From Nick's perspective

Nick’s on call today. But right now, he’s up at the hospital giving blood. He got called in a few hours ago for an admission. He ended up having five patients come in. One of them was a kid who died from anemia waiting for blood. His hematocrit was 5 - probably means a hemoglobin of around 1. Normal hemoglobin is somewhere about 12-17. In the United States we usually give a blood transfusion once it gets down to 7. Death and suffering is so commonplace here. We usually end up talking about his day by focusing on what he’s learning or something new he was able to do with ultrasound. Here’s a few snippets he wrote in an email about life at the hospital. The email was to the director of the fellowship and the other fellows going abroad in January so it's pretty technical.

"They were really hurting for help when we got here and were really glad to have us. In looking back they were really gracious to let us have a couple days and the weekend to catch up before really getting thrown in. There is one pediatrician and one med/peds post residency fellow who had been the only medical doctors here for basically 2 months while one family was on furlogh. They were getting burned out seeing every kid and adult in both the outpatient and inpatient areas. 

I started out for the first week in the PMI which is their outpatient ward for kids <5 yrs. It is lots of empiric treatment of disease which has been a little difficult for me as we really rely on history and have very few definitive diagnostic studies. Labs we can get: CBC, HCT, ALT/AST, Na, K, Cr, CO2, urine dip, urine micro, thick smear (no thin smears), peripheral smear (for sickle cells and once they saw filaria!), sputums for TB, and HIV 1/2. They do stool exams but I think they are few and far between and there are no cultures done and little to no gram stains of anything. They have medical screeners that treat basic medical problems that are straight forward and then send everyone that is sick or complicated to us. Probably 60% of what we are seeing now is malaria in kids and it isn't even malaria season yet!! There are also lots of superficial skin infections with bullous impetigo, sickle cell crises, pneumonias, diarrhea/dysentery, dehydration (that gets really severe), and really crazy malnutrition. Any people that we admit from the clinic or while on call we take care of until we discharge them, which usually means rounding on 6-12 patients in the AM.

Cerebral malaria and seizures here are a conundrum. IV/IM diazepam and oral phenobarb are the only seizure meds that we have available currently. I had a kid seize for almost 24 hrs straight and couldn't get them to abort even with huge doses of diazepam and trying to give phenobarb by NG. It was the most frustrating thing that I have encountered here and I think took me from the "everything is interesting and fun" to "this sucks" pretty quickly. It was a good spot to be in to have to rely on the Lord and for Him to be sufficient for both me and the child.  If you have any extra IV anti-convulsants around in the US, send them this way as malaria season is coming...

The second week I moved to the OPD (adults and kids >5 yrs) and Parker moved to the PMI. The OPD is ultrasound heaven. I have loved learning and have really improved my skills in the one week I have been here. I have diagnosed with ultrasound: pneumonias, pneumothorax, pleural effusions, constrictive TB pericarditis, CHF, metastatic liver masses, perforated typhoid, gangrenous large bowel, bowel obstructions with perforation, ascites and liver failure, intussecption, splenomegaly, ovarian cysts, neurogenic bladder, hydronephrosis, BPH, Bladder masses, extremity abscesses, and probably more. I really love it and have enjoyed being able to have more of a definitive diagnosis for things in the OPD that I can diagnose with ultrasound. I have been surprised by the variety that we see there from hypertension and diabetes (?), filariasis, lots of TB, lots of typhoid, lots of malaria, some HIV, skin infections, one case of cutaneous leishmaniasis, asthma (that has nearly no treatment options here), etc. The x-rays I have seen here have been like none other too!! 

We have not got into the OB side of things yet but probably will soon now that we are getting more comfortable with the Med/Peds part."

Let's go fly a kite

Nick got to use his father’s day present tonight. If you know Nick well, you know he’s in to weird things. So it makes sense that he wanted an air foil kite. For those of you like me who don’t know anything about kites, that means it has two strings to hold on to so your kite can do fancy tricks and stuff. We went out on the air strip before sunset to test the kite in the mild breezes we were getting. Nick went first and was quite impressive. He passed the handles off to me, and it took me all of about 3 seconds to crash it into a tree over the fence line. We realized we had an onlooker who ran over to help untangle the kite from her side of the fence. The air strip is between the compound to the south and millet fields to the north.

