Pictures from Aru

Someone’s been making mulberry juice with his hands…again.

Weird cloud means RUN HOME!

Whatever floats your boat.

Hard Case

This past week I did an operation which resulted in the untimely death of a patient.  The man had come to the hospital with his daughter, hoping that I could do an operation on her.  She had been born with an anorectal malformation and shortly after birth she underwent a diverting colostomy.  The girl was now seven years old.  The father had heard there was a surgeon at the hospital and he came in the great hope that I could do an operation to repair the defect and reverse the colostomy. This is a pretty specialized operation and not one I have experience in doing. I had to tell him that, sadly, I could not undertake the operation.  I thought we were done, but he kept talking. The interpreter informed me that the father also needed surgery.  He had been operated several years ago for a bowel obstruction and he had what is called an enterocutaneous fistula.  This means that the intestines have a hole which communicates with the abdominal wall. The result is that intestinal contents drain continuously.  It is a miserable condition.  Disappointed to not be able to help the daughter, I thought I might be able to help him.  There is nothing quite so dangerous as wanting to help someone.

In an ideal world, a detailed record of prior operations would be available.   Imaging studies would help delineate the location of the fistula, determine the amount of scarring, suitability to recover from a major operation, etc.  In the context of this hospital, my pre operative work-up consisted of looking him over and figuring that I could probably help him.  Would it be a difficult and risky operation?  Yes, it most certainly would.  The intestines were going to be stuck together and it would be difficult to free them up and repair the holes.  He was malnourished, as these patients always are.  This is a combination of malabsorption from a shortened working intestinal tract, and the tendency to not eat or drink.  These patients learn that the more they take by mouth, the more drains out the hole.  I’ve had a lot of experience dealing with these operations, and without seeming vain, I knew I was his best shot at fixing the problem.  

As I began operating, I quickly realized that the intestines were very stuck together.  I changed tactics and tried operating through the upper abdomen, to find a window.  There were no accessible planes.  In a difficult operation, you look for that critical juncture, where you either go forward or you stop, limit the damage, and do whatever you need to do to finish the operation.  Unfortunately, by the time I had reached that point, I had already burned my bridges and I had torn the intestines in several places.  I had no option but to keep going on.  I eventually ended up removing a huge knot of intestines, and sewing the ends together.  I also tore a large hole in the urinary bladder.  It was so thin that I thought it was a membrane.  I eventually was able to close the abdomen and send the patient to the ward.  I knew that he would not be able to survive, and in fact he died two days later.  

Here’s the thing about a high risk operation; it is risky. Maybe 9 times out of 10, things will go OK, but not always.  The stakes are very high.  Now I am left with the terrible knowledge that I saw a person who was walking, talking, living his life and providing for his family, and I performed an operation that ended in his death.  I made the decision and my hands did the damage.  He traveled a long distance to see me, trusted me to open him up, and ended up dead.  It’s hard to write about this.  I feel guilt, sadness, responsibility.  I didn’t even want to talk about it for a couple of days, because there’s nothing much to say.  I am not looking for someone to say, “It wasn’t your fault.”  It was.  In my heart I wanted to help him, I did the very best I could, but I made things much worse.  This is the terrible reality that a surgeon must deal with and be honest about, especially in this context where resources are limited.  I cannot explain to anyone how hard it is to go through this, and to go on working.  But go on working you must…there are other patients to see, other things to do, other people who want you to help them.  Somehow you learn to say to yourself, “This happened and it was terrible…but maybe in some mysterious way it was part of God’s plan.”  Maybe it will make me a better doctor by giving me a better sense of judgment.

I think I’m going to see a lot of death here in Aru.  Things are very basic and patients come late.  Most of the patients I’m dealing with have been operated on at other health centers.  I won’t go into all the disasters I’ve seen.  The problem seems to be not a lack, but a dangerous surfeit of operations.  I’m working with practitioners who don’t exactly know when to consult a surgeon.  This morning I saw a coffin being carried out of the hospital and asked what happened to the patient.  It turns out that she had a dental abscess and died because it was obstructing her airway.  I asked why no one called me, and they told me that I was busy operating.  Maybe I couldn’t have done anything to save her life, but it would have been nice to have been asked to see her.  This is a hard place for me to work, but I’m trying to figure out how to fit in.  

We like happy endings.  If not a happy ending, at least let there be a moral to the story.   In this case I don’t have either.  This man died in the night and in the morning the bed was empty.  His wife left a widow and his girl (the age of my own child) an orphan. She left till suffering from the same affliction that brought them to the hospital in the first place. 

