Christmas

What a joy to celebrate Christmas with all the Pfister pfamily traditions and with the whole family together for the first time in several years!

 

Lauren, Alyssa, Mom with Sam, Dad, Bud with Emma, Leslie

We did miss Lauren's fiance Wei Chi, but we enjoyed some pre-wedding fun with lunch and bridesmaid dress shopping with a few of Lauren's closest friends. Looking forward to the big event June 23! And so thankful I'm in the country for all the fun!

Isn't Emma adorable?! She's so much fun and quite the dare devil - loves being thrown up in the air and climbing the stairs whether anyone's spotting her or not.

Gigi (my mom) found so many fun activities for the grandkids like this cardboard castle. Isn't Christmas so much more fun when little ones are around?!

Christmas Eve enjoying the festivities at Opryland. (From Bill Bryson's book "Notes From a Big Country": "But what really sets Opryland apart is that it is a Total Indoor Environment...It is, in short, a flawless, aseptic, self-contained world, with a perfect unvarying climate and an absence of messy birds, annoying insects, rain, wind, or indeed any kind of reality.") It is a beautiful place, especially at Christmas-time, but I'm thankful I don't live there. The messiness and irregularity and annoyances of everyday life, and my response to them, are what remind me that I need a Savior. And I'm so thankful Jesus came to cleanse the incredible ugliness of my heart and to bring true beauty into this fallen world. 

Samuel blowing out his candle at the Christmas Eve service at West End Community Church. Samuel continues to love church and sits more quietly than I do through the service! 

Traditional Christmas morning breakfast - sausage and egg souffle

Dr. Samuel, gift from Auntie Alyssa! Maybe he'll join me in practice in Burundi someday!

Examining baby sister Emma

Enjoying laughter and conversation with special family friends, the Spillmans

I'm thankful for the peace and joy of the Christmas season, the reminders of the beauty of Christ and the gospel, fellowship with the body of Christ, and the giggles of small children. Merry Christmas!

Work

Last week I began working nights as a hospitalist (nocturnist, some would say - but that sounds like a possum or other night critter to me) here in Alabama. I must admit, the first couple nights I walked around a bit dazed by the wonders of modern technology. Thankfully things haven't changed too much since I finished residency in 2009, but wow, are things different from Kenya! A few examples (and I apologize for the medical lingo for my non-medical blog readers - it's a little hard to avoid in this post):

1) An intubated patient was transferred from the Emergency Department (I can't stop calling it Casualty in my head - the British term we used in Kenya) to the ICU via CT (certainly no CT scans available for inpatients during my years in Kenya). As the nurse gets her settled in the ICU, he reports to me, "I think her ETT may have dislodged a bit during the transfer, but she's still pulling good tidal volumes on the vent, so I don't think it's come out too far." An astute observation that likely would not have been noted in another setting. He orders an x ray. Within 10 minutes, I look up and see that not only has the xray been taken, but it's actually visible digitally right there on the portable x ray machine. The tech waits patiently while the nurse & I unsnap the ETT securing devise (no pulling off tape or unrolling gauze), push the ETT in a bit, and resecure it. Then she shoots another x ray and I verify the placement immediately - again, on the screen. I still listen for equal breath sounds with my stethoscope, but out of habit more than anything else. And then a radiologist actually calls me with an official read of the x ray in another 10 minutes. I'm completely astonished at the efficiency of it all!

2) Another ICU patient has both pulmonary and cardiology consultations complete within 5 hours of admission (which was after 5pm). I missed subspecialty consults greatly in Kenya! Though it does take some adjustment to remember when I should consult a specialist here.

3) I was paged to the bedside of a lady with advanced cancer who was developing respiratory distress. For better or worse, I certainly gained a lot of experience with end of life discussions in Kenya. There was a steep learning curve there, though, as so much of end of life care, expectations, and decisions are culturally derived. In Kenya, these discussions are traditionally had with family members, not with the patient. And no one wants to be the bearer of bad news, so they generally don't tell other family members who aren't present that a loved one has died but only ask them to come. Even the Kenyan nurses describe a dying patient as having "changed condition" as opposed to a more definitive assessment. Speaking to this lady in Alabama about her wishes was so simple - we spoke the same language, she understood the implications of what I was saying, & I knew she understood because we even spoke the same nonverbal language. And I knew the culturally appropriate ways to comfort her. I did feel significantly more pressure to document this discussion in the chart than I ever did in Kenya, though!

