Travel Missed Adventures

A lighthearted look at what ALMOST went wrong during our travels this year. My family would call much of this Toews luck (my maiden name for those many times when we, on my dad’s side, don’t plan well and just happen to have good things still happen).

Nairobi

Traveling, with and without littles, is usually an adventure. Flights connecting Nairobi and Europe are not always, or usually, catering to people living in Kenya. Our flight to Greece left at 4:20am. I have made many trips to the airport this year, so I calculated accordingly. Early in the morning, there is usually very little traffic and the trip takes about an hour. At that time of the morning there is usually not much of a line at the airport. No sense in leaving super early with small kids just to wait with the cranky kids a long time before getting on the plane. Ideally, it is best to arrive just as we can get through the last bit of security with 10-30min left to spare and not hours.

I asked our usual taxi driver when to leave, suggesting 1am. He agreed 1:30am,would also be fine. BUT, he was sending someone else to drive his car as he personally was out of town. Well, we left a bit late around 1:45 because...kids. Though we rarely get stopped at police checks here in Kenya, we did that morning. I was trying to keep the kids asleep in the backseat, and I mostly ignored the rapid conversation going on in Swahili. Clearly something was amiss, but I wasn’t concerned until the police said in English, obviously to shame the driver, “I could have you thrown in jail for driving without a license!” What?!? At this point we did start worrying about time, but after a few more intense looks, the policeman indignantly waved us on.

We were looking at the time, but hopefully we could still make it to the airport a little after 3am. We did need to check baggage, so it was cutting it close for the hour before mark, but we’d probably make it. We always carry extra clothes in our carry-ons anyway. At the security checkpoint before the airport, again we were delayed for some time. I assume this was continuing to be the lack of license issue. Who drives a taxi without a license?? It’s like playing baseball without a glove or running in a marathon without a number. We were getting anxious, and really I just wanted to ask the security personnel, who had every right to detain us, to just let him drop us off a few minutes later and then they could arrest him. I contemplated how long it would take for use to walk/run to the airport from the security area. Nope, not with the kids and luggage.

They finally let us go, and I don’t know why. We arrived at the terminal only to see a HUGE line outside the door to go inside. As I wrangled the kids and Ryan put our luggage on a cart in the dark, Ryan immediately said, “We’re going to miss our flight. There is no way. This line is at least an hour long.” It was nearing 3:30am. I felt adrenaline surge. “No we’re not. We have little kids! Let’s just go up to the front of the line.” So we did. We totally cut the line, and when we got to the front, I asked one of the passengers when their flight left. 5am. 6am. I said that ours leaves at 4:20am. They looked at our full hands, sleepy kids, and gestured for us to get in front of them, saying, “You’re late!”

We raced through security to get to the check-in counter. It looked closed. My heart sank for a minute, but then I realized that there was still someone behind the desk. Whew! And then not 5 minutes later another passenger on the same flight came with his baggage. Ryan pointed out to me that he probably arrived at the airport an hour before we did. Gulp. But, we made it. Just in time to walk through immigration, find our gate, go through more security lines, and finally get in the boarding area and sit, even if just for a few minutes.

Greece Missed-Adventure

I was standing near a message board at our conference, reading through the bus schedules so that I could know which one to sign up for in order to catch our flight back to Africa. It was a couple of days before we were to leave. Providentially, I overheard another couple talking about how their flight to Egypt had been canceled and that they were now on an earlier flight. Curious, I asked them which flight it was. Same one we were on. I checked my email. Nothing. Hmmm. I asked Ryan if he had heard anything from our travel agent. Nope. For once, I was thinking ahead and planning. We emailed our travel agent, and they assured us there had been no notifications. However, it was too much of a coincidence to overhear a conversation about that flight and I wanted to make absolutely sure. I decided to ask the concierge service at the conference center to verify our flight details. They called the airline directly. Sure enough, our evening flight had been canceled and we were now booked on the afternoon flight. Had we gone the three hours ahead of time as recommended, we would still have missed our flight by an hour. Whew!

