Sunday, February 19, 2017

Finishing well in Togo.



The Hospital of Hope is the Mayo Clinic of the northern part of Togo, serving people throughout this region, including Togo, Burkino Faso, Ghana, Niger, Nigera and beyond.  As many as 28 languages are spoken daily at the hospital, requiring an entire department of translators.  The translators seem at times to be in bigger demand than the doctors, nurse practitioners and nurses.

The challenges of communicating can sometimes be more demanding than the art of medicine.  As my nurse and physician colleages can see on this vital sign temperature graph, the diagnosis could be a bacterial infection, or a viral infection, or perhaps a parasitic infection.  Well, in this case it is all three.  Post op infection plus malaria plus chicken pox.  And yet, because of language barriers, I am completely dependent on the nursing staff to communicate with this patient, because the only gestures she understands from me is the smile on my face, perhaps a nod, and a gentle touch.  

Although lately it seems as if the diagnosis is always either just malaria or malaria plus pregnancy or malaria plus pneumonia.  Even though we are in the dry season and malaria is "less" common now than during the rainy season, it seems that we are treating malaria on nearly every patient.  I actually thought I was getting pretty good at diagnosing malaria until one of my surgeon colleagues here laughed out loud and remarked, "that's because everyone has malaria." My ego was quickly deflated with the realization that he was absolutely correct.

As for wait times to be seen at the hospital, could you imagine going to a hospital that is a long way from home and then camping out in front of the hospital to hold your place in line?  If you leave your place in line then you have to go to the back of the line.  And then, depending on how serious your problem is, if it is not so serious, having to wait for several days camped out in front of the hospital?

This reality reminded me of when a Chick-fil-a restaurant recently was opening near our home at 59th Avenue and Thunderbird Road in Glendale, Arizona, and they announced that the first 100 people through the door on opening day would receive free Chick-fil-a for a year.  People started camping out for two or three days before the restaurant opened.  But that is a restaurant and not a hospital.  But as word of the excellence of this hospital spreads across the region, people are coming to the hospital in buses and vans and bring dropped off in front of the hospital in hopes that they can be seen by a doctor here.  The needs are overwhelming.

We just continue to see patients; caring for the patient that is in front of us at the moment; loving them and serving them.  We strive to bring not only physical, but also emotional and spiritual healing as well.  We treat the whole patient and not just their physical needs.  Often these appointments end in tears, not only for the patient and their family or friends, but often also for our own team members.  No tears were held back recently when a young child had lost it's mother due to an acute viral syndrome, leaving this child without a source of breast milk, and the challenges that such a problem creates in a society such as this.  This was a difficult situation to fathom, and struck a blow to the hearts of the health care team members caring for this young mother and her baby.

Behind me in this last picture is the "waiting area" by the front gate of the hospital where people camp out for days waiting for their chance to be seen.

This is the front entrance of the hospital.  The patient waiting area is behind me to the right.  This is a dry and dusty place during the dry season, and then green and muddy during the rainy season.  It has been my pleasure to serve here and to try to bring health and healing to these people and to serve my colleagues who work here full time.

In just a few short weeks I will be returning home to my family. It has been difficult being away from them for the past month, and I still have a few more weeks to go.  However, I have cherished the opportunity to serve here for this season, and pray that I have served here well.

Thursday, February 9, 2017

He heals the brokenhearted and binds up their wounds.

In the middle of the night during the first week that I had arrived in Togo, the phone rang next to my head.  Delirous I answered the phone, and the voice on the other end of the phone beckoned me to come to the operating room.  A woman had arrived from another hospital, having suffered horrible complications from childbirth.  Our team worked on her until the early hours of the morning, pouring blood into her veins, and suturing her injuries.  Her baby had died even before arriving at our hospital, and the lifeless body of her little baby was brought out to her family.

The next morning, as sunlight lit up my room and hot coffee waited in the dining area, I wondered if she had even survived the night.  Even if she did survive, surely she would have a horrible infection or have other serious and potentially life-threatening complications.  But when I arrived at the hospital she was sitting up in bed asking for something to eat.  Not even 6 hours had passed since she had come out of surgery!  

