Kinshasa Highlights

After our wonderful weeks in Vanga, it was difficult to return to a complex, crowded, traffic-congested city. But we have had some very beneficial and meaningful experiences here. This is what we have been up to- the highlights.

Monday we worked at the Compassion Clinic in a very poor neighborhood in Kinshasa. Someone quoted ~80% of Kinshasa functions as a village within the city. Certainly, walking along the road with the graywater running along the side as children play there, looking down over the immense Congo River and realizing there are "houses" crammed along the edge, or realizing a drainage ditch is a large village market makes me realize that most of Kinshasa is not like the Art Market or the downtown avenue with stoplights and wealthy residents. The clinic was started in conjunction with New City Fellowship (in St. Louis). There is a small church on the same property, and this church definitely has an outreach to the orphans in the area. Each church we visited took orphans into their own homes or cared for them in some way. The nurses at Compassion Clinic seem like they are doing a good job for the most part. Our role while we were there was to supervise the clinic process and do some minor education of the nurses and give suggestions. Of all the conversations or patient encounters we had this week, we realized that one of the most important was with our interpreter while we worked. Briefly, it was a very meaningful conversation regarding eternity, and the good news that Jesus does not ask for more "religion," but He loves us as we are and wants a real relationship; He does not care as much about the rules as He cares about our heart. The actions necessarily follow in response, not vice versa.

Yesterday and today, we taught in one of the medical schools. Fortunately, they all speak some English, so we were able to have meaningful presentations and dialogs with the students. We had lectures and practical hands-on teaching about proper presentations, complete physical examination, labor and delivery, ob and gyn emergencies, and differentiating between rheumatoid and osteoarthritis. Paul did an excellent job as my pregnant patient, and I acted out various neurological disorders for Paul. Tim was the master at the opthalmoscope. Our hope is that our small contribution will help them to become better physicians for the future of Congo. This medical school is the same that is in charge of the residency program we were involved with in Vanga, so there is continuity of relationship. The Dean of the medical school is very active and has good vision of the future. They will graduate their first medical school class next year I believe.

We walked through part of Kinshasa to find a place to eat several days this week. Yesterday, we (as in Tim) decided to be adventurous and try to find a shortcut back. It was getting dark quickly, but we felt we had one shot to make it. Otherwise, we could go by the main road which, although full of diesel fumes, is also better lit. We turned down a side road, and another, and another, and finally came to a dead end... we thought. There was a wall to our left, a wall in front, and a large gully with village housing to our right. But there was a sentinel at the gate in front of us who pointed us down into the front yard of the village house. In short, we went through several "front yards" with children playing, down a very steep drop, over a wall, across a small stream, turned right, went past the tent someone was living in under a tree, took a sharp left and went straight up the other side, then through a few fields and finally over a (large) wall to get back to the road in front of our hostel. On second thought, guess that wasn't so short... my description nor our journey. At any rate, it was good to see once again, the village within the metro area which is Kinshasa.

We visited the oldest functioning church in Kinshasa. It was sobering to see the grave site of a 38 yr old missionary who died after only 3 yrs in Congo. Perhaps it was malaria or a snake bite. Whatever the reason, this underscores the major differences between the older generation and ours. They came to Congo prepared to die. We come for 4 weeks (some years), but most of us can retain contact with loved ones and return to our home country to die.

We connected with several other ex-pats here in Kinshasa. The American School of Kinshasa (TASOK)  is literally across the street from our hostel. Saturday afternoon we were able to play softball with several Canadians/Americans who work for MAF (Missionary Aviation Fellowship- our pilots!) and Korean and Congolese. It was a grand time, even if Tim's team did win. We walked through the campus of TASOK which is quite large and has the largest portion of rain forest left in Kinshasa. 50 foot bamboo, a thick thick forest, canopy trees over 100 feet tall, mango trees, papaya and avocado: it was beautiful.

Our week in Kinshasa is coming to a close, as is our time in Congo. We leave tomorrow evening on our long journey home to waiting spouses and families. I think it is safe to say that we are all anxious to be reunited with our families but are immensely grateful to God for the experiences we have had here in Congo.

Escargot Without a House

Sometimes, a language/cultural barrier can be quite hilarious. Over the past 3-4 weeks, we have worked with people whose mother tongue is: German, Swiss German, French, Kituba, Lingala, Hindi, and Canadian :) Here are the highlights.

"Escargot without a house." - Swiss Brother who was trying to think of the word "slug"

"So, what does it mean when another guy starts holding your hand?" - Paul, as we walked through a village. We then noticed he was holding hands with our male guide. (It means nothing except friendship here)

"She is walking her feet so they don't get tired from sitting." - Kituba-speaking woman, explaining why we were just going for a walk in the countryside.

"Hello together. Goodbye together." - Swiss lady who took Kituba/Lingala greeting of "Mbote na bano" and directly translated it to English, "Hello to everyone"

"The bladder is taking a voyage away from the uterus." - English translation of how I used the few French words I know to describe why I am making a bladder flap during a cesarean section.

"Change your pants." - The Congolese doctors in the OR telling me to use a different instrument, mixing English with the French word for clamp, which sounds like pance but is spelled pince.

"My God is your God and your God is my God."- song in English and sung by the Congolese about the community. Then continuing with, "my child is your child and your child is my child." And then going overboard by making up a third verse, "my wife is your wife..." Yeah, that one didn't work.

"It has been 2 days since my last Kwilu" - my confession after I had to shower instead of bathe in the river.

"Just a minute, I need to put my shoes AND socks back on." - Oregonian Tim who found it necessary to become BAREFOOT while eating in a nice restaurant here in Kinshasa. He's a missionary kid already!

"Hommes" - prominent sign on the men's outhouse. Saying "my homie" takes on a whole new meaning when it seems you are talking about a men's restroom. It really is pronounced, "ohm," much to my disappointment, and simply means "man" in French.

"Yes, yes." - good natured Congolese Dr. Joseph in answer to an obsurd question like "Are you female?" This would cause peals of laughter in his friends who knew he was faking his English more often than not.

"You are speaking Congolese English" - Congolese OR personnel, when trying to insult their friends. They were talking about the differences between British English and American English when I piped up, joking, and said, "Yes, and you speak Congolese English." They took that and ran with it. So when anyone was having difficulty with their English, they would taunt, "he/she speaks Congolese English," or if really rudimentary, "he/she speaks Vanga English."

"Friedhelm, try English." - our team to poor Dr. Friedhelm, the German Brother, who would oftentimes change from Kituba to German to French when addressing us.  

Post Traumatic Passenger Disorder

Tim wrote about this briefly in his blog, "He drives like my dad," but I would like to reiterate our experiences last Tuesday. This is our story.

