Month: April 2019

February 4, 2019

My hands (and shirt and lungs) got covered with chalk dust today. It’s been awhile – eight months to be exact. This time, I wasn’t demonstrating formation of Greek letters, diagramming compound-complex sentences, or creating a timeline of Restoration Age English literature. I was drawing circles and lines.

Our class worksheets involved no translation, parsing, or analysis of sentence components. We were circling pictures that looked the same. (See the cup on the left? Look to the right. What’s that? A pencil. Good. Is that the same as the cup? Nope. Okay, skip it. What’s next? A pot. Also not the same. The last picture in the row? Yes! That’s a cup! Circle it! Good work!)

Providing feedback to students involved no editing or morpheme cuts. Just… finding the students whose pages were upside down and helping them get to rights. Then, identifying that someone matched a fish with a plane. (Nope. Sorry. Those are not the same thing.)

Why all the struggle? It’s not because my students today are children. Most of them are adults with children of their own. It’s not because they lack intelligence. They know how to survive in a harsh place. They can wrangle food out of the ground on the sides of mountains that I just fall down. They can build houses with no power tools. They know how to use everything in their world to provide for their families, and they’ve been doing that for generations. Oh, and they also know how to speak and understand a language that has a dizzyingly complex verbal system with seemingly endless affixes.

So why the challenge with these worksheets? As I look out the window, I see why. There are no billboards in view. No street signs (not even any streets). No newspaper stands. No bookstores. 

No words for the eyes.

They live in a society that doesn’t require literacy for people to function. Many of these adults have never in their lives needed to read or write. Paper, pens, letters, written words – what are those for?

So as we gather for the first day of literacy school, the first steps are discriminating marks on a page, starting from the left and top of a page, and holding a pencil. If you’ve never needed a piece of paper before, wouldn’t you wonder how to hold it and what the marks meant? Would you understand how lines in different shapes correspond to reality?

This bears the question “Why learn to read?” What will you read? Where will you get a book? What has changed in this society now so that forty-two people crowd into a room, looking nervous and happy and worried all at the same time? Of course, the kids need to learn to read so they have a better chance for school. But why these adults?

We started class with that question. I asked, “How will it help you to learn to read?”

Leften and Imai, two of the fathers in the class, answered immediately, in surround sound: “So we can read the Bible.”

You see, fifteen years ago, the gospel came to the Kamea. God moved, people believed, and a church was born. And the church is nourished by a book. For these believers, learning to read became a need precisely because they started following Jesus.

Amon is a deacon. His wife, Margaret, learned to read a couple years ago. Amon wants to lead his family in worship. He sits in class next to his son, Leden, helping him as they learn to read together.

Leften runs a store. He is a sharp guy. He and his wife, Sedina, have three children whom they need to train in the gospel. They sit in the same class now, across the aisle from each other (since men and women don’t sit together).

Imai attends Bible school on Mondays and Fridays. It’s hard to study, write notes, or take tests if you haven’t learned to read. Imai’s wife doesn’t always come to church faithfully. Imai needs to know the Word so he can shepherd his wife well.

As we gather, we are about a bigger work than sounding out letters and sentences. This class is not about reading for its own sake. This is about family and personal discipleship. These brothers and sisters can hold in their hands the revelation of God, but right now they can’t read it. This class exists so they can eventually see for themselves the glory of God in His Word. In this room, we are about the work of expanding eternal joy. What a weighty opportunity!

Have you ever considered the value of literacy? Think about it. What would your spiritual life look like if your only option for truth intake was a sermon several times a week? How would you be growing in discipleship if you could never feed on the Word of God for yourself? How would you discern truth from error in preaching if you could never check to see what God has spoken?

What does your spiritual life look like?

Is your only truth intake a sermon several times a week?

Is your discipleship stunted because you never feed on the Word of God for yourself?

Are you susceptible to shifting winds of doctrinal error, because you don’t cultivate the discipline of Biblical discernment?

Do you hold in your hands the revelation of God, possessing every ability to read it, but neglecting to see for yourself the glory of God in His Word?

