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Further along the unexpected road

Surgery number three in Kenya, May 23-- not our choice of how to end our first vacation of the year.  We were, however, thankful to be together this time.  Our children had been to Tenwek Hospital 2 years earlier, and still remembered many of the kids.  They were excited to renew friendships and meet new families that had more recently joined the work there.  

With Elizabeth attending to me before and after surgery, and the kids enjoying themselves with us, this surgery was a much more peaceful experience.  The surgeon replaced the retina, dissecting the scar tissue which had formed after the first two surgeries and caused the second detachment.  He placed silicone oil in the eye to keep the retina in place, with the understanding that the oil would need to be surgically removed six months later.  Recovery was much quicker than the previous times-- which seemed to be related to the presence of my wife and family.  I still had no useful vision in the right eye, because of the oil and the damage to the retina, but we were ready to settle in with life again.  I was encouraged by one of the doctors there that I might still be able to do surgery with eyesight in only one eye.

Back in South Sudan, I resumed work-- minus performing surgeries.  After about 3 weeks, my partner was going on holiday, so I thought I would try operating with him a few times.  It was difficult, and I was more cautious than before my loss of sight, but I found that I could safely do what needed to be done.  While many were praying for restoration of my sight, God showed us that He would instead give us what we needed to continue.  His grace is sufficient, and His power is made perfect in weakness.  It is our hope that in our weakness, others will see His greatness.

In early August, a recheck revealed that the retina is still in place and the nerve is healthy!  On the other hand, the iris is stuck to the lens (causing the pupil not to constrict much), a cataract is forming in the lens, the pressure is low (likely due to a leak inside the eye), and the right eye is not aligned with the left.  The vision is still worse than 20/400, with distortion of what is seen.  After praying and considering the options, we have determined the next round of evaluation and surgery will be best accomplished in the US-- in December of this year.

In the process of these many trips to Tenwek, the Lord has connected us with new friends and initiated discussions about how to strengthen healthcare in South Sudan.  We share what we are learning medically, and dream about how God would have us encourage health providers in East Africa.  Perhaps He will use this series of trials to save lives in South Sudan and bring glory to His name-- which is His goal, and therefore ours as well.

Last Updated on Saturday, 16 August 2014 17:07

Second Surgery... and a Scary Sickness

After 2 weeks of recovery (and waiting for the gas bubble in my eye to dissolve) in Kenya, I made the return trip to South Sudan-- by myself and with sight in just one eye.  Arriving in Uganda late at night, they wouldn't allow me to transfer to the terminal for my connecting flight the next morning.  So I sat near the open door next to the runway, being swarmed by insects and smelling jet fuel.  It was too late to leave the airport (in the rain) and pay for a visa, taxi, and guesthouse.  After waiting for several hours and asking multiple people, I finally found a security guard who made some calls and granted me access.  I rested in the terminal and boarded my flight the next morning.

It was a great comfort to be back with Elizabeth and the kids-- we had not been apart for that long in all our 17 years of marriage.  The kids took turns reading to me (as my good eye got tired quickly), covering a good portion of the original Nancy Drew series (we have several pre-teen girls, can you tell?).  I arrived back the day before our South Sudanese pastor was officially installed, for which I was extremely thankful. We had seen him go from schoolteacher to pastor-in-training, through Bible college, to leading the church.  It was a good day of celebrating with him.

The Lord brought doctors to cover in my absence, and another came from the US in response to our call for help.  In between, though, there were 2 days without coverage.  A local South Sudanese surgeon came to do a C-section one of those days, and the next day a baby in distress prompted me to go over and assist with a difficult delivery.  She had a bad laceration, but I was not yet able to see well enough to do it, so I talked our "clinical officer" (like a physician's assistant) through the challenging suturing job.

