Wednesday, April 10, 2019

Of Feet, Cow Dabs, and Easter

By Mark

When I was a young boy, I would often play outside barefoot.  Certainly my mom discouraged me from doing this, but I was a normal kid who sometimes pushed the envelope of obedience.  In the pasture by our house where the cows grazed, I would run around and joust with imaginary creatures and generally have some fun.  Occasionally, I would squish my feet in what we (and many others) called “cow dabs”.  Now you really don’t need to be brilliant to be able to define “cow dab” nor to realize that oozing this stuff through your toes is probably not a good thing. I can’t even imagine the micro biome of a cow dab and how many diseases I risked by dancing that barefoot squish.  Thank goodness my feet didn’t seem to mind, after the hose rinsed the bulk of the goo from them.

Feet go through some gross stuff! In addition to cow dabs, feet walk through all kinds of nasty things.  They are prone to fungi (i.e. Athlete’s foot), corns, bunions, hammertoes, diabetic microvascular issues, neuropathy, trauma, and so many things that only a podiatrist can truly appreciate. It was only in the past few years while serving in Haiti that I have been able to see even more things that occur with feet.  The staff of the emergency department at the small country hospital in Saintard, Haiti sees foot and ankle “issues” nearly every day.  Machetes mercilessly mangle feet and remove portions of them.  Motorcycles burn them, run over them, and twist them in directions that I never knew possible.  Thorns can pierce inadequately covered feet, allowing the indigenous dirt and grime into an open wound, creating some incredible infections. In addition, cysts, tumors, and cancer all seem to have somewhat of a preponderance for the Haitian foot. 

A few years ago, I was made aware of a disease in Haiti that most often starts with a foot.  The locals call it “chik” and I initially had no idea what it was.  After seeing chunks of feet that were literally falling off, I knew that I needed more research.  I asked our local doctors and some “smarter than I am” missionaries whom we know.  After doing an internet search and being able to define “chik” as something called Tungiasis, I discovered that the causative agent was a small insect.  The insect, which is like a small flea, lives in the dirt and enters the foot through any opening, then during its reproductive life cycle, ends up destroying the vasculature in the foot and the resulting necrotic toes eventually can just “fall off”.  It is horrific to see and worse to treat.  If, when attempting to remove the fleas surgically from the wounds the creature is ruptured, the eggs invade the wound even more, further complicating the possible recovery process.  It is ridiculous to treat, but that is a whole different blog!

So before you start believing I have an abnormal fascination with feet, let me get to my point.  I come from a church that celebrates Maundy Thursday (the Thursday before Easter Sunday) each year with a ceremonial foot washing.  To symbolize and celebrate the humility of Jesus and to follow his example, we would take a pitcher of water, a basin, and a towel, and wash each other’s feet.  While meaningful at the time, it is even more so today.  With the frequent lack of adequate foot covering here in Haiti, the ever-present dust and grime, the necessity to walk for great distances, and the pathology found in Haiti, feet can sometimes be “not pretty”.  If I could extrapolate this back in time a couple thousand years ago, I wonder if the feet in Jesus’ time had some of these same issues?  How sturdy were their sandals?  Did they walk through thorns?  Did they experience infections?  Were there disease states such as “chik” or Athlete’s foot or other traumas?  I can’t begin to imagine that the God of the universe loves us so much that He sent His only son who humbled Himself to wash “those” feet.  Not only that, but He continued to humble Himself on the cross.  He did this for you and for me and for all of us.  I am certainly excited to serve this kind of God: a God who loves me in spite of my sins, my flaws, and my icky, “cow dab” squishing feet.

Happy Easter everyone!  He is risen!

Thursday, January 31, 2019

Another Day in the Emergency Room


It was Friday in January, and the patient flow to the emergency department of the Church of God hospital in Saintard, Haiti could be described as typical, but busy: a man whose finger had been severed by a machete, a child who had been vomiting for a couple of days and was dizzy and a bit dehydrated, an elderly lady who had experienced a stroke, a mom who was in the early stages of labor, and a man who had fractured a femur from one of our many motorcycle accidents.  The load of patients kept the small staff of the ER quite busy, as the outpatient department across the courtyard, the optometry department, radiology, laboratory, vaccination area, intake staff, and the many support personnel buzzed around managing the daily patient load. 

