Hyderabad & First Week at Herbertpur Christian Hospital
We are about half way through our time at Herbertpur Christian Hospital. Hopefully we can give you a little perspective about our time here so far and about our week in Hyderabad in this blog post. For those of you who like the bulleted version here we go: (Some final pictures of Duncan Hospital are at the bottom of the post)
Praises:
- Lots of opportunities to teach residents and interns at Herbertpur.
- Wider exposure to trauma care in India since there are a lot more motor vehicle accidents that present to Herbertpur when compared to Duncan hospital.
- The kids seem to be adjusting well to the routine at Herbertpur.
- A fun drive with Dr. Daniel and his family to the mountains outside Herbertpur for a few hours to get a better sense of where we were and for us to see the Yamuna river.
Prayer Requests:
- Pray for endurance. It has been difficult being away from home and a normal routine for over 6 weeks. I think we have all become fairly weary of living out of a suitcase.
- Pray for more laborers for Herbertpur. They are short staffed especially with regard to OB-GYN and surgical care – Dr. Daniel is taking his first vacation with his family in four years later this summer.
- Pray for discernment regarding a decision about where we should join staff long term – there are multiple pluses and minuses to each hospital and we need to approach this decision very prayerfully.
- Healing from sickness – Melissa, Luke, Vivek and I have all gotten a horrible case of dysentery and are not feeling well. I took off a day from work for the first time in the last 7 years of medical school and residency because I felt so poorly.
We’ll begin with our time in Hyderabad and then move on to some highlights from our time so far in Herbertpur. We had a much-needed week of rest in Hyderabad and got to spend time with Elvin, my cousin, who works for the US consulate in Hyderabad. We were excited to be able to eat more than dal, rice and chapati for a couple of days while we were there and the kids thoroughly enjoyed being able to eat at McDonald’s again! We were quite amazed by Hyderabad and how developed the city is. Its roads are amazingly well designed and you can find almost everything we find in the West in the city. We made a trip our first weekend to Inorbit mall – the first mall we had gone to in India. We are not the typical mall people and rarely during our time in Dallas have we gone to malls but it was nice to be able to do our shopping in one location rather than visiting 10 different stores in various parts of the city.
Early that week, we met with Dr. Varghese Philip (VP), the managing director for 4B Healthcare, an organization that seeks to make failing mission hospitals viable again by infusing capital and management expertise.
The Villages of Bihar
We are now at Herbertpur Christian Hospital in the state of Uttarakhand. We arrived here on Sunday night and will be here for a month before returning to Delhi and then on to Dallas. We had a wonderful week of rest in Hyderabad with my cousin Elvin and the kids got to heal up from all their mosquito bites. We enjoyed visiting several sites in Hyderabad along with some great food. We spent two days visiting a 4B hospital in Nandyal and then spent another day with 4B Serve to see how different ministries are partnering together to care for communities all across India. We’ll write more about our time in Hyderabad and the exciting things happening through 4B but wanted to share some final thoughts about our time in Bihar courtesy of Melissa (a guest post requested by many). But first some highlights (some amazing pictures we were able to capture about life in the villages are at the bottom of the post):
Praises:
- Safe travel from Hyderabad to Herbertpur with no lost luggage.
- A wonderful week to rest in Hyderabad before starting the second part of our trip.
- 4B Serve – a wonderful partnership between multiple ministries all across India that helps facilitate greater cooperation between organizations.
- Getting to meet and spend time with Dr. Varghese Philip – a man with a great heart and vision for meeting India’s healthcare needs.
- Elvin (my cousin) and the work that God is doing through him at the US consulate in Hyderabad to impact India and the US Foreign Service for Christ.
- A good start to life at Herbertpur with meeting new friends.
- Vivek is finally speaking – we were quite concerned about his speech (we had met a couple of times with a speech therapist before we left for India) but God has worked marvelously during the past month and he has probably tripled his vocabulary in the last month.
Prayer Requests:
- Quick integration into the team at Herbertpur.
- Provision of much needed staff for this mission hospital.
