Just for fun...Joshua antics

How about a glimpse of our funny little "monkey?"  From tree climbing to head shaving, Joshua entertains us regularly.

Opportunity to become stronger…and possibly more stinky.

Why have we come to Nepal?  We believe we’ve been called here.  Jesus tells his disciples, “Go and make disciples of all the nations…”(Matt. 28:19)  We are his disciples, and we have gone.  Yet, making disciples is a challenging endeavor.  It doesn’t happen overnight.  Is anybody out there making disciples among your children?  You might know what I mean about long-term investment.  One of our observations here is this: in the process of cultures coming together, and ideas mingling, rather than a convert being made a disciple, sometimes that person is corrupted (often by money).  So, now here we are encountering people with “problems” (as far as we can tell).  And we are tempted to offer solutions before we even know what resources and assets our “troubled” friends here have.  Our goal should be to empower our friends to solve problems, being careful not to create dependency by doing things for them.  So, making disciples is not that dissimilar from raising children: and doing that well is no simple task!

So, that brings me to our opportunities to grow.  Today, I worked on the Maternity Ward.  The obstetrician that I work with keeps telling me that he practices obstetrics because it is simple and he is confounded by generalists, like me, who keep track of so many different aspects of medicine.  Well, the truth is that I don’t find obstetrics that simple.  I feel overwhelmed sometimes by the pregnant women I see and I find the decision-making quite taxing when the obstetrician is away.  Thankfully, the nurses and midwives are amazingly talented here.  Still, I get the opportunity to grow when I am assigned as a maternity doctor.  So while I was feeling challenged at the hospital, David was finding opportunities to be strong at home.  Our tanks ran out of water today.  It has been raining almost daily lately and the water supply should be good, but for some reason our connection with the city water supply has been cut off.  Furthermore, our Nepali helper was having a very hard day today.  Although her husband abandoned her many years ago, she became very upset today upon learning that he has died.  I’m not sure that we understand all of the reasons for her pain and struggle (we have a few hypotheses) but it is a difficult time to clarify what is really going on.  Still, we hurt with her in her widowhood, and we seek a good response in this relationship.  What would true disciple-making look like?  Please pray with us as we seek this.

When I came home briefly for lunch to see how everybody was doing, I learned that two of the kids have headache and general malaise, while Ana is struggling with insomnia.  You know the concept that muscles only become strong by meeting resistance/challenge.  Today, I looked around at my little social circle and saw that we all have the opportunity to become stronger in our spirits as we continue to find ways to cope with our challenges here in Tansen, Nepal.  And the first step to becoming strong is trusting God in every circumstance that he allows to filter through his hands into our lives.  Speaking of life here, we recently heard an historian speak on the beginnings of missionary/medical service in Tansen (in the 1950s).  A few devoted disciples of Christ faced many very difficult challenges while establishing Tansen Mission Hospital.  We live and serve in relative comfort and ease, I see, as I consider the true pioneers here.  

So, how are your spiritual muscles being strengthened today?

Thank you for journeying with us.

With love from the dirty (not enough water for showering) Beines.

A Different Way to Spend Easter

All seven churches in Tansen came together for the Easter service this year.  There were about 500 people worshiping together.  In past years, they have done marches around the town, demonstrating Christian unity and they have passed out tracts and Bibles.  The churches decided this year to give a different kind of gift to Tansen.  We split up into groups of ten or so, and went to different parts of town to collect up trash from the roads.  The idea of using trash cans hasn’t really caught on here yet, so in our two hours of trash collecting, our small group filled a few 50-gallon bags.  All together, they needed a tractor trailer to haul away all of the trash collected by Christians that day.  So many people asked us what we were doing.  We said we were giving them an Easter gift by cleaning up in front of their houses and stores.  They agreed that it looked much nicer after we had finished.  We even convinced two children to join us in our efforts.  I pray that such children will be the future leaders in Nepal.  Our circuit ended at the bus park where there was no small amount of trash.  We told people that this was a group effort of all of the Christians in Tansen.  We serve because our LORD served.  Some people were appalled that doctors would collect trash.  But then again, the Creator of the universe made things from wood, fed hungry people, talked to women, made mud with his spit for a blind man’s eyes, and held children.  We are compelled to be like our Master.

