Friday, 17 June 2016

Some Things I am Thankful for

I know we have made a lot of people cry with us recently, so on the start of this Sabbath, I wanted to share some things I am thankful for.

1.  Its Sabbath, and we get to rest
2.  God is a God of love and freedom
3.  Sin and sickness will one day be no more
4.  I am married to a beautiful woman who loves God, my family, and me with all her heart
5.  I have parents who raised me to fear God
6.  I am part of a worldwide church that believes the Bible, and encourages freedom of thought and difference of opinion.
7.  Freedom to worship
8.  To be part of a dedicated and talented group of medical missionaries at Malamulo Hospital
9.  Caleb will be 1 month-old tomorrow
10.  Georgia Peaches
11.  Michigan sunsets
12.  The Rocky Mountains
13.  Yellowstone
14.  Pretty rocks
15.  God’s promises, particularly Romans 8:28 today.
16.  Eternal life
17.  Gardening
18.  The generosity and support of friends
19.  Computers and the internet
20.  Eden Valley Institute of Wellness
21.  Modern Medicine
22.  That Shallena does not have any cancer in her bones, brain, or lungs
23.  Air to breathe
24.  Water to drink
25.  Family love and support
26.  Kai and Kristi Steele
27.  That our church values Education, Health Care, and Mission
28.  Abigail
29.  Jedidiah
30.  Kittens and puppies (to make children happy)
31.  Fishing
32.  The generosity of strangers
33.  Izod seaside poplin short sleeve shirts
34.  That we are not alone
35.  The Bible
36.  Electricity
37.  Running water
38.  Cherries and blueberries
39.  Malawi Mangoes
40.  The Shanti Ruth Pediatric Fund at Malamulo Hospital, and all the lives it has saved
41.  Intimacy
42.  Miracles
43.  Ceiling fans
44.  Disposable diapers
45.  Healing
46.  Prayer
47.  Peace in the middle of a storm
48.  Love in the midst of grief
49.  Companionship

50.  Hope

Wednesday, 8 June 2016

The Love of My Life


“You call it a Bible study, but it’s not a Bible study.  It’s an Ellen White Study.”  I looked for a moment into the intelligent and fiery eyes of this mysterious and opinionated young lady, and pondered for a moment. 

“She’s cute!” I thought to myself. 

Hardly the romantic start of a never-ending fairy tale, but oh-so truly the start of our love affair.  The strange new girl on campus was no other than Shallena Russell, and she was working her way up my list.  We met at a Bible Study – well, actually an Ellen White study – that I was leading.  Despite fundamentally different perspectives on the nature of the exercise, we met on the level of the discussion – we both cared deeply about spiritual things.  She had come to Andrews University looking for spiritual community.  I was knee deep in a Biology degree looking for a soul mate who could help me figure out why I was doing a Biology Degree, and just about everything else in life.

I didn’t have a lot of time to lose – Shallena was hotly pursued.  As I valued her independent thought, listening ear, and raw honesty, others were also noticing.  We went for long walks, climbed trees, talked by the moonlight, and sledded down sand dunes.  Those others were becoming less relevant.  I was walking on air, she was still not entirely convinced. 

What exactly it was that convinced me is not clear even today.  Whether it was her blunt honesty in the face of doubt and perplexity, her staunch commitment to family, her love of the natural world, or her search for an authentic walk with Jesus – it didn’t take long before I knew I wanted to be in the inner circle with this Georgia Peach!

Then one sunny summer Sabbath day, I finally managed to ask her to marry me, and she finally managed to say yes.  It’s always taken us longer than other people, but once we get rolling, we usually get it done.

February 3, 2002 Shallena and I became one.  Since that day we have shared life as a family in all of its joy and woe.  I thank God for you, Shallena.

Several months after our wedding, we took a five week “honeymoon road trip” which took us to the Rocky Mountains.  Wyoming had gotten under my skin, and I wanted to show it to my new bride.  I showed her the snow-capped Wind River Mountain Range in Northern Wyoming, and it was not long until we were in it.  We had planned a five-day backpacking trip, and it promised to deliver a memorable experience.  Our first day of hiking was rigorous.  We packed our bags, started plodding up the mountain.  I’ll never forget how she got frustrated with the 13 switchbacks up one of the mountains, and just decided to go four-wheel drive straight up the incline.  At the top, a refreshing breeze cooled the sweat on our brow.  Just around the next corner was Clark’s Creek. 

Now, I didn’t know much about Clarks creek, but as we surveyed it that June day, the water level was high from the melting snow, and it was looking more like Clark’s River.  There were several logs thrown across the rocks making a precarious bridge with raging whitewater underneath cascading down the mountainside.  It didn’t look too good to me – it was unthinkable to Shallena.  I got to work sourcing logs to bolster the viability of our bridge, and finally arrived to what I considered passable.  Shallena wasn’t convinced.  I teetered across with my backpack, put it down, then crossed again with Shallena’s backpack.  Finally, I found a sturdy stick and held it out for Shallena to hold on to.  She slowly started the journey over the raging water.  One step at a time, holding on to the stick.  Gentle encouragement, a little slip, a little fear, a safe landing on the other side. 

Once safely across the river, we hugged and danced, and felt like we could do anything.  Clark’s Creek had become the best one-hour marriage enrichment seminar possible.  Our growing love had reached a new depth in trust and accomplishment.  One small step for the trip, one huge step for the marriage.  We went on from Clark’s Creek to Summit Lake, Porcupine Pass, and finally down the other side of the mountain.  It was our first trip of the sort, but became a defining event for us as we have returned to the Wind River Mountains at least 4 times since to retrace our steps. 

