A day at the Hospital

Yesterday began with ward rounds before morning prayers.  I met several new patients that needed attention, including a 7 year old boy (about half Levi's size, due to the same pervasive malnutrition that seems to affect all children here) with a both-bone forearm fracture on the right.  His arm was held in a home-made, or more likely hospital-made, splint of a torn cardboard box with fabric wrapped around.  Luckily the x-ray showed relatively well-aligned fractures, so a long-arm cast would do the trick.

After repairing an inguinal hernia and removing an intramedullary nail (long metal rod used to stabilize a fracture) from a young man's femur, I was called to the pediatrics ward to see a 10 year old girl who had been brought by her mother the night before.  Her abdominal x-ray showed several areas of dilated bowel, but did not reveal a specific diagnosis.  She was listless, and looked quite anemic.  She had typical signs of malnutrition, weighing in at about 40 lbs (my 6 year old daughter Anna weighs 40-50 lbs).  Her abdomen was bloated and tender.  The mother informed us that this had been going on for 3 days.  

The pediatrician and I made a plan for giving IV fluids and checking a few laboratory values, and I returned to work in the OR and on the surgery ward.  When I returned to see the girl, her abdomen was now even more distended and tender.  The labs showed an elevated white blood cell count and though I couldn't come to an exact diagnosis, I was sure of one thing: this girl belonged in the operating room.  

After she was under general anesthesia, I made an incision down the middle of her abdomen, curving slightly to avoid the belly button.  I had no idea what we would find... a perforation from typhoid?  Intussusception (inside-out telescoping of the intestine)?  Any of a variety of more rare tropical diseases?

What I actually found was more surprising, and disconcerting than I had imagined.  At lease 2/3 of her small intestine was dead.  It had spiraled around its own blood supply and kinked, then clotted the blood vessels.  Working quickly we clamped the blood vessels, then began to untwist the knot.  As we did, both myself and the other surgeon jumped as we came face to face with a crawling Medusa-head of Ascaris (round intestinal worms about the size of earthworms) penetrating the wall of her dead intestine.  Gross, and otherwordly-appearing, yes, but even worse it meant adding insult to injury for this young girl.  We measured-off the remaining healthy small bowel - knowing that a length of about 100cm is necessary for digestion and absorption of nutrients from food (and therefore necessary for life).  Thankfully, just about 100cm remained.  

While sewing her wound closed, I kept thinking of the huge odds she is up against for surviving.  Her chronic malnutrition will now only be compounded by shortened intestinal length, and there is no option for alternative nutrition (i.e. IV nutrition) here.  We lack many of the diagnostic tests that could help identify problems early, so they can be "nipped in the bud."  It will definitely be an uphill battle.  

When surgery was over I explained everything the girl's mother with the Rwandan nurse anesthetist translating.  She stoically accepted the news and warnings of a difficult recovery, likely fraught with complications.  It will truly be a miracle if this little girl survives... but that is just what we're praying for.

More Lauren Quotables

Lauren:  What does that say?
Julie:  The Holy Bible.... and this says NIV
Lauren:  Oh!  Like poison ivy?!?


After Macy painted Lauren's finger & toe nails...
Lauren:  Do I have any more nails you can paint?
Macy:  Nope.  But that sure would be fun if you did!
Lauren:  Ok.   Well then can you paint my eyelashes?


Lauren entering our room at 5:30am.....
Joel:  Lauren, it's still night.  Go back to your bed!
Lauren:  But I got out of bed and looked out my kittens and saw it was light out.  But I need someone to move my pisquito net!

Monday, May 22, 2014

From Lauren:

Hi to Nana & Papa, and Grandma & Grandpa,

I love you. 

I wish I could come to your house.

