Homeward Bound, last reflections

It is our final full day in the Philippines today. It is almost strange to think of going back to reality and normality of life in NZ but tomorrow we are getting on the plane to head back after 3 months away.

Work

Clinic has continued to be great with lots of new experiences and things to see and learn. Dermatology, definitely a weak point for me has had lots of learning opportunities. I saw my first case of measles which is currently sweeping the community here in Antipolo. The level of vaccination here is no where near what it is in NZ and the effects are definitely seen. 

In the last week I have also had the opportunity to spend some time at the birthing home down the road. One area that I have had very little experience in is obstetrics and the birthing process. Having only seen one natural birth before it was definitely an area I feel very unconfident in. Over the 3 days I got to assist in 2 deliveries, great hands on experience for me. The midwives were all so keen to get me involved and show me how to do things which was great.

Today I had to say my final goodbyes to the staff. I don't like goodbyes and these were harder as I have enjoyed so much my time with this wonderful people. I also had the opportunity to share my testimony in front of the patients at clinic today which was a great experience and I was glad to be able to share what Christ has done in me with them.

Chris

Chris has continued to work on some small projects with Juan including rebuilding compost boxes, plumbing a tank and building some dividers for the classrooms they use for tutoring upstairs. Both Juan and Chris really enjoy working together and have plenty of challenging times and some laughs due the language barrier.

Weekend away

Last weekend we got the opportunity to travel down to Tagaytay with Dr Scott, Cindy and a visiting Canadian doctor, Helen. Tagaytay is a beautiful volcanic area with the main town overlooking a lake which has many mountainous islands in it. One of these is Taal which is a tourist destination we visited. It involved getting a boat across the lake to an island and then trekking up the hill to the top of the volcano. The views from walking right to the top were spectacular. This particular volcano is famous for having a lake inside it with an island in the lake ( making it an island in a lake in an island in a lake on an island in the sea). It was nice to see a bit more of the Philippines and a nice change from the crowded city areas. That night we got to try some really great Filipino food and then stayed overnight at one of the local orphanages before heading back to Manila the next day. 

Final days

The final days have really brought mixed feeling for me. I'm excited to get home, catch up with friends and family and settle back into life in NZ, but at the same time I'm sad to be leaving this place and these people. I have really enjoyed the clinic here and all that I have been able to learn. The people have definitely been a highlight. The staff at the clinic have been amazing- not only knowledgable but so friendly and good to me. They have been so patient translating for me, showing me new things I haven't seen before and helping me with unfamiliar treatment plans. There have been so many neat people we have met along the way, visiting doctors from Germany,Canada and Australia,  and so many other missionaries working here and the fellowship has been so good. The Filipino people themselves are really special. They are so welcoming and friendly to us as foreigners and have infectious smiles. And of course Scott and Cindy have been so good to us having us stay for 6 weeks, always happy to help out where they can, bringing us treats, entertaining us for many evenings. Scott has been a patient teacher for me and they both have been great hosts.

So tomorrow we will be on our way out of the tropics and back to what sounds like a typical cool end of NZ summer!

Prayer and praise points:

- Prayer for safe travels back to NZ

- Praise for such a beneficial and fun time for me in my training and for the great connections and friendships made

- Prayer that we will settle back into life in NZ well after the time away.

Halfway mark in Manila

Less than 3 weeks left! After being away for so long we are looking forward to going home and seeing family and friends again but at the same time we are still really enjoying our time here. Personally for me it has been a great time of rest and refreshment in the Lord. Having more time to read  and reflect and pray has been great, especially after such a hectic year last year. This week we listened to a sermon on Psalm 23 about resting and it made me think about what a privilege these weeks have been and how I do feel this has been a time of rest and restoration for me.

Thank you also for your prayers for Chris' health. He stated to recover the day after writing the blog although it has taken some time for him to get back to 100%. The Lord kept him out of the hospitals here for which we are very grateful. We are also very grateful that The Lord has kept my health so good throughout the trip, especially with being pregnant and around so much infectious diseases.

