<![CDATA[BruceSteffes.net - The Steffescope Newsletter]]>Tue, 13 Feb 2018 02:34:24 -0800Weebly<![CDATA[August News]]>Sun, 27 Aug 2017 07:00:00 GMThttp://brucesteffes.net/the-steffescope-newsletter/august-newsMinistry:  I participated in the Samaritan’s Purse International Disaster Assistance Response Team (DART) training course in North Wilkesboro, NC, during August 23 – 25.   Samaritan’s Purse has a disaster relief team for N. American (NAM – North American Ministries) and they have swung into action this week in response to Hurricane Harvey.  Their international disaster assistance team is the one I am joining. 

The DART program is committed to meeting the critical needs of victims of war, poverty, famine, disease, and natural disaster. They (and now “we”) stand ready to respond at a moment’s notice whenever and wherever disaster strikes. The DART specializes in providing water, food, shelter, and medical care while sharing the Good News of Jesus Christ. The DART is composed of a roster of on-call professionals trained to respond within a complex international environment to save lives and reduce suffering in the name of Jesus Christ. DART members work in the midst of devastation and tragedy. They need flexible people who can overcome daunting logistical challenges to bring help to those who need it most. Every DART needs resourceful and competent professionals experienced in providing international assistance, program management, administration, logistics, finances, water & sanitation, communications, and medical care.

They have responded to 112 disasters since 2008 – sometimes it is just a small team and twice now it has been an entire emergency hospital such as the one that is presently in Mosul, Iraq.  With the defeat of Isis in that area, they are winding that effort down and will close it by the end of September. They presently have a complete hospital in the warehouse ready to go and another under assembly.

You can find out more about the DART ministry at https://www.samaritanspurse.org/our-ministry/dart/.  As a member of the DART team, you are a temporary employee of SP and they take care of the expenses, logistics and pay a small salary – and in exchange, you work hard hours under grueling conditions to make a difference in this world in Christ’s name.  Please pray for this effort – and consider applying to take the training.
Family:  Storms and plumbing leaks last summer had ruined three different areas of our kitchen ceiling – but for months, we were having trouble finding anyone to fix it and frankly, it was the smallest of all of the crises that we were entertaining. It was just a small repair job and finally a friend in the construction business referred us to a friend of his who was did drywall – and who was a preacher on the side.  When the drywall man/preacher returned my call, I described the job and apologized for its small nature and the annoyance factor.  He was quiet for a minute and I was pretty certain his hesitation meant I would have to keep looking for someone else to do it – then he stunned me by saying, “I guess I will do it, since I owe you my life!”  What in the world?!   I was clueless as what he was talking about.  He continued on to tell of seeing me with his problems 24 years ago with a pleural mass (on the outside of the lung) which caused him to cough up blood, lose weight and kept him from working. His pulmonologist and I thought it was likely a mesothelioma, a highly malignant tumor with a poor prognosis.  As he tells it, I performed the surgery and the specimen was sent off to experts because of the uncertainty in diagnosis; the local pathologist wasn’t sure what he was looking at.  After a month, the report returned as an odd but non-cancerous growth.  However, by that time, he had already regained his vim and vigor, had gained ten pounds and was walking a mile a day.  He laughed on the phone when he relayed to me that I told him back then that he had better start walking two miles a day with that weight gain!  Sounds like something I might say.  I must confess that in retrospect, I likely saw God provide a true miracle for this man who was an evangelist at the time.

I sure wish I still had access to his medical records and the pathology reports because I still don’t remember the case.  But it is always good to be in contact with someone who is glad to hear from you!  He told me that while he doesn’t normally do this sort of job, he had called our mutual contractor friend and asked if I had been a surgeon in Fayetteville. When our friend confirmed that, he called me back. Micky is pleased with the repaired ceiling and so am I (bringing to mind the old saying that “happy wife, happy life”).

Sean spent four days with Bruce’s sister, Sally, and her husband, Tim, in Wake Forest, north of Raleigh.  He had a great time – a zip line park, museums, small airplane flights around Raleigh, and other things.  They made a great effort to spoil him. His other highlight of the month was obtaining his Level II driver’s license.  On the very first day that he was eligible, he took his driving test and now is able to drive without supervision during the day under certain conditions.  On his first day of eleventh grade, he drove to school and felt himself quite the special young man.  Fun to see one’s children go through the rites of passage.    This year, he is taking two courses at the local Community College that count for both high-school and college credit – his first class there was Monday, August 27.

Micky helped Ryan and his wife, Chrissy, at a big wedding show at the State Fairgrounds in Raleigh on August 12.  Ryan is a photographer and Chrissy is an event planner. They had never done such a show and were very busy the first day.  Micky’s help was much appreciated and the leads they received were promising.

Outpatient surgery on my eyelids has slowed me down considerably this month and another outpatient procedure is scheduled for the end of the month which may result in more serious surgery, depending on what is found.  This has interfered with my schedule and travel plans. There is an upside, however. Staying around the house has allowed me to work on some woodworking projects and check off some of the “honey-do” items.  I have assembled a grandfather’s clock made of cherry (still have to finish it), made a three-in-one rocking stool for our grandson, refinished the kitchen table, almost finished some wooden suitcase racks, re-upholstered a hope chest and so on. I have enjoyed getting some of those things done – and so has Micky!

Prayer Requested: Please pray for us for simultaneous meetings September 6 – 8.  I will attend and facilitate some small groups at the CMDA/Medsend 2017 Healthcare Missions Leadership Summit at the SIM (Serving in Missions) mission agency headquarters in Charlotte, NC. During the same time frame, Micky is driving to Bristol, Tennessee to attend some orientation meetings for the new PAACS financial controller.  

