Don't you love your kids?

We've been asked some interesting (and funny) questions over the last couple of years about Zambia and our decision to move there. I thought I'd share a few of them with you and try to answer them as well. Maybe you've wondered the same thing but never asked. Here goes...

1) Are you taking the children??

Yes, we are taking our children with us. Though after flying home from Florida yesterday with them and facing a 6-7 hour drive to Texas today, I may very well be reconsidering that one later tonight.

2) Don't you love your kids?

Yes, someone really asked me this question before. And yes, of course we love them. It seems strange that someone would come out and ask it so directly, but to be honest, we've heard many, more subtle forms of this question over the years and I fully understand where people are coming from when they ask it. More commonly, we've heard this sentiment in the statement, "It's great what you're doing and all, but I don't think I could take my kids." To quote famous missionary physician, Dr. Thomas Hale, "Gracious, you're not going to the Gulag." That's right on. Zambia is no Gulag! And in a lot of ways we miss the simplicity of the place for our kids. You've probably heard us say it before, but they had a great experience there in that they were always outside playing, getting scraped up and dirty, making friends and using their imaginations. The stuff kids ought to be doing in my opinion. More importantly though, we want them to know that mom and dad are trying to listen to God's calling and follow. I trust God will keep us and them safe and that one day, he'll help them hear and follow His calling on their lives too.

3) Why bother?

This question came up in the context of a discussion about the many health challenges facing Zambia now. The gentleman that asked us this was sincerely looking for any hope in the situation and wondered how we see our work making any difference. Wow, great question! In fact, it is something I probably asked myself on a daily basis while working at Mukinge. In purely physical terms, the situation in rural Zambia is overwhelming (as it is in most of the world) and it's hard to see the answers to such massive economic, social and health problems. Goodness, I feel the same way here in the States! Where's the hope to be found? Only in one place...the Gospel. That's it. I firmly believe that it is right and good to practice medicine in a place where there is little access to healthcare and I want to do that as well as I can. There is value in binding up physical wounds and healing sickness. I believe I can give glory to God through my work. I also know that there's only one Great Physician, and ultimately, the best thing I can do in this life is point people to Him for real hope and healing.

4) Where is Zimbabwe?

Zimbabwe is just south of Zambia. The two are confused because they're neighbors and both start with Z. We were in Zambia in 2008-2009 and are going back there soon.

5) What is the weirdest thing you've eaten in Zambia?

The fried caterpillars and flying termites were umm,...very interesting. Taste a lot like Chicken McNuggets....crispy on the outside and mushy in the middle. Fortunately, these were not a part of our regular daily diet. If you come and visit though, I will make sure they are available for breakfast, lunch and dinner if you so desire.

6) Are you independently wealthy? Are you self-supported?

No and no. While we've been blessed in the last year and a half to have a "real" income, this work can really only be accomplished by and through the generosity of others. We're supported, in the full sense of the word, by friends, family and churches who believe in what we're doing and have chosen to partner with us to make it happen. We're are currently at about 70% of our needed support, so there is still work to be done. Praise God though for the progress we've seen recently in this area.

7) When are you leaving on your mission trip?

Well, we're hopefully leaving this spring (April or May). The funny thing about this question, and we've heard it a couple of times lately, is the reference to "mission trip". Nothing wrong with mission trips (we've been on a few and they certainly pointed us in this direction) but what we're embarking on is hopefully more than a "trip". We've been accepted to SIM (Serving In Mission) to their long-term missions track. And while we don't know what the future holds, we're hoping to be involved in this work for a long, long time.

the lost art of the physical exam

Dr. Verghese shares a powerful lecture on the necessity and ritual of the physical exam in medicine.

What shameless self-promotion???

Hello friends. Well, I sure hope this won't come across that way, but we're trying to get the word out about our plans to get back to Mukinge. I hope you'll take a few minutes to check out this little video that the nice folks at SIM made for us. Feel free to share it with everyone you know:)

The Tompkins-Serving in Zambia from SIM USA on Vimeo.

