"Home Assignment": What is it?

What is Home Assignment (aka: Furlough)? 

This is a good question, and something we have been asking ourselves since arriving in Canada 4 months ago. We had heard of missionaries spending time back in Canada, and while that was understood to be a part of this life, we didn't really know what this was supposed to look like. In all honesty I think we pictured it a lot more relaxing. Not unlike a prolonged holiday perhaps?

Okay, maybe not quite, but I did wonder what we would do with ourselves for the 6 months between coming back to our passport country and then leaving again for our new location at the Good News Hospital in Madagascar. In my minds eye, I had visions of plenty of family time, quality time with friends, reading and studying topics related to what we were doing, and then maybe dealing with the logistics and homeschooling on the side. 

In reality, it has looked different then I expected. Not only is the world re-evaluating what they do and how to do it, we have been as well. Here are some of the things we have found ourselves doing with the transitional season we find ourselves in: 

REVIEW

 This time back in Canada has given us an opportunity to look at life and work overseas through a different lens. Being out of the very different (and sometimes very challenging) physical environment allows us the opportunity to gain clarity and perspective. Rather then navigating weather, language and cultural differences on top of the everyday work of living and the added burden of resource limitations, we get a chance to step back and look at the overall picture of life and work in Africa. 

RECONNECT

Obviously one of the biggest sacrifices in being overseas is being so far from those we love. Home assignment allows us to bring our work with us, and do the appointments and paperwork and meetings while getting to spend time around friends and family who we have so dearly missed. It gives our children the opportunity to get to know their cousins and do life in a country they don't entirely remember. Not only that, it gives them a chance to be re-acquainted with the culture they have come from, and discover their roots while making new connections with old friends. 

And it allows our families to get to relearn us and our kids! The decision to go means they also have to sacrifice their plans for what life would otherwise have looked like. Being back gives us a little time to "do life" together - at least get a taste.

REFOCUS

For Jesh and I, this has allowed us to evaluate what we are doing, why, and how. It provides a period of time where we get to reevaluate our vision, our work, our home life, and determine what has gone well, what hasn't, and what we need to change for the future. 

REMIND

Being back in Canada is such an interesting experience after 3 years of living in different countries and cultures. It's such a reminder of the way in which I was raised, and the culture and background that has shaped my worldview growing up. It gives such an interesting perspective, and even highlights how and what has changed over the years. 

RENEW

Quite literally - we have had to renew everything possible while we are in a country with more reliable postal services and the ability to visit the offices necessary to benefit from things like wonderful gift of healthcare. Or even repair some bad dental work, and replace a tooth. Who knew!

All the logistics that have gone into updating and renewing papers and getting visas and passports ready has been incredible. From lost licences to closed offices (cause you know, COVID) it's been no end of phone calls, emails and even faxes. (Who knew people still fax?!)

We have also been "renewing" our term overseas by transitioning to a new sending organization, while applying with the group that we will be working with at the hospital itself. We sure didn't realize how involved all of this would be!

REDO, RETRAIN, RELEARN

As part of these changes, we have been using this time to do workshops or courses, or read relevant materials so we are equipped for serving at a new hospital, with a new team, and alongside a new sending agency. There is much to learn and we are grateful for the time to work out some of the details before we hit the ground again!

This is just a taste of what this Home Assignment period has been. I could add more (re-entering, raising funds, readying ourselves for what's next, running, running, running...) but you get the idea. It's been such a ride!

However, as we have had opportunity to reflect and re-tell what has gone on these last few years, we are reminded of what we are doing this for (or rather, WHO). God has been working in all of this, and it is such a privilege to walk this path and get to be a part of something so much bigger then ourselves.

Thank you for your part as you share in this journey with us! 

Ready or not, Home Assignment will come to an end (end of November perhaps?), and we are just so thankful for this precious gift of time to ready ourselves for what's next.