I have been right back into the routine of clinic since Chris has recovered. I had a few days of being nurse at home for him and was very ready to get back to the clinic after having the weekend and then 2 days off. I am really enjoying the work here and it isn't a burden at all to have to get up and go to work. Every week I'm continuing to learn new things, especially about the Filipino culture. There is a lot of what to me, coming from a western system, is strange medical beliefs. One example of this is many of the Filipinos with blood results saying they have anaemia ( low iron in the blood) don't believe it because they already have high blood pressure. They can be confused how they have both 'high blood' (pressure) and 'low blood' (iron) and this is even a view also held by some of the older medical professionals in the country.

Chris, since recovering has been right back to work. Today he finished the building project he was doing with Juan and I think he has really enjoyed learning so much and getting some hands on experience before he starts his building course in a few weeks.

We have also had the opportunity for some sightseeing this week and on Tuesday Dr. Scott took us and another doctor, Dr. Russ to a waterfall just out of Manila and also to see an orphanage of his friend. The waterfall was beautiful, and reminded me a bit of New Zealand swimming holes. We didn't have much time there but it was nice to dip my feet in the water and enjoy such an idyllic setting. From there we continued to go further into the countryside. It was strange to see large empty fields of grass and open space but a nice change from the concentrated population of Manila. 

The orphanage we visited was an interesting learning experience in some of the difficulties missionaries have with sustaining ministries. The ministry had beautiful new buildings for medical clinics and for more housing but they were currently hardly being used. The issue with many of the ministries is that people will donate money for buildings but when it comes to long term supporters to help with the daily running of these buildings including salaries for staff members it is hard to get the support. As a result these building are sitting unused. We also got to see the part of the orphanage that is currently running. There were so many gorgeous wee kids there that would run up to you and grab your hand or hug your leg or want to show you the pictures in their books. It can be hard to see a room full of children who have been left by parents but at the same time it is great to know that there are people who are caring for these  children and sharing Jesus' love with them. 

Prayer/ praise points:

- Praise that Chris has had a full recovery and that i have had good health

- Prayer for continuing good health for the rest of our time here.

- Praise that this time has really been a time of rest in The Lord.

- Prayer that in our final weeks here we would really be living and trying to serve in the present, not just thinking about going home.

Manila

We have been in Manila for 2 weeks now and it feels like the time is just flying by. The pace is a bit more relaxed here than in Africa but there is still plenty to do!
We are staying with Dr Scott and Cindy Nelsen in an apartment below their house. There are 2 buildings on their land and more missionaries live next door as well as some visiting missionaries. It is a great community to come home to and Chris and I are really enjoying the fellowship we are having here.

The clinic

The clinic runs on Mondays, Wednesdays and Fridays. It is much like a general practice in New Zealand- the patients in general don't need urgent medical attention or hospital care. In the mornings we have patients who we are following up their progress and treatment. As in africa there is a lot of TB here. The other common follow up cases are diabetes and hypertension. As I don't speak the language I have one of the nurses to translate for me. I can pick up occasional word and sometimes can get the jist of what they are saying but in general I'm lost so im very grateful for such willing and patient staff. All the staff are really great and knowledgable here and are a big help for all the things that are foreign here to me- whether it's new drug names, dermatological conditions they see here or how they can treat conditions with limited resources. After taking a history, doing an examination and coming up with a treatment plan for each patient we pray with the patients. This is an aspect of the ministry I really enjoy seeing is the spiritual input into the patients lives. It really is emphasised here that it is more than just treating medical conditions but also a chance to share Christ with them, both through actions and words. Afternoon sessions are patients who aren't in for follow up so it has a bit more variety, although there is still lots of viral illnesses and ear infections in children. Before each afternoon session one of the staff will share the gospel with the new patients who are waiting to be seen. The staff here are all so committed to both helping the physical needs and spiritual needs of the community around and it is a great team to be part of.

