Tuesday, October 6, 2015


Burkina Faso. Yemen. Syria. Burundi. Libya.

Burkina Faso ousted their past president in advance of their upcoming presidential election. An interim president was named. The presidential guard then arrested the interim president and prime minister on the grounds of… boredom and misaimed devotion to the ousted president, it would seem. The military isn’t sure what to do… except make their own power grab. The population is ticked that they have no president and the interim guy was arrested for reasons yet unknown. Hot mess.

Yemen has been a Muslim no-man’s land filled with Al-Qaeda and Al-Qaeda rumors. There’s little to no political infrastructure. Little to no infrastructure period. But they have lots of sand. They have that going for them. That’s one plus. Probably about the only plus.

Syria is undergoing massive civil war with factions fighting over who can dominate what and whether it be secular or Muslim. People are fleeing by the millions, willing to risk drowning in Mediterranean to make it to Turkey or Greece, then to Macedonia where the government is providing trains to move the fugitives on to the next country. They continue to cross borders across eastern Europe illegally while authorities turn a blind eye, going by foot or bus or train or any other means to reach Budapest, Hungary and the EU, where they stall for ages, before finally being allowed on to Austria, Germany and a dozen other destinations. Super hot mess.

Burundi. Al-Qaeda straight up says they’re gonna blow up the US embassy. Crazy.

Libya. Bengazi. Al-Qaeda. Embassy. Ghadafi’s shadow. Lockerbie. More boats drifting across the Mediterranean. Take your pick of historical and current hot messes.




Tchad is now one of six countries from which the US State Department is recommending departure of all American citizens as soon as is feasible and is allowing non-essential embassy personnel and personnel families to repatriate.


We’re one of the six most dangerous countries to be an American in?

There’s just no way.

Well, we got the message Sabbath morning, September 12, directly from the State Department via the US embassy list serv.

Easy decision to leave, right?

Not so.

It’s not as easy as saying, go where you’ll be the safest. If that were the case, we never would have come to Tchad in the first place. And you don’t spend five years of your life dedicated to building up an institution just to leave it at the drop of a hat. We have bled here. We have shed tears here. And goodness knows we have sweat here. This is our home. Our house is here. Our friends are here. Our dogs and cats are here (and the buried bunnies and hedgehogs and genet). The majority of our married life has been spent here. Our three (and soon to be four) kids don’t know any other home but this one. Our entire professional careers have been spent here after training. We’ve spent the last five years learning tropical medicine, learning the languages (I can say vomit in French, Arabic, Nancere, Ngambai, Maraba and Fulani and greetings in several more), learning the people, learning the culture. We’ve recruited my in-laws, my aunt and uncle, the McDowells, Zach and a load of other volunteers. We’ve probably seen 200 volunteers come through in the last five years.

And then what do we go back to? We don’t have a car in America. We don’t have a job. We don’t have a school. We don’t have… anything meaningful, really. Well, extended family is meaningful.

And if we leave, what will let us know we can come back again? Once the State Department puts up a warning, it usually doesn’t come down for a while. Years. 

If we leave, how long do we sit on our butts in America waiting on Tchad before we move on with our lives? Who pays our salary? Who pays our medical school bills? Who pays our insurance?

If we leave, where do we go?

Another mission?

Stay in America?

This is not nearly as easy a decision as it seems on the surface.

Understandably, the evacuation insurance company wanted to get us out sooner rather than later. If things head south, evacuation gets pricy.

Understandably, our church wanted to get us out sooner rather than later. Worst-case scenarios probably flying through their heads, the last thing they need is a missionary killed or kidnapped.

I can’t blame the church. They made the right call for their purposes. I can’t blame the insurance company. They made the right call for their purposes.

We negotiated with the church and arrived at a compromise. I would stay in Bere. James would go to Moundou. The other twenty would leave. Including Danae and the kids. We packed as we always do. Empty suitcases headed to America with plans to fill them and return to Tchad full.

So September 15, poor little old me was left alone waving goodbye to my in-laws, my volunteers, my 32-week-plus pregnant wife and my 3.8 children. I was understandably depressed for the first few days. I still don’t like it, but I’ve realized how much more efficient and productive a human being can be when there aren’t kids aged 6, 4 and 2 running around. Not a trade I’d make voluntarily, but at least there’s some upside.

But the McDowell four will never return. It’s highly unlikely any of our four student missionaries will return. At least one volunteer won’t be returning to Moundou.

