Mongolia April 2009

          We’re en route home from Mongolia and, as is tradition, I’m writing an update.  We usually do a big trip to Mongolia every Fall with a Searching for the Broken Hearts week, a Mending the Broken Hearts week, and a team of at least 50 people.  This was a short trip with a small team:  Kirk (peds cardiologist and team leader), Mary Porisch (peds cardiologist), John Kupferschmid (pediatric heart surgeon), Bart Hensler (perfusionist—runs the cardiac bypass pump during heart surgeries), and me (anesthesiologist).  We were missing one team member, Minette Son (pediatric intensive care doctor), who sadly couldn’t join us at the last minute.  We were only in the country from Friday night to Wednesday morning.  We performed three heart surgeries and three cardiac catheterizations.  We went on this quick trip to fulfill some promises.

            Instead of children, we actually operated on adults this time.  All three had congenital cardiac defects, meaning they had heart defects they were born with.  They just weren’t diagnosed until later in life.  We had a smaller team this time because we had promised to come help the Mongolian doctors operate on these patients.  In the four years we’ve been doing these surgical trips, we’ve been doing lots of training and have watched the Mongolian doctors and nurses come a long way in their proficiency.  We usually duplicate each and every member of the team required in the U.S. to take care of heart surgery patients, which results in us having up to thirty people on our surgical team.  On this trip, the Mongolian medical team took the lead, with us just offering assistance.  It was so gratifying to see how far they’ve come, from doing surgeries without cardiac bypass and with an approximately fifty percent mortality rate four years ago to becoming proficient enough to have done almost fifty bypass cases in the last six months with a less than five percent mortality rate.

            There a great stories regarding all three adults and how we came to be involved in their surgeries.  The first was the father of a girl, Anujin, who we operated on two years ago.  We met her three years ago when Kirk diagnosed her mother with inoperable congenital heart disease.  She asked Kirk to examine her daughter and he found she had a hole between the collecting chambers of her heart (ASD or atrial septal defect).  He promised her then that we would operate on her the following year and she was our first surgical patient two years ago.  She came back last year for follow-up and her father mentioned some concerns about his heart.  Kirk examined him and found that he had the same defect his daughter had had.  Our promise to operate on him was the reason we planned this trip.  The second patient was the niece of one of the Mongolian operating room nurses that we have worked with over the last four years.  She also was diagnosed with an ASD by our team last year and we promised to help with her surgery too when we came to take care of Anujin’s father.  The last patient’s story is a little more involved.

            Shinebayer was diagnosed with heart disease by the Mongolian doctors two years ago.  Her family had the means for her to go to Hong Kong to get an echocardiogram (ultrasound of the heart) to confirm her diagnosis, also an ASD.  Her family then began seeking help from various NGOs (non-governmental organizations) for her care.  They had even found a hospital in Utah willing to perform her surgery, but she was unable to get a U.S. visa.  One of the organizations they had written to was Samaritan’s Purse.  Kirk was able to see her last year and confirm her diagnosis.  She had proceeded to look for ways to have her heart surgery outside Mongolia.  She had just been accepted by a hospital in Korea and was going to be able to travel there by herself, without any family members accompanying her, if she could cover her own travel expenses.  She was debating this option until just last week when a member of our team called her and offered our help.  Shinebayer’s sister-in-law speaks excellent English.  She took us out to dinner as a thank you and it was wonderful to hear firsthand all the details of this story and the tremendous gratitude of Shinebayer and her family.  They truly saw the hand of God in all the circumstances of her story.

            We operated on all three adults on Monday.  Each trip we seem to get blessed in being part of something historic in Mongolia.  This day was historic because it was the first time they had ever performed three cardiac bypass cases in one day there.  This would be a strenuous schedule even by U.S. standards.  All three patients did well.  They were able to have their breathing tubes removed in the operating room so did not require any time on a ventilator in the ICU.  It was wonderful to see all three of them sitting up in bed first thing Tuesday morning and walking around the ICU by Tuesday afternoon.

            There are always lessons on every trip we take.  As I said, we arrived Friday night.  We went to the hospital on Saturday morning to meet with the three patients for Monday.  Then we spent Saturday afternoon screening more children for heart disease.  This is a regular part of what Kirk and the other pediatric cardiologists do on every trip to Mongolia and the main focus of our annual Searching for the Broken Hearts trips.  I, however, am not usually involved.  As the anesthesiologist, I’m usually involved when it is already decided what children need procedures.  Now, I have been involved in the past and, of course, I’m married to the primary screener, so I’m not ignorant of the process.  It’s just easier to escape the emotional burden by not being primarily involved.  I was already thinking on Saturday afternoon how good it was to be there and how slow I am to learn the lessons that the Lord must teach me over and over again.  I know how good we have it in the U.S. and how incredibly blessed we are, but I have to stare the alternative in the face again and again and again to be reminded.

            On Saturday afternoon alone we saw at least three babies with severe enough heart disease that they are likely to die soon without intervention.  There are not more of these babies born in Mongolia than in the U.S.  They are just diagnosed and treated in the U.S. in a timely fashion.  Many children in Mongolia go a long time without diagnosis or have few treatment options if they are diagnosed.  I have already told you they have come a long way in Mongolia, but they are still able to perform surgeries on the simplest of cases and on patients usually above about forty pounds.  There are not a lot of options for the littlest and most complex cases.  I know this.  I know it goes on there, and a lot of other places in the world, all the time.  But I don’t have to see these beautiful baby faces and the tear-filled eyes of their parents who so apparently love them.  Kirk does and, once again, it gives me so much appreciation for what he goes through as our team leader.

            These situations introduce a horrible dilemma for us who are there as team members.  We have the overwhelming desire to “do something.”  With the five of us who were there, it is easy to consider taking these children to the operating room or to the cardiac catheterization laboratory.  But a simple procedure is such a small part of the process.  We went on this trip planning to do three adult ASD cases.  That is what we had the supplies and personnel to do safely.  We did not have the medicines, supplies, personnel, or even time in the country to take care of all these babies safely.  A surgery or a cath is one thing, but it is often the post-operative care in the ICU that determines whether these children live or die.  We had no ICU doctors or nurses with us to ensure these babies would be well taken care of post-operatively and we were leaving the country on Wednesday morning.  Please know we do not take these decisions lightly.  We considered all kinds of options.  Do we cancel the adults to take care of the babies?  But that would be breaking a promise to the adults.  Do we try to take care of the babies knowing the great risk involved?  One of the considerations is how long do we think they will live.  Would we be potentially hastening their deaths?  And do we think we can get them to the U.S. soon for repair?  Are there hospitals that will accept them?

            We ended up taking one of the babies to the catheterization laboratory on Tuesday.  She was the smallest baby we’ve ever taken care of in Mongolia, another historical moment.  From our U.S. standards, it did not go smoothly given all the glitches in the system and the fact that we were charting new territory.  But we left a living, breathing, smiling, cooing infant in her parents’ arms when we left…and we think we did her some good.  She will need more procedures.  We hope and pray we will see her again in Mongolia when we return in September and we’ll complete her repair. 

            We left two other sets of parents heartbroken.  We pray we can get them to the U.S. for repair.  The clock is ticking.  Samaritan’s Purse Children’s Heart Project will get them to the U.S. or Canada, if we can get a hospital to accept them.  The economic downturn is affecting hospitals as well and limiting the amount of money available for charity care.  The complexity of these cases also limits the hospitals that will accept them.  There is a chance we can negotiate with a hospital in San Antonio to take them for a flat fee.

            So, as always, pray.  Pray for the healing of the five patients we took care of (the last two patients I didn’t explain were a 16-year-old who had a diagnostic cath and needs to come to the U.S. for repair and another teenager who has already come to the U.S. for repair who had a diagnostic cath to confirm all is well).  Pray for the continued care of pediatric heart patients in Mongolia, for the ones that they are able to take care of and, most of all, for the ones that they are unable to take care off.  Pray in specific that we’d find a way to get these two we met taken care of.  And pray for the many more that we haven’t met there and all over the world. 

            In church on Sunday, they sang in Mongolian one of my favorite worship songs:  “Blessed Be Your Name.”  I love this song and always pray that it would be true for me:  “Every blessing You pour out I’ll turn back to praise.  When the darkness closes in, Lord, still I will say ‘blessed be your name’.”  When I sat in that room, sad for those babies and their parents, the only thing I could rest in is that the Lord is good and He is sovereign.  “The Lord giveth and the Lord taketh away.  Blessed be the name of the Lord.”  Job 1:21b

            We have witnessed so many victories in Mongolia and for that we rejoice.  We are so blessed to be a part of this work the Lord has called us to do.  We always feel we get more than we give on every single trip.  The gratitude of the patients and their families is humbling.  We pray they see in us the love of Jesus, the reason we do what we do.  To Him be the glory, great things He has done…and will continue to do!

Mongolia 2008

Praise God from whom all blessings flow,

            Praise Him all creatures here below,

            Praise Him above ye heavenly host,

            Praise Father, Son, and Holy Ghost.

 

 I (Kim) am on the plane flying home from Mongolia.  It is my tradition to write these updates on my way home.  This year was amazingly good.  It’s interesting to me that I wondered, “what am I going to write…it was so good?”  Why is it easier to write hard tales than good ones?  I guess we humans, especially me, like the drama of a hard tale. 

Don’t get me wrong.  It wasn’t perfect.  There are at least 50 people who worked and traveled with us this year that could offer lots of tales and who might reprimand me for failing to recount dramatic occurrences.  But the Lord was so gracious and so merciful to us this year…and I am so grateful.

This was Kirk’s fifteenth and my fifth trip to Mongolia since December 2000.  This was the sixth annual Searching for the Broken Hearts week and the fourth annual Mending the Broken Hearts week. 

In the Searching for the Broken Hearts week, Kirk is trying to visit all the “aimags” (equivalent to states or provinces) of Mongolia in order to screen children for heart disease and educate physicians and families about the importance of having children with heart disease seen early before their conditions possibly become inoperable.  This year 32 Americans and 13 Mongolians traveled with him for a week to the north of Mongolia where a people group of reindeer herdsmen live.  Evidently this people group is very small, hard to locate as they are nomadic, and have not been reached with the gospel of Christ.  They actually met a family of 12 and were invited to visit with them in their teepee (yes, teepee!  There are actually lots of similarities in the Mongolian and Native American cultures and there is some belief that these people groups are related.)  They met them on the last day before they were to move 300 kilometers north into the forest for winter (they say it is warmer in the forest).  They were able to screen their six children for heart disease and were able to share the gospel with them and give them a Bible, which they accepted gladly.  In addition, over four screening days in this region of the country, they were able to screen over 1100 children for heart disease.  They found 12 with heart disease that required treatment and one was already treated in the subsequent Mending the Broken Hearts week.  They gave away almost 300 Bibles and almost 1000 gospels of John. 

