Time to go

It's hard to believe the time has finally arrived. We're leaving Karanda to head back to the States this week. We have found Zimbabwe to be a beautiful country with many kind, hospitable Shona people, especially at Karanda Mission Hospital where they serve the needs of fellow rural Zimbabweans everyday.

We are leaving in the middle of planting season, when most people in the rural areas are planting corn and other crops to feed their families and possibly sell the rest of the year. Consequently the ward census is much lower than previous months. In fact, as I finished my last day of rounding on Sunday morning, the nurse in charge looked around the men's ward that was maybe one-third full and told me that only one of the patients there was from the hospital's local catchment area, the rest were from places like Harare, the capital, or other areas of the country, but they had all come seeking care at Karanda because of its reputation for quality medical care. Everyday, in fact, a large public bus picks up people in Harare and makes a round trip to Karanda and back because of the demand for transportation.

The doctors, nurses, and others at Karanda are doing a great job of being the hands and feet of Jesus on this earth as they seek to show his love to the people of Zimbabwe daily in word and deed.





We as a family have greatly enjoyed this opportunity as well. The pace of life has been relaxed, and though we've worked hard, the absence of distractions has allowed for family bonding time and building relationships with people whom we will certainly miss once we return home.




As we said goodbyes, almost everyone asked, "So when are you coming back?" Truthfully we don't know, it's in God's hands. But Zimbabwe has certainly found a place in our hearts, and we will not quickly forget the people or experiences we shared. Our prayers is that our service has left lasting fruit in the lives of those we met, and that our experiences in Zimbabwe will change us to make us more like Jesus. He is the one who humbled himself in love, service, and submission to the will of his Father so that through his life, death, and resurrection, each one of us might have true life if we turn from depending on ourselves to trusting in his sacrifice for the forgiveness of our sins and acceptance in the eyes of God. He made us, loves us, and wants us to reach out in love to each person around us. Let's be honest, that's a hard calling, and none of us does it perfectly, but it's what we were made for. In the words of the Lord Jesus, "It is more blessed to give than to receive." Help us Lord to live like you did, and experience the abundant life you desire for us. Amen.
We look forward to seeing many of you soon!

An African Gentleman

This really is just an random rural African man waiting to be seen in clinic. Believe it or not, the temperature at the time this picture was taken was somewhere between 80-100 deg. (roughly).

I puzzled at the frequent sight of men walking along the roadside on a hot, sunny, 100 degree day in a full suit, until a Zimbabwean friend told me that the saying here is "The Gentleman has no weather."

Good day, gentlemen...

Today

I hope you’ll forgive me for the massive number of blog posts today in such a short time. The internet here is generally very slow, but for some reason this afternoon it’s blazing fast. I write a few blog drafts off and on, but so often don’t upload them because getting the pictures online is torturous. Somehow this one ended up as a very long rambling post about my day. In any case, here goes.

This morning  (a few days ago) our friends from Ashland, KS, left Karanda to return home. They had been here for ten days installing screens in the Karanda Mission Hospital Guesthouse where we and other volunteers stay. 

The building is quite large, and they designed and built wood frames with screens for approx. 50 windows. Toward the end it became apparent that only 4 of 12 boxes of staples needed for fastening the screens made it into the luggage, but God provided through Dr. Stephens who happened to have wood staples at his house. They finished with about 50 remaining. It reminded us of Jesus’ feeding 5000 with the loaves and fished. The crew consisted of three- Ben and Kaila Anderson, he is a hospital administrator and she is in school for social work, as well as Chance Wilkinson, who works in maintenance at the Ashland hospital. All three are great people who love Jesus, and have hearts willing to travel halfway across the world to serve us and the people of rural Zimbabwe.

After breakfast with Lisa and Jude, I headed off to devotions for the nursing students at 7am. There are usually 60 or so in attendance, plus miscellaneous other staff. Thursdays have been my day to lead, so this morning I spoke about Jesus teaching that we should be salt and light from Matthew.  Many of the nursing students are believers, but not all.

The next item of the day was hospital rounds. The last week or two we have noticed that the census is dropping off, both in the number coming for outpatient clinic visits as well as inpatients on the wards. A few weeks ago the wards were full and we were working until 6pm every night, but since the rains have started it feels like a different place. The local staff say this is because, with the rains, people are now working their fields, and travel is more difficult due to high rivers.

Each of the medical providers here takes a different ward each month, and this month I am rounding daily in female ward. Each day brings a mixture of patients waiting for or recovering from surgery, older patients with chronic illnesses, acute infections or illnesses, and then many patients with HIV and/or Tuberculosis and the opportunistic infections that accompany HIV. Accurately diagnosing and treating these conditions here is the most challenging medicine I have seen, as the infections are complicated, and the available laboratory and diagnostic tests are very limited. Nonetheless, we do our best, praying and trusting God to give us wisdom and use the treatment resources to the best of our abilities.

