Giants Upon the Earth

"Hi, Jon."

I had just descended the stairs after passing through immigration at Nairobi's airport. There were Sue and Alan, my old neighbors and colleagues at Kijabe. They had arrived from their current place of service to attend the same conference.*

Seeing the two of them always unleashes a flood of memories. Many times I had enjoyed their hospitality while living as a single person at Kijabe. Alan is a surgeon, and I an internist, and we shared many patients together.

The first time I met Alan was a little nerve-wracking, to be honest. Newly arrived in Kenya, I was invited one Saturday to go to Nairobi. After we had climbed up the long escarpment from the hospital, Alan maneuvered the car onto the country's main artery.

"Drive on the left hand side, drive on the left hand side..." He persisted in repeating this mantra, om-like, for a minute or two, as if to assure himself he was indeed on the correct side of the road and would not spontaneously drift into oncoming traffic. Only later did I realize that Alan and Sue had just been evacuated yet again from eastern Congo, where they had served many years and where they had left their hearts.

In Congo, they drive on the right-hand side.

Still, I couldn't help thinking, "Is this guy OK?"

I came to learn that he was more than "OK," even if a bit eccentric.

Alan could do a lot. A general surgeon, his skills extended to obstetrics, trauma, urology and basically whatever needed to be done. But what was more important was not what Alan could do, but what he was willing to do, and how he did it. Kijabe Hospital today has about 30 doctors, but not that many years ago there were just five of us, along with a few interns, covering the hospital for a month. Alan rotated surgery call with a visiting general surgeon, obstetrics with a young Kenyan doctor, and medicine and pediatrics with me. He covered one or more services every night. He never complained. In fact, he enjoyed work immensely.

Before we had a formal intensive care unit, a few rooms were set aside for the sicker individuals. Called the "high-dependency unit," it was aptly named only because it was highly-dependent on me being there most of the time. I often grew utterly exhausted and found it hard to do a good job anymore.

One young woman had gone into kidney failure following a miscarriage. Blown up like a balloon full of excess fluid, the IV lines kept slipping out of her hands and arms. We urgently needed to give her injections through the vein to remove the fluid and ease her labored breathing.

I told the nurses to try again, but if they couldn't do it, then I would come back after dinner to place a large catheter in the neck. Trudging back to my house, staring into my instant noodles, I dreaded the prospect of returning to the poorly lit room, bone-tired, to attempt this risky procedure.

My pager rang. It was the high-dependency unit. I knew they wanted me to return and place the line. I dialed the number.

"Hi, Jon. It's Alan. I see that one of your patients doesn't have IV access. Do you want me to place a central line?"

An anvil fell off my shoulders. Bless you, Alan! Yes, I would very much appreciate that! So I was able to rest for a few hours before going back in to check on the patient (who ultimately recovered).

When Alan and Sue decided to leave Kijabe for the final time, a young Kenyan doctor told a revealing tale. In those days in Kenya it was very difficult for a junior doctor to approach a senior consultant. But in challenging cases this is exactly what needs to be done, to ensure the best care. This intern was in her very first month of training. One night a man came to the hospital with urinary retention: his bladder was distended because of a blockage, causing tremendous swelling and pain.

Not skilled in the necessary procedure, Catherine called Alan, who promptly came down and spent a few hours placing the catheter, teaching Catherine and admitting the patient. After the process was completed, Alan said gently to her, "You know, next time you could page the surgeon on call."

Alan had not been on call. But he was following his oft-stated philosophy: When someone asks you for help, you have a choice. You can assume they need help, and help them, or you can pass it off. Alan always helped.

The young intern was mortified. Already scared of paging a senior consultant, she had in fact contacted the wrong person. If Alan had yelled at her or criticized her, she might have been reluctant to ask for aid the next time it was really needed to save a life.

At the same medical missionary conference where I reunited with Alan and Sue, I saw other friends and colleagues. I take care of patients with TB; a missionary doctor had contracted TB and had become quite ill for a time. I have evacuated expats from Malawi to South Africa; a colleague had himself been evacuated from rural Ethiopia to South Africa because of serious illness--only to promptly return to Ethiopia.

One of the finest all-around doctors I have ever been privileged to work with (and who delivered my oldest child) has moved to South Sudan, not far from the fighting, where 50,000 refugees now crowd the area around the mission clinic which receives funding from AMHF.

Also present at the birth of my son was a missionary obstetrician with decades of experience in Africa. I learned this month that she has multiple sclerosis, and recently suffered a stroke. Yet still she is headed to the Congo to help rebuild the mission hospitals destroyed during the war.

At a presentation where all present bemoaned the declining interest in and vitality of mission hospitals, a young Nigerian doctor protested: "When I was a child, the only place you could go where people cared about you was the mission hospital. That's why I decided to become a doctor serving the poor." He manages an AMHF-supported program to repair vesico-vaginal fistula (VVF) injuries resulting from obstructed labor.

In residency, we used to speak--half-joking, half-in-awe--of the giants who before us had roamed the earth (defined, of course, as the wards of Hopkins): Osler, Mckusick and other luminaries. "Well, in the days of the giants, this is the way it was..." We weren't the giants. I wondered if they ever really existed. Like dragons or unicorns, they were more myth than real men or women.

Having served in Africa I know giants do still walk the earth. You must search carefully for them amidst lonely places. There you will find them treading softly, enduring secret wounds, bearing healing gifts, carrying heavy and joyful hearts.

Yours in struggle,