Over the course of the next week, she didn't even get a fever.  Her kidneys were working just fine, and her laboratory tests and vital signs were completely normal.  

Eight days later she was discharged from the hospital.  Going through multiple translators, I explained her discharge instructions, her home care, and her follow up appointment to return in a week.  

When we were nearly finished, she was told through the translators that God had saved her life.  This message was translated from English to French and then to her language.  She smiled, looked at me, and said back through the translators that yes, God had saved her life, but that she was also grateful to me and the other doctors who had helped to save her life.  Her eyes were bright, and her near toothless smile was precious.  She then said to me, in English, "Thank you!"

 This would not be the first time that the degree of gratitude expressed by a patient caused my eyes to flood with tears, nor will it be the last.  What was particularly touching, however, was that she had made such an incredible recovery, and yet her body had sustained such trauma.  The explanation could not be in the skill of her physicians and nurses, but clearly she had been healed of her wounds.  Her obvious gratitude was worth far more than any Hallmark card could ever convey. 

One of the last items to be packed prior to my departure from Arizona to Togo was a set of navy blue scrubs gifted to me by a patient.  She had embroidered Psalms 147:3 below my name on the scrubs.  It was even more fitting that on the day that this patient was discharged from the hospital that the embroidered scrubs reminded me of this psalm. 

Psalm 147:3

"He heals the brokenhearted and binds up their wounds."  

This woman's baby had not survived the birth, and for this she was brokenhearted.  Her wounds had been divinely healed.  Indeed He had healed the brokenhearted and bound and healed her wounds.  

Wednesday, February 1, 2017

Making a Difference...One Life at at Time...

A midwife working so hard that she has barely left the hospital for weeks. A woman who comes into the hospital clinic a week past her due date and has hardly any water left around her baby.  A young physician, new to the hospital, is orienting to the hospital, clinics and life here in Togo.  A woman, who after over ten pregnancies comes into the clinic with her insides literally falling out.  The phone rings and a there are twins being delivered; can you please come now?

As the first week here at the Hospital of Hope in Mango, Togo, has unfolded, these opportunities to serve have all been presented to me.  To the overworked midwife I asked if I could assume her responsibilities for a week next week so that she could take some time away with family who is visiting.  There was immediately joy visible in her eyes, followed by tears of gratitude.

For the woman who presented to the clinic past her due date, we admitted her to the hospital and delivered a healthy baby boy for her.

For the new physician, offering time to teach, encourage and mentor were met with gratitude and appreciation.

For the woman who had carried many pregnancies and now her body was showing the wear and tear from these pregnancies, a surgery is planned for next week to repair the long term damage.  When she heard this was the plan, there was joy on her face.

And when the phone rings, and help is needed STAT, just being available to go and help is a blessing.

When Jesus was asked what was the most important law in Judaic Law, Jesus replied, “Love the Lord your God with all your heart and with all your soul and with all your mind.”  He went on to say, “This is the first and greatest commandment.  And the second is like it: Love your neighbor as yourself.”

Commandments or laws are often perceived as constraints imposed on us which impinge on our freedom; however, the command to love your neighbor as yourself brings forth joy, not only for your neighbor, but also for yourself.  Being in a situation where I can bring reprieve for someone who is weary; healing to someone who is ailing; mentoring to one who needs to be mentored; or delivering a healthy baby to a mother who is not progressing normally on her own; each of the opportunities to serve and to love brings joy for both the giver and the recipient.

Each of these have brought joy not only to the one who is the object of the action of love; but to me, the one who has been  commanded to love.  The command to love is not a rule that limits freedom or imposes hardship; but rather, the commandment to love thy neighbor has become a source of great joy.

As the weeks unfold here in Togo, I look forward to sharing not only the stories of the experiences here, but more so about the rich relationships that are being formed.

