Kirk and I are en route home from Mongolia, where we conducted a pediatric cardiac catheterization mission with a team of seven:  two cardiologists (Kirk and Dr. Mary Porisch), two anesthesiologists (me and Dr. Maria Garcia), a pediatric ICU doctor (Dr. Barbara Jo Achuff), and two pediatric ICU nurses (Katie Tankersely and Karene Proffitt).

In my yearly Bible reading this morning, I found myself at the end of Galatians and read again the verse “Let us not lose heart in doing good, for in due time, we will reap if we do not grow weary. So then, while we have opportunity, let us do good to all people…” (Gal 6:9-10).  It was perfectly timed and I almost had to laugh out loud.  I confess I had a hard time shaking weariness all week.  I wondered and prayed about my seeming lack of stamina.  I’ve been convicted and written about Gal 6:9 on previous trips.  Why can I not seem to move on from this lesson?

This was my 17th trip to Mongolia since 2000 and something like Kirk’s 44th.  Easily hundreds of people on our For Hearts and Souls teams have been a part of screening children, training doctors, performing heart catheterizations, and performing heart surgeries.  This is the first September since 2005 where we have not done a pediatric cardiac surgical mission.  It was scheduled and faithful team members were planning on joining us again.  However, the dedicated surgeon, Dr. Tsgeenjav, with whom we’ve worked all these years retired and his replacement does not seem interested in pediatric heart care.  This is a huge step back for the children of Mongolia, as now they have to leave the country again in order to have cardiac surgery, which is often prohibitively expensive.  We still had a commitment to keep, however.

We usually do a cardiac catheterization mission simultaneous with our surgical mission.  We perform diagnostic caths, determining if children’s conditions are operable.  Sometimes if they have waited too long to have an operation, they are not.  We also do interventional caths where we can open tight valves with balloon catheters and close holes with devices, preventing patients from having to have an operation.  In 2012, Kirk had diagnosed a woman with a tight pulmonary valve on a screening trip in Gobi Altai and had promised her we would open the valve in the cath lab during our 2013 trip.  She got pregnant, however, before we returned and the Mongolian physicians told her she should have an abortion.  She sought the advice of our dear friend Mongolian pediatric cardiologist Dr. Ariunaa, who also consulted with Kirk, and they both reassured her she could safely continue her pregnancy and we would balloon her valve in 2014.  Thus, despite not getting to do a surgical mission, we kept our promise of planning a cath mission.  We were excited that we had secured the donation of the devices and balloon catheters we needed from a company we had not worked with before and planned on taking care of 20 children.  While the rest of us traveled in, Mary (our cath doctor for this mission) and Katie screened over 50 children on Sunday and made a tentative schedule for the week.  As Kirk and I arrived on Sunday afternoon, we learned that the company that had promised us the devices decided not to support the mission.  We met and prayed as a team that evening, came up with an alternate schedule based on the supplies we had brought with us and left from previous trips, and sent out pleas for prayer.  After a flurry of emails, the company promised they would provide them by the end of the week.  They have yet to arrive.

When we arrived at the hospital on Monday, we hauled hundreds of pounds of supplies up to the fourth floor to new cath lab adjacent to the ICU where we had been assured we would work.  We were told that instead we would have to use the first floor cath lab, which has less capability and honestly increases the risk to patients with long transports after general anesthesia and division of our team, supplies, communication, and ability to help one another in emergencies.   But we hauled our supplies to the first floor, got organized, and were able to create a safe, workable clinical environment to take care of four patients.  We did diagnostic transesophageal echocardiograms (TEEs) on two patients and determined one had a defect that had to be closed surgically and did not qualify for a device and that the other had a defect we could have closed with a device had it arrived.  We told that second patient to stay in the hospital in case the device arrived by the end of the week.  He now has to wait until we return another time with a proper device.  Thanks be to God, we found appropriate sized devices in our storage closet of supplies from past trips and were able to close holes in two other patients without surgery.  We were all encouraged by the Lord’s provision and our new plan for the week.

On Tuesday, we were told we actually could use the new cath lab later in the day and for the rest of the week.  So we started on the first floor with a TEE on a patient who also turned out to have a defect that would require surgery and not a device.  Then we packed up our supplies, hauled them up to the fourth floor, and reinvented the clinical setup wheel.  We were able to do two diagnostic caths on two patients who had previously been declared inoperable because of the delay in their receiving heart surgery.  We were able to tell the parents of both these children that the news was, in fact, good and their conditions were still operable.  There is such joy in delivering this news and restoring these families’ hope.  Now we pray for the provision of a place for them to have surgery.

