New Partners in Hope Videos

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

The Patient Died Before I Got to See Him

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

Mudzalephera

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

Economic Meltdown and Teenage Boys

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)

Cultural Misunderstandings Can Happen in the US, Too

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.

Born on Third Base

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

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

In 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.

Six-Year-Old Update

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

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

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

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

Premature Baby - It's Good to be Wrong Sometimes

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

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