WATER

Please pray for Karanda right now.... No water for 5 days.... Borehole is drying up....hospital is in rough shape, as you can imagine.

We can survive fine, but things at the hospital are difficult. No water makes things like sterilization and running oxygen very difficult. Also, the bulbs on all the microscopes in the lab are burnt out so they are not able to do "Malaria Parasitic Smears" to diagnose Malaria. We only have about 50 rapid diagnostic tests for malaria, so that will last through Tuesday or so. We made a trip down to the borehole to fill some buckets last night to find that the borehole is also drying up. God always provides so we're not too worried, but please remember the hospital in your prayers today.

I smile as I read Psalm 63:1 " O God, you are my God; I earnestly search for you. My soul thirsts for you; my whole body longs for you in this parched and weary land where there is no water."

God is in full control :-)

It's amazing how often the Bible speaks of "water" :

John 4:10 Jesus replied, “If you only knew the gift God has for you and who you are speaking to, you would ask me, and I would give you living water.”

John 7:38 Anyone who believes in me may come and drink! For the Scriptures declare, ‘Rivers of living water will flow from his heart.’”

Nehemiah 9:15 "You gave them bread from heaven when they were hungry and water from the rock when they were thirsty. You commanded them to go and take possession of the land you had sworn to give them."

Isaiah 41:17 "When the poor and needy search for water and there is none, and their tongues are parched from thirst,then I, the Lord, will answer them. I, the God of Israel, will never abandon them."

John 4:13-14 Jesus replied, “Anyone who drinks this water will soon become thirsty again. But those who drink the water I give will never be thirsty again. It becomes a fresh, bubbling spring within them, giving them eternal life.”

We Have No Power, Yes

I'm sitting in the family room of the guest house here at the Karanda Mission Hospital. We're currently out of power and water. This has typified the last week or so, though the supply of both was essentially uninterrupted for the first two weeks of our trip. Apparently, the news media announced yesterday that the entire country would be experiencing power outages, as the "cold" winter months mean greater demands on the power grid nationwide.

Hearing that news bit reminded me of our experiences last year at this time, when brown river water was average fare for showers and our water filters. On more than one occasion were my hands literally covered in mud when cleaning out the ceramic candles on our British Berkfeld water filter. We do have certain expectations of the visceral nature of life here in this place. That is, we have chosen to embrace the satisfaction and frustration of the simpler life that we've come to know here.

I find myslef, not unlike many Americans (particularly North Americans, as my South American friends have reminded me) to be a big fan of efficiency. On my first longer term trip to Bolivia, I was shocked with the inefficiencies in work flow processes and a bit put out by my "untapped talent" as a fourth year medical student. I was certain, at the time, that if the powers that were only realized just what they were missing, they'd just feel plain foolish. I spent the better part of the month stocking shelves and inventorying the pharmacy- which was completely depleted of all of it's diazepam after we injected and reinjected a pig for an "anatomy lab" with the local surgeon. I learned some good lessons on that trip, the greatest of which was that my value lies squarely in my relationship with Jesus Christ, the Risen Lord, and nothing else. Perhaps if my "supreme medical student greatness" had been realized during that trip, I wouldn't have learned this very important truth.

Recently, another volunteer, who will be coming to our hospital this summer has been corresponding with Alice regarding any needs that the hospital might have. In addition to listing a few items that might be helpful on the wards, Alice mentioned that we'd recently had a few OB mishaps. Among them was an issue of a laboring woman, whose baby demonstated "fetal distress." Now in the States, that baby would need to be delivered by c section within about a half hour of seeing those warning signs. Here, things are just different. It took about two hours to get the necessary people together and longer just to get everyting in order. I think the mom and kiddo did OK, regardless. Praise God!

The reason for such delay is easy to see from here. Every time the operating room needs to be opened after hours, the guard must be located and then sent to alert theatre staff that an emergency is taking place. Now, usually the guard would walk (not very briskly) to the south gate of the mission compound, to the "shops" area and get the staff. However, since we're also out of water, the towns people have been stealing water from the hospital system and the south gate has been locked. So, the guard must now walk out the front gate and traverse the entire perimeter of the hospital in order to get the message to our anesthetist. This usually would be remidied by the use of our on campus phone system if the power were on, but the phones have not been working in months.

