Escripts--September 29, 2016--Looking back, looking forward

Here I (Rick) am, sitting in the airport in Frankfurt, Germany, making the transition again-- from the USA to Liberia; from advocating, fundraising and praying from afar to working, interacting, and collaborating side by side; from the beginning of autumn to the end of rainy season. I’m really happy Debbie and I get to travel together this time! From this vantage point, right in the bend of the road, it is a pretty good view looking back to where we’ve come from, and a pretty good view forward as well, so let me share the view from here with you.

Looking back….
Dr. Rick’s Ride turned out to be a lot of fun! I think my biggest surprise was how many people spent so many hours assisting with this project—I am so grateful! Seven different riders joined me on different legs of the 3-day ride, 165 miles from Springfield to Wayland, to Lowell, to Worcester (Massachusetts). Someone drove the “back-up car” for first aid and mechanical help along the way. A gracious host at each of these stops (assisted by others they recruited) put together an opportunity for me to share the burden God has placed on my heart for the current challenge of HIV in Liberia. Many prayed, listened, and donated. Thank God for answering so many prayers! We had a very safe ride. 164 donors have given over $20,000 so far for the ELWA Hospital HIV/AIDS Education Project, and more is coming in. The total need is $200,000 over 5 years.

Looking forward….

October is going to be a busy month in Liberia. I’ll be working with Rachelle, who heads up our HIV/AIDS Care Team at ELWA, to get the initial activities of our project going: expanding and promoting our monthly support groups; selecting, training and deploying our community outreach team; and working out the details of supervision and reporting on the project’s outcomes.  Debbie will be working on publicity for the dedication of the new ELWA Hospital building, coming up on October 22^nd. And both of us will be finding ways to pitch in and help with all the administrative details needed to make the move to the new building a success.

HEY!
If you missed Rick's talk on HIV-AIDS in Liberia you can watch it on YouTube.  

Please continue to pray with us!
Pray for God to guide and direct the new efforts to reduce deaths from HIV.
Pray for the dedication of the new hospital facility to be an event at which God is glorified as Samaritan’s Purse and SIM join hands in meeting the health needs of our patients in the name of Christ.
Ask God to provide the needed staff and volunteers to provide top-notch, compassionate care at our new facility

Dr. Rick's Ride!

For all those of you who weren't able to make it to one of the Dr. Rick's Ride's presentations on the HIV/AIDS challenge in Liberia, Here it is on Youtube! : ) (This was the talk at Trinitarian Congregational Church in Wayland.... thanks to Ken Keyes for the awesome video work/powerpoint integration!) Enjoy....

https://youtu.be/KfkzdNy1tcg

Flat tires

So, I was inspired back in May to do a 160 mile bike ride across Massachusetts, to raise funds for HIV care and prevention in Liberia—It’s coming up soon, September 8^th to 11^th!  I’ve been doing a lot of cycling to train and get ready. One day in early August, I was doing a 30 mile ride, and just a few miles into it I had that unmistakable experience… I hear a noise, a little “thunk” as I run over something. And then I notice that there’s a little more resistance to forward progress. I start to feel the road a little more. At first I look down, and everything looks OK, and I think it’s just my imagination. But then the bike starts to slow down, and I’m really feeling the road, and I look again…. yep, my back tire is flat. Suddenly my progress has halted, and I have to stop and fix my tire. No problem, I have a spare tube and a little toolkit. I stop, find a safe place by the road to get the tire off the rim and pull out the tube. I get the tube changed and pump it up, pop it back on the bike and get on my way again. My hands are a little greasy now, but I’m thinking it’s not so bad… just puts me about 15 minutes behind what I was hoping for, but I have the time. So I’m continuing on, having a good ride, getting a little past the half-way point, and “pop” I hear the sound again, this time from the front tire. Now this is worse luck than usual! I look through the stuff in my bag, and realize I don’t have everything I need to fix another flat. I call Deb to come and pick me up.

If this was a one-time occurrence, that would be one thing. But over the last month, I’ve had 7 flat tires! Some in front, some in back, different places around the rim, so it’s not that there’s something stuck in my tire. I’ve ridden well into the thousands of miles over the last 6 years, and I’ve probably had a flat tire about once a year. Could God be sending me a message? 

