31 July 2010
SAFELY BACK IN THE UNITED STATES!
We are back in the the U.S., and safely in our new home in Grand Junction. The journey home was exhausting to be sure (6.5 hour drive, 1 hour flight, 2 hour flight, 7 hour flight, 9 hour flight, 4 hour flight, 5 hour drive), but well worth the blessings we received for having served in Rwanda for the month. We were very grateful for Brian & Jeri picking us up in Denver and driving us all over the mountains to Grand Junction. There was a bit more room in the cars than expected, as 4 of our 7 bags managed not to make it from Dulles to Denver. But, fortunately, they were dropped off at our house this morning in good shape.
Accomplishments? Well, for those of you interested in the numbers (and given that many of you contributed to the $14,000+ that it cost us to serve for the month--you probably should be, at least a little!), in our month at Kibogora, we accomplished the following. Eric evaluated 92 patients in the outpatient setting, and saw another 25 or so inpatient consults, performed 65 operations, and performed 10 endoscopies. As far as productivity is concerned, this is considerably more than his busiest month as a resident at Johns Hopkins or as a fellow at Duke. Regarding Jenn and the kids, Jennifier completed the mission complex book project that Sheila (the head missionary on the compound) had asked her to do. She sorted through hundreds of books, discarding at least 200 books that were either damaged from book worms (the majority of the discarded ones) or of limited value/appropriateness as far as their content was concerned, and then organized all of the remaining books by author in one of the houses. This will now double as a library. It's quite impressive. You could probably get the equivalent of a doctorate in church history or in Rwandan history just from reading the books there. Jennifier and the kids visited patients and their families in the hospital around 15 afternoons, spending multiple hours each visit playing with the infirmed children, teaching them games, and generally providing encouragement and sharing God's love with them.
From an educational perspective, Eric taught the incoming surgical doctor (Fidele) how to hand tie (he only knew how to instrument tie at the beginning of the month), and how to do simple hernia repairs, as well as exposing him for the first time to thyroid and gastric surgery. Hopefully he did a good job as far as the hernia instruction is concerned, as the wife of the experienced surgical doctor (i.e. Ndasu's wife) is expecting their first baby any day now, so Fidele will need to be doing these on his own in the upcoming days. From a relational perspective, we very much enjoyed getting to know Brandon & Ella, the other visitors at Kibogora during our time there. We had multiple great late-night discussions with them at our house where all of us shared about faith, the role of God in each of our lives, and we had the chance to clearly present the gospel to them multiple times in different ways over the course of the month. We will persist in praying for them both as they continue their search for answers, truth, and, ultimately, God.
As far as how the trip changed each of us, our children's eyes have definitely been opened to the reality that the vast majority of the world's people do not live as they do. They were definitely stretched by being constantly conspicuous, frequently pointed at, and even occasionally laughed at because they were "different." Jenn was reminded that being a follower of Jesus doesn't just mean praying a prayer or going to church. Being a disciple means full all-out radical devotion to God in everything we do. It's not a means to salvation, but rather a consequence of a vibrant, dynamic relationship with Christ. God did for Eric exactly what he was hoping He would--his perspective was reset. We spend so much time fretting about things that, in the grand scheme of things, simply just don't matter. Professionally, devoid of fancy laparoscopic equipment and $30,000 pieces of biologic mesh, Eric was reminded how much you can do for people with good training, a blade of steel, and a few sutures. Most importantly, Eric treasured his mornings alone with God, enjoying the view of Lake Kivu--constantly being reminded that God is truly magnificent.
We are very excited about the new life we have ahead of us in Grand Junction, and we feel tremendously blessed to be embarking on this new chapter in our lives fresh from the jungles of Rwanda. While we may be tired physically, God has definitely honored our desire to "tithe" of our first month of freedom (from surgical training)--he has given us renewed hearts and minds, and has made his voice more audible (figuratively) and lovely. We are extremely grateful for the people who gave of their resources (money) and time (prayer) to make this mission such a success, and we are even more grateful than ever to serve such a mighty, glorious, and loving God.
In the final photos for the blog you see... The view of Lake Kivu from the road to Tcazo (where Jenn and the kids often walked to buy Fanta, etc.); The family at the end of the month (each kid has their Kumbya VBS t-shirt on--Jenn and the kids got to attend the first 3 days of this area-wide missionary conference during our final days at Kibogora); Sheila (Kibogora head missionary and long-term veteran of ~30 years of service in Rwanda) with Jack (son of missionaries Matt & Lisa); Our family with (strangers from left to right) Ella, Julie (long-term missionary from the U.S.), Brandon, & Jack; and Baboons on the road back to Kigali at the end of our trip.
