Raw

After sitting on the sidelines here in Kenya, so to speak, for the first term (Sept-Dec), I was eager to have my board exam behind me and looking forward to the chance to be on the team down at the hospital. Just before we left for the US at the end of November, we had a very difficult meeting with several people in leadership at the hospital, wherein I was told that they aren’t going to offer a position to me: surgical, clinical, or educational. Nothing part-time or full-time. And yes, this felt like death. Death of yet another dream for us as a couple on this journey in missions.

It still is raw, and part of why I haven’t blogged about it or written much in our newsletter is that I simply don’t want to bring up the feelings that it created within me, over and over and over. The questions are inevitable, and I’m struggling to find a concise way to answer and stop further questions when people ask me, “How do you like working in Kenya?” and “How are things at the hospital?” and “When do you start?” and “Have you decided whether you and Ryan are extending your time past a year?” I have also found that I am re-dealing with the sorrow of leaving our dream in Vanga, DR Congo. A counselor reassured me that although we have gotten a great deal of debriefing about that and felt emotionally stabilized, when something new comes along that is similar, it can reopen a healing place in our hearts. And that is certainly what I feel like: raw. Tears come easily, and I don’t think it is just the pregnancy.

�

I know you may be thinking, but I have so many questions! How can this be? Isn’t she volunteering to work as a physician in a hospital for free? Isn’t the hospital busy? I’ve never heard of this. Aren’t missionary doctors always overworked? Is this just a temporary ‘no?’ Why would they not invite her? What is wrong? Where is the misunderstanding? And I assure you I’ve been asking myself the same questions. When I get really down and allow the Enemy to whisper to me, it is usually, “You aren’t good enough. They didn’t like you. You haven’t been able to stay in one location longer than 14 months so you aren’t showing perseverance or being patient enough. You aren’t a good doctor. You aren’t a good teammate. You didn’t ask enough questions on your visit to Kenya last May and made a mistake.” And I have to fight it. Every. Day.

A rainstorm in the Rift Valley

The truth is, I don’t resent the hospital leadership, or our organization, or those who are working there right now. I am frustrated by a situation that I don’t fully understand. I’m upset that when Ryan is finally thriving in his role on the mission field that I’m not fulfilled. I’m worried our supporters won’t like to hear that I’m not doing medical work here and stop supporting us. And I’m sad to not be a part of a medical team, to not see on a regular basis our friends who also did the post-residency program with us and are now permanently here. But… I don’t think I’m supposed to understand. God was not surprised by this. I can look back at our Ebenezers and clearly see that we were supposed to come here. I’ve prayed and prayed for clarity and this ‘no’ is about as clear as they come. For some reason, I’m not supposed to be working. I’m supposed to be at home with my kids and have the freedom to come and go when need be.

Before I start in with some of the good news, I need to be forthright that January was a low point for me. We had just come back from spending time with family after I finished—and passed—my oral board exam for the final step to becoming board-certified in OB/GYN. So there was a natural post-holiday slump. But we brought the dreaded flu back on our flight home, so about a week after getting back, we were sick, one after the other, for most of the month. I wasn’t working, but I had set up our household so that I could have been working, so I felt like I was simply not needed around the house. Then I was cooped up with one kid sick and the other stir-crazy, then I was dog-tired and pregnant with my own flu, and then the other kid was sick and the former one stir-crazy. Needless to say, it was a tough start. Ryan was very busy with a full class load and coaching basketball—and thriving.

Ryan enjoying his roles as basketball coach and math teacher

Continuing to teach at home

When we were on the upswing of sickness, but I was feeling quite depressed by the situation, we were contacted by Samaritan’s Purse to see if I could go and fill an urgent need back in Togo where we just left in June. Ryan encouraged me to pursue it. I looked at the calendar and considered what activities were going on at the school and what I’d already committed to as far as volunteering for things like nursery duty and hosting students. I decided that even though the need was for the entire month of February, I thought, I could only commit until Feb 14. I sent an email, not realizing that the Togo team had already sent me a message saying that my end date should be…. you guessed it, February 14. It was a confirmation to me that the Lord was behind this. “Whether you turn to the right or to the left, your ears will hear a voice behind you, saying, ‘This is the way; walk in it.’” Isaiah 30:21 NIV

Less than a week after booking tickets, Sydney and I were landing in Togo. It was a bit of déjà-vu. We had also booked our tickets less than a week in advance when we moved from Congo to Togo last time. As we left the baggage claims, went through customs, and exited the airport in Togo, the first person that I saw was an airport employee who sort of ran up to me saying, “Oh Doctor, you are back! I need to come see you.” To me, this was like getting a big hug from God Himself as I was dealing with self-doubt. There were lots of happy reunions over the next few days. The maternity was significantly less busy than when I had left, a purposeful scaling back of services due to the shortage of doctors. I had heard that the numbers of deliveries were down to about 20/month. Even so, the moment I walked into the labor room I was able to assist in a delivery. Another hug from God.

