Friday, May 4, 2018

Kindly light

"Lead kindly light, amidst the grey and gloom
The night is long and I'm far from home
Here in the dark I do not ask to see
the path ahead, one step enough for me"


A couple weeks ago I walked into our pediatrics ward to begin my morning rounds.  A new patient and her parents awaited me on bed 10.  Maria had recently been taken for surgery for a possible abscess in the back of her throat.  Her surgery revealed very little, if any, infection there - but her neck still tightened and she complained of difficulty swallowing.  After examining her, I adjusted her antibiotic coverage and IV fluids, moving quickly on to dozens of other patients that needed my help that day.

The next day I saw a note from the on-call doctor who had been called to see Maria because of a "fit" - which turned out to be a muscle spasm, commonly encountered in one of the diseases I've seen working here in Papua New Guinea and have grown to abhor - tetanus.

Over the next few days, Maria's body contorted itself in frequent, uncontrolled spasms - through which she remained conscious and alert but paralyzed.  She could not eat or drink and pain etched itself more deeply in her young face.  I remembered Lesley whose drawn out battle with tetanus ended when the spasms and subsequent paralysis overwhelmed his breathing and he died.

In a hospital with ventilators, the treatment of tetanus is difficult but largely successful.  The patient is put on a respirator and strong medications given to halt the spasms while antibodies are given to help clear out the infection.  Here, we haven't been able to get the antibody treatment supplied for a while and we have no ventilators.  So we focus on "supportive" care - an IV antibiotic against the Clostridium organism, IV fluids for hydration, medicines to decrease the spasms - balanced against the need to not completely tranquilize the patient and halt their breathing.  We also place the patient in the darkest room we can contrive, blacking out windows and minimizing stimuli which are known to trigger spasms.


Several days into this treatment, I entered Maria's room where her mother typically slept on the floor next to her bed, to avoid touching her and triggering the illness.  As my eyes adjusted to the tiny ribbon of light allowed through the side of her window I noticed that Maria, who had each day been lying on the bed, was now sitting up slightly in her mother's arms.  She forced a weak smile on her face and after I reviewed her IV drip and medicines, glanced at her mother who asked me a question that inspired this post:

"Em i askim inap i go autsait na lukim san"

"Can she can go outside today for a few minutes to see the sun"

In the darkness of that room, the tears that instantly rimmed my eyes were hidden, but my breaking voice choked out, "yes."

Often my patients are looking for a glimmer of hope in their struggles.  A kindly light to lead them out of utter darkness.  Sometimes that little hope goes against all medical reasoning, but I believe it is no less crucial.  Maria's question taught me this in an instant.

"Each stumbling step where other men have trod
Shortens the road leading home to my God."

The next day, Maria's mother told me she was so happy to be outside that, despite having another fit in her room, she relaxed enough to eat a small amount.  Over the next two weeks Maria waged war with tetanus - occasionally being thrown into muscle spasms, occasionally glancing at the ribbon of sunshine in her room, kindling hope and gaining strength.

After a month in the hospital, I finally put my pen to Maria's chart for the last time - not to sign her death certificate as I so often do, but to write her discharge order to go home.  

Through a rough and stumbling road in that darkened cave, the Light had brought her home at last.


Sunday, April 1, 2018

Risen indeed

On this Good Friday, I made rounds in the hospital on the pediatrics ward, tending to about thirty children with ailments ranging from HIV and malnutrition to pneumonia and diarrhea.  As the on-call doctor, I also checked the other wards, emergency department and labor & delivery unit.  In the bustle, a nurse summoned me to the medical ward to assist with a patient who had just arrested.  I recognized him as a young man I admitted to the hospital a few days ago for a central nervous system infection of unclear cause.  Over the last couple days his condition worsened and although we eventually identified the tuberculosis in his spinal fluid, our interventions were too late.  As we gave medications and attempted to restart his heart and breathing, his brother looked on.  After several minutes, I instructed our nursing staff to stop their efforts and told him, "Em i dai pinis" - "He is dead"  He collapsed onto his brother and wailed in grief.

To lose a patient, a young man perhaps half my age, on the same day that I remembered Christ's own death and suffering on our behalf made me ponder how much further we have to go in order to see His completed work in our world.

