Three Week Blitz in the US

Imagine a 2 year old, sitting atop her daddy's shoulders, waving her passport out of his reach. This was just one of the fun airport moments we had during our long travels with a 6 month old and toddler. Perhaps the airline crew member did not approve of us coming through the line with the other priority boarding members, but most airlines encouraged early boarding for families with young kids. The crew member stopped us the first time we tried to board, saying we each had to be holding our own passports. With Zack on my front, I usually lugged the carry-ons while Ryan had Sydney on his shoulders while handling the passports or boarding passes and the kid's bag. We stepped to the side, Ryan gave me my passport which took some reshuffling of hands, and we stepped up again. She again said, "everyone needs to have their passports in their hands," and shooed us to the side. Ryan asked incredulously, "You want me to give the passport to our two year old and the baby?" She nodded her head, motioning for him to give it to Sydney. Thus, we had the situation which followed. Sydney joyously took the passport, held it up like a trophy, and started swaying back and forth in tiredness and boredom, refusing to let Ryan take the passport back much less show it nicely to the crewmember before boarding to compare her face (still her 3 month baby pic anyway) with her ornery 2 yr old face. Ryan looked back at me and smiled. What was she thinking??

Our journey started as took the short 1.5hr flight from Vanga's grass runway to the regional airport in Kinshasa. We stayed overnight with our good friends, the Lind's, who graciously host us when we spend time in the capital, and provide entertainment for Sydney and Zack with their 4 kids. 

The Lind and Potter kids (minus Levi)

The newest missionary babies, already holding hands

The next night, we took a flight from Kinshasa to Paris to Atlanta to San Antonio. Our 8 checked items took the first flight, 3 joined the airline strike in Paris, and 1 took a vacay in Atlanta. We got our lost half of baggage back in 3 installments, and one had to be mailed to our final US destination because it enjoyed the Paris airport THAT much. In all seriousness, we had what we needed except for my breast pump.

We spent about a week each in San Antonio, St Louis, and Tulsa. Ryan, of course, spent several days in Dallas standing up in a wedding for a good friend. Turns out the bride was originally from Congo! I don't want to blog an endless itinerary, nor do I want to leave people out. Everyone we saw, even if it was for a short time, was a tremendous encouragement to us. I will highlight a few things. 

My grandparents and my aunt DROVE over 20 hrs roundtrip to see us for just a few hours on Sunday morning. It was a complete surprise, and they were waiting behind a door when we walked through. It was one of those familiar feeling, wrong place moments, and I wondered who else might be lurking around the corner. I confess that I spent more time watching Zack pick up and swing my grandma's cane during the service that I did paying attention, but it was a moment I will cherish. 

Snuggles with great-grandma

Coloring with great grandpa

My initial reaction when walking into Walmart was utter joy to be able to get haircuts, buy food, electronic items, misc, and clothes, and go to McDonald's, all without leaving the building. I ate ice cream 1-2 times a day. And it was awesome. Sydney enjoyed playing on many playgrounds with old and new friends. This is not original, but a quote from a missionary mom on Facebook, but it is very similar to our feelings.

"I did the most amazing thing today. I was feeling cooped up and wanted to get out with my daughter. I slipped my shoes on and we walked out the door. Three and a half blocks later we were at a beautiful park. Playing. On a playground. all I could do was cry. Innocence. Beauty. Adventure. We don't realize the bondage we live in until we taste freedom. No one was staring at us, or touching us, or wanting to take pictures with us, or asking us for stuff."

First haircut :)

Reading with Granddad Potter

All smiles with Nana

Making breakfast together

Jump!! into the backyard pool with the cousins

We left open several time periods to fill with hanging out or meeting people, but no one had filled the day before we left San Antonio. On the same day, my brother-in-law had a job cancellation. So, on the spur of the moment, we all decided to spend the day at Schlitterbahn Waterpark. Nana, Kara's whole family including 3 girls, and our family headed out to a day of splashing around. My favorite moment was getting to the front of the line and finding out that Zack had to ride in his own tube (with a bottom)! The kids all had lifejackets on, and the tubes indeed proved to not tip as they went down the steeper parts of the slide. In fact, Zack slept through most of it as we floated along between chutes. At the top of a particularly steep chute called "a waterfall" the lifeguard pushing us over the edge looked at Zack sleeping peacefully and said, "Sorry buddy," as he pushed him over the edge. Although it woke him up for about 20 seconds, he went right back to sleep.

