I (Kim) always write these updates on the way home from our trips.  I didn’t want to write the one I wrote coming home from Fallujah, Iraq (our last trip).  I don’t want to write this one either.  That’s because, for me, this trip was not wrapped up in a tidy little easy to explain package.  It’s not Spirituality 101.  It’s an advanced course in the Lord that I love.  But here’s what I know:  He is good and He is in control.

​I always seek the Lord for the lesson of the week.  This year, I selfishly sought Him for the miracle/lesson that I specifically wanted.  I’m not saying that the Lord is not gracious in answering prayer.  He is so very gracious and He answered so many of our prayers this week.  But He is not a vending machine.  His ways are not our ways (Isaiah 55:8).

​There is criticism and opposition to what we do and how we do it in Mongolia.  Kirk and our Mongolian pediatric cardiologist friend Dr Ariunaa have taken the brunt of this.  It has been indescribably wounding.  I know the hearts of these two people that I love and their desire to improve the pediatric cardiac care in Mongolia and I know the battles and consequences they have faced to do it.  What I wanted for the week was miraculous reconciliation.  This is rough territory.  That’s why I hesitate to write about it.  We desire to do what the Lord has asked us to do with humility and pure motivation.  We fully confess mistakes and imperfections.  We’re not perfect, but our hearts are in the right place.  When opposition was at a peak a dear friend who knew all the intimate details asked us “no matter what, are you still going to take care of the children?”  Our answer was yes and his counsel was that the rest didn’t matter.  He is right.  I have seen Kirk and Ariunaa press on despite obstacles, despite opposition, despite criticism, despite consequences, despite difficulties, despite lies, despite slander…and I truly honor them for the faith and perseverance.

​They accomplished a tremendous milestone this year.  Kirk started going to Mongolia at the request of Samaritan’s Purse Children’s Heart Project in 2000 in order to teach Dr Byambasuren, the only pediatric cardiologist in Mongolia at that time, how to use an echocardiogram (heart ultrasound) machine that they had donated.  What a pleasure to have Dr Byambasuren still working alongside us in the catheterization lab this week now 12 years later!  Ariunaa was a pediatric resident and his translator then. She subsequently trained to be a pediatric cardiologist and it is not an understatement to say that we could not do what we do in Mongolia without her.  As Kirk started screening children in Mongolia, he was finding children who were too old to have their defects repaired.  Some of this was because of misinformation on the part of the doctors who were referring them for care too late.  He had a vision for screening in every Aimag (province) in Mongolia in order to find these children earlier and to educate the doctors on referring them for care earlier.  For Hearts and Souls started these screenings in 2003.  Kirk and Ariunaa have led every single one.  This year during our Searching for the Broken Hearts week, they accomplished their goal of screening in every one of the 21 Aimags at a total of 27 different locations.  This year, they did not find any “too late” diagnoses or any children who need to be referred out of the country for care.  Their goal of improving education and referral patterns has been met.  Truly well done, good and faithful servants!!  Thank you to the many of you who have gone along and supported and participated and made this possible!

​Dr John Kupferschmid, our surgeon, and Dr Minnette Son, our lead pediatric cardiac intensivist, went with Kirk in 2004.  They realized the number of children who needed care was too great to be able to refer them all out of the country for care.  Unless cardiac care was improved in Mongolia, many children would continue to die.  We started our Mending the Broken Hearts weeks in 2005 and have done one every Fall since then, as well as an additional week in April one year.  Bart Hensler joined us as our perfusionist (he runs the cardiac bypass pump that makes the majority of our heart surgeries possible) and I joined as the cardiac anesthesiologist.  The five of us have participated in every Mending week.  We started doing cardiac catheterizations in Mongolia in 2006 and pediatric cardiac interventionalists Dr Mary Porisch, Dr Allison Cabalka, and Dr Dana Janssen have been faithful servants.  Pediatric electrophysiologist Dr David Bush has been faithful in screening, research, diagnostic caths, and electrophysiology care, including placing and managing pacemakers.  Cathy Woodward, PhD, doctor of nursing practice, has conducted a nursing conference every year and it also cannot be understated how much she has done to transform the quality of nursing care in Mongolia.  Mike Andersen joined us as a pharmacist in 2007 and we wouldn’t want to do these weeks without him.  Todd Poor has been a faithful biomedical technician and we wouldn’t and couldn’t do these weeks without him and his colleagues.  Kayleen Lundstrom has returned again and again as a surgical scrub nurse.  Tim Sanken and Ken Seim have been faithful servants year after year, handling logistics and whatever else needs to be done.  The number of other dedicated doctors, nurses, pharmacists, biomedical technicians, child life specialists, chaplains, and other volunteers who pay their own way, give up their time, exhaust themselves for a week, and serve and even return year after year are numerous and we thank and honor every single one.  Forgive me for not naming every single one of you.

