Zeke growing up: 15months

Zeke with his friend, Eva

We were trying to get a nice family picture.... Daniel had a temporary mohawk and Zeke was very distressed about our removing him from the fish pond he was swimming in. 

Catching up

We visited for our first time last month Kalukembe/Caluquembe hospital with the team from CEML. Just a 45 minute flight away (and now with paved roads only about 2 1/2 hours by car), this hospital was founded  over 100 years ago. It is a busy place with a wide reputation and without any permanent physician for over 10 years. It only shut down one day while it was being bombed by government forces during the civil war. Today, it is a church-administrated, government-funded hospital. The CEML staff go almost every month for a long weekend to perform surgeries on complicated cases (vesicovaginal fistulae, complex femur fractures, oromaxillofacial surgeries, and so forth), round with staff to see the difficult cases and discuss questions they have, and encourage everyone in the good work they do. While Annalise Olson performed surgeries all day and night, Priscila was busy repairing vaginas in the OR; Daniel taught a some ultrasound, saw medical patients and relocated a hip that was out for 2 weeks! and Zeke entertained the off-duty nursing students. We look forward to returning later this month, then hopefully extending our time to a few weeks in September with them. For more stories on Kalukembe, check out Dr. Tim Kubacki's blog at http://kubacki6.wordpress.com

 Daniel, Eduardo and Annalise with a sequestrum and the patient (from whence the rotten mandible came) at Kalukembe. For those with stomachs, we have pictures showing how far the infection spread. Feel free to ask. 

 Zeke and friends on the airstrip at Kalukembe

Priscila and Annalise at the weekly radio show on medicine and health. Yes, even an OBGYN and a surgeon have opened Harrison's. Priscila has been involved in the topics of sexually transmitted disease and endometrial cancer. Daniel volunteered to watch Zeke at home for these shows. He did try his hand at the motor vehicle accidents show and realized his Portuguese was still at an elementary level. He answered an open-ended question with "Sim! (yes)" The moderator wisely navigated the rest of the questions to others for the remainder of the show.

At Hospital CEML

Dermatology is not my strength, so skin diseases continue to keep me humble. I read in one manual that skin diseases make up 20% of outpatient visits in the developing world. That’s more than I see, but there isn’t a day that goes by without at least one patient with concerns regarding the body’s biggest organ. Here are three of many patients I have seen. . . .

This is a young lady who had lived further in the interior of the country for a couple years and came because she was having an itchy rash all over her body (except her head). These lesions were tight and were not fluid-filled.

She had a slide of her blood prepared and reported to have microfilaria whipping around. Diagnosis: Loiasis. Since we don’t have the first line treatment, DEC, available, the royal we prescribed a 3-week course of albendazole. She hasn’t returned, so we hope it worked.

This 45-year-old gentleman has a rash I’ve seen several people with. It started on his shins 10 years ago and gradually has spread up. He had a (successful?) ligature of his veins on the right leg that stopped the spread, but had an unsuccessful attempt on this left leg. He also went a 6-month treatment course for pulmonary TB but this rash continued to spread during that time. He is in the hospital for a skin graft of a part of the rash that had ulcerated; he was treating that area with cow dung—to no avail. He had a couple checks for lymphatic filariasis that were negative (and he’s HIV and VDRL non-reactive, too). Diagnosis: not sure, and we welcome your thoughts! Being a surgical hospital, his skin grafting will be prioritized.

The right leg (like his other side) had a saphenous vein ligation.

We frequently find this strange boy waddling around in our kitchen, getting his hands, feet and face into anything he can find. The lesions on his face tested positive for chocolate. Diagnosis: bagunça

Spring 2012 letter

At our new home: Lubango!

La Leba: a scary road

Young men singing on the edge of cliff.

We were praying the roads were de-mined.

Daniel and Zeke looking out at the expanse.

The valley bellow the plateau; during the war, victims were shot and thrown off the edge... until recently, bodies and skeletons could still be seen.

Zeke playing on our new porch.

Making bread with Berta, our friend and neighbor. 

Patients at the Rio de Huila Hospital: Zeke loved meeting them! 

Zeke's first birthday in Lubango with friends.

