The Steffescope Dear Friends and Family

The SteffeScope

Dear Friends and Family:

The first day of the new year found us on our way to Zambia! A new location, a new experience and a new volume of The Steffescope all make a good start for the millennium. Leaving Sunday afternoon, we spent 43 hours in car, plane and airports to finally arrive at our destination in Zimba, Zambia late Tuesday afternoon. The nor’easter that dumped a foot of snow on JFK airport slowed us down a little on our way through but didn’t stop us. We were able to get 120 pounds of extra supplies on the plane without incurring any other charge (although it was nip and tuck at one point) and then get four trunks of valuable medical supplies and gifts through customs in both Zimbabwe and Zambia without duty fees! We praise the Lord for the traveling safety and for taking care of all the little details. One of those little details was not much in the great scheme of things, but seemed to show us in a definite way that the Lord is involved in even the minutiae of our lives. Saturday night, in a last minute packing frenzy, we were going through boxes of what is technically known as “stuff” when Bruce realized that he had neglected to beg, borrow or buy1 surgical masks and examination gloves. Those two items are often in short supply at mission hospitals and given the high prevalence of infectious diseases in Zambia, he prefers to carry them in a fanny-pack when he makes rounds in order to have them immediately available for use while changing dressings. To be a bit more graphic, he is also struggling with a cold right now and anyone who has had to reuse a paper surgical mask several times when they have a runny nose will understand. Anyway, back to the story: Before Sunday School, Pastor Bruce Martin called Bruce into his office and told him that he had a box of supplies for us that had been delivered to the church. Fully cognizant of the bulging trunks at home that were near their weight limit, Bruce despaired at the thought of taking anything more but dragged it out to the car. The box was a large one. We opened it at home and it was full of only examination gloves and surgical masks! We found room to take enough for the month and thanked God for His care in even the small things. Despite our fatigue upon arrival in Zimbabwe, we took an hour to walk along the Zambezi river gorge and marvel at the mighty Victoria Falls. Seen best from the Zimbabwean side, the Victorian Falls are actually situated all along the greater curvature of a crescent shaped gorge that cuts through the 4000 foot above sea level plateau. The falls actually cover several miles on that side and range from mere rivulets to roaring monsters that rival the Niagara in force, noise and mist. We overheard one repeat visitor say that we were lucky that it hadn’t been raining as much recently because the river was somewhat lower than its maximum level. When it is at full bore, the mist prevents much of the view. The best view is from a hot air balloon or helicopter because from that vantage point you can see the whole crescent. Maybe next time! As close as we were on the other side, the mist and limited angle of vision allowed us to view the Falls only a part at a time, but it was still worth the two mile walk in the 90o F humidity. As much as we enjoyed the spectacular view, we were ready to get to what would be our new home for the next five weeks. About an hour’s drive northeast of Livingstone, Zambia (which is on the border), we entered Zimba. Zimba, in the local Tonga dialect, means “bump in the road” and that pretty much is right on the mark! The local hospital, the primary and secondary school, a hundred foot long market and a few houses makes up all the sights there are to see. Under the aegis of World Medical Missions (the medical arm of Samaritan’s Purse), we are working at the Pilgrim Wesleyan Zimba Mission Hospital. The Wesleyan Methodist mission in America originally started the hospital in the 1950s and subsequently has turned it over to the national church. It is a hundred bed hospital but has been struggling with part-time physician coverage since two doctors here for two years under World Medical Mission left last July. There has not been a physician for six weeks but the four Clinical Officers (equivalent of Physician Assistants in the US) and a dedicated nursing staff keeps the place running. Off all the places we have worked and visited, it presently takes first place in being the farthest stretch from how Bruce practiced medicine in North Carolina. Anxiety and uncertainty are certainly part of his life right now. We would like your prayers about the following: 1. That God would show us where and how we are to be maximally effective for both the hospital and for the advancement of the good news of Jesus Christ. Stretching the envelope is never fun for us and yet we realize that it is an opportunity to learn more lessons about trusting God and seeing His hand in things. When you realize you are totally out of your element, anything that gets accomplished is obviously not of

1 We didn’t think it was right for even part-time missionaries to use the term “beg, borrow or steal”.

your doing. Micky is searching for her role here and Bruce is trying to clarify it – pray for clarity for us. Insomnia and jet-lag is making the problem that much worse. 2. We are here during the wet season and malaria is reportedly at a near record peak of prevalence throughout much of Africa including Zambia. Liz Anderson, the missionary we are staying with, had her second documented attack in two weeks. We are taking all the usual prophylaxis and trying to avoid getting bitten, but we would like you to pray for our health and safety. Also, the recent UN data states that Zambia has the dubious distinction of being tied for 5th place in the prevalence of AIDS – 20% of adults have the disease. This is a reason to pray for both a surgeon’s safety and for all those people who will face a Christless eternity unless they are told about His salvation. We encourage you not only to pray but also to take an active part in being a Sender of missionaries. Remember, Paul exhorts us in Romans 10:13-15 “…Everyone who calls on the name of the Lord will be saved. How, then, can they call on the one they have not believed in? And how can they believe in the one of whom they have not heard? And how can they hear without someone preaching to them? And how can they preach unless they are sent?…” 3. Pray specifically that the Great Physician will work through Bruce and in spite of the limited resources to bring both physical healing and to demonstrate through him the loving nature of the Almighty God. 4. Our usual e-mail address is not available to us through AOL here in Zambia. There are AOL servers here in Zambia but we have not been able to connect despite multiple attempts. In case you are wondering why this newsletter is coming from our usual address, we are going to send it to Bruce’s son Ryan and he will send it out on AOL for us. For limited communication with our family, we are able to use the missionary’s e-mail site but cost and courtesy limit its availability and its reliability has already been demonstrated to be marginal. The server has been down all week. We are thankful that such an alternative is available but pray especially hard for Bruce – the withdrawal tremors from the loss of regular e-mail are terrible to behold! If you need to reach us, put our name in the subject line and send the e-mail to <> Please pray for us.

Yours, serving Christ in Zambia,

Bruce and Micky Steffes

Friday, January 12 Dear Friends and Family:

The keyword for this week is “adjustment”. No matter how many times we do this, it is always difficult to adjust to a new area of service. Despite past experience that should give us a heads-up, we always seem amazed that the missionaries we meet are not perfect, that the resources are always more limited than we expect and that we ourselves are not really the cure-all to all medical, spiritual, economic and political problems we find in Africa. We feel more out of place, less efficient, less effective and less spiritual than we had hoped to feel. Our training, pretensions and dogma are never sufficient to avoid the stress of living and serving. But when we finally get to that point of realizing that we are not very much in the face of all we find, we begin to see more clearly, experience more fully and trust more unabashedly because it is then that it is evident that Christ is our source of strength and the only answer. It is sometimes pretty painful and God doesn’t share His plans with us for our approval as often as we might think appropriate. Thanks for your prayers! We have needed them. Zambia is about the size of Texas with about 10,000,000 people, which makes it a much less densely populated land than many of the places we have been. It is situated on a high plateau about 4000 feet above sea level and Zimba is 16 degrees below the equator. The altitude drops a thousand or two feet going toward Livingstone, 100 kilometers southwest of here on the Zambezi River. The terrain rises about the same number of feet to the north. The plateau around Zimba is rather flat with scrub trees and brush, now green from the rainy season. Speaking of that, we have had several days in a row with clear skies and temperatures in the mid-90s. A nice breeze is all that makes it tolerable. A couple who is here building an eye hospital are very pleased because it makes the pouring of the concrete floors possible, but the farmers are moaning. They really count on the rainy season and it is way behind the usual amount of rain. Subsistence farming is the main way of life here. It does make for a good selection of vegetables and fruits and the nearness of Zimbabwe and South Africa mean that many dietary treats are available with a bit of careful planning and shopping.

There are over 70 tribal languages and distinct dialects here in Zambia, but English is the official language and Tonga the local language spoken by much of the Southern District (albeit in various dialects – each claiming to be the “original” Tonga). We have truly enjoyed getting to know people here. They are warm and open, but live a hard life. As a reference point, an unskilled worker will work all day for about US$1 and a nurse at the hospital gets about 100,000 Kwacha a month plus accommodations. That works out to about US$24 a month. Senior staff may get salaries at the rarefied level of 200,000 Kwacha a month plus accommodations. An average day at the hospital consists of a time of devotions at 8:00 AM. All staff members who can possibly get free attend. The singing is a capella and in four part harmony. It is a true joy to listen to and we are getting to be able to read the written Tonga. Of course, unless we know the song, we don’t know what we are singing but we are praising God with our Christian brothers and sisters. There is a quick review of the happenings of the previous day after the short Bible study, any announcements are given and we are released to work. There are three clinical officers functioning as the medical staff here and one eager student. Clinical officers are the equivalent of Physician Assistants. One has been turned into the administrator and so Bruce tries to make rounds with the remaining COs, turning the first two hours into an opportunity to teach. Since there are 70 – 85 patients here (including the long- term TB patients), it is sometimes rather chaotic and disjointed but he tries. Whenever they finish, the Clinical Officers go to clinic to see as many as 200 outpatients a day. The student goes with Bruce to act as his interpreter and to learn what he can. On Mondays, Wednesdays and Fridays, Bruce has the MO (Medical Officer) clinic and sees patients upon referral from the Clinical Officers or those patients who pay an extra fee to see “the doctor”. As news is getting out to the white and Asian Zambians that the hospital once gain has a real doctor, more and more are showing up to see him. Tuesday and Thursday are surgery days, but it takes a while to get the pipeline of cases full. Since they are not having anyone with surgery skills coming soon after we leave, Bruce is not trying hard to build the elective schedule in order to avoid disappointing a lot of people. Since the hospital only charges from $2 to $8 for an operation, it is not like he is not providing income to the hospital when he does not do the elective cases. The reasons for such a strange fee schedule in what is supposed to be a self-sustaining hospital are hard to unravel, but it is obvious to us – even without the foreign concept of full cost-accounting – that every operation Bruce does actually costs the hospital money since that fee includes anesthesia, drugs, the personnel, suture, bandages and overhead. The OR has not had a generator for six months because they failed to do routine maintenance on the engine and it seized up. That means that Bruce has no good OR lights, no EKG monitoring, and no device to monitor oxygen. They all run on 110 volt 60 cycle electricity that is unavailable and the rest of the building only has 220 v 50 cycle electricity. Unfortunately, this fact escaped Bruce’s notice until he had put in the spinal for the first emergent C-section (“Yes, We Have No Anesthesia Trained Personnel” can be sung to the tune of “Yes, We Have No Bananas” but you have to kind of scrunch the words in real fast at the end). He was prepping the case when this unpleasant fact was made known. The Lord was good and the case went well, but it was not a comfortable experience. The case was done for an 8-month pregnant woman with eclampsia and seizures. The medications (and laboratory and x-ray departments) here are limited and it was not possible to control the eclampsia well, so the C- section was done emergently after the pregnant mother was stabilized somewhat. At the time of this writing, the mother and baby are doing well and soon to be discharged. The afternoons are spent in clinic but they “knock off” for the day at the very civilized hour of “sixteen hours”. They refer to time here as do the military back home. Micky has been spending her days either working with the accounting department or in the pharmacy. Soon, she will be getting some ministry accounting records and will be doing some auditing for the mission itself. By “seventeen hours”, we have tied up the loose ends and are usually home, parked in front of the fan to cool off. The evenings are quiet, spent in conversation, reading or computer work, with only the rare call back to the hospital. On Sunday, we worshiped in the local church and truly enjoyed the time together. The singing was again the most remarkable thing. The pastor spoke in English and it was translated into Tonga. We were somewhat surprised when they quit after only two hours. Later that afternoon, we had an English vespers service here in the guesthouse. Other expatriates as well as those Zambians who are very fluent in English attend that service. This past week, we had a nun and priest from Ireland worship with us. She runs a vocational training program here in Zimba. On Wednesday evening, we drove 45 miles to worship with a group of missionaries and expatriates from various backgrounds. We were on a farm that is a mission ministry and enjoyed a great potluck supper, a time of fellowship, a videotaped sermon, a time of prayer and capped it with a birthday celebration. For a very special entertainment, it was the night of a full lunar eclipse starting at “twenty hours forty five” and as the full moon faded, the rich canopy of stars became evident. The Milky Way pointed the way across the velvet darkness to the Southern Cross and we drove home with the eclipse in full view in front of us the whole way. It reminded us of that fact the heavens do indeed proclaim His glory. Sometimes, in spite of that, we also let the shadow of who we think we are and the shadow of our own problems eclipse the fully reflected glory of what the Lord is doing.

The only major problem this week besides the frustrations we mentioned in the first paragraph is the fact that last Saturday, Bruce twisted his ankle badly while walking to the hospital. It took him off his feet the rest of the day and most of the day Sunday. It has been slowly knitting but he is still having pain and swelling to twice normal size when he spends the day walking and standing on it. We would appreciate your prayers for his recovery. We are thankful that finally we were able to get e-mail service. As we mentioned in last week’s newsletter, we could not use AOL and the local server was down. Our parents and children never got our e-mail message that we had arrived safely. We were glad to hear their voices on the other end of the telephone line this past weekend when they called to make sure we were okay. Having a functional e-mail system, even though we have to use the missionary’s computer, is a real blessing. As we draw this note to a close, we realize we have come full circle in our attitude. It is easy to start out discouraged and frustrated in our own strength but as we recount the blessings we have received, those things resume their rightful size and position. Psalm 77 is a comparable case history. In the first 12 verses, the psalmist uses the term “I”, “me” and “my” at least 24 times and gives a great example of “Woe is me!” type of thinking. But in verse 10, he begins to prescribe his own cure and in verse 11, he says, “I will remember the deeds of the Lord”. From then on, it is no longer “I”, “me” and “my” but rather he focuses on the Lord and what He is and what He has done. May we always remember to do the same.

Yours, so grateful for the opportunity to serve the Lord despite our inadequacies,

Bruce and Micky Steffes

Friday, January 12 Dear Friends and Family:

Greetings from Zimba, Zambia! Micky and I have little catchphrase that we use between us. It is, “Sometimes, you have to suffer for the Lord”. We may use it in its literal sense when things are going badly from our perspective and it never fails to bring a wry grin to our faces and a lightening of our hearts. Usually, we use it in exactly opposite conditions. For example, two years ago in Uganda on our last day in Jinja, we were eating a tasty restaurant meal on a veranda overlooking Lake Victoria as the sun set. “This is the day that the Lord has made. Let us rejoice and be glad in it!” was the verse that came to mind. We looked at each other, grinned and simultaneously said, “Sometimes, you have to suffer for the Lord.” In another example, last year people in North Carolina were sweltering in the already stifling heat of June when we were getting ready to return to Africa. Some made comment that they were glad that they didn’t have to return to hot equatorial Africa. Remembering the cooler 68-degree nights and 82-degree days, we grinned and said, “Sometimes, you have to suffer for the Lord.” Last Saturday, we took a day off from our duties at the Zimba Mission Hospital. Liz Anderson (the Wesleyan missionary who is stationed here in Zimba) and we drove back to Livingstone for a day of tourism. We combined a trip to one of the national museums with a trip to the Zambian side of the Victoria Falls, souvenir shopping, a restaurant meal and an afternoon game drive. That was followed by a great outdoor barbeque meal in the beautifully landscaped grounds of the home of the owners of the game drive company. Sometimes, you just have to suffer for the Lord! Isn’t He good? The game park in Livingstone is one of the smallest in the country but large enough to drive for 3 hours looking at the animals. It was so very dry there that the elephants had swum the Zambezi River to get to the islands in the middle for better forage. There are no predators in this game park because of the proximity to farmers and the town. The giraffes are of the common variety and are sufficiently inbred that their markings are very pale. It is always a great experience to see all of the animals in their natural state. We saw a great object lesson. There is a small tree frog that crawls out on the branch of a bush that overhangs a dry mudhole. She lays her eggs in a ball of foam several inches in diameter. Somehow, this foam is durable and preserves the eggs from the dryness of the air. When the timing is right and the rains have come, the eggs begin to mature and eventually the tiny tadpoles take a free fall from the foam into the water below. It is then a race with time as the frog hopefully develops legs and the maturity to survive on dry land before the water dries up and the mud once again cracks into a dry mosaic. Paul wrote in Hebrews 11:1 (NIV) that, “Now faith is being sure of what we hope for and certain of what we do not see.” We would not be so anthropomorphic as to suggest that the little frog has any concept of faith, but gambling the continuance of your genetic legacy on the “hope” that the rains will come, “certain” that they will, is certainly an object lesson in faith as well as an example of God’s provision for His creation.

God has honored His promise to creation and answered prayers. The rains have once again come and while that little frog may still not have gotten as much as it requires, it has rained hard down in Livingstone at least twice in the past two days on his little bush. We have had more rain here in Zimba than that. The farmers are grateful but continue to pray for more. Work at the hospital continues apace. We have taken on the project of trying to inventory and evaluate every piece of electrical equipment in the hospital. Many pieces have been put aside due to the lack of routine maintenance and the lack of parts with which to repair them. We have borrowed a 110-volt petrol generator from the couple building the new building for the eye hospital (Dave and Patti Linton) and that allowed us to test the equipment. We sure wish we had more skills in the way of biomedical engineering! We have had a few pleasant surprises when pieces we were told were broken seemed to work. We have been in contact with World Medical Missions and they are giving advice and offering to help where they can. We are so pleased for the hospital that they are so willing to help! The lack of patients in the pipeline and the lack of some of the equipment have kept the surgical schedule light for Bruce but the clinical and hospital work takes up the slack. The most common medical problems seen in the hospital here are malaria, anemia and AIDS. Feeling that it makes a difference as to how we approach a patient both medically and spiritually, Bruce has been ordering AIDS testing for many patients. Three have refused to be tested. All but one of the others has been positive. AIDS is devastating this country. Also, just this week, the government announced that too many people were dying from chloroquine-resistant malaria and have changed their recommended treatment. Bruce had already realized the high resistance rate and had advocated the change; the formal announcement bolstered his argument. It is so hard to watch these little babies die, either because of the malaria itself or because of the profound anemia it causes. The article reported that 67% of children, 39 % of non- pregnant women, 47% of pregnant women and 26 % of men in Zambia are anemic. We have trouble getting enough blood to transfuse the patients that need it even with waiting to very low levels before transfusing. This week Bruce donated blood for one young woman who was so anemic that she is in full heart failure. We have been participating each morning in the hospital-wide devotions. As we mentioned last week, every morning a time of singing is followed by a 20-minute sermonette and then prayer and announcements. This week, both of us had the opportunity to speak. We enjoyed having the chance to address the staff. For a few days this week, we had some visitors from Memphis, Tennessee. The two Americans came to tour all the Wesleyan works in Zambia. Their guide was a Zambian who is studying for his Masters of Divinity degree at Asbury Seminary. It was fun to talk to them and watch their excitement at their first visit to Africa. Before we started this ministry, neither one of us either realized the importance of missionary guesthouses. It is a great ministry and badly needed. The host and hostess combine the skills of hotel manager, cook, confidant, friend, concierge and nurse to provide whatever is necessary to guests that range from greenhorns from the States to short- term missionaries such as ourselves to missionaries just traveling through and grateful for a good meal and clean bed to burnt-out missionaries needing a refuge and a place to heal. Liz Anderson has been a real blessing to us here as have every one of the hosts and hostesses with which we have stayed. Maybe God is calling you to serve somewhere in such a position. It takes only the skills you all already have. God can use them mightily and to great effect. Think and pray about it. We want to thank you for your prayers. Bruce’s ankle is still sore and swollen but each day brings improvement. Our health remains good and our time of serving is a blessing. We thank God for each and every one of you and pray that you too will rejoice in the day that the Lord has made. Read the back of the Book – we win! God bless you.

