warning...moderate gross out factor.

WARNING..GRAPHIC BLOG ENTRY...PLEASE SKIP THIS ONE IF GROSS MEDICAL PHOTOS MAKE YOU QUEASY.

Well, I figured it was high time I provide you guys with a more "medical" blog entry. Friday, The Sheets family arrived at our hospital. Dr. Sheets and his family have been coming to Karanda for the past 12 years or so. Dr. Miller, an anesthesiologist friend of the Sheets also arrived with his family. A total of fourteen people came with the Sheets crew. I met Dr. Sheets in passing a year ago, but it has been a true pleasure getting to know him and his family better over this past weekend. They are remarkable people and it seems that everybody around here has been touched by their friendship and generosity.
Friday was a busy day in the operating theater (AKA "operating room"). As usual, we had a vast variety of pathology. I've been trying lighten the workload from Dr. Roland Stephens, our surgeon. He's in his early 80's and has provided heroic levels of service and care to the Shona people in our region (and people throughout this region of Africa, really). Usually, I'm able to take care of the ultrasound scans and minor surgery that happens. But, since this years international fellows wrapped up their time here, I've been happy to jump into more substantial procedures. I feel quite comfortable with c sections, tubal ligations, suprapubic prostatectomies, ventriculoperitoneal shunt placements, urethral dilitations, hydrocelectomies, orchidectomies, skin grafting, and most closed orthopedic procedures, to name a few. I'm growing in my comfort levels with other procedures as well.
Below you can see Dr. Sheets and I grafting the side of a guy's face that was in a car wreck several months ago. The white spot you see in the first picture is skull. This was visible through a defect in the tissue about the size of my thumb nail. In order to cover the bony area, we created rotation flap, which you can see repaired with blue sutures on the last photo. We probably could have used a smaller mesh setting on the grafted skin, but the final product will still look good.

Warm Heads All Around

As many of you know, Karanda is the major provider of surgical management of hydrocephalus in Zimbabwe. Consequentially, better than half of the kids in the pediatric ward suffer from hydrocephalus (literally too much "water on the brain"). Sometimes these kids come to us from nearby, but most of the time they come from far away. We even get kiddos from neighboring countries, such as Botswana, coming to us. More often than not, the children and their families have been put off for months by larger hospitals. I guess most neurosurgeons prefer doing back surgery on paying customers. As you can imagine the cost of surgery, a mere 200 dollars, seems onerous to a peasant farmer with a disabled child. Sometimes, by the time a baby gets to us, his head is the size of a watermelon- so heavy that he cannot hold it up. The sheer weight of it often causes sores to develop on the side of the head most often laid upon.

Before we left the US, a lady from my parent's church hand made a bunch of beautiful stocking caps for us to give away. Our previous experience here left us with more memories of sweating than shivering. So, though we were thankful for the donation, we were a little unsure of how useful they would be. Recently, we've learned that Zim can be colder at night than we realized. I've often shivered during the middle-of-the-night trek into the hospital on call nights, even while wrapped up in a fleece jacket. The winter chill is easily in the 40's. This is REALLY, REALLY cold to an African. Even during the day, I'll see guys walking around in puffy down-filled winter jackets and stocking caps- while we're in short sleeves. Most of the children in the Ped's Ward have very few warm clothes. So, unbeknownst to us, stocking caps were the perfect gift. Some of the hats the lady made were very small and some were very large - big enough for any adult. Amazingly, we found a head to match each hat, from the tiny premie heads, to the over-sized hydrocephs. Even better, we somehow had the exact number of hats as children in the hospital - not one less or any extra! I love seeing God's provision in simple matters. It's truly a privilege to experience God's goodness with our family, and for Abbi to learn this first hand. The mothers were very thankful, and the children are now warm!

Pillowcase Dresses and Shorts

Some nice ladies in a quilting guild from our town put a lot of hours into making these adorable dresses and shorts for us to bring to Karanda. They made literally a few hundred of them - enough for 2 suitcases full!! That's a lot of hours of sewing! These dresses and shorts are made from pillowcases - some of which were donated by people in town. It's so nice to have such an involved and supportive community - Thank you everyone who helped with this!! As you can see, they will get put to good use :-) The majority of the clothes will be handed out by a program here called HBC (Home Based Care). This is a local Karanda ministry that provides food, clothing, ect. to those in greatest need. They travel on outreaches to those who are not close enough to receive the occasional "handouts" from the short term missionaries. It's nice to know that these will go to the people who need them the most. We did take a few of the items with us on a walk and were able to hand some out to provide these pictures :-) It's always fun to see the kids getting some brand new clothes-especially when lots of kids walk around in rags on a daily basis! The kids seemed so happy to receive these beautiful clothes. They were very proud of their new outfits! Thank you quilting ladies!!

