How can I keep from singing?

My apologies for my long delay in writing for my blog. I could easily write about the many activities that have filled the last few months, and I might eventually, but I instead want to reflect on some of the stories from the past few months.

 

At a laity retreat recently, I sat down at the back of the tent knowing that I would need to leave shortly for a night call shift. I came with the desire to support the community, not necessarily expecting much before I had to leave. As the tent started to fill up, a group of young men filled up the row in front of me. Within the highlands of Papua New Guinea there is a crisis currently among the young men. So many are being led into harmful addictions to drugs and alcohol by slightly older role models. For the many who are unable to finish school (for many different reasons including family instability, lack of school fees, not passing entrance examinations, etc), there is very little to look forward to in the future. There is a generation of young men with little hope, full of anger and disillusionment. My heart has often broken for this group. However, as the music began for the retreat, the group of young men in front of me began to sing, and not just to sing, but to worship with fervor and life. I found myself weeping, unable to sing, moved by the faithfulness of these young men. They had found life in the midst of the darkness.

 

 

My life flows on in endless song;

Above earth’s lamentation,

I hear the sweet, though far-off hymn

That hails a new creation

Through all the tumult and the strife,

I hear that music ringing

It finds an echo in my soul

How can I keep from singing?

 

I held her shoulder as she softly broke into tears, her hand stretching towards but not reaching her dead baby. He had come early and struggled to breathe right from the beginning. We had tried all that we were able, antibiotics, oxygen, IV sugar solution and medication to try to help him keep breathing. When he had stopped breathing, the nurses called me and we had tried CPR, to no avail. My words failed as I squeezed her shoulder, trying to convey my sorrow and support. I learned from the nurses that she had lost her last child as well. I mourned with her at the side of the warmer.

 

 

What though my joys and comforts die?

I know my Savior liveth

What though the darkness gather round?

Songs in the night he giveth

No storm can shake my inmost calm

While to that refuge clinging

Since Christ is Lord of heaven and earth

How can I keep from singing?

 

A few days later in that same nursery, I congratulated a young mother on the growth of her baby. The baby had been in the nursery a while but was finally big enough to go outside and sleep with her. The young mother next to her reached over a gave her a fist bump, a recognition of her hard work and the solidarity of the mothers working side by side to help their little ones. My heart lifted at the encouragement from this impromptu community.

 

 

I lift my eyes, the cloud grows thin

I see the blue above it

And day by day this pathway smooths,

Since fist I learned to love it,

The peace of Christ makes fresh my heart

A fountain ever springing

For all things are mine since I am his

How can I keep from singing?

 

 

Through hard times, God has continued to be present. Through an immense workload, He has continued to provide just enough energy and strength. Through others, He has provided encouragement at the right times. How can I keep from singing?

New Life

 

He is Risen! This week as I have been reflecting on the new life and hope found in the resurrection of our Lord, I have been thankful for the ways that I have seen God move and work here.

 

 

One day in clinic, Dr Angeline, one of my PNG colleagues, asked me to come see a little boy in her clinic. As I walked into the room, I was amazed at the transformation of the figure I saw before me. A month and a half before, Jacob (name changed) had some into the hospital with complete paralysis of the right side of his body. He suffered from a double-outlet right ventricle, a congenital heart defect that caused him to be chronically short of oxygen. We weren’t sure if he had developed a clot in his poorly functioning heart that had then broken off and gone to his brain or if he had some type of infection in his brain causing the symptoms. Without neuroimaging it was impossible to confirm the diagnosis, but we started him on TB medications and strong antibiotics and prayed for his recovery. I took care of him for a couple of weeks and saw some marginal improvements before I was moved to another ward. Now, he was greeting me with an almost straight smile and a firm handshake. He had walked into clinic by himself. I smiled and laughed with him and his mom and we prayed again, thanking God for the healing.

 

 

 

When Dr Susan, our only Pediatrican at the time, left, I was handed the work she had been doing with our congenital heart disease children. Although I was trained to take care of children, I am certainly not a Pediatric Cardiologist. But over time I have slowly improved my ability to identify and diagnose some of these children. With the help of a visiting team of Pediatric Cardiologists from the US we have been able to do better screenings and identify some children for treatment. Last year I helped to arranged transportation for 9 children to go for screenings in Port Moresby and 2 received procedures, one to help open up a stenotic valve and one to close a small hole. Last month I put in a lot of extra work to help one patient get all the paperwork needed to fly to the Mayo Clinic in Rochester, Minnesota where he was able to have open heart surgery (for Ebstein anomaly). He is continuing to recover in the US from his surgery before he will return to PNG. This is truly life changing for him and his family.