When we arrived Wednesday, we were told we would have to go back to the first floor.  We were a little out of patience at that point.  We had met with the director of the hospital on Tuesday.  He had apologized for our not being able to do surgery this year and he apologized for the confusion regarding the cath lab on Monday.  He assured us we had the new cath lab for the rest of the week.  So, after his intervention again, we were able to start late on Wednesday on the fourth floor.  We were able to perform a procedure where we opened a narrowing in a child’s aorta with a balloon we found in our old supplies.  She’ll have to have a surgery eventually but this will buy her some time.  We were then able to open a narrowed aortic valve on another patient with a balloon we had on hand.  We had hoped to do one more case on Wednesday but the hour was late because every step takes so much longer than we’re used to in the U.S. so we postponed it until Thursday.

Kirk and I had to leave the team on Thursday morning due to a previous family commitment, but we have heard the praise report that they we were able to keep our 2012 promise.  There is a mom with a healthy one-year-old baby who finally had her tight pulmonary valve successfully treated.  They were also able to open another tight pulmonary valve and close an ASD, all this once again from supplies left in our beloved storage closet.  We are praying about what they will be able to accomplish on Friday as we have been told the hospital is celebrating its anniversary and it is being declared a work holiday.

None of the things that caused me to be weary this week should have surprised me.  We work with limited supplies in relatively austere conditions.  We’re jet lagged.  We work long hours.  It’s clinically stressful.  The Lord’s plans are often very different than our plans so He uses all kinds of circumstances to constantly change our schedule.  But probably very true confession:  I’m sure I thought that after all these years and trips to Mongolia, it just shouldn’t be that hard any more.  Before the trip, I had a very hard time motivating to go to our storage unit in San Antonio to organize and select medical supplies to take with me to Mongolia.  I thought surely after all this time and progress they will have appropriate supplies?  I felt somewhat silly after I filled one bag and then two, wondering if it was going to be worth the extra baggage fees and effort to haul all that stuff to Mongolia.  It turned out that I was glad to have every single thing I packed in those two bags, as was everybody else who threw extra things in their suitcases.  I was profoundly discouraged this week that it seems that after all these years of investment, care is not progressing, and maybe even going backward.  I was disappointed by the lack of integrity we kept encountering.  And I no longer seemed to have the stamina for all the logistical and clinical frustration.

But then perspective enters.  When we got to Mongolia, we were picked up at the airport by the father of a child we were going to take care of who then treated us to dinner.  That same father got up early to take us to the airport this morning and will make sure all of our other team members make their flights as well.  Other fathers provided rides to and from the hospital.  These are not expressions of bribery or looking for favors.  These are expressions of gratitude by men who are incredibly thankful that we would come to take care of their children.  The father who took us to and from the airport is highly educated and his work involves exposure of government corruption.  His salary is not great, so he does not have the means to take his child out of the country.  But he’s a desperate father who loves his daughter and wants her to be taken care of well.  We had incredibly honest discussions with him about the state of health care in his country.  Mongolia is very rich in mining resources and many are getting rich.  I am amazed by the addition of fancy hotels and restaurants and stores such as Louis Vuitton.  But the majority of the population is still incredibly poor.  And the riches pouring into the country are not pouring into the government health care system.  There are renovations and improvements, but they are not commensurate with the amount of money we know was supposed to be spent, meaning pockets were lined and patients did not benefit.  And like a lot of places in the world, they spend a lot of money on fancy machines, but not on simple supplies such as alcohol pads, IV supplies, and reagents for laboratory equipment.  I come visit, work, and am incredibly frustrated by this system for one week.  For people like this man and his daughter and the many Mongolian health care professionals with dedication and integrity, this is their daily life.  And our coming to help them gives them hope.

“He has told you, O man, what is good; and what does the Lord require of you but to do justice, to love kindness, and to walk humbly with your God?” (Micah 6:8).  It is so very easy for me to get wrapped up in concerns about my comfort, my rest, my safety, and my resources.  Because of the circumstances of our life, I hadn’t been on an international medical mission trip this year, when I usually do six a year.  I liken it to an athlete failing to practice and getting flabby.  I had gotten flabby and comfortable and selfish.  The Lord needed to send me out once again to remind me of the lesson He keeps having to teach me over and over again.  I am indescribably blessed and have plenty to give out of the abundance He has given me.  It’s not about me.  It’s about Him and what He asks me to do for His children in His name.  Keep praying!