Do Not Worry

²⁵ “Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes? ²⁶Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? ²⁷ Can any one of you by worrying add a single hour to your life^[e]?

²⁸ “And why do you worry about clothes? See how the flowers of the field grow. They do not labor or spin. ²⁹ Yet I tell you that not even Solomon in all his splendor was dressed like one of these. ³⁰ If that is how God clothes the grass of the field, which is here today and tomorrow is thrown into the fire, will he not much more clothe you—you of little faith? ³¹ So do not worry, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ ³² For the pagans run after all these things, and your heavenly Father knows that you need them. ³³But seek first his kingdom and his righteousness, and all these things will be given to you as well. ³⁴ Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own."

Matthew 6:26-34

I saw him laying there, under his woolen blanket. It was grey in color, accented with flies that crawled upon it when not performing small aeronautics around my ears. Male ward is always a veritable cornucopia of smells. Yesterday was not an exception. The blend of urine, feces, and sweat stings the eyes and forces one to breathe through the mouth. I tend to just barely open my lips as I do this, so as to avoid any insects on a errant flight path. I could tell that he was small, just over fifty pounds or so, judging by the bulge lying on the bed. I purposefully read through his chart before lifting the covers, knowing that it would be hard to process information objectively once we met. He was seventeen. He had end stage HIV. Months of uncontrollable diarrhea finally had convinced his father to bring him to our hospital. His father stood by his bed, poor, uneducated, helpless, detached. Around the boy’s wrists, about the size of my three year old daughter’s, clung bracelets of red thread. Surely, he had been to the “traditional healer,” the prophet of his village cult-church well before this; well before his bones wore his flesh like skin wears wet fabric in August heat. His eyes protruded from his gaunt skull, which was adorned with thin hair the color of rust. Like a car corroding quickly, he was covered with rashes and wounds. Thrush had consumed his esophagus. He constantly leaked stool and with it any hope of retaining the little nutrition he could take in. His strength had long failed him. Surely he was carried to us in a cart drawn by two of his family oxen. I looked away, detaching myself from the “situation,” as the nurse told me in a flat tone that he had been crying out in pain throughout the previous night. I continued his antibiotics, his IV fluid, and awaited the results of our standard work up for tuberculosis. I partially covered him back up with his blanket, and moved on to the next bed.

His bed was empty this morning. His father gone. His bed still sits empty among thirty or so other men in the ward, each with varying degrees of suffering. Some, like the dead boy I met yesterday cling to life by a thread. A few will get better quickly and leave, soon to be replaced by others. It’s hard to know how to process this sort of thing. Sorry to be a downer.

And now...a picture of my kid with a puppy.

"Even though the fig trees have no blossoms,
and there are no grapes on the vines;
even though the olive crop fails,
and the fields lie empty and barren;
even though the flocks die in the fields,
and the cattle barns are empty,
¹⁸ yet I will rejoice in the Lord!

I will be joyful in the God of my salvation!
¹⁹ The Sovereign Lord is my strength!
He makes me as surefooted as a deer,
able to tread upon the heights."

-Habakkuk 3:17

Created In His Image

Water and power are back! Going without for just a short while really makes us thankful for the daily things we take for granted! Thank you for the prayers! We've been keeping busy at Karanda, as usual. We'll send a longer update this weekend, as Paul is not on call :-) Until then, here are some of the beautiful faces of children who we've been blessed by during our time here.

"Jesus said, “Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these.”" Matt 19:14

"Yet, O Lord, you are our Father. We are the clay, you are the potter; we are all the work of your hand." Isaiah 64:8

"For you created my inmost being; you knit me together in my mother's womb." Psalm 139:13

"So God created mankind in his own image, in the image of God he created them; male and female he created them." Genesis 1:27

"Great is the Lord and most worthy of praise; his greatness no one can fathom." Psalm 145:3

A great Abbi story to end with. Abbi always asks "Why?" "Why?" Why? She often asks us "why we are here?" or "why did we leave our Iowa house (and come to Africa?)" We try not to ignore her and to be very honest about answering all of her "why's". We try to explain to her that we are here to tell people and "show" people love because Jesus loves them. Simple enough for a child to get. On the way to one of her friend, Jo Jo's, house yesterday Abbi had her hands full of "things," one of them being her Bible. I tried to reason with her that we were coming right back and she could leave some of them behind. She very urgently explained to me that she had to have her Bible. "Mom, I know God loves Jo Jo, and I have to tell him. And I need my Bible to show him!" Wow - she gets it! OK, how do you argue with that?