Tuesday, September 7, 2010

home.

I'm finally home, and very much looking forward to sleeping in my own bed tonight (and soon!). Kelli and I arrived in DC Monday afternoon, and I got back to VA this afternoon.

I wrote the following while we were still on the plane Monday morning.

It’s Monday, around 9:30am on the East Coast, and we’ve got about 3 hours left in our flight to DC. The last couple days have been busy with last-minute activity (this will be a long post), so there’s been little chance for us to post a last update. (And though I’m writing this on the plane, I won’t actually be able to post it online until we get back to Mom & Dad’s house).

We made it back to Libreville from Bongolo with no problems. Tim and Meredith picked us up between the ceremony and reception parts of a wedding, so after grabbing a bite to eat, we headed back to the mission house to wash off the dust we accumulated on our trip from the hospital to the airport (and believe, there was a lot of it).

Saturday morning we traveled to the Avea II, the home site of the mobile medical clinics, so I could teach them the database I was working on. The pastor, Jean Marc, requested a few changes – but I knew that this would be something that I would continue to support, even after returning home.

We went to the tourist market to pick up souvenirs. We had been by over a week ago, but since we knew that we’d be going a second time, Kelli and I used the time to mostly scope the place out, then we made a plan of attack. We both got to practice our bartering skills, with the help of Jean Roman, the administrator for Envision (formerly STMO) in Gabon.

After lunch, we went by Hope House once last time. Anna broke out her video camera, and the kids loved performing, then watching themselves on camera. We took some food to them, and Kelli and Anna donated some of their clothes that they thought would fit some of the older girls. I’m still praying about what my involvement in Hope House should be from the U.S., so I would appreciate your prayers as I try to discern what God is asking me to do (and how to fit it all in to an already-packed schedule).

Then it was back home to shower and get cleaned up for dinner out at a Chinese restaurant (Kelli and I both found it a bit ironic that we went out for Chinese in Africa). Three local families (Tim and Meredith Brokopp, Tim and Amanda Kelly and their kids, and Steve and Alace Straw) went with us, and it was great way to end our last night.

Sunday morning we attended a village church, and though we couldn’t understand a word of the service, we both enjoyed being there, especially the worship. This was the church that I mentioned last week…

We went to the beach for a couple hours, then went back to the mission house to finish packing, eat dinner, and head to the airport. Our flight was scheduled to leave Libreville shortly after 8pm, though it was delayed over an hour due to problems with check-in at the Libreville airport. This cut our 3-hour layover in Frankfurt down to 2 hours, which meant that although we weren’t rushed, we didn’t have any extra time (Frankfurt required us to go through security again, and since it is an incredibly busy airport, it takes a pretty long time to get through the lines). This was much to my disappointment – I was looking forward to stopping by Starbucks.

One small blessing – we accidentally left Kelli’s bandage scissors in one of the suitcases we used for a carry-on. They were mostly hidden under the cover at the bottom of the suitcase, which is why we missed them. They found them in Frankfurt, but missed them in Libreville (and it was much easier to explain them to security people who speak English!)

Thursday, September 2, 2010

last night at bongolo.

Tonight is our last night at Bongolo. Tomorrow morning we're planning to get up to watch the sunrise (and hopefully get some great photos), then we'll pack up for the 2-hour car ride back to the airport. We should hopefully arrive in Libreville sometime Friday evening (I say sometime, because these flights are routinely delayed).

It really is amazing what God has built here at Bongolo. Its not like anything that you would find in the US, of course, but it works for Africa and is quite awe-inspiring. The three missionaries who first came here over 30 years ago are still here, and I can only imagine how it must be for them to look around, in light of what was. Because the medical care here is cheaper (and better) than in Libreville, people come from all over the country for surgeries. And in addition to medical care and surgery, there is an eye clinic, dental clinic, maternity ward (with equipment for preemies), prenatal care, lab and x-ray facilities and HIV/AIDS counseling. It is estimated that ten percent of the Gabonese are HIV-positive, and many discover this during prenatal screening.