I like it here in Africa.  I like it when we came here the first time because of the bunnies.  They are not here this time.  But instead we have kittens!  They are gray and white and black with stripes and spots.  There are 4 kittens named:  Lily (that’s ours), Sprite (that’s Sam’s), Sophia Button (that’s Macy’s), and Jesse (that’s Zach’s).  They are still too little to come to our house, so they stay with their mother at the Berg’s house for now.  The mama meows like this:  maaaa maaaa maaaa!  The babies meow like:  meooow, meow, meow!

I have played with the toys here & have a stuffed animal puppy to give to the African kids because they don’t have any toys.  Sometimes I give toy cars to the African kids in bed who got sick from the worm egg water.  Every day we visit Mary and we give her eggs & cheese… and flowers.  She smiles at us.

I like it when Mommy pushes me on the swing.  It’s really big!  I like the puskeeto net in my room.  My favorite food here is fruit snacks that we brought from home.  I like the bananas too.  And the purple Fanta.  We get to drink a Fanta on Saturdays. 

I like going on the airplane.  I liked it when we slept.  I like it when we went up in the air.  I liked watching movies.  I watched Monsters Inc. 

When we go to the market, we sometimes get samboosas – they are spicy.  I do not like them.  They are little meat pies shaped in triangles.

I love you!

From Lauren

May 22, 2014

Thursday, May 22, 2014

 

It’s another beautiful morning.  The birds are chirping loudly enough to wake everyone up at 5:30 each morning!  I have been so tired at night – Julie tells us that 9pm is “missionary midnight” and I’m feeling it!  By 9pm my eyelids are drooping & I can’t stay awake any longer!  The combination of fresh air all day, hot sunshine, managing the kids, the stress of being in a different culture, the tension of poverty mixing with wealth, not being able to communicate easily, etc… tiring!

 

There have been lots of fun things going on the past couple of weeks.  Julie, the kids & I made pizza last week on Friday night! Mmmmmm!  It was yummy!  Combined with a Fanta for everyone made a perfect night!  (Fanta is bottled pop & comes in flavors:  Coke, Orange, Citrus, Sprite & Fiesta – a purple berryish taste).

 

Josiane brought us sugarcane & that was a highlight for our kids!  Yesterday we were able to participate in serving the elderly in the community at their quarterly meeting.  There is song & dance, a special message from the pastor.  We serve them hot tea & bread & then they leave with a gift of rice, beans, salt & soap.  One of my most favorite things to participate in here.  

 

School has been going really well, overall, for the kids.  Their teachers gave me plenty of things to keep them busy.  We have been reading through the story of David each morning as we begin school – what a GREAT story to read to kids (and paraphrase as you go, of course!)  So there are so many exciting, surprising, disgusting, hilarious & entertaining details that I had forgotten all about!  Do you remember David marrying the princess & then she helped him escape out a window while she disguised his bed to look like he was still in it using a statue & goat hair?!  Do you remember that the whole reason David played the harp for Saul was to calm Saul down when God sent an evil spirit to torture him?!  Do you know about the intense man, Doeg?  (we call him Doug)…. He has quite a story!  (find him in 1 Samuel 21-22)…. And that David goes & pretty much steals Goliath’s giant sword from the church for protection?!  And one time when David gets frightened he puts on a good act of being insane – drooling all over his beard & digging marks into the gate?!  (the drooling part is Lauren’s favorite detail!)  Anyway, we have been enjoying this story! (maybe me more then them!)

 

After school we go down to the hospital & take hard boiled eggs to 3 patients.  Marie (Mary), Albert & Filicien.  I like taking the kids, even when they’d rather be playing outside climbing trees or playing with friends, because the patients LOVE seeing the white kids; and because I think it’s good for them to spend a little time with the bed-ridden people – to bring the patients a smile and to be thankful for their own able legs.  It’s good for me, as well.  The girls have brought Mary flowers a couple of times & she smiles so big!  She has a baby of her own that is sometimes with her in bed, and other times her sister is holding her baby (her sister is nursing both Mary’s baby as well as her own baby during this time).  Mary had an infection from an injection at a health center… the infection spread throughout her entire leg – requiring Dr. Tim to remove all the skin from her entire leg!  Mary was extremely thin & malnourished to begin with – Dr. Tim had a very grim outlook for her as he left for the states a couple weeks ago.  He told us to take her protein (via eggs & cheese) each day to help her body heal.  Last week, Joel replaced the skin on her leg with skin from other parts of her body (so she essentially is filleted and wrapped in bandages from the waist down).  But by God’s mercy, she is doing really well!  She has a smile for us every day and seems to be taking the skin grafts well.   Joel says Dr. Tim will be astounded when he returns tomorrow!! 

