Contentment

Life in Tansen, as with anywhere else overseas, has its ups and its downs. You can't argue with the view we get from our window. We have a full-time house-helper, who not only does our laundry (by hand), cooking (all from scratch), and cleaning for us, but she is also a lovely lady. Nepalis in general are really lovely people, easy to get along with, very warm and friendly. We have a very comfortable house to live in (at least we do now that Paul has done so much work on getting it fixed up). Jessica's work is steps away from home, which means we usually get to see each other periodically throughout the day, and we can often eat lunch together. We have a great team of people here, and some good friends. And being here together is such a blessing...so much better than being here (or anywhere) as singles. We have much to be thankful for.

Still, there are many challenges. Water and electricity supply is somewhat sporadic. It is a rare day where the electricity doesn't go off at least once. We have to filter all our drinking water. Even with filtering, we still get sick regularly. We have each had Giardia (a GI infection that is very common here) - Paul twice, Jessica three times - in the last 4 months. Not to mention the wicked food poisoning that Jessica got just after arriving in Nepal in January. Even when we're not overtly sick, we still often don't feel well, and that tends to be most people's story over here. It takes a toll on your health, energy, and overall sense of well-being. Work is busy. There are many cases that are not straightforward, and even those that are take more work and energy here than they would at home. Why? A culture that is different than our own. Trying to do it in a language not our own. Not feeling well a lot of the time. Etc.

There are critters...spiders, cockroaches, snakes (not too many around here compared to where Paul was in Mozambique, but still an issue), termites, and other lovely things. The weather is not freezing cold in winter, but cold enough when you don't have heat inside and you get frostbite from washing your hands because the water is so cold. And in the summer it's hot, and soon it will be monsoon, during which we get so much rain that our 1 million litre water storage tank gets full within 3 days! You don't come to Nepal for the weather, except maybe in October!

Then the community we live in, as wonderful as it is, is small. We get bored of each other. And we say a lot of good-byes, since most people that come come at most for a few years, and then leave. So far in the last 3 months we've said goodbye to 3 families that had been here for 3 years or more! Thankfully, that's it for awhile, now, I think. Goodbyes are tough! We get a bit claustrophobic here in Tansen at times, because there isn't really all that much to do, and there aren't many options for going out or getting away. If you enjoy walking/hiking, living in Tansen is a dream, but that can get old after awhile. Other than that, there's not a whole lot to do, and boredom is an issue more often than we'd like. We watch a lot of movies and TV series (on my laptop). If you want to get away, the nearest place you can get away to is Pokhara, a 4-5 hour drive on a road that makes you so nauseous you really want to make sure you are truly ready for a break before you venture on that trip. Add that to being far away from friends, family, and all else that is familiar, and at times you wonder if you really would be better off packing your bags, heading home, and forgetting this whole thing.

It's easy to think that the proverbial grass is greener on the other side. But if we're always living for the next weekend, the next vacation, the next time we go home, the end of our term, graduation, our children growing up, retirement, or whatever, then we'll miss what God has for us TODAY. At a retreat we were at recently, the speaker said that "the only time that matters is now and the only place that matters is here." This doesn't mean that we don't plan for the future, or look forward to future events. But it does mean that we choose to be thankful for the opportunities God has given us today to love and serve Him, to experience more of His presence and His love in our lives, and to be thankful for all the blessings we already have.

We've been working on contentment this week. The apostle Paul tells us that Godliness with contentment is great gain. He also said that he had learned the secret of being content in any and every circumstance. You don't need to do an extensive study on Paul's life to know that he didn't have it easy! Shipwrecks, beatings, hunger, cold, tiredness, being stoned, etc. (Makes our life here in Tansen look pretty cushy, actually, but that's beside the point). He learned that he could do all things through Christ, who gave him strength. This is true for us, too. God has called us here, and that is far more important than weighing the pros and cons of staying or going. We know that where He has called us, He will give us not only grace, but also joy as we do what He's called us to do.

