A Tale of Two Babies: New Life

As I write, my healthy, happy children are playing in the family room (OK, maybe Peter just hit James - but you get the point).  We just wolfed down a breakfast of fried plantains and pancakes, complete with coffee and real cream.  From the cow.  Down the street.

It's been an interesting week(end) here in Canillá.  Our buddy Ryan was kind enough to take me on a rescue run up the mountain on Thursday.  The bone dry mountainside has been burning only a few miles from our house for the last week - don't worry, we're fine down in the valley.  We heard through the grapevine that a family was trapped in their home far up the mountain.  After a quick ascent up smoke-filled switch backs, we drove up into the area of the blaze on four wheelers.  We found the family alive and well at the top amidst a previously burned area of the forest fire. Praise God!  Fairly anticlimactic, but it was a good adventure all in all, and we are very grateful that all were safe.

Thankfully, we've had the first rains of the rainy season since that trip.  Crops will begin to thrive soon and the fires have died down.

We did have two very different deliveries over the last couple of days.  In the early days of beginning an OB program, there's a pretty steep learning curve.  We found this to be true when we re-opened our OB department back in Iowa seven years ago.  We've had some bumps along the way there, but have awesome nurses and (I think) happy patients.  It has definitely been a privilege to get to serve, laugh with, and pray with some really great ladies in that time span.

We feel the same growing pains here.  On Friday around supper time, I was called to the hospital to evaluate a woman who had given (normal) birth 7 times before.  These are supposed to be the easy ones.  They are supposed to go off without a hitch.  A Neonatologist friend happened to be visiting from Guatemala City at the time.  Our OB unit is just opening, so myself and friends stayed by her side throughout the night, praying for guidance each step of the way.

The mosquitos were ravenous and despite our medicines, the woman just wouldn't kick into labor.
So in the wee hours of the morning, we decided it would be best to transfer the patient to the government hospital in Quiché.  This merely involves loading the woman, her husband,  and huge bundles of patient "luggage" into our suburban, taking her to the airstrip, putting all of the above in a four person airplane, getting a taxi in Quiché and dropping her off.  No problem.  Except during the very bumpy trip in a truck without shocks on the dirt, rocked filled road, she began contracting.  A lot. You don't have to be an OB expert to know that the odds of this very experienced cervix dilating quickly and shooting that baby out at 1000 feet above ground in a four person plane was growing more likely by the minute.  I got about 2 blocks from the hospital before I whipped the truck back around through a herd of cattle on the road.

Once back in the labor room, her contractions continued to pick up.  She delivered shortly thereafter, but the baby had immediate respiratory problems.

Thankfully, our neonatology friend was waiting for hand off.   After half an hour, it was clear that this child would need a neonatal ICU for at least a few days.  He was having severe breathing issues and would probably would not have survived a home birth.  And here we found ourselves on the question of transfers again.   I was amazed as our exhausted team coordinated with the government hospital in Quiché, got the plane ready, and worked like crazy to get somebody to pick us up from the airport on arrival.  All the while, seeing and trusting the Hand of God's protection and plan over this little life.

After downing more than several cups of coffee, I cradled our little patient in my left arm, my right arm holding the neopuff (air pressure device), an IV bag, and a pulse oximeter.  Others loaded the portable oxygen tank into the back of our suburban.  Somebody drove us to the airport.  My eyes were fixed on the sat monitor and my hands on keeping the tubing functioning and neopuff positioned correctly.  The whole journey was one long prayer.  I slid awkwardly with all gear into the back of the airplane.  We jostled along to Quiché, stopping in the middle of an empty airstrip, greeted by armed military guards.  We then walked on to a main road nearby, where we hitched a ride in the back of a pickup truck - winding through Easter parades - to the government hospital.  That was a first for me.

Dropping the child off at the government hospital was bittersweet.  I was spent.

We continue to push forward daily to serve the "least of these" in the most excellent possible way in Jesus' name.  We embrace life here.  We fight for life here.

Situations like this leave one feeling a little bit run-over.  The sheer expenditure of resources of human capitol in the incident was draining and left us with many questions.