Wanting to take advantage of as much of the conference as possible even though we were leaving on an earlier bus, Ryan and I divvied up the tasks we needed to do before leaving, agreeing to meet at the bus before it left promptly at 11am from the front of the conference center. I took some luggage to the waiting area and went to a session while Ryan finalized packing. Then we swapped and he took some luggage and went to say some goodbyes and pick up a flash-drive while I got the last of the luggage and picked up the kids from their kids sessions. Being over 30 wks pregnant, I decided to drag the luggage to the kids and then haul it all together back to the meeting point. Problem was, the kids were busy having fun. Sydney was getting her face painted so I went and picked up Zack first instead. When I came back, Sydney was still finishing up, but I finally tore her away and we said goodbye. Then we headed with the luggage to the meeting point. It was a good distance away but along the road the bus was going to travel at least. Of course the kids did not walk in a straight line nor did I have enough hands to carry them both and drag the luggage. It took a bit, but even so I did not realize how close we had cut it until we reached the bus. 

There were two buses already loaded but no Ryan in sight. I sent Sydney onto the first bus and held onto Zack while looking for Ryan. The buses were ready to pull out. Finally I saw Ryan who had been frantically running, trying to find out where to come help me. He had been back to our room and again to the conference center at least twice but I’d come a different way. He had our other luggage on the second bus. He grabbed the bags from my hands and I started coming with Zack. “Where’s Sydney?” Right! Sydney was on the first bus which was about to pull away. I ran up those steps and snatched her :) and we ran together to the second bus. Ryan was sweating despite the cold weather and put his head forward on the seat as we started the first part of our journey. I felt horrible for causing the stress I’m sure he had felt for the last 15 minutes. I should have been way more anxious. But it didn’t do much good for me to get worked up about what could have happened.

Our heart rates had returned to normal when we got to the airport. We were there a lot earlier than we normally are (see above). As we usually do in airports, we took turns and scouted out the kids’ area first. We waited for a bit to check in our luggage as it would have been impossible to lug it all over. Finally, our hands lighter, we headed first to McDonalds to satiate tummies. We still had a smaller cart with carry-ons along with the two kids. Both are so active. Ryan held onto Zack and went to put our trash away and I maneuvered the cart through the very large McDonalds, thinking Sydney was in front of me. She wasn’t. Ryan and I met outside with Zack and luggage but minus Sydney. Great. Our very independent child was now lost in McDonalds or somewhere in the airport. Ryan headed back into the McDonalds. Not anywhere where we had been. I tried to look but I couldn’t go up and down stairs with the cart and Zack. Ryan quickly scoured the area, looking downstairs and I looked in a second restaurant closeby. Finally, Ryan went back into McDonalds and located her on the opposite side, trying to order from an electronic menu. Whew!

Our beautiful, independent girl

We headed, finally, to the kids’ area. We didn’t have a lot of time anymore, but we had promised the kids that they could have some time to play. As we sank back into the parents’ chairs for a respite, Ryan looked at our tickets and saw that it said we needed to be at our gate over an hour before. Weird. We reluctantly left the kids’ area after less than 15 minutes. It was better than nothing. The security line was pretty normal, although longer than it had looked initially. As we walked up to our gate, we noticed that the sign said, “Final boarding call.” What?!? We walked up and gave them our boarding passes and they directed us out to a bus. In a few minutes, the bus took off and bused us a ways to our waiting plane. We weren’t late at all, but why were we cutting it so close? Whew!

Immigration Missed Adventure

We had taken a bit of a risk when we left for Greece and then Egypt. Due to the extensive traveling we have had, both Ryan and Sydney’s passports had no free pages left. We realized this without enough time for Ryan to take off time from teaching and to get new ones. We had been thinking that the last two pages of the passport would suffice, but they are apparently endorsement pages and not visa pages. We knew we would get stamps and perhaps a big visa in Egypt. Would they use the endorsement pages or would we have to spend our days in Egypt going to get an emergency passport at the embassy? Turns out that Egypt just put their big visa over a previous page, ignoring whatever was already on that page. Ha! So Ryan and Sydney were both allowed into Egypt and back to Kenya.

Egypt Missed-Adventure and Misadventure

Our layover in Egypt was a bit more than 48 hours. We wanted to have a little adventure with our kids, see the pyramids, and have some family time. We organized an AirBnB that would pick us up from the airport. I notified them that our flight had been moved up many hours (see above), but I hadn’t gotten a reply. We waited in baggage claim and noticed a few people that had been at the conference and on our flight with us. They lived in Egypt. We decided to Uber our way to our destination using their local phones if our AirBnB wasn’t waiting outside. They weren’t, so we caught an Uber along with our new friends who were going to their homes. We got in the first car and they got the next. On our way! To the pyramids and camels etc. Little did we know that our friends were detained with their Uber driver for over 45 minutes after we left because he did not have permission to enter the airport for customers. We would not have had the language nor a cell phone to help get ourselves out of that or to know what exactly we should do. Whew!