Our mission: to visit, observe, teach, and experience [even more] rural health care taking place in Congo.
Our vehicle: a 4 wheel drive 2001 Toyota Landcruiser- quite a survivor considering the conditions.
Our driver: Jamaican Crocodile Dundee- laid back, Dundee hat, aviation sunglasses, arm out the window, chewing on a blade of grass, no fear.
Our passengers: Tim, Paul, myself, Katherine, Dr. Lay (health zone director), Dr. Ji' May (resident), 4 or 5 health zone nurses and an infant- couldn't see well beyond the giant packs of mosquito nets, medications.
Our destination: Kingala, located 80 km away as the health center furthest from Vanga of the 52 centers it services within the health zone.
 
We left early in the morning and stopped by another health zone along the way. We met the 4 staff members which consisted of a nurse, a midwife, a lab tech, and a sentinel/guard/go-fer. They gave us a tour of the clinic, lab space, and surveillance areas within the first building. The second hut was for maternity with an exam table and a small amount of instruments as well as a birthing room/postpartum room. Outside, under a large tree, people were gathered for the start of preschool clinic. There are special days of the week for preschool clinic and for prenatal clinic so it is more organized and people know when to come. As we walked out of the huts and toward the throng of people under the tree, I noticed there were many women dressed in the same material for dresses. All at once, they began chanting and singing, complete with motions. As Katherine interpreted what they were saying, we understood that they were sending health messages out. They sang about the importance of vaccinating your child. (Incidentally enough, they have better vaccination rates than we do in the US! Good for them!) They sang about STDs (would love to have that running though my head). They sang about coming to prenatal clinic for maternity care. It was the highlight of my week to be among these health ambassadors. The nurse had community support from this volunteer development team, and the people were getting a message which was memorable in their oral culture. Preschool clinic began and, like an assembly line, children's names were called, they were weighed (in a sling hung from a scale mounted on a wooden frame under the tree), they were given vaccines, and this was recorded in an orderly fashion. We left with a gift of bananas and joy in our hearts at what an impact this small group of people is doing for their villages/communities.

Then came the road. The dirt road is fairly maintained for a stretch. It is basically sand. When it is dry, it is a bit like driving on 2-3 inches of snow. We were fishtailing and careening down stretches of the road that were dry. When it rains, it erodes quickly into big gullies and potholes.The best part of the road is where it is damp, packed down, and where the ruts cut by the rain are quickly filled by the shovels of the road crew (paid for in sections by the Belgian government, to keep the roads open to export the palm oil). So when we were not careening/fishtailing, we were navigating the gullies. This is where PTPD comes in. See, when I was in Kenya in 2005, we drove in a bamboo rainforest which was uber-muddy! We were packed to the gills just like we were now. In Kenya, we drove careening through the mud and on a steep incline sideways at a 30-40 degree angle and at one point, we actually tipped over against the mud bank on my side! All "100" of us piled out and they pushed the car back upright, or I should say, back on a slant. They then drove the car and we sloshed through the mud until the car was in a more flat spot and we all 100 piled back in. So therein lies my post traumatic passenger disorder. Now, in Congo, when we were driving through the gullies at a 30-40 degree slant, I was slightly paranoid that we would tip on over onto the bank again.I was okay when my side was on the upper part, but when I was on the lower end of the slant, I became nervous. In addition, when I was small, I fell out of an old truck when the door came open when we were driving around a corner. Ever since then, I have been careful to make sure doors are locked when I am tightly squeezed into a vehicle. PTPD again. I was sure to check that the door was locked as we careened and fishtailed.

To finished the story, we made it safely to Kingala in one piece. We had a very productive and informative time there. The chiefs of 5 villages as well as the chief chief with his carved wooden staff were present as Dr. Lay talked to the village people gathered around about the importance of coming for care at the clinic. We then saw 86 patients, 30 for prenatal clinic and 56 for general medicine consultations which were over the level of expertise of the nurse. We ate the local cuisine in the nurse's hut across the road/path from the health center building and played games with the people of the village as the sun went down (this is their time to just hang out, after the work day and before dark). It was a wonderful time.

On the harrowing drive back, it was dark, yet our Jamaican Dundee was as laid back as can be in the rutted, now dark road. It was a perfectly clear night without a cloud in the sky. Tim had a great idea that we should stop and look at the stars. I say that without any sarcasm. It was glorious. We stopped on a patch of road and turned the car and lights off. We tumbled out of the car and walked down the road a bit. There was not an ounce of light pollution. The Milky Way seemed a little too bright! The moon was not out, just the stars. It was amazing to see how well lit the road was just by the light of the stars. Words are just not sufficient to describe the glory of the sky, so perhaps you can just imagine it.

On Being "In Your Element"

My perception of people is radically different when I see them in their element. Identifying “your element” is important in leadership, and when people function in this capacity, they perform the best, and the team as a whole will move forward. Similarly, when you are using the unique gifts God has given to you, that is when you shine and show His glory. Enough of the philosophical… here are the examples.

We have had the opportunity to invite various groups over to our house for dinner. We had dinner with the residents. Two are very outgoing and speak English well. They were very competitive against each other in Qwirkle, while the third sat back and was very quiet. He didn’t seem to understand the game or perhaps he was just not interested. Saturday, the doctors all meet at one house for prayer and breakfast together. Ji may lead the group. He did a fantastic job. His house was clean and table decked with a nice tablecloth and food/coffee/tea. His friends joked that “a man certainly did not set that table.” Nonetheless, he organized it and convinced a lady friend to come fix it up for him. He led a devotion time with a passage from the bible and thoughts on it. I was impressed by his leadership and had a very different impression of him after we left.

We also invited 3 of the Congolese supervising doctors over for dinner. Again, two were outgoing and spoke English well. We have gotten to know Dr. Fina and Dr. Mpoo very well during our time here. But Dr. Lay and his wife were quieter except when they were able to tell the story of how they met and were married. However, we were able to spend a day with Dr. Lay visiting a couple of health centers in the Vanga Health Zone. Boy was he dynamic! We sat underneath a tree with 5 chiefs of surrounding village and the chief chief of them all who was sitting with a carved wooden staff. A group of village people were standing all around us. Dr. Lay then began telling them why he continued to come from far away to supervise this health center. “We care about you. If you do not use the health center or the nurse we provided you, why should I come here? If there are very few people coming for visits, why should I bring more mosquito nets or more aspirin? But if you use this health center, you can be well and your wives will have a better chance at a good birth by going to prenatal clinic and your children will live because they get vaccines and information about nutrition.” Rough translation. But all around him, the village people and the chiefs were nodding their heads in agreement. One asked, “When will you fix up our health center?” (the building is not in the best condition, made of local materials but with a rusted roof and some of the walls are leaning a bit). Dr. Lay turned to them and said, “This is YOUR health center. If you want to have a new building, you should build it! Have each family bring 2 bricks and you would have enough material for the walls.” Brilliant! What makes Dr. Lay so effective is that he was a nurse in the health center prior to becoming a doctor and then taking over the job of oversight of the Zone. So he knows what the nurses are going through. He knows the frustrations they probably have when people don’t come for prenatal clinic or preschool clinic for vaccines.

