The Koleskis on Mission

Hey, We're Famous

2011-09-28T12:17:00.001-04:00

We are famous. We are on another web site, to prove that we exist in cyberspace, which doesn't really exist. I'm so confused that I exist in a place which doesn't exist, but it's true.

See you.

One Slightly Odd Sunday in Africa

2011-08-30T00:50:00.000-04:00

A new adventure in Malawi:

Elizabeth's purse is stolen at lunch. We were upset. Our friends suggest we pray.

We prayed.

After Elizabeth canceled all her credit cards by skype, a friend calls. Her name is Amanda, the first name on Elizabeth's phone. The central police station called Amanda saying that Elizabeth's purse had been recovered. We celebrate, but know that the $100 cash is gone, but hope the credit cards and license are still there.

We get to the station, and see the purse on the desk. The police woman says it was found in the bathroom with a note inside saying it was "found" at the restaurant where it was stolen.

No cell phone, but the credit cards and license are there.

I call the cell phone. A man answers. I say that we're at the police station. He answers that the purse is in the bathroom. He says that we will find her car keys, her documents, "and everything."

Now I know who put it in the bathroom, the guy who answered my wife's phone.

I ask, "OK, can we have the phone back, too, please?" I actually said "please" to a thief.

He answers, slowly, "OK" then CLICK.

So I sent the guy a text, to my wife's phone, "Thanks for returning the purse. We will pray for you to stop sinning. We forgive you. God loves you."

I couldn't fit in one text, " I'm glad you have half a conscience, but I hope you regrow the lost half, because if you aren't careful you will lose both halves permanently."

We go back to the scene of the crime, a longer story, and just for the heck of it I call the phone, hoping to hear a guilty cell phone, but since this is not a movie, the cell phone is turned off and no guilty ring.

T I A this is Africa

What Should I Specialize In to be a Medical Missionary

2011-08-18T04:15:00.000-04:00

What Should I Specialize In?

I used to think that the only useful specialties for the medical missionary were Family Medicine and General Surgery. My ideas have broadened a bit since I have had some real experience on the mission field.
One area I never thought of was Anesthesiology. Without an Anesthesiologist the surgeon is extremely limited in what he or she can do. They are limited to minor procedures or trying to put the patient to sleep, and more importantly, wake her up again, all alone. Additionally, since the anesthesiologist put people on ventilators all the time, she is the doctor best prepared to manage patients on a ventilator in the Intensive Care Unit. One or two patients in the Intensive Care Unit can keep an anesthesiologist without a good night’s sleep for a week.
In general, the broader the training, the better one is prepared to be a missionary physician. The three most useful specialties in my mind are Family Medicine, General Surgery and Anesthesiology. In my opinion, combined Internal Medicine/ Pediatrics is a close fourth, followed by Internal Medicine or Pediatrics alone. In Shell, until we had a Pediatrician who cared for hospital patients, the Family Practice doctors were caring for sick Newborns. All we had to work with was two weeks of NICU training in residency and the Harriet Lane Handbook. We were practicing way over our heads, but most of our patients did alright because the handbooks were well written and God was gracious.
There is a role for specialists and sub specialists, but that’s mostly in teaching in short term stints in the large medical centers in a country. The Christian Medical and Dental Associations and medical schools regularly have groups that go to developing countries to teach local specialists at the big medical centers. The specialists will teach new procedures or do an update on information to the national specialists.
Another place for specialists in developing countries is on one to two week medical brigades. Long term missionaries able to treat most anything that walks through the door, which means a generalist who is able to find information or know where to send a patient is best equipped to greet the patient at the door. The problem is than when a specialist is needed, one specific specialist is needed for one patient right now, not in four months when the brigade is coming.
In Ecuador every year a group of Ear, Nose and Throat surgeons from Operation Hope would come for a two week intensive caravan to repair cleft lips, cleft palates and ears that never grew. They did a lot of great work, but they were US doctors fifty weeks a year and US doctors who worked overseas two weeks a year. They would take an entire crew of surgeons, anesthesiologists, nurses, translators and helpers. The only part of third world medicine these doctors experienced was the beds the patients used post-operatively. I was always grateful to Operation Hope, but I also knew they would be gone for fifty weeks once they left.
I took a group of children from the jungle to the Operation Hope Brigade every year. I would translate for the doctors and bring them my patients. The surgeons would teach me about what they were doing, what criteria they would use to make their decisions and how they would do their miraculous surgeries, and let me bring my patients to the front of the line. The more they taught me, the more I could prescreen patients for them and make their time more efficient. They did a great work but they weren’t International Doctors in the way I want to be, but my patients and I were very grateful for their work.

What Else I Thought I Needed to Know

2011-07-11T12:43:00.000-04:00

Section 3
Before I actually worked overseas, I also thought I needed to know how to do a lot of procedures. There are a number of procedures one can do one the field, but I learned that it’s best to learn on the equipment one has on hand in the field.
In Ecuador, our gastroscope (the scope for looking into stomachs) was incredibly old. It didn’t have a TV camera like scopes in any US hospital. We looked through a tiny window the size of a microscope eye piece. It didn’t even have air insufflation, the part that blows up the stomach so the doctor can see what’s in there. We had to blow air down the suction port of the scope with a nebulizer, one of the breathing machines used for an asthma attack. Any amount of training with state of the art equipment in the developed world would have been just about worthless with our barely functional scope. Learning on the job with the equipment on hand was the best way to learn.

What I Thought I Needed to Know

2011-06-12T15:07:00.004-04:00

Section 2
When I was a fourth year medical student planning to do medical missions, I thought I needed to know how to do everything, especially every surgical procedure known to humankind. I thought, and have since heard many medical students say, “I want to know how to do an appendectomy in case I need to do it.” I actually thought that the best international doctor could do an appendectomy with one hand while doing a Caesarian section with the other hand.
I was not the first medical student to think I needed to be an expert in surgery, obstetrics and family medicine to be an effective medical missionary. One interview at Marshall University International Health Residency went like this:
Experienced International Doctor: “So, you want to do International Medicine?”
Me: “Yes, sir. Very much!”
Experienced Doctor: “I suppose that you think you need to learn Surgery and Obstetrics?”
Me: “Oh yes, sir! I need to know how in case there is no one else around who can do the surgery.”
Experienced Doctor: “Wrong! You should only do Surgery and OB if you like doing them.”
His point was that if you do what you love and feel comfortable with, you will be a better International Doctor. In Ecuador, when the patient needed a Caesarian Section, we called in the surgeon. Since the surgeon was more experienced at cutting and sewing, he took the baby out and sewed the patient back up. He was the best person for the job, and the Family Practice doctors were better at receiving the baby and doing neonatal resuscitation when it was necessary. So the Family Doctor would decide when a C/section was necessary, but the Surgeon would do the work.
In Ecuador, we had surgeons and anesthesiologists. In Malawi, we don’t have surgeons, we don’t have anesthesiologists and we don’t have an operating room. There are other hospitals with all of those within an hour’s drive, both missionary and government hospitals. They have the personnel and equipment to do surgeries properly.
A doctor who is unpracticed in what he’s doing combined with lack of facilities and staff members who don’t know what they are doing is a real recipe for hurting someone. Having a plan in place for what to do if a surgical patient walks in the door is much better than trying a surgery you have not done in years. Of course, in dire emergency, with no other options, trying a surgery may the best option, but exploring all the other options first is vital.
Another issue is that a surgeon is only as good as the anesthesiologist working with him or her. There’s a reason that anesthesiology is a four year residency, there’s a lot to learn. Putting someone to sleep and waking them up again looks easy because anesthesiologists are really good at what they do and they have trained a long time. Anesthesia and surgery are not places for amateurs.
So unless the doctor is cut off from any other resources for many days, knowing where the best available surgeons and anesthesiologists are is far better for the patient than attempting a procedure you have never done. Patients often can be stabilized and moved to a proper facility in about the same time that it takes to find all of the instruments when the doctor and the staff rarely use them.

What I Thought I Needed to Know to be an International Doctor, and What I Really Needed to Know

2011-05-10T09:38:00.000-04:00

Section 1
What can we learn from one doctor’s experience? The most important thing to learn is that one experience is not everyone’s experience. I have had a pediatrician colleague who had to do a Caesarian Section because he was the most qualified person available at his hospital in Gabon, Africa and it needed to be done. I have also heard of overseas physicians who put the patient to sleep themselves, then operated while every few minutes stepping to the other side of the curtain to ask the patient how she was doing. Thankfully, I have never had to reach that far to care for a patient.
Many doctors have a variety of experiences. Few have to be the Lone Ranger who can do everything by themselves, but most have to adjust to the medical environment and medical personnel as they are. When I was a medical student, I thought I needed to know how to do a lot of things all by myself. What I really needed to know was how to learn while making decisions, how to adjust to changing situations and medicine stocks, how to work with professionals of various cultures and education levels, all while having the final responsibility as “captain of the ship”.
I have been a missionary doctor for seven years, five in Shell, Ecuador on the edge of the Amazon rainforest, and two in Lilongwe, Malawi, a tiny country in southeastern Africa. While I was a resident, I spent two months in a mission hospital in Washim, India. Each experience taught me more about what a missionary doctor really does and who a missionary doctor really is.

