Surreal Moments

I doubt I'll forget some things in life.

Walking back from the Hospital I looked to my left as my eye caught movement by the morgue.
A motorcycle (Moto), with the driver, was balanced there as they placed a dead woman on the seat. That is nothing new here. When someone dies, you have to transport the body away. Motorcycles are cheaper than a taxi, especially if you have to pay a local "Shaman" to clean the car. Passengers often refuse to ride in a taxi that hasn't been "cleaned" of evil spirits.
But it wasn't the dead woman on the motorcycle that caught my attention.
It was the man who was meticulously tying the dead body to the driver, her arms around his waist, her ankles to the bike, ..., tying her to him for the final ride to her funeral.
It was a surreal moment.
Two alive humans, tying a dead body to one of them, to be transported to it's final resting place.

I wondered what it must be like to be tasked with the responsibility of having a body tied to you - to ride over the bumps and pot-holes of the roads/trails of Africa with a cold, limp, dead corpse jostling against you the entire way. Your sweat soaking into their clothes.

What must go through the driver's mind? What did he think about on the way to the woman's home? How every bump and pot-hole must remind him of what is tied to his back?

A surreal moment, indeed.

This occurred while I was walking back to grab a quick lunch. It was a quick bite to eat in order to return to repair a torn hand that had been caught in a corn grinder. The sun was warm, hot, and windy. The sky a deep blue. The ground red with a sandy covering.

But the vision of the lady's body and her driver stuck in my head. Ashes to ashes and dust to dust...but who cares for our bodies in the process - alive or dead?

I often wonder about God's purposes in allowing moments like this. I thank Him for working in me, around me, directing my steps and orchestrating hundreds of little moments (some recognized, most not) in order to develop what He designed and planned. I'm left grasping at the edges of some great tapestry, sometimes desperate to see the whole, but often only catching a glimpse at the frayed undone edges. Or, more likely, seeing the picture dimly, knowing I can not comprehend the whole.

Some day I know God will allow each one of us to see the whole design. How He has been working in each and every life for His glory. And we will finally begin to grasp a little bit how much He has loved us the entire time - and how that love was what gave us life, meaning, existence. We are because He is.

Meanwhile, there is another body to mend before the life that inhabits it leaves. A privilege for this moment which humbles me daily.

Togo - July 2015 (First post)

Hospital of Hope - Mango, Togo

One of the nicest, most efficient, well-run hospitals I’ve visited on the African Continent. From Maternity, Pharmacy, Peds, ICU, Surgery, Nursing, Chaplains, OR staff, Ward clerks, nurse’s aids, cleaners, and washing. The entire hospital is hands-down the top. Medical/Surgical/Peds/Maternity/ICU/Outpatient/Wound care... Some hospitals are better in certain areas, but none come close to comparing in all aspects of overall care. 

I’m amazed at how well the hospital works as a cohesive unit this early in it’s infancy.

The compassionate care says a lot about the people who are working here - Nationals, Ex-pats, locals, and those who have moved from other parts of the country. All work together very well. They have trained ICU nurses, PICU nurses, ward clerks, nursing assistants...the list goes on. "Many hands make light work" - is true. The staff here work hard - but I've never heard any complaining. Rather I observe a lot of "glad to be here with you today" type of interactions. These people enjoy working together. And it is obvious.

Nothing is perfect, of course, but as a whole I am very impressed.

Thankful for the blessing and opportunity to be here to assist a bit for this month of July. The cases have been typical rural West Africa type challenges. Typhoid, snake bites, arrested labor needing C-sections, necrotizing fasciitis (flesh-eating bacteria) needing amputations, skin grafts, hernias, sequestrectomies, and broken bones requiring rodding and plating…

Dr. Lai was a huge blessing as he came at the beginning of our time here - performing some huge Head and Neck cases requiring a true plastics approach. Learned a lot from him. Amazing talent, and a wonderful attitude. He is an excellent teacher - not just an instructor - patient, kind, and always encouraging. The staff and personnel are looking forward to him coming back again.

Julian is one of the boys we operated on while Khoa was here: He smiles every day with the biggest smile, always thankful, and very appreciative. We can’t correct his facial deformity, but the mass that was bulging out through his nasal canal and roof of his mouth is gone. He can swallow again, and breathe easily :-)  He was gurgling through his spit when I first me him. I think his happiest moment this entire hospital stay was when he realized he could breathe through his nose again!
He woke up from surgery. His trach is out, he is taking full-liquids, and is nearly pain free. He is a happy kid! It makes rounds in the morning quite enjoyable :-) He put on his "serious face" for the second picture.

There are the sad cases too…like the little 3 1/2 month old boy whose liver is failing. We opened him  up to see if we could drain his liver anywhere, and there was no place to create a connection. His liver was already beginning to fail prior to surgery, but the family asked us to try. He did well with the operation, but his days are going to be few. He still smiles at me when I check on him in the mornings, even as his eyes are slowly becoming dull as his liver fails. He reminds me of the brevity of life, and how without Christ there is no hope. We are dead men walking, unless the spirit of Christ lives in us. And then, while are bodies will die, our spirits will continue to exist, live, be with Jesus, for eternity.

I am glad I do not worship a dead god who hangs on a cross, nor rebellious spirits that are constantly lying and provoking me to harm - but THE God who is alive, knows me personally, loves me, and relates with me with dignity, compassion, joy, and in reality. When my body ceases to function, I will continue to live, and live with even greater fulfillment. This life now is just the portal to a whole new world. 

My little guy with the failing liver will pass through this portal soon - and I know my God will walk him through this step too. I don’t understand why his life is shorter on this earth than mine. Nor do I understand why I have the privilege of walking a few days with him. But God knows. And I’m content to trust Him - because Jesus IS trustworthy - I know, because He has proven it to me.

It is a huge privilege to be here with these people - all of them - the staff, missionaries, nationals, workers, patients… Not always sure what God is doing, but glad to be walking with Him. And for the next couple of weeks, the Lord wiling, it will be here...

- for that I’m glad!

Sunday in Koutiala

A bicyclist almost upends in front of me, a donkey backs up barely missing the truck guard, children bounding down the road next to the window as the dirt and dust blow in the wind.
Chickens squawk, sheep bleat, a dog scuttles away and a horn beeps.
The air-conditioner is trying to keep up with the heat and humidity but I roll down my window in order to take in the sights, sounds, and feelings. "Will I ever come to find this irritating instead of a quiet, settling, feeling?". To see life going on around me, flowing with the traffic of vehicles, animals, and people?
I am constantly reminded of "life" here. Especially while driving.

