With a Smile

        M has been at Karanda for about 3 weeks now.  She is 26 years old and came to our outpatient clinic after delivering a baby boy at a small local clinic.  After delivery she had a postpartum hemorrhage with subsequent hemoglobin of 3.8 (normal 12-15 for women) and was transfused 2 units of blood.  When she arrived, all of the fingers on her left hand were black from dry gangrene.  As we waited for the necrotic tissue to demarcate in hope of saving as much of her hand as possible, her new son died unexpectedly.  Despite the pain of losing her newborn infant and watching more and more of her left hand turn black, M always had a smile on her face (except when being photographed because that is serious).

M

Her gangrenous hand before surgery

        Even after the painful process of debriding all the dead skin and subsequent amputation of most of her left hand, her smile remained.  She is a shining example of being joyful in all circumstances and I love seeing her inspiring spirit each day.

We saved as much of her left hand as possible

"Everyone smiles in the same language."

      Thank goodness, especially for people like myself who lack a natural ability to easily learn new languages!

A Different Perspective

      As I finished rounds in maternity on Sunday, the midwife mentioned a new transfer patient from a local clinic had just arrived.  Transfer patients are usually assessed by the physician on-call because they are often high risk or in need of an intervention.  The reason our most recent patient was transferred?  According to the chart she was an “elderly female, primip with precious baby.”  And what age makes a person elderly?  33!  I laughed as I told the midwife I was sure she could take excellent care of the patient and to call me if there were any questions or problems.
  
      The next morning during rounds I asked if our "elderly" patient had delivered--apparently not yet--and then said; "I don't really think 33 is old," to which the midwife spun around, looked at me wide-eyed and exclaimed, "you don't?!"  I learned something new that day: I am elderly.  Ah, only in Africa...right? :)


(Good news--she delivered a healthy baby without complications.)

“Age is not important--unless you’re a cheese.”

--Unknown

Living Legends

          The 50th anniversary celebration of Karanda Hospital took place last weekend with lots of festivities!  Many of the people instrumental in the formation of the hospital returned, including those from Zimbabwe and overseas.  I was honored to live with 2 of the living legends, Sister Lorraine Waite (who is 85 and still speaks Shona fluently) and Ann-Brit Smayzck (nurse-midwife and former matron).  Their stories of creatively and bravely caring for patients with fewer resources than exist now were inspiring.  They shared of walking miles & miles to villages performing immunization campaigns, building an entire real model nutrition village to teach mothers how to prevent malnutrition in their newborns, which has significantly reduced the number of children with kwashiorkor and marasmus in the area.  Stories of flying to remote villages to perform clinics, doing deliveries, episiotomies and D&Cs independently, living in huts initially and of having to close the hospital and evacuate as many patients as possible with 2 days notice during the Zimbabwean independence war.  There was no internet, minimal electricity and no running water early on, yet they persevered and have left a legacy of love here at Karanda.  True pioneer missionaries, true living legends.  It was hard to say goodbye!

          “If you think you are too small to make a difference, try spending the night in a closed room with a mosquito.”  

--African saying

Ann-Brit & Lorraine-two inspirational women

Lorraine, known as Sister Waite around Karanda, came to the area before the hospital was built!

Sunset while heading home from hospital

Mary

          I would like to introduce you to Mary and her daughter, Faith, who came my first week here.  Mary, a 53 year old widow with 3 daughters (Faith is the oldest) is very sweet.  She is HIV+ and for the past 2 years has had an enlarging growth on the left side of her face.  The growth began in her eye and grew until it obliterated her left eye, nasal passage and most of the left side of her face.  Mary has few remaining family members and they don’t offer to help much, so she has been moving her family around northern Zimbabwe over the last couple of years.  She hasn’t seen a doctor before because as Faith said: "we didn’t have any money.”  

         When Mary is finally able to be evaluated at the hospital it is clear that she has advanced cancer, likely squamous cell carcinoma (which she is at high risk for given her immunosuppression & sun exposure).  Radiation is the best treatment, but is usually cost-prohibitive for our patients (like Mary).  She is offered surgery to determine the extent of invasion and remove as much as possible, hopefully all of it.  Mary decided to have surgery.

Mary before surgery

Mary after removal of as much of the cancer as possible

          The good news is that Mary survived the operation.  The bad news is that the cancer has not only spread through her eye & cheek, but also into her brain.  We removed as much as possible, almost the entire left side of her face, but were unable resect all of it.  And because the remaining hole is so large, a skin flap was  needed--meaning she will need a skin graft later.  

          Mary is a fighter and exceeded all my hopes by not only making it through surgery, but regaining her spirit shortly post-op.  She still has a tough, tenuous road ahead, but for now we rejoice in the small successes and mercies granted, grateful the Lord has given us more time to spend with one of His precious children.

Mary and her daughter Faith

First Call

          The first call in a new hospital or country is often memorable and my first call here was no exception.  Actually, it began with one of my most dreaded scenarios.  The phone rang and the voice on the other end shared: ”Hello, I am calling from the pediatric ward”--uh oh, I thought--“We have a 5 day old patient who is intubated and now having oxygen desaturations.  Can you come?”  My heart skipped.  I hung up the phone, grabbed my headlamp & stethoscope and ran to the hospital.  

          As I entered the peds ward, I saw a tiny baby girl being manually ventilated through a tube down her trachea.  The nurse was sitting at her bedside squeezing the ambu bag rhythmically (if you intubate you have to manually ventilate for as long as the patient is intubated- the only ventilator machine is in the OR).  She was very sick, not oxygenating well, had a low heart rate and was likely septic.  She was on all the appropriate medications that are currently in stock at the hospital.  Her lungs rattled, I could barely hear her heart sounds, her feet and hands were cool to the touch.  As I re-intubated her, fluid rose out of the trachea.  Despite assuring proper ET tube placement several times, her oxygen saturation continued to drop.  Shortly thereafter her little body became too weak to continue fighting.  Her name was Diana.  

          As I prayed and grieved with Diana’s mother (who had been abandoned by her husband a month ago) and grandmother (who’s husband died a couple of weeks ago) I was reminded once again of God’s sovereignty, the limitations of medicine and the similarities that bind people together everywhere--we all love, hurt, laugh, cry and have hopes & dreams for the future.  

“We can do no great things, only small things with great love.”  --Mother Teresa

Mangwanani!

         Mangwanani! Mangwanani! Marara sei? Ndara mararawo. Ndara zvangu.  "Good morning!  Good morning!  How did you sleep?  I slept well if you slept well.  I slept well."

I love the back & forth greetings and how they roll off of everyone else's tongue.  The different responses for morning, afternoon and evening are beginning to imprint in my mind, but usually result in a slurred response as I race to match the time of day with the appropriate response.  The Shona people and language are beautiful!  I am excited to be at Karanda Mission Hospital for the next few months & hopefully improve my language skills. :)

Karanda hospital is located in northeastern Zimbabwe and cares for approximately 75,000-90,000 patients every year by providing pediatric, obstetric, surgical, outpatient and home-based care.  There is a large number of HIV/AIDS patients-it is estimated that 25-45% of the population is HIV positive, so there are a lot of AIDS related complications and opportunistic infections.  The hospital cares for those living with HIV/AIDS with a great model of education, counseling and through an opportunistic infection clinic.  Here is a picture of the hospital and ‘town’ of Karanda--I will share a few stories from the past month soon!  --Kristin

Karanda courtyard
(Building to left = female ward, peds ahead, clinic to right)

Main street