The Longest Week- Stepping Out

It’s been the hardest week of my life. I have a gift of empathy, and it is extremely hard for me to disappoint someone. Try disappointing a whole village, a whole hospital, your “family”, and closest friends for the past year. It’s awful. It’s additionally awful not because the situation was out of our control, but because we were actively taking a step of courage to be obedient to what we feel God has called us to. And that allows all sorts of doubts to creep in. The same, “Did God really say to ….?” that Eve dealt with in the Garden of Eden is whispering in my ear as we say the hardest goodbyes.

Sydney, oblivious to danger, stands atop the dirt and waves to people as they go to get water from the Source

Stepping back for a minute, here is the context. At the recommendation of our sending organization, we took a vision trip to Togo from mid-August to mid-Sept. This year has been extremely difficult for Ryan especially, trying to find a place and purpose in a location that has used tribalism, witchcraft, intimidation, and passive aggression to thwart his intentions to help the hospital run more efficiently. His talents and gifts have gone largely un- or under-utilized. For me, I have been able to work in my field of specialty in OB/GYN, have been able to teach, to make friends, to have colleagues that work well with me. It hasn’t been all roses; I’ve had my share of frustrations. But it has been nothing like what Ryan has endured at the hand of a few influential people.

Visiting the triplets born in my absence, but all named after me because I diagnosed and gave prenatal care. Jean. Jeanine. Jeanette. Here I go by my middle name, Janeen, because it is French (Jeanine) and easier to remember.

As a result of this disparity of experience, we as a couple have not been on the same page regarding our future. Thankfully, our marriage has stayed strong as we have so many outside forces opposing us. But still, our vision for what the future of our family looked like was not the same. I saw opportunities for improvement in the situation at Vanga; he saw obstacles left and right as he tried to move forward. I saw our kids being so well taken care of by Mama Lutti and Tata Mbuta; he saw the need for school options and more interaction with friends for our kids. I saw the pain of leaving; he saw the pain of staying. So we committed to praying together every day, out loud, for unity and clarity regarding our future. And so we continued throughout the months of July, then August as we saw family and friends in the US, and then Aug-Sept as we experienced a new hospital situation in Togo.

There is a time to plant and a time to uproot what is planted. A time to tear down and a time to build. A time to weep and a time to laugh. -Ecclesiastes 3

In brief, Togo was a very good experience. We both easily integrated into their hospital system, enjoyed the numerous relationships renewed from language school days, and our kids had quite a few friends to play with. Two moments in particular felt to me like they gave some direction for our future.

After a women’s bible study, one of the older women was telling someone just ahead of me in life stage (Melissa) that God WILL make things clear. We just need to be still and quiet for long enough to hear Him. In my head, I was shaking my fist. Isn’t that what we’ve been yearning for, praying for since April? And so far, it has felt anything but clear. Melissa then turned to me and we began talking about life. She said, I believe led by the Holy Spirit, that “there have been several times in my life that I have let loyalty hinder me from doing what God wants me to do.” She told me a couple of examples, one being a contract that they had to shorten because they felt strongly that God was telling them to go to Togo. It felt eerily similar to our situation. “Our loyalty needs to be to the Lord.”  I left feeling like that was a message straight from heaven, but I didn’t like it.

The next night, I was recounting this conversation to Mindy, a labor and delivery nurse who is volunteering there for 3 months. I teared up, saying, “I’m sad because I feel like that was from God. I feel like all roads are leading us away from Vanga, whether that is us going back to the US so Ryan can feel fulfilled or us coming [to Togo] to finish out our term and potentially stay long-term. What are we supposed to say to those we pushed for change? I’m not sure what to say, because things are changing, but now we might still not stay. Why were we…?” And then an overwhelming sense of peace came over me. That change needed to happen regardless of us. And God is working His Will out in Vanga. If we were only there for a year to help make that transition happen, to be a catalyst, that was still HUGE. And God cares about that goat more than I do. (This is a reference to a previous blog.) God cares about Vanga more than I do.

But the decision to move from Vanga to Togo was complicated. From the moment we left for the US, change was happening so rapidly in Vanga it was hard to keep up. The corrupt district pastor finally moved on.  The interim seems unafraid of witchcraft and proves that as he walks out in the village after a curse has been placed, proclaiming that Jesus is more powerful than the evil spirits. The hospital medical director resigned and was replaced by our partner, Dr. Tim Rice, who has a huge job in front of him to get the house in order. An internal audit was called immediately to determine the financial condition of the hospital. The staff seemed to understand the situation and were actually quite ecstatic to get their salaries only 2 weeks late instead of up to a month late. The village has stopped listening to the old village chief who was calling on them to riot to stop the changeover in administration at the hospital. The village was completely quiet, despite 2 attempts over a megaphone to call people to action. Ryan saw rebuilding from zero as a challenge which might be fulfilling to him. The needs are huge. But making a decision based on need is problematic. The reality is that most mission hospitals around the world need help. The majority don’t have the luxury of turning down scores of surgeons and medical personnel trying to come work in a resource limited setting. It was too difficult to give a final answer and we, oddly enough, needed a sort of vision trip back to Vanga to complete the loop.

