Needs in Zim

Greetings once again.



I hope this finds you physically well and spirtually fulfilled. Since my return to The States many have asked how they can help. As you all know, the needs are endless as Zimbabwe's healthcare infrastructure continues to struggle. The latest reports reveal that the cholera outbreak has taken over 1500 lives with death rates as high as 50% in some areas of the country.

Below you will see an email I received from the executive director of PAPA Missions, Terah Ott. Basically, a shipping container is leaving from Wichita, KS in February for Karanda Mission Hospital in Zimbabwe. You will also see a list of needed medical supplies for the hospital that was recently provided by Dr. Dan Stephens. If you have any access to these types of supplies, any donations would be greatly appreciated. The needs also go far beyond medical supplies. If the Lord leads you to assist the people of Zim in any other way, just send Terah an email and work out the details.

Please feel free to forward this message to anyone you feel may want to help.

Thanks again.

IN HIM>
kevin.




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Kevin,

Thank you for asking about sending food to Karanda. We have asked the same question over the years, and have been told that including food on the container will cause problems at customs. Apparently sending food would precipitate the involvement of a completely different branch of government, creating the potential for delays and confiscation. There are a couple of food-type items that we could send that will help undernourished children/infants, but not cause problems with container passage. The two items that seem acceptable are baby formula and food supplements specifically designed for undernourished children and infants. These can be labeled as "medical" supplies, thus, not involving the other governmental agency. Dr. Stephens sent me a list of items that the hospital specifically needs, and I would love your help in finding any of the items on the attached list as well.
Our container will ship in early February from Hospitals of Hope in Wichita. I have ordered some supplies for the container, and am having those sent to the warehouse in Wichita. There are other items that have been requested, however, that may need to be purchased locally to avoid shipping costs. Would you be willing to make a run to Wal-Mart or Sam's Club for some basic supplies for the guesthouse and hospital if I supply the funds? You could then deliver them to Hospitals of Hope, alleviating shipping costs for us. Any Via Christi Medical supplies that are being wasted can be taken to Hospitals of Hope as well. Please do keep in mind that Zimbabwe customs does check expiry dates and will confiscate items with expiry dates within 6 months of shipment. This will not only waste supplies, but will delay progress of the entire container. Expiry restrictions aside, we welcome any help you can provide in supplying Karanda with necessary goods. You know better than I what they need.

Hospitals of Hope
3545 N Santa Fe
Wichita, KS 67219

I think your idea of sending a yearly container is a good one. I would be willing to take care of the logistics if you can help me raise the money. It costs ~$12,000.00 to send a container from Hospitals of Hope, and that includes some medical supplies that they have in their warehouse.
I saw the video you recently posted on your blog. Is there any way I could get a copy of the photos you used, as well as a DVD of the slideshow? I do not have very many current photos for the Web site, and will not have anyone traveling there until late May.