By Julie

Logistical Blessings

When we began our journey into surgical missions, we didn’t quite realize the extent of what was involved in bringing safe, affordable and compassionate surgery to the developing world.

As you know from our last post, we are making plans to move to the northern Madagascar. It is a mission filled with new excitement but also complex logistical challenges.

Shortly after returning to Canada, we learned that Samaritan’s Purse wanted to help us send a 40 foot shipping container to the hospital in Madagascar. They had unexpectedly shipped a container there 25 years ago after diverting it from another country due to instability. This original container was instrumental in helping start the hospital and contents from it are still being used 25 years later. Containers like this are lifelines to mission hospitals.

Needless to say, a container is a huge blessing, especially as we were planning on just bringing checked air luggage! 

But what goes into packing a shipping container anyway?

From our family’s perspective, this is where Julie comes in. She is not just good looks but is also the brains behind our family packing. With 4 international moves in 3 years across the the Atlantic and the continent of Africa, she could write a book on how a family can travel internationally on a budget. 

Julie has advanced skills in planning what our kids will wear for the next 2-3 years. She also plans their education, what books they will read, what Christmas presents they might want and what toys they will play with. She calculates how many tooth brushes and how much toothpaste we will need and assesses what foods and ingredients are available in county and what she will need to cook with. Printer paper, printer ink, transformers, adapters all have to be planned in advance. She does all this while balancing the value of wanting to live modestly in order to not separate us too much from the community around us. We try to avoid bringing things we can purchase or have made in country to support the local economy.

These items are then packed into our famous yellow and black bins. Why do we always use yellow and black bins anyway? Well, they are cheap, reasonably disposable if broken, stackable and durable. Their dimensions also exactly fit airline requirements thus maximizing volume as air luggage if needed.

With these bins and a number of other purchased surgical supplies, I travelled with a U-haul trailer 16 hours one way from Ontario, Canada to Wilkesboro, North Carolina. The trip was also necessary to carefully select surgical instruments, patient monitors, crutches and equipment. Essentially, what Julie does for our family, I do on a surgery level trying to anticipate what we can use and what we will need. 

And this is where the help of Samaritan’s Purse World Medical Mission is invaluable! Their warehouse is packed with donated and carefully acquired medical and surgical supplies. They also have a wealth of knowledge about what works and doesn’t work in a developing hospital environment

I try to plan for what the surgery department will look like with a newly constructed surgical building, operating theatres and recovery rooms. Additionally we hope to start performing higher level orthopaedic surgery and that needs to be planned so we have the right tools to do the job. If a tool breaks what can be used as a back-up? Are the tools compatible with country’s electrical systems? I am in constant communication with my future colleague in Madagascar in order to avoid shipping items that are not useful.

It was incredible to see the World Medical Mission Warehouse. Imagine a building the size of a Costco and filled with donated items to support missions hospitals around the world. 

Talk about impacting the world through healthcare in Jesus name! 

Performing life-saving and disability preventing surgery overseas requires equipment and this equipment requires a skilled team of people to service, prepare and package it for transport. Equipment is serviced by the on site biomedical team and adapted to fit the electrical requirements of the destination country. Discussions are also held about the capacity of the hospital to maintain and operate the equipment. It’s a tedious process as we do not want to ship equipment that is beyond the ability of the hospital to maintain or use.

All these items are then organized, categorized and prepared for loading into the container. 

SP logistics coordinators then must carefully plan the shipment of the container taking into account a potentially devastating cyclone season and a rainy season when the road between the port city and hospital is impassable for a container to travel by land.

As the surgeon who will end up using much of this equipment, I am humbled to see the complexity of the process and countless people who serve with their professions to help missions hospitals around the world. Our prayer is that all his work will bless the Good New Hospital, it's staff and patients and that ultimately Christ would be glorified through our actions!

By Jesh

We like to move it move it!

