But God.....

 I am a little over 2 weeks away from leaving Togo and moving back to the US. My time in Togo, West Africa has been one filled with so so many joys. So often being able to witness the hand of the Lord work something out, bring healing, or do something only He could do. It has been a time that has stretched me and grown me and I can truly say that I am not the same, but better and stronger than when I arrived some 5-6 years ago. 

 

But, it has not all been highs that is for sure. There has been lots of lows and hard during my time here. Things I will never fully understand, loss of friends and co-workers that still cause pain when I think of them. Loss of patients that sometimes felt like my heart was being pulled out of me. Because, after we fought so hard for them and prayed so hard for them we lost them anyway and I had to reconcile myself to that fact. That ultimately God decides, not me. How arrogant of me to ever think it was up to me in the first place. But sadly and honestly there were times that I did. I have been comforted by so many things over the years but pouring over the scriptures where the writers pointed out the Lord’s sovereignty has given me the most comfort. 

 

The Lord’s men facing battle, “Do not be afraid and do not be dismayed at this great horde, for the battle is not yours but God’s” 2 Chronicles 20: 15

 

“But God will ransom my soul from the power of Sheol, for he will receive me” Psalm 49:15 

 

“My flesh and my heart may fail, but God is the strength of my heart and my portion forever” Psalm 73:26

 

“With man this is impossible, but with God all things are possible” Matthew 19:26

 

“But God chose the foolish in the world to shame the wise. God chose what is weak in the world to shame the strong; God chose what is low and despised in the world even things that are not, to bring to nothing things that are” 1 Corinthians 1:27

 

“But God, being rich in mercy, because of the great love with which he loved us, even when we were dead in our trespasses, made us alive together with Christ” Ephesians 2:4-5

 

But God, in his unending mercy allowed me to see him work in ways that I could never have imagined: 

 

I had a massive hole torn in my heart by the death of a child a few years ago, But God used that to transform an entire family and draw them to Himself as believers and build a church in that village. 

 

Patients and work and deaths have piled on so often, so high that I felt like drowning, but God brought encounters with families or others that showed me Himself even when He seemed nowhere to be found. 

 

But God, has grown this hospital to be a sought-after referral center for northern Togo and southern Burkina Faso because we tell the truth and provide the very best care possible. 

I have experienced so many But God moments here and I will treasure them, even the hard ones. 

 

So why leave? Because as certain as I was that I was supposed to be in Togo in 2015 and then stay despite such hard circumstances in 2016, I feel the Lord leading me away from Togo to something new. 

 

Change is easy, transition is hard. I heard this statement a few months ago knowing that I was going to face those very things: change and transition. It stuck with me and has rung true in so many ways. 

 

Change has been in on the horizon for months and it is culminating in a couple of weeks. I am moving back to the US and the US will be my home base. I am not getting out of the missions game though. The Lord has given me a vision for what is to come. My best friend, Kelly Faber, and I will be engaging in quality improvement and best practice development projects in mission hospitals all over the world. I have seen the challenges of practicing medicine in low resource settings and have seen that great quality can be achieved. But I am also aware that there is NEVER enough time and energy to tackle some things even though it is needed. This is where our vision comes in. We believe that a high standard is achievable in low resource settings and we want to help mission hospitals reach that. We have coined what we call the Silver Standard. Western medicine strives for the gold standard in all areas. However, in low resource areas, the gold standard is often just not possible. However, we believe a standard is needed, hence the Silver Standard, the very best, possible care that can be delivered given the all of the nuances of the setting. This will be my new mission. 

 

I have joined Christian Health Service Corps (CHSC) and Kelly and I will head up this project for them. We have called it Iron 2 Silver to emphasize the importance of taking something that already has value and elevating it to a higher level. This is based off of Isaiah 60:17 when the Lord is speaking of restoring Israel. “Instead of bronze, I will bring gold. Instead of iron I will bring silver” 

 

This will require lots of traveling to initiate and coordinate projects once they are in place. This will be a huge life and direction transition, and I am very excited to get started on this new journey.  There have been so many things that have confirmed this decision as well over the past months. It is exciting to be moving in the direction that has been cleared by the Lord. However, I do not discount the process of transition that will take place over the next few weeks to months. I have heard it said that with every new change there is a grieving process as well as an excitement. Such it is with this. Despite the excitement that I have for this new journey, I grieve for my Togolese and ex-pat colleagues as well as my Togolese friends that I now have to say goodbye to. And as it is with grief, it tends to come in waves the closer I get to my leave date. I welcome your prayers through this transition process. 

