6 April 2012
--see also http://teamrwanda2012.blogspot.com
On Saturday most of the group walked to Kumbya Retreat, a beautiful, quiet spot on Lake Kivu owned by the Free Methodist Church since 1944. While most went in the morning, Micki and I decided to go after lunch. By that time a large thunderstorm had covered the area, rattling windows with powerful explosions of thunder that followed closely on the heals of brilliant flashes of lightening over the lake. Storms here come up quickly in this rainy season, often with an accompanying light and sound show, but most last only a short time and roll quickly on over the next mountain. Those who did go to Kumbya either walked back early and were soaked or sought shelter on the porch of the house there and waited it out. All seemed to have been glad they went.
Sunday was not a day of rest. Just as we were preparing to leave for church, my local cell rang with a call for help--a small preterm infant with respiratory distress had been found in its incubator with cyanosis and a dangerously low heart rate. There are no heart monitors, so infants often are in extremis by the time anyone realizes there is a problem. Dr. Ngoy (our Congolese friend) had bagged the baby back to viability by the time we arrived, but the infant could not be sustained without intubation and ongoing positive pressure ventilation. I intubated him to give all of us time to consider our options--continue bagging for days with only a glimmer of hope of success or stop right then and accept the limitations of life where we were (this infant has a 98-99% survival in our NICU's in the States). The group of students (really doctors for all intents and purposes except for a piece of paper) quickly committed to setting up a schedule to bag the infant during the evening and night, with the nurses to carry on during the day. The latter part of our plan proved to be the undoing of the baby's chances, as just as the first folks from our team arrived the baby was discovered to be without pulse, a nurse sitting beside the baby, her hand not on the Ambu bag--she was unaware of what had just happened. William Perez gives a moving account of that afternoon in the group blog, teamrwanda2012.blogspot.com.
Unfortunately, the death of that infant was not an exceptional event. Infants with respiratory distress are placed on a nasal oxygen cannula with no means of assessing oxygen levels in the delivered gas or in the babies blood. Without heart rate monitors and with inadequately functioning saturation monitors, no ventilators and inadequate numbers of staff to watch the babies, unattended deaths are not uncommon. There have been at least four since our arrival.
On Monday afternoon we attended a stat c/section for a mother with a bleeding placenta previa (a dangerously low lying placenta) at 29-30 weeks gestation. We intubated the infant in the delivery room and then extubated the infant and placed her on a cannula with oxygen in the "nicu". She weighed 1300 grams (about 2 pounds 14 ounces). She did reasonably well until Tuesday night when a power outage stopped her oxygen concentrator from working--we went down to find her blue but breathing, with a saturation below 50 (acceptable is greater than 88 in a baby her age). Her father was at bedside and used his cell phone light to help us assess her. After 10-15 minutes the auxiliary generator came on and she recovered her color. We said goodbye to her dad and left, praying that the power, which goes out almost daily here, would be sustained until her oxygen needs were gone. Early the next morning she was found without pulse or any sign of life. Another infant with a 95+% chance of survival in our country had succumbed to the lack of support here. Lack of artificial surfactant, no mechanical ventilato, no monitors, and an unpredictable power supply were obstacles she and this delivery system could not overcome.
Early in the week, Carl Albertson, the orthopedic surgeon and our group leader after Duane's departure, was asked to see a one year old whose hand had been severely cut by a machete wielded by an slightly older sibling. The injury will require several hours of restorative surgery by Carl and his team, and months of recovery and rehabilitation will follow. The injury was preventable merely by keeping dangerous tools out of the hands of children. As I write this, Carl and his team are laboring to return that boy's hand to usefulness-- a critical determinor of his eventual ability to earn a living in this agrarian culture.
Children here are often left unattended at very small ages, something we noted while walking through local villages. While driving here from Kigali it was common to see three and four year old children walking right beside the road unattended by an adult as buses and cars drove by at 50 mph. Life's value here, to many, is discounted. The costs of risks are often not clearly counted except in the retrospective agony of injury or death. This rather pervasive attitude appears to be part and parcel of the apathetic and fatalistic view of life that an animistic culture produces.
On Wednesday Micki and I, with an afternoon free of medical activities, decided to walk to Kumbya Retreat with the hope of some quiet rest by the lake. The road to Kumbya is a dirt and rock road (mud and rock with heavy rain) that descends steeply from Kibogora, winding through the countryside, an occasional village, across one field of coffee beans, and down to an inlet to Lake Kivu, where Kumbya sits on a small peninsula. The walk is about 3 miles, or in Rwandan distance, one to two hours, depending on how fast one walks and how many pictures of the beautiful countryside you choose to take. No walking trek in Rwanda is taken alone, for children follow everywhere, often shouting "mazuka" and asking for money. Somber adults speak if spoken to, and smile if they see you smile, some saying "good morning", no matter the time of day. Children here are now learning English as the new official language so they tend to know more English than the rural adults, but everyone seems to know some form of greeting in English and/ or French.
At the retreat we watched the local boats going to and fro across the lake. They are dugouts, hollowed tree trunks that natives use for travel and fishing. Some came within a few yards of our waterside perch, their occupants waving and speaking if we acknowledged their presence, and laughing if we took their picture. We did not swim, though the water is quite inviting-- the thought of contracting schistosomiasis, a common pathogen in lake soil and water with serious consequences for the liver, dampened any enthusiasm we had.
After a peaceful hour at Kumbya it was 4 o'clock and we headed back in order to return before dark; traveling at night on foot on the rural roads is not recommended for expatriates-- for all manner of reasons. We decided to take the local's short cut across a field to shorten the more laborious trip back up to Kibogora. We did not know that path involved walking across a rapidly flowing, muddy stream on two flattened logs with nothing to hold onto. Micki hesitated a moment and calmly walked across. I didn't. I stood paralyzed, knowing a muddy dunking would make travel back very uncomfortable and would almost certainly kill Carl's cellphone, which he had loaned us for the walk (we had excellent cell coverage the whole time). A Rwandan woman, quietly amused at my indecision, walked over, took my hand, and without a word led me across. When I thanked her she smiled shyly and walked on, her good deed done and my ego only slightly dinged. What she did for me--taking my hand and showing me the way with quiet confidence and humility--is a template for all believers.
Someone offered us a hand in our walk of faith, perhaps knowing we were having a difficult time taking that first critical step. Our vertical relationship with our heavenly Father and our human relationships both involve a hand reaching out in humility and a hand grasped in gratitude. St. Paul said that the greatest attribute in life is love (1st Corinthians 13). No other accomplishment can take the place of love; all of our best put efforts added together are a "clanging (worthless) cymbal" if we lack love. Agape' love, unselfish, other-motivated, selfless love begins with the hand of Jesus reaching to us, and continues as we reach out and share Him and His love with others.