Yesterday on a white board in the common dining area here someone wrote a quote by Francis Chan which says, “Our greatest fear should not be of failure, but of succeeding at things in life that don’t really matter.”  My hope is to share the richness of the experience of doing things here that really do matter.

Tuesday, August 2, 2016

Medical Missions for the Rest of the Family

Going on a medical mission trip with the entire family adds multiple options in terms of ways to serve.  Our son Andrew and his friend Ty Nowatzki made this video that tells how the rest of the family served at Mbingo Baptist Hospital in Cameroon where we served during the month of July 2016.  Click on this link to watch the video:  Medical Missions for the Rest of the Family

Anna giving Amber anesthesia.  (Just playing doctor.)


Thursday, July 21, 2016

Bed F12

It's 3 AM and even though my body was warm and comfortable under blankets and my head resting on a nice pillow, sleep was elusive.  The sound of rain beating down on the metal roof sounds as if we were living at the base of a waterfall.  A different pitch of sound is made from the water pouring out of the downspouts.  There is no other audible sound, as the sound of the rain and the water overpowers any other sounds in the house at this hour.

At the end of a long day in the operating room, I went to check on my patient in bed F12 on the female ward. Her bed is at the end of a long ward of 24 beds, 12 on the left and 12 on the right.  Bed F12 is at the end on the left.  Each bed has a dark green modesty curtain that can be pulled, and mosquito netting dangling down in a loose knot from above.

As I entered the ward through the modest nurses station, I peered at the chart rack to read the notes that had been made that day and to check the labs.  She was on five different chemotherapy drugs to treat her cancer, called choriocarcinoma.  My hand ran down the slots to F12.  The slot was empty, which was not at all unusual.  All of the other charts seemed to be in the wooden rack, and the counters of the nurses station were uncharacteristically barren of charts.

There was a solitary nurse in the nurses station and I queried here as to the location of the missing chart. Her expression told me before her words did.  "F12 expired this morning doctor."  Our eyes locked for a moment, and then I turned and peered down the tops of my bifocal lenses to the end of the ward.  F12 was empty.  The bed was made.  No care givers were sitting at the bedside of bed F12. There were no belongings on the shelf or piled on the chairs.  Just two days ago I had stood at her bedside talking with her about the side effects she was having from the chemotherapy.  I had held her hand and prayed with her.  I had slipped her two tootsie roll lollipops to put something sweet in her mouth to replace the nasty taste of the bile that resulted from the side effects of the chemotherapy.

Then I took a deep breath, let out a long deep sigh and turned and walked out of the female ward down the corridor to the hospital circle driveway, then down the hill past the hospital chapel, down the slippery muddy road past the helipad to guest house #11 where we have been staying for the past month.  As I walked the tears that had been leaking out of the corners of my eyes dried on my face.

F12 had died.  Another patient with a cervical biopsy which had shown a rare form of cancer called a rhabodomyosarcoma had been transferred to palliative care; a place where pain management and spiritual and emotional care are provided, but where cure is no longer the goal of therapy.  A third patient with even a more rare form of cancer called a sarcoma botryoides had also been placed in palliative care that day; her tumor replacing her uterus and filling her female parts with grape-like clusters of cancer; fixing itself firmly to the bones of her pelvis.

The aroma of something delicious filled the air of guest house #11.  Debbie, the wife of the pathologist here, had "dashed" (gifted) us with a freshly butchered chicken.  I found out later that Debbie's friend had done the butchering and plucking and my wife, Teresa, cut it up.  Teresa had found a delicious recipe calling for Italian dressing and brown sugar and she had baked a delicious dinner of chicken and pasta.  We sat around the table, sharing the events of the day. I heard about the boys hiking a mountain today at sunrise, and the different ways that our family had served at the hospital today.  My spirits were lifted by game a Hearts and successfully "shooting the moon" once during the game before Teresa could celebrate her victory by "shooting the moon" herself.

The last three weeks have been filled with new relationships and touching lives of others, teaching them what I know, and sharing with them the knowledge that I have been given.  Below are pictures and captions of some of these people.