 

 

A few months ago, a young man came into my clinic room looking miserable and tired. He had clearly been sick for quite some time. He related that he had gotten medications repeatedly at different hospitals but continued to get worse. He had large skin lesions on his face and swelling of his left leg. In consultation with a colleague, I ordered a test I almost never check, a skin slide looking for Mycobacterium leprae, the bacteria that causes leprosy. His slide showed the presence of some of these bacteria, and he was able to start treatment for this curable disease.

 

 

 

 

A few updates outside of the hospital. I help serve on the Spiritual Life Team here on station. Easter morning we put on a Sunrise Service for our missionaries, a time of reflection on Jesus’ work on the cross. Our men’s bible study continues to meet at my house and has been a great encouragement and support to me and many of the other guys. 

 

 

Stella is doing well and has been enjoying our newfound activity of hiking on the weekends. We have to go early before it gets too hot.

 

Dr Ben, our current Director of Medical Services, is leaving for home assignment. I will be taking over his role while he is back in the US. Please be praying for me with the new responsibilities.

 

 

The Father's Love

 

The overwhelming wave of realization slowly crested and came crashing down on the young man. He slowly folded inward as his strength to hold up a strong front crumbled. But then he turned into the embrace of his father who was kneeling next to the bench he sat on. The new diagnosis of HIV had shattered him, three months into his new marriage, both with what it meant for his future and the shame he felt. Like two figures carved form the same block of wood, the young man turned into his father’s chest, tears flowing down his old blue jacket. His father stared out, like the mother from Dorothea Lange’s famous photo. I sat for a few minutes, a stranger on the outside of this intimate scene.

 

 

She was carried into the ER in his strong arms, the blood flowing down his bare arms. She had been hit by a car and it was apparent that she was not going to be with us much longer. Blood streamed from her ears, nose, and mouth. We started to try to stabilize her, protecting her airway and obtaining intravenous access, but we knew that there was nothing we could do to halt the process that had begun. Her father, sensing what was happening, anxiously followed each breath. As they began to slow, he cried out again and again, “Lewa, no can lusim mi,” “My heart, don’t leave me.”

 

In the love of these two earthly fathers, I glimpsed the smallest picture of what our Father’s love is like for us. These two fathers would have done anything for their children, gladly taken their place. In Isaiah 49:15-17a, God is speaking to Zion, answering their complaints of feeling forgotten: “Can a mother forget the baby at her breast and have no compassion on the child she has borne? Though she may forget, I will not forget you! See, I have engraved you on the palms of my hands…”

 

 

As we enter this season of Lent, I pray that you would know and feel the love of the Father for you. Even in the midst of darkness and suffering, He is with us.

Approaching Advent in the Dark

 

My grandmother on my mother’s side was a true southern lady. She had a certain sense of propriety about the way things were done. She could cook mean collard greens and black-eyed peas. But she also had a saucy side and a bag full of sayings that she would love to pull out, “Y’all eat like birds. Next time I’m making birdseed!” Towards the end of her life when she would have to visit the doctor, she would put on her nicest clothes and make sure that her hair had been done at the hairdresser.

 

The old lady sitting in my office had a smile missing several teeth and the pearl necklace around her neck was obviously fake, however it was clear that she had put on her best clothes for the visit. She didn’t speak Pidgin, but her eyes lit up when I said hello with the “Kawi” of her local Tok Place. She wrapped me in a tight, encompassing hug taking me back to the ones my grandmother used to give and a feeling I didn’t know that I had missed.

 

She had been feeling some abdominal pain for a few months and had blood in her stool, something that was becoming increasingly harder to do. Her daughter had brought her in out of concern, a concern that had developed not through the patient’s complaints about her symptoms but out of the daughter’s careful observation of her mother.

 

As we moved into the ultrasound room and the picture of her illness began to become clear, I began to seek a way to break the news to them. Tears brimmed my eyes as I saw understanding alight in the daughter’s eyes. But as the heaviness settled in the room, it didn’t seem to touch the patient. Even as her daughter explained the cancer that had grown in her pelvis, she reached out to me and her. She was at peace.

 

 

Rita comes every Wednesday to clean my house and help me with some of the housework that gets neglected while I am at the hospital. I hadn’t seen her for several weeks because of vacation and a difficulty that had come up in her family. She and her husband had faithfully cared for his mother over the last few months as she navigated one after another health crises. When she passed away the rest of the family became very angry, threatening Rita and her husband with violence and destroying her pineapple garden, the product of lots of time and money and the main source of income to help cover expenses like school fees for the children.

As Rita was telling me the story over our weekly Maggi noodles, I felt myself fuming inside desiring justice to be done. I couldn’t believe that people would act that way and felt my anger ignite. But then Rita stunned me with a simple sentence, “Mi lusim rong bilong ol” or literally I lost their wrongs. She had forgiven those family members who had so unjustly hurt her. And I felt immediately humbled at this lesson in forgiveness and love. Rita showed me what Christ-like forgiveness looked like that day.

