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.