After rounds, I stopped by theatre (OR) and scrubbed in to a VP shunt surgery that was in progress with Dr. Stephens. These are the kids I wrote about earlier with the “big heads,” swollen with cerebrospinal fluid that their bodies don’t drain correctly. We broke for teatime and them came back to finish another VP shunt placement on another child.

Each day  at 10:00 am we break for “tea,” a religiously observed custom in Zimbabwe carried over from the days of British colonization. Some days we actually drink tea, but most days it means a 30 min. break to walk home and see Lisa and play with Jude for awhile. This is one of those elements of Zimbabwean culture that I wish I could transport to America, since we’ve so much enjoyed the extra family time each day.

The rest of the day held an assortment of other surgeries and procedures. For some reason the hospital water system was turned off at 1 pm, so after that we had no running water. I walked out of an operating room, taking off my gloves to find that there was no running water to wash off the latex powder. There were still several procedures to be done and patients to see, so this meant no hand-washing in-between. There is a large trash can filled with clean water that can be used if needed, but I left that for the scrub techs who were dipping into it for water to clean dirty surgical instruments before sending them to the sterilizing machine.

We finished up in theatre mid-afternoon, so I headed to the outpatient clinic to help out by seeing any remaining patients. There I visited with a young male patient in his early 20s, complaining of blood in his urine as well as genital warts. He was well-dressed and from Harare (the capital city), but had ridden the half-day bus-ride to Karanda seeking treatment, not uncommon here. After a urine analysis we discovered he had Schistosomiasis, a tropical disease contracted after swimming in freshwater lakes or rivers infested with this parasite. They burrow through the skin, into the blood vessels, and this particular form eventually live in the bladder lining, where they cause inflammation leading to blood in the urine, and if left long enough, cancer of the bladder.

I gave him a prescription to treat the parasitic infection, and then took him to a procedure room to remove his genital warts. During the procedure I asked him what his plan was to prevent himself from getting HIV. (He hadn’t yet been tested, but I was being optimistic). He said circumcision (a new finding in recent years that is being promoted here in Africa) as well as “not sleeping around. I told him those were both good ideas. We finished up and I headed home. As I walked away from the hospital, we met on the sidewalk again, so I walked with him out to the parking lot. As we walked out, he thanked me for his treatment and asked, “So what should I do about her?” I asked who her was, and he said it was his girlfriend. He said he had had sex only one time, and was concerned about sexually transmitted diseases. I told him the best thing they could do was both get tested for HIV, wait to have sex until they were married, and then be faithful to their spouse, since that’s the way God designed it to be. I asked if he had any spiritual beliefs, and his reply was, “I am a Christian,” and “I read the Bible.” He then said, “my girlfriend called me recently and wants to go to church.” I encouraged him to be a leader and take her to church soon. He seemed encouraged by the entire interaction, and asked for my Zimbabwe cell phone number. I told him that I was only in the country for a few more weeks, but if he had a reason to come back to Karanda during that time I would be here. Unfortunately we only had a short time to talk, as he needed to catch a ride back to the city.

Interactions like this make me wish I was here longer, as medicine is a great avenue to meet people during their time of need and provide encouragement toward living a healthy life, as well as to introduce them to Jesus, who created them, loves them, and alone can truly bring the fulfillment they are seeking for their lives. This is difficult to do with the short amount of time available with each patient in the hospital, but from time to time opportunities arise to move beyond the physical condition at hand to the inner issues that are often plaguing patients just as severely.

I headed home a little after 5 pm, feeling the need to wash my hands after going an entire afternoon without running water. Thankfully there was water left in the hot water tank of our house that served the purpose well. At that moment I realized that I’ve adjusted to the intermittent/lack of electricity without much of a problem, but running water is something I’ve rarely been without, and I’m finding it harder to let go of, especially in a hospital setting. Thankfully this doesn’t happen very often, even here, but it raised all kinds of questions when I realized that running water is still a relatively new invention in our world, and even more so in rural Africa. There are in fact numerous families living without running water or electricity barely 100 yards outside the hospital compound. It’s one thing to see others live that way, but it’s different when the experience becomes personal.

 
Just the night before we had eaten dinner with Ben, Kaila, and Chance (our friends here to install window screens) in the home of Mai Kedere, who lives with her two sons and niece in a mud-brick house about a mile from the hospital.  

She gets her water from a hand-pump about ¼ mile from her house, and her electricity come from a solar panel on her roof, which powers a small radio and a single bare light bulb in the living room. Nonetheless, the food was excellent, and her hospitality was great as always. Her husband died ten years ago from HIV. He passed it to her before he died, but she is healthy and doing well on medication, and working hard everyday to expand her gardens and subsistence farm to the point that she can sell crops to support her family and send her kids to school. One of the local missionaries has become a good friend of hers, and often provides her with bags of fertilizer and seed to help support her farming endeavors in ways she could not on her own. Whether you visit in her home or see her walking past the hospital, she is always quick to greet you with a big smile and a hug, and talk about how the Lord has blessed her and been good to her even to today.

