Nathan recently called my attention to the fact that we have an abysmal track record for providing updates and posts.  I’d like to say that we are turning over a new leaf, but I’d prefer not to make any rash promises I am unlikely to keep.  So for now, I would just like to say that your patience is so very greatly appreciated.  We feel beyond blessed that you all have continued to partner with us in spite of our lack of communication, and we want you all to know that your prayers have been very much felt and continue to be answered.

At the hospital, with the theatre in the distance and the Kenyan flag flying proudly.

Having not even updated you since finishing language school and starting in the hospital, you must be wondering, WHAT ON EARTH ARE THEY EVEN DOING OVER THERE?!  A legitimate question, and we will attempt to provide some legitimate answers.

Our accelerated Kiswahili lessons concluded in April, and since May we have been working full-time in the hospital and nursing school.  The time has passed quickly, and we feel very grateful for being welcomed into our departments so warmly.  I (Amy) spent the first few months trying to learn from my mentor surgeon the basics of orthopedics, urology, ENT, and all the rest that fall under the purview of general surgery here.  With new skills added to my toolbox, I am now enjoying working with the interns and surgical residents to care for our full-spectrum of surgical patients.  (But I am very thankful that my very patient mentor is still only a phone call/consult away!) 

Teaching bowel anastomosis using cow intestine

 I have especially enjoyed teaching again, be it through lectures, skills labs, or on the wards and in the operating room (theatre).  Of course, having excited and invested learners is what makes it so much fun, and I am thankful for all of the trainees that are here with us and the time I have with them.  They teach me so much, about Kenya, patients, and the love of Christ.

Meanwhile, Nathan has been teaching in all sorts of capacities.  He spends his time mostly at the nursing school, with lectures, skills labs, and exams, but he has also been working as a nurse practitioner and preceptor in the emergency department two days a week.  In addition, he has helped provide some additional training for our clinical officers and medical officer interns in Advanced Cardiac Life Support (ACLS).

These sweet Heritage ladies brought hugs!

We were also very excited to get the opportunity to see some of our family from our home church when we joined a short term mission team from East Tennessee in June.  The outreach–called Wheels for Kenya, part of Luke 14 Ministries–focuses on distributing wheelchairs to disabled Kenyans.  We thoroughly enjoyed the work with the team and were excited to make new friends (both American and Kenyan).  It was also a fun change of pace, even allowing us to see some other parts of Kenya we had yet to see.  I (Amy) worked in the clinic triaging and evaluating patients for medical needs that might require chair modifications.

Martha, Cleo, and Nathan were an incredible therapist & mechanic chair team.

Nathan was a wheelchair mechanic, modifying and tailoring wheelchairs to fit patients.  Several of the cases were for disabled children, and it was incredibly fulfilling to get to see their smiling faces when they were placed in their chair for the first time.  There were over twenty people that came to salvation through the ministry outreach (!!!), and many others were encouraged and shown the love of Christ.

In September we were able to travel back to the U.S. for a few weeks, primarily so that Nathan could present at a conference in Florida.  It was fun to attend Prescription for Renewal (PFR) in Orlando, and even more fun to get to hear Nathan present about the importance and impact of nursing in healthcare missions.  (He did a great job, even after correcting for any of my bias.)

From there we traveled to Maryland where we were blessed to have some training on diagnostics and basic repair of endoscopes by the amazing team at EndoMaster Medical Inc.  They welcomed us warmly and were oh so patient with us (especially Mr. Wang, 2nd from the left).

Though I (Amy) use scopes regularly (for EGDs and colonoscopies), we had no idea how they work, how to take care of them, and definitely no idea how to fix them.  After a few days of study under a scope-repair master, we are hopeful that we will be able to take these skills back and tackle the scopes in Chogoria.  One of the problems that we have encountered in Kenya is broken or unusable scopes with no good way to source repair services.  We are hoping to be able to get the parts to fix a couple of the scopes so that we will have at least one upper and one lower scope in good working condition to help our many patients.  (Please pray with us about this.)

That tiny speck (a tiny nozzle) is probably the part that causes the biggest problem in Chogoria…

Our only regret is that we couldn’t stay longer in the U.S. and weren’t able to visit with and catch up with more of you.  (This trip was mostly a working trip.  For our next return to the U.S. we will plan to allow time for visiting and will definitely let you all know so we can make plans to see as many of you as possible!)  After a much-too-short but wonderful visit with family, we flew back to Nairobi, with Amy returning to Chogoria and surgery, and Nathan heading on to Egypt to help out due to a significant shortage of teachers at a nursing school there.

