The Pfennigers – Fred and Lydia

She walked into the door with a 25 week pregnancy and ruptured membranes (her water had broke) –the prognosis was poor.

In the US a baby has a chance for living after 24 weeks and as such, and at this time, interventions are done to increase the chance of survival. The mom is given steroids to help mature the baby’s lungs and antibiotics to discourage labor. Once born, the baby would have access to surfactant (a medication for the lungs), a ventilator, IV nutrition and a slew of specialist. Here we can do only the steroids, antibiotics, CPAP (some pressurized oxygen), and IV fluids (no nutrition). And in terms of specialist, what can I say, have you met Dr. Lydia, Dr. Fred and Dr. Russ the pediatrician?

In Togo we believe the age of viability is 27 weeks, not 24 due to a lack of ventilators, surfactant and specialists. But because all things are possible under God, we usually attempt treatment at 24 weeks.

She’d come all the way to see us from Lomé, she had only one living child with a history of multiple pregnancy losses, and she’d come because she heard that we could help her. We discussed with her the gravity of the situation and the very big limitations that we had at this stage in the pregnancy. We prayed with her and then put her on bed rest in the hospital, did the few medical interventions that we could do and put her and the baby in God’s hands.

If you’ve ever had to lay in bed for a long period of time, it’s not very fun and let alone when you’re pregnant and worried. This was a challenging time for her, but little did she know the real challenge was about to come. It was about a week and a half later and she went into full labor in face of anything we could do to help. The baby was born and immediately started on all treatments that we could provide at this young of an age. The physical challenge for the mom was over, but now the physical challenge for the baby and the emotional challenge for the mother was just beginning.

After 48 hours of requiring CPAP, we were able to switch her to regular oxygen and over a period of weeks was able to wean her off this. She was placed on medication to keep her from having spells of not breathing (common in premies) and she was placed on antibiotics and blood tests were done. In addition a tube was placed running from her nose to her stomach –as babies at this age do not have the ability to breast or bottle feed and with high risk of aspirating the fluid into their lungs. Despite all of the challenges of being a premie and needing to come off and on antibiotics during her stay here, she actually did remarkable well, considering all the premies we’ve delivered and worked with, helped and lost, she is one of the youngest we’ve had and one of the ones that has done so well.

During this time it was not without its emotional challenges for the mom –she spent over 6 weeks in the hospital day and night to be there for this baby. Though we have nurses –realize that the majority of care of patients falls to the family. Also, realize most of this time she was sleeping on the floor and buying just the basics of nutrition from alongside the road outside the hospital (there are no local restaurants nearby). We’d talked to her about the time she would need to stay in the hospital after the baby was born, but it is not easy to fully comprehend what that means until your there. There were several mornings when she would have tears slipping down her cheeks as she tried to keep her emotions at bay –she was tired, not fully rested, anxious to be at home with her husband and family, and to be able to get the food she was used to. It was those times, we hugged her, encouraged her, and prayed with her. I know that during these times she thanked God for the life of her baby and still does to this day! We have enjoyed watching this baby grow.

She came in to the medical clinic because of fluid in her belly –she looked like she was 9+ months pregnant. She was admitted into the hospital because of ascites (extreme fluid accumulation in her belly) that had failed initial outpatient treatment. As a part of a “normal” work-up a pregnancy test was done and surprise of all surprises she was found to be pregnant.

Further work up gave her a diagnosis of Hepatitis B and thus the cause of her ascites and a 24 week pregnancy. In the US, Hepatitis B can be treated and possibly cured. Treatment is carried out by specialist. Here we do not have the medication nor the specialist. Here we cannot treat to cure, we can only treat her symptoms. Complicating her pregnancy is the ascites and vice versa. The baby cannot grow if the uterus is restricted by the ascites and this can be a major point of concern. We did not know if we could help her, let alone if she would survive this pregnancy.

The gravity of the situation was discussed with her and treatment was started. Over the following twelve weeks, she went from 98 Kg to 55 kg and at 36 plus week, she delivered a healthy baby. But this is not the whole story.

Throughout her twelve weeks with us, she was cared for, loved, and prayed for. During her time here, she made the decision to follow Christ. After that whenever we saw her, it was always with her Bible open and her reading some portion of scripture. In this time she seemed to almost always reflect a spirit of gratitude and gentleness.