I’ve contacted a Brazilian pediatrician, an American surgeon, a Ukrainian surgeon, and American FP and his friend, a Brazilian GP, a nurse with her BSN, a contractor team, and electrician team, an accountant and others. I’ve told them to hold off on their plans to come. This hurts. This sets us back. Way back.

So there you have it. We’re trying to make the best of the situation. Danae is driving to Virginia tomorrow and will enroll Lyol in school, a couple weeks late. 

The church will meet this week to decide our fate. If there’s no change, can our regulars return in a couple weeks? The Blands, Zach, the Gardners? These are people critical to our success. 

Or if there’s no change, does that mean people still need to stay away until embassy staff are called back and the recommendation to evacuate is lifted?

If that’s the case, like I said, how long do we wait? Honestly, we’ve poured so much of ourselves into this mission, I don’t think we could start over again someplace else. It would take too much out of us. It’s certainly not a job you can do halfway. 

But we don’t feel ready to quit. Surely this isn’t how God planned our stay here to end. It’s just not possible. While we’re not ready to move on to another mission field, we’re also not ready to move back to America, buy an SUV, shop at Trader Joe’s and take our kids to soccer practice while living the upper-middle class suburban picket fence dream. Not that there’s anything wrong with that. But it’s just not us. From here to there? No. Can’t be.

And get a job? I love emergency medicine. Everything about it. But who’s going to take me at the drop of a hat with no American experience in over five years? I’d need to find a job, get licensed, get hospital privileges. That would take a minimum of three months, usually more. Do I start looking now?

So everything is in the balance.

For the moment, I’m sitting tight in Bere, alone. Wondering how long I dare delay before going to America to my pregnant wife. Can I wait until 37 weeks? 38? 39? If I leave before somebody comes back and there’s no longer a presence, will it be harder to come back later? Will I ever get to come back?

Why not leave? We spent five years of our prime as the dumb idiots here while God tripled our income, doubled our patients, tripled our square footage, laid the foundation for a nursing school, fenced in the hospital, trained anesthesiologists (thanks, Mase), started branch Sabbath Schools, among other things. And if we leave, what happens? Odei is a kind doctor. Samedi is a natural surgeon. Antoine is an honest administrator. Ndilbe runs an operating room like no other. Jonathan and Sabine get it on pediatrics. Baikao gets it on maternity. Bernard understands post-op wards. Dainone is one of the smartest people I’ve ever met. We’ve trained people the best we can.

Medically, the quality of care wouldn’t drop too much. Danae can definitely do things no nurse can. Rollin can do surgeries nobody else has business even looking at. But we’d still be above-average. We would no longer be known as the hospital with the foreign doctors and our patient census would drop significantly. We would need to lay off staff. We would need to shut off the generator at night.

And there are vultures. They came the same day they saw twenty Americans leave town. Fortunately, they see me still here and they leave. But the moment I leave, it will be over. People with unkind and selfish ambition would be here to take what they could. And it’s not as easy for somebody to say no in this culture as you might think.

So yeah, I provide a little medical advice. The day before flying out, Danae spent over $6000 on an ultrasound machine and sent it to me. I can do that when Doudje is gone. I can do rounds. No biggie. I can do procedures. I can do consults. And I provide my typical limited administrative guidance. Do this. Don’t do this. But mostly, I’m here as deterrent. A big billboard that there is not yet any carrion here for you to be picking the scraps off of.

In terms of the danger, the security notice stated there are no specific threats. And legally, the embassy cannot allow their personnel to leave based on information that isn’t public. And legally, if there’s information that puts my life in danger, they are required to inform me. There are rumors the president’s health is flagging, but he was supposedly out and about during the Muslim holiday Tabaski last Thursday. There are rumors Libya is mounting a force in the desert mountains to the north. Or take your pick of rebel rumors. Take your pick of Boko Haram rumors. The rains came in late this year, but they came. There was worry of drought and famine, but it would seem we now have enough rain. The global price drop in gas means it’s no longer profitable for foreign companies to come in and export oil. So the government is no longer making any money. And they are fighting a very expensive war against Boko Haram. And they are telling government employees they will need to take pay cuts, which has never been an acceptable statement in the history of francophone culture. So there is set-up for badness. But there really isn’t anything concrete. The missionaries from other denominations are not leaving. The other embassies aren’t issues evacuation warnings.

James and I still feel perfectly safe. Nothing seems different from a few months ago. I spoke with the governor and with the Minister of Security. They said all was well. All our local authorities know what’s going on and nobody can figure out why the State Department put out their warning. The rumor is the embassy families had such restricted movements in the capital that they requested permission to leave. And when the State Department granted permission, they threw in a line about recommending all Americans leave, a statement they can’t quickly go back on and a statement the embassy seems frankly embarrassed about.

