Mali - August 17, 2009

Ne's smile is one of the greatest "Thank you" I've ever received!

The little gal went home this week, and took a bit of my heart with her.

I came to help at the Women's and Children's hospital of Koutiala, Mali. But I know I received as much, if not more, than what I gave here.

Ne's operation went well. Thank you to those who were praying. She recovered well, and finally smiled :) That was a happy day. Both she and her older brother received Christ a few weeks ago. She was here nearly three months, and had ample opportunity to see the lives the Christians lived out daily, and to receive their love and care. She in turn shared her little heart with us. I only knew her for just over a week, but the rest of the staff knew her well. After multiple abdominal operations for perforated Typhoid infection, she is finally well, and

normal again. Truly normal in a very real way.

God is GOOD.

I have been truly blessed with time to work and time to rest. The time here has flown by, but in a non-hurried sort of way. The interaction with staff and patients has been good. And I have had time to rest and reflect along the way. It seems like life always appears to have a different perspective coming from the sands of the Sahara.

I'm starting to realize deep within my heart just how important it is to take time to reflect and acknowledge God's hand in our lives. I believe Jesus talked about that a fair bit - I just have not taken it to heart as much as I should. Thankful for His patience.

There are many memories I'll take with me as I leave.

Besides Ne, there are a few women who had C-sections who have done quite well. And their babies are quite cute! The woman with a uterus

swelled with tumor to the edge of her ribs, the baby who's belly was as big as he was - and died the same night. The woman who is a year younger than I, who we told would have to go home - there is no cure for her cancer. Or the

woman who came in with a swollen leg, and then died suddenly.

But there is also the little 2 y/o girl who swallowed lye, and we dilated her esophagus twice so far and she is doing well! Swallowing liquids again. Or the little baby that I helped the pediatrician with for 2-3 hours this afternoon - holding off his Malaria and sepsis.

And the brave little girl who never winced and even thanked me (in English!) after I removed her stitches :)

Swimming, sharing dinners, relaxing evenings, cool rains, and even a rainbow are just a few of the memories I take with me.

But it is the people, the staff, and friends like

Saskia, Jake, and Nienke who have made this time so meaningful. It is the eternal aspect of living life now and one step closer into eternity.

People and God's word - two things which are

eternal. And that is what Life is about - God and

people, and our relationship to both.

Saskia is the Dutch physician who I've known since Gabon. An incredible heart for the people, and a joy to work with. Jake is an ICU nurse who does anesthesia par excellance - and has a wit to boot! And Nienke is a medical student from the Netherlands who's assistance was invaluable on rounds. She is quite adept at C-sections too! It has been a joy to work with them, and to know the fellowship that comes from being together as believers. I will be sad to leave them.

Learning to trust God more and more these weeks.

Trust - what lasts for eternity is born today.

God is my Protector, the maker of heaven and earth - and I KNOW I can trust Him. Seeing these women and children come here because they trust us to care for them reminds me of my coming to Christ for the same reason - each day - as I recognize I can not help myself. Humbling, but reality. God is so gracious.

Thank you for your prayers.

I hope to write at least once more before the end of this trip. Thanks for your patience :)

In Him, John

Mali, West Africa, August 2-5, 2009

MALI

Bon jour!

