Wanem bai kamap bihain

"What will happen next?"

Today I visited with a patient in our clinic for some time. 

On the 5th of February, a relative thought that Koki was being unfaithful to his wife.  His sister-in-law became enraged and attacked Koki with a bush-knife.  He suffered several knife wounds, losing part of his hand and breaking bones in his foot.

The bush-knife pervades society here, and even children as young as four or five will carry small ones.  The nurses in the emergency room  created the acronym "BKW" which means Bush-knife Wound, because they see them so commonly.

Unfortunately the other thing that pervades society here is revenge.  Any attack potentially begins a tribal or "line" war.  In Koki's case, his son, Tony took matters into his own hand and killed the woman who attacked Koki.  Now Tony occupies a cell in the nearest prison awaiting Kot, or trial.

Around here, what comes next is anybody's guess.  Tony might pay some compensation.  He might have to live in prison.  He might be released and later fall victim to yet another revenge killing.

The past two weeks have seen healing come to Koki's body, but I spent most of my time speaking into his heart.  

When I asked Koki what will come from all of this he wasn't sure either.  Koki has attended church, and most people from PNG love Bible stories.  I went through the story of David and Saul - that David would not take matters into his own hand against Saul when he had him at his mercy, even though Saul had tried to kill David and hunted him in the wilderness.  Koki nodded and seemed to understand.  I asked him what he thought the story meant.  He said that it was not our place to take Kot into our own hands but leave it to God.

"Let the Lord judge between you and me, and let the Lord avenge me on you.  But my hand shall not be against you." - I Samuel 24:12

What if Koki had understood and learned this lesson years ago?  What if he taught Tony that lesson when he was younger?  Would Tony be a free man?  Would a now murdered lady still breathe and walk among us here at Kudjip?  I don't know what could be - and I don't believe God intends that we should ever know what might be different in our lives if circumstances changed.  

But I believe He has placed me here for a reason.  The more I see the victims of revenge and violence here, the more compelled I am to urge them to Peace.  The more my heart breaks for my patients.  The more I fear for those I may see in a week or a month from the same tribal fight.  The more I wonder aloud in my prayers, "What will happen next?"

Nameless

Rachel, Jennifer, Jeremiah

 Meet Rachel, her daughter Jennifer and her son Jeremiah.  Rachel brought up five children, and Jeremiah is the youngest.  All of her children live close to her, which is good because Rachel is dying.

A few months ago, Rachel was admitted to the hospital with congestive heart failure.  Her heart doesn't pump blood properly, probably from years of untreated hypertension.  Because of this, she gets short of breath anytime she walks.  Now her kidneys are shutting down.  When she left the hospital, her creatinine level was 7 and now it is 11, for those medical folks out there.

I told Rachel this week that she was dying when she came to see me in clinic.  Jennifer cried.  Rachel said that she felt something was very wrong but didn't know how serious it might be.  She trusts God and believes in Jesus as his Son.  I cried and prayed with this family - my first prayer in Tok Pijin.  Then I saw the next of dozens of clinic patients, many who are like Rachel.

Dr. Bill McCoy wrote a book called Until We All Have Names some years ago describing the plight of some of his more memorable patients working in Swaziland and here at Kudjip.  In it, he points out that the broken and suffering peoples of the world are often nameless, which I touched on in my last blog.  But God knows each of their stories.  Though Rachel's story will end sooner than most, He has allowed me to see into the lives of her and her family.  And there are many more.  For the privilege of putting names to those lives, I am grateful.

Anna at the orphanage outreach church

Last weekend Anna and I attended Lotu (church) at a nearby Orphanage.  Dr. Jim (Kudjip's surgeon) preached a very good sermon in Pijin and played the trumpet while his wife acted out the Hannah and Samuel bible story.  Did I mention their children Josiah and Lydia played the guitar for worship?  I will be having a serious discussion with God about the distribution of talent when I get to Heaven.  Anna and I enjoyed the service, which took place in a grass-hut church in the mountains just off the Highlands Highway.  

After this, we came back to Kudjip for English Lotu, a once-a-month all-English church service put on by the staff here and attended by many of the expat missionaries in the surrounding areas.  It helps that a potluck lunch precedes the service, which our family gladly took part in.

