An update from Nick

Considering that we are half way through our time here in Galmi, I (Nick) wanted to give a quick update from my perspective as Michaela has been doing much of the writing for our blog. I wanted to share a story and give a synopsis of my usual days. We have been really challenged as a family and I have been challenged personally as a husband, father, and physician here. Everything is different. Raising children and connecting with Michaela have had to take on a completely new appearance. I had never seen a case of malaria, typhoid, or severe “kwashiorkor” malnutrition before coming here and these are the “bread and butter” diseases here. I can think of one or two children that died on our pediatrics service in Wichita with our most intensive care. Here with the medicine that we are able to provide, children come in gasping for what seems to be their last breath and miraculously most of them get better. Death is a very harsh reality here that I have not seen the likes of before – nearly every day there is at least one of the patients that I had some role in their care that dies.

One of the things that we are learning that bridges the gap for us and we have had to rely on heavily is listening to the Spirit. Our sense of this need has been heightened with everything that has been new, different, and difficult. Though, truly living in the Spirit is and was a huge need we had even before we came to a new land. We actually had a chance to share some of our thoughts at last week’s church service here on the compound. The missionaries take turns leading the service each week, including the short termers. It was a great chance to think back and reflect on the time we have spent here as well as what comes next for us here as well as in our future. Below I mention one of the stories that I thought a lot about while preparing what we shared.

My usual day starts at about 8 am, rounding on the admitted patients in the hospital. There are 5 wards that are divided up between the children, men, women, isolation, and “intensive care” units. I have been rounding on about 20-25 patients a day and here this takes only about 2 hours! I then get a morning break from 10-10:30 and then have clinic for either adults or children. The clinics are always overflowing with people who come from hours away to get care. When I ask people why they come, they say it is the best care in the region and they trust the care and medicines that they get here. I generally get a lunch break from 1-3 pm and finish clinic at about 6:30 pm. I am on call about every 3^rd or 4^th day and in the evenings of my call I also usually take any of the C-sections that come in.

The compound we live on is directly connected to the hospital and the main road runs straight to our house. One of my favorite parts of the day is finishing exhausted from a full day at the hospital and beginning to walk down the road to find Charlie tootling towards me as fast as he can or Moriah running and yelling “daddy, daddy!” as they see me on my way.

I often have patients that I admit at the end of the day that I have to wonder if they will be alive in the morning. One of those patients was a little 3 year old girl (same age as Moriah) named Aliyah. She came to the clinic and had malaria with a superimposed pneumonia. She had a hematocrit (blood level) of 8 when normal is in the mid 30s from the breakdown of her blood cells by her malaria infection. I was unable to awaken her and she was limp with her eyes rolled back in her head. Her oxygen saturation which should be more than 90% was in the 60s and 70s. We do not have ventilators here but in the intensive care unit called the “uche” here we do have oxygen concentrators that can deliver up to 6 Liters of oxygen by a nasal cannula.

I ran her up to the uche and got oxygen on her, started her on antibiotics and antimalarials, and got her mother to get a family member to donate blood for her – the lab here has a blood bank that is a huge benefit to treatment but in order to get blood you have to have someone give a unit first. In the US she would be on a ventilator, seeing every intensivist in the hospital, getting 30 lab tests a day, and vital signs every 10 minutes. She would have tubes sticking out of every opening measuring everything that is measurable. Here she got transfused blood, 3 lab tests, antibiotics, and a little bit of oxygen. She laid on a bed with 2 other babies also needing oxygen – no such thing as single rooms, or often single beds for that matter!

This is the reality of most of my days, and many of my patients… And remember this is what the people here know to be the best care available, and truthfully I take pride in the care that we are able to give even with little resources!

Not being able to be a micromanager of care, monitor levels hourly, and give advanced treatment can be a really frustrating thing to a physician who knows what is available in other places. But it leaves much more recognition for me to be aware of the need for the Lord through his Spirit to intervene in and through us. When I would usually ask for more tests or a consult, I am left with prayer and asking the Spirit “what does this patient need that You can show me or You can do?” I am also reminded that it should not be my last resort, but rather my first.