Blessings to you and your family.
Sincerely,Terah Ott

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LIST OF MEDICAL SUPPLIES FOR KARANDA HOSPITAL

DRESSINGS:
Tape: Medipore, adhesive, paper, any type
Gauze: 3x3 or 4x4s, Kerlix, kling, Conform, drain sponges, Vaseline gauze, nu-gauze, iodoform gauze, aquacel Ag, duoderm, basically any type of dressing.
Wraps: Ace bandages, any stretchy type bandage
Plaster of Paris
Fiberglass casting material
Plastic dressing: Op-site or tegaderm type
DRAINS AND TUBES:
Foley catheters: 8 Fr- 26 Fr. But primarily 14-18 Fr and then 12 and 20Fr.
3 Way catheters: 20-26 Fr.
Urine drainage bags
Texas/Condom catheters
Chest tubes: 20-32 French (Fr.) with or without trocar
Drainage tubes: Penrose drains and any close suction drains (JP Drains, J-vac drains, with suction bulbs or similar connections).
Naso-gastric and Gastric tubes—8 Fr – 18 Fr or 20 Fr.
INTRAVENOUS SUPPLIES:
Intravenous catheters for starting IV’s 24 to 14 gauge
IV tubing, preferable that that does not require a pump.
Sterile IV bags for drawing blood or making IV fluids.
SUTURE:
Absorbable: Vicryl (1,0,2-0, 3-0, 4-0, on needles -- round except for the 4-0 that should be on a cutting needle), Chromic catgut (1,0,2-0, 3-0, 4-0), Dexon (1,0,2-0,3-0, 4-0). Also 10-0 8-0, 9-0 ophthalmic only—Dexon or Vicryl). Any other absorbable suture is okay too.
Non-absorbable: Primarily use: 3-0, 4-0 nylon or prolene (cutting needles) and 1-0 and 0 ethibond and 3-0 silk (or any braided suture) on GI needle.
OTHER:
Linen savers, incontinent devices
Warm, heavy duty, washable blankets
Bed Linen
Surgical gloves 6.5-8.0
Latex-free surgical gloves (Dan Stephens, size 7.5)
Latex and latex-free exam gloves
OB ultrasound for Fetal heart monitoring ( more than one)
Pulse oximeters
Oxygen concentrators (220v 50 hz)
TRACTION:
Weights, Pulleys, rope,
ORTHOPEDIC;
Plates, Rods (Kirshner rods, K-Nails, Tibial rods,), Pins (K-wires, Steinman pins)
Austin-Moore Prosthesis (Femoral heads), screws (all sizes).
Hand drills and bits
Pin cutter (large)
Electric drill (with batteries okay) but if we could plug it into the wall even better as batteries are so expensive and don't last long).
Bone saw: Hand held and electric
Gigli saws (wire devices--work great)
Dermatome: Padgett with spare blades
UROLOGIC:
Cystoscopic instruments: Basic set with biopsy ability and the ability to place ureteral catheters
Catheters as above
OPHTHALMOLOGIC:
Laser for ablating posterior capsule opacity
Automatic refractor
Aplanation tonometer or other type of tonometer (one that would attach to a slit lamp) or one that puffs air into the eye and gets a reading that way.
Hand held cauteries
Another List (may have some repeats)
urine test strips, protein/glucose (GP2 020)
methylene blue powder, 25g
autoclave tape, steam sterilization, 18mmx50m
sterilization tape, dry heat sterilization, 18mmx50m
adhesive tape 2.50cm x 5m
adhesive tape 5cm x 5m
applicator stick, wood, with cotton tip, 15cm
bandage crepe, 10cm x 4m
blade for surgical knives size 10
catheter Foley, balloon 5-15ml, Ch 16, sterile
catheter Foley, balloon 5-15ml, Ch 18, sterile
catheter Foley, balloon 5-15ml, Ch 24, sterile
catheter Foley 3-way, balloon 30-50ml, Ch 22, sterile
clinical thermometer oral/rectal, ºc+ºf ,flat type
elastic bandage, 8cmx5m stretched
gauze impregnated with paraffin, sterile, 10x10cm
handle for surgical blades no.4
needle luer 26g x 1/2" (0.45x12mm), sterile, disposable
scalp vein infusion set 25g
Plaster of Paris or Light cast (fiberglass cast)
spinal needle 22g x 40mm disposable
surgical gloves, sterile, latex, size 7.0
surgical gloves, sterile, latex, size 7.5 and non-latex (Dan Stephens)
surgical gloves, sterile, latex, size 8.0
syringe luer 10ml disposable, without needle
umbilical cord clamp, disposable
umbilical cord tie, 3mm non-sterile, 100m
undercast padding, synthetic 7,5cm x 2,7m
Intravenous fluids (Ringer's lactate, Normal saline, D5W )
Skin staplers
GIA type staplers
TA type staplers
Ultrasound Jelly
K-Y lubricating jelly
Povidone iodine, Scrub and paint
Gauze 4x4 or 3x3 gauze dressings
ACE bandages and Kerlix type dressings
Physical Therapy equipment
Paraffin baths
Ultrasonic heat machine
Crutches (all types and sizes)
Endoscopic equipment (Esophagogastroduodenoscope, bronchoscope)
Urology equipment including cystopic instruments and scope
Video endoscopic equipment
Surgical overhead light
Operating room table
Ventilator
Oxygen concentrator
Pulse oximeters
Non-latex gloves sterile for surgeon 7 1/2 size
Non-latex gloves non- sterile for surgeon 7 1/2 size
Latex Gloves Sizes 6.5 – 8.0 Sterile
Colostomy and ileostomy supplies
Surgical stools
syringes especially 5 and 10 cc
Otoscopes
Operating room side tables/trolleys and MAYO stand
Sutures--Any and all (especially 4-0, 3-0, 2-0, 0 and 1-0 absorbable sutures (Vicryl/PDS/Maxon/dexon/monocryl)
Sutures Any and all (especially 3-0/4-0 prolene, nylon and 3-0 nurolon/silk, 0 and 1 ethibond/mersilene/ticron)
hand held cautery
Surgical gowns reusable for use in sterile environment
smooth mover or mover to transport patient from surgical bed to trolley (cart)
EKG machine
Surgical EKG monitor
Ophthalmic suture (10-0 nylon/prolene on Ophthalmic cutting needle
Dermatome with blades
Weckcell dermatome with blades and various size cutting widths.
cidex
Hibitane
Surgical drapes--especially reusable cloth drapes

Re-entry

Salutations to all.