Yours, serving the King and His kingdom!
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<![CDATA[Return from Zimbabwe and Michigan]]>Sun, 30 Jul 2017 09:49:20 GMThttp://brucesteffes.net/the-steffescope-newsletter/return-from-zimbabwe-and-michiganAnother set of very long rides are over.  Last Sunday, I flew to Bulawayo, Zimbabwe for PAACS-related meeting with the College of Surgery of East, Central and Southern Africa (COSECSA) and Micky and Sean drove almost 14 hours to Lapeer, Michigan.  I returned from Africa yesterday and Micky and Sean arrive tonight from their 14 hour drive.  The travel was unremarkable if you discount the misery of rides of that duration.

I am a member of the Examination and Credentialing Committee of COSECSA.  That committee hosted an OSCE writing seminar for two days.  OSCE stands for Observed Standardized Clinical Examination.  Although I agree that the attempt to standardize the testing experience and to remove bias are good and needed goals, I was still very skeptical about their ability to test the more advanced professional.  Dr. Peter Gillen, a professor of surgery from the Royal College of Surgery Ireland, did a yeoman’s job of helping to sway the opinion of a room full of skeptics like me.  Writing these testing stations is not easy.  Each one took two or three surgeons two or three hours to write.  Typically, the exam might have 15 – 18 such stations.   Since I may be taking the leadership of the exam committee next year (that is still awaiting confirmation), I may go to Ireland sometime before February to learn more about it from Professor Gillen.  Our PAACS residents have never seen this testing technique in action in some of the areas and I would like to figure out how to help them prepare.

Most medical missionaries owe a debt of gratitude to Dr. Maurice King, a British Christian whose name is not well-known outside of certain circles.  A few decades ago, despite his training as a pathologist, he created three texts designed to help interns do surgery and give anesthesia when there was no other viable alternative.  Although some have scoffed at their simplicity, virtually everyone I know has consulted these texts for those cases beyond their ken.  I certainly have.   In June 2016, Michael Cotton announced the publication of his revision of Volume 1 of this classic text.  A few days after that, it so happened that I ran into him at a surgical reception in Switzerland (where he now lives); I offered my assistance on the second volume.  Since then, the first volume has been downloaded without cost almost a million times; arguably making it the most widely used surgical text ever. 
​I heard nothing further until recently.  Last week, an e-mail wended its way to my inbox saying that the revision of Volume 2 is underway.  I replied immediately that I was interested.  I was very surprised to see Dr. Cotton again while I was in Zimbabwe. I probably shouldn’t have been.  For over 20 years, he practiced surgery in Zimbabwe. During that time, he established a Flying Surgeon service to rural hospitals, led basic surgical practice courses, mentored over 100 surgical trainees, became a Founding Fellow of the College of Surgeons of East, Central and Southern Africa (COSECSA), and was the Inaugural Professor of Clinical Practice at the National University of Science & Technology in Bulawayo. I hope that I will be involved in the rewriting and updating of one or two chapters of it.  If I am invited to be part, that organizational meeting will be in Berlin October 26.
While in Zimbabwe, I was also notified by e-mail that I had been accepted into Samaritan’s Purse DART (Disaster Assistance Response Team) program.  I will attend a 2.5 day course in N. Wilkesboro August 23 – 25 and will stand ready to help after that.
In the past two days, 43 PAACS residents took the remediation exam that the PAACS team worked so hard upon in June and July.  Somewhat less than half of the residents were “required” to take it and the rest took it for practice. I may assist Dr. Thelander in the scoring of the results the early part of this week if he needs help.
Family News
Sean wants to take some courses at the local technical college this coming semester. They would count for both high-school and college credits.  He missed the cut-off in math by one question and therefore retook the exam when we returned from our trip out west.  Again, one question short.  Quadratic equations kicked his butt.  With the help of Khan Academy online and tutoring from me (after I learned it again along with him), he passed handily four days later.  His mother and I admired his willingness to keep working on it until he accomplished his goal.
Sean loved his week at the church teen camp in S. Carolina.  He spent the entire six days in ministry and felt it was a great experience. He arrived home on Saturday (July 23), only to leave for Michigan early the next morning.
That same Saturday night, Micky’s mother was admitted to the hospital with a bowel obstruction.  Micky drove all day, went directly to their local hospital upon arrival on Sunday night and they were told that surgery was likely if her obstruction didn’t improve.  In response to prayers, she indeed improved and was able to go home later in the week without another scar.  Micky praises God for His timing – that she could be with her parents during this scary time. 
We are also rejoicing that Micky’s final test was normal and she has been released from her surgeon’s care.  Thank you again for all of your prayers on her behalf.
Coming up:
  • By mid-August, Micky will get the end of the year fiscal reports for PAACS from the Christian & Medical Dental Associations and she will be very busy for several weeks after that making the final reconciliation.
  • Sean starts grade eleven on August 16.
  • Sean will spend most of next week with his aunt and uncle at their home in Wake Forest north of Raleigh.
  • Micky will assist Ryan and Chrissy the weekend of August 12-13 at a wedding show in Raleigh. Ryan and Bruce recently had fun building and upholstering a fainting couch for use in their booth and pictures.
We continue to covet your prayers for a clear direction for the future but are trying to remain faithful in those things that He shows us until then.  With hope and joy, 
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<![CDATA[July jottings]]>Sun, 09 Jul 2017 09:43:10 GMThttp://brucesteffes.net/the-steffescope-newsletter/july-jottings​This month, this letter is more an epistle about our family than about our ministry. We deeply appreciate your expressed love and concern about us and continue to request your prayer during this transition.

Family time: Since our last newsletter, we have enjoyed our long-delayed R & R.   We have not taken any extended family vacation time in years and we truly enjoyed our beautiful country and the time together.