After checking on our nursery, I went to the emergency department to see a baby of four months struggling to take breaths with a low pulse - barely alive.  The baby was born at Kudjip in December and was diagnosed with multiple congenital abnormalities affecting the brain, heart and other systems.  Although the mother knew her son would not live long, she lovingly cared for him until Friday.  I counseled and prayed with her, and tears flowed freely as the pain of her son's death sank in.  I was struck by her example.  That she spent every day for months in a bittersweet reality of enjoying this life but knowing it was coming to a steady end.



In the book of John, after Christ is crucified, Mary goes to visit the tomb in which his body lay.  Seeing the stone removed she quickly tells the disciples.  After seeing that their friend's body has been taken away from them, they return home.  But Mary chooses to endure the grief.  She remains in the garden, weeping. 


Why did she stay there?  Jesus was dead.  The disciples left.  Even the body of her Lord was gone.  Why remain in a place where reminders of loss, tragedy and grief surrounded her?  This moment in scripture has powerfully shaped my ongoing work in the rugged highlands of Papua New Guinea.  I think that Mary gives us an example, like my patient's mother, that God may use the times that seem  darkest to make even small lights appear bright.  Because of Mary's willingness to simply weep, she became the first person the risen Christ chose to reveal himself to.  Perhaps God wants those who suffer to endure those times of loss because it highlights the Resurrection.  Not to minimize the suffering - but to contrast it against a sharp relief of hope.

On this Easter Sunday, when I celebrate a risen Christ, may the dark and empty places in my world not frighten me away.  Instead, may they foster in me a patient expectation for the resurrected Lord.

Friday, March 9, 2018

Phantoms

"May it be an evening star
Shines down upon you
May it be when darkness falls
Your heart will be true
You walk a lonely road
Oh! How far you are from home"

At about 3:40 in the morning on Monday I got a call from a medical student visiting Kudjip about a patient in the Emergency Room who needed prompt attention for a hand wound sustained during domestic fighting.  Just as I hung up the phone, the ground started to shake.  Several minutes later, after taking shelter with the kids under a sturdy bed, I went up to the hospital.

After clamping some arteries and stabilizing the hand for later surgery, I got breakfast back at the house and then returned to the hospital.

After a few minutes a nurse asked me to come to the ER to evaluate a child just brought in.  When I arrived at the bedside it was obvious the child, a boy of about 5, had passed away some time before.  His mother was upset but alongside her grief she wore a face searching for answers.  In fact, the reason they came to the hospital was not to get care, but to ask, "why"?  What had caused her baby to suddenly stop breathing and die so suddenly?

I could have given many answers.  He had a distended abdomen - perhaps there was a congenital malformation that caused an intestinal rupture.  Perhaps there had been an unknown injury that worsened in the night.  From a big picture, the absence of routine well child care and preventive services could be to blame.  Ultimately, why would any child of 5 die, other than the lingering effects of a fallen world still groaning for its final redemption?

But what that mother really wanted, I think, was for her child's life and death to have a reason.

Throughout that week we heard news on the quake.  A strong 7.5 on the Richter scale that hit west of us with reports of homes being swallowed in avalanches.  Much of the international news media covered the quake for a day or so before quickly moving on to other topics.  After the initial "unconfirmed" death toll it seems that, sadly, the lives of those affected by this catastrophe will resume being "invisible" in their struggles to most of the world.

"How many are sicker ... of whom, the first takes knowledge, is the sexton that buries them, who buries them in oblivion too!  For they do but fill up the number of the dead in the bill, but we shall never hear their names till we read them in the book of life with our own"
John Donne

Wasana Village, Photo MAF

My mentor, Dr Bill, wrote a book some years ago titled Until We All Have Names, chronicling the stories of just some of the thousands of patients he has seen.  Stories and lives that have no birth certificates, no forms of identification, no accolades other than the powerful testimony of lives colored by incredible endurance.  As a hard world went by, like those who were swept away last week in numerous avalanches, they made no headlines.

I used to think my blogs and stories from this mission hospital represented a battle against this anonymity - that I could give names to the people that much of the world saw only as phantoms.  But I think I understand things differently.  Each of them has a name, a purpose, a reason and incredible value that may not be fully known this side of Heaven.

When the night is overcome
You may rise to find the sun

So while the world takes a fleeting glance at an earthquake in one of its remote corners, numbering the dead briefly, we press on trying to know and, at times, bring healing to those whose names will one day be accorded their rightful place.

A patient evacuated to Kudjip by MAF from the earthquake area


Friday, February 9, 2018

Black and white


“I used to think I needed all the answers
I used to need to know that I was right
I used to be afraid of things
I couldn't cover up in black-and-white”

Thanks to the generosity of an individual sponsor, for the past five weeks I have been able to study courses at the London School of Hygiene and Tropical Medicine. This represents part of my ongoing work toward getting a Master's in Public Health there.