Well, not exactly! I am writing this to you from the house of our good friends. They have kindly offered their home and space to our family as we re-integrate back temporarily into Canadian culture. It's not easy to find a furnished rental for "a month or so” for a family of five during the covid pandemic. We are so blessed to have an amazing church and friends who have really reached out to help our family with everything from a place to live, vehicles, groceries and even some good times fishing! 

But what does our future hold? In March of this year, I travelled to the northern part of the island of Madagascar to visit a surgeon from the UK I had previously met at a surgical conference. 

The town of Mandritsara

Our transition from the Post-Residency Program with Samaritan’s Purse, opened a door for us to join a french speaking mission in Mandritsara, Madagascar. We wanted to continue using the french we have learned and used during last 3 years.

Wait! Madagascar… King Julian… “I like to move it move it.”  Yes, that is the place. But aside from an incredible natural world inspiring a popular animated movie, what is also found in Madagascar is immense poverty and a great need for surgical care and the gospel.

Foundations of the new surgical building

We are excited to partner with the Good News Hospital to help build their surgical program, train Malagasy surgeons and live out the gospel in word and deed. For a great film by Mission Aviation Fellowship on the travel challenges to the Good News Hospital, click here.

Currently the hospital is undergoing a major construction project to build new operating rooms, a peri-anesthetic care unit and sterilization area. This will greatly enable the surgical and teaching capacity of the hospital.

Our family will join a Malagasy and expat team dedicated to improving health and spiritual care in the region. 

New surgical building construction

We are humbled and grateful for the current and ongoing support from so many of you whose prayers, encouragement and finances have enabled our family to assist those less fortunate. We are also grateful of during this season of COVID that the poor, who don’t have income assistance much of what we have here in North America, have not been forgotten.

Over the next few months, Julie and I will be helping load a shipping container of surgical and personal supplies to Madagascar. We are so thankful for the role Samaritan’s Purse has played in organizing this and look forward to continuing to work closely with them despite being with a different organization that supports long-term missions. I will be travelling to help pack surgical and personal items on the container. Julie is already planning how to set up a home in what will be the most remote location we have lived in. We will also prepare to learn the local language in addition to improving our French.

We are looking forward to visiting with many of you during our time back in Canada. 

Please keep our family in your prayers as we embark on yet another adventure. 

Pray for our children as they meet old and new friends and juggle a life that has spanned many countries, languages and cultures. 

Pray for wisdom as we purchase and pack equipment that will be shipped to Madagascar.

And ultimately pray that our efforts would glorify our Lord Jesus Christ. 

Please reach out to us if you would like to hear more about what we are doing and the projects we are supporting. We would love to talk to you face to face or via other means.

(Photo credits thanks to Dr. Ted Watts)

Greetings from Quarantine

Trying our hand at a V-log - a video blog!
Many have asked us how this quarantine is going...click below to get a snapshot.

The Not-So-Simple Question

What a simple question, and yet the answer seems a whole lot more complicated.

Here in Togo, the healthcare war we were waiting for has not yet come to pass. The country has encouraged certain measures to be put into place to keep the virus at bay, and perhaps these measures are helping. There are many more theories going around, but for now, what we know is that the onslaught of sick patients has not come. We have been waiting, but the COVID ward remains empty.

This is incredibly good news, albeit hard to believe. Could it be true that African countries may truly avoid the mass pandemic and casualties that Western countries around the globe have faced? We hope and pray this continent might escape what others have had to experience.

So, to answer the question regarding COVID, things are going alright so far.

Answering this questions for ourselves is a little harder. How're we doing? In the words of Ross from Friends "I'm fine!" (insert high squeaky voice that is not so convincing...).

We are doing ok. I mean, really, we are healthy and well-fed. The kids are doing well with their schooling, and Jesh's load at the hospital has lessened as the borders to neighbouring countries have been closed, keeping patient numbers lower then usual. We have access to more home activity options then ever before as the internet floods our feeds with fun ideas. We have been more connected then ever with friends and family back home, thanks to the open schedules and a renewed intentionality to stay in touch.

