Wednesday, February 14, 2024

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.

 

Florence Owens Thompson - Wikipedia

 

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.

Thursday, December 21, 2023

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.

 



Monday, November 20, 2023

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.




 

Sunday, August 13, 2023

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.


Saturday, June 17, 2023

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)

 


 

Monday, February 20, 2023

Heading Home


As I have approached my return trip to the US, a number of feelings have sprung up inside of me. I am excited to see family and friends and to have some much-needed rest. I am sad to leave the many friends that I have met here. I feel guilt over the workload that I am leaving behind to others during my absence. I feel remorse over the ways that I have failed to be the doctor and witness of Christ that this community needs. I am excited about the vision and calling I feel for when I return in June. I am touched by the many memories I have with patients and the friends that I have made here.

 

I have been thinking a lot about union recently. God has created us for union with Him. We are only made whole, only able to serve and love others out of union with Him. The work I do here in Papua New Guinea can be exhausting and heavy sometimes, more than I can cope with on my own. When I have attempted to go by myself, I have run into burnout and versions of myself that I don’t like, that do not show Christ to the people here. But when I am connected to Him, I feel His sustaining love and joy helping me in my work. It helps me to listen patiently, to explore the pain others are feeling. It helps me to be a better doctor and to see Jesus in those I serve.

 

I feel a deep ache as I leave. I will miss this place and these people. But I am excited to reconnect with my family and friends in the US as well. I could not do what I do without your support and prayers. Please reach out to me while I am in the US. I would love to talk or video chat to hear about how you are and what you are doing as well as share more of my life.

 

 

 

Life Updates

 

Stella loves our new chickens! She can’t quite figure out why they do not want to play with her. She has tried to make other friends as well.

 


 

 


 

We saw a spike of patients in January as most hospitals around the country had limited services due to the Christmas and school holidays. With a limited crew of doctors, we routinely saw 100-150 patients a day!

 

One of my patients was a little boy who had swallowed a coin two days before coming to the hospital. Our surgery team was able to use a catheter to get behind the coin, inflate a balloon and pull the coin out. Another patient was a young man with months of abdominal pain with worsening over a couple of days. All of his labs and his ultrasound were normal; however I followed an impulse and got an Xray. Praise God that He gave me that impulse because there was a large amount of free air on the Xray (an emergent finding usually due to a hole somewhere in the bowel). In surgery he was found to have an intestinal perforation, likely secondary to typhoid.

 


 

 

I have been leading a book study for a few PNG guys that I work with at the hospital. It has been so good to learn from them and to process some deep questions together. One of the highlights of the last few months was hearing one of them excited about getting a better understanding of how good life with Jesus could be.

 

I work with a great group of doctors. Please be praying for them, for strength for their work and encouragement as they take care of a large volume of patients.

 


 

Sunday, December 18, 2022

The Sound Keeps Coming Out

 Untitled Haiku
by Basho
(Translated by Robert Bly)

The temple bell stops.
But the sound keeps coming
out of the flowers.

Advent is a time of longing, expectation, waiting. We remember the anticipation of those looking for hope and light to come into the world. And we wait for God to come again, for His justice to be established, for the end of war and suffering, the coming of His kingdom.

 

But it is also a time of acknowledging his presence, seeing it not just in Jesus’ presence in Bethlehem at one point in time, but His continued presence among us now. Even though His physical presence is gone, His Spirit is like the sound that continues to come from the flowers, filling our hearts.

 

 

I’ve seen God’s presence here. I’ve seen him bring healing in situations beyond my hope. But I’ve also felt Him present in the grieving of a young mother with her dead child. I don’t always understand it. Sometimes I am angry or sad beyond words, but even then, He is present.

 

“God is a God of the present. God is always in the moment, be that moment hard or easy, joyful or painful.” (Henri Nouwen, Life of the Beloved)

 

In this advent, may you know God’s presence even as we wait for Him to return to make all things right.

 

 

 

Some of you already know, but my time with Samaritan’s Purse is quickly coming to an end. I am returning to the US in February for 3 months before returning to PNG through the Nazarene Church. I believe that God has called me here for a longer season. While Samaritan’s Purse covered some of my costs, I now need to raise the full cost of my living and working here. If you would like to donate to my work here, please use the following link: https://give.nazarene.org/pledge/dyer.

 


 

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 ho...