As I backed out this morning, the little boy who is barely over a year toddles out of the adjacent courtyard and directly into my path. Once again I'm grateful for Carol's warning to watch out for the "little one who likes the white people".
I climb out to close the gate behind me and he has already latched onto my leg :-) I take his hand and together we walk back to his compound where is older brother is coming to greet me. A common moment, but only because it is full of life. The dirt stained with early morning washings and the sound of goats scrambling by in the dust. Then I climbed into the Land Cruiser to head for church.

Craig and Marilyn invited the Whistlers and me to join them in going to an outlying village for church today. It felt good to be back in a village again. Not quite the same as Niger, but very similar. Mud houses, mud walls surround mud courtyards. Open wells dropping maybe 15 feet to brackish water. And the millet growing all around. Chickens scratching. Children coming and going. Beautiful.

After church they brought us a meal because we were the honored guests. Macaroni and Goat - by hand. I don't get that every day in the US :) These people are so kind.

The Whistlers are a family who are here to help with the construction and maintenance at the hospital. They are their three children are learning the language(s) and life here in Mali for several months before officially starting their work. I say "officially" since Matt has already unofficially been helping out on projects. He is a builder by trade - but gave up living and working in the US to bring their family to the desert in order to give people the opportunity to come to know Jesus. He and Amy told me it wasn't their first choice, but God made it clear it was the best. And they are living it fully!

Tomorrow I return to the hospital to take-down and ostomy (re-connect bowel), and open another lady to see why she is leaking stool through an old incision which is most likely from TB. The sort of cases that are kept for a general surgeon if one is coming here. Turns out the one that is leaking came at an opportune time. Thanks to the gifts of others, I found equipment in the storage depot on Friday that should come in handy for reconnecting the bowel on both ladies. We'll put it in the sterilizer in the morning in preparation for the afternoon cases.

The little gal pictured below is a good example of the wound care here:
She was struck by a vehicle a few weeks ago and lost the thumb on her right hand. She was just recovering well when she burned her other hand. Now she comes daily for dressing changes. No anesthesia on most days, just Jake's gentle talking to her and assurance as the skin is debrided and new dressings applied.

Mary and Jake, nurses here, are running the wound care center and doing a marvelous job. I'm impressed with the care the patients receive, and how meticulous the Malian nurses and assistants are to taking care of these women and children. It is a level of care I've seen rarely, even in the US.
I would like to show you the skin grafts they have done on another 3 y/o child - legs, buttocks, belly...but it is too disturbing to post. The little guy gets all his dressings done while listening to songs on a phone clutched tightly in his hand. He just zones in on the music and turns the rest of the world off for a bit as the dressings are removed. The methods for handling hardship, pain, distress...they are learned early in this land.

Yet, whatever technique a person finds to dull life's pain, divert attention, or avoid the reality of suffering, there is never enough to fill the void in the heart. And that is where knowing Jesus - the real Jesus - comes into the story. I am quite sick of the God I hear touted in most parts of the world, the "Jesus" that is sung about so glibly and without thought. I'm not pointing fingers - been there myself. But there truly is an Awesome God who can, will, does, talk and walk with us. I'm not a theologian, but I do know reality. Come walk with me through a few births, c-sections, perforated bowels, broken bones, and burned children. I'll show you reality. And there really is a God who knows how - and does - heal, restore, and fill the hearts of those who turn to Him. Not a religious God. Not a God of "belief". But a true, living, being who can enter deeper into the deepest parts of your soul and restore the broken and messed up parts. And He makes beauty even more beautiful, songs more colorful, and feeling more full than you thought imaginable.
He is the Creator God. The only One who offers full life without asking you to work for it, prove it, or believe it strong enough to make it real. He just gives it freely to those willing to receive it. Simple.
No technique, religion, or skill necessary.
It simply means relinquishing your hold on all aspects of your life - acknowledging the rebellion that you held onto in order to hang on to your life, and accepting His forgiveness. And with that forgiveness, His life.

That's why I'm here. To give each one the opportunity to come to know the Author of LIFE. The TRUE God - not a religion, experience, or belief. Reality.
And tomorrow I plan to cut open two abdomens in order to address the physical suffering - and pray they will open their hearts to accept the Christ who can heal ALL suffering. That is a privilege that makes me wonder at a God who would allow me to be here with these people. To serve with men and women who have given everything to serve Him. To be here but for a moment while they are here as witnesses of this God every day. These are the ones I think of when I think of people who serve our awesome God.

The day after the long day

She looked good this morning!
The picture above was taken post-op, but this morning she was looking even better :-)

Dr. John Gililland is one of the kindest, most compassionate physicians I've met. He asked her this morning if she had any pain - "No".
Drink any water yet? - a shrug from her mother.
So, he helped sit her up, asked for a cup of water, and then allowed her to hold it in her good hand and drink. She drank it down as fast as her little throat could take it! And then sighed.
He helped her stand up and steadied her for a second as she adjusted her balance.  Her expression barely changed at all as she felt her shoulder much lighter on the one side.
No dizziness? "No".
Was she feeling better? "Yes".
Then he helped her lay down again.
Her face had shown relief after the drink of water.

A new day, the first day, of a new life has started for her. We prayed that she would come to know The One who can heal completely and restore life. The One who can one day give her a whole body, complete and fully restored. I'm looking forward to that day :-)

Very thankful for the examples of kindness John has shown me this week. I came to "help out", but already I feel like I have been the one blessed the most by being here. Watching the staff relate with patients, participating in discussions around the patients with other doctors (in French - so I listen mostly), and preparing for the next operation... has been good for me.

I still don't know where God would have me land some day - maybe Lafayette, IN is the place - but in the mean time I'm grateful for these moments of living life where there are no other medical options.

Driving to the hospital this morning while dodging a couple of carts, and a free ranging bull, I thought again how much  I enjoy driving Land Cruisers in Africa on dodgy roads while avoiding rain puddles. Maybe it isn't often noticeable, but it really is the small things in life which make it fun!

My sister in China commented that it feels surreal to see people making momentous decisions in a seemingly innocuous manner. Her good friend is considering an abortion, and they talked about it last night. Today she was wondering what decision had been reached. And how absurd it seemed - yet felt completely normal - to be going about a routine day and know that her friend may be killing her own baby that moment. Yet the day felt so "normal". Somehow that didn't seem right. And it troubled her.
I recalled the many times driving home after someone died in an accident, or from an illness, or was horribly mangled, burned, etc... and yet I still stopped to pick up groceries, put fuel in my truck, pay bills, eat dinner... life seemed unchanged, yet I knew other lives had changed completely. It felt odd because if felt so normal. And that bothered me too.