Are you daily expanding your eternal joy in the God of the Book?

Or do you take for granted knowing how to read and possessing the Scriptures in your own language?

May we thank God for the gift of His Word and the literacy to read it. Then may we be faithful to do so, that we might know, and worship, and rejoice, and love, and serve.

Stories from the Bush, Part 3
October 6, 2018

“Em klostu. Yumi go long 8:00 na kam bek long 10:00.”

Some phrases spoken by a friend here should make any outsider wary. For one, “It’s a shortcut.” If you hear those words, go the other way, unless you love doing one-leg squats up a muddy ninety-two degree incline, sliding down the other side on your derriere, and/or balancing on slippery pyramid-shaped sticks over a twenty-foot drop to the river below.

Closely following the “It’s a shortcut” phrase is “Oh, it’s nearby” (“Em klostu”). When you hear those words, prepare yourself for a journey to the center of the earth. Then, you’ll be pleasantly surprised when your destination is only a couple hours’ walk away.

On Sunday, Sila told me that she was taking Marie to her garden later in the week.

“May I come with you?”

“Mm,” and she nodded.

Plans materialized into a Saturday morning excursion. I had been told of Sila’s garden, accompanied with a warning about not falling into a hole or down the side of the mountain. Fairly confident I could handle those two goals, I was excited about the chance to spend time with Sila, get out of the house, and learn about life here.

“Wait, I told Selestin I would teach her guitar on Saturday afternoon. Will you be gone all day? Is your garden near or a long way away?”

“Oh, it’s close to here. We’ll leave at 8:00 and come back at 10:00.”

Perfect. We’ll go to the garden in the morning, work on some stuff at home after, and then finish the afternoon with guitar lessons.

Saturday morning rolled around, and Sila came for us at 7:45. Water bottles, bilums (string bags that can be used to carry everything from sweet potatoes to small children), biscuits (thick crackers = lunch) – we’re ready to go. The only question was which shoes to wear? My Chaco sandals had given me blisters the last walk I took, and I had failed to clean all the mud off them, so they didn’t seem a good choice. The garden is close by, I thought. I’ll just wear flip-flops. I’ll clean the sandals later. (Spoiler alert – that was the wrong decision.)

Following Sila across the field, up the hill to her house, and down the hill to the stream, I marveled at the beauty around me. It’s easy to get caught up in the work of the clinic and miss the fact that this place really is breathtaking. The sun was shining (a recent phenomenon) and the sky was clear. Both the foliage around us and the mountains in the distance seemed to sparkle. The water in the stream we splashed through was cold and clear. What a perfect day!

“Hey, you wore flip-flops,” Sila observed with a half-laugh, half-grimace. “You’re going to fall.”

Of course, I’m going to fall. That’s part of walking here. Every time I leave the house, unless I’m going to clinic or church, I plan on falling – that way it’s a win when I don’t. 

Should I have known better, and run back to the house for actual shoes at this point? Yup. Did I? Nope.

We crossed another stream and headed up a steep incline…then another, and another. Sila was so kind and patient. “Yumi rest here.” She picked plenty of places to stop so we could catch our breath. I didn’t mind. I like breathing. 

As the trail became muddier and narrower, I began to realize the error of my footwear choice. The flip-flops sank into the mud, sometimes remaining there after my foot emerged. The mud here is like grease. Once my feet were muddy, they would no longer stay on the soles of my shoes. Sliding left and right, slipping and falling, I decided to drop the offending flip-flops into my bilum and proceed barefoot.

Another incline…still going up…more mud. Tree roots created steps in some places, and thick layers of soft, green moss covered others. Sticks and stones may or may not break my bones, but they sure can make my feet tired. 

How far is “close to here”? I wondered. Wait…I remember this now…never ask someone who doesn’t own a watch how long it takes to get somewhere. There’s no telling how far away this garden is.