But similar to what I hear reflected in status updates and phone calls and emails right now, we are also not ok. Correction: I'm ok, but not. Along with everyone else, our life had taken on major elements of uncertainty. I opened my day planner the other day and the blank pages were a reminder of how the summer is just not going to look like we had envisioned. For the time being, the coffee dates and social events and speaking engagements are all up in the air, and that's a definite disappointment.

A few days ago, Jesh asked me what I need, and it didn't take long to create a big list of what I perceived as being my present needs. Alone time and privacy. More quality time with the kids, but more space from the kids. A break from the monotony of cooking and schooling and parenting and then doing it all again the next day. I realize these needs are in no way unique to me these days!

At the top of the list was the need for a solid and reliable plan. The truth is, the certainty of our plans and future is really hard for me to let go. I want that control back, however false it may have been. I don't like the constant shifting that feels like sand being pulled from under my feet with the latest wave of change.

In all the changes happening around the world, I find my feelings changing faster then I can keep up with (my husband can attest to this!). How fickle they are, and yet how quickly they can dictate my reality.

It's interesting to me that at this same time I am reading a book aptly titled "Telling Yourself the Truth." The authors make the powerful statement that feelings are caused by what we tell ourselves about our circumstances. They say "what you think and believe determines how you feel and what you do." Or in the words found in Proverbs, "As a man thinks in his heart, so is he."

What am I telling myself these days? All the things I need in order to be ok? Do I really NEED a reliable plan? It's not bad to have one. But convincing myself that is what I need ties my feeling happy to having that plan.

As I practice "taking every thought captive" (1 Corinthians 10:5), I find myself realizing that I really AM ok. I don't always feel like my circumstances are ideal, or the way I had envisioned or hoped they would be. But my current circumstances are not terrible...they are just not going to look as I had planned. And that really isn't the worst thing ever.

At the end of the day, I want to instead "give thanks in ALL circumstances"; even when things don't go as planned.



By Julie

P.S. Even just during the time it has taken to get these words written out, we have had our tickets changed and/or cancelled 5 times!

To date, we have 'plans' to return June 1 for quarantine, then will spend time in Ontario and BC, hopefully with a run into AB and SK in the months that follow. We will keep you posted in this ever-changing itinerary, but hope to catch many of you as safety and social distancing allows!

Visit our here on our Facebook page for the most current event updates in your area!!

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The Battle on COVID-19

It's happening here, too.

The first coronavirus case was reported March 6th, and while the reported number of cases remains minimal and there have been no confirmed deaths, there is great concern as to why. To think we have not truly been affected the way the world has seems too good to be true at this point. Especially considering the state of our neighbouring country. Today alone, Ghana's number of reported cases jumped by 50%. We hope and pray it will not happen here, but we are under no illusions that we will be spared what is to come.

We are preparing for a healthcare war.

When we read and listen to what is happening around the world, we are bracing ourselves. Our Hospital here in Togo has been thrown into planning and preparation for what many believe is inevitable.

The biggest difference for us here in Togo is no surprise - we lack the resources needed to truly battle this pandemic. While the hospital has oxygen, we have no ventilators. Rumour has it there isn't a ventilator in the country. Our PPE is highly limited. Jesh is currently strategically choosing when to use his face masks - a commodity we aren't sure will always be there.

Still, plans are being made as to how we can best treat what may come at any time. Wards are being cleaned and prepped, supplies counted, staff informed.

For us personally, this has impacted our family life in many little ways. As everyone in North America experienced, hour by hour things have changed and evolved. Last weekend the country suspended in-country travel, advised against church groups and gatherings, and began sending out text messages to the public.

Sunday evening we were told there would be no missionary school the next day, and therefore like so many others, commenced with an early spring break.

As a family, we have begun social distancing. In our context of community living here, this proves to be incredibly difficult. Life out here is isolated on a good day, but our saving grace has been the wonderful relationships we have here. Needing to intentionally close our door, even slightly sooner then some of our teammates, has proven to be quite stressful.

