Listening to the Heartbeat of Our Ministry Saturday

Saturday, January 10

Dear Friends and Family:

Happy New Year to all of you! The start of 2004 finds us safely back in Togo for a month of service. Thanks for your prayers for us. After spending almost eight months here last year, it was very strangely like coming home when we drove in today. We were met by the two non-variables that so characterize Togo at this time of the year: the harmatan and grassfires. As we try to stop coughing and wheezing and struggle to catch our breath, please excuse us and take a moment to see how you do on this quiz designed to see what you remember about Togo (the answers are in the postscript):

1. We’ll start with an easy one. Togo is on the continent of: (A) Africa (B) Australia (C) No such place 2. The Harmatan refers to great swirling clouds of dust reaching high into the atmosphere that ride northerly winds and cover much of Western Africa from December to March each year. This dust comes from which of the following deserts? (A) Mojave (B) Gobe (C) Sahara 3. Togo is approximately the size of which of the following states? (A) Michigan (B) West Virginia (C) California 4. The population of Togo is approximately: (A) 2.5 million (B) 3.8 million (C) 5.3 million 5. Although there are approximately 37 ethnic groups and corresponding languages spoken in Togo, which language is the national language? (A) French (B) English (C) German 6. After WWII, the German colony of Togoland was divided into two countries. The eastern end was given to French West Africa. What country was created by the British from the western end of Togoland? (A) Benin (B) Liberia (C) Ghana 7. Although in 1991, Togo officially became a multiparty republic, election irregularities have kept the same man in power for over 30 years. The man who is effectively a dictator is named: (A) Eyadéma (B) Taylor (C) Mbeke 8. The average per capita income in Togo is approximately: (A) $13 (B) $300 (c) $1724.35 9. In the US, there are only about 550 people per physician. In Togo, that number per physician is: A) 6,000 (B) 8,000 (C) 13,500. 10. Of the three groups listed, which has the greatest percentage of followers in Togo: A) Christianity B) Islam (C) Indigenous (Animism) 11. The official estimate of the incidence of AIDS in Togo is: (A) 1 in 40 (B) 1 in 16 (C) 1 in 4 12. Which of the following is not a common diagnosis made here: (A) Malaria (B) Anemia (C) Guinea worm 13. The hospital (Hôpital Baptiste Biblique in French and the Karolyn Kempton Memorial Hospital in English) presently has this number of beds: (A) 32 (B) 72 (C) 220 14. There is a small but thriving additional ministry on the hospital compound. It is a (A) well-drilling ministry (B) outreach to the Muslims (C) printing ministry 15. The hospital’s greatest needs are in the area of (A) more financial support (B) more prayer (C) more God- led people to come and to help.

We have not settled in enough yet to let you know how things are going or give you much in the way of specifics. We are pleased to hear that God has answered prayers for the hospital and there now seems to be adequate surgical coverage for the next 18 months. We trust that it will turn out to be so and even if so, running a hospital with short-term volunteers is always tough on everyone. The hospital is very dependent on the surgery done here to bring in enough income to cover much of the costs of running the hospital. Since Dr. Cropsey was unable to come back as a career missionary due to his wife’s filariasis (a tropical worm infestation spread by fly bites), it has caused a great deal of uncertainty and generated a lot of prayer. However, we know that this work is not dependent on any one person or any groups of people. It is God’s work and we must trust in that for the long run.

Praise and Prayers:

1. Several of you have asked about the final outcome of Bruce’s last malpractice case which stretches way back to 1994. In brief, there is not yet a final outcome. After the jury ruled against Bruce, the judge ruled that the expert witness for the plaintiff was in fact not an appropriate expert. We concurred. It took two

years and a few months for the Appeals Court to rule that he was – but Bruce’s lawyer, the malpractice insurance company and Bruce all felt there were several irregularities in their ruling and so the case is now being appealed to the NC Supreme Court. We are not optimistic that they will agree to hear it, but if the existing appeals ruling stands, then it essentially makes the definition of an expert witness to be one without serious meaning or significance and it is another blow to defendant physicians everywhere. The judge recently ruled against the motion for a repeat trial and so now our hopes hang on the Supreme Court. 2. Pray for our health and the health of the missionaries here. Typhoid fever has been rampant here and respiratory illness due to the harmatan is always a problem. 3. Tomorrow (Sunday), Bruce will be operating on Steve Mills, one of the career missionaries. Please pray that it will go well and without complication. We are pleased to report that Steve and his wife Mary Jo also returned to Togo this week with apparent resolution of his debilitating headaches which were felt to be to a rare leak of the cerebrospinal fluid around the brain. 4. Please pray for the safe return of Dr. Sam Williams and his wife, Liz, back to their home in Virginia. Their time here was a real blessing to them and to the hospital. There are also many other short-termers coming to help with the hospital and to do construction on the airplane hangar. Please pray for their safety as well.

We are glad to be back serving in West Africa. We thank all of you for your prayer support and for those of you who have provided funds that serve to allow us to serve you when serving those who serve others. Please feel free to e-mail us – we would love to hear from you.

Yours, serving our risen Lord and Savior,

Bruce, Micky and Sean Steffes

P.S.: The answers to the quiz are as follows: 1. A – Africa 2. C – Sahara. About 3500 – 4000 years ago, the Sahara became overgrazed and deforested. A fall in rain levels led to the desert which has been slowly expanding since then. 3. B – W. Virginia 4. C – The 2002 estimate is just shy of 5.3 million 5. A – French 6. C – Ghana 7. A – Eyadéma. The election irregularities led to an long-standing embargo by the US and other countries which continues to depress the economy here. 8. B - $300 9. C – 13,500 but that is only part of the picture. The level of training is inferior and the medical resources abysmal. 10. C – Indigenous religions. This the home of voodoo and the influence of the spirit world is great, even in the lives of so-called Christians. 11. B – 1 in 16 It may actually be higher. 12. C – Guinea worm. This is one disease targeted for eradication by the World Health Organization and is now rare here. Malaria remains a scourge that kills regularly and anemia is found in up to 50% of the patients. 13. A – 32 beds. 14. C – Printing ministry. The potential for both of the other answers is great. Many of the diseases here can be prevented by good water and good sanitation practices. Now there exists a plan for expansion to the town of Mango in the north of Togo. In a rather unique development, the Muslims there have actually asked Christians to come and set up a work there. ABWE is planning to expand their work into the north but it will be several years before it can be implemented. Pray for wisdom, workers, and the finances needed to make it work. “Ask the Lord of the Harvest to send workers”. 15. This is a trick question – this was a true-false question and the answer is TRUE! All are very much needed.

Saturday, January 17 Dear Friends and Family:

We are settling back into the routine here at the Karolyn Kempton Memorial Hospital in Tsiko, Togo. Some patients don’t even know we have been gone and treat us like old friends. Of course, some have just now finally returned for their first visit, having neglected to come sooner! It has been cooler this week than previous years that we have been here in January – only 96 degrees in the shade at noon this week instead of the more customary 100 degrees. Since we do not have air-conditioning in the house where we are living, the windows are kept open to catch any available breeze. The grit blowing in the wind keeps a thick layer of dust on everything, requiring daily dusting and daily mopping just to keep abreast. Two days without housekeeping and you have to break out the shovels to move the dirt…. Presently, there are only two physicians here. Russ Ebersole, a pediatrician who now has a year’s experience under his belt as a career missionary, and Bruce are holding down the fort in the hospital. Russ spends much of his day as a hospitalist, seeing outpatients as necessary as he holds court at the end of the nursing station or in the clinic. The word has gotten out that Bruce is back at the hospital and the surgical schedule is ramping up quickly. Steve Mills is a physician assistant and career missionary who spent much of this week recovering from his hernia surgery. He is doing well and Bruce is thankful that he is now well enough to take call today. Four Togolese employees (including two physician assistants and one retired nurse) see the majority of patients in the outpatient clinic. Bruce gives surgical and medical consults between OR cases. This week, we continue to average over 4 major cases a day, with some mornings like Thursday when we did nine cases by noon. This is despite the fact that Tuesday was an official holiday (imagine a country where the independence day celebrates the assassination of the previous president) and Wednesday was an unofficial one (“bread and circuses” in the form of extra holidays is a popular concept here in a government which can offer little else). As always, as judged from our American perspective, we have an inadequate selection of medications, laboratory tests and radiological options open to us and yet the Lord continues to bless the work done in His name. Dr. Sam Williams and his wife Liz had to delay their departure for a few days but left on Thursday. One of the last cases he did before he left demonstrates the fact that we all believe the Great Physician is more responsible for the outcomes we see than we are. A woman came in with profound septic shock. She was cold and clammy to touch and had an obvious rupture of her uterus. When Dr. Sam opened the abdomen with the electrocautery, the dead fetus (which was freely floating in the abdomen) had become so infected that there was free methane gas in the abdomen. The sparks from the electrocautery pencil ignited little jets of gas along the incision. It was unprecedented and more than a little scary to have the cautery pencil turn into an igniter for an acetylene torch! Everyone was surprised when she survived the operation and even more shocked when she was still alive the next morning. Without intensive care units, ventilators, Swan-Ganz monitoring, blood gas determinations and the accoutrements of critical care that we consider necessary in the US, it seemed unlikely that she would live. Not only did she live, but the next morning she was alert and coherent – enough to accept Jesus as her Savior. She is still very ill but hanging in there. Please pray for her. We try not to bore you with statistics but the ones from 2003 reflect in some small part the result of our ministry with the team here last year. In 2003, this little 32 bed hospital and outpatient clinic saw almost 10,000 new patients. The two operating rooms handled 1490 major surgical cases, the majority of which were non-scheduled and non-elective cases. There were at least a thousand more admissions and thousands more seen in the outpatient clinic who were there for return visits. Keeping in mind that the main thing should be the main thing, we are thrilled to report that 1700 people came to accept eternal life from Christ their Savior. It brings to mind the observation that we once heard David Killel, the head of the chaplaincy program at Tenwek mission hospital, say, “More unsaved people go through our hospital each week than through our churches”. He is right. Interestingly, in December, more than 80% of those patients who were saved were from areas of Togo and surrounding countries where we do not presently have a missionary outreach – that is to say, we have no church in the area and no good way to help them grow in the knowledge of God. The missionaries and the Christian Togolese are having a major effect here – but there remains a great need for more resources and more people. As Christ said, the fields are indeed white unto the Harvest. Please pray to the Lord of the Harvest and ask Him to send workers. If you hear your name when He speaks – please listen and come! Micky is back in the accounting department of the hospital, trying to help close out the year, especially in the area of accounts receivable. The poverty among patients here is great and there is a large percentage of unpaid bills. Those of us in the United States may be thrilled with the rise in the stock market and the falling value of the dollar may make it easier to sell our manufactured goods overseas. That is good for our economy and us, but for

Listening to the Heartbeat of our Ministry The Steffescope Volume 7, 2004 © 2004 missionaries who must live on the economy in another country, the falling value of the dollar is a disaster. The dollar is down twenty percent since we first arrived here last January of 2003. That means the missionaries have taken a twenty percent pay cut over the last year or, to put another way, everything costs twenty percent more. For those who were on marginal support in the first place, it is a major crisis. Please consider sending some extra money this month to those you support and ask your church’s missionary committee to consider increasing your church’s monthly support of missionaries to help them defray the effect of the falling dollar. This is a worldwide phenomenon.

Praise and Prayers:

1. The hospital team is grateful that many short-term surgeons have volunteered to fill in the gap in surgical coverage this year. A few gaps remain. The most critical is for three weeks in May where there is no surgeon at all. A second surgeon could be of great help in March, April, July, August and December. Other specialists, especially orthopedic and urologic surgeons, are desperately needed. If you know of anyone who can help, please have them contact Dr. Ebersole at [email protected] or Mary Snead at World Medical Mission ([email protected]; (828) 262-1980). 2. This dry season is the time of meningococcal (bacterial) meningitis and typhoid fever. Malaria remains rampant despite the general paucity of water. Each day brings to our door new critically ill patients far beyond our knowledge and resources. Please keep us in your prayers. 3. We are so pleased that Steve Mills is recovering so well from his surgery and that his headaches, for which he had to return to the States for a few months, have been infrequent. 4. This coming week is the Field Council meeting here on the mission compound. This is when the missionaries get together to plan the next quarter. It is a time of fellowship, fun, planning and prayer. Bruce will be carrying an extra portion of the burden of the work at the hospital in order to try to free them up for their meetings. Please pray for him during this time. 5. Over the next week, Bruce plans to continue teaching proper surgical instrument repair to the operating room national staff. Our friend in the States has again been very generous in providing some new instruments and some supplies that were needed to sharpen certain instruments. 6. A construction crew is here to finish the airplane hangar. Please pray for their safety while they work and for the quick completion of their efforts. Matt and Mandy Cropsey are coming in a few months to rebuild the plane itself and begin their aviation ministry. 7. A church in Rochester, Michigan has provided the funds for the construction of more clinic space and a covered area for waiting that will keep the patients out of the sun and the rain. 8. In just three short weeks, Micky and Sean will be heading home and Bruce will be flying over to Kenya to attend the Christian Medical and Dental Association meeting. He will be both lecturing and obtaining needed medical education credits. Please pray for traveling safety for us, the dozens of other medical lecturers and the hundreds of medical missionaries who will be attending. Pray that their hearts, souls and minds will be prepared ahead of time. Pray that those missionaries will get the knowledge they need and they will be ministered to in the areas of their own needs. Pray for rest, relaxation, a sense of the greater unity of Christ’s church and the encouragement to go back to their stressful and critical ministries.

It is very easy for Christians to become discouraged, but it is important to realize that great things are happening on this speck in the universe. God is preparing His church for the imminent Second Coming of Christ. The number of missionaries has increased from less than 3,000 in 1886 to greater than 200,000 in 2000 and the number of Christians has increased from less than a small fraction of one percent to greater than 5% of the world’s population in the same time period. As the old Southern Gospel song goes, “I read the back of the Book – and we win!” There are more Christians than ever – what are you going to do with them to make an eternal difference? God is working – are you going to join Him? The only way you can lose is to not play!

Yours, waiting for Christ’s soon return,

Bruce, Micky and Sean Steffes

Saturday, January 24 Dear Friends and Family:

Greetings from West Africa! Here we are, trying to be missionaries – or at least act in such a way so that we do not embarrass them – and despite that resolve, this past weekend Micky had to go and act the part of a scofflaw. The sad tale is on this wise: Micky is pretty brave in her travels around the world, using common sense but running around as she needs to do so. Last week, while Bruce was busy at the hospital, she had some business to do in the nearby town of Kpalimé and so she loaded Sean into the backseat and off she drove in the Jeep borrowed from the Cropseys. While she was in Kpalimé, she parked in a rather narrow area in front of the Coke kiosk to run in and get two cases of soda pop. As she was going in, a gendarme who was walking by called to her, “Madame! Madame!” It was clear that he was upset about her choice of parking spots. He spoke only French and she forgot all of her limited French in her panic. He wanted to see her permit for the car. He went through the stack of paperwork that was in the glove compartment and kept pointing to something but couldn’t get his point across. When the language failed, he got in the car with his AK-47 and motioned that she was to drive. While she drove, he directed her to the police station. He then wanted her to come in, but because Sean was asleep in the back seat, she was reluctant to go in. He went to get his boss who fortunately spoke some English. The boss came outside to talk to her. During the time the gendarme disappeared into the building, Micky used the cellular phone she had borrowed from the Mills (which she has never done before) to put in a call to Steve Stadtmiller, one of the ABWE missionaries in that town. She couldn’t figure out the memorized phone number menu already programmed into the phone but had brought another list of phone numbers with her (which she also never has done before). She was very grateful that she had it. She put in the call to Steve but was afraid that he and his son would still be out in the yard mowing. Wherever they were, they were able to hear the phone and answered it. Steve was very gracious. He promised to come over immediately and was there in a few minutes, having brought Agbeko, the accountant from the blind center that Micky had helped last summer. The gendarme kept promising Micky there would be a stiff fine (“No permit! You will pay!”). He insisted she would have to call her husband to come down from Tsiko and bring the permit. There was no real way she could reliably reach Bruce. Steve and Agbeko worked it out with them – the police wanted a fine for the lack of her permit, for the lack of her driver’s license (which she had forgotten and left in her other purse) and for her lack of parking skills. Despite the fact that she had neither piece of paper, they worked out something where she did not have to pay them the 10,000 cfa (US $19) they wanted. They said it was because she had no previous offense and was obviously a visitor. They were gracious and tried to shake hands with a now awake but thoroughly grouchy and still sleepy Sean. Agbeko then suggested that Micky offer a “gift” of 3000 cfa. The missionary concurred with the suggestion. Micky was glad to pay that small amount to get out of there still in their good graces. Micky said she was not really afraid at any time, just frustrated about the lack of communication, but admitted she was a little antsy when the man climbed in with his gun. She is not eager to drive down there again, though. She was amazingly calm. She even came away with the two cases of Coke that she went for. She keeps her priorities straight! We got the paperwork straightened up early this week so it won’t happen again (if she remembers her driver’s license). This week was the first quarterly Field Council of 2004. It was an excellent time for the career missionaries and they had a special program to promote team-building. Because those of us who are not career missionaries were trying to facilitate their attendance, we endeavored to do cases in such a way that it would not require their presence. One day this week, Bruce was able to do some cases that could be done with the personnel available to us. One afternoon, in a little over two hours, we did three hernia repairs. That was not so remarkable but they were done by a fellow with a third-grade education (an ex-gardener cum OR tech) and he was assisted during surgery by a PA student. The spinal anesthesia was given by a surgeon who also played the role of circulating nurse. The post-op pain was controlled by just ibuprofen (Advil) and ice packs and they would do just fine with excellent long-term results, thank you very much. And all for $70.47 each. Eat your hearts out, HMOs of this world! We mentioned in last week’s The SteffeScope the results of the ministry in terms of patients taken care of here in 2003. The head nurse recently attended a meeting for nurses from all over Togo and found out that this little 32 bed hospital perched on the edge of the world (just before you fall off) is the third busiest in Togo, second only to the university hospital in Lome and the big governmental hospital in the large northern town of Kara. The regional medical director of the Peace Corps also stopped in for a visit and thanked us for our service to their folks – he told us they consider this the “go to” place in Togo for their expatriates. We admitted that we were glad to operate on their folks – one good payment from an American insurance plan could make the difference for the hospital between a good and a bad month financially!