Everyone on this trip has been frustrated by inadequacies--sometimes by the facility, sometimes by the attitudes, sometimes by our own shortcomings, sometimes by the obstacles put before us here. But, as Oswald Chambers said so eloquently in My Utmost for His Highest, God does not give us overcoming life, he gives us life as we overcome--the struggle is part of the process of maturation and without it we would not grow closer to Him or to each other. Gratitude, Obedience, Dependence is the acronym of a whole and holy life--taking His hand, offering our hands to others, and letting Him be responsible for the results. Kibogora--the hard working Rwandan and Congolese physicians, the staff who labor under unfavorable work circumstances, the patients who wait in stoic patience for their care, the limitations of the hospital's infrastructure, the very remoteness of its location--is a lesson in offering what is possible and letting God be in charge of the outcome.
Friday, April 6, 2012
Saturday, March 31, 2012
Kibogora Week Two
Saturday, the 24th, was a day of exploration for many as most of our team went to the National Forest to see a colony of Colobus monkeys and then lunched on a Rwandan island in a river that forms the boundary between Rwanda and the Congo. The Congo is visible across Lake Kivu from our compound at Kibogora.
Micki and I decided to stay behind to rest up and I had a chance to write some, which is my way of recharging and decompressing the emotions of these days. We made morning rounds in the "nicu" for Dr. Ngoy, who had a mandatory meeting off site. We discovered a baby girl who was eating poorly at breast--a real problem in a culture where formula is unaffordable and carries a much greater risk of infection due to unsafe water and the removal of Mom's immune system as the final milk purifier. More below on this little infant girl.
Sunday began with church at the Kibogora Church located a few yards outside of our compound, a large brick structure which could seat over a thousand. The second service began at 9 a.m. (the first was a youth service--no late sleepers among Rwandan Christian teens, who came in their school uniforms) and was complete with electric keyboard and guitars that accompanied five different choirs, all of whom had clearly put effort into preparation both of the music and the choreography. Each choir, from children's to adult and all those in between, sang with a rhythmic to and fro side step. They were all quite good. After congregational singing--familiar melodies with Kinyarwandran lyrics--we were formally welcomed, and Duane went before the congregation to express our thanks. Since the sermon was also in Kinyarwandran we left as it began and had our own worship time at the "black house" (our houses are designated by colors).
The new week began with a busy schedule, including the addition of "health center" visits by two students each day. The nearest center is a 20 minute walk*. There are 11 others throughout the countryside, and they provide much of the outpatient care as well as performing many uncomplicated deliveries. Kibogora Hospital serves as the referral center for all of them for problems that exceed the clinic's level of care.
*(It is notable that distances as measured by miles or kilometers are seldom expressed. In a country where most walk everywhere and even a 90 mile trip by car can take 5 to 7 hours, time becomes the currency of distance.)
Paradoxes abound here. In a place where McDonald's has not yet sold a happy meal, where Starbuck's is outstripped by the coffee grown down the road and CVS and Walmart are unknowns, where paved roads and air conditioning, mowers and electric dishwashers and elevators are absent, 25 yards from the hospital gate sits a computer store. Cell minutes are sold in 90 cent increments (roughly 550 R. Francs); minutes for your wireless Internet access can also be purchased, or, if you have no computer, you can purchase time on theirs, all in a 10x10 building. Cell coverage here is better than at USA Children's Hospital, and texting to the U.S. is as instantaneous as being in the next room. Our bus driver on the way here, when not actively risking the lives of pedestrians in an uneven game of chicken, entertained himself by texting and talking on his cell, all the while negotiating curves and construction zones. Some behaviors appear to be universal. :)
By Tuesday, the baby mentioned above was no better, and with a persistent heart murmur since Saturday, we had ordered a chest X-ray, which along with auscultation and an EKG constitute the extent of available cardiac evaluation. The murmur had been louder on the right, and as it turned out, so was the heart. About the time we viewed the X-ray the infant's color deteriorated rapidly and we spent some time trying to achieve viable oxygenation, hampered by poorly functioning equipment, an oxygen concentrator as the only source of oxygen, and poor lighting and thermal support. Mom had no resources for transport or evaluation in Kigali, 7 hours away, but the hospital administration okayed the transport anyway and the next morning the babe was off to Kigali with her Mom. No report on her status as of yet, but the ultimate fate of infant's with complex congenital heart disease here is not good.
The entire week we have been treating Destin, a four year old with a major pneumonia and empyema (basically a left chest full of pus). We needled his chest on Monday, and after the minimal test we can do on the fluid suggested a staph infection and not tuberculosis, Shannon Burgess, on Wednesday, inserted a chest tube, draining about 200 cc's of milk chocolate colored fluid with an odor that made one wretch. We have drained an additional 200 hundred cc's over the last two days, and Friday his fever was beginning to diminish. Please pray for him--he has a long way to go if he is to recover.
Both of these patients' care have driven home how blessed we are to have simple things like wall suction, portable X-rays (when an X-ray is ordered the mother carts her child, paper in hand to X-ray), blood gases, oxygen with analyzers and saturation monitors, echocardiagrams, and, oh yeah, basic electrolytes. For those in medicine you will perhaps be amused to know that neonatal bilirubins are reported as positive or negative, making them of use only to those dependent on Braille. Physical exam is enormously more important when all of the tools (spelled c-r-u-t-c-h-e-s) we lean upon are absent. I think we will all be better doctors, certainly more appreciative doctors, upon returning to our technologically dependent medical worlds.
Thursday was a sad day as two of our team members and another U.S. physician headed to Kigali and on to their homes. Richard Ellingstad is a family doc from Wisconsin who was here for two months without his wife, who had contracted severe malaria on a previous trip to Tanzania. He was very gracious and helpful in getting us oriented to Kibogora. We will miss his presence at our group meals. Jeanne Claude Bataneni, a Congolese surgeon who traveled with us from Kigali to Kibogora, returned to his mission hospital in the eastern Congo's jungle. JC, as we know him, has returned to his birth village as the only surgeon, passing up much more lucrative and prestigious positions because he and his wife, also from the village and also a physician, have felt God calling them to serve His Kingdom there in Nebogongo Hospital. He is a kind and gentle man with a great testimony of persistence in the face of major obstacles to the practice of medicine. Please pray for him and his family.
Our spiritual leader, Duane, also headed home to Kim and the kids. He did a magnificent job of organizing this trip and in leading the group both in terms of logistical support, spiritual stimulation, and sensitivity to the emotions of a group far from home in a strange culture. His calm in the face of his own fatigue and a sharp witted bunch of tired travelers has been a lighthouse emotionally. He will be missed.
Comment on week two After two weeks in this land, where Christianity is more of a palpably present influence than in Alabama, we are struck by the fatalistic approach to illness, death, and dying that an animistic cultural inflence produces. Tradional medicine practitioners (think "medicine men") discourage allopathic medicine and value their own power base and influence mor than human life. Compare that to our home culture, where a secular utilitarian view of life also erodes the Christian's high value on the sanctity of life, and deluded influence peddlers (think "politician") sell their souls on the alter of public opinion at the expense of the unborn and unprotected. Both are evils that medical providers who follow Christ will battle throughout their careers.
