Preparing for the Mission

Needs in Zim

2008-12-30T14:35:00.000-08:00

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

2008-12-08T13:24:00.001-08:00

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

2008-11-25T10:34:00.000-08:00

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

2008-11-24T21:42:00.000-08:00

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

2008-11-19T19:58:00.000-08:00

"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

2008-11-14T08:28:00.000-08:00

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

2008-11-14T04:21:00.000-08:00

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.

In Times Like These...

2008-11-04T04:02:00.002-08:00

In times like these we need the prayers of many.

Things have just become interesting here at Karanda. Yesterday we heard that all the government hospitals had closed due to the stressors created by the current economic and political situation. That left us as one of very few functioning hospitals in the entire country. We're not sure what this will do to our patient load, but we're expecting to see our numbers climb. We are also out of corn meal to feed the patients and staff. More corn is supposedly "on the way," but no one knows exactly where it's at. To top it all off, the ancillary and junior staff at our hospital decided to go on strike today. This is a very delicate issue to tackle. Nearly all of the hospital staff are government employees here at Karanda, and they are not seeing the wages that they have worked for. This is where it gets kinda complicated. Since the new currency was created a few months ago, there hasn't been enough paper Zim dollars to go around. The government pays hospital employees as a direct deposit to their bank account. Sounds okay.....okay if they could withdraw a significant amount of money. As of late, they can only withdraw 50,000 Zim dollars at a time. With the current street exchang rate at 1.5 million ZD to 1 USD, 50,000 ZD doesn't do a whole lot for ya. To make it worse....yes it get's worse....the value of the Zim dollar continues to plummet. By the time the employees withdraw their money it has already devalued significantly. Last I heard the inflation rate was at a record 231 million percent! It has to be somewhere around 300 million percent now. When my parents and Katie were here just a few weeks ago the street exchange rate was about 10,000 ZD to 1 USD, and now look where it's at! It's absolutely devastating to this country and it's people. Futhermore, there is minimal food for sale. You really have to hunt and peck to find what you need. I went to one of the major grocery stores in Harare a few weeks back to find only a few vegetables available and a shelf of wine. The rest of the store was nothing but bare shelves and remnants of past marketing campaigns. Another issue is the upcoming planting season. Since the people have little funds, they have been unable to purchase seed to plant. With no seed, no harvest....with no harverst, no food....with no food, there will undoubtedly be further suffering. I know our economic situation back home is less than ideal, and the media is doing it's best to convince us that we are in a recession, but I don't think we have a clue what it is like to endure true economic hardship. Having to ration out corn meal to your starving children is hardship. Having to dig up the roots of last year's harvest as a food source is hardship. Not being able to take your dying child to a clinic due to lack of resources is hardship. Losing part of our excess in a retirement fund somewhere is not hardship.....at least not to most of the world. I'm not trying to make anyone feel guilty here, I'm just trying to provide some perspective. Perspective seems to go a long way when it comes to finances. I'm also pleading for your prayers for this place and the debacle it is in. We are also out of i.v. fluids again and are currently attempting to sterilize homemade normal saline to be used as i.v. fluids. Please pray that this works or that we get the i.v. fluids in that we ordered several months ago. So yeah....things are kinda rough for the people here, and I hope your continue to keep them in your thoughts and prayers.

Remember, "The prayer of a righteous man is powerful and effective."

Once again, thank you for taking the time to read this and for praying for Zimbabwe. Your prayers will not go unappreciated.

In HIM>
kevin.

Stories of the Past Weeks

2008-10-27T05:12:00.000-07:00

Greetings once again from Karanda.

We have been enjoying our time here as much as ever this past week. As to the norm, God continues to do incredible, miraculous things here. I wish you could be here to witness it all first hand.

This little guy is standing on the streets of downtown Karanda. The word is that this little place was quite busy back in the day. With the economy suffering here, most of the shops are closed and the street vendors are elsewhere.

