A Bug's Life

Most of my family and friends would know how much I hate bugs, bordering on phobia for some select species such as cockroaches. Truth be told, I wouldn't lose a night's sleep if the entire Class Insecta was exterminated (although I've been told it throws the ecosystem balance completely off centre, that mankind may be doomed etc. Whatever).

Anyway, the reason I mentioned it is because, ironically, they're everywhere here in South Sudan! They drop from the branches above or the ceiling into your hair, get in your food, and causes things to go literally bump in the night as the bigger ones bang on my room door in an effort to get to the light inside (in a spirit of denial, I just hide inside my mosquito-net-covered bed).

As for the pic, please observe the fly inside the black circle feasting on a newly excised HUGE breast fibroadenoma. The whole operation took place under ketamine sedation and without any muscle relaxation, so you can imagine how tricky it became at times. Which, as you can tell, means the surgical field is less than sterile for most of the procedure. I'm trying to figure out if there are ways to at least reduce the insect population inside the operating suite, if nowhere else!

As we celebrate the death and resurrection of our Lord Jesus Christ this Easter, let us remember how He made it possible for us to know God and be known by God.

1 Corinthians 15:51-58 "Behold, I tell you a mystery: We shall not all sleep, but we shall all be changed - in a moment, in the twinkling of an eye, at the last trumpet. For the trumpet will sound, and the dead will be raised incorruptible, and we shall be changed. For this corruptible must put on incorruption, and this mortal must put on immortality. So when this corruptible has put on incorruption, and this mortal has put on immortality, then shall be brought to pass the saying that is written: 'Death is swallowed up in victory. O Death, where is your sting? O Hades, where is your victory?' The sting of death is sin, and the strength of sin is the law. But thanks be to God, who gives us the victory through our Lord Jesus Christ. Therefore, my beloved brethren, be steadfast, immovable, always abounding in the work of the Lord, knowing that your labour is not in vain in the Lord."

What hope is there in life without the assurance of His salvation? O happy day, when we finally meet Him face to face, and be freed from this mortal existence! Truly, "to live is Christ, and to die is gain" (Philippians 1:21).

Of customs and culture or cultural customs

One of the first things I learned when I got here was how I would be mistaken by the local people for a Caucasian due to my fairer skin tone. Being of Chinese descent, I was a little annoyed and have set out to educate my colleagues on the difference, but sadly, to no avail (I was told, "you look the same!").

Another was to get accustomed to the shocked look on their faces when I inform them that yes, I am single, and yes, I don't have any children. And thank you very much, I don't have a problem with that (and generally don't have a problem, period)! It was similar to the experience I had when I served with YWAM in Papua New Guinea mid 2012; women my age would be on to their third or fourth child and any deviation from the norm was seen to be an aberration to be avoided at all costs!

One of the biggest difficulties for me, however, was in how the local culture dictates that women should always wear skirts or dresses. Back home, I practically lived in shorts, jeans or pants with the occasional foray into foreign territory for special occasions. I half-expected that from my aforementioned trip to PNG (over there, women in jeans were seen as prostitutes!). What I wasn't expecting was to have to don the same apparel at work in the hospital; nope, no exemptions for docs! Although part of that could be explained by how there seems to be no female doctors in the country. The pastor and I had a good laugh when she related how the kids from the orphanage came up to her on Sunday (after I was introduced to the church congregation) and asked how I could be a doctor when I wasn't a man! Anyway, that explains the pic above. Reluctantly, I can now be found in a scrub skirt (which I didn't even know existed) at the hospital.

As the wife of the (other) Aussie missionary doctor quipped, "if wearing a skirt means I can do missions better and not offend the local people, then I'll wear a skirt!". The Apostle Paul also eloquently elaborated on the same theme in his epistle to the Roman church:

Romans 14:15-21 "Yet if your brother is grieved because of your food, you are no longer walking in love. Do not destroy with your food the one for whom Christ died. Therefore do not let your good be spoken of as evil; for the kingdom of God is not food and drink, but righteousness and peace and joy in the Holy Spirit. For he who serves Christ in these things is acceptable to God and approved by men. Therefore let us pursue the things which make for peace and the things by which one may edify another. Do not destroy the work of God for the sake of food. All things indeed are pure, but it is evil for the man who eats with offense. It is good neither to eat meat nor drink wine nor do anything by which your brother stumbles or is offended or is made weak."

Indeed, the kingdom of God is not food and drink (regardless of what most Malaysians may think!) - or for that matter, clothes, a nice house, a good salary with a tidy sum for retirement, etc. An upside to all this? I've to say it's probably more comfortable than pants in the heat!