Here in Rwanda the battle is one on one, a relational effort to change people's hearts through the establishment of trust in our skills, our love and our faith in Christ. In the U.S. the battle is no less intense on the personal, relational front, but is compounded by the increasingly aggressive attack by the government on our rights as providers and patients to determine our own attitudes and actions in protecting all human life. Unless we are firmly founded in what AND why we believe what we do in regards to human dignity and sanctity of life, we risk having our resolve eroded. On this issue the daily renewing of our minds in Christ through the leading of the Holy Spirit is an indispensable habit of life. Please pray that these weeks "on a hill far away"** will be a time of formation and strengthening of values that will last a lifetime, however long those lives may be.
**see: On a Hill Far Away by Dr. Al Snyder, who gave his life to serve Christ at Kibogora
Micki and I decided to stay behind to rest up and I had a chance to write some, which is my way of recharging and decompressing the emotions of these days. We made morning rounds in the "nicu" for Dr. Ngoy, who had a mandatory meeting off site. We discovered a baby girl who was eating poorly at breast--a real problem in a culture where formula is unaffordable and carries a much greater risk of infection due to unsafe water and the removal of Mom's immune system as the final milk purifier. More below on this little infant girl.
Sunday began with church at the Kibogora Church located a few yards outside of our compound, a large brick structure which could seat over a thousand. The second service began at 9 a.m. (the first was a youth service--no late sleepers among Rwandan Christian teens, who came in their school uniforms) and was complete with electric keyboard and guitars that accompanied five different choirs, all of whom had clearly put effort into preparation both of the music and the choreography. Each choir, from children's to adult and all those in between, sang with a rhythmic to and fro side step. They were all quite good. After congregational singing--familiar melodies with Kinyarwandran lyrics--we were formally welcomed, and Duane went before the congregation to express our thanks. Since the sermon was also in Kinyarwandran we left as it began and had our own worship time at the "black house" (our houses are designated by colors).
The new week began with a busy schedule, including the addition of "health center" visits by two students each day. The nearest center is a 20 minute walk*. There are 11 others throughout the countryside, and they provide much of the outpatient care as well as performing many uncomplicated deliveries. Kibogora Hospital serves as the referral center for all of them for problems that exceed the clinic's level of care.
*(It is notable that distances as measured by miles or kilometers are seldom expressed. In a country where most walk everywhere and even a 90 mile trip by car can take 5 to 7 hours, time becomes the currency of distance.)
Paradoxes abound here. In a place where McDonald's has not yet sold a happy meal, where Starbuck's is outstripped by the coffee grown down the road and CVS and Walmart are unknowns, where paved roads and air conditioning, mowers and electric dishwashers and elevators are absent, 25 yards from the hospital gate sits a computer store. Cell minutes are sold in 90 cent increments (roughly 550 R. Francs); minutes for your wireless Internet access can also be purchased, or, if you have no computer, you can purchase time on theirs, all in a 10x10 building. Cell coverage here is better than at USA Children's Hospital, and texting to the U.S. is as instantaneous as being in the next room. Our bus driver on the way here, when not actively risking the lives of pedestrians in an uneven game of chicken, entertained himself by texting and talking on his cell, all the while negotiating curves and construction zones. Some behaviors appear to be universal. :)
By Tuesday, the baby mentioned above was no better, and with a persistent heart murmur since Saturday, we had ordered a chest X-ray, which along with auscultation and an EKG constitute the extent of available cardiac evaluation. The murmur had been louder on the right, and as it turned out, so was the heart. About the time we viewed the X-ray the infant's color deteriorated rapidly and we spent some time trying to achieve viable oxygenation, hampered by poorly functioning equipment, an oxygen concentrator as the only source of oxygen, and poor lighting and thermal support. Mom had no resources for transport or evaluation in Kigali, 7 hours away, but the hospital administration okayed the transport anyway and the next morning the babe was off to Kigali with her Mom. No report on her status as of yet, but the ultimate fate of infant's with complex congenital heart disease here is not good.
The entire week we have been treating Destin, a four year old with a major pneumonia and empyema (basically a left chest full of pus). We needled his chest on Monday, and after the minimal test we can do on the fluid suggested a staph infection and not tuberculosis, Shannon Burgess, on Wednesday, inserted a chest tube, draining about 200 cc's of milk chocolate colored fluid with an odor that made one wretch. We have drained an additional 200 hundred cc's over the last two days, and Friday his fever was beginning to diminish. Please pray for him--he has a long way to go if he is to recover.
Both of these patients' care have driven home how blessed we are to have simple things like wall suction, portable X-rays (when an X-ray is ordered the mother carts her child, paper in hand to X-ray), blood gases, oxygen with analyzers and saturation monitors, echocardiagrams, and, oh yeah, basic electrolytes. For those in medicine you will perhaps be amused to know that neonatal bilirubins are reported as positive or negative, making them of use only to those dependent on Braille. Physical exam is enormously more important when all of the tools (spelled c-r-u-t-c-h-e-s) we lean upon are absent. I think we will all be better doctors, certainly more appreciative doctors, upon returning to our technologically dependent medical worlds.
Thursday was a sad day as two of our team members and another U.S. physician headed to Kigali and on to their homes. Richard Ellingstad is a family doc from Wisconsin who was here for two months without his wife, who had contracted severe malaria on a previous trip to Tanzania. He was very gracious and helpful in getting us oriented to Kibogora. We will miss his presence at our group meals. Jeanne Claude Bataneni, a Congolese surgeon who traveled with us from Kigali to Kibogora, returned to his mission hospital in the eastern Congo's jungle. JC, as we know him, has returned to his birth village as the only surgeon, passing up much more lucrative and prestigious positions because he and his wife, also from the village and also a physician, have felt God calling them to serve His Kingdom there in Nebogongo Hospital. He is a kind and gentle man with a great testimony of persistence in the face of major obstacles to the practice of medicine. Please pray for him and his family.
Our spiritual leader, Duane, also headed home to Kim and the kids. He did a magnificent job of organizing this trip and in leading the group both in terms of logistical support, spiritual stimulation, and sensitivity to the emotions of a group far from home in a strange culture. His calm in the face of his own fatigue and a sharp witted bunch of tired travelers has been a lighthouse emotionally. He will be missed.
Comment on week two After two weeks in this land, where Christianity is more of a palpably present influence than in Alabama, we are struck by the fatalistic approach to illness, death, and dying that an animistic cultural inflence produces. Tradional medicine practitioners (think "medicine men") discourage allopathic medicine and value their own power base and influence mor than human life. Compare that to our home culture, where a secular utilitarian view of life also erodes the Christian's high value on the sanctity of life, and deluded influence peddlers (think "politician") sell their souls on the alter of public opinion at the expense of the unborn and unprotected. Both are evils that medical providers who follow Christ will battle throughout their careers.
