Swaziland: Advanced Health Care Worker course April 2008

25 teachers from the Care Points and Mercy Centes attended the Advanced Health Care Worker course. This was the advanced course that I developed in additon to the Basic course that I give in differnt countries. The first day was a advanced anatomy and physiology. I held a show and tell dissection lab in the afternoon: we got a cow's liver, an oxen's heart, and an oxen's kidney, and I dissected them showing them heart valves, the inner workings of the liver and the kidney. Then when I was done, the students took the organs outside, and cooked them...and then ate them! Try that in the US!

The second day was all advanced disease recognition and algorithms. Peak Flow meters were donated to us and I showed them how to use them and then we used them on the children. Asthma is a big problem in Swaziland. The third day was basic pharmacology of antibiotics and we finished up with cases.

We now have 25 teachers who are trained on disease assessment, recognition and basic treatment. They will serve as the first health care line caring for the children at the Care Points and the Mercy Centers. This will insure that children will be cared for before they get sick so they can grow spiritually and with His love.

In all things give thanks,

David

Mozambique Assessment April 2008

Soon after we finished the medical clinics, I took off for Mozambique with Daren, Teresa and Jason to assess the medical needs there. The drive was 4 hours of beautiful scenery. We arrived and went right to work. Isaac and CArol the missionsary couple with Healing Place Church/Children's Cup have done an outstanding job in getting things going there. They set up a small room in the church to serve as a mini-clinic and stock it with medications. A Brazilain doctor with the Baptist ministry (Maria) comes once a week to see the children. I was very impressed with what they have done so far. The local government health care post where people go for care was dismal. But the government hospital that children get referred to was awesome! A seperate 32 pediatric ward, and a playroom!

The over all healthcare of the children is marginal at best, with malnutriton, malaria, URI's, and diarrhea the common casues of death and morbidity.With time, we'll have the children looking fat and healthy!!

As for us, we got stopped late evening by a group of "police/soldiers" who were loking for anything they could to get us. 3 of them with AK47's flanked the left side of our SUV while 3 of them on the right, talked to Daren telling him we had violated some law (passengers not wearing seat belts). After some "discussion" we paid them off (about $80) and they let us go. You never know what's going to happen next on trips like these.

In all things give thanks,

David

Swaziland April 2008: Day 5 and summary

Day 5: Maphiveni

We traveled about 1 1/2 to two hours north almost to the border Mozambique. A Mercy center has been established in that area. Because of arrival time and departure time we see only saw about 156 patients. But those patients were some of the sicker patients that we've seen all week since that part of the country that we were in has a high incidence of HIV with approximately 90% of the population being HIV-positive less than five to 10% of those receiving ARVS. We saw number of young children, some as young as 10 months of age with mothers who had been HIV-positive while pregnant never receiving HIV treatment, thereby ensuring that their children were positive. We saw significant amount of malnutrition, tuberculosis, and overall general poor health.

The week has gone by quickly when we look back to see what we have done. It was quite amazing:

Madonsa: 322 patients.
Makholweni: 400 patients.
Logoba: 422 patients.
Zombodze: 438 patients.
Maphiveni: 156 patients.

Total: 1738 patients seen

Total Medication perscriptions dispensed: 5500
Total indiviudal pills, ointments, drops, etc dispensed: 22,000
Total reading glasses given: 400
Total who got HIV testing: 375
Total seen in spiritual counseling: 1738
Total number of people who participated in working the week of clinics(US medical team, local missionaries, teachers, interperetors, drivers, cooks, HIV testers,pastors,and alot more): 220

The whole team (US and local) was incredible. We all came together within the first few hours of the trip and work very well together. The missionaries here in Swaziland, the teachers, the pastors, the interpreters, the drivers, the cooks, and many many more who helped us, worked as a team with a singular and common purpose: to be Christ's servants to those who are vulnerable and ill. It has been quite the week, and quite the experience. God does some incredible things, and puts people together for a purpose.

Two residents, husband and wife Philip and Kathleen, from Baylor joined us on the last day, We were blessed find out that they were believers. It was awesome to see them openly pray with their patients and to be a part of our devotions. To see unexpected people join our group who embrace our mission is simply God's work.

The medical team leaves for the United States tomorrow. Jason and I, and Daran and Teresa, leave for Mozambique for a three day assessment trip. I hope to be able to determine the medical needs of Mozambique and how we are going to deliver medical care to the children there. I'll return to Swaziland after that to give the advanced healthcare worker course to 28 healthcare workers who have been through the basic health care worker course. I'll return home soon after that.

