Pictures and Perspective

 My translator, Usman, holding one of our few healthy patients

 Katy, Marta, me and Lisa posing for the album cover of our upcoming record "Galmi, Maybe"

 Malnourished 2-month old

 An exceptionally large and ugly bug (not in my house, thankfully!)

 Short-termers, brought together by the promise of pancakes

 The obligatory "my picture with a cute African kid"

 Katy and Marta riding camels (I hear it is rather uncomfortable)

 Camel shadows (nice picture by Katy)

 Galmi is the "Onion Capitol of the World." What better reason could there be to make onion rings?

 Makes Katy and I look like we were travelling light.

 Shopping on "Market Day"

 Me, Usman, and Katy on our last day

 Note the multiple beds on the floor and beds with multiple patients and their mothers

Recent flooding has caused a lot of damage in Niger, and made this a terrible malaria season.  We were able to see some of the damage as we flew over.

I've been back in the US for almost 2 weeks, during which I have: worked a shift in a small town ER, tried to fill out my advance voting ballot, paid rent, shopped at Walmart, eaten at nearly all my favorite restaurants, seen a movie at the theater, ordered stuff from Amazon, and generally been living the "normal" comfortable life that I was born into.  Ask me how Niger was, and I will have to think for a moment before saying that I saw a lot of really sick kids.

  It is amazing how hard it is to see the whole picture clearly.  When I was in the hospital in Niger my thoughts were nearly consumed with sickness, death, and an overwhelming hatred for malaria.  I couldn't imagine that somewhere in the world were healthy children, likely to survive the week, though I knew that just weeks before I had seen such things with my own eyes.  Now that I am back "home," watching kids in costume ask neighbors for candy it seems surreal that there could be children who haven't had enough to eat any day of their lives, and are losing the battle to fight off a sickness that began with a common bug bite.

  Despite the overwhelming differences between life at a mission hospital in Africa, and life in the suburbs of America, it always surprises me that I am the same.  I don't suddenly become less selfish, or more grateful when I switch contexts, although I am enjoying my temporarily bug free existence!

  All that being said, I think that it's time for me to commit to something more permanent.  I've been accepted by a missions agency and have some possible locations in mind.  Please pray for me as I seek to be obedient (not my strong suit!) to God.  The Global Missions Health Conference is in a week and I am looking forward to seeing friends and hearing from really awesome people doing amazing things around the world, but I also hope that it will be an opportunity to clarify my next steps towards a particular location.

  My job is not to see the big picture clearly, but rather to follow the lead of God who does see everything clearly, who is gracious, abounding in kindness, all-wise, and loving.

 Thank you to all of you who have followed along this journey with me.  God has encouraged me and strengthened me through your prayers.

My life in Niger

I would like to tell you more about my life here in Galmi, Niger.  There is more to it than bugs (thank goodness!) 

  I live in a duplex with my own space.  I have a kitchen, dining area, and living room all connected and then a bedroom with a bathroom attached.  My neighbor is a young woman from the US who is here for a year teaching at the dayschool for missionary kids.  Despite having my own space, it feels a bit cramped and institutional and not homey at all, so I spend most of my time at my friend Marta’s place.  Her living room is more pleasant and personal and I have done most of my cooking in her kitchen.  There is a gas oven/stove in each unit which is lit with a match each use.  No pilot light!  The oven is unpredicatable, but Marta managed to bake a dark chocolate birthday cake for Katy that was amazing, maybe the best I’ve ever had.  Unlike my time in Zimbabwe, water and electricity are reliable here.  There is even a built in water filter at everyone’s kitchen sink. 

  I keep my mosquito net tucked in around my mattress at all times to keep unwanted visitors out of my bed.  They “fixed” (read : doused with insecticide) my swamp cooler so at night I can get the temp in my room down to the 80’s which lets me sleep more comfortably although the night it rained the air was so humid I stuck to everything.  Yesterday the high dipped nearly 20 degrees to 89 and people came to the hospital wearing sweaters.  The fans were off in the hospital because people were cold, so there was no moving air to absorb my sweat.  I am definitely not fully acclimated, but less uncomfortable than the first week.

Last week, I heard that there was a baptism going on at our compound swimming pool, Katy and I went to watch.  It was exciting to see nearly 20 people, most teenagers, be baptized.  I thought that it was interesting that no one here claps, since that is usually my experience of church affirmation in response to a baptism.  They tell me that it is rare to see baptisms here, so I am glad that I got to witness these. 

  Hospital rounds start between 8 and 8:30, and we each round on our own patients that we admit.  Today my stack was the largest it has been: 25, all children.  I was relieved that none of my children were in the deaths box today.  On Saturday, my first weekend call day, a severely ill 17 year old came in.  her blood pressure was 60/? (normal is 100-120/60-80) and despite our efforts to get IV fluids into her, she died within 15 minutes of my seeing her.  I found out later that she was one of the teenagers that had been baptized the weekend before.  Today I sent home about 5 children who would probably be dead without the treatment they received from the hospital and from me.  I sent 2 more to the Nutritional Center to have intensive nutritional support.  I am on call tonight and am afraid that my stack of people to round on tomorrow will be even higher than today.

   We are all working hard and barely keeping up with the burden of malaria here.  My favorite age for kids is between 4 and 8, but it is amazing how hard it is for children born here to make it to that stage.  Most days I work in the under-5 clinic, which is swamped with children brought from near and far, most with malaria and some with something else.  In some ways it is easy, because at this time of the year, we just assume that everyone has malaria, but that makes it hard sometimes to see clearly and notice when something else is going on.  Many children are malnourished.  Children without good nutrition do worse with everything.  Brain development is put on hold and even mild infections can turn life threatening because their bodies can’t fight.  I see between 30 and 50 patients a day in this clinic.