As they flew into this region of the country, the team was reading in the airline magazine that this region contained the height of shamanistic religion in Mongolia.  One team member even asked Kirk if he was going to change his evangelistic approach as a result.  Our perspective on these trips comes from Mark 8:36:  “For what does it profit a man to gain the whole world, and forfeit his soul?”  We can mend hearts, but it profits these children and their families nothing if they lose their souls.  Every child and their family members are offered a gospel bracelet, hear the gospel, and are offered a copy of the Word of God.  This is done after they are screened.  There is no compulsion.  And there was no different approach this year.  The gospel is the gospel. The Bibles and the Gospel were received with great gratitude and enthusiasm. We hope and pray many will continue to come to know Him by the Word of God that was planted in Khuvsgal.  By the team’s best estimation, hundreds accepted Christ.  We didn’t keep count, but Gani, a precious Mongolian who oversees evangelism for us on our team, wrote down every single one of their names so she can pray for them.

The second week was the Mending the Broken Hearts week in the capital, Ulaan Baatar.  There were another 30 Americans involved in this week, 14 of who stayed on from the Searching week.  For Hearts and Souls does this week in conjunction with Samaritan’s Purse World Medical Mission and Children’s Heart Project.  This was year 4 for this project.  I’ve written (and therefore experienced!) some gut-wrenching tales from this week each year.  The first year our container of supplies did not arrive and we did everything with what was available in the Mongolian hospital and what we had in our suitcases.  In years 2 and 3, we lost two precious children:  Undermaa in 2006 and Bogi in 2007.  Of course we had tons of praises from those years and lots of children successfully taken care of, but the drama of those years are prominent in the minds of those of us who experienced them.  This is all hard to put into words.  I absolutely believe in the sovereignty and perfect love of the Lord.  His will has been done all four years.  And He has had much to teach us as we have cared for His children.  I have no criticism with the Lord over the past years’ experiences.  But I confess I prayed for His grace and His mercy this year:  “oh, please, Lord, can it not be as hard this year?”  Every year this week in Mongolia is the hardest and most wonderful of my life.  We work so hard and I don’t believe I’m ever as tired.  But it’s so worth it knowing the impact we are having on the children we are taking care of. 

The report is so good this year.  We took care of 22 children.  We did 9 surgeries requiring cardiac bypass and one without.  Our team used devices in the catheterization laboratory to close cardiac defects in 8 children, so they wouldn’t have to have cardiac surgery.  And we did 3 diagnostic cardiac catheterizations in order to determine the future operability of these children with cardiac defects.  We had no deaths and any complications were quite manageable.  We had the biggest team ever and all were sacrificial servants, making the work go smoother than it ever has.  We felt we made the biggest breakthroughs ever with the Mongolians we were working with.  We so desire to train them so that they can provide better care to their own children.  In a sense, we want to work ourselves out of a job in Mongolia.  We saw the most progress toward that goal this year.  Most importantly, the gospel and the Word of God was shared with all the children and their families, as well as most of the Mongolian staff we worked with and many accepted Christ, or at least showed an openness to learn more about Him.

As I have reflected on this week as I prepared to write this, the word that comes most frequently to my mind is humility.  I do not know if I have ever been so humbled.  It is an awesome, indescribable thing to see the Lord so powerfully at work.  I am humbled by even having to recount the story.  Each member of our team has told me stories that have brought tears to my eyes.  To see the Lord at work so powerfully in each member of our team as they answered His call to come to Mongolia and gave of their time, money, knowledge, skill, energy, and love humbles me.  I wish I could single out every member of the team and tell you specifically how well they served.  To see the Lord use us to change the lives of 22 children humbles me.  The gratitude the families demonstrate actually pierces my heart.  They bring us gifts I know they cannot afford and I so wish they wouldn’t.  But I guess the Lord uses those heart-piercing gifts to give me a sense of the magnitude of the gift the families believe they have received.  I don’t think the Lord wants me to miss it or count it lightly.  Even the staff we work with gives us heart-piercing gifts I know they can’t afford either.  It humbles me and convicts me to be much more generous.  Finally, it humbles me to see the lengths the Lord will go to in order to bring even one to Him.  Ed Morrow, director of World Medical Mission, who blesses us with his presence during this week every year and serves as our chaplain, reminded us of how the Lord loves and weeps over every person of Mongolia (and the entire world).  He can bring these people to Him without us.  The fact that He would allow us to share in it blows my mind.

The best gift we received this week was a post card for every member of the team.  On it were pictures of the children we took care of this week and it said “Thank you for mending my heart and soul, from the children of Mongolia 2008.”  There was no better gift. 

In closing, I’d like to pray big.  The need is great, in Mongolia and throughout the world.  The Lord has blessed us with a dream team with a passion to serve Him through excellent pediatric cardiac care.  I pray for the funding and the ability to send us all over the world.  Also, we were extraordinarily blessed this year to be given, for the third time, a private concert by the Mongolian national symphony, an indescribably unique and fabulous experience.  I’d love to share that blessing by having them provide a concert tour in the United States that would benefit pediatric cardiac care in Mongolia.  God is very, very big.  His will be done.  

Spring 2008

     We haven’t written an update since January because, honestly, it’s been too painful.  In our last update, we wrote about our time in Zambia and proclaimed victory in our work and relationships there.  This changed before we even got on the plane to leave South Africa.  We had travelled there with a team of 9.  At the time we left, there was a team of 6 still serving there.  One, in fact, still remains serving there.  There were 3 others who stayed there for a little over 2 months.  With much angst, effort, and prayer, we really do feel we tried everything to make our relationship and ministry there work.  In the end, our board voted unanimously to end our relationship with the ministry overseeing the orphanage in Zambia. 

            To explain this decision, history is important.  Our call to orphanage work began in the 3 years that we lived in San Diego and served as the physicians to disabled orphans at La Mission Carmen Serdan, Mexico.  We visited there one weekend monthly for 3 years and were so impressed by how well these children were loved and taken care of at this orphanage that was fully supported by Applegate Church in Medford OR.  We experienced firsthand James 1:27:   “This is pure and undefiled religion in the sight of our God. And Father, to visit orphans and widows in their distress.”  Kirk felt the call for us to continue to be involved in orphanage work after our time in San Diego.  He had read a book about George Mueller called “Man of Faith” that describes George Mueller caring for some 2000 orphans without ever asking man for money.  In January 2003, Kirk felt the Lord calling him to put his reverence for George Mueller’s faith into action and start an orphanage relying only on the Lord for money.  Having met a pastor in Kitwe, Zambia in 2001 and knowing the need for the care of AIDS orphans there, he sent that pastor an e-mail sharing his vision.  Although they had never discussed this subject before, the pastor was enthusiastic about the vision and began praying and researching what it would take to open an orphanage in Kitwe.  At the time, For Hearts and Souls had $250 in the bank, so it was going to require a work of the Lord.  The pastor traveled to the U.S. soon after this and spoke at a church about the vision for an orphanage in Zambia and the church poured out a generous love offering.  This and other donations allowed the opening of For Hearts and Souls Children’s Village (FHASCV) in a rented house in July 2003.

            Our vision from the beginning of FHASCV was to never seek man for money to support this work, but to always seek the Lord.  FHAS committed to always meet the monthly budget for this work.  God was gracious in answering this promise.  From July 2003 to February 2008 FHAS was never unable to meet the agreed upon monthly budget for FHASCV and was always able to increase the budget when requested to do so.  In addition, FHAS was able to provide funding to purchase land for FHASCV so that it would no longer be housed in a rental home.  Kirk led a team there in the summer of 2004 to build a foundation for this new building.  By the grace of God and through the generosity of many donors, we returned with a team in January 2006 to officially open this building.  We called the building Mimi’s House in order to honor the generosity of a woman who helped make the opening of this building possible.  In 2006, we opened Betsey’s House, honoring the generosity of a widow who enabled us to start a ministry to teenage girls who formerly lived on the streets.  This was also started in a rental house and FHAS has since been able to acquire land in order to build a house for this ministry.  A foundation has been laid on this land.  The amount of money (over $300,000) donated through FHAS since July 2003…without ever asking man for money…is really a testimony to the grace and goodness of the Lord.

            The beginning of the end of our relationship in Zambia was when, in 2007, we discovered pictures of the children who live at FHASCV on another ministry’s website seeking donations for support of an orphanage of a different name.  We will confess difficulties in our relationship over the years, but nothing worth ending the relationship over.  We had introduced a friend to the ministry in 2004 who, we believe with the purest of heart and best intentions, ended up causing much offense.  Consistent with Zambian culture, this offense was credited to us because we had introduced this person.  We have had countless conversations seeking forgiveness, but, we realized again this past January, have never been completely forgiven.  This offense caused the pastor overseeing the work in Zambia to believe we were not trustworthy and to start another foundation to seek funding for his work in Zambia, including the orphanage work.  This foundation is named Sarah Rose, after his daughter who died right before the orphanage opened in 2003.  We knew this foundation was started and why and truly respect this couple’s desire to honor their daughter.  Our only request was that this foundation not be used to seek man for money to support For Hearts and Souls Children’s Village.  We realized last year that this request was not being honored.  In meeting and talking with the pastor this past January, we further realized that the name of FHASCV had long ago been changed in Zambia without our knowing it.  He has partnered with other ministries since FHASCV started that do not know the name or history of FHASCV.  Although we have been accused of wanting the glory for this ministry, our true concern is that the Lord get the glory.  We understand that many people and organizations have made donations of time, money, and materials to make this orphanage ministry possible and have no issue with and are grateful for that.  We simply desired that all involved in the ministry trust in the Lord to lay it on people’s hearts to provide for His orphans.  We can testify that in the almost 5 years that FHAS provided for the monthly budget, there was not a single month that there was not enough money in our bank account to do so.

            We took our team of 9 to Zambia in January truly desiring, hoping, and praying for reconciliation.  As we wrote in our update shortly after our trip there, we submitted to Christian mediation and sat for hours with the pastor and his wife.  We truly felt at the end of this meeting that we had finally been forgiven for the past offense credited to us and had an agreement for moving forward in partnership with the Sara Rose Foundation.  We did desire honor for the history of the ministry in acknowledging the name For Hearts and Souls Children’s Village, but we were willing to share the name with Sara Rose Foundation.  Sara Rose Foundation is involved in a lot of good work in Zambia.  We have no interest in how they run their affairs for their other ministries nor in how they seek funds for those ministries.  We simply desired that they not solicit funds for the two ministries named Mimi’s House and Betsey’s House, but continue to rely on the Lord to provide.  It came down to our integrity as an organization.  We testify regularly that we never seek man for money.  This testimony needs to be true.  Also, we left 3 of our team in Kitwe for over 2 months specifically to oversee the ministry and how funds were being used.  One of these people was Kirk’s mom, who serves as For Hearts and Souls’ accountant.  The other two were a couple who are among our closest friends.  They both have significant international ministry experience and she serves on our board.  We discovered that money we sent earmarked for certain expenditures was not being used as we believed.  We absolutely have no integrity with our donors if we cannot guarantee that the money they are giving for a specific purpose is not being used for that purpose.  The details of the story are long and not worth recounting, but suffice it to say we could not come to agreement on these two particular issues and the board of For Hearts and Souls unanimously agreed we had to part company with Sara Rose Foundation.   At the time we informed them of this decision, we told them we would be willing to entirely administrate and fund Mimi’s and Betsey’s Houses, but we could no longer do so in partnership with Sara Rose Foundation.  They were unwilling to let us do this.           