This week had some pretty weird weather for the middle of the dry season – it rained for three nights in a row! It was a wonderful respite from the heat and dust, but now the Harmatan is back with a vengeance. This first big rain was six weeks early but within 24 hours, the flying ants were everywhere. We would love to better understand the chemical/hormonal trigger that allows them to grow wings, fly and leave the nest in just 24 hours, even when it is a fluke rain out of season. God’s creation is awesome! For those of you who may be wondering about this favorite snack food here in Togo, we did not fry and eat any of them. We are trying to cut down… We would like to apologize about the problems we are having with our e-mail distribution system. We really don’t know when you will get last week’s newsletter (Number 2 from January 17) or this one. We have been able to post them on our website (www.brucesteffes.net) but not able to send them out on e-mail. We hope to have this fixed soon!

Praise and Prayers:

1. Last week, we mentioned the patient operated upon by Dr. Williams. She had a ruptured uterus and a dead baby free in the uterus. It had decomposed to the point that there were literally flaming jets of gas and the woman was nearly dead. We rejoiced in last week’s newsletter that she had lived long enough to accept Christ. Late this week, she was discharged to home on some antibiotics but otherwise she is doing well. Thank you for your prayers on her behalf. 2. This week, we operated on a 10 year old girl who had a large pelvic mass. It turned out to be what we believe to be a rare sarcoma (type of cancer) of the uterus. There was nothing curative that could be done. Her prognosis is poor. She and her family had not accepted Christ. Please pray for them. Another 46 year old Muslim was operated upon and closed upon finding a huge gastric carcinoma invading the spleen, pancreas and diaphragm. He also declines to accept Jesus Christ as Lord. 3. We received a request this week that has radically altered our plans to serve here in Togo. Our already too short time is becoming even more abbreviated. Samaritan’s Purse asked Bruce to consider coming to assist on a special project in Eastern Africa. They would find a replacement to cover the hospital in Togo if we could come. They were able to find a fellow who happened to be free right now and who had a modicum of experience here – a dashing young surgeon by the name of Dr. Bob Cropsey. Micky pointed out that he hasn’t done much surgery lately, but we will just have to trust that it comes back to him! We do not know if we are at liberty to publicize the nature of this SP project so we are choosing not to give you any specific details, but given the nature of it and how it came to our attention, we believe this to be something of God’s leading and an answer to our prayers. Micky and Sean will be returning to the United States in just a few days and Bruce will be flying to Eastern Africa to work for a few weeks on this project. His lecture schedule times have been rearranged so he can give them the second week of the Christian Medical and Dental Association continuing medical education conference. Please pray for traveling safety for all of us and for Dr. Cropsey and also pray for God’s leading in this project.

Excited to walk through this new door, we remain

Yours in serving Him!

Bruce, Micky and Sean Steffes

Saturday, February 7 Dear Friends and Family:

Greetings from Nairobi, Kenya! Before I give you an update about the helter-skelter travels of the last two weeks, let me tell you about a project that is exciting to Micky and me. A few years ago, we had dinner with a young African-American man by the name of Jason Perry. He told us of a book he had written entitled, “How Far Can You Go? Straight Talk about Sexual Purity.” At the time, he was excited about an upcoming Youth For Christ sponsored program entitled Generation 21 Leadership Conference that was to be held in Nairobi, Kenya – so excited that he printed 2500 copies of the book with his own funds. The response to this material was fantastic. Dr. Tukunboh Adeyemo of Kenya gave the book this endorsement: “Talking about sex is taboo in most of our churches. And at the rare times we do, we are often judgmental or defensive. Brother Jason has broken that taboo effectively…The strength of his work lies in his Christ-centered answers to the sensitive questions posed. This takes his small book beyond cultural confines. The principles and precepts hereby exposed are transcultural…” With that

Listening to the Heartbeat of our Ministry The Steffescope Volume 7, 2004 © 2004 encouragement, the dream of a much more widespread publication of the material across Africa took root in his heart. At the time, he was kind enough to send me an electronic copy of the book. I thought it was excellent. In a conversation with Judy Bowen, the director of the CRC in Togo, a year ago, I mentioned the book to her and told her I felt it was something that would be appropriate for the Christian printing ministry in Togo to print. She read it the copy I shared with her and she agreed. I put the two of them in touch with each other and now the project is moving right along. They have reduced it to an English base text and have done research on the West African French slang and idiom for sexual experimentation. It is now being translated into the simple French that is most readable by Africans (who are reading it in their second or third language). Rev. Perry has begun the process of raising money and has found a printer in Japan who can print and ship them for less than 50 cents a book. English and French versions and French versions that also include a leader’s discussion manual are also being considered. The goal is to raise enough to print and distribute 180,000 copies free of cost to the teens receiving it across francophonic Africa. It will require $90,000 to have this project take off on its first stage. I was thinking today about how a seemingly random meeting at an unremarkable restaurant about an entirely different topic would lead to the outreach to hundreds of thousands and, God willing, millions of Africans. God has His hands on things, doesn’t He? If you would like to help put this desperately needed material into the hands of tens of thousands of African teens, please send your tax-deductible donation to Oak Tree Publications, PO Box 441216, Aurora, CO 8044. If you have any questions, please e-mail or call Tameka Montgomery, the project manager at [email protected] 303-523-1399. Just a dollar can put the books in the hands of two teens. In a land of rampant AIDS and sexual disease, you can save or salvage a life with the Holy Spirit’s help for just that little bit. Please consider helping. In our “Praise and Prayers’ list of the last newsletter we sent out two weeks ago, we mentioned that we had received an invitation from Samaritan’s Purse to come to East Africa on a special project. It has been amazing to see how the Lord has answered prayers and all of the little niggling details which could have derailed our involvement have come into place without difficulty. Without going into all of it, the end results was that Dr. Bob Cropsey returned to the hospital in Togo to cover our absence. On Tuesday night, January 27, Micky and Sean left for the United States. They missed a connection in Amsterdam and Detroit and ultimately landed in a North Carolina that was coated with ice, but they arrived safely. On Wednesday morning, January 28, I flew to Nairobi. After a few days of rest and having undergone a briefing on the project, I flew last Sunday to Kampala to begin work. There are 25 million Ugandans and at least 13 million children. More than two million are orphans. There is no such thing as specialized pediatric care in the majority of the country and even at the university hospital in the capital city of Kampala, the level of care is substandard by our values. There is no hospital with a pediatric intensive care. There is no neonatology and no board qualified pediatric general surgeons. The range of specialists for pediatrics just doesn’t exist. A sick child must be flow out of the country or face death. A group of people are trying to change that. They are envisioning a privately owned, evangelical, national referral hospital for children. The problems facing such a project are great. There is no way for such a hospital to be self-sustaining in this country which means that most of the funding must come from outside the country. However, the potential of such a hospital is great – not only for the children it can save, but for the significant effect it could have on the quality of care throughout the country, training nurses and physicians to go out and make a difference. Children are NOT just little adults and the care of them in Uganda and in the majority of African countries leaves a lot to be desired. I have been tasked with trying to talk with many of the principals who take care of children in the country and to help focus the effort, prioritizing the needs and helping to rough-hew the shape of the project. I spent most of this week talking to folks and after the time off for medical conferences, I will fly back to Uganda next weekend to finish up several days of interviews before flying back to the US. This is a God-sized project for which I am inadequate. I am excited because it is clearly needed and those trying to put it together have clearly stated that their goal is helping the children of Uganda medically while telling them of the Gospel of Jesus Christ. This past week, when returning to Kampala from Mbale’s C.U.R.E. Children’s Hospital of Uganda (a neurosurgical specialty hospital), I was able to stop in Jinja and make a very quick visit with friends from our time of ministry there a few years ago. I am pleased to report that John and Rebecca Fulks, missionaries working at the Global Theological Seminary, are doing well. I took a quick side-trip to Canaan’s Children’s Home and Good Shepherd’s Fold as well. Things are going well at both orphanages and it was good to be back and hear the shouts of “Dr. Bruce”. Friday and Saturday, I had the unexpected pleasure of attending an orthopedic conference at the Kikuyu PCEA Orthopaedic and Rehabilitation Hospital outside of Nairobi. This conference is designed to teach general

Listening to the Heartbeat of our Ministry The Steffescope Volume 7, 2004 © 2004 surgeons a little about orthopedics. I never expected to be able to attend, but last minute changes in the schedule allowed me to do so. It was good to see my friend from Tenwek Hospital, Dr. Michael Chupp, and to gain a goodly number of new friends. Three of my newfound friends are residents in the Pan African Christian College of Surgery programs in Gabon and Cameroon. I was appointed to the board of that group late last year. This week, I received this information in an e-mail from the PACCS: “The European humanitarian group, Doctors Without Borders, estimates there are approximately thirty surgeons serving the 44 million living outside Kinshasa in the Dem. Rep. of Congo. This is on average one surgeon for every 1,466,667 people, a tragic and deplorable situation! The PACCS is presently training two Congolese surgeons: Dr. Hubert Kakalo is in his third year in Gabon. Dr. Domain Fuka is in his first year. A third Congolese, Dr. Albert Makangila, is expected to begin in March or July. Please pray for these three, that they will complete their training without delay, to return to their nations where their service is so desperately needed.” The cost of training a resident is only $6,000 per year, for four years, to train each resident. This modest amount covers his (and his family's, if married) housing and meals, travel, medical care and children's education. I can think of no more worthy investment than to enable one of these residents to become a surgeon so he can return to Congo to serve the staggering needs of his people. I have met Dr. Kalalo this weekend – what a neat guy! Residents in these programs not only become of the best-trained surgeons in their country but they have undergone a solid theological training during their residency as well – they will be leaders in their church and in their country. If you would like to help support one of these fine men and women, you may contribute financially to the training of Christian surgeons in Africa. Please write your check to CMDA, note that it is for the PACCS and mail it to: The Christian Medical and Dental Associations; PO Box 7500; Bristol, TN 37621

Praise and Prayers:

1. This week I will be attending the Christian Medical and Dental Association medical education conference. I speak on Tuesday, Thursday and Friday. Hundreds of missionaries and nationals will be coming from all over Africa and surrounding countries. Please pray for safety for all those traveling, and for a time of fellowship and a recharging of batteries for all the missionaries. Pray for me while I try to speak to them. 2. Next weekend, I will be returning to Uganda. Please pray that I will be able to talk to the right people, to ask the right questions, to be discerning and to be wise on how next to proceed. Pray that the Lord will clearly open or close the door for this project and for my continued involvement. 3. Please keep my wife and son in your prayers. It is hard to be apart.

Yours in Christ, serving in East Africa

Bruce Steffes

Saturday, February 14 Dear Friends and Family:

Happy Valentine’s Day! It is amazing how big a holiday that Valentine’s Day has become in Kenya and Uganda. I had presumed that only Americans would spend too much money on flowers, candy and entertainment but it is a big deal here too. The only good thing is that many of the flowers for Europe are grown in these two countries and flown out by plane every night. That means that at least you can get reasonably good prices on long- stemmed roses. The ongoing Christian Medical and Dental Association (CMDA) conference at Brackenhurst is a rousing success. Originally planning for only 230 participants, there are over 340 attending and 285 of those are attending for professional continuing education credit. There was not an empty bed to be found and people are driving for up to an hour each way in order to attend. There are many Christian African physicians who are attending. It will continue until next Thursday. I hated to leave early. It is hard to give you a good sense of this meeting. It is an odd mixture of a reunion, a professional meeting, an old-fashioned camp meeting, a summer camp like those you attended in your childhood and a retreat. Reminiscent of the story of Elijah who complained that he was alone in the service of the Lord only to find out that there were at least 7,000 others who had not bent their knee to a false god, there is a sense of rejuvenation and camaraderie for the missionaries that is hard to comprehend until you too have been in a challenging situation and faced with discouragement. Missionaries may come in a state of burn-out, but by God’s grace, they often go home once again fully aflame, burning with excitement about the future.

Here are some glimpses of this past week: • One night we had the evening worship service in the dark with only a single strip of fluorescent light in front. Why? A hive of African killer bees had taken over the rafters of the auditorium and despite the best efforts to get rid of them before the service, they were still making a nuisance of themselves. It was somewhat disconcerting to suddenly feel a groggy bee walking on your neck. Fortunately, the poison was taking the aggression out of them and no one was stung. Despite the dark, the old anthems and hymns sung from memory rose majestically in harmony and with conviction. • The first few days were damp and chilly. You would expect equatorial Africa to be blazing hot but at thousands of feet above sea level, everyone was a little chilly and asking for extra blankets and the loan of a spare sweater. By Thursday, the skies had cleared. Looking to the south from the hills, one could see the snow-covered peak of Mt. Kilimanjaro clearly, even though it was hundreds of kilometers away. • A group of men was praying about a sticky situation. One of the national churches is presently refusing to let the name of Jesus or God be included in an HIV manual because it might offend people – and not-so- incidentally, it might dry up sources of help and money from non-Christian organizations. The missionaries knew two things – that Christ is the only hope these dying victims of HIV have when they do not have access to antiviral medications and that for themselves, the chance and need to share Christ is the only reason to serve in these conditions. If this carnal national church would not allow them to tell others of the love of Christ, there seemed no valid option but to withdraw from the country. They were on their knees in love for the people of the country asking God for wisdom and for the strength to make the proper decisions in the right frame of attitude and with a humble and broken heart. • Much teaching went on in the classrooms but perhaps even more went on in small groups over tea or Coke. “How do you handle this?” “I need your advice on something”. A first-time attendee told me she was stunned at the networking and partnership that was evident everywhere as people endeavored to share or to connect; Denominationalism and nationalism were set aside in the effort to serve man and God. • It was a time of reunion. I met literally dozens of friends that I have not seen since I was last at their institution or at a meeting of some sort in the States. Pictures were shown, stories were told, tears were shed and hugs and pats on the back were given to encourage. Spontaneous prayers were lifted heavenward as needs were shared. I had the pleasure to see our friend, Dr. Steve Merry. After an emergent evacuation from the Ivory Coast, he worked for a year at Togo where we got to know him. He is now in the States and came here looking for what God will have him to do in the future. It was great pleasure to see how God used several people and Scripture passages to help him clarify once again what God would have him do, to see that flame brighten once again. He may not know the particulars but the direction once again seems clear. • Lectures were a time of give and take. Just because you serve in the middle of the dark continent doesn’t mean you have lost your mind – figuratively or literally. The intellectual interchange was stimulating. • Last week, I wrote of the Pan-African Christian College of Surgeons. Since most of the members of the board were at the CMDA meeting, two long meetings were held during the week and it was encouraging to see the vision of the group enlarge and mature. There are many needs in this God-sized project, but the next steps that need to be taken are now clear. It was also exciting to hear the story of the first surgeon who graduated from the program. The “rest of the story” clearly demonstrates the need and efficacy of this program. Dr. Sahalanirina Harison Rasmimanana is his name (you can see why he is called Harison by everyone!) He has gone back to the evangelical Lutheran hospital in his home country of Madagascar to, as the back of his sweatshirt read, “heal with steel”. The hospital was literally about to close the doors and the surgery ward was empty. In a little over one and a half years, the surgery ward is fully open, the hospital is again financially viable thanks to the income from the surgery and people are once again hearing the gospel. He is a pillar in his local church. That is why this program is so needed – it cannot be someone from Europe, Australia, the US or any other country that saves Africa. It must be Africans.

It was a great week even if it was fatiguing. As they say here in Kiswahili: Bwana asifiwe! I can only echo that: Praise the Lord!

Praise and Prayers:

1. The week at Brackenhurst has been a real blessing for me and for others. I am very thankful that my lectures went well and were well-received. One in particular stimulated a great deal of discussion and it

has been suggested by a few people that I turn the lecture into an article for publication. I have some hesitation to do so. I am praying for guidance about that idea. 2. Please continue to pray for those who are attending the remainder of the Christian Medical and Dental Association continuing education conference. Pray that those who attend will continue to heal, to be spiritually rejuvenated, to rest, and to learn and partner in new ways to spread the good news of Christ through medicine and dentistry. Pray that all the attendees will be safe as they return to their places of service all over Africa and the world. 3. Pray for the PACCS and for Dr. Harison. Pray for the residents and their professors. We need to identify believing and well-trained African surgeons with a heart for teaching to be on our board and in our institutions. We need additional training centers. We need additional money to support these African residents and their families while they train. Most importantly, we need God’s leading and timing. 4. Pray for all the national churches here in Africa and indeed for those at home. Pray that we will all seek the heart, mind, and will of God rather than to be swayed and seduced by money, prestige, power and the other lures of living in this world. Pray that our priorities will be correct in all areas of our lives. 5. I received many requests to come and help in various places and I saw even more needs where Micky and I might be of assistance. The need is great and I want to be everywhere at once. Pray that we might properly select the places where God would have us be. Pray that others will come and help. 6. Early Monday morning, I will be returning to Uganda. Please pray that I will be able to talk to the right people, to ask the right questions, to be discerning and to be wise on how next to proceed. Pray that the Lord will clearly open or close the door for this project and for my continued involvement. 7. Unless I need to delay my departure to complete my work in Uganda, I hope to be home in the US late on Friday. Please pray for traveling safety for me and the ability to adjust quickly, since we must leave the following Tuesday to speak in California.