I wonder what Jesus must have felt as he walked this earth and related with people? What was going through his mind? How was his life affected, and what was his perspective? I know he saw a lot of hurting people, people who's lives were being changed in dramatic ways - and yet he knew how to walk in that reality. Knowing Jesus drives me back to reading the Gospels again in order to understand what He said in light of the reality we all know.
And I'm looking forward to the day when we can see reality from His perspective.

Tomorrow I'll stop by and see how the little ones are doing. And thank God that He holds them in His hands. And I'll pray that I am one step closer to walking in His world with Him.  Pray to see the children with His eyes and live to show kindness like John when he gave the little girl a drink of water.
Hebrews 12:1-3

Long day

Just a quick note.

I hate evil.

Amputating an 11 months old baby boy's leg is horrific. Especially when it is dead from infection.

Following that with another amputation is even worse. Like removing the arm  of a 9 y/o girl because her broken arm was "fixed" by a Shaman (Witch Doctor). He "repaired" it by stopping the blood flow completely. She was brought in today because her arm became a stench in the house - from the necrotic muscle and rotten bone.
I can not imagine the horror she has lived through for the past several weeks.

Two children. Both "add on cases" for the OR. This evening.
I hate evil.

I'd post pictures. But, quite frankly, they are too horrific. I took them to remind myself to pray for them. But I won't forget. I know that I won't forget now that I'm back where I am staying. The smell, frightened look, suffering. It will be with me for a long while. That, and the feel of a small, soft, necrotic arm that almost falls off in your hand when you lift it.

I hate evil.

And some people wonder why I come to places like this?

How could I not come??

Jesus said to let the little children come to Him. I'm looking forward to the day when He comes to destroy evil. Why do people even hesitate when I ask if they would like Jesus to return at this very moment? I would. And I would especially if I was living with a rotting arm, dead leg, or other disease.
It seems to me it is only people who are sitting in luxury, ease, without pain, who ponder whether or not they would like Jesus to return this moment. If we had even the tiniest idea of what it would be like to be free from evil - I really doubt we would hesitate to see Jesus return.

That is, of course, you don't recognize evil, or Christ.
And that would be a pity - because there is a reality and both exist.
And not in fairy tales. I know.

I know because the smell of that little girls arm is still in my nose tonight. The little baby;s cries are still in my ears. God, my Father, my Savior - His love for me is why I'm here. I have no other reason to live except for that reality. And I'd really like to see evil destroyed. Forever.

Matthew 19:13-15

Vessels from a Surgeons perspective - contemplative

Now here’s an Idea... After spending a couple of weeks working in Africa a comment was made to me about humility in our lives as Christians. What it looks like, how it is communicated, perceived, and lived. That comment has been niggling at my consciousness throughout the single engine plane flight to the capital city, the afternoon, during dinner, onto the Boeing 777, in-between naps during the night...and into this morning sitting in the Air France lounge.

Caveat, right up front!

Not many people are probably going to appreciate this perspective, but I think there will be some who agree. And sometimes thoughts should percolate.

Might need to open the thought with a couple others first...

Humility: Walking with God in recognition of what HE has done, is doing, and will do in the future.

Perspective: A right understanding of God. Impossible to fully grasp at this time, or ever for that matter, but should be growing steadily!!

I walk with God. THE God who created the Universe. Why should I be anything but humble? God who created me - loves me. That reality alone is awesome, literally. He gives me the breath that I breathe. How can I truly take any credit for any “accomplishments”? To admit I am entirely dependent on Him only makes sense.

“Life’s dim windows of the soul

distort the heaven’s from pole to pole

And goad you to believe a lie,

when you see with, not through, the eye”

- William Blake

God created my eyes. He gave me sight. Gave me my mind, my hands, gifts, abilities.

I cannot take pride in this. They are gifts given out of His love, design, purpose, and choice. What option do I have but to give them back to Him? How could I honestly think I could steal them as my own, or somehow contrive the flimsiest excuse of a thought that somehow I am “Captain of my destiny”? What ludicrous foolishness! Yet, to those who do not realize this relationship - to them - I am the fool. They are blind to the truth that there is no such thing as a “self-made man/woman”. We do not create our destiny. We are simply given the choice to accept or reject God. No middle ground. And some are not given that choice. For those who know me, you know who some of those are - for certain.

Now the thought: God has made this vessel holy. And it is made holy by Him, for Him, and completely HIS.

Some religious leaders would have me consider my life as nothing but a hideous evil, an ignominy, a physical being harboring a heart that is full of sin, evil, and has nothing good within it. They love to quote Calvin and Augustine along these lines. 

But somehow they don’t seem to recall the words of my Creator: “I am the resurrection and the life. He who believes in me will live, even though he dies; and whoever lives and believes in me will never die. Do you believe this?” - John 11:25. 

Or, “A person who has had a bath needs only to wash his feet; his whole body is clean...” - 13:10 

“Because I live, you also will live. On that day you will realize that I am in my Father, and you are in me, and I am in you.”- 14:19-20. 

“I am the vine; you are the branches. If a man remains in me and I in him, he will bear much fruit.; apart from me you can do nothing.” - 15:5

“My prayer is not for them [the disciples] alone. I pray also for those who will believe in me through their message [that means me and all others who have believed in and given their lives to Jesus], that all of them may be one, Father, just as you are in me and I am in you. May they also be in us so that the world may believe that you have sent me. I have given them the glory that you gave me [!!], that they may be one as we are one: I in them and you in me. May they be brought to complete unity to let the world know that you sent me and have loved them even as you have loved me.” - -17:20-23.

When I read these passages and numerous others, I realize that I can not look down upon nor denigrate my God’s creation. I have no choice but to respect it greatly - to be in awe of His goodness and praise Him with every thought, action, breath. 

God does not live in sin. He does not indwell hideous evil. His spirit does not indwell unholy vessels. The vessels are not intrinsically holy. Because of sin the human vessel is unutterably evil without His presence. But His presence changes everything!

Do not denigrate what God has done by calling it evil! Take no pride in the blessing we have received from Him. Only be entirely grateful and give praise to the Awesome God we serve! I thank God I no longer have a wicked and unbelieving heart, even though I am tempted at times to act and feel like I do - when I see with, not through, my eyes.

It is when I see life from a perspective of one locked inside a vessel that is “me” and accept every facet as evil, unregenerate, despicable...I have no choice but to see myself as unloveable, evil, despicable. But this is not the creation God has made - at least not now - because His Spirit now lives within me. I see through my eyes - seeing life from within a vessel that while wasting away has been remade into a holy vessel because of the LIFE that GOD has placed within me! The vessel is pure, not because of me, but because of the Spirit of God that dwells within me. His touch has made the leper clean. Literally.