So I stay. We have a trigger word. I have a computer bag packed to throw over my bag and walk out the door at any time with five seconds’ notice (unless I have to rinse the shampoo out of my hair). I have all vehicles and motorcycles full of fuel. I know the way to the N’Djamena airport, the Moundou airport, the dirt strip and Cameroon. Honestly, safest route is probably to stay put. And by far the most likely thing is nothing happens.

But if it does, I will leave.

But understand, if I am evacuated without plans to return, Danae and I are not walking away from our earthly belongings in our house about to be mowed down by a forest fire where we can buy another house a little distance away. We are not walking away from our dogs. We are not walking away from our friends. We are not walking away from our memories. We are not walking away from colleagues. We are not walking away from our local church. We are not walking away from the familiar. We are not walking away from our hospital. We are not walking away from our jobs. We are not walking away from our mission.

We are walking away from our identities.

We are walking away from our lives.

With nothing but our family and the suitcase of clothes Danae took back to America.

I know you’re well-intentioned. But don’t judge me. That’s not what I need to hear right now.

Sunday, September 27, 2015

Arresting Development

So yesterday I did an ultrasound on a Muslim patient who hadnt had a period for three years. She came from several hours away with her mother to figure out why she hadnt had a period in three years.

I did the ultrasound and then turned to her and her mother. Alhamdullilah! Praise Good God, youre pregnant! Just past 27 weeks! I dont know why you were having issues with your periods, but this baby has a solid heartbeat and is moving around. Everything looks perfect! Congratulations!

Neither one of them seemed terribly excited, or even convinced. She did seem a little under the weather and had a fever and positive malaria test. She also reported a little burning when she peed. I decided to admit her overnight for some IV therapy.

Today on rounds, I repeated this was the miracle momma, being six months pregnant after no period for three years! Still no smile.

After rounds, the mother of the patient asked to see me in private. I joked with her, Well, my wife wouldnt like me going into a room alone with another woman.(This woman was old. I figured this was an obvious joke.)

She assured me that my nurse could accompany us and asked repeatedly that I pardon her for the intrusion. I assured her right back that there was no intrusion at all and Id be happy to talk to her. Didnt really matter medically, but I was curious to find out why they werent happier about the pregnancy.

Once in a vacant delivery room, the mother started by asking me to pardon her over and over again. I told her I pardoned her, but Id prefer to know what exactly I was pardoning her from. Explain.

She told me her daughter was beat up by her husband three years ago, when the periods stopped. The patients father then repaid the husband the dowry to buy his daughters freedom.

Could this be the ex-husbands baby?

I told her, yes, it absolutely could be the ex-husbands baby! But not from three years ago. She got pregnant sometime about six months ago.

The mother told me it was impossible for her daughter to have gotten pregnant six months ago, as she hadnt had a period in three years.

I agreed with her that it was odd, but still possible she had that solitary ovulation and got pregnant. I wondered, How do you know your daughter wasnt having her periods?

Well, in our family, if you have your period, you need to eat by yourself. She eats with us every day.

Oh, I see. Scientific-like.

The mother continued, Also, she says she hasnt been having sex with anybody. How is this possible?

Well, both the Quran and the Bible are in agreement Mary was a virgin when Jesus was born. So theres been at least one case study. Nobody here owns a toilet seat or a swimming pool, so you cant use that excuse.

Its medically impossible.

In our family, we all marry within the family.

Well, maybe shes back with the husband, or a family member thats too close, or somebody outside the family, or maybe a Christian, or who knows. But its highly likely she has had sex with somebody in the last year. I can put the odds of that pretty high.

Pardon, pardon, pardon, doctor. Ill pay any amount. We cant go back to our village with her. If they find her pregnant without a husband…”

Oh, boy. I cut her short. Im sorry. Abortions are illegal in Tchad. And while theyre legal in America, we still dont do them unless theres a risk to the mothers life.After a very short reflection, I added, Unless theres a medical risk to the mothers life.

No, no, doctor! I would never want an abortion! Thats sin! I just want you to give her a medicine that will stop the pregnancy for a short time. Then after we can marry her to somebody, then she can stop the medicine and the pregnancy can continue.

Um, even in America, that doesnt exist.

Ok, what about a cream or something you can smear on her belly to make it look smaller.

I assure you, if I had such a cream, Id go to America and be a billionaire.

She was definitely non-plussed.

