Recovering in Tanzania!

Tanzania, country so diverse and unique who could refuse a trip there? This was our thinking as we booked a tag-on vacation to our Congo trip. It turned out to be a truly serendipitous idea, as I was in great need of a holiday after the Congo.

Working at the remote hospital in the Congo for 2 months pushed me farther than I have ever been pushed. The heavy stress no doubt contributed to the stomach ulcer I came down with, and the 23 pounds of weight loss in 1 month!

To make it through periods of heavy stress I often fall back to a dogged stoicism. I grit my teeth and try to minimize what I am going through. It probably helps me avoid feeling overwhelmed. It is definitely a defense mechanism, and like most, not always beneficial.

In times of peace and quiet I reflect a lot on my life. I journal. I try to make sense of where I am, who I am and what I ought to be doing.

In times of stress I shut this down, and only afterwards can I start to put together what I went through. Being a physician, I have had my fair share of moments like this. I remember feeling this way after an obstetrics rotation in residency. It turns out weeks of call shifts that keep you up for over 24 hours is hard on the body but also the soul.

Thus, when it came time for our trip to Tanzania I was actually quite reluctant to plan or think about it. It seemed like just another stressor to add to the pile.

It turns out it was precisely what I needed! A time to relax and process all that preceded. I needed the time to journal and think without the pressure of telling my story to my loved ones back home. I needed time to release the tension and stress that had been building and heal my body.

The trip was amazing. But to be honest, it came with a lot of a guilt. How could we leave a country with such extreme poverty and proceed to indulge ourselves in the luxury of travel?  Well, I don’t know. Maybe it wasn’t justifiable, as much as my life in Canada isn’t justifiable either. But this trip I certainly needed.

So with that sobering, rambling, and unexpected introduction, I present to you our wonderful vacation to Tanzania!

I have said enough already, I suppose, so I will leave the rest of this in the style of a photo blog. Enjoy.

First stop, Mount Kilimanjaro! (and area).

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We went on a coffee tour, and learned their traditional method of coffee preparation. They roasted their beans then made the coffee over a fire!
One of the many unexpected but beautiful sights!
We trekked up to the first camp on Mt Kilimanjaro, Africa’s highest peak.
The people of Tanzania were incredibly resourceful when it came to carrying stuff on their heads!

The Serengeti: the place that goes on forever!

A surprise visit from an elephant as we drove through a forest! (this guy was being aggressive!)
A more calm encounter with elephants occurred on our safari in the Serengeti!
We couldn’t believe the eyelashes on the giraffes!
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A couple male lions just chilling on some rocks!
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We were incredibly close to these female lions, at times they were just 5 feet away!
A lion cub hanging out in a prickly acacia! (we were incredibly close to these guys as well)
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Cheetahs escaping the heat of the sun.
Hippo pool!
We were fortunate enough to see the largest mammal migration on earth! The wildebeests number in the millions, with zebras often following behind!
An early morning also means a beautiful sunset.
Some hyena scavengers running off with part of a kill after the lions were finished.

Zanzibar: silky white beaches, Arabian nights!

The white sand was so fine and lovely!
Stonetown had some amazing architecture and narrow streets!

Hope you enjoyed this post, feel free to like and comment!

I leave with relief and reluctance.

I don’t know what to say. I don’t know how to say it. Yet it needs to be said.

I will start with the what. The why tends to take some time.

I have just finished working for 2 months as a doctor in the Congo. I was on call to the hospital 24/7 during that stretch, with the exception of a couple day trips. I had never worked in the capacity of a tropical medicine physician before. I was scared before I left but looking forward to the challenge. For around 4 long weeks, I was the only physician serving. For almost 3 of those weeks we had no person capable of performing a surgery at the hospital.

At one point we had 3 kids that would have needed the pediatric ICU in Canada. This 6 year old girl was in a coma from cerebral malaria.

11 people died during my time in Impfondo. Some were old, most were young. Some were expected, most were not. The only constant: wailing. Shouts of grief would fill the air. It was eerie at night. The loudest was after a muscular 29-year-old husband and son could not be resuscitated. The disbelief as I told them quickly turned into screams.

But they were all hard. Hard in their own way. The youngest was 5 days old. 5 days old. I had never seen a child pass before this trip. I hope I won’t see any more.

It was a lot for me. Almost too much. But I don’t want it to sound like it was all misery and death. In spite of all this I still had an amazing experience and loved the people and culture.

This indeed, is the problem. My time in the Congo remains an enigma for me. I can’t make heads or tails of it. It was a time of extremes. There were these moments of pure sorrow but also of pure joy. I witnessed tragedies but also miracles.

There was a beautiful, authentic life to the Congo. An ethereal beauty. It was in the people singing while burdened with massive loads. The feeling of connected-ness and camaraderie was palpable. Everyone took the time to greet you, chat, play or sing.

Walking down the road she happily stopped for a picture, then refused when I tried to give her money!

In many ways, the Congolese were doing things right. Their priorities were the people around them. Relationship is in their marrow. It was in their language. Elders were given the title of mama or papa regardless of parentage. I can still remember the first time a little girl looked up at me and called me papa.