Yours because of His grace,

Bruce and Micky Steffes

Friday, January 26 Dear Friends and Family:

We head back to the United States in less than two weeks – time sure flies when you are having fun! It is hard to realize that our time is almost up here. Last Sunday, we went to Choma, a town about 90 minutes northeast of here, to pick up a short-term missionary who will be here for six months. Caleb Clinkingbeard is a native of Arizona who has come to help in whatever way he can before returning to enroll in medical school next fall. He is hoping that by the end of his time

5 The SteffeScope Volume 4, 2001 © 2001 here, he will know if he is to be a medical missionary or not. Bruce has had a great time with him, taking him on rounds and having him scrub on certain select surgical cases. Were we ever so young and enthusiastic? While we were in Choma, we had the opportunity to have Sunday dinner with some members of the church. While we were waiting for the meal to be served, Bruce pulled out some latex pencil balloons and entertained the three children by creating giraffes, dogs and hats with the balloons. It was a big hit. Bruce spent some time showing the children’s father, Passmore, how to create the balloon sculptures. It was a great deal of fun, especially since Passmore was convinced he would have the balloons explode in his hands. The meal was a traditional meal of nsima (a corn meal dish that we had known before as either ugali in Kenya or posho in Uganda), a chicken flavored sauce and chopped rape leaves (very similar to sukamiwiki). It was of course eaten with our hands and washed down with the typical African drink, Fanta orange soda. Seriously, after the Fanta, we did have a traditional drink that our host missionary Liz Anderson suggested that we try. It is called chibwantu. She described it as “the drink you chew”. They set in front of us a cup of clear liquid with pieces of white corn floating in it. Our first reaction to it was that it didn’t taste bad, just the consistency was odd. Micky had trouble getting it to go down and Bruce thought “grits in water” described it well. They were watching our reaction and so we asked how it was prepared. To cut a long story short, they make porridge out of grits, then add water and let it stand overnight. So we were right – grits in water! A small glass was gracious plenty, as they say back home in North Carolina. If any of you would like detailed preparation instructions, e-mail us and we will try to get them in time for your next dinner party. On the way home, we stopped to take a picture of a sign along side the road. In the US, we often see signs with the silhouette of a deer, warning drivers of the possibility of those animals in the vicinity. We saw two signs close together, one definitely that of a cow and the other Bruce swears is a hippo. There are hippos in every major body of water here and it seems possible that the sign would warn of them. Hippos may leave the water and walk as far as four miles from their homes to graze each night. We are fairly certain you would not want to hit one with your car. So despite the harassment from the female contingency here, Bruce continues to swear it is a hippo on that sign. Monday, we were shocked to get an e-mail that told of the death of one of the missionaries we knew at Tenwek Hospital in Bomet, Kenya. Tammie King was an integral part of the fine nursing school there. She was on her way home from Nairobi when some children ran into the road. She swerved, lost control and rolled the car. She died instantly of severe head and neck injuries. This has been a great sorrow to all of her fellow missionaries at Tenwek, her friends and her family back in the United States. She will be missed and her death will be a major blow to the newly expanded nursing school. Please take a moment and pray for her family, co-workers and friends. Pray for the nursing school, its staff and students, as they deal with this sorrow and struggle to put the program back together. And while you are at it, pray for traveling safety for all the missionaries you know. The most common cause of death on the mission field is not malaria, AIDS, or rebellion; it is motor vehicle accidents. Sometimes it is due to the state of the roads or the general driving habits of the populace and sometimes the missionaries are driving unsafe vehicles. Do your missionaries have sufficient support to allow them to drive something safe for them and their children? Please make sure they do. Micky has been working this week at an audit for the national Wesleyan Methodist mission group. Although she has had some very exciting times when figures matched and columns balanced, it is hard to write about that in any gripping, cliff-hanging style. Nonetheless, she has been a blessing to them in this ministry. She has also used some spare time to tutor a man from a local Catholic vocational ministry who is trying to pass his national accounting boards after two previous failures. Her spare time has been spent helping the pharmacist fill prescriptions and just being her usual blessing to those she deals with. The hospital workload has been rather typical this week. Bruce is grateful that the Lord has chosen to heal some patients that were beyond the capabilities of this little hospital. He really thought a few of them were going to die but they did not. Others have died, often of what we in America would consider preventable diseases, but here they present either too late or we do not have the resources. Watching several babies die this week of anemia and malaria, unable to get blood to transfuse them, has been hard. We have had a rash of measles cases here – they are popping up all over. Although there is a pretty good public health system in place, we are seeing the disease in patients who have had previous vaccinations. There has to have been deactivation of the vaccine, probably through a break in the cold chain. Keeping the vaccines cool in this heat is always a problem and single break somewhere along the line will ruin the batch. As miserable as those patients feel, we are still glad that we have only a measles epidemic. In the north part of the country, near Kabwe, there is a full-fledged cholera epidemic going. Pray with us that it will stop and not reach this far. Just today, a nineteen year old had a caesarean section for prolonged labor. This was Caleb’s first experience with childbirth or a C-section and he got an eyeful. His EMT experience came in handy. The child was

6 The SteffeScope Volume 4, 2001 © 2001 unresponsive at birth. It was touch and go, but after an aggressive resuscitation, she is alive. Given the stress of her birth and the possibility of aspiration of meconium into her lungs, she is still a high-risk infant. Please pray for her survival and even more importantly, her mother and grandmother are not believers. They felt that her prolonged labor was the result of some bewitchment. Pray that somehow they will be willing to listen to the story of Jesus’ love and be willing to accept Him as their Savior. Every once in a while, you run into the unusual patient. Bruce was called to see a patient recently who had a problem. The circumstances of the call made him suspect that this was someone who was a local bigwig and the fact that the patient was waiting in the “high cost” ward bore that out. (Do you think any hospital at home would have the courage to call a special set of rooms “high cost”?). As is his custom, Bruce took pains to choose his words carefully to make it easy to understand. He explained the pathophysiology, the natural course of the disease and the possibility of surgery. While the nurse went to get some dressing material, the patient asked where we were from in the States and he informed Bruce that he was an MBA from Harvard. He had worked with Coca-Cola here in Zambia and is somewhat of a local big shot. Being a Duke MBA, Bruce immediately recognized his error, apologized and explained it all again – using one-syllable words! Zambia – the final resting place for people with degrees from second-rate institutions. Seriously, it is fascinating who you may run into out here in the bush. Another obstetrics case was interesting this week. This young woman had delivered in her village and they had put too much traction when removing the placenta. The uterus was turned inside out. Having never seen a case this before, Bruce still recognized it for what it was. Realizing time is of the essence, he made arrangements to have her taken directly to the operating theater (as they call it here). The only thing he could really recall having read about this condition was one of the James Herriott’s veterinary stories where Mr. Herriott used granulated sugar to shrink the swollen tissue of a cow’s uterus so he could push it back in. Fortunately, there were somewhat better reference materials to peruse in the books he had brought, so Bruce felt a little more confident as he strode into the OR, still musing about what they would say if he had to ask for granulated sugar. Fortunately, as is often the case here, the experienced nurse had already bailed him out. She had dealt with this before when she was a midwife in the bush and when he walked in, she had already managed to reduce much of the uterus back to its usual position with just pressure from the palm of her hand. With a sudden movement, the rest reduced before Bruce had a chance to touch the patient. Nevertheless, he gloved up, confirmed a perfect reduction, ordered some medication to have the uterus clamp down to maintain the reduction and then congratulated the nurse on her fine work. Bruce offered her his entire usual surgical fee here, but she was wise enough to know that she would be getting all of nothing. She laughingly thanked him just the same for the thought. Saturday, Dr. Chuck Paine and his wife, veteran medical missionaries with experience in India and Sierra Leone will be coming for a six-month stint here. They were here for two years a few years back. Please pray for their safe arrival and for an effective ministry for them here. This coming Sunday, Bruce has been asked to preach at the Sunday morning service. Since preachifying is not his strongest suit, please pray that he will be a conduit for whatever message God wants to deliver. Please continue also to pray that we would serve here in the way God wants and accomplish what God intends for us to do. Thanks for your friendship and support. May God continue to bless you.

In His strong right arm,

Bruce and Micky Steffes

Friday, February 2 Dear Friends and Family:

It is always hard to leave and always exciting to consider going home. Perhaps we could come up something original to capture that ambivalence succinctly. Perhaps, “Parting is such sweet sorrow”. That has a certain panache but we doubt that it will ever catch on. If it does, remember that you read it here first. We have enjoyed getting to know the missionaries who came here to Zimba, Zambia last week. Dr. Chuck Paine and his wife, Grace, came out of retirement to work here for six months. They were here for two years in the mid-1990s and have a lot of experience in both India and Sierra Leone. A pathologist by training, he is now a very competent jack-of-all-trades in a medical way of speaking. It was fun to discover that we have many mutual acquaintances, including Dr. Donn Ketchum and his wife, and also Patti Anderson, our friend with whom we worked in Uganda. This evening (Friday), we are also going to have three more physicians land at the airport to join us. They are coming out under the auspices of World Medical Missions, the medical arm of Samaritan’s Purse. One of them is Dr. Paul Wright with whom we worked last year in Togo. A family practice resident is coming from

Flint, Michigan and Paul is bringing a friend of his, a physician from Tyler, Texas. That will create a bit of confusion and a need for more interpreters, but it should make the hospital staff very happy that there are so many doctors around! It will raise the reputation of the hospital by not just a little. We hope that this coming month will be used to establish some patient care protocols, do some serious teaching of the clinical officers and have a great time working and learning.

We have a series of praise and prayer items:

1. Last Friday, Bruce operated on a young man (definition of a young man? Someone younger than he is!) who was found to have a necrotic loop of sigmoid colon (a volvulus). Our one operating technician was out of town for a funeral and so the case was done with some people who had very rusty operating room skills. Caleb used his EMT skills, Liz brushed off her nursing skills and two nurses were recruited who at least recognized what the operating theater was. The patient was in great distress, septic and hungry for oxygen. He thrashed and fought to breathe. In a long career marked by cases that were not fun, this was perhaps the most difficult and “least fun” case Bruce had done in a while. He was able to resect the loop, place a colostomy and with a great struggle under ketamine (which causes no muscle relaxation), got the abdomen closed although the stitches were tearing through as he placed them. Bruce was so glad that the patient was alive and the case was over that he was not too upset to find that there was a question of a retained sponge within the abdomen. The man lived through the weekend, showing slow improvement each day. The x-ray on Monday confirmed the sponge was present, but this time with adequate relaxation under spinal anesthesia, it took only ten minutes to remove the sponge and repair the torn muscles. He is slowly improving each day. Please pray for his continued improvement and for the salvation of his soul. 2. Bruce’s sermon went well last Sunday morning. An amusing anecdote you might enjoy: Tonga, the local language, does not have an “r” sound and they, like the Japanese, will often substitute an “l” sound and vice- versa. Pastor Alfred Chikobela introduced me by saying that I had an easy name to pronounce. All you had to do is look out the window, see the blue of the sky (pronounced here with an “r” instead of an “l”) and add an “s” –Dr. Brues. Liz Anderson, our host missionary, laughed until she cried. Bruce will always be known in Africa as “Dr. Bruce” – Steffes is a name that bewilders them. Micky is usually referred to as “Mrs. Bruce”. 3. Micky finished her audit of the books. Everything was just fine! 4. We actually got to watch the SuperBowl, albeit a few days late. One of the missionaries in Livingstone has a satellite dish and ESPN, so he taped it. We had a regular party with all the expatriates in the compound. Of course, we knew the final score ahead of time, but it was still a great deal of fun. 5. Grace Paine has had some medical problems, which delayed their coming a few weeks and are still causing some concern. Please pray for healing for her and wisdom for Dr. Paine as he tries to make the right decisions for the two of them and fulfill their obligations here. Liz Anderson has also heard disturbing news from home. Her elderly mother has had yet another small stroke. It is so hard to be 9000 miles away from home when your loved ones are ill. Please pray for both of them. We do want to praise God for Liz – she has been such a wonderful host and friend to us while we were here. 6. We want to thank God for His faithfulness while we were here. Despite the various problems that have arisen, He has been faithful and many people have been healed of their physical problems. We trust that somehow He will use those things to speak to their hearts. The physical healing is only for a few years; salvation is eternal and that is something we must always keep in mind. The main thing must always be that the main thing is the main thing. 7. Please pray for safety in traveling. We will be leaving next Wednesday and will arrive in Raleigh late Thursday afternoon. We will only have a few days at home before going to Atlanta for a mission conference. We would like to be able to avoid extra weight charges at the airport, have no problems with customs or connections and arrive without too much of a jet lag. Guess God can handle those requests if He has a mind to do so. 8. We have not received any further word on any of the three lawsuits but they continue to haunt the recesses of our minds. We would like the will of God in these matters, His Peace and the resolution of these cases that are hanging around worse than the kid who has moved back home after college!

Since we can seemingly no longer keep this under wraps, we have an announcement to make. Micky will not be going to Togo for those ten weeks in March, April and May. The reason why? Airlines have this policy about having women about to deliver flying on their planes and the May 20th return date from Togo is very close to the expected due date of May 28th. This will be the first child for Micky and we are very thrilled about God’s gift to us. Please pray for her health and the health of the baby – and also that that she will know how to keep to a schedule.

Ryan’s graduation from college is scheduled for May 26, so she must cooperate if Bruce is going to get everything done! And while you are praying for all that, pray for Bruce’s sanity and peace of mind! Our pastor in Fayetteville recently adopted a child and he and his wife are about our ages. They have claimed that they will drop the child off at college and drive straight to the old folks’ home. Seems about right….

With Paul, we pray “that out of his glorious riches he may strengthen you with power through his Spirit in your inner being, so that Christ may dwell in your hearts through faith. And [we} pray that you, being rooted and established in love, may have power, together with all the saints, to grasp how wide and long and high and deep is the love of Christ, and to know this love that surpasses knowledge—that you may be filled to the measure of all the fullness of God.” Praying that we are also filled to the measure of all the fullness of God because we are grasping God’s love and forgiveness for us, we love you and thank God for all of you.

Bruce and Micky Steffes

Friday, February 9 Dear Friends and Family:

We have arrived home to North Carolina, jet-lagged and tired. We are thankful that all our luggage arriving with us and we are also thankful that we had no major traveling problems. A. mountain of mail and e-mail awaited us and we still haven't made it through it all. We are still very pleased about the experience at Zimba Mission Hospital in Zimba, Zambia, and yet, at the same time, we are looking forward to next week in Atlanta. We will be speaking at and attending a five-day mission conference at Johnson Ferry Baptist Church in Marietta, Georgia and look forward to some time with other friends in the area as well. That sort of conference will be a new experience for us since we have never participated in something like that before. Bruce will be giving the challenge the first night of the conference and we are praying that the Lord will use what he has to say. We have always wondered how many people actually read these newsletters and we have confirmed the answer –not nearly everyone! In the short time we have been home, many people are amazed at our announcement and since they are sent the newsletter and still didn't know, they have been caught! For those of you who still don't know what we are talking about, look in last week's newsletter. By the way, we are back on the "[email protected]" e-mail account and we hope that Bruce can be reached in Togo at that same address. Micky will be able to be reached at "[email protected]". Some follow-up from Zambia: 1. Grace Paine, Dr. Paine’s wife, is still having some potentially severe medical problems and the etiology is unclear. They are considering the possibility of having to fly back to the US to get the problems clarified. Please pray for wisdom for Chuck as he tries to decide the best way to handle the problem, for healing for Grace and for peace for both of them. If they have to leave, it will leave the hospital short of physicians. Please also pray that God will provide a replacement for the hospital if it becomes necessary. 2. Pray also for the physicians that are left for the month of February The hospital is now without a trained surgeon and that is always a difficult position for any non-operating physician to be in. Chuck Paine has picked up a lot of experience over the years on the mission field, but there is still a lot that a surgeon would be better suited to handle. Pray that God will give them wisdom to do what they can and a peace as they stretch way beyond their comfort level. 3. The patient I mentioned in last week's The SteffeScope had dead bowel continues to improve and if no untoward consequences arise, should be going home soon. Thank God for his healing and thank you for your prayers on his behalf. He will eventually require another surgery to reconnect his large intestine and there is no one presently scheduled to work at Zimba who can do that sort of surgery. He will have to seek help at the government hospital when the time comes– something that many Zambians are loath to do. 4. Liz Anderson’s mother continues to make slow recovery from her small stroke. Please continue to pray for both Liz and her mother. Being apart is one of the prices that missionaries pay. We received a note from a missionary in Togo. She told of one of the missionary women was sobbing at the unthinkingly cruel remarks of one of her “supporting” church members who said that she must not have a close family

if she could leave them like that. That sort of thoughtless remark just underscores the many sacrifices that career missionaries make when they follow the leading of their Lord. Say an extra prayer for those who are away from their family when, if it were left totally up to them, they would not be apart. Write a missionary and encourage them, thanking them for all they give up. Please remember that the rewards are great, but the pain and sorrow can be great too. We are all human. 5. Before we left, we had the opportunity to welcome Dr. Paul Wright to Zambia. We worked with Paul last year in Togo. We made some new friends that came along under the auspices of World Medical Mission, too – Dr. Gordon Uretsky, an ER physician from Tyler, Texas and Dr. Robert Grimshaw, a third-year family practice resident from Flint, Michigan. Actually, Micky and Robert were not entirely strangers – she had known his brother and sister and had watched him play third base on a softball team many years ago. It is indeed a small world. 6. Leaving someplace where we have worked is always difficult As the word got out that the surgeon was leaving, many people wanted to be evaluated or have surgery the last day. Bruce had to pick and chose in order not to leave complex cases without appropriate follow-up. A very nice good-bye party given by the hospital staff topped off the last full day. Micky was given a dress and Bruce a shirt, both done in the national fashion. It is hard to say good-bye to people that you have befriended and it is amazing how deep the bond of the brotherhood of Christ can make a friendship become in a short time. We were asked innumerable times whether we are coming back and all we could say is that if that is where the Lord wants us, we will be back in a flash. We are thankful that we know we will have a reunion someday – at the throne of God in heaven if not before. The suitcases haven't even aired out yet from Zambia and Bruce is beginning to pack already for Togo. When we leave a place, we tend to leave all the contingency supplies that we bring – batteries, personal medications, books, and everything we think they can use. It must all be replaced before the next trip We also try to come up with medications, medical books and supplies that will be of help as well as lots of little things that speak of home to the missionaries – recent Christian music, videotapes, books, chocolate chips, cooking spices, peanut butter, pepperoni, popcorn and many others are little things that mean a lot when you are thousands of miles from home. The one preparation that means more than all of that is the prayer that is offered up by you. We know that our prayer team is the most valuable thing we take to the field and any success we may have had is directly in proportion to the number of people who are home praying for us and for the medical and spiritual results. Keep it up – you are doing great! Thank you for your support – we couldn't do without it.

Yours in His strong right hand!

Bruce and Micky Steffes

Friday, February 16 Dear Friends and Family:

We are presently just outside Atlanta enjoying the experience of being involved with our first ever missionary conference – that is, the first ever from the standpoint of being one of the special guests. Rev. Henry Holley and his lovely wife Bettie are a godly couple that work with the Billy Graham Evangelistic Crusade. They have become dear friends as we have met at various functions over the past three years. They ensured that we were invited to their home church, Johnson Ferry Baptist Church, for this year’s global mission conference. It is a large and vibrant church with a phenomenal emphasis on missions. We were honored to be invited. We spent the past weekend trying to put together a display table that would reflect the diversity of the ministry we have. We borrowed a display board from Bruce’s old surgical practice and were pleased with the final result we came up with. Bruce was fighting jet-lag and some undiagnosed febrile illness the whole weekend and so it was sleep, work on the computer, sleep and work on the computer all weekend. We were blessed to be back in our home church and have our Sunday School “family” around us again. After a long six-hour drive Tuesday morning, we set up the table Tuesday afternoon, attended the orientation meeting for all the missionaries and met Jim Moore. Jim is a friend who is a medical technician from World Medical Mission. He drove down from Boone, NC, to support us and to display the work of Samaritan’s Purse and World Medical Mission. Bruce was the after-dinner speaker for the kick-off banquet Tuesday night. Thank you for your prayers for him – he would have been more comfortable showing the group how to do a liver resection than preaching to them! However, the Holy Spirit is working and the sermon has resulted in many heart- to-heart discussions with folks since then. Each day has had some new way of interacting with the members of this

10 The SteffeScope Volume 4, 2001 © 2001 on-fire church. Since they are good Baptists and equate food with fellowship, we are certainly not starving as we meet with various Bible studies, mission groups, and Sunday school classes. It has been a great blessing to us. We will continue here through the three Sunday morning services. Please continue to pray that we will present what the Lord wants us to say. It is fun to see the Lord at work as we talk with people. A couple of weeks ago, we received a request from the Togo mission hospital for electrocautery pencils; today, a medical supply representative shipped a large box to our home, filled with electrocatuery pencils and grounding pads to take to Togo. Another man has promised us help in finding someone to develop or modify a dual currency accounting program. We have a few other projects in mind and will present them over the next few days as we talk to new groups. We look forward to seeing how the Lord will provide. Another blessing has been the wonderful hospitality of our hostess here in Marietta – it has been truly a haven away from home for us. Monday was a rough day for us emotionally. We received a message that Micky’s prenatal blood screening for Down’s syndrome was “positive” for an increased risk of chromosomal abnormalities. The morning was one of uncertainty, sorrow, anxiety and fervent prayer. That afternoon, we met with a genetics counselor who calmed our fears somewhat. After discussing it with her, it appears that this positive result may have been due to a rather marginal increase in risk due to our ages (which we already knew was a risk factor). An ultrasound seems to show a healthy child. After weighing the risks and after some reflection, Micky decided to undergo an amniocentesis so we would know for certain. It will be two weeks before we get the results – please pray for peace of mind for us as we wait and for the strength and faith to accept whatever God’s will is in the matter. Bruce has rearranged his scheduled departure for Togo in order to give him a few more days at home before returning to Africa. He will be leaving March 3 instead of February 27. An item of praise and an answer to prayer – it would appear that the lawsuit brought by Bruce’s ex-partner has come to an amiable settlement. While in Atlanta Thursday, Bruce received a call to tell him about the counter- offer. A meeting of his old surgical group last night decided to accept the counter-offer, feeling it was advantageous to do so. Hopefully, he will be able to sign all his share of the paperwork before he leaves for Togo. Settling this case brings one of the three open lawsuits to a close and we continue to ask the Lord to work in whatever way He deems fit in the two remaining suits. Please begin to pray about the upcoming trip to Togo – for wisdom, patience, safety in traveling and for a ministry for Bruce that would bring both physical and spiritual healing to the patients and staff of the Karolyn Kempton Memorial Hospital. Any success that any of our trips may have is in direct proportion to your prayers. Thank you for your prayers for us this week. We are so fortunate to have friends and family like you. With you all in our corner and God holding us in His mighty hand, how can we lose?