PAACS:  The first weekend of June was the annual in-service exam for the PAACS residents.  Despite being on holiday, I used time in the early mornings and evenings to help grade and analyze the results.  Because some will need to take the remediation exam, I have also spent a fair bit of time helping to write the remediation exam that will be given the last Saturday of July.   Micky spent many afternoons and evenings during our holiday to keep up on her work for PAACS. 

I will be traveling to Bulawayo, Zimbabwe in late July. I will be attending the College of Surgery of East, Central and Southern Africa (COSECSA) Examination and Credentialing Committee meeting and participating in a two day OSCE-writing exercise as well.  OSCEs (objective standardized clinical examination) are the latest politically correct movement in medical education and have many advantages at lower levels – but with some significant weaknesses at higher levels.

I am also beginning to make plans to fly to Maputo, Mozambique the first week of December to assist with the Membership and Fellowship exams of COSECSA.  I am supposed to take over the leadership of the examination team in the next year or two and I have a lot to learn.

Fall is the time for mission conferences.  There is one in September in Charlotte that I am definitely going to attend and I am deciding to which of the other meetings I should go .

S3 Ministries:  We have two Hospital Radio projects that are under development, one in Malawi and one in Angola, and we expect a request for funding in the next few months  The specifications of each have not yet been settled, but it is expected that each will be in the $7K range.  The hospital radio project so neatly addresses the issues of the hospitalized patient and his or her family – boredom, public health education and sharing of the Gospel, all in the local language(s).  They even get the equipment to record their own messages and radio dramas.  
Two of the instrument trays have arrived and were excitedly received.  One went to the PAACS hospital in Egypt and the other to a PAACS graduate in Rwanda.  Two more trays have been ordered and the instruments are trickling in slowly.

Future areas of ministry:  We continue to seek God’s guidance for the future.  It is clear that retirement is not really my thing, but I need to find something that matches my passions and abilities!  Lots of people have suggested things that will make their lives better, but don’t really interest us. Plans for a trip to the Baptist Hospital in Togo in October fell through.  This week, I have placed an application for the Disaster Assistance Response Team (DART) with Samaritan’s Purse.  They are presently running a hospital outside of Mosul in Iraq.  I had offered to go in September or October, but they are winding it down (if the present gains by the Iraq army against ISIS continue to hold).  In any event, if they accept my application, I hope to go to a training program in Boone, NC for two days in late August and then will be ready to assist in the next disaster around the world.

I have also renewed my application with the SP World Medical Mission.  We had served our first 8 years largely with them and while our commitment to Sean’s schooling prevents long-term service until he graduates in a couple of years, I am looking to see if I can use our experience to help brand-new short-term missionaries adjust to the realities of the mission field. I am again looking at a possible travel time in September or October.

Way back in medical school, I made some pin money doing the narration for 35 mm slide shows (no, in answer to your unstated question, I did not record back then on wax cylinders!).  I have recently been asked to do the narration for some videos on anesthesia techniques in the developing world.  No money but should be fun.  The first one is done.  I have always wanted to be like my boyhood friend and renowned voice talent, Wayne Shepherd!

