Thursday, July 6, 2017

The Final Act

 

“Injection, ointment, strapping.”  The eye patch was placed, the patient was helped off the bed, and a new one was brought into position before I began another cataract surgery.  Over and over and over again.  Near the end of our eye camp, we had fallen into a rhythm.  As I looked around me, I saw the beauty of everyone at work in the operating theatre – everyone with their role, everyone doing their part.  There was beauty in the green operating linens that draped all the stainless steel mayo stands, tables, and beds.  There was beauty in the way we donned our gowns and gloves with the proper sterile technique.  It was a like a ritual.  A sort of dance. 

We were at Kanye Adventist Hospital once again for another eye camp – another amazing experience of caring for the blindest of the blind in a small corner of Botswana.  The majority of patients had either light perception (LP) or hand motions (HM) vision, unable to distinguish even the number of fingers held in front of their face.  Many had pseudoexfoliation syndrome and small, floppy pupils.  But by God’s grace we were able to serve them.  By the fifth day of our eye camp, we had completed 117 surgeries on 112 eyes (111 cataract surgeries and 6 “other” surgeries). 

But as I was completing the last manual small incision cataract surgery (MSICS) of the eye camp, the realization hit me full force – this will be my last surgery of this type in a very long time!  This was my last day of surgery on the continent of Africa, the last MSICS procedure (until my next international eye camp or until I encounter a patient in the U.S. with cataracts so dense and advanced that MSICS would be the preferred option).  I realized I had gained so much after serving a six-year term at Lusaka Eye Hospital.  My surgical skills had been broadened, as I was forced to perform techniques and procedures outside of my comfort zone.  My clinical skills had been honed, as I was challenged with difficult cases and ophthalmic conditions literally at their end-stage.  My interpersonal and administrative skills had been sharpened, as I was forced to take on leadership roles that would humble any young professional.  My accounting skills had been nurtured, as I was led to become, by default, the unofficial accountant and business manager at my institution. 

I have, no doubt, become a different person because of this experience.  My core values and character are still the same, but I have changed in so many other ways.  If I were given the liberty to judge my own personality, I would say that I am more assertive, less na├»ve, more proactive, less hesitant, more vocal, less unassuming, more present, less aloof.  I would say I have grown up, though I still feel like a child.  And speaking of children, we arrived in Africa with none, and now we are leaving with three.  This, in itself, is one of the greatest gifts that has been bestowed upon our family.  When we first came to Zambia, we thought that we would be a big blessing to Lusaka Eye Hospital.  Au contraire, Zambia has been a big blessing to us.  And we will miss her greatly. 

1.  March sickness.  As is my routine, I shall start off where I ended in the last blog.  We had just arrived back to Zambia after four months of leave in the U.S.  We tried to get back into the routine of life and work.   
Korean ahjumma
Zach enjoying being back in Zambia
Essie at 4 months
With Isaac, Aunty Satipha's 4 month old baby boy

Making muffins
Making pizza
Jaycee, learning to draw

And insisting I give her drawing as a gift to a patient
Zach, getting potty trained at 2.5
Our family had been hammered with various ailments and sicknesses during our leave, and the month of March was no exception.  But as soon as Zach arrived in Zambia, he developed a deep, hacking cough, accompanied by vomiting.  Jaycee followed suit two days later.  Even baby Essie developed the same deep, hacking cough.  Brushing it off as another viral illness, we treated symptoms and charged on with life.  But about two weeks into the entire ordeal, I entered what was clearly my 4th episode of tonsillitis.  Exasperated, I reached out to my infectious disease friend for advice on antibiotic regimen, it was suggested that our entire family – even the asymptomatic carriers – attempt to eradicate strep from our systems.  So a whole lot of amoxicillin was purchased and everyone got a good 10 days of antibiotics (except me, as I was instructed to be on a higher dose for 3 weeks).  This intense regimen bought us a good 2 months of freedom from illnesses, which was the longest we had gone since November! 

Getting checked out by Dr. Lauren Sandefur
2.  International Dental Show.  From 19 – 29 March 2017, Paul and Wesley Arnold (the young, new dentist from Loma Linda who has come to take over the work at the Lusaka Adventist Dental Clinic) had the opportunity to attend the International Dental Show in Colonge, Germany.   
 