Yours and His,

Bruce and Micky Steffes

Friday, February 23 Dear Friends and Family:

We want to thank all of you who have prayed and written to encourage us while we waited for the results of the amniocentesis. We are thrilled and grateful to be able to report that a call this morning confirmed that all results from Micky’s pregnancy were normal. We are expecting a healthy little boy and we are probably going to name him Sean David. Sean means “God is gracious” and David “beloved”. It is hard to convey our sense of relief, but almost as hard to convey our sense of thanksgiving for both the miracle of this child and for the warmth and love that surrounded us during the period of waiting. We thank God and all of you. We truly feel that God is gracious to us. Our mission conference at Johnson Ferry Baptist Church in Marietta, Georgia finished up Sunday. What a great time that was, sharing our ministry with the combined Sunday School classes of our friends Henry and Bettie Holley. We are eager to see what the Lord will do. Since most of our ministry is really one of sharing and supporting the ministries of others, it was somewhat difficult to figure out what we should ask them to help with. We shared the following three needs: 1. A publisher for the handbook on short-term medical missions. The potential market for this book is small and therefore it may not be financially profitable. We are looking for either a publisher who is willing to take that risk or for an “angel” who will underwrite the cost of publishing. We intend to explore the possibility of turning over the copyright and any profits to Samaritan’s Purse or some other mission agency.

2. Interest in the African burn project. Although all the details have not yet been worked out, we are daring to dream. At the risk of being repetitive to those who remember our previous newsletters on this topic, we will review the rationale for this project and what we have proposed. In much of rural Africa, children sleep in the cooking hut. Fires are made at ground level. They roll over and are instantly in flames. Most African mission hospitals lack whirlpool equipment, necessary burn ointment and often the equipment necessary to skin graft these children. Depending on the hospital, they may need: • Whirlpool units • Disinfectants for whirlpools (1 year) • Antibiotic burn ointment (1 year) • Skin graft machine (dermatome) • Skin graft “mesher” • Total Cost per facility -- $12,000 - $19,000 with ongoing cost $1000 per year We hope to be in Togo when the first whirlpool units that were provided by Providence Baptist Church of Raleigh arrive there this spring. We are excited about this beginning. 3. Dual currency accounting software. We would like to share a lead that we have about which we are optimistic. We have found out that the Canadian version of QuickBooks Pro can handle multiple currencies despite the fact that the United States version does not (which we found out after we spent the money on the new software). We have ordered that software from Canada and look forward to evaluating how well it does so and how well it handles marked currency exchange fluctuations. If it does, our problem of identifying the software may have been solved and then the next phase will be raising the money to provide the software to various ministries (and teach them how to use it!) This week, we have we have been relaxing, visiting Bruce’s sister in Winter Haven, Florida. It has been a great time of rest and fun. We are driving back to North Carolina tomorrow to begin preparation for Bruce’s departure to Togo next Saturday, March 3. It may be interesting for you to know what sort of things missionaries on the field ask for. In the next week, we have to try to: 1. Find a donation of a used flexible gastroscope including suction machines and a light source (used in examining the stomach for ulcers and cancers). We are not too optimistic about this one but nothing is beyond God’s ability to provide! 2. Find and pack a new arc-welding unit for the hospital maintenance shop 3. Find a simplistic inventory software for use in both the medical warehouse and in the pharmacy 4. Find computer cables and computer printer cartridges that were requested 5. Pack our collected medications and medical supplies 6. Shop for and pack the long list of foods, books, magazines, videos, music CDs and over-the-counter medications that we like to take to the field for gifts to the missionaries and nationals. Some of the popular foods are Velveeta cheese, pepperoni, nuts of all sorts, chocolate chips, Kool-Aid®, flavorings, spices, popcorn, dressing and spice mixes. We must never forget the ever-popular American peanut butter! Please pray for: 1. Traveling safety for Bruce 2. Traveling safety for the Cropseys as they come back to the United States for a very brief furlough. They will be attending their son’s graduation from college, meeting with their churches, and thrilling at their first sight of their new grandchild, recently born to their son Matt. 3. Matt Cropsey. He and his wife are still waiting for the necessary funds for support to go to the field as missionaries. Also, Matt is still having some problems in recovery from his back surgery a couple of months ago. 4. The help of the Great Physician as Bruce once again endeavors to serve at the Karolyn Kempton Memorial Hospital, sometimes as the lone physician again. It is an overwhelming task and can only be accomplished with the help of the Lord. Keep praying for Bob Cropsey – we are amazed at his ability to do it day in and day out for years. 5. Micky as she faces the separation and uncertainty of the next three months. Thanks for being our support team. We are so grateful that you are on our team!

Giddy with gratitude, Bruce and Micky Steffes

Friday, March 9 Dear Friends and Family:

Weizo lo! {Your proper response in Ewe (pronounced A-Vay) is a prolonged and falling “Yo”.} Greetings from Togo, West Africa. It is good to be back, albeit without my darling wife. Because of the concern about the possible results of the amniocentesis, I decided about two weeks ago to delay my departure for Togo by a few days. It was good that I did since my passport and visa did not arrive until the day after my previously scheduled departure date. God is even in the details. Last Saturday, Micky drove me to the airport and said good-bye with tears in her eyes. I suspect it was as much that she could not go back to a place and people she has grown to love as the separation we would face. Truly it is difficult for both us to be apart during this time and I would ask you to remember to ask the Lord to keep His gracious hand upon her and the unborn son. Thank all of you who have offered help to her. The 27-hour journey was unremarkable and I arrived in Lome, Togo, Sunday evening on the flight from Paris. Steve Mills, one of the career missionaries who has become a good friend as well, was there to meet me, and to shepherd me and the 5 suitcases through immigration and customs. We were pleased and thank God that we had no trouble in getting the welder and other supplies through without so much as a single inspection. I had been required to pay an excess baggage charge at the Raleigh airport for the extra trunks but avoided extra duty fees here. We stayed overnight in Lome and then drove up the next day. Within an hour of arriving, I was seeing patients in the clinic. It was great to see the many Togolese and expatriate friends here in the hospital, all of whom seemed to want to know about “Madam”. Being put to work within an hour seems quick but is actually the longest I have ever had to relax at any of the mission hospitals. One time, I didn’t even get my suitcases to my room before being asked to help in the operating room! Bob and Shirley Cropsey left the following day to spend a few days in Italy and Austria before returning to the US sometime early next week for the first furlough they have had in several years. Dr. Cropsey has borne the load of being the only career missionary doctor here for several years and I am pleased to be able to spell him. I am now the only doctor on the compound although there are several coming over the next few months to help out. Please pray for me that I might have wisdom, patience and the strength to do a job honoring to the Lord. Karolyn Kempton Memorial Christian Hospital (Hôpital Baptiste Biblique) is a 35-bed hospital serving about 50,000 people. French is the national language but there are over 40 tribal tongues in this narrow little country the size of West Virginia. Here Ewe and Kabiye (“Cob-e-yay”) are the two most common languages although many others occasionally are heard. The mission is an official work of the ABWE (Association of Baptists for World Evangelism). There are presently 12 – 18 missionaries (depending on furlough status) here at the hospital. Most of the work centers on the hospital and the outreach to local native churches, but there is also a French, Ewe and Kabiye literature outreach based here as well. It has been exciting to see the revitalization of a printing ministry here, printing many materials in local languages. In a future SteffeScope, I will tell you about that ministry. An aviation ministry is also being planned for this area and the new hangar is nearing completion. Death and frustration marked my first full day as the sole physician. A twelve-year-old, a nephew of one of the nurse’s aides, came in with seizures and died of respiratory arrest within two hours despite my best efforts. Two woman delayed coming to the hospital when they could not deliver and the prolonged labor led to the delivery of two dead babies by cesarean section. I have already observed that AIDS is a much more significant disease in the awareness of the people around the hospital now. It is too early to tell whether this is an increased awareness due to more testing or whether the disease incidence has increased. Evidence of fetish ceremonies remains common as many patients seek help from the national fetish doctors before coming to the hospital. Although some of the traditional treatment protocols have some efficacy, those that rely on the intervention of the spirit world rarely have any salutary effect. The demon world is usually destructive rather than constructive, brings illness rather than health and therefore when the Lord works in ways that are sometimes hard to fathom to our “civilized” mind, it stands out more dramatically than ever that our God is one of light, healing and love. I would appreciate your prayers about and help with the following things: 1. Peptic ulcer disease is common here and a flexible gastroscope is needed to help make the diagnosis and guide treatment. A new scope can be purchased for $6000. We are also looking for the donation of a used light source and suction machine. 2. They are still trying to find a simplistic inventory software for use in both the medical warehouse and in the pharmacy. Any ideas you may or recommendations of programs would be appreciated

3. Traveling safety for the Cropseys as they travel back to the United States for a very brief furlough. Pray that their ministry will be effective. Please continue to pray for Matt, their son, as he faces a continuing tough recovery from back surgery. 4. One thing that has struck me upon returning to Togo is the higher quality of care that is given to patients here than in many African and mission hospitals. This is based on the philosophy that something done for Christ must be done to the best of one’s ability. A major factor in that is the high quality of the nursing staff, most of whom have been trained at the nursing school here by the missionary nurses. They are about to start their second class of twelve students in 8 weeks but are facing some serious needs. Please consider whether you can help: • $50 provides for one month for one student • $1500 provides for one student during the entire 30 month course • $2500 provides for all of the needed textbooks and reference books for all students • $3000 provides for all printing and photocopy needs for all students 5. Last year while we were here, an oxygen concentrator was delivered and is ready to function except for one thing – the lack of money to install a hospital wide system. Initial estimates are in the $20,000 - $30,000 range. This is a significant sum but one that the Lord can provide through someone or some group. 6. We need to set up a pathology lab. The medical technicians from Samaritan’s Purse (World Medical Mission) are coming this month to install a new x-ray machine (the 1953 Picker unit finally died after years of faithful service) and will be setting up a trial software system that would allow us to send pictures of pathology slides from a microscope to any pathologist in the US. You can understand the difficulty of making the right treatment decisions when we don’t even know what sort of tumor or disease process we are looking at. We must be able to identify a simple system to fix the tissue, cut it with a microtome and stain it so that we can photograph it for the eventual reading. We also face a similar problem with infection. Presently, our treatment is based only on an educated guess about both the offending organism and the sensitivity of the organism to various antibiotics. We need to set up a microbiology lab. These two projects combined will have a cost of several thousand dollars but may save innumerable lives. If you want to help with any of these projects, please make your contribution to ABWE, PO Box 8585, Harrisburg, PA 17105-8585 and mark it either for the general account (#76350) or the nursing school (#76355). Both will have a major impact on the hospital and ultimately, the people of Togo. This week, pre-operative screening on a hernia patient revealed an unexpected positive result for HIV. When informed of the results, the patient, named Adame, told Steve Mills that he had often wondered how he would die and now he knew. He was very open to the good news of Jesus’ death for him. I praise God that the exact mechanism of his death is still unknown, but he now knows he will die gloriously saved. That is what this is all about. More unsaved people go through our hospital than through our churches. Pray that this mission work will always reflect the love of Jesus Christ.

Yours, serving Christ in West Africa,

Bruce Steffes

Friday, March 16 Dear Family and Friends:

The rainy season has begun in earnest. There are two ways you can tell. One is rather obvious – it rains! We have had three nice storms in two days. The brown turns green overnight. During those times of rain, it is almost cool here (compared to noon time temperatures of over 100 degrees). When it occurs at night, you need a light covering – a real improvement over sweltering all night. The second way you can tell the rains have begun? Flying ants (termites) are everywhere each evening. They swarm around any and all lights, crawl in every crack and land on everything – whatever you are trying to do, including the sterile field as you work. They crawl down your collar and up your pant leg. In the morning, the discarded wings will literally be blown into small drifts consisting of nothing but the nearly transparent wings. The only real revenge is to eat them. Protein is protein and they are over 90% protein. I am told they are especially tasty when lightly fried in very hot oil – taste like peanuts, so I hear. Some like them raw. Couldn’t tell you. Didn’t try them. Probably won’t any time soon. This morning we had some other visitors fly in. They were not pests but rather very welcome. Dr Gus Barkett and Dr. Kerry Sullivan have returned for their yearly two-week visit. They have both been here several

14 The SteffeScope Volume 4, 2001 © 2001 times before and there is always a list of patients waiting to see and be operated upon by Gus, an ob-gyn specialist. Kerry is a radiologist and in that our x-ray machines are not functioning, we will have to see if he can remember which end of the stethoscope goes on the patient… I worked with them last year and it was good to see them arrive on the compound this morning and to renew our friendship. The hospital has been constantly busy all week. Steve Mills and I have been keeping abreast of things but have been working hard to do so. We are having a number of patients, especially children, with typhoid fever and we lost a two year old with it yesterday morning. That seemingly senseless death was hard on everyone. This time of year is also a time for meningococcal meningitis, the most dreaded form of bacterial meningitis. I had a woman in her 20’s come in yesterday, comatose. I was so glad that we had the right antibiotics available with which to treat her. Her prognosis is still grim. One of the more difficult cases for me this week was a young Fulani girl, seven years old, by the name of Fatima Ibrahim. She presented with a left arm chronically swollen to twice its normal size and with a huge open running sore at the elbow and running sores on two of the five fingers. Her hand was so swollen that the fingers stuck out like little sausages. She was unable to bend them. X-rays showed that the bones of the forearm and hand were destroyed by osteomyelitis, an infection of the bone. After consultation over the Internet with three different orthopedic specialists, the consensus was unanimous – she needed her arm amputated. It was left to me to discuss this with her family. The Fulani are a tall and slender people, physically attractive and always dressed in a unique and colorful way. Their dignity is attractive to me in some difficult to describe way. They are Moslem. It was hard, both emotionally and practically, to go through two interpreters to explain again why such mutilating surgery was the only thing we could offer and to try to get them to understand that failure to act reasonably quickly could jeopardize her health. The father agreed but the mother was not happy and sat with jaws clenched and eyes ablaze. I asked them to think about it and come back this past Monday before we made the final decision. Again, father agreed and mother was angry so as is customary in this culture, Papa wins. Tuesday, I did my best to sedate the child and make the parting as painless as possible for both mother and child, but I will not forget the mother’s banshee-like wails that followed us as we pushed the child on the gurney out the doors to the operating room. The surgery went technically well but as I placed the dressing, the four-inch long stub of the upper arm seemed unfairly and obscenely grotesque. Although admittedly necessary, my mutilation of this beautiful child made me faintly ill. On rounds each day, we do our best to show our love for this child and for the parents. The first few times, the child’s mother pointedly ignored us but as the child has recovered somewhat, the relationship is thawing a bit. Today, Steve Mills talked through an interpreter to explain that we were treating her as we were treating our own and that we did not want her to be angry with us. We have had several prayer sessions, praying that despite the language barrier that the love of Jesus Christ will be evident and this family might turn from Islam to Christ as Savior. Please join us in asking that Fatima will heal without further infection and that they will see the Light, all of them. Death and unnecessary disease are always the hardest things for me to handle. So many patients delay their admission until they are near death’s door and then they come in. It is a rare day where someone does not die or deliver a dead baby that might have otherwise been salvaged. Right now, we are fighting for the life of a 14-year- old woman who took some traditional herbs and then instrumented herself to get rid of the three-month pregnancy. She is gasping for breath because of the effects of the sepsis on her lungs. Another elderly man had an incarcerated hernia that he hoped would go away as he sat at home with for three days before coming in – the loop of intestine had lost its blood supply and was dead and reeking. He too is fighting the effects of sepsis and requires oxygen. Unfortunately, they are often out of their minds from the infection and they might never respond to the gospel before they pass off into eternity. It is often more important to spend a few minutes telling them of a God who loved them before we take them to the operating room in an attempt to save life or limb. Given the language barriers, it is difficult for me to do that well – one of the distinct disadvantages of being a short-termer. I am so glad for the two godly men who are the hospital chaplains and for the rest of the staff, both expatriate and Togolese, who take such a responsibility very seriously. This week, I had the opportunity to meet a man in his thirties who had an injury that with neglect, and despite the ministrations of a national healer, turned gangrenous. Dr. Cropsey had to remove his leg below the knee a few weeks ago. This outpatient told me through an interpreter that he was grateful for the injury – because now he knew about Someone who had died on the Cross for him and he knew where he was going for eternity. His family also came to know the Lord. This transformation came about because the lab technician (with the strangely apropos name of Divine) continued to work with him after discharge and led him to knowledge of an assured salvation. The prayer list for this week: 1. Fatima Ibrahim, her family and the others who are near death.

2. For salvation for all the Moslem people in Togo. In April, Dr. Viggo Olsen, who spent his career in Bangladesh and who has a heart for the people of Islam, will be coming with others to explore how best to evangelize Moslems in Togo. Please pray for wisdom for that team. 3. Identification of a simple inventory software for the medical warehouse and pharmacy. 4. The financial needs of the nursing program that I discussed last week and the selection of the proper students. I am thrilled at those of you who have offered to help. Thank you so much. 5. A flexible endoscope (gastroscope). 6. The wherewithal to install the hospital wide oxygen system that I discussed last week. 7. Equipment to prepare slides for pathology and also a microbiology lab. 8. Gib and Marilyn Dickinson, career missionaries who have returned to Togo, as they settle in and figure out how best to help plant new churches as an outreach of this hospital, following up and making disciples of those who came to know Christ here. 9. Praise – the outside phone lines are back up after being out for four days. I strongly dislike being without e-mail, especially with a pregnant wife so far away from me. 10. Praise – for all the notes of encouragement and all the prayer that I can feel covering me from day to day. 11. That I will have the strength to work as I need to, the wisdom to heal, the skill to operate, the ability to encourage the career missionaries and Togolese staff alike, the love to see each person I meet as God does and the transparency to let Christ’s love shine through all that I do and say. I am a tad overwhelmed at times, but glad to be serving under the One who can do it all!

Bruce Steffes Friday, March 23 Dear Family and Friends:

Today we hit another milestone at the Karolyn Kempton Christian Memorial Hospital -- surgical case number 10,000 was performed! It is hard to believe that there have been ten thousand surgeries performed since the hospital opened in 1985. That is a great tribute to all of the fine men and women who have worked here over the years. Late this afternoon, Dr. Gus Barkett, a visiting obstetrician, performed a C-section and a healthy baby boy was born. Dr. Kerry Sullivan and I gave Gus unmitigated grief because I had an emergent case already scheduled that would have been number 10,000. We accused him of being so jealous of the fame and attention that would accrue to such an event that he convinced himself that an unnecessary (at least to the impartial bystander such as myself) C-section was somehow necessary. It goes without saying that there are no sour grapes on my part… Instead of dwelling on such blatant attention-grabbing maneuvers perpetrated by publicity hounds, let me tell you a little about case number 10,001 (which should, of course, been number 10,000 but who is counting?). Komla Desire Ayissou is a one-month-old boy with a massively distended abdomen. It was to the point that the child had trouble breathing because of the pressure on the diaphragm. The belly was so tense that it was shiny and the baby was significantly dehydrated. The child needed help desperately. Three days ago, the surgeons in one of the Lomé hospitals made a diagnosis of probable Hirschsprung’s disease (congenital aganglionosis). Because the colon in these children develops without the requisite nerve supply, it cannot dilate to act as a needed reservoir and it effectively causes an obstruction. If allowed to persist, it can cause a rapidly progressive lethal inflammation of the colon, which can perforate or make the child toxic from infection. Alternatively, it can cause a slower but equally lethal obstruction. Because the baby’s parents could not come up with enough money to buy the needed surgical and hospital supplies and pay the demanded surgical fee, nothing was being done and the child was slowly deteriorating. Today, they decided to come here to seek help. The child’s father is a student in one of the Assembly of God Bible schools in Lomé. A complicating factor is that the child already has the ginger-colored hair of a patient with kwashiorkor (severe protein malnourishment). Poor protein stores and chronic illness make high-risk surgery even more so. The lack of a functioning x-ray machine forced us to proceed on only a clinical diagnosis without any confirmatory x-rays. The lack of a sophisticated lab like we take for granted in the US made determination of some of the co-existing risk factors hard to ascertain. The lack of nutritional support makes the outcome much less certain. With many prayers, we proceeded with surgery tonight, praying that our diagnosis was correct and if it was, that the little child could tolerate the stress of surgery. I found what I expected and the surgery went well. Now infection and nutrition will be the greatest obstacles. I was able to place a colostomy and hope that he can be reconnected (and reconstructed) with 18 – 24 months. Please pray for healing for this little one.

