McQuillens Without Borders

warning...moderate gross out factor.

2011-06-19T05:44:00.003-05:00

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

2011-06-18T05:35:00.010-05:00

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

2011-06-09T01:58:00.003-05:00

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

2011-06-05T15:03:00.001-05:00

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

2011-06-03T02:21:00.007-05:00

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?

WATER

2011-05-30T01:32:00.006-05:00

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

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

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

God is in full control :-)

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

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

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

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

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

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

We Have No Power, Yes

2011-05-27T15:59:00.006-05:00

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

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

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

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

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

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

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

Proverbs 14:31

" Those who oppress the poor insult their Maker,

but helping the poor honors him.

1 Cor. 13:3

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

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

Flat Stanley

2011-05-18T02:31:00.009-05:00

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

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

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

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

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

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

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

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

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

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

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

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

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

Busy Hospital Days!

2011-05-17T05:15:00.006-05:00

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

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

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

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

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

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

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

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

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

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

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

1 peter 1:22

"Now that you have purified yourselves by obeying the truth so that you have sincere love for your brothers, love one another deeply, from the heart. For you have been born again, not of perishable seed, but of imperishable, through the living and enduring word of God. For,
“All men are like grass,
and all their glory is like the flowers of the field;
the grass withers and the flowers fall,
but the word of the Lord stands forever.”

2011-05-15T06:06:00.004-05:00

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

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

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

2011-05-08T08:39:00.004-05:00

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

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

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

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

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

2011-05-04T13:07:00.003-05:00

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

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

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

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

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

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

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

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

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

From the Zimbabwean bush with love

2011-05-01T15:10:00.003-05:00

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

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

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

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

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

Back in Zim

2011-04-29T16:35:00.003-05:00

Well, as many of you know, we're back in Zim. We actually left this place about this time last year, so we didn't get to see many of the "winter" flowers in bloom. Marshall, the grounds keeper, gave Abbi and I the dime tour of the guest house property when we arrived late yesterday. His papayas and avocados are coming along nicely. Abbi made fast friends with his granddaughter "Chanti" and spent the better part of the day holding hands with her, playing in the dirt and just being a kid ( a very jet-lagged kid, at that). April, Abbi, and I found ourselves just staring at each other at 3 this morning. So, we had a snack and put on a DVD in Abbi's portable dvd player, which is a God send, but better batteries would be nice. Otherwise today, we found ourselves reconnecting with old friends here and April procured some necessary supplies for our trip out to the hospital. Overall, it's great to be here. So far we've been blessed with some really good family time and have had the opportunity to slow down and see what God is doing in the world and in our lives. We'll try to keep everybody updated as best we can! The photo above was taken while spending some time in Missouri prior to leaving for Africa and was just put in as a gratuitous display of cuteness.

wrapping things up

2010-06-17T15:24:00.002-05:00

Hello everybody!
According to our family and friends, we owe everybody an updated blog post. So, here goes...

A couple of weeks ago, we packed up our room at the guest house at Karanda Mission Hospital. In doing so, we said goodbye to some dear friends. After five months of working, sweating, praying, and living with folks on the mission compound, we came to develop some really neat relationships. Additionally, we are continuously grateful for the Epperly family, who loved and supported us well during our time in Zim. They are truly faithful friends (thanks for putting up with me). We especially appreciate the doctors, nurses, and missionaries we worked along side of. We think of them often, especially as the hospital is short staffed in our absence - an exacerbation of a chronic problem (to use geeky medical jargon). It would go without saying that April and I find our lives profoundly affected by the people that we were privileged to meet and serve during our time in Zim. We have returned to our families safe and sound, and for this we thank the Lord. Abbi has adjusted to life in the US beautifully. The love of her grandparents and family has made this a smooth transition for her. We're very proud of her and thankful to be able to serve
As I write, I'm sitting in my friend's ice box of a basement. It's over 90 F outside, but I have a blanket on my toes. Really, it feels very nice. My African friends would disagree.
Tomorrow our International Fellowship graduation festivities begin. We will enjoy good friends and good food and share stories of our travels and of our upcoming move. We're thankful for friends to stay with during this time of transition. Still, we find ourselves a bit restless and in limbo. I knew that life would be hectic coming back to the US. However, I don't think I was prepared to feel so out of place. I didn't know that I'd be straddling so many realities. In a very short period of time, we've known dear friends that live in mansions and friends that live in huts. This collision of opulent wealth and abject poverty makes my head dizzy. As I furnish the home I am renting this year, each expenditure of cash elicits mental imagery of hungry children. Certainly, we should make a nice home for ourselves, I'm not saying that we shouldn't. One can have nice things and live well within one's means. It's just so clear to me that we've confused our wants and our needs, that I've confused my wants and my needs. I'm finding it hard to relate to our "bigger is better" culture. And, though I feel a little misplaced in the here and now, I have come back to our country with a new perspective. If ever I appreciated the freedoms, opportunities, and equalities our country has afforded her citizens, it is now. No country in the world affords such justice and opportunity to those born into poverty. America is not perfect, but I love her.
After this weekend, we'll wrap up "school." I've been at this since I was like 5, so I guess this concludes the last 26 years of my life that I've spent as a "student." But, we never stop learning and I'm sure that the majority of the most important lessons in my life are yet to come. We'll be packing up the Budget rental truck on Saturday and by Monday afternoon, we'll be settling into our new home in rural Iowa. It will be a fairly unique practice that will allow us to practice full spectrum family medicine in the US and still remain very involved in missionary medicine. Getting this new practice off the ground is both exciting and daunting and is another story altogether!

Karanda Oasis Spa

2010-05-15T13:37:00.004-05:00

Friday we decided to give the girls at Kid's Club a treat. We painted their nails!

Complete spa and all with a nice warm, soapy foot soak!

We soon discovered though that the boys felt left out, and that they too wanted their toenails painted - how funny!!! They even wanted the little white flowers on their big toes too! Who would have guessed?!

We finished the day with a little face painting! What a fun afternoon for all of us! I am really going to miss these kids.

journal ramblings from the past two days

2010-05-13T13:51:00.006-05:00

A couple entries from my journal (in part):

Tuesday, I was tired of standing, having been in the OR all morning. I just needed to get home and kick my legs up now that 1 PM had rolled around and I was due for an hour's lunch. So, naturally, I headed back to our place.

The thing is, while I was walking up the little hill to our place, a pickup truck, full of people in the back had collided head on with an even bigger pickup truck, also full of people out side of our hospital gate. I guess pretty much everyone whose trajectory wasn't obstructed by a pesky windshield was tossed clean out of the vehicles. So, I put down my delicious bowl of home made chicken soup (which April makes very well, if I do say so myself) and moseyed begrudgingly down to the outpatient department. Looking around myself at one point while running this quasi mass trauma, I counted 16 patients sitting on the benches in various states of disrepair, some bleeding quite a bit. I think there were at least 2 in the private booths, and 2 that had been admitted. Of note, we had a kid with a cobra bite, who, on his way home was thrown into the windshield, we had a questionable c spine fracture, a pelvic fracture, and an number of cuts and scratches on various people involved. For a chaotic mass trauma situation, things went well. John, April, Shea, and Kwenza were all there, too. We took care of buisniess quickly as a team, all considered.

That night, we drove into the bush and met with one of our friends Ms. Kadere, at her musha (musha=rural village). she welcomed us in very warmly. Having been widowed in 2002, Ms. Kadere is a fine example of discipline and hard work. Upon the death of her husband, her inlaws came and took all her land, which is (i guess) a relatively common scenario here. Though much hard work, she has bult up a five room square frame house, a large thatched round store house and raised several children. I was impressed with her extreme generosity, and thankful for the chance to eat at her house. Her 13 year old son gladly showed off the family stereo system, powered by a solar panel, battery, and power inverter. In the dimly lit hut, Shakira, Julio Iglesias, and Puff Daddy played loudly. The speaker's tweeters, long since blown, barked loud westernized music throughout the dinner. I felt like I was sitting in "Club Musha" at some points. Beau and Abbi had a riot dancing around and chasing the cat and dog that were running in and out of the house. After dinner, we sipped on tea. Halfway through the tea, our hostess proudly informed us that the milk in the tea was from her own goats. It really was good tea.

Today was gorgeous. The sun was shining beautifully, the eucalyptus trees dancing in the breeze, which kicked up occasional dust twisters in the barren spots in the landscape. The cool of the morning balanced perfectly with the warm sun on my face as I walked through the breezeways of the hospital. Women's ward is filling up with patients after a 2 week long slow spell. That, in combination with an early morning C section (see above), caused me to get home for "tea time" a little later than I'd had hoped for. On a less busy morning, I might be able to sneak in a quick run over tea time. Instead, April and Abbi sat with me at the gazebo, sipping guava juice while I enjoyed my coffee. The two of walked me back to the hospital after tea. It was nice sitting there with April and Abbi, just enjoying the day (and we still managed to run after work).

Here's an excerpt from the devotional I did with the nursing students this morning at chapel. It comes from 1 John.

1 John 2:1-2" ¹ **My little children, these things I write to you, so that you may not sin. And if anyone sins, we have an Advocate with the Father, Jesus Christ the righteous. ² And He Himself is the propitiation for our sins, and not for ours only but also for the whole world."**

This begs the question what is an advocate? what is a propitiation? We need to define these words to understand the text.

An advocate is someone who speaks on behalf of another person. This has a legal connotation to it, much as a lawyer would advocate for a client in front of a judge in a courtroom.

God is Just, and ultimately wrongdoing (otherwise known as sin) must be punished. If God simply dismissed sin, he would not be full of justice. Even in our courts, If a man is on trial for a crime (theft), even if he has lead a decent life overall, will a just judge simply allow the man to go free? No. A just judge must give the man the punishment that the country's law requires. A moral law of conduct- even the conduct of our hearts- exists. We have all broken this law and a price must be paid. Jesus took the punishment that should be ours. By his work on the cross, his suffering and death, he appeased the anger of God, which was directed at us, making it possible for God to both forgive us our sins and remain Just. This is the meaning of that big old fashioned word propitiation.

Balloons!

2010-05-09T13:21:00.003-05:00

A couple days ago Abbi and I and one of our friends here, Nicci, went down to the Ped's ward to hand out some balloons, paints, and paper. It doesn't take much to start a party with kids that aren't accustomed to such festivities!

Nicci, a pediatric nurse from New York had a bunch of kid's stuff donated from her church that she wanted to pass out to the kids before she leaves this week. The Ped's Ward right now is very full, and there are literally sick children sleeping on mattresses on the floor. It was such a sight to see all the kids throwing balloons in the air and so excited to get some water paints and colored pencils! It was especially nice for the kids who are "in traction," having to sit in the same position for three weeks in order to let their broken their thigh bones heal.

The one little guy who really touched our hearts is a little nine year old boy. He is an HIV orphan and lives with his "sekuru" or grandfather, his father dead from HIV related illness and his mother having abandoned him. He is severely malnourished, weighing 10 kg ( about 22 lbs), significantly less than my 2 year old! He has Noma, a condition of malnutrition which causes a hole to rot all the way through his cheek. There is a hole about the size of a quarter in his right cheek- all his teeth on that side are visible with his mouth closed. He actually smiled when we gave him a balloon, which probably took most of the strength he has. Please pray for him as he probably will not live very long.

the big trip: a recap

2010-05-08T12:29:00.008-05:00

Yet again, our photos have been cut in half. Please click on the image to see the full image or view this blog in the "google chrome" web browser. Thanks!

Hello, everybody. As the time approaches for our departure (we have less than two weeks left here), we wanted to stop and recap our big "vic falls" trip for ourselves and for you, of course. If we don't write some stuff down, the memories will just be fuzzy later. This is just downright wordy, and I apologize. But hey, it's basically a journal entry for our family. So here goes:

After six weeks in the bush, we were all good and ready for a break in the action. We'd been on call lots prior to leaving, just as we are now. I think we're on 14 of 17 nights or something according to John. I don't really keep track. The call nights aren't as bad as back home, as I mentioned before. Oh, I did eat my words after the last blog by the way. I got called in immediately after writing!
Anyhow...back to the trip. We packed all things needed for a 10 day vacation in Africa for a family of three, The Epperly family of four, and our neurologist buddy, David. David was just visiting and thus was taking all of his stuff back to the capital city for departure to the states. We also had some stuff to take back to the mission office in Harare. Needless to say, we loaded our big blue Land Cruiser to the gills, and headed out into the wild blue yonder- adventures ahead of us and work behind.
I crammed in the back with April and half the gear, the kiddos snug in their middle row car seats, John driving with Dave and Shea beside him in the front seat. The other half of our gear was tied to the luggage racks on top of the truck. I'm not talking Toyota Camry luggage racks. These are things are real "man" racks. You could, for instance, tie another Land Cruiser with it's man rack all full of gear up there and you'd be just fine. I guess getting it down would be a trick, but it'd ride OK.

