Friday, July 18, 2014

Legos and Hope

Not only so, but we also glory in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope. And hope does not disappoint us, because God’s love has been poured out into our hearts through the Holy Spirit, who has been given to us.

Romans 5: 3-5.


Have you looked at Lego sets lately? They appear to have advanced along with everything else over the last 20 years. The projects are amazing, and amazingly complicated. We look at the beautiful finished products on the front of shiny boxes, ignore the age parameters, and go for it! The result? Usually a frustrated little child with big dreams and a shiny box and little Lego pieces mismatched all over the table. The directions are correct, but when you cannot read well and you are still working on left versus right, what seemed easy peasey in the toy store can quickly become a BIG MESS once reality hits. Mom and Dad step in-these things are hard! The finished project is complicated. And then, watch out! The Lego creations can break apart pretty easily in all those battles with heavy flying, driving and maneuvering. Where are those pieces? Where are the directions? The picture on the box still looks great, by the way. Zip lock baggies come out. We look for the directions. We are met by a little one with tears in his eyes, holding a bag filled with hundreds of disarticulated plastic pieces that used to fit together.


Last night I watched a recorded presentation of Joni Eareckson Tada speaking at Shadow Mountain Community Church. The title of her talk was “Hope is the Best Thing.” For any of you who do not know about this remarkable lady, her story is told in the book Joni, and on her ministry pages at www.joniandfriends.orgShe had a diving accident in her teens, and went through incredible depression leading to despair; but ultimately, God led her to a place of dynamic hope and faith.  God’s plans were certainly not her own, but she testifies how His plans for her were actually for her best. And how He has used her life and her testimony! Her ministry has touched tens of thousands across the world, many of whom are disabled-the forgotten, the lonely, the despairing. Her message last night was about hope-and how Jesus Christ gives us hope even in the most desperate of places.


So what do Legos and hope have in common? Our return to the States for home ministry has been challenging. Yes there is such a thing a reverse culture shock, and kids experience it too. We long for the security of home-but then realize that home is not the same, and we are not the same, and anyway, home is no longer geographically defined for us.  I went to bed the other night wondering how in the world all of this-our family, our ministry, and our call-could be put together, and how we could accomplish what we believe God is asking us to accomplish in our service to women and children in East Africa. We were discouraged. Our son was discouraged. Not a great place to be when trying to find some sleep. But I prayed: God please show us how to do this, how to return to Africa fully funded, how to build a building and a program, how to better love the patients and the staff, our neighbors and our community, and to do all of this while providing for our family and our home life and our relationship with one another. TOO BIG. TOO MUCH. I looked ahead in my mind and saw a big shiny completed project. But how do we get from here to there? IMPOSSIBLE.


Now answers to prayer can come in unexpected ways. Early that morning, I awakened from this dream: I was standing in front of a person I did not see but knew somehow that He was God. He looked at me and asked me what I had in my hand. I looked down, and it was a zip lock bag full of disarticulated, boldly colored Lego pieces. He told me that I was right-I was completely unable to assemble this project-too many pieces, too many variables, too much broken apart. He then told me, “Give me the bag.” I reached up and handed it to Him. He said, “I will take care of it all, for this is mine and you are mine and nothing is impossible for Me.”  I woke up suddenly. Hope filled my heart.

As Joni said from her wheelchair (quoting from the movie Shawshank Redemption, by the way), “Hope is a good thing, maybe the best of things.” And it is what we have in Jesus. All of our plans and dreams rest in Him. He gives us our hearts. He created our dreams. No matter where we are, we cling to Him in hope and confidence that He loves us, and takes joy in us and accomplishing His purposes through us.


So the next time you feel that your life is like a broken down Lego project, remember that nothing is too hard for God. We do not lose hope even though what we have built is seemingly broken or misshapen or not according to plan. Pick up the pieces. Put them in a large zip lock bag. Give them to God. His plans are far greater than we know. And have hope. It is a good thing-maybe the best of things.





Wednesday, May 21, 2014

If you had been here

If you had been here, my brother would not have died.