It's Official, We're Staying Another Year

2011-01-22T02:30:00.001-05:00

Since we returned to Malawi in September, we have been praying about how long we should stay. Logic has a number of reasons to stay through June 2012 and a number of reasons to leave in the summer of 2011. But the Lord says,

Isaiah 55:8-9
8 “For my thoughts are not your thoughts,
neither are your ways my ways,”
declares the LORD.
9 “As the heavens are higher than the earth,
so are my ways higher than your ways
and my thoughts than your thoughts.

Human logic is nice, but God has a plan for our lives that at times defies human logic, but is always the best plan. So we prayed. We prayed for three months.
As we prayed, it became apparent that God wanted us to stay until June 2012. The logical reasons to stay are that Andrew will graduate high school From African Bible College Christian Academy and we will stay be here while our director spends a year on furlough. Those reasons are nice, but they pale in comparison to the most important reason, God directed us to stay.

We’re excited about staying. The time in Malawi hasn’t been easy, but it has been a time of tremendous growth for each of us individually and as a family. We are a happier, closer family for working through the hard issues that Malawi brought up. If nothing else good happens, we’re grateful to the Lord for bringing us together.
How did the Lord bring us together? Our time in Link Care helped us to talk about what each of us wanted from the family and work on setting goals as a family. That time also taught us that “You are who you are, not what you do.” Try reading the Gospels with that thought in the back of your mind. It seems like that is much of what Jesus is saying.

So, we are here following God’s will, asking for your prayers that we will follow His perfect will joyfully, and that He will give us direction for our next step in June 2012.

15 year olds shouldn’t have AIDS

2010-10-02T15:53:00.001-04:00

This week I thought I was seeing a 15 year old boy with a stomach ache, until I looked in his mouth and saw Candida (a fungus). Oops. He was there with his mother, so I had to tell them I suspected AIDS. I sent them to VCT, Voluntary Counseling and Testing, and he was positive. He probably has fungus growing all along his esophagus, which puts him at stage 4 out of 4 AIDS. That is pretty darn sick.
He had very cool shades and a very macho black T shirt, but he was choking back tears as I was telling him all about HIV. I’m not surprised. His world just turned upside down. Now instead of looking at another 60 years, he might be looking at another 10 years, 15 tops.
How did he get AIDS? There are three possibilities:
1. He was born with it. No one else in the family knows their status, so He could have been born with it, having gotten it in his mother's womb. It would be late to present, at age 15, but he is from a well-to-do family, so he could have been healthy enough all along.
2. He could have started having sex at age 12 or 13. That would be odd that he would get that sick that fast from 2 or 3 years of sexual activity, but it's possible.
3. He could have been molested. He has been at boarding school for two years, so he could have been molested by one of the older boys or by a teacher or another adult.
So, as we get to know each other a lot in the coming months, it may come out how he thinks he might have become infected. The how doesn’t matter much now. He is infected and sick. The why doesn’t matter much either. He is unlucky in a fallen world.
The only question s that matter now are “Who?” and “How?”
Who? : Not, “Who gave this to me?” But, “Who do I turn to since my life has flipped upside down?” I will humbly be suggesting that he turn to Jesus. He probably won’t make the infection go away nor will He punish the infector on this Earth, but He will be with the young man as he struggles to live a healthy life. Jesus will sustain him when there seems no hope. Jesus will redeem his soul. It doesn’t seem like much consolation from a 15 year old boy’s point of view, but it is all we have on this Earth.
How? : Not, “How do I get even?” or “How do I get rid of this?” but “How do I live with this horror?” I will also humbly suggest that Jesus is the same answer to that different question. Jesus can turn horror into hope. There isn’t anything redeeming about dying young or being sick young, but there is redemption in eventually using his illness to help others who are ill and to give glory to God.
How does AIDS in a boy who is just becoming a man glorify God? I don’t have a clue how it will happen, or even how it can happen, but I pray that glory does come out of this. I pray I can give some comfort as he starts this very sad journey.

Zacharias is with the Lord

2010-05-07T13:03:00.000-04:00

The young man with juvenile arthritis that Elizabeth was caring for passed away about one month ago. We learned of his passing last week.
As you can see from his picture, Zacharias was very unhealthy. He was often fed only every two to three days by his family. When Elizabeth would see him, he would be lying in his own excrement and urine, covered in flies and bed sores, and often hadn’t eaten in a day or two.
Thanks to Elizabeth and Jessica McMillan, Zaccarias was moved from his village to the Michinje District Hospital. When they visited him there, Zacharias said he preferred staying in the hospital because they fed him and bathed him.
On one of her visits to Zacharias’ village, Elizabeth took a woman who spoke Chichewa to explain to Zacharias about Jesus love and His forgiveness of sins. Zacharias accepted Jesus as his Savior that day.
It is horribly sad that an eighteen year old boy who just had arthritis died, but because of Elizabeth and Jessica, he died clean and fed and most importantly, saved. Thank you Elizabeth, thank you Jessica and thank you God.

Chicha: Yum, Yum

2010-03-20T13:20:00.003-04:00

One of the more interesting items that comes form the jungle of Ecuador is chicha.
In the jungle, there is food, but keeping it fresh without refrigerators, canning and other modern conveniences is hard. Rodents are everywhere, as are bugs, rot, fungus, and all other kind of things that ruin food.
So, what is chicha? Yucca root, also known as manioc or cassava, is chewed up by the women, spit into a bucket and allowed to ferment. In the jungle, each woman makes her own chicha from her own batch of spit. Then to show their hospitality, each woman wants you to try her own special brand of fermented spit.
You may be asking, “What does chicha taste like?” Elizabeth says it tastes like warm, lumpy beer. Jerry says it tastes like a mixture of skim milk and vinegar. Both descriptions way oversell the quality of the brew.
So why do people make chicha, and more importantly, why in Heaven’s name would anyone consume it? Both are very good questions.
Adults consume chicha for two reasons. Since as long as history has been written, almost every culture and civilization has writings of epic heroes and recipes for beer. People just like to get drunk. I used to like to get drunk, and can’t for the life of me remember why I thought I was having fun. Go to most college campuses on a Thursday, Friday or Saturday and you will find a large number of young people spending their parents money. By studying? No, by drinking fermented beverages and thinking they are having a great time. Most cultures consume alcohol, and the jungles of Ecuador host a number of tribal cultures that like drinking.
The second reason is that from the time jungle children are young, they drink chicha. The water is mud brown and the open sewer from the Andes at 16,000 feet down to the 1000 feet of the jungle. That’s 15,000 feet and miles of human sewage. It’s hard to imagine that fermented spit is more sanitary than anything, especially river water, but in the Amazon chicha is definitely a cleaner beverage. Even a couple of days of fermenting will keep the starch from going bad. Being a liquid, rodents don’t go for the chicha, and mold is less likely to grow so in a really low tech way, chicha is a way to store starch.
Chicha is a comfort food for people from the jungle. It’s what fills your belly when you are a kid. It’s what you drank to get your first buzz as a teenager. It is what you drink after a tough day in the jungle or after a long hunt.
True chicha stories:
> Folks from the jungle will bring chicha on the missionary airplanes when they fly, since you can’t buy chicha in the stores in town. Since it is a fermented drink, it doesn’t like the drop in pressure as the plane goes up to 10,000 feet. Sometime when it is brought out of the storage locker under the plane, the chicha will burst out of the two liter coke bottle it flies in and soak the pilot or ground crew with fermented starch spit.
> I watched a jungle nurse, a man, suck down almost two bowls of chicha after work one day. I saw him again about 45 minutes later, quite tipsy. The alcohol is real.
> Chicha is drunk from a bowl, not a frosted mug. The bowl is made out of a hollowed gourd or a turtle shell.
That’s chicha. I don’t like it, but thousands of people who live in in the amazon rain forest have a right to what they like. Some people like to eat raw fish on a wad of rice, but sushi is a different blog.

New Partners in Hope Videos

2010-03-07T08:56:00.003-05:00

Here is a new video about the new in patient ward at Partners in Hope. (Click on the title to see it. Pretty cool, eh?)

Blessings,
Jerry & Elizabeth

Questions the Chinese guys have asked at our Bible Study. How would you answer?

2010-02-28T14:29:00.004-05:00

1. Why didn’t God send a prophet to China?
2. When Jesus was staying in Jerusalem, did he stay in a hotel? (from the story of Jesus meeting Andrew and John in John 1)
3. In John 1:38 when Jesus showed John & Andrew where He was staying, did He take them to Heaven or where He was staying? Was it a hotel?
4. Jesus genetic make-up? (Was it 23 chromosomes from Mary & 23 from the Holy Spirit or all 46 from the Spirit or some other way? “You’re a doctor. You should know.”)
5. Was Jesus light or God or a man or words? (Prologue from John 1)
6. Is Muhammad a prophet?
7. Was John the Baptist a son of God?
8. Are trees, plants and animals sons of God?

Please us know how you would answer by clicking on Post a Comment.