After 36+ hours of travel, miles of the streets of Paris, and three airplanes...I arrived in Bamako, Mali. Arrived in pouring down rain with water running everywhere. Walked off the plane and waited on the stairs while everyone ahead of me tried to get down them without slipping. Finally made the bus. Once we made it to the terminal I waited in the door of the bus till everyone else had crammed into the airport terminal. It was around 8:30pm, dark, warm, and very wet :)
Another traveler, who happened to be a Malian surgeon from Norway, stood together with me in the dry bus till the driver blew his horn at us - he then laughed with us when he realized why we were waiting. We both ducked in the door of the terminal together - only to realize that TWO planes had disembarked, and everyone else around the airport had tried to get into the same dry room. Talk about close pesonal space!
When the luggage started coming in...the electricity started coming on and off. Warm building, flashing lights, no airconditioning, dark, wet, and very, very close. Good thing claustraphobia isn't a worry of mine. Remember the caves in Bongolo? (See below)
After nearly three hours of standing, politely holding my position in the que, and making it through customs, etc...the arrival at Keith and Krista's home was very welcome. It was a fitting end to the flights :) They were staying up to take another traveller back to the airport at 1 am...but I politely excused myself and went to bed just before they left.
The ride to Koutila yesterday was not less eventful :)
I wish I was quick enough to photograph the runaway cow that nearly picked off our front end at 60 mph. Or the people walking down the highway which we passed within inches on occassion. Or when we swerved to the center of the road to avoid a person who ducked off the shoulder, only to nearly collide head-to-head with a truck doing the same thing from the opposite direction to avoid a cart. The herd of goats that ran full-steam across directly in front of us were dead for sure, except Brett was quick on the brakes. A typical drive across Africa for 5-6 hours...except we didn't have any flat tires!
What made it even more African was 5 adults, three children in three car seats with luggage packed into a Toyota. Thankful for airconditioning, and no flat tires :) Moments of quiet followed by moments of amazing sound. Everyone carried a good attitude, which made the trip go quickly.
Today we started at 7:30 with time in the word and prayer- the entire hospital staff. I enjoyed their spirit. Then rounds. Hypocalcemia in a young lady who had a typhoid perforation repaired a week ago - no labs, just phyiscal exam and history. A young baby died last night and we have no idea why - malaria smear negative. Children with cleft lips, burn contractures, neonates, and an amazing little gal 3-4 y/o who survived swallowing lye. She is able to swallow her saliva now :) Cute as a button. Fun to see God healing her.
Tonight it is time to catch up on a bit of sleep. Thankful for all you who are praying. It is good to be here, and I'm thankful for the privilege. God is very good, even when we don't see all the reasons for what is occuring in life. Just grateful to be apart of his family, a member of his body. That is what life is about.

Bon Jour!

God is very good.
Thankful for His protection and strength.

The weekend travelled by quickly.
Morning rounds on Saturday were followed by a couple of smaller cases including debridement of a foot. And cleaning up some fairly nasty wounds.

The man who was nearly killed by a wild bull (buffalo) continues to make progress. Both of his chest tubes have slowed considerably, but his leg is still a bit concerning. The bull's horn tore his thigh muscles to shreds, and disconnected his knee cap. But he still smiles and is very grateful. I know he is happy to be breathing again, even with a "flail" chest.

Following this came a lady with a lumber hernia which was incarcerated...in short, it meant that we had to open her up and remove part of her bowel. She is doing fairly well too.
The maintenance director stopped by my house just before midnight last night to see if it was ok to let the power go out. We were running on generators and he only had another 80 gallons of diesel fuel in the tank. I explained about the lady and man who was attacked by a bull...and that if at all possible it would be good to keep oxygen going for them. So he did his best. I heard him get up around 3 am to fill the tank again. It takes a strong team working together to keep people alive.

After finishing the day with a C-section for twins who were breech with "locking heads" the day was over!

Then today started with church...interrupted by another man with a perforated bowel. The resident was happy since he is an intern "first year surgeon" here, and was able to do two bowel operations in two days. The rest of the residents returned today so he is back to the bottom of the totem pole. But he had a good couple of days!

Huub and I did an earlier C-section together, and then again tonight...we were called with the exact same case - another set of twins locked together and breech. Two in two days. Very rare...but that is what it is like here. So we did it together. This time the Plastic Surgeon with us did the C-section and I walked her through it. She used to do them all the time in training before specializing - so it was sort of like riding a bike again. She did an awesome job, and both little girls are doing great! So is the mom :)

Now it is after midnight, nearing 1am. I leave in the morning around 8am (2am EST) to start the journey home. It will take 3-4 days depending on weather and I should arrive back in Lafayette on Thursday. Thank you for your prayers for safety in travel, and for smooth travels. There were delays for some coming this way because of weather.

Thank you, Thank you, Thank you for all your prayers.
The director of surgery returned today and was surprised at all we had done. He noted that they rarely have traumas, even rarer to handle what we were taking care of this time. And he noted that we were doing the same level of operations with 2 surgeons that they were doing with 6-7!
So it is not surprising we were a little busy at times.

But God is very good. And having the Plastic Surgeon here at the end was a huge, huge blessing. She was very helpful in caring for the wounds, doing the cleft lip, and helping with multiple other operations giving her insights and input. Without her expertise many of the patients would have suffered greatly. I am leaving knowing the patients received the upmost care possible - and that is really good feeling.

Thank you for praying. Many times this trip I have known that God's hand was involved. There are a few patients alive who would have died without intervention beyond what I could give.
It is good to know we don't walk this world alone.

I look forward to hearing what He is doing in your life!

Time to get a bit of sleep :)

In Him,
John

Friday, 23 of January 2009

Bon Jour!
I hope your week has gone well.
I hear it is very cold back in the USA, especially in Michigan and Indiana where my family is living. Can't say that I miss it much...today was "cold" since it dropped into the low 70's this morning!