So, back to my earlier comment - 

There is no room for anything BUT humility. All gifts, abilities, sight (physical/spiritual), understanding, wisdom...are simply that - gifts! We are stewards of abilities and opportunities. Yet even then He is willing and will direct and guide according to our obedience to his command: To love one another. There is no pride in real love. Only a desire to see every person through eyes which have opened to see from the perspective of Jesus. Not the view of people and life from an unregenerate perspective. But of Jesus.

And He said he would do that for me. For you.

He can make each of us holy - Now - Give us eyes to see through and continually grow in appreciation of His incredible love for each one of us.

That truth settled deeper into my soul this trip to Africa.

A deeper desire to love out of a heart that has been filled with the love that Jesus gives. To live in an expression of a pure heart that has been redeemed and changed. To see through eyes that have been given His perspective. To see dimly now, but ever clearer. And never return to lies that blinded me in the past. To choose truth - the reality and person - Jesus.

There is no room for pride in this body. All is lost without the presence of Jesus alone. A vessel that is made holy by His presence. And I long for the day when we will be in that Presence and it is seen clearly beyond what any of us can imagine! To experience love as it truly IS. Jesus Christ is the same yesterday, today, and forever. Heb 13:8

THAT is reality :-)

A day in Africa

Every once in a while someone asks me what it is like to work in Africa. Granted my trips are very short and only snippets of the reality of what actually occurs on this continent. But today was bit of a smorgasbord.

After rising early to have a fresh banana, banana bread muffin, bowel of oatmeal, and a cup of Via Starbuck’s coffee (brought with me) I left for the office with the PAACS director. I was going to assist in practice oral examinations for the Chief residents. It is their opportunity to prepare for their final exams coming up in a month or so.

We waited 15 minutes before their late arrival, which meant shortened question time and no feedback for them before weekly Grand Rounds for the hospital began.

The Pediatrician for the hospital gave a superb lecture on Measles after which there were no questions - just silence - followed by enthusiastic/polite applause. Some appeared genuinely appreciative. But I seriously wondered how many were actually listening. I find it very difficult to tell when people here are actively engaged in life/learning vs going through the motions. Reminded me of some of my meetings back in the US!

Then conference with the surgical residents. A chief resident gave the remainder of his lecture on the Liver as Keir and I interjected comments. New surgical scrubs were handed out. I presented the two OB-Gyn textbooks donated by Dr. Renee’ Knutson - and the guys were VERY grateful. She received a cheer :-)

The OR team started working on cases as the 2nd yr surgical resident and I started “lightening rounds” together to see all of the surgical patients (? 24). Shortly after we started the mid-wife showed up at the door to one of the rooms with at least 2-3 assistants in tow. I think they were there to learn how to “talk to the surgeon”. She proceeded to lay out the difficulty with a certain patient who was at term, in labor for the past 20 hours, labor had stopped, she was bleeding, and the baby appeared to be in distress. We agreed we would come see her in a bit.

After we made it about 1/3 of the way through, Amanda came to tell us one of our patients was in trouble. After some hesitation (on our part) she re-stated the situation - she really wanted us to come with her immediately, i..e,  now. Two of our paraplegic ladies, one of whom has HIV/AIDS, have been declining. Both have been moving towards death, only one a bit quicker than the other. It was the “healthier” lady who had become rather unresponsive, hypotensive, with decreased oxygenation, and lost all IV access. 

The difficulty - the surgery team knew she was dying. It was only a matter of hours or at most days. Now her husband was insisting that he was taking her home immediately. Minimal blood pressure, rather incoherent, and increasing fever, unable to take anything by mouth...and it was at least two hours to the closest “hospital” (if you want to call it that) near their home. A death sentence.

After a bit of persuasion, via multiple persons, he agreed to allow an IV to be re-started (by our Med/Peds physician - thank you!) and IV fluid. After she started to respond to the fluid bolus, it was another round of discussions before he agreed to at least one dose of abx to tide her over till she was closer to home. She was gone later this afternoon. 

Why the difficulty? When someone dies, often no one will transport the body away, and if they do, they charge exorbitant prices because they have to hire a witch doctor to “clean” the vehicle. Without an exorcism no one will ride in the car again. So, our patient went home to die so her husband wouldn’t be responsible to pay for cleansing a car. 

Simple.

Back to rounds -

We made it out of the adult side of surgery and started into Peds. Thankfully all the little ones are doing great! The 5 y/o boy who drained >500cc of pus out of his hip from TB was walking a bit better. Decided to leave his drains till Friday. The 3 y/o boy who has lost >1/2 of one of his clavicles to osteomyelitis is looking much better. The 2 1/2 y/o girl who burned her hand after being knocked into an open fire is able to make a fist (sort of) again. She wasn’t scared of us today :-) And the little boy after a hernia repair looked perfectly happy!

Then to maternity...

We had stopped by there after the discussion and IV start re: lady dying, and decided that our patient at term needed a C-section. Probably ruptured uterus vs abruption. She was in the OR being prepared for a spinal as we rounded Maternity. There was another gal in labor who had a prior C-section, then delivered next at home. We were waiting to see how she would do.

Eventually we started the C-section on our first pt. Baby born in distress, meconium/blood/amniotic fluid. No rupture, but looked like a possible early abruption. The baby perked up fairly well with aggressive resuscitation. Mom did well. And the 2nd year resident, Fabruce, did a fabulous job! Fun to assist young surgeons who are doing well.

Back to Maternity - now there was a young gal who looked all the world like she was undergoing a ruptured ectopic pregnancy. Thought we would check with the u/s. It doesn’t work anymore. So the junior resident walked back across the compound to the surgical clinic to retrieve that machine. Musical u/s machines are the norm around here. Out of four, I think one is working at present.

History was perfect for a rupturing ectopic. Exam was all over the place. U/S indicated intra-uterine pregnancy (by my less than perfect ability). The patient wasn’t pale. Blood pressures were good. Abdomen was still soft and no evidence of peritonitis. Only she had severe pain in the pelvis. So we implemented the time-worn method of surgery - tincture of time. 

Back to the OR. I was slated to assist an upper-level resident with bilateral hernia repairs. But as I waited and hung out with Keir as he and a Chief resident performed an urethraplasty for a stictured urethra (remember - it is GENERAL surgery here) I finally discovered why the 3 hour wait. They were sterilizing more gowns!

Apparently there are not enough gowns when people like me start showing up. We have been using the same cotton gowns, patched and re-patched since I started coming in 2005. And they were at least 10 years old at that time! Needless to say they are much shorter, arms are torn in many places, and several have finally disintegrated. So...we waited. 