It continues to be a wonderful journey.

In all things give thanks,
David

Swaziland April 2008: Day 3 and Day 4

Day 3: Logoba

422 patients were seen. It seemed like a busier day than most with a lot of sicker patients than we had previously seen. We saw a lot of children who came without parents looking for healthcare all on their own. They had heard that we were there and brought themselves to the clinic with some significant and serious complaints of illnesses that needed to be treated. We gave the medications knowing that there were no parents for them to return to and that they were truly responsible for themselves. An 11-year-old with significant developmental delay and a seizure disorder with left hemiparesis arrived on his own seeking help for his seizures. Because of his developmental delay, he was unable to really communicate other than to tell us that he frequently fell down. A 38-year-old male with skeletal tuberculosis also with lower extremity paresis came for help. He was unable to walk, and his wife and he were both HIV-positive. A whole family devastated by two serious diseases.

Sometimes I wonder where the resilience and fortitude comes from. Looking around at the mass of people waiting to be seen, it was clear that survival was a common theme. But surviving at what expense? The team was more subdued today, and I think realized the magnitude of what they were doing. There is no other way look at what we do other than with hope and compassion.

Day 4: Zombodze

A day, not unlike the rest with 438 patients seen. We did have a late start and an early ending, and still saw a large number of patients. While the team traveled to the site I met with the Baylor team to discuss the healthcare of Pepe. We were able to come up with a nutritional program that would be beneficial and insure her possibility of having a comfortable life for a least a period of time. A young mother and her baby came to the clinic. Both turned out to be HIV-positive. The baby was severely malnourished as the mother had no money and was feeding the baby a dilute porridge. A little eight year old girl who had been raped last year and was seen by Sabine came back for a visit and was looking really well and had recovered from her horrendous experience.

Children's Cup has continued to grow with 19 missionaries and seven more on the way before the end of the year. Additional Mercy Centers and Care Points are being added and a new church opened just a few weeks ago, which we attended tonight. The mission here is beyond words. The growth and out reach to those who are so vulnerable is occurring at a rapid rate. We are fortunate and blessed to be a very small part of it.

In all things give thanks,
David

Swaziland April 2008: Day 1 and 2

Day one:

We started our week of medical clinics at Madonsa where we saw 322 patients. There were no surprises other than a late afternoon hailstorm, followed by a thunderstorm as we're examining children outside. The medical team got their feet wet, so to speak and finished off the day feeling more comfortable about the types of children and adults that will be seen for the rest of the week. We were visited by two doctors from Baylor, who joined us in seeing patients and it was comforting to know that our approach and treatment of common diseases was in harmony with what the Baylor team has been doing.

Day two:

Day two was spent at Makholweni where we saw 400 patients. Today was a difficult day for many of us as we began to see the impact of the epidemic of HIV and AIDS and the general well-being, both health and spiritual, of the patients that we saw. I took care of an 11-year-old girl who'd been raped and needed to be examined. I was fortunate to have Teresa, Jackie, a Children's Cup missionary and one of the teachers get her to trust me to do the examination. A 14-year-old boy with HIV, who had been on ARV medication, looking very sick told us that he had stopped taking his medications, because his grandmother refused to allow him to do so. She couldn't believe that a child 14 years of age could have HIV and AIDS. We are struggling now with finding a way to convince her to let him take his medication.

A young lady whom I wrote about a year ago, who has a seizure disorder and was raped, came back to the clinic today and had a seizure right in front of us. You may recall that when she falls she hits the right side of her face. And today was no exception. It was clear that she had been having multiple seizures, and her face was severely bruised and swollen on the right side. We saw two children with severe asthma, who required immediate intervention. And there were many more.

For what it's worth, I continue to be amazed at the resilience of those who have not. And what is more amazing is to see that regardless of what is happening to them they maintain a sense of dignity and continue to hold their head high as best they can under the circumstances. The young lady who had a seizure clearly demonstrated this. As she was recovering from her seizure and still incoherent, she reached for a paper towel that we brought to clean her face with and took it herself and started to brush herself off.

There's more to come as the week moves forward. There is more for us to see and more for us to realize how fortunate we are to have the blessings that have been bestowed on us. Being humbled is a difficult thing to experience. Today was a very humbling day.

In all things give thanks,
David

Swaziland April 2008

We are back in Swaziland for another medical trip. In addition I'll be traveling to Mozambique for three days to do a medical assessment, and then back to Swaziland to do a three day advanced healthcare worker course. On this trip we have been fortunate to have Sabine, Donald, Carleen, Maisie, Jason, Kelly, Don from Phoenix, and Jason a friend of Don's join us as our medical team.