 
This is a huge convention where >2100 dental vendors and suppliers gather to showcase their products and work.  Somehow they scored a free upgrade to Business Class on Emirates Air.   
At the convention, they were the most casually dressed dentists in attendance, but they had a wonderful time visiting the myriad booths and trying out the newest dental technology the world had to offer.   
They even got to cross over into Belgium for a few days to explore and enjoy the delicious delicacies – yum, Belgian waffles!
3.  Andrew Chung rotation.  From 20 March – 9 April 2017, the last Loma Linda University (LLU) ophthalmology senior resident came out to Lusaka Eye Hospital for his international ophthalmology rotation.  It’s hard to believe that Andrew Chung was the 12th individual from LLU’s program over the past 4 years to fly across the world to LEH to spend a month learning MSICS and about ophthalmology in a developing world setting with me.  Andrew was such a pleasure to have around.  His wife, Trina, a 3rd year dental student, was even able to join in on the fun by spending 2 weeks serving at the dental clinic.  We miss you, Andrew & Trina, and loved spending time with you!
A large, brunescent cataract

 
4.  Zimba Eye Camp.  The last week of Andrew’s rotation was spent down in Zimba (in southern Zambia near Livingstone) for an eye camp.  I had pumped sufficient breastmilk in preparation of leaving Essie for the week, but my 4.5-month-old daughter had another agenda.  She adamantly refused to drink from the bottle!  So last minute rearrangements required that I bring Essie and Annie, our nanny, down with us to Zimba.  At least Essie got to experience her first mission trip and everything that accompanies it!
 
What we love about serving in Zimba is that it is so well-run and nicely stocked.  Dr. Bud Tysinger, founder of International Vision Volunteers, had invested time and effort into raising up this beautiful free-standing eye clinic and operating room adjacent to the existing Zimba Mission Hospital.  This Zimba Eye Clinic has gained such a positive reputation down in that region that patients will come (often by foot) for many kilometers to be treated there.  We were happy to be able to serve so many needy patients during our week in Zimba.  I will truly miss coordinating eye camps to this site.
Ana, helping with postops
British anesthesiologist volunteers - Elle & Sonia
Bilaterally blind cataracts - happy on postop day 1
Our awesome team
5.   Rhinos in Livingstone.  Being so close to Livingstone, we decided to take an afternoon trip down to Mosi-oa-Tunya National Park after our last surgery was performed Thursday afternoon, 6 April 2017.  I had only seen one rhino during all our years in Zambia, so I was intent on seeing the famed, protected “white rhinos” at the Mosi-oa-Tunya National Park.  When we got to the gate, we were told the entrance fee would be >500 kwacha (~$50) for our entire team.  After some discussion, we agreed to drive to the ZAWA (Zambia Wildlife Authority) headquarters to request a discount.  We were thrilled when our driver returned with an official letter, stating we would only need to pay 75 kwacha (~$7.50) total for the entrance fees.   
We hired a guard for $10, who took us to the rhino guards, and we ended up getting a close-up walking tour encounter with four white rhinos!  It was amazing and exhilarating to be so close to such magnificent creatures.  At one point, the rhino looked straight at Essie and me, as if to say, “You’re a little too close for comfort.”  The guard then commanded us, “Walk quickly to this side but do not run!”  After a few minutes, he stated, “We can go now before we agitate the rhinos any further.”  Already feeling nervous about the rhinos, our group readily agreed. 
Walking to where the rhinos are grazing
Umm, yes, there are supposed to be 4 rhinos behind us, but the lighting was bad so just use your imagination!
I learned a few things about white rhinos that day.  Contrary to what their name might suggest, these animals are actually grey!  They are different from black rhinos in that they have a wide mouth (so the “wide”-mouthed rhino got lost in translation and was called the “white” rhino instead), elongated head, and are grazers (as opposed to browsers).  In Zambia, there used to be more than 100,000 white rhinos, but they all ended up getting poached.  Why are they so endangered, you might ask?  On the black market, 1 kg of rhino ivory is sold for more than $100,000!  That is worth way more than gold or silver.  So now in Zambia, there are only 14 white rhinos left (11 at Mosi-oa-Tunya National Park, 3 at Lusaka National Park).  The ones at the Mosi-oa-Tunya National Park were actually imported in from South Africa, and they have been protected like no other, with personal guards holding serious firearms, accompanying them wherever they graze.  Eight of the 11 white rhinos there were born within the park, which is huge progress for the white rhinos in Zambia. 

