Trading Worlds

     And just like that, 2 years have gone by. I remember preparing to move to Tenwek and wondering how I would ever learn to live in this culture, a culture I didn’t know, didn’t understand, had no frame of reference for. And now, here we are, ready to leave and rejoin our home culture. By no means have I mastered living in Africa, or Kenya specifically, but I do feel like I have figured out how to live here day by day (well, some days).

    There are things I am so looking forward to in America: clean water, consistent electricity, stores close by, privacy, the library (yep, nerd), cheese, cereal, family and friends, holidays. But there will be things to miss as well: beautiful weather year round, the view out my front window, the ladies selling carrots at my door, the man who brings eggs (and raises money for the orphanage he runs), my kids BFF’s right outside the door always ready to have a Nerf war, always being able to borrow things from someone on the compound, friends that "get" missionary life, my househelpers that brighten my home (and my bathroom), ten cent avocados and mangos.

There are the questions:  

Will I figure out how to work an oven that actually cooks at the temperature it says?

Will the grocery store overwhelm me?

Will I remember how to drive??

Will I “look like a missionary”? (if I do, don’t tell me, just buy me some new clothes)

Will I have grace when I see someone pay $4 for a coffee that could feed a child I know for 4 days?

Will I forget quickly the lessons I have learned?

Will I take what I’ve learned and use it in a new context?

Will I love the poor when the poor look very different from the poor I know here?

     My mind keeps going back to a story I heard this week about a primary age boarding school in Massai land (a little more than an hour from here) that is only feeding it’s students Wed-Saturday because they don’t have enough food for 7 days a week. Food doesn’t grow well out in their barren land where there is never enough rain. Heaven help them.

    There are lots of hard questions with no good answers. But God calls us to be faithful to what He has called us to, where we are. To look beyond ourselves to the hurting around us, to live below our means, to love the unlovely. He is now calling our family to America for the next 2 years. Pray with us that we will be faithful His call in Africa, in America, wherever He takes us. And pray that I don’t have an anxiety attack in the cereal aisle at Meijer.  

     

Last day teaching 1st grade

A surprise birthday party for one of the MK's

Field Day

Tucker's BFF, Benjamin

One last hike up Mt. Motigo on Eric's 35th birthday!

PAACS Article...and Our Future

Approximately 80% of graduating surgery residents today pursues fellowship training after residency.  I chose to do a fellowship, just not a traditional one.  Instead of learning robotic thyroid surgery through the axilla (armpit), or how to do an EVAR (endovascular aneurysm repair), I have served at Tenwek Hospital in Kenya with the World Medical Mission Post Residency Program and learned how to do surgery in the developing world.  My two years here working with seasoned missionaries and PAACS residents has taught me a lot.  I became a true “general surgeon,” learning how to do operations never taught to me in my surgery residency.  I learned how to teach and conduct myself in another culture, how to be concerned with cost and practice medicine on a budget, and about how mission hospitals are constantly balancing patient cost and their institution’s financial sustainability. 

While at Tenwek, I also learned more about PAACS.  I learned a few practical things like how the finances work, what COSESCA stands for, and what the resident’s academic requirements are.  I learned many spiritual lessons and the value of dedicated Bible study time with the residents.  Overall, I learned that we are training a generation of Christian surgeons that are going to bring about a surgical revolution to the continent of Africa.  My fellowship experience has been worthwhile. 

Surgery Residents Jack and Tony and I at Tenwek

At the PAACS conference in Brackenhurst this year I also learned an aspect about PAACS that I believe was an unintended consequence.  Before PAACS existed, there were missionary surgeons at various mission hospitals throughout Africa all practicing with minimal collaboration.  They all shared similar vision yet had similar struggles.  The creation of PAACS not only set up the structure to train residents, but it also brought missionary surgeons around Africa together.  The PAACS organization and meetings like Brackenhurst brings over 30 surgeons together and gives them the ability to collaborate, have camaraderie, provide emotional support, and pray together. 

PAACS faculty from across Africa at Brackenhurst conference 2015

First and Second year PAACS surgery residents from across Africa. February 2015

Participating in the meeting this year and helping out at Tenwek brought to my attention that many of these surgeons are struggling.  They are doing the work of several people, juggling a full surgical practice with residency program director responsibilities, hospital administration responsibilities, mission agency duties and family life.  Many surgeons stated they had too many hats to wear and not enough heads.  Burnout was close at hand, but the love of the ministry and the PAACS residents kept them going, one day at a time.