After Levi's attempt to perform salad-tong Cesaran on Esther, we restricted him to the wooden variety

 Some things I love, and one of them is when a child I really worried about improves and gets read to go home.  I wrote about Steward, a 13-month old boy who spent much of his life sick.  He came to Kudjip about ten days ago deathly ill with fever and what looked like meningitis to me.  Turns out Steward had a bad pneumonia and likely has pulmonary hypertension, explaining his recurrent bouts of respiratory issues since his birth.  Dr. Susan Myers at Kudjip trained as a Pediatrician and has good skills with ultrasound in children as well.  She identified Steward's condition and started him on medicine for his heart and he has finished his antibiotics.  Now he eats, drinks, pees and poops normally and may be able to wean off oxygen and go home in the next few days.

Steward looking bags better, now hoping to wean from oxygen

I also love healthy moms and healthy babies.  Magdalene delivered her baby on the 6th.  She experienced a retained placenta which needed manual removal resulting in a large tear.  But her baby boy thrives and she feels well enough to go home.  She gave me a bilum (bag) as a gift for delivering her baby.  During the delivery process she prayed for strength from Jesus for herself and even for me.  I feel blessed to have been there for her and her baby and will proudly wear my bilum to and from the hospital now!

Please pray for my confidence and trust.  I love seeing the moms and babies that we can help here, but my heart breaks for each of the babies we lose due to prematurity, congenital defects or neonatal infections.  I also struggle with wanting to control many of the small things in my patients.  But I know that ultimately my obedience to God and service to Him and to them makes a greater impact than my medical knowledge in this place.

Thank you for joining us in this adventure with your prayers, your thoughts and your generous giving.

Two sparrows

My office door

Many doctors delight in their first "office" - which typically has a plaque with their name and specialty posted on their door somewhere in their clinic.  I suppose I'm no different, though my door may not look like those dreamed of by medical students and residents in the States.

In our OPD (out-patient department), patients come one-by-one to each of the different doctors.  No appointments, no insurance forms, minimal paperwork, two to four dollars per visit - but plenty of broken and hurting people.  In my few hours in the OPD this week I've seen everything from deafness caused by untreated ear infections to Tuberculosis.  

 Yesterday I saw a child in the office and once the parents laid the baby on my exam table I knew we would have a fight on our hands for him.  Steward had been sick several times the past few months though he just recently celebrated his first birthday.  He barely cried as I examined him and he reflexively raised his entire body off the table when I held his head up.  I believe Steward contracted pneumonia which progressed to meningitis.  He is now receiving IV fluids and antibiotics in our pediatric ward but will need a miracle to thrive after this illness.

Pleased to get Steward's spinal fluid

 I've been working in the Operating Theatre this week with Dr. Jim Radcliffe.  My first experience in the OR last week for a C-section felt like a train wreck to me.  Dr Erin was very gracious.  I worried about how I would cope with the procedural medicine I need to be able to practice here.  I received a lot of OR and procedural exposure during my Family Practice training.  Some of the skills I learned then are returning thanks to this extra time with Dr. Jim.

Please pray for Haddie, who needs a miracle

 

 One of my patients on Surgery ward needs a miracle.  Haddie suffered from a bowel infection unique to PNG called Pigbel.  Dr. Jim performed surgery to remove the infected and dead tissue and now she struggles to recover her ability to eat.  Each day she suffers while we give her fluids and antibiotics and pray that God will touch her.  Healing for Haddie will have to be supernatural at this point.

 Last night I was on call and treated a lady in our Emergency Room.  She suffered from obstruction of her lungs (COPD) and needed oxygen and breathing treatments.  While preparing her to stay in the hospital, the ER staff nurse told me about another child who came and left just prior to my arrival.  Apparently the child experienced diarrhea for a few days and then developed dysentery.  The family brought the little four year old girl to Kudjip, but when they arrived she had died en route.

My first reaction to this news was, "Why wasn't I called?  Someone, a child no less, came to our hospital dead and then the family left and the doctor on call wasn't even notified?!"  I am ashamed to admit I thought this, because I now see that it is selfish.  In this place, the loss of a child is no less tragic than if I lost my own Anna - but it is tragically more common.  Now I struggle knowing that despite the years of school, months of preparation and all of the hardships that went into our moving here I still could do nothing for this particular little one.  In fact, I will never see her face or know her name.

In Matthew 10 Jesus says "Are not two sparrows sold for a penny?  And not one of them will fall to the ground apart from your Father."

I take comfort knowing that those I can't help or don't even know are not lost to God.  I may not get notified of every patient that comes here, whether they leave healed or to their eternal home.  But God sees each of them.  He will not part from them.  And their lives are not lost, nameless or faceless to Him.

Home

Hold on to me as we go.  

As we roll down this unfamiliar road.  

Although this wave is stringing us along, 

just know you're not alone - 

'cause I'm gonna make this place your home.

