Friday, February 7, 2014



You know what it’s like to see that 13.1 mile marker while you’re running a marathon? Me neither. Marathon runners are crazy. Who wants to run for five hours just to be able to say you’re peeing blood the next day? But I can imagine what would be going through my head if I ever did see the 13.1 sign. Probably something totally upbeat and inspirational and self-motivating, say, ‘I think I’m going to vomit last night’s carb-loaded pasta dinner and this morning’s carb-ridden bagel on my fancy $120 marathon-running shoes now,’ or, ‘I wish I had put on bandaids to prevent the chafing,’ or, ‘I regret not going on that half-mile walk around the neighborhood to train for this,’ or, ‘So this is what my patient meant when he said he felt like there was an elephant sitting on his chest.’ Actually, I’d probably be thinking something like, ‘Man, I’m sure glad I decided to take a taxi for miles two to twelve. Where’s the next one?’

This summer, in fact, I did something quite similar. I let my brother-in-law sign me up for a ‘metric century’ bicycle ride. 62.2 miles, 100 kilometers. Roughly a week before the ride, we rode a half dozen miles or so around his neighborhood, then perhaps 15 miles the next day. I figured that was adequate training. After all, I rode all the time back in college. And it had only been 12 years since college graduation. You know what they say: ‘You never forget how to do it. It’s just like falling off of a bicycle.’ Something like that. Surely I hadn’t gotten that out of shape. Surely my muscle memory would kick in.

Surely I hadn’t really gained 40 pounds since then.

I think Shirley was actually the name of the person of ambiguous gender who passed me on his/her Wal-Mart mountain bike, grey hair flapping elegantly in the breeze. Meanwhile, I was really focused on not loosing my free-with-the-price-of-admission-I-paid-for-this-draconian-course-of-metric-pain-and-suffering lunch. Turns out the Appalachians have a wee bit more elevation change than the farm roads of Berrien County, Michigan. Of course, so does a pimple on a teenager.

Actually, back in college I wanted to take part in the Eco-Challenge, a 12-day, 24-hours-a-day race taking place in Patagonia, Argentina. And before college, I went on a six-day, 500-mile bicycle tour, as well as a six-day hiking trip. I even once dated a girl for four months. Like four months straight. In a row. No break. Same girl. Serious.

I have witnesses. Ok, it was like 3.5 months. I round up. And it was long-distance. I also traveled Europe for months with no shower, deodorant, change of underwear or expenditure on hotel rooms. All of this is just to demonstrate how I’m all about the long-term, endurance feats.

And so here we are, halfway through the longest commitment I’ve ever made. (Wait, no. I guess I actually committed a lifetime to Danae. But besides that. Oh, and baptism and having kids, I suppose. You know what I mean.) We agreed to serve six years in Tchad. December 12, 2010 was our arrival. We’re now past mile 13.1.

Without going into too much allegory of runner’s high, hitting the wall, cramping up, getting a second wind, etc, we can just say there have been ups and downs. The metaphor has probably been taken as far as it should go at this point.

Day by day, it seems as if nothing ever changes. We still have the same clashes of culture, differences of working styles, different priorities, difficulties motivating our staff, discipline challenges, health challenges, medical challenges, etc. When new volunteers arrive, full of energy and good intentions, but short on time, we are embarrassed to have them see what goes on at the hospital. It’s nothing that would pass for quality care in the states. There are so many short-comings in our system that it’s hard to adjust. And it’s hard to squash their good intentions by explaining the reasons why things are the way they are. Sometimes it’s for cultural reasons. Sometimes it’s for financial reasons. Sometimes it’s for infrastructural challenges. Sometimes it’s just because I’m tired and there’s only so much I can do. I won’t be that missionary who works himself into a burnout, I hope. It’s really easy to do.

But when we look back at what the hospital was a decade ago, it’s incredible. James Appel really changed the place from a run-down chicken coop of a health center on the verge of collapse into a respectable full-service referral hospital. We just tried to continue James’ momentum since our arrival three years ago.