And really, in the midst of the challenges, we are very blessed. We may not be able to go out for breakfast, or to Starbucks (or Tim Horton's - take your pick!), or out for a nice dinner. But we've been learning to make breakfasts that we'd say are worthy of a restaurant, and we love our weekend breakfasts together. We've also figured out how to make bagels and even some version of cream cheese! We make our own lattes, and other nice coffee. And our most recent endeavour was creme brulee...yum! It's been fun to experiment, and fun to enjoy nice food that we've made with our own hands.

Paul has dreamt of having an orchard/vineyard for some time now. While we're not sure if this will ever happen (at least on this side of eternity), around our house is a plum tree (currently full of yummy plums), an orange tree, a peach tree, and an apple tree! Our didi is currently making plum jam, since we have no way of eating all the plums, even after sharing them with many others. We grow vegetables in our garden, and we're getting some fencing ready to plant grapes in a couple months when the season comes. So we have our own little orchard here, and we haven't even really had to work for it. What a sweet blessing from the God who knows the desires of our hearts and who loves His children!

So we're praying that in the midst of the challenges, we would learn to rest in a place of contentment, knowing that God has called us here, and that sooner than we'd like to think, our time here will be over. May we not miss the joy of embracing TODAY, with all its joys and challenges, and may we be content whatever our circumstances, for that is great gain.

Outside the hospital

Most of what we've written so far has been about the work in the hospital and on our house. All of which still continues, of course, but there is more to life than work...

Pokhara

We spent a few days in Pokhara, a place about 4-5 hours from here, last month. The worst thing about going there is the road there and back, which is very twisty and not so nice for those of us prone to motion sickness. But since there aren't really places nearer than this to go to get away from Tansen, people tend to go there relatively frequently for a break. There are lots of restaurants to choose from, unlike Tansen where we have 1. There are places to shop for some of the necessities that you can't buy here in Tansen. There's a lake where you can go for a boat ride, walks you can go on to see the sunrise (if you're so inclined), paragliding (not for me, thanks!), and other opportunities for R+R. We had a great time away, and came back rested, and laden with supplies and treats.

Chitwan

Last week we went to Chitwan, also about 5 hours from here, for an expatriate retreat. Unfortunately we didn't enjoy this as much, as it was HOT (43 degrees celcius!), and Jessica got sick with strep throat and was quite miserable for a few days. But we did get in an elephant ride. Chitwan is the place in Nepal that is known for animals...tigers (supposedly, though we didn't see any), rhinos, elephants, crocs (yes, we saw a couple), and lots of birds. There is a "jungle walk" you can go on, but we were told you have to be able to climb a tree in an emergency (i.e. if a tiger comes along), so we opted out of that experience!

Tansen

Although the best way to get a break is to leave Tansen, there are options here, too. We certainly don't lack scenery and nice places to walk. We also recently enjoyed a very short visit from some good friends from Canada. Their arrival marked the inauguration of our spare bedroom (below), which was the last room of the house to be finished (we finished setting it up late the night before they arrived). There are still a few small projects Paul is working on inside the house, but the majority of the work is done, and we love our home. We especially love that we have a verandah that gets sun during the morning but shade in the afternoon. It looks out at the Himalayas (when you can see them), and is a really sweet spot to sit and enjoy some rest....and homemade lattes!

While there are options for R+R, the work here is busy and with all the demands and requests that come from many different places, we do find that we get tired. Please be praying with us that we would be able to find a good balance between work and rest, and that we'd be able to set boundaries effectively.

This and That

First things first: Gopal is doing much better! Every day he improves a little bit. Today he was walking, eating, sitting up, and answering questions. He eventually got overwhelmed answering questions and got tired, but overall he is doing amazingly well. I love watching his mother with him. She is thrilled to be getting her son back, and we are thrilled for her! Thanks to those of you who have been praying for him.