25 July 2010
Sorry it's been so long since the last update. As we've been approaching our last week here, the pace of things has been picking up even more. Even running two operating rooms 4 days a week, there still just isn't enough time to get all the surgical needs met here. I have people with large wounds that are ready for skin grafting who could go home if I could just find time to get them grafted--some of them have been waiting weeks now, but I just can't seem to find time to get them done. I've started to cancel some of the easier hernia cases that I think Ndasu and Fidel can do without me after I leave so that I can get the bigger cases done (there's a 2 week gap between me and the next surgeon coming in). It's also been extra busy around the mission compound as preparations have been made for the big regional African missionary conference that started yesterday at the Kumbya Retreat Center (where we go swimming in the lake). Most of the Kibogora mission staff have been pulled down there to prepare food, ready the cabins, build grass huts (for campers), etc. So Jenn's been doing a lot more food
preparation and gopher-type stuff around here.
I honestly can't believe the cases I did last week. I did everything from the comfortable (for me) G.I. cases like V&Ps/ V&As for peptic ulcer disease (since people can't afford drugs like Prilosec here, it actually makes more sense to do the old fashioned surgical treatments), gastrectomies for cancer, more thyroidectomies, another thyroglossal duct cyst (the size of a lemon!), to the less comfortable (for me) gynecology cases like uterine suspensions for vaginal prolapse, to the WAY out of my comfort zone cases like a facial hemangioma plastered all over the facial nerve in a 21-year-old man. I ended up bailing on that one once I realized it was a hemangioma. Very frustrating as I was really proud of myself for developing an awesome facial flap, exposing and identifying all the branches of the facial nerve, etc., all based on pictures from a book, I might add! I'd certainly never done a case like this before! But when I realized the significant risk of bleeding (preoperatively I had thought it was going to be something a little more forgiving like a lipoma or a parotid tumor) and nerve damage if I didn't do it perfectly, given my lack of expertise in the area, I decided to follow the "first do no harm" mantra and walk away. It took a lot of pride swallowing, but I know it was the right thing to do. I did have some pretty major victories on cases that I'd have no business doing in the U.S. though. For example, I did a carpal tunnel release (for carpal tunnel syndrome) in a man who's been unable to work for months now (pain is almost completely gone already), and I also did an open reduction of a bad radial fracture. It's actually pretty amazing what someone with general surgery skills and good old-fashioned common sense can pull off here just by following the pictures and instructions from the appropriate subspecialty surgical book!
I'm sure you can tell from the tone of this already, but I've been having a blast! I just wish we were going to be here longer so that I could help more people. I'm especially sad since I learned last week that, after August, there aren't any surgeons scheduled to be here until November or December!
Jenn's book organization project is going well, and she should be able to finish before we leave. She's uncovered some real gems among the many old books here. There's even a copy of National Geographic from the very month of Queen Elizabeth II's coronation--pretty cool. Mical is in heaven as even she would need at least a couple of years here to read all the books of interest to her here. The boys are doing great. Micah's been collecting taracko feathers (not sure I'm spelling the name of this bird correctly, but it's absolutely beautiful--it's a big bird with a black body, a yellow crest, blue proximal wing feathers, and bright red wing tip feathers) and enjoying the basketball hoop. He also lost another tooth a couple of days ago, and was very pleased to learn that the tooth fairy does actually make the journey across the Atlantic. Josiah can't stop playing the piano (we don't have any music, so the boy just thinks of every tune he knows, and figures out how to play it!). Rachel is her usual cute self, and is having lots of fun playing on the swings in front of the old school house. The kids have been really good about faithfully heading down to the hospital every day to play with the pediatric patients there. Duck Duck Goose has become a regular favorite, and each day they introduce another new game as well
Jenn and the kids took a hike down the hill earlier in the week to see a huge colony of fruit bats living in a bunch of trees near the lake. There were literally thousands of bats swarming around, and each time someone threw a rock or other such object into the tree, another 100 or so would go flying around. Good thing they only eat fruit!
My biggest "fear" almost became a reality last week when we found out that there was a 2-month-old orphaned baby boy sitting in the nursery with no family to go home to. His mother had died of AIDS/TB shortly after his birth. Apparently the hospital had started to search for a missionary family in Kigali or elsewhere in Rwanda to adopt him. When Jenn saw a picture of him, her maternal instincts kicked in and she went on a mission to find out if we could adopt him. A couple of weeks before we left Durham, our pastor (who was piped into our satellite church, had never met us, and was definitely not aware of our upcoming trip to Africa) had preached a sermon on the ministry of adoption, and, in the application section of his sermon, had uttered the exact words, "Does this mean that all of you are called to walk out of here this morning and adopt a child from Rwanda? No, but some of you are!" I walked out of there that Sunday looking at Jenn in horror, asking her, "Did he REALLY say, Rwanda?" Anyway, after that I had resigned myself to the idea of becoming an adoptive father, but only if God sent the stork to our door. So, when this news emerged last week, I was convinced that this was God's stork knocking at the door. Fortunately (or maybe not, I'm not sure now!), we later learned that an uncle of the baby had finally agreed to take the baby, so it looks like we're off the hook for now!