The third example is just of my perceptions of missionary kids (MK) when I was growing up. I looked at the children who came with their parents on furlough and saw them as shy and somewhat awkward. Then, in college there were many MKs and some were quite different… running around everywhere without shoes, etc. But when I have been on the mission field, what a difference it makes to see them in their element! They speak multiple languages, run around with the village kids in bare feet, and have a more expanded worldview than most. 

For me, I certainly don't shine when the conversation revolves around popular music or "name that artist." I have an appreciation for music but don't pay attention to the artists. But when I have been working in Congo, I feel like I am in my element. I enjoy my work, laugh with my coworkers, love to teach, enjoy bathing in the river, etc. Speaking of which, the Kwilu is calling my name.

From Scarlet Fever to Pott's Disease- Paul Tuttle

Working in an inner city academic hospital for the last three years has exposed me to many very sick patients.  However, working in Congo with the significant malnutrition, lack of routine medical care, extreme poverty, and existence of tropical diseases has given the term “pathology” a whole new meaning.  I have felt more enlarged spleens and livers here in one day then in the last year at Saint Louis University.  

A few days ago we saw a child who complained of a sore throat for the last few weeks.  She had been seen in an outlying community health center and only took a few days of amoxicillin due to a rash that started after the initiation of amoxicillin.  She still complained of a sore throat and had a faint rough nonerythematous rash on her trunk with a few areas of desquamation.  We were suspicious for scarlet fever from what sounded like an inadequately treated strep throat and told the patient to return the next day after starting a course of erythromycin.  The next day she had significant desquamation of her distal extremities as well as her axillary and inguinal folds that was accompanied with a “strawberry” tongue.  This was a textbook presentation of scarlet fever, a disease process that we do not see in the United States due to the widespread use and--some would argue--overuse of antibiotics.  

Then there was the 2 year old child who slowly lost her ability to walk.  She was seen by a doctor in the capital city and given medication for malaria without help.  Her mother brought her to the countryside hospital of Vanga for further evaluation with its reputation as being one of the best hospitals in the country.  She had a small kyphotic deformity of her upper spine with signs of upper motor neuron injury and was subsequently diagnosed with tuberculosis of the spine otherwise known as Pott’s disease.  She is responding well to treatment and is a very cute little girl!  We are praying that she will recover her ability to walk as treatment progresses and the infection is better controlled.

On the internal medicine service, we saw a middle aged female who had presented with shortness of breath.  Her chest xray showed a heart that filled up almost two thirds of her chest cavity with an echocardiogram showing a very large pericardial effusion that was found to be due to tuberculosis.  Then there was the middle aged women with an amoebic hepatic abscess being treated conservatively with anti-parasitic medication or the man who was paralyzed from the waist down after suffering a spinal compression fracture from falling out of a tree while collecting food.  To make the situation even worse for this gentlemen the local custom is to put the paralyzed person’s feet in the fire in order to try to regain the ability to walk.  He now has a third degree burn on his foot with exposed bone and will probably need an amputation in the near future due to the infected bone.

Last week, there was a small party consisting of bottled Fanta and Coke with fresh peanuts and rolls.  This was to celebrate the start of a national research trial for a new medication for the treatment of trypanosomiasis, which is otherwise called “African sleeping sickness.”  African trypanosomiasis is an almost universally fatal disease if left untreated with the highest number of cases found in Congo.  There is great hope that this new medication will be as efficacious as the old medications but with less side effects.

Yesterday, we saw a very sad case of gram negative bacterial meningitis in a 5 year old.  The child is doing better with antibiotics and steroids but will likely have some neurological damage. 

There are many sad stories but there are also many encouraging stories such as the young boy with severe tetanus who gives me a big smile and high five whenever I see him in the pediatric ward or the man who praises God for his improvement after antibiotics and debridement for his extensive lower extremity necrotizing fasciitis or “flesh eating bacteria” infection.  The Lord has poured out His grace and mercy in many real and tangible ways.  The faithful hospital staff display the hope and promises of Jesus Christ everyday.  We may be limited in our diagnostic ability, limited in the availability or affordability of medications, limited in the various treatments, but we are not limited in what God can do physically or spiritually.  Jesus, the Great Physician, came into this world to not just heal physical maladies but to heal us spiritually by making us right with God.  He has promised to wash away our sins as far as the east is from the west (Psalm 103:12) and to complete the good work that he has started in us (Phil 1:6).

What is Your Life? -Paul Tuttle

What is your life?

“Come now, you who say, ‘Today or tomorrow we will go into such and such a town and spend a year there and trade and make a profit’ - yet you do not know what tomorrow will bring.  What is your life?  For you are a mist that appears for a little time and then vanishes.” - James 4:13-14

“Only one life, ‘twill soon be past, only what’s done for Christ will last” - C.T. Studd

My time here in Congo has caused me to reflect more upon this verse.  Life is short, moreover eternity is infinite and final.  The United States is a wonderful country in many respects.  The freedom and material blessings we enjoy are truly gifts from the Lord.  Our individualism and wealth can be stumbling block or an opportunity.  Jesus and the apostle Paul often spoke to the many dangers of wealth, but at the same time Paul charges the rich to be generous and ready to share in order to take a hold of that which is truly life (1 Tim 6:17-19).  Christ said much is expected from those who have been given much (Luke 12:48), and to store up treasures in heaven and not on earth (Matt 6:19-21).

It is very easy in America to store up treasures on earth rather then in heaven as we live in a society where we are bombarded daily by the materialism and death is usually something that happens in old age.  Congo is a war torn country that lacks basic infrastructure and hence is plagued by disease, poverty, corruption, and death.  As much as we Americans say we understand that death is a fact of life, the Congolese understand this much more.  The wealth disparity between the United States and Congo is stark to say the least.  Thus, the wealth disparity and common occurrence of death has forced me to reevaluate my life.  What is my life? 

The word “gospel” literally means good news.  It is good news that Jesus Christ died for us on the cross and has therefore paid the due penalty for our sins.  God gives us grace and mercy through Christ.  Grace is getting something we do not deserve and mercy is not getting what we do deserve.  Through Christ’s work on the cross, God gives us the grace of eternal life and the mercy of escaping eternal damnation. 