On the way out of the park, we saw impala, warthogs, zebras, a monitor lizard, baboons, and a whole herd of cape buffalo, making the short game drive a high-yield one.  Watching our nanny, Annie, gasp, sigh, and marvel at each animal she saw made the experience worthwhile.  In all her years of living in Zambia, she had never seen any of these animals in the wild.  This was a thing of television, not something she would have dreamed of enjoying with her own two eyes. 
 
After our thrilling encounter with the rhinos, we headed to Olga’s – The Italian Corner – for a feast of Italian pizza.  What a wonderful end to my last eye camp at Zimba. 
 
6.  Zach Elkin rotation.  From 10 – 28 Apr 2017, Zach Elkin came through as the very last resident to rotate at Lusaka Eye Hospital with me.  Since Stanford does not have a site quite like ours for ophthalmology residents to rotate through, Zach had been on the lookout for an opportunity like this one.  Sophia Fang and Eden Yoon (previous residents who rotated in Lusaka) provided him with my contact information, and after a bit of red tape and paperwork Zach received approval from his school to come to Lusaka for 3 weeks!  I loved working with Zach, who is not only super intelligent, but very interested and knowledgeable in pediatric ophthalmology.  I was able to bounce so many peds-related questions and ideas off him, and for that I was so grateful.  This experience in “teaching” residents has been rewarding for me in that I have also learned so much from them.  Thanks, Zach, for coming out to Lusaka and being my last official resident to Zambia.  Good luck in your career and as you continue your training in pediatric ophthalmology.
 
Jaycee, learning how to use the slit lamp
Little Zach with Big Zach
 
7a.  Last corneal transplant.  I had vowed not to do any more corneal transplants in Zambia after August 2016, since I wanted a long follow up time for my transplants before leaving the country.  However, on 10 April 2017, I made one exception to that rule.  “Peter” is a boy that I met three years ago when he was only 16 years old.  He had had a history of keratoconus with corneal transplants in both eyes done in India in 2011.  His left eye unfortunately developed endophthalmitis, so an evisceration was done.  But when I had met him, he had HM vision OD with a severe corneal ulcer in his graft, causing graft rejection.  I performed a glycerol-preserved corneal graft urgently in order to remove the nidus of infection.  5 months later, I performed a second graft – this time a fresh graft.  Subsequently, his intraocular pressures were uncontrolled – shooting up to 42 mmHg at one point (normal is usually <21).  One year after his surgery, he was able to see 6/36, but the pressure issues were still fluctuating from controlled to uncontrolled.  So about 2 years ago, a trabeculectomy was done.  IOP improved after that, but acute graft rejection ensued.  A PKP triple was done successfully, but then a pressure spike to 62 mmHg a few months later forced me to perform an Ahmed tube shunt in that right eye.  Once the eye decompressed, however, the tube proved to be too long for the eye and began to touch the graft, causing it to fail.  His course was further complicated by a graft infiltrate.  Of course, the pressure began to rise again.  A tube revision was performed 2 months ago to release the encapsulated cyst that had formed around the tube shunt, and the pressure was fine again.  Finally, last month, I decided to do a third and final PKP for Peter, giving him the last opportunity to see again from his only eye.  Eversight generously donated the tissue.  Zach, the Stanford resident, carried the tissue over from California.  And a successful transplant was performed.  We even trimmed the long tube at that time.  Sight improved to CF@3m, but I still was not happy with the position of the tube.  So I decided to take him back for surgery one last time to reposition the tube.  15 May 2017 was my last day seeing Peter.  He is able to walk around on his own (VA OD is CF@3m), and his IOP was 14!  I am so happy that he is stable, but I know that we are not yet out of the woods.  Please pray that Peter will continue to heal properly and that his sight in his only eye will continue to improve. 
It is patients like these – for whom I have cared over the years – that I will truly miss.  They have become like family to me, entrusting with me over multiple surgeries and clinic visits, with one of their most important assets – their eyes.  As we close this chapter of service in Lusaka, we hope and pray that our patients will not feel abandoned, but that God will provide them with continued healing and help for their conditions. 

