Sent to...

  

“Each of us has a mission in life. Jesus prays to his Father for his followers, saying, “As you have sent me into the world, so I have sent them into the world” (John 17:18 NRSV). We seldom fully realize that we are sent to fulfill God-given tasks. We act as if we have to choose how, where, and with whom to live. We act as if we were simply dropped down in creation and have to decide how to entertain ourselves until we die. But we were sent into the world by God, just as Jesus was. Once we start living our lives with that conviction, we will soon know what we were sent to do.” – Henri Nouwen

At times over the last few months, it has been easy for me to forget why I am here, what God has called me to do. When I find myself working late into the night or getting woken up from sleep for an emergency or dealing with someone who is not happy with me due to a decision, I have considered whether to keep going. But God keeps providing reminders, lights in the darkness, that I am where I am supposed to be.

It was the end of the clinic day when he came back to me with the lab result. He had come a couple of days earlier with vague symptoms of some weakness, weight loss and abdominal discomfort. I wasn’t too concerned until I did my abdominal exam and noticed that his spleen was quite large. Ultrasound exam confirmed this and his initial blood work came back with very elevated white blood cells, showing that he likely had some form of leukemia. Cancer is often very difficult to treat here in the highlands of Papua New Guinea. Imaging and pathology results can take a lot of time to obtain. However, there is one type of leukemia, Chronic Myelogenous Leukemia (CML), that we have better options for, including a blood test to look for the underlying mutation and a partnership that helps supply us the needed medications. Sometimes I weary of the extra work and documentation required to participate in the program, but this afternoon showed me why it was so important as the test came back positive. We talked for a while. I explained the disease, it’s symptoms and treatment, emphasizing how important it was to take the medication faithfully. At the end, he gave me a look that conveyed fear and gratitude and emotion beyond words. “Yu brukim lewa bilong mi,” he said, which literally translates as “You broke my heart.” This was a new use of this expression for me, and yet I knew deeply what he meant. And I also was reminded of why I am here.

Another night, I was in the ER seeing patients when a 10-year-old girl was brought in. She was confused and agitated after being hit by a car. Her X-rays showed a fracture of her skull. Our team took immediate steps to stabilize her and try to decrease the pressure in her head. I prayed with her parents, uncertain if she would be able to recover. The next several days I checked on Serah. Slowly she began to open her eyes and respond to speech. For several days I wasn’t able to see her on the Ward, but when I finally came back to see her, she was sitting up and eating with her mother. She had started to walk again. 

Papua New Guinea celebrated its 51^st year of Independence on September 16^th. As part of the celebration, the hospital recognizes employees who have hit notable milestones of service with the hospital. I was encouraged and humbled to see so many who have been here for 10, 20 and in one case, 40 years. And I knew that I was where I was supposed to be, where God has called me to be. Even though the work is sometimes beyond what I can do, God is still with me in it. 

 

I am praying that He will give you strength to follow Him into what He has called you to do.

Prayer Requests:

1.        We are still suffering from the consequences of El Nino here, which has meant the most severe dry season in my 5.5 years here. This has led to an increase in diarrheal and respiratory illnesses as well as problems for our water and power infrastructure (hydroelectric dam). Please pray for consistent rain.

2.        The hospital continues to have issues with inconsistent funding, similar to what we experienced at the end of last year. Please pray for government officials to be receptive to our concerns and that money could be found.

3.        Several of our doctors will be gone in October for conferences and exams. Please pray for those remaining to have perseverance and encouragement as the work increases.

4.        I am taking some of the MK teens on a trip to climb Mt Wilhelm later this year. We have been training with some hikes and runs. Please pray for the opportunities to be a resource and encouragement for them.

 

Lukim Place: On Remembering Why I Am Here

  

This morning, for the first time in several months, I went for a run off of station back through the local village and along the river. The road was pockmarked by numerous rain puddles in potholes, a testament of the current rainy season. The sun was up but not yet streaming through the clouds, except where it alighted onto the distant mountains. Everywhere green leapt up to greet the new day and the air was fresh from the overnight rain.

