The Dot


Waiting for the guests to arrive

(Note to reader: I spent a long time writing about Essohanam and Komi’s dot ceremony weeks ago, but I suppose I didn’t complete that important, final step of clicking “save”. Alas, here is a shorter and less fresh version of the original.)

Last month, I had the great honor of being invited to the dot, also known as the dowry, ceremony of one of my friends, Essohanam. I had to idea what to expect. All I knew was the ceremony was to be held in the morning in the village of Agamé, which is directly behind the hospital compound. I was nervous going to bed the night prior to the ceremony, afraid I might miss it, or be late, or be painfully awkward!

I woke up early to brew my coffee and get the kids clothes set out for the babysitter. Essohanam’s brother “picked me up” on foot around 6:30am and we began the trek to the bush. It was a lovely morning; the sky was bright and full of fluffy clouds. We were greeted by children, families, chickens and goats as we made our way back to Essohanam’s childhood home.

When we arrived, the women of the household were busy preparing fufu and sauce. I found my seat in a blue plastic chair under a freshly constructed gazebo made of palm fronds. Guinea fowl and goats were underfoot, and I stared off at the beautiful view of the surrounding mountains. The pastor was the only other guest when I arrived. Within 30 minutes, others began to trickle in to the designated seating area–the bride’s family and friends on one side, the groom’s on another.

There was considerable ceremony that took place, and despite the translation by Essohanam’s little brother, much of it went over my head! I do know we greeted one another multiple ways and multiple times. The atmosphere was warm and cheerful, though you wouldn’t always know it by the bride and groom’s expressions.

At one point, Essohanam’s little sister was paraded out covered in one of the African wax print cloth. This was part of the back and forth ritual of verifying the groom’s family truly knew their son’s bride to be. Everyone found this hilarious, and it was– though I felt embarrassed for shy little sister, Abigail!

Once she was correctly identified as the future bride, Essohanam was asked to confirm that the dot was adequate. She was taken to a private area where she examined the gifts. I’m sure to the relief of the groom, she declared the dot satisfactory. Finally, Essohanam and Komi were able to sit beside each other. They stared ahead as they listened to marriage advice shared by their community. I enjoyed hearing what their Togolese elders had to impart to the young couple. What a special time to get input from the people closest to the bride and groom.

The ceremony concluded with singing cantiques, or hymns, as a group. The loud, accapella singing was gorgeous against the quiet rural backdrop and lush green mountains. I was moved seeing mamas and little babies, brothers and sisters, and elderly guests engaged in this whole celebration. Afterward, we all ate fufu, ablo and a spicy tomato, chicken sauce washed down with syrupy, cold Fantas.

Being the only “blanche” (white person) and a non-Kabyie speaker, I certainly felt a little bit like an outsider at the dot–but the family welcomed me so warmly, I couldn’t stop smiling the entire time. At points, Essohanam’s mother would even caress my back in a loving, affirming way— just as my own mother would! I certainly wouldn’t trade the opportunity to attend the dot. It was moving to witness how faithfully this couple prepared for the special moment where their families could be unified in the support of their marriage. It was powerful to see the two families come together in worship and celebration as a result of Essohanam and Komi’s commitment to one another.

There are so many things I don’t understand about Togolese culture, like the dot, yet I am trying to approach the people, the circumstances with an open heart. And each time I’m drawn deeper into the lives of my Togolese friends, the greater my love for the people here grows.

Disclaimer: My phone’s camera is foggy due to the humidity here, so all of these are reverse selfie shots taken by Essohanam’s little brother.


Abigail hides under the pagne


Great shot!…..


Essohanam and Komi exchange rings


The whole group after the ceremony



Essohanam and Komi with Essohanam’s siblings, Joseph, Malachi, Abigail, and Seto


What Just Happened?

Bryant Deer in Headlights

I can’t imagine this look inspires much confidence from my patients…

There’s nothing like being on a roll, then hitting a wall.  A few months ago we hit that wall here in Togo. A fellow missionary, Todd DeKryger at our sister hospital in Mango got sick. After being he was evacuated to Europe for treatment, he died. He was young, healthy and the leader of the awesome outreach to the Muslim northern part of this country. About two weeks after Todd’s death, we learned that he had contracted Lassa fever, a cousin of Ebola that up until this past year had rarely caused fatalities. At nearly the same time we learned that this information, another missionary from our sister hospital, who provided care for Todd was critically ill with all the same symptoms and evacuated to the US.