Schlitterbahn kids play area

Sooo much fun!

The Potter clan all together in San Antonio

On our trip from Dallas to St Louis, one of our supporters based in St Louis was the pilot. He made sure we had extra water on the flight and greeted us by name when giving the captain's greeting before the flight!

We were able to visit the hospital where I lived, err, did my residency, in St. Louis. It was wonderful to be reunited with faculty and nurses that were nearly my family for four years. 

Speaking at First Free church in St Louis

Spent the better part of a day at the St. Louis Zoo with my mom and the kids. It was so fun to see the joy and excitement on Sydney's face, see the new polar bear which put its face right up against the glass for Zack to stare wide-eyed at. The Orangutans were hilarious. The male kept spitting on the female, antagonizing her until she had had enough, started chasing him and wrapping him up in a rolling tackle. 

The carousel!

Up close and personal with the polar bear!

I had little hope that we'd get an appointment, but I decided to call one of the dentists who supports us to see if we could come in to get our teeth cleaned. At first we were told they were booking into the month of October, but after I explained that the dentist had invited us personally by email to call, they got back to us that we could come the next day in the afternoon. It just fit perfectly into the very hectic St Louis schedule. Even though it was less than 24 hrs notice, the dentist gave us a personalized frame of our family picture from the newsletter. It was one of those moments that we felt particularly cared for.

The hospitality shown to us was over the top. They specifically stocked their pantry with food items they knew we missed, the laundry fairy came by and our clothes were neatly folded, sometimes with extra items added. They told us to make ourselves at home and invite others over, and they truly meant it! That significantly freed us up to spend more adult time with old friends as our kids could rest in their beds as needed.

In Tulsa, we got to eat at a Brazilian Steakhouse to help celebrate my parent's 40th anniversary! If you haven't eaten there and you like meat, it was a place not to be missed! Tulsa was our most restful stop, with lots of time spent just hanging out with the family at home. My aunt and uncle drove to see us and we got to see a cousin’s wedding in realtime as it streamed live from California.

This was a perfect capturing of a relaxing afternoon playing yard games, Zack eating, and Sydney playing in the background with cousin Marcus

Yard games with a competitive family :) This is a spoof on a pic we took many years ago with aerobies

Toews siblings

Toews grandkids all on Grandpa's back

The Toews clan all together in Tulsa

Realizing a dream

As you may know, I became certain of my desire to become a doctor, and specifically an OB/GYN, when I was in Ethiopia in 2006. Visiting the famous Addis Ababa Fistula Hospital and seeing the complete transformation in these women’s lives was inspiring. My desire to emulate Dr. Hamlin, the hospital’s founder, remained a principle motivator as I went through medical school, residency, and then as Ryan and I applied to World Medical Mission to come serve Jesus somewhere in Africa where fistulas are still a problem.

The joy of going home healed! This is the first successful vesicovaginal fistula repair that I've performed here. 

My first 10 months here, we saw a few fistula patients. Two we operated on and failed. A third I put a catheter in to await the end of my pregnancy to give her the best chance for a good outcome (without my belly getting in the way of visualization and my fatigue decreasing the chance of success). When I came back from maternity leave, we joyfully found that she was dry and healed from a few months’ rest for her bladder. My desire to do fistula surgery waned.  After all, I hadn’t gotten good results at first and there was no one to coach me. Instead, I worked on other things- teaching vaginal surgery, improving prenatal care, teaching the midwife OB courses at the nursing school. Regarding fistula surgery, I had read extensively about it, watched almost 50 cases in Ethiopia on an elective rotation, and performed one during residency, but there is nothing that can replace experience. The only place to gain experience is in the developing world like Africa. And I was beginning to feel like Vanga would never be that place. Perhaps God was moving my vision elsewhere.

But then in May, we found out that there was a fistula surgery campaign that was being planned to come to Vanga! This was a “my cup runneth over” moment where God was giving me more than I asked for or even imagined. It was not just that I would get training and finally have someone to coach me (to cut a bit more here or to adjust the angle of the needle), but it was also that the OR and pre/post op teams would be updated on techniques and the very real difficulty of getting good visualization for the surgeon. It was not just that a couple of surgeons would come to help us, but also that these surgeons speak the local languages and know the culture as they are Congolese. I hadn’t even dreamed of such an experience!!

