Unreasonable Hope

She lay there on the operating table, and as I watched her breathing, her hair discolored from malnutrition, her thin frame like a child's beneath the surgical drapes, I knew that despite our best efforts we had not been successful. She was no better off than before we started. And yet, I had an overwhelming, confusing sense of peace. I felt an unreasonable hope for her. 

Always be prepared to give an answer to everyone who asks you to give

 the reason for the hope that you have. -1 Peter 3:15

The OB/GYN ward in the waning hours of the day, around 5pm

 She was a "typical" fistula patient... very very poor, abandoned by her husband. Her only child had died during labor many years ago, and she has been leaking urine constantly since then. We had removed a 4cm stone from her bladder about a month ago. It is important to wait to repair the hole in the bladder because of the high rate of infection associated with stones and thus a high failure rate in closing a fistula. After the initial operation, we waited until she was fever-free for 2 weeks, adding on a week because of one thing or another (couldn't find her in the hospital grounds to get her registered for surgery multiple times). Because she had already experienced a delay of more than a week for no reason, I insisted on adding her to the schedule as there were only 8 other major cases listed (sometimes there are 10 or 11!). I was trying to be her advocate.

Hindsight is 20/20. The downside to adding her to the schedule was that she went last in the day. We were all tired, and 5:30 pm is not a good time to start any non-urgent case, much less a very difficult case. We started to operate, and immediately I realized there was a ton of scar tissue and very little good tissue left. Secondly, there was not just one but two holes in the bladder (one was clearly visible and fairly "easy" to close). As the surgical team only takes breaks in-between surgeries to eat peanuts, tea, and bread, at this hour, I was quickly becoming hypoglycemic with my pregnancy as well. I switched back and forth being the main operator and assistant with another experienced general surgeon. Long story, a bit shorter, we stopped the operation vaginally after we realized that most of our sutures were just pulling through very fragile tissue, and we then made an incision in her abdomen from above. Upon entry, her bladder literally tore open. And my heart broke with it.

At this point, it was 7pm. I was feeling very poorly, and had to step out of the surgery. Open abdominal operations on the bladder aren't really my specialty, but I felt guilty nonetheless. I went out to take off the hot surgical gown and get some water, but realized I had already finished my bottle of water. This was not good as there was no tea left, and I can't drink the unfiltered water here without potentially getting sick. I sent an urgent message for someone to bring me a banana and water if possible. After the banana and water, I indeed felt much better. The operating room staff instructed me to leave and go home, but I knew I couldn't. She was my patient. I had insisted on her being on the schedule. To top it off, I knew the surgical assistant, herself, was sick with malaria and yet she was still there. No. In good conscience, I couldn't leave.

Back in the operating room, the surgeon told me he had found not 2, but 3 holes in the bladder. He had repaired 2 of them from above, but was now again trying the repair of the 3rd vaginally. As I didn't want to "waste resources" by scrubbing in again and using 2 more pairs of gloves and another gown, I stayed out but offered advice. I think one or two comments made a difference in his management. But he otherwise closed the holes as best he could. (I'd say he is king of doing surgery in the dark- not always precise, sometimes potentially causing harm, but probably more people are helped because he isn't afraid to try.) I certainly would have done things differently, but I had no choice but to abdicate my responsibilities and my position as the operator in this case because of my health.

It was as they were closing the bladder and abdominal incision from above that I experienced that unreasonable hope for her. I've heard people say things about their ailing grandparents like, "I know they will go to a better place..." but I've never really FELT that hope and that gratitude for good endings for someone, let alone someone so young. And that phrase- that cliche- didn't capture the peace that came over me. I have no doubt that God will redeem her, that God will completely restore her health when she is in heaven, and that it will truly be a wonderful ending. I may have "failed" to see God's kingdom come here on earth as it is in heaven through a physical healing now, but I have the HOPE, the CERTAINTY, that His Kingdom will come and she will have a new body. And in the meantime, perhaps she experienced a bit of emotional/spiritual healing by the love shown to her by those of us here at the hospital.

Pic taken from the OB/GYN ward towards the lab, surgery, and post-op.

Some of our colleagues work in a remote area of Cameroon, and they recently blogged about how we can best love the poor around us. I'll include the link, and I hope you'll read this story in full, but it describes a bit of what I was feeling.

"There are so many problems here: illiteracy, disease, very limited access to medical care and clean water, violence and so on. Honestly, I want to try to fix them all. Although we can attempt to solve these problems, we want so much more for these people then just clean water. Jesus said himself that everyone who drinks physical water will be thirsty again but whoever drinks of the water that he gives “will never be thirsty forever” (John 4:13-14). If this is what Jesus supplies, then is this not a long-term solution to Simon’s water problem? In the same way, even as we are ready to help Simon pay for a surgery, what we really want for him is to get a whole new body that will never pain him again. Every day he walks very far away on a dirt path to his field, and although it would be nice to have a smooth paved road, what we really desire for him is to parade through the clean, gold-laden streets of Heaven forever."