Here in Rwanda the battle is one on one, a relational effort to change people's hearts through the establishment of trust in our skills, our love and our faith in Christ. In the U.S. the battle is no less intense on the personal, relational front, but is compounded by the increasingly aggressive attack by the government on our rights as providers and patients to determine our own attitudes and actions in protecting all human life. Unless we are firmly founded in what AND why we believe what we do in regards to human dignity and sanctity of life, we risk having our resolve eroded. On this issue the daily renewing of our minds in Christ through the leading of the Holy Spirit is an indispensable habit of life. Please pray that these weeks "on a hill far away"** will be a time of formation and strengthening of values that will last a lifetime, however long those lives may be.
**see: On a Hill Far Away by Dr. Al Snyder, who gave his life to serve Christ at Kibogora
Saturday, March 24, 2012
Kibogora Week One
Kibogora, Rwanda 24 March 12
Greetings from Kibogora, the site of Kibogora Hospital in SW Rwanda. To view pictures and commentary from out group please go to: teamrwanda2012.blogspot.com.
The trip: We departed Mobile twice. A short round trip to Satsuma was necessitated by a passport left behind--the owner shall remain nameless. We arrived in Atlanta with time to spare and spent a considerable time getting our personal luggage and supplies checked. The flight from Atlanta to Amsterdam, a little over 8 hours, departed at 18:00 EDT and arrived in Amsterdam at around 08:30 Sunday with only about 90 minutes of layover. Security checks in Amsterdam are at the gate, necessitating a second pass through the gauntlet. One traveler's otoscope drew attention because of its appearance similar to a gun. That resolved, we boarded a KLM flight to Kigali, Rwanda, for nearly 8 more hours.
The Kigali airport, while able to accommodate an airbus, has a terminal only slightly bigger than our plane. We passed through customs without incident. None of our luggage was inspected, and none was lost in transit (minor miracle considering the volume and short layover.) We were met at the airport by the Albertsons, who had arrived ahead of us, and the Finleys (included Will the 2+ year old who was kick). The Finleys are missionaries in Kigali, a city of approximately 1 million people and the capital of Rwanda.
We spent the night at the Eden Motel in Kigali: as Duane said, picture Eden AFTER the fall. Beds were slightly softer than plywood, the water was undrinkable (everywhere in Rwanda without treatment/filtering), and the windows had no screens which meant a decision: be uncomfortably hot or battle mosquitoes that might carry malaria. We decided to be cool.
The next morning (Monday, the 19th) we had breakfast at the Eden--it was consistent with the bed quality, enough said. Shortly thereafter we boarded a 24 passenger bus for the trip. The buses here are designed for passengers, not luggage, so we stored 30+ large bags in the back of the bus and crammed the sixteen of us into the front portion. Kudo's to Jeanne Claude, the Congloese surgeon who joined us in Kigali, Lee Ann, our new friend from Montana (friend of the Albertson's), and others for sitting for 8 hours in a jump seat with no padding--the last two hours were on roads with no pavement and under construction, making for a very bumpy ride.
We stopped for lunch in Butare, a sit down affair with a cooked meal in a motel that catered to expatriates. After that there was a roughly 5 hour test of bladder and bowel for the 17 occupants (driver also) until we arrived at Kibogora. The test was exacerbated by the uneven pavement and the daredevil driver who must have a utilitarian view of human life. On the trip we passed thousands of people walking the prepared paths along the main highway. As the bus would approach, he would blow the horn if anyone dared to wander into his path, but rarely used his brakes.
At one point he rounded a curve in a one lane construction zone and came face to face with a Mercedes transport truck. The two trucks, with brakes fully applied, stopped a few feet apart and all of our occupants exhaled, groaned, and then laughed with relief. An argument ensued as to who should back up and we lost, so we backed up a bit, let him pass and we were own our way. The buses here have very good brakes and very good suspensions. Going at considerable speed they handle curves with minimal lean, even with a weight load that our baggage had added to its usual burden. The cost of transporting 16 people and their luggage for 8 hours was 18000 Rwandan francs, or just 300 dollars.
We were greeted at the compound by several people whose first job was to escort all to "the facilities". Afterwards we were assigned houses, unpacked, and collapsed into bed for the first decent chance at sleep since Friday night. On that note, I should mention the great spirit that everyone exhibited throughout the trip in spite of considerable fatigue.
Tuesday: We were escorted around the hospital and oriented by Edi, a nurse from Germany who has just returned here to work, having spent 2004-2007 here, and Kari a medical student from Albert Einstein in N.Y. City, who took a 4th year sabbatical to work on an OB project for one of her faculty in N.Y. Kibogora Hospital is built on the side of a hill and has three main levels, the highest being the main entrance and then down to the other two sets of buildings. At full capacity it is said to hold 260 patients. Pediatrics is housed at the bottom, which is somewhat symbolic, I think, of how the child is viewed in the culture.
Wednesday: We broke up into teams and began seeing patients. In our group were Britni Bradshaw, Liz Donahue, Caroline Bryars, Micki, my wife, and me. Our M.D. host is Dr. Ngoy, a Congolese generalist, who is currently assigned to pediatrics for his day responsibilities. We began in the "neonatology unit", a room approximately 10 by 14 in which 5 incubators, 5 cribs are housed along with the mothers of any babies housed there. While the temperature here is quite pleasant, the neonatology unit is akin to a sauna, with the only moving air coming through old style windows that open horizontally with cranking (jolis?). Infants are bundled in heavy sweaters and blankets with no monitors, so visual inspection is impossible without entering the incubator. There are no monitors--if an infant has an apneic event, he/she is on their own. There are no pumps--intravenous fluids are dripped in with the attendant variations in delivery that arm position produce. For that reason, every effort is made to get I.V.'s out quickly.
We rounded in neonatology and then in pediatrics with Dr. Ngoy. He has a broad base of knowledge for a generalist so young (around 32 y.o.). On the first day alone we were introduced to cerebral malaria, a severe gastric outlet obstruction, pneumonia, sickle cell disease, and a myriad of other disorders. When not being seen the children generally play outside, watched by their moms, their family wash hung on the clotheslines beside the building. Our group got to interact both medically and socially as the children love to have their picture taken and to be hugged. If you smile at them, they almost always smile in return, but the moms and children are wary until they see your expression.
The tendency in medicine is to treat diseases, not people. I mention the diseases above but not the people--they are gentle, cautiously friendly, and cooperative. The children are quiet while we round and are amazingly cooperative with exams, in general. A great ice breaker was taking pictures with the various smart phones and showing them to the children and moms. This always illicits a smile and helps to break the ice. In both the neo unit and the wards we asked to pray on several occasions and were never refused--in fact on two occasions we were called to another bedside as a result of the first prayer being asked to pray again.