I want to thank you for your prayers for the patients, your prayers for the work the team is doing here and your prayers for me. Let me give you some follow-up on the cases I have mentioned in previous editions of this newsletter. Little Fatima Ibrahim, the seven-year-old Fulani girl, was in the clinic today, all bright-eyed and bushy- tailed. She offered me a spontaneous smile that repaid all my efforts on her behalf. Despite the language barrier, her mother was also very congenial and obviously much less hostile. Fatima’s wound is almost healed and I have discharged her to return for a wound check in four weeks. We have had trouble because of the language barrier in communicating the Gospel but we can only pray that we have followed the advice of St. Francis of Assissi when he said, “Preach the gospel daily. If necessary, use words”. I only pray that she saw something here that would give her the hunger to find God and that God will use someone to seek her out with more news of the Savior. The two patients who were overwhelmingly infected and having trouble breathing because of the resultant lung problems have also recovered and been discharged. They are not out of the woods yet, but are heading in the right direction. (By the way, the hospital could still use someone to underwrite the installation of the hospital-wide oxygen system!) They have both had a chance to hear the Gospel several times since they regained normal brain function, but as far as I know, have not yet accepted Him as their Savior. The young woman with meningitis is slowly recovering. Despite fevers in excess of 106 degrees for two days, she is slowly regaining function. She has several areas of neurological loss (questionable deafness, paralysis of the left upper arm and paralysis of lateral movement of the right eye) and is still in the need of a lot of prayer and healing. Please do not stop. I want her too to be able to hear the good news. This week, we had an interesting interlude. Suzanne Schmitz, a Southern Baptist missionary, was flown into our landing strip for treatment of debilitating dysentery. She and her husband Burt work in Dapaong, as far north as you can go in Togo before you get to the country of Burkina Faso. The arrival of the plane was a point of great interest for all the folks around and within seconds, a hundred or so interested spectators arrived and crowded around the Cessna 206. Since the local authorities have been told repetitively that this airstrip represents a “terrorist threat”, they arrived in their civilian clothes to scope out the situation before they identified themselves – to arrive in their uniforms could get them shot if terrorists had landed! We thank God that Suzanne is recovering rapidly. Pray with the missionaries in Togo that the developing aviation ministry here will someday have a major impact for the work here. The tragedy of AIDS continues to impact our daily care. This region of Togo has the highest prevalence of the disease. Three of the interviewees for a potential slot in the new class of nursing students were found this week to be positive for HIV upon screening. What a tough thing for the missionaries to counsel them and inform them of this tragic abbreviation of their life. Pray for them. If it were me to whom such news was being given, I don’t know how I would handle getting that diagnosis when I thought I was healthy. AIDS is such a scourge. Over 50,000,000 people alive right now will die of the disease worldwide and most of them are in Africa. Most of those are dying with knowing Christ. What is the church of Jesus Christ doing about it? Are we doing enough? Do we care enough? Do we pray enough? Do we reach out to care for the dying? For their orphans and families? Do we give enough to help those who are on the front lines? It is truly a God-sized problem, but our job is to be where He is working. Some people have told us that mission efforts should just let the local indigenous church take care of their own problems. Since I refuse to think that such a way of thinking represents callousness, I prefer to believe that such comments are indicative of a poor understanding of the severe limitations under which these national congregations labor. When the average income for much of the world is the equivalent of a dollar a day, there is not a lot of extra cash lying around! As Americans, we are used to having a significant portion of our budget as discretionary income (we can spend it where we want) and in reality, much of our previously committed budget items really reflect personal decisions in the way we want to live rather than true non-discretionary items. Almost none of us live at the level where our budget forces us to make decisions between eating and not eating. One of the hospital employees is working with a seminary student to open a new church in a nearby village. When I asked how someone might be able to help, the budget for benches, hymnbooks, Bibles and transportation needs was figured and given to me. The grand total on the sheet of paper was $94. My wife and I may blow that much on a special dinner for friends and us – but here it represents three months wages and beyond anyone’s practical ability to underwrite. For the price of a dinner back home, a new work can be started in an unevangelized village. This sort of realization makes me struggle with my own priorities and makes me reclassify a great number of my “needs” into what they really are – life style choices and “wants”. How do I make my spending consistent with God’s demands on my life? Sorry – didn’t mean to get so “heavy” in my thinking. It is just that I see so much that we can do to help make significant strides in propelling the advance of the Gospel and it is frustrating to realize that as Americans, we spend more each year on chewing gum than we spend on missions. So little given to God can do so much. He needs none of it but He honors the right spirit.

I thank God for each and every one for you. I pray for you too and am coveting only your prayers.

Yours serving Him,

Bruce Steffes

Friday, March 30 Dear Family and Friends:

One of the medical students I worked with last year in Kapsowar, Kenya, wrote me recently in response to one of the newsletters: “Life where you are seems to encompass the extremes of emotions: tragedy and then healing. I'm sure it doesn't seem that way to you all the time and I have seen enough of mission work to know there isn't nearly anything romantic about it. Thankfully, I didn't expect it to be like that or I would have been really disappointed.” I gave some thought to her observation. She is right in that there is not anything romantic about what is done at most mission hospitals – most of the time, it is hard work. I wondered however whether I was somehow wrongly emphasizing or overemphasizing the extremes of emotions that we all go through. I will admit that such stories are more interesting to write and presumably more interesting to read. Is it like that all the time? More often than not. A boring day occasionally would be nice. In the past week, we have had the usual number of incarcerated hernias, acute abdomens for probable typhoid fever, emergent C-sections, and the usual amount of routine surgery. We have also had two young children and a young man with unresectable tumors of the head and neck. We have had a young woman virtually bleed to death during a C-section because the placenta would not separate properly (placenta accreta). Attempts at removal caused the uterus to turn inside out and then it wouldn’t contract properly which ordinarily stops the bleeding. Blood was in short supply and during her resuscitation, I had to take time out to lie down and donate a pint for her (I did get a much appreciated ice cold Coke from the blood bank in payment!) Another woman presented with four units of blood in her abdomen, caused by the bursting of an old scar from a previous C-section. We were able to save her life, but lost the baby and she had to have a hysterectomy. A thirty four year old woman presented with metastatic cancer to her liver and neck but who accepted the Lord as her Savior that day. A twenty-four year woman struggled with a diagnosis of AIDS. A woman went into premature labor at five months into her pregnancy and delivered a grotesque fetus, deformed by some sort of cystic tumor distorting the head, neck, chest and abdomen. Another woman was referred with a dead full-term infant and we had to use general anesthesia to finish the delivery when the shoulder stuck. Taking all into consideration, I guess I wasn’t exaggerating the extremes at all. The milestones just keep coming. Last week, we celebrated the performance of the ten thousandth surgical case. Today, we celebrated a more personal milestone – Mary Jo Mills performed her thousandth spinal anesthesia. Of course, we gave her all sorts of “encouragement” including having everyone watch her do it, have the OR staff point and give suggestions and having open discussions about whether it would actually work or not. She ignored us and did a bang-up professional job once more. Yesterday, Dr. Gus Barkett, his daughter Ann, Dr. Kerry Sullivan, his wife Barbara and his daughter, Jennifer, all left for the US. Dr. Barkett kept busy in his specialty of gynecology and obstetrics and Dr. Sullivan did a yeoman’s job in holding down the clinic. Without his willingness to work outside of his comfort zone (the specialty of radiology), we would not have had the opportunity for Steve Mills to get free enough to spend some concentrated time in learning surgical techniques. This is the third time the two physicians have been here and the first time for Barbara. I think it is safe to say that she had a great time. She and the two girls, when not doing the obligatory homework for their schooling, worked in the Christian Resource Center and in the printing shop. Kellie Mills also had a great time with her visitors. They spent some free time with the children, with the national staff and even went witnessing on the wards and in the “cuisine”, the open kitchen area where the families stay and cook for their loved ones in the hospital. It was fun to watch the teens’ excitement when someone in the cuisine responded to their faltering attempts to witness and came to personally know the Lord. In total, four women came to know the Lord because of the efforts of the three teens. Of course, sandwiched into all of that were the required numbers of pajama parties, discussions about music and guys, hair-arranging and nail fixing sessions that occur when three teenaged girls get together. The end of this week, we were visited by Glen and Eunice Priddy, the Director of Missionary Finance for the Association of Baptists for World Evangelism, and their pastor and his wife, Ches and Elaine Carr. They are on a swing through Ghana, Togo and The Gambia visiting the ABWE missionaries there. Sunday, we will have a new medical student, Loretta Scheler, coming here. She will be here for about a month. Next Wednesday, two new

Praise and prayer items: 1. Please pray for traveling safety for all of these folks and for a productive and meaningful experience for the medical personnel who are coming. Perhaps the Lord will speak to them about a career in missionary medicine. 2. Praise God for those who are willing to come to help out. 3. Please continue to pray for the nursing program as they finish the selection process, attend to the myriad of details necessary to get it started again and the continued need for funding. 4. Shortly before I left for Togo, one of the women in our Sunday School class, gave us the name of an old friend of hers who was in the publishing business. She suggested that I contact him about the handbook that Micky and I are writing. I did so and sent a prospectus describing the book. I was very pleased this week to get an e-mail from him saying that he was favorably impressed with what he had read and would talk to some of his contacts. This week has been very productive for me in that arena, as I have finished the rough drafts on six of the chapters in the past week. I am not sure yet how many more I have to go, but I would estimate that I am probably about one quarter of the way finished. Obviously, once the book is written, then it will have to be gone over with a fine-toothed comb and rewritten and rewritten. Please pray that I can continue to write at a good pace and that I will be writing what the Lord would have me say. 5. I have also been asked to speak to the missionaries here at Tsiko during the Sunday night service. I hope to challenge them and encourage them – pray that I would do so. 6. The meningitis patient has survived despite here initial fevers of 106 degrees but still has dense neurological deficits. She has not made a decision for Christ. Please continue to pray. 7. Praise that little Komla, the Hirschsprung patient from last week, did well after his emergent colostomy and has gone back today to his home in the capital city of Lomé. 8. Praise that Micky continues to do well, both from a health standpoint and as she copes with the distance. Her mother will be arriving soon to stay for two weeks and that will help. 9. Pray for the new work at Danyi Koudzaragan. One of the men attending the new church seems to be leaning heavily toward Christianity but he is the number two man in the village. His prestige, power and position in the village comes from his function as a leader in the voodoo and fetish spirit world. His conversion would carry great weight but it must be a true and valid one. Pray for his salvation and for the encouragement of the pastor and hospital staff who are starting this work. I was able to use some of the money that many of you have given to us for such purposes, and soon they will have their very own hymnbooks, Bibles and benches upon which to sit. Last week, most of the congregation had to stand because they had to return the benches to the church from which they had borrowed them. They are grateful to you for your generosity. 10. The local Christian congregations here are being affected by sin and sexual immorality. Please pray with me for a true revival within the church and hospital here for both Togolese and Americans. 11. One of the employees has told our hard-working chaplain that his work is not really important. It is indicative of the spiritual state of even some of the employees and has been very disheartening to him. Pray for his work, that the Spirit will give him peace and give him the fruit that will demonstrate to all that medical missions is about evangelism. My care might lead to a physical cure of a few years; his pastoral care might have eternal consequences for good.

Keep praying – it makes all the difference. Yours because of His great love,

Bruce Steffes

Friday, April 6

Dear Family and Friends:

What a week – seven such days make one weak! I have said before that I don’t know how Bob Cropsey keeps this pace up year after year. Still don’t. Pray right now for strength for that man and his wife. I have been the

19 The SteffeScope Volume 4, 2001 © 2001 primary one on-call all week because Steve Mills was busy traveling last weekend and this week has been suffering with malaria. Other missionaries are suffering from parasitic disease, amoebic dysentery and fatigue. Pray for them! I had a severe headache that lasted several days this week and I questioned whether I had malaria, but like my Grandmother Stock would say, “I didn’t have time to be sick so I couldn’t have had it.” I don’t have an agenda or a theme this week, just some jumbled impressions and thoughts. Here are some random reflections, vignettes and cases of this past week: One woman in labor had an odd appearance to her abdomen and we could feel a hard area above the uterus. She didn’t progress with her labor and the baby began to show signs of distress. We proceeded with a cesarean section and I was surprised to find a large mass above the uterus. To make a long story short, I delivered a 6 lb 8 pound baby and then a 13 lb 4 oz dermoid tumor of the uterus. The hard area that was palpated before delivery was a piece of bone in the wall of the tumor. This is the type of tumor where the many types of tissues are present but all jumbled. Hair, skin and bone were obvious in this one. We have no microscopic capabilities, so I cannot say more about what else was there. But now for the rest of the story…. During that surgery she had dropped her blood pressure to very low levels and then did it again in the late evening. I ordered two units of blood for transfusion. Her husband was one of the donors and was found to be HIV positive. We were not able to inform him of his disease for several days and there are many here who would criticize us strongly for telling him at all. Even the pastors get angry with us for doing it, but it seems self-evident that people view things differently when they know they are dying. It would be hard to stand before God’s throne and explain that we never told this patient of Christ because we didn’t want to make him feel bad enough to seriously consider whether he really needed Him. Fortunately, the woman was not HIV positive when she was tested subsequently and so the baby was spared the exposure to the virus. Unfortunately, the mother had probably developed pituitary dysfunction from the very low blood pressure and she is not producing milk at all (Sheehan’s syndrome for you medical types). We recommended that they find a wet nurse because they can’t afford pre-mixed or even homemade formula, but will have to make sure the wet nurse that is recruited is HIV negative too. Not so easy in a culture where more and more are turning positive. What horrible consequences of a few minutes’ infidelity. Fortunately, Steve Mills got a chance to talk to him today and he accepted Christ. Another young man from deep in the bush came in after an argument with his brother. He lost. His brother had a “coup-coup” (a machete) and effectively severed all the fingers of his left hand, leaving only his thumb, and severed the fifth digit on the right hand, too. A blow to the forehead with the blade fortunately just glanced off. I had to take him to the OR and complete and close the amputated sites. Anger and most probably alcohol. Two patients who had complications of herbal treatment – one woman had an abortion induced with some herbal concoction. She developed massive ascites. There is little I can do for her here. I suspect a rather rare condition called Budd-Chiari syndrome variant caused by distal venule obstruction that is known to have as one of its causes the “bush teas” containing pyrrolizidine alkaloids and other cytotoxic agents. A big mouthful of words reflecting hundreds of years of cumulated medical knowledge. Such knowledge is useless because we can neither confirm nor treat the diagnosis here. Don’t even have all the diuretics we need to treat her optimally. A mesocaval shunt or peritoneal-jugular shunt is a pipe dream. Unmarried sex, ignorance, and limited resources. The other was a man with an incarcerated hernia. Consulted a herbalist before coming here and drank some sort of drink. There was a red residue on his hands and on his groin. He was writhing in pain out of proportion to the length of time that he had been incarcerated. As soon as we reduced the hernia in the operating room, he passed liters of bloody stool. He continues to do so intermittently. That concoction must have taken the lining right off of his intestine. Not sure he will live. We did make sure he heard the gospel at least once after surgery and have been continuing to counsel him. No decision yet. Another case that is the result of ignorance and poverty. On to lighter subjects: Wednesday morning, all the nonessential members who could be spared from the hospital work met for three hours of prayer and preaching. I understood only the occasional word of the French but understood the desires of the hearts of those who were leading it – a staff turning on their sin and uniting in a desire to present Jesus Christ. Please pray for a true revival; starting with the hospital staff and missionaries here, let it spread through all of West Africa. It may come from the younger generation. As I write, the sounds of dozens of little girls singing hymns in Ewe is coming in the window on the left and the boys are joining in an unintentional contrapuntal arrangement as their songs come in the window on the right. The weekly afternoon joy club has as many as 150 boys and 50 girls – the hope of Togo hearing of the Hope of heaven. And now a few paragraphs adapted from the introductory chapter of the handbook that Micky and I are writing. The question is on the topic of why should God’s church be involved with medical missions. “Jesus was. His ministry of healing and the message of salvation are intertwined in every book of the four Gospels. Matthew 14:14, “And Jesus went forth, and saw a great multitude, and was moved with compassion toward them, and he healed their sick.” His healing was not designed as a

“hook” to get to people to listen to the message but a totally consistent outflow and consequence of His love for the people around him. It was not designed to be manipulative nor to be impressive in a false way. “Healing is totally consistent with God’s nature. He is Jehovah-Rapha, as described in Exodus 15:26: “He said, "If you listen carefully to the voice of the LORD your God and do what is right in his eyes, if you pay attention to his commands and keep all his decrees, I will not bring on you any of the diseases I brought on the Egyptians, for I am the LORD, who heals you." Psalm 67.2 reads “That thy way may be known upon earth, thy saving health among all nations.” The major driving force for medical missions must be evangelism, the telling of God’s love for mankind. Medical missions that does not have evangelism as its raison d’etre is really just social work, not missions, and while that social work may be a good thing, it is not the best thing. The hospital and clinic can be a fruitful and fertile ground for evangelism when the medical work is done as a work of compassion and a natural outflowing of Christ’s love in us. As David Kilel, the chaplain at Tenwek Hospital in Bomet, Kenya pointed out, ''More unreached people will go through our hospitals than our churches.'' I will never forget Micky and my experience of visiting last year the Tamberma, an unreached people group of the northern part of Togo, West Africa. A primitive tribe, their lives are as saturated with fetish and ancestor worship as it seems possible to be. We were very surprised when, after the gospel message given by the veteran missionary, two of them responded with the news that they were already following the “Jesus path”. When we later asked how they had heard, they had been to this small Christian hospital almost 500 miles away for medical care. It is probably safe to assume that they would not have gone that far to hear a preached sermon, but medical necessity required them to do so – where they saw a sermon lived out and they responded to their Savior.” You want to read more? Buy the book! Back to this past week: It was only a small percentage of the missionaries last Sunday night, few in number because of travel and illness, but I enjoyed the chance to lead the devotions with them. The Spirit was there as we looked at all of the times in the Old and New Testament that God used nothing to make something. He takes what the people had – a cruet of oil, a stone, a little flour, a staff, a cloak, 300 men, two mites, a few barley loaves and a couple of dried fish – and made a miracle each time. He didn’t ask that they come up with their own resources or do things in their own strength – only that they be willing to be used. What about us? Where is God working in your church, your hometown or here in Togo? How can we join His work? Can He take a little 35-bed hospital and make it the center of a nationwide revival? Can He use a young couple armed with old printing presses and a heart to serve, combine it with a woman who loves God and runs a literature distribution service, and make little Tsiko the center of a literature-based ministry of revival, public health and discipleship? Can He use three nurses to create a nursing school that may generate nurses, nurse practitioners and physician assistants who take the complete physical and spiritual healing of God to the people? Can he take the little Bible Institute and with its graduates, light a fire of revival and salvation that changes the face of Africa? Can He? He is still the Alpha and Omega, the same yesterday, today and tomorrow. Yes, He can! He doesn’t need our resources and we can’t hide behind their limited nature. The question is always whether we will join Him – always whether you will join Him. This week, three have joined the effort. Loretta Scheler is a fourth year medical student who will be here for two months. Vivian Pearson and Colleen Clendenin are residents of the pediatric department at Johns Hopkins and will be here for a month. They have come under the aegis of World Medical Mission, too and Colleen has been to Tenwek in 1998, the year I was there the first time, although we didn’t ever meet. Teaching is something I love but it is time consuming and requires patience. I struggle to have enough of both of those. Please pray that I will model Christ in all ways for them, for the patients and for the missionaries I strive to serve. Pray that this will be a time where God speaks to them in a way that will affect their life as Christian physicians forever. In closing: Jesus said, "'Love the Lord your God with all your heart and with all your soul and with all your mind.’ This is the first and greatest commandment. And the second is like it: 'Love your neighbor as yourself.'” How are you doing? I fail each day but He picks me up, brushes me off and loves me anyway. What else is important? The apostle John referred to himself as the “one Jesus loved”. So can I, despite my failures. I am not being presumptuous. I know it…He loved me enough to die for me once and to forgive me daily.