Why share such a story?  Can people handle it?  Maybe it is a way of sharing how hard it is to do this job, how much we need prayer.  Maybe, in the end, our tears and our witness of suffering in this world is part of our offering to God, an acceptance of the cross that we each get to carry.  I asked a friend of mine to read a preliminary version of this account and he told me this. “I hope you print your story on the blog, and that it will be a summons to all who read it to live life with courage, and surrender the good and the harm we do in our lives to the Lord.”

Those who sow in tears will reap with songs of joy.  He who goes out weeping, carrying seed to sow, will return with songs of joy, carrying sheaves with him.

Psalm 126:5,6

Warren

Switzerland

November 21, 2021

Trip to Switzerland

  


We have returned from an unexpected trip to Basel, Switzerland to visit Warren’s family, a supporting church, and friends.  Warren’s mother had a recent fall and broke her hip requiring multiple surgeries.  It was the right time to go and was a blessed time to spend together. We overlapped with Warren’s brother who was also providing support.  The physical problems that come with aging and the slower regaining of strength are difficult to watch parents go through.  We extended our stay to provide support and observe Warren’s stepmother recover from complications.  Most days we visited his folks in the hospital and nursing home, helping them with daily tasks such as eating but mostly just being together.  The weather was mostly warm midday so we could go for walks outside and escape the Covid restrictions of hospitals.  The leaves were radiant!  We rode trams around Basel and ate too much chocolate and cheese.  We witnessed the passing of the fall season in all of its’ glory in only a month.

   

We also had the opportunity to make new friends and connect with old supporters, as well as visit one of our supporting churches.  We enjoyed a trip to the countryside to see our friends.  They have preserved an old homestead with many original features.  There is a fireplace in the middle of their home with ducts leading throughout the house and an oven for cooking.  It is fun to imagine how this must have worked to heat the house throughout the cold winters.  Now they have a modern heating system that heats the floors.  We took a trip to a nearby farm with a variety of species of steer, rabbits, chickens, and crops to support the farm.  It was very interesting for us to see a Swiss farm nearby.

   

Another highlight was meeting Noemi, a young woman who is a freelance photographer.  She has brought awareness and financial support to our work in eastern DRC through her photography workshops.  She is a passionate young believer in a very secular country where many churches are closing their doors due to lack of attendance.  It was an honor for us to meet her and see her work.

We also connected with Stücklin’s, Ehrsams, Bloms, Fischers, Denise and Raymond, Chinchin, Molly, Reinles, Ferrairas, Hills, and others from Basel Christian Fellowship.  We are grateful for the warm reception and kindness shown towards us and our parents Jim and Anita.

         

   

           


We have had a lot of international trips lately!  As Emmanuel made a thankfulness tree for his grandparents, Emmanuel wrote that he was grateful for them and for “planes.”  So we are thankful to be back again in Africa.  But as usual we will miss family.  We treasure the days!

Our Pre-travel Checklist

Traveling is a unique experience, especially across continents and climates.  We are always learning new tricks to traveling well.  Here is our “two cents”: 

-Pack a suitcase within a suitcase to allow for carrying treasured items back to Africa.  You know, chocolate and the like.

-Do laundry at least 3 days in advance in case it takes this long to dry!  This happened to us during rainy season.  We washed our clothes in one village, traveled with wet laundry to the next and attempted to dry again, and finally finished drying in a third city on day of departure.  

We don’t have the luxury of a dryer!

-Pack malaria prophylaxis (at least a month) so as to prevent getting sick in another country.

-Pack malaria testing kits and medication in case of sickness.  Bring a thermometer.

-Bring basic antibiotics for travelers’ diarrhea, pneumonia/ear infection.

-Get COVID Test in plenty of time to travel.  Bring home COVID tests in case of sickness.

-Make sure travel VISAs are up to date.

-Travel with collapsible camping chairs and blow up mattresses in case of long layovers (or being stranded).  We were stranded in transit once for 4 days.

-Travel with at least one days’ food.

-Travel with multiple SIM cards and different currencies if crossing international borders.  Assume you may have to purchase flights in cash and plan accordingly.

-Travel with bungee cords to tie suitcases together if there are no luggage carts.

-Bring roller skates for young child to provide amusement for long layovers/efficient movement.

-Bring warm clothes if traveling to cold climate, ie shoes, hat, gloves, jacket, wool socks.

I like to think that we are good travelers and are prepared for most things.  I used to travel with a life jacket for our son in case of over water travel in Africa…if that isn’t funny!  