Items for prayer for us:
  • As I recover from burn-out, I am caught between the need to rest and recover and my strong desire to be involved.  Pray that God will give me patience and a clear direction when new opportunities of service arise.
  • Pray that God will provide the funding for the two Hospital Radio projects so that patients will be comforted and perhaps healed by meeting the Great Physician in a truly personal way.
  • Next week, Micky has her last test for follow-up of her surgery last fall.  If okay, she will be released from care.  She is doing very well, praises God for her healing and thanks you for your prayers on her behalf.
  • Sean will spend a week with the teens from our Church July 17 – 22.  He will return to school in mid-August as a junior at his Christian high school.
  • While I am in Zimbabwe, Micky and Sean will spend the week with her folks. Please pray for traveling safety for us all.
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<![CDATA[Adjusting to "retirement"]]>Sat, 27 May 2017 10:11:30 GMThttp://brucesteffes.net/the-steffescope-newsletter/may-27th-2017We have a new pastor at our church, Richard Mark Lee, who arrived several months ago.  His schedule and mine have been so busy that we kept missing each other, but Micky and I finally had a breakfast meeting with him at a local greasy spoon.  It was a great encouragement to us to hear his vision for missions in the local church and his advice and thoughts on the next stage of our life were helpful.  He is intent on stirring things up at our church – and we are all in favor, even if the changes might be uncomfortable.
Micky remains busy with PAACS – as do I.  We worked the first part of the month to get all the financial reports for PAACS in shape and I had a phone meeting with the financial committee. We have solidified the budget for next year – just shy of $2,000,000.  When I started, we were well short of $100,000 for the budget for the year – and God gets the glory for the increase and all that has been done.  I did NOT go to the PAACS Commission meeting this month (May 19-20) for the first time in 14 years – I wanted to make sure that I cast no shadow over Dr. Thelander in his first meeting as the full-fledged CMO.  By all reports, he did well – and the sun continued to rise despite my concerns that my absence might upset the universe.  I have also worked on the PAACS phone app that I hope will be put out for beta testing within the next week.   I have just designed the next part of the database that needs to be revised so that we can get a bid on that work and get it started.
It was confirmed that I will be the deputy head of the COSECSA Membership and Fellowship exam panels – so a trip in late July to Zimbabwe is now in the works.  I will also be going to Mozambique (first time) the first part of December.   I am also trying to work on a trip to Togo, perhaps in October.   Unfortunately, Micky and Sean will not be able to accompany me. After my successful presentation on writing exam questions in Nigeria, I have been named as an administrator of their “Images of Surgery” surgical review program which uses Telegram, a group phone app.  At their request, I have used that format to distribute daily lectures on the proper construction of multi-choice questions and help oversee the case-based discussions that occur.
Lots of other things kept the schedule full:
  • In order to keep up my certification and skills, I taught advanced life support courses three times this month.  Two days were spent in Greenville teaching Advanced Trauma Life Support (ATLS) and I taught Pediatric Advanced Life Support (PALS) this week.  I also helped with the Basic Life Support course at the local hospital.   The time with Carl and Lu Haisch in Greenville was a blessing and we got a bit of work done on the PAACS exam as well.
    • Speaking of the exams, Keir Thelander, Carl Haisch and I finally put both annual in-service exams for the PAACS residents to bed.  The two exams have 200 multiple-choice questions.  One is focused more heavily on basic science and is for the residents in the first two years; the other is more heavily focused on clinical decision making and is for the residents in the last three years.   These exams are the results of literally 200 – 300 hours of work each and have demonstrated high validity and reliability in the past.  I spent several days in getting them in final shape and working on the grading spreadsheet. Performance on the exams is just one of many factors used to assess the progress and promotion of the residents, but is a major one.   Residents who do not pass will be given a chance at a remediation exam to be taken the last Saturday of July.  Pray for the residents taking them on June 3 would not go amiss!
  • We mailed out three trays of surgical instruments.  A special head and neck tray went to the new PAACS head and neck graduate, Chege Macharia, at Kijabe, and two general surgery sets went to recent graduates in Kenya and Rwanda.  I have ordered two more general surgery sets to get ready to set out.   We are also excited to know that the rigid bronchoscopy set will be shipped to Papua New Guinea from the factory in Germany – we are only waiting for release from customs.
  • Sean is finished with his sophomore year the end of this week.  He took the nationalized exams at school and thought he did well.  His semester marks were good enough to excuse him from all but one end-of-year exam.  He is making arrangements to take some fall courses at the local community college; he will get both high school and college credits for those courses. He is preparing to attend the National Academy of Future Scientists and Technologists to be held the end of June on the U of Mass-Lowell campus.  It is a great honor for him to be invited.   The program is promising to be awesome.
  • This was also a month for birthdays.  Ryan’s wife, Chrissy, and Sean both celebrated one and we enjoyed being together.  This was the big “16” for Sean (we will not announce Chrissy’s age).  Sean is 6’1” and change – and still growing.  Bethany, my daughter, and her friend, Michael, came out to celebrate with us.  That is a blessing on so many levels.
  • Micky and Sean were ill with a virus that weekend of May 6 and 7, so I travelled to Northpoint Baptist Church in Weaverville on my own.  I stopped at the Christian Medical and Dental Conference at Ridgecrest, heard Keir’s presentation on global surgery and then we had a three hour conversation on the issues facing him.   The time at Northpoint was a real blessing and things went well.  It was so good to be with the Byrds and the others who have become so dear to us at that church.  That is the only church that supports our ministry other than our own.
  • Almost two years ago, I was asked to write a 53-page chapter on tropical medicine that a surgeon needs to know.  The book, “Global Surgery: The Essentials”, was finally published this week and I received my author’s copy.  One of the editors was my friend, Adrian Park, and there are 9 PAACS-related authors in the book.  
​Struggling to adjust to retirement but I have found some time for a new hobby.  Someone contacted me via Facebook to see if we were relatives.  We weren’t, but it made me realize that my mother was the keeper of the genealogy – and that I had lost contact with most of my relatives (both those I knew about and those I didn’t!)   I have opened an account on FamilySearch.org, the free LDS genealogy site, and I have become addicted.  I am back to the 1600s in almost every family line; there are some fascinating stories of Immigrants, oil-drilling and the Deerfield Massacre.  It is like doing crosswords (which I generally hate) but this is very similar in that you can look and look for a piece – and finally you find it and whole sections snap into focus.  A lot of names I remember from my childhood are finally making sense in the relationships that I never understood as a kid.  I think I even found the gravesite of a great uncle who disappeared in the late 1960s – he was a serious under-the-bridge alcoholic and came and went.  It would appear that he was buried in a Potter’s field in Ohio just a year or so after we last saw him.  It is very sad – just knowing gives an odd sense of closure.

We are very much looking forward to our family time together. We have a long car trip planned that will include several national parks and most importantly, a visit to our grandson.  We hope to use this time to rest and to focus on what God will have us do in the future.  Your prayers for us along those lines would be much appreciated. 
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<![CDATA[Looking forward to a respite]]>Sat, 29 Apr 2017 23:24:47 GMThttp://brucesteffes.net/the-steffescope-newsletter/looking-forward-to-a-respitePictureBruce, Professor Ezeoma (WACS) and Professor Koto (S. AFrica)
The past week in Ibadan, Nigeria was a good one.  I was again invited to be an observer for the exams for the trainees of the West African College of Surgery (4 days) and I also gave a 3 hour workshop entitled “Good Exams, Good Questions” to the exam-writers of the college.  It was training designed to help the surgeons there write good multiple-choice questions for a high-stakes exam and then how to analyze the psychometrics of the items and the entire exam. I was surprised how well this topic was received and I can only hope that it will lead to improvement in their exam process. They are already talking about having me come back and there may also be a forthcoming invitation to speak to the equivalent group of the Surgical College of S. Africa. The direct flight between Atlanta and Lagos certainly shortened the trip each way.

The past month has been a busy one – between tackling a list of long-neglected “Honey Dos”  for Micky’s nearly retired husband (me) and continued activity for both PAACS and the Continued Medical & Dental Education Commission because I am not really retired yet.  I spent a lot of time on the refinement of the junior and senior exams which will be given on June 3.  I also worked on the Excel workbook that “automatically” scores and evaluates the exams.  I wrote it several years ago while working at Methodist University.   I finally figured how to add two psychometrics (measurements on how the exam-takers did on a given question) on which I have literally worked on and off for over 10 years.  A minor private celebration important to almost no one else!  I was able to share it with a dean of a Ghanaian medical school while in Nigeria, however.

