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.

It’s difficult to describe how different hospital work is here compared with the U. S. Walking into the hospital is culture shock in itself, with strange smells, wide-open windows, and rooms full of patient beds. The work itself, though, is also quite a bit different than what we’re used to in the U.S.  CT scan and MRI are not available, x-ray is used judiciously, but you can ultrasound anything. Blood counts are available, but no electrolytes or cardiac monitoring. Oxygen is available in a few locations, but doesn’t always work as I found while trying to resuscitate a baby after a delivery. Last night I had two men brought in after they hit a tree in their car. One was conscious; one was not. Taking care of traumas has a different feel here, as there is no trauma ICU, no ventilator, and nowhere to send them by helicopter. It’s just the care we can give here and the grace of God. Amazingly the unconscious passenger from last night did well overnight and was talking, walking, and ready to go home today. On his required police accident treatment summary form I wrote that he recovered quickly “by the grace of God”; that’s truly the case.

The other night on call a 5 year old boy came in who had fallen from a tree earlier in the day. He had no blood in his belly on ultrasound, but did not have any breath sounds in the right lung and was grunting with each breath. I put a needle in his chest to relieve the air and then placed a chest tube, after which he immediately began to breath better. It feels good to perform a life-saving procedure in a place like this were there is so much death on a daily basis. We commonly walk onto a ward in the morning to find that a severely malnourished child or other very sick person didn’t make it through the night.

On the brighter side of things, I was called out (no pagers here, just someone knocking on your door – or window) about 1:30 am a few nights ago for a woman in labor who was not progressing and needed a C-section. I placed her spinal anesthetic and then in order to test the level of anesthesia asked the scrub tech to translate in her language that I needed her to tell me at what level on her skin the cold alcohol swab felt “very cold.” He talked to her for a bit, and then said, “She does not understand this word.” I’m not sure if this was a misunderstanding between different tribal languages or if she actually didn’t understand the concept, but yes, it is hot here.

A few of the "rare in the U.S." things we’ve seen recently include: late-stage malnutrition, neonatal herpes, more malaria, more typhoid fever, multiple cases of severe pneumonia and meningitis, elephantiasis, HIV, buruli ulcers, skin infections and abscesses of all kinds & places, cysts, lipomas, and other strange swellings. 

I had my first case of uterine rupture the other during which happened during a normal labor. We did a C-section but the baby unfortunately had already died. Instead of repairing the uterus we did a hysterectomy since the mom had five children at home already and she had requested a tubal ligation before the C-section (very rare here since most people want large families).

We are also seeing some of the things we see more commonly in the U.S., such as hypertension, congestive heart failure, COPD, acid reflux, inguinal hernias, hydroceles, Down syndrome, meningocele, infertility, abnormal uterine bleeding, seizure disorders, sickle cell disease, preeclampsia, obstructed labor, various bone fractures, and osteomyelitis, to name a few I can think of. 

The poverty here is beyond anything we see in the U. S. I feel strangely more “used to” it since this is our second visit, but it is still just as real. The majority of the people in the surrounding villages and even here in town live still in mud huts with mud floors, mud walls, and thatched roofs. This week we’ve had a few cool rains brought in by strong winds, something we welcomed gladly, until several people told us they dread these winds this time of year because “they will take off the roofs of our houses.” This same thought was voiced as a prayer request this morning in the church service we attended. Despite the poverty, however, many in the younger generation are being educated and have a desire to improve their living circumstances. It's hard to get a good sense of how people here think about their lives and their futures, but for me it is a challenge to hold this life more loosely, as this environment has so many hazards to health, life, and the enjoyment of it that never cross my mind in the U.S. As Paul says in 2 Cor. 5, this body is truly a tent, and this life a temporary dwelling. 

This is a 2-week old baby girl who was brought into my exam room during OPD (clinic) today. My first impression was the same as yours might be, that this baby is severely malnourished. It became quickly obvious however that something more serious was wrong, as the baby was breathing very fast and was very lethargic. I quickly send her to the pediatrics ward where she would be able to receive antibiotics, IV fluids, and nutrition assistance, however in just a few hours one of the pediatric residents who is volunteering here this month let me know the baby had died. The mom lives in a village 20 miles away, so it was mostly likely quite a feat for her to reach the hospital today. Most people who live that far out walk or ride bicycles everywhere, and the only way they might get a ride on a vehicle is if someone with a pickup is kind enough to stop and let them ride in the back. It's not uncommon for them to walk six hours to reach the hospital to be seen, something I didn't believe until I took a ride out in the back of a truck myself three years ago, and saw the people walking or riding three to a bicycle. Incidentally, our driver was very compassionate, stopping to give rides to everyone he could on the way back to the village. By the time our small Toyota pickup reach home it had approx. seven in the crew cab and no less then 16 people (one being me) and a baby in the bed. But, who would opt out of that when the alternative is walking 20 miles on foot?