 

There is currently a team of 9 people from Texas visiting for 2 weeks & we are housing 4 of them with us in our home here.  We enjoy having them here so much!  I like the company of some fellow Americans (not to mention their awesome accents!) – and they are like Grandmas & Grandpas to us.  Dorothy encourages me in my attempts to learn cooking here & is so positive & energetic!  Her husband, Will, likes bird watching – so Joel has been spending bits of his mornings before leaving for work with Will watching the early birds outside.  The team has prepared a VBS for the kids at the hospital.  So each afternoon, we are teaming up with them to present songs, a drama story & crafts.  I love having an organized program down there & all the kids are enjoying some action in their otherwise boring days.  Anna has even gotten into it with us – she acted as a bird in one of the stories & then she was a seed the next day!  I’m so proud of her!

 

There are heavy challenges Joel faces every single day at the hospital.  Every day he encounters problems that are uncommon, advanced and beyond his scope of training.  The communication & cultural barriers are extremely difficult to work effectively within. And the lines for clinic are never-ending.  It really wears him out. 

 

 For our 12^th anniversary, Joel took me to “Kumbya Paradise”!  We walked the kids there (about 1 ½ hour walk) and Julie & her parents came to pick us up later with the truck.  It is a fun walk to take because there are kids all around us, following us, holding our hands & tagging along the whole way.  There is a lot of giggling from them as they watch the white people walk fast and try to speak Kinyarwanda greetings to them.  They try to practice their English to us.  They inspect our watches & are interested in our phones when we take pictures of them.  They especially get a kick out of Joel when he carries Lauren.  Here, the moms & girls do all the carrying of children…. As well as everything else.  So Joel is sacrificing his “macho-ness” when he helps me out by giving me a break from carrying Lauren on my back!  Thanks, Babe!  Very, very, VERY few people have a car here, so most everyone is walking … and they walk nice & slow – there’s no hurry to get anyplace. 

 

As we walked along, I asked Joel if 12 years ago, he would have imagined we’d be walking along a dirty road, with 3 children, surrounded by little Rwandan kids on our 12^th anniversary.  I don’t remember what I imagined out future would be.  Our journey has definitely been more difficult than I could have dreamed.  (I may or may not have admitted that there would be no such thing as surgeons if the medical students knew the full truth of what life would be like through residency & beyond… sometimes it’s better to just not know!)  Our journey has also been more blessed than I could have dreamed.  We have always had exactly what we need – and usually more than we need.  We are thankful for Levi’s enthusiasm, Anna’s pure, fragile heart & Lauren’s joy!  We are thankful for Joel’s practice back home – for their support for our family & their unique camaraderie. We are thankful for our school – and their gracious encouragement toward us taking the kids out of school early this year.  We are thankful, oh so thankful, for our amazing friends and family – both here & there. 

Our memory text for the summer is Psalm 139.  Oh Lord, You have searched me & know me.  You know when I sit & when I rise.  You hear my thoughts from far away.  You know when I go out & when I lie down.  You are familiar with all my ways….. Our Big God knew exactly where we’d be on our 12^th anniversary.  And He also knows where we’ll be on our 24^th anniversary.  He is forever faithful.  He is full of surprises!  He is our Good Shepherd & we are His little lambs.