Along with the hospital planning and the immediate little changes required for our family is the ongoing topic of safety. How can we live our lives safely? How can we protect our Togolese community? How do we model and inform others of what measures will need to be taken for the next little while as we battle this together?

When we decided to bring our family to Africa, someone asked me how we could bring our children to a place with so much risk and suffering. Our answer was we need to trust that God goes with us, no matter what happens. Our call has never been to safety, but to obedience.

The same applies today.

As the security measures slowly decrease, I am forced to think long and hard about where, and in Whom, my true security lies. Up until now, we have had the luxury of a security blanket. Should things get really ugly, there's always evacuation insurance. A medical evacuation. At the very least, a flight out.

But we are now preparing ourselves for the reality that these may not be options for long. As countries continue to close their borders, flights get cancelled and airports locked down, our back up plans are quickly disappearing.

This is no way means that we don't evaluate the situation and make wise decisions with the information we have. But it does mean that we don't need to panic or react in fear (something I am choosing to practice daily). If I think too long about "what-ifs", then anxiety and worry become the filter through which our decisions will be made. And frankly, it's easy to get caught up in that.

What if it comes to our hospital?

What if we can't control it?

What if Jesh is exposed, and unknowingly exposes our family?
Or gets sick, and is isolated from us?

What if we respond poorly to the virus? And there's nothing we can do?

What if we could have received more care in Canada?

Even as I write these questions out in black and white, it's disconcerting. I know what I believe to be true, but it doesn't always feel easy.

I have found myself turning often to the Psalms, and the cries and laments within.

"My God, my God, why have you abandoned me?
Why are you so far away when I groan for help?
Every day I call to you, my God, but you do not answer.
Every night I lift my voice, but I find no relief.

Yet you are holy,
enthroned on the praises of Israel.
Our ancestors trusted in you,
and you rescued them.
They cried out to you and were saved.
They trusted in you and were never disgraced.

Psalms 22:1-5


"God is our refuge and strength,
always ready to help in times of trouble.
So we will not fear when earthquakes come
and the mountains crumble into the sea."
Psalms 46:2-3

In uncertain times, the hope of Christ is our certainty, and for that I am grateful.


By Julie

Toilet Paper Perspective

I was talking with a friend here in Togo about a week ago who asked "Am I crazy to consider travelling still? I mean, I almost stepped on a viper, I met a taxi and opened the door to help a patient with meningitis...it's about perspective, I guess."

I am not interested in sparking a debate about whether or not to travel right now. The research and information is changing by the moment. But in light of these events, can we pause for a moment and use this as an opportunity for perspective?

A month ago, long before the North American Toilet Paper Crisis, I took this picture as we began our trip to the capital city.

When we get in the car, we need to consider the many places along the way where there may not be washrooms, let alone toilet paper. And while it's not my first choice, it's possible to survive without! I'm just saying'...

Similar to what might be found in washrooms here

Similar to what we used in India

This is a pic of our grocery store (2 hours away) - all the time! Well-stocked means there's maybe even a handful of any particular item (although next time, don't be so sure it will still be there!).

This is the lighter side of perspective, but at a time when there's so much buzz about stockpiling and hoarding precious resources, those of us in more limited-resource settings can perhaps encourage our friends and family elsewhere that you would be surprised, maybe even shocked, at what you can live without.

But this perspective goes beyond the stockpiling of foods and household products.

On our way back from Kenya last week, just the kids and I were waiting for our flight in the airport in Ethiopia. I was sporting hand sanitizer, encouraging the kids to not touch the hand rails, and far more diligent that dropped pieces of cookie not be picked up and consumed.

The call was made to line up, and I'll admit, I intentionally stayed at the back of the line with my kids, a little distance between the next passengers.