Curiosity got the best of her and she soon hopped over the fence to get a closer view. Nick insisted she get her hands on the strings for at least a bit. We also had a security guard who paused on his rounding duties to watch the beautiful kite and snap some pictures with his phone. We exchanged Hausa greetings. It was fun family time as well as a way to connect with a couple locals. 

Times like this I really miss my Thailand experience. I lived with a family and was immersed in the culture all the time. I had no need to find a way to practice language or connect with local people. I was surrounded by a foreign language and local people were the only ones around me. This immersion is the kind of missionary experience Nick and I have envisioned when we’ve talked and thought about missions. Don’t get me wrong. Life on the compound is nice in a lot of ways. And rural Thailand is more advanced than rural sub-saharan Africa. We have reliable running water in our sink: locals haul large plastic drums to and from a fill station.  We have sufficient electricity for lighting a 3-bedroom house, a full size refridgerator/freezer, computers, a microwave, a toaster oven, etc: locals who can afford it have electricity for a few lightbulbs and maybe a television and small refridgerator. We have a nice sewage and garbage burning system, enough said. We have all of our fancy bulk food items without constantly feeling the need to give them away to people who have little and buy food one meal at a time.

We also have a lady who sells delicious fresh fruit on the compound a couple times a week. If people buy too much to carry home, she kindly sends her daughter with them. Her daughter helped me carry a few things home. I asked her name, and she asked me mine and my kids’ names (usually I have them with me). When we got inside she was disappointed they were sleeping. A couple hours later, she came back with a peeled orange to share with the kids. She wanted to play with them. While we waited for them to wake up, she helped me finish the cooking and baking I was doing to get ahead. She washed all the muffin tins and every pot I had used. She was very sweet and so excited to play with Charlie when he woke up. 

It was a strange mix of feelings I had with her in the house. I was excited to have someone in the kitchen forcing me to scramble for the few Hausa words I knew and to quickly learn new ones. But I was embarrassed at all the food in our refrigerator and pantry. She probably thought I was baking for the masses because I made a couple dozen muffins. Most people in a culture of poverty are used to having enough to get by. They don’t think about buying in bulk or making a large batch and saving some. Even though it’s cheaper in the long run, it requires an investment, which they often don’t have. If they do have enough, they usually don’t buy in bulk anyways because everyone expects them to share. I saw this with Prang in Thailand. She would try to buy bulk items she and her kids used everyday. But whenever she would have a large case of, say, boxed milk, her nieces and nephews would grab some because the understanding was people ate what was available. If they didn’t have much, they went a little hungry. If they had more than enough, they shared. I hid my precious food items in a suitcase in my room so they didn’t disappear so quickly… which left me with a rotting mouse in my bag after a couple months. Sadly, I had to stop hoarding :(

Having the sweet girl around challenged my thinking. The idea of "incarnational living" is great and so important. How can we be like Paul in 1 Corinthians who became all things to all people, so that by all means he might save some? And of course like Jesus, who was himself God but took on flesh? How do we live among the people we are serving when we will never be just like our local neighbors? After seeing pictures of Nick's long hair, Nick's translator asked him why he cut it short. "Because I didn't want to stand out anymore than I already do," was his response. "But we know you're different than us. You're never going to be like us even if you cut your hair short," the translator replied. I think we can navigate how to do some things differently because they're cultural or helpful - like buying bulk cases of green beans because we can only get them in the capital and we really like them... or making large batches of muffins to save - without constantly feeling guilty about our plenty when others are in want.

Our Via Christi fellowship group discussed principles of giving and dealing with asking in cultures of poverty. We need to carefully consider our lifestyles in light of Jesus' clear teachings on generosity and money (give to everyone who begs from you, if someone takes your tunic give him your cloak too, don't store up treasures on earth but treasures in heaven). We also need to be careful not to make ourselves into "the God who provides" and not to rob people of the dignity of earning their own fair living, subtley telling them "you don't have what it takes to provide for a family."* Paul learned to be content living in plenty and in want. Did that mean when he had plenty everyone else did too so he didn't have anything to feel guilty about? Or that he gave it away until he had the same as everyone else? I don't know. But all this thinking about heavy stuff is clogging my brain. Kite flying was fun :)

*These ideas are core principles in the book When Helping Hurts by Steve Corbett and Brian Fikkert.