Back in Africa

So now we are back in Aru- homeschooling Emmanuel and seeing patients at the hospital.  Our home is literally a stone’s throw from the hospital.  We are continuing to work in partnership with Nyankunde Hospital.  Over the last 3 months Nyankunde has seen an alarming number of neonatal deaths and birth complications.  Many women arrive to the hospital with prolonged or obstructed labor.  There is a delay simply due to distance traveled or insecure areas.  I am working together with administration on plans to create an antenatal care unit for women.  The goal is to have a place they can come for prenatal care and birth preparation to hopefully prevent complications before they occur.  We are hopeful that plans will go forward to meet this acute need.

We are still learning how we can help patient care in the Aru area. It is peaceful here and for that we are grateful! The language and people groups in this part of Ituri are completely different than the Bunia region so we are re-learning greetings, etc, but medicine doesn’t change too much.  

Using our spiritual gifts

The message from this morning’s hospital meeting was about the importance of using our spiritual gifts to build up the body of Christ.  The goal is UNITY in the faith and in the knowledge of the Son of God, attaining some kind of fullness.  “It was he who gave some to be apostles, some to be prophets, some to be evangelists, and some to be pastors and teachers to prepare God’s people for acts of service.”  Ephesians 4:11-14. It is not about one particular gift, but about everyone using what God has apportioned to him to the benefit of others.  It really is a beautiful picture of how God intends for us to live full and abundant lives.  If there are things that are keeping us from using our spiritual gifts:  conflict, discouragement, particular difficulties we ought to address this quickly for the good of others.  It is as if the health of our body is at risk if one of the members is not well.  In medicine we have been given a gift of healing which is mentioned elsewhere as a spiritual gift.  It is our hope that we can use it to benefit as many people as possible to live abundant lives while on this earth.  

Thank you for following our adventures and walk of faith on this side of the earth.  We appreciate your prayers and support as we adjust to life and serve!

Lindsey (for us)

    

 

A book I strongly recommend for a child in today’s world:  Far From Home by Sarah Parker Rubio.  It is about having to leave home, becoming a refugee, and learning a new life.  Emmanuel loves it!  Each child’s story is different, but many children can relate to this in some way.

Back in Congo

October 23, 2021

We made it back to eastern Congo again.  Our first couple of weeks were spent getting settled in Aru, north of the Nyankunde area.  We will be assisting Ania Hospital with education and health care and hopefully other hospitals as well.  We are thankful for the warm welcome we received by the German mission Diguna and the staff of Ania Hospital.

Hearing again

We recently had an opportunity to visit Nyankunde for a few days.  Going back was a sensory experience with something that had become unfamiliar. We left under such abnormal circumstances and these were my last memories, of gunfire followed by deafening silence.  Our last experiences were of fear and flight. I wasn’t sure what we would observe or what our experience would be.

Upon landing I was pleasantly surprised by signs of life returning to the village-like the sounds of spring . The first thing I noticed was the birds singing and the insects making noise! It was magnificent. War chases away the natural world and the silence is deafening. Everything was green, grasses longer than usual, not quite so many fields planted, even a cow or two. Mud, lots of mud. People were milling around everywhere on footpaths and in front of the hospital. Refugees sitting around cooking fires, just sitting, waiting, talking. The atmosphere was that of a refuge. This is such a contrasts from the absence of people, especially children, and quiet in the months leading up to our evacuation from Nyankunde in April.

When I asked people “how do you feel being here?” I most often got the answer, we feel mostly at ease. People were thankful for their fields which still yielded crops, thankful for each other, thankful to be in their homes again. Many people added comments like, “it is passed, in life you have to move on, keep going.” Children were going to school again. There was some semblance of normalcy.

Now I know that it is not as simple as “it is passed.” There was huge issues still, tribal in nature, but people want to live in their homeland.

I woke up to the sound of a bird I had never heard before, a complex melodic song. It sang for maybe 15 minutes and then another species of bird started. How lovely it was! Our home was much the same as we left it and we were thankful to see our dog and parrot again.

Our guesthouse was full of refugees again, this time from Komanda where there was a recent militant attack. It is the third wave of people we have welcomed there for an extended period of time. We are thankful to have the space for them to live and cook outside. There is running water and electricity which are a huge blessing. It is a reminded to count my blessings.

We found many old friends and colleagues living courageously-this was the greatest joy of all.  Even Emmanuel’s friends are back and met up with him again.  There was a lot of tree climbing!  