Shallena cried as we drove away from the mountains that had stretched and grown us. 

Then came Medical School and Residency with all of their demands.  “I miss you”.  Her sweet brown eyes fixed intently on mine.  We hadn’t planned on being a doctor’s family when we said “I do”, but God had made it clear we were supposed to go, and Shallena supported me every step of the way.  When I had more reading to do than I had time, she read to me.  I remembered best those long words that she didn’t quite pronounce right...

We went on from the training life in the United States to the working life in Malawi.  It took us a long time to get started in Malawi.  We spent many nights talking until we couldn’t talk anymore.  I will always remember her soft, calm, wise voice speaking wisdom in the middle of the night into my young and immature ears as we faced our biggest challenge yet. 

After returning from our Intern Missionary Year, Shallena was diagnosed with Breast Cancer – DCIS.  I will always remember her response – true to every non-entitled fiber in her being – “Why NOT me?”  She didn’t chafe, didn’t complain, but simply asked God for more time to raise her children, and to work for Him.  Her wish was granted. 

We returned to Malawi with a renewed energy and commitment to the work God had given us to do. 

Then a couple years later the phone rang.  I didn’t want to take the phone call, because I knew what she was going to say.  However, it was better for me than Shallena.  

“Jamie, the biopsy showed invasive ductal carcinoma”.   There were a lot of questions of how an essentially benign and fully treated problem had in actuality recurred and spread.  There had also been concerns about an ultrasound that showed a mass in her liver, and we knew too much to remain in denial. 

We asked the children to play while we sat on the porch with our newborn baby and cried.  Jedidiah saw us, “Mommy, is everything okay?  Why are you crying and praying, is somebody going to die?”

“Jamie, we have to be strong for the children.”  We wiped the tears away, and went in to play a hollow game of UNO.

Later that night as we processed the news alone, we sat and looked at each other through blurry eyes.  She knew as surely as I that this was a malignant diagnosis.  She told me I would have to get remarried because the children need a mom – providing for her family, even in the event of her absence.  I told her I was not ready for that conversation, and asked how she was being so even and composed about the whole thing.

“Jamie, when you come to a raging river, and you have no choice but to cross over, you have to take hold of the stick that God is holding out to you and go forward, even if the other side is eternity.”

So, dear friends, here we go.  We don’t know how long this journey is going to be. We do know that it ends in eternity when God has safely carried us across the raging river and wiped these salty tears from our eyes.  Why we have been given this road to walk will one day make a lot more sense than it does today.  But just as Clark’s Creek grew our love and trust in each other from the fear of it, so Breast Cancer is not a fit foe for the grace that God has already shown to our family.   We are taking it slowly, one step at a time, holding on to everything that God has given us to stabilize our stumbling feet.

As I write this tribute to My Love, she is undergoing Lifestyle Treatment at Eden Valley Institute of Wellness.  We have met caring and dedicated staff who have helped to highlight the value of lifestyle choices and simple treatments in the fight against cancer.  We came because Shallena needed some time to recover from a difficult pregnancy, as well as to process the road ahead – we are staying because we feel God has led us here.  We will be leaving Eden Valley in a couple weeks, and plan to stop by Mayo Clinic on the way home to help us with the next step in sorting out other treatment options.

I want to say a deep and heartfelt thank you to all of the friends, family, acquaintances, and strangers who have so generously given to us their love, prayers, and financial support.  We didn’t ask for it, but our dear friends the Steeles and Jefferys didn’t really give us a choice in the matter.  The encouraging words you have sent our way have renewed our strength day by day, and you have lifted the financial burden we would otherwise be bearing.  We have felt God’s divine love in the overnight community that you have become for us.  Thank you for your love.  Thank you for your prayers. 

Tonight, I have one new request.  As many of you may know, there is an undeniable psychological struggle that comes with a diagnosis that is as morbid as Stage 4 Breast Cancer.  We are gearing up for the fight of our lifetime, and there is no looking back.  God is taking us where we have not been, and every step is a new experience fraught with fear and faith.  You have already helped us by your words of encouragement and prayers, and we are eternally grateful.  My request now is if you could also share with us some of the happy memories that you have had with Shallena.  She eagerly reads the messages of support, and in the trying days ahead, those stories will give her strength.  I know not everybody has a story, or is a story teller, but for those who are, I would deeply appreciate your story about the Love of My Life.  It doesn’t have to be long, and if it’s funny, you get bonus points.  For now, I am requesting you post the story under the comments on the YOUCARING page which can be found at


Thank you for caring, we thank God for you. 

Wednesday, 1 June 2016

What I am Praying For

What I am Praying For

“Daddy, is mommy going to die?”

We were laying in one of those snuggly end-of-the-day lounges where daddy is the pillow, and Jedidiah (6) and Abigail (2) were the wiggly squirming children who were supposed to be going to sleep.  That cold night back in December 2013 left me feeling chilly, but I was strong.

“No sweetie, (big sigh), mommy isn’t going to die”. 

We were awaiting a definitive surgery to make sure the good news that the surgeon had told us earlier was really true.  The workup until that point had been unnecessarily frightening, but we waited for confirmation of our guarded hope.

Finally the day came, the surgery went well.  “The sentinel lymph node was negative” seemed to be the icing on the cake, and we had a new lease on life!  Shallena was sore from surgery, but our hearts went home leaping like “calves out of the stall”.

Two and a half years later, and a few days ago we received the news that the cancer that had been cured had spread to her lymph nodes and the liver adding up to a diagnosis of stage 4 breast cancer.

Stage 4 breast cancer is something that is a little harder to stomach.  Average overall survival around two years, no accepted cure, palliative chemotherapy…

“Daddy, is mommy going to die?”