  There was a mother who brought 2 of her children to the clinic.  Her younger child died in the 5 minutes spent writing admission paperwork for the hospital.  A little while later, a child was noticed in the waiting room having a seizure (either from malaria itself or from the fever).  The staff brought the child in to give her medicine, but couldn’t find the mom, who was trying to make arrangements for her dead child.  I don’t know if she lost both her children that day or if maybe the older one lived. 

  I was asked by one of the long term missionary doctors if I am having “more fun” here than in Zimbabwe.  He suggested that I am probably saving a lot more lives here.  That may be true, but I admit that this work makes my soul weary.  Even if 5 or 10 live for every death, I feel the pain of 10-20 deaths a week more strongly than the joy of 100 lives saved.  So pray for me and the other doctors and staff at the hospital.  We are soul weary, even when well rested.  And we are not always well rested. 

For me the constant itching is also trying.  I have mysterious bites all over my body that itch all day long and try to keep me up at night.  I am taking Benadryl every night and Claritin every day, but still the itchiness persists. 

Much as it was in Zimbabwe, cooking is a creative outlet here.  I made delicious onion rings and applesauce this past week, and not so delicious burgers.  I bought meat off a man who had strapped a chunk of cow to his motorcycle and brought it to the compound.  Then I had to dissect the tendons from the meat and figure out how to operate the electric meat grinder.  This may be the freshest ground beef that I have ever eaten and I am more seriously considering being a vegetarian than I ever would have thought possible.

Niger is a hard place.  Not the hardest, but definitely hard.  I don’t know if I will come back, but I think that if God called me here, I would be both honored and humbled that he would entrust such a difficult place to me.  

Creepy, Crawly (Hoppy, Fly-y) Things: The Plagues of Niger

  Many years ago, I decided that for me to go to Africa would prove the existence of God, because I hate bugs so much, only God could get me to go somewhere with so many of them.  I have since learned that while Africa may have some more bugs than home, it isn't usually that overwhelming.  (Caution: if you are squeamish about bugs, skip to the last sentence of this post)

   In talking to my friend Marta last week, I mentioned that I feel like I am experiencing the plagues of Egypt.  This conversation was sparked by noticing the abundance of frogs that are everywhere at night and the random rash that all of us here have on our arms (pretty sure it is from some form of bug not deterred by DEET).  Watching children dying of malaria is also sadly reminiscent of the plague on the firstborn.  At the time of the conversation, I said to Marta, "just watch, the locusts are coming next," to which Marta replied, "yeah, so they told you about that?"  Um, no.  I was just being facetious!  But unfortunately, it is true.  Tonight there were thousands of locusts flocking about the hospital. While I tried to write admission orders on my two patients tonight, no less than 20 locusts landed on me.  Walking to and from the hospital was walking through a swarm of the the flying creatures.  There is a swarm of gnats that has started to hang out right in my doorway.  Earlier this week, I killed a 2.5 inch scorpion in Marta's house.  And I haven't mentioned the 10-15 earwigs that I find in my house daily (and which like to randomly drop from the ceiling onto innocent bystanders).  Or the 5-10 crickets that sneak in under my doors.  Or the web of 50 baby spiders on my door handle today. Or the 30 ants that climbed into my homemade syrup.  And did I mention the malarial mosquitoes? no... that's because even though they may be deadly, I've only seen a few.

  So if any of you wondered... yes, there is a God.  And he is currently training me to survive bugs.. in Africa.  Please pray for me!

The First Week

I regret that it has taken me so long to write an update, but since I did not bring my own computer and started almost immediately working in the hospital, today is my first day to think and write (and cook!) since arriving.

From now on, I have decided that I will always travel with Katy.  God seems to give her special grace in the area of transportation, and all of our flights behaved well and our luggage arrived.  I was able to bring many of the things that the hospital had requested, although I was not able to bring some things because I did not order medications early enough to get the government clearances needed.  I did learn a lot that will help me to plan better next time. ;)  Katy and I arrived in the country of Niger on Sunday afternoon and spent that evening at a guesthouse.  I intermittently turned on the air conditioner in my room for 3 hours during my stay and it was glorious.

We flew to the hospital in the smallest plane that I have ever been on.  It is a 6-seater, but we took out 2 seats to accommodate the trunks we brought along.  We flew over the countryside at about 4000 feet and were able to see the faint green of the crops watered by the recent rains.  By the time I fly back, I am told that all the green will be gone.  This place is what most people picture when they think of Africa, although I have been to many places where the land is lush, with rolling hills and even cool temperatures.  Here it is hot.  110 today.  No air conditioning, only fans.  The temperature inside is in the 90s.  Because of the recent rains, the air is oppressively humid as well, so the sweat that drenches me can’t evaporate away to provide relief.  Culturally, as a woman I must wear a headscarf, which adds to the warmth.  I am missing the cool fall weather that began just as I left.

Malaria has been terrible this year and though the pediatric ward is supposed to hold up to 35 patients, the other day there were 115 pediatric patients.  They share the beds, with 2 to 3 children and their mothers sharing the same mattress.  Additional mattresses are spread in any available space.  The nursing staff are overwhelmed by the number of patients and with 2-3 per bed, often with similar names, it is frighteningly easy to get their charts and medicines confused.  They are all on the same medicines but at different doses.  Thankfully, most of the patients seem to be getting better, although one day last week 26 died between one day and the next.  The hospital staff is noticeably worn down. 

My first day was really difficult.  It is amazing how much variation there can be between different African mission hospitals and I arrived knowing almost nothing about how this hospital functions.  So on Tuesday I followed the other doctors around in the morning.  My French lessons didn’t get as far as I’d hoped, so I’m completely without any communication ability without a translator and there are only a few who speak English.  I write in the charts in mostly English with a few bits of French that I picked up.  But that first day I was reminded by everything including the other staff that I don’t know how to do things here.  At the same time, when I asked for help, I was told that I was slowing things down and when I didn’t ask, I was told that the things I did were wrong.  One of the doctors here hasn’t taken a day off in over 6 weeks, so I understand his impatience, but I definitely went home and cried that night.  First days are always hard. 