Peter Chasing ChickensI’ll go ahead and add the caveat that the burden we bore as a result of this was nothing compared to that of the families and friends of those affected. That being said, the aftermath for us was very difficult for us. Information was slow to reach us and our minds swirled with images from all the dramatizations of infectious disease outbreaks, not to mention the recent Ebola outbreak in West Africa. World Medical Mission did an amazing job supporting us through this entire episode. They sent out extra supplies of medications and equipment to help us prepare for any spread of the disease. We are so thankful to have the support of such an amazing organization.

The next week was the worst week (at least medically) of my life. Nearly every day I lost a long and emotional battle to keep a young person alive. I was devastated. I was scared for my family. I felt alone. Where was the God who answered prayers? Where was the Good Father, the one who gives good gifts to his children?

In some ways I’ve spent the last several months trying to figure out how to get out of the shadow of that period. I still have lots of questions, but I’d like to share what I’ve learned:

1)     The real problem is sin in the world. Maybe that sounds obvious, but the last few months have really impressed that on me. From the obvious: unfaithful spouses spreading HIV, drunk motorcycle drivers crippling and killing little children; to the less obvious: the very presence of disease, systems that hold people in poverty and beliefs that push people to do ridiculous things in an effort to avoid offending their dead ancestors. The effects of sin are devastating.

I think America could probably be compared to a rich person who can afford a lawyer to

Peter Cake Face

Peter Enjoying His First Cupcake on His Birthday

sneak them out of trouble. In the same way, money and other resources often help us avoid the immediate effects of sin. Here there is no buffer. If a dad becomes an alcoholic there is no social safety net. When somebody dies the funeral must be extravagant; otherwise that person might come back to haunt you. This routinely depletes savings and incurs debts, which means no money to pay for school, suitable housing or timely healthcare.


2)     I’m not a big fan of sports analogies, but I’ll use one because I think it’s very relatable: “Everybody has a plan until they get punched in the mouth.” – Mike Tyson. I’m embarrassed to look back and see how quickly I let go of so many good habits, which pulled me into an even darker place. My daily Bible reading and prayer times vanished. I stopped communicating with a lot of my friends. I was vulnerable to that happening because those habits were relatively new. I won’t make excuses for myself. I’ve been a Christian for over 10 years, but I’ve never been great at carving out a consistent time in my life to formally seek God. Fortunately, I have a super supportive wife and lots of great examples here in Togo who inspired me to regroup and move forward. Discipline isn’t an exciting word. Discipline without joy and inspiration can be ultimately destructive, but Paul uses his own sports analogy:

“Do you not know that in a race all the runners run, but only one receives the price? So run that you may obtain it. Every athlete exercise self-control in all things. They do it to receive a perishable wreath, but we an imperishable. So I do not run aimlessly; I do not box as one beating the air. But I discipline my body and keep it under control, lest after preaching to others I myself should be disqualified.” – 1Corinthians9:24-27

Restarting those disciplines for me was prophetic, in that it pulled me back into prayer and Bible reading – back to truth. I’m learning to love discipline. I’m learning to use it like a springboard. Rather than a checklist, it’s more like studying in med school, you have to work hard every day to keep up so when test time comes you’re ready. Only in real life pretty much all the tests are unannounced.

Jasper With Cicada3)      The most important thing is The Gospel. I hate sickness and death. God does too, more than me. Because of sin we are all affected by both. Like I mentioned earlier, in the US we’re sheltered from this because we have so many ways to delay the consequences of sin. I believe that delay allows us to deny the cause and effect relationship. James 1:15 tells us: “…Sin when it is fully grown brings forth death.” Especially in the developed world that process can take years and is hidden behind layers of rationalization and blame shifting. Here there is often no such luxury. Thankfully, as Peter wrote: “Blessed be the God and Father of our Lord Jesus Christ! According to his great mercy, he has caused us to be born again to a living hope through the resurrection of Jesus Christ from the dead, to an inheritance that is imperishable, undefiled, and unfading…” (1Peter1:4). Here it rings even truer. No disease or accident or corruption can take away the imperishable reward we have through Jesus. We share the Gospel with every patient and family that come through the doors. Thousands make a choice to follow Jesus every year. I’m so thankful that despite all the death I see so often, I can rest assured that we are giving a gift that never breaks.