Runza night

Thanks to so many of you for all the encouraging texts and for everyone praying for us. I, Michaela, have been overwhelmed by support. God has given me heaping amounts of grace to have extra patience with the kiddos. The other night I realized when I thought about my kids the natural feelings I had towards them were often frustration or annoyance. At best my feelings were neutral. I had been thinking about them as bodies to take care of, as minions getting in the way of my packing, of my traveling smoothly, of my cooking, of my learning language. I couldn't even remember the last time I truly had fond feelings towards them. Maybe 3 weeks ago? This lack of enjoyment of my kids is not something I deal with often. I have plenty of issues, and I deal with not having fond feelings towards people, but my kids are usually not among them. It was nice to have this realization so I could process through it.

I think for the first time as a mom, I struggled with giving my kids unconditional love. Charlie has been crabby (not his usual!), and Moriah is NOT getting this potty-in-the-toilet thing. God gave me a glimpse into my heart and showed me I wanted to withhold my affection from them because they were too much work and were testing the limits of my patience. Six years ago when I was in Thailand, the ministry leader was giving me a pep talk because I was struggling. I was the only fluent English-speaker in my village, and life was hard. He reminded me about John Piper's mantra about enjoying God and enjoying being part of His work, not in trying to do work for God. He encouraged me that being a part of what God is doing in people's life should feel like a huge privilege, not a huge workload. He said I should be able to sit and talk with a girl, a child, anyone, and - because of my love for God and my enjoyment in watching Him work - feel overwhelming love for her and overwhelmingly grateful that God would choose me, ME!, to sit and talk about her life, about her family, about God.

What? Yeah, right! That's crazy-idealistic and romantic thinking. But, wow, as I grew in my worship of God and in my appreciation for the way He makes people new, I felt that love and gratefulness often. This week I thought about his wisdom regarding my kids. For quite some time, I hadn't felt gratitude that God would choose me, ME!, to be their mom and to spend most of each day with them. As I've been throwing up short, desperate prayers for God to sustain me as I am being stretched in so many new ways, He has given me new doses of patience for my kids and renewed feelings of affection for them. He is sustaining me and making me new! Instead of seeing them as a workload, I can - because of my love for God and my enjoyment in watching Him work - see them as a gift. It is so refreshing to be grateful that God would chose me to love Moriah and Charlie,

...It is also so refreshing to have the Schwan man in Jammal. People stop by daily with delicious (?) treats for sale. Some even luxuriously take orders ahead of time and bring the food in time for dinner. Last week we tried some "samosas." They are fried pockets of beef, cabbage, and onions - with curry and hot pepper. We decided these would make a regular appearance in our meal schedule, so tomorrow is Runza night. Now all we need is some Husker football ;)

They were a hit with the kids. Aren't those two precious? :)

Thanks be to God

This weekend was a tough one. I got to the barely-able-to-function point and felt like I was hanging on to the Lord by a thread. Friday was day ten of being here and waiting for our trunks to arrive with most of our luggage. Most importantly, I was missing my running shoes, a yoga mat, and almost all of the food supplies I had brought from the states. Gracious neighbors had made us meals for the first several days and brought over fresh-baked bread, but that food was gone, so I was needing to make 3 meals a day from scratch… With new ingredients and not having some of our staples (dried fruit, nuts, honey), I was totally exhausted from trying to think of things to make, let alone from actually getting around to doing it. Nick was on call Saturday, so the kids and I were outside by the swing set. I told Moriah, “Sweetheart, I can’t push you on the swing right now. I’m not feeling very good. I’m kind of tired, kind of sad, and my head isn’t working quite right.” She comes over and plants a kiss on my head. “Is it working better now, mommy?” she asked sweetly. What a tender heart. Ever since a very young age, an uncanny young age actually, she has seemed to have a really powerful read on people’s emotions and an ability to respond appropriately. I’ve gotten to this barely-able-to-take-care-of-myself-and-kids point a couple times, and it doesn’t feel very good. In fact, it’s kind of scary. 

I sent out a plea for prayer to virtually everyone on my viber contact list. (Viber is a great app we use here for texting and calling.) I also read some sweet notes in a journal a whole bunch of my best wichita ladies wrote in thanks to my thoughtful friend, Robyn. AND I turned the air conditioning on in the kids’ room to ensure great naps and then took a long one myself. I woke up overwhelmed by the supportive responses and great verses of encouragement from people praying for us. I felt like God had cleared my thinking a bit (my head was starting to work better…) and given me ability to soak in some great truth and encouragement from all these amazing family and friends. 

