Fruit Salad! yum

Me and my housemates made this salad for the surgeon's 81st birthday party. I think it was the best fruit salad I have ever tasted.

Mangos, Bananas, Pineapples, Oranges, Green Grapes, and Apples, sprinkled with pineapple, orange and lemon juice.

Daily life

Life has settled into somewhat of a rhythm here. Every morning at 7AM there are devotions in the chapel. This involves all the nursing students and a couple missionaries gathering together for about 15-20 minutes. First we sing in Shona (ok, ok, first they sing in Shona... I'm still learning). The sound is beautiful, but I can't help feeling sad that many of the faces are blank and appear to take no joy or even interest in these vocal exercises to praise the Creator. Then someone shares a short message. Topics have ranged from The Lord's Prayer, to grace, to a Canadian pastor's life, to gluttony. Ideally, I shower before devo's but I'll admit that some mornings the cold water chases me away. Then back home for a bite of breakfast and getting things together for rounds at the hospital.

Rounds start around 8am. I am still in the pediatrics ward and most mornings it is just me and the supervising nurse. She is amazing. She functions like a resident and gives me the low down on each patient as we come to them. Unfortunately a fair number of the presentations sound like this: Infant is feeding well, still having fevers, and oxygen level was 65% (should be over 90%) last night (after the power went out and the oxygen compressor stopped working).

Currently there is a 2 week old with jaundice who we have under blue lights to help the level go down. His mom is HIV positive which means that he needs to be breastfed only to reduce his chances of getting the disease. The other treatment for jaundice at this age is frequent feedings, so we are trying to get mom to feed him every 2 hours, but without being able to supplement feedings with formula, this is difficult. What also makes it fun is that right now we don't have the necessary reagents to check the baby's bilirubin level. So each day I look at baby's eyes to see if they are still yellow and then continue encouraging frequent feedings and blue lights.

So far I've done 3 c-sections. It is a very warm experience. There is an air conditioner in the room, but it usually doesn't work and under the operating lights in a surgical gown with a surgical cap and mask I feel like I'm in a sauna. At the end I am literally drenched with sweat, but the results of the blood, sweat and tears can be beautiful.

Yesterday I had an interesting experience, which started with a dead man. I was in the operating room (theatre) and when I stepped out into the hall, there was a man lying on the ground. He had been waiting for surgery and suddenly stopped breathing and they couldn't feel a pulse. So they started chest compressions and used a face mask and bag to breathe for him and then gave him some IV fluids and he actually came back. The surgeon asked what surgery he needed and then indicated that they should take him back to the OR. (I would usually avoid doing surgery on someone who was recently dead.) Turns out he had an abscess on his neck that needed to be opened up, so we did and it was really gross! I kept making "blech"sounds because I was so grossed out. Then as I am leaving the room, I hear the dead man behind me say "sorry." Guess you never know. Not only was he alive and with it, he spoke English!

My afternoons are spent in either the outpatient department (OPD) or in theatre. The patients I see in OPD are generally very sick, they are seen and treated by nurses first and only the serious cases make it through to me. I have seen at least 3 terminal cancer patients and wished there was some form of hospice training available for their families and some stronger pain medications.

I also have adopted a new sister. She is 6 and HIV positive. But she came in because one leg is shorter than the other. X-rays (yes, we have x-rays again!!!) showed that she has avascular necrosis of her hip, basically the top of the leg bone has died and is dissolving. But she is the sweetest, happiest little girl. I just wanted to take her home with me. I asked if she wanted to come home with me and her mom told her to say yes. I about cried.

My ultrasound skills are improving and I am so grateful for the learning I had in Wichita last fall. We do a lot off ultrasounds and they can be really helpful in deciding how to treat patients. I've seen liver cysts, bladder cancers, ovarian cysts, pancreatic cancers, pericardial effusions (fluid around the heart), empyemas (lung abscesses), and measured lots of babies to date the pregnancies. I even tried an echocardiogram (heart scan) yesterday. Not sure whether the bladder that had 3 liters inside (ouch!) or the galbladder that was probably nearly a liter in size was more impressive.

Most evenings, I get home between 5 and 6. There is an aerobics class that meets in our guesthouse conference room 3 days a week between 5 and 6. I've gone once and was very sore afterward, so usually I just sneak by as I return from work. The class is really a neat mix of Zimbabwean and missionary ladies.

Usually by then, the electricity is off, so I cook dinner on the gas stove (challenging!), and try not to open the fridge or freezer. Then maybe I'll chill with my housemates: watching a movie on a laptop or playing a game. I also attended a bible study with the midwifery students this week. And last night I actually read a book for a while. Generally, I go to bed between 8:30 (if power stays off) and 10:30 (if power comes on again).

Please keep praying! I believe it is making a difference here. The surviving twin is doing well. Generator fuel arrives just in time. The x-ray machine is resurrected. I find strength and hope to keep going. A Shona tutor appears. A little girl in a coma wakes up. Really, God is at work and I'm glad to be part of it and glad you are too!