You should know that there are two ways to drive through the middle of nowhere to get to Karanda. The long way and the longer way. Going the long way, you drive through a river, wind around through the bush a lot and then head out onto a highway. The longer way just drive until you find what must be one of the narrowest bridges in the world, drive over it, then wind through the bush and out onto the highway. This time, at the advice of our boss, we headed for the river. Now, men like to do things like drive through rivers. It makes our testosterone surge and gives us something to grunt about. As we headed to the river, we drove right past a group of locals bathing and washing there. We let out a hearty guffaw as we plowed right into the waters. The adrenaline filled excitement quickly turned to nail biting anxiety as we realized that the waters probably shouldn't cover the tires completely. I got my video camera out and captured some really tension filled moments as the waters surged up near the bottom of the truck windows. When you're in the middle of a river though, it's a little difficult to turn around and go back. John drove on, disregarding the competing instructions from us to "stop"," go", "go faster", and "slow down" all at the same time. As the dripping hulk of a vehicle emerged from the waters, we were grateful to God for our safe passage. The blue skies ahead welcomed us to the road and we happily left work behind us for a time.
After three hours or so in the car, we made it to Harare. Upon arrival we got some good eats at Jacob's Well, a local coffee house. Great food and great coffee. We make a habit of not cooking or cleaning too much in Harare. After unloading our stuff, April, Abbi, and I headed to the Spar, our local grocer and geared up for our trip. We bought plenty of good-for-you food, enough cookies, beef jerky, crackers, and candy to feed an army. We even found some "musk" flavored mints. They tasted like grandfathers smell plus soap. They weren't a big hit.
We had pizza that night from Pizza Inn. It's a really tasty pizza shop in Harare that's only a couple of miles away from the TEAM office. So, we eat there at least twice every time we go to Harare. We repacked our gear, readying our families for our driver to come get us in a "van" in the morning. I envisioned, with agony, traveling a couple thousand kilometers in an old Ford Astrovan with five adults (including our guide), three (screaming) kids, and all of our junk. Just to help you stretch your imagination:

You can imagine our surprise when our guide, Stephen, rolled up in an extended 8 seater mini bus style van with a huge cargo bay, towing a cargo trailer. We got all of our gear into the van with plenty of room to spare- didn't even need the trailer. Stephen, a super cool yet very mature 20 year old Zimbabwean native was great to travel with. He drove, cooked, made all of our lodging and tour arrangements, and became much more like a friend than a hired guide. Hiring his company ACTS (African Christian Travel and Safari) was a huge blessing, allowing us to just focus on family time. Stephen's incredible maturity may have something to do with being orphaned as a child and coming up in the world the hard way.

We bounced through the country side, stopping often at police road blocks. It turns out that if you're super polite, they usually just wave you through. Our first stop was "antelope park, " which is a fairly interesting small game reserve about 4 hours from Harare. (http://www.antelopepark.co.zw/index.html) It's interesting in that it is a Lion rehabilitation reserve by purpose and a small game reserve by accident. The owner (who now has one arm due to his occupation) raises lions from birth, teaching them to hunt on the reserve grounds at night, and eventually releases them into areas where Lions are endangered. Here, you can swim on elephant backs, walk with lions and lion cubs, and just enjoy the grounds- which are stunning in their own right. We arrived at dusk and checked into our "deluxe river tent," which is basically a waters-edge safari tent turned into a hotel room with a hot shower and nice tiled bathroom added on to it. Before a delicious buffet dinner cooked over wood fire grills, we strolled through the grounds of the fenced off lodging area within the park itself. Passing by the dinner grill, we headed off to the opposite shore of the lake we were staying on via a long wooden bridge. The waters, clear as glass, below us were no good for swimming, as a crocodile had been spotted in the waters previously and, as they say, "you only swim with a crocodile once." So, we ventured around the lake shore, perusing the buildings on the opposite side. Three villas were set up, one with lots of bunk beds and two others as "honeymoon suites." The suites were gorgeous, thatched roofs two stories high with a glass wall facing the lake. A large cast iron bath tub sat in the back section of the studio apartment like layout. The water for that tub kept hot by a wood fire, perpetually stoked under the water tanks out back. The sound of drum beats called us back to the grill area where we feasted.

Abbi was absolutely thrilled with our accommodations. She said "it's awesome" as she rolled around on the soft beds. We really enjoyed sitting on the personal porch of our river tent together, just taking in the sights and sounds of the wild life in the water in front of us.

We woke up early the next morning. Refreshed, having spent the night under several blankets from the cool weather, we walked to breakfast surrounded by mist coming off of the lake in front of us.

That morning we took a trip with the Epperlys, our friend Nicci, and Stephen through the game reserve in a horse drawn carriage. It was a great way to take in the zebra, giraffes, gazelle, gnu, and monkeys as we toured the park.

April, Abbi, and I took a dip in the pool before heading off for a sunset pontoon boat ride. The lake itself reminded me of Lake Bracken, a lake dug for steam engines on the railroad in Illinois that I grew up swimming in as a kid. The sunset was breathtaking, as you can see in the sunset photo above.

As we headed out early the next morning to our next destination, we were sorry to leave this little paradise. We traveled about six more hours towards Victoria Falls, and stopped at a rustic Safari Lodge called Miomba Safari lodge. The cabins were sparse, one room villas with thatched roofs. Abbi took one look around and said "it's not awesome." And, that's how I felt initially, too.

We spent that whole evening in Hwange game reserve in the back of an "overlander" truck outfitted for such safari viewing. Hwange is HUGE. (http://en.wikipedia.org/wiki/Hwange_National_Park)

It is 14,600 square kilometers (9,000 sq. miles) with 105 mammal species and 27 "large species" including 8 large predator carnivores.

As we entered the park, a huge male elephant lumbered through the bush, crossing the road in front of us. We encountered many elephant at play, zebra sleeping in the shade, herds of spring buck, and crocodile and hippo swimming lazily in a watering hole. We returned tired from our safari to an excellent meal of beef stroganoff before hitting the sack.

Naturally, Abbi was up and ready to go on the third morning of our trip. So, I decided to let April sleep and take Abbi "exploring." I figured I'd get some coffee and we'd kill some time looking for rocks and sticks. Standing by the pool, looking at bugs, I heard a little movement from the other side of the pool. Quietly, I picked Abbi up - still in her footie pajamas - and headed over to check out our new find. Sure enough, a huge elephant had wondered into the lodge grounds. Abbi and I hid behind a tree and watched him bathe himself in the water hole there. When we got back to the room, I said "Abbi, what did we see when we were exploring?" "An elephant" she answered nonchalantly. Miomba, it turns out, was awesome.

The ride to Victoria Falls was a quick and uneventful 2 hour drive from Miomba. The town of Vic Falls proper isn't much to look at. It has your usual tourist trap stuff, from open markets (with very, very aggressive sellers) to adventure sports outfitters, etc.

We pulled up to our accommodations for the next two nights, Lokuthula Lodge. The building we stayed in had a back wall made of canvas that completely retracted. This allowed us to watch the warthogs that were constantly in the yard. The monkeys and warthogs that live in the lodge area are much too accustomed to humans and are fairly tame, but will charge a person when challenged, as Beau found out. Watching him tell the story with wild hand gestures and squeals is really funny. Abbi referred to the warthogs as "horkhogs" and Beau called the "hotdogs."

We ate that night at "The Boma," a unique outdoors African restaurant, where we feasted on warthog, crocodile, kudu, mopani worms, ostrich, buffalo, sirloin steak, lamb, and a variety of local delicacies. African dancers flitted about during the meal and afterward, the staff passed around a few hundred drums for a group drumming session. The sound was immense, the kids had a blast!

Victoria Falls itself is the most powerful and breathtaking spectacle I have ever seen. Vic falls is the largest sheet of falling water in the world. We ran with the children, like children, through the mists sent up by the falls. Though it was not raining that day, we left the park completely drenched and enthralled from our adventures.

Ice Cream!

2010-05-05T04:43:00.003-05:00

Paul has mentioned the Kid's Club group before that Abbi and I enjoy working with. They are a group of HIV positive orphans that meets every MWF for a couple of hours in the afternoons here on the hospital grounds. Many of them walk over 7 km one way to get here. They get a meal, which for some of them are the only 3 meals they may get, and then we have time to play. The goal is just to love on them and let them know that they matter because Jesus loves them. We get to just focus on the emotional and spiritual needs of these little people. They are so great, and we have just really been blessed by having known them.
Last week we were able to go down to the river for some play time, and I thought it would be fun to take some ice cream that we were able to bring in coolers back here from Harare. WOW! Talk about excitement! Imagine having never even seen or tasted ice cream and getting to experience it for the first time. Needless to say these kids devoured the entire 5 Liter bucket we had brought! What a memorable day for all of us! Afterwards, Abbi came home and just kept saying, "The kids liked the ice cream, Momma!" Yes, Abbi, they did.

Happy Birthday, April

2010-05-02T14:22:00.004-05:00

Thanks for putting up with me and gracing my days with your beauty...

"There's something in the way she moves,

Or looks my way, or calls my name,

That seems to leave this troubled world behind.

And if I'm feeling down and blue,

Or troubled by some foolish game,

She always seems to make me change my mind..."

-James Taylor.

This week at Karanda

2010-04-30T15:40:00.003-05:00

A quick note before we begin: The above photos getting cut off. It's really frustrating and I'm not sure how to fix the problem. If you use "google chrome" as your web browser, you should be able to see them well. Otherwise, if you just click on the photos themselves, you'll be able to see the whole photo!
This week has been a good one. I think partially it's because we're refreshed from a great trip to Victoria falls and several game reserves and partially because we've really come to know the ropes of how life and medicine generally works out here. I'm working in the female ward, as I mentioned before and the ladies are generally much more chatty and warm to work with than the patients in male ward. Managing Intensive Care patients is a fun and interesting challenge in the absence of most resources we take for granted back home. For instance, we don't have a ventilator and it would only work when the power is on if we did. Sure, there are many sad cases and much more death than we are accustomed to back home, but there are many times more people that bounce back from certain death, especially the kids. The Shona people love to laugh and I really enjoy joking with the patients and staff as we make our way around the wards on rounds. We've become good friends with many of the nurses, which makes work and ministry quite enjoyable.
Several issues I managed on rounds today include

Cerebral malaria
Acute renal failure
many post operative patients (orthopedic surgeries, excisions of various cancers, amputations)
burns
stroke
Tuberculosis
Brain Injury due to trauma
HIV and it's various complications (cryptococcal meningitis, TB, cancers, etc.)

After rounds I went to the operating room and did

a central line
sedated several children using ketamine
spinal anesthesia
reductions of fractures (supracondylar and a distal radius fracture)
put in a VP shunt for hydrocephalus
fixed a broken knee cap (ORIF patella) - assist
excised a rectal tumor- assist
thoracentesis
several other cases went on, I was just busy doing other stuff

All of this, and I still had an hour lunch with my girls AND saw them for a half an hour long tea break (during which time Shea's mom fixed us an amazing brunch). We even wrapped up early around 4 O'clock and after counseling some family members in Female ward, headed home for a nice run. April and I have enjoyed running on our usual route with Abigail in the evenings. It's been getting darker earlier here as winter approaches. We really enjoy the cool evening air (mid 70's or so) and rocky hills, alive with banana trees and thatched huts look beautiful in the setting sun as we jog.

Making up for lost time

2010-04-27T16:18:00.006-05:00

We're on call again tonight. It's not so bad (watch me eat my words). Most of the easy stuff is handled by nurses here, and we just mainly get called for emergency c sections, traumas, and any really sick patients that wander in during the night (though sometimes they don't call on those either).

It's our last month here, so we're really trying to buckle down and finish strong. I've just started work on the Female Ward. The nature of the ward is pretty self explanatory, with the exception of a small 4 bed "ICU" ward within the ward. This again, is basically just four beds that are close to the nurses station. These beds can be occupied with kids, men, or women. Right now, one of the guys in those four beds is a local pastor is who is deathly ill with cerebral malaria. We've gotten past the actual malaria (his MPS is negative now), but he is now having major bleeding problems and brain swelling (DIC and cerebral edema). So, please pray for that guy. He's much beloved by the community, as evidenced by the constant flow of staff visiting his bed and the endurance with which his wife holds a vigil at his side. We have to get a little creative getting blood for folks like this in emergencies, so we wind up checking relatives for blood types. I spent a long time cleaning this guy up, clearing his airway and basically doing stuff that ICU nurses in the states would usually do this morning. Afterward, I walked his two brothers to lab to check thier blood types, as we need more blood for him. As I walked, I gained a sense for all the nights the three of them had spent laying side by side at night talking as boys and of the many open fires they surely sat around telling stories. Written on thier faces was a deep love for their brother and a fierce desire to give thier own blood to save his life. This simple love of family touched me deeply. It was easy to imagine my own father in such a bind and catch a glimpse in my mind's eye of my dad's brother, Monte, walking with me to that lab. It's a little rough when your protective mechanisms that help distance you from the horrors around you break down.

The crew here is doing well, save for a touch of the stomach bug. I think it's one of the souveniers from our trip that we didn't want to bring home with us, but did. I'll try and get some more photos from our trip up soon. Our connection to the internet is fairly slow right now!

2010-04-26T16:17:00.003-05:00

I think I start off half of these blogs by apologizing for not having written more, so I'll not do so this time around. Hmmm, I guess I just did. Anyhow, lots of really momentous things have happened around here since my last blog.

Most notably, yesterday, my little girl turned two. That's right, Abbi is the big 2. I have this terrible feeling that twenty years will go by just as quickly as the last 2. We just returned from our big trip on Saturday. We had been gone since the previous Thursday and driven many, many hours in a big van with our friends, the Epperlys. I won't go into details now, but it was a phenomenal trip. For more day by day records of the trip (at least from John's perspective), check out http://www.epperlyadventures.blogspot.com/ . He's done a good job keeping things up lately- I think he was typing in the van!

here are the websites for the places we visited:

1.http://www.antelopepark.co.zw/index.html

2.http://en.wikipedia.org/wiki/Hwange_National_Park

3.http://www.afrizim.com/Places/Victoria_Falls/Accommodation/Self_Catering/Lokuthula_Lodges.asp

We got back to Karanda on Saturday from the trip and the power, as is too often the case, was out. So, we just waited until Sunday morning to start baking up a storm. We made 2 pans of brownies, two pans of cup cakes, one layer cake, and two (failed) pans of chocolate cup cakes. April worked very hard to give Abbi a special day out here in the bush, and I'm very proud of her. Abbi really needed very little fanfare to feel special, as she's been building this day up in her head for the last week or so. She's been saying "Abbi's got a big day coming up!" for a week now. And a big day it was! We had some local kids over at 3 for swimming, cup cakes, and ice cream. Then, we had the missionary community over at 6:30 for a second party. Abbi was a ham the whole time and really had a great time. Her grandparents event sent her nice party favors and gifts in the mail, which she really enjoyed yesterday! We were sad, though, to be without the rest of our family on this big day.