Hearing all these program reports and prayer requests made me feel excited that I will be graduating from “fellowship” soon and could help alleviate the burden.  I had been researching future locations of service, but in Brackenhurst I really began networking with people to figure out where to go.  Where are the greatest needs?  Where would my family fit in?  After many lunch and dinner conversations I suddenly I found myself feeling like I need to be everywhere, helping all these programs.  But the reality is that I can’t.  I can only be one surgeon.  There are 14 active PAACS programs at 10 sites, and by my assessment, approximately 10 more surgeons are needed to fill these programs with full time faculty.    Ten more surgeons would share the responsibilities with the existing PAACS faculty and allow the PAACS training sites to be sustainable.  And, this need only considers the existing programs.  There are also approximately 10 hospitals located in countries with atrocious access to surgical care that need to start up PAACS programs but lack the necessary 2 full time faculty to start the program.  One example is in Burundi at Kibuye Hope Hospital where Dr. Jason Fader would like to start a PAACS program.  I spent three weeks with him this year and really felt a pull to join him with the hopes of starting a new surgery residency program.  There are so many places where full time missionary surgeons are needed. 

Leading Valentine, a third year surgery resident, through an operation.

As I pray for wisdom and insight to where God is calling our family to go next, I sit and wonder, where is everyone else?  Why are so many missionary surgeons looking to me to be the cavalry coming at a time of need?  What is preventing other people from coming and joining what God is doing?  He is doing something amazing as PAACS is growing and on target to train 140 surgeons in Africa by 2020.  The PAACS budget is increasing, the number of administrative people is growing, and the number of residents is increasing.  In order for PAACS to continue to train quality Christian surgeons, the number of faculty must increase as well. 

As I prayerfully consider what my future holds, I find myself at one of those critical points in the decision tree of life.  What hospital do we serve at next?  Do I help start a new PAACS program in an area desperate for well trained Christian surgeons?  Or, do I provide reinforcements to an already existing program that needs more faculty?  No matter what, I want to serve God with the gifts and abilities He has entrusted to me.  It is also my prayer that He would be stirring the hearts of more surgeons in the first world and convicting them that there is an opportunity to get on board with the work He is doing in the rest of the world. 

Hooray for Helpers!

We wanted to take the time to highlight some people who have been a huge part of our life here in Tenwek- our house helpers! Without them, life here would be very different!!  When we first arrived in Kenya almost two years ago, we knew that we would be hiring a house helper.  First of all, I (Erin) would be teaching all morning and we figured we would need help with all the extra chores that living in Kenya requires (since there are no modern conveniences like dish washers, dryers, clean water, clean vegetables, etc).  Also, we knew it would give someone in need a job, and for us to hire someone would be very inexpensive.

So, we began the interviewing process and while the other candidates seemed fine, we really felt a connection to Regina. We hired her our first week and she has been a blessing to us every since! She is the wife of the assistant chief of her village and mom to 3 girls. She is an amazing cook, a great cleaner, loves my kids, reminds me to lock my doors, and gets things clean that I've given up on, etc. She also is a great cultural teacher, and has been a great mentor into all things Kenya.  We just love her! We have been to visit her home numerous times and even took our families when they came to visit. Every weekday, Regina gets up early and works her farm before making the 30 minute walk to our house. After work she often sells bananas around Tenwek as supplemental income before walking home. Eric's sister said "Regina is the most amazing women I have ever met."

Chopping Wood at her home

Cooking Ugali for us when we came to visit. No stove, this is fire in her "kitchen"

Regina’s birthday was last week- April 26^th. With my (not so secret) love of birthdays, I decided to throw her a birthday party! I’m so glad that I did, because she told me it was the first one she’s ever had!! Oh, for shame! We had a great lunch with some of the other wonderful house helpers from around Tenwek who are her friends. It was so fun.

First birthday cake!

With some of her friends- I love these ladies!

(Emily, our other house helper, is the first one on the left) 

She loves our boys well 

We are going to miss her so much when we are gone! I joke with her that I am taking her to America. She tells me she’s coming!