It Just So Happened

2010-02-15T14:06:00.001-05:00

Sometimes something just falls into your lap, and you know God dropped it there.
Jerry was working at the main public hospital here, and happened to meet a young Chinese man volunteering at the same hospital with a Chinese government program. It happened that this young man is a Christian. It also happened that he lives just down the street from us.
So Jerry went over one day and took some avocados from our tree to Tuki. They prayed together, Jerry in English, and Tuki in Chinese. Jerry invited Tuki to a Bible study starting in our area that happened to be next door to Tuki’s house, run by an English businessman who goes to our church. When Tuki came he brought three other Chinese volunteers with him and the following week he brought five. Through very broken English we found out that these young people had never met any Christians until they came to Africa and that they were eager to learn about God and about what Christianity is all about.
In Ecuador, Elizabeth used a Bible Study in Spanish that was especially designed for people who have never looked at a Bible, and concluded that it would be useful now if we had it in English. She determined to translate it herself. Well, guess what? It happened to have been translated in to English last year.
After printing out scanned copies of the Bible Study sent from Ecuador, we walked over to Tuki’s house and gave homework to a bunch of enthusiastic young people. We started with the Gospel of John. Friday was the first day of the new Chinese Bible study for Chinese volunteers curious about Christianity.
The students came ready with homework done, and loaded with questions like, “Why did God send prophets to Israel, not to China?”
“Was Jesus just light or spirit or man?”
“Are animals and plants children of God?”
“Was John the Baptist the son of God, too?”
After an hour of lively discussion we had only covered the first nine verses of Chapter One but there were smiles all around and enthusiasm to continue on next week. And off they quickly went to prepare dumplings, because tomorrow happened to be Chinese New Year and we happened to receive a last minute invitation.

The Adventures of Molly the Catatonic Kitty

2010-02-12T06:29:00.002-05:00

We adopted Jessica’s cat on Tuesday. The poor cat was catatonic all day long. She hid between Lorraine’s mattress and the wall all day long. When Lorraine would pull her out of the space, Molly would go right back to the gap. After a number of hours, Molly finally would go about six inches from the wall and let Lorraine pet her, but only as long a Lorraine kept holding her.
This went on for a whole day and night. The next day Molly actually walked around the girls’ room. She wouldn’t venture out of the room, but she would actually sit on the desk, looking out the window and meow to get out. That was an improvement until the early hours of day two with the catatonic kitty, when she started meowing loudly and insistently that she wanted to go hunting at 5 am. In a battle of wills between a cat and a human, even two humans, the cat will win. Molly won. The girls came to our room to sleep, and Elizabeth went to try to sleep in their room for two good reasons: 1) she is a self sacrificial mother who will do almost anything for her “babies” even when her babies are almost her height, and 2) she was so sick that night that she hardly slept anyway, with or without the cat.
On day three the cat gave us a fright that she had run off. Andrew left the back door open and Molly couldn’t be found for a few tense seconds. She had gone to the porch but came back at Elizabeth’s call. Why are we keeping the cat locked up inside? We were told by cat people it takes a week for a cat to imprint on a new home, so we are keeping her locked in the house for a week to let her imprint on our house, then she can go back to her catly duties like hunting rodents and snakes and placing the rotting corpses under our bed. We can’t wait.
We are up to day four now, and Patty the mop dog is about to learn about his new competition for our cuddling affections. Right now he is just confused as to why we aren’t letting him track the red mud of Malawi into our house. In a mere three days we can open the doors again to let Molly out and Patty in. We can’t wait.

Both Hands Tied Behind Our Backs

2010-02-04T14:45:00.004-05:00

Professionally, I’m having a blast. I’m at the government hospital in the capital, Lilongwe, which makes Wishard look like Clarian North.

We had two kids die of rabies last week. One of the kids was bitten on Christmas Day. It was a 1/4 inch lesion on the thumb. The parents took the kid to the health center, but it was closed on Christmas day. Since Christmas was on a Friday, by Monday they thought, “It looks OK,” so didn’t take him back. He didn’t start the post bite vaccines at all and died a month later. He had hyperreflexia followed by hyporeflexia, progressive paralysis, and myoedema. The other kid, 12 y/o, had the foaming at the mouth. I’ve now seen four cases of rabies in six years: 2 in Malawi, 2 in Ecuador.

You can ask, “Why didn’t we use the Milwaukee protocol (induce a coma for 3 weeks)?” We didn’t even think about it because there are only three ventilators in the hospital, and only one can handle kids. It’s not right to use such a limited resource for a kid who has a 0.01% chance of living, even after a month long induced coma. There are also only 3 working dialysis machines in the country, all at the hospital where I'm working.

I’ve been a doc for 17 years and only encountered Burkitt’s lymphoma on board exams. In one hour I saw 15 kids with Burkitt’s lymphoma. A General Practice doctor from Nigeria has an interest in Burkitt’s & pediatric cancers, so he does the Burkitt’s kids. (Burkitt's lymphoma has mortality anywhere from 5-30%, depending on the stage when diagnosed and whether they relapse after chemotherapy.)

I took a sample of peritoneal fluid to the lab on January 3rd. Since I couldn’t find a lab tech anywhere in the lab, I put the sample down on the counter, right next to a sample of peritoneal from the SAME patient dated December 31st. It had been sitting on the counter for 4 days, untouched by human hands. All the crud growing in the test tube wasn’t so much of an issue because we can’t do cultures here. You are lucky to get a cell count, glucose and protein. My issue was that I had done all I could for the patient and if no one could do even five minutes of work over four days to help another human being, and the systems were so nonexistent that labs samples can go untouched for four days, there wasn’t anything else I could do. So, I just got in my car and drove home.

I did come back the next day. (That’s the difference between being fed up and giving up.)

Mind you, this is the free labor I’m doing in the government hospital to get my medical license. Tomorrow is my last day. Not that I’m counting, (20 hours).

Next week I start at Partners in Hope. It’s not a perfect place, and it has similar problems with motivated staff, but we can fire people who don’t do their work, pray with our patients and at least know that most everyone at the hospital cares about the patient.

This is getting long and might look depressing, but since most of the patients get better and go home, and we actually can make a huge difference. “We had both hands tied behind our back and STILL saved the patient.”

Three factoids before I quit.
1. There are three residency trained pediatricians in a country of 14 million, two here in Lilongwe and one at Queen Elizabeth Hospital in Blantyre.
2. Every day at morning report on the pediatrics ward they discuss the admissions and the deaths. There are 3 – 9 deaths per day. That’s one death every 3 to 8 hours. (In the US, if a child dies in the hospital, the whole building goes into mourning.)
3. No one can get reliable data about admissions and deaths, but the estimate is that the mortality rate is 9.1% of all pediatric admissions, down from 9.6% last year.

HCJB In Haiti

2010-01-24T12:53:00.002-05:00

HCJB sent a team to Haiti.

See the photos on the BBC website.

http://news.bbc.co.uk/2/hi/americas/8466989.stm

The Patient Died Before I Got to See Him

2010-01-12T08:17:00.004-05:00

Yesterday was Monday. The doctors divided up the patients who came in over the weekend. I had six. I started seeing them one by one, and as I came into a room, there was a body wrapped up and ready for the morgue.

I asked, with some anxiety, “Is that Charles?”

“Yes.”

“Do you need help putting the body on the gurney?”

“Yes, but you don’t have gloves on, so don’t help.”

It was sad that my patient died even before I got to see him. At least I don’t feel guilty that he died while under my care or even under my stethoscope. It is a recurrent problem here that patients came long after it is too late. They are not comfortable with western medicine, a place that is totally unfamiliar: multi-story buildings, electricity, odd looking machines, even elevators.

You can see little nicks with black tint on the sick part of the body made by the medicine man. The patients are so much more comfortable with the witch doctor. He lives in their village. He speaks their language. He lives in a grass hut like they do. He believes in curses, demons and ancestor worship like many Malawians do. He may even place curses or say that he can prevent curses. By the time the family has given up on the medicine man they are long past the point where we could have helped.

I don’t know what the story was with Charles. I never even got to see him.

Blessings - Jerry

Happy New Year everyone, Happy New Decade!

2010-01-03T05:10:00.003-05:00

This year started in a cold Midwest winter and ended in the warm heart of Africa. We have just moved into a “permanent” house here and it’s already feeling a bit like home. Home for me is not really a place. I’ve lived in eight countries and five states. The longest I’ve lived any where is eight years (five of them while I was in college). Home for me is a feeling, a feeling of comfort and security. I feel it most with family and with friends that have lasted over several moves. I feel it in prayer sometimes. I begin feeling it after about six months in a new place. Still, sometimes no matter how long I’ve been somewhere, there is a longing for “home”, whatever and wherever that is. We Christians are fond of saying that our home is in Heaven, so maybe that’s as things should be.

We wish everyone a sense of home in this New Year, and praying that Malawi would indeed become home for us this year.

Under 5's Clinic

2009-10-31T04:23:00.003-04:00

Teaching health care practices with song and dance in Malawi! I filmed this with my camera at an under 5's clinic I helped out in about one and a half hours outside of Lilongwe.

Update on Zachariah

2009-10-17T09:13:00.003-04:00

We were able to go back to the village where Zachariah lives. With the help from the Malawian government we could bring him some food supplements, it’s a food called “plumpy nut” which is like peanut butter, and has the protein and nutritional supplements he will need. We also were able to secure a wheelchair that was donated by the Rotary Club. The best news of all however, is that a chief from a neighboring village has agreed to be responsible to make sure he is fed and taken outside daily. On the bad news side, we found he has developed a bed sore, and for someone in his condition it could prove fatal. I washed and dressed the wound with the few first aid supplies I had, and we left with words of encouragement. I’m not sure how much future he’s going to have, but maybe he can have a few nice days in the sun.