I’ll compare two recent happy endings:

It’s midnight after a long day on call. A 3-year-old comes in comatose. Then he starts having uncontrollable seizures. We give him maximum doses of two medicines with no effect. He starts to have trouble breathing. This is a bad sign – most kids that present in this way die here. I want to go home. For some reason I get the sense that this will be different, so I quit whining in my head, pray for wisdom, then start pushing back. We intubated the child, who is still having seizures despite the addition of another powerful medicine. After another hour he finally starts to calm down. It’s two o’clock, and I’m really ready to go home. We pray again, and I leave. I check back in a few hours later, and thanks to the efforts of one of our Togolese anesthetists and our visiting respiratory therapist the seizures had stopped. A day later he was breathing normally without oxygen. The next day he walked out of the hospital. I wish this was more common, but I’m so thankful for this victory over death.Peter Riding Car

A few days ago I got a request from our clinic to remove fluid built up in a patient’s
She is 65 (65ish, after 40 you rarely see anything other than 0’s or 5’s at the end of an age) and has visited 4 other hospitals. She doesn’t have money to do more complicated or invasive tests, so she’s travelled very far to our hospital looking for help. The procedure goes well, but the results are not so great for her. We don’t have any way to confirm, but everything points to cancer. I inform her that while she will probably feel better for a little while the fluid will likely return, along with her symptoms. She comes back the next week, short of breath, just like before. We’re out of tests. She can’t afford to go anywhere else. We share the Gospel with everybody, and this time she professes a desire to follow Jesus. Again, thank you God! I’m bummed that I don’t have any medical tools to fix her cancer. We still prayed for her healing, but she received something much more precious and long lasting.

Back to the child with the miraculous recovery; I honestly do not know what happened with that family spiritually. But the physical healing he received is temporary. The spiritual healing the older woman received is eternal.


I want to extend a special Thank You to all the people who donate a few weeks or few months of their time to serve with us here. If not for that I would never have the time to write any of this stuff. I also want to thank all the people who make it financially possible for us to be out here as well as those who partner with us in prayer.



Thanks for reading!

Beads around the wrist, cross around the neck

I started Ewe lessons this month after deciding I’ve learned as much French as I can with my private tutor, Mr. Tukpo. He and I meet in the “paillote”, a shaded gazebo down the path from our house. I was apprehensive about learning an entirely different language, mostly because I maintain a strong desire to master French. Some of that apprehension dissolved when I saw the obvious glimmer in Mr. Tukpo’s eye at the suggestion. He is cllearly passionate about his mother tongue and culture.



I had two lessons last Friday because of a scheduling mixup. I could only absorb so many Ewe greetings before my brain became mush, so Mr. Tukpo and I drifted into a French conversation about Ewe culture. I got lost in our discussion of his life growing up in the mountain village of Agou, where German missionaries started churches in the late 1800’s and shared the teachings of Jesus with his grandparents. We talked about names (as my friends know, one of my favorite subjects in any language and culture!) in depth and he shared the complete description of each of his 5 children’s French and Ewe names.

Eventually, we landed on the topic of traditional religion. I’d been curious about some of the practices I’d witnessed in village life. For instance, the practice of pouring the first sip of a beverage onto the ground for ancestors. Or, the practice of putting a strand of beads around babies’ waists and wrists. Mr. Tukpo appeared more than a little frustrated as he shared his observation that a large numbers of followers of Christ still engage in these cultural practices. “It’s just our Ewe culture”, they’d say. He shared about how important ancestors are to people here because they’ve touched them, seen them with their own eyes. It’s hard for people to believe Jesus is a mediator to God because they haven’t seen him with their own eyes, he explained.

I couldn’t help but tear up as Mr. Tukpo talked about his frustration with the muddling of animistic culture and Christianity. Time and again, he’d met people who would pray to their great-grandfather when they wanted healing for something, and if they were healed, they’d spend the rest of their lives making sacrifices to that great-grandfather. How confusing it must be when villagers see their neighbors preaching the salvation of Jesus, but holding on to amulets and beliefs in the power of their ancestors to transcend death and help them in their suffering.

