The Skin and Its Contents

We've Upgraded!

2010-04-18T18:43:00.000-07:00

Check out our new blog at bekahandjon.wordpress.org.

New Opportunites

2010-01-04T17:32:00.000-08:00

Another way for Jon to fulfill his vision of training others has come from a completely unexpected source...Emory. It seems that there is interest in developing an international surgery program. This would enable Emory physicians, residents, and medical students to be invovlved in surgical work oversease and allow for additional research opportunities. We're hoping it will also bring much needed resources to the hospital we end up at. This is program is still in it's infancy, but it will be exciting to see how it develops. Jon will spend the year after he finishes his residency working for Emory and helping to build this program. It will be exciting to see what happens!

Future Ministry Possibilities

2009-12-30T08:53:00.000-08:00

When will you return to Bangladesh?

This question comes up a lot and we're working on our plans, however, it is doubtful that we will return to Bangladesh. As much as we learned during our time there and came to respect the team, God seems to be opening other doors. Our experiences so far have continued to shape our priorities and philosophy of ministry. Jon feels a strong desire and sees the best use of his gifts, not just in being a general surgeon, but in working to train others.

In light of this, we've come to greatly respect the work of PAACS (Pan-African Academy of Christian Surgeons), an organization committed to training African physicians in Africa for Africa, a vision that seems to match our own. They, and we, desire to see these future surgeons become leaders in their churches, communities, and other mission hospitals. In order to fulfill this vision, PAACS has established surgery residency programs at several mission hospitals. One critical need is for more board certified general surgeons to be program directors so that they are better able to handle the tremendous demands involved in training and discipling, as well as meeting the surgical needs of the communities served by the hospitals.

Specifically, we've been drawn to a hosptial in Ethiopia. A newer hospital situated in a key location in the horn of Africa, they are actively training surgical residents through PAACS. They are also in need of another general surgeon. More on this later.

Merry Christmas!

2009-12-28T17:25:00.000-08:00

Merry Christmas! We celebrate with you the birth of our savior who alone can bring light to penetrate the darkness of our hearts and transform us into his likeness. We rejoice because his kingdom has come and he reigns on the throne. We find hope knowing that he is renewing his creation and are excited to be involved in this work. And we find comfort in the assurance that all of his promises to us will be fulfilled. It is our awe of and gratitude toward this savior that motivate us to reach out in love and compassion and that are the basis for our lives and ministry.

In one of our newsletters reporting our trip to Bangladesh, we quoted Proverbs 19:21, "Many are the plans in a man's heart, but it is the Lord's purpose that prevails." Although we meant this, it has proven to be especially true this year. God has spent the last year affirming some things, saying no to others, and giving us a glimpse of new opportunities that we couldn't have dreamed of on our own. Check back because in the next few days I will include entries that describe these.

Pictures

2009-01-30T17:46:00.000-08:00

I added a few pictures to the blog because we now have reliable internet access. I also uploaded almost all of our pictures to Picasaweb from Google. Here is the link. http://picasaweb.google.com/bekahandjon

Back Home

2009-01-24T08:57:00.000-08:00

We're back safely, although jetlag has made us nocturnal creatures for the past couple of days.

Waking up at 3:00 am, we're ready for bed by dinnertime. We're trying to force ourselves to stay up, but that only lasted until 8:00 last night. Grace is happy to be back home with her books, toys and Skype for talking with grandparents.

In the days and weeks we will continue to process what we've experienced, observed and . As with any growing experience, realizations come in bits and pieces, times of pain and struggle, and "aha" moments.

More than a vision for ministry, I think God has given us a better vision for our family. In light of the demands of an American family living in a foreign culture and raising third culture kids, life in the context of a foreign, non-believing culture, and the sinfulness and selfishness that we must confront within ourselves we've been challenged to consider how we're to relate to one another. We (especially me) have been led into further exploration of what kind of parents and a family God has called us to be. How, as a married couple, do we reflect the relationship of Christ with the Church? What is God's desire for us as parents and how is this different because of our faith? How, as God's chosen basis for society, can the family reflect the best of his creation? What does this mean for our ministry pursuits and the balance between family and ministry?