We were very grateful to see the doctor the next day.  As soon as he set down his bags, he put on scrubs and asked to be pointed in the direction of the hospital.  While he was only there one week, he hit the ground running and never stopped!  He had worked in Niger for 6 months, so he was savvy to and equipped for the type of work in South Sudan.  Aside from medical work, he taught our son new guitar skills (which I couldn't do because at age 10, he's already better than I am!).

The Lord had already arranged that another similarly trained doctor was coming for a 2 week visit, arriving on the day the other doctor left.  During this time, we also welcomed our first South Sudanese intern doctor, who came to work and learn alongside us at His House of Hope.  During this time, I was due to travel back for a recheck of my eye.  

Elizabeth and I decided we would go together, as we anticipated another surgery to wash out the blood from my eye.  Arriving Saturday evening, we decided we do some labs just to be sure that the bleeding complication in the first surgery wasn't due to an underlying problem in me.  To our surprise, both screening labs were abnormal.  This started us down a trail of talking with hematologists in Nairobi, which led to a one day trip to Nairobi and back for more labs.  I was cleared for surgery, but only if I was given fresh frozen plasma (FFP-- contains clotting factors) before and after surgery.

The next morning, I was given FFP and had the surgery.  The retina was still attached, and they were able to remove most of the blood from my eye.  I had to sleep upright, and had a fair bit of pain and nausea, but after 36 hours, we boarded a flight to return to our children, who were under the watchful care of one of our missionary nurses back in South Sudan.  As we started our return trip, she mentioned that our youngest child (Winnie, who had just turned 5) had malaria and had been started on treatment.

Upon our return, she had taken a turn for the worse.  She was laying on the floor and didn't even get up.  We promptly started her on IV fluids and stronger malaria medications, but she didn't get better.  The next day, she got a high fever, so we retested for malaria, and found it to be negative.  She got a little better, then got an even higher fever (up to 106+ degrees).  The visiting doctor and I scoured our brains for what we could be missing.  We started her on treatment for typhoid, but she continued to worsen.  After 2 days of illness, we thought about evacuating her, but realized that even if we did, it would take several days for them to evaluate her and have more information than we did then.  It was Easter morning, and I prayed more earnestly than I can remember doing previously.  The only other illness that seemed to fit the description of high cyclical fevers, severe shaking chills, and abdominal pain was tularemia.  We weren't covering for it, and there is no good way to test for it.  So, we chose to put her on a strong antibiotic (chloramphenicol) even though it had risks of causing problems with her blood.  It would cover for this illness as well as resistant typhoid.  

At this point, I really didn't care if I ever regained sight in my right eye-- the life of our daughter was much more important.  We were aware of the fact that God might not grant her continued life.  It was a process of releasing her to Him, trusting that He could sustain even through the loss of her life.  Honestly, I told Him I didn't think I was ready for that, but I knew in my head that He could see us through it.

Later in the day, her fever went away and did not return again.  She started eating again and regained her strength slowly by slowly.  We thanked Him for sparing her and trembled at how close we were to her death.

The day after Easter, with Winnie recovering, I noticed the little vision I had regained after the second surgery seemed to darken, as if a curtain was pulled down over my right eye.  I mentioned it to my eye surgeon, who was concerned.  We thought likely I had bled again.  We could not fathom another trip so soon again, so we waited until we were scheduled go through Nairobi a few weeks later.

Meeting us in the parking lot of the Nairobi airport, while others around us knelt and prayed to the east, the surgeon examined my eye and delivered unexpected news-- the retina was detached again-- this time much more extensively than the first.  I would need another surgery.

While not excited to have needles stuck in my eye again, we were at peace that God was still in control.  "He's still sovereign..." we repeat to each other.  "It's like He knows everything."  (We say this "tongue-in-cheek", as we know He truly does know everything, but often forget this in daily life!)  As we were traveling in Kenya as a family, we would be together for surgery number three-- a great comfort to us all.

(In the next post, surgery #3, trip #4 for a recheck, and what God did in the midst of all this...)

Last Updated on Saturday, 16 August 2014 14:12

"Seriously, God?!"