We also needed to hire someone this year to watch Tucker/AJ a few hours each morning while I teach 3^rd grade. We found a wonderful lady named Emily who has been helping to watch missionary children for many years. She is patient and firm with them (which they need!) and we have been blessed to have her around too!  Without asking, Emily often does other helpful things around the house...all while keeping AJ and Tucker alive and out of trouble (which itself is a full time job.)

Our last helper is Geoffrey who is a gardener. We don’t really need a gardener, but he needs a job, so we hire him one day a week to tend to our garden, rake leaves, etc. We are thankful for his help as well.

Many of the house helpers around Tenwek have become my closest Kenyan friends. They are hard working, wonderful people. They care about my kids, are always happy to see me, greet me with much kindness and are so helpful. They have given me a glimpse into true Kenyan life. So thankful to the Lord for these brothers and sisters in Christ!

A Visit To One Of The Poorest Countries In The World

July 1st is coming fast.  I can't believe that we are coming down the back stretch of our two years at Tenwek.  As our time winds down, Erin and I have been on the lookout for where God would have us next.  We have been exploring the needs throughout Africa and knew of a great work going on in Burundi at Kibuye Hope Hospital.  We know several of the missionary families there and decided to go check it out.  Not only did our trip serve to test the water, but also to give Dr. Jason Fader a break from the day-to-day grind of surgical practice and free him up for some administrative work.  

Even though I’ve been a surgeon missionary in Kenya the past year and a half, I have never taken care of the types of patients that I saw in Burundi.  Several kids were malnourished and had severe osteomyelitis, an infection of the bones that is hard to clear even with antibiotics and surgery.  Benjamin, a twelve year old with a great smile, lies patiently in bed with his leg in traction, as his osteomyelitis was so bad that his femur broke in half as he was walking around.  He’ll be in bed for 6-8 weeks.  Four-year-old Clarice needed an amputation of her leg, and eventually died from overwhelming sepsis.  One day on rounds I counted all of eight-year-old Aisible's ribs, as they were so prominent under his skin.  We treated him for severe malnutrition, osteomyelitis, TB, and even typhoid.  Because the lab there isn’t very robust (by this I mean we could only do CBC, UA, malaria smear and CRP), we could not clearly diagnose TB or typhoid, but he had symptoms and XRAY findings that pointed us in that direction.  

Patient little Benjamin waiting 8 weeks in bed for his leg to heal.

Terrible chronic osteomyelitis in a tibia.

Emmanuel was my most challenging patient.  He is an eight-year-old boy who has osteomyelitis so severe that he needed a below knee amputation of his right leg a few days before we arrived.  The stump of his amputation got infected and I felt he was going to need another amputation done more proximal, above the knee.  At the same time that I determined he needed another amputation, the rest of his body started showing signs of sepsis and I suspected the amputation stump as the source.  As is routine before surgery we checked his labs and found that his platelets were dangerously low (10K).  They were too low for a safe surgery.  In fact, with platelets that low he could start having spontaneous hemorrhage from anywhere.  In the US, I'd order a platelet transfusion and do the surgery.  (Actually, in the US, I'd hand him over to a pediatric orthopedic surgeon.)  But, at Kibuye we did not have platelets nor the ability for anyone to donate fresh blood.  So I had a dilemma.  Do the operation and risk him bleeding to death?  Or, don't do the operation and risk him dying of a bad infection.  I evaluated his wound and there wasn't any pus so I made the judgment call to wait it out with antibiotics.  The next morning on rounds I fully expected his bed to be empty.  But he was still there, slightly improved.  Five days later his platelets finally improved to 40K. That was all I needed to take him for surgery.  We amputated his leg at the mid thigh, and found a huge pus pocket that hadn't been draining from the leg.  It was coming from osteomyelitis of his femur and it was destroyed by infection.  He will likely need an amputation at the hip if his infection doesn’t improve. With the lack of resources, it seemed like we did just about as much praying as we did doctoring. Without a lot of tests, medicines, or fancy therapies, we were forced daily to tap into the healing power of God.  Emmanuel's platelets improved and he battles on, but he still has a long way to go.