The last week has been a roller coaster at best.  While we have the sweetest newborn baby you could imagine who only wakes us up three times a night, I also have this new strange feeling in my chest.  It’s that feeling you get when your wife says, “Please don’t buy me any new clothes”, or “They are little, they need a mommy”.  Or just one of the many sporadic daily red eye sessions.  I have only felt honest to myself when I have been crying or praying – everything else has been pretense.

But in the very same week, the week that has marked our life forever, there has been a mysterious grace.  The encouragement, prayers, and support of family, friends, and even strangers is a balm to our soul.  Friends we haven’t seen or heard from in decades writing to share their support, and add their flame of faith to our flicker. The love that I feel when I look into those beautiful brown, tear-stained eyes.  Fourteen years married to my best friend, and the miracle that two willful adults could experience such love.

And then there are the prayers…we have never been prayed for as much as we have been in the last week.  The outpouring of goodwill from family, friends, churches, missions, and others has been overwhelming.  Thank you for your prayers and your support. 
As we have spent more time on our knees in the last week, I thought I would share what I am praying for.

1. That the will of God be done.  We serve an all-powerful God who created this world, and designed each of us from the dust that makes our DNA.  Disease, even stage 4 cancer, is ruled by His permissive will.  It is our desire that this trial brings glory to God, salvation to our family, and the likeness of Jesus to our souls.  We didn’t choose this, but it has been allowed to pass through the nail scarred hands of Jesus.  We pray to be faithful in the middle of it.  Please pray that God’s perfect will be done in our family, and especially in the life of Shallena.

2.  To not become bitter.   We pray that God melts our hearts through this fiery trial.  It is so easy for self-pity to creep in with a sense of entitled merit, but we pray to always remember His Grace.  Jesus—the purity of the universe-- became sin for us, and He has promised to be with us in the fire.  Please pray that we will not become bitter.

3.  The Glory of God.   We live as the unworthy objects of an infinite grace.  When Jesus was contemplating His ultimate sacrifice He said, “Now my soul is troubled and what shall I say? “Father, save me from this hour?  No, it was for this very reason I came to this hour.  Father glorify your name!”  John 12:27,28.  At the bottom of all of our tears is a desire that God’s goodness be seen in our lives and in our struggle.  Please pray that our story will glorify God and increase His Kingdom. 
4.  Healing.  We have asked God, and will continue to ask God to heal Shallena.  Whether it is by a miracle of a moment, by following natural laws and principles, or modern medicine, we are praying that God brings complete healing.  We will wait, follow where He leads us, and watch to see what He will do.  As He reveals His will, we will submit and praise Him for His leading in our lives.  We know there will be healing.  Please join us in praying that we will know the best course to pursue to help the healing process, and that we will recognize it as it comes. 
5.  Our Children.  We have three beautiful children who are all processing this situation very differently.  Jedidiah is more aware of the situation while Abi is just acting out her feelings, and Caleb truly does need a mother.  Please pray for our children – they need it in every way.
6. Malamulo.  For the last three and a half years our family has been working at Malamulo Seventh-day Adventist Hospital in Malawi.  We thought this was our calling, and fully planned to continue the work there.  Malamulo has stood for Christ-centered healing for over 100 years, despite the enemy’s sundry attacks.  Please pray for the Mission at Malamulo including the other Missionaries and the administration. They are doing God’s work, and now have more work than before.
For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.” Romans 8:38,39.

Friday, 13 March 2015

Words

Hey Guys,
This is not a "mission" post. If you're looking for that, stop reading here. It's a personal learning post, but it's part of the journey, right?

This morning I read these verses:

Proverbs 25:7-10

What you have seen with your eyes
   do not bring hastily to court,
for what will you do in the end 
   if your neighbor puts you to shame?

If you argue your case with a neighbor,
   do not betray another man's confidence,
or he who hears it may shame you
   and you will never lose your bad reputation.

Ouch! Stabbed in my guilty heart! How many times have I told someone (even my own husband) what I saw another person doing for my own purposes--either to prove my point, or justify my feelings about that person or situation--only to discover later that my assumptions were wrong? I "brought them hastily to court" so to speak, without first learning the truth of the matter, and I felt ashamed.

How many times have I, when arguing with my neighbor, felt that my position needed reinforcement, maybe because of my own insecurities or because I didn't know how to deal with a forceful personality? In those times, have I slipped in something that someone told me in confidence to try to "solidify" my argument and "outnumber" their objections? Convicted! Painfully the knife twists.

Is my reputation tarnished forever?

But I don't really need to worry about that, because each day that God wakes me up is a day to hope! HE hasn't given up on me!  When I feel convicted while reading the Bible, it is encouraging "because the Lord disciplines those He loves" (Proverbs 3:12). That means God loves me! He still has a plan for my life. He forgives me and is creating in me a clean heart.

This is His promise:

I will write my law in their minds
   and write it on their hearts.
I will be their God,
   and they will be my people.

For I will forgive their wickedness
   and will remember their sins no more.  (Jeremiah 31:33,34)

Thanks be to God! Thus He can make my words honest, helpful, and beautiful, "like apples of gold in setting of silver." (Proverbs 25, the next verse.)

I want to live for Him.


Wednesday, 11 March 2015

A Jungle Hike

A Jungle Hike, in pictures.

Jungle destination--Mount Mulanje, covered in fog.

Let's Go! Jungle Adventure!

Jungle Pipe

Jungle Stairs

Jungle Flower

Jungle River



Jungle Boy
Jungle Beauty

Jungle Girl
Jungle Splash!

Jungle View

Mulanje Jungle Cedar

Jungle Bridge


Jungle Fungus

Bye!