Moments with our family... en route to Angola.

In the Air

We are on our way to Angola! Saying good-bye to our brothers, sisters, friends and neighbors in Kapsowar, the Familia  are now en route to Houston to pick up our visas. We are now enjoying a 3-day stop in the Netherlands on the way.

Zeke enjoying  his last rolls in the yard with his favorite toy

part of the Rorok School church family Easter Sunday

Priscila's last hysterectomy, with RN Wilson and med student Christine

Tchau to our neighbors

Our mother in Kapsowar, Laura Rhodes

The society into which the Christian is called at baptism is not a collective but a Body. It is in fact that Body of which the family is an image on the natural level. If anyone came to it with the misconception that membership of the Church was membership in a debased modern sense—a massing together of persons as if they were pennies or counters—he would be corrected at the threshold by the discovery that the head of this Body is so unlike the inferior members that they share no predicate with Him save by analogy. We are summoned from the outset to combine as creatures with our Creator, as mortals with immortal, as redeemed sinners with sinless Redeemer. His presence, the interaction between him and us, must always be the overwhelmingly dominant factor in the life we are to lead within the Body, and any coneption of Christian fellowship which does not mean primarily fellowship with Him is out of court. . . . The sacrifice of selfish privacy which is daily demanded of us is daily repaid a hundredfold in the true growth of personality which the life of the Body encourages. Those who are members of one another become as diverse as the hand and the ear. That is why the worldlings are so monotonously alike compared with the almost fantastic variety of the saints. Obedience is the road to freedom, humility the road to pleasure, unity the road to personality.

--C.S. Lewis, from “Membership,” The Weight of Glory

Zeke at 10months

Happy to have daddy back!

Helping clean mommy's drawers. 

Do you like my art work?

Moment with mommy at lunch.

Cuddling with daddy before bedtime.

Winter 2011 letter

One week on Maternity (labor and delivery)

We live on a beautiful hillside in Kenya, a couple hours from the border of Uganda. Idyllic scenery to say the least: gorgeous mountains, rippling streams, shady old trees, and sweet song-birds. On my way to work I pass shepherds grazing their cattle or sheep on the hospital property and have to be careful with the large cow pies. I love walking to work, stumbling in at two in the morning on a moonless night when the Milky way is at her most glorious.

But the genteel landscape doesn't hide the back-breaking labor of the farmer tilling his land, the five-year-old child carrying gallons of water, or women lugging hundred-pound firewood packs. But even with these heavy burdens, my patients are some of the most kindest women you will ever meet. If you had been with me on rounds last week you would have met Isabella a G9P8 with an abusive husband who caused her own septic abortion by shoving a 13cm nail into her uterus desperately trying to get rid of a pregnancy; Albina a cachectic young lady with AIDS who precipitously delivered her 32wk infant and is now breastfeeding, since she has no money for formula; Jeseah a mother recovering from her cesarean delivery with a live infant, her last two children had died in utero; Judith three days postpartum referred from a health center comatose, jaundiced, and with diarrhea; or Theresa a 25yo blind woman with fungating breast cancer, thyroid cancer and 20 weeks pregnant. Most of the time I feel like I can be of some use, whether it be delivering a live baby, helping a mother recover, removing a cancerous uterus, etc., but sometimes it seems futile.  

My phone rang at 2am, the nurses were calling me about a referral, Ketai, a young pregnant woman with abdominal trauma and a concerning abdominal exam. I stumbled in, under the glittering Milky Way and found a 20yo G4P3 at 30wks status-post a fall while carrying firewood two days before. She had a dead baby, a belly full of blood, heart rate 140, saturation 85%, hemoglobin of 6, and was writhing in agony. I ruptured her membranes, delivered her tiny baby, called Bill (the general surgeon) and we took her for an exploratory laparotomy. We found liver and renal lacerations and he attempted to repair them, finally just packing her abdomen with abdominal packs and closing, saying if she survived we could go back in a couple days to remove them. She did not survive the night.

I still wonder what is going to happen to her three young children, her grieving husband? Who will pay for the hospital bill that costs more than they earn in a year? Why did it take her three days to come? Why was a pregnant mother carrying 100 pounds of firewood?