I went on. Im sorry, but I dont know of any means to stop her from delivering a healthy baby in a few monthstime. Even if she delivered now, some babies at this age survive. If shes going to be killed by her family in three months for having a baby, we can hide you here in the hospital for three months. We can call your family and say she has a medical condition that will take three months to treat. After delivery, I can find a couple looking to adopt. We have so many couples with infertility who are wonderful people and desperately want a baby. I could find a very nice couple, Muslim or Christian, whatever you want.

The mother opposed. No, our family will come. Everybody knows our family. Eventually somebody would see her with a large belly and would discover her.

We sat in silence for a minute while I thought of what else I could offer her. I quoted her the Quran, 
God knows what every womb bears, by how much they fall short of their time or number or do exceed. Every single thing is before his sight, in due proportion.
He knows the Unseen and that which is open: He is the Great, the most High.

She nodded her head in agreement. I wasnt really sure what that meant, because there wasnt much counsel in it, just comfort, or at least I hoped comfort. Reminder that there was a greater plan.

The grandmother-to-be decided. Can you discharge us? Ive heard of a Marabout (witch doctor) past NDjamena who will either be able to suspend the growth of the baby for a time until she finds a husband or who can smear a cream on her belly to shrink it.

Sounds reasonable. Ok, but if that doesnt work, you always have an open invitation to come hide here and we can find an adopting couple.

No. If he cant do it, I will travel the entire country until I find somebody who can.

Ok, but travel quickly. Shes gonna be mighty large in a few weekstime.

We had a most amicable parting. Walking away, I just shook my head. Five years ago, this would have deeply shaken me. NowJust another day at the office. Just another prayer whos end result Id never know.

Wednesday, September 16, 2015


Enemies are scary. Kinda by definition. Youre supposed to shoot them. Or something. Who are your enemies? Who are ours? Who are mine? Stop and think. Start naming our enemies. Do you have enemies in mind? You need to get one before you continue!!! Think of one! Ok, now go on.

Well, back in the Old Testament, the Children of Israel had enemies. A lot of them. But those closest to us can always hurt us the worst. Ive had some fun lately digging into some Old Testament history.

About 1400 B.C., Joshua dies (unsurprisingly at the end of the book of Joshua). After that, Gideon lays the smack down on some Midianites (in Judges, its such a sweet story, too bad its really unrelated to this one) and then Eli, the high priest, leaves Mosesdesert tabernacle on Mount Gerizim and builds a second one under his rule among the hills of Shiloh (1 Samuel), somewhere around 1100 B.C. The folks still back on Mount Gerizim feel this creates an illegitimate priesthood and a bogus tabernacle. And the folks at Shiloh harbor some ill will toward the old farts back on Gerizim.

Now do you remember the time in the Old Testament when Israel split into the northern and southern kingdoms in 931 B.C.? Well, this was pretty much the cause of it. Saul and David and Solomon did an admirable job trying to keep the kingdom together. But still, the guys in the north really didnt like the temple in Jerusalem. It couldnt be held together any more. The north was quite adamant God was high atop Mount Gerizim. So there. Okay, fine then. The south said the north was full of heretics, practicing idolatry up there in them thar hills far away from Jerusalem. Civil war ensued. The TEN tribes in the north kept the name Israel. The TWO tribes in the south took on the name Judah.

Then the feud got exceptionally nasty around 722 B.C., when Sargon II from Assyria conquered the northern kingdom. Skipping ahead to 2 Kings 17, Sargon II decides to take a pass on going after Judah in the south, and contents himself in bringing all his POWs from Israel back to Assyria. But they didnt stay in Assyria. This Sargon cat was wicked smart. And mean. He split all the Israelites up and dissipated them out to the farthest-flung provinces of his empire, essentially shattering any chance they had at maintaining a sense of culture and heritage. These became lamented as the Ten Lost Tribes, one of historys most affective, thorough, mysterious and amazing disappearing acts.

Shortly thereafter, those in the southern kingdom (Judah) essentially suffered the same, if somewhat delayed, fate. The north had prophets warning them (Amos and Hosea) as did the south (Joel, Isaiah, Micah, Zephaniah, Jeremiah who recorded the norths demise and predicted the souths, Habakkuk and whichever lugubrious soul wrote Lamentations, probably also Jeremiah), before the south got nailed about 136 years after the north in 586 B.C.

A couple hundred years after the north was taken and just a bit after the south was taken, Ezra, and then Nehemiah, return home to Israel/Judah, only to realize it appears Sargon the Deuce and his successors did the same thing to others, taking non-Jewish POWs from his other wars and scattering them all over the place too, including old Israel/Judah. Now in Israel/Judah those returning from exile find their ancient lands occupied by these apparent squatters. The returning exiles were appalled such a ragtag group of imposters would dare call themselves Jews! And the squatters were downright livid the exiles didnt recognize their inherent Jewish-ness.

