Sometimes things happen because of what you do...sometimes in spite of

Several things have become obvious during my trip here...I have learned a ton since my time here as a medical student, Family Medicine is a perfect specialty as it allows me to care for a host of patients, and there is much I still don't know.

Here's a little example of this:

A few days ago I was attending a delivery.  Mom had been in labor a long while, but thanks to a few interventions she was able to avoid a C-section.  After an hour of pushing, the baby finally delivered.  Unfortunately, there was a large amount of meconium in the amnionotic fluid right behind the baby (in layman's terms - the baby had pooped a lot while mom was in labor; this is both a sign of a stressful labor for the baby and there is a risk of problems if it gets deep into the baby's lungs).  The baby wasn't breathing after delivery (not too abnormal - but something that needs to be rectified), but since there was meconium I knew I should intubate and suction the baby before encouraging her to breath on her own (which could lead her to aspirate the fluid deep into her lungs).  I relayed to the nurses, "I need the intubation and suction supplies."  The nurses search frantically.  A minute later the laryngyscope to intubate the baby is still unavailable.  "I can't let the baby not breath forever," I think.  Finally, they find a laryngyscope.  I make an attempt; the light doesn't work on it, making the equipment useless.  Since the baby must breath I go ahead and suction the back of throat and place the suction catheter down the nostril to see what I can get back.  Not the normal order of things, but at this point I'm having to improvise.  The baby starts breathing a little better.  Someone has finally fixed the laryngyscope.  Since I still hear fluid in the lungs I decide to try another intubation but at this time the baby is fighting me so I abort this attempt and suction more.  Thankfully the baby is starting to breath well.  When we discharge the baby a day later it shows no signs of aspiration.

Fast forward a couple of days, and this time I have a 29-week premature baby that is precipitoiusly delivering.  Mom's water had broke, but she hadn't sought care, so she had an infection her body has gone into labor.  "The head is here," shouts the nurse.  Looks like I'm not stopping this delivery.  I deliver the baby and place it on the bed.  She is nice and pink, but still not breathing.  I try to stimulate her.  She's still not breathing, and the heart rate is less than 40.  I drag my neonatal resuscitation algorithm from the recesses of my mind.  Next step is to provide ventilation with a bag mask.  I hope this works.  After a minute the baby starts crying an the heart rate is up.  I thank God, because I didn't feel as confident about the next steps, especially in Africa with limited equipment.

I share these experiences to give a picture of what life is like.  The past week I've been running the maternity department here, which is increased responsibility from what I am used to.  Thankfully, I've had good training that God has allowed me to use during this week.  Thankfully, He also hears my prayers and works even when I am at my limitations.  Thankfully, I can see all of your prayers at work too.  The time has been challenging, stretching, encouraging and I'm glad we could serve the missionaries and Togolese here.  We pray God would use these tangible demonstrations of love to give them a picture of Christ.  Keep praying for us!

"My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me...For when I am weak, then I am strong.

2 Cor 12.9-12

~ Stephen

A Daily Brush with Life and Death

(A short disclaimer – after our last time in Togo, my pastor informed me that Lisa was the better writer; feel free to read on, but if your time is short you might be better with sticking to her posts. ;-)

This post is bit somber…I realize this as I write. That’s not to say we aren’t enjoying our time serving in Togo and aren’t experiencing many of God’s blessings. Yet my time has also impressed on my mind the brevity of life and the urgency with which we must consider our condition before God.

“So teach us to number our days that we may get a heart of wisdom” Ps. 90:12. Whether it’s in America or Togo, our time on this earth is brief. It is just more evident here in Africa because people face death in starker terms. Two days ago, a mother brought in her daughter pulseless to one of my colleagues. He attempted a short resuscitation, but it was evident this girl had no life in her. She had been treated at an outside clinic with malaria medications, but had not been able to receive the blood she so desperately needed. This girl was the exact age of my daughter Evelyn. Two days ago a pregnant women came in for “swelling.” It turns out she has nephrotic syndrome (a type of kidney disease); she is also 23 weeks pregnant. Sadly, there is often no cure for this in adults and she won’t have access to dialysis. Will she live long enough to see her baby delivered? During rounds today, a middle age lady passed away from a massive variceal (in the esophagus from liver disease) bleed…she had come in too late for our care to make a difference. Even in the US, our best medical care only postpones death. Only God has raised the dead, and though some doctors may think they are God, I have never seen one do this.

Yet still a greater question remains. How do you face death knowing you are right with God? Whether it’s in the US or Togo, this is still the crucial question: “…it is appointed for man to die once, and after that comes judgment” Heb 9:27.