 

People streamed along the road, some gathered to talk with neighbors, others headed to the market, and still others headed to their gardens with shovels and machetes. I passed an old man wearing a blue and pink snow suit a few sizes too small that reminded me of what my mom would ski in back in the 1990s. A group of kids wearing improvised head dresses of leaves and grass ran out on the road to wave enthusiastically as I passed. An older group of boys in their early teens headed to work in the family garden. An old woman held out her hand to shake mine, a tremulous and passionate greeting on her lips. Even the young men who are smoking and using betel nut give respectful greetings as we made eye contact and acknowledged one another.

And I remember why I am here, why each week I pour out my life in hours of work at the hospital and in admin, why it matters even though sometimes it is really hard. These people are so beautiful and kind, hardworking and industrious in the face of immense hardship and difficulty. It is a blessing to join my Savior in caring for them and learning from them.

 

The panicked look on one of our experienced labor and delivery nurses as I walked in the door one morning for rounds immediately shot my adrenaline up. “Oh good,” she said, “doctor we need you.” A mom had been referred from a nearby health center due to a retained twin. The baby was transverse and was starting to become distressed due to labor. I immediately began to do an assessment and was joined by our Obstetrician Dr Laura, also coming in for rounds that morning. My initial attempts to move the baby to a head down position were unsuccessful, but Dr Laura was able to grab the feet and bring the baby down into a breech position. I then helped to deliver the baby until only the head remained to be delivered. After a couple tense minutes of encouraging mom to push and positioning the baby, we finally delivered the baby. The baby needed some initial help breathing but soon was crying.

 

 

The last few months have been full. We have not had some of the major issues that came up at the end of last year (financial crisis, nearby tribal fights), but we have been trying to catch up from the disruptions that those caused. Personally, I have appreciated this season of Lent as a time to reflect more deeply on my faith, and the work Jesus did on the cross. I have gotten to do some enjoyable hikes (some with Stella) and continue to appreciate the beauty of this place. 

 

I sometimes get asked whether I enjoy the administrative aspect of my job, and the answer is it depends on what I am doing. This ties into the other question I sometimes get, which is what do you actually do in administration? My position of Director of Medical Services has some concrete responsibilities, but also a handful of tasks that end up landing in my inbox because there isn’t another good place for them to go. These include hiring staff to our allied health and ancillary departments, supervising the physician staff of the hospital, overseeing the overall provision of clinical services, clinical governance, managing the budget for equipment and medical supplies, orienting volunteers, disciplinary issues, procurement of supplies in conjunction with our pharmacist, and reviewing hospital statistics and reporting to the government. Some of these tasks I quite enjoy, especially thinking about ways to improve the work of the hospital. Others can be stressful and difficult, particularly the disciplinary issues.

Please be praying for:

Strength and encouragement for the work

Unity among our team

Continued peace in the communities surrounding us

Prince of Peace

Recently, I was reading an Advent devotional that had this passage from Isaiah:

"The people walking in darkness have seen a great light; on those living in the land of deep darkness a light has dawned. You have enlarged the nation and increased their joy; they rejoice before you as people rejoice at the harvest, as warriors rejoice when dividing the plunder. For as in the day of Midian’s defeat, you have shattered the yoke that burdens them, the bar across their shoulders, the rod of their oppressor. Every warrior’s boot used in battle and every garment rolled in blood will be destined for burning, will be fuel for the fire. For to us a child is born, to us a son is given, and the government will be on his shoulders. And he will be called Wonderful Counselor, Mighty God, Everlasting Father, Prince of Peace." Isaiah 9:2-6

The phrase that struck me, which I had never really noticed before was “every garment rolled in blood will be destined for burning, will be fuel for the fire.” A tribal fight broke out recently between two sub-clans in the community that borders our hospital across a small river. The fight stemmed out of a recent council election. From my backyard, I could see some of the flames and the smoke rising from many houses that had been targeted. We could hear the gunshots ringing across the river. In the ER, I sutured the wounds of several men, one with a deep laceration from the base of his neck to his tailbone, another with a gash in his neck and face and into the bone and another with a cut through his deltoid shoulder muscle and across part of his back. We threw out many shirts, jackets and pants, soaked in blood, destined for the incinerator.