What a team! Dr. Delores of Kinshasa, Mama Maguy the chief of maternity here in Vanga, Mama Alice, community prenatal care here in Vanga, and Dr. Paulin Kapaya, fistula surgeon trained originally in Vanga as a nurse, now from Kinshasa

With the fistula team coming, excitement within me was building. But I was also left with questions. Why didn’t the administration tell me about their coming and ask for input? I’m the only (ONLY) OB/GYN specialist who isn’t working primarily in the capital Kinshasa in the whole of west DRC, but their arrival was only mentioned to me in passing one day. I decided to make an effort to go meet the team ahead of time in Kinshasa. Then it appeared that the campaign would be cancelled with our medical director out of town. A fellow staff doctor and I sprung to action and, with permission, coordinated everything, sent out radio messages, evaluated patients, organized payment structures, food for the patients, all stuff I’ve never done before much less done in a new culture.

Getting the message out by radio for the women to come in for fistula repair. (The reporter is holding a recorder and interviewed us all.) Yes, gulp, even me in French unedited on the radio. 

Our task was to find 40 patients. There were only 27 on a list previously made by administration. This was muddied by the fact that the memo sent out was for anyone with a fistula or anyone with a mass felt coming out of their vagina. It was hard to know if we’d get the numbers to ensure the team’s coming. They delayed their start date a couple of times due to this. I felt stressed and so very much did not want to miss this opportunity. I started intake of patients and diagnosed them prior to the team’s arrival. Even though we only had 12 confirmed fistulas, the team decided to go ahead and come.

Dr. Delores, medical director of St. Joseph's and fistula surgeon on the left. Justin, anesthetist on the right.

The miscommunication about the prolapse surgeries also being part of the program and free caused significant consternation. As the fistula patients started getting their surgeries scheduled, I had a throng of people I’d promised to do surgery on as well who accused me of abandoning them. Plus there was an influx of women coming to get evaluated. It was so busy. In addition, at home, Zack decided that this was a good week to stop sleeping well at night and to eat a lot extra. I had no extra milk supply; I had only “the daily bread,” so to speak. As surgeries started, I was frustrated to have to leave the very interesting, once-in-a-lifetime experience to go and feed Zack. All the women demanding to be seen as I passed them on the sidewalk walking up to the house also made it difficult. 

But oh the patients. The possibility of seeing them healed and lives restored is why we are in medicine! One had had the fistula for 17 years! One had an operation for the repair 3 times, another 4 times. I was beginning to understand why they didn’t come for surgery- destitute, with little guarantee of a good outcome. Their joy as they have been singing together in the wards is palpable, infectious, and makes all the work worth it. They cannot stop smiling as they walk about without leaking urine. It’s what I remember from Ethiopia.

Dr. Delores's time in Vanga was impactful in many ways, but above all her humble, caring and generous spirit towards everyone from the doctors to the people cleaning instruments to the poorest of patients. An inspiration.

We started discharging the first group of fistula patients this week, and it was a joy as well. I expect that as they go back to their villages, word will spread and women will start coming with their fistulas and we will be able to build capacity in this area. Perhaps it was the Lord’s will that we are taking a bit of a break to come to the US. Lord knows I cannot rest here if there are patients still waiting for me. In the end, though, we did work hard to make sure that most of them had gotten their prolapse surgeries before the team left, and the rest I am slowly finishing throughout these following weeks. It was such a mix of amazing and exhausting to have the fistula campaign here in Vanga; we have been truly blessed!

Dr. Paulin Kapaya, fistula surgeon extrordinaire. Justin, anesthetist, looks on in the back.

Several wonderful ladies who walked in with their uterus's swinging between their legs (complete vaginal prolapse) and who walked out without shame, dancing in the wards as they left. 

Left Turn

 

According to the urban dictionary, Left Turn can mean "an unexpected change in events." That would describe my day. It felt like a whirlwind.

Normally, Monday’s are operating room days. There are 6-10 major surgeries and many minor procedures scheduled. I went into our morning report with the medical students as usual, after which I headed down to maternity. It was more chaotic than usual, with 2 patients bleeding with placenta previa (placenta blocking the cervix), one woman with a miscarriage that was bleeding, and a grand multip (lots of kids already) with a normal labor but with the breech (bottom) coming first. I quickly made plans… let’s do a C section ASAP for the one at term, give medication to stop the labor for the second, and reevaluate the lady with the miscarriage. The grand multip could continue her labor without interference or medicine. When things were in a semblance of order, I headed over to the OR, both to inform them of the incoming C section and also to start our long list of procedures.