Always be prepared to give an answer to everyone who asks you to give

 the reason for the hope that you have. -1 Peter 3:15

I'll end with a second quote from their blog:

"So when you pray for [our fistula patient], pray big. Pray that [she] will be able to have every needed surgery, but do not forget to pray that [she] will get a whole new body. Pray that the Lord will provide [her] daily water, but remember to pray that [she] will follow Christ and never be thirsty again. Do not just pray that [she] will have a nicer house but pray that [she] will live in a mansion made for [her] by Jesus. Pray [she] will not spend [her] days worrying about what [she] is going to eat, but pray that [she] will seek God and ask God to “worry about” providing for [her]. Let us not just give our neighbors an America here in Africa, let us aim to give them the very Kingdom of God."
http://haretranslation.blogspot.fr/2015/09/how-can-we-best-love-poor.html#links

"Puff! Puff! Puff!"

It’s not what you think. Trust me. Has nothing to do with drugs, or make up, or girls, or a magic dragon, or even CPR. It is a phrase that has uplifted me in the midst of a difficult week. 

There are times when I am struck with an unreasonable feeling of discouragement or loneliness. It happened this week again. We were able to reconnect with some friends and family over the weekend, and should have been refreshed when the week started. Instead, I watched as Ryan struggled to find his purpose and place, feeling frustration over our lost shipment and over the fact that he hurt his knee playing soccer (minor this time) and is unable to connect on the one place he is most comfortable- the soccer field. Instead, I felt lonely for our friends we have left. Instead, I felt as I worked on Monday that I was working in the dark without cultures or pap smears or the ability to biopsy. This feeling of working in the dark, along with the numerous patients with cervical cancer too advanced to operate, gave me pause as I advised a resident doctor not to do a hysterectomy; nevertheless, the cervix looked ok (to the naked eye).

I felt prepared for heat, for mosquitoes, for limited options for medicine. I felt prepared for the inability to perform minimally invasive procedures like hysteroscopy (looking with a camera at the inside of the uterus) and laparoscopy (doing surgery through tiny holes with a camera). I felt prepared for difficulty with follow up with patients, for tropical diseases and conditions I’d never seen, and for bigger complications like uterine rupture. But I didn’t feel prepared for the battle within my mind of just how inadequate I might feel when asked for advice by residents and students, or for the loneliness that I might face, or for the darkness of discouragement. But God is good, and He reminds me time and time again to rely on Him for strength and provision of grace. It is so good to know that He is the one ultimately in control.

Four things encouraged me this week, one of them being “puff, puff, puff!” First, I was able to talk with a colleague who is working in Kenya with Samaritan’s Purse as well. Her experience is much the same, and that certainly helps me not to feel alone. I know there are many many people lifting us in prayer daily. Secondly,  I also have been able to keep in contact especially with two very close friends from language school- we are all living in different places here in Congo, and that has been a great source of laughter and sharing of tears. The third and fourth things happened while teaching in the maternity ward.

Sydney also got to practice helping the baby breathe

We started teaching a course, internationally known, called Helping Babies Breathe, for the maternity nurses.  Dr. Rice and his wife Kathy, nurse educator, and one of the Congolese doctors and I directed the course. It is so much different than the rote memorization I think they are used to. We had life-like baby mannequins and real ambu-bags and practiced every step of the way. At first, it was like pulling teeth to get them to come up from their chairs and practice with the babies. Kathy and I acted like crazy pregnant women coming during active labor, and soon they were laughing and playing along. And even though what we were practicing was very simple (we only did the first part which is when the baby is breathing and everything goes smoothly), we could immediately correct the small errors that they were making.

I watched as one of the older nurses went literally from sitting in the corner with a disinterested look on her face to actively participating, feeling for pulsations in the umbilical cord before cutting it, and telling the younger nurse, in French of course, “Well we haven’t been doing it like that, but we are going to start doing it like this from now on!!” I also watched as she connected what she had seen me doing in a delivery with her earlier this week, which at the time had seemed quite strange to her, with what we were teaching them now. She was all smiles with her new knowledge of the importance of drying off the baby, skin-to-skin contact with the mom, and waiting to cut the umbilical cord.

Practicing Helping Babies Breathe

And lastly, I spent one afternoon in the maternity ward, while waiting for patients or any questions from nurses, with the medical students and a resident. They had their heads buried in their books at first, but I told them I thought it was important during their clinical year that they be taught practical and hands-on things, as these are hard to learn from just reading. I brought in my suture training kit, and I told them we were going to practice tying surgical knots. Here in Congo, they almost solely use instrument ties as this conserves the suture the most and is the most simple. But time and time again, I watch as they make one crucial mistake in this knot which makes it more like a slipknot and susceptible to come untied. I first reinforced with the students the concept of square knots, and changing directions. Then, we moved on to one-handed and two-handed knots. They eagerly tried it out, teaching each other after they had figured it out. And then they would groan as I told them they had to switch hands (dominant hand switching to non-dominant hand) because from my experience, if they can switch hands, they truly understand the theory and technique of that knot. The resident explained that they had only been taught one part of the one-handed knot in their school. So when I explained that that would make more of a slipknot than a square knot, and had to be paired with its opposite, they were eager to call the first part the Congo knot, and second the Shannon knot.