We've had some really great discussions of late with a British medical student (Ella) and her South African fiance (Brandon) who are here for roughly the same period of time as we are. Neither of them are Christians, but I guess it's just been impossible for them to resist asking excellent spiritual questions in an environment like this. For those of you so spiritually inclined, please pray for them--Jennifier and I sense a real spiritual hunger in them both.
Church today was really cool. We drove down to Kumbya to join the group at the retreat center. The service was very informal, was 100% in English (and all songs that we knew), was set up on the beach overlooking the lake, and we got to hang out with about 150 long-term missionaries from all over Rwanda, Congo, Burundi, etc., hailing from all over the U.S. and the U.K. At one point, I noticed a kid with a University of Wyoming Cowboys t-shirt on. I couldn't believe it, so I tracked the kid down, and, sure enough, he was from Casper, and his dad is a doctor! We had a great time talking with Michael and Amy about their adjustment here and about Michael's work with the family practice residency programs in Rwanda.
Today's photos are of: 1) A woman who walked 10 hours to see me in clinic about her neck lump (a thyroid nodule). She walked home another 10 hours, and is making the same journey here again as we speak in anticipation of her surgery tomorrow! 2) In the O.R. removing a large thyroglossal duct cyst from the neck. 3) Dinner with other short-termers Jill, Brandon, & Ella. 4) Orphaned baby boy. 4) Joseph, the kid at the hospital who is always the happiest to see the kids when they come down to play games. 5) Rachel and Daddy catching a few Zzzs yesterday afternoon at the cookout at Lisa & Matt's house (long-termers from England).
Well, here goes the fourth and final week. Pray that we finish strong and return home safely this weekend!
20 July 2010
Yesterday was really funny. Jenn and the kids went down to the hospital for their usual afternoon visit with the patients and their families. They taught them how to play Tick Tack Toe, and also handed out stickers. Everyone really appreciated the distraction from the boredom of living at a hospital for weeks at a time waiting for fractures and wounds to heal. But the funniest thing was regarding the local ladies' obsession with Rachel. They all want to hold her, but she's not particularly fond of the idea, so they try to bribe her. One lady tried to bribe her with a bracelet, another with a rosary bead necklace, but the lady who really took the cake was the one who lifted up her shirt and offered Rachel the chance to suckle on her breast! Rachel was unmoved, but Jenn couldn't stop laughing!
For Eric the day was a good one. I repaired a pediatric hernia, removed a wrist ganglion, performed a cis trunk procedure for a thyroglossal duct cyst, supervised a traumatic forearm tendon repair case, and did three endoscopy cases. One of the scopes was in a lady that I was convinced had a big gastric cancer. Because one of the other scheduled cases for the day had not shown up, we decided to explore her in the afternoon (we can't do much of a staging work-up anyway, so there's not much to do). Just as I feared, I found a large antral stomach cancer with metastases to the liver and fixed bulky disease in the root of the mesentery and head of the pancreas. I bypassed her stomach so that she'll be able to eat for her remaining time (probably 6 months), but her cancer was definitely not removable. It's a really sad story as the lady is only 47 years old and still has children at home. Anyway, the pastoral care and palliative care are really great here at Kibogora, so that will be the thrust of things once she recovers from surgery.
We miss you all!
19 July 2010
GREAT WEEKEND AND LATE-NIGHT ORTHO SURGERY
It's 1:30AM Sunday night / Monday morning. I just finished an open washout and reduction of an open distal tib/fib fracture sustained in a 25 year-old man who got in a motorcycle crash. Before and after photos are below (yes, that's bone sticking out in the first photo).
Had a great weekend. On Saturday morning, the kids joined me for the second half of rounds so that Jenn could walk to the open market in a nearby (sort of) town with some other missionaries. She bought the kids some sugar cane which we all ended up enjoying later. They then walked to Kumbya Retreat Center (where we go swimming) where the kids and I met her (coming by car). Enjoyed the lake, and found an old flat soccer ball, which we brought back to life with an 18G venipuncture needle and the mission's air compressor. Used it as a basketball on the mission's small driveway-like court. Micah and I enjoyed schooling everyone, and a good time seemed to be had by all. Church was really good today as the sermon was translated into English for us. This evening, we played some more basketball before Sunday evening mission devotions. Josiah noticed the Sunset and, of his own volition, invited Chelsea (the 16-year-old MK girl here) to come watch it with him. That boy is something else! Had some great prayer time with the other missionaries, and then off to bed. Was just about asleep when they called me for this fracture.
The other photos are of the kids teaching the hospital patients and families how to play Hop Scotch and Duck Duck Goose, thirteen of us piled into a Land Cruiser to come home from Kumbya, and a typical Rwandan woman carrying stuff on her head.