- Continued prayer for discerning God’s leading and direction regarding where to serve in India.
- Opportunities to challenge the junior doctors here to consider serving long-term in missions.
- Pray for Vivek’s sleep – he has been quite disturbed now by thoughts of lizards (or li-li’s as he calls them).
- Karuna and Luke’s understanding of life in India and the need for people to serve in hard places to that they can have access to good healthcare and opportunities to hear the Gospel.
Finally what many of you have been waiting for…a post from Melissa. Here are some thoughts that she penned together about some of the village work being done in Bihar.
One of our final days at Duncan Hospital was spent with the Chetna project which is the arm of Duncan that works in the surrounding villages. Altogether they serve in 152 villages in the East Champaran district and we got to visit seven of them as we caught a glimpse of how they are serving and transforming the area.
Changing Minds, Cultures & Lives
So we have finished the first part of our journey and are done with our time at Duncan Hospital. We arrived in Hyderabad, located in the state of Andhra Pradesh on Thursday night. We spent two days traveling by road from Raxaul to Patna with stopovers in Motihari and Muzzaffarpur to visit several Indian ministries that work among the people of Bihar to get their perspective on what God is doing in Bihar before flying to Hyderabad to commence on the second part of our journey.
We will be in Hyderabad for a week as we visit a second hospital in Nandyal (about 4 hours from where we are staying now) to see the work of an organization called 4B Healthcare which seeks to make mission hospitals viable again by infusing capital and management expertise. We will spend a few days visiting that hospital before traveling on to Herbertpur Chrisitan Hospital in the state of Uttarakhand where we will spend our final three weeks before returning to the US in June. I hope to cover some of the specific areas where there needs to be change in Bihar and about some of the work Duncan Hospital is doing to promote that change. Melissa will soon write some about the community development work that has been started in the East Champaran district of Bihar in the next post but first for those of you who want to get to the highlights (pictures are at the bottom of this post):
Praises:
- Safe travel through some very difficult roads from Raxaul to Patna.
- Great conversations with Indian missionaries serving in Bihar as we saw how powerfully God is working in Bihar to changes lives and communities.
- Safe arrival in Hyderabad with no missing luggage even after we barely caught the flight out of Mumbai since our flight was delayed in Patna.
- Wonderful time of fellowship with many families at Duncan to hear how they felt called to missions and to the work at Duncan Hospital.
- A wonderful farewell party where we got to spend time with the junior doctors and other friends we had made during our time at Duncan.
- An amazing time of worship with local villagers on Easter at one of the village churches near Raxaul.
- A great day of visiting about 7 villages with the CHETNA project to see the many ways Duncan Hospital is helping to reach the poor and marginalized in Bihar.
- Provision of an amazing place to stay and great company in Hyderbad as we stay with Christo's cousin, Elvin.
Prayer Requests:
- God would bless our time in Nandyal as we see a different model for medical missions and to see if this model might be a possibility for how we might be involved in medical missions in India.
- God would continue to increase the number of people that hear about Christ in Bihar and that He would transform the lives of individuals and their communities.
- God would use this week of rest in Hyderabad to rejuvinate us before traveling on to the third mission hospital at Herbertpur.
- Provision of much needed staff from different backgrounds to consider working at Duncan Hospital to make it a place of great training and teaching for medical professionals in North India.
Our second week at Duncan was largely spent working at the hospital during the days and during this week I took pediatric call every other night (splitting the responsibility with Dr. Blessy, the pediatrician at Duncan) so that she could have a break. We also had the opportunity to meet in the evenings with many of the senior staff at Duncan so that we could hear their stories and how they felt led to serve at Duncan. Those conversations were a great opportunity to hear about the myriad ways in which God has worked to put together an effective team at Duncan. The kids especially enjoyed getting to play with the many kids on campus and have stuck with this even after getting plenty of mosquito bites in the evenings.
The lack of good medical care in this region of north Bihar was especially impressed upon me during this past week. Although there are many so called doctors and pharmacists in the area, the medical advice and treatment given to a large majority of patients is suspect at best.
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.