Our AirBnB was as advertised—right across from the Great Sphinx. The window right above Sydney’s bed looked straight out on the pyramids and Sphinx “Look mom! They are in order!” and straight down 4 stories to the street below where the street was crowded with camels and buses and horse-drawn chariots and taxis. What an odd mix! Thankfully, I inspected the room carefully and when I got to those windows, I noticed that they easily opened without a screen or a window lock. They were large, and did I mention we were 4 stories up? I was just imagining my kids trying to get a better look at the camels by sticking their heads out of the window and then falling 4 stories. Gives me shivers. We soon had jury-rigged a sort of lock using the end of a broom handle to ensure that the windows only opened a crack big enough for an arm. Whew!

Sydney looking out at the pyramids from our AirBnB window.

Because of our early flight, we were able to plan a bit for what we would do the next two days of being tourists. Turns out we had chosen a day to explore the pyramids when nearly everyone in Egypt was not working. Good Friday meant Christians had a holiday. Friday is the Muslim weekend. And it was also the day before Jewish Passover. All of the regular tour guides were already taken (ahh, lack of planning). We had few expectations, but we wanted a camel ride, a chariot ride, to explore the inside of at least one pyramid, and see things that were generally climbable and not breakable.

Our chariot driver ended up being our tour guide of sorts, though he mainly just took us to the different sites so that we didn’t have to walk. Ryan rode a camel alongside us, usually with Zack or Sydney. Most of the others visiting the sites seemed to be Egyptian. We got as many pictures taken of us as we took of the pyramids, especially of Zack with his white hair. We explored. The kids really wanted to climb the pyramids but at least we got to explore the tombs underground. Nearing the end of our journey, we were looking forward to finally going inside a pyramid. This was the smallest one of the three, but at least it was something. We waited around, not sure why we weren’t going in. Finally, after at least 20 minutes of stalling, we found out. Our guide had neglected to get us tickets. What?!? That was the one thing I asked for other than the camel and chariot rides. Ryan and the guide took the chariot to an office close to the main gate to buy the tickets because as Sydney said, “I don’t want to ride the slow camel. The chariot goes fast!” I tried to keep the kids from climbing the pyramid or going inside, etc for an uncomfortable and frustrating 30 extra minutes, but we finally got to go inside. :) Long day but good memories, even with the misadventure.

Ryan and Sydney on the "slow camel"

Enjoying the chariot ride

The second day we went to the oldest of the pyramids, from around 2600BC! There was a lot of fine smooth sand for the kids to play in. We joked that it was the oldest sandbox in history and that they liked the sand more than the amazing architecture that had withstood the test of time. Imagine that Jesus may have seen these pyramids when he lived in Egypt and they would have been old—over 2000 years old at that time! As we were walking to one that we were able to go into, our kids were running and falling and having a grand old time. We had no idea that there were many many open tombs scattered around. They were over 40 ft deep with stone bottoms leading to a burial chamber or perhaps a fake one to discourage tomb thieves. BUT, these tombs were surrounded by only a thin railing. I realized that Sydney or especially Zack could easily have walked, stumbled and certainly crawled through the sand and fallen into one of these pits. We kept a closer eye out for these and our kids closer after that. Whew! Missed adventure.

The oldest  sandbox

Sand filled with hidden tombs and treasures from ancient Egypt

Pregnancy Travel Missed Adventure

I’ve been co-coaching volleyball this term of school, which has been an absolute blast. Our last game of the season was over an hour away and my fellow coach was not able to come due to a previous commitment. At over 36wks and with my history of fast labors, traveling without an extra adult wasn’t smart, so I recruited a good friend to come with us. You know, just in case I need to go to the hospital instead of the game. Would be quite awkward for me to just leave a group of high school players and then be alone myself somewhere in labor. I brought my medical records, gloves and a towel. :) No labor. Whew! And I thought I was done traveling.

BUT, immigration officials here in Kenya decided to have all foreign workers come in to get fingerprinting and to validate their work permits during the next two months. (Imagine the backlash if the US did this.) Faced with possibly standing in line very pregnant or standing in line with a newborn, I chose to take the chance and go early. I mean, it wasn’t very early, but as early as I could. I went with a group from the school. The driver joked that he knew he was leaving with 5 and coming back with 6. "If anything will put her into labor, it’s standing in line for a long time in the sun." Again, I brought stuff to be prepared. I even found out there was an L&D nurse and a pediatrician in line with us. The line was shorter and the process way faster than we thought it would be. I was prepared but it wasn't needed. Whew!

