The Gift of Numbness

I wish I could explain it. I wish I could somehow wrap it up with words and convey the height and depth of the joys, the frustrations, the griefs I experienced while in Africa. But it's impossible. Because I have yet to fully feel and know the weight of what I've seen and known. Pieces of it seem like a dream, one that I wish I could spend the rest of my life in, and the other parts seem like my worst nightmares become reality. The daily contrast of light and dark, joy and pain, life and death.

I spent most of my time in Zimba feeling a strange sense of numbness. Meg talks about it here and in a similar way, I wrestled with my lack of feeling and what it meant. Could it be that my heart somehow had grown calloused so quickly? I didn't cry more than five tears the entire time I was in Zimba... maybe it was just too much to process, too heavy to bear, too much work to get done? It was never a matter of detachment or apathy. I deeply connected with the patients, my heart sank in their struggles and overflowed in their victories but the degree of emotion was dampened and the outward expression remained stagnant. 

As I left Zimba on Saturday, the wall that had been guarding my heart for 5 weeks crumbled and I finally began to grasp the reality of the things I’d seen and experienced. Sitting on the plane, the tears started flowing and couldn't be stopped and I grew thankful for the gift of numbness, like maybe it was part of God's grace so that I could do the work that needed to be done. To love those who hadn’t been loved well in a while, laugh with those who hadn’t laughed in a while, provide hope to those who had probably felt the hope fade long ago and couldn't see past the gravity of their condition. They looked to me for strength and encouragement and without the strength and grace of a mighty God, I would have been crushed beneath the weight of what I faced each day. 

So I think the numbness was a holy protection from my own emotional instability so that the King of Glory could use a wreck like me. Because the glorious thing is that Jehovah God does not change with the rollercoaster of my feelings. He is always good, never swaying, from beginning to end the same. He makes life out of death. He shines light in the darkness. He makes beauty from ashes. He gives hope to the hopeless. He never forsakes, never abandons, never tires, never suffers defeat. He has overcome the world. 

Homecoming

No, I'm not talking about my return to the States, though it is right around the corner. 

Do you remember sweet Esther? Esther was my patient in the female ward two weeks ago. She was a joyful presence in the ward and I looked forward to seeing her face everyday. At 89 years old, she has doubled the life expectancy of most Zambians. Her heart was failing, her legs were swollen, her abdomen was sunken in except for the pulsatile mass that was protruding, her blood pressure was rarely stable. I worried about her condition every day she was in the hospital but finally we had her stabilized and she was able to go home. I was ecstatic to watch her walk, yes walk, out of the hospital on her own, though she was literally at a 90 angle because her spine was so badly hunched. Precious Esther. 

Monday afternoon, around 4:30, as I was trying to finish up the long line of patients waiting to be seen in OPD, Meg rushed into my exam room. Esther was being wheeled into OPD. 

From the second I placed my stethoscope on her chest, I knew she had deteriorated since I'd discharged her. Her lungs were congested, her heart rate was erratic, her legs had filled back up with fluid. We wheeled her over to casualty and hooked up the cardiac monitor where my fears were confirmed. Her heart was contracting irregularly and she was getting progressively weaker. I admitted her to the female ward that night and hoped her condition would somehow turn around. 

I stopped by to check on her yesterday morning and she was awake and feeling better. Her chest X-ray showed progressive pleural effusions and her oxygen saturation had dropped but she was hanging in there. As Dr. Joan came home from the hospital last night, she assured me Esther's condition was unchanged. 

I arrived to the hospital this morning and headed straight to OPD. I quickly got word that Esther had begun vomiting and was not doing well. I walked over to female ward and was relieved to see Tanner and Dr. Joan doing rounds standing by Esther's bedside. Esther was awake and talking so I went back to OPD to work. Around 11:30, one of the interpreters came to my exam room to tell me Esther had taken a turn for the worst and passed away. It literally took my breath away.

The heartbreak of losing another patient. It's always gut wrenching. It happens too often here, at least once or twice a week and it never becomes normal or gets any easier. Last week, three of my patients from the male ward died. One of which I was standing over when he stopped breathing. I listened to his heart as it stopped beating. There was nothing that could be done. His family looking on, watching me, hoping for a miracle. 

Esther told Tanner this morning that she was feeling well after a long time of prayer and confession. She was in good spirits and at peace. Her faith was strong.

Two weeks ago, I was rejoicing that Esther was going home from the hospital and while my heart is weary and grieving, today I rejoiced that Esther was truly going home. 

Hope remains. 

