Merry Christmas 2016

     Merry Christmas to all of you! As we celebrate the birth of our Savior, many gather with friends and family. Since we are so far away from family, we don't get to experience that blessing in the same way. At this time of year we miss our families and the time that we could be sharing with them. We are grateful for their sacrifice in that they are willing to allow us to be here instead of there with them. We did have the enjoyment of skyping with family again this year, which makes us feel so much closer.
    Since being here for the third Christmas now, I thought that I would have less of a struggle being apart from our families. As we entered December, I found it to be untrue. 'It just doesn't seem like Christmas' kept going through my mind, as I sat sweating while sitting underneath the fan thinking of all the excitement and family time that surrounds Christmas when we are in the US. I felt that way for several days, until God reminded me again that I spend too much time focusing on all the 'extras' of Christmas. This glorious day is about His birth, not about where we are or who we are near or what fun things we get to do. Basically, it's not about me. It is good to enjoy seeing the lights and decorations, going caroling, gathering with friends and family for celebrations, giving gifts to each other..., but that does not make Christmas. Christmas is still Christmas without decorations, without gifts, without food, without friends and family. This is a day completely about celebrating God. God, the creator of the universe, loved us so much that He left His glorious heavenly kingdom to become a feeble baby. He did this knowing that He would grow up being misunderstood and then beaten and killed as a sacrifice, so that we could have a relationship with Him.
    At church on Sunday, we were reminded about this wonderful gift, and then challenged to share this with others. What better way to show our gratefulness to God for what He did than to tell others. Isn't that what we do when we get a gift that we are excited about? We go and show everyone this wonderful present. Then I was blessed to see my daughter try to tell people in the hospital yesterday about Jesus in Mampruli. All she knew how to say was Jesus loves you very much, but she told several people with such excitement. It reminds me of the song "Go Tell It On The Mountain." She wanted to go everywhere to tell people about God's love for them.
    This challenged me to try to talk with a Muslim woman in town. God has had me praying for her for about 2 months now. I went by to take her a 'Christmas box' and to tell her that Jesus loves her. She speaks very little English, so I didn't think that I would be able to say much more. When I went, she had a few of her granddaughters there who spoke English and would translate some of what we were saying. By the end of our conversation, she said that she would like to believe in Jesus, but she wanted to wait until she could go to church. I invited her to come to church with me on Sunday, but she said that she couldn't go (her daughter just had a baby, so she won't be able to go to church for a few weeks). This is where her granddaughters lost interest in translating for me. Unfortunately, I won't be here to follow up with her for a while, but please be praying for her. Pray that God would open her eyes to the true gift of Christmas and that she would pursue after it. Pray that God would put believers in her path who can speak Mampruli or her native tongue who will lead her to Christ and disciple her. Pray that God will continue to give us opportunities to pray and share Jesus with towns people and patients.Thank you for your continued support through prayer! It is one of the best gifts that you can give to us.

making Christmas ornaments

decorating tree with 'Snow White'

caroling and passing out oranges on Christmas Eve

visiting hospital on Christmas day

Merry Christmas from the Cahills!

and more Cahills

and 'Princess Aurora' and  'Cinderella'  

God loves me more

     My grandmother has a saying, ‘God loves you, but He loves me more.” Often when I am at my grandmother’s house (which frequently coincides with this time of year), I am certain to hear this phrase at least once. It is always followed by an explanation of one of the recent ways that God has shown her how much He loves her. Sometimes, it is something extravagant such as the masses found on CT scan and ultrasound that were gone a few months later. Other times, it is something small that means something special to her because she knows that God did it with her in mind. Today, I feel like I can say God loves you, but He loves me more.

    I know that each day passes and is full of its own worries and beauties. For months now, we have sought God about what to do after January. As December is now on our doorstep and we are still uncertain of what He has for us, we continue to pray. There are times when I just can’t help but become anxious, so I try not to think about it too much. I spend a lot of time with the girls, cooking, and cleaning. Today, I spent a fair amount of time in the kitchen preparing food and cooking. I had spent most of the afternoon avoiding the kitchen, as I didn’t want to see the mess waiting for me to clean. I finally decided that I would regret waiting, if I delayed until after supper. As I approached the sink and looked at the pile of dishes to be washed, my heart sank. I still didn’t want to do them, but I knew I should. I began getting everything prepared. As I finished washing the first dish, I looked up and saw the kitchen window glowing orange. I pushed on the metal lever to open the windows and saw the most beautiful sunset. It could have been a painting, with the fiery orange edged with thin lines of pink that became the boldest purple that I have seen in the sky. This was the captivating backdrop to the dark shadow of the bare trees that I can see out my kitchen window. This ever-changing spectrum of colors was my delight to watch as I then happily washed my dishes. After I finished washing all the dishes, the sky quickly changed from the vibrant strokes of color stretching across the canvas out my window into a dusky grayish blue, then darkness.