So, I arrived home to find that Lisa and Jude were out visiting friends, and decided to go for a run. I headed uphill toward the airstrip (Karanda sits on the side of a small mountain/large hill) to see a beautiful sunset beginning over the top of the hill with massive clouds trailing the sun. Looking out over the landscape from up on the hill I could see a sea of African scrub forest, with occasional clusters of huts dotting the landscape. I was struck again with the strangeness of my surroundings, but also with how familiar they’ve become after almost four months. The run was refreshing and tiring, and I arrived home to find Lisa and Jude returned and supper in process. After supper I put Jude to bed while Lisa went to a prayer meeting that is held every Thursday evening for the missionaries and senior hospital staff. It is a time of prayer regarding any issues occurring in the life of the hospital, and we usually take turns going or staying home with Jude. The electricity was off, and when Lisa returned she found me fast asleep on the couch in the dark.

It’s hard to believe we’re coming down to the final weeks of our stay here. We’ve met many wonderful African friends here that we will miss. I don’t think I’ll know what to do with myself when I have fast internet that doesn’t require waiting several minutes for my email to load and make uploading pictures a huge exercise in patience. At the same time, I think I’ll actually miss not having electricity at nights, which means eating supper by candlelight and finding ways to spend the evening that include mostly reading and relaxing with friends and family. This pace of life has been much healthier for our family than residency was, what a blessing.

Burn Contractures

Burns are so much more common in the developing world than they are in America. The majority of rural people in African and in many other countries have no or intermittent electricity, and still cook over open fires. Young children are prone to falling into the fires, whether accidentally or as a result of seiure disorders. Occasionally people here use kerosene or "paraffin" stoves, which are also a major cause of burns.

Burn wounds often require skin grafting, which means shaving a strip of skin from a healthy part of the body, often the thigh, and sewing or stapling it to the burn-affected area. If a burn is severe or not treated early, it may heal with a "contracture," where the skin contracts together, and limited the normal mobility of a joint.

This young 8 year-old boy had two contractures. Here you can see that his knee joint has limited motion, as he is not able to fully extend it due to scar tissue.






His foot also healed with a severe contracture, seen below. In the picture you can see the hand of Dr. Roland Stephens, who is my teacher and mentor here at Karanda. He turned 80 years-old last year and still practices full-time full-spectrum surgery.




On this day we were able to perform a surgery to release these contractures, restoring full mobility to this boy's knee and foot. The foot portion required a small skin graft but should heal well. Very little is more gratifying than restoring function to a portion of the body that was previously limited. Surgeries like this in the U.S. are so rare that they would be done only by a plastic surgeon, but they are in fact fairly simple to do, and there is such a huge need in the developing world. This case is just one illustration of the reasons we are here at Karanda, to learn practical skills through which we can glorify God by taking something diseased and unusable, and making it functional again. What a privilege.

Clubbed Feet

I just wrote about burn contractures, and here I want to highlight another great procedure done here at Karanda. This young girl was born with "clubbed feet," as you can see from the pictures below.











By means of a fairly simple 45-minute surgery, her feet can be restored to their proper position. She may never play soccer, but she will certainly walk normally, and grow up without the obvious deformity in the pictures above. Surgeries like this in the U.S. are done only by specialists, but this surgery, just like the burn contractures I mentioned in another post, is not that technically difficult once someone has done a few. I count it a privilege to learn skills such as these, such that God may choose to use me as a simple family physician to be a blessing to children like this one in the future, who would otherwise have no chance at a cure.

Freezing patients

I have now had enough experiences with small children and objects stuck in noses to know that Ketamine is a gift from God. Awhile back I watched someone struggle for 30 min. against a 5 year old with the help of the child's father and a surgery tech., but with no success in removing the object. We came back after a break, gave him ketamine in his IV, he froze in sleep, and we had the object out in less than a minute.

Last week another small child came in with something reportedly stuck in his nose. He thrashed and screamed as the nurse injected ketamine into his IV. A few minutes later the object was removed without difficulty, and he was waking up peacefully on the bed.

This man had a posterior dislocation of his 5th MCP joint - the knuckle where the finger meets the hand. It needed to be put back into place, but this would cause severe pain if he was awake.



This picture was taken just after ketamine was given in his IV, and shows how patients tend to "freeze" in whatever position they receive the medication. While he slept we put the finger back into place and applied a splint. Oh, and he also woke up singing.

Crocodiles and land mines

You never know though what might come through the doors of Karanda Mission Hospital.

This guy came too close to a land mine.




The Mozambique border is not far to the north of us, and there are unfortunately many land mines remaining from the civil war in the late 1970s.


Recently a 16 year-old girl was brought to the theatre (surgery) with the report that she had been bitten by a crocodile. She was with her brothers using mosquito net to fish in a river when she was attacked. The report was that it was a small one, which is why she escaped.







The incident had actually happened the day before, so by the time she arrived to us her wounds were already infected, with pus and dead tissue that needed to be removed. The pictures above unfortunately don't do justice to the multitude of puncture wounds. We didn't count but guessed at around 50-60 that had to be cleaned out and packed, meaning we stuffed sterile gauze in the holes to allow the wounds to drain. She did have two puncture wounds on her face unfortunately, but they should heal if the infection can be controlled.