While we waited I walked across to the endoscopy room to locate a bronchoscope for Keir to use in locating the exact location of the stricture within the urethra. He slid it through a hole in the bladder and along the urethra to see where the light ended up. We stuck the source end in the laparoscopic light machine for a light source. It doesn’t matter what you use, just make it work. Brochoscopy ( for lungs) in a bladder. Yep.

As they were sewing up the urethra, I asked about suture. No suture is wasted in marking or holding tissue. Even the type of needle is rarely considered - why? - because so many times just having the right type of suture (or any of the right size) is a miracle in and of itself. I use at least twice as much suture on my repairs at home, and I’m one of the most conservative surgeons in our hospital! Mainly because my assistant, Rhonda, keeps reminding me that I could use less - she came with me to Togo and learned the suture lesson well.

Which reminds me, we are out of narcotics here - only Fentanyl is left, which is short acting and only used sparingly. All surgical patients use Tylenal and Ibuprofen, 3 times a  day. That is it. Prostatectomies, Mastectomies, C-sections, hysterectomies, hernia repairs, hemorrhoidectomies, orthopedic cases,... Pain is a matter of life. Period.

Brief consultation with Medicine about an elderly Frenchman who is dying of TB. He is coughing up blood now, and has perforated his lung somewhere since there is air coming out under his skin and up into his neck. He is a long way from home and has no family here. He will end his days on earth here, and likely soon. In the “old days” we would pack his chest with ping pong balls to collapse the lung and shut off the bleeding. No ping pong games around here. And he is too advanced to attempt it anyway.

Discussion held about the elderly man who fell and broke his jaw. We wired it shut last Friday after he laid in another “hospital” for over a week with his mouth hanging open without food/water or care. He is now doing somewhat better with his mouth shut. But to do another operation would likely kill him. If he learns to drink he may live.

We finally started on the last case of the day (which was slated for 10am) around 2. Simplice did a great job. Fun to see him making progress, and he wants to learn. I left with the Junior resident who offered to let me drive “my” old Suzuki which I first used over 9 years  ago. Some things never change.

As I stepped out of the car he reminded me that I had walked him through his very first hernia surgery. He was still thankful, and had remembered our working together. It struck me that we never know, really, when God has used us to have an impact in someone’s life.

Over the course of this day I wondered what difference do we make?

Two ladies dying - one of sepsis, the other of AIDS.

A baby survives, and her mom made it through the C-section.

Little children walking again, and a little one using her hand.

I wonder what heaven will be like.

Because this life on earth often reminds me we are not made for this world. We all know it - somewhere deep down inside - we all know it. Some admit it. 

I am thankful to know Jesus who made it possible to live with purpose and in reality - seeing beyond the frail vessels which hold our spirits. To be a part of His purpose even if we can’t see it. 

But sometimes it takes someone like Fabruce to make a comment about learning to repair a hernia a long time ago... and I’m reminded that God is doing things outside our realm of thinking. For that I’m glad.

Gabon again :)

Just thought I'd give a brief update...

This is a note I sent to a couple friends who came with me last year:

Thought of you two when I came back from the OR a bit early today (4ish). I have a couple of hours before supper and a nice, fresh, avocado was sitting on my counter.

So...

I cut it up, put some on a piece of bread, and squirted cheese spread on it! 

Not exactly the healthiest of all snacks, but it made me smile to think of the toasted ones we made for before dinner snack one night.

Anyhow, no c-sections this week but there is one brewing in the distance. Mama Julienne came by the OR three times today to try to convince the residents to do it...but so far they have resisted. She should be able to deliver on her own, but the midwife is off for the weekend and wanted to have her complete before she left in the morning. Funny how some try to make babies fit to a schedule :-) I think you must have taught these guys something Renee'!

Today in the OR, we had a patient come back with a probably PE. When I mentioned getting the U/S, immediately they jumped and were eager to get it. That is much different than in the past (before you came Rachel) when they would hesitate, mumble something about "I'm not sure what that will show us", and then shuffle off to get it. Today they were back in a flash and quickly started assessing.

I can definitely see some things that you all taught them have stuck!

Outside of that, it is quite warm, humid, and sticky. With most of the team away except three of the guys, it has been rather uneventful. The two chiefs have handled nearly everything by themselves, and I assist here and there as needed. It is good to see the hard work that Keir has put into these guy's lives paying off in huge ways.

Trust you two are doing well!

No pictures this time, but will try to find something before too long.

As I walked home from the Davies this evening I looked up...
There are no words to describe the beauty of a full moon in a clear sky while looking up through the canopy of a warm, humid, equatorial jungle in Africa :-)
Only one Being could create such beauty - and I'm glad I know Him!

Saturday in Koutiala

Well, it's another warm day :-)

Enjoyed rounds this morning with Robert, while Craig graciously acted as  my interpreter. I "hear" much of the French, but I don't always pick up on the little things, the "little" aspects which provide the true picture of what is happening. So thankful or Craig's willingness to serve. I like seeing the progression of patients, the returning patients for wound checks, and the new babies born in the night. Always better to see improvement.
No C-Sections last night, and I'm on-call today...so the odds are... 2 am...?

After we finished I went to Peds to see how Jason (Pediatrician) and Kristen (Nurse) were doing. As usual, they were having fun :-) We changed a PICC line dressing together, and saw the babies and children. The boy and girl pictured below are here for chemotherapy. They look so much better than when they first arrived - and both are quite the little characters! Jason and Kristen are as well, but that goes without saying :)

You are looking at 2/3 the CMA team here now, and the entire medical team for the 100+ bed hospital, except for two of the Malian interns.

 Normally there would a CMA team of 35-40 plus children. So, it is a small community at present with various vacations coinciding nicely with the current rebel conflict up North. You don't see many "white" faces in the country at present as tourism is ~completely shut down, and most ex-pats are staying away from the country.

I really enjoy the "team" aspect of working with Saskia (Med Doc/OB-Gyn),  Lisa (Nurse/Anesth), Jason and Kristen as they work with the medical Interns and staff in caring for the patients here. I get to work on "both" sides of the fence - Med and Peds - as the surgical consultant. Sounds like a big deal, but in essence it is helping out wherever they can use me :-)

The toughest thing is seeing children when there is little we can do to help. I won't put their pictures in here - it would turn most people's stomachs.

I will remember the 2 y/o who walks on her hands and feet because she can only see out of one eye. Her other eye is completely replaced by a tumor that sticks out 2-3 inches from her head. Can you imagine trying to learn to walk with only one eye?
She rubs the tumor once in a while and starts it bleeding again. Her mom tries to keep the flies off of her.
In my heart I wanted to take her to the block immediately and enucleate the tumor, but the better treatment would be for her to go through the system already set up in Bamako. It sits like a rock in my stomach that we can't do something for her. She is scheduled to leave Monday.

