On a Journey

June 2022

On a Journey.

 I love kids’ picture books.  One of my all-time favorites has become “Harold and the Purple Crayon” by Crockett Johnson.  It is about a little boy who goes for a walk in the moonlight.  He draws his adventure with a purple crayon.  He tries to make a long, straight path, so as to not get lost.  But he didn’t seem to be getting anywhere, so he takes a short cut in the moonlight past many challenges (mostly good).  At some point he only wants to go home and can’t remember where his home is.  Finally he remembers that the moon fills his bedroom window, so he draws it and arrives home.  The constancy in the story is the moon even when Harold is disoriented and does not know where to go.  He eventually figures out the path to his home.

       

It is a beautiful story.  The moon is there on every page which is very significant in picture books.  I realized today that our relationship with the Lord is like the constancy of the moon.  Sometimes we get lost, we forget who we are, but that relationship is always there.  We can always find our way home.  If you haven’t read it, there are tube versions at:  https://youtu.be/yl94zwz8cKU

This last year we have been on our own adventure-of transition, of hanging onto hope of being able to return to Nyankunde.  It was like we set out to draw our story with a purple crayon.  This whole time of limbo, God was like the constancy of the moon.  He finally asked us to draw our own window back home in Nyankunde in February.  These last few months God has shown Himself to be our strong companion.  

We have needed personal courage on this adventure.  We have been challenged in coming back to a community still reeling from displacement and insecurity.  At times it has felt uncertain and we have felt lonely.  We have had to confront our own grief and pain of leaving last year, and see some hospital staff fail to return.  It has also been a time of belonging.  Moving back feels like putting on an old pair of shoes that fit well, being part of a hospital ministry with unique skills to offer.  Our home was looted, yet it was therapeutic to re-purpose physically broken things, like making a linen closet out of our vandalized house doors.  

Maternal/Child Health

In this part of sub-Saharan Africa (and probably much of the world), the presence of a mother in the family determines the health of the whole family.  It is partly a joke when we say, “If momma ain’t happy, ain’t no one happy.”  It’s true though, and applies to health.   If a woman is healthy the chances that her children are thriving is also very good.  

This leads me to a recent story.  Baby L was so tiny at the age of 3months, he appeared to be a premature baby.  His body was wasted and dehydrated, with no baby fat, and below his birthweight.  His mother was admitted to the hospital in a weakened state, and not lactating.  She was found to have tuberculosis.  She appeared to be older than her years, but she is only in her 20s.  Baby L began gaining weight rapidly with infant formula and treatment of his infections.  His skin is clearing of insect infestation and he is beginning to smile.  Fortunately he has not shown any signs of active tuberculosis and has been receiving medication to prevent tuberculosis.  

  

This case demonstrates many things about the need to support mothers and babies in at risk settings.  According to the WHO the incidence of tuberculosis in DRC is 326/100,000.  Tuberculosis is endemic here in Democratic Republic of Congo.  Pregnancy is a time when women have re-activation of tuberculosis infections.  Tuberculosis puts the life of an expectant mother at risk, not to mention the risk of spontaneous miscarriage and premature birth.  The current recommendation of the World Health Organization is to screen where the incidence of disease exceeds 100/100,000.  Each year we have at least 1-2 maternal deaths following delivery and often the suspected cause is undiagnosed tuberculosis.

We work in a rural area where people live on a narrow margin.  People come to the hospital without shoes sometimes.  Food is never wasted.  People often wait a long time to come in for medical care so we see the consequences of advanced disease.  Not a day goes by when we feel like we aren’t making a difference or that God has work to do here.

Some days it feels like half of our patients are displaced from somewhere else.  DRC has had the most neglected refugee crisis for years now (50% of our province).  We can only imagine how displacement affects ones’ life.  How can one farm the fields and educate ones’ children when you don’t know where you will be in 3-months’ time?  It is always the most vulnerable among us, the children, that suffer most from the fallout of armed conflict.  Our malnutrition ward is bursting at the seams and many kids have tuberculosis.  I am caring for many orphans and some abandoned children.  

   

Thank you for your interest and support of our ministry here in eastern DRC.  We are grateful.  We are preparing for a short-trip back to the USA this fall.  We hope to see you!