7b. Dental retreat.  Paul led his dental team, after years of delayed gratification, on a fun-filled retreat down in Livingstone from 11-16 April 2017.  Team bonding was the theme of the trip, along with activities like cuddling with a large lion cub!
 
8.  Easter weekend at Riverside Farms.  Over the Easter holiday weekend from 14 – 17 Apr 2017, we decided to go down to Riverside Farms.  The guesthouse was pleasant, and it was a wonderful chance to reconnect with our good friends, the Busl family.  We were able to share delicious meals, and our kids had a great time playing together. 
We shared delicious meals together
Best buddies

Essie, chillin' at the guesthouse
Making pizza!
At the cookout
Chowin' down on veggie hotdogs
9.  Kyim Mung rotation.  From 17 April – 12 May 2017, we had a rare dental student join the Lusaka Adventist Dental Services for an international rotation.  Beautiful, spunky, Burmese Kyim had an exciting time in Zambia, not just helping out with dentistry, but also crashing a few Zambian weddings, seeing Victoria Falls, and even going on a dental outreach to the “bush” with the dental team.  Congratulations on your graduation from dental school, and best of luck as you look into serving in Saipan as a missionary dentist!
Kyim sharing a milkshake with Jaycee
JoyJoy and Jaycee, getting ready to meet Kyim for a night on the town

Heading to the mall, the ultimate (and only) source of entertainment in Lusaka
More homemade pizza!
10.  Moving sales.  The months of April and May were busy, not just with visitors and students, but also with all the activity that accompanies a big cross-country move.  We successfully sold our two vehicles without too much difficulty.  Although we had come to Zambia with a whole 20-foot container full of “stuff” (furniture, appliances, clothes, kitchenware, household items), our plan was to leave Zambia with just 11 suitcases.  Thus, we had to figure out what to sell/give away and what was going to return with us in those suitcases.   In order to avoid the phenomenon of hoarding things just because they are being given away free, we decided to sell them at a "give-away" price so that those truly interested in the items could "buy" them.  We ended up having 2 major yard sales/auctions open to just our staff at the eye hospital and dental clinic.  Many of the items were sold for $0.50 to $1.00, but bigger items were auctioned off.  This was a fun, fair way to distribute goods to our staff at a bargain price, and everyone went away happy.   
Yard sale
Pam, our auctioneer
The majority of our bigger furniture items went to the Harding family, a wonderful missionary family that recently moved from Tennessee to Zambia to help with the running/administration of Riverside Farm Institute.  We were happy that the Hardings were able to use our things, and the pick up day in the middle of May was sort of surreal; once all our furniture in the house was gone, it solidified the fact that we were really going to move away from the home we had known for 6 years! 
Alicia Harding, with the moving truck packed and ready to go!
11.  Josie Bailey.  Regardless, as our house seemed to declutter itself from material items each week, we continued to host guests and visitors.  Josianne, who had once been a former student missionary at Riverside Farms, came back to visit Zambia, but this time as a medical student.  It was wonderful to see her again and reminisce on times past.
Mmm, thanks for the Baklavas, Josie!
12.  Patrick Minor & Jonathan Calbayan.  It was great having Patrick Minor, who was in Zambia briefly for work, and Jonathan Calbayan, back from doing relief work for the South Sudanese refugees in Moyo, Uganda, over at our home for lunch on 1 May 2017. 
13. Darrah Kauhane-Floerke.  From 2 – 14 May 2017, Darrah Kauhane-Floerke, Executive Director of the Hawaiian Eye Foundation, was able to visit us in Lusaka in her quest to learn more about the establishment of self-sustainable eye clinics.  She graciously agreed to come with me to Botswana to assist with our eye camp.  I learned and gleaned so much from our long conversations over dinner and at the airport; it was a pleasure to have you join us, Darrah, and hope to see you again soon in Hawaii!
 
With Darrah & staff at Kanye Adventist Hospital
14.  Kanye Eye Camp. As described above, the eye camp in Botswana was another wonderful experience and took place from 7 – 13 May 2017.   
Preop evaluations
Teaching the medical officer how to do retrobulbar blocks

With Virginia

With a happy patient
 At the end of the week, a special farewell ceremony was conducted.  
Formal farewell ceremony, speeches and all!
With the administrators of Kanye Hospital
It was touching to hear the testimony of one gentleman that we worked on who had gone blind from bilateral diabetic cataracts and whose sight had been restored during our eye campaign.  Although we were able to successfully complete 111 cataracts in that short week, there was still a backlog of another 300 cataracts remaining.  The good news is that the Hawaiian Eye Foundation may be able to send a surgical eye team to Kanye next year to fill the need, since I will not be able to return to Botswana immediately.  Hopefully with this new connection, Kanye Adventist Hospital can continue the momentum it has already built up in the field of eye care. 

