Home

We are home! We arrived home last Monday afternoon and have been grateful for the not-so-frigid temperatures. On Tuesday it was in the 50s and sunny and our sleep schedule was way off, so Daniel and I went to the zoo in the afternoon.

Our trip home was very smooth. We left from Kilimanjaro airport around 10pm and Daniel went right to sleep. Surprisingly, he slept through the lights on, switching passengers, announcements and safety videos at our stopover in Dar es Salaam less than an hour later. He ended up sleeping almost all the way to Amsterdam waking up just in time for breakfast. Unfortunately, Dave and I didn’t sleep nearly as well (I was holding Daniel for half the night after he woke up the first time.) He got to play in the Children’s Forest at the Amsterdam airport before boarding the flight to Detroit. He did pretty well on the flight to Detroit, except for the last hour or so when he kept wanting to yell (maybe “screech” would be more fitting). We got a snack with ice cream around then, so I told him he needed to use a quiet voice if he wanted ice cream. Worked wonders :) He didn’t have anyone sitting in front of him, so he could put his feet up on the seat and not worry about disturbing someone.

I think we’re finally adjusted to the time change. Daniel seemed to do better than the rest of us! Daniel and I went to bed at 5:30pm on Monday, which was as late as we could make it. I went to bed with him for several days knowing I’d need to be up with him whenever he woke up – anywhere from 4:45 on! It was nice to see Dave before he left for work at 5:30 and it’s amazing what you can do in a morning when you’re up so early, but I think I’d rather be sleeping. For several days, Daniel woke up between 4 and 5am, waking me up too. He would go back to sleep, but I never did. Today, though, we slept until 7:30!

We weren’t gone long enough to be making very many cultural adjustments back to the States. A few things I noticed, though, were greeting people in English rather than Swahili, not having to turn on the water heater an hour before showering, having consistent electricity, water and internet. Though those last two show you that we were living a pretty easy life in the city – we HAD running, water, a way to heat it, electricity, internet access, etc. It’s been very quiet here, especially at night (in the winter – summer in Detroit is a whole ‘nother story!) No roosters or cows or loud diesel trucks bumping and creaking up the hill. In other ways, Detroit is so much like an African city - you never know what you’re going to see and nothing is really surprising. We were on our way to a fruit market the other day and I noticed a random abandoned boat on the side of the road in front of an old warehouse. On the way home, I realized there were actually two abandoned boats.

After all the preparation to go to Tanzania, it seems incredible that we’ve gone, were there for two weeks and are already home and back into the swing of things here. Then again, I’ve never gone to Africa for such a short time before. More to come about our experiences and where we’re going from here.

Daniel

Daniel LOVES Tanzania. We’d been prepping him for weeks about how we were going to go on an airplane to Tanzania and he was so excited. The morning we left, he woke up and asked to go to the zoo (like he does almost every day) and I told him that we couldn’t go to the zoo, but that it was the day to go to the airport and go to Tanzania. His eyes got wide and he said, “Go on an airplane to Tanzania!!”

The weather in Tanzania this time of year is hot and sunny. Daniel loves being able to play outside and would really appreciate living in a place where he could easily play outside all year. This is a dry season and he found lots of dirt to play in – in the yard around the house where we were staying, at the market and any time we walked down the road. We had to enforce “walking time” when we were in a hurry to get somewhere and he really couldn’t stop and play in the dirt every five feet. He was pretty intrigued by all the noises too – “woosters” crowing, cows mooing, lorries bumping up and down the road, pikipikis (motorbikes), music playing, the metal cutting shop nearby.

Playing in the dirt

Exploring Outside

Helping water the garden

Daniel has adjusted so well to everything – and he’s usually a kid who takes a while to warm up and be comfortable with new things. When we first arrived, I was asking God to give Daniel a real love for Tanzania too if this is the place for us. Several times I asked him if he liked Tanzania and if he thought it would be a fun place to live and he replied with a very enthusiastic, “Yeah!!” He did really well greeting people and responding when people greeted him, though he usually needed a prompt and for a while he was using a very funny voice any time he was speaking Swahili. In Tanzania it is important to greet people and be respectful towards elders, so I really wanted him to be friendly and polite.