            I still function as the chief financial officer for both CMDE and PAACS.   I attended the CMDE Commission meeting in Rochester, MN April 6 – 8.  Micky had spent several hours over a few days helping me get the financial binder ready for that meeting.  It was inconvenient to get there (compared to our previous traditional meeting site in Chicago) and weather-induced disruption of Delta flights made it much worse.  It took over 12 hours to go both ways because of delays.  Still, it was a good meeting, despite the residual jet-lag that awakened me at 3:00 AM each day.

Micky and I have worked together on several days this past month, spent time with Susan Koshy and Keir Thelander by Skype and we almost have the 2017-2018 budget proposal in its final form.  We will spend the next 48 hours finishing the financial committee report for the PAACS Commission meeting which will be held near O’Hare Airport May 19 and 20.  For the first time since 2003, I am not attending this meeting to avoid eclipsing Keir in any way as he attends his first meeting in the role of full-fledged Chief Medical Officer.

We have ordered three more trays of instruments – the previous order for two trays placed in mid-December and one placed in early February are still not complete as the less commonly sold instruments are still trickling in. I am eager to get the trays completed and then bless some fine surgeons who truly deserve them.  If anyone would like to help with the cost of these, please send a check to S3 Ministries, PO Box 300, Linden, NC 28356 and put “instruments” in the memo line.  The thyroid tray is about $1600 and the discounted price for the laparotomy tray is about $2300. A box of discarded instruments have just arrived and I will spend some time seeing what can be salvaged and refurbished before sending them out to someone.

The weather in April makes it my favorite time of the year in North Carolina – and it has been only rarely that I can be here to enjoy it.  We celebrated our 19th wedding anniversary on April 11 (one of only a handful of times that we have been together on that date since we have been married).  With only the now-honored commitment in Nigeria left on my remaining list as PAACS CMO, the stress has begun to lift and getting a lot of things ticked off the “Honey Do” list has been satisfying for me.  Sean spent the third week of April on Spring Break from his school and he chipped in to help us get a lot done around the house.

Plans for the future of our ministry are still open.  I will teach Advanced Trauma Life Support in early May for two days and continue to work on the PAACS exams, while continuing to seek God’s heart for the next steps.  Because we have promised Sean that he can stay in school his entire junior and senior years, that puts a crimp on the usual type of mission service.  Micky can’t travel with me and that means that either I make shorter trips (less cost-effective and more problems with jet-lag) or we are apart longer – neither is appealing.  I am trying to arrange a trip to Togo in the late fall to help the program there as it prepares to join PAACS.

As part of our long-delayed vacation, we are very excited about a long car trip we will take from May 27 to June 28.  Leaving and returning to NC, we will visit Mt. Rushmore, Yellowstone and several national parks in Utah and Colorado.  Michelle, Joey and Auggie will travel from LA to join us for a weekend in southern Utah.   We will be home in NC for just a couple of days after that trip before going with Sean to Massachusetts.  We are taking Amtrak there and back (should be fun!) and while Sean attends the conference, Micky and I will take a weekend along the shore of Maine – the only state I have never visited.


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<![CDATA[Back from Cameroon and Tanzania]]>Sun, 02 Apr 2017 12:25:52 GMThttp://brucesteffes.net/the-steffescope-newsletter/back-from-cameroon-and-tanzaniaPictureThis is sthe second day group. Dr. Smith is the tall Caucasian guy on the third from the left.
            Always good to leave and always good to be home!

             I got into my own bed well after midnight this morning after a two-week trip to Cameroon and Tanzania.  It was a good trip despite the problems in getting to Africa in the first place and then getting around Africa later.  I had scheduled the last plane out of Raleigh for JFK on a Saturday but it was delayed twice due to poor visibility at JFK airport.  Finally, it was obvious that I would miss the connection for my flight from there to Istanbul.  That in turn meant I would miss the mission plane we had arranged on Monday morning and that I would miss the majority of the first day of the faculty development session on Tuesday.  After a flight the next day through Brussels and an unexpected rearrangement of my ride in Cameroon, I finally made it 24 hours late after a seven hour drive over rough roads.  I dragged into the seminar just as the last of “my” lectures was being given.

            The next two days were pleasurable, albeit long.  Dr. James D. Smith (a dear friend, Professor Emeritus in the ENT department of the University of Oregon, and the most vibrant octogenarian I know) and I gave two more full-day (from 8:00 AM – 6:00 PM) faculty development seminars at the PAACS program in Mbingo Hospital from March 21 – March 23.  The sessions were repeated on three sequential days to allow everyone in the PAACS and Christian International Medicine Specialties program to attend.   A total of 43 residents and faculty members attended the sessions in additional to the two presenters. One PAACS graduate, Dr. Ben Malikidogo from nearby Banso Hospital, and several other Samaritan’s Purse Post-Residency physicians from Mbingo attended as well.  It was a rigorous schedule but it was enjoyable and educational.  I learned a lot from Jim Smith and hope to be involved with other programs like this in the future.

            I was also able to use my second suitcase to bring several major surgical textbooks, some mosquito netting for hernia repairs, some instruments and other goodies (total of 70 lbs of stuff for the missionaries.