 

I also would love to share more about Iron 2 Silver and this new journey that is starting to any and everyone. Feel free to reach out to me by email: mssndoc@gmail.com, scates@heatlhservicecorps.org, what's app or signal 423.297.6794 or text  

Frankly, to move this forward, we need funding. Please consider helping us as we start this new initiative to aid mission hospitals and elevate care around the world. 

 

To give: You can text i2s to 41444 and you will be prompted from there OR you can simply

click on http://igfn.us/f/1rsymf

 

Rejoice with those that rejoice

             

Often times here I do not post or share what is happening at the hospital or with me. Some of that is just a time factor but a lot of the time the stuff to share is the hard stuff. The patients that didn’t make it or the outcomes we wish were different after the fighting and pushing. Those are hard stories to tell and often not the stories people want to hear. But they are the reality of working in a resource limited setting where often patients wait too long to come in and a hundred other reasons.

            So you are thinking what’s coming. Is she going to go down the dark path and share those stories now. No, I am not those are the stories best kept close to the ones here that fought hip to hip with me and we lost anyway. 

            

          

 What I am going to share are two stories that should have also been on that list but by God’s grace and healing hand they are not. Here at HOH we get lots of newborns that come in on day of life 1 or 2 that were born either at home or at a clinic and something is wrong and they come in or get sent in. These babies get a full septic workup including blood and CSF cultures and antibiotics. It is standard workup that we do many times a week. This little boy came in on day of life 1 and got the full workup. He was found to have neonatal meningitis which is not super uncommon here and was started immediately on antibiotics. His counts in his spinal fluid were high enough that we decided to re-do his LP on day 7 of antibiotics to make sure his infection had cleared appropriately. On day 7 his CSF showed over 20,000 white cells (normal for a newborn is around 30 or less and his initial CSF had about 850). His infection was much worse and what we were using for antibiotics, standard anywhere in the world, was not working. We switched him to the broadest spectrum antibiotic we have and prayed. He was not doing great at this point. Granted he was 7 days behind on a bad meningitis. A bad nursing error occurred 2-3 days into treatment and he missed 18 hours of antibiotics. The next morning he went into full cardiac arrest. We got him back but wasn’t sure what we were getting back as far as neuro status. He was stable but very critically ill. The next day, he took another bad turn and started struggling to breath. A STAT CXR was done and his entire right lung was whited out. I then put in a chest tube and he stabilized again. That stayed in for close to week and the day I took it out he opened his eyes and looked at me like, “seriously take this thing out of me.” The chest tube came out and he quickly came off of oxygen. He had another LP later in his antibiotic course to see how the antibiotics were working and he had zero white blood cells, the antibiotics had worked. Now, to see if he would eat. We had been feeding through an NG tube for close to a month now. He stayed in the hospital and struggled to eat by mouth for another couple of weeks until we decided to put in a G tube so he could go home. He did go home and about 2 weeks later he started eating everything by mouth and the G tube was able to be removed. I kept telling mom while he was in the hospital that she should name him Lazarus because he was dead and now he is alive. I was kind of joking but trying to convey the gravity of his case with her. I got to see them in clinic right after the G tube was removed and Dad was with Mom and I asked him, “What did you name him?” He said, “We named him Lazare.” (That is French for Lazarus). I have gotten to see him a couple of times since he left the hospital and he is eating and gaining weight and has two of the happiest parents you can imagine. 

 

            

The next patient, is a 10 year old boy who presented with abdominal distention and pain for several days. This is not an uncommon complaint that we see. We have lots of diseases here that cause intestinal problems, the most common probably being Typhoid. This patient came in overnight and I received him the next morning. I examined him and another patient with the same complaint that were currently both in general pediatrics which are non-monitored beds meant for stable patients. He was awake and sitting up in bed and his exam was benign. The other child was very touchy in his abdomen so I decided to move that child to a monitored bed and left this child where he was. 