The people were truly beautiful. Their insurance system was family. If someone was sick everyone would pitch in for the bill, knowing their family would do the same for them. The cooks who came to prepare our meals were always smiling and laughing.  They made the most amazing food with raw ingredients and only a few pots over the fire.

In these moments the Congo would feel light and comfortable. Many times Steph and I would say how lovely it would be to live there. The Congolese people were often shocked to hear us say this. In many of their minds, Canadians had something so much better. Something unattainable for them and distant. I am not sure if what they would find, should they come to Canada, would be what they expect.

I fear what the Congolese would see (there are many that look but few that see).

Yes, at first, they would see our fancy cities, houses, cars. Our beautiful hospitals, schools and the like. They would see our abundance. But then I would expect the inevitable questions: how can there be so much waste? where does this all come from? does every western country live this way?

They would see our absurd standard of living. The daily excesses. After only 2 months in the Congo I have been struck by these things. It just hit me. It is the way they wash a plastic bag out for reuse over and over again. The way a child will take an old tin can for a toy. The way they ration water and soap when doing dishes. The ingenious way they give hair cuts with a single razor blade. The resourcefulness was astounding. Old cars would be held together by shear will. Once their cars did finally fall apart, they would salvage nearly every piece to be used in some ingenious way.

Our cook made us absolutely amazing meals over a fire in this small shelter!

They are incredibly hard workers and I rarely heard any complaints. Something as simple as cooking requires wood to be gathered (often kilometers away), water to be hauled (there was no running water so they would have to fetch it from a cistern), and then they would prepare it all over a fire!

The next shock for a Congolese visitor would be the way we interact with each other. They would no doubt find us cold by comparison. Rushing from place to place. So focused on doing that we forget about being present. I think about the slow way they would walk from morning chapel to morning meeting. Greeting each other and laughing. The sheer amount of visitors for each patient admitted to hospital was astonishing! I think they would find Canadian hospital rooms gloomy and empty.

So then, when they would imply that things must be so much better in Canada, I can only think of all the ways in which they are not.

It is the combination of these thoughts that make it hard to say what the Congo was for me. Being face to face with poverty and suffering was shocking to say the least, especially in a medical capacity. Yet there was also such amazingly beautiful moments that would draw me in and make me feel like their lifestyle made so much more sense than mine. And then something incredibly frustrating would happen and continue the cycle of highs and lows!

I will leave another to summarize my thoughts in a much more eloquent manner than I could ever hope to…

“…we buy more but enjoy it less; we have bigger houses and smaller families; more medicine, yet less wellness; …We’ve added years to life, not life to years. We’ve been all the way to the moon and back, but have trouble crossing the street to meet the new neighbor.”

Dr. Bob Moorehead

Only in the Congo!

Warning: this post may just be an excuse for me to vent about all the uniquely Congolese, frustrating, odd, and wonderful things that have happened to me here!

“Only in the Congo.”

If you live in the Republic of Congo long enough, you will inevitably find yourself saying this in exasperation or in good humour, and sometimes both. My most recent utterance was that of exasperation, as I found out I would not be able to order a single lab test here for 4 days because it was the long weekend in spite of having 2 very ill patients!

The only explanation I have for this, is found in the Congolese word for tomorrow, lobe (pronounced low-bay or low-bee). This is a word they have for tomorrow, and yet I am told, it only means some time in the future! It could be a day, a few days, a week! Maybe this would be her response as to why we couldn’t get it done, we’ll do it lobe.

Their disconnect with time is not limited to the future. The past is often even murkier, which is a difficult thing when trying to ask someone about their medical history. Sometimes this gets to an extreme, like an Aka gentlemen who didn’t know how old he was! When I pressed the question, he got out an ID card issued by the government some years ago that had a generic birthday documented that would make him far too young. They explained they get these cards and he probably just told them he was born sometime in the 1970’s, so that’s what was documented!

I had this happen again during rounds on the pediatric ward. I came to a young boy, and all that was on his chart for his age was a question mark. He was the most malnourished patient I have seen here, and was tall enough to be around 2 years old. I could see each and every rib, and he was lying in his own feces. It was heart wrenching. His current guardian was an elderly relative, who explained that his parents lived in Brazzaville but had shipped him up here and she was the only one to take him in!

A reason for a lot of the kids being malnourished is not a lack of food, most families can get enough for their kids from the jungle and their gardens. The problem is more often that they only feed the kids when they cry. So if you get a really content newborn baby, a mother may only be feeding them every 4-5 hours! There is a real lack of understanding of basic nutrition.

This isn’t the only misunderstanding. I work at a mission hospital, which pays a salary only to the local workers. I think many would understand this concept back home, but here people just can’t understand it. I realized this one day when we were talking about a patient having to pay their bills and I asked if they thought I was getting paid to be here. Everyone on the unit thought I was being paid well to work here!

People have to walk long distances daily, so the back of our Land Rover is always full!

It is very bizarre to come across these ideas, yet I get it. Why wouldn’t you distrust authority here? Medicine here is plagued with fraud. I have heard everything from the counterfeit medications at the pharmacies to a person performing bogus xrays out of his mud hut. This ruse  turned out to be him flashing lights at the patient and then he would produce an xray film of the appropriate body part (most of the time) that he had stolen! Only in the Congo.