Last night was interesting.
Thank you for your prayers. You have no idea how God is using them, but to give some hint...
We had a very nice meal with Huub and Margrite last evening. Unfortunately we missed Rebecca since we arrived late and she had to go to bed. Huub was helping me find IV access for a young lady who had lost a fair bit of blood from her medical condition as well as surgery earlier in the day (we cleaned out an old bone infection). The short of it is that it took "us" (me) nearly 3 hours to do what should have only taken 15 minutes if I was doing the same thing in the USA.

After dinner I arrived home and a few minutes later received a call asking if I would assist the new surgery resident on-call to do a C-section. No problem...it was only 10:30pm.
By the time we actually started and finished it was nearly 1 am.

In the process, the young mom almost died.

For no apparent reason she started breathing very irregularly, began speaking garbled speech, passed out, then quit breathing. The baby had been delivered and was doing well. As the surgeon-in-training sewed I saw the blood turning black and the uterus blue/gray. He immediately left the operation site and started working on the patient's breathing. I took over sewing the uterus to stop the bleeding.

There are no anesthesiologist here, only nurses trained to give certain drugs. If something goes wrong one of the surgeons has to take over the anesthesia. Since he spoke French I figured it was better that he work on the oxygen and breathing issues and I sew.
As I worked, prayed, and prayed as the young surgeon worked, the uterus became pink she started breathing again. Miraculously this morning you would never know that she had almost died last night. Within a few minutes she had gone from life, to giving life, to almost death, and back again. I know God has a reason, but I don't know what it was. Why she is alive is still a mystery. But thank you for praying.

As we finished up we were informed of a patient in the ER who was almost dead. So at 1 am we met a 45 y/o man who was gored by a wild "beouf" (similar to a water buffalo). He apparently startled it as he left his regular fisshing hole and it attacked him. It took them over 6 hours to get to our hospital.
The man had a "flail" chest with his right chest wall moving in and out because of all the broked ribs. His leg was ripped open along the entire right thigh and into his knee...snapping off his knee cap. The muscles and tendons were all laying exposed, except there was grass, dirt, and leaves all ground into it - so it looked like brown muscle instead of nice pink/red tissue. Both of his lung had collapsed, and there was air leaking out under his skin all over his chest.
The patient was quite polite, didn't complain much of the pain, and was quite interested in how we might help him - he was hurting and couldn't breath well at all.
We removed some of the blood from his chest, repaired the breathing problem, and washed out his leg for a looooong time. By 4 am I was home to sleep.

3 hours later I was up again and returned to the hospital to head into the day. We had a few "little" procedures today as well as clinic. Thankfully it was a "light" day and we were finished by 5pm. Had a very nice dinner with the director of Maintenance (he and his wife just arrived a month ago. It was a good way to finish off the "formal" part of the day :)

It is a good feeling tonight to know that the patients are doing better. I know it is by God's grace. I'm still amazed the man survived the wild buffalo attack. I can't imagine what it would be like to have that happen knowing the animal was trying to kill, and almost succeeded last night. Praying the patient will not succumb to infection from his injuries. Thankful that God has his life in His hands. I'm also very grateful for the work of the surgeons in training. Dr. Damle is only a first year resident, yet is quite helpful and well on his way to becoming an excellent surgeon. Glad I can be a part of their training and grateful for God's blessings.

Thank you for your prayers! It is now midnight and I'm planning to get a little more sleep.
Sorry there are no pictures in this blog. They are pretty gory, so best left to your imagination.
I am thankful we have a God who cares about the details :)
Walk with Him!!

John

Bongolo - Saturday 17 January 2009

Good Evening from warm, humid and very nice Gabon!

Thank you for your prayers. I can not express well enough how much your praying for me means, and for how God is working in my life. It has been a very rich, full, and fulfilling two weeks since I left "home". The work here has been challenging as everyone except Huub and the medical student left last weekend. We have kept up with the surgical work thus far, and had some good challenges in the mean time.
This week I have been working longer hours, but still managing to get to the evening dinners relatively "on-time". They are used to surgeons running longer than usual, so automatically made the meals 30-45 later than normal. Quite practical around here!
The picure to the right is of Huub and I in the "Re-animation" room - where the patients come for post-operative recovery.
This was Friday afternoon (late) after a full day of clinic with 4 operations during the midst of seeing patients. Huub is from Holland (married to Margrite) and is a lot of fun. They will be moving to Guinea soon to begin medical work there. Huub will be doing some basic surgery so I am working with him on hysterectomies, C-sections, and basic bowel operations...as well as basic orthopedics. He and Margrite have fast become good friends and I expect we will be in contact for eternity.