In other news we picked up Shea's mom, Rhonda, in Harare on Friday night. She'll be with us until we leave here in a month to come home. She's already been a delight to be around, a huge help around the house, and generally a nice part of home that came to us a month early.

COMBOBLOG...a mix and mash of stuff I should have written about all week.

2010-04-02T15:59:00.001-05:00

McQuillen Family, Easter 2010

This is carmelius. He's the chameleon we found in a tree outside, and subsequently brought inside to play with. He's super cool, and you can see how he changes colors with his surroundings. Don't worry, after letting him scale the drapes for a little while, we turned him loose. Maybe we'll catch him again some day. The Africans are scared of the chameleons, thinking that they are poisonous (don't worry- they're not!). Just as a fun fact, there are 160 species of chameleon in the world and 135 of them are found in Africa.

This is cobra. We didn't name him because we didn't like him, which is why he is dead. One of the missionaries here blew his head nearly clean off with a shotgun. I know it doesn't look like it , but we had to be really careful with it, as they can still be dangerous if handled carelessly when dead. (disclaimer: all bravado displayed in the photo is only an act, this thing was just nasty).

And, here is Beau with not one, but two horny toads that he caught:

Ahh, reptiles.

Anyways, Happy Easter! We went to a little Easter service this morning at the chapel. It was small and brief and comprised of a larger percentage of white people than usual, owing to the fact that the majority of the people in the area are attending the "Easter Meetings." Dump trucks full of people were rolling out of here on Thursday headed for the meeting place. As the name implies, a whole bunch of people pretty much have a lock in at a school complex for four days, doing workshops, sharing food and conversation, and worshiping of course.

Here are some gratuitously cute photos of Abbi

Naturally, the Easter bunny came this morning. I'm pretty sure ours was the only house around he hit. The kids were pretty pumped this morning to see the baskets that the Easter bunny had left them, and to go hunting for the eggs that he'd hidden around the family room. We extended the fun by re-hiding the eggs after the kids found each one and excitedly plopped it into their basket! See the spiffy hiding places below!

I thought I'd put a little dittie in here about life at the hospital, so that people following the blog for professional reasons could have some tid bits to think about:

I'm still in charge of the pediatrics ward. This will be the case until early this week, when we switch roles for the last time. I'll then rotate to the female ward, which will be good for me. The pathology in the two wards is quite different, so I'm sure I'll learn a lot as I go along. I'm going to go around the peds ward mentally now, in order to highlight some of the illnesses we care for here.

I show up at 8 AM and start with prayer (except every other Wednesday, which is my "theater day"...then I just pop through and see the really sick ones). The ward is rudimentary, concrete floors, ceiling, and walls, decorated with the occasional poster. Mosquito nets tied in knots hang down above the white metal cribs that the majority of the kids lay in during the night. Those that are even moderately able tend to migrate together into the commons area outside of the hospital during the daytime. A kind nurse in a old fashioned green polyester nursing uniform meets me most days. I don't see many nurses in scrubs around here. Lets get started rounding:

On the right, just past the nurses station is a small "ICU." Maybe it should be called the "I see you" because the only advantage of these two beds is being close to the nurses station. Sometimes these kids are on oxygen concentrators, which still go down when the power goes down. The two kids in those beds this week had 1. a head injury from an ox cart accident and 2. a low blood oxygen saturation from what I presume is a congenital heart problem. We have no way to assess kid number 2, so we had to refer him to the capital city for a special ultrasound of the heart. I don't know if he'll get it or if he'll live. Sending those kids out is really, really tough to do.

After seeing those two, I'll turn to the small unit of 3 beds behind me. For the past three weeks, they have housed a motely crew of preteens with femur fractures. They all had to lay pretty still with ropes attached in various manners to their effected extremities, and weights on the other end of those ropes via a pully system, hanging precariously off the end of each bed. They were more or less well, aside from their broken legs, and so were fun to tickle, harass, and read to while they were here. They've since gone home and a new crew of 1. a four year old with a huge abdominal (Wilm's) tumor, 2. a 7 year old with both hydrocephalus AND abdominal tuberculosis, and 3. a kid that just had a hernia repair have taken the beds.

I work my way out of that little space, trying to make myself skinny enough to avoid bumping up

against the kid's traction weights, and move on to the next section of the room. Here, just past the traction area, are three beds along the wall, and four beds running perpendicular to those beds. The later four almost universally have kids with hydrocephalus in them, usually for 7 days at a time, if all goes well. Our hospital does about 75 percent off all shunt operations done on kids in Zimbabwe. It's pretty remarkable really, and I've come to feel strongly about taking care of these kids. So many of them get neglected, with disastrous consequences. The other three beds are now divided between a kid that had an undescended testicle who just had surgery, a kid that had a chronic foot wound, and the other sits empty because the 14 year old that was in it died of end stage HIV last night.

As we swing to the other side of the room now, doubling back towards the ICU, we meet with a child that has severe malnutrition. We don't know what his HIV status is yet, as he'll need to be tested at a year and a half, as is the standard, but his mom has HIV, so i'll start him on anti HIV meds before we send him home because he looks so sick. A lot of these "feed and grow" kids stay for a while in order to get their nutritional needs sorted out. As we continue on we'll find a kid with pneumonia, a newborn with sepsis, a kid that just had surgery on his genitals (hypospadius repair) and more kids with hydrocephalus that either need surgery or are undergoing treatment for the complications of hydrocephalus/surgery for hydrocephalus. Additionally, there is a little girl called "Rumbi" in one of the beds there. She is precious and has a terrible wound on her leg that we've been operating on and re-operating on for weeks. Often times, these beds will also house kids that have had surgery for clubbed feet, various hernias, fractures, and severe malaria.

As we walk past the ICU now, headed for the door, we duck into a small 8x8 room that usually holds two patients. We had a kiddo in there who was born with her intestines on the outside of her body (gastroschisis). Abbi loved that little one- "the baby with the hurt tummy," she called her. After weeks of careful feeding and nursing following a successful repair of her birth defect, she died in the night. It was very sad. I haven't adjusted to the high death rate here or to the lase-fair attitude of the locals regarding death. However, the little victories and the joy of kids getting better keep me encouraged.

Well, I hope you enjoyed rounding with me. I left out the small talk and just tried to give you a thumbnail sketch of the ward. I hope you learned something.

Happy Easter!

Futility of Care and Fatalism

2010-03-24T14:00:00.003-05:00

IFMF from Websmitten on Vimeo.

The above video/slideshow was made by our friend KC Morris, the lovely wife of one of our Via Christi Family Medicine Residency colleagues. I hope you like it. Frankly, the first few photos look cool, but I haven't been able to watch the whole thing.

In other news, we were on call last night. Just as I was settling down for what was sure to be an easy call night, compared to those residency call nights of old, John knocked softly at our door. He'd gone in to check on a new admission in male ward. This 35 year old patient had been panning for gold in a mine shaft, had an accident, and had a cut on his ear. He'd transferred himself to our hospital after sitting at another local hospital all day long. I thought to myself "weak admit" as I answered john's knock. I guess I had forgotten that we just don't get as many "worried well" around here as we do back home. Like, nobody shows up at 3 AM with a rash, you know? So, it turns out that this man had fallen down a mine shaft or that the mine had otherwise collapsed on him. We went in, headlamp and flashlights in hand, to check in on the man's wounds in the light of the operating room. The power had been off since early in the morning and it was now around 11 PM.

As we walked towards the dark ward where the man lay silently in agony, we passed by soft glow of candles and soft chatter of the female ward. With great effort, we wheeled the man up to the Theater (O.R.). By the light of our flashlights, and the back up lights we examined the man. His right ear, nearly severed, hung somehow to his head. His eyes were wide in desperation as his chest heaved up and down abnormally with each breath. Both of his lungs sounded terrible. given the fact that the level of oxygen in his blood was very low (02 sat 5o%) and we had no access to a radiology tech or electricity by which to take the chest x ray, we decided to take action. His lungs sounds were markedly abnormal and he seemed to even have air trapped under the skin of his neck. We, with some searching by the light of our flashlights, found two chest tubes and the necessary equipment to make them work. I inserted the first chest tube and with a WHOOSH, a huge amount of air that had been trapped in his right chest escaped. His blood oxygen levels improved, but not to our satisfaction. As John inserted a second chest tube on the other side, a copious amount of blood escaped from the man's chest. With some supplemental oxygen, the man began to speak and felt relatively good. Without power, however, the oxygen machines in the wards simply don't work. Even so, the patient seemed stable. He was even able to converse with us a little as we told him about God, man's brokenness and imperfection, and inability to be with God in that state of imperfection. He said he did not know God, all of this was fresh to his ears. We talked about how we deserve, because of our imperfections to be apart from God forever. But, because of God's great love for that man, God sent his son Jesus to receive the punishment that we deserve for our actions that are against God's laws. I told the man that Jesus says if we ask him to forgive us for our wrong doing, that if the man would just open the door of his heart, and receive Him, that God himself would make His home in the man's heart. Furthermore, that with Christ in the man's heart, God would no longer even see the man's wrongdoing, but only the perfection of Jesus, God's own son.

Here's some nice reference verses. I'm not making this stuff up:

Rev 3:20

"Here I am! I stand at the door and knock. If anyone hears my voice and opens the door, I will come in and eat with him, and he with me."

1 John 1:9

"If we confess our sins, he is faithful and just and will forgive us our sins and purify us from all unrighteousness. "

Psalm 103:12

"He has removed our sins as far from us
as the east is from the west."

At this point in the conversation, the man was awake, alert, and Chest Tubes functioning well, engaged in the conversation.

Satisfied with our teamwork and happy with our patients condition, we walked home under starry skies. The belt of orion, the southern cross, and a brilliant moon lit the way as we went through what is basically a play by play review of what we did right, wrong, and what we'd do next time. This fellowship has been an immensely good tool for team building and for allowing like minded people to sharpen each other for service to the poor in these settings.

Several hours later I was awakened by a knock at my window. The bundled up security guard (they do this here when its in the low 70's even) brought me the dreaded news that our guy wasn't doing so well. Now 4 AM, I walked into male ward. By candle light, I could see that our patient was declining rapidly. With much duress, nurses went to collect equipment to monitor oxygen saturation in the blood, a bag to assist the patient in breathing, and oxygen. The tank of oxygen did not work correctly, and no on knew how to make it do so. The power was dead, so the oxygen machines were still of no help. Finally, a nurse showed up with the kind of portable oxygen machine that old smokers drag around casinos while playing slot machines. It had a little battery life left on it, so we quickly but it to use in conjunction with my bagging efforts. Still the blood oxygen registered dangerously low (50-60). He'd been like this for hours, but now the patient was listless, I was told in a flat tone by the nurse on duty. As I bagged and bagged and tried to fix the oxygen tank, a bat flew around the dimly lit ward over my head for several minutes. A large frog hopped between the beds. A different man died a few beds over. These things combined with the cries of old mental patient in the corner made for the strangest candle lit quasi code blue I've ever taken part in by myself. For an hour I pushed air into his bruised and bloodied lungs. Despite my efforts and the old-smoker-goes-to-Vegas oxygen setup, the blood oxygen levels did not rise and I deemed treatment futile. I gave the man a low dose of Morphine to keep him comfortable (but not too much), prayed silently and went home, the man still thrashing and gasping. With no power, no ventilator, and so many catastrophic injuries, designating this "futility of care" seemed appropriate. This was among the most helpless times I have experienced as a physician to date.

This morning, I walked down to his bed, fully expecting him to have passed away during the night. I was wrong. He continued to lay there, thrashing about, his oxygen now even lower- the battery on the oxygen machine now dead. I was unable to help him, despite drawing fluid from around the heart with a needle. I intubated him, but without any power for suction, his throat had filled with blood and I had no way to remove it. It was at that time that the full extent of his jaw and rib fractures became more apparent. Shortly thereafter, he died in our arms.

I was kind of in a funk today over this whole thing. One thing that people struggle with around here is the idea of fatalism. "What will be will be, so why try to intervene." Maybe that's why nobody called me for three hours after the guy had already had severely low oxygen levels. Because he was going to die, and they knew it. No sense in fighting it, right? So, I ask myself, why was I up all night with this guy? What is it in me that makes me pull out all the stops for a dying man? I mean, I certainly felt like those hours of care could have been but to more pleasurable use (i.e. sleep) if the he was just going to die anyhow. And how far can you extrapolate this idea of fatalism? Why lift a finger to care for anyone? Why intervene in any disease process, especially when survival may mean severe disability? This is especially enticing when the people we are caring for smell badly, are different than us, or even have been overtly mean people.

The reason, as it became clear to me this moring, is because:

1. People are made in God's image and have inherent value. The way we treat them directly reflects our feelings towards God and His worth.

2. Our actions go on forever, and ultimately we are responsible for them. This man is, as is everyone else, a human with a soul. I firmly believe that his existence did not stop this morning. I do not know what impact our conversation during the man's lucid interval had, but I don't believe in meaningless circumstances. It is the highest honor to care for a man in his last moments and to hold out hope for him.

3. Because this is how God is with us. Constantly in denial of His person, his greatness, even his existence, or constantly impressed with ourselves and our spiritual rightness, we are offensive to God. But, he continues to hold out hope for us. Patiently bearing with our futile case, which in a matter of a few years will be over, he works on us- attempting over and over again to rescue us from our self destructive tendencies and restore us to Himself- that is to a state of total and real health. All this, because he loves us.

