Happy Towel Day!

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Happy Towel Day! Today, May 25th, marks the annual celebration of the life and work of Douglas Adams, and especially his wholly remarkable book, The Hitchhiker’s Guide to the Galaxy. Whether your are a new fan or an old frood who has sassed H2G2 for years, I wanted to share with you a few ways you can celebrate Towel Day and enjoy The Hitchhiker’s Guide to the Galaxy.

1. Carry your towel!

The Hitchhiker’s Guide to the Galaxy has a few things to say on the subject of towels.

tumblr_ltjletsceR1qg6gwlo1_250A towel, it says, is about the most massively useful thing an interstellar hitchhiker can have.Partly it has great practical value—you can wrap it around you for warmth as you bound across the cold moons of Jaglan Beta; you can lie on it on the brilliant marble‐sanded beaches of Santraginus V, inhaling the heady sea vapours; you can sleep under it beneath the stars which shine so redly on the desert world of Kakrafoon; use it to sail a mini raft down the slow heavy river Moth; wet it for use in hand‐to‐hand‐combat; wrap it round your head to ward off noxious fumes or to avoid the gaze of the Ravenous Bugblatter Beast of Traal (a mindbogglingly stupid animal, it assumes that if you can’t see it, it can’t see you—daft as a bush, but very ravenous); you can wave your towel in emergencies as a distress signal, and of course dry yourself off with it if it still seems to be clean enough.

More importantly, a towel has immense psychological value. For some reason, if a strag (strag: non-hitchhiker) discovers that a hitchhiker has his towel with him, he will automatically assume that he is also in possession of a toothbrush, washcloth, soap, tin of biscuits, flask, compass, map, ball of string, gnat spray, wet-weather gear, space suit etc., etc. Furthermore, the strag will then happily lend the hitchhiker any of these or a dozen other items that the hitchhiker might have accidentally “lost.” What the strag will think is that any man that can hitch the length and breadth of the Galaxy, rough it, slum it, struggle against terrible odds, win through and still know where his towel is, is clearly a man to be reckoned with.

Hence a phrase that has passed into hitchhiking slang, as in “Hey, you sass that hoopy TJ Webb? There’s a frood who really knows where his towel is.”

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2. Read, or listen to, the trilogy!

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The Hitchhiker’s Guide to the Galaxy is a wholly remarkable book. Perhaps the most remarkable, certainly the most successful book ever to come out of the great publishing corporations of Ursa Minor. More popular than The Celestial Home Care Omnibus, better selling than Fifty-three More Things to do in Zero Gravity, and more controversial than Oolon Colluphid’s trilogy of philosophical blockbusters Where God Went Wrong, Some More of God’s Greatest Mistakes and Who is this God Person Anyway? It’s already supplanted the Encyclopedia Galactica as the standard repository of all knowledge and wisdom, for two important reasons. First, it’s slightly cheaper; and secondly it has the words DON’T PANIC printed in large friendly letters on its cover.”

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If you haven’t read the 5 part trilogy, this is obviously the place to start! My cousin gave me a copy of the anthology when I was 17 years old and it took me until my 20’s to actually pick it up. I thought it was going to be a bunch of charts and graphs about stars and constellations. Instead, it was an imagination expanding series of adventures that I’ve picked up again nearly every year since.

I haven’t had as much time to read recently, so I’ve been listening to it on audiobook; in my opinion, the edition read by Martin Freeman after the movie was released in 2005 is the very best way to enjoy the novels, aside from curling up with an actual book. Freeman does a superb job.

 

3. Drink a Pan Galactic Gargle Blaster!

The Guide says that the best drink in existence is the Pan Galactic Gargle Blaster. It says that the effect of a Pan Galactic Gargle Blaster is like having your brains smashed out by a slice of lemon wrapped round a large gold brick.”

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The original recipe for Zaphod Beeblebrox’s Pan Galactic Gargle Blaster is as follows:

      Take the juice from one bottle of that Ol’ Janx Spirit.

  1. Pour into it one measure of water from the seas of Santraginus V (Oh, that Santragian seawater! Oh, those Santragian fish!)
  2. Allow three cubes of Arcturan Mega-gin to melt into the mixture (it must be properly iced or the benzine is lost).
  3. Allow four litres of Fallian marsh gas to bubble through it, in honor of all those happy hikers who have died of pleasure in the Marshes of Fallia.
  4. Over the back of a silver spoon float a measure of Qalactin Hypermint extract, redolent of all the heavy odors of the dark Qalactin Zones, subtle, sweet, and mystic.
  5. Drop in the tooth of an Algolian Suntiger. Watch it dissolve, spreading the fires of the Algolian Suns deep into the heart of the drink.
  6. Sprinkle Zamphuor.gargle_drib
  7. Add an olive.
  8. Drink . . . but . . . very carefully . . .

