I (Paul) am writing this from Kenya but my sweetheart and kids are, unfortunately, in Ethiopia. This is the Christian Medical and Dental Associations’ Continuing Medical Education conference at Brackenhurst in Limuru, Kenya. It is a conference that alternates each year between Africa (Brackenhurst, usually) and Taiwan and is designed to help missionary health professionals to maintain their requirements for continuing education. Unfortunately, due to housing limitations, kids aren’t allowed.

It is also serving as an unofficial meeting for the Pan-African Academy of Christian Surgeons, both for program directors and senior residents. In addition to Dr. Anderson and me, we have two residents here as well. So, in addition to the various offered lectures, there will be PAACS administrative meetings, resident research presentations and oral exams for the chief residents.

Last night, as I got ready for bed after checking in, I had to chuckle at what I was doing. I snuggled up into bed and began going over the lecture schedule for the next week and a half, interestedly selecting which meeting I would attend for each available hour. Good grief, I thought, it’s like a geek candy store. This is what happens when high school nerds grow up and become doctor nerds. You can take the beast out of the jungle but you can’t take the jungle out of the beast (I like that analogy better).

Despite my cerebral stimulation, though, my heart is back in Soddo. Being away from Becca and the kids is tough but I know that they are firmly in God’s hands. Times like this help me to more clearly see the illusion of our perceived control and the firm assurance of God’s direction and sovereignty of our lives. Becca, Nathan and Lydia are no more or less our Father’s grasp now than when we are together. It comforts me greatly. But I still miss them.

 As is often the case, this break came when I was in keen need of it. The last five or six weeks have been hard and all the doubts and fears were attacking with fervor. It’s difficult to describe the details and, indeed, I can’t describe all the details in such a public arena. But it all builds up. Surgically, it’s been full of ups and downs and plenty of busyness. We’ve seen a strange influx of bad appendicitis. We’ve seen far more cases in the last month or so than all my prior time put together. Unfortunately most of the people are arriving at the hospital quite late in their illness. Most of the time the appendix has completely disintegrated and the abdomen is full of pus. A week and a half ago I spent the morning with our anesthesiologist, Dr. Aarsland, at the bedside of a sixteen-year-old girl while she died of overwhelming infection due to ruptured appendicitis. As usual, the young ones hit you the hardest.

On a positive note, though, we had an old man arrive last week with a condition called sigmoid volvulus that survived against all odds. This is a condition where the last part of the colon twists around itself and kinks off both the lumen of the bowel (causing an obstruction) and, in this case, the blood supply as well (causing dead bowel). This man, in addition to being older, was also rather malnourished and arrived very late in the process. His abdomen was incredibly distended, tense and tender. When obstructed, the bowel will slowly dilate and fill with air and the colon in particular can grow to an amazing size. Normally only an inch or two in diameter, his obstructed colon was about ten inches across for a distance of a couple of feet. And, of course, it was dead. After untwisting and removing the dead colon, we brought up a colostomy and got him into the recovery room. By God’s grace he did quite well and is pulling out of it.

My final punch in the gut before coming to Kenya, though, was the post-operative death of a baby that I truly cannot explain. I believe I wrote previously about a baby that came to the hospital with a congenital abnormality of the anus. He had no anus but there was an abnormal opening of the rectum onto the skin just behind the scrotum. Because he was so sick and delayed in presentation, we had to perform a colostomy on him when he was a month old and then he came back for the reconstruction of the anus. I’ve never seen or done this before and, again by God’s grace, it went wonderfully. The anus was beautiful (only a surgeon can say that). His anus was now open and in good condition so we were going to reverse his colostomy. The operation went completely smoothly. About six hours later I check on him before leaving the hospital and he looked reasonably good. I went home and ate dinner and, forty-five minutes later, one of the residents called and informed me that he was dead. We’ve all discussed it over and over again and I don’t have a definite reason why the boy died. It’s possible he had another congenital abnormality such as an opening between his esophagus and trachea or a heart problem or something, but…  This is one of those times where I don’t have answers and have to trust that God is good.

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