I’m compelled to sift through my own practices and thought patterns to identify where I’ve let my own “American” cultural hangups distract from the true message of Jesus. Am I telling people about God’s perfect love that overcomes fear, but letting fearful thoughts rule my day under the guise of “being a good, protective mother”? Am I preaching a gospel of humility, sacrifice, and caring for the poor, but elevating a capitalist mindset of “gain, gain, gain, gain” above all of those principles?


While the Ewe language is anything but clear to me now, I hope to never confuse what I was reminded of with Mr. Tukpo during my lesson under the trees last week.


On Feeding Babies


On Friday, Dr. Becky Haak called me in to do a lactation consult for a new mother of twins. I was excited to be invited to participate in this meaningful, somewhat clinical activity. Before the meeting I reviewed some World Health Organization breastfeeding materials and studied up on the French terms for nursing (le sein=breast; l’almintaetion maternale = breastfeeding, etc.). As I was studying the material, I stepped back and recognized my own wealth of knowledge born from experience nursing my boys. I thanked the Lord for this and smiled at the fact that I’m much more well equipped for this teaching role than I would’ve been had I run away to Africa at 18 like I wanted.

I carried my index cards full of little notes and reminders to the maternity ward where I greeted the mama and her twin baby girls as warmly as I could. I was confident as could be talking to the mom; questioning her about the girls and making comments about how cute they looked sleeping on the floor, facing one another beneath covers of colorful pagne (African wax print fabric).

I demonstrated how to use the pumps, assisting her at first with the electronic one, and then with the manual version. We discussed nursing frequency and duration, how to operate the pumps, the most comfortable position for mama, and I even mentioned the importance of “Kangaroo care” – or skin to skin contact with the babes, especially if they weren’t eating at the breast. The mama nodded emphatically and seemed to understand, thanks in part to the helpful nurse who translated into Ewe for me.

Somewhere in our interaction, the mama’s caregiver (all women here bring their belle-mere (mother in law) or some other female caregiver to assist them postpartum) mentioned that the mama already had 5 girls at home. She suggested we swap on of my boys for one of the baby twin girls. I laughed, mostly chocking it up to Togolese humor that I find sometimes involves asking for a little more than we’d deem comfortable in the U.S. Nevertheless, I had a creeping suspicion that something was amiss in this story.

Later that evening I popped over to the hospital inquired about the new mama. I was eager to see if she’d made any progress in producing milk. Through the grapevine of doctors and nurses, I learned that the mama wasn’t really that interested in pumping. The joke about trading babies carried more brutal honesty than I’d hoped. She didn’t want the twin girls; she had enough girls at home and her motivation to increase her milk supply was shockingly low. When I asked if I should check on her the next day I was encouraged to let it go; my WHO facts and index card notes would not be of much use to a mama who had given up on ensuring she had enough milk for her daughters.

My little Peter recently left newborndome. I can empathize with this mama’s disdain for hooking up a pump and having to sit still for long stretches of time while your body is trained to do what you’d think should happen so naturally, so effortlessly. It’s a sacrifice of time, energy, and did I say time? To watch your baby grow exclusively off milk your own body created, however, is nothing short of miraculous.

All weekend, the image of this mama reposed on the hospital bed, staring down at the diminutive twins resting peacefully on the floor played on repeat in my mind. The fatigue on her face and the disappointment in her expression became more apparent in my memory’s eye.

I went to visit her one last time on Sunday. I knew she’d be discharged early in the week and I wanted one last chance to convey the importance of pumping and nursing frequently before she left. On my way, I started to pray for her – only this time my prayers changed from asking God to give her more milk to asking God to help her love her daughters.

I walked into the maternity ward to find the two girls being held by the caregivers. They were dressed in matching gingham blue dresses with big lacy collars and puffy sleeves. The mother looked peaceful, well rested, and content lying on the bed next to them. The caregiver closest to me made some joke about the Yovow (white lady) and told me how well everyone was doing. I asked mama about her milk and she said that everything was good. These positive sentiments were echoed by Bryant –who said that the mother was making plenty of milk and seemed to have bonded with her daughters over the weekend.