Yours and His, imperfect and loved,

Bruce Steffes

Friday, April 13

Dear Family and Friends:

We all know one. The kind of person who you hesitate to ask how they are – because they will tell you. Ache by ache, system by system. A true organ recital. I don’t want this newsletter to be like that. It is very easy to let this letter slip into a sort of grand rounds – gee, look at all the fascinating medical cases we have seen this week. My motivation behind the writing of these letters has always been different. I want to try, the best I can, to herald the unheralded and let you know what a magnificent job that the missionaries are doing as they struggle each day to carry out God’s commandment to reach those who do not know Christ with the message of His love. I want to let you have a glimpse into their struggles, their resources, their heart and their work. Even the medical stories are told to demonstrate that there are people behind the fascinating findings – people, who despite their differing hues of skin color, differing culture and differing educational backgrounds, hurt and bleed and struggle with the same types of things that you struggle with at home. Admittedly, they do it with vastly different levels of resources. I want you to know that some are dying because of the lack of the very resources that we waste and to challenge each and every one to ask daily, “Have I done my best for Jesus?” At the very least, I want you to pray for this work and the thousands like it around the world. That being said, let me tell you of some of the fascinating medical cases we have seen this week…. Tuesday, one of the short-term pediatricians was asked in clinic to evaluate a child who had been born elsewhere the day before. It had an odd bulge around the middle and when she unwrapped the child, she was surprised to see a grapefruit-sized omphalocele. Now class, you will remember that the intestine actually develops outside the abdominal cavity for a time during fetal development and then as the fetus grows, it is pulled back inside the abdomen, rotating into the usual place. This is how God gets 30 feet of intestine into the small space. In these children with omphaloceles, that process is arrested and much of their intestine, liver and spleen remain outside. In an omphalocele, it remains covered by one of the layers of the umbilical cord but this covering is not durable and if the child is to survive, the abdominal wall must somehow be stretched back over the intestine. All of these children will not have the proper twisting of the gut into its usual position (which can cause its own set of problems) and many of these child have associated developmental abnormalities, including serious heart disease. Getting things back is not a simple matter either. The abdominal cavity developed without sufficient room; if everything is simply stuffed back in and the abdomen closed tightly, the children cannot breathe on their own because their diaphragm is not strong enough. So the trick is to put a little in each day and let the child get used to it. This has its own limitations. Too slowly done and infection and malnutrition set in. Normally, in the US, we use the ventilator and intravenous hyperalimentation to solve these problems. Neither of those modalities is available here. Finally, even if you do everything right, many of these children die because of the associated congenital problems. With all of that in mind, we promised the family to do our best, prayed with them and began. We ordinarily use a special silastic impregnated sheet to create a “silo”. It is so named because it is the general shape of a farmer’s silo. After stretching the muscles manually to gain as much room as we can, we sew the sheet around the edges of the abdominal musculature and then sew the top shut. Each day, we take the child back to the operating room and slowly roll the top of the silo down, much like a tube of toothpaste, forcing the contents inside and forcing the abdomen to stretch a bit. Too fast and the child can’t breathe; too slow and infection will make the silo come undone in a few days. We didn’t have the special (and expensive) sheets, so we looked around to see what we could improvise with. Dr. Sullivan had brought a couple of bags of intravenous fluid in case he needed them and had left them. We cut them up and used the sterile plastic for the bag. It worked great and when we were done that first time, we had reduced the volume of the intestine outside the abdomen by 50% and the little silo stood up proudly, emblazoned with the words “D5W/Lactated Ringers” in bold print across the top. The child gave us a scare at one point during the operation, dropping his blood pressure and oxygen level, but since then, has done remarkable well with God’s help. We have taken the child back twice on subsequent days, tightening the silo. Tomorrow, we hope to go back, do a complete procedure for malrotation and close the abdomen. It may only be covered with the skin, but I will be more than glad to accept a big hernia in a live baby – it can be fixed at some later date. This will be a risky procedure as far as the baby is concerned – please pray for the child and for us. Even if he tolerates the closure, there is a long way to go before we can get the child on adequate nutrition. At his present weight, he has no reserves. If he lives, it will be all God’s doing. We do not think the family has yet accepted Christ as Savior – we pray that no matter what the physical outcome, they will come to know peace in Him. Another fascinating case was more mundane but demonstrates one of the unique problems of just scratching out a living here in Togo. Cassava (manioc) is the main food staple in this area. A large tuber, it has two

22 The SteffeScope Volume 4, 2001 © 2001 varieties, one of which is very bitter but edible if properly prepared. If properly prepared by boiling it a long time, the cyanide that gives the bitter taste can be removed. Once boiled, both the bitter and non-bitter varieties are further prepared by placing the vegetable in a huge pestle and then the women pound it into a thick paste called “fufu”. It is eaten with a sauce that is flavored in many ways, usually very spicy, made so with hot peppers or ginger. The fufu is often eaten at each meal as the main “filler”. Three times a day, fufu. I use the term “filler” advisedly, because it has very little taste. Even if it is not flavored by the sweat of the women who make it (as they lean over the pestle, I have seen the water run off their body into the pestle – I guess if you look on the bright side, it saves on salt), it is not remarkable. Very bland. Library paste that is drying out comes to mind. Anyway, back to the story. We had a little child come in who was seizing. Three members of his family were also ill but he was the most ill. He had cyanide poisoning from the cassava. We don’t quite understand whether it was not cooked long enough and the water not properly changed or whether the poisonous water was used for something else they ate. In any event, there was not too much we could do but control the seizures with Valium and take the advice of a tropical medicine book and wash out the stomach with a glucose-containing solution. The book did recommend trying to instill a solution of potassium permanganate down the tube to counteract the cyanide. Right! Unfortunately, I forgot to pack my potassium permanganate this trip and so did everyone else. I vaguely remember the stuff from high school chemistry class but there was no chance we had any here. The child ultimately lived and went home. I knew that manioc was poison and have known so since I was a kid. Why would I know that? Tapioca is made from manioc and since my sister, with whom I was always fighting, loved tapioca, I had always harbored the vague hope that somehow enough of the poison would get through to her. I didn’t want her to die exactly, just suffer a little. I was a despicable child, no doubt. This week has not had any remarkable great spiritual highs or lows – just the constantly abiding presence of the Holy Spirit as we have worked our tails off. We have done 22 cases in the past three days and have filled the hospital to overflowing. Many have terminal disease and we can only hope that the spiritual cure we tell of is taken internally. In Malachi, chapter 1, the prophet quotes the Lord as objecting to receiving blemished sacrifices. He says that we defile Him when we don’t offer our best. Last Saturday, most of the mission compound spent all morning in the intense heat, trying to go through the warehouses and storage containers, trying to identify medical equipment that needed to be repaired. Two biomedical technicians are on their way from Samaritan’s Purse (World Medical Mission) to install a badly needed new x-ray machine to replace a 48 year old veteran machine from the Korean War era that finally died. We don’t them to be bored or have a moment to spare and we have much equipment that is malfunctioning because of the voltage fluctuations, dust and plain old-age. We found some fascinating things. Several pieces I recognized from medical museums (or sadly to say, I am now old enough that I once used them as a medical student). We also found such useful items as an army surplus ski repair kit (very handy in case your skis break while skiing Mount Togo in 100 degree heat). We laugh and talk about the famous stories of used tea bags for the missionaries, barrels of used clothes suitable only for rags and other such things. “Junk for Jesus”. I personally am grateful for and strongly endorse the efforts of such groups as World Medical Mission, International Aid and TECH who try to ensure that the stuff they send is appropriate technology, works perfectly, has enough spare parts and has the complete operating manual. It prevents wasting precious resources paying for shipping and paying of duties, only to have it not work when it gets here. Every hospital has rooms of equipment that is not working because the technology is too primitive or too advanced, the spare parts unobtainable or the conditions too extreme to have it stay in good working order. Is it honoring God to send your second best to the missionaries to use? Don’t get me wrong – much of it is very useful and very much appreciated. Being used is not the problem as much as it is that some of it is the “second- worst”. Let me make an appeal that you consider very carefully what you send and how you send it. But that is not really my point at all. My point is that often I am guilty of exactly the same thing in my own personal life. I am willing to give the Lord something – but not my best. Malachi talks of offering blinded animals for sacrifice instead of the spotless animal, free of blemish. We wouldn’t give them to our rulers or our friends for fear of being thought mean or cheap, but we offer the Lord God Almighty less than our best. Do I decry the “Junk for Jesus” campaign when it inconveniences me but run my own “Junk for Jesus” campaign in my own life? Some quick praises and prayer: 1. Thank God that everyone is finally again hale and hearty. 2. Thank God for the other short-term missionaries that are making this busy stretch tolerable. 3. Pray for the upcoming visit to Togo by Dr. Viggo Olsen and his team and that the missionaries here can use his expertise to devise a reasonable strategy for the evangelism of the nation of Islam. 4. The healing that the Lord has provided for many of the patients I have mentioned before. 5. That we all eradicate the “Junk for Jesus” campaigns in our own life.

Grateful for your prayers, I remain yours and His in West Africa,

Bruce Steffes

Have I Done My Best for Jesus? By Ensign Edwin Young

I wonder, have I done my best for Jesus, Who died upon the cruel tree? To think of His great sacrifice at Calv’ry! I know my Lord expects the best from me.

The hours that I have wasted are so many, the hours I’ve spent for Christ so few; Because of all my lack of love for Jesus, I wonder if His heart is breaking too.

I wonder, have I cared enough for others, Or have I let them die alone? I might have helped a wand’rer to the Savior, The seed of precious Life I might have sown

No longer will I stay within the valley – I’ll climb to mountain heights above; The world is dying now for want of someone To tell them of the Savior’s matchless love.

Chorus: How many are the lost that I have lifted? How many are the chained I’ve helped to free? I wonder, have I done my best for Jesus, When He was done so much for me?

Friday, April 20

Dear Family and Friends:

This has been a week for visitors. One of the highlights of the week was a visit by Dr. Viggo Olsen. Dr. Olsen is a surgeon and one of the elder statesmen of the Association of Baptists for World Evangelism. He is known for his work in Bangladesh at the ABWE hospital there, for his authorship of two books (“Daktar” and “Daktar II) and for his work on the translation of the Moslem Bengali Bible. Because of his interest and expertise in evangelism of Muslims, he was traveling with two new missionary couples that want to consider helping to open such a ministry to the people of Islam here in Africa. His visit was too short. He held a conference for the Togolese pastors and laity in the nearby town of Kpalimé at the beginning of the week and swung back by on their way through to the airport on Thursday. It was good to see him again and to hear his challenge on Sunday night. One of the new missionaries, Lisa Sunday, will go home with an uncommon story to tell. She was posing for a picture with Jeremiah Teusink’s pet vervet monkey and turned her head away. The monkey bit her on the finger. Bites are amongst the dirtiest of wounds, so it was not closed and treated only with antibiotics. She should heal without problems and will always have a scar as a souvenir of her trip to Togo. She is probably the only one in her Sunday school class back in Pennsylvania who has been bitten by a monkey this week. Another visitor arrived Wednesday night. David Joyce is a fourth year medical student at Harvard, slotted for his general surgical residency at John Hopkins starting this summer. He is the first student to go out under the aegis of World Medical Mission. That makes the third Hopkins person around here. I am not a strong Duke advocate despite being on the clinical staff there, but this many Hopkins folks is a bit much…. On Thursday, the long awaited arrival of Bill Wright and Ed and Dona Martin came to pass. They are here due to the graciousness of Samaritan’s Purse/World Medical Mission to install a new x-ray machine and to help with lots of other repair projects as we can talk them into it. We have been hamstrung without a functioning x-ray machine the entire time I have been here. I explained to them that there was absolutely no hurry for them to get it functioning and we could only pray that the old lady with a broken femur would still be able to walk, the little girl with osteomyelitis would still have a shoulder and I recited a litany of other cases, all selected to invoke the maximum amount of guilt about any dilly-dallying. They understand there is of course absolutely no pressure…. Seriously, we are thrilled with their arrival and with the prospect of a new machine of quality. In two days, Dr. Tom Corson is coming. He is a pediatric attending at Hopkins (another one!) and is also the staff advisor of the Christian Fellowship there. He has spent much of this month in Bangladesh at the ABWE

24 The SteffeScope Volume 4, 2001 © 2001 hospital there and is arriving home in Baltimore from there one day and turning around to come to Togo the next day. Not my idea of a travel itinerary! He is the official sponsor for the two residents that are here. He will be here for two weeks. One of the chronic problems in almost all mission hospitals where I have been is the lack of a reliable source of oxygen. We have two concentrators here that take room air and make it very rich in oxygen. They are wonderful, but require a lot of power. We can only run two of them at once on our battery back up and then all electricity dies out for the entire hospital when the batteries are exhausted. We can run diesel powered electrical generators but they are expensive to run day in and day out. Also, we occasionally need more than two and in that case, we have to try to make one machine serve two patients. Death due to lack of oxygen is not as uncommon as I would like. I mentioned in one of the previous newsletters that someone had donated a big system that can provide both oxygen and suction to the whole hospital and because of its storage capacity, is not dependent on the presence of electricity. I mentioned that the price tag for installing it was great ($20,000 - $30,000) and the money not available. I have some great news to report. Dr. Cropsey has talked with the folks at Samaritan’s Purse/World Medical mission and the engineer there feels that he can install the system for only $10,000 needed for the necessary parts. Samaritan’s Purse has offered to send him at their expense and another anonymous donor has offered a matching gift of $5,000. If donors can be found for the other $5,000, the money will be raised and by fall, perhaps the system will be in place and more importantly, no more unnecessary respiratory distress and death will occur. If you are interested, you can use the address listed in the first prayer request below and just send a separate note along with your check with instructions to use it for the oxygen system. As this newsletter was getting ready to “go to press”, an e-mail brought terrible news. A CNN report from Andrea Koppel reported that a Peruvian military plane shot down a private floatplane, despite radioed protests by the pilot. Two ABWE missionaries were killed. Roni Bowers and her newly adopted 7-month-old daughter, Charity, are now with the Lord. The father and son, Jim and Cori, were not injured. Kevin Donaldson, the pilot, was also serious wounded. They were flying the border between Brazil and Peru when they were shot down and then the plane continued to fire as they were on the river. As is expected, the whole story is unclear and reports are sketchy. Please pray for Jim and Cori as they adjust to this painful loss of their wife and mother, daughter and sister. Pray for their family and friends that they will be comforted. Pray for healing for Kevin Donaldson. Most of all, pray that some worthwhile thing will come from this tragedy and that God’s name will be glorified at a time when such loss seems so senseless. Items of prayer: 1. The nursing program will begin the end of this month. The funds necessary for running that program have still not come in. Because this is so important to the running of this hospital and future plans for expansion, I beg your indulgence and mention it again. Please consider whether you can help: • $50 provides for one month for one student • $1500 provides for one student during the entire 30 month course • $2500 provides for all of the needed textbooks and reference books for all students • $3000 provides for all printing and photocopy needs for all students’ “textbooks” and teaching materials If you want to help with this project, please make your contribution to ABWE, PO Box 8585, Harrisburg, PA 17105-8585 and mark it for the nursing school (account #76355). 2. The development of the outreach ministry here in Togo to the people of Islam. 3. The upcoming Field Council meeting at the end of the week. All of the ABWE missionaries to Togo will be congregating here. Pray for their safety in traveling, wisdom in their decision-making and problem solving, and rest and encouragement. 4. Continued safety in traveling for Dr. Olsen and his team as the members seek out where and how they are to serve God as new full-time missionaries. They are going to The Gambia on the next leg of their trip. 5. We are praising God that the little omphalocele child mentioned in last week’s newsletter is doing so well. He is eating and his wound looks great (from a surgeon’s point of view, at least). It is definitely the Lord’s work, not ours. However, the little fellow has developed a murmur that suggested that he has a hole in the heart between the ventricles. It does not seem to be causing him much difficulty at the present time. If it does, there is little that can be offered him here in this country. Pediatric open-heart surgery is not an option in much of the developing world. We pray for God’s healing. 6. We praise God for an answered prayer. We have been looking for accounting software to use in mission settings that allows the use of multiple currencies – a real plus where that is necessary. We were able to get a copy of the Canadian version of QuickBooks Pro and it handles fluctuating currencies very well! Unfortunately, it refused to recognize the full records from its American cousin, which means a lot of

manual re-entering of data. We are still trying to get help from the company to see how best to get around this, but at least we have a good program if we are starting over somewhere. If you know of someone who needs a good and robust software for multiple currencies at a reasonable price, this is it. It can be ordered over the Internet. E-mail us and we can help you get it, if you need help. 7. We are continuing to try to find a potential publisher for the handbook for short-term medical missionaries. We are talking with one company but as you can imagine, the demand and potential market for such a book is rather small and rather specific. Please pray that the Lord will provide someone to publish it, or we can find the funds to publish it ourselves. Please also pray for wisdom for me as I continue to try to squeeze in writing between the other demands here. 8. I am getting tired – I need His strength and your prayers. 9. As we get closer to Micky’s due date, we pray harder that she will deliver close to (or after) her expected date so I can be back and with her at the time. Her mother has just spent two weeks with her and my folks are spending the next two weeks and I am grateful for their support.

God is good. All the time. I thank you all for your prayers, your support and your e-mails of encouragement. May God richly bless you. Yours, secure in His hand,

Bruce Steffes

Friday, April 27

Dear Family and Friends:

I am heading down the home stretch – only 16 days left before I head toward home. Like the horse that knows he is finally headed toward the barn, I am now eager to see the my own stall, strap on the feed I am used to eating and see the old nag that …perhaps I have carried this analogy a bit too far! However, the fact remains that I am always glad to go overseas and always glad to come home. This has been an interesting week and almost nothing has run as it usually does. Dr. Tom Corson, the staff physician from Hopkins, has come to help and oversee his residents. Now we have so much help, we are almost tripping over each other. It has been somewhat hard to convince him that his two residents really have been working hard prior to his arrival. Because of the need for the career medical staff to attend various Field Council meetings, the hospital deliberately tries to diminish the workload during that time. Add the Togolese Independence Day today and a Labor Day next Tuesday, and things really slow down. For my part, it has been a good time to catch my breath. One advantage of the extra help is that Steve Mills could use this opportunity to get away for a week. Bill Wright, from Samaritan’s Purse/World Medical Mission, and Ed Martin have been using the slack time to great advantage. They got the new x-ray machine installed and running in just a few days. It is so nice to be able to take x-rays again, especially high-quality ones. Ed has been teaching the laboratory men how to use this new equipment and Bill has been working long hours, fixing various pieces of equipment and helping with the design of the upgrades to the electrical systems, both at this compound and at the Blind Center in Kpalimé. He is also trying to design the future oxygen system to be the most functional it can be. What a blessing their visit has been! Yesterday, I came out of the dressing room and was startled to see one of the operating room technicians carrying two large rats by their tails. Jokingly, I asked if they were lunch. He did not catch the humor and replied in all seriousness that he could not eat these because they had been poisoned. I remember how stunned Micky and I were last year when the maintenance crew gathered around a pile of wood that they were moving, hoping to catch the mice that were uncovered. They would kill them and put them in their pocket for the next meal. Protein is a precious commodity here. A couple of weeks ago, they killed a snake in the hallway at the hospital. It was only a little one but by the description, it sure sounded like a small green mamba. I have been trying to think – I can’t remember exactly when the last time was that we ever killed large rats and snakes in any of the hospitals back home. Just makes life interesting. I had the opportunity to address the entire Togolese ABWE missionary contingency twice this week. Once I presented a survey of AIDS in Africa. The presentation was one modified from a presentation sent to be me by Dr. Dan Fountain, a career missionary in the Congo and now an associate with MAP International. It was stunning to many who had not grasped the scope of the problem but it stimulated many discussions that could be fruitful paths of future endeavors. Pray that the missionaries can put together a “God-sized” plan for Togo.

The second time I spoke to them was to present a time of devotions yesterday morning. For some reason, the Lord impressed on me II Samuel 14:14b. , “But God does not take away life; instead, he devises ways so that a banished person may not remain estranged from him”. What a great verse! That verse encapsulates the entire story of redemption woven throughout the Bible. When you examine it in light of the three parables of Luke 15, we have to realize that we are each important to God (although only God knows why He remains interested, given our usual modes of behavior!). He is out looking for us in each of those three parables because the loss of any banished person is a heartfelt loss to Him. Speaking as one of the people who didn’t deserve it, I certainly appreciate His mercy and love. I want to thank each and every one of you who have taken the time to ask about Micky and to care for her in many ways. It is a great comfort to me. The e-mail I get from her and from our folks who have been visiting tells me that she is doing fine. A woman friend from our Sunday School class has stepped in to substitute for me and is going to the “puff, pant and blow club” (my disrespectful term for the Lamaze class) and I appreciate it. One of the rather earthy expressions I use to impress upon students not to order unnecessary lab tests is that ordering an unnecessary test is like picking your nose in public – you won’t know what to do with a positive result! That happened to two of us here this week. Ed Martin and his protégés were looking for people who needed x-rays in order to train on the new equipment. One of the expatriates volunteered and his chest x-ray showed a small calcified nodule and several calcified lymph nodes – that is consistent with old tuberculosis or some fungal disease. He didn’t know about it and it was a moment of anxiety for him. I didn’t learn my lesson and had my own chest x- ray done. It shows a nodule in the lung that is not calcified. I couldn’t quite believe what I was seeing – “this only happens to other people. I am a doctor, not a patient!” I will have to get a CT scan as soon as I get home and look carefully at old chest x-rays – if it is new and if there are no calcifications seen on chest CT scan, I am facing the prospect of a thoracotomy (chest surgery) and possible a more extensive lung resection if it is malignant. In my personal daily journal, I admitted that I asked the question, “Why me?” but then I had to be honest and ask, “Why not me?”. I detest those people who are willing to take the stock market increases but complain about the downside. I thought this was similar, albeit a little more serious. Since I am in the habit of sending my journal entries to my immediate family, my son sent back the following reply: “It takes a great deal of faith in life to ask the question "Why me?". When you stop and think about it, simply by asking "why me?" you are expressing many deep theological truths. The first truth is a simple and yet powerful one: in order to ask that question, you assume both that there is a God, and that God has some measure of control over life as we know it. This is important because very often people turn from God over "Why me" type questions. This turning away cannot be logical, for by asking, you are acknowledging the supreme nature of the Lord. Another aspect of the question implies that on some level, you believe God cares about you. As I learned in management class, and I'm sure you have learned as well, motivation is the result of desire coupled with the probability of success. As I'm sure you are highly motivated to know the reason, it would then follow that not only do you strongly desire to know, but that you feel at some level that God cares enough about you to let you understand. “These two assumptions couple to form a third assumption, that there is an underlying reason known to an all-powerful God who cares about you and who can control your life. Similar to Lewis' 3 L's of Jesus, a God who can control fate and does care about you must have allowed this for this to happen, and therefore must have had a reason, or else He does not care, or could not prevent this. By asking "Why me" you have to assume the latter two are not true, and therefore God must have a reason. “What that reason is, is entirely up to God. As Job shows, there is no particular reason to assume that God is punishing you, or that the reason is necessarily related to you directly. What other reasons might God have? Spiritual warfare? Surely you cannot discount that what with your experiences with water towers, watchmen, phantom puma's and spirit lady warriors. Perhaps that is a reason, although it is not completely satisfying one from a human standpoint. There are other reasons that are possible, though. How many people have you treated while in Africa? How many of them might feel you are not on their level, despite your care for them? Might any of them feel the healthy white doctor cannot understand the pain they are experiencing? Might even the African clinic workers think this same thing? Perhaps God is showing them that rain falls on both the just and unjust. Perhaps God is showing them, as He will heal them, He will heal you. That His method of salvation is needed and desirable for all people, not unlike medical care is needed and desirable for all people. “Then there is the reason that perhaps is the most reassuring, that this is a simply a predictable result from previous TB exposure. This might feel like the best response, as it does not take as much reliance on God's power to get you through; only the reliance on His strength for the anxiety and comfort while you wait. Personally, I pray that this is what it is.