            A dozen people accompanied me back to Douala via a grueling 8-hour van ride Friday, March 24.  Jim Smith was going on to Cairo in the wee hours of the Saturday morning and Drs. Jim Brown and Dennis Palmer were taking their wives with them to visit Vellore Hospital in India to see if some resident  rotations could be arranged in various specialties for their respective surgical and internal medicine training programs.  A few other visitors were also headed home. I was scheduled to fly out Saturday to Kilimanjaro via Nairobi and take a taxi to Arusha, arriving at the home of Dr. Wendy Willmore after midnight on Sunday morning. However, my bad luck was consistent; Kenya Airways cancelled my flight, delayed my arrival 24 hours and I had the pleasure of luxuriating for 24 hours in a ½ star African hotel instead.  I used the time wisely, putting a good dent in some work for PAACS that needed to be done.


PictureL to R: Steffes, Chew, Madinda and White
Once in Arusha, I spent the next two days helping Dr. David Halter get the PAACS case log software system up and almost functioning.  One bug took the programmers days to find and fix.  Dr. Andrew Chew had come down with his wife , Sok Hui, from Soddo Christian Hospital to also attend the three days of meetings with the College of Surgery of East, Central and Southern Africa (COSECSA) and we had an enjoyable time together during the week. We participated in the Basic Science workshop to look at future requirements in basic sciences, suggesting a new model.  We also participated in the first-ever curriculum workshop as PAACS attempts to revise and improve its overall curriculum.  I also participated for the first time in the Exam and Credentialing Committee and there is consideration of some role for me in the leadership in the exam process, but that awaits approval by the Executive Council.

            We also had a great time when all the residents and faculty came to Wendy Willmore’s home for a meal and a discussion of research that is being done at Soddo.  Russ White, from Tenwek Hospital, was also there and added comments about their experience.

Instruments: Long-time readers of this newsletter will know that from time to time we ask for help from you to obtain the funds for pediatric bronchoscopes and esophagoscopes – specialized equipment and telescopes for the evaluation of the airways and the esophagus.  They have many diagnostic uses but the removal of foreign bodies is the biggest need.  Last Saturday, I received this e-mail from Dr. Jason Fader who is an outstanding missionary general surgeon in Burundi.  “Yesterday, a 5 year old boy came in to our hospital having difficulty breathing.  He had inhaled a piece of corn that was lodged in his right bronchus.  The bronchoscope was not yet all unpacked, but I went home, unpacked it and we were able to retrieve the piece of corn from his lung.  This is the first of many lives that will be saved with this bronchoscope.”    You can see why provision of these scopes is such a passion for us – and thank you for all you have done over the years to help provide them.  We are presently helping another hospital in PNG get such a set; they have been able to raise the money themselves as did Jason’s hospital, but we are pleased to facilitate the process and the discounted pricing.

Plans:

  • Tomorrow I fly to Chicago to help with the budgeting process for PAACS. I return late Monday night.
  • Thursday, I fly to Rochester, MN to attend the two-day CMDE Commission meeting.  As financial officer, Micky will help me with the final financial reports on Tuesday and Wednesday. 
  • My next overseas trip is to participate as an observer in the annual exams of the West African College in Ibadan, Nigeria.  They have also asked me to speak to the examination committee while I am there. I will be leaving the US on April 22 and returning on April 29th.

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<![CDATA[Ready to go again!]]>Fri, 17 Mar 2017 14:10:57 GMThttp://brucesteffes.net/the-steffescope-newsletter/ready-to-go-again            Heading back out tomorrow for Africa.  The time home has been busy and short.  Dr. Jim Smith, Professor Emeritus in the ENT department in Portland, friend and colleague from PAACS, CMDE and the MEI (Medical Education International) Commission, and I will spend the first week at Mbingo Baptist Hospital near Bamenda, Cameroon.  We are putting on three seminars on faculty development for the surgery and medical faculty and residents.  I look forward to learning from Jim (who is a fair bit older than I am but with an envious intellectual and spiritual vigor) because this sort of thing is something that might be part of my own ministry over the next couple years until Micky can again travel regularly with me and we can stay for longer periods of time.   The second week will be in Arusha, Tanzania.  I hope to work with Dr. Dave Halter the first two days on the PAACS computer system at the two PAACS hospitals there and then the last three days will be with the College of Surgery of East, Central and Southern Africa attending a basic science curriculum meeting and then two days of meetings for the first time as a member of the exam and credentials committee.  I will return on April 1.

            The past three weeks have had some highlights:

            At the behest of a Christian surgical resident in the Master’s in Public Health Program at Harvard, Andrew Giles, I was invited to speak to the first Boston Global Surgical Society held in Boston, MA on March 4.  I was able to use airline miles to fly there. Kee Park, a Korean-American neurosurgeon in the same program and someone I have met before in Louisville and at the G4 Alliance meetings, and his wife hosted me the night before and it was a blessing to fellowship with these two strong believers.  He is becoming a strong voice of neurosurgery in the realm of global surgery and works with my good friend, Walt Johnson, at the World Health Organization.  Later, I was able to make some e-mail contacts for him with a couple of other people to whom he needed to communicate.  The next morning, approximately 200 bright students, mostly medical students from Ivy League schools, met to learn about their future role in global surgery.  Each session was streamed over the internet and hundreds of others joined in (you can view any session at https://www.globalsurgerystudents.org/live-streaming-recording).

            Robert Riviello, a trauma surgeon in Boston and a member of the General Surgery Council of PAACS, Kee Park and I carried the banner for faith-based work in this secular environment.  It was amusing at one level – and encouraging at another level – to speak with the students afterward who are so used to keeping their faith private in a secular world; they would come up and give the metaphorical secret handshake!

            One student, Mallory Peterson, has subsequently put me in touch with leaders of the Capstone Project of the engineering department at Penn State U in Hershey to see if their students would be able to help with the need for cost-effective and robust suction machines in the developing world.  This is a great need in most of our hospitals, even more so since negative pressure wound treatment has been proven so valuable in the treatment of huge wounds.  It will cost $3,500 to sponsor the project to develop such a thing and I am praying for God’s wisdom and the funds for this.