One of the highlights of my trip to Botswana was the fact that I had the chance to stop by and say hello to my friend, Kilele.  She is now a 4-year-old lion, adopted at only a couple weeks of age by a two-veterinarian couple who lives near Gabarone.  It was amazing to see how much Kilele had grown in just one year.  As soon as Kilele saw me, she seemed to immediately recognize me!  She came to the side of the fence and rubbed her face against mine.  She then immediately rolled onto her back as if to say, “Play with me, rub my belly” just as a domestic cat would.  I wanted with all my heart to jump into the cage and roll around with this loving, oversized cat, but I knew that I might end up with some broken bones.  Bye, for now, Kilele!  Hope to see you again one day. 
 
Kitty kisses from Kilele
15a.  Dental outreach to Gwembe Valley.  From 6 – 9 May 2017, Paul and his dental team went down to the Gwembe Valley (an 8-hour drive from Lusaka) for another successful outreach in the mobile dental clinic.  They had been at the same site last year (at the crocodile farm), and so the patients flocked to be seen and treated.  At the end of the 2 working days, they extracted over 400 teeth from about 250 people.  What a service they provided to this rural community!
Two fully-equipped dental chairs in the mobile clinic
Dental team
 
Grateful patients
During this outreach, Paul got stuck with a dental instrument.  Deep.  While working in a patient’s bloody mouth.  Not knowing the status of the patient, he was instructed to start on HIV medications for one month.  A rapid HIV test a couple weeks after the incident proved to be negative.   
Negative rapid HIV test
And a recent blood test 2 months later was also negative!  Hallelujah!  To be honest, each time my bloodwork for HIV comes back negative, I always breathe a sigh of relief.  One of the realities of doing medical work in a nation where the HIV rate is so high is that a fingerstick or bodily-fluid-squirt-to-the-face could lead to infection.  But we thank God for his provision and care, allowing our family to return from the mission field unharmed and intact. 

15b. Lusaka Dental Training School.  Back in Lusaka, Paul taught a class at the Dental Training School for a group of dental therapy students.  They were excited to learn from the American well-reputed dentist.
Paul, with dental therapy students
16.  Namibia.  After wrapping up our work, eye camp, dental outreach, final patient consultations, good-byes to many friends/patients, and packing, our family embarked on an epic 9-day road trip throughout Namibia (18 – 26 May 2017) with Mom and our two student missionaries.   
 
Layover in Johannesburg
Namibia is a unique but spectacular destination, one that we had been meaning to explore during our time in Africa, but had never had the time to until now.  Namibia is the second least-populated country in the world (second only to Mongolia).  It has exceptional landscaping that stretches out for miles into open nothingness.  The landscape and scenery changes constantly – almost every hour that you drive you feel like you’re in a different country altogether.  But it is all beautiful and serene. 
 
 
Zebra crossing
Thursday.  Our first stop was Windhoek, the capital of Namibia.  This was a clean, cute, German-influenced city that appeared brimming with culture and style.  Unfortunately, we did not have much time to look around, as we simply stayed the night at a cute hotel (Villa Violet) before heading out to the Kalahari Desert the following morning. 

Friday – Saturday.  Our rental car (a brand new VW Kombi van) was given to us Friday morning, and after a grocery run we made the 3-hour drive down the B1 highway through Rehoboth to the Kalahari Red Dunes Lodge.  This was an amazing, isolated site in the middle of the Kalahari Desert.  Our chalet was more than comfortable, and we enjoyed the peace and solicitude as we entered into the Sabbath.  
 
 
Petting the baby ostrich!
Taking a break during our hike in the hot aftenoon sun
Bathtime at the chalet
Awakening to the light of dawn each morning
Hiking around the area, watching the millions of bright, twinkling stars, and enjoying delicious meals were themes of this restful weekend.  Zach especially liked hanging out with Oscar the Eland.