Part of the maternity team in Togo

I’m trying to settle into a new expectation for this season. I have a group of students I meet with on Sunday mornings, I am starting to see formal and informal consults for students and other staff who want help with medical issues, and I am working on editing a medical book meant for health workers in developing countries. In the near future, I’m hoping to help out with menstrual issues and eating disorders at student health. I’ve even just recently been chosen to help with a resolution by this year’s Model United Nations regarding menstrual health hygiene. Of course, I help out with preschool and run around with my kids. It’s a beautiful climate to live in, and there are lots of things to be thankful for. But, for now, the issue of our future and work in the hospital is raw. God knows and I feel His love in the midst.

Fistula Surgery on the Africa Mercy

AFRICA MERCY
If you are unfamiliar with MercyShips, they are an organization that uses a completely volunteer workforce to do life-changing surgeries off the coast of Africa using a hospital ship. The advantage of this approach is that even in a war-torn country with minimal infrastructure, they bring all of their equipment and personnel right to the shore, dock for 10 months, and then move on to another country. I had the privilege of working alongside an experienced fistula surgeon (former Vanderbilt faculty) named Andy Norman. As he mentored me, I was able to mentor a Cameroonian GYN who is part of the medical capacity building program that MercyShips provides. Being fluent in French, I was able to translate for her as Dr. Norman explained various aspects of the surgery in English. We did 30 operations in the three weeks. Over half were fistula cases, and the rest were hysterectomies and prolapse cases that really affected the quality of life for these women.

THE PROCESS
MercyShips provides all surgeries for free, and they focus on surgeries that are not usually done in the country due to requirements for multidisciplinary teams or special imaging like CTs or due to lack of resources. If the surgeries are done in-country, MercyShips provides training so that local surgeons can improve their skills or perhaps learn a different way of doing things. In this way, there is a concerted effort to avoid competing with local doctors and their source of income. Because the surgeries are free, there is quite a demand for the services, and lines are long at screening sites. Some of our ladies came from 3 days journey, sent by the government of Cameroon in buses. I believe they went from village to village and asked anyone with problem of leaking urine or stool to join them on the journey. As a doctor coming to work, the process is very streamlined. The patients have already been interviewed by the screening team. The surgeons then have one or two days of their scheduled time on board to screen the patients. We would see as many as possible, diagnose the problem, decide if surgery was needed, and then put a priority on them. The rest of our days were entirely surgical.

Part of our surgical team. Dr. Andy Norman is center.

A DAY
We made our postoperative rounds to see patients just after breakfast and headed to the OR. The hospital is all on one deck of the ship with wards and beds on one side, and the 5 operating rooms, lab, CT and Xray, and pharmacy on the other side. As you can imagine, there are no windows in this part of the ship and patients and nurses alike enjoy their afternoon time to go up on one of the upper decks for fresh air. There are places for children to swing and ride trikes, but most of the time the women would walk around and sing. We surgeons typically finished surgeries just before an early dinnertime. After dinner, we would go back down to the ward to check on the patients and to consent the patients who were scheduled for surgery the following day.

Beautiful! Patient waiting for her turn to be introduced at the dress ceremony

A PATIENT

One particular patient had been having problems of leaking urine for 10 years. This was not uncommon, as the range was from a few months to 27 years. The sad part of her story was that she had been going from hospital to hospital looking for a solution without result, for 10 years! Indeed, when we filled her bladder with the blue dye, there was none that came out into the vagina that would have indicated a fistula connecting the bladder to the vagina. Although these are the most common type of obstetric fistula--even our name tags said VVF surgeon for vesico(bladder)-vaginal(vagina) fistula surgeon-- they are not the only fistulas we see. There are also connections between the ureter (the tube coming from the kidney before it goes into the bladder) directly to the vagina or the rectum to the vagina. For our patient in screening that day, after further questioning she mentioned that she has blood in her urine once a month, just like her period, but she doesn't have any vaginal bleeding. Bingo! We diagnosed Yousseff's syndrome by injecting contrast into the bladder and looking on CT to see that there was a connection between the uterus and the bladder. So every month, she would have a period but all of the blood would flow into the bladder because it was easier than going through the thick muscle of the cervix. And conversely, only if her bladder were extremely full, the urine would flow into the uterus and then have enough pressure to come out of the thick muscle of the cervix. So she would leak urine intermittently from the cervix and into the vagina, but she would always have her period through her bladder. During a long abdominal surgery, we were able to separate the uterus from the bladder, remove the uterus, and close the bladder.

Putting on makeup prior to the dress ceremony

THE DRESS CEREMONY
The patient is one of many who are so grateful to finally have resolution to a problem that has significantly affected their life. Each woman who has found a cure (or at least a significant improvement in their condition), has an opportunity to be involved in a dress ceremony. They get dressed up in a new dress, their makeup done, and they then dance together down the hall of the hospital deck in their bright new clothes and enter a room of cheering MercyShips crew. It is a highlight. They sing and dance and then (usually tearfully) share their stories, praising God that they were healed. Comically, they usually have to get up one by one to use the bathroom during the ceremony. And I always smile. Imagine needing to go to the bathroom after all those years!

Dancing through the hallway during the dress ceremony