Medicine doesn’t have the answer to this question. In addition, there are so many other areas of life that intersect with the medical conditions my patients have, and yet medicine answers none of these. I can treat HIV, but that doesn’t solve the sense of betrayal a young pregnant woman feels towards her husband after receiving this new diagnosis. Nor does it help her deal with the stigma those diagnosed with HIV face in her culture, nor the guilt she may feel at knowing she can pass it on to her child and may have to those she has already given birth to. After I had diagnosed another lady with a recent miscarriage, she looked at me with tears and asked why each of her four pregnancies had ended this way. She desperately wants a child; she faces scorn from society and even possibly her husband for not being able to produce one. Maybe we can find a medical solution, though the answers are fewer to the poor in Africa. But how do we deal with these deeper questions of shame, despair, and betrayal?

It is moments like these, in the midst of the sadness, that I am so grateful I have a sovereign God. Some may ask why He allows such things. Yet I ask why He should give us anything good when we have turned our backs on Him. I’m not going to try to answer all these questions here. But I want to express what I have been reminded of – that my frailties are matched by an infinitely powerful and loving God. Medicine is humbling; I have some answers, but many things I don’t know. Medicine definitely does not provide the answers to these truly important questions. This is why I am so blessed to know a God who gives His answers in His Word. He is the Creator of all things, He provides hope in suffering, and He can make all things good for those who trust in Him. “Come to me, all who labor and are heavy laden, and I will give you rest” Mat. 11:28. Praise God we have this answer! ~ Stephen PS Our bags came...didn't realize I'd be so thankful for my boxers and sandals.

~ Stephen

PS  Our last bag came...didn't realize I'd be so thankful for boxers and sandals!

A Hope Worth Sharing

I heard my Savior say

“Thy strength indeed is small

Child of weakness, watch and pray

Find in Me thine all in all”

Jesus paid it all, all to Him I owe

Sin had left its crimson stain,

He washed it white as snow!

  These words have been echoing through my mind the last couple of days. I don’t even remember hearing the song anytime recently (though ironically, today the song was randomly playing from Stephen’s itunes – but that was after I had already been thinking about it!). I expected life with a toddler here to be a challenge, but in some ways it has been an even greater one than I anticipated! Especially when said toddler has not yet started sleeping well here… as a result, I have at times felt tired and weak. And yet the Lord has softly and sweetly encouraged me with these words. In Him I have all I need, and to Him I owe all I am. I am so thankful for the “precious and magnificent promises” my God has given me, such that I have “all things that pertain to life and godliness” – including to life here in Togo (2 Pet. 1:3-4). What hope I have!

  Well, Evelyn and I have still been laying low the last couple of days. She is not seriously ill or anything, but she has developed a cough that is interfering quite a bit with her sleep. She isn’t quite herself and I haven’t wanted to spread her germs around, so we have only done a couple quick visits to the women and kids in the hospital so far. We will see what the Lord has for us to do in that area later on, but for now I am just taking care of my girl – which is, after all, one of my main purposes/roles in life right now anyway =-)  Stephen has been super busy still at the hospital… I’m trying to let him tell you about that part, but anytime the poor guy sits down to write a blog post he gets another call to go down to the hospital. =-p

  On Sunday we had such an… interesting? fun? thought provoking? slightly sad?... experience at the little village church we went to. At first Stephen and I were planning to walk down the road about a mile to Tsiko Church, which is the closest (and also the local “mega-church”, haha!). We decided Evelyn couldn’t handle the walk in the sun, so at the last minute we hitched a ride with one of the missionary ladies to her church, which is in a small village about 20 minutes away (by car, phew!). It was just a little hut made out of bamboo-type sticks, a dirt floor, and a thatched roof – about the size of most people’s master bedroom =-p There were probably about 50 people packed in there! What I loved about this little church was how they worshipped. Many of the Baptist churches around here sing a lot of American/western hymns they’ve learned from missionaries, and just give them a kind of African flavor in their delivery =-) This church did sing a hymn or two in Ewe (the most common local tribal language) that we recognized,  such as “How Great Thou Art” – which is always a treat to worship along with them! Our hearts can sing a long in English. But what we really loved was the rest – the most truly Togolese and heartfelt worship service I have seen here. In addition to those hymns, they sang their own music in their own particular way, and it was a joy to watch and even participate in! Yes, believe it or not – percussion and dancing in a Baptist church! ;-) The people welcomed us kindly and though we couldn’t understand the service (it was in French, then translated into Ewe), worshipping with God’s people is worshipping with God’s people. The sad part though was what Stephen told me later (I had to take a restless Evelyn out). The missionary lady, Brenda, translated enough of the sermon into English that it left us feeling a little troubled. Like our experience with some of the other little churches in our previous visit, this pastor (and seemingly the rest of the congregation) had much passion for the gospel and for salvation, but Scripture was not explored in depth. “Jesus saves!” was excitedly proclaimed, but the riches of what Scripture has to say about the gospel and the inheritance that is ours in Christ, His instructions for life and godliness are usually not touched on much. Many of the churches here are in such great need of teaching and discipleship. In addition to sharing the love of Christ through medicine, this is where our heart really longs to help these people. We can (at times) postpone death through medicine. We can also (at times) improve people’s quality of life. But we all eventually die – the gospel is the true answer to death, and only in Scripture do we find true quality of life! That is hope, and that is what we long for these people to fully know. The hope that encourages my heart when life is hard and gives me purpose is the same hope we want to share!