In the early afternoon, a pick-up truck sped to the door of the ER.  Stacked in the back of the truck were three men, bleeding, moaning, and in various states of consciousness.  The passengers and driver of the vehicle quickly described that an accident had occurred about a mile from the hospital and more victims were on the way.  The next vehicle arrived and then the next, and then the hospital’s transport vehicle traveled to and transported from the accident scene until all eight of the injured arrived and quickly overwhelmed the two nurse, one physician staff managing the ER.  I normally prefer that the Haitian staff at the hospital take care of the daily routine, but they came and asked if I might lend a hand. 

Entering the area where patients were arriving, I noticed that the security guards were donning gloves and had already asked permission of the ER staff to move some of the patients to another part of the hospital, since all ER beds were full.  They quickly did so and then other beds were wheeled into the area to hold the newly arrived injured people.  The physicians and nurses from the outpatient clinic and staff throughout the facility stopped what they were doing and soon there were two more physicians, two more nurses, and even a few from the Saintard community who were waiting with sick family members, who helped to move patients around to other beds in the inpatient area of the hospital.  The small ER was buzzing with activity and another of our staff, who was leaving work at the time, came back to help, as did some of our lab techs.  Pressure was being placed on wounds, fractures were being stabilized, IV’s and pain meds were being administered and in general it looked like a scene from a re-run of M*A*S*H. 

I was working with the most seriously injured patient, a young man in his early twenties.  He was quickly deteriorating, in spite of what we could do.  Soon, I found myself doing chest compressions as the defibrillator was attached.  After a few minutes of doing all that we could do, we all stubbornly agreed that this would be the first casualty of the accident. Moving on to the next patient and then the next, the staff of the hospital used what resources that were available to patch, splint, x-ray, medicate, and stabilize each of the victims.  Wounds were still in need of suturing, fractures were in need of surgery, and transports to larger facilities still needed to be done in our one bed-equipped transport vehicle, not in the back of a pick-up truck.  There was still a lot of work to be done, but the initial assessment had passed and the staff started to dissipate back to their regular jobs at the hospital.  The patients were, at the moment, stable. 

Toward the end of the ER “push”, the mom who had begun labor prior to the influx of accident victims began to show signs of more advanced labor.  As I left the hospital for the day, the family of the one accident fatality had arrived at the facility.  The all too familiar survivor’s wail cut through the air and entered into saddened hearts.  The family of the mom in labor sat near the grieving family and waited with anticipation of a new life in their midst.  The antithetical emotions seemed as if they should not belong at the same facility concurrently, but somehow they defined the “normal” so many times in Haiti: such tragedy juxtaposed against so much joy. 

As Kathy and I drove back toward our home that Friday evening, we didn’t talk that much, even though the traffic snarls kept us in the car about an hour and a half longer than normal.  Sometimes, we grow tired.  Sometimes we are overwhelmed.  Sometimes we wonder why in the world we just aren’t sitting in our living room in the US watching M*A*S*H re-runs instead of living them.   As we have time to catch our breath, and reflect on situations such as this we realize and learn many things:  we are thankful for the staff that God has provided to care for situations like this accident, we are thankful for the so many people in the US who have donated so the facility can even be available to the public, we are thankful that the generator was working so that we could take x-rays, we are thankful that we had medicine to help with infection and pain, we are thankful for God’s provision. 

The overworked, underpaid staff of Hôpital L’Eglise de Dieu Réformée deals with situations like this all of the time, utilizing what limited resources they have to make the best of each situation.  They have my admiration and my gratitude. Most of all, however, I am thankful that God has provided so many of His people to come together to form the beginnings of a beacon of hope to those in need in the underserved Saintard area. May these hard lessons allow us to grow and to be more determined to serve God and others to the best of our abilities. 

Wednesday, December 12, 2018

Ice Cream and Superheroes


It was so wonderful this year on my birthday, that the staff of Hôpital L’Eglise de Dieu Réformée not only took the time to repeatedly wish me “happy birthday”, but were so kind to bring me my favorite foods, complete with a whole quart of ice cream.  I am so spoiled!  They presented their wonderful gifts and left me to enjoy my meal in the relative quiet of our office.  It was a great time of reflection.