If you can’t make it to the market to pick up the one or two of these ingredients you don’t already have in your cabinet, there are a number of variations, both alcoholic and non-alcoholic. A quick google search for local Pan Galactic Gargle Blaster recipes should point you in the right direction.

If you aren’t feeling quite so adventurous, you may wish to sit back and enjoy reading, watching, or listening to the Hitchhiker’s Guide to the Galaxy with a nice cup of tea, or a refreshing Gin and Tonic.

It is a curious fact, and one to which no-one knows quite how much importance to attach, that something like 85 percent of all known worlds in the Galaxy, be they primitive or highly advanced, have invented a drink called jynnan tonyx, or gee-N’N-T’N-ix, or jinond-o-nicks, or any one of a thousand variations on this phonetic theme. The drinks themselves are not the same, and vary between the Sivolvian ‘chinanto/mnigs’ which is ordinary water served just above room temperature, and the Gagrakackan ‘tzjin-anthony-ks’ which kills cows at a hundred paces; and in fact the only one common factor between all of them, beyond the fact that their names sound the same, is that they were all invented and named before the worlds concerned made contact with any other worlds.”

 

4. Explore an alternative universe.

Most people don’t realize this, but the Earth, far out in the uncharted backwaters of the unfashionable end of the western spiral arm of the Galaxy, is part of Galactic Sector ZZ9 Plural Z Alpha. Being part of a plural zone means that pretty much every thing that happens here is happening the same way, albeit differently, in an untold number of alternative realities. I especially like this because it means I get to choose whichever of the many plots and endings of H2G2 I happen to feel like on any given day, as the real one. Here are some of the alternate realities of H2G2 for you to enjoy:

The Hitchhiker’s Guide to the Galaxy Original BBC Radio Broadcasts

Back in the earliest days of The Guide, when men were real men, women were real women, and small furry creatures from Alpha Centauri were real small furry creatures from Alpha Centauri, before the story of Arthur Dent and company had ever been printed on paper, there was a radio show. The Hitchhiker’s Guide to the Galaxy originally aired in 1978 as a live radio broadcast, and featured some of the greatest British comedians and voice talents of the day. The radio trilogy is in five parts (the Primary, Secondary, Tertiary, Quandary, and Quintessential phases), and altogether is about 15 hours long.

QUANFans of the H2G2 who have never heard the radio broadcasts will be intrigued by the variant plot points and delighted by new jokes and stories. Moreover, those who felt the books ended a little too despondently (this was well before George R. R. Martin set new standards for literary sadism) will enjoy the radio adaption of Mostly Harmless.

You can find the first 12 episodes here or here. The rest can be found at various places online, or purchased with remastered quality from Amazon.com or Audible.com (which are now, apparently, the same thing).

 

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The Hitchhiker’s Guide to the Galaxy BBC Television Series

Based not on the novels but on the original BBC Radio Broadcasts, the series follows Arthur (played by Simon Jones), Ford and company through the events of The Restaurant at the End of the Universe. It features a number of appearances by Douglas Adams himself and some now-iconic artwork and animations that make the Guide come to life for the first time on film.

 

 

 

The Hitchhiker’s Guide to the Galaxy Movie

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Maybe my least favorite version of the Hitchhiker’s Guide to the Galaxy features, IMHO, the best versions of Arthur (Martin Freeman), Trillian (Zooey Deschanel), Ford (Mos Def), and a beautifully built Marvin voiced by Alan Rickman. Their interpretation of Zaphod I’d rather forget atumblr_md8z9bcowo1qh5qzao6_250bout. It’s a very odd film that still retains some amazing moments, thanks in part to Douglas Adams direct involvement, and original contributions just for the movie. The scenery and cinematography just leaves the TV series standing (1981 vs. 2005). Though the story is the most divergent, it does do a pretty good job covering a version of events from the first novels of the trilogy, and has a special place in my heart as being one of the first movies I took my wife (and then not-even-girlfriend) to see in the theatre.

 

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The 6th book of the 5 part trilogy, And Another Thing… was written by Eoin Colfer (author of Artemis Fowl) in 2009, based on Douglas Adams’ intention of adding another book to the series. Adams had stated, “People have said, quite rightly, that Mostly Harmless is a very bleak book. I would love to finish Hitchhiker on a slightly more upbeat note, so five seems to be a wrong kind of number; six is a better kind of number.” The final book in the trilogy consists, perhaps appropriately, less of original invention and more of returning to characters and ideas from the original anthology. It accomplishes the stated goal of giving H2G2 a sunnier ending, but the ending to the radio series is as satisfying and a whole lot quicker. Still, writing even a passable homage work to this amazing series is a great feat, and Eoin Colfer deserves the credit for such an undertaking.

 

5. Play The Hitchhiker’s Guide to the Galaxy:

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The Hitchhiker’s Guide to the Galaxy contains an entry on Recreational Impossibilities, the first of which is learning to fly. It states, “There is an art to flying, or rather a knack. The knack lies in learning to throw yourself at the ground and miss… Clearly, it is this second part, the missing, that presents the difficulties.”