Yesterday afternoon and this morning, we spent some time helping Meladee Davis sort through the depot (a huge storage area filled with tons of medical supplies). The sheer volume of items in the depot is overwhelming, and Meladee has struggled to organize it since she doesn't have the medical background to know what everything is. Kelli and Heather (a summer intern, who is a nurse) were able to make some significant headway for her, and Anna and I sorted and folded what we could without getting in their way.

Meladee and her husband Paul are just two of the huge number of people it takes to make this whole thing work (like any hospital, I guess). They are here for their retirement, and they're completely self-funded. Paul oversees maintenance for Bongolo ("the station"). Tonight they took us to dinner at Ditchi's (sp?), one of the two restaurants in Lebamba, the town right across the bridge from the hospital (the other restaurant is the Barack Obama cafe). We had fried chicken, topped with a spicy sauce, and french fries - and it was delicious. Ditchi's is special because its a sit-down restaurant that actually has an air conditioner (though its not working currently).

Its hard to believe that our trip is almost at an end already! I'm ready to leave Bongolo (there is much more for Kelli to do here than me, though it is absolutely beautiful), but there is a part of me that isn't ready to leave Gabon all together (especially Hope House). Then there is the other side of me, that is eager to get home and see the friends and family I've missed, but mostly to get on with the work that God has called me to do - even though I'm still figuring out what that is!

Wednesday, September 1, 2010

hopital de bongolo

Monday we left Libreville for Mouille by plane. Tim and Meredith took us all to the airport where me, Kristy, Anna, and Heather (the intern) waited around for our flight to Mouille. We boarded a small aircraft, about 30 seats total, and headed over the jungle (and the equator!!!) to Southern Gabon.

In Mouille we met our ride to Bongolo. Surveying the red dust covered Land Rover clued us in that not only would it be a dusty ride, but due to the accumulation of dust on the inside, it would be one without air conditioning. Fortunately, since we have slowly become more accustomed to the hot weather in Libreville, it was slightly cooler in Mouille. Felipe drove us the 2 hours to just outside of Labamba, over the red dusty roads, full of pot holes and washboard rutts. The countryside was more picturesque of Africa....minus the wildlife. Finally we made our way through Labamba and wound our way up a small mountain, past the small waterfall and rapids below it, and up to the mission's guest house.

Unfortunately it was already dark by the time we arrived, so true exploration would have to wait until the morning. Felipe dropped us off at the guest house and it seemed like we had stepped into luxury. Gorgeous architecture with polished woodwork and brick floors, arches in the doorways, a large stone fireplace. The guest house was previously a schoolhouse with all of its openness and charm, but converted to have over 6 bedrooms and 4 bathrooms, with a separate suite, currently occupied by one of the missionary nurses.

We had the pick of any room we wanted, but us girls (Kristy, Anna, and me) were enjoying our slumber party time, so we chose the room with double bunk beds --- surprisingly sporting the Ikea style along with Ikea blankets. Just a little touch of home.

In the morning we made our way down the hill to "the plateau" where the hospital sat. Each ward has its own establishment, with hallways serving as porches allowing more fresh air to ciruclate. The surgical suite consisted of a small post-op and ICU area, and 3 operating rooms. It is amazing how easy it is to find your way around an OR, even in another country. Anna (since she is a Pre-Med student) and I observed a laprascopic cholecystectomy (gall bladder removal) first. Similar to the States, but sandels are allowed in the OR and many instruments we throw out in the US are cleaned and sterilized to be reused. They have little waste here. During my surgical rotation I had always thought there was so much waste - disposable gowns, drapes, instruments. These are all valued more here, so cloth gowns and drapes are used so they can be cleaned, and instruments resharped until the next order can arrive, possibly within 2 months.

I was invited by the head surgical resident to scrub in on the next case, a thyroidectomy to remove a very large goiter from a patient's neck. The patient was prepped and cleaned using Mr. Clean Multi-Surface and then drapped for surgery (crazy, huh?). I've been told betadine scrubs are used for more dirty cases. Scrubbing in was just the same, except we used reusable brushes and conserved as much water as possible. There was no "time out" prior to starting surgery, as is strictly required in the US, but instead the doctors took the opportunity to pray over the patient before starting the procedure.