Dr. Lema is from Tanzania and is currently in the PAACS surgical training program and doing a rotation at Mbingo Baptist Hospital in Cameroon for three months.  His wife and daughter are back in Tanzania.  He always has a smile and such a great positive attitude.  It has been a pleasure to work with him, teach him and to have enjoyed several meals with him.

Dr. Laura is a physician from Cameroon who I work with daily in the women's clinic at Mbingo Baptist Hospital.  She tirelessly addresses the needs of women here in the clinic.  She speaks French, English, and the local dialects and patiently has translated often for me.  She is a sponge for knowledge and it has been a joy to invest in her life while serving here.

Ty Nowazki, aka the "Gringo at Mbingo", is like another son to us, and has traveled to be with us here at Mbingo.  He and our son Andrew don't sit still for long, and have been extremely adept at finding different ways to serve here, doing everything from entering years of pathology data into databases to helping a medical student from Stanford doing research on amputees with his research.  Today Ty and Andrew are going to give of themselves by donating blood at the hospital. It has been fun to watch the impact of this experience on Ty. 

Dr. Amir is a PAACS resident from Egypt spending three months here in Cameroon at Mbingo Baptist Hospital.  I have had the pleasure of working with him and teaching him in the operating room and in the surgical classroom.

Dr. Carol has been one of my favorite people to work with here. She and her family live in Cameroon, and once a month she commutes 3.5 hours to come and work at the hospital for a week each month.  She effortlessly slips between English, Pidgin and French and engages her patients and colleagues beautifully.  Her son Eddie guided us up the mountain to the top of a nearby waterfall.  Without Eddie I don't think I would have ever have dared to make the trip through the tall brush, knowing that some of the most poisonous snakes in the world live here.  I just tried hard not to think about it as we forged our way up the mountain!  The view of the mountains, the valleys, the waterfalls and the hospital and clinics below made the hike (and overcoming my fear of venomous snakes) worth it.



Saturday, July 16, 2016

What does TIA mean?

Robert Emmons, perhaps the world’s leading scientific expert on gratitude, argues that gratitude has two key components, which he describes in a Greater Good essay, “Why Gratitude Is Good.”
“First,” he writes, “it’s an affirmation of goodness. We affirm that there are good things in the world, gifts and benefits we’ve received.”
In the second part of gratitude, he explains, “we recognize that the sources of this goodness are outside of ourselves. … We acknowledge that other people—or even higher powers, if you’re of a spiritual mindset—gave us many gifts, big and small, to help us achieve the goodness in our lives.”
TIA is the abbreviation for transient ischemic attack, which some people refer to as a mini-stroke. However, here in Cameroon TIA means, "This Is Africa." I think of "TIA" when I think of the obstacles, or truly mountains that need to be moved, as we look at how do we move forward here with such enormous issues as prevention of cervical cancer, or early diagnosis and treatment of breast cancer here in Africa.  I think of TIA when I use a pair of surgical scissors that don't cut; indeed not performing the very function for which the scissors were designed.  
We had been made aware that many of the surgical instruments at the hospital here at Mbingo were decades old and in various states of disrepair and dysfunction.  Over the past year many of the readers of this blog had donated tens of thousands of dollars in order for us to place a special order for new surgical instruments for Mbingo Baptist Hospital in Cameroon, West Africa. 
When we arrived with extra suitcases filled to fifty pounds, and several to seventy pounds, crammed full of brand new, never used, high quality, stainless steel surgical instruments, there was a ripple effect that happened here at the hospital.  There was a buzz among the surgeons.  The operating room staff were talking.  The surgical residents were elated.  Even the CEO of the hospital was very aware and extremely grateful for this gift.  
The two components of gratitude are expressing gratefulness for the gifts received, and recognizing that we could not have done this great thing without you.  On behalf of the hundreds of people who work at Mbingo Baptist Hospital, and the thousands of patients who will benefit from your gift, thank you!  
Operating Theater Director Jackie Griffin, Nurse Beverly, Head Surgeon Dr. Jim Brown and Dr. Allan Sawyer survey the gifts of surgical instruments, gowns, drapes, sutures, surgical loupes, surgical headlights and surgical dressings brought to Mbingo Baptist Hospital in Cameroon, West Africa.