One of the students, in particular, looked to me as he tried out the two-handed knot. Each time I affirmed that he had the technique or movement right, he nearly shouted with excitement, “Puff!” So as he got more proficient, I just saw his smiling face as he went through the motions, “Puff! Puff! Puff! Puff! Puff!” The joy of teaching is summed up in that face, in that smile, and in that shout of “Puff!”

I joked with him that I would go to bed that night, hearing him in my head saying over and over, “Puff! Puff! Puff!”

Serenity in the Delivery Room

I find the familiar Serenity Prayer very applicable at this time.

God, grant me

the serenity to accept the things that cannot change,

the courage to change the things that can,

and the wisdom to know the difference.

I often find myself wondering where my expertise should outweigh their experience here. What would be good to change? What is best left as it is because through trial and error, it has proven to be the most effective? When should I insist on my knowledge and when should I rely on the years of experience of the nurses? I find this to be an extremely difficult balancing act. Again, here is an example…

Last week we had slew of bad outcomes—three uterine ruptures and 1 baby who died shortly after C-section at term for unknown reason. Indeed, I learned many lessons last week about the system, discussed areas of delay or poor communication with various departments, and in general was overwhelmed with sadness at the loss of these babies. While waiting for a patient to arrive from the maternity for what was supposed to be an urgent C-section, the scrub nurse had asked almost incredulously why I was so worried. “If the baby dies, you didn’t kill it. God decides who lives and who dies.” And while that is very true, the delay of a C-section can in fact cause the loss of a baby who might have been saved a half an hour earlier. On rounds in the C-section postpartum room, only 2 of the 6 mamas there had babies in their arms. At least there were still 6 mamas there.

My surgery shoes, for some reason went unwashed this week, but were reminders to me of the bleeding from the uterine rupture as well as blue from the blue dye test where we found a vesico-vaginal fistula after prolonged labor elsewhere.

After such unfortunate results, the knee-jerk reaction in the maternity ward was to prepare and ask for a C-section as soon as anything abnormal was detected. A pregnant mom came in with the fetal heart rate very high. I was told by the students and residents that there was fetal distress and therefore a need for C-section right away. Everything from my training was telling me that tachycardia (high heart rate) in the presence of contractions is not usually a sign of distress but commonly from maternal fever. Everything from the past week was screaming at me to just go along with their thought process and get that baby out before it died.

I decided to go with my training this time, a bit reluctantly. She did, in fact, have a fever. But the fever had been present for several days. Perhaps the baby was septic (infected) and suffering. But no, when I scratched the baby’s head, it moved a lot and the heart rate increased. That was reassuring. But what might malaria do to a baby? But no, there were no drops in heart rate during or after contractions to indicate distress. We gave Tylenol and started antibiotics, and waited… and the heart rate was still high. “We need to perform a C-section, I think,” the resident said again. And one of the nurses agreed. My gut just didn’t agree. “Wait. Please just wait. I think the heart rate should normalize with a bit more time,” I replied, not knowing if that time would be detrimental to the baby.

I called another experienced staff doctor over to see if he had any further insight. At first, he advised to go ahead with the C-section to avoid having another dead baby. Just at that moment, the nurse listened to the fetal heart rate and it had finally dropped to the upper limit of normal. Upon hearing this, the staff doctor agreed with me that we could continue to wait. Just before I left the maternity ward for the night, the lab result came back positive for a high level of malaria parasite in the blood. We started treatment for malaria right away, and then made both the lower level resident as well as the supervising staff doctor aware of the situation. They both seemed a bit skeptical but agreed to just continue to wait for labor and watch the fetal heart rate closely.

Some of the sutures we have available to use during surgery

I walked into the maternity ward in the morning, certain I’d find her in the post C-section room, hopefully with a baby, but maybe not. The nurses came out to greet me with a good morning, and I asked about the lady. To my surprise, they pointed in the opposite direction, to where ladies go after a normal vaginal delivery. I may just have let out a little whoop of joy. The nurses seemed a bit surprised but definitely joined in the celebration outside the maternity building. I think they are used to doctors who like to operate, so finding my joy so abundant at a normal vaginal delivery perhaps was weird. It was just the encouragement I needed. I’ve made plenty of judgment calls, some good and some less than stellar. Hindsight is always 20/20, and this is especially true in OB. Sometimes we all just need a good vaginal delivery to make it through the day…. Said no one but me probably. :) 

Later in the week, I saw evidence for change in the vitesse (quickness) of urgently-needed cesarean sections. Because of a few conversations I’d had last week with the OR staff and maternity, we sped up the process by eliminating a few of the steps (like going to the lab and finding a blood donor and paying up front and finding an IV bag and finding a catheter and shaving the patient, etc…), and significantly reduced the time between decision to incision. We were able to perform two cesarean sections back-to-back and both babies who had previously had heart rates in the 90s (normal is 120-160) were born alive! The OR staff was pumped that the surgeries were done so quickly, and one of the medical students exclaimed, "Wow, that was great! That was so fast! You saved those babies!" I immediately thought of the conversation with the scrub tech earlier in the week and pointed out, "If I take credit for saving these babies, I need to take responsibility for the death of the others. God is the one who decides, God is the one who heals. I'm just working to do my best."