First day at work

The staff at His House of Hope hospital start each day with morning devotions. Today, the passage came from James 4:1-6 -

"Where do wars and fights come from among you? Do they not come from your desires for pleasure that war in your members? You lust and do not have. You murder and covet and cannot obtain. You fight and war. Yet you do not have because you do not ask. You ask and do not receive, because you ask amiss, that you may spend it on your pleasures. Adulterers and adulteresses! Do you not know that friendship with the world is enmity with God? Whoever therefore wants to be a friend of the world makes himself an enemy of God. Or do you think that the Scripture says in vain, 'The Spirit who dwells in us yearns jealously'? But He gives more grace. Therefore He says: 'God resists the proud, but gives grace to the humble.'"

The person who was sharing drew examples from real life; as mentioned in my previous post, South Sudan had only recently emerged from decades of conflict and violence. However, what struck me the most was his closing statement:- "God opposes the proud, but gives grace to the humble. So don't be proud, even if you're a doctor". That sure woke me up! All thoughts of self-congratulation of making it here evaporated at that instant. All the more potent that I was the only doc there (the other two were at some administrative pow-wow). I can't say that it was directed at me but I think I would be foolish not to take that to heart. One of the biggest pitfalls of missions is certainly the area of pride, likely stemming from a 'Messiah complex'.

Moving on to the nuts and bolts of the day itself...
It was interesting, to say the least. I felt like a medical student all over again! I basically shadowed the on-call GP and did not make any clinical decisions or perform any procedures, even if it was only a lowly cannula or IDC. So different from the hustle and bustle of my last job (neurosurgery at a tertiary centre). Rather disorienting as well as I had fully expected to be thrown into the deep end upon arrival. The on-call doc encouraged me instead to not focus on the medical side of things during my first three weeks here, but to 'soak up the culture' and concentrate on learning as much as possible of the language (Juba Arabic) and local customs before I leave on my short break. Entirely reasonable but frustrating at the same time; I forgot how disempowering it feels to only be able to watch!

The hospital was better equipped than I expected; it has a proper operating suite with huge UFO-like lights, a three-bed labour ward with obstetric ultrasound and CTG monitoring as well as a path lab and X-ray facilities. But, no biochem! The nurses/lab techs (the staff take the definition of multitasking to the next level!) are waiting for some external training (the actual machine is already ready for use). However, without an anaesthetic machine, the docs are limited to regional anaesthesia and ketamine for sedation. Even with that, they manage to do plenty of Caesarean sections, closed reductions, incisions-and-drainage, and the like.

E.g. today we attempted closed reduction of a supracondylar humeral fracture for a 10-year-old girl; unfortunately, the post-reduction X-rays didn't show much improvement so we'll probably make another attempt tomorrow. Decisions like this are based on two salient observations: the first, that patients here frequently present very late. Case in point, the picture above shows an 18-year-old boy with a mid shaft of femur fracture FOUR years after the initial complaint. The second, that most specialty services we take for granted back home aren't available in town (at times, in the country).

Praise God for
- Understanding senior colleagues
- Continuous improvements in health care delivery. E.g. the hospital has pushed the viable age of premature infants from 36 to 33 weeks with tocolysis, dexamethasone, NG feeds and home-made CPAP.

Please pray for
- More health care workers from both the local and international community to rise up and serve the people of South Sudan
- Wisdom and guidance for everyday clinical decision making, especially when we are limited in what we can offer

First post!

Hello from sunny South Sudan!

As most of you already know, I've decided to take this year off work to volunteer in a missions hospital in Yei, South Sudan.

Why and how?

It all came about late last year when I found out that I was out of a job...kind of. What happened was I didn't succeed in getting a critical care HMO (house medical officer) post as I had initially hoped. Most residents in my position would then apply for either a medical, surgical or general year instead. I saw it as an opportunity to further explore what I always had in mind when I entered medicine, i.e. missions. Having already been a part of three different mission trips (to India, Thailand and Papua New Guinea), two of which were medical in orientation, I was (I thought) ready for a longer stint!

I set about asking the different missions agencies around Melbourne how I could serve as a relatively new doctor and eventually ended up in Pioneers. I knew they had a good reputation in the field via a couple who were medical missionaries in Central Asia. Among the options given to me was South Sudan. My interest was piqued; I had been following the progress of the Republic of South Sudan through the mainstream news as well as newsletters from organisations such as the Barnabas Fund. Two decades of civil war, oppression, persecution and even slavery (as some claim) naturally marked out the newest country in the world.

To cut a long story short, I prayed and (I believe) God answered. Rather than getting what I wanted, He has given me something even better! The privilege of serving alongside our brothers and sisters in this fledgling nation and the chance of seeing His work among this precious people. God willing, I will be spending two-thirds of the coming year here to the glory of His name. But don't be surprised to see me back home as I will be taking trips back and forth to fulfill various commitments. Just in case you wonder where I've disappeared to, now you know :)

To find out more about Harvesters and His House of Hope, see http://hrtn.org/projects/#his

P.S. Regarding the photo, it's of the choir after service at church this morning. The lady standing at the right is our pastor, who also hails from Malaysia! Such a blessing to have a compatriot in this corner of the world.