A Restful Sunday

2010-03-21T04:50:00.006-05:00

Abbi closely examining her new friend, Froggy.
Enjoying some sidewalk chalk with Dad

I'm laying here in bed, the electricity having just turned on. Our fans are abuzz and a cool breeze now runs through the room as April naps and I lay here typing. I feel a little bad, skipping out on the church service- the songs of which, we can hear through the window of our room. Abbi got grouchy and went down for a nap about 10, which happens to be when church starts. This became a really convenient excuse not to go, which i didn't really mind, as the service is 2 hours long and is in Shona for the most part. The people are great. and things singing/dancing in worship is great, but hey, my kid is sleeping and my Shona is worse than bad. Instead, i read through a sermon by Matt Chandler. The ones I've been going through lately include

Games People Play (Part 1)Luke (Part 43)Matt Chandler

Games People Play (Part 2)Luke (Part 44)Matt Chandler
Games People Play (Part 3)Luke (Part 45)Matt Chandler

These three sermons are the last three done on a 2 year long series on Luke. I thought these were phenomenal. The green icon above is the mp3, the red is a written format, and the SG is a study guide.

The whole series can be found here:

http://hv.thevillagechurch.net/sermons?kw=luke&type=sermons&match=any

I find Chadler's practical application of scripture, sense of humor, and general mocking attitude towards the prevailing religious silliness of the bible belt to be really great. The Truth of scripture, as presented by these sermons, has cut right through me and changed me at a deep and real level. I recommend them to anyone who hungers for depth and truth in their life, especially those disillusioned by religious hobbyists and religion in general.

April and some of her friends at Kid's Club

We're on call this weekend. So far we've only had two C sections. One of them was yet another transfer from the local district hospital. We've come to refer to this as "the Mount Darwin special." We get lots and lots of transfers from District and even Central hospitals here. It's definitely a commentary on the state of the medical system in Zim. We've also had a bunch of random admissions. It gets a little tricky around here because, oh, 50% or so of the time I'm definitely in "never seen this before" territory, but I guess that's one reason why we're here. Additionally, there's no lab when the power's down, no x ray on weekends, etc. So, we just have to get a little creative sometimes.

I'd write more, but John and Shea have just announced to us that they are babysitting Abbi and that I have a hiking/picnic date with my lovely bride. Gotta go...

Date Night!

2010-03-16T00:59:00.002-05:00

It's difficult around here to find time for dates. And if you did have time, there is really no where to go. So, John and Shea informed us on Sunday night that we were having a date! They made us dinner, set up a nice movie "theater", and John even acted as our own personal waiter!

Today was a relatively light day. After rounds and an early morning C section, we all went for a quick run before clinic began. Yes, even Abbi went with us. We picked up a BOB jog stroller a few months before we came. Even though it was sturdy, we just thought we'd never use it. Wrong. The thing is built like a tank and we use it daily- it takes the abuses of rocks and trail ruts in the African bush with flying colors- and allows Abbi to run with us. We enjoy running several miles every day that we can. It is a great family time together!

Following a fairly uneventful clinic time, I was walking by the pediatric ward. April, Abbi, and our friend Nicci happened to be there handing out stickers and candy to the kids. I had brought Eric Carle's "From Head to Toe " for such an occasion.

With our friend Miriam translating, I read the book to the kids. They didn't know what to think. I think they enjoyed it, though. I know if I had my leg in traction for three weeks (as four of these kids do) I'd enjoy any form of diversion.

Tomorrow is "Theater Day," which is Zim speak (AKA British) for "a big day in the operating room." Tomorrow we'll be doing

-exploratory laprotomy

-Hysterectomy

-Open Reduction Internal Fixation Radius

- Prostatectomy

-z plasty wound revision

hmmm...There's probably double that number of items, but you get the idea.

here are a couple of the kids we operated on today. The fist is the worst case of hydrocephalus I've ever seen. The head measured 72 cm around. This is maybe 20 cm bigger than any of the other kids I've seen. Unfortunately, this child will likely suffer profound disability because of the delay in surgical treatment. He's six months old and the hospital in the capital city has apparently put him off for about that long. Very sad. See the kiddo in the second picture to see how these kids usually present to us...pretty normal, except the crying and all. I guess white people are just a little scary for the little ones. The third is a strange neck mass on a 10 year old little girl. She's a cute kid and her neck looks good as new now. Forgive me for the blurry photos, I just like to try not to use a flash when I'm photographing patients. I figure I'm a little less intrusive that way.

2010-03-12T14:59:00.001-06:00

Luke 18:15

^"¹⁵People were also bringing babies to Jesus to have him touch them. When the disciples saw this, they rebuked them. ¹⁶But Jesus called the children to him and said, "Let the little children come to me, and do not hinder them, for the kingdom of God belongs to such as these. ¹⁷I tell you the truth, anyone who will not receive the kingdom of God like a little child will never enter it."

I've been running the pediatrics ward here lately, so this passage took on new meaning. If you get swamped with people when handing out stickers, just think how ear splitting the situation must have been when the Son of God showed up to hold and love the kiddos. I bet he was just inundated by loud requests from all the moms. I have more appreciation for his patience and love for these little ones, now. Especially now that I am in a culture that does not particularly value children, much like the culture in Jesus' time.

It's hard to believe that our time here is nearly halfway over. For me, that creates a sense of urgency to learn as much as I can while we're still here- that is to learn as a husband, father, friend, and physician.

We're having a lot of rich time here as a family. April is really appreciating being able to spend so much time with Abbi. She is an excellent mother and finds the time at home, which this year affords her, both exhausting and invaluable. April has been cooking "sadza" recently. The local staple food, which is basically a corn meal and water mush about the consistency of dense mashed potatoes isn't much to look at. But, it goes down nicely with the various traditional local sauces April makes to accompany the stuff. Abbi keeps us laughing, she's so great. The other day she was touching our fruit basket which she knows she is not suppose to do. April looked at her and said, "Abbi, now what is our rule." She quickly responded, "Abbi don't eat playdough!" Funny kid. She's been working on potty training recently. She has been taking to it pretty well, except that she recently developed a phobia of the birds that chirp outside our bathroom window. So, she's kind of afraid of the toilet and the birds that might get her these days. She must think that they are right behind her or something.

April and Abbi are really blossoming here, especially in their relationship with the Zimbabweans. The two of them attend "Kids Club" 3 times a week. It's a "club" for kids whose parents have died of HIV. some of them walk greater than 5 miles each way in order to come and get food, medicine, and hugs from April and the others involved in the ministry. All of them are destitute. We have been really falling in love with these kiddos. The other day we had 2 kids that were sick - Praise and Wilma. These two orphans are some that just break your heart. Praise was crying the entire time, and I found out that his ear had been hurting, so I took him down to the hospital to be examined. He laid his head on April's chest and just held on like it was the only affection he would get for a long time. His mother died 3 years ago from HIV. Wilma is another one of the HIV orphans who walks to kids' club barefoot with her 4 year old little brother, Tino over 5 miles of rough terrain. These two never show any emotion and I've never seen them smile. It really makes one wonder what is going on in their "foster" home- there's just no safety net for at risk kids around here. Wilma had a wound on her big toe, so I took her down to the OR a drained it. We would have just kept the two in the hospital, but pediatrics ward was so full, that two patients were sleeping on the floor. So, we decided to fire up the Land Cruiser and drive the children home. We couldn't just drive 2 of the children home, so April ended up with 7 of the kids club kids sitting in our living room while I worked on the little girl's toe at the hospital. I guess the kids just looked like deer in headlights when they walked into the guest house where we live- they froze and just looked around amazed. Many of them just stared at the moving ceiling fan like they didn't know what to think! The kids all crowded onto the couches and had pink lemonade and each one got a gummy vitamin. It was a good moment for all of us!

We all piled into the big blue land cruiser and bounced over the rain-worn dirt roads singing childhood hits such as "Jesus Loves Me" and "Jesus Loves the Little Children." I got pretty choked up singing with those kids. Yes, Jesus does love them, but with both their mother and father dead, they are truly vulnerable kids with very few adults to protect and love them in this world. While we drove the children home they would yell out the window at people they saw that they knew - they felt like rock stars, I'm sure! As we sang "Jesus Loves Me" over and over as they would say "again, again." This is a sweet memory that will be forever stamped into our memories. We drove over the dirt roads and continued on and on like what seemed like forever - I thought at one time they were just taking us on a joy ride! But they kept saying "let's go" and pointing ahead. All the time in the car I just kept picturing little Wilma and 4 year old Tino making this trip barefoot and Wilma with an infected toe, 3 days a week, just to make it to kid's club for a meal and an hour of fellowship. It took us almost 1 hour round trip driving to get to their home and back. Tino weighs a lot less than Abbi and does not look well.

I just returned from the most challenging C section I've done here. A woman who was in labor for 2 days or more showed up. Her uterus had ruptured and we had a bear of her time putting her back together. Her baby did not do so well. We have been given more and more freedoms both in the wards and in the operating room as our time here as progressed and feel very good about our educational experience here.

We humbly ask that you pray for us in regards to the following items

1. Saftey and health for the kids

2. That we would come to know and love the Zimbabweans we are serving

3. That the gospel would advance through our work here

4. For strength in our marriage

5. For wisdom in parenting Abigail

Abbi loves coffee! She is a McQuillen for sure!

Wrestling with dad.

rounding on the peds ward with Abbi. April and Abbi love coming around and handing out stickers to the kids and then heading to Maternity Ward to see the babies.

Abbi lookin' spiffy in her rain boots and pig tails.

Nope. She's not pregnant with quintuplets. I removed 22 liters of fluid from this woman's abdomen.

2010-02-27T11:31:00.002-06:00

The rain is tapping out a tune on our roof as I write. Abbi is tucked into bed, her curly hair falling over her face as she lays there. We've just had a fabulous dinner of Boerwors, a south African kielbasa meets chorizo tube meat thingy. Sounds weird, tastes good. We served it up with some eggs and tortillas, which you can actually get in the capital city. We probably should learn to make them, though. We ate our food with a great dip mix that my sister Katie sent us. Abbi loved it and kept saying "more spices, more spices!" She was also quick, as usual, to pray for uncle Casey at bed time.

This week has been a step forward for our family life here at Karanda. We're coming into full stride, I at the hospital and April with the HIV orphans and nursing students (at aerobics class, which she teaches). We're getting to know and love many of the locals, which is very satisfying. I've recently "taken over" the male ward. I use that term very loosely as Dr. Roland Stephens still rounds on the ward. I guess I just haven't seen as many wild surgical cases as he. Admittedly, I do like it when he is managing the post op laryngectomy, for instance. It's a tough ward, as one or two patients seem to die every night. Some are expected, others are not.

I've had the opportunity to talk to patients about the Gospel on the wards too. This involves slowing down a bit. But, sitting there surrounded by death watching the message of heaven collide with the stuff of earth is priceless. Watching a person's eyes as the message of the Gospel sinks in, I think I have seen some come from spiritual blindness into the light. I do not know their hearts, but some very close to death have actually come to life in those moments. Talking about God in this culture is not taboo. Indeed, these people are very in tune to spiritual realities. The idea of a spiritual realm is quite normal to these people. The ideas of an agnostic entertainment-centered culture, laced with political correctness would seem odd to most of these people.

In other news we're still learning a ton. Things I am starting to feel comfortable with include:

TB management and all things TB

HIV management and the slew of opportunistic infections/issues that arise in those patients

Malaria management

Really, really bad malaria management

Spinal Anesthesia

Ketamine sedation

various incisions and drainages

Suprapubic prostatectomies

VP shunts

Hysterectomies

Open reduction internal fixation of various long bones

Closed reduction of various fractures

hydrocele repair

amputations

wound care

skin grafting

I'm learing a lot about bowel surgery, thyroid surgery, and hernias as well.

There is a lot of other stuff we're learning on a daily basis as well. There's always a lot to learn.

The best part of working here, however, is the quality time spent together as a family, quality time spent with our friends, and growing in our relationships with the locals. Life this week has been deep and real in the ways I had hoped for when we left. More and more ministry is happening on the wards. This too, is one of the best parts of working here. Indeed, it is why we are here.

Some nice photos:

Huge thyroid we took out the other day.

Priceless photo of Abbi filling up rain buckets to fill her pool (mom and dad helped too!)

Surgery list from last wednesday

Luke 7:

Jesus Anointed by a Sinful Woman
³⁶ One of the Pharisees asked Jesus to have dinner with him, so Jesus went to his home and sat down to eat.^{h]" style="font-size: 0.75em; line-height: 0.5em; ">[h]} ³⁷ When a certain immoral woman from that city heard he was eating there, she brought a beautiful alabaster jar filled with expensive perfume. ³⁸ Then she knelt behind him at his feet, weeping. Her tears fell on his feet, and she wiped them off with her hair. Then she kept kissing his feet and putting perfume on them.
³⁹ When the Pharisee who had invited him saw this, he said to himself, “If this man were a prophet, he would know what kind of woman is touching him. She’s a sinner!”
⁴⁰ Then Jesus answered his thoughts. “Simon,” he said to the Pharisee, “I have something to say to you.”
“Go ahead, Teacher,” Simon replied.
⁴¹ Then Jesus told him this story: “A man loaned money to two people—500 pieces of silver^{i]" style="font-size: 0.75em; line-height: 0.5em; ">[i]} to one and 50 pieces to the other. ⁴² But neither of them could repay him, so he kindly forgave them both, canceling their debts. Who do you suppose loved him more after that?”
⁴³ Simon answered, “I suppose the one for whom he canceled the larger debt.”
“That’s right,” Jesus said. ⁴⁴ Then he turned to the woman and said to Simon,“Look at this woman kneeling here. When I entered your home, you didn’t offer me water to wash the dust from my feet, but she has washed them with her tears and wiped them with her hair. ⁴⁵ You didn’t greet me with a kiss, but from the time I first came in, she has not stopped kissing my feet. ⁴⁶ You neglected the courtesy of olive oil to anoint my head, but she has anointed my feet with rare perfume.
⁴⁷ “I tell you, her sins—and they are many—have been forgiven, so she has shown me much love. But a person who is forgiven little shows only little love.” ⁴⁸ Then Jesus said to the woman, “Your sins are forgiven.”
⁴⁹ The men at the table said among themselves, “Who is this man, that he goes around forgiving sins?”
⁵⁰ And Jesus said to the woman, “Your faith has saved you; go in peace.”