The surrounding bush really was beautiful, if I stopped walking to look up at it. And Sila was looking out for me so well – she stopped walking often to cut footholds in the clay. When we reached a small pit crossed by a log bridge, she laughed, “When I took Chelsea here, she fell into this hole.” So THAT is what Chelsea was talking about…Noted. I will follow Sila stepping down INTO the hole and NOT across the log. Success! I’ll make it to the garden without falling into a hole.

I wasn’t worried at all until we came around the side of one incline, and the trees opened up to reveal the garden. I took a step and was startled as the “ground” wasn’t actually ground – just grass and sticks that disappeared beneath my foot. I fell. Again.

Sila apologized, “Sorry – step HERE,” pointing to the barely perceptible trail.

Oh, I see now. Step HERE, not six inches to the right. Step here, and you’ll follow the path. Step six inches to the right, and you’ll fall down the mountain (probably not very far, but still not a comfortable turn of events).

“Wait here. I’ll go make a road.” And Sila scampered off, practically prancing along, chopping away at brush and grass with the greatest of ease. I marveled again. These people are amazing. And Sila is so kind and patient.

We made it to the garden without further mishap. Sila taught us how to dig up taro, gather kumu (greens), and find siko that is ready to eat (We harvested quite a few that were too big and prickly. She laughed at us, split them open, and tossed them aside. They would become new plants to produce more siko).

I loved being with her. She gave us easy jobs, and then jumped across a stream fifteen or so feet below to gather kumu on the other side. She reminded me of a gazelle – just gracefully bounding from one place to another, filling her arms with kumu…nevermind the drop to the water and rocks below. We clumsily attempted to follow her directions. I felt like a child.

After eating our crackers, we bundled everything up into the bilums to head home. Marie was following PNG fashion. You sling that thing over your head, girl. You will make Sila happy…and procure a sore neck and a headache in the process. I was too lame to carry stuff on my head.

The walk home was just like the walk there, only in reverse (shocking, I know). We stopped at a stream to wash the taro and kaukau. Once we reached Sila’s house, she turned and pointed. “You see that tree at the top of the mountain?” Yes, we do. It’s tiny. “We passed that and went down the other side. 

Wow. Perspective. That was quite the climb.

But for Sila, it was just a walk to get some food for a couple days. No big deal. It’s like running to Walmart for some milk and eggs.

I understand now what it means when Sila walks up to our door with a shy smile, holds out a bundle of kumu, and says, “This is for you.” She walked barefoot over a mountain, wandered through her garden, leaping from rock to rock, plucking the tender ends from the vines that cover the mountainside. Then, she put the kumu on top of the kaukau and taro in her bilum, slung it over her head, and returned home across the same mountain. She stopped at a stream to wash the dirt from her root crops, dropped off some at her own home, and then walked across the field to our porch to share with us the life that she had gathered that day. It isn’t just food that she’s offering. It’s friendship.

That day we spent together – every time she chopped away at brush or mud to make the path easier to walk, every time she extended her hand to grab mine, every time she paused and smiled, “Yumi rest here” – there was a picture of divine grace. Sila didn’t need us. There was nothing we could do to help her with her work. We actually made her work harder. She could have been to the garden, gathered the food, and returned home in less than half the time we spent. So why did she want to take us with her?

Because she’s our friend. And that was the point of our Saturday trip. None of this was about our helping her. But just like a mother who tells her toddler, “Yes, you can help me – hold the dustpan,” Sila loved us by bringing us into another part of her life. Our garden excursion was her gift of friendship to us. 

What a precious gift that is!

September 25, 2018

It was the end of a long Tuesday. 

Tuesdays are long in general, because we run three clinics simultaneously: the usual sick line, the baby shot line, and the bel mama (expectant mother) line. On this Tuesday, Marie and I had been working together, independent of an experienced nurse for the first time. Emma was working the baby shot line, and Manandi was taking care of the bel mama clinic.