Sit with me in my clinic. It is Wednesday afternoon. Everyone, including the patients and their families, are tired. The queues are still long. The problems are many. My intern comes in with a wheelchair bound patient from the female surgical ward. She has brought her here to examine, because doing a pelvic exam in the wards is atrociously difficult (Where is a light? Where is an exam table? Where is a speculum?). So I look up, and there is the patient. She is a 38 year old lady who had a stroke a few months ago and really cannot communicate. She was admitted because she had gotten a blood clot in her leg and had to go on blood thinner so she would not get an embolus to her lungs. She had had polio as a child, and her left leg was limp and paralyzed. Add to this the stroke and being bedridden-and she was a set up for a DVT (deep venous thrombosis). So now she is on blood thinner-and she is bleeding out from her menstrual period every month. Enter me, the gynecology consultant.  I examine her in our busy clinic. It is hot. She cannot move well. She cannot speak. We lift her to the bed.

In my mind, I flash to Bethesda: to the man on his palate by the pool. There is no one to lift him into the water. Enter into his frustration, his pain, his helplessness: the dirt, the smell, and the chaos.

And then Jesus is there. And it is simple. “Pick up your bed and walk.” And he does.

I finish examining this woman: no cervical cancer, no fibroid uterus-just a debilitated woman on blood thinner. And there is little I can do for her. We carry her back to her wheelchair. My eyes fill up with tears. Nothing I can do. If Jesus had been here, he could have healed her-her legs, her clots, her stroke, her bleeding.

I write a note in her chart. We pray for her. She returns to the ward. I see the next patient.

Walk with me up this hill. It is early in the morning. I trudge up to the hospital wards. All of our corridors are outside. I walk past a bench with a woman seated upon it. We are outside of our ICU. Suddenly, as I pass, she lets out a long wail. She shakes her head again and again, and takes her outer skirt and covers her face. “What is wrong, Mama?” One of my interns comes alongside. It is silent except for the wailing. “Her son has just died in the ICU. The father is with him now.”

Her son was ten. He had had a headache for two days. Once he arrived here, he was treated for meningitis-but it was too late. He was brain dead.  The doctor had just removed him from the ventilator. The father is with him. The mother sits alone on a bench and wails.

In my mind, I flash to another small dusty village, two thousand years ago. I hear the wailing. The child is dead.

And then Jesus is there. And it is simple. “Arise little one.”  And she does.

I place my hand on the woman’s shoulder. Her grief is unbearable. We pray for her. She awaits her husband and the body. I walk on. I stumble through the haze.  I go down the hall and into Maternity to begin rounds.

Lord if you had been here . . .

Martha said it at the tomb of Lazarus. And Jesus wept. I think he wept for the fall of man. For all of this brokenness that was never supposed to be.
Which is easier to say:  ‘Your sins are forgiven?’ or ‘Get up and walk?’  But just so you know that the Son of Man has the power to forgive sins, I say to you ‘Pick up your bed and walk.’ (see Luke 5: 17-26)

I know that healing is real. I have seen it here, without medical explanation. But God did not choose to heal this woman or raise this child. And yet, we walk on, through the pain, through the Via Dolorosa of our lives and the lives of the people God has placed upon our path. And we KNOW, because the Son of God died in our stead, we can have forgiveness of sins. So that one day, ONE DAY: the lame will walk,  and the dead will rise.

Many years ago, when I was a little sprout, my mama took me to a Passover Seder, conducted by the Ministry of Jews for Jesus, in Richmond, Virginia. It was about seeing Christ in Passover. Part of the ceremony involves hiding a piece of Matzo bread somewhere in the house. The children of the family then go and try to find it. The bread represents Jesus in this ceremony. I was anxious, and surrounded by many children. And yet, I went to a place in the room where no one else was looking: and I pulled out the bread-it had stripes upon it from baking, and was covered in a white cloth. I found it! And I remember holding it up, and knowing that in finding it, I had been found. And that Jesus would always be with me, not because of something I had done, but because of his great love for me, because of the stripes he bore on his body.