This encounter left an impression on me. Through it, extremes in our human condition were personified. Darkness tried to steal the day. To steal the beauty we witness in the bonding of newborns with their mothers. To steal the joy that comes when a mama finally meets her baby after many months of hopeful anticipation. To steal the gift of being able to nurture a new life with milk, gentle caresses, and those blissful first encounters when a naked baby learns his mama’s touch and smell as they rest body to chest.

Darkness tried to win by planting roots of ingratitude. Somewhere along the way, the mama was convinced that there was a defect in her gifts. She wanted boys and she got not just one but two more girls.

Beauty and love won in the end. Those girls were created in the image of God, just like their mama. At some point, he awakened that realization in her and drew her out of her dark ruminations. The mother relented and set down her frustration only to find herself freed to love her daughters. The result of this was an increase in her milk production and weight gain in the twins.

Mama and the girls went home yesterday. They’ll be back for a checkup in a week. Pray that that seed of love that was growing in the mama’s heart will flourish this week, and that she will sense Father God’s overwhelming pride in her for choosing to embrace and nourish her new little gifts.



The Right Kind of Smile

The Right Kind of Smile

I think I’m going to start doing a theme on “Get Your Vaccines.” In the third world vaccinations are much less accessible. Even as accessibility improves, education regarding their benefit or availability is also lacking, and decreases the number of people who utilize them. Because vaccines have been available in the US for my entire life I had limited exposure to vaccine-preventable diseases during medical school and residency (a testimony to how well they work).

everyday asheville.jpgTraining in Asheville, the east coast capitol of all things “alternative,” I had plenty of patients and friends (and colleagues) who were “anti-vaccine.” To be fair, I can completely understand the skepticism and hesitation surrounding vaccines. Most parents are very particular about what goes into their kids. They buy the best and most organic/free range/happy-until-butchered food they can find. They read books (websites) on how to bring up their kid to be happy and well adjusted. They agonize over every little decision and feel really guilty when they let their kids watch TV or play with their phone. So I can understand why they would be suspicious when somebody tells them they need to give their already healthy kid these mysterious shots filled with all kinds of “chemicals” that could have it’s own side effects.

I think the root of the issue is that most people alive today have never seen the diseases that we now vaccinate against- because due to vaccines they are nearly non-existent. Of the 11 or so things my kids have been vaccinated for I’ve only seen 5 in pediatric patients in the US: Rotavirus (diarrhea), Pertussis (Whooping Cough), Meningococcal Meningitis (only once), Chicken Pox and Pneumonia (still very common because there are lots of different strains).

Tetanus Before

You can’t really tell from the picture, but his face in stuck in that position, and if you use your imagination you tell the spasms are causing a pseudo-smile

Here in Togo many vaccine-preventable illnesses are quite common. Tetanus is one of
them. It is caused by Clostridium Tetani, which lives as a spore in the dirt. When it enters your body the spore wakes up and starts reproducing bacteria, which can cause an infection. The infection itself isn’t anything to write home about. It’s pretty much like any other wound infection, and often your body can eventually overcome the bacteria without antibiotics. Now comes the bad part: As the bacterial cells die they activate a potent toxin that binds to nerve cells which regulate muscle activity. The result is all of those muscles being in a constant state of activation, or tetany (thus the name). One of the classic signs is something called a “sardonic smile” (I’m sure that brings back memories of studying for boards for most of you doctors). I’ve attached a picture of our patient. He obviously doesn’t look happy. At this point in his course any stimulation: a loud voice, lights being turned on, adjusting himself in bed, resulted in an all-out spasm.

The only way to prevent Tetanus, besides living in a bubble, is with the vaccine. This little boy’s father told us that he took him in for prompt treatment after his injury (stepping on something sharp with his foot) and his medical booklet said that he’d received the appropriate treatment at the government health center. It’s hard to know how true all of that is, but what is certain is that he didn’t have the recommended vaccines before his injury- which would have almost certainly prevented him from getting sick.


Tetanus After

Again it’s hard to tell that he’s happy from my picture, but at least he can open his mouth again!

Fortunately his story ends well! We recognized his illness quickly. We gave him the right
medicines. When the symptoms are severe we give the medicine not only in his iV, but into his spinal fluid as well. He continued to have spasms for several days. Once the toxin damages nerve cells they have to regrow the connections. Sometimes this can take weeks, so he was lucky. The picture shows him opening his mouth. He’s still camera shy, but obviously much more comfortable.