Silliness :)

Here are some Lauren quotes to make you smile today:


Joel:  "Can you name some of the fruits of the Spirit?"
Levi:  "Self-control."
Anna:  "Love."
Lauren:  "Peanuts!"
Joel:  "Ok, we'll call that peace!"
Levi:  "Nobleness."
Anna:  "Joy."
Joel:  "Lauren, can you name another? ..... What do you need when you have to wait for a long time?"
Lauren:  "My little tiny white puppy from Nana & Papa!"


................................................


Paula lost in a good stare at breakfast.
Lauren:  "Mama!"
I shake out of the stare & smile at her.
She smiles & giggles: "Oh, Mama!  I thought you were dead!"


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One morning I was making my bed when Lauren came out of the bathroom crying & holding her mouth...bleeding.  She said, "Mommy!  I didn't know you had a blue thing like Daddy's!"  I had no idea what she was talking about so I went into the bathroom to find out.  I saw my blue razor sitting on the shelf. 
"Did you try to use my razor?!?"
Crying... "Yes!"
Me:  "Why?!?"
Lauren:  "Because I thought I had a beard!"

Week 1

Saturday, May 10, 2014

 

One week here – it’s going well.  Here is a brief recap of how we are spending our days…

 

Joel has been busy at the hospital – learning a lot of ortho (with Dr. Albertson – Joel is thankful to be working with a trained orthopedist!!), reading a lot before cases and seeing many, many patients.  He leaves the house about 7am each morning & usually returns sometime around 1 for a quick lunch, then back to the hospital until 6 or 7 or 8 or 9pm…  just depends on the speed of turnover in the operating room as well as the difficulty of the cases.  Some of his cases (nearly 30 of them) this week include:  hernias, hip prosthesis, laparotomies (opening belly), hysterectomy, and he placed a nail in a femoral fracture.

 

After breakfast the kids have about ½ hour of playtime outside while I clean up & prepare for the day.  Then we have “school” from 8:30 – 10ish.  (Bible story, verse, handwriting, math, spelling, reading, journal writing…)  Our friend, Brandon, joins us during school.  He is also finishing up 2^nd grade.  (though he is pretty much finished with school for the year, so he spends a lot of the time annoying Levi & trying to coax him to finish early) J

After school, we take hard boiled eggs & cheese to 3 patients in the ICU who are very poor & in desperate need of protein in order to heal.  The sun is hot, hot by then and the kids play until lunch.

We eat lunch, take a rest time for an hour (Lauren falls asleep & Anna & Levi read during this time…. Who am I kidding?  I usually fall asleep with Lauren for a quick nap!)  We go to the pediatric ward for a couple hours each afternoon.  It’s a time to join the kids playing or crafting or just sitting & being.  Brandon has come with us to peds this week.  He has quickly become part of our family!  The kids have a great time together, they also fight like siblings & the boys tease Anna and make Lauren cry…. It’s good to know things remain normal :) 

We wait until 6 to eat dinner & sometimes Joel is home, and sometimes not.  Brandon is with us for dinner often – and sometimes Levi goes to his house for dinner.  It’s pitch dark shortly after 6, so the kids have been enjoying flashlight games outside after dinner and coming home filthy dirty.  Baths are needed every night – except when the water pressure isn’t working… then dirty feet go into bed!  We all keep a flashlight close in the evenings as the power has been going out frequently.

 

Yesterday we added some new pets to our chameleon collection.  (the mission no longer has chickens & bunnies as they were too expensive & not producing the meat & eggs hoped for).  One of the other mission moms (Linda), found out that there were some kittens nearby.  So the mission now is home to 4 baby kittens.  Linda even “rented” the mother cat for a month so the babies could continue to nurse!  Those kittens have been LOVED by all the kids here (3 teens and 4 kids).  Just pray Lauren doesn’t accidentally kill one of them as she refuses to put it down once she is holding it – and she screams & screams & is brokenhearted every time we put the kittens back in the box with their mother for a break. 