May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit. Romans 15:13

These Days

The days are moving so quickly and this has just not been the best week here in Zimba. But instead of going into detail of the Montezimba's revenge that attacked my stomach today along with the heaviness of the male ward that seems unending and risk becoming the most depressing blog ever, I'll just share some non-depressing facts and photos about my time here so far.

Zambians can't seem to figure out their "R"s so no one can say my name. After 5 weeks, I don't think twice when the patients yell out, "Dr. Lola, Dr. Lola" as I walk past. 

This is my room. Bottom bunk is mine and unless a visitor comes through town, its just me. Complete with a zebra throw rug and decorative mosquito net. Glorious. I shower with a gecko every day. Not sure if its the same one or if they take turns but there is always a lizard somewhere in my shower and somehow it doesn't bother me at all. When in Africa...

This sweet baby at church made me so happy. It's not a trip to Africa without a Little Mermaid appearance.
Right, Marisa and Emily? 

Africans are born to harmonize. I am constantly amazed at how perfect the harmonies are in chapel or church. Effortlessly, not a note out of tune. For instance, choir at Sunday church:

Earlier this week, while doing rounds, the TV in the male ward was blaring some Zambian soap opera when a commercial started playing the country song "God is great, beer is good, people are crazy." I couldn't help but think of home in Nashville. Thankful for God's reminder & sense of humor. 

One of my favorite people here is a 13 year old boy named Cholwe. He is quite the character and we've become good friends. He is the older brother to Caleb, 4. He is the sixth grade choir director at school, loves English and Science, and is a master at photography. Last night, he knocked on our back door and with his hands behind his back, told me he'd brought me a gift. Grinning from ear to ear, he presented me with a giant African toad. Boys.

Speaking of Cholwe, he and his little brother Caleb snagged my IPhone and left some pretty killer videos behind. I mean, seriously, it does not get better than this.

I leave for Safari tomorrow. Meg, Tanner, and I will be headed to Livingstone and then on to camp in Chobe National Park in Botswana. Like literally camping in tents, in the middle of lions and elephants and giraffes. It's going to be epic.

Half Way

Today marks the half way point here in Zimba. Time is flying too quickly. As I looked at my calendar last night, the reality sank in. Half way. I should be longing for the familiarity of home but mostly I'm craving more time in this unfamiliar new place, with its glorious sunsets, its beautiful people, its sweet simplicity. 

I can't describe it, maybe its the quiet, maybe its the time to disconnect, but something in the deepest part of my being comes awake when I am in Africa. Unlike any other place, I experience a freedom here, the ability to breathe more deeply, a clarity of mind, and a peace that only confirms what I felt so strongly in Uganda... this is what I was created for. 

Even in the most frustrating moments when the X-rays are blurry and the labs are missing and the roosters are crowing every hour of the night, I haven't wanted to pack up and go home. Even in the loneliest moments, I truly haven't been homesick. Evidence of God's grace and the interceding of my people back home. Certainly not of anything I'm capable of. Thankful, so incredibly thankful. 

My day at the hospital ends with a walk home to the mission house. A daily display of God's splendor. Fields of dried corn stalks, sun peaking through the trees right before the sky burns shades of orange, then deep reds, then bright pinks. The hospital with the small chapel behind me finally quieting from the day's normal chaos. One day closer to Nashville is one day less to soak up Zimba. The two halves of my heart. Pray that time slows down. 

Hope Remains

This week at the hospital was too much to describe with words. I suppose most of my experiences here are. It seemed each patient had a tragic story of unrelenting sickness, abandonment, and hopelessness. 

I was in charge of the Female Ward and in five days, we admitted three suicide attempts. Three women caught in the enemy's lie that all was lost, this life was not worth it. Each one had a different story but all three had the same sad, lifeless look in their eyes, eyes searching for a glimmer of hope. 

Two more patients were admitted last week with severe sickness and neither were improving. We had done all we could do, used every antibiotic in the hospital (which is only 3 or 4 on a good day), ordered every lab available (which is as basic as it gets), prayed for a miracle, and were now just waiting. 

The Female Ward was packed all week & by the end of the day on Friday, I was physically, emotionally, spiritually exhausted. All I wanted was rest. All I could think of was those patients. I could feel the weight of it.

"Come to me, all you who are weary and heavy laden, and I will give you rest." Matthew 11:28 

I woke up Saturday morning two hours before my alarm and couldn't go back to sleep. I made some coffee, sat outside on our front porch, prayed, and waited for the sun come up. And like the sun creeping over the wall of the mission, I felt this hope welling up in me. I could feel the weight lifting. 