I may not understand all the time, but I trust that God is good. 

The problem: 

Your wisdom and knowledge, they have deluded you; For you have said in your heart, 'I am, and there is no one besides me' - Isaiah 47:10b

A  good reminder:

"Where were you when I laid the foundation of the earth? Tell Me, if you have understanding."- God to Job in Job 38:4

The solution:

If you seek [wisdom] as silver and search for her as for hidden treasures; then you will discern the fear of the Lord and discover the knowledge of God. For the Lord gives wisdom; from His mouth come knowledge and understanding. - Proverbs 2:4-6

For it is God who works in you to will and to will and to act in order to fulfill his good purpose. - Philippians 2:13

To end, I'll end with an adaptation of St. Augustine's quote. It is one of my favorites. 

Work as though everything depends on you.

Pray as though everything depends on God

Because it does!

A Goat and a Bag of Peanuts

“I only have a goat and a bag of peanuts. Can you save my wife?” When I say that almost everything is different here as it regards to medical care, I mean, really almost everything: the language, the terminology and classifications used, the medications and treatments available, the depth of poverty, the lack of a safety net for the poor, etc. As someone who was supposed to come in as an “expert,” I am so thankful that I am being given the opportunity these first weeks/month(s) to do more observation and learning of the system, rather than being primarily responsible or acting alone. Stories are better than abstract principles, so read on…

One of the differences- this is a main road leading to the hospital. Some patients are carried as in this photo (a woman in labor who is sitting on a wooden chair which is tied up to a pole that is carried by two men on their shoulders), others come by motorcycle or pedal bike, and most walk.

I met her in the ultrasound clinic room. She had been sent from the local health zone prenatal clinic, which is run by nurses, to get an ultrasound because her uterus was not growing in size as expected and she reported no fetal movement for 3 days. During the ultrasound, I confirmed the dreaded news—that her baby had died in her womb at almost 7 months. But something else was not quite right. Despite the abnormalities that can be seen on ultrasound with a fetus which has not had a heartbeat for an unknown amount of time, something about this was just unclear. Something was blocking the cervical canal. The quality of ultrasound is a bit different than in the US, but I could see that the placenta was in the front and low in the pelvis. The placenta was potentially blocking the cervix, which is bad news for someone who has had more than one previous C-section. The risk that the placenta has invaded the muscle of the uterus within the previous incision site is >60%, which can mean a hysterectomy would be necessary.

I normally avoid doing a cesarean section in cases where the fetus has died in the womb, but I found there was no choice in this case. I mentally prepared myself for a cesarean section with hysterectomy, just in case. Upon hearing the news, the patient was understandably distraught, but even more so after I told her she needed an operation. Both she and her husband were in tears. Both looked chronically malnourished, with very short stature and thin frames. The husband looked at me, and understanding the seriousness of the situation, said very sincerely, “I have only a goat and a bag of peanuts. Can you save my wife?”

Because this was an urgent (and not by choice) operation, we were able to proceed despite their inability to pay in full prior to the operation ($80-120 is a typical surgical fee). As with most surgeries, though, the family is required to find someone to donate blood, hopefully with a matching blood type. Sometimes the medical students and residents volunteer to donate money or blood to their patients. It is not uncommon to have a post-operative patient make the decision between an antibiotic and pain medication! Just as heart-wrenching as it is to see this, it is equally hard to see starving mamas selling—not eating—the little food that they have grown during this dry season so that they can pay for things like school fees.

After praying briefly for the operation and the health of this mama, we opened her abdomen. It was a mess. As with the ultrasound, nothing was clear, except thankfully, that the bladder was not involved (as can sometimes be the case when the placenta comes through a prior incision). The incision into the “uterus” was our first clue as to what the situation actually was. The “uterus” broke open just like one might expect the bag of waters to break… because it was the bag of waters (amniotic sac)!  The placenta in the front had masked the fact that there was no uterine muscle surrounding the amniotic sac. In actuality, what was “blocking the cervix” was in fact the uterus itself, empty. It is a very rare form of ectopic (outside the uterus) pregnancy called an abdominal pregnancy. Usually it is caused by a fertilized egg that implants in the tubes, which after it grows big enough, breaks open the tube and then re-implants somewhere if it finds a good blood supply. In this case, the placenta had attached to the intestines, the fat in the stomach, and the tubes and outside of the uterus itself. The baby had died simply because its need for blood outmatched the ability of the intestines to provide that blood to the placenta. Because of its numerous attachments, we were forced to leave much of the placenta in place to resorb on its own.