Patient updates

I thought it would be a good idea to write updates on a couple of patients I had written about previously.

Clayton Mufambi is the guy who had a large mass resected from his face. He returned for a follow-up visit and is doing well.





He did require another small skin graft. Before he left I gave him a Shona Bible as I had promised, with verses written in the front cover regarding topics we had discussed during his hospital stay. He expressed his gratefulness for how God had blessed him through Karanda.


Another update on a smaller patient - the 2.5 lb. baby of the HIV positive mother is now over 3 lbs. She still has another couple of pounds to go before she gets to go home.





The nurse taking care of her was excited to show me a Zimbabwean method of caring for pre-term babies, called the "Kangaroo method."





Here are mom and baby kangaroo-style, skin-to-skin. They say that pre-term babies carried this way grow more quickly than other babies. It's God's natural built-in incubator.

Babies and Goats

Babies are usually born after about 40 weeks in their mothers' wombs.




This baby was born after only 28 weeks, which is early for the U.S., and extremely early for Zimbabwe. She weighs about 2.5 lbs.




Her mother sits and sleeps next to the baby warmer day and night, just as you would expect.

Her mother is also HIV positive. This brings a dilemma. Should the new mother breast feed her infant, increasing the infant's chances of contracting HIV, or... what other option is there?

This mother, like most rural Africans, cannot afford "formula" milk, so as is the case for many infants of HIV positive mothers, this young baby must either drink her mother's breast milk or starve, a decision in which this infant will have no say, but will profoundly affect her life.

It is for babies like this that Karanda Hospital has a "goat program." Goats are raised and given to HIV positive mothers, who then feed their new infants exclusively goats' milk to reduce the risk of HIV transmission.

So far the program has been supportably significantly by donations to the TEAM missions organization, but recently funding has become much more of challenge. A full grown goat sells for $25, raising a baby goat even less. I can't think of a better place to give.

Work and Play

These last few weeks have been a mix of work and play. After several weeks of uneventful work at the hospital, we took off for a few days in mid-October to drive to Victoria Falls, which is one of the seven natural wonders of the world, at the junction of four countries- Zimbabwe, Zambia, Namibia, and Botswana. Lisa's parents accompanied us, as they had just come for a two week visit. 

On the way to the falls we stopped at Hwange National Park, a huge game preserve with 39,000 elephants! We took a 2 hour game drive through the bush during which we saw giraffe, zebra, cheetah, hippos, ostrich, kudu, impala & springbuck, and of course MANY elephants. We survived a "mock-charge" by a mother elephant. I tend to think of elephants as docile creatures, but try to imagine sitting in the back of a small pickup truck about 30 feet from the largest land mammal (20 tons or so) as it is trumpeting loudly with its trunk in the air, pawing the ground, and flapping its ears at you. 

It gets your adrenaline pumping. Our driver stood his ground and revved the engine of our tiny truck, and the elephant backed down. Afterward he told us, "they usually give a mock-charge before a real one." Not sure what would have been the result of a "real one"...

We spent many hours driving on our recent vacation, and saw so many kinds of wildlife along the roadside and crossing the road that we came up with our own African wildlife road game. If you hit a cow, you earn 20 points. If you hit a goat, you get only 5 points. For hitting a donkey you get zero points because the animal is not smart enough to know it shouldn't be in the road. If you hit a lion, you automatically win the game, because your odds of that are so small, and finally, if you hit an elephant, well... you lose.

On the way home at dusk Lisa thought she saw a lion running off into the bush. Lions are rarely if ever seen on game drives, as they sleep during the day and hunt at night. Because we had to drive across most of the country to make it to the Falls, we spent a night at Antelope Park, a game reserve that breeds lions and teaches them to hunt in the wild. There we had our fill of lion interaction, as we were able to take about a one hour walk with three 10 month-old lions. 

At 18 months they release them into a large fenced in acreage filled with zebra, impala, etc. After several months of learning to hunt, they are sorted into groups and released into much larger game parks. 

Lisa loved having her mom here at the hospital this past week for encouragement and companionship. Her Dad helped us out by designing a frame to use in applying screens to the windows of the hospital guesthouse. The windows here are odd sizes and not made for screens, but with malaria, hot weather, and no A/C, screens make a huge difference. 

We also participated in a "hog butchering" with the Siamukwari's, an African family we have learned to know, and later that evening had a feast of grilled pork with them and other friends from here at Karanda.

I learned the hard way that I shouldn't have worn flip-flops to slaughter an animal in Africa. A nest of large black ants came running at the first smell of blood, and I happened to be standing right in the middle of their highway between home and a feast of pig remnants.

The weekend before Lisa's parents left Karanda, the local church invited an evangelist from Harare to speak to hospital workers as well as at the local "shops," which is a collection of bars and small stores near the hospital. 

