Monday, July 3, 2017

Brokenness aside

"You take brokenness aside and you make it beautiful"

I don't do a lot of Facebook.  Not because I am against it.  I love that my kids' grandparents can see pictures of their daily lives despite being a world away.  I do struggle sometimes looking at the consumer-saturated culture displayed in the various items marketed on my screen.  But overall I feel we have a good relationship with our social media.

I recently clicked on a link to a popular Christian blogger.  (They have an agents if you would like to "book" them).  The post dealt mainly with parenting in a wholesome way.  What stood out to me though wasn't the content.  It was a picture.  The cover picture of this popular blog shows a pristine bible resting on a table top next to a fountain pen and a mug of coffee.  Two sets of hands rest next to it, one of them bedecked with jewelry and indicating a particular verse.  I think this picture encapsulates something - and I am sure that is the intent.  The embrace and study of God's word.  However, I struggle to make this picture do that for me.




In my high school year book I got one or two snaps outside the typical roster-style photos of my 600+ graduating class.  One of them shows me sitting at a table in a coffee shop with an open Bible underneath my hands held above it clutching a disposable coffee cup.  For those who know me well, they realize that this picture was obviously taken in the latter half of my high school days after I had an encounter with God in the 10th grade.  At the time, I was happy to see that I made the yearbook for something I considered positive.  Now I think back on that picture (I don't even know where my yearbook is) and have to wonder ...

A patient of mine here in PNG came to my clinic room a couple weeks ago, barely able to walk, supported by his friends and relatives.  We will call him Rob.  Rob and I have known each other for a little over two years.  When I first met him he had lost a ton of weight and coughed incessantly.  After a short discussion and blood test, I discovered Rob was living with HIV.  The virus had ravaged his body. Over the next month, though, Rob started medications to control the infection and his family helped bring him back to health.  After staying well a couple years, Rob now looked worse than I had ever seen him.  It was obvious he needed to be in the hospital and have tests done.

Checking his Xray, blood test and cerebro-spinal fluid I disappointingly realized that Rob had central nervous system complications of HIV and I couldn't give him any additional medical help.  I asked the nurses to bring him to the privacy of my clinic room to break the bad news.  Roaches scuttled through some of my drawers, papers were disheveled on the table behind me, a dirty blue drape clung to my exam table and the squeaking wheels of my stool sang incessantly as I made my way to him across the torn linoleum floor.

After telling Rob I had nothing left to give him and I expected he would die soon, I put my hand lightly on his shoulder, feeling every bone and sinew through his wasted frame.  He looked up at me and said, "Doctor - where is your Bible?"  I grabbed it from the shelf.  Rob then led me to a passage of scripture in Hebrews - explaining that if he had continued in his old life he would have already died long ago.  He felt that during his battle with AIDS, God had given him new wisdom and that he could now share this and instruct others.  If he hadn't gotten HIV, he would not have the ability to minister like he does now.  His frail hands grabbed mine and we prayed before he slowly walked back to the ward and likely out my life until Heaven.



I remember being back home for a few months in 2015 in the fall.  There was a miniature furore over the fact that Starbucks cups no longer carried any Christmas symbols.  Some thought Starbucks was doing away with Jesus and Christmas in general.  As a first-time furloughing missionary, I remember struggling to identify with my home culture.  I had just returned from a rugged land working to bring a little health to those struggling with cancers, HIV, and the many injuries born out of incessant tribal violence.  I thought of patients who taught me so much about life, God and His son, Jesus ... Many of whom were soon laid in the ground for an eternal rest.  All I could think was, "we are looking for Jesus in the wrong places"

For over a week I have been absorbing Rob's message to me.  A message he gave in a busy clinic room peppered with roach droppings and the scattered instruments of a missionary doctor.  He will never have an agent to book him for engagements.  In fact, he will probably never again walk unassisted in this life.  But perhaps he has more to offer than my "Christian" culture appreciates.  Perhaps Rob is where I ought to be looking for Jesus more.