  

  Well, I was going to tell you about some funny interactions Evie has had with the people here, especially the kids at church on Sunday… but that will have to wait for another post because this one is already long winded =-p Thank you friends and family for your prayers!

Getting Settled

In reflecting on the last couple of days, I think this is the best way to share how it’s going: (I’ll call it “Bad News, Good News”… because I always think you should end on a good note ;-)

11.       The bad news is almost all of Stephen’s clothes and my shirts were in our lost luggage… the good news is none of Evelyn’s were!

22.       The bad news is I have to handwash our underwear every night… the good news is I packed an extra shirt and pair of said underwear in our carry ons ;-)

33.       The bad news is most of our food was in our lost luggage… the good news is none of Evelyn’s clothes, diapers, etc. were

44.       The bad news is Stephen and I don’t have a brush or comb… the good news is Evelyn does and is willing to share! (we appreciate all two inches of her comb, trust me)

55.       The bad news is we are all still pretty exhausted and Evelyn hasn’t been sleeping well since she’s been here (jet lag I think, plus all her teeth have been trying to come in at once =-/ )… the good news is our traveling here went off without a hitch (except for previously stated bag fiasco), and Evelyn even slept for 3/4 of the flight – which, if any of you know my daughter, you know could only have been a direct result of prayer!

66.       The bad news is my stomach is having some issues while it adjusts to the new foods and normal but different bacteria and flora in the produce here (I’m not sick, this happens every time I travel internationally)… the good news is the food here is terrific and even Evelyn has been eating amazingly well, and the food and water here at the hospital compound are clean and trustworthy

77.       The bad news is we do have some bugs, spiders, and crickets (which are nothing compared to the enormous crickets I had in my basement at home!) in our room… the good news is we also have geckos, and they eat bugs! And they are cute, especially the little ones – unless of course I step on one barefoot in the middle of the night =-)

88.       The bad news is there’s nothing quite like your own home and bed… the good news is we have a terrific large room and bathroom that is perfect for a family and very comfortable!

99.       The bad news is Evelyn sometimes finds all the people that stare at her and reach to touch her a little overwhelming… the good news is we have been treated with welcome and kindness by everyone, from the airport all the way to here

110.   The bad news is Evelyn seems to have come down with a mild cold… the good news is she has no sign of malaria, typhoid, meningitis, yellow fever, tetanus etc!

  Ok, I’ve had my fun =-) To summarize, our biggest struggles since we have been here have been improvising without our luggage, and Evelyn not sleeping well at night. Sadly the bag that didn’t make it (which apparently Delta couldn’t fit all the luggage on our flight from BWI, so they just decided to leave it in Baltimore – thanks Delta) was kind of a key one. I tried to spread our stuff out but in retrospect didn’t do a very good job with mine and Stephen’s clothes! But it’s ok, we have borrowed a few things and are making do. We’ll probably get our bag back on Wed, when another missionary family arrives in Ghana and drives here.

   Evelyn’s sleep has been a struggle, so please pray for that. I thought she would be so exhausted she would sleep like a rock the first night here and then would be changed over, but it hasn’t worked like that. We really are quite comfortable here in our room – it’s large and has plenty of shelves and drawers for our things (which makes this organizer’s heart happy!). Not only do we have a clean sink, toilet, and shower – we have two of each! I would kind of compare it to a retreat center – not a fancy HBC Women’s Retreat center, but more like your typical youth retreat in the mountains kind of place. I’m grateful for it!