Last week

2010-02-22T11:21:00.004-06:00

Last week flew by. The week itself was sandwiched between two eventful weekends. The first weekend was marked by the celebration of Beau's 2nd birthday. We blew up the pool and had a crew of the local Afrcian kids over, along with thier moms and dads, who we've become freinds with. It was really a treat, because these kids have only seen pools like this on TV or read about them in a book. The same goes for things like tents, firemen, and other things we consider staple experiences of life growing up in the states.

We bbq'd some hot dogs, cooked up some mac and cheese, and served it up with cold coca cola. Coca cola is yet another treat that people usually don't choose to spend limited funds on, so that was nice for the kids.

We were on call this past weekend. Aside from the usual C Sections and sick people being admitted to the hospital, we had an interesting night on Friday. I was awakened at 4 AM by John softly tapping on our door. I figured he was just getting me up for a C section. I rolled out of bed and was shocked as he repeated to me, "A lady just stepped on a land mine." It turns out that the combatants in the war in Zim in the 1970's employed a great number of land mines. Attempts have been made to remove these, but they have obviously fallen short in their efforts. Don't worry too much, the mines are mostly located far north of us on the Mozambique border, where this woman came from. There have been no incidents like this where we live. The explosion devastated our patient. The shrapnel shredded her left leg and injured the rest of her extensively. As we unwrapped her bloody stump in the OR, the remains of her foot hung from thready sinew. The atmosphere was solemn as we initiated spinal anesthesia, amputated her injured leg below the knee, and cared for her wounds. I have not included photographs of this out of respect for the woman, who is recovering well. I have included several photos of other patients, though (and their chickens).

This woman was more than proud of her chicken. People sometimes pay their bill in chickens here. I guess a chicken is worth 2-4 dollars and a cow is worth 200.

We resected the mass from this boy's face the following day. He'd been misdiagnosed many times before coming to Karanda.

Abbi and Beau hanging out at the pool. The smell of the chlorine (yes, we chlorinated it) reminds me of hanging out at the pool when I was a kid. I can just taste the frozen snickers and coca cola from the snack bar and hear the 80's music in my head when I smell the chlorine. What a great childhood I had!

April looking pretty at one of the many birthdays here. Pretty much, people play football (soccer), go to church, and have birthday parties around here for fun. Not much else going on in out in the African bush.

Pretty soon he'll be carrying jugs of water on his head too. The African ladies won't know what to do with themselves.

A two sentence commentary on Luke 7:22:

²⁰ John’s two disciples found Jesus and said to him, “John the Baptist sent us to ask, ‘Are you the Messiah we’ve been expecting, or should we keep looking for someone else?’”

²¹ At that very time, Jesus cured many people of their diseases, illnesses, and evil spirits, and he restored sight to many who were blind. ²² Then he told John’s disciples, “Go back to John and tell him what you have seen and heard—the blind see, the lame walk, the lepers are cured, the deaf hear, the dead are raised to life, and the Good News is being preached to the poor. ²³ And tell him, ‘God blesses those who do not turn away because of me.’”

I find it remarkable that Jesus puts telling the poor about God's plan for making broken people right with God on par with raising the dead. Just amazing.

2010 Valentine's Day Special!

2010-02-13T12:50:00.008-06:00

It has been a week since we drove back to Karanda Mission Hospital, over the lush, floral highlands, flanked by mountains in the distance and down into the arid bush where the hospital is located. John and I felt like school boys who had just gotten our drivers licences as we bounced along the winding two lane highway in our late model blue Land Cruiser. I've wanted to drive one of those for many years and getting behind the wheel (on the left side of the car) was a thrill. A sea of people, cattle, and women carrying the day's wears on their heads parted before us as we mounted the crest of each hill. We jimmy rigged three car seats in the truck, as you can see above. I'm sure it wouldn't pass inspection back home, but we definitely felt better with the kiddos strapped in.

This past weekend, we weren't on call. So, we did a whole lot of nothing- which was great! It was incredibly hot, so we set up the swimming pool in the courtyard. Grandma and Grandpa sent it to us with Dr. Todd when he came, and we've been dying to bust it out since then. The kids had a great time at what we jokingly referred to as "Karanda Country Club" or "Karanda Beach Club."

Sunday, John and I went traipsing through the old air strip, which is now a maize field, in search of flowers to cut for the girls for Valentine's day. John valiantly hopped a barbed wire fence to cut down some wild flowers for the girls, while Abbi and I stood watch with the getaway stroller. We had to bolt when we spotted an ox cart plodding our way. We didn't want to be caught on property not ours' with contraband flowers.

April got me Valentine's day coffee mug down at one of the local shops. As she entered the "shop", in which she was the only customer, the shop keeper announced aloud in broken English "Happy Valentine's day 2010 special," It was surreal having a Blue light special announced to a crowd of one. This is especially true, as Valentines day really doesn't exist anywhere Hallmark doesn't have a strong market share (i.e. Zimbabwe). The shop keeper then proceeded to read to April the words plastered on the side of the three different available mugs. "Happy Valentines day, I Love You, Best Lover in the Word" she repeated again and again in case April couldn't read them. We were shocked to see any Valentine's gifts as the shops here usually only have things like flour, sugar, milk, the basic survival foods. It was quite hilarious!

After John and I totally botched a huge batch of pancakes that same morning, we headed to church. Abbi decided to wander out during the first song, so I just followed her. She found some ants and a rock she called "Abbi's little rock" that she managed to hang on to for an impressive amount of time. We meandered home and Abbi fell fast asleep. The two hour Shona church service just cuts in on nap time. I chuckled as one at a time, John and Shea came back home early too, kids in tow. April made it through the whole thing, though. Well done, April.

That night, Ms. Niamonde, the food services lady for the nursing school here, had us over for dinner. We were served sadza (said phonetically), greens with oil, vegetables with peanut sauce, two kinds of beef (one with peanut sauce), popcorn, and peanuts. I have had sadza in the past and was never a big fan, but this was really quite delicious. About fifteen of us crowded into Ms. Niamonde's small living room, and shared the tasty meal in the dark as the power was out all day on Sunday. I was humbled by her generosity.

Laying in our beds surrounded by still, hot air on Sunday night, we prayed for the power to come back on. As we concluded the prayer with a sweaty "Amen," We heard the whir of fans kick on. Amazing. I don't know that God kicked the power on just for us in response to our requests. But I am pretty sure that He wanted us to ask him for the power. It certainly did get our attention! As I walked out of our place to shut the generator off, the cool night air accented by the hot pavement under my feet and brilliant stars overhead, I was acutely aware of the blessing and where it came from. Had we not had electricity, it would have been a long, long sleepless night.

I spent today in surgery. We had our usual assortment of various cases today. Skin grafts, VP shunts (tubes to take extra fluid from the head to the belly), lots of ultrasounds, and orthopedic cases. It's funny. I'm starting to have weird cravings for things that I wouldn't have thought much about in the states. Today I was craving going into a truck stop and just buying some coffee and maybe picking up a couple of things I don't need on the way out- maybe a bag of Combo's or something. I also really wanted to listen to Dr. Dre today, too. I was really bumping in my head as I did a couple of ultrasounds today. I'm not a gangsta rap kind of guy...I'm just saying, I've got weird cravings.

Also, of note, Beau turned 2 today. We had a blast...more on that later. Also a shout out to Colton (born 2/15/10) and Kate (born 2/16/10), John's new nephew and niece. Welcome to the world!

coffee and surgery

2010-02-01T13:54:00.006-06:00

Those of you who know me know that coffee easily ranks in my top 10 things I love in life. You'll find most places have instant coffee, which will do in a pinch. Here, 10 AM signals tea time. Most things grind to a halt for a half an hour or so, while people consume tea and some form of cookie AKA "biscuit" (said with an English accent). We have no coffee maker here in the guest house, where we live and instant coffee can only satisfy a man for so long. Imagine my joy when our new friends, the Everswicks, lent us their french press last weekend. For those of you who don't know what a french press is, see the photo above. It's not my french press, but it is a french press. and my coffee cups aren't that fancy. definitely no saucer. But, you'll get the idea.

Just as an aside, and this whole post is pretty much an aside, we've been listening to sermons by a guy named Matt Chandler recently. He's a pastor at the Village Church near Dallas, TX. The website for his church with his sermons can be found at:

http://fm.thevillagechurch.net/sermons

My favorites of those sermons are those on Ecclesiastes. I went ahead and linked them below. Do yourself a favor and listen to them, I think they changed my life. You might even just make yourself a cup of coffee and then listen to one. Who knows, the possibilities are endless. just click on the little green file and listen to it or if your computer savvy (AKA under the age of 30) you can just put it on your itunes. I find that his sermons are immensely practical. He approaches the things that plague today's church with a great deal of honesty and practicality. He just works through Biblical texts and draws out very applicable lessons. Just check them out. You won't be disappointed.

7.09.06The Sixth SenseEcclesiastes (Part 1)Matt Chandler 7.16.06QuenchedEcclesiastes (Part 2)Matt Chandler

7.30.06The GiftEcclesiastes (Part 3)Matt Chandler

8.06.06IngredientsEcclesiastes (Part 4)Matt Chandler

8.20.06Out of BreathEcclesiastes (Part 5)Matt Chandler

8.27.06Communal LessonsEcclesiastes (Part 6)Matt Chandler

9.03.06Approaching the DivineEcclesiastes (Part 7)Matt Chandler

9.10.06Searching for SatisfactionEcclesiastes (Part 8)Josh Patterson

9.17.06Coffee with Granddaddy IEcclesiastes (Part 9)Matt Chandler

9.24.06Coffee with Grandaddy IIEcclesiastes (Part 10)Matt Chandler

10.08.06Love InterruptsEcclesiastes (Part 11)Matt Chandler 10.15.06ReconciliationEcclesiastes (Part 12)Matt Chandler

10.22.06Occupied TerritoryEcclesiastes (Part 13)Matt Chandler

12.03.06Daily ContactEcclesiastes (Part 14)Matt Chandler

12.10.06A Life Lived WellEcclesiastes (Part 15)Matt Chandler

2.17.06To the Young and the OldEcclesiastes (Part 16)Mat Chandler

On a medical note, I'm currently reading through selected entries of this book:

much of the text can be found here, though I believe without the great illustrations:

It's an excellent text and has a second and third volume in the set. Those are on the topics of the surgery of trauma (largely orthopedics) and that of anesthesia. We are progressively being allowed to do more in the operating room. We see lots of urgent cases in the OR but surprisingly few acute abdomens. I'm starting to enjoy the outpatient medicine that we do on a daily basis much more. In fact, the situation here is such that the people we see in the outpatient department with surgical needs are sent (more or less) straight to the OR and seen by whichever one of us is not in the outpatient department that day. We get some pretty quick feedback on how the patient did and just what was done for them. So, it's a good way to learn. Additionally, we're becoming much more comfortable with Malaria, HIV, and TB- which seem to be the "bread and butter" of ambulatory care here.

BTW...Abbi got her hair did by one of the nursing students. check it out.

and when the braids came out...

on call

2010-01-31T05:51:00.009-06:00

We're in Harare now, at the TEAM guest house. The internet is working well, a lot faster than out in the bush. Dr. Todd, our program director, as well as our friends Dr. Leu and his son in law, Craig came to visit us on Tuesday. It was absolutely wonderful seeing them, and they brought us some goodies from home. The guys rounded with us during the week and shared their wonderful insights into the patients on the wards, in outpatient department, and in surgery. Heck, Dr. Todd even scrubbed a couple of C sections!

We were on call last weekend. Aside from the usual rounding in all of the wards and seeing some out patients on Saturday (who are usually sick enough to become inpatients, or they wouldn't be there on a Saturday) the weekend was uneventful. That is until Sunday night. We received a call around 8 PM for a mother who'd been in labor for a while. The story was typical. She had labored at home, then gone on to a rural health clinic, then gone to a local hospital, and finally arrived in our maternity ward around 5 PM or so. We came as quickly as we could and began our Cesarean Section in the standard manner.

It became quickly evident that the baby's head was stuck deep in the mother's pelvis, as she had labored for many hours. As we entered the uterus, we became acutely aware that infection had set in already in the fluid surrounding the baby, which was thick green, and smelled badly. Our patients were clearly in danger. I prayed aloud as we struggled for what seemed to be forever (but was in reality only a couple of minutes) to get the baby out. Finally, we pulled the limp, blue little boy from his mother. As the nurses worked on helping the little one, we were faced with the task of working on the woman, whose uterus lay as soft and limp as her child, bleeding profusely. After much work, we finally repaired the extensive bleeding tear in the uterus, my salty surgical mask now sticking to my face. Still, the woman's blood pressure was barely registering on our monitors. The quiet in the room was disturbing as the nurse pumped air into the little one's chest, interrupted only but the alarm from the blood pressure machine, a sobering reminder of the blood loss we had just worked so hard to stop.

After stabilizing the mother, we put all of our energy into the little boy, laying lifeless on the newborn warmer. We pumped up and down on his little chest, breathed for him, and gave all the drugs we could to jump start his little heart. Despite our greatest efforts, we could not bring him back. There in the dim light of the maternity ward, soaked in my own sweat, I wanted to weep.
I thought we'd lose the mother too. My heart aches for her, but she gets to live another day.