Of course I'm also amazed by almost immediate lab results, computerized records, and hand sanitizer everywhere among other things. But, though these conveniences and technology are a refreshing change of pace, the fact remains that another doctor would care for these patients if I wasn't here. My heart goes out to my overworked colleagues at the mission hospitals in Kenya right now. At Tenwek, a series of recent events (one being the loss of the five McCropder docs a couple months ago - a scheduled departure, but nonetheless challenging to find five docs to replace us) has left them significantly understaffed. And December is always a busy month with higher numbers of patients and lower numbers of hospital staff due to annual leave. But to make matters way worse, now the mission hospitals are essentially the only hospitals open in Kenya. The Kenyan doctors went on strike on Monday due to concerns of lack of drugs, equipment, and adequate pay. Click here to read an article about the strike. This means government hospitals are closing and mission hospitals are running over capacity. Click here to read a missionary colleague's blog about her experience at Kijabe mission hospital the last couple days (note interns are included in the strike).

Please pray for this situation in Kenya. And pray for compassion for all of us - for the members of parliament and the doctors in Kenya, for the exhausted and overwhelmed staff at the hospitals there, and for me as I seek to care for patients here in Alabama - patients perhaps not so physically needy, but just as much in need of the compassion and love of Christ as anyone else in the world.

Thoughts

I'm continually amazed by the interconnectedness of people around the world. I met a girl at church today in Nashville, TN who spent the summer in Kenya working in community development and microeconomics just 30 minutes away from Tenwek. I stay connected with friends around the world through email, blogs, & Facebook. Though I hadn't heard of Burundi two years ago and thus don't expect others to know it, I regularly run into people who have been there or who know Burundian refugees or who have read the book "Strength in What Remains" (the story of the Burundi genocide).

And yet somehow, despite all this interconnectedness, despite the fact that I talk about both Kenya and Burundi daily with friends and strangers as I share my story, sometimes it still seems surreal. I lived in Kenya for two years, and, though I missed aspects of life in the U.S. and certainly faced unique challenges, my daily life was very comfortable and even felt normal. I didn't notice the cows or donkeys on the dirt path on my way to work or the ladies selling local produce on the corner. I forgot that before living in Kenya I used to drink tap water and buy eggs and milk from the grocery store. I shook hands with everyone and greeted them in Swahili without thinking twice about it. I wore long skirts daily. I expected to treat patients with meningitis and malaria and HIV/AIDS on a daily basis and to take a break for chai at 10:30am. I visited with friends and neighbors every day because, with the exception of an occasional trip to Nairobi (3 hours away), most people, missionaries included, rarely traveled farther than walking distance from their house. It was not uncommon for me to not even ride in a vehicle for a month or two at a time.

Now that I'm back in the States, though, life here seems normal, too - decorating for Christmas, driving my car everywhere, going out to eat regularly, brushing my teeth with tap water, pumpkin in a can. And of course, the joy of all the Pfister pfamily Thanksgiving traditions:

Family Thanksgiving. Congratulations, Lauren and Wei Chi on your recent engagement!

Boulevard Bolt - 5 mile race my family runs every year on Thanksgiving morning

With a November 28th birthday, I always enjoy a family birthday celebration sometime during Thanksgiving weekend.

To give you a glimpse of some of the juxtaposition between worlds, though, I'd like to share with you some recent news and observations from here and there:

Many of my friend's 7th grade English students in South Sudan have not even held one book this entire year.

My mom's third grade students are blessed to be surrounded by hundreds of books on a daily basis. I loved getting to share with them my story and vision last week. They were so sweet to listen enthusiastically and even pray for me.

Other friends report that in Doro on the Sudan/South Sudan border, there are currently 8700 refugees. The United Nations has exhausted their food supplies at that site and people must wait in lines for 4-5 hours to obtain water from one of the three boreholes near the camp.Medical needs are already significant and climbing with problems of severe starvation and lack of sanitation.

I enjoyed the fireworks display at the Summit mall in Birmingham, AL a week ago - an impressive show to kick off the holiday shopping season.