With so much ahead, so many choices and so many problems, I appreciated the opportunity to learn the words of a new chorus this week. It goes:

And all I know is You have called me and that I will follow is all I can say. I will go where You will send me, and Your fire lights my way

Hoping only to follow Him!

Bruce Steffes

Saturday, February 21 Dear Friends and Family:

Greetings from North Carolina! It is good to be home safe and sound and back together once more. The flight from Amsterdam was out three hours and then had to turn back because there was a mismatch between the loading luggage and the patient list. We passengers had to stay in Amsterdam another 24 hours. It was an expensive mistake for them and a significant delay for all of us, but I am home. The joy in little Sean’s face was worth the long trip! It is 2:00 AM in the morning and I am up because my internal clock is all messed up but that will adjust. Just a short note this week: I had a very worthwhile time earlier this week in Uganda. After the weekend in Nairobi, I flew back on Monday and spent the entirety of Tuesday and Wednesday in meetings and interviews. There seems to have developed an excellent consensus about the nature of the first stages of a national children’s referral hospital and the enthusiasm runs high. There are many, many problems to solve; gazillions of details to address; several key people to identify and hire; lots of people to train and millions of dollars to raise, but we continue to have a confidence that God is in this project. The potential is great, both in terms of testimony and in lives. It is rare that a group of Christians have the opportunity to impact a nation and a continent. From a personal standpoint, I am tired of watching children die for the lack of reasonable medical care and die without Christ as their Savior.

Praise and Prayers:

1. Please continue to pray for those who have attended the recently completed Christian Medical and Dental Association continuing education conference. Pray that their rekindled enthusiasm, newly laid plans and revitalization be used to minister at their hospitals. We trust that their return to their homes was a safe one. 2. We are leaving Tuesday morning to take part as the last speaker of eight for the mission conference sponsored by the Palm Desert Presbyterian church. I will be speaking to a large group Thursday night at a banquet and three times in the Sunday morning services. Please pray that I will speak not my words nor my wisdom but rather those from God with the power of the Spirit behind them. We are excited that we will be able to see my daughter, Michelle, and perhaps some other relatives while we are in California. 3. We will return mid-week and turn around and drive to Michigan. The following Saturday, March 6, Dr. Bob Cropsey and I will be putting on a day-long intensive seminar “showing you how you can be involved with the adventure of serving others at home or in a distant land in order to demonstrate God’s love for them through an outreach of compassion.” It will run from 8:00 AM to 4:00 PM and be held at Berean Baptist Church, 7813 South 12th Street, Portage, MI 49024 (Take Exit 31 off of US 131 (west side of Kalamazoo) on Centre Ave 1/8 mi to the west. Take the first turn north on 12th St. and ¼ mile on the right is the church.). The registration fee includes a continental breakfast and lunch, a course syllabus CD and a copy of our Handbook for Short-term Medical Missionaries. The registration fee is $20 for non-medical folks and for medical, nursing and PA students and $40 for medical professionals. If you are interested in attending and within a few hours drive of Kalamazoo, Michigan, please call 717-703-3460 to register. There are still plenty of spots left. This is the first time that we have done anything like this and we admit we are nervous about it. Please pray that we will do a good job and that we can vividly share the need for those to go and those to send and support. Please pray that their hearts and minds will be open and receptive. 4. On March 7, I will be using some of the same material from the day before and putting on a mini- conference at Hunter’s Creek Community church just outside our hometown of Lapeer, Michigan, speaking in the morning, afternoon and evening. On March 8, I will be speaking at the St Joseph Regional Medical Center Family Practice Residency in South Bend, Indiana on the following topic: "Bush medicine -- challenges in care and medical education in developing countries". That invitation to speak to the residents came out of the clear blue sky at the suggestion of a resident with whom I worked two years ago at Tenwek, Kenya. I will be giving surgical grand rounds at the Orlando Regional Medical Center on March 26 on the same topic. Please pray that it will give a picture of vibrant and practical Christianity to those who are not Christians and challenge those who are. The week previously, I will speak to a church in the Lakeland area and to three classes at the Lakeland Christian School. We have been praying that similar opportunities to speak will open up. On March 28, I leave for Belize to begin a month of service there. I am feeling a bit overwhelmed right now at all I have to do and prepare, so please pray for me.

This month was supposed to be one of rest and relaxation but has gotten rather full. We do hope to have some time for a vacation the last week. Please pray for our traveling safety and effectiveness in communicating as we go to California, to North Carolina, to Michigan, to North Carolina, to Florida, to Michigan, to Florida and back again to North Carolina. There is even a chance of a short return to Uganda. We feel that Lord has laid all these opportunities on our doorstep, so we will continue on, redeeming the time.

Feeling rather peripatetic but pumped!

Bruce at home with Micky and Sean Steffes

Saturday, March 27 Dear Friends and Family:

I (Bruce) leave tomorrow for my trip to Belize to work in the Presbyterian Medical Clinic there. Micky and Sean will be staying home for this trip and the one next month to Sierra Leone. Later in this letter, I will share some facts about the work we will be joining, but first, here are some quick facts that focus on the country of Belize. I have compared them with the US and with Togo, the small African country where we have served many times before. They may help to give you a grasp on the day-to-day life in Belize:

• GDP per capita: The Gross Domestic Product per person is 10 times higher in Belize ($3,420) than it is in Togo, but only 1/10 of what it is in the United States. • Population density: Togo is 3 times more densely populated than the United States which is in turn almost 3 times more densely populated than Belize (30 persons per square mile) • Population growth rate for Belize and Togo is almost 3 times that of the United States • The US has only about 470 people per physician; Belize 2000 and Togo 13,300. • Literacy rate – US 100%, Belize 98%, Togo 62% • Life Expectancy – US 78 years, Belize 72, Togo 55 • Cars – In the US, there is almost 1 car for every 2 people; in Belize 1 for every 20 and in Togo 1 for every 40 people. A little country in northeastern Central America, Belize was previously known until 1973 as British Honduras and the country achieved full independence on September 21, 1981. It is bordered by Mexico on the north and west; Guatemala on the south and west and it faces the Caribbean Sea. Belize is about the size of Massachusetts (one sixth the size of North Carolina) but has only a little in excess of a quarter of a million people, giving Belize the lowest population density in Central America. The northern half of Belize consists of lowlands, large areas of which are swampy. The southern half is dominated by mountain ranges, but they are low peaks, rising only to a maximum elevation of 3,675 ft. For a scale of comparison, the Appalachians reach 6,700 ft and the Rockies reach 14,400 ft. The Caribbean coastline is fringed by coral barrier reefs and numerous cays (islets) and Belize is known for its world-class scuba-diving. The climate of Belize is subtropical. The following is edited and abbreviated from Microsoft Encarta’s1 article on Belize: “The majority of the population of Belize is of mixed racial descent. The largest group is of black or partly black ancestry. Other groups include Native Americans, principally Carib and Maya, located in the north and west; people of European descent, mainly English and Spanish; and people of mixed Native American-European descent. “Population is concentrated in a few principal urban centers, of which Belize City (population 49,050) is the largest; it is also the principal port [and has the major international airport]. Belmopan (pop. 13,260), a newly constructed city, supplanted Belize City as the official capital in 1972. English is the official language; other languages spoken include Carib, Mayan, Spanish, and a Creole dialect of English. “Belize is governed under a constitution that became effective at independence in 1981. The British sovereign is head of state and is represented by a governor-general, who has little power. Executive power is mainly exercised by a cabinet of ministers, led by a prime minister. The bicameral National Assembly consists of a Senate and a House of Representatives The prime minister must have the support of a majority of the members of the House. “The main economic resource is Belize’s arable land, although only 3 percent of the total land area is under cultivation. Agricultural exports include sugar [from sugar cane], citrus fruits, and bananas. Rice, beans, and corn are grown as subsistence crops. Lumbering, formerly the chief economic activity, has declined in importance. Major manufactures are processed food, wood products, and clothing. A road network of 2,872 km (1,785 mi) links the major urban centers, but some areas remain inaccessible.” My four-week trip to Belize is split into two two-week rotations for the Physician Assistant students from Methodist College Physician Assistant Program where I teach in the fall semester. Two students will be with me the first two-week period and two the second two-week period. They will be working at the Presbyterian Medical Clinic in Patchakan village (near Corozal in the far north of the country). The clinic was founded in 1992 to give health care to the under-served Mayans. Spanish and Mayan are more commonly spoken there than the national language English. The clinic is run by a mission agency called “Mission to the World” located in Lawrenceville, Georgia. If you would like to know more about the work, you can visit their website: www.missionaryclinicbelize.org. Exactly what I will be doing each day at the clinic is uncertain. They have same- day surgery capabilities, so I may be doing some minor surgery in addition to helping in the outpatient clinic. In addition to helping in the clinic, the students and I will be in charge of the entire clinic during the week of April 11 while the team of missionaries attends a retreat. I still await a final acceptance, but I may also be addressing the Belize Medical and Dental Society on the topic of burns one of the last days I will be in Belize. (Busy? Summary of the next paragraph: ~7500 air miles; ~3600 car miles, 8 speaking engagements, 25 speaking hours, 1 very proud father) This past month has been busy but very productive. We spoke in Palm Desert to 1700 people in four services. We had a great time with good old and new friends and the Palm Desert Community Presbyterian Church generously contributed enough to support a Pan-African Christian College of

Surgeons resident and his family for an entire four years residency. The following weekend, we also had a great all- day mission conference in Portage, Michigan. Over 50 people attended the all-day conference and the Cropseys and we now have many new invitations to give similar conferences in other churches. Exactly where we will fit another conference in is another whole question! The next day, I spoke at Hunters Creek Community church in Lapeer, Michigan for a four-hour seminar during the day on the topic of supporting missionaries in the local church. The next night, we spoke to a group of family practice residents at the St. Francis Family Practice Residency in South Bend. It was a great time and a fitting capstone to a busy weekend. I must admit to getting old – speaking for 14 hours in three days wore me out. After a few days rest, we went to Florida where we spoke to two chapels and two classes at the Lakeland Christian School and presented our work to two groups at Lakeland’s Heritage Baptist Church. The time in Florida was interrupted by my flying trip (literally and figuratively) to the East Lansing Film Festival. My daughter Michelle had her world premiere of her new short film “Say it Again Sam”. I confess to a great deal of pride in her work and in her. It was well-received, we had a great visit with my cousins there and I also had the opportunity to speak to the Sunday School in the church pastored by an old acquaintance from Bible School. We have enjoyed this last week in Orlando, sharing it with my parents and with my son and his wife who came down to enjoy the fine Florida weather for a few days. We also spent some time with family and friends while we were in Florida. Yesterday, prior to the long drive back to North Carolina, I gave the surgical grand rounds at the Orlando Regional Medical Center on the topic “Bush Medicine – Challenges in Medical Care & Education in Developing Countries.”

Praise and Prayers:

1. Micky and I have been asked to join the Commission for Continuing Medical and Dental Education, a commission under the aegis of the Christian Medical and Dental Associations. We are very pleased to have been asked to join for we have very much enjoyed our experience with the continuing education conferences in Thailand last year and the recent conference in Kenya. The ministry of service to and the medical education for missionaries is something that resonates with our hearts. Please pray that we will be productive in this new role and that God will provide the finances required for the trips each year. 2. Thanks for your prayers for safety and for an effective ministry in all of our speaking engagements this past month. We have seen some results already in the lives of some individuals and we trust that the Spirit will continue to work. 3. Pray for the trip to Belize – for wisdom, the ability to handle the new challenges and for the ability to minister to the PA students, to the missionaries and to the Belizeans. 4. The morning after I return from Belize, I fly up early the next morning (Monday) to Washington, DC, for a meeting with representatives of Samaritan’s Purse and with Ruth Sims, the director of the proposed Hope Hospital (Uganda) project. I will fly back on Tuesday and on Wednesday fly to Sierra Leone to begin my time on the Mercy Ship. For that quick turnaround, begin to pray for a clear mind, adequate rest, a clear individual and corporate vision for the creation of children’s national referral hospital in Uganda and a clear sense of what and how Micky and I are to be involved. 5. We thank God that we already have a furnished apartment arranged for the eight weeks we will spend this summer in Morgantown, W. Virginia. Bruce will be attending the Tropical Medicine Course at the University from mid-June to mid-August as a full-time student and will sit for the credentialing exam in early November. Learning this material and becoming credentialed is also critical in order to set up the tropical medicine emphasis next year at the Methodist College PA program.

Keep us in your prayers as we serve and prepare for future service!

Bruce, Micky and Sean Steffes

Saturday, April 3 Dear Friends and Family:

Maybe, just maybe, I will have to admit to being a Type-A workaholic. It is not that this idea is an entirely out- of-the-blue revelation for me since some of you have hinted in the past (both delicately and not so delicately) at such a thing, but I have always been able to use the great amount of work to be done as an excuse. Presently, I am sitting on a porch overlooking the peaceful Caribbean Sea. Cooled by off-shore breezes in the 85 degree morning, fisherman are casting nets for menhaden to use as bait for their day’s fishing, tourists are walking up and down the

Listening to the Heartbeat of our Ministry The Steffescope Volume 7, 2004 © 2004 beach, dive boats are heading out to the other side of the reef, a cormorant and a gull are battling it out for the top of a particularly desirable piling in the water – and I am somewhat lonely without Micky and Sean, bored and looking forward to getting back to work. I definitely have to work on this learning to relax thing…. Two Methodist College Physician Assistant students and I left Raleigh-Durham airport early last Sunday morning. It was an unremarkable flight and we landed in Belize in early afternoon. We were picked up by one of the short-term missionaries from the Presbyterian Medical Clinic in Patchakan and we drove up the northern highway. I had mentioned in last week’s newsletters that the population density of Belize is much lower than anyplace else we have served and it was rather odd to have both good roads and no houses along it. The land was very flat and not as forested as I had somehow expected. The second half of the trip was remarkable only for cane field after cane field. The missionaries later told us that this dependence on the cane sugar market has caused some serious economic hardship in the past several years. I can definitely say that eight hours for the total trip definitely beats the 40 hour trips when traveling to Africa! Patchakan is a village in the north of Belize, consisting of only a couple of thousand souls (a generous estimate) and located only a few miles from the Mexican border as the crow flies (or sometimes more accurately, as the toucan flies). It is peopled largely by folks of Mayan descent. Although many have adopted Spanish ways and most speak Spanish too, a significant number of modern Maya maintain traditional cultural practices. The Mayans have a long and proud tradition. At their peak, the Maya people lived in the region that is now eastern and southern Mexico, Guatemala, Belize, El Salvador, and western Honduras. The Maya culture reached its highest development from about AD 300 to 900. The Maya built massive stone pyramids, temples, and sculpture and accomplished complex achievements in mathematics and astronomy. They had complex and highly accurate calendars and could predict astronomical events with great accuracy. They had a form of picture-writing and a number system that allowed both the concept of zero and of very large numbers. For unknown reasons, the civilization collapsed about a thousand years ago, thriving only in the Yucatán Peninsula of Mexico where they continued to dominate the area until the Spanish conquest in the 16th century. Despite past glories, most of the Maya in this area are hard-working farmers who struggle to eke out a living. The clinic was a pleasant surprise. It has four examination rooms, a dental room and an area where physical therapy treatments are done. It has a small lab, a pharmacy that is better than almost any hospital in the developing countries that I have visited, plain x-ray capability and such nice amenities as an ultrasound machine, a colposcope, pulse oximeters, respiratory therapy devices and so on. The clinic waiting room is being expanded at the present time which has led to a great deal of dust, some confusion and lots of noise this week, but the space is needed. In the back of the clinic building is a dining area and kitchen for the staff, some guestrooms (where we stay) and laundry facilities. Despite all the amenities, the lack of hospital beds does limit what can be done and usually once or twice a day this week someone has been referred to the small (16 bed hospital) in the nearby town of Corozal (about 8 miles away) or to the larger regional hospital in Orange Walk (about 25 miles). Several specialties are represented on the staff at Orange Walk but many things require referral to either Belize City or over the border to a large town in Mexico named Chatumal. The one Mexican town of Chatumal has a greater population than all of Belize. We have had lots of help this week. One of the short-termers who is here for several months was visited by her parents who are a pediatrician and a dermatologist. Aided by the help that we brought, the pace in the clinic has been rather slow for us individually. Our day usually starts out with devotions from 8:10 to 8:30 AM and then patients are brought back. It may be 9:00 AM before we actually start seeing patients. Sometime after noon, we break for lunch and resume seeing patients at 2:00 PM. At 4:30 PM, we quit although many times people straggle in and at least some of us are still going at 5:30 PM. With the slow pace, there is plenty of time to talk to the patients, time to try to understand the dynamics of their life style and how it affects their disease, and time to pray and counsel them as necessary. There is no pharmacy staff, so every prescription is counted out and labeled (in Spanish or English) by the care-giver. Given the confusion caused by the temporary relocation of supplies due to the construction, it has resembled a Chinese fire drill at times. Because of the extra help, it was decided that an outreach to a nearby village would be a good thing to do. On Tuesday, we loaded up several cartons of supplies and set out to the village of Chunox (pronounced shoe-knowsh). On a map, it isn’t far away; in reality, it is a two hour trip. Roads are few and far between and with the rivers, swamps and bays in this part of Belize, they trace their course around them rather than over them. One exception on the way to Chunox is a hand-cranked ferry over one of the rivers. A cable stretches from shore to shore and goes through a series of pullies. Two men handcrank the big wheel that “walks” the boat along the cable, moving it from shore to shore. The ferry is nothing fancy – it is essentially a large box-like pontoon, topped with planks for the cars and with a small shelter over the crank to protect them from the tropical sun and the rain. The two PA students took their turn at the wheel, much to the delight and mystification of the two Belizean men whose job it really was.