These are the tale of two ladies who we had the chance to come to know very well due to their long stay in the hospital and multiple doctor visits. We were challenged by the gravity of both of their situations. There were a lot of discussions over how to handle their care. We were blessed by how God worked not only physically in the lives of the moms and babies, but also how they were touched spiritually during this challenging time for both of them. Thank you so much again for the way that you pray for us, encourage us and give to the ministry here in Togo –these are at least four lives that you’ve had the chance to be a part of and give to.

Thank you so much and God bless.

See our updated prayer requests and a few new pictures

“How do you know what your life will be like tomorrow? Your life is like the morning fog—it’s here a little while, then it’s gone.” James 4:14

How true this rings for us all. But there are times in our life when we are reminded of this more so than other times.  She was 24 years old and came into the hospital with nausea and vomiting and pregnant. At first glance this seemed like it was a simple case of “hyperemesis gravidarim” (extreme nausea and vomiting due solely to pregnancy –not uncommon), but within a short time this proved not to be the case. She’d started having problems with mid-chest/upper abdominal discomfort and some nausea about 2 years prior but had been told it was most likely gastritis and/or an ulcer. She was given medications and diet guidelines to help; however, things hadn’t improved and with the pregnancy had only gotten worse, to the point where she had lost several pounds of weight and wasn’t able to keep anything down. She was somewhere around 6 months pregnant when we first saw her.

On her first admission a scope was done to look down into her stomach and that was when the mass was found, in the lower part of her esophagus.  Later during that stay in the hospital a tube was surgically placed through her abdomen into her stomach so that she could start getting nutrition. In the initial scope a biopsy was taken and sent to the US, where a doctor could look at it and give us a diagnosis. The difficulty is waiting, waiting for someone to be able to transport it to the US and then waiting 4-6 weeks for the results.

We’d scheduled a follow-up visit around the time when we thought we would have the results back. It was that day that I will remember. The one thing about Togolese, that I am still getting used to, is that they do not tend to show emotion, especially in a hard situations. Mothers going through a miscarriage or having just delivered a dead baby seem to show little to no emotion and want little to do with the baby. Husbands, also seem to be remote and distant with emotion. It may be a protective mechanism as they see and experience death so much more frequently than we do in the US.  And that was what I was expecting as we shared the grave news with the husband and wife.

We told them that the biopsy result was positive for cancer, and that if it had spread, that her chance of survival was minimal. If it hadn’t spread that there was nothing the hospital could do for her here, and that she would need to go to Ghana as there are no oncologists in Togo.  This in itself is a huge financial challenge for any family, and this couple did not appear to be in any way well-off.   Then the question came, despite what we had just explained, “Wasn’t there something that we could do to help her?!” Outside of sharing the love of Christ with her, there was nothing medically that we could do for her. Then came a response that we had not expected, the husband broke down crying and again asking, “Please wasn’t there something that the hospital could do for her?!” He didn’t need to say in words that he loved her –it was written all over his face and in his actions.   We prayed for them, asking God that somehow He would work in their lives during the remainder of the pregnancy and what was to come afterwards, that God’s love and Jesus’ life, death, and salvation would become something real to them.

Weeks later and close to term (9 months), she was induced and delivered a healthy baby boy.  On discharge, we were talking to the husband again about what were the next steps. Ideally, they needed to go to the referral hospital first, but the cost of the trip and the initial consultation will be extremely expensive, and they were struggling just to pay the bill for what we had done for them a few months ago. The other step was to go for further testing in Lomé to evaluate her chance of a successful medical/surgical treatment, or if things were “too far gone.” As I am explaining things and talking with them, the same questions come up, “Please, isn’t there some medicine we can give her that will make her better? Or at least help her?!” My heart breaks for them and I say a prayer as I explain to them again that there is nothing medically that we can do for them. I explain that at this time our sole hope rests with God’s help and that I pray that during their time here they have come to understand more the love and grace of Jesus.

That was just a few weeks ago, and they have not come back in for their follow-up appointment, so I cannot tell you what the outcome is nor can I tell you that her and her husband have made a decision to follow Christ. But I have been and will continue to pray for her, her husband, and their new baby as they go through this very challenging, life changing process. I’m praying that not only will God physically intervene but that spiritually He will work in their lives and that somehow they will come to know and accept God’s love, grace, and salvation. Please join with us in praying for this family and the struggles that they have already and will be facing over the next few weeks to months.

