinched myself a few times this last week as we read the news of the Coronavirus pandemic striking the world by storm.  I keep hoping that I will wake up.  Is this really happening?  How is it possible that countries have closed their borders and people are repatriating home? It seemed at first like a disease that was only affecting China, and now the whole world is trembling.  Even the Congolese border is now closed, as are many borders around us.. It feels like the world is riding some giant wave of unknown magnitude, with so many unknowns.  The lives of so many people has changed overnight and we are scrambling to make our own medical masks!  Even our jobs and livelihoods look less certain these days.  These are crazy times. 

This new pandemic has given me pause to look back on the last 1.5years.  We have been living through an Ebola epidemic here in DRC for the last 1.5years.  This epidemic has drastically changed our lives and caused us to mitigate risk.  I (Lindsey) chose not to provide patient care so as to reduce the risk of exposure of our son.  We were vaccinated against this terrible disease.   We don’t shake hands.  I still haven’t shaken hands with anyone for 8months since coming back.  We don’t touch patients with ungloved hands anymore.  Sometimes we have had to delay life-saving care due to the need to test patients.  We have practiced social distancing and avoided large markets and public areas for weeks on end.  We spend more time at home and less time traveling.  Our daily lives have changed in significant ways.  Ebola is not a forgiving disease-it is a deadly one if not detected and treated early.  We have learned that vaccines and novel therapies are game changers for the prevention and treatment of Ebola.  At long last, Ebola appears to be coming to a close.  In just 2 more weeks with no further cases and they can declare the epidemic is over. It has been a long haul to get to this point and we are so grateful!

Some of the same principals we have learned from living through an Ebola epidemic may apply to treating coronavirus.  Even some of the drug therapies may be similar.  Let’s hope that we can properly put on/take personal protective equipment, wear N95 masks, dispose of waste properly, self-quarantine, wash our hands in bleach multiple times a day, and identify patients with this disease early.  I am thankful in a strange way for everything we have learned.  Probably the most aggressive thing we can do is test/isolate/trace and isolate contacts. We need to equip health care workers to do their jobs safely to protect their lives and the lives of others.  Hospitals need to treat only essential conditions to avoid exposing people to the virus.  Health care providers need to cohort care to limit exposures.  We need to educate the general population from ALL angles on why it is important to limit contacts.  People need to limit their movement and interactions and consider the essentials of life.  On a community level in Africa this does not mean staying in one’s often very small house 24/7, but avoiding large groups.  Here we need to consider things like food security and the possibility that goods could become scarce.  For this reason we are planting more of the fields around us and considering how we can anticipate the needs of others.  

Now life is back to basics. Many parents need to school their kids and find new activities together.  This brings challenges, but also rewards.  We are forced to slow down our frenetic life….unless of course you are in healthcare.  If you are working in healthcare your life just got infinitely more complicated and risky and may separate you from family temporarily.  We need to pray for those in health care and public service who care for others.  We need courage for the tasks ahead of us.  We need a way to surrender our worries to God, lest they overwhelm us. He is faithful and He hears our prayers and I believe we will see His intervention.

Let’s take care of our mental health-getting outside to appreciate nature.  Let’s get enough  physical exercise.  Let’s check-in with the needs of others, help a neighbor.  If possible, let’s limit our news intake as hard as that is.

A visiting doctor

Just before the DRC/Ugandan borders closed, we were able to welcome a visiting surgeon

Dr. Peter Stafford who was traveling from Togo.  He and his family are trying to discern where they should serve as medical missionaries. There were a fair amount of obstacles affecting his trip: obtaining a “letter of invitation” with signatures from mayors/chiefs/important people in our province, a temporarily lost passport, a wife approaching her due date, the on-going Ebola epidemic, and then now the coronavirus epidemic.  Somehow it worked out and he was able to get back to Togo two days early!  We had a good time together and hopefully helped him to understand a bit more about Nyankunde Hospital, its’ history and vision for the work here.

Planting

We are getting ready to plant our fields as the rainy season begins.  Warren loves driving

Dr. Peter Stafford with our family

around the tractor and Emmanuel loves to ride along.  We are hoping to plant peanuts, soy, and corn in a couple of fields around us.  I really am thankful that our vegetable garden is starting to produce okra, onions, tomatoes, squash, and beans among other things.  Our gardener has been working hard to get things re-established since we were in the USA much of last year.  I always gain greater respect for how the Congolese

Tractor shenanigans

live off the land around us. How would we all do if we had to grow almost verything we eat?  That is how people live in this part of the world.  

A few special patients

I have a lot of special patients.  One in particular is a little girl with a protein losing kidney disease (a nephrotic syndrome).  It can be a very serious problem to treat and cause a reduction in kidney function. She has been dependent on steroids which have not really controlled her disease.  We needed to try something else.  We have had a small surplus of a immunosuppressant drug called tacrolimus which was about to expire.  Well she has been on that drug for the last month or so and seems to have better control of her disease.  In the USA, this little girl would have had a kidney biopsy and countless tests to better define her disease.  I would love to do that!  We don’t have a pathology department and it is really challenging to send biopsies out. So we treat her disease using clinical measures and she is getting better!  It is so rewarding to see her improving and getting off steroids.

One of our nutrition kids is almost 3years old and only weighs 6kg.  As a point of reference,

Mixing a corn/soy blend for our outpatient porridge

this is usually the weight of a 6mo baby.  She simply isn’t growing and is cradled in her mother’s arms most days.  She has never walked or crawled.  She simply hasn’t gained weight since birth.  The mother has been displaced from a few communities over time and her father is no longer alive.  She does not have an immunodeficiency like HIV/AIDS.  She does not appear to have cancer or a heart condition.  She does not have a thyroid deficiency.  It is more likely that she could have tuberculosis which is effecting her weight gain.  Many of the nutrition kids get better with just a little support and then there are others which confound us.  We will keep working with this little girl whose Swahili name means “Looking for peace.”

I would like to close with a song called “It is Well With My Soul” written by Horatio Spafford

In 1873.  It is a well-known hymn,a favorite of my grandmother.  It is about our hearts being at peace because of the work of Christ on the cross for our sin.  We can have a deep peace even when we go through great hardships.  A little background on the hymn’s author:  Horatio was a devout Christian and successful lawyer in the Chicago area.  He was married with 4 daughters and 1 son.  He was doing well, yet his faith did not spare him from adversity.  His son tragically died and then he lost property in the Chicago fires.  Then he sent his wife and children on a boat trip to Europe in the wake of this turmoil at home.  The ship was shipwrecked and all 4 of his daughters died.  He wrote this song when he was passing over the ocean to meet his wife, an ocean that had claimed the lives of his daughters so tragically.

When peace like a river, attendeth my way,
When sorrows like sea billows roll
Whatever my lot, thou hast taught me to say
It is well, it is well, with my soul

It is well
With my soul
It is well, it is well with my soul

Though Satan should buffet, though trials should come,
Let this blest assurance control,
That Christ has regarded my helpless estate,
And hath shed His own blood for my soul

It is well (it is well)
With my soul (with my soul)
It is well, it is well with my soul

My sin, oh, the bliss of this glorious thought
My sin, not in part but the whole,
Is nailed to the cross, and I bear it no more,
Praise the Lord, praise the Lord, o my soul

It is well (it is well)
With my soul (with my soul)
It is well, it is well with my soul

Weathering the pandemic storm from DRC.  Let’s encourage each other while today is today.

Lindsey Cooper

Bob the parrot who likes to socialize (eat) with us in the morning

Saying "goodbye" for now to some of our friends in  Kenya