We saw over 70 patients in the four hours. Many of the complaints were due to a viral epidemic, but back pain, hypertension, diabetes and the vague and wondrous “all-overs” were also common. We were fed lunch at the home of one of the volunteer workers. Rice and beans is a common dish here. We were fed a pasta and vegetable dish. She called it “chomin” and I thought it good. Later, I realized she was calling it “chow mein” – yeah you know, the traditional Belizean dish of chow mein. On the way back, when we stopped for the ferry, we were treated to the spectacle of one of the workers beating the ground. It was not a religious dance but rather the cultural tradition of “beating the heck out of a big coral snake”. It was over two and a half feet long and one of the biggest coral snakes I have ever seen. I have read they can get to six feet long in South America. They are beautiful colored but highly venomous – but without fangs in the classic sense. They have to “chew” on you to inject the venom. On the way to and from Chunox, we passed one of the several large Mennonite enclaves that exist in Belize and in Central and South America. Still speaking German, these pacifistic groups remain isolated but contribute to the agricultural, cabinetry and packaged meat needs of the country. The group we passed live simply but this group is not Amish in their rejection of modern society. I understand there are some groups in Belize that are. This week, we also had a chance to visit a couple of projects that the missionaries have facilitated. In order to reduce the dependence on cane growing, the local farmers in the church decided they wanted to try growing onions. They grew some last year and planted more this year. We visited the fields and they are growing beautifully. They will harvest more than ten tons of onions – storage and distribution is the major problem they have next to overcome. We also visited another micro-enterprise run by the women of the church. Ordinarily, to make something so simple as tortillas, the women must work for hours. The day before, they soak the dried corn in water and lime, cooking it and letting it soften the hulls. The next morning, it is ground and made into the dough, rolled out and then fried. A few years ago, the women of the church decided there was no good reason for all of them to do the same work day after day. They bought a diesel engine that ran the corn grinder and an electric and kerosene device that cleverly rolls the dough, cuts out uniform tortillas, delivers those down a conveyor to a rotating griddle, cooks (and bakes) the tortillas, delivers them to another conveyor belt where they are weighed and wrapped. For a Belizean dollar (50 cents US), the whole family can have fresh tortillas and much work and time has been saved. The ladies have gotten entrepreneurial – they have paid off the money they borrowed, have taken some profits and are now opening a small store to sell needed supplies. This village is so small that there are no stores to speak of. Micro-enterprise projects work if they are done rightly. This weekend, the two students and I flew on a small prop plane to visit the town of San Pedro on the island of Ambergris Cay. It is a rather typical American tourist Caribbean town but lovely, offering snorkeling, scuba diving and expensive lodging and food. It is admittedly fun to play tourist for a change. I had the opportunity to brush off my rusty scuba skills and thoroughly enjoyed the experience. But, coming full circle, I am ready to go back to work.

Praise and Prayers:

1. Pray for our remaining time in Belize – for wisdom, the ability to handle the new challenges and for the ability to minister to the PA students, to the missionaries and to the Belizeans. 2. Pray for the three of us as we are apart from each other for most of the next seven weeks. 3. Continue to pray for the Hope Hospital, the children’s national referral hospital in Uganda. Pray for divine guidance, wisdom and for clarity for our role in the project.

Thanks for your encouragement, your prayers and your partnership!

Yours in His Service,

Bruce Steffes

Saturday, April 10 Dear Friends and Family:

Last week I complained about not having enough to do. I now have decided I don’t really like to actually do any work either. As my mother has always said, some folks are too light for heavy work and too heavy for light work. My father has always said that some people will complain if you hang them with a new rope. I guess I fall into both categories.

Many of you have encouraged me over the years as I went through the legal hassles and expressed interest in the outcome of the last of the lawsuits. I can finally announce the last thing that I hope you will ever hear about them. It was almost exactly 10 years ago that the problem started with the last malpractice case. It came to trial in 2001 and the “jury of my peers” ignored the preponderance of medical expertise and decided that the plaintiff deserved some compensation because something “must have been done wrong” even though no one could say what it was. The judge threw it out and apologized to me personally after the case but the plaintiff appealed and the Court of Appeals reinstated the judgment. We appealed that decision. This week the Supreme Court refused to hear our appeal. It is over. There is no more to do. The settlement will be paid by the insurance company. It has no great consequence to me since I do not plan to practice in the US again, but it is tough on my self-esteem, my ego and my sense of justice. It, along with hundreds of similar cases, has increased the cost of medical care and will serve to aggravate the shortage of physicians by ultimately helping to raise the malpractice insurance premiums. I continue to feel that this case is a miscarriage of truth and a damning example of the need for tort reform, but there is nothing I can do at this point but hand it over to the Lord to handle. If anyone knows what it is like to be falsely accused, it is Him. It has been almost a decade of nonsense and unnecessary anxiety, but I can only trust that it is true that “all things work together for good to them that love God, to them who are the called according to His purpose” (Romans 8:28). Even with my foggy view of my own history and my poor understanding of how God works in our lives, it is clear that God used my distaste for such shenanigans and also used other things to divert my interest into medical missions and into serving Him. For that I must thank Him. Life this week in the Presbyterian Medical Clinic of Patchakan village, Belize has been just “ordinary”. No dramatic cases, nor have any deep spiritual highs or lows occurred. Just “life”. The effort has consisted of the sometimes monumental task of living out Christ’s commands in my day-to-day interactions with patients, trying to reflect Christ the best way I can and like most of you, failing often. I don’t know about everyone else, but for me, it is sometimes easier to keep the way clear when the stress obviously demands an effort than it is when I am faced with the mundane. In other words, it is easier to be “on stage” and remember the lines and the movements than to do so when I think no one is looking or when I think that it doesn’t really matter. The stresses of cross-cultural adaptation and loneliness aggravate that tendency to let down. Tomorrow, Micky and I will again celebrate our anniversary together – but once again we do so apart. Many more anniversaries have been spent apart than together in our six years of marriage. Yesterday, the clinic closed for Good Friday and many of the local churches got together for a church service that lasted nearly all day. It was a time of preaching, singing, many special numbers and dinner on the grounds. Huge tamales wrapped in banana leaves could be had for the equivalent of fifty cents and beans, rice and chicken for the princely sum of $1.50. Since 95% was in Spanish and the temperature was 95 degrees, I didn’t mind missing part of the afternoon to make a trip with the administrator Gary Chambers to pick up a new physician, Dr. Randy Lea, who came to serve for the next six months,

Praise and Prayers:

1. Please pray for traveling safety for the two Methodist College PA students who are leaving Belize tomorrow and the two who are arriving from the States. Please pray for our next two weeks in Belize. This coming week, all of the regular missionaries will be attending a retreat in another part of Belize. It is for the entire group of Mission to the World missionaries here in Belize. The students and I will be totally in charge of the clinic with lots of needed help from their regular Belizean staff. There will be lots of things and situations that we will face for the first time. Please pray for wisdom, the ability to handle the new challenges and for my ability to minister to the PA students, to the missionaries and to the Belizeans. 2. Please continue to pray for the Hope Hospital, the children’s national referral hospital in Uganda. Pray for divine guidance, wisdom and for clarity for our role in the project.

Mel Gibson’s movie The Passion of the Christ has had the topic of the death of Christ on everyone’s lips. Yesterday, on Good Friday, the Christian world noted the anniversary of his horrifying death two millennia ago. With the debate about the degree of violence and brutality that movie displayed (actually probably underplayed if my understanding of Roman crucifixion is correct), there is a risk that His suffering and His death will seem to be the main point of Jesus’ life. That is not so. His death, as horrible as it was, was just a necessary prerequisite for the ultimate goal He wanted to accomplish. It was certainly not the ultimate goal. His death redeemed us, reconciled us to God, and paid the price for us. In other words, He took the full consequences of being an object of the wrath of God. That wrath was from a Holy God and was aimed at us because of our sins. We needed those things to be done on our behalf. We could never do it for ourselves. Therefore, His death was and is important, but not the most

Listening to the Heartbeat of our Ministry The Steffescope Volume 7, 2004 © 2004 important thing he accomplished. Our ultimate need was and is life. Ephesians 2:1 reads “As for you, you were dead in your transgressions and sins,” and Romans 6:23, “For the wages of sin is death”. Quite frankly, we are all the walking dead. If I have a corpse brought into my home, will the best pair of shoes make him walk? Will the finest suit of clothes make him warm? Will the finest meal make him a good companion? Of course not! What does that corpse need? He needs life. So do we. We are all dead if the verses above are to be believed. Only the dead need life. Forgiveness through the cross is the prerequisite to our getting life, the price to be paid to permit the gift of life to each one of us. Thank God that the remainder of Romans 6:23 reads “but the gift of God is eternal life in Christ Jesus our Lord.” It is a gift for which the price has been paid. It has been offered to you by a loving God. But a gift is not a gift until it is accepted. No more is required but your acceptance. Rejoicing at the anniversary of His resurrection, I am

Gratefully and gloriously alive, forgiven and fully resuscitated,

Bruce Steffes

Saturday, April 24 Dear Friends and Family:

One of the short-term missionaries we have met in our travels is Tom Garber, who serves repetitively, often and faithfully with a wonderful group of electrical engineers in a mission support agency called Tech Serve. That group provides among other things the engineering, planning and installation of high-power lines for mission groups. He reported in his recent newsletter the following story: At the Airport, preparing to board, we were ushered into a room where we began a very thorough security screening. It took a few moments to understand that they were doing everything by hadn including a hands-on “pat down” because the electricity was off and the new electronic scanners were useless. Just when everyone’s patience was running thin, the power came back on. Everyone got in line to go through the metal detectors. Just that quickly, the power went back off and everyone sighed, knowing was was next. Now a first: The man in charge stood up, got everyone’s attention and asked, “Does anyone have any GUNS or KNIVES?” No response. “OK, let’s board!!” Now there is a person with faith in the basic goodness of people, even of terrorists! When I think of how much time I have wasted over the past six years standing in airport security lines, it is sad to find out that it was so unnecessary. They just never thought to ask us all if we were bad folks or doing bad things…. It has been so simple all this time and the experts have missed it! Tomorrow, I am heading home from Belize. I can only hope that the airport security in Belize City is that easy to get along with. The past two weeks in the Presbyterian Medical Clinic here in Patchakan, Belize, has been productive and worthwhile but rather unremarkable in the telling – so last weekend I skipped writing the newsletter and gave you a break. Thank you for your prayers for the week before last when the career missionaries all left for their retreat in the west of Belize. It was a time of refreshment, both spiritual and physical, for them and the two Physician Assistant students and I did just fine with the great help from the regular Belizean staff. We kept the home fires burning. On that first Tuesday, one of the students went back with a visiting ultrashort-term missionary to the village of Chunox that I told you about in the last newsletter. The next day, both of the students went with him. They had a great time and saw a lot of sick folks. Meanwhile, back in the clinic, I ended seeing more patients by myself than the team did in the village. Thank God, it all went well. Last weekend, these two students also wanted the experience the previous two students had when they visited the coastal village of San Pedro. Being the warm, considerate and caring person I am, I was reluctant to let them go to such a place without adequate chaperonage and therefore I forced myself to go back. We had the pleasure of scuba-diving again and this time we dove the famed Blue Hole and some walls that were equal of the famed ones in the Cayman Islands. The Blue Hole is a coral atoll, the center of which is the collapsed roof of a subterranean limestone cave. At 130 feet, the deep limit of safe recreational diving, we swam with the eight foot sharks, weaving through the huge stalactites that reached down into the depths we could not achieve. A wall is a coral formation that forms on the edge of a shelf. The ocean side is nearly vertical, dropping into the darkness of the inky depths. Such walls give divers an opportunity to see the ocean life that lives at various depths and pressures. I was once again awed by the diversity, the vibrant and intricate coloring and the adaptive mechanisms that God has created for His creatures. We serve a great God! Today, as our last hurrah here in Belize, we visited the Mayan ruins. It certainly was reminiscent of Indiana Jones (I always thought I looked dashing in a slouch hat and a bull-whip…) After a two-hour motorboat ride down the crocodile-infested New River which was also festooned with water lilies and water hyacinths, we

Listening to the Heartbeat of our Ministry The Steffescope Volume 7, 2004 © 2004 explored the Mayan ruins of Lamanai (“Submerged Crocodile”). On the way, the flora and fauna were amazing. Ruffed basilisk lizards and northern jacana, a brightly colored water bird, were both doing their “walk on water” trick. The basilisk actually uses its webbed foot to capture a bubble of air and it is the air’s buoyancy that keeps it from sinking more than an inch into the water. The jacana is sufficiently light and long-toed that it can walk on the top of the fine floating vegetation. On the forested edge of a broad lagoon, the two-square-mile site of Lamanai has hundreds of ruins, the vast majority of which are mounds still covered by jungle. This site was inhabited from 1500 BC to the 19th century. The vast majority of the site has not been cleared or reconstructed. The landscape is overgrown, and thick vines grow from the top of buildings and strangler figs have a chokehold on the ruins. Brightly colored bromeliads decorate the high branches of the trees, tropical flowers perfume the air and jungle creepers drape the trees. The only sounds are the calls of birds echoing from the ancient stone and the unearthly roar of black howler monkeys gives an eerie accompaniment. Ancient steps up the old High Temple allow one to have a view over the jungle canopy. On this site, children and others were sacrificed to the blood-thirsty gods and even sport had its downside – the losers on the ball court may be put to a ritualistic death to satisfy the demands of the five dozen blood-thirsty but impotent deities. An eerily amazing site, a never-to-be-forgotten experience and a chance to be thankful that the sacrifice for my sin has been made and accepted by an omnipotent God. I arrive home late tomorrow (Sunday) evening. At dawn Monday, I fly out to Washington, DC to meet with Ruth Sims, the developer of the Hope Hospital project in Uganda, and with another pediatric cardiologist from the Children’s National Medical Center who is trying to set up a cardiology center and an open heart surgery at the Mulago University Hospital in Kampala. The heart project is a secular program without any goal of evangelism but is a badly needed program in that country. There are many things where we can agree, can work together and can help each other. Tuesday, I fly back to Fayetteville and pack my bags in order that Wednesday I can fly out to Sierra Leone to begin a 4-week stint as a general surgeon on the Mercy Ship Anastasis. I must confess that I am eager to go from treating coughs and colds, diabetes and hypertension to doing surgery again. I am not eager about separated from Micky and Sean again.

Praise and Prayers:

1. Please pray for Dr. Randy Lea. Randy is an orthopedic surgeon who is going to be doing family practice here in Patchakan for the next six months. He will be out of his comfort zone much of the time and have the usual stresses of cultural adaptation, loneliness and so on added to that burden. Please pray for him while he covers half of the year-long Smith family furlough. Dr. Wiley Smith is the family practitioner here and he and his family are heading home to the States soon. Please pray also for Randy’s health. He is having some odd neuromuscular problems and the diagnosis is unclear. 2. Please for traveling safety for me and for safety for the entire Mercy ship in the unstable and war-torn country of Sierra Leone. 3. Please pray for Micky, my children and myself as we must be separated for yet another month. 4. Please pray that I might have an effective ministry on the Mercy Ship and for the knowledge and ability I must have to face yet new challenges in areas where I am not an expert. 5. I have been asked to help with the ABWE’s Medical Mission Interface. It will be held July 16 – 18 at the ABWE headquarters in Harrisburg, Pennsylvania. Continuing medical education credits are offered and it is a great and inexpensive way to find out something about the many medical works that they are involved in. If you are interested, contact Barbara Andersen by e-mail at [email protected] or by phone at 717-774- 7000, Ext. 360. Please pray for the speakers and program directors and pray for those who will be challenged to determine how they can be involved. 6. Today, our home church is beginning the “Forty Days of Purpose”, the program to study the truths found in Rick Warren’s “Purpose Driven Life”. It is a great book and I strongly recommend it to you if you have not read it. Pastor Warren has clearly stated the principles that I have discovered on my spiritual journey over the past 10 years, the things that have changed my priorities and my life. Please pray that God will use it to fire up our church to become the kind of church that cares and that shares the good news of Christ to the community and to the world. 7. Please continue to pray for the Hope Hospital, the children’s national referral hospital in Uganda. Pray for divine guidance, wisdom and for clarity for our role in the project.

Looking forward to being home, both on earth and in heaven!