Thank you for praying about the Kidney operation. The kidney was huge! It went quite well overall. A bit scary at one particular point, but was grateful for good exposure and excellent assistants (Huub and Amy) and together it came out well. God is very good, especially for the patient. He is a young man who will hopefully have a much longer life. The operation was potentially curative.
It is good to see him walking now, and no longer taking pain medications. Most of my patients in the USA for this operation wouldn't even be out of bed by now, let alone not taking any narcotics!! He is pretty excited about doing so well.
God is very good.

We ended the day on Friday with another C-section for a woman who is HIV+ By doing the C-section it cuts down on the risk of the baby becoming infected. It is higher risk for us, but this is the one time in life where we can make a huge difference to a baby's life and potentially save him or her from a devestating beginning. This little girl was perfect!
Amy is smiling behind the mask :) As a medical student she isn't allowed to scrub the HIV cases, but is right there to work with the baby. Fun to see the whole team working together.

I can't thank you enough for your prayers.
God is defnitely at work in my own heart. It has been good for me to interact with the patients, try to speak with them in French, work with the staff and missionaires, and spend time in the evenings just relating and enjoying people. And most of all, enjoying the fellowship of believers with a common goal of serving God with their entire lives...and demonstrating it daily. The missionaires here did not pick their co-workers, yet they relate day in and day out with them. They pray together, have bible study together, work together, and struggle through tough times together. They are not bonded together because of common interests, languages, personalities or interests...but each is here because of their walk with God. Any other reason and they would leave immediately. You don't work in a place like this for any other reason except your relationship with Jesus. And through that relationship there is grounds for relating and encouraging each other no matter the personality, interests, or social connections. It is all about Christ and His changing power in our lives. That makes the difference.

So far the fish and plants have stayed alive :) I'm taking care of the director's home while they are away. Not a little pressure!

Thank you, again for your prayers. Feel free to let me know how I can pray for you.
The work is difficult at times, and the challenges definitely beyond my scope of abilities. But God has been faithful, and I look forward to what tomorrow brings. I pray the same for you!

In Him, John :)

Sunday, the 11th of January

Good Afternoon from Gabon!

It is a beautiful warm evening as I write. In the 80's, but not too humid since it rained really hard last night.

I was awakened ~5am by a phone call from Huub. A lady had arrived with the umbilical cord coming out, without the baby. The blood to the baby was being cut off so we needed to do something quick.
Hoop is training to work in Guinea and will be there in a couple of months. So this is his last chance to do operations with someone like me to assist/teach. He did very well. Even after all the trauma, miraculously, the baby survived. When he arrived he wasn't breathing...but a few minutes later he was doing fine.
That is why I am here.

A little while later I headed back home through the morning mist while reflecting on the fragility of life. The woman had lost both of her first two babies in birth. And today, on my own mother's birthday, the third baby survived. I don't know what God has planned for this young life, but I know His hand is already at work.


Friday another lady's life was spared. It was quite frankly a miracle. She had swallowed a fish bone a day earlier and it was stuck midway down her esophagus. We put her to sleep and then I tried to find it with a "scope". I could barely see anything, yet there was a shadow off to the side. I could not see the tiny grasper I was attempting to put into the "shadow", but after a couple of attempts something moved and it ended up in her throat where I finally grabbed it.
It was serrated like a saw-tooth knife. If it had stayed she would likely of died from an abscess. She could not eat or drink because of the pain. Later I reflected on the odds of that bone being retrieved - barely able to see anything, let alone a bone, the grasper was too small to grab it, and yet it was enough...with God's help. It reminded me of the story of the fish and loaves - Jesus just asks us to give what we have, and he takes care of the rest. I feel like a loaf of bread or piece of fish sometimes, but I'm grateful that God uses me in spite of my inadequacy.


It is because of people like Huub and Margrite who are here with Rebecca (1 1/2 y/o) that I come Africa. They have a call to assist and help the people of Guinea to hear the good news that God loves them - not with a "love" which distorts reality, but a true relationship with our Creator God which changes all the rules the world claims as "reality".

I see things in this world which are not explained by our science. I see the love of God expressed in ways which few ever have the opportunity to see.
Without the power of God present in our lives none of this would be possible. It is a privilege to see God at work so clearly.


This week I will be doing operations which I would rarely, if ever, do in the USA. It is because of God's grace that I am here, but it is the prayers of those praying for me that sustain me in the challenges. Thank you for praying.