As we were waiting, the middle-aged gentleman in front of us and his 20-something-year-old sons pulled out their face masks (and let it be said they were not coughing or sneezing, so chances are it was not so much about protecting the rest of us). My oldest turned to me and said "Oh, we should have brought some of those from the hospital to wear as well!" I replied, in a voice that was maybe louder then it needed to be, that actually we needed to leave those masks at the hospital so that daddy and the other doctors and nurses could use them when they were most needed.

Here's the thing. I wasn't just trying to prove a point (ok, maybe a little bit...). The reality is that weeks ago our team here was already discussing what to do with the fact that there was a potential mask shortage, and what if we couldn't get any?

Long before the COVDI-19 pandemic, our hospital was preparing for Lassa Fever season, which is now upon us. As a referral site, there is a risk that any day a very sick, contagious person might arrive, and we needed to be prepared. (For those unfamiliar with this virus, as I was, it is an ebola-like virus. Wikipedia states "About 15-20% of hospitalized people with Lassa fever will die from the illness. The overall case fatality rate is estimated to be 1%, but during epidemics, mortality can climb as high as 50%.")

The point is that facing resource limitations is a pre-existing and ongoing challenge in many areas of the world. And it is serious. Our Togolese friends had to think about that months ago as they prepared themselves for this current dry, hot season by storing the foods that their families would survive off of. The pharmacists here need to plan far in advance to have medicines on the shelves. And it goes on and on.

Perhaps it would help use all to gain perspective on what happens on a regular basis around the world. This is not to minimize others' challenges - we all like to have those soft white squares available.

But what if the craziness of suddenly wondering if we will have access to basic resources can be used as a reminder that this is a daily reality for many around the world? What if we took a moment to stop and think, wow, I have never considered before what a luxury it is to throw a bag of TP into my grocery cart. If we saw the empty bottled water shelves and could pause, just for a moment, and realize the gift that clean water is.

What if, after all this begins to clear again, and as things resume to normal, we could remember what it felt like to wonder if we would need to go without?

Maybe, even now, we can use this perspective to remind ourselves that millions go without toilet paper. All the time.

And by the way, if you run out, we have toilet paper.



By Julie

Deaths that Haunt

For those who have heard me speak in recent years, you will have noticed that I often struggle through tears when attempting to recount patient stories. I am not entirely sure why this is, but I have spent a lot of time trying to understand the impact dealing with death and suffering has on a daily basis. As a surgeon, I sometimes struggle to answer the question “how was work today?” 

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For example the night before last, I was up every 4 hours monitoring a 3 year old child who I had operated on that day. His diagnosis was challenging, having both typhoid and malaria, but when he was brought to the OR, the damage was already well underway with multiple holes in his distal bowel as his innate defences were being overcome by the typhoid infection. This coupled with anemia from malaria presented a deadly combination. Normal hemoglobins range around 12 and we normally transfuse patients at or below 7. This boy was at 4.8 with a raging infection. He needed an operation urgently.

Antibiotics cannot fix an extensive bowel perforation, and the effects of sepsis on blood pressure and heart rate in a setting with minimal ICU support are difficult and sometimes impossible to treat. In the end, I had to remove a section of his small bowel and colon. Joining bowel together in an abdomen full of infection is dangerous because the risk of that sewn joint leaking is high. "How is he doing?” I asked our anesthetist. “Sort of stable," came the reply. Surgeons often will protect a sewn bowel joint with an ileostomy. An ileostomy is a piece of bowel brought up through the abdominal wall proximal to the new joint so that the patient stools out the side of the abdomen rather than the normal way. This diverts stool away from the fresh bowel joint and reduces the risk of further leak/infection.

"I hate ileostomies," I thought to myself as I weighed the risk of a leak while sewing the new joint. Patients that come to our hospital cannot afford the appliance and bag that protects the skin. Living without these appliances in Canada or the US would be unheard of, but my patients often just collect the fluid/stool in a piece of fabric. The fluid is caustic and eventually will erode away at the skin it touches, not to mention there is no capacity for continence with an ileostomy. But, this surgical procedures saves lives and when compared with death, its the lesser of the two evils.