Nathan was able to help out with the teaching and even managed a weekend visit to Cairo. (Visiting the pyramids and riding a camel were my requirements for vicarious living in agreement for him being able to go.)  Those five weeks were the longest that we have ever been apart during our five years of marriage and I am so glad to have Nathan back home safely.

There have been several changes at the hospital recently, including the loss of three physicians in the last month due to the ends of terms/contracts, including one of the other surgeons.  This has definitely been felt at the clinical level, including in the surgical department.  Patients are many but the workload is manageable and we still have a great team, but please pray for encouragement and strength, especially as my mentor continues to have to help me out with certain patients and cases.  He is beyond patient with me and for that I am so grateful.  We continue to feel incredibly blessed by the community that we have here, both in and out of the hospital.  We are both feeling more at home in Kenya and are still so very glad that God brought us to Chogoria for this season.  We have loved getting to know more of our neighbors and community, improving our Swahili with actual human interactions, seeing the beauty and wildlife of Kenya, and working alongside strong believers, both Kenyan and expat.  Please continue to pray for us, for our community here in Chogoria, and for our patients, that through us all God will be glorified and His name will be made known.

Safari njema.  Bon voyage.  Say what you will, the past couple of months have seen a lot of traveling on our part.  In late November, we were encouraged by Samaritan’s Purse to take a break from language school to attend a debriefing meeting in Michigan.  Traveling from equatorial Africa to Michigan for a few weeks in December is not for the faint of heart, nor advisable to be done without a parka.  It was tough unpacking all that we had experienced in Liberia, but we greatly appreciated having Godly folks with missions experience to walk us through that process, and have been astounded to see the difference that processing through that time and those things has made in our day-to-day lives and how we think about our future in medical missions.

After appropriately bundled, we also enjoyed seeing snow again.

After our time in Michigan, we were overjoyed to be able to head back to East Tennessee to visit our families for the holidays.  We were also able to see a few others during our time home, including our church families.  It was exciting to get to share with people we love the things that God has allowed us to see, do, and be a part of over the past year. We gave and received so many hugs, enjoyed the presence of family and friends, laughed a lot, cried a little, and ate way too much delicious food.  It is hard to explain how Satan can use time and distance to try to undermine the love that exists between even family and friends and church community.  We know it sounds/was crazy, but we had some (completely unfounded) anxieties that our people might not like us anymore or might have forgotten about us since we had been separated physically for so long.  The Lord used our time at home to show us just how unfounded those anxieties were and to reaffirm much needed love for us from some of those we love, reminding us again and again how much we are cared for, even from afar.  It’s impossible to describe the outpouring of love we experienced from our church (visit Heritage Baptist Church if you are in the Tri-Cities and looking for a solid, Biblical church that oozes love), opening their hearts and homes to us, and blessing us in so many ways.

One of our friends from church made us a quilt and then had the members of our church sign it.  What an incredible and thoughtful gift.  It’s now with us here in Kenya, reminding us of their love and keeping me from freezing to death.

Almost exactly one year after leaving home for Liberia, we found ourselves back in the same airport, leaving again, this time headed back to Chogoria.  Feeling refreshed and renewed, with our love tank full, and our purpose clarified, we returned to Kenya.  We have been back at the Swahili since, and have progressed to the point of some actual understanding and speaking meaningful sentences, albeit understood and spoken slowly.  Sema polepole has likely been the most important phrase for my learning, which means speak slowly.  (Not to be confused with pole which means sorry.)  Also, best we can tell, there are at least 9 different ways to say “it/them,” depending on how you make the noun plural. Mind blown.

In other news, we have continued our attempt to figure out life here, exploring some (see pictures from Mount Kenya below), learning to cook some Kenyan food (githeri and sukuma wiki have both been successes… up next are chapati and ugali), and even adding a new family member.

He pretends he’s not a cat person.

Kivuli (key-voo-lee), which is the Ki-swahili word for Shadow, is a stray kitten who was found in the ceiling of one of the buildings here on the housing compound.  After a bath, some worm and flea meds, and regular meals (he eats scrambled eggs with a little bit of tuna), he has established a fairly permanent residence on our porch and turned into quite the handsome little study partner/reading buddy.  He also likes to follow me around and generally get underfoot, thus the name.