One friend pointed me to 1 Peter 4 and 5 and shared some verses and encouragement from there. I have been thinking about them often since yesterday afternoon. She pointed out verse 19 and encouraged me to entrust my soul - even and especially - in the middle of my discouragement and depression to my faithful Creator. Thinking of God as the faithful Creator, who does not leave His children alone, was such an encouragement. Also, thinking I can rejoice in my suffering because I can share in Christ’s suffering and therefore have that “bond” with him gave me a glimmer of hope that my pain was meaningful. Isn’t that the hope of the Christian life? Not that God takes away pain and trials, in fact, pain and trials will increase as we commit to follow the One who suffered to the point of giving up his life. But the hope of the Christian life is that God gives meaning to our joy and our pain. Our joy is a taste of the eternal life to come. Our pain is a tool He uses to bond us with Jesus and make us more like Him. For we know that God works all things for the good of those who love Him. A favorite verse that is often taken out of context, “I can do everything through Him who gives me strength,” was so perfect for yesterday because in Philippians 4 Paul is talking about learning to be content in every circumstance, whether having a lot (of convenience and provisions) or whether having nothing. Paul can be content in both of these conditions through God’s strengthening power. When our desire is to have contentment with the conditions God is giving us at the moment, not necessarily to score a touchdown or get straight A’s, we can be assured His strengthening power is ours! So thanks be to God, He gave me faith yesterday to trust him with all my heart, to lean not on my own understanding, but in all my ways, even in my discouraging times, to acknowledge Him as my faithful creator who is with me, who strengthens me, who helps me, who upholds me with His hand, believing that He will make my paths straight! And He did. He gave many tangible blessings on top of the faith to believe in His truth:

• Moriah showed motivation for the first time to purposefully potty on the toilet, rather than just sitting forever watching cartoons on the toilet until she accidentally potties. And she went twice in the evening.
• Nick got NO calls overnight so we all slept!!
• Our trunks arrived this morning and we had granola bars and raisins straight out of the package!!!

And for some comic relief, here’s some pictures of us riding camels. Definitely one of the most awkward things I’ve ever done.  I guess we can cross it off our list! Think of riding a horse that lurches ungracefully with every step and is another 3 feet off the ground. Then add a tired baby who wants to nurse while you try to keep both of you from tumbling to the ground. And a saddle that somehow gives you more pressure points rather than relieving them. And then do that parading around a rural African village with 7 other white people. Yeah, a little awkward. Ha! I think we’re done riding camels ;) It will make for some good memories!

Family pic. I'm wearing the traditional head wrap for married women. I've been reading a book called "Mini-skirts, Mothers & Muslims" about modesty in a Muslim culture and will post on that soon.

Look into mine eye.

Somehow Charlie and I got the tallest camel who led the pack...

And Parker got the runt of the litter who trailed at the end. 

Happy Campers

I'm a big fan of baby-wearing, it's my favorite part of having a baby by far. I love my homemade ring sling in the States, so when I saw how African babes always rode on their mommas back, I wanted to try it out. I had Anna help me get Charlie tied up and felt pretty African. But I didn't get it quite right; I kept feeling Charlie would fall right on his dome. So I asked Anna if she wanted to carry him instead. We were headed to market for my first experience, and I knew it would be overstimulation even without a squirmy baby on my back who felt like he was falling (I hate to shop - it gives me anxiety). She happily agreed, and Charlie fell right asleep and stayed that way for over an hour. They were both happy campers.

Moriah stayed back at the rehab center to play with friends while we were gone. She got to help in a burn patient's therapy. The occupational therapist has been working with this little girl for over a year.

It may look like Moriah is facing away from the camera with her arms freakishly in back of her, but that's just the way she likes to wear her hat... really far down on her forehead.

Settling In

Here's some snapshots of our house. I didn't get a picture of kids' room before they went to bed, but it's fairly spacious as well. Our living conditions are much more western than many of you have probably imagined.

Yes, that really is.... an actual corded phone?!? 

Don't mind our diapers drying on the backs of chairs. One of the perks of cloth diapering during rainy season.

