"Normal"

A “normal” work day here is never normal as I would think of it in the US. On a “normal” shift in the US I may see 2-3 patients an hour, admit a few and discharge most. 

Here when I am “on shift” I round on all of the patients and then take care of any urgent medical patients that may come in. That includes NICU, peds, peds ICU, medical and medical ICU. It is definitely nothing like my days at work in the states. 

Our hospital is so very heavy towards Peds that on any given day 90% of the patients I see in the hospital will be pediatric. 

With that and it being malaria season, the hospital has been pretty full lately.  Malaria is one of those things that I think we take for granted living in the US. We don’t have it so it probably just doesn’t register in our minds. Malaria is contracted by mosquitos. You get bitten and then the malaria parasite attacks your red blood cells. The malaria parasites lyse the red blood cells that they attack causing, at times, dramatic anemia. It can also get into the brain causing cerebral malaria which is severe. Many kids with malaria develop seizures so one thing I know very well is dosing of all the seizure medications that we have. 

I think the best description I can think of is malaria is a thief of life. A healthy 2 year old playing one day, has cerebral malaria 3 days later and is either dead or now has cerebral palsy because he seized for so long and for so hard that his brain just cannot recover. I have seen kids come is so pale with anemia that they need multiple transfusions just to get their blood counts up to a number that doesn’t make my US medical mind cringe because it is so low. 

How do I walk in there every day and know that today I may have a child arrive at reception without a heartbeat but still so warm that she had to have just died on the way. 

I do because there are also so many stories of cases where God intervened though me or the rest of the medical team and they turned around. Kids with Hct of 5 that went home the next day after a transfusion and are fine. A woman in her 30s with a new baby that when she came was so swollen that when starting an IV, water came out. After beating our heads against a wall for a few days we starting down a plan of antibiotics and steroids and she was discharged with a smile and back to normal. 

The only way I can do it is knowing that whatever part I play, in restoring life or watching it leave, the Lord is also painting a story in the life of that family. A testimony that I will most likely never know of hopefully how they saw their loved one cared for with excellence and dignity regardless of the outcome. The Lord has used cases here of death and restoration of life to impact many. We have many village Bible studies that have been established solely as a link to a patient or family member of a patient at this hospital. Those are the truths that keep me going. Please pray that the Lord continues to use me and everyone on the medical team to impact the lives of our patients and families. 

I love music. I don’t sing well but I love it anyway.
I will leave you with the lyrics to a song that has become a go to song for me lately. Such good words. I encourage you to listen to it. https://youtu.be/FP003C5dP3k

Defender by Rita Springer
You go before I know
That You've gone to win my war
You come back with the head of my enemy
You come back and You call it my victory
You go before I know
That You've gone to win my war
Your love becomes my greatest defense
It leads me from the dry wilderness

All I did was praise
All I did was worship
All I did was bow down
All I did was stay still

Hallelujah, you have saved me
So much better Your way
Hallelujah, great Defender
So much better Your way

When I thought I lost me
You knew where I left me
You reintroduced me to your love
You picked up all my pieces
Put me back together
You are the defender of my heart
When I thought I lost me
You knew where I left me
You reintroduced me to your love
You picked up all my pieces
Put me back together
You are the defender of my heart

Goat, sheep, or child?

We play this game in Togo. We will be sitting in our house and you hear a sound and you have to decide if it’s a sheep, a goat, or a child. Sounds pretty easy but actually they can all sound pretty similar. 

I have been back in Togo for a little over a week now….there are so many familiar things here that are just so foreign to the things that happen in the States. I was asked so many times when I was Stateside about day to day life and about living here that I thought I would try to explain as much as I can as since I just returned all of the “shocking” things are still fresh in my mind. 

It is the rainy season in Mango, which means it rains almost every day.  This gives cooler temperatures but turns the dirt roads into ever-changing rivers and gullys. I ride a moto here everywhere I go so the drives are never boring. There have already been quite a few times of sliding or slipping trying to navigate these roads but so far I have managed to remain upright.  Oh I haven’t even mentioned the constant worry of goats, chickens, or sheep that are always in the roads and threaten to dart in front at any given time. It’s always entertaining to say the least. 