We had the opportunity to take a day trip to a nearby national park and Daniel had a wonderful time driving around and seeing lots of animals, especially twigas (giraffes) – his favorite. He associated the tarmac road with going to see animals and any time we were on a tarmac road after that he asked if we could go to “the zoo” to see the animals again.

We also met up with several other families with small children so Daniel was able to play with some new friends. At one point, we had three boys three and under rolling around on the ground at a playground – completely covered with dirt. We found out about a lot of fun things to do with kids around Arusha as well as various school options.

Another thing I really appreciated about having a small child in Tanzania is that people nurse freely – there’s no shame about it and no one is offended like in the U.S. I wasn’t sure how it would be nursing an older toddler, since, I’ve mostly seen young babies nursing, but every time I did, the women around were so supportive – “Just like an African!” they would say. 

First Couple Days in Tanzania

We’ve been in Tanzania for a week now. We’re feeling pretty comfortable. Fortunately, we have enough experience in Africa that it isn’t all new and overwhelming and we can focus our attention on whether Arusha and the two hospitals are a good fit for us more than on whether we could live in Africa.

We finally have semi-reliable internet access, so we’re starting to catch up a little on sharing about our experiences.

Our trip here was pretty smooth, except for Daniel vomiting an hour into the trip and having a stinky car seat the rest of the way! He fell asleep shortly after, but only slept for about 30 minutes before waking up again. After that he was wide awake until we were just about to land in Amsterdam. At least he was happy. I don’t mind wide awake as long as he’s not cranky or crying. He slept for a few hours in Amsterdam and a few hours on the flight to Tanzania. The Amsterdam airport, by the way, is fantastic, especially for traveling with children. They have a baby care lounge that’s dark and quiet, and there would have been room to get him a bath if he hadn’t been sound asleep. They also have a playground where kids can run around and climb. We’re hoping to take advantage of that on the way back.

Daniel was so excited to arrive in Tanzania, and we were too! As soon as they opened the plane door, we could feel the warm air! We got our visas and bags with no trouble and then met the director of the hospital who had come to get us. He gave us a bit of geographic orientation and told us about the things we were passing in the dark along the way. I showed Dave where I studied Swahili back in 2006. Daniel fell asleep right away in the car and we were hoping that would transfer into bed when we got to the guesthouse in town, but according to his body it was just an afternoon nap. Dave stayed up with him for a while to read and play while I went to bed. Apparently Dave fell asleep on the couch and the next thing I knew, Daniel had climbed up into bed with me.

Tuesday morning we went to the town hospital (Arusha Lutheran Medical Center or ALMC) where had some orientation to the hospital and it’s history, mission and vision. Then we met with most of the surgeons (with chai and mandazi – yum!) and heard a little of their stories and how they got to this hospital. We were really impressed with the surgeons. They all seem very competent, kind and wise. They have a lot of experience and would be a great team to work with. As we heard more about the hospital, it seems like we share a lot of common vision and ideals. We’re finding out that some of the things that drew us to the hospital on the surface are reflections of a deeper philosophy that certainly resonates with us. 

Africa Update Part 4: Next Steps

This is part 4 in a series about our journey towards working long-term in Africa. Part 1 described our decision to go back to Africa long-term, Part 2 describes Dave’s desire to train residents. Part 3 talks about a particular hospital in Tanzania that we are considering.

I’m writing this from the airport. We are on our way to Tanzania to visit the hospitals, meet the team of people Dave would be working with, see around town and generally get a feel for it all. This should give us a sense of whether this would be a good fit for us. It is also their chance to get to know us. We will be in Arusha for two weeks. (And yes, there is someone staying at our house while we’re gone.)

During the time we’re gone, we will be sharing some of our thoughts and experiences here.

Africa Update Part 3: Tanzania

Part 1: Going Back to Africa is here

Part 2: Working with Residents is here

This was definitely the hardest part to write, partly because we've been so busy the last couple months and partly because this is so much harder to describe in a succinct way.

I've been interested in Tanzania for a long time. When I was in Kenya in 2002, I went on a retreat with the other students in East Africa and we traveled around Tanzania for a week. I spent a summer in Tanzania studying Swahili and really grew to love so m any things about the people, places, culture and history of Tanzania.  