The rest of the week has been better.  I had one child die overnight that night.  They had come in too late.  I wrote “near death” on their admission note and unfortunately turned out to be right, but since then, all of my patients have survived.  A mother brought me her 6 year old daughter seizing from malaria.  Her firstborn son had died several years before, and her second-born, a daughter, had died when this daughter before me was born.  Now her only living child was dying and she was panicked.  I led her to the bench we call “the ER” and then had the mother hold her seizing child on the scale so we could know the proper dose of seizure medicine to give.  The needle on the scale bounced with every twitch of the girl’s arms.  But it was enough to get her the medicine.  The first dose didn’t help and after another very long 10 minutes we gave a second dose.  A couple minutes after that, she finally went limp.  I watched to see if she still breathed and was relieved to see her chest rise and fall.  We gave her malaria medicine and Tylenol, and I prayed that she would somehow live, though things looked bleak after at least 15 minutes of seizing.  By the next morning, when I came to round, that patient had faded into the back of my mind surrounded by many other children I had seen.  As I walked into the nurses room, a woman grabbed my hand.  This isn’t unusual, every mother with a child in the hospital wants their child to have the doctor’s attention, so I continued walking with just a brief smile at her.  Then she gestured to the child beside her: a lovely young girl sitting up with bright eyes and a smile.  I continued walking and made it another five feet or so before realizing it was the seizing child from the day before.  God’s memory is perfect.  Though I had forgotten her, He had not.  I pray that the joy in that mother’s face might direct her to the God who saw her distress and saved her child, rather than towards me.

Preparing to Go

I write this while preparing to leave for a new (to me) part of the world.  I am going to live among strangers that I hope to call friends, but there are many things that separate us.  Language, Culture, Race, Religion.  It is possible that some of those I meet may not trust me or like me.  It may even be possible that a few might hate me.  Is that a reason I should not go?  Jesus came to earth for us under similar conditions, and I will follow him in this wherever he leads me.  My Hope is unshakable.  Though the foundations of the earth may falter, the hope found in Jesus Christ is a sure foundation.  There are more people today than ever before in history who do not know that God has declared us his friends based on Jesus sacrifice.  Some of these people live next door to me and across the street.  Many live on the other side of the world.  For years, I have felt and followed a desire to travel further to live out the good news of Jesus.  Aware that I cannot do this on my own strength, I ask you to pray for me.

On Sept 22, I leave for one month in Niger, West Africa.  For a bit of sobering perspective, the U.S. has one doctor for about every 370 people; Niger has one doctor for about every 25,000 people (so I will be VERY busy!)  Two good friends of mine who are both single female doctors are currently there for 4 1/2 months as part of the international family medicine fellowship which I completed just over a year ago.  Traveling with me is another good friend of mine, Katy, who is also a doctor. We look forward to serving alongside the long term missionaries and national staff at the hospital.  We also look forward to seeing our friends and hope to bring refreshment and encouragement (and chocolate!) to them. 

            I am deeply grateful for to all those who have poured into my life.  I want you to know that because you are part of my life you travel and serve with me. (Most of you probably never expected to travel to Africa, huh?) 

Please remember me and the people of Niger in your prayers. 

Specific requests

1. An end to the cholera outbreak

2. That those who lost homes in the recent flooding will be sustained and that rebuilding will be able to progress.

3. That those who need malaria treatment will be able to get it (many hospitals have run out due to the high number of cases currently)

4. That I will be able to take the supplies and medicines that the hospital has requested (lots of red tape on both sides of the ocean)

5.  Ability to communicate well with patients and staff (despite multiple language barriers)

6.  God's guidance about where to do long-term mission work in the future

7.  Physical and spiritual protection

His,

Alexis

Below: world map from 2006 showing population to doctor ratios around the world)

Tanzania

My time in Tanzania both flew and crawled by. I was so anxious to head home that at times it seemed the week would never finish, but now I can't believe it has gone by!  You may recall that my first week in Africa, I posted a snail that I saw so it seems reasonable to show you the huge snail that I saw in my final week in Africa.

Last Sunday we did something I haven't ever done in Tanzania before: we went to "city church." Usually we go out to one of the villages. Pastor Raymond (who has the biggest and most beautiful smile on earth) preached the sermon and a couple excellent choirs sang. The sermon was in Swahili, so I can't say what it was on, but the singing was delightful.

Afterward we ate lunch with the pastors and the bishop. My home church has helped to sponsor the education of several young men who are now leaders in the church. So many of them are familiar faces that I have seen again and again during my trips to Tanzania. Lunch also included a special treat. Apparently in the 2 years since my previous visit, Pepsi has moved into Tanzania (it used to have only Coke) and introduced the joys of Mt. Dew.

On Monday we began clinic by driving out at 7:15 in the morning to a village over two hours away on the far side of the mountains. The drive is beautiful, but jarring since very little of the way is paved. There were several times that I earnestly thought we were going to get stuck in the mud. But we arrived and set up our clinic in a school. School was let out especially so we could do this, and I think we doctors saw every student in addition to the many people from that village and surrounding villages. Many people were well. Some had malaria. Many had intestinal worms. Some had elephantiasis. I saw a woman who likely had advanced cervical cancer.

Our team included a pediatric nephrologist, an ER nurse/paramedic, several nurses, a dentist, a pharmacy student, an optometrist and several helpers of various backgrounds. This is the first trip where I have really felt like I was the most qualified physician, and that made it difficult as I still have plenty of questions and would have loved to have someone to go to with those questions. On the other hand, because I was feeling so anxious to get home, I almost wished I hadn't agreed to come to Tanzania, but I was definitely needed.

