Matt Papa tells the Story of God in ten minutes.
-h/t Tim Challies (Challies.com)
Matt Papa tells the Story of God in ten minutes.
-h/t Tim Challies (Challies.com)
August 15th, 2012 marked my last official day of work with my previous employer in North Carolina. Two days before, I had out-processed from post. The separation from the job requires lots of bureaucratic form stamping. I sat down in the separations counselor’s office and watched her unceremoniously stamp my DD214 paperwork, officially signing me out. I walked to my truck and sat in the parking lot for a long time. In the preceding years, I had lost friends in the fight. I felt like a quitter. My identity was gone. I drove home and finished packing for the trip to Ethiopia the next day. I cannot describe the despair of leaving behind a pregnant wife and four crying children at the security checkpoint at the airport. It felt worse than any previous trip for some reason. Karisa and I had planned on this solo trip to Ethiopia to be a “site survey” to scout out the hospital to better plan for our needs. I was immediately homesick for my family. Once Karisa and kids were out of sight, there was loneliness that superseded any previous moment.
When I landed in Addis Ababa, I was met at the airport by Dave Ayer. Dave and his wife, Julie, have five children too and will share the other half of the duplex currently being built in Soddo. We met at a conference a few years ago, and have been close friends since. Karisa and Julie correspond now almost daily. The Ayers have been living in Addis for the past six months and are enrolled in an Amharic language school. We all loaded up in the hospital van for a two hundred mile drive south to Soddo.
While in Addis, Dave and Julie met a former farmer, now evangelist named Ben Skaggs. Ben has lived in Africa for over thirty years. Ben has an almost awkward quality about him–a bit rough around the edges, but a gentle spirited man with a passion for the unreached tribes of Ethiopia. He is more comfortable in the bush than anywhere else. He is a bear of a man with a thick graying beard and a booming voice to match it. A natural philologist, Ben speaks nine languages.
For the past several years, Ben has been working with a people group called the T’ara tribe in the Omo River valley. The T’ara people live in a remote region of southern Ethiopia that recently National Geographic called “Africa’s last frontier.” The T’ara tribe was completely unknown to the Ethiopian government until a few years ago. Accessibility to the T’ara people is difficult. There are no roads to the T’ara region and it is a difficult overland journey by trail. Ben had asked Dave Ayer if he was willing to come and do a clinic for the T’ara people while Ben taught the Bible. The tribe had essentially no access to medical care. Ben had invited me to come too. The trip was scheduled for the last week of my month long stay in Ethiopia.
The time in Soddo passed by quickly. I was able to envision our family growing and ministering together in one spot. Paul Gray had done an incredible job as a surgeon and administrator. He has a heart for training and discipling the PAACS surgical residents. For a small mission hospital, Soddo is quickly gaining the reputation of being the “go to” place for surgery. During my brief stay, patients travelled hundreds of miles for surgery-some as far as the Somali and Kenyan borders. At the end of the trip, I regretted leaving Paul behind; he has worked humbly and tirelessly for the past four years. He has my utmost respect, and I look forward to serving alongside him in the years to come. When we return, we will be there long term as a family!
On the day of our trip to T’ara, it was raining hard. The previous day, we had driven to the town of Hawassa, Ethiopia; Helimission Ethiopia is located there. The town is situated on the western bank of a large Great Rift Valley lake called Lake Awassa. The hangar sits on a hill with a beautiful view of the lake below. The morning we left, a hippo was grazing in the grass just below us. Dean, our pilot, was a rescue pilot from New Zealand. When the rain began to subside, we lifted off in a Eurocopter 350 and headed south. Flying south, the views were incredible. As we flew, the terrain grew more rugged and vertical. There were fewer signs of human inhabitants until eventually there was nothing but mountains and virgin forest. Dean’s flight path paralleled the Omo River. After an hour of flying, we reached a bare ridge line where a helicopter landing zone had been hewn out of the forest. Behind the landing zone, a church had been constructed with mud walls and a sheet metal roof. Dean circled once and landed. The engine powered down and immediately we were met by a crowd of about a hundred people. Dave and I stood there awkwardly being greeted and hugged by people and watching Ben pick up Chiango, the village chief, off his feet with a giant bear hug.
Each time Ben visited, he would distribute new booklets of the Bible that he had translated in the T’ara language. The T’ara treasured these. Ben had tediously gone through the Bible in chronological order. There was so much joy seeing Chiango and many of the men sitting in front of a tiny blackboard learning to read and write. They took great pride in being able to write their own names neatly on their books.
The first night we were there, Ben taught late into the night. The villagers wanted him to start again at six in the morning. Ben, Dave, and I sat in a dirt floored hut and ate in the dark as Chiango and many of the men peppered Ben with questions.