Sick line was down in numbers, which was fortunate for us. New nurses take longer with each patient, probably due to inexperience and paranoia about missing something (coupled with learning Pidgin in the process). A little after three o’clock, Marie and I were finishing cleaning up on the porch. Manandi was still checking several bel mamas in the exam room. I don’t remember what Emma was doing – probably cleaning after finishing the day’s vaccinations. Down the road, we could hear and see a crowd gathering (never a good sign). Then Anjuda, Pastor Ben’s wife, ran up the clinic steps, breathless and teary-eyed.

“They’re — they’re bringing a man in a stretcher…there was a fight…he was cut,” and she motioned a slash across her neck.

Dear God, I thought. Help. I don’t know a lot, but I know that a cut across the neck as she indicated would probably mean a severed carotid artery. If this man had sustained THAT kind of injury, he was either already dead or about to die on our porch. How far had he already been carried? When was he cut? How much blood had he lost already?

MaryBeth appeared behind Anjuda to offer help. She had heard from someone what was coming our way, and started gathering supplies with us. IV kit, suture basket, extra saline and iodine bottles, absorbent pads, pulse oximeter…

The poor unsuspecting bel mama waiting for her checkup was cleared out of the exam room, joining the audience on the porch to open space for whatever was coming up the clinic steps. The crowd surrounded the men bearing the pole on their shoulders, supporting a body wrapped in a pink sheet. As they lowered him onto the porch, my stomach churned in apprehension of what we would unwrap.

He was moaning softly. That’s good – at least he’s conscious. His neck was not bloody. So where’s the big cut? There wasn’t much blood on him or the sheet. So why is he about to die? Is there internal bleeding? Is this drama? What in the world is going on?

Marie the ER nurse slid seamlessly into incident commander mode. “You count respirations. I’ve got blood pressure. Pulse ox is 94. Somebody write this down…”

“Hemoglobin’s 11. That’s good.”

“Blood pressure – one hundred over forty.”

I tried unsuccessfully to get people to back away on the porch, then gave up and went inside to find a pillow and make sure the exam table was cleared. As soon as Marie and Emma completed the initial assessment, Manandi got the stretcher-bearers to bring the patient inside.

Pieces of the story drifted together over the next hour (and week, actually). His name was Simon. On Monday, he and another clan had disputed ownership of some ground. On Tuesday, Simon went to his garden. Nine guys from the rival clan came for him and beat him up with sticks. There was a knife involved, but fortunately he wasn’t cut severely, though he was unquestionably in pain.

3:27 P.M. – pain med administered

We started with him on the exam table, but he began to lose consciousness and then wanted to be on the floor. Okay. Whatever you want, bro. He’s shaking so badly…he must be in shock. But where’s the blood he’s lost? Transitioning to the floor, we got him wrapped up with blankets better, and that eased the shivering.

3:37 P.M. – BP 100/64, RR – 24, HR – 59

Simon’s vitals remained stable, but I expected an imminent crash anyway. I was just certain that he had lost a lot of blood, and he was about to go down. He had been beaten with sticks, and his torso was bruised on the upper left quadrant. Spleen rupture?

There were two cuts to be addressed – one on the back of his left arm, and one on his head. It was impossible to tell how bad the cut on his head was, under such thick, curly hair, matted with blood. Manandi shaved it away, with remarkable speed and dexterity, revealing a less-than-remarkable laceration that had already stopped bleeding. His head was swollen where he’d been hit. Intracranial bleeding? There HAS to be something critical here…

3:50 P.M. – BP 100/70, HR – 73, O2 – 95%

Marie started an IV. “Can you grab the 20-gauge? Thanks…Hm, he has nice veins.” (I’m sure he was proud to hear that.)

“Hey, inap yu holim dispela?” I recruited an observer (friend or family – not sure…probably some kind of family…we were down from the audience of fifty-two on the porch to only seven in the exam room) to hold the saline up for his drip, and took vitals again, adding the stats to my little 3×5 card.

Simon started shaking again, as the IV fluid entered his bloodstream. We got a pillow underneath his torso to get it off the floor, and the shaking stopped.

Once everyone was certain he was stable, the next task was determining what to do with him from there. The head trauma seemed to indicate that he should be observed overnight, which we are not able to do here at Kunai. We had given him pain relief that could have been masking the severity of his injuries, so even though he seemed alright, we couldn’t really be sure about his neurological status.