Friends here and there around the world have suffered from significant disappointments and loss in the last month.

Recent news from Tenwek includes another man gored by an elephant and a lady with a completely dead uterus two weeks after a C section was done at a district hospital. Both patients miraculously survived.

Poignant story copied from the Myrhe's blog: "This is Tume, the severely malnourished 9-year-old girl who was transferred from NE Kenya with TB, a dislocated hip, sores where her fragile skin had broken down as she lay immobilized in bed, and allergic reaction to her drugs. Two weeks ago she was not moving or talking, let alone smiling. Now she's up with a walker, coloring pictures, and chatting. Progress. But something about the poignancy of her "Prom Queen" shirt tugged at my heart. Her mother is also HIV-positive. This girl's challenges include eventually being orphaned, and possibly being lame. A bit far removed from some other distant little girl whose cast-off shirt seems shallow and vain in this context. Yet I hope Tume feels beautiful too, and loved and admired in the same way the prom queens do."

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I found this definition of poverty from the book, "When Helping Hurts" (which I would definitely recommend):

"Poverty is the result of relationships that do not work, that are not just, that are not for life, that are not harmonious or enjoyable. Poverty is the absence of shalom in all its meanings."

 

While few of the people reading (or writing) this blog are materially poor, most of us suffer from some element of poverty - poverty of relationship with God, with self, with others, &/or with the rest of creation. 

I've been blessed with so much and yet, like this blog writer and fellow missionary, I don't truly live a life of gratitude. I complain. I judge. I don't demonstrate the compassion and love of Christ to family and friends in my heart or in my actions.Thankfully, God is transforming even me, slowly, into a new creation. Thankfully, He loves me and Tume and the refugees in Doro and the third graders in Nashville unconditionally. He created each of us in His image and through Jesus' life, death, and resurrection, He is calling us back to right relationships. We won't fully experience shalom (peace, wholeness) until the coming of the new heavens and the new earth, but we see glimpses more and more each day around the world.

 "For God was pleased to have all his fullness dwell in him [Jesus], and through him to reconcile to himself all things, whether things on earth or things in heaven, by making peace through his blood, shed on the cross." Colossians 1:19-20 (italics added)

GMHC

 

McCropder Team at Global Missions Health Conference November 2011.                            From left to right: Jason, Heather, Anna, & Abi Fader; Jessica & Samuel Cropsey; Alyssa Pfister; Carlan Wendler; John Cropsey; Rachel, Ben, Eric, & Maggie McLaughlin

Last week I attended the Global Missions Health Conference in Louisville, KY. This annual conference has been very influential in my life and is something I look forward to every year and I missed in Kenya. During residency I even arranged my vacation requests around this event. Through this conference in medical school, I explored opportunities for an international rotation and subsequently spent two months at Tenwek during my fourth year. In residency, I pursued another international rotation in Togo. I also continued to pray and seek God’s direction for after residency and through this conference I learned of the post residency program with Samaritan’s Purse. I applied and was accepted into the program my third year of residency, and while attending the conference during my fourth year in 2008, I decided to serve at Tenwek in Kenya for 2 years. I also first met most of my McCropder teammates at that time – needless to say, a good first impression!

Through listening to speakers such as John Patrick, Dave Stevens, Steve Saint, David Thompson, & many others, I have wrestled with ideas of sustainability, calling, development disparities, suffering, the Great Commission, limited resources & even martyrdom. I’ve thought through issues of families and singleness. I’ve learned about malaria, HIV/AIDS, the millennium development goals, and even photography.

And the highlight, this year more than previous years, was reconnecting with friends from around the world. The medical missions community seems to grow smaller as I recognize more and more people at this conference of 3000 people. What a blessing to be surrounded by friends from college, medical school, residency, Togo, Ethiopia, Kenya, and beyond – all with a shared vision of caring for the physical, emotional, and spiritual needs of the “least of these” around the world. One of my teammates once described this conference as being the place in the world where he feels most at home, and I’m tempted to agree with him. Especially now as I’ve been living out of a suitcase for two months traveling around the U.S., processing my experiences in Kenya, Burundi, the States, and not feeling fully at home in any one place.

