The toll of working at Mukinge

As my last post intimated, it's pretty easy for me to get in over my
head here in Africa. Currently I'm juggling a lot of hospital
responsibilities, educational responsibilities, and various projects,
etc which keep me up at night. I was struck by how many of the
long-term missionaries here suffer from chronic, stress related
illnesses -- 3 people with chronic migraines, another 3 with insomnia,
several others with depression -- and I can't help but feel that that is
a direct result of working and living in a setting where resources are
scarce, information is sketchy, and communication with the outside world
is poor. Certainly as I push myself past what I've been trained to do
-- ultrasound for malignancy staging; surgical techniques for which my
training is limited at best, non-existent at worst; pediatric
chemotherapy; gastroscopic endoscopy -- I find myself rather than
becoming more confident, becoming more hesitant, because I never get to
do the things that I'm good at anymore -- ER resuscitation, diagnosis,
etc. Fortunately, my fingernails are still long and my aphthous ulcers
have remained quiescent, so I guess I'm currently being protected
against the ravages of stress myself.