What Chris is up to

Chris has got straight to work here on the language, spending much of the time I am at the clinic learning through the Rosetta Stone program. The staff here have been very helpful listening to phrases he is saying and helping him out with things he is unsure of. He has just got another building project as well, helping to pull down and rebuild an old shed that has had it's wood destroyed by termites. He is enjoying this and also has the chance to practice some Tagalog with Juan a Filipino worker who has very little English.
In the last 2 days Chris has become unwell developing fever, headache, body aches and abdominal pain. Being in the tropics it could be any weird tropical fever and we are unsure what it is yet. Prayer for him to be able to make a quick recovery and stay out of hospital here would be appreciated.
Prayer and praise points:
- Praise for such a great welcome and wonderful staff here and the wonderful fellowship we have been having so far
- That I may be a help to the clinic while I am here and that the patients may see Christ through the interactions with staff at the clinic
- For chris' quick recovery

On the other 2 days of the week I have the option to help out/ learn at the birthing centre down the road or at another small clinic further out of town. I have been to the birthing home only briefly so far but it was great to see what they are doing there using medical care as an opportunity to share Christ with the women and their husbands. I'm looking forward to spending some time there as my exposure to birthing has been quite limited so far and I'm sure I have heaps I can learn while I'm here! Last Thursday I spent the morning at a clinic right on the outskirts of Manila. It is an area where poverty is a lot more evident and squatters homes lined the streets in the area. The people, even though they don't have much are beautiful- always able to smile, even when they aren't 100% healthwise.

Onto the Philippines

Final days in Kalene

The final days in Kalene were hectic to say the least. During our first week there were nearly no C-sections, where you would normally expect a few. The last couple of days certainly made up for it. The last evening in Kalene was the worst with 3 nearly back to back. By this time Dr Gill the orthopaedic surgeon who can also do C-sections and Dr Allen, the anaesthetist had left so it was Dad, me and the theatre assistant. The first one went fine with mother and baby doing well. The second C-section was a real emergency as the placental cord had prolapsed which causes reduced blood flow to the baby. The heart rate of the baby was very slow, less than 50 beats per minute where it should be above 120, and that was before we even got the baby out. The baby had no heart rate when he came out, and I was the only person there to do anything as the midwife hadn't shown up. I started getting the baby hand ventilated and as soon as he could dad came over to help me and start chest compressions, leaving the assistant to finish suturing. It seemed like a miracle that we got the heart started and beating at a normal rate. Unfortunately after nearly an hour of hand ventilating the baby he wasn't showing any signs of spontaneous movement or breathing so we had to make the hard call to let him go. He was probably deprived of oxygen for too long already and would have needed to go to an intensive care unit to even have a chance at surviving. 

In Zambia the families don't want to hold or see their babies when they die, they just want someone to take them away. I found it so hard hearing that, that they would rather let their baby die on a table rather in their arms so I held him while he slipped away. I found that baby's death one of the most frustrating ones here. Unfortunately the training of the staff is not as comprehensive and no one really knew what to do with cord prolapse, how urgent it was to get the doctor in or how to do CPR on an infant when he came out heart not beating or not breathing. There really is a need for knowledgable people to train others in places like this so when these situations arise the chances for survival are better. The last C-section for the night went better and it was good to end on a positive note with a healthy baby and mother. 

Leaving Africa
Saturday morning we got all packed up, said goodbye to the friends we had made and flew back to Lusaka. The next 4 days were a good break from what had been a crazy last week of working. On the Sunday we went to a local church which was very encouraging. It was the most clear explanation that Chris and I have heard of how when we are born again we can still fall into sin so we need to fight and work for holiness, but this does not determine our salvation.  Philippians 2:13.
 Sunday afternoon we got to explore the market, buy souvenirs, and we decided to go watch the Hobbit. Movies are a lot cheaper both in the Philippines and Zambia and it was a nice treat, although seeing the New Zealand landscapes did make me a bit homesick! Dad left that evening back to New Zealand and for the next 3 days chris and I just relaxed in Lusaka.