Oscar the Eland
Sunday – Monday.  On Sunday morning, we took to the road again as we made our way to our next destination in the Namib Desert – the Agama River Lodge.  What should have been a 4-hour drive turned into a 6-hour trek.  When we came to a dead end in the middle of farmlands, we realized we had made a wrong turn.  At least we got to see a wild ostrich on our detour. 

Monday morning we left bright and early for the one-hour journey to the famed Soussesvlei, an area famous for its high red sand dunes surrounding a salt and clay pan in the Namib-Naukluft National Park.  Our main missions were to see Dune 45 (the most photographed dune in the world) and to summit Big Daddy (the tallest dune in the Soussesvlei area). 
 

 
 
I honestly don’t know what I was thinking when I agreed to climb Big Daddy with our student missionaries, Pamela & Ana, in the middle of the day.  Standing high at 325 meters and overlooking a white pan studded with the dark fossils of camelthorn trees, Big Daddy is one impressive dune.  The view was spectacular, but the going was hard.  At one point near the summit, having run out of water, I almost gave up completely when the tracks from previous trekkers were completely erased by the sweeping winds that accompanied the heightening altitude.  It took almost all my energy to make new tracks in the sand, which sank at least 6 inches with each step.  As we took a break pondering what our next step should be, we saw another couple making their way up the same way.  We suddenly realized that if we let them pass us and forge the new path ahead, we would have an easier time making it to summit.  Indeed, their footsteps were a heaven-send, and we finally made our way to the top! 
 
Takes a bit of balance not to fall off the sand dune
At the summit
We conquered Big Daddy!
As wonderful as reaching the summit was, the more exciting part of the adventure was actually the descent – I felt like a giddy child as I ran (screaming) down the steep mountain dune at high speed, leaning slightly back, allowing my feet to sink into the sand with each step.  What an adventure.

Euphoric after dashing down Big Daddy
Tuesday – Thursday.  Our last stop was Swakopmund ("Mouth of the Swakop"), a unique beach resort on the west coast of Namibia fraught with German colonial architecture and lots of German restaurants.  To illustrate the uniqueness of this little town, the student missionaries described a point during their bike ride along the beach in which they saw the Atlantic Ocean to their right with dolphins doing beautiful acrobatic jumps, and on their left they saw the Namib desert red sand dunes with a herd of camels walking by.  Only in Swakopmund!  We sponsored a session for them to go quad dune biking, which they thoroughly enjoyed.  As for Jaycee and me, we got hit with another round of fever and sore throat (tonsillitis episode #5), so we just used that time to enjoy the city and rest.  Thursday morning, we made the 4-hour drive east back to Windhoek, caught our flight, and returned home to Lusaka.  And that, my friends, ended our epic trip to Namibia.

17. Beene family.  Over the weekend, we hung out with one of our favorite Zambian families – the Beenes.  Wesley Beene, one of the long-time lay board members for Adventist Health International Zambia, has become such an amazing friend and support for us during our time in Zambia.  We will miss him, his wife Judy, and his whole family greatly. 

18. Permanent return.  The big day arrived on 30 May 2017 – the date of our final move back to the U.S.  Last minute packing ensued, and my heart was heavy as employees from Lusaka Eye Hospital dropped by one by one throughout the course of the day to say their final goodbyes.   
I was impressed that I had kept it together all day (normally I am very much a crybaby), but when my trusty HR officer, Linda Muleya, started to cry as she hugged me for the last time, I couldn’t help but shed tears of sadness.  Around 4:30 pm, we boarded our beloved bus – accompanied by a small entourage of friends – to make the final journey to the Kenneth Kaunda International Airport.   
Our final airport trip
Saying farewell to our faithful staff
We had made so many trips to and from that airport in the last 6 years; it was hard to imagine that this would be our very last trip (at least for the next several years).  The entire experience was so surreal, and as we boarded the airplane we realized, “This is it!”  We have lived in and loved Zambia.  We have learned and grown.  We will recall that final day as a bittersweet one, in which we hesitated to depart from those with whom we had bonded, whose friendship has been molten into our hearts, but in which we also anticipated the new chapter to come, a new life in the beautiful state of Hawaii.
The long trip home -- 7 hours to Dubai and another 16 hours to LA
19. San Diego family trip.  Once we landed in America, our bodies went into an immediate shock from the severe jet lag.  Midnight awakenings were the norm, at which time the kids were up and ready to go for the day.  But plans had been made for a family vacation by the beach, so we packed our bags for San Diego.   
Grandparents enjoying Essie
 
Cousin time
 
On Sunday, 4 June 2017, we thoroughly enjoyed the beach house, which was literally 1 block away from Mission Beach.   
 