Dr. Thompson told us goiters are not endemic in Gabon, but due to the lack of iodine in the diet, they are seen occasionally. In first world countries, iodine is fortified in salt to ensure adequate intake, but here iodinized salt can be more expensive, so the value is not seen by the Gabonese.

Today (Tuesday) Anna and I joined Dr. Thompson and the surgical residents on rounds. Dr. Thompson requires the residents to know English and study medicine in English, so this we were finally able to understand! We saw a variety of patients, reminding me again of the similarity to the States, minus the elective surgeries. We saw post-op prostatectomies, hysterectomies, myomectomies, and ulcer debridements among other things. Ectopic pregnancy is another issue here in Gabon, most likely linked to the high rate of STDs.

In the peds unit, we saw a young girl, Grace, who was burned in a gas fire one month ago. Her mother died shortly after the fire, and Grace was brought to Bongolo about a week ago. She has been septic and spiking a fever, with an unknown source that has all of the doctors puzzled. One of the residents led us in prayer for Grace after examining her. Please keep this young girl in your prayers so that God may not only heal her physical wounds but her emotional wounds as well.

Another story that touched our hearts was a women burned after a domestic violence dispute with her husband. She has been here at Bongolo for over 20 days and has already received skin grafts to both thighs and has burn wounds on both arms. She is healing well, but has declined any other skin grafts. May God watch over her as she heals and will soon be discharged from Bongolo. Domestic violence is said to be another issue here in Gabon.

Observing the doctors here in Gabon has taught me a new type of medicine. The American view of treating medicine is to heal patients on our own. Here, with the help of prayer - before surgeries, before rounds, and with particular cases, there is an understanding that we can only do so much. We can only give of ourselves and utilize the knowledge that God has given us.

Kristy has been put to work on any computer related issues here at Bongolo. Her client list seems to be growing the more people we meet! Although many things are technical support issues, she is still a big help to the administrative functions of the hospital.

Monday, August 30, 2010

sunday.

Sunday morning we went to one of the local Gabonese churches for the early service. The entire thing is in French, so of course we understood none of it. From what we were told, it’s also important to go to an early service, because then there is a time limit to how long it can last – apparently, the last service of the day can last up to four hours. That would have been a stretch for me even in English.

There is a lot more dancing during worship than in the US, which didn’t surprise us. However, as visitors, we’re expected to sit at the front (and sometimes on stage), and get pulled into the dancing. Kelli managed to do so minimally, but I got pulled directly onto the stage.

We spent Sunday afternoon at the beach, though it was too cold to really go into the water (it was overcast and very cloudy). I stood at the edge of the waves a bit, letting them lap around my feet, until my ankles were stung by a series of jellyfish. Fortunately, it didn’t hurt much, though one of the other missionaries offered to pee on my feet if I needed him too (I declined).

Sunday evening the tailor came by to take orders and measurements for the outfits we wanted out of the fabric we purchased at Mont Buet. Kelli and I both chose a separate skirt and top, because we wanted something we would wear more than once.

mont buet.

We spent Saturday morning and most of Saturday afternoon painting and helping Tim and Amanda Kelly and their family move into the upstairs rooms of the mission house. Tim and Amanda previously oversaw the guest house at Bongolo Hospital, but are currently in Libreville for language study. They’ll be here until December, then they’ll be back in the US on home assignment.

We took a break in the afternoon to travel to Mont Buet, translated, “the market.” It was similar to the open-air market I went to Russia (renok), though I’m not sure the US has an equivalent. A craft fair might be the closest thing, but its really not the same. It was incredibly busy, so one of our primary goals was just keeping up with the person in front of you! We also bought fabric to make African outfits.

While there, we walked through the meat market, which is filled with raw meat of all kinds, including lots of fish. The smell was pretty horrible, even to me, and I was terrified I would brush up against one of the tables and actually touch the fish (if you know how I feel about fish, this will make sense to you). In a way, it also underscored the differences between the things that Kelli is interested in, and the things I'm interested in – I was focused on navigating through it as quickly as possible without looking around too much, and she was looking for some of the animals she’s dissected over the last several years.

Saturday, August 28, 2010

back to avea 2 and hope house.

