The rain is tapping out a tune on our roof as I write. Abbi is tucked into bed, her curly hair falling over her face as she lays there. We've just had a fabulous dinner of Boerwors, a south African kielbasa meets chorizo tube meat thingy. Sounds weird, tastes good. We served it up with some eggs and tortillas, which you can actually get in the capital city. We probably should learn to make them, though. We ate our food with a great dip mix that my sister Katie sent us. Abbi loved it and kept saying "more spices, more spices!" She was also quick, as usual, to pray for uncle Casey at bed time.

This week has been a step forward for our family life here at Karanda. We're coming into full stride, I at the hospital and April with the HIV orphans and nursing students (at aerobics class, which she teaches). We're getting to know and love many of the locals, which is very satisfying. I've recently "taken over" the male ward. I use that term very loosely as Dr. Roland Stephens still rounds on the ward. I guess I just haven't seen as many wild surgical cases as he. Admittedly, I do like it when he is managing the post op laryngectomy, for instance. It's a tough ward, as one or two patients seem to die every night. Some are expected, others are not.

I've had the opportunity to talk to patients about the Gospel on the wards too. This involves slowing down a bit. But, sitting there surrounded by death watching the message of heaven collide with the stuff of earth is priceless. Watching a person's eyes as the message of the Gospel sinks in, I think I have seen some come from spiritual blindness into the light. I do not know their hearts, but some very close to death have actually come to life in those moments. Talking about God in this culture is not taboo. Indeed, these people are very in tune to spiritual realities. The idea of a spiritual realm is quite normal to these people. The ideas of an agnostic entertainment-centered culture, laced with political correctness would seem odd to most of these people.

In other news we're still learning a ton. Things I am starting to feel comfortable with include:

TB management and all things TB

HIV management and the slew of opportunistic infections/issues that arise in those patients

Malaria management

Really, really bad malaria management

Spinal Anesthesia

Ketamine sedation

various incisions and drainages

Suprapubic prostatectomies

VP shunts

Hysterectomies

Open reduction internal fixation of various long bones

Closed reduction of various fractures

hydrocele repair

amputations

wound care

skin grafting

I'm learing a lot about bowel surgery, thyroid surgery, and hernias as well.

There is a lot of other stuff we're learning on a daily basis as well. There's always a lot to learn.

The best part of working here, however, is the quality time spent together as a family, quality time spent with our friends, and growing in our relationships with the locals. Life this week has been deep and real in the ways I had hoped for when we left. More and more ministry is happening on the wards. This too, is one of the best parts of working here. Indeed, it is why we are here.

Some nice photos:

Huge thyroid we took out the other day.

Priceless photo of Abbi filling up rain buckets to fill her pool (mom and dad helped too!)

Surgery list from last wednesday

Luke 7:

Jesus Anointed by a Sinful Woman

³⁶ One of the Pharisees asked Jesus to have dinner with him, so Jesus went to his home and sat down to eat.^{h]" style="font-size: 0.75em; line-height: 0.5em; ">[h]} ³⁷ When a certain immoral woman from that city heard he was eating there, she brought a beautiful alabaster jar filled with expensive perfume. ³⁸ Then she knelt behind him at his feet, weeping. Her tears fell on his feet, and she wiped them off with her hair. Then she kept kissing his feet and putting perfume on them.

³⁹ When the Pharisee who had invited him saw this, he said to himself, “If this man were a prophet, he would know what kind of woman is touching him. She’s a sinner!”

⁴⁰ Then Jesus answered his thoughts. “Simon,” he said to the Pharisee, “I have something to say to you.”

“Go ahead, Teacher,” Simon replied.

⁴¹ Then Jesus told him this story: “A man loaned money to two people—500 pieces of silver^{i]" style="font-size: 0.75em; line-height: 0.5em; ">[i]} to one and 50 pieces to the other. ⁴² But neither of them could repay him, so he kindly forgave them both, canceling their debts. Who do you suppose loved him more after that?”

⁴³ Simon answered, “I suppose the one for whom he canceled the larger debt.”