Eventually, Ben told them we were going to sleep. We pulled out our sleeping bags and crawled in. With curiosity, the men kicked our sleeping bags like tires on a new car. I drifted to sleep with a host of people standing over me chatting excitedly. Ben explained we must give them some grace as there was much excitement when he visited-kind of like Christmas. Eventually, the hut got quiet. We were awoken at three and again at four in the morning that first night with the spontaneous prayers of the those who were also sleeping in our same hut. It was endearing initially, then eventually annoying. I felt bad that I was annoyed and wished I had a relationship with God that woke me up in the wee hours of the night to pray like that.
The next morning, Dave and I set up our second day of clinics. As soon as we started, we were brought a paralyzed woman who was carried far over mountain trails by her family. She had not been able to walk for years. With scores of people watching and crowding around, we explained we could do nothing but pray for her. For two days patients arrived one after the other. Outside our makeshift clinic there was singing–nonstop singing–The T’ara love to sing! On our final day, we were brought a fourteen year old boy with a severe, life threatening soft tissue infection. We did not have adequate equipment to perform the needed operation. A shot of ceftriaxone would have to suffice until we could fly out the next morning. I borrowed Dean’s Iridium satellite phone and called Paul Gray in Soddo and told him we would be bringing back a patient who needed urgent surgery. We loaded the frightened young man for his first flight and medevac back the hospital in Soddo; after multiple operations, he recovered fully and was returned to T’ara.
The greatest part of the trip to me was the Bible teaching session that final night in T’ara. The entire village sat packed in the dark little church that night. Men, women, and small children sat quietly listening to Ben preach. Ben would preach for an hour, then there would be singing, followed by more preaching. There were two kerosine lanterns hanging from the ceiling providing the only light. Ben asked us if we would like to teach from the Bible. You simply read the Bible passage, verse by verse, which was translated into the T’ara language, then followed with questions to the crowd. I got to read the Christmas story from the second chapter of Matthew that night for the first time to the people of T’ara; They had been waiting patiently to hear how God would send His Anointed the Messiah and how the people of Israel would be saved from their sins. After reading, I asked, “why was Jesus to be called Immanuel?” They replied in unison, “Because Jesus was God the Savior coming to live with the people!” I continued, “Why was God not angry that the wise men worshipped Jesus?” Their reply, “Because Jesus is God. Jesus is God and man.” The purity of their faith and desire to learn was incredible. Watching the fruit of four years of labor through Ben’s teaching was a wonderful thing. The following morning we flew back to Soddo.
Ben and Dave have continued to visit the T’ara regularly since our trip in September. Since I left, Ben has now taught all the way through the Gospels and Dave continues to regularly hold his clinic. The T’ara have built Dave a clinic hut next to the church. In the third week of November, Ben and Dave returned, on the Ayer’s blog ourgreatestjoy.com Dave wrote:
“Many who had heard the teachings from earlier in the day returned and one by one were asking to receive Christ as their Savior…
These were the same people who said just a few months ago, “We have been meeting and praying, asking God to send us someone who could teach us.”
They have been ready. They have been waiting. How many others pray and wait?
May the Father so burden our hearts for those who are waiting and longing to hear.
The Harvest is ready, lift your eyes.”
Five years ago, with my previous job, another mountaintop helicopter mission left me with the desire to go to these isolated places where Christ has not yet been proclaimed. I wanted the privilege of sharing His Story. I thank God that He used this mission to show me that His Spirit is on the move.
It’s worth it.
It has been nearly a month since I left North Carolina for South Sudan. I miss my family. It has been hard being away from Karisa and the kids. I have the best wife ever! Karisa has always encouraged me and has been ever so patient. She is 8 months pregnant and has been homeschooling our four children by herself. As I was leaving South Sudan, Karisa asked me if the work was done. I said, “no, not really.” She replied, “If you think you need to stay longer, then do it.” I told her that there never will be a good stopping point, but it was time for me to come home and be a husband and daddy. I need to be something more than a fleeting presence on Skype.
As a doctor, when I used to read the stories in the Bible of the sick and dying, I never really could conceptualize their illness.
Withered hands, leprosy, the crippled and the lame. Those people still exist. Patients are brought on their sleeping mats by their loved ones, often being carried for many days to the hospital.
One young man named Mahdi arrived at the hospital thin and and wasting away. Mahdi is about twenty years old. I found him lying in a hospital bed too weak to move. He was lying in his own urine and excrement. He had become weak from chronic illness, dehydration and malnutrition. Mahdi’s legs had become contracted and curled under his body. He scooted around on his hands dragging his body behind him. I started stretching Mahdi’s hips and knees each morning on rounds. Without X ray, I had no idea whether any fractures were present, but my guess was that Mahdi had just been lying down so much that one day he never got up.