God bless and May you have a blessed Thanksgiving with family and friends.

If you haven’t already -check out our updated prayer requests and pictures.

Noah continues to be a joy to us and to make us laugh!  We have been very grateful for Xohali and Benny and Akou who have been here three days a week with our house help and have so much fun playing with Noah.  They don’t always play like this but when they do it is so much fun!  And I finally was able to catch it on camera!

“All things work together for good, for those who love the Lord and are called according to His purpose.” Romans 8:28

“The earnest prayer of a righteous person has great power and produces wonderful results.”  James 5:16b

I love these verses, there have been many times in my life when I have used and encouraged others with these. But tonight they confuse me –my heart wrestles with fatigue, worry, sadness and trying to hold onto faith.

Amidst all the business that we’ve been surrounded by –sometimes just trying to keep our heads above water –I feel like I’ve lost some of the spiritual focus that, at one time in my life, I had. But life has a way of squeezing this out. Recently I was reminded of this by two short-termers that came out here.

One taking just a few extra minutes to tell the dying patients, “There’s not anything medically we can do for you, but we can share with you the hope of eternal salvation and what will happen to you when you die.” It’s amazing for some reason how much effort it seems for me to be able to take the time to say that when he seemed to say it with such ease. Then a to-be long-term missionary that was helping us out here had told me that she was praying that God would heal the baby with the sole purpose of hoping to make a difference in the spiritual life of the mother. This really hit me –I had been asking for prayer for the baby, but just simply so the baby could live, not with the purpose of helping to spiritually bring the mother to Christ. What else have I been missing?!

What made things harder is that about a week after she said that we lost that baby. God, that was a hard one to take –why? It seems that with a spiritual focus that somehow that should change the outcome of what you [God] are going to do.

Now there is a baby that was born last week that is a nephew to one of our best nurses here. This was a “precious” baby. Due to circumstances this was a failed vacuum delivery that ended up in a c-section that ended up in a “bad baby.”   There is another nurse and her husband, also a nurse, who has lost multiple pregnancies –this is the farthest out she has carried a baby, now we are having to make the call to take the baby early –thank goodness we were not alone in making the call. Now after the c-section the baby is stable and seems to be doing okay, but she is not. She’s requiring lots of oxygen to maintain the minimum of O2 sats, she is having fever and chills and we’re not exactly sure why –we think we know and we are treating to what we think is the best, but what if we lose her? What if we lose both of them? These are not just another Togolese, who after this the family will walk out of the hospital and I will not see them again most likely, this is a “family” that I will need to work with every day –what will they think of me, of us?

These are my fears, these are the thoughts that have been plaguing me over the past 24 hours. I’m tired, I’m fatigued, and I’m physically drained. How do I process this? How do I deal with this? How do I balance it all?

I rack my brain for answers from the past, for answers from scriptures that I’ve relied on in the past. I know God is omnipotent, that He loves me and those around me more than I every could. I know that He has a plan in all of this. But how do I face the families? How do I tell them, that I’m not perfect in what I do? How do I face myself, knowing that God is ultimately in control of all things, but that we are also responsible for our actions or lack of action? How do I bring back the spiritual focus to what I do and how do I live amidst all this trying to keep from “drowning?”

God, I trust you, I need you, I want to see you, and I’m asking/needing your help to get me through this fog, this valley of the shadow of death –I long for the mountaintop, for the peace, the rest, and the assurance that . . . You are truly in control.

Interesting few weeks. Some tough decisions. It is hard to be in charge, to be the expert, to be the one making the calls. For me the decision does not end with a plan of action, it starts. From there the question changes from should we do that to should we have done that. It is how I learn. It is a tiring process. Compounding this are my emotions, right or wrong.