“That’s right,” Jesus said. ⁴⁴ Then he turned to the woman and said to Simon,“Look at this woman kneeling here. When I entered your home, you didn’t offer me water to wash the dust from my feet, but she has washed them with her tears and wiped them with her hair. ⁴⁵ You didn’t greet me with a kiss, but from the time I first came in, she has not stopped kissing my feet. ⁴⁶ You neglected the courtesy of olive oil to anoint my head, but she has anointed my feet with rare perfume.

⁴⁷ “I tell you, her sins—and they are many—have been forgiven, so she has shown me much love. But a person who is forgiven little shows only little love.” ⁴⁸ Then Jesus said to the woman, “Your sins are forgiven.”

⁴⁹ The men at the table said among themselves, “Who is this man, that he goes around forgiving sins?”

⁵⁰ And Jesus said to the woman, “Your faith has saved you; go in peace.”

Last week

Last week flew by. The week itself was sandwiched between two eventful weekends. The first weekend was marked by the celebration of Beau's 2nd birthday. We blew up the pool and had a crew of the local Afrcian kids over, along with thier moms and dads, who we've become freinds with. It was really a treat, because these kids have only seen pools like this on TV or read about them in a book. The same goes for things like tents, firemen, and other things we consider staple experiences of life growing up in the states.

We bbq'd some hot dogs, cooked up some mac and cheese, and served it up with cold coca cola. Coca cola is yet another treat that people usually don't choose to spend limited funds on, so that was nice for the kids.

We were on call this past weekend. Aside from the usual C Sections and sick people being admitted to the hospital, we had an interesting night on Friday. I was awakened at 4 AM by John softly tapping on our door. I figured he was just getting me up for a C section. I rolled out of bed and was shocked as he repeated to me, "A lady just stepped on a land mine." It turns out that the combatants in the war in Zim in the 1970's employed a great number of land mines. Attempts have been made to remove these, but they have obviously fallen short in their efforts. Don't worry too much, the mines are mostly located far north of us on the Mozambique border, where this woman came from. There have been no incidents like this where we live. The explosion devastated our patient. The shrapnel shredded her left leg and injured the rest of her extensively. As we unwrapped her bloody stump in the OR, the remains of her foot hung from thready sinew. The atmosphere was solemn as we initiated spinal anesthesia, amputated her injured leg below the knee, and cared for her wounds. I have not included photographs of this out of respect for the woman, who is recovering well. I have included several photos of other patients, though (and their chickens).

This woman was more than proud of her chicken. People sometimes pay their bill in chickens here. I guess a chicken is worth 2-4 dollars and a cow is worth 200.

We resected the mass from this boy's face the following day. He'd been misdiagnosed many times before coming to Karanda.

Abbi and Beau hanging out at the pool. The smell of the chlorine (yes, we chlorinated it) reminds me of hanging out at the pool when I was a kid. I can just taste the frozen snickers and coca cola from the snack bar and hear the 80's music in my head when I smell the chlorine. What a great childhood I had!

April looking pretty at one of the many birthdays here. Pretty much, people play football (soccer), go to church, and have birthday parties around here for fun. Not much else going on in out in the African bush.

Pretty soon he'll be carrying jugs of water on his head too. The African ladies won't know what to do with themselves.

A two sentence commentary on Luke 7:22:

²⁰ John’s two disciples found Jesus and said to him, “John the Baptist sent us to ask, ‘Are you the Messiah we’ve been expecting, or should we keep looking for someone else?’”

²¹ At that very time, Jesus cured many people of their diseases, illnesses, and evil spirits, and he restored sight to many who were blind. ²² Then he told John’s disciples, “Go back to John and tell him what you have seen and heard—the blind see, the lame walk, the lepers are cured, the deaf hear, the dead are raised to life, and the Good News is being preached to the poor. ²³ And tell him, ‘God blesses those who do not turn away because of me.’”

I find it remarkable that Jesus puts telling the poor about God's plan for making broken people right with God on par with raising the dead. Just amazing.