 

We miss our friends & family.  We think of you all the time.  Anna is always asking what her class is doing back home – usually they are sleeping because it’s still the middle of the night when she’s doing school here.  We are also enjoying our friends here – God has been faithful in answering our specific prayers for friends for each of us.  Julie & I have good talks & she lets my girls paint her fingernails!  Linda, Anne, Stephanie & Francie give me perspective & encouragement with the kids – Josiane is my sweet friend.  Levi has Brandon as a constant playmate.  Anna has Maci, Brandon’s older sister (she’s 15 and Anna thinks she’s Cinderella).  Lauren has friends everywhere she goes.  And Joel has Dr. Carl, Dr. Tim & Reagan… and many co-workers, as friends. 

 

Love to you all!

May 3, 2014

Saturday, May 3, 2014

Kibogora, Rwanda

 

We made it!  We’re here.  Our luggage arrived intact, un-stolen and all there.  We left on Wednesday & we ended up checking 10 suitcases/totes each weighing 49 pounds according to our cheap-o home luggage scale.  We prayed hard that we would not be overweight at the airport check-in.  Each time we lifted a tote onto the airport scale, I prayed & held my breath.  Every single box weighed in at 50 pounds on the dot!  We also gate-checked 5 pull behind carry-ons (freeing us from worrying about leaving any of those in the plane overhead compartments – see last year for this not-so-funny reference J ).  That left us with 5 backpacks to keep with us at all times – full of snacks, games, books & a few stuffed animals.  (10+5+5=20 pieces of luggage…. And 3 smallish children).  So having made it here without losing anything – or anyone – is not a small miracle!!!  Thank you Jesus for every second of protection.

 

Our plane rides were split into 2 flights, each 8 hours long.  The kids were champs!  There might have been 10 minutes of crying from Lauren while she tried to go to sleep – but otherwise, we flew with ease.  Joel & I were even able to read books, sleep (a little) & watch movies!  That has never happened before – and I’m loving this new chapter of life!

 

Arriving at the Kigali airport was nostalgic.  We stepped off the plane to walk across the runway & into the airport.  Anna immediately said “Oh it’s warm!  And it smells like Africa!”  I reminded her we were, in fact, in Africa & she was surprised.  Traveling across the world, stopping for a few hours in Europe, watching a few more movies….then landing in a tropical climate that smells familiar….It’s hard to make sense of this when you’re 6.

 

We gathered all our luggage & wheeled it out on 3 carts to a special friend who was waiting, Ben, who owns & runs the Good News Guesthouse.  We remembered each other & hugged!  He helped us load up into two vehicles & drove us to his guesthouse.  A beautiful, peaceful, extremely comfortable place we were excited to rest in.  The kids found their second wind & ran around – up & down the slippery, tiled hallways & all around the gardens outside.  They needed to run off the 16 hours of sitting!  It was pitch dark – it’s dark at 6pm here.  The moon was a perfect smile (exactly like the Cheshire Cat, as noted by Anna).  We rounded the kiddos up, had a prayer time on the bed – thanking God for all his grace, protection & surprises.  We prayed for the next day’s trip – the plan was to ride in a bus to Kibogora.  We hadn’t done this before, and the busses we’ve seen have had crazy drivers! 

 

Anna & Levi slept wonderfully under their mosquito nets – Lauren got a little disoriented in the night & thirsty.  She ended up in bed with us & missed several hours of sleep – just laying there awake because her body felt like it was late afternoon, not the middle of the night!

 

The morning came & we had a yummy pancake breakfast outside in the gardens – complete with the tiny bananas that taste like strawberries (Lauren ate 6 before the day was done!)…. And coffee & fresh pineapple & crunchy, tangy passion fruit… is your mouth watering yet? J  We packed up, said good-bye to Ben, Scholastic (she’s our friend who takes good care of us there) and Anastas, the cook with a huge smile.   We packed into the bus & drove to Kibogora.  We left Kigali at about 9am.   We stopped at the bank for a quick money exchange and once about half way for lunch.  I think we arrived a little bit after 4pm. 

