Trying Small

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.)

20180214_021032This 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.

20180213_202347In 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

4 thoughts on “Trying Small

  1. So so very proud of you both! What a amazing job and blessing you are! Sure wish I was able to go see you work with people who are in need! Prayers hugs best of wishes ! I love you my little Amy!🙏🙏🙏❤️❤️❤️🙏❤️🙏❤️


  2. I feel your pain, real similar in Belize. But my mantra is to “do what I can, with what I have, where I am”. Just try to imagine what would happen to the sick if you weren’t there? Praying for your success! Best Regards Dave Walters

    Sent from my iPhone



  3. Haha! We call tape “strapping” here. If plaster is tape, what do they call plaster? Very confusing I’m sure Blessings! Stacy

    Stacy Harms Zabriskie Karanda Mission Hospital



  4. Nathan and Amy,

    Thanks so much for your update. I’m glad you have made it through your first month there. It sounds like it has been challenging. When it is time, I pray you will pull out your notes from pre-field training and be reminded of some of the issues we covered. Those first weeks are full of so many changes – inciting both excitement but also disappointment. You, Amy, are really forced to face the reality of working in an place that is understaffed and undersupplied without proper systems in place. And if what I heard was correct, you are now the only surgeon at ELWA. Knowing God is in control should help but the reality is that life is HARD. If I can be of any help, please let me know.

    For now I am asking the Lord to send you some senior help. The ladies at WMM are the ones who told me the other surgeon has left to become head of a government hospital. I know they are actively looking for someone to come work with you. I will join them in praying that they are successful.

    You will have to remember that it is not possible to work 24 hours a day. You two will have to keep your marriage a priority. I hope you received this month’s e-pistle with an article on Family. It is true even in your type of setting. It is hard but may be necessary to say ‘no’ to some surgeries. I know that goes against everything in your training but if you finish yourself (African wording) you will not get to help anyone. Nathan, that may be a way for you to pray for you wife – that she will remain compassionate while recognizing the need to say ‘no’ to some surgeries.

    I wish your earliest days in Liberia could be easier but for some reason the Lord has allowed this. I hope it is not too long before you can say, we saw the Lord intervene and through it all, He was faithful!!!


    Susan A. Carter
    Director Center for Medical Missions
    Christian Medical & Dental Associations
    P. O. Box 7500
    Bristol, TN 37621

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