Blessings,

Lindsey for us

-Thanks to God for completion of a successful school year (1st grade) for Emmanuel with his parents as teachers and the support of Angel!  Thanks for a great visit of our medical colleagues Ellen and Iyad.

-Pray for the many needs of Nyankunde Hospital.  One of the greatest being maintenance and equipment technical support.  Pray also that the hospital will be able to thrive during our time in the US this fall.

-Pray for our upcoming travels to NC this late summer and Emmanuel’s adjustment to 2^nd grade.  He is very excited to have classmates for a few months.  

-Pray for continued peace in the region.  Pray that the church would lead the way of peace and having the courage to examine the roots of ongoing conflict.  

     

  

By the shores of Lake Kivu & Loads of Village Children

May 30, 2022.  

  

This May 15th marked our 12 year wedding anniversary!  We enjoyed time on the shores of Lake Kivu together, swimming, kayaking, eating good food, and just having family time.  

So Many Kids

“There are so many kids here!  Where do they all come from?”  said our current visitor.  It is true.  There are so many children here in this season, compared to a few years ago.  Children are the majority of the many displaced persons living in our community.  In the ED/ICU the other day and ¾ of the patients were internally displaced.  People are truly moving from place to place these days as the security is fluid.  Now we are a safe haven for many-last year this was not the case.  A year ago when we bolted the doors to our house shut during a military siege there was doubt as to whether we would return.  Yet a year later and here we are again.

Homes have recently been marked with a triangle representing the number of households living in them.  I saw one home with 5 triangles today.  It is amazing that people are able to make things work under such challenging conditions.  We are seeing more and more cases of advanced chronic diseases such as tuberculosis.  Many women are coming in late to give birth, many with complications and infections.  Our maternal and neonatal mortality rate is quite high; much of it due to lack of prenatal care and trained birth attendants.  The insecurity we experienced last year has set our community back for years.  

We are finishing up an antenatal ward, a building where women with high risk pregnancies can await the birth of their babies.  It is going to be wonderful to be able to offer this to these women.  It is simple and has an outdoor kitchen, but it will be adequate for our needs.  We are grateful for the help of the organization “Saving Moses” that is helping us to get this program going.  Sub-Saharan Africa has the highest neonatal mortality rate in the world.  We need these kinds of interventions in place to help the most vulnerable women in our communities.  It is simply a safe place adjacent the hospital in which to give birth.

Practicing Pediatrics

There are so many stories I could share, of children who have found healing recently.  Just two days ago a child traveled with his parents at night, on a motorcycle, unable to breathe with a bead in his airway.  They were desperate, otherwise they never would have taken such risks.  Warren placed a surgical airway and was able to see the bead and remove it.  The child survived!  I have seen children with rare genetic disorders-hemophilia.  Kids with inherited heart defects making them blue…I always get nervous managing these kids.  Then I usually have at least 4 kids hospitalized with sickle cell anemia.  It seems like children are the ones coming in with the greatest needs these days.

I wonder what it would be like to practice pediatrics in the USA again.  It would be so nice to be able to call a cardiologist!  All of these kids would be going to clinics to see specialists and I would probably miss out on managing them.  Kids come back for their “hospital follow-ups” and simply show up on the wards.  What a joy it is to see them again!

Visitors

We are very thankful for our current American visitors-Iyed and Ellen.  They were planning to come a year ago, but our evacuation caused them to cancel their plans.  They transported some critical endoscopy equipment here for us (thanks Samaritan’s Purse)!  They have been seeing patients and troubleshooting machines.  They are our second “wave” of medical volunteers this year.  Their curiosity about people and the way people live here is refreshing.  Iyed has been training our doctors and nurses in anesthesia and the use of ultrasound for procedures.  Their presence has been encouraging to us at a time when we needed it.  

  

Home Life

Emmanuel is finishing up first grade!  He has done a great job having his parents as teachers this last year.  We have seen him gain confidence in his reading and writing.  It has been such a blessing to be part of his development and to see his unique abilities and interests.  We have done our best to connect regularly with one of his classmates from last year and his previous teacher Angel.  We are so proud of him for his hard work.  

