"medical tourism" and other firsts

I'm not actually sure what "medical tourism" is...but I'm pretty sure the last 2 weeks of my life would fall into a category with a name like that.  Two weeks ago today, Bethany and I decided around mid-day to pack our bags and get into the truck and drive to Juba in order to be able to fly the next day via Uganda to TZ where our beloved teammate was sick alone admitted to a hospital in Arusha with what we heard was 2 strains of malaria.  We ended up getting her on a med-evac flight to Kenya and admitting her to Kijabe Hospital for 5 days and along with a whole slew of adventures here's a few "firsts" from the last two weeks...

•  First time in Tanzania - Let’s hear it for another new stamp in the ol’ passport! - winning the prize for: "best and ultimately most unimportant bonus of the last 2 weeks"

• First time flying on TZ’s “Precision Air” - winning the prize for "best bologna sandwich on wheat ever served on an airplane”

• First time on a med evac flight - and hopefully the last! Winning the prize for “the first opportunity I really felt free to take a deep breath and relax in someone else’s care" of our precious patient

• First time to be *hot* for the entire duration of a flight - winning the prize for “my only complaint about our AMREF Flight Doctor’s med evac experience”...and really, nothing at all consequential considering the circumstances

• First time riding in an African ambulance - or any ambulance at all actually (Arusha, TZ & Nairobi, Kenya) - for future reference I do not recommend riding in the back of a pressurized ambulance on a side facing bench on a particularly bad African road if you have a fairly strong history of motion sickness...but I do recommend doing it when needed so that a sick friend isn’t alone.  The Kenyan Red Cross winning the award for "the snazziest African ambulance EVER" - if you ever find yourself deathly ill in Kenya, look 'em up.

• First time sleeping on an African hospital floor - or any hospital floor actually (Arusha, TZ & Kijabe, Kenya) - Kijabe Hospital’s Private Ward wins the prize for “best hospital blankets which can easily double as sleeping palates when folded in half”

• First time ever having left the house headed to an airport without tickets booked or a plan B - and not only once but twice in the same trip (South Sudan & Kenya) - Air Uganda winning the prize for “most unhelpful airline staff by phone”  AND “most helpful airline staff in person”

• First time seeing the effects of severe malaria on a non-immune, non-African person - this particular patient winning the prize for "the face appearing more colors in the same hour than any other known malaria patient" ;)  AND “the most brave non-immune, non-African, severe malaria patient to stick it out alone as long as she did in a strange country”!

• First time watching an African presidential debate (Nairobi, Kenya) - Kenya winning the prize for “the most presidential candidates who are apparently not actually serious contenders for the top post in their country”

• First time talking by telephone with a person in Japan (our precious patient’s mom - who wins the prize for “most patient mother of a severely ill child on another continent relying almost exclusively - for the first 24 hours I was involved - on information by one-sided international text message”)

• First time taking part in a crisis being managed between 6 countries/3 continents (South Sudan, Uganda, Kenya, Tanzania ,USA, Japan/ Africa, North America, Asia) - and for very possibly the first time ever, Africa wins the award for "getting the most done in the shortest amount of time"!

• First time using 5 SIM cards in 2 days (SS - MTN, SS-Zain, Ug - MTN, TZ - Vivacell, Kenya - Safaricom)  Vivacell TZ winning the award for "worst SIM card purchasing/registering experience EVER" and quite possibly "the point in the trip in which Heidi was closest to flying *completely* off the handle" - and this was before we ever made it to the first hospital...

• First time splitting the drive to Juba up over 2 days - thankful for the pause in the constant bumping and jumping - thankful also for the *few* hours of sleep afforded us in the fairly safe/clean hot box of a room we rented for the night - not so thankful for the award wining "cockroach party in the latrine" - win based sheerly on number of cockroaches in attendance - thankful for being travel-dehydrated enough that I didn’t have to use said latrine while staying at said lodge.  Proud of Bethany for braving it! Go girlfriend!

• First time that residents of Rokon, South Sudan witnessed the sight of two white women in a white pickup truck driving up and down the *very* small strip of shops in their village, in the dark, looking for a lodge called Muze’s place, about 4 times, going in and out of each opening in the bamboo fence we were told to look for when actually the “bamboo fence” we were looking for was a brick wall and the name of the lodge was something starting with a B or a G, certainly not “Muze’s place” on the sign...winning the award for "turning the most heads in the shortest period of time"

• First time to delay travel on a day of fun & relaxation due to “riots” - aka students protesting in the street across from the mall we were visiting by setting fires near a neighboring petrol station...winning the prize for "the worst way to spoil what had been a *wonderful* day of doing whatever we wanted"

• First time wondering if my “black cloud” - known to follow me most every shift at St. Louis Children’s Hospital - had followed me to Africa just in time for this event...winning the prize for “the least hoped for outcome” of such a trip...

