Mission to Heal

Sharing Medical Knowledge at Africa's Pole of Inaccessibility

Glenn Geelhoed

• Publisher: Greenleaf Book Group Press
• Year: 2014
• Print ISBN: 9781626340282
• eBook ISBN: 9781626340299
• Topic: Medicine
• Subtopic: Medicine Biographies

Teaching and healing in a remote and precarious land Some might ask why Dr. Glenn Geelhoed has the right to make wrenching life-and-death decisions about the impoverished people he treats. Simply, where he travels, there is no one else to make them. This is especially true in the Central African Republic, where the so-called government provides no security and no infrastructure. Mission to Heal is the story of several weeks in the CAR teaching, healing, and learning. This is a tale of Western and indigenous caregivers operating side-by-side on the fringes of surgical civilization. Day by day, Glenn and his teams operate without electricity, with limited supplies, often with only local anesthesia. Their patients are stoic, and the supporting caregivers are resourceful and generous in the extreme. Many believe that the Zande and Mbororo people in this region, very near the most remote point on the African continent, are beyond help. Yet Glenn tells a different story--sometimes tragic, but frequently funny and often hopeful. Despite the backdrop of marauding invaders, refugee camps, and a deep history of geopolitical instability, Glenn works with the local people to develop a sustainable healthcare program--work he has been doing around the world for more than forty years. The feats of his caregiving teams and the indigenous communities in which they work reveal a crucial lesson for our time: humility, perseverance, and resilience can be effective weapons against some of the world's greatest problems.

CHAPTER ONE

THE TEAM GATHERS

June 1–2, 2012, Derwood, Maryland, to Addis Ababa, Ethiopia

THROUGH SOME COMBINATION OF MINOR MIRACLES, WE WERE ALL seated in a Boeing 777, seven across, on an Ethiopian Airlines flight from Washington Dulles International Airport to Addis Ababa, Ethiopia. Aft er a brief layover there, we were on to Entebbe, Uganda. And from there, it was on to the African pole of inaccessibility, in the Central African Republic (CAR).

Our group had gathered from several compass points just the day before, amid a downpour and tornado warnings, in Derwood, Maryland. The day had started with an early trip—at 6:50 a.m.—out to Dulles to pick up Claudia Vazquez. She is petite in stature at just ninety pounds, but has voluminous energy and enthusiasm. She is a veteran mission team member, and it showed in her well-packed bags; she understood that space on the trip came at a premium. A registered nurse (RN) and certified surgical first assistant (CFA), she had coordinated the vast number of various clinical kits for this trip aft er operating with me for the second time in South Sudan just six months before.

Under threat of a rainstorm, I drove Claudia to the National Mall so she could tour the newer monuments and then scurried over to George Washington University (GWU) to perform some eleventh-hour administrative tasks. Then we headed out to Derwood, phoning the others, who were flying into Baltimore and Reagan National Airports.

Dan Vryhof, another mission veteran, took the Metrorail to Derwood. He had flown in from Michigan, but he knew DC well after his previous orientation trips. He had just graduated from Calvin College in Grand Rapids, but he was preparing for his first year at GWU’s medical school. He would enter with more time in an operating room than most of his colleagues would see in their first three years—this was his second medical mission with me in just six months. And with Dan on the trip, I knew I would have at least one running partner—if we found any time to run.

Dan first contacted me after he heard me speak at Calvin College, my alma mater, in January 2011. (A podcast of the speech, “Mission to Heal,” is available on iTunes.) In his email, he had described his earnest wish to do what I do, where I do it, and had told me about his interest in applying to medical school. Since hearing my lecture and noting my affiliation with George Washington University, he had moved GWU to the top of his application list. He asked to meet me when he came to DC to interview at the university. I responded and asked if he was related to Wesley Vryhof, who had taught me physics in high school. He responded, “Yes, and my grandfather said you were a very bright kid.”

The Grand Rapids community is a small, tight-knit one.

In January 2012, one year after hearing me speak, Dan had accompanied me to South Sudan, Chad, and the CAR, just five months before our current trip. In April 2012, he attended the annual Students for Medical Missions Symposium at the University of Toledo, where my student teams present on their experiences. Dan’s brother Nick, friend Josh VanderWall, and junior classmate Kyle Burghgraef came with him. At this conference, which is held in association with the induction ceremonies of the Medical Mission Hall of Fame Foundation, Josh asked me if he could join us on the June return trip to the CAR, and both Nick and Kyle asked to be included on the missions planned for January 2013. They would be part of a half dozen Calvin College premed students signed up for missions with me to Nigeria, South Sudan, and two islands of the Philippines, along with students from other schools.