 

And my heart cried out for peace, for an end to the violence that would not accomplish its end; for peace for the children deprived of their homes and parents; for the shalom and final restoration of God.

This Advent the imagery in this passage struck me in a new way. While there is a need for that final violence-the breaking of the yoke and shattering of oppression, it will be the precursor to our Prince of Peace finally coming to reign. And that is what we both long for and look forward to in Advent.

The day after the fighting broke out, community leaders from both sides and outside, including church leaders from our ministry, helped with peace talks. Thankfully, both sides responded and the immediate violence was concluded. There is still a lot of healing that needs to take place, but it was a much-needed answer to prayer.

Other Updates:

Accreditation: September and October were for me full of preparing for Accreditation for our hospital. This is a standard assessment of health facilities by the government to determine level of care and areas for improvement. The process is relatively new to PNG and it was the first time our hospital had gone through it. In November, a team that consisted of many of the clinical chiefs from the capital came to do a thorough and extensive review of all the parts of our hospital. They were impressed with our services and our staff, and we received full Accreditation as a level 5 facility. Our staff were excited and proud of their work.

 

Hospital Funding: Shortly after this, we needed to start making plans to close the hospital as we had not received enough funds in 2025 and had already run through most of our savings. Thankfully, within a couple of weeks, the government heard our need and supplied all the funding we needed to remain open. Praise God!

New Faces: In October we were joined by two new doctors, Cristina Franqui-Dominguez and Alessandro Avila. They are both Family Practice doctors and it has been nice to have them join our team. We also hired a local PNG physiotherapist named Joysaka and we are excited about the benefit she will bring to our patients who need rehabilitation. 

 

Testimony: Ricky was a young boy from the Jimi valley who came into my clinic 2 weeks after falling between two logs. He was carried by his father with concerned family following behind. His Xray was one I had not seen before, his growth plate had been completely displaced and flipped up next to the bone instead of being positioned at the end of the bone. Without correction, he would never be able to walk normally again and would be significantly limited. We were short on surgeons, so I tried to refer him to the Orthopedic Specialist at a nearby hospital, but they did not have any beds. Thankfully our surgeons were able to take him for surgery next week and were able to correct the fracture. A few weeks later, I walked past a boy on crutches and it took me a few seconds before I realized that it was Ricky. I continued to see him for the next several weeks, gradually increasing his mobility and strength. We got to celebrate with him and his family when he was finally able to go home.

Merry Christmas to you! May God’s peace rest with you this season.

I got to play Santa this year for the Christmas party and had a lot of fun handing out presents to the kids :)
 

God's Scale: Small in the Eyes of the World

“Our salvation comes from something small, tender, and vulnerable, something hardly noticeable. God, who is the Creator of the Universe, comes to us in smallness, weakness, and hiddenness.”

His sweet smile was like many of the boys I see as they come through the hospital, but his blue lips signaled the underlying disease affecting his life. Born with a congenital heart defect called Tetralogy of Fallot, John was subject to chronic hypoxia (low oxygen levels). He would occasionally faint when he exerted himself too much. He was unable to go to school or play with friends. He has a hard, difficult life. But his face lit up with radiance as I slipped a bracelet brought by one of our volunteers that said, “Jesus Loves You.” A small gift, hardly noticeable, yet full of joy and love for John.

She was rushed into the emergency room by a young doctor from the Provincial Hospital in the city an hour away. She had inhaled a coffee bean and had stridor (high pitched noise when inhaling) when she was agitated. Outside of the capital, we are the only hospital in PNG that could help with this type of case. But even still, it was a difficult case. Our surgeons needed three attempts and finally finding the right piece of equipment to remove the coffee bean, something that almost certainly saved this little girl’s life. Such a small thing, but with huge potential consequences.