For the medically inclined, here are some of the challenging diagnoses of the week:  young adult with high fevers on and off for a year, with no response to antibiotics nor anti-malarial medicine, and no other abnormalities can be found (except for an increased white blood cell count and the fevers are now daily), tuberculosis with treatment interruption at six weeks (the patient was so thin, I asked what they were feeding him; they answered: rice and lentils and Red Bull; oh my!), Kala Azar, opacity on chest x-ray that I could not discern, ascites of unknown etiology, and then too many people killing themselves through addiction to alcohol.

On a high note, there was a premature baby that I cared for last week, for whom we had to stop the resuscitation efforts.  When I came home and shared the story with Ana, she immediately put out a request for prayer.  Well, I went to see that little one today.  She is breathing on her own.  She is off of oxygen.  She is through her jaundice.  She is nursing.  And she has now surpassed her birth weight of 1900 grams.  The parents are so happy.  They still haven’t named her yet.  They want to wait to see if she is really going to survive.  This is a miracle.  Our God continues to perform miracles.  Thanks be to Him!

-Kimberly

FAITH, HOPE and LOVE...

This morning I came out of my slump.  You know whenever you step out of your comfort zone, to do hard things, you are bound to go through what I am calling a slump.  To me, a slump includes things like doubt, sadness, apprehension, disappointment, feelings of inadequacy, fear, confusion, or some other “difficult” feeling that persists for a while.  I have noticed that every single one of us who serves at this mission station goes through times of slump.  For me, returning to inpatient care has accentuated my “difficult” feelings.  Yesterday, I was the senior doctor for pediatrics; my colleagues: an intern and a brand new resident.  Did I mention that I lack training in this specialty?  The day was extremely difficult.  It started at 7:30 am with the 8-month-old in the ER with septic shock.  Then we began rounds.  One of our patients was two-days old, having been born six weeks before her due date.  Again, I sensed my lack of experience and training.  At 10 am, we were called back to the ER to resuscitate the septic child who had stopped breathing.  It seemed that we had resuscitated him successfully and he was prepared for transfer to the ward.  We returned to rounding on the inpatients and finished at noon.  We were on our way to the outpatient clinic to see the 60 patients who were awaiting our arrival, and we were called to the operating room.

Here is the highlight of the day.  The patient: a woman who had lost her first four babies (either in utero when they were full-term, or at the time of delivery).  She was having a c-section while this baby was still alive; I prayed that she would receive her first live, healthy child.  We were there to care for the baby in any way that he might need.  THANK YOU GOD…this little guy (whom they had estimated to be four pounds, by ultrasound) came out crying and weighing at least six pounds by my estimation.  All I had to do was dry him and examine him.  He looked perfect.  I was so happy…I wanted to kiss the adorable little guy!  To avoid being misinterpreted as eating her child, I settled for big smiles and telling the mom that she had a beautiful, healthy baby boy.

Unfortunately, during this c-section, we were called again to the ward; the 8-month-old had a respiratory arrest again, and this time he died.  I made it in time only to say to the mom that I was so sorry.  One-o-clock: finally on our way to clinic.  There were some of the usual diagnoses that we see in pediatrics (pneumonia, ear infections, etc.) but there was also the five-year-old who weighed barely more than twenty pounds.  Her TB is now cured; why isn’t this child growing?  After some help from a Nepali speaker, this is what I discovered: the mom is made to work all day long, by the husband who beats her if she doesn’t obey.  While she is out in the fields, there is nobody home with this five-year-old and she goes all day without eating.  She is simply not being fed…and she shrinks away.  I feel that old pain in my heart again. 

We did our best to see the 60 patients in 3 hours; that’s how much time we had before we were called to the maternity ward for the 2-day-old.  She had stopped breathing.  We breathed for her, with a hand-held resuscitation bag, off and on, for three and a half hours.  Unfortunately, not one of the doctors on duty yesterday knew how to use the ventilator, which this baby might have most benefitted from.  I spent a few hours that evening consulting with other doctors to see if we could find someone to be responsible for the ventilator for the night so that she might make it to morning when we could investigate the potential causes of her apnea (the cessation of breathing).  In the end, I had to release the nurses to tend to the other patients and we stopped our resuscitation efforts.  Ouch.  Are there any pediatricians out there who can come to Nepal to help the generalists like me?