The OB I’ve been seeing as well as a midwife I’d really like to be present at my delivery are currently both out of the country. Such bad timing! They have been gone for almost 2 wks and will get back tomorrow night, just before my due date. I’m really praying for our little girl to come on her due date but not before, and this is why. It will probably all go fine in any case, but birth is sacred and memorable and having people there that I really love is important to me. 

If I deliver in the next two days, it will be ok, but last weekend was a missed adventure for sure! Imagine... my doc and my midwife are gone. I have an L&D nurse who has agreed to help, a nurse practitioner with a lot of delivery experience, and a back up family practice doc. BUT, last weekend was midterm so many of those on campus were gone as well on (mostly) day trips. Monday of this week, it was still midterm. Ryan had to go to Nairobi to do his fingerprinting and I volunteered to keep a couple of extra kids for another couple who were going to stand in line. So I was at home (thankfully with househelp!) with 4 kids at 38w6d, the very day that my water broke with Zack. I was at home with those 4 kids but without Ryan. And all of those people I mentioned had agreed to help if needed? Gone as well for the day. Really, every single person I was hoping to help me was not there. I am so thankful we missed that adventure.

Nancy (Nounou) is here!

Nancy Rice arrived the next morning, as planned, to be around to care for the kids when I’m in labor. I’ve felt much more at peace. If I go into labor now, I have a lot of people around to help and Nancy will handle the kids, just as she did for Sydney when Zack was born. Still, I’d really like to start labor on Monday or Tuesday when the doc and midwife are also back. That would just be wonderful. We will only be missing Dr. Jennifer Goldkamp who delivered my other two. I know she would rather be here than taking another (final!) board exam, but I’ve heard those are important. Hopefully my next blog will be another African birth story. :)

Raw

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

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

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

A rainstorm in the Rift Valley

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

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

Ryan enjoying his roles as basketball coach and math teacher

Continuing to teach at home

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

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

Part of the maternity team in Togo

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

Fistula Surgery on the Africa Mercy

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

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

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

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

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

A PATIENT

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

Putting on makeup prior to the dress ceremony

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

Dancing through the hallway during the dress ceremony

Good? Or a Letdown?

In my American mindset, I just couldn’t accept that it was too late. A friend of mine from Congo had traveled to Kenya for an interview for a surgical residency program, but in doing so, he was giving up his spot in Kinshasa to take an English exam required for those desiring to study in the US. Rather than losing his registration fee, I had made the suggestion, before he planned the trip, to change his exam site to Kenya. It would be a fee, but not nearly as much as the registration. We both looked on the website and I made calls to Nairobi. We made plans for him to have transportation to Nairobi on the day of the test. As soon as he arrived in Kenya, he got a SIM card and called to make the arrangements, and he had money sent so that he could pay the change fee. This all took several walks to the local shops, and he didn’t have sufficient time to actually make the payment. On his second day in Kenya, as soon as he had a chance after his duties at the hospital, he called to arrange payment. And they said the last day to pay was the prior day. He would no longer be able to take this exam for which he had studied for months. He would forfeit his registration fee. All because he didn’t understand a phrase in English that detailed the deadlines. And I was angry. I felt responsible for not rechecking. I felt responsible for recommending the interview in Kenya in the first place. I was angry.

It was also spiritual emphasis week at Rift Valley Academy. That night, as we worshiped the Lord, the words of the song stung and did not ring true.

Let the King of my heart be the mountain where I run

the fountain I drink from

Oh, He is my song

You are good, good, ohhhhh

You are good, good, ohhhhh

You’re never gonna let, never gonna let me down

You’re never gonna let, never gonna let me down

Ebenezer: "stone of help"

In fact, as the worship leader said to sing it out if we believed it, I stayed silent. I even felt tears welling in my eyes. Because even though I believe that is true for me—I’ve had too many Ebeneezer moments that I can reflect on and see why the Lord allowed circumstances and how He redeemed them—but I did not, in the moment, trust that He would never let others down. I reflected back to our experiences in Congo. Sure, God took great care of our family as we chartered a plane away from the difficult situation and started over in Togo. But our teammates who were left, our Congolese colleagues who carried on, and the patients that I wouldn’t be available for…. What did God do for them? Didn’t our leaving signify an event where God let them down? What about all the Congolese who are suffering and starving because of the political climate created by a few that has caused their money to devalue by over 50%, leaving the common people without means to survive? What about them God? What about my friend who, despite spending a significant amount to come interview in Kenya, and despite making a genuine effort to properly register, and despite his amount of studying, despite all that, he wasn’t able to take the test. Wasn’t He letting my friend down? No, I did not trust Him for my friends.