Friday morning we headed back out to Avea 2 to work at the medical clinic. I spent most of my time watching Kelli consult (it was fun for me to see her using her training). Most of the patients are older, with issues with blood pressure or back pain, but we did see an adorable 8-month old baby. He had malaria, but because he was so little, it took some time to figure how to give him the medicine he needed. We were limited by the medicines and dosages available at the clinic, so Kelli and Heather (a nurse and 6-month intern here) had to get a little creative.

Friday afternoon we headed back to Hope House. This time we took the soccer balls the kids from the Bridge bought, and they were a huge hit! Kelli and I both spent some time kicking around the ball with the kids (though the kids had way better moves than either of us did). We got some great photos and videos of them with the balls, and I'm excited to share these with the kids at church when I get back.

I also got to meet Pastor Israel, who runs Hope House with his wife, Flor. We talked about how kids come to the orphanage, and the process they're currently going through to be accredited by the government. The last thing they need is mosquito screens for the windows, and then they'll be fully licensed. We also talked about adoption in Gabon, which is pretty much impossible between the red tape and the cost. I told him a little about how the foster care and adoption systems work in the US, and some of the stuff I've seen as a volunteer for CASA. I asked him about some of the specific needs they have, and I'm praying about the role God wants me to play in meeting those.

Today (Saturday) we spent the day painting and helping the Kellys (another missionary family here) move, and we took a trip Mont Buet - but I'll let Kelli describe that experience!

Thursday, August 26, 2010

medical clinic, day two.

Today we went to one of the villages outside Libreville with the mobile medical clinics. Kelli got to be a lot more hands-on today, and definitely saw a lot more patients. Along with Anna, Tim, and a few of the Gabonese who run these clinics, I walked throughout the village, letting people know that the clinic was here.

There is so much poverty everywhere, on a level I've never seen personally before. The houses are small, often one room and made with slatted boards and a tin roof. There's literally trash everywhere you look. Kelli says she has noticed a scent since we landed, though its not trash that she's smelling. I don't notice it, except a small handful of times - so this is a reason to be grateful that I don't have a strong sense of smell!

I've been trying to process why all of the poor living conditions aren't shocking to me. I expected to be surprised, not just by the level of poverty, but how prevalent it is. Then today, I remember my friend Kelly saying that on her short-term missions trip to Peru last year, she didn't experience culture shock until she got back. I imagine that will be true for me when I get back to the US, as well.

The church ladies from the village prepared a meal for us - manioc, red beans, and an eggplant dish. We had been warned that we needed to eat everything on our plates, so for that reason, we had a pretty light lunch. There are definitely Gabonese foods that we've tried that are good - fried bananas and sweet potatoes, bean sandwiches, and a chicken and rice dish last night.

While we were eating lunch, a few of the villagers started a fire in the dead brush nearby (to clear it out). So we ate the last part of a meal through a haze of smoke, and maybe some falling ashes. Kelli asked about the s'mores - but I think I'm content to wait until we can enjoy a bonfire at Katie's house.

One of the things that Tim has been involved with here in Gabon in Operation Christmas Child (shoebox Christmas gifts). These are distributed through the local churches, and in addition to the shoeboxes themselves, provide for continuing discipleship for the kids. One church now has 50-100 kids that attend each week because of this (which is especially amazing because there are only about 15 adults attending!)

Up until a month ago, the church met under a couple of mango trees, but now they actually have a structure to meet in. The floor itself is dirt and grass, but is surrounded by a cement border. There is a metal roof, with a handful of beams holding the structure up. As Kelli pointed out, what would be considered an abandoned building in the US represents a new beginning for the church.

On the agenda for tomorrow - more medical clinics in the morning, then Hope House in the afternoon (when we're delivering soccer balls).

Wednesday, August 25, 2010

medicine, shopping, and grub..... 3 of my favorite things :)

Today Kristy and I were welcomed by the Ospac and RBC medical teams at the Avea 2 Alliance Church. We were openly greeted by Mama Janine and Mama Christine, the nurses working in the clinic. Kristy was whisked off to work on a database for record keeping of the patients, in hopes to provide statistical data to aid in applications for financial aid.