On October 1st, 2013 Esther and I moved away from our home in West Tulsa.  In the 97 days that followed, our family of four changed houses five times!  At long last, we are home in Kudjip, Papua New Guinea.

  

The first six days of our new lives in PNG we spent in a nearby village called Ambang.  The Lenzs working with New Tribes Mission looked out for us and helped us to learn the local language and customs.  During our six days, three of the local villagers died from various causes. 
What follows a death in this culture is the "house-cry" - a multiple day event in which people from the community express their grief by wailing and crying out loud multiple hours at a time.  A couple years ago I treated a young woman at the hospital for profound dehydration from a "house-cry".  Unfortunately, the wailing for some serves as a way of expressing enough remorse to convince the deceased's family that they didn't practice any sorcery to cause their death, or to keep the ghost of the dead from haunting them.

 Looking out from our house in Ambang at the sunrise.

I worked with a man called Gabriel on learning the language.  In the shade of our patio, looking out over the mountains covered in mist, I stumbled through narrating Anna's picture book Bible to him.  It felt agonizing, but as Levi Lenz pointed out, this is how our children learn language and it was easier than just writing / copying / parroting phrases.  I now command maybe 5% of Tok Pijin.

 Gabriel, my language helper.  He wasn't sure if the Canada shirt had a marijuana leaf on it.  We straightened that right out.

We've had very generous hosts at Kudjip thus far and have enjoyed home-made meals from neighbors the past couple days.  This allowed Esther and I to unpack some as well as make grocery / supply lists for our trips to town this week.  While we need a few things to make our home, the house here is everything that we need and then some!

Anna has struggled a little while here.  She does well during the day, but she frequently wakes up in the nights crying, without any real specific reason or complaint.  I think that she realizes now that we have moved away from cousins and friends she cares for.  There are plenty of play-mates around though and she is getting close to a girl named Reegan.

 Anna in Ambang

Levi seems content as long as he can run around in the mud outside and occasionally play with an airplane or "choo-choo".

 Levi gets a ride with the boys

This Thursday I start orientation to the hospital and will begin work next week.  I take call on the 30th with another physician as well.  Please pray for my medical skills to return!  I worked an urgent care office for the past year but haven't done much medicine the past couple months as we transitioned.  I know there will be trying times and difficult days ahead, but trust that God will provide the reserves of strength, skills and knowledge I will need as I need them.

Thank you for thinking of us, praying for us, caring for us and supporting us!

Settle down, it'll all be clear.

Don't pay no mind to the demons, they fill you with fear.

The trouble it might drag you down,

If you are lost you can always be found.

Just know you're not alone,

'cause I'm gonna make this place your home.

-Phil Phillips, "Home"

... and back again

About 20 hours ago we arrived at our new home in Papua New Guinea.  Though it seems this journey stalled frustratingly along the way, I look back at the past season of preparation and see God's hand at work in it.

After spending Christmas at home with my parents, we began our earnest preparations for moving to Kudjip.  Packing and repacking, confirming baggage allowances, buying or replacing items to take with us and, most difficult, saying goodbye to our familiar haunts as well as our loving family and friends.

 12 pieces - which all eventually made it into our new home

 

 Our send-off at my parent's home before leaving

Esther and I have both felt somewhat overwhelmed these past couple weeks.  I remember approaching our wedding and feeling that we lost track of the marriage ahead of us in the logistics and details of the wedding plans.  Our move to PNG feels that way to me.  While we've been in various stage of preparing for this the better part of 8 years, I feel that getting luggage sorted, paperwork in order, tickets purchased, etc has affected the amount of time I would have wanted to prepare my heart.  Esther said it more poetically - "The burden of the urgent crowds out the important"

Now that the journey is behind us, the real adventure begins, and I covet prayers that I would approach this time with a focus on what God wants for me, my family and our work and ministry here.

On our arrival, the kids quickly bonded with several other children on the station.  We got a very warm welcome, with banners, flowers, visits, groceries in our home and a wonderful meal with Bill and Marsha McCoy. 

Anna spent a good chunk of the morning with Reegan, another 4 year old girl here.  They pulled fruit from the trees and then snuck under her bed to eat chocolate Maltesers. 

 Anna and Reegan pulling down lemons.  Fresh bananas hanging on our back porch.

They have both adapted well, but Anna woke up from her nap yesterday to say that she wanted to go "home."  I'm sure I should have taught her that his is our home now, but we were both so tired that I just curled up into her bed alongside her until she fell back to sleep, and has since been enjoying the time.