Kibuye Hospital, located in the rural hills of Burundi, is a microcosm of the hope and growth present in a poor land.  Although they don't have many resources, the hospital is one of the best in the entire country.  A team of medical missionaries (seven doctors, three teachers/moms, and 11 kids) descended on this hospital a little over a year ago, finding it poorly staffed, without running water, and in desperate need of support.   Many of the team members, like Erin and I, had spent two years at Tenwek with the Samaritan’s Purse Post Residency Program.  After their “training,” they found Kibuye, and decided that the potential of this rural hospital was too good not to invest in. Their goal now is to pour their lives into a generation of Burundian doctors and teach them how to practice medicine and follow Jesus.  This amazing group hopes to do this by turning this 100 bed hospital into a 300 bed teaching institution that will take care of rural Burundians and provide a platform for teaching. 

Surgery rounds with my team...two interns, twelve medical students, 4 nursing students, and a physical therapist.  I was recruiting the guy in the back to play BBall for Michigan State.

Patient ward at Kibuye Hope Hospital

Contrasted against the hard cases were some challenging yet fulfilling cases.  With no orthopedic surgeon, any patient with a broken bone is also taken care by the general surgeon.  Usually this is Dr. Jason Fader, who is a great carpenter as well as surgeon...which allowed him to learn some basic ortho rather quickly.  Relieving him for the 2 ½ weeks now gave me opportunity to do some bone carpentry.  Several patients presented with broken femurs (the bone of your thigh) so I put a metal rod in the middle to stabilize the fracture while it heals.  Instead of two months in traction, they can get up with crutches the day after surgery.  My dad would be proud of my new carpentry skills.

Mid-shaft femur fracture before surgery

After surgery, using the SIGN nail system.

One morning at Kibuye, as I walked down the red dirt road that leads from the missionary houses to the hospital, my mind was busy thinking about what to do with the sick patients awaiting me, and trying not to step in the mud puddles created from the previous night’s rain.  On one side of the road was the local church with a big field.  On the other side were a few old mission houses that are past their prime.  I passed a few Burundian men on the road, also on their way to work. They were scruffy guys, aged beyond their years and dressed in well-worn clothes. “Amahoro,” they greeted me.  “Amahoro” I responded, the only Burundian word I know.  Literally translated as “peace,” saying “amahoro” is a common way to greet people, and I hear it many times a day.  Fitting that such a greeting is used so often in Burundi, a place that until recently hasn’t had much peace. Since independence, Burundi has been ravaged by many civil wars. Thankfully Burundi has been peaceful for a few years now and the country has started to reemerge from their dark past.  Scarred from the war, Burundi is one of the five poorest countries in the world, with one of the lowest per capita GDP of any nation.  Some have even classified it as the hungriest nation on earth.  Perhaps greeting each other with “amahoro” is a way of reminding each other the devastation that war brings, and the stability that comes with peace.

The men I passed on the road that morning were on their way to work too.  Kibuye is employing hundreds of locals for various building projects; from new missionary houses to patient wards, a new church, and a plant for processing busoma (a nutritious grain that is fed to malnourished children.) Three other families have agreed to move to Kibuye, including an engineer, a second ophthalmologist, and a family practice doctor.  Five years from now, Kibuye will look like a totally different place.  Erin and I are trying to figure out if Kibuye is the right place for our family and if we have a calling to minister to the Burundian people.  

                       

Medical student housing, one of the buildings newly constructed on campus.

Pray for us as we try to discern what is best for our family.  We have just returned to Tenwek, and then will go back the US at the end of June / early July.  A lot of changes are happening, but we know that with change comes the ability to increase our faith in God and what he wants for our lives.

Two surgery interns Marvin and Gad.  They hope to join a PAACS program next year and Dr. Jason Fader is getting them ready!!  I was fortunate to have them, as they both spoke French and English (as well as Swahili and Kirundi)

Our Big News!

We have been blessed with 4 amazing little boys. Each one is so unique, (how can they all have different personalities?!) and special. 

We enjoy them so much and thank God for how he has blessed us. We don’t take that lightly. However, there has been a stirring in our hearts for some time that our family is not complete. With all this rough and tumble light sabre battling and Lego building, we are in need of a little pink in our lives :) . 

Many of you know our story, that we are unable to have any more children. So God has placed on our hearts a calling, from James 1:27. And friends, it must be a calling, because anyone who has walked this road will tell you it is not easy.  

WE ARE ADOPTING!