​There is such a clear satisfaction in the accomplishments of the Searching weeks.  There is satisfaction in the accomplishments of the Mending weeks too.  When we started in 2005, surgical techniques were 1950s era and mortality was 50 percent.  We did the first pediatric cardiac bypass case in Mongolia in 2005 and they now use exclusively cardiac bypass, as opposed to their old method, and their mortality is less than 5 percent.  Mongolia is about thirty to fifty years behind pediatric cardiac surgical care in the U.S.  We developed in the U.S. at the cost of high morbidity and mortality.  Now that our outcomes have improved, we have low tolerance for allowing other countries to develop as we did.  However, if we have such low tolerance that we don’t allow them to develop at all, more children will die.  Surgeon Dr Tseengaav has been a faithful supporter and advocate since the beginning and perfusionist Drs Gerlee and Tuul have done a masterful job.  Our Mending team has taken care of hundreds of children in the operating room and the cath lab and our morbidity and mortality while we are there is the same as care delivered in the U.S.  But despite these accomplishments, we have encountered tremendous obstacles and opposition.  And I fully confess I don’t want it to be difficult anymore.  I have to remind myself of Galatians 6:9 “let us not become weary in doing good” over and over and over.  And Lloyd Folsom, who served as our chaplain this year and last, when I was complaining to him and confessing anger and anxiety, had to remind me that the Lord would fight our battles for us.  Oh, forgive us when our flesh rises up!

​Such a great and profound lesson!!  Am I seeing the hearts of others as I’m wishing them to see ours?  Am I a source of encouragement for others?  Am I acknowledging their efforts, their sacrifices, their accomplishments?  The Lord has blessed us with an abundance of encouragement.  Just recounting history and remembering the names of all who have traveled with us is a tremendous encouragement.  It is doubtless that those that encourage far outweigh those who discourage.  The Lord taught me this week to see and to treasure each delightful gift of encouragement.  But I was still focused on the tremendous wound that I so badly want healed.  As I was discouraged and praying about it as I woke up early Friday morning before starting our day, I felt that Lord telling me I was looking at man and not at Him.  “[Fix] your eyes on Jesus, the author and perfecter of faith, who for the joy set before Him endured the cross, despising the shame, and has sat down at the right hand of the throne of God (Hebrews 12:2).”​

Kirk started the week with a sermon at church on James 1:2-4:   “Consider it all joy, my brethren, when you encounter various trials, knowing that the testing of your faith produces endurance.  And let endurance have its perfect result, so that you may be perfect and complete, lacking in nothing.”  The trials began with getting all our supplies into Mongolia this year.  We were unable to use a container as we have before, so we had to get everything there in suitcases, which was a huge logistical effort.  Everything arrived, but we had to fight many battles starting throughout the Searching week to get everything through customs.  These battles convicted Kirk to share the message he did.  As Joshua and the Israelites did in Joshua 4, we need memorial stones to remind us how the Lord has been faithful.  We also need to maintain an eternal perspective that the Lord desires to spend eternity with each of us and sometimes what we see as needless suffering is part of His plan to accomplish that goal.  There’s the story of the child’s family who refused a pacemaker at the advice of their Buddhist lama and the child died, but that enabled a beautiful presentation of how the gospel is about us having a broken heart because of sin and needing to ACCEPT the free gift of Jesus’ death that is offered to all of us in order to save us that caused several people to accept Christ as their savior.  There’s another story of the boy who had complications after his heart surgery that resulted in us meeting more of his family members who then accepted Christ.  There’s the story of the beautiful girl that died after her heart surgery who desired her family members to come to Jesus…and many did at her funeral.  He admonished us through tears to never forget that God is good despite circumstances that appear to the contrary.

Team member and cardiac intensive care doctor Heather Chandler told me on Saturday morning that the stage was perfectly set for the week with that message.  We who take care of heart children are absolute control freaks.  Heather told me that in spite of her wanting to be in control of everything, the Lord constantly reminds her that He not she is sovereign over her ICU and she is to use her gifts to serve Him and His children to the best of her ability and He is responsible for the outcomes.