A few days after the surgery, the husband found me walking outside the maternity building and asked where our house was—he wanted to bring us some bananas from his village in gratitude. Indeed, this could have been deadly for his wife, but thanks to the team effort of the nurses at the health zone level, the small level of outside donations provided to the hospital for these situations, and the willingness of doctors here in Congo to work in a rural setting, she was able to get timely healthcare. And, I’m happy to report that here the 10 year contraceptive implant that will continue to protect her life (while the placenta is still in place, it would be very dangerous to get pregnant again) is only $5 instead of over $200 like in the US, and I think that a bag of peanuts sells for more than $5. Hopefully their family can keep the goat.  

Second week... and how to (and how not to) party in Vanga

We had the privilege of having a great cultural and language interpreter this week- Katherine Niles. She is the daughter of late Dr. Dan Fountain who is credited with decentralizing healthcare for this area, starting a nursing school to staff the outside clinics, and has written several book about it. Katherine grew up in Vanga and speaks the local language. For her, it is like a vacation to come from the city of Kinshasa and be able to swim in the river every afternoon and stay in the house she grew up in.

I, Shannon, started work at the hospital this week, malimbe-malimbe, or slowly slowly as they say in Kituba. Katherine said it is better to start slow and observe a lot because hospital work is endless and can swallow a person before he or she knows what to prioritize or the global picture. More on that later.

Household progress

Working at the house (she had just woken from a nap, that's why she has quite the expression :)

Our other large task was organizing our household. We moved into our house over the weekend, but without electricity save the 3 hours given by hospital generator from 6-9pm, and also without any appliances like stove or fridge. We spent time organizing and orienting househelp, although at times it really felt like the other way around. J We have chosen, for now, to ask several people to work for us that have worked for years and years for other missionary families, including families who lived in our house. So many times, I just asked them how it worked, what they would like to do, or what foods I needed to buy in Kinshasa vs at the local market. I think it might take me a long time to learn what they know so well. But that is the best thing about hiring well-known and trustworthy people.

Ryan spent a considerable amount of time coordinating temporary workers. We had carpenters come and replace a ceiling tile that was rotted, painters come to paint a very dark pantry a welcoming bright white (as well as the replaced ceiling tile), a tailor come to recover a chair that is over 100 years old, etc. Ryan also removed old electrical lighting fixtures and put up new ones, installed some child safety locks, and went with the maintenance man to see his workshop and discuss needs at the hospital and at home.

Yesterday, Saturday, was a huge day because Katherine’s husband and son came overland with our oven, washing machine, solar panels, batteries, and cables in their truck. They got 4 large panels installed on our roof by lunchtime. It really was cool to see! And we have had electricity for longer than 3 hours in our house today (Sunday) for the first time!

Solar panels going up!

Medical Work

Monday morning, Dr. Rice and I were introduced to the nursing staff at their morning circle. Then, we were given an extensive hospital tour (which Ryan joined us for part of) for more introductions and also a better knowledge of patient flow, where to go for X-ray, ultrasound, labs, etc, and where the pseudo-isolation rooms are located, etc. Ryan commented that he was surprised by the immensity of the hospital. It really is quite remarkable to have a 500 bed hospital in a village like this. I met with nurses in the maternity, a couple of doctors who are on the OB/GYN rotation this month, and also with Dr. Rice to sort out a temporary schedule. On Thursday, I attended “grand rounds”with the residents and staff doctors, observed the prenatal clinic at the local health zone offices in the morning, performed and taught ultrasound in the afternoon while consulting on some of the difficult OB cases.

A little more should be said about the prenatal clinic. They are held every Thursday all over the health zone at each center. Some are held under trees, but here there is a nice large open room with plastic chairs for each patient to sit in. Two exam rooms are at one end. The room was packed this week just as it had been in 2012 during my visit. The ladies were split into new patients and old patients. The new patients gathered around for a basic talk on prenatal nutrition, and it was great to see the interaction between the wise and experienced nurse and the patients asking questions. “What do we call someone who doesn’t have squash seeds or greens or peanuts to eat?”They responded, “Lazy!” (because they grow in the soil here) And the nurse then said, “But if you don’t have fish or meat, it’s not your fault.”And they all nodded in agreement.

After the general education, each patient is registered and pays a one-time fee. They are given an HIV test, iron tablets, and three times a pregnancy a medication for the prevention of malaria. Their blood pressure, height and weight, fundal height, fetal heartbeat, and expected due date are all recorded on a sheet of paper which the patient is charged with keeping throughout the pregnancy. In my opinion, it is a system that works very well here, even though there are a couple of things I think could be improved with very little effort.

I haven’t started doing surgeries yet, but I will plan to start the observation process this week. A new group of medical students and other temporary doctors start their work this week, so it should be a good transition point for us all.