However, situations like this also point to the reality of...
God is in control and we are not.
God's faithfulness to us as we serve him in our inadequacies.
God's provision for and goodness to that child - a neonatologist just happened by that day.  We are grateful for the help.

In our fatigue, we got a call again on Sunday that another woman had been brought in by a midwife (these are untrained village midwives).  She was completely dilated and "stuck."  She'd been pushing for hours. Despite all this, April and I got to do our first delivery together in a long time.  It was smooth, easy, and beautiful.  The baby was given the middle name "Pablo."  He's the bright one to the right.  I don't think I have ever been anybody's namesake before.  After praying with the her, the mom got up and walked out with her kiddo like nothing had ever happened in the span of a few hours.  I think God knew we needed a easy one.  We all went home grateful, with our spirits lifted.  I took a nap.

"But you, Lord, are a compassionate and gracious God,  slow to anger, abounding in love and faithfulness"

Psalm 86:15

Praying with Don Pablo and mom of Don Pablo

"He will also send you rain for the seed you sow in the ground, and the food that comes from the land will be rich and plentiful.  In that day your cattle will graze in broad meadows,

Isaiah 30:23

Watching God move mountains

We've been in country for a week now.  Thanks to a lot of help from some very good friends, we were able to get to the airport in Des Moines with all four kids, a stroller, a car seat, seven 50 (and a half) pound bags plus carry ons.  Our house, grass, garden, and mail are all teed up to be cared for by some special people- you know who you are and we thank you.

So far we've gotten settled in to the guest house here in Canillá, which will be our home for the next couple of months.   The long term missionary community here is great and we found ourselves settling in more quickly than we have at the beginning of previous trips.   The kids don't sleep too much, but that's nothing new.  They are great.  They just don't sleep.  We are both tired and blessed.

The longer I've been involved in missions, the more obvious it becomes that God has a different set of priorities than I do.  His inherent completeness and profound love for people result in Kingdom of Heaven social and economic policy that would leave both mainstream economists and time management gurus scratching their heads.   One of the really beautiful things about being involved with organizations that provide care for "the least of these" in the name of Jesus is seeing the impossible (or, OK, the exceedingly improbable) happen to the benefit of those who, in the opinion of the world, don't really amount to much and probably don't deserve it.

God's love is like that.  Time after time, God shows up and makes impossible things happen.  I've never actually seen a mountain get thrown into the sea, but I think you get the point.  These things do happen every day. It's just that sometimes we are so distracted or preoccupied that it's hard for us to see them.

I'd like to tell you about Sarah *, a sweet 28 year old mother, whom I first met in our outreach clinic in San Andres (a 20 minute drive from the hospital).  Sarah smiled as she lay on the ultrasound table, her triplets wiggling wildly within her. She and her husband locked eyes, beaming as we watched one of the babies suck her thumb.  We have been planning for Sarah- already high risk with triplets- for the last few weeks.  She is now 28 weeks along (37 weeks is full term). As I carefully measured her various parts on the ultrasound and checked her baby's fluid levels, all seemed to be well.  

Before completing her prenatal visit, our nursing staff checked a blood pressure, which produced an alarmingly high result.  We then checked a urine study, which confirmed that, despite a lack of symptoms, Sarah was in the early stages of a dangerous pregnancy related condition called preeclampsia.  Thankfully, we were able to bring Sarah back to the hospital for further evaluation.  

Preeclampsia is a condition defined by high blood pressure and protein in the urine which can progress in severity to eclampsia, which is a life-threatening emergency for both mother and baby(s).

Because of the Hospital staff, laboratory equipment, and nurses we were able to provide proper diagnosis and treatment for Sarah.  Without these resources, we would not have been able to identify abnormalities of Sarah's liver enzymes as well as her blood sugars.  This liver problem allowed us to categorize Sarah as very high risk which led us to give her medicine to prevent life threatening problems and protect her babies.  Because of the extremely high risk nature of her pregnancy, we flew Sarah and her premature babies to a larger facility in the capital city where appropriate neonatal care will be available after delivery, which will occur in the very near future.  Without the hospital facility and laboratory capability that we now have, this disease progression would have been impossible to detect in a timely fashion and results would have been catastrophic for Sarah and her family.  

