“But Mary treasured up all these things and pondered them in her heart.” Matthew 1:19

We’re flying home from a week in Kosova. We went there to do our first pediatric cardiac surgical mission trip there as a joint project between For Hearts and Souls and Samaritan’s Purse Children’s Heart Project (CHP). This was Kirk’s eighth trip there since 2001. Like Mongolia, he has traveled there to screen children for heart disease and train local pediatric cardiologists. And also like Mongolia, Kosova is a country from which CHP sends children with heart disease to the U.S. and Canada for surgical repair. It was my second trip to Kosova. Five of us had traveled to the capital, Prishtina, in 2006 to conduct a symposium on how to establish a pediatric cardiac surgical program there. There are so many children to be treated that many of them die in these countries while waiting on a list to be accepted by a U.S. or Canadian hospital. Our hope is that more children can be treated successfully if we help these countries develop their own cardiac surgical programs. It was our sixth such trip, the first five being to Mongolia. These trips are always filled with joy and sorrow, successes and frustrations. This week was no different.

Our week actually started with tragedy of a kind we’d never experienced before. The majority of our American team of twelve (Kirk, peds cardiologist; me, anesthesiolgist; Dr. Minnette Son, peds intensive care physician; Beth Huskamp, RN and CHP staff; Mike Andersen, pharmacist; Dr. Cathy Woodward, peds nurse practitioner (PNP); Nelia Doenges, PNP; Lisa Matasovsky, PNP; and Molly King, RN (PNP in training)) had arrived in Prishtina on Friday. We joined five of Samaritan Purse’s wonderful in-country Kosova staff, headed by Country Director Val Kroeker, there, as well as four sweet, serving translators who helped us for the whole week. We arrived early so that we would have the weekend to examine the children we were planning to take care of, screen more children, and attempt to get set up for the week of surgeries ahead. Dr. John Kupferschmid, pediatric cardiac surgeon, his wife Elizabeth, and Dr. Mary Porisch, peds cardiologist, arrived on Sunday afternoon. While Val went to retrieve these three from the airport, the rest of the team had planned a relaxing outing to the coutryside with some of the local Kosovar medical staff and their families in order to get to know each other better before our week of work together began.

As we were driving through a local village, our bus was hit by a car. I did not see it happen. Given the frankly wild driving we’ve witnessed in Kosova and other countries we’ve traveled in, we’ve been thankful in retrospect to piece together that our bus driver was on the right side of the road and not traveling at excessive speed. Some of our team in the front of the bus saw it happen. An Audi traveling toward us at a high rate of speed had gone off the shoulder, tried to correct, lost control, and fish-tailed into us. Their right side hit the front of our bus and spun so they ended up resting with the right side of the car against the front left of our bus. None of our team were hurt. I heard the screech of tires and felt the impact. From the force of the impact we felt, most of us just thought someone had pulled out in front of us and it was nothing more than a fender-bender. Someone on our team yelled that the four teenage male occupants of the car were not moving and all of us with medical training piled out. The scene was actually indescribably horrific. The occupants were not wearing seat belts, nor did they have air bags (they’re often removed from these cars to be sold). Despite our best attempts, two died at the scene while we were attending to them. We got one into a private vehicle (the emergency response system is nothing like the U.S. and we could not count on an ambulance to arrive in a timely fashion), but he is brain dead. Our team did help stabilize the fourth, least injured victim and an ambulance did arrive for him. Praise the Lord, his injuries were not life threatening and he will survive.

I hesitate to take up a lot of this update with this event. However, as you can imagine, it was incredibly significant for all of us who experienced it. We’ve had a week to “ponder it in our hearts, “ talk about it, cry about it, and pray about it…and most of us can see the loving, sovereign hand of the Lord all over this tragedy. My first reaction was “what did we do wrong?” What did we do wrong that the car hit us and that three occupants did not survive? That’s why it’s been so important to most of us to realize our bus driver was absolutely driving responsibly. I’ve come to realize that the car was out of control and was going to hit someone, either pedestrians or another car or cars. The fact that it hit us, who could absorb its high-speed impact without us being hurt, prevented even further tragedy. One of the Kosovar peds cardiologists had wanted to drive ahead of us in his private car with his wife and two sons. He fully realizes he could have been the vehicle hit and is so thankful Kirk talked him into riding with us. Evidently it is cultural when an event like this happens to find someone at fault and administer instant justice. We were immediately surrounded by a riotous crowd as we attended to the victims at the side of the road. It actually occurred to many of us that although we survived the crash, we may not survive the crowd! I remember praying for protection and keeping to my task. As quickly as the thought came into my head that we were in trouble, the crowds calmed. It turns out two European Union (EU) police officers were returning from the airport and had come upon the scene and immediately, with the help of Kosovar police and some of our Kosovar team mates, established crowd control. One of these men was trying to coordinate an emergency response, including the ambulance. He had even tried to get us a helicopter. The Kosovars tell us the fact that police and ambulance arrived as quickly as they did was actually miraculous for this country.

