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

Here, kitty, kitty...

Hi friends.  Sorry it has been so long since I have updated my blog.  Two weeks ago I actually went on vacation.  It was so nice to have a week without the stresses of hospital work.  Along with Alice (who is here doing the same thing I am) and her husband Elliot, I got to explore some of the beautiful country that is Zimbabwe.  We packed up and headed into Harare where we were met by our guide driving a small blue extended cab pick-up.  His name was Taps and he took great care of us driving and cooking for us the whole trip.
  Our first stop was a private animal park, Antelope Park.  There I fulfilled a long time dream of mine to go horseback riding in Africa.  We saddled up and rode through the game park, herding a family of warthogs and getting pretty close to a group of zebra.  The next morning we walked with lions.  They have four 15-month old lions who they release every morning and allow people to walk along with.  These lions are perfectly capable of tearing people limb from limb, but seem to be unaware of their own power yet.  So we walked with them and petted and posed and survived.  Yay!  Afterward we participated in elephant training.  It's a bit like a circus.  They show us what the elephants can do then we get to climb onto their backs.  There is an option of doing a safari elephantback, but I was glad we picked horseback instead.  Elephants have big uncomfortable backs!

  We then hit the road again, arriving in Victoria Falls that afternoon.  The place that we stayed was beautiful and we were able to see wild elephants at a watering hole from the balcony of the main lodge, but we stayed in our own beautiful lodge house with a backyard and view of the stars.
  The next day we visited Victoria Falls.  Because this is the rainy season, the shear volume of water going over the falls is staggering.  It creates a cloud of spray that rises up to the clouds and falls back to earth as rain.  Just when we thought we couldn't get any wetter we did.  Looking across several of the lookout points we could see nothing but water flying up into the air.
  I crossed the bridge into Zambia which had some beautiful views of rainbows created by the spray from the falls.  In Zambia, my friend Ashley from residency and her husband, Sean, met me and we had lunch and discussed life in Africa, working at mission hospitals.  They had just finished some time in Angola at a mission hospital.  It was so great to see friends and to talk with people experiencing the things I am.
  On the way back across the border into Zimbabwe, I stopped to pet a cat.  A man passing by saw me and claimed ownership of the cat.  He told me he would sell her to me so I could take her back to Zimbabwe.  He also pointed out that she was pregnant and hungry.  I told him that he should find "his cat" some food.  He asked for money to "buy her food."  Ahhh... the entrepreneurs here, always happy to sell things, whether they own them or not. ;)

  We ate at the biggest tourist trap in Zimbabwe that night.  The Boma restaurant.  This is me eating pumkin soup out of a caudron.  I also ate a fried worm, impala, warthog, ostrich, and crocodile.  The ostrich and the warthog were pretty good.  Sorry Pumba!

   I also got my hair braded by a woman who worked at the restaurant.  As she worked, I asked about her family.  She told me that she was a single parent of a 13 year old boy.  I asked her if she wanted more children someday (yeah, I'm nosy).  She told me she had once had another child, but when he was seven, he went to visit some relatives and they called her one day and told her he was dead.  She doesn't even know what happened to him.  My heart broke for this young woman trying to raise her son alone and missing her other child.  Please pray for Maureen.
  We stayed another night in the beautiful lodge house and our guide cooked us french toast for breakfast with chutney (my new favorite thing that goes with everything), then on to the gamepark where we drove around for a few hours and saw several elephants, giraffes, crocodiles, hippos, impala, zebra, kudu, monkeys, an eagle, and a rhinoceros (which, in full disclosure, we could only tell was a rhino when we looked through our binoculars).

  But all in all it was an amazing vacation, good to get away for a bit, great to see friends, and humbling to see some of God's many wonders.

A mother's heart

A week ago I could have told you there was something called a molar pregnancy.  I could also have told you its classical appearance on ultrasound: a cluster of grapes.  This week I can tell you about Rachel.  She is 24 and fairly well to do by Zimbabwe standards.  She has 1 child and has been expecting her second child in May.  At her recent 28 week check-up they noticed that her belly was measuring significantly larger than 28 weeks and they couldn't hear baby's heart sounds.

  I found Rachel lying on the ultrasound table on Wednesday afternoon waiting for me to tell her when her baby would arrive.  I began to look around her belly with the ultrasound probe, but found nothing that looked like a baby.  Just a uterus full of something.  I called Sekuru (the seasoned surgeon) to have him look also.  And he agreed: full uterus, no baby.

  I broke the startling news to Rachel who nodded and agreed to have surgery in the morning to clean out her uterus.  I took her outside to get on the schedule and then caught a glimpse of her face, stoic moments earlier, now awash in silent tears.  For 6 and a half months Rachel had been waiting for this little one.  Everything had seemed ok.  Her belly grew.  She had no bleeding.  She kept her appointments with the antenatal clinic.  Perhaps she wondered that she didn't feel the baby move much.  Now all those efforts and hopes were gone and she needed surgery.

  The next morning I did the surgery and found a placenta and tissue consistent with a molar pregnancy.  There never had been a baby, just a mass of cells.  But for Rachel there was a baby, the one in her mind that she was expecting.