This is one of God's miracles. She recently fractured her hip and went to surgery to get it fixed. The day after surgery she looked like her days were numbered. The second day after surgery the only response I could get from her was a slight grimace to pain stimulus. She was otherwise unresponsive to audible or visual stimuli. During rounds I explained to her daughter, standing to the left of the patient in the pic, that she had a very poor prognosis and that she would most likely not be with us much longer. "Oh ye of little faith...." so goes the well know scripture. I nearly withdrew all care so she could die as comfortable as possible. We then decided to place a nasogastric tube and give her liquid feeds to provide her some source of nutrition. The daughter placed her mother's life in the hands of our Lord and prayed. Needless to say, the next day on rounds the patient was wide awake, smiling, and talking. Wow, wow, wow.....God never ceases to amaze. I went back to the patient yesterday to take this picture to find the daughter just full of joy and thankfulness. As we talked I said, "You've been praying, haven't you." She just smiled ear to ear and said "Yes."

This is yet another of God's gifts. The woman on the left was transferred to us one afternoon at 4 pm with a histoy of continuous vaginal bleeding after a vaginal delivery at 9 pm of the prior day. The baby was doing great, but the mother was in hypovolemic shock. She was anxious and sweating with a blood pressure of 80/40 and a thready pulse in the 130-140s. We then had to decide how to best care for this patient. It may seem straight forward for some of you, but let me remind you that you are in an African country that is currently withstanding a devastating economic crisis. So, with that said, we have no donated blood available and only about 3 bags of isotonic i.v. fluids. One of the hospital workers thought we should send her to another nearby hospital where they reportedly have blood to give and i.v. fluids as well. The only concern with that option is that we will never know what kind of medical attention, if any, they patient will receive from a physician. Many of the physicians here are on strike or are working in a very limited fashion due to economy. Some of the hospitals have closed altogether, and some are operating as a clinic only. So, what do you do? After a meeting of the minds and a changing of our plan several times, we decide to first take her to the theatre to see if we can find the cause of her bleeding. Oh yeah, and Dr. Stephens, the surgeon, is out of town for the weekend. So we get her to the theatre and find that the entire placenta is still in her uterus. She is given ketamine and the placenta is extracted and the bleeding almost completely stops. Her vital signs are still about the same, and we get her hemoglobin result back, it's 5 (normal is somewhere around 12). We tried to get her typed and crossed for a potential blood transfusion, but I guess the lab tech decided it was time to go home before the test was completed. If we were to give her blood, it would have to be someone who has the lowest risk of HIV because we just ran out of the kits to test blood for HIV, i.e. one of us would need to donate. But, we never got her blood type result back and it's Friday, which means that we will not be able to get any labwork done until Monday and a result most likely not until Tuesday. So yeah, managing something like this can have it's challenges here. Anyway, after the placenta is removed, the patient is sent to the "ICU" with our last bag of isotonic i.v. fluids. What do you do next? That's right, you pray and watch God's hand at work. And then you get to experience the true joy of being a part of God's gift to the three generations of family in the above pictue. What a blessing of blessings this is.

The mission field experience isn't always nothing but miracles and praises as many of you know. There are often very tragic things that happen her that are difficult to understand and accept. One such case involves the baby girl above. She was attacked by a jackal and suffer many lacteration to the scalp. We were all concerned that the jackal may have had rabies and transmitted the virus to the baby during the attack. The patient's family was able to purchase some rabies vaccine (we have none here), and we were able to give it to the patient. We also cleaned her wounds and repaired the lacerations. She did great during her hospital stay and the sutures were removed in about 7-8 days. She never had a fever or any other concern while she was here. We then decided to let her go home to finish the rabies vaccination course at her local clinic. A few days after her discarge, we received news that she had been doing very well and then died suddenly during the night. The rabies virus can act very slowly, but the news of her death still had us stratching our heads. Did she die of rabies? But she had received nearly all of the vaccine course. Was the vaccine given properly and soon enough? Was the vaccine still good or had it expired or was it not stored properly? Was it even rabies that she died from? The jackal's head was sent in for examination to detemine if it had rabies or not, but I kinda doubt we will ever hear back from them. So...many questions and not many answers.

This is a pic of the guesthouse here at Karanda. It's been a more than adequate place to stay. We have running water (at least in the mornings), electricity (most of the time...especially here as of late), a small open air courtyard in the middle of the building, a computer / TV room, a large meeting room, fully equipped kitchens, wireless internet (yeah....crazy isn't it), a laundry room, and even a nice little gazebo out back.

