Handing Things Off

As the time draws near for Stephanie and I to get on the airplane for our home assignment we have become quite busy. I never realized how much we actually did until we had to write it all down to hand it off. We are busy writing up schedules and procedures for our health workers, nutrition workers, and midwifes. Writing protocols for medicines, and diet plans. Packing the clinic away, buying enough supplies for 5 months, finishing administrative things. The biggest job has been getting all the charts together for our review patients that our health workers and midwifes will be checking on. Getting their medications laid out and writing instructions for when they are to be checked on and what is to be done etc. We are trying to plan a mini graduation for all our workers to acknowledge how far they have come in these past 6 months and reward them for all their hard work and commitment to us and to their communities. It’s great and exciting to give them this chance to show us what they can do on their own, but also a little scary to leave the program in their hands for so long. Please pray as we feverishly work to get everything handed off in time and laid out clearly. Also that all our workers would have strength and wisdom with all their patients over these next 5 months, that they would apply all that they have learned and that the light of Christ would shine through them as they work.

Fight with the System

There are a few small health posts in our area that carry basic medicine and a nurse and we even have a “hospital” that is more like a clinic. It has basic medications and one nurse for all 5 wards. We are the closest thing to a hospital having the most resources for a quite a distance. Maamba Hospital which is about 90 minutes has an operating room but doesn’t even stock oxygen on a regular on a regular basis. We have made it a priority to have 2 tanks of medical oxygen in our clinic because we have some many asthma patients and little grandmas with congestive heart failure. However there is only one company in the entire country that supplies oxygen and they are less than reliable.
Stephanie and I make a great team. She is the bad guy and I am the good guy. We are constantly having to argue with them to get our oxygen. The arrangement is that they will deliver two tanks to Choma, which is 2 hours away from us and we will pick them up from there. However every time we make the trip they have sold our tanks to someone else, or they forgot to order them etc. The manager at the Lusaka branch as become quite familiar with us. We are constantly calling him, being very nice at first, explaining that our tanks are not there. Then yelling when he says it is not his fault for forgetting to order them. Responsibility in this country is not in their vocabulary.
We have even gotten Theuns involved thinking that getting a man to fight our battle (women our not respected here) would help us. He ran into the same problem...it’s not their fault for not ordering the tanks. So we called the manager in South Africa. We are not trying to cause problems or get people in trouble, we just want to be able to give our patients oxygen so they can breath. Theuns threatened to place a story in the newspaper about our patient dying because they didn’t have the oxygen they needed, didn’t you know those tanks were here 3 hours later. Our patient didn’t die, we ended up transferring him to the hospital in severe respiratory distress. I wish that this company would understand how valuable their product is and take some pride in the service they offer instead of just seeing it as a job. People depend on them and they are letting us down.

Akim's Smile and My Nutrition Kids

Akim






When I first came to the Longezia Mission Base I had no idea that one of my jobs would be to run a malnutrition program. I am not qualified to head a program like this, but it has quickly become one of my favorite things to do. I spend many hours doing research on diets, malnutrition, vitamin supplements, and nutrition related diseases. More than just the physical side of things and I am extremely attached to the children. Due to their weakened state these kids are brought faithfully every two weeks by their caregivers, some as far as 15 miles by foot. I have watched expressionless 2 year olds weighing only 8 pounds blossom into bouncing fat little toddlers. It is a tedious job that brings me so much joy, I always look forward to Thursdays when I get to see them.
One of my favorite kids is Akim. He is a street kid that was taken in by a local pastor when he was one year old. From the time he was taken in till about 8 months ago he never smiled or said a worse. He is extremely shy and timid. I have been seeing him for about 7 months now and from the first day I was drawn to him. He has never said a word to me and I have tried so desperately to get him to smile with no success. Over the past few weeks he has started to come to me and give me hugs and hang out with me while I work, but he still never said anything nor smiled. Until last week. I saw him walking down the hill with his brother and mom so I ran out to meet them. When he saw me he started walking a little faster to come and greet me and came to give me a hug. When I pulled back a looked at him he smiled and said “I am fine”. I had not even said a word to him but here he was talking to me with a big smile on his face. Of course I cried, I had been waiting 7 months for this. Luckily he kept smiling that day so I was able to get a picture of him. I saw him two weeks later and now he won’t stop smiling and talking. I guess its true when they say that all good things are worth the wait!