I just wanted to thank all of you for your prayers and let all of you know that I have arrived home safely. I've been back for about a week now, and I think i've kicked all the jet lag stuff. I must say that the culture shock of re-entry has been much more prominent than previous trips. The day after I returned, I went to grocery store to get a few things, and I was unexpectantly overwhelmed when I walked in. Look at all of this food! It's everywhere.....and there's tons of it! People are milling around through all the fresh vegetables picking the ones that are up to par. Aisle afer aisle is stocked full of any type of food you can imagine! Everything is so clean and there's even some nice Christmas music playing. Whoa....this is weird and a bit surreal. I quickly think of Zimbabwe and the grocery store I visited that was nothing but empty shelves except for a few produce items and a rack of wine. I also think back to my conversations I had with the Zimbabweans about how things were back in The States. I then took my stuff to the check out counter, swiped a plastic card, and left. On my way out my mind is running and Zimbabwe is at the forefront....hurting. I get in my Jeep and notice that I'm parked next to an $80,000 SUV. Man....what I could do with $80,000. Then I think about another conversation I had with one of my Zimbabwean friends, Gilbert.

"Do all Americans have there own cars?" he asked.

"Yeah, most of us do," I replied.

"Wow....so you can go anywhere you want when you want to?"

"Yep, pretty much."

"What kind of car do you have?" he asked.

"A Jeep Cherokee."

"A Jeep! Wow, only the rich people here have Jeeps."

"But mine's about 12 years old," I replied in an attempt to convince myself and him that I wasn't one of those 'rich people.'

But I am one of those rich people. I am of the top 1% of income earners in the world.....the top 1%! I am that rich guy down the street. I am on the top end of an incredible disparity of wealth distribution in the world. Something all the sudden doesn't feel right. Why am I here and they are there? Is this the way it is supposed to be? A scripture comes to mind;

Our desire is not that others might be relieved while you are hard pressed, but that there might be equality. At the present time your plenty will supply what they need, so that in turn their plenty will supply what you need. Then there will be equality, as it is written: "He who gathered much did not have too much, and he who gathered little did not have too little."

2 Corinthians 8: 13-15

So, what if the coin was flipped? What if we were there and them here? How would we think of them? How would we want what they had? Why don't they use some of what they have to help us? Why wouldn't they just make a small sacrifice to help us....to help us feed our families and provide medical care for our children? Why won't they just see how we are hurting and how challenging it is to live like this? Why don't they just understand that this life isn't just about themselves? Why don't they live like the Christians they say that they are?

Whoa.....that's something to chew on.

So, yeah, re-entry culture shock is quite a bit more challenging than the initial imersion culture shock. Please pray for me a God continues to work on my heart in this regard.

Well, I think this is it for now.

In closing, just remember to think for yourself and follow what the Lord is leading you to do....not what the world is misleading you with.

In the presence of God and of Christ Jesus, who will judge the living and the dead, and in view of his appearing and his kingdom, I give you this charge: Preach the Word; be prepared in season and out of season; correct, rebuke and encourage—with great patience and careful instruction. For the time will come when men will not put up with sound doctrine. Instead, to suit their own desires, they will gather around them a great number of teachers to say what their itching ears want to hear. They will turn their ears away from the truth and turn aside to myths.

2 Timothy 4: 1-4

In HIM>
kevin.

My Michelle

Greetings once again.

Sadly my days here are now numbered.....at least for this season. It has been an incredibly unforgettable time in service of our Creator and His creation. God's hand continues to be undeniable, and I wanted to share another such example with you today.

