Wrapping up

The countdown is on! We will be back home in less than 3 weeks now. It doesn't seem like 16 months since we came here together, but here we are!

We've entered a very lovely season here in Nepal, much, I'm sure, to the jealousy of those of you still battling snow and wondering if spring is ever going to arrive. The days are starting to get hot, but the mornings and evenings are very pleasant. It's sunny almost every day. We could actually use some rain to fill up our water tanks, as there is a severe water shortage at the moment. We have run out of water a few times in the last few weeks. Surgeries had to be cancelled over the weekend because of a lack of water. There are fights breaking out at the local water taps, where people who don't have running water in their homes go to stock up. Our large storage tanks are less than 30% full, even with getting tankers of water to truck water in and pump it into the tanks for us. Send the rain, Lord!

This is an issue every year at this time, and the solution isn't obvious. Trucking water in is expensive and not sustainable, as more and more people move to the community and also rely on the town's water supply. Our rainwater storage tanks are a great idea...when there is rain! In a couple months, the monsoon will start, and the tanks will be full to overflowing, and most will forget that we were in a crisis just weeks earlier. There are plans to build an even bigger rainwater storage tank (over 1 million litres of water), which will certainly help, although it still may not be enough during the dry season. Drilling for water may be a better long-term solution...assuming when we drill there is actually water to be found (which is not a guarantee). It is an issue that has very much been on our hearts and minds since we came to Tansen, and we continue to pray that God will make the way for us to have an abundant, clean supply of water, not just for the hospital, but also for the surrounding community.

As Jessica goes on maternity leave, the hospital is facing even more of a shortage of surgeons than there has been. This challenge is compounded by a new policy that medical licenses are not being granted to short-term visitors, so our usually steady stream of short-term surgeons coming to help is also not happening. She is leaving the department in the hand of 1 Nepali surgeon who has worked here for the last 3 years, but may be leaving in the next few months to go do further training, and 2 newly graduated Nepali surgeons who had some significant gaps in their training and are still learning the ropes. Please do pray for the surgical service and for provision of adequate coverage and support, both as we are away, and when we come back.

Our new Nepali surgeons operating together

Paul's building projects are coming along, though disappointingly, it is likely that neither of the 2 major projects will quite be finished before we leave. He's working hard to try to get them to a place where they don't need his oversight anymore. They're getting close, but we're still waiting on shipments of supplies that should have been here ages ago, as well as some other things that are outside of our control. He is sad to be missing out on the satisfaction of being able to survey the finished project, but trusting that it's all in God's hands. 

The nursing station in process

With the challenges and suboptimal circumstances we're leaving behind both on the surgical side and the building side, we're reminded that this is indeed not our work but God's, and that we need to hold onto things loosely, allowing Him to use as as He sees fit, but remembering that we are only a small piece of a much bigger puzzle. "Unless the LORD builds the house, those who build it labour in vain." (Psalm 127:1)

Our current plan is to be home for about 6 months, and then to return to Nepal in late October. The baby is due on July 11. Do please pray for us as we wrap up the last couple weeks here in Tansen for this season and prepare for the next chapter of our lives.

Leaving our comfort zone

With the increasing availability of specialists in Kathmandu who provide a reasonable quality of care, we try not to do things here in Tansen that are too far out of our realm of expertise and comfort when we can help it. These days, it seems that more and more patients are able to afford to go to Kathmandu when needed and pay for the care there, and so we often refer more complex cases there. However, Nepal is still a very poor nation, and there are many patients who could never afford to go to Kathmandu for care. In fact, their hospital fees here get paid for with charitable funds. In those cases we do the best we can, even when we are pushed beyond our usual scope of practice.

We have a visiting pediatric surgeon here right now who has been here many times before. He was asked to help with a little 6-month-old girl who was born with an encephalocele. For those of you non-medical types, that is where a portion of the spinal canal doesn't properly form, so there is a connection between the spinal canal and the surrounding tissues, and causes a leak of the fluid around the spinal cord and brain (CSF, or cerebrospinal fluid) into a fluid-filled sac outside the spine. This little peanut had a big mass, about 30-40 cm in size, coming out from the back of her neck, filled with CSF and connected to her spine and brain. Normally this would be operated on by a neurosurgeon, but this family was dirt-poor, and couldn't even afford care in Tansen, let alone go to Kathmandu. So we sent the MRI (which we sent her elsewhere for and paid for out of charity funds) to this surgeon over e-mail to get his opinion. Not being a neurosurgeon himself, and never having done a case like this, he consulted a neurosurgery colleague back home, who thought that this was probably doable, and told him how to do it.

We did the operation on Monday. Aside from some nervous anesthetists (and surgeons!), everything went well. The mass came off easily, and the hole in the spinal canal was closed off. Baby did well. We were pretty pleased. The next morning we heard that she was doing "Dherai ramro" (very well), and we were excited to hear that. But on rounds we noticed that her fontanelle (baby's soft spot on their head) was a bit full and bulging (a sign of increased pressure in the brain). She looked okay otherwise, though, so we just watched her closely. By later in the day her level of consciousness had deteriorated, and her breathing pattern was abnormal. We knew there was a potential for this to happen. We decided to remove some of the excess fluid with a needle and hope for the best. (We understood from the neurosurgeon that sometimes it takes time for the CSF balance to sort itself out after an operation like this). But the next morning she seemed worse. Now her right eye was not focusing, and she was even less alert. A quick SMS/e-mail consultation with the neurosurgeon and we decided the best thing was to send her to Kathmandu ASAP for something called a VP-shunt (where they insert a drain that drains the CSF into the abdominal cavity). If she deteriorated in the meantime, we could insert a temporary drain here in Tansen before sending her to Kathmandu. He told us how to do this.