And now, years later, in this hospital in rural Africa, as I struggle to comfort, to treat, to love, to bring the hope of healing to the sick, the frightened, the grieving, the dying:  I somehow know, in the midst on my own brokenness, that He is here. And by his stripes we are healed. ONE DAY. Come Lord Jesus.

Sunday, March 9, 2014


It is not how much you do but how much love you put into the doing and sharing with others that is important. Try not to judge people. If you judge others then you are not giving love.
Mother Teresa

Trust in the Lord with all your heart, and lean not on your own understanding.
Proverbs 3:5

When I first saw her in our Maternity ward, I believed her. My years of clinical experience told me not to believe her, but she was earnest in her story, and so I believed her anyway.  I believed her right up to the point when we opened her abdomen and found the results of a botched abortion in the form of a dead fetus and a lacerated, necrotic uterus.

I heard about the bad motorcycle accident over the weekend. Some poor family had been rushing to visit their sick relative at our hospital. As so often occurs here, multiple people piled onto the Piki-Piki. Helmets—are you kidding? This time, a two year old was on board with her parents and her grandmother, stacked up behind the driver. That’s a total of five souls over an engine with two wheels, speeding over dirt and rock roads. The parents were killed instantly. The grandmother sustained head injuries. The little girl had an open femur fracture and was now an orphan.

It wasn't until the next day that I learned the patient to whose side they were racing was my patient, the woman who had come in, lied about her history, and was finally taken to the OR where we had to perform a hysterectomy, followed by staged debridement and multiple washouts. Her history unfolded over a week: married with three children at home, she went out and attempted a late term abortion. Someone had perforated her uterus. She was becoming sick. She had gone to two different hospitals where she continued to deny that she had gotten an abortion—and so the days passed and she continued to worsen until she finally came into our hospital.

Postoperatively, she started to get worse. She became septic. She had seizures. She had to be intubated. Finally, her lungs and her kidneys failed. I sat with the family. Her husband was intoxicated on local brew. He had just sold off his farm in order to pay all the bills incurred by her hospital stays, and for the care of the mother-in-law, and the two year old child with a broken leg. He had other children at home asking for their mama. When was she coming home? The brothers and sisters, aunts and uncles sat by, trying to understand what had happened, what was happening, what could be done, and terms like “multi-system organ failure.”

I sat at the little nurses’ station and watched her family members surrounding her in the unit bed. They were saying goodbye. She died that night.

“Let’s go visit a patient,” Angela, my friend and visiting colleague, said to me. I really did not want to go. The death of this woman had shaken me. Watching her die had shaken me. Days later, I could not forget her last hours. I would never forget her or the tragic events that had unfolded around her story. Angela knew this. She came up to me in her sweet, matter-of-fact way: “Let’s go,” she said.

I found a precious little girl on the Pediatric Ward. She tucked her head and smiled when she saw
Angela approach—for my friend had been visiting her all along, bringing her sweets. A young woman was there with her, her auntie. She obviously loved the little girl. Angela gently pulled back her blanket: I saw her right leg was healing, from an open fracture sustained after being thrown from a Piki-Piki.

For those of you reading this story that follow Jesus, I can share this hope: our patient accepted Christ as her Savior before she died. The little girl with the broken leg is healing and physically will recover. Her aunt will raise her. I do not know if the mother-in-law will recover, or how our patient’s husband and children will cope. But I hold onto the promise that one day, Jesus will make all things new. And one day, all of this brokenness will be healed, and our faith will become sight.

Wednesday, February 26, 2014

Christmas reflections . . . in February

The following three vignettes were written throughout the recent holiday season. I share them now while taking a deep breath before the next plunge. My family and I are so grateful to be here in Africa. Thank you for your care, support and encouragement!