Back in the Saddle Again

We’re actually still in Kansas but we’re not changing the name of the blog because, let’s be honest...the name is really cool. We are, however, making plans to return to Zambia within the next year and because of that, I thought I’d start blogging again to keep everyone updated. Plus, hundreds of people my mom and sister have asked me to start posting again.

The plan at this point is to return to Mukinge Hospital by late spring/early summer of next year. We still have some work to do before that is possible but we trust that God is going to get us back there in His timing. This time around though, we’ll be going through Serving in Mission (SIM) and will be going back on a long-term basis. Previously we were in Zambia with Samaritan’s Purse and the program we were on was only a 2 year deal without the possibility of renewal. The purpose of the program was to link up young docs with long-term sending organizations, like SIM, in hopes that we’d catch a vision for career medical mission work. So, that is where we’re at right now. We’ve caught that vision. The work we’re returning to will be pretty much the same as what we were doing previously, but being there on a longer term basis will hopefully open up some new doors for ministry.

We hope that you’ll continue to follow along with us on this journey. I’ll try to keep interesting updates coming and keep you posted on our progress. Hopefully, I’ll be able to get one of those awesome fund-raising thermometers posted on the blog at some point. If you have or know of any friends, family, neighbors, churches, community clubs, small groups, pets, fishing buddies, people you met once at so-and-so’s...who might be interested in medical mission work in Zambia, let me know and we’ll add them to our list and harass them often. Thanks and stayed tuned...

Home

Well, we survived the flight and arrived safely in Tampa last Saturday. We've spent the past week spending time with family and recovering from the travel. We'll be staying in Brandon, FL until early May and then we'll head back to Kansas. Elissa is due with #4 (i think we're just going to call him that) in early April and should deliver at TGH. So, for now, I think we'll be shutting down the blog...I appreciate all of you keeping up with us in this way and I hope we'll have a chance to spend some time together soon.

17 hours???

That's how long our flight is tonight from Johannesburg to Atlanta. Hard to imagine doing that with the kiddos but the whole trans-Atlantic boat thing just takes too long. Were leaving Jo'burg around 9pm tonight (Friday), which is about 2pm your time. Please pray for us and the kids if you remember. Please pray especially that the the Benadryl will work. Love you all and see you soon!!

Twinkies

I always Vowed that I'd never wear matching clothes with my wife. I know, you may think it's no big deal, but it is. It could start rather subtly, with your wife Handing you a nice tie that just so happens to match the dress she's wearing to the party but one day you'll look up and realize you're wearing matching air-brushed t-shirts that you got together at the state fair and that have inter-locking hearts with your names written in them, Surrounded by Unicorns and puppies ... You see what I mean? Anyway, this weekend, for a very good reason, I was forced to break my own rule. We're headed home to the States in a few days and our friends at church gave us these nice clothes as a gift. We had a big party on Saturday afternoon with Elissa's friends from the praise team and not only were they very kind with their words, but they also fed us and presented us with the outfits. We were honored to sport then our get-ups to church Sunday morning and then to another party on Sunday afternoon. The kids received their matching clothes earlier in the week. So that explains the pictures. We thought you'd get a kick out of them. Seriously though, these last few days have been tough as we've started the process of saying good-bye to some very dear people and good friends. If you remember, please pray for us over the next week or so as we'll be traveling with the kids and leaving this beautiful place called Mukinge. Hope to see you soon!

Lessons from Pastor Mutumbwe

Yesterday, Pastor Mutumbwe, one of our local pastors and a good friend, stopped by the house to say hello. I happened to notice that he was carrying a small bottle of olive oil in a sack and so I asked him about it. It turns out that he and one of the hospital chaplains had spent the entire afternoon praying over one of his church members. They’d anointed her with oil and spent hours praying with her in her home. When he told me who it was I recognized the name right away because I had actually been caring for this nice lady on and off over the last few months. She’s a young mother of 5 children who is struggling with severe heart failure that started just weeks after delivering her last child (peripartum cardiomyopathy). She’s been in and out of the hospital and we’ve pretty much maxed out her medications but she’s just getting worse. On her last admission, it finally occurred to me to start praying for her. I’m embarrassed to admit that one, but sometimes I forget to do that until I realize that I’m in need of some kind of miraculous intervention.