And although God has really blessed Bere Adventist Hospital to prosper and triple our income, increase our staff, increase the number of patients we see, make us the leading surgical hospital in the country, triple our square footage… There’s still a long way to go. At least 13.1 miles.

Do marathon runners get tired thinking about the last half of a marathon? Sometimes it seems so far. There’s so much ground to cover.

We need to open a nursing school and graduate our first class of nurses and get them into the system. We need to get a midwifery school. We need to start our anesthesia program. We need to start our surgical training program. We need to get our new Tchadian doctors trained and on their feet. We need to finish this MASSIVE construction project. We need to do a better job at public health and evangelism. We need to get our system online with accounting, medication ordering, store room forecasting, lab orders/results, patient tracking, etc. We’d love to get a computer school and radio station running. We have so many invitations to open health centers and hospitals. We have so many relationships to build with the government. We have so many relationships to build with EVERYBODY. That’s why we’re here, right?

This is much more than 13.1 miles left to go. It can’t be done in three more years. It can’t be done in four more years. It will be at least eight or nine more years.

Marathons are daunting, intimidating. I don’t really enjoy running, although I’ve done it for exercise. It always struck me as such a loner sport, isolated. I’m much too sanguine.

They say during marathons you tend to find a person that is about at your pace. You stick with them, strike up a conversation between the gasps for the air and occasional flurry of emesis, encourage each other and eventually build that relationship to finish together.

Anybody up for a jog? I’m always looking for a jogging parter.

Does anybody get to the finish line of a marathon and say, ‘You know, that was fun.

Let’s turn around and run the course again backwards’?


This goes out to all of those people who are mad at their OB doctors. Mad because they got a c-section. Angry because they did not get the chance to be a “real woman” or something. Oh no, now I’m stirring up turmoil, and I’m going to get nasty e-mails and comments.

I know. I didn’t want a c-section either. I understand. I really do.

I just want you to hear my side of things. My side of things from Africa. Where there are mostly NO doctors to do c-sections.

Where women die from c-sections.

Where women die from labor WITHOUT c-sections.

Where it’s no surprise at all when a child dies during childbirth.

It’s sad.

And I’m sad.

And tonight I feel guilty. I feel guilty for doing a c-section.

Why do I feel guilty?

Because the baby died. Would I have done things differently if I would have known the baby was going to die?

Yes. I would have let her labor longer even though she wasn’t progressing. I would have let her labor longer so that the child could die in labor, and then I could extract the fetus.

I would not put her through the risk of rupturing her uterus during her next childbirth when she refuses to come to the hospital and labors too long at home.

I would not have put a cap on the number of children she could have.

But, I didn’t know whether the baby was going to live or die. I don’t have fetal monitoring here. All I have is a fetal doppler and ultrasound. I can tell if the heart is beating, but I can’t tell how healthy the child is.

This child WAS living. It had a heart beat for about 10 minutes after being born. Ndilbe and Simeon breathed for it, but to no avail. CPR didn’t work. He died. Just like that.

Would he have lived in America? The mom would have come in earlier maybe, and not come in 24 hours after breaking her water with labor. The mom would have been placed on a fetal monitor. It would not have been reassuring and she would have still ended up with a c-section.

But her kid would probably be living. He would be in a neonatal intensive care unit.

Possibly on a breathing machine. Depending upon how early or late she came in labor.

If her kid was living and healthy, would she be one of those moms mad at their OB doctors? I hope not.

All I want today is to be able to give this almost mom a healthy, living child. That’s all she wants too.

But I can’t.

All I could do was give the husband a wife who was still living. And here, they are still so thankful for that.

Tonight I tried to save a child who had some signs of distress and the mom wasn’t progressing. I did a c-section instead of an oxytocin drip. But every time I try to save a child with a c-section, I am reminded that it’s a bad idea here. The kid dies anyways.

And I always feel guilty.

Guilty for trying too hard. Guilty for caring.