4:25 P.M. – Manandi cleans and sutures the laceration on his arm

My recollection of the conversation is unclear, but the decision was to send him to Kanabea Hospital for the night. Unsure of their supply, we packaged the meds he would need and gave them to his sister. 

4:30 P.M. – Transfer to Kanabea General Hospital

Simon walked out of the clinic, which felt like a win since he had been carried in. Regrettably, he was not the least bit interested in going to Kanabea. “You fixed me. I’m a strong man. I’m going to my house.” The end.

His family said he was talking crazy. Was that from his head injury or the pain meds? No way to be sure…but he was walking down the road, arguing with his company (and the other random people who just came to watch the show. I guess there was nothing interesting on the evening news or sports channels in their huts).

I felt sick again. What if he really was critical, but we gave him too much pain medicine? What if his confidence in his ability to walk two hours home was based on the meds? What if he went home feeling fine and died in his hut from internal bleeding or swelling around his brain?

The drama after Simon left the clinic was just about as intense as the drama that preceded his arrival. He’s walking towards Kanabea, entourage in tow. He’s turned around and sauntering towards home, entourage still in tow. Everyone’s yelling. He’s going to the hospital. Now he’s going home. Now he’s going to the hospital. What is going on?!?

Should we go get the medicine back? We hadn’t given detailed instruction for the oral antibiotics, because we thought we were just sending the stuff to Kanabea. Did anybody in Simon’s crew know the amount and timing of the required dosage? Also, we had sent something for an IV or an injection (I didn’t know what…and I still don’t). That was a total waste if it went off to the bush instead of the hospital.

I walked toward the company with Linda (she works in the clinic) to at least explain to Simon’s sister, the holder of the medicine, how to take the antibiotics IF Simon ended up going home. Manandi came right behind me – good. Far better. Linda could translate my Pidgin into Kamea, but Manandi understands everything that’s happening and can just talk to whoever. She’s awesome.

After plenty of dialogue incomprehensible to me, we walked back to the clinic together, Manandi shaking her head. “These people…” You said it, not me…and they are your people, so that’s okay for you to say, I guess… “I don’t know if he’ll go to the hospital or not. He wants to go home. He says he is fine. He’ll go home and then get people and go fight back tomorrow.”

Well, that should work out beautifully…

And we cleaned up the clinic and went back to the house. The end. 

Sort of.

Over dinner with MaryBeth and the kids, we reviewed the afternoon’s scenario – what we thought was happening, what actually happened, what we would do differently, what we’d do again. Did he actually need an IV? Did he actually need the pain medicine? 

I realized that my initial response was an adrenaline spike and the expectation of a very critical patient. What we uncovered was less than what we expected, but my mind never came down from the expectation of imminent death. I convinced myself that since what I saw was not critical, there must be critical internal damage.

Or not. Drama happens. Maybe the patient really has a severed artery and is bleeding out. But maybe he has two small cuts and some bruises. We don’t know what we’re getting until the sheet is unwrapped. 

We determined that we need to communicate better, both what we want to do for treatment and why we want to do it. We need to learn to balance a sense of urgency for patient care with an ability to pause and assess what we see. AND, we need to assess what we SEE, not what we expect to see – without losing the ability to still look for what we can’t see at the moment.

And at the end of the day, patients are autonomous. We can do everything we know to help them, but they can only get the care they decide they want. Once again, I am not God. I cannot determine the ultimate outcome for any patient. I can and will do everything in my power for their care, but I have to trust and pray where my power ends.

That has to be enough.

(PS – Simon did end up going to Kanabea overnight. He walked home on Wednesday, and was feeling well enough to gather his clansmen and go fight another round on Thursday. But that’s another story…literally.)

(By way of intro…I’ve written about some experiences and people over the last seven months. Since I’m serving in the bush, “Stories from the Bush” seemed to be the logical thing to call these sketches.)