Central Sterile Director Ben and Operating Theater Director Jacqueline Griffin demonstrate the folding and unfolding of surgical drapes for a video made by Andrew Sawyer and Ty Nowatzki to be used for staff and surgeon instruction.

Surgical instruments on a Mayo stand preparing for surgery.  Note the kitchen towels being used for surgical towels. 

Removing a large ovarian tumor and cancer staging.
Left to Right: Dr. Carol Loescher, scrub tech, Dr. Sama Akanyum, Dr. Sawyer, anesthetist Mr. Gilbert

Surgical Instruments in Surgery.

More Surgical Instruments in Surgery.

Our photographers, Andrew Sawyer and Ty Nowatzki.

Left Ovary waiting to be opened by Dr. Loescher. 



Friday, July 15, 2016

Red and Yellow, Black and White

Several months ago, a friend of mine and vascular surgeon, Dr. Paul Osteen, shared a story about a patient of his that he had cared for in Zambia.  Her name was Precious.  It was a heart warming story, one that leaves you with tears ready to spill from the corners of your eyes.  At the end of his story he shared the lyrics to the children's song which is familiar to many:

"Jesus loves the little children,
all the children of the world,
red and yellow, black and white,
they are PRECIOUS in his sight,
Jesus loves the little children of the world."

Dr. Osteen's story and the lyrics of this children's song have been going through my mind as we serve here in Africa.  Being here in West Africa and reading the disturbing news events of the past week in America leaves my heart troubled and saddened.  Earlier this week I sat in the hospital chapel at 6:45 AM joined by hundreds of the hospital staff as they sang and listened to the morning message.  The hospital chapel is filled to a standing room only capacity with hundreds of people each morning, Monday through Saturday, six days a week.  In the company of my co-laborers, each of us here united in the purpose of bringing healing to the sick in the name of Jesus, I realized that I was one of only about a half-dozen white skinned people in the room.  The best part of it all was that the color of my skin didn't matter.  

Mbingo Baptist Hospital Chapel
My family met with Pastor Mbuh Julius (last names are written first here) to discuss placement of vinyl transfer Bible verses that we had brought with us.  Seventy percent of the patients here are Franco-phones rather than Anglo-phones (French speaking rather than English speaking), and in preparation for our time here we had asked Amanda George (www.etsy.com/shop/babygeorges) to make large vinyl transfers of two scripture verses; two in English and two in French.  My family went to work with Pastor Julius to find places in the hospital and chapel to place these scripture verses.

In the maternity waiting area, my family transferred Psalms 139:14.   


Above the check-in window in the surgery clinic they posted Deuteronomy 31:8.

"The Lord himself goes before you
and will be with you;
he will never leave you nor forsake you.
Do not be afraid; do not be discouraged."




We were extremely honored when Pastor Julius asked us to place the English version of Deuteronomy 31:8 in the front of the chapel where the entire hospital staff meets six mornings per week.  


Red or yellow, black or white; French speaking or English speaking, no matter how short or tall, small or large, we are all precious in God's sight.  

Indeed, when Jesus was asked what is the most important commandment, his response to the religious leaders of the time was, 

"Love the Lord your God
with all your heart and with all your soul and with all your mind,"
This is the first and greatest commandment.  
And the second is like it:
"Love your neighbor as yourself."  
Matthew 22:37-39

The problems of the United States will not be solved by decree, law, Congress, the Supreme Court, or whoever is elected as the next president.  The problems of the United States need to be solved with a change of heart of the people of our country.  These are heart issues, not political issues.  We would do well to consider what advice Jesus had to say to to the lawyers of the day in biblical times, "Love the Lord your God with all your heart and with all your soul and with all your mind" and "love your neighbor as yourself."