This is Michelle. She has just been with a part of this world of ours for the past few weeks. She came unannouced and somewhat untimely, but she is here with us nonetheless. Her mom went into premature labor when little Michelle was only 26 weeks in gestational age. After her first night in the hospital we were all encouraged to see that she made it through the night. Michelle didn't seem so surprised. She just went about her business and did what little babies do....she sleeps...she eats....she poops....she pees....and she cries for mom every now and then. Michelle was just over 700 grams when she came out, but every ounce of her is a fighter. She refuses to believe that she can't make it. She refuses to listen to those who say she hasn't got a chance in a bush hospital such as ours. She's a baby just like all the other babies...but just a bit on the skimpy side of the scale. She's now puttin' on the pounds....or grams I should say.....like nobody's business. Today she broke 800 grams for the first time! And then there's her mom. She always there....always watching....always feeding....always smiling. She's become quite comfortable in the neonatal unit, and she's always lending a hand and helping out with the new mothers as they come through. It's gotta be the highlight of my day to peer through the window into the neonatal unit to see her squirming around as she goes about another day. God is good....isn't he. Again, what a blessing it is to see Him do his thing.

Hope this finds you encouraged and experiencing Him personally as well.

In HIM>

kevin.

New Email Addy

Sorry to go about this in such a manner, but looks like my old email address is kaput as of November 21st. Since this happened without warning, I was unable to make the appropriate notifications prior to its demise. So, this is the easiest way for me to reach some of you as of now. I know most of you could care less, but for the few of you that this concerns here it be;

kevin.k.raymer@googlemail.com

Thanks again.
kevin.

There He is Also

"When two or more gather in prayer there He is also."

Thank you so much for you prayers. We just received a truck-load of i.v. fluids and seed corn. We're not too sure where the i.v. fluids came from as of yet, but we think it may be part of the large shipment we were expecting. We are so grateful for God's provision.

Thank you all again for your prayers.

in HIM>
kevin.

Zimful Odds & Ends

Salutations.



Here are a few more pics and stories from Zim.





















This little one is the newest addition to our Karanda family. She is now the youngest of the Chigumira family as well as the most sought after. We were all overjoyed to get a chance to hold this precious little gift.

















Here sister Pauline and I are working on an above knee amputation. This was an unfortunate case of osteosarcoma in a 13 year old girl was causing her much pain, and she was not able to walk. With the cancer as large as it was and with its location at the top of her tibia, we had no choice but to amputate.


















This is what you call a nasty lookin' foot. Evidently this patient had a rod placed at another hospital and was cared for there for a few days. He then came to us looking like this, complete with maggots crawling in the wound. It wasn't the most pleasant thing to take care of, but hopefully he'll still get to use his foot.

















Here all of the post cartaract extraction patients are receiving their post-op eye care education. Every Tuesday you get to see all of these patients lined up with their eye shields on. The coolest thing is being there when the eye shield is lifted off and they get to see for the first time in a long time. They just look around at everything and smile the widest smile you've ever seen.





















This little fella had a supracondylar humerus fracture. Here we had just placed a traction screw in his ulnar olecranon prior to doing a more definitive surgery a few days later.





















This is a patient being unloaded from an oxen drawn cart at the hospital. A few weeks back I saw a patient being trasported by wheelbarrow. Every now and then you seen an ambulance of some sort, but this seems to be the rarest of transport vehicles.
















This guy is on of our peds patients with heart failure....which we seem to have quite a few of. He was quite a talker. Every morning he would just be talkin' away expecting you to understand every babble. We all got a good laugh tryin' to talk with him on rounds.





















This is a quite common sight outside of the outpatient department. We continue to see more and more patients with the closure of the government hospitals. If you want to read a good article about the fallout of the healthcare system here in Zim, go to http://www.bbc.com/ and search for Zimbabwe. You should be able to find the article there somewhere.





















This patient has AIDS and is suffering from advanced Kaposi's sarcoma. These often be complicated by secondary bacterical infections as well as fungal infections of the skin. Our options for treating these lesions is quite limited to ARVs, antibiotics, and antifungal agents.





















This little cutie got quite excited every time we took her photo. I couldn't resist pickin' her up for this pic.





















So, this is a pic from our friend Itei's birthday party. It was quite interesting because no one there had been to a birthday party before and no know knew what to do. So one friend was named the M.C. of the day and we went about a somewhat formalized birthday program. It was quite funny but enjoyable nonetheless. The most impactful thing was their desire to glorify God through this celebration. We shared about Itei, prayed together, and praised God through song...what more could you ask for?


Let's see.....what else has been goin' on around here. Oh yeah, we just received our first rains of the wet season. This place goes months without a drop of rain and then it gets poured on. I realized how much I missed the rain when the cool winds came up and all that nice moisture was in the air. They say everything will green up in about 4-5 days now.


