Rain, rain go away!

November 3, 2019

We did it again!  Another 21days…alas we just passed another 21day observation period from another Ebola positive case in our health zone.  He was traveling from another health zone and was sick when he arrived in our health zone. Our community has gone through another vaccine campaign in response to this exposure, as the individual was in the community for a week prior to testing positive.  This was taken very seriously by the community at large and schoolchildren were vaccinated, etc.  Praise the Lord, we made it without any cases of community transmission!  I am proud of our community and hospital.  I believe that it is a testimony to the Lord and His ability to direct and protect our medical teams.  This is my prayer.  We remain vigilant in triage and transferring suspicious cases.  

We are also currently experiencing a measles epidemic (see road sign announcing vaccinations).  There is a spike in measles cases around the world and DRC is leading the charge with countries like Madagascar!  There have been more children who have died of measles than have died of Ebola this last year in DRC.  The recent spike in cases is likely due to widespread displacement and health zones affected by Ebola with delays in measles vaccinations, etc.

Building a Fence

Yesterday I was reminded that “small things really matter.”  Let me illustrate.  We ordered some high quality aluminum fencing materials from the USA for our upcoming pediatric garden.  I also ordered materials for our house…posts, fencing grill, end posts, top bars.  The only thing I didn’t order was the connectors for the fence posts.  It turns out that these pieces are quite important because they tie the top of the fence together.  You also suspend the chain link portion of the fence from this piece.  Seemingly small and important, yet so critical to our being able to put this fence together.  We wait to cement the fence posts in place until we have all the proper pieces. It seems like there is a life lesson here.  Small things matter immensely.  Salt is a small thing, but it can make or break a good soup.  

I think there are many parallels in life, particularly in how we value people.  Often we value people in a differential way.  Some people have more glamorous gifts and abilities to offer others.  Maybe they are gifted musicians or the person who always know the right thing to say or is always right.  Some people just seem more important than others.

I am reminded of many things that Henri Nouwen said about leadership in the Church.  Maybe leaders, missionaries even, are a bit like fence connectors.  He said, “If there is any hope for the Church in the future, it will be hope for a poor Church in which its leaders are willing to be led.”  He describes a leader as someone with outstretched arms, one who chooses a life of downward mobility.  “It is the image of the praying leader, the vulnerable leader, and the trusting leader.”  Not only that, but a leader is one who suffers alongside.  There is a human temptation to be powerful and respected and known. But Jesus says has a different view of someone’s value.  It is about someone who knows their truth worth as beloved by God.  This person seeks to share this love with others. This kind of leader can bring people together in a powerful way because each member knows it unique worth and what they can contribute.  This kind of leader is like the connector on top of the fence post.

Sam the Goat

For the last week we have been nursing our newborn goat, named Sam, back to health.  I have been amused to see that my recent Facebook post about Sam received more “likes” and “loves” than anything else recently.I have become friends with a local veterinarian who is amused by my love for this animal.  I joke about my patient, who just happens to be an animal.  I realize that baby animals usually don’t survive these illnesses here.  It started with rapid breathing, weakness, and inability to stand on his front leg. We have been treating him for tick-borne illness and generalized pneumonia and he seems to be gaining strength with nasogastric feedings.  Now he needs to learn how to eat grass!  It has been fun to learn a few things about animal husbandry.

Homeschooling

I have been homeschooling Emmanuel this last month.  It has been an unexpected blessing to watch him finding joy in learning how to write his first words, to make connections between sounds and letters on a page.  It is fun to watch letters pouring out of him on the page.  Sometimes his name has an extra “M” or an L before a U and I smile.  There are times to correct spelling, but mostly to really encourage listening for understanding…and correction will follow.  We are happy that Emmanuel’s teacher is with us again, so I will once again take a backseat.  But this experience will help me to better assist him at home.  It is fun to see his creativity and facility with shapes/design.  It has been fun looking at things under the microscope and doing little projects together. I want to encourage him and see his giftings develop.  I love that he has the opportunity to do this in Africa!  We can learn about  reptiles and then see a chameleon or monitor lizard and understand things in real life.