15 July 2010
Today was a great day. Ran two rooms (operating rooms, that is), doing 4 cases in the major room and 5 in the minor room. The big case was the intra-abdominal mass of unknown origin that I mentioned in yesterday's blog. Surprisingly, my ultrasound interpretation was right--it was distinct from every right-sided intra-abdominal organ I could think of: liver, gall bladder, kidney, adrenal gland, colon, head of pancreas, small bowel, uterus, and ovary. When we first got in, it was more obvious that it was a retroperitoneal mass, and the thing felt a bit more fixed than I anticipated on exam so I started to sweat it a bit--it felt really close to the caudate lobe....yikes! I had had to ask the anesthetist to place a second, bigger I.V. before starting (for the medical people reading this, can you imagine doing a big open retroperitoneal mass resection with one 18G I.V.?!). So, initially, my biggest fear (that the thing involved the IVC!) was being realized, and while I was really patting myself on the back for checking the I.V. access before starting, I was also already planning how I was going to explain to everyone why we opened up and then bailed out (no way was I gonna mess w/ the IVC in this environment). Anyway, with a little steady persistence (just like my mentors taught me), I seemed to be making headway, and before you know it, the thing was just hanging on the psoas muscle (some sort of benign or very-very-low-grade malignant tumor of mesenchymal origin--may never know, I've been told that the send-out path turn-around process takes between 6 months to a year!). Resected a swath of muscle in case it was malignant, and voilla, it was out. Took less than 3 hours--and good thing too, cause we lost power to the electrocautery for the next 3 hours when some laborer digging a trench along the road hit some power lines (see photo below)! The tumor Was right around 10 pounds--about the size of a large rotisserie chicken (yum, yum!). Anyway, it was pretty cool to do a case like this here, and I've been praising God all afternoon for not making it attached to any major blood vessels! Jennifier did, indeed come and watch. In fact she ended up taking a bunch of photos which I will try to post at the bottom of this. Furthermore, she tried her hand at circulating for a bit and was a big help! It was really GREAT to have her in there to finally see what all her hard work at home taking care of everyone like a single mother for the last decade and a half has allowed me to learn.
Also, one of the O.R. scrub nurses told me her life story during our last case. Absolutely HEARTBREAKING. During the genocide of 1994, Susan lost her entire family--all her siblings and both of her parents were murdered. At the end of her story, and with tears in her eyes, she told me that the people at Kibogora Hospital were her family now. Wow.
Praise God, Jenn is feeling better (stopped taking her malaria meds--always an excellent cure!). The kids are managing fine with their colds. Enjoyed Thursday night fellowship with the other missionaries here. Carried each of the sleeping kids home in their feet jammies (don't think the Rwandan mission complex guards had ever seen feet jammies before), and now off to bed. Miss you all, but I've got to tell you, I'm really happy here, so don't feel sorry for me at all (oh, those poor Hanlys--in that terribly poor, disease-infested and politically unstable country of Rwanda!). Yeah, right. God has placed me in my element for this time. Thank you for making this possible!
14 July 2010
Greetings everyone. This is going to be a short update, as I need to get back to the house. Why? Jenn and the kids are all sick (colds, plus Jenn is nauseated--think it might be from her malaria prophylaxis med, but would appreciate your prayer either way). Otherwise everything is great. Church on Sunday was quite the experience. We'd been warned that the service was at least 3 hours long, and that we'd be advised to arrive late and leave early. The service started at 9, so we showed up around 9:30. Apparently, they had only just been getting warmed up for the preceding half hour as far as the singing was concerned. We had hoped to just slip in the back where our spoiled kids (used to a 75-minute made-for-kids Sunday school-type church experience) wouldn't be as disruptive, and where we could easily slip out unnoticed when our flesh became weak. Well, they weren't about to let that happen. As soon as we were spotted approaching the church, we were escorted around to a side entrance and seated right at the front at an angle to the majority of the congregation (about 1,000 people in attendance!) where we could be properly on display! After about an hour of singing, we were asked to come up to the pulpit to introduce ourselves and "say a little something." After that, another hour of singing, and we were spent. We left before the message even began. Now don't get me wrong, it was absolutely wonderful. The Rwandan people have the most amazing voices, and the African flare to worship is nothing short of amazing. But it is exhausting being on display in front of 1,000 people when you're trying to keep your kids from making a scene. Again, I know our kids are good kids, but I just don't know how those Rwandan kids sit so quietly for so long (conditioning, I guess).
On Sunday afternoon, Sheila drove us down to the small retreat spot that the mission owns on Lake Kivu (the one we overlook). There's a tiny little beach there, and there's a floating platform about 50 yards from shore that we all swam out to (don't worry, the kids had life jackets on) to sun bathe and jump into the lake, etc. Jenn got scolded by Sheila for doing a back flip. :-) The only real bummer is that the lake has Schistosomiasis in it, so we'll have to take some more medication to rid our systems of that bug once we get back. Anyway, it was a great time of refreshment and rest after a very busy week--too good to miss.