Or the little 3 y/o girl who came in yesterday with a large tumor expanding across her abdomen. She has a scar along her left side, long and narrow. The parents are quite poor, uneducated, and have no idea what kind of surgery she had in the past. I couldn't find a kidney along her left side, and the tumor appears to involve the one kidney on the right. How long will she live? I plan to obtain a biopsy to check, but it looks like there is little we can do for now. She is quiet and looks tired all the time.
I don't wonder why.

Doctors without Borders is around the corner from here. They send us their complicated patients or the ones who may need surgery. I've thought of working with them in the past, but when I see the attitude and care for the children and women at the hospital here, it is an easy decision to work with groups like the CMA. A place where the patients come and are cared for not just physically, but also spiritually. A place where Jason from Arkansas, Kristen from WI, Lisa from IL, and Saskia from Holland are working daily to see a difference made here - for eternity. These medical servants are living from their heart; not just because it is a slogan on a  wall, or a "mission statement", or somebody somewhere thought it would be nice to treat people well. These men and women live who they are - heart, soul, and body - in a place which gives them the opportunity to express themselves so eloquently.

It has been only two weeks since I landed in Mali. The second time is sweeter.
The days may appear mundane sometimes, but then I catch the glint in a child's eye, see a mom wrap their baby closer to them, or watch a nurse patiently explain for the 4th or 5th time what needs to be done...and I realize that it is in the moments that we truly live life. It is these moments that I live for - to see Life and know God is in it all.
Live the moments.

Koutiala, Mali - 


Last post was in Gabon...without much follow up. I'll have to catch that up-to-date soon :-)


Earlier this summer Saskia wrote and asked it I would be able to assist as a back-up surgeon for the Women's and Children's hospital here in Koutiala, Mali. The catch was that there was a coup, then a rebellion up North...all of which upset the country a bit and prompted the US Govt. to suspend all travel for US citizens. It has stayed relatively safe in this section of the country...and now I'm here.


Today I sent a brief update to a couple friends. I decided to use the excerpt following as a post today. Nothing extravagant, but it may give a flavor for the work.

"...Yes, Gao is a bit further north/east - probably about 150 km or more. No disturbances down this way.
There are only 4 singles and one couple left of about 35-40 missionaries not including their children, here in Koutiala, who all work in or for the Women's and Children's hospital. The National staff is still fairly full-tilt, so no worries there.
Thanks for your prayers. Much appreciated.
I'll include a bit of what I shared with my tech, Rhonda earlier today...

"Why Yes! Open Chole's can be fun!! Especially when they are for cholelithiasis and not infection, so good tissue planes and nice anatomy (whew!!). Little blood loss, and an assistant that is brand new, hardly trained except to set up a table, and had never seen a gallbladder. He was excited - calmly excited, as I think he was a bit nervous. It is funny, but "big" cases over here are quite "normal" since nobody knows the difference. I sometimes have to tell the team that it is a "big" case and I need more equipment, otherwise they give me the exact same instruments for a c-section, bowel excision, leg amputation, and cholecystectomy!

I also worked with him to disarticulate a hip and do a leg resection on a lady with Nec. Fasciitis, also removed her dead baby. I think that was a HUGE eye-opener for him. One of my top-5 "worst" cases that I've stored in memory. I don't ever want to do one of those again - and thankfully, will never likely have the chance. She died later in the day. It was her only chance - and if it weren't for the overwhelming sepsis she might have made it. Definitely not a good day on Monday.

...
Hearing what the weather is like there is making me feel a bit guilty. It is hot here, but it is supposed to be hot! My brother wrote me and said he was watering the lawn in front of my house - which means it is REALLY dry. I still see some occasional twigs of green grass around here. Rare though.

Last night it was quite warm as I ate dinner at a Malian family's home. It was typical African, with eating with our hands, and the men inside (where it was warm!!!) and the women and children outside in the cool evening. Kind of wished I was a kid in a way :-) It was some kind of dish made up of a grain, spices and onions, and fish sitting on top of it. Lots of oil mixed in to give the "millet" some substance and make it stick to our fingers.
Afterward we drank a sweet millet/grain type of porridge for desert. Kind of like drinking thick oatmeal, partially cooked, with lots of sugar and a little milk.
Then,...the rounds of HOT Tuareg Tea (the pure tea/sugar combo) poured in shot glasses and sipped loudly (to keep from burning your tongue). Thankfully there was about 15 minutes between rounds to allow the caffeine to kick into place in time for the next shot. Good stuff. 

Jason and our Host

Home around 10:30p in order to put together a lecture for this morning - didn't have any problem staying awake! :-)

Gave a lecture this morning to the nursing students. They seemed to like it. Gives the staff here a break from lecturing as well.

...
Ok - it's quiet here, at the moment. Slow Wednesday. A couple of procedures, barium enema and EGD to do in the next couple of days, and possibly some skin contractures to debride - otherwise only emergent cases expected. So I'm going to work on a lecture or the docs.
"

-- There you go. I know it isn't too exciting. But Life is often lived in the mundane wrapped in eternal perspective.
Thanks, again, for your prayers and I do hope you are having a wonderful summer.
Blessings,
John

Three days - complete

So, we are sitting here discussing ice cream in the middle of the jungle.

And its not even hot out!

While walking to dinner this evening we were discussing just how cool it was after the hard rain this afternoon. It seemed like a "night" rain since it usually rains that hard at night here, not during the day. Day rains are a bit less tumultuous - most of the time.

The guesses on the current temperature ran from 67-72 deg F. Turns out it was 80 deg F.

I guess we have adapted when we think 80 deg. is "cool".

Eric and Wendy were wonderful hosts, and Rachel's green beans from Libreville fit the fried rice combo perfectly. After Eric's just cooled from warm brownies, we were content to sit and chat while Esther (10 mo/o) entertained us. Wendy is due with their second baby this summer, and they are very happy that Rachel, Renee's niece who is an ultrasonographer, is here. "Very Happy" is probably an understatement as they would like to know if they should expect a boy or a girl :-)

The guys here (surgery residents) are definitely enjoying both Renee' (Ob-Gyn) and Rachel's expertise. So much so, that the acting-Chief resident asked Renee' to assist on a rather large thyroidectomy today! That was followed up by the removal of a huge uterus, and again with case that Renee' hasn't seen a quite few years :-) Enough to keep her happy for sure!

