The new operating theater building is connected to the old operating room building but they are separated by a brick and concrete wall (what was the outside wall of the old operating room building). The construction team has been trying to find a good time to take down that wall so that it opens up a hallway between the two buildings. The trick has been trying to do the demolition without disturbing surgeries going on in the old operating room or creating a dust cloud that would contaminate the surgical areas.
Today was the day we had picked for this job. Dr. Kari had multiple surgeries scheduled throughout each of the previous days so we didn’t want to do the job then. But, today she had four procedures schedule for the morning, hoping to be finished by 2 pm because today was the day the hospital had schedule their semi-annual meeting to discuss issues and plan for the future. That meeting was to begin at 2 pm and all of the hospital staff was supposed to attend. We expected that we would be able to start when the last surgery ended and work on into the evening until it was done so we wouldn’t have to continue working on it tomorrow and disrupt the tomorrow’s surgeries. That didn’t work out.
Anesthetist Barb encountered a couple more mechanical challenges with some of the anesthesia equipment which Bud was help to help work around – but lengthened one of the surgeries. Then one of the other surgeries started by the local staff ran into an unexpected problem which took a while to figure out. Since the patient was a male, Dr. Kari (an OB-Gyn) was challenged to figure out how best to solve the problem. (Last evening she was able to use SKYPE to call an urologist colleague in Battle Creek who assured her that she had done exactly the right thing – having colleagues willing to consult and the technology to reach them is a real blessing). Nevertheless, addressing these took extra time. The surgical team finished the planned surgeries by about 3:30. As we began preparations to start the demolition, Dr. Kari found out there were two more emergency surgeries to do.
The surgical team didn’t finish until about 6 or 6:30. By this time, the construction team had decided to wait and start the demolition first thing in the morning.
Nurse Ann had worked with local nurses again and had an opportunity, now that she had built rapport with several of the nurses, to ask questions about why they do things certain ways or don’t do other things. Both what she has been told and what she has observed have been very helpful in understanding the nursing staff better and appreciating the skill level and training. The cultural differences are considerable.
Diane also continued to help around the hospital during the morning. In the afternoon, she accompanied Missionary Joan to Kaloma, a bigger town about 30 miles north of Zimba. They had errands to run. Since Zimba is very small, rural and remote, almost every need generates the a road trip somewhere. It takes considerable effort, time, and resources to sustain normal life let alone the special needs of breakdowns or construction.
Our days have a certain rhythm to them. Most of us begin rising around 6 or 6:30, brace ourselves with coffee and personal Bible study, then gather for breakfast at 7 or 7:10. We leave for the hospital by about 7:50 to attend the morning chapel services at 8 am which attended by perhaps half the hospital staff who will be working that day. The morning service starts with one or two songs familiar to us but in the Tonga language. When a hymnal is available, we can sing along, otherwise we can hum. One of the hospital staff has been asked to prepare the morning’s message and they have almost always been quite good. After the message, the head nurse reports on the census of patients in the hospital for the day. Following this, the hospital administrator makes comments or announcements. Then everyone is dismissed to do their work. We make our way to the construction projects or the patients to be seen.
We try to break for lunch at noon, although the medical team rarely gets back to the mission house for lunch until later, and then return to projects around 1. The mid-day break for locals typically lasts until at least 2 so we sometimes have difficulty getting things going after lunch because the person we need to get assistance from isn’t yet available. We usually wrap up work by 5, although the medical team may keep seeing patients or wrapping up surgeries later than that (occasionally 6 or 7).
We nearly always eat dinner together as a team. Our meals are prepared for us by Missionary Joan and Edy, the Zambian woman who works at the mission as the cook and housekeeper. The menu is filled with common American dishes, albeit with a North Carolina twist, reflecting Joan’s background. Typically, one dinner meal during our visits is a Zambian meal, a pasty grits-like dumpling (Ensema), cooked cabagge, and a stewed chicken eaten together with your right hand. That was our meal this evening. When the Drs. Jones are here, they usually eat with us along with Joan.
After cleaning up after the meal and doing the dishes (we take turns), we gather for an evening devotional. We take turns being responsible for the evening’s devotional. Ann led the devotional Monday, Barb on Tuesday, Larry on Wednesday, Mark today. It’s a minor miracle negotiating shower time among the eight of us in the one shower, but we’re a pretty agreeable, accommodating group of people. Some of us didn’t know each other very well before we came. Getting to know each other better is one of the fruits of the mission trip.
Friday, June 27, 2008
Thursday, June 26, 2008
Day 3
Today went better for the construction team. Mark and Larry repaired a broken water pipe and spigot. Glen and Bud finished some rewiring in the new operating room including connecting the outlets for 110 current from the backup generator. Mark and Larry spent much of the day trying to install lockers in what will be the medical team changing/locker room of the new operating theater.
Toward the end of the day, Bud figured out that one of the electrical transformers we brought to finish powering the new surgical lights was the wrong model. He was pretty down and frustrated. He was anxious that it might be months before the correct model could be sent and arrive and then be installed to make the new O.R. useable. When we got back to the mission house in the evening, Missionary Joan helped Bud use SKYPE (the internet phone system) to call the electrical supply house in Michigan where he had purchased the transformer. Bud was able to speak with the owner with whom he has worked for about 20 years. They talked through the problems, the owner said he needed to check on some of the transformer’s specs and that Bud should call back in half an hour. Bud did and the owner of the electrical supply house said he would try to get the right transformer shipped out by DHL (like FedEx, but operates in Africa, too) the next morning. Bud was almost relieved and optimistic about being able to finish the job. We hope the new, correct transformer will get here by next Thursday so it can be installed before we leave. The technology is incredibly helpful, but the incongruity is mind-boggling: we can carry on a conversation we people on the other side of the planet (literally) and download instruction manuals for equipment, but are struggling to meet the basic needs for water, sanitation, food, education and health care.
Dr. Kari and anesthetist Barb performed two big surgeries. The afternoon surgery lasted more than 3 hours. It was expected to be a difficult surgery beforehand. It got more difficult once surgery started because the equipment for the preferred anesthesia wasn’t working, the internal health issues were greater than could be determined from the outside examination and, as a result the prognosis less good. You could see the stress on the faces of the doctor and the rest of the team. It’s difficult encountering the limits of your ability to help, perhaps especially here when you know that the technology available at home would make helping easier and more probable.
Nurse Ann continued working with the local nurses and got a chance to help care for the very tiny premature baby (roughly 2 pounds) that is being kept in the incubator. The incubator that is keeping the baby alive is the same one Ray fixed last October when we were here. Ray was the other electrician on that trip accompanying Bud. Dr. Kari told him at the time that infants can die from cold when they can’t sustain their body temperature and that in fixing the warmer of the incubator he had probably saved more lives than the rest of the medical team. We’ve taken a picture of at least this one his repair job helped to save.
Toward the end of the day, Bud figured out that one of the electrical transformers we brought to finish powering the new surgical lights was the wrong model. He was pretty down and frustrated. He was anxious that it might be months before the correct model could be sent and arrive and then be installed to make the new O.R. useable. When we got back to the mission house in the evening, Missionary Joan helped Bud use SKYPE (the internet phone system) to call the electrical supply house in Michigan where he had purchased the transformer. Bud was able to speak with the owner with whom he has worked for about 20 years. They talked through the problems, the owner said he needed to check on some of the transformer’s specs and that Bud should call back in half an hour. Bud did and the owner of the electrical supply house said he would try to get the right transformer shipped out by DHL (like FedEx, but operates in Africa, too) the next morning. Bud was almost relieved and optimistic about being able to finish the job. We hope the new, correct transformer will get here by next Thursday so it can be installed before we leave. The technology is incredibly helpful, but the incongruity is mind-boggling: we can carry on a conversation we people on the other side of the planet (literally) and download instruction manuals for equipment, but are struggling to meet the basic needs for water, sanitation, food, education and health care.
Dr. Kari and anesthetist Barb performed two big surgeries. The afternoon surgery lasted more than 3 hours. It was expected to be a difficult surgery beforehand. It got more difficult once surgery started because the equipment for the preferred anesthesia wasn’t working, the internal health issues were greater than could be determined from the outside examination and, as a result the prognosis less good. You could see the stress on the faces of the doctor and the rest of the team. It’s difficult encountering the limits of your ability to help, perhaps especially here when you know that the technology available at home would make helping easier and more probable.
Nurse Ann continued working with the local nurses and got a chance to help care for the very tiny premature baby (roughly 2 pounds) that is being kept in the incubator. The incubator that is keeping the baby alive is the same one Ray fixed last October when we were here. Ray was the other electrician on that trip accompanying Bud. Dr. Kari told him at the time that infants can die from cold when they can’t sustain their body temperature and that in fixing the warmer of the incubator he had probably saved more lives than the rest of the medical team. We’ve taken a picture of at least this one his repair job helped to save.