Dan and Nick’s father, Steven Vryhof, met me when he accompanied Dan to DC, and on that trip he had asked to become an active part of my ongoing mission efforts. He is now a crucial member of the M2H board of directors. Three generations of Vryhofs have subsequently visited me in Derwood, and by coincidence, Dan’s grandparents, Wes and Fran, are close friends of my sister, Shirley, and she had already shared with them the audiotapes, narrative texts, and photojournalism I regularly send home from these remote missions.

I picked Dan up at the Shady Grove metro station, along with Bruce Visniski, a CFA from Muskegon, Michigan. This was Bruce’s first trip with me, though he’d long wanted to go on one. He had first read about the missions on the National Institute of First Assisting (NIFA) website, where the CEO, Jerry Kekos, recommended the experience and explained that NIFA would help by covering some of the travel expenses. Bruce is also a hunter and had recently discovered an avid pupil in his seventeen-year-old daughter, Jenna.

Bruce gets his chance to scope out the Derwood game room.

Dan’s friend Josh VanderWall arrived soon after. He grew up on a farm in Marne, Michigan, and is entering Michigan State University’s College of Human Medicine in Grand Rapids, Michigan. (This school was opened in 2010, and in May 2014, I’ll be its inaugural commencement speaker.) Josh and Dan could almost be twins—they are both about six feet tall with short sandy hair and blue eyes—and they look especially similar when both are wearing their blue Mission to Heal T-shirts. Josh, like Bruce, is a hunter.

Dan and Josh look almost like twins, especially in their Mission to Heal T-shirts.

If I can help it, I never go on a medical mission alone. I have always brought medical students and other health-care workers who are interested in learning from and educating others. (The exception is when I travel to areas of active warfare.) The purpose is to educate both ways; I want the students and team members to learn from those who have never been in school or a developed medical setting, to see what care is possible using only eyes and fingers and ears. And I want the indigenous workers to recognize that those accompanying me are young folk who are at the same level in terms of their knowledge but who are accomplishing great things by dint of diligent effort and applied discipline. I want everyone involved to see that we are all in the process of learning.

It was beginning to seem that I had constructed the group for this mission around two of my passions: running and hunting. Of course, that wasn’t quite the case. Only those who are prepared to pull their weight in a surgical setting need apply. Although, on this trip, we would have one additional member, which was a bit of a sore spot for me. But I’ll get to that in a moment.

In the mission control room—my basement—Claudia had set to work organizing the drugs and surgical kits into the fourteen bags that would hold all of our supplies and belongings. (At the time, there was no additional charge for two checked bags per person. Now it costs $70 to $100 per bag after the first.) The supplies had been primarily scrounged from overstocks at local hospitals, the Medical Mission Hall of Fame Foundation’s distribution center, and Project SAVE (Salvage All Valuable Equipment). The other team members helped Claudia while I ran through the orientation for the mission, talked about expectations, and passed around the photo album from our January trip. The pictures of Flore got much attention as we waited for word from the last two team members, who were on planes that were trying to land in stormy conditions.

Leenta Nel, a CFA originally from South Africa who now lives in Victoria, British Columbia, wouldn’t arrive at Dulles until after midnight, so she would spend the night at a hotel near the airport and meet us at the terminal in the morning. Like Bruce, Leenta was a newbie and had heard about M2H through the NIFA website. Despite the fact that she was caring for her ailing mother and her own family, she had long-held hopes of returning to Africa to serve. She read Gifts from the Poor (Austin, Texas: Greenleaf Book Group Press, 2011), decided that she and I were kinfolk, and signed up for the next mission.

The last to arrive was our lone ranger, Joseph Chavez—the sticking point I referred to earlier. Despite delays, he landed in Baltimore and found a van to get him to Derwood, where he arrived at 2:30 in the morning. Dan and I welcomed him in the wet driveway despite the fact that we would be leaving for the airport in just four hours. And we discovered that our work wasn’t yet over. Joe had been misinformed and brought along a large backpack that would need to be checked. We would have to leave behind one of the fourteen big, blue bags we had loaded with cataract kits and other surgical supplies. Joe was the odd man out of our highly motivated group, through no fault of his. He was simply someone I did not know, had not vetted, and had not invited on the mission, but who had been offered an all-expense-paid trip—funded by me—by an overreaching administrator who wanted to do a documentary of our work abroad. The trouble was, Joe had never traveled outside of the country, had never been in an operating room, had no experience filming medical procedures or travelogues, and had never shot or produced a documentary. And we had no contract for a specific work product. But it was done, he was going (a nonrefundable ticket had already been purchased), and I could only hope for the best and focus on the work in front of us.