I also moved into a new place this time around and so this past week has been filled with unpacking, washing, and rearranging. I started back to work to this week too,  so no rest for the weary. One of the doctor’s said, “Oh it’s like riding a bike.” To which I quickly replied except the bike has a flat tire J. So here I am, attending C sections, doing exchange transfusions, treating seizing children. All just a touch out of my norm of ER medicine at home. It keeps me humble that’s for sure. I wouldn’t trade it because by caring for patients in the hospital gives me the opportunity every day to show a patient, a family member, someone who Jesus is. 

But really the sweetest times since my return have been the reunions.

As I am sure most of you remember, there was a sweet, sweet child (nicknamed “puddles”) here that died that me and another doctor had cared for for many months. Just before I left for the States, a Bible study was started in the village where this child’s family lives.  Also, “puddles” mom found out she was pregnant again just before I left as well. I prayed so fervently for her to have a good pregnancy and to have a healthy child. Well, I received a photo in June that she had another boy and had named him Soloman. Needless to say, I was excited to get back and to visit. 

Well a picture is worth a thousand words so…….

That smile is his brother’s smile for sure…..

I asked the chaplain that has been doing the Bible study in this village if he knew why she chose the name Soloman. This is definitely not a traditional name in their tribe. He said they chose it because in the Bible, when David lost a son and God gave him another one he called him Soloman. 

The Lord is moving in Togo folks…..this family had a great loss when “puddles” died and they are also a very dark and really demonic tribe so for Soloman to receive that name and for that reason is truly astounding. Deuteronomy 30:6 says, “And the Lord your God will circumcise your heart and the heart of your offspring, so that you will love the Lord your God with all your heart and with all your soul, that you may live.”

So please join me in praying that the Lord would do just that so this family can truly love the Lord with all of their hearts. This study happens every Wednesday morning so please join me in praying for this sweet family and this sweet new boy. 

Stepping through the wardrobe…..

I have been back in the US now for about 2 weeks and I am continually struck by all things ‘merica. Don’t get me wrong, I have enjoyed the endless coffee, cheese, and chick-fil-a but the stark juxtaposition of setting is so ever close to the surface all the time.

I have and continue to have sweet reunions with family and friends but the friends I left are ever on my heart and mind as well. It is truly a process to return just as it is a process to go.

As the adjustment continues, I find myself so many times thinking and praying for the ones there. I was able to see the beginning of something so encouraging before I left….

It is a Wednesday morning and I am waiting in a parking lot for a friend of mine who is a chaplain. We are heading out to a village to visit a family that has become very dear to me. After about a 30 minute moto ride, we come to a fork in the road and my friend has stopped. I catch up to him and he asks me which is the right direction and we continue to our destination. He goes on to remind me that the last time he was in this village it was the middle of the night. He was coming to tell this family we are visiting today, that their 1 year old child has died and they need to come to the hospital. You see this family’s child “lived” at our hospital for many months and at times the family could not stay because of the other demands at home. We would care for their child so that they could return home. But, on that night, my friend had to go and retrieve them and tell them that the worst had happened and they needed to come.

I had been out to this village several times since then but I had forgotten that my friend had not and all of that emotion just flooded back in that moment.

However, today was the day that a Bible study would start in this village. The death of their child had cut a wound in a couple of us that was very deep, but through that loss and pain, we began a journey with this family that led to this day. To the day when the Bible and the truth of Jesus could be told among them, in their heart language, in their own village. I was so encouraged to be able to see the beginning of that study before I left. I told my friend, who will continue this study weekly, that my heart was full when we left that day. As I am here, in the US, it is comforting to know that this study continues. I pray for the walls to fall and the veil to be lifted from around the hearts and minds of this family, this village.

Below are the lyrics to a song that cannot play without my mind and heart being reminded by times in Togo that were so hard and more questions remain than answers. One of those times is that night with this family’s child. But, there is a hope that even when my human mind and heart cannot and do not understand that I can rest that there is one that is sovereign over me.

https://www.youtube.com/watch?v=4x8TZiwPGaO&sns=em

Sovereign Over Us

“There is strength within the sorrow, there is beauty in our tears

And you meet us in our mourning, with a love that casts out fear

You are working in our waiting, you are sanctifying us

When beyond our understanding, you are teaching us to trust

Your plans are still to prosper, you have not forgotten us

Your with us in the fire and the flood

You’re faithful forever, perfect in love, you are sovereign over us

You are wisdom unimagined, who could understand your ways

Reigning high above the heavens, reaching down in endless grace

You’re the lifter of the lowly, compassionate and kind

You surround and you uphold me, and your promises are my delight.