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·     Pray for us as we continue to serve in this challenging environment where Ebola remains a risk.  Pray that our presence here will be an encouragement to the Congolese.  

·     Pray for Emmanuel as he continues learning in kindergarten and for a desire to know who God is.

·     Pray for an upcoming trip to Uganda to acquire materials for our home and the hospital.  

·     Pray for a terrazzo flooring project in the ICU/OR as it begins this next week.

    Pray for a Bible study in the book of Joshua, that participants would be hungry to know God in a deeper way and encourage others to do so.

It has been extremely rainy here in Congo and we finally are seeing sunny days which makes life much easier!

Blessings,

Lindsey for the Coopers

Terrazzo flooring

Warren's rocket stove water heater in development

A seedling cinnamon plant (thanks to Ashley Peterson)

  

21days are over!

October 2019

 21days are over!

We have officially made it through the 21days post-Ebola exposure here at Nyankunde Hospital.  There were no further Ebola cases that appeared. We are so thankful!  And it looks like Ebola is officially being squeezed “into a corner of DR Congo,” a more rural area in the vicinity of where it originated.  Ebola is now officially “on the run” according to the UN.  The areas still affected have not yet managed to eradicate their cases for the past year, so I am still reserved.  Yet, it is good news.  

Having Ebola cases in our community recently has given me pause for much introspection.  When we returned to Congo in August I was uncertain as to what it would be like to live here.  I had a lot of reservations, but I knew it was time to return.   I liken living in an Ebola affected country to walking in a serious rainstorm,  wearing a raincoat and rainboots.  You can’t stop the rain, but you can still choose to function in it.  Although more difficult, you can still do farming and activities essential to daily living in the rain.  But just like when it rains here, travel decreases.  Roads may become impassable and rivers overflow.  There are places you should not go.  Life slows down a bit as it should, as mud makes it more difficult to get from place to place.  Living in an Ebola affected country is a bit like that.

Our whole family has been vaccinated, as has the hospital community, even Emmanuel’s preschool.  It is reassuring to live in a health conscious community that acknowledges the existence of Ebola.  There has been a long-standing history of health care delivery here and that is so helpful.  It is a poor community with many needs, but people value health care.  It seems like there is less conspiracy theory here and more community engagement

I realize that not everyone should live in an outbreak zone.  

We have had to make some

significant life changes and be very flexible.  We accept a higher level of risk.  We have contingency plans and bags packed if we need to travel. We are supporting other missionaries that are experiencing similar things and need temporary housing.  I am not able to practice clinical care, but rather focus on teaching and support of existing health programs.  We lost our planned teacher for the year, as she has not been allowed to stay here with the recent Ebola case.  Mission Aviation Fellowship (MAF) was told to evacuate due to the recent cases and so we have lost many of our missionary colleagues.  It is a sad change.  Now I am homeschooling Emmanuel in pre-K/kindergarten.  It is not forever, but it is necessary now.  We are not living in “survival mode,” but we have had to make significant life changes.  It hasn’t always been easy, but there is still joy.

We have started a Bible study looking at the book of Joshua with hospital staff.  It has been

a blessing to see everyone’s interest and desire to meet together.  I can sense spiritual hunger.

We have realized that Congolese rarely have an opportunity to discuss the Bible together, ask difficult questions, and ponder what it means in our lives.  We are learning about obedience to God from Joshua’s leadership style, the importance of remembrance and consecration in crossing the Jordan, intolerance of idolatry, and even how to persevere in God’s promises in difficult times.  We have talked about how Rahab is credited with faith in the God of Israel, which she shows in her actions.