So, when Mr. Mutumbwe told me where he’d been that day, I was really glad to hear it. While we were talking, Elissa brought him some tea and a little brownie. He was very thankful and went on to explain to me that he hadn’t eaten anything in a while. I thought that maybe that meant he hadn’t eaten since lunch (that’s what I would have meant) but it turns out that actually, he and the chaplain had been fasting for 3 full days in preparation for the anointing and the prayer for healing. Now, I thought I'd done well praying for her a few times and trying to sort out her medications. I even did a little extra medical reading a few nights ago just to see if I was missing anything that we could do to help her. But fasting for three days??? No, I’ve never done that for a patient. I’ve never done that period. Mr. Mutumbwe casually (in no way was he bragging) went on to explain to me that he does that kind of thing pretty often before he goes to pray with the sick members of his church. Now there’s a true pastor for you.

Eddie

Have you ever tried breathing through one of those tiny little juice box straws? That’s the equivalent of what “Eddie”, a sweet 6 year old little boy, was having to do when he came to Mukinge a few days ago with severe respiratory distress from a retropharyngeal (back of the throat) abscess that was almost completely obstructing his airway. It took all of his effort just to force tiny amounts of air in and out of his little body and you could literally see the desperation on his face. He was fully awake and obviously very aware of how sick he was. If you’ve ever seen this type of air-hunger in someone fully awake, you will never forget it. It is really one of the more frightening things we medical folks ever see.

Dr. Friend got Eddie into the operating theater pretty quickly and he asked me to come in and help out as he thought he might need an extra set of hands. Eddie’s mom stood beside him right up to the moment that we put him to sleep. She obviously knew things were bad (if not by Eddie’s appearance, by the way we were buzzing around getting set-up and the looks on our faces) and that there was some chance he wouldn’t come out of the theater alive. We knew it too and putting him to sleep to get this thing dealt with was scary to say the least. If you anesthetize someone, they stop breathing and you can’t provide for an airway, you’re in big trouble. Thankfully (really…thank you Lord), Dr. Friend was able to quickly drain this abscess and within minutes this little guy was breathing on his own with no more than a little oxygen given by mask. By the end of the day, he was off any supplemental oxygen at all. He spent a few more days in the hospital but was able to go home well a couple of days ago. I’ve said it before, but often the work here (especially on the medical/non-surgical side) is slow-going and not always so immediately gratifying. Sometimes it even feels like your laboring in vain as some folks just don’t get better despite all of the hard work. It’s not every day that we get to see such a dramatic recovery but we’re sure thankful for this one.

Name that baby

In case you haven’t heard, we’re expecting baby #4 in early April. We’re pretty excited to meet the little guy (we’re thinking another boy) but we’re struggling with guilt over our ever-growing carbon footprint. Actually we haven’t burned too many fossil fuels at all since our van was stolen in August and hopefully by the time all our many offspring are ready to drive, they’ll have those flying cars that run on solar power like in the movies. However, if you can believe it, we actually have an even bigger concern right now than the melting of polar icecaps…a name for the baby. Picking names isn’t easy and we are asking for some advice. So far this is all we’ve come up with (and Zach and Nate have had a lot of input):
1. Bob
2. Baby Bob
3. Bob the Builder
5. JoJo the Baby
6. Harry
….so far this is all Zach and Nate…
7. Amos—my pick
8. Anything that starts with “T”, because alliteration is cool
9. Something Old School/Old Testament, because that would be pretty cool too.
10. Zachary—yes, I know we’ve already used that one, but Zach said we could use it for the baby if we let him change his name to “Larry Boy.” I’m not wild about this one but I’m gonna keep it on the table just in case we don’t come up with anything by the time Baby arrives.