 

 

Looking through the NY Times pictures from the year, I was struck by the incredible violence and pain across the world. I saw a picture of a number of premature infants being prepared to transfer from a hospital in Gaza to Egypt, and the advent phrase, ‘there was no room for them’ played through my mind.

 

As we prepare for Christmas this year, in the midst of the brokenness of sin and hate, may the light of Jesus, his redeeming blood and forgiving love, move us to help those around us, to be lights of peace and forgiveness to our needy world. As he came in vulnerability and weakness to us, may we find the strength to choose the way of surrender, the way of our Savior.

 

A Long Expected Blog

The last few months have run past me with only brief moments for me to catch my breath. I apologize for the long gap since my last blog. I do frequently think of my friends and family in the US and am so thankful for the support that you provide.

 

The longer I go between blogs the more daunting the task feels to try to write a new one. I will give a few highlights from the last several months and hopefully in a couple weeks I will be able to reflect in more detail.

 

Shortly after my last blog, our missionary doctor team met to make schedule changes to try to decrease our burnout rates. It was a powerful time of vulnerability and sharing. Our new schedule is an attempt to allow everyone to fully use their gifts while having space for rest and other God-given responsibilities. In this time of life, I have been blessed with greater freedom and time, and so I am now trying to help support my teammates with families and children. I also picked up the new responsibility of Medical Education Coordinator. In this role I serve as a supervisor to all of the residents and students that come to work with us at Kudjip. I have enjoyed getting to work more closely with these students. I have also enjoyed reorganizing our Friday lecture times as doctors to provide time for spiritual development in addition to increasing our medical knowledge. In this process we also get to model to our trainees what it looks like to be doctors who love and follow Jesus.

 

Top: Spencer and I on PNG Independence Day. Bottom: Our awesome team of doctors

 

In September, I was able to celebrate several baptisms at our local church. It was powerful to see people that I work and live with and some of their children being baptized into Christ’s body.

 

Also in September, I traveled to a leadership conference for the Nazarene Church in Papua New Guinea. I met many leaders in the church here in Papua New Guinea as well as leaders in  the colleges run by the church. I gained a deeper appreciation for what God is doing in PNG and the many challenges that our faced here. It is humbling to meet the ministers of Christ who are working with next to nothing in the rural areas of PNG, walking miles every day to go to different villages to share the love of Jesus.

Top: Leadership Conference; Bottom: Sepik-style Stations of the Cross at conference center

 

At the beginning of November I arranged for transportation of 10 pediatric patients with heart disease to go down to Port Moresby to be seen by Pediatric Cardiologists from the United States who were visiting for the week. Two patients had operations, a mitral valvuloplasty and a PDA closure. The others now have plans for their care, although several will need surgical intervention outside of PNG.

Here are a few clinical cases from the last few months for my healthcare friends.

Top 2 pictures: 40yo M with cervical vertebral compression fracture secondary to either TB or metastatic cancer  Bottom: MRSA sepsis in a 13yo F from a pyomyositis leading to bilateral pneumothoraces

 

Finally, a donor provided some funds for vacations for the doctors at our hospital. I used this to go to New Zealand (hence the blog title for LOTR fans) for the last week and a half. It was a much-needed break in a beautiful part of the world.

 

Annunciation

 Annunciation
by Marie Howe

Even if I don’t see it again—nor ever feel it
I know it is—and that if once it hailed me
it ever does—
And so it is myself I want to turn in that direction
not as towards a place, but it was a tilting
within myself,
as one turns a mirror to flash the light to where
it isn’t—I was blinded like that—and swam
in what shone at me
only able to endure it by being no one and so
specifically myself I thought I’d die
from being loved like that.

 

I have had many times to reflect on that love that first overwhelmed my heart so many years ago-how I have so poorly repaid it, how I long for others to feel and know it, how I come so short of showing it to others.

 

 

As I prepared to share at our chapel service a couple weeks ago, I could not help but use much of the time to ask forgiveness for my poor ability to show God’s love faithfully and consistently to the staff and to my patients. And yet there is something so different in this love, not of shame or condemnation, that I am not discouraged but filled with hope and joy to be here and to have the opportunity over and over again. To the young man with a new diagnosis of HIV, to the elderly lady slowly dying from metastases to her lungs, to the young boy with epilepsy and frequent seizures, I get chance after chance to show God’s love to the people of PNG. I am truly blessed.