Worth checking out

this is a link to a great blog post about the surgeon we are working with here in Zimbabwe. http://epperlyadventures.blogspot.com/2011/01/happy-birthday-sekuru.html

and another one about life without consistent power or water...

http://epperlyadventures.blogspot.com/2011/01/no-power-no-water-no-problem.html

Housemates

My Roommate, Corrie, eating delicious homemade pesto pasta with our housemates, Grace and her husband Jeff.

A few pictures

The flowers around the guesthouse are beautiful. (click on images if you want to see a larger image)

The surviving twin is doing well. This morning he was breathing easily. He is on antibiotics because he spiked a fever last night. Please keep praying!

Living life at a snail's pace...

I was admiring this little guy the other day.

Hospital work

Well friends. Where to begin. Work. Alice and I are rounding together on the pediatrics ward. There are about 20 patients. Many are children with hydrocephalus (big swollen heads because their spinal fluid builds up inside and pushes the bones apart. To fix this requires surgery to place a small tube in the brain that drains into the belly. It can allow the child to develop normally if done early enough, but often we see children who have already had the problem a long time. One of the saddest cases I have seen is a 1yo girl who weighs probably 10lbs, of which her head is probably 5 lbs. Her little body is the same size as a newborn baby only thinner. A rat chewed on her head an broke the tube that had been put in to drain the extra fluid from her brain. Often the children with hydrocephalus are not fed until after everyone else in the family. I feel like one of the things we can do is touch them and love them to show their families that they are still valuable, but this child is so horribly deformed I find that my natural response is to shrink back. Makes me think of Isaiah's description of Christ, "his appearance marred beyond any man."

I have been working in the outpatient department after I finish rounds in the morning. It is fun to work with the nursing students as my translators, and I am learning a lot about medicine here. So much is different. Different problems, different medicines, different attitudes.

Speaking of attitudes. I was working in the out patient department the other day and running around checking to see what medicines we had or going to do an ultrasound and suddenly realized that when I returned from "tea" (a break from 10-10:30 during which all hospital staff vanish without a trace) I forgot my wrap that I had been wearing over my jeans. It is a very strange sensation to be fully clothed and feel naked at the same time. A friend who has been here for a while told me the only ones I was likely to scandalize were missionaries, but I still embarassedly tiptoed up to the guesthouse to get my wrap. :)

We had a 35yo patient with a snake bite last night while Alice and I were on call. Can't say I've ever treated one of those before. He was in shock with low blood pressures, cold and clammy skin. His pupils were dilated and he was drooling profusely. We don't have any anivenom, so we gave him fluids, epinephrine and atropine. His heart is very irregular, but still beating this morning. I hope that he will pull through, but there is no ventilator to breath for him if his breathing fails.

I also got a 13yo girl who had fallen from a moving vehicle and has a skull fracture we are pretty sure. We can't do x-rays at the hospital right now so we sent her to a town about 45 minutes away, but their power was out, so she was brought back to us. we had no collar to stabilize her neck, so by the time she returned we decided that trying another hospital farther away was more risky. So she is on the peds ward and I don't know what will happen to her.

Surprise twins were born last night. The mother had no idea that there were 2. We delivered the first, reached in for the placenta and encountered another head instead. Unfortunately these little ones were too early. They would have done well in the US where we could give them surfactant to help their little lungs work, but here we have none. They were placed on what oxygen we had and their bodies wrapped in plastic bags to hold in their body heat. I was called later in the night because they needed to turn off the generator, but the babies oxygen was from an electric compressor. They would die. Then the nurse asked if it was ok to turn on the smaller generator. I almost cried with relief as I answered "yes." However only a few minutes later I received word that one of the twins had finally run out of strength to breathe. The other is still alive this morning and we are praying for a miracle for those tiny lungs.

My living situation here is actually really wonderful. My roommate is a blessing and the other couple sharing our kitchen (a med student and his wife) are great fun too. Last night we made an italian feast complete with spiral noodles topped with homemade spaghetti sauce and fresh basil. An appetiser of mozzarella, fresh basil and tomatoes in olive oil and delicious garlic bread. We ate by candle light since the power was out. Amazing!

And, last but not least, my roommate and I removed a 6 inch centipede from our bathroom last night. As first we thought it was one of the harmless millipedes that merely look disgusting, then we realized that it had 2 spikes on its tail and only one pair of legs per segment. Making it both ugly and poisonous. (gulp!) We took it outside and doused it with insect poison.

Please pray for the power to be fixed soon. Please pray for my patients. Please pray that the supplies for the x-ray will arrive, and that God will guide us as we try our best to care for people in horrible situations. Please also pray for a language tutor for me. I would like to be able to talk to my patients or at least respond to greetings from passerby.

Much love! Sorry for the long post. It's been a busy week.