I was quickly sent in to consult patients with Mama Janine. We saw a variety of patients from those with high blood pressure, palpitations, and other medical conditions. Due to the language barrier, I found myself focusing on the patient and the way they expressed their concerns and pain with their hands and expressions.

A Gabonese translator was available to translate, so between broken English and the common latin roots to medical terminology, I was often able to make sense of the discussion. And thank goodness for similar names for medicines! Pharmacology is tough enough in English!

In Gabon, due to the inconsistant medical treatment, patients carry their own medical records with them, as basic as they are - consisting of vital signs, chief complaint, diagnosis and plan only. No HPI, no PMH, no formal PE. Physical exams consisted of a quick listen to the heart or a quick look in the ears. Good thing 85% of diagnosis is in the history! (Sorry for the medical jargon - just a reach out to my fellow PAs out there!)

The medical system in Gabon does not provide easy access for the people here. There are a multitude of medical clinics, but the hospitals are often too expensive for the people to afford. A trip to the Bongolo Hospital (where Kristy and I will be visiting next week) is at least 10 hours away, but is the only hospital in the vacinity that has the resources to offer financial assistance to its patients. An operation at the local hospitals here in Libreville can easily cost twice as much as at Bongolo.

Working in a small clinic setting is a humbling experience. You have the same patients, with the same conditions, but so little in the way of resources. The clinic, although helped by the missionaries here, is alive and thriving due to the hard work and dedication of the Gabonese that run it. The clinic runs 5 days a week, with a mobile clinic often 2 days a week - with a small staff commited to helping the patients. The dedication displayed by Mama Janine and Mama Christine is only encouraging for the work I look forward to starting soon after I return to Frederick. I am anxious to get settled in to practicing medicine and soon find a way to outreach in my own community. To minister through medicine to those in need in my own world.

Lunch was bean sandwiches.... yummo! Considered the hamburgers of Gabon.

This afternoon, we frequented the local tourist market, where bartering is required if you want to walk out with any money left in your pocket. Much harder to do while calculating the exchange rate of money in your head! Kristy and I are working on a game plan to tackle the souvenir buying in the near future.

Adventures continued through dinner, where we tried some traditional foods of Gabon. We had a chicken and rice dish prepared by a close-by restuaruant (almost the size of a small deli) that we walked up the road to pick-up. We also had street food including fried bananas, fried sweet potatoes and a type of bread called montauk (sp??) -- also known as "mon-YUCK" by Tim. Needless to say the bread wasn't the highlight of our trip.

Tomorrow we will be working again with the medical team in the mobile medical clinic. So many more medical adventures to follow!

hope house and the beach.

We've been in Gabon for a little more than a day now, and I'm finding it difficult to describe all of the things we're seeing. Its not that its overwhelming, exactly, but it is very different.

There are both paved and dirt roads in Libreville, but unlike the US, there's no specific lay-out to them. The buildings are much like what I pictured, from pictures I've seen of Africa - I don't know what the sides of the houses are (cement, stucco maybe?), but the roofs are metal. Occasionally, a mango will fall and hit the metal roof, which startled me the first time, but I'm getting used to it.

The most different thing, at least to me, is that there are people everywhere you look. I don't know if this is because there are so many more of them, if there isn't enough housing, or if the Gabonese just tend to be outside more.

Yesterday morning we went to Hope House, a local orphanage started by a pastor and his wife who were unable to have children of their own. They're used to visitors here, and the minute you step out of the car, there are kids running up to hug you or shake your hand. Some of them are learning English in school, but even the ones that aren't know how to communicate anyway - they'll point, or grab your hand to pull you to where they want you to go.

We took some craft supplies - construction paper, colored pencils, and glue sticks - and spent some time just hanging out with the kids, drawing and hanging out with them. We'll go back again on Friday, so we're planning to take the soccer balls then (and our tennis shoes, so we can run around a little).

After lunch we went a local beach for a while (though I couldn't find shells, sorry Mary!). It was beautiful - I love standing by the ocean anyway, and it was a bit of surreal experience to be standing on the other side of the Atlantic. Anna (the college student from Washington who is joining us on our trip) was delayed a day getting in, so after a couple of hours at the beach, we headed to the airport to pick her up.