I must admit, at first I thought it was because I’d had a couple early mornings where I had gotten up and gotten straight on the bike without having my usual time of Bible reading and prayer. I took it as God telling me: “Put me first”. So I made sure from then on to first have my time with Jesus before taking off on a morning ride. But that was about 4 flats ago….

As I’ve been reflecting on this (I’ve had lots of time to reflect… each time I find myself by the side of the road, changing another tube!), I think God has put this little inconvenience in my life to help me understand a few things. He’s saying, “Rick, if you have something worthwhile you are working on, that you feel called to do, burdened to do, convinced from the core of your being that it’s the right thing to do, are you going to let a few flat tires discourage you? Nope, you’re going to press on. Does another obstacle, another disappointment, another delay mean that I have turned my back, that I don’t want you to persevere?  Nope. I’m telling you that I want you to dig deeper.”

But most of all, I feel like God is letting me know that the highest priority in life is not reaching a destination or accomplishing a great achievement. It’s walking with Him. It’s allowing each disappointment, each delay, each difficulty to draw me closer to Him.

Weekend call...

Quite a weekend…. I’d arrived late Wednesday night, spent the day Thursday organizing and distributing the meds and supplies I’d brought with me. Friday I met with the medical staff and with our SIM Liberia Director.  Saturday morning I took over as the on-call physician at ELWA Hospital, covering our 50 bed facility for the weekend. One of my local colleagues helped me with rounds on Saturday.  And then, about 11:30 AM, it all started….

Amelia (not her real name) is a 32 year old mother of 3 who had not been to ELWA before. She came from 25 minutes down the road—the rural area between Monrovia and the airport. She told us she’d never had a day of formal education. She was 9 months pregnant, and had severe abdominal pain starting around 10:00 in the morning. There were no fetal heart tones, and she had significant vaginal bleeding. The abdomen was so tender that it was difficult to really get a good exam.  I talked with Amelia, her sister, and an Aunt who had helped get her to the hospital. I told them she’d need an urgent operation, as it looked like the placenta had separated from the uterus and we needed to get the baby out and get the bleeding controlled, though it looked like the baby had already died in her abdomen. 

After the surgical team made their preparations, I scrubbed in and got ready to start the case. I’d been hoping for an easy first weekend—maybe a c-section or two, but let them be healthy ones with good babies. Not this time. As we entered the abdomen, we encountered copious clots and blood—I reached my hand in through the incision and explored, and realized this was not an abruption, but a uterine rupture—the baby had been expelled through a tear in the lower uterine segment, along with the placenta. We extracted the stillborn baby and the placenta and brought the uterus into view—there was a stellate rupture extending in 3 different directions. With some skillful help from Gideon, the assistant, we pieced the uterus back together and repaired it in 2 layers. After a transfusion, Amelia’s BP stabilized and she was able to go on the postpartum ward.

Sunday morning I was awakened at 5:30 by a call from the ER—a pregnant woman had come in, short of breath, with O2 saturation of 57%. When I arrived, she looked like she might give up the ghost at any moment. Her heart was massively enlarged, she was in pulmonary edema, and she was full term. I silently prayed for her as we gave her oxygen, lasix, hydralazine, and IV digoxin. Miraculously, she gradually stabilized, and later in the day delivered a full term baby girl who unfortunately appeared to have brain damage from her prolonged hypoxia. 

Add to that a couple other challenges—a vacuum extraction on a woman whose baby had apgars of 5, 5, and 7; and a c-section on a patient attempting a trial of labor after prior cesarean. 

All these women survived, and two of the four had good neonatal outcomes. If these women had been pregnant just 18 to 22 months ago, during the worst Ebola epidemic the world has ever seen, it’s quite likely that all 4 of them would have died or had even more complicated deliveries, due to the closure of most health facilities here. Timely, skilled maternity care is a lifeline in a place like Liberia—a very fragile lifeline. One of our priorities is to extend that lifeline to as many women as possible, as well as training local midwives and physicians in quality emergency obstetric care. I’m so grateful to practice as part of teams, both here in Liberia and in Worcester, that make women’s health and maternity care such a priority!  

The answer to his own prayer request

One of the first people patients meet when they check into the clinic at ELWA hospital is William Pewee. He receives their clinic card with a warm greeting and a smile, then hands them their medical record before they join the line to see a provider. If they have a question, he will help, because he wants people to feel cared for when they come to ELWA.  In fact, before he was employed in the records room, Pewee was a volunteer  who led devotions and prayed with patients on the wards.