The experience exceeded my expectations. Those at the School emphasize providing realistic public health care in settings of conflict or development – things that I feel complement my work in the hospital at Kudjip.


But for all I have learned I feel that my perspective has been unique. As the eighty-plus students around me take notes and the well-versed professors give insight into challenges I have personally faced the past four years, I am periodically drawn to look out the windows. My mind wanders back to my exam room, the delivery unit or the TB ward at Kudjip. I see clearly the faces of patients whose earthly burdens I've witnessed. Many seem so far removed from the walls of my school that my heart breaks – wondering how many have lost their earthly fights in my absence.

I am a life-long learner and I love black-and-white answers. Perhaps that is part of the reason the Lord put me in Papua New Guinea. Things so rarely declare themselves in black-and-white and the answers are even more complex. Perhaps he needed me to let go of that mindset.

I believe my studies will help me, and help those who come to Kudjip for care. More than that, I believe they have shown me that, even surrounded by the high ranking public health minds of academia, the most valuable contribution I can make as we serve in PNG is to truly care for and love those that put their trust in our hands. To consider how I can go “upstream” and make bigger impacts, but never lose sight of those individual faces.



“So I just want to look
a little more like love.”
-Ben Rector

Friday, January 12, 2018

Joly ol' England



Our crew just arrived in the UK this morning to visit with Esther's family for 5 weeks before returning to Papua New Guinea in February.

We are so grateful for those who came to hear about our work in PNG and who have joined our team in bringing hope and healing to the highlands there.

In the next few weeks we plan to connect with Esther parents, brother, sister and in-laws as well as her church family at Long Crendon. We are staying with Esther's family in a beautiful village called Studley Green. I will also be attending classes on Wednesday, Thursday and Friday each week to continue working on my MPH through the London School of Hygiene and Tropical Medicine. I'm excited about this opportunity and have already felt like my studies enhance my work at Kudjip.

Thank you again for being part of our journey!

Thursday, December 14, 2017

Nearly there ...

What a privilege to see so many of you these past weeks.  It is hard to believe that in just less than a month we will be going on to the UK to visit Esther's family before heading back to Papua New Guinea.  Through our open houses we've shared stories and the great challenges facing the highlands where we live and work - but tried to convey the great hope that we have in the coming years of our service there.


With several doctors retiring in a short span of time, Kudjip will be busy tending to patients, reaching out into the community, making disciples and training the next cadre of health workers for Papua New Guinea.  We continue this work called to an important task, challenged by a difficult place, but motivated by a matchless love - that Christ would give himself sacrificially as an example to follow.



We are grateful to our new prayer and financial partners that have joined with us after hearing about our desires and our needs to continue working at Kudjip.  We are nearly to our monthly support goal and trust that the remaining need will continue to be provided through those who are called to join with us.  Not all can physically go to Papua New Guinea but many have already put virtual boots on the ground by sending their prayers and financial support to the patients we treat, people we teach and communities we touch.



Wednesday, November 15, 2017

Join our team

We could not serve in Papua New Guinea without the prayers and financial gifts of friends, family and the body of believers that support us - thank you!



Current prayer needs are:
Our marriage and family to grow closer to each other as we minister.
The ongoing work of the hospital.
Financial provision for us and for Kudjip.
Health and safety for ourselves and our children.
Disciples to be made among our Melanesian neighbors and co-workers. 

We moved to Kudjip in January of 2014 with two children and the intention to stay for a year to "try things out."  We now feel a call to ongoing ministry there, and we have added two children!  We are grateful for the faithfulness of our supporters.

After four years of service we are looking for additional prayer partners and financial support.  This will enable us to remain serving at Kudjip bringing health and hope to the highlands.  Thank you for considering giving toward the Lord's work in Papua New Guinea.


Our monthly support covers travel to/from the field every 2 years, as well as our expenses while in PNG


There are two organizations that you can use to support our ministry financially: the Church of the Nazarene or In His Image, International.

To give through In His Image, follow this link.  Instructions are available for online giving through card or bank account, also via gifts through mail / paper checks.
Be sure to designate your giving for "Mark & Esther Crouch"

To give through Church of the Nazarene, follow this link.
(This web page allows online bank transfer only)

Your giving is tax-deductible and you will receive a year-end receipt for donations made.