Today we'll be going to the base of operations for the mobile medical center. Kelli will actually be seeing patients, and I'll be working on a database to help those who run the clinic track patients and medications. Having records and measurements of the work that they're doing will hopefully allow them to secure government and other funding to help with their work.

Monday, August 23, 2010

made it.

We're here! After hours and hours on planes, we finally arrived in Gabon a little after 6pm on Monday. Our flight at Dulles was delayed in leaving, which made our connection in Frankfurt a little tight, but we made it. Anna will be coming in tomorrow (her plane was delayed) so we'll meet her then.

First impressions of Africa - its hot, but not incredibly so. By the time that we got here, it was very dark, even though it wasn't super late. Libreville seems busy - there are people everywhere! We're both pretty exhausted, so I doubt it will be long before we're ready to crash.

There's a five hour time difference between the East Coast and Gabon.

In the spirit of honesty, I did have a little freak-out moment when we landed in Gabon. Even though I expected everything to be completely different from what I knew, there was a brief moment after we landed and before we reached the gate, that I thought, "what the heck are we doing?" It only lasted a moment, and I'm chalking it up to exhaustion.

Tomorrow we'll spend some time at Hope House (the orphanage).

Saturday, August 21, 2010

Ready..... Set...... GO!

So I am a little new to the blogging experience, so bear with me as I learn as I go!



Tomorrow is the big day! Wheels up by 1800 hours and off to Germany we go! Unfortunately we don't have time during our layover to meet some of our distant Deutch relatives, because we shortly leave for AFRICA!



I must say these last few weeks have been jammed packed, and I have not fully recovered.



Graduation on July 29th seemed like a blur, and although it was wonderful to celebrate with friends and family, I had to move back into study mode pretty quickly to prepare for my boards. Just a week after graduating (Aug 6), I dug into my 6 hour board exam, and came out completely unsure of if I had passed.



Packing quickly commenced in preparation for moving day on Aug 13. Why I chose Friday the 13th to move.... I still don't understand! Good news arrived the day before --- I had passed my boards! My name is officially lengthened to have the PA-C suffix!



The last week has been a culmination of moving from Baltimore, cleaning out in Baltimore, signing employment paperwork, applying for Maryland PA Certification, reorganizing stuff from the move, and packing and preparing for Africa. Wow - what a week! But why stop now?!



I must say without everyone's prayer and support I would not have survived. I am so very blessed to have all of you in my life. I cherish every one of you and look forward to sharing this adventure with you.

Thursday, August 19, 2010

2 days.

Today is Thursday. I leave for Frederick on Saturday.

Excuse me for stating that obvious, but that's in 2 days.

So while I run around like a crazy person, trying to do laundry, pack, clean out my refrigerator, deal with my smoking car, finish up the last-minute work stuff, and prep for Saturday night's church service, here are a few suggestions for prayer requests:
  • The last-minute details - there are always so many little things to do before a trip, especially one that will have you on another continent for two and a half weeks. Plus, I have a tendency to over-estimate what has to be done, something that would be evident if you could actually see my to-do list right now. I'd much rather do the things that need to be done, and still be able to enjoy the next two days.
  • Relationships - we're meeting a college student, Anna, in Frankfurt (she's flying in from Seattle), and she'll be joining us for the rest of our trip. Please pray that we'll connect with her quickly, and with the others that we'll be working with.
  • Physical safety - both for traveling and for our health while we're in Africa.
  • Purpose - I know that God has a purpose in sending both of us on this trip. I can make a guess as to what those reasons are, but only he knows them. Please pray that even as we finish last-minute physical preparations, that we'll be receptive to what he wants to teach us and do in us.
Thanks for supporting us!

Wednesday, August 11, 2010

welcome.

Welcome, and thanks for joining us as we chronicle our upcoming adventures in Gabon, Africa.

We've got just about a week and half before we leave. We've had all our shots, our passports and visas are ready to go, and all that's left to do is the last-minute shopping and packing. And of course, this is on top of our "regular" lives - I'm still busy with work and ministry responsibilities, and in the last 2 weeks Kelli has graduated, taken her boards, accepted a job offer, and is getting ready to move out of her house in Baltimore this weekend.

I figure we can slow down once we're on the plane.