 

 Top: Neighborhood boys helping me pick strawberries in my garden; Bottom: A generous gift of produce from a local church for the missionaries

 

The last two months have pushed me in new ways. I have been the most senior general doctor for about a month and a half, which means I get questions about our most difficult cases. It also means I have to decide how many patients we will see every day. I constantly feel the tension between wanting to help the biggest number while also trying to protect the well being of our team of doctors. Additionally, I supervise the medical trainees currently working at our hospital, following up on how they are meeting their requirements and scheduling their lectures. I am part of a committee tasked with bringing an EMR to our hospital and I continue to help with our medication inventory and ordering. I have also had the privilege to be in a number of conversations as we seek to make some foundational changes to the work we do at our hospital, better tailoring our work to show the love of God to our patients and to create sustainability through improved education and growth of the local healthcare work force.

 

Some of you may remember a blog post I shared last year about taking a trip to a rural health center called Waffa. I made good friends with a local boy named Guam and did some education for the local nursing officers about basic obstetric care. A couple weeks ago, Dr Spencer went back to visit Waffa clinic. Below are pictures of the new obstetrical ward and Guam with his family. It is fun to see new resources becoming available for the remote areas of Papua New Guinea. I am hopeful to be more involved in this when we have more doctors here for coverage.

Top: The new OB Ward at Waffa; Middle: Guam and his family; Bottom: The truck without breaks that transported me to Waffa now at it's final rest

 

I shared at a small bush church a few weeks ago. My sermon was based on Matthew 6, where your treasure is there your heart will be also. I also was able to share part of my testimony and the way in which God overwhelmed my heart, “ and swam/in what shone at me/only able to endure it by being no one and so/specifically myself I thought I’d die/from being loved like that.” It is such a privilege to worship with the people in these churches whose treasure is so completely set on God. I restarted our men’s group when I returned, and we have been studying James. I have been struck at the frequent theme of how God has blessed the poor to be rich in faith and to lead those who are rich in materials but poor in faith.

 

A couple quick cases for my medical friends

An 8yo boy came with shoulder pain and an inability to move his arm after falling while playing with friends. This was his Xray. He required several surgeries to revise the fracture.

 

 

This is the chest Xray of a 50yo woman who came to clinic with some chest pain and cough plus mild dysphagia. She had a large, calcified cyst in her chest. I’m not entirely sure what has caused it. A CT scan would be helpful in delineating the cause, but that is not readily available here and very expensive. I started her on TB medications, and she is supposed to follow up this week.

Return to PNG

Familiar scenes flooded my senses as the car rolled down the Highlands highway. I had finally arrived in Papua New Guinea after close to three days of traveling, a missed connection in Manila extending the trip. Taking in the deep greens, the backdrop of the mountains and the people walking along the roadside, I felt in my heart that it was good to be back, maybe even that it was good to be home.

 

 

I have now been back in PNG for two weeks. I am here for another two-year term, although I think God may be calling me here for a longer time. My program through Samaritan’s Purse is over so I have come back through the Nazarene Church, which runs Kudjip Hospital, my place of work for the last two years. It wasn’t long after my arrival that I was back in the hospital seeing patients again. It is such a joy to be able to live and serve here.

 

A huge blessing to me was being able to work with Dr Kirk, a pediatric cardiologist from the US who has worked in PNG with our congenital heart disease patients for years, but who has not been able to come recently due to Covid. Last Friday, I spent the whole day doing echocardiograms with him, learning how to better identify and treat our patients suffering from congenital and rheumatic heart diseases. We identified 6-7 patients that would benefit from surgical intervention, some of which will take place in November in Port Moresby, the capital of PNG. Pictured is a patient who had a patent ductus arteriosus (PDA) repaired with Dr Kirk a few years ago.

 

 

 

My second call shift was a good opportunity to remember some of the breadth of my work here. The morning was busy in the ER with a variety of illnesses from pneumonia to meningitis to heart failure. In the afternoon I was called to see a young boy who had been hit in the eye with a stick. He had a large tear in his cornea. I communicated with a Papua New Guinean colleague in the nearby town of Hagen who is an Ophthalmologist and we arranged transport for emergency surgery. Later in the evening, I took a woman for a C-section after the baby was taking too long to come down. Both baby and mom did well. Around 1 in the morning, I got called in for a car accident involving 5 individuals, several of whom needed suturing and one who’s hip had been dislocated and required a reduction. As I finished rounds the next day, I was exhausted but glad that I could use my skills to help the people here.

 

 

 

Stella was excited to see me when I got back. It has been fun to see her and all of the friends I had left here.

 

 

Prayer requests:

-For all of July and a good chunk of August I will be the most experienced full-time general doctor at the hospital. We will also be short our normal number of doctors. Please pray for wisdom and endurance as we do our best to take care of our patients.

-Deeper relationships with local PNGers

-A greater hunger for God among our community

-Protection and health (I have already been a little sick and many in our community have been struggling with health. Additionally, I have a stress injury in my right hip which prevents me from being able to walk far or do any running. This has been difficult for me as I really enjoy getting outside into the community and into nature)