The first 3 days of this week have been back at full throttle. Jenn is hard at work with her book organization project, along with visits with the kids to the hospital to spend time with lonely folks with nothing to do but wait for their wounds to heal. Monday was a good day for me in the O.R. Did a thyroid lobectomy for a big nodule, as well as some bread-and-butter stuff. Picked up some good cases in clinic yesterday, and had another good day in the O.R. today. A final-year medical student from Scotland joined us this week, so that's been fun as well. Tomorrow, I've got an exploratory laparotomy in a lady with a 10-lb (predicted) intra-abdominal mass. Can't tell where it's coming from (I'm the ultrasonographer and the radiologist, so the reliability of those studies is somewhat lacking!), but it's apparently been growing in the lady for 20 years, so it's not likely to be malignant. Have arranged for one of the teenage MKs here to baby sit for Jenn for part of tomorrow so that she can come watch that case--should be a good one!
On the spiritual side, I've been reading "Radical: Taking Back Your Faith from the American Dream" by David Platt in my quiet times. Matt Helms recommended this to me. I can not recommend it highly enough to all of you. Really hard-hitting stuff, and very timely. Better get back to Jenn and the kids. Miss you all!
10 July 2010
AN AMAZING FIRST WEEK IN RWANDA!
It's Saturday morning here at Kibogora. Our first week has been so filled with opportunities to serve, that it has been difficult to find time to access the internet to send updates (especially given the limited access). So now, I find myself in the very difficult position of trying to convey in a single update all that has happened this week. As I write this, I sit on the back patio of our little mission house. The view is absolutely amazing--overlooking Lake Kivu, a large mountain lake that winds around numerous steep beaches and red clay cliffs. This patio is the perfect place for personal morning devotions, and the fact that I now get to spend time alone with God when it is actually light outside (work doesn't start until 7:30!) is a treat I have missed for years. Everyone is healthy, the gastrointestinal issues have all settled, and the kids now know how to swallow pills (thanks to a daily anti-malarial tablet).
Let's start with Jenn and the kids. If we ever questioned whether or not there would be "enough" for them to do here, we certainly don't any longer. The basic day goes something like this... 7am Dad wakes everyone up for breakfast as a family (which is prepared and served by our cook/helper, Anosietta). At 7:30, one of the kids goes with dad to the hospital for the daily hospital worship/devotional service. Jenn and the kids are all back together and ready for the day between 8-8:30 when they walk to the charming little school house on the mission compound that has been the site of missionary kid homeschooling for generations (they are the only ones using it at the moment, but they still really love it). Lunch is served around noon at the house and is followed by a short nap. The afternoon is when Jenn and the kids do the service part of their time here. Jenn has already inventoried a bunch of surgical supplies that were donated to the hospital. She has also been asked by Sheila, the head administrative missionary (an amazing woman from England who has been here since 1983!), to collect, organize, and catalog all the books on the compound. There are around 10 houses on the compound, and around 200-300 books per house, so this should keep her busy for a while. Sheila has given Jenn carte blanche regarding which books to keep and which books to trash (Jenn tells me that the handful of Danielle Steele novels here are not making the cut!).
But the most rewarding thing that Jenn and the kids have been doing is visiting the patients at the hospital. For a number of reasons, the patients stay at the hospital much longer than we ever would in the U.S. As way of example, let's take a small boy with a broken leg. This was our very own Josiah last fall. When we took Josiah into the orthopedic urgent care clinic in Durham, NC, he was x-rayed, given a toe-to-thigh fiberglass cast (Duke blue!), given a pair of light-weight aluminum alloy pediatric crutches, and sent home. 4 weeks later, we drove him back to the clinic in our air-conditioned minivan, they x-rayed him again, took off his long cast, and put on a new walking fiberglass cast (Duke blue again--though he had the choice of about 6 different colors!). Two more weeks later, we took him back in, they took off his cast, and gave us physical therapy exercises to work on with him. Here, we don't have fiberglass. The fact that you can't get plaster casts wet wouldn't be a huge problem except that you can't at all be assured that the child has a house that actually keeps him dry in the rain. Crutches are way too expensive for most families here, and rarely even available in sizes small enough for little children. And furthermore, because so many of the patients come from so far away, riding multiple dangerous (and expensive by Rwandan's standards) buses, you can't at all guarantee that they will come back if you let them go (which means a cast might get neglected and left on for months with disastrous results). Thus the same injury that Josiah had is managed here as an inpatient for the entire 6-week process. This means that there are a lot of kids (and adults too) lingering in the multiple large 40-patient surgical wards (various ones for men/boys, and ones for women/girls) for weeks on end with nothing to do.