After my time in Zimbabwe, I am very aware of HIV. There was a Tanzanian nurse and HIV educator who joined our team and helped us do HIV testing. I think during the week we did around 600 tests. I didn't order them terribly often, but feel like God really led me to order them on a couple of patients. I tested a young girl pregnant with her first baby. She had not yet had any prenatal care and was around 15 weeks pregnant. Mostly I was checking for malaria, but since we were drawing blood, it seemed reasonable to do HIV testing also. As it turned out, she was positive. This puts her in a very difficult position. She has to somehow go home and convince her husband that they should both go for testing. If she reveals that she has been diagnosed, he will likely blame her. On the other hand, now that she knows her status, she may be able to prevent the baby from getting the disease. Please pray for Grace and her husband and baby.

Another patient that stood out was a 13 year old girl, Esther. She had a beautiful smile and alert, curious eyes. There is a special spark in her and when I saw her I thought she could grow up to be a doctor if she wanted. Her mom and little brother were there at the clinic with her. Much like my other patient, there was nothing that overtly suggested HIV, but I wanted to check them for malaria and so went ahead and did both tests. Esther and her mom got the surprising and difficult news that they have HIV. This poor 13 year old with so much potential, and such a difficult struggle ahead...

I saw several patients with infertility who I could pray for, but there was nothing medically that we were equipped to do for them.  It was hard to deal with being so limited in our diagnostic abilities and treatment capabilities.  After working in the hospital in Zimbabwe, this just felt like such inadequate care.  As the week progressed, I went from praying with a couple patients a day to praying with all my patients, because I recognized that my medical care was not going to be enough.  I also asked the patients if they had anything they wanted me to pray about and many said a good life, or success in business, or healthy animals.  A few women prayed that their children would come to church.  Please join me in praying that God will bless those I met this week with the life that is found in Jesus, and that he will multiply and complete our feeble attempts to bring healing.  

travelling adventures and misadventures...

So I arrived at the Zimbabwe airport very early last Thursday to catch my flight to Tanzania. No one at the airport seemed to know where the check-in for my airline was, but after about an hour someone arrived at one of the counters and began checking in the few of us who were waiting. My bags were checked, and praise the Lord the weight was ok. (Flying within the African continent involves a much lower weight allowance than flying to the US from Africa.) I was feeling very Zen at that time so the delay didn't phase me too much and I bought a Coke to help me wake up. I began to feel a bit nervous that my flight didn't appear on the departures monitor, but I was reassured by the fact that my boarding pass looked legit and there were at least a few other passengers waiting for the flight. A lady approached me and asked if I was waiting for the flight and I said yes. Then she asked, "are you Alexis?" Uh oh. "yes." "Your connecting flight to Tanzania doesn't fly today." In fact, there is never a flight on this airline to Tanzania on Thursday. Despite the fact that I have a confirmation number for the imaginary flight, I am escorted back out of the airport and my departure stamp in my passport is crossed out.

They did tell me there was a flight on Friday. I called the missionary who had dropped me off and asked to come back home with her for another night. Because of the delay, I was present for the arrival of a new missionary team which was headed by a doctor I apprenticed with in medical school. I had actually lived with his family for a month, so it was wonderful to catch up.

On Friday I headed out to the airport again. I briefly encountered the issue that I wasn't on the passenger list, but that got sorted and I arrived in Tanzania at 1Am on Saturday. Unfortunately the medical team I was meeting had already departed for our headquarters, 3 hours from the airport. The Tanzanian missionaries, however, had been able to change my reservation at the last minute so I had a place to stay. They also left me enough money to pay the cab driver and buy a bus ticket in the morning. I actually came up about three dollars short because I asked the taxi driver to help me find an ATM, and then I realized that I couldn't remember my PIN. Ooops! He forgave me the shortfall (maybe to get rid of the crazy American girl).

The next hurdle was that the bus I was on (with no money...again) had one of my suitcases underneath the bus in storage. The headquarters is on the road the bus takes, but they usually only drop you off if you have no luggage underneath. I spent some prayer on the issue because I couldn't afford another ride back to headquarters, and lo and behold, they let me off right where I needed to be! (maybe once again to get rid of the crazy American girl!) Oh, and on the bus, would you believe there was a vendor with a cold can of Mt Dew? I got him to accept an American dollar for it. :)

And so, despite all the craziness, I arrived and met up with the medical team on Saturday evening.

Final thoughts on my time in Zimbabwe...

The end of my 5 months in Zimbabwe caught me by surprise; it came so fast. Overall this experience has strengthened my faith in God. Some of you may know that I seriously considered not coming to Africa. After my last long stay in Africa, I made one of those rash statements that goes something like “God, I’m not coming back to Africa unless I’m married.” And last year, I dated someone who I could imagine sharing life with, except that life would have to be in the U.S. He loved Jesus and loved serving others, but didn't feel called to do that overseas. And this brought me to my Jonah moment. Choosing for myself, I thought that being married in the States sounded better than being single overseas. Then I got swallowed by a fish. Ok, well actually I just ended up in a situation where saying no to going to Zimbabwe seemed so catastrophic that I had to say yes. So I came to Zimbabwe more or less against my will.

But in Zimbabwe I found myself overwhelmed by the sense that I belonged. I was surprised by contentment even in the incredibly difficult and heart wrenching situations which arose daily. God graciously provided the right people at the right times so I never felt alone. He scattered flowers on my path every morning, sent me valentine’s candy, Mt Dew, and beautiful letters of encouragement from home. He restored my soul. And I am so grateful for his mercy that gives us not what we deserve, not what we want, but what we most desperately need.

I spent the last night before my flight out watching a total lunar eclipse from on top of a huge rock covered by ancient cave paintings. And I spent many nights as I walked between the my house and the hospital staring up at the stunning array of uncountable stars. I watched and experienced the tremendous power of Victoria Falls as an entire continent worth of water crashes over the edge. I saw the rainbows cast by sunlight through the mist. And I walked with lions. And I am blown away that the God who, with a word, created such things also knows me and loves me. He knows you and loves you even better than you are able to know and love yourself. I am honored that he has given me the great joy of proclaiming that truth to his children in Zimbabwe who may feel that he has forgotten them. And I am glad to share it with you too.