Other kids I have fallen in LOVE with!

Little Grandma

We go to the “hospital” that is near the base fairly often because we admit patients there. We use there beds but we assume care of the patient. It is a great arrangement because we are not legally registered to have people sleep overnight in our clinic and we can provide better care in some instances, so we work together.
We were at the hospital one day showing Ann and Chris from the Care Now Foundation around when we saw a little old grandma we recognized. She had been there 5 weeks earlier when we hd a patient there. This was strange because the hospital never keeps anyone over 2 weeks. We inquired about her and they told us that the family refused to allow her to be transferred to Maamba hospital because no one wanted to go with her. her in Zambia when someone goes to the hospital, a family member has to go with them to make cook and take care of them. The nurses responsibility is only to give medication. The hospital in Sinazongwe had taken her as a charity case and kept her, but she was getting worse. She could not go home because she was to sick to take care of herself and there was no one to go with her to the big hospital so she was left there to die. Well I think you can guess what we did, we took over her care.
She had congestive heart failure and they had placed her on Lasix, Aspirin, and Proponol orally. They treated her for a respiratory infection (PCN injections) because she had a cough, and tapped her abdomen taking off 6L in 8 hours. She had been there for almost 6 weeks with no improvement.
Our assessment revealed minor respiratory distress, HTN, ST with a S3 and S4. I didn’t have a heart monitor but from her rhythm I would bet money that she was throwing PVC’s. She had 3+ pitting edema all the way to her hips bilaterally. Her lungs were crackly in all lobes with audible wheezing and sternal retractions. Her abdomen was hard and distended with a positive fluid wave and she had no urine output was drinking water like we were in a drought. Her capillary refill was almost 5 seconds and her face was dark. I know that she is black, but her face was BLACK, I’m pretty sure that if she was white her face would have been a shade of blue from oxygen deprivation.
We tapped her abdomen, placed her on a bunch of meds, put her on the last O2 tank we had and left for the weekend. I fully expected her to be dead by the time we came back from Lusaka but when we walked in Monday morning (we had to go to Lusaka for the weekend) she was sitting up with all her tubes pulled out. She yanked out her urinary catheter and decided that her IV line was not necessary. I had taken some blood with me to Lusaka and ran some labs. i explained to her that her kidneys were fine and that the problem was with her heart. If she let me put the tubes back in and gave me 4 weeks she might be able to walk out of there. Up until this point she couldn’t even get herself into the wheelchair she had such a hard time breathing. She agreed and we started.


Stephanie and I went to the hospital 3 times a day checking vitals, abdominal girths, intake and output, and monitoring medications. She was a VERY hard stick and we couldn’t keep a line in her. We started with IV Digoxin but had to move to oral. We treated her with beta blockers, ACE inhibitors, diuretics, potassium, vitamins, antibiotics for a urinary tract infections, and tylenol for all the times we poked her. She was a super star and never complained once. Slowly slowly her edema started to decrease, her breathing got easier, and her color began to change. We brought her some new clothes and though she could barely stand she got up and did a little dance to show off her new digs.


After four weeks of medication and close monitoring of her ever changing erratic heart rate and unstable rhythm we discharged her home. Her edema is completely gone, she has been walking around the hospital on her own accord, and has no difficulty breathing. She has defied all odds and improved. With no oxygen, no heart monitor, and no IV but lots of prayer and determination this lady persevered and is now back home.

Can You Hear Me?