 

Every adoptive family’s story is different. Some know they want to adopt from a certain country. Some know they must have an infant. Some are drawn to the foster care system. Some aren’t looking at all, and then it falls in their lap.

For us, we didn’t really have a strong pull any way except that we knew we wanted a little girl.

When we moved here we knew that we wanted to try and start the process from Kenya, as to not waste any more time. Since it is such a long process, we didn’t want to put any more of our life on hold by waiting till we returned to the US in the summer of ’15.

We didn’t know where to start at first, so we prayed. And prayed. And prayed. We felt we needed to just wait. So we waited. Then finally we were led to Lifeline Children’s Services. They came highly recommended AND they were the ONLY agency that would let us start from here. BINGO. Now let me tell you, living in a country other than the US and trying to do this process is CRAZY. But you already knew we were crazy.

So...where are we adopting from, you ask? We are adopting a special needs child from China. We are so excited. And nervous. And scared. And happy. And....you get the idea. Why China? It just fit our needs/desires. 

Our timeline from start to finish is approximately 18-24 months, much faster than a lot of international programs. We have been working like crazy; trips to Nairobi, fingerprinting, sending mail back and forth to the US, doing online education with limited electricity and internet.......and we are *almost * done with our home study! We found an awesome American social worker who lives in Ethiopia to come over and do the home visit. That wasn’t without it’s own set of crazy. Her plane was late and our first meeting was from 10p.m.-midnight! 

So, we ask that you would pray for us, pray for HER, our beautiful child that we don’t know yet, but our loving Heavenly Father knows so well. Pray for US, that our waiting would count, that we would use this time to PRAY, to PREPARE, to GROW in our faith. Pray for our BOYS, as this will rock their world, as every new child entering a family does. Pray for our adjustment, bonding, etc. Most of all, pray that GOD would be glorified in this process and in our lives.

We will keep you updated as things progress, feel free to ask questions...we’d love to have you on this journey with us!

It's the Most Wonderful Time of the Year!

It’s the Most Wonderful Time of the Year!

And this year not just because it was Christmas, but because Eric’s family came to visit!

We filled up our days with 7 extra people: Joe and Diana (Eric’s parents) and Doug, Crista, Ella, Annabel and Charlotte Reaves (Eric’s sister and family).

Wow! How to cover what we did in 2 ½ weeks...

I will hit the highlights and low points...

Highlights:

Birthday parties- 2 of them! Cole turned 9 and Ella turned 8!

 

A “coming out” party! No, probably not what you are picturing! When boys are around 13-15 they get circumcised and go away to camp for a month, “coming out” as a man! It was filled with food, lots of waiting around, rain, speeches, cramming 70 people into a room and everyone eating stale cake off the same fork. Oh yeah, and trying to get home down a muddy hill in pouring rain. What could be more fun!?

                                                       Climbing Mt. Longanaut! (not the kids)

Christmas Caroling at the Hospital and a fun party.

Christmas Eve- climbing Mt. Motigo, yummy dinner, church and games!

Christmas Day- good food, gifts and relaxing and sledding on fake snow :)

 Bosto Children’s Home- going and putting on a Christmas fun program for kids in an orphanage

Safari!!!! No more needs to be said, except for some members of the family did not LOVE the fact that 6 lions were circling our jeep.

Dr. Joe and Dr. Crista going to work with Eric.

 Haircuts for all by Nana! (thanks Nana for that ministry to Tenwek!)

Going to Regina’s house to learn how to chop wood,  make ugali and cut sugarcane.

NYE homemade waffle cones, fun and games.

Going to dedicate the house that we mudded a month ago, so that Amos can move in!

Lots of game playing, laughing, reading, hiking, food prep, and fun!

Low points:

Discovering Crista’s passport was not valid for travel at the airport so she ALMOST didn’t get to come! Stress! Thankfully she was able to come one day late.

Doug tore his Achilles tendon the FIRST day they were here! :( Limping and not as much fun for Doug. 

Lost reservations at the Fairmont= almost NO safari.

Stomach bugs, bee stings, allergic reactions.

Torrential rains that got us stuck lots of places.

Flat tires. 

The good far outweighed the bad and we are so glad they were able to come! They were a huge blessing to us just by taking time to be with us and love us well. We miss them so much and look forward to seeing them again in 6 months!