It was such a difficult day.  I came home and had a long talk with Dave.  I realized that without him, to talk to after such days, I might not be able to do this mission work; it might break my heart.  So, I thanked God for my husband.  We talked again this morning and something suddenly became so clear to me, that I came out of my slump.  We lack skilled personnel here, and I myself lack knowledge and experience that I wish I had.  Still, I keep going to work, with a learning attitude, hoping to keep becoming a better clinician.  I find it hard and humbling.  But, this morning I realized that I do have three things, and these three things will last forever: FAITH, HOPE and LOVE.  These I have in abundance.  These I can freely give.  And I do.  I demonstrated love to every patient that I saw yesterday, as best I could.  I hope that they saw and felt it.

Faith, hope and love abide, and the greatest of these is love.

Thank you for being somebody who loves us enough to follow along in our journey,
Kimberly

Heartache again…please soothe the pain, LORD.

This is what I can focus on…praying for comfort for those who suffer.  You know, for some reason (not well understood by me), I was made as a person who feels so much, so deeply.  This personality struggles to live so close to so much suffering.  And yet, I wonder about Christ.  He submitted himself to the center of the suffering, and some Scriptures convince me that he felt the experience deeply.  Just this morning I read, “You know the generous grace of our Lord Jesus Christ.  Though he was rich, yet for your sakes he became poor, so that by his poverty he could make you rich,” from II Corinthians.  And we know that he wept in the midst of the experience.

So, this is all leads up to a difficult case that I recently saw on Pediatrics.  I only learned some of the details later, but here it is.  This family waited 10 years to have a child.  Finally, he came; yes, it was a boy…what a precious reward according to this South Asian culture.  There is even a saying here, “If it’s late, it will be a boy,” meaning something like, “After the long wait, the reward will be great.”  So, their boy reaches 10-months of age.  He is pudgy and seemingly thriving.  But one day he gets a fever and a cough.  They wait a few days, get some medicines from the local medical hall, and wait again.  Finally, they decide that their precious son is not going to get well at home.  They find transportation to the mission hospital and arrive at our emergency room.  The child has a rapid respiratory rate, taking a breath more often than every second.  The fever is high and the lungs sound like it’s a case of pneumonia. Oxygen is given, an intravenous line is started, and antibiotics are begun.  Then the parents are told that the child will need to stay in the hospital for a little while; they can bring him to the ward.  This is where I meet the child.  But at the meeting, the child is not conscious.  Why is this child unconscious?  Nobody seems to be aware of exactly when he lost consciousness.  A quick check of oxygen level and blood sugar eliminate two possible causes.  The child’s temperature is noted to be 105 degrees.  We work at cooling this kid with medications and external cooling.  He isn’t waking, and his pupil reactions aren’t quite normal.  A head CT is not an option; that can only be found a one-hour car ride away.  We change medications, thinking that the infection may really be in the central nervous system (perhaps meningitis?).  It would be good to take some fluid from the spinal column to evaluate for this, but suddenly we notice one hand twitching…then the other…eventually all four limbs.  Now we have seizure activity, and it is not appearing to be simply related to fever.  We begin anti-seizure medications.  The response is for a brief period of time, but again the seizure activity begins.  After five doses and medication adjustments, the seizure activity is under control.  The fever subsides, the breathing gets easier (with good oxygenation), but still the child does not awaken.  Our next problem is the failure of the IV, and multiple attempts to replace it on this plump kid fail.  He needs that IV.  He has a brief awakening (I am told after I get back from a weekend away).  He is sent to the operating room where he will have a “cut-down” procedure to secure a good intravenous line.  During the preparation for the procedure, he has a respiratory-cardiac arrest.  CPR is performed.  He dies.  So many questions unanswered…was it encephalitis?  It was certainly incredible pain for the family.  And the cycle of suffering continues.  We pray for COMFORT for this family in their loss.  Oh Lord, I pray that they experienced LOVE at our hospital.

Above I mentioned the medical halls where the family got some medicine.  This is a predicament here.  Western medicine has definitely arrived.  Medicine can be found around every corner.  But training in the administration of such things is clearly lacking.  So often, patients arrive at the hospital having already tried a large variety of medicines from the medical hall, not necessarily in the proper doses and quite often mixed in combinations that are certainly ineffective, probably dangerous and occasionally downright harmful.  Dave, the anthropologist, thinks that medical halls may be replacing the witch doctors.  Their efficacy may not be much different.

