What do you do when you’re faced with health problems, whether yours or a loved one’s? I’m sure you can relate to me on some level – I get stressed out, overwhelmed, and even scared sometimes. I’ve said it before, but health concerns are without a doubt the biggest challenge for our family on the mission field. Take an already emotionally-charged and confusing situation and add cultural and language barriers and differences in medical practices – it’s easy for my fears and doubts to start multiplying until I feel like I’m being buried alive by it all.
I shared last week that my husband, Josh, was recently diagnosed with thyroid cancer. Despite the initial (and honestly, continued, at times) shock and terror, we have a much greater sense of peace now overall. The cancer is very treatable, and the doctors have all given us reason to believe that with surgery and some follow up treatment, Josh should recover fully.
We’re beyond grateful for this good news and for the multitude of people who have contacted us, prayed for us, offered practical help, and been there to comfort, encourage and distract us as needed!
Health Problems on the Mission Field
This blog is a missionary blog, so it seems only appropriate this week to give you a small glimpse at what it’s like for us to respond to major health issues on the field. Dealing with the news of cancer and the fears that are involved is – to put it lightly – a huge challenge in and of itself.
But, as missionaries, trying to decide how and where to treat is an additional, monumental stress that is different than it would be in the States. I’m not saying at ALL that it wouldn’t be hard to figure this all out there – just that there are some unique considerations we have to take here that we would not have in America.
Consideration #1: Healthcare Options in Our Country of Residence
Understandably, the first option we considered is to stay in L’viv for Josh’s operation. The Ukrainian doctors who have helped us have been phenomenal. Kind, compassionate, eager to help, eager to make every option available, knowledgeable. We have every confidence that they would perform the surgery with exceptional skill and expertise.
But, clearly, there’s more to an operation than just the surgeon who performs the procedure. We have to consider availability of good technology, cleanliness, conditions for recovery. Unfortunately, public health institutions in Ukraine are significantly lacking in funding and resources. The medical professionals we’ve interacted with in L’viv have amazed us at their hard work, ingenuity, and resourcefulness, but where there is no money…there simply is no money.
One way that costs are cut for public health is that patients bring nearly everything themselves for hospital stays. When I gave birth to Titus in Ukraine, I was responsible to bring everything from toilet paper, to syringes, to the umbilical cord clamp, to any standard meds and sterilizing materials they would use…even the rubber gloves for the docs and nurses!
When Josh and I went to the hospital here for his first cancer consultation, a patient was walking out the door as we walked in. He was clearly on a catheter, but instead of a catheter bag, he had a recycled beer bottle!!! In all likelihood, the reason for this was that he had to buy everything himself, and it made more sense for him to use the old bottle than a new bag.
Lack of funding impacts other areas, too. Private or even semi-private recovery rooms are possible at times, but never guaranteed. The two major concerns that arise for us are the risk of infection and difficulty in recovering from surgery. My post-natal recovery room with Titus regularly had at least twelve adults, plus six newborns in it – you can imagine that not a lot of sleep happens in those rooms!
Recovery rooms may or may not have their own toilets; sometimes there’s only one for an entire floor. We also know that hospitals here can lose water and electricity unexpectedly. Granted, this doesn’t happen often – but we know of times when it has.
Even as I write this, we are open to surgery here and have been considering that option all along. We’ve sought counsel and prayed. It seemed wise to us that if the opportunity was there to do it in a nearby country, that would be best.
Consideration #2: Operation in Which Country?
Ok, so not Ukraine. Then where? Our two best options seem to be Poland and Hungary. We can drive to either country in just a few hours, we know that healthcare resources are higher in either place, and both options would be much cheaper and much more convenient than getting back to the States.
We don’t know any doctors in either country. We don’t speak Polish or Hungarian. So, what do we do? Well, because it’s cancer and we need to act without too much delay, we take a shot gun approach. We reach out to as many people as we can think of who might be able to help. Consequently, for weeks, we’re multi-tasking to make headway on our options in two different countries (Hungary and Poland), while also still trying to get answers on best practices from those countries, as well as from Ukraine and the U.S.
Here’s how it goes down…
Hungary. We contact a friend and fellow missionary in Ukraine, who has a friend in Hungary who is a pastor and a doctor. He’s not a specialist, but he agrees to help find one there. We send him all our Ukrainian test results, and he sets about trying to find a Hungarian specialist to consult and possibly treat Josh. We follow up with one another every few days via email.
Poland. We contact three different people who live in or have contacts in country, none of whom are doctors. The goal – to find a hospital or doctor who will communicate with us over email or Skype. I communicate with one of these contacts via Facebook – in Polish – using Google Translate. She gives us the name of a specialist in Krakow – a “doctor-of-a-relative” kind of referral. We post on Facebook, looking for friends who speak Polish so that we can call the doctor, then find out that the doc speaks English (big sigh of relief!), so we email him directly.