Friday, 27 February 2015

Malawian Spirit

The Malawian spirit. It is resilient and positive. I will illustrate, but first a disclaimer.

You probably know that when most missionaries move to a new culture, there is a "romance" period. For us, the time of year (rain, mud, and bugs), combined with certain events that occurred immediately after we arrived, denied us that infatuation. Many of you have read the blogs that I first wrote and you know what I'm saying. If I were transparently honest with you, I would tell you that I arrived in Malawi carrying within me the deepest wound of my life. The pain caused my soul to grow dark, combative and restless. That was a setup for difficulty.

Our first thoughts about the people and the culture were less than positive. We saw jealousy, envy, clutching, greed, refusing to let people climb out of their class, and more. It seemed they did not want us here.  We questioned many things, right down to the meaning of life. 

We prayed a lot and others prayed for us when we couldn't. Light began to glow from the very people we felt rejection: Malawians.


"Madam, my baby died and I know this man killed her." 
"You do? Will you do anything?"
"No, madam. That is God's plan. It is my plan to forgive. I will chat with him as my friend."


A man and woman gave Jamie a ride up the hill after work. 
"How are you, doctor?" they asked.
"Tired, and glad it's Thursday night," he replied.
"We are, too."
"But we must thank God," said the woman. "We have our business jobs, but today there were men digging holes all day. We must thank God for our good jobs."


A woman's husband stole her money and abused her. I said to her, "I'm so sorry for what you've been through!"
Her response? "It's okay, Madam. I must thank God. I have a house, healthy children, and a job."


When I told a Malawian lady the troubles we were having finishing some of our projects, the obstacles seemed to be insurmountable to us at the time. Not to her. She replied confidently, "But you will finish. It will not be long now. You will get it done." I stared at her, realizing that her life is harder than mine, and my struggles to complete a construction project insignificant.

According to the World Bank, Malawi is currently the poorest country in the world, with half the population below the national poverty line. Life expectancy at birth is age 55. To say life is difficult in Malawi paints too small a picture. Yet we see hope, faith, and courage. "It is the will of God," they say and leave it with Him. It is not hopeless; it is acceptance.

During the two years that we've been here, I have fought for respect, my rights, against things that make no sense. Fighting. Striving. Having every advantage the world has to offer but living without peace. God brought me to a land that is in vibrant contrast to all I know to show me that there is peace that truly passes understanding. That it is possible to have faith even when I don't have the answers. There is hope.

All through these gracious and gentle Malawian people. God bless them.

Monday, 23 February 2015

Expectations

Why did we come to Africa as missionaries?

Was it for personal gain?

Was it to make a name for ourselves?

For me, was it the times when I was little that my dad returned from his business trips to South 

Korea, bringing beautiful traditional clothing, elegant dolls, an exotic smelling hard (stone?) chess set, and stories of wonderfully kind people?

Was it the mission stories he read to us weekly for years when I was young?

All I know is that was in my heart most of my life.

For Jamie, it was a mission trip with Pathfinders when he was in ninth grade. He found his path in missions.

So we came. We’re here, and it’s not at all what we expected.

We expected a lower standard of living, and it is.

We expected big fat bugs and skinny muddy roads, and there are.

We expected tropical fruits and exotic birds, and they abound.

We expected daily tasks to take more time, and they do.

We expected to meet very poor people and barely clad children, and we have.

I expected to make deep friendships with the nationals, and we haven’t.

I expected to join a united group of missionaries, and was disappointed.

I expected to be wise enough to know how to help when asked, but I don’t.

I expected to transition smoothly, because this is what we’ve always wanted, right?

I expected to be the person who easily forgives, who is always gracious, always focuses on our purpose, and stays close to the Lord. That is who a missionary is, isn’t it?

Truthfully, I almost always feel lonely. Doesn’t that mean I’m a failure?

As I write this there is the sound of desperate wailing in the street. My heart feels a deep sadness as I listen to their pain. How often these dear people must lay a loved one to rest! The pastor in church last week said, “There is not one of us here who has not lost a loved one.” Not one!

Then I realize that I’m lonely, empty, hurting, floundering, lost, and discouraged because my expectations were all about me. All my striving and fighting. All my hopes and fears. And that is not why I’m here.

It’s not about me. Not being a missionary. Not life.

Time to change my expectations. 


Saturday, 25 October 2014

Coming Home, Take 2

You know, I'm always exhausted when it's time to go on Annual Leave. It's a lot of work sorting out the house and staff for other Americans to live in my house when I'm gone. I pack away the most valuable items, organize closets and shelves so there is room for another family's stuff, train my workers on new duties heretofore unlearned, try to get hospital maintenance to fix some of the broken items in the house (with a 1:5 success rate), move furniture around, stow away carpets since it will soon be the rainy season, pack our stuff, visit with our friends who want to say good bye, and clean a big concrete house. Btw, I will never own a concrete house.

The flight over the Atlantic Ocean was very bumpy. Usually that scares me a lot, but this time it didn't. It just felt like the Makwasa road, the road we have to drive when we want to go to the nearest city an hour and a half away. Truth be told, it was gentler than the road, because even though there were sudden movements, there was no jarring impact such as the potholes give a person. 

The children did great on the airplane. No vomiting this time. When Abigail fell asleep, I immediately noticed that her pants legs were pulled up. Tensing, I reached over to pull them down, but then stopped and relaxed. "There are no mosquitoes on the airplane to bite her," I reassured myself. That happened twice. It has become reflexive to always think of protecting the children from mosquitoes and malaria.