For so many are crying:

My God. My God why have you forsaken me?

                  Why are you so far from saving me,

                  So far from the words of my groaning?

Oh my God I cry out by day but you do not answer, by night and am not silent.

But He is with those who are suffering:

… they have pierced my hands and my feet.

I can count all my bones;

people stare and gloat over me.

They divide my garments among them and cast lots for my clothing.

And I know that:

The poor will eat and be satisfied;

                  They who seek the Lord will praise him-

Posterity will serve him;

Future generations will be told about the Lord.

They will proclaim his righteousness to a people yet unborn –

For he has done it.

Psalm 22.

Kapsowar continuum

“A woman wholly given in love is held

By a dying man and an immortal one.

The man dying knows himself departing

From her, leaving her in the arms

Of the man who will live, cherishing her,

Given to him as she is forever.”

--Wendell Berry

JK was 4 days post-partum when she was brought to our hospital from another facility. She had yellow eyes, was comatose and had been vomiting blood the day she was transferred. She had delivered twins, and though one of them a stillbirth, the other a healthy child. After receiving the test results (I could only check a CBC, a creatinine, a malaria smear, CSF microscopy and an HIV test), i presumed the yellow eyes were from a liver failure that was unclear in origin (no hemolysis evident on the peripheral blood smear). Her ultrasound looked like it showed a normal liver and gallbladder. She never took home remedies but there seemed to be something missing from the story. She improved over the course of the week, no further vomiting nor any pain to speak of. I even considered discharging her, but then on her seventh night, she vomited large amounts of dark blood. We have no abilities to look with a camera down her esophagus and the nearest place was over 2 hours away on bumpy roads. I recommended that the family immediately accept transfer there, but they were not sure they could afford the transfer and opted to stay. She lost blood fast, went into kidney failure, and I presumed she was also back in liver failure. She died the next day. I still don’t know the full story.

Operating together

JM was a 33 year old woman, nursing a 10 month old and had been healthy until 3 days prior to being transferred to Kapsowar. She went to a health center complaining of headache and fever and did not improve on some antibiotics and antimalarials. She was sick when I saw her, had a stiff neck, but could carry a conversation. As the days went, none of the antibiotics or antimalarials had any effect. Her fever persisted, she became comatose and died. Perhaps it was a parasitic meningitis (I don’t know if Naegleria is found in these parts), doubtful it was TB; regardless, I am not sure what infection cut her life short so quickly.

It’s humbling to sit at the bedside of these young dying patients and not know what else to do for them. In the States, with smarter doctors around and more tests and procedures available, I felt shielded from these mysterious sicknesses that would claim people’s lives. Now, many of my diagnoses are based on probabilities and guess-work. “Not sure, but we’ll try this and see how it goes,” seems to be my most commonly used sentence some days.  Standing or sitting at their bedsides, it humbles me to be trusted by them to heal. I get to see asthmatics improve with the nebulizers, or other patients with meningitis get better on the antibiotics given.  But there is a steady flow of “medical mysteries” that I feel even more burdened by, now that specialty care is far away and difficult to obtain for most people.  More than in the States, I am acutely aware of my limitations and the limitations of what can be offered to the medical patients here.

Please remember to pray for them, and for us. These deaths and disappointments push us to acknowledge our dependence on God.

Da Gurls: Abby from Philly came to visit! We love you, Abby!

Zeke with our sweet, gentle helper, Sellie

.

Kapsowar, Kenya

We've arrived in Africa! The plane carried us here on the 27th and we are very thankful to be serving at Kapsowar Hospital in Kenya. The visas for Angola are still in process (the last we heard), and the Kapsowar community has generously welcomed us in the meantime. We celebrated the new year yesterday with patients in the chapel, encouraged by their trust and love for God in spite of their suffering. There is much to get accustomed to, both at the hospital and in the community; but thankful that Priscila's two cesarean section cases today had happy outcomes and that Zeke is enjoying a multitude of new friends. We wish you all a happy new year! 明けましておめでとう！

Carrying Zeke, Kenyan mother style

Zekewith our lovely helper, Ednah

Our new home in Kapsowar

Mr. Cheeky Trouble