The posers claimed to be the remnant, the group Sargon II missed when he carried off the POWs, descended a couple hundred years. They claimed to be the ethnically intact and pure Jewry. And argued the returning exiles had been defiled, lost their pure blood and pure religion to their slavery and mixed-breeding. Wait, no! The ragtags that were sent to occupy Israel by Sargon II were the mixed-breeds!!! Oh, boy.

Well, the Talmud, the renowned historian Josephus and 2 Kings all seem to support the claim that Sargon II did indeed send a diverse and piecemeal bunch of pagans to repopulate Israel. In fact, 2 Kings goes into some detail, explaining how the pagans begged Sargon II to send back a Jewish priest to teach them the religion of the land when lions started snacking on them. And wouldnt stop. 2 Kings even goes into the details of where these squatters were sent from, and its a long list of various towns.

But as you would expect, they just mixed Yahweh in with their own gods to form a witchesbrew of half-baked heretical beliefs and erected altars and statues to such in the temples of this abandoned Israel. 2 Kings even goes into specifics such as child sacrifices and other unpleasantries. If you read the end of the chapter, you can even sense the ill will Jeremiah had toward them, that their children and childrens children kept up these ugly practices, even to this day.

So when Ezra and Nehemiah get back and want to rebuild the temple, these half-bred heretics come and welcome them home like long-lost brothers and offer to help them rebuild. Well, they dont even look like theyre the same ethnicity, let alone speak the same language. Ezra tells them thanks, but no thanks. Except hes not that nice. In his own book (Ezra 4), he describes the squatters as the adversaries of Judah, even though theyve been the stewards of the land for the last 200 years, feeling like theyve been practicing good Jewiness and probably using words like Jewinesson accident, and offering to help rebuild the temple. Ezra says, You may do NOTHING with us!Well thats not very neighborly.

So the squatters got pissed. They started writing letters to the new king, Cyrus at that time, then Darius later, just trying to give the returned exiles trouble. The squatters developed a sense of freedom fighters against a much larger group of occupiers who sought to disband them.

Despite the opposition, the returned exiles eventually rebuilt the temple in Jerusalem. The two groups, both claiming to be the true Jews and accusing the others of being fake and corrupted Jews, settle into this enduring enmity. The squatter Jews who are accused of not being true ethnic Jews and mixing religion, retreat up to the northern kingdom of Israel and Mount Gerizim, the site of the original and true temple. The returning exiles, accused of being corrupted and outbred while in exile without organized religion and study and worship and community, settle toward the south and Jerusalem, Judah. Whoa.

Thats not the end, though. The apogee came in 167 B.C. after Alexander the Great swept through with Hellenistic culture. The Seleucid king Antiochus Epiphanes ruled over the Jews. The dude proclaimed himself to be the incarnation of Zeus and condemned to death anybody refusing to worship him. Thats just harsh.

Well, the savvy mixed-breeds in the north decided they could accommodate. They would allow Antiochus to dedicate their temple up on Mount Gerizim to Zeus, and get this, somehow the north allowed Antiochus to erect an altar to Zeus in Jerusalem, in the south. Antiochus sacrificed a pig there, pretty much biggest heresy somebody could do. This became known as the abomination of desolation, which sounds impressive and important. Antiochussuccessor even leveled the temple on Mount Gerizim in 128 B.C.

But under the Romans, the temple was rebuilt and the group became a large and established community occupying a sizable chunk of land between Judea and Galilee. 

Do you know who these people were?

These were none other than the Samaritans. They even got the name clear back in 1 Kings 21.

Yup, thats right. These bastard displaced persons during the exile who dared to ask if they could help rebuild the temple and finally withdrew to Mount Gerizim, the site of the original Jewish temple to Yahweh, these are the Samaritans.

So there you had it. Jesus came along at a time when the mainstream Jews were in Judea to the south and Galilee in the north. Samaritans were sandwiched between the two groups. And they were hated. I mean hated. They were openly cursed in synagogues. They werent allowed to be witnesses in courts! Imagine, somebody could lodge a claim against you and you couldnt even call a witness! In fact, get this, Samaritans were not even allowed to convert to Judaism!!! Hows that for evangelism! The official Jewish position was that no Samaritan could ever achieve any sort of afterlife.