• First time to have a taxi driver get out of the vehicle he was driving, not once, but three times: first to convince other neighboring traffic jam vehicles to pull out into the third and actually nonexistent lane known also as *oncoming traffic* to avoid being stuck for hours behind a stalled car, second to direct the driver of a brand new volvo how to pull around the car infront of him he was fearing would certainly scratch the paint of his new ride, and third to “have a word” with the traffic police at said intersection about how best to order the lines of cars allowed to move when and where in order to achieve optimal traffic conditions - thereby easily earning the award for “most proactive taxi driver ever.”

• First time to observe the riotous performance of street corner comedians in a major African capital (downtown Nairobi Kenya at rush hour complete with 2 “clowns” dressed in ragged coat tails, wearing hats and beards painted on their dark faces with toothpaste or something white of the sort along with black tribal markings, and blackened front teeth, carrying old cordless phones and canes and a few other props around which their comedic entertainment was staged - involving us as passengers in vehicles stopped at their corner waiting for traffic to move and pedestrians greeting each other like long lost friends who managed somehow to completely ignore the prodding of said comedians) - winning the prize for “most random sighting of the last 2 weeks”

• First time partnering in crisis management with the lovely Bethany Ferguson.  Turns out we make a good team.  A good realization and perk of the whole trip - twas a pleasure. And Basin, as she is affectionately known here in Mundri, is the winner by far of the award for "most phone calls/text messages fielded/social appt's made & kept/taxi driver interactions/conversations held" in this whole ordeal...like a machine I tell you.

• NOT the first time managing medical crises with the Drs. Myhre, but a pleasure as usual.  These two are the clear winners of the "maintaining the most roles and activities through said medical crisis" award...hands down.  Being on call for multiple other wards/services, hosting us as visitors, being class sponsors for the Junior class on Banquet weekend at RVA, parents, spouses, field directors, etc.  It's almost inhuman.  Myhre's are a unique and wonderful breed. 

• First time to travel through 4 countries and not take a single photo - just wasn’t *that* kind of trip - although it was the kind of trip in which God’s provision and real presence were very evidently in remarkable ways the *whole* time - winning the award for “best opportunity in recent months to see the body of Christ and God Himself at work in *very* tangible ways.”

To God Be the Glory, Great things He has done.

"Baby it's HOT outside"

The trees and ornaments and paper snowflakes are long packed away again, the sing-a-long music familiar to all of us in the team house has been replaced by whatever musical craving someone has who felt like listening to something.  The readying of presents and cooking baking and recreating of traditions has been replaced by planning for next month’s crazy travel in/out of the country, in/out of Mundri, handing over of responsibilities to cover for upcoming travel, strategic planning and “cluster” meetings, and questions of why are we here and how best to be collectively and individually faithful to our calling(s).

I have been asked what the holidays are like here, by many who have a hard time imagining spending Christmas in a place where you sweat instead of shiver, where it’s the crackle of the dry sorghum blowing in the afternoon wind that you hear instead of the howling of the cold wind in a snowstorm, where the special beverages are frozen mango slushies with a splash of lime instead of peppermint hot chocolate or steaming wassail from the crock pot.  So, on the last day of January, it's about time to give you a glimpse.

On several of our Christmas ipod mixes here, the song “Baby it’s cold outside” popped up fairly often...thing is, here in South Sudan it couldn’t be further from the truth.  My sister told me it was 19 degrees F in St. Louis on Christmas Eve, it was approximately 90 degrees hotter than that here on the same day.  Every once in a while you would hear someone sigh and sing along with a “Baby it’s HOT outside,” and everyone in the room would twist their brains in a knot trying to imagine the classic American Christmas images we grew up with, from movies like It’s a Wonderful Life, of cutting down evergreen trees while bundled in coats, walking in snow filled streets, ice skating and drinking hot chocolate while hovering by the fire.

Christmas looks different in South Sudan, but we do what we can to recreate some of our family traditions when possible and adopt new traditions for the rest.

We had a Christmas tree - with low energy usage LED fiberoptic lights:

“Snowflakes” in the form of Christmas lights (again, low energy LED's) and paper cut-outs:

The Norwegian “White Dinner” complete with lefsa but with pierogies and chicken kebabs grilled outside over charcoal instead of the traditional baked fish(?):

the whole team at our "white" christmas dinner

We shopped for presents in the market instead of the mall:

we wrapped presents, but with kitenge cloth not paper with santa’s and reindeer:

We cooked Christmas feasts with our South Sudanese friends, involving butchering the cow with meat that is still quivering instead of a trip to the grocery store:

and cooking with firewood over three stones instead of turning the appropriate knob to light the oven to the correct temperature.

the Christmas feast preparations at my church 

and the firewood required for cooking said feast

We made Moru Christmas cookies with friends, involving mixing the ingredients with your hands in a basin on the ground instead of a KitchenAid mixer on the counter:

about to get my mixing on

Larissa cranking the "cookie mill" with a friend laying them out neatly on the greased pan

the oven is in the back on the left behind us heated by hot charcoal on top,  pans of cookies go inside

We gave packages of gifts to friends, walking/biking to their house with the packages in our bike baskets instead of wrapping brown paper packages and putting them in the mail:

We made familiar Christmas sugar cookies but with carefully distributed butter from we flew in from another country (Uganda) instead of Land’o’Lakes from Schnucks:

and an advent wreath with plastic greenery instead of fragrant evergreen clippings from the neighbor’s yard.