Day 2
The day began at 1 am with a knock on the mission house bedroom window with an urgent call for Dr. Kari. The six month old son of Edy the woman who cooks for the mission house had collapsed and his body had gone completely limp. Edy thought her son had just died or was about to. She called Missionary Joan who rushed to help while Nurse Ann knocked on Dr. Kari’s window. Edy cried aloud, praying for and thanking God for her son. But almost as quickly as baby Jeremiah had collapsed, he revived. Edy’s anguish turned to relief and thanksgiving as the baby began looking about and jabbering.
After a couple more hours of sleep, the team awoke to the second day’s challenges. Dr. Kari and Anesthetist Barb joined two of the Zambian operating room team to complete successfully two surgeries. They tended to other patients the rest of the day, scheduling additional surgeries and preparing for those scheduled for tomorrow. Ann continued to work with other local nurses, getting to know their routines, but also providing key pre-op information and a good role model for other nurses.
Diane spent much of the day helping two of the office staff learn more about Excel spreadsheets to help with their accounting workload. Glen made the bone-jarring, dust eating trip back to Livingstone again, this time to meet with prospective suppliers and contractors for the planned water and sewer renovation project. His meeting yesterday with Mr. Khondowe in which he reviewed the ‘final’ plans for the new water and sewer distribution system and new water treatment plant had gone well and he was eager to find supply sources – preferably in Zambia if possible – and a contractor who could assemble and manage local labor for the project. Glen was pleased to find a supplier in Livingstone who is also an engineer who will double check his plans and who assured him we can get all the materials necessary locally, except for the water treatment plant we knew would have to be shipped. He also met with a contractor with an excellent reputation for getting work done on schedule who seems like a good candidate to manage the project, although Glen still thinks it will be prudent to have one of our own people on site for the duration of the project. While in Livingstone, he picked up a few other supplies we need for the work ahead. He had a good day.
Bud, Mark and Larry worked primarily on trying to finish the wiring in the new operating theater. They had some successes and a few set backs. Bud and Larry had both brought walkee-talkees to facilitate communication when people are scattered about the hospital site and these worked very well. But the electrical work was of the ‘two steps forward, one step back’ variety. But they got somethings accomplished while also developing plans to wire and install a float based auto start/shutoff for the pump that fills the water storage tanks and to remove the brick wall separating the old and new operating rooms.
Early this evening, Pastor Chikobela stopped by to greet us and visit. While introducing newer members of the team, Larry chatted with Pastor Chikobela for quite awhile, particularly about the plight of AIDS related orphans in the Zimba area and approaches being tried or that might be tried to help them. Mark wisely asked Mr. Chikobela if he might videotape the conversation and Mr. Chikobela agree. The discussion was very fruitful. Mr. Chikobela is directly involved in several activities to not only reach these youth for Christ, but also to provide them with healthy opportunities to earn food, resources needed to continue their education, and to main their self-respect. It was a very promising meeting.
After a couple more hours of sleep, the team awoke to the second day’s challenges. Dr. Kari and Anesthetist Barb joined two of the Zambian operating room team to complete successfully two surgeries. They tended to other patients the rest of the day, scheduling additional surgeries and preparing for those scheduled for tomorrow. Ann continued to work with other local nurses, getting to know their routines, but also providing key pre-op information and a good role model for other nurses.
Diane spent much of the day helping two of the office staff learn more about Excel spreadsheets to help with their accounting workload. Glen made the bone-jarring, dust eating trip back to Livingstone again, this time to meet with prospective suppliers and contractors for the planned water and sewer renovation project. His meeting yesterday with Mr. Khondowe in which he reviewed the ‘final’ plans for the new water and sewer distribution system and new water treatment plant had gone well and he was eager to find supply sources – preferably in Zambia if possible – and a contractor who could assemble and manage local labor for the project. Glen was pleased to find a supplier in Livingstone who is also an engineer who will double check his plans and who assured him we can get all the materials necessary locally, except for the water treatment plant we knew would have to be shipped. He also met with a contractor with an excellent reputation for getting work done on schedule who seems like a good candidate to manage the project, although Glen still thinks it will be prudent to have one of our own people on site for the duration of the project. While in Livingstone, he picked up a few other supplies we need for the work ahead. He had a good day.
Bud, Mark and Larry worked primarily on trying to finish the wiring in the new operating theater. They had some successes and a few set backs. Bud and Larry had both brought walkee-talkees to facilitate communication when people are scattered about the hospital site and these worked very well. But the electrical work was of the ‘two steps forward, one step back’ variety. But they got somethings accomplished while also developing plans to wire and install a float based auto start/shutoff for the pump that fills the water storage tanks and to remove the brick wall separating the old and new operating rooms.
Early this evening, Pastor Chikobela stopped by to greet us and visit. While introducing newer members of the team, Larry chatted with Pastor Chikobela for quite awhile, particularly about the plight of AIDS related orphans in the Zimba area and approaches being tried or that might be tried to help them. Mark wisely asked Mr. Chikobela if he might videotape the conversation and Mr. Chikobela agree. The discussion was very fruitful. Mr. Chikobela is directly involved in several activities to not only reach these youth for Christ, but also to provide them with healthy opportunities to earn food, resources needed to continue their education, and to main their self-respect. It was a very promising meeting.
Tuesday, June 24, 2008
First Day
We were greeted this morning by the cool, crisp air of the Zambian winter morning. “Cool” was the low 50’s. It warmed to the low 80’s, but the sky was cloudless and bright all day with a light breeze that refreshed. We thought it to be nearly ideal weather. The locals thought it was too cold.
Nearly everyone slept well and certainly looked better today after showering and resting than we did when we arrived after the long flights.
As always, the day started with a chapel service at the hospital. Wedon, the Zimba anesthetist spoke on fellowship and relationships. The message was foundational and articulate. We’re almost always impressed with the depth of Biblical understanding and insightfulness of the Zambian hospital staff asked to present at morning chapel. The administrator, Mr. Khondowe, welcomed us warmly as did the other staff, many of whom recognized most of us from earlier trips.
Nurse Ann went off to shadow one of the local nurses for the day. Anesthetist Barb assisted another nurse part of the day and then assess things in the operating room to prepare for surgeries that will begin tomorrow. Dr. Kari met up with Anna, a now retired local nurse who has translated for Dr. Kari each of the past two trips. Together they settled in to see the dozens of patients that showed up for care, several of which had been told a week or two ago to come back today when Dr. Kari would be available for a possible surgery. By noon, they had scheduled at least three surgeries – possibly four -- for the next three days. By 7 this evening when Dr. Kari and Nurse Ann finally called it a day, several more surgeries had been scheduled.
The construction team had a mixed day. Early in the day, we toured the hospital grounds to orient Diane and Mark as well as to assess progress on the new operating theater and the new nurses’ quarters. The walls of the new operating theater have been painted and, somewhat to our surprise, the window panes have been installed in the window frames. The new nurses’ quarters are getting close to being ready for people to move in. Janet will be going home for a short visit at the end of July and really wants people to be living in the apartments by the time she has to leave. There has been a lot of progress since October but not quite as much as she’d hoped.
Bud and Mark put some finishing touches on the wiring and adjustments to the overhead lights in the new operating room. Diane worked with one of the nurses for awhile and then worked with one of the guys in pharmacy to refine a couple of excel spreadsheets they use to keep track of inventory that Andy had helped them build last October. In the afternoon, Bud, Mark and Larry continued work on some of the electrical in the new operating room and began preparing to knock out a brick wall separating the old and new O.R.s that will be a hallway between the two.
The big news of the day was that the airline located our missing luggage and had it for us in Livingstone. Missionary Joan, Diane and Glen braved the pothole and crater filled road back to Livingstone to retrieve all ten bags. They arrived about 7:30 this evening with a car full of luggage and it was like arriving anew for the second night in a row.
Ann led the devotional this evening. Today was her son’s 18th birthday. She led us through scripture and prayer about sons. We could all relate.
Nearly everyone slept well and certainly looked better today after showering and resting than we did when we arrived after the long flights.
As always, the day started with a chapel service at the hospital. Wedon, the Zimba anesthetist spoke on fellowship and relationships. The message was foundational and articulate. We’re almost always impressed with the depth of Biblical understanding and insightfulness of the Zambian hospital staff asked to present at morning chapel. The administrator, Mr. Khondowe, welcomed us warmly as did the other staff, many of whom recognized most of us from earlier trips.