Seven weeks had passed since His House of Hope Hospital had reopened.  I was the only doctor on site, and my partner was not due back for another six weeks.  I noticed some blurriness in my right eye, which I casually mentioned to others.  "Must be sleep deprivation," we mused-- which made sense, given that we were doing 40-60 deliveries per month, and awake at least part of most nights.  

Day by day, the blurriness grew worse.  I started to self-diagnose, and realized it was a darkening of the upper inner quadrant of my vision.  After consulting a book, then emailing several eye doctor friends around the world, it became apparent that I was having a progressive problem with either my optic nerve or my retina (the inside surface of the back of the eye which receives images and transmits them to the brain).  It was unsettling-- I was 42 years old, running a mission hospital by myself, and potentially losing my vision.

One friend happened to be a retinal surgeon, serving as a missionary in Kenya.  As we exchanged emails, he suggested I objectively test my vision. I kept second-guessing myself, thinking I was making it up. However, doing these simple tests made it apparent that the visual loss was real and progressive.  Late one Friday night we talked on the phone— "I think you need to make a trip to Kenya..." he told me—bringing the reality of the situation to light.

With only two flights out of our South Sudanese town each week, we quickly called the local airline representative (on his cell phone, at 9PM on a Friday night) to see if there was space on the flight the next morning.  There was-- but only one seat. We had wanted someone to accompany me, but that was not an option. In the midst of it all, our first response was “Seriously, God?!”

I left Saturday morning, taking several plane flights and a long car ride to reach Tenwek Mission Hospital in Western Kenya on a Sunday afternoon. Our friend, the retinal surgeon, immediately took me to the eye ward and examined me. I wasn’t making it up. My retina was detached, nearly to the focal point of my vision. He recommended surgery—a vitrectomy to remove the gel-like fluid (vitreous) in the back of my eye, then laser treatment to scar the retina back in place. I nearly passed out as I considered the radical nature of the surgery he was describing. I had been hoping he could just zap me with a burst of laser and call it good.

During the trip to Tenwek, I had been wrestling with God in my thoughts, telling Him how I didn’t want to have surgery. (Similar to the previous few months, when I had wrestled with Him about doing emergency C-sections when exhausted…) Something about 3 large needles and draining my eye didn’t interest me. Late that Saturday night as I waited at the Nairobi airport, He impressed upon me that I needed to surrender ALL to Jesus. “But Lord, I have surrendered all to you—we are serving in South Sudan!” Yet I knew if I trusted Him completely, I would submit to Him even in this very unexpected reality.

Less than an hour after diagnosis, I was in surgery. Under local anesthesia, I was awake, and being a doctor, I understood more than I wished I did. Near the end of the surgery, I was aware of the electrocautery being used to control bleeding. In the last few minutes of the surgery, my eye swelled up due to bleeding around and inside the eye.

After the shock of the diagnosis and surgery passed, the two weeks of waiting, recovery, and keeping my face down toward the ground began. Not only had I required surgery, but I had a complication of surgery (one of those things all of us that do surgery tell people can occasionally, but rarely, happen). More significantly, my family was 600 miles away in South Sudan (not a particularly safe or stable place) while I recovered. What was God doing in all of this?

Again I cried out, “Seriously, God?!” I was struck by my powerlessness, weakness, and lack of understanding—and simultaneously by the fact that He is God. I knew Him to be good, and I could trust what He was doing.

He is God. It isn’t my right to understand what He is doing—even in my own life. What He allows in my life often seems harsh, unnecessary, and unpractical in the common sense of the world. But He is God, and He knows what I need a lot better than I. This is the essence of surrendering and trusting Him completely.

I thought we were through most of the difficulty, but the story was not yet done.

(to be continued in a subsequent post…)

Last Updated on Tuesday, 24 June 2014 05:24

Termite Mounds & Teak Roots

It was a frigid morning in South Sudan—the guard was warming himself by a fire in the backyard, and I put on a long sleeve T-shirt to go for a run with my wife. How cold was it, you ask? It had dipped to 61 degrees! After living at 85-105 degrees, that truly does feel cold.

