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!