2009-10-17T08:27:00.002-04:00

We are feeling more and more "at home" here every day. We found a house that we hope we can rent, and we went to an auction yesterday and bought a few pieces of used furniture. The whole experience was a hoot. It was just one body press of people as we moved from one item to another crowding around the auctioneer. Everyone shouted in Chichewa and pretty much bid everything up sky high. I bid on several things without getting them. After a while I heard the people saying this and that about the azungu (white person), and finally when I was about to give up on another bid, this guy said I'll give you another thousand Kwacha to just bid again, so I did, and I won this old desk, and everyone cheered (although I never did get the promised 1000 Kwacha (about $7). It was exhausting and I got sunburned, but it was fun. I don’t think it was anything like Christies.

2009-10-02T15:28:00.003-04:00

Zaccharias

2009-09-30T00:18:00.002-04:00

We finally have better internet, email only by day and internet after 5 pm, but it's more consistent. I still can't upload large files (or even medium ones). I was trying to put a video on from the village, but haven't been able to yet. Things are better as we get more adjusted, and actually I like it here quite a lot. Here the purple Jacaranda trees are blooming they are beautiful, it’s getting hotter everyday as we head into full summer. I've been out to some of the villages now a number of times, there are so many needs... and I need prayer to know where to focus my efforts.
I also feel that the spiritual battle here is more obvious. In the US we are sort of lulled to sleep in our comforts, so much so that we don't think we need God. Here there is no question of that. Yesterday I was in a village near the border of Mozambique, and we saw a boy with Juvenile Rheumatoid Arthritis whose disease is so advanced that his many of his joints have become immobilized, His name is Zacharias, and he's 18, but he has not been able to feed himself lately so he's basically starving. His grandmother is elderly and can't lift him to bathe him so 2 other nurses and I bathed him. One of the nurses gave him her lunch and he wanted his picture taken with her. so we took a few, and we’ll bring him some prints when we go back.
It broke my heart, and I don't know what I can do to help him long term.
Anyway, Jerry and I are impatient to start working while I study language... Well God bless you. Thanks for your prayers and support, it means so much.
Love, Elizabeth

Mudzalephera

2009-09-16T14:32:00.002-04:00

I’ve just been thinking of the Kingdom of God, of what Jesus talked about in the Sermon on the Mount. I traveled to a tiny village yesterday, one where a small group of people have been putting forth focused effort and money to transform the health of this community under crushing poverty. As I spoke to the workers, I was told of the multiple problems and a year’s efforts seem to have come to nothing. This is not a picture of the kingdom of God.
This place needs the life, cross and resurrection of Jesus, they need the Good News that comes with hope and power. I met a beautiful lady with her baby, I introduced myself and told her in English how beautiful her baby she smiled and told me his name. Then I asked her name, she told me “Mudzalephera”. I carefully repeated it and smiled at her. Then someone next to me told me her name means “You will fail”. This is why we need the Gospel, Mudzalephera”s life has been saturated with injustice and the heavy fatalism of her environment. The Kingdom of God that Jesus preached is GREAT news, light and fresh air. We all need it, and it makes my heart ache to offer them that hope and life.
Elizabeth

Letter from Malawi - Week 3

2009-08-31T03:50:00.001-04:00

We’ve been in Africa 2 weeks. It looks very… African. The soil is orange red, and quite dusty, the roads are busy with pedestrians and bicycles that you have to take care not to hit on the narrow roads. The women wear colorful prints, carry babies on their backs and bundles on their heads. Others wear suits. The weather is nice this time of year, cool at night warm in the daytime. I’ve seen some beautiful birds and flowering Jacaranda trees. The Malawians we have met have all been warm and very willing to practice our greetings in Chichewa. I think we are going to like it here.
The kids started school this week, and seem to be adjusting quite nicely. They have all made a number of friends already. We have also met and been helped about by missionaries that have lived here a while, they have made the transition a lot easier. We had our first meeting with the missionaries of Partners in Hope where we prayed for the work and for each other. I’m so happy to be with a group of people who know they depend on God.
Speaking of transitions…. Please, please pray for ours. We need to find a house, furniture and a better internet connection! Pray for our language learning, and for us to be effective in our work here.
Love,
Elizabeth

Early Impressions of Malawi: A List from Week 2

2009-08-25T06:19:00.007-04:00

A gardener cutting the grass with a manual hedge clipper – the giant scissor kind.

A very functional sprinkler made out of a hose taped to a water bottle with holes poked around the middle of the bottle.

All the houses have razor wire and electric fences around the walls. The electricity is enough to give a zap like a bee sting, but not to kill or even maim. It still feels like a prison at times.

Crows have white bellies so that they look like they’re wearing tuxedos.

Beautiful birds with iridescent red wings, a long skinny crest on their heads, long tails and glowing green bodies.

Kids who appear well-fed, begging, sticking their hands out when I walk by. Even two-year-olds are begging when they see my white skin. I understand it, but I don’t have to like it.

God comes through exactly on time. We got the support we needed just two days before we left the US and a little more has come in since we arrived. Thank you, God.

No hummingbirds. They’re Western Hemisphere birds.

The internet is often too busy to log on, especially in the evening.

Everything is imported, so everything except corn flower is very expensive. Gas $4.50/gal, Jelly beans $4 for a tiny bag, which would be less than $1 at Walgreen’s.

I wish I weren’t allergic to cats. The Jonats (the family we are house sitting for) have a very friendly cat, but I can’t pet it without feeling raw in my eyes and nose.

The weather is really pleasant in late winter, which means summer is going to be really hot. Here there are really three seasons: hot, cold, wet (which should be called hot & wet.) Since we're in the Southern Hemisphere, the seasons are reversed, so winter is just ending.

I’ll have to relearn how to drive a manual transmission, not hard, but now left handed while driving on the left. Yikes.

I am beginning to have some culture shock as different annoyances catch up w/ me; we’re house sitting so we can’t unpack all our stuff, and we are learning how to function in a new environment. All this will pass and God will get us through, but after ten days, I have frustrations.

As I was writing this blog the first time, the electricity went out, which means that the 1 hour internet access card I bought was running, although nothing else was. Bye, bye 1 hour internet access.

I know that we will adjust, and the adjustment is painful, which hopefully means God is scrubbing off some rough edges and stretching us. As time passes we will adjust our rhythm to the rhythm of life here. Right now I feel like an opera singer trying to rap.

People are tickled pink when when we try to say even a few words in Chichewa.

We can see God working in many ways, even the most minute details. As hard as things are here, we know we are in God's gentle hands.

Please pray for us. We need the prayers and everyone could use more practice.

Stepping Out in Faith or Running Ahead?

2009-05-19T19:31:00.005-04:00

Things are moving very quickly here. Just as winter ended and I thought, "Great, we can enjoy spring and summer in the mid west." Then, we realized we are now 3 months from leaving, if we leave in August. August makes sense because the doctor I'm replacing leaves in July, school starts August 26th and we want to be over jet lag before the kids start. If we don't leave then, the next option is December, when it would be very hard to find someone to rent or buy our house.

We are in that area where we wonder if we are stepping out in faith or stepping out in front of God's perfect timing. Whenever we pray, God seems to be saying, "August" or is that just me? Logically, there are too many things to do before then:
Sell 2 cars
Lease or sell our house
pack a family of 5
raise 40% more support
start buying & shipping stuff we will need there
and that's just the big stuff.

Oh, did I mention I have my Board re-certification in July?

Just for fun, our kids are adolescents. They are not enjoying monster public schools after Nate Saint Memorial School. The whole school, K - 8, is the same size as most of their classes in the monster public schools.

So please pray we will receive wisdom, and most importantly, that we will be in step with God, not in front or behind. God is still on the throne, I just am not sure which way he is pointing, August or December.

P.S. Since I wrote the letter to a friend, the Lord has increased our support. It sure looks more like August.

Thank you, Lord.

Malawi Isn't in the News Much

2009-04-26T22:18:00.003-04:00

Malawi isn’t in the news very much. It doesn’t have a war going on like Iraq or Sudan. It isn’t having atrocities like Congo or Kosovo. It isn’t even having piracy like Somalia or a cholera epidemic like Zimbabwe. What is happening in Malawi is too slow to get the attention of the news. Even the African press doesn’t see much newsworthy about Malawi. What is happening is that people are dying; not by thousands a day, and not in a way that looks gruesome in photos or videos. People are dying of AIDS, slowly, but a lot of them. Not enough to catch world attention, just enough to lose all that attention.

So what to do? Mother Theresa said, “We can’t do great things, just small things with great love.” We give AIDS medicines with great love.

We tested a child who was sick for a couple of months to see if he had AIDS like his mother. When she was told that her son was HIV negative, I saw one of the biggest smiles in my life. The people of Partners in Hope rejoiced with her, loved the woman and her son, and then made an appointment to see her the next month, so that she could keep getting the medicines and the love.

“A man with leprosy came to [Jesus] and begged Him on his knees, ‘If you are willing, you can make me clean.’
Filled with compassion, Jesus reached out His hand and touched the man. ‘I am willing,’ he said. ‘Be clean.’ ” - Mark 1:40 – 41 (emphasis added)

How do you show love to a person with AIDS? The same way you show it to any other person: a handshake, a look in the eye, a smile, sharing the Word of God.