Holiday in Davao- Philippines
On Wednesday we were back on a plane again making the journey to Manila. 20 hours later we were in Manila and after another 6 we were finally in Davao where Chris spent 3 years of his childhood. We were exhausted after very little sleep but were delighted to have a welcoming party from Oasis Family Ministries, the organisation Chris' parents started up. Jet lag hit us a bit harder this time and we took a week to recover from the journey. 

We spent about 2 weeks in Davao, having a bit of break, seeing places from Chris' childhood and meeting people from Oasis and other ministries. We got to do a skit for the children's and young adults Christmas party at Oasis which was lots of fun and it was really cool to meet the staff who were so wonderful to us during our stay. Christmas we spent on an island called Samal, 10min boat ride from Davao. Chris' parents very generously gave us a ticket to stay overnight at the resort for Christmas and it was such a nice break at the beach with the warm water, coral reefs and tropical fish to enjoy.

Us at Paradise Island for Christmas!

We also got to do another touristy activity on Chris' 24th birthday when we went to the crocodile park, which is more like a zoo with lots of different animals to see. The remainder of our time in Davao was pretty low key, spending lots of time just motor biking around and going to the malls where it was cool and air conditioned. We had a lot of adventures with the motorbike breaking down in the middle of traffic (and the traffic is pretty crazy in the Philippines) but had no accidents or injuries, and with a bit of prayer always managed to get back on the road pretty quickly.

Close one with a python!

Back to work
We are now in Manila on my second placement, enjoying the slightly cooler weather and the great hospitality of Dr Scott and Cindy Nelsen here. Clinics here run on Monday, Wednesday and Friday and are similar in structure to general practice in New Zealand. On the other 2 days I can join the staff at the local birthing clinic or the nurses who run a clinic on Thursday. We are really enjoying it here so far and in the next blog I will try and explain a bit more about what I am doing and how the clinics run etc. For us this a very exciting time as we are seeing if the Philippines may be a place where we serve long term.

Some prayer and praise points:
- Praise for safe travels and a good break in Davao
- Prayer for the Lord to show us whether Philippines is a long-term mission 'calling' for us!
- Pray that our hands would serve well and our actions testify to the love of our Lord Jesus!

End of time in Kalene

This blog has come a little late. Unfortunately, although most if this was written 2 weeks ago, due to Internet cut outs and computer troubles and then traveling it is only arriving now.We are now in the Philippines but I will update you on that in a later blog. Anyway, here is the blog from 2 weeks ago!

We are in our final days here at Kalene and time sure has flown by! Just over a week ago Geoff, the Kiwi pharmacist we were staying with, flew back to New Zealand to be reunited with his family after a year. He was such a blessing to us and his absence is very much felt. Before he left there was a farewell lunch for him which was a great time to relax and meet the other missionaries.

Life here has not slowed down one bit however and the hospital continues to bring in any new patients. Some days in particular have been very busy. There was one day in particular that was very full and had some firsts for me as well. On top of the normal ward rounds, surgeries and outpatients for the day that already keeps you busy many of the patients weren’t doing well. After we were finally done with the outpatients Dr Alison and I went to the wards. There was a patient that had been reasonable well the for the last few days who suddenly went down hill. She had unexplained abdominal pain but as she also had a heart condition she was just too unwell to take her to theatre to have a look and try and fix anything. She was dying in front of us and despite all the measures we tried to resuscitate her, with the limited resources we had it was just impossible. That is the first time I have a patient die in front of me while I’ve been trying to resuscitate. I felt bad for the mother who was watching, hoping that we were going to bring her daughter back. In some ways I think it may have been better to let her die in her mother arms instead of with white strangers standing over her. 

