Niger - May 2010

Bon jour, Sanu, and Good day!

This is a short update for a few of you who have been praying.
It has been nice, hot, busy, and typical for Galmi experiences. One of the surgeons was laughing about how he and his wife had been in another part of Africa and thought it was the dirtiest, hottest, and most miserable place to work (he grew up in India), until he found out that missionaries came there from Galmi for Rest and Relaxation!!

He later came to Galmi and realized why.
It has been getting down near 104 or so at night. During the day I have no idea how hot it is getting, but inside it runs in the 115-118 range. Humid to ~50% now because of the rains a couple hundred miles south of here.

Almost lost a lady and her baby this morning - emergent c-section, and she arrested before I made the incision.

It was her first baby, and she was pre-eclamptic (high blood pressure, and had had a seizure earlier because of the blood pressure). There is an OB-Gyn visiting from the US and she is VERY good - but she was already doing another emergent section and asked me to help.

While I was finishing putting on my gloves the woman quit breathing as her heart rate slowed.

They started CPR as I started cutting. Quickly.

Got the baby out, but there was no breathing.

The mom wasn't bleeding. Her uterus was soft and purple, blood was purple, bowels were pale, nothing was bleeding... and they were still doing CPR.
I sewed up the mom fast, and just as I was getting ready to close her abdomen her skin started bleeding and the blood turned red. I was very, very happy to see red blood and bleeding.

Both mom and baby survived.

God is in control of our days.

Side note - the power was out and we were running on the generator, so no air-conditioner :) When the guys came in from doing morning rounds they took one look at me and wondered what had happened... I told them it had been raining indoors :)

That's a snippet of life here.

After 2 C-sections, a couple hernias (large and recurrent), lunch and clinic...there was a lady with a ruptured uterus & dead baby. I assisted the OB-Gyn visiting here with that operation, then headed home for a siesta :)

Thankful for a relationship with the Creator God who holds each of us in His hands. Without that relationship life here would be meaningless. And that relationship is what makes it worth every minute. It is truly life.

February 18, 2010

Well, just in case you were wondering if it really was warm over here...

99 Deg F in the shade today. Humidity Index - High.

Even Dr. Renee K. noted the OR's were a bit warm. I was working on Pediatric hernias (2 month old, with circ, and a 2 y/o) so figured my room was warm because of the kids. I did think it was odd that the "air-conditioner" didn't seem to be working quite like normal...but since the kids were nice and warm it seemed ok. That being said, the OR's are never less than 80 on a good day since I've been here :)

Turned out, it was so hot with the sun on the metal roofs that there was no hope of cooling down the rooms!

Interesting cases continue - but everyone was safe today. Thank you for your prayers.

Incredible suppers here - tonight it was Curry Chicken and rice, with Star Fruit Crisp with home-made vanilla ice cream at Lisa's house. I'm afraid I'm living better here than at home! Between the fresh fruit, yogurt, fresh bread, Laughing Cow Cheese, fresh poached eggs, and incredible brownies (Thanks Renee!) I can not complain in the least. Someone wants me to keep trying the Etonga's ( a particular "fruit" that grows here ), but I'm not sold on them - yet. I keep trying one about once a week. One of these years...maybe.

All in all it has been a good week. Nearly two weeks complete now, and Renee leaves tomorrow - which means I'm back on my own for Ob-Gyn :( She has been an outstanding help and a great teacher for the residents. I know they are sad to see her go as well. Having her here has been one of the greatest gifts to the teaching going on these past couple of weeks.

Keir (the Director of Surgery) returns Monday - and we have a couple cases lined up to do together. Considering a chest case -which will be quite large, as well as a couple other technical cases. Will talk about that on Monday with him.

Thank you for your prayers.

Cleaned my house again today :) I clean a bit each day, and am amazed at how quickly the insect population trends down if you keep them at bay. But give them an inch...and they'll take the whole house! The geckos and lizards are doing nicely - and I haven't seen any spiders in a few days (not that they are not here - just haven't seen them). Today I thought it was pretty quiet in here, till I flipped up a seat cushion and found the most recent hiding place for one of my pet geckos. I haven't started talking to them - at least not much.

I know this isn't a very "special" blog, but it fills you in a bit on some of the more mundane aspects of life here.