Our lovely participants

Discussing the battle of Jericho

Even in the Old Testament there was the idea that people are justified by their faith, by grace.  This is the basis for our faith.  We are encouraged to hear their questions and even to have a hospital patient participate in our discussions together.  He is hearing the Gospel and God promises, even in the Old Testament.

News on our small farm-Our momma goat had two babies a week ago.  Baby goats are adorable and allow you to pick them up and carry them around. It has been fun for Emmanuel to learn a bit about goats.  We now have 2 parrots and an outdoor aviary where they can recreate.  We have something like a bird door from the living room into the outdoor aviary.  I am learning a bit about animal husbandry and giving antibiotic injections to our chickens and goats.

Just minutes after birth

Goat care involves checking for ticks and insects

Jon and Cher Cadd passed on their beloved bird Bob to us.
They return to the USA for life's next chapter.

Bob and Smeagol in their outdoor aviary

We need your prayers and support.  We enjoy hearing from friends and family and supporting churches.  It is good for us to feel connected to others as we “weather the storm.”  We will be taking a few days off later this month with a necessary trip to Uganda.

I leave you with a few African proverbs that spoke to me recently.  I find them to communicate a cultural twist/nuance here that life is dynamic and can change unpredictability.  Let us consider that our actions always have consequences, intended and unintended.  We need to be thoughtful.

1) Do not look down or hurt anyone in your life.  You may be more powerful today, but remember that time is more powerful than you are.

2) When a bird is alive, he eats ants, but when a bird dies ants eat him.  Circumstances can change at any moment.

3) Everything like a tree can make a million matches, but given the opportunity, a single match can burn a million trees.

Blessings,

Lindsey (for the Coopers)

"Always be joyful.  Never stop praying.  Be thankful in all circumstances, for this is God's will for you who belong to Jesus." 1 Thessalonians 5:16-18

Birthday celebrations

We had 4 cakes (2 not pictured) between the 9 of us!

 Not everyone cares to hear about medical cases. I get that. I’ve had a bunch of difficult cases recently, including a lot of deaths.  There has also been a lot of advanced cancers, several in children. It is hard when you know that many things could have had a better outcome had they come earlier or been managed more appropriately. It’s just part of the deal when you work in a place like this. Anyway, you learn to appreciate the occasional case when things turn out well and everyone is happy.

I was not happy when they called me to see a kid who had a foreign body in his airway. He has been seen in Bunia, intubated and they had been ventilating him the whole way to Nyankunde. These cases take years off my life. I never have the right materials to deal with them and they are very, very difficult. It was a boy of a year and a half who had aspirated a kernel of popcorn. Popcorn is bad. Not as bad as a peanut, but still bad. Peanuts tend to fragment. Popcorn is very hard to grab.  

Don’t worry, I won’t go into all the details. It involved a number of scopes, a few different graspers, a tracheostomy, pediatric urinary catheters, hemostats, sweat, prayers and anxious moments.  At one point the child was so hypoxic that I feared he might have permanent brain damage. In the end I got it out. At this point, holding a kernel of unpopped popcorn, one feels great relief, as well as the thought that it was a lot of work for such a small, ridiculous thing. Still, small things make a big difference, and a kernel lodged in the right mainstream bronchus is a big deal. 

Here is a picture of the family, truly blessed and thanking God to be leaving the hospital with their child alive and well, and a surgeon grateful that the story had a happy ending. 

Warren

Ebola Update from Nyankunde Hospital

September 20, 2019

"I will be brave Mom."

We have had two Ebola cases at Nyankunde Hospital this past week. They arrived in the middle of the night, and it seems that they intentionally deceived the staff.  They lied about the town they came from.  They had a family member who had Ebola.  Rather than comply with the recommended observation period, they fled and came here.  One of them died in the hospital, and the other has been transferred to an Ebola Treatment Center nearby.  Both of them have tested positive.  