All these things really start to wear you down over time! It makes life for local people here incredibly complicated, unjust, and frustrating. So then, it makes a lot more sense when they approach life and work with an easygoing attitude. If you got frustrated every time you were slighted here, you would probably go mad!

There are also a lot of positive things that would happen only in the Congo. Like lounging after supper to the sound of distant drums that are so incredibly regular that it feels like the pulse of Africa. Or the singing that is done with the drums; it is so simple yet profoundly beautiful!

One of my favourite things is the ways they can say hello. In Lingala, you can say a simple “Mbote” for hello, or you often here “Mbote mingi!” This roughly translates to “hello very much”, or a respectful and exuberant hello! This would then be followed by shaking hands with their left hand clasped on their right forearm, a way of showing respect. Similarly, they will often wave with both hands and a slight bow to show respect. Steph and I are always greeted emphatically by kids as we ride through town on our bikes with hello’s, mbote’s and moondele (their word for white person)!  If you forget it is only because you are white, it almost feels like you are a celebrity.

The Aka people (pygmy) are also one of my favourite things you will only find here! They are so friendly but have gone through so much abuse at the hands of people (the Bantu) who treat them as sub-human. They took us on a jungle walk and showed us their medicinal plans, got a vine for us to swing on, built a shelter and fed us their edible fruits, including cocoa!

Steph with some of the Aka kids that came along for our jungle walk!

Lastly, the close community is palpable here. People often pay their hospital bills with their own type of insurance system. People ask others in their family and community for help and raise money for one another on an as needed basis! They are very caring and helpful in this way, and always willing to humour me with a conversation in broken French. Even with complete strangers, people will stop and chat for some time!

Only in the Congo could I find things so incredibly frustrating and beautiful at the same time!

A day in the life of an average hospital patient…in the Congo!

My last blog was about a day in my life as a doctor in the Congo. And don’t get me wrong, it is a pretty complicated job. Yet, it is nothing compared to the life of an average Congolese patient! I have talked with many patients and nurses, and collected some stories. Some are bizarre, some are funny, and some are extremely sad. So here we go…

Where to even begin?! Probably the hardest thing I see coming from a country with universal health care coverage is when patients struggle with payment for our services. The first one that comes to mind is a 9 month old was sitting in triage with his mother. He had fevers, diarrhea, and was severely malnourished. For context, the normal weight for a 9 month old is 9kg and the lowest percentile for weight is 7kg. This child was literally off the charts at only 4.5kg! In addition to being severely underweight, he probably had malaria and needed some lab tests and treatment. We explained to the mom that at this hospital we treat malnutrition for free, they just have to pay a basic admission fee (something like 10000cfa, or $18). Unfortunately, the mom was unable to pay for anything and requested that we just give her the medicine so she can leave! It was heartbreaking!

If you decide to get a full admission to hospital, the next step is paying for everything ahead of time. You buy your medicines from the pharmacy, and bring them to the nurse. What if our pharmacy doesn’t happen to have it? Well, you go walking in to town to find it at another local pharmacy. These are often tiny and very untrustworthy.

The tiniest little pharmacy!

So you’ve got your medicines, now you have to supply a “guarde de malade”, which roughly translates to the guardian of the sick. A family member must accompany any person who is in hospital to make them meals, change their sheets, buy their medicines, give them baths, pay for their medicines etc. I can only imagine how ecstatic nurses back home would be if they found out that the patient’s family would be the ones dis-impacting the bowel, or ushering them to the commode!

If you are really sick you will be spending a night or two in the salle d’urgence (emergency room) or the sale d’observation (observation room; this is the closest we get to an ICU, but make no mistake, we have nothing special except for an oxygen concentrator). Typically, to make it here you will have malaria that has gone to your brain or malaria that has made you ridiculously anemic.  If you are anemic and need a transfusion, we can do those here (unlike the other hospital in town). The catch is that you have to get 2 of your family members to donate blood to replenish our little blood bank!

Also, just about every patient that walks through the doors will be dehydrated by a liter or two, constipated, and if you are a kid you will have worms. Literally almost every patient has these, and it really complicates the medical treatment! I had a little 4 year old girl come in who had been poisoned by a neighbour, and had a kidney injury as result! We were trying to collect her urine but each day we came she only had a small cup half full to show us. So we finally asked how much she was drinking, and it had to have been less than 300 ml per day! We gave her the task of drinking 1-1.5 liters, and she couldn’t believe we wanted her to drink that much. The main problem is that there is no running water for the city or power most of the time, so almost every has to haul water from a cistern!

Maternity cases are their own special thing. Women here generally freak out if it is their first child and we often hear them yelling in the suite d’accouchement, the maternity building. I know this is coming from a male and I will never know what they are truly going through, but women go crazy here compared to Canada. I had a patient literally roll out of bed and start writhing on the floor with her IV arm dangling above her in the middle of labour, and those floors are not clean! The nurses here have seen so many dramatic labouring patients that they have a hard time telling if there is actually something wrong!

Another fun thing is the buildings here all have these shutter type windows that never fully close. The family’s of the ladies in labour find this out quickly. So imagine you’re in the middle of labour and having a confidential conversation with your doctor when your mother-in-law starts chiming in through the window! Next, if you are an Aka pygmy or just anxious to have your baby, you may just decide to take a traditional medicine to help kick in labour or make it faster.  In Canada someone would usually take something like cod liver oil that works worse than it tastes. But in the middle of a rain forest in the Congo, people have found some absurdly potent medicinal plants that act way too well! I frequently have someone in labour who shouldn’t be but is having huge and painful contractions because they have taken some of these plants! It sounds funny at first but is actually quite dangerous and often end in C-sections.