Feeling a bit on the sad side as I realize I'll be leaving in just about a week. Time flys quickly. It has been a welcome change of pace, challenges, and good time of catching up a bit with friends - especially seeing how much Luke and Sarah have progressed in learning to swim :)

It's the "little" things.

Today the second year resident did an outstanding job with a pediatric hernia. It is seeing guys like him make progress that make the teaching so rewarding. The first year is asking great questions and growing by leaps and bounds. The third year (Chief while the others are away) has improved so much it is hard to describe. He is going to make an excellent surgeon, as they all are. It is quite a privilege to work with these guys. On top of that, each of them have a real heart for the people, care about them physically and spiritually, and are quick to pray for and with their patients. They are appropriate, kind, and caring. One of the patients with a prayer rug (Muslim) obviously feels welcome and enjoyed as the residents banter with him on rounds and relate with him about his beliefs. These doctors obviously love their patients - and the love of Jesus is evident in their lives as they take care of them.

It is a joy to be here. Thankful for the honor it is to work with the patients and staff. The love of God is evident.

February 16, 2010 - Weekend et al

Interesting weekend and on into today.

About lost a patient today. She respiratory arrested, heart slowed and nearly stopped, aspirated, had full blown pulmonary edema and was coughing out foam for over two hours, and nearly died. Thankful to God that she survived. It took a team of people, all trying their hardest even if they didn't know really what they were doing. I appreciated their willingness to help. There were even some in the room just to pray and sing. But she made it - and was sitting up talking this evening.

Thankful.

Lost a 14 y/o gal this weekend from a snake bite. Green Mamba. They tried traditional witchcraft first, and then as she was dying they brought her in. That was my Sunday morning from 1:30-5:30. Then, today, a little baby came in with malaria and pneumonia. She, too, died. So it hasn't been particularly calm around here.

But otherwise the operations are going well.

One large cystic lesion, supposedly an ovarian mass, disappeared when we gave her a spinal and placed a foley. There was some mild levity when after the patient was prepped and draped the surgeon discovered that the "mass" had melted away - and the foley bag was popping! I was getting reading to scrub the "difficult case" and noticed there was a bit of consternation at the table as the surgeon-in-training tried figure out what happened to his patient's tumor. One look at the urine output and everyone realized what had happened. The patient was an elderly lady with diabetes, and her bladder does not quite work so well anymore. It was a bit of a relief actually, after fighting to save the other gals life for a couple of hours. Thankful for the small things - and the resident learned a valuable lesson in the mean time (and I may need to look at all the ultrasounds first!)

Sunday was fun as we took a break and went tropical fish fishing up a tropical stream in a tropical forest :-)

Didn't see any snakes - thankfully - and had fun catching the little guys. The larger ones there were going to feed to their cats, and the small ones were going in the fish tank. A bit different than going to the store to pick out you

r favorite fish to stock the aquarium - and a lot more fun!

Dr. Renee is doing wonderfully well. The residents have thoroughly enjoyed her teaching, and she enjoying their humor with them. She is great in the OR's and in class - and they have learned much, much more than I could have hoped. Very thankful for her work here. She leaves Friday, and then it is just me and the guys till Keir comes back next week.

Thankful for many things this evening - especially for God's grace in helping save the young lady's life today. Sad about those who have died. Praying that in all of it God will be glorified. Terrible to see what sin does to people, and how it destroys. Thankful for God's provision for LIFE through Jesus. It is not religion, but truly knowing the one True God, who is there and does speak. Thankful for His hand in my life. Realizing more than ever how He is the one who holds me in this life - for HIS glory.

PS - I'm still not quite used to the little geckos jumping off my door as I enter my house :-) Always something to keep you on your toes around here!

Quite a week thus far.

Mainly Gyn cases, and thus VERY thankful Renee Knutson is here. She is invaluable.

This morning we held journal club and I think the guys appreciated it greatly. It was on ectopic pregnancies, which generated a lot of questions regarding various clinical situations here in

the jungle. Quite a lively and good conversation. I enjoy those "learning" times where everyone is involved and actively processing new information and applying it to their lives immediately. One of the primary reasons I enjoy these opportunities.