Pick a nice day and try it. The first part is easy. All it requires is the ability to throw yourself forward with all your weight and the willingness not to mind that it’s going to hurt. That is, it’s going to hurt if you fail to miss the ground. If you are really trying properly, the likelihood is that you will fail to miss the ground fairly hard.

One problem is that you have to miss the ground accidentally. It’s no good deliberately intending to miss the ground because you won’t. You have to have your attention suddenly distracted by something else when you’re halfway there, so that you are no longer thinking about falling, or about the ground, or about how much it’s going to hurt if you fail to miss it.

It is notoriously difficult to prise your attention away from these three things during the split second you have at your disposal. Hence most people’s failure, and their eventual disillusionment with this exhilarating and spectacular sport.

It goes on, but since I’ve never been able to accomplish the second part successfully, I don’t much feel like talking about it. The section on Recreational Impossibilities also includes walking through mountains, and trying to get the Brantisvogan Civil Service to acknowledge a change-of-address card. If it were to include one more, it might consider the Hitchhiker’s Guide to the Galaxy Computer Game.

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Released in 1984, the game was the #2 best selling Infocom game ever after Zork I. The text based adventure game might have been designed by Vogons, based on how much pleasure it seems to derive from killing you in the most frustrating and increasingly perplexing ways. In one notorious bit, if you don’t take a certain action very early in the game, you will die right at the end, once you finally get there hundreds of tries later (if, indeed, at all). I can’t recommend it enough. If this sounds exactly like the way you’d like to spend your evening (or week, or month, or whatever length of time you can safely set aside before your friends and loved ones take steps to get you into some sort of rehab program), you can play the game right here, courtesy of the BBC..

Please leave thoughts, corrections, questions, and especially THE question (it always bothered me that we never found out), in the comments section.

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And at the end they travelled again.

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The past month feels like a whirlwind. We are sitting in the Entebbe airport, eating samosas and drinking coke (with sugar, not high-fructose corn syrup) out of glass bottles and waiting for our flight to Doha, Qatar, which leaves tonight at 6:30 pm. Alex points out that the Entebbe airport seemed pretty run-down when we first came through (the power just went out as I was typing that sentence), but after 3 weeks in Yei it feels like NASA HQ. Currently we are sitting at the café and he is explaining to us the difference between, jacked, ripped, cut and shredded. I can’t tell if this is about working out or violent crimes. The flight is about 7 hours, and we are hoping the kids will be wiped out enough to sleep for a few of those. We only have an 8 hour layover (midnight to eight am), so no airport hotel this time through; our plan is to pay for pool access only, which means we will be able to swim with the kids, Alex will be able to lift at the gym, and we will be able to take showers in the locker rooms; everything we need except a place to actually sleep, which neither of the children made use of last time anyway. After that it’s just a 15 hour daytime flight to Dallas with Aubrey and Caleb in our laps. Can’t wait.

Alex just called somebody on instagram a “monster” and said he must be taking drugs. It could still go either way.

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It’s been an eventful few days since our last weekend. I finished my last day of call at His House of Hope Hospital on Saturday to cap a final week on maternity. It has been 3 weeks of deliveries, c-sections (both performing the surgeries and helping to teach and assist the senior CO’s. Dinya, on of the CO’s that has been here the longest, did his first case from start to finish, or “skin to skin,” on Friday night), OB ultrasound, pre-term deliveries and newborn care, malaria, typhoid, very sick children, death and mourning, recovery and hope, tea at 10, lots of teaching and arguably more learning. I am returning to the relatively quiet life of supervising interns at Hillcrest Hospital (trips like this sure give you perspective), while the hospital goes on and new people come in. On Saturday Dr. Perry’s friend Dr. John Waits came, and brought two of his residents from Cahaba Family Medicine Residency in Centreville, Alabama. My final day’s responsibility consisted of orienting the new residents to the hospital. At the end they seemed a bit shell-shocked, like I was on my first day less than a month ago. It was good closure.

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If you can’t beat ’em, join ’em

Outside of the hospital, we tried to cram as much into our last week as possible. Alex walked to town several times and made friends with a group of Boda drivers (apparently they are some sort of mix between a motorcycle gang and a taxi company). The younger Perry girls had a slumber party with Aubrey on Saturday. We followed this with a game night on Sunday and a dinner with just us, Alex, Jeff and Elizabeth on Monday while the Perry kids watched Aubrey and Caleb. The Perrys are coming home in April for home assignment (the term furlough has fallen out of favor, since long-term missionaries are generally travelling and working hard while back in the States), and we are excited that we’ll get to see them again in a few months, instead of 2 years.