On the 16 hour flight from Johannesburg to Atlanta, usually the flight attendants become noticeably irritable with the passengers. This time they were all courteous the entire time. At the end of the flight, they took donations for breast cancer research. As we touched down into Atlanta. I started crying. I was trying to hold back, but I felt like having a good bawl session. This confused me. I stood up and stupidly went to tell the flight attendants that I appreciated how courteous they were during the long flight, and this is what happened. "I just want to thank you...sniff sniff...for how kind you all were...sniff, sniff, wipe tears...during that long flight. That was the first time...sniff, sniff, boo hoo..." A stewardess interrupted me, "Are you okay?" "Well, I'm feeling emotional," I wailed as she nodded and walked away. 

There were no car seats on the Super Shuttle, but the roads are so much more orderly here, and the shuttle so big... .

When we arrived home, the same home in which my children first lived, Abigail said, "I like this home better than the Malawi home. It's cleaner. And if I hit my head on this wood floor, it won't hurt me like the floor in Malawi does." This is the same little girl who, upon arrival in this home last year, said, "Dis not my home! My home Mawawi!"

Jedidah wanted to take a walk at 1:00 a.m. and I tensed before I remembered that I don't have to spray him first or say no. There are almost no mosquitoes here and definitely no malaria. Relaxing, I replied, "That sounds fun!"

A calorie conscious friend (that I love dearly) came over, and I don't know if any of you missionaries can relate to this, but I just wanted to give myself three or four days to eat freely, whatever I want! There is so much tasty food, so easily available, that is so much easier to prepare. I bought prewashed salad and carrots! I didn't have to haggle about the price of my avocados! My children begged for Taco Bell, and one day I bought it, but my friend was here when we arrived home so we didn't get to eat it. Then she and her children ate it! 

They ate my Taco Bell! 

They ate my watermelon! 

We have waited all year for good watermelon! Her children eat it nearly daily because they live in Southern California. I told her that we daydream all year for good watermelon, and that it was the only one we have purchased and just chilled, but it fell on deaf ears. That was hard for me, but good for me. We can buy more watermelon, and it is good to share even when we were not planning to...but I must say that a missionary salary is not extravagant! And when we come from a land of many limits to the land of freedom and plenty, there are a lot of expectations and many things we look forward to:

Like wearing pants!
Like dressing my children in white!
Like being able to throw away my ziplock bags!
Like having a real garbage can and garbage bags!
Like having a dryer to shrink our clothes back into shape!
Like having a shower!
Like the convenience of driving a few minutes on a good road with a car the works properly to a clean store that accepts credit cards when I need or want something today!
Like having no cockroaches in the house!
Like not having the stress of revolving the house cleaning around keeping cockroaches and mold out of the house!
Like being in my house without being asked for something 20-50 times a day!
Like having a chance to play crafts with my children!

Like crisp, sweet, juicy watermelon!!!

Today I enjoyed the deliciousness of just staying at home. No one has interrupted me once. The house and laundry are so easy to keep clean, food is so simple to prepare. The electricity and water work every time I need to cook or wash dishes or bathe children. I made crafts with my little ones for two hours and peacefully cuddled them when they fell asleep. And now I've had an hour to write about it!

Life seems so simple here.

I hope you appreciate what you have. It's not that way everywhere.

And maybe tomorrow we'll buy a Taco Bell bean burrito fresco again, and see who else we can share it with.








Monday, 15 September 2014

Surprise

Sometimes my job takes me by surprise. Like the time we were delivering twins and found
triplets. How those three triplets all weighing less than 3 lbs in the harsh African conditions
survived, and how just last week their mother and grandma “agogo” visited us at our house
looking very healthy and fat at 13 months of age. I really liked that surprise, and look forward to
surprises like that.

Unfortunately, not all surprises in my job are good. The other day I was called to see a little
18 month old baby who was struggling to breathe. His bed looked extra large next to his
small body with his mother snuggled next to him. Mom was quiet and sweet as almost every
Malawian mother I have met watching over their precious charge. The baby while not wasted
appeared chronically ill. It was not very surprising to find out that this child had HIV, and was
likely struggling with pulmonary tuberculosis. I wish it were surprising; it's not.

Another surprise is that in Malawi, there is a medical record system that is much more efficient
than in most developed countries like the United States where I come from. Patients carry with
them a health passport. It is a small book -- about the size of a real passport -- and serves as
a repository of all pertinent medical information. In one or two minutes you can review the sum
total of an individual’s interface with the health care system. I asked to see the mother’s health
passport book, knowing it would have more information. That is where I found what I did not
expect.

It seemed she had been diagnosed with HIV after she had delivered her child, and therefore
had not been put on treatment to prevent transmission to her child. In Malawi, there has been
a lot of effort to prevent congenital transmission of HIV from mothers to children by universal
HIV testing and treatment during pregnancy. Through national efforts, the rate of perinatal
transmission has dropped from 25-30% to less than 5%. Consistent with the African trend of
improved outcomes for people living with HIV/AIDS, these statistics give me hope that one day
this scourge will abate.

Unfortunately, my little patient and his mother missed out on all this. I continued reading the
story -- six months ago this quiet sweet 28 year-old mother of three had been diagnosed with
stage 4 inoperable cervical cancer. She would not have long to raise her children.

I have become a little bit “tough” after working in an environment where bad outcomes are more
common than we would like, but that caught me off guard. How in a short time this nursing
mother would be taken from her family by the sadistic synergism of two preventable diseases.
How her last to be born son was also suffering from a deadly combination of preventable
infectious disease. How if he were to survive this illness, for the rest of his life he will deal with
the stigma and consequences of having congenital HIV, and to face it all without that comfort
God has graciously given to little boys who deal with injustice...