Being left with nothing else to rely on except the Spirit that lives in us is actually a wonderful place to be. In John 7:37b-39 Jesus said: “If anyone thirsts, let him come to me and drink. Whoever believes in me, as the Scripture has said, ‘Out of his heart will flow rivers of living water.’” Through belief in Jesus we are filled ourselves with living water (the Spirit) and have the ability to spill over onto others.

So I came back the next morning and was with one of the translators. We came to the uche and I saw Aliyah. I was surprised she was alive, but she did not look good and was still limp and not responding. I watched for 3-4 minutes for any evidence of breathing and there was none. I pulled out my stethoscope and put it on her chest. Her heart was beating about 70 times per minute which is too slow for a 3 year old. I looked at the translator and said I think she is going to die. He agreed.

Usually there is little benefit to “bagging” a patient here with a mask as we are unable to ventilate them for long periods of time, but I thought we might as well try. I bagged her giving supplemental breaths for 5-6 minutes and then watched again for what seemed like an eternity for signs of breathing. The mother (who likely can’t read or tell time and has no idea how old she is or when her children’s birth dates are) was looking at me bewildered but there was a sense that she knew that it was not going to end well. I told the translator that there were no more medical treatments that we could do for the patient and that she was going to die. People experience so much pain and difficulty here that they don’t cry and generally don’t mourn outwardly. The mother had some tears in her eyes and was clearly preparing herself for the worst.

The mothers here all carry their babies on their backs as Michaela has talked about and shown pictures of in the previous blogs. All babies get carried out of the hospital on their mother’s back, regardless of whether they are alive or dead. This has been one of the most emotionally difficult things for me to watch in the hospital – a mother pick up her limp, deceased child and place him or her on her back, tie them on with a piece of cloth and leave the hospital to return to their village with a dead child. Only then to be greeted by a life of other sick and malnourished children, back breaking work, and no hope that comes from the creator and sustainer of life.

The translator, who doesn’t know the Lord personally yet, said why don’t you pray. Of course! It's sad that I have to be reminded again of the living water in me that my translator had seen at work and knew had power. I prayed for her to be healed and if she was not, that her mother would be comforted and through this time their family would come to know the Lord. And I left her there, not breathing at all.

The Lord does some pretty awesome things here, but this was the most awesome I have seen. I came back the next morning and she was awake, sitting in bed breathing on her own. The mother was ecstatic showing me how she was alive and breathing. I asked her through my translator if she remembered what happened and she retold the story. I told her I was thankful to God, that my medicines were not the thing that healed her and that the God who heals wanted her daughter to live and be healed physically, but more importantly to give them a new heart and a new Spirit. She listened eagerly with a smile from ear to ear. Every time I came back into the ward she greeted me with a raised fist above her head (reserved for those who hold authority) and a smile.

Here is a picture of Aliyah and her mother.  

One of the wives of the surgeons here who Michaela has written about before went up to see them in the hospital and took a picture book to explain the gospel to them in Hausa because she could not read. I discharged the little girl alive and much improved soon thereafter.

In Ezekiel 36 God says that the “nations will know that I am the Lord” and the means for accomplishing this is that he gives those who follow him heart transplants, replacing our heart of stone with a heart of flesh, and also giving us His Spirit inside us to be life to us. Seeing the nations come to know God is why we are here doing this fellowship and training for the future. It is so wonderful to be filled with His Spirit! Oh, that we would abide in him more fully and have a more complete union with him. He does awesome things and is at work in us.

Holiday Celebrations

*This post is a couple days late because of slow internet...*

Today is a holiday in Niger, actually in all this religious culture. Our beloved story of Abraham and his son on Mount Moriah is not simply a random one in a string of stories in the Old Testament of the Bible. While the story has special significance for us because of Moriah’s pregnancy story (written here), it is actually a pinnacle story for understanding God’s plan for bringing us back to Himself. The people here remember the story this weekend during Eid al-Adha, “Feast of the Sacrifice.” They literally slaughter a lamb to celebrate Abraham’s willingness to listen and obey God. Since they are celebrating this holiday right now, I wanted to write a little more about the significance of Abraham on Mount Moriah. Since this holiday is as big a deal as Christmas is to us, the story must hold some significance, right?