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This morning we had a special birthday breakfast for Given, who turned 8 years old. We were delighted to bring a Doc McStuffins toy with us from the U.S. as a special surprise present from us and her parents. After that we loaded up the landrover and half the family drove us the 30 minutes to the airport on the other side of Yei. A note on logistics; our plane was scheduled to depart at 8 am, but Elizabeth insisted on us leaving from their house at 9:20! We got to the small building, unloaded our bags, checked in, stamped out of the country, and went through customs in time to walk out and watch the plane land at 10:22 am. We waved goodbye and got our small plan back to Entebbe. The mood was a bit somber; 3 weeks just isn’t enough time to live around people like the Perrys and Loftus’s and the rest of the team there at Harvesters, and work at a place like His House of Hope Hospital. We all felt like we could have stayed another month at least.

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We’ll likely be writing more in the next few weeks about our time in South Sudan, as we process the trip and think about the future. Perhaps the most wonderful thing has been watching the kids go from being scared of everything to feeling comfortable and at home in that small missionary compound in the heart of East Africa. Just now Aubrey told us, “I want to go back to our house in Africa!” Please pray with us that when the time comes, we would be faithful in following God’s call to make those words a reality.

All the Little Things

I think this post will just be a simple human interest piece with a culinary focus. I’ll try to fit in several of our favorite moments and the laughs in between. I have been amazed at how well Aubrey and Caleb have just continued with who they are in this very different place. There have been mentions of home between TJ and I as we plan out this last week, trying to fit in all the things we want to do (namely a few more family walks, more time with the Perrys and another game night with Maggie and Matthew), and Aubrey, always a keen listener to conversations she isn’t a part of, picked up on it. I’m not sure if she had wondered about going home at all or was too busy learning about life here to think about it, but she started just yesterday asking about her house in America and her friends there. Caleb of course is fully in the moment and it is interesting to see how acclimated he is now. He does bring up some things about home though! Someone said the word hot tub in a story today, and Caleb started yelling, “hot dog pees! Peessss, hot dog!!” He was very sad when I couldn’t give him one. Other than a few moments like that, this is his new home and life as far as he is concerned. What will a real move to the field look like? TJ and I continue to process this question as we find our rhythm here.

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Elizabeth and Jeff

Last week we had a double date with Jeff and Elizabeth while Aubrey and Caleb stayed with all the Perry kids (their oldest, Lilly, is 16) at their house for a movie night. It was wonderful fun. Hazel, Given, and Winnie were beside themselves excited about getting to give Aubrey and Caleb a bath and put them in pajamas; they helped me pack up a little back pack of all the things the kids could possibly need and walked us over to their house. TJ and I had a great time getting to talk to Jeff and Elizabeth without interruption.

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They took us to the Bishop’s compound (they have a great chef) in town after a quick trip through the open air market. We got a neat curry take on American hamburgers with chips (French fries) on the side. And an almost cold coke. Such a luxury! Date night second edition happened last night and we went to the only other restaurant. I didn’t catch the name, but it was Ethiopian. I will say, TJ and I had never eaten Ethiopian food before and we were both shocked when Elizabeth tore the white spongy looking napkin the food was served on, dipped it into the sauce and ate it. For anyone who doesn’t know, it’s called injera and is a sourdough flatbread (thanks, Wikipedia!). It reminds me of a crepe just a little.

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Our delicious Ethiopian injera

We thoroughly enjoyed our time together. Driving to the restaurants (and everywhere else) is really more like off-roading it. I wish I could have taken a picture of the gullies and sometimes waist deep trenches all through the main dirt roads. I was too busy hanging on as we slowly lumbered in their range rover over the rough terrain! I am going to have to gain some serious courage (and learn how to drive a stick) to get behind the wheel on the mission field.

Filling the hours of the day has been more challenging after the first week, but having nowhere to be promptly means we can stop and enjoy things like a long trail of huge pale orange ants climbing up a tree (Caleb stuck his hands right in the trail and there was a slight frenzy on my part to swipe them off),  random wide short logs that are fun to try to roll, and any small green weed daring to grow during the dry season (Aubrey likes to pretend she planted them and yells out, “Look Mommy! My seed is growing! We need to bring it water!!”).

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Log rolling for fun

During walks, Aubrey likes to make dust trails for us to follow by dragging one foot or shuffling both feet in the inches of dust everywhere and asking Caleb and I to only walk in the “path” she made. We have managed on several occasions to take thirty minutes to walk to the Pyatt (a one minute walk without kids) and I usually don’t mind. We have visited Maggie and her two kids, Naomi and Leo, multiple times and switch off houses. Our latest favorite, as it has been getting hotter, is playing in the water tubs (yes, the same dread water tubs that Caleb would not go near during our first week). Lots of busy pouring from one container to another and then episodes of intense splashing fill the afternoon nicely! This has cured Caleb of his fear of baths and now he wants to climb in one every chance he gets, clothes on or not.

 

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Sushi with difficult to find cucumbers, lots of avocado, and home made cream cheese!