                                                                Kivuli is definitely my little reading buddy.

We are in the second portion of our language school currently, and are about to start adding in some medical Swahili in anticipation of starting work in the hospital toward the end of March.  Nathan is excited to become more involved with the nursing students and plans to begin teaching at the nursing school around that time also.  He and I are both thankful that teaching is all done in English, as our Swahili hasn’t quite reached a level of competence that we would be able to teach in Swahili at this point (or anytime in the near future).  Please continue to pray for us as we finish up the formal part of language training, try to become more conversational, continue to develop a deeper sense of community here in Chogoria, and prepare to start “actual” work again.  (Which we will be able to do since our work permits were finally approved this past week!)  May we see with His eyes what He would have us to do each day, and may every thing we do, above all else, glorify Him.

Lake Ellis on Mount Kenya.

Work permits approved!

Declare His glory among the nations.  Nations, with emphasis on the “s” apparently.  When God pressed this verse on our hearts during our preparations to move overseas, we never considered that He might truly mean nations, as in more than one.  We were prepared and excited to go to Liberia and, after a few months, we began to feel at home.  Things were difficult and nothing like we had expected, and yet He proved faithful beyond my measure of faith.  While at ELWA, we witnessed Him do incredible things, meeting needs in a way I never would have truly conceived possible.  In spite of the difficult times, I have no doubt that God brought us to Liberia for this season.

Lovely sunset on my birthday, the night of our “see you later” get-together with ELWA folks.

And yet, now we have found ourselves in the midst of another move, from West Africa to East Africa, from Liberia to Kenya.  As you probably know, we came to Liberia through the Samaritan’s Purse Post-Residency Program, a program designed to pair you up with a medical (or, in my case, surgical) mentor at a mission hospital.  With my mentor leaving (see previous blog post), the question remained how I would gain the various skills necessary to provide comprehensive surgical care for patients—orthopedic, gynecologic, urologic, and neurosurgical skills in particular.  These surgeries, performed by other specialists in the U.S., fall under the very large blanket of general surgery in most mission hospitals.  (To put it in perspective, Liberia has two orthopedic surgeons and one neurosurgeon for the ENTIRE country, and these surgeons are frequently not accessible to most people.  The neurosurgeon, for instance, is about eight hours from ELWA, and can take even longer during rainy season.)  Our time in Liberia has shown us many things–maybe I will find a chance to share a few of those, given enough time, reflection, and humility.  But among other things, it became clear to us that if we are to fulfill this long-term call, there are things we need to learn, both in and out of the OR, surgically and personally.  Our team at SP voiced their concerns and commitment both for us and the hospital–not only of agreement that I need to learn and that a change of location would be necessary, but also that they will continue to seek surgeons to help assist with surgical coverage for ELWA.  Knowing this, we prayerfully allowed SP to choose a new Post-Residency Program training site for us.  A month or so later, after an SP conference and vacation, and after acquiring a couple of electronic visas, here we are in Chogoria, Kenya.

This tree is on the walk between our house and the hospital/church.

This has all happened rather quickly, such that we are still processing it ourselves.  We have ALL the emotions about this move.  We miss our Liberian home and friends, but are trusting that the Lord has picked us up from Liberia and placed us in Kenya for now. We know that He is sovereign and are trying to submit ourselves to His refining fire as He continues to form us into what He would have us to be for Him and His glory.  We are choosing to focus on the positives (just ask Nathan about the weather in Chogoria if you want to hear what he’s most excited about) and are trying to settle into our new home and community.  We are thankful for our mission family we left in Liberia and ask that you will continue to pray with us for them, the hospital, and the work there at ELWA.  We are also thankful for those here who have welcomed us so warmly, and we ask that you pray for us as we discover what life and work looks like here.  Currently, and for the next three months, we are doing language school learning Swahili.  Please pray for us as we daily attempt to learn and as we are repeatedly humbled by the discovery of this new language and culture, that we may be able to join in the ministry here, declaring His glory among this people.  May we always be faithful to Him and His call, whatever that looks like and wherever He leads.  For now, thank you for going with us on this unexpected journey and karibu Kenya.  Welcome to Kenya.

View from our back porch in Chogoria.

Declare His glory among the nations, His marvelous works among all the peoples!  –1 Chronicles 16:24

Rainy season is upon us.

My hope is built on nothing less

Than Jesus’ blood and righteousness;

I dare not trust the sweetest frame,

But wholly lean on Jesus’ name.