There were special Christmas outfits that are borrowed from friends and strategically planned to be as cool as possible, instead of newly pressed and with as many layers as possible to keep warm:

special hair-do’s that are done while sitting on the cement water run-off drainage canal from the borehole next to your friends’ house, instead of in a beauty salon with lights around the big mirror and a hand full of machines to make your hair look the way you want:

hours of washing dishes with water from a 50 gallon drum filled by young girls carrying heavy jugs on their heads from the pump and reusing the previous bowl full of water for watching each bowl under it in the stack and strings from a sugar sack as a scrubbing sponge, instead of a dishwasher where you load organized racks and dump the soap in and press START:

(really I could write a whole blog post just about the dish washing scenario...complete with marriage proposals - and my prompt refusal with the single word “sorry”- and input/suggestions/scoldings from about 4 different women on my technique of what felt like washing and rewashing the same 20 beef-greasy plates with minimal amounts of cold dirty water used to wash the plate before...fun times, fun times :)

a night of Christmas caroling where children run from neighboring compounds to hear our meager attempt at singing, and where women “ay-yi-yi-yi-yi” in the dark during our rendition of “God Rest Ye Merry Gentlemen” instead people who are not interested closing the front doors of their well lit and warmed houses:

Viewings of The Nativity Story movie at two local churches, projected outside at dark on a tarp screen:

gingerbread houses decorated with hovercraft and florida 'hood themes:

Andrew & Gaby's hovercraft house

Melissa & I's Florida 'hood house

nativity story re-enactments complete with trophies and genie lamps as frankincense and myrrh:

holiday parties at the neighbor's house complete with men playing dominos and women cooking:

Jenn honing her kisra making skills (Moru spongy flatbread)

St. Nicholas' day (thanks to Bethany) with grass baskets instead of sturdy shoes, and Far Side comics and Christmas Trivia cards instead of coal or oranges:

Crafts with friends (cross stitching instead of knitting cold weather garments):

portraits with Santa and Frosty except with shaving cream instead of a bushy fake hair beard:

 

and Christmas morning conversations with family that are actually Christmas morning for them but Christmas evening for you, and over a blurry Skype video stream instead of face to face at the kitchen table over hot cinnamon rolls :(

It was all good, really good.  It was a good combination of quality time spent with different groups of people I love.  Hot, yes, but fun, cheerful, festive, meaningful, encouraging, relationship solidifying, tradition building and Christmas just the same.

Evacuations

No, there’s no security risks, we’re not being evacuated from South Sudan, I’m rather referring to the medical term used here to describe a procedure following an aborted pregnancy (whether elective or spontaneous) to “clean out” the woman’s uterus if she has persistent abdominal pain following the abortion, or is having trouble conceiving when she has been successful in the past.  We call them D&C’s in the USA.

I’ve seen 4 of them in the last 2 days that I’ve gone to the health center.  One for a woman having difficulty conceiving and 3 for women who have lost 2nd trimester babies days/weeks before, and 3 of them back to back yesterday.  It’s been a smack of reality for several reasons.

1) It’s out of my usual pediatric/wound care nursing realm - my only OB/GYN experience was while studying abroad in Israel 13 years ago.  I think getting experience from different angles of medicine is really eye opening.  Usually I get to take care of children who are sick, but survived childbirth at least.  This is caring for women whose bodies could not, or chose not to, sustain life for one reason or another.  Seems like it should be similar but felt very different - and very outside my skill set.

Whether it’s true or not, there’s at least enough prevalence of syphilis here in Mundri
to cause Zebra, the Theatre Assistant/Nurse who does the D&C’s, to blame the 2nd trimester spontaneous abortions on the presence of the disease even though their medical histories including nothing of it...Again, I’m used to treating children, some of whom have STD’s but not as many as I’ve seen in adults young and old here.  The promiscuity evidenced in the prevalence of syphilis is disheartening/maddening depending on the day.

3) The way that women’s usually private anatomy is treated during the procedure like a car being worked on by a mechanic makes every muscle in my body tense up (similarly to Scott’s while we watched Zebra do a couple circumcisions a few weeks ago).  Metal rods and forceps and clamps and such (no idea what the instruments are actually called) being shoved and scraped around inside there is not what our bodies were made for - I’m pretty sure of it after watching that as a woman.  NOT OK.  But that’s just it, death occurring inside of us isn’t what our bodies were made for either.  One in certain instances requires the other.  For some reason the car mechanic approach is easier for me to handle when there’s a scalpel and cutting involved...shoving and scraping things inside natural orifices is just disturbing - kinda like dentistry...