There are small churches in the area, including one next to the hospital, however many local people practice only traditional animistic African spirituality. Alcoholism is definitely a problem here as well. The evangelist held meetings on the hospital grounds during the day, and at the shops at night for several nights, with a good turnout of local people each night. Many people including thirty hospital workers committed their lives to Jesus Christ. God is at work here at Karanda.

Hydrocephalus, Prayer, and Saving Babies

Saturday night when I was on call last weekend I had just finished my fourth C-section in 24 hrs and was sitting at the dining room table thinking about sleep when I was called by a nurse from the "ICU" (a 4-bed section in the female ward) to come see a patient who had arrived after ingesting an unknown poison. I arrived to find three male nurses trying to manage an agitated, combative man who would yell and thrash wildly whenever they approached. They succeeded in holding him down long enough for a injection, however, and the second medicine we tried sedated him rapidly.

While we were dealing with him a nurse from the Peds ward appeared beside me and said, "Doctor, we received a baby who just arrived from Harare, and the condition of the baby is not good." I told her I would be right there, but a few minutes later she was back, asking me to come right away. I arrived in the Peds ward to find a 7 month old baby girl with hydrocephalus (very enlarged head because cerebrospinal fluid - CSF can't drain properly).

She would take a gasping breath about every 20 seconds with nothing in between. She had a strong heartbeat, but I knew with her breathing pattern she probably wouldn't make it through the night. She had had a VP shunt placed in April (a tube that drains fluid from the brain into the abdomen), but it was obviously not functioning as her anterior fontanelle (soft spot) on the front of her head was bulging with excess fluid, compressing her brain and now affecting her respiratory center.

Expecting her to quit breathing any minute, I called Dr. Stephens for advice. He recommended I insert a needle in the anterior fontanelle and drain off 150 milliliters of CSF. I inserted the needle and started draining fluid, but after only 5 mL it stopped flowing. I asked the nurse for another needle and tried again, but once again it stopped flowing after after only a small amount of fluid had come out. The fontanelle wad obviously still bulging with fluid, but something was not right.

I decided to go to the theatre (O.R.) and look for a bigger syringe, and I needed a minute to think about why my attempts weren't working. As I turned on lights and rummaged through drawers I mumbled inside my head something like, "God, this baby's about to die, so if you want her to live you had better do something for her because I don't know what to do." At that moment a knew thought popped into my head. Maybe the needle was clotting off with blood or clogging as it entered the skin, sonwhat about trying a needle with an introducer (a shaft inserted in the hollow part of the needle that is removed after the needle is in place). I grabbed a spinal needle, and as I walked back to the Peds ward I smiled because I knew I had found the answer. I inserted the needle and CSF flowed beautifully.

As I removed syringe after syringe of fluid, the fontanelle became flatter and she began to take more frequent breaths. After I had removed 120 mL's of fluid I could get no more out, and the baby girl was taking more regular, even breaths. I bandaged her head, ordered some antibiotics, and left. I was somewhat uncertain how she would do overnight, but yet confident that God had answered my spur of the moment prayer. She was so close to death, yet God brought her to me, and the moment I acknowledged my need for his help, he gave the needed wisdom and her condition reversed.

As I left the ward, I heard wailing coming from near the female ward, and found that a patient there had just passed away. I realized again that God is sovereign over the days of each of our lives, just as his word says. The next morning she was doing well, and has since had the needed surgery to correct her condition for the time being. God's ways are not always ours, but for His own glory he chose to spare the life of this young child that night.


Below are a few pictures of other children who have also been admitted with hydrocephalus and received shunts placed surgically to drain fluid from their brains.

Strange Swellings

Karanda is known for doing a great deal of surgery, and people arrive with all kinds of surgical needs. The picture below looks a little like a pregnant abdomen ready for a C-section.






It is actually a person's back, and below is a lipoma (benign fatty tumor) that I removed last week.






This patient has a recurrence of a malignant tumor, but returned seeking surgical help. I assisted Dr. Stephens in removing the cancerous portion last week.





Below are a few other patients with what we call "strange swellings" who present to the hospital seeking help. I praise God that Karanda is here and is able to aid in relieving the suffering and disfigurement experienced by these patients.

Clayton Mufambi

Almost two weeks ago, Clayton Mufambi arrived at Karanda with a huge, unsightly, foul-smelling tumor growing from his face and neck, seeking treatment. He was admitted and I assisted Dr. Stephens in removing the tumor from his face that weighed in at more than eight pounds.

Since then he has remained at Karanda while he waits for a skin graft to cover the area of his face and neck once occupied by the tumor. For the last few weeks I’ve seen him every morning on wards, where he greets me with a smile and friendly words.

Recently I sat down with him one afternoon because God had been impressing upon me a desire to find out more about him. He told me he grew up in a rural area but spent time with children of a white family, from whom he learned to speak English well. He has a wife and six children, and grows tobacco on a two-acre farm. At one point he had joined a Seventh Day Adventist church, but was forced to leave because he continued to grow tobacco on his farm. Tobacco is the only “cash-crop” grown in his area of the country. He says he would be given fertilizer in exchange if he grew corn, but if he wants to sell a crop that someone in his area will buy, the only current option is tobacco. As we talked he asked, “If I continue to grow tobacco, will God still be with me?”