I am no tropical medicine doctor. I had no idea what was causing Mahdi’s illness. We checked antibody titres for typhoid. It was positive. Additionally, Mahdi had evidence of chronic non pulmonary tuberculosis. I started him on broad spectrum antibiotics and TB meds. He was fed a corn soy diet that is high in caloric density. Over time, a light appeared in Mahdi’s eyes. He began to smile. Over several weeks, Mahdi was showing signs that he would walk again. His left leg could support his weight and his right knee would stretch almost enough to extend his knee fully. There is an African proverb “you eat an elephant one bite at a time.” I was trying to tell Mahdi he was making progress, but needed to keep going. I asked him, “Do you know how to eat an elephant?” Mahdi replied, “We don’t eat elephants here, we don’t have any.” I don’t think he ever really got the gist of what I was saying… I left telling Mahdi that I would return again one day and he and I were going to run South Sudan’s first marathon together.
Many patients made great progress and had survived incredible illnesses-
some did not. In a hospital where there is no electricity at night, some mornings I would walk to the wards and find an empty bed where we had left a struggling patient overnight. To hear the wail of a mother mourning the death of her child unnerves the soul. Malnourished children have little to no reserve when they become ill. Despite trying our best, these children would often die of illnesses like pneumonia, diarrhea, or malaria. This breaks my heart. I think of my own kids. I would often sit by the bed praying for God to spare the baby. I would think in my mind, “Lord, I am not asking for something selfish. I am not asking for some sort of blessing or something trite. God, please save this baby for Your glory!” Prayer is a first line therapy in Africa. It should always be that way, but often in the West, we rely on our technology first and God last. I believe in and know a God who has raised the dead. I want to see Him heal the broken and dying.
At home, I think we sometimes wish Christ’s return would be delayed. We are too busy building our kingdom’s on earth. We are living the dream of heaven on earth now. We fail to see that life is Ranger school for eternity. I am often more focused on this world instead of things eternal. I care more about my name and my glory than His name and glory. I shouldn’t. I forget that it’s not about me. My humility is often nothing more than false pride wanting a pat on the back and the praise of others. This is the danger of our deeds. “Righteousness” done for anything other than His glory alone is worthless.
I cannot rightly summarize all that has transpired since our transition to Africa. In 24 hours, I will be home with my family in North Carolina. I pray the Lord gives us a healthy baby girl in November. If everything works out, we will be in Ethiopia some time after the first of the year. I am so thankful of all who have sent messages of encouragement to us.
Maban, South Sudan
3 October 2012
The day started out last night. It is still the rainy season and we had a hard rain that left everything muddy but it cooled the temperature down very comfortably. Around 8PM last night MSF brought in a woman who had been sick for 4 weeks with weight loss. She was treated for one day for sepsis, but was noted to have severe abdominal pain. When I examined her at the hospital, her heart was racing and she had a high fever. She was semi-conscious, but was awake enough to wince in pain when I examined her abdomen. The OR team all lives near the hospital and a truck was sent to pick them up to prepare for surgery.
There is no general anesthetic, only IV sedation with ketamine and spinal anesthesia. The anesthesia provider here is a brilliant 28 year old named Saddiq. Saddiq has no formal training, yet can perform anesthesia, then don scrub attire and assist or operate. He can perform C sections, hernia repairs, appendectomies, and various other operations by himself. It is a blessing to have him here as well as the other hospital and SP staff here.
Saddiq placed a quick spinal anesthetic and we then performed a laparotomy. We found the woman had several perforations in the small bowel and signs of chronic typhoid infection. I resected part of the bowel and then sewed the remaining ends together again. I have never seen a bowel perforation from typhoid. To be honest, before last night, I have never seen typhoid fever. The patient did well and we returned her to the ward. We returned back to the camp at around 1:00 this morning. Later this morning, I began rounds and found my patient was doing well. Her fever was gone and her vital signs had returned to normal.
While I was still seeing patients on the wards, the S. Sudan Police brought in a fellow police officer who was shot through the chest with an AK-47. He had a wound in his left chest near the nipple and a second wound on his back just to the left side of his spine. In trauma, we call this an injury to “the box.” These are often lethal. The patient did not have any breath sounds on the left and was having difficulty breathing. The patient needed a chest tube placed to drain the blood out of the chest and re-expand the lung. There weren’t any chest tubes. We improvised a chest tube out of a foley catheter bag. It worked well. The tube was already connected to the bag which made it even easier. I placed fenestrations on the tube with scissors and inserted it. The patient had some relief breathing, but the amount of blood returned was ominous. The bag drained nearly two liters of bright red blood. When I emptied the bag, it began to fill again. We do not have the ability to measure a hemoglobin or hematocrit or a complete blood count. In some ways, it makes things easier–the algorithm is pretty simple and short here.