When you move from one country to another, you expect changes.  What we had not planned for were the significant changes that have taken place here at the hospital since our arrival in Liberia.  These changes have caused us to be much busier than we had imagined possible, but they have also caused us to cling more closely to our solid Rock who we are confident was not surprised or caught off guard by any of these changes or challenges.

On Christ, the solid Rock, I stand;

All other ground is sinking sand,

All other ground is sinking sand.

A little over a month after our arrival, ELWA’s surgeon (and briefly my very capable surgical mentor) Dr. Jerry Brown was recruited by the new Liberian government to lead the administration at the main government hospital to facilitate revitalization and advancement there.  It truly is an honor and very revealing of Dr. Brown’s character and capabilities that he was recruited for the job.  I am thrilled that a Godly man who cares deeply about patients and who has a strong medical and surgical background has been placed into a position of authority to help bring about positive change in the health sector of Liberia.  Please join with me in praying for Dr. Brown as he deals with day to day management issues and pursues long term goals to help make this facility a quality referral hospital for the country of Liberia.

When darkness veils His lovely face,

I rest on His unchanging grace;

In every high and stormy gale,

My anchor holds within the veil.

The direct implication of Dr. Brown’s leaving ELWA was that I was left as the only surgeon here, and a baby American surgeon at that.  Living near the ocean where the path I walk to the hospital each day is sand, and now entering into rainy season, I am regularly experiencing obvious examples of sinking sand. Frankly, after only a month I was both overwhelmed and exhausted.  Being stretched professionally, physically, emotionally, and spiritually began to make me sink.  But what a powerful place we find ourselves in when we have finally come to the end of ourselves.  “My grace is sufficient for you, for my power is made perfect in weakness.” (2 Corinthians 12:9).  After laying down my pride and having my team mates here in Liberia join with us in fervent prayer, ELWA was able to locate and hire a young Liberian surgeon who has helped to ease the workload, both physically and intellectually, and with whom I can alternate call.

His oath, His covenant, His blood

Support me in the whelming flood;

When all around my soul gives way,

He then is all my hope and stay.

During all of this, Nathan and I have felt very supported by our two organizations, Samaritan’s Purse and SIM.  They have been seeking for the best long-term solution for us and have been generous to work with us to allow us to stay here in Liberia in spite of the less-than-ideal circumstances.  Both organizations have been praying with us and working diligently to try to secure a long-term surgeon for the hospital and mentor for both myself and my Liberian colleague.  While a permanent surgeon has not yet been located, it has been wonderful to watch as God provides, in His timing, for coverage and mentorship through multiple short-term surgeons, the first of whom is here with us currently and has been a huge blessing.

On Christ, the solid Rock, I stand;

All other ground is sinking sand,

All other ground is sinking sand.

What has been the most significant encouragement for me over the past four months has been God’s clearly apparent leading and guiding.  “I have set the LORD always before me; because he is at my right hand, I shall not be shaken.” (Psalms 16:8).  What a joy to proclaim out loud to my patients that God is the great Physician and the only one who can heal, to pray with them before and after surgery, to feel His presence with me literally at my right hand guiding me surgically through case after case.  There are so many stories of God’s faithfulness and His healing power… stay tuned for a soon-to-follow blog post highlighting a few of these examples of God’s provision as well as another with more details of day-to-day life and Nathan’s happenings.

Author’s Note: Please ignore Nathan’s finger in this photo. We’re going to give him a pass. Shortly after this photo was taken, a very large wave literally knocked me off this rock and during Nathan’s rescue efforts, both of our phones were lost at sea. Ok, well, they were irreperably damaged. Also, it should be noted that Nathan told me not to climb onto this rock, that the waves crashing over it were too strong. As usual, I should have listened.

Happy Liberian month-iversary to us!  We can’t believe that we have been here a little over a month already, and, my, what a month it has been!  We are learning so much about the people, the culture, and the hospital… daily we discover new things about our new home, our new jobs, and ourselves through the process.  We are settling into our roles at the hospital, and I am enjoying operating and taking care of patients regularly again.

Each morning when I greet my patients and ask how they are doing, they most often quietly respond, “I’m trying,” or “I’m trying small.”  At first I wondered what they were trying to do… To tolerate their pepper soup?  To ambulate outside to the palava hut?  To have a bowel movement?  But I quickly began to take it at face value and discovered that it is one of my favorite phrases in Liberian English, especially when said in that quiet, sincere tone.  Just like my patients in their hospital beds, unable to bring about their own healing but maintaining their determination to get well, we keep trying and looking for ways to do what we can to improve while knowing that the situation is all in God’s control.