As a woman who has been blessed to become a mother, but who also craves intellectual pursuits, there is internal tension. I've always stated that within a ministry context, my family must come first, that I will not sacrifice them for any number of others. I'm now being challenged to make my life consistent with my words...

Bekah

The Journey Home

2009-01-20T08:45:00.000-08:00

Tomorrow we begin the journey home. It's not the three month boat ride that it used to be, allowing for reflection on past experiences and anticipation of the future. Instead, it's 40hours of shifting around trying to be comfortable, walking around finding gates and allowing time to pass, and hauling around bags, Grace, tickets, and passports.

The past week has presented many opportunities. A few include:

A visit to a tribal village for the first day of a tribal renewal conference. We were able to see how this group of people lives differently from the rest of Bengalis, learn about the economic challenges facing them, and witness their response to the message of Hope.
Tea at the home of a hospital employee. We were able to meet his wife and kids, see their home and walk through a village near the hospital.
Visit a working Compassion site and the home of one of the social workers.
Bekah was able to spend a couple of hours in the OR, finally believing that Jon has been learning how to do surgery. During this time, she watched as they fixed a baby's club feet, repaired a fistula, and cut a tumor out of a man's chest.

We will see you all in a couple of days...in person or on our computer screens.

Bekah

A Camp Adventure

2009-01-06T06:20:00.000-08:00

We busted out of here! Living on a compound begins to feel confining after awhile so we, especially me, have been looking for ways to get off the compound and be able to see more of the country and people. We found our chance on Saturday when a retired couple who is back for a few months offered to take us with them on a trip to the camp that they've established. The morning began with a two hour drive, which we were warned about. It was bumpy at times as we drove down the brick and then pothole filled dirt road, but was overall manageable. Grace's fun and then nap certainly wasn't disturbed by the bumps! It was especially enjoyable to listen to our host couple as they related just a few of the stories and insights gained over the course of 40 years of work.

After arriving at the camp, we were served some of the amazing Bengali tea with samosas and sharingas. We were then taken to a village where we witnessed a family at work in their pottery business. The clay was hand mixed to the right consistency and placed on the "pottery wheel" which was carefully caked with mud in order for an even rotation and turned by the potter putting a stick on a hole and manually turning the wheel around and around until it was spinning fast enough. This is the pre-foot pedal version. We also met a family who had had part of their house burned down, the part in which the believing part of the family lived. Since this incident, the rest of the family has come to belief.

We were also able to visit one of the two churches that have been started through this ministry. This church hosts an Awana program and a Compassion site through which children's lives are touched.

Finally we were served rice, dhal, chicken curry, and vegetable curry for lunch and shown around the little camp. Including housing for 100+ kids and counselors, two playing fields, a covered basketball court, and a challenge course used for team-building, this small but well organized camp is the culmintion of 40 years of ministry for our host couple and the fruit of their commitment and our God's work was evident.

Bekah

Week in Review

2009-01-01T06:05:00.000-08:00

Ok, so I stink at blogging. No suprise. In my defense, this is the 4th time I've written this post. Each time. I write it adding more details of the week, only to find that as I try to publish it, the internet connection is lost and everything I have written is lost with it. So here I go. If I lose it, I will have saved it onto a word file and will be able to upload it when the connection is back. It has been quite a week for us, here are some highlights.