The patient began sweating and asking for something to drink. The is the last thing I have heard many patients say as they bleed to death. Often, shock causes the patient to have immense thirst. The patient’s blood pressure dropped into the 60s and his heart rate rose into the 140s. He was bleeding to death.
At this point, a huge crowd had gathered. Some crying, most just taking up space and adding to the confusion. I told all the family and the patient’s fellow police officers to queue up next door at the lab and go donate blood. I explained that the man was dying and if he did not get blood quickly, he was not going to live much longer. I think much of the family was resigned to the fact that the patient was going to die.
An interesting thing happened. Isaac and Camille Hatton are visiting here for a week. Isaac is a third year medical student and Camille is a nurse training to be a midwife. Both of them are blood group O blood types. This means they are universal donors. They both walked over and donated 500ml of blood each. One of the hospital staff noticed the people around talking. Apparently, Isaac and Camille’s gift had not gone unnoticed. Soon after, a large line formed and we had no lack of blood after that. It was well needed. The patient required over 4 liters of blood.
In the United States, a patient who has lost two liters of blood would be taken to an operating room. He would be put to sleep and an endotracheal breathing tube would be placed. We did not have a ventilator here. We did not have an endotracheal tube nor did we have any thoracic equipment. We also do not have general anesthesia and we cannot do a thoracotomy under spinal anesthesia. I asked the OR staff if they had ever done a chest operation. The answer was “No.”
I was not really sure what to do to be honest. The man was dying. More blood was coming out of the tube than we could pour in his IV through transfusions. He was fully conscious and his family wanted to spend time with him. His wife was sitting with a baby who was about 18 months old at the bedside. The wife had the baby sharply dressed in a double breasted suit. I did not want them to be robbed of their last minutes together. I went to the corner of the room and prayed and gathered my thoughts. I pulled the trigger and we loaded the patient on a worn out stretcher and took him to the operating theater.
By the time we got the patient on the table, the patient was unconscious. I could barely feel a pulse; his oxygen saturation was in the 30s. Saddiq gave ketamine sedation. I did an anterolateral thoracotomy and opened the chest. The lung was bleeding. I oversewed the lung as best as I could. We placed three improvised chest tubes then closed. The wound went from the patient’s sternum to below his armpit. When we finished, I could not see any more bleeding. I knew we might win when the bleeding was stopped and the patient asked if he could have some porridge. I have never sewn up a patient’s lung and had the patient ask me if he could eat. Saddiq asked the patient who had shot him. He said, “finish up and I’ll tell you later.” We finished up with close to 3 liters of blood in the floor and suction canisters. We improvised underwater seal chest tube bottles out of used suction tubing and suction canisters.
We brought the patient out of the operating theater and were met by a large crowd. I told them the man had lived and that God should be thanked as He had allowed the bleeding to slow down. I asked if we could pray for him. Saddiq was translating. They told Saddiq they were all Muslims. Saddiq said in Arabic, “it’s okay, I’m Muslim too.” They all bowed their head and I thanked the Lord for what He had done and asked Him to save the man’s life for His Glory and that He alone be glorified in this.
At 8pm tonight, I walked over to the hospital and check on our patient. As of now, the bleeding has stopped. The patient is awake. He says he is doing well but is having a little bit of pain. He is eating porridge. To God be the glory!
Please pray for these patients. I greatly appreciate it.
As the only general surgeon here at Soddo, Paul Gray is on call all the time. There is an old saying in surgery, “the only thing bad about being on call every other day is that you miss half the cases.” Paul gets the benefit of not missing any of the good cases! This sunday morning, Paul did an appendectomy on a young man. It took about twenty minutes. In the age of laparoscopic appendectomies back home, Paul did an open appendectomy through a single one inch incision. Granted, the young man was thin, but his one incision is smaller than some of my three incision “minimally invasive” operations back home. On the short commute back from the OR to the house (100 yards or so), a sheep charged Paul and ran to the end of its tether like a guard dog. It made me think about all the Psalms and other Bible references to us as sheep. I always thought about the idyllic, tranquil pasture with a lovable and calm sheep cuddling up to the shepherd. After walking through this field every day, my conclusion now is that sheep are silly, dumb, poop a lot, make horrible belching noises and eat trash. I’m thankful that the Shepherd is patient with me and all the silly, dumb things I do.
after writing this, I did a short, scientific Google Search “Are sheep really dumb?” I found an article from Tim Challies with similar parallels on sheep. I thought it was interesting and have linked it below. I read Tim Challies’ blog often and find him insightful.