Nurse Ann went off to shadow one of the local nurses for the day. Anesthetist Barb assisted another nurse part of the day and then assess things in the operating room to prepare for surgeries that will begin tomorrow. Dr. Kari met up with Anna, a now retired local nurse who has translated for Dr. Kari each of the past two trips. Together they settled in to see the dozens of patients that showed up for care, several of which had been told a week or two ago to come back today when Dr. Kari would be available for a possible surgery. By noon, they had scheduled at least three surgeries – possibly four -- for the next three days. By 7 this evening when Dr. Kari and Nurse Ann finally called it a day, several more surgeries had been scheduled.
The construction team had a mixed day. Early in the day, we toured the hospital grounds to orient Diane and Mark as well as to assess progress on the new operating theater and the new nurses’ quarters. The walls of the new operating theater have been painted and, somewhat to our surprise, the window panes have been installed in the window frames. The new nurses’ quarters are getting close to being ready for people to move in. Janet will be going home for a short visit at the end of July and really wants people to be living in the apartments by the time she has to leave. There has been a lot of progress since October but not quite as much as she’d hoped.
Bud and Mark put some finishing touches on the wiring and adjustments to the overhead lights in the new operating room. Diane worked with one of the nurses for awhile and then worked with one of the guys in pharmacy to refine a couple of excel spreadsheets they use to keep track of inventory that Andy had helped them build last October. In the afternoon, Bud, Mark and Larry continued work on some of the electrical in the new operating room and began preparing to knock out a brick wall separating the old and new O.R.s that will be a hallway between the two.
The big news of the day was that the airline located our missing luggage and had it for us in Livingstone. Missionary Joan, Diane and Glen braved the pothole and crater filled road back to Livingstone to retrieve all ten bags. They arrived about 7:30 this evening with a car full of luggage and it was like arriving anew for the second night in a row.
Ann led the devotional this evening. Today was her son’s 18th birthday. She led us through scripture and prayer about sons. We could all relate.
Sunday, June 22, 2008
Arrival in Zambia
Friday, the First Wes Team gathered at the church at 4:30 pm to begin the trip to Zimba, Zambia. We shuffled materials around among the 16 suitcases and 8-9 carry-on items trying to keep all the bags under the 50 pound limit while still taking as many medications, and medical and construction supplies as possible. Getting checked-in at Detroit Metro wasn’t completely uneventful. We were spread across several different check-in stations and some tried to check our luggage through to Livingstone, Zambia (correct) and some tried to check our luggage only as far as Johannesburg, South Africa. Although we managed to get everyone on the same final destination page, it did mean the Lufthansa check-in staff did have to track down three bags they had already put on the conveyer belt to load on the plane and change their destination tags. This wasn’t a particularly good omen.
The flight to Frankfurt was uneventful, but no one slept that well (the usual). With a ten hour lay-over in Frankfurt, we took a brief subway ride into the city to walk through a couple of street festivals in the downtown area. We returned to the airport, went through security, and boarded our plane for departure to Johannesburg – another 8.5 hours on the plane. That was also an uneventful flight although a couple, Dr. Kari, Barb and Bud slept less than on the previous night’s flight. The lay-over in Jo’burg was only about 3 hours and, with changes in the airport as they expand to host the World Cup, more complicated than on past trips. We had to go through passport control/immigration, customs, check-in for our flights and go through security again. We had about a half hour to spare but re-newed concerns about our luggage.
We arrived in Livingstone, Zambia shortly after noon local time. The lines were long and slow going through immigration/passport control. We could see Missionary Joan ahead through the double doors. We waved and she, recognizing us half a football field away, waved back. We then spent the next hour trying to gather up our luggage. It turned out that a
little less than half our bags made the full trip with us. Only Glen got all his bags. His wife Diane was missing both of hers. Missing one bag each were Dr. Kari, Larry, Ann, and Mark. Missing all four of their bags were Bud and Barb. We’re hoping the bags catch up with us in the next couple of days.
We finally loaded the cars to begin the 48 mile drive to Zimba. This has usually been an hour drive. There has been an interesting convergence of circumstances that turned this into a two hour drive today. This year, the rainy season was much rainier than usual. The paving of the highway from Livingstone to Zimba seemed to use a sub-optimal strategy of a thin (2-3”) veneer of blacktop over top of sand and gravel – the sort of road surface that wouldn’t hold up very well with lots of rain and lots of heavy truck traffic. And then there has been lots of heavy truck traffic hauling copper and cobalt from the mining area of Zambia in the north to South Africa. The convergence has resulted in a highway full of pot holes and badly worn shoulders. The cars and trucks crisscross the roadway, swerving and braking to avoid each other and the pot holes. It added an extra hour to the trip.
BUT, we arrived safely, minus a few clothes, meds, and supplies, but we expected them to catch up. We unloaded, and spent time eating and renewing our friendships with Missionary Joan, Drs. Dan and Joan, with Janet and Zimba generally. We were all worn out, but dinner was great and the showers beckon. Its good to be in place. Now we get to see what God has planned for us – it's always a bit different from what we thought. We already know it will be. We’re happy to do what we can. – Larry
The flight to Frankfurt was uneventful, but no one slept that well (the usual). With a ten hour lay-over in Frankfurt, we took a brief subway ride into the city to walk through a couple of street festivals in the downtown area. We returned to the airport, went through security, and boarded our plane for departure to Johannesburg – another 8.5 hours on the plane. That was also an uneventful flight although a couple, Dr. Kari, Barb and Bud slept less than on the previous night’s flight. The lay-over in Jo’burg was only about 3 hours and, with changes in the airport as they expand to host the World Cup, more complicated than on past trips. We had to go through passport control/immigration, customs, check-in for our flights and go through security again. We had about a half hour to spare but re-newed concerns about our luggage.
We arrived in Livingstone, Zambia shortly after noon local time. The lines were long and slow going through immigration/passport control. We could see Missionary Joan ahead through the double doors. We waved and she, recognizing us half a football field away, waved back. We then spent the next hour trying to gather up our luggage. It turned out that a
little less than half our bags made the full trip with us. Only Glen got all his bags. His wife Diane was missing both of hers. Missing one bag each were Dr. Kari, Larry, Ann, and Mark. Missing all four of their bags were Bud and Barb. We’re hoping the bags catch up with us in the next couple of days.We finally loaded the cars to begin the 48 mile drive to Zimba. This has usually been an hour drive. There has been an interesting convergence of circumstances that turned this into a two hour drive today. This year, the rainy season was much rainier than usual. The paving of the highway from Livingstone to Zimba seemed to use a sub-optimal strategy of a thin (2-3”) veneer of blacktop over top of sand and gravel – the sort of road surface that wouldn’t hold up very well with lots of rain and lots of heavy truck traffic. And then there has been lots of heavy truck traffic hauling copper and cobalt from the mining area of Zambia in the north to South Africa. The convergence has resulted in a highway full of pot holes and badly worn shoulders. The cars and trucks crisscross the roadway, swerving and braking to avoid each other and the pot holes. It added an extra hour to the trip.
BUT, we arrived safely, minus a few clothes, meds, and supplies, but we expected them to catch up. We unloaded, and spent time eating and renewing our friendships with Missionary Joan, Drs. Dan and Joan, with Janet and Zimba generally. We were all worn out, but dinner was great and the showers beckon. Its good to be in place. Now we get to see what God has planned for us – it's always a bit different from what we thought. We already know it will be. We’re happy to do what we can. – Larry
Sunday, June 15, 2008
First Wes Team Prepares for 4th Trip to Zambia
For months now, we've been preparing for the next trip to Zimba, Zambia. There will be eight of us going this time. As in the three previous trips, the group is a combination of medical and const
ruction personnel. Six of the people going this time have been to Zimba on at least one of the previous trips. This will be the fourth trip for Dr. Kari and Larry, the third trip for Barb (nurse anesthetist) and Ann (nurse), the second trip for Bud and Glen, and the first trip for Mark and Diane. The group includes three married couples, one of which will celebrate a wedding anniversary in the middle of the trip.
We try to make plans as to what we'll work on or accomplish while we're there and we gather supplies accordingly, but in the end, what we really do is what God is ready to have us do -- sometimes its quite different from what we planned. But we make plans nonetheless. Tonight we met to divide up the medical supplies among the eight of us so we each can carry a share of all we're taking. Now we just have to get it all packed in the suitcases -- we hope it all fits.
This time, the medical team plans to do patient care much as it has previously, although nurse Ann will likely spend more time shadowing some of the other nurses to get a better feel for what and how they manage patients. We hope she is able through this to get a better sense of their needs, protocols, training and challenges.