And so, here we are, also trying small.  We are trying small to adapt to this way of life, both in our home but especially in the hospital.  The nebulous concept of time here has been the most difficult to grasp and adapt to, particularly in the hospital where increased time for each part of every process can compromise a patient’s well being, allow their condition to worsen, or delay their treatment/recovery.  For example, I am used to STAT labs taking ~15 minutes for the entire process, from the time I electronically enter the order until I am either called with or able to electronically see the results.  The current process here is that I see the patient and write a lab slip which is given to a family member who then proceeds to get in line at the business office to pay for the test before taking the receipt and lab slip to the lab where it is placed in a cue with the rest to be collected in batches by the technician who then returns the sample to the lab where it is analyzed and finally resulted and sent to the appropriate ward. If you are exhausted by that run on sentence, I feel your pain.  This process could take anywhere from one to twelve hours, IF the lab test requested is available and currently able to be completed.  So we are trying to learn to make do with less and to function without all the gadgets and medical amenities we are used to (i.e., supplies, lab tests, imaging, specialist referrals, etc.)

This is but one example among the oh-so-numerous “issues” we have each day.  It makes me stop and think about the blessings that I have so often taken for granted, particularly in regards to patient care.  How many times did I take for granted running to the clean hold of one of the med-surg floors to grab dressing supplies (which are always difficult to find here, especially “plaster” which is the word for tape), NG tubes (which are currently out of stock in the hospital), suction tubing (when there is no suction even available here on the wards), etc.?  How comfortable had I become with laparoscopic cases/equipment and patients going home the same day or after only a few days with minimal pain?  Did I even stop to think about how my patients might feel postop without access to any antiemetics or narcotic pain medications?  Given these things, it is easy to become frustrated with the injustices that we witness/are complicit in here.  My heart hurts for the people here, and I go back and forth between being angry at the lack of care options and the scarcity of resources that provide less than ideal care, and rejoicing at how God provides, both in the way of resources and through His healing that I know at times is clearly supernatural.  Blessedly, we are covered in prayers by you all and our mission community here, and are loved and encouraged by the Prince of Peace (who is clearly the one keeping me from losing my mind).

Clearly, there is room for improvement and growth.  But as we get to know the workers at the hospital better each day we are encouraged by the love that most of them have for God and their patients.  What they lack in official training they make up for in compassion and commitment.  Because of this, we see great potential.  We are seeking how we can help not only our patients directly but also indirectly through staff education and development and better quality measures throughout the hospital.  We know that change will come sloooooooooooowly but we are excited to be a part of this hospital and ELWA family.  And we will keep trying small.

In other news, our first house guest arrived at the beginning of February. Her name is Liz and she is a friend from Lipscomb who practices family medicine. It has been wonderful sharing in this growing process with her, spending some time together after all these years, and even doing a few OR cases together.  She has been such a blessing and we will be sad to see her go.  But we can’t wait to host others!

Photos (top to bottom):                                                                                                                         1. View of Monrovia from Waterside market bridge                                                                   2. The OR, my home away from home, after a difficult surgery (the patient is doing great, praise the Lord!)                                                                                                                                   3. Liz and I after scrubbing our first surgery together (she’s an excellent first assist & that patient is doing great also, praise the Lord again!)                                                                       4.  Sunset from the hospital courtyard (one of the perks of being at the hospital late) with the healing gardens in the foreground and the OR building in the background

WE ARE IN LIBERIA!!!

Thank you all so much for all your prayers.  The last several weeks have been hectic but also absolutely wonderful, between packing, spending time with family and friends, and MOVING TO LIBERIA.  We weren’t able to visit with everyone we love… not enough hours in the day or days in the week… but we are SO glad to have spent time with those of you we did get to see.  (Just let us know and we will make a plan to meet up with some of the others of you the next time around!)

We don’t want to bore you with the details, but as a quick packing recap, I do not necessarily recommend trying to fit one’s (or two’s) life (lives) into checked and carry-on baggage.  But, if you must, remember that compromise is key.  Some of you will be excited to know that Nathan managed to bring a few board games and I snuck in my wind chimes.  Also, a carry-on is a great place to pack 45+ pounds of surgical textbooks, but bear in mind that you might get stopped by security because the books are apparently thick enough that you will be suspected to be hiding contraband in them.  Also bear in mind you should bring a strong fellow traveler to place it in the over-head bin without dropping it on someone’s head/looking suspicious.

