I read an article today where the Prince of England said “I dream of Africa”. It is not the first time I have heard someone express their heart for Africa. I too am attracted to Africa not only as a place to live but as a place to practice medicine. I am left to wonder why, why Africa? The obvious answer, it is different. The not so obvious answer, Africa is still a “hunter / gatherer society”.
In Africa, food is not a given. Yes it is available, but not to the same extent as it is in America. Here in Africa there are no large grocery stores at every corner filled to the top with perishable and non-perishable items. Also, refrigerators and freezers are rare in Africa. Yes we have a fridge/freezer set up here on the compound, but this is unusual. This is not common to every household. As such, time is spent every day “hunting” for and “gathering” food. Thus we are connect to and are reminded of our morality every day. Meals and or no meals become a celebrations of our “daily” success and failure. They are not routines that become lost within the 24 hour day. They do not become “bottle necks” within our “productive days of work”. Eating has meaning and is a celebration. I am successful today not because I got a promotion, finished a work project and or visited some friends. I am successful today because I was able to “hunt/gather” three meals.
In medicine, the idea is similar. We do not have rooms full of medicine nor offices full of doctors. Our medicine and doctors are limited. We prescribe medicine and do procedures not out of routine or habit and/or experience, but out of necessity . . . if we do not do it the patient will die. We do not read and study medicine for the details of whether the new studies support or refute a new and or current treatment course. We study medicine to understand the big concept of treatment. We study medicine to figure out what we can do with the medicine we do have and when to tell the patient we have done all we can.
This is an exciting process when we are successful. It is a ground shaking, demoralizing process when we are not. Failure makes you question your role, purpose and ability.
A week ago one of our newborn babies at 36 hours of life had a bilirubin of 32, normal is less than 13. Bilirubin can cause neurological brain damage. Treatment is dependent on level. Phototherapy is indicated at levels higher than 13, and a transfusion is indicated at levels higher than 23. Working with Dr. K, the pediatrician, I placed a central line through the umbilical vein and we did a double volume blood transfusion. All and all we spent six continuous hours treating this patient. The patient then got 3 days of phototherapy. Prior to discharge, the baby had a bilirubin around 5. We felt good.
About 7 days later we admitted a 13 day old baby girl born at another hospital. She came to us with a fever and a bilirubin of 74. Working with Dr. K again, we did a lumbar puncture and we struggled to place a femoral central line, after which we started a double volume exchange. Unfortunately, we lost the line after transfusing only 60 ml of blood, our goal was 400 ml. By this time, we had spent five continuous hours trying to treat this patient. Our other work was piling up and I was both hungry and tired. We decided to call it a day and treat solely with phototherapy. After getting the baby placed under lights, saying a prayer, our day and night continued. The next morning, after a night on lights, the baby’s bilirubin was 18 and I felt bad . . . I gave up on this baby!
Despite me, this baby got better. Remember, I gave up on this baby. I chose sleep, food, and other work over this child. Granted I did not sleep much during that shift which saw me later resuscitate a 30 week old newborn. By God’s grace, this child who I gave up on is better.
The balance here is tough . . . I cannot work 24 hours a day and I cannot simply say “it is in God’s hands now” to every patient who walks in the door. Where is the line between give it your best shot, persistence, futile stubbornness, and God’s grace? I believe in God, and I rely on God, but I am not sure what this means practically.
With treatment and procedure successes I feel a part of this place, like I have a role. With failures I feel the weight of this place, and question my ability. This weight becomes sharp and digs deep when I am asked by a nurse a simple and honest question, “Is there nothing more you can do?” The answer is complex . . . “yes” is the response if I can look beyond myself – the hunger, the fatigue, and the other patients; . . . “no” if I realize that we cannot do it all and that God has a role too!
“But he said to me, ‘My grace is sufficient for you, for my power is made perfect in weakness.’” 2 Corinthians 12:9
God Bless
So beautifully said. Thank you for sharing your stories and your heart.
Leslie L.
I ALWAYS ENJOY READING ABOUT THE COUNTRY AND ALL YOUR EXPERIENCES THERE… KEEP UP THE ****GODS WORK*****BEST WISHES, MARGARET B.
Thanks for the beautiful stories and reminding all of us, WE ARE NOTHING WITHOUT GOD’S HELP!!!!!!
God Bless all of you.
Keeping you in our prayers. God is sufficient in all things and I know he will renew your strength and help you persevere to further his Kingdom. Thank you for allowing God to use you for his glory even when it is difficult. God Bless. Debbie Woodard
It’s all a mystery…life, death, and the part we play in it all. It’s part of the suffering of being a missionary, not being able to do it all. Please try to remember that what you do everyday matters and that your presence there makes a difference. I pray for you everyday.
Beloved Ones, thanks for being the Lord’s servant’s there–through the many challenges–to minister to the needs of His children in Togo.
As I read your words, I realized that in the midst of your tension-filled hours and tedious work, you experience daily the truth of the Apostle Paul’s words that “we have this treasure in earthen vessels, that the surpassing greatness of the power may be of God, and not of ourselves.” (II Co. 4:7)
Meanwhile, realizing the immensity of God’s tasks for you there amidst so many critical needs, “we also pray that you will be strengthened with His glorious power so that you will have all the patience and endurance you need.” (Col. 1:11)
Know how much we love you two docs–and your one-year-old side kick!
We are praying for you. Thanks for posting what is on your hearts.
Fred and Lydia, I can’t tell you how you are touching our lives each time we read your day to day experiences. My heart breaks not only for these people you are treating but for your dear hearts. You are truly sacrificial servants…how many of us would give up what we have to do what you are doing? How many of us would trade the many blessings we have for the heartbreaks you are experiencing? Just know that from our advantage point, we are able to see that without you there, there would be many more heartbreaks…you are doing what you can do, to the glory of God. And Fred, the baby you gave up on…God knows that you are a man who needs sleep and rest and that night he carried it for you. Just remember He is God and we are not. He will make a way where we see none. He has much for you to do and he will make a way for you to do that. Our small group starts up this Friday. I will share with them about all you are doing and we will lift you up in prayer as if you were right there with us…you know you are still in our small group even though you are in Togo. What an amazing perspective on the tediousness of life…with regards to eating. I will consider this every time I eat and will remember what you said. We will pray that God will sustain you in everyway. Love you all! Allison and Matt
I say it almost every time, but you guys are so amazing and doing a job that such a small percentage (obviously) of people could even attempt. WOW. Michigan loves and misses you.
“He neither slumbers nor sleeps”. That is your salvation. “He knows that we are dust…”
May He continue to give you discernment, wisdom and strength. He doesn’t say be successful, but He calls us to be faithful. Thank you for your faithfulness. Praying for you today, Margie
Poignant prose. Almost thou dost persuade me to be an African Doctor.
Rome
Remember dear friends that without you there, they would have no hope. So even when you ‘ve done all you can and feel it isn’t enough, your efforts are more than they would have had. God has called you and He will sustain you. All you can do is your best and rest knowing that you did and that the final outcomes are in His hands. I am sure that is much easier said than done. Praying for you and hoping we can skype soon. Sure miss you lots and love you more! So proud of you. 🙂