And now, how to party (and not to party) in Vanga

Sydney is sleeping wonderfully since we received a pack n play which we will borrow until a more permanent solution can be found. We are so thankful for this. We were excited to move up to our house this past weekend, despite the paucity of electricity. The village seems quiet, and after the hospital generator turns off at 9pm, the lights are out as well except for those with battery and solar power back-up. It is a great environment to sleep in… we thought, until Tuesday. The first warning was the eerie sound of a microphone feeding back. Then there was a sound of some piano synthesizer that was turned up way too loud for the system, causing the sound to be very muffled/unclear. A few notes were played, repetitiously, and I thought, “do they realize that it is 10:15pm?? I hope Sydney doesn’t wake up because it sounds like it is right outside her window!” In France, we were used to quiet hours starting at 10pm, and it really was quiet. Here in Vanga, our annoyances had been just the rooster, and occasional loud conversations or a goat stuck in a fence bleating. Surely this synthesizer will stop.

But at 10:30pm, the horrible sound had not gotten quieter nor any different. It really was just the same few notes played over and over and over and over and over and over and over... and we asked a night guard what was going on. He had no idea, but said there were quite a few people and he didn’t feel comfortable asking them to stop. Ryan decided to just stay up rather than be frustrated by trying to go to sleep with that racket. But alas, when I awoke at 5:15am, it was STILL just as loud and still going on. I wouldn’t even call it music, just noise! Ryan had given up around midnight. The sound didn’t stop until just before 6am in the morning! Not a cool thing in a “quiet”village!

Thursday night, there was a bit of a racket again, but this time it was quieter and much more musical in nature. We didn’t really mind it so much. And anyway, we knew that there was a big graduation for the nursing school Friday morning, and that nursing school along with its student dorms are just across the path from our front gate. Friday morning before the graduation ceremony, we heard the sound of drums—not African drums, but big band bass drums along with flutes. The sound came from the soccer field close to our house. As it got closer, I went outside to see a parade of children surrounding 5 flute players and 3 drummers as they played walking down the road. They paraded onto the grounds of the nursing school, where I lost sight of them.

I continued to hear the flutes and drums just until the time of the graduation ceremony, so I’m thinking that they picked up the students along the route and paraded them to the church where the ceremony took place. I was outside the packed church (and I mean packed, with kids sitting in the windows and crowds outside the doors and windows!) when the ceremony ended. People were dancing (especially moms of grads), the drums and flutes started again, and then the flouring began. This we had already seen a bit in Kinshasa. When someone receives a diploma or a passing score on a big exam, the student as well as his or her family gets showered with a white powder, which usually flour. It shows up brightly in their dark hair. The application of the flour reminds me of coaches who get iced after a big win. There is a chase, but really the person is quite happy to have deserved the shower.

Friday afternoon, there were receptions throughout the village with dancing and food for friends and family of the graduates. It looked like a grand time! And Friday night, not a peep of loud sounds was heard throughout the village. They had probably eaten so well and danced so hard that they were plumb worn out the night of their graduation. Now that’s a way to party! 

First week's work and how to take a shower in 28 steps

Every morning this week we have started fairly early. This is mostly because of a (annoying doesn’t begin to describe it) rooster who decides to start its cock-a-doodle-doo at 2:40am or 4am or whenever it wants. Then there are the church bells that give rhythm to the village, getting them up at 5:40am, a snooze reminder at 6am, and a warning at 6:15am, and then to work at 7am. Sydney has been waking up around 6:30am. By this time, it is very light outside. Being 4 degrees south of the equator, we have a 12 hour day year-round from approx 6 to 6. The internet has been working quite well during the early morning hours. So between that and getting breakfast ready and having personal time with the Lord, it is soon the hour when people come in a stream to the house. Some are looking for a job, others are selling pineapples, peanuts, eggs, passion fruit, bananas, freshly-caught fish, etc. It is the market right at our doorstep! If only they would come after breakfast instead of, usually, exactly when we are sitting down or starting to eat.

Sydney has been taking morning naps, and during this time, Ryan and I have been going up to our house to unpack and arrange the house. We had a carpenter come to replace a ceiling tile, an electrician to help Ryan work on electricity, etc. There have been definite ups and downs during this process. I would describe it like replacing the belt on a vacuum. Imagine you are taking it apart and putting it back together, only the instruction manual has been lost. So you fiddle and try, you ask around, and maybe you look up something on the internet. Once you’ve found the correct order to remove panels, the correct flat-head screwdriver with which to unclip the latch, and the plastic piece that fell on the floor, it seems like a relatively easy process. The next time you have to replace the belt, it only takes a short time. Now, imagine doing this kind of process for every aspect of life: how to get clean water, how to make the electricity work, how and who to hire for house-help, how to get internet, where to put garbage, how to get more phone minutes, how to get food, how to cook food, how to greet people on the path. Yes, we have to try and fail, ask other missionaries or Congolese, sometimes look up solutions on the internet if it works, text a friend in Kinshasa.