30 year old lady pregnant with twins. She comes to us for her first visit at 32 weeks gestation. All is well except for a blood pressure of 200/140. We admit her, rule out pre-eclampsia and start medications. Within a couple of days her blood pressure is down to 160/100. We are happy. At 33 weeks gestation, despite medication, her blood pressure begins to rise. After a couple of days of IV medications we call it, we make the tough decision of early delivery knowing that although we may be helping mom, we are putting the babies at risk. At 33 weeks and 2 days there is a good chance these babies will not survive due to immature lungs –that was two weeks ago. Today, mom is doing well. Her blood pressure on medications is 140/90. Unfortunately we lost twin A on day of life 3 secondary to respiratory distress/ failure. Twin B is still with us on day of life 18. We have started him on nasal gastric feeds and hoping and praying he has turned the corner. Good decision? Technically yes, but if we lose the second baby it will not feel that way.

10 year old boy brought in unresponsive secondary to an “accidental hanging”. He is placed on a bed. I confirm no pulse, no respiration; however, he feels warm. My guts says pronounce him there is no hope. I am hesitant. I call a code for multiple reasons . . . for the family, for the practice, he is warm. I do not call it because I believe he will survive. After two rounds of CPR we re-establish a pulse, but no respirations. Shortly after, he begins to breath. He lives for two more days and then passes away. The family is at a loss. Now they are burdened not only by the loss of their son, but by a hospital bill that will strain them financially. Was I selfish?

35 year old male vomiting blood. He is signed out to me on rounds. The bleeding is believe to be secondary to esophageal varies secondary to cirrhosis caused by Hepatitis B. My first reaction, why did we admit him. We cannot treat this here, he needs to be referred. I discharge him on Sunday with instruction to follow up Monday morning for a referral to Lomé. He is brought back to the hospital hours after the discharge secondary to vomiting blood. I explain to the family, there is nothing we can do here. We keep him for the night. He is discharged in the morning to Lomé. Two days later we hear that he died on route to Lomé. What could we have done better? Would the referral on Friday have made the difference?

28 year old lady pregnant at 25 weeks and 4 days. She comes to us for her first visit. All is well except for blood pressures of 240/140. She is admitted to the hospital. Over a three day period, we rule out pre-eclampsia and reduce her blood pressure to the 150’s. She is discharged with close follow up. Three days later, at 26 weeks and 4 days, she is back in our clinic with blood pressures in the 200’s and strong fetal heart rate. We readmit her for blood pressure control. During the night fetal heart tones are lost, baby has died. Now she is an induction for fetal demise. I am quietly relieved, God forgive me.

A 20 year old male with an electrical injury comes to us 1 week after the fact. His right and left arm and back are badly damaged. This is a loss. We should do nothing. The fact that he is still alive is a miracle. His condition is discussed with the family by the surgeons. There is no hope, we cannot do anything here. They want us to try. We do. His right arm is amputated below the elbow, his left is taken below the shoulder. He lives for a few more days. The night of his last day he is making a lot of noise, moans and groans. I think he knows his time is coming. The nurse tells me he wants his oxygen mask off. I respond without compassion “that is alright with me as it will not make a difference”. I catch myself before the nurse tells the patient, and with my hand on his shoulder I rephrase it as such “explain to the patient the oxygen is there for his benefit. However we do not want to force any treatments on him that he does not want, thus if he wants the oxygen removed, we will remove it”. He decided to keep the oxygen. I think I lost my spine that night.

25 year old female, pregnant at 27 weeks, unable to swallow. We admit her, scope her, take biopsies and place a gastric tube. Prior to discharge and at the two week follow up, she is gaining weight and feeling better. At the 7 weeks follow up, she has lost weight and the pathology report is back, she has esophageal adenocarcinoma. The baby is 34 weeks and 1 day and growing well. She needs a specialist, an oncologist –there are none available in Togo. The patient cries silently as I explain the situation. With no clear option, we decide to keep the baby in mom until around 37 weeks. After that, we will deliver and work on a plan to try to find a solution to her cancer, but there is not much hope. As mom leaves the clinic, dad is standing in the corner silently crying.  There is no noise, just tears flowing like a water fall. He looks at me and in broken words asks if there is anything I can give her to make her better, anything I can do. The simple answer is no. The complex answer is yes, I can become mad.

On and on it goes. It does not feel like a normal hospital here. It feels like a crisis center, a death service. There are no simple admits. If there are, nobody is calling me on them.

At the worst of times, it is discouraging, it is hard to blog. What do I say? How do I blog? How do I tell their stories here without sounding negative, discouraged, beaten, mad at this place they call “the modern world”? How do I put a positive spin on what I see? I cannot. And for that I apologize.