Enter the next set of problems. In Kathmandu at the moment, all the doctors are on strike. In fact, this is nearly nationwide, though it hasn't affected us yet. I don't really understand all the reasons for it, but only true emergencies are being cared for. Everything else is on hold. Thankfully, one of our Nepali doctors here has a brother who is a pediatrician in Kathmandu. He contacted him, and arrangements were made that we could transfer this little one today (Thursday) and someone would care for her there. I think they even agreed to do the surgery for free. Social services agreed that we would cover the cost of her getting there and for any medicines she would need.  All well and good, provided she was still alive by today. (Did I mention that we have been praying up a storm over these past few days?)

As the day progressed yesterday, she grew worse and worse and we knew we needed to put this drain in or she was going to die. Unfortunately our anaesthetist doctor is away, so we only have nurse anaesthetists right now. They are very good and very experienced, but they were understandably nervous. Fortunately (??) for them, by the time we got her to the OR, she was so deeply unconscious that we didn't need to give her anaesthesia other than a bit of local anaesthetic. We then used a central line (special kind of IV) kit...expired, by the way...as a drain. When she got to the OR she was only breathing (gasping, really) maybe 3 times a minute, and I really thought she was going to die in front of us. (Insert more fervent and desperate prayer!) We got the drain in, and a LOT of fluid came out, obviously under high pressure. We waited....

After a few minutes, she started breathing on her own. Her heart rate normalized. She started making a few...just a few...movements. We all realized we'd been holding our breath and all started breathing a little easier. She was coming back to us in front of our eyes. It was amazing...truly miraculous! Over the next several hours she started moving more, opening her eyes a bit, and her pupils, which hadn't been reacting at all, started reacting. She wasn't totally awake, but she was getting there. This morning at 5 am she was put in the ambulance and they left for Kathmandu. We pray she made it there safely and that she is able to get the care she needs. We pray for a full recovery for her. We pray for her parents to enjoy many years with her. And most of all, we pray for her and her family to come to know the One who really has saved her life. We serve, Jesus heals.

Why it's hard to get things done in Nepal

Paul has been diligently working away at a couple different building projects here in Tansen. One of them is coming along swimmingly...the one that involves a dedicated team of skilled workers from Kathmandu who have a deadline after which they will lose money on the contract. He is more of a consultant for that job. The other project, the building of a new nursing station for the medical ward, is being done by the hospital workshop staff, and it isn't coming along quite so quickly. Paul gets asked regularly how much longer it will be before it's done. If he could keep workers there for more than an hour or two at one time, it would really help!

That isn't to say there isn't progress being made. A few months ago they were working at chiseling away (by hand!) the extensive rock that needed to be removed before the building could even start. Eventually someone figured out that if they held a blowtorch to the rock for a few minutes and then poured cold water on it the rock would break faster. It was a little frightening to see the fragments of rock start flying everywhere, but thankfully there were no injuries!

 Now the foundations have been laid, the walls built (the gaps are where large windows will go), and the roof trusses built, welded, and secured in place. The bathrooms have been tiled, and the tiles for the rest of the nursing station have been ordered. There remains the installation of windows, tiling the whole place, designing, building, and installing the cabinets, countertops, and shelves, as well as some other things. Theoretically this is doable by the end of April (when we come home for a few months...more on that later), but given the challenges along the way, we're not sure what will happen.

A typical day for Paul:
-9:30 am go down to the job site, where 2 or 3 workers are ready for the day's work. Instructions given, as best as he can give in Nepali, and work started.
-10:00 am - one or more of the workers gets called away for one reason or another. Perhaps they need to haul some oxygen cylinders somewhere, or repair a leaking pipe, or paint the house of someone who will be moving in the next week, or any number of other things. Paul is left with one worker (if he's lucky!)
-10:30 am - Paul gets called to a surprise meeting that could have been planned in advance, but advance planning doesn't seem to be a familiar concept here in Nepal. The meeting takes the rest of the morning.
-12:45 pm - Paul goes back to the building site to check in before lunch. The workers have left for lunch 15 minutes early, and Paul sees that the tiles, which had been going in straight while he was directly overseeing the tiling, are now uneven and crooked and need to be re-done.
-1-1:30 pm - Lunchtime, during which we often pray desperately for some kind of progress to be made for the rest of the afternoon
-1:45 pm - the workers come back from lunch (10-15 minutes late). Thankfully there are now 2 of them. The other one is busy with something else for the rest of the day. Paul explains to them that they need to redo a lot of the work they had done in the morning. The funny thing is, they KNEW the tiles weren't level...but maybe they thought it didn't matter.
-1:45 pm to 5 pm - Amazingly, they are able to focus on work for the afternoon (okay, so perhaps not so typical a day!), and so after removing the crooked tiles and replacing them, they are able to make some progress with the tiles.
-5 pm - Paul is explaining what the plan will be for tomorrow, when one of the workers tells him, "Oh by the way, I'm taking leave tomorrow." Again...advanced planning is a non-concept here. No wait...that IS advanced planning - they told him the evening before!

It is no wonder Paul's hair is greyer than it was when we arrived! Ideally, this project needs to be done before we leave in late April. Without his direct supervision, it may never get done. Pray that they are able to meet the deadline.

Why the deadline? Well, our exciting news is that we're expecting a baby in July, so we will be returning home for a few months to have the baby and adjust to being a family of 3 before coming back to Nepal, Lord-willing, in late October. Jessica is now into her second trimester and is doing well. We do appreciate prayers for this time of transition, and for a safe and healthy pregnancy and delivery.