Cox's Bazaar - Cox's Bazaar is the southernmost major city in Bangladesh and a tourist destination located on the Bay of Bengal. The day after Christmas, we took a trip down there (about 45 minute drive) and played on the beach, swam in the Bay of Bengal, and visited the local fish market (an intense sensory experience). Cox's Bazaar is famous as the starting point of the world's longest continuous sandy beach.
Election day - Monday was election day in Bangladesh. These were the first elections held in 7 years. Bangladesh has an interesting political system. The founding fathers figured that any government in power would be incapable of holding free and fair elections so after each 5 year cycle, the government resigns and an interim government takes over to preside over the election process. In 2006, the interim government determined that the country was so corrupt that is needed an extra 2 years to clean up the mess. This election pitted the Awami League's Sheik Hessina (daughter of the George Washington of Bangladesh) vs. the Bangladesh Nationalist Party's Kalied Zia (wife of a popular former president who was assassinated in office). Both women have been prime minister before and both spent time in jail for corruption during the last 2 years. In the end, the Awami League won in a landslide, claiming parilment seats out of
Dulahazara Safari Park - This is a zoo/forest preserve located about a mile south of the hospital. This place is famous all over Bangladesh and over 1 million people visit per year. Because of it's proximity, Dr. Kelley has taken care of many of the people who work at the park over the years for things like Baboon bites and the occasional poor person who sneeks into the lions area looking for food, only to wind up as food himself. We were treated like royalty, allowed to drive the Kelley's LandCruiser through the park, go behind the scenes, and go for a ride on an elephant. Grace loved it. We'll have pictures posted as soon as we can.
The hospital has been slow because of the holidays, but we are still taking care of patients. This week's operations included a carotid endarterectomy. Bangladesh, in spite of being so despirately poor, still has a growing problem with obesity and vascular disease. We've also had some very sick people to care for with very little resourses. More stories for another post.

Jon

Christmas in Bangladesh

2008-12-27T07:21:00.000-08:00

Walking through through the small but crowded market on the other side of the street from the hospital, our presence invited stares from young and old alike. Cell phones came out to take pictures and videos of the strange white visitors on this morning of December 25th. For the majority it was just another Thursday, but for a minutely small percentage of this country it is the day to celebrate Christmas. Finding ourselves among that group, we made our way through the market and then the rice fields, some green with life and others brown with the leftovers from the most recent harvest. We then walked through the brick road that goes through the town, a crowded area with brick, mud, and bamboo houses all mixed together. Arriving at the church, we found a crowd of people mostly in brightly colored saris, newly bought for the occasion. With the women seated on the left and the men seated on the right, the left quickly filled up and overflowed into the half-empty right side. The significantly larger number of women was an indication of who has responded to the invitation to Truth. We enjoyed the service, although agreed that it will be infinitely more enjoyable when we can understand some of what is being said.

After a two hour worship service, we left in order to particapate in a common Bengali custom, visiting friends. A community affair, Bengalis celebrate Chhristmas by visiting one anothers' homes. Ducking down to avoid hitting our heads on the low doorway, we entered the home of a hospital employee. We were shown around the modest two-room mud brick home and it's accompanying outdoor cooking area. When it was time to eat, we were served a spicy chickpea dish with Bengali sweets. As the next group of visitors were waiting, we were served Bengali spiced tea to finish the meal. With snacks eaten, the next group waiting, and a child who had swallowed a pin waiting at the hospital for the doctors to see, it was time to go. Offering the Bengali Christmas greeting, Shuvo Boro Din (literally "happy good day"), we thanked our hosts and left.

Bekah

Salwar Kamiz

2008-12-23T07:39:00.000-08:00

Grace proudly modeling her new salwar kamiz that Bekah bought in the bazaar.

A Few Pictures...again

2008-12-20T06:07:00.000-08:00

Grace enjoying cake at a Christmas tea party

Tea time with the OR staff

Fishing boats that fish the Bay of Bengal (taken from the hospital property)

Life and Death at Malumghat

2008-12-20T05:37:00.000-08:00

I'm on call this weekend, which afforded me the opportunity to get involved with aspects of medicine that I'm not exactly used to. Pediatric diarrheal illnesses are straightforward enough, but malaria, OB, seriously? With C-sections, I'm following the see one, do one, teach one model. After assisting with a section on Friday, tonight it was my turn. I did one skin to skin as they say. Anyone need a lesson now that I'm ready?