At the best of times there is a relationship, a moment of time where a connection is made between you, the patient and the family. Something, in the depths of this all is realized, somebody is trying, somebody is holding their hand, somebody cares. At first I think I, in my pride, and they, in there nonbelief/loss/ grief, think it is “we” making a difference. As they continue to watch us, see us in our struggles our prayers, I think and pray and hope “we” come to see it is not “we” but God who is making the difference. I pray that “we” come to know God and/or if “we” already “know” God that “our” faith is strengthened knowing that this is not the end but only a beginning.

Do not get me wrong, I am happy to be here. I am a better doctor for it. I would not trade this experience for the world. And yes we are leaning towards full time missions, but this does not change what I see or what I feel. It does not change “the worst of times”. Surely we can do better than this. Surely with God we will.

God Bless

See our updated pictures and prayer requests

Our Summer news letter is now posted!  Go to our website under “newsletter” tab or click here.   Hope and pray that you have a blessed Easter.

Please also see our updated prayer requests as we head into this new year and be looking for new pictures to be coming soon!

God bless

Fred, Lydia and Noah

We were excited, but we weren’t sure we were going to be able to go at all. Two of the three hospital vans were broken down and the second one, the one we were supposed to take, had just been towed the day before to Kpalimé.  We were still awaiting word on whether it would be ready or not. Thus, we were very happy when one of the other missionary families said that we could use their van for the trip instead! So despite the rainy morning, we loaded up the van with three of the five PET carts, said a prayer, took a picture and headed on our way. With us were Pastor Jeremie and Gnoyi both who had helped us in finding the people that we were hoping to meet and give the PET carts to today.

 Story #1

First stop wasn’t too far out from Adéta and was in a small one room house that was a bit off the main road. Fred and the driver found a dry covered area to put the cart together while Pastor Jeremie, Gnoyi, and myself went to meet our first recipient. He was a young man in his 30’s who is married and has a little girl, just a few months older than Noah. He had been training to be a truck driver –the kind used to transport heavy equipment and goods. He had been on one of his first few trips down to Lomé when he became tired and decided to pull over to the side of the road and take a nap. The exact details of what happened next are not exactly clear, but he laid down outside and somehow several of the heavy bags of coal that he had been transporting suddenly fell on top of him, crushing him. How much longer after that the he was found, I’m unsure, but he was then taken to a local hospital and found to have a severe spinal cord injury that left him paralyzed from the waist down. His wife had been about a month pregnant with their first child when this happened. Can you imagine going from a position where you are a strong young man taking care of your new wife and soon-to-be first child, to all of a sudden being completely dependent on others –not only physically but now also financially. He has had to depend on his extended family and his wife to be able to provide housing and food and clothes –as there is no social service or disability services here in Togo.

Yavoi & the local Pastor

After the accident the local Baptist church reached out to this man and his wife to give them encouragement, support and aid. Before the accident, Yavoi had been a believing Muslim, but due to his interactions with the local Christians and missionaries, he and his wife had made a decision to follow Jesus Christ.

Yavoi is very excited about using the PET cart –it will give him some independence to get around.  Also, he is hoping he will now be able to find work –something he can do with his hands, maybe as a shoemaker.

In talking with him and his wife they would much appreciate your prayers that God would continue to meet their financial needs and that Yavoi would be able to find work that would allow him to be able to provide for his family.

 Story #2

The second house we pulled up to was right off the main road and appeared to be a bit bigger and nicer. When we got out of the van and started walking towards the house I noticed a woman in her late 30’s who was sitting on the floor of a doorway with her legs underneath of her. As we approached she reached for sandals that were sitting nearby and placed them on her hands as she went into a crawling position using her knees and hands to push herself along. She was coming out of the house on the wet ground to greet us –she was our next recipient!

Her mother relayed the story to us of what happened. She was a twin and around 2 years of age when she got suddenly very sick with cough and fever. Her family took her to a local dispensary (clinic) and she was given an injection of some kind.  She gradually started to recover.  During this time, her mother carried her around on her back –as if she were an infant –she never regained her ability to walk. Her twin sister was unscathed by the illness.

She since had gotten married and had five children; however, her husband had divorced her and she has been left raising and supporting four children while living with and getting help from her brother. She has been selling peanuts on the roadside to help supplement her family.