The history of this Hospital is long and winding.  So many different people and resources have come together in the most unlikely of ways to bring us this particular point in our history. It has been said that it's like somebody took a box of puzzle pieces, dumped them out on a table, and had all the pieces just fell together and completed the picture.   

The construction of the hospital itself has been expensive, exhausting, and challenging for many involved.  But also a beautiful and inspiring thing and is surely a picture of God's goodness, greatness, and his love for those we serve.

I'm convinced that God brought this hospital into existence to bless many, but would have done so even if Sarah was the only one to benefit.  His love for her is like that.  God often shows up in impossible situations against overwhelming odds in order to confirm his love for individuals.  He still moves mountains.

During the past week here in Canillá we have had the chance to connect with friends - both old and new and to spend lots of time together as a family.  Anybody who has young kids knows that good old fashioned family togetherness can both warm your heart and make you pull your hair out.  There are a lot of young families amongst the missionary community down here, so the kids have had some great playmates.  Only in Guatemala do your kids pretend to make concrete when playing with their friends.
As we consider the last year's events here in Canillá, it is obvious that something incredibly unlikely is happening- we clearly see the Lord's hand at work, weaving together people and resources to bring healing and hope to the people of this rural Guatemalan valley and beyond.  A local mayor recently promised that if we built the hospital he would repair the now ruined bridge on the road that connects our town to the 1.5 million inhabitants of his community who are also without adequate care....thank you Mr. Mayor.
We recently met one of the newest additions to the hospital team - Dr. Luis and his wife Naomi.  He is a Guatemalan family physician and Naomi is a nurse.  They are fantastic people and the hospital literally couldn't function without them.  Having moved to Canillá after completing his family medicine residency in Spain, their young family is getting used to life here as well.
Dr. Kyle Sheets and his wife and friends were also here this week.  We're incredibly blessed to be able to partner with their non-profit organization (PAPA).  They have become dear friends and I hope to become a little more like them by osmosis when they are around!

I'm not a construction guy, so I have only a layman's understanding of the physical hospital build so far. As I looked at the hospital build site, only the bottom few inches of each concrete wall now rises from the earth.  Little more than a very large set of three dimensional blueprints at this point, an incredible amount of resources sit unassumingly under the ground.  However, without having invested much resources including hundreds, if not thousands of man hours and on what lies beneath, the entire structure (and ministry) would be at risk.  Upon seeing this the word integrity jumped into my head.  Surely rising to the daily task of walking with the Lord, rooting ourselves in the word, and choosing to obey Him when nobody else is looking are analogous to the costly, painstaking, and excellent work that have been done here.  I always knew that we are to build our "house" on the solid rock of Jesus Christ.  I guess I never thought about the struggle, blood, sweat, tears and just plain hard work that must go into building our firm foundation that nobody will really ever see, an indispensable support lying just under the surface.  I am thankful for the fresh perspective.
The sheer work that goes into making one load of concrete here is mind numbing.  The guys in Canillá have literally scooped hundreds of loads of sand and rock out of a local riverbed, sorted the rocks from the sand, washed the sand, crushed the rock in a rock crusher, and re-sorted the rock in order to make from scratch concrete components and a small but adequate concrete plant.  It's really cool to see advanced construction techniques (i.e. use of concrete forms as seen in the pic below) in the construction of this building, where block, concrete, and construction principles are usually inefficient and substandard. The locals working with the Adonai missionaries here will walk away from this job with a very advanced skill set compared to their peers.  We hope to pour the same degree of excellence into medical and nursing education in the future.
Adonai missionaries and construction crew pouring concrete into concrete forms in order to make foundation walls.

On a walk with the family (Pete is strapped on April's back)

The final corner of the hospital foundation dug out and ready to be poured.  over 300 dump truck loads of dirt were brought in to level this land out.  Those ditches were deeper than several Henrys stacked on top of each other.