In the midst of the busyness that has been the last three months since my return to PNG, I have been thinking a lot about this quote from Henri Nouwen. God so often comes in quietness and tenderness, but only as we are willing to lay aside the many things that scream out for our attention. It is critical for me to not forget that, as it can be easy to lose site of God as we get so busy going about “His work.”

I arrived back from home assignment May 17^th and jumped right back into work, starting in my new role as the Director of Medical Services while still working in the hospital. Over the summer many of our missionaries returned home for home assignments and sabbaticals. This has left us with a small but mighty team for the last several months. But God is continuing to work in Kudjip in mighty ways.

A mom with her young baby treated for pneumonia and now ready to go home

 

This morning as I write this, I am in Port Moresby waiting to meet with the Health Secretary and Health Minister. Our hospital is currently in a financial crisis as we are swiftly depleting our savings and are looking at the possibility of needing to close the hospital later this year if we are unable to secure more funding. Please pray for grace in this meeting and that God would provide for our hospital’s needs.

Other prayer requests:

Accreditation: The hospital will soon be undergoing an evaluation process called Accreditation that will establish our hospital level and determine our funding. Please pray for that process to go well and that our team can show the quality care that we provide.

Doctors: Please pray for our team of doctors that have been pushed this summer while we have been short. Pray for encouragement, strength and endurance.

New arrivals: We have several doctors joining our team starting in October. Please pray that God would be preparing their hearts and that our team here can support them well as they start life and work here at Kudjip.

 

Thank you for your prayers and support for me. I want to leave you with the continuation of the quote from Henri Nouwen. May you find God’s work of salvation today in the deep and quiet places in your life.

 

“The work of salvation takes place in the midst of a world that continues to shout, scream, and overwhelm us with its claims and promises. But the promise is hidden in the shoot that sprouts from the stump, a shoot that hardly anyone notices.” Henri Nouwen Gracias

 

If you would like to give financially to help the hospital you can do so here: https://store.nazarene.org/category/global-missions-projects/png-nazarene-hospital-greatest-need-fund 

Reflection on 2024

 

The longer I go between posts, the harder it is for me to find the words to start a new post. So much has happened over the course of the last year that I have unfortunately not been able to communicate with you. But I do want you to know that I appreciate you all very much. The short emails or texts of encouragement, the prayer, the financial support help me to continue in the work. So, thank you.

 

I am currently back in the US for home assignment and will be here until mid-May. I would love to connect with you so feel free to shoot me an email or text.

 

First, I wanted to share a video made by one of our volunteers that gives a much better idea than I can of what the hospital and its work look like. It is too big to attach here so it is included in the email I sent. If you didn't receive this and would like to see it, please let me know.

 

 

Second, I wanted to give a few highlights from the last term that didn’t make it into previous updates. God has been so faithful and I continue to be amazed at the incredible work of my PNG colleagues.

·      Rural clinic opening at Tsingaropa: Our rural clinic in the Jimi valley had to close last year due to staffing shortages and some small problems in the community. In August, the clinic was reopened with an incredible young nurse named Simon as the officer in charge. The celebration in the community was amazing.

 

·      Helping Babies Breathe: I participated in a training with some of our other doctors that we can now use to help train our hospital staff as well as the staff at our rural clinics. We are hoping to run this out with some new CPAP and T-piece resuscitator machines donated to the hospital starting this year.

 

·      Visit to Omae clinic: In September I was able to visit our clinic in Southern Highlands Province to see patients and do education with the staff. It was an incredible trip, and I stayed busy, seeing many patients from the surrounding communities and teaching basic neonatal resuscitation and obstetric care.

 

·      Congenital Heart Screening: Dr Kirk and his team returned last year, and we did echocardiography screening for more pediatric patients. We identified some more possible candidates for surgical intervention.

·      Christian Health Services (CHS) conference: While covering for Dr Ben in the DMS role, I attended the national CHS conference. It was cool to praise God with healthcare workers from across PNG.

 

·      Doctor’s Friday meetings: This year we have altered our doctors’ meetings to give more space for growing in our spiritual walks with time for prayer, sharing and lament for difficult cases. It has helped us to grow closer as a team and to seek God in our work.