Bruce Steffes

Saturday, May 1 Dear Friends and Family:

Greetings from Sierra Leone and from the deck of the Mercy Ship Anastasis! This has been a hectic week and I am just getting settled into life aboard ship. Please forgive me if I am a bit confused as to locale and time. I arrived home in Fayetteville late last Sunday evening. The enthusiastic welcome home from Sean was one of those moments that make you thrilled to be a parent. After only four and a half hours of sleep, I left home the next morning to fly to Washington, DC where I met with Ruth Sims and Sue Bonner, who are here from Uganda and who are the two women who are trying to put together the Hope Hospital project in Kampala. We had a great meeting and resolved many points of discussion. The next day, I flew back to spend less than 24 hours at home. It was a whirlwind of packing, family time, and many pages of necessary paperwork that had to be done and mailed before I left the next day. Midday Wednesday, I began the long trip to Africa via Washington DC and Brussels. The flight was enlivened a bit when I was called upon to assist my seatmate who had neglected to take his cardiac medications in a timely fashion. He walked to the lavatory in the back, passed out in the hallway, seized and vomited before coming around. Administration of his forgotten meds soon corrected his problem. I was very glad that he was no more ill than he was, but it did make sleep hard to come by on that leg of the flight. Another young woman hyperventilated and I was called to assist on that as well. Given the fact that nowadays one is only allowed plastic utensils in economy class, I was glad no one needed emergent surgery. The rest of the trip was uneventful, just only very long. Sierra Leone is considered the poorest country in the world. I knew that landing at an airstrip that prominently featured army tents, uniformed soldiers, big white helicopters with bold blue “UN” lettered on them and machine guns meant we were probably not in Kansas anymore, Toto. We took the hovercraft across the bay and then piled into the Mercy Ship’s Land Rover. The ship was moored only about 10 miles away by road but the trip took almost 2 hours. Sierra Leone has a few hundred thousand more people than Togo but at a lower population density (78 vs. 94). About 2 million of the 5.6 million live in Freetown and it seemed that all of them were out on the street! After six years in developing countries, it takes a lot to shock me, but the filth and poverty was worse than any place I have been other than the slums of Islamabad and those of Bombay (Mumbai). Sixty-nine percent of the inhabitants of Sierra Leone live below the poverty line, compared to 33% in Togo. It is reportedly the poorest country in the world with a GDP per capita of US$130 per year versus Togo’s US$270 a year. I could believe it. It was shocking. It was a collage of open sewers, trash, rusting tin roofs and even hulks of rusted cars piled in the cemeteries, competing with toppled headstones for space. Vehicles were predominantly either public taxis or vehicles of NGO’s, of which the UN peacekeeping force constituted a significant proportion. Street vendors were everywhere, trying to make a Leone (2750 Leones to the dollar) with which to stave off hunger. Many were obviously failing. We passed a large camp that consisted only of amputees from the civil war. Sierra Leone rebels were notorious for chopping off hands and arms for no particularly good reason except that they had caught you. It is a country still besieged by hatred, poverty, death and the devil. It is said that the light from a single struck match can be seen at a distance of two miles on a clear night. It is for that reason that the brightly lit white hospital ship stands out even more brilliantly against the backdrop of darkness and destitution. The ship and the 400 volunteer staff are not the solution for all of Sierra Leon’s problems and not the solution for even the medical problems of this desperate land. It is however a symbol of hope and a clear “light upon the hill” that displays the reality of Christ’s love for the world. Jehovah-Rapha – the God who heals – is still alive. The Psalmist clearly announced the mission of the Mercy Ships long before the idea was born: “That thy way may be known upon earth, thy saving health among all nations.” Psalm 67.2 (KJV) The 522-foot flagship, the Anastasis, is currently the world’s largest non-governmental hospital ship. Acquired in 1978, she contains three fully equipped operating rooms, a dental clinic, a laboratory, an X-ray unit, and a 1,500 ton cargo capacity. The ship is a self-contained unit and as such, has all the amenities necessary to support the staff and patients. Presently, in dock, it has a crew of approximately 400 including all of the volunteer medical staff, day-workers, interpreters and the like. It will sail in early June back to Europe with many fewer on board. It started life as an Italian ocean liner but is relatively small and certainly never, even on her best day, matched the opulence of the modern cruise ships. The first few days on the ship have found me lost most of the time but I am slowly finding my way around and now, at least, the areas are looking familiar enough that I know I have been lost there before. The ship and I have a lot in common. We are both approximately the same age. You don’t have to inspect either very closely to see the effects of age and it takes us both a lot of work to look good anymore. In the past, we both sunk but more importantly, we have been raised up and refurbished for the Lord’s work. I heard something

Listening to the Heartbeat of our Ministry The Steffescope Volume 7, 2004 © 2004 yesterday that the ship will no longer meet certification requirements by the year 2010. I sincerely hope that there is where we differ! My first morning aboard found me in the operating room. My scheduled cases don’t really start until next week and so I had the pleasure of assisting Dr. Judith Goh, a Malaysian/Australian urogynecologist, with great expertise in vesico-vaginal fistulas. It was a pleasure to watch and learn from her. This problem is a rare one in the developed world because prolonged labors are uncommon and Caesarean sections are readily available. In much of the undeveloped world, either because of lack of knowledge, lack of money, lack of trained midwives or lack of available hospital services, women will labor for days in an attempt to deliver a child. Usually the child dies but if the mother lives, the prolonged pressure of the baby’s head on the bladder causes the tissue of the bladder and vagina to die. These poor unfortunate women then develop a connection (fistula) between the bladder (vesicle) and the vagina (hence the term vesico-vaginal fistula or VVF as they are often known). These women are family and social outcasts, reeking of old urine and unable to control their loss of urine. One can always tell when one of these women is in the clinic, either by the smell or by the wet footprints. The ability to repair these can restore women to wholeness and to usefulness. Their gratitude is great. Unfortunately, these are sometimes very difficult to repair and most American- and European-trained surgeons do not have any experience or expertise with them because of their rarity in the developed world. There are only a few charity hospitals in each continent of the Third World which handle these patients in any numbers. The condition is almost always associated with poverty which is how they got it and why they can’t get it fixed, so even the private and government hospitals in developing countries do only a few cases and have limited experiences. Even if you want to learn how to do the procedure, it can take up to five years to get a slot to be trained. This is why these women are so thrilled to have the services of the Mercy Ship available to them and why I am so pleased to be able to watch and assist such a trained and experienced surgeon. Perhaps it is for this reason, that my operating schedule next week was “fortuitously” kept light. Seventy women have thus far been operated on this time in Sierra Leone. There are tens of thousands remaining in Africa alone that need help. Most will never get the repair. Even if I can learn to do only the “simple” ones, perhaps I can help to make a dent. I will tell you more next week about the outreach of the ship and my work on it. Here are some statistics from the Mercy Ship ministry to ponder in the meantime: • Over a 25-year history, Mercy Ships has performed more than 2 million services, with a value of 250 million dollars, and impacted over 5.5 million people. • Performed more than 18,000 operations such as cleft lip and palate, cataract removal, straightening of crossed-eyes, orthopedic and facial reconstruction. • Treated more than 300,000 people in village medical clinics. • Performed 110,000 dental treatments. • Taught over 5500 local health care and professional workers, who have in turn trained multiple thousands in primary health care. • Trained local medical professionals in modern health care techniques to carry on after the ship leaves. • Delivered more than $21 million of medical equipment, hospital supplies and medicines. • Completed close to 350 construction and agriculture projects including schools, clinics, orphanages and water wells. • Demonstrated the love of God to people in 95 ports in 53 developing nations. • 850 career staff and crew from more than 40 nations serving today. • More than 1,600 short-term volunteers serving with Mercy Ships each year.

Praise and Prayers:

1. Please for safety for the entire Mercy ship crew in Sierra Leone. 2. Please pray that I might have an effective ministry on the Mercy Ship. 3. Please continue to pray for the Hope Hospital, the children’s national referral hospital in Uganda. Pray for Ruth Sims as she meets with governmental officials, charity organizations and addresses Samaritan’s Purse this weekend. Serving the God who heals – here in Sierra Leone and everywhere!

Bruce Steffes

Saturday, May 8

Dear Friends and Family:

The Mercy Ships organization partners with a wide range of other organizations that contribute finance, cargo and services in the support of its work. Every dollar that Mercy Ships receives is complemented by over $2 in contributed gifts-in-kind and services. The medical community donates pharmaceuticals, medical equipment and supplies. Port fees are often waived as well. Most significantly, those serving on the ships contribute monthly crew fees and raise their own finances to serve with Mercy Ships. Yes, you read that correctly – everyone from the captain on down is serving as a volunteer to the organization, providing or raising their own support. I have met people on this ship who have been doing it for 16 years. The Mercy Ship Anastasis is not just a hospital ship but it also provides aid in many other areas to the people it serves. There are workers and outreaches in community health, teaching of traditional birth attendants, well-drilling, adult literacy programs, evangelistic outreach (Jesus film and others), animal husbandry, dental work, and village medical clinics. Three churches have been planted. First Steps is a program that provides orthotics and prosthetics to those who need them and has been involved in a nearby village and work for polio victims. All of these programs are designed with an effort to provide both appropriate technology and sustainability. I mentioned in last week’s The SteffeScope that the Anastasis is nearing the end of her working life. There is a new Mercy Ship, the African Mercy, in the dry docks of Newcastle-upon-Tyne, UK. Purchased with money donated in April of 1999, the 16,000 ton Danish rail ferry Ingrid was rechristened the African Mercy. They are converting this ferry into an even bigger hospital ship and it is hoped that it will be launched to begin seeing patients in 2005. The volume of the boat is approximately 40% larger than the Anastasis and then it will take over the title as the biggest non-governmental hospital ship in the world. It will have twice the number of operating rooms as the present ship (six) and the number of wards beds will be nearly doubled (80). This will allow the doctors and nurses to treat twice as many people. The hospital and ward beds will all be on the same deck, so there will be no more of the ropes, stretchers, pulleys and rails that are necessary on the present ship to take post-operative patients from the hospital deck down to the ward deck. God has provided nearly $30 million to pay for this renovation. There are already plans for new and larger American Mercy and then an Asian Mercy after that. Working on the ship is a fantastic cross-cultural experience. English is the official ship’s language but it is English with many and varied accents and vocabularies. Even those who have English as a national language find that we are all English speakers but separated by a common language. I find it very hard to understand some of the accents here and they find mine difficult as well. They are more than 30 nations represented among its permanent and associate crew and it is always interesting to find out that you have many more things in common than things that separate you. When you add to the fact that you are all members of the family of God and have as an overriding purpose the goal of showing Christ’s love, it becomes a glimpse of what heaven may be like. The nationals who interpret and who work shoulder to shoulder with us are very fine people and very fine Christians. The people of Sierra Leone have persevered through some tough years. Last Sunday, we went to church with one of our interpreters, Papa John. He is a retired school teacher of uncertain age. Often, since age is venerated in African cultures, folks say they are older than they really are. In 1996, during the ten-year civil war, the rebels burned all four of his houses on a piece of property which is located upcountry. They herded his three sisters into one house and burnt it, burnt the other three homes and then killed his brother, his son and his grandson. They captured him and threatened to cut off his arms. He thought he was going to die and had seemingly nothing much more to lose. The young soldier making the threat with his cutlass at the ready was shocked when this old man verbally abused him, and threw in his opinion of the soldier’s mother and his father for good measure. That so amused the older soldiers that they let Papa John go. He still has ownership of some 100 acres of coffee and palm nuts but no one is able to take care of it for him. He also has the responsibility of providing for the children of his dead brother. It is a tragic story, but he demonstrates an amazing faith and equanimity in the face of all that has transpired. Each day when you greet him and ask how he is, his reply is invariably “Praise God!” Serving on the Mercy Ship is a real privilege and a blessing but is not perfect. This is not exactly a cruise ship. It is full to overflowing. There are real downsides to community living on a ship. The cabins are not spacious. I wouldn’t really say they are crowded – it is just that if one of you needs to open the drawer, one of your cabin mates needs to move into the hallway to allow enough room. You have to brush your teeth up and down as the dentists recommend – because you don’t have room in the head to move your arm from side to side. Okay – so perhaps I am exaggerating just a little… On the ship, it is true that it seems nearly impossible to find space get off by yourself – there is always someone about on their duties or someone walking through who is involved in the same quest for privacy. The food on the Anastasis is adequate in amount but reminds you very much of your junior

Listening to the Heartbeat of our Ministry The Steffescope Volume 7, 2004 © 2004 high cafeteria – very high in starches and any vegetables are often steamed well into the soggy range. All my childhood, I heard the traditional admonition “Don’t waste that food. There are millions of starving children in Africa.” My stock smart-alecky reply as a kid was to send it to them. Now, docked in an African port and surrounded by poverty, there are times I would like to give it to them but still can’t seem to find those kids – at least not at the very moment I need them. Doesn’t seem right somehow. This week, we on the ship had a wonderful view of a full lunar eclipse. Without light pollution and from a perch on the railing of the upper deck, it was an amazing visual experience. There was a disturbing commentary on public education these days -- several of the young college-aged people around me were asking what a lunar eclipse was! Sigh…. Last year, a tragedy befell two of our friends who were serving in Kenya. Dr. Carol Spears, a surgical resident serving for a year, and Joy Phillips, a career missionary at Tenwek Hospital, were abducted and one of them assaulted. Many of you prayed for them. I have stood in admiration as Dr. Carol Spears was willing to bare her soul and share her experience with the world via radio and seminars. I recently received this note from Dr. Spears and I share it with you in follow-up as a wonderful tribute to the healing power of prayer and the maturation of her faith under tribulation: “May 12, 2004 will mark one year since my friend, Joy Phillips, and I were abducted and kidnapped by armed robbers and I was raped by one of our assailants. People will occasionally ask me if I think about “it”. Every time I hear an airplane (and many other times), I am reminded of “it”. But, I choose to think of God’s blessing in sending a plane to be a part of leading to our escape and rescue. I am not haunted by my memories, but I am humbled and amazed at our awesome God. “As I reflect on that time of our lives and on the subsequent twelve months, I am flooded with so many emotions: • PRAISE for a God who loved us, spared our lives, protected me from disease and pregnancy, and revealed Himself as I had never experienced before • THANKFULNESS for the amazing body of Christ and Christian brothers and sisters who carried me when I could not stand on my own, prayed for me and loved me and supported me through the difficult journey. Thankfulness that Joy experienced the same thing and that she is doing well and is not fearful – even as she drives around Kenya continuing to carry out her ministry with Community Health at Tenwek. • HUMILITY as I think of my unbelief as I wrestled with God and questioned how He could allow such a thing could happen ….. and then PEACE as I finally acknowledged His Unfailing Love and His Divine Plan and His Faithfulness and I TRUSTED HIM – which was all He asked of me • GRATITUDE for how God has healed me emotionally and protected me from fear most of the time • AMAZEMENT in how God could bring me to a place of forgiveness toward these men and how my life has returned to such American normalcy (for better and for worse!) • Something very similar to GRIEF as I miss living in Africa and working alongside my Kenyan and American colleagues • SORROW that the fervor of my testifying to God’s amazing blessings seems to lessen as my life returns to the normal hectic pace, and time and space heal the wounds………I pray that I will never forget His amazing love and that I will be bold in telling my story for His glory. “I continue to cherish your prayers as I continue with my final year of General Surgery residency which will end June 2005. After residency, I plan to return to Africa as a missionary surgeon. I am not sure of the specifics, but God is, so I am just waiting on His direction. I will likely work for a year in America as I raise support and prepare to return to Africa. “God used the experiences of last May to test my faith and to allow me to really, really KNOW Him and to experience aspects of His character that I would have never known any other way. For this I am eternally grateful. I know that the next time difficulties come my way, I don’t have to doubt or have unbelief. He will be there with His unfailing love. All I have to do is Trust Him. Safe in God’s Hands and Trusting Him, Carol Spears”

Please continue to pray for Carol and Joy and while you are praying, remember all of the missionaries in this world who are facing danger, illness, discomfort and the attacks of Satan all for the purpose for sharing the Good News of the salvation by Jesus Christ.