A safe burial of the dead patient has been conducted.  Decontamination procedures have been performed.  We are hoping that vaccinations willl take place in the near future.  Several of our medical staff were exposed to the patients, including a training doctor who had not been vaccinated.  Neither Lindsey or myself had any direct contact with the patients.  

This has been an unsettling experience.  It is difficult to identify high risk patients when they intentionally lie and deceive. We do not know what will happen next.  I have done a few operations, but we are trying to keep a low profile and minimize our exposure in the hospital. 

We are also facing the uncertainly which will result as other missionaries consider their own evacuation procedures.  We

Many children and family members of health workers were vaccinated

are not currently evacuating.  We believe that our current risk level is low (no evidence that it is replicating in the community) and we want to serve as long as we are able to. If we begin to see more cases popping up, or if we can not practice effectively, we will re-evaluate.  Our family has been immunized for Ebola which is imperative to our being able to live here now.  Emmanuel received his vaccine yesterday and has handled it very well.

It was inevitable that we would get another case sooner or later.  This disease is simply not going away anytime soon.  It has a disruptive effect on the hospital on many different levels.  We will do our very best to be cautious.  Lindsey and I both feel that God has called us to serve in this difficult place at this difficult time. We know that he can take care of us.  

Please do pray for us as we live and serve at Nyankunde.



Blessings,
Warren, Lindsey, and Emmanuel Cooper

Giving consent to receive the Ebola vaccine

Measles Outbreak

September 13, 2019

Pediatric Wards at Nyankunde Hospital

Many of you are aware that DRC is experiencing an Ebola epidemic, but you may not have realized that the Congo (and the world) is also experiencing a measles epidemic on a larger scale.  This past month the number of deaths from measles has surpassed the number of deaths from Ebola this year alone.  There have been over 3200 deaths and most of them are children!  The measles outbreak is the world’s largest and fastest moving outbreak-with 165,203 cases so far this year.  Since June the government has declared the measles outbreak with emergency vaccination already reaching >3,4million children.

I don't usually talk much about public health, but I really feel it is important.  Measles is not just a problem in Congo.  There were more measles cases reported worldwide in the first 6months of 2019 than any other year since 2016.  There have been 364,808 cases worldwide by July 31^st.  It is one of the most infectious diseases

One measles case is considered a public health emergency by world standards.  In April, New York City declared a public health emergency due to the presence of measles.  It is highly infectious and the consequences can be catastrophic if the brain is affected. Children who are immunocompromised or malnourished have a high risk of contracting the disease.  Herd immunity occurs if 95% of the population is vaccinated. This article points out that in DRC immunization coverage was only 57% in 2018.  https://www.telegraph.co.uk/global-health/science-and-disease/measles-has-now-killed-people-drc-ebola-almost-children/

This is all fine and good. Measles is a problem.  But now this disease affects my medical practice and could even affect my family.  As I looked through hospital records today, I found 12 cases in our hospital since July 2019 (and a few in the months preceding this). This is just in our hospital and it probably ties the incidence of the number of cases of treated meningitis.  The World Health Organization is following the situation closely and has prioritized our health zone as a priority for vaccination this month, and upcoming months.  

The initial focus here has been vaccinating displaced peoples, protecting an estimated 27,000 children living in crowded camps in and around Bunia (an hour from us).  There are an estimated 35 refugee camps like this across our province.  It is hard to imagine the living conditions and scale of the problem from reading the news. It is under conditions like this that measles spreads, as do other diseases.  

https://www.msf.org/deadly-measles-outbreak-spreading-wildfire-democratic-republic-congo

I am hoping to bridge two very different parts of the world.  Measles is a worldwide problem.  It occurs in parts of the world where the vaccine is readily available, but it really shouldn’t be there.  It is more understandable in parts of the Congo which are largely unreachable by road and where cold chain is hard to maintain.  Our health zone is working hard to eradicate it here and protect our vulnerable children.  May God help us and bless the work of our health zone.

 Lindsey