The Lord giveth, and the Lord taketh away

Another month has flown by, and I’m not sure where the time has gone.  It’s hard to believe that Paul and I have lived in this country for the last 7 months.  Although we’re slowly growing accustomed to the culture, the people, and the way of life, we are still very aware of our foreignness and the fact that we are so different from the people that we are serving. 

1.  The first major event that has occurred is that we moved!  At the end of February, we packed all our belongings (which is not much, considering we still have not received our container from the U.S.) as well as the furniture that has been loaned to us by our work into a moving van and transferred it to our new home. 

The only problem is that our new home is not yet complete.  This home is a 10-year-old house where the first doctor who founded Lusaka Eye Hospital lived.  Several other doctors have lived in this house since then, but by the time we decided to move the house was in serious disrepair.  And when I say serious, I mean serious.  They began renovations in the middle of January – reroofing the entire leaking roof, replacing most of the rotten ceiling boards, retiling the bathroom walls, floors and living room floors, repainting the inside and outside of the house, rewiring the broken electrical outlets, replacing all the broken windows, fixing many of the broken toilets and faucets, etc. – and they were hoping that things would be complete by the end of February. 

Of course, knowing the pace of Africa and how things realistically get accomplished here, it is now the end of March, and our house is still not complete.  For the last month, we have been living out of a single room furnished with a single bed.  Because they’ve been painting and renovating and hammering and fixing, we’ve been unable to move any of the furniture into the house from the garage.  No kitchen table, no chairs, no sofas, no nothing.  I got tired of eating standing up, so I put one chair in the kitchen so I can eat sitting down while Paul still stands at the counter to eat.  The worst part of it is having no privacy.  Every day, there are many strange men coming in and out of my home to work on one thing or another.  The good news is that they are almost done with renovations.  And word has it that our container is somewhere on the continent and should be delivered sometime within the next month. 

2.  Below is an email excerpt I sent to a friend on 22 February 2012.  

"Today was a very sad day.  I had to hold back my tears throughout the day so I could appear strong as the leader of my Eye Hospital.  But we lost a child today.  It's common to lose children here in Zambia due to AIDS or malaria.  But to lose a child after a simple eye surgery was one of the harder things I've encountered in my life.  I thought of sharing this with you, as you are an anesthesiologist. 

She was 2 years old, a pretty, happy-go-lucky Muslim baby.  Just that her eyes were a bit crossed.  I saw her 2 weeks ago for an evaluation, and we agreed to proceed with surgery.  Surgery went flawlessly, and our anesthetist extubated her without any difficulty.  She was breathing spontaneously for about 5 minutes, but then the anesthetist noticed that the baby's breathing rate had slowed.  Everything went downhill from there.  She was masked, then reintubated, given ampules of atropine/adrenaline/aminophylline, then initiated on CPR.  We didn't have a defibrillator, nor did the Adventist Clinic in town.  It took us half an hour to find an ambulance emergency service who had a defibrillator, and it took another half hour for them to arrive.  But after a long 2 hour battle with life, and after the ambulance arrived confirming an agonal heart rhythm (and eventually no rhythm), we had to pronounce her dead. 

It was so hard to explain the death to the patient's family, which by then had amassed to a large extended family of 20+ members.  They had all understood the surgery to be a simple procedure and were completely unprepared for the sudden passing of their beloved toddler.  I shared the news initially with the father of the baby and one of his brothers.  Immediately, they began to wail, and they walked out to share the news with the extended family.  From our board room, I could hear the wailing and screaming of bereaved family members piercing the air. 

After some time, I was able to sit down with 4 of the brothers to explain the situation - that the child must have had an adverse reaction to anesthesia or possibly an underlying congenital heart anomaly.  They thankfully and calmly accepted my explanations.  They seemed to accept the death of the child as the will of Allah.  According to their Muslim traditions, they requested that the body be quickly taken home for cleansing so that the burial could take place before sunset.  We urged them to get an autopsy, but respected their wishes for a proper Muslim burial.

My heart is still aching for the beautiful child, whose eyes tomorrow were going to look so straight and beautiful!  For the family, who unexpectedly lost a two-year-old who had so much potential for life.  For our Eye Hospital, who is still in shock over the first patient death here since 2005. 

Although there is tremendous joy that comes from bringing restoration of sight and working in the mission field, I am acutely reminded of the risks involved when we leave our comfort zone to participate in the work.  I can't help but think about how much more we could have done if we were in the U.S., with the proper emergency medications, an actual defibrillator, a better anesthesia machine, a continuous blood pressure monitoring device.  There are so many "what ifs" and "what could I have done to prevent this?" thoughts that pass through my mind.  But then I realize that if I demanded to have everything up to U.S. standards before I would commence working in the field, I would never have come to a point where I could start working.  Ultimately, it is up to me to leave these things in God's hands.  Although it's hard to imagine that anything good can come out of this unfortunate event, I must trust that He is in control and that He will work in His time, in His way, for His purpose." 

Although the death of the child was tragic experience, my staff seemed to accept it more easily than I, since death is such a common theme in the thread of life here in Zambia.  I pray that I'll never become numb to the reality of death.