BUT----When I got near the door, I was met by a staff doctor, informing me that all the doctors in the hospital were called to go to a “nearby” village to vote in person for something. So surgeries were canceled that day… all of them, and now I was supposed to go on a 2 hour drive over bumpy rutted roads to cast a vote. I rushed back to the maternity where we performed our first C section in the new maternity OR!! The novelty of it and the celebration it really deserves were dampened a little by the stress of the change of the day, and the need to get done quickly so as to get ready for a trip. I'll celebrate it a bit with several pictures of opening day before continuing the story.

Chief of the operating room standing by the new maternity OR bed and lighting. 

Preparing the first case in the maternity OR-- a C section for placenta previa

Praying together before we make the incision to start the surgery

Sure enough, I was just scrubbing out as the assistant was closing the skin when I was told to finish quickly because the vehicle had been prepared and other doctors were waiting on me.

I started panicking just a bit. I hadn’t pumped or fed Zack since 6:15am and it was already after 11am. I had to go back to the house. I was going to miss lunch. I had no idea when I’d get back- afternoon or evening. I finally decided the prudent thing to do would be to simply take Zack with me, endure the 2 hour roads there and back, but at least not be out of control with his needs. I ran back, Ryan helped me gather water, diapers, changes of clothes for Zack, and I stuck in a jar of peanut butter. That’ll do in a pinch. My phone rang but I missed the call. I was out of units to call back. I was certain they were calling to say they were about to leave. And I started off down towards the waiting vehicle. A woman called after me on the path, waving her medical chart paper. I felt completely overwhelmed by everything going on, by the still-bleeding patients in the maternity, by the need to take care of my son, by the heat of the midday sun beating on us, by the total and utter randomness of the change, and by my incomprehension as to what we were doing this for.

BUT----When I arrived at the vehicle, it was neither ready, nor filled with waiting doctors. It really was quite confusing. Zack was stirring in the baby carrier, wanting to be fed. It was hot. Two of the doctors, seeing me with Zack and a little harried from rushing around all morning, suggested that it wasn’t so important that I go. I had a hard time understanding what was so important that all the doctors of the hospital were told they should go and thus the operating room schedule had been canceled so abruptly, if indeed it weren’t so important that I go. But in the end, I started back up to the house, a little sheepishly as I was still uncertain of the decision. I called a couple other doctors to try to understand this situation more culturally, but in the end I decided to stay.

I readjusted my expectations to be the bleeding ladies who needed treatment in the maternity. Sure enough, I got a phone call that the second patient with placenta previa needed a c section because her hemoglobin had dropped from 8.7 to 4.5. Even though the baby would not make it, and just by a few weeks, we needed to save the life of the mother*. I hurried to feed Zack, and ran down to do the C section.

BUT----She was still in the maternity, lying just as she had when I had left her. Though the C section didn’t seem quite as urgent as I thought initially based on the phone call, I did agree with its necessity. She wasn’t gushing blood, but with a very low hemoglobin, starting a C section before finding a blood donor didn’t outweigh the risk. It’s the family/assistant of the patient that has to find someone to donate blood or pays $10 for the lab to find a donor in the community to keep the blood in the bank. This can take time, sometimes hours. So I trudged back up the hill to catch the end of lunch with the family. By now, it was almost comical to see Ryan’s face when I walked in the door not having done what I had expected to do moments before.

The rest of the day was pretty straightforward without further huge left turns. I nearly cried with the baby who we delivered just a few too many weeks early to survive here. It would likely have done well in the US. It did cry, and was sent to pediatrics for as much support as we can give here, but if it survives the night, I’ll be surprised.** I then headed over to see about doing a dilation and curettage for our bleeding miscarriage. However, she met me on the sidewalk and said she felt like she had passed something since the ultrasound that morning (which had showed retained products of conception) but lamented the fact that the placenta always stayed in. Unfortunately, she had already had 4 miscarriages. I decided she needed further evaluation again before taking her to the operating room.

It was amazing! As in, I’ve never seen it except in cool professional photography. The gestational sac with the 10 week old fetus had come out intact with the medication we had given. We were able to see the fetus floating in the amniotic fluid, with its formed arms and legs, spinal cord, and head. Its heart had stopped beating long ago, but it was amazing to see this tiny being just a bit bigger than a gummy bear. So cool!! 

