Facing Our Limitations & God’s Healing Hand
The cost of healthcare is a huge issue faced by most of the families we care for. Because there is little outside funding of the mission hospital with regard to daily expenses the hospital has to charge enough to break even. So even in the emergency department, unless the patient is critically ill, we write out a list of IV supplies, catheters, and medicines we need to help their family member which is then used by the family to go and buy those supplies from the pharmacy. They return back with the supplies and only then the treatment begins. Of course there are many families we care for that cannot even afford the basic supplies and so the staff make a quick judgment about whether they can really afford supplies or whether they are lying to us. If the determination is made that they really cannot pay then the care is still provided but on a charity basis. I thought this would be an extremely difficult thing to do but even in a week it is fairly obvious which families are genuinely poor and which ones are just pretending. Duncan Hospital has a standing policy to never refuse care because of an ability to pay but most patients still don’t function under that mindset. In fact the vast majority of the patients we care for here come in only when they are so ill that they really cannot fathom any other options because they are worried about cost and they first want to give a chance for their local medicine men to do their treatment. This explains why I took care of six-month-old child this week who had been having a fever for 2 months and only after she became comatose did they come in. Her investigations showed severe acidosis and a new leukemia causing a white cell count of 90 thousand (normal is less than 10 thousand). Or the case of the elderly man who came in after his family noticed he had not eaten or drank anything for 15 days. He was so dehydrated and in such bad renal failure that his creatinine came back at 5 (normally less than 1) and his blood urea nitrogen was 326 (normal less than 20). When patients come in so late, other than God performing a miracle there is little else we can offer them.
Probably the two best success stories of this week were two women in their fifties – one who came in with a massive heart attack and the other came in 3rd degree heart block. The first was a woman who was working in the fields when she developed sudden onset of severe chest pain. She came in crying and moaning and the ECG done here showed a massive ST elevation myocardial infarction of the inferior part of the heart. The family did not have the money to take her to a bigger heart center where they might be able to get stenting done and so they asked us to care for her. Her heart rate was in the 30s when she first arrived because the vessel that fed her AV node was blocked – she barely had a blood pressure when she arrived. We got her moved quickly to the ICU where she was started on a medication called streptokinase (a drug we used in the US about 15-20 years ago which can be purchased here for about $50). This medicine helps to break open clot and within about 3 hours her EKG was returning back to normal. Of course we also faced the second problem of her extremely low heart rate. The defibrillator here does not have a pacemaker function and thus there is no way to temporarily pace someone while they have severe bradycardia. So I put her on a medicine that I had never used before called isoproterenol, which finally got her heart rate high enough to give her a measurable blood pressure. She was discharged from the hospital three days later under her own strength.
First Week at Duncan Hospital
We’ve now been in Raxaul almost one and a half weeks and life finally seems to be getting into a routine. Melissa and kids have settled into a daily routine and I’ve settled into the work at the hospital along with teaching the junior doctors. More details in the paragraphs to follow but I’ll highlight our first week at Duncan with the following praise and prayer requests.
Praises:
- The kids and Melissa are all feeling much better. Gastroenteritis seems to have run its course in our family and the kids have gotten their appetite back.
- The kiddos are all over jet leg and sleeping well through the night which means better sleep for us as parents.
- I’ve been getting some amazing opportunities to see clinical cases that I’ve never been exposed to in my emergency medicine training including measles, organochloride and organophosphate poisoning, TB meningitis, pericardial tamponade necessitating pericardiocentesis, and neurotoxic snake bites.
- The opportunity to teach many of the junior doctors some key emergency medicine principles and to share with the staff some of my insight to their clinical problems from an emergency medicine perspective.
- Getting to meet with several families on campus so that we could hear about their call to missions and their vision for Duncan Hospital.
Prayer Requests:
- The town of Raxaul – one of the least developed and polluted cities we have visited in India. Pray that Christ’s redeeming work would also extend to this city and transform it.
- Work/life balance – it can be very easy to get completely overwhelmed by the work and lose time with our families and time with the Lord.
- The plight of women in Bihar – there is little societal value to women and thus their lives are filled with sorrow and grief.
- The opening of the new hospital – happens in early May, pray that all the necessary details would come together to make this a reality.
- The junior doctors at Raxaul – that God would give them a clear sense of calling so that they might seek to serve Christ long term.
- Strategic vision – pray that God would use Duncan as a strategic center to train providers for many parts of North India.
- Provision of some more ventilators to care for intubated patients in the ICU so that they do not have to be hand ventilated.
Now for the longer version – we spent the first few days at Duncan with sleepless nights and sick kids. Thankfully in a few days the GI bug we had picked up had left our family. Karuna and Luke adjusted fairly quickly to sleeping through the night but we continued to have problems with Vivek waking up at 3 AM until we finally converted our kitchen into a bedroom to allow him to sleep there and he finally seems to have gotten into a routine with regard to his sleep.