We plan to spend a couple of months in North Carolina in late summer/early fall of this year.  Emmanuel will attend a local Christian school for a couple of months and then we hope to continue to curriculum throughout the year in Africa.  We are “tentmaking teachers” so it will be good to have this encouragement and continuity with a peer group in future years.  We’ll see how it goes.  Emmanuel has developed a certain proficiency in spoken French.  We hope to also teach him written French, but we have wanted to take one written language at a time.  

Our puppy Sirius is growing by leaps and bounds!  He is now bigger than our 3year Basenji dog named Jacob.  We usually have at least one chameleon in in our possession.  

  

We are just plugging along here in eastern Congo with the work that the Lord has given us to do.  The needs are tremendous and we believe in being people that promote peace.  We would love to hear from you.  Please drop us a line.

Blessings for us,

Lindsey

Thanks for our recent 12 year wedding anniversary.  We are thankful for each other and the love of God that binds us together.

Pray for peace in DRC in particular North Kivu and Ituri Provinces.  It is a very complex environment.  There is a new insurgency north of Goma, pray for this region.

Pray that we would continue to have confidence to walk in the will of God.  Pray that we would have a voice to speak for peace.

Pray for the plans to come together for our upcoming home assignment.

  


Peanut butter manufacturing & checkers with friends

  

A new take on a traditional oven (pot thanks to Jon Cadd)

Snapshots of Village Life Again

May 8, 2022

Wishing a Happy Mothers Day to all the moms out there.  There has been a lapse in our communication, but we are still here and doing well.  We are busy planting fields and getting settled into village life again.  I will try to use stories and pictures of people I know and have cared for recently to give you an update.

Snapshots of Village Life

 

Occasionally children bring other children to the hospital for care.  Sometimes children admit themselves to the hospital when they are sick.  It always grabs my attention when I see this.  This week a 9yo girl sibling arrived to the malnutrition ward carrying her little brother.  She came with a transfer note from a nearby village stating their concerns.  He was malnourished and weakened by malaria.  He was unable to sit and had edema in his extremities.

“You are his mother today, thank you, I said.”  Without any emotion she told me her mother had died a while ago and now she was caring for 4 children on her own.  She told me her father was sick and in the local health center.  She told me that she had prepared foo-foo and sombe (cassava leaves) for him the day before and that he had eaten.  Today he was refusing to eat, had a fever, and diarrhea.  He had signs of muscle wasting and protein malnutrition which is common.  

It is not ideal of course to have a child caring for another child, but we have been doing our best.  A community nurse visits the child every morning and evening and our kitchen prepares daily meals.  The extended family has abandoned these children and the father is labeled a “sorcerer,” which makes him a social outcast.  The hospital plans to do a home visit in hope of convincing them to be involved in the children’s lives.  I have not encountered this exact scenario before.  Clearly there is a spiritual aspect to this and we will be praying for a breakthrough.  Meanwhile we will love this child well.  

Jungle Rumblings

Last weekend a group of terrorists marched across the Ituri River invading a series of villages.  I will not give the name of this group for security reasons, but if you re not aware of the many tens of thousands of displaced peoples in Ituri Province I would encourage you to google it.  We have been seeing some refugees from this region for a while.  I have been caring for a little girl from the village of Lolwa, which has been next in line for invasion.  One day on rounds the father explained to me in Swahili that he needed to go back there to find his wife and kids. It really wasn’t safe to do so and the young girl could not be left alone in the hospital.  I advised against it.  Their village was in fact attacked a couple of days later.  He has not been able to reach his wife by phone since.  Today he requested discharge so he could search for his family.  We prayed together and I advised him to find a family to welcome the girl while he went searching.  The suffering and separation that people go through on a regular basis is beyond what most people will ever experience.  This other dear family (pictured here) recently evacuated this particular region where there are terrorists in the forest.  We are glad they are here with us.  

Back to Work

We have been back in Nyankunde for the last 3 months or so.  It has been a blessing to be in our home again.  We and get re-established in the work here and feel like we belong.  This is an interesting season that God is asking us to work actively for peace and our true identity being found in Christ, not in tribe.  We do this mostly through healthcare.  Promoting peace is active work, pursuing reconciliation between God and man, and man with fellow man.  Our walk with God is never really authentic until we learn to truly love our brother(s) who are different from us.  At times distrust and fear for others different than ourselves can lead to defensiveness and even violence.  Somewhere along the way we can stop seeing people as people.  