Remember that Mount Moriah is a descriptive story, it describes. It is not a prescriptive story, it doesn’t tell us what to do. This idea helps me to address my own question of “How is it okay for God to ask Abraham to put his son to death as an offering to him?” In other areas of the Old Testament, God clearly articulates His hatred for the fact that some people, in their total wickedness, offered their children as sacrifices. So, by including Abraham’s story in the Bible, God is in no way implying we should follow suit by sacrificing our kids. He wants us to know that He asked Abraham to do something very significant, and that Abraham obeyed.

So… God says to Abraham, “take your son… your only son, whom you love, and go to the land of Moriah, and offer him there as a burnt offering” (Genesis 22:2). God says He knows Abraham loves his son. God also points out Isaac is his only son. Abraham and his wife, Sarah, were childless into their late, late years. To prove to them that He could make something out of nothing, God tells Abraham he will have a huge number of descendants. God will uniquely bless these descendants, and God will use these descendants as a tool to bless the whole world. God tells Abraham that through Sarah, his barren wife, he will become a father of many.  You know the song? Father Abraham, had many sons, and many sons had Father Abraham. God promises Sarah will have a son named Isaac. And God says Isaac will inherit the promised blessing as well as the responsibility of being a blessing.

Abraham may have had some deliberations about God’s astounding request, but all we know is that “Abraham rose early in the morning… and went to the place of which God had told him” (verse 3). He lays the firewood on Isaac to carry, and Abraham carries the knife and the tools for the fire. Isaac asks Abraham where the lamb is for the sacrifice… “God will provide for himself the lamb,” Abraham answers. So up the mountain walks Abraham and his son, his only son, whom he loves, carrying wood on his back. Sound familiar?

At the top of the mountain, Abraham lays down the wood, puts Isaac on top of it and takes the knife in his hand to kill his son. “Abraham! Abraham!” says an angel of the Lord. “Stop! I know you trust and revere God because you even gave him your only son” (a paraphrase of verse 12). Abraham looks up. What does he see? A male lamb is caught in a bush. So Abraham offers the lamb instead. In the post about Moriah’s birthday, I summarized our commentary of this story as “God will provide for us what He is asking from us.” What He asks from us is so much greater than energy and strength and patience and love to care for a special needs child we thought we were having. He asks from us total obedience, for us to always do what He says is good and to avoid what He says is bad. He is our Father, so He knows what is best for us. He knows we don’t always understand why it’s best. Still, He asks us to listen to Him on the premise that He is God and we are not. Sadly, we often don’t listen. We don’t believe that He is God and He knows best. This failure to listen, failure to trust? That’s our sin. It’s a problem. It separates us from God. When we are eternally separated from God? That’s hell. A scary place to be sure.

Some people might not see it as a problem. “Sin and hell are what religious people use to scare people into coming to church or doing ‘good things,’” some  say. If you are one of those people, that excuse may work for awhile.  But I’m going to venture... that someday you will be nagged with the sneaking, but unshakable, suspicion that you are, in fact, estranged from the God who formed the universe, the God knows everything about you.

Okay, it’s a problem. This sin. This not listening. What can I do about it? Go to church more? Do more good things? That’s what many people here are doing. They learn that praying, that following standards of not eating pork, that sharing with the poor, that all these duties will take care of their sin problem and restore their relationship to the God who made them. In fact, they are so convinced they have a problem that separates them from God they spend a weekend physically killing a lamb and eating it together in order to make themselves right with God.