“I think the most important thing to consider is that God deals in coincidence. Part of the greatness of our Lord is His ability to control His own strength. Like gunpowder with no casing, an all-powerful God who cannot control His own power is not truly all-powerful. Our Lord, however, can follow His own rules, and I believe that – rather than by large miracles – it is the absolute perfection of His plan that causes things and events to follow it. While everyone has free will, the overwhelming perfection of God's plan calls the Universe toward it, despite humanly corruption. “I believe that coincidence is simply a proof of God's plan and control in our lives. There was no compelling reason that you should get an X-ray; yet you did, potentially catching a problem that could have been beyond catching in the worst case by the time you ever thought to be checked. Even if this spot proves to be nothing important, it is proof that God knows your life, inside and out. God knows what you need and will provide it for you, whether you ask for it or now. God understand the very fiber of your being in ways that even you, as a surgeon, could never imagine. “He is more than your Lord and Protector; He is your Comforter, Provider, and Creator. Even though you cannot be here with our arms around you, you are in Jesus' hand, and no man can pluck you from it, and He is in His Father's hands. God holds you together, and will continue to do so. Whether you are doing his work or not, whether in His will or not, He will never leave you, nor forsake you.” Wow - maybe he did go to classes and learn to think after all! This session in West Africa is coming to a close, but I pray that my lessons in the goodness of God are ever ongoing! Thanks for your prayers. In His loving arms!

Bruce Steffes

Friday, May 4 Dear Family and Friends:

This morning at 7:00, the sounds of African men singing was carried on the breeze through the windows. For nine months a year, every Thursday, Friday and Saturday morning is filled with this sound as the African pastors begin their day in the Bible Institute. These dedicated men are here to study all day each day to find out more about the God of the Bible from other Togolese pastors and from the missionaries. Five men in the first year and eight men in the second year attend classes; most of them have never finished the high school equivalent. In America, they would be called “bivocational”. In Togo, bivocational means men who do not like for their families to starve because they are literally sometimes preaching for peanuts (or a yam or a chicken). But because they are also called of God, they coax crops out of the ground part of the day and fulfill the role of pastor and teacher to their villages during the rest of the time. Some walk tens of miles each day to try to evangelize the next village. Most of them do not have any library other than their precious Bible. Because of some generous gifts in the past, there is a program that attempts to provide them with a basic pastor’s library of a few books when they graduate. I have a real heart for these pastors who have so little to help them prepare lessons and sermons. Pray for these men of Africa. They are almost uniformly of short stature and slender build, but they stand tall and great in the eyes of their beloved Savior. If entry to heaven were a function of faithfulness, I would be well behind these humble men. I am honored to know them. This Monday was the long-awaited beginning of the nursing school classes. Since both of the career medical missionaries were not here, I was honored to stand in for them to represent the medical corps at the opening ceremony. Later in the week, I had the pleasure of giving the morning devotional on the topic of healing and Christianity. These young men and women represent the best and brightest of our Christian community here and their enthusiasm was exciting. We praise God that the funds to underwrite the nursing program are coming in – perhaps slower than the nurses in charge would prefer, but certainly in God’s timing. The Christian Resource Center is a fascinating ministry to me. Christian bookstores of the type we are familiar with are unknown here. The missionaries presently running the materials center, Judy Bowen and Allison Mackey, scour their sources for good literature in French and work with their team at translating the most needed pamphlets and books into Ewe and Kabiye. They presently handle almost 800 titles of books, pamphlets and tracts. Some manuals, pamphlets and tracts are written specifically for the work here. Every effort is made to keep them affordable. There is a lending library for Sunday school materials and a videotape ministry as well. A wonderful part of this Christian resource ministry is the print shop. A young couple, Amy and Wes Sigler, are both graphic artists but since they had a single college course in printing, they have been transformed in typical missionary style

28 The SteffeScope Volume 4, 2001 © 2001 to become the local expert printers. The print shop is churning out literature in order to reach a people hungry for the truth. One of the big projects right now is a series of AWANA books in French – they will influence the youth of all of West Africa with this. Because paper is so expensive here in Africa and good quality is hard to obtain, they are shipping donated paper from America. This permits publishing at a fraction of the real cost. Therefore, it is a lower cost for the Togolese. Pray for that work – many of the machines are antiquated and some are over 75 years old. There is a tremendous wish list of needed equipment that will do it quicker, better and more reliably – please pray that the Lord will provide either the funds or the equipment: Heidelburg or equivalent printing press with two tiers for 4 color work; Perfect binding machine, Imagesetter (and automatic film developer), 11 x 17 air feed folder, 3-knife book trimmer, saddle stitching machine for creating stapled books, colorimeter and a Rip for sending data to Imagesetter. I don’t really know what most of that equipment does, but I know that the Lord is blessing their efforts as they struggle to do the best job they can. I definitely understand what it is like to practice medicine without the proper equipment, doing the best you can and leaving the results to God. There are many opportunities to be over your head here and it is not always because of a lack of training in some procedure. Equipment and supplies are lacking. However, it gives great opportunity to see the Lord at work. Just two days ago, a woman fell from a tall baobab tree. The fruit of the baobab is prized for a special soup. When she fell, she impaled herself on the broken off stub of a sapling growing there. The two-inch thick spear went up through the perineum and into the abdomen. I explored her soon after her injury and found massive venous bleeding coming from the pelvis. I thank God that it stopped when I crammed two lap sponges down there. I worked with Mary Jo Mills and we were able to get her blood pressure back up from "unobtainable". I knew it was time to quit to fight another day and so I closed her with two sponges packed into place. Yesterday, being as loaded for bear as I could be, I re-explored her and found – nothing. I removed the packs and there was no bleeding. It had stopped. There was nothing to do but wash things out, remove a few remaining fragments of wood, give praise and skedaddle out of there. She is Muslim – please pray for her salvation and for that of her family. We had two other dramatic cases earlier this week. Without inhalational general anesthesia, we were probably crazy to tackle them, but I felt I had no other choice. One was a 2 year old with what was probably a cystic teratoma wrapped around the jugular and involving the posterior cervical triangle; these tumors have malignant potential and it was difficult to do. This case is also an argument for the value of medical missions. This family traveled hundred of miles from the north of Benin to seek care here and they have heard the message of salvation. They would not have traveled to hear a sermon preached, although we pray that they have traveled to see a sermon lived. We also had to open a young man’s chest for a persistent collapse of the lung. This is a sixteen-year-old boy who has been here over a month. The bill is astronomical by Togolese standards but discharge is in sight. Most importantly, he has become a child of God while here. It warms the cockles of your heart to see this young man reading the Bible hours each day. Along with many of you, we have been wrapped up in the story of the ABWE missionaries who were shot down in Peru. It has been amazing to hear the stories and to see the effect of their inspiring faith and testimonies. We have heard this week that God has already used this tragedy to call two physicians to a career in medical missions. They will quit their practices and begin the process of becoming career missionaries in Togo. We are continuing to pray that God will continue to use this tragedy to His honor and glory.

I have a lengthy list of prayer requests:

1. On next Wednesday, Steve Mills and I will give a 3-hour seminar for the Togolese pastors on the topic of AIDS. The disease is rampant and the even the church is often abandoning these people as they operate out of ignorance and fear. We hope to educate about the disease and emphasize that this disease is not hopeless. Indeed, the hope offered by Christ is real and there is a very real opportunity for Christian service on behalf of its victims and the family of its victims. Pray that the pastors will catch the vision and His perfect love can cast out fear. 2. Dr Tom Corson, one of the short-term missionaries here last week, left on Monday rather ill with the beginning stages of malaria. Please pray for his continued recovery. 3. There are many people traveling. Drs. Vivian Pearson and Colleen Clendenin are leaving this weekend, having finished their month here under World Medical Mission. They have been a real blessing to me. Dr Forrest Fernandez, his family and some friends are coming this weekend to be my replacement for a month. Steve Mills is also flying back from the US. Please pray for their traveling safety. 4. Sunday night, I am speaking in the evening worship service to the missionaries. Pray for wisdom for me and also that I might be an encouragement to them.

5. Pray for the families of Roni and Charity Bower and for healing and full recovery for Kevin Donaldson, the injured pilot. 6. A good man, Gary, in my home church has recently undergone surgery for metastatic cancer of the oral cavity and faces radiation therapy. Pray for his healing of body and heart and for peace for his soul. 7. On a personal level, I have been scheduled for a CAT scan of the lung mass on May 15, the day after I arrive back in the US. Please continue to pray. Thank you for all of the many notes of encouragement that I have received. 8. When I return, my schedule will be hectic. My son graduates on May 26 in Indiana and the baby is due in North Carolina on May 28. This may be a little selfish, but I would like to ask for prayer to the effect that we travel safely, everything stays on schedule and that little Sean David is born without complication.

A closing thought: Steve Saint spoke at the funeral of Roni and Charity Bowers, the ABWE missionaries shot down in Peru. Steve lost his father, Nate Saint, when he was one of four killed by the Auca Indians of Peru many years ago. He said something that really struck me as profound, "To the secular world, pain is fundamental and joy is superficial. But to the Christian, pain is superficial and joy is fundamental". This echoes Nehemiah 8:10 that admonishes us, “…Do not grieve, for the joy of the LORD is your strength." In benediction, I repeat the words of Roman 15:13, “May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit.” I hope your joy is overwhelming and overflowing today.

Yours and His in Togo;

Bruce Steffes

Friday, May 11 Dear Family and Friends:

This will be the last newsletter from Togo this year. In a little over 48 hours, after my last remaining night of call, I will be climbing onto the Air France flight to Paris, after a four-hour layover in Paris on to Atlanta and then home. I was eager to come here and I am eager to return home. Sometimes I wonder exactly what the Lord will use out of all the things that we do. It is obvious that His way of looking at things is significantly different than mine, and that I probably spend a good deal of my time fussing over the wrong things. Every now and then though, I think I get a glimpse of what was really important. Wednesday this week was one of those days – that day may have more eternal significance than anything else I have done here in Togo. The hospital hosted the first conference on the topic of AIDS. This being Africa, of course it didn’t start on time and ran late (3 hours!), but it was a very satisfactory day. The room was packed and there were over 35 people in the audience. After prayer and introductory remarks, I presented the survey of the disease in Africa. Marge Lund, a missionary nurse with tons of public health experience, then spoke about the disease and how it is spread. Many questions were answered during that time. We finished the morning talking about why we at the hospital tell patients they are positive (something that is culturally frowned upon) and laid the rest of the groundwork for the real crux of the seminar. Steve Mills took the third part of the presentation before and after lunch. The groundwork paid off in that the pastors were thinking exactly along the path we hoped they would. They were asking perfect lead-in questions and giving perfect answers that fit beautifully with our next points. We asked the hard questions. Because of the long latency between infection and clinical disease, it was possible that some of them in the room have contracted the disease before they were saved. Steve asked whether they had prepared their churches to take care of seropositive members were in their congregations and then he asked if the churches were ready if one of them (the pastors) turned out to be positive. That rattled them a bit. At one point, one pastor made the comment that if what we said was true, then he should be tested to protect his loved ones. That was a major revelation to most. Throughout this whole presentation, we presented the reality of the disease but emphasized the Hope that keeps the disease from being hopeless. We emphasized Christ’s behavior to the leper as a model and emphasized the possible role of Christians and the church as they serve the victims of the disease and their families. The church must be a haven for them and demonstrate that faith has works as an integral part of it.

God was with us and filled in the cracks in our planning. One of the seminar participants was someone who is a member of one of the Lomé churches and he is high in the Togo anti-AIDS program. He was soft-spoken and reasonable but his concurrence with what we said put the seal of validity on what we were saying. There is a tendency for the pastors not to trust fully what the missionaries have to say (for who knew what their real agenda might be) but his agreement with our statements legitimatised our presentation. I am also thankful that because Dr. Fernandez arrived last weekend; I had the luxury of taking some time Monday and Tuesday to prepare our presentation adequately. Your prayers were definitely felt and appreciated Thank you. During the last prayer of the conference, I had the thought that this had gone so well that this single conference may well be the real reason I was led here by God this year. The pastors were now beginning to understand what the disease was and a little about it, what the goals were, why we at the hospital responded the way we did and were beginning to have an inkling of what they would need to do in their own lives and in their churches. They were eager for resources and help – we need to develop rapidly materials that do a good job of combining public health information and the good news of Jesus Christ (and get the money to print them). I pray that this will be the start of a significant change in the life of the Togolese church and for all those hundreds of thousands who are dying without Christ here in Togo. Last Sunday, I was supposed to preach to the missionary’s evening service here on the compound. I had run across a book that put a whole new perspective on salvation for me and I would like to recommend it to you. It is by Bob George and is entitled “Classic Christianity: Life’s Too Short to Miss the Real Thing” [Harvest House Publishers (Eugene, Oregon), 1989, ISBN 0-89081-660-3]. I hope it is still in print. If so, get it and read it. Maybe some of those concepts he elucidates are obvious to all of you but they were not to me! It is rare that I read something that literally restores the excitement of Christianity to me. The planned sermon opportunity fell through, however. Instead, we listened to the funeral service of Roni and Charity Bowers, the missionaries murdered in Peru. What a powerful service and celebration of faith that was! Today, Bea Ward was kind enough to arrange and do much of the work for a hospital-wide party that I hosted as a celebration of my time here. The employees wanted American food, so we had hamburgers, baked beans, Pringles and soft drinks. Many of the missionaries served. It was a good chance to thank all the Togolese who had tolerated my whims, offered their friendship and helped me in my work. It was also a lot of fun! Like we would often do in the US, we used an informal seating arrangement, let the women go first and kept the administration until last – all that was a culture shock for them! However, given the enthusiasm with which they ate this strange food, the shock didn’t affect their appetite. Dr. Bob Cropsey called me from the US just before it started, so I was able to pass on his greetings to all of them as well. I mentioned in one of the previous newsletters2 about the church that is starting up on the plateau at Danyi Koudzaragan. I told you at the time that I was able to have the blessing of using some of your gifts to help them hire someone to build benches for the congregation. This week I have a chance to play Santa Claus again (can a missionary say that?) and I used more of your gifts to buy a carton of songbooks and a carton of Bibles for their use. What a bargain – a hymnal for less than a buck and a Bible in either Ewe or French for a buck and a half! I hope to be able to visit the church this Sunday just before I leave for the airport. For the first time since I have been here, there is someone else here to cover the surgical emergencies so I can actually get out to a village church. I will be have the honor of delivering the Bibles and hymnals to the church and tell them of my friends who provided the books to them in Christian love. I hope for the chance to preach – if I do, I will tell them of another Gift that will change their eternity. Thanks for the opportunity to be here and for a chance to complete a triple blessing – you get it when you give, I get it when I give on your behalf and they get it for eternity. What a great Savior we serve and what a blessing it has been to serve Him here in Togo. Thanks for your encouragement, your prayers and your support. I hope to be going back to Uganda with our church for the last two weeks of June, but that obviously depends on the new baby’s arrival and what my chest CAT scan shows. I would appreciate your prayers and we will keep you informed. God bless you all. You are a blessing to me!

Held in His strong right hand,

Bruce Steffes

2 Number 12, March 30

Dear Family and Friends:

Having spent the time as a father of three teens, I have to finally admit that perhaps they are right, but it pains me to admit it! Before I go directly to that starting conclusion, first let me thank you all for the myriad of prayers that have gone up on behalf of Micky and me. Just after I finished e-mailing the last edition of the SteffesScope from Togo on May 11, I received a note that Micky was beginning labor. I was able to get my ticket moved up 24 hours and made a dash back across the ocean – praying all the time that I could arrive in time. God answered that prayer and indeed did it so well that we had to induce labor a week and a half later. Things went well and on May 23, little Sean David entered our lives. Remembering the scare about Trisomy 21 earlier in Micky’s pregnancy, I made sure to count everything twice and examine him very carefully, but can modestly say that he was (and is) perfect! For those of you who missed our brief e-mail notice, he was 8 pounds 1 ounce and 21.5 inches long. After waiting 24 hours to make sure everything was okay, I left Micky and her newborn son safely in the hands of her mother and then drove all night to Indiana in time to attend my son Ryan’s graduation from Taylor. He and his fiancée, Rachel Algorri, both graduated this year. We spent the remainder of the day and the next morning packing them both up for the move back to New Jersey where Ryan will take a position with a computer services company. They are going to get married on August 11. I spent the rest of the day with my daughter Michelle who had flown back for the graduation weekend and then after putting her on the plane, drove all night back to North Carolina. During that time, it was not as if I was just loafing. Shortly after I arrived back in the US, I underwent a CT scan of the lung to better characterize the mass that had been unexpectedly found by a routine chest x-ray in Togo. The bad news was that it couldn’t be definitely characterized as benign but the good news was that it was very easily accessible to the thoracoscope, meaning I might avoid a huge incision. Surgery was scheduled for last Thursday, June 7, and I kept busy with all the mail and paperwork that had piled up over the past six months. Unfortunately, part of that was the beginning of preparation for the last malpractice case that will finally come to trial after seven years of agonizing waiting. That case is scheduled to begin July 31. A very pleasant interlude was a visit by Dr. Bob and Shirley Cropsey. They were able to stay overnight on their way from their son’s home in South Carolina to a church in Cary, NC. The break they have had has rejuvenated them and it was fantastic to hear how the Lord is providing the needs for oxygen and electrical projects in Togo. They have also been granted success is raising scholarships for the new nursing program. The Lord seems to be leading us to go back to Togo in 2003 for 8 months – that will give them a longer time of furlough and we are praying that others will consider coming there before or after our time there to allow them an even longer time. Finally the day of surgery came. I have decided that I would much rather be the cutter than the cuttee! The procedure went extraordinarily well and they were able to remove the wedge of lung tissue through three relatively small incisions. They did not have to cut bone and by going between the ribs, stapled the lung and removed the abnormal tissue. My surgeon and family happily received the very good news that it was benign – I was still in la-la land. Versed® is an amazing drug – I was totally coherent and neither embarrassing myself nor asking stupid questions, but I have no memory of anything from the time I received the first dose in the pre-op area until the time I awoke about time I was leaving the recovery unit. I have had entire conversations related back to me but have absolutely no recollection of them. I do understand that my first question in the recovery room was whether it was benign or not. Normally when the lung is stapled it will continue to leak a small amount of air for a few days, but I had no air leak at all and all of my tubes were removed in the ICU early the next morning. Other than some vague discomfort easily controlled by pain medications, I was doing well and ready to be discharged early the next morning, only 48 hours after surgery. I have continued to do well (and probably a little too much – to the consternation of my wife and parents who had come down to be with us), and I praise God for His protection and healing. I credit my rapid recovery to your prayers and the fact that God is truly omniscient – He knows I am a wimp and He didn’t want to watch it any more than I wanted to go through it! The pathology showed a fungus known as blastomycosis. This is a rare disease in humans. One question I have often gotten is, “Is this something you picked up in Africa?” The truth is that I don’t know. It is very common in North America as well as Africa and almost every place we have been. It is plausible that I picked up doing something like crawling under the house to fix the dryer vent but somehow that doesn’t have the same panache as saying that I picked it up in Africa, implying great sacrifice and suffering for the Lord! So the most dramatic answer I can give is “Could be!”

That brings me back full circle to my opening statement – I now fear that my teens were right all along. Blastomycosis is a mold at normal temperatures (a yeast at body temperatures). I mean I don’t really mind turning fifty this year but to have documented incontrovertible proof that I am truly – as my children were quick to point out – a “moldy oldie” is disheartening! We are awaiting the final culture results and I will probably have to be treated with six months of antifungal therapy – but I am the first to declare that deciding about six months of antibiotic therapy is very welcome compared to the real fear I had that I might be deciding about six months of chemotherapy! This will probably be our last communication for a few months but we would ask you to continue to pray for us when we come to your mind. Some praise and prayer items:

1. Praise God for Sean and for the results of the surgery! 2. Bob and Shirley Cropsey are flying back to Togo on June 25. Pray for traveling safety, God’s continued provision of funding for the various projects and for His wisdom in deciding how all of the missionaries are going to expand the ministry there. Thank God for His answers to so many prayers during the Cropsey’s short time back in the US. There are over a dozen missionaries that are trying to get their funding lined up to go to Togo – pray for them and consider giving if you can. 3. We will be traveling to New Jersey and to California to introduce Sean to his sister and brother. Pray for traveling safety for us. 4. Micky’s lawsuit is still in the works. We are trying to negotiate a settlement that we can afford. We are fairly certain that the requested $600,000 is not feasible! A preliminary court hearing is scheduled presently for August. Bruce’s malpractice suit is coming to trial the first two weeks of August. Although we would love for it to “go away”, it is unlikely. It is particularly nerve-wracking for him as he prepares but we ask only that it be go in such a way that the Spirit will be close, Christ will be glorified and that it is finished in time to attend Ryan’s wedding. 5. We are already beginning to plan the next two years. We are not sure what we are doing in January and February of 2002, but we have committed to spend five months at Tenwek Hospital in Bomet, Kenya in 2002. This will allow both Dr. Chupp and Dr. White to be gone at the same time as they go home on furlough. The high altitude makes the risk of malaria very low and we look forward to taking Sean with us. In 2003, we will spend all of our available time in Togo in order to give the Cropseys the longest possible furlough. We ask for your prayers that we remain sensitive to the leading of the Lord and that He will provide people to serve along with us or before or after us. Consider coming to visit and/or work with us during those times! 6. I will soon be returning to my volunteer work with the surgical residents at Duke University and my almost-volunteer work at Methodist College teaching anatomy to the physician assistants. Pray that I will be bold in proclaiming Christ in these endeavors. I consider these areas as much a mission field as Togo. 7. I want to use this forced inactivity to work on completing the manuscript for the short-term medical mission handbook. Pray that we will stay focused as we work, and that some means of publication will become evident. Although it is (in our opinion) a book for which there is a distinct need, the market for it is admittedly small and not economically viable. I suspect that we will have to pay to have it published and the estimate for that is about $8,000.

God bless you all. You are all such a blessing to us. We thank you all for your prayers and notes of encouragement. We praise God for your partnership in our attempts to serve the Lord God Almighty – who loves each and every one of us enough to die on our behalf, paying the price and bringing life to all who are willing to accept Him as their Lord!