Arrival in Raxaul
So we have finally arrived in Raxaul – the site of the first mission hospital we’ll be working at for the next three and a half weeks. We arrived here three days ago but have been in convalescence since because all of our children are ill. I’ll write in more detail about our trip so far on the next couple of paragraphs but for those of you who want the highlights here they are (pictures from our trip can be found at the bottom of the post as well):
Praises:
- Arrived safely in Raxaul after 24 hours on the train and 24 hours in flight
- No problems with getting through customs in Delhi with our medical supplies
- Big help from one of our family friends, Levi Paulos, who helped us navigate Delhi
- Extremely kind people on the train who went above and beyond to help us as we struggled with sleep deprivation and two very sick kids.
- Drs. Philip and Leeja have been great hosts and helped us immensely as we have tried to settle into life here at Duncan
Prayer Requests:
- Vivek, Luke, Karuna and most recently Melissa are all ill with gastroenteritis - pray for a quick recovery
- Melissa and I are extremely tired from multiple sleepless nights with sick kids and jet lag. Pray for recovery so that we can be useful here
- Christo would learn the hospital system at Duncan quickly since he will start taking call next week.
- Building relationships with the families here at Duncan so that we have a better sense of the community here and whether this would be a good fit for us long term.
For the longer version…we were able to get the second flight directly from Paris to Delhi after we missed our connecting flight to Bahrain. We flew on Air India and they were extremely helpful to us and moved seats around to allow us enough space to have a place to let our children sleep. After arrival in Delhi one of our family friends, Levi, met us at the airport in Delhi to help us get to the hotel. By the grace of God we went through customs without a hitch – in fact they did not even ask us to stop and just waved us through. That was a huge blessing in terms of being able to bring in the donated medical equipment we had with us. Also we had become a little wiser with regard to dealing with the porters in Delhi and so our total bill to get our bags from the luggage carousel to the car was a lot less than when we were in India last.
Departure & Going the Extra Mile
The day has finally arrived. After nearly a year of planning and preparation we’re on our way to India. We just arrived in Paris about five hours ago. Because our first flight from Dallas was delayed we ended up missing our flight to Bahrain and thus we’ll be flying out of Paris later tonight directly to Delhi. We’ll arrive there about 5 hours later that originally planned but it is a direct flight so that might end up being a blessing. This past week has been a busy one with lots of last minute errands to get finished along with packing quite a few medical supplies we were able to get donated from Parkland Hospital. A couple of big praises:
- Through the hard work of several people at Parkland in materials management we were able to obtain several boxes of newly expired or old equipment that they were no longer using. This was a huge blessing in that we were able to get almost 35 central line kits, some surgical supplies and lots of airway equipment. A huge blessing in that several roadblocks were overcome to allow us to take these materials with us.
- Melissa’s packing was excellent as always – with 9 checked bags between all of us, she still managed to get them all under the magical 50 lb limit (although several were 49.5 lbs!
). - We were able to enlist the help of some extended family in Delhi who will be coming to meet us when we land and help us navigate getting on the train there.
- Finally praise that India won the Cricket World Cup – the first time in 28 years – it should be much more pleasant to travel in India with people excited over a victory rather than angry about a recent defeat.
A couple of items to pray about in the next few days:
- Pray for an easy passage through customs. All of the items we are taking to the hospital are donated so it should not be too much of a problem but with rampant corruption it is hard to know who we’ll get as our customs officer.
- Travel to Raxaul. We arrive in New Delhi on Monday and on Tuesday we’ll take a train for 24 hours to get to Bihar. I suspect that all of us will be quite exhausted by this point in our journey so pray for extra grace as we travel.
- A quick turnaround from jetlag.
One thing that God has been teaching me over this past week has been an important lesson in trusting Him and relying on Him rather than my own strength to accomplish what He has called us to. In my quiet times this months I’ve been reading through the book of Acts and this week I read through Acts 12 and the story of Paul being thrown in prison by Herod so that Paul could be put to death. As Paul slept chained between two guards that night, an angel appeared, the chains fell off of him and he escaped out of the prison. It was a powerful story for me to reflect on to think about what type of God I serve. I was convicted about my own fears about this trip and the worry about traveling with three young kids to some remote parts of India. As I read through this passage, God used that to calm my heart and to trust that He was in control. I serve the same God who was able to cause an earthquake to open prison doors, raise the dead and even split the ocean in two so why am I so afraid of the unknown? What is the worst that could happen to us? Death? Illness? Loss? Even with the worst of those, to be absent from this life means being with the Lord. So as I’ve spoken with others this week – I have been less focused on the fears about this trip and more concerned about how God will use this trip to refine our vision. As I prayed this week it was in a spirit of boldness than fear because we serve an amazing God who is able to accomplish His will. The only question is whether we’re following His leading.