Once we knew that we needed to go back to Africa (see Part 1), we hoped that we would end up in Kenya or Tanzania. We have experience in East Africa. I have a lot of time and energy invested in learning Swahili. Most of our relationships in Africa are in Kenya. At the same time, though, we were trying very hard to be open to whatever God had for us.

Once we were sure we wanted to pursue residency training through the Pan-African Academy of Christian Surgeons or PAACS (see Part 2), the options of where to go narrowed to the places that either have a PAACS program or that are waiting for surgical faculty to be able to open a program. We had several conversations with PAACS administrators about the different places they needed people and God worked with us to get to the point that we would be willing to go to any of them, even the one that was the-place-I'd-always-said-I'd-NEVER-go. Still, we were most seriously considering existing programs at two hospitals in Kenya and a program in Tanzania that is in the planning stages. Over the course of several months, we felt like the two programs in Kenya weren't the best fit for us long-term, for a number of reasons. At the same time, we felt increasingly drawn to the hospital in Tanzania.

ArushaLutheran Medical Center (ALMC) and Selian Lutheran Hospital are sister hospitals in northern Tanzania that are preparing to open a general surgery residency program. Selian is located on the outskirts of Arusha and serves as a referral center for the district while ALMC is a new hospital in the center of town. Together, the two hospitals would serve as the training site for residents.

Here are just a few highlights of the journey and a smattering of things that draw us to this hospital:

- In our first conversation with one of the PAACS leaders at the conference last year, he mentioned that they were considering a program at a hospital in Tanzania. I think he said that he wasn’t actually supposed to share about it yet, but knew we would be interested. Dave and I both felt our hearts stir as he mentioned that possibility and we were definitely interested.

- To make a long story short, we were fasting with our church during lent last year and asking God for direction about our future work. Two days before we finished, Dave got an email from the CEO of PAACS asking if he would be interested in talking further about the possibilities for working there. We thought that the timing was somewhat of a coincidence, but when Dave talked to him more about it all, he said that he felt like God was telling him to contact Dave about it just then.

- The hospital has several surgeons, three of whom are Tanzanian. This means that Dave would be working alongside Tanzanian surgeons to train residents and not just a team of westerners teaching Tanzanians. This is HUGE for us.

- Dave’s current residency program operates across two sister hospitals. There are unique opportunities and challenges to administering a program like this. As a chief resident this year, Dave is getting a lot of experience with the ins and outs of this type of program. This seems like good preparation for developing a residency program in Arusha.

- Tanzania is one of the poorest countries in the world. There are currently about 150 surgeons (of any kind) for 41 million people. That’s like 35 surgeons for the whole state of Michigan or just three surgeons for the City of Detroit. Our calling has always been to the poor and we feel a special burden for people and places that have been “left behind.”

- To work effectively in Tanzania you really must learn Swahili. Hmm, sounds great to us!

- We really like Tanzania and are very excited about the possibility of living there. 

Next up will be Part 4: Next Steps, the highlight of which is that we're heading to Tanzania in a week to visit the hospitals, meet the team, see the town, evaluate whether this would be a good fit for us and see whether this is really where God is leading us. 

Africa Update Part 2: Working with Residents

Part 1: Going Back to Africa is here
Part 3: Tanzania is here

Once we realized we needed to go back to Africa, we had just enough time to make plans to attend the Global Missions Health Conference in Louisville in November 2010. We were hoping that the conference would help confirm that this was the direction we should be going, which it did. It was also a great time to visit with my family. My parents and brother helped with Daniel while we were in the sessions and he had such a great time with them - hurray for hometown conferences!!

We ended up making some key connections at the conference (in a very providential way, but that's a whole 'nother story) and found out about an organization that runs general surgery residency programs in several mission hospitals across Africa (the Pan African Academy of Christian Surgeons, or PAACS). The more we considered this, the more we were drawn to the idea of training residents.

This was a bit of a mental shift for me, because I had always envisioned that we would be working in some remote area (ahem, westen Kenya) where there is a significant need for doctors and not a lot of other expats (foreigners). I thought that would be the place we'd have the biggest impact, plus there's something really special about living in the village (though I do recognize that I tend to romanticize village life and sometimes have selective memory about my own experiences. That's a whole 'nother story too, though!) But remote rural communities are not really where you find teaching hospitals that have the capacity for advanced surgical training.