Sheila rightly suggested that Jenn and the kids take on as one of their ministry service projects, visiting these folks and trying to bring a little joy to their long stay. So each afternoon now for the last 3 days, Jenn and the kids have walked down to the hospital and just started interacting. Once they leave the mission compound, the local people follow Jenn and the kids around like they're Angelina and family, so before they even get to the hospital they have an entourage following them. It doesn't take long before a real crowd develops around them. The people push in closely, violating all western standards of personal space in a way that is initially quite uncomfortable. Yesterday, the five of them just sat down and started playing duck-duck-goose in the pediatric ward courtyard. Before long, there were many more kids playing with them, and a crowd of 40+ adults around them watching a laughing at the funny looking white people playing this silly game. For many of the people, getting a good look at a white person (especially a white child) is interesting enough by itself. Rachel gets picked up and passed around so that everyone can touch her long, straight, sun-bleached blonde hair. The other day, a grown woman took a hold of Mical's hands and studied every aspect of them--their color, the pattern of palm lines and finger prints. Everyone laughs and laughs at Josiah's antics--whether he's pretending to be something or even just doing jumping jacks. Micah's shy toothless grin is equally endearing to them.
My first week as the surgeon at Kibogora hospital proved busy, challenging, and rewarding. Fortunately, I am not completely alone. 2 of the 8 or 9 doctors employed full-time by the hospital are currently assigned to surgery. Interestingly, they are both from across the border in Congo. The most experienced of the pair is Ndasu. Ndasu has been doing surgery at Kibogora for a couple of years now, and functions at the level of a 3rd- or 4th-year surgery resident. He speaks Kinyarwandan (the local language), French (the official hospital language), and English. He is well respected at the hospital and really knows the ins and outs of the place, so he's definitely keeping me out of trouble. He does a lot of the basic emergency cases by himself (appendectomies, c-sections, etc.), and definitely knows the old-fashioned open inguinal hernia repairs (McVay, Bassini, etc.) WAY better than me. The second of the pair is Fidel. He is very smart, very conscientious, and a quick learner, but, given that he started here 2 days before me, he reminds me of a July surgery intern. I think he appreciates me teaching him all that I can, and he definitely takes care of a lot of the admin stuff that I'm not as fond of, so it works out well.
On the normal O.R. days, we usually have between 4-5 scheduled cases, and by the end of the day, we've usually picked up at least 2 emergency cases. We have 1 "major" room and 1 "minor" room, and we keep both going all day long. It's pretty awesome, though I know I'm getting totally spoiled having a job for my first month out of fellowship where I get to run 2 rooms! I bounce back and forth, or sometimes Ndasu does the easier cases by himself in the minor room while Fidel and I do the bigger cases in the major room. The nurse anesthetists are fantastic. They do a great general endotracheal anesthetic, a wicked-fast spinal (the majority of cases), and can do all manner of impressive regional blocks. In my first week here, we did a total of 23 cases! Some of these are "lumps and bumps," but there are a lot of really great cases mixed in. My favorites from this week? A modified radical mastectomy for a large breast cancer, a scrotal hernia the size of a small watermelon, a traumatic wrist tendon and nerve reconstruction case (used my magnifying loupes for the first time since residency), a radical hysterectomy (TAH/BSO) for cervical cancer, and a traumatic eyelid reconstruction case (used my magnifying loupes for the second time since residency!). Of course I also really enjoyed re-learning primary open inguinal hernia repairs (no laparoscopic surgery here and mesh is in very short supply). I hadn't done any of these since I was a 4th-year medical student volunteer at Kwai River Christian Hospital in rural Thailand (thanks for teaching me how to do these, Dr. McDaniel!).
While 4 of the 5 weekdays are spent in the operating room, Tuesday is all-day outpatient clinic (plus emergency cases, of course). In my first Tuesday clinic I saw 30 patients--20 new patients and 10 follow-ups (from the work that the volunteer surgeon from last month had done). Of the 20 new patients, I scheduled 15 of them for surgery in the upcoming 2 weeks. This is an extremely awesome ratio of consultation-to-operation for those of you not in the general surgery business. What's even better is the incredible variety of cases. I picked up 2 thyroids, a lateral neck mass, a spleen, 2 lower-extremity vein-strippings (no laser vein clinics here!), a bowling-ball sized abdominal mass, and a bunch of hernias. Unfortunately, there were a few cases that I just don't feel comfortable doing (primarily complicated gynecology pelvic reconstruction/ fistula cases). Hopefully, there will be a volunteer OB/Gyn out here soon!
Well, that's the first week in a "nutshell." Don't worry, I'm sure that future updates won't be nearly as long. I just thought that giving a bit of context would help for future comments. In closing, here are a list of the notables from everyday life here at Kibogora: tilapia for lunch caught the night before from the lake, tea with every meal, the view from our house, the beautiful landscaping of the compound, the human lawn-mowers (teams of 3-4 men swinging large knives back-and-forth at the grass until it is just the right length), and the brooms made of pine-needle-like bush branches tied together at the end of a stick!