We have been so busy lately and it is great that we have so many people coming to help. This past week Alfred Mwamba came down from Lusaka to treat some patients. He is an audiologist that was trained in the states and now works here in Lusaka. We have been communicating with him over the past few months about the possibility of him testing some people. Once we got a connection for hearing aids he jumped on board, left his 7 month pregnant wife at home and came to hang out with us for a week. We had a list going of patients that were hard of hearing or "deaf" and they all came together at 3 different clinics to be assessed by Alfred. We also went to the school for the disabled to see the kids there. Out of 21 students that they had written off as deaf we found 16 that will be able to hear will aids. Most of the deafness has been caused by cerebral malaria and meningitis. Some of them had been written off because they had a little trouble hearing and no one wanted to bother teaching them. It was so much fun to see peoples faces light up when they heard that little beep for the first time. As people get older and their hearing starts to go others just ignore them and they get ostracized from the community. We found many children we had recurrent ear infections that had never been treated who now can not hear. We can now help all of these people integrate back into the life they used to know. He even taught Stephanie and I how to conduct the hearing tests. Alfred will come back 2-3 more times to fit the ones selected for hearing aids and for fittings. We are so thankful that he took the time and effort to come and help us with this. If you would like to help us purchase hearing aids for the 38 people we have selected please email me ASAP.

VIsit from the Care Now Foundation

We recently were able to host Anne and Chris from the Care Now Foundation. They came to visit for a few days to see what the ministry was doing and how their support has been able to help. They were troopers as they helped with clinics, passed out medication, ate traditional Zambian food, and loaded boxes for us. We had a great time and even though their visit was short I'm sure that hey got a pretty good idea of what happens in a typical day over here. We were so blessed to be able to spend some time with them and can't wait for them to come back next year!

Omp's Foot

When we first arrived in SInazongwe 1 year ago, Karin immediatly told us about a young women who had stepped on a thorn and it had been left untreated. Over several months it had turned into a massive open festering wound contracting her tendons and deforming her foot. She wanted me to go and see if there was anything else that could be done for her. Over the past year she has gone back and forth between treatments usually taking steps backword. Her husband does not approve of her recieving care so everythime she stars getting better he makes her stop treatment and then sinks back to where she started.
A few months ago I sent her to Lusaka for a tissue biopsy to rule out cancer. After 4 months of waiting for the results, they proved to be negative. This ruled out amputation which other doctors had suggested if the results were positive. SO now we had a choice to make. If we send her home with this information she will never get better and we knew that we had to do something. So we went a little radical and admited her to Sinazongwe Hospital.
Admitting her to the hospital simply means using one of their beds. All of her care, vital signs, feedings we placed in our lap and we only had 1 weeks to "fix" her foot. The hospital would only aggree to keep her for 7 days so we had to work fast. We prayed hard and got started. I won't go into details but she was on around the clock IV antibiotics, dressing changes every 4 hours, and we even performed minor surgery on the foot. We kept our regular program of teaching and clinics but also traveled to the hospital every 3 1/2 hours to attend to her. We lost a lot of sleep but it was worth it. At the end of the week the wound had healed 1cm in all directions. It is no where close to being healed but she is well on her way. The infection is gone and she is now pain free. WIth visits twice a week from our health care workers and a lot of education about dressing changes, we pray that her wound would be healed pretty soon.

Medical Team

We now in full swing of our team season and our most recent was a medical team from the UK and Canada. It was made up of 2 doctors, 3 nurses, and a one women prayer team. We held 5 massive clinics and saw over 1,300 people in less than a week. Stephanie and I ran around for weeks before hand trying to get schedules together, medication bought, and plans organized. Once the team arrived everything went extremely smoothly and we had a great team. Many people were reached and the team brought a level of expertise that we don't have. Many of our recurrent patients we able to be treated by the MD's, minor surgical procedures were performed, and we went through lots of medication. It was a very fast paced week and it took us awhile to recover but it was worth it.






To see more pictures please click here to be redirected.

UK Medical Team Pictures

It's a Girl....and a Girl!