Earlier in the day, as I was in my office, a group of 3 ladies came to my office door with referral sheets from another missionary medical group who refers patients to us.  I pointed them in the right direction and explained to them how to check in and see the doctor.  The other missionary group had kindly paid for their visit so they were making sure that all was in order.  As they scurried off to their appointments, one of the ladies held back and seemed to be a bit befuddled by the instructions.  She was very diminutive, quiet and demure.  Her clothes were dirty and tattered, and her teeth were black with decay.  I asked her if she understood and she incorrectly described the directions. 

As the story unfolded, she had only shared a ride with the other ladies but really didn’t know them as she had come from farther up in the mountains than her comrades.  She showed me her referral sheet and said it was for her son who was in her arms.  As I glanced at the sheet, the name, age, height, and weight of the little guy was listed along with a simple note that said “malnourished.  See Dr. Mark”.  I took my first good look at her son and noticed his mismatched sandals, too large brown shorts and his too small “Incredible Hulk” flannel pajama top.  The sleeves were long enough to cover his elbows but didn’t come close to his wrists.  The area around his middle was too small to be buttoned due to his swollen belly.  His hair was non-existent and his size was way below average for his 2 ½ years of life.  Mom and he stared at me as if to ask “what’s next?” so I thought I might give them a bit of personal help to navigate our confusing maze of check-ins. 

One of the staff members helped them to check-in and they were placed in the queue to be seen by one of the pediatricians.  After the usual long wait (we are “first come, first serve” for outpatient services), Mom and “Hulk” again found me in the ER and without speaking, gently handed me the prescriptions for blood work, a chest film, and some meds.  Mom was unable to read them, and once again very politely asked me for some help.  After navigating them through x-ray and the lab, they went back to see the pediatrician for a more definitive diagnosis and a plan. 

Staff seeing a child in the malnutrition program
After another time lapse, Hulk’s mom found me in the pharmacy.  The pediatrician had suggested that Hulk be admitted, but mom said she needed to get back to the rest of her family.  I told her that it would certainly be in his best interest to stay and be cared for by us, and that without the help he might be in danger of getting worse and even succumbing to his physical problems.  She paused and said that the pediatrician wanted Hulk to be part of the malnutrition program, which monitors at risk children twice monthly, and provides some basic nourishment and necessities for them.  The next time the program occurred would be the following week, so she and Hulk would return at that time.  I argued against the delay as Hulk really needed to stay.  Unemotionally mom stated that he would be ok, even though he was too weak to stand for long by himself, and that he had been that way for awhile.  She would not be able to leave him behind or stay with him.  The group had provided a little money for her to get back home, so she left, with a very polite “mèsi” and said that she would see me next week.

So as I sat in my office with a big plate of my favorite foods, waiting to devour a whole bunch of ice cream, while the memory of my birthday with Hulk and his mom were haunting my office. Knowing that this little guy was just one of many I have seen with similar stories made the meal a little more difficult to swallow and generated a time of reflection, a time of gratitude, a time of prayer.  I don’t understand the inequality that life presents sometimes, nor why I have been given what I have been given.  The irony of such a little guy having an Incredible Hulk shirt didn’t escape me on my birthday and that produced a grin on my face.  As another chorus of “Happy Birthday” was presented by a staff member, I was overwhelmed by the blessings of my birthday, including a visit from a tiny “superhero”.  I pray that someday, on his birthday, Hulk will have all of his favorite foods in front of him, be surrounded by friends and his loving mother, and know that there is an eternity ahead when all of this inequality will be made “right”.

I sure hope I get to see you again next week, Hulk!  I’ll be waiting!
This was written on October 31st, Dr. Mark’s birthday, and since then the little Hulk did return, but in worse condition.  After some exams and blood work, they found that again it would be in the boy’s best interest to be admitted.  The mother agreed but was unable to provide any money for his stay.  Because of our generous donors, we were able to cover the cost for Hulk’s testing and time at our facility.  He is still at the hospital and we pray he continues to improve each day.

