Monday, August 19, 2019

The thinnest air

 "I'll take the last climb
Up the mountain, face my fears
The time has come, to make a choice
Use my voice for the love of every man
My mind's made up, never again
Never again, will I turn round"
-Josh Garrels

Many of my blog posts center around a patient's story.  This one is no exception, but it is dramatically different than most.

I was recently blown away by an experience among the mountaintops of Papua New Guinea.  Four of the doctors here, along with a couple of our closer friends from Kudjip station, made the arduous journey and trek up Mt. Wilhelm - the highest mountain in Papua New Guinea (and Oceania).  For several weeks leading up to our trip, I would load up my backpack with water bottles and textbooks and climb the various hills around Kudjip.  Other times I would strap Gabriel on and take him to "enjoy" these long walks.  I knew I needed to build up some muscles and stamina to climb 14,793 feet above sea level on rocky and narrow ledges into the clouded heights above our Waghi valley.

Our two-day adventure started on a Saturday, departing Kudjip in the morning for the nearby Simbu province where we would drive as close to the base of the mountain as we could - a town called Gembok.  Once there, we parked our car, grabbed our gear, hired a few "carriers" and started a 3-hour trek up to base camp at 11,000 feet.  As we climbed higher, the cool air began to thin and the light drizzle of surrounding clouds soaked us.  Once at camp, a small fire provided a little warmth to our chilled feet.  We needed to get an early dinner (noodles and tuna fish) because our next day's march would begin in the pitch dark at 2 o'clock in the morning.



As we ate our noodles trying to retain some heat in our extra layers, a sacred thing happened.  Our dear friend, pastor Apa, told his story.

I will not relay all of the details, but as a young man, Apa found himself entangled in many of the struggles facing Melanesians.  Through a series of tragic events, he lost his son in a flood and found himself ostracized by his family - culminating in some of his brothers beating him and leaving him for dead.  He was brought to Kudjip where he underwent surgery with Dr. Jim Radcliffe and then months of rehabilitation in the hospital.  He described times of incredible challenge while he recovered - questioning the Lord and himself, wondering where he was headed.

We finished our supper early and wrapped up in blankets and sleeping bags to snatch a few hours of sleep before the long march the next day.  At 130 I was stirred by Matt's alarm and the light of some headlamps clicking on.  Our team put some food and water into backpacks and started the trek up Mt Wilhelm.  In the pitch dark we could only see our footing by headlamps and relied heavily on our guides, but about five hours later the sun touched the horizon and we saw high ridges around us and a large mountain still above us.  We had hoped to hit the summit near sun-rise, but it took a couple more hours winding around it to strike the path that would take us to the top.




During Apa's injury and recovery at Kudjip, he turned his life over to Christ and began to seek a new road.  He ultimately landed a job working security for the mission station and then went through Bible College after being taught to read by the Bennetts - a former missionary family here.  Many years later, he now he works on station helping to keep the hospital and mission houses in good repair, but he still pastors a church and is building a home for the disabled - people often neglected in this place. 

After nearly giving up circling the summit, our guide finally directed us to the path that would take us up the steep climb to reach the top.  Apa's son, Bol, led the way showing his youth as the rest of us followed behind.  I never thought I could find a place so cold and windy on our tropical island home, but the noise of the wind and the damp of the clouds reminded me of the incredible diversity of PNG - and the incredible resolve and endurance of our Melanesian brothers and sisters to face whatever comes at them.




I thought I would find the thinnest air in PNG on the chilly heights of Mt. Wilhelm.  But the most sacred presence I felt was huddled into the small A-frame house at base camp listening to Apa recount his incredible tale of being lost, injured and broken - receiving healing and new spiritual life at the hospital - and his ongoing journey into God's path for his life.




Friday, May 17, 2019

A glass darkly


“I need to know that You're still holding the whole world in Your hands.”


The sun ascended slowly over the hills surrounding Kudjip station as I completed some paperwork in the operating room. I wanted to get home and eat a quick breakfast before starting my ward rounds and the full day of clinic ahead of me. But my hands literally shook as I tried to pen the last words of my note in Lucy's chart.

She arrived about 10 days before that eventful night and her difficult story unfolded like a slow train wreck. Only 25 weeks pregnant, she started bleeding. She left her three children in the care of relatives and made her way to Kudjip. An ultrasound showed a premature baby and a previa – the placenta implanted over the birth canal leading to a dangerous situation in which Lucy could bleed to death if she tried to deliver her baby vaginally.