We write back and forth with this specialist for a week (so thankful he’s very responsive!) and consult with him on his recommendations. We send him all our Ukrainian test results, work with him to decide what additional tests could be done in Ukraine, how early we would need to be in Poland, how long we’d need to stay, if we’d do follow up care in Poland or back in Ukraine…(I keep waiting to get a miffed email from him because of all my annoying questions, but he’s great!).
We go ahead and book an admission date in Krakow.
In the midst of emails, phone calls, Skype calls, Internet searching – all to decide WHERE to treat – we’re also STILL working on exactly HOW to treat.
Consideration #3: What Treatment Should Josh Have?
We often find that there are differences between medical recommendations in Ukraine and western countries. Let me be clear that I do NOT believe that just because a practice is standard in the west, it is right, or vice versa, but our common experience with serious health concerns is that we have to get all the information from both perspectives, identify any differences, and decide which seems the wisest course to pursue. Not an easy or stress-free task for non-medical minds, let me tell you, especially when one of us is a Type-A, gotta have every duck in a row, analytical personality!
In the situation of determining treatment for Josh’s thyroid cancer, we were given two different recommendations: remove part of the thyroid or remove it completely. On the one hand, we have doctors saying that it’s better to preserve at least part of the thyroid if possible to leave Josh some of his natural hormones, since he’s only thirty years old. Granted, they might biopsy the material and find out they have to take the whole thing anyways, but why take it if that’s not needed? Makes sense.
On the other hand, we have doctors saying that the size of the carcinoma is big enough to require complete removal and that if we don’t, there’s a higher chance of cancer recurring. Hmm…Also makes sense. Also a bit scary.
The initial recommendations we received were from Ukrainian and Polish doctors. We were interested in what a Stateside doctor would advise. In some ways, it seemed like that would give us a “tie-breaker” opinion! (Ever feel like you’re just rolling the dice on HUGE decisions? Sheesh!)
We don’t know any specialists in the States, so what do we do?
We post on Facebook, email a group of people who regularly pray for us, and make direct contacts via email, phone and Facebook, trying to find a U.S. specialist or someone who knows a U.S. specialist who would be willing to offer a consult long distance. Harder than you’d think.
Four different people offer suggestions or say they might have connections. After about a week, we have two solid “leads”. Once again, we don’t know who will respond quickly, so we call them both. In both cases, we get the triage nurse at the office and have to clumsily explain that no, Josh is not a doctor or a patient…we are missionaries overseas…no, we’re not looking for treatment, only a consult…you can hear the suspicion on the other end of the line at first (“Who is this weirdo,” they’re thinking), followed by eventual compassion and a “Sure, I’ll find the doctor and make sure he contacts you.”
We have an email address for one of the doctors, so we also send him all our Ukrainian test results and a series of questions, most importantly – take out the whole thyroid or only part of it? After the email is sent, we play phone tag (with a seven-hour time difference). All I can say is, thank God for the Internet and Internet phones!
We eventually connect with both these doctors, who are awesome and graciously offer a western perspective on the situation. Their take – remove the whole thyroid.
In the midst of all this, two other American docs also respond via Facebook and give the same confirmation.
So, now what?
At that point in our “story”, it had been been one week and one day since Josh first told me his diagnosis. We’d communicated with multiple people in four different countries across multiple media. We had an answer as to what treatment Josh should have and a surgery date in Poland, which was three weeks away. Since then, we’ve also been connected with a Hungarian specialist and are now determining if Poland or Hungary is the better route.
While deciding that, we have a battery of pre-op tests and exams Josh needs to have done in Ukraine. We need to figure out where to get them done and make sure all results are in English before we send them to the doctor (either in Poland or Hungary). We need to find a place for me and the kids to stay, find a Polish or Hungarian translator to help at the hospital, coordinate with my parents and sister, who are coming to help with the kids, look into how our insurance will work for all of this, and figure out when and where Josh will need follow up appointments and treatment (because there are discrepancies in that, as well!).
And that, my friends, is a week in the life of a missionary dealing with health issues! Is your head spinning? ‘Cuz mine is!
Finding the Purpose in it All
So, now, back to my original question. What do you do when faced with health issues, whether yours or a loved one’s? What emotions do you experience, and what do you do with them? How do you make it through each day?
Throughout these chaotic few weeks, we’ve gone through an extensive gamut of emotions – fear, grief, anxiety, disbelief, confusion, anger. We’ve been overwhelmed by the details and angered that we have to deal with this at all. We’ve been lost in planning, emails, phone calls, and Internet searches. We’ve held close to support each other and been overrun by frustration with one another. We’ve lost patience. We’ve cried together. Offered each other hope. We’ve been confused by God’s sovereignty and flooded with His peace.
It sounds cliche, but for me, I’m making it through each day by finding purpose in those twenty-four hours. Purpose in loving on our kids. In holding my husband close. In offering an encouraging word to a friend. In receiving encouragement from a loved one. Purpose in being open before my God – not fake, not pretending it’s all ok. But openly telling Him what’s in my heart and asking Him to help, to give strength…asking Him to somehow use these experiences for a greater good in someone’s life. I’m finding purpose – and therein hope – in relationships.