That is one of the difficult things that has to be decided here in Kalene. In the west we through so much effort at keeping death at bay, but without the resources here to do the same is often to prolong the inevitable and leave the last days these people have as ones spent in hospital with doctors instead of at home with their loved ones. Straight after that experience came another first, draining a lung abscess. The hardest part of that procedure was the fact my hands were shaky from having to hand ventilate the previous patient for the last 30min. It still worked out and we were able to get a lot of the muck out. It was a lot later going home that day and I was pretty tired after that. The night was a bad one in the hospital however and 4 patients died. One of them was a wee boy with HIV and TB. Those are the deaths that have been the hardest to see. A child, who should have had his whole life ahead of him, is snatched because of the infidelity of one or both of his parents. This world is as broken over here as we see in the west, and these people need Jesus just as much as those in New Zealand, even when they seem more ‘spiritual.'

A particular prayer request I have right now is for Dr Felix and his wife. This morning she was unwell, her blood pressure was rising and the baby was starting to drop his heart rate. It was decided that the only chance was for a C-section, and even then the chances a 30 week gestation baby would survive without the equipment was close to, if not 0%. The baby was delivered and survived for a couple of hours before they decided to let him peacefully slip away. Please pray for this family as it is a hard time for them losing their precious, much wanted child. There have also been some good moments here at the hospital in the last weeks too. There have been 2 babies that were born by C-section that had to be resuscitated but both are doing well now. It makes the hard times here worth while- there are ways in which we can make a difference.

We have also had the opportunity to have more of a look around the area in the last week. Chris and I took a bike ride to a nearby village to look at the market. It was fine getting there but it was only 15 min on our way 'home' when we realised we had gone the wrong way. Luckily we were able to get to the market and figure out the right route home before we got too lost! 
 We also made a trip to Sekeji, where there is a Christian school, to watch an end of year Christmas production and on Sunday, Dr Gill, a visiting orthopaedic surgeon took us on a trip around the Kalene area. We went to visit the hydro dam, which was built by the locals using a lot of man power and only a little machine power. It was impressive to see it and how much can be done without all the machines and technology available to us in the west. We had a lot of fun walking up the 'rapids' which were still very shallow but nice and cool on a hot day. We also journeyed into the Congo on a small dirt road, that did not have border officers, to a old boundary marker. We only were told later what could happen if you got caught in the Congo without the paperwork! Overall it was a very enjoyable day and a good break from the craziness of the hospital. 

Chris has been busy with all sorts of things in the last couple of weeks. He has been helping out the local handyman with electrical jobs, helping with more moving and packaging jobs and also been doing some building. One of the old trellises at 'the orchard' was falling down and he built a new one. He made a really good job of it and his help is much appreciated as there is always heaps to do!

Life in Kalene

It has been a while since the last blog but we are having some difficultly with blogging! Unfortunately the blogging site is blocked here in Kalene so my blogs are going to have to be put up by someone in New Zealand via email so they may not be as often as I had hoped.

Kalene

We have been in Kalene for 12 days now and are really starting to settle in the work here. Praise God Chris was not sick on the 3 hour plane ride here despite some of the ride being a bit bumpy. Kalene is at a greater altitude than Lusaka so it is a bit cooler here which is a relief. The rains have just started in the last couple of weeks and heavy downpours accompany the amazing lightening and thunder. I am enjoying the weather here, it is hot but not uncomfortable and the storms are spectacular to watch and listen to. Kalene itself is beautiful at this time of year- green and lush, lots of beautiful flowers and trees that are ladened with ripe mangoes at this time. It is far from what I imagined of Africa- the dry and dusty landscape with little vegetation often depicted in movies and books. 