Some other things I hope to remember from my time in Zim include the

universal desire to be acknowleged, valued, and appreciated. It can be easy to do great damage in ministry by not acknowledging the importance of others contributions. And it is really easy to unintentionally overlook or simply fail to express appreciation and respect. We can drive away people who are vital to our mission and work, by not letting them know it and by treating them as less vital than ourselves. We truly are a body and the eye should not say to the hand, because you are not an eye, I don’t need you.

I am so grateful for the friends God has given me in Zimbabwe. It was very hard to say goodbye. Please pray for Rejoice, Anna, and Priscilla who I am already missing.

One of the hardest things about serving in Zimbabwe was realizing that some people hated me for my skin color, while others ascribed to me special status or knowledge because of it. There were people who viewed me as an invader, and those who looked to me to be a savior. And in some sense I am both and neither. I am so grateful for those who opened their homes and their lives and their hearts to me despite my different culture and skin.

Look out world! Alexis is behind the wheel in Africa!

So this last weekend in Zimbabwe was quite an adventure.  The original plan was actually for me to travel into the capital city on Friday and sit on my duff until my plane flew out this Thursday.  Which honestly sounded seriously boring, but beggars can't be choosers and in Zim, I am definitely in the beggar position with regards to transportation.  I was exceptionally grateful to be offered a couple extra days to say my goodbyes to the hospital  and my friends here.  Then on Thursday morning, I received a strange invitation.  One of the missionaries, Anna, had agreed to drive some of the local staff across Zim for a college graduation of one of their children.  But they needed 2 drivers and the second driver was now unavailable.  Would I like to drive a vehicle to the town of Mutare in the mountains of Zimbabwe leaving Friday mid morning?  To be honest the whole thing sounded crazy.  I have never driven in Africa.  They drive on the left side of the road which makes turning and passing confusing.  The speeds are in kilometers per hour.  To leave the hospital requires driving through the river.  And I have never met the person graduating.  So I was considering ways to say no to this absurd suggestion when I found myself considering that, originally, I had planned to be sitting around doing nothing.  It seemed like God had given me some extra time at the hospital and maybe I should pass along the gift.
  So Friday morning I rounded in the female ward, threw some warm clothes in a backpack (Zimbabwe winter is here) and agreed to the crazy scheme.  Thankfully the missionary had an automatic transmission in her car (I don't think I could learn to drive in Africa, while learning to drive a manual transmission, while transporting people across the country).  We were picking up the second car and the extra people halfway into the journey, so we began in the same car, with the missionary coaching me on how to drive, and the passengers warning me when we were coming up to sharp curves in the road or places where people they knew had been in car accidents.  Arriving in Harare, we split into 2 vehicles.
  So why did they need me?  Well having a drivers license is not a given in Zimbawbe.  Many people here never learn to drive at all.  Passing the driving test here is very difficult without paying a bribe, and many people can't even think of affording a vehicle to drive.  (We frequently have patients arrive at the hospital by ox-cart).
  So at this point, I am driving a borrowed car in a foreign city with passengers who have never driven a car.  I stuck to Anna's bumper as closely as I dared, because if we got lost I didn't know how to get found again.  Amazingly, in answer to many prayers we made it safely to Mutare by about 8p.m. (involving a fair bit of night driving which is also awkward).  The "highway" is actually very nicely paved, but only 2 lanes and passing requires pulling into the oncoming traffic lane on the right and it's super hard to judge speed and distance of oncoming vehicles based on the headlights.  Add to that the fact that I saw a lot of pedidles (not sure how to spell this, but cars with only 1 working headlight).  After driving back and forth across town we found our way to the relatives house that we were staying at.
  On arrival, all 14 of us poured out of cars to sit around the living room and exchange greetings.  This is not a mere hello, but a long involved discussion of the family relationships represented and recognition of each individual with a recitation of how they are connected.  This was followed by dinner.  I was shown out the back of the house to an attached small "bathroom."  This consisted of a toilet bowel set in the ground and a large bucket of water to pour into the hole to flush.  During the day they have running water, but at night no such luck.  After dinner we began to figure out sleeping arrangements.  Blankets were pulled out and laid on the cement living room floor so that 5 of us girls could sleep there.  Then 5 other women slept on the kitchen floor, while the 8 men piled into the single bedroom.  It was very cold overnight and there was no heat, but I did get a little sleep.

In the morning, people began waking up at 4:30 to start water boiling so we could all bathe.  One at a time we made our way out into the frigid morning and claimed a steaming bucket of hot water.  This we carried into the "bathroom" from last night.  In theory I was supposed to scrub down with the water, but it was so cold, I decided against it.  The graduation was at 9am outdoors on a beautiful, if chilly, campus.  Mahatmas Gandhi's grandson was the guest speaker.  Then  we headed back into town.
  The best part of the trip for me was getting to hear the people in my car discuss their thoughts on many issues in Zimbabwe and the hospital.  It really helped me to get an idea of what things look like to Zimbabweans.  I also had the opportunity to ask questions on their thoughts.  I think that travelling with local staff on long drives might just be a good strategy for building relationships and learning.
  Saturday night Anna and I escaped to a delicious Italian dinner in the capitol and the crawled between cold sheets at the guesthouse in search of sleep.

  Sunday I attended a wonderful church with Anna.  The congregation is truly a blended multicultural group and it was enjoyable to hear some testimonies of God at work from Zimbabweans.

  And in answer to many prayers, I arrived safely back at the hospital on Sunday afternoon.

A Final Project

  As my time at Karanda is finishing up, I was thinking about what I might be able to do to leave things here a little better than when I found them.  First I decided to clean the drain in my shower, which had never drained well since I moved in.  One very large slimy hairball later, that problem was solved, and I felt empowered to take on another project.