"This is love, not that we loved God, but that he loved us and sent his Son as an atoning sacrifice for our sins. Dear friends, since God so loved us, we also ought to love one another."
1 John 4:10-11

Gabon - January 8

Well, I'm still alive and it appears all is going fairly well. Of course, Dr. Thelander and all the residents, as well as Huub and Amy (the medical student) are still here so it should be going well!

More operations today, and more opportunities to scratch my head and wonder what it was we were removing. Big tumors, which shouldn't be that big. Amy is holding what is probably a prostate tumor. But the patients did well which is the main thing.










Last night as I was walking home I saw the sunset over the far ridge. It was beautiful to hear the birds singing and calling as the calmness of night settled. About 3 am there was a down-pour (literally pouring) of rain and today it is quite cool and nice (70-80's).

Right now the sun is setting again, and the cacophony of sounds coming up from the jungle is incredible. I had no idea insects and birds (&?) can make that much noise!





Amy mentioned that she doesn't care for the tall pine tree next to her house since it harbors millions of spiders (maybe not "millions") because they spin webs during the day for her to walk through in the evening as she goes up the steps. I haven't seen any snakes thus far, and quite frankly, I'd rather look out for spiders than snakes.
Speaking which, I haven't seen any thus far (snakes that is)





Reading in Ephesians and 1 John today. Reminded again how God's love for us is not earned, nor is it gained through trust in Him - it IS love for us because He chose to love us. Because of His example in my life I can love the people here who have not earned my trust. God's love is great enough for me to love those around me without regret and without fear. It is a joy to relate with patients who I know are made in God's image, even as little as I can see it sometimes. The horror sin affects on us is universal. I am glad we have a God who lived through that horror to make it possible for us to have eternal life.

Pretty amazing actually :)

Appreciate your prayers. Keir and the residents leave in the morning. Keir and Joanna are a wonderful couple, along with their two children. It was a blessing to have dinner with them last night and spend a few hours catching up and being blessed by their fellowship.

Thankful for your prayers!

John, Heb 13:1-8

Gabon - January 2009

Bonjour!

If you found this blog than you found the right spot. Many of you had asked for the opportunity to hear a bit more regularly about this time in Africa, so I'm willing to try and oblige.

I apologize up front if it isn't updated every day - but I'll do my best :)

For a brief summary:

Daparted on Saturday, Jan. 3rd about 9am from Lafayette, Indiana.

Arrived in Paris the following morning around 6:30 am local time - and it was only 19 deg F. The airport isn't "heated" per se, and the staff were all wearing coats and scarves insided the terminal, as were the travellers. I had my customary hot chocolate and Pain de chocolate while keeping my fingers warm.

(Yes that is the Eifel Tower below the wing)

The next stop was Libreville, Gabon. Exited the plane with winter coat in hand to experience 80+ deg F warmth and lots of humidity. So humid it felt "wet" on the concrete walls of the airport. About an hour later we passed through customs without a hitch. The costums agent heard that I was travelling to the hospital and noted her elderly parents were flying down the following day to be seen at the hospital as well. It seemed like I was to keep an eye on them to make sure they got off at the right airport. With my limited French who knows what was actually being arranged!

Had a wonderful relaxing evening (aka sleep) as well as dinner with the Solvigs before flying to Mouila on Monday. It was only about 1 1/2 hours with one stop. Not bad. But it was kind of humorus to see one of the pilot's daughters sitting in the cockpit throughout the trip. Security is a relative term, especially in Africa. Remind me to tell you about the Yellow Fever cards some time. Crazy, especially since they are sending sustpected Ebola virus samples here to be tested. By the way, the Ebola virus is back in action a couple hundred miles to the East. I don't think I'm going into the caves this trip (see prior blog).

Last night was a great night of "Settler's of Catan" as we met together to have an evening of food (Pizza - REALLY good pizza) with Keir and Joanna. Keir is the Director of Surgery for the hospital and in charge of training the 5 residents. It was a lot of fun, and very good, to be back with Keir and Joanna, and to see their two children - Luke and Sarah. Luke swam all the way across the pool the day before I arrived! We worked on that together last year.

Today was a good day - only about 10 hours in the OR.

The picture is of a bladder that is distended to almost 4-6 months pregnant proportion! He felt a lot better once it was drained.

My cases which I assisted the Chief and Intern on today, besides helping out here and there on others:

- Thyroidectomy
- Mastectomy for a huge breast cancer

- Inguinal mass - ? cancer

Tomorrow it looks about the same.

Next week there are a couple of challenging cases posted - and then it will be the medical student and Hoop (from Holland) and I. Should be interesting.

Thank you for your prayers.

Sorry this is more of a "list" update...but hopefully it will expand with time :)

Have a wonderful, warm, day!

John