A favorite has been lunch with the Perry family. We have had homemade sushi, thai soup and pad thai. They often eat later (around the kids nap time) so twice my kids have slept at our house (with an eager Perry helper or two hanging out just in case they wake up early) while TJ and I have enjoyed lunch kid free with the rest of the family. This usually includes Alex and that makes TJ and I happy. Alex has all the older kids laughing at his antics and stories within a few minutes of sitting down. Elizabeth has endeavored to find a way to make all their favorite dishes even on the mission field despite limited fresh vegetables, not very much meat, and very different dairy products. When the power went out for several hours the first week we were here, Elizabeth had been in the middle of baking 9 loaves of bread that would last her family the next week and a half and had to switch all those pans to the wood fire oven outside the Pyatt! Three hours later, they were done and still turned out great! She and Rebecca (the Canadian doctor here for three months) just made cheddar cheese the other night and are waiting for it to age. I think I should go to a cooking from scratch class with a focus on creative substitution in recipes prior to moving somewhere without grocery stores.

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On our field trip walk

I have missed being able to take the kids to a park or library or Mayborn, until we discovered the pig farm! Just a small walk away down the big dirt road outside the compound, there is a small wooden fence enclosed pig sty with four large pigs. They are owned by someone the Perrys know and Elizabeth pointed it out to me on a run one morning. Never have we been on a better field trip. Maggie and I teamed up with the Perry girls extraordinaire (including two other MK toddlers they were watching) and led our little troop, munching on digestive biscuits on the way, to the destination. The Perry girls hadn’t ever stopped to look at the pig farm so they thoroughly enjoyed it as well.

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Pig farm!

We ooh’d and aww’d over the stinky dirty pigs and their big rubbery looking noses, and the kids’ eyes almost fell out of their heads when they saw the pigs getting fed “slop.” We walked back to our house and promptly colored pig pictures to hang on the walls. Since that first trip, we have been two more times!

 

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burger and fries night

Oh, one other highlight I can’t forget to mention was the night we ordered “delivery” from the EPC compound (the same one we went to on our date night). Alex paid 450 pounds (about 22 dollars) for five hamburgers and five orders of chips. He had also gotten us cokes and REAL ketchup in town earlier that day and we had a feast! The kids were so excited they had a dance party around the table.

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Aubrey leading the dance party and Caleb loving it!

Neither one of them actually ate anything but fries and lots of ketchup since the burger meat was a bit spicy, but that didn’t matter. We had just finished eating (thankgoodness!) when Caleb stood up and turned around in his high chair, and TJ said, “What is that all over his back?” Yep, poop explosion. We hadn’t had to deal with one of those since before the 1 year mark! Not even that could put a damper on our fine dining evening.

To find some sort of conclusion to this random assortment of recaps, I will say the Lord has so richly blessed us during this trip by providing fast friendships, good fellowship, and time for long conversations. The kids are thriving, and TJ and I love the adventure of new and different together. The sobering thought is once the newness and excitement wears off, underneath there will be a depth of confusing cultural differences, language barriers, and very difficult medical work wherever we end up going. We are praying for grace to see us through the “Dancing Elephant” stage on our own foreign mission field and His energy to stay the course when we become weary. Only three more days before we fly back! Thank you for all of your prayers and thoughts!

Medical Culture Shock (part 2)

After years of conditioning and institutionalization, many residents have a hard time adjusting when they are not on a strenuous schedule. Even though we commonly work 80+ hour weeks, we still feel like we are stealing from the clinic or getting away with something when our schedule gives us an afternoon off. In the hospital, life begins at 5 am; that’s just the way it is. Life does NOT begin at 5 am at His House of Hope Hospital in Yei. The day begins with a staff devotional from 9 to 10, followed by tea until about 10:30.  After tea there is either teaching rounds or case presentations, after which the work of rounding (finally) begins. There are important reasons for this. Many of our staff walk for miles to come into work, and starting the day shift while it is still dark isn’t possible for them. Also, rounding is generally more helpful if you already have lab results available for patients who need them, and since our main source of power is solar (and solar power doesn’t work as well at night), having all of those labs finished by 7 am is pretty much impossible.

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Dr. Perry teaching for the CO’s

Patients are cared for during this time, of course, but when you are used to knowing about all of your patients and having the bulk of your work done by 8, 10 o’clock tea can be a little exasperating. Regardless, by 11 things have really ramped up… and then we break for lunch from 1 to 2. I’m no stranger to eating on the go or working straight through meals (in med school I consistently lost weight on EVERY inpatient rotation), and my first day I decided I would just grab a quick 10 minute lunch and keep working, with or without the rest of the staff. This became challenging when I returned to the maternity ward to find it deserted; almost all of my patients had left to go have lunch, too. I guess in my hurry to finish the work I could have tried to press on without even them, but a doctor must have patience.