I was challenged the next day, as I talked to my life coach, to think of how this situation may work out in my friend’s favor. I was still angry with God. I could think of very few reasons why THIS plan was better than the ones we had made. The phrases, “God is in control,” and “He works everything out for good to those that love the Lord,” seem trite and, frankly, unfortunate and often not true. As I prayed to the Lord, I told Him so. I told Him I was angry. My friend said, “I prefer to trust God.” But I was still angry for him. It was almost a dare- SHOW ME, GOD, HOW YOU ARE GOOD.

A field near where I walk and talk weekly with a life coach

As I waited for it, thinking God had His work cut out for Himself this time, I was struck by a couple of sentences written in a devotional by Beth Moore on the book of 2nd Timothy.

As I waited fo

“Not one whit of [a life] experience need be good for a merciful God to use it for good.

He can rob the darkness of the gain of your pain and redeem it powerfully in the light.”

Meaning, it’s perfectly acceptable to say that life sucks sometimes. People get the raw end of a deal. We don’t have to call it good. Jesus didn’t come to heal everyone here on earth. Jesus didn’t come to make everything good now. What did he come for? He came to redeem everyone and everything. Redeem! Not that we have to say it’s good. And the second phrase that is comforting to me, in lieu of, “God is in control,” is

“This didn’t surprise God.”

Although it means quite the same, it doesn’t feel the same to me. A God who is controlling painful circumstances feels different than a God who is never surprised, is prepared to redeem it, is comforting us through it until He redeems it, and who has a plan to make all things new.

In this case, God was up to the task to show me how He was good. In less than 2 weeks, I found out that the mere fact that my friend was studying to take that exam helped him significantly in his interview as the residency program is in English. He was accepted (though not in Kenya, he will be in the equivalent surgical program in Niger!) and this means that having a test result is not necessary for him in his current career path. Rather than losing money as I assumed, he actually saved money from not paying the change fee!

I’m not suggesting that we will always see the reason for difficult experiences this side of heaven, but I am comforted that even if not one bit of an experience feels good, I can long for the time when all things will be redeemed. I was reminded again of this fact while serving on MercyShips in Cameroon last month. I was counseling a woman with terminal cancer who had unfortunately been taken from her village from very far away to come and be screened as a fistula patient because she was leaking stool. As I shared with her that we could not help her recover, and that she would have this sickness the rest of her life (who knows how many days or weeks she has left), I mentioned that Jesus did not come to the earth to heal everything now, but He came so that everything can be healed and redeemed for an eternity. Even if we could heal her with surgery, it would only be temporary, but trusting in Jesus brings peace and healing and restoration that lasts forever.

When I struggle with the goodness of God, the thing I cannot refute (at least haven’t been able to thus far), is that God, as a good Father, allowed His own son, who only showed love to others, to suffer. This Good Father allowed His son to experience hate, betrayal, hunger, to be humiliated and beaten, and to die. I haven’t been able to come up with an experience that would be worse for my own child than what a good Father allowed His son. And He did that for me, the one who is angry over an exam registration fee. Even the thought of the redemption of all the evil in the world was enough for Jesus to trust His Father. The picturing of our reunion and redemption in heaven was “the joy set before him” when He “endured the cross, despising its shame.” And if a good Father can watch His son suffer and use it for good, that same good Father can certainly watch the unnecessary suffering we see around the world and still be called good. 

When Potato Soup Makes You Cry

Having proper expectations has been said to alleviate much of the difficulty of a transition. Our move to Kenya should not have been any different. I mean, it is not like we haven’t made international flights with young children or packed (most) all of our earthly belongings or said too many goodbyes and hellos. I remember my mom fondly recalling how fun it was to set up her home after she got married, but that excitement has lost some of its luster now that I’ve set up a new home, in a new country, 4 times in the last three years. And I’ve visited Kenya for extended periods of time. So if anyone should have proper expectations, it should be me, right?

