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.