    In the midst of the Ebola crisis, Pewee shared a request at the monthly ELWA prayer meeting for the patients in the Ebola Treatment Unit, that someone would encourage them in the Lord. For obvious reasons, volunteers could not enter the unit to lead devotions. That night, he dreamed that a man in a white gown came to him saying “we are coming for you, so get ready,” meaning that he might die, but he argued and wrestled against him.  He had recently read the story of King Hezekiah, and he told the man he was a preacher and wanted more time like Hezekiah was given.

    The next morning as he got ready for work, he felt the chills of a fever. Although he did not think he had been exposed to Ebola, he knew he should be careful. When he arrived at the hospital, Dr. Fankhauser saw his bloodshot eyes and put him in the “suspected cases” ward of the Ebola unit. 

    The Ebola test was positive, but his case was not typical. Although he experienced bleeding from his nose and ears--one of the scarier symptoms--it subsided after a few days. In the end, his sickness was very mild and he never even had the diarrhea that weakens most patients.

    After just four days in the ETU, Pewee felt better. But he realized that his prayer request was very relevant, because dozens of people were dying around him.  People were truly afraid, especially at night when so many seemed to pass away. So he became the answer to his own prayer request and “opened a revival,” as he puts it.  Late every night, after the last medications were administered, the patients who were strong enough gathered to read the Bible and sing and pray.

    While he was recovering, he met a familiar face.  A surgeon and former medical director of ELWA Hospital, Dr. John Dada, was admitted to the ETU. Dr. Brown asked Pewee to look after him, and call whenever there was a concern. But sadly, even as he seemed to be improving, the beloved doctor suddenly died.  Losing Dr. Dada hit the ELWA staff very hard.

    SIM recognized that many people would be affected by the traumas they faced in those months.  They organized a program to train local facilitators of “Trauma Healing Groups” who would learn about the emotional impact of trauma and the road to healing.  Eighty facilitators were trained in July 2015. There is such a demand for these groups among those who have been touched by the Ebola crisis and other past traumas in Liberia that more facilitators will be trained in May.

    Pewee participated in the first trauma healing workshop.  Although he was able to reach out to others in the middle of his own Ebola experience, he said the program helped him to understand and cope with his own lingering emotions: "it helped me come down," he says. Losing patients he prayed with, watching the body bags leave the ETU was a painful experience that has stayed with him.   

William Pewee’s job at ELWA may seem like a small one, pulling and replacing files all day. But for him, it is a way to show the love of Jesus to someone who may be having a difficult day. He is one of the wonderful staff that we get to work with at ELWA--so many of them have a story to tell of God’s faithfulness. 

And I’m excited to share that it is going to be my new assignment with SIM-Liberia to tell these stories. I am now the Communications officer for our field, a job that I began during my trip in February.  I’ll be doing my best to fill the role from the U.S. with occasional trips to Liberia as our family situation allows.  I hope that you will be encouraged to hear more about the way God has been working in Liberia through these stories.

Praise God for the power of the Resurrection in our lives and in our world!

Debbie 

Thank God for Life

 

 

 In Liberia when you greet people, “How are you?” they often respond, “Thank God for life.”  I’ve always appreciated that answer—it says so much:  God is in control, God has given me life, this day is a gift from Him and I want it to honor Him.  That answer is even more real to me now.  
     September 1 was the one year anniversary of Rick’s diagnosis of Ebola virus disease.  It is hard to believe that life is so normal now, considering the possibilities that this day held for us a year ago.  While Rick waited for the result of his test, and began to feel the effects of the virus taking hold, he felt the strong arms of his heavenly Father holding him close.  For my part, I took long walks and shed many tears, trying to imagine life without Rick, but completely sure in my heart that God would carry me through.
     As the news broke, we were caught up in a tidal wave of evacuation plans and media attention, and held afloat by the prayers and acts of kindness of our family, friends and community.  We have often said that for a few days, Rick was probably the most prayed for individual on the planet.  There are no words that could ever express our gratitude for the way our family was loved through our crisis, so we wish to just say thank you and God bless you.
     We admit that the story of the Ebola epidemic reveals many uncomfortable realities of our world today, including apathy towards the crisis from the developed world in the early months and the social inequalities exemplified by the evacuation and treatment of the Americans who contracted the disease. But there were no guarantees because our times are in God’s hands.  By His mercy and thanks to the amazing professionals at the Nebraska Biocontainment Unit, Rick recovered fully. We trust that in some way, God has used him in the battle against Ebola in West Africa, which is hopefully in its last days.  Although Liberia has been Ebola free for much of the last 5 months, Sierra Leone and Guinea are still reporting a few cases each week. But now there is promise that a vaccine could finally bring this epidemic to an end, and prevent future ones.
      However, that vaccine will not prevent a crisis like this from happening when a new disease or virus emerges to sweep through West Africa or another region. Strengthening the healthcare systems in countries like Liberia is the real “vaccine” that will prevent a future crisis.
     This week, SIM has invited missionary and West African healthcare leaders to meet in Ghana for a conversation about how the mission and its partners can help strengthen healthcare resources in the region. Rick couldn’t be there, but you know his heart is with them.  Please pray along with us for these Christian leaders who desire to change the realities that caused African families to lose their husbands, fathers, wives, mothers, brothers, sisters, and children in the last year and a half.