And so goes life here. It seems to be a raw, primal sort of fight for survival. The woman in the story above has nothing. I am sure she lives in a hut in a patch of corn without running water or electricity. She eeks out her existence any way she can, spending her days carrying water buckets on her head long distances so that her family can drink and tending fires to cook the little food she has.

I don't want to put words in God's mouth or go outside of the scriptures for my beliefs just because I want something to be true. But, I trust in the character, mercy, and sovereignty of God. In doing so, I was thinking about that little one's short time in this cruel world. In the arms of Jesus, he will never know the pain of hunger, the depths of loss, or humiliation of poverty that his mother has known for decades and now will know for many more. It's hard to make sense of this world, especially when confronted with the hard reality of it on a daily basis.

Stories like this beg the question, "How can suffering like this exist if there is a God?" or "If there is a good God, why does such injustice exist?" These are good questions, and those who face suffering in life are bound to wonder about them. I was encouraged today in reading a book called "The Reason for God," by Tim Keller. He points out the firstly, in the assumption that things in the world are broken or unjust, one naturally assumes that there is a certain way that things ought to be, that is we assume that things in the world shouldn't be broken. Without God, as the absolute standard for good and justice, we have no reason to assume that things should be going any sort of right way (and they obviously are not in many respects). A world without God, organized only by the survival of the fittest, leaves us no such standard by which to judge things. Therefore, without God, thinking that the world should be a just or fair place is simply nonsense. Suffering is therefore not a good argument against the existence of God

Secondly, Christianity alone among world religions believes that God took on human flesh to come and be with us (Immanuel = "God with us"). Christ, when he died on the cross experienced separation from the God head (that is, the Father and the Holy Spirit). People know the deep pain of loss of intimate relationships in divorce or the loss of a loved one. We can relate to this pain of separation on that level, but we cannot fathom the pain of separation of the Son of God from the Father, with whom he had lived in perfect harmony for eternity. Jesus provides people a Savior who can sympathize with loss, imprisonment, fear, abandonment, injustice, and death. Christianity may not provide a concrete answer for the specific suffering, but Christ does provide a very real source of strength for those who suffer. Jesus talks about the future "New Heaven and New Earth" and the "Renewal of all things," or what the Greeks knew as"παλιγγενεσια" or "palingenesia." The Greeks understood this word to mean the re-creation of the universe. Jesus promises in a way that we cannot imagine to some day make all of those things right, or even better than right in a very concrete way.

Suffering is therefore also a very poor argument for a detached, impersonal, or uncaring God.

On a happy note, I figured out how to make ice cream. It consists of 3 liters of milk, 2 packets of pudding, a can of sweetened condensed milk, and some vanilla extract. Put it in the deep freeze overnight (if you have power) and presto! Tastes just like a Frosty. Not too shabby when the closest Wendys is a few thousand miles away.

Here are some cute pics to offset the sad story at the beginning of the post:

Today in photos

2010-01-31T02:17:00.004-06:00

Today in photos:

Abbi just about flipped out when she saw this photo of her "passies." It was just too much for her to handle.

Lots of surgery these days. I try to keep my camera on hand, just for opportunities like this. John was working with Dr. Roland Stephens here. I think they were fixing the femur (leg bone) you can see below on X ray. I did one just like it on Friday. Dr. Stephens was kind enough to let me do most of the surgery.

OK, so the hut on the right has a satellite dish on the "roof." No power. No water. In the middle of nowhere. But, hey, they've got Sports Center.

This kiddo has Hydrocephalus (the fluid around the brain doesn't drain correctly). We put a shunt in his head a few days ago. He'll do well, whereas he would have died without the surgery. We do lots of these here.

The blurry thing in the man's right eye is a huge tumor. We have lots of eye tumors here. So, we take lots of eyes out. HIV does a lot of terrible things to people. For instance, cancers like this one.

Broken Femur.

Pulmonary TB, picked up on chest X ray. This is a classic appearing X ray. We see this most every day in the outpatient clinic. Yet another common finding with HIV.

Kaposi's Sarcoma. Yet another HIV associated disease.

I've decided to try not to blog too much more than a couple of times a week. The nights are just too precious with my family and the internet takes so long to upload these darn photos.

This week has been a good week of growth for both families sharing the guest house. We continue to wrestle through challenges and work through issues as they arise. I guess I thought when we arrived on the mission field, I'd find answers to some of life's big questions. That is, in following God here, that maybe I'd find myself content, full of purpose, or at least gain clarity of insight into life. While I am certain that the intentionality of our work here lends itself to very purposeful work, huge questions still loom for us. It is clear to me that this time period, like each day, is only a stepping stone. That we must still must pursue God in His Word in the hope of knowing and loving Him

-How is our work influencing others for the gospel?

-What is this training for (i.e. we are learning great skills, but how will they be used in the future?)

-What will regular mission work look like as part of our lives?

-How will we best use this training to serve people both here and in our community in the U.S.?

-How can we best become involved in both communities?

Abigail is enjoying helping April cook these days. We make a lot of stuff from scratch using the book below. It is full of inexpensive and delicious meals, usually made from scratch. I heard about it from some savvy folks who have spent time overseas:

You can see her here helping make some banana bread. We buy bananas from people that come to our door selling them. they cost about 1 dollar for 20 bananas. Right now, I'm making some ice cream in the deep freeze. I hope that the power stays on for the next few hours! We'll have to see how that goes. We're getting used to "the daily grind" at home that consists of making food, cleaning up, repeat times three and raise kids in between. It seemed overwhelming at first, but we sense that we're always getting nearer to our goal of growing in depth of relationship as a family and deeping our walk with God.

Weekend update

2010-01-25T15:06:00.003-06:00

I know it's kind of weird to have a weekend update on a Wednesday, but I guess late is better than never. I guess you could call it a midweek update.

Our fist weekend on call got off to a wild start. at around 3AM John and I were called in for an emergency C section. The lady had labored for 19 hours or so at a "nearby" district hospital 50 km from here. We stumbled out of the house, sleepy, and into the OR for the cesarean. We've been doing such late night stumbling together, just to back each other up. We figure it's better to do the late night surgeries together just in case we get into a bind. It's funny, the referral pattern is supposed to work in the opposite fashion- the bush hospital transferring to the district hospital and then on to the big city hospital and so on. However, the medical system here is so dysfunctional that we get people from the capital city, driving 2 1/2 hours out into the bush for their medical care here. It is said that last year at this time, many hospitals didn't even have an aspirin on the shelf.

Anyhow, where was I... Oh, yes, The C section went off without a hitch. As we walked out of the OR a woman lay on a cot covered by a blanket, obstructing the exit into the labor and delivery ward. My sleepy mind thought little of it until the clerk announced to me in a flat tone that the woman had been in labor for 2 days in a far off village. A policeman had found her walking along a dirt road, trying to get to help, and had brought her to us. She died as she passed through the hospital gate. It was then that I noticed her blood, pooling below me on the floor. It was an such a paradox- elation and life in one room, sorrow and death in the next.

After a glass of cold water, we went to sleep, but not for too long. Rounds began at 8AM. We had to see all of the patients in the Male, Female, Pediatric, and Maternity (plus neonatal) wards. We were unfamiliar with two of the wards that we'd not been seeing regularly, so this took quite a while, as many patients needed procedures done and medications adjusted. After rounds, John took to the OR to take care of a few items that needed doing. I headed to the outpatient department to tie up some loose ends. It turned out that the loose ends were several dozen people who seemed to be falling apart at the seams. I admitted many of those people to the hospital and sent many to the OR. After wrapping up the outpatients, I headed to the OR to tag team some items with John. Aside from seeing all of the patients in the hospital and seeing all of the patients in the OPD, we got comfortable with Ketamine sedation, reducing a dislocated jaw, setting a complicated fracture of the forearm in a child, did two lumbar punctures, two paracentesis, debrided a child with second degree burns, and performed several other procedures.

We then headed to a celebratory lunch for Dr. Roland Stephens, who turned 80 on Sunday. The festivities were nice. We enjoyed a wonderful sense of community with the long term misisionaries on the compound. One of them even brought fireworks in honor of the day. It turns out that none of the locals have ever seen fireworks and some of the patients just didn't know what to make of the loud, beautiful balls of fire in the sky! Some watched in amazement, some hid under their beds.

Early Sunday morning, the Drs. Stephens as well as their brother, Mark (who grew up here and is now visting from the states for the first time in 30 years) took us for a "hike" at a place called "Pulpit rock." It turns out that this "hike" was more like a 200 foot vertical ascent up a huge piece of rock sticking out of the Zimbabwe bush. It was fun. I made it to the top. I mean, I really thought I might die at points, but I made it. Dr. Stephens got out some ropes for me to use that he says he has used "for women and children" making the climb in the past. I guess this was the climbing equivalent of bumper bowling.

Of course, we rounded after the climb.

Overall, the entire weekend was very good. The missionaries brought us lunch on Sunday, cementing within us a strong feeling of belonging to the community.

This week in Zim

2010-01-22T13:13:00.008-06:00

Today marks the second week that we've spent at Karanda and our third week in Zim (I guess that's what the hipsters call Zimbabwe). Our time here is shaping up nicely. The first two weeks here were quite a struggle, just getting the kids adjusted and all. As I alluded to in my cheesy poem in the last post, the mission guest house, which we call home was much like a sauna at night after closing the windows in order to keep the mosquitoes out. The weekdays this week were challenging in that we largely had no power or water most of the time, unlike last weekend when ZESA (Zimbabwe Electricity Supply Authority or "Zimbabwe Electricity Sometimes Available") smiled upon us. We fretted a little over our deep freeze, which is pretty important out in the bush. However, with the newly installed screens on many of our windows, even nights without electricity (electricity= fans) are tolerable and even pleasant after a nice rain. Dr. Dan and his brother, Mark (who has returned to visit Karanda after growing up here 30 years ago) blessed us immensely by hooking up our fridge and deep freeze to a dedicated generator and by fixing our leaky water filter. They even fixed the ceiling fan in the family room! We're learning to live with a little less. April is getting good at cooking over the gas grill when the power is out and we're getting more efficient with meal time activities. Preparing, cooking, and cleaning up after three meals a day can easily become a full time activity. April is a saint, and I am constantly impressed with the way she takes the challenges we face gracefully. She is of very strong character. Abbi, naturally, is a hit with the locals and the other missionaries at the hospital. I have been referred to by some as Dr. Paul and by some as BabaAbigail ("father of Abigail"). It's common to refer to a man or woman as "Father/Mother of (fill in the name of your first born)." Dr. Dan Stephens, the surgeon we work with here, pulled out the PA system and the projector system and we watched a movie on the big screen tonight. The kids really enjoyed "Open Season," a cartoon. They also enjoyed dancing, singing, and grabbing at Dr. Dan's toes during the film. We enjoyed popcorn too, before the toe grabbing and all.

As we grow accustomed to life in the African bush- yes, even with running water and electricity (sometimes), it's still the bush- I also work to fit the mold of the missionary doctor. The vast array of ailments seen here is staggering. Each patient I get through in clinic feels like a small victory. Much of the time, people wait to come to the hospital until they are close to death it seems. People literally drag their relatives into clinic. The ones you see latest in the day seem to be the ones that need to be seen most. Too sick to fight for a decent place in line, they wind up at the back of the pack fairly easily.

I'd like to highlight Dr. Roland Stephens in this post, Dr. Dan's dad. A career missionary, he has made his home and his life here at Karanda with his lovely wife since the early 1960's. He turns 80 tomorrow, and there is a big birthday party for him tomorrow. I doubt his a big internet junkie, so I figure the secret of his surprise party is safe on the blog. The man is truly one of the most remarkable individuals I've ever met. At 80 years of age, he runs 3 or 4 miles every Monday, Wednesday, and Friday. He is so respected that all of the locals, patients, and staff call him "Sekuru," which is Shona for "grandfather." He seems to have seen every medical condition and does every kind of surgery one could ever imagine. There is no kind of surgery that this man and his son do not do. I hope a little bit of their experience rubs off on us while we are here.

eye see you

2010-01-20T13:49:00.003-06:00

Well, the girls are tucked into their beds and I thought I'd take a moment to write some. We've certainly enjoyed getting lots of email from you guys. Sorry if we've not had a chance to respond to all of your individual emails! Please know that we certainly appreciate the love, support, and contact. Last night was super hot. Like tonight, the power and water were out, so we slept listlessly in a lot of still, hot air. Today, we had a good amount of generator power so the deep freeze is still a freezin' and that's good. One nice thing about the power being out is that most folks are not using their computers, so we have a good internet connection tonight. I was in surgery all day today. We did Hysterectomies, Prostatectomies, and Splenectomies. Also, I got involved with some spinal anesthesia as well. The girls had a good day, participating in "kids club." We're enjoying a lot of fresh bananas, mango, and apples that ares sold locally here. There is a town adjacent to the hospital compound with some small stores. I joke that the road in "town" looks like the old west. It's always dusty and the sights are a throwback to a much earlier time with livestock running in the street and people loitering in the shade of the store fronts. There is a lot of "hanging out" with 90% unemployment in the country.

Each morning we kick things off with devotions at the chapel prior to rounding on the pediatrics ward. The nursing students are all there, singing beautiful Shona hymns in many-part harmony. The pediatric ward is always hopping with severe malaria, burn patients, orthopedic patients, and kids with hydrocepalus. Lots of very advanced diseases pop up in the Out Patient Department daily, one of which is the guy shown here. We took his eye out yesterday. Sounds brutal, but it may save his life.

Overall, life is different here. Lots like life many years ago. I feel like we're on a long camping trip sometimes. But, Abbi is happy and overall we feel quite safe.