Since those first few days, I’ve really come to appreciate parts of this schedule. The later start to the day has allowed Katie and I more time to read scripture and pray together in the morning (something that often feels impossible to maintain on hospital months at home), and gives me time to eat breakfast with Katie, Aubrey and Caleb. The devotional time itself is really quite beautiful; the hospital begins each new day with praises and worship offered to Christ through prayer and English and Arabic hymns, and a short message focuses our hearts, reminding us that we are each working for God and not for men, and relying on Him for healing.

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Dr. Loftus sharing in morning devotion

 

This reminder is important, because the other shocking part of working here is just how difficult it is to take care of patients who are so ill. Because many patients come from far away and do not seek medical care until the last resort, His House of Hope often sees the sickest of the sick. Any child here would be the sickest on our service at home, or already transferred to a specialty pediatric hospital. One night on call I had just arrived, along with my CO, at the bedside of a small child who had been admitted earlier that day for severe malnutrition, severe dehydration, severe malaria. He was 1 year old and weighed about 11 pounds. His hospital care had been appropriate so far, but I was just coming on call and wanted to see if there were measures that we could add that night. I had no sooner laid eyes on him then I was called away to a truly emergent C-Section. As my CO and I were finishing the surgery and Dr. Perry was intervening for the premature newborn baby, we heard the all too familiar wail of mourning from outside. We were informed that the small boy had died.

If I had thought about and worked with that child for that hour instead of performing the C-section, would I have been able to save his life? Or was it just too late to intervene when he had been so sick for so long? I’m not sure. But the truth of this and so many similar experiences is clear; when you are a missionary doctor in a setting like this, to be one place means you cannot be another. His House of Hope has grown so much since the Perry’s moved here 5 years ago, and now there are several full time missionary and South Sudanese doctors, and short termers like us, in addition to the CO’s, midwives, nurses and other staff. There is fellowship, there is support, and maybe most important of all, there is backup. Culture shock is one of the things that can end a call to missions prematurely; burnout is another. You have to have a break, you have to see your family; but depending on where you go, taking a day off might mean that people are going to die who might have lived if you had been there.

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Matthew Loftus (matthewandmaggie.org) and Jeff Perry (perryclan.com)  Two of the full time missionary doctors here in Yei.

I’m not sure how to process that yet. Looking ahead, I know that same part of me that worked through lunch and dinner all those days in med school and residency would be tempted to try to work night and day. That part, unchecked, would get me a plane ticket back home before we had been on the field for a year. I know the docs who are here have struggled with that and have had to set-up strict rules for themselves, to make sure they have time to rest and spend with their families. You can’t “work until the work is done” when the work is never done.

Thank you so much for sharing in this journey with us and for all of your prayers and encouragement. As we enter our last week here, please pray for the doctors, the CO’s, the nurses and the staff of His House of Hope, and for all of our patients, big and small.

Medical Culture Shock (part 1)

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Looking back, I think I may have experienced just a little bit of culture shock during my 3 weeks in Burkina Faso in 2006. It’s hard to say. On the one hand, I don’t remember much in the way of anxiety, fear, feeling homesick, a desire to withdraw, or judgment of the host culture. On the other hand, we had a deck of cards out in the Lyele villages and we played A LOT of Gin Rummy. I mean, like 200+ games. I’m not sure if it was really a form of escapism or just a way to fill the 14½ free hours each day, but it was certainly a coping mechanism. I have definitely experienced reverse culture shock, and this is one I’m pretty embarrassed about. After that trip I came back to the States and had to take a few Summer classes at Bossier Parish Community College. After registering as a student and paying tuition at the business office, I walked outside to explore the campus a bit, when nature began to call. Remember, I had been in the bush for the 2½ weeks prior to this. Without thinking, I walked up and stood facing the outside wall of the administration building, and… realized what I was about to do just in time, and quickly walked inside to find a restroom!

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Those bushes weren’t there yet in 2006

Here in Yei, I only seem to be experiencing culture shock in the hospital setting. Healthcare in much of the developing world tends to be quite paternalistic (not that we are exempt from this in the U.S!). In my practice, if I’m treating a patient for a bacterial infection I will explain the condition, what I think caused it, the treatment I am recommending and some of the major side effects, and other medical and home remedies or supportive measures the patient might find helpful while the antibiotics are treating the infection. I’ll pause for questions multiple times and assess whether the patient and I are on the same page and whether they are likely to be adherent to the treatment regimen. This process isn’t as arduous as it sounds, but even if it was I’ve been taught that this is the best way to communicate with my patients. The process here is more straightforward: “Take these pills for 1 week.” Or, if you are feeling particularly smarmy, “You are sick. Take these pills for 1 week.”