This is one of those "only in Africa" pics. If you look closely there is a sign posted on the tree that basically says "car parking" in Shona. This is the "parking lot" outside the hospital, and we do tend to have quite a few cars parked in it from time to time. I chuckled when I saw that this guy decided to park his ox cart in the parking lot. Makes sense.....why not? ....just kinda funny nonetheless.

So were still experiencing the beautiful changes of springtime here. This tree is known as the Flamboyant tree around here. It's red blossoms are quite stunning and add great color to the landscape here. I wish I could take own back home with me.

This is another pic from downtown Karanda. The guy up front here is holding his dinner......a little black chicken. The lady back by the ox cart is waiting to load up some ground corn from the corn mill inside the shop.

Here's Katie working on a bleeding wound on a patient in the theatre.

Here Katie and I are taking out a calcified trochanteric bursa on an ol' ambuya (grandmother). That thing was as hard as a rock! We both laughed when the patient asked to see it after it was removed and then oooh'd and aaah'd over it as she poked it with her finger.

This patient here has a jaw tumor that we may be taking out soon. We're waiting on the pathology to come back first. If it's a Burkitt lymphoma tumor, we'll try a chemotherapeutic agent before any surgery is done.

Here's Katie and I enjoying an African sunset walk. Katie just finished her time here and has since arrived safely back home. Everyone loved having her here, and our time serving at the hospital together was incredibly enjoyable and fulfilling. I'm now suffering from KWS (Katie Withdrawal Syndrome).....so any and all prayers will be appreciated.

Well I think that's all for now.

In HIM>
kevin.

Manheru!

2008-10-22T02:07:00.000-07:00

Manheru!

I just wanted to share a few photos with you all from this incredibly special place called Karanda.

So here are my parents and Katie out by the big sign. My parents just returned to the States a few days ago, and they're being missed here in Karanda bigtime! My dad helped out with all kinds of odds and ends while he was here....putting up lights in the guest house, fixing doors, painting the school house, and all kinds of other things. He filled a definite need during his short time here. My mom also helped out quite a bit here on the station. She helped teach at the school, painted at the school, and best of all.....made bierocks, cinnamon rolls, bread, banana cream pie, apple pie, and the like! We didn't really feel like we were out in the bush with her cookin.' My parents also helped out with the AWANAS program while they were here and with all kinds other projects as well. The best thing was seeing how joyful they were to help and how they were blessed in return. Everyone has been asking about them and asking when they are coming back. So, Mom....Dad.....when are you headin' back?

The little one on the left was in our Peds ward for about a week or so. She had a burn to her left ankle that we initially tried to skin graft. The graft didn't take, so we just watched it real close and changed her dressing daily. The daily dressing change thing on a healing burn isn't the most fun thing for these little ones to experience. I always thought she would never forgive me for being the mean guy to pull her dressing off everyday, but she never failed to shake my hand after the torture of the dressing change. She is now at home and doing well.

This little gal is one of many sad situations. Her mother is HIV positive, and she likely is too. To see these little ones struggle through this merciless disease just tears at your heart. They are so innocent yet they are victims of the most relentless of diseases. Of all the unthinkable things we see here, this has got to be the most difficult to bear witness to. Please be praying for her and all of those who are battling the same circumstances.

Here's a pic of my dad learning the do,s and don'ts of Zimbabwean etiquette. It's a hands-on affair complete with sadza, greens, and all kinds of tasty sides. Sadza is the staple food here in Zim. It's basically ground corn cooked with water, but it's much more complicated than that when you watch one of the ambuyas (grandmothers) cook it up.

Here's Katie learning how to be a Zimbabwean mama. What do ya think Debbie (my mother-in-law).....looks like a natural 'ey? This is how all the mothers transport their children here. It's acutally a quite efficient setup. They simply bundle them up in some sort of cloth and secure 'em in front with a few tucks of the material. They then have their hands free to go about the day's work. Genius!

This is Tatenda and his parents. He's the little boy I asked you to pray for. This is the first day I saw him sit up in bed. He was still quite weak, but I was so excited to see him sitting up I had to grab a pic of the occasion. He left the hospital a few days later thanks to your prayers and God's healing hand.

This last one is an all too common site. Every morning we see the men, women, and children head down to the nearest "bore hole" to pump out and collect water in jugs for the day's need. It really makes you think a bit of the luxury of running water.