For a week or so she stabilized. The bleeding stopped. Every few days I watched her little baby kick and suck its thumb, checking his fluid levels. Every day I notified the on-call doctor of the difficult truth – that Lucy would die if she went into labor and didn't have a cesarean section. We all knew, sadly, that this little one couldn't survive in this place.

It was on my watch that the call came. “Dokta Mark – Lucy em karim plenti blut nau”

I went to Lucy's delivery bed as a pool of blood steadily formed. Two more bags of blood were brought down to transfuse her. I prepared her for surgery and choked out a prayer that we could save her life. While the surgery felt mostly routine, the little one that I clutched in my arms before handing him over to the nurses was agonizingly small. There were no cries.

I managed to complete my notes and the orders for Lucy's post-op recovery. She needed some sedation at the end of the procedure and drowsed comfortably as they took her back to the ward. I skipped breakfast and went into the nursery. A tiny but perfectly formed baby passed away just as his mother was opening her eyes to the first rays of tropical sunlight. The birds were singing – but somehow the songs seemed all wrong.


To the deceased,

I hope you can forgive me. I did what I thought had to be done. Perhaps my prayers and tears at the end were enough to convince you.

Your mother loved you and wanted you in her arms. Even in the short couple of days that I saw your heartbeat I wanted you to join them. Your brother and sisters wanted you. But I think they needed your mother more, and I couldn't save you both.

If we lived somewhere else perhaps it would be different. But in this place – where lives are broken and the earth groans for its redemption – it simply cannot be.

I hope that your new home is a true paradise. I hope that these last few days can be forgotten. I hope that you can tell Him I'm sorry – though I have a million times. I hope you can receive me with forgiveness when my time comes.




 I recently discussed with one of the other doctors the challenge of having to make difficult decisions and seeing subsequent poor outcomes here. From the U.S. I remember imagining myself bringing critical medical care to the truly hurting and sick of our world. I believed there would be lives I could change or save. I failed to grapple with the hard truth that many of the things determining life and death in this place would be completely out of my control. My patients are often sicker than any illnesses I would encounter back home. I must make decisions that seem like a cold calculus at times: thinking about the number of blood bags the hospital has, how many patients the nursing staff can truly handle, or whether I have the physical, spiritual and emotional reserves to take on ill-fated heroic efforts.

My son Levi provided the answer. We sat on the porch, swinging in the hammock enjoying some down-time during my Saturday call. I asked him to practice some memory verses with me and he gave me the entire chapter of 1 Corinthians. I teared up as he approached verse 12: “But now we see through a glass darkly”

So many of my challenges in taking care of patients here come from staring at that dim looking glass. I don't have the information, the resources, the specialists or the technologies that I would want. I must make hurried decisions affecting life and death as I wander in a fog of uncertainty. Yet I have this hope as an anchor for the soul – that I may be greatly encouraged. Though I must make decisions that are beyond me, I do not make them alone. Once my knowledge, strength or skill have been exhausted, another joins my efforts. One day I will see clearly, but for now I must pray and trust it is enough.



Later that day I met a pleasant and nearly unbelievable sight. I made my way between wards taking what I call my “bed biopsy” - assessing how many spaces were available in the hospital for the patients I would soon be tending in the clinic and emergency room. A young woman stood in crutches with her unmistakable smile. Moana had been in the hospital for a few months. When she first came she looked like a wraith – skin and bones, covered in chicken-pox and bed sores.  The infection in her bones kept her from walking, leaving her debilitated and unrecognizable. For several weeks she received treatment and once the infection stabilized, the difficult task of recovery began. Thankfully a visiting physical therapist worked with Moana every day – mobilizing her tender limbs and teaching her to use her slowly gaining strength to walk supported.

Throughout her difficult stay, Moana kept a special joy and smile – even on her toughest days.

On this day, I needed that smile more than most. A reminder that God was present among the broken lives groaning for healing in this place.


Friday, February 22, 2019

Tearless morn

"O joy that seeks me through the pain
I cannot close my heart to thee
I trace the rainbow through the rain
and feel the promise is not in vain -
that morn that shall tearless be"


I have struggled for several weeks to put down in writing the myriad emotions that have descended upon our mission here.  Our mentors and forever friends the McCoys left a career of ministry in PNG last month and I felt I needed to honor that.  We have some new physicians joining us this year and it has been exciting to see where that will go in the future.  And with it all the daily triumphs and tragedies of working in the highlands of Melanesia.