On the burn ward, we have had a few successes recently. I did a skin graft last week on a lady in her 40s who has been with us for over a month now. We took the dressing down the other day and the graft has taken beautifully. It was such a relief to finally see a nice result after a skin graft - we've had so many failures lately. She still has one more grafting operation to go, as her burn was so extensive we thought it would be better to do it a little bit at a time. We pray she does well after this second operation, too.

Lest I start thinking I have some magic touch when it comes to skin grafting, the baby whose dressing I took down today to look at the graft for the first time didn't do so well. Part of the graft has taken, but a large portion of it is infected. So on we go.

In other news, we have moved into our house, finally! We are currently living out of the bedroom, bathroom, and kitchen, as the living room is still in process (as you can see in the photo, below), but we're getting there. We should be into the living room by next week. It's nice to finally be in our house, and despite the chaos of ongoing work, we both feel like we've been able to settle into more of a routine here, and that is really nice.

This past week there has been a fair here in Tansen, complete with very loud music, crowds of people, booths selling things, a magic show (which never seems to have actually been shown!), some kind of circus dome where motorcycles and taxis drive around and around like crazy (amazing no one has been killed...some people around here call it the "dome of death"), and some very old rickety roller coasters and a ferris wheel. We did go to check it out, but opted to stay on the ground! Not sure about safety standards here in Nepal. We did enjoy some cotton candy, though!

This weekend we are off to Pokhara, a town about 4-5 hours away, for a break, and to do some shopping for things for the house that aren't available here in Tansen. [As a side note: It is amazing how much we've been able to find here, with a bit of looking. Paul knows the bazaar better than anyone by now, I think, at least when it comes to plumbing, paint, electrical, and other construction materials.] We're looking forward to a weekend away. Please pray for safety for us as we travel there on Friday and back on Monday. The roads are quite dangerous and there was a serious bus accident just this past week (bus rolled over and fell 300 metres down). Mind you, it didn't help that the driver was drunk! We have one of the hospital drivers taking us, and he is very careful...but we'll still take all the prayer we can get...

Gopal

Pray for Gopal, a 7-year-old boy who had a bad fall several days ago, resulting in a severe head injury. He had bleeding in his brain and was unconscious. One of his pupils was "blown" (which is medical speak for the pressure in his head was too high and his life was in danger). One of the other surgeons here took him for emergency surgery early in the morning to evacuate the blood and try to take the pressure off his brain.

He survived the first 24 hours, though he didn't seem to be showing any signs of regaining consciousness, and we were still quite concerned for him. We started praying with his family and praying for him. Many prayers are going up for him. It seems like each day he's getting a little closer to waking up. His pupils are now just about equal in size (meaning the pressure and swelling in his brain has significantly decreased). Today he opened his eyes twice, not fully, but he definitely opened them. He also has been crying when we do things that hurt him, again an improvement from making no sounds at all. Today as we were washing out a wound on his arm (he also has a very severely broken arm), he actually said, "Mommy" in the midst of his cries.

Here at Tansen hospital our motto is, "We serve, Jesus heals." I have been very aware of this lately as I've cared for and operated on many patients who were close to death, and as we've been praying for them, they've recovered, despite being very sick before and after surgery. I wish I could say this happened with every patient. There are others that we pray for who don't survive, like so many of the burn patients I wrote about last week. I don't have answers to the "Why" question, but I do know that Jesus heals, and we're praying that He heals this little boy, so that he not only wakes up, but wakes up and walks out of here with normal neurological function.

Where we live

Not too much to say at the moment. Things on the burn ward have quieted down...mainly because almost everyone has died. Paul has been working on our new house to get it ready for us to move in next Wednesday. He is keeping his workers amused up there as he liberally uses the few Nepali phrases he has learned so far. He definitely brings a lot of smiles to a lot of faces :)

We thought for today we'd share some photos of where we live. We certainly are blessed with beautiful surroundings, especially when the weather is clear. It's not hard to be reminded of God's greatness living in a place like Tansen!

On a clear day you can see the Himalayas off in the distance. We live in the foothills.

