April Ministry Update

A Lesson I Recently Shared with My Family

I am a detail-information man and I am starting to understand why. The details and information help to decrease the stress by putting expectations into perspective.

In the absence of details and information, I am left to think that everything is fine. And then, when things are not fine, I find myself asking a lot of questions in an attempt to not only understand why something unexpected occurred, but also how do I avoid the situation the next time around.

Interestingly enough, I tend to go after more information when something is my responsibility, and less information when it is not my responsibility. This is difficult at times, such as when I assume responsibility of something or when I pass off responsibility as the expectations are different.

It is, as I explained to my kids, why we study the Bible. We study with no expectations except to learn the details and information of God and our story. In learning this, we come to understand who He is, what He stands for, and who we are. We come to understand “God’s expectations” and our nature. In understanding God’s expectations, living life becomes less dramatic, but not necessarily less hard, as we aren’t focused on a specific outcome, but on the moment or the situation we are in. In this we know not only the importance of growing our faith, but also developing goodness, knowledge, self-control, perseverance, godliness, kindness and love. In understanding our nature, we understand that being disobedient is a lot easier than being obedient. My life is now easier as I have both a better understanding of God’s expectations and our nature.

For example, I have become a better father because, from the Bible, I understand that it is easier to be bad than to be good. I explained to the kids that I recognize that for them, getting up in the morning to exercise or to pick up their clothes and make their beds takes effort and is contrary to their (and our) inherent nature of not getting up in the morning, of leaving our clothes on the floor and not making our beds. No, I will not reward them for doing these tasks, but I will recognize the effort they have made in starting their day out in glorifying God.

Togo, HBB (Hôpital Baptiste Biblique) – “More Than Just a Hospital”

Soccer Ministry: Most Saturdays our day starts at 4:30 AM as our house starts to wake up. By 5:45 AM I am on the road to a church in Beme-Tutu to pick up some Togolese kids. We then drive them to the airfields at HBB where we spend time in Bible study (20-30 minutes) and then playing soccer (for an hour and a half). From there I am back on the road driving the Togolese kids back to home, cleaning up the van and water coolers, and washing the “jerseys”. In an attempt to develop relationships with the Togolese kids, during Bible study we are starting to have the kids present themselves by telling us a bit about themselves.

OB Meetings: We have been asked, by the medical director, to meet with the OB nurses to discuss two questions: 1. Would you, as the OB team, like to do more OB? 2. What do we need to be able to do more OB? We have been encouraged by the discussions and responses and are left to ponder the question of how to engage the OB nurses more. Can you say skilled-birth attendant training program?

Medicine meetings: I have volunteered to do a few lectures for the HBB trained nurses and PAs who staff the outpatient clinic. My goal is not only form a relationship with them, but provide an environment where we can review and discuss cases. My first few lectures will focus on determining whether a patient is sick through visual observation, vitals, physical exam and labs.

Carte-de-Séjour: We have completed our carte-de-séjour application to stay in Togo for the next year and are awaiting a response.

Worship: Here at HBB there are daily opportunities to participate in worship and fellowship: Sunday night services, Monday morning medical devotions, Tuesday morning PA devotions, Wednesday morning employee worship, Wednesday noon Bible study, Wednesday night prayer meeting, Friday morning medical devotions, Saturday morning bible study (soccer ministry), daily morning family devotions, and participation in a local national church on Sunday mornings. In considering all this, we are pondering the question, “is there such a thing as too much God?” In 1 Corinthians 7:33 Paul recognizes the divided interest of a married man such that he (the married man) cannot give undistracted service to Christ. On the other hand, we are challenged by Tozer who would spend hours each day with God alone. Where is the line for us? Logically, it seems the line for each person would be different and be based on where he/she is in life. Please pray for us as we work to find this balance.

OB and Medicine Call: Interesting cases and we are starting to pray with patients.

A young-teenage mom delivered a baby early at 6 months along. Birth weight of 1.8lb. Today the baby is weighing 2.8lb. We have had the opportunity to talk and pray with the mom and grandma a few times. Mom is struggling with becoming a mom and the change it has forced in her life;she wants to be in school. Grandma asked if there was a way we could cause her, the grandma, to produce breast milk so she could take care of the little one. Please pray for this young mom (Mama A) and the baby as they get ready to go home in the next few weeks.

First-time mom coming in for routine delivery. During the labor process she developed severe pre-eclampsia, and because she was not progressing in labor, we had to deliver the baby by c-section. Mom and baby were discharged 2 days later. Praising God for the health of mom and baby.

Got a call from clinic. A mom pregnant with twins with one baby already delivered and the other one was still inside mom and had come by taxi. Will I accept the patient? From a hospital point of view this is a difficult question because the hospital is short of man power and not in a position to accept all cases. From a medical stand point, it is an easy question. To send mom on to the next hospital we must ensure she is stable. To ensure mom is stable, we need to do an evaluation of her. Mom was admitted to labor and delivery and the 2^nd baby was delivered by c-section. Baby was floppy (blue, no tone, no reaction to stimuli and minimal respiration but he did have a solid heart rate) and needed some resuscitation. Baby was placed on CPAP, IV fluids, and antibiotics. I prayed for the baby. I wondered if he would survive. Mom and both babies were discharged 5 days later! Thank you Lord!

Saw a patient (with Dr S) complaining of shortness of breath. The patient was praying out loud, asking God to help him. He was afraid he was going to die. Per family, he started having chest pain about 10 days ago. He came to HBB. On physical exam, his vitals showed a blood pressure of 133/117 (normal is 120/80). Otherwise, and outside of a feeling of impending doom he seemed fine. Moments later, as we were discussing a workup, he “coded” (heart and respiration stopped). We attempted to resuscitate him with no success. We did not have a chance to pray with him. These cases are hard.

