Dear MDA,

Terese and I would like to thank you, the friends and family who have supported us in this mission, and the greater community of individuals who make up Mission Doctors Association for the opportunity to serve on mission in Nyakibale, Uganda at Karoli Lwanga Hospital. Our experience has been richly blessed by the Lord through work, in faith, and as family.

Medical Work

Terese arrived at the hospital with co-workers Mark and Sheila Bisanzo at the beginning of July. Paul and André (age 6) arrived mid-July, joining in work at the hospital. Medically, our work was shared between attending on the paediatric ward in the mornings and then helping to staff the ED in the afternoons with Dr. Mark Bisanzo. The paediatric ward was frequently crowded. For two weeks we had the pleasure of teaching medical students during work rounds about medical principles and physiology while they taught us about the epidemiology and usual treatments for common diseases affecting many of the children such as malaria and malnutrition. Other common illnesses that we treated included gastroenteritis, meningitis, complications of HIV such as opportunistic respiratory infections and diarrhea, and asthma.

After work on the wards was tied up for the day, we would usually break for lunch, going to the guesthouse to eat food prepared by the nuns. Our break from the morning’s work was appreciated. We would talk about what we had seen, what treatments we had prescribed, and we would enjoy our time with André at lunch before going back to the hospital. Our work in the afternoon was frequently spent in the Emergency Department with Mark Bisanzo. Terese used her skills in family medical care to help treat both the aged and the young, with everything from orthopedic problems, to lacerations, to chronic heart failure to acute severe malaria. She developed skills in sedation to help with procedures that were required for the patients. Paul applied his training in pediatric critical care to assist with acutely ill children and newborns and also used his skills in sedation to help provide anesthesia for patients who needed procedures.

In addition to providing direct patient care, Terese and Paul were instructors in Dr. Bisanzo’s ED curriculum. Dr. Mark Bisanzo is training the ED nurses in advanced emergency care to give them the skills they need in triage, resuscitation, and first line care of patients who present when there is no doctor immediately available. Terese gave formal lectures on the principles of antibiotic treatment and Paul lectured on the assessment and resuscitation of the acutely ill child and newborn as well as early management of shock in healthy and malnourished children.

Our experience in Uganda was the first time that we had worked together as colleagues, side by side. We often asked each other for input and learned from watching each other with patients and staff. Terese was able to help Paul a great deal in adapting to a very different clinical hospital environment limited by few nurses, no monitoring, and different medications. She helped orient him to the common illnesses and diseases. And finally, she was able to offer suggestions for communication to obtain more information about patient histories and possible chronic co-morbidities. Paul was able to provide help to Terese by helping her assess critically ill children and was animated by working together to manage the paediatric ward.

Spiritual Blessings

Our spiritual life was renewed and cultivated. Terese had rich experiences of the Lord’s providence and love both in her time alone and in her time with Paul and André. The same was true for Paul.

When Terese was preparing to go to Uganda, she had to make a few difficulty choices about what NOT to pack. The medical supplies took up most of the space! There were also a few important items that she forgot to put in her bag. Upon arrival at the guest house in Nyakibale, she was humbled to find all the exact items she had forgotten or chose to leave at home. This was a special answer to her prayer that God would provide for her on her journey. God was so generous with His provision…even the Lord of the Rings movie which she was unable to transfer to her laptop was playing one day at the outpatient clinic. Upon settling into life in Nyakibale, Terese joined a Catholic charismatic prayer group on Saturday evenings. Terese loved the prayer life of the community, worshiping God with song and dance to the beat of the drums. After her second attendance, the leader of the group invited Terese to preach at the next prayer meeting. Terese found this a very spiritually enriching time to study scripture, pray for Jesus’ guidance, and prepare for preaching. She was very blessed by the communal prayer of blessing prayed over her prior to preaching. The experience was an incredible witness to the oneness we share in Christ. Despite all cultural differences, there is “one body and one Spirit, as you were also called to the one hope of your call; one Lord, one faith, one baptism; one God and Father of all, who is over all and through all and in all.” (Ephesians 4:4-6)