Things at the hospital have been busy lately. TWO eye surgeons were here last week, mainly performing cataract surgeries on the teaming masses of eye patients that showed up upon hearing of duo's arrival. I'm quite sure that all of the eye patients brought thier entire extended families, as we've had several uncomplicated patients intersperced with the living skeletons and long festering wounds that usually show up in the clinic here. All in all, the place has been a zoo for the last week, and I don't really think that is forecasted to let up any time soon. Last weekend I took operative OB call for Kiersten, the PA that wears several administrative hats (in addition to clinical duties) for the time being. As I mentioned, I did eight C sections during my weekend of call, which is busy, even by Karanda standards. Among them was a ruptured uterus, placental abruption, and several which gave me cause to pray silently and the mother's bleeding seemed like it would never stop.

Sunday was a particularly busy day. April and I had laid down to take a nap that afternoon. When I woke, it came out that Alice and Alexis had gone down to take care of a C section on a mother who had been transferred from a nearby clinic. I quickly went and relieved Alexis, glad to keep Alice around as the case was likley to be ugly. I smiled at several dozen lively faces, thinking that such a crowd gathering at the hospital gates was odd on a Sunday afternoon. I'm sure that I attemped my very sparse Shona banter with them as I walked, but I wasn't greeted with the usual pleasantries. The girls filled me in on the particulars of our patient, including her very low blood count and distressingly low fetal heart rate. I immediately requested the presence of the on call lab man, but it turned out that he had gone to a soccer game in town about an hour away. I looked for the security guard to help me find the back up lab guy, but the security guard had gone to find the other theatre staff. Rather than just sit and stare at each other, Alice and I set to work attempting to ready the patient for surgery. The generator was on, so I grabbed some oxygen tubing to help out the mother and baby. I was met only with a loud beeping noise. In desparation, I wrestled with a huge oxygen tank, dragging it into the patient's bedside in the operating room. I never knew an EMPTY oxygen cylinder could weigh so much. Finally, we drug a third oxygen unit, an old concentrator, into the room and got it working. I decided to place the spinal anesthesia myself, but was unable to find Ephedrine, in case we ran into blood pressure troubles during the section. It happens that there is not a single bottle of the stuff in the hospital. About that time, the scrub tech told us that we had no sterile drapes for surgery. Working hard to hide my frustration, I re-approached the security guard at the front gates. I asked him if he'd gone to get our anesthetist. His blank stare was answer enough. After asking him a second and third time with only a "deer in the headlights" response, he told me that he'd go try to find them. It seems that the growing mob at the gate was actually a large, disgruntled family who were angry because the hospital had given away the body of their loved one to a different family. This would only have been an embarrassing foupaux, but the body in question was now under several feet of earth near the Mozambique border. Talk about falling patient satisfaction scores. In the midst of an embarrassing conflict, our guard had forgotten to get our anesthesia people. After the theatre staff trickled into the maternity ward, we finally went to scrub for our c section only to find a scrub solution so watered down that it did not make even a hint of bubbles on our hands as we prepared for surgery. Things got dicey when the scrub tech notified us again that the hospital was completely out of sterile drapes. So, we then draped our patient in surgical gowns and got on with the operation. It seemed that anything that could go wrong was going wrong. But, in the end, the lady got the blood she needed and the surgery went off without too many setbacks. Thankfully, in the end the lady and her baby did well and everyone lived to see another day despite the spiraling chaos around us.

Proverbs 14:31

" Those who oppress the poor insult their Maker,

but helping the poor honors him.

1 Cor. 13:3

"If I gave everything I have to the poor and even sacrificed my body, I could boast about it; but if I didn’t love others, I would have gained nothing."

Just some photos from a walk that the girls and I went on the other day:

Flat Stanley

Flat Stanley has had a long journey since leaving his comfy classroom of Ms. Haskell's in the Midwest. He had been on a few airplanes, first landing in Washington DC, then Addis Adaba Ethiopia, and finally Harare, Zimbabwe. Enjoyed the bright new shirt and shorts he was given by Abbi, his 3 year old new caretaker! They have had many adventures together already!

First, he was introduced to the beautiful Plumeria trees here in Zimbabwe and even got to climb one!

Then, he was learning how to pump water from "borehole," which is like a well. This is how people here get their water - a lot of them don't have faucets and sinks. So, they may walk long distances and fill a bucket with water. Then, they walk home carrying that bucket of water on their head!

Flat Stanley has come to Zimbabwe with us to serve and help people at a hospital. Here is the view from our hospital gate. Very beautiful!

Here's Abbi introducing Stanley to his job as a missionary at this hospital - Serving God and Serving Others. Stanley is excited about this great opportunity!