            Yesterday morning, I received this e-mail from Stacey Giles, Andrew’s wife.  It was a great encouragement to me, since I had experienced some reservations about going:

My friend… watched the Global Surgery Symposium over Live Video. While you shared at the Education/Capacity building panel, Kim was apparently stirred to tears by your words and something was activated in her. She feels like Father is reviving her desire to go to the nations and while you were talking, a lot of hopes/dreams she had in the past were resurrected. She wanted to pass on her thanks to you. She recognized a mantle of authority on you and she wants you to know, that she will continue to lift you & your family up to the throne of Grace. 

I think it was absolutely incredible that you were able to fly up to Boston. Father used your words & heart for the nations to encourage my friend Kim - so thank you for coming! May God continue to use your voice in the academic arenas, institutions, and in the developing world. 

We also had the pleasure of meeting with old friends who I had not seen since 1970!  Ken and Jinner Rudolph are youth speakers and missionaries and were speaking at another Baptist church in our town.  It was such a blessing to see them again – and the years fell away.  We found they now live north of Charlotte and hope to see them much more frequently.

The rest of the time home was spent organizing the two annual exams for PAACS (days and days!), working on the new phone app for the PAACS system (including writing a manual), developing the budgets for next year for both PAACS and CMDA-CMDE, uploading and preparing reports for the upcoming CMDA-CMDE Commission meeting in early April (to be held in Rochester, MN), helping the program directors prepare for the upcoming Loma Linda University accreditation trip in April, arranging the new insurance for the house and cars (praise God!), arranging for repair of the unfinished electrical work from last summer’s lightning strike, working on three surgical instrument trays that are only waiting for back-ordered items in order to send them out, helping the Nazarene hospital in Papua New Guinea with their order of a pediatric bronchoscopy set, writing and recording five hours of lectures for the Tropical Medicine course and getting over the worse-than-usual jet-lag.

Praise and Prayer:

  • Pray for funding to come in for the instruments that have been ordered.
  • Pray for safety in travel and effectiveness in all that is done.
  • Pray for wisdom and funding for the Capstone project. 
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<![CDATA[Home from Asia!]]>Sat, 25 Feb 2017 13:00:22 GMThttp://brucesteffes.net/the-steffescope-newsletter/home-from-asia            I am writing in a dense mind-fog due to jet-lag, having arrived home less than 24 hours ago and now trying to switch my internal clock a full 12 hours.  The trip home from Asia was made even more uncomfortable when I spent six hours with renal colic, presumably from the passage of another small kidney stone.  The seat was already uncomfortable enough for the 15 hour trip from Guangzhou, China to JFK – and writhing in pain and gritting my teeth didn’t enhance the experience!

            One of the highlights of each of the past 15 years (excluding 2008 when civil unrest in Kenya forced cancellation) has been the Continuing Medical and Dental Education Conference.  Held in Africa or Europe one year and the next year in Southeast Asia, it is a great time of encouragement and medical education for a good portion of the world’s Protestant medical missionaries.  This year, over 500 medical missionaries, faculty members and their families attended.  Many of these cross-cultural witnesses are in very difficult places and the field reports were a great wake-up call to all of us who listened – both because of what they were facing and also because of what God is doing.  The children’s program was vibrant and a true blessing to both those kids who attended and to those children’s workers who contributed time and money to provide the program.

            Sean is in 10th grade and despite a strong desire to attend the teen program with so many friends he has made, he didn’t feel he could miss classes (and therefore Micky had to stay home with him).  I attended this two week conference alone as part of an extended trip which included the previous four weeks in Africa.  I flew directly from Kenya via Abu Dhabi and Bangkok.  Both connections were very tight and I suspect I created quite a spectacle as this old, bald, overweight guy sprinted the full length of both airports (and nearly died of respiratory failure at the gate!).  Both times, I made it with literally only a couple of minutes to spare.  But my luggage made it both times, for which I was very grateful. 
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<![CDATA[Finishing up in Kenya - and then onward!]]>Sat, 25 Feb 2017 12:56:54 GMThttp://brucesteffes.net/the-steffescope-newsletter/finishing-up-in-kenya-and-then-onwardPicture
            The time in Kenya is drawing to a close – only two more weeks before I head home.

            Last Saturday’s walking safari to Crescent Island was a great time for those who went.  They were ferried by boat past hippos to the peninsula (it is a peninsula into the Rift Valley Lake Naivasha and not truly an island despite its name) where animals roam without concern for predators.  The animals were placed there during the filming of “Out of Africa” and “Born Free”. Many of the African residents have never had such an experience before, coming as they do from areas where all animals have long been eradicated.

           My son Ryan and his wife also learned a valuable lesson about the dangers of African traffic.  On their way home the bus stopped by an accident.  One person had a severe head injury and they were relieved when he started to breathe.  The bus that they were on just happened to have 21 surgeons ranging from interns to experienced gray-beards.   They triaged the scene and then loaded the man on the bus to take him to the nearest hospital.  Ryan and Chrissy were rather shocked by the entire experience and stated they stayed out of the way while watching avidly.  They got back to the conference center about three hours later than expected, but still in time to enjoy the remaining bonfire and barbecue.

            Ryan and Chrissy have been very helpful.  They videoed all the lectures, took lots of still pictures, took some interview video and generally helped facilitating things.  They are not necessarily fans yet of African food (I couldn’t convince Ryan that my favorite roast goat was delicious!) and I suspect a hamburger will be their first meal back in Raleigh Friday night.  I have really enjoyed having them here and I trust that what they have seen and heard will have a deep impact that lasts a long time.  He will have weeks of work left to do the edits.  We will distribute them back to the programs by messengers who will hand-carry them.