I pray that I will continue to find Him in the dirty clinic, the grass huts of villagers, the bloody emergency room and the hearts of those who, I have discovered, are already so near to Him.


Wednesday, May 31, 2017

One forsaken grave

“So give me hope in the darkness
that I will see the light
'Cause oh, you gave me such a fright.
But I will hold as long as you like,
just promise me we'll be alright.”
 
Most people who read this blog know that I am a twin. My brother, Luke, and I were numbers four and five, separated from our older siblings by at least eight years. We are very close to this day, and even as kids I can remember only one or two instances where punches might have been thrown. I love the connection we have and I believe it is unique.

In 2010, Esther and I suffered our first miscarriage. I remember the heartache of not getting to meet our child. Then in 2011, while Esther was pregnant with Levi we had another scare. Our doctor called with some test results and thought a medicine might help. I raced to the pharmacy while praying furiously. Few people know that Levi had a twin sibling in the womb, and as it turned out we lost one child but one survived. I sometimes wonder about that – if he somehow knows there is a twin brother or sister waiting to meet him one day.




It was nearly midnight when my phone rang and woke me up from the couch where I sleep when I'm on call – to try and spare Esther and baby Gabriel more disturbances in the night. A visiting family medicine resident named Christie from the US needed me to see a patient in the hospital. When I arrived, I saw Delma gasping for breath, barely conscious.

I recently cared for Delma and her twin sister Elma on the ward for severe breathing trouble. I remember the confusion each morning as these 8-month old twins often got switched around in the bed and it took a few moments for their mother to sort out who was who. But they improved and went home. The respite wouldn't last, though, and both fell ill with breathing complications again.

As soon as I arrived I knew Delma was in trouble. The nurses couldn't get intravenous access to give fluids or drugs and a nebulizer aggressively pumped “gas-maracin” into her face, trying to open her constricted airways. Delma was slowly suffocating. It brought back harrowing memories of Levi's illness a couple years ago.

I got adrenaline from our drug cabinet and injected it into Delma's skin, then placed a special needle directly into the bone of her leg and gave a powerful respiratory medication through the intra-osseous line. She seemed to relax some, but I knew she needed to climb a big hill to recover. Christie and I grabbed the hands of her mother and prayed for her. All the while, her sister Elma watched on, mostly oblivious to Delma's obvious distress.

The next day our staff gave every possible treatment to Delma. Sadly, her breathing wore out and she succumbed to the constriction in her lungs. Elma watched passively as their mother cried over her lost twin sister.

Recently in our nursery, we lost two babies to prematurity. Each had a twin that survives them and are doing well. Those babies are a blessing to their grieving mothers. I love the strength of these women who can love on their living children, but know that a tinge of sadness lingers as they consider the departed siblings – ghosts that we all knew.



I worry that I don't have the right words for the families here when they lose children under our care.  

As a medical missionary, I feel those moments are precisely why I wanted to come to a place like Kudjip.  I believe doctors have a special connection to their patients - encountering their moments of greatest vulnerability and triumph.  As a follower of Christ, I see the opportunity to present the love of God in those circumstances.  So why am I so paralyzed?

Perhaps I struggle to find something to say because, in those moments, I am simply trusting in the persevering hope we share in Christ.  Hope in the darkness.

For every child we lose to malnutrition, pneumonia, diarrhea, pre-maturity or one of the other myriad illnesses we might see here, we probably send five home to their families - to life.  As they gather their belongings from the bed preparing to leave for the village, I take a moment and appreciate that they have been restored.  That a grave meant for them remains empty.  I want that same paralysis to grip me - grateful that their recovery, like those we lose, represents something truly beyond me.