Well, I think that's all for now.

"See to it that no one takes you captive through hollow and deceptive philosophy, which depends on human tradition and the basic principles of this world rather than on Christ."

In HIM>

kevin.

Wednesday

2008-10-16T12:20:00.000-07:00

So, last week was Katie's first Wednesday here at Karanda. Wednesday has traditionally been "Surgery Day" at Karanda, but as of late this has been a bit of a misnomer. Everyday seems to be surgery day since Dr. Stephens is now the only surgeon full-time at the hospital. The other surgeon, Dr. Stephens' father, is currently in the States....he typically did all the ortho cases. So anyway, all of the major elective surgeries are all scheduled on Wednesday and kept on the board until they're done...usually not until Friday or Saturday. Here's a pic of the surgery cases scheduled for Katie's first Wednesday.

So, 19 cases on the board and everything else the day provides, and you never know what the day will provide. On such case was a middle-aged female with lower abdominal pain. She was first seen in the Outpatient Department and was found to have an acute abdomen with vaginal bleeding. I immediately took here to the theatre to do an ultrasound scan. On the scan a tubal ectopic pregnancy was diagnosed. By measurement the baby was about 13 weeks gestational age and was without a heartbeat. The mother's last mentrual period was in June, so this little one had likely expired a few weeks ago, and the mother was complaining of vaginal bleeding and lower abdominal pain for the past month. Basically, this ectopic preganancy had needed to be removed for quite some time. The ultrasound scan also revealed a significant amount of blood in the mother's abdomen, and we soon found out that her hemoglobin was 7 (low). The scan also showed a somewhat unusual finding. There was another small calcification within the cavity of the ectopic. It at first looked like another much younger baby, but I couldn't quite convince myself that is was indeed another baby. Once the scan was done, I poked my head into the theatre to discuss the patient with Dr. Stephens. A middle-aged female with an acute abdomen, vaginal bleeding, and a ruptured ectopic pregnancy.....get her ready for the theatre.

So, Dr. Stephens and Katie open her up to find the ectopic. As Dr. Stephens attempts to free-up the ectopic, it ruptures and there is the small 13 week baby, lifeless. He’s small enough to fit into the palm of your hand, yet he already has all his fingers and all his toes. It never ceases to amaze how we are knit in our mother’s womb and how quickly we take the human form. There’s a moment of silence as we all stare in awe at this little one….saddened that he didn’t make it…encouraged that God alone is in control. Our hearts are heavy, but the case continues. The ruptured tube is removed and the excess blood is evacuated from the abdomen. Since the patient’s hemoglobin is low, the excess blood in the abdomen is collected and then injected into the patient's veins as an autotransfusion. Once everything is cleaned up and tied back together they proceed to close the incision. After the incision is closed, they clean the wound and start taking down the sterile field. While they are doing so, the scrub tech asks Katie if there were twins as she points to another small baby on one of the sterile towels. This one was much smaller than the first and looked to be about 6 weeks old. So, there were indeed two babies in the tube! I’m guessin’ that they were ectopic twins and that one expired before the other. After a quick Google search, I found that this occurs about once out of every 20,000 pregnancies. It's quite a rarity, but then again we're at Karanda. I'm not sure that anything is considered a rarity here. Anyhow, the mom is did quite well and recently went home.

With our staff being a little short-handed, I've been trying to help out by spending some extra time in the Outpatient Department, but I ended up rounding up some more work for the surgery crew. Next an incarcerated inguinal hernia and then an acute bowel obstruction ended up in the theatre. So needless to say, Katie’s first surgery “day” ended up being a surgery “week,” which seems to be more and more the norm around here.

One last parting word;

"O LORD, you have searched me and you know me. You know when I sit and when I rise; you perceive my thoughts from afar. You discern my going out and my lying down; you are familiar with all my ways. Before a word is on my tongue you know it completely, O LORD. You hem me in—behind and before; you have laid your hand upon me. Such knowledge is too wonderful for me, too lofty for me to attain. Where can I go from your Spirit? Where can I flee from your presence? If I go up to the heavens, you are there; if I make my bed in the depths, you are there. If I rise on the wings of the dawn, if I settle on the far side of the sea, even there your hand will guide me, your right hand will hold me fast. If I say, "Surely the darkness will hide me and the light become night around me," even the darkness will not be dark to you; the night will shine like the day, for darkness is as light to you. For you created my inmost being; you knit me together in my mother's womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well. My frame was not hidden from you when I was made in the secret place. When I was woven together in the depths of the earth, your eyes saw my unformed body. All the days ordained for me were written in your book before one of them came to be. How precious to me are your thoughts, O God! How vast is the sum of them! Were I to count them, they would outnumber the grains of sand. When I awake, I am still with you."