Henry hanging out in the heavy equipment

Front fence for the hospital, complete with (temporary) sign

Clinic

Today we rode up into the mountains.  The place is full of hairpin turns and steep drop offs.  I'm told that before the roads were improved, the missionary family here used to ride horses and four wheelers up to the clinic.  The horseback ride is 4 hours up the mountain and 4 hours back. I'm sure nobody's backside was too happy after a ride like that.  Transportation here is difficult and sometimes small aircraft use is the only decent way into some of the 90 or so small villages that dot the mountains surrounding our valley.  Thankfully Adonai International Ministries (AIM) with whom we are partnering has a flight ministry, which has been used to airlift very sick people to the capital city and to get health clinics set up in these remote locations.

In clinic today, we saw mostly garden variety stuff, with the occasional curve ball mixed in.  We provided prenatal care for 30 or so women.  Ultrasounds are done with generator power (though solar would be better if there are any potential donors out there!)  AIM sees 250-300 people weekly in the clinic setting and does prenatal care for 400-450 women per month according to their records.  AIM also runs a nutrition program to provide much needed food supplementation to at risk and underweight infants and small children (if you'd like information on child sponsorship, let me know) Most women deliver their babies at home with lay midwives here.  I anticipate we'll see the complicated and operative deliveries once the hospital is up and running.  The closest c section is currently over two hours away.

Though the missionaries here have spent a considerable amount of time developing relationships, those relationships are fragile.  We must be careful to act with the greatest degree of respect, modesty, and compassion.  An ill timed photograph can start a riot.  Rumors sometimes abound in small, disconnected villages.  People occasionally will believe that we have come to

take their gold or to fatten and eat their children.  Vicious, backward seeming rumors like this make us scratch our heads a bit.  But, these rumors have kept people away from our clinics for months at a time.

Why work so hard for those who cannot pay you?  Why face such rejection by those you have stuck your neck out for?  You can see why villagers look for an underhanded or malicious motive.  The only motive here is Jesus, and that those who come for care might know him.  Really, clinic is a great picture of what God has done for me.  I was separated from God, but he went to the greatest lengths possible to come after me.   The price he paid on the cross for my pride, brokeness, and selfishness I can never pay him back.  I have nothing he needs from me in return.  So why did he come?  Because He loves me, like the old song says.  And so the missionaries here love the people in Jesus' name.

Below is the start of a health science school. It used to be a brothel. Literally, this building was historically used to objectify and defile women. Two South African missionaries just moved here from a very remote and hostile part of Guatemala. They were literally asked to build a nursing school and (hopefully) a medical school in Canillá by an Christian leader of a large university. These missionaries are impacting the educational system here in big ways. This request for a health sciences school from the government occurred completely independently of the Fickers desire to build a hospital here. Canillá really is a remote and insignificant town. There is currently no education beyond sixth grade available around here beyond a basic teaching degree. for every 1 available teaching position, there are 400 applicants. If a hospital, nursing school, and medical school pop up here, this will be nothing less than an act of God, making something beautiful out of that which was once a brothel.

This is Henry and his new friend, Freddie!  

Matt 25:34-40

McQuillens in Canillá

This week has been a huge blessing to our family.  We took off from the Kansas City area last Saturday, just over a week ago.  Many thanks to my father-in-law, Mark, for getting up well before the crack of dawn in order to get us to the airport by 4:30 for our 6 AM flight.  We are grateful that the kids traveled well the entire trip (all of 6 hours of flight time - a major improvement over the previous transatlantic voyages), including the four seater flight from Guatemala City out to the valley where Canillá is located.   Many thanks to Joseph Ficker for a safe take off, flight, and landing (times two). See below.  The plane made two trips to get our whole family out to the mission station/clinic.  

During the first week, we've really focused on developing relationships with the family of missionaries that have been here for the last 15 years.  They are a delightful and extremely gifted group that moved here after experiencing an obvious call from the Lord to come to Guatemala specifically to build a hospital many years ago.  The couple has a large family, including 2 little ones that are a little older than Abbi.  She's really enjoying her time with her new friends here.  Together the three of them are gathering eggs, doing science projects, running around barefoot, eating copious amounts of oranges, and enjoying a wide array of animals (horses, chickens, dogs, tadpoles, etc.).  Henry mainly plays with the dogs.