            Ryan was also instrumental in doing something special that I did not suspect.  He interviewed various faculty members and asked them about my impact upon them and upon PAACS.  He then did a quick rough edit and showed it to everyone after the Bible Study I led on Wednesday.  “Intense” was one of the words that more than a few used in referring to me – I don’t know if intense the right word to describe such a teddy bear as myself, but everyone is of course welcome to their opinion (even if wrong J).  They followed it with a gift of a photo book written by the program directors.  I was deeply touched.

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<![CDATA[Jambo from Kenya]]>Sat, 04 Feb 2017 10:19:12 GMThttp://brucesteffes.net/the-steffescope-newsletter/jambo-from-kenyaPicture
            Time flies when you are busy.  I was shocked to realize I have gone a month without writing a second newsletter.

            Snow in the mountains cancelled our trip to the Global Outreach mission conference in Weaverville, NC scheduled for January 6 – 8.  We were disappointed. We have rescheduled a time to go there later in the spring and look forward to the time with our second church home.

            I was very pleased to hear from someone I hadn’t seen in years.  Tom Garber is an expert in high power electricity that I met in Africa.  He wrote out of the blue, ““It has been many years (1998) since we met in Togo along with Bill Wright.  We (www.itec.org) have been very busy providing power to mission hospitals, orphanages and mission stations worldwide.  You are partly responsible for this as you gave me the book Half Time at a time in my life when I was trying to make a decision to leave my great job with the power utility and step into full time missions at age 49.  Thank you for doing that as it has been an awesome 18 years with hopefully many more to go.”  Praise God that we have been able to be used by God when we were not really planning on it being so!  You might want to go to the ITEC website and see the great work they are doing.  View the video there.

            In a humorous sidebar, he reminded me of a trip we once took together. “You might remember the mass blessing we received one time on the commuter flight out of Nairobi when the power was off.  The crew finally asked, "Does anyone have any guns or knives? No? Okay, board the plane!"    They were obviously relying on the well-known truth that a terrorist would never lie about such a thing.

            Despite my “retirement”, I continue to put in full days.  A lot of it was related to ongoing PAACS projects and I also approved the final printer’s copy of the 60+ page chapter on tropical infectious disease for a new textbook in global surgery.  That chapter has been more than a year in completion (I hit my deadlines, but the overall process is slow). 

            On Saturday, January 14, I left Sean and Micky and flew to join three others for the Loma Linda inspection tour of the programs in Tanzania and Kenya.  I was the only one to make it on the right day when delayed flights and the loss of an engine delayed the others.  With a little finagling of the schedule, we were still able to give due time in Tanzania.  We visited the general surgery programs at Arusha Lutheran Medical Center (and its sister hospital Selian Hospital) in Tanzania, and Kijabe and Tenwek Hospitals in Kenya.  We also inspected the orthopedic program at Tenwek and the pediatric surgery program at Kijabe Hospital.   Keir Thelander, my replacement as Chief Medical Officer, and I also had a side conversation with the orthopedic surgeons at CURE-Kijabe and AIC-Kijabe Hospitals about a possible new PAACS-approved orthopedic training program there.   Later in the month during the Basic Science Conference, Keir and Susan Koshy, the PAACS CEO, went back to talk with the administration at both hospitals. Such agreements can take an amazingly long time to finish.

            The team from LLU included Dr. Mark Reeves, the Program Director of the general surgery program at Loma Linda, and for the first time joining a team, Dr. David Turay, a native-born Sierra Leonean and now a trauma surgeon at Loma Linda.   These gentlemen gave up their leave time to accomplish this visit and over a year, Dr. Reeves will very generously donate more than six weeks’ time to this process.  They were very pleasant travel companions and a great resource to both PAACS and the various programs.  The programs hate the process but appreciate the results.

            S3 Ministries gave a grant to record the science lectures for PAACS.  This permitted my older son, Ryan, and his wife, Chrissy, to come to the 5th PAACS Biannual Basic Science Conference in Kenya to video record all of the lectures.  Ryan is now a wedding photographer and videographer by trade, so he bundled up all his camera and lens and lugged them Africa to help us out. He also serves as a wonderful still photographer.  Once back home, he will edit and put all these lectures together (which will take weeks to months to finish) and they will be distributed to all programs so the residents can review them at their will.

            Under the premise that all work and no play make Jack a dull boy, I went with the LLU team for two safari drives in the Masai Mara preserve area.  It is a tented safari camp that I have visited before.  Ryan and Chrissy arrived early enough to join us for a total of four drives (despite the jet-lag).  It was so much fun to show them the Africa that Micky and I love.

             The Fifth PAACS Biannual Basic Science Conference began Sunday, January 29.  Thirty seven PAACS residents and 10 COSECSA and CURE residents are here, including the 16 new general surgery residents and 2 new orthopedic residents.  One new head and neck fellow did not attend.  There are 28 faculty members for our programs in Africa and some from the US who came at their own expense to lecture.   Unfortunately, at the last minute, our Spiritual Dean, Rev. Stan Key, had to stay home to take care of his beloved wife who fell and broke three bones.  However, he graciously sent his material and the Lord has still shown up as the faculty divvied up his lessons.  I am taking two of his lessons, lecturing six times and pitching in wherever necessary.  I am also working these two weeks as an administrative assistant to Keir to help facilitate the whole program.   I have truly enjoyed having Ryan and Chrissy here.  

            The residents have had very long days with worship starting at 7:30 and evening meetings going to 9:30.  They have truly been drinking from a firehose!   This afternoon, however, they are going on a walking safari at nearby Crescent Island and will have tomorrow off for worship and relaxation.  Ryan and Chrissy are eager to go along.

            I will help Keir with the final details when everyone leaves Thursday and will fly out Friday morning toward Southeast Asia for the medical and dental education conference.  

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