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.