As we considered it (and as I let go of my expectations about where we would live and work), we realized that Dave could spend the rest of his career or even his life working in a remote hospital filling an urgent need but that the need would still be there when he's gone. By training African surgeons, he would be doing surgery in a way that is developmental and building local capacity.

This was huge for us. I knew that surgery could be very useful and good, but I had not really seen how surgery could be truly developmental. When I thought of health and development, most of what I saw related to primary care and public health. Surgery seemed more about meeting an immediate need.

We also realized that teaching and mentoring residents would be a really good fit for Dave. He’s a great teacher, able to explain complicated medical information in a way that a lay person can easily understand. He works best relationally in one-on-one or in small group settings. As a senior resident, he does a lot of teaching of junior residents and he both enjoys it and is good at it. As a chief resident this year, he’s getting more experience with the logistics of administering a residency program. He’s always had a long term interest in teaching, but now has a strong desire to work specifically with residents.

Once again, more to come about where we’re thinking of going.

Africa Update Part 1: Going Back to Africa

Part 2: Working with residents is here
Part 3: Tanzania is here

Back in March, I posted that we were making plans to move to Africa after Dave finishes his residency. I’m finally making time to share more about how we got here and how our plans are shaping up.

First a little background. For those who don’t know, in college I spent 6 months living in a rural community in western Kenya, teaching in a primary school, learning about life in the village and exploring issues surrounding poverty and development. As a graduate student studying community development, I spent another 5 months in that same community studying local development efforts. I also studied Swahili, both at Michigan State and in Tanzania and Dave spent six weeks during his medical training working at a hospital in Malawi.

We always thought that we would end up in Africa eventually, probably in rural Kenya. Then we landed in Detroit and realized that this was a great place to put down some roots, build relationships, and engage in transforming our community. We had never dreamed we’d be in Detroit, but once we got connected, we were absolutely sure that God had placed us here. So we began to wonder whether we should stay here in Detroit. We knew we’d be here for a while (General Surgery residency is LONG!), but would this be the place for us long term?

We began asking God what was next. We entertained ideas of all the “fun” places we could live. We considered what life in Detroit would really look like and all the things we would miss if we were not here. We wondered about the possibilities for serving in Africa. But as Dave asked, “what’s next?” God clearly showed him: “You’re not ready yet to hear what’s next.” So we waited and wondered, prayed and pondered, all the while seeking to learn and grow.

Then one day, we both knew that we needed to go back to Africa. It was different circumstances for each of us, but on the same day, we each came home convicted that we needed to go. Our calling has never been to live in America, make a doctor salary, give away a lot of money and take short term trips overseas (the justification we used for the “live in a fun place” fantasies.) We also realized that our time in Detroit is for a season. We’ve learned so much while we’ve been here and have grown in so many ways. But this is not the place for us to stay.

More to come...

Quote of the Day

Me: (After a bath) Let's dry off your back, your side, your arm
Daniel: Other side, other arm.
Me: left leg, left foot
Daniel: other left foot

A few Danielisms

The other night, Dave was singing Daniel a bedtime song and Daniel said, "No. ABCDEFG" asking for him to sing the alphabet song instead.

Today Daniel and I were playing at the playground and he wanted me to go down the big slide. Then he said "Catch you!" ran down the stairs and around to catch me at the bottom of the slide. When I got to the bottom, he clapped!

On the way up for a nap today, I had Daniel say night-night to all the things downstairs since he was feeling a little reluctant to go upstairs. He got pretty into it and we said goodnight to about 20 things in the kitchen, his toy train, several things in the dining room, his toy train, things in the living room and entryway, and then to his train a couple more times on the way up the stairs. I suggested a few things to say night night to in the bathroom and then he just kept going: "Night night sink. Night-night lights. Night-night tub..." It was really fun to hear the things he noticed to say goodnight to.

Daniel has been learning to count for several months now. At first he counted "one, two, one, two, two, one, two." Then the next thing I knew, he counted, "one, two, three, six, seven, eight, nine, ten, eleven." At first, I was excited he got three and then he rattled off all the way to eleven. Now he can count to nineteen: "One, two three, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, eighteen, nineteen" is about how it goes. Someday we'll get four and five :) To me, it shows just how much kids pick up just from listening and engaging in what's going on around them. I didn't try to teach him to count that far. He just did.

Trying on Glasses with Grandma