I don’t think about all this when I see patients -- it would incapacitate me from a healthcare
professional to what I am right now -- emotions and tears. But the fact that I don’t think about it
doesn’t mean that it is not everyday life for these dear people. They are mothers and children
first, and patients last. I take off my white coat at the end of the day, they suffer. This story has
been repeated time and again in our villages.

Cervical cancer is the leading cause of cancer related death in Malawi. It is a sinister disease
that attacks women in their prime of motherhood. The pathogenicity and course of HPV (the
cervical cancer causing virus) in HIV is accelerated, and a cancer that would ordinarily take
decades to progress to a life-threatening disease, only take a few years or less. It is because
of this that our hospital has targeted cervical cancer as a top priority for prevention. Through a
simple screening technique called a pap smear, the rates of cervical cancer have been cut by
over 80% in developed countries. Malamulo Hospital is one of the only places in Malawi where
a pap smear program has been developed. With the help of Loma Linda University, the PAPS
International Team, the Coto Family, and the leadership of our previous Medical Director, Dr.
Cristy Shank, and our dedicated Malamulo staff we have to date screened almost 3000 women.

We have treated over 100 early cancers with minimally--invasive surgical procedures, and over
30 women have had a life-saving hysterectomy provided free-of-charge by our Surgeon Ryan
Hayton. Through what has been done in the last two years at our Women’s Health Center we
have saved over 125 mothers’ lives. How surprising is that?

The reality is that Malawi is a country of over 16 million with no fewer women than men. What
we have done is only little, and we would like to do more. We need to increase our capacity for
screening and treating women with early cancers. We need to train more cytotechnologists to
read the pap smears, and we need more supplies and equipment.

If you would like to partner with us, please pray for our work. We have given our work into
God’s hands, and we are dependent upon Him as He leads us forward. He knows no haste nor
delay or surprises, and we have seen His hand moving us forward.

“For we are God’s handiwork, created in Christ Jesus to do good works, which God prepared in
advance for us to do.” Ephesians 2:10.

If you would like to partner with us by giving, we request you do so by making your contribution through Adventist Health International with a note that you would like it to go to the “MALAMULO CERVICAL CANCER” project. Their website can be accessed at the following address: http://www.ahiglobal.org/main/main/

Friday, 23 May 2014

Today

Jamie took the children outside this morning to transplant tomatoes in the rain. Abigail came in first, covered in mud. I changed her into clean clothes. After two bowls of oatmeal with raisins and two Big Franks with ketchup, she was satisfied. The men came in and ate while wearing their muddy clothes. I washed the dishes in a tiny bowl of water, so they didn't feel really clean, and that made me feel a little grumpy. But then I was happy that we had water at all. I swept the floor.

"Baa, baa, baa, baa." Mama Sheep was bleating and stomping. It was a good day, because Jamie was home to take care of them this time! "You better go check on Mama Sheep!" I said. "She doesn't bleat like that unless there's something wrong."

He walked to the ewe, then ran away from her and then ran back to her. The next thing I saw was Jamie running, followed by three sheep! More ants! He planned for the sheep to run behind him to the backyard, but they had different thoughts. Spying the ripe papaya sitting on the front step that Jamie had picked that morning, they turned and started happily munching! When Jamie ran back from the backyard, there they were! He chased them away only to return to find the chickens claiming their share! Before they departed the front step, they left a deposit.

After putting Abigail to nap, I heard, "Cluck, cluck, cluck." Three hens were sitting in my dining room chairs! Grabbing a broom I shooed them outdoors and quickly disinfected the chairs and swept the floor.

Abigail awoke, and after she ate, three more hens ran into our house, with Jedidiah and Ellie the German Shepherd giving chase. Two went back outside, but the third one took off down the hallway, right into the children's room! She ran over all of my children's scattered toys and perched on top of their wooden kitchen. When I took her outside, there was Abigail, jumping in huge muddy puddles. I called her in and changed her clothes, again. And swept the floor.

Thankfully the water was flowing by that time and I began disinfecting toys. Then Jedidiah and his oversized puppy ran inside. Chunks of soil covered the floor and muddy paw prints marked a line to the dog food. Again, I swept the floor. The children took their baths.

Then Jamie came in, and the mud was from man-sized shoes and pants that time. I swept the floor. They ate supper while I sank into a chair with a headache.

Sometimes I just want to feel clean.



Our yard today

Monday, 5 May 2014

Welcome Back!

“Doctor, there is a patient in Maternity”.
It had been a good day of administrative discussions. As part of becoming the new Medical Director, I had spent the day catching up on the hospital business. We had wrapped up nicely by 5 pm. I had told my wife that I would be “home by 5:15”. She was obviously looking forward to it. 

“She is in labor, but the baby has no heartbeat”.

After the talks I decided to wander over to the Medical Ward as I had heard it was a “very busy day”. I hesitated as I thought about 5:15, but only being back in the hospital for a day, I thought I should at least show up to support our busy troops. I arrived to see a flurry of activity with our staff admitting, triaging, and treating multiple severely ill patients all at once. Our Clinical Officer was waving admission papers in his hand feeling the pull of multiple emergencies at once. A 29 year-old patient with hypoglycemia and alcohol intoxication had just pulled out his IV, and was about to seize and aspirate. He died a few hours later. 

“She is fully dilated, but having a lot of pain. The baby is not coming down”.

This story wasn’t sounding good. I looked around for a qualified delegate, but realized all hands on deck were busy. I reluctantly said goodbye to 5:15, and we went to see her together.

She was tired and pale. Her heart rate was fast, and blood pressure was low. She was tender in the middle of her abdomen, and while fully dilated, the baby was not coming. We discussed her. “Doctor, she is having strong contractions, if her uterus had ruptured, there would be no contractions”. That sounded reasonable, but something didn't make sense.