In HIM>

kevin.

Back at Karanda

2008-10-11T21:05:00.001-07:00

Mangwanani.....

I hope this again finds you in the midst of your work for the Lord. Life here in Zim continues to be a daily adventure. My family and I returned from an excursion to Victoria Falls a few days ago. Wow....talk about beautiful. I think Katie and I agree that it is the most impressive of God's creations that we've seen as of now. On the way to the falls we spent a night in Hwange Game Park (the largest game park in Zimbabwe). We caught up with the giraffes, zebras, cape buffalo, wildebeasts, hippos, and the like. Its was just incredible! At the falls we "walked with lions," canoed the Zambezi, and feasted on some of the local cuisine (wart-hog, ostrich, crocodile, eland, cape buffalo, lamb, and maponi worms). On our way back to Harare we stayed at Antelope park. Again it was an amazing place to overnight and view the wild game. All in all an unforgettable time with the fam.

We are now back at Karanda and excited to get back to "work." I must say that I have never looked foward to "work" like I have here. Everyday promises unbelievable stories, beautiful loving people, intense medical cases, true reliance on God, and the continuous development of new relationships. Who could ask for anything more? What an undeniable blessing it is to be here now.

This is Trish. She is about 8 months old and is currently being treated for hydrocephalus. I'm not quite sure how common this is throughout the country, but we sure do see our fair share of them here. It sounds like we're 1 of 2 hospitals in the country that will place VP shunts, and you can only go to the other hospital if you have the means to do so. So, with that said, we always seem to have around 3-5 patients in the peds ward with hydrocephalus. We do therapeutic taps until we can fit them on the surgery schedule for a VP shunt placement. Most of them do alright in the hospital after the shunt is placed, but some don't. As they get older various cognitive deficits can declare themselves, and some will have no deficit. Anyway....back to Trish. She's been here since I arrived due to some blood-tinged CSF. Now that the CSF is clearing, she finally had a permanent VP shunt placed. She went home today.

These two siblings here are dealing with a protein-energy malnutrition syndrome classically known as kwashiorkor. If I would have taken their photo a week earlier, you likely would not have recognized them. As with this syndrome, they were both incredibly edematous in their face and limbs. It really is amazing to see how they have improved over the past few days. It's a bit difficult to see in this photo, but they also have severe muscle wasting as well as thin light colored hair. I still can't believe how different they look now compared to how the look upon admission. It's nearly unbelievable how proper nutrition can have such an immediate impact.

So we had a visitor to the male ward the other night. I guess a cobra decided to stop by and hang out for a bit. Word is that he just slithered in the main entry to the male ward. It cause quite a ruckus up at the hospital, but thankfully no damage was done.

I have a specific prayer request for you all. We now have a seven year old with cerebral malaria on the peds ward. He's as sick as they come but has made slight improvement the past couple days. Please be praying for his complete recovery. His name is Tatenda.

In HIM>
Kevin.

THEY'RE HERE!

2008-10-04T00:47:00.000-07:00

Thank you for all your prayers. Katie and my parents arrived safely....a bit jet-lagged but safely! We picked up all of their luggage with the exception of one checked bag. We hope to pick it up today. Please pray that we get it without difficulty.

We will leave for an excursion to Victoria Falls on Sunday, and then we will head back to Karanda to spend some more time at the hospital. Please pray for safe travel.

Our journey is just beginning. I will try to keep you posted on all that God does during our time here together.

In HIM>
kevin.