But then, as has been expressed many times before, none of us are fully at home on this earth. But we do have a home and I look forward again to the day when most everyone I love will be in one place and we will fully rest in our comfortable, glorious home with our Heavenly Father.

“These all died in faith, not having received the things promised, but having seen them and greeted them from afar, and having acknowledged that they were strangers and exiles on the earth. For people who speak thus make it clear that they are seeking a homeland…But as it is, they desire a better country, that is, a heavenly one. Therefore God is not ashamed to be called their God, for he has prepared for them a city.” Hebrews 11:13-16

Precious

 "Precious in the sight of the Lord is the death of his saints." Psalm 116:15

Grandan, Grandma Chris, and me (2009)

Grandan and his two children - my mom and my Uncle Chris (2007)

On Saturday night my grandfather entered into the presence of His Lord. I am so thankful for God's perfect timing that I could be here now. I visited with Grandan 6 weeks ago at his home in Indianapolis before his health began to seriously decline. He has always been an enthusiastic vicarious participant in all my adventures. He read the "Miracle at Tenwek" book more than once and was thrilled when I came to know characters in the book. He bought a detailed African map and marked out exactly where I was in Kenya and where I will be in Burundi. He checked the Nairobi weather daily in the paper. :) He cared about all the specifics of my journey and clearly had read and remembered my many blog posts and update letters from Kenya and Burundi. He was the first person to commit to supporting me financially in Burundi. Even in the hospital last week as he struggled to breathe at one point he looked over at Grandma Chris and me and remembered, "We haven't yet opened the Burundi coffee Alyssa gave us last month!"

My Grandan was the epitome of thinking of others above yourself - he always expressed interest in others, listened carefully, and made others feel special. He loved to laugh and frequently made jokes - even in his hospital bed last week. As a voracious reader, he could converse on most any topic but he did so in such a humble way that did not draw attention to himself. As my father stated in the service today, he embodied the fruit of the Spirit extremely well. 

What a blessing that I am in the country now and was even available to drive my mother to the hospital last week and help sort out the medical information. These occasions certainly are bittersweet as it was a joy to be with family I haven't seen in years, though sad under these circumstances.

Extended family - Pfisters, Conlins, Lutz's, Wongs

Grandan would have been so proud of his great-grandson Samuel, age 3, who led us in reciting the Apostle's Creed - he saw the live version a couple weeks ago when Samuel used Grandan's oxygen tank as a pulpit and led church in his living room. :) Grandan was an amazing grandfather to little ones and to grown grandchildren. :)

Pfister family - special congratulations to my littlest sister Lauren on her engagement to Wei Chi on Saturday!

Fall

I love fall! And though I was only out of the U.S. for 2 years and the weather in Kenya is lovely year round (70s and generally green with lots of blooming flowers), I did miss the seasons - especially fall. It has been such a beautiful time of year to be driving around the Eastern U.S. - I've enjoyed leaves in 16 states these last 8 weeks! 

I love this Nathaniel Hawthorne quote: "Our Creator would never have made such lovely days, and given us the deep hearts to enjoy them, above and beyond all thought, unless we were meant to be immortal."

We were meant to be immortal! And I think we glimpse that eternal home with our Creator through the beauty of fall leaves, picking apples and painting pumpkins, cool, crisp days shared with friends and family, and even through pumpkin spice lattes!

Word & Deed

Many of you know the title of our team blog is "Word and Deed" (linked on the left). We truly believe that God calls us to share the gospel both verbally and through our actions in caring for "the least of these". The last couple weeks, I've been encouraged through several "Word" opportunities here in the U.S. As I've shared about our experiences in Kenya and our future plans in Burundi, I've known the joy and strength of Christ in giving me the words and encouraging me through the response of others. I've even felt further confirmation that God has equipped me and called me to this work and is continuing to guide me as I process the joys and challenges of these past two years.

Speaking on Vaccine Preventable Diseases at the Missionary Medicine Seminar associated with Prescription for Renewal at The Cove in Asheville, NC

Missionary Medicine Seminar speakers - Our team spoke on several topics such as Suffering and the Christian Physician, HIV in pregnancy, Surgery as a Public Health Measure, Medical Education in Missions, and our team's Vision for Ministry in Community

We're so thankful for the enthusiastic and ever-present support of Scott Reichenbach and Mary Elizabeth Jameson with Samaritan's Purse's Post Residency program over the last 2 years.