I cannot fully describe to you how heartbreaking this decision has been.  I alluded to problems in the relationship over the years.  I can testify, as his wife, how many nights, for years, Kirk has laid awake thinking and praying about this situation.  We never wanted to be guilty of pride in reference to this work, so we have overlooked concerns, wanting to make sure our motives were pure.  And our overwhelming concern since July 2003 has been the care of the orphans that we truly love.  We wanted to make sure they were taken care of well.  We submitted to mediation.  We brought many people we love and respect to visit the work in Zambia who could give us their advice and perspective.  We sought endless counsel.  And we finally submitted all we had discovered and been through to the board of For Hearts and Souls, who voted unanimously for our separation from Sara Rose Foundation.  It’s been over 3 months since this decision was made.  I am just finally getting around to writing about it.  We have yet to update our website about it.  Please forgive us.  We weren’t trying to hide anything or be deceitful.  I confess we were honestly hoping we’d be able to be involved in the ministry again.  The history of the ministry has been changed for those who now know it in Zambia, but this ministry was a vision given by the Lord to Kirk.  By Zambian law, we had to have a Zambian in oversight of the ministry when we originally set up the ministry.  In Zambia, the name of the ministry was changed without our knowing it.  For Hearts and Souls has no rights or privileges.  It became something that we could no longer be involved in and maintain our integrity.  Our Zambian pastor friend who served as our mediator said “when the giants wrestle, only the grass is injured.”  The orphans are the grass.  We so desired for them not to be injured by our wrestling.  We sincerely pray to the Lord for His care and protection of them.  We have truly been humbled and broken by this experience.

The work of For Hearts and Souls continues, however.  We still fund the schooling of some 25 orphans in Lusaka, the capital of Zambia.  We were supposed to take a team of 16 to Yemen in April to participate in a pediatric cardiac surgery symposium and perform heart surgery on 8 kids.  The day before we were supposed to leave, there was an attack on US Embassy housing in Yemen, prompting the State Department to “strongly discourage” us from coming.  Following this disappointment, Kirk and I were able to respond to an eleventh hour request to return to the Mayan Peninsula in Mexico (where we did a children’s heart screening trip last year) and evaluate some children, as well as a hospital where teams from the U.S. will be able to train physicians and perform cardiac surgical procedures.  In fact, a team has already returned there subsequently to perform some cardiac catheterizations.  Lord willing, we will lead teams to Yemen and Mexico in the future.  We do have a trip planned to Mongolia again this September:  one week for screening children for heart disease and one week of cardiac surgical and catheterization procedures.  We are still the Lord’s willing servants and will follow where He leads.

In Him,

Kim & Kirk 

Guest Posting: Mending and Searching for the Broken Hearts 2007

This was written by one of the nurses who joined us for both the surgical and screening weeks this year. I (Kim) asked her permission to post it on our website because I thought it was such a beautiful and honest account.

Several of you have expressed interest in hearing about my trip. I’m sorry if I’ve been vague or non-descript in my stories…it’s just there is so much to process…It was like entering into another world. Now that it’s been a few days since returning home I’ve had a little more time to reflect on the last few weeks.

The words of the U2 song, Crumbs from your Table, crept into my head and played over and over as I watched a 13 year old boy hobble from the echo station (a machine used to see the inside of the heart) and out the door. “You speak of signs and wonders, But I need something other, I would believe if I was able, But I’m waiting on the crumbs from your table, Where you live should not decide Whether you live or whether you die.”

As he leaves someone grabs his hands and snaps a picture of his purple nail beds, which were rounded by some of the worst clubbing (due to lack of chronic lack of oxygen to the tissues) I’ve ever witnessed. He pauses briefly by the door to catch his breath and give a faint smile to the girl on our team who stopped him to give him a toy. His elderly grandmother places her hands under his armpits to support his weight as he steps out of the building and into the swarm of Mongolian children and their weary parents waiting outside.

My heart breaks. I just learned he probably won’t make it through another month; his lungs are so bad from his heart defect he can’t lie down without feeling as if he’s drowning in his own fluids. And yet, he managed to smile at me when I listened to his heart and his face lit up when I gave him a spider man wallet and NYC postcard. His eyes told of sadness but not bitterness. Do you think he knows that if he was born somewhere else he might be helping his grandmother out the door? He might be playing soccer outside with the other kids? “Where you live should not decide whether you live or whether you die”.

Two nights prior I stepped into the “pediatric intensive care unit” at the Women and Children’s’ Hospital in Ulaanbaatar. I’d only been there for an hour when a distraught couple came running into the unit carrying their 11 year old son. The boy’s eyes were rolled back into his head and blood poured from his mouth. We quickly cleared a bed and lay him down. Upon hooking him up to the monitors we saw that his heart had stopped. Immediately we started resuscitating him.

Things ran quite smoothly considering our resources. However despite sucessfully retrieveing a heart beat and blood pressure his pupils were dilated and fixed and his blood gas revealed that he was beyond a point in which we could do anymore for him medically. I watched as his heart stopped beating yet again. His parents who remained in the room as we worked, ran to the bed and his mother threw her body over his, weeping. His father stood back a few steps, attempting to maintain a controlled expression despite the tears that flooded his eyes. I stared on blinking back tears, as the nurses wrapped his body in preparation for the morgue with an efficiency and speed as if they’d done it several times before…

He was in end stage kidney failure. A condition that in the states we normally treat with dialysis. Many kids can live for a long time with regular dialysis treatments until they receive a kidney transplant. In America kindney transplant’s are performed routinely and with high success rates. Most of the time children go on to live a normal life after their transplant. Yet Mongolia doesn’t have dialysis and consequently he had no chance of survival. “Where you live should not decide whether you live or whether you die”.

I walked out of the hospital that morning, through the maze of concrete walls, paint peeling or simply omitted, hopping over the gaps in the flooring, feeling overwhelmed. I didn’t know how to process this.

Flashing back to the first week in Ullaanbatar, it was hard not to feel like celebrities. As we arrived at the hospital we were greeted by lines of anxious Mongolian families either anticipating a scheduled heart surgery or hoping they might get lucky enough to be seen by an American doctor. We had 3 cardiologists, a surgeon, two anesthesiologists, a perfusionist, 10 ICU nurses, 2 child life specialists, 2 bio mechanical engineers and 3 ICU intensivists all from the best hospitals in the U.S. The Mongolians smiled and waved as shuffled through the crowd awaiting us. Kim, one of our anesthesiologists looked at me as I commented on the situation saying, “It’s almost scary having so many resources because it gives you a false sense that we are in control…sometimes it makes it harder to depend on God when you seem to have so much”. Little did I realize at the time, I was going to learn such a life-changing lesson in humility through our “fame”.

We operated on a little boy named Tsend…he was very sick from the start. Because of his heart defect his coloring had a bluish hue from the lack of oxygen in his tissues and he only had enough energy to sit on his mother’s lap and weakly watch the other kids his age playing around him. After the heart surgery we performed he came back to our unit critically ill. He was requiring multiple medications to sustain his blood pressure and heart rate and a breathing machine to keep his oxygen at a level compatible with life. His prognosis didn’t look good. Tsend would have been a really sick unstable patient in the states and with our limited resources in Mongolia his condition was even more tentative.

That night I left the hospital with an uneasy feeling in my stomach. I wasn’t sure that Tsend would be there the next morning when I returned. Yet the following day he was still fighting. We continued with our planned surgeries. Our next patient to be operated on was beautiful little Bogi. Bogi’s very presence lit up the room. From her over sized pink ribbons to her sparkling black eyes, Bogi was quinescentially childhood innocence and joy. She’d reserve the brightest smile for every one of us no matter the circumstances. As Bogi awoke from her sedation after her cardiac catherazation she gave the doctor and nurses two thumbs up and a weak little smile. We all fell in love with Bogi…it was hard not to. Her parents loved her very much too. Bogi’s daddy walked three days from in the desert to make to the hospital in time to see her before her heart surgery. Bogi’s mom was a woman of faith I can’t begin to comprehend.

Bogi died just hours after her heart surgery. Her surgery was a “routine” one. It was one of the simpler surgies scheduled for the day. We’d expected her to recover from it in a day…and yet she died. I felt like the world stopped. I didn’t understand…how, why? Why Bogi of all the children? Why any of these beautiful children? “Why the pain before the child is born?” – Bono

I could hardly lift my fork at dinner that night…how was I going to muster any reserve to go back the next day and do it all over again. Bogi died…and little Tsend was probably on his way out as well. I tossed and turned all night. I woke up several times to pray…praying for a miracle. I’d made a choice to trust and follow Jesus…I didn’t understand what God was doing but I’d made a decision to trust Him…that night I had to hold onto that decision even though my heart was begging me to let go. I prayed for a miracle for little Tsend over and over that sleepless night.

The following morning…I could hardly compose myself as I walked to little Tsend’s bed and saw that he’d decompensated even further over the last 10 hours. God…were you not listening to me last night? I don’t get you. I watched, demoralized, as Kirk and our other doctors prayed over little Tsend’s bedside for wisdom. The offered him up to Jesus and waited. It was then they decided to take him back to the operating room and try to re-do his surgery. Thank Jesus that is exactly what he needed. Without the aide of the equipment and tests we could normally run in the states the operating room was our best option. The days to follow Tsend’s condition improved.

I had the opportunity to stay when the rest of our surgical team returned to the states, to take care of baby Tsend. I was able to see his breathing tube come out and let his mommy breast feed him again. It was a miracle…and it wasn’t because of our fancy American team, our years of experience at top hospitals or our shiny equipment. It was because God is sovereign and He is in control. Little Tsend taught me that there is hope in hopelessness.

I’ve been back in the states for about three weeks now. The transition is tough to say the least. It’s hard to have “normal” conversations about Brittany Spears and the Red Sox anymore. I find myself withdrawing a bit and tearing up at random times as flashes of memories from my trip ruminate in my mind. We are so blessed and so rich monetarily in America. The value of human life stretches beyond class, color, creed and country and yet it still holds true that, where you live DOES decide whether you live or whether you die. My prayer is that someday it will not.

Thanks for listening.

Genevieve

Mending the Broken Hearts Mongolia 2007

               As often is my practice, I (Kim) am en route home from another mission trip as I write this.  It’s always a good time to process what I’ve experienced in the preceding days.  I just spent a week in Ulaan Baatar, Mongolia for our third annual Mending the Broken Hearts week, a project led by For Hearts and Souls and Samaritan’s Purse’s World Medical Mission.  There were 30 of us on the team, including a CT surgeon, 2 pediatric cardiologists, 3 intensive care doctors, 3 anesthesiologists, a perfusionist, 9 ICU nurses, an OR nurse, a scrub tech, a nurse practitioner, a pharmacist, 2 biomedical technicians, 2 child life specialists, 2 extraordinary helpers, and the Director of World Medical Mission, who served as our chaplain.  The team did at least 10 cardiac catheterizations, including 2 atrial septal defect (ASD-“hole in the heart” at the collecting chamber level) device closures and we performed 8 surgeries on a total of 6 kids.  These numbers are significantly less than we had planned.  We had the biggest team we had ever taken, the most supplies, and the most medicines.  With these “dream conditions,” we had hoped to do 15 caths and 15 surgeries.  The theme of the whole week was the Lord’s ways are not our ways and His plans are not our plans.  We had a number of “firsts” that I would rather not ever experience again.