  I know a lot more about molar pregnancy now.  Rachel is at risk for cancer.  She needs to have close follow up to make sure her "pregnancy hormone" levels go down to normal.  It is important that she not get pregnant again for a year while her hormones are monitored for a rise in the hormone that could signal a cancer.  I also know that a mother's heart was broken this week and that I don't have a medicine for that.  So I'll ask you to pray for Rachel.

  I have some pictures of Zimbabwe that I have been wanting to share with you.  This is a beautiful place.

Double rainbow seen from the guesthouse in Harare

 Nyasha ('Grace') who sells in the market in Harare

 Flowers on a tree outside the Harare guesthouse

 Rain clouds on the horizon at sunset

Miscellaneous Fun

Thanks for praying for rain! We've had good rains twice in 24 hours.

I did the first C-section that I have ever done by myself. The other docs were gone for a walk when the maternity ward called. I looked around and realized that it was me or nothing. Ok, ok, I wasn't by myself, there were a scrub tech and a nurse assisting me. But no other doctors around. It went very well and mom and baby are doing great! And it made me feel loads better.

I found a wild kitten near the hospital. They let the cats live at the hospital because they keep the rats away. This little guy isn't much use yet, but he sure was cute and soft.

My roommate, Corrie (who, incidentally, I no longer share a room with) has her birthday this Monday. We are having a party for her Sunday night and I was asked to bake a cake for her. This was the result. I think if she was 5 years old and having a princess party this would go over well, but it might be a bit, er, pink for her.

Yesterday I assisted on a surgery to remove the biggest tumor I've ever seen in real life. Warning: it's intense...

This was from one of her ovaries. We're actually pretty sure that it is a benign tumor. It was sitting in her belly just about where I am holding it. (and please ignore the fact that it bears a strange resemblance to the cake above.)

Miracle!

This morning at 3am the phone rang. The Shona accents over the phone still throw me for a loop, but I caught the words "maternity ward," "bleeding," "can't find heart tones" and it was enough to set my heart racing and me racing down to the maternity ward. I arrived to find a young woman groaning in pain.

The report from the midwives was that she was 37 weeks along and someone had thought maybe she had twins. She was dilated to 3cm and had been having pain for about 10 hours. They had not been able to hear any heart tones for the baby. I asked for the small ultrasound locked in the c-section room and about 5 minutes later we found someone to open the door so we could get it. I struggled to get information from the 5-inch gritty black and white screen before me. Only one baby. Head down. And I saw lots of things that looked like mom's pulse, but not baby's. Then I caught a glimpse of something faster. A baby's heartbeat! I couldn't tell if baby was ok, but I had a strong feeling things were not ok. Mom wasn't bleeding a lot, but something seemed to be wrong. I checked her cervix and found that she was completely dilated. I believed that she needed to deliver now and the midwives encouraged her to push. This was her 5th baby. We broke her water and a few minutes later she pushed the baby out.

But my relief was over in a second. Baby and placenta came out together with a large clot attached to the placenta. She had abrupted (when the placenta breaks free of the uterus early and loses it's blood supply.) The baby was dead. The midwives sat it aside to deal with mom, but I was certain that I had glimpsed heart activity within the last 15-20 minutes, so I grabbed up the limp baby and carried him to the warming lamp. There was no pulse, no sign of life in the tiny body. I started doing chest compressions, pushing against the soft chest to push blood out of the heart and around the body. A nurse joined me and gave baby breaths with an oxygen mask and a bag. I began to pray, "Lord, please. Just give me this baby." "Please, Lord. Not another dead baby. Please, let him live." I just kept pressing on that tiny chest and praying. All around me the world was going crazy. Just behind me the midwives were working to deliver a breech baby whose head was caught. Across the room there were other patients in active labor. And still I kept pressing on that little chest. I could feel the tiny waves of blood pushing around with each compression, but no sign of life. The little body seemed so cold. I wrapped a blanket around his legs and moved the warming light closer. And then, 20 minutes after starting CPR, I felt something under my fingers. A tiny flutter. A heartbeat. We continued to breathe for the baby, squeezing the little bag of oxygen and I rubbed that little body dry and pink. Another 20 minutes passed and I prayed over and over again, "please, Lord, give me this little one back" and then the nurse held up a hand to stop me, pointing to the chest where it was now rising and falling with baby's own breaths. We kept the little boy under the warming light with oxygen and another 20 minutes later we were getting weak cries, almost squeaks, of protest and he was waving his little arms. The midwife who had delivered the baby and set him aside walked up to me and said, "baby responded well to resuscitation," and I thought "HECK YEAH!" "THANK YOU, LORD!" This morning, about 6 hours after his birth, I checked on the little man and he had started to suck and been trying to eat. He opened his eyes to my voice. I wonder whether he recognized it from those long minutes when I pumped his heart for him and told him to wake up, he had things to do. I am still completely overwhelmed, by the grace and mercy of this miracle. I feel like the Lord saved me when he saved this little one. It is by far the coolest thing in which I have ever played a part.

Some specific prayer requests:

1. We need rain here. This is supposed to be the rainy season, but rains have been sparse and the crops are suffering.

2. My boss, Dr. Todd, visited this week and will be heading back to Wichita in the next few days along with Dr. Leu, Dr. VinZant, and Todd's daughter, Sarah. Please pray for their safe travels.

3. Today, a 5 month old baby died suddenly and unexpectedly. Please pray for this family.

4. Pray for me that I will have endurance and represent Christ well in my work here.