OR #2 still has no air-conditioner. A new experience today was seeing water run off my sleeve and onto the OR table. I thought it was coming from the ceiling - but no - it was

coming out of my gloves! It was so warm the perspiration had built up to form little pools in my sleeves, which eventually leaked out and started running down my arms! There was literally sweat sloshing around in my gown sleeves. Oh, well. The hemorrhoidectomy turned out well, and the intern learned a bit in the process, which is why we are here.

Turns out it was up to 97 F today. But only around 50% humidity - so not bad all the way around, except if you are in a little room with a tin roof, hot sun, no windows, and no air moving :) It's the little things which make it memorable.

Otherwise it is a joy to work with these residents. They are all "junior" level (3rd year and younger) but already are showing great aptitude and far excel their stated levels. It is fun to operate with them, and the teaching/learning ratio is about even as I learn their techniques on some cases while practicing my French. They speak to me in English, and I try to reply in French, but quite frankly it is mostly in English that anything is actually understood!

Rounding Peds is fun, although a bit sad with some of the cases. One little gal has severe hydrocephalus. She is shunted now, but her head is several times too big for her little eyes. She is quite sweet, and doesn't cry immediately when she sees me now. We are so incredibly blessed in the US with healthcare well beyond anything else in the world. All politics aside, we live in a country with blessings well outside the norm for anywhere else in the world.

Tomorrow promises to be a full day. Many options, depending on which patients are ready, and which ones show up tonight. A variety of Colon, Gyn, Ortho, and General surgery cases - most of which would only be tackled by the "super-specialist" in the U.S. Here they have to do with us. Praying for wisdom and reading a LOT in preparation for the cases. Renee is doing the same. Thankful for a good team of surgeons in training, great attitudes, and fun people to work along side as we seek to ease the suffering of the people here.

Thankful for the privilege to be here - well aware of and humbled by what God is doing.

Feeling a lot like a turtle on a fence post at the moment.

Thank you for your prayers!

Gabon - 2010

Thank you for praying!

We had a relatively uneventful trip over, except on arrival to Gabon we discovered Dianne's visa was in her old passport.

No worries - nearly three hours later, she was not going back to Paris, but entering the country with us. Pastor Serge, the hospital administrator, was in the jungle 12 hours away using his cell phone, and many people were praying. He called a minister of the interior, who called the Chief of Affairs for Gabon, who called the Head of Immigration, who called the Commandant of the hospital, who called the police who were holding her and preparing to evict her on the same flight (within two hours)...and she was allowed out of "jail" and through customs with us.

Meanwhile, Renee and I sat on the metal benches in the empty baggage claim area waiting to see if she would ever come through. We had her bags, and couldn't go through customs - which had already closed by that point.

Welcome to Africa! Where in one night the heads of various parts of the country all "happened" to be home and available, and all were willing to try to help, and eventually Dianne was allowed in with a temporary visa. God IS good! I was especially glad since Dianne is Keir's mother-in-law. Keir is the surgeon I'm coming to fill in for while he is in Kenya and Cameroon for the next three weeks.

Outside of that it has been fairly uneventful. A nice weekend of heat, humidity, couple dips in the pool, church, dinners, and a super-bowl party which started at midnight (since we are 6 hours ahead of the East coast).

Today was 12 straight hours of work - without lunch. Started the morning with chapel, rounds, and then clinic at 9:30 and finished up after 7pm. People with malignant tumors, broken bones, gangrenous wounds, bleeding, pain, prolapsed rectum, hernias, goiters, and constipation. Quite a variety. We filled up the next three days of OR time...and still have the rest of the week to go!

I'm living back in my hill-top house. It is beautiful, small, and perfect for me at the moment. Somewhere to sleep, and easy to keep clean. I'm also used to where all the ants try to come in - and have stopped that activity quite quickly :)

Dr Knutson (Ob-Gyn) is doing remarkably well with all the living and cultural adjustments. She was very busy today in clinic - and many women came just because they heard she was here. I'm very glad she is here too! Most of the cases this week are Gyn-related, so both of us are working in that area for the next few days.

Besides that, the air is warm and humid, fans are working well, electricity is staying on most of the time, and I have internet! I've only seen one snake bite thus far (they say the venom is less toxic in these parts - mostly), and I'm catching up on jet-lag. Looking forward to a very full day tomorrow. Appreciate your prayers.

Thankful for the privilege and opportunity to be here at this time. God knows what is best - grateful to walk with Him.

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.