Thursday and Friday were similar to Wednesday except that our U.S. team began to see most of the neonatology patients and were more involved in the pediatric wards. Our little team had one crisis on Friday when a 5 month old child was noted to have extreme respiratory distress, having presented with the mother's complaint of abdominal pain for 2 months. The infant's saturations were dangerously low, so Dr. Ngoy put her on oxygen (the only oxygen available is an 02 generator). We became increasingly convinced that she had a congenital heart problem, probably a Tetrology of Fallot, and doubted she would survive. Caroline, a high school senior who plans to follow in her mother's footsteps as a nurse, lead a prayer for her. We were all pretty shaken to leave her, knowing she might not be alive when we came back in the afternoon. The hope I had was that she was having a "Tet spell" and that if she resolved it, she would improve. We returned about two hours later and she was breathing quietly and breastfeeding without distress--an answer to Caroline's prayer. Sadly, unless she can get to a location that does CV surgery, she will probably not survive the next few weeks or months. That kind of transport cost and surgery expense has to be borne by the family, and few have those resources.
Saturday: Most of the team decided to go to a National Forest to see the monkeys there. Micki and I decided not to go, and I made rounds in place of Dr. Ngoy in the neo unit because he was away at a mandatory meeting. We also checked on the little girl with Tetralogy and she was doing well.
A comment on the first week: Life here is a struggle, unlike anything we experience in America, though far less dramatic than in places such as Darfur. Our compound night "guard" walks two hours to work 12 hours and then returns home, being paid 3 dollars per night, and that is about 3 times what he would make working in the fields picking crops of tea or other crops. The people here live in a constant survival mode, heavily dependent on rain for crops. Most carry water (50 gallon jugs) from a well at the bottom of the hill up to their abode as their only source of water. Their fishing boats, which we see coming in each morning, their occupants singing, are made from logs, much as the early American Indian made their canoes. The grounds of the compound are "mowed" by men using a small machete, cutting a 6 inch span of grass with each swing--we are talking over an acre of grass. Lawn mowers are non-existent here.
Life is day to day, sleep, work, eat, sleep. The vast majority will rarely or never leave this general area, and if they do it will usually be on foot. So, is their life less valuable than someone who lives in the U.S. or Europe or another developed country?--only if one judges the value of a life by its surroundings. Instead, if we judge value of life by the relationships that each of us has with our family and friends, and especially with our God, we are all equally a part of God's human creation.
One of the cultural barriers that we have already seen here is the acceptance of death as a matter of course--that is both a healthy attitude (that many in the U.S. ignore/deny until the bitter end) and one that results in a diminished effort to sustain life if too much effort is required. We would be naive' to think in a few short weeks we can change a culture of centuries, but we can relate, love, and temporarily relieve pain and suffering--and in the final analysis, those are truly the only real meaningful things we can do for each other, whether in medical care or in daily life. We are not so different from these folks, and the things of real value transcend cultures and do not involve the luxuries and distractions of life--those things actually can either add to our lives or be hindrances but they will never be the core of our existence-that core is our relationship with our Lord and our fellow sufferers.
Please pray for our group and its mission: for physical health (as we try to remember not to drink the shower water or wash out our toothbrush under the faucet); for emotional health, as we all miss home a bit; and for spiritual health and insight--that Jesus would lead us to our true mission here--to glorify the Father.
Greetings from Kibogora, the site of Kibogora Hospital in SW Rwanda. To view pictures and commentary from out group please go to: teamrwanda2012.blogspot.com.
The trip: We departed Mobile twice. A short round trip to Satsuma was necessitated by a passport left behind--the owner shall remain nameless. We arrived in Atlanta with time to spare and spent a considerable time getting our personal luggage and supplies checked. The flight from Atlanta to Amsterdam, a little over 8 hours, departed at 18:00 EDT and arrived in Amsterdam at around 08:30 Sunday with only about 90 minutes of layover. Security checks in Amsterdam are at the gate, necessitating a second pass through the gauntlet. One traveler's otoscope drew attention because of its appearance similar to a gun. That resolved, we boarded a KLM flight to Kigali, Rwanda, for nearly 8 more hours.
The Kigali airport, while able to accommodate an airbus, has a terminal only slightly bigger than our plane. We passed through customs without incident. None of our luggage was inspected, and none was lost in transit (minor miracle considering the volume and short layover.) We were met at the airport by the Albertsons, who had arrived ahead of us, and the Finleys (included Will the 2+ year old who was kick). The Finleys are missionaries in Kigali, a city of approximately 1 million people and the capital of Rwanda.
We spent the night at the Eden Motel in Kigali: as Duane said, picture Eden AFTER the fall. Beds were slightly softer than plywood, the water was undrinkable (everywhere in Rwanda without treatment/filtering), and the windows had no screens which meant a decision: be uncomfortably hot or battle mosquitoes that might carry malaria. We decided to be cool.
The next morning (Monday, the 19th) we had breakfast at the Eden--it was consistent with the bed quality, enough said. Shortly thereafter we boarded a 24 passenger bus for the trip. The buses here are designed for passengers, not luggage, so we stored 30+ large bags in the back of the bus and crammed the sixteen of us into the front portion. Kudo's to Jeanne Claude, the Congloese surgeon who joined us in Kigali, Lee Ann, our new friend from Montana (friend of the Albertson's), and others for sitting for 8 hours in a jump seat with no padding--the last two hours were on roads with no pavement and under construction, making for a very bumpy ride.
We stopped for lunch in Butare, a sit down affair with a cooked meal in a motel that catered to expatriates. After that there was a roughly 5 hour test of bladder and bowel for the 17 occupants (driver also) until we arrived at Kibogora. The test was exacerbated by the uneven pavement and the daredevil driver who must have a utilitarian view of human life. On the trip we passed thousands of people walking the prepared paths along the main highway. As the bus would approach, he would blow the horn if anyone dared to wander into his path, but rarely used his brakes.
At one point he rounded a curve in a one lane construction zone and came face to face with a Mercedes transport truck. The two trucks, with brakes fully applied, stopped a few feet apart and all of our occupants exhaled, groaned, and then laughed with relief. An argument ensued as to who should back up and we lost, so we backed up a bit, let him pass and we were own our way. The buses here have very good brakes and very good suspensions. Going at considerable speed they handle curves with minimal lean, even with a weight load that our baggage had added to its usual burden. The cost of transporting 16 people and their luggage for 8 hours was 18000 Rwandan francs, or just 300 dollars.
We were greeted at the compound by several people whose first job was to escort all to "the facilities". Afterwards we were assigned houses, unpacked, and collapsed into bed for the first decent chance at sleep since Friday night. On that note, I should mention the great spirit that everyone exhibited throughout the trip in spite of considerable fatigue.