               The week started with our surgeon and two of our intensivists being stuck in Beijing en route.  They were supposed to arrive Sunday a.m. but did not arrive until Monday afternoon.  We were able to begin cases in the cath lab as planned on Monday a.m., but did not start our first operating room (OR) case until after 3 p.m. on Monday after these people arrived at the hospital directly from the airport.  This first case was a promise kept.  Kirk had found the child’s mother last year on the Searching week.  The mother has an inoperable heart condition.  After receiving this bad news, she asked if Kirk would check her daughter.  Kirk’s heart sank when he learned her daughter had an atrial septal defect and would need heart surgery.  He promised the mother we would perform this surgery when we returned this year.  I’m happy to report Anujin did very, very well.

               Tuesday we started the OR day with approximately 1 ½ year old Tsend, a boy.  He has Tetrology of Fallot and was very, very blue due to very little blood flow to his lungs.  He was at great risk of sudden death and was not a candidate to go to the U.S. for repair due to the extremity of his condition.  I don’t know how to explain it other than to say he “tried to die” many times during that operation in which the surgeon placed what’s called a central shunt to allow blood flow to the lungs from the aorta.  Staci (the anesthesiology resident that was my invaluable right hand woman all week) and I were extremely relieved to deliver him alive and stable to the ICU.  However, he “tried to die” many times over the next 48 hours.  The ICU team worked so very hard around the clock to keep him alive, including hand ventilating him over many, many hours as the ventilator kept ceasing to work.  The second case was a teenage boy with a ventricular septal defect (VSD-“hole in the heart” at the pumping chamber level).  Most children with VSDs are inoperable if they are not repaired by age 2 due to too much blood flow to the lungs which irreversibly damages the lung blood vessels.  His type of VSD allowed his lungs to be protected and for him also to do well with this surgery.  We had a big scare when we were trying to take him off the cardiac bypass pump though.  A normal part of the separation from bypass is to get the heart, which has been stopped, to start beating again.  Often the heart goes into ventricular fibrillation during this time and we electrically “shock” it out of this rhythm.  His heart went into ventricular fibrillation (a lethal rhythm when not on bypass) and we could not get the defibrillator to work for a good ten minutes.  We were giving medicines to try to help, but finally the Lord answered the fervent prayers of a lot of stressed out people in the operating room and the defibrillator worked.  He is now doing very well.

               On Wednesday, our first OR case was Bogi.  Bogi was 7 years old and looked like she was 3 or 4, in terms of weight.  The team fell in love with her when they met her at church on Sunday.  Bogi had an inoperable VSD due to the irreversible pulmonary hypertension described above.  She had actually been to the U.S. in hopes of having a repair 2 years prior and had been turned down.  Her mother became a Christian on that trip and was an active member of the church started by our missionary friends in Ulaan Baatar, Rita and Margie.  Bogi was taken to the cath lab for a diagnostic cath on Monday to assess how bad her pulmonary blood pressure was.  She got an unexplained heparin overdose and bled A LOT at the end of the cath lab case, a scary first that she survived.  The heparin had been mixed by the Mongolian team, so we had our pharmacist mix the heparin for the rest of the week.  We had a second heparin overdose on the second day despite this precaution.  We found ourselves repeating over and over throughout the week “it is Mongolia.”  We do a lot with their equipment, medicine, and supplies…and sometimes it goes far from smoothly! 

Anyway, back to Bogi’s condition, Kirk has lost count of the number of children and families in Mongolia he has cried with as he has had to break the news about inoperable VSDs.  I’m sure the number is well into the hundreds, or even the thousands, over his eleven trips there in six years.  This is something we just don’t see in the U.S. because our kids get repaired in a timely fashion.  This is a problem our team has made a concerted effort to do something about.  That is why Kirk leads a Searching week every year to try to find these kids before it is too late and to educate the Mongolians in different parts of the country about getting their kids seen early.  We have also been trying to teach the Mongolian doctors to place what is called a pulmonary artery (PA) band on these kids before they are 2.  This is a simpler surgery than a full repair and it doesn’t require cardiac bypass.  The mortality rate for the more complicated repair in Mongolia is easily 50 percent.  If the kids get a PA band, their lungs will likely be protected and they have more time to get to the U.S. for a full repair.  In fact, our first case 2 years ago was an approximately nine-year-old girl that an Australian team had put a PA band on seven years prior.  This allowed her to remain operable and we were able to remove her PA band and close her VSD…and likely save her life.  Bogi would be considered inoperable in the U.S.  I’m trying not to get too complex with the medical explanations, but despite her high pulmonary blood pressure, she still had what we call “reactive” pulmonary vasculature.  Our team has been trying to put PA bands on some of these kids in the hopes that their lungs will heal and they will become operable.  This, admittedly, is a last ditch effort that we don’t know will work.  It’s not something we’re familiar with doing in the U.S. simply because we’re blessed enough not to have to.  If it works, we have the chase to save countless kids.  Bogi’s parents had known for 2 years that she was inoperable.  They were well counseled that we didn’t know if this would help her, but it offered them a measure of hope and they were willing to proceed.

Bogi’s procedure went quite well.  It was actually quite straight forward and I even said so in the OR to the Mongolian anesthesiologist I was training.  I’ve learned nothing is straight forward in Mongolia and to take nothing for granted.  We took her breathing tube out in the OR.  She went to the ICU and was awake and interacting.  She was probably there for at least 2 hours when she medically decompensated quite suddenly.  You can imagine we’ve debriefed this and debriefed this.  The ICU team did everything rapidly and right.  We got her back into the OR as fast as we could.  Staci and I actually had another child asleep on the table with all her invasive lines in ready for her surgery, which had not begun.  In the U.S., you’d just go to another OR with an emergency case like this.  Problem was, there was no duplicate equipment in the other OR.  We put the child on the table on a portable monitor, placed her on a gurney, and Staci kept her stable in the hallway while we rolled Bogi into the still sterile OR.  Our surgeon got her chest opened and we performed a heroic, valiant “code” for a very, very long time and were never able to get her back.  Despite an autopsy, none of us can explain what happened.  In the OR, Kirk finally made the difficult decision that nobody wanted to make to cease our efforts.  That OR was full of praying people who had fallen in love with that little girl.  Kirk prayed a beautiful prayer committing her to Christ, which was translated into Mongolian.  There was not a dry eye in the room, Mongolians included.  That actually is very significant given they see death A LOT and those that work in the medical field are often quite stoic to it.    

Bogi’s parents’ reaction was indescribably miraculous.  Of course they were appropriately heart-broken and sobbing.  But Bogi’s mom, shortly after hearing the news, raised her hands to heaven and started saying “I praise you Jesus and thank you for every minute I had with my daughter.”  Her father told Kirk that he knew we did everything possible and how thankful he was that we had offered hope in a hopeless situation.  They came back the following day and gave everyone on the team a sheet of bookmarks on the back of which Bogi’s mom had hand-written for all of us the following 2 verses which she said God had given her to give to us:  “I thank my God always on your behalf, for the grace of God which is given you by Jesus Christ (1 Cor 1:4)“ and “Therefore, my beloved brethren, be ye stedfast, unmoveable, always abounding in the work of the Lord, forasmuch as ye know that your labour is not in vain in the Lord (1 Cor 15:58)“.  You can imagine how tremendously these verses ministered to and encouraged us.

We decided to cancel the case of the child who had been whisked out of the operating room.  I actually think that was one of Bogi’s many gifts of the week.  The child had had a “cold.”  In the U.S., I would have cancelled her surgery.  That’s a harder decision in Mongolia when you’re only there for a week and not doing a surgery might mean the child dies.  But she had pulmonary complications immediately after putting her to sleep and I think it was divine intervention that we did not proceed with a case that would have resulted in potentially another very sick child.

The surgical team arrived Thursday morning to a very tired ICU team and a very, very sick Tsend (the first case from Tuesday).  We decided to take him back to the operating room.  Lots of prayer required there.  We were going to put him on bypass to fix his shunt again, already a difficult proposition if you’re not starting with a very sick child.  We all knew there was a high likelihood this child could die in the OR too.  His case was an exhausting, hard fought battle.  When we were trying to get him off bypass, his lungs would literally not move—another “first” I’ve witnessed.  I suctioned them out I don’t know how many times, replaced his breathing tube twice, and used asthma medication over the course of an hour.  We came off bypass, because we had to eventually, with lungs that would barely move.  By the grace of God, his lung function got better and better over the next 2 hours.  Then he got better and better over the next 2 days, all in answer to a lot of fervent praying.  Another “first”:  we’ve never had a child still on the ventilator on Saturday of the surgical week.  We always try to do the difficult cases early in the week so we can have everyone out of the ICU by the end of the week.  So, for the first time ever we transported a child across town from the adult hospital where we do the surgeries to the children’s hospital.  Our 3 intensivists were leaving on Saturday, but, by God’s grace and planning, another intensivist arrived on Thursday for the Searching week.  Two of the ICU nurses were planning on staying for the Searching week and two more agreed to lengthen their trip.  I just learned from Kirk that through the Lord’s miraculous intervention his breathing tube has been removed!  It brings tears to my eyes to consider what a miracle this is!!  Our second case on Thursday was a 9-year-old ASD who, thankfully, did very, very well.

On Friday, we were supposed to do another PA band case and an ASD.  Given what happened with Bogi, I think we were all nervous to do another PA band, but, praise the Lord, it went very well.  The interventional cardiologist on our team had tried to close a patent ductus arteriosus (a vessel necessary for fetal circulation that should have closed after birth but didn’t) with a device in the cath lab, but the device size was inappropriate for this defect.  So, again not in keeping with our plans, we had to take her to the OR and close this defect operably.  She also did well.  It was then late in the day, too late to do another cardiac bypass case that would have to remain in the ICU when most of the team was leaving, so we had to cancel this case.  This patient will have a normal life span if we fix her defect by age 20, so we promised her, Lord willing, we would do her case next year.  This, however, was incredibly and understandably emotionally hard on her, her family, and those who had to break the news to her.

 So, 15 caths planned.  Only 10 done, and at least 2 with complications.  15 surgical cases planned.  Only 8 performed on actually 6 patients, with 2 “bring backs” and 1 death.  I only told you the stories and difficulties I know from being directly involved in them.  There are 29 other people who could offer you their stories and perspectives.  All of us would tell you it was one hard week, easily the hardest of the three surgical weeks we’ve had.  Not a great report.  Pretty discouraging.  So, what’s the lesson?  We’ve all processed that a lot.  Kirk and I spent what little time we had alone together processing it.  Is the lesson that we should quit?  I wondered that last year when Undurmaa died.  I wondered it again this year when Bogi died.  I don’t think that’s the lesson.  Neither does the team.  I in no way want to sound callous when I say this, but as Kirk has pointed out, pediatric heart surgery has been built on the deaths of many children.  Every new procedure, every new advance has come at a cost.  The pediatric cardiac surgery mortality rate in Mongolia is easily 50 percent.  In the U.S., it’s less than 1 percent.  We are slowly, agonizingly making progress in our training of the Mongolians.  We are offering hope to families that otherwise have none.  When you see the magnitude of the need in Mongolia and the number of families begging us to take of their children and sobbing when we can’t, you don’t want to quit.  I’ve marveled the last 2 years that, despite what we’ve been through, the team members keep talking about “next year.” 