September 8, 2018

Sandra’s dad carried her to the clinic on Saturday afternoon (my first one in the bush). Her brother had been cutting grass with a bush knife, and she walked up beside him. He never saw her. On a long swing, the knife sliced the back of her left ankle.

We (editorial “we”) got her foot unwrapped and cleaned to determine the severity of the damage, which ended up being serious. The knife had severed all the way through her Achilles’ tendon, calling for a surgeon and an OR. Wait, our room is the OR…and one of us is the surgeon…

I got to take in the scene with the eyes of a newbie. Sandra lay on the wooden exam table, quietly enduring the pain. Her dad stood nearby with arms folded, quietly observing. Chelsea and Mom A poked and prodded, quietly discussing the likelihood of suturing the tendon. Emma scurried around, not-so-quietly gathering supplies. I stood by the table, holding a flashlight and trying not to pass out.

Chelsea seemed reticent to begin searching for the two ends of the tendon. Though I didn’t understand why at that moment, I did about two hours later.

The first step was lidocaine. Emma was leading out, so she took the syringe Marie had drawn up and inserted it above and below the wound, numbing the entire area. I’m told it is painful at first, but then immediately puts everything to sleep (which is significant when you’re about to dig around inside a part of someone’s body).

Emma began the suturing process, with help from extra hands. She inserted the tweezers through the groove where the tendon used to be, searching invisibly for something that would feel different from the soft flesh and muscle. Blood is slippery, which makes the process more of a challenge. 

After squeezing and slipping and splattering blood for awhile, feeling the tendon but struggling to clamp it, Emma switched out with Chelsea. She leaned in, picking right up with the squeezing-slipping-splattering. Emma (whose face was also in close proximity to the wound as she was holding things for Chelsea) kept jumping at every splatter of blood from the slipping clamps, which could have been funny in another situation.

Chelsea eventually found the tendon on top, clamping it and pulling it down into the opening. The end on the bottom proved to be more challenging, but she was ultimately successful. Once both ends were secured, Emma pulled the two together as Chelsea began to suture them  with absorbable stitches. The process looked complicated, more so because of how tough tendons are. This was my first time to see suturing. Talk about total immersion…

Once the two ends of the tendon were re-attached, Chelsea tapped out and let Emma suture the flesh back together. I also switched out with Marie – her turn to hold the flashlight. It was day, but there isn’t great light in the clinic for that sort of job. The little light Landmark gave me has been a huge help for several suture jobs.

I was feeling weak in the stomach and mind. It sounds so simple – “just suture the tendon together.” It’s a two-hour job. At least, this one was. The pressure Chelsea felt was apparent. Tendons are apparently quite significant, if people are going to be able to walk. Having in your hands the responsibility for someone’s ability to walk – that is pressure.

When you walk away from a job like that one, there is just this nagging “What if?” What if we didn’t get it right? What if the sutures dissolve too fast? What if we missed something? If Sandra can’t walk right, is it our fault?

When I closed my eyes that evening, all I could see was her gaping wound and the blood (even after I cleaned the specks off my glasses). In another case, could I handle that kind of pressure with the poise and skill that Chelsea did? I can only hope, at this point anyway.

I went to talk with Chelsea after dinner that night. I was feeling like it may have been a bad idea to come here to work in the clinic, uncertain if I have the ability to respond to needs like Sandra’s. I feel so deeply for other people, but I can’t be immobilized by someone else’s pain if I’m going to help fix it.

That conversation encouraged me. Ultimately, responding to emergencies successfully comes back to a theology of sovereignty. At the end of the day, do I trust that God is in control? You do your best, you give your best, and you trust that God is God and you are not. He is in charge of healing. You do what you can, and you move on, doing your best yet not to let the worry of “What if?” cloud your ability to help someone else.

There is a place to weep with those who weep, but that isn’t the exam table. That is the place to fix what’s broken – with compassion, but with enough emotional detachment to do the job. Cry later, if you have to, but fix the problem that’s in front of you.

And every suture job isn’t like that one, for which we can all be grateful.