We spent our first week here overlapping with our partners and dear friends, the Epperly family (epperlyadventures.blogspot.com).  The week was a wonderful time of fellowship and planning.  It is amazing to see what God is doing for the "least of these" in this rural Guatemalan valley.  I'll try to write more specifically on the dizzying number of circumstances here that just frankly defy statistics - events that can only be explained as evidence of a God who loves the poor and forgotten and has gone to great lengths to express his love to them.

Dr. Kyle Sheets and his daughter Cory from PAPA missions (www.papamissions.org) arrived today.  Dr. Sheets is one of my favorite people.  We've been blessed to work with him and his wonderful family over the last four years during our short stents at Karanda Mission Hospital in Zimbabwe.  We hope to partner with PAPA missions in some capacity for service in Canillá.  Dr. Sheets, the Fickers,  and our family spent some time tonight looking over the architectural plans for the proposed hospital- spread out on the pool table.  We walked the land together where the hospital will sit.

I'm embarrassed to say that I knew next to nothing about Guatemala prior to coming, only that the Lord was making it obvious that we should come here and that He is up to something very special here.  So far, I've compared this hospital project to going to a movie I know nothing about, and being taken by surprise by an amazing plot, lovable characters, and my desire for a sequel.  Canillá is situated in the "poverty belt" of Guatemala, a historic hotbed of racial tension and civil war where the neonatal mortality rate is 55 per 1000 children and maternal death rate is 110 per 100,000 annually.  Women with obstructed labor must be transferred to a hospital hours away if operative delivery is required.  Fifty percent of the children here are malnourished.  It is a perfect place for DOCS for Hope to be part of building a hospital and invest long term.  The folks at Adonai International Ministries love Jesus with all their hearts and are perfect partners for this endeavor.  

Poor access to health care is especially pronounced for the indigenous Mayan-Guatamalan people, who comprise over 40 percent of the population, but have little political voice and experience marked racial discrimination.  90 percent of these people live below the poverty line.  This has only worsened with recent decades of civil war, which left a trail of orphans, broken families, and shattered communities in its wake.  

There is no hospital in Canillá yet, only a clinic which is open two days a week.  Other days of the week, our health care team travels to rural mountain villages in order to deliver health care in rural clinics.  Drs. April and Shea had a great time during last Friday's prenatal clinic.

As you can see, our valley here is surrounded by beautiful mountains.   Below is a view of the property where the hospital will sit, just beyond the big house with the steel roof in the middle of the picture.  We will, of course, give plenty of advanced notice to the pigs, chickens, ducks, and horses that now live on the land prior to beginning construction.

As we hiked back down the rocky hill, from which the above picture was taken, my son (now 2 and a half) went barreling down the hill, which is full of rocky outcroppings and various other head-splitting obstacles and little cliffs.  My daughter enjoyed running around with the other kiddos.  Those of you with kids will attest that boys and girls are different.  Knowing that Henry is a walking head injury, I was constantly yelling at him to stop.  I got tired of yelling "No, Henry!, Stop Henry!"  Instead of telling him what not to do, I started running in front of him, encouraging him to follow me - to jump when I jumped and follow my trail - occasionally taking him by the hand.  Wouldn't you know, he actually started listening to me. Together we sprinted down the rocky death-trap in the most fun and safe way imaginable.  

I hope I can remember the lesson I learned when he is older and navigating the rocky road of the teenage years.  It's easy to tell a child what they should not do.  It is hard, but much better to go before them and demonstrate for them how to live life out in the positive rather than the the negative. I pray for grace to do so in the years ahead.

"Unless the LORD builds the house,

the builders labor in vain.

Unless the Lord watches over the city,

the guards stand watch in vain."

"Children are a heritage from the LORD,

offspring a reward from him.