Stephen jumped right in to the hospital the morning after we got here, and is the only doc here doing OB at the moment so he is always on call for OB for the next week or so. I think the midwife that is normally here will be back around then, so then they will share it. It is so nice for both of that everything immediately felt familiar from our last trip. And we have loved seeing missionaries and Togolese hospital staff again that we got to know last time - even more now since we know them already! Yesterday and today I have spent a lot of time unpacking, getting settled in, and giving lots of attention to Evelyn to try to give her as much a sense of normalcy as possible. We did go down to the hospital for a little while today and “talked” to some moms and babies (ok, so our talking consisted of me greeting them in French and thereby exhausting my French vocabulary, and me talking and cooing in English to their baby strapped to their backs, while they talked and cooed in French or Ewe to my baby strapped on my back, and Evelyn ecstatically pointing her pudgy little finger at their baby and screeching “Beebee!!!” at the top of her lungs). We handed out some stickers too, but most of the kids around right now were toddlers or babies and rather scared of the strange white lady trying to hand them something weird =-) On Monday I am hoping to be able to start going down regularly in the mornings and spending more time with the moms and babies, which will hopefully make us less scary.

Ok, sorry for being so scattered and superficial… I will write more in a few days. I think Stephen is going to try to update soon too. Tomorrow we will try to go to a local Togolese church, which I’m (mostly) looking forward to =-)

We are here!

We have arrived safely =-) Evelyn did TERRIFIC (not perfect, but soooo much better than it could have been!). Our only major travel issue is that we are minus one bag. Sadly, it is the one with most of Stephen's clothes and a lot of mine... Anyway, I will write more soon when we can. Thank you so much for your prayers!

Ready yet?

No =-) I've been asked that a lot of times in the last week or two. In fact, a few people looked at me aghast today when I told them I hadn't even started packing yet! But really there's so much packing you just can't do until the end anyway, that it just makes me feel disorganized to be half packed. Don't worry though - I have a monstrous and very detailed packing list, and I think I have just about everything purchased and ready to go.

We do have a lot to get through in the next few days though, and packing is fairly low on the list really (Stephen says that will take 2-3 hrs... but I always at least double his time estimates ;-). There are just a lot of home and life related things that have to be tied up before we leave. And I was "ordered" today to make sure my husband sleeps before we go...

We leave Wed., Jan 23 at 5:40pm EST. We'll fly to New York first, and from there we have an overnight flight to Accra, Ghana. A driver from the hospital will pick us up and drive us to the hospital in Tsiko, Togo (Hospitale Baptiste Biblique, or HBB), which should take about 6 hours. My best guess is that we will arrive there around 1pm EST on Thurs, Jan. 24. We will try to write a quick update that evening just to let you all know when we arrive safely.

Here are a few things you can be praying for us in the next few days and as we travel:

- that we will be able to get things tied up around here that need to be - including...but not limited to...some home repairs (basement waterproofing issues, long story), and a final signing of Stephen's post-residency job contract
- that we will remember (brains are getting old over here!) to do everything we need to do, and to pack everything that we need to pack - and of course, that it will all fit =-p
- for Stephen and I to work together to get ready in a unified way, with patience and without misunderstanding
- no flight delays and smooth connections 
- sleep for Evelyn, our 17m old daughter, on the overnight flight (and maybe a little for us too!)
- for all of us to stay healthy before and during our travel time
- that we will have no problem connecting with our driver ("Johnny") picking us up in Ghana
- for all of our baggage to arrive with us and go through customs easily (we are transporting some things for the hospital)
- for a safe drive from the airport to the hospital in Tsiko, Togo (over very bumpy pot-holed mountainous roads!)
- for a quick transition to Togo time (5 hours ahead of EST), especially for Stephen as he will likely be jumping right in to his work at the hospital
- that we will be patient with each other and flexible in responding to any unexpected and 'un-fun' situations that may come up as we travel
- uh, did I mention SLEEP for Evelyn?

Thank you all for remembering us before our Heavenly Father. We are completely convinced that apart from His working in us, through us, and around us - we could do nothing of eternal value (here or there). Please follow along with us on this blog, feel free to comment and encourage us, but most of all - PRAY! It is a privilege to be used by God to participated in His mission of spreading the gospel to all the peoples of the earth, specifically right now in Togo. Through your prayers, you can participate in that too!

Here we go again!

Yep, we are excited to be going back to Togo in early 2013! We are thankful to have another opportunity to go, and looking forward to what God has in store for our trip. This time will have a whole new set of challenges, as Stephen will have increased responsibility, and... well... we'll be bringing a toddler (enough said, for any of you who also have a toddler!). Our trip dates are Jan. 23-Feb. 23. We probably will not be posting much until then, but will resume regular posts when we leave. If anyone would like to review our posts from our last trip, feel free to browse the posts from 2010. Thank you for reading, and please feel free to leave comments - it was definitely encouraging for us to here from our friends and family during the last trip! And most of all please remember to be in prayer for us as we prepare.