4 July 2010
WE'VE ARRIVED SAFELY IN KIBOGORA. It already seems like there's so much to say, but, given that it's almost 11pm Sunday night here, and I have to hike from our (very lovely) mission house to the top of the compound to get internet access, risking tripping in the dark and/or being bitten by the malaria-carrying mosquitoes that prefer to feed at night, I will keep it brief. In short, the trip was exhausting, everyone is a bit out of sorts, but we are all safe and sound where we will be for the next month. A missionary from England named Matt (can't remember his last name at the moment) picked us up at the airport in Kigali where--praise God--the customs folks didn't even peek in our bags (as we learned later that they probably would have confiscated and then tried to tax the hospital for the surgical staplers we were bringing into the country). We stayed the night at a western-style hotel last night in Kigali, and then made the long (5 hour) journey to Kibogora on the western end of Rwanda. The drive was brutal--windy roads, tons of potholes, dirt track for the last hour, Rachel needing us to stop multiple times for getting car sick (only vomited once), but, eventually, we got here. We did drive for an hour through true rain forest which was really cool--saw wild monkeys and everything (pictures forthcoming). We got here around 3pm, got settled in our little mission house (which is really cute), had some food (they had some small pieces of cake and some candles waiting for us so that we could celebrate Mical's 9th birthday, which was today), went to Sunday evening mission devotions, and then put the kids (and Mommy) to bed. Tomorrow morning we start full swing. Thanks to everyone for your prayers. Top requests at this time:
1. The kids emotional stability--both Mical and Micah did some serious crying today. They already miss home and recognize that things are very different here. Micah pointed out that everyone else here (save 3 or 4 other missionaries) has black skin and everyone stares at him. :-)
2. Our health--lots of aching stomach already (obviously too soon to be related to anything here, but troublesome nonetheless).
HAPPY 4TH OF JULY!!! HOPE EVERYONE ENJOYS THE FIREWORKS--DON'T TAKE THEM (AND THEIR SYMBOLISM) FOR GRANTED.
1 July 2010
Today we leave: Eric from Durham (having just finished his fellowship, and the last leg in his marathon of surgical training), and Jenn and the Kids from Denver (having just moved the household to Grand Junction). God has been SO faithful with respect to this period of service. When we answered the call to come serve at Kibogora in Rawanda, I really didn't know how in the world we were going to raise the funds necessary to make the trip possible. This has been a tremendous lesson in faith for me. Through the generous donations of friends, coworkers, family, and even a few people we don't even know, we have raised $14,530.90! For God to have made this possible, has given us a tremendous sense of confirmation as we begin the long journey today. Thank you so much to those of you who have committed to pray for us throughout our time overseas. Thanks also to those of you who have been praying already. Our biggest prayer is that God would use the time of long travel to prepare our hearts for serving him--that we would be quickened unto his voice--that we would meet Him and know Him better than ever before. We will try to leave a quick blog as soon as we get there!
2 June 2010
Wow, we are now less than one month away from our departure for Rwanda. The Benefit Concert was a big success. About 30 people were in attendance, everyone seemed to have a good time, the performance was really quite incredible (way to go dad & Dr. Minger!), and we raised over $2,000. Thank you so much to all of you who attended! This brings the total of our support raising to just over $10,000! Looks like our final budget for the trip is going to be around $15,000, so we are making excellent headway. Thanks so much to those of you who have given so generously to support this work.
Preparations for the time in Rwanda are already underway. I am in the midst of collecting surgical supplies that will help me while I am there (just got a big box of surgical staplers to use on GI cases while I'm there--thanks Covidien!). I also just got in the mail a series of three basic surgical texts (Primary Surgery I & II, and Primary Anesthesia) that tell you how to manage everything from a femur fracture to a ruptured placenta to a urethral stricture (and how to do the anesthesia!). They are written specifically for the rural mission surgeon who has to do everything. As I don't do any Ortho, OB/GYN, or Urology here in the States, I can tell that these are going to come in very handy! Thanks so much to Dr. Richard Davis (a general surgeon serving long-term at Kijabe Hospital in Kenya) for his advice regarding this purchase.
Believe it or not (if you know my wife, you probably will), Jennifier has already packed the kids suitcase. Yep, that's right, 1 big suitcase for all their clothes for the entire month. I am so blessed to be the leader of a low-maintenance family. If only the same was true for me!
By the way, for those of you who are interested, here is our plane itinerary (except I meet Jenn & the kids at Dulles on the way out, as I have to work all the way through June 30). Looks like our itinerary is actually better than I anticipated. Only 4 legs, and the longest is only 8 1/2 hrs. Of course, I'll bet we don't get to get off the plane in Rome, so legs 2 & 3 may end up seeming like a long 15 single leg.