Last Night

2008-10-02T22:38:00.000-07:00

So last night got a little interesting. I was called in for a cord prolapse (when the umbilical cord comes out before the baby's head...an obstetrical emergency!). We called in the troops and prepped her for a "stat" c-section. We didn't have time for spinal anesthesia, so we did the whole case with ketamine only. When the baby came she was very limp and no breathing. I immediately began to pray. The nurses then took the baby and bagan stimulating, suctioning, and providing oxygen. The silence after the delivery enhanced my anxiety.....this has to be one of the worst "silences" we face as physicians. We she take a breath? Will God breath into her? Will that long awaited cry fall on our ears? The seconds seem like hours and then the Lord provides and she gasps! Then comes the cry and the relief overcomes all of us. God is good.....really.....really.....good. I went back this morning to check up on the mom and baby. Both are doing well.

To God be the glory.
kevin.

Whoops....

2008-10-01T21:39:00.000-07:00

Sorry 'bout the multiple posts today, but I failed to mention another prayer request for I.V. fluids. Yep, we're out of isotonic fluids again and can't do any further major surgery cases until another stock of fluids come in.

Thanks again.

In HIM>
kevin.

Hypovolemia

2008-09-22T20:59:00.000-07:00

So we’re experiencing some severe hypovolemia here. We used our last two bags of isotonic fluid today while operating in the theatre. Our I.V. fluid supplies have been quite limited for the past few weeks, but every time we get down to two or so bags, the Lord provides, and we keep on keepin’ on. There is a huge supply (3 tons worth I believe) on the way, but it is stuck somewhere between customs and here. Prayerfully a temporary supply will arrive tomorrow. As one would imagine, the economic crisis here effects everyone…including the hospitals. We have also been out of insulin for quite some time, and I hear that there’s hardly any to speak of in the entire country! Food shortages in various parts of the country are beyond extreme as many have suffered into eternity via starvation. Please continue to pray for this situation and all that are affected.

On a lighter note, it's springtime here and the infamous Jacaranda trees are in all their glory. Their purple blossoms and sweet fragrance are quite a nice gift as I enter the hospital courtyard for rounds in the morning. I’m told that the Flamboyant trees will be next with their vivid red flowers. It’s kinda exciting to be here this time of year and watch as God displays His creativity through the trees, flowers, and other shrubbery. That’s right….shrubbery.

Things in the hospital have been going well. The national doc is now back and the American P.A. just arrived today. This will be quite helpful with morning rounds and the outpatient department (OPD). I’ve been trying to settle into a schedule, or some resemblance of one, for the past week or so. As of now, I’m rounding in the morning on 2-3 of the wards, and then tracking down Dr. Stephens to help with a few minor procedures. We then break for tea time. After tea, I head to the OPD for the morning. The OPD has given me an entirely new perspective on the HIV epidemic here. Nearly half of all the patients I see in OPD are HIV positive. Half! I guess I was somewhat familiar with the statistics, but seeing the destructiveness of this disease firsthand has given me an entirely new perspective. They look as if they are the walking dead as their bodies slowly surrender to every infectious disease imaginable. I have never seen such widespread destruction….it is far beyond what I ever pictured it to be. Please pray for them. So, after OPD I head home for lunch. From lunch I then go to the theatre for several “major” surgical cases. Once we’re done, we head home for supper and email.

Switching gears again…..we had quite an experience this past weekend. After rounds and a femur ORIF on Saturday, we packed up and headed to Pulpit Rock. I thought we would be climbing one of the local peaks to get a view of the land. Well, this was partially true. The only thing Dr. Stephens left out is that we would be scaling a vertical ascent above a 300 foot drop! So we get to the rock face and Dr. Stephens just goes about his business and makes the climb with ease. One of the nurses from the States then follows suit as well as the Pre-med student and a national nursing student. It was then my turn. Surely if all those ahead succeeded with ease, I would as well. Nope, couldn’t do it…came up short…chickened out…got shown up by a nurse…wait got shown up by TWO nurses. I’ve got nothin’ but respect for nurses, but come on! ....that’s a bit too much. So, I had to go up the “easy way.” But hey, at least I didn’t tumble to my demise. Anyways…enough ‘openness’ for one blog.