George Beverly Shea, age 102, made a surprise appearance at the conference and even sang a song and made a few jokes

Myself, Heather, Jason, & Eric (Rachel not pictured as she was with the kids) with Mike & Ann Kendall, friends we met at Tenwek

Radio appearance on Charlotte's NPR!

I met Naphtaly Matta (on left) while working on Mfangano Island in Lake Victoria. He was visiting Charlotte, NC as was I, and Mike Kendall arranged for him to be interviewed on Charlotte's public radio station about his work with orphans and Bible translation. The radio station requested a medical perspective to be included as well, so that's were Mike and I come in!

 If you'd like to listen to the hour long radio broadcast (recorded live), click here.

Honestly, my most interesting speaking engagement of the past week was to the 4th grade students at High Point Christian Academy in High Point, NC! These students displayed such a heart for the world as they asked insightful questions and even prayed for me. I look forward to hearing how God continues to work in each of their lives as they share His gospel with the world.

Memory Lane

Last week I visited my alma mater Wheaton College for my 10 year reunion. I had the opportunity while there to speak to the pre-med students about my journey from being in their shoes to now. I remember thinking as a college student that this journey towards medicine was forever - would it really be worth it? But ten years has flown by; there has been lots of joy along the way; and I so enjoy using the gifts God has given me in medicine to serve His people around the world. I thought I'd share a little bit of that journey (and of my presentation) with you through this post.

Wheaton College, Wheaton, IL

My medical ambitions began young. At age four I decided I wanted to be a doctor and drive a bulldozer to work. Somehow the first goal was easier than the second because I have yet to find someone willing to let me drive their bulldozer! My medical journey continued and the interest grew greatly through my experience with Transverse Myelitis at age 10. I woke up one morning paralyzed from the chest down from a virus in my spinal cord. Through two years of physical therapy, God healed me completely and gifted me with the ability to walk again and even run and climb mountains. My interest in other peoples and cultures began as a young child listening intently to stories of missionaries in Sunday School. Our family embarked on a life changing cross cultural experience when we moved to the Mexican border as I was entering 8th grade (picture on the right is my mother, my sisters, & I with a friend in Reynosa, Mexico). During the three years we lived there, I grew to love learning Spanish and learning about other peoples and cultures.

I truly believe all these formative childhood events occurred so that the work of God would be displayed in my life.

Chicago - John Hancock building, Lake Michigan

 In college, I grew to love missions more through a summer working with a community development project in Bolivia. Despite suffering from significant reverse culture shock on my return to the U.S., the people and the place of Trinidad, Bolivia still hold a special place in my heart. My first medical missions experience encouraged me greatly during my first year of medical school. I loved leaving the textbooks behind and observing firsthand how amazing it was to serve the impoverished people of the Ecuadorean Andes Mountains with medicine and the gospel, word and deed. My journey in medical missions continued through experiences in medical school and residency in Kenya, Trinidad, Togo, and the Dominican Republic.

My sister Lauren and I both graduated from Wheaton and now she works there! I so loved getting to spend quality time with her last week. 

 

Two of my college roommates - in 10 years the three of us have added two husbands, 3 1/2 kids, 2 additional degrees, criss-crossed the U.S. multiple times, lived overseas, and traveled to at least fifteen countries! I'm so thankful for these and other friends God has given me who know my history, know my weaknesses, and love me anyways no matter the physical distance between us!

The Wade Center at Wheaton with the actual wardrobe which inspired C.S. Lewis as he wrote, "The Lion, The Witch, & The Wardrobe" - one of my favorite books

I've referenced this quote before on the blog, but it continues to capture perfectly my feelings towards the work ahead of me: now with support raising, in France with becoming fluent enough in French to be able to lecture medical students, & in Burundi with working at a hospital with no running water and extremely limited resources. I'm so glad that where I am most weak and insufficient, God's strength shines through all the brighter.

"The boundary lines have fallen for me in pleasant places;
   surely I have a delightful inheritance." Psalm 16:6

I'm so thankful for the heritage God has blessed me with - what a joy it is to have parents and others who have been discipling me and praying with and for me all my days. 

Thank you, too, for journeying with me!