Well, it’s been a busy couple of weeks since the family left. The missionary staff has shifted too. Dr. Duane Anderson, the orthopedic surgeon, and his wife, Jackie, have gone back to the States for a couple of months. Dr. Sharon Morad, the obstetrician/gynecologist, is away for a couple months in other parts of Africa learning new gynecologic surgery and boning up on pediatric care. In their stead we have two visiting doctors and one of their wives. Dr. Bob Greene and his wife Elaine are here to fill in for the Anderson’s. Bob is an orthopedic surgeon with a lot of missionary experience. Elaine is teaching Jackie’s English classes. Both of them are spending about a year divided between the various PAACS hospitals teaching orthopedic surgery. Also, Dr. Jim Adams, a family practice physician, is filling in for Sharon with the labor and delivery ward. Jim has also been helping a lot with the residency and has been scrubbing into the OR providing help.

I’ve really enjoyed having these visitors here. Their deep walks with God have inspired and encouraged me and it’s been a pleasure getting to know them, rubbing shoulders with them and learning from them. God continually amazes me how He sends blessings in many and varied ways.

We’ve been trying to care for some really sick people lately. One 13 year-old boy came in with a bowel obstruction and was initially operated on by the residents. He didn’t really ‘turn the corner’ and became progressively worse. Two days ago we took him back to the operating room and found an abdomen full of intestinal juice. There were four areas of dead small intestine with huge holes. I have no idea what caused this… many of my medical experiences here have been quite humbling. He was so sick and his bowel so questionable that we just removed the obviously dead stuff and left the ends of intestine tied off. We temporarily closed his abdomen and took him back to our recovery room to resuscitate him. This morning I took him back to the OR and, after confirming the bowel still looked OK, sewed all of his intestines back together. We’ve been praying for him every day now, multiple times a day really. God has kept him alive so far and I’m praying fervently that he will pull through. I’m going to have to start feeding him soon because he was rather malnourished when he arrived in the first place and it’s been too long since he’s had any nourishment. What I wouldn’t give for some TPN (IV nutrition) from back at Baylor!

We admitted an 18 year-old man this afternoon with probably the worst abdomen I’ve ever examined. He had developed abdominal distension and failure to pass anything ‘from down below’ for 12 hours. He was extremely anemic, his heart rate was really high, we couldn’t measure a blood pressure, he was making no urine and his abdomen was hugely distended. Amazingly, though, he was awake and alert and talking to us. When I pushed on his abdomen, I could hardly believe it. In the last seven years, I’ve pushed on a lot of abdomens but nothing compared with this. It was like pushing on a solid rubber mannequin, no give at all. We began pouring fluid into him and began the ever-painful process of trying to find blood donors. I talked with the anesthetist and, despite his horrible condition, we insisted on operating because his incredibly tight abdomen was probably impeding his blood return to his heart and adversely affecting his heart function. We put him to sleep and opened him up to be greeted by a smell that literally made us gag. Massively distended loops of black, dead, stinking intestine glared at us. Further exploration revealed that most of his small intestine was dead, having twisted around on its blood supply, strangling itself. We did find enough small intestine at the ‘upstream’ end that might potentially survive and provide enough nutrient absorption to hopefully let him live. We quickly removed the obviously dead stuff and, once again, sewed off the ends remaining. Again, we temporarily closed his abdomen and started the resuscitation process. I don’t know. He looks pretty bad. We’ve been praying for him too and it will be God’s mercy and healing if he survives until tomorrow when I plan to take him back and have a second look.

Unfortunately, I could go on. There are lots of sick people trying to die in our ICU. Getting blood for patients has been a problem ever since I’ve been here. We are having the first hospital blood drive this Friday to try and adequately stock a supply of blood for our patients. Ultimately, we need patient’s families to donate but sometimes they are unwilling and, even if they are willing, they may not be able to give enough. Our prayer is that having a small blood bank will help this. We have another critically ill woman who came in yesterday after giving birth at home. It had been three days and the placenta still had not come out. The umbilical cord was still hanging out. Unfortunately she was now thoroughly sick and had become septic. We managed to get the thing out after much effort but she’s looking pretty shaky right now. Her blood count was still low after getting a unit from her husband. Being O-positive, I was compatible with her so I gave one as well. This is the fourth unit I’ve given in the last eleven months. I don’t know for sure how much is ‘safe’ to give but I feel fine and the patients sure as heck need it more than me. As an aside, by the way, I will confide and advise you to not give two units at one time. You will feel like road kill. But, if you think you’re invincible too, at least don’t go play volleyball right afterwards.

I’ve been reflecting on my time here and what I’m going to say to people when I go home to visit. It’s going to be challenging. I’m very thankful that God led me here. It’s been hard but I’ve learned so much. I find myself thinking more than ever about my heavenly Father, about how much I love Him, about how much He loves me and about how much I long to be with Him, face to face. I have never before thought so much about heaven or longed so much for Christ’s return. In a sense, the world seems paler, its grip on me looser. Bear in mind, though, by pale I refer to its promises and enticements. At the same time, though, I am more appreciative and delighted than ever in life and the gifts God has lavished on us during our sojourn here in this land that is not our home. I suppose it’s like many things, that they are most lovely when held in the proper perspective. God is plenty big and wonderful enough to be held first and leave lots of room for joy in the blessings He gives which should always rate below Him.

I miss my family and can’t wait to see them again but they are doing great in Galveston. I can’t believe God is blessing me with a daughter. He is amazing. Sorry for not writing enough, I’m trying to improve that area.

Paul

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