A usual patient in the medical ward has no choice but to be quite social because it consists of 5 stretchers (iron bed frames) laid out with old mosquito nets dangling over head. No walls. No privacy. Your business is everyone’s business. This is so typical for the Congo that people are completely unfazed. I mean, the usual home has around 10 people living in about 300-500 square feet of space! So when I am explaining a diagnosis to someone during rounds, I often see many more attentive faces hanging on each word. They also aren’t afraid at all to chime in with their thoughts for other patients as well. More than once a spirited debate has broken out during rounds with all the members of the ward!

The one and only time Steph joined me on rounds, haha. A whole crowd of opinions!

The main drawback of this set up is with sensitive diagnoses, particularly HIV/AIDS. This is a diagnosis you will never here anyone say out loud in the hospital. Instead we use code word because there is a huge stigma surrounding HIV here. It is so bad that I have literally heard these words from a 24-year-old woman refusing an HIV test, “if I was HIV positive I would hang myself.” A 30-year-old woman I treated faced the same decision. Her husband was abusive and she had just had a miscarriage and was quite sick. She was losing consciousness so was transferred from the other hospital to ours for treatment (this happens not infrequently). She had a bad cough, was thin, and looking so ill we decided to order an HIV test. For 3 days in a row she agreed to the test during rounds but would later back out. Finally, we walked her to the test with her approval. It came back positive. Her husband promptly left and her father in law was one of the only one’s who stuck around to be here guarde de malade and to pay her bills! She came extremely close to dying, and I don’t think she could have waited another day to start the anti-HIV treatment.

One of my favourite patients I have is a 75 year old man who greets me emphatically every morning with a hoarse “Mbote Docteur!” and both hands waving! This acts to somewhat counteract the smell of incontinence emanating from his hospital bed, a hospital bed that has no shiny layer of vinyl but some sort of porous canvas to protect it from the ‘rains’. He has a chronic ulcer on his leg and has been in hospital for months, but you wouldn’t know it. His attitude in spite of all this is remarkable! He always has a smile on his face.

Some patients travel from a long distance to stay here. We were driving with a local missionary about 8km out of town and an Aka pygmy family flagged us down. Their daughter had just had a seizure from malaria!

This was the Aka village we stopped at!

The view from inside the hut. The little girl had just a seizure from cerebral malaria. The mother has her head covered because she had a severe bacterial eye infection! They are sitting on their bed (note that their bed is just wood planks with a mosquito net overtop!).


There are many more stories to tell like these so stay tuned! Let me know what you think in the comments, and I hope you enjoyed the read.

A day in the life of a doctor…in the Congo.

Impfondo, where my wife and I are working at the Pioneer Christian Hospital, is ever so slightly above the equator. This means there is consistently 12 hrs of daylight, rising and setting around 6 am/pm. They have a rainy and dry season, and currently it is the dry season. This means an average high of 33oC, and with humidity it feels more like 40oC!

So we wake up with the sun around 6am, turn on our propane stove to boil some hot water for coffee and porridge. The stove is only for us, the cooks that make us our lunch everyday use an outdoor kitchen and cook over a fire or charcoal. A sign above our stove reads, “Please conserve propane because when you run out we may not be able to get more.” We take this verrrrry seriously; no stove means no coffee! They only have instant coffee here, but being the addicts we are, we brought 3 bags of coffee for ourselves (plus one more that I surprised Steph with)! It usually gets down to around 20oC at night.

Chapel is at 7 am every morning for the staff of the hospital. It is often in French or Lingala, and our translator comes most days and helps interpret for us. There is usually a rousing song with lots of clapping and someone gets up to play the super tall drum at the front. Otherwise, it is all a capella. Next is a slow journey to the staff room, this is caused by the heat. People are rarely in a hurry to get anywhere! There we get morning report and the other doctor or I do some teaching. The room gets stiflingly hot by the end, and more than a few people have fallen asleep.


The hospital has about 30-40 staff, 60 patient beds, and is arranged as a group of 12 buildings connected by sidewalks. We walk in the hot sun to see any patients in E.R., a small building with 6 beds packed closely together. It rarely has more than 1-2 patients in it. We pass by the nursing consultation office, who sees and initiates treatment for patients without any physicians orders, usually based on protocols put in place by Dr. Harvey (the visionary, manager, chief medical officer). It is not uncommon to see a kid having a seizure, and a nurse casually walking around going through the usual treatments (cerebral malaria is very common here). They don’t usually even consult us for these cases!

Our little miracle baby! Lived in spite of a uterine rupture!

We move on next to maternity, which frequently houses very complicated or premature infants. Next is the medical wards, a small building each for men, women and pediatrics. Each have about 7 beds. They have 2 isolation rooms in each as well. As I walk in I say “ Mbote nobino!” (hello all), and almost always get quite an enthusiastic and surprised response back! The nurse tells all the family members to leave. Family is always around because they have make meals for them at the communal shelters, wash their clothes and buy their medicines. We work through each patient, and I review the chart that is a grand total of 3 pages! I think of our bloated charts back in Canada which have 50-100 pages, and at times I would wager up to 500 for the long stays. There is something to the efficiency!