Humbled and honored to be serving with such folks,

Bruce Steffes

Saturday, May 15, 2004

Dear Friends and Family:

Every missionary has his or her snake story. Since I am on a ship, I don’t have one from this trip but being the trooper she is, Micky tried to take up the slack for us. She called last week worried about a lil’ ole four-foot venomous cotton-mouthed water moccasin that had taken up refuge under bushes near the house. I was never quite sure what I was to do about it from here but I was very free in giving advice. After all, I could recommend all sorts of things with impunity – it couldn’t bite me! Sean was reportedly very interested in this interloper and was disappointed the next day when it was gone. Micky was not. This week was a busy one here on the ship. Life was simple. I got up, I went to devotions, I operated all day, I ate, and I went to bed. This was repeated five times. I did 28 cases this week. Fourteen were the huge goiters that are so common in Africa. Next week, I am scheduled for 37 cases, among which are another 14 goiters. The goiter patients are especially appreciative of our work. One of the goiters was huge, weighing well over a kilogram in weight. To you can get a rough idea of what it is like for these patients, take a quart bottle of water, hang it around your neck so it is positioned sideways and live that way for 10 or 15 years. Know that you can never afford to have it removed – and then have a white ship of mercy offer to do it for free. Such is life on a hospital ship but to get the full flavor, add to that experience the large number of patients with cleft lips and cleft palates who are mocked and who cannot eat with spitting out food or having it go up into their nose. Add the folks with huge tumors that distort their face, force their mouths open and prevent them from eating properly. Add the folks with orthopedic problems, blindness and all the other sad cases that stretch on ad infinitum. Go to the screening days and see a line of people stretching a mile or more waiting patiently and perspiring in the hot sun, a line of folks who hope against hope that they can be helped and that they will be chosen. Ninety percent will be turned away, either because the Mercy Ship does not have the equipment, people, time or resources to help or sadly, they are often turned away because it is too late to do anything. It can break your heart. This week, Dr. Tony Giles, the maxillofacial surgeon is leaving the ship, having been here in Sierra Leone for the entire outreach. The ENT surgeon, Thermon Crocker, who has been here for six weeks is also leaving. That will leave only Tom Elmer, the eye surgeon, and I to carry on to the end of the outreach. This coming week will be the last week of surgery on board the Anastasis. I will stay for three days after my last case to make sure the patients are doing well and then leave the following Monday to fly back to the US. The ship sails three days after I fly out, going first to the Canary Islands and then England and Holland. One of the concerns that the Mercy Ship has is that it might be perceived as being in competition with local caregivers, hence by design they try to select the difficult and highly specialized cases that cannot be easily taken care of in country. General surgery is something which is usually available within the country (albeit in woefully inadequate numbers) and so the ships do not recruit many general surgeons. However, near the end of an outreach, the complex cases which require long-term follow-up cannot be safely done as the time runs out. It is a good time for general surgeons like me to come. I try to point out to the other specialists on board that is must be because my cases don’t have complications like theirs do, but the truth is that my cases don’t need much follow-up and so they allow me to come. That way the operating rooms and wards can be maximally utilized to the very end. I have already made a tentative commitment to come next year at the end of the outreach in Benin. There is a real and continued need for plastic surgeons, maxillofacial surgeons, ENT surgeons and those who know how to repair vesico-vaginal fistulae (VVF). If you know of someone who would like to come to work, please encourage them to do so. The web site address is www.mercyships.org. Since the urogynecologic surgeon has gone home to Australia, it has fallen to me to continue to care for her patients. There have been four failures from the repairs of the vesico-vaginal fistulas. Given the numbers of cases done and the severity of the scarring, that percentage of success is a very good one; to each of the women for whom it has failed, it has been a disaster. They came to the ship with the hope of being able to live without dripping urine (and sometimes stool) everywhere they go. They dreamed of being socially acceptable once again, of living a life where they were not literally outcasts living on the edge of the community. They went through a difficult and painful operation – and now they are not any better off. Most of them will require an abdominal approach to try to fix it the second (or third) time. This may necessitate the removal of their uterus. They will then lose any chance to bear children. That is a disaster for a woman in Africa. Women are often considered chattel, valued only for their dowry, their capacity for work and for child-bearing. The abdominal approach will be difficult, extraordinarily expensive and out of reach for most of them. The sadness, sorrow and disappointment in their eyes is more than I can bear. I wish the ship would be here long enough so I would be able to tackle these complex cases for them. The Mercy Ship and the Sierra Leone Ministry of Health are working together to develop a VVF hospital here in

Freeport that will continue the work long after the anchor is weighed. It is badly needed. However, politics, hunger for power and greed are already causing problems and the first brick has yet not even been laid. Please pray that it will be successfully built and successfully run so that these unfortunate women can be rehabilitated. God continues to open doors for the Hope Hospital project. After our meeting in Washington, Ruth Sims and Sue Bonner have written and tell of the amazing contacts they have made. They met with representatives of the US Department of Health and Human Services, the Global Fund, the Africa Development Foundation, the CDC, the Faith-Based and Community Initiative group and the World Bank. They also had further discussions with Samaritan’s Purse International Relief and with a charitable foundation in Chicago that is very interested in helping to raise the millions of dollars necessary to build the project. It is exciting to see what God is doing! Micky and I may be flying to Uganda the first week of June to meet with an architect and to meet with others. In 2002, as an unintended but God-led consequence of my trip with Samaritan’s Purse to help with the construction of the hospital in Kholm, Afghanistan, I spent some time with Pastor Ishaq Mazhar in the slums of Islamabad, Pakistan. I was impatient to get to my “real job” and almost missed what God had for me to see and to do. Going with this elderly godly pastor on his appointed rounds, I met and spoke with our Christian brothers and sisters who are forced by the Moslem majority to take low-paying jobs and who live cheek to jowl in slums of indescribable squalor. Based on my reports to you on what I saw, Samaritan’s Purse promptly headed up a fund- raising project to build churches in those slums and many of you responded generously to help our fellow Christians. I received a note from Pastor Ishaq this week, asking me to attend the inaugural ceremonies of the fifth church. Four are up and functioning to God’s glory. Although I had to turn down the invitation with great regret, I am thrilled that your generosity is continuing to be manifest among our fellow Christians in Pakistan and I wanted to let you know that a light continues to shine in Islamabad.

Praise and Prayers:

1. As the Mercy ship winds up its outreach to Sierra Leone, pray that we all will finish strongly. Pray that our patients will recover without complication and without the feeling of being “abandoned”. Pray that the VVF hospital will rise above the problems and prosper for God’s glory. Pray that the churches and other community programs that have been established will prosper. Pray that we will not have security problems (stowaways, violence). Pray that this old ship will sail without problem to the Canary Islands. Pray that God will bless those who have participated here and will prepare the hearts and minds of those who are to serve next in Benin. Pray most of all that the message of Jesus Christ will continue to flourish and flame up to a conflagration of revival that will change the face of Sierra Leone and Africa. The more time I spend here in Africa, the more I am convinced that the only real chance for the reclamation of Africa is the blood of Jesus Christ. 2. Pray for our brothers and sisters in Pakistan and in all Moslem countries. They are at risk of their lives and often disadvantaged in many ways. Pray also for the millions of Muslims around them who are dying as you read this, dying without Christ as their Savior. 3. We are increasingly being led to consider serving for an extended period of time in Uganda. There are many things about that decision that are very bothersome to us. There are many details that would need attention – financial, housing, schooling and many more. Then there is the simple fact that while I have handled a lot of small pieces that would fit into such a project, I have never ever built an entire hospital or worried about training everyone in it. There is also the fact that I may have to give up my involvement with several groups with which I am very involved and to which I have been committed; I will struggle to maintain my medical licensure, to meet my continuing education requirements and to grapple with the very real problem of maintaining my surgical skills and knowledge base. Contemplating the move has made me face the fact that I am so wrapped up in being a surgeon that I am not sure what to do if I no longer able capable of performing as one. What would be my options then? Actually trusting on God? Talk is cheap but putting feet to it – that is another thing altogether. It scares us but I realize that our way seems clear. Blackaby makes a point that we must look for God-sized projects and if we can do it in our strength, then it is not really God’s project. Well, if he is speaking truth, then this is exactly the project I would need to be involved in -- I am scared to death and feel totally inadequate. I must learn so much more than I have ever learned before about leaning on him. Please pray with us!

Continuing to serve one step at a time,

Bruce Steffes

Saturday, May 22, 2004 Dear Friends and Family: Whew, I am tired! I am not the man I used to be – but then I never was and probably never will be! In my time here, I have done the equivalent of three months’ work for the average general surgeon in the US. Here in the operating theater of the Mercy Ship Anastasis, it was a very busy week as we operated up until 5:30 on the last day of the surgical schedule for the outreach to Sierra Leone. One of the very frustrating thing about this ministry, and indeed any medical ministry in the developing world that I have been involved in, is the fact that you often have to turn away people who truly need help, who lack the resources to get that help if you can’t do it, and who may never be helped because the country may lack both the necessary capacity and/or the compassion necessary to help. And yet our time and resources are limited and we must accept that, but I can’t help praying for more help of all kinds. Medical missions needs so many more people to serve and to give. There are a few patients who are in still in the ward but there is a stark contrast to earlier this week when every possible space had a bed and a patient in it. Now even the beds are broken down and stored as they are emptied and the ward has only a handful of patients who will be going home in the next day or two. The din has quieted and now the sound echoes from the metal walls. The medical staff volunteers are leaving for home and there will be another sizable exodus the first part of the week. Attention of the remaining crew is being turned to the cleaning and inventory of remaining supplies. We found some suture in the theater that was outdated in 1983 – but it was still good and strong. It will be given to someone who can still get use of it. I know there have been times in the past six years that I would have been thrilled to get it. The security of the ship is tightening. There are many reasons. Today is a local election and that is often a time that foments unrest. Also, the ship is now closed to visitors and security search teams are being formed and trained. Before sailing, the ship will be searched several times, looking in any crevice, nook or cranny for unexpected passengers. Any stowaway could cause the Mercy Ship to pay very heavy fines in the next port. At the same time, the celebrations and good-byes are beginning. Ceremonies and parties are organized to express appreciation to the interpreters, the day workers, the government officials and indeed anyone who has partnered with Mercy Ships while in Sierra Leone. Tomorrow, Sunday afternoon, there will be a city-wide celebration held in the Victoria Park in downtown Freetown. Life on a ship in the Third World continues to have its own unique problems. The entire ship is on water restriction and that means no laundry can be done. It seems that the port authority has not paid its water bill and so the ships docked at the pier get no water. The ship contains a lot of stored drinking water but not enough to waste on laundry or on long showers. If the water is not turned on before the ship sails next Friday for Tenerife in the Canary Islands, the folks aboard may be getting rather gamy by the time the ship docks. Yesterday, I helped Tom Elmer, the ophthalmologist with a rather sad case. This 3-month-old child was born with bilateral retinoblastomas. These malignant tumors have made Lansana blind since birth and it took a lot of persuasion of the family to get permission to remove the eyes with the goal of perhaps saving the child’s life. I helped with the case since this is something that I have been called on before to do in cases of trauma and didn’t know how. Please pray for this little child and for the family as they struggle to adjust to this blow. I pray that they will come to know the Lord to harvest some good from this tragedy. I have received good news from Uganda. Micky and I will be flying to Uganda June 1 to meet with Ruth Sims and with the architect to further our plans for the Hope Hospital. God continues to work and promises have come in from people who want to help raise funds and support this hospital. Others are offering to come to teach and mentor the nurses we need to train. We are already beginning plans for a fund-raiser in the United States next March and have a promise from one of the most influential Africans in the world to help us. That is good news, but it pales in comparison to the realization that God himself is moving and working. We will be leaving Sean with my parents while we make the week-long trip. Bill McCoy wrote the closing words in the final chapter of our Handbook for Short-Term Medical Missionaries. As I leave the field each time, I have found it challenging to review those words. The line below “God never gets on an airplane and flies back to suburbia” always gets to me. Perhaps through our words in these newsletters, you have seen a bit of what we have seen and these words will resonate within your heart. The advice and themes are valid for all types of ministries and missions. Can you see with Christ’s eyes and feel with His heart?

You have seen medical missions. Their faces are imprinted on your mind; their blood was so recently washed from your hands. You have heard the cries and you have wiped the tears, from their eyes and from your own. For a brief time, you became part of their lives, and they became part of yours. Medical missions took on a shape, but even more than a shape, medical missions became a name and a face. What will you do next?

The Lord said (to Moses): “I have indeed seen the misery of my people... I have heard them crying out... I am concerned about their suffering... So I have come down to rescue them!”(Exodus 3:7-8) God never gets on an airplane and flies back to suburbia. The eyes and the ears and the concern of God are forever directed toward the misery and the cries and the suffering of his people. Before you volunteered, before you gave a second thought about the needs of the people served by medical missions, God’s heart was breaking over their suffering. It has always been so, and will be so until the end of time. “So now, go. I am sending you!” (Exodus 3:10) Moses had already tried to rescue the people in his own strength, and failed miserably. That is why God finds him on the far side of the desert tending sheep. Moses is trying to hide from the misery and cries of the people and, in doing so, is running from God¹s call on his life. But God invites Moses to participate in His own amazing redemptive purpose, and Moses’ life will never be the same! Medical missions is not something we do, it is something God is doing, and we have the great privilege of participating in it. God is healing, God is redeeming, God is changing lives! “Through God’s mercy, we have this ministry” (2 Corinthians 4:1). It is only by the mercy and the grace of God that He invites us to participate in ministry. It is a profound mystery but it is clear that we are the instruments God has chosen to rescue his people, to redeem his creation. “He has committed to us the message of reconciliation” (2 Corinthians 5:19) What are we doing with the invitation of God and the message committed to us? Therein lies our only hope for fullness of joy, deep meaning, and freedom from all that would entangle us. Trouble free? Absolutely not! You have tasted some of the many difficulties encountered in medical missions. Cultural differences, limited resources, lifestyle changes, ingratitude, personality clashes, persecution, danger, sleepless nights, excessive demands—the mission field has all of these and more. But these are “achieving for us an eternal glory that far outweighs them all” (2 Corinthians 4:17). If the call of God for your life is medical missions, then you are among the most privileged. For God has “come down to rescue them” and He is calling you to witness and participate in His miraculous work! Seek the will of God, listen to His voice, and stay involved in medical missions! It may mean a career change. It may mean a new structure to your medical practice or new priorities in the way you make and spend money. Maybe you are called to regular volunteer service or recruiting others or identifying resources to strengthen a specific ministry. The life of Jesus Christ gives us a clear model for Kingdom ministry. Matthew chapters 8 and 9 vividly portray Christ teaching, preaching, and healing. “When he saw the crowds, he had compassion on them, because they were harassed and helpless.” If your experience in medical missions has opened your eyes to the suffering of the crowds, then listen closely for the calling voice of the Lord of the harvest. That voice bears your name.2

Praise and Prayers:

1. Pray for the ministries of the Mercy Ship. Pray for safe sailing. Pray that our patients will recover without complication and without the feeling of being “abandoned”. Pray that the VVF (vesico-vaginal fistula) hospital, churches and other community programs that have been established will prosper. Pray that God will bless those who have participated here and will prepare the hearts and minds of those who are to serve next year in Benin. Pray most of all that Jesus Christ will continue to be proclaimed. 2. Pray for a safe flight home for Bruce on Monday and Tuesday. 3. Pray for the upcoming meeting in Uganda – that it will be effective and the thousand details will work out. Pray for our safety while we fly there and back and for Sean as he is left with his grandparents for the week. Pray that we will find the housing and find satisfactory answers to the questions we have about moving there. Pray for peace for us and for the funds we will need to live there without a salary.

Listening for the calling voice of the Lord,

Bruce Steffes

2 © ABWE, 2002

Saturday, June 12, 2004 Dear Friends and Family: Since the last newsletter three weeks ago, Bruce arrived home safely from Sierra Leone, tired from his busy stint on the Mercy ship. Only six days later, Bruce and Micky left Sean with his delighted grandparents and they flew to Uganda to further explore the Hope Hospital Project. No rest for the weary, but more on that trip in a moment. Bruce’s week at home was a great time of rest and catch-up on two months worth of reality. All of Bruce’s children were here for the Memorial Day weekend and little Sean celebrated his third birthday. He had a blast and his brother, sisters and both sets of grandparents spoiled him rotten. Of course, Bruce has been gone for two whole months and he did his share of hugging and spoiling Sean, too. The week-long trip to Uganda was an amazing time. A mechanical problem with our very first flight made us miss all of our other connections, so we had to spend more time in transit than we had expected but we arrived safe and sound. Our goal of this trip was to solidify and unify the vision for the hospital, to begin the serious planning necessary to put out a proposal for an architectural and engineering bid, to do the preliminary budgeting needed to begin fund-raising and to pray together over each stage. God was good. Every detail seemed to fall into place and difficult-to-get appointments were made with amazing ease at convenient times. We had a good meeting with the Minister of Health. He was hugely supportive of this project, despite the fact that it would be an independent Christian hospital outside the purview of his department. He has offered his assistance in making contacts and in helping us through the labyrinthine of international and governmental politics. Such planning was tedious and difficult. Day after day, from “can see” to “can’t see”, meetings and discussion amongst the five of us would go to the point where hunger and fatigue would intervene and then the planning would take up again. The problem of determining the personnel and supply logistics of a large hospital in the developing world is big enough already but the details to consider were astounding. One small example: just consider the fact that electricity is very expensive and so to save money on the operating costs of electric dryers, we would prefer to dry the laundry (and then we must iron them to prevent the eggs of the mango fly burrowing into the skin of the patients). However, there would be a minimum of 500 bed sheets each and every day. That alone would require over a half-mile of clothesline. Add the towels, patient gowns, scrub uniforms and so on and it becomes overwhelming. Now consider 200 in-patients, a thousand out-patients, one or two caretakers for each patient and then a staff of 800 and the logistics of crowd control, security and provision food services become major deals. Add to that, the fact that there are essentially no nurses with specialized pediatric nursing skills and only a few dozen pediatricians in the country. None of those are sub-specialists. The need for training then dictates the opening of the hospital and the services it might offer – and so a large Pediatric Training Center becomes the first stage of the project. An estimated construction and outfitting budget of $35 million made us swallow hard – more than once. Given the fact that virtually no children’s hospital in the world is self-sufficient without private donations and government support (including programs like Medicaid), the $15 million number on the yearly budget loomed large. Yet in despite of the daunting size of the budget, we believe that God is great, that God is in this and that God is already lining up the right people for the job. We are increasingly convinced that we (the Steffes family) are to move to Uganda in January for an indefinite period of time. There are a lot of details and obstacles to work through and the cost of living in Uganda is not cheap; indeed, some things are more expensive than in the States. Our financial support is a matter of concern and prayer for us, but we are going forward with faith in Christ’s promises (Matthew 6:25 – 34). Throughout all of this, we must fall back on the realization that God is either God – or He is not. If He is, His leading and promises are faithful. His resources are not limited. He is still Jehovah-Rapha – the God who heals. And if He is in this, we wouldn’t miss it for the world – literally or figuratively.