Friday, November 2, 2018

Such a Simple Thing: Water


“We don’t have any water!!!”
For the last few months, this statement has been uttered many times at the Hôpital L’Eglise de Dieu Réformée.  From bathing patients to mopping floors to flushing toilets to doing laundry, hundreds of gallons of water are being used each day.  One day, as I (Mark) entered the hospital, one of our OB/Gyns met me at the door, and announced:  “I have just finished my second C-Section, and have been using alcohol, bleach, and hand sanitizer to clean myself up.  If we are to continue, we need water!!!”
I could not and cannot argue that point.

Since the days of opening as a small clinic in 2005, the Hôpital L’Eglise de Dieu Réformée has been blessed by Missionary Phyllis Newby’s generous spirit and her sharing of the water provided by the one well on the property.  As the demands for water increased with the growth of the hospital, it has become necessary to regulate the water from that well to the hospital so that Miss Phyllis will have an adequate supply for the more than 60 people living under her auspices.

First Attempt to Drill a Well
There was no question that a new well needed to be dug, and we could tie it in with the other well on the property so that it could serve as a back-up for the water needed for Miss Phyllis’ needs should a problem arise. So the search for water began.  It seemed like such a simple request.  In early August, a fellow missionary, Nicky Runk, came to the Church of God property where the hospital is located and began to dig for our much needed liquid “manna”.  With the rocky, sandy terrain, the drilling was difficult and after a few hours of digging and the breaking of parts of his rig, Nicky was forced to abandon the project until at least November of this year. After reiterating that the area of Saintard is a difficult area to dig, Nicky’s advice was simple:  “Pray for water!” 

..but again, the battle cry at the hospital became louder “We are out of water and we need water to work!!”

Second Attempt to Drill a Well
After several weeks of prayerful searching for a qualified well driller, one was identified, a contract was signed, and drilling began again in mid-September.  After a few weeks of digging, and multiple broken parts, the Haitian well drilling team stated that they were not sure that water was available where they were digging and they felt that abandoning the site would be better.  Within a few days, they and their equipment were gone, and we were unsure of if and when they might return.  Hearing of this, I contacted Nicky Runk again and with his God-given determination and prayer, he agreed to return to try to find water again in November. 

So, again we waited, and again heard the frustrated statement:  “We are out of water!”
After a long two weeks, the Haitian company returned with another well drilling rig, borrowed from another company.  The man in charge said they would try one more time.  They began again.  Finally passing through the so-called impenetrable shelf of rock and surpassing 200’ deep, the group still had doubts of finding water.  Prayers were lifted in the Saintard community, in the US, and by friends in so many places, but water was still not found.

Last Sunday, at around noon, I received a phone call from the hospital.

“They found water!”

I never thought those words would be so exciting! 

“Not only did they find water, but the flow rate is about 16 gallons per minute.  They said it was like a river.”
The Water Tower Being Built
I wish I could say “I never had a doubt” but that would be lying.  I wish I could say that I never had a moment of discouragement about this:  False.  I wish I had more faith.  I can only say that I trust my Father in heaven and I never stopped praying for His will.  I am thankful that His will included some water for our little hospital.

He provided water.

As we begin construction of a water tower, within a few weeks, we should have a good supply of water at the hospital.  Until then, when I arrive at the hospital and I hear:

“We are out of water!”
I know that it is temporary….and I smile.

The whole Israelite community set out from the Desert of Sin, traveling from place to place as the Lord commanded. They camped at Rephidim, but there was no water for the people to drink. So they quarreled with Moses and said, “Give us water to drink.”

Moses replied, “Why do you quarrel with me? Why do you put the Lord to the test?”

But the people were thirsty for water there, and they grumbled against Moses. They said, “Why did you bring us up out of Egypt to make us and our children and livestock die of thirst?”

Then Moses cried out to the Lord, “What am I to do with these people? They are almost ready to stone me.”

The Lord answered Moses, “Go out in front of the people. Take with you some of the elders of Israel and take in your hand the staff with which you struck the Nile,and go. I will stand there before you by the rock at Horeb. Strike the rock, and water will come out of it for the people to drink.” So Moses did this in the sight of the elders of Israel.

Exodus 17:1-6