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.
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.
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.
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.