Many things seem better on the surface.  Health centers are functioning, patients are coming for care, there are less traumatic injuries, markets are open, babies are being born, life continues…but you don’t have to look far to find problems.  As an example, within the geographic area of Andisoma where we live, 15 of 58 villages have inhabitants.  Only larger villages have inhabitants .  It is true that many rural areas are void of people and people are gathered in larger settlements for security.

We believe that God wants us to be salt and light, to represent Him in Word and deed in this season.  “You are the salt of the earth.  But if the salt loses its saltiness, how can it be made salty again?  It is no longer good for anything, except to be thrown out and trampled by men.”  Matthew 5:13.  Salt adds flavor to food and it also preserves it.  Salt can disinfect a wound and can be painful.  It is also essential to maintaining our blood electrolyte balance as it flows in our blood, essential to functioning of cells and organs.  Jesus calls us to be salt in the world-a reminder of who God created people to be.  We are able to live out this calling as Christians anywhere, and we believe in not shying away from “difficult places.”

This year we are planting fields again that we WILL harvest.  Last year we planted fields but were unable to harvest, due to a local rebellion leading us to evacuate.  It is a blessing to work the earth and plant the fields again. We have planted peanuts, soybeans, black beans, corn, carrots, eggplant, onions, green peppers, orca, tomatoes, and squash.   A variety of fresh vegetables are hard to come by, so this will be a blessing.  We only have 1 chicken compared to the 20 we had last year and no goats, but that is ok for now.

We have a new puppy named Sirius, named for brightest star in the sky in Canis Major.  He is growing by leaps and bounds and is loved!  Emmanuel has made lots of local friends and is adjusting well.  He is finishing first grade!  He has a new wheelchair go-cart which his dad made him which he loves to race down the hill.

Thank you for your interest in our lives in eastern Congo. We are grateful for your prayers.  Continue to pray for peace in the region…not transient peace but deep peace that comes from people being right with God and man.  Pray that we would use our voices to glorify God.  Pray for villagers who have fallen into traps of tribalism, that they would turn to the one true God and not false ancestral gods.  Pray that Nyankunde Hospital could again serve all people well.

Blessings,

Lindsey

  

    

3 weeks at Nyankunde. We plan to return!

We just returned from another trip to Nyankunde.  We were going to spend two weeks there, but we ended up spending three.  The time went by in a whirlwind.  Maybe it’s a simplistic way of looking at life, but I think that the more that time flies, the better time I am having.

It was a privilege to have a protégé.  I was accompanied by a surgical resident.  He had grown up in Congo and his program had given him the opportunity to do a short stint abroad.  It was fun to watch him confront the diversity of cases that Congo will throw at you.  We saw a fair amount of general surgery, but also a smattering of ortho, urology, pediatric surgery, obstetrics, etc.  We had some pretty tough cases.  

We did the first case right after arriving.  I thought we were just going to the hospital to greet the staff, but as soon as I opened the door, I smelled an all-too familiar odor that told me we had work to do.  It was the smell of rotting human flesh and I followed it down the hallway to a room where a young man lay with a very swollen leg.  It was cold and pulseless and there were black patches of skin at the upper thigh.  There was a sensation of gas bubbles as I pushed on his abdomen and chest.  His urine in the drainage bag was the color of strong black coffee.  Anyone with any medical knowledge understands that this is a very dire situation.  It meant necrotizing fasciitis, “flesh-eating bacteria” if you need a more dramatic version. 

Perhaps the medical story makes a little sense, but the social history made none.  The story I got was that this young man was a member of the local militia.  He had taken it upon himself to punish a local “sorcerer” and had beaten him.  This seems to be one of the practices of the local movement, but he had apparently not obtained the proper permission for this action.  As a result, the young man was apprehended and beaten severely.  These beatings are no joke.  This man received 250 blows, so I was told.  It’s some pretty medieval stuff.  His leg started to swell and he was seen by a traditional healer, who performed hundreds of tiny cuts on the skin.  By the time he reached the hospital he was very sick and on the day we arrived he had progressed rapidly to the state already described.  It seems a bit ridiculous to recount such a bizarre story.  Do such things really happen in 2022?  In Congo they do.  