The more I understand the depth of the gospel, that is, the more I understand the love of God shown on the cross for a sinner like me (Eph 3:14-19), the more I will strive to store up treasures in heaven rather than on earth.  Whether we are a missionary in Congo or in our own neighborhood in the United States, these eternal treasures are found through the participation of God’s work through prayer, money, and time.  Life is short and we have been given much in the United States and much will be expected from the Lord.  To truly live means to daily die to yourself and to live for the glory of Jesus Christ.  

Congo Epic Problem

For my coworkers in St. Louis, you will understand the title of this post. For everyone else, Epic is the computer program that we use in our hospital for orders, documentation, vitals, etc. We have a love hate relationship with the functionality. We love to say that we have an Epic problem. Yesterday, I performed a tubal ligation, several gynecologic exams, and two cesarean sections. One was for presumed eclampsia. She came to the ER in a coma, seizing, and 28 wks pregnant with elevated blood pressure and edema. They gave her phenobarbital, a bolus of magnesium in her IV, Rocephin for possible meningitis, ruled out cerebral malaria, and observed her overnight. When I heard about her in the morning, I immediately went to see her. Her uterus was tetanic (contracting constantly) and I had little hope for the fetus. But the treatment for eclampsia is delivery and often the mothers will do better after delivery. I indicated a cesarean section and we delivered a stillborn infant. After the surgeries of the day were finished (Gyn-wise), I went to see the the patient with eclampsia. She had not improved. She was still tachypnic in the 50s/min, blood pressure was rising, and she had made minimal urine output. I discussed with the resident that they should give more IV fluids and minimize the lasix as she was likely dry. She did not have any crackles in her lungs to indicate fluid overload. She had only received 1 dose of magnesium the night before, and as her blood pressure was rising, I thought she likely needed it to avoid another seizure. There was no way to intubate her in this situation as we would have done in the US. The following is the process I went through to get magnesium started. To my fellow OB residents, remember how frustrated we get when we order magnesium and it is not even going 30 min later? Read on. :S

1. Asked the resident about mag. He said, "it is very difficult" and went back to the OR for more cases. 2. Looked around, and all in the room were assistant nurses or techs and did not speak English. 3. Walked around the hospital to find Dr. Rice for a second opinion. Found Paul in the peds ward who said he was at home. Walked home to get further consultation with Dr. Rice 4. Walked back to the hospital with Dr. Rice 5. Assessed the patient. Assistants were faithfully taking blood pressures. Blood pressure was 150/110. Still in a coma. Edematous eyes, face, feet, no crackles in the lungs. Responsive to pain, pupils reactive to light. Still tachypnic. Decided we should start mag. 6. Walked to OR to get back up with the supervising doctor, Dr. Fina. He agreed, sent a different resident with us to get the mag going. 7. Walked to the lab to ask them to obtain a creatinine and sodium level. 8. Walked to the patient to order the mag on the chart. 9. Resident went to the central pharmacy to get the mag 10. Lab tech came to the patient to get blood 11. Dr. Rice walked with the lab tech to find the result 12. Resident came back with a bottle of mag. I was unsure how much mag was present in the bottle or how many mL to give. 13. Walked to the lab to tell Dr. Rice I was going to the OR. 14. Walked back to the OR. (which requires me to change into different shoes and put on my scrub hat every time) Asked Dr. Fina about the concentration. 1mL = 500mg. 15. Walked back to the lab to see if there was a result. Negative. 16. Walked back to the patient bedside. Wondered how to give 2g/h by IV after the initial bolus.  
17. Looked up on Epocrates (my handheld drug reference) that I can give magnesium 4g IM q 4 hours. Calculated 8mL = 4g. 18. Dr. Rice returned to the patient bedside without a lab result. Failed. They would try again. 19. Dr. Mpoo, another supervising doctor and the medical director, came to the patient bedside. We discussed that we needed to give the magnesium IM. He agreed. 20. Walked to the maternity to find the nurse in charge. Explained to her how to give the magnesium and to check for respiratory status and reflexes prior to giving the magnesium doses each time and the side effects. 21. Dr. Mpoo wrote the order in French. 22. We decided to minimize the number of doses due to our inability to know creatinine at this time. Changed the order on the record. 23. Nurse in charge reported that there were no reflexes. 24. Walked to the patient bedside with the nurse in charge and Dr. Mpoo. Checked reflexes. They were 1+. 25. Taught the nurse to effectively check the reflexes. She was able to do this. 26. Walked home.

  

All in all, 26 steps and 2 hours later, our patient was on mag. And in the US, I write, "mag" and it pops up in an order set.  A few mouse clicks later and this is sent to the pharmacy automatically who sends the medication in a tube system to the nurse who checks the reflexes and hooks the patient up to the mag. Sadly, our patient needed intubation with the severe tachypnea and we found out she passed away overnight. This is life and death in Congo. It is my hope that these deaths can be minimized with prevention at the level of the health centers on the front lines with prenatal care and blood pressure checks monthly.

No Snow days but a Rain day in Congo--By Tim Rice

In Congo they never have snow days but today we took a rain day...well we Americans find it hard to take the whole rain day.  Last night it started raining with a Missouri thunder storm and ended with an all night and morning Oregon steady rain.  I want to check to see if the hospital patients are all doing well.  Most concerned about the patient in renal failure after eclampsia and the death of her baby in the womb.

Geckos, Hippos, and a River Expedition

 Geckos

The geckos have a good life here. Our ceilings are tall, approx 15 ft. There are windows at the top with screens for ventilation and a covering with several wide slits in them vertically. This inadvertently traps many moths and bugs attracted to the light coming from the house. We then watch as those geckos sit and wait for bugs to come through the slits and then have a captive dinner. It is a wonder they are not the size of monitor lizards by now.

Hippos

River Kwilu is just below our house. We go nearly every evening (except when it is already dark when we are finished with work) to swim and get clean. We have been warned about the hippos several times. They are a deadly animal when provoked. In fact, Katherine said that as a child, she would spend many days rolling inner tubes up the footpaths and then floating down the river back to Vanga. Many years ago, the float trips were abandoned when some visitors who were not well acquainted with the river nor the customs of the boatmen (who know where hippos are) jumped in and floated right over a mother hippo and her baby. One lost her life and another was injured in that tragic accident. Last week, we heard the hippos and ran down to get a better look. They nearly always are on the opposite bank, and this was true again that evening. We stood waist deep in the water, watching the evening sky and talking of the events of the day. Suddenly, we heard the hippo again from behind me and it startled us. We were out of the water in a jiffy. We laughed because in actuality, the hippos were probably across the river, but they sound very close when there is very little ambient noise and the sound echos so clearly. You can certainly hear people talking distinctly from across the river.