This post was supposed to be a positive reflection of Bill's more than 30 years of medical service in Africa and here in PNG.  So on our last call night we performed what we thought would be our final surgery together.  Esther came to take pictures of Bill, who attended my birth 36 years ago, performing a C-section with me.  Those pictures will not be seen, though, because like so many unfortunate times before, our interventions for this young family were unsuccessful and while Doris survived, her baby never took a first breath.  As Bill and I despondently washed our hands after the case, he said, "it makes me realize that the work isn't finished."   




Bill's legacy is palpable in this place. There are not (yet) plaques with his name on them, but the enduring compassion that he poured into the lives of people continues in those of us that refined our own ministry alongside him.

While I have learned innumerable medical pearls, I have grown the most in my ability to feel the comfort of Christ in situations that seem unbearable.  There is no way to teach this.  Only through fire can something like a persevering faith be refined.  There are few doctors in this world that possess those skills ... and those scars.  Those that do must often put on an armor that allows them to see a stream of tragedies without becoming paralyzed.  But the thick skin can be reopened, and must be at times.

Two days ago one of our new doctors and I stood around the trolley carrying the charts for our pediatric patients, deeply discussing how we approach all of the suffering we encounter.  There were a few simple ideas I could come up with ... journals, exercise, reading scripture ... because the truth is there is no anesthetic for grief.  

As if on cue, later in that busy clinic day, a young man I have known for a few months came to see me with his grandparents.  He bears the name of my own son and he thinks he is about 8 or 9 years old.  He was born with HIV and while his family has taken great care of him, the reality is that he is approaching the end of his short life expectancy.  It became clear that he was no longer responding to my care, and had developed a cardiomyopathy from a combination of his longstanding HIV and the drugs used to treat it.  I excused him to the waiting area and told his grandparents that I would try to make him as comfortable as possible, but that he would likely die within a month.  The three of us ... William, Mary and I ... clasped hands and I prayed as I often do for the peace and comfort of Christ in the face of a certain, yet tragically preventable, death.  I held it together until they left to collect some pain medicine and diuretics at our pharmacy.  Then I went to sit on the stone wall of the hospital, cry, and look over the breathtakingly beautiful scenery of the mountains. A five minute respite before returning to the long line of patients still waiting to see a doctor - some of them for the first time in their lives.



As Bill and Marsha departed PNG our mission family honored their dedicated service here in a special evening of fellowship and sharing memories and stories.  I was grateful to hear these words that night and they give me strength to continue a journey, through times of suffering, to that tearless morn:
 
"I have many times felt overwhelmed by suffering and death.  However, feeling overwhelmed is not the same as being overwhelmed.  If I were to count the cost of waging war on suffering and death, and my ledger was the sum total of my gifts, my strengths, my courage, and whatever other resources I might possess in myself, the result would be catastrophic.  Death wins by a landslide.  But that is not my fight, not my war.  Christ Jesus faced suffering and death and overcame them.  They still spit and fume, but they shall not have the last word.  The last word belongs to Christ.

We have this hope as an anchor for the soul (Hebrews 6:19). Our response to suffering and death,  very real and formidable enemies, is the test of everything we as Christ followers hold to be true.  There can be no such thing as “gospel” or “good news” unless that news addresses death. Thankfully, it does. And therefore, so must I."

-Bill McCoy


Monday, December 24, 2018

Hopes and fears

“The hopes and fears of all the years are met in thee tonight”

I was seeing patients alongside a visiting resident in the clinic when we were summoned to the delivery room by a nurse to assist a mother who was struggling to deliver her first son. She had been in labor for some hours and hovered on the verge of exhaustion. An aunt was there attending her, along with a couple of our nurses, each giving encouragement. But etched in her face was a look I have seen hundreds of times. A look of fear – that this child would not come, that she didn't have the strength.

I instructed Daniel, our resident, in preparing a vacuum extractor to assist with the delivery. She looked doubtful as we made the instrument ready, but a brief explanation seemed to allay her fears. She pushed. Daniel pulled. A vigorous baby boy soon rested in the arms of his exhausted but obviously joyful mother. The hope of those nine months now breathed against her chest.