 Kijabe and I go way back... to 2005 when I came as an undergrad student at LeTourneau. This May we met up with a professor of mine who attended school at Rift ValleyAcademy and was on the team in 2006

When Ryan came home from one of his first days of teaching and found me teary-eyed, he knew why. I was struggling with loneliness, struggling to remember where to buy milk and how to get more cell phone minutes and who to hire to work in our home. I was juggling new schedules of Ryan as a teacher and coach and my schedule of when the preschool moms got together or neighbors walked for exercise. My head just felt like it was exploding with all the new information it was supposed to keep filed away, all the while my heart was simply longing to be known without explaining our long complicated story. Our evenings which used to be filled with swims in the Kwilu River and dinner with the Rices in Congo, or more recently, filled with laughter during Kendall-Potter game nights in Togo were now empty slates. So as Ryan looked into my eyes, he gently said, “It’s only been a couple of weeks. How long were you giving yourself until you expected to feel settled?” I looked up at him and sheepishly answered, “A week. We’ve done this so many times before.”

An analogy I like to use is that of jumping into a very cold swimming pool. You KNOW what it is going to be like, you’ve done it many times, but it still SHOCKS you and takes your breath away when you first enter the water. That’s how it feels to move to a new country with small children. First in the airport as you realize you don’t have nearly enough hands to push all the luggage carts needed to transport your stuff and to keep your kids from attempting to get a ride on the luggage conveyor belts behind the counters. Second you hold your breath when you board that first flight and know you must convince your two active children to stay in a 10 square foot space for hours. And then there is jet lag. And the initial inability to communicate either due to lack of language acquisition or lack of a SIM card in your cell phone. They are just experiences you EXPECT are going to be hard, but that doesn’t take away the SHOCK of the journey it takes to make it through to the other side.

Sydney learned that drinking chai is a nice twice a day tradition in Kenya

Here in Kenya, we found someone to help with basic household tasks right away. It was a huge blessing. She has over 20 years of experience, can cook really well, and loves the kids. In preparation for my return to work, we also decided to try out someone who could focus on caring for our precious active kids when we can’t be home, taking them to play at the playground instead of being cooped up at the house while someone is cooking or cleaning. This is where the potato soup comes in. A sweet woman agreed to come a couple of days a week to do primarily childcare, but our trial period wasn't going so well. Sydney ran away from her once and resisted her care, which isn’t so surprising. Living in her 5^th country and feeling out of control is a little how I feel sometimes- and Sydney is expressing it by trying to control her very small piece. The nanny had seemed stressed out by the kids instead of enjoying them. To top it off, while the kids were napping during the afternoon, I asked her to prepare a simple potato soup for the evening. Just before she left, potato soup sitting on the stove, she asked me if it was going to get better. Broken, I replied, “They are little sinners just like me. I promise we’ll work on it but I can’t promise it will get better because I don’t know.”

Rift Valley Academy has a lot of space to run... and get lost in!

That night, stressed at the probability we were going to have to try another new person with our kids, stressed that our kids were not behaving and putting that guilt on myself for moving them so much, and stressed that no one would love our kids like their nannies in the past, we started eating the potato soup. And I started crying. It was… really spicy hot. Hence the tears. But the crying continued because the soup was also terrible. It was so thick that we didn’t need a bowl and a spoon but a plate and a fork. Did I mention the soup was really spicy? Little red flecks looked back at me from my bowl. I went over and checked the recipe. Nothing in that recipe was spicy or red. So now I looked at my family who was depending on me for food that night, and I had no plan B. I was failing at staying at home, failing at trying not to stay at home (preparing to go back to work in January), failing at parenting, failing at being a wife.

Before I finish the story, I need to admit something. I dread the question, “So how are you doing?” or “Are you feeling settled yet?” at this point in our journey. Because I want to be honest and foster greater community. Because I know that the person asking usually genuinely cares. But I don’t know what to say. I dread it because I have no idea how to put into words that make sense how I’m doing. It’s been a month now, and I don’t feel settled deep down. Sure, routines are getting established and I spend much less mental energy on simple tasks of daily living. But I am still adjusting to the huge transition of being the primary parent. In nearly 4 years since having Sydney, this is the first time when my primary role is to be a mom and where no one is relying on me as a doctor. It’s hard to say this without guilt pouring in. But any physician who has suddenly stepped away from his/her practice of medicine, any working mom for that matter who has stopped working outside the home, even for a season, has somewhat of an identity crisis initially. I’ve read about it on blogs. I expected it. I knew what was coming. (Picture cold swimming pool again.) But it is still a huge adjustment. I LOVE my kids. I LOVE spending time with them. I am so glad that I get these 6 months to soak up each new word Zack says and each new skill Sydney learns. But I also LOVE medicine and delivering babies and doing surgery and physically working hard and many times saving lives. I MISS talking about medicine in a campus full of teachers. I MISS interacting with patients. I MISS feeling competent.