Death is just a hard reality, whether the woman has chosen it for her body/offspring or not.  The 3 in a row thing yesterday made the reality of the loss of life here even more in my face.  And this is after being greeted in the morning by a friend who when I asked what the news was, she told me “akubar mafi, kulu mutu bes” - “there is no news only that everyone’s dying.”  We talked about how it seemed like there were funerals daily (and yesterday I knew of 3) for people young and old, important people and lowly people, everyone here is susceptible, no one can escape this reality.  She went off to bury her cousin-sister’s 9 mo baby who died that morning at the hospital 45 minutes away, and I went off to the maternity ward where Zebra was waiting with an apron, mask and sterile gloves for me to help her face a similar reality, just a different form and  just a few steps removed.

And the reasons go on.  But I rushed home to cook dinner for the team and be a part of a house chores discussion and Bible/book study re. our calling and why we are here in South Sudan and what that and we should look/live like here.  Not even a re-run of the Cosby show could quite shake these realities from my mind...if Bill can’t do it, you know it’s serious :)  But that’s why I’m here, to offer help and hope in the face of such realities,    I pray that’s what I did.

breech

32 years ago today, my mom produced.  She was 26 years old.  It was before malpractice insurance was sky high for obstetricians, before childbirth and parenthood and access to information were what they are now.  But my mom had been around the block.  Not only had she produced (the african version of "given birth to") me 20 months before, but she was working as a Labor and Delivery nurse at the time...so when the nurses told her that the baby she was in labor with had turned since her last appt. the week before (which "they" say never happens) and was presenting in breech position, she knew a few lives were at risk, both hers and the baby's. 

She was less than two miles from home (a 7 min. car drive away according to Google maps - about right from experience) in a teaching hospital, not only with experienced doctors, but a host of doctors in training (residents) and medical students and, of course, nurses.  One of the residents came into the room, intending to deliver my mom's baby, but my mom knew better.  My mom, who is never rude to people she doesn't know and bends over backwards not to appear to be so, said to the "youngster" - "Don't take this personally, but I'm waiting for the attending."  And she did.  Although I'm not sure how long.  I'm also not sure how to spell the Dr.'s name, but from the stories it's pronounced "Toddy."  She knew Dr. Toddy had been around the block too, and she knew that the difference between experience and lack thereof in this situation could be the difference between life and death.

Dr. Toddy came.  The first of the baby to come were the feet.  They were blue.  My dad started to cry.  It wasn't until Dr. Toddy skillfully delivered the rest of the baby boy's body and he began to cry that the tears turned to tears of joy.  They named the 9 lb. 13oz.  bruiser, Jeffrey Kurt. In Lutjens fashion the boy's middle name was that of his father.  It was December 14, 1980 - St. Louis, Missouri.

The rest of the story goes that when my dad went home to look after me and brought me back to the hospital, I looked a hot mess waddling down the hall dressed in red corduroys with a pink sweater and spaghetti sauce all over my face...but I digress...the story's not actually about me for once...

Fast forward 32 years.  It's 7pm on November 28th, 2012 - Mbari, South Sudan.  Citi is 23 years old.  She has just begun laboring with her firstborn.  Her husband is around and is active in the community as a Community Based Distributor (CBD) for first tier basic community medicine interventions. Citi's mom, the grandmother of the baby, is a TBA (Traditional Birth Attendant) and is present to deliver her grandchild.  Citi labors at home, in a mud tukul with a thatched roof.  It comes to 10pm and the baby starts to come - the bottom is first...eventually the feet come...but everyone knows there is a problem.  The rest of the baby won't come...hours go by.  The phone network is poor, often calls are dropped or the reception is close to un-intelligible.  Mbari is what you call "the bush." Attempted calls are made all night to reach anyone who could send a vehicle to get Citi and the baby to help.  No one can find anyone with a vehicle to come.  Someone gets a hold of James.  

James is Citi's paternal great uncle.  His late brother was Citi's father, so now James is the one "responsible for" Citi and her well being.  James is a primary school head teacher and a pastor in the Episcopal Church of Sudan.  James lives near Mundri, where the phone network is a bit better, and knows Bishop so he manages to get through to him on the phone to request use of Bishop's vehicle to rescue his "granddaughter." It's now 7am.  Citi has been in the process of delivering her firstborn for 12 hours now.  Bishop is on his way to the bus park, headed to Juba.  Our teammates drove him to the bus park and he passed along the request for vehicle assistance to the teammates who gave him a ride.  Bethany knew James and John was willing to drive, so they set off, not know what they would find when they arrived at Citi's house.  They knew she was in trouble, that the baby was breech, but that was it.  Both Bethany and James are brilliant individuals, but neither has a lick of medical training, and with both the mother and baby's lives in jeopardy, they were wisely feeling outside of their comfort zones.

When "Brown Sugar" our beloved passenger Land Cruiser reached Mbari, Bethany went inside the tukul and there were 25 people standing around Citi, who was laying with a gray baby laying between her exposed legs, head still inside her body.  A dead, not yet fully delivered baby.  Not something a nurse sees everyday, let alone a teacher/counselor and a water engineer.  Bethany and John's instinctually accurate fear told them they needed to get moving, if the mother's life was to be saved.