I also found an interesting review from the University of Tennessee on sheep behavior. Here it is:
With my last job, I went on several trips, many of which were much longer than a month. When I planned this trip, a month away from family seemed easy compared to those previous ones. I am not sure if it is because the kids are older now or the additive homesickness of those trips away, but this trip has made me homesick for family more than what I expected.
I landed in Addis Ababa on the 15th of August. It was my 38th birthday. It also marked the official beginning of civilian life again. The day was bittersweet. I will miss my old job and the great friends made along the way. At the airport, I was greeted by a familiar face, Dave Ayer. Dave is pediatrician from Washington state. He and his wife Julie have five children and are currently in language school in Addis learning Amharic-the Ethiopian national language. The Ayers will be moving to Soddo Christian Hospital later this year where Dave will be on staff. We will share a duplex with them. We couldn’t have asked for better neighbors.
We drove the 200 mile trip to Soddo later that day. Driving to Soddo is like driving a car on a sidewalk. The roads are made for people and livestock to walk on, vehicles are secondary traffic. Silas, our driver, honked his horn well over a thousand times. As the vehicle weaved around donkeys, goats, horses, cattle, kids, and pot holes, I wondered how many people are struck by vehicles on a daily basis.
(After visiting a few days in the hospital, I realized one of the most dangerous things in this part of Africa is not a wild animal. The are many adults and children here with brain injuries, amputations, and fractures from auto-pedestrian accidents. Ethiopia has one of the highest fatality rates for motor vehicle related trauma).
It is the middle of the rainy season here in Soddo now. It doesn’t rain all the time, but stays cloudy most of the day. It can rain hard for sustained periods with thunderstorms, but overall, the climate is great. It gets into the upper 70s during the day and low 50s at night. I love the weather. The altitude is 7000 feet. The town of Soddo sits at the base of a mountain called Mt. Damota. It is a beautiful sight to see every morning as I make the 200 yard commute to work. From the back window of our duplex under construction, you can see the the Great Rift Valley and its lakes below.
One of the things I am looking forward to most here is being able work so close to home and be with family. From the operating room window, I can see the house where we will live. I have visions of seeing my children play outside the window and being able to walk home to lunch and a short visit. I also can envision Karisa and the kids making visits to the wards with me to visit with patients.
This past saturday I had some time to visit with a patient of mine who was recovering after a cholecystectomy. I asked him if he knew the Lord. He said he was a Christian, but had been living a life of sin and wanted to turn his life around and follow God. We visited for a while and prayed together. As the residents and I were walking out of the room, another patient who was not our patient stopped us. He asked us if he could know Jesus too. He said he was a sinner and wanted to repent and follow Christ. We gladly stopped and visited with him and prayed with him too. I am thankful to God for giving me the opportunity to be part of this. It gave me a glimpse of the future here with my family.
This is the latest photo of our duplex we will be sharing with the Ayer family at Soddo Christian Hospital. Two families and 10 kids total! We are really excited to see the progress. The home is beautiful. We are getting closer each day to meeting our fund raising goal. Thanks to all who have contributed.
One of the rate limiting steps of moving to Ethiopia was the problem of where to fit a family with five kids. The hospital in Soddo had no usable living space on the grounds. In addition to us, The Gabrysch and Ayer families were also moving to Soddo. Three families with 12 combined small children placed an acute need on housing and space. An answer to prayer was an organization called MSAADA Architects. MSAADA architects is a mission based architectural firm that builds structures for various mission organizations and NGOs around the world. David Ayer contacted MSAADA they were able to quickly draw up the plans and begin construction of duplexes which would house our families. In addition, MSAADA is also helping construct housing for the PAACS surgical residents and their families. We are excited to see pictures of our new home progress along. The Hardin and the Ayer families will be sharing a duplex. As you can see, progress is being made and by the time we arrive, our home should be complete!
Last week Karisa and I attended Missionary Orientation Training in Tupelo, Mississippi at Global Outreach International. Global Outreach will partner with our sending church Liberty Baptist here in North Carolina. We had a great time and were treated like family as soon as we got there. We received great teaching and were able to spend the week with some great veteran missionaries. Karisa and I thoroughly enjoyed the training with several other families who are heading all over the world to work and serve. It was one of the most encouraging times we have ever had as a couple. The trip could not have been a better blessing to us.