     I have asked people here about what they think about the nice sunsets here. Most people that I ask say they never have the time to stop and look at it. Also, I often get too busy to admire God’s masterpieces. Today, I can’t help but think that I might have been the only one to see one of the most beautiful sunsets that I have ever seen. I was able to enjoy the smile of God while doing my dishes and it felt like it was directed specifically towards me. Not because of anything that I had done, but just because He loves me.

Maternity Ward Stories

           God has not specifically gifted me (Tim) with writing, but I felt like I should write a post telling about what has been going on at the hospital over the past few months. Lori has described a few of the experiences we have had together in earlier posts, but I would like to share some more. Since coming back to Ghana in July, I have been spending most of my time in the Maternity Ward of the hospital, and especially since the beginning of September. I also round on the Isolation Ward each day, but this post will be dedicated to Maternity Ward stories.          

           The reason that I have been the main person rounding on the Maternity Ward since September is because Dr. Victoria, one of the Ghanaian physicians that I started working with almost 2.5 years ago at BMC and who is interested in obstetrics, has had to take some time off from work for a couple different reasons. Fortunately, in September, there was a fourth year Family Medicine resident, Charlie, from my residency program in Texas that came for the month, and he was a tremendous help. I also hope that he learned a lot from the variety of cases that came in that month.

One patient that we had toward the end of September was a young woman that came in with repetitive seizures. She was found to be pregnant at about 23 weeks, had mildly elevated blood pressures, lots of protein in her urine, and her baby was not alive. In obstetrics, you pretty much assume that anybody that is pregnant and with new onset seizures has eclampsia (a life-threatening condition in pregnancy that requires urgent delivery). She was admitted from our outpatient department one morning at a time when I was somewhere else in the hospital, and she was started on magnesium sulfate (the medicine of choice to control seizures in eclampsia). I came by the ward a little later and saw the woman for the first time, and she was seizing continuously, so we checked her blood sugar (low blood sugar can cause seizures), which was normal; we then gave her two doses of one type of anti-seizure medicine (but it did not help); we then gave a loading dose of another type of anti-seizure medicine (and it also did not help); we also gave Artesunate IV (to treat possible malaria, which is endemic here) as well as Ceftriaxone (an antibiotic to treat possible meningitis, which is also endemic here). I had placed a pulse oximeter on her finger at one point, and it was reading that the oxygen in her blood was around 40-50% (normal is above 90-94%), both on and off oxygen. At this point, I decided that we needed to do a Cesarean section (since delivery is the ultimate treatment for eclampsia, she was not close to delivering on her own, and she was severely hypoxic (low oxygen levels) despite being on maximum oxygen available on our ward (plus the OR had access to a tank of 100% oxygen, which I hoped would help). We took her to the OR, and her oxygen levels went up to the upper 90s on the 100% oxygen with a mask. We then did the Cesarean section and monitored her in the OR for around 6 hours afterwards until her oxygen levels were above 90% on the oxygen concentrator (what we have in the wards for administering oxygen). She even began to wake up some and resist us. We then transferred her back to the ward, and the next morning her blood oxygen levels were in the mid 90s on oxygen. Unfortunately, later that day, they called me back to the ward because she had begun vomiting up green stuff and had stopped breathing. Her heart stopped soon after that, and despite CPR, she then died. This was by far the hardest obstetric situation I have faced since coming back to Ghana.

Our hospital is pretty rural, about a 2.5-3 hour drive away from a larger hospital, which is the teaching hospital in Tamale. Even though that is the case, we are still very blessed to have the possibility to transfer patients to a higher-level of care, even by ambulance if we need it. There have not been very many times where I have needed to transfer obstetric patients to Tamale, but in the last couple of months, there have been several cases that have needed it. Also, there is normally no feedback that I receive about the patients that I transfer, but I will tell you about a few where I have received some word. Dr. Victoria had given me the phone number of one of the OB/Gyn specialists at Tamale Teaching Hospital (TTH), and I have been calling her to discuss difficult cases prior to transfer. It gave me some assurance (in kind of a strange way) that I was not transferring silly cases when I called this specialist about the third transfer for the month, and she told me that she was starting to get palpitations whenever she saw that I was calling (because of the complexity of the cases).  To name a few of them:

First, there was a lady that came in with a suspected partial placental abruption (the placenta, or life supply for the baby, was coming off of the inside of the uterus) at 23 weeks, and the baby was not alive. She delivered normally shortly thereafter, but then the rest of her placenta was stuck inside and had to be removed. The next day, she was very anemic (looked pale), had low platelets (in the 30s- low normal is 150), and her eyes looked yellow. I was concerned about HELLP syndrome (acronym for Hemolysis- breaking apart of red blood cells leading to anemia; Elevated Liver enzymes- as shown by the yellow eyes, but we cannot check liver enzymes at BMC; and Low Platelets), a very serious condition in pregnant and postpartum women that usually requires several units of blood and blood products (which is limited at our facility). We transferred her by ambulance to TTH, and I later received word back that she was treated as HELLP and recovered.