As always, we were met by Darren and Teresa, and the rest of the missionaries here in Swaziland. The afternoon was a quiet one as we gathered our thoughts and energy to prepare for the week ahead.

I did go with Teresa to go see Pepe who has been hospitalized for some time now with multi-drug-resistant tuberculosis and HIV. She is 12 years old and now only weighs 14 kg. When I saw her she was continually coughing and was very weak. She was unable to take nutrition and seemed severely withdrawn. She was apprehensive and afraid. Having just seen her a year ago she was clearly a different child. I couldn't bring myself to take her picture.

There is a lot to talk about regarding her long-term care what she is going through. I hope to have a care conference with all the wonderful people who have been caring for her here so that we can look at the difference between keeping her alive and ensuring that she has a life. We all want to do things for her and not to her. There is an end to all things. The taskmaster is deciding when that end is.

Be with us as we begin our week. Be with Pepe.

In all things give thanks,

David

Ethiopa Assessment Trip January 2008

Ethiopia: an African country, unique in its needs, beautiful in its own way. For 7 days, I traveled with my close friend Peter Omran and Getachew, the field director for our projects in Ethiopia. We saw 8 projects, traveled by car a long distance and flew even further, to see all the projects that MoM has there. There are close to 3000 children, all in various stages of growth, development and health. The pictures will speak for themselves.

What we can expect when we go is a large population of children with malaria, TB, malnutrution, chronic respiratory tract infections, and parasitic disease. The environment that these children live in are as expected: no water, no sanitation, one room with 10 people living in it, exposure to communicable diseases and no toilets. We'll have a lot to do, and alot to see. Wait for it. It's coming....

In all things give thanks,

David

Cambodia: Wrap up

With a team of 12 from the US and a team of at least 20 from Cambodia, we did it. Our original estimates of patients seen over the 8 days was about 1700. Final counts from Kelly (boy) make it more like 2000. MoM children, villagers, teachers, and alot of others. The pace was fast, but thorough and the excitement was there. The spiritual side was awesome! Here is a quote from Kelly (boy) in an email he sent to me:

"The spiritual impact report is also still being put together but I know many were uplifted by the prayers of you as a team and our spiritual counselor team. The one morning I was there was a lady who asked me to pray for her for personal salvation. Obviously the seeds of faith had already been sown but your presence prompted her to make that commitment during the first hour of our village outreach (Dambok Khphua village)." Kelly Robinette

How great is that!! Cambodia was our first medical intervention and has been the country that we have been to the most. There are almost 4000 MoM children in the country and for that, we are thankful that the missionaries are there. We try to help the best we can.

My thanks to all who went on this trip, to all who helped, to all who stayed in prayer with and for us, and to all who thought of us. There is still so much more to done...

In all things give thanks,

David

Cambodia: Day 7 - Unbelievable!

We saw 520 children today in the village of Ang. Don't ask me how we did it but we did. The team ran like an oiled machine, the kids flowed to each of us to examine and off to the pharmacy they went, then off to get a vitamin and a worm pill on the way out. It was a great day, no drama, no sad stories, nothing to really talk about, other than the fact that we never missed a beat smiling as we saw all the children.

It is said that every turn brings you to a new place, either in location or in your heart. Our hearts today found a new place, a new sense of optimism, a new realization that there are still children in this world who are innocent enough not to relaize what they don't have and when they do, they really don't care. I saw that today. Torn shirts, broken sandals, dirty faces, and runny noses. But always smiling and thankful for the fact that we were there. How great is that. And the smiles on our faces showed how thankful we were to be there as well. Having nothing and having everything...it can happen, when we realize that having nothing is all the "stuff" that we thing we have until it's taken away from us, and having everything is simply having a faith in the one who is our Father. I saw it all today. The have's and the have not's. And I'm so glad to be one of the ones who "has".

In all things give thanks,

David

Cambodia: Day 6 - Good news

Kelly is returning from Bangkok tomorrow with good news. He passed all his tests, and is ready to come back. We are anxious to see him back and to have him with our team again.

We saw 350 patients today, no drama, and a very nice day. Everybody is tired and off to an early nights rest before we leave for Ang tomorrow. It's all good.

In all things give thanks,

David

Cambodia: Days 4 & 5 - Grace defined

There is never a good time to share disturbing news. However, news like this needs to be shared to simply remind us of how vulnerable we are at times.