Sydney learning from Mama Lutti as Zack watches.
Mama Lutti has taught Sydney colors and numbers and
how to work and cook and color and we love her dearly.

We arrived back in Vanga last week on Thursday. Indeed, a sense of peace prevailed and people seemed optimistic and very welcoming. The hospital seemed to be functioning well enough, and Ryan was invited to a meeting for planning the interim period. I stayed at home to get things in order before starting work on Monday. We enjoyed reuniting with friends and colleagues, as well as our beloved Mama Lutti and Tata Mbuta playing with and enjoying our kids. Even though we were leaning towards finishing our two-year contract with Samaritan’s Purse in Togo, maybe we would stay through December and help out with the transition, or maybe and better yet, I thought, we would find that the situation had improved enough that Ryan would feel fulfilled. I was still leaning to stay; Ryan was leaning to go. We didn’t yet have unity.

Carrying down donated baby blankets to the maternity ward.

Then Saturday evening happened. We were sitting around the table after dinner celebrating our return with the other missionaries. The discussion turned more serious as we learned that some paperwork still hasn’t been finalized for my work to continue in Congo. It is a direct result of the local political conflict here and actions not taken by administration last year at this time, and other actions taken by administration in February this year, specifically aimed at intimidation. As we talked, I realized that this news, in turn, is a threat to my ability to finish my board certification in the US this year. And time is running out. Secondly, another letter written by the village chief in the adjacent village was delivered on Saturday which was disparaging of the missionaries in general.

Turmoil within. The rest of Saturday night and Sunday were spent mulling over the options. We talked, thought, prayed, and had no inner peace. In the end, we decided to wait until Wednesday of this week to try to see how things would play out in Kinshasa. I decided to go to work as planned on Monday. I hardly slept Sunday night. Monday morning, I was exhausted as I pulled on my scrubs and white coat and started towards the hospital- my family was still asleep. As I continued down the path, I found I couldn’t continue. I had zero peace. My mind was whirling. What if something happened in the operating room while I’m in this emotional state, exhausted, in turmoil? I turned to the left on the path away from the hospital and cried as I trudged to the Rice’s house.    

Nighttime routine- reading books with Aunt Kathy after dinner

Nighttime routine- discussing really important goings-on at the hospital with Tim

I sat on their porch swing overlooking the beautiful Kwilu as the sun rose and cried. I knew I had to say yes to God that I’d follow Ryan’s lead and we would leave Vanga. Tim cried. And Kathy made a list. (If you know them, this might make you chuckle). I called Ryan and we knew what we had to do. But doing it was another thing. It took a boatload of courage that I didn’t think I had to start the process- to get past the point of no return was extremely hard. As the schedule for flights out of Vanga was limited, it was a choice to leave quickly or leave after a couple of weeks potentially. Knowing we would leave for sure, we chose to leave sooner in order to not prolong the pain.

“Be willing to act and expect God to be responsible for all the consequences that flow from obedience to His guidance.”

We made the decision to leave Monday morning, and started the painful process of telling people we were leaving. Heartbroken does not begin to describe the emotions. Congolese frequently wail when family or friends die, but many times this is to demonstrate to others that they did not put a curse on them or cause their death. But this was a different kind of sorrow. Some left the room sobbing loudly. Some had tears streaming down their face silently. Some were more stoic but then broke after a few minutes. Most, like me, were in disbelief. Why? Why now when things seem to be getting better? I cried most of the day and fitfully slept most nights from Monday-Wednesday. As I walked and went through the motions of packing on Monday, it took all my strength to keep going. Big deep breaths. Tears. Packing our life. Denial about what was happening. Hoping I could wake up and it would all be a bad dream. Seeing the looks of shock and disappointment from those I love dearly here over and over in my mind. We had only told a few by Monday night, but we finished packing late and went to bed, knowing the next days would be more emotional than physical.

One last C section with my best friend, fellow
doctor, fellow new mom, Laurene.