Held in His strong right hand,

Bruce Steffes

Sunday, August 12

Dear Family and Friends:

This is a newsletter of praise! The last two months have been very eventful…

1. We thank God that the malpractice trial is over. Sometimes the answer to our prayers is “no”. The jury did a masterful job of ignoring the facts, the expert testimony and common sense; believed a fanciful tale of plaintiffs who swore I never saw them after surgery and other half-truths, innuendoes and insinuations; and then gave a $375,000 judgment to the plaintiff. However, the fat lady hasn’t yet sung. The judge will rule sometime in the next two weeks on a motion to throw out the testimony of their sole expert witness and that would negate the jury finding. There seems to be a reasonable likelihood that it will happen that way. Be that as it may, we learned several things from this experience. We are grateful that we have great friends who stand by us, who pray with us and even some who came to sit with us in the courtroom. We have peace. Bruce even had the opportunity after the trial to give a limited testimony to the plaintiff’s attorney, who also accepted a copy of Dr. Melvin Cheatham’s book “Come Walk with Me”. We don’t know why this result was allowed but we know that God was not surprised and we can only pray that there will be some eternal good that comes from it. As far as we are concerned, we echo the Psalmist who wrote (119:71), “It was good for me to be afflicted so that I might learn your decrees”. 2. Micky’s hearing was postponed until September 4th and at that time a motion will be presented to throw out the case based on a theory relating to the statute of limitations. This too is in His hands. 3. We have just returned from a wonderful time this weekend in Cape May Court House, NJ, where we watched Ryan marry his sweetheart, Rachel. It was an intimate, beautiful wedding despite the rain on a garden wedding! Ryan had asked Bruce to be in his wedding party and that was an honor for him. It was good to have all the family together and rejoice together in His faithfulness in all of our lives. 4. The constant chest wall pain that Bruce was enduring since surgery has dramatically improved over the past two weeks. He is tolerating the antifungal medication without difficulty. Thanks for your prayers for healing. 5. Bruce has been offered a full-time job as the academic coordinator at the Physician Assistant’s Program at Methodist College here in Fayetteville. It would be for the time between now and the time he leaves for the next tour of duty in December in Papua New Guinea. This job would solve some problems regarding health insurance coverage as well as some others. We are praying about it and are excited about some of the possibilities that it might spawn. 6. We had a great time in July in Harrisburg, PA, at the Medical Mission Interface, the medical missions conference hosted by the Association of Baptists for World Evangelism (ABWE). Several new friends were made and some new contacts and possibilities were opened. We particularly enjoyed seeing some friends from Bruce’s brief visit to the Amazon hospital a few years ago (Dr. Chip and Laurie Phillips), the Wards and Brenda Mastin from Togo, and several other friends we have met over the past few years. 7. The manuscript for the handbook for short-term medical missionaries is coming along slowly but it is making some progress. With the Damoclean sword of the malpractice trial gone, Bruce hopes he can focus and write more productively now. We have a lead for a possible publisher and we are praying about that and exploring that possibility. 8. We are already working with World Medical Mission about a trip to Papua New Guinea. The sole surgeon at the Nazarene hospital there will be on furlough, so Bruce will be going alone to that hospital for the last twenty days of December and most of January. He will return for some conferences in February and then all three of us will go for 5 months to Tenwek Hospital in Bomet, Kenya to help cover that hospital while both career surgeons are on furlough. 9. We will be attending the 25th reunion of Bruce’s medical school class in Ann Arbor in September, attending the Prescription for Renewal medical missions conference in Asheville in October and the Medical Missions Conference in Louisville, Kentucky in November. If any of you with serious interest and medical backgrounds have the chance, we highly recommend both the meeting in Asheville and in Louisville. These are great times of fellowship, encouragement and education. 10. Sean is healthy, growing rapidly and Micky is having a great time with this new addition to our lives. We remember the scare we had during her pregnancy and are blessed anew each day.

There are so many other blessings that have come out of trials in our family and in our circle of friends. We can focus on the problem or we can focus on His provision. Psalm 34:19, “A righteous man may have many troubles, but the Lord delivers him from them all”. Thank God – for we have a Deliverer!

Delivered by His strong hand,

Bruce, Micky & Sean Steffes

Friday, November 9 Dear Family and Friends:

When Bruce came tearing home from Togo for Sean’s birth, the idea of spending 7 months in the United States seemed like a waste of time – there was so much we wanted to do overseas. However, despite our chafing, it has gone quickly. Bruce is beginning the sometimes zany and hectic process of ordering materials and supplies to take with him on his next trip, winding up his lecture responsibilities at Methodist College and attending to the dozens of details that need to be taken care of before leaving the United States for an extended period of time. His next scheduled trip is to Papua New Guinea, the eastern side of an island north of Australia. The only career surgeon at the Kudjiip Nazarene Hospital in the Highlands there is still on furlough and will not return to PNG until after the holidays. We found it difficult to argue that after a lifetime of holidays with our family that we should not or could not spend one holiday away so a career missionary and his family could spend one with their families. Bruce leaves December 10 and after more than 2 days of traveling, will begin work there on December 13. He will stay until the end of January. Because of Sean’s young age and concern about malaria prophylaxis, Micky has decided to forego this trip but we will travel together to Kenya in March for another 5 month stint there at Tenwek Hospital. She is eager to get back to Africa and back to serving the Lord in the way she loves. There is some concern about traveling and living overseas given the terrorist situation but PNG is largely a Christian nation and we feel this trip is the will of God for Bruce. It is time to put faith in our belief that the safest place in the world is in the center of God’s will. With that confidence, Bruce is ignoring the jibes of his friends who feel that his greatest concern should be, that with the vivid legacy of cannibalism in PNG’s past, the idea of presenting recent converts a “fatted calf” may just be too tempting! Convinced that they will judge the indigestion not to be worth it, he will resume reporting from overseas the weekly editions of The SteffeScope come mid- December. Just a quick update on several areas: Handbook on Short-Term Medical Missions: ABWE Publishing (a division of the Association of Baptists for World Evangelism) has agreed to publish the handbook for short-term medical missions. Micky and I are still in the process of writing it. The proposed date of printing will be in the late spring of 2002. We are thrilled and consider this a real answer to prayer. Now we are praying that the book will have a real impact on those who are going to serve in short-term medical missions. Legal wrangling: The saga continues. Since our last newsletter, we received news that the judge had overturned the jury’s ruling but now the other side is appealing that judgment. We don’t know when that will be settled. Micky’s legal hassles also continue: In a surprise hearing, a visiting judge disallowed our lawyer’s contention that she should be dismissed because the statute of limitations had run. We have made a nominal offering for settlement but have not heard anything. Medical Mission Conferences: After a trip to attend to the American College of Surgeon’s meeting for some much needed continuing medical education credit, we had a great time of blessing at the Prescription for Renewal held each year at The Cove in Asheville. Bruce gave a lecture on the care of burns in the mission hospital environment. It may well be that some tricks with PowerPoint may be remembered long after the important stuff! That meeting is always a time of reunion, rededication, challenge and new friendships. Those of you who are physicians and who have never attended need to do so. It will be held October 3 – 6, 2002 but the spots go fast. Call soon. Call 1-800- 950-2092 or go to www.thecove.org and look for the 2002 seminars. We also recently returned from the Medical Missions Conference (www.medicalmissions.com ) in Louisville, Kentucky where we spent the weekend with some dear friends and had another great time of fellowship and learning. We were especially blessed to hear the reports of friends – physicians who have decided to make missions their second career, turning their backs on the lures and rewards of practice in North America to honor God’s call on their life and His eternal rewards. Pray that more will answer the call for workers. By the way, this conference is not limited to physicians but is open to anyone interested in the concept of medical missions. Pencil this in your schedule too. Mark your calendar to check the web site next July in order to register. It is the first weekend of November, 2002. Our schedule: December and January, Bruce will be in Papua New Guinea February, we will once again participate in the Global Missions Conference at Johnson Ferry Baptist Church in Marietta, Georgia and then go from there to Washington, DC to attend the Prescription for Hope, a 4-day conference hosted by Samaritan’s Purse. This conference to designed to explore the role of the worldwide church in combating the scourge of AIDS. March through mid-August, we will be going back to Tenwek Hospital in Bomet, Kenya. Dr. Russ White is on furlough and Dr. Mike Chupp will be leaving the end of March. That will leave the surgical care

35 The SteffeScope Volume 4, 2001 © 2001 at the hospital in the hands of short-termers like myself – a dubitable proposition perhaps. We are hoping to make a side trip to visit our previous places of work in Uganda. This and that: We found ourselves in the position of having an extra car and after much thought and prayer, we contributed Micky’s beloved (and much babied) 1993 Riviera to some missionaries. The story of how it came about is interesting. Bernie and Carole Beverly from Winston-Salem were missionaries to the Philippines with ABWE and are continuing to work with them here in the US. On Sunday, they were at a conference in the North Carolina mountains and shared with their prayer partners that they needed a car to replace their old car. To their surprise, they were asked what kind they wanted. Their somewhat joking response was, “A Cadillac or Buick”. What color? “Red”. When they got home from their conference, they found waiting a forwarded e-mail offering our car. They drove over the next day, were thrilled with the vehicle and were amazed at the fact that God did indeed give them a Buick. The color wasn’t perfect but at least it did have a burgundy interior. Two things about this strike us: One is that God takes our requests very seriously and often “we have not because we ask not”. Secondly, the number of missionaries needing reliable transportation who responded was surprising to us. So, if you have a surplus vehicle and want to make a significant contribution to someone’s ministry, considering donating it. It is a tax-deductible gift, just in time for the end of 2001.

Praises and Prayer requests: 1. We need the Lord’s help in completing the rough draft of the handbook before Bruce leaves for PNG. 2. Pray for safety and a sense of the Lord’s presence for our family while we travel and are apart from each other. 3. Pray for God’s solution to our legal problems and peace for our hearts. 4. Pray for a leader to arise and take over the weekly Bible studies and Fellowship of Christian PA program Bruce started at Methodist College. 5. Sean continues to thrive – he is almost six months of age and is already in 12 – 18 months clothing. A real blessing to our lives – even if he hasn’t gotten this sleeping-through-the-night thing down! 6. Other than continued intermittent chest wall pain, Bruce continues to do well from his lung surgery and is almost finished with his long course of anti-fungal therapy. 7. Our home church continues to grow in their awareness of the need for a mission outreach. Recently, the first church wide campaign netted over 600 boxes for Operation Christmas Child, the Christian shoebox gift program carried out by Samaritan’s Purse. We are about to launch a “Change for Change” program that we pray will net tens of thousands of dollars just from spare change, all for the purpose of underwriting various mission projects. 8. Gifts given by all of you are continuing to bless the missionaries and the people they serve. A brand-new set of whirlpool tanks has arrived at the hospital in Togo. A refurbished flexible gastroscope is now seeing duty, aiding in the making of diagnoses and guiding therapy. Several national churches are in building programs largely due to your generosity to the beleaguered congregations. A ventilator in Kenya saves lives daily and several African children are running around because special scopes allowed the removal of foreign bodies from their airway. The list of good you have done is long, but most importantly, many will have the opportunity to meet you in heaven to thank you personally for your interest in their lives and souls. We are honored to be your messengers. We want to thank those who have been led of the Lord to contribute to our work. We want to clarify the principle that underlies all that we do. We personally provide our own day-to-day living expenses. With the increased traveling, longer trips and one extra person, those costs are rising. We know the Lord will provide for us for our personal needs. However, we often see needs on the field that we feel we should help with and we cannot always personally provide for those needs. Some of those are rather expensive medical texts, medications or pieces of surgical equipment. Some of those involve special care of the missionaries themselves. Some of those involve the national church itself. It has been our practice and our plan to continue to use ALL gifts given to our account for His work. Every dollar given to us has been used for the people and missionaries we serve and not for our personal expenses. Pray with us regarding this matter that God will provide the necessary funds so that we may continue to help provide these things. If you feel led to help financially, a tax-deductible gift can be given to our account at World Medical Mission. If you give, send it to the following address at WMM but be aware that the receipt will come from Samaritan’s Purse. The address is: Attention: Mary Snead, World Medical Mission, PO Box 3000, Boone, NC 28607. Place with the check a separate slip of paper with our name and indicate that it is for account #2257. Do not write our name or account number on the check itself; it could jeopardize the tax-deductibility in case of an audit.

Thanksgiving as a holiday is almost upon us; thanksgiving as a way of living should already be here. Thanks be to God for His mercies, His love and His Son – and for our prayer team!

Yours in His mighty Love,

Bruce , Micky & Sean Steffes

Friday, December 7 Dear Family and Friends:

A change in plans and a run-away calendar (where has the time gone?) has brought me to the eve of the trip to Papua New Guinea. I am never real thrilled about going alone and facing new things by myself. The thought of missing my baby’s first Christmas is also a little hard to bear. However, I am never truly alone and it helps to know that Jim Radcliffe (the missionary surgeon for whom I am filling in) and his family will have the joy of sharing the holidays with their family. When I reflect upon it, Someone else once left His home for the purpose of serving mankind and for that, we are eternally grateful – guess it makes a trip to PNG pale in comparison. Micky, Sean and I want to wish each and every one of you a very joyous and merry Christmas. God bless us everyone!

NEW E-MAIL ADDRESSES: Although our AOL addresses will be good for at least another year, we would like you to start using our new e-mail addresses. Bruce’s will be [email protected] and Micky’s will be [email protected]. Please take a moment and change your address book right now. These addresses should be easier to remember and give us the advantage of being to better able to handle our e-mail while overseas without you having to remember a temporary address. If you use the new addresses, we will change the forwarded address internally and it will automatically go to wherever we are receiving e-mail at the time.

What’s with the “brucesteffes.net? That is the new web site that my nephew, Jeof Oyster, is constructing for us. It will have areas where current editions of The SteffeScope can be viewed and old copies retrieved from the archives. It will have an area where a scrapbook will let you look at the present trip (including fresh updates) and pictures and reports from previous trips. You will be able to retrieve helpful material (and even chapters) from the “Handbook for Short-Term Medical Missionaries” that is being written – bibliographies, packing lists, etc. (For family members, it will have loads of pictures of our darling son!) It will be under construction over the next few months, so be patient. It will be hard for us to help Jeof because of the lack of reliable Internet access. By the way, add Jeof to your prayer list. He is a freshman at Azusa Pacific University and is also functioning as faith-based missionary as he works in the area of Internet and information technology for Top Flight Leadership. Topflight Leadership is a Christian para-church ministry focusing on the development and mentoring of tomorrow’s Christian leaders.

So where is Papua New Guinea exactly? This question is one I have heard many times in the past few months. Let me go into my teacher mode: The former German and British New Guineas merged in 1975 into one country that is a member of the British Commonwealth, now called Papua New Guinea. It is eastern half of New Guinea – the second largest island in the world. It is a land of high mountains, dense forests, lowland swamps, coral islands, torrential rainfall and beautiful flora and fauna including the bird of paradise (the national emblem). These sometimes formidable geographical barriers have led to marked isolation of the 1,000 different people groups. Although English is the national language, there are 816 languages, over half of which are not related to any of the others. Tok Pisin is the name of the Melanesian Pidgin English that is rapidly becoming the lingua franca. Until relatively recently, the various tribes lived lives of isolationism, punctuated by frequent intertribal warfare and cannibalism. The intertribal warfare and revenge killings are still a problem in the Highlands, the area where the Kudjip Nazarene Hospital is located. That is where I am going to help. I would strongly recommend to you two books about missions in the western half of the Island (Irian Jaya), both written by Don Richardson. One is entitled "Peace Child" and the other "Lords of the Earth". Given this colonial history, almost the entire population has a link to a Christian denomination but the old ethnic religions remain a powerful underlying influence. Because of a lack of proper discipling of converts, many people are once again returning to the old ways because Christianity “doesn’t work”. Within the church, the multiple languages and history of tribal antagonism have led to multiple problems. There remains a lack of the Scriptures in many of the languages – reading about God’s love in your own heart language is an entirely different

37 The SteffeScope Volume 4, 2001 © 2001 thing than reading about it in a “foreign” language. Almost 600 languages still need translation work. Strong tribal ties, ancient animosities and the lack of a common tongue are barriers to Christian fellowship and the flow of spiritual blessings. Denominational rivalry is also a problem (even among the missionaries – there are 2,221 missionaries from 88 agencies and 35 countries). Add to that mix the usual problems of a developing country being exploited for its resources: poverty, ecological disruption, unemployment, urbanization of a rural people, a high rate of crime, and limited health care. A limited road system and isolation requiring air travel as the sole means of getting there work together to slow down the spread of Christ’s work. Top it off with natural disasters – tsunamis and volcanic activity – and you have a volatile and difficult country in which to spread the gospel. I will be helping at the Kudjip Nazarene Hospital. It is the only hospital supported by the Church of the Nazarene World Mission Division (PNG Nazarene web site). Founded in 1967, it is a rural hospital, located 43 km from Mt. Hagen in the Highlands. The hospital now has 98 beds and serves as both a district and regional referral hospital. Despite the inevitable shortages in a mission hospital, it has a reputation as the best in the country. The occupancy rate is 98-100% or above. There are wards for pediatric patients, male and female medical-surgical wards, a ward for obstetrics, a nursery, an obstetric holding unit and a malnutrition unit. The range of problems treated there is great. Trauma, including those injuries from tribal warfare, adds to the usual surgical load (35 major cases and 120 minor cases a month). There is a nursing school that graduates 90 students a year and is considered to be a premier training site. To give you an idea of the volume of work, the hospital will deliver 1,200 babies a year and admit 400 patients each month to the other wards. The outpatient department is very busy, seeing 4,000 cases each month. All this is done with limited resources. The imaging modalities available are by US standards limited (simple x-ray and ultrasound), the available lab tests are limited in number, the pharmacy struggles with maintenance of an adequate inventory and there is no physical therapy department (despite their fervent wish for one) – in short, the usual mission hospital. However, once again, this setting provides the perfect background to watch the Lord work as the Great Physician, healing and ministering to body and soul. HIV/AIDS is not yet a major crisis but is increasing. The incidence is reported to be approximately 1.5% at the present time. Public health measures remain the most important and cost-effective things to teach and implement.

How can you pray for me and for PNG? 1. Safety and good physical, emotional and spiritual health. 2. Pray for Micky and Sean while we are separated – being apart is hard on them, too. 3. Pray for wisdom for me, that I might properly diagnose and treat the myriad of new diseases and conditions with which I have had no prior experience. 4. Pray for a true spirit of servanthood for me, that I might serve the missionaries and the people of PNG to the best of my ability. 5. Pray that I might have the opportunity to share Jesus Christ and what He has done for all of us, boldly proclaiming the story of His birth, His death for our sins and His resurrection that brings us eternal life! 6. Pray for all of those who are evangelizing PNG – the translators; the radio, video and cassette ministries; the very vital airplane ministries (who need safety as they fly in some of the worst conditions in the world – localized storms, tricky wind currents, rugged terrain); the people who are still discovering new people groups who have not heard the gospel; the health workers; the church-planters. 7. Pray that the nation-wide revival that led to many Christians being elected to Parliament in 1998 will continue and will lead to a change in the people and in the government.

Thanks for your prayers and support. May God grant you a very Merry Christmas and great New Year!