The tumor on his face had been growing for about 3 years, and he finally went to a hospital in Harare hoping for a surgeon to remove it. He told me that many surgeons come to the large public hospital where he waited, but unfortunately would do the operation at their own private surgery centers where they charged a large fee. One day someone told him, “You’re wasting your time waiting here for surgery. You should go to Karanda.” Therefore he got on a bus and rode 2 ½ - 3 hours into the bush to Karanda Mission Hospital, hoping for someone to do an operation. He says that when he arrived, he was so weak that he was sure he was near death. He credits God working through Karanda and the operation he received for saving his life, and is now longing to return home. He said local people believe that God is present at Karanda, and that if it were to close, God would also leave.

As we talked, I gained insight into his understanding of God and the world, which helped me understand more of the world of the patients I treat everyday at Karanda. From the teaching at the SDA church, he understands the biblical account of the life, death, and resurrection of Jesus Christ, and says he has believed in him for salvation. Even though he has heard stories from the Bible, he was full of questions about heaven. “Will there be fields where we can work, and mombe (cattle)?” “Where will this place be? On earth, or in space, or somewhere else?”

We continued talking back and forth, and at one point he said with sincerity, “You say in heaven there will be no more sickness or pain. I know God has blessed the Israelites, but he has not blessed the Africans. In heaven, when God is handing out food, for example 2 kgs to one and 2 kgs to another, will he give 10 kgs to the Israelites and only a few grams to us Africans?”  

I shared the best I could about God’s love for all people in Christ, and how the Bible tells us that in Christ, God no longer makes distinctions between Jew and Gentile, slave and free, rich and poor, male and female, or even black and white. It was the “right answer,” yet I could see that every experience in his life has taught him that he is on the bottom rung of the ladder of this world.

As we finished talking, he told me about how he feels like he has two hearts; one that wants to follow God, and one that does what he knows is not right. He shared how his family and friends at home ask him to make sacrifices to traditional African gods, but he believes there is only one true God, and he is not sure if he is strong enough to say no once he returns home.

As an American, the thought of making an animal sacrifice to the gods of my ancestors is not a serious temptation. But what is he really doing? He is giving up something of value in the hope of gaining better crops, better health, and a better life, without acknowledging the One True Giver of all good things.  Working hard to succeed is a noble endeavor, but how often is my heart divided, being pulled to sacrifice time, energy, money, and relationships to the gods of financial security, successful career, or a comfortable life without acknowledging God and asking whether the path I am on leads to him or down the wide road that will prove to be empty and filled with despair when I reach the end?

 

We talked some more and I prayed with him before I left. I plan to give him a Shona Bible before he leaves, and mark some scripture verses to help him stand strong as he returns to his village and faces the pressure to return to the worship of the other gods of his traditional ancestral African beliefs.

On Call

This was my first weekend on call at Karanda. My first call came at 1 am Fri. night/Sat. morning for an urgent C-section. I had to concentrate a
little harder simce I has been a few months, but everything turned out well. As I was walking out the door to go home a nurse said, "we'll take the next patient back now..." I finally walked out of the hospital at 5 am and the sky was already turning pink on the horizon.

Saturday evening brought another C-section double-header, making 4 in 24 hrs. Sunday morning as I was finishing rounds just before church I saw a scrub tech walk out of the maternity ward and asked what she was up to.
Her: "C-section"
Me: "When?"
Her: "Now"
I missed church but I could hear a little bit of the beautiful Shona singing as I waited for patient #5 to be ready.

Saturday afternoon brought a 9 yo girl after a "road traffic accident." Her left upper arm was broken, with much of the skin gone and bone exposed through torn muscle. I called Dr. Stephens who does the Ortho surgery here, and helped him put in a pin to hold the bone together and then close up the torn tissue.

Being on call here gives an experience like no other, as we are small town ER and major referral center combined into one. I'm thankful for the competent African nursing staff here who are extremely helpful and make things run smoothly despite the occasional chaos and limited resources.

I did have another interesting case while on call this weekend, but I'll write about that later. It's a story that needs it's own page.

Land Cruising

I've always thought driving a land cruiser through a river sounded fun. To leave the hospital to go to Harare this past weekend, we had to drive through a river that crosses the road just below the hospital. During the rainy season everyone drives around the river which is an extra 30 minutes longer, but why not save time by driving through a river when you can?



We packed up the land cruiser and headed off to Harare on the left side of the road with me behind the steering wheel on the right. For the first few miles I repeated "left side of the road" out loud to remind myself I wasn't crazy. Driving on the left in the city traffic brought more excitement, but thankfully all went well. I may have grown too comfortable, because on the way home I got a speeding ticket. Twenty dollars later though we were on the road again. We had just reached our last major turnoff on the way home when we recognized a nursing student among a small crowd of people waiting for rides by the roadside. Hitchhiking is a common way to travel here. We pulled over to see if she wanted a ride. She said "yes, but..." looking at the four other people with her and then at our vehicle already full with 3 adults (we had Corrie, a short-term teacher with us) a baby, and a month's worth of food piled in the back. Five minutes later we had crammed in three midwifery students and two nursing students, Lisa and Jude BOTH sitting in his car seat and Corrie laying on top of the food and bags in the back.