Community Health Survey

Last Saturday afternoon was bright and sunny after a rainy morning. Because I had the day free, I had contacted a few friends to let them know I might be visiting. First I walked up Rock Hill across the main road from ELWA, to visit old family friends Tom and Bindu. It’s always so wonderful to get off the compound into the community, to greet people as they’re sitting on their porches or working in their gardens. I was encouraged to see that the city had run water pipes up to the top of Rock Hill and now residents can fill 2 buckets of water for 5 Liberian Dollars (about 6 cents US) at any of several stations like this one: 

 

 

This setup solves a major problem for the community. In the past, during dry season, people would have to walk 15 minutes to get to reliable wells where they could draw water. The money goes to pay the city water bill.   

   My visit to Tom and Bindu was a house call of sorts—Tom’s foot was hurting and he was having difficulty getting around.  So I did an exam and recommended some treatment that would help him recover. I enjoyed some nice sweet potato greens, rice, and fresh mangoes and bananas that Bindu had fixed, and caught up with everyone in the family.  

   Getting out in the community is more than just a chance to see old friends and greet people. It helps me to understand the context which has such an impact on peoples’ health. As I walked up the hill, I noticed a lot of big holes full of water in yards and near the road. Many of the residents of Rock Hill make a living by breaking up the rock (with hammers) around their houses into gravel for road and construction projects. The holes are left behind after they have dug out the rock. During rainy season, these holes fill with water and become a drowning risk for toddlers and kids who wander away from their caretakers and fall into them unobserved. Bindu told me that each year there are incidents of drowning in the community.  What a heartbreak it is for those families when a tragedy like that could be prevented.

   On Sunday morning I was on duty at the hospital. An elderly man who had died at home during the night was brought in the back seat of a car. The family needed a certificate from the hospital stating that he had not died from Ebola, so that they could take the body to a funeral home.  The man had not been ill, and there were no signs to suggest Ebola. As I was filling out the paperwork, I overheard some of the family members saying that others in the home were not feeling well. When I inquired about it, I found out that all the others who had slept in the house were dizzy or disoriented. I asked about generators and learned the family had been running a small generator in a utility room inside the house. I immediately asked the family to have the others who weren’t feeling well brought to the hospital, and we treated 3 of them with oxygen for carbon monoxide poisoning. This is another common safety issue that occurs in Liberia: there is no utility power for most Liberians, so they purchase a small generator to provide household power.  The generators are not always vented properly and cannot be left outside for security reasons.  There isn’t a system of enforcing building codes for most residences, and people don’t always understand the safety precautions they must take with a generator. 

   I don’t want to give the impression that people are simply careless with these matters – the truth is that safety costs something.  You have the rock available to help provide income but then what do you fill the hole with?  You can’t use the money to build a safety fence-- you need it for important things like school tuition. You find a way to buy a little generator and a liter or two of fuel for each day so you can have lights, but you can’t afford to build a proper exhaust system. And the generator will be stolen if you run it outdoors (or it might be raining). We don’t realize that safety is a benefit of affluence.

   In spite of that reality, I feel compelled to try to raise awareness when I see things like the water-filled rock holes and carbon monoxide poisoning.  ELWA Radio airs a program called “Appointment with the Doctor” which is a forum for educating listeners about health issues.   Yesterday I recorded a radio program about these two community safety matters. I am praying that our listeners will be able to share information and ideas with their neighbors and help communities in our area become safer!