Tuesday: We were escorted around the hospital and oriented by Edi, a nurse from Germany who has just returned here to work, having spent 2004-2007 here, and Kari a medical student from Albert Einstein in N.Y. City, who took a 4th year sabbatical to work on an OB project for one of her faculty in N.Y. Kibogora Hospital is built on the side of a hill and has three main levels, the highest being the main entrance and then down to the other two sets of buildings. At full capacity it is said to hold 260 patients. Pediatrics is housed at the bottom, which is somewhat symbolic, I think, of how the child is viewed in the culture.
Wednesday: We broke up into teams and began seeing patients. In our group were Britni Bradshaw, Liz Donahue, Caroline Bryars, Micki, my wife, and me. Our M.D. host is Dr. Ngoy, a Congolese generalist, who is currently assigned to pediatrics for his day responsibilities. We began in the "neonatology unit", a room approximately 10 by 14 in which 5 incubators, 5 cribs are housed along with the mothers of any babies housed there. While the temperature here is quite pleasant, the neonatology unit is akin to a sauna, with the only moving air coming through old style windows that open horizontally with cranking (jolis?). Infants are bundled in heavy sweaters and blankets with no monitors, so visual inspection is impossible without entering the incubator. There are no monitors--if an infant has an apneic event, he/she is on their own. There are no pumps--intravenous fluids are dripped in with the attendant variations in delivery that arm position produce. For that reason, every effort is made to get I.V.'s out quickly.
We rounded in neonatology and then in pediatrics with Dr. Ngoy. He has a broad base of knowledge for a generalist so young (around 32 y.o.). On the first day alone we were introduced to cerebral malaria, a severe gastric outlet obstruction, pneumonia, sickle cell disease, and a myriad of other disorders. When not being seen the children generally play outside, watched by their moms, their family wash hung on the clotheslines beside the building. Our group got to interact both medically and socially as the children love to have their picture taken and to be hugged. If you smile at them, they almost always smile in return, but the moms and children are wary until they see your expression.
The tendency in medicine is to treat diseases, not people. I mention the diseases above but not the people--they are gentle, cautiously friendly, and cooperative. The children are quiet while we round and are amazingly cooperative with exams, in general. A great ice breaker was taking pictures with the various smart phones and showing them to the children and moms. This always illicits a smile and helps to break the ice. In both the neo unit and the wards we asked to pray on several occasions and were never refused--in fact on two occasions we were called to another bedside as a result of the first prayer being asked to pray again.
Thursday and Friday were similar to Wednesday except that our U.S. team began to see most of the neonatology patients and were more involved in the pediatric wards. Our little team had one crisis on Friday when a 5 month old child was noted to have extreme respiratory distress, having presented with the mother's complaint of abdominal pain for 2 months. The infant's saturations were dangerously low, so Dr. Ngoy put her on oxygen (the only oxygen available is an 02 generator). We became increasingly convinced that she had a congenital heart problem, probably a Tetrology of Fallot, and doubted she would survive. Caroline, a high school senior who plans to follow in her mother's footsteps as a nurse, lead a prayer for her. We were all pretty shaken to leave her, knowing she might not be alive when we came back in the afternoon. The hope I had was that she was having a "Tet spell" and that if she resolved it, she would improve. We returned about two hours later and she was breathing quietly and breastfeeding without distress--an answer to Caroline's prayer. Sadly, unless she can get to a location that does CV surgery, she will probably not survive the next few weeks or months. That kind of transport cost and surgery expense has to be borne by the family, and few have those resources.
Saturday: Most of the team decided to go to a National Forest to see the monkeys there. Micki and I decided not to go, and I made rounds in place of Dr. Ngoy in the neo unit because he was away at a mandatory meeting. We also checked on the little girl with Tetralogy and she was doing well.
A comment on the first week: Life here is a struggle, unlike anything we experience in America, though far less dramatic than in places such as Darfur. Our compound night "guard" walks two hours to work 12 hours and then returns home, being paid 3 dollars per night, and that is about 3 times what he would make working in the fields picking crops of tea or other crops. The people here live in a constant survival mode, heavily dependent on rain for crops. Most carry water (50 gallon jugs) from a well at the bottom of the hill up to their abode as their only source of water. Their fishing boats, which we see coming in each morning, their occupants singing, are made from logs, much as the early American Indian made their canoes. The grounds of the compound are "mowed" by men using a small machete, cutting a 6 inch span of grass with each swing--we are talking over an acre of grass. Lawn mowers are non-existent here.
Life is day to day, sleep, work, eat, sleep. The vast majority will rarely or never leave this general area, and if they do it will usually be on foot. So, is their life less valuable than someone who lives in the U.S. or Europe or another developed country?--only if one judges the value of a life by its surroundings. Instead, if we judge value of life by the relationships that each of us has with our family and friends, and especially with our God, we are all equally a part of God's human creation.
One of the cultural barriers that we have already seen here is the acceptance of death as a matter of course--that is both a healthy attitude (that many in the U.S. ignore/deny until the bitter end) and one that results in a diminished effort to sustain life if too much effort is required. We would be naive' to think in a few short weeks we can change a culture of centuries, but we can relate, love, and temporarily relieve pain and suffering--and in the final analysis, those are truly the only real meaningful things we can do for each other, whether in medical care or in daily life. We are not so different from these folks, and the things of real value transcend cultures and do not involve the luxuries and distractions of life--those things actually can either add to our lives or be hindrances but they will never be the core of our existence-that core is our relationship with our Lord and our fellow sufferers.
Please pray for our group and its mission: for physical health (as we try to remember not to drink the shower water or wash out our toothbrush under the faucet); for emotional health, as we all miss home a bit; and for spiritual health and insight--that Jesus would lead us to our true mission here--to glorify the Father.
Tuesday, February 21, 2012
The Necessity of Daily Renewal
Each of us is a unique individual, created by God with a specific purpose and without duplication in mind or spirit. Imagine a sculptor taking raw, dry clay and slowly adding water to form a malleable material. In the artist's mind a vision of the finished product already exists and his work is to form a mold that expresses that vision when filled with the artist's medium.
For each of us, the Artist began with an image in mind. He fashioned a mold and poured in our flesh and blood, our emotions and intellect, and our spirit. In Eden, Adam and Eve fit perfectly in His mold and were perfect renditions of His creative work.
But they, and each of us in turn, having been given a choice, chose to change the shape of His creation--in our rebellion we no longer fulfill his intent for us. We resemble the original in flesh and blood, but that is failing with age and disease. Our emotions are flawed by our willfulness and the distortions of sinful anger and selfishness. Intellectually we are dulled no matter how we may deceive ourselves as individuals or as a society. And our spirits have withered in their separation from the hands of the Master.
How do we recover? How do we return to be the creation that God intended when He first formed us? In my mind, in my prayers, I ask God to return me to dust--not to take my life, but to spiritually accept my confession that I have rebelled against His intentions, and humbly ask Him to return me to the first raw product of His creative process and to begin again. Add again the water of life to my dried clay. Reshape me to the original design He saw for me before the Earth or I were formed. Renew my flesh and blood, heal my emotions, restore my intellect to His purposes, and reconcile my spirit to His, so that I fit the mold and emerge as the image of His creativeness.