We look forward to touching the hearts of those with AIDS, and with your help, your prayers, your financial support, you can touch them as well.

"Behold, I will do something new..."

2009-04-26T21:49:00.004-04:00

Lorraine, our 12 year old, had her hand up in the air and was tentatively saying “I have one”. We were in a Bible study group talking about God’s answers to our prayer. She went on to say that she had asked God to help her with the stress she felt about saving enough money to go to summer camp; she said “He answered my prayers by having the camp cancelled, so now I don’t have to worry about it!” I was amazed; I knew how much she had wanted to go to camp and how hard she and Alison had worked to save up the part they needed to pay. It reminded me about how God sometimes answers prayers in ways we don’t expect, and sometimes don’t like. The verse in Isaiah 43:19 came to mind..

“Behold I will do something new, now it will spring forth, will you not be aware of it, I will even make a roadway in the wilderness, rivers in the desert”

-Isaiah 43:19

God is often doing new things in our life. Even when it seems to be all wilderness, there is a path we need to find and walk, by His grace.

Economic Meltdown and Teenage Boys

2008-12-18T15:02:00.002-05:00

Whenever I turn on the radio or TV, I hear about how bad the economy is and how it’s only going to get worse. The unemployment rate keeps growing. The value of most people’s investments is falling. Most people’s homes are worth less than they were just a year ago. The price of gas for our cars goes up and down faster than the stock market. Trying to decide when to fill up my tank makes me feel like a futures speculator. “The price has been going up for the last two days. Is it going to go up more before I go home or will it go down by morning?” Making the wrong guess can cost me ten dollars per fill-up.

The people we are going to serve in Malawi don’t have to worry about the price of gas. They don’t have cars. However, the price of gas is reflected in things they buy, like school uniforms for their children, shoes, even the little bit of food that they don’t grow themselves.

When you live on less than a dollar a day and prices go up, where do you trim your budget?

Another phenomenon is watching my son Andrew sprouting like good Indiana corn. Every morning his pants ride higher up his ankles. For his after school snack, he eats his way through half the refrigerator, and then asks, “What’s for dinner?” If you are missing a child or small pet, you know where to look.

In places where there isn’t enough food, adolescent boys must always be hungry. In Africa, rice is food for the rich. Meat is a rare treat. How does a teen ager have a growth spurt on a diet of millet and corn mush?

Times are tough in the US and the whole developed world. In Africa, where people are living on the edge of survival, as the cliff starts to crumble there is only one place to go.

Even when we feel like we have nothing to share, Jesus asks us to share anyway. I think He might say, “You really have more than you think. Plus, real giving means giving up a little of what you need so that others can have something. Please share even when times are tough, maybe even more now that times are tough. Don’t worry. I really will take care of you.” (Luke 12:22-31)

I Miss Group Prayer

2008-09-19T10:50:00.000-04:00

I’ve been in the US for three months now. Something that I miss terribly is daily group prayer. In Shell we prayed every day at the beginning of rounds, at the beginning and end of our weekly staff meeting and we had a weekly Men’s Bible Study.
Here at the secular university, we don’t do any of that. Except for a very few patients, like maybe once a week or less, I don’t get to pray with patients. I miss group prayer. Jesus says where two or three are gathered in His Name, He is there. I pray for patients, but it’s not the same as praying with them. I pray for students, residents and colleagues, but it’s not the same as praying with them. We have rounds to discuss the patients, but they don’t start with prayer. I miss beginning the right way, in the Name of Jesus, very much.
The university is treating very well. I love the work; taking young doctors at various ranges of training and helping them move to the next level is the best part of my day. I have the privilege of teaching very new doctors how to look in eyes and ears all the way to doctors about to graduate how to find a job and not get cheated on their contracts. I also see patients, which is what pays my salary. But my heart feels empty at times without the prayer.
I’m praying more with my wife, and we are in a small group at church that meets twice a week, but it’s not the same as every day prayer for our patients, for wisdom and compassion in treating our patients and their families.
I’ll just have to keep praying on my own to the Lord, and praying for more brothers and sisters in Christ to pray with.

Cultural Misunderstandings Can Happen in the US, Too

2008-07-16T15:50:00.002-04:00

After a month working with the Family Practice residents at Indiana University, I have been happy to see that they are a group from all over the world; South Asia, East Asia, Latin America and Africa. They all really like each other and are all likable people.
For these young doctors, their second or third language is English and they speak English with each other, but they also communicate well in laughter and love. I see the new residents liking each other. It’s rewarding to hear the Pakistani resident learning to say good morning in Spanish so that she can greet her classmates from Honduras and Colombia. It is even more rewarding to see the residents starting their second year really love each other and laugh at their war stories like old soldiers. They are young doctors who know how much they have to learn, are dedicated to becoming excellent doctors and are caring people. It’s really a great group.
The hardest part of the hiring process must be finding truly caring people in a one day interview. Many people can fake being a nice person for a day or two, but by judging the results, IU seems to have separated the wheat from the chaff. I saw the difficulty while interviewing residents at the University of Arizona and in Ecuador, so I appreciate how much wisdom is involved in picking this group of residents. It’s a testament to the discernment of the people involved in the process and people who refined the interview process.
Just this morning I saw that cultural misunderstandings can happen anywhere, and can be embarrassing, no matter where you are. In Ecuador and much of Latin America, it is considered highly rude to walk between two people talking. It’s easier to avoid walking between people because Ecuadorians stand closer to each other than Americans.
This morning, I was walking down the hall. Three people were talking, one of them a resident from Pakistan. Seeing a small, brown person in a conversation, I kept making little steps to try to go behind her so that I wouldn’t walk through a conversation. Apparently, in Pakistan, walking through a group that is talking is not a big deal, so she kept making small little mincing steps to allow me to go through the group, not around it. We went through this little dance for about 15 seconds, then I finally remembered that this resident, although small and dark skinned, was not from Ecuador. I needed my second cup of coffee to get my brain out of first gear.
It’s a small thing, my little embarrassment this morning. I’m not even sure the resident would remember any of it, but I remember that I am out of the culture loop after five years overseas. My children are really out of the loop, since their last time living in the USA was almost half their lives ago. I personally love learning about the little things of other cultures, except for when I make a total fool of myself. I don’t even need to be in another culture to make a fool of myself, but it’s a convenient excuse.
When you’re on the mission field, if you haven’t made a fool of yourself at least once a day, it’s because you didn’t leave the yard.
Your ego, try to leave home without it.

What I'm looking forward to in the US

2008-05-20T12:53:00.002-04:00

As much as I’ve loved my time here in Ecuador, I am looking forward to some things in the US. Here’s an incomplete list of what I’m looking forward to in the US:

Electric lights that turn on every time you flip the switch.
Toilets that flush every time you push the handle.
Not having the fear that I will go to jail for a little fender-bender. Here, everyone in or near the accident goes to jail until the judge sorts it out.
Public restrooms that are clean and have toilet paper.
Not having the fear that any time you get in a vehicle it could be your last look at Earth. (The drivers here love to pass on 2 lane bridges, blind curves, and going up hills.)
Pretzels. (There is every kind of junk food available, even Sour Cream and Onion Ruffles, but no pretzels.)
Diet Dr. Pepper (You can’t even get regular Dr. Pepper here.)
Tunnels that you can see in, because they have lights.
The power is on always.
Not having to change the propane gas tank on the hot water heater to get a warm shower.
Drinking the water.
Newspapers and books in English.
News in English on the radio.
Autumn leaves.
Seeing as many of you as possible.

See you soon.
Blessings,
Jerry

Things I'll Miss about Shell, Hospital Vozandes and Ecuador

2008-05-08T15:02:00.003-04:00

· Everything within walking distance.
· Living across the street from the hospital.
· Getting into a car maybe once a week or less.
· Little kiosks where you can interact with a human when you buy something.
· Serving the very poor.
· Shaking hands with everyone you meet.
· Saying hello to everyone every morning and again in the afternoon.
· So little car traffic that you can walk or jog in the middle of the street.
· The big crime wave: some lawn chairs stolen from a porch.
· $1 lunch, $1.30 if you go to the expensive place.
· Knowing most everyone I deal with daily.
· Praying at the start of every work day and whenever a patient has a crisis.
· NO INSURANCE FORMS
· No malpractice claims, lawyers, or threats.

Born on Third Base

2008-04-17T13:47:00.003-04:00

If life were a baseball game, I was born on third base. There's nothing wrong with being born on third base, unless I become proud and think that I got to third base through my own efforts. Honestly, anyone who is reading this was probably born on third base, also.

For those of you who don’t know baseball, think of football (soccer) as being born getting to kick a penalty kick with no goalie trying to block the shot. It’s not a guarantee you’ll make a goal, but the odds don’t get much better.

Why do I say I was born on third base? My parents could read and taught me to read. I was born in the US, where free public education is really free. In some of the countries I have visited, "free public education" means you have to pay for uniforms, buy new textbooks every year, pay special "fees" for the teacher, computers, and miscellaneous rip offs. In the US, public education is really free and quite good.