We’d love to hear your suggestions as you can see we need some help.

Loose Change

Heard enough about “change” recently? I just came across this the other day in G.K. Chesterton’s Orthodoxy, which was written 100 years ago, but found it incredibly timely. In writing about the “false theory of progress” he says…

It is true that a man (a silly man) might make change itself his object of ideal. But as an ideal, change itself becomes unchangeable. If the change-worshipper wishes to estimate his own progress, he must be sternly loyal to the ideal of change; he must not begin to flirt gaily with the ideal of monotony…The main point here, however, is that this idea of a fundamental alteration in the standard is one of the things that make thought about the past or future simply impossible. The theory of a complete change of standards in human history does not merely deprive us of the pleasure of honoring our fathers; it deprives us even of the more modern and aristocratic pleasure of despising them.

It’s also notable that making change our “object of ideal” deprives us of the ability to judge ourselves in the here and now. Or at least, it provides us with an overwhelmingly cheap standard. And maybe, just maybe, that’s the point of our fascination (dare I say worship) with change. It’s dirt cheap. As long as things are changing…then hey, we’re doing well. Don’t worry about the quality of our progress…Never mind how hideous the results may be…We’ll just keep on evolving. So, as a campaign slogan "Change!" is great (especially when times are tough), but let's hope and pray that we (and our elected leaders) haven't become so silly in our thinking that we've made it our highest ideal.

Flat Stanley Comes to Zambia

Flat Stanley recently came out to Mukinge for a little visit. He's pretty quiet but we were glad he came to see us. Hope you all are having a Happy Thanksgiving.

Charles

Doctors often lament the difficulty in giving patients the “bad news”, sometimes forgetting what receiving that news might feel like. Unfortunately, I end up having those conversations fairly often here at Mukinge as patients frequently come in with conditions that are just too advanced for any medical treatment we can provide. A few weeks ago I had one of those dreaded discussions with a man named Charles, who’d come to our outpatient department with end-stage, metastatic cancer. He was completely wasted, weighing only about 75lbs and clearly in the end stages of his disease. Our surgeon had performed a palliative operation on him just weeks before, but there was nothing more we could offer other than weak pain medicines. As I talked to him and his family about his poor prognosis, he sat stoically, listening and nodding his head occasionally. He had very few questions and agreed with me that “home based care” was his best option. I asked him about his relationship with Jesus (you can get away with that here) and he told me he was a believer. We prayed together for healing of his body, physical comfort and strength to handle the rough days ahead. Again, through all of this, he was completely composed and stoic.

As we wrapped up, his wife informed me that they had come from very far away (he was transported on the back of a bicycle for many kilometers) and she asked if I could help with transportation for Charles as he was too worn out for the long trip home. The translator then told him that I had recently been robbed and that our vehicle was stolen. At this news, Charles’ facial expression completely changed. He looked at me as though his heart had been broken. “Sorry, sorry mwane…sorry mwane”, he repeated over and over. I told him we were fine and that God had really protected us during the robbery but I was really uncomfortable talking much about our little incident in light of the conversation we’d just had about his desperate situation.

I haven’t seen him since but I don’t think I’ll ever forget our encounter. The fact that he was so sad for me says a lot about the Zambian sense of community, family and “bearing one another’s burdens”. The fact that I’ve grown so accustomed to giving the “bad news” probably says something about my own understanding of those things as well. However, I learned a few things from Charles that day and I’m confident that if I don’t see him again here in clinic or on the road, I will see him one day with our Father in Heaven.