We arrived at the village to find a swarm of people waiting for us. Within minutes of our arrival a torrential rain started, leaving us ankle deep in mud and water and little dry place to set up our examining tables, pharmacy, registration, glasses, and spiritual counseling. But as always we were able to adjust and within an hour we began seeing patients.

By 11 a.m. the drama began.

Kelly our main missionary here, was said to be sitting in the van cooling-off and not feeling well. I went to check on him and found him to be extremely pale, diaphoretic, and slightly incoherent. With backup called, a blood pressure of 80/30 was recorded and I quickly put in a large bore IV and ran 1 L of fluid in as fast as I could. We transported him to the hotel bypassing hospitals as it is said that one goes go to hospitals only to die here in Cambodia. At the hotel with the team now back at the village seeing more patients, I gave Kelly two more liters of fluid and watched him closely. By the time the team returned from seeing about 170 patients for the day, Kelly was feeling better but now complaining of indigestion. It was that very word "indigestion" that was of concern. By now it was clear that we had to move Kelly to a higher level of medical care. But first I needed an ECG. The first hospital we tried sent us away telling us they did not have an ECG machine despite the fact that they were a trauma hospital. We drove into town and found a roadside medical clinic and we rescued in old ECG machine. The primitive ECG that I was able to obtain showed significant and concerning changes. It was clear that we had to move Kelly to Phnom Penh. At 9:30 at night we began the four and a half hour drive in torrential rain to Phnom Penh in order to get Kelly and his wife on an airplane in the morning for Bangkok. By early morning Kelly and his wife were on their way to Bangkok and I tried to get the MAF airplane to fly to Battambang, but it was down for maintenance. So another 4 1/2 hour ride by taxi this time back to Battambang to meet the team for the rest of the day's clinic. We wound up seeing 350 patients today. I just heard from Kelly who confirms that there is a strong probability that he has had a small MI and he is scheduled for a stress test in the morning and that he is doing well and in good care. Grace was with Kelly and still is. There is always grace from He who leads us and directs all that we experience.

But there is another part to the story. This afternoon I saw a 41 year old man with complaints of a fast heart rate for over a year and a 30 pound weight loss over the last two years. He was extremely cachectic, anxious, and sick. His heart rate was 125 and his blood pressure was 160/110. He said he had seen 2 doctors in the past, both of whom said that he had heart problems and that they would not do anything for him since he had no money and told him to go away and that he would die soon. He had no family and lived alone and came to us for reassurance and help. This man was no different than Kelly, entitled to the best care available and an opportunity for cure. But because of what he was, a poor man, he was denied that which is a simple right: compassion. I started him on medication and arranged for weekly follow-ups with the hopes of finding a way to get him the care that he needs. And for all that I'm embarrassed to say that I pretended to be better than those two other doctors simply because I gave him some medication.

I am not a god in a white coat, and for me, kindness and compassion has not come easily. There are many definitions of grace and for me its definition came one afternoon as I cared for a young child in the intensive care unit: grace means simply moments and gifts of kindness. Both Kelly and this man received grace today. But the thing that's missing the most is what happens because of that grace. Kelly will get better because of grace. That man, despite grace, will more than likely die. As I watched him walk away, I saw his hand clutch the medicine he was given and look back just once, before he disappeared. I caught his eye, and gave him a smile, but he looked away. Grace. Moments and gifts of kindness. I pray that where ever he goes that grace goes with him. May kindness and compassion be with him always.