We’ve completed four full days at the hospital now, and to be honest it feels like they’ve been a blur. It’s a blessing that so much is familiar to me from our last visit, but that still hasn’t prevented a little bit of culture shock when I’m actually in the hospital. Because of our living situation, we’re relatively insulated from the actual village life (something we had wished could be different after our last visit, and something we hope to change more of during our time here). The hospital sits on a 500-acre compound with approximately 15 housing units that at one time were all full with missionaries. Currently there are four housing long-term staff, and three housing volunteers. I must say it has eased our adjustment this week as we are able to eat dinner and spend time most evenings with American English-speaking individuals. While in the hospital, however, it’s total Ghana immersion. There are 6 wards plus isolation and maternity, each with 8-30 beds divided up among men, women, children, maternity, and isolation for more communicable diseases such as meningitis, TB, etc. The majority of the patients don’t speak English, so we usually go first to the nurses’ station to ask for assistance. The funny thing is that the English-speaking Ghanaian nurses have difficulty understanding our flat American accents which are different from their British/Tribal version of English. The doctors here change their “accent” when they speak to the nurses, which at first sounds comical, but after having nurses look at you with a blank stare and say “what” three times, you find out that they can actually understand you better if you try to imitate them.

In the three short days we’ve been here, African pathology has already been in abundant supply. So far I’ve admitted multiple patients with cerebral malaria, meningitis, pneumonia, severe malnutrition, abdominal infections, and miscarried pregnancies. Yesterday in clinic between two full-time physicians, 4 residents, and a few medical students, we saw over 400 patients in clinic. The most common surgical procedure here is elective inguinal hernia repair, of which I’ve helped with one, but in the last two days I’ve also performed multiple ultrasounds, two D&C’s and done my first African C-section. It wouldn’t have been a proper initiation without the power going out in the middle of the C-section, but thankfully it was daytime and the frosted-glass windows let in enough daylight for us to continue without interruption while the circulating nurse found a flashlight. The power came back on within a few minutes, which is a blessing because when the window AC unit stops, the surgical gown quickly becomes your own personal sauna. Yesterday evening I thought regretfully that I’d only taken 3 or 4 pictures so far of all of the strange swellings and pathology I’d seen so far, and then realized, “It’s only been two days.”

As I mentioned above, there several other volunteers from the U.S. here with us, two pediatrics residents and five medical students. So far the flow of patients and problems has been heavy enough to keep us all plenty busy. We usually start at 7:30am with rounds which last until around 9am, and then after a 30 min. break begin either clinic (OPD=Outpatient Dept.) or surgery (theatre). We finish around 6pm on clinic days (M,W,F), and a little earlier (b/w 3-6pm) on surgery days (T-Th). I've enjoyed re-connecting with Ghanaian hospital staff that I interacted with on our visit three years ago, including several translators and theatre (OR) staff. We've found that Ghanaians overall are a very friendly group of people, especially as we interact with them more and more.

Not all of the medical staff volunteers are associated with a mission organization, in this case the medical students being from a state university, so it’s been a mixture of people from different backgrounds whom we’ve enjoyed learning to know. We look forward to more time spent with them as well as with the English-speaking hospital staff and community members we see each day.

Our little ones are adjusting to the time change and heat fairly well, but spending a lot of time in just diapers. Our wives are doing well too; I’ll let mine update you with her own perspective on life in this new, strange place when she has time.

Last but not least, it really is hot…I tried to quantify how much water, milk, tea, fanta, lemonade, and crystal light I drank yesterday and stopped after about 4 liters. There’s rarely a time when I’m not at least a little bit thirsty. The upside is that we get to experience the satisfying feeling of having our thirst quenched a multitude of times each day. I realized that makes a great spiritual analogy- whether fasting intentionally from something or experiencing the unintentional fast of a difficult experience, I am finding that leaning into God for protection, strength, endurance, patience, and a good attitude brings a similar satisfying feeling to having thirst quenched as I see God work undeservingly on my behalf. It’s difficult to describe, but so is the feeling of quenched thirst, unless you’ve experienced it for yourself. May we all continue to lean on Him for our satisfaction from whatever dryness we may feel in our lives today.