Yours because of Christ,

Bruce, Micky & Sean Steffes

Friday, December 14 Dear Family and Friends:

Halpim mi plis (Help me please)! Before I tell you exactly how I need your help, please forgive my bad manners. Apinun! Yu stap gut? Mi stap gut! (Good afternoon. How are you? I am fine!) Greetings from the Highlands of Papua New Guinea in proper Tok Pisin (Melanesian Pidgin). In what has become a tradition for me, the e-mail service here promptly malfunctioned upon and in honor of my arrival. I am not sure that news of my arrival has yet gotten home, nor whether anyone else still exists since I have not heard anything from them either. I am not sure when this newsletter will get to you, but if the e-mail ever works again, you can reach me either at [email protected] (my new Stateside e-mail) or [email protected] (my address here). The trip here was one of the more interesting journeys I have had on a short-term mission trip and yet it is obvious to me that God had his hand upon me the whole way. God is indeed of God of coincidences, or perhaps more accurately, they are God-incidents. When laden with four over-stuffed and bulging pieces of luggage I pushed open the doors of the Raleigh- Durham airport last Saturday, I thought I had magically been transported to some Third World. There was no electrical power and there was controlled chaos as they tried to check in passengers, process their luggage without conveyor belts and preserve even the smallest remnant of their carefully thought out security protocols. Unfortunately, the only thing which seemed to work was their demand for extra money to cover the cost of shipping the extra trunk. I was thankful for a recent gift from a member of our church that covered this unexpected expense. They also gave me the bad news that the last flight of the 5-stage flight itinerary had been cancelled, at least according to their computers. This did not augur well for my trip. Before I boarded the first flight, I had called the 24-hour number for the travel agency and made arrangements for a seat on the next available flight the following day and made reservations for a hotel in PNG. I called Micky and we made plans for her to contact them to let them know I would be 24 hours later in my arrival. Thought I had it covered. Congratulated myself on my handling of the situation. The flight from Raleigh to Chicago, then Los Angeles and then on to Sydney, Brisbane and finally Port Moresby, Papua New Guinea could be summed up on a single word: “long”. Or two words, “eternally long”—of the “will this trip never end and my derriere is killing me” variety of eternally long. The only bright spot in that time was a few minutes I had to spend with my daughter, Michelle, at a restaurant near the airport in Los Angeles. It was 26 hours in the air by the time we touched down in PNG, plus the fun-filled and dramatic hours spent in the airports along the way. On top of that, there was another 2 hours in the air to my final destination. By the time I stumbled into the Port Moresby arrival lounge, jet-lagged and somewhat malodorous, I was secretly glad that I didn’t have to go on to Mt. Hagen right away. I looked forward to a night of luxury in the local Crowne Plaza hotel. I could just feel the hot shower pounding on my shoulders, the needles of water massaging my skin. I had only to make it past customs and figure out what to do with my luggage overnight and I would be just peachy. How wrong I was! It was only 30 minutes for the planned departure of the next flight when I got up to the customs agent. I gave him my inventory list, trying to finesse him with my cover letter from World Medical Mission with its impressive gold seal. The list of medications alarmed him and he had to check with his supervisor. I prayed the whole time that I would not get too much hassle and was grateful when he let me go after a rather perfunctory exam of only one of the trunks. I then got into the transfer line to recheck my luggage and got a shock – the next flight had not been cancelled and I had 20 minutes. However, the substitute travel agent on Saturday had somehow wiped me out of the system entirely and none of my flights were in the computer. He worked to get me the last seat on the plane but was just about to hit me for another extra baggage charge when the power went out. I thought the extra baggage charge was not quite fair because, after all, I only had 72 of the allowed 16 kilograms of baggage! Finally, as the seconds ticked away, he finally hand-wrote a boarding pass and let me go without paying anything extra at all. I had 10 minutes and being cheap, I wanted to try to call the hotel to cancel my reservation before my credit card was charged for the unused reservation. I found the only phone in a row that took coins. Most phones in the world take only the local telephone company’s calling card. I didn’t have one of those and didn’t have time to find someplace to buy one. None of them took credit cards. However, I had exchanged some money while waiting for my luggage to unload and I had some change. The problem? How much was the call and which of these coins was I to use? I found a woman janitor nearby who probably thought I was crazy, but told me how many coins and picked the right ones out of the handful I offered her. I got the hotel and hope that despite the confusing conversation, that I cancelled the room. It was now 5 minutes before take-off. It was now that I realized the not-inconsequential fact that I was at the wrong gate and the correct gate just happened to be in another entirely different terminal! I literally sprinted to the next terminal about 100 yards away and burst through security. It must have been a sight as a fat, sweating middle-aged man ran with his arms full of stuff and dragging his carry-on behind, the wheels only bouncing on the ground every 10 feet or so. I set off the

39 The SteffeScope Volume 4, 2001 © 2001 security alarm with the coins in my pocket but they realize that this crazed American was no one to fool with and they waved me through. I was the last one through the gate and they were all cheering me on. I saw my luggage on the tarmac about to be loaded onto the plane (thank God!) and I got into the last seat on the plane, sweating profusely in the 90+ degree heat. I had half of my paperwork in my hand, my jacket slung over my arm and my water bottle stuffed in one pocket. I was frazzled and my thoughts were now filled with what I would do when I arrived unexpectedly in Mt. Hagen. No one would be there to meet me. The remainder of my trip is a long story of meeting a Papua New Guinean who would try to call the hospital for me when he got off at the first airport on the way to my ultimate destination. Of a young Missionary Aviation pilot I met coincidentally who took pity on me, helped me find a place to stay in the local missionary home and dragged a stray home to supper. Of another Brethren missionary who, after we discovered that telephone service to the hospital was out and shortwave radio didn’t work, figured out how to get touch with the hospital via satellite phone and even paid for the call with his telephone calling card. Of finally meeting up with the missionaries from Kudjip and spending the first day shopping for food and spending an entire day helping them run errands before arriving late Tuesday night at the hospital. It was a long trip. God remained large and in charge. Were all of these things coincidence? I think not. The missionaries congratulated me on my resourcefulness. I think it was not me. The first two full days have been one of trying to figure out how things run here and what I am to do to help, all dimly interpreted through the fog of jet-lag. I have already performed 7 cases and taken over the care of a 26 bed surgical ward. I am struggling to learn some Pidgin and put together a gazillion new names and faces. I have met some very nice folks and some impressive missionaries. I haven’t been in connection with anyone in the outside world. I miss my family. But I am at peace because this is where I believe God wants me to be. All of that to get you back around to my opening gambit: Halpim mi plis! Next Tuesday is already shaping up to be a big operative day, but there is one case in particular that worries me. I am going to have to operate on a 2 or 3 year old (they are very fuzzy on exact ages here) who has what I believe to be congenital bullous emphysema of one lung. As these abnormal cystic spaces enlarge due to the trapped air, it begins to push the heart way over to the other side and crowd the normal lung. It causes progressive shortness of breath. For months, little Yambo has not been able to play, run, jump or shout as he should because he gasps for air. I am not entirely sure that is what he has. It is a rare condition in a child. I don’t have CT scans or the pediatric bronchoscopes I would like to have to make sure of the diagnosis and rule out other possibilities. We are not really set up to do that kind of anesthesia and we don’t have any ventilators for post-op care. We also don’t have any other options. They cannot afford a trip to Australia and there is no viable option within the country. I think he will die without surgery and may die with it. This is a God-sized problem and I need your help in prayer for the entire team and that little oxygen-hungry Yambo. And while you are praying, pray for another man named Edward. Yesterday, his arm was caught in the conveyor of a rock-crushing machine and it was mangled beyond salvation. I was forced to amputate his right arm leaving only a 5 inch stub. It will have to be revised next week. You can only imagine the grief, shock and rage that he is experiencing. Life is tough here and although he will get some compensation from the company for his injury, it will not be enough to truly make up for his loss and he will struggle to find a job and support his family. Pray that God will use this terrible accident in some way that good will come of it and that he might come to know the Lord as a personal Savior. I have a jumble of impressions about PNG and I will try to sort them out somewhat in time for next week’s newsletter. In the meantime, thanks for your prayers for Micky and Sean at home and for me here – I especially need them. I know I will accomplish things only in proportion to how much you are holding me up before the throne. It is so good to have you on our team. Mi laikim yu tru!

Yours in the hands of a God of coincidence,

Bruce Steffes

Friday, December 21 Dear Family and Friends:

The 49th chapter of Isaiah is a prophecy of the coming of Jesus Christ that starts in verse one with these words: “Listen to me, you islands; hear this, you distant nations”. Join me here on one of those distant island nations:

Imagine if you will a land of eternal summer. The sun spreads its warmth and light over the broad Wahgi valley each morning at 6 AM and plays peek-a-boo through the clouds until it bids a good night’s rest at 6 PM each evening. Five thousand feet above sea level and three degrees off the equator, the air is pure and temperatures rarely drop below 60 nor rise above 85. Woven cane mats for walls and thatch for roofs suffice for protection from the elements. High above the usual malaria belt, the deep volcanic soil is rich, capable of growing anything with the help of frequent afternoon rainfalls. One hesitates to lay down a walking stick in fear of having to uproot it when one returns. The vegetables are picture-perfect, succulent fruits is easily at hand and coffee and meticulously trimmed tea plantations accent miles of carefully tended gardens. Hundreds of varieties of orchids, many other kinds of showy flowers and colorful plants are abundant. There are no poisonous snakes and indeed little wildlife, but the trees are filled with gaily colored birds including the gorgeous bower birds and the dramatic birds of paradise. Aptly named they are for this is truly paradise on earth. Or is it? Within the hearts of the inhabitants of this fair land abides fear, darkness and death. Their traditions are steeped in the concepts of retribution and violence. The seeds of this terrible couplet are ingested with your mother’s milk and reinforced day by day by a culture that has known no other way of living. The veneer of civilized behavior is a thin one even now. Like many such veneers, it is easily dissolved by the alcohol found in home-made brews concocted from banana and pineapples. Although few could recognize Hammurabi’s ancient code by name, they know it. They know it well for it is their code too – an eye for an eye and a tooth for a tooth. There are no Hatfields and no McCoys in these hills, but they understand such blood feuds. An injury, accidental or intentional or an insult, real or imagined, can rapidly escalate into violence. For centuries, they fought with arrows and spears, now with bush knives (machetes) and firearms. If your actions injure me or mine, I will injure you and yours. Any relative or close friend of your enemy is fair game. Such a mentality leads you to trust only your family or tribe and over time, your language becomes unique because you can’t talk to someone more than a few villages away. Paranoia becomes a way of life. But this cancer is more assiduous – it begins to destroy friendships and family. .If you leave a child with someone and the child becomes ill through some sort of neglect, there is a logical recourse – the mother will cut off the other woman’s hands with a few vicious swipes of the bush knife. Two women married to the same man may settle matters of competition or slights with an all-out machete melee. If your mother offends you, a thorough beating or a swipe with your bush knife that eviscerates her will teach her more respect next time. All of life here is affected by the deeply ingrained twinned concepts of retribution and compensation. Compensation is asked for if some sort of relationship exists and there is some real or imagined wrong. This philosophy of life has a good side in that one must always carefully weigh the consequences of one’s actions before deciding upon a course to take, but the downside is that there is no such thing as letting something go. As one of the New Zealand missionaries told me, “It is as bad as America but at least there are no lawyers involved”. The aggrieved person will come and demand some sort of financial recompense, asking you to “buy their heaviness”. At times, it can get truly ridiculous. A Missionary Aviation Fellowship pilot told me of one time when their plane came down somewhat short of the runway. A man saw it, came running to gawk and slipped in the mud. His misfortunate became the source of much merriment amongst the other rubber-neckers. He latter demanded that MAF “buy his heaviness” because after all, such embarrassment would have never happened had he not had such great concern for the safety of the pilots and not had come to see what he could do to help. On the other hand, among the Christians, the concept of grace is slowly taking a foothold. At a recent regional conclave of the Nazarene preachers, one pastor told of a recent event. His children set fire to grass and bamboo during the dry season. Flaring out of control, it rapidly burned his tinder-dry house and those of 7 neighbors. He knew he faced financial ruin, loss of his reputation and perhaps physical injury from others because he could not afford pay to replace even his own losses let alone their losses. When they came to him to talk with him, to his great surprise and immeasurable relief, they told him there would be no compensation required and they prayed with him. He wept as he related the story. Grace is not what one expects in this culture. In thinking about this, I realized that there are some close parallels with our own actions and with our relationships with God. Despite our claims to cultural sophistication and moral maturity, our propensity to selfishness and sin is never far below the surface. We often squawk indignantly to all who will listen about our concepts of “fairness” when we want to protect our “rights”. Yet if we are truthful with ourselves, we don’t really want true fairness in our relationship with God. We certainly don’t want justice. Justice and fairness imply that we will get exactly what we deserve, no more and nor less. We want mercy. Like the pastor, we cannot afford to pay for the result of our misdeeds. Amazingly, God is willing to “buy our heaviness” and provides mercy and grace. Not only is He willing to do so, but He already has done so. Two thousand years ago He sent His Son to pay the price. That is what Christmas is all about. He has promised to take away our heaviness and given His Spirit to make

41 The SteffeScope Volume 4, 2001 © 2001 sure it stays away. But in PNG and in our hearts, it only works if we ask for it and accept His promise that it has all been made right. There is another concept here in PNG that bears some meditation. Wantok is the word for friendship and kinship and it is the Pidgin modification of “one talk”. If you come from the same village, clan or family, you have “one talk”. Wantok carries with it a serious send of duty, responsibility and reciprocity. If someone is your wantok, he can always make a claim on you. You would never dream of letting him go without a place to stay, something to eat or a need you can supply. You are never alone if you have a wantok. As Christians, we too should all be wantok. Our heart language should be the same and that should bring us a sense of brotherhood and unity. But it also carries responsibility. Whether we know the person intimately or not, we have been instructed by God that we have serious responsibilities to those who are wantok. There should never be those among us who have unfulfilled needs and there should never be disunity. We live in fabulous wealth and yet let even those in our own society do without. We do not share what we have despite Christ’s demands. Also, sadly, the unity demanded by the concept of wantok is among the members of the Christian church too rare a thing. Christ’s parables pointed out that our neighbor, our wantok, is really the whole world. How often do we live up to our wantok responsibilities despite our many blessings? Margaret Mugang, one of the operating theater nurses who functions as my Girl Friday here by keeping me out of trouble and by helping me immensely, understands this better than I do. A few months ago, she took her two weeks vacation and went on a short-term mission trip with members of her church. Only for her, it meant driving two hours to the drop-off point and then walking a day and a half through mud and the rain forest up and over a mountain to a village that has virtually nothing in the way of amenities. Please understand that this close to Australia, if you have money and access to the city, it is not too difficult to get the things necessary to live the good life. This godly woman, who lives at a far lower standard of life than we do in North America, had her heart broken as she visited these folks and saw their need. She shared the Gospel and what goods she could carry in on her back. This village in the bush is not far as measured in miles, but was at the same time almost incomprehensibly remote as one measures time – this village is not far removed from the Stone Age. Her dark eyes mirrored the raw pain in her heart as she related her experience to me. She is already planning to go back in six months to do what she can for her fellow countrymen. These are not wantok by PNG standards but they are by Christ’s teachings. She understands that and knows what she must do. Two thousand years ago, Paul described Christian wantok and how it fits into Christmas. Philippians 2:1- 11 reads, “If you have any encouragement from being united with Christ, if any comfort from his love, if any fellowship with the Spirit, if any tenderness and compassion, then make my joy complete by being like-minded, having the same love, being one in spirit and purpose. Do nothing out of selfish ambition or vain conceit, but in humility consider others better than yourselves. Each of you should look not only to your own interests, but also to the interests of others. Your attitude should be the same as that of Christ Jesus: Who, being in very nature God, did not consider equality with God something to be grasped, but made himself nothing, taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself and became obedient to death-- even death on a cross! Therefore God exalted him to the highest place and gave him the name that is above every name, that at the name of Jesus every knee should bow, in heaven and on earth and under the earth, and every tongue confess that Jesus Christ is Lord, to the glory of God the Father.” In last week’s The SteffeScope, I asked for your prayer for two patients: Yambo, the boy with the lung problem and Edward, the man who lost his arm. I wrote a brief update earlier this week about Yambo – he continues to do fine. Edward has come to accept the Lord as his Savior and his arm will be skin-grafted sometime next week. Thanks to you for your prayer and to God for His answers to those prayers. This week has been one that has stretched me to the limits of my medical expertise. Two open chest cases, two craniotomies, four orthopedic cases, three gynecologic cases and an assortment of other cases I actually knew something about has kept me busy in the operating “theater”. This weekend, as we approach Christmas, there will be three opportunities to go caroling and since I can pronounce most of the Pidgin words even if it takes me a while to puzzle out their meaning, I am going along with the group. We will be caroling in the hospital, the mission hospital compound and the local neighborhood. I do not think there are any other special events planned and it will be a quiet Christmas for me. It will be a four-day holiday for the hospital, so I don’t expect to be too busy. For me, there will be no Christmas feast, no mountains of tinsel, no exuberance of presents, no distractions. I will spend my time over Christmas surrounded by a rural people and the eternal hills. In some ways, it will be like the first Christmas Eve. I will certainly take time to reflect upon the great gift that was given to me – and to each and every one of us. Please do not feel sorry for me – I am truly blessed. I am only sorry you cannot experience it with me.

On behalf of Micky, Sean and myself, I want to extend to each and everyone one of you the greetings of the season. Merry Christmas! I wish that God may richly bless each and every one of you as you celebrate the birthday of the Savior and King Jesus. Filled with wonder at His gift, the baby Jesus,

Bruce Steffes Friday, December 28 Dear Family and Friends:

Another year draws to close – it is hard to realize that time has flown so fast. This will be the third year in a row that I have celebrated the coming of the New Year while being somewhere on the mission field. Try it – you will like it! Thank you to all of you who remembered and prayed for my family and me over Christmas. Some e-mail actually made it through and it was good to hear from you. Finally opening that mail after several days of no mail was almost as good as opening presents under the tree. The Christmas time was a good time when I was able to focus on the real reason for the season. We went caroling in the hospital and on the compound and I joined the missionary family for celebrations on Christmas Eve (I don’t mean to brag but I won the drawing for the gingerbread house that the missionary kids decorated!) and for dinner on Christmas. The hospital was relatively quiet and I was able to spend a lot of quality time in front of my computer writing the rough drafts of three more chapters for the soon-to-published handbook on short-term medical missions. After the holidays, I have hit the ground running. We did eight cases Wednesday and Thursday and I have four scheduled for today. Some big cases on the books for the next week or two. There is a lung resection for cancer coming up – again a case that is mighty big for here. Another is a patient with a tongue cancer. I saw three of those in one day and of course, most of these cases are unresectable. Such cases are normally treated with radiation therapy (not available here) but occasionally we will find one in the mobile part of the tongue that has not spread to the lymph nodes in the neck. Those we can sometimes help with surgery but it requires removal of half of the tongue and all the lymph nodes in the neck. Many people here chew betel nut (buai)3 and that can lead to oral cancer. Chewing betel nut is a wonderful habit. It can start as early as five years old and causes you to spit large streams of bright red juice that looks like a spontaneous hemorrhage. It has a mild narcotic-stimulant effect and is popular for that reason. Nothing like a pick-me-up in the middle of the day. It reportedly tastes awful but the kick is apparently worth it. You crack the nut between your teeth and pluck out the kernel. Chew it until well mashed and then dip your mustard stick (daka) into the powdered coral lime (cumbung). Bite off the frosted portion of the stick and keep chewing. Repeat this a few times and soon you too will experience the rush and begin to spit volumes of blood-red saliva. Apparently, the technique of chewing is important and until you get a hang of spitting, it is important to not wear a shirt that you really want to wear again. That is unless you like red streaks. Wonderful habit. Please do not worry that your teeth flash bright red when you smile – they will turn black with time. Anyway, back to my story, we also have a boy with imperforate anus scheduled for sometime in the next two weeks. He was referred for reconstruction of an anus. He was born without one and he received a colostomy at another hospital a year ago. Two of those cases scheduled for today were really emergencies that should have been done yesterday. However, in this culture, the patient does not sign his or her own operative permit. The husband, father or tribal leaders are the only ones who should sign for such things and of course, they were not here. In the United States, we have the legal right and ability to sign for the patient if two physicians deem it appropriate in their judgment. Here you cannot. Proceeding without permission has the very real possibility of starting a tribal war against the hospital. There is another potential advantage of working in PNG. If any of you would like to feel taller, this is the place to come. Not having done a proper statistical sampling, I would still feel safe in hazarding a guess that the average height for man or woman is about five foot and six inches. The Highlanders are of stocky build and often wear brightly colored knit caps that look like ski caps (or toboggans as some of you know them). The adult men are usually bearded and even the women tend to be hirsute. Their hair is kinky and their skin dark – some of the islanders reportedly have the darkest skin in the world. Men and women have the most amazing calf musculature. It is from walking up and down hills all the time. That is why when Margaret, my surgical helper, told me that the walk to her mission village was a hard one for her, I knew that meant I would probably die on the trail! Their culture centers on their pigs (for both practical and spiritual reasons), their beautiful farms, polygamy and the ever-

3 Nut of the areca palm.

43 The SteffeScope Volume 4, 2001 © 2001 present violence. Familial violence is present here is a way I have never seen before. Over half of the machete cuts I have seen are inflicted by one family member on another.

Praises and prayer items: 1. Little Yambo is slowly improving. All staples and tubes are out and he is being treated with a digitalis derivative for the heart failure secondary to the strain of pumping against the abnormal lung vasculature for all that time. He still requires oxygen supplementation but I hope that time and prayer will take care of that. 2. Edward, the man with the amputated arm, underwent skin grafting of the stump yesterday. He has accepted the Lord as Savior and his personality has become radiant. 3. Dr. Jim Radcliffe and his family are soon to leave the States to return to the hospital. He is the surgeon for whom I am substituting. Please pray for safety in traveling. 4. Dr. Susan Myers and her family are on holiday this week on the northern coast in the city of Madang. Pray that they will have a time of rest, relaxation and family time as well as safety in traveling. 5. When we went caroling in the hospital, we handed out a bag of gifts and tracts. The whole process fascinated them. Family members surrounded all of them because in this culture, you must bring a “watchman” to take care of you while you are in the hospital. Pray that they will understand the message of the Gospel tracts and make the leap from accepting the physical gift we gave to accepting God’s gift of salvation and forgiveness. 6. This has been quite a year for my family and me. We have weathered the scare that Sean would be born with Trisomy 21 (Down’s Syndrome). We have gone through three months of separation from March through May and again in December. A chest x-ray of Bruce in Togo demonstrated an unexpected mass that, if you went by the odds, was most likely malignant. Little Sean David became an integral part of our lives. Surgery this summer gave the report of a fungal infection and we rejoiced at the diagnosis and the quick recovery. Two gut-wrenching weeks in the courtroom led to a defeat – and then it was reversed. The reversal is still being appealed. Micky’s lawsuit grinds on. Just to keep it interesting and to give us something to do, Ryan graduated from Taylor University and later in the summer, he married his love Rachel. A lot of stressors to the usual process of just living. However, I cannot count the blessings we have received this year. The list would be much, much too long. It is impossible to get you to understand how precious our relationship to God has become in all of this. He has always been there and we thank God that so many of you have been there with us. Some with prayer, some with the encouraging word, some with your presence. Through all of it, we have come to better appreciate the wealth we have. It is a wealth not of financial nature but in friends and love. Thank you. We are blessed.

We wish you a very happy and blessed New Year. I pray for each of you, that you will have a close relationship with Christ this year. It is the greatest blessing I can hope for you.

Yours in the arms of the great Father,

Bruce Steffes