Second, there was another lady who was about 29 weeks pregnant who had Hepatitis B, a seizure disorder, and who had been vomiting blood for the past 4 days and was confused and not talking. She was transferred by ambulance to TTH and improved.

Third and Fourth, I sent two ladies so that they would have access to the Neonatal Intensive Care Unit because they were likely going to need to be delivered early. One was at 26 weeks with preeclampsia with severely elevated blood pressures who had persistent spots in her vision. Another one was at 33 weeks by an earlier ultrasound with preeclampsia with severely elevated blood pressures, and her baby was measuring significantly smaller on U/S than it should have (~27 weeks). I have not received any feedback about the first one yet, but just this week I saw the second lady. Unfortunately, she said that her labor was induced about 1 week after being transferred, but the baby died a few hours before she delivered.

Fifth, there was a lady who had a seizure disorder and was undergoing induction of labor. Unfortunately, her baby died during the induction (as a side note, intermittent monitoring of the heart rate of babies during labor is not the same as in the US; instead of being checked every 15-30 minutes or more often, it is usually checked about every 4 hours or so; therefore, babies dying during labor are much more common here than in the US, where we can catch a baby early that is not doing so well and either take for Cesarean section or try other maneuvers to help the baby). She later delivered normally and then had a retained placenta, which needed removal. Prior to removal, we noticed that she was breathing a little fast, so we placed a pulse oximeter and saw that her blood oxygen levels were in the low 80s. We placed her on oxygen, finished the procedure, and started some new medicines to treat the suspected infection. The next day, she began having much more difficulty breathing and her blood oxygen level was in the 70s on maximum oxygen, so we got her set up with an ambulance for transfer to TTH. Then, just this past week, the woman, her husband, and her mother came by our house with one of the pastors of a local church to tell us thank you. I have attached the picture for this lady and her family on this blog.
             Even though the outcome for the baby in many of these stories was not good, God was gracious in saving most of the lives of the mothers, and we praise Him for that.

There are many more maternity patient stories that I could tell, but these are some of the ones that stood out and that I wanted to share with you.

Black cloud

   When I was working in the hospital as a medical student, some of the craziest things would come in on the nights that I was there. It was always very busy on those nights. Later, when I was a resident, it seemed to be even worse. I would always have very busy call nights and rarely get to sleep at all. Tim and I would compare how our nights went, and they were always starkly different. He would be what we termed a ‘white cloud’ with less business, and I would be a ‘black cloud’. I remember pondering this one time during residency, and I decided that God knew that I learned things best by active learning. As I reflect on the mornings that I have worked this last month at BMC, things don’t seem to have changed too much for me.

   I went to the hospital to help out this morning. At first, I thought that I was going to get to watch Tim and Charlie do a C-section and possibly help out with the baby. Well, it was postponed due to another surgery that had already started. So, I went with Tim and another volunteer, Tony, down to isolation to round. There were only two patients to see, so Tim saw one and Tony saw the other. As I stood watching Tim change the dressing on this man’s skin graft on his arm and remove the staples that held the graft on, I wondered why God had brought me there this morning. All I was doing was tagging along like a small child, looking over Tim’s shoulder. I didn’t want to get in the way, nor take any experiences away from the volunteers that were here. There was nothing for me to do.

   I tried to be helpful, so I went to see what needed to be done to prepare for the C-section. They were bringing the patient to the theater (OR) and they were ready for Tim and Charlie. I was discussing a patient with Heidi, our surgeon, when a man came toward theater holding a small lifeless girl in a light blue school uniform with blood on her face. We found the one open procedure room and the man placed the girl on the bed. Heidi rushed to her side to see what was wrong. Then, another man came carrying another small girl in a light blue school uniform with blood on her face. There were no empty rooms to put her in, so we placed her on the gurney in the hall way and wheeled her beside the other girl. What had happened, a car accident?

     One of the men who brought the girl down said that a wall had collapsed at their school. Were these two girls the only girls that were hurt and brought to BMC? Our question was answered as a few more girls were brought down to the theater. After a quick assessment, we determined that the two that were brought down first were the ones needing our attention the most. Heidi began with the first girl. No one knew her name. She was a small girl around 8 years old, unconscious with blood around her mouth and nose. Her lungs sounded like fluid in the airways and her oxygen saturations were dropping. Heidi kept examining the patient trying to determine if the patient needed a hole in her skull to release pressure from bleeding around the brain, as she and Oleta (a surgical nurse volunteer) cleaned her face.