Stanley was then taken to the Pediatric Ward here, where we thought he would enjoy visiting with the children. We won't take you inside today because many of these children are very sick right now, and we try to be careful about where we go.

Stanley did have to get used to sleeping under mosquito nets, like this one in the hospital. It protects him from mosquitoes at night that could give him an illness called Malaria. It took a little while for Stanley to get used to sleeping under these nets, but it made it more fun when we pretended like it was a "tent!"

Stanley really enjoyed visiting with the patients at the hospital - he had lots of fun taking pictures with them, especially the babies!

Later in the day, we took Stanley up to the local school and visited the 1st Graders as well as the Preschool. Stanley liked being in the familiar setting of the classroom and saw that these kids were learning similar things to the kids in Ms. Haskell's class. He was able to jump in on some spelling and math lessons!

He did notice that all of these children wear uniforms and walk a long way to school!! They speak a language called Shona, and English is a second language for most of them.

But no matter how different these kid's lives are from the kids back home, they still love to laugh and have fun!

We ended our day with a hike to visit one of our friends, Mrs. Grace's home. She lives in what they call a "musha." This is a round home built of bricks with a straw roof. She is one of our friends who helps cook food for kid's club. Stanley loved getting to visit these kind people and seeing where they live. He had fun with the chickens, cows, and dog running around. We also showed him their storage bin of corn, which is their main source of food. They grind it up into a substance called sadza - kind of like mashed potatoes.

Stanley has had a big trip already and really loves helping us in Zimbabwe! He misses his friends and family back home, but he is so thankful for this opportunity that God has given him and is enjoying every day here!

Busy Hospital Days!

Our time in Zim is moving steadily along. While life is generally a slower pace (think less meetings, softball games, cell phones, and trips to wal mart), things have been quite busy at the hospital lately. This is a typical picture of the "waiting room" here at Karanda!

Just a before and after picture of a massive tumor resection of this man's shoulder/arm.

While the wet season- usually followed closely by her ugly sister malaria season- is long past, we have had an unseasonably high number of malaria cases. All of our wards have been affected. I've had urban men in their late fifties, otherwise healthy women in their early twenties, pregnant women, and even young children passing through our clinic with the diagnosis of malaria. The hospital- perhaps even the country- is completely out of our Rapid Diagnostic Test supplies for malaria. For the lay person, this is analogous to the EPT of the pregnancy testing world. simple. easy. could be used by a third grader. only it involves a skin poke, so I don't actually endorse third graders running around doing RDTs. Consequentially, we're relying on our lab manpower to get more work intensive diagnostics done for those suspected of malaria. I've been pretty surprised at the accuracy of a Malaria Parasite Smear.

In addtion to being out of rapid malaria tests, we're also out of Coartem, our usual go to med for simple, short course malaria eradication. So, I've been getting good at several other forms of treatment. there is more than one way to skin the proverbial malaria cat. The flavor of the day is chloroquine and fansidar. Many of the sickest patients come in having seizures, tipping us off immediately to the diagnosis of Cerebral Malaria. These people usually wind up spending most of their time with us on a concoction of quinine and doxycycline.

Aside from treating TB, the great masquerader, HIV, that ravenous beast, and malaria, (and the permutations thereof) we care for a broad swath of surgical and medical maladies native to this part of the world. In any given day, we'll see Lymphoma, pediatric protein malnutrition, hydrocephalus (and subsequent shunting), cervical cancer, prostatic hypertrophy (and resultant , asthma, congestive heart failure, prostrate cancer and it's resultant orchidectomy, adult male circumcision, fungating cancer of the X (fill in the X), and all manner of orthopedic trauma.

This particular weekend I was on call for our hospital. This basically entailed rounding on all of the wards, taking night call, cleaning up Saturday clinic, doing any surgical work that I am qualified for, fielding all emergent labor, delivery, and neonatal work that went on. I would have literally been at the hospital all day saturday and sunday if our new pal Alice wouldn't have seen a couple of wards for me.

Our wards currently consist of 25 beds in the peds ward (sometimes kids are on the floor too), 30 beds in male ward, 30 beds in female ward, and 20 beds on maternity. We've got a 2 OR operating theatre, an orthopedic theatre, and an OB theatre room. It gets a little hairy around here when all of those beds are full.

My weekday assignment has been to round on the post partum moms and the premie babies. I've got a couple of 1 kg (2.2 pound) twins i've been caring for for the last week and a half. please pray for them. They seem to always just be on the edge of life and death. It's hard to be patient as we "feed and grow" these little ones. Many of the post c section ladies have complicated stories. Many labor for multiple days before we get to meet them.