We got everything out of customs on Sunday and in hindsight that seems just a minor annoyance.  We took care of 29 children this week, 9 in the operating room and 20 in the cath lab.  The second surgery on Monday was incredibly hard.  We were at the hospital until after midnight and we were very concerned the child could die.  What a discouraging and exhausting start to the week!  But what an encouragement to walk into the ICU on Tuesday morning and see him stable and hear him cry because he was no longer on the ventilator!  The Lord continued to provide grace, stamina, and good outcomes, despite the normal challenges that come with providing pediatric heart care in Mongolia, through Thursday.  We were supposed to take care of two children in the operating room that day.  We took care of one, finished after 4 p.m., and she seriously nearly died.  We thought we were not going to successfully get her off the cardiac bypass pump and Kirk started asking team members to pray.  What a beautiful picture to look through the window into the room where so many of our team members observe the operating room and see them praying, with tears rolling down their faces.  There was literally a moment where the girl’s heart got dramatically better and we knew she would survive.  It was absolutely a miracle and we praise the Lord for it.  Another joy to walk in Friday morning and see her stable and not on the ventilator!!  We have had two children die since 2005 and every year we beg God not to have to go through that again.  We canceled the second case Thursday because it was so late in the day, we were all exhausted, and we always want to re-evaluate if things do not go as expected.  What we do is incredibly challenging and fraught with risk and every year we do harder and harder cases because we want to teach and develop the system, but we never want to take unnecessary risk.  Friday went incredibly well in the operating room.  We took care of two children relatively easily and efficiently and were done by 5 p.m.  An early day is always a gift and I was ready for the end of the week euphoria.  It never came.

When I arrived with the surgical patient in the ICU, there was two-year-old boy Ireedui, who had been taken care of in the cath lab, who was not doing well.  Kirk has known this baby since he was born.  His mother is a doctor.  He has very complex heart disease.  He would have received care in the U.S. as a newborn.  No such care is available in Mongolia yet nor is it easy for such children to get care outside the country.  The longer he has gone without care, the harder it is to do anything for him and the more likely it is that he could die at any time.  Kirk had counseled the parents numerous times about this.  He was not originally on our cath list for the week, but we were asked to look at him again.  John evaluated him with Kirk and John thought he could personally offer him some sort of repair in the U.S. (he would be far too difficult to take care of surgically in Mongolia, even with our team) but that he would need a diagnostic cath first in order to determine if he was operable.  If the lungs get too much blood flow as a result of a cardiac lesion they can be irreversibly damaged and it is actually more dangerous to do a repair than to let the child live as long as possible as is.  Everyone, including the parents, knew he was a high risk, challenging case, but agreed to proceed.  The news with the cath was not good.  And now he was doing poorly.  My first concern was that he had malignant hyperthermia, a complication of general anesthesia, but we were able to rule that out.  Our next concern was either a medication reaction or bacterial contamination from something that was injected in the cath lab.  Our final devastating realization and current working diagnosis was that he had had a stroke.  With normal hearts, the lungs can usually filter accidental air or emboli.  Not so with this boy, any accidental air or emboli returning to his heart gets ejected to his body, placing his brain at risk for stroke.  We think this is what happened.

No joy in the morning on Saturday.  He was no better.  Our remaining team had a time of tears and prayer.  We spent lots of time talking with and praying with the family.  And we had to arrange to transport him to the Children’s Hospital.  Cardiac care is fractured in Mongolia.  The surgeons, the perfusionists, and the cath lab are all at the adult hospital where we work.  The pediatric intensive care unit is at the Children’s Hospital.  It’s a wacky, frustrating system that I have to have Ariunaa help me understand every time we deal with it.  For the intensive care that this boy would need after we left, we would need to transfer him to the Children’s Hospital.  Ariunaa and I did this harrowing adventure in an ambulance that afternoon.  He got progressively worse in transport and on arrival.  I was impressed by the care I witnessed delivered to him there, which prompted me to have Ariunaa explain the system to me yet again.  Ariunaa and I spent most of Saturday afternoon with this transport.  We spent over 2 hours at the Children’s Hospital after we arrived with him there.  We had some time to get away into a quiet room with just the two of us.  We have never felt so discouraged.  The outcome is devastating for this boy and his family.  Our hearts break for them.  The situation uncovers so much that is still deficient about pediatric heart care in Mongolia.  And it absolutely provides fodder for our opposition.  We prayed together and reminded each other that God is good, God is in control, God knew this was going to happen, and He knows the future.  I confess it is absolutely tempting to quit.  While we were doing this transport, however, Kirk was screening another 20 children and being convicted again how great the need is.

I’m so thankful for Heather’s encouragement on Saturday morning.  We offer our hands, our gifts, our training to the Lord and His children to the best of our ability…and we trust Him for the outcomes.  “Therefore, those also who suffer according to the will of God shall entrust their souls to a faithful Creator in doing what is right (1 Peter 4:19).”