In all things give thanks,

David

Cambodia: Day 3 Sunday

A praise band, worship, clapping, singing, and a sermon from Pastor Don, started off the day. We attended Battambang Asembly of God church this morning and from there we moved into the first day of our medical work. We saw 80 patients in about 3.5 hours, with every thing running smoothly from registration right through spiritual counseling and pharmacy. The 4 of us who were examining patients, moved slowly at first, then picked up the pace as we got used to our interpretors and the types of illnesses that were being presented. We have a medical school graduate and a 3rd year medical student working with us. While the patients were being seen, the construction team put together a play ground set for the church, and the pharmacy guys and gals had everything organized so well, that the flow was quick and streamlined.
And of course,there is always a story or two. She is 24 years old, shy, and quiet. I saw her for complaints of headache and menstrual cramps, but knew that there was more to what she was telling me. With a little coaxing, Chhaiden my interpetor and medical student, got her to tell us why she really was there: she had been diagnosed with leukemia 2 years ago, and she was waiting to die. She wanted to know if her death was going to be painful, and if it was going to take much longer. I looked at her and thought no way she has leukemia. She was healthy, not anemic, and had lived 2 years with a diagnosis that kills within months without treatment. In questioning her more, she said that she had had a blood test that showed more white cells than red cells and they said she had leukemia and that there was nothing anyone could do. It had to have been a lab error, or a mis-interpretion of the values. She had lived for 2 years waiting for the end. I assured her that she did not have leukemia, and that she would live a long time. She simply said thank you, smiled, and walked away. I watched her as she went to get her vitamins and some ibuprofen for her menstrual cramps that I had prescribed, no emotion showing in her walk or face. You would think that the news I just gave here would have been joyous news, but after 2 years of waiting to die, I guess one has to take time to accept that life will be around for a while. I wonder if she was a little disappointed. Perhaps she had prepared herself, and now she has to look further down the road to a life that may not be much better than the death she had been expecting. Living in Cambodia is not for the faint of heart. She was ready for death. For you see, she had with her as well, a letter to her mother and father that she was going to give to us to pass on to them when she died. As she walked away, the letter that was clutched in her hand, disappeared into a trash bin and I wondered what she said in that leter to her parents. But on the other hand, I'm glad that they will never have to find out. Not for a long time at least, if ever...

In all things, give thanks,

David

Cambodia: the Start

Day 1:

We all make it to Phnom Phen, meeting at the airport, and finding Kelly (boy) and Mark Larson, 2 of the missionarys that we will be working with. Luggage makes it, everyone is tired, and it begins to rain. The end of monsoon coincides with our visit.

We check in to the Sunway Hotel which is right across the street from the American Embassy. A short period of rest and a shower, and we regroup for a team meeting with dinner at our favorite restaraunt, the Rendevous. The week ahead of us is full. After looking at the places we'll be going to, we may be seeing over 2000 paitents. The four of us who are medical look at each other and wonder how we're going to manage that. It is clear that the members who came to do some construciton may be working with the medcial team alot more than expected. Here's what is planned:

Sunday: Chruch in the am and clinic for church members in the afternoon: 125-150 patients
Monday: Dambok Kpus village - about 40 minutes by car, isolated, no electricity, bamboo huts: 400 patients
Tuesday and Wednesday morning: Prey Dach school and village: 700 patients
Wednesday afternoon: Salaa Hope school: 160 patients
Thursday: Ang school: 600-700 patients
Friday morning: Battambang AOG school: 50 students
Friday afternoon: flight back to Phnom Pehn

Saturday, Day 2:

The weather is overcast, with a hard rain during the night. I get on the internet and check the aviation weather for our area, and the airprots we'll be flying out of and to. The weather is marginal, but doable. I call Emil our MAF pilot and he has already flown to a pat of Cambodia in the morning and says that our flights today are doable. Becasue of weight limitations on the airplane, 2 members have to drive to BB: Mike and Tim. The rest are going to fly: 5 on each flight. I fly the first flight with a new MAF pilot from Australia, Paul, and we leave a little late. He is kind enough to let me do the flying, and off we go. The ceilings are at 2000 feet so I "scud run" the whole flight: flying just below the clouds. I flew at 1500 feet which gave us a great view of the country side. I skirted severeal heavy rain cells, and climbed once to get over a mountain ridge, but overall, it went well. The second half of the team came later in the afternoon.

We arrive at the clinic at Salaa Hope school to find members of the school and villages bagging meds. The next 5 hours is chaotic organization, with counting pills, labeling, bagggies, putting pills in baggies, sorting, and packaging. We ended up with over 26 suitcases, and rolling cargo cases of meds. By 3 in the afternoon, over 30 people were working on getting the meds ready for our first clinic in less than 16 hours.

A late dinner, and rest at the Golden Gate Hotel, our safe haven for the week: hot water, A/C. a bed, very slow internet, but internet all the same and thankful for it. All for $12 a night. You gotta love Cambodia.

In all things, give thanks,

David

Cambodia

I leave tonight for our Cambodia trip. I’m leaving before the team to go visit my father who is in Bangkok and will meet up with the team in Phnom Penh on Friday October 26^th. This is going to be an exciting and different trip. We will be flying MAF from Phnom Penh to Battambang, making 2 trips to get everybody there. Then it’s off to 5 villages and schools to see children and families, a little construction, and some new sites. I’ll be updating our trip as often as I can, so check back often.

 

Kelly

Don

Marcia

Pam

Joshua

Tanner

Sam

Mike

Jessica

Timothy

Jeremy

 

Be with us….

 

In all things, give thanks,

 

David