8-10 wk fetus inside its intact amniotic sac

The emotional sting of the miscarriage had dulled over the two days since its diagnosis, and the mother was truly fascinated by the tiny being that had been growing inside her. She and her husband both wanted to see it, which is very rare in this culture. Afterwards, I used an ultrasound (from our new mobile ultrasound available in the maternity!!) to check to see if she had anything left in the uterus requiring further management. Fortunately for her, she did not need it. I asked her for permission and then proceeded to teach about 15 medical students, nursing students, and nurses the basics of ultrasound as we looked at her uterus, her bladder, her liver, her abdominal aorta, her kidneys, and her heart. It’s a joy to be able to see the wonder of learning something for the first time.

The new ultrasound is mobile, so we can easily move it into the delivery room if we have an urgent need for further evaluation.

Teaching ultrasound in the new maternity ultrasound and consultation room

As I headed home in the evening, I was greeted on the path by my kids with Nancy, their beloved nounou (nanny in French), who will be leaving at the end of the week. She graduated from high school and won’t be living here any longer except for limited periods. This season of life is coming to an end for Sydney- Nancy has been with her sporadically since the very evening of her birth and daily since she was 9 months old. We are all happy for Nancy, but very sad to see her go. At any rate, I joined them as they walked down to the Rices’ house. We had pineapple ice cubes for a snack, went and jumped and played in the river with Tim and Ryan also joining us. We ate dinner at the Rices’ and afterward came up to our house, put the kids to bed, and watched the second half of a movie we’d started. Overall, despite the crazy changes in expectation, it was a great day!

*From the Dublin Declaration 2012, an international consensus regarding abortion to save the life of a mother. “As experienced practitioners and researchers in obstetrics and gynaecology, we affirm that direct abortion – the purposeful destruction of the unborn child – is not medically necessary to save the life of a woman. We uphold that there is a fundamental difference between abortion, and necessary medical treatments that are carried out to save the life of the mother, even if such treatment results in the loss of life of her unborn child. We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.”

**The baby has, in fact, defied all odds and is still alive. As a colleague of mine said as we encouraged the nurses to make the normal efforts in neonatal resuscitation at the C section, "We think the baby is too premature to live, but God can still do a miracle."

Short stories- Maggots, Goats, and Rats

With two kids now, I find my days very full with work at the hospital, running back and forth to keep up a milk supply, with free time spent kissing scrapped knees, redirecting, playing with, scolding, and laughing with an increasingly active and talkative two yr old, and when the kids are finally asleep in the evening, I just want to do something mindless or I fall asleep quickly from exhaustion. So I've written several short stories throughout the last months, and just now am getting it posted. 

Young kids. So fun and cute. So exhausting too. :)

Maggots

She came in walking a bit hunched over, but there was more to it than that. It was almost a waddle. When we examined this elderly woman, her problem was obvious. Her feminine parts were completely outside her body. There was large ulcerated part of this mass that was the size of a grapefruit hanging inbetween her legs. As we cleaned it off to distinguish what was cervix, what was the ulcer, what was the situation, I noticed something moving. This poor woman had been dealing with this complete prolapse so long that maggots had taken up house in her ulcerated inside-out vaginal tissue, eating dead tissue and keeping it relatively “clean.”

Sorry for those who get grossed out. For those who are curious, the skin of the vagina is shown, the cervix is the very bottom of the photo that is a bit purple, and the circular area is the skin worn away and the bladder hanging out. Maggots are the whitish yellow around the bladder. Ewwww.

I indicated a vaginal hysterectomy, reduction of the prolapsed, and closure of the vagina. Basically, I was going to take out what was not useful, push everything back, and hopefully cut out the ulcerated, maggot-filled tissue so that this poor woman could walk down the street as proudly as every other woman who achieves the feat of old age in this culture and this hard life.

At surgery, let me summarize it by saying  I experienced a number of firsts: first time operating with maggots present, first time I couldn’t find the rest of the uterus even though the cervix was clearly in my hands, first time I couldn’t find the abdominal cavity, first time mistaking the bladder for the uterus. It was very difficult surgery, with distorted anatomy. In my experiences in the US, I usually felt like we had a good deal of control. If bleeding was found, we could cauterize, suction, readjust lights and find the source. If structures were unclear, we could use fancy imaging to figure it out. We could call in back up general surgeons, urologists, etc. But here, sometimes we tangibly feel the powerful hand of God, we pray for Him to give us supernatural wisdom, to give us skills we didn’t know we had, and to heal patients that probably shouldn’t have a good result. It feels quite out of control sometimes, but God getting the glory is exactly the sort of thing He prefers.