She had grown up in the Protestant church and early on her life had made a commitment of faith in Jesus Christ. The challenges that she has faced growing up and now being a single mother has not caused her faith in God to waiver.   Please pray for her in the growing of and witnessing of her faith, pray that God will give her grace and wisdom as she raises her children, and also as she uses the PET cart.  She is hoping that it will allow her to be more mobile and allow her to increase what and where she is able to sell things.

 Story #3

The third house was quite the drive. What we thought would only be a 20-30 minute drive more, turned out to be over an hour on a road that had many large potholes that were only made worse by all the rain that we’d just received. We were thankful that Noah fell asleep on the way and actually stayed asleep until we got back home! When we finally pulled off on to the side of the road, there were no nearby houses or village –we were out “in the country.” The shelters that we were headed to were about 100 yards off the road along a dirt path through a field. Unlike the other houses that had been made of concrete, these were made of dirt with a thatched roof (definitely the poorest of what we’d seen so far). As we walked up we were introduced to the mother and father and then some other family members. The father appeared as if he had a mild structural problem with his leg but was able to get around with minimal problem. Then they introduced us to two of their children. The first was an older sibling, a girl, who had little development of her lower limbs and very deformed development of her arms. The boy sitting next to her, Myoba, was 14 years old, and had also been born with poor development of his lower extremities, but completely normal development of his arms.

Myoba had previously had some sort of bike that he had apparently been able to get around on –I’m unsure of how this worked, since he would not have been able to pedal with his legs.  But this had broken a while back and he’d had no way of getting around. Both he and his sister had had to quit going to school, as they had no means of transportation and extreme difficulty for mobility within the school itself (there are no handicap measures/aid available).

He and his sister had somehow been attending a local Baptist church that had been reaching out to them and ministering to them, but their parents and rest of their family are not going and seem to have more of animistic beliefs. While the PET cart was being put together, Pastor Jeremie had the chance to share with them the message and love of Jesus Christ. Though, no decisions were made on this day, we are hoping that when we follow-up with Myoba in a few months that we will also be able to follow-up on his family and how God may be working in their hearts and lives. Please pray for Myoba that the PET cart would give both him and his sister some mobility (as she could ride in the cart), that he would be able to find things that he can do to help support his family, and also to be able to enjoy life a little more. Also, please pray for his family, that somehow through the PET cart and the words were spoken and the love that was given that the family will allow God to work in and speak into their hearts so that they too can come to know the love and gift of Christ that is offered to them.

We want to thank all of you for your prayers for us and the distribution of the PET carts.  Thank you also to all those who have given to help support our ministry here.  And a special thanks to Madison First Assembly for helping to make the PET carts and the gospel available to the people here in these stories.

For more pictures see our “Picture” page and for updated prayer requests, see our “Prayer Needs” page.

It has been a while since I have blogged not because I have not wanted too but because I am not sure what to write.

Our lull ended near the end of June and we are back on the schedule of 20+ shifts a month. It is tough. We are like single parents working a full time job. Compounding this challenge are the cases we face in the hospital. I haven’t the experience for it. I need somebody beside me.

24 year-old male presents with progressive paralysis x 4 days. At presentation he is barely able to move his left arm and leg. Diagnosis: suspected Guillain-Barré Syndrome. Treatment required, IVIG –we don’t have it. We tell him he is sick and that there is not much we can do beyond just supportive care. We explain to him, he may or may not get better. Two days later he dies after we coded him for 30 minutes.

2 year-old presents with malaria and anemia. During rounds he goes into respiratory arrest. We bagged him for 30 minutes and decide to place him on BIAP, hoping he will survive. He survives the night. Follow up exam show fluid in the lung. Chest tube placed drains copious amounts of pus. He is alive today on antibiotics and eating up a storm.

19 year old males comes in because of loss of consciousness x 5 days. When it started he was treated at another clinic with a plethora of medications. We suspect meningitis based on a lumbar puncture and start rocephin and dexamethasone. The following day he is like a new man; however, this was not to last. After completing 10 days of IV antibiotics he is no better than when he came. We are at a loss for his actual diagnosis, but we cannot do anything more for him. We have sent him home to die.