Slithering rope

As I was about to hop into bed I saw something lying on the floor, just 2 or 3 feet between me and a good night sleep. We leave the bathroom light on for the kids and the little amount of light that was shining in my room that night just happened to be illuminating the area of the floor right beside my bed. In that faint light, I noticed a little rope-like something lying about three feet in front of me on the tile. Can you see where this is going? With all of the critters around lately since the rains have started, I thought I’d better make sure about this “little rope” before I moved any closer. Probably just something the kids left out, right? Well, no…unless the kids had been playing with a snake, which is possible I guess. When I flicked the light on, the little rope started moving away, slithering toward the shelter of the dresser. This time, no girly screams from me though, just action. I’ve come a long way in 20 months. I ran and got the broom and dust pan and was able to pin him down before he made it under our dresser. I then chopped him in half with the sharp edge of the dust pan, leaving snake blood all over the floor and leaving Elissa and I a little nervous about where he came from and whether or not there were more.

We examined him closely afterwards and he appears to be the same kind of snake we killed in the back yard a couple of weeks ago…a twig snake. They’re not very big but are still evidently capable of harm due to their hemotoxic venom. Not to worry though, in order to deliver enough venom to do much harm (i.e. to make you bleed to death), they evidently have to gnaw on you for while. Ah, that’s reassuring.

The Long Defeat

“I have fought the long defeat and brought other people on to fight the long defeat, and I’m not going to stop because we keep losing. Now I actually think sometimes we may win. I don’t dislike victory.... We want to be on the winning team, but at the risk of turning our backs on the losers, no, it’s not worth it. So you fight the long defeat.”—Dr. Paul Farmer

This quote comes from a book entitled Mountains Beyond Mountains, written by Tracy Kidder, which tells of the life and work of Dr. Paul Farmer, who has worked as a physician in the impoverished country of Haiti for many years. While I’ve not read the book, I had heard this quote before. Dr. Farmer was evidently a fan of Tolkien, who initially used the phrase “the long defeat” in The Lord of the Rings. Tolkien later said, “Actually, I am a Christian, and indeed a Roman Catholic, so that I do not expect 'history' to be anything but a 'long defeat' - though it contains (and in a legend may contain more clearly and movingly) some samples or glimpses of final victory." It seems Tolkien’s philosophical understanding of history, in this regard, was framed by his Christian worldview. I imagine Dr. Farmer’s is as well.

It seems pessimistic to look at the world this way and it certainly isn’t something that the guys with slick hair and fancy suits are preaching about on TV. In no way does it sound anything like that lie known as the “prosperity gospel” which is obsessed with “victory”. But while believing that the world is fallen and corrupt, and that consequently much of our labor in the fight against the evils of this world will be frustrated by failure, may sound pessimistic, there also seems to be a deep truth there that you just can’t ignore. More importantly, though, is the truth that, even as messed up as the world seems, there is a Creator God who is concerned over His creation. The Bible tells us exactly how concerned He is in the story of Jesus Christ. His ultimate victory over death and sin gives us hope in the midst of despair. And while it may be extraordinarily difficult to find meaning or purpose in the defeat sometimes (the poverty, corruption, disease, terrorism….), meaning exists nonetheless.

Ironically, as I was reading about the history of this short phrase last Sunday, I was called in to the hospital as an ambulance had arrived from one of our referring rural health clinics. When I heard which clinic it had come from I knew it couldn’t be good. This particular clinic is notorious for sending people to us too late and at ridiculous hours. The patients they send us are usually very sick, near death or already dead by the time they get here. On Sunday, it was no different. They unloaded two young women who were in need of immediate treatment. One lady was bleeding severely and in shock from a miscarriage and the other had eclampsia as well as a severe intrauterine infection. I was able to attend to both of them pretty quickly and am glad to say that they are doing well now (and miraculously, so is the little baby of second lady). On my way home that night though, I couldn’t help thinking about the battle here at Mukinge. At times, it feels like a long defeat...patients just keep coming and you don’t get the feeling that things are “improving” or that we’ll ever “win”. However, we do have days like Sunday, when sick people come in and get help they need and eventually return home to their families. To give up at Mukinge because it’s hard would mean there’d be no place for that rural health clinic to send anyone. There’d be no place for those two women we cared for this Sunday. No, it’s not worth it to turn our backs... And so we’ll keep fighting head on and we’ll trust God to give us what we need to keep going.