We were glad there were no more police checkpoints. If we had left the ladies, they likely would have been dropped off by someone else at the last major road 4 miles before the hospital unless they were lucky enough to get picked up someone else headed to the hospital, which is rare late on a Sunday afternoon, especially since the weekly Sunday afternoon Karanda soccer game was away that week. Needless to say, we were glad we could give them a lift. Everyone but Jude was also sore and "squished" by the time we finally reached the hospital, but thankful that God brought us safely back home.

Chiremba Rick

"Chiremba" (doctor) Rick Moberly finished the fellowship last year, and after volunteering again at Karanda the last month, just left for home last Friday.




We had great times at the hospital, and as you can see here, wandering around "Karanda Town." Rick learned quite a bit of Shona last year, and did a great job of making patients feel at ease.


Just before he went crazy with the balloon animals, he introduced us to the Dokwane Eating House, the (only) local restaurant where you can enjoy sadza, greens, and meat of some kind, usually beef. Sadza is the staple of the diet here- sort of like a mashed potato paste but made from ground corn. If the right person makes it, it can be really good.
Rick is about to start a new practice in New Hampton, Iowa with several other Via Christi graduates. We'll miss you Rick. Fambai Zvakanaka (go well).

Zoster

This patient is recovering from herpes zoster, commonly known as "Shingles" of his left hand, arm, and chest. He has HIV, making him more likely to manifest this disease and to have a more severe case. It is caused by the reactivation of the virus that causes chickenpox, and usually happens at mid-adulthood or later. These kinds of "opportunistic" illnesses are seen everyday in the clinic due to the large number of patients with poorly-controlled HIV who are more susceptible to diseases that cause problems either rarely or not at all in healthy individuals. Great strides have been made toward the prevention, treatment, and de-stigmatization of HIV in Zimbabwe, but there is still a long way to go.

We are enjoying the Shona people and culture of this part of Zimbabwe. Most people I meet each day are quick to give a smile and a greeting in Shona. My favorite word so far is "Zvakanaka," pronounced similar to "Shhh" but with a "Zhhh" sound, and a "Spanish" A (zzzhaw) and it means "Ok," "Alright," or "It's all good." To really say it correctly you need to whistle through your teeth as you say the first syllable. I hope this finds you all Zvakanaka today.

OVC Camp

It is commonly said here that Zimbabwe has lost an entire generation to HIV/AIDS. Educational programs were started as far back as the 1980's according to Dorothy Churindo, director of Karanda's HIV Home-Based Care program, yet very little has changed in terms of the high risk behavior of the local population. Consequently, there is a large number of children here orphaned by parents who died of HIV, and a significant number of these orphans are infected themselves.


This week is "OVC Camp" - or a "spiritual-psycho-social camp for orphans and vulnerable children." Fifty of the area's most vulnerable orphans are attending to learn more about the plague they are growing up in the midst of, and how to deal with the social & psychological effects of the illness on themselves and others. The teaching is done by nurses and chaplains from Karanda along with local public health workers.
What would you do if you were an 8 year-old child infected with HIV? Would you marry? Have children? What kind of job opportunities would you have? Or more appropriate for an orphaned child- how do you respond when the people caring for you abuse and make you work harder than their other children? Or even, "Why did my parents die?"
It doesn't take much reading of Scripture to realize that God has a special love and concern for these children.
I am continually amazed as I see how much life here has been affected by the HIV pandemic. Already a generation has been lost, and educating the public on the reasons for this and how to stop its spread has been a slow and laborious process that still has not been perfected. Excellent medications have been developed, but a change of heart and behavior is still the only guaranteed way to stem the tide of social destruction.
How can a person respond to this devastation? How should we respond to any disaster this great? And these three remain: walking by Faith with our creator and savior, Hope in his mercies that are new every morning, and Love for him and these around us who need food, clothing, shelter, medicine, acceptance, a gentle touch, and knowledge of the one who loves them far more than the parents they never knew.

Arrival

We arrived at Karanda Hospital at about 1:30pm Saturday.


The electricity was off from about 3pm - 8:30pm, but there are two backup battery lights in the ceiling by which we ate supper. The water system here is dependent on electricity to refill, so we have cold water from the hot water tank and no cold water until everything recharges- but that doesn't happen until someone turns the switch back on in the morning, and that time is early but somewhat variable according to the people here.

The guest house accommodations are actually very nice- nicer and more homey/Americanized than Ghana even, which is nice for a little less culture shock. We are also staying just across the drive from the hospital, much closer than we were in Ghana. The hospital sits on a hillside, with a river at the bottom of the hill, and we literally had to drive through the river to continue on the dirt road up to the hospital. There is another route that is about 10-20 miles longer that they take during the rainy season. Neither the hospital nor the government have been able/willing to come up with the money to build a bridge yet.