   As Heidi addressed the first patient, I began assessing the second patient. She was also a small girl around 8 years old, lying on the gurney fearful and in pain. She had difficulty speaking, but she was alert, knew who she was, and knew what had happened. She had a deep laceration across the base of her nose that penetrated through her lip to the roots of her upper teeth. She had another smaller laceration that went from the corner of her nose down towards her swollen, bloody red lips in a ‘Z’ like fashion. Her front 8 teeth were missing leaving behind bloody gums. We determined that she possibly had a facial fracture, but she was stable. She would need her wounds to be washed out and repaired, but she would be ok.

         Meanwhile, a man appeared at the door of the procedure room looking for his daughter. When he entered the room, he recognized the unconscious girl as his daughter, Memunatu, and his face froze for a few moments in shock. We escorted him back out into the hall way, assuring him that we would take care of her as best we could. As her breathing worsened, we asked the anesthetist about giving her oxygen or intubating. We moved her to the small OR room to give her oxygen and to monitor her better. Although she laid still on the OR table, we prayed that God would spare her life.  As we watched and continued to examine the little girl, she slowly began to show signs of improvement; her oxygen levels were higher on the oxygen, her lungs sounded better, her pupils began to respond more normally, she began spontaneously moving her arms and legs. Heidi decided against drilling a hole in her skull since she was improving, but she was still unconscious and needed monitoring. A little while later, Heidi noticed that there was some clear fluid also draining for her nose, revealing that she did have a fracture of her skull. After being monitored for several hours, Memunatu remained stable. She was moved to a bed in the wards, where she has been improving slowly. Yesterday evening, she finally woke up enough to tell Heidi that she wanted to lay down. Although she is still in the hospital and is not back to her normal self, she appears to be doing well with exception to now having fevers. We are grateful that God spared the lives of all the girls in that classroom. Please pray for Memunatu as she is recovering. Pray that she and her family will also come to know Jesus. Please pray for the other girls and their families as they heal. 

    Unfortunately, my phone isn't connecting to the computer, which means I can't attach any pictures. Sorry!

Two hard weeks

     The past two weeks have been pretty hard weeks in the hospital for both of us. Tim had previously admitted a woman who was pregnant with bleeding. He did an ultrasound and saw that she had a placenta previa, the placenta covers the cervix and won’t allow the baby to deliver vaginally. He also saw something unusual and was unsure what it meant. He came home and thought there was a possibility that it was a placenta accreta, where the placenta has actually grown into the wall of the uterus. If this was what he saw, this can be very dangerous for the patient. They continued to monitor her for several days, as her bleeding slowed to occasional streaks on the pads placed underneath her. On Tuesday last week, Tim was on call and rounding in the different wards as usual and I was preparing to come to the hospital, as this was my morning to work at the hospital for the week. Tim received an urgent call from maternity, asking him to come evaluate the patient as she had begun to bleed more rapidly. I arrived at the hospital just after Tim realized that this mother needed to have a Cesarean Section right then. He asked me to come to the OR, so that I could help resuscitate the baby. At this time, the mother was only 29 weeks pregnant. Although she had been able to receive steroids to help the baby’s lungs to develop faster, this baby would likely need as much help as we could give her.  Tim did the C-section rapidly, attempting to get the baby out and stop the bleeding as quickly as possible. He handed the pale bluish, lifeless small baby to me, as he continued to work quickly to save the mother’s life. As I placed the new little girl on the cold hard table, her chest caved in as she tried to gasp for air. There was no sound made and only a slow heartbeat. We quickly dried her off and began CPR, as Tim was working on removing the placenta. As Tim was removing the placenta, he realized that what he had seen on ultrasound was a placenta accreta and this mother was in great danger of bleeding to death. He was able to remove most of the placental tissue in pieces, but the patient continued to bleed a lot. This is the sort of case that only OB/GYN trained doctors do in the US, because it is rare, and dangerous complications are associated.  Tim was considering performing a Cesarean hysterectomy (taking out the uterus after doing a Cesarean section), when a Ghanaian physician poked his head in the OR room. He had previously seen a couple of placenta accreta patients in his housemanship training, where they placed a special balloon to stop the bleeding from the placenta accreta. They gathered together the tools needed and placed the balloon. Meanwhile, a midwife and I continued CPR on the little girl, also giving her epinephrine and an IV fluid bolus. Her chest would occasionally cave in as she tried to gasp for air, and her coloring improved only a little as we continued CPR. After a while, the little girl stopped trying to breathe and eventually we decided that the CPR was futile. This little girl, who was just born into this world, died before she was able to experience being lovingly and warmly held by her mother, who was also fighting for her own life. As Tim and Dr. Yakubu worked to place the balloon in the mother’s uterus, her bleeding began to slow. The doctors finished the operation, were cleaning up and noticed that the balloon had fallen out. They tried to place a new balloon but it would not stay in place. Thankfully, God had slowed the woman’s bleeding to only a slow trickle. We were still nervous that Tim may have to do a hysterectomy over the next day or two, but the bleeding stopped and the mother continued to improve. She was able to return home a few days later, but sadly leaving without her little girl. Tim did see her again in clinic this past week, and she was doing well (had no more bleeding, her blood count was stable, and the ultrasound did not show any retained tissue in the uterus). Praise God for preserving this woman’s life!