Medical knowledge changes every day. I’m sure you’ve all seen the posters from not that long ago when doctors endorsed cigarettes. Margarine is the healthy and cheap alternative to butter- now it’s on par with pesticides. The reason for this is that we base the things we tell people on the best information that we have, which will always be imperfect. The studies and experiments that we use aren’t always clear, and the balance of evidence for or against something can change…and then change back! Vaccines, however, are not in that category.

Putting the Bed Together

Jasper watching us put together our new bed

Right now there is overwhelming evidence to support our current vaccine programs and the schedule we use. Vaccines, like any medicine have side effects. Right now there is no evidence that those side effects (fevers, pain, and rarely febrile seizures) are long lasting. There has been a single study linking vaccines to autism. It was published in a major British medical journal created a huge amount of suspicion about vaccines. There had been lots of other larger and better-designed studies looking for problems associated with vaccines, which did not show a link to autism. When an outlier study like this occurs we pay attention, and try to validate it by doing another similar study or going back through old information to see if the results can be replicated. Years went by and study after study failed to find a similar pattern. Eventually it came to light that the study was funded by lawyers representing families suing vaccine manufacturers. You might be thinking: “Well don’t drug companies fund studies all of the time?” The answer is yes, but those studies don’t get published in major medical journals and are generally taken with a grain of salt. The result was that the study was retracted and the author lost his medical license. Unfortunately, the original story made much bigger headlines than it’s debunking, and that’s what people remember.


Happy Madmen

There is currently no credible evidence linking vaccines and autism. There are thousands of anecdotal stories from parents of children who were “normal” before getting their MMR vaccine; they went to the doctor and got their shots, got sick and were never normal again. I had patients in Asheville who reported very similar stories. Going back to the earlier commentary on paying attention to what goes into your kids, I think it’s logical to suspect vaccines as a culprit in this case. Doctors and researchers have taken this seriously as well, but haven’t found any association. The biggest confounder for the apparent association is that the second dose of the vaccine was traditionally given at 2 years, which is also when serious screening for autism begins. This is a big subject and could fill up much more than you want to read from me, so I’m only going to hit the high points. The increase in autism has increased with increased numbers of vaccines. The same can be said for its correlation with the price of milk or the number of electric vehicles on the roads. Almost certainly the uptick in prevalence is mostly a factor of increased surveillance. The cause of autism is not currently known. For most kids it is probably congenital/genetic. There are other theories that point the finger at environmental exposures (other than vaccines) or infections. One day (maybe even tomorrow) somebody will discover a link between vaccines and autism or something else really bad. If that happens I (and almost certainly whoever takes care of your children) will be paying attention. For now, the most compelling statistic is that vaccines have increased life expectancy in the modern world more than any other thing except for access to clean water.

Window to InfectionNow I’ll hop down from my soapbox. I’m thankful that my patient survived and had a quick recovery. I’m thankful that my kids probably won’t have to ever experience what he went through. I’m thankful that my kids probably won’t have to experience a number of other diseases that used to kill tens of thousands of people in the US every year. I’m thankful that most of the world now has access to vaccines that can prevent Tetanus and a variety of other diseases. I’m thankful that I’m able to be here, to treat people’s physical needs as well as share the Gospel.

Thanks again for reading! And for making it possible for us to be here!







Entertainment is a bit different here. There aren’t malls or coffee shops or movie theatres that we can just swing over to. We don’t have a car, so the only shopping that we can consistently do is what’s right outside the compound; not much.

anne.jpegInternet is spotty at most. If we want to download a movie to watch it can take a few days depending on the connection. Fortunately for us, some of the missionaries have amassed quite a movie collection over the years. Last week we watched Anne of Green Gables for date night. I had no idea what the movie was about; maybe something like Little House on the Prarie? Rachel seemed excited, so I went along with it.

It’s a long movie, so it took a couple of showings to make it the whole way through. I have not enjoyed a movie more in years. I think outside of my current place in life it probably would have been less impactful. Don’t tell anybody, but I cried…and more than once!