River Expedition

Sunday afternoon, we were able to take a boat trip in a dugout canoe. It was a gorgeous day. It had rained the night before and was cool. The two boatmen stood on either end of the canoe, using very long paddles for locomotion. We floated downriver toward an island. Along the way, we stopped several times to see the local economy. There was a place where mud bricks were made from clay, placed in molds, dried the sun, and then stacked in such a way that fire could be lit underneath to cure them. In another stop, the palm oil industry was shown. They take the palm nuts from the abundant palm trees, stir them in a barrel similar to a millstone process, and use the inside of the nuts for fuel for fire. We continued down the river when we heard commotion to our right. There were 3 or 4 hippos on the bank of the island, walking into the water! The boatmen paddled faster to get to a safer distance as we tried to capture the moment on our cameras (unsuccessfully). The hippos were not aggressive, but stayed near the bank. The boatmen hit the sides of the boat to try to get their attention for pictures. It was to no avail, but it was awesome to hear how well that echoed throughout the riverbanks. The boatmen said that when we use our cameras, it is like we are shooting the hippos and they don't come near. :) We continued around the island and as we started going upriver, we hugged the bank of the island (opposite side of the island as the hippos). We were so close to the bank that we were going under large tree branches and it felt like we were going through a swamp. We crossed the river (now opposite Vanga) and then set out on foot to see a village. This was definitely a swamp. I was glad I had my Chacos as we "fell" into the mud/water several times as we traversed the land. We came upon a water source in which a small child was pumping and several women were filling containers of water. As we took turns at the pump, it was good to know how easy the handle moved and how much water came out. We continued on into the village, which was the boatman's village. We stopped at several huts of people he is related to. What an industrious guy! Not only does he run a  boating operation, but he also raises guinea pigs, a pineapple field, and has a very large field for growing peanuts and manioc and green leafy's. Throngs of children followed us like the pied piper, wanting us to take pictures and show them. We continued on, then reaching a solemn gathering. Saturday (the day prior), two 15 yr old boys drown in the Kwilu up the river not more than 50 yards from our swim area. One of them could not swim, but was following his friends to bathe. The river is up due to the rainy season and rains upriver can cause a huge difference in the water height. From verbal reports, the boy who could not swim lost his footing and was starting to struggle to stay afloat in the swift current. A second boy reached out to try to help him, and instead of taking his hand, he panicked and grabbed his rescuer around his torso with great strength. They both went under and were swept away. One of the boys was from the village we were now walking through. A group of teenage boys walked by us on the path and one was loudly weeping. At what must have been this boy's family huts, many people were gathered outside, some crying, some solemn and silent. They sleep outside after a death like this, if I understand correctly, so that the spirits can see them and know they are mourning the death.

We continued up the path and finally reached our rendezvous point with our boat. We got back in and went further up the river in order the be able to cross and come out near our house in Vanga. As we neared our bank, we jumped or dove off the canoe so we could float home just a short distance with the canoe for safety. What a blessed afternoon!

Comprehensive Care in resource limited situations--Tim Rice

On Tuesday we saw first-hand the miracle of Community Health Centers here in Congo. The chief said to us that many from his community have died on their way walking the 12 hours to the hospital 60 km away and he was glad to now have a Health Center in their village where problems could be caught early and either corrected or sent on promptly.

A local health care team consists of a nurse, a midwife, a lab tech and a sentinel that provide care for a small group of villages about 5000 or less.   This team of four workers collaborates with a group of community volunteer health promoters to organize monthly well child clinics and monthly prenatal clinics. They may be held in various locations or patients come to the central location of the Health Center. The sentinel tells the health promoter of the upcoming event and then these folks tell the individuals in their portion of the community.  On our visit to the first Health Center all the health promoters were in the colored out fits and were leading the group in songs that promote healthy behavior.  They helped get the people organized and help weigh the kids while the nurse recorded the information and let the mom’s know when the next immunization clinic was going to be held.

The Health Center team provides all this care on an extremely low budget.  For example the basic tools for the nurse costs $175.  The lab tech needs a microscope and a few other less expensive items.  The team needs some supervision from the central office to assure the integrity of the finances and to provide regular training.  The outcome is they have high levels of vaccination and can address problems in the local level.  

Then Jesus said, "How much...do you have?"   Mark 6:38  With God's blessing, as we share what we have, we have enough enough to meet our basic needs and share with others.  

He drives like my Dad--By Tim Rice

The driver that took us to Kingala Health Center reminded me of the kind of all out driving my father did on the dirt roads in Oregon.  Driving fast and fishtailing down the sandy road.  We went through deep sandy soil and  up steep sandy hills. I told our driver he would do great on the snow covered roads in America.  Once we drove around a broken down truck.  We made our own road on an area covered with thick tall grass where no one had driven before to get around the truck.

My father used to brag that he could drive anywhere someone with a four wheel drive could go.  This was true because I have been with him when he did.  But, I expect my father never was in a ditch with only 3 wheels on the ground. Today we got stuck teetering in a ditch with one wheel off the ground.  When one of your rear tires is off the ground all the power from the engine is transferred to that wheel and you go nowhere. We got unstuck quickly when the driver ground the gears to put the car in 4 wheel drive. (Humm I think this is an illustration of how the four person team made up of Katherine, Paul, Shannon and myself is working so well together.)   My dad also never drove in the back roads of Congo but I suspect he would have really enjoyed the challenge of driving in Congo bush roads.  I also suspect he would have been very good.  I’ll ask dad next time I see him. 