Flying on the small plane to Kalene

The Hospital

My first day at the hospital was a real eye opener. Going around the wards I felt like a 4th year medical student again- I knew nothing. More than half of the children in the children’s ward were being treated for malaria, something I had never had to deal with before. The other problems included malnutrition, HIV and TB which I had also never seen treated in New Zealand. Moving onto the men’s and women’s ward it was much the same. Malaria is the main cause for hospitalisation at this time of the year- definitely a good incentive to be taking our prophylaxis! Of the conditions that I could recognise they were a lot further along than most conditions I had seen. Abdominal masses are one of the example of this. The second day was an operating day and the large masses that had been seen the day before were removed- an ovarian cyst the size of a soccer ball, then an ovarian cancer the size of a basketball! I have had to catch on very quickly to this different type of medicine. The nursing staff here are very knowledgable about many of the illnesses such as malaria and will often begin treatment themselves. Their knowledge was been particularly helpful in the first week. The only full-time doctor for the hospital, Dr Felix, was called away suddenly as his pregnant wife was unwell with preeclempsia (high blood pressure doing pregnancy) and malaria. Suddenly my dad and I were the doctors for the whole hospital. He joked that he has the medical experience and I have the medical knowledge as I just finished my 5th year exams, but I definitely did not feel prepared for the medical problems that are seen on the wards. The nurses helped us along with the drug regimes where we were stuck and we are slowly we getting into the swing of it. It is incredible busy here with 4 wards, the surgical theatre and outpatients to get through. It is a lot more intense than in New Zealand and you have to get through patients quite quickly.

We are really grateful this week for the arrival of a Canadian doctor, Dr Alison, who is working in one of the mining communities. She was meant to arrive earlier but had trouble getting away from her regular job but praise God she is now here. She has worked for a while in Africa and has great knowledge and is also a great teacher. Her arrival has provided good relief for my dad and I am also getting some great teaching from her.

Me, Chris and Dad outside the Hospital

Reflections

Last weekend was a hard one for the hospital however. There were many very sick patients. Most of them would have gone straight to ICU in NZ and undergone extensive testing and treatment but with the limited resources here there was not much that could be done. 4 of the patients died. It is hard seeing people, some of them young, dying were in NZ they may have had a chance but this is just part of life here in Kalene.  My dad ended up dealing with most of the hospital stuff over the weekend as it was Chris’ and my first wedding anniversary. We were able to go to a place called ‘ the Orchard’ which was built as a place were missionaries could have a place to have some time out. We had a great time just relaxing, swimming in the pool and reflecting on our first year of marriage. We have really grown over the last year and are even more in love now than a year ago.

Chris has also been put to work, building a archway for “The Orchard” which had termite rot right through!  He is enjoying being a helping hand and taking on projects here.  He has just finished reading Pilgrims Progress and is raving about it so it must be a great read!

Its been eye opening for us coming here to see the missionaries and the things they have to give up to be here, on a daily basis.  Although there is good housing and food etc, many comforts we take for granted aren’t available here.  Thank God for sending people like them who give up so much to be here.

Me jumping for joy at the top of Kalene Hill

Prayer

We now have 2 weeks left here in Kalene. Some prayer and praise points over this time:

- Praise God for good health so far and pray for continuing good health (No malaria especially)

- Praise God for the arrival of Dr Alison and the work that she is able to do here, and pray for Dr. Felix’s wife also - Lawsia, who needs good health at this time.

- Pray that in the business we will have time and patience to really care for and share the love of Jesus with these people. 

Africa- day one

Finally here! After 33 hours of sitting on a plane, making our way from Christchurch to Lusaka we finally touched down in Africa. We were welcomed by a blast of warm air as we stepped off the plane. It was 34 degrees and humid, definitely not what a Kiwi from Dunedin is used to. The airport was not what I was expecting for a capital city, it was a small building in need of repairs with no air con inside. After getting our visas we grabbed our bags and left. There was no real customs to go through, no one to check your bags or scanners, very different from the rest of our journey. It was great to arrive at the flight house and have some food and a shower before getting some rest. We are staying here for another night before flying on to Kalene where the hospital I will be working at with my dad.


Us on the flight - Chris shaved his head for fun the night before we left. Should help with the heat!

I am looking forward to getting there and getting stuck in to a different type of medicine. There will be limited resources in Kalene so I will really be tested on my ability to use clinical reasoning based on history and examination to figure out a diagnosis- no CT scanners or unlimited number of blood tests to help! To get to Kalene we have a 3 hour journey in a small plane. Chris doesn't always travel well and is a bit nervous about this flight tomorrow so prayer that he would get through it well and that we would all get there safely would be appreciated.