This is what was on my mind Sunday:

Dust in the street

where the children play

on the water pump

at mid day

where the chickens run

and the goats stray

and the sun shaded shop keepers pray for rain

Power is out

the windows are closed

we're sitting here sweating through our clothes

the air is stagnant and feeling much hotter

i've learned the blessing of a cool drink of water

children are dying

people are sick

my best offering

seems insignificant

Teach me to lean upon your love

to gather new strength from above

Your yoke so easy

Your burden so light

Somehow You'll make everything right

Some day You'll make everything right

Rain.

2010-01-17T08:32:00.003-06:00

Today has been one of the best days in the last month. We went to church this morning. Church in many places in Africa is a long affair. And, true to form today's service was over two hours long and all but 15 minutes of it was in Shona, the local language. We can say "good morning, good afternoon, and good evening" in Shona, but that's about it. The whole thing reminded me a little of the all German Christmas services we had when we were kids. At least I knew the tunes to those songs.

We came home from church and cleaned up the house, which was great. I love cleaning up and finding out where the heck all the stuff I lost went. Meanwhile, the sun was shining outside. So, we did something we'd been wanting to do for awhile. We filled two big wash tubs from the laundry room up with water and the kids went "swimming" in the guest house courtyard (as you can see above). The two are great friends and I can't imagine Abbi not having Beau around. Basking in the sun, the kids playing in the "pool" with a cool breeze blowing felt like we were on vacation. I could just close my eyes and pretend that we were on a vacation on a beach in Florida somewhere- that we had just grown tired of playing in the salty surf and were hanging around a hotel pool.

With perfect timing, after the kids were done swimming the sky turned gray and torrential downpour ensued. It has been a day full of joy and thanksgiving. The power and water have been on for a full 24 hours...seems like a record!

2010-01-16T03:04:00.005-06:00

Friday was nice in that we got to get up a little later than usual, as devotions on Friday consist of singing on the wards. the docs aren't obligated to do this and my Shona singing voice is sub par, so i didn't go. i rounded on peds again, this time feeling a little more comfortable about the kids and my management on their issues. things surely are different here. For instance, if a child is malnourished, we'll give the mother Thorazine to make her lactate more. crazy. but, there is no formula and kiddos need to eat or they will not do well, so we "treat" the mom for a few days. John and I did a lady's fourth repeat cesarean. With no cautery, no blood, and no suction a little bleeding makes me a lot nervous. John and his mom left for Harare yesterday. April and Abbi spent the afternoon at "Kids Club," which is a "club" for AIDS orphans held at the hospital. The club does medical treatment, but also makes sure the orphans are getting proper nutrition. The girls had a great time just loving the kids, reading to them, and sharing time with them. I was the lone doc staffing the outpatient clinic yesterday. Like Wednesday , nothing seems to wind up being a minor deal. A quick sampling of the many people I saw would include:

TB in various and sundry presentations

HIV, chronic and acute

Severe malaria

end stage liver cirrhosis

uterine fibriods the size of a basket ball

pelvic tumor

abdominal tumor

progressive neuromuscular disease

osteomylitis

severe congestive heart failure

and lots, lots more.

I was the only one there and felt like things went OK, all things considered ( i don't speak the language, i have no idea how things work around here, etc.) I really need to invest some time in reading this weekend especially on HIV, TB, malaria, and hydrocephalus. Lots of people come really, really sick from a long way away. I admitted 4 or 5 people to the hospital.

Not much goes on during the weekends around here. I feel compelled to micromanage stuff, so I'll likely go down and check a few patients. It's a hard mix of adjusting to medicine under heavy resource constraints and treating the patients with excellent medical care.

I made eggs and fried potatoes and onions this morning. it was nice. the power was off, so i made them on the big gas stove. now there is a cool breeze coming in the window, the sun is shining and the birds are singing. the power is on and the water is working, so that's a winning combination.

Despite it being the rainy season, there has been no rain since the new year. This is horrifying, as the vast majority of people that I've met here seem to subsistence farm. The corn (maize) is midway through it's growing season. As corn meal is the staple food here, people will starve if no rain comes and the crops die. Last night, the clouds filled the sky and the wind blew leaves from the Plumeria tree outside of our door. Still, no rain. I have a better understanding now of Prov 25:14 "A person who promises a gift but doesn't give it is like clouds and wind that bring no rain." I guess I just understand the basic necessity of rain a little better now.

"He has showed you, O man, what is good. And what does the LORD require of you? To act justly and to love mercy and to walk humbly with your God."

Micah 6:8

Fun times in Zim

2010-01-14T13:03:00.004-06:00

I had my fist day in OPD (outpatient department yesterday). Not too many people show up complaining of just the sniffles. I don't really deal with HIV, TB, and malaria that often in the states. I really was stretched- not only was I figuring out what needed to be done, but how to do it. You really have to dig and dig to get the full story from people too. For instance:

Patient: "I can't breathe right."

Me. "Oh, I'm sorry. Tell me about that."

Patient to translator: "unintelligible words to translator in Shona"

Me: "What?"

Translator: "He wants a TB test."

Me: " Oh. Have you had TB?"

Patient: "No".

Me: "hmmm (thumbing through patient's record). I see here that you do have TB, and your lungs have been full of fluid in the past. You need a chest X Ray."

Patient: "that's too expensive"

Translator: "No, he has HIV."

Me. "You have HIV?" (this changes entire treatment plan)

this went on...

On and on these interactions went. I was thankful that we had relatively few people lined up for OPD that day. hundreds of people could easily present any given day for OPD.

We (foolishly) asked for extra C section call last night, and call they did. At 3:30 AM, John and I tag teamed our first Zimbabwean C section. Praise the Lord, there were no complications. Mother and Baby did well. We walked home in the dark, completely enjoying the moment. We had a cold water toast when we got home. I was soon thereafter woken up to see a woman vomiting blood and an asthmatic in severe respiratory distress. True to form, medicine is just not straightforward here. The woman turned out to just have been discharged from the hospital following an admission for malaria. She now had "blackwater fever" (for you medical types). Her kidneys had stopped working- a rare but serious potential consequence of malaria. I'm still a little hazy on where the vomiting blood came from. She isn't vomiting now, but it will take a miracle for her to survive this. I got to pray with her before leaving the hospital today.

The man with "asthma" didn't have asthma. Upon digging in the chart (usually a well worn notebook), the man was found to have a history of a throat cancer (laryngeal mass). It had become so large, it had completely blocked his airway.

We took him to the operating room and I assisted in tracheostomy placement (a hole in the throat to breathe). He looked so relieved after the surgery, poor guy.

Immediately afterward I rounded on pediatrics. There are some very sick kids in there, many of whom have hydrocephalus. The sickest kid in there died today of what we presume was a brain abcess. It was sad, though not totally surprising. Death is a common occurrence here.

I got to get involved with lots of operations throughout the day. I'm very excited about the surgical and medical experience that is unavoidable in the next 5 months.

Through all of the power and water outages we are experiencing here, we are so thankful that everyone is healthy. We feel very safe in our surroundings. In all of this we are learning to appreciate the blessings of life: cool drinks of water, a refreshing shower, meals together. We love and miss all of you. For those of you worried about Abbi, know that she's getting along well. She's taking the heat in stride and is enjoying meeting lots of new people. She puts a smile on everyone's face that she meets and she is constantly with April or I! She's having a very rich experience here in Zim!

Zimbabwe is pretty

2010-01-11T12:47:00.003-06:00

We experienced a major turning point since the last time we had internet access. Since our arrival, we had been growing gradually more comfortable with our surroundings. The TEAM missionaries, who had been at a conference in South Africa had still not arrived as of mid day on Saturday. We were in a holding pattern until they showed up. Though getting used to the time change with kids has been a little weird, we resigned ourselves to enjoy the "down time" that we had left. We could swim in the pool! We could nap! Oh...the possibilities. However, on Saturday evening mid-dinner, the TEAM people began showing up in full force. Suddenly, we were being given a quick briefing on what the next few days would hold. We gladly surrendered our dreams of R&R as April and Shea were whisked away immediately by the missionaries to buy food for both of our families for an entire month. Just pause for a moment and think of buying food for 2 families for an entire month.

OK...

Well, I was impressed when I thought about it. The girls made good time doing this, as the folks that work at Karanda do this regularly. We sent a Land Cruser out to Karanda with one of the full time missionaries Sunday morning absolutely packed with all of our suitcases (except an overnight bag). All four Epperlys, John's mom, and the three of us crammed in to an extended cab pick up and made the two and a half hour trek to Karanda today. The drive to Karanda was absolutely breathtaking. We drove over relatively well maintained roads, except for the last 7 kilometers, which was a dirt road. Through the lush hill mountainous country side we drove during the first half of the trip, mountainous terrain silhouetting against mountainous shadows in on the skyline, tulip trees in full bloom. People, goats, and cattle lined the road as we made our way to the hospital. At the end of the trek, we actually drove through a river and then up the steep hill to the hospital.

We met some of the staff here, unloaded our things, and fell asleep. I am excited to see what today brings.

From Zimbabwe with love

2010-01-09T02:43:00.003-06:00

To everyone who has anxiously awaited news from our end, I sincerely appologize. We're still here in Harare, Zimbabwe awaiting full time TEAM (The Evangelical Alliance Mission) people who have been at conference in South Africa. The trip to Harare was brutal, all told carting 16 checked pieces of luggage, two car seats, two strollers, three kids, and all of our carry-on items (which would never have been allowed on the airplane if somebody stopped to actually wiegh them). After 27 hours of travel time, thankfully, we arrived in Harare with all of our baggage intact (basically). We were missing both of our strollers, though- one of which has been recovered. Traveling with kids makes adjusting to the time difference (we are 8 hours ahead of most of you) very...interesting. So, we've been thankful for the down time in Harare. Really, Abigail and all of the kids did very well during the trip and managed to befriend lots of the travelers around us. I was so proud of her.
We're staying at the TEAM guest house here, which is very beautiful. The temperature is very pleasant here in Harare, probably 80 degrees and sunny with a cool breeze. As I sit in the office of the guest house, a cool floral scent drifts in from the doorway. It's the rainy season and everything is very green and in bloom. The grounds of the guesthouse has mango, orange, lemon, guava, papaya, avacado, and apple trees growing in it. Most of them are small, but the variety is impressive by any standards. Marshall, the wonderful grounds keeper who lives on the grounds, has a huge garden whose beans, corn, butternut squash, peppers, and potatoes are thriving in this rainy season. Nearly daily we have a downpour, but it is short lived and overall the weather in Harare is very pleasant. I am told that when at Karanda, in the valley, the temperatures are much higher.
Zimabwe is an interesting country. I'm still trying to sort out how most things work around here. Power is a real problem, which is one reason I've not written yet. We experience frequent, unpredictable blackouts on a daily basis. The power is off now and I'm working on generator power. This causes major issues with communications, industry, food storage, and standard of living. According to Lil, the very sweet secretary here, problems with water have been similair in the past. Though we boil and purify all of our water, we have a constant supply of it and I have no worry about that currently. We've had a chance to go to the local grocery store while we have this down time in Harare. I have been surprised by the variety available at the store. Just last year, the International Fellow at the time told me there was very little food on the shelves of the grocery store. According to Marshall, Zimbabwe adopted the US dollar as it's currency in 2008 or so and since that time things have gotten much better. The Zimbabwean dollar is now only used for payment for minibus transit. The Zimbabwean dollar has declined in value by 23 decimal places, according to our hosts here. I believe that the exchange rate would be something like 6 trillion zim dollars to one US dollar. This hyperinflation has been solved by adopting a new currency. It's just mind blowing.
As we adjust to the major time difference, we have had a chance to spend lots of time together as a family reading, playing with play-doh, and walking around the grounds of the guest house. We feel very safe here and we're eating quite well. No one has gotten ill yet, and we pray for good health. We look forward to heading to Karanda, about 3 hours from here, in the next couple of days. As of yet, we cannot get any of our laptops to connect to Internet, so emailing is sparse and our phone number and skype will not work until we find a way to have our laptops connected. We appreciate all the emails though - it is so nice to hear from people from home! We apologize for not being able to write back as frequently as we would like, but please know your communication is much appreciated!!!! We miss you all!

Homeless

2009-12-26T00:25:00.004-06:00

Well, we did it. We finally left Wichita. It was hard. I mean, we've met some very dear friends during our time in Wichita. We sold our house, moved into the top floor of a day care, and really have been privileged to see this "IFMF" training program get up and running. We learned how to pull teeth, graft skin, manage trauma patients, and do spinal anesthesia, among other nifty new skills. The best part of all, I think, as I sit here late Christmas night is the tremendous fellowship and bonding I experienced just living and working with John and Logan (two of the other fellows) and their families. Rarely do we get a chance to live so deeply and get to know another person so intimately as during our time in Wichita in the old aparments above the daycare. It was close-quarters living- like being in college- just with a little more sense about us. Not much, just a little.

I am thankful for that. Now I sit in Kansas City, snowed in and ready for bed. Having put all of our stuff in storage, we're just spending our days hopping back and forth between April's parents and mine, towing our (now 20 month) toddler and our remaining possessions between the to loci. We're pretty well packed up and just biding our time until we leave for Zimbabwe. It really is great to see family, and bittersweet to watch the joy that our daughter brings to our families, knowing that we will take her away from them for a few months very soon. It hurts to know that our decision to go will cause those we love pain. It was a white Christmas today, as you can see in the pics. Zim will be a switch, for sure.

Thanks to everyone who is following our story and praying for us. We truly appreciate it. We'll keep you updated. Merry Christmas everybody!

wonderment

2009-12-12T17:50:00.004-06:00

won⋅der⋅ment

[wuhn-der-muhnt]

–noun

1.	wondering or wonder.

2.	a cause or occasion of wonder.

