Sunday, June 29, 2014

Reunited with my boys and safe in the home I love, I swell with gratitude, yet feel caught between worlds.  Hourly, shadows of Kenya weave into my thoughts.  On a neighborhood walk: The palettes are similar – the rich greens.  But in Luanda, the vegetation hems you in, crowds from either side to gather you into the bush.  Strapped into a dentist’s chair:  So many with tooth decay, whom I couldn’t help, and here I am, declining tooth whitener.  They snap X-rays with such perfunctoriness.  I would have loved access to an X-ray machine. . . .   When my son squeals, “Balloons!” at the sight of “Welcome Home” decorations cascading down the bannister: Just like the schoolkids.  They all love balloons. Children’s laughter chimes the same everywhere.  Then I remember the faces, so many of them: the elderly, weathered, with years creasing their brows like rings from an acacia trunk.  The young, their eyes sad, dark pools that trembled in the sunlight.  The children who protruded their bottom lip as I leaned in with my stethoscope. They never recoiled, but instead studied me and waited, straight, silent, and obedient. I would crouch to their level, and we would remain connected for a heartbeat or two, I listening to the cadence of their breath, they searching my face.

Searching for what?  Understanding?  Hope?  The missionary leading our team often remarked, “You are the face, and hands, and feet of Christ.” At the time, that idea seemed both presumptuous and daunting.  Yet as the days wore on, interactions with these steadfast people demonstrated that any good we provided sprang not from our own toil, but from God’s work in and through us. 

Myriad circumstances threatened to plunge us into despair, and would have if the Holy Spirit had not girded us from within.  Others have already described the 10-hour bus rides, hikes through the mud, lack of electricity, and illness that struck half the team.  In the clinic itself, obstacles mounted as our work seemed drowned in inefficiency.  We had no diagnostic techniques, aside from malaria tests and our own physical examination skills.  This limited arsenal created a heavy reliance upon history taking, but barriers in language and perspective clouded the stories we elicited.  My interpreter had not spoken English in a decade, and during each patient encounter she translated my English to Swahili in her head, then translated that Swahili into the local vernacular, then back again.  The resultant process was laborious, halting, awkward, and riddled with misunderstandings, and at day’s end she appeared even more exhausted than me.  Furthermore, the Luo’s concept of illness is rooted in the present – “I have the pain now,” was the most common reply to my inquiry, “for how long has this bothered you?”  “My arm hurts” indicated pain in any anatomical location from fingertip to shoulder, without specificity, and further clarifying the precise joint proved cumbersome for all involved.  When asked about medications, most patients responded, “I take tablets,” but did not know the indication or prescription.  Occasionally, they would dump a crinkled plastic bag of broken, nondescript pills onto my table, and I would force a smile and struggle to conceal my discouragement.  Lord, how on earth can I help here?

The most heartbreaking cases punctuated these encounters.  With furrowed brows, parents would enter cradling children with sepsis or severe malnutrition.  The babies were lethargic; those with the strength to cry were too dehydrated to produce tears.  From a practical standpoint, these were the “easiest,” most straightforward patients to manage, because their need for hospital transfer was obvious.  From a spiritual standpoint, however, something vital within me tore with each encounter.  They were by no means the first faces of suffering I had witnessed; as an ICU specialist, it’s my job to nurture patients in their final days.  However, the severity of preventable illness in children so young, incited a raw sense of anguish within me that I’d never previously confronted.  The first of these babies managed a feeble cry when I took her into my arms. I felt her hip bones protruding through the blankets, saw the pain and fright in her eyes, and feared I would break down myself.  Instead, I prayed for strength.  Then, “Mama? I am a mother too. She is very sick. She needs help.”  I led them both out, my hand on her elbow, the Lord supporting mine.

Had the Lord not walked with us during such trials, despondency would have overcome.  We met so many people in the advanced stages of illness, for whom we could provide only basic care.  We witnessed inadequacies in infrastructure, and financial disparities that sparked recurrent thoughts of injustice and hopelessness.  Despite all the children for whom we diagnosed and treated malaria, during those first two days I perseverated on what we could not do – the CT scans and colonoscopies we could not order, the lesions we could not biopsy, the blood tests we could not draw.  I concocted schemes in my mind for starting a mission hospital, to provide real care. However, as the areas for improvement stacked up in my head, my heart – still anchored in the world -- became heavy.  This is just one village.  How many more are in similar circumstances?  How many so direly need help?  How can we endure so much poverty and suffering?