The hardest part of this event for all of us was to have so much medical training and expertise…and to feel completely impotent to prevent these three deaths. I really do console myself that their head injuries were so bad that even in the U.S. all three would have died. We would have had the illusion of intervention, but the outcome would have been the same. I prayed for our witness as we cared for these victims. I cannot overstate how Americans are absolutely revered by Kosovars. I kept hearing one of the Kosovar doctors telling the crowd we were American doctors. I confess I worried that we had come to their country to help their children and their confidence in us would be damaged by the fact that we could not save these three. The word of mouth that we have received is that most who observed us were thankful and touched to see us try so hard and realize we did everything we could. It turns out that the victims were gypsies, who are highly discriminated against in Kosova. It broke my heart to learn that some in the crowd actually said we shouldn’t try to help them because of their ethnicity. I praise God that we were able to demonstrate that every single human life has value. The EU police officers came to visit with us at our hotel for several hours over dinner Thursday night. They are still reeling from witnessing this event and were actually leaving for Germany the next day to undergo post-traumatic stress counseling. I praise God that we were able to share with them the hope that is within us, what we felt we had learned from the experience, and how we could have peace in the sovereignity of a loving God in the midst of this tragedy.

I think one of the most powerful lessons was trying to take care of patients without the appropriate supplies or equipment. We experienced this for maybe one hour and it was heart wrenching. After working with them for one week, I now know that this is what the Kosovar physicians experience every single day. We were amused with how the doctors and nurses would respond to us in English when we asked them for a particular supply or medicine. They would say “we haven’t.” It became one of our team’s comic relief catch phrases for the week. “We haven’t.” However, it is actually their tragic reality. They have the desire to care for their countrymen. We were impressed by their level of medical education and training. But when it comes to what they need to do their jobs, “they haven’t.” It was important for us to feel what that is like, if even for one hour.

After the week’s hard start, in terms of taking care of the children, the week actually went miraculously well. We were supposed to start surgeries on Monday, but Dr. John’s luggage did not arrive until Monday and he had checked some donated surgical equipment that we needed. I am thankful for one additional day of organization. They don’t currently do pediatric heart surgery in Kosova, so what we accomplished was historic. There were lots of logistical false starts as we tried to sort out who and what we needed from the Kosovars to pull this off, but the Lord was faithful. There were lots of things we thought they had that we found “they haven’t,” but I can testify, like on every surgical trip we’ve been on, we may not have had everything we wanted, but we had everything we needed. We do not want to reduce our standard of care to do these surgeries internationally and we in no way want to compromise the safety of these children. We were able to accomplish this successfully.

We chose to do “simpler” surgeries that did not require the heart-lung bypass machine, as they are not currently performing these surgeries in Kosova, even on adults. We did one patent ductus arteriosus (a remnant vessel from fetal circulation that usually closes on its own) ligation, four coarcation of the aorta (narrowing of the large artery that feeds the body) repairs, and one diagnostic heart catheterization. The heart cath was also historic in that they had never done a pediatric cath, let alone general anesthesia in the cath lab. Dr. Mary had actually wanted to do an intervention on this child to hopefully enlarge her narrowed aorta (she’s already had one repair and a stent placed), but decided the conditions were not safe to do so. Although this was extremely hard on her not to do what she had wanted to do for this child, it ended up being a powerful lesson in us not being willing to do procedures we consider unsafe. She will likely go to the U.S. again for repair or we will take care of her on a subsequent trip if we can be more assured of the right conditions.

The end result is we were able to be the hands and feet of Jesus to six children and their families and there are six healthy children to show for it at the end of the week. There is no greater joy. The needs continue to be great. We pray for workers for the harvest field, more medical professionals who are willing to do these trips. We pray for the children we took care of, the additional children we diagnosed, and their families. We pray for comfort for our bus driver and for the families that are grieving, and we pray for healing and comfort for the young man who survived.

Our desire is to glorify the Lord in all that we do. I pray that in all circumstances this week, both good and bad, that our desire was accomplished. Soli deo Gloria.