     Later that same day, Tim was also called for another C-section. Mother and baby did well. Then, he was called to evaluate a possible ruptured ectopic (pregnancy outside of the uterus). He performed an ultrasound and confirmed that she did indeed have an ectopic pregnancy with lots of blood in the abdomen. The patient ended up having the ectopic where the Fallopian tube connects to the uterus, a rare location. Again, God guided Tim’s steps as he quickly rushed her to the OR to remove the ectopic and give her back some of the blood that she had lost into her abdomen. The patient improved, and several days later, she was able to go home. Tim will follow up with her next week.

      This week also came with its own challenges. Tim was on call on Wednesday and had to perform a C-section in the middle of the night (Thursday morning) for another lady with a bleeding placenta previa. He had only had a few hours of sleep, so he had hoped to finish rounds quickly that morning and return home for a nap. This also happened to be my morning to work at the hospital. I went to maternity to see if I could help Tim round on the patients there. As we were finishing rounds, one of the midwives approached Tim. She was concerned about a patient who had just arrived. The Kakumba woman had been in labor and pushing since daybreak and it was now 10:30am and she had not delivered. Her contractions had stopped and the midwife thought the patient’s stomach felt unusual, like a possible uterine rupture (where the uterus tears open). Tim quickly examined the patient and agreed that it was likely a uterine rupture. He grabbed the ultrasound to confirm and to see if the baby was still alive. Sadly, the baby, that she had carried for 9 months and had been trying to bring into this world, had bled to death inside her abdomen. However, this tired, frightened mother was pale, cold, and internally bleeding. We had to rush her to the OR or she would bleed to death as well. We asked for anyone who could communicate with this woman and finally found someone just before taking her to the OR, and they confirmed that she did not desire another pregnancy (she had 7 children at home). Tim and a volunteer, Charlie, worked hard and were able to stop the bleeding by repairing the badly rent uterus and tied her tubes. She required a couple units of blood during and after the surgery, but currently she is in maternity ward and doing well.

     Even early this morning (despite the fact that Tim’s day off was to begin 1 hour later), Tim was called in to see a pregnant woman. She had delivered her seven previous babies too early, and she had no living children. This pregnancy, she had a cerclage placed (helps an incompetent cervix hold the baby in the uterus) in hopes that she could carry this baby to term. She had gone to a clinic in her town, Bunkpurugu, early this morning in labor. They realized that she still had a cerclage and needed to go to a hospital. They referred her to Tamale Teaching Hospital, but as she passed by Nalerigu she decided to stop at BMC (God’s divine guidance). The midwife called Tim to come quickly, as the patient was bleeding profusely. Because of the cerclage and the patient being in labor, she was at risk of a cervical laceration A cervical laceration can cause severe bleeding, putting the mother at risk of bleeding to death. Tim ran to the hospital, was able to remove the cerclage, and fortunately, there were no cervical lacerations. Because of her poor obstetric history, current bleeding, and history of one previous C-section, Tim took her to the OR for a repeat C-section. Praise God that the baby and mother are doing well after the procedure.

   These are not all the stories from the past two weeks, but a sampling for you to see what is happening here in the hospital and how to be praying. Thank you to those of you who prayerfully support us and the people of northern Ghana!

chicken lesson

   Oh, to the best laid schemes of mice and men. Before returning I had told myself that I needed to be much better about blogging. It is difficult for people to understand and prayerfully support what God is doing, if they don’t know what is going on. Upon return, there were so many things that I wanted to blog about, but we were so busy doing all these things that we had no time left to write about them. Then by week 2, we began the cycle of sicknesses. At least one of us has been sick the majority of the time we have been back. We have gone through flu-like stuff, pneumonia, pink eye (twice for me), and now cold-like stuff. I complained to Tim the other day that I was just tired of being sick and tired.  All of this has kept me from having much time or energy to sit down and write, until now.

bacterial acute conjuntivitis- not pretty, but healing

paramount chief and girls

    I will recap some of what we have done. When we first returned, things were calmer at the hospital than typical (which means that Tim was home more). I don’t remember all the things that we did, but I do remember two things. While we were gone, the brother of the paramount chief (who was a chief of one of the local towns) died. We returned just before the funeral, but we were not able to attend (Tim had to work and it was in a town about 2 hours away). However, we did go to the paramount chief and pay our condolences. We took a gift for him, so Rebekah wanted to bring a gift too. That morning, she picked out and colored a picture in her coloring book of David playing the harp for King Saul to give to the paramount chief. When she presented her gift, the paramount chief responded with a saying in Mampruli talking about a child’s friendship, meaning that they were very close friends now. Rebekah and Abigail spent the rest of our time there running all through his courtyard, chasing his animals (cats, turkey, baby goats). All had to stop what they were doing to watch the girls as they ran after the animals (even the chief’s grandchildren stopped playing to watch them).