 
 
 
Monday, we headed to Balboa Park for a stroll, a ride in a rented surrey, and a picnic lunch.   
 
 
 
  
We spent the entirety of Tuesday exploring the San Diego Zoo.   
At the petting zoo
Unsure whether to pet the goat or not
 
Contemplating how blubbery the hippos look
 
 
And Wednesday was Jaycee and Zach’s first experience at Legoland.    
 
 
 
 
 
 
 
All in all, the kids enjoyed San Diego; but most of all, they enjoyed playing together as cousins.

The Three Muskateers - Oliver, Jaycee, and Zachariah
20. Packing.  When we got back from San Diego, we were laser focused on our big job of packing our belongings in preparation for our move to Kauai.  We made an IKEA run, in which basic furniture like bookshelves and dressers were purchased.   
 
Zach even got a haircut.
Boxes were packed, labeled, and ultimately organized neatly into a ReloCube (6 foot container), which was eventually shipped out in mid-June.

 
In the midst of this, we had the opportunity to see my cousin, Grace, Eddie, and their kids, as they were all in Loma Linda for Christopher’s graduation from his MPH program.  Congraulations, Chris, and good luck as you continue on your path to becoming a doctor!
 
 
21. Orlando trip.  On 14 June 2017, we packed our bags once again for another trip, this time to Orlando to visit Kar-Yee & Mervyn Ng.  
Acting silly while waiting for Papa to pick us up with the rental car at the Orlando International Airport
It was my first time visiting the state of Florida, and I was not disappointed.  Orlando is entertainment central, with tons of places to go and things to see.  But we were content simply to hang out with Kar-Yee’s beautiful family.  
Art time

Ride 'em!
Popcorn time

Story time
More story time
Jaycee loved playing with Kaylee.   
Jaycee & Kaylee - two peas in a pod
Zachariah and Kenan played more independently as 2-year-olds tend to do, but by the end of our week they were actually playing well together.   
Zach & Kenan
One day, we enjoyed letting the kids splash around at Coco Key Water Park.   
For the grand finale, we celebrated Father’s Day at Disney World.   
Lunch at the Crystal Palace
 
 
 
 
Riding the Astro Orbiter with Zach
Getting to meet Cinderella with Jaycee
Alladin's Magic Carpet
Magic Kingdom!
It was wonderful hanging out with Kar-Yee after all these years.  Hope our kids can hang out again one day soon!

22. Georgia/Tennessee trip.  On 20 June 2017, we flew to Atlanta.  Our first stop Tuesday was Marianne’s house in Cartersville, GA.  It was hard to believe 10 years had passed since we had last seen each other.  Thanks for the amazing meals you cooked for us! 
 
Wednesday, we headed up to Chattanooga, TN, to hang out with John & Kendra Lee, Madigan & Tatum, friends we had not seen since our time in Boston 6 years earlier.  A ride on the carousel at Coolidge Park, dinner at Cool Dog, an ice cream run, and sliding down a steep hill on a piece of cardboard made for an entertaining evening for the kids.  Plus, it was great catching up with John & Kendra, who are planning to make the big move back to Boston in a few weeks!
 
 
 
 
Thursday we drove on up to Pikeville to spend two nights with Fred & Jane Lee, Joshua, Caleb, and Noah.  Seeing their beautiful, custom-designed home with an amply-producing farm/garden/greenhouse sitting on almost 10 acres of land in the beautiful countryside of Tennessee was a sight to behold.  I was impressed with their lifestyle and devotion to their kids, and I learned so much from their family simply by seeing and observing what it takes to raise up three boys in Christ.  The rain kept us inside the entire time, but it gave us a good excuse to chat and catch up on all the years of missed time during our friendship. 
 
Offering Jaycee fresh strawberries
Baking cookies with Aunty Jane
Cutting watermelon with Uncle Fred
Boy, did we eat!
 