The word has spread that we are available for births and now that the women in the area are beginning to trust us more Stephanie's ministry has begun to pick up. Not only has she broken off from the medical side of things a little bit and begun to work more in the homes of her trainees, but we had our second birth a few days ago.
We got the phone call on our day off (its always on our day off) that they were on their way. We quickly moved everything out of the clinic because we had not yet cleaned up from the medical team that was visiting. Just as we had finished and gotten changed into scrubs one of my health care workers came walking down the road saying that she needed to be picked up that she was not going to make it. We threw some gloves on, grabbed our birth kit and jumped in the car. As we tore up the road we found Sandra, Stephanie's trainee slowly walking with our lady in labor. Her water had broken and they got scarred. So much for the adrenaline rush, we got in the car and drove back to the base at a much slower speed since the baby wasn't coming.
Stephanie immediately recognized the patient and had remembered seeing her before on a pre natal visit but couldn't find her chart. This was a little disconcerting because we didn't know if there were any prior complications during the pregnancy that we should be aware of. As Stephanie did her exam she got this big smile on her face and said I can feel a hand...wait a foot. It was an extremity of some sort and signaled that this baby was not necessarily in the right position. But everything else checked out so Steph decided to keep her. We quickly reviewed all the different positions and maneuvers for a breech birth and tried to prepare ourselves for anything.
Since her water had already broken before she got to us we didn't have long to wait. About two hours after she arrived she began pushing. We had her stand in a modified squat in case the baby was breech. Her contractions were so tight that it was virtually impossible to feel the baby's position so we were going off of the extremity that Steph felt during the internal exam. She did a fabulous job and in no time a absolutely beautiful tiny 1.5kg (3.3lbs) little girl was born with no problems or complications. The mother was utterly exhausted so she asked to lay down for the birth of the placenta. We quickly obliged as we proceeded to exam her and take care of the baby. Just as I clamped the umbilical cord and got the baby wrapped up for her mom Stephanie mentioned that the placenta was not coming as it should. Our mom was pushing awfully hard for an afterbirth and then we were surprised with a huge splash of water spewing all over our table. Stephanie said it jokingly but I didn't believe her and the next thing we knew a tiny little bottom began to emerge! By now the mom was laying down, not a good position for a breech birth, and she was too tired to push. Stephanie did a GREAT job and didn't touch the baby, letting her come out on her own. Touching a breech baby can cause them to try and breath but all they have to breath is meconium and fluid leading to aspiration. Knowing that only one baby had been monitored during labor and not knowing which one we had been watched was not a good feeling. Yet as she came out about up to her umbilicus she began to wiggle her little behind and we knew she was alive. It was an amazing feeling to know that at least she had a chance. Now we had to get our mom to push, she was so tired and had no interest in sitting up. We got her up and made her push for fear that the head would get stuck. As soon as she pushed out popped the second breech baby girl weigh exactly double at 3kg (6.6lbs). Baby girl #2 needed some help at first but soon livened up and is definitely the feister of the two.


The placenta fused together to create this really cool picture

Stephanie went the following day to visit the new family at home. They are all doing great and are healthy. The main focus know is to get Baby girl#1 enough food so she can grow and catch up with her sister. Know the only question is...when is the next one?!

It's a Boy

This is the story of our very first birth here in Zambia as told by Stephanie.


We were having a going away lunch for Michelle Engelbrecht on the 1st of June, at the base with some of the South Africans we know who have been friends of the family for years. It was about 2:30 when Susan heard my phone going off in the house and went to answer it. She came back with a funny look on her face. She told me one of my midwives-in-training, Sandra, had called and there was a client in labor at her house, did I want her to bring her over to the clinic? I paused in shock for a second and asked, “Do we want her to come? Should she come? Yes? Yes. I mean, yes, she should come!” Susan agreed so we asked Sandra to bring her over.

It took about 35 minutes for them to walk what is normally a 20 minute walk. We were nervous. Everything was all set up and we had found the chart. Dales had some for two prenatals, both of which were normal, except for slight anemia. I was glad to find that there were no warning signs at the start as this would be my first labor in two years and seven months, not to mention my first birth absolutely on my own without anyone more experienced to back me up.

Susan and I talked through a few preparation items—it was Dales’ 8th pregnancy which could mean some special complications on its own and we wanted to be prepared for the worst while hoping for the best.

Dales and Sandra finally arrived. Sandra was completely pale and said she had been so nervous and prayed a lot as they walked, hoping that Dales would not deliver. I hadn’t really thought about it, but it was Sandra’s first birth ever and I had just assumed she would have said they couldn’t walk if she was really that nervous! In the end, Dales was only 3cm.