  During my time here, one of the things that has caught my attention is the difficulty encountered in resuscitating newborns.  There are many times that despite attempts being made, the newborn resuscitation fails.  Sometimes this seems to be related to baby being born far too early or having severe problems during the delivery or even having severe birth defects.  Other times infants who could survive seem to die because the attempted resuscitation is incomplete, haphazard, or completely neglected.  So as a last minute attempt to make things better, I asked permission to try and address this issue.

  With the help of a girl here who is an artist, I created a large (~3ft x 2ft) poster designed to take the guesswork out of resuscitation and give those attempting it a easy and visible algorithm to follow.  There were already a couple papers on the wall with neonatal resuscitation information, but they were too small and complex to be referenced during a resuscitation.

  Here was the result of our attempts...

 
In case you are wondering about Step 9, Chiremba is the Shona word for doctor, which is to say that steps 1-8 don't require a doctor and can be done by the midwives, nurses, and even nursing students.

  I was really proud of the aforementioned poster, but the sad truth is that after I handed the poster to one of the midwives to put up on the wall last Thursday afternoon, the poster hasn't been seen since.  Not quite sure what happened.  Several people have searched for the poster to no avail.  Now I don't know whether to spend a couple hours making another poster, or not.  The culture here is such that perhaps someone thought the poster was wrong or inappropriate or even offensive in some way, but since it would be too confrontational to tell me, they instead "lost" it.  Hmmm... I wonder.

  With the help of one of our anaesthetists and my friend, Rejoice, who is a midwife, I also made a chart of commonly used supplies and medicines for newborns with their sizes and doses, so that there will be an easy quick reference for treating these babies.  This I will print out and put up on the wall in the hopes that even if my other poster is never found or recreated, it will help some anyway.

  I also sorted through the resuscitation supplies to determine what items were missing.  In the process I fixed the pediatric pulse oximeter (checks oxygen levels) which hadn't worked for a long time.  I also found a small IV pump that would allow us to accurately give the fluids needed by our newborns (currently a real challenge).

 I would love to see more results like the ones below...

The other stuff...

Since I've written alot about my work in the hospital, I thought I'd better tell you that's not all I do in Zimbabwe...

  I spend my evenings and weekends off cooking, surfing the internet, watching movies, and reading.  I think I've read about 15 books since coming to Zimbabwe.  All for fun (with the exception of scanning our surgery textbooks.)

  One of the long-term missionaries taught us to play a card game,"Nines," which has entertained us many an evening.  I've also enjoyed several movies here, most recently "The King's Speech," "The Adjustment Bureau," and "I am Number Four."  Sadly our movie projector bulb died a couple weeks ago, so our movie parties are a bit less exciting these days.  We watch in clusters of 2 or 3 people instead of all together.

Cooking is a necessity here, but I also find that it is cathartic for me.  Especially when I get to share it.  So I have to share a couple more cooking pictures.  (I also shared the actual food!)

This pizza was delicious and huge about 18 inches in diameter.  I made the crust from scratch and Alice made the sauce.  If medicine doesn't work our, I think we may open a Zimbabwe pizza parlor. :)

   In my entire life, I've baked 2 apple pies, both in Africa, so I suppose for me the saying goes: "As African as apple pie."

This gentleman had no idea how thirsty his shirt made me.

 This is one of our wall spiders who became confused and thought this egg was a new kind of rounded wall.  I buy eggs from one of the nurses at the hospital.  He raises chickens and apparently they are very healthy, because they lay super big eggs.

I went out and sat among the plumeria blossoms that I enjoy so much.  I'm going to really miss the plumeria when I leave Zimbabwe.

  I will be returning to Wichita when I come back to the U.S.A.  Looking forward to being roommates with one of the residents who I knew from med school.  I have applied for a job, but no official word yet.  So please be praying for those details.

 

 

It's the little things...

This afternoon I was asked to talk with a young woman who had come to the hospital looking for help with an abortion.  She was unmarried and had recently found out that the father of the baby actually had 3 wives and wasn't interested in a fourth or in supporting another child.  The young woman is unemployed and takes care of her mother who is disabled from a stroke.  She wanted the baby inside her taken away so she would be able to continue to care for her mother.  I spoke with her and prayed with her at length about her difficult situation.  I told her that God knew all these things she is facing and still decided to put that baby inside her.  I remembered that Mary was also unmarried when God placed Jesus inside of her.  I don't know how God will provide for this young woman and her baby and her mother, but I believe that he can and will, if she will trust him.  Please pray for Marie.
  After talking with Marie, I went by maternity ward to drop something off, only to stumble in on a delivery of a 24 week premature baby.  The smallest baby that has survived here was 800g (about 1.75 lbs) and around 30 weeks and this baby was a mere 620g (1.3lb).  Baby didn't ever breathe, but her little heart was going right along.  I asked to hold baby and cradled her in my hands until her little heart slowed to a stop.  (culturally people do not want to touch a dead body, so parents here prefer not to hold their children when they are dying - which makes me feel very sad!)  Not even 20 minutes later, another mother delivered her 20 week baby.
  I don't know if Marie is still hoping to find someone to remove her baby, but I know that life here is very hard and it is the little children who fall prey first.  But I am also reminded that to enter God's kingdom we must become like little children.  And in his measurement, any service to the smallest child is a service to Christ himself.
  So even as tears threaten to fall, I am thankful for these little reminders of what God values, and I ask that He will help me to trust Him and become like one of these little ones to whom His Kingdom belongs.

life on the pediatric ward...

For the month of May, I am rounding on the pediatric ward.  It can be very difficult to see so many sick kids.  The first day I rounded in peds, the ward was full and overflowing.  Thankfully things have calmed down and now the ward is only half full.  Some of the kids I really feel bad for are kids with femur fractures.  They have to lay in bed in the hospital for weeks with traction on their broken leg.  And unlike hospitals at home, there are no toys and no "child life specialists" to distract them.  Currently I have 2 children in traction and when the second one arrived, I hatched a plot.  They were in different areas of the ward, but I convinced the nurses to put their beds next to each other.  So the 9 and 10 year old boys at least have each other to talk to and commiserate with.  