Jews typically would cross the Jordan when traveling between the lands of Judea and Galilee just to avoid Samaria. After all, it could defile your holiness! You wanna start a fight, call a Jew a Samaritan and just see what happens! They were a spiritual brand of lepers, avoided at all costs, vocally condemned, and preferably struck with rocks should you unfortunately cross paths with one at an intersection. Idolaters worthy of death.

They were openly counted as enemies. Archenemies if ever there were. Centuries of bad, bad blood.

Lets jump to Luke 10:25. And behold, a certain lawyer stood up and tested Him, saying, Teacher, what shall I do to inherit eternal life?

He said to him, What is written in the law? What is your reading of it?

So he answered and said, “‘You shall love the Lord your God with all your heart, with all your soul, with all your strength, and with all your mind,and your neighbor as yourself.’”

And He said to him, You have answered rightly; do this and you will live.”’

Okay, cool. Love God. Love neighbors. Im down with that. Hang on

But he, wanting to justify himself, said to Jesus, And who is my neighbor?”’

Then Jesus told the story of the Good Samaritan.

In the Good Samaritan, the Jew gets beat up and the holy priest and Levite pass him up, while the Samaritan helps him out. So Jesus says the Good Samaritan is the neighbor.

Yeah, I get that.

Wait. No. You mean

So what youre saying is


We just said, Love your neighbor as yourself.

Then we said, The Samaritan was the Jews neighbor in the story.

I studied math. If A = B, and B = C, then that means A = C.

So, that means Im supposed to love the Samaritan as myself?

Im supposed to love my ARCHENEMY as I love myself?!?!?!?

Surely you dont mean that. Dude, this is complicated. Theres a loophole, right? Its a parable, right? Theres wiggle room here, right? No?

Jesus traveled frequently through Samaria, refusing to traverse the Jordan River to avoid them. On one of those trips, he met the woman at the well. He asked her for water and she responded what the what? You know, right, Im a Samaritan? Youre in Samaria. You know that, right? And you are aware youre Jewish? Youre not even supposed to be stooping to speak to me. You want to drink water I give you?

And then Jesus does some craziness. He tells her she can have eternal life. Thats so a no-no for a Jew to think a Samaritan can get in on that! Not cool, Jesus!

It goes on. The woman tells him, Jesus, you know, right, that our fathers worshiped on this Mount Gerizim and you Jews say that people should worship in Jerusalem.

Are you kidding me??? This woman is rehashing the 1100-year-old debate?!?!??! Really?!??! She still knows 1100 years later what causing this divide! How messed up is that? Which mountain we can worship our omnipotent, omniscient and OMNIPRESENT God on?

But check it out, shes ahead of the Jews. She goes on to recognize, I know that Messiah is coming. When He comes, He will tell us all things.Hell sort this big mess out between us. No worries.

Jesus responds, Yup. You got it. Thats me. Guilty as charged.

Wait, youre the one to sort out the divide between us?

At this point, the disciples return from town and start straight trippinseeing Jesus chatting up a Samaritan woman. The woman walks into town and brings out a bunch of men, saying, Come see this dude! Could this guy be the Christ?

Then the Samaritans invited Jesus to stay and teach them. And Jesus stayed days with them. Amazing.

Even after the resurrection, Jesus still has his mind on the Samaritans. In Acts 1:8, the very verse before His ascension to Heaven, Jesuslast words were, You shall be witnesses to Me in Jerusalem, and in all Judea and Samaria, and to the end of the earth.Dude specifically mentions Samaria. This guy for sure practices what He preaches.

And you can go on to read Acts 8, 9, 15, etc, where the disciples go ahead and witness to the Samaritans! Philip, Peter and John came and laid hands on them and they received the Holy Spirit. Saul, Paul and Barnabas all pay visits to Samaria too.

You know, when you really boil down Jesuslife, you could make a reasonable argument that Jesus died for preaching the message Love Your Enemy. Very unpopular in Jesustime. Hmmyou know what? Its actually a very unpopular message today. You say its easy? We all buy into it? We say we do. What would our lives actually look like if we genuinely bought into this principal. Its powerful.

Martin Luther King, Jr. Gandhi. They pretty much both died for this message.

Its a scary message. It could change the world.

What would be different if you could just Love Your Enemy?

Imagine. Imagine specifically. What was the enemy you thought about in the first paragraph? Do you think God gives you an out so you dont really need to love that enemy as you love yourself? How would you behave differently, what would be different, if you loved that enemy as you love yourself?

Love Your Enemy. No exceptions. Imagine. Jesus felt it was worth dying for. Do you?