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My clinic team, at the end of a long day

I’m not quite there. It’s always hard to find the line between ethnocentrism and “now I will show you a more excellent way,” but for now I’m going to continue to try to model intentional patient communication for the CO’s and nurses. The patients don’t quite know how to handle it. They laugh when I introduce myself, and especially when I ask if they have any questions at the end of the visit. The most confusing part for everybody is the anticipatory guidance. When I explain the warning signs and symptoms the patient should look out for, including reasons to come back to the hospital, the interpreters nod at me and say ‘ok’. When I further explain that I want them to now tell that to the patient, there’s an awkward pause. They are probably just figuring out the best way to explain what I said, but I secretly wonder if they are actually waiting to see if I am joking.

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Finally got a picture of the labor ward

Medical privacy is another area I’ve had to adapt to. Generally I sit down next to my patients when talking with them; it helps people feel heard, less hesitant to ask questions, and softens the perceived power differential. Last week on rounds on maternity, sitting across from my patient meant I was actually sitting on the next patient’s bed. We’ve had surreal moments where we are trying to convince someone that a medication or intervention is necessary; when she is hesitant, other patients and visitors in the ward are likely to chime in to convince her to listen to us (or I assume that’s what they are saying). It’s the same in clinic. This week I’ve been on antepartum clinic, and because of Yei’s size it’s not unusual to see 60 or more patient’s in a day. After they are assessed by the midwives, they are called in 4 or 5 at a time and sit in a row next to my desk. After I have seen one, she leaves and they all move to the next chair in line. This is a great system for efficiency, and necessary to take care of so many women who are in such need of good quality prenatal care; but it still feels pretty awkward to talk with my patient while my next 4 patients watch and listen from a foot away. Fortunately, as best I can tell I am the only one that feels at all uncomfortable with this.

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Antepartum clinic. I’ve still seen worse (ahem, Denver Health)

I’ll share more tomorrow. In the meantime, please pray that the God who commanded us to go into all nations would also give us wisdom once we get there, and that He would show me both what to teach and what to learn from the way things are done here.

Time with Orphans

I have so many thoughts about what we are learning here that it’s hard to know how to write them all down. That’s why it has taken me so long to blog! So the other night we were hanging out at the Perrys’ and enjoying their fellowship. I was overhearing Jeff and Elizabeth’s conversation with TJ (Caleb wasn’t interested in what they were saying so he and I were playing on the floor) and was so intrigued by the wisdom and experience they have as senior staff here and long term missionaries. Jeff was describing three types of short term mission trips. Feel good trips, do good trips, and real good trips. We all laughed at this and he elaborated with multiple examples.

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Playing next to the Harvesters huge truck on the compound

Feel good trips are when teams or individuals come mostly wanting to feel good about what they get to do or their interactions with the people here. They want a quick fix for all the hurting they see because it makes them feel better. Instead of following the advice or even instructions of the long term staff, they make their own decisions about what seems best and very unintentionally make things harder for the missionaries who live here and have to deal with the consequences after they leave. An example is when people freely give handouts or gifts, unintentionally creating expectations. A do good mission is one that provides a service or offers some good but makes a lot more work for the long termers. An example would be a specialty surgeon coming to the hospital. They offer a needed service, but also use up all the OR time (so all the normal c-sections have to be done late at night), all the supplies from the OR, and because of so much extra work and long hours, leave the staff feeling burnt out. A real good mission is when that same surgeon returns but this time, brings all his own scrub techs, assistants, and supplies and is able to provide follow up. How interesting is that? I really appreciated hearing that perspective. Especially as Jeff and Elisabeth went on to say that although short termers can be more work, when it is viewed as part of their ministry, it is a blessing they are thankful for!

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Splashing party with baby Leo in the Pyatt

During orientation Jeff had mentioned that the orphans stay on their half of the compound and aren’t supposed to come around the mission housing. He said not to give any one on one special attention or any handouts. I love kids and hearing that made me wonder why there were such boundaries. I have learned a little more since then. Establishing real relationships with the orphans, learning their names, staying the course with them, and giving them firm authority is the best, what they really need from adults. A month long short termer can’t really offer that. Fun games, ‘football’ and good laughs is a great level of interaction. Reaching beyond that and then leaving makes it harder for these kids to trust and build lasting relationships. They are also pretty street wise (precious little sinners like the rest of us) and tough survivors so they like to take advantage of unsuspecting westerners (phones have been stolen, or if allowed to play with a phone, passcodes have been changed as a trick). Several short term teams have come and passed out candy and toys and had no boundaries. It feels good to the team to love on the kids and give them special treatment. But then they leave and their actions aren’t sustainable. Do you see what I’m saying? All these kids are WORTH it and so adorable and loved by the Lord. AND we need to see them as individuals who need authority, structure and consistency. I understood a little better after Aubrey and Caleb and I hung out with a few of the kids one afternoon.

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Caleb enjoying some milk!