Flights were uneventful but long, with no transfer or layover issues.  I slept a good bit, watched a movie I would recommend (A United Kingdom), and enjoyed talking with some Liberians who were also headed home.  Nathan (who I regularly peered at between the seats) appeared to enjoy napping and playing games.

When we arrived in Liberia we were greeted warmly by both the people at the airport and the climate.  The heat and near-oppressive humidity hit us at once, even though it was after 9pm local time, making our jackets we had worn onto the plane seem utterly ridiculous.  By the time we were through the passport line, all of our bags had already been gathered into a group by the porters (the bags were all marked “ELWA Hospital” and I fully recommend this method) and we were so excited to see that all of our bags had arrived with us!  We traversed customs quickly with the help of the porters with no issues.  It was a testament to us of the quality of care and reputation of ELWA that we, though strangers, were taken care of so well simply because we were going to ELWA Hospital.

We were met at the airport by both SIM and Samaritan’s Purse folks, the beginning of our beautiful blended-family experience.  We are here with the post-residency program through Samaritan’s Purse and SP funded the rebuilding of the hospital, but we are seconded to SIM as they own and operate the ELWA compound and hospital.  It is a somewhat confusing but beautiful thing, as what it essentially means to us is that we have lots of incredible people and two very reputable organizations watching out for us.

So here we are on the ELWA compound, house J-17.  Our home sweet home.  And sweet it is, above and beyond what we had expected or hoped.  We were blown away with how much space we have and are praying that even now God would begin to allow us to use it for hospitality and His kingdom.  We even have a spare bedroom with a bed already in it, just waiting for guests!  Now accepting reservations with openings beginning March 2018. 🙂

The last two days have been a dazed flurry of arriving, unloading, unpacking essentials, attempting to reset our internal clocks (we are 5 hours ahead of EST), figuring out communication essentials (with Mrs. Nancy’s indefatigable assistance our phones are working and we have internet/email access as of yesterday afternoon so we would LOVE to hear from you!), and meeting oh so many people, both expats and Liberians.  This morning (our first day without any schedule or agenda given that it is Saturday), we were able to sleep in and awoke to the sound of the ocean and children playing.  We will attend church tomorrow and have meetings again on Monday.  I am still awaiting my interview date to appear at the Liberian Ministry of Health in order to obtain my Liberian medical license before I will be able to begin work.  Prayers for an expeditious process are greatly appreciated as I am excited to begin working as soon as possible.

Admittedly, it’s only the very beginning of our time here, but it is such a blessing that things so far are exceeding everything we had expected.  What we can say with complete confidence is that God has watched over our going out and our coming in, and we fully trust that He will, both from this time forth and forevermore (Psalm 121:8).

Here’s a fun random pic since we are random people: 

We arrived back home to this little guy sitting in our living room last night.  Per Nathan, his name is Carlton. We had a little visit, a photo shoot, and then I caught him and put him outside.  I think he was sad to leave… I could almost see it in his beady little eyes.

Please continue to follow along as we share more stories and pictures from our Liberian adventure as it unfolds!  We can’t wait to discover Liberia with you.

All I know of real estate I learned from Peanuts’ Lucy van Pelt sometime in the early 90s.  Having never sold a house, Nathan and I had no idea what we were getting ourselves into.  Fortunately for us, and thanks to our incredible realtor the amazing Kathy White who took care of ALL the details, we still have about the same very-limited understanding, but our house is SOLD!  (Huge praise!  Thank you God!  Thank you all for your prayers!)  In a whirlwind of mere days, our home went from familiar and, um, “lived-in” to a presentable and somewhat alien house, ready for market. Photographs of our family, friends, and places we love were replaced with neutral photographs or artwork. Counters and desks were cleaned and cleared.  Pictures were taken, the sign was planted in the front yard, and our home was visited by scrutinizing strangers.  After being on the market for less than two days, our house was sold.  (Please note that pretty much this entire process was completed while I was in Philadelphia preparing for and taking my general surgery oral boards and while Nathan and I were traveling together… Seriously, if you need a realtor, call Kathy.)  After returning to town, and after four days of frantic packing, we closed only two weeks after originally placing the house on the market. God has truly blessed us with a quick sale, making me laugh at my “what if it doesn’t sell” anxieties.