On our run, we run up and down the potholes, which, being dry season, are filled with powdery red clay dust which poofs up with each step. The air is filled with dust and smoke, as it so dry, and because people are burning the fallen teak leaves and baking mud bricks stacked in giant rectangular piles resembling Mayan temples.

We cross the main road, greet some men standing near the “boda boda” stage (the place where the motorcycle taxis pick up customers), and proceed to run a loop around the expansive tobacco warehouse which was recently built. It is a veritable fortress, with a paved street within the fence with several houses for the management, two immense metal buildings, and a separate entrance with a large metal gate where delivery trucks are seen coming and going. The entire square compound is enclosed with a high chain link fence with human barbed wire, and thorny bushes growing up just outside the fence. To circle it is nearly a mile in length

We cross back over the main road and enter a footpath in our community again. In places, the path is wide enough for a car to make its way through the dense teak forest—and sure enough, we come upon a well-built house with a metal roof, that has a small sports utility vehicle parked in front of it. We pass other homes that are simple thatch roofs and mud walls; some have painted a black border at the base of their home (as the rain splashes the dirt onto the lower 18 inches during rainy season). Some homes are very neatly painted, despite being made entirely of grass, mud, and sticks—a small tin of paint to cover a “tukul” like this costs 6 pounds at the local hardware store ($1.50 US).

As we make our way toward home, the trail becomes rougher, and we pass by some recently formed mud bricks still drying in the early morning sun. We run through the soft sandy soil, hopping over termite mounds and teak roots. Says Elizabeth, “this is true cross-country running!” So goes our early morning run in South Sudan during dry season.

Last Updated on Sunday, 02 March 2014 15:05

First Time Mothers in South Sudan

The 17 year old first time mother brought her 1 week old baby to clinic after delivering at His House of Hope. She complained of the baby having a fever. Our nurse had already evaluated her, and the vital signs and labs were normal. She was eating well and didn’t look sick. As I reviewed the case, I looked more closely at the baby, caught a knowing glance and poorly-concealed smile from the nurse, then began explaining to the mom in my broken Arabic that everything seemed normal, and perhaps she should dress her in lighter and less clothing especially during the afternoon—as the baby was wearing a long knit outfit and was wrapped in a heavy knit blanket, and it was at least 100 degrees outside. The young mother smiled and nodded appreciatively.

The day after reopening the hospital, our second labour patient arrived. Sadly, the woman was somewhere between 30-34 weeks in her first pregnancy, and our staff could not find a fetal heartbeat—even using ultrasound. Our missionary nurse and I stood back and talked, sad that this mother's first pregnancy should end in a death.  The nurse on duty easily handled the delivery. As we were conversing, the staff nurse suddenly exclaimed, “The baby is alive!” Sure enough, the tiny baby girl was breathing and even crying a little. Weighing only 1250 grams (2 lbs 12 oz) and appearing to be about 30 weeks gestation (7 months), she did remarkably well. Over the next 16 days, she struggled to maintain her body temperature and gain weight, but was then able to breastfeed and demonstrate she could eat on her own and continue to gain weight. This first time mother surprisingly went home with a healthy, albeit small, baby—when at first it did not seem she would.  We thank God for granting her life.

Last Updated on Sunday, 02 March 2014 19:07

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Our Mission:

Share the gospel of Jesus Christ and strengthen His Church through medical care and education, discipleship, and loving the people of South Sudan as a family.

 

Exciting Bridge Jeff and Elizabeth had to cross
Filtering water one bottle at a time
Moyo District - our new home
Our property with Mango and Avacado trees and a soccer area for kids to play once we mow.
Hazel in our new kitchen.  Here you have to provide everything:  cabinets, counters, applicances
Exciting Bridge Jeff and Elizabeth had to cross
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