We wake up each morning with a choice of how to approach our day. The "wild animals of the day" (C. S. Lewis in Mere Christianity) assail us and we are immediately confronted with the temptation to be self-centered, cynical and unconcerned about God and our fellow man. If we do not submit to God, awaiting His reformation, we risk going out in our cynicism and selfishness. If we allow ourselves to be ground back to dust through repentance and confession, we are the clay in God's hands to be reshaped again that day into His purposes. If we make a habit of being open to His reformation each day, we approach, asymptotically in this life, the shape of His original creation, and prepare ourselves for the full realization of His intent for us in eternity.
Father, help us to renew our minds and spirits in Your truth daily. We age physically in an unalterable process over which we have no control. But we can be reborn in spirit and renewed in mind and spirit through your grace and mercy. Help us to avail ourselves of those daily opportunities. Amen.
For each of us, the Artist began with an image in mind. He fashioned a mold and poured in our flesh and blood, our emotions and intellect, and our spirit. In Eden, Adam and Eve fit perfectly in His mold and were perfect renditions of His creative work.
But they, and each of us in turn, having been given a choice, chose to change the shape of His creation--in our rebellion we no longer fulfill his intent for us. We resemble the original in flesh and blood, but that is failing with age and disease. Our emotions are flawed by our willfulness and the distortions of sinful anger and selfishness. Intellectually we are dulled no matter how we may deceive ourselves as individuals or as a society. And our spirits have withered in their separation from the hands of the Master.
How do we recover? How do we return to be the creation that God intended when He first formed us? In my mind, in my prayers, I ask God to return me to dust--not to take my life, but to spiritually accept my confession that I have rebelled against His intentions, and humbly ask Him to return me to the first raw product of His creative process and to begin again. Add again the water of life to my dried clay. Reshape me to the original design He saw for me before the Earth or I were formed. Renew my flesh and blood, heal my emotions, restore my intellect to His purposes, and reconcile my spirit to His, so that I fit the mold and emerge as the image of His creativeness.
We wake up each morning with a choice of how to approach our day. The "wild animals of the day" (C. S. Lewis in Mere Christianity) assail us and we are immediately confronted with the temptation to be self-centered, cynical and unconcerned about God and our fellow man. If we do not submit to God, awaiting His reformation, we risk going out in our cynicism and selfishness. If we allow ourselves to be ground back to dust through repentance and confession, we are the clay in God's hands to be reshaped again that day into His purposes. If we make a habit of being open to His reformation each day, we approach, asymptotically in this life, the shape of His original creation, and prepare ourselves for the full realization of His intent for us in eternity.
Father, help us to renew our minds and spirits in Your truth daily. We age physically in an unalterable process over which we have no control. But we can be reborn in spirit and renewed in mind and spirit through your grace and mercy. Help us to avail ourselves of those daily opportunities. Amen.
Tuesday, December 20, 2011
The Advent of Grace
God oppresses the proud, but gives grace to the humble. Ephesians 5:21 (Proverbs 3:34)
Grace-unmerited favor.
As we experience the Advent Season, we focus on the grace of God that was given through the birth of Jesus, the Christ. As we reflect on how Jesus came to be born, we find that we have little understanding of God's purposes and how he effects our redemption through them. We are left to read His word and trust in His love.
Isn't that how grace always is? Are not His purposes usually a mystery to us? How often do we pray for days, weeks, years, with seemingly no answer? Only in retrospect do we see that God's grace has slipped quietly into our lives, answering our prayers as quietly and unobtrusively as the birth of a baby in a stable. Our prayers were for an outcome; His purposes included the process.
Praying for a change in heart that that I knew I was powerless to achieve, I found after years of prayer the change had been miraculously accomplished. I do not understand His purpose in making me wait. I know that part of the delay was my own failure to humble myself to Him. I also know that He waited long enough for me to be certain that my change of heart was His grace and not my doing; He receives the glory, and I trust Him more than ever.
We had no choice in the timing of Jesus' birth. His birth and death and resurrection were collectively unmerited favor delivered to those who mostly did (and do) not recognize their need. That grace is offered with extraordinary patience to all who have been called to receive it, and given to all who accept it.
Daily grace, the grace that changes the way we think and act, that changes the way we love our neighbor, treat our children, value our wives, do our acts of service, even how we do the menial tasks of daily life, is given in the same mysterious way. It is offered to all who have been called to receive it, and given to all who accept it.
We receive daily grace in the same manner that we receive Jesus: we recognize our need, humbling ourselves and acknowledging our powerlessness to do what only God can do, and asking for His deliverance, both in our salvation, which is complete, and in our sanctification, which is an unending process growing out of daily renewal in His Word.
The Advent of Grace is a River, flowing from the throne of God to us.
Thanks you, Father God, for the gift of Your Son, and for the daily, eternal flow of grace from Your throne into our lives. Amen.
Grace-unmerited favor.
As we experience the Advent Season, we focus on the grace of God that was given through the birth of Jesus, the Christ. As we reflect on how Jesus came to be born, we find that we have little understanding of God's purposes and how he effects our redemption through them. We are left to read His word and trust in His love.
Isn't that how grace always is? Are not His purposes usually a mystery to us? How often do we pray for days, weeks, years, with seemingly no answer? Only in retrospect do we see that God's grace has slipped quietly into our lives, answering our prayers as quietly and unobtrusively as the birth of a baby in a stable. Our prayers were for an outcome; His purposes included the process.
Praying for a change in heart that that I knew I was powerless to achieve, I found after years of prayer the change had been miraculously accomplished. I do not understand His purpose in making me wait. I know that part of the delay was my own failure to humble myself to Him. I also know that He waited long enough for me to be certain that my change of heart was His grace and not my doing; He receives the glory, and I trust Him more than ever.
We had no choice in the timing of Jesus' birth. His birth and death and resurrection were collectively unmerited favor delivered to those who mostly did (and do) not recognize their need. That grace is offered with extraordinary patience to all who have been called to receive it, and given to all who accept it.
Daily grace, the grace that changes the way we think and act, that changes the way we love our neighbor, treat our children, value our wives, do our acts of service, even how we do the menial tasks of daily life, is given in the same mysterious way. It is offered to all who have been called to receive it, and given to all who accept it.
We receive daily grace in the same manner that we receive Jesus: we recognize our need, humbling ourselves and acknowledging our powerlessness to do what only God can do, and asking for His deliverance, both in our salvation, which is complete, and in our sanctification, which is an unending process growing out of daily renewal in His Word.
The Advent of Grace is a River, flowing from the throne of God to us.
Thanks you, Father God, for the gift of Your Son, and for the daily, eternal flow of grace from Your throne into our lives. Amen.