Why else was I born on third base? Despite claims of reverse discrimination against white males, white males in the US have lots of advantages. Some people are not fond of the US at this point in time, but having a US passport gives lots of advantages throughout the world. When I go to get my Driver's License here, I don't have to pay a bribe like my national friends. Why no bribe? I have a blue passport form the USA.

I could easily have born to a family in the jungle, where my parents could not read and there are no schools, where a man has to kill or be killed, where girls are married off after their first menstrual period. (I really have delivered a baby from a 12-year-old girl from the jungle.) I could have learned a language that is only spoken in a handful of villages and precludes me from getting a job in the money economy. Those are people are born at bat standing at home plate.

For those of you following the football (soccer) analogy, jungle folk were born at the far end of the field, all by themselves, with all eleven players from the other team trying to stop them from scoring a goal. It’s not definite that they won’t make it, but it’s not likely.

I have a friend who was born in Africa to Indian parents. However, both his parents were teachers, taught him to read, instilled in him a love of education and passed on their intelligence genes as well. He didn’t have his mental development destroyed by malaria, malnutrition or military actions. My Indian/African friend was born on second base. (For you soccer fans, that’s a little outside the penalty area.)

So now that we all realize that we were born with multiple privileges… (What? You’re still not convinced?) You have access to a computer. You learned to read from your parents. You aren’t in prison or trying to survive from day to day like the folks in Zimbabwe or the rest of Africa. You can see so that you can read. You have hands that can manipulate a computer mouse. Yes, you have made the most of the opportunities God blessed you with, but you didn’t earn those blessings.

We’ll try again. Now that we all agree that we have blessings we didn’t earn, what do with do with that knowledge? I can’t tell you what God wants you to do with the gifts He has given you, but I can make a couple of suggestions:

Share. You can share the money you make from what you do with your gifts or you can take the gifts on the road to share them with people who don’t have ready access to those gifts.
Thank God for the gifts. If you didn’t earn gifts, you can thank the Giver daily for them.
Avoid pride. If you could just as easily have been born to live you days barefoot in the jungle, don’t feel so smug. Really believe the phrase, “there but for the grace of God go I.”
Share regularly. If you have money in the bank, or even loose change in your pocket, you are richer than 80% of the people in the world, so share some of that blessing every pay day. Kind of like a tithe. I know we live under the New Covenant, but tithing is one of the best ideas the Old Testament has to offer. God doesn’t need your money, but you need to give it to Him.

So now that we are all on third base, let’s get home well. Now that we are kicking to an open goal, let’s score. God is on His feet, in the stands cheering for us.

Blessings,

Jerry

What I Will Miss about Shell

2008-04-03T23:24:00.001-04:00

You can walk on the street anytime before midnight and feel safe.

The kids can walk to their friends’ houses safely.

After 50 years of missionary presence, there is a lot of kindness and care in Shell.

The hospital really makes a difference. People come from very far because we treat them well and give good medical care.

I have patients who are good friends.

The weather is great.

The fruits and juices are wonderful.

Beautiful birds.

I can pray openly with patients.

We start every day with group prayer.

The medical students and residents are eager to learn.

The missionaries.

Getting a front row seat to see God’s miracles.

No TV, no X-boxes, and no weapons in neighbors’ houses.

The children’s friends’ parents share our values and standards.

We will miss Shell a lot.

Blessings,
Jerry

Big Urine, Little Urine

2008-03-07T13:45:00.003-05:00

Ecuador

, especially among indigenous people, big urine is stool, and little urine (la orina chiquita, la orina pequeña) is urine. When people complain of problems urinating, the doctor has to be sure to specify which one.

Humorous story to remember this by: One doctor had an elderly gentleman who came in repeatedly saying, “I can’t urinate.”

The doctor gave him Hytrin, a medicine to help men with prostate trouble pee. He still couldn’t go. Finally, the doctor took him to the Emergency Room to put a Foley catheter in him. He starts to scream, “NO! I just can’t pee!”

The doctor remembered big urine vs. little urine and asked how many days since the gentleman pooped. It had been about 4 days. Milk of Magnesia cured him when a Foley catheter put into his bladder couldn’t.

A Grizzly Day by Mike Hardin, MD

2008-01-27T11:19:00.001-05:00

Do you ever wonder if all your life’s training was to prepare you for one moment? In retrospect, Saturday, January 19, 2008 seems like that day.

The setting is our 30-bed mission hospital with a two and a half bed E.R., running on generator power since the electricity was out to our section of the country, with one doctor, one resident, one intern and two nurses on duty on a Saturday morning. At 10:15 AM a bus crashes and overturns on the road winding down from the Andes towards the Amazon, about a 25-minute drive from the hospital.

Six are dead on the scene. Bystanders begin loading other victims into pickup trucks, cars and eventually ambulances to be transported down the road to our hospital or up the road to others.

As soon as we realized the number of wounded arriving (eventually 23), we enacted the finely tuned hospital disaster plan: call everyone related to the hospital and then some and ask them to come help. The hospital ambulance trolled through town to find employees and bring them in.

Broken and bloody body after body came through the door and were placed on stretchers or benches in the hallway. It resembled a scene from a war movie. The amount of blood and gravity of the injuries were overwhelming. We made quick triage decisions as we decided one victim was too far gone to save – we stopped resuscitation and pushed the body to the end of the hallway to free up space for others that could be saved. The number of critical patients quickly outnumbered our medical personnel.

Four with severe head injuries were intubated and placed on our three ventilators. Short one ventilator, a patient’s mother-in-law was quickly briefed on how to keep her son-in-law alive by squeezing the ambu bag and ventilating him while we moved on to other patients. She kept it up for two hours before he was transferred.

Victims were labeled with tags with numbers and brief exam findings. Only later were people identified. Some of the injured had to identify their severely wounded or dead relatives for us.

One scene still plays in my head. A 21-year old Korean American girl wandering through the E.R. door with the entire right side of her face from her nose to her ear hanging off, exposing her skull, the skin held up by her right hand. A missionary took her off for treatment.

Everyone came to help. All of the missionary doctors, various spouses -- even the kitchen, janitorial, maintenance and administrative staff of the hospital were all enlisted in some way. Our administrator’s wife found herself shaving and prepping victims’ heads for suturing. Missionaries and staff donated blood that was immediately transfused into patients -- the closest blood bank was unable to process blood due to the power outage.

A call for help to the nearest hospital brought another five Ecuadorian doctors, among them a much needed orthopedist and general surgeon plus two radiology techs to help with the numerous x-rays.

In all, two patients died, six critical head injury patients were transferred for CT evaluation, several underwent major surgery for internal bleeding or extensive suturing and the remainder had lacerations sutured and fractures splinted or casted.

There were numerous heart-wrenching stories. An injured mother with a one-month old baby identifying her dead husband, her four nephews and nieces severely injured as well, their own mother later found dead at another hospital 45 minutes away. Another mother with her severely injured five-year old son at our hospital, her daughter in another hospital and her husband in even another one two hours away undergoing neurosurgery to remove blood clots from his brain. The American girl, severely disfigured, far from home and alone, in such shock she could only worry about her missing backpack that contained all her research data for her graduate thesis.

And there were bright spots. The incredible spirit of teamwork in a gruesome situation, the accidental transfer of anonymous patients (who ended up being related) to the same hospital, gravely injured patients whose lives were saved. I’m proud of a dedicated staff that freely gave their all to help in a horrendous situation.

The following day we airlifted seven more patients (paid for by the local ministry of health, a miracle in itself) to other hospitals for further treatment and discharged the least of the wounded, an 80-year old woman with a small cut on her forehead.

Missionaries contacted the relatives of the American girl, notified the U.S. Embassy, made lodging and transportation arrangements for the family, arranged for her transfer to a Quito hospital and welcomed her there with hospital visits by English-speakers. Another very determined missionary traveled to two separate towns, three different police stations and the regional transportation office in search of the backpack. She even searched the wreckage of the entire bus and found nothing. Eventually, in a locked storeroom in a ministry of transportation office in a town two hours away she found the backpack, still sealed with all the girl’s research data, cash, credit cards and passport. It arrived in Quito today.

I’m not sure how to end except to ask for your prayers for the numerous victims and their grieving families and for a shocked hospital staff that experienced a lot more than they ever bargained for.

Is This the Quiet Week We’ve All Been Hoping For?

2007-11-18T19:36:00.000-05:00

We have four patients in the hospital. Yesterday we had seven, but two went home and one was transferred to Hospital Vozandes Quito because he had a heart attack that wouldn’t slow down.

Why are things slow here in Shell? There’s a strike. Strikes in Ecuador don’t just have people with signs walking in a circle, that doesn’t get the attention of the authorities. A strike in Ecuador is not a strike without roadblocks and burning tires. The strikers have found out that the police can pull apart a roadblock of burning tires lined up across the road with long metal poles, so now they use dump truck loads of dirt on the road so no one can pass until they decide to end the strike. Burning tires make great TV shots and blocking the roads brings capitalism to the aid of the strikers. The truckers and bus companies want to travel and make money, so they pressure the authorities to give in to the strikers' demands.

The semi-good thing about a strike for a day or two is that hardly anyone can come to the clinic, which means we don’t operate, which doesn’t affect me, but we also have very few patients in the clinic, which gives me time to catch up on my journal, emails and other important communication.