As the number of unknowns has decreased this week, so has the amount of stress related to lack of knowledge of expectation or lack of control. At times, it seems like nothing is working and we are so frustrated. For example, we are unable to locate some of our shipment, and our pack n play was a crucial part of this. The difficulty of helping Sydney to take a good nap spills out into the day, even though we, thankfully, have the help of Nancy and Megan to watch her while we work. Secondly, on the first day of work at our house, my Chacos broke. Yes, the sandals that have a lifetime warranty and are supposed to be the best thing since sliced bread. Then one evening we spent 3 hours trying to upload one or two pictures to attach to an email. These are some of the down moments.

At other times, there are incredibly encouraging moments. For example, we found out the charger/inverter at our house will likely last for the interim until our 6-month delayed solar energy system hopefully arrives. We look around at our house and marvel at how much great wooden furniture is still relatively intact compared to the damage which could have been done over the last 15 years by termites. We enjoy the newly-tiled floor, take a swim in the refreshing water of the Kwilu River, find an infant life-vest that fits Sydney perfectly, just sitting in the bottom of a drawer, and I could go on. I think I will. This is the biggest house we have lived in since we got married almost 7 years ago. When I was feeling especially lonely for friends we just left in France, I got a text from one that is now living in Kinshasa that she’d be able to loan us a pack n play until we find a solution for sleep for Sydney. When I was feeling out of touch with the reason why we came and had some anxiety about starting back at the hospital after a year out of medicine, I met one of the interns while walking home and his enthusiasm and thankfulness that we had come to teach them was so very uplifting and encouraging, just when I needed it. There have been incredible answers to specific prayer requests.

Let me end this blog post by describing how one might take a shower here. Remember the vacuum analogy as you read this.

28 Steps to taking a Shower in Vanga

1. Decide you stink, or are hot, or both
2. Turn on the faucet in the bathtub to determine water pressure- it is dribbling
3. Decide to use the camp shower
4. Find camp shower in boxes that need to be unpacked
5. Fiddle with camp shower for a few minutes
6. Ask husband to come help you know how to fill it- he quickly shows you how to unhook and open the top
7. Start filling the 4 gallon bag
8. Wait because it takes awhile with the dribbling.
9. Spend a few minutes closing and rehooking the bag, not quite knowing the process because your husband unhooked it so quickly
10. Stand up with the quite heavy bag of water, heave it out of the bathtub with the intention to put it outside to heat up in the sun
11. Realize that the top just unhooked and you have just spilled 2 gallons of water on the floor
12. Husband is quickly back in the bathroom, bringing good towels
13. Ask husband to bring bad towels as the floor is dusty and now muddy
14. Rehook the camp shower, better this time, and place gingerly back in the bathtub in case of further spill
15. Help husband mop up the 2 gallons of water with bad towels and wring them into the tub
16. Finally, gingerly, take the camp shower with now 2/4 gallons of water outside and into the sun
17. Wait at least 2 hours for the sun to heat up the water
18. Realize it is too late in the day and the shower will have to wait
19. Overnight, the guard is terrified of the mystery black blob in the middle of the patio, and does extra surveillance (he told us today J )
20. Next day, after working up a sweat and allowing time for the sun to reheat the water, decide it is now time for a shower.
21. Gingerly take the camp shower inside
22. Realize the hook above the bathtub is too tall and call husband over
23. Husband realizes the shower nozzle wasn’t closed as it sprays him as he is hanging the camp shower. He shows you how to close it
24. Rinse the tub as it is muddy from husband’s shoes
25. Chase and kill a spider which had taken residence in the tub since yesterday
26. Get in and use the cold water to wash muddy feet
27. Open the shower nozzle and take a warm shower with water pressure!!
28. Praise the Lord for a warm shower, for a husband who insisted on making what seemed like a silly purchase at REI over a year ago, and for being clean and cooled off. J

And that is how it really happened. It was one of the best showers I have ever had. 

Vanga!

The plane ride to Vanga was on the caravan. Ryan was co-pilot, Sydney and I were just behind him and the pilot- Sydney in her carseat and wide-eyed at all the new things she was experiencing. Our trunks were stacked up in a line directly behind her and the Rices were in a row behind me.

We took off over Kinshasa and very quickly were flying over the Congo River, where just the day before we were in a boat and on a sandbar. It was much easier to see the great size of the river from above. We ascended to 9000 feet, above clouds so that we were unable to see the ground at that time. Most of the team took naps, but of course Sydney was wide awake and reading books, trying to kick the back of the pilot’s seat, asking for water, etc. In the co-pilot seat, Ryan was able to communicate with the pilot via headset, and among other things, Ryan talked about his past engineering projects.