We told most people during a regular morning hospital meeting on Tuesday, inviting them to a going-away party of sorts that evening. I then engaged in tying up some loose ends at the hospital. I did some ultrasounds for the last time, I did a C-section with my best two friends for a final time, I saw a few patients that had been waiting for weeks for my return for follow up. It wasn’t much, but did help with closure. We swam in the Kwilu a few more times with the kids, played games with the missionaries, and focused on relationships. I cried a lot. We got on the plane on Thursday (after getting the ok from SP due to the unrest in Kinshasa it was literally “up in the air” until then). We have closure. We felt very loved on our exit. It will take time to make sense of this, the timing, the why’s, and to see how God will take care of Vanga and the loved ones and patients we left behind. Regarding our partnership with the Rices and the Congo Health Connection, it feels like when Barnabas and Paul went separate ways for the sake of the gospel, although we’ve had no conflict. For now, we and the Rices are clinging to these promises.

Playing a new card game with the missionaries- we hail from Oregon/Missouri,
Texas/Missouri, Switzerland, and Germany

“I know what I’m doing. I have it all planned out—plans to take care of you, not abandon you, plans to give you the future you hope for.” -Jeremiah 29:10-11 MSG

New Congolese outfits, made by Angele (left) that same day. Sydney has one too!

“You parents—if your children ask for a loaf of bread, do you give them a stone instead?” -Matthew 7:9 NLT

We gathered with all of our employees and their (large!) families,
as well as employees from the hospital for a small going away party.

“Brothers and sisters, we want you to know about those Christians who have died [in our case, left] so you will not be sad [in the same way] as others who have no hope [to see each other again.] 

-1 Thessalonians 4:13 NCV

Junior and Ryan, coworkers and friends

“Being confident of this, that he who began a good work in you will carry it on to completion until the day of Christ Jesus.” 

-Philippians 1:6 NIV

Ladies from the maternity came and sang with me our last day in Vanga. And I cried.

“So do not throw away your confidence; it will be richly rewarded. You need to persevere so that when you have done the will of God, you will receive what he has promised.” -Hebrews 10:35-36 NIV

“Now then, stand still and see this great thing the Lord is about to do before your eyes!” -1 Samuel 12:16 NIV

There is no one quite like Mama Lutti

“’Not by might nor by power, but by my Spirit,’ says the Lord Almighty.”- Zechariah 4:6b NIV

“Jesus looked at them and said, ‘With man this is impossible, but with God all things are possible.’” -Matthew 19:26 NIV

The operating room team

“Do you not know? Have you not heard? Has it not been told you from the beginning? … He sits enthroned above the circle of the earth, and its people are like grasshoppers. He stretches out the heavens like a canopy, and spreads them out like a tent to live in. He brings princes to naught and reduces the rulers of this world to nothing. No sooner are they planted, no sooner are they sown, no sooner do they take root in the ground, than he blows on them and they wither, and a whirlwind sweeps them away like chaff... Why do you say [Potters], “my way is hidden from the Lord; my cause is disregarded by my God?” 

Trying to hold it together. One last "family" picture before we took off.

Do you not know? Have you not heard? The Lord is the everlasting God, the Creator of the ends of the earth. He will not grow tired or weary, and his understanding no one can fathom. He gives strength to the weary, and increases the power of the weak. Even youths grow tired and weary, and young men stumble and fall; but those who hope in the Lord will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint.” -Isaiah 40:21-31 NIV

Saying goodbye to some doctors I taught in Kinshasa who just got their results that they passed. 

Hanging out with the Spanns in Kinshasa (A MAF family we love and will miss)

He Giveth More Grace- Annie J Flint

1.       He giveth more grace when the burdens grow greater,
He sendeth more strength when the labors increase;
To added afflictions He addeth His mercy,
To multiplied trials, His multiplied peace.

2.       When we have exhausted our store of endurance,
When our strength has failed ere the day is half done,
When we reach the end of our hoarded resources
Our Father’s full giving is only begun.

3.       Fear not that thy need shall exceed His provision,
Our God ever yearns His resources to share;
Lean hard on the arm everlasting, availing;
The Father both thee and thy load will upbear.

4.       His love has no limits, His grace has no measure,
His power no boundary known unto men;
For out of His infinite riches in Jesus
He giveth, and giveth, and giveth again.

Eating cheesecake with Uncle Jonathan in Kinshasa

Enjoying kittens and Mama Katherine in Kinshasa

SBarring any new developments or flight cancellations due to unrest in Kinshasa, we will be leaving for Togo tomorrow, less than a week after we made the decision to leave. It's been the longest week, but we are stepping out in faith that God wants us to take this leap. We will trust that God will keep His promises to work out His Will in Vanga and for those we left behind, and also in our lives in our new adventure and life in Togo. 

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.