One night I was unable to sleep, processing it all.  Two years ago, our container of supplies did not arrive.  We had a much smaller team.  We did 8 surgeries with only the supplies the Mongolians had to offer and what we brought in our suitcases…and all the children did well, with few, if any, complications.  I was expecting this year to be so much easier because we had a dream team and incomparably more medicines and supplies.  I couldn’t figure out how we pulled it off before.  Then I realized…we didn’t.  The Lord did.  Even last year, despite the conflicting fact that we had a devastating death, was “easier.”  The Lord gave us an incredible covering of grace.  Truly, it is utterly amazing that we accomplish what we do over there.  I think this year He drew back the curtain a little and showed us how much He had been covering us…and, in the process, continued to cover us.  All the “firsts” and complications made all the good outcomes that much more miraculous.  And, never ever wanting to minimize Bogi’s death, I can already see how the Lord is using it for good and to His glory.  I love the song by Tree 63 which goes “Every blessing you pour out, I’ll turn back to praise.  When the darkness closes in, Lord, still I will say, ‘Blessed be the name of the Lord.’”  I will never forget our entire team, on the morning after Bogi’s death, standing in the ICU and beautifully singing the song “Sing Hallelujah to the Lord.”  The darkness closed in and we were still able to say, with Bogi’s mom leading us with her example, “blessed be the name of the Lord.”  So, we will “not grow weary of doing good” (2 Thess 3:13) and, Lord willing, we’ll be back next year.

The week after the surgical week, Kirk led a team of thirty Americans and sixteen Mongolians to the south Gobi desert for the Searching for the Broken Hearts week.  They screened over a thousand children and found sixty-three with heart disease (6 were inoperable, 19 were added to the waiting list for the Children’s Heart Project, 8 will be taken care of in Mongolia by a visiting team from Japan, and the rest did not need surgery).  A group from Okinawa raised over $13,000 to buy 1,100 Bibles that were given out during the week.  Most importantly, close to 300 people came to Christ.  He is good!

  

Spring 2007

“For our struggle is not against flesh and blood, but against the rulers, against the powers, against the world forces of this darkness, against the spiritual forces of wickedness in the heavenly places.”  Ephesians 6:12

What a strange way to start a For Hearts and Souls’ trip update.  Sounds like a “downer”.  And these trips are so not “downers.”  They are some of the most amazing experiences of our lives.  But I realize I have been on three trips now without writing about them.  What is that about?  I believe it’s about Ephesians 6:12.  But, I digress.  I am truly a chronological story teller.  So, probably for my sake more than anyone else’s, let me tell the story in order.

We were in Mongolia the last two weeks in September.  The statistics from that trip are impressive.  There were around fifty team members over the course of the two weeks.  The first week was the Mending the Broken Hearts week, where we performed eleven surgeries and fourteen heart catheterizations.  The second week was the Searching for the Broken Hearts week, where almost eighteen-hundred children were screened for congenital heart disease.  But, we had a death:  beautiful 5-year-old Undarmaa.  Hers was the most complicated operation we had undertaken there.  Medically speaking, she did not act “right” from the moment I put her to sleep.  She required a lot of pharmacologic support to keep her blood pressure up in the operating room and in the twenty-fours she lived after her operation.  She had us all scratching our heads.  Even her death was a surprise.  She had had her breathing tube removed.  She had been speaking and interacting with her family.  Then she had a sudden cardiac arrest.  Our ICU team was incredible.  I cannot praise them enough.  They did everything right.  Sure, hindsight is 20:20.  And when something like this happens, we all wonder what we could have done differently.  We wonder if she would have lived if she had had her surgery in the United States.  We’re not sure.  But, we’ll never know.  The Lord knows though.  He is good and He is sovereign.  I rest in that.

I don’t know how to describe a scene like that though.  It is truly terrible.  The wail of a mother who has lost her child is unforgettable.  My dear husband Kirk always counsels physicians he is training to never, ever forget that wail so that we always remember the sacred trust granted us when we take care of people’s children.  I confess that the night she died everything went black for me.  The Mending week in Mongolia is thoroughly and utterly exhausting.  As the team leader’s wife, I confess I worried that it would ruin everything.  People travel at their own expense and work really, really hard.  Would they be too discouraged to go on?  Would they ever want to come back?  Would the Mongolians continue to trust us?  Would Samaritan’s Purse, who has so graciously and abundantly supported and partnered with us, continue to trust us?  She died late Wednesday night.  Not everyone on the team knew she had died until morning.  We met for breakfast in the hotel when most everyone found out.  We had this precious cook who made to-order eggs for us every day.  He found out what happened and tried to reassure our team members “Everything will be all right.  You are here and you serve the children.  I am here and I serve you…eggs.”  What a sweet man we all have come to love as he has made us breakfast over the last two years. 

After breakfast, we gathered at the hospital for our usual team devotions before starting our work.  Kirk put the question to the team “are you willing to continue?”  The answer was a resounding “yes!”  I don’t know that I remember the specifics of that devotional time, but I knew we cried, we prayed, we sang…and we continued to trust a loving and “faithful Creator in doing what is right” (1 Peter 4:19).  This was my first lesson in Ephesians 6:12.  There really is an enemy, Satan, who wants us to get discouraged and lose heart.  The team acknowledged this reality and refused to give him the victory.  I was so blessed by their faith and their resolve.  The rest of the week went very well.  Twenty-four lives changed.  The number currently escapes me how many children are brought to the U.S. and Canada out of Mongolia per year for cardiac care, but it’s about the same.  That’s a year’s worth of impact in one week. 

However, I didn’t learn the lesson of Ephesians 6:12 well enough to be courageous enough to sit down and write an update about it.  It’s so much easier to write an update when all goes well.  I in no way want to come across as defensive or as minimizing the loss.  The loss is tragic.  But I believe that beautiful little girl is in heaven.  And her family is continuing to be ministered to by members Samaritan’s Purse Children’s Heart Project in Mongolia.  And we will not know until we get to heaven how many learned about and began to trust Jesus because of what happened.  “For what does it profit a man to gain the whole world, and forfeit his soul” (Mark 8:36)?  That is why our organization is called For Hearts AND Souls.  What does it profit those we serve if we simply medically fix their hearts and do nothing for their souls?  In our human thinking, a medical mission trip is successful is we have no deaths or complications.  But “‘My thoughts are not your thoughts, neither are your ways My ways’, declares the Lord.  ‘For as the heavens are higher than the earth, so are My ways higher than your ways, and My thoughts than your thoughts” (Isaiah 55:8-9).  In God’s economy, there is victory in human death, if it is exchanged for eternal life with Him.

Continuing with the chronology, over Martin Luther King Jr. weekend in January, thirteen of us went to the Mayan Riveria, near Cancun, Mexico, to screen several hundred Mayan children for congenital heart disease.  Part of my writing these updates is, I confess, an opportunity for me to process personally what the Lord taught me in each trip.  You who read them have to somewhat suffer from my “thinking (or, more appropriately, typing) out loud.”  In keeping with what I believe the Lord is teaching me about spiritual warfare, the only thing I can think about that trip in that vein is that I didn’t write about it.  It was a great trip.  The Lord put together an absolutely wonderful team.  Our accommodations the first night were really quite sub-optimal, but they willingly endured it without a single complaint.  As team leaders, I cannot tell you what a blessing that is!  We were rewarded the following nights with truly beautiful (and cheap!) accommodations.  This was supposed to be the first trip that I was supposed to lead without Kirk, as he was supposed to be headed to Iraq.  His departure to Iraq got delayed and he got to go down to Mexico on Thursday night with the team.  He left Mexico on Saturday morning to head back to the U.S. and then on to Iraq, but it was such a huge blessing to have him there at the beginning!  And I am truly grateful for how the team loved and supported me through my grieving his departure and for how they provided for spiritual and medical leadership in his absence.  OK, I did get stuck for 48 hours trying to get home due to the freezing weather that hit Texas.  I think the spiritual warfare there is trying to convince me it’s just too difficult to get the time to get away and do these trips.  My absence affects my partner greatly in terms of workload…and I feel awful when I’m gone too long because I so appreciate her willingness to support what we do by bearing the brunt of the work and call when I am gone.

So, I just returned from Zambia this week.  A team of ten of us went there to conduct a pastor’s conference and to minister to the thirty-six orphans collectively being taken care of by what we call For Hearts and Souls Children’s Village.  In terms of spiritual warfare, this was what I began to call a “Satan Attack Fest”!  The four of us who left San Antonio together were delayed from the start.  Our flight out of San Antonio into Chicago was delayed due to weather, causing us to miss our connection and ultimately delaying our arrival by twenty-four hours and our luggage’s arrival an additional three days!  Due to a collision of circumstances, three of us did not get to the airport on time to depart Zambia, thus delaying our return home another twenty-four hours.  My partner, tragically, is getting way too used to these delays!  There were numerous other little frustrations during the week that are not even worth recounting.  But, call me crazy, it was still a fantastic trip.  The delays allowed for some wonderful quality time with the people I was traveling with.  And not having my luggage really taught me what I really need to have, versus what I would like to have.  The Lord may have taught me more on this trip than ever…and I truly felt closer to Him than I have ever felt.

This is the first time I’ve led a trip without Kirk.  I confess this caused me a lot of anxiety, as did the fact that the trip did not seem to be working out in keeping with the vision we had for it when we started planning it over a year ago.  Joshua 3 relates the story of the Israelites crossing the Jordan River into the Promised Land.  The river only parted AFTER those carrying the ark stepped into it.  Sometimes the Lord’s plans only become evident and accomplished AFTER we take the initial step of faith.  I went to Zambia not really knowing what exactly we were supposed to accomplish there and the Lord made it perfectly evident as the week went on.  We thought we would take a team of doctors and do medical outreach.  Only two doctors went:  me and my loyal friend Audrey, who decided to come at basically the last minute because I told her, on so many levels, that I needed her.  (I have to give credit to my friends Tae and Richard who did the exact same thing for the Mexico trip.  I am blessed beyond words by our many wonderful and supportive friends.)  The two of us only had the capacity to examine the thirty-six orphans, but this was exactly what was necessary.  Other outreach would have distracted from the quality time we needed to spend with them.  We thought we would take dentists to do dental outreach.  No dentists came.  We thought we would do building.  There were two couples that came for the pastors’ conference.  The other six of us were women.  Not exactly a strong building team.  But a strong team for simply loving on the orphans, which again was exactly what was necessary.  And, sorry men, it was such an incredible bonding, ministering time among these six women, I can now see why the Lord didn’t call other men to come.  All that being said, we would love it if doctors, dentists, and builders felt called to come with us same time next year!  And if you want to come just to love on orphans, as they say in Africa, you are welcome!