Citi and her not yet delivered baby, still on the mattress she was laying on, were carried outside and laid into the back of Brown Sugar.  Her mom climbed in next to her along with another female relative.  Citi's husband, James, Bethany, John and another male relative, climbed into the front 2 rows of seats and took off towards help.  John was at the wheel.  Bethany was manning the phones - hers and John's,  trying whichever would get the best signal at any given time, on whichever network happened to be available at that given time.  She managed to get a couple calls through to Scott, the PA, but the reception was terrible and he couldn't understand much of what was needed other than the question of whether the Mundri Health Center would be able to help Citi or if they needed to drive further on past Mundri to Lui Hospital where there is a doctor.  Scott decided he was pretty sure Mundri would be of no help, that unfortunately Lui was the closest place Citi could find the help she needed and that was about 45 min. past Mundri.  He also decided the 2 of us could be of help once they came through Mundri, and after asking if I was willing to go, which I of course was, he gave me instructions as to what supplies would be good to have on hand in the vehicle...IV start supplies, and IV fluid supplies and where I might be able to find them in the house.  He went to confirm at the Mundri Health Center that Citi needed to go to Lui, and I hurriedly gathered supplies...thinking of a basin at the last minute in case there was a lot of blood and the baby was going to be delivered in the vehicle so that we could try to limit blood spread and have something to put the dead baby in.  Thing is, I had just set my laundry to soak in my basin, intending to wash it sometime that day (obviously that plan was slightly waylaid at this point), so I ran by Andrew's tukul asking for his, so he dumped his dirty laundry out and off I went with a basin full of IV fluids and needles and syringes and tape and such.  Scott went of to find more fluids and we met at the roundabout where I'd told Bethany in a very crackly phone call that we'd be waiting when I confirmed with her we would need to go on to Lui.

Brown Sugar rumbled down the road towards the roundabout with dust flying behind.  Scott has one of the women in the back re-locate to the front to make room for us next to Citi.  I climb in first to be closer to her arms, and Scott climbs in after me, positioned to examine the baby and the rest of Citi to see how dire the situation was.  We were told Citi was in and out of consciousness along the road, which worried us, but other than that, we knew nothing.  As we were arranging in the back, John got out to return to his work, and Bethany took over at the wheel.

I started opening cannula packing and putting gloves on to put a couple IV's into Citi veins for fluid replacement since we knew that in 12 hours she had to have lost a LOT of blood.  Scott lifted up Citi's skirt, and we both got a look at the gray baby girl basically hanging out of Citi's body.  There wasn't any bleeding currently, thank God.  Deep breath, and I went back to my task of IV insertion, knowing I was just wasting precious time by looking/pausing.

Now, if any of my nurse friends are still reading, they will gasp or laugh at the fact that I was the best choice available for the person to put in 2 emergency IV's in a severely dehydrated woman while bumping along a TERRIBLE dirt road in the back of a vehicle!  Venous sticks are NOT my strongsuit.  Never have been.  But today was a day for prayer.  I learned from Michelle K. back at SLCH the short prayer of "Sweet Jesus, please!" when a patient really needed an IV and veins were few and far between.  Citi's were TINY.  The "Sweet Jesus"prayers began as I wrapped the glove around her forearm as a tourniquet.  (Scott told me later he was praying like crazy too!)

The few IV skills I do have work best when I can see the veins really well, so I asked Bethany to stop the car for a minute and in I went into her left hand with a #20.  I didn't think I'd be able to get the #18 in the tiny vein.  The first vein was shifty, but eventually by God's mercy (and it really was His mercy alone), I got a blood return and threaded the cannula in successfully.  Bethany started driving again and Scott had hooked up the fluids line while I was putting the IV in and so the water started dripping.  I held the bottle while he listened to Citi's heart.  She was tachycardic, which was good, so I went back to attempt the insertion of IV #2.  Bethany had to stop again for me to be able to get #2 in without poking Citi's eye out with all the bumps.

Bethany was a great driver.  It was a tricky ride, she knew Citi needed to get to the hospital ASAP - so she needed to drive fast.  She also knew that we didn't want the baby to come out while we were in the vehicle so she couldn't go too fast in fear of jolting the baby out and the mom bleeding to death in front of our eyes.  Bethany balanced all the factors with expertise, weaving all over the road to find the best path.  We decided on this trip to coin a new term.  Instead of "the grass is always greener" on the other side the South Sudanese equivalent should be "the road is always better" on the other side...it's a tricky business this driving in Africa, and Bethany totally rocked it!

An #18 IV went into Citi's right hand with relative ease and then all we could do was wait.  Scott held the 2 bottles of fluids dripping "wide open" into Citi's veins trying to giver her the water and sugar she needed to stay alive until we reached the hospital.  I had gotten motion sick as I focused on Citi's hands in the back of the jumping/bouncing vehicle, so I finished taping the IV and promptly stuck my head out the window and vomited several times.  I felt like a wimp, vomiting from motion sickness when this woman was lying here, no doubt in excrutiating pain, without making a peep. Scott asked Bethany to stop so I could shift to the front and in minutes I was nausea-free.  