This week we also lost a child. A 6 year old with 3rd degree burns covering 25% of his body. His story is sad enough to break even the hardest heart. His family's village burned to the ground last year, leaving his family without anything at all. A couple of weeks ago, his twin younger brothers were killed in a freak accident. After the funeral, it is tradition that the family serve a meal to all those that attended the service. As his mother was bring out the meal, she stumbled and spilled the boiling water onto him. His clothes, soaking with boiling water, were difficult to remove and got caught around his neck, resulting in very deep burns to his face. As we excised the burns early this week, we found that an invasive infection had caused all of the soft tissue to become necrotic down to the bone. We proceeded with radical debridement but the next day it was apparent that we were fighting a losing battle as all of the tissue surrounding the excision was dead. He died the next night and joined his brothers were there is no more suffering. For his parents, the suffering continues.

A Few Pictures...will have to wait

2008-12-19T00:47:00.001-08:00

I've been trying to upload some pictures for the last hour and a half, but we are at peak internet usage times and to say its been slow would be charitable. I'll post some pictures when I can.

A note from Grace

2008-12-19T00:24:00.000-08:00

There have been a few questions about my experience on our big trip. I've mostly had a really good time. I've been tired and less agreeable than usual but that's getting better as I get over jetlag and adjust to the new time zone. It's like having one huge yard to play in, with a great sandbox and swingset that I've already spent hours playing in. It's a good thing mom brought a bunch of clothes for me. I'm having so much fun and get so dirty that I get to wear 2-3 different outfits each day! There are so many things to explore here! Unfortunately I've had a few time outs because Mommy doesn't seem to think I should explore out of her sight. Silly Mommy, doesn't she know that I'm just checking things out?

The most frustrating this here is that everyone wants to touch my face or pet my hair. And most of them don't look at all like Mommy and Daddy. I find this extremely annoying and either bury my face in mommy's shoulder or try to slap or kick them away. Mommy doesn't seem to approve of this, but it's the only way I know how to get them to leave me alone. I'm used to a lot of attention, but not this kind.

Grace

Mashi

2008-12-18T23:44:00.000-08:00

For the sake of honesty and I feel compelled to share a bit of the negative. Desiring to actually contribute to something here and find a bit of relief from running after an incredibly curious and active two-year-old, a long-term worker tried to help me find an ayah (nanny). The first day was to be a trial run and what a trial it was. The day began with Grace becoming agitated as soon as she saw Mashi (kids here call their caretakers "auntie"), running from her and back to me. With advice from another long-term worker I decided that I would need to stick around for the first part of the morning, so I, along with the lady I was paying, watched as Grace played in the sandbox. Mashi even tried to push Grace on the swing, but she would not allow this and became angry. Mashi and I soon amused ourselves by hiding behind the swing and seeing how long she could push Grace before Grace realized it was her and not me!

I attempted to redeem the time by asking Mashi to teach me the colors in Bangla, but the rest of the day ended up consisting of more of the same, with Grace becoming increasingly more agitated as time went by. I did get a small break when, after I put her down for a nap, the poor lady sat and walked around, listening for Grace to wake up. Fortunately for Grace, I returned before she woke up from her nap.

Feeling horrible about it because Mashi had done nothing wrong, the first day was to be the last. I couldn't justify making Grace this uncomfortable in order to fulfill my desire for myself. I will add this to the list of "cultural experiences," realizing that not all will be positive.

On a more positive note, after two meetings with a Bengali tutor, I am well on my way to speaking Bangla. I can now pick out the subject pronouns and words such as child, son, daughter, good, and . Grace is constantly asking, "What his name be, mommy?" Therefore, the first phrase I asked to be taught was, "What is your name?" "Apnar nam ki?" in transliterated Bangla. I have been encouraged by realizing that the setup of this particular hospital and it's related activities should allow for me to learn to communicate even while taking care of Grace, a particular challenge that I have feared.

My next challenge is to practice ordering at the cantina (hospital cafeteria). I've tried twice so far with varying lack of success although the food has been good both times.

