I've always noticed how God has taken care of me as I move around Monrovia and managed to avoid having car trouble at times or places that were dangerous or without access to someone to help me.  Yesterday, I was reminded again of how He is looking our for His daughters. Dr. Debbie Eisunhut and I went to Vai town on Thursday to look for some clothes and household things in the used goods market.  Just as we were looking for a place to park the car, she noticed that the brake pedal went to the floor under her foot. She was alarmed and pulled right into a parking space (amazing thing #1 -- there was one). Amazing thing #2 -- we were just a one mile (maybe a tad less) walk from our mechanic's shop -- so we hiked over there and got the mechanic and he came and got the car, took it to the shop and fixed it while we did our shopping. My legs were exhausted by the end of the day from all that extra walking, but we reflected on how amazing (thing #3) it was that she was not alone, not going 40 mph and stopping suddenly for a pedestrian, and really so close to the shop (which is no where near where we live!) Our Father's watchcare is so personal!! and amazing, right?!

I have come back to Liberia from the US many times over the years, but this time is different.  Because I am doing something new (starting a Family Medicine training program), the journey feels very much like it does to travel a new road to a new destination—as I move along, I am aware of every interesting turn in the road, and each glimpse I get of the goal far up ahead, of all the obstacles and potholes in the road as well as the places where it has been well-prepared for my travel.  I have that feeling that I know in general where I am going, but to be honest, I have no idea where I am along the way or exactly what my final destination will look like.  One thing I know, God is in the driver’s seat—He continues to show me that He is at work to get us there.

              

Within a few weeks of our arrival in Liberia, I was able to meet the leadership of the Liberia College of Physicians and Surgeons (LCPS)—the body that runs residency training for doctors here, and the body that will need to approve the program we are hoping to begin at ELWA.  I presented them with a proposal, expressing our desire to train Family Practice doctors for Liberia.  They agreed wholeheartedly with the need for post-graduate training for primary care physicians, so that meeting opened a dialogue that is continuing.  Soon after, at the beginning of November, I traveled to Abidjan, Côte d’Ivoire for the Annual General and Scientific Meeting of the West African College of Physicians (WACP)—the regional body we also hope to have accredit our program. The conference was an opportunity for me to network with trainers and faculty from Nigeria, Ghana, and Sierra Leone, as well the leaders of the LCPS.  On the flight home, I happened to be seated next to one of our WACP officers who is a psychiatrist, and we chatted about what a psychiatry rotation for our residents might look like.   

Last week, I would say we reached our first critical “milestone” on the journey.  On Tuesday, I spent the morning  with the LCPS President, Dr. Marshall, a Liberian woman who spent over 20 years practicing pediatrics at Johns Hopkins in Maryland, and is now heading up the Pediatrics Department at the Liberian medical college.  I visited her at JFK Medical Center, the main teaching hospital, and got a tour of the Peds Department including their Neonatal ICU.  There has been great progress at JFK—the hospital is clean, well-staffed, with many patients receiving care.  I was really impressed.  We had a good discussion about the future of Family Medicine in Liberia, and especially how a training program at ELWA might look.  The key result from this meeting was that I was given a “green light” to publicize our plans to start training family docs next year, so that prospective residents can prepare themselves for primary exams (which they will have to pass in order to enroll in the program). 

Later in the week, the Chairman of the local WACP Chapter Family Medicine Faculty visited ELWA hospital to thoroughly inspect our facility in preparation for an accreditation visit by the WACP sometime next year.  This visit resulted in a very long list of “things to do” to get the hospital itself in good shape.

Finally, we’ve recently been joined in this journey by two more traveling companions—Dr. Kent Brantly and Dr. John Fankhauser, family docs who’ve arrived from the USA in the past five weeks with their families. I’ll tell you more about them in our next update! 