We did partner for the first time with Shepherds’ Support (www.shepherdssupport.org) to conduct a pastors’ and wives’ conference in Kitwe, Zambia.  Shepherds’ Support is the international ministry of my former Pastor Steve Troxel and his wife Connie that they stepped down from over thirty years of pastoring our church to start.  They did a three-day conference for around one-thousand pastors and wives that was wildly successful.  This was the fulfillment of a dream for Pastor Edward Mwansa, who oversees the orphanage work in Kitwe.  He, like Steve, has a heart to minister to and teach pastors, so it was a beautiful fit. 

What has been accomplished in Zambia since we first met Pastor Edward and his wife Barbra there in 2001 and since For Hearts and Souls Childrens’ Village (FHASCV) opened in 2003 is truly miraculous.  FHASCV started in a rental home.  You may remember last year we went to open Mimi’s House, a home FHASCV owns on land it owns.  There are now twenty-eight AIDS orphans living there.  A foundation has been laid to build a home of equivalent size on the same site.  A house has been rented for Betsey’s House, which is a home for eight teen girls who have been rescued from a life of drug abuse and prostitution on the streets.  Land has been purchased to make their home permanent as well.  There are twenty orphans in the capitol, Lusaka, who are going to school because of FHAS.  Another ministry has donated land to build a home for teen boys and building is going on there.  Meanwhile, Pastor Edward and his church members are ministering to the street boys once a week there with food, showers, clothes washing, and Bible study.  Barbra’s crisis pregnancy ministry, Silent Voices, continues to grow and counts over three-thousand babies alive because of it.  They’ve recently had an ultrasound machine donated to them.  We are praying for a doctor or ultrasound technician to go spend a significant amount of time with them to train them how to use it.  Pastor Edward’s Church on the Rock has been lavishly supported by Solid Rock Church in Portland, Oregon and they have purchased land to build their own building.  Someone else is assisting Pastor Edward and Barbra to build a guest house that will be so helpful for people going over there to minister. 

There is so much need there, it can easily become overwhelming.  Without being guilty of being satisfied and thinking it is enough, I do marvel and praise the Lord for what He has already done there.  A favorite song the Zambians love to sing when we’re there is “Come and see what the Lord has done.”  He has done so much…and it is so important for me personally to “come and see” it.  There are thirty-six children with names and personalities that have woven themselves into my heart because I’ve gotten to see and touch and hold and hug and interact with them.  Team members took their pictures and wrote down their stories.  We’re going to try to get them on our website so people can specifically pray for them.  And we continue to pray for how the Lord keeps expanding the vision.  We’d still love a farm for the orphans to move to once they get older, where they can learn skills they can use to support themselves.  There’s now a pre-school at Mimi’s House.  We’d love to have a school for all the orphans at FHASCV who now go to public school and for the orphans in town who may have family to live with but no money to go to school.

There is a spiritual “high” in going on these trips that is indescribable.  I honestly wasn’t tired the entire week I was there, which is miraculous because, ask my husband, I’m an expert at being tired!  I think it has to do with this:  “pure and undefiled religion in the sight of our God and Father [is] to visit orphans and widows in their distress and to keep oneself unstained by the world” (James 1:27).  There is simply a blessing in taking care of orphans that is palpable.  In contrast, I’ve been exhausted all week since I’ve been home.  This is probably the hardest time I’ve ever had writing an update.  It’s weighed on me all week.  And, like I said, it’s the first update I’ve written in three trips, despite the fact that people have told me they’ve missed them.  I finally realized it’s all about Ephesians 6:12.  The Lord is doing amazing things in the world through those of you who go with us, pray for us, and support us.  I named some names in this update, but there are so many names I’ve left out.  Please know that we are blessed by every single one of you.  What we are doing makes Satan mad.  And I consider it an honor.  If he weren’t mad, I’d question the effectiveness of what we’re up to.  The good news is we know who wins.  We are children of the King.  Through faith in Him we are able to “extinguish all the flaming missiles of the evil one” (Ephesians 6:16).  “In all these things we overwhelmingly conquer through Him who loved us” (Romans 8:37).  For me, the lesson is not to be discouraged by, but simply to be aware of, the spiritual battle.  I will continue to “be strong in the Lord, and in the strength of His might” (Ephesians 6:10).  And I will continue to be thankful for all of you who make the ministry of For Hearts and Souls possible.

Dr. Kim Milhoan, President, For Hearts and Souls

As a footnote, praise the Lord that Kirk’s time in Iraq is over half over.  The last time he was there he got to screen around sixty children for congenital heart disease, many of whom have traveled throughout the world to have treatment.  He’s praying for a similar opportunity this time.  In February, he did have the opportunity to travel to Yemen in an official capacity as an Air Force physician to screen children for congenital heart disease there.  He’s been invited back and is praying he’ll get to go on his way home from Iraq.  Stay tuned for a potential FHAS trip to Yemen.  Kirk never goes anywhere without getting the vision for more ministry!  Meanwhile, Lord willing, our upcoming schedule consists of Mending and Searching weeks in Mongolia in September, a Searching week in Mexico again in January, and a trip to Zambia again next March.  Is the Lord calling you to come with us?

Kosovo 2006

We are again enroute home from yet another trip where I am awed and humbled by what I have experienced.  Kirk and I are traveling home from Pristina, Kosova.  We were accompanied there by our good friends, Dr. John Kupferschmid (pediatric heart surgeon) and his wife Elizabeth and Dr. Minette Son (pediatric intensive care unit doctor).  John has been to Mongolia with Kirk three times now and Minette twice.  This was Kirk’s fourth trip Kosova since 2001 and it was the first trip for the rest of us.

We went to fulfill part of the dream of Dr. Ramush Bejequi, a pediatric cardiologist that Kirk first met in 2001.  He and Kirk have become good friends over the years.  Dr. Ramush has an incredible heart for the children of Kosova.  They have even less access to corrective heart surgery than the children of Mongolia.  Samaritan’s Purse Children’s Heart Project has brought over 100 children out of Kosova since 1999 for corrective heart surgery.  However, in the same time period, over 70 children have died either because they have had heart defects that could not be easily repaired or because they were waiting for acceptance for care at an international hospital.  There is absolutely no pediatric heart surgery in Kosova.  So, Dr. Ramush and his colleagues must day after day diagnose conditions they can do little about.  Dr. Ramush has a dream of bringing pediatric heart surgery to Kosova and he is dogged in pursuing it. 

The first step in Dr. Ramush’s dream was the organization of a symposium on pediatric heart surgery in Kosova.  The four of us went to speak at this symposium.  Dr. Ramush is not a Christian.  Most Kosovars are nominal Muslims, meaning they are Muslim by culture but not by practice.  A woman that works for Samaritan’s Purse in Kosova says that Dr. Ramush’s heart has been changed by this Dr. Kirk Milhoan who keeps coming back to Kosova and who was willing to fulfill his promise.  Kirk promised Dr. Ramush that he would one day help him to organize this symposium.  He kept his promise.  I was blown away by the joy and excitement with which he first greeted Kirk, “his friend,” when we arrived. 

I was also blown away by the lengths he went to in organizing this conference.  His goal was to have 500 people attend.  We all thought if 20 to 30 people attended, that would be impressive.  Pediatric heart surgery is such a specific, specialized topic, it’s hard to get many people together in the U.S. to discuss it.  He filled a downtown theater in Kosova with over 150 people.  We were impressed.  Dr. Ramush said it was not enough.  Like I said, he is incredibly dogged in his determination.

He published pamphlets and flyers and banners.  He had a Kosovar drug company provide sponsorship, with materials and briefcases for the participants.  He had businessmen donate funds so that he could cover the travel and lodging expenses for physicians from Albania and Macedonia, and so that he could feed the participants lavishly.  I was humbled to learn that the participants paid 20 Euros (about 27 U.S. dollars) to come to the conference.  However, I was relieved to learn that at least included breakfast, lunch, and a “gala” dinner.  Gala it was, lasting until past 1 in the morning and including traditional Kosovar dancing.  I particularly enjoyed the dancing part.  I did not particularly enjoy the getting up at 4:30 in the morning to get to the airport this morning after going to bed at 2.  Actually, it was well worth it.  I was so touched by these people and their desire to do something for their children. 

Part of the reason Dr. Ramush could get 150 people together, many of them to hear about a topic they know little to nothing about, is because we are Americans.  Sounds arrogant, but there is no other way to say it.  We were told over and over and over again by many different people how much the Kosovars love Americans.  They see us as their saviors.  Conversations consistently include the phrases “before the war” and “after the war.”  About one in twenty Kosovars died in the war with Serbia.  Most everyone lost someone. 

One of the people we met with was one of the former translators for Samaritan’s Purse, a young man named Hilke.  He says his brother was killed in the war.  He spent six months in his house, never leaving because young men were rounded up to be either killed or sent to prison camps.  After the war, his uncle, who had fled to Finland, started writing him and sending him tapes about his newfound faith in Christ.  Hilke said, despite the social cost of accepting Christ, he was overwhelmed by His truth and could not deny it.  Despite the fact that his family is only culturally Muslim, this still had tremendous personal cost to Hilke.  His uncle was funding his education in dentistry.  He disowned him and he had to quit school.  His father asked him at least three times to denounce Christ.  He said that first conversation with his father was the hardest of his life.  His father also disowned him and kicked him out of his house.  His father sent his uncles and cousins to change his mind, sometimes physically beating him.  They ended up telling his father that his faith was real and Hilke was winning all their debates with him.  His father did not talk to him for 4 years.  Hilke was allowed to go visit his mother during this time, but his father would never speak to him.  Finally, his father got deathly ill and Hilke went and took care of him, physically and financially.  They now have a relationship again. Hilke says a lot of his cousins have now accepted Christ.  Hilke is back in dental school and getting married next Spring, to a Christian woman his father has even accepted.  Hilke desires to go to Turkey to do missionary dentistry. 

Kosovars say they experienced atrocities in the war you’d never want to imagine.  One said “if you were watching it on a movie, you’d turn the movie off.”  And, as they see it, the U.S. came to their rescue.  We were told time and again that they would love to volunteer to help the U.S. forces in Iraq.  They watch the news with great interest and grieve when an American soldier dies.  Dr. Ramush’s partner, Dr. Ragijb, said he prayed for Kirk every day when he was in Iraq and that if Kirk had to go back, he wanted to go with him.  I cannot tell you how much they insisted on this point that they love the U.S.  The hotel we stayed in was “Hotel Victory,” with a replica of the Statue of Liberty on the roof.  There were American flags and symbols and names (including Boulevard Bill Clinton) everywhere.  It was truly, truly humbling.