When I see expectant mothers in our antenatal clinic or outpatient department I notice the mingled hope and fear of the new life growing within them. Hope of a child with all of its innocent promise and the expanding joy of their family. Fear of all that may happen in a place challenged by difficult maternal and perinatal mortality figures.

I am perpetually wonder-struck at Christmas. I have grown up knowing that God chose to become man for our sake and that his arrival was marked by a humble birth. But until I saw the challenges of childbirth in Papua New Guinea, I don't believe I appreciated the incredible courage of Mary and Joseph. I did not fully comprehend a God who was willing to take any chance to safeguard His children. Nor did I grasp His love – that would put his own Son in harm's way from his first breath. But when I see the faces of those mothers, full of concerned anticipation, I take a moment to ponder the miracle of Christ's coming.

“Awaken your forsaken hope and look upon your king.”


Sunday, November 4, 2018

Nevertheless

"Launch out into the deep and let down your nets for a catch"
-Luke 5:4

I got the phone call at about midnight late Sunday.  The previous day I was bumped and jostled up the highlands highway returning from the national medical symposium 9 hours away on the coast, so I was a little sore.  The calmness of the voice on the other end of the line clashed with the message delivered.  "Doctor, your C-section patient is in arrest."

I flew out the door and up to the hospital.  It didn't make sense - her surgery had been fairly routine a few hours before.  Her baby simply wouldn't come vaginally so I took her to surgery and delivered a big, vigorous baby.  But when I arrived in the ward, there she was without breathing or pulse, receiving chest compression from a nursing student while an anxious family looked on.  I quickly placed a tube in her airway while nurses prepared drugs to try and restart her heart.  After several minutes and rounds of exhausting CPR, she had a pulse.  One of our anesthesia officers arrived to help but she kept losing her heartbeat so we started a continuous infusion of adrenaline to keep her alive and took her back to the operating room, allowing our ventilator to provide artificial breaths while we tried to reverse whatever happened to her.  Did she get too much anesthesia or pain medicines?  We reversed it.  Did she bleed too much?  An ultrasound of her abdomen suggested no.  What happened?  After many hours being kept artificially alive, her body eventually wore out and she passed away - her cause of death shrouded in mystery.

I got some hurried breakfast and went back to the hospital.  Only hours later another mom came to the delivery room who had been laboring in a bush health center without any progress, awaiting a car's availability to bring her to Kudjip.  Her baby was clearly obstructed in her pelvis and she needed surgery.  The nurses had reported a strong fetal heart beat before surgery, but it became apparent they had detected the mother's pulse.  I delivered a baby that seemed to have died some time before.  I put the last stitch into my patient's skin and went on to clinic, preparing to work my way through a steady steam of the destitute sick of Papua New Guinea.  I was mere hours back into work and I was already feeling drained.


After an invigorating time teaching at the PNG national medical symposium, I returned to the maternity ward at Kudjip.  For the past several weeks, I have experienced the highs and lows of helping deliver babies in a country that struggles with some of the worst maternal and perinatal mortality rates in the world.  And it felt like I was losing the never-ending battle against them.

Some years ago my mentor, Dr. Bill, shared about his journey through the perils of trying to save the world through medical missions.  He points out the story in which Jesus encounters Simon.  After a long night of fruitless toil, Jesus asks him to help him teach the people.  Simon likely didn't need to be there, but I believe our Lord saw something that he needed to learn.  Scripture doesn't actually give us the sermon - but his message comes through loud and clear when he asks Simon to go out into the deep waters.  The waters where had just spent hours of work with nothing to show for it, where he had just failed - where he lost.  Although he was ready to give up, his response motivates me every day:

"Nevertheless, at your word I will let down the nets."

 

"Doctor, the baby's head is stuck."  Once again, I raced up to the hospital, convinced that this baby would die in those hurried moments as I made my way up the stony road.  When I arrived at the delivery bay, I saw a nurses clutching the body of a baby in her arms, the head still inside its mother's womb.  Without any antenatal care, this breech (feet first) presentation had not been detected until the mother arrived at Kudjip ready to deliver, with the baby being partially born immediately after she laid on the delivery bed.  As I worked to relieve the obstruction of the head, I felt the body in my arms grow limp.  After what felt like hours, the baby's head delivered and its lifeless form lay on the bed.  I wanted to cut my losses then, to give up - to clean my nets.  But there was a slow, faint heartbeat still.  Seeing an opportunity to teach newborn resuscitation (but without any real hope), I instructed our nursing students in doing CPR for this baby boy.  In a minute or two, that heartbeat was a little stronger.  I placed a breathing tube while a small spark of hope nestled in a corner of my heart - the corner where so many fizzled out in the past.  But the baby "pinked up", began to move, took his own breaths and tried to cry.  A short time later, we removed the breathing tube and that baby lay resting comfortably at its mother's breast.  A couple days later, they went home to his big sister who had been eagerly waiting for him.