Saturday, September 24, 2011
Necessarily Incomplete:Thoughts on Repentance, Love, and Forgiveness
As Thou dost forgive us our trespasses, so may we forgive others who trespass against us.*
I think part of the difficulty in living a life that experiences the "easy yoke and light burden" that Jesus promised His followers is our hesitance to repent at the moment we know we have sinned. Instead, our tendency, the human, fallen tendency, is to mimic Adam and Eve: we run away from God, hoping He didn't notice. But, we know in our hearts, we can run but not really hide.
So how do we change this habit of behavior? How do we change any destructive behavior, be it the sin or the response to the sin which compounds the original offense? The answer is simple but not easy: submit in humility; admit that, try as you might, you cannot successfully change the heart behind behavior without the Holy Spirit's work; and you cannot change the behavior permanently without a change of heart.
So, do we just sit and wait and do nothing ourselves. No, we are creatures of free will; we have choices, the most important of which is to submit in humility, but while God is changing our attitudes and healing our wounds that lead to destructive thoughts and behaviors, we can choose to act differently, not as a rebellious attempt to circumvent the need for a spiritually derived change of heart, but as a statement of faith that we trust God to carry our "heart-change" to completion.
C. S. Lewis said: "When you are behaving as if you love someone, you will presently come to love him." If we direct our actions to love someone, even if in our hearts we despise them, we are humbling ourselves to God. We are saying, in essence: "You, Father, love this person who is part of Your creation, so I will be obedient and act as though I love them, too." Our obedience opens the door for God to change our hearts using the emotions that He placed within us.
We cannot of our own volition change our hearts, but we can use our hands and feet, our words and actions to do the opposite of what our selfish hearts will us to do, submitting those evil desires to God even as we act in love, even as our actions speak the forgiveness of God that we have not yet experienced in our heart.
Some say that unless we forgive we cannot be forgiven; unless we love our neighbor as ourselves we are not true believers. There is an element of truth in these propositions, but they leave another aspect of God's grace unspoken: As we develop faith in Him, we love ourselves as He loves us; we forgive ourselves as He forgives us; only then are we prepared by Him to forgive others and to love others in the way we should love ourselves.
The concept of being loved to love and being forgiven to forgive necessarily implies that we have to first accept God's love and forgiveness before we can love and forgive as He demands. They are not actions that are the initiators of our salvation, but the fruit of it, and the fruit may take years of nurturing and pruning before it is produced, meaning that between our salvation and our perfection will be many trials in which we may fail to love or forgive as we should.
Packer points out in his book, Evangelism and the Sovereignty of God, the occurrence in nature of antinomies, a situation in which two necessary laws appear to be contradictory. He uses the analogy of light being both particle and wave, two contradictory theories but both needed to adequately explain the action of light.
The need to forgive to be forgiven, to love others as we love ourselves, can be viewed as antinomies as well--we cannot forgive without divine grace first being given to us, without divine love first being offered to us; at the same time we are to forgive and love as a condition of that forgiveness and eternal love. A cause (being forgiven, being loved) is necessary for the effect (forgiving others, loving others), yet the effect is required in order for the cause to be in place--two necessary laws that seem to contradict each other.
Only God has the depth of intellect to understand such an antinomy. We only have to "trust and obey"---someone ought to write a hymn about that :).
When we walk with the Lord in the light of His Word,
What a glory He sheds on our way!
While we do His good will, He abides with us still,
And with all who will trust and obey.**
What a glory He sheds on our way!
While we do His good will, He abides with us still,
And with all who will trust and obey.**
Peace and grace be yours. Amen
*(translation from Aramaic to Old English by G.J.R. Ouseley from The Gospel of the Holy Twelve)
** Trust and Obey, John Sammis (1887)
Wednesday, July 27, 2011
Daily Crossings
When Moses and the fugitive Israelites arrived at the Red Sea, their backs were against the wall. There appeared to be only two choices that provided an escape from the brutal slavery to which they had been subjected--turn and fight Pharaoh or plunge into the Red Sea--both choices equally certain to produce death and destruction for the Chosen People.
Then God provided a third choice, miraculously moving the waters back to create a dry path through the Sea. All the Israelites had to do was step out in faith that the waters would stay where they were. I wonder if the average traveler saw this as opportunity or risk; I wonder how I would have viewed the situation.
How do I respond when such opportunities appear before me? The first question is: do I even recognize what I am seeing? Do I understand my hopeless plight, my enslavement to whatever it is from which God is offering deliverance? The first step in seeing "Red Sea" opportunities is to know I am in need of deliverance. My enslavement may involve dependence on gods of materialism or other addictions; it may involve a disordered set of priorities; it may involve bitterness in relationships; it may even be manifested in Pharisaic legalism that I have mistaken for Christianity. If I am deluded and don't recognize my enslavement, I will not come to the point of crying out to God for deliverance.
But let's say God has revealed to me my plight, and I have asked God for deliverance from my burden that weighs down my life and steals my joy. When the Red Sea parts, how do I respond? My tendency is to begin to analyze the risks, to calculate the odds of a successful crossing: "hmmm, the water is 20 feet high, the wind is 30 miles per hour, and I have about 40 minutes to make the crossing, or else I'm going to drown"--in other words, I forget Who it is who parted the Sea and I begin to lean on my own understanding of the risks and benefits rather than being obedient.
I calculate the harm to my reputation if I admit my addiction: I justify my need for financial security by claiming prudence as my god; I defend my pride by assuring myself that to try to mend that relationship will just result in my being betrayed; I argue that love has to have limits and that boundless compassion is just a license for someone else to sin, so I stand by my legalism. All the while the dry land waits, the waters roil, and the hope for the Promised Land lies on the other side.
The Other Side: The Promised Land AND lots of desert and difficulty.
How often do I consider the Red Sea opportunities in that light? Instead of valuing the supernatural event that God has placed before me, I argue for assurances that the other side will be all comfort and joy upon arrival. That wasn't realistic for the Israelites and it isn't realistic for me--there was desert on the other side and their subsequent disobedience delayed their arrival in the Promised Land.
Its the same for me: I can step out in faith, cross my Red Sea, but life will still be difficult in some ways, obedience is still required AFTER I cross, and there will still be temporal consequences if I make bad choices down the line--if I leave behind enslavement to one god and then fashion a golden calf on the other side.
The Israelites problem was not that they crossed the dry land to freedom, but that they turned to another form of slavery after they crossed. The risk for me, and for you, is similar--obedience in crossing may bring new challenges and new temptations. The answer is not to refuse to make the crossing, but to commit to obedience on the other side.
So, a challenge to you and to me: Let's open our eyes to our enslavement; let's pray to God for deliverance; let's walk on the dry land when God provides it; and let's remain obedient on the other side as we travel on to the Promised Land.
Father God, give us courage to step out in reliance upon your provision, not fearing the "other side" but trusting you moment to moment, day to day, with the outcome. We pray in the name of Jesus, Who died on the Cross in obedience to You, Amen.
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