While Kathy & Nathan were busy selling our house, I was studying for and taking the final part of my board certification.  Oral boards in Philadelphia on September 27th were the culmination of my 9 years of medical and surgical training.  By passing this final exam, I am now a board certified general surgeon.  So much praise to God for seeing me through and giving me His peace for the exam, as well as huge thanks to our family and friends who have supported me (us) along the way.  We couldn’t have done it without you all, nor would we have wanted to.

With boards behind us, we took a much-needed and much-enjoyed vacation up the Atlantic Coast to visit places on our bucket list.  We traveled around having adventures in New York City (including finding out I passed boards while hanging out in Grand Central Station, thus allowing me to reeeeeeally enjoy the remainder of the trip), exploring Boston in the fall, driving up the coast of Maine and going off the beaten path looking for tiny lighthouses, taking in the glory of God’s creation in Acadia, and following backroads through New Hampshire and Vermont enjoying the sights and tastes of New England before heading home.  After returning home, we had a quick pack-and-move turn around prior to closing, and then were able to attend SP’s Prescription for Renewal at the Cove in Asheville, NC.  There we were both challenged by other dedicated believers and learned about new advancements/updates from the medical mission field.  It was so encouraging to get to meet and fellowship with other people with similar passions who seek to use their gifts to share Christ’s love around the world.

After spending most of the past month or so away from Johnson City, we have come home to and settled into our new temporary living place, a cozy and affordable above-garage apartment.  This allows Nathan to continue his work at the clinic and allows us to continue being with our church and near family and friends during our last few months in the States.  More than anything else that we have done on this journey so far, selling our house and downsizing our lives has made our upcoming move to Liberia seem real and imminent, in a very positive sort of way.    We are realizing that this time will go by quickly, and we are trying to remain focused while enjoying it with our family and friends.  We are currently continuing the Great Purge of 2017, further organizing as we continue to donate/give away/throw away while ultimately attempting to pack for Liberia.  There is nothing that will make you realize just how blessed you are quite like being forced to individually hold and consider the inherent value of every single item you own.  Realizing you have an attachment to things is both eye-opening and somewhat difficult at times.  But with that realization, He has given us the option to choose.  And as we choose to lay these things down, we feel more free to pick up the call that He has given us for our lives, to declare His glory among the nations.

ALSO:  Our address has obviously changed… and will change a couple more times in the next few months.  So, if you need us, you can either call, email, or send things to my parents’ house which we will be using as our permanent address (thanks Mom & Dad!): 625 Citico Road, Vonore, TN 37885.

I don’t sit well.  I go, I do, and then I go and do some more, but when I sit I fall asleep.  This is partially a trained behavior learned from years of residency, but it’s also just who I am.  So if I were to tell you that I have spent the last month sitting, most of you who really know me simply would not believe it.  I haven’t sat like this since medical school.  And yet, fact is stranger than fiction.  First studying for and taking written boards, and then a week and a half of orientation… I’m all sat out!  But yet, what does God say?

“Be still, and know that I am God.” –Psalm 46:10

During my time studying this past month, I found myself becoming frustrated as time and time again, reviewing standards of care and how/when/why to treat, I realized repeatedly that I will likely not be able to provide this same standard of care in Liberia.  Without adequate access to pathologists, technology, and other resources, what does that mean for my future patients and my future as a surgeon?  But then, as I sat, God reminded me that He is the great physician and that neither my pride (let’s call it what it is) nor Liberia’s lack of some resources can limit His power.  The verse above continues:

“Be still, and know that I am God. I will be exalted among the nations, I will be exalted in the earth!” –Psalm 46:10

And so, as we dove headlong into orientation (literally the same evening of taking boards… Nathan took great notes the first day, as promised), Nathan and I were eyes-wide-open and minds full of questions.  What does it take to live this life God has chosen for us? What fears were there of unknown culture, of leaving family behind, of being vulnerable beyond anything we have yet experienced, and of things we had not even yet considered?

We have sought to answer these questions (and so many more that we didn’t even know that we had) in orientation with Samaritan’s Purse over the last week and a half.  What we expected was a steady stream of information, calm and reassuring.  But God can be present in the calm or as a mighty force and sometimes, especially when you’re not a good sitter, He has to use more of a torrent.   That downpour of information can seem somewhat unrelenting and occasionally overwhelming because of its sheer volume and intensity, but, just like the steady stream, the torrent also brings refreshing water.  We both have found ourselves drinking deeply from the things we have been taught and feeling nourished, encouaged, and so excited for the future.