Kosova is currently in limbo status.  They are not yet a country.  They are a disputed land, under U.N. management and NATO police protection.  Kosovars can travel fairly freely to Albania, Macedonia, Bulgaria, and Greece.  However, it is almost impossible to get a passport to travel anywhere else.  They told us, because we are Americans, that we were the “most favored of men.”  We have freedom to travel and are very welcome in their country and most countries in their region.  They so desire to be their own country.  We saw many signs that said, in Albanian, “We do not want to negotiate.  We want to be free.”  They desire to establish their own government and begin addressing some of the problems in their country.

They say that life out from under socialism is in some ways better and in some ways worse.  At least then everyone had jobs.  Now the unemployment rate is 70 percent.  Physicians only make about 240 Euros ($320) per month.  Dr. Ramush works full time at the public hospital and every evening and weekend (7 a.m. to 9 p.m., 7 days per week) in a private clinic so that he can make ends meet.  U.N. management has resulted in a two-tiered society where those with U.N. jobs make 1000 Euros ($1333) per month, while the rest of the population makes far less.  They say the cost of living is so much higher then their income, but somehow they survive.  Families do a very good job of taking care of one another.  Dr. Ramush’s two nephews, both of whom have college degrees but are unemployed, did a lot of helping with the conference.  I assume their family is helped by Dr. Ramush in return. 

Dr. Ramush desired to organize this conference to inspire the Kosovar doctors, medical administrators, and local government and businessmen to try to bring pediatric heart surgery to Kosova.  The U.S. ambassador to Kosova did visit the hospital and take a tour with us the day before the conference.  Dr. Ramush did invite the local Minister of Health to attend the conference.  He did not.  This was a source of great frustration to Dr. Ramush and many of the other doctors at the conference.  Two surgeons came up to us after the conference was over.  They had been trained in surgeries of the chest and lungs, but had not received any training in cardiac surgery, although they had very much desired to receive this training and perform these surgeries.  They said, though, that they have no support from local officials, such as the Minister of Health, for training and resources.  They said “please help us, however you can.”

We did meet an official from a foundation named for Mother Teresa that attended all of conference festivities.  He came to us at the “gala” dinner and said he wanted to raise a lot of money to bring pediatric heart surgery to Kosova.  Hallelujah!  Kirk saw 21  heart patients on the day before the conference, screening them for potential inclusion in the Children’s Heart Project and surgery in the U.S. or Canada.  He had to tell the parents of three of these children that there was nothing we could do.  We all fought tears as he did this.  What amazes me is the Kosovar pediatric cardiologists have to do this day in and day out.  That is what drives Dr. Ramush’s dogged determination.  We pray that the Lord helps him realize his dream.

 

Dr. Kim Milhoan, President, For Hearts and Souls

Zambia 2006

I am writing this as Kirk and I are on a plane back from a “quick” trip to Zambia. Upon our return, we will only have been gone from San Antonio six days. However, it takes well over 24 hours of flying just to get to or from Zambia. We were blessed with four fulfilling days there though. We were also blessed with four friends who traveled with us: two pastors from a church in Oregon who wanted to see how there church might become involved and some of our best friends, another doctor couple from our home group in San Antonio who’ve now moved to Okinawa.

This was my second trip to Zambia and Kirk’s fifth. We first went there in July 2001 when we were asked by the crisis pregnancy center that we were on the board of to visit a center that they supported inKitwe, Zambia. It was then that we met Pastor and Mrs. Edward and Barbra Mwansa and were touched by their heart to serve the Lord in ministering to the people of Zambia. One-and-a-half years later, Kirk, who was inspired by the orphanage work of the late George Mueller (who took care of as many as 2,100 orphans without ever asking man for money but by faithfully seeking God for provision) and the overwhelming number of AIDS orphans in Zambia, felt that God was leading us to help start an orphanage in Zambia. He wrote an e-mail to Pastor Edward asking him to pray about it. Just six months later, through a series of miraculous events, Kirk was there to witness the opening of For Hearts and Souls Children’s Village (FHASCV) in a rented home in Kitwe in July 2003. On a subsequent trip to Zambia in January 2004, Kirk inquired of the “mothers” who so faithfully take care of the orphans what they thought the orphanage needed and their common response was: a home of their own. FHAS was subsequently able to acquire land and Kirk returned in September 2004 with some other volunteers from the U.S. to help pour the foundation for the new building. This trip was to witness the opening of that new building.

The “opening ceremony” was Sunday afternoon. The worship team from Pastor Edward’s church sang a song at the ceremony that easily expressed the theme for the trip: “Come and See What the Lord Has Done.” The miraculous hand of God is so indescribably evident in the fact that despite obstacles too numerous to quickly summarize, this building was erected in such a short amount of time. The original rented FHASCV was meant to house ten orphans. At the time of the new house opening, eighteen children were being taken care of by FHASCV. The new house will likely accommodate up to thirty children.

Prior to taking this trip, I admit questioning whether it was a wise use of time and resources. It was going to be so short and relatively expensive. I was convicted over and over on the trip though how important it was that I was there, not for anything I could contribute, but for everything that the experience had to teach me. As I struggle to write this, I realize how words are so inadequate to explain what I was able to “come and see.” One of the most inspiring things to see was the orphans themselves. It’s one thing to talk about caring for orphans. It’s another to see them, to hold them, to play with them, to see them smile and laugh and cry, to put faces to names. There were eighteen of them, all with incredible stories. All are orphans of AIDS. Seven are HIV-positive. The youngest is two months. Most are toddlers. We laughed at this sea of little people we saw moving around, all about the same height. The oldest is twelve. They are thankfully surrounded by love. There are eight “mothers” who take care of them full time. Pastor Edward’s church members are heavily involved in volunteering there. They called most of us adults “mommy” or “daddy.” They loved to be held and played with and talked to and read to. I say there were eighteen of them, because as of today there are only seventeen. The littlest one, Peter, died this morning, right before we left. He had HIV. We noticed he looked sickly when we first met him on Saturday. By Sunday, he was in the hospital. By this morning, he had died. He’s the sixth child that has died since the orphanage opened and the second this month alone. He’ll be buried tomorrow in a baby graveyard that is very full and very busy. There were four of us physicians on the trip. We were all struck by, despite all our combined skills and training, because of his disease and because of the scarcity of resources, there was so little we could do for him.

That was the other important thing to see: the magnitude of the need. I cannot adequately communicate the passion and heart of Edward and Barbra for the people of Zambia. Theirs is an incredible ministry, that includes a church, the crisis pregnancy center, and the orphanage, that God in His providence has led them to in order to meet many needs. Barbra has an incredible ability to put their experiences into words. One night, as we were visiting in their very nice house by Zambian standards, she told me that “you know, you sit in this house in Zambia and everything looks fine. But something is terribly wrong in this country. Our people are dying.” She talked about the life expectancy of males in Zambia now being around 33. One in four, to maybe even one in three, Zambians are HIV-positive. There is an extremely high rate of HIV positivity in the teenage population. She said “we’re about to lose an entire generation.” She has an incredible passion to talk to teens about abstinence, the only foolproof method of protection against HIV. She says she talks to them about their hopes and their dreams and how best to protect themselves so they can live out those hopes and dreams. And on days when babies die, she says she wants everyone to be able to witness that experience. I believe it was God-ordained that we did.

We’ve had four days of seeing how much the Lord has accomplished in this ministry and how much more He is calling us to. We’ve got big dreams and visions: more room for more orphans, outreach to orphans who live with extended family, a school for orphans, a home for teenage girls that would save them from a life of prostituting themselves for food on the street and teach them skills to get a job, a farm where possibly teenage boys could live and raise chickens and crops, a medical clinic that would increase the medical resources and standard of care for the community. They’re God-sized dreams. But He’s already shown us what He can do. Meanwhile, FHASCV will keep loving orphans. And since we’ve chosen to minister to AIDS orphans, many more will probably die. But, as Kirk says, they’ll be loved into heaven. And when they get there, they won’t be surprised by the love of Jesus, because they saw it lived out in those who took care of them on earth.

 Dr. Kim Milhoan, President, For Hearts and Souls 

Mongolia 2005

For the long update on the trip, I decided to just give you the play-by-play I typed to my family while I was there….

Date: Wednesday, October 26, 2005
Subject: Woohoo from Mongolia!!!

I am typing in a state of exhaustion and relief. We did the first pediatric cardiac bypass case in Mongolian history today!!! And the child is doing very, very well!! Praise the Lord! I cannot even come near to explaining how this week has gone. Our container of supplies, including the anesthesia machine and cardiac bypass machine and LOTS of other important stuff, did NOT arrive!!! We now see this has been totally in God’s providence. Our goal was to do 10 ASD (atrial septal defect–hole between the 2 collecting chambers of the heart) cases starting on Monday. Well, given that we didn’t have our equipment, the Mongolian physicians invited us to observe them doing two of their hypothermic cardiac arrest cases on Monday. This is when they literally wrap the child in ice, wait for the child to cool, stop the heart, and operate as fast as they can. I think all of us were completely nauseous watching the whole thing. It was a completely heartwrenching, frightening experience!!! One case, a 27-year-old, survived. The other, a 3-year-old, did not. That’s about their mortality rate: 50%.

Meanwhile, in the screening, Kirk had been coming across a lot of other kids who we could really help with different types of surgeries. So, we went back to the drawing board figuring out what we could do with their supplies and what we brought along with us. For the cases we watched on Monday, they used an antiquated Russian anesthesia machine with ether anesthesia. I’ve only read about ether anesthesia historicallly. It is no longer on our boards!! So, after we watched these horrible cases, their surgeon’s were really pushing us to do some other cases. Plus, we were considering some other cases we really wanted to do. We want to do cases where the benefit outweighs the risk, meaning they are likely to die if we don’t do the surgery…or they’ll die if the Mongolians do their version…or we can’t get them on the Children’s Heart Project list to get them accepted in the U.S. I admit I was completely freaked out Monday afternoon and thought there was no way I could safely proceed!!! I needed a little alone time and some good debrief and prayer time with some of the wonderful people on the team, including, of course, my wonderful husband. I figured out how I thought I could safely do things my way. I was so freaked out because I thought there was no way I could safely do things their way!!

So, we did two non-bypass cases on Tuesday. I told the team I would go set everything up and see what I had and would not proceed if I did not feel it was safe. I cannot tell you how nervous I was starting that first case!!!! Lots of prayer and tears (I kept getting all this amazing confirmation that all would be OK that made me cry) getting there!! But, hallelujah, both kids did really well. I was able to extubate (remove the breathing tube) both of them in the OR, which is a victory. So, I was feeling a lot of relief going into today. But, today we did our first bypass case. Our perfusionist (who runs the bypass machine) was feeling the stress I was feeling yesterday. He had the same criteria. He’d set it up and if he didn’t feel safe he would not proceed. Well…we did it!! And that child was extubated within a half-hour of arriving in the ICU…another victory. I cannot even tell you the relief!!!!! Kirk told the team way back in Feb. that we would plan and the Lord would likely blow all our plans and make us totally rely on Him. Well, that is what has happened!!!The director of Samaritan Purse’s World Medical Mission is here and his morning devotion before we did the first cases yesterday was about the Lord being personal, a provider (ohmygosh has He provided just exactly what we need…and no more!), a protector (He would keep us out of trouble), and powerful. From what I have witnessed in the past 2 days, I cannot tell you how true this is!!!