Citi was alert and appropriately responsive throughout the whole trip from Mundri to Lui...about a 45 min. drive.  Can you imagine?  Riding in the back of a vehicle, with your firstborn child dead between your legs, who not more than 12 hours ago was kicking in your stomach, trying to let you know it was time for her to come out, with 2 strange white people hovering over you poking you with needles and looking between your legs with downcast faces...I can't.

As we were driving, as I was trying to look for the best vein, I heard a couple phrases of a song playing from Bethany's iPod up front:

"You make beautiful things

You make beautiful things out of the dust

You make beautiful things

You make beautiful things out of us" - (Gungor)

It was a song I'd heard for the first time just a few days before, when our teammates John and Andrew had done a harmonized duet of it at our retreat.  The first time, I'd been more ready to believe it's truth, this time, in the back of a vehicle with a laboring first time mom and a dead baby, I wasn't quite sure but was holding on with a white knuckle death grip that it could be.  That if there were to be something beautiful to come of this: God would have to be the one.  Please Lord, I silently prayed as the song played on, please make something beautiful out of this.

We reached the hospital - a 2 hour journey for Citi and her family, a very kind midwife met us as we backed the vehicle up to the delivery room porch.  Several people lifted Citi & Baby with their mattress onto a stretcher which they then pushed into the delivery room.  Scott and Citi's mother went in with her and the midwife, then the doors were closed.

Bethany and I waiting outside with the rest of the family.  At one point, the family said "the baby must be out, Citi made a noise and now she is silent."  A white doctor went in and out of the room a couple times...Dear Father, spare Citi's precious life, I prayed.  Bethany and I talked about loss and death in this place, the reality of women here and the reality of childbirth here...the distance from health care, the lack of vehicles, the public exposure of your body in such a situation as Citi's and in such grief, how Citi and her baby girl put "faces" to the numbers of "infant mortality" statistics, and the risk factors for pregnant mothers in this country...

We waited until the baby was delivered and brought out in a small cardboard box to be taken home for immediate burial.  We waited until we knew Citi was a bit stable and with her mother and the rest of us left and returned to Mundri by the same road.  We sat and mourned with wailing women who greeted us when we arrived with the box carrying the nameless baby girl.  We sang, we prayed as the small hole was dug.  We were served tea and we said our goodbyes.  Bethany and I took a couple people back 4 days later for the final prayers, an ECS burial tradition.  Everyone was so thankful to us for the help we provided, and we tried to re-direct the thanks to God - afterall it's His vehicle, His supplies, His  gifts in the skill sets we have.  I've heard Citi was to return home from the hospital this week, hopefully physically stable enough to have the freedom to do whatever remaining grieving she needed to do.

God made my wonderful brother out of the dust of fear my parents had 32 years ago, a beautiful thing indeed.  

14 Dec. 1981 - 31 years ago - Jeff's 1st birthday (as I look on)

Now my prayer is that he would make something beautiful out of the dust of the loss of Citi's baby girl...the dust of the disparity of resources in our world, the dust of death.

"I want HOME!"

A blind pianist named Ken Medema wrote a song that echoes this thought over and over again.  It's a simple song, one I've been listening to since I was in elementary school probably...one of those songs I never knew would fill out it's meaning in exactly this way decades later.  Between the echoes of this longing the songwriter names all of the things he hopes for in a place he would call home...

• a place to hang my hat
• a place to learn to run
• a place to be alone
• a place where someone cares or maybe no one cares at all
• a place out of the sun
• a place to scream and shout

etc. What would make your list of things you long for in a home?

Mine was called to question this last week.  Is a place where you have to question the male:female ratio's present at any given moment, wondering at certain times of day who is where and what people might think, altering your activity based on who is where when, a place I want to call home, or ask anyone else to call home?  

It came to our attention that the cultural perception of a man and a woman sitting inside a room at night without anyone else present, even if said room is the kitchen and the door is wide open and the lights on for all to see, is that the man and woman are sleeping together.  So, when Scott goes to someone's house for dinner, leaving Andrew and I at home in kitchen eating dinner together and chatting about the day's goings on, the South Sudanese assumption is that Andrew and I are sleeping together - which we ARE NOT.  Evidently people ask our friends *frequently* if I am Andrew's wife or Scott's wife, to which they reply no, but the inquiries continue.

So, what to do.  If Andrew's sleeping up at the team compound and none of our South Sudanese friends are around and I'm cross stitching in the kitchen, then Scott spends the evening in his room so as not to create suspicion...if Wycliff stops by to chat then Scott can come out of his room and the three of us catch up, but as soon as he leaves, Scott goes back to his room?  This is no way to ask him to live his life, no way to go about life in one's own home, always having to assess whether the situation is culturally appropriate or not...