girls chasing turkey and everyone watching

Ben in a chicken house

   

Shea nut fruit

Rebekah and Rebabigail

building chicken coop

all three 

 The other thing that I remember was that we were able to go out to town more to visit with people. There is a man in town, Ben, who has asked us several times to come and see his farm. We did not realize the extent of his farming, but some of the volunteers went with us to see his farms. I say farms, because he had a chicken farm, corn field, bean fields, a fish farm…. We enjoyed getting to know Ben better and learning about all different types of farming. We were able to try our first Shea nut fruit. Rebekah also acquired a small white hen, which she named Rebabigail. As a side note, originally we thought about raising chickens while in Ghana. Once here, I decided that the risk of enticing snakes to come around was too much for me and I nixed the idea.  Anyways, Ben gave Rebekah this small chick and she was instantly attached (ex: ‘Daddy, you are not allowed to ever kill my little chicky’ ). Now, we had to make a home for it. Tim spent all his free time the rest of that week building a chicken coop. We really enjoyed Rebabigail, as she would follow us around when we were outside and stand at the door watching us when we were inside. Two weeks later we bought two more young hens, a brown and a black one. Sadly, a few days later, Rebabigail disappeared. The other two are beginning to grow accustomed to us, but they are still afraid. The other day, both of the hens disappeared for several hours. They had never really left the back yard before. I was so sure that they had met the same fate as Rebabigail and almost started to cry. I went so far as to tell God that I really didn’t like the way things worked around here. God then reminded me how much more valuable the people’s lives here were than these chickens’ lives. It was a pretty sobering thought. I had almost cried over chickens, but had I ever cried over the lives of the people here? Sadly, I find myself too often focusing on unimportant things and missing what is truly important. After letting that sink in all afternoon, I watched God bring those two young hens back to their chicken coop that evening.

planting our garden

making friends at grinding mill

last time to pick Bella berries

Rebekah and Rebabigail

      

Tim with chameleon

in town with store owner Rebekah drinking Alavaro fruit drink

trekking through the jungle at Nakpanduri with volunteers

            

Dancing and an outdooring, all on a Sunday morning

  On our first Sunday back in Nalerigu, we were in for a blessing. We had the privilege to attend a service and outdooring on Sunday morning at First Baptist Church Nalerigu for some friends of ours. For those of you unfamiliar with the term outdooring, this is a celebration for a new born baby. When a woman has a baby here, she and her baby mostly stay indoors for about a week or so (traditionally 8 days). They have a celebration when they take the baby outdoors for the first time (although I'm sure many have actually been outdoors already). At this celebration they announce the baby's name and are showered with gifts from friends and family. Many Christians here will have the celebration as part of their church's services, kind of like a baby dedication. We were so blessed to be back in time to be a part of this little one's Tapiaya ('God's blessing') outdooring.

Pastor David with the parents, Nelson and Naomi, and Naomi's sister Rose holding Tapiaya

    The celebration of thankfulness to God through music for this little one's life was so contagious. They were singing and dancing with such joy! There was one part that particularly touched Tim and I as we watched. There is a young gentleman who faithfully attends church every Sunday. This man doesn't have good use of either of his legs and uses a hand bicycle to get around town or pulls himself by his arms. At the beginning of one of the songs, this gentleman was the first to jump out of his seat to come and dance before the Lord. It was a beautiful sight to see this man so joyful before the Lord!

Finishing our time in the US

     We have enjoyed our time here in the US, reconnecting with so many of you! Before we tell you more about our time in the US, we wanted to share with you a praise that we had. When we were planning our trip back to the States, we knew that we would be arriving in Fort Worth and would definitely need a car for that first week until we would get to Memphis, and it would have to be either an SUV or van to hold all of our luggage. We were not sure about what we would do about car insurance or what our vehicle situation would be for the rest of our time in the States. We prayed for God’s guidance on our situation, and then we reserved an SUV for the first week (which was not cheap). Within about a week of making the reservation, Lori’s parents had received a card from a guy in Memphis who provides vehicles along with car insurance for missionaries during furlough- for free! (the ministry is supported by donations). So we applied, got accepted, and then cancelled our other reservation. The vehicle ended up being a minivan, which provided ample room for our family and luggage. What an answer to prayer!

 In our last post, we had completed about half of our trip (mostly in Memphis). We continued to enjoy our time in Knoxville, where we had plenty of time to relax and spend time with Tim's parents and his brother, Chris', family. The girls were able to go swimming at the neighborhood pool several times, as well as go to a local splash pad for the first time and play on some playgrounds. Both Rebekah and Abigail loved swimming with floaties (first time for them) and playing with their cousins in the water.