The first thing I wanted to do after the story really began to develop was to jump up and hug my kids. It broke my heart to see the way Anne was treated. How she was dehumanized and undervalued. I remember speaking with a Good friend of mine a year or so ago about being eager for Jasper to start talking. This was while we were in the car with his 4 year old asking unending “why?” questions. He chuckled and responded: “When he gets to this stage you’ll wish he couldn’t talk.” I won’t pretend that I can’t empathize with him now. At that same time I pray (Rachel and I really prayed for it) that our kids would have that same inquisitiveness and fearlessness that Anne showed.Jasper Reading to Peter.jpg
Jasper Wheelie.jpgI think that God wants the same for us and from us. I don’t read from the way that Jesus taught his disciples that he wants us to be quiet until we know exactly what to say. Or that he wants us to make sure we have our life jacket on before we step out of the boat. I don’t think that life is about making the fewest mistakes possible. As a dad (I only have boys, for now) I love to see them try new things. I don’t want them to fall or to fail, but I know that’s a big part of how they learn. It’s not all black and white. I don’t know where the line is between faith and common sense. I have life insurance and disability insurance. I felt like that was smart for me and my family. I don’t let Jasper play with our kitchen knives or with matches. Conversely I cheer him on when he runs down a hill and falls and gets skinned up. The same for when he doesn’t make the jump from our coffee table to the couch.

The other thing that came to mind was how much I appreciate foster and adoptive parents. I grew up with an older brother who was adopted just before I was born. In my adolescence we had a near constant stream of foster kids. Right after I left for college my parents fostered another little boy who eventually became my brother. I’m not going to pretend that it was always, or through some stretches even frequently easy for me or the rest of my family. I know however, without a doubt that my parents changed the lives of many kids; namely my two brothers. They also changed me by being such an example of sacrifice and service.
Peter Hungry.jpgWe also have a couple of friends who have recently decided to adopt new children. A
couple in our small group in Asheville had been fostering off and on. A couple of years ago, right around when Jasper was born they were asked to keep a baby girl for a few days that turned into weeks and months and ended in adoption. Unfortunately her mom had substance abuse issues with drugs and alcohol. Now she has two parents who love and cherish her.

Some of our best friends from medical school are in the process of adopting a little girl. They had just completed their certification for becoming foster parents when they received a call about a newborn whose mother wanted to give her up for adoption. In less than six hours they became parents again.

I am inspired and encouraged by our friends and family who have opened their homes to children without one. Scripture talks a lot about orphans. Isaiah communicates God’s heart for the homeless:

“Is not the fast that I choose:
to loose the bonds of wickedness,
to undo the straps of the yoke
to let the oppressed go free,
and to break every yoke?
Is it not to share your bread with the hungry
An bring the homeless poor into your house;
When you see the naked, to cover him,
And not to hide yourself from your own flesh?”(Isaiah58:6-7)

James is very blunt when he says: “Religion that is pure and undefiled before God, the Father, is this: to visit orphans and widows in their affliction, and to keep onself unstained from the world.” (James 1:27)
We’ve had a lot of people tell us that they could “never do” what we’re doing. Right now we feel the same way about adopting a child. It’s just not where God has us. Maybe one day he will. For now we’re thankful for the example our friends have been to us lately in their faith and selfless love.







Feast or Famine

Just in case you don’t make it through the whole thing, I want to get it out there: We need OB coverage at this hospital from April onward! If you want to come out here or know somebody who might, please direct them to me or to World Medical Mission. French is helpful but by no means required.


The OB Ward – Jesus Film in the Background

Our hospital here in Togo has been around for more than 30 years. This past year, for the first time in those 30+ years it temporarily stopped offering obstetrics due to a lack of medical staff. This extended from the summer of 2015 until the middle of January 2016. It was a blow to morale at the hospital and to the community.

The hospital here is currently staffed by 3 long-term missionaries- an FP, a surgeon and a pediatrician ( the latter two of which are currently on furlough) , 2 FPs provided by the Post-Residency Program via World Medical Mission (the program that I’m in; I’m one of the 2), and physicians who come for 1-6 months at a time. We’re an ~50 bed hospital, along with a booming clinic. Typically we have around 600 Deliveries each year and perform more than 1000 Surgeries. It’s busy here. I’ve been fortunate that for the whole 2 months that I’ve worked here we’ve almost always had at least one short-term volunteer to help out.

Without the help from short-term volunteers our hospital would not be able to keep it’s doors open. I’ll get back around to begging for help again at the end, so stay tuned.