The Doctors

I am so impressed with the staff at this hospital. There are three supervising doctors: Dr. Mpoo (pronounced em-poe), Dr. Fina, and Dr. Freidhelm. We have eaten meals with all three at our guest house and spent time with them in the hospital for teaching and patient care. Dr. Mpoo is a little older, very experienced, and I suspect, very tired. He has a characteristic laugh. "A he-he-he" in a higher pitch than you expect. He laughs often, even though his circumstances could make him very bitter or grumpy. He has the weight of the hospital on his shoulders as the medical director and his wife died tragically and suddenly this year while he was away from Vanga attempting to get additional training in France (which didn't happen). After explaining to me the circumstances of her death, he quietly said, "This is what God gave me, so I accept." When we were having our VERY sugary tea, bread, and peanuts, which is our only sustainence during a long OR day, he admitted to me that he is constantly pulled in many directions. He said, "To get rest, I need to find a place where they do not know I am a physician. If I go somewhere, people will come find me and ask me to take care of them. I have been asked several times to leave Vanga to go work somewhere else. But how can I leave? I am here because of the people. If I did not work, what would they do? Who would treat them? I am here because of the people." To that end, I have sought to be an encouragement to him, staying until the end of the surgical day so that he is not working by himself late in the day when the other residents or doctors in training have left. I suggested to him that his orthopedic cases make him exhausted, and he agreed. He speaks fair in English, so it is wonderful to operate with him. During one of the fracture cases, which are always done at the end of the day, I tried to cheer him by suggesting that he looks  like he is dancing when he is manually cranking a drill to make a hole in the bone for the screws. I started mimicking his movements and soon he was going "a he-he-he, a he-he-he" while we were sweating to get this femur put back together at 6pm. He then commented, "I think this is a man's dance." Definitely not graceful, that is for sure. 
Then there is Dr. Fina. He is young, looks about in his 30s, and he could pass for an American any day. He is an exceptional teacher. We performed a hysterectomy together today and his most common phrases were, "Please, can you.." and "Perhaps we could..." He is utterly polite, knowledgeable, and someone who could easily work in the big city but chooses to work out in the Bush overseeing the residency program.
Lastly is Dr. Freidhelm. Oh, he would be a character played by Robin Williams on a movie. He has the kindest heart (they all do, really). He is a Friar from Germany. Together with his Brothers from Switzerland and Germany, they have chosen to live in celibacy and wholehearted service to the people of Afghanistan and Congo. He walks with a very determined gait, almost a limp, on his toes, swinging his shoulders and arms at the same time. He is usually wearing scrubs (sometimes you can see his belly peaking from below the scrubs when he sits down). He has thick coke bottle glasses with black rims. When he speaks, it is emphatically. He counts by using 1 with his thumb, 2 with his thumb and forefinger. He will say things like, "First, we HAVE to get this.... Second, we NEED xyz." I have been interacting with him primarily in ultrasound. He is a trained pediatrician, but here has has been forced to be the sonographer. He has had very very little training in obstetrical and gynecological ultrasound, yet here he is, just like the rest of them, reading from a book to learn how to do things. It was such an honor to teach him even the most basic obstetrical ultrasound skills. He was sooo very grateful. He looks at me with the extra big eyes behind the glasses, one hand on top of his head with fingers coming over like bangs, the other hand counting, and says, nearly running out of breath to do so, "See Shannon, I have NO training in this. It is so HELPFUL to get these ideas." What an honor to work among such noble good-hearted people such as I have described above!

We were privileged to share a meal with the doctors. It was a rich conversation. They asked the question,  "What does Evangelistic Hospital of Vanga mean?" They continued to answer it themselves. "It means that we love our patients. That was God’s first commandment, that we love one another. People who come to visit are surprised that we are surrounded by patients wherever we go. When we walk in the hospital, when we go on the road, when we are at home. In other places, those people would not be near to such an important person. But here we love them. That is what it means to be evangelistic."

We said that in St. Louis, even though we are a catholic university and hospital, we would never sing a gospel song prior to clinic as they do in Vanga. “Why?” they asked. It was such a genuine question. Perhaps it is because we have become too specialized and leave all of the God stuff to the chaplain and pastor, as if the physical and spiritual are completely separate. We don’t acutely perceive the need for a savior, but many do turn to God in a crisis. But it seems that in Congo, they have many problems and rely on God to help them solve their problems. Although we don’t have a lot of outward problems such as the need for electricity or water or food (not speaking of the poorest in our country), many do have more inward problems of things like depression, loneliness. Dr. Mpoo suggested that we were made “not to be living alone in the forest, but we should be living in community with one another.” Ryan would say Amen to that one.

Congolese Live Outside

“Congolese live outside”

We slept well under mosquito nets, and the temperature is quite nice in the 70s at night. The windows stay open night and day. With no cars or machines competing for your attention through sound, it is amazing what you can hear. You can hear a motorcycle far in the distance, children laughing across the river, people cheering at a soccer game, goats and chickens, birds, bugs, crickets and even hippos at times in the River we have heard. During the night, it is mainly the bugs, but sometime in the very early morning before dawn, the rooster decided it was morning. But it seemed to know that its role is becoming obselete and no one considers him, because instead of a nice cock-a-doodle-doo, it made more of the sound of cock-a-doodle-doawww with a downward inflection at the end. In reality, our day started as all of our days will start... with the clanging of the church bells around 545 am. You can literally hear the village waking up. It is such a different experience than the sometimes isolated world of waking up in a quiet house and getting ready alone, driving away in your car oblivious to the many neighbors who are present all around you. Americans definitely live inside.

My Protector (of creatures and things...)

I spent the day in the operating room. We had at least 10 operations + minor cases on the schedule for two supervising doctors, Dr. Fina and Dr. Mpoo. I wore scrubs and a surgical cap, and changed into shoes like Crocs which were provided in the changing room as well as a cloth mask. There are 4 operating tables. Two are in one main room where a majority of the cases are performed. There is an OR for eye cases which is currently being used as another general OR area as the eye doctor is away at the time. The fourth room is for septic cases, emergencies, and GYN exams. I assisted Dr. Mpoo all day. Among many things, we performed total abdominal hysterectomy and we had a fistula case! It is incredible how many different surgeries Dr. Mpoo performs... prostatectomy, hysterectomy, hernia repair, fracture reduction, etc. And he is not specialized in any specific area. I brought a book with instructions and pictures of how to perform fistula repair. As I have seen over 40 fistula cases in Ethiopia, I was able to offer suggestions on ways to repair the fistula and discuss postoperative care with Dr. Mpoo. I also brought a head light which will be immensely helpful in vaginal cases where it is difficult to have enough light. During the hysterectomy, I was amazed at the dullness of the needles, which are reusable with different sutures. At one point, I felt the needle slip and possibly go into my finger. I have had a couple of needle sticks in the US, fortunately with HIV negative patients and no sequelae. Here, though, I was nervous. HIV is much more common in Congo. I looked at my glove, and there was  a hole in the outer glove at least. I was unable to see whether it went completely through. When the case was finished, I removed the top glove and realized the second was also torn. I have always had a puncture/needle stick if both gloves are pierced through. I removed the second glove and thoroughly examined my finger. There was no puncture. I am so grateful for My Protector. The team reminded me this evening, “A lot of people are praying for you.”

Secondly, I was sitting on the toilet and looked down. Right by my heels, there was a giant spider about 7-8 cm in diameter. I quickly got up, watched it for a minute, and promptly ran to get my camera. The next morning I looked for it again, and it was on the shelf above the toilet, eating something. I haven’t seen it since, but no one has killed it so it is probably eating insects still.

The last incident was that our yard worker mentioned that he was cutting the grass and suddenly saw a snake. Turns out it was likely a pit viper, which is poisonous. It was in our yard! I’m glad he was cutting grass with his machete instead of pulling it by hand!

**Please note, with internet scarcity, there is a delay in posting, so the above was from Wed, Oct 3. We have since found that huge spider. It was sitting inches from my suitcase. I recruited Paul to get rid of it.