I had been talking to Aubrey about being brave and showing love to the kids here, so when we walked to the swing after nap and collected a following of giggling children, I was so proud of Aubrey for smiling and waving and even shaking their hands (greetings are a BIG deal here). But after a little while she got tired of being touched and patted and having her hair stroked. Caleb was in the swing at this point; I honestly wanted to get him up and out of the way because the orphans are a little rough. Aubrey was standing as close to my legs as possible and wasn’t smiling any more. Lots of sweet black faces were crowding around and giggling at everything we said. Then I saw one little girl pinch Aubrey. Just a little quick pinch on the arm, but I switched into parent mode and suddenly saw these kids through the eyes of a mother. This might have been fueled by the shocked look on Aubrey’s face. I firmly told the girl no and shot her a stern look. She returned the look with an impish gleam in her eyes and I will admit I was a little surprised. I caught them pinching Aubrey or tugging her hair several times over the next few minutes and had decided we would just retreat since I couldn’t always tell who was doing it and me saying NO wasn’t doing any good. I got Caleb out of the swing and started back for the house. Aubrey lagged behind and started playing with one of the girls on the bridge so I hesitated. Should I see what happens? Nope, there were just too many kids playing too rough. Maybe I was being too protective. After all, I had hoped we could spend time making friends with these kids. But I called Aubrey and when she tried to come to me the biggest girl blocked her way. TWICE. Momma bear came out and I stormed back towards that adorable bully fully intending to…well I don’t know what I would have done, but all the orphans shrieked and fled. Hum. Not the interaction I had imagined. I ended up talking to some long term people (ones that work with the orphanage) over lunch at the Pyatt about our interaction. They know the kids by name and addressed the issue. They also offered me advice on having a loud voice, engaging with the children in THEIR space instead of interacting with them on the missionary housing side, and taking any discipline issues straight to the head master so he can keep the expectations for their behavior consistent. Consistency is SO needed for these kids and short termers can often get in the way of that!

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How many kids can you fit on one see saw?

After lots of conflicting thoughts and a few prayers for wisdom, we walked to the orphanage one afternoon. Maggie and I had our boys on our backs in carriers and our girls by the hand. And we brought Alex with us because he is great fun and an extra set of eyes. And we had a marvelous time. We watched the founder, Pastor Denis, working on a new cooking area for the orphanage, then we played on the jungle gym with the kids and had a crazy game of duck duck goose (though their rules are different and we were very confused at first). It was a wonderful afternoon and Maggie and I talked a lot on the walk back about figuring out healthy boundaries around the orphans (for the sake of the orphanage, our own children, and our sanity); mostly for her since she actually lives here.

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This jungle gym was built by an Australian engineer short term visitor and it is well loved!

I had a conversation with Aubrey after our first interaction with the orphans about loving people even when they aren’t kind to us. She hasn’t ever really had to practice that and my first impulse as a parent is to protect her from having to! But that shouldn’t really be my priority, should it? I discussed this with Elisabeth and it led to a deep conversation about how missionaries respond when the people they are pouring their lives into steal from them, lie to them and betray them. Tough love takes a new form in my mind now as I hear about the struggle to balance forgiveness and turning the other cheek with teaching consequences and earning respect by not being taken advantage of. Jesus was mistreated and betrayed and promised us the same when we follow him. It’s funny how I forget that and get surprised when missionaries face difficulties. Being on the field long term is starting to sound and look very different from what TJ and I had always imagined. Our prayer is that God will grow us and prepare our hearts to deal with the struggles we will surely encounter!

 

A Chance at Life

Dr. Perry is writing to the supporters that provided for the Waiting Mothers House about a patient that I mentioned in my recent blog post. He has given me permission to share his letter here as well.

 

Rebecca is a 25 year old who had one birth by C-section, then lost 7 babies to preterm rupture of membranes and delivery. In this, her ninth pregnancy, she had a “cerclage” placed, in which a suture is placed to hold her cervix closed. For almost 3 months, it kept her baby inside. On January 7, 2016, she was 27 ½ weeks along and her water broke.

At His House of Hope, preterm babies have a chance at survival if they can reach 29 weeks gestation. Rebecca was started on antibiotics and steroids to prevent infection and help baby’s lungs mature. As she had no bleeding or pain, we admitted her to the Waiting Mothers Shelter, and monitored her daily for several weeks.

When she was almost 30 weeks, she began showing signs of infection, so we removed her cerclage and restarted antibiotics. The following day, the baby’s umbilical cord fell out of the patient (a “cord prolapse”)—which is usually fatal to the baby immediately. The baby still had a heartbeat, so we rushed to C-section, and delivered a small, but breathing, 2 pound 14 ounce (1310 grams) baby girl.

As I write this, the baby girl is 5 days old and struggling with issues of prematurity—breathing, tolerating feeds, and infection that threaten her tiny body. The parents are attentive and concerned, but have yet to name her, as they hold loosely to hope, having lost so many babies before. The Waiting Mothers Shelter allowed Rebecca to remain near the hospital so we could intervene quickly when problems arose—giving this baby a chance at life.