This was taken just outside our new house. You can see the mountains from both our bedroom and living room windows!

The "White Lake," as it is known, can also be seen from our house (though this wasn't taken from our house). We live above the clouds!

Not scenery, of course, but I couldn't resist. This kid wouldn't stop looking at his X-rays. A budding doctor, perhaps?

Burn ward - Part 2

The reality of caring for badly burned patients is that it is discouraging work with a very low success rate, especially in the third world. But even at home infection often gets the best of them. Here is an update on the patients I wrote about in the last post:

Died yesterday: The 18-year-old girl, who was badly burned by fire 3 days after her wedding. Her husband had stood faithfully by her throughout the whole ordeal. What will he do now?

Went home after almost 2 months in hospital - disabled but alive: The baby whose feet and legs were burned by fire such that all the toes of one foot were amputated and some of the toes on the other foot were, as well. He underwent 2 skin grafting procedures, and even after the 2nd one not all the skin had taken, but he'll be okay and his wounds are small enough now that they'll heal on their own. His mother doesn't look more than about 18 years old.

Died the day after she received the news that her 2nd skin graft had failed: The young woman who had 2 skin grafting procedures and who screamed every time her dressings were changed. When we looked at her wounds after the 2nd operation, we saw that this one had also failed and she would need yet another operation. The discouragement and despair was evident both in her face and in her aunt's, who is the only one there caring for her. She had already been in hospital a month.

Died: The woman in her early 50's who, after finding out that her 3rd skin graft procedure was yet again a failure, lapsed into unconsciousness.

Went home to die: The man in his 50's who showed up one month after being badly burned in both legs? The burns were so deep that trying to operate and remove the burned tissue would result in not enough leg muscle or tissue for him to walk. We recommended that he have an amputation high up on both thighs, just to save his life. He opted to go home, because at least he could walk. It's only a matter of time before infection gets the better of him.

Still alive, but his skin grafts failed twice. His family wants to take him to Kathmandu - they're freaked out by all the people dying around them: The young male athlete in his 20s who begged us to make sure he can still do his athletics after his operation. His legs are so badly burned this is very unlikely. He had 2 failed skin grafting procedures.

Went home and should recover without disability: The young woman who, in the midst of no electricity in her house, accidentally sat on a pot of boiling water instead of her chair. Fortunately her burns are pretty superficial.

Both died this week: The 2 woman whose burns were so extensive that we are only treating them palliatively (pain control, fluids, and pastoral care). Actually, one of them seemed to be doing so well that we decided to start treating actively. We started doing dressings in preparation for her to go to surgery soon, and then she died yesterday.

We decided to treat actively. Took her to OR and she died the next day

: The woman with 40% of her body surface area badly burned from her sari catching on fire. Our usual cut-off in deciding whether to actively treat these patients medically versus palliatively is 40%. She was right on the cusp. 

Yesterday after rounds, when I discovered that 3 more of our patients had died, I went home and wept. Even as I write this, there are tears in my eyes. I guess maybe you get used to it after you've cared for burn patients for awhile, but maybe not. At any rate, this is my first real exposure to multiple severely burned patients, and it seems tragic to me!

As I process it all, I realize that the tears are good, because they mean I'm still a human being and I haven't become hardened by it all. And I hear Jesus saying, "I make all things new." We may not see it here in this life, but He promises a day when He will make all things new, and He will wipe away every tear from our eyes, a day when there will be no more death or mourning or crying or pain, because the old order of things will have passed away. That is the hope that we have when we know Him and trust in Him.

I don't know if these patients found that hope and life or not. I did start to pray for each of them in the name of Jesus in my faltering Nepali every day. It was something I felt God was prompting me to do. I guess I'd hoped that His response would be to bring physical healing, but we didn't see that. But maybe there was a more eternal reason I was to pray for them. I pray that through their time here, they did find Him. Only He knows.