"Our wayside planet, carrying land and wave,
Love and life multiplied, and pain and bliss,
Bears, as chief treasure, one forsaken grave."
-Alice Meynell

Tuesday, May 23, 2017

Beyond reach

"Today, we live in a media-saturated, Internet-connected, cell phone-equipped world in which everything that happens anywhere is instantly available everywhere ... We now have the opportunity not only to see those in extreme poverty but also to help them."  -Richard Stearns

For many of the people who read this blog, it might be difficult to imagine what things are like on the ground.  What is the hospital like?  What are the conditions like?  What challenges do the people face?  Perhaps the stories and pictures from this blog have painted a virtual picture for you.  But the amount of stories, information, and pictures coming into the typical western home every day are staggering - often stories about hard-hit places in the world where help is desperately needed.  Nothing can quite compare to experiencing PNG on the ground

From the enjoyable fireside at my home in Tulsa, Oklahoma, Papua New Guinea felt like a million miles away.  I remember spending a month here as a resident, and then running through the rest of my training wondering if I were called to come back.  Back to 'those' stony roads, 'those' hospital wards, 'those' sick and hurting in the middle of the Pacific.

Not quite a million ...

One thing I love about being here is how supportive our families are toward the mission we feel like God has given us to reach out to the suffering patients of Jiwaka.  We are so grateful that they are willing to spend years at a time away from us and grandchildren, nieces, nephews and cousins.  Many of them actively support our work - through their thoughts, prayers and gifts.

A few months ago, my brother Luke and nephew Anson were able to get bruised and bloodied on the ground in PNG.  While they mostly came to see the kids, spend time with us and help with some chores around the home, they got to see first-hand what the country is like and how we fit in here.  Before they came, I arranged a day to get them into the true village and bush experience of PNG that so many of our patients encounter every day.  In particular, I wanted to look into a specific valley - where my twin brother Luke and I each have a namesake child running around the jungle because of our efforts at Kudjip to treat their mother.  During their visit, we summited Mount Kulpope, which lies on the range north of our station, looking down into one of the most remote places of the world - the Jimi valley.


Anson, Luke & I on Mt. Kulpop

Intro

We are not the “world travelers” of the family. Before this trip, Anson had been to Canada exactly once. And Luke sometimes gets home-sick on his way to the office. We’re both used to our comfortable American lifestyles.
Even reading this blog is a jolt - Papua New Guinea seems unreal. It's much easier to read whatever stories & pictures our Facebook feeds and reddit put in front of us.
So we're very thankful to Papa & Mimi for encouraging us, and supporting our trip. We had a chance to spend time together, and to experience PNG for real. (After a quick day full of banter in Sydney)

Arrival

First, we filled 20 hours of travel and a day in Sydney, Australia with some Crouch banter. Then we flew from Sydney into Port Moresby. The airport is modern, but small. We made a short walk outside from international to domestic terminals. A local "pikinini" pinched Anson's (white) leg. A lady in the airport asked Luke if he was a doctor at Kudjip.

We landed in Mt. Hagen's new terminal, complete with a real baggage carousel. Mark, Esther, and all the kids came to pick us up! And we got one of the first “real” PNG experiences that doesn't appear much on this blog - the "roads" of PNG.

The US Army Corps of Engineers developed the "Pavement Condition Index." It's a number between 0 (worst) and 100 (best) that indicates general condition of pavement. It includes distress types from "alligator cracking" to "bleeding." I assume the PNG Army Corp of Engineers’ scale goes from 0 to negative 100 and includes “bus-sized sink-holes”.

But, we did arrive at the Nazarene Hospital station.

I noticed immediately how much the station felt like a monastery. I’ve visited the Abbey of Clear Creek in Oklahoma dozens of times. There’s something about places of enduring intentional community. They are quiet, and there are few frills; opposite to most modern Western environments.

Week


We started with a hospital & station tour. This blog doesn’t describe the amazing gardens - especially fruit - at Kudjip. Almost every house on the station has a large garden (by American standards). And every plant in every garden is always bearing fruit. We also saw some of the station operations. We met Jordan who builds and repairs many of the facilities.



That night, we played the board games that we brought for the family. Levi beat us all with "the dream" draw in Carcassonne.