The bad thing about strikes is that travel gets bogged down. Our ophthalmologist, eye doctor, got stuck about 10 miles away. They let ambulances through, so our ambulance went to get him from the far side of the barricade. He called us to ask the ambulance driver to come get him. Thank goodness for cell phones.

Another bad thing is that the medical student who took the patient having the heart attack to Quito got stuck about 2 am ten miles away from the hospital. She tried to sleep on the gurney in the back of the ambulance, but when the ambulance driver lay down on a bench and started to snore loudly, she didn’t sleep anymore that night. She ended up walking with some patients in the rain, coming from 4 hours away to our fair hospital about 5 am. She is about 22. They are about 70, but because they walk everywhere out in the rural areas, and they have worked at manual labor all their lives, they walked her into the ground and the old folks had to slow down so that the young college student could keep up.

The worst thing is that the patients who need to come to the doctor can’t get here. The ophthalmologist is only here one week per month. Most of the patients who received operations last month can’t get in for their follow ups appointments, and patients who need to come to the clinic can’t get around the barricades. For me, the worst thing is there’s no bread and no Diet Coke in the stores. We missionaries really suffer. (Just kidding.)

Tomorrow, if the strike ends, we will be extra busy. If the strike drags on, patients who early need care won’t get it, and that could be tragic. For now, it’s just a relaxing slow day after a few weeks of horror.

Something about me

2007-10-28T15:59:00.000-04:00

Elizabeth tells her story

I grew up in a nominally Catholic home. I also grew up as an expatriate in South America, my father was a businessman, and in my youth I met a number of children of missionaries. I first heard the gospel in an understandable way from missionaries when I was fifteen years old. When I went to college in the US, God brought me to a church where I could learn and grow in my faith.

In college I decided to study nursing specifically so I could do mission work anywhere in the world. A few years out of college I joined a church planting team to start a Hispanic church in Miami, Florida. I began graduate school to become a Nurse Midwife, when I met Jerry at the University of Miami. We married and moved to Tampa for him to start medical school. During the following years I entered a time of serious questioning and exploration of my faith, and at the same time we began having our children. I thank God for this time, as it helped sharpen and mature me, and prepare me for service.

We moved to Tucson AZ in 1996, so Jerry could work at a community health center and help pay back the student loans he owed. We became involved in leading a marriage ministry (and worked on our own marriage as well!). By 2002 all our student debt was paid. We applied to HCJB World Radio after exploring other medical mission’s options at the Yearly Global Medical Missions conference in Kentucky. I remember seeing the tremendous medical need in Africa, yet feeling that we fit better with South America. As I was struggling with that idea, I spoke with a representative of HCJB World Radio Inc. who told me of a great place to work for in Ecuador, but that they were opening doors to Africa, and looking at options in Malawi! I thought, “What a perfect fit, we could get our missionary feet wet in ‘comfortable’ South America, and yet Africa could be in our future some day!”

We have been in Ecuador for four wonderful years. I’ve worked part time in the hospital, begun a health education and community outreach program and started and a pre and post test counseling program for our HIV. I also lead an evangelical Bible study for Ecuadorian women who have had little or no background in the Bible. We have loved living and serving our awesome God here, and don’t feel our time for serving in missions is anywhere near up. Perhaps, If God allows we can continue to serve Him with the needs He puts before us in Malawi.

“My Father is glorified by this, that you bear much fruit…” John 15:8

Elizabeth Koleski

That Time of Year

2007-09-23T22:34:00.000-04:00

Well, it's that time of year again.

The first day of fall? No

The baseball pennant races? No

The start of football season? No

The kids are back in school? No

Well, what time of year is it? It's the flying of the ants! Duh!

The flying of the ants is the one or two days each year when the ants fly. They can be found under any street or porch light the following morning.

Last Thursday the Indians who live near our house were out collecting them before school. They had big garbage bags full of them. Elizabeth asked for a few.

You see our employee Martha preparing them. You take off the wings and the head and cook them. Around here we call them "Jungle Bacon Bits." They have a touch of a lemon taste, plus a bit of a Baco-s taste.

So, next time you see ants on the move, keep in mind that you too can have a high protein, low carb topping for your salad, or give the kids a nutritious after-school snack!
I'm sure they'll be available at Trader Joe's soon.

Yes, We Are Trying to Change Their Culture

2007-09-21T21:37:00.001-04:00

At times, people will accuse missionaries of trying to "change the culture." I'm involved in a case now that involves a part of indigenous culture that really needs to be changed.

A month ago, I delivered a baby that almost died during labor. Those types of tragedies happen on occasion, and they are horrible. What makes this situation even more tragic is that the mother is only twelve. (Yes, 12.) She got pregnant when she was eleven.

She told our female chaplain that the 22-year-old man who is the father of the baby gave presents to her parents and her uncles. To show their appreciation for his gifts, her father gave her to him. She then had to live with him. He forced himself on her often and beat her the rest of the time.

The mother of this little girl said she didn't like the situation, but "That's how life is." As a woman, she has no say over what happens to her daughter. The girl, and the mother are the sole property of the father. The "husband" now is the owner of the little girl.

Where does this idea come from that a twelve-year-old girl is ready for marriage and motherhood come from?

The culture states that after a girl's first menstrual period, she is ready to be married and start producing children for her "owner". (Yes, the indigenous people use that word themselves.)

Well, can't the Child Protective Services do something?

Ecuador has very little money to protect anyone, let alone children. There is no justice in the jungle other than "jungle justice". Since the people of the community all agree that a twelve year old girl is marriage material and the property of her father, to trade for stuff like a cow or a chicken, there will be no protection for this little girl.

Well can't you do something?

If the girl wants to run away, leave everyone she has ever known and everything she has ever known, we can help her get to an orphanage in the capital. That means we take a child from the jungle from a community of 150 people maximum and move her to a city of 1.2 million people, where people will take care of her, but her friends, her family and her brain damaged child will never see her again.

I pray that the Holy Spirit will prevail on the people to change their attitudes and their society to treat all people with human dignity and human rights.

Do I want to change the culture of the untouched people? In this case,
YES, I WANT TO CHANGE THE CULTURE!

A culture that treats human beings, and especially children, as property is WRONG. I defy anyone to make a case that this aspect of the "untouched" culture is something that missionaries should not address.

Six-Year-Old Update

2007-08-12T23:20:00.000-04:00

David Santi went home a couple of days ago. He is the six-year-old who kept thwarting our efforts to change his bandages. He wore donated clothes as he left because he came to the hospital without a stitch on.

As you can see in the photo, he went home with quite a haul of goodies. He has two cars, each about 4 to 5 inches long, plus a coloring book. Not bad for a naked little boy from the jungle The last few days he was in the hospital, David made himself quite at home. He would sit with the nurses at the nurses' station. He always had candy or gum. He went from a frightened boy in pain to a little pistol.

David's home life is sad. He is an orphan, and his twelve-year-old sister takes care of him and his younger siblings. We can't change everything here, but we can do what we do very well and with great love.

We already miss David.

Blessings,
Jerry and Elizabeth Koleski

Outwitted by a Six-Year-Old

2007-08-03T18:44:00.001-04:00

We have been trying to change little David Santi’s bandages for the last two days. David burned himself by spilling hot soup on his back four days ago. Because David is only six and in our hospital all alone from the jungle, we don’t expect him to grin and bear it when we change the bandages, we do it under anesthesia.

There is only one drawback to anesthesia; you can’t eat for a few hours before you get it. That is where one little six-year-old from the jungle has defeated six doctors from the big city. Yesterday the resident wrote the order “Do not feed until after lunch.” The nurses thought that David was to get lunch, then nothing else. David, being a hungry little boy in a strange place, ate what the grown ups gave him. He was finishing lunch just as they were going to take him to the Operating Room to change his bandages. The dressing change had to be put off, because if David vomits from the anesthesia, he could inhale the vomit and give himself a nasty pneumonia.

Today, everyone was told that David was not to eat breakfast, so that the bandages could be changed. Everyone was with the plan, except David. As they were about to take the little guy to the Operating Room, he was finishing the apple he had begged from the nice man across the hall. The doctor asked, “Why did you eat an apple? You weren’t supposed to eat anything.” With brilliant six-year-old logic, David replied, “Nobody gave me any breakfast and I was hungry, so I asked the man for some food and he gave me an apple.”

David will be fine. The burns aren’t very deep and cover less than 10% of his body. He would be fine faster if we could change his bandages and clean his burns more often, but he will be fine anyway. He’s really cute, so when he does what he wants, which is the exact opposite of what we want, it’s impossible to be angry with him. Still, getting outwitted by a six-year-old is embarrassing and frustrating.

Blessings,
Jerry

Each Heart Knows It's Own Bitterness

2007-07-26T23:38:00.001-04:00

What do you do when there are three patients who need a ventilator, and your little hospital in the jungle only has two ventilators? You pray, you put the intern and resident to work ventilating by hand the patient most likely to die, and in a sad way, you hope that the sickest one passes to his final destination before the poor intern and resident stay up all night trying to keep alive a man who lost his pancreas.