 Our living room.  About 500 pounds of luggage are just outside the frame of this picture.

Today we leave for a mission station about 45 minutes away from Kudjip to begin an immersion experience for language / culture acquisition.  We feel at peace about this now after some initial reservations given Esther's pregnancy and Levi's recent illnesses, but things have worked out that we can study our language in safe setting.  We will be gone for six days and then return to our house to finish settling in while I orient at the hospital and we set up bank accounts and get driver's licenses.

Pray that our family transitions well and that we can teach the kids the importance of following God's call even if it means we are far from "home"

Nearly there

I am borrowing Esther's most recent blog to give an update of our status here - she did a lot of excellent work recruiting the appropriate pictures to include so I've just modified the content a little!

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"We're still here?!"

As Christmas approaches, we ask ourselves this question.  The answer, obviously, is 'yes' - and it's one that gives us mixed feelings. Back in the spring, when we tentatively put together a time frame for leaving for Papua New Guinea, we planned to celebrate Levi's second birthday (which falls in the last week of November) in PNG. Honestly, this was a somewhat arbitrary date, since we made the decision in part because we celebrated Anna's second birthday while we were visiting the hospital back in 2001 and thought it would be fun to do the same for Levi - but it gave us something to aim for.

As we raised our support during the summer and fall, we realised that from a financial standpoint we were still on track to move by the end of November. God has truly amazed us during the fundraising process, and it's been both humbling and encouraging to see the group of people He has drawn around us to support us through funding, prayer or both. We are fully funded!

However, our visa paperwork has been a somewhat different story. And based on previous missions experience (both our own and that of friends and family living in developing countries), this hasn't come as a huge surprise to us ... but certainly brings us days of frustration! After initial hold-ups surrounding my medical license were cleared, it looked as though adjusting our plans to move in the first two weeks of December may be realistic. As I write this on December 4th, without visas and therefore also without plane tickets, we are sensing this departure timeframe, too, sliding by us unmet...

It is a mixed blessing, though, and there are things we're very thankful for even in the delay. We had some really precious time with family and friends over Thanksgiving - some of our family doesn't live in Tulsa so the holidays gave us some extra time with them that we might not have had otherwise.  Celebrating with family on Friday enabled us to also invite good friends over on the Thursday and get the chance to connect with them before leaving.

Esther has been able to get a few more weeks of OB care in with our doctor here, which has allowed us to see a reassuring formal ultrasound and gestational diabetes test while we still have access to those kinds of care.

The packing is able to happen in a more relaxed and methodical way with more time to spend on it, which we know will make unpacking much easier on the other end and hopefully reduces the chances that we leave any 'necessaries' behind!

And it looks like we have a winter storm headed our way, which is so far promising the kids an atypical couple inches of pre-Christmas snow before we move to a climate that definitely won't be affording us any snow days!

As we are in this final stage of waiting before we leave, we are trying to be patient and just enjoy this time of stillness that God has given us before all of the travel and uprooting begin (although stillness may not actually be a very accurate descriptor, as I think about all the 'last' things we are trying to do and people we want to see, ha!).

We would love for you to join us in praying that there aren't any unnecessary delays and that all of our paperwork would be processed in God's timing for us - thank you so much for standing with us in this time.  We'll keep sending out updates as things change!

Across the pond

Thank you to those who were praying diligently about our visas.  The first hurdle has been officially cleared.  There are a couple more, but within a week of bringing our need before our church and supporters we saw a breakthrough.  We still await paperwork processing in PNG before having the go-ahead to submit our passports and final applications to the embassy in Washington.  We are still praying and hoping for a Fall departure!

Now the secret is out!  We are in the UK until November 1st giving our children a chance to reconnect with their grandparents here before moving to Papua New Guinea.  We have not seen Esther's family since June 2012 when they visited Tulsa for my graduation from Residency, so this time together is somewhat overdue. We surprised Esther's mother, Mathilda (pictured above with the kids at the River Thames in Marlow), who knew nothing of our trip until we rang the doorbell.  We are staying in a missions home in Thame for this month and express great thanks and appreciation to Long Crendon Baptist Church, Esther's church growing up in England, and the Shunem trust for this.

While here, Esther continues teaching Anna's homeschool and we look for ways to enjoy the time with family.  We spent a day last week in Marlow on the River Thames with the whole family, and plan a week near the Welsh countryside as a family for Mathilda's birthday later this month.  Several of Esther's friends plan to visit during the month and we look forward to each of them.

I'll update again later this week or next with the most recent happenings here.  Thank you for supporting our family in your time, finances and especially in your prayers.