            A couple of hours later, this child, the I left in pediatrics goes into full cardiac arrest. After about 10 minutes we get him back. His ultrasound at that time showed many dilated loops of bowel and he needed to go to the OR but he just arrested. I put him in our intensive care for resuscitation. He was clearly in septic shock and we could not get an IV anywhere on him. I ended up placing a femoral line for a few hours until he settled out a little bit. His exam got worse and worse and his abdomen more and more tense. He did finally go to the OR. I took some time before he went to pray with him and his mom with a translator and told him I would see him when he got out. In reality I was not sure he was coming back out of the OR. He had a volvulus, which a twisting of the bowel on itself, and a lot of his bowel was dead. He was given a jejunostomy and had very little viable small bowel left at the end, but was alive and awake. The surgeons were able to do a re-anastamosis less than a week later which was the first big step for him. Next and the biggest step was nutrition and would we be able to come up with things for him to eat, in small quantities, frequently, that would give him everything he needed. We talked to a nutritionist who has been in Togo and knows what is available and came up with a plan. He was in the hospital for another couple of weeks and his parents did everything exactly the way we asked them. And he gained weight, did not have diarrhea or vomiting, and had no complications from his surgery. I have been able to see him twice since his discharge and I have finally gotten him to give me a high five. I tell his parents every time how much of a miracle he is and how their care and concern has made his recovery possible.     

This is him in clinic last week 

So many days here are hard and so many cases are difficult. But sometimes…..sometimes….there is joy and gladness. I choose today to rejoice with those that rejoice. 

            “Rejoice with those who rejoice, weep with those who weep” Romans 12:15 

Death to Life ....

         During my time in Togo, I have been able to be a part of seeing a village Bible study progress and grow into a church. It’s something that came out of extreme grief and so many questions before the Lord to seeing lives changed and renewed by the love of the Lord. 

 

    Many of you know the story of a little boy, Tama aka Puddles. He was a medically fragile child that my best friend and I cared for in and out of the hospital for many months and at times in our home. He ultimately went to see Jesus just before his first birthday. 

        His family became fixtures in our life and in a way to cope with our own grief we started visiting his family in their village. His tribe is Gam Gam and no one in his family speaks French and I do not speak their language other than simple greetings. But every time we would head out there, the Lord would provide a passerby to translate for us. 

It was a healing time for me as I had felt like my heart had been crushed by the losing of this little boy and I could not understand why it would happen. It was soon evident that a chaplain needed to be a part of this so that better communication could happen. 

 

We asked our Gam Gam chaplain if he could start doing a Bible study with this family. He did and not one but two Bible studies started in this small village. Everyone in the village knew Tama’s story and that was a jumping point for the Lord to do something there. 

 

The Bible studies continued and grew and many, over the course of a couple of years, became believers and followers of Jesus. Tama’s Mom and Dad were part of that group as well and the transformation was incredible. Tama’s Mom then became pregnant about a year and a half after Tama died and she ultimately gave birth to another boy. They named him Solomon citing that when David’s son died, the Lord gave him another and he named him Solomon.  

A full circle, ashes to beauty story, is rare and I feel privileged that the Lord has allowed me to be a part of this one. A church now exists in the town and when I am not working on Sunday mornings, I attend. This is the church. 

 

 

 

        Not that impressive by the standards of the west but this is what they have right now and every Sunday they gather sing and learn more about the Lord and how best to live for Him. The church has recently decided that they want to find a way to build walls and make this a proper structure. It’s a big undertaking for them and it is fun to watch these new believers work out all of the things that we take for granted like tithing, offering, what to do with money, etc. 

 

            “But when one turns to the Lord, the veil is removed. Now the Lord is the Spirit and where the Spirit of the Lord is, there is freedom. And we all, with unveiled face, beholding the glory of the Lord, are being transformed into the same image from one degree of glory to another.” 2 Corinthians 3:16-18

 

            The transformation of this community is so evident and the Lord radiates from them. You can see it on their faces and hear it when they worship. What a day it will be in Heaven when we all worship before the throne of the Lord. All in our own language and all at once, no division, just children of the Lord worshiping the King. I get to catch a glimpse of that here and it is amazing. 

 

I am attaching a video recording of this church worshiping Jesus. Hope you enjoy. 

    Church audio

 

    If you would like any more information about this story or would like to help with the building project for the church, please contact me directly. mssndoc@gmail.com

            

Solomon and his mom at a recent visit to my house 

Thank you for your prayers and support. I could not be here without that and it is never taken for granted.