Praise and Prayers:

1. Praise God for the many ways that God is already working on the Hope Hospital project. There are a myriad of details still to be worked out. God must supply the money to build, equip and run the hospital. God must supply the right people to help raise the funds, to build the facility, to run the departments and many, many expatriates willing to come and train Ugandans to run this hospital in a way that honors the principles of good medicine and that honors Christ. From an administrative standpoint, because of the inherent human tendency to want to complete a job, there will be many temptations for us to accept money with strings attached that could limit our ministry or to accept people that might attenuate the evangelistic emphasis or destroy the testimony of the hospital. Pray that it will not happen. 2. On a personal level, we as a family are facing many decisions on the timing of a sale of our house, our possessions and the details of housing, transportation and education for Sean in Uganda. Pray for wisdom

for us. We have worked since 1998 without taking funds for our personal support. We felt that we were following God’s direction in our life in doing so. However, we now have the freedom to accept funds from those who wish to help. We will not do any sort of active fund-raising ministry but will leave it to God to provide the funds through those friends and churches that want to have a more active partnership in our ministry. Once we have the details cleared, we will let you know how to help if you feel led to do so. 3. Tomorrow (Sunday, June 13), Bruce is driving to Morgantown, W. Virginia to begin the course in tropical medicine. Micky and Sean will join him in about a week. The course is eight weeks in duration. Please pray that Bruce will be able to maintain his focus on all that he wants to learn, while doing all that he needs to do for Methodist College and for the Hope Hospital project.

Excited about what God is doing in Uganda and in our lives,

Bruce , Micky & Sean Steffes

Saturday, July 10, 2004 Dear Friends and Family: Four weeks down and four weeks to go. This course in tropical medicine at the University of West Virginia has been a great experience thus far. Almost all of the people attending or teaching them have had tropical medicine experience and more than half of the attendees plan a significant missionary medicine experience in the near future. I have made some great new friends and spent some time with old ones that have lectured here – Dr. John Tarpley from the Baptist Hospital in Ogbomoso, Nigeria (now at Vanderbilt) and Dr. Paul Jarrett from Tenwek have spoken this week. I must confess that sitting in the lecture hall more than 40 hours every week trying to absorb all the knowledge has made my head spin. My head is not the only thing out of adjustment. The long days of sitting also brings to mind the truth of the old saying that the mind can only absorb what the derriere can tolerate. I must confess that an up-close study of the dangers of just plain living can be intimidating. I don’t mind so much the various poisonous or toxic flora or fauna that are in this wide world because you can usually see them coming. It is the parasitic disease can give you the willies if you think on the concept too long. The idea of a 30- foot long tapeworm perhaps residing in my gut is bad enough but some of the other less-known critters out there really get to me. For example, the Guinea worm (Dracunculus medinensis) is a real sweetheart. If you drink contaminated water that happens to have an infected microscopic crustacean in it, the larvae of this worm come out of the now dead Cyclops and burrow right through your intestinal wall to the free peritoneal cavity. There they mate, the male dies and the female grows to over 3 ft in length. After a year of vacationing in the neighborhood on the corner of Gut and Liver, it decides to migrate to your leg or to another spot until it is ready to lay eggs. It causes a nasty, itching blister and when you put your leg in cool water, the end of the worm pops out and lays eggs. It is only then that you can grab it and slowly, over days to weeks, roll it on a matchstick to pull it out, hoping and trying not to break it off. If that isn’t disgusting enough, how about the various varieties of filaria, the little round warms that are out there? If you are bitten by the right mosquito or black fly, it regurgitates a larva into the bite. The larva then migrates to some spot within your body, sets up homemaking in some convenient locale that varies by species, matures over months to years. Eventually, it spawns thousands of larvae each and every day. These little worms cause havoc, migrating through your blood stream and tissues, causing blindness and elephantiasis amongst other things. The mature adult worm lives for years to decades snugly inside you. All the while, you may literally have thousands of littler offspring in each cubic centimeter of tissue of your tissue. They are awaiting another insect bite to serve as their taxi-ride to their chance to set up housekeeping somewhere in someone else. Yeech! But the one critter that gives me the most shivers in the depths of my soul is not a worm at all but rather a little fish from the Amazon. The Candiru (Vandellia) catfish ordinarily is a blood-sucker living on the gills of fish, but if you make the mistake of swimming in the Amazon and pee underwater, it mistakes the source of the flow of water and swims upstream, lodging in your urethra where it gets a free blood meal. This course is definitely a case of borderline “TMI” – Too Much Information. I have learned far too many ways that flesh can fester or fall off, exposing that which God never intended to be exposed. Sure wish Eve and Adam would have left that ol’ apple alone so none of this would have happened. I would stay in bed to hide from the reality but even that option has now been cruelly stripped away. I have been burdened with the knowledge that a two-year old pillow owes a quarter of its weight to bed mites (alive and dead). It is now too disgusting to consider the head-under the pillow option. I might as well go out and find something else to do. Perhaps I could go and buy a new pillow instead – I have sure been meaning to do that ever since that one lecture…. Sean and Micky have made the eight-hour car trip to visit me since I have been here, but the small “college freshman” type of furnished apartment that I have rented is without a place to play, entertainment or toys. It is

Listening to the Heartbeat of our Ministry The Steffescope Volume 7, 2004 © 2004 enough to make both of them go bonkers since I spend all day in lecture and much of the evening hunkered over the books. Despite the fact that I think we have been apart too much this year, I certainly understand why they would want to go back home. Micky has a lot to keep her busy at home since there are so many details to attend to as we prepare to sell our home and belongings. Two weeks ago, I skipped a day of classes and met in Washington, DC with an old friend from our time at the orphanage in Jinja, Uganda and with Ruth Sims and Ken Isaacs, the international project director from Samaritan’s Purse. We were meeting to further discuss the Hope Hospital, the proposed evangelical national children’s referral hospital in Uganda. The highlight of our time there was a meeting with Janet Museveni, the first lady of Uganda. Hope Hospital is her brainchild and it was an honor and a pleasure to meet her and to talk with her. I was impressed with the quality of her intelligence, her character, her humility and her obvious love of Christ. It will be an honor to work with her over the next few years.

Praise and Prayers:

1. Next weekend, Micky and I will be attending and speaking at the ABWE Medical Missions Interface conference being held in Harrisburg, Pennsylvania. I will be joining Dr. Bob Cropsey in a presentation meant to challenge folks like you and me to consider short-term or career medical missionaries. Please pray that our words will be used by God for that purpose. 2. Please continue to pray for us as we work to develop the Hope Hospital and seek knowledge about our role in it. God must lead the development team to the right people for help – people who have the right skill sets, talents, resources and contacts. We cannot do it alone but if He is going to do this, we want to be involved. Pray with us that we will be able to recognize His timing and leading in all things and to stand against the attacks that are sure to come.

Honored to be His child,

Bruce Steffes

Saturday, September 4, 2004 Dear Friends and Family: “If you want to make God laugh, tell Him your plans”. We heard that many years ago and it remains true. Even when we think we understand His plans for our lives, things change and we must learn patience once again, learning to lean on His direction. What brings up that bit of introspection? Since February, it seemed that things were all set for our involvement with the Hope Hospital in Kampala, an evangelical national children’s hospitals. We put our house on the market and were making plans to move in January. We planned to stay for a several year period – and now everything is on hold. In mid-August, the First Lady of Uganda called in our co-worker in Uganda who has been leading this project and for reasons still only known to Ms. Museveni, pulled the project out of her (and our) hands. There are many reasons why we feel this may doom our vision of the project but there is little that we can do but wait upon the Lord. We do know that for us to be involved, the hospital has to clearly promote the Gospel, has to have a clear dedication to education as well as quality patient care and has to have a relationship in which responsibility and authority are clearly spelled out and the lines of communication and respect are open. At the present, those conditions are not being met to our satisfaction and so we do not feel we can be involved until the problem resolves. Whether this is something the Lord is doing to teach someone something or whether this is the first of the expected salvos from Satan is unknown. We must just continue to wait and keep doing what the Lord shows us to do wherever He shows us it needs to be done. Don’t worry about what we will do – when you have even a small talent but are willing to work for free, there are plenty of offers of places to work! Bruce successfully completed the eight week tropical medicine and parasitology course in Morgantown, W. V. and has moved home again. It was a great course and he is scheduled to fly to Miami Beach in November to take the certification exam. He has a lot of studying and reading to do before then! He also completed his certification in Advanced Trauma Life Support (ATLS), Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) and this fall will take the instructor courses in preparation for teaching those topics at the CMDA- CMDE conference in February, 2005. Bruce continues to teach anatomy and physiology at the Physician Assistant’s Program at Methodist College and has resumed teaching advanced laparoscopy to the general surgery residents at the Durham Veteran’s Administration Hospital. Sean is going to preschool two times a week, speech therapy once a week and will soon

Listening to the Heartbeat of our Ministry The Steffescope Volume 7, 2004 © 2004 start attending choir practice for a choir made up of 3 year olds (!). He will also be starting in AWANA, the parachurch youth movement. The idea of our little 3 year old in a Sparky uniform cracks us up. Micky is busy keeping the house clean for tours of potential buyers, learning the joys of running a taxi for her son and coming up with lists of home repairs for Bruce to carry out. Despite remaining busy, we all feel it is good to have something resembling a normal and settled life for a few months. We continue to prepare to return to somewhere. Even if we don’t have specifics, we are still under marching orders to serve. We are getting our booster immunizations in everything from hepatitis to rabies to meningitis. We continue to prepare and to serve where God has planted us. Our schedule for the remainder of the fall is as follows: • Ruth Sims and Sue Bonner, our friends and co-workers in the Hope Hospital project, will be coming to the States in September. We will have meetings with some folks at Samaritan’s Purse in an attempt to determine what path we should now take regarding the hospital. • October 8 – 10, we will be attending the World Medical Missions’ conference for medical missionaries in Asheville, NC. This “Prescription for Renewal” is always a great time of encouragement and challenge. That Sunday, we will skip out a bit early and will be preaching about medical missions at Northpoint Baptist Church in the northern Asheville region. Late that same day, Bruce will fly to New Orleans to attend part of the American College of Surgeons meeting. • October 23, both of us will join Dr. and Mrs. Robert Cropsey to put on the next regional medical missions conference. This day-long conference will be held at Calvary Baptist Church in Ypsilanti, Michigan. A second one will be held November 20 at the Colonial Baptist Church in Cary, NC. If you are free on those dates and reasonably near, we would love to see you there. • On November 6, Bruce flies to Miami Beach to take the American Society of Tropical Medicine and Hygiene tropical medicine certification exam. • November 11 – 14, we will attend the world’s largest medical missions conference at the Southeastern Christian Church in Louisville, KY and while there, will attend the board meeting for the Pan-African Academy of Christian Surgeons. • Bruce will give Grand Rounds for the East Carolina University surgery department December 8, 2004. The topic will be on “Bush Medicine and the Challenges of Surgical Education in Developing Countries” and it is always a good change to push the idea of medical missions.

Praise and Prayers:

1. We received an e-mail from Steve and Kayleen Merry. You will remember that we worked with them in Togo for eight months in 2003. They were new missionaries who had to escape the troubles in the Ivory Coast just a few weeks after finally arriving in Africa. Their recent e-mail read: Dear Friends and Family, We received bad news this AM from Dr. Litzow, head of hematology and the bone marrow transplant team at Mayo. Kayleen has acute myelogenous leukemia. She will need to begin chemotherapy soon; bone marrow transplant is a real consideration. She will need to be hospitalized for much of the next month for the induction chemotherapy, and frequently thereafter. We'll be returning to Mayo on Monday to begin preparations for chemotherapy. We ask again for your continued prayers for strength and courage, particularly as we handle the immensely complex task of arranging loving care for our (five) children in our absence, and handle all of the details (job, finances, housing, etc.). The older twins have expressed their desire to be with us out there and we've considered bringing all of the children with us; we need more information about resources available there vs. here for their care/housekeeping/schooling. If they were with us there, at least I would be able to see them each day. If here, the resources are more abundant, but we will both not be here. Continue to pray that God will be glorified; we don't understand His ways, often, but we affirm that HE is good and loves us. The scourge of evil and the Evil One will not have ultimate victory. We've read the back of the Book. In His love, Steve. Please pray for them as they face this major crisis. 2. Our travel to, participation in and speaking at the ABWE Medical Missions Interface Conference in Harrisburg, Pennsylvania several weeks ago went well. Thanks for your prayers 3. Please continue to pray for us as we work to understand and seek knowledge about our role in the Hope Hospital. Pray with us that we will be able to recognize His timing and leading in all things and to stand against the attacks that are sure to come. We have amazing peace about the whole thing in the face of all the confusion – we want only to serve wherever and whomever God directs.

4. Please pray for the sale of our home – and clarity about what we do then! 5. Pray as we establish a local accountability committee of people who are committed to helping with, praying for and advising us in our ministry. 6. Pray for Bruce as he prepares for the tropical medicine certification exam in November 7. Please pray that our ministry this fall will be effective as we speak, network, encourage and challenge.

We may not know when, we may not know where, we may not know why – but we know Who!

Thanks for being on the team!

Bruce, Micky and Sean Steffes

Addendum #1:

We had just sent the SteffeScope when we got this note from Steve Merry: Read it, pray for them and help if you can.... Bruce and Micky Steffes

Dear Friends and Family, Ever drive along a little road in a dense fog at night? The faster you go, the more insecure and vulnerable you feel. Yesterday was like that for us. I want to share with you some of the awesome things God has done today to remind us He is Immanuel, God with us, particularly in our suffering. Writing this is my act of worship in the midst of difficult emotions; I'm only partially doing it so you can read it too. When I awoke yesterday morning, I felt terrible, in a fog. I hadn't slept well, and knew we had to accomplish the difficult task of finding housing in Rochester, find adequate help for the children, and find out more about what to expect if the children did come with us. Would they only see me or would they be able to be with Kayleen? I doubted the oncology floor would allow much visitation. But, certainly during such a prolonged treatment of many weeks to months they needed to be with us. After our recent two week absence, Matthew said through tears that he would rather leave home and school and church and friends again than be without us by his side for such a long time. And, the faster the thoughts spinned, the worse I felt. We had begun to think that we should transfer our care to U. of Michigan where we'd be closer to Kayleen's extended family. U of M is a reputable oncology center. So we had begun to gather information about that option, too. Then the signposts began to appear in the fog, reminding us that God is present in our helplessness, guiding the way through the uncertainties. First, I had a good conversation with Linda Lanasa, a Physician Assistant in my former practice here in the UP. Mike, her husband, a National Forestry Service employee, is being treated for a similar type of leukemia at Mayo since April; he underwent bone marrow transplant the end of July. We'd spent a couple of hours with them last week while we were there at Mayo, reflecting on old times; and I shared with Mike the pictures of our backpacking trip Matthew and I took this summer through Pictured Rocks National Lakeshore -- a place dear also to his heart. Linda this morning shared with me, and I with Kayleen, the encouraging news that the oncology floor at Mayo is very family-friendly. They have a playroom for the children in the oncology ward so parents can share in play with them while undergoing treatment, rather than the stiff old go-see-mommy-lie-in-bed for a few minutes type interaction. And, they allow prolonged family time in the patient rooms. Mike's new little grandchild spent a couple of nights sleeping beside him. What a great encouragement to Kayleen to think that tender little Ben might be able to stay with her sometimes! Second, as I continued with the pedal-to-the-metal calling rental agencies and property managers and residence complexes desperately trying to find a place to stay, my head still spinning, I was getting only more and more discouraged. Nothing was available for a reasonable price. Either I needed to pay a one year lease, and most rentals weren't furnished, or I could rent a furnished 2 or 3 bedroom apt for between $3000 and $3900/mo! Now, there was a time when I could afford that kind of money. But God, I've learned, uses adverse situations during our most vulnerable times of life to mold us into people more useful in His service. And, so we now find ourselves unemployed, living on our home equity loan, in the midst of this critical illness, all because we willingly chose a few years ago to give up the security of a fine medical practice, an excellent income, good medical insurance and family medical leave pay to go serve in Africa, and are now in the middle of a transition, taking a leave of absence from the mission. But, I'm learning. I threw myself on the Lord in prayer and told Him like it was; I'm helpless. Help me. The Sisters of St. Francis came to mind. You see, Mayo Clinic is what it is because of a partnership between the