After hearing on Saturday night a report from other friends confirming that in fact this is the cultural perception, although some may realize that we have a different culture, I went to bed with a heavy heart.  What do we do now?  Does this mean I need to move?  Laying in the dark of my tukul with a blue door, the tears began and I opened the precious bag of mint M&M's for comfort :)  The longer I lay there, the more I was convinced that the best solution to the problem of the perception of us, who "preach" the ABC's (Abstinance, Be Faithful, and use a Condom) of sexual health then sleeping with each other while not married - is for me to vacate the situation.  

Before I moved to town in July, I had asked Rena, Bishop's wife, about the cultural implications of me moving onto the ECS compound and sharing the kitchen space with Scott and Andrew.  Her only concern was that we not go into each other's bedrooms, but that sharing the kitchen space would be fine.  I asked her again, was she sure?  She was.  So, I moved without wondering further.  But evidently in the minds of young men and women, the cultural assumptions are different.  I didn't want to have to live every evening, worrying about how many people were going to be around the kitchen that evening, wondering if me or one of the guys was going to need to go into our room to keep everything above board...I didn't want to ask them to have to live like that either.  A home, in my mind, should not be place of worry, but rather of rest and relaxation, of being able to be where you want to be when you want to be there.  My 4 months or so spent living on the ECS guesthouse compound was not a place of worry, but our conversation Saturday night changed that.

So back to The Shire I would go.

 

I woke up on Sunday morning sure that I needed to move, but not very happy about it.  "Sucks to be a girl" I thought.  "Sucks to have to go back to a life of a trek every time I want to be with South Sudanese people."  "Sucks to have to move because people think I'm doing something that I'm not."  "Sucks to have to readjust to another place, another group of people to live with, another pattern of life, another ebb and flow of activities and expectations."  "Sucks to not be able to keep up with Kaya's fishing expeditions and Aniwa's baking endeavors, and Tata's newfound excitement in reading, and the saga of the bride price Wycliff's been asked to pay and cannot afford by a long shot, on a daily basis."  "Sucks to move to my 9th bed of the month."  "Sucks not to have a home."

But on my iPod I put on the next sermon in a series on Theophanies in the Bible from Redeemer in NYC that I'd started several months ago, and God met me.  He met me with Jacob and the ladder to heaven (Genesis 28).  Jacob was on the run from his family, from his home, and spends the night in the middle of no where, laying his tired head on a rock.  God meets him, standing at the top of this ladder (sounds totally spooky to me), and essentially tells him, "I am the God of your people.  I see you alone in the wilderness.  I am going to make this wilderness your home; I am going to give you a home, AND a people.  In fact, through your people I am going to bless the whole earth.  AND on top of all of that, I am going to be with you not just here, but WHEREVER you go."  Hm.  That wasn't JUST what I needed to hear or anything...wow. really?  Then I mosied on to church and was met again in 2 stories of God's miraculous provision, when people were worried about what was going to happen, worried about lacking something, and God provided extravagantly (2 Kings 4, Matthew 14) in ways they would have never been able to predict.

And then there was Wilma, the blind woman who faithfully comes to church every week and sings in the section of ladies that leads the singing and the percussion shaker-shaking.  Wilma gave me a gift she'd made for me - she sent someone over to give it to me during the service so I could put it to use...it was a shaker of my very own: a hollowed out gourd with seeds inside and used chewing gum stopping the hole up.  To this girl who *loves* giving gifts AND the hearts of people with disabilities, what better a reminder that home looks like many different things than a homemade gift from a blind woman.  best. gift. ever.

So, after church I packed up my tukul, back into the ever - present plastic Contico trunks, and Monday after work I moved to my next home, back up at the team compound in Miri Moto - the place God has for me in this moment.  I dusted off the shelves, sweeping away 5 months of cobwebs and spider egg sacks, resettled my sunscreen and skirts and tv series', and sighed a sigh of thanks, thanks for this home, for this moment.

his NOT mine

"You live in South Sudan?!" or actually usually it's the more generic "You live in Africa?! Wow.  There are probably lots of bugs and snakes there, huh?  I could never do that.  You're a saint."  These are the kinds of things people say.  To me.  Yes, these exact words.

"Come to me, all who labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light.”  ~ Matt. 11:28-30

Turns out I'm more fond of my own yoke, or burden, than HIS.  Because I'm constantly told that my choice to live in "Africa" must be a burden, somehow subconsciously I've let it fall into that category.  When in fact, while there are surely challenges involved in life here, it is actually more often the opposite - quite a joy.  But it's a joy I've chosen, or by other people's definition (that it seems has seeped into mine) it's a "burden" or a "yoke" that I ("ana yaau de" - I am the one)  have chosen.  No one had to forcibly push me onto the British Airways flight that brought me here.  No one had to force my pen to the paper when I "signed on" with World Harvest to move to South Sudan.  I made the choice.

Seems I like to keep things that way.  The way that means that I get to choose how things go...where I will go and when, when things will be hard and how.  I like to choose my own yoke.  My own burden - how heavy, how I will carry it and to where.  When someone else chooses those hard things for me, those circumstances I like to have a say in,  I essentially throw a fit.  At 33, thankfully these don't include screaming or stomping my feet and waving my arms around (although, now that I think about it, that sounds quite cathartic), but they are fits nonetheless.