2010 Valentine's Day Special!

It has been a week since we drove back to Karanda Mission Hospital, over the lush, floral highlands, flanked by mountains in the distance and down into the arid bush where the hospital is located. John and I felt like school boys who had just gotten our drivers licences as we bounced along the winding two lane highway in our late model blue Land Cruiser. I've wanted to drive one of those for many years and getting behind the wheel (on the left side of the car) was a thrill. A sea of people, cattle, and women carrying the day's wears on their heads parted before us as we mounted the crest of each hill. We jimmy rigged three car seats in the truck, as you can see above. I'm sure it wouldn't pass inspection back home, but we definitely felt better with the kiddos strapped in.

This past weekend, we weren't on call. So, we did a whole lot of nothing- which was great! It was incredibly hot, so we set up the swimming pool in the courtyard. Grandma and Grandpa sent it to us with Dr. Todd when he came, and we've been dying to bust it out since then. The kids had a great time at what we jokingly referred to as "Karanda Country Club" or "Karanda Beach Club."

Sunday, John and I went traipsing through the old air strip, which is now a maize field, in search of flowers to cut for the girls for Valentine's day. John valiantly hopped a barbed wire fence to cut down some wild flowers for the girls, while Abbi and I stood watch with the getaway stroller. We had to bolt when we spotted an ox cart plodding our way. We didn't want to be caught on property not ours' with contraband flowers.

April got me Valentine's day coffee mug down at one of the local shops. As she entered the "shop", in which she was the only customer, the shop keeper announced aloud in broken English "Happy Valentine's day 2010 special," It was surreal having a Blue light special announced to a crowd of one. This is especially true, as Valentines day really doesn't exist anywhere Hallmark doesn't have a strong market share (i.e. Zimbabwe). The shop keeper then proceeded to read to April the words plastered on the side of the three different available mugs. "Happy Valentines day, I Love You, Best Lover in the Word" she repeated again and again in case April couldn't read them. We were shocked to see any Valentine's gifts as the shops here usually only have things like flour, sugar, milk, the basic survival foods. It was quite hilarious!

After John and I totally botched a huge batch of pancakes that same morning, we headed to church. Abbi decided to wander out during the first song, so I just followed her. She found some ants and a rock she called "Abbi's little rock" that she managed to hang on to for an impressive amount of time. We meandered home and Abbi fell fast asleep. The two hour Shona church service just cuts in on nap time. I chuckled as one at a time, John and Shea came back home early too, kids in tow. April made it through the whole thing, though. Well done, April.

That night, Ms. Niamonde, the food services lady for the nursing school here, had us over for dinner. We were served sadza (said phonetically), greens with oil, vegetables with peanut sauce, two kinds of beef (one with peanut sauce), popcorn, and peanuts. I have had sadza in the past and was never a big fan, but this was really quite delicious. About fifteen of us crowded into Ms. Niamonde's small living room, and shared the tasty meal in the dark as the power was out all day on Sunday. I was humbled by her generosity.

Laying in our beds surrounded by still, hot air on Sunday night, we prayed for the power to come back on. As we concluded the prayer with a sweaty "Amen," We heard the whir of fans kick on. Amazing. I don't know that God kicked the power on just for us in response to our requests. But I am pretty sure that He wanted us to ask him for the power. It certainly did get our attention! As I walked out of our place to shut the generator off, the cool night air accented by the hot pavement under my feet and brilliant stars overhead, I was acutely aware of the blessing and where it came from. Had we not had electricity, it would have been a long, long sleepless night.

I spent today in surgery. We had our usual assortment of various cases today. Skin grafts, VP shunts (tubes to take extra fluid from the head to the belly), lots of ultrasounds, and orthopedic cases. It's funny. I'm starting to have weird cravings for things that I wouldn't have thought much about in the states. Today I was craving going into a truck stop and just buying some coffee and maybe picking up a couple of things I don't need on the way out- maybe a bag of Combo's or something. I also really wanted to listen to Dr. Dre today, too. I was really bumping in my head as I did a couple of ultrasounds today. I'm not a gangsta rap kind of guy...I'm just saying, I've got weird cravings.