Uterine Rupture is one of the most feared complications of childbirth. It is also a leading cause of pregnancy-related death in Malawi. The most common risk factor is a previous Caesarian Section (which our patient had several years earlier).

I did an Ultrasound of the uterus. While I’m no expert at ultrasound scans, it seemed there was free blood in the abdomen. She needed a surgery.

In the Operating Theatre, her condition deteriorated. Heart rate going up, blood pressure going down; she was starting to get confused. Pulse 150. My pulse close to 150. We commenced the operation with a prayer for help. Blood gushed from the abdomen. The small rupture in her uterus had bled two liters into her abdominal cavity. An average human being has 5 liters of blood in their body. With the additional blood loss of surgery, she had lost at least 50% of her blood. We had 200 mls of blood available for transfusion (about half a pint). We started to give it. We removed the baby -- a perfect lifeless baby -- and proceeded to sew the uterus back together. Our Clinical Officer, Mikson, performed the surgery with skill far beyond his training. Jaqueline Uy, a Loma Linda University Family and Preventive Medicine Resident calmly assisted him in the procedure. I watched with admiration as the international team work to save a mother’s life.

Fortunately, we had the equipment to perform an autotransfusion of another 700 mLs of blood we could salvage from what she had lost.

The bleeding was arrested, her vital signs gradually improved. After thanking the team and ensuring she would be closely monitored all night, I started to head home a little after 8 o’clock. Her life hanging in the balance.

“5:15?”.

“I’m sorry”.

“You weren’t on call”.

Most developed countries have a maternal mortality rate of 20 maternal deaths per 100,000 live births or less. In Malawi the number is hard to know for sure, but is between 400-600. Easily 20-30 times higher than in the United States (which is far from the best in the world).

My children were energetically going to bed when I got home. “I was taking care of a mommy whose baby died”. I couldn’t help but notice how energetic and healthy they looked tonight. Jedidiah had lots of six year-old questions about how that was possible, and what we did about it. Abigail, our spunky two-year old, just got upset. “The mommy should have her baby. I want to pray for her.” She proceeded as only a sensitive angry two year-old could, “Dear Jesus, please help the Mommy that doesn’t have her baby. I don’t like that.  Amen”.

Hug your babies tonight; hug your mommies tonight. If you live in a country with good healthcare, thank God for it, and remember those who don't.

Saturday, 3 May 2014

Ready to Return

It's time to go back.
Time to go back to...

fog that mysteriously rolls across the ground seconds before the sound of rain
squawing turacos in the brilliant orange flamboyant trees
chattering monkeys perched in the blue gum forests which rise like sentries amid rolling tea fields
chitenge clad women carrying baskets atop their heads with babies tied on their backs laughing together
the bleating response of goats to the goatherd's waved stick
rainy season's odor of decaying masuku fertilizing the tree from whence it grew
roller coaster pot-holed muddy roads
mournful wailing passing my house as another villager closes his eyes for the last time
jealousy and greed and entitled demands
missionary strife and discord
a battle that is more than flesh and blood

Monday, 20 January 2014

Thirty Something


I am thirty something.  We are an interesting group.  Most of us have moved from studying to working.  We are building our castles;  securing our posts.  Being fruitful and multiplying.  We are moving up the ladder, consuming anything that gets in our way.  

I’ve been told this is the age of competition--we are trying to prove to the world that we really do have what it takes.  Alexander the Great conquered the world by thirty something, Jesus of Nazareth conquered the cosmos by thirty something.  It can be a powerful time, but what am I doing?

I’m driving a borrowed minivan that has a squeaky belt, and when I pull up to church or the drive-thru I feel like I’m “barely squeakin’ by.”  Maybe its because I’ve gone to school for 24 years and my liabilities are still more than my assets.  Maybe its because I am really not sure where home is anymore, or if I have one...

“Store up for yourselves treasure in heaven… .”  Matthew 6:20

Growing up American, I have acquired an interest in the “American Dream”.  Its sort of natural, I suppose, and being thirty something, I should be well on my way.  I don’t need a mansion or a fancy car, but a comfortable house with lots of land in a safe neighborhood would be nice.  My family wants to be comfortable and safe.  

I’m not sure if it was the comfortable part or the safe part that led us to decide to work at a rural hospital in a developing country, but it didn’t really work out that way.  We had things stolen on multiple occasions.  We found a thief in our garage.  We had spotty water, a shocking stove, and a constant dribble out of our shower head.  My work consumed me in an often losing battle with suffering and death for which I spent most of my time feeling incompetent.  We didn’t feel comfortable, and my family didn’t feel safe.

We returned to the United States from our rookie year a bit disheveled in spirit.  The warm shower was so luxurious, and we reveled in a trip to Costco.  Its amazing how a short time in a different environment can make what used to be normal seem luxurious.  It felt so comfortable and safe.

Then a shadow blew over our path that led us to the doctor and a diagnosis which we did not want.  In a moment the troubles of life abroad paled in comparison with the reminder that our days on this earth are numbered.  My plans and possessions were all placed on the bargaining table.  All of my material worth was rubbish in my eyes next to the continued presence of my wife.  

“And this is eternal life, that they might know You, the only true God, and Jesus Christ whom you have sent.”  John 17:3

I used to think that heaven was a beautiful place.  I used to think I was somehow supposed to invest in heavenly commodities instead of the stuff of earth.  To use my earthly money to be “rich” toward God.  To “buy” heavenly stock with US dollars.  Unfortunately, my concrete materialism did not help me understand the treasure of heaven.  