I quickly made the ileostomy and washed the rest of the contamination out of his abdomen. I sewed his abdomen shut. It was a race against infection and I feared we were already behind given his diagnosis. Night came and I finished my other cases for the day. The boy went to our ICU where we can provide more extensive monitoring. He was transfused during the night, and I checked his labs trying to correct the abnormalities that present with a raging infection.

I couldn’t help but think that this boy is the same age as my son as I laid in bed awake that night. Between the heat, the mosquito I couldn’t kill, the noise of the ceiling fan, and checking on his status every 4 hours, I didn’t get much sleep. "I must sleep a bit," I thought, given that my colleague and I are on call every other day and every other weekend for 2 months.

Morning arrived and he was still alive. Somewhat reassured with his condition, I tweaked a few things and continued to see my other patients when I got the dreaded call. 

"Doctor come quickly!" His heart had suddenly stopped. 

People quickly gathered at the side of this little body and started CPR and various other things. When doing CPR, 30 minutes can seem like just a few, and despite correcting everything we could, we could not get him back. Time of death 11:07am.

The father watched the events unfold looking helplessly. I felt helpless. This was the third patient this week I had in hospital with a similar infection. My other 11 year old patient has undergone 3 operations but is now in the clear. Another lady, my age, is struggling to learn to live with the dreaded ileostomy but she is also doing well. 

It is cases like the story of this boy that divide my being. The logical part of me can’t help but recount his clinical course and try to figure out what could have changed his outcome. The emotional part of me grieves with the family. Sometimes it is just easier to try and forget as the next patient will be arriving any minute. Maybe a trauma patient with a mangled leg, or another child with some horrible infection.  It's not that surgeons want to be apathetic, but each patient is a series of mission critical decisions and steps. There often isn’t time for emotion. 

Death forces me to review those mission critical decisions. I suspect one way to deal with recurrent death and suffering is to just not think about it at all and move on to the next emergency. I find this hard because at the end of the day, I genuinely care about every life in front of me. I hate death. 

This post is a glimpse of the deaths that haunt me. It is one of many gravestones of a life lost that is etched in my mind. 

I am sure you are thinking, wow, this is a super depressing post!

But by understanding a low like this, you can begin to understand the pure highs I experience when seeing a patient totally healed after their life-threatening surgery, or one unable to walk now able to move again.

You can appreciate with me the joy of averting the course of someone spiralling towards death. When you see me smiling on my facebook posts, it’s real! It's the reason I practice surgery in Africa. I love and I hate what I do. It’s the blessing and the curse of being a surgeon.

Today I joked with my OR staff that I look forward to being unemployed in heaven. Even my muslim colleagues laughed. As I reflected more on this case, I was reminded that 

I serve a God who cares about kids.

In fact, he reprimanded his disciples for hindering kids. He cares about life, He hates death and He understands what it feels like to suffer and die as a human. It makes going through situations like this a bit easier and it’s what gives me strength for each new day and each new case.

By Jesh

Missions & Debt

People send us foods we can't get 

like Miss Vickie's Chips. 
Not always received as sold in stores.

I am inspired to write this post as we approach what can be the January financial blues. It’s that not so wonderful time of year where credit card bills arrive and chequing accounts need replenishing to pay for that “most wonderful time of the year.” I admit, this may be a pessimistic view of the holidays but if you read any newspaper you will see a plethora of articles about how to deal with the post-Christmas financial blues. I am reminded of the commercial “for everything else, there’s Mastercard.”

So what does debt have to do with medical missions?