Who am I? I miss feeling competent.

 Not feeling competent when ALL the milk is anywhere but in a bowl or cup after 5 minutes of my absence.
Mama said there'd be days like this.

I miss feeling competent because, as my primary role during this short season is to be a mom, days that are wrapped up in two tiny people don’t often go according to a plan and don’t often reflect the effort I put forth. Some days I feel awesome and others are train wrecks. It’s the difference between the moment your kids have gotten up from their nap for the third time while the other is still crying himself to sleep, and the glorious moment when he finally falls asleep and your three year old is sitting and “reading” her bible stories. One moment you feel you can’t do this any longer and the next you realize you have time to yourself and can sleep and then you love being a mom again.

Sydney has made a good friend already. Hoping she becomes as dear to the kids as their previous nannies.  

So… the potato soup was the end. And the beginning. A new day came. We asked someone new to come and she has been wonderful so far. Zack has started to sleep through the night and is eating well. Sydney stayed with two sweet families while we went to Malawi and was a “great houseguest” and “so polite” from their words. Encouragement came. In this new season, I need to put into practice what so many working moms turned full time moms have talked about. My kids’ behavior is no more a marker of my worth than the number of surgeries I do or babies I deliver. I need to cling to the fact that I am a child of God. Yes, I’m also a mom, a wife, a doctor, a friend. But the one thing that will not change even with death or disability is that I’m the daughter of a King. Jesus is our rock, unchanging, unfazed in His love for us whether we are helping to save a life or helping wipe another snotty nose.  

I LOVE my kids :)

Air Born

 We were less than halfway into a 10 hour flight when the call was made for medical assistance at the back of the plane. There had already been hints that something was amiss. Chasing around a one year old, I had noticed that they were washing the floor in the back galley and didn’t want children freely coming back for water and snacks. I overheard a flight attendant asking one of the other dads who was also running after his child if he spoke Arabic. So the call for medical personnel did not surprise me. I scooped up my son and walked toward the back. Please, Lord, don’t let this be an old man with a cardiac problem, I thought. Instead, it was a younger-looking woman, sitting in the jump seat that flight attendants use for takeoffs and landings, and though she wore a traditional abaya, I could see on her face that she was in labor. I was so relieved.

Though not our plane, this is identical to the one we flew in. (Photo credit: flyinginireland.com)

You see, an OB/GYN responding to a cardiac emergency could be compared to a Toyota mechanic stopping to fix a VW bug on the side of the road. Sure, we’ve had all the training and theory, but it’s going to take some time for us to remember what the right dose of drug might be needed. In addition, we haven’t likely been keeping up with new recommendations outside of our specialty in an ever-changing field of medicine. So I was relieved. Actually, I was feeling right at home. For those of you who clicked on this blog but don’t know me, I’ve spent the past 3 years overseas, working in limited-resource settings, usually with a translator and definitely without epidurals or many IVs. And for some reason, I’ve had several instances of births in unconventional places. Not one, but two babies were born in my apartment building in France, both requiring my help. At least on the plane, we had plenty of blankets and gloves!!    

Blankets and pillows prepared for delivery. Photo credit: airliners.net

 The flight attendant’s eyes widened as I confirmed that, indeed, her water was broken and her cervix already dilated. After the initial questioning, I thought her baby would be quite premature and I wanted something to help stop her labor. My mind was racing as I scoured the medical kit for their available drugs. However, after further questioning and examination, I felt like she was more likely nearly at term. In that case, I told the flight attendants, we could simply observe her contraction pattern. Her contractions had significantly slowed after her water broke. With nearly 6 hours left, there was a chance she could make it until we landed, especially if her contractions didn’t pick up, but we should be prepared for a delivery in the air.