During one weekend of our stay in Knoxville, we visited some friends from residency, one family in North Carolina and another in Tennessee. On the way, we took advantage of an American treat, National Doughnut Day. On this day, you can go to Krispy Kreme and get a free doughnut for each person. It might have been our girls' first exposure to doughnuts and they chose well- the chocolate glazed doughnuts. After arriving at our friends' house in North Carolina, our girls played as they shared with us about small town US life, and we shared with them about small town Ghanaian life. We had the pleasure of being joined by another friend from residency for dinner. The next day, we were able to go on a quick hike to see a waterfall before we left to see other friends. When we arrived at the next friends’ home, we were able to sit and talk while our 4 daughters played. We went to church with them the next morning, and it was a unique experience because it was literally a “home” church (the church had recently sold their old church building and the new building was not yet built, so everyone was meeting in the living room of one of the church member’s houses). We enjoyed getting to catch up with old friends and seeing the new additions to both of the families.

                        While in Knoxville, we went on a Tyke Hike at Ijams Nature Center, where we saw tadpoles/frogs, dragonflies, a snake, an owl, a vulture, a falcon, and various plants. We also got to spend a little time with one of Tim’s high school friends. In addition, Tim had the opportunity to give a talk on his time in Ghana in front of the Family Medicine residency program at UT Knoxville thanks to one of the volunteers he had met previously at BMC. We celebrated Tim’s sister-in-law, Jina’s, birthday as well as Tim’s birthday before we left Knoxville. We were also graced with the last-minute visit of some old friends from Fort Worth, Ray and Juanita, for Tim’s birthday, and we had a blast celebrating at Putt-Putt (on Tim’s request) for Super Saturday (unlimited miniature golf plus hot dog and drink plus batting cage tokens and/or arcade game tokens)!

         We then traveled back to Memphis for a week, where we enjoyed some fireworks, more swimming and the girls having fun with their cousins, peach and blackberry picking, celebrating Lori’s nephew’s and brother’s birthdays, and just spending time with family. We were going to have to turn our minivan back in before driving to Fort Worth (where we were departing from to go back to Ghana), so we did a trial packing of Lori’s mom’s car, and everything barely fit (God is good!)! Lori’s cousin blessed us again with opening up her house for us to stay for the few days before our flight left. We also got the chance to see the rest of Lori’s cousins from that side of the family during our stay.

          Our international flights were smooth and uneventful- which, with kids, hardly ever happens! We even had the blessing of being upgraded for free to business class for the second leg of our journey, which was a pleasant surprise. The next day, our flight from Accra (in southern Ghana) to Tamale (in the north), was cancelled secondary to an airport worker strike, so we had to reschedule for a couple days later. The extra two days were nice for recovering some from jet lag and to see some fellow missionaries that we had not seen in a while. Our rescheduled flight was delayed due to weather, and when we finally checked in our bags, they said we had too many to go on our plane and that the rest would be sent up with another plane. We were a little concerned about how this would logistically work since Nalerigu is 2.5 hours away from the airport, the driver needed to get back to BMC before dark, and the Tamale airport had no way that we knew of holding luggage if you were not there to pick it up when it arrived. By God’s grace, at the last minute they told us that God must be with us because they would be able to send all of our luggage on our plane…so our dilemma was solved!

          We are now in Nalerigu and have been cleaning, unpacking, and fixing things. It is good to see the smiling faces of some of our old friends again!

Please pray for:

1)     Getting readjusted back to life here

2)     Tim starting work again on Monday

3)     Tim maintaining boundaries between work and home

4)     Our chest freezer to start working properly (fan motor running all of the time)- we have tried a few things so far, but none have been successful yet

5)     The hospital and all of its challenges (staffing, financial, etc.)

6)     Wisdom for us on what to do next after January 2017 (i.e.- pursue the paperwork required to stay in Ghana, pursue a position at a mission hospital in a different country, come back to the US to practice medicine, or other)

Good bye Post-Residency Program

   Well, we have completed our 2 years of service in Nalerigu, Ghana with the Post-residency program of World Medical Mission, an arm of Samaritan's Purse. We are sad that our time with them is over, as they have been wonderful people to work with, full of support and encouragement. Despite our sadness over less communication with the wonderful people of the PRP program, we are excited about what is to come. We have committed to returning to work at Baptist Medical Centre in Nalerigu as volunteers with WMM through December and possibly returning to the US mid January. We are still unsure of what God has for us beyond that.

Church at the TB village on Easter Sunday

   We have had a busy couple of months. Before leaving Nalerigu, we celebrated Easter. The day before Easter, we went to a woman's home, where she invited many of the nearby missionaries and other ex-patriots. She organized an egg hunt and a potluck dinner for us to celebrate and fellowship together. On Easter, we went to the church at the TB (tuberculosis) village. It was fitting that the first church we went to in Nalerigu (the TB church) was also the last church we went to while there. God is stretching Tim in the area of public speaking, as it is not an area where Tim feels very comfortable. However, both times that we attended the TB church, he was asked to speak. What an honor it was for him to be able to speak about what Jesus did for us on the day we celebrate His resurrection!

