Last week, this newsletter came from Kenya; this week, it comes from Liberia on the other side of the continent. Today, I flew 3,300 miles from Nairobi, Kenya to Monrovia, Liberia (with a stop in Accra, Ghana). I am looking forward to tomorrow to relax. Sure is hot here at sea level, compared to the cool highlands of Kenya.
I have spent the last week traveling with Carl Haisch, a transplant surgeon from Eastern Carolina University. He is a close friend and an active member of the PAACS Commission. After the Surgical Education course was over in Nairobi, we crossed the Great Rift Valley with Drs. Russ White and Carol Spears as well as two residents. Sunday was a day of worship and rest. I met with many old friends and acquaintances. One of those was Sam Powdrill, a Physician Assistant who was a missionary here at Tenwek when we first started coming here. He is now teaching in Kentucky at a PA program there. He favored us during the music worship with a few songs on a musical saw. It has been a while since I have heard one played. As much as I enjoyed his playing, it was the 8 year old boy on the drums during the worship service that truly delighted me. He was enthusiastic and joyful – and had a good beat!
From Monday through mid-day Wednesday, we participated in the life of the PAACS residency at Tenwek. Morning rounds, teaching conferences, operating room and so on. Carl had come to Kenya to work on a way to allow visiting short-term faculty to assess and test the residents. He learned a lot by just observing the realities of mission surgery in this setting. A lot of “good ideas” were jettisoned and some new ones obtained. He had last been here at Tenwek with his family in 1994 and so there were more than a few changes in the hospital to which he had to adjust.
Monday night, we had a time of fellowship (games and a meal) with the residents. Given the hectic schedule at Tenwek, such relief valves are critical for mental well-being.
Tuesday was a difficult day. Rheumatic heart disease was still relatively common in the US when I was young but has become a rare disease in this day of frequent antibiotic usage for everything. However, because that medical care is not universally available, it is still very, very common in the developing world. The result of untreated streptococcal infections, the heart valves are damaged severely by the patient’s own antibodies. The scarring can cause the valve opening to shrink to 1/8 of its original size, making it impossible for the blood to keep flowing forward. Russ White, the chief of surgery here at Tenwek and Program Director for PAACS, has been developing expertise in an operation used before open heart surgery become available where one can crack the calcific valve open with either a finger or a special instrument. He has brought great hope and relief to dozens of patients since he started. Tuesday, there was a middle-aged woman who was near death if she didn’t receive help. Her atrium was massively dilated on the left side and in consultation with a visiting cardiologist, it was felt that surgery was her best hope. I won’t go into all the details, but she died on the table despite fervid efforts to help her. I scrubbed in partway during the case to help but our combined skills were insufficient. This is the downside of surgery in general and missionary surgery in particular. Losing a patient is hard. We had made sure that she knew Jesus as her Savior before we started the surgery, but even so, it is very stressful on everyone in the OR and especially on the family and on Russ. Please pray for the medical missionaries that you know – they need your prayers.
Tuesday afternoon, I joined Colleen Johannsen and helped with the megacode testing for the Advanced Cardiac Life Support course that she had been giving. I spent a couple of hours putting the interns and residents through their paces. Most did amazingly well.
Wednesday afternoon, we took a taxi back across the Rift Valley to Kijabe Hospital. There are two roads from the floor of the valley up the escarpment to the Hospital. Both are in horrible shape, but one is very steep and was not negotiable with the car we were in. The other road has a more gentle slope (but no fewer potholes). Unfortunately, it has a long tradition of robbery and hijacking. We had to stop at the police station and ask an armed policeman to accompany us up the 8 km potholed poor excuse for a road up to the village of Kijabe. Interesting experience….
Just as we unloaded our suitcase and wondered what to do next, Dr. Burton Lee and his wife walked up. Burton is an intensivist who is on the CMDA-CMDE Commission with me and is spending the next two years here at Kijabe. They sheltered us until we found out which apartment we would have and the person with the key came. As we carried our luggage up to the third floor, an unrecognized voice greeted us. I didn’t pay much attention at first to who was actually speaking but I looked again and realized that it was Dr. John Axelson, a classmate of mine at the University of Michigan Medical School. I had seen him about a decade ago or so at a Michigan class reunion (the only one I ever attended) and then had seen him and his wife Lynn at The Cove’s Prescription for Renewal Conference in 2009 in Asheville, NC. It was so good to see him.
Kijabe means “place of the winds” and it has lived up to its name. During the day, it is pleasant and breezy but at night, the wind just howls. There were some heavy rains on Thursday (early for the spring rainy season) and by Friday morning, it was down to 47oF. We shivered and asked what had happened to the heat of equatorial Africa. The 7,500 ft altitude here has a lot to do with it and the relative heating and cooling cycle between the hills and the deep valley causes the winds to change direction and blow so hard.
Thursday and Friday, we replicated the same sort of schedule we had observed at Tenwek. We met with the Kijabe residents, went to lectures, visited in the OR and gave mock oral examinations to the two senior residents (who had missed that grueling experience at Brackenhurst because of other commitments). I met with the surgeons and anesthesiologist to talk about the new PAACS software – they were enthused and gave me some good suggestions.
Yesterday morning, we left Kijabe at 6:00 AM. I was taken to the airport to fly to Liberia and Dr. Haisch spent his day relaxing at the Mennonite Guesthouse and enjoying the beautiful landscaping around it. He did the obligatory souvenir shopping and then left Nairobi last evening on the KLM flight to Amsterdam. I had no particular problem on the flights to Liberia but the hotel pick-up was late. Fortunately, they had a nice welcoming group for the WACS conference (including a free SIM card that allowed me to SMS Micky to tell her I was okay) and they gave me a ride into town. It is a nice hotel (probably not as nice as the price would suggest that it should be!), but then from my times here on the Mercy Ship, I already knew how bad the average hotel was here in Monrovia. I knew I would be getting rather weary at this stage in this long trip and rather easily talked myself into feeling that I “deserved” it. Knowing that is not really true, I am assuaging my conscience by offering to share my room at no cost with Dr. Yakoubou Sanoussi, the new assistant Program Director at the SIM-Galmi Hospital in Niger. He arrives tomorrow afternoon and will be inducted later this week into the West African College of Surgery (WACS) as a Fellow. I truly enjoy him as a brother in Christ and fellow surgeon; his company will be welcome here in Monrovia.
Praise and Prayer Requests:
- I have a meeting scheduled February 28th with the President, Secretary-General and other important personages to discuss the relationship of PAACS to WACS. Please bathe this important meeting in prayer. Please also pray that God will put into my path those others who I should meet and may I reflect Christ to all.
- Thursday, I fly back to Nairobi arriving early Friday morning. Saturday, I fly to Dhaka, Bangladesh and then on to Cox’s Bazaar in the south of the country before driving back northward to Malumghat and the Christian Memorial Hospital there. Please pray for traveling safety, for rest and for my interactions there. I am a bit rusty as to clinical medicine and I know that there are many issues there outside of medicine in which I need the Spirit to lead me.
- Please keep Micky and Sean in your prayers as we are apart. Please pray for my daughter Bethany, my father and my brother-in-law as they face various health issues.
Resting in the nature of God, I appreciate your prayers on our behalf.
Bruce for Micky and Sean