Most of us understood the difficulties that lay ahead, but the excitement of the team was palpable. One encouraging point was Flore. Dan had seen her firsthand, and the rest of the team had seen her photos and learned what we had done.

Six months before, we had arrived with her, her brother, Blaise, and her caregiver, Ambroise, in Kijabe, Kenya, with the hope of saving her life. First, though, we had to get past the somewhat ridiculous hurdle of immigrating into Kenya. We stood in line in front of a Kenyan woman in a cage-like booth while Flore sat on a baggage cart nearby, feeling sick from the long flight and still covering her face with her scarf. Despite her hideous facial deformity and the turmoil of trying to get out of the country and provide for her children on short notice, she sat calmly on a baggage cart with her neatly painted toenails poking through her sandals.

We handed the woman our passports and visas and she quickly responded, “You do us a disservice. You must pay for a new visa. We must have a $100 bill.”

“Here it says multi-entry visa,” I said. “This is only our second entry. And this visa is good for five more months.”

“No,” she said. “You must pay me $100 now.”

I was exhausted and worried about Flore and rapidly losing my patience. There was no way I was going to pay this woman $100—money that would go into her pocket, not the till—because each of the others with me would also have to pay $100, and none of us had it. I looked up and saw a sign on her booth: “Anti-Corruption Police: If you encounter any corruption, you are to notify this number.”

“Where are the police?” I asked.

“Well, you will have to go downtown and notify there.” Of course, we would have to immigrate first and then pay another $100 to get downtown, but neither of those points mattered. It was 5:30 p.m. on a Friday and the offices were closed.

Dan, who is generally a soft-spoken guy, stepped up and got in this woman’s face. “Look, you fool,” he said, “we have paid and we’re not going to pay twice.” Then Jon Hildebrandt got involved and began yelling at the woman in Kiswahili. All during this circus, I had my arm around Flore’s shoulders, rocking her back and forth.

Finally, I decided to end the commotion. I stood up and said to the woman, “Look, you’ve got your thing, and I’ve got mine,” and then pushed Flore on the baggage cart through the gate, with the rest of the team following me. The woman blustered at us, but what could she do? Call the police because we weren’t letting her steal from us?

We went out into the parking lot, collected our bags, and I negotiated a taxi to carry Flore, Ambroise, and Blaise to the neighborhood around Kijabe Hospital, several hours to the west on the scarp of the Great Rift Valley. I had written a thorough letter of referral for Flore, emphasizing that she was not beyond the bounds of resectability and listing all of my credentials and affiliations to help ensure she got care. Flore, Ambroise, and Blaise also needed money to live, so I gave them $500, and Scott Downing, a missionary kid (MK) who’d been born in Africa when his parents had worked in Assa Congo with AIM and who was with us on the mission as a “homecoming” to his Azande friends now in CAR, gave them another couple hundred dollars.

As the rest of the team prepared to return home, flying west through Europe, I prepared for my departure east to Doha, Qatar. From there I would fly to the Philippines, where I would be on another adventure doing similar surgical missions on the Asian extension of this circumnavigation. But Flore, Ambroise, and Blaise were on their own adventure. They had arrived in an unknown place and had to find a place to stay, which turned out to be a sort of flophouse that the three of them moved into. The next morning, a Saturday, they went over to the hospital and found a woman named Susan, a plastic surgery resident visiting from Vanderbilt University Medical Center in Nashville, Tennessee. Fortuitously, Susan had been a resident of John Tarpley’s; Tarpley and I were both fellows at the National Cancer Institute. When she saw my affiliations, she emailed him, and he responded that I wasn’t a fly-by-night surgeon or a tourist on a pleasure trip, that this is my life’s work, and that if I said the tumor was resectable, they should have a go at it.

Sometimes, where you’ve been and who you know make a difference. Two days later, Flore had her operation done—masterfully.

With James Umweke’s knock on the door at 6:30 a.m., we all rendezvoused in the drive, scrambling to eat the perishables from the refrigerator as we loaded our bags into the back of a Ford F-250. James is a member of the Ibo tribe and was born in Ozu Abam, a small village in Abia Province, Nigeria. He came to America and became a civil engineer (he now works for the Maryland Department of Transportation). James found me through the mysterious web of people who operate humanitarian missions. Janice Walker of...

Table of contents

• Cover Page
• Title
• Copyright
• Dedication
• Contents
• FOREWORD
• PROLOGUE
• PART I: Toward the Pole—Into the Central African Republic
• PART II: Reaching the Pole—Obo
• EPILOGUE
• INDEX
• ABOUT THE AUTHOR