The next day, we “helped” paint Lucy’s new school desk, and Anson got to teach the elementary kids in Anna’s PE class (soccer, of course). We joined Mark for a “swim” in the "station canal". Where "swim" means "harrowing death-race against the current." And where "station canal" means "10-meter fork of water between death-by-waterfall or death-by-grinding-in-the-hydro-power-generator."

Anson strikes the post in the kids' PE class

"Warning!  All adults must look after kids in this area!"


Since that was so much fun, we also visited the Kudjip dam. At least there were signs warning of death. And yet we saw many PNG pikininis doing back-flips into the reservoir inches away from a 12-foot fall. We played a game of volleyball with many station docs, and finished the day with dinner with the McCoys.

The next day, we joined Brandon Zimmerman - a professor from the Good Shepherd Seminary - for a hike up Mount Kulpop to try to get a view into the Jimi Valley, which you may have read about on this blog before. Brandon arranged for a guide, but by the time we reached the foot of the mountain, we had at least 4 guides. We wore hiking boots and high-tops; a few of our guides were bare-footed. Brandon suggested we were 4 of only 50 white people to ever hike up the mountain. It was the hardest thing either of us has ever done. But we saw some kid's homework on the trail - now THAT'S a hard walk to school! (Luke: When someone complains about box-jumps at CrossFit, I now say "Somewhere in Papua New Guinea there's an 8-year girl doing 100 box-jumps on her way to school.)




That night, Mark & Esther hosted a board game night for many of the station docs & staff. We got to share a couple of our games with them, and they showed us "Colt Express" - which we now play back at home.


Our last day was slow and quiet. So of course we invented a new dumb game called "honor" - a completely despicable variant of soccer to make your opponent run as far as possible as fast as possible. We packed our bags and watched The Lion, the Witch, and the Wardrobe to finish the night.


We left the station in the morning for the Mt. Hagen airport and our return flight to Sydney. We ate breakfast at a restaurant near the airport, said our last good-byes, and were back in cozy hotel beds by sun-down.

Reflections




I can’t get over how much the Kudjip station feels like a monastery. The trip was absolutely a spiritual retreat for me …

Years ago, I struggled with an episode of depression with a strong spiritual dryness - a crisis of faith and a dark night of the soul. Since then, I keep my faith and spirituality deeply to myself. (Maybe I’m afraid of triggering a relapse?) While becoming Catholic, I studied theology intensely. After my depression, I resolved to study the faith less and “to live real life with real people” more.

At my Easter Vigil Confirmation, my pastor - Fr. Joe - spoke about the Resurrection, and the many ways we experience the risen Jesus. But that “the best evidence of the resurrection is you: you are the Body of Jesus alive in, to, and for the world.”

I have never experience the truth of that statement more deeply than this trip to Kudjip. The real people at Kudjip saving real lives.

Even having been there, now that I’m back in my American home and routine, Kudjip and Papua New Guinea are already starting to feel exotic and remote again. (It doesn’t help that it took us 5 months to write this down!) It makes me sad that our culture seems to make real meaningful and spiritual life experiences so hard, and after we have them, it crowds them out with noise.

But I have no doubt that Papua New Guinea will be with me the rest of my life. I’m so thankful for everyone who made our trip possible. And when I do get some quiet moments, remembering the people of Kudjip is my new favorite way to remember how real Jesus is in the world.

Monday, March 20, 2017

Long Martyrs

 "Find me in the river
Find me on my knees
I've walked against the water
Now I'm waiting, if you please."

Often times I find it difficult to discuss serious illness with Papua New Guineans. I think the language is partly to blame. Pijin is not a sophisticated language, and rarely the mother-tongue of my patients. Describing a terminal illness or a permanent disability is challenging. I also think the cultural understanding of illness differs from the “Western” understanding. Illnesses are usually thought to be the result of the attacks of others or a spiritual imbalance, rather than misfortune or the result of a fallen world.
So when a patient comes to the clinic and I find that they have cancer, I know they will need a thorough explanation and a chance to ask questions, and I try my best to make enough space for that to happen, remembering the hundreds of patients still needing to be cared for that day.