I headed over to the hospital at 8am for morning rounds and walked into a half empty ward. Many of the patients had been well enough to go home. Praise the Lord. Like Esther, who had been there for a week with congestive heart failure and gastroenteritis. Such a sweet spirit. 

Irene, the patient who had been the most critically ill, barely able to move or communicate the day before, was not in her bed when I walked by. As I turned around, her mother was pushing her into the ward in a wheelchair. She was alert and sitting up on her own. 

Two of the women who had attempted suicide were discharged with the remaining patient doing remarkably well. I had the opportunity to spend time with all three, holding their hands, praying for them, watching the life return to their eyes. Hope. There is always hope.

But I will hope continually & will praise you yet more and more. My mouth will tell of your righteous acts, of your deeds of salvation all the day, for their number is past my knowledge. (Ps 71:14-15) 

I left the hospital feeling like I was able to take a deep breath for the first time since Monday. We all met back at the house, packed up the van, and headed to Livingstone for a day out of Zimba. 

Victoria Falls is one of the seven natural world wonders and I hope some day you get to see it with your own eyes. I promise pictures and words don't do it justice. We hiked, climbed, explored, and got absolutely drenched. We hung out with Zebras, drank Coke Zero, and watched the sunset over the Zambezi River. It was a much needed break. 

Hope is not lost. Hope remains. 

Rejoice in hope, be patient in tribulation, be constant in prayer. (Rom 12:12)

You may have noticed, I am not a great photographer but guess who is. This guy. If you want to see more photos of our adventure, check out his photojournal. 

New Day, New Breath

Today has been exhilarating and exhausting. I was assigned to work with the surgical team and there definitely was not a dull moment. 

It started with rounds in the female ward with Dr. Joan then I headed over to OPD to find 100+ patients waiting to be seen. Classic Monday. Tanner was making the best of it and seeing patients as fast as he could. I jumped in and saw a handful of patients before being called by the surgery guys. Dr. Greg Alty is an American surgeon working at Zimba with his son for a month doing pretty much any and every procedure you could imagine. 

Surgery clinic basically entails reviewing each patient's case file, physical exam, determining if the patient needs an inpatient or outpatient procedure, and scheduling the surgery or doing the procedure there in the minor theatre (ORs are called theatres here.) Two men with BPH in retention needing Foley catheters, three hydroceles, two inguinal hernias... basically all urology surg cases, right up my alley (thanks to Alison, Dr. Locke, & Dr. Tissot). Two pediatric burn cases, which despite seeing many here, never gets easier to stomach, and a dermatofibrosarcoma protuberans (yep, it's a real word) and the day was wrapping up. 

That is, until Dr. Dan called for me to assist him with a C section. The baby was breech so delivery would've been dangerous. The experience was nerve wracking and surreal and glorious. I was the first person to wrap my hands around that baby girl. I cut the cord and watched her first breath. Praise Him. Less than an hour later, we were wheeling the mother into recovery and the newborn baby girl was doing great. 

I can't help but think back to the stark contrast one week ago when death and mourning had filled my first day at Zimba. Today was filled with new life and rejoicing. There is a time to be born and a time to die, a time to weep and a time to laugh, a time to mourn and a time to dance. (Eccl 3) In death and life, we see His hand. The hand of the Holy God we serve. Our hope is not in this life for this world is not our home. May our patients rest in the truth. Praise the King of Glory.

OPD

It is 8:00 Saturday morning in Zimba. Monday through Friday, we have chapel services before starting work but Saturdays we get to rest a bit more. The last two days, I have worked in the outpatient department (OPD) on my own, seeing patients with the help of my sweet translator, Purity. I'm learning some Tonga here and there but obviously it is slow going. I think I only saw four or five patients in the morning on Thursday while there was a long line waiting. As I apologized to several patients for having to wait, they all said the same thing with smiles, that they did not mind waiting, they were just grateful for care. So different from the States. 

The learning curve here is huge. The medications have unrecognizable names, the dosing is different, labs have British values, my brain is overwhelmed. Most nights, I come from clinic to study meds and a slew of infectious disease facts. And all of it is awesome. Because each day I return to clinic a little bit faster and a little bit better at helping those waiting for care. Yesterday was much smoother and I suspect I will eventually get the hang of it. 

Saturdays we work half days either in OPD or rounding on patients so that's where I'm headed now. Thank you for continued prayer support and encouraging words! 

This is Dr. Joan. She and her husband are the head physicians at ZMH. I am working with her the most  and learning a ridiculous amount from her teaching. 