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A 31 week preterm baby we are caring for. It was delivered as a twin in the middle of the jungle, the umbilical cord was cut with a machete! They love to bundle up their kids even in 30 degree heat!

The surgical wards (a building each for men, women and wound care) are much of the same. There is a lot of leprosy left in the Congo, and people that don’t seek treatment immediately end up with a lot of sores and amputations. There are always 4 or 5 patients with leprosy here. A diagnosis I would never see in Canada. If there is a visiting surgeon this ward can be more full, but still not as full as you would expect considering the need. The difficulty is with the payment. Surgeries are prohibitively expensive for most even though they are only around $100 USD.

Our rounds finished, we may have time to see some patients in clinic prior to lunch. This requires a translator because a lot of patients won’t speak or understand French well enough, and the more common language is Lingala. For clinic, there isn’t even an attempt at a daily schedule or appointments. People arrive whenever, and then wait to see a doctor in order of arrival. Their medical charts are little notebooks that they carry with them any time they need to be seen! They then place these in order of arrival in a little hanger near my door. People come in with anything and everything. I recently saw a man who had been shot a month ago in a hunting accident and had shrapnel still imbedded in his face and brain! We had two head x-rays to confirm and that was all!

Shrapnel visible on an x-ray. Unfortunately not much could be done for this gentlemen unless he flew to another country.

Lunch is served around noon, and is prepared by local Congolese women for us. They have been taught to cook foods that blend their traditional foods with food palatable for us. Compared to the average Congolese meal, we get different meat (they eat a lot of goat) and more vegetables. Some ingredients for our meals would be very costly for them, but again, very cheap for us. They do all the cooking and cleaning for this meal, which is very much appreciated because it takes them about 4 hours to do all of this! We simply wouldn’t have any time to make our own, plus, it is a means of supporting local workers.

I go back to clinic after this, and right now do not see many patients. They tell me that when a new doctor arrives, the people don’t come in as often because they don’t trust them yet! Clinical decision making is very, very difficult here. I have to ask what a person can afford and unless they are rich, only order the minimum of our basic tests. It is also quite difficult because we have a total of 32 different lab tests. I recall searching for a particular blood test in a hospital in Canada one day, and searching through hundreds of possible tests. To make it worse, we are running out of HIV tests and so they are only ordered for mothers and the very sick!

My day finishes whenever patients stop arriving or by 3:30pm, usually earlier. The heat is often thick at this point and I retreat to the house to rest and drink a whole lot of water. Any time patients come in or they need me they can call me or knock at my door (located within the hospital walls). Steph and I make supper or heat up leftovers, and then relax. We play games, read, go for a bike ride, go to the market or watch some of the movies or TV shows we downloaded before we came!

So that is a typical day for me here! These are usually interspersed with little trips to local villages as well!

We visited 5-6 local villages one day, saw 11 patients, and diagnosed a serious eye infection here!

To the Congo (but stuck on the runway)!

Vancouver, BC is not made for the snow. This is a sad fact I contemplate sitting in a plane for 3 hours while they struggle to clear the runway and de-ice the plane. A mere skiff of snow to Edmonton is a disaster to the un-seasoned. There is probably a witty metaphor there.

Yet, we are still going to the Congo. The truly applicable metaphor for this situation may be an ominous one. Working in developing countries with limited resources is wrought with setbacks, and we should learn to take them in stride. I expect this to hold true given my past work experiences both in the Congo and in rural Saskatchewan.

As our travels continued we ended up in Paris just in time to miss our flight. Luckily(?), Air France had already booked us a connection through Casablanca (which also was late) and then through Point Noire to Brazzaville, Congo at 6 am. Yay? A day in Paris was starting to sound okay.

If nothing else, I suppose it gives me time to pause and contemplate. My first thought is there are worse things that happen to people every day, this really isn’t so bad. Further, in Cuba we waited in 30oC heat on the side of a road hoping for a taxi to drive by for hours. It is amazing to think how painful that was for us but how natural it came to the Cubans waiting with us. In our Western culture we are used to absurdly quick results and aren’t very trained in waiting.

I also think about why we are where we are. On a plane heading to an evangelical Christian hospital for 2 months. Some would call us missionaries, but I do recoil a bit to think of us as that. Growing up, a missionary meant someone doing heroic things in rough circumstances, they seemed perfect and somehow better because they gave up a lot to do what they do. I am too well acquainted with my flaws to think of myself that way, what we are doing does not feel heroic, and it was a thoughtful decision but also a matter of chance and circumstance. There is also the side of mission work in the church that was very detrimental and dangerous. Proselytizing at the expense of other’s cultures, varying abuses by missionaries, ethnocentrism, and questionable outcomes by some missions.  The critique of mission work is fresh on my mind because a co-worker was painfully honest about his thoughts on missionaries. He had first hand experience with abuse in Kenya.