Saturday, September 12, 2015

Reality/Daily Mission Life

My nurse on maternity just came to my door.  Its 1:30 in the morning.  Sabbath morning.  Shes got lots of experience so I trust her.  She just came to tell me that one of our patients had delivered and was quite anemic (hemoglobin 4).  The baby died soon after delivery.  I gave her the keys to the operating room where we keep the blood bank so she could get another bag of blood to transfuse because the family still wouldnt give blood.  Sad.  One of my realities.  

The same patient had come in the night before very pale with anemia symptoms and a hemoglobin of 3 and no bleeding.  (For reference, any hemoglobin under 7 is typically considered life-threatening and gets transfused in America.)  We gave her two bags of blood, about half what she would have received in America.  The family wouldnt give.  Our blood bank is limited.  Mom said baby was moving less.  She had no due date (unsure of her last period, which is typical here) and I have no ultrasound for the moment.  I explained that the baby needed the moms blood to survive.  Still the family wouldnt give.  They fear they may not have the strength to work in their rice fields if they give their blood.  They play a dangerous game of chicken to see if we will give from our blood bank.  And its a game we always lose, drawing blood before every elective surgery, drawing blood from our volunteers, drawing blood from our staff…  

Once last year I went without an ultrasound machine for two days.  It was a very long two days because I depend on it so heavily.  Now Im at five days and counting with two busted machines.  It is a very terrible situation.  But what do you do?  

Three days ago I opened a young lady with a small Phannensteil incision for possible ectopic pregnancy.  Positive pregnancy test.  No ultrasound to confirm, but pain.  Not too terrible though.  Not anemic to speak of.  I just couldnt send her home without knowing.  And..theres nowhere near that has an ultrasound.  Everyone usually comes to us for referrals.  Lai, Keloeven further.  

Well, its a good thing we opened her, because she had a growing and life-threatening ectopic pregnancy in her right tube and she was actually ruptured with a small amount of blood in her pelvis (500cc).  

Oh, and just prior to her case I was told we didnt have any 10, 12, 14, 16, 18 size foleys  (tube to empty urine from bladder).  I found a bunch of straight catheters, so taped one of those in place during the case.  Again, one of my realities.  Its never a surprise anymore.  Just do the best for the patient with what you have.  

Today I opened a three monthpregnant lady with a huge flank/pelvic mass that I shouldnt have had to.  An ultrasound would have clearly told me that I didnt have to open her.  She had such pain and the patient said through translation that it had only been there since the pregnancy started.  Differential diagnosis: ectopic (hey, Ive had a seven-month ectopic pregnancy), torsion with large ovary, huge liver abscess, other abscess, cystic kidney, intestinal tumor (less likely) given no vomiting.  

No ultrasound.  What to do?  Positive pregnancy test.  I opened her.  

It turned out to be a large retroperitoneal mass (more than 15cm) extending down into pelvis with a normal (or at least intrauterine) pregnancy.  So my most likely diagnosis now is a large cystic kidney.  Of which an ultrasound would have easily shown.  At least it was a small incision.  And dont judge me for opening a normal pregnancy.  

I closed her up, not messing with a kidney while pregnant.  Well bring her back after she delivers to deal with her mass if still necessary at that point.  I re-questioned the family when explaining the diagnosis.  They said, oh ya, shes had that mass since she was married (a few years).  Awesomethats not what you said BEFORE the case!  

Invasive testing (a surgery!) when otherwise wouldnt be necessary.  Part of my reality right now.  
Back to the repair of our ultrasound machines…  We swapped ultrasounds with our sister hospital in Moundou, since their machine was better and we do more ultrasounds.  Then Moundous ultrasound broke while in our possession.  We sent it back to America for repair, which took three months.  We then took back our ultrasound machine from Moundou while their machine was getting fixed.  We finally got back the good ultrasound machine from America.  But then it just broke.  And then the old machine broke right away after that!!!  I dont know what we can do with the old machine, but we will send both machines back for repairs with the next volunteer returning to America in a couple weeks.  But it will likely not return until January.  So odds are good we will be without an ultrasound for the next 4-5 months!!!  Thats really going to hurt us financially and with the care we give also.  (Ultrasound is about 6-7% of our income and 1% of our cost.  Thats good business!!!)  Were hoping to find either a donated machine or the funds to buy a new one.  SonoSite sells Adventist Health International a sweet portable machine for $7500 plus $2500 for each probe.  We really should have a spare.  

This week I got to remember what its like to be a single parent to three kids temporarily.  Olens been in the Ivory Coast for a week and a half for global healthcare conference.  Mom usually watches the kids during the day.  Butshe got malaria this week.  Thankfully our new student missionaries have jumped in and helped out so much taking care of the kids when Im at work.  