26 year old females present with difficult breathing x 3 days. Work up shows concern for a right lower lobe mass. There is not much we can do for her. I explain to the family that she is very sick and that she may die. I tell them she needs more than what we can provide here. They tell us they cannot afford to go anywhere else. We treat with all that we have – antibiotics, steroids, broncodilators, oxygen, and place her in the ICU. The first and second nights were rough, she became sicker, developing subcutaneous emphysema (air leak in the tissue). But then she started to turn the corner. Five days ago she was discharged from the hospital. Boy were we wrong on that one. Thank you Lord.

On and on it goes . . . the successes put you on a high. The failures put you on a low.

Experience is a funny thing. If you have it, a patient benefits. If you do not have it, the patient does not benefit from it. But you have to go through it to know it. Somebody has to be the “first/test case.” I wish there was another way. I wish experience could be simply observed and taught. I think that is what systems, protocols, and stories are for.

The Bible is just that –it is the story of Christ. It tells us through stories, illustrations, and parables on how we are too live our lives. No, it is not going to be all roses all of the time, maybe even none of the times, but there is hope in the end. And in that we must believe, because if life is just now and for the moment, the stories and struggles over here are depressing. But if there is truth in the Bible, and there is, then the stories and struggles over here are joyful. They are stories –through action and prayer –of love, hope, compassion as we at HBB reach out to the sick and the dying in times of need to show, if only for a second, to a stranger, they are loved and God cares.

“God I ask for your strength and your wisdom in interacting, treating and ministering to the patients here in Togo. I pray my inexperience will not be there burden. I also pray for the future Lord, that if it is your desire for us to remain in the field you will open the doors. Amen.”

God Bless.

See our updated pictures and prayer requests

He came in very thin and looking very weak and several months younger than he actually was.  He had a rash over his whole body. After a few moments of questioning “mom” a very different life-picture emerged. The real mother had abandoned the baby shortly after birth because she was upset with the two other wives that the husband had. This was actually the sister of the husband who had been looking after the baby. She was single and unmarried and so didn’t have breast milk and the family couldn’t afford to buy powdered milk/formula and so they had been boiling biscuits in water and then feeding the baby the boiled concoction since birth.

I happened to be spending some extra time with the pediatrician when this little guy came in. My first reaction was shock at the situation and then anger and confusion at the family situation not fully understanding the cultural dynamics and saga that had taken place here. The diagnosis was actually relatively simple: severe malnutrition with kwashiorkor (swelling in the feet) along with a skin infection.

The complicating matter in this situation was how to treat –it needed to be done very carefully! If we fed him too fast he could die. Fifty percent of deaths in children in Africa between 6 months and 5 years is related to malnutrition and complicated by infection that can cause a quick spiral downward. Effects of the malnutrition affect everything in the body from brain development to kidney function (not being able to excrete sodium well or excess fluid) to poor intestinal digestion and absorption, electrolyte imbalances, decreased immune system, and more. The first step in this situation was to initially stabilize him the first few days with IV fluids, antibiotics, and then gradually adding in milk and then possibly other food sources.

The big question was if his little body would be able to handle it or had it gone too far in damages? One of the first things we needed to do was to warm him up –his body temperature was registering at 34-35˚C –this was because he literally had no fat insulation and a large body surface area with very little weight. After ordering labs, our next responsibility was to determine what type of fluid and how much should we give him, and what electrolytes (Potassium, Magnesium, etc.) did we need to get him and when. Then using a special formula put out by WHO (World Health Organization) we started him on some slow oral feedings with plans to transition him to formula sometime over the next few days depending on how he tolerated it all.

Initially things were concerning, his skin began to peal all over his body, and the edema was getting worse, now extending up his lower legs, into his upper legs, and into his lower abdomen. His aunt was very concerned the first few days that he was actually getting worse. It is in this time that we had done everything we could –followed all the known directions that we could down to the smallest calculation of electrolytes and such –and now just step back, pray and allow the body to heal and praying that it wasn’t too late and that God would allow this little guy to survive.

Each day we had a chance to interact with the surrogate mother and to pray with her for the health and healing of this little one. Then all of a sudden one day there was a sudden and dramatic change that seemed to turn the corner for this little guy –his swelling was all of a sudden gone, he was taking in good amounts of formula and he started interacting and playing a little! It is not every child that comes in that we pray with that survives, and I often wonder what is it about one child that God calls home versus another that he allows to stay on this earth longer?