My mom is really sick.  Sick with something that I can't control.  Something she can't control.  Something the doctors can't control (gasp!).  Unless God chooses to do something drastic, I will lose her long before I ever thought I would, long before I want to, long before I would ever-in-a-million-years choose to.  But no matter how many mornings I wake up hoping it's a bad dream...it's not.  It seems this is HIS yoke.  His yoke for her, His yoke for me.  His yoke for us.  It seems this is the burden we are joined to HIM under.

Thing is, somehow HE says, HIS yoke is light.  "Easy" in fact.  But I'm tellin' you what.  This yoke that I'm sharing, carrying - it ain't anywhere near close to "light" or "easy."  Maybe that's because I haven't rested under it.  Maybe that's because I'm still throwing a fit and trying desperately to get back to mine.

But He says HIS offers me rest.  Sign me up.  I'm tired of pitching fits.  My soul needs rest.  Maybe I'll find rest when I stop trying to carry it by myself.  Maybe I'll find rest when I take up the yoke that is shared WITH HIM.  The yoke He says is HIS.

You know what I never noticed before?  This rest, this light and easy yoke, when you look at the verses that come before it, it's rest from the wearying and heavy things that are hard to understand, hard to bear...those things whose meanings/reasons are hidden from the wise/learned and revealed to who? To little children.  Kids are pretty good at sharing hard things...things they aren't excited about.  Maybe things like moms who have terminal illnesses?  Maybe I should take note.

nurse mode

deciphering key pieces of information, communicating them clearly, clarifying known/unknown information, picking up on small changes in symptoms, trying to present hard information in a loving way, asking the obvious or the really hard question, thinking creatively about solutions to problems,  holding a hand, calming quiet presence, bridging gaps of communication, willingness to say "that's a good question, let me get back to you on that,"presenting information clearly, knowing where to look for what information, knowing when to say "we don't know,"  being willing to cause pain in order to encourage/create opportunity for healing, a listening ear, gentle when helpful, firm when appropriate, providing dignity in times/places where there is little to none to be seen...

this is the stuff of nursing...behind the obvious stethescopes, the IV pumps or poles, shots, medicine cups, and bandages, this is where the essence of the job is, the stuff you don't necessarily notice, but that each nurse builds up an instinct for over the course of a career.  These aren't things you necessarily learn in school, they're the things you piece together from lessons learned from other nurses, from patients, from failures and successes, from physicians you respect and who respect you...they become part of how you approach the world.  Instinct.

Turns out after 11 years as a nurse, my instincts are pretty strong.  I don't even think about them.  I don't  think about which situations to apply them too and when not too, when is it appropriate or not, it has just become part of who I am and how I approach life and everyone in it.  Turns out, this includes my own family.  I've found myself in "nurse mode" with my mom and family with mom's new diagnosis.  Not by choice, but because it's an instinct evidently.

My dad does it as a pastor - goes into "pastor mode."  I've never been a big fan of him using that mode with us in his family, it feels a bit distancing on the receiving end, but now I understand it's not a choice he's making - it's an instinct.  It comes from years of doing something that, in time, becomes part of you.

My prayer is that my "nurse mode" instinct with my interactions with my mom in this new stage of illness doesn't feel distancing on the receiving end, that I can still be primarily her daughter first and foremost.

I've been in the US for the last 5 weeks or so.  When you come back from a place with very little access to current printed word resources, you pick them up and read them everywhere you go (at least in my experience).  In my most recent Pennsylvania Gazette (UPenn alumni magazine), I found a fascinating article with the following quote:

"Neonatologists were vigilant.  The nurses were even better, as much psychologists as highly skilled technicians.  They exuded optimism.  They never showed fear.  They became friends you could laugh with and cry with.  They offered eternal hope whether they believed in it or not..."  

- Buzz Bissinger (author of Friday Night Lights and writer for Vanity Fair and The Daily Beast from his book Father's Day)

I don't exude optimism, and I hope that I don't offer eternal hope that I don't believe exists, but I do believe there's a part of nursing, learned and honed over the course of a career, that parallels the "skilled technician" skills learned in school...the interaction with people part...one of the reasons I love what I do.

For some reason this trip home, I've had a lot of "nursing" interactions...opportunity to encourage a friend through the rough and tumble parts of nursing school, opportunity to hear from a friend on her first job as a new nurse and how she both loves it and is simultaneously terrified...I told them both that the fear is healthy :) I read the above article I found here at my parents' house and I've watched the first few episodes of the BBC show called "Call the Midwife."  Some really interesting writing, by the way.  One of my favorite quotes thus far:

"You made her feel safe. That’s the mark of a good nurse. A midwife, too. Everything else is just mechanics." - Dr. Turner to Chummy, the rookie nurse midwife who seems at first to get everything wrong

Spot on. That's it.