 

Girl with severe burns

Pulling teeth

As a change of pace, the last week of work at BMC, Tim was able to take part in a full-day village dental clinic (aka - pulling lots of bad teeth) when a volunteer dentist came to BMC. Two other notable moments of Tim's last week were: seeing a baby, now several months old, who had been the first to respond to the make-shift bubble CPAP (device that helps newborn babies having difficulty breathing be able to breathe better that Tim and a resident made); and being able to discharge a girl after more than 3 months in the hospital for a severe burn (back of head and most of her back) which was covered with multiple skin grafts.

Baby who came back to see Dr. Tim

The VanDingenens

     Before we left Nalerigu, we had to say several 'until next time's and goodbyes (some fellow missionaries and volunteers). We will miss having the VanDingenen's next door. Thank you for your family's service here at BMC and among the families on campus! May God bless you and your family as you serve God elsewhere. We also miss all our friends in Nalerigu.


 








  Upon leaving Nalerigu, our family attended a medical missions conference. On the way, we stopped in Accra. There we caught up with some old friends and met a few news ones as well. This was a surprise blessing just before heading to the medical conference. The conference was a great time of learning and we were even able to have a little family time. We met several other medical missionaries and enjoyed the fellowship outside of the lectures we attended. The lectures expanded our knowledge and the girls enjoyed the children's groups, where they made several friends and learned more about Jesus. We were a little concerned how the girls would do since Lori is home with them almost all the time. Despite this, they did very well. They were even quite sad when we were having to leave all their friends. Rebekah is still asking when we will see some of her friends again.

    Not long after returning from the conference, we headed back to the US (as the ending to our term with the PRP). We flew into Fort Worth and enjoyed time with some friends and family. We stayed and visited with some of Lori's extended family in the area. We also enjoyed catching up with many friends from residency and our church, as well as others. Tim was able to speak at our old residency program about what he does and what our life is like. We hope he encouraged them about what all you can do with Family Medicine and possibly to volunteer at BMC. Rebekah and Abigail were able to make new friends every day. They had so much fun playing, but they began to have some difficulty with all the goodbyes.

     After a week in Fort Worth, we traveled to Memphis. Lori's immediate family all live near the Memphis area and we stayed with her parents. Our time was quite full while in Memphis: we celebrated our 8th wedding anniversary; Avalee (Lori's sister's new baby girl) privileged us with her arrival; there was mother's day and grandma's birthday celebrations; strawberries were picked and made into homemade ice cream; while at the zoo, we watched animals climbing, romping, swimming, jumping, and nesting; a few friends met us for dinner, and more. Again, Tim was asked to speak. This time he spoke at our medical school's Christian Medical and Dental Association's end of the year meeting. He did a great job of telling them what we do and encouraging them to follow Christ's leading in their lives. We also were able to speak at a 4 and 5 year old missions class and a 5th grade Sunday school class while in Memphis.

     We then headed towards Ohio, stopping off in the Nashville area to visit some friends. We visited with an attending from residency, Dr. McRay, and his wife.  We enjoyed spending time with this wonderful couple who has played such an important role in our lives. His wife even surprised us with one of our favorite meals for dinner. We then visited with one of Tim's childhood friends, Geoff, and his family. We were able to enjoy visiting with each other while our kids tired each other out playing (a win-win for all of us). Finally, we made our way up to Ohio. Jon, a close college friend of Tim, invited us to stay a couple of days with his family. He and his wife have 2 sons the same ages as our girls and one more on the way. We enjoyed the time of fellowship, as they shared so generously with us. Next, we visited with Tim's extended family and stayed with his cousin, Tracy, and her family. Tracy, an elementary school teacher, and her teenage daughter, Claire, were able to keep our girls happily busy imagining and creating. We enjoyed visiting with Tracy's family, as well as each person that came to Granddad's house for dinner.

   We are now in Knoxville and are being showered by the kindness of Tim's parents. We have been able to enjoy down time filled with playing, grilling out, and swimming. Also, we are sharing as many pictures as we can while we have good internet. We look forward to the rest of our time here and visiting others nearby before heading back to Fort Worth to return to Ghana. We have enjoyed all of our visits with everyone and are sad that we were not able to visit everyone we would have liked. God has used this time to give us some rest and encouragement. We look forward to seeing what God has for us during the next 6 months in Ghana and beyond. We desire that more people will fall in love with the God that has brought us there.

    Please pray for God to show us what He still has for us in Ghana. Please pray for the hospital, as there have been some issues that have occurred while we have been away. Please pray for the people of Northern Ghana to be prepared and eager to know the Truth. Lastly, please pray that God would reveal to us what he wants us to do next year. Thank you for all of your love and support!