Date: Friday, October 28, 2005

The Lord continues to miraculously intervene. We successfully did 2 pump cases and one non-pump case yesterday. All 3 kids were extubated within an hour of arrival in the ICU. More woohoo! I think everybody sees it and feels it. Kirk said I feel like it’s a failure when they wake up crying (because I want them to be comfortable and not in pain!), but everyone else is so excited to hear them crying! Especially their parents. You should see their tears of joy and relief!

Today is a big day. We are going to do a baby that will absolutely die if we don’t do surgery…but who is so sick he might not survive the surgery. His father has been driving us around the whole time we have been here because he has wanted to serve us for what we are doing. He and his wife understand the risk of the surgery…but they understand the absolute risk if we don’t do it and want us to proceed. Please, please pray! Another child is 13. He is the son of the man who owns the 2 vehicles that they have been using to drive us around. He is at risk of sudden death if he doesn’t have surgery. The last is a little baby. Littler patient, bigger risk. Only one case is a pump case. We had just enough equipment to set up one more pump case and no more. It is truly amazing to see God direct our steps. We feel like it’s like the widow’s flour and oil…it lasted just as long as the famine lasted and then dried up. We keep opening suitcases and finding what we need. And I bet when we’re done, the supplies will be gone.

The Mongolian surgeons were going to do another hypothermic circulatory arrest case today. Kirk and Dave (Kirk’s partner) saw the patient…and said he doesn’t even need surgery!! Thankfully, they cancelled the case. That is another prayer of ours. The risk of their surgery is so, so great. It’s even more heartbreaking to think they are putting kids at risk who don’t even need it. Kirk and Dave and John (our surgeon) have been working valiantly to try to help them improve their diagnostic skills and figure out who really needs surgery. Kirk and John are meeting with the Minister of Health for Mongolia today to try to get them to start funding the supplies for the pumps for the children who need heart surgery in Mongolia. That’s the whole problem. They have pumps but no appropriate supplies for doing peds pump cases. And the doctors and hospital only get $5 per case. I honestly think they don’t want to hurt these kids. They’re doing the best they can with extremely limited resources. So, prayerfully, I’ll have a good report tonight!

Date: Saturday, October 29, 2005

Today’s is a mixed report. Bottom line is we did 8 successful surgeries this week and have 8 kids doing very well and 8 very happy families. I don’t know if I’ve ever been so tired! The director of the hospital and the surgeons hosted us for a nice dinner last night. I was so, so tired I had a hard time rallying to get there, but I’m glad I did. We were showered with presents from them…and 2 of the families of the kids we treated showed up with more presents. Truly, truly humbling. I came home and slept like the dead. First night since we got here that I didn’t wake up in the middle of the night thinking about what was before me. It’s a really good tired though. I get tears in my eyes just writing and thinking about it.

We’ve staffed the ICU every night this week. Kirk’s partner Dave and one of the nurses were there last night. So, Kirk, another nurse, and John the surgeon got up this a.m. to go relieve them…and hopefully send the kids from yesterday out of the ICU to the floor. They were both extubated early after surgery too and all the rest of the kids have been able to go to the floor post-op day 1. Then the surgeons want to take us to the countryside. So, its a nice day to relax a little and reflect before we get on the plane tomorrow.

I said it was a mixed report…we didn’t get to do the child who will most definitely die without the surgery. It has a lot to do with politics and circumstances that are not worth getting into, but what an incredibly hard decision! It’s a chance for a lot of us to see what Kirk has been seeing for 5 years. He’s had to tell countless families there’s nothing we can do. Sounds strange, but I’m happy for him that there are many more of us who are experiencing it and can share the emotional burden with him.So, anyway, much progress made. Much more to be made. Kirk said the meeting with the Minister of Health was just ceremony. No real progress on policy there. But, after 9 trips, it was at least a meeting with the Minister of Health. It’s easy to get discouraged with how far there is to go…but we’re trying to keep focused on how far we’ve come. There’s that parable in the Bible about the shepherd leaving the 99 sheep for the one. We came halfway around the world for eight. That’s pretty remarkable.

To God be the glory. Great things He has done.

Oh, yea, the container arrived today. I think that was God’s humorous exclamation point on the week. He wanted us to do all in His strength, not our own. Another oh yea: I can’t tell you how many things we used the last of on the last case! On the last case, the blood warmer on the pump failed. We were able to get the patient just barely warm enough. After he was off pump, the oxygen line to the pump broke. Truly amazing! We did so many creative things to get this all accomplished, I think my skills must have grown exponentially. I will be so appreciative to do my job in the U.S. now!!!

Thank you so much for praying and supporting us!

Dr. Kim Milhoan, President, For Hearts and Souls

Fall 2005

Once again I am writing from high above ground as I start a journey to Mongolia. But, first allow me to thank all those who have been faithfully supporting this ministry through your prayers and generous giving. Next, I would like to apologize for the delay in “Updates”. Please know that the lack of updates is not because nothing is happening but rather that I spent the last 4 months in Iraq.  (If interested in my writings about my time there, please go to www.brokenmasterpieces.com and click on “Thoughts from the Cradle.”)  Please allow me to share with you what God has been doing while For Hearts and Souls has been in the neighborhood.

For Hearts and Souls Children’s Village, Kitwe, Zambia, a ministry to AIDS orphans

The orphanage in Zambia continues to bless and be blessed. Since opening in July 2003 we have seen the faithfulness of a loving God who cares for the fatherless. The new home we are building is almost finished. I am planning on traveling for the opening in January 2006, Lord willing. We currently have approximately (numbers can change daily) 14 orphans, including a 16 y/o orphan Cecelia and her two children. She was a street child until a year ago when she came to us. Shortly after arriving she was noted to be pregnant from before. She has since given birth to her second child and has become a real help around the house. Cecelia has opened our eyes widely to the problem of young girls living on the street. As the new home opens, I would like to keep the rental home and have it become a home for young girls who currently live on the street. We want to care for their physical, emotional, and spiritual needs. The new home will be primarily for young children. All of these children are AIDS orphans and about one-third have HIV/AIDS. I would also like to purchase a 20-acre farm for food for the orphans as well as an on-the-job training facility for our older orphans. I would like to share some of the financial blessings that God has poured down on the orphanage. I list these not to solicit, but to give glory to God for His faithfulness. The monthly budget to care for 14 orphans and employ 8 staff is $1640 a month. God has been faithful to provide. We continue to seek only our God for financial help and He has directed many to share with this ministry. The cost of the farm will be between 2000 and 4000 dollars. We trust that if it His will for us to buy the farm then the money will be available in His perfect timing. Please continue to pray for the work in Zambia as the need continues to grow larger. But our God is even larger.

Searching for the Broken Hearts, Playa Del Carmen, March 2005

In March, I had the pleasure of traveling to Mexico. I saw 48 patients and 16 of those children had significant heart disease that needed either surgery, cardiac catheterization, or medication. The other patients did not have any heart disease and were very relieved to know that their heart was OK. I am happy to report that, as of Oct 13 2005, eight of these children have traveled to the U.S and undergone care, either with catheterization or surgery or both. One nine-year-old child’s family, after she underwent further diagnostic evaluation in the catheterization laboratory, elected for her not to have surgery as the risk of surgery for her would have been very great. One 3-year-old boy with Down syndrome had been turned down for care multiple times in his life, both in the U.S. and Mexico. What a gift to see the tears of joy in his father’s eyes when he was told his son could have surgery. Another three of these children have undergone surgery in Mexico, performed by the
U.S. pediatric cardiothoracic surgeon who traveled there with me in March.

Searching for the Broken Hearts, Mongolia 2005

There are 18 team members who are currently traveling to Mongolia. This is our third large scale medical mission to Mongolia to search for children with heart problems. We plan to see 1500-2000 children in 4 ½ days. All children will receive toys and a gospel bracelet. Children who are thought to have a heart problem will receive an echocardiogram at no charge to the family. Children who are diagnosed with a lesion that requires surgery will either be treated by the Mongolian physicians, be treated by our team, be treated by a Japanese team, or become a part of the Children’s Heart Project, a Ministry of Samaritan’s Purse. Please pray that the children and their families are able to clearly see Jesus through our lives, actions, and words. We will be screening children from October 17-21.

Mending the Broken Hearts, Mongolia 2005

In 2001, I had asked God to show me children with heart disease that I may be able to help. Shortly after that prayer I was in Kenya and I saw many children who needed heart surgery but I had no way to help them. As I sent one child home to die, I walked to lunch with tears in my eyes, pleading with God that now that he has shown me all of the need that he would allow me to do something to directly help the children and teach the local physicians. Over four years later a door has been opened for us to bring pediatric cardiac surgery to Mongolia. The Mending the Broken Hearts team has 12 members: pediatric cardiac surgeon, pediatric cardiac anesthesiologist (my wife Kim!), 2 pediatric cardiologists (including myself), pediatric intensivist, pediatric cardiac perfusionist, and 5 nurses who specialize in caring for children with heart problems. We will be working with the local physicians and nurses in Mongolia to train them on the equipment that has been donated for the project. Our plan currently is to do two open heart surgeries a day for 5 days. We hope this is will start a collaboration where we can come and help them bring up the standard of pediatric cardiac care in Mongolia, so eventually no more children will need to leave to receive the life saving surgery they need. We are doing the project in conjunction with Samaritan’s Purse, who has been very generous with gathering the donated medical equipment as well as purchasing items that were not donated. They also have provided for the shipment of a 20-foot container. This is where we need your prayers. The container’s arrival is still in some question due to some unforeseen problems. Please pray that the container will arrive and be released from customs so we will have the equipment so desperately needed. We trust that God’s perfect will will be done. Please pray that God would be glorified by the works of our hands and that the children and the families would sense God’s love through His son Jesus Christ in a very real way.

Iraq

Many of you know I was deployed as an Air Force Flight Surgeon to Iraq for four months over the summer. One of the highlights of my time there was when I was able to go to Baghdad and screen 57 children with significant heart disease for eligibility for surgery. 27 of the children need surgery and do not need any further evaluation. 20 children need further study with a catheterization prior to a decision being made on surgery. 7 children were not operable and 3 did not need surgery. There are 4 organizations that are interested in helping these children find places where they can receive surgical repair. One of the most interesting is Shevet.org. They are a Christian Jewish organization that has brought 50 children out of Iraq so far. Some of these children have been treated in Israel. What a testimony to the work of Christ: Christians bringing Muslims to Israel for healing. Please pray for this work.

Future trips

         Zambia: I plan to go to January 2006 for the opening of the new orphanage.

Mexico: We will continue to help children in Mexico at Playa Del Carmen. I already mentioned that the pediatric cardiothoracic surgeon that traveled with me in March has been back to perform surgery. Our next trip will be in early Spring.

 

What I ask of you is to pray. Pray that we are worthy to serve the people God puts in our path and that our service brings glory and honor to our Lord and Savior Jesus Christ.

 

Soli Deo Gloria

 

Dr. Kirk Milhoan, Medical Director, For Hearts and Souls