Listening to the Heartbeat of our Ministry The Steffescope Volume 7, 2004 © 2004 two Mayo brothers, physicians in the late 1800's and early 1900's, and the Sisters of St. Francis in Rochester who built St. Mary's Hospital. Sister Marjean runs the Gift of Life Transplant House, a residence facility for patients who've undergone transplants. Mike and Linda have been staying there for some time. So, I called Linda and got Sister Marjean's number. I told Sister our situation - a missionary doc back from Africa and unemployed with a big family and a sick mommy. She said she'd call me right back. When she called, she began to tell me about the options for "extended stay" hotels in Rochester; my heart sank; that's all I'd heard all day. Then she paused and said something like this: "well, there is another option if you'd be interested. You see the Sisters have a house right next door to the Transplant House that's vacant. I think it's 4 or 5 bedroom. Has a washer and dryer. Its not furnished, but it has a couch, and we can bring over some dishes and a TV and there's a full basement that's carpeted and a fenced in back yard..." She went on and on becoming more animated about how they could provide for us, ending with something like,"and whatever else you can't bring, we'll go out and buy for you." How much? "Well, does $1000/mo sound like too much?" I chuckled, "No, Sister, that sounds great!" Then I heard her talking in the background. She wanted to check out something with Sister Jane. "No," she said, "Sister Jane says we should charge the same as patients pay at the Transplant House. You'll just need to pay $25/day to rent the house!" Third, in the midst of all of this, Kayleen spoke with her older sister, Linnea Boese. Linn had prayed about this all yesterday and today decided that God was leading her to drop out of seminary (she'll be able to do some of the work by extension) . Linn will be joining us in Rochester to be with the children and Kayleen. We are immensely grateful. Kayleen's parents and my parents will also be joining us; and Kayleen's sister-in-law, Jill, and my sister-in-law, Kathy, will be flying out from time to time. We want to thank all of you for your love and prayers. Thank you for the offers of assistance of all kinds, including the many of you who've offered your bone marrow. If the time arrives for bone marrow transplant, Kayleen's siblings who are willing will be tested first and hopefully from amongst the 5 of them a good HLA match will be found. They are all the same blood type, but matching is much more complex than that. If none of them is a good match, then the transplant team would search the National Bone Marrow Data Bank for a match. That said, I don't want to discourage any of you from offering your bone marrow since it might save the life of another person somewhere, sometime. Some of you have offered to help us financially during this challenging time. In addition to the $750/mo rent, food and utilities, we have an $800/mo expense to continue paying into our mission's insurance plan which we'll be able to continue by law for 6 months more. We'll also need to pay into another insurance plan that will take over after that. To paraphrase Calvin, "should I refuse the providence of God when it comes in the hand of man?" If you decide to send a financial gift, please send it to our home address at the bottom of the letter. I'll send you our mailing address in Rochester once we arrive there in a couple of days in case you want to send something to the children or flowers or whatever. Just to let you know of some of the love being shown, Pastor Eldon Carlson from our supporting church in Bloomer, WI is going to drive down to Rochester with a chest freezer full of frozen food. Our next door neighbor, Barb Karas, has offered to mow our lawn and take care of the bills and the cat and goldfish. Folks here are bringing over food - Dale and Stella Ecklid have been a great source of encouragement and shoulders to cry on, and brought BBQ venison and corn over last night. We thank you deeply for each of you who are ministering to us during these difficult days and the many, many others of you who have been so moved and have joined us in fervent prayer. May God be glorified. He is our Hope; our only Hope. Blessings, Steve for the Merry 7 My hope is built on nothing less Than Jesus’ blood and righteousness. I dare not trust the sweetest frame, But wholly trust in Jesus’ Name. On Christ the solid Rock I stand, All other ground is sinking sand; All other ground is sinking sand. When darkness seems to hide His face, I rest on His unchanging grace. In every high and stormy gale, My anchor holds within the veil. His oath, His covenant, His blood, Support me in the whelming flood. When all around my soul gives way, He then is all my Hope and Stay.

When He shall come with trumpet sound, Oh may I then in Him be found. Dressed in His righteousness alone, Faultless to stand before the throne. Steve, Kayleen, Matthew, Marielle, Karston, Katianna & Benjamin Merry 9976 S.75 Road Rapid River, Michigan 49878 Home: (906) 474-9667 Cell: (906) 235-4413 [email protected]

Addendum #2:

Dear Friends and Family: In response to questions about your generous offers to help, Dr. Steve Merry has sent this e-mail. I send it on for your information. Bruce Steffes

Dear Friends and Family: Just a quick addendum: A tax-deductible charitable fund has been established at our home church, Grace Baptist Church, 528 28th Street, Gladstone, MI 49837. If you wish to help with our financial need, please make your check payable to Grace Baptist Church and write "Kayleen Merry fund" in the memo line. If you would like to join us in thanking Sister Marjean and Sister Jane, you may write to: Gift of Life Transplant House, 705 2nd Street SW, Room # 56, Rochester, MN 55902. Our (the Merrys') mailing address will initially be: Steve and Kayleen Merry, Room B, Gift of Life Transplant House, 705 2nd Street SW, Room # 56, Rochester, MN 55902 Blessings, Steve Merry

Thursday, October 7, 2004

Dear Friends and Family: We have some great news! God has put our involvement in Hope Hospital back on the front burner and things are coming rapidly to a boil once again! Resolving major problems at a distance is always difficult but God has used a series of e-mails, presentations and last-minute meetings to iron out the problems. As always with any big project, there will be issues of differing visions, differing methods of implementation, egos, and disagreements caused by desires for influence and power. Add the possibility of a large budget, cross-cultural conflicts and the fact that this project will have a great spiritual impact and it is not hard to see that you can stir up both the natural and the supernatural worlds. Pleased to be beyond worst of the first salvo, we shall press onward. We had the privilege of hearing about this dramatic, last-minute resolution in person from Ruth Sims and Sue Bonner. Two weeks ago, they came to the US on a previously-planned trip and the breakthrough (literally hours before their airplane would lift from the tarmac) was a matter of great rejoicing. The discussions switched from damage-control to excited planning for the future. A trip to Boone, taking us directly into the eye of the remnants of Hurricane Ivan, was remarkably anticlimactic from the weather standpoint but the meeting with the folks at Samaritan’s Purse International Relief was a blessed time. They have been very encouraging through the difficult waters of the past few months and they remain very supportive. Our next step is to pursue legal and charitable status here in the US and the UK and then fly on a trip to London over Thanksgiving to meet with the architect and to meet with some other folks who have promised to help. In January, Bruce will go to Uganda to begin the hard work on the planning and the financial prospectus. In March, Micky and Sean will move with Bruce to Uganda. The scope of this project is absolutely overwhelming to Ruth, Sue and us. The detail is immense. Please pray for us as we slog away at it, one step at a time. It would seem that we now need a major initial donor – someone with the faith to see the vision of a national children’s hospital that brings glory to Christ and who will give despite the lack of solid numbers and a solid plan. We have no real idea who that will be but we know that God owns the cattle on a thousand hills – we are only asking for Him to sell a few. We are also aware that this will take a team of people – people who are willing to donate their time and efforts to make a significant thing happen in their life and in the life of millions of children. We will need nursing and medical educators, financial and accounting experts, people with expertise in all the departments of a hospital, people who can help set up and run the financial and organizational structure here in the US and in the UK, people with fund-raising and grant-writing skills, people

Listening to the Heartbeat of our Ministry The Steffescope Volume 7, 2004 © 2004 with communication and informational technology skills and lots of others. We must do it all with people who will make it (1) excellent and (2) evangelical. Most of all, we need serious prayer-warriors. We give credit to the recent breakthrough in the conflict to the hundreds of people who were praying here in the US and in the UK. The need for such prayer support will only grow greater with time. It is good to know that faithfulness is awarded. One often never knows the ramification of one’s actions or the consequences of one’s obedience. We recently received this e-mail that shows how long and how far the “Hound of Heaven” will chase His target. It also shows the results of faithfulness even when it sometimes seems fruitless to us to continue. It came from a missionary friend who Bruce met in Guatemala on a mission trip. He has subsequently served in Costa Rica and is now with the International Mission Board in Mexico. He wrote, “I received an email from our former neighbor in Costa Rica, Walter Montero. He writes the following: ‘A miracle has happened. A year ago, we passed out 30,000 tracts in the Romeria in Cartago. One of those tracts made it to Long Beach, California, where a man received it. The man went looking for a Baptist Church near to where he lives and accepted the Lord. About a month ago, this man came to the church in Cartago and shared his testimony.’ Let me add a note: Each year over a million people travel to Cartago on August 2nd on a pilgrimage to the Virgin Mary. Last year, we had a volunteer team from Village Baptist Church, NC that helped us pass out these tracts! Let's give God the glory for the new brother in Christ! In His Name, Billy and Debbie Hurst”

Praise and Prayers:

1. We are thrilled to hear that Kayleen Merry has tolerated her first round of chemotherapy at Mayo Clinic for her leukemia and is doing as well as can be expected. Thanks for your prayers but please don’t stop – she and her family have a long road to hoe in front of them Since they will be in the Rochester, MN, area for several months, Steve is looking for employment as a family physician and particularly employment that comes with health insurance that allows pre-existing disease. They are presently on the limited health insurance they had before under the mission board and it will run out after a few months. Ask for her healing, but please keep this insurance matter in your prayers too. Bone marrow transplants are very expensive and can financially ruin them. The lack of an income is obviously a problem, too. 2. Our home is still on the market. Pray for a buyer – and then clear direction about where we go then and how we dispose of our goods. We were very pleased to hear that a house that we had looked at in Entebbe, Uganda will be coming up for lease – exactly the month that we had planned for Micky and Sean to move to Uganda. God is in the small details, too. 3. Pray as we continue to try to establish a local accountability committee of people who are committed to helping with, praying for and advising us in our ministry. We are also going to be able to set up a fund through our home church which allows you to make tax-deductible gifts to help meet the expenses of our ministry. The cost of daily living (and of course, the effort and time) is something we are contributing to this project, but the additional expenses of moving, travel, equipment, expenses related to the development of the project and similar costs are something outside of our budget. We are trusting in God to provide those things through you and others. Please prayerfully consider whether you can partnership with us by giving either a one-time gift or if possible, a recurring tax-deductible gift on a regular basis. 4. Pray for Bruce as he prepares for the tropical medicine certification exam in November – soon, he has to kick into a serious study mode to avoid being embarrassed! 5. Please keep our schedule and travel plans in your prayers: • Next weekend, we will be attending the World Medical Missions’ conference for medical missionaries in Asheville, NC. This “Prescription for Renewal” is always a great time of encouragement and challenge. On Sunday, we will be preaching about medical missions at Northpoint Baptist Church in the northern Asheville region. Late that same day, Bruce will fly to New Orleans to attend two days of the American College of Surgeons meeting. • October 23, both of us will join Dr. and Mrs. Robert Cropsey to put on the next regional medical missions conference. This day-long conference will be held at Calvary Baptist Church in Ypsilanti, Michigan. The conference in Cary has been postponed until after the first of the year but another conference has been added for mid-January, just before Bruce leaves for Uganda. • On November 6, Bruce flies to Miami Beach to take the American Society of Tropical Medicine and Hygiene tropical medicine certification exam. • November 11 – 14, we will attend the world’s largest medical missions conference at the Southeastern Christian Church in Louisville, KY and while there, will attend the board meeting for the Pan-African Academy of Christian Surgeons.

• November 19 – 26, we will be in London meeting with people about the Hope Hospital. • Bruce will give Grand Rounds for the East Carolina University surgery department December 8, 2004. The topic will be on “Bush Medicine and the Challenges of Surgical Education in Developing Countries”. Pray for him - it is always a good chance to promote the idea of medical missions to a professional group for whom compassionate Christianity and philanthropy may be a new concept. • In October and December, Bruce will be attending courses to become an instructor for advanced life support courses in medicine (ACLS), pediatrics (PALS) and in surgery (ATLS) so he can use this rating to help teach missionaries attending the Christian Medical and Dental Association Continuing Medical Education conference in Thailand in February.

Yes, we are nervous about the changes that are going to come into our life. We understand the downside and the cost and we certainly feel the uncertainty – it is just that we have decided that we cannot afford NOT to do as He has asked. We do covet your prayers and support.

Thanks for being on our team!

Bruce, Micky and Sean Steffes

Tax-deductible gifts can be made to Samaritan’s Purse, PO Box 3000, Boone, NC 28607. To insure tax deductibility for you, please put our name and account number 2257 on a separate sheet of paper. Alternatively, you can make a contribution to Village Baptist Church, 906 S. McPherson Church Rd, Fayetteville, NC 28303 and again, on a separate sheet of paper make the notation that it is for the Steffes Mission Fund.

Saturday, December 24, 2004

Dear Friends and Family:

HELP WANTED! We are asking for 200 people who will promise to uphold us daily in prayer as we begin this new phase of our ministry. We are fully aware of our inadequacies for the tasks ahead and therefore of the need for intercessory prayer on our behalf. We ask you to consider partnering in our ministry in this way. Following this paragraph is a partial list of the issues about which we would like you to regularly pray with us. There are so many things that are simply overwhelming. Bruce is leaving for Uganda on January 6, 2005 to work on the design of organizational structure and the design of the physical structure of the Hope Hospital project. As a stranger in Uganda, there are many things he does not know and he does not necessarily know where to find the answers. There are many aspects of the project that are potential minefields – problems can arise that are political, cultural, spiritual, individual and governmental in nature. Discernment and wisdom are desperately needed. An organizational fund-raising structure here in the US and in the United Kingdom is also needed and that is something we have never done before. It is mind-boggling and will require divine intervention to have it happen. The Hope Hospital project owns a good portion of the land it will ultimately need but has not the first dollar nor the first brick to begin the building. We are praying for the first major gift that will allow the development of the project. As our consultant at the National Christian Foundation put it recently, Hope Hospital Uganda is looking for a Christian entrepreneur who understands venture capitalism and the need for development. He or she must be willing to invest because they have glimpsed the vision and not because they are sold on the project by the numbers. Like most venture capitalism, it is a high risk investment – but with high return if one looks at the eternal dividends. We do not know who that person or organization is – but God does! Items for continuing prayer include:

1. Moving to Uganda: • That the right home for us will be available for us to rent this year • That we will be able to buy used appliances, vehicle, etc. • That we will identify the right people to employ as drivers, guardians, yardwork and so on • About schooling and playmates for Sean • That we will eventually be able to identify the right home to buy or the proper piece of land upon which to build a house

• For us as we establish the logistic support necessary to cover banking, mail, finances, etc. on both sides of the ocean • That Uganda medical licensure will be granted and that Bruce can establish a good working relationship with Makerere university 2. Regarding Hope Hospital, Uganda: a. For the right vision & approach • That it will always reflect honor to Christ • Ability to find out reliable providers and medical supply places • Ability to find biomedical support for the hospital • Wisdom to design or find providers for hotel services of hospital • A good relationship with key governmental and mission ministries, hospitals and people • Wisdom to avoid the land mines – ego, politics, pride, cross-cultural conflicts, etc. • Ability to get the contacts who know what we need to know • Ability to write this all down so it can be replicated and shared • Establishment of the right spiritual and personnel policies and networks to resist deterioration of the evangelistic focus • Establishment of the right partnerships with other agencies and ministries. • Establishment of a program that will survive the transfer to the second generation without losing the evangelistic focus b. The right team • The right developmental team comes into being • Bruce will need an assistant - pray that the right person will be available and finances exist to support him • The right hospital team: logistics, hotel services, nursing, administration • The right key people: CEO, CFO, Head of Nursing, Support services are identified early on • The right heads of departments who manifest people skills, godliness and academic prowess • Pray for the ability to hire the numbers of people and the right kind of people as employees • The right board members and board of advisors are identified and participate in the American and English boards c. The financial support • Avoid compromise in testimony and pressures to take money with strings attached • Financial gift of faith ($1 – 2.5 million) for development – architectural plans, engineering plans, development of fund-raising materials, travel, etc. • Establishment of the right fund-raising team who will develop the right God-honoring strategies • Contacts with the right donor base and the right governmental agencies • The money, people and expertise needed for the development of 501(c)3 organizations here in the US and the UK 3. Our personal needs and concerns • Distance from family and friends • Protection for our belongings and home while we are away • Spiritual support – finding a new church home and the ability to stay in the Word and in prayer • Spiritual support – an effective relationship of support with our home church • In Uganda, a new circle of godly friends • Patience, faith, trust and encouragement in the face of an “impossible” task and limited resources • Micky’s home-schooling of Sean • Our health • Ability to keep medical skills and training up

Additional Items of Praise and Prayers:

1. Pray for Micky and Sean as they stay in the US until late March and for Bruce as he begins to put together the business plan for the Hope Hospital, as he teaches in Kenya and in Thailand and as he travels literally around the world in the first two months of 2005.

2. Our home has sold! After much prayer and thought, we have decided to build a smaller one that will serve several purposes for now and we will be able to use the remainder of the selling amount to build something in Uganda when the time is right. 3. Bruce has achieved instructor status in Advanced Cardiac Life Support and Pediatric Advanced Life Support and has taken the instructor course in Advanced Trauma Life Support. He will be teaching those courses in both Kenya and Thailand in February. He also took the certification exam in tropical medicine. Unfortunately, the results won’t be sent to us until the end of this year – but he feels good that at least he recognized most of the words in the questions! 4. Our financial support. The cost of daily living (and of course, the effort and time) is something we are contributing to this project, but the additional expenses of moving, travel, equipment, expenses related to the development of the project and similar costs are something outside of our budget. We are trusting in God to provide those things through you and others. Please prayerfully consider whether you can partnership with us by giving either a one-time gift or if possible, a gift on a regular basis. You can make a contribution to Village Baptist Church, 906 S. McPherson Church Rd, Fayetteville, NC 28303 and to insure tax deductibility for you, on a separate sheet of paper make the notation that it is for the Steffes Mission Fund. Alternatively, gifts can be made to Samaritan’s Purse, PO Box 3000, Boone, NC 28607. Again, please put our name and account number 2257 on a separate sheet of paper.

Merry Christmas and thanks for being on our team!

Bruce, Micky and Sean Steffes

Listening to the Heartbeat of our Ministry