We’ve read that before the sacrifice someone writes a list of people’s names on a piece of paper. They slaughter the lamb in order to wipe away the sins of the people on that paper. Are they confident the blood of a simple bleating lamb actually takes care of this huge problem? I don’t think so. I think that’s why dozens of people here are hungry for words of truth about how to mend our relationship with God. Just this last weekend, a local religious leader invited a Nigerien hospital worker and his wife to a large mosque in the region to teach children about the way to God. Why would they ask a Christian to teach in a place where they learn about their own religion? I think they ask because they are keenly aware of their estrangement from God and are hungry to have this problem fixed.

So again, what can we do about our sin problem? God will provide for us what He is asking from us! Did you catch what God was giving a “sneak preview” of with Abraham and Isaac? The son, the only son, the beloved son, carrying the wood on his back, up the mountain, as a sacrifice. It’s Jesus. The sacrifice of Isaac was a preview for Jesus! The Father, who gives up His son? Who would dare ask a Father to give up a Son? God gave up His Son, voluntarily. Jesus carried His cross up that hill, voluntarily. He went through with it. There was no lamb that day. Jesus was the lamb. The Lamb of God. When Isaac asked about the lamb, Abraham confidently responded, “God will provide for himself the lamb.” God required a lamb’s blood for our sin, but clearly no animal was good enough. So what did He do? He required it, and He supplied it. He took on human flesh, walking in the perfection He required of us. And then he offered himself as the Lamb, shedding his own blood, washing away the dirtiest of our sins and making us as white as snow. He provided for us what He asked from us. Sure, we go to church. Sure, we do ‘good things.’ But we don’t do them to make ourselves right with God. We do them because God has made us right with Himself, and now we want to enjoy this closeness with Him.

That’s why we’re in Niger. We are amazed that God has been so kind as to make us right with Him, and we enjoy being close with Him. Truthfully, we enjoy being close with Him more than anything else we ever enjoy. And we know people all over the world are hungry to be close with Him as well. So if Nick coming across the world to give medical care helps some people understand even a hint of the great lengths God went to in bringing us back to Himself, then our time here is valuable. And we believe that is happening. Nick got to pray for a little girl last weekend and ended up seeing a miracle. I’ll leave you hanging and let him write about it in the next post :) 

Pictures 2

And some more...

Mo and her best bud Jonathan reading and playing in Charlie's pack and play. That's his blue mosquito net hanging from the ceiling. Sorry, buddy. Yes, you are sleeping in a pink crib :(

Charlie loves Hausa food!  I try to feed him toast or a muffin for breakfast, but if he sees Anna's food, he reaches for that instead. Anna calls Charlie, "Buh How She," which means a Hausa boy.

Reading books in Moriah's "princess" bed, which is how we get her to sleep under the mosquito net. As above, Charlie is almost always just in his diaper while we're inside the house.

Our usually friendly, but very annoying, new house guests called earwigs. The compound gets an invasion every year at harvest time and our house has some nice entry points unfortunately. Thankfully, they haven't made homes in our bed, but they love any dark, slightly damp place, such as under drying dishes or inside hanging towels. Lovely! We have been vigorously spraying a child-safe pesticide permethrin and using a powder form available in the village to try and minimize the pests. I could easily sweep up this many critters in our bedroom most mornings even if I've swept before bed. They last several weeks, but we see an end in sight! They aren't around forever.

Making forts with Daddy at lunch time!  Most days, Nick is able to come home for coffee break from 10-10:30am and then lunch from 1-3pm. His work hrs are usually 8-6:30, not including call (every 3-4 days). He is busy, and work is intense, but we like seeing him a few times throughout the day!

Pictures

Sadly, our internet has been extremely slow for the last several weeks, which makes texting and sharing pictures with many of you difficult, and phone calling virtually impossible. Here is a slew of fun pictures I thought you may enjoy.

Anna brought her boy over to play one of the days she was working. He had fun playing with the kiddos!

Moriah playing hide and seek in a Nigerien basket

Not a maternity shirt... just tailor made so if you get the front dirty you can turn it around and wear it again the next day without washing it :)

Matching outfits!

Charlie surprised us one night with his stack of blocks. This little bird mouth has replaced his permagrin as his favorite expression.

I finally "backed" my baby right.

Nick's triplets!  All healthy.