The other big thing is the cholera and cutaneous anthrax outbreaks. We have yet to definitively diagnose anyone with cholera yet, but we keep hearing that it is getting closer to Karanda. With our i.v. fluid shortage, we are all concerned about how efficiently we will be able to treat patients with cholera. Please pray that our area is spared from the cholera outbreak and that we have enough i.v. fluids to care for those that are transferred to us.


Of our interesting cases of the week we had an adenocarcinoma of the colon that involved the small bowel, large bowel, and aorta among other vital organs. We resected a large portion of the cancer that included portions of the small and large bowel. We then had to do a reanastomosis of both the small bowel and the large bowel. Hand sewing the bowel takes some time, but it's definitely a skill one needs at a mission hospital. I saw the patient today on rounds to find out that he is doing well, eating, and moving his bowels on post-op day 3.


I had another interesting case the other night when I was on back up call for the physican assistant. I was called in for a C-section for a term fetal demise that was transferred to us. When I opened peritoneum copious amounts of dark thin blood gushed out. Once I was able to feel the uterus, I realized that the uterus had ruptured on the posterior side. The baby did not survive the rupture and half of the baby was in the mother's abdomen while the other half was in the uterus. Fortunately the bleeding from the uterus was controlled, and the mother survived. So, the mom mad it, but the baby did not. Sometimes it's difficult to understand God's plans and provisions, but we can always find comfort knowing that they are indeed His faultless plans and provisions.


"The ways of the Lord are not the ways of man."


In HIM>


kevin.

Flying Cobra Breech

I hope this finds you once again in the unexplainable yet undeniable presence of our Father. Things are “lookin’ up” here at Karanda. All of the strikers have returned to work, and the hospital is functioning at full capacity once again. I don’t think we ever really slowed down. We’re now starting to see more admits from the areas where government hospitals have closed down. Overall, I’d say our numbers haven’t made a significant increase as of yet, but we’re still waiting to see how this all pans out. Thank you once again for all your prayers and concern. You have made a difference here in Zim.
I want to share a couple of stories with you from last week. The first occurred early one morning. I had made my way out to the little gazebo-like shelter outside the guesthouse for my quiet time and was enjoying another morning in the Word here in beautiful Zim. As I was doing so, I noticed something moving out of the corner of my eye. I turned and looked to find that ‘twas a snake slithering about. I thought “hmmm…..that looks like something I’ve seen on the discovery channel before. I best throw a rock at it to find out.” So I stepped out of the gazebo and gathered some small stones. When I reentered the gazebo, the snake got spooked and raised its head and flared out its sides. It was a cobra! We had a stare-down, that he quickly won, and I went to find someone to help deal with the little critter. The hospital guard grabbed his trusty snake stick and headed up to the guesthouse. We looked around in the dry leaves for a bit before finding him. Once we had him on the run, the guard stopped him with the stick and then flung him up in the air. I quickly noticed that the flying cobra was headed my way! I let out a screech, similar to what you would expect a 6 year old girl to do when a frog makes an unwelcomed appearance, and ran. The guard then wacked the thing good with his snake stick a few times. Once it was good and dead I got a little closer look of him. Here’s the guard with his prize.

I know….I know it looks to be in prepubescent snakehood, but it’s still a cobra!
That very same day I saw a patient in male ward with a necrotic finger. I asked him how it came to be, and he said a cobra had bitten him. I’m told that cobras don’t bite all that often, but it looks like one did a number on this fella’s finger. Here’s the pic.

Now the other, more serious, experience that occurred on Katie’s last night here. We were on call and enjoying a good night’s rest when the phone rang. It was the maternity ward, and there was a breech delivery that the midwife was having a difficulty delivering. We arrived to find the baby stuck with her legs out but with her head and arms still inside. The legs were purple in color and without movement. We delivered the baby quickly and started resuscitating her. There was absolutely no movement, she was purple in color, was not breathing, her heart rate was about 40 beats per minute, all muscle tone was absent, and she wasn’t responding to any of our stimulation. If you’re counting up an APGAR score…..let me just tell ya it was far from ideal. So we continue our resuscitation, intubate her, give her epinephrine, and slowly watch her come around. After 10-15 minutes she finally starts breathing on her own, and she starts moving her arms and legs. Her color improves and she does her best to cry for us. We kept a close eye on her the next few days as she regained her strength and got oriented to her new surroundings. I’m not sure what the mom will name her, but I call her “Miracle.” It’s one thing to hear stories how God works…it’s yet another to witness them firsthand. This miracle was yet another day of glory for our Father.

In HIM>

kevin.