Without going into all the gory details, we immediately performed a very high amputation at the level of the hip joint.  Over the next several days we performed progressively more radical operation to remove dead tissue, but he died several days later.  It was sad, but certainly not unexpected.                                                                                                            

There were other tragic cases.  I recall the young lady who presented the a bowel obstruction and a perforation of the intestine.  Throughout the entire operation she had no measurable blood pressure and we operated essentially without anesthesia.  Again, it was not a surprise when she died shortly after.  We saw several mismanaged orthopedic surgical cases and struggled to do what we could with the few resources we had.  We saw kids with advanced tumors and struggled to explain to mothers that we had little to offer, but the truth and a prayer.  We treated kids with severe infections of the joints and the bones. We saw a series of young men who had been shot.  Two of them died.  Treating gunshot wounds sounds like very dramatic work, but in real life it is pretty monotonous.  We took off fingers, an arm, cleaned up wounds, put on external fixators and put in chest drains.  We had a lot of challenging cases and we worked long hours to get through them.

In addition to the broken bodies, I found myself working on broken equipment and systems.  The solar power in several areas had problems.  We were able to get a donation of several solar batteries for the maternity ward, and we took the “best” of the bad batteries and distributed them around several other systems.  This is the stuff that someone else should be doing, but for whatever reason, I seem to the be the man who can troubleshoot these systems,  and get something to work.  Most surgeons probably do not have to fix the oxygen concentrator before they can give general anesthesia for a complicated case, but that’s what I end up doing.  In the end I used a small wooden plug to patch up a leak so that I could do an operation.  This is all kind of fun on one level, but also infuriating.  It’s impossible to do surgery if things don’t work.  On the technical side the hospital is really suffering.  The generator sounds rough and needs some TLC. The oxygen concentrator needs a better solution that a wooden plug.  The solar energy system needs to have the right inverters in place so that our huge solar array and batteries (installed but never hooked up 😢) can be used. The panels and batteries have been sitting there for three years, but for lack of technical support have yet to produce one electron of useable energy.  In the meantime we provide poor care for lack of power and we lose patients for lack of oxygen. I do what I can, struggling between cases to sort things out, but I am what they call a “bricolleur,” trying my best to Macgyver a solution with duct tape and a bent paperclip. 

On the security side things are better.  Though there have been alarming incidents, people seem more willing to talk and work through problems.  In the past there was a lot of fear.  Now there is an element of hope and a new-found determination to work things out.  I am trying in my own imperfect way to be a voice for peace.  I was in a very interesting meeting, involving certain community leaders, the church, hospital administration and representatives from the local militia.  Though positive in many ways, I noted nearly every participant do three things.  First of all they gave me a history lesson of the wrongs done to their community, but never the wrongs done by their community.  Secondly they reasserted that their own tribe was known for inclusiveness, but neglected to acknowledge the obvious fact that outsiders did not feel welcome.  Thirdly they decried the ineffectiveness and corruption of their own government and that of the Congolese Army, yet indicated that they were waiting for them to take effective action.  I pointed out these observations and succeeding in touching a nerve here and here. I believe I’ve been here long enough, and treated enough patients on all sides to have the right to speak my mind. 

We enjoyed being at Nyankunde so much. It was so peaceful and so calm. We enjoyed taking walks and climbed the ridge to our “Hill Hut”.  It was fun to catch up with friends.  For all the challenges it is such a wonderful place.  Emmanuel loved playing with his friends, climbing trees and building forts.

For our part, we are looking to come back in early March and stay at Nyankunde.  We will again be the only expatriates, but that’s ok.  Perhaps our presence will give others the courage to return. You might ask, “Is it safe?”  This is a hard question to answer. We feel that it is safe enough, as safe as things can be in this chaotic country. We are doing things that will help us to feel safer.  We will continue to monitor the situation and adjust our plans accordingly. We believe that God is still at work in this community and we believe that the hospital has the potential to be a powerful voice for peace and for the Gospel of Jesus. We don’t want to just wait until things improve, we want to be part of that process. 

Please pray for us as we return to Nyankunde.  Pray for that delicate balance of wisdom and courage.  Pray for us to experience and to exude the perfect peace that comes only from God.  Pray for balance as we manage needs at the hospital, in the community and in the home.  Pray for Emmanuel as we continue to home school him.  Thanks for your support and your encouragement. 

Warren, for all of us.