As I make my way through our maternity ward every morning, I must choose to let down the net.  There are days that it remains empty, when it seems like it will spoil.  There are days when perhaps I haven't pushed out far enough into the deep.  Nevertheless, there are days when when it nearly breaks with the new lives that we are part of bringing into the world here at Kudjip. 

"Never again the shallows.  Never again the same."
-Bill McCoy

Friday, August 10, 2018

Hearing the brokenhearted

"He hears the brokenhearted
He binds their wounds"

Not for the first time, my vision blurred as I examined the patient in front of me.  This baby, less than a few hours old, appeared healthy.  Pink skin, good muscle tone, breathing well, crying strongly.

It was the crying that went to me and brought my own tears, clouding my vision.  I knew what this child couldn't yet comprehend - that she would never know her mother.  Only a few minutes prior, I removed the breathing tube I had inserted in our attempts to resuscitate her, and helped prepare her body to give to the new grandparents.

"Josephine" had delivered her baby at home.  After the delivery, as her father explained to me, she bled heavily and simply wouldn't stop.  She collapsed, and the desperate family scrambled in the early morning hours to find someone with a vehicle to bring her to Kudjip.  When they arrived, our newest doctor, Matt Woodley, and I saw them carrying her limp body onto one of our exam tables.  An anxious relative walked in behind her, with a new baby bilum over her head.  We attempted CPR and placed a breathing tube, giving medicine to try and restart her heart but she likely had died before ever arriving in our hospital and I couldn't bring this baby's mother back for her.

Josephine on the left behind curtains, her mother and baby on the right at bed 4

USA Today recently ran an investigative article looking at the maternal mortality rate in the US, bemoaning how high it is and highlighting a few stories from the 700 cases of mothers who died around childbirth there last year.  The piece makes for compelling reading, a call for action on the "abysmal" safety of delivering a baby in the US.  But it also captures something else ... the impressive ability of our human condition to focus on us ... our country, our people, our problems and what we can see.  What it neglects is the tragic reality the rest of the world faces - that becoming a mother often truly represents the most dangerous thing for a woman to do.  The reality of orphans around the world, crying fruitlessly for their first feed at their mother's breast.

“We’re not talking about a Third World country, we’re talking about us, here.  This shouldn't be happening here."
-Trainer, The American Hospital Association


Josephine's grandmother watched attentively through muffled sobs as I examined her new granddaughter.  She said that another woman in their tribe recently had a baby and could breastfeed this hungry child.  Her father was already helping some of her brothers to lift Josephine's body back into a vehicle that would take her home for burial.  In less than thirty minutes their grief and struggles became the overwhelming reality that swallowed the heart of this medical missionary.  Then she disappeared out of sight again, back to a family that is tragically all too familiar with this kind of loss.  And much of the world could care little less, only occasionally remarking on depressing numbers.  Numbers that it has somehow chosen to accept as inevitable for orphans in the "third world."

"Crying is all right while it lasts.  But you have to stop sooner or later, and then you still have to decide what to do."
-CS Lewis

For nearly five years I have absorbed some of the challenges of the PNG highlanders whose crumbling health services remain conveniently shadowed in the remote jungles of this Pacific island.  But as many as I can touch, help, suture and resuscitate I know that there are important ways to move upstream.  For me, teaching is an important step in this process.

During our last furlough, I became an instructor for a course that teaches practical obstetrics skills in an effort to curb the suffering of mothers and babies in childbirth.  In a few weeks, a team from In His Image in Tulsa, Oklahoma will join me in conducting the first of these courses here in Papua New Guinea.  We are aiming to teach staff from many hospitals throughout Papua New Guinea during the PNG Medical Symposium.