Bush Life

The Bush

The flight to Vanga was like everything I used to imagine when I read missionary stories from Africa. Four seats including the pilot, diesel engine, flying over huts and rivers, landing on a grass runway, waving to cute African children on the edges, and seeing women walking on the road with baskets on their heads. Off to the side, there was a desk under a large tree where some government people were sitting. (Apparently, they have a tax for getting on the plane and a tax for getting off the plane. Maybe to pay them a salary to sit under a tree. We considered asking whether we needed to also pay a tax for breathing, but thought better of it :S ) We were greeted by the hospital doctors and administration and welcomed warmly to the village which has recently burgeoned to 6000 from a simple mission station with a church, school, and hospital. We drove in a land rover over sandy, eroded roads for only 5 minutes before we reached the guest house we will be staying in for the next 2 wks. Flowers adorned the gate along a natural fence line to welcome us. The house is made of white, painted concrete on the outside. Inside, there are 15 foot ceilings with ventilation windows along the ceiling, tiled floors, 4 bedrooms, and a spacious living space with 6 foot tall windows. The yard is spacious with a huge canopy tree, chickens, hand cut grass, clothesline, and a view of the Kwilu River far down the bank below. The guest house is part of a row of ex pat housing which runs parallel to the River. At the end of this row, the hospital stands with nearly 500 beds. Across the road from these houses (away from the River), there is a school and several houses where the Congolese doctors live. We were very surprised at the good conditions of the housing. We asked many questions of Katherine Niles, our interpreter who travelled with us from Kinshasa. She grew up at Vanga as a missionary kid. Her father is Dr. Fountain who worked at Vanga for about 30 years. Thus, she not only knows the local dialects, French, and English, but she also understands the dynamics of the hospital system, the mission, and many of the people we will be meeting.

Kwilu River

If you know me, you know I love to explore. As soon as we put our things away, I was eager to see the River. Katherine showed us the way down to the public area at the river’s edge. There is also an area just below our house which is much more private. But the public area has many people, a small market, some small houses, and an artesian well with clean water. Congolese were lined up to fill their containers or to wash their kids in this great water source. There is also an area where dugout canoes are tied. For 10 cents, they will take you across the river in the canoe which is very long and narrow. The navigators stand up and paddle the canoes. There should be several pictures in the slideshow which depict this very well. The River itself is majestic. Flanked by green forests of palm trees and canopy trees (those you would imagine as the canopy of a rainforest), it is the width of the Mississippi. In the rainy season as it is now, it can be quite muddy, but it was beautiful to behold. It is amazing to consider that Congo is canvased in rivers just like this one. It would be an amazing transportation mechanism if they were dredged or maintained for larger boats, but this has not been done regularly since nationalization of the country. All these rivers dump into the Congo River, which is the 2nd largest in the world and definitely the deepest.

Vanga Evangelical Hospital

We toured the hospital next. Unlike large hospitals in the US, it is only one story. There are separate buildings for the administration, pediatrics, emergency, surgery, maternity, etc. It is very well laid out, some of it designed by a German architect. It was very interesting to hear Katherine talk about its history as we walked and greeted people by saying, “Mbote” or “Bonjour.” There were patients lying near the entrance of the hospital grounds, staying on mats of straw, cooking small amounts of food. Goats, especially very cute kids (baby goats), were running around. We were introduced again (once already at the airport) to Dr. Mpoo (pronounced em- poe), chief medical officer, Dr. Fina and Dr. Freidhelm, a friar from Germany and pediatrician. Our schedule while here will be morning meetings with the residents, visiting physicians, medical students, surgery MWF, and more extensive rounds on Tues, Thurs, Sat mornings with outpatient clinic Tues and Thurs afternoon. I was excited to hear that we would have a fistula case my first day in surgery on Wednesday!

God’s role in healing the sick

Back in our guest house for the evening, we discussed our expectations over dinner. We asked Catherine many questions as she has vast experience in Congo and Haiti. One interesting topic was on God’s role in healing. She explained, “Some say that Congo is --% Protestant, --% Catholic, --% Muslim, and 100% Animistic. It is the background, the fallback worldview. They invoke the Ndoki (pronounced en- doe- key) which is also known as witchcraft or black magic. Many times, there are patients receiving treatment for an illness and they are not getting better. Then, it finally comes up that someone in the family has felt that the person is cursed or there is unforgiveness or animosity. Prayer has been powerful in these circumstances and once the name of Jesus is pronounced as Lord over this issue, patients have gotten better with no change to their treatment.” As Katherine told specific stories and accounts of seeing the power of Jesus and the power of prayer, I got chills. We just don’t see this kind of spiritual battle very often in the US, for whatever reason. I sensed this in Ethiopia and I sense it again now. The spiritual forces are very real and prayer is powerful. Treating the whole person involves getting a spiritual history as part of the social history, and especially in this primitive context, it can make a huge difference in the healing of patients. 

Something to Chew On

 A hot shower and air conditioning? What? It seems like Congo, at least the capital of Kinshasa and in our hostel, has many of the same comforts of home. It was a welcome surprise after such long flights. It was an unwelcome surprise to get woken up early this morning so that the residents could get the containers (our donated medical supplies) out of my room to take to Vanga by road. Nothing like meeting people in green pajama pants.
We got acquainted with Kinshasa by daylight today. It is beautiful in many ways, with palm trees and a tropical climate. But there is also the stark reality that Kinshasa is home to well over a million orphans, victims of HIV and war. We drove to one of the small community clinics which was built after Tim's first trip here in 2006. The roads are fairly well paved (by the Chinese) on the main avenues, there are stoplights (somewhat paid attention to), and there are high rise buildings (some finished). The temperature is fairly comfortable when there is a breeze to tear at the cloak of humidity. We turned off the main road and into a muddy dirt path between concrete houses to find a 2 room clinic with very basic but life-saving medical supplies. Our first patient received treatment for malaria- a good reminder to take our medicine and kill as many of those suckers as we can. (We are sleeping under mosquito nets.) We ate a meal there, our first taste of the local fare. It was a feast: chicken, rice, salt water fish, fresh water fish, beans, kasava bread, plantain, and caterpillars. Yes, caterpillars. Now that's something to chew on. Contrary to popular belief, they do not taste like chicken...
Tomorrow, we are flying to Vanga which is a more remote village. I just hope the caterpillars don't get bigger. 

Biggest Loser and Carousel Comedy

Snafu number 1: luggage limit exceeded. At the airport check in at St. Louis, we were told that a previously agreed upon arrangement for additional luggage allowance for a medical mission was no longer possible. We had 9 containers neatly packaged with donated supplies, all under 70lb. We needed to have 6 containers all under 50lbs. What a disappointment! That was 630lbs down to 300lb in one sentence by the flight meister. I felt like humming, "United Breaks Guitars," a funny YouTube video about a disgruntled flight customer. But, flexibility is a key in these ventures, so we set about to lose that weight like the Biggest Loser. It soon looked like a bomb went off in our luggage. 9 containers suddenly all opened with books and sutures and gloves and medicine on the floor. Thankfully, we still had the support from our spouses at this time and we made good memories trying to decide what to take and what to leave.