 

I wish I could capture with words the warm welcome we received as our bus pulled into the mission.  Muganga hugged us both so hard & welcomed us back – when Joel told him that Ryan sends his greetings, he laughed so loudly & hugged harder!  Buckweay welcomed us with hugs & immediately began carrying all those heavy bags.  Julie came down the steps & we hugged – so great to see her!  Then we saw Drs. Bill & Lydia coming down to greet us – we didn’t expect to see them this year!  What a special surprise!  Hugs, again!  We unloaded the bus & began making rounds with Julie to meet all the new people – what a full mission compound!  It is a hopping place this year!  I’m pretty sure every house is full.  As I was meeting a new friend, I heard a loud squeal & turned to see Josiane running out of her shoes across the grass to me!  We hugged hard!!  She was all smiles!  It was wonderful to see her.  We caught up a little & she had brought a bag with a gift in it for my kids!  Bananas!!!  She knows how much they love those little bananas J

 

We went to bed last night on quite an overwhelming high!  It felt so good.  So familiar.  And God’s surprises are far from over.  There is a new family here (they arrived one week ago and are staying for a year).  They have 3 kids.  Their youngest is an 8 year old boy.  Need I say more?  Levi has already told me that Brandon is his best friend (and quickly clarified that Cole is really more than a best friend… just so there’s no confusion!)  I’m pretty sure I didn’t see Levi from just after lunch today until past dinnertime – and Brandon joined us for dinner!  In fact, I’m alone in my living room now, Lauren sleeping in her bed and the others over at the Berg family’s house for a movie night.  Brandon is a gift from God.  And Levi is a gift to Brandon & his family.  His mom (Stephanie) shared with me that they were a little worried about Brandon last week as he seemed pretty lonely & lost.  Anna has even joined in the fun of catching frogs, chameleons & climbing trees with the boys. I might have applied more than 10 band-aids already! Julie let Anna brush her hair & paint her nails this afternoon – then asked her to come & help her cook dinner this evening.  Annie loves the girly attention.  And Lauren is just happy running around holding that silly chameleon.  I’m positive she would let it sleep in her bed if I let her!

 

Joel was up at the hospital all morning, rounding with Dr. Tim Berg, as Tim will be leaving tomorrow.  He is super excited to begin & learn from Dr. Carl Albertson who is an ortho surgeon here.  Carl & his wife, Francie, are retired & will return home to Alabama in June – after being here 6 months.  A beautiful, special couple we are so excited to get to know.

While Joel was up at the hospital, the rest of us went with Julie and a few others to Kumbya for a swim & picnic lunch.  A great start to this adventure!  The rest of today, I spent unpacking, inventorying hospital supplies we brought & delivering things people had asked us to bring.  I’m almost done J  There are a couple of families visiting from Kigali, so I spent some time chatting with the moms.  It was refreshing.

 

So if truth be told, I had some moments of sadness before leaving our house on Tuesday evening.  I was washing up the last of the dishes in the sink, looking out at the new green grass, practically watching the flowers grow after the thunderstorm we had just had – and I had a moment of regret.  I told Joel “I don’t want to go anymore.”  I was imagining how fun a summer we could have at our new home, with a new, big yard, playing in the sprinkler & playing with our friends.  Helping my dad build his cabin up north.  Going to fairs.  Picking strawberries. Camping at Lake Michigan. We walked out on the damp deck & smelled the sweet, humid air.  Leaving was a little painful.  We thanked God for our beautiful home.  Prayed it would be a blessing to others and prayed for His blessing on our summer in Africa. 

 

As we rounded the bend in the road that leads to Kibogora, and we could see the hospital off in the distance, with it’s blue roofs… my heart shouted inside “Why would I ever want to leave here?”