Rachel (or Rrrrahshell as the residents call her) has been busy going between cases seeing in real live living color the organs and structures that she has, up until now, only visualized on the black/white/gray screen of an ultrasound machine. She has said several times "that doesn't look like the pictures in the book", or "so that's what it looks like!". When she isn't in the OR she is off to other parts (buildings) of the hospital scattered around us to do ultrasounds for all kinds of conditions - even an eye :-) Which, by the way, was still attached and functioning well! She had to explain how she did it!

Fun to still be learning.

The walk home after dinner also included a brief perusal of the heavens - one of the clearest nights I've seen in the jungles. Brilliant stars with the massive milky way stretched out overhead. Beautiful :)

Rachel Thompson walked with us and we started looking for spider eyes glinting back at us from the rocks and grass along the path. Brilliant green glass dots sprinkled along our path. I didn't make Renee' and Rachel G. feel any better to hear our "oohs" and "aahs" as they walked along in their flip flops wondering how many of the critters were actually around!

Speaking of critters, the Thelanders have new pet! They've named him Einstein. I've seen him once, and believe the name "Houdini" would be more apropos. He's one of the largest "mice" I've ever seen - aka, probably fits well in the rat family :-) I keep telling Joanna (the lady of the house) that just because he comes and goes through their attic without invitation doesn't mean they have to hunt him! So far he has eluded three rat trap, eaten all the bait, and never stepped in the glue traps. At the moment, he is still the elusive unwelcome mammal that makes noise over their heads at night. My recommendation to give up the fight and adopt him as a pet isn't making much headway. I'm still on rat patrol call every-other-night in case a trap snaps. I didn't get a chance the swing my machete the first time I chased him out from under a door, but I'm better prepared now - he is definitely big enough to hit (but I'm still calling him a large mouse so as to encourage the pet idea). At least it isn't a snake.

And we haven't seen any snakes thus far. For the record.

To sum up the past three days:

~30 operations over three days with 2-3 residents operating isn't bad at all. I'm doing purely "general" surgery, meaning my operations are Nothing that I "generally" do at home. Prostatectomies, Hysterectomies, Orthopedics, Hand...but I did get in on an epigastric hernia :) Even Renee' is stretching her boundaries like assisting on a large thyroidectomy today! She is good at anything she puts her mind to :) Incredibly good teacher. And the guys are really enjoying her input and expertise. Very blessed to have her with us.

It is fun to work with these guys - all capable, good humored, excellent work ethic, and personable. They obviously know and walk with God. His spirit is evident in the way the work with the patients, and each other. Fun to see their progress over the past few years. Keir (the Director for PAACS - the surgical residency) is doing an outstanding job. We definitely feel blessed to be able to work in assisting in the teaching of the residents and care of these patients.

Never a dull day!

I'll have to talk about that some other time.

And the ice cream... Renee' is going to give me her recipe for Pistachio Ice Cream. And we all thought Breyers 5 Vanilla ice cream would be awesome tonight! And the rain has begun again...

Bon Nuit :)

February 13, 2012

First day of clinic - Successful!

Renee', Rachel, and I (aka. Ree'johnal) survived the first day of clinic here in the jungles of Gabon. "Survived" might be pushing it a bit, as it was a quite enjoyable day with a nice number of patients (steady stream), an excursion to the Ob-Ward for a check on a delivery, multiple ultrasounds for Rachel, and Renee' was in high form with most of the cases in her expert field :-)

The Residents worked efficiently and saw quite a few patients - ranging from a little boy with a swollen arm (and likely Lymphoma), a man with a huge prostate (and likely cancer), women with various uterine anomalies, infertility, and a man with colon cancer and an "apple core" lesion, to name just a few. The 2nd yr resident effortlessly reduced the jaw of a lady who "yawned" three days ago - and her jaw stuck open. They tried unsuccessfully to reduce the dislocation where she lived, then it took three days to get here from her village. She was quite relieved to have a bit of anesthetic and have her jaw back in place. Little things like that make a person's day much better.

By the way, you can't close your lips with your jaw dislocated.

Three days.

Occasionally someone asks why I would come here. I most often refer them to these blogs. It is easier than trying to sum up an answer in one sentence.

But, in short, I come because I have been blessed to have the privilege of the opportunity to work with these residents, nurses, staff, and missionaries. God opens the door - and by His grace, I just walk.

Now - getting here this time was a bit of an adventure for Renee' and Rachel! They started at about 2am last Thursday - flew from Indy to Washington DC, met with the representative of Gabon at their embassy to obtain a visa, flew to Atlanta where they met up with me, flew across the ocean, ran through the Paris airport to be the last people on the airplane to Gabon, and finally arrived 36 hrs later in Gabon in time for dinner - but without their luggage. It didn't quite make the quick trip through the Paris airport.

A few hours later we were up and off to the airport again to fly across the equator, down, deep into the jungle, to the mission hospital. As we flew over our usual stop with the african airlines I commented to them (i.e., yelled as loud as I could into the back of the plane) that from that point we would have needed to drive another 2 1/2 hours. About 12 minutes later we landed. 12 minutes vs. 2 1/2 hours. Crazy.

Ever wonder why I enjoy flying? :-)

The gals were very glad Joanna T. is such an incredibly kind hostess - after 2-3 days of travel they were ver ready for a change of clothes. And, thankfully, our luggage arrived last night before midnight.

Speaking of midnight - just before then I received a call from the house next door. It seems a certain rat has been stirring in their attic for at the past few days. Traps and glue have not been successful in trapping the beast. However, a few hours into the wee hours of the morning, the phone rang and I was scurrying up into the attic myself to see what was banging around in the dark.

Turns out the rat had eaten all the bait, successfully avoiding the traps, and had been industriously chewing away at a large plastic travel bin. I caught site of the critter as it made its exit, just before I could swing my machete. I would have slept better having bagged the beast of the night, but instead had to go back to bed for an hour and wonder about better options. Just before dinner tonight we made one more foray into the attic - but still not rat, and I reset one of the traps.

We are going to win the contest before the trip is over. Or else Keir (Joanna's husband) will come home and solve it for us! The kids and I had fun hunting for it this evening anyway :)

Tomorrow will be a full day. Three OR's are scheduled for four residents along with Renee' and I. Rachel will be busy with Ultrasound I'm sure - she is quite a good teacher and the residents are enjoying her teaching immensely.

Somehow I'm scheduled on two hysterectomies and Renee' is scheduled on a thyroid - so it should be interesting for the both of us!

So, the week has started. Good food. Good fellowship. Good work. And a whole lot of thankfulness to be here at this time. Thankful for God's faithfulness as we have looked into the many faces of hurting people. I know there are tough times ahead. And I'm thanking God for his grace and love already.