Douni and her daughter Esther walked to my exam room in the morning, one of the first patients I would see that day. Douni looked to be almost sixty, slightly bent over with the long labors of her difficult life evidenced in her joints. Her daughter, Esther, lived in the nearby town of Mt. Hagen but brought her mother from the village to Kudjip because she had been having pains in her abdomen and losing weight.

Douni's skin and eyes glowed with an unnatural yellow appearance. Her abdomen held a soft mass in the right side near the ribs – a collection of findings known as Courvoisier's sign, which I've written about before.

An ultrasound confirmed my fears – Douni had cancer that couldn't be treated and she would die in the next few months.

I let Douni sit down on my exam table and put her clinic book down on the counter. I told her that she had a bad illness (“sick nogut”) called cancer. We had no medicine or surgery that could cure her. She did not get it from someone else and she would not give it to her daughter or her family. I advised her against using all of her money on bush-doctors or tribesmen selling herbs in the village. I could give her medicines to help her pain, and her daughter or family members could get new supplies of those periodically if she was feeling too weak to make the journey back tot he hospital. But nothing we gave her would cure her illness.

I give this explanation about once or twice a day to patients with various cancers – liver, pancreatic, ovarian or breast. Many times the patient and their relatives immediately start asking questions. “But can I eat something that will heal me? But can I go to Australia to cure this? How did this happen to me? A long time ago my brother fought me with a coffee stick and hit me there, is that why the cancer came up?” It makes my long-winded explanation feel like an exercise in futility.

But Douni and her daughter sat quietly through my talking with them, with their faces slowly dropping as genuine realization sunk in.

Then this beautiful Papua New Guinean mother (“lapun mama”) brought her hands up until she was holding my face in them. She said, “I thank God, because he sent you to help me and my people. Now the rest of my life is in His hands.”

We prayed together – Douni and Esther were not the only ones crying through that prayer.



Esther thanked me as she helped her mother off the exam table. I showed them to our dispensary to collect promethazine for nausea and paracetamol for pain - releasing Douni to her long martyrdom with cancer.

In the book of John a friend of Jesus, Lazarus, fell ill and it appeared he would die, so his sisters summoned Jesus – who advised his disciples that the illness would not kill him, but show God's power. But by the time they got to there, Lazarus had died and his body was already entombed. There are likely many commentaries about what happened next, but one of the most striking verses in the Bible follows.

Jesus wept.

Until moving to Papua New Guinea, I'm not sure I realized why this verse was impressive. I used to believe that this verse showed Jesus was entirely human, despite being entirely God. He had feelings and emotions - he struggled with sadness - he had close friends whom he could mourn. But reading through the rest of the Gospels, the humanity of Christ is already revealed impressively. His compassion on crowds, for example. There was more in this weeping than just being human.

Jesus knew that Lazarus lying in a tomb, wasted away by an illness, was a violation of God's plan. That the illness and suffering of the world were a tragedy. As he looked at the stone in front of the tomb I believe he saw the millions of graves around the world filled with mothers, children, grandparents and young men like Lazarus. He saw beyond Lazarus' resurrection to the need for a resurrected world, completely free of sickness and death. And perhaps, to this end, he saw his own tomb and knew what trials were in store for him.

I've only ever seen one person who I believe might have been resurrected from the dead.

But I've seen hundreds others who walk the long and lonely martyrdom of cancer, HIV or Tuberculosis that I can't cure.

And in one of those moments, to which I sadly become less sensitive, Douni brought me back to the front of Lazarus's tomb. Where the savior I serve let his heart grieve and weep. That I might truly be conformed to the fellowship of his suffering.

And I felt a beautiful joy. Knowing that, for some, I may not heal their physical bodies. But that their beautiful spirits now rest with Christ in a world free of sickness or suffering.

"But if the blessing's in the valley
then in the river I will wait."