Our flight path from Lomé to New York (photo credit: cheapoair.com)

Contractions weren’t too frequent, so I suggested we get comfortable. We moved from the back galley makeshift bed of pillows and airline blankets into the back two rows of the airplane. She rested, her dutiful husband recorded contractions, and I spent time with my kids and updated my husband. The flight attendants were able to use that galley for its intended purpose. The only excitement during this time was the frequent trips to the bathroom, which is quite common when a baby’s head in the pelvis is acting like an overweight man next to you in an economy seat. One particular instance, as she was trying to exit the tiny bathroom, her husband and I could not contain our laughter as we watched her snatching the end of her abaya from the clutches of the automatic flushing toilet. Let me tell you: in person it is even funnier than in the movies.. And it sure helps lighten the mood when things are tense and uncertain.

With less than three hours to go, it was becoming painfully obvious, pun intended, that her labor was intensifying. We decided to move back to the galley for more privacy and space to stand and move around. Her husband didn’t leave her side. One or the other of my kids occasionally escaped from my husband to see what I was doing at the back of the plane. My daughter, who has seen a cesarean section from the window of an operating room, gently asked me, “Are you going to break her?” I reassured her that I would not need to, but that the baby would be here soon.

Back labor can be excruciating. From my extensive experience in labors without epidural pain relief, I have found a few tricks to help with pain naturally. Providentially, less than a week prior to our departure from Africa I had learned a new osteopathic technique which can help improve labor specifically when the fetal head is putting pressure on the sacrum. I had been a bit skeptical that I could actually apply this technique with my limited osteopathic experience, but it clearly made her pain more tolerable judging from her body language. And then she turned to me and said, through her husband translating, “Something is coming out.”

Upon examination, indeed, the baby’s head had descended. I turned to the flight attendant and asked how long we had. Thirty minutes was her answer, but then she added that even with an emergency priority landing (meaning we land as soon as we get into the airspace instead of waiting our turn) we would still have a 40 minute taxi before the ambulance could be ready to take her. I looked back at my laboring friend, knowing she would not be able to suppress her urge to push for over an hour. I said, “Well, when you feel like you need to push, go for it.” The flight attendant holding up an extra blanket for increased privacy said in disbelief, “So this is happening. Ok. Well should we ask the pilots to hold the landing?” We had been rapidly descending, and our ears were popping as we laid out extra blankets. I said, “No, we just need to get there as soon as possible. Let’s land!” I said, fearing that any delay could jeopardize a chance at higher level care for her or her baby if it was needed.

She pushed just a few times, holding on to the safety bar used by flight attendants as they work in the galley. I told her husband, “Tell her to trust God that He will help her push this baby out.” And with the next contraction, the head delivered, then the body, and we had a screaming beautiful newborn baby getting wrapped in Ethiopian Airlines blankets. The mama sat down and we quickly put her new baby skin-to-skin to breastfeed, with only a moderate amount of wrangling her battle-scarred abaya to make way for the baby. When the placenta came, we put it in a small trash bag, tied it closed with a string, and wrapped it and the cord up with the baby in fresh airline blankets. It was a lotus birth by default, and it was beautiful.

The flight attendants took everything in stride, but they still had business to do. With just minutes left, they said, “We are assuming she cannot go to her seat for landing. How should we do this?” With her husband on one side and me on the other, we shielded the mama from moving while holding with our free hand onto the same safety bars she had used for delivery. “Ok good.” The flight attendants said as they buckled up in their jump seats. “She can hold the baby. We’ll let you know exactly when we are landing.” With that, this precious new life touched ground for the first time. As we taxied toward a waiting ambulance, the whole crew of flight attendants came back to get pictures with the new family in a joyous celebration. 

My personal photo, edited to protect identity and posted with permission. Notice the food carts behind us.

 Due to the noise generated by the airplane during its descent and the calmness displayed by the mama and the entire Ethiopian Airlines crew, most of the other passengers on the airplane had no idea that a baby had just been born. The paramedics and police and border patrol agents came on and escorted the beautiful family through the plane. The mama went first in a wheelchair, her triumphant abaya looking no worse for the wear. I followed the dad who was carrying the newborn. When he reached the row where my husband and kids sat without me for the last 6 hours, he turned to my daughter and bent down to show her the new baby, just as we had told her a few hours before. Until that moment, there had been little interest in the pile of airline blankets that he was holding, but all eyes turned to the bundle. A flight attendant then pointed to me and said in answer to their questioning eyes, “She just delivered a baby. She’s a hero.” I just pointed to the strong mama who just delivered a baby during crazy changes in pressure and turbulence. For me, it was all in a day’s work. And it certainly was easier than chasing around a one year old for the whole flight.

Photo credit: the proud daddy- taken in the hospital.