 

·      Hike to Mt Wilhelm: I climbed Mt Wilhelm for the second time with a new group. Jake made a cool video of the trip, which you can check out here: https://www.youtube.com/watch?v=iWObFvj7bio

·      Hike to the lakes: Since coming to PNG and hearing the story of Drs Jim and Bill hiking to the lakes up in the mountains to the south of the hospital, I have wanted to climb there. I finally got the chance to go. It was one of the hardest hikes that I have ever done (very steep, overgrown and muddy), but it was awesome to get to the top and look out over the Waghi valley.

 

·      Visit from my parents: My parents were able to come for their second visit to PNG and meet Stella as well as see my work at the hospital.

 

 

Lastly, I wanted to give an update about the future and to request prayer. I will be heading back to Papua New Guinea in the middle of May for my next term (likely 2 years). I will be taking over the position of Director of Medical Services when I return. In this role I will be a part of the administrative team and responsible for the staff, and breadth and quality of the services provided by the hospital.  I will be doing more administrative work, although most of my time will still be clinical.

 

Prayer requests:

·      Grace to manage my time well and to know what responsibilities to take and to which to say no

·      Wisdom in how to best serve the hospital staff

·      Close friendships and brothers (two of my close friends and running buddies have left or are leaving Kudjip this year)

·      Consistent funding for the hospital

·      Smooth transitions for new doctors and staff joining our team

 

Merry Christmas!

 

Merry Christmas!

 

 

Over the last few weeks as Christmas has approached, I have found myself amazed as I ponder the truth behind what we celebrate. One night, I was called in to help with a delivery in which the baby was coming out the wrong way, feet first instead of head. It wasn’t her first baby, thankfully, and she was close to delivering. I called in the team to be ready for a C-section, but she wanted to try for a vaginal delivery, so I said that we could try. After pushing for a while, we hadn’t made much progress so I went over to the Operating Theater to get the team ready. A nurse came running over a minute later saying that the baby was part of the way out. I ran back to the delivery room to see most of baby visible with the head still yet to be delivered. My heart raced as I went to help the midwife and I prayed a quick prayer. With the next push, the baby’s head delivered. While he was initially a little stunned, he soon gave a big cry.

 

 

Coming into this world can be a harrowing process, especially when you do not have the help or the resources that you need. And even after you arrive, there are a lot of things that can happen in the first few days. A significant part of my work here is trying to keep mothers and babies safe and healthy.  And yet, God chose to enter the world this way-through pain and blood and uncertainty into abject poverty.

 

The Magnificat, or Mary’s Song in Luke 1, has resonated with my heart this year.

“My soul glorifies the Lord
⁴⁷     and my spirit rejoices in God my Savior,
⁴⁸ for he has been mindful
    of the humble state of his servant.
From now on all generations will call me blessed,
⁴⁹     for the Mighty One has done great things for me—
    holy is his name.
⁵⁰ His mercy extends to those who fear him,
    from generation to generation.
⁵¹ He has performed mighty deeds with his arm;
    he has scattered those who are proud in their inmost thoughts.
⁵² He has brought down rulers from their thrones
    but has lifted up the humble.
⁵³ He has filled the hungry with good things
    but has sent the rich away empty.
⁵⁴ He has helped his servant Israel,
    remembering to be merciful
⁵⁵ to Abraham and his descendants forever,
    just as he promised our ancestors.”

God, through the manner in which He gave His Son, has revealed to us the way He operates in the world. He has scattered the proud and sent the rich away empty, but he has lifted up the humble and filled the hungry with good things.

 

 One of my favorite parts of Christmas here at Kudjip is the nativity play put on by the children at the church. They have a moment at the end of the play where all the shepherds, wisemen and extras come to where Joseph and Mary are with Jesus in the stable. But they don’t just walk in to see Jesus and finish up the play. They come dancing through the church with joy and a simplicity of heart. Every time I feel my heart swelling like the grinch and tears come to my eyes at this earnest response to Jesus.

 

 

 

May you be able to meet Jesus with joy and simplicity of heart this Christmas.

 

 

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?