There is a reason we ended up going to this hospital to work. I believe in their goals and philosophy. The hospital helps a massively under-served population in remote Congo. The vast majority of its workers are local. The good it does is always going to be positive because nothing existed prior to it, as it started as a teen indoctrination camp. It didn’t take the place or opportunity from another organization. The government is largely inefficient, always ranking high on the global corruption index, and was unlikely to act meaningfully. Medical work is particularly essential to establish without delay as people do suffer irreparably without it.

So like anything, the system of mission work has its glaring flaws, but done right, it can be a self-sacrificing journey that bridges cultures. We can assess it based on its fruit, pruning the detritus and nurturing the positive growth, especially with humility and an open mind.

As I finish this post we are sitting in Casablanca, Morocco, it seems like our bags should make it with us to our final destination, and we are excited to finish the 38 hours of travel complete with a snowstorm, delays and 4 layovers.

Wish us luck!

We will be traveling to a remote hospital in the Congo!

Yes, we are frightened.

L’Hopital Evangelique le Pionnier (HELP) is located in Impfondo, The Republic of Congo, Africa.  It is a 60 bed facility that has been transformed from a Communist youth camp into a hospital, serving the neediest part of Africa in the Congo River Basin Rainforest.

“Pioneer Christian Hospital serves an estimated population of 300,000 people, including local residents, villagers, and vulnerable people groups including indigenous peoples, refugees, the poor, elderly, chronically ill, and AIDS orphans and widows.”

Personally, the medical aspect of this trip frightens me the most. Although there are many well trained staff that are there to help in any circumstance, I will still be the only physician at the hospital for around 1 month. Given a preponderance of tropical diseases in the Congo, a lot of the medicine will be new to my practice. Traveling to this area lends a high risk of acquiring a tropical disease like malaria, parasites etc, and also has a high incidence of HIV/AIDS.

I also haven’t mentioned it yet, but I have been there before! 11 years ago. At that time thoughts of medical school were but a dream! I helped as much as I could, painting a whole lot of buildings but also helping out in the operating room as first assistant because the surgeon there at the time found it useful to speak to me in English!

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Reading some xrays!

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A view of the hospital.

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Sarah Speer working with pygmy tribes.

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The hospital! (former Communist youth camp)

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Walking out after surgery! Note that there were no IV poles, do they have to be held up by hand!

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In between surgeries.

We do have some needs! We will be supporting ourselves financially, but medical supplies are always running short due to inadequate government resources.

  1. Compresses, gloves, IV tubing (not the ones used in machines), IV needles/catheters (the usual ones), sutures.
  2. They are always in need of common medications used everyday, like tylenol, advil, benadryl etc.

If you would like to help support this amazing hospital, here is the link to donate:

Homeless in Nepal!

The loveliest people and mountains are found in Nepal. My wife and I were recently privileged enough to make a 4 week trip to this amazing country. We arrived at the beginning of November after 33 hrs of flights (it seems about as far as you can get from Canada!). Here are 7 essential parts to being homeless in Nepal:

1. THE PREP. In many ways we were in a perfect position to leave the ‘Canadian versions’ of Ryck and Steph and become the ‘international versions’ of Ryck and Steph. Also, our beloved osprey backpacks were pressuring us for another international adventure (sometimes I like to think that our bags are sentient and when we travel we’re really just porters carrying them to new countries and over mountains).

Next, all of our belongings were already in storage unit, and we had no mortgage or even rent to worry about. You see, we are currently homeless. After leaving our home of 3 years in Saskatoon last year, we never achieved more than ‘no fixed address’ status. We have bounced from town to town working for 6 months around Canada and this has culminated in our current trip. When forms ask us for our address we smile and put in our parents address.

2. TO NEPAL! Nepal has held our thoughts for quite a few years. Some amazing friends made the journey before us and struck up the desire in our hearts. Being avid hikers, we also loved the idea of exploring the Himalayas. The land of giants that plunge as high as airplanes into the blue and poke holes in the jet stream.

Arriving at night, the airport was organized chaos. People were there to herd us to our next task, but no system was obvious or particularly efficient. We were shuttled from one desk to the next to get our visa on arrival and stood in lines we weren’t totally sure were intended for us or necessary, but finally made it to the final line. This line inexplicably had another security check complete with metal detector and X-ray scanner for carry on bags. Carry on bags! The ones we just got off the plane with may not be safe enough to carry into the country!

A little confused, I put my bag onto the conveyor belt and started to empty my pockets of a handful of Hong Kong coins, not wanting to set off a metal detector in this odd airport. But a security guard stopped me and just pointed that I should walk through. With a ridiculous amount of metal on me I started imagining what was about to happen after setting off this metal detector in spectacular fashion. The security guard simply nodded approvingly and sent me on without any trouble. The cherry on top was that the bag scanner wasn’t even on!

3. THE NEPALESE PEOPLE. A main highlight for me were the amazing people we met on our journey. The guide that we had arranged for our trek met us outside the airport, and with a big smile he adorned us with traditional Buddhist scarves as a welcome. Despite our fatigue we had lots of questions for him on our way to the hotel which he answered patiently. The cab ride was a soft introduction to the chaotic driving culture of Nepal where the only rule seems to be to honk before you do anything. Our guide, Bhabi, was an amazing, self sacrificing, patient and doting man that never had a bad day. Judging from the other guides we met this was the rule not the exception.