Back to this difficult surgery… we repaired the giant hole we had made in the bladder. We removed the cervix and what we could find of the uterus. We systematically replaced the mass back intra-abdominally, cut away excess skin, and closed the vagina. It took 4 hours. During that time, there was a middle-aged woman with a relatively simple operation on the other OR table in the same room. For some reason, she coded- as in, her heart stopped. They did CPR, tried the defibrillator, and eventually withdrew resuscitation efforts. It was traumatic to witness the death while trying to finish my complex case in the same room.

In the days that followed, I kept expecting to have urine leaking or some problems, but the only complaint that this woman had was that the catheter was uncomfortable. We removed it the second week, and she fled the hospital that night with her family. (This is not an uncommon occurrence with a good chunk of patients unable to afford their care, however modest the costs compared to US standards.) I am praising God for giving this woman the ability to walk out of the hospital upright and without a strange gait, even if it was in the middle of the night. Perhaps we’ll see her again one day, though I hope she simply goes home and lives out the rest of her life maggot-free, with the Lord as her guide.

Why did the Lord decide to heal this old poor woman with a significant medical problem, and yet allow the young woman on the other side of the room to die when the latter was receiving a relatively simple operation? Matthew 5:45- … for He causes His sun to rise on the evil and the good, and sends rain on the righteous and the unrighteous. This was a reminder to me that we only have the false perception that we are in control- it is the Lord who directs the outcome.

Sydney grabbed a boy's hand while we walked through the hospital. It was adorable, so I am including it.

Who cares?

I was grabbing my towel after a swim in the Kwilu when a goat just a few hours old, flies clinging to its still (barely) wet hair, timidly sidled up to me with wobbly new legs and plopped down, right at my feet. Instinctively, I reached down to give it a pat. Who can resist one of the cutest baby animals in the world? I scanned the dirt path to the left along the river which disappeared around a bend of bamboo. No mama goat staring back at me. I glanced up the steep dirt incline towards the houses, and there was no sign of its mama. As I started to walk up the path, I hesitated. The tiny heap that was just at my feet was starting to make noise. Where was the mama? What kind of goat mama leaves its newborn like that? Just abandons it? I started to get angry. Then worried. What if the mama got chased by some boy running through the trees? What if the mama was herded back to a fenced-in enclosure and the owners didn’t notice she had already given birth? I started walking a little faster up the hill. I could hear a goat or sheep bleating somewhere. I needed to find its mama for that helpless goat.

A still small voice crept into my mind, chiding me. Who cares, really? Who am I? Do I think I care about that goat more than God does? Even if it dies? Yes, even if it dies, it’s not a surprise to God. 

Who cares when a poor woman dies because she couldn’t afford antibiotics? Who cares when yet another mom comes in too late to save her baby, her uterus ruptured, all because there is an inexperienced nurse at the remote health center who didn’t recognize danger signs?

A face off between Sydney and a sheep

We’ve gone through a rough patch here in Vanga. A wall was constructed and we ran into it, figuratively. Now we are trying to figure out whether we are supposed to climb the wall, go around, turn around, or just knock the wall flat. 

But the sign given to me with the goat (who was shortly after spotted with its mama) was that God is in control, and God cares about Vanga more than I do. So whether we stay and are a part of God renewing this place, or whether we leave, God has got this. He is not surprised. And He cares so much more than I do. This is a great source of comfort to me amidst uncertainty about the future. 

Rats... so many rats

They were eating our fruit. Every morning, we’d find evidence that rats or mice were invading our house, with our fresh fruit looking more like the moon than bananas and passion fruit. Our neighbors have cats, and even a cat ladder to help them get between the roof and the house to eat rodents, but we don’t. 

The awesome cat ladder. Look for cat eyes at the top. :)

Without a local hardware store to run to for a mousetrap, we asked our househelp for suggestions. They assured us that it was easy to poison them. They got a medication from the local pharmacy, put it in some fish, and laid the fish in hard-to-reach places so that Sydney couldn’t get to them. Wait. Now we had a fish smell. And then? Apparently the stench of the fish is overpowered by the stench of a dead mouse/rat. Awesome.