“Thou shalt love the Lord thy God with all thy heart, and with all thy soul and with all thy mind, and thou shalt love thy neighbor as thyself.”  Matt 22:37

I have come to see heavenly treasure as relationships.  First and foremost living in love with God, and secondly our neighbors.  When this law is realized in us, we have crossed over from death to eternal life, and we are storing up treasure in heaven.  The goodness of God leads us to love others, and we make huge deposits into our heavenly account.  

As I sit here feeling a bit of a thirty something year old failure, its hard for me to ignore that the American dream kills heavenly treasure.  I think it must have been upright and conscientious leaders in Jesus’ day who for their safety and comfort killed the King on a cross of shame.  He gave up His comfort, safety, and so much more because He was the sum of heavenly treasure. He came to live an immaterial life to build a personal and eternal relationship with every willing human being, and to convince thirty something year olds that we can trust Him instead of money, or other worthless things.  Baal and Molech didn’t save many Israelites, and trusting money won’t save a single soul in post-modern America.  If the status of my bank account or portfolio means more in my life than a meaningful relationship with God, I am bowing low to the golden calf.  

As Jesus is the sum of heavenly treasure, my relationships are a share.  Investing in my wife and children with time and love is the most tangible way to invest in heavenly treasure.  I hope 2014 finds this thirty something year old male investing in God and family.  I hope 2014 finds the false security of materialism dethroned, and the King rightfully exalted in the lives of thirty something year olds all over the world.  

Tuesday, 31 December 2013

Weeping may endure for a night...

"Shallena, I had a dream. In my dream, we had lived in Malawi for ten months, and we were packing up to go home. I remember that I felt badly about not being able to work here, but not too bad because for some reason I knew we had to return and there was no other choice."

Jamie's dream was still whirling around in my mind when I saw Sharlene two days later and she told me that she had a dream about us. She said, "Shallena, I had a dream. In my dream Jamie and I were walking together and he was crying big, man tears. He said, 'I've given so much to this hospital and now I've lost Shallena.' But when we walked to your house, there you were making supper for your children." She sounded bewildered. I told her Jamie's dream. She gasped and asked, "Which night was that?" It was the same night.

Fast-forward about a month. We are at home in Loma Linda on our long-anticipated, joyful first annual leave. "It is so GOOD to be home," I exclaimed each day! Sunshine, perfect temperatures, no humidity--this is what Southern California is all about! Then Jamie walked in on me after I finished my shower.

Concern shadowed his face. "What's that?" he asked, looking at my breast.
"Oh, that's blood. It's been doing that a while."
He palpated my breast. Very clinical. His frown deepened. "You should see someone about that."

The next day we flew to Michigan and told Jamie's mom. She scheduled me a doctor's appointment for a week and half later, when we planned to return to Michigan. The following day we drove to Louisville for CME, and then to Gatlinburg to see my cousin and her family.

"I am telling you this because we have a family history," I began. Then I told her what was happening and concluded with, "I don't think this is cancer, because this hurts and cancer isn't supposed to hurt. It's probably a strange parasite I'm hosting."

My children and I drove to Michigan and Jamie flew to Utah for CME. The next day I saw the family physician. She examined, palpated, and wiped some slides with the fluid. "I think it's nothing, but I'm sending you for a mammogram." That was Wednesday. The mammogram was Thursday.

Later that Thursday afternoon, the radiologist talked to Jamie while he was in Utah. "It's diffuse and aggressive. I think a random biopsy would be diagnostic. It's cancer until proven otherwise." That night Jamie cried big, man tears. The next day, Friday, he changed his ticket and flew home. We cried incessantly that weekend. We couldn't sleep. I didn't know how long I would have with my beautiful, innocent, trusting children. I thought of their lives without Mommy, and my heart ached.  Our deep sadness made us very gentle and compassionate to others.

I squeezed Jamie's hand through the painful biopsy on Monday. We cried a lot. We saw the family doctor again on Thursday. Jamie held my hand as the physician said, "I'm sorry, there is bad news. You have cancer." She cried and prayed with us, and touched my heart with her sympathy. The diagnosis: "Breast Cancer, DCIS, Grade 3, 7cm, EP positive (20%), likely invasive." The date was November 20, 2013. The month until surgery hurt.

Surgery was scheduled for December 16. While waking from a drug-induced sleep, I heard someone say to me happily, "The lymph node was negative!" Good news!

The pathology report arrived at our temporary residence a few days later. "DCIS, grade 3, at least 4.5 cm, necrosis, noninvasive, 2mm clear margins, lymph node negative for cancer cells."

What can I say, except to quote the words of David, in Psalm 21?

             "The king shall have joy in Your strength, O Lord;
              And in Your salvation how greatly shall he rejoice!
You have given him his heart’s desire,
And have not withheld the request of his lips...
He asked life from You, and You gave it to him—
Length of days forever and ever.

His glory is great in Your salvation;...

For You have made him most blessed forever;
You have made him exceedingly glad with Your presence.

For the king trusts in the Lord,
And through the mercy of the Most High he shall not be moved.
13               Be exalted, O Lord, in Your own strength!
              We will sing and praise Your power.


I would also like to say that our church has only given us the love of God in this situation and has been thoroughly supportive, compassionate, encouraging, gracious, and kind. We are completely grateful!

We will be in the States until spring, or until my healing is complete, at which point we will be cleared to return to our mission post. Thank you for being our friends and for lifting us up in prayer. Please continue to pray for us, because the fear and emotional pain lingers along with the physical pain. But we know it will end! As a dear friend of the family said, "God knows your name. He hears it often." What an honor and an encouragement!

And, my friends, please remember "... BUT JOY COMES IN THE MORNING!"