The Nepali were so welcoming and helpful everywhere we went. Their lovely nature and commitment to family is also evident in their language. To address one another they use bai/baini meaning little brother/sister, also dai/didi meaning older brother/sister etc. The truly great part of this system is that every time you address a stranger you first have to guess their age!

4. THE HIMALAYAS! These giants are an obvious attraction for anyone venturing to Nepal. Standing among them at high elevation fills anyone with wonder and awe. We spent 14 days trekking the Annapurna Circuit and it was phenomenal. The landscapes varied from jungle to desert to alpine to high altitude. Hot springs abounded and we sat in one thinking about how just 3 days ago we were at an altitude of 5416m (nearly 18000 ft) in -25 Celsius conditions at the Thorung La pass. Endless cups of tea were enjoyed resting our legs and backs from the days trekking. In total, we had 11 days of trekking travelling over 160 km with around 7000m of elevation gain! (That amounts to about 15km/day).

5. POKHARA! This is the second biggest city in Nepal, and though only about 300km west of Kathmandu it is a full days bus ride through some crazy terrain and traffic. The tourist area of the city borders the lake, and features an oasis of good food, drink and hotels that we fully indulged in after spending a couple weeks in remote towns! A highlight here was renting a party paddle boat for just the two of us to cruise about the lake in style. We set off down the shoreline of the lake and around the island temple, beers in hand. It was lovely.

6. CHITWAN NATIONAL PARK! This was something of an after thought on our trip and we only decided last minute to take a break on our way back to Kathmandu. It was meant as a small detour but travelling just 75 km on Nepal’s roads can easily take 4 hours!

To our delight, we didn’t have to go far to see elephants in town as they would walk right by you on the roads (accompanied by their owner of course). We stopped to pet as many as we could!

I was told Chitwan means the heart of the jungle, and jungle is what we got. Waking up at the crack of dawn, we spent an hour cruising into the park by canoe (picture a hollowed out tree with 15 tourists crammed in it and a local man standing at the back paddling). The next 4 hrs took us quietly back to town. We saw some spotted deer, rhesus macaw monkeys, wild boar, alligators and almost a wild elephant. The almost could also be translated as ‘we heard an wild elephant and if we waited too long could’ve been killed’. I will explain…

We had been informed at various points that wild elephants were more dangerous than alligators or rhinos, and we needed to carefully follow our guides instructions if we came across one. These words came back with force when suddenly we stopped and could hear deep breathing and the snapping of relatively large trees only about meters away! Our guide was listening intently and we received these helpful instructions in a forced whisper: “I’m 90% sure it’s a rhinoceros, but if it happens to be an elephant we have to run that way as fast as we can!” Poised to take off we watched anxiously as the gray outline of an elephant appeared with a long trunk sweeping through the trees! Luckily it was already angling away from us so the best course of action was to sneak away before he noticed us!

We didn’t get to see a single rhino on our long walk. So we decided to console ourselves with a relaxing lunch on the river facing the park. And what happens to just walk out just down from us, two rhinos! From the safety of the river bank we probably got to see them closer than if we had been hiking anyways!

However, the coolest thing we saw was actually a bird! Apparently, it is rare to see great hornbills but we were fortunate to get a few glimpses of them and hear their odd mating calls that sound like a barking/growling dog.

7. KATHMANDU/TEMPLES/STUPAS! Kathmandu was bustling and a bit chaotic, but also charming in its own way. There were still signs of the city rebuilding since the massive earthquake in 2015, and if you walk down any street long enough you’ll come across an amazing stupa or temple built some centuries ago.

My favourite place was colloquially dubbed the monkey temple and the name was immediately obvious on arrival. We had walked about 2 km to get there, so I stopped to buy some peanuts from a street vendor (something I hadn’t done yet on the trip but for some reason the urge just struck me). Admiring my bag as I made it across the street to the foot of the temple, I looked to find Steph who had gone ahead. The next thing I knew a swarm of monkeys (honestly like 10-15!) descended upon me! The next moment a large buggar climbed a statue and swung around it, extended his arm and smacked the bag. Reeling, I spun away and gripped the bag tighter. I now had monkeys bumping into my legs reaching their arms up at me like beggars. I looked down at them and was distracted just long enough for another to take a running leap behind me, elevating himself at least 3 feet off the ground. I noticed him just in time to yank the bag of peanuts higher. Bewildered and laughing, I now had no idea what to do. I could see all the locals and Steph were enjoying the show, and some were sympathetic enough to yell that I should hide the peanuts in my bag. Easier said than done with a pack of monkeys ready to take advantage of any misstep. Later on the way up I discovered that feeding them was possible (and fun) in small handfuls!

The town Canada forgot.

The call was simple enough. Travel to a remote area of Canada to provide medicine to needy people. I was expecting a rough town with a jagged past. What I found was heartbreaking. A town that seemed forgotten. Forgotten in spite of the gruesome school shooting by a minor that took 4 lives and wounded 7 others.

So where do I even begin? I was optimistic initially. I arrived after dark and found my place nice enough. I woke to the sun the next morning delighted to find that the town is situated on the East side of a beautiful lake. The hospital has the most wonderful view right along the shore with dazzling sunsets.