What happened to his pancreas? It died. It was dead and black, except for the areas that were filled with abscesses. He survived about a month with a dying pancreas, but he passed away tonight. We went way beyond the call. He came in near death. We saw that he had air in the parts of his abdomen that should not have had air. He was taken to the operating room with the understanding might die during the surgery, but the surgery represented his only hope, as slim as his hope was. When the surgeon found that there was dead tissue and pus where his pancreas should have been, he closed the man's abdomen and took him back to his room.

As soon as the man returned to his hospital room after the "open and close" surgery, his heart stopped. After three minutes of work and medicines, his heart started again. The resident and intern did the work of a breathing machine for about 30 minutes until he started breathing again, but 2 hours later, his heart stopped and did not start again. His wife did nothing for about five minutes, then she started to cry and cry and cry without ceasing.

King Solomon wrote in the book of Proverbs:
Each heart knows its own bitterness,
and no one else can share its joy. (Proverb 14:10)

The husband and wife and their two sons had many moments of joy in their lives together, and everyone's life ends in sadness for those left behind. Tonight the couple's life together ended. She and the boys will know bitterness for a while, and loss forever, but they will have many moments of joy in the future.

After seeing a number of deaths here on the edge of the jungle, I think that we should work at making more joyful moments and work at remembering them more. Bitterness comes pretty easily; joy takes some work.

Malawi, Here We Come

2007-07-07T22:41:00.001-04:00

Our son Andrew will finish eighth grade in June 2008. After that date, we will need to look for other ways to educate our children.

We took a trip to Malawi in April. We liked it a lot. We prayed and were convinced that God wants us to go to Malawi. There is a clinic there called Partners in Hope founded by Dr. Perry Jansen. The needs are huge, but God is alive there.

The life expectancy at birth in Malawi is 37 years. 1 in 4 children die by age 5. 15% of adults and 30% of the population is HIV positive. One half of a million children have lost one or both parents to AIDS. There are 2 doctors per 100,000 Malawians. That is 1% of the rate in the United States. There is a joke, that is half funny and half true that there are more Malawian doctors in England than is Malawi.

We pray we will make a difference.

Blessings,
Jerry for the Koleski family

Standing on the Shoulders of Giants

2007-06-17T18:57:00.000-04:00

Hospital Vozandes del Oriente has been here in Shell for 49 years. We do some great work with very little, and have a great reputation. We have patients who come 11 hours to see us. People seem partly to trust us because we are gringos, but mostly because we are Christians. We don't recommend surgery because we want the money but because we think it is best for the patient.

We are reaping the good reputation built up over years by great doctors who came here when there was nothing here. Everett Fuller was the first doctor here, even before the hospital existed. He was a surgeon. His wife Dorothy was a nurse. Dr. Fuller had a operating room and a clinic. Before he had completed the hospital, all the patients that needed to be hospitalized were placed on the first floor of a small hotel down the road. After surgery, the patient would be wheeled down the road on a gurney. One of the people pushing the gurney would hold an umbrella over the patients face to shield them from the sun or the rain. It's either sunny or rainy here in Shell.

Dorothy Fuller was Everett's scrub nurse in the Operating Room. In most hospitals, the custodians or the nurses are responsible for cleaning the Operating Room, but not in the early days of Hospital Vozandes del Oriente. Dr. Fuller loves telling the story that when his wife was his "assistant" and he had a particularly bloody surgery, Mrs. Fuller would hand Dr. Fuller a mop and say, "You put the blood on the floor. You need to clean it up!" Dr. Fuller is sure that he is the only surgeon who ever had to mop his own Operating Room floor.

We are living the words of Jesus from the Gospel of John, "Thus the saying 'One sows and another reaps' is true. I sent you to reap what you have not worked for. Others have done the hard work, and you have reaped the benefits of their labor." (John 4:37 & 38)

Jerry

Mud Slide Slim

2007-05-26T19:33:00.000-04:00

Since children in the jungle don't get to go sledding on snow, they still can slide down hills. Here, they go mud sliding.

The day started with the kids trying to slide on a large sheet of plastic wet down with spay water. They quickly discovered that the plastic wanted to slide down the hill with them. Since the first try was not fun enough, fast enough or dirty enough for the kids, the kids decided just to slide on the mud. It made a huge mess, grinding mud into their clothes. After they were done, they turned the bathroom into a new mud pit.

The great thing about kids is that they will make their own fun, and are usually more creative than the adults around them.

Blessings,
Jerry and Elizabeth

Premature Baby - It's Good to be Wrong Sometimes

2007-05-23T22:18:00.000-04:00

It's good to be wrong sometimes. I thought the premature baby admitted two weeks ago was going to die. Shows how much I know. The baby at first lost weight and needed antibiotics, but now she is growing and getting ready to leave the hospital in the next few days.

Her birth weight and her Bilirubin, the chemical that makes people with Hepatitis look yellow, were horrible. She was born at 32 weeks. We have had babies 33 weeks of age die here. This tiny girl doesn't think much of numbers and statistics, she just keeps on growing and eating. When she was born, she weighed 1900 grams (4 lb 3 oz). During her first week of life, she dropped all the way to 1580 grams (3 lb 7 oz). Now she's almost back to her birth weight. She never developed any of the problems most premies develop, like pneumonia or other infections. She never ended up on a ventilator. I'm amazed.

If she can keep gaining weight and clear up her jaundice, she might get to go home to the jungle in a few days. That would be a great surprise and a time when I'll be very happy I was wrong.

Blessings,
Jerry

Premature Baby

2007-05-14T13:37:00.000-04:00

Friday night we admitted a baby from the jungle. She was born at 7 months, 2 months early. She was the color purple, like a nasty bruise, from the waist down. Her skin was almost glassy smooth, not normal for a full 9 month baby. She weighed a little over 4 pounds.

It is a horrible situation. Her odds of survival here are really poor. Even in Quito, her odds of survival are really poor. Mom is 16 and Dad is 20. How do you explain to two children that their first child will probably die? We told them we will do everything we can, which we will, but that the odds of her leaving the hospital alive are less than 10%. Mom cried.

It's a scene we work through often. A baby with no prenatal care is born early. We work our tails off, they looks good for about 3 to 5 days, then they start spiraling down and die in a couple of days later. The whole process usually takes a week.

I find it heart breaking. One of my first questions to God, at least from this side of Heaven, would be, "Why do innocent little babies suffer and die?" I don't know the answer. I don't have any clue.

Someone smarter than me said it is because people are sinners and the wages of sin is death. He assured me that the baby didn't sin, but that because she is human, and humans sin, she suffers unfairly. It is like the students at Virginia Tech who never hurt the crazy kid who shot them, they were just the caught in the crossfire of his sin or mental illness. This baby is an innocent victim of the crossfire of human sin.

So today the little baby from the jungle with a child for a mother is OK. If she survives even a month it will be a miracle, but we have to work as if the miracle is coming, but not get our hopes up too high, so that when the worst happens, we aren't too broken hearted. The thing is, no matter how pessimistic I am, it still kills me when these babies die.

Children dying is the part of missionary medicine that I absolutely hate.

God be with you,
Jerry and Elizabeth
Koleski

Clemencia Puwanchin

2007-05-11T22:46:00.000-04:00

Clemencia Puwanchin left the hospital today. She was a 32 year old woman I met on a malaria caravan to the jungle over two months ago. She had been sick for one year and four months; bed bound for the last eight months. She was totally blind - she could see light and dark, but not shapes or human forms in front of the light.

We brought her in with the team that went to the jungle. she had to be helped to walk to the airstrip in the middle of town. Her belly was huge, like a woman pregnant for a year and a half might look. Her community had given her up for dead, but not her husband.

We had no idea what was wrong with Clemencia until we got her to the hospital in Shell. It turned out she had diabetes. For the lack of $1 per day in medicine, she lost her sight and almost died.

We treated Clemencia's diabetes, and she started gaining weight and getting energy, but she still was blind. Our ophthalmologist came from Quito, and he operated on one cataract, and a two days later, she could see. We had to keep Clemencia and her husband at our hospital for two more weeks because her diabetes put her at risk fo infection to the eye, which would have cost her newly gained sight.

Clemencia and Jose went home for two weeks, so she could see the faces of her children, which she hadn't seen in over a year. She just came back, had surgery on her other eye, and now she has the binocular vision we almost all take for granted. She has gained weight, is doing the things she used to do, and is about the happiest patient I have seen for years.

In the Bible, the book of John, chapter 9, God tells a great story:
1As he [Jesus] went along, he saw a man blind from birth. 2His disciples asked him, "Rabbi, who sinned, this man or his parents, that he was born blind?"

3"Neither this man nor his parents sinned," said Jesus, "but this happened so that the work of God might be displayed in his life. ..."

6Having said this, he spit on the ground, made some mud with the saliva, and put it on the man's eyes. 7"Go," he told him, "wash in the Pool of Siloam". So the man went and washed, and came home seeing.

The miracle that Jesus did more than any other in the Bible was to give eyesight to the blind. It's a metaphor for how we are blind to the things that really matter in life, like God, as we chase the brass rings of physical beauty, new cars, new clothes, and all the other idols we think we can't live without. Clemencia saw all that the modern world has to offer; TV, SUVs and the latest fashions, but none of that compared to seeing her own children's faces.

It's really a privilege to have a bit role in a miracle. Here in Shell we get that privilege often. Have you thought how great it is to have two eyes? Have you thanked God for that gift? We thank God for you.

Blessings,
Jerry