Thursday, 1 JUL 2010
United Airlines 866
From: Denver CO, USA Depart: 2:38 PM
To: Washington Dulles DC, USA Arrive: 8:02 PM
Friday, 2 JUL 2010
Ethiopian Airlines 503
From: Washington Dulles DC, USA Depart: 10:05 AM
To: Rome Fiumicino, Italy Arrive: 12:40 AM 3 JUL
Saturday, 3 JUL 2010
Ethiopian Airlines 503
From: Rome Fiumicino, Italy Depart: 1:25 AM
To: Addis Ababa, Ethiopia Arrive: 8:20 AM
Saturday, 3 JUL 2010
Ethiopian Airlines 807
From: Addis Ababa, Ethiopia Depart: 10:00 AM
To: Kigali, Rwanda Arrive: 11:25 AM
Thursday, 29 JUL 2010
Ethiopian Airlines 806
From: Kigali, Rwanda Depart: 4:15 PM
To: Addis Ababa, Ethiopia Arrive: 7:15 PM
Thursday, 29 JUL 2010
Ethiopian Airlines 500
From: Addis Ababa, Ethiopia Depart: 10:15 PM
To: Rome Fiumicino, Italy Arrive: 3:25 AM 30 JUL
Friday, 30 JUL 2010
Ethiopian Airlines 500
From: Rome Fiumicino, Italy Depart: 4:10 AM
To: Washington Dulles DC, USA Arrive: 7:55 AM
Friday, 30 JUL 2010
United Airlines 427
From: Washington Dulles DC, USA Depart: 10:00 AM
To: Denver CO, USA Arrive: 11:59 AM
Total round-trip distance: 19,422 miles!
10 May 2010
Here are some photos from the Kibogora Mission. Can't wait to see you all at the Rwanda Benefit Concert on Sat, May 15th!
Original Post (April 2010)
Kibogora Hospital is a rural hospital located in southwest Rwanda. Established by western missionaries in the early 1960’s, Kibogora Hospital now boasts 260 beds, and is the district referral hospital for ten outlying health centers, providing the only hospital service for a population of 250,000. Staffed by seven Rwandan national physicians, the hospital’s lone surgeon left over a year ago to take a position in the country’s capital city of Kigali. To put this in perspective, in the United States we typically have one general surgeon for every 10,000-15,000 people. Of course that doesn’t even account for surgical subspecialists like orthopedic, cardiac, urologic, ENT, OB/gyn, and neurosurgeons. Can you imagine 250,000 people without anyone trained to treat appendicitis, fix a hernia, or surgically remove a cancer? The potential for loss of life from simple, surgically preventable causes of death is simply staggering.
The Rwanda of 2010 is politically and economically way ahead of the country that received international attention in 1994 when genocide saw 800,000 people (including many at Kibogora Hospital) killed in less than four months. However, Rwanda, especially the rural areas of the country like those served by Kibogora Hospital, is still extremely poor by western standards—thus the hospital simply can’t afford to hire “temp” surgeons to work until a new surgeon can be trained. For over a year, patients at Kibogora have depended on European & North American volunteers to fill in a month at a time. While the Lord has met this need each month so far, when our family started searching for a place to serve this summer, we found that Kibogora Hospital had not yet found a surgeon for the very month that we are available to serve! Furthermore, because the Kibogora Hospital complex is also home to a farm, a school, and a program for orphans, there are a number of ongoing service projects that will be perfect for Jennifier and the kids to help with.
Would you consider supporting our family in this endeavor? While the cost of living in Rwanda is extremely low, and our expenses once we get to Kibogora will be negligible by western standards, we need to raise $14,000 to pay for our air travel to and from Rwanda (and that’s using the discounted four-stop/ 35-hour-each-way Ethiopian Airline fare!) and multiple vaccinations that each of us will need to get before going. Here are three ways through which you could help us in our efforts to serve the patients at Kibogora Hospital:
1. Attend and invite your friends to our major fund-raising event, a benefit concert at our home on Saturday, May 15, 2010. We will have a reception at 7pm followed by a recital by artists Brian Hanly (Professor Emeritus of violin and chamber orchestra at the University of Wyoming, and yes, Eric’s father) and Frederick Minger (former pianist of the Baltimore Symphony Orchestra). The program will include works by Vivaldi, Strauss, Debussy, and Gershwin. Suggested minimum donation is $100/ person. Please email me to let me know you are planning to attend: firstname.lastname@example.org (For program details, please click here.)
2. Make a tax-deductible donation to help defray the costs associated with this project. Checks can be made payable to Central Africa Healthcare Organization—CAHO, with “Rwanda” on the memo line, and then mailed to our home address. You will receive a receipt in the mail.
3. Pray for the success of our mission: adequate fundraising, safety during the long journey, good health while in Rwanda, openness to serving in whatever way God might use us, and blessings on those whom we will serve.
Believing that the work at Kibogora Hospital has been prepared in advance for our family to do, we are very excited about caring for the people of Rwanda and introducing our children to the joys of ministering to some of God’s children who are far less materially fortunate than they. Thank you for prayerfully considering partnering with us in serving “the least of these” at Kibogora Hospital. For more information about Kibogora Hospital go to http://www.kibogora.org/ and please return to this webpage in August for pictures and a report at the end of our time in Rwanda. We look forward to hearing from you!
Eric, Jennifier, Mical, Micah, Josiah, & Rachel Hanly
Rwanda Benefit Concert