Having taken care of the obstetrics ward over the last week, I was delighted to pick up the female ward as one of our local docs is away.

The female ward is great. The patients are a diverse bunch of ladies and much more conversant that the babies, so that's nice. There is a nice mix of medical pathology in the female ward, from cerebral malaria to advanced cervical cancer. Additionally we provide surgical care for a variety of conditions. we currently have patients that have hip prosthesis (austin-moore), pelvic fractures, tubo-ovarian abcesses, chest tubes, and ruptured ectopic pregnancy.

Currently we have to eye surgeons in town, so we are swamped with eye patients. All of the eye patients seem to have brought their entire families with them, as we are totally inundated with patients this week. it should be interesting. i'll keep you posted.

1 peter 1:22

"Now that you have purified yourselves by obeying the truth so that you have sincere love for your brothers, love one another deeply, from the heart. For you have been born again, not of perishable seed, but of imperishable, through the living and enduring word of God. For,

“All men are like grass,

and all their glory is like the flowers of the field;

the grass withers and the flowers fall,

but the word of the Lord stands forever.”

This is Abbi's new friend, Vimbanashe. She is 4 years old and lives here at Karanda with her Grandma, who is the cook for the hospital and nursing school. They love to dance and sing together. It's pretty entertaining to watch and listen to Abbi's broken version of "Shona."
Kids Club started back up this week. This is a program on MWF afternoons for HIV orphans. A meal is provided along with a Bible story, love and encouragement. The Kid's Club ministry has also have provided their school uniforms, shoes, and medications. It was very fun catching up with our little friends that we have missed! We brought some pictures we took last year and they loved seeing themselves in the pictures! Many of these have never had a picture of themselves. I think I will take some more and send them to a group coming in late June. We noticed a lot of our old friends from last year were not there. I learned that once they enter 7th grade, because of school schedules, the kids are no longer able to attend Kid's Club. We missed seeing a lot of the girls from last time! After talking with the missionaries, there has been some discussion about starting a Saturday Kid's Club for these older girls. This would at least provide them some high protein food, and even more important a time to study the Bible and build relationships with a Christian mentor - at such an influential time in their teenage lives! After discussion and prayer, we realized that the amount of money it would cost to fund this for at least a year, is the exact amount we were given by a generous family + the amount raised by the local Catholic school at our home! Praise God! Please pray for these kids!
Blessing, Collin, and Praise enjoying some Dum Dum's during Kid's Club!
Another friend, Caleb, is the 6 year old son of the Hospital Administrator. Abbi just loves playing with Caleb and he speaks English very well. She often obeys him much better than she does me! He is good at helping me keep track of her!
The kids (and adults) all love soccer here! Our church was able to send some soccer balls like this one Praise is enjoying!

I will be taking over a Wednesday Bible Study for about 10 Midwifery students starting this week. I am very excited about this opportunity! Most of these students are married and have children. They have finished 3 years of nursing school, worked at a hospital for at least 2 years and are now in a very demanding year of midwife training. I look forward to spending time with them . I think we'll go through a devotional by Beth Moore, "Jesus, the One and Only." We'll focus on the life and character of Christ. Most of them know the Gospel story here, but it's difficult to determine what they actually believe. Please pray for these women on their spiritual journeys with Christ.

Well, this is the non medical update of our week. We're doing really well - thank you so much for the prayers and emails! It's always so nice to hear what is going on at home! We'll do a medical blog update soon too!

Friday I drove to Harare with our hospital administrator and got my license. We drove 6 hours round trip for me to sign my name on a slip of paper. Now that I'm legit, I'll likely take over rounding responsibilities on one of the wards.

The past week has been a great time of family togetherness and as I've mentioned, I've been able to hop in on rounds, surgeries, and help out with various emergencies as they arise. Many of these emergent/tragic situations have involved our littlest patients, as seen above (these are the healthy ones!). Don't worry, Abbi isn't a patient, I just thought I'd throw in a photo of her on the swings for her grandparents!

On this mother's day I've had cause to reflect on the blessings of my mother and my wife. My mom is a wonderful woman and I'm grateful for the constant, tender care with which she raised me and for the wise friend that she is to me today. Of course, I'm grateful for April too and the wonderful mother that she is to Abbi as well as the wonderful mother she'll be to the little one within her. She is an incredible blessing to me each day.