The construction team plans to install glass panes in the window frames of the new operating theater, finish installation of some of the electrical fixtures, install a float-based auto start/shutoff for the water pump in the storage tanks, complete a number of other repairs, and continue work on the larger water project. The water project involves building a new water and sewer distribution system for the hospital and installation of a new water treatment plant. Glen has been working with information Larry sent/brought back from previous trips to design the new systems and has been working with an engineer on the water treatment facility. We'll be bringing 'final' blue prints and plans to get approval from the hospital administration. Then we can proceed with finding sources of the materials, a contractor, labor and equipment and coordination of schedules to get this done. We think it could be completed in a year.
We also hope to make progress on planning for adding toileting and wash facilities in each of the patient wards.
During the last trip, several people we talked to indicated that one of the most serious problems facing the community was the numbers of AIDS orphans. A number of people have spoken to us about the magnitude and severity of the problem. Some of us have visited Sons of Thunder which is a mission orphanage near Livingstone, but we still lack information and a good idea as to how we might help. That's another issue we intend to explore.
The team is getting excited about going. We leave Friday evening. This trip, we'll fly through Frankfurt, Germany, to Johannesburg, South Africa, and then on to Livingstone, Zambia -- half a planet away, the other side of the globe, the other hemisphere, a whole different night sky, about as far away from life in the U.S. as you can imagine in many ways. And at the same time, the locals we work with believe in the same Bible, the same God, Son and Holy Ghost, the same salvation, they sing some of the same songs (different language), and they too are trying to reach out to the lost and broken.
We're trying to help brothers and sisters, trying share some of the many blessing we've been given with some of those in need. Its what Jesus said we were to do. Its the same as doing it for Christ (Matthew 25:31-46).
The team would great appreciate your prayers that
ruction personnel. Six of the people going this time have been to Zimba on at least one of the previous trips. This will be the fourth trip for Dr. Kari and Larry, the third trip for Barb (nurse anesthetist) and Ann (nurse), the second trip for Bud and Glen, and the first trip for Mark and Diane. The group includes three married couples, one of which will celebrate a wedding anniversary in the middle of the trip.We try to make plans as to what we'll work on or accomplish while we're there and we gather supplies accordingly, but in the end, what we really do is what God is ready to have us do -- sometimes its quite different from what we planned. But we make plans nonetheless. Tonight we met to divide up the medical supplies among the eight of us so we each can carry a share of all we're taking. Now we just have to get it all packed in the suitcases -- we hope it all fits.
This time, the medical team plans to do patient care much as it has previously, although nurse Ann will likely spend more time shadowing some of the other nurses to get a better feel for what and how they manage patients. We hope she is able through this to get a better sense of their needs, protocols, training and challenges.
The construction team plans to install glass panes in the window frames of the new operating theater, finish installation of some of the electrical fixtures, install a float-based auto start/shutoff for the water pump in the storage tanks, complete a number of other repairs, and continue work on the larger water project. The water project involves building a new water and sewer distribution system for the hospital and installation of a new water treatment plant. Glen has been working with information Larry sent/brought back from previous trips to design the new systems and has been working with an engineer on the water treatment facility. We'll be bringing 'final' blue prints and plans to get approval from the hospital administration. Then we can proceed with finding sources of the materials, a contractor, labor and equipment and coordination of schedules to get this done. We think it could be completed in a year.
We also hope to make progress on planning for adding toileting and wash facilities in each of the patient wards.
During the last trip, several people we talked to indicated that one of the most serious problems facing the community was the numbers of AIDS orphans. A number of people have spoken to us about the magnitude and severity of the problem. Some of us have visited Sons of Thunder which is a mission orphanage near Livingstone, but we still lack information and a good idea as to how we might help. That's another issue we intend to explore.
The team is getting excited about going. We leave Friday evening. This trip, we'll fly through Frankfurt, Germany, to Johannesburg, South Africa, and then on to Livingstone, Zambia -- half a planet away, the other side of the globe, the other hemisphere, a whole different night sky, about as far away from life in the U.S. as you can imagine in many ways. And at the same time, the locals we work with believe in the same Bible, the same God, Son and Holy Ghost, the same salvation, they sing some of the same songs (different language), and they too are trying to reach out to the lost and broken.
We're trying to help brothers and sisters, trying share some of the many blessing we've been given with some of those in need. Its what Jesus said we were to do. Its the same as doing it for Christ (Matthew 25:31-46).
The team would great appreciate your prayers that
- We have safe travel to and from Zambia
- Each of the team members is protected from illness, disease and injury on the trip
- All the supplies get to Zimba with us, that they are things that are needed to be most helpful
- The team functions well together and gets along under close and challenging circumstances
- We each grow in our personal walk with Christ and represent him in a way that honors and glorifies Him
- The people of Zambia we go to serve are open to our assistance
- We communicate in ways that are not offensive or overbearing, but rather demonstrate our intent to come alongside the Zambians to reduce their struggle and help them move forward
- The families and businesses we leave behind at home thrive even in our absences
- Our sons leaving or possibly leaving for military service are kept safe and healthy
There are lots of other things to pray for, but this would be a good start for this trip.
Sunday, December 9, 2007
OUR TRIP TO ZAMBIA – OCTOBER 2007 (SUMMARY)
Dr. Kari
INTRODUCTION
Several people have asked us “How did your trip go?” in reference to our most recent trip to Zimba, Zambia. I find myself unable to say much of anything -- there is so much to say. While I cannot possibly tell you everything, this is an effort to begin to answer the question, tell you what we did, how we were impacted, how we impacted the people there, the things we learned and perhaps how you might pray for the people there and explore how God might be leading you to partner with Him in His work there.
REGIONAL BACKGROUND
Zimba is a community of CisTonga speaking people (although most also speak varying degrees of English) in southern Zambia (formerly Southern Rhodesia), about 1 hr. drive from Livingstone, the location of Victoria Falls (one of the 7 wonders of the world). About 50 years ago a local chief visited a Livingstone missionary stating his people’s need for 3 things: a church, a school and a hospital. When the missionary told a Wesleyan church in the U. S. of the need, a parishioner stepped forward and funded all three projects. Nakowa primary school, Nakowa Pilgrim Wesleyan church and the Zimba Missionary Hospital were built soon after. The school and hospital were nationalized after Zambian independence from the British; however, the hospital in particular, remains dependent on the Wesleyans and other churches for many critical supplies, medications and support. Many of the staff members’ educations were supported by the Wesleyan Medical Fellowship. Wesleyan missionaries (currently a nurse and, as of a few months ago, 2 doctors) are stationed there.
Zambia is a poor country but politically stable with some natural resources. The Tonga people were displaced into poor, arid areas like Zimba by the building of a power dam several decades ago. Like so many places in Africa, AIDS, malaria, malnutrition, schistosomiasis, TB and other diseases are common. The government bureaucracy, poor roads, lack of supplies, unemployment, unclean water, and corruption are realities in the everyday life of the people. However, most are Christians, at least in name, thanks to the work of decades of missionaries (starting with Dr. David Livingstone). Traditional beliefs about healing and potions are used by the people. Polygamy is common. Children orphaned by AIDS are a major tragedy with many already poverty stricken families trying to support these children. 25% of children cannot afford to go to school. Many (even near the mission house) are forced into prostitution in order to eat.
FIRST WESLEYAN CHURCH (of Battle Creek) INVOLVEMENT
This was our church’s 3rd team to be sent to Zimba. The first, in July, 2006, was composed of both medical and construction personnel. A new operating room (“theatre”) was started by a team from another American church and our group worked with a Zambian team to further the work. At that time there had been no long-term physician at the hospital for a few years. While we were there, emergency surgeries were performed (instead of being sent another hour away to Livingstone), medications were made available, and care was provided that exceeded what could have been done had we not gone. We learned about the people, got to know some of our partners (nationals and missionaries), began to learn about the needs and establish relationships. We were deeply moved by the overwhelming medical and material need and the kindness and joy of the people (despite their poverty). Many of us fell in love with the people there. We were told the hospital water system itself was contaminated and there was a suspicion some children, in particular, may become even sicker due to the water while at the hospital. Also we learned that the critical lack of nursing staff was largely due to the lack of housing for them.
The next First Wes trip was in Feb, 2007, with mostly a medical team. This time we performed many lifesaving surgeries, thanks to a short term missionary doctor there in December who directed appropriate patients to come at the time we were going to be there. Also, now that we were starting to understand the needs, research was conducted that confirmed the contamination of the water system, explored sources of contamination and began to figure out ways to solve the problem. Discussions were held with the administrative staff as to their priorities and needs. “Reconnaissance” was conducted on the electrical problems and other physical plant needs to plan for the next steps. We continued to develop relationships with the local people.