Its just me and my dad taking care of things at the hospital.  Then Dad also got malaria!  So one of those days it was just me.  He was in bed for a day, though I did make him come in for five minutes to start a thoracentesis. I just didnt feel like puncturing a lung since it wasnt urgent.  

Dads getting better (hes 72-years-old) after three days of Malarone and Fansidar.  Moms (also 72) treatment is finished, but shes still sick.  So continue to pray for her recovery.  She may need quinine, but well see how she does overnight.  I told my dad that I am stuck with the old (them) and the young this week!  Hes not really old, my parents have a strange youth to them!  Malaria can knock any young whipper-snapper down on their butt.  

On a positive note, I somehow managed to treat a few cases out of my comfort zone while Olen and Mason were away and while Dad was under the weather.  A 20-year-old boy with diabetic acidosis (complete with Kussmaul respirations and not quite with it in the head).  Fluids, fluids, fluids.  Lots of checking to see if nurses were actually giving it.  Checking to see if family were paying for the fluids that I prescribed.  Night one at 11pm,  found nurse sleeping.  Didnt yell (go me!) and instructed to please get a second line like I said to the previous nurse, and pound the fluids (10 more bottles before morning!).  Next morning, no more Kussmauls.  Yay!  Some improvement. 

More fluids.  

Next day.  Patient actually able to communicate and actually with it.  Thank you Jesus.  I thought for sure I was going to kill him.  (Not me, but the sickness of diabetes).  

(Editors Note: Danae treated this extremely-non-obstetric patient who would have otherwise died as perfectly as any physician could in our circumstances, saving his life. I discharged him the day I got back.)

Next to him was a CHF exacerbation that I somehow managed not to harm, and actually to treat.  No ultrasound.  And weve never had a working x-ray here.  Another reality.  Just go on exam and symptoms.  Labswhat are those?  Im serious.  Hope hes not hypokalemic with the Lasix Im giving him.  If he were, we dont have any potassium supplementation.  Eat lots of green foods!!

(Another Editors Note: Danae treated this dying patient perfectly as well. I discharged him too the day I got back on atenolol and minimum-dose furosemide.)

Another 20-year-old kid on surgery that had a couple of leg abscesses walked for the first time in a year and a half with the help of a walker.  He is such a bright, happy, smiley kid.  He is so happy to be up on his feet.  

He thought he was paralyzed.  But his legs actually have sensation and can move some.  He cant bend at his hips at ALL.  I have no idea what he has!  Im an OB doctor.  But because of his sensation and slight movement, I said, why dont we see if the walker can help him!  Up till now his family has been carrying him around everywhere, or he just stays in place.  

Today I got to see his smile while he was using the walker for the second day.  He was so, so happy.  He said he hadnt been upright like this for a year and a half!  Pray for his continued practice with the walker.  Hopefully we can give him a little independence with practice!  

We were just in America for a month to celebrate my parents 50th wedding anniversary!  Congrats mom and dad!  

Its not really a shock to go back and forth anymore (between America and Tchad).  

However, this time I attended a board review course for my obstetrics/gynecology oral boards.  The shock now is in studying!  Ha ha, really it is in studying what labs and tests Im supposed to be ordering on my patients.  It makes me chuckle and laugh, and a little sad.  These patients dont even have 1/10th of the care they are supposed to be getting!  We dont have much to offer them.  (And now we dont even have an ultrasound!!!)  Its sad.  Its the reality here.  You get used to it.  You get used to not having supplies.  Accepting less than quality care because to enforce more would literally take up your last amount of energy and youd never make it long-term.  You get used to death.  Of cute little babies dying.  Of moms, struggling to have a family, dying in childbirth.  Of old people who have lived a happy life dying.  Fifty is old here, well past the average lifespan.  If you live to fifty, you have made it.  

Im so happy that Olen has returned from his galavanting!  Mason and Olen returned last night.  The conference was wonderful and now they will fix our hospital!  Ha, not likely, but hopefully gathered a few more tools to keep us from going insane earlier than expected.  (The cultural challenges as they pertain to work, school, church and home are still by far the greatest stressors. Perhaps that will change over the course of generations as the world becomes smaller and globalization advances each year.)

Please continue to keep us in your prayers.  Its easy to get back to America and forget that the daily struggles continue here.  And its impossible to describe fully the struggles we share with the Tchadians.  But, I assure you, they are very real every day here.  But so is God, and He keeps us sustained.