I recall as a medical student and surgical resident wondering how would I provide for a family on a missionary income. As a current surgeon in medical missions, the donations given to us and processed by Samaritan’s Purse can be used for ministry related expenses (strictly governed by Canada Revenue Agency rules). Samaritan’s Purse does not take any administrative fees from these funds which is generous on their part! Things such as flights to and from the mission field, luggage costs, country visas (sadly not my plastic visa:-), language study, patient expenses and/or surgical equipment and projects can be paid for using this donated money.

As a missionary surgeon, our family also receives a modest stipend from Samaritan’s Purse which was recently increased! (and we are super thankful and grateful for this)

If you crunch the numbers though, to provide for a family of 5 living overseas, it takes a significant amount of work and organization to live within these means.

Our local market.
Eating local is usually healthier for
our bodies and our budget.

But hold on! You are living in the 10th poorest country in the world. Life should be cheap there shouldn’t it? 

Well, it depends if we want to drive a car, have electricity and plumbing, and eat occasional imported food like cereal or chips, tomato sauce or cheese. Most of the community around us does not live with these things and buying them is actually more expensive here than in Canada. For example, new vehicles are taxed at 50% and they are all imported so their base price is already more expensive than in Canada.

Another example is if we want to go to a grocery store bigger than a 7/11 (which is 2 hours away) we need to drive 8 or more hours. Its true, life is cheap for the average Togolese person, but most of us would not want nor could we live like the average Togolese and work 80hrs a week doing surgery, with no household running water and less than subsistence living.

So where does debt fit into all this?

I have owned the same pair of sandals for 10 years.
They have made 5 trips to Africa and this year
they found a sole-mate.

Julie and I both knew many years ago that to survive financially on the mission field we would need to manage debt wisely. Most single medical students today will finish residency with more than $150,000 worth of student debt often in the form of student loans and professional student lines of credit with a bank.

Upon graduation from residency, that debt needs to be paid. We knew our future missionary stipend would not be able service a massive debt. Most new doctors are forced to look for “high” paying jobs immediately after graduating to deal with this “debt” problem - especially if the bank of mom and dad is not involved or they don’t have some sort of prior savings.

So Julie and I created a plan when I started medical school and this is how it went. Julie would stay home to minimize our expenses. She shopped for deals, made food instead of eating out and raised our kids instead of putting them in daycare. In addition...

• We rarely ate out 
• We slept on a bed without a bed frame for many years
• We lived within our means at Christmas 
• We drove older vehicles
• We constantly re-evaluated and decreased our cell phone plans 
• We kept our chequing account balance low and any extra cash was placed against our highest interest debt
• We applied for grants, bursaries and student loan assistance
• We paid off our credit card balance EVERY month 
• We shopped second-hand for everything we could
• We bought refurbished technology
• We had staycations instead of vacations
• We planned family experiences instead of buying stuff 
• We chose a residency program based on lower housing prices so we could maintain an affordable mortgage. 
• Julie wore cheap jewelry
• I wore cheap cologne
• We prayed many times that somehow it would all work out in the end

Julie and I lived as minimally as we could because we knew missions would never be a possibility if we were slaves to our debt. We wanted to be able to serve in the mission-field as unhindered as possible. 

Despite all these efforts, we still graduated with substantial student debt. It was the cost of getting a surgical education in Canada but our debt at the end with a family of 5 was substantially less than most single residents.

The day I graduated from surgical residency in 2017. 

Julie is expressing her love of cheap cologne and

I am expressing my disdain at the cost of a surgical education.

Thankfully since being on the mission-field, we just spend less in general. You can’t spend money on a burger and fries when there is no place to buy them. 

For people interested in missions or supporting missions in general, my advice would be to start planning early. Be prepared for hard work and hard financial decisions. 

Be prepared to live counter-culturally. 

Resist becoming a slave to debt. Keep the end goal in mind and be wise with what you have been entrusted with - debt included.

We are grateful to our many financial partners who invest with us to serve on the mission field. One of our partners includes the CanMedSend Foundation whose mission is to help Canadian medical missionary physicians with their student debt. Thank you!

Jesh