The stench of the fish went away. The pieces were gone. But still no stench of a dead mouse. Around the 3^rd day, I remarked that Zack’s diapers sure were potent- significantly more than normal. Our househelp said the same thing, and asked to take his diapers outside before we got them washed. I came home later that day to hear that the smell we had been blaming on poor Zack was, in fact, a dead mouse behind the dresser. Yay. We got em.

Not so fast... I was changing sheets on the beds when I noticed that the top layer was covered in ?rodent? poo and pee. Surely not. I went to get a second opinion on what the stains were. Just as we were lifting the top sheet out of the drawer, a huge rat jumped and scurried further into the deep drawer. I ran away. I ran to get reinforcements in our other househelp. They came together to combat the rat in the drawer. They closed all the doors, but since the drawers were at the end of a T shaped hallway, Sydney and I stood guard at the end of the T with a broom in hand to scare it back. They took the linens out one by one, and eventually were left with only the rat. Sydney got the honors of taking the dead rat to the cats up at our neighbor’s house.

Taking the rat to the cats

The black cat was a bit afraid of such a big rat, but the runt of the bunch (calico) seized the moment, jumped off her flower pot and snatched that rat up and ate it while hiding under a flowering plant

That night, we opened our kitchen cabinets and saw something scurry behind the cups. Again I called in reinforcements, this time Ryan and our night sentinel. I fled the room, but I know that a mouse was killed and taken up to the cats.

Fast forward a week. I opened the cupboard to get a glass for water, and was startled by a mouse running on the second shelf. I ran to get our sentinel. He came in, gingerly took out the glasses in front of said mouse, and... whoop, the mouse jumped out of the cupboard and into his free hand. He clutched it against his chest, and took it out to the cat. This operation took all of a minute.

Fast forward two weeks. We came home from a weekend in Kinshasa, and our househelp showed me my prized imported mint M&Ms had been eaten by a rat. 

Sad days. I love mint M&Ms and I'd been saving them. There is a hole in the bag and bites out of all of these M&Ms.

Yep, bag bitten through, tiny rat sized bites taken out of the candy shells. You better believe we have more poison fish strategically placed.  

Is financial collaboration possible?

By Ryan

I find myself often stressing about being a good steward of the support entrusted to us. Money issues here in Congo are so very different than what I know. I recently wrote this response to a friend who wanted to donate to us.

Thanks so much for your willingness to partner with us. The needs are great here and financial support is greatly appreciated. Right now the main source of expense we have is on patient care. Shannon is able to pay for patients' medical bills and generally spends about $1000-1500 per month. Our current support level is able to cover this and our other living expenses, especially since Samaritan's Purse covers much of these.

The really challenging thing here is that money does not solve heart issues and can provoke them. We are seeking wisdom on how to partner with the hospital, but corruption, mismanagement of resources, lack of communication, and little to no maintenance make both big and little support a huge challenge. For example, I have wanted to update the laboratory here for about $15,000, but there is no financial system in place to ensure that consumable test supplies are replenished. Practically everything here is hand to mouth. There are no budget or savings accounts. They make decisions based on how much money is in the cash box at that moment. It is horribly short-sighted and makes planning for any projects practically impossible. I am also interested in investing in a solar energy system for around $250,000, but right now there is no one here who is capable of maintaining this system and there is not a clear system of reserving money to ensure that the batteries are replaced every 5 years.

All this to say we would love your financial support, but we also really need your prayers for wisdom in how to use the support we have been entrusted with.

Much like a parent teaching personal finance to teenager, it is a hard place to be when you want to help and have the financial resources to help, but you also understand that helping by just giving will do more harm than good. The difficulty, just like parenting, is that it is a lot of work to take the time to teach financial responsibility. It is even more difficult when you take culture into consideration. In this culture, financial resources are meant to be consumed as soon as they are available, and if you do not consume them your community will come asking for them and if you do not give to those who ask you are often ostracized.

Often I feel like missionaries are primarily viewed by the Congolese as fundraisers, and if we are not bringing in money, we are chided.

The systems of Africa, as described in the book “African Friends and Money Matters,” is microeconomics-focused, whereas Americans see things in terms of macroeconomics. A prime example of this is that, here, broken-down cars are often repaired in the middle of the road and not moved to allow traffic to flow normally. This short-sighted advantage helps the owner of the car but hurts the entire system of traffic movement. It is this micro vs macro view that can, in part, describe why traffic rules are not followed in much of Africa. Everyone seeks to get a small advantage for themselves at the cost of the entire system breaking down. Completely blocked roads from traffic jams in Kinshasa are often the result of multiple cars passing other cars in oncoming traffic lanes, resulting in 5 cars face-to-face with 5 other cars on a 2 lane road. That leads to a 3 hour delay as cars disentangle.