First, a bit about our family and then some more professional notes:

Remember Christmas when you were a year and half old? Neither do I. I can't help but smile, though, as I watch the Christmas season come to life in the eyes of our little girl. She's really a gem. Check out the photo of her first interaction with Santa Claus at the Christmas tree farm in Kansas City. She was terrified. She has however since that time been humoring us with her own shortened version of "Santa Clauz is coming to town." Which is pretty much those six words over and over and over. She becomes quite frightened if we continue onto the next verse about "he sees you when you're sleeping." She gets a nervous look on her face and repeatedly asks "Santa, night night?" "Abbi, night night?" in anxious tones. So, we leave that part out now.

Last week she hauled off and smacked April and immediately reprimanded herself "Don't Hit Mama." It was pretty funny. She also recently memorized her first bible verse. "The Lord is my shepherd." As the girls were reading through the same children's bible, Abbi suddenly looked at April and exclaimed "Jesus hit mama." Hmmmm - not sure where we went wrong in that story, but we'll keep trying. She's a talker. We get lots of "I love you" these days.
In other Abigail News, she has recently developed an addiction to chocolate milk. I gave it to her for a treat and she just hasn't been able to quit. We'll have to work on that.

As we wrap up our time in Wichita, we are continuously thankful for all the life experience we've had here and for all the wonderful relationships we've developed. Our apartment continues to look more like a living space and less like a home as all of our personal effects take up their new residence in our storage space for a while. The other International Fellows, some of our best friends, find themselves in the same situation - that of change. Change is in the air. It's uncomfortable and promises to leave us changed on the other side of this discomfort. Much like a child maturing, the growing pains ache, but in the end the child becomes the physical and (hopefully) spiritual adult that he was meant to be.

Our Christmas letter spoke a little bit of the above. I figure many of you who read this probably won't get a physical Christmas letter from us. Those of you who will (mom and dad) can just read it twice, or just gawk at the picture of Abbi that you'll get with it. reads like this:

December 2009

The relentless wind blows, as usual, against the building that the McQuillen family now calls home. I've often wondered why they don't call Wichita "the windy city." Change in our life this year seems to come like the wind, ever changing direction and propelled by an unseen force. We've called the hospital campus "home" this fall after our graduation from Family Medicine residency last June. We moved into our apartment, nestled in the top floor of the hospital day care building, after having spent the summer studying at West Virginia University. All this moving around is part of an extra year of medical training to learn how to function better in a mission hospital. If last year was a "year of firsts" for us, this year could easily be called "a year of change." The toddler-handprint art has come down from the walls of our home just as quickly as it went up several months ago. Most of our earthly possessions now rest in caddy wompus stacks in a small storage space. As I write, our suitcases lay open on the floor, ready to be strategically crammed with enough stuff to get us through the upcoming 5 months our family will be spending at Karanda mission hospital in Zimbabwe. Following our tenure in Zimbabwe, we will be moving to the great state of Iowa in order to join several dear friends. We look forward to our start date at Mercy Medical Center in New Hampton, Iowa on July 12, 2010.

Again, things have been pretty wild around here. Abigail, at 19 months of age, has developed an impressive vocabulary and manages to keep April and I busily entertained. Spending time with her brings us joy that is only rivaled by watching our parents with her and seeing the joy that she brings them. All curly hair and smiles, she is the cutest thing I've ever seen. She and April are my treasures.

Many people have funny reactions when I tell them about this year of international medicine training, about working in an unstable country, and about our goal of lifelong involvement in mission work. Indeed, we are very blessed to have many friends and family in our lives who care very much about us and our well being. We would like to wish every one of them a Merry Christmas in this letter. Yet, we know that even as you read this, you may wonder why we are choosing to go to Zimbabwe. The answer to this question fits in very well with the Spirit of Christmas! Indeed, the "Reason for the season" and the Reason for our trip is one and the same.

In the Bible, the book of Ecclesiastes follows Solomon's search for significance and meaning in his life. Solomon really lived it up. He was smarter, richer, better looking, and more powerful than any of us will ever be. He made Bill Gates look like a pauper and made Hugh Hefner look like a dweeb. The man had more than 1,000 women around the house. Despite all of his wealth, pleasure, and comfort he was never satisfied. I think at a deep level, we can all relate to this longing for significance, meaning, and security in our lives. If this wasn't the case, we (as a society) wouldn't be buying armloads of self help books with our maxed out credit cards. Though we try to fill our lives up with newer gadgets, more entertainment and louder distractions, the need in our hearts is never satisfied. This is clearly not a new problem for the human race. Solomon concludes that everything we try to fill this eternal need with is meaningless. In the end, He tells the reader (you and I) to "Remember your Creator" because He's going to judge us in the end.

This isn't just an idle threat, meant to inspire good behavior and social order. It's just the way it is. There is a God in heaven who made the entire world. We were made to "remember" Him, to truly know him, to have those seemingly unsatisfiable needs in our heart met by Him. We were meant to have peace with God. But this harmony escapes us. This is evident in our attempts to escape reality, in the secret shame that haunts us, and in the heavy burdens of guilt each of us carries. And in the end, our relationship with God is a broken one and we are guilty. We know this in our hearts. The Jews knew it. Check the history books. For thousands of years, Jews tried to follow the religious rigor of the day. Even a good shot at following God's law fell so short of perfection. Day after day, those who knew God's law absorbed themselves in sacrifice and ritual, never able to escape the heaviness of sin. They, like us, found themselves in need of a Savior.

Suddenly, in a remote corner of the world, a star shines brightly. Lowly farmhands are greeted by Angels announcing truly remarkable news. A baby is born in a stable in Bethlehem. He is the Messiah, the Son of God coming to fix our broken relationship with Him. Hope bursts onto the scene. The Bible tells us that this child, this Jesus, did not come to condemn the world but to save the world. At the end of his years on the this earth, this perfect Christ paid the price for my disobedience to God with his very life. The anger of God towards my sin was fully absorbed in his death. My sin was completely defeated when he rose up again from the grave! He took my shame. He took my guilt. He has filled our deepest needs and given us great purpose and meaning in our lives. The Bible says in Romans: "Therefore, there is now no condemnation for those who are in Christ Jesus." God looks at me, sees only Jesus, and He is pleased. I am humbled and amazed that this is true.

People all over the world are stuck, drowning in a sea of guilt and shame, trying desperately to satisfy a need that can never be fulfilled by anyone or anything apart from their Creator. So many years ago God provided a way, in that special little baby from Bethlehem, to be saved from the tyranny of sin. Jesus offers peace, hope, joy, and meaning for all who receive him by faith. He longs to fill people's deepest needs, but how can that happen if people do no not hear that terrific news? And how will people hear if no one goes to them? That is why we are joyful this Christmas. That is why we are going to Zimbabwe. Jesus.

You'll find enclosed a picture of our family. If you're inclined to do so, we ask for your prayers while we're overseas. While we celebrate the birth of Jesus, it is our hope that you will find your deepest needs met in Him this holiday season.

Wishing You and Your Family a Very Merry Christmas!

Love, Paul, April and Abigail McQuillen

paulandaprilmcquillen@gmail.com

Follow our story at: mcquilleninternational.blogspot.com

International Phone Number: (816) 368-1120

Our "prayer card" looks like this:

Sweet Moments

2009-11-21T22:53:00.005-06:00

I mentioned in my last post that we got together last week for a Thanksgiving dinner. What I didn't mention was that our friend Julie brought some deserts that were tasty and, as you can see below, are fun to look at. We're working on the whole potty training thing these days, and Abbi will definitely hold you to the promise of treats in the event that she is successful in her potty training endeavors. So, when April offered her one of Julie's thanksgiving treats, Abbi just didn't know what to think. I mean, the thing was too pretty to be a treat. After a moment it dawned on her just what this was. As a huge grin broke out across her face she began to sway her hips and dance, singing her own truncated version of "Happy birthday to you, Happy birthday to you..." It was pretty funny.

She also has developed the habit of blessing herself (and others) after she sneezes. Mostly, she'll just exclaim "Bless You, Abbi." Today in the store, she said to a passerby, "Bless you, kid." Ah, sweet moments.

As Abbi grows, It seems ever increasingly important to parent intentionally. The world is so full of distraction and lies that poison the soul if not kept in check by Truth (or denied access into a person's world totally). During these formative years, it has become plain to me that good books serve a child (and parent) on a number of levels. On one level books teach important lessons about words, sounds, languages , and grammar. On a deeper level, books and the stories therein, teach object lessons in Truth, creativity, and a richer understanding of the world around us. I recently ran into a book called Honey for a Child's Heart. Aside from a discussion of the value of good books, there is a great list of suggested books for kids by age group. Most of the text, as well as those of many other books, can be found on Google Books. This book can be found at:

http://books.google.com/books?id=f9UbcKMkxfcC&lpg=PP1&dq=honey%20for%20a%20child's%20heart&pg=PP1#v=onepage&q=&f=false

Mrs. Hunt's blog is available at: http://tumblon.com/honey

Just reading the first few paragraphs of the blog will give you a good preview of what the book is like.

Good Friends, Good Food.

2009-11-19T11:55:00.006-06:00

As I plug along during this month of Trauma training, I pretty much have two days in the middle of the week off, having worked most of the weekend. It turns out that people hurt themselves a lot over the weekend, so it winds up being a good time to learn about Trauma. When I'm not hanging out with my girls, I try to sneak in some extracurricular procedural training. I can't really elaborate on that here, though.

Yesterday, April and I cooked our first turkey. We pretty much had no idea what we were doing. But, sticking with my theory that lots of butter (or cheese, but usually not together) makes anything better, I pulled up the skin of the turkey (blunt dissection for you medical types) and put a nice layer of butter between the skin and the meat. Add herbs, cook for a few hours, and presto- a tasty Thanksgiving bird. Living together, almost communally, is wonderful- especially at times like these. During our Thanksgiving meal last night we all packed into our friends' kitchen and ate a thanksgiving feast. The food was delicious, though it was the love between friends, the beauty of the children around us, and the goodness of our Saviour that made the time truly rich.

Most of us present for dinner had just come home from the Global Missions Health Conference. This year's conference was absolutely superb. We learned much and connected with many missionaries and missions organizations with which we needed contact. We came home changed people. I'm not exaggerating. As I mentioned in the last post, I had the chance to sit and listen to John Patrick, who has been very influential in the way I see the world and the problems we currently have in our churches and in society. A brilliant biochemist and pediatrician, he spent much of his career treating malnourished children in Jamaica and Africa. Dr. Patrick is fun to listen to and everything he has to say smacks of a salt and light in a way that is lacking in much of our culture, especially in academia. He has the ability to tear the liberal, post modern world view to shreds and does so with humor and candor. His lectures make you think and even make my head hurt a little. I think in that respect, the American church could stand to have a few headaches. He has a website of his own, which has some excellent MP3s and papers. it can be found at:

www.johnpatrick.ca

additionally, he has a college- which I would have liked to experience myself, had it existed before I entered University. Maybe I'll be able to check out one of his week long courses at some point. This is a little bit prettier of a website than the former website.

http://www.augustinecollege.org

In other news, Abigail is becoming quite the little lady. She's now getting into wearing dress up jewelry and putting on (make believe) make up, as you can see in the video

cool article

2009-11-11T00:31:00.001-06:00

Here's a cool article about our Fellowship. I just stumbled upon it. It's an oldie but a goodie!

http://www.cg-ins.com/news/?p=985/

Momma Jo

2009-11-10T23:28:00.004-06:00

Well, as usual, it's been awhile since the last post. Abbi, who has in recent months, always referred to herself as "Abbi" has taken to calling herself "Abbi Jo," which was the original idea. We don't really call her Abbi Jo too much, so she just kinda started saying "Abbi Jo, Abbi Jo" on her own last week. It was pretty cute. I guess, she thought the "Jo" part was a good idea, as she occasionally now refers to April as "Momma Jo." No daddy Jo yet.

I finished up a month working on the Burn Unit last month. It was productive, overall. I learned a lot and feel much better about managing burns, wounds, skin grafting, etc. Also, I got to put in some central lines and chest tubes. We're coming along well in enhancing the curriculum and didactics as well.

I've moved on to working with the Trauma team this month. I have had some experience running traumas in emergency rooms in small towns around Kansas, but this is definitely revolutionizing the way I approach trauma. The surgery residents have been great to me and I look forward to the remaining half of the month.

We continue to make preparations for leaving for Zimbabwe in January, as well. My girls headed to Kansas City to see family last Friday, as I worked most of the weekend. They will stay there until I meet up with them tomorrow. At that point, we'll head out to Louisville to the Global Missions Health Conference.

http://www.medicalmissions.com/GMHC/Home.html

It's a life changing conference where most missions organizations with a medical ministry will have a presence. It was there that I first heard my favorite speaker, Dr. John Patrick, talk. I love being in the presence of men and women who have served the Lord on the mission field. Generally, aside from being interesting and full of compassion, they are the kind of people that I just want to be in the presence of- just hoping some of their character and essence will rub off on me. They are some of the neatest people you'll ever meet.

I traveled to K.C. to surprise April and Abigail yesterday after I woke up from working all night Sunday. April's grandparents were in town, staying with her uncle. So, I figured it would be a nice opportunity to see the family. I snuck up on April when I got there, and she was quite surprised to see me! It's always nice when a surprise plan works out!

We had a great visit, catching up with April's family and, of course, loving on my little girl. April and I had a great evening together. Abbi seems to say everything under the sun now, and has moved into a phase where she always has her baby doll or stuffed bear with her. I love my girls more than anything on this earth. I'm so thankful for her family and for the legacy they've given me in their daughter and in my daughter. On the way back home today, I dropped in on my mom in her classroom. It was wonderful, as usual, to see her. I'm blessed more than I could ever ask for, having families on both sides of the family that care so much about April, Abbi, and I. I don't deserve such goodness in my life and I am thankful to God for it.

In other happy news, I we'll be adding to our family in December when my sister, Becca and her fiance get married on New Year's Eve. Becca is a beautiful person and I look forward to getting to know Joe better in the future. I'm very happy for them.

OK, on to the pictures...