 Reminds me of a photo I took last year of what looked to me like a window to heaven through the clouds. As I looked at it, I thought, "Now we see in part." We don't know or understand why things happen they way they do, but one day we will understand fully. And in the meantime, we hold onto the One who is good, who knows all their names, and who holds all things in His hands.

Burn Ward

Which burn patient shall I tell you about?

The 18-year-old girl, who was badly burned by fire 3 days after her wedding? Her legs were so badly burned that even if she does walk again she will be severely disabled. Her new husband stands faithfully by her. Thankfully her skin grafting procedure seems (so far, at least) to have been a success. But the dressing changes sure are traumatic for her!

The baby whose feet and legs were burned by fire such that all the toes of one foot were amputated and the toes on the other foot may have to be, as well? His mother doesn't look more than about 18 years old.

The young woman who has had 2 skin grafting procedures already and who screams every time her dressings are changed? Yesterday we looked at the places that had been grafted previously and it seems they haven't worked, so she's going to need yet another operation. We pray this one works. The discouragement and despair was evident both in her face and in her aunt's, who is the only one there caring for her. She's already been in hospital a month.

The woman in her early 50's who, after finding out that her 3rd skin graft procedure was yet again a failure, lapsed into unconsciousness, and hasn't awoken since?

The man in his 50's who showed up one month after being badly burned in both legs? The burns were so deep that trying to operate and remove the burned tissue would result in not enough leg muscle or tissue for him to walk. We recommended that he have an amputation high up on both thighs, just to save his life. He opted to go home, because at least he can walk right now. It's only a matter of time before infection gets the better of him.

The young male athlete in his 20s who begged us to make sure he can still do his athletics after his operation? His legs are so badly burned this is very unlikely.

The young woman who, in the midst of no electricity in her house, accidentally sat on a pot of boiling water instead of her chair? Fortunately her burns are pretty superficial.

The young girl whose skin grafts actually were a success, and who will be going home soon?

The 2 woman whose burns are so extensive that we are only treating them palliatively (pain control, fluids, and pastoral care)?

The list goes on! At last count, there were 17 burn patients in our hospital, 12 of whom have major burns. No wait, 18 and 13...one more came in yesterday with 40% of her body surface area badly burned. Our usual cut-off in deciding whether to actively treat these patients medically versus palliatively is 40%. She is right on the cusp. Neither decision is an easy one. Nobody here can remember a time when there were so many burn patients in the hospital.

Most burn centres in the west will only accept up to 5 patients before they close and won't accept any more. Most burn patients are on ventilators because of the amount of pain medication they require to be kept comfortable. They are given complete anaesthetics (put to sleep) for every dressing change, as least initially. The resources in terms of OR time, nursing time, doctors skills, and just emotional energy that are needed to care for these patients are significant. Here in Tansen patients are given a small dose of morphine (if that!) before their dressing changes, and even the strongest of them screams in pain. It's really heart-wrenching and emotionally draining. And there are still so many of them who need surgery, and often who need several surgeries before all is said and done. The ones who seem to be doing well initially often experience setbacks, which sometimes result in much longer hospital stays, and sometimes claim their lives.

It's draining and exhausting. We're so thankful for a German plastic surgeon who is here at the moment to help with the load and to share his expertise. But he's just as overwhelmed, and he's leaving on Friday.

It's easy to become discouraged, or to develop a callous heart towards these patients and this situation. It's a defense mechanism to keep from getting burned out (no pun intended) from caring for them. But they have nowhere else to go. I am continually reminded that I need to just focus on the one in front of me, take them one at a time, and approach them as individuals loved by Jesus, not as "another burn patient." I am continually reminded of my absolute dependence on the Lord for strength, grace, wisdom, and endurance. He promises that His grace is sufficient and His power is made perfect in our weakness.

We pray that in the midst of these situations these patients and their families will experience the love that only Jesus can give, and that He would show Himself to them, both in life and in death. And we pray that His light would continue to shine through us as we do our best to be His hands and His feet, and to communicate His heart, to them.