Another challenge described by a fellow missionary here in Vanga is learning to be patient. One of the tactics of the hospital is that when a critical need is brought up and identified, they will wait until the missionaries lose patience and pay for it. This tactic, mixed with a lack of will to get certain issues addressed, leads to lots of delays and a general frustration. This waiting puts the breaks on improvements and maintenance.

An example of this has been playing out as I have been working with Shannon to get an emergency maternity Cesarean section OR operational. The funds for this project were set aside around 5 years ago, but it is still not operational. The room is constructed, but on our arrival, there was no electricity, among other things. We found out that a lightning strike took out the inverter which converts battery energy into usable electricity. The hospital did not devote any resources to repairing this. We took matters into our hands and had a colleague purchase a new inverter and batteries for the maternity from Kinshasa with money from our account. Despite that this was nearly $3000 of equipment gifted to the hospital, it was like pulling teeth to persuade the hospital to provide the wire and outlets to install them. When you operate on a hand-to-mouth system, each expense takes away from the bottom line of paying the salaries.

Side note: salaries here are rarely if ever paid the 1^st of the month. This is because the hospital has to wait until enough money comes in to the hospital from patient fees the proceeding month to pay salaries. Often salaries are paid between 15 and 30 days late. There is no monthly budget or reserve account to help balance out the ups and down of the seasonal fluctuations in patient care, so the whole staff feels the effect of, say, a broken down inverter, because they do not get their salary for a few extra days.

The Maternity Operating Room is still not functional due to a lack of planning for the needed materials which they are trying to gather now: linens, medicines, and the OR table. Poor planning led to the purchase of an OR table that cannot be adjusted to a gyn position for common OB/GYN operations; thus, it is not practical.

Money may solve some issues here; however it often creates bigger issues in the minds of the individuals here. One person recently said that a weakness of the hospital is that they do not have an external financial support. Donations without any cost and cooperation from the people here appear to lead to a sense of entitlement and a lack of personal responsibility which, in turn, encourages passivism and lethargy. Also, as a hospital with missionaries, many people with sufficient money come here on the chance that they might be able to get free medical care. It makes it very difficult to know who really needs help and who is playing the system.

Is financial collaboration possible? I am not sure, nor do I know what it will look like at this point. I ask this question because this is what I seek with the Hospital of Vanga. Collaboration is my goal, but at this point it is still a moving target. How much support is appropriate, what investment should be required from the hospital, how can proper budgeting be put in place which is in line with the mission and vision of the hospital, and more profoundly, how can I address the issues of the heart related to money that seeks to cheat the system at every level?

In the coming months, I hope to be appointed Budget Director and a Hospital Analyst. The administration seems hesitant to give me either of these positions likely because of the authority this will give me to reveal areas of weakness or mismanagement. My hope, however, is to begin strengthening collaboration by helping to give my analysis of the financial and hospital management so better decisions can be made. Yet, decision making here could be a whole blog in itself. Essentially, the structure of a Western style board of directors and various administrative meetings are in place, but they appear to me as mostly a show, while the real decisions are made by the chief of the hospital on his terms without oversight or accountability from a board of directors.

I would appreciate your prayers that God would give me wisdom and discernment to see clearly through a very cloudy and confusing system and that the administrative staff would be honest with me and turn from dishonest practices.

I am wading into a very delicate area as I look at finances and my hope is that the mismanagement described to me by the staff is a result of lack of training and ignorance by the administration and not intentional corruption. If the latter, I will have a much harder time getting reliable information and avoiding parallel forms of administration which usurp anything I try to do. I fear the administration is a small clique where everyone watches out for each other and covers up what needs to be hidden from the greater staff.

Pray also that I might be able to find a reliable individual in the administration who might stand for justice and work with me to root out the bad weeds.

I think my feelings are a little bit like Joshua after Moses has just died and Joshua is placed in charge to lead the Israelites into war. I am stepping into unknown territory with very little experience and a fear that my enemies might overwhelm me. I hope that I can “Be strong and courageous” Joshua 1:8, be obedient to his call, and that God will part some rivers and break down some walls so truth and justice will win.