This week we'll be transitioning to more of a leadership type of role here. April will soon assume leadership of a student bible study as one of the missionary teachers has needed to return home several months early for medical reasons. She's been hoping for an opportunity like this. Always personable, April will be a wonderful mentor and friend with these girls. As I mentioned above, I'll assume a much more hands on role her now that I have my paperwork all completed. Please pray that I can care for patients well. More importantly, pray that the beauty, glory, and perfection of God will be pointed out through our lives during our time here. Hopefully we'll be able to do point people to Jesus on the wards, while leading devotions, and in our interpersonal interactions. We'll try to keep this thing updated as we go along!

Chickens, and Goats, and Cows, Oh My!!

This week is going quickly and going well. Thanks for all of you who have commented on the blog or dropped us an email. We appreciate it. We're all getting our internal clocks adjusted to the new time schedule. Tomorrow will be one week since we've arrived, and we're hoping we should be pretty well adjusted by then! April and Abbi are getting along nicely. They look forward to the Kids Club orphan ministry which will resume this Friday. They have been on break from the "Easter Holiday," as the kids have been out of school for a week or so.

I am still waiting on official word for my Zim medical license. Never the less, I've been able to get very involved in activities at the hospital. It's been nice to scrub surgical cases with this year's international fellows, as well as pick the brains of more seasoned practitioners regarding pathology that I just don't deal with routinely in the United States. I have also been able to take care of some of the "grunt work" around the hospital that others would probably rather not do or don't have time to do. License or not, there has been more than enough going on to keep us busy.

Yesterday, Abbi and I went for a walk down around the hospital compound with our friends. As we walked, we encountered all sorts of animal friends. Please see the above photos of Abbi with the chickens that she was chasing (unsuccessfully) and the baby goats we were chasing (successfully). The goats are a part of a new feeding program here at the hospital. Many mothers in these areas die, mainly from HIV related diseases, leaving very young babies without a source of nutrition. Infant formula is scarcely available in the rural areas and is exorbitantly priced for our rural farming population.

Therefore, the hospital has started a goat project in which goats are bred and their milk is used to sustain the lives of orphaned children who would otherwise die of starvation. Though a fledgling program, I think it will play an important role in sustainable health care for this region.

We are very thankful for the opportunity to be here, and we have enjoyed already the change of pace and family time we are blessed with during this time. We value dearly the friendships we have and are excited to see how the Lord will lead us during our time here! Thanks for following along with our story!

Hebrews 4:12-13, “For the word of God is living and active, sharper than any two-edged

sword, piercing to the division of soul and of spirit, of joints and of marrow, and

discerning the thoughts and intentions of the heart. And no creature is hidden from his

sight, but all are naked and exposed to the eyes of him to whom we must give account.

From the Zimbabwean bush with love

After an English language church service this morning, we packed up and headed out into the bush in our long term missionary friend Judy's double cab Nissan pickup truck. We managed to get most of our luggage, including many generously donated supplies by churches back home in the states in the back of the truck interspersed with food items to supply our family for the next couple of months. At the end of a lovely three hour ride out into the African bush, we drove through a river that runs next to our hospital compound. Abbi got a real kick out of driving through the water, which at its deepest point nearly ran over the hood of our truck.

Upon pulling up to the guest house, which will be our home for the next couple of months, we were greeted with familiar smiles of local kids that we'd come to know very well last year and warm hugs from missionary friends. At this time last year, my freak-out-o-meter was registering off of the charts. This trip feels like coming home in a sense. Don't worry mom, we'll still be careful!

After a quick dinner(or supper for you fine Midwestern farm folk) several of the missionaries had pulled together a birthday tea and cake event for April and Alice. Alice, along with Alexis are two of the "Via Christi International Family Medicine Fellows," working and training here much as we did with the Epplery family last year. For those of you unfamiliar, you can check out the Epperly blog at www.epperlyadventures.blogspot.com. Abbi enjoyed the cake and drinks as much as everybody else. I was worried about Abbi spilling her large glass of juice during the party, but I was the one wearing most of my cake on my shirt in the end. I had to chuckle.

According to Alice and Alexis, call has been tough here recently and the work load has been great. So, we're glad to be back at this time. Please pray that my medical license would finish processing quickly so that I can work independently in the hospital. Zimbabwe isn't the most efficient place on earth in terms of paperwork, so these things happen. Please also continue to pray for Abbi as she adjusts to a new place and new time schedule.

We look forward to the next couple of months working and living here and we're excited to see just what the Lord has in store for us. Please also pray for April and the newest addition to the McQuillen family. April is out of her first trimester of pregnancy, which is one of the main reasons to delay our trip to Zim until now.