OCTOBER 2007 TRIP
On this trip, we took 2 electricians, a construction worker, a “computer guy”, 2 nurses, a nurse anesthetist and myself, a gynecologist as well as my husband, Larry, who by this time was becoming an “expert” on the hospital water problems.
Once again we were profoundly impacted by the material needs of the people and hospital. For the first surgery (before we had unpacked the supplies we had brought), I was handed a used suction tube that had been soaked in a disinfectant and still had old blood in it from a prior surgery and gray surgical sponges that were being reused because no others were available. In an area with 17 % HIV positive patients, this was horrifying, but they are doing with what they have. The Zambian nursing staff was constantly turning down I.V. fluids (in very dehydrated patients) in order to conserve the fluids. They knew that after the I.V. fluids we had brought were gone, there would be no more for who knows how long (months, most likely). Children die there regularly from dehydration. A 2 yr old died our first day there due to gastroenteritis (stomach flu) when we could not get an I.V. started. Often we have seen the staff decline to start I.V.’s until the child is so dehydrated it cannot be inserted, so then the child dies. We have never been to Zimba when we have not seen the death of at least one child. (The usual pediatric census is 13-16.) People dying for lack of adequate supplies of I.V. fluids – in the US, we never even consider this could happen.
We were silent at the amazing endurance of the people when faced with what must be unbelievable pain. 2 of the women on whom we did surgery had extensive pelvic abscesses. They only had reported, what seemed to be, minimal complaints of pain. One of these abscesses was the size of a small soccer ball and must have been painful for quite some time. Then after surgery, we gave the patients a few doses of a morphine- like drug, then they had to handle the rest of their pain with ibuprofen (Motrin) and acetaminophen (Tylenol). Like-wise for the burned children and woman after a home fire – very little to provide pain relief. We compare this to all the complaints we American’s have about our aches and pains of everyday life.
The profound lack of resources includes the lack of nursing staff. The whole hospital is staffed by 2 nurses a shift. They pass medications, arrange for labs to be drawn, monitor I.V.’s, and are responsible for all nursing care. They have time to take a temperature once a day on each patient – that’s all. No blood pressures, pulse or respiration are evaluated. The lack of staff (especially well-trained nurses) is directly responsible for the inability to adequately care for patients. For instance, while we were there a patient with a breast abscess developed sepsis and died without a single pulse or blood pressure taken in the 24 hours prior or notification of the doctors about her condition. (She was a young wife and a mother of 2 little girls.) A couple of times we have been told newborn infants “just died” in the night without anyone being aware they were sick. Until adequate staff comes on board, this “place of last hope” for many ill people, will be the place they come to die. This is horrifying for the medical staff on the team, knowing so many of those we see die there would never die like this in the US.
The main reason for the severity of the nursing shortage is the lack of adequate housing for nurses. It is the hospital’s obligation to provide housing in Zambia. What they have now is tiny buildings, even by Zambian standards, with 2 room houses for up to 9 extended family members (remember most families care for orphans) often without regular running water. Many nurses won’t come to work in Zimba under these conditions. A church in Memphis is funding/supervising construction of 5 more houses but this still will not be enough. Also, until the new water/sewer system is complete, they will not have water. While it may seem a little dramatic to say it, it is true that building nursing housing will definitely save lives by attracting staff. Currently over 60% of the hospital budget is used to pay rent for the staff – money that is badly needed for medication and supplies. New housing will not only bring more staff, it will free up money for other much needed items.
As I said, on the first trip we were told the hospital had been cited by the inspectors in the past for having contaminated water. You see, people come and essentially camp out on the hospital grounds waiting for care or staying to be with family members who are in the hospital. There is also a “Woman’s Temporary Shelter” where women await labor. The toilet facilities for these people (and all the patients) are at the back of the hospital and are filthy and decrepit. We think there is direct contamination into the water system. Furthermore, hospitalized patients must walk 50-100 yds. to the facility, no matter how ill. There is nowhere for patients to bathe so we take dirty patients to surgery. During the 2nd trip, Larry was able to verify the contaminated system and investigate the problem and hospital needs. In discussing this with appropriate people on return to the US, it was decided that the only way to solve the problem was to replace the entire system. Glen Harris has spearheaded the effort to design a new system. Larry, with help from Larry E., did some additional on-site research this trip including the arduous task of doing a “percolation” test to plan for the new water and sewer system. This involved spending hours in the 100 degree heat digging a hole, hauling water and making measurements. We now are praying for a solution to the next step: a detailed survey and then a contractor who can stay on site to supervise construction of the system. Until then, people who are already weakened by disease will continue to be exposed to the unclean water.
PRACTICAL HELP and HOPE
The electricians and construction team did an awesome job this trip, accomplishing many large and small tasks. Before they could get too far they had to investigate the needs and find materials. A day trip to Livingstone only turned up a few of the needed items despite much looking. After a team meeting, we decided to authorize a trip to Lusaka, the capital city 5 hours away to the north. Our dilemma, based on the Livingstone expedition, was that they did not know where to start to find the items in a strange country. Fortunately, God foresaw the need. Janet, the missionary supervisor from the Tennessee church building the nursing housing, had met a contractor supplier at the US embassy. He is a Moslem man born in Sudan but who had escaped to the US and was educated here – the perfect match: understands what our electricians were talking about but knew the Zambian sources. A call from Janet and it was arranged. They met in Lusaka, acquired most of what they needed and established a friendly contact with a “pre-Christian” (well, maybe). He was a generous man with a good heart and willing to help.
The electricians installed a backup generator for the operating room, and just in time as the power went out when a major surgery was planned. As it was, we had to do a minor surgery with flashlights the night before the generator was hooked up. They ran wire and conduit, installed receptacles, hooked up the electrical panel, breakers and the O.R. lights. They purchased and installed a water heater for the new O.R. sink, purchased the new O.R. window panes, and installed receptacles in the lab for the expected new CD4 counter (needed to appropriately treat HIV patients). They repaired the cautery for surgery, fixed a suction pump, incubator, infant warmer, oxygen tank, air condition, O.R. light and probably other stuff I forgot about. Joan Wallace, the nurse missionary there, said several babies had died last rainy (cold) season due to cold, so the infant warmer repair likely saved more lives than any other thing we did there!
Our nurses organized and distributed the hundreds of surgical and medical supplies and medications we brought with us. The Zambian staff is so appreciative of these items as they are completely out of lifesaving supplies much of the time. They also worked with the Zambian O.R. tech to help organize and identify ongoing supply needs. They took vital signs of ward patients so we could appropriately assess them. While each of the nurses was ill (minor illnesses but enough to need extra rest) part of the time, this actually gave them more time to continue the friendship they had started with Joan Wallace who was also our hostess. Joan has children and grandchildren back in the US and has made the sacrifice to spend this season of her life in Zimba. Despite the friendships she has developed in Zambia, it can get lonely away from family and the culture you know. She has expressed great appreciation for the friendship offered, in particular, by Ann and Diana. Ann also had the thrill of her trip getting to see a child (Bless) who had been near death with pneumonia in July 06 whom Ann had tenderly cared for and treated at that time. The child is now growing well and essentially healthy. I didn’t think Ann would ever stop smiling after seeing Bless again! Diana, after her first Zimba trip, had done research on treatment of burn patients. She was able to swing into action when 2 small children and their mother were burned the day before we left. She also found the key to keeping the Zambian children from crying each time we approached them (a major problem the first trip) – candy suckers! (She brought more than a few!).
Barb, the nurse anesthetist, did the anesthesia for most of the surgeries as well as multiple other nursing related tasks. However, near the end of the visit, the Zimba anesthetist (who started a few months ago) came home from an out of town training session and they were able to share notes and work together. She and Wedon hit it off and she was able to give him several pointers on safer surgery. Wedon is a true blessing for this hospital and we are all very excited to see him there. He is well trained and conscientious. He has high standards for himself. In him we see a great hope for the hospital in that he advocates for great medical practices. For example, we were alarmed in the past that no one seemed to be trained/ interested in standard newborn resuscitation – he does it routinely in a manner consistent with the best Western standards. He monitors patients carefully with great documentation. He fully participated in a “code” while we were there when no other Zambian staff seemed able/ willing. On top of this, he has a heart of gold. He preached one of the morning chapel services quite ably, insists on praying with the O.R. personnel before each surgery, and leads a church youth group. A young teenager singled him out as the person who most helped her in her walk with Christ. Please thank God for his presence there. (He was educated with a Wesleyan Medical Fellowship).
One of the chronic problems we have seen is that is if difficult for the people at the hospital to keep track of the supplies and medications and what they need. Andy was able to do training on computers for this purpose with several people. He installed some programs that should help them. Hopefully these ultimately will make it easier for them to acquire what is needed and for outsiders to help bring what is needed most.