  The weather here is beginning to get cold, especially at night.  Several weeks ago, I admitted a 3 year old girl with about 25-30% of her body burned.  Kids with burns are so hard to keep warm but it is very important for them.  I was able to get one of the American nurses here to let me use her space heater to warm the small isolation room at the from of the ward.  The little girl with the burns did miraculously well and was able to go home after a couple weeks. Currently we have several babies with malnutrition and a couple of them are only weeks old, so I've tucked the littlest ones into the warm room, in hopes they will do better there.

  On Wednesday night, Alice got called down to the hospital for a child who came in with fever and trouble breathing.  The poor 15-month old looked terribly ill.  His lungs sounded full of junk and he was working exceptionally hard to breathe.  The mother told us this all began at 1 o'clock that afternoon, but clearly the kid was too sick for that to have been the beginning.  We started him on antibiotics and oxygen and breathing treatments, and counselled mom that he was very sick and might not survive.  At that news, she began cutting off the strings tied around baby's neck and wrists and ankles.  The strings are blessed by "prophets" and are purported to prevent evil from entering the body.  The "prophets" often tell people not to go to the hospital.  (we recently lost a breech baby of a first time mom during delivery because the prophet told her she would deliver fine without a c-section, so she didn't come for her surgery).  As we got more of the story, it became apparent that mom was quite definite about this all starting at 1 o'clock while the baby had been playing outside.  We now realized that it was very likely the child had put something in his mouth and then gotten it stuck in the airway.  Unfortunately our scope for looking down into the lungs and fetching small objects out of them, was too large for this child.  We began considering other options and were able to contact an ENT who works near a government hospital.  He spoke with the doctor at the hospital who could do the procedure.  (understand this is a huge miracle.  Hospitals in Zimbabwe often don't have phone numbers, doctors are frequently unreachable, and coordination of care is mostly impossible)  Our hospital driver was gone, so one of the missionaries volunteered to drive the child 3 hours to the other hospital,  We loaded a huge oxygen tank into the truck bed and ran the tubing through a window.  The child arrived after hours and a doctor actually came in and did the procedure that night (also never happens here).  They found a small seed stuck in the airway and removed it and the child is recovering very well.  The long term missionaries say that they have never seen something like this happen so smoothly.  So we are thanking God for enabling us to save this little one's life.

The hardest week...

  Several weeks ago a patient arrived at the hospital.  She was a nurse from another hospital who was in her 50s and had a colon cancer.  The surgeon believed her cancer was resectable, meaning it could be removed and possibly cure her.  We admitted her a couple days before surgery to begin preparing her for the surgery.  One of the new interns (Zimbabwean doctors in their first year after medical school) wrote the orders to admit her to the hospital and was exceptionally thorough.  We usually minimize the pre-op work-up because of limited resources, but the poor intern was too new to know that.  So they ordered a test to check the patient's bleeding risk during surgery.  It showed that the patient had a bleeding disorder.  We gave her medicines that might fix it and then checked again on the day of surgery.  The test results were still abnormal, so I talked with the patient and convinced her that we should delay surgery and try to find out what was going on.  Every day as I came by her bed she would ask me if I would pray with her.  Her English was very good and we talked about the things happening to her body and about the surgery.  Unfortunately further tests suggested that her problem was not correctable.  So after a week of talking and praying daily with her and her family they decided that they wanted us to attempt the surgery.  We managed to get 4 units of blood for the patient (which is really hard to get in Zimbabwe), and took her to the OR.  The surgery lasted nearly 3 hours and she did well at the beginning, but as we were nearly finished her blood pressures began to drop and her heart started to race.  We finished and she felt cold when I touched her, but the anesthetist assured me she was hanging on.  Hers was the last surgery of the day, so I left and went home only to find out later that night that her heart stopped 5 minutes after surgery.  I feel like I lost a friend.
   That same week I also had a 6 day old and an 11 day old who died, as well as a 17 year old with malaria who also died.  It may have been the hardest week of my time here.  I appreciate those of you who saw my brief prayer request on Facebook and prayed for me, and those of you who have been praying for me regularly.  Daily I see things that can make me feel God is somewhere else, but He has sustained me through these things in answer to your prayers.

Good News

  After my last post, you may be wondering if anything good happens here.  (I know I was!)  This week has been a blessing in that area.


   Last Friday, I was able to travel with an outreach team to a small clinic about an hour drive from the hospital (only 30 minutes if the river is low enough to drive across).  The district health vehicle was unavailable so we were loaned a truck from a nearby clinic.  I was given the honor of sitting in the front seat with only the driver and one other person and I got the window seat.  For reference the door had no handle and was tied mostly shut with a cord knotted around the empty seatbelt shoulder harness. It was a beautiful drive and I spent it thanking God for bringing me to Zimbabwe.  I truly am glad to be here even with so many difficult things.  We arrived at the small clinic to find about 200 people gathered who all sang and clapped when we arrived.  The hospital representative in charge actually did a silly dance to the singing.  Made me smile.  The people who were gathered were all those in the local area with HIV.  They come every two months to be checked on and get medicine refills.  There were many who seemed to be doing very well.  I was asked to see about 20-25 patients who were thought to be ready to start antiretroviral medicines, or who had particular additional health issues.  It was a pleasure to see them and pray for several of them and try to help them stay healthy in spite of HIV.  And then we had a beautiful drive back with the sun setting and the stars appearing.

  We helped a 17 year old last week.  He had a massive bone cancer (osteosarcoma) involving his left arm, shoulder blade and collar bone.  It was my new "largest tumor in real life."  He had been to the capitol several times trying to schedule surgery and they were continually postponing it, so he came here.  By God's grace we were able to remove the tumor completely (involved a blood transfusion during surgery and some really intense moments in the OR.)  He is now doing very well and even able to smile at being without his arm because the tumor caused him so much pain and disability.