As of this week, we have been here two months, and we are rejoicing in how quickly things are moving along.  Our primary prayer request as we departed was for FAVOR with those who would have to give the Residency Program approval and GOD IS ANSWERING those prayers in abundance.   Please CONTINUE to pray for every step we take with Jesus in charge! Specifically, pray for our medical and administrative team at the hospital to work together well as we tackle the list of upgrades and corrective measures that need to be made before we can be accredited to host a residency program.    

Happy Thanksgiving!  Our hearts are full of thanks for all that the Lord is doing already.

Yours in Christ,   Rick

Introductions...

I like doing introductions… Today I got to introduce a concept at the Liberia Medical and Dental Association (LMDA) meeting: the concept of starting Family Medicine Residency training in Liberia.  

I’ve been having some discussions with those in authority over physician training, and they encouraged me to speak on this topic at the LMDA. I reviewed the exciting history of the discipline in Nigeria, where thousands of Family Medicine residents have been trained since the early 1980s; reflected on some of my own experiences over the last 18 years; and wrapped up by asking the question “Is it the right time for Family Medicine in Liberia?” 

There was some pretty enthusiastic support for the concept, as well as some lively questions and discussion about the logistics and details. I was joined at the meeting by our newest arrival, Dr. Kent Brantly, a Family Physician from the US serving here through the Samaritans’ Purse/World Medical Mission 2-year Post-Residency Program. He’ll also be a part of developing this vision. We are anxious to see what God is going to do! 

A Trip Down Memory Lane

www.sim.org featured an article today about our evacuation from Liberia in April 1996.  It has some great photos as well as a good account of that day from someone who remembers the details far better than I do.

http://simusa.org/content/latest-news/3247/a_17_year_evacuation_reunion

 Transitions…

Debbie and I have been here a week… we’re over jet lag; I’ve even seen a couple patients! But we’re just getting into the real business of this transition, and we are right in the middle of a rather big transition for ELWA Hospital that will last at least another year. 

The obvious physical transition is that ELWA is going to move into a new hospital, hopefully by the end of 2014.  The hospital is being built for ELWA by Samaritan’s Purse (SP). The Kitchen/Laundry Building is complete; the cement block structure of the new Outpatient Clinic is mostly done; the Male, Female, and Pediatrics Wards are being built; and the Operating Room and Obstetrics Ward will be next. 

Some masons working on the upstairs Pediatrics Ward (above), and the new Male Ward (below).

SP’s Construction Supervisor, our good friend Rusty Laird, alongside the Outpatient Clinic (below):

The less visible transition is actually even more challenging, but also more rewarding.  We already have 2 new surgeons here (one missionary and one Liberian); two more family docs are scheduled to arrive during the next couple of months.  We will need to find ways to fit in with the doctors already here working, to improve the conditions and care at the hospital to a level where both effective ministry and residency training can take place, and begin the routines of quality improvement and learning that will help us start a Family Medicine Residency Program for local doctors.  All with a cross-cultural team of physicians.  Should be exciting!  Stay tuned…. 

This may be a bit abstract or esoteric... but it's time to reactivate this channel of communicating with all my good friends.  This is a "55 word story" I wrote a while ago at the family health center, reflecting on a visit I had with a patient in downtown Worcester.  It is more of a "closer"... closing this chapter.  Soon you'll be hearing more about Liberia, as we are heading there September 25th.

The Encounter

I've never met you before
my 48 years and your 50 intersecting for 20 minutes
but your life is complicated
too much pain, diabetes, cigarettes, foster kids, your own kids, kids with psychiatry appointments.
But my job is to care for you
your blood sugars, your pain medication, your kidneys.
Do you want to quit?
Time's up for now

Safe Trip!

Just got back from a week in California, visiting friends, prayer partners, and God's people who have served alongside us in Liberia.  Awesome trip!  California has some of God's awesome handiwork! from sequoias to starfish to a wide range of wonderful people!

Working  over the next 2 weeks on some things that need to happen to get us back to Liberia! God has provided several additional staff for ELWA who will help us to start a new residency program for Liberian family doctors. Please continue to pray for us and stay in touch for more info!  --Rick