Like arrows in the hands of a warrior

are children born in one's youth

Blessed is the man whose quiver is full of them."

Psalm 127: 1,3

December 14, 2013

Welcome to our blog.  Here within you'll see a mishmash of events that have happened over the last four years.  Some stuff will make you smile, some will make you cry, and some (the last post of 2011) will gross you out.  Albeit incomplete, it's a window into the journey God has taken our family on. You'll notice that there are huge gaps in time on the blog.  I did journal during those times and, as my kids will tell you, took way too many pictures.  It will be fun recreating some of those memories for you here.  Most of our memoirs involve Jesus, our family, and work overseas (particularly Zimbabwe, though we've worked in a few other places as well).  I think we probably have a lot to say about being small town doctors too.  Maybe I'll try to post some stuff that wouldn't get us into too much trouble with our patients (it's a really small town).  

Recently DOCS for Hope www.docsforhope.org has become a reality.  As such, we feel it is important for us to share our life with you- for you to come along with us.  Hopefully this blog will help that to happen in some small way.

Journal 5/26/13

I got a little choked up singing to Henry today as I put him down.  The words "Ive got a river of life flowing out of me, makes the lame to walk and the blind to see, opens prison doors and sets captives free..." suddenly sprang to life with meaning.  For those of you who don't know it- here's a fun campy version from youtube:  River of life .  It's usually such an up tempo song, but I've slowed it down and mellowed it out to sing the kids to sleep.  It's a favorite along with "Be Thou my vision, Come thou fount of every blessing, and Sanctuary".  I've seen the Holy Spirit at work here at Karanda in a very tangible way.  It is a humbling honor to see this work and to be used in a small way to accomplish it. 

I rounded forever on Saturday.  We had a fantastic breakfast of bacon, eggs, toast, and coffee and I was off to the races by about 8 or so.  I didn't finish the day until supper time.  The wards are full of very sick people - I believe 5 of them died during the day.  I probably saw sixty people on rounds or so.  After finishing ward rounds, Including multiple admissions, I was simultaneously hit by two broken arms, a foreign body lodged in a kid's trachea, a bad obstetric laceration, and a close personal friend running into some real post operative (post C section) problems.

Just after noon, the nurses called and told me that our friend Miriam's abdomen was becoming distended.  I felt ill, as I had performed the emergency C-section the day before.  I ordered IV fluids and a blood count. The lab was out of CBC (complete blood count) reagent, but was able to do a manual blood count.  We found that her blood count was dropping over night, and her heart rate rising.  In short order, another physician and I took her back to the OR and opened her.  She had lots of blood in her abdomen, including old and new blood.  We oversewed a couple of areas, but over all I had not committed any surgical errors - she was just diffusely oozing blood from all over the place, mostly wound and skin edges.  Ultimately, we explored her entire abdomen.  We found that she had evidence of old a really scary bleeding and clotting problem called Disseminated Intravascular Coagulation.  She was still able to clot - but was doing so poorly.  We had no way to get a platelet count and therefore assumed she was in early stages of this life threatening condition.  We closed her when we were satisfied that we had done all we could to help her.  We honestly thought she was not going to survive.  Thankfully, we had just received several units of O positive blood, which was the patient's blood type.  Prior to that we had no blood products in the hospital.  Also three American nurses had just returned from an outreach to a local village.  They "happened" to be the same blood type as Miriam.  Miriam was in need of clotting factors and platelets which are not found in packed red cells (usually stocked by hospitals).  The only platelets and clotting factors for miles and miles were in the blood of those nurses, so the Lord provided the blood for Miriam, which we gave her for most of the evening.   I prayed at the bedside for her in the ICU, her husband standing at her side.  Many people have been praying ceaselessly for her...

As you can see below, Miram and her baby wound up doing very well.  It was a miracle.  I saw them a lot while working at Karanda.  Also, the pretty girl with the chicken at the top is also named Miriam (her husband, Prosper, is in the background) - they are good friends of ours, too. In the picture, Miriam is buying one of the chickens that our patient's husband was selling in order to pay the hospital bill.  I think these are our only friends named Miriam.

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?