Not exactly how we would fix a broken femur in the States. 

A pin through the tibia tied to a jug of water to provide traction. 

Zimba Mission Hospital Day 1

We awoke this morning, still fighting the jetlag, and excited about the day ahead. Every morning, we start with a chapel service of worship in Tonga (the local language) and a short message. I hope that heaven sounds like that. There is truly nothing like acapella African worship.  

After chapel, I began rounds with Dr. Dan in the maternity ward and let me start by saying, I knew these 6 weeks were not going to be easy. I just could not have imagined the reality of how hard it would be. It was a hard day. One hopeful pregnant woman tells me her story through a translator. Pregnant for the 6th time and she has no children. 2 late term stillbirths, 1 miscarriage, 2 newborns dead from malaria and pneumonia. Many women had similar stories. While not completely uncommon in her culture, her pain and tears were as real as any American woman hoping to be a mom. Heartbreaking. 

Next, we made our way across to the pediatrics ward. The first bed we walked up to there was a small child who looked to be about 8 or 9, curled up beneath a blanket hooked up to IV and oxygen. She was brought in last night after being sick many weeks and was thought to have pneumonia. The child's family sat anxiously by her bedside. As Dr. Dan pulled back the blanket to examine her, it was clear she had died several hours before. My first pediatric case here in Zambia. Heartbroken.

The remainder of the day I worked in the outpatient and the HIV clinic as a steady stream of sick patients filed in. It was not an easy day. 

But there were also moments of joy today. Children with giant smiles making faces at me and giggling as I treated patients in clinic. Watching the expansive Zambian sky turn 15 shades of red and orange as the sun went down. There will be more moments of joy here, there will be moments of dancing and singing and healing. His mercies are new every morning. 

Today was a reminder that God is God, I am not. Today was a reminder that this life is a gift that will fade like the dust. Today was a reminder that this world is not our home. God is still good all the time, on the best days and on the most heartbreaking days. Come, Lord Jesus, come.

Tomorrow I will be rounding on patients and working in outpatient clinic on my own. Prayers appreciated. 

Today's the day

Today we will be traveling to Zimba, entering the rural African life and beautiful people that I fell in love with 3 years ago. Outside of the big cities, in the tiny villages, in the mud made churches, with those voices singing praise and those precious babies' big brown eyes staring back at me. That is where my heart awakens. That is where my soul is overwhelmed with joy. These are the people who impacted me so much before and I know they will do the same again. "I need Africa more than Africa needs me." You can't understand it until you've been, then it all makes sense. 

Many people have asked how they can pray for us. It is so greatly appreciated!

Pray that we are given enlightened eyes to see each of our patients as our Abba does. Ps 68:5-6 "A father to the fatherless, a defender of widows, is God in his holy dwelling. God sets the lonely in families, he leads out the prisoners with singing." 

Pray for miracles, healings, revivals, and giftings that the Spirit would rush like a mighty wind and the King of Glory would be renowned. 

Pray for words of compassion, hands of gentleness and love, and boldness to speak the truth of the gospel. Ps 147:3 - "He heals the brokenhearted and binds up their wounds." 

Pray for daily revelation of the power we have in Christ, that we are more than conquerors when we feel defeated, and humble spirits that we are capable of nothing in our own strength. 

Pray for physical and mental endurance, focused minds, and good health that we may serve well. The jet lag has definitely set in. Thank you, thank you, thank you! 

You can also follow Tanner's photojournal here: http://tannercale.com/photojournal 

Nashville -> Johannesburg

At 5:40pm yesterday, after a last American meal of chipotle (thank you Dulles), Tanner and I settled in for the long 17 hour flight to South Africa. I have this issue where I revert to a newborn baby on international flights, only waking to eat and use the bathroom and then turning back over to sleep. I did, however, manage to watch Silver Linings Playbook, Date Night, & about 17 minutes of Les Mis. 

We stopped for an hour to refuel in Dakar, Senegal and then flew 8 more hours to arrive here in Johannesburg, South Africa. We took a bus to our hotel and got to see a quick glimpse of this bustling city. It reminds me of the old school section of the Vegas strip. Tons of neon lighting. 

Right now, I'm sitting in my hotel room thinking that its actually almost 1pm and not quarter til 8pm as it is here, thankful for wifi, and excited for the adventure to come. Tomorrow we fly to Livingstone, Zambia around 11am before driving to our final destination, Zimba.

Thank you for your continued prayer and words of support! My sweet friends sent me off with a card to encourage me every single day and those words have already given life to my exhausted heart. Thank you! Miss you! Much love!