IMG_2118When I chose family medicine as a specialty (kind of an oxymoron huh?) I envisioned two things: missionary work in Africa and being the quintessential, do a little bit of everything small town family doc in the states. I imagined pushing the boundaries of my training to encompass all kinds exciting stuff in my practice. I pridefully assumed that the reason family doctors are becoming more “specialized” was because they just weren’t as cool as I planned to be when I finished training.

Obstetrics (OB) is usually happy. For most people pregnancy is something that happens when they are young and pretty healthy. It’s often uncomfortable, and the actual birth can be tough (but like I tell Rachel, I really do think I’d be awesome at labor!) but it almost always ends with a happy result. In my residency I personally delivered close to 100 babies. Plenty of them were “high risk,” meaning that they had conditions that put them and their babies at risk. Almost every one of those deliveries went really smoothly. I alluded to it above; most family doctors don’t deliver babies any more. Some people just didn’t receive the training to do it. Some people never intended to. Others have interest but don’t want the extra time commitment that it requires.

Bryant Snake MAHECWhere I trained, in Asheville we have the opportunity to do enough obstetrics to feel comfortable continuing to do that after we graduate. Most of my class started out interested in delivering babies after residency. I was one of them. As I settled in to training and started to pick the brains of my upperclassmen about whether they planned to practice OB after training I heard a common theme: there will come a time in OB where things go really bad. After that you’ll know whether you can do OB. Again prideful as ever I had a hard time imagining getting scared off of anything.
My scary moment didn’t come while I was on duty. It came as a husband and future father. While Rachel was laboring with Jasper his heart rate suddenly dropped…and stayed down. It was an agonizing couple of minutes. As most of you know, Rachel ended up having a c-section. I didn’t realize that was my moment for awhile after that. All the peaceful and easy and happy births I’d been a part of up until then disappeared. I wasn’t so sure I was cut out for OB any more. Fast forward to now. I don’t have that luxury. There are three medical doctors here who can deliver babies and I’m one of them.

FullSizeRender 5Our OB service is off and booming. We’re averaging ~35 new patients each week. If that is sustained we’ll approach ~1000 deliveries this year. The first week started out great. Healthy moms and healthy babies – the way things are supposed to be. Then all of a sudden one day the hammer dropped. Patient after patient came into the clinic with complications. One patient, in her final trimester was sent from a large hospital about 2 hours away. Unfortunately when she arrived her baby no longer had a heartbeat. Another patient with pre-eclampsia began to bleed heavily during labor and had to have an emergency c-section. Only a couple of hours later another baby developed troubling decreases in his heart rate and had to be delivered with a c-section. Then saddest of all happened in the early hours of the morning. Another patient with pre-eclampsia on the edge of viability (the medical term for the age at which a baby can survive being born. In the US is now around 23-24 weeks. Here it is 28 weeks because we don’t have the same resources to support premature infants) began to have signs of trouble and before she was able to make it to surgery her baby died.

Coupled with some heartbreaking cases in the non-pregnant hospital population, I walked out of the hospital that evening feeling devastated and angry. I saw a vulture perched in a tree just outside the hospital. I stopped and screamed at it. I’m struggling with seeing so much death and disease here. But I’m resolved not to get used to it. It’s in those times that I have to fall back on God’s promises: That He is in control and that He has a plan(Rom8:28). That any notion of unfairness or empathy or sympathy I feel, He feels it more(Heb4:15). That He is a good father (Mt7:7-10)

Most people in Africa have their babies at home. For most people that works out just fine. I’m sure a few people will get stirred up over my next statement, but in my line of work, and especially concerning moms and babies we don’t shoot for “most.” “Natural” is what happens in Africa – in this country neonatal mortality is 10x more than the US. Maternal mortality is 30x. At our hospital we’ve had two maternal deaths in the past 3+ years.

We also share the Gospel with every patient that walks through the door. Sadly, if we aren’t able to muster more OB coverage after April of this year one of those doors (OB) will probably temporarily close again. That means a step back closer to “natural” and less people who will be reached with the Gospel through our mission. So again, if you can think of any physicians or midwives who might be able to help out, please pass it along.

Again, thanks for reading. Thanks for supporting us. We’re making a difference here. We love you guys!