Participated in the care, including prayers, of a first-time young mom (Mama B) at 8 months. Medical evaluation showed multiple issues and concerns including anemia, elevated liver enzymes, elevated bilirubin, renal failure, and sepsis (all very concerning, possibly life-threatening conditions). We “sweated” the decision to not deliver right away giving the baby a bit more time inside mom. Shortly after we delivered her. I thought mom would not survive, but her labs normalized and her and the baby were discharged. During their stay the mom was encouraged in her faith in Christ. (Thank you so much to Dr.G & Dr.T, in the US, who took a lot of phone messages from us in this & other cases!)

Attempted to resuscitate an infant suffering from breathing issues. When I first saw her in the pediatric ward her pulse ox (oxygen level) was in the 70’s (normal >94). We attempted medications, oxygen and CPAP. No effect. She died 2 hours later. These are hard cases.

We participated in the care ofa young woman (from a nomadic tribe) who came to HBB with a breech (butt-first) delivery in-progress. Unfortunately, the baby passed away. Despite this, her friend made a comment about how well she was treated by the staff at HBB. We were able to be “Christ’s hands and feet.”

We participated in the care of a young teenage boy who came to the hospital unresponsive. Work up was concerning for malaria and a bacterial infection. We thought he was going to die. Seven days later he was discharged. Thank you, Lord, for the encouragements you give!

It is tough, to say the least, as I feel the weight of the decisions. And at times it feels like a very lonely process. I am being pushed in my understanding of medicine and often ponder, am I doing all I can. In the USA it is different. If, as a doctor, I am in a bind, I consult a colleague and in this the responsibility is, if not completely transferred, shared and the burden is partially lifted. In this I am recognizing not only that we cannot do as much here, but the importance of doing the little things well that we can . . . taking a set of vitals, doing a good physical exam and timely work up, using the medications we have on hand, and talking and praying with the patient. In this, the hope becomes not the result of the situation, but the situation itself, a showing of compassion and love in a time of need.

Family Update

Fred / Lydia / Noah / Nathanael / Noémi / Noll: We are finding our routine of family devotions, physical exercise, family and friends and work and school. Since arriving in Togo we have gone through the gospel of John together and are currently discussing Acts. Most mornings we are up doing exercise. Noah and Nathanael are involved in soccer with the Togolese most Tuesdays and Thursday afternoons, while all four kids (and Dad) play soccer with the Togolese on Saturday mornings and the kids participate regularly in the Sunday afternoon missionary-compound-sport game, whatever it may be (hockey, soccer, handball, ultimate frisbee, etc.). The kids are still communicating with friends in Sherbrooke, Quebec and Fort Wayne. Fred and Lydia are job-sharing a full-time position at HBB, learning to switch between managing the kids and working at the hospital, on a day-to-day basis. This process is a bit tough at times, as it is hard to let go of a sick patient in thought, and be able to focus on time teaching the kids and managing the home. School is progressing well for the kids as a whole. The schedule for the 3 younger kids will stay the same next year (Sept to May), with the MK school doing Bible, science, English and history, while they will be continuing to do year around, French, math, music and physical education at home. Noah’s grade 9 curriculum will continue with physical education at home and French, math, and music on-line as he is currently doing. In this, we are adding on new on-line courses (English, biology, history, Bible) from Liberty University, Potters School and Veritas Press. We are praying it will go well.

Prayers and Praises for:

Family

Prayers:

For the kids schooling, friendships and continued adjustments. (It’s getting easier. 😊)
Togo carte de séjour –for timely approval. (Application has been submitted, awaiting response so that we can stay in country for at least one year.)
Transitioning (still) in medical & OB work; wisdom in the decisions that are being made for the care of patients; and making evangelism a “normal” part of our medicine care.
Balancing family, community, and ministry life ‒knowing where and when God would have us to invest, both individually and as a family.
Wisdom needed in relationships (spousal, parenting & team).

Praises:

For one of the other missionary moms who is working with Noll in addition to her own kids for basics of reading and writing during the MK school.
For the friendships that our kids have started locally & the ones they have been able to maintain in Indiana, Michigan, and Quebec.

Togo, Hôpital Baptiste Biblique

Prayers:

Soccer ministry -that we’ll be able to start developing relationships with the kids who come. (One challenge is that French is their 2^nd language as well as ours. They speak one of several local tribal languages.)
OB meetings ‒please pray for continued wisdom in these discussions for both us and the hospital staff as the hospital decides if we can “open up” (not limit the patients we accept) OB; also pray that we are able to develop deeper relationships with the OB nurses and that it can become a true team atmosphere.
Mama A (teen mom with premie baby) -please pray for her to see this baby as a gift and not as a burden, please pray that the door will open for her to be able to return to school in God’s timing; pray for God’s love to be known and grow in her heart, as well as that of her family and the baby’s.
Mama B and baby (young mom with multiple problems on admission & delivery) -for full health of baby & recovery for Mom, and that her relationship with God would be strengthened as a result of her stay.
For the team, the vision/expansion project (wisdom & construction) ‒solar panels were just installed and the next group is starting on housing construction.
Encouraging teaching environment –wisdom and grace as we step forward to help lead discussions about evaluating patients.

Praises:

For the encouraging cases where patients shouldn’t have survived but they did, and open doors with patients, as some stay a short-time and others stay a long time.
Opportunities that are occurring in tough patient situations and the discussions with the staff that are happening afterwards.
For the different short-termers who have come out to help in the hospital and those who are coming to help in other ways (construction, sports, etc).