While I trust that skills we teach can make a difference in the lives of mothers throughout Papua New Guinea, my other prayer is that we could raise the awareness of their struggle.  A struggle shared with mothers around the world who deliver babies in surroundings that have no access to services that are often taken for granted in other places.

While I look to teach others some skills to make a difference in these women's lives, I hope that those challenges may one day catch the attention of a world sometimes spinning too fast to take notice.


-----------------------
Update
-----------------------


In the last 2 weeks we have hosted the first 2 ALSO courses for Papua New Guinea physicians.
What a privilege to be part of the Society for Rural & Remote Health and to meet and
work with great doctors who want to make a difference for the mothers and babies
of rural Papua New Guinea.







Monday, June 4, 2018

A day's work



Typical queue outside the hospital in the morning

Many of my blog posts focus on a particular patient's story – one that captures and speaks to me. I hope that those stories bring a fresh perspective to those who read about them. But I recently came across the journal of another medical missionary who outlined his typical day. I want to do the same, in an effort to make “a day in the life” of Dr. Mark a little more real to those who have partnered in our journey - this amazing ministry of medical missions. Perhaps this can also help those considering a similar career for their future.

So recently I kept a log throughout my day. As a general outline, we usually get up around 6:30. I make some coffee (french press if the power is off) and usually try to sit on the swing on our back porch looking out on the clearing of the fog from the misty mountains around us. The children are up at 7 and we get them fed and Anna ready for school. By 7:45 or so I am off on a walk with Anna to drop her off at school on my way to the hospital.

Lately I have had some protected times in the morning from 8-9am to study for my upcoming tests, but I usually will see patients on a ward (Medicine, Pediatrics or Obstetrics). During this particular day I saw patients on our pediatrics wards with a variety of childhood ailments ranging from heart disease to pneumonias to diarrhea and malnutrition. After ward rounds, about 9am, I go to the hospital's out-patient department (clinic) and see patients there as well as covering the emergency room or delivery ward.



On this particular day, after ward rounds, I saw cases of:
Pericardial tuberculosis, tetanus, severe asthma requiring IV aminophylline, typhoid fever, a follow-up of pneumonia in a pregnant HIV patient, an undescended testis in a 4-year-old which I confirmed with an ultrasound examination, hypertension, a follow-up of a supra-condylar fracture in a child I reduced and splinted the day prior, splenomegaly from portal hypertension caused by congenital hepatitis B infection, and a bronchitis in a patient with hypertension. 



It was then time for a meeting with the provincial malaria officer to discuss a case of artemether-resistant malaria I picked up in a young boy living in a remote part of the province. We needed to organize a community outreach to confirm any additional cases and put plans in place to deliver bed nets and alert the national malaria control program. I also met with our provincial TB officer to talk about staff from WHO that were planning to come to our province and conduct a survey of our TB patients.



I went home for lunch with Esther, Levi, Lucy and Gabriel – Anna takes her lunch at the school. Lunch breaks are great ... an hour every day that I can take just a 5-minute walk to escape the pressures of the hospital and see my family. I know that if I were practicing in the US, the odds of getting lunch with my family would be pretty slim, and I'm grateful to have that chance here.


In the afternoon I was back to the clinic to finish a busy day, including cases like:
Gastroesophageal reflux, vomitting in a newborn, a 10-month old with pneumonia, osteoarthritis in an elderly lady, and then a summons to the delivery room to assist with a severe shoulder dystocia that needed very involved maneuvers to deliver – thankfully after resuscitation efforts both mother and baby survived, then back to clinic for a forearm fracture in a 6-year old, persistent diarrhea and weight loss secondary to enteric fever, a new supra-condylar humerus fracture needing reduction and splinting, carpal tunnel syndrome, rheumatic fever, a 12-hour old foot laceration, a child with nephrotic syndrome and finally a young woman who likely had infertility from polycystic ovarian syndrome.


About 10-12 pediatric inpatients
10 clinic patients in the morning and two meetings with provincial disease control officers
12 patients in the afternoon along with a severely complicated shoulder dystocia delivery

Every day at Kudjip is different. Each one brings its own challenges and rewards. Each one is tiring. But each one holds work that needs doing and, often, a patient that needs special care and prayer.

It would be impossible to capture one day and call it typical. But for those who would like to imagine what medical ministry looks like at Kudjip hospital, perhaps this can provide a glimpse into it.

“Throw away, in the first place, all ambition beyond that of doing the day's work well.”

-Sir William Osler