It didn’t take us long to notice that Dales had not brought a thing with her. In most countries outside the Western world there is a list of obligatory things that must be brought to a hospital or clinic. You need: a person to take care of you (because there are not enough nurses), food, gloves, cord clamps, stuff for the baby, stuff for you, medications the medical staff might need to use on you, etc. In fact, many of the clinics require even the baby blanket and clothes to be all new and can refuse to deliver your baby if they are not. We had never set up any requirements, but had assumed that some of these things would be brought along.

As we talked with her, Dales revealed that her husband has abandoned her and their children, as well as his other two wives and their children. Dales would be taking home a new baby into a home situation where she was the only provider and where this child might be seen as the latest trial. As I prayed with Dales and for Dales this made me think of so many patients we have that bear a name or have named a child something equivalent to a curse. Karin Engelbrecht and I had talked a few times about how people use English words as names without always knowing the meaning, but we had a teen mother who had named her child ‘Malice’ because the father hadn’t owned up to his role. And another whose child was called ‘Killer.’ I really felt that God was calling me to help Dales to remember who He was and not how difficult her situation was.

The hours drug on and Sandra, Susan, Michelle, and I sat in the med room reading textbooks while Dales rested. She had been in labor since 5 am, but everything was going normally and it seemed she just needed a breather. Susan took a break and had a quick nap. We hired our neighbor’s wife to make food for Sandra and Dales to eat and we had some dinner as well. At 8pm Dales was still 3cm, but there was some progress noted and the baby was fine. At 10pm Sus switched with me and I crawled into bed, anticipating a long night. I tried to persuade Sandra to rest in the corner, but she was too excited. Michelle also went to rest.

Just past 11pm I got a call. Susan was practically yelling into the phone, “Baby coming!” It was a good thing I had much experience with sleeping on a top bunk while on call for births, because I was able to carefully get myself down and run into the clinic just after the baby’s head came out. Sandra was in a support hold from behind, Dales was in a beautiful squat, and Susan was moving from in front of the patient as I entered.




I wasn’t sure the exact seconds on ‘head out,’ so I checked if there was a cord around the neck, but everything was fine. In a few seconds the new life slithered out and I held the baby up so Dales could identify him. 11:07pm. She wasn’t in a position to hold him just yet, so she acknowledged that he was a boy and Susan toweled him off before giving him to her.

It was one of the cleanest births I have ever attended. We had prepared in case Dales’ hemorrhaged, but she didn’t. Dales pushed once for the placenta and it came, but trailed membranes for a long time. Then it was over. My first Zambian birth.

Once Dales and her son were settled back in bed, we looked over a very unhealthy, malnourished placenta. It looked intact, but with the long membranes it was hard to tell if there might be a small piece missing. It was so wonderful to be able to teach and explain everything I knew as we went along. Sandra just soaked it up.





Dales’ body normalized quickly after the birth and, after 45 minutes, I took her to wash up while Susan and Michelle washed and examined the perfectly normal baby boy.
Susan drove Sandra home because the water from the lake has risen so high that the hippos (known for being one of the most deadly animals in Africa) would walk onto the road. Dales stayed the night with her baby. In the morning we put together some clothes for her and her son. I sat with her a while and conversed through a translator. I told her how we had prepared, in case there were any problems, but how God had intervened and not allowed any to come. I encouraged her to think about how the Lord has been gracious to her in this time and to name her child something that will be a reminder. That speaking his name will be like speaking a blessing over his life each day instead of speaking a curse. Dales agreed that she wanted to bless her child.



Karin noted later that it was interesting. After having seven unattended (or attended by untrained birth attendants) home births, Dales had walked all the way to our clinic to find help for her eighth delivery. Perhaps it was because she was feeling alone or because she enjoyed our care in prenatals. But, whatever the reason, I believe that God sent her. Not so much for me, but for herself and for that little boy. God has a plan for his life and I pray that the name Dales gives him will reflect the blessings that God has already been faithful with and will continue in that child’s life.

Monday morning Susan and I ran clinic as normal, but it seemed everyone already knew we had our first birth the night before. The community was so excited for us and thankful to us for a healthy baby. It was an interesting response. Glory to God, but also thankful that we were here and glad that we were helping. Sometimes it’s nice to have someone say, “Thank you.”