This week I saw several patients who have advanced heart failure or liver disease.  One is a beautiful young woman of 28 years.  I have seen her several times over the past few months.  She has HIV and TB and severe ascites (fluid collecting in the abdomen).  This week her kidneys began to fail. I told the patient that we were reaching the end of things we could do medically and asked if I could pray for her.  Then I asked the chaplains to talk with her.  The next day, I found a note in the chart that she had accepted Christ.  We talked about it a bit and I told her I would see her there someday.  While I mourn the too soon loss of her life here, I rejoice that she has found life that will not fade or grow sick or weary.

  Today I saw two sisters with seizures.  They have both had them for about 2 years and the seizures have been daily since last Sunday.  I had been told that the spiritual history is important, but I often don't get to it.  But I felt a steady prompting that I needed to ask about spiritual things.  So I asked and the nurse translating for me told me they attend church, but it is a cult.  I asked if the children have ever been offered to spirits or been possessed.  (I felt weird asking that question)  The mom said yes, they had both been possessed and spoken with other peoples voices.  I called the chaplain and we prayed for these 2 children used as spirit mediums to be set free.  Please continue to pray for Tina and Tisha.  I know the only one that can protect them is Jesus.

  Back when I first arrived at Karanda and was rounding on the pediatric ward, there was a young man with meningitis.  He was only about 3 or 4 years old, HIV positive and was weak, sleepy, and confused.  We had tried many antibiotics without being able to make his fevers go away or him get any better.  I wanted to try treating him for cryptococcal (fungal) meningitis, but the medicine (fluconazole) isn't available at the hospital.  Finally i discharged him home fully expecting him to die within a couple weeks.  I told his parents to try and find the fluconazole if they could and try it.  Today the father returned to the hospital with a little boy i'd never seen before.  He was an adorable smart, inquisitive, giggling child.  I am so glad I got to meet him.  He said hello back to me and brought smiles to everyone in the room (even the seriously ill) with his infectious laughter and chatter.  Praise God for bringing this little boy back from the dead.  I asked him if he wanted to listen to his heart with my stethoscope and he did.  He even made little heartbeat noises.  I think he should be a doctor when he grows up.  Pray for this little man to continue to grow stronger and healthier.  He is now on HIV medicines as well as the fluconazole for life, or until there is a cure.

These are some of the plumeria flowers that God scatters on the ground for me to walk through everyday.

Life (and death) after vacation...

   Well I returned from vacation nearly 2 weeks ago.  Arriving back at the hospital was great.  It felt good to get "home," but no sooner had I gotten settled in then things began to get crazy.  I was on call the Monday night we got back and the national doctor had wednesday through friday off, and the doctor whom I go to with every question (she's a PA, but knows more than I ever may about taking care of people here) was gone Friday.  Alice was on call tuesday and thursday.  And I was on for the weekend.  I think that I was literally up  in the middle of every night that week except for thurday.  Alice and I share all our c-sections under the theory that 2 pairs of hands, two pairs of eyes and two brains are better than one, but that means that we were on c-section call every day and  night for 7 days straight.
   On Friday, I was up most the night waiting for a c-section to happen, admitting a patient, checking on another patient.  Then Saturday morning began at 6:30am with a horrible phone call that there was a child with grunting respirations.  I hurried down to the hospital to find them wrapping up the body of a 12 year old girl who was never even seen by a doctor.  My day continued with rounding on the wards and finding out that the baby I delivered Friday evening had died.  He was a 32 week premature baby and mom had placenta previa (the placenta blocks the exit from the uterus) and was bleeding.  Baby's heart rate was racing.  So we had done a c-section to try to save baby, but he couldn't breathe outside mom. How I wish we had surfactant to help these early babies breathe!
   Then that afternoon I received a call that I would have thought was a prank except that the person had a Shona accent.  (So far Shona people don't seem to be pranksters).  The voice on the other end of the line said, "we have a situation on male ward.  9 patients were struck by lightning and we have a transfer from another hospital, and there is another transfer on female ward."  Umm, really?  11 patients at once?!  So I went to male ward and found my second dead body of the day, one of the lightning victims.  Another needed to be admitted to the hospital and thankfully the others just had aches and pains.  Then I evaluate the transfer who has a hernia with bowel trapped and dying inside.  So he needed emergency surgery.  Then later that night another patient arrived with an open leg fracture that needed emergency surgery to clean it out.  And then there was a second open leg fracture that arrived at 3am.  At which time, a patient with kidney failure died.  My third dead body of the day.  We tried to transfer him for dialysis, but they will not take patients with HIV, so he stayed with us, until he died in the middle of the night.  The death came so quickly after the diagnosis his family wasn't even around for the end.  I did get to pray with him that afternoon, but I still wish I'd been able to do more.
  Sunday was blessedly less eventful and I was so grateful to have the other doctors arrive back in town!
 
After a cheerful post like this, I'd like to include a cute kid picture: (and there is a lady behind him with a major goiter!)

There are several things I'd like to ask for prayers for:
1) a kid bitten by a jackal several weeks ago who remains in a coma likely due to rabies
2) the mom mentioned above whose baby died.  Her family hasn't come for her yet and it has been a week.  Please pray that they would love and support her and not abandon her.
3) A 7yo girl with hydrocephalus who had a shunt replacement this week and hasn't woken up.
4) The husband and children of the young 20 week pregnant mom who died suddenly this week.
5) We have 2 new interns starting this month.  They just finished medical school here in Zimbabwe and will be at Karanda for 3 months.

Thanks for praying!

 
 

More vacation pictures

Dr Carmer and Dr Livingstone, I presume?

reflecting on an African Sunset

The double rainbow across the base of Victoria Falls

Stunning clouds at sunset

This is a left-tusked elephant for all you lefties out there

Africa is full of contrasts

baboon glamour shots, 

Among my favorite road signs of all time.

Mosi Oa Tunya: "the smoke that thunders"

Elliot and I with an elephant skull

Falling in love with Victoria Falls