By the way, for our non-medical readers, Jon's lists translate to many basic general surgery cases, a few heart wrenching stories, a bunch of new things not seen in the U.S., and a few really crazy things, all of which he finds fascinating and every one a dark situation in which he feels drawn to bring the light of Truth.

Bekah

Victory Day

2008-12-16T16:15:00.000-08:00

Happy Victory Day! Tuesday marks the 37th anniversary of victory in the war for independence in Bangladesh. A time for great celebration in this country. It normally means a day off for everyone, however, we had a full day of operating.

Monday we did 5 cases

modified radical mastectomy on a man with breast cancer
hernia repair
open cholecystectomy (removing gallbladder) with drainage of half a liter of pus from above the liver
burn debridement and grafting
cholecystectomy with common bile duct exploration

Tuesday was a day for emergency cases only because of Victory day.

We started out with an a patient with a perforated esophagus from Boerhaave's syndrome followed by a burn debridement, a C-section, and a fasciotomy of foot (!) compartment syndrome.

Rounds, Clinic, and a Wedding Feast

2008-12-14T06:48:00.000-08:00

Rounds at 7:30. We saw only 6 patients. Its been slow because of the holidays. The patients include an electrical burn, a scald burn, resolving acute cholangitis, resolving acute cholecystitis, diabetic foot infection and a femur fracture.

In clinic patients come fast and furious. A small sampling of cases seen

depressed skull fracture

locally advanced breast cancer

inguinal and incisional hernias

tonsilitis

parotid tumor

malignant fibrous histocytoma

In the afternoon, we had ortho clinic - wide range of cases from perinatal elbow dislocation resulting from birth trauma to nonunion of midshaft femur fractures.

Finally, this evening a wedding. The groom is a former patient of Dr. Kelley's who was quadraplegic after a c-spine fracture who regained complete neurologic function after reduction and fixation. He now works at the hospital as a janitor and is a very happy groom.

The Fog

2008-12-13T17:00:00.000-08:00

During a moment of down time I can't read, something I'm normally deperately trying to do, because once I start I will no longer be reading. Instead, I will be sleeping. The fog of jetlag is heavy, granting relief early in the day (today at 3:30 am) but settling over one's mind and body by early afternoon. As the day progresses, the fog thickens, impairing one's ability to comprehend and remember. There is so much to see, smell, taste, hear, touch, and sense but full appreciation of these experiences must wait for a later time.

Jon, in an opportunistic manner, took advantage of the situation to share, gently and unaccusingly of course, that this is the post-call feeling that leads to occasional inattentiveness and unresponsiveness at home. Ok, so he may have a point; but I'll have to think about that.

Bekah

We made it!

2008-12-12T22:26:00.000-08:00

4 flights, 36 hours, 3 countries, 1 tired girl.

more information soon

The Skin and It's Contents

2008-11-27T18:21:00.000-08:00

So I started a blog. In 2 weeks Bekah, Grace, and I are going to Bangladesh. I'm going to work at Memorial Christian Hospital in the extreme southeast part of the country. Hopefully, this blog will keep anyone who is interested updated on what we are doing. I'm sure I will be doing some incredible cases and working very hard. Bekah and Grace will be busy, too, but at this point we're unsure about the specifics of what they'll be doing. We're taking 150 lbs. of surgical supplies that I've managed to beg, barrow, and steal. Well, beg and barrow anyway.

The title of this blog is a reference to a saying used by a few old time general surgeons. They say that they limit their practice to the skin and it's contents, meaning there is nothing that they can't (or won't) operate on. Memorial Christian Hospital is an 80 bed hospital that serves a population of 10 million people in the southeast portion of Bangladesh. It is staffed by 3 MD's only one of whom is a surgeon, Dr. Steve Kelley. He is a general surgeon in the fullest sense.

Some of the things we're bringing include

Intramedullary nails - to fix long bone fractures
A 30 degree cystoscope for urologic procedures
Suture for C-sections
Laparoscopic equipment
Hernia mesh
Assorted car parts
Coffee

It's going to be fun.