Even what the enemy means for evil, you turn it for our good.

You turn it for our good, and for your glory

Even in the valley, you are faithful

You’re working for our good, you’re working for our good, for your glory

You’re faithful forever, perfect in love, you are sovereign over us. “

This study happens at 7:30am every Wednesday. Consider spending your Wednesday mornings praying for this study, this village, this family.

Wins are wins and I'll take them

I’ve been back in Togo for 6 weeks…..after a stent in the US to see family and refresh a bit, I am back for a few months.

Some things I have been trying to focus on at home and now back in Togo is learning to abide in Christ. I read a great book while at home called Humble Roots. I highly recommend it. This is a quote from there that has really stuck with me: "Your heavenly father knows what you need. He knows your heart is troubled. He also knows better than you do, that all these things are beyond you. And so, this is what you must do, all that you must do: you must seek Him and let Him take care of the rest.”

I am trying to solidify in my sinful mind that even when things are hard and the answers are not what I want, think, or expect that He is in control, knows me, cares for me, and is there if only I would go to Him. Here are some verses that have been helping me along the way: 

“The Lord is good, a stronghold in the day of trouble; he knows those who take refuge in him.” Nahum 1:7

“In this you rejoice, though now for a little while, if necessary, you have been grieved by various trials, so that the tested genuineness of your faith – more precious than gold that perishes though it is tested by fire – may be found to result in praise and glory and honor at the revelation of Jesus Christ.”   1 Peter 1: 6 – 7

“…Your adversary the devil prowls around like a roaring lion, seeking someone to devour. Resist him, firm in your faith…..And after you have suffered a little while, the God of all grace, who has called you to His eternal glory in Christ, will himself restore, confirm, strengthen, and establish you.” 1 Peter 5: 8b, 9a, 10

I share these in a hope that they may be an encouragement to some of you as well.

I returned at the height of rainy season which brings daily storms and cooler weather but also loads of malaria. I don’t think I have ever experienced a disease that just steals children from this world as quickly and relentlessly as malaria. It is merciless in its attack and despite our best efforts and great medications, we see way too many succumb to it.

I think I forget a little, when I am away, just how much heartache we have with death here. How many times a day or week I will sit with a mom that just lost her child and try in some way to comfort her.

It is easy here to be beaten down by the heartache…..by the death. But, sometimes we get a win. I want to share just a couple of the “wins” I have seen since my return.

Just a couple of days after I got back, a young woman was brought in with a snake bite. These are fairly common here and the venom causes the bitten extremity to swell. That is the outward signs anyway. Inwardly, though, the venom spread and prevents the blood from clotting. It is common to get bleeding throughout the body: abdomen, head, etc and this can wreak havoc and lead to death. The effects of the venom progress the longer the person waits after the bite before being treated.

This patient came in 5 days after she was bitten. She was completely unresponsive on her arrival. I immediately started the antivenin but the destruction was already severe and she was anemic, requiring transfusion.  Several hours after her arrival, I was called to see her and was barely breathing. I feared she was in flash pulmonary edema either from the whole blood she was receiving or from the effects of her envenomation.  She received some meds and was placed on a non-rebreather but I talked with her brother and told him I did not know if she would live. She had a bad night for sure but the next morning she was so much more comfortable and actually opened her eyes for the first time. She continued to improve dramatically over the next couple of days and went home recovered.

My next story is an ongoing prayer request…….we have a new preemie in our hospital that is right at 2 weeks old. He was born emergently by C-section after his mom had a placental abruption at 30 weeks.  He was born weighing 1.27kg (just over 2.5 pounds). To say his first 24 hours of life were rough is an understatement. I was the physician on the day he made his arrival and I ended up resuscitating him for several hours because his effort of breathing was not sustaining him. Two times, during his first 24 hours, he was handed over to his parents for them to say “goodbye” because there was nothing else we could do for him. Both times he got better by being held by his Dad. I am not one to throw out the word miracle haphazardly but truly I have no other explanation for him living. I told the Dad that God was doing something here and we would continue to pray and trust and see what would happen. Well, this child is progressing well for a preemie, however, he is still very tenuous given his size. Pleas pray for him and for us as we make medical decisions for him. Pray especially for his parents, who are very strict Muslims, that they may encounter Jesus during this time of trial. Pray for us as we interact with them every day that we would find ways to show Jesus to them as well.