     

Resilience

Resilience is a property of materials/metals that describes their ability to hold their shape after being deformed. Google provided the following definition: “the ability of a substance or object to spring back into shape; elasticity.”  Not all materials are resilient though.  Some materials are resilient but over time the material becomes weakened and can not recover its original shape. 

Resilience is also a word that refers to person’s ability to withstand enormous stress and hardship without falling apart-even more to carry on.  Resilience is a positive attribute to bestow on someone. The word can mean “the capacity to recover quickly from difficulties; toughness.”  It is a quality that keeps missionaries on the field and allows people to overcome tremendous difficulties. 

I believe that Congolese people are very resilient. They have to be to survive. Our muscles can become stronger with right training, but they can also become weak and easily injured by repeated misuse. The Congolese are weakened by continued stresses of life, of insecurity. It may seem like everything is all right, until the next stress comes.  It is more difficult to function. The hidden cracks had not been tested by new weights and the cracks grow wider. Repeated stresses can cause damage to a person’s ability to function psychologically. Anger and even violence, or deep depression can surface. Where is this breaking point? I am not sure.

I do believe that God is able to comfort and heal from tremendous difficulties and despair. We need each other. We need space to mourn and acknowledge loss. It is not about becoming tougher and overcoming something. It is more about inviting God into it, because only He can handle these deep waters.

We live by the grace of God

One afternoon a group of Sunday school kids came to our home and fields to work to earn funds to have new choir uniforms made. What a blessing to see them working together, all different ages. How happy they were! You see their uniforms were pillaged during the recent conflict. Now they will have beautiful new ones. Afterwards they held choir practice in the backyard. I was touched by the song they sang called “We live by the grace of God.” As I looked from face to face, I saw children with serious expressions. Life has been difficult for these children. It occurred to me that probably every single one of them fled the recent violence. They had fled gunfire into the bush. Many slept by rivers, without any belongings, and perhaps not even shoes. They had all experienced hunger at one point of another, fear, and hopelessness. And here they were singing this truth, “We live by the grace of God.” The context of their life experiences makes these words all the more powerful.

It is my prayer that these children will experience hope again and know how incredibly beloved they are by God. Life has dealt them a difficult hand lately. Oh God show your grace and love towards these children.

Displacement

It was a strange experience after we evacuated to visit a new community in Congo and introduce myself as someone displaced by war. It is not common I guess for a foreigner to be “displaced.” It was very humbling to not have a home and depend on others to help you with food and lodging, the practical aspects of life. I think returning to the USA after this happened was important for us to feel grounded again, not as refugees.

So many Iturians have been displaced. No one really knows the actual statistics, but I think it is upwards of 1/5 persons. Ituri Province has more IDPs than anywhere else in the world. So many of these refugees do not live in official camps, so is hard to know their numbers. Our little community of Nyankunde (populations 10,000 previously) has received thousands of refugees over the last couple of years, always in waves. They come, they stay for a while, they work to survive, and they return. At some point they accept the risk of returning home.

We are experiencing another wave of refugees at present due to an extremist group operating to the southwest of us. I will limit my comments, but ask you to please pray and educate yourself about Ituri Province. There is a dark destructive spirit which threatens our Province.

Land is part of a person’s identity

In the Western world, many of us live, more or less disconnected from the land and the food it yields. There is often not a relationship between people and the land they inhabit. There is an Old Testament proverb which wisely says, “Plant your fields before building your house.” People live in close relationship to the land here in Congo. Fields are directly related to people’s livelihood and therefore identity as a people. We grow peanuts, soybeans, corn, squash, and coffee mostly. We do not depend on this exclusively for food or income for food. We do it to appreciate the land, to give needed work, and to learn ourselves a bit about agriculture. It is incredibly hard work!

As we flew over the troubled Ituri region around Bunia I noticed that many areas with arable land had not been planted. Also the land was away from people’s homes. Farming was not happening as much around rivers. All of this is a generalization. Curiously much of these areas are conflict zones, gold mining areas. As we moved out of these conflict areas we then saw parcels of land closer to people’s homes and larger groupings of homes. I keep coming back to how living well seems directly related to being able to have fields, and/or having animals nearby.

Thank you for your prayers as we pay a short visit to Warren’s family in Switzerland.  His stepmother had a recent fall and his father needs increasing assistance with life activities.  It is a blessing to be here to reconnect with them and help in whatever way we can.  We are enjoying cheese, chocolate, and the radiant fall colors and crisp days!

Blessings,

Lindsey for us