Let’s see, what else? Some of y’all might be interested in what types of surgeries I’m getting in on. Well, we’ve done a few cholodochojejunostomies, a couple bowel resections, several hernia repairs, all kinds of VP shunts, two femur ORIFs, a patella ORIF, a knee fusion, quite a few TAH/BSOs, many suprapubic prostatectomies, a handful of C-sections, eye enucleations, cataract removals, spinals, intubations, bore holes, eye blocks, orchiectomies, hyrocele repairs, cleft palate repair, myelomeningocele repairs, joint injections, OB sonos….well just about any kind of sono, patella tendon repair, removal of odd growths from the nose and gums, skin grafts to burns, and all kinds of other interesting cases. This is definitely a surgical hospital, and it has been an outstanding experience thus far. One can only guess what we’ll get to do next.

Well, I think that’s about it.

One last thought to chew on;

“And this is the testimony: God has given us eternal life, and this life is in his Son. He who has the Son has life; he who does not have the Son of God does not have life.” 1 John 5: 11-12

I hope you enjoy life today.

In HIM>
Kevin.

Finding the 'Zim' Within

2008-09-09T10:18:00.000-07:00

Salutations to all....

I hope this finds you all well and in strong faith with our Lord.

As many of you know, I have arrived in Zimbabwe safely as per the Lord's provision. Last evening I made the trip from Harare to Karanda Mission Hospital. Wow....this place is incredible.

I awoke this morning and went to the chapel for morning devotions. As I made my way to the chapel, I soon began to appreciate the incredible harmony of the Shona people singing. It was absolutely heavenly.

I then made my way to the operating theatre to find Dr. Stephens. He had six cataract removals with lense replacements lined up for the day. After getting through the cataracts and learning how to properly block the eye for such a procedure, we broke for tea. (Ya gotta love this part of working in the developing world.) We then made rounds on the female, male, maternity/neonatal, and peds wards. HIV, TB, femoral fractures, sigmoid volvulus, burns, sepsis, amputations, infected wounds, hydrocephalus, meningocele spina bifida, meningitis, septic abortion, and the like filled the wards. We then headed back to the theatre for an eye enucleation, several wound debridements, a fracture reduction, a tendon repair, a toe amputation, and several other "minor" procedures. It was quite a day, but tomorrow looks to be fun as well with multiple "major" surgeries on the schedule.

Although Zimbabwe has been out of the U.S. press ever since the political talks commenced, the country is still suffering a paralyzing economic crisis. I will spare you the details for now, but I will ask for your prayers for this country and it's leaders.

As always, the people have been incredible. I have been staying in Harare for the past few days, and had the pleasure of meeting several of the missionary couples here. They have all been a blessing and an encouragement. The Zimbabweans have been quite welcoming as well, and I'm looking forward to developing friendships with them.

In addition, I want to ask for your prayers for Katie and my parents as they prepare for their upcoming flight to Zimbabwe. The Lord has provided an unforgettable time for us to experience together her in Zimbabwe. I can't wait for them to get here!

I want to share with you a quote the Katie shared with me a couple days ago.

"I pray that you will understand the words of Jesus, “Love one another as I have loved you.” Ask yourself “How has he loved me? Do I really love others in the same way?” Unless this love is among us, we can kill ourselves with work and it will only be work, not love. Work without love is slavery." ~Mother Teresa

I hope you love what you are doing today.

In HIM>
kevin.

....and so the fellowship commences

2008-06-27T16:16:00.000-07:00

Greetings all!

Now that I'm getting settled here in Morgantown, I wanted re-enter the world of blog. Things are going well here. The material we a learning is incredibly interesting and seemingly endless. I must admit that I have long forgotten what it is like to sit in a classroom for 8 hours a day...tends to lead to a somewhat sore bum by day's end. As for those of you who are not familiar with the Via Christi International Family Medcine Fellowship (IFMF), the first 8 weeks of the year are devoted to the study of tropical medicine and parasitology here at West Virginia University (http://www.hsc.wvu.edu/som/tropmed/tropMedCourse.asp). As of now our brains have been flooded with copius amounts of information regarding schistosomiasis, paragoniomiasis, bilharziasis, and every other kind of "-iasis" you could dream up. Please pray that I am able to learn what I need to learn in order to properly tend to those who may have these dreaded diseases. On the order of prayer, please be praying for the situation in Zimbabwe. Please pray that the political climate continues to stabilize and that the leaders of Zimbabwe will do that which is in the best interest of the people.

Well, I believe that is it for now.....stay tuned.

In HIM>
Kevin Raymer.