December Madness

December was a challenging month here at our Mission Hospital. While we were trying to get into the holiday spirit with Christmas trees (thank you prelit Home Depot tree that traveled well-second year in use and still going strong), twinkle lights, and a crèche made from a gourd, we encountered some difficulties up the hill. First and foremost, December is our July in Kenya. For all of you American docs out there, you know what this means: new interns. But this year we had some added stress: most of the doctors and nurses in Kenya went on strike. There were a few hospitals that remained open, and we were one of them. What this meant was that our patient volume and acuity sky rocketed. At one time on Maternity, we had over 130 patients registered. They came on foot. They came on piki-pikis. They came on matatus. And they just kept coming. There were women laboring in the halls, and often two or three women sharing a bed.  One morning I looked up and saw one of our nurse midwives, Evasha, standing in front of a woman he had just delivered. Another was about to deliver. He was covered in sweat, his hat and his mask were askew, more patients were coming in—they needed a place to deliver. All of the sudden, amidst the chaos, he stopped, threw back his head, and shouted: “His grace is sufficient! “

We stood in stunned silence, and then broke out cheering. Because--

--it was. Through all of the admissions, sick patients, normal and abnormal deliveries, emergency surgeries and late nights that turned into early mornings, His grace WAS sufficient—for us, and for these precious women whom we serve.

The Broken Ultrasound
In the thick of the strike, we lost all ultrasound capability. We are very dependent on our little ultrasound. We do not have continuous fetal monitoring, and we often do not have paper for the monitors that do work. Our one doppler was broken. Fetoscopes do work, but not to diagnose things like placenta previas or ectopic pregnancies. And yet His grace was sufficient in the midst of broken technology too. One of our visiting Obstetricians was on call the weekend the ultrasound went belly up. She had a patient who was bleeding, but the etiology was unclear. As she turned to look at the useless machine in the corner, a verse came to her: In all things, at all times, having everything that you need . . . (2 Corinthians 9:8).

In her own words: "It is a promise: I have everything I need tonight."

She got the ultrasound probe out and tried to turn on the machine—it flickered on, and she was able to see that the patient had a placenta previa. The machine then went off: AND IT NEVER FUNCTIONED AGAIN.

And the promise given to her covered us for the weeks we did not have ultrasound capability. Unbeknownst to us, an Obstetrician from America had felt that he should raise money for an ultrasound for Tenwek OB.  Now ultrasounds are extremely expensive, but when the call went out that our service was without an ultrasound, he was ready to purchase it, and with the help of folks from across the U.S. and here in Kenya, it is being brought out to us this month.

A Christmas Carol

Christmas caroling will never again be the same for me…

She was an HIV positive mom with a history of two previous cesarean scars who came in in labor. She went for cesarean in the morning, and the docs who performed the surgery reported that all had gone well.  My senior Medical Officer came to me after the patient went to recovery—he had been called because she was slightly hypotensive in the recovery room. Her urine output was still good, and she had responded to a fluid bolus. Her exam was initially normal, but she did not maintain her BP—and it dropped again despite fluid. We rushed her to theatre—and it took everyone, from anesthesia, to our nurses in recovery, to our staff in Maternity to get her to the table. She was becoming unstable rapidly. I opened her incision, expecting a huge gush of blood. Dry—no blood in the abdomen. What I did find was the BIGGEST HEMATOMA I HAVE EVER SEEN dissecting back into the retroperitoneum. The word from our lab came: NO blood. She was crashing. I asked my general surgical colleague to scrub in and we started to perform a hysterectomy. Still no blood. We thought she was going into something called DIC—where the patient is so overwhelmed by blood loss that their ability to clot is lost—and if not turned around rapidly, they bleed to death. At that moment, while we were working, we were praying, and sent the word out: we need A negative blood. My surgical colleague is A negative. He left the table and came back in with his own blood in a bag. Unit number one went in while he rescrubbed. Then something amazing happened: the word had gone throughout the missionary staff about our patient. Now it was evening, and the other missionaries were assembling for our annual caroling at the hospital. Before they caroled, all of our A negative folks donated blood. 30 minutes later, our patient had stabilized. As I took a deep breath, I looked up and saw a normal BP flashing on the anesthesia monitor. Freshly donated blood was being transfused.

 And just then, I heard them. Christmas carols were being sung throughout Maternity, by the very ones who had given their own blood so our patient could live.

Silent Night, Holy Night, All is calm, all is bright . . .

Strikes, broken equipment, a patient very near death. His grace was and still is sufficient. His strength is made perfect in our weakness. He provides what we need. A different kind of Christmas? Yes. But one I shall never forget.