Mistakes & Failures
First, a big praise. We got to 100% of the support we needed for our upcoming trip to India as of one week ago! Thank you to all of you who have been praying for our trip as well as the many who have so generously given to help make this trip a reality. This whole support raising process has always been an incredible process of faith building for us. It is amazing to see how God moves in the hearts of people to generously give to make this possible. Of course, I would like the whole process to work on my time frame but often God uses delays and frustrating days to continue to increase our faith and to trust HIS provision. Yet again we were amazed at the variety of people who gave and especially moved by those who gave who did not have much to begin with - a true lesson for us about sacrificial giving. We are also excited because we are now less a week away from leaving for India. We leave next Saturday, April 2nd. A couple of things you can be praying for:
- Travel mercies as we spend over 24 hours in flight and travel through Paris and Bahrain on our way to Delhi and then as we spend another 24 hours on a train on our way to Raxaul.
- Pray for supplies to be become available for us to take to the hospitals in India. We have hit several roadblocks with getting supplies donated from Parkland due to hesitation from the legal department and we need God to work to allow us to have several pieces of equipment to take to India.
- That our hearts would be in the right place and that we would rely on God and not ourselves as we make this trip
In my continuing series of posts on themes from the emergency department, I wanted to use this post to write about several patients where I made a mistake or did not pick up on a condition fast enough to prevent them harm. I think very few physicians want to speak about mistakes because they ruin our sense of infallibility but I feel like the lessons I've learned for patients where I made a mistake have been invaluable in my development as a young physician and have taught me to hold on to my humility. I'm human and will always make mistakes but sometimes these are hard lessons when they involve the life of a patient.
Humor in the ED & Support Update
It's the beginning of February and we are having a hard time figuring out if we are still living in Texas or Minnesota. We have had almost two weeks of sub-freezing temperatures along with ice and snow which have again reinforced for us why we live here and not a 1000 miles further north! Melissa was quite sick last week and spent 4 days in bed with the flu but she seems to finally have turned the corner. Appachan and Ammachi and Chrisly were gracious enough to watch the kiddos for several of those days so that Melissa could work on regaining her strength.
We are continuing to make progress on our support raising goal although it has slowed the last few weeks. Hopefully many of you got a reminder postcard in the mail to continue praying for us and to consider supporting us financially to make our upcoming trip to India possible. We are almost 60% of the way to our final goal but still need to raise about $5500 to make the trip possible. We trust that God will provide us with the resources to make this trip possible and we are excited that we are now less than 7 weeks away from leaving for India. If you would like to help us with our trip just click the donate button on the top right or send us a check made out to Crossroad Church with "India Medical Mission" in the memo line for a tax deductible donation. Vivek got his visa in the mail today which was one of our last administrative hurtles to make the trip to India and the other kids all got a series of vaccinations a couple weeks ago to make sure they are well prepared for our trip. Thankfully Melissa and I did not need to get new vaccines for this trip which was better than our last trip whenI think we ended up getting over 25 shots between the entire family!
I wanted to write about the lighter side of the ED. People often wonder how people can work day after day in a place as stressful as the emergency room. Although I do meet a lot of people on their bad days, there are always patients or stories that bring a smile to my face or sometimes have me on the floor laughing. I think it is these lighter moments in the ED, the ability to laugh about the little things, the ability to laugh with my coworkers that makes my job fun and keeps me coming back to the emergency department.
Futility
I want to get back to my series of posts on different themes that I see in the emergency department and for this post I want to explore the issue of futility. Also wanted to let you know that we made it to Nebraska on December 31st after driving all night on the 30th and surviving a blown tire at 4:30 in the morning on a highway in rural Kansas. We spent a good hour trying to get ahold of a Triple A contractor to come and help us since it was about 5 degrees outside with sleeting rain - not ideal conditions by any means in trying to change a tire. Thankfully we survived that mishap and only managed to arrive in Nebraska about 4 hours later than expected. We were talking after this past trip about how blessed we have been in all of our travels (which I'm sure now is closed to 200K miles) that this was our first vehicle problem while traveling!