Venting

We've been waiting to get Emelyn's social security number for months now. The initial application was filled out over a year ago...the repeat application was filled out over 6 months ago because the first one was lost...I recently checked the SSA website (that's where I was frigidly referred by the people at the embassy) and the application tracking function requires you to enter the S.S. number for the application in question. Ummm.....How's that supposed to work as we don't have the number yet!!??!

I don't know about you, but I can't wait for the U.S. government to sort out our healthcare woes.

Termites, frogs and snake

Thought you guys would like this one:) We had our first rain in almost 6 months last Saturday afternoon/evening. So that triggered the flying termites to emerge from the ground (Biblical, plague-like swarms) the next evening...which triggered the sticky, slimy frogs to come out for their annual feast (also Biblical, plague-like numbers)...which triggered the snakes to come out for their feast! (thankfully we only saw one) This particular snake was in our back yard, having already had a few frogs (as you can see by the bulges in its body) but Daren took a shovel to it! Turns out that it was a Twig snake, which is highly venomous (hemotoxic)!, but also, thankfully, usually pretty shy. God watches out for us (as Nate and I were headed straight for it - I saw it in time to stop and flee!)...so keep praying for His protection, as I know that is the reason that we have been kept safe so far. From now on, we'll be staying indoors when the flying termites, frogs and snakes are out!

Baby Steps

A couple of posts ago I put up a video of Emelyn learning to walk. Well, we've all gotta start somewhere. Years ago, the docs at Mukinge were big-time hunters. Dr. Foulkes would evidently kill an elephant or a hippo every year to provide food for the hospital patients. Thankfully, now-a-days, the patients don't count on us to provide any protein in their diet...You know that if they did, they be in trouble. I've never really been much of a hunter....OK, that is a bit of an understatement...I've actually never shot anything. I did kill that little bat in my kitchen a few months ago (but he'd been asking for it), somehow though, that just doesn't compare to killing an elephant does it?

A couple of weeks ago, I was invited to go on a little hunting trip with Mr. Fumbelo, one of the men involved in the Mukinge HIV/AIDS outreach program, and a great guy. I took a much needed day off and with him to the game management area a couple of hours from here. Now, I didn't actually end up doing any hunting myself...I pretty much just went along for the ride. But man, what a ride. We spent the whole day and night out in the bush, driving around, walking a little and seeing lots of game. We saw impala, puku, warthog, and even a hippo. We didn't see any elephants but I did get tripped up in their massive footprints at one point. The men I was with ended up killing a nice sized puku, a small common duiker, and a guinea fowl. Mr. Fumbelo even let me skin the puku (see below--can you believe that?). After the animals were field dressed (I think that's what you call it) we boiled the kidneys and livers in a little pot over an open fire. When they were done cooking, it was time to go. Mr. Fumbelo then put those select goodies in a little bowl, placed the bowl on the front seat between us and we were off. We snacked on bits of liver and kidney all the way home. Not bad.

The whole experience was incredible. For me, just to get off the station for a little while was a big deal. Now, I'm thinking about getting a rifle and a license, so the big game better watch out.

Sabbath

I'm just starting to learn the importance/necessity of Sabbath. I've misunderstood and neglected it for far too long. I recently read a book some friends of ours sent out last year called "The Rest of God", by Mark Buchanan, and not only is it a good read, but more importantly, it has encouraged me to rethink what Sabbath is all about. We (like you too I'm sure) have been pretty busy here lately. It seems the work never stops. But God knows what we need. This past Sunday afternoon, a few hours in the hammock with a good book and the three cutest kids you've ever seen, were exactly what I needed to remind me of the overwhelming goodness and grace of God...which I think is what Sabbath is all about.

(thanks Neefs for sending out that book)

Watch Out!!!

She's walking now.