Reality set in quickly in clinic when I saw a paper chart waiting for me at the door of my first patients room. It was not the first I have ever seen. In training once I had to fetch an old chart to look up information that had not made it into his electronic record years ago. A call back to former times. My first thought was “how do I even use this thing?”. It didn’t get easier from there. I struggled to find old notes, old x-rays, old prescriptions, past medical conditions. I couldn’t help but be surprised that I found myself wishing there were some sort of manual to use a ‘technology’ so simple. Then it struck me, is this the type of care a scarred and hurting town gets? Has everyone forgotten about La Loche?

I struggled my first days there. Trying to come to grips with the lack of proper medical resources and care for a town in need. Trying to understand how a town of roughly 3000 people could have 2 grocery stores, 2 take out restaurants, a bar, a gas station and a liquor store. The other businesses in the town are government buildings. At about the same size Port Hardy had a hotel, restaurants, cafe’s, hardware stores. It seemed a town of potential that had never been realized. Like a beautiful swingset on a beach without any swings…


La Loche is a town with a marred past. Not just the school shooting either. It boasts one of the highest crime rates in Canada, including violent crimes like homicides. The nurse and physician residences have been broken into and sometimes gutted on several occasions, mostly when vacant. There was quite obvious damage to the deadbolt of my apartment. Dogs roam the streets unhindered and wild, free to give chase to joggers that may happen by. The hospital was ill equipped for its residents’ needs. There was no patient room to properly protect others from contagious TB patients. Resources for those with an acute mental health crisis were lacking. The emergency room had no proper place to house them, and when they needed specialist help in a secure facility it was a monstrous task to transport them out. Health care workers faced burnout due to chronic understaffing. One day we had to discuss transferring the patients that were currently admitted because we only had one registered nurse in the entire hospital (we usually had 3). Public health initiatives are badly needed here, as many parents bottle feed their children up to 3 years of age. Due to poor nutrition almost every child I see had a mouth full of cavities and too many are anemic.

La Loche was an enigma. I could not fully understand or accept how it came to be, and why nothing was happening about it. I asked fellow physicians what they were able to understand about it, but found out they were also puzzled and disappointed. Reaching out to town residents, they most often shrugged. They were almost complacent, resigned. As if the question was one they had not thought of for a long time. Some were, rightfully, a little taken back and defensive. When they saw my heart was genuine, they often offered that it was complicated. The suicide rate is up to 40x the national average. Few people here haven’t been affected by it. The legacy of residential schools is still fresh as well. Local schools only closed their doors in 1976 and 1983. Adults no doubt still live with the hurt these institutions.

Around half the adult population is on some sort of social assistance. Those that decide to work are often chastised for being too good for welfare. This town, this land is their community, their lives. They visit one another in their homes. Family ties run deep in La Loche, the majority of people have one of 5 common last names. Their streets are even named after these families. Some go out on the land hunting and go fishing on their beautiful lake summer and winter.  It is hard for people to leave their land and family, but then their is little industry to keep them employed. Drugs and alcohol rule the town relatively unchecked.

A town forgotten. The massive mobilization of public health and community resources was strangely absent. I think that is the most frustrating part!

“Why do people have to drink so much?”, I lamented to a gentlemen I was stitching up. He had been hit in the head with a wine bottle after passing out. His reply?

“People here are hurt”.

So where is the massive public push for more health resources for addiction treatment, public health initiatives and mental health supports. I can only answer that this town is politically weak and isolated, and easy to forget. Just another blip on the map of historically terrible First Nations and Metis relations.

I have not forgotten.


Voices of La Loche.

“What are you taking pictures for?”, I heard in an unfriendly tone. I froze a little. It wasn’t that I was doing anything wrong but I did find myself in a Northern first nations town and was trying not to be disrespectful in any way. After explaining who I was she took it upon herself to give me her informal tour. “Welcome to LA! <hoarse laughter> That’s what the locals call this place…”

“In my language my name means butterfly.”
And so began my tour…



“They put those up for the kids after the school shooting”.



“Two of my brothers are in there. Died as kids.” I did not want to open any wounds with any kind of response begging an explanation. I could only look on sympathetically.



“People stand outside the liquor and offsale stores at night. We call them zombies. They slowly walk up begging for money or booze to anyone that walks by.”



“They call this (area) the bermuda triangle. People come drinking down here, and don’t make it home!” The three points on the triangle were a bar, a liquor store and another bar. When asked where they end up her reply was “The cops get em or they end up in another bed or on the street”.



“I’m a wino.” <hoarse laughter>
Parting ways (she was heading to the liquor store), she couldn’t help but ask if I could give her money for wine. She asked even though she knew I was a doctor. With stubborn sincerity I explained I couldn’t do that for her, knowing it was for alcohol. Maybe I would have seemed more real to her if I had given it…




“Where are you from?”. It is a simple enough question but it happens too often here. I wear very casual clothes, jeans and t-shirts. I suspect it is the color of my skin. I am in a huge minority in La Loche. People assume I am a teacher or in health care. When I tell them I am a doctor it is met with silence. I’m not sure what it means.





“I love the land. I hunt and fish. It’s my home”. I had asked another gentlemen why he stayed in such a rough part of Saskatchewan.



A health care worker told me, “I was going to leave years ago. I was stressed and couldn’t take it. But I stayed because I wanted to help the people here.”


Stay tuned for more.