After a 3 hr flight to Washington DC and a 7 hr flight to Belgium, we were ready to embark on our last leg- a 9 hour flight to Angola and 1 hr flight to Kinshasa. The "holding" area for our gate reminded us of Ikea with neat box shapes; we were surrounded by glass on all sides inside the larger airport. Since it was standing room only, we moved closer to the actual gate when it neared time... as did everyone else who was sitting down. When the gate opened, although we were only about 5 people away from the gate, at least 30 people somehow fit in front of us. From my time in Ethiopia, where you literally needed to have your shoes touching those in front of yours in order to keep your place in a single file line, I realized I needed to stick close to Tim simply to stay together as a group. Paul was right behind me, for a second. I made it through the gate and was going down the gangway and looked back. Because this was Ikea and we were in a square fishbowl, I could still see him. He was in the same spot. At LEAST 40 people somehow got between Paul and that gate. Welcome to Africa!

We stepped out of the plane in Kinshasa, Congo. Imagine the smell of campfire mixed with boys basketball jerseys wafting over you in early summer in humid St. Louis. We walked down the stairs onto the concrete, were greeted by several uniformed Congolese, and boarded a bus to be transported to the two story airport. Customs was no problem, but then we arrived the one luggage carousel. As we waited for our 6 containers, we noticed that among the large pieces of luggage, there was a small package of tissues on a napkin. This seemed like a clear message. If we don't have your luggage, no worries. Take a Kleenex served on a fancy napkin. We waited some more. Suddenly, out of the shoot came the bright orange jacket worn by an airport employee. He was STANDING on the carousel as it went round and round, holding a small box labeled with bright orange caution tape. Although at first we thought it may be a box with hazardous materials, turns out they just didn't want a song written about "United Breaks 'Super Tiny Box That You Should Have Put in Your Purse.'"

 Don't forget to visit Facebook.com/newcityfellowshipcongo

My Provider

Some things are hard to chalk up to coincidence... read on! (Caveat: I realize that not everyone reading this has the same spiritual views, but hopefully you can relate to my posts all the same.) I started participating in volunteer missions trips when I was 14. In every instance, I have received donations very close to the exact amount of money required. I was hoping this trip would be no different, especially as I felt several distinct challenges: A. The amount of money was significant ($5150), B. The time was short (1 month), and C. My personal time to devote to soliciting, speaking, and promoting was severely limited with a resident work schedule. Amazingly, I received the needed amount in less than 3 weeks. And it kept coming, even from missionaries in the US and Thailand who are themselves supported by others! I wondered what God was up to, other than fulfilling my dream to start a fund to provide other residents with opportunities to go on a medical mission elective in the future. However, when I looked closer, I noticed something VERY interesting. If you didn't count a few larger departmental/hospital donations and just looked at individual donations, I realized last week Wednesday that I had exactly $5050. As I talked to the financial office I said, "Just wait, I'm going to get a $100 check in the mail. God always has worked like that in the past." And you know what? I got a $100 check in the mail!! So thank you, thank you, thank you to everyone who donated and sacrificed. Any extra money (now counting the larger donations) has been placed in a medicine abroad program fund to be used for future medical mission trips.

Secondly, I went to REI to get a pair of Chacos. (If you don't know what they are, anyone with these multipurpose sandals would be happy to regale you with stories of how long their pairs lasted, etc, Trust me, just pretend you know what they are.) The store, REI, had...drumroll please... one pair of women's chacos. And they fit. And they were half price.

Lastly, I approached both St. Mary's Hospital and St. Luke's Hospital to see if they would be willing to donate sutures or surgical equipment. They said, and I quote, "Oh, it is your lucky day. We just sorted through all the operating rooms and we have this huge bag/box which you can have. It's at least $500 worth." That's right. Both said the same thing. They both had just cleaned house. Not only did I receive sizable donations, but I also had no delay/hassle in receiving the sutures.

Jehovah Jireh, My Provider
My God will supply all my needs, according to His riches in glory

Thank you for being a part of this venture, whether in spirit through prayer or in deed through giving financially. 

The Details

It has arrived! We leave today for the Democratic Republic of Congo. There are three of us traveling together: Paul Tuttle, med-peds resident, Tim Rice, teaching physician in adult and pediatric medicine, and myself (OB/GYN resident). We are taking 9 containers packed with medical books and supplies which have been donated, and we are praying they make all the transitions through the airports!

Tentative Schedule

Sept 29-30: Fly to Kinshasa, Democratic Republic of Congo

Oct 1: Sleep, get oriented in Kinshasa, visit medical school

Oct 2: Fly to Vanga at 6am to start work at the hospital

Oct 2-16: Work at the hospital, with surgeries M, W, F

Oct 16: Fly back to Kinshasa

Oct 16-25: Teach at the medical school in Kinshasa

Oct 26-27: Fly home

We plan to collaborate with surgeons and physicians in Vanga Evangelical Hospital, about 300 miles east of Kinshasa (a short plane ride away from Kinshasa). Vanga Hospital is a 500 bed referral medical center that has been serving the rural poor in the heart of Congo for over 100 years. They have requested surgical teams to come and teach the healthcare providers and to care for patients. The hospital has ongoing training of several Family Medicine residents and provides an opportunity for medical students to see patients in a rural setting. Vanga is a very busy referral hospital, serving a population of 250,000 in addition to having patients who are sent from Kinshasa and internationally from Angola, etc. They are well-known in the area and have an excellent reputation for low cost quality care. There is a need for surgeons to repair fistulas, which is my special area of interest and passion. The fistula—injuries to the bowel and bladder—are mainly due to prolonged labor complications. Rape/assault is also a cause, although this is more likely in the eastern regions of Congo. There are also patients undergoing infertility evaluation due to the high cultural importance of having kids. I am eager to care for these patients!

When we travel back to Kinshasa, we will be visiting the local medical schools as well as several clinics/orphanages/schools. I hope to give health lectures (translated into French) and provide hands on teaching at these sites. My missions philosophy is that we should participate in sustainable, collaborative efforts rather than paternalistic, one-time experiences. The partnership between New City Fellowship (the sponsoring church here in St. Louis) and these entities in Congo has been ongoing for approx 10 years. Dr. Tim Rice has been working on health related issues in Congo for the past 6 years as a result of interactions with Congolese pastors who are immigrants/refugees living in St. Louis. New City Fellowship has a long term relationship with Congo; in addition to healthcare training, there are ongoing efforts in caring for orphans, bolstering the educational system, and aiding economic development with microfinance and small businesses. It is exciting to join this effort!