On Saturday, after attend church in Collegedale, we headed to Eli & Susie Kim’s house.  It had been so long since we had seen them that we had never met any of their four children – Branden (9), Tysen (7), Audrey (5), and Aria (8 months)!   
Nevertheless, we picked up in our friendship as if just 1 month had passed, although more than 120 months had probably elapsed.   
Girls being girls

That's a lotta kids
Are they all ours?

Yoos & Kims
That evening was a party at the Kim residence, and unbeknownst to us they had invited other classmates/friends we had not seen in years – Eric & Rachel Nelson, Selwin & Edwin Abraham (and their families), John & Kendra Lee, Fred & Jane Lee – as well as new friends like David & Ji Lee, Dan & Diana Chung, etc.  To top it off, 24 June 2017 marked our 10-year wedding anniversary, so it was a blessing to able to spend that special day of our lives with old friends. 

Sunday was a low-key day in which we slept in, hung out, and allowed the children to play together.  Jaycee even accompanied the Kim kids to a birthday party.   
 
 
On Monday, we took a trip down the street to the playground (Imagination Station) and public library before the Busl family came over for dinner and swimming.   
 
Having only known the Busls in Zambia, it was different but wonderful to see them on this side of the world.  It was neat to introduce one amazing family with four kids to another equally amazing family with four kids. 
Kims, Yoos, & Busls - 26 June 2017 - Collegedale, TN
 
23. Indianapolis.  Our next stop was to Indianapolis, where I had been scheduled to observe a day of DMEK (Descemet Membrane Endothelial Keratoplasty) surgery with the illustrious Dr. Frank Price.  It was great to meet him as well as his fellow, Jonathan Crews, who were gracious enough to let me watch as they prepared the donor tissues themselves and performed DMEK (and 1 DSAEK) surgery on 7 patients in one morning.  I really felt like I was meeting a celebrity.  Dr. Price is a kind and compassionate, soft-spoken but brilliant individual, and it was a real honor to get to spend a day with him at the Price Vision Group. 
Learning DMEK with Frank Price, Indianapolis
24. Morettas.  On 1 July 2017, we had the opportunity to hang out with Carlos and Dafne Moretta.  Because we hate to say farewell, we simply end each precious meeting with the words, “Come visit us in Hawaii!” 
 
25. Temecula fireworks.  The Fourth of July this year was a special one in that we decided to attend the 4th of July Extravaganza in Temecula with James and his family, his parents-in-law, my parents, and my cousin Helen’s family at the Ronald Reagan Sports Park.  The kids enjoyed playing at the Kids Fun Zone.  It seemed everyone in the Temecula had come out for the event.  Almost every square foot of grass was occupied by families with food/barbeques, blankets, and tents.  A live band kept the scene lively, and the streets were filled with cars trying to find parking.  The fireworks began promptly at 9 pm, and they did not disappoint!  The show was spectacular and seemed to welcome us back into the great and beautiful United States of America.  It’s good to be home!
 
 
 
 
26.  Kauai.  It’s hard to believe that in just a few days – 9 July 2017, in fact – we will be flying to our new home on the island of Kauai.  We still don’t know how God orchestrated this, as it seems too good to be true, but we are simply going for the ride.  I will be joining Crane Eye Care as their new associate doctor, and I couldn’t be more excited.  Please pray for us as we make this new transition into life back in the United States.  And if you’re ever on Kauai, feel free to drop by and say hello!  

As we close this chapter of our lives and reflect on our six years of missions in Zambia, we realize we could not have come this far without the help and support of everyone.  We thank all of you who prayed for us - we would not have lasted in the mission field without your prayers.  Thanks to all our financial donors and supporters - the Colin Glassco Foundation, Loma Linda University's Global Health Institute, Adventist Health International, Loma Linda Eye Institute, Loma Linda Korean SDA Church, and individuals who contributed generously to the special projects and cataract camps.  A special thanks to the eye banks who helped - Eversight, Tissue Banks International, and Global Sight Network.  Many thanks to the many colleagues who have supported our mission in various ways, the mission organization and supporting partners - we couldn't have done it without you.  Thanks to all the volunteers and residents who have come out to Zambia, as well as the many people, family members and volunteers, who helped watch our kids.  Finally, one huge THANK YOU to the missionary grandparents who were invaluable in making it possible for us to be missionaries - Annie Yoo, Jennifer & Edward Lee.  We love all of you!