Overall Zimbabwe has been interesting- outside the capital (Harare) it seems to be made up of very poor bush people like Ghana in one sense, but there are a lot of "white Zimbabweans" in Harare who had settled here just as many Dutch and English did in South Africa. The history is very interesting- back in 2000 many (actually I believe all) of the white farmers were forced to leave their farms, which were given to black Zimbabweans. (I actually met one of these Dutch farmers in Paraguay in 2000 without realizing the significance at that time. I just remember he was devastated and trying to re-create a dairy farm from nothing). Since then the farm economy in Zimbabwe has crashed. Before that Zimb. was a huge exporter of crops to this part of Africa. There is a lot of interesting history both here and in South Africa, and most of it has happened in the last 30 years. This country has a lot of gold and diamond mineral wealth, and huge agricultural potential. In the capital the weather was gorgeous, and sounds like it is most of the year; palm-ish trees everywhere, and the missionaries have multiple different kinds of fruit trees in their yards. But this country has been hit hard by AIDS (they say it has essentially lost a generation between the ages 20-40) and there are the economic issues that I mentioned above. If the economic situation was different, I think everyone would want to move here.

We left Ghana this spring very concerned for the hospital where we worked, Baptist Medical Centre, because for the first time in its 50 year history it was facing the prospect of have zero physicians on its staff. This is a hospital that treats well over a thousand patients a week. Thanks be to God that the hospital has signed a contract with a Nigerian surgeon who is graduating from a PAACS residency program site. PAACS (Pan-African Academy of Christian Surgeons) is an organization started by American missionary surgeons who want to work themselves out of a job. They are turning mission hospitals into residency training sites for Christian African medical students who are committed to staying in Africa after their training to serve their own people. This may not seem significant, except that between 25%-90% of health personnel trained in African medical schools (rates vary for each county) have left the continent for better paying jobs in Europe and the United States. Africa also accounts for 1/4 of the world’s global disease burden, but has only 3% of its workforce to care for it. The map included shows the global distribution of working physicians. What happened to Sub-Saharan Africa? It’s almost not present.
Who could fault the medical personnel leaving Africa for wanting a better life for themselves and their families? I certainly can’t, as I can run back to America with its first-world amenities anytime I want. What is somewhat more troubling, however, is that 25% of the United States’ physician workforce is made up of foreign medical graduates and growing, which means that we are in a sense complicit in draining poor regions such as Africa of the talent they need to maintain and improve their health care systems. We do need more physicians in the United States, but we also need to think about the effect of our actions on the poorer populations of the other nations involved as we contribute to their “brain drain.” How will it change? That’s a difficult question, but we praise God again for organizations like PAACS that are producing real solutions as evidenced by the provision of a surgeon for Baptist Medical Centre as they seek to spread the gospel by word and deed.

West Virginia

As I sit here writing we are enjoying summer in West Virginia, where I am taking a global health course in clinical tropical medicine and traveler’s health. http://www.hsc.wvu.edu/som/tropmed/Tropical-Medicine-Course/.

West Virginia is the only state that lies completely within the Appalachian mountain range, and was formed after it broke away from Virginia during the American Civil War in 1863. Some have asked if we’re studying tropical medicine in West Virginia because it’s like the tropics. It is one of the poorer states in the Union economically, but the real reason is simply that several people experienced in tropical medicine at the WV University medical school created this great course for medical professionals to come and prepare medically for what they’ll see in Africa, Asia, and other tropical parts of the world where the diseases have a lot more to do with worms, flies, and mosquitoes than the heart attacks and strokes that we often see in Kansas. All that aside, now that it’s 90+ degrees and humid, it’s starting to feel a little tropical around here.

I never really adequately finished writing about our time in Ghana, as it passed by so quickly, and as soon as we returned home we found ourselves busy with wrapping up our time in Wichita and preparing to travel again. On our way home from Ghana we took an extended layover in Europe for several days with our friends Drew and Rachel where we saw some great historical sites and generally just relaxed, enjoying some days without responsibility or the need for ceiling fans day and night. The portions of Europe we saw had their own beauty, but they felt almost like we were back in the States already, with their paved sidewalks, green grass, drinkable water, and animals behind fences where one would think they should be.

The last part of May and June were filled with finishing residency responsibilities, saying goodbye to friends, packing for West Virginia, packing for Zimbabwe, packing for Wichita next Spring, packing for our upcoming move to Lakin, KS, etc... I’m so proud of my wife and her amazing flexibility. God blessed me with an amazing life partner who has been willing to jump into adventures that she had no way of seeing when she said yes to marrying me.

In the meantime, we’ll continue on here in West Virginia until mid-August when make a brief stop through Kansas to shift gears and gather up our things before heading off for almost five months at Karanda Mission Hospital (http://www.teamzimmoz.org/kmh.html) in Zimbabwe, located in the southeastern part of Africa just above South Africa.