I wanted to write one final blog post in my series of posts about themes in the ER – this time about going the extra mile. I went into medicine because I first wanted to do mission work. Over the years as God continued to impress upon my heart the need for many to hear the Gospel who had never heard it, it seemed a natural fit to choose as my profession medical work since in it there is a great opportunity to minister to people’s physical and spiritual needs. One of the qualities Melissa and I have tried to cultivate in our marriage is the willingness to be hospitable and take the risk of being involved in the lives of my patients even outside my job. These experiences have been extremely rewarding but have also caused their share of heartache.
Support Raising & December Update…
We were blessed this year that my schedule worked out so that I was able to have Christmas day off - the first time in about two years. We celebrated together with our immediate family on Christmas and the kids had a great time enjoying time with some of our cousins and with Appachan and Ammachi. The kids of course were spoiled by the rest of the family and they were excited to receive the presents we had made for them which were books of pictures of their last year. We had noticed that the kids loved the books we had made for them in the past because whenever we have guests over they always want to bring out their books. They had lots of fun showing off their books to the rest of the family over Christmas. I've posted below the three books we made for them:
We are getting ready to drive up to visit Melissa's family in Nebraska on December 30th. We'll be there for several days as part of my week of vacation, celebrate Christmas with Melissa's family and rejoice at Melissa's grandparents 59th wedding anniversary! What a blessing and a testament to their love and commitment to one another.
We also wanted to give everyone a quick update about where we are in our support raising process for our upcoming trip to India (you can read more about our trip by clicking here: Medical Mission Trip to North India). We have received about 30% of the support we need to raise out of the $13,000 we need for our trip. It has been a slow and faith building process so far but we trust that God will provide the support we need to allow for us to go in a few more months. If you would like to partner with us as we prepare for this trip you can make a check out to "Crossroad Church" and write "India Medical Mission" in the memo line and send it to us and our church will send you back a tax deductible receipt. We are excited about our upcoming trip and pray that we would get a clearer sense of where God would have us serve long term in India and that it would be a time for us to continue to refine our vision of reaching India for Christ through medical missions.
I'll try to get back to my series of blogs on different themes in medicine hopefully in the next couple of days. We wish everyone a blessed New Year!
Perseverance
I am often amazed by how strong a person's will to live can be. Of course there are also many patients I have met over the years where I have wondered why they try to claw on to the last bits of their life when they are so ill. Often times that is a decision a family makes to somehow keep their loved one alive when they probably should allow their family member to pass away in peace. I'll focus on the issue of futility in my next post but this week I wanted to share some stories of patients who have truly amazed me by their desire to live even when the odds are stacked against them. I find it difficult to imagine how complex of a medical system many of my patients have to navigate to get care. I also have a hard time understanding the amount of suffering my patients have had to endure just to stay alive.
Loneliness
The emergency room is a very lonely place to be. It's an even lonelier place to die. It has been an interesting and sometimes sad look at people and what happens to them when they come to the ER. It is often times even more noticeable regarding who is not with them. I cannot begin to count the number of of people that come to the emergency department alone. They come to the ER because of a work accident, a gunshot wound, a car wreck, altered mental status or seizure and often come alone. What to me is even more depressing is how many come to the ER and die alone. To die in a place that is cold, sterile, with no one who knows you - it's a lonely place even for me.
Courage
What does it mean to be courageous? To me it invokes the stories of soldiers conquering distant lands, fighting for freedom, being self-sacrificial but I think I have been more deeply attuned to this quality as I have interacted with many patients as they deal with some of the most saddening and painful experiences of their lives.
I’ll be honest – most of the patients and the families I have cared for over the years in the hospital are not courageous. I’m not sure I’d be much different if confronted with the reality of death, of a lifetime of suffering, of losing someone dear to me. Most people come to the emergency room unexpectedly – they were not planning on being in the ER. Most of the patients that come in from a trauma or suddenly get sick come in pain, crying, asking for comfort – they are scared. So it is very noticeable to me when I encounter a patient or a family member that faces the problem head on – finding the courage to face their fate.
Medical Mission Trip to North India
First a couple of quick updates. We just attended the Global Health Missions Conference (GHMC) that gathers together every year during the 2nd week of November in Louisville, KY. It was a time of much needed spiritual encouragement and a time to meet with several organizations that we have been considering partnering with in order to facilitate our return back to India. The conference is the largest of its kind in the US with over three thousand medical professionals that have a heart to serve in medical missions here and overseas. The last speaker we heard yesterday, Dr. Carol Spears, was especially encouraging to hear about how God has worked in her life and through her sufferings to call her to a life of mission service in Kenya.
We also wanted to let all of you know that we have set into motion most of the things that need to happen for us to go to India in early 2011 to work at two missions hospitals that are part of the EHA network of hospitals.
The Dog Days of Summer
So the end of July and August has been unbearably hot in Texas. I believe we've had almost two weeks of greater than 100 degree weather! Our plants are wilting and so are our spirits as we try to stay indoors as much as possible. I finally had some time to work on some of the pictures from our big road trip to the west and northwest coast which I've uploaded along with this post. I think I've got a couple hundred more pictures to look through to get to the end of our trip and then I can start taking some new pictures!