We began at Christian Medical and Dental Association‘s headquarters in Bristol.  There we were taught by, among others, CMDA CEO Dr. David Stevens, World Medical Mission director Dr. Lance Plyler, and long-time Hitchcock favorite and Johnson City mission motivator Dr. Daniel Tolan.  Their dedication to culturally-congruent and gospel-centered care was demonstrated time and again, giving us practical ways to engage with our patients across cultural lines while keeping God always at the center, the gospel at the forefront, and remembering that resiliency is practiced.  Dr. Tolan specifically challenged us to use the acronym ARM as we go forward:  Admit your fears, Replace them with an attribute of God, and Make the promise yours. This helped us to intentionally counter our fears concerning our future work overseas, and reminded us that:

“The Lord of hosts is with us; the God of Jacob is our fortress.”  –Psalm 46:11

We headed on to Boone to the Samaritan’s Purse International Headquarters for the next week of training, a little unsure how much more they could find to tell us.  But oh, they were ready.  The incredible team at World Medical Mission had put together more than we could imagine.  Perhaps most shockingly, what was penciled into the schedule ambiguously as two days of “Security Training” turned out to not only NOT be a waste of time, but was thoroughly gospel-centered and very much interactive… almost a whole day not sitting!  The training was taught by a Christian not-for-profit organization Concilium, started by an Army Ranger sniper Scott Brawner who penciled these words for IMB’s Fusion Creed:

• As a follower of Christ: I am called not to comfort or success but to obedience.  Consequently my life is to be defined not by what I do but by who I am.
• Henceforth:  I will proclaim His name without fear; follow Him without regret; and serve Him without compromise.
• Thus:  To obey is my objective, to suffer is expected, His glory is my reward.
• Therefore:  To Christ alone be all power, all honor, and all glory that the world may know. 

Seriously though, it truly was incredible to see how God uses other people’s passions, including security, to advance His kingdom.  We also felt incredibly well cared for after learning the extent of the different layers of Samaritan’s Purse, from security staff to morning prayer times, such that we now truly know that people throughout the organization are and will be supporting us both spiritually and physically.

We concluded the week with convocation in which the physicians received white coats and our families were specifically prayed for by the corporate Samaritan’s Purse body.  What could have been a seemingly endless amount of sitting actually went by very quickly.  We were thankful to have such a time to spend with others also preparing to go (there are 11 post-resident physicians headed to hospitals around the world, plus lots of incredible spouses and many adorable kiddos), as well as being encouraged by the stories that others were able to share from their time serving, many for decades.  What a blessing to be surrounded by such strong believers with common callings, to share in others joys and to pray for each others fears and futures.  Now that we are back here at home, not sitting, getting our house ready to put on the market, may we not forget that sometimes what we really need to do is just sit at our Savior’s feet.

“Be still, and know that I am God. I will be exalted among the nations, I will be exalted in the earth!” –Psalm 46:10

Photo cred to Dr. Ben Randel, fellow post-resident and photo documentation guru.

In 1 Chronicles 16, David gave thanks to the Lord in song when the Ark of the Covenant was brought to Jerusalem. It is written:

²³ Sing to the Lord, all the earth!
    Tell of his salvation from day to day.
²⁴ Declare His glory among the nations,
    his marvelous works among all the peoples!
²⁵ For great is the Lord, and greatly to be praised,
    and he is to be feared above all gods. (1 Chronicles 16:23-25 ESV)

We are humbled to have the opportunity to declare His glory among the nations, specifically in Liberia. The journey to serve overseas has seemed long to us (well over 10 years since God individually called us each to go!), but we know that it is in God’s perfect timing. Now it is through Samaritan’s Purse’s Post-Residency Program that we plan to embark on a two-year adventure to Liberia to serve at Eternal Love Winning Africa (ELWA) hospital starting in January 2018. We are so blessed to have the support of our family, church family (Heritage Baptist Church in Johnson City, TN), and friends. Please pray for and with us as we begin the next step in our journey serving the Lord through medicine/surgery and declaring His abundant glory.

Also, if you haven’t read the entire passage in 1 Chronicles 16, do it.  You will be blessed and we hope it will spur you on to tell of His salvation daily and to seek the Lord and his strength, to seek His presence continually (vs 11).