After just over an hour, we started descending, quickly able to see the ground where there were palm trees, brown huts in clumps, and even a purple flowering tree. I recognized the hospital as soon as the Kwilu River came into view. I searched for our house, but I was unable to identify it through the cover of the trees. As we started to land, we saw the German pediatrician enthusiastically waving from his bicycle on the side of the runway, kids were running to gather at the fence line, and we could see that there was a large group assembled at the hanger. The wheels hit the grass softly, but firmly, and we coasted to a stop, turned around, and came back to the waiting crowd.

We came down the steps of the airplane in the rear of the aircraft, so Sydney and I were the last ones down. I no sooner let go of her hand to wave and shake hands then Sydney was going right back up the stairs and back onto the airplane. She loved playing like this, going back and forth, up and down, as our luggage was unloaded from the opposite side. Finally, as it was time for us to make room for the passengers going on the return flight to Kinshasa, I told Sydney to go run to the kids who were waiting to greet us. She took off, but not in the direction which I was meaning. No, she had seen the group of village kids on the opposite side of the runway as we had come in and had waved to them. Therefore, instead of going straight to the hanger and that group of kids, she went running across the runway, alone, towards the kids there. 

Sydney running across the runway to greet some children

Ryan and I chuckled and followed her. I’m sure those kids never get greeted first! She boldly went up to the fence line and poked the first child that she could, right in the belly, and then went down the line and looked at the others but didn’t really say anything. What could a 21 month old think of this??

We then bid au revoir to them and went back across the runway to the hanger. There, a large group of kids gathered around her. But instead of them touching her hair and pointing or being loud as I had assumed, they were quiet and waited for her to come to them. Indeed, I was quite surprised to find that she was “bothering” them more than the other way around by; for instance, she was poking her finger at a little boy’s belly because she was curious about the Mr. Potato Head on his shirt, or blabbing on and on after seeing a girl with pretty beads in her hair, then trying to pull them out one by one. Then there were some very young kids that were scared of her, so of course she tried to give them, not just a high five or handshake, but a big hug to squeeze them out of their fear…. Which didn’t help. J

As for the adult side of things, there were a lot of hospital staff and village leadership present to welcome us. It was great fun to see again a few of the doctors and nurses with whom I had worked in 2012. I missed most of the logistical part of the welcome, luggage handling, government stamping, etc as I was chasing a very small child, but just before we departed from the airport, we gathered in a large circle. The German pediatrician, Dr. Friedhelm, formally introduced us and then some of the prominent members came by and shook our hands in a more formal line. Then we regrouped and prayed together, that God would have His hand on our work here and that we would feel welcome.

We loaded up into the two awaiting landcruisers: the Rices and their luggage in one, and our family with our luggage in the other. We made our way down the sandy road (it is dry season now, so it is quite sandy and not packed at all). There is really no village center, other than the hospital and church, but these are situated right by the riverbank, so by nature, the village is formed a bit like St. Louis really, with the rest of the village spreading out from the focal point of the hospital. Along the road, there were chickens, goats, small stands of women and children selling bread or peanuts or bananas, and guys under umbrellas selling cell phone minutes. Every few minutes, we would go over what seemed like a large speed bump (which would make it impossible to navigate with any vehicle which sits low). These “speed bumps”are really just to stop water from washing straight down the road. It diverts the water to the side of the road where sometimes there are 4 foot open pits where the water can then settle.

We turned to the right at a soccer field, appropriately enough, and the Rice’s vehicle took them on towards their riverside home. We skirted the soccer field, went past several palm trees, the nice maintenance shop, the Brothers house, and finally to our gate! The dirt had been swept, the garden looked great, there were newly-laid cement steps in the back and sidewalk in the front, and the house exterior had a fresh coat of paint. With excitement, we walked through an open door. Mama Lutti was working on keeping the new tiled floor clean as we entered. For the next hour, we worked on very basic sorting into piles of bags and boxes. We then headed over to the Rice’s home for lunch that had been prepared for us there. Whew! A bit of chaos but it is great to finally be home!

After lunch, everyone fell asleep. And by everyone, yes everyone. I only slept a short time, as I was excited about being in Vanga finally and had many items on my to-do list that were running through my head. So when the Swiss maintenance man named Heiner came, I was awake and went with him to deliver another car load of our shipped items to the house. In addition, we stopped by the house of a missionary who is currently on home assignment, I tried out their 150+ year old rocking chair, and promptly absconded it to our house. J One thing about moving in to a house in Congo is that there were about 5 guys who helped get the trunks from the landcruiser and into our very full living room! 

I spent the next couple of hours alone, getting acquainted with the house, deciding on what rooms to use for what purpose, and starting the large task of organizing some of it. When I returned to the Rice’s house, Ryan had just woken up from his nap. We ended the day with dinner at the Brothers. With Sydney as active as she was during the day, she was ready to go to sleep immediately after she was done eating, and I volunteered to take her back to the Rices where we will be staying until electricity is in place. It was a peaceful walk in the dark, with the sentinel and his flashlight leading the way. The stars are brilliant, and as there are no traffic sounds, the crunch of leaves seems almost deafening.