Now the big question is to what kind of a life will this little guy go home to? The family had initially come in because of some workers from an community outreach group, YWAM, had encouraged them to come –so we are hoping that YWAM will continue to have interaction with them and support this little boy and family during the next few months as he grows –there is no governmental system to follow-them once they leave our care. But we also hope and pray there will be a true change in the life of this family as a result of the interactions that they had here at HBB –that is his only hope.

After fasting forty days and forty nights, he was hungry. The tempter came to him and said, “If you are the Son of God, tell these stones to become bread.” Jesus answered, “It is written: ‘Man shall not live on bread alone, but on every word that comes from the mouth of God.’” Matthew 4:2-4

See our updated pictures and prayer requests.

It has been a strange 8 weeks.  It has caught me off guard.  I am not sure how to interpret it all, nor am I sure how to write about it.  I feel like up until now we have been traveling at 100 miles an hour, and then all of a sudden we stopped.

It is strange, with this change of pace I have had to re-learn how to take time for myself – to read, to exercise, to study.  It has been a welcomed change but also concerning.  I was near my end.

Noah loved the water!

The start of the change was abrupt and planned.  Short term help was coming and we were given 10 days of vacation starting March 15.  We left the compound tired but happy.  We traveled to Ghana for the 10 days spending time hiking, sleeping, eating, and exploring Accra and the Gold coast learning about the slave trade.  We return to the compound on the 23^rd having had a good time but also a bit anxious on what was waiting for us.

What was waiting for us turned out to be more doctors.  Surprising what a few more doctors can do!  It’s like night and day.  We have been running anywhere from 8 to 11 doctors for the last 8 weeks.  This is up from 5 doctors during our first 9 months.  Oh the difference it makes!

With the extra help I was able to spend 4 weeks working solely with the surgeons.  Yes, I was on call every 3^rd night but it was different.  Prior to these 4 weeks, when I was on call, I was making the decisions.  Now I was nothing more than a resident, a lackey, working under two other doctors.  The responsibility was not mine!  It was nice for a multiple of reasons.  First, I got to see and be a part of a lot –para-cardiocentesis, inguinal hernia repair, exploratory laparotomy, bowel resection, below the elbow arm amputation, sign nail, casting, fracture reduction, biopsy, mastectomy, central line, cardiac window, supra pubic cath placement, prostectomy, anal fistula / fissure repair, myelomeningocele repair, etc.  Second, I was not responsible for all the decisions being made.  Third, I learned a lot and because of it, I have become a better doctor.  Now, if I could only get five more months like that.

Since the beginning of May, and because of the short termers, our call schedule has changed.  We are now each now doing call – OB and Medicine – only every 4^th night giving us a total of 15 on call shifts a month, in addition to regular hours, and not the 20 to 30 we were doing before.  Topping this off are Dr. B and Dr. C, two family doctors who also do OB.  There seems like nothing the 4 of us will not hesitate to tackle and/or discuss – tetanus, Potts disease, breech delivery, oligohydramnios, polymyositis, TB, etc.  It is refreshing and fun.

Reaching beyond this, we have started to reach out to the community in the first of what we hope are many projects.  We have arranged to get 5 PET – personal energized transportation – vehicles from the US to Togo.  A hospital pastor has identified 5 persons suffering from debility who require “all-terrain” wheelchairs to get around.  We are hoping the vehicles will be here by the end of June to distribute them during the months of July and August.  If the PET wheel chairs turn out to be sturdy and practical in the Togo environment, we are hoping to import more.

The timing of the lull is interesting as we are considering and praying about our future.  If it was a matter of interesting work, it would be a no brainer, we are staying.  But there are more factors than that such as sustainability.  To stay would mean a commitment of not merely two years, but a place to build a home, a base, a future.  Anyone can work hard for 6 months to a year, but what about 5 years? 10 years?  Without the lull I would call the schedule unsustainable.  With the lull I would call it sustainable.  The challenge becomes now to determine what is normal, the first 9 months or the last 8 weeks?  Looking to the future, I am afraid that it is former.  I am afraid the lull is going to end sometime near the end of June.  Please continue to pray for us for God’s very clear direction in our lives and that we would find his strength during the tough times.

God Bless

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