Another chronic problem we have seen is communication difficulties. For instance, in the past, if there was an emergency at the hospital, the only way to get help was to send a precious staff member to the needed person’s home. This meant extra delay’s for cesarean sections or other emergencies. We had suggested providing a cell phone for nursing staff to use to contact people. This is now in place! Also a new cell tower right in Zimba was installed since our last visit so communication is much better. This has made more of an improvement in use of time than you can imagine. Hopefully this will continue to improve as right now the nurse has to go to the lab or pharmacy to notify about or pick up what is needed – time that she could otherwise spend taking care of patients.
On the Feb 07 team trip, we did lots of surgeries including many hysterectomies. I was able to work with the “medical licensee” (sort of a junior surgeon who is trained to do emergency and common surgeries like C–sections and appendectomies), Ken Siabowa. One of my goals was to teach him how to do a hysterectomy in an emergency as this can be a lifesaving surgery for a hemorrhaging patient after a delivery. I was pleased to learn he had continued to perform some after I had left so that he now feels he can handle it in an emergency. While Ken was sick much of the time during this visit, we at least got to ‘scrub’ together on a couple of cases. Please pray for him as he was ill enough to need to leave before the end of one of our surgeries. They really need him there.
DRS. JONES’
Dr. Dan and Dr. Joan Jones arrived in Zimba a few months prior to our last visit as long-term medical missionaries. The hospital has not had a long-term physician for several years. Dan is a Family Practice physician and Joan is an Internal Medicine physician. For two months, they had been waiting for their permanent medical licenses and work permits which were finalized the same week we arrived. They are very patient-centered in their care and committed to working with the Zambians in a culturally sensitive manner. They are excited but somewhat frustrated by the difficult task of being a guest and yet faced with being change agents. It will be a challenge and they definitely need to be in our prayers. It is hard professionally and personally to go from an environment where you basically have every resource to care for a patient to one where you have very little -- knowing you could be a better provider for the patient in a different place and time.
I especially enjoyed doing rounds in the wards with Dr. Joan. She knew so much more than I did about the patients’ illnesses and I learned a lot. I can’t tell you how much more I enjoyed this trip than the others just knowing that there was another doctor there to talk to about the things I did not understand. I have felt such a burden in the past about how inadequate I was to meet the needs of the patients and so in the dark about many of their conditions, that I have always left quite heavy-hearted. This trip was much more positive for this reason for me. Also, it was gratifying to me that I could teach some gynecology to the Jones’s. Dan and I did several D and C’s together so that he is ready to take care of emergency hemorrhaging from miscarriages, for instance. We discussed diagnosis and management of ectopic pregnancies and other female problems. This trip, while I know things are still not as good as they will be (God willing), I know that the patients will be getting so much better care after we have left, compared to the past. I am very hopeful that as long as churches come along side the missionaries now in Zimba, things are looking up.
We delivered donated children’s books and some school supplies. We also delivered devotionals to the pastor for use by the parishioners.
THE ZIMBA WESLEYAN CHURCH
The Zimba Pilgrim Wesleyan Church is at a crossroads in its life. As I stated, the church was started by American missionaries, but has now come of age in that, for the first time, they are seeking to be a sending church, sending missionaries to other countries. What a privilege to be there when the pastor first announced this new phase in the church’s life at the Sunday service!
They have outgrown the building and are building a new one but the work is slow due to the lack of funds. In the last 18 months they have gone from a foundation, to a poured floor and foundation, and now to having the walls built to the lower window edge level. As funds become available, another round of bricks is added. Poverty stricken as the church is with poor parishioners, they have a heart to send missionaries to save others. Amazing.
One of the most profound experiences of each trip, and this one was no exception, has been the Sunday church service. The music is wonderful and spirited. The church is filled with people, including children crowded into the front. Everyone sings wholeheartedly. The choir is committed and enthusiastic. The preaching is pointed but with the content Bible-based. Amazingly, despite significant cultural differences, it is relevant to us and the leaders could be preaching anywhere in America (or elsewhere in the world). The universality of the Biblical truths never seems so real. There is a point in each service we have attended where the music plays but all are invited to pray and most do so out loud. The Holy Spirit fills the church and there is a cacophony of voices praising and pleading with the Lord. It is totally awesome and brings me to tears each time.
When I asked the pastor about the greatest problem facing his church, I was surprised by his answer. He said it was the orphans in their community. Many of these children, just a few hundreds of yards from the mission house, are being molested/ prostituted for money for food. After the tragedy of losing their parents, they suffer malnutrition, hunger, illness, and living in homes (if they are lucky) of relatives who often cannot afford to feed or clothe them, much less send them to school. (I guess I thought he would say they needed a new church building – how blind of me and I’m ashamed of that blindness). When I asked what he would like to tell/ask of the American church, again I was surprised. He did not ask for help for his parishioners or church, but for help in learning how to do missions. It is his passion that more be brought to Christ. These are astounding people, fellow believers, who struggle in unbelievable circumstances, not of their own doing, but who somehow manage to maintain an outward focus. While we in America complain about our minor inconveniences and troubles, our self-centered needs and wants, our illnesses, stresses and depressions that are largely brought about by our own deeds and habits, they live lives so on the edge of disaster and they lean on the Lord.
WHAT THEN…
There is not a person from Battle Creek that has not been changed by their experience in Zimba. For me, it is learning not to dramatize the minor inconveniences or annoyances – they pale in comparison to what the people of Zimba deal with daily-- no, hourly. I more fully appreciate just how good we have it here. Even the most poor or difficult circumstance in the U. S. is not anything like what the Zambians face. Any hospital in America, even in the most remote area, gives golden and wonderful care compared to what these people get at Zimba, a “referral” hospital for the more rural areas. I much more fully appreciate just how fine an education I have been privileged to have and how much good we actually do every day in health care in America. (Sometimes it seems we really don’t make a difference – but trust me, we do. I see now just how bad it can be without everyday care we expect and take for granted – clean water, antibiotics, clean O.R., good nursing care, etc.).
Finally, you cannot go to Zimba and think it is okay NOT to help. Yes, we all have seen those sad looking people on TV or in magazines. However, you cannot meet them face to face, and not be changed. It becomes very clear that it is morally unacceptable to live in such relative luxury (even the poorest American is rich in comparison), and pretend places like Zimba do not exist.
Jesus says the same thing in the book of Matthew in the Bible. To the people who ask the following, he says. . .
...”When did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick and in prison and go to visit you?”
The King will reply, “I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.” Then he will say to those on his left, “Depart from me, you who are cursed into the eternal fire prepared for the devil and his angels. For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.”
They also will answer, “Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?”
He will reply, “I tell you the truth, whatever you did not do for one of the least of these, you did not do for me. “ Then they will go away to eternal punishment, but the righteous to eternal life.
No, I cannot change the entire world. But I CAN make a big difference in lives in Zimba. And so can you.
INTRODUCTION
Several people have asked us “How did your trip go?” in reference to our most recent trip to Zimba, Zambia. I find myself unable to say much of anything -- there is so much to say. While I cannot possibly tell you everything, this is an effort to begin to answer the question, tell you what we did, how we were impacted, how we impacted the people there, the things we learned and perhaps how you might pray for the people there and explore how God might be leading you to partner with Him in His work there.
REGIONAL BACKGROUND
Zimba is a community of CisTonga speaking people (although most also speak varying degrees of English) in southern Zambia (formerly Southern Rhodesia), about 1 hr. drive from Livingstone, the location of Victoria Falls (one of the 7 wonders of the world). About 50 years ago a local chief visited a Livingstone missionary stating his people’s need for 3 things: a church, a school and a hospital. When the missionary told a Wesleyan church in the U. S. of the need, a parishioner stepped forward and funded all three projects. Nakowa primary school, Nakowa Pilgrim Wesleyan church and the Zimba Missionary Hospital were built soon after. The school and hospital were nationalized after Zambian independence from the British; however, the hospital in particular, remains dependent on the Wesleyans and other churches for many critical supplies, medications and support. Many of the staff members’ educations were supported by the Wesleyan Medical Fellowship. Wesleyan missionaries (currently a nurse and, as of a few months ago, 2 doctors) are stationed there.
Zambia is a poor country but politically stable with some natural resources. The Tonga people were displaced into poor, arid areas like Zimba by the building of a power dam several decades ago. Like so many places in Africa, AIDS, malaria, malnutrition, schistosomiasis, TB and other diseases are common. The government bureaucracy, poor roads, lack of supplies, unemployment, unclean water, and corruption are realities in the everyday life of the people. However, most are Christians, at least in name, thanks to the work of decades of missionaries (starting with Dr. David Livingstone). Traditional beliefs about healing and potions are used by the people. Polygamy is common. Children orphaned by AIDS are a major tragedy with many already poverty stricken families trying to support these children. 25% of children cannot afford to go to school. Many (even near the mission house) are forced into prostitution in order to eat.