Just recently, Dave reminded us all of a surgeon who worked in Tansen last year.  Just before she left she shared a story with us.  She had a young patient with cancer, and many were praying for the girl during her hospital stay.  The surgeon’s prayer had been that God would show His strength to this Hindu family through a miraculous healing.  The girl died.  The family went home.  The surgeon felt sadness.  Then just before her departure, she discovered that the family had turned to the God who is LOVE.  She was shocked.  Their response was that the LOVE they experienced at the hospital was something entirely different than anything they had experienced before.  It was their pathway to God.  PRAISE HIM…He always knows what He is doing.

Trust Him, Kimberly, trust Him…even in the pain.

Thanks for listening.

Because some of you like to see us...

A jumble of thoughts...

We all had recent dental appointments here.  It cost each of us 95 cents, except for the one who needed an x-ray…that bill totaled around $10.  The contrasts between our two worlds are almost incomprehensible.

I also had a very small surgical procedure here for a bump on my foot that had been growing for about a year.  I pursued a resolution while we were in the U.S., but even getting an opinion surpassed $300, and then the doctor didn’t really want to operate.  Here, I have a friend who is a surgeon working at the mission hospital.  We went through all of the proper channels at the hospital.  I got the lump removed.  And the bill totaled just over $13.  I am thrilled with the outcome, and so happy that I could make this contribution to the budget here.  So many patients cannot pay their bills and need to use the funds that come from generous donors around the world, and that fund is running dangerously low.

I have had a blessed opportunity to receive training in neonatal resuscitation and in caring for burned patients (a common occurrence), as applicable to this place with our current set of resources.  I was thrilled when a few days after the resuscitation course, I was called to the operating room for a baby who was being delivered by c-section because of decreased movement and hardly any amniotic fluid.  I was so thankful to be equipped with an understanding of the local protocol.  The baby did fine.

In regard to adoption, every door we have knocked on has remained closed.  Our own government has erected a large barrier to adoptions because of insurmountable corruption in the system here in Nepal.  I recently read a book called Little Princes, which documents just one of the problems here: many of the orphanages in Kathmandu are full of kids with living parents.  Their parents gave money to a child trafficker (unknowingly) during the recent 10-year war in Nepal, believing their kids would be taken to the city where more food was available and where they could get an education.  Along the way to the city, additional funds were collected from foreigners who believed these children were orphans (and some false parental death certificates were sometimes provided to encourage that belief).  In the capital city, money was collected again as the kids were sold to wealthy people who wanted laborers in their homes.  Many of the children were neglected and some near death when they were discovered by international groups who established orphanages to save these kids from their slavery.  So now there are orphanages full of kids who are not truly orphans and yet reuniting them with their parents is fraught with difficulties and some are physically faring better in the orphanage than they ever could in their villages again.  I fear that not all parents would desire to take their children home again.  When I contemplate the emotional suffering that these kids have endured, I shudder.  This is only part of the story. 
We continue to see and know that there are many children wandering this country without parents.  Even if their parents are alive, they have abandoned their children, often due to hopelessness, in a world where they cannot adequately provide for their children.  Their inability to provide may stem from lack of resources, oppression as a single parent, addiction to destructive substances (most common being alcohol), lack of understanding of what children need, etc.  My heart is getting that ache again, even as I write.  So, the conundrum of our current situation is that we have the resources, the desire and the know-how to raise at least two of these orphaned children, and yet every avenue where we have pursued, our access has been denied.  We wonder why the LORD has put this on our hearts.  Finally, the next barrier that we may soon run into is our advancing age.  We have recently read some Indian documents in regard to adoption that say that once our combined age exceeds 90 years, we will be out of the window of opportunity to adopt in this part of the world.  This year, after our birthdays, our combined age will equal 90 years.  My current prayer: “We look to you, Lord Jesus…what have you placed in our hearts and for what purpose, and do you intend to move the mountains that stand in between us and some orphaned children?”  Will you join us in asking that He would grant us insight?  Thank you!

Finally, you might think that in our going back and forth between these two cultures, we might eventually become immune to culture shock.  Oh, I wish it were true.  However, I find myself in the doldrums of culture shock again, wondering how it was that I once saw beauty in this culture.  Don’t get me wrong, I still see beautiful people here, whom I admire and even love.  Yet, the dark glasses that my eyes seem to be wearing right now only see all the corruption, the darkness, and the dysfunctional aspects of this culture.  Yet, like all cultures, this one too is mixed with good and bad.  Please pray that I could soon remove my dark glasses and see more fully the beauty that is surely here.

Appreciating your input into our lives,
Kimberly