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