The positive aspect of this whole experience is that we've taken this time to revamp and renovate our anesthesia services at our hospital.  New anesthesia forms, new preoperative/intraoperative/postoperative protocols, new emergency trolleys with all the available emergency medications, and even new equipment have been quickly created and resourced over the last few weeks, and I believe that our pediatric eye surgery service will be back in full swing, and even better than ever, by the beginning of April.

3.  Although I live in Africa, somehow I made it on the front cover of a Canadian newspaper, the Calgary Herald.   

Apparently four teens put on a fundraiser to help raise funds for the Glassco Foundation, which is sponsoring some of the pediatric surgeries we are doing here at Lusaka Eye Hospital.  This fundraiser received some media coverage after raising >$5000 for these surgeries.  Kudos to these 4 young women who are trying to make a difference in their world.  

Being here in Zambia and witnessing all the examples of individuals who share the same passion for serving and contributing to the betterment of lives has been refreshing: 

• Ophthalmologists like Chris Croasdale, who has never met me but went out of his way to help me obtain corneas, who went as far as to send me a care package full of supplies (corneal trephines, punch blocks, iris hooks, etc.), and who is actively working toward developing a viable eye banking system in Africa.
• Eye banks like Midwest Eye Banks, International Sight Restoration, and Global Sight Network, who have all sent me the precious corneal tissues needed to help restore sight in our needy patients.
• Philanthropists like Colin Glassco, who continues to support the pediatric eye surgeries here at Lusaka Eye Hospital, and who even recently committed to donating funds so we can purchase our much-needed defibrillator and intraoperative monitoring system (ECG, BP, pulse, O2 sat).

These individuals and organizations are such an encouragement to me, especially when I am most discouraged and wondering if any of our work is truly making a difference. 

4.  Pastor Ted Wilson and his wife came to visit Zambia at the beginning of March.   

This was a big deal for Zambia, and they made sure that there was quite a group available at the airport to greet him.  A host of “Dorcas mothers” (or “smurfs,” as Paul calls them) in their blue and white uniforms and white beanies, a busload of Pathfinders with their flags, and a hired marching band, as well as a whole bunch of Zambian church officials were all there to welcome him into the country.   

His stay was very brief (3 short days), but I’m sure he got a good feel for the Seventh-day Adventist church in Zambia during his visit. 

5.  We got a dog!  Cino (short for Capuccino) is a 3 year-old ?pomeranian-?chihuahua mix dog.   

She belonged to a Zambian university student who basically gave her to us as she confessed she was too busy with school to take care of the dog.  For one week, Cino has been following us around the house, begging to be rubbed on the belly, begging for attention.  She’s had two litters in the past (a litter of 6, then another litter of 4), so she’s quite mature for her age.  She’s a very good dog, completely house trained, and a welcome addition to our family.  Since her previous owner did not even know her birthday (stating she was probably born about March or April 2009), we have deemed March 25^th her official birthday, as this is the day she came to live with us!  =)  Welcome to the family, Cino!

6.  Speaking of additions to the family, we are expecting another Yoo who will be joining us in September.  More news on this later.  =)  

7.  Racial profiling is very real here in Zambia, too.  Paul does not walk around wearing a hoodie, but being an Asian man in a Black country makes him stand out like a sore thumb.  In our few months with a car, he's been pulled over 3 times by police officers.  He's been informed by locals that the color of his skin is an indication that he has some $money$.  The corrupt, underpaid police officers often harrass expats to make their extra income for the day from bribes.  Fortunately, Paul has been able to weasel himself out of paying, mainly through standing his ground and intimidation (threatening to tell on them to his patients, some of which are high-ranking officials in Parliament).  Usually the police don't have cars, so they demand a ride to the nearest police station.  Paul usually refuses to give them a ride, and instead tells them to walk.  He insists he will pay the fine once the ticket is issued, which is too much work for them since they don't directly benefit from that fine.  So he's been getting away with simple warnings.  We hope the harrassment will subside over the years. 

8.  Finally, no update would complete without another frightening picture of the eyeball.  Remember the gentleman with the Mooren’s ulcer who got a transplant in February?   

His right eye is doing well.  It's been one and a half months after his surgery, and his vision is still good enough for him to count fingers and walk around without a guide.  His graft is clearing nicely.

This past week I decided to do surgery on his other eye, whose vision was barely light perception.   

We planned to eviscerate (or take the eye out), but I thought of a better plan.  Why not try to put a glycerol-preserved (or alcohol-preserved) graft on the eye to attempt to save it?  If all failed, I could always eviscerate.  I took him to the theatre, making sure he was fully prepared mentally to have the eye removed.  Intraoperatively, I found the cornea/iris/lens all stuck to each other.  I removed them all en bloc, did an anterior vitrectomy, and managed to sew on an alcohol-preserved corneal graft!   

The next day, he was seeing Counting Fingers at face!  I would love to see this large-diameter tectonic graft survive; perhaps we can even rehabilitate it with a scleral-sutured lens and fresh corneal transplant in the future!  Just thankful I didn’t have to remove the eye.  I do dislike eviscerations.