FIRST WESLEYAN CHURCH (of Battle Creek) INVOLVEMENT
This was our church’s 3rd team to be sent to Zimba. The first, in July, 2006, was composed of both medical and construction personnel. A new operating room (“theatre”) was started by a team from another American church and our group worked with a Zambian team to further the work. At that time there had been no long-term physician at the hospital for a few years. While we were there, emergency surgeries were performed (instead of being sent another hour away to Livingstone), medications were made available, and care was provided that exceeded what could have been done had we not gone. We learned about the people, got to know some of our partners (nationals and missionaries), began to learn about the needs and establish relationships. We were deeply moved by the overwhelming medical and material need and the kindness and joy of the people (despite their poverty). Many of us fell in love with the people there. We were told the hospital water system itself was contaminated and there was a suspicion some children, in particular, may become even sicker due to the water while at the hospital. Also we learned that the critical lack of nursing staff was largely due to the lack of housing for them.
The next First Wes trip was in Feb, 2007, with mostly a medical team. This time we performed many lifesaving surgeries, thanks to a short term missionary doctor there in December who directed appropriate patients to come at the time we were going to be there. Also, now that we were starting to understand the needs, research was conducted that confirmed the contamination of the water system, explored sources of contamination and began to figure out ways to solve the problem. Discussions were held with the administrative staff as to their priorities and needs. “Reconnaissance” was conducted on the electrical problems and other physical plant needs to plan for the next steps. We continued to develop relationships with the local people.
OCTOBER 2007 TRIP
On this trip, we took 2 electricians, a construction worker, a “computer guy”, 2 nurses, a nurse anesthetist and myself, a gynecologist as well as my husband, Larry, who by this time was becoming an “expert” on the hospital water problems.
Once again we were profoundly impacted by the material needs of the people and hospital. For the first surgery (before we had unpacked the supplies we had brought), I was handed a used suction tube that had been soaked in a disinfectant and still had old blood in it from a prior surgery and gray surgical sponges that were being reused because no others were available. In an area with 17 % HIV positive patients, this was horrifying, but they are doing with what they have. The Zambian nursing staff was constantly turning down I.V. fluids (in very dehydrated patients) in order to conserve the fluids. They knew that after the I.V. fluids we had brought were gone, there would be no more for who knows how long (months, most likely). Children die there regularly from dehydration. A 2 yr old died our first day there due to gastroenteritis (stomach flu) when we could not get an I.V. started. Often we have seen the staff decline to start I.V.’s until the child is so dehydrated it cannot be inserted, so then the child dies. We have never been to Zimba when we have not seen the death of at least one child. (The usual pediatric census is 13-16.) People dying for lack of adequate supplies of I.V. fluids – in the US, we never even consider this could happen.
We were silent at the amazing endurance of the people when faced with what must be unbelievable pain. 2 of the women on whom we did surgery had extensive pelvic abscesses. They only had reported, what seemed to be, minimal complaints of pain. One of these abscesses was the size of a small soccer ball and must have been painful for quite some time. Then after surgery, we gave the patients a few doses of a morphine- like drug, then they had to handle the rest of their pain with ibuprofen (Motrin) and acetaminophen (Tylenol). Like-wise for the burned children and woman after a home fire – very little to provide pain relief. We compare this to all the complaints we American’s have about our aches and pains of everyday life.
The profound lack of resources includes the lack of nursing staff. The whole hospital is staffed by 2 nurses a shift. They pass medications, arrange for labs to be drawn, monitor I.V.’s, and are responsible for all nursing care. They have time to take a temperature once a day on each patient – that’s all. No blood pressures, pulse or respiration are evaluated. The lack of staff (especially well-trained nurses) is directly responsible for the inability to adequately care for patients. For instance, while we were there a patient with a breast abscess developed sepsis and died without a single pulse or blood pressure taken in the 24 hours prior or notification of the doctors about her condition. (She was a young wife and a mother of 2 little girls.) A couple of times we have been told newborn infants “just died” in the night without anyone being aware they were sick. Until adequate staff comes on board, this “place of last hope” for many ill people, will be the place they come to die. This is horrifying for the medical staff on the team, knowing so many of those we see die there would never die like this in the US.
The main reason for the severity of the nursing shortage is the lack of adequate housing for nurses. It is the hospital’s obligation to provide housing in Zambia. What they have now is tiny buildings, even by Zambian standards, with 2 room houses for up to 9 extended family members (remember most families care for orphans) often without regular running water. Many nurses won’t come to work in Zimba under these conditions. A church in Memphis is funding/supervising construction of 5 more houses but this still will not be enough. Also, until the new water/sewer system is complete, they will not have water. While it may seem a little dramatic to say it, it is true that building nursing housing will definitely save lives by attracting staff. Currently over 60% of the hospital budget is used to pay rent for the staff – money that is badly needed for medication and supplies. New housing will not only bring more staff, it will free up money for other much needed items.
As I said, on the first trip we were told the hospital had been cited by the inspectors in the past for having contaminated water. You see, people come and essentially camp out on the hospital grounds waiting for care or staying to be with family members who are in the hospital. There is also a “Woman’s Temporary Shelter” where women await labor. The toilet facilities for these people (and all the patients) are at the back of the hospital and are filthy and decrepit. We think there is direct contamination into the water system. Furthermore, hospitalized patients must walk 50-100 yds. to the facility, no matter how ill. There is nowhere for patients to bathe so we take dirty patients to surgery. During the 2nd trip, Larry was able to verify the contaminated system and investigate the problem and hospital needs. In discussing this with appropriate people on return to the US, it was decided that the only way to solve the problem was to replace the entire system. Glen Harris has spearheaded the effort to design a new system. Larry, with help from Larry E., did some additional on-site research this trip including the arduous task of doing a “percolation” test to plan for the new water and sewer system. This involved spending hours in the 100 degree heat digging a hole, hauling water and making measurements. We now are praying for a solution to the next step: a detailed survey and then a contractor who can stay on site to supervise construction of the system. Until then, people who are already weakened by disease will continue to be exposed to the unclean water.
PRACTICAL HELP and HOPE
The electricians and construction team did an awesome job this trip, accomplishing many large and small tasks. Before they could get too far they had to investigate the needs and find materials. A day trip to Livingstone only turned up a few of the needed items despite much looking. After a team meeting, we decided to authorize a trip to Lusaka, the capital city 5 hours away to the north. Our dilemma, based on the Livingstone expedition, was that they did not know where to start to find the items in a strange country. Fortunately, God foresaw the need. Janet, the missionary supervisor from the Tennessee church building the nursing housing, had met a contractor supplier at the US embassy. He is a Moslem man born in Sudan but who had escaped to the US and was educated here – the perfect match: understands what our electricians were talking about but knew the Zambian sources. A call from Janet and it was arranged. They met in Lusaka, acquired most of what they needed and established a friendly contact with a “pre-Christian” (well, maybe). He was a generous man with a good heart and willing to help.
The electricians installed a backup generator for the operating room, and just in time as the power went out when a major surgery was planned. As it was, we had to do a minor surgery with flashlights the night before the generator was hooked up. They ran wire and conduit, installed receptacles, hooked up the electrical panel, breakers and the O.R. lights. They purchased and installed a water heater for the new O.R. sink, purchased the new O.R. window panes, and installed receptacles in the lab for the expected new CD4 counter (needed to appropriately treat HIV patients). They repaired the cautery for surgery, fixed a suction pump, incubator, infant warmer, oxygen tank, air condition, O.R. light and probably other stuff I forgot about. Joan Wallace, the nurse missionary there, said several babies had died last rainy (cold) season due to cold, so the infant warmer repair likely saved more lives than any other thing we did there!
Our nurses organized and distributed the hundreds of surgical and medical supplies and medications we brought with us. The Zambian staff is so appreciative of these items as they are completely out of lifesaving supplies much of the time. They also worked with the Zambian O.R. tech to help organize and identify ongoing supply needs. They took vital signs of ward patients so we could appropriately assess them. While each of the nurses was ill (minor illnesses but enough to need extra rest) part of the time, this actually gave them more time to continue the friendship they had started with Joan Wallace who was also our hostess. Joan has children and grandchildren back in the US and has made the sacrifice to spend this season of her life in Zimba. Despite the friendships she has developed in Zambia, it can get lonely away from family and the culture you know. She has expressed great appreciation for the friendship offered, in particular, by Ann and Diana. Ann also had the thrill of her trip getting to see a child (Bless) who had been near death with pneumonia in July 06 whom Ann had tenderly cared for and treated at that time. The child is now growing well and essentially healthy. I didn’t think Ann would ever stop smiling after seeing Bless again! Diana, after her first Zimba trip, had done research on treatment of burn patients. She was able to swing into action when 2 small children and their mother were burned the day before we left. She also found the key to keeping the Zambian children from crying each time we approached them (a major problem the first trip) – candy suckers! (She brought more than a few!).