Despite our meager services, each day more patients flocked to the clinic.  Volunteers guided entire families into queues and beneath tents, where they waited for hours just to sit with us, to talk with us about their back pain, their toothache, their cough.  They left their homes at 5 am and rode their bikes or walked barefoot along the muddied roads, just to talk with us.  The numbers overwhelmed me, until I realized that the Lord guided all these people to us, and that our clinic was His vehicle, not the ultimate aim. God worked in our hearts, and in those of the patients we served, in ways both subtle and dramatic, indiscernible and cacophonous, beautiful and mysterious. 

I drained a facial abscess in a young boy.  The infection had spread throughout the soft tissue of his face, swelling his left eye shut. Without treatment, he risked sepsis or blindness.  On a rickety exam table we’d crafted from a board and two student desks, on a dry day when dust and dirt coated every surface and clung to my teeth, he lay on his side, alone, and allowed a mzungu to incise his face.  He winced, but uttered not a word.  I worried for the next two days about secondary infection, given the dirty conditions, and was relieved to watch the swelling subside during his follow up. On our final day, he astonished me. During our church service before departure, at an earlier hour than most worshipped, he arrived, lingered against a mud wall, and listened to the pastor, with a clean dressing over his wound and a calm and watchful expression on his face.  Whatever strength the Lord had stirred within him to seek treatment and silently suffer a procedure, further drew him to hear the Gospel among strangers that day.

“I am in the Lord’s hands,” one patient assured me, after I explained to him a terminal diagnosis. “I must trust in Him. He will provide what is best for me.  I see you have sympathy for me.  Thank you so much for spending time to talk to me.”

Time.  Sympathy.  Trust in the Lord.  Strength from the Lord. These were the reasons we came.  Not to distribute Tylenol.  Not to cure all ills.  Rather, we came to connect, to say, “I value you, because Christ values us all.”  To extend love, for He loves us.  To serve, because He served us first.  In my room at night, huddled under a mosquito net with a battery-powered headlamp, I would read the book of Matthew, and revisit the innumerable accounts of healing during Jesus’ ministry.  While I had wasted precious reserve lamenting our paucity of technology, as if medicine were entirely titratable and mechanical, the Lord healed with just a touch of the hand.  With faith.  God alone is the Great Physician.  Despite extensive training rooted in the secular, we physicians heal only through God’s grace.  We can support, but He alone can heal.

The moment I stopped trying to do, and instead focused on being present for the people of Luanda – to be Christ’s face, and hands, and feet – narratives unfolded from amid the foggy details of patient dialogues.  I heard themes of rejection and discouragement at local clinics; anecdotes of struggling with ailments for years without any understanding of the cause; and the frequent complaint, “they just give me tablets, but don’t explain why.  They just give me tablets, and it never gets better.”   What little healthcare the people of Luanda received, seemed delivered with an air of aloofness and paternalism that left villagers dissatisfied, frightened, and discouraged.  They received tablets, but no care.  No laying on of hands.  No consolation.  No teaching.  No hope. No hint of the Gospel.

In most instances, I could only give tablets, too.  But with the Lord’s mercy, I could also offer my time, sympathy, and trust in the Lord.  I could assure them that I had traveled halfway around the world to be with them, because we are all one in Christ.  I could reach out my hand, and replace the distant white coat with the warmth of my palm. I could listen with sincerity to how their illness affected their work, their families, their homes.  I could explain that although I could not cure their pain, I would help them to understand the cause, and offer methods to help.  When circumstances seemed particularly dire, I could connect patients them with the local congregation, to buttress their support within the church and the community. And I could conclude each encounter with an appeal to God, to remind them that all are without pain and suffering in Heaven.  

The secretary of the Evangelical Lutheran Church of Kenya (ELCK) delivered several sermons during our time, and more than once he stated, “the work done here, is not our work, but God at work.”  I recall the many faces and stories we were privileged to witness in Luanda, and the truth of those words unveils itself.   Senders, thank you for this precious opportunity to serve, and to witness God’s grace and glory.  We are all one in Christ, and as such, you all have brothers and sisters in Kenya.  When we journeyed to Africa, we carried each of you with us in our hearts, hopes, and minds.  Your prayers steeled us, and your love spurred us on. 

A closing thought, again from the pastor of the ELCK: “This church is only a few months old. Before we built this church, we worshiped under a tree. And God was there, under that tree! Because he promised us, ‘I will be with you, until the end of the age.’ So God is also with each of you.”