Grace

No alarm clock.  Nothing mechanical or electronic at least.  Open windows allow entrance to the sounds of other early risers, including the neighborhood roosters.  My son is another of these early risers and I treasure this time with him. 

Boil the water.  Ready the French press with grounds from the surrounding hillsides.  Check the eastern windows for the “white lake” and for the progress of the rising sun.  Check the northern windows to see if a panoramic Himalayan view warrants giving Andrea the, “Annapurna Alert!”  Occupy the baby with bread pieces while the pancakes and eggs are readied. 

Out the door, hand the buffalo milk back to my wife, and start the three-minute walk to the hospital.  A young girl is returning from the well carrying water for her family and circles round the loitering cow obstructing the road.  I savor the wood smoke hanging in the air before being greeted by the distinct smells of an old, poor, and crowded hospital.  Morning in Tansen.

The hospital day begins with a devotion; currently we are working through the Gospel of John.  Following the reading is a prayer for hospital staff that rotates daily by department, to include all the people that comprise the mission hospital team.  Then the interns, who were on call, with shadows from the night lingering under the eyes, present the patients that came in on their watch.  Fever, partially treated meningitis, caesarean section for fetal distress, a baby burned by a spilled pot, a snake bite, a child who fell from a tree…  The hospital census is given and then to the ward for rounds.

“Namaste doctor!”  “Namaste!”  This open ward is bustling with activity.  The nurses gather up the charts while the security guards usher out the remaining family that spent the night on the floor by their loved one.  There will be at least 30 patients to see this morning before heading to the operating room; despite this, we strive to make eye contact, greet, and acknowledge each one of them.  Some days we do better than others.  We start with the patients that we operated on the day before.  Vitals?  Drain output?  Pain?  “Esto garnos” (do like I do) – good, all the nerves are working.  Who’s next?

This is Tilak who has been with us a few weeks.  He had a fracture of his shinbone and arrived with a large wound and exposed bone.  Unfortunately due to poor roads and a far distance it took almost two days for his family to get him here.  He is getting better, but has required multiple surgeries to clear the infection from his bone and obtain soft tissue closure.

During these last few weeks, he has become friends with the boy in the next bed who, should not have been in the hospital at all.  Two weeks before arriving at Tansen Mission Hospital he fell and had a minor injury to his arm.
Unfortunately he was also days from proper medical care and he was taken to a local healer.  The boy would have done well with benign neglect; however, the local healer instead bound his arm tightly with a rope.  The family relays that he screamed through the night as the evolving compartment syndrome killed his muscles and nerves.  The function of the limb below the elbow is now gone.  We hope that with the infection now cleared and skin grafts taking he will be able to use the arm to brace objects and help carry things.

About 80% of the people we see in orthopaedics here are trauma patients and more than half of those are children.  They provide us plenty of challenge in the operating room where we work without much of the equipment most would deem requisite to practicing orthopaedic surgery.  After a good result I congratulated one of the Nepali surgeons, Dr. Tul, on his fine work.  “Whatever is accomplished is by God’s grace alone, not my own doing,” he replied, echoing Paul in his letter to the Corinthians (1 Corinthians 15:10).

Whomever looks will see that God’s grace is abundant at Tansen.  This is the same grace given to us all wherever we are.  The developing setting tends to sharpen the contrast, helping me to see this more clearly.  Out of seemingly hopeless circumstances arise daily miracles.  We just have to look for them.