Barb, the nurse anesthetist, did the anesthesia for most of the surgeries as well as multiple other nursing related tasks. However, near the end of the visit, the Zimba anesthetist (who started a few months ago) came home from an out of town training session and they were able to share notes and work together. She and Wedon hit it off and she was able to give him several pointers on safer surgery. Wedon is a true blessing for this hospital and we are all very excited to see him there. He is well trained and conscientious. He has high standards for himself. In him we see a great hope for the hospital in that he advocates for great medical practices. For example, we were alarmed in the past that no one seemed to be trained/ interested in standard newborn resuscitation – he does it routinely in a manner consistent with the best Western standards. He monitors patients carefully with great documentation. He fully participated in a “code” while we were there when no other Zambian staff seemed able/ willing. On top of this, he has a heart of gold. He preached one of the morning chapel services quite ably, insists on praying with the O.R. personnel before each surgery, and leads a church youth group. A young teenager singled him out as the person who most helped her in her walk with Christ. Please thank God for his presence there. (He was educated with a Wesleyan Medical Fellowship).
One of the chronic problems we have seen is that is if difficult for the people at the hospital to keep track of the supplies and medications and what they need. Andy was able to do training on computers for this purpose with several people. He installed some programs that should help them. Hopefully these ultimately will make it easier for them to acquire what is needed and for outsiders to help bring what is needed most.
Another chronic problem we have seen is communication difficulties. For instance, in the past, if there was an emergency at the hospital, the only way to get help was to send a precious staff member to the needed person’s home. This meant extra delay’s for cesarean sections or other emergencies. We had suggested providing a cell phone for nursing staff to use to contact people. This is now in place! Also a new cell tower right in Zimba was installed since our last visit so communication is much better. This has made more of an improvement in use of time than you can imagine. Hopefully this will continue to improve as right now the nurse has to go to the lab or pharmacy to notify about or pick up what is needed – time that she could otherwise spend taking care of patients.
On the Feb 07 team trip, we did lots of surgeries including many hysterectomies. I was able to work with the “medical licensee” (sort of a junior surgeon who is trained to do emergency and common surgeries like C–sections and appendectomies), Ken Siabowa. One of my goals was to teach him how to do a hysterectomy in an emergency as this can be a lifesaving surgery for a hemorrhaging patient after a delivery. I was pleased to learn he had continued to perform some after I had left so that he now feels he can handle it in an emergency. While Ken was sick much of the time during this visit, we at least got to ‘scrub’ together on a couple of cases. Please pray for him as he was ill enough to need to leave before the end of one of our surgeries. They really need him there.
DRS. JONES’
Dr. Dan and Dr. Joan Jones arrived in Zimba a few months prior to our last visit as long-term medical missionaries. The hospital has not had a long-term physician for several years. Dan is a Family Practice physician and Joan is an Internal Medicine physician. For two months, they had been waiting for their permanent medical licenses and work permits which were finalized the same week we arrived. They are very patient-centered in their care and committed to working with the Zambians in a culturally sensitive manner. They are excited but somewhat frustrated by the difficult task of being a guest and yet faced with being change agents. It will be a challenge and they definitely need to be in our prayers. It is hard professionally and personally to go from an environment where you basically have every resource to care for a patient to one where you have very little -- knowing you could be a better provider for the patient in a different place and time.
I especially enjoyed doing rounds in the wards with Dr. Joan. She knew so much more than I did about the patients’ illnesses and I learned a lot. I can’t tell you how much more I enjoyed this trip than the others just knowing that there was another doctor there to talk to about the things I did not understand. I have felt such a burden in the past about how inadequate I was to meet the needs of the patients and so in the dark about many of their conditions, that I have always left quite heavy-hearted. This trip was much more positive for this reason for me. Also, it was gratifying to me that I could teach some gynecology to the Jones’s. Dan and I did several D and C’s together so that he is ready to take care of emergency hemorrhaging from miscarriages, for instance. We discussed diagnosis and management of ectopic pregnancies and other female problems. This trip, while I know things are still not as good as they will be (God willing), I know that the patients will be getting so much better care after we have left, compared to the past. I am very hopeful that as long as churches come along side the missionaries now in Zimba, things are looking up.
We delivered donated children’s books and some school supplies. We also delivered devotionals to the pastor for use by the parishioners.
THE ZIMBA WESLEYAN CHURCH
The Zimba Pilgrim Wesleyan Church is at a crossroads in its life. As I stated, the church was started by American missionaries, but has now come of age in that, for the first time, they are seeking to be a sending church, sending missionaries to other countries. What a privilege to be there when the pastor first announced this new phase in the church’s life at the Sunday service!
They have outgrown the building and are building a new one but the work is slow due to the lack of funds. In the last 18 months they have gone from a foundation, to a poured floor and foundation, and now to having the walls built to the lower window edge level. As funds become available, another round of bricks is added. Poverty stricken as the church is with poor parishioners, they have a heart to send missionaries to save others. Amazing.
One of the most profound experiences of each trip, and this one was no exception, has been the Sunday church service. The music is wonderful and spirited. The church is filled with people, including children crowded into the front. Everyone sings wholeheartedly. The choir is committed and enthusiastic. The preaching is pointed but with the content Bible-based. Amazingly, despite significant cultural differences, it is relevant to us and the leaders could be preaching anywhere in America (or elsewhere in the world). The universality of the Biblical truths never seems so real. There is a point in each service we have attended where the music plays but all are invited to pray and most do so out loud. The Holy Spirit fills the church and there is a cacophony of voices praising and pleading with the Lord. It is totally awesome and brings me to tears each time.
When I asked the pastor about the greatest problem facing his church, I was surprised by his answer. He said it was the orphans in their community. Many of these children, just a few hundreds of yards from the mission house, are being molested/ prostituted for money for food. After the tragedy of losing their parents, they suffer malnutrition, hunger, illness, and living in homes (if they are lucky) of relatives who often cannot afford to feed or clothe them, much less send them to school. (I guess I thought he would say they needed a new church building – how blind of me and I’m ashamed of that blindness). When I asked what he would like to tell/ask of the American church, again I was surprised. He did not ask for help for his parishioners or church, but for help in learning how to do missions. It is his passion that more be brought to Christ. These are astounding people, fellow believers, who struggle in unbelievable circumstances, not of their own doing, but who somehow manage to maintain an outward focus. While we in America complain about our minor inconveniences and troubles, our self-centered needs and wants, our illnesses, stresses and depressions that are largely brought about by our own deeds and habits, they live lives so on the edge of disaster and they lean on the Lord.
WHAT THEN…
There is not a person from Battle Creek that has not been changed by their experience in Zimba. For me, it is learning not to dramatize the minor inconveniences or annoyances – they pale in comparison to what the people of Zimba deal with daily-- no, hourly. I more fully appreciate just how good we have it here. Even the most poor or difficult circumstance in the U. S. is not anything like what the Zambians face. Any hospital in America, even in the most remote area, gives golden and wonderful care compared to what these people get at Zimba, a “referral” hospital for the more rural areas. I much more fully appreciate just how fine an education I have been privileged to have and how much good we actually do every day in health care in America. (Sometimes it seems we really don’t make a difference – but trust me, we do. I see now just how bad it can be without everyday care we expect and take for granted – clean water, antibiotics, clean O.R., good nursing care, etc.).
Finally, you cannot go to Zimba and think it is okay NOT to help. Yes, we all have seen those sad looking people on TV or in magazines. However, you cannot meet them face to face, and not be changed. It becomes very clear that it is morally unacceptable to live in such relative luxury (even the poorest American is rich in comparison), and pretend places like Zimba do not exist.
Jesus says the same thing in the book of Matthew in the Bible. To the people who ask the following, he says. . .
...”When did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick and in prison and go to visit you?”
The King will reply, “I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.” Then he will say to those on his left, “Depart from me, you who are cursed into the eternal fire prepared for the devil and his angels. For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.”
They also will answer, “Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?”
He will reply, “I tell you the truth, whatever you did not do for one of the least of these, you did not do for me. “ Then they will go away to eternal punishment, but the righteous to eternal life.
No, I cannot change the entire world. But I CAN make a big difference in lives in Zimba. And so can you.
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