Paul experienced the Lord’s care from the first moments of his trip to Uganda with André. André was a dear travelling companion. He was strong and patient and provided the comfort that only a child can provide, sleeping trustingly in his father’s lap as they flew across the Atlantic or rode a bus over the dusty pot-hole-ridden roads to the southwestern corner of Uganda. There was an abundance of kindness and help along the way: Paul and André always found themselves travelling beside individuals who were eager to offer a friendly smile or a kind word and a tip of advice. The Lord calmed Paul’s fears and anxieties. Finally, the readings of scripture took on a strong guiding role for Paul and came alive through his experience as a doctor in the hospital. Because the liturgical schedule assigns the reading of Exodus and the account of the passage of the Israelites into Canaan to July and August, Paul was able to reflect on how God had taken the family to a new land, and how the Lord was asking them to trust Him and to leave fear and worry behind, even though some of the experiences were difficult and the comforts of home were lacking. The Gospel readings also dwelled on the passage of John 6, the Bread of Life Discourse. This was rich spiritual reading for Paul as he adapted to having less than back home (both materially and medically) but found himself having to depend more on Christ as he was blessed with time for reflection, time for family, and time for fellowship with Ugandans and Americans who were there on mission.

Another spiritual blessing that was born of our work in the hospital was the sense of caring for the Lord in our patients and in their families. Terese and I both had been taking care of a little boy with cerebral palsy and severe malaria. He had a terrible seizure when he was 6 months old that left him pretty bad-off. But his parents had been feeding him (by mouth!) and caring for him with quiet determination and much love. I spoke to the father one day about why his son is the way he is. He had copies of brain CTs that they had done in the capital city a year prior. They showed hydrocephalus (water on the brain) and some old strokes. The Dad nearly wept after our conversation. Not because of sadness, but because of relief! He told Paul that he had frequently been on his knees begging God to cure his child because he did not know what had caused his disability. Worried that it was an evil spirit, he had been going to traditional healers and witchdoctors for remedies in hope of a cure. “Now I know why my son is this way; now I know that no one has cursed my child. I will continue to love him and to care for him. I do not have to worry anymore.” It was a terrific moment. Paul was able to remove the oxygen the next day and he was discharged home in good condition just several days later. The boy’s name, in Runyankore, the local language, means “We have been blessed by God.”

Traveling to Uganda with a Child

Being with André was a blessing and a source of much fun. André had his own way of adapting to the new surroundings. He especially enjoyed his free time with the local children in the evening. We would not see him from 5:00-7:30pm when he ran free with the boys playing soccer, trying vegetables from their family gardens, and wrestling around. He came home at dark when the other boys returned home. He also enjoyed caring for a goat for 1 week whom he named Alexandria Rover. He fed the goat bananas and banana peals. He boasted that he was becoming a “goat shepherd.” He helped heard the goat several miles to it’s new home up the mountain on a goat farm. He enjoyed safari and seeing all the animals…. giraffes, hippos, elephants, baboons and Cape buffalos. André cried when we left Africa. He will look forward to going back.

André thankfully was not afraid of all the attention he received from the Ugandans, especially the children, for being so fair skinned with curly brown hair and blue eyes. Groups of boys would swarm around him and giggle at his every word or action. After some time passed André commented, “I like being in Uganda. People like to smile at me here. I think they really like me.”

Challenges

Transitioning to a new culture always takes time and energy. We found may interesting differences in culture including the slow pace of life, raising one’s eyebrows to indicate “yes,” a true contentment with very little, stoic strength in the face of suffering, and a very bland repetitive diet. Paul will definitely travel with hot sauce on our next mission there. Some of these cultural differences became challenges when desiring to work at a fast pace on the ward or in the emergency department. Preventative efforts against malaria were very difficult because even child death from severe malaria was seen as a part of life rather than something that needed to be prevented. We were challenged to deal with the cultural differences while in Uganda and then again to readjust to our American culture upon return.

Hopes for the future

Paul and Terese were thankful for this opportunity to serve in mission. They continue to pray for God’s guidance to lead them to future medical mission work. We hope to partner with MDA for years to come.