A view out our front porch on a rainy day. You can see the edge of the playground on the right. Kids love being close to the playground, and momma loves being able to let Moriah play and still be able to see her from the kitchen :)

Big news here... the kids had their first night without waking up!  Those of you who know how much I like my sleep know I am surely praising God for that blessing.  Nick feels he is getting the swing of being in the hospital, and I can tell he is excited about the work he has. He spends free time listening to lectures on ultrasound and reading up on tuberculosis. Translation: he enjoys learning about caring for patients with different diseases and practices here. I will have him write about hospital life soon. We have a sweet woman, Anna, who comes to help at our house three mornings a week. Having house help is common for many missionaries, and it is standard here in Jammal. Daily life tasks take much more time here. Anna washes all our clothes, cleans our house, and will start helping in the kitchen. If you’ve ever done your laundry by hand, you will join me in gladly paying someone to do this hard job! And with all the rain and dirt/sand around here, floors tend to dirty quickly, so regular sweeping and cleaning is helpful. I told the missionary in charge of helping newcomers find house help that I will take as much help as is culturally appropriate, without appearing lazy :) The standard rate for help is just under $1/hr. Women are happy to have the work so house help is a blessing to everyone involved! Anna knows how to bake bread, as she usually works for a family who is in the States for their home assignment (furlough). This family has 4 children, so she loves being around kids and is hoping for some of her own. Moriah and Charlie have quickly warmed up to her. This morning, Moriah followed her around reading her a story. Anna speaks no English, so my Hausa is getting off to a quick start! 

I think I have also found a needed way for me to serve here. While I would love to get some time at the hospital in nursing, I see more pressing needs I can meet indirectly by helping long-termers with their littles. Some of our neighbors on the compound are a family with 4 kids. Both parents are doctors, and the mom has been staying at home almost full-time. Three of her kids are school-aged this year, and she would like to get more time in at the hospital.  More physician help is certainly needed as doctors are always swamped. We had a test play-date today, and it went wonderfully! I will probably be watching her almost 3-year-old son regularly in the mornings, along with his older sister occasionally after kindergarten is dismissed. The kindergartner is very outgoing, and Moriah thinks she’s pretty much awesome. I am excited about being able to contribute here in a way that doesn’t require as much of a learning curve. Nothing too profound to write today. Thanks for reading and for praying for us :)

We're in Jammal!

I'm up with jet lag while the internet is at it's fastest, so here's our first blog post in Jammal. We arrived in the capital city Monday evening and spent 36 hrs resting and grocery shopping before taking a 4-seater out to Jammal. Much to Moriah's delight, we were greeted here with fanfare. She proudly announced to our large welcoming crew, “I took a plane to Jammal. Now I’m going to go potty!” Up until we’ve arrived, the only two things she’s known about Africa are that we take a plane to get there, and that she will need to go potty in the toilet once we arrive because she won’t have any more diapers. For the record, I’m letting her (and myself) recover from jet lag before we hit this potty training thing. And while I’m on the topic… dealing with kiddos with jet lag is probably the toughest physical endeavor I’ve undertaken. Except for my first childbirth experience, and maybe biking up the Vail pass both ways. My brain is mush from trying to keep my kids and I alive while we’re adjusting to the time change and heat, so I’ll stick with a few highs and lows from our first week here.

High - our plane ride and arrival in Jammal!

Jammal from the air - it’s rainy reason and really green.

Low - being awoken by the pilot knocking on our door because we set our alarm wrong :( And then leaving a chocolate bar in the freezer because we were in such a hurry to get out. Also finding a “chocolate” nugget under the bed that rolled out of Moriah’s diaper while Nick was changing it in a jet-lagged fog.

High - new friends! Anyone surprised who is making the most of them?

Low - friends a few hundred feet away hearing our jet lagged children screaming in the middle of the night :/

High - being in a place where we think God has asked us to be for this season. A place not many are willing to go. Moriah gets to go to “work” today. The occupational therapist has asked for her help in doing some play therapy with a Nigerien toddler. I’m looking forward to seeing some faces of the precious people we came here to love. I’m hoping these faces make our jet lag struggle feel meaningful. That they’re a glimpse for me of hope for joy beyond our trials. Of hope in the joy of seeing Jesus make all things new, one person at a time.