Also, of note, Beau turned 2 today. We had a blast...more on that later. Also a shout out to Colton (born 2/15/10) and Kate (born 2/16/10), John's new nephew and niece. Welcome to the world!

coffee and surgery

Those of you who know me know that coffee easily ranks in my top 10 things I love in life. You'll find most places have instant coffee, which will do in a pinch. Here, 10 AM signals tea time. Most things grind to a halt for a half an hour or so, while people consume tea and some form of cookie AKA "biscuit" (said with an English accent). We have no coffee maker here in the guest house, where we live and instant coffee can only satisfy a man for so long. Imagine my joy when our new friends, the Everswicks, lent us their french press last weekend. For those of you who don't know what a french press is, see the photo above. It's not my french press, but it is a french press. and my coffee cups aren't that fancy. definitely no saucer. But, you'll get the idea.

Just as an aside, and this whole post is pretty much an aside, we've been listening to sermons by a guy named Matt Chandler recently. He's a pastor at the Village Church near Dallas, TX. The website for his church with his sermons can be found at:

http://fm.thevillagechurch.net/sermons

My favorites of those sermons are those on Ecclesiastes. I went ahead and linked them below. Do yourself a favor and listen to them, I think they changed my life. You might even just make yourself a cup of coffee and then listen to one. Who knows, the possibilities are endless. just click on the little green file and listen to it or if your computer savvy (AKA under the age of 30) you can just put it on your itunes. I find that his sermons are immensely practical. He approaches the things that plague today's church with a great deal of honesty and practicality. He just works through Biblical texts and draws out very applicable lessons. Just check them out. You won't be disappointed.

7.09.06The Sixth SenseEcclesiastes (Part 1)Matt Chandler7.16.06QuenchedEcclesiastes (Part 2)Matt Chandler

7.30.06The GiftEcclesiastes (Part 3)Matt Chandler

8.06.06IngredientsEcclesiastes (Part 4)Matt Chandler

8.20.06Out of BreathEcclesiastes (Part 5)Matt Chandler

8.27.06Communal LessonsEcclesiastes (Part 6)Matt Chandler

9.03.06Approaching the DivineEcclesiastes (Part 7)Matt Chandler

9.10.06Searching for SatisfactionEcclesiastes (Part 8)Josh Patterson

9.17.06Coffee with Granddaddy IEcclesiastes (Part 9)Matt Chandler

9.24.06Coffee with Grandaddy IIEcclesiastes (Part 10)Matt Chandler

10.08.06Love InterruptsEcclesiastes (Part 11)Matt Chandler10.15.06ReconciliationEcclesiastes (Part 12)Matt Chandler

10.22.06Occupied TerritoryEcclesiastes (Part 13)Matt Chandler

12.03.06Daily ContactEcclesiastes (Part 14)Matt Chandler

12.10.06A Life Lived WellEcclesiastes (Part 15)Matt Chandler

2.17.06To the Young and the OldEcclesiastes (Part 16)Mat Chandler

On a medical note, I'm currently reading through selected entries of this book:

much of the text can be found here, though I believe without the great illustrations:

It's an excellent text and has a second and third volume in the set. Those are on the topics of the surgery of trauma (largely orthopedics) and that of anesthesia. We are progressively being allowed to do more in the operating room. We see lots of urgent cases in the OR but surprisingly few acute abdomens. I'm starting to enjoy the outpatient medicine that we do on a daily basis much more. In fact, the situation here is such that the people we see in the outpatient department with surgical needs are sent (more or less) straight to the OR and seen by whichever one of us is not in the outpatient department that day. We get some pretty quick feedback on how the patient did and just what was done for them. So, it's a good way to learn. Additionally, we're becoming much more comfortable with Malaria, HIV, and TB- which seem to be the "bread and butter" of ambulatory care here.

BTW...Abbi got her hair did by one of the nursing students. check it out.

and when the braids came out...