I mentioned the lady with her jaw stuck open for three days...because it is one of the easier things to talk about. There are more painful examples, but that will do for now.

Thank you for your prayers. God IS good. Thankful for what He does through each of us.

John

Life out of Africa

4 Feb, 2011
Sitting in CDG after an uneventful flight from Gabon. Quiet. Starting to feel a bit tired.

Amazing to see how old I have become at this point in life. It takes time to mature, just realizing how purposeful life must be lived in order for maturity to be to become a reality. Takes years. Watching Luke and Sara grow up has been insightful to me, just to realize how consistent and enduring the training and relating has to be to lay a solid foundation for future maturity. Fun to see it happening in their lives! Same for little Luc :-)

Yesterday was a rather longish day -
Woke at 4:30 to roll out of bed beneath the whirling dervish of a fan spinning loudly overhead - but not loud enough to drown out the sounds of insect and avian activity outside my house. The sounds of the jungle awakening to another warm, humid, sun be-splotched day.

Quick shower and breakfast, final clean out and house review, and then into the old Land Cruiser to start for Mouilla 2+ hours North.
Boarded the OP “bus” for the 6-7 hr trip north to Libreville - a rapidly deteriorating dilapidated Toyota designed for 17 people without luggage. We packed it with 17 people AND all their luggage - which included huge bunches of plantains, bags of potatoes, and coolers. The tires rubbed the wheel-wells when we rolled over the pot-holes.
Thankfully my long legs earned us a berth in the first row which allowed for a scosh more room :)

Traveling at speeds up to 75 MPH we made pretty good time towards Libreville. The tires started smoking after a couple of hours of rubbing them intermittently on the metal frame every time we hit those “potholes”, which became very frequent. The smell of burning rubber convinced a few of the passengers we were in for trouble.
When we stopped for lunch several tried to convince our “chauffeur” to look for another tire. He appeared to be about 17 y/o, and acted much less mature. Their pleas fell on deaf ears.

About another hour down the road the driver stopped to pour water on the smoking brakes - which started to convince me we were not only smelling hot tires but also burning brake fluid. I started praying we wouldn’t end up flying off one of the curves and ending up in the jungle a few hundred feet down a hill and upside down.

Another 30+ minutes and the bus came to a growling (literally) halt as the right front wheel seized. Loud voices of protest and remonstration followed the driver out his door and even though it was in French I caught the gist quite distinctly. Swearing in French is still swearing.

We all piled out on the side of the road to see how bad the tire was - and it wasn’t the tire. It was the wheel.
The driver got back in and tried to get it to move, and that’s when we heard the distinct metallic growl and saw the growing pool of fluid coming out of the rear axle. The differential joint had been tortured to destruction when the driver had tried to using the transmission rather ineffectively as a brake on the last few hills. He had been jamming the gears pretty hard.
We were going no where in that vehicle.

After a couple of phone calls by the driver he announced that there would be another bus in a few hours :)

Dr. Miller had started talking with another passenger about an hour before the events. He was a physician studying cardiology on his way back to school. As our phone didn’t work he was kind enough to allow me to place a call to our travel coordinator who instructed me to flag down a passing car and try to hitch a ride to Libreville - still 4-5 hours away!
Johari was really praying at this point. She could see any hope of a couple days in Paris quickly disappearing, as well as the price of another ticket out of Gabon.

Word got around pretty quickly that the “Americans” were going to miss their plane out that evening and I was frankly amazed at how the other Gabonese began earnestly flagging down any vehicle that passed and asking if they could take us to Libreville. It almost looked like it was the “mission” for the afternoon to see us on our way!

Shortly, i.e., within an hour, a lady passing by in a compact, four-door Mitsubishi, car stopped and agreed to take us on with her.

When she opened her trunk for our luggage I saw it was packed with fresh and old (very ripe) plantains, a huge smoked jungle rat, and another large slab of relatively fresh beef, along with stacks of fish! After trying to re-arrange her trunk, the other passengers agreed it would be best (along with my encouragement) to get all our baggage in the back seat instead.
After a bit of negotiation, and the lady getting in on the packing, ALL the luggage and myself were stuffed in the back seat. I figured Johari would enjoy trying to communicate with the lady in the front seat - plus there was seat-belt up there! I didn’t want her getting hurt on my conscience.

The sun came out strong about that point and began to heat the jungle along with our car.

I quickly found the smell of the humid, hot, jungle wafting through the wide-open window only partially dampened the odor of fish, smoked rat, and rapidly ripening meat coming through the backseat - permeating my sweat-soaked shirt.

Blessed with finely tuned olfactory sensors I just pulled my hat tighter, put on my sun-glasses, plugged in my ear buds, and pointed my nose toward the open window. I was very happy to be moving North! After an hour or so I didn’t notice as much. It was well-worth all discomfort just to be moving towards Libreville instead of standing on the road-side feeding the mosquitoes. It was kind of humous because while I had even more room than on the bus (crazy!) I was awakened by a hard smack on my head when the roof collided with my skull. Not much suspension in the rear of that tiny car.

Far be it from me to complain whatsoever!! That wonderful lady got us to Libreville (after a couple of her shopping stops) in enough time to grab a shower, eat an unbelievably good meal by Alace, and on to the airport with plenty of time to spare. Just before all this transpired I had been telling Johari about some scrapes our family had been in - and how God had always provided a way out. Today was no different.

So, after a 12 1/2 hour road-trip, followed by a shower and a supper, we were sitting in the airport ready to depart. The plane left on schedule at 11pm. Slept about an hour on the 6 1/2 hr over-night flight. Enjoyed a raisin croissant, cappuccino, with my malaria pill for breakfast. Now waiting to depart in another 2 hours.

I’m in France :)

SO - thank you for praying.

Another average trip.
I love it when average is not normal.

It is becoming colder as I sit here. The fog outside is still very thick. The planes come and go. And soon I’ll be on board.

Thankful for life and the opportunity to just live it. Maybe today I will get to see Jesus face to face. If not, maybe tomorrow.

Meanwhile it is always interesting to see what the next few moments hold. There is nothing mundane about living in anticipation. Full life includes expectation, fulfillment along with filling, giving and receiving - time, people, places, relationships.
Thankful for the blessing to catch glimpses of the reality we all take so much for granted.
I know most of my interactions with people is not “extraordinary”. Most of our conversations and relating is “normal”. Beneath it all though I still sense a river of reality flowing deep with more implications than I will ever appreciate.
May you be blessed and filled with the wonder of living another day in relationship with our Creator and in anticipation of what is next in eternity. Have a beautiful day!
See you soon!

John