Tuesday, November 4, 2014

4- of patients and clinic experiences

"Though the dark brings grief,
And the valley is filled with the shadow of death,
There remains a greater shadow still.
       It is a deeper shadow.
       The shadow of the Almighty..

                   And in His shadow, there is rest."

This quote is hitting a tender chord with me tonight as I am tucked deep 
into the heart of Tanzania.  I am living in a very dark place that is full 
of grief.  This valley is most definitely filled with the shadow of death. 
 The power of Satan is real and sometimes it is entirely too easy to focus 
on the overwhelming sadness of the lives of the people I come into contact 
with every day. It can almost be easy to forget about the shadow of the 
Almighty that is much greater then the power of Satan. The more involved I 
become with the people here, the more their sadness and pain of wickedness 
burdens my heart.  What a relief it is to take those burdens and throw them 
on the shoulders of my heavenly Father who is much stronger then I am.

Much has happened since my last update, just over 2 weeks ago. Thursday, 
the 31st, Trudy and I bid farewell to Rachel and Rebecca early one morning 
in the cool Mbeya darkness, and began our own cycle of the day that took us 
back to our little home in the valley.  The next morning, Tim, Sheryl, and 
little Amy headed to Mbeya in their land rover to take care of some 
business, and along side of settling back in, we helped Teresa keep the 
house and the three boys that Tim's left behind.  If you remember from my 
last update, we girls had to pack up our main house in order for some 
renovating to be done while we were gone.  Well, it STILL isn't finished, 
so ever since we got back, Trudy and I have been living here at Zeiset's 
compound, and sleeping in my bedroom house at night.  All of our earthly 
possessions are piled into the little house as well, basically leaving us 
with walkways to our beds.  Yes, it's quite annoying at times, as I do find 
myself relishing order and the absence of clutter, but I'm learning that 
"in whatsoever state I am, therewith to be content." 
The first few days after we returned to Ivuna, I had a makeshift clinic set 
up between the kivuli (shade porch) and living room in Tim and Sheryl's 
house, but I quickly wearied of not having space and being so disorganized, 
plus when Tim's returned, I knew we would need to come up with a better 
option.  Since our house was no where close to being ready to accommodate 
patients, and the men have been working on fixing up another house Tim owns 
in preparation for being a clinic someday, we decided to quickly clean up 
that house enough to be usable, and move in!  It has been absolutely lovely 
to have a NICE clinic, with nice rooms, lot of room, and quietness.  It's 
fast becoming my little domain, and even tho we had patients amongst dirt 
and clutter, (we were quick trying to finish some projects) I was so 
thankful for the space.  I decided to ignore the piles of dirt and concrete 
left behind by the fundi. :)   I began painting some of the walls, and am 
thrilled with how fresh and welcoming it's starting to look.  Give me some 
time to add some Swahili teaching posters, and to paint a Bible verse in 
Swahili on the wall, then I'll send some pictures. 
Clinic.  You know, I knew I would be stretched, and I knew I would find 
myself out of my comfort zone, but more and more, I'm finding myself thrown 
into new situations and dealing with cases that I feel so unprepared for. 
 I am learning to lean even more heavily then ever on God, and it's very 
good for me.  It's hard to prepare to be the highest and only trained 
professional in a setting where there's very little back up...and to only 
be an LPN!  I'll admit I've had times when I've wrestled with a lot of 
questions as to WHY I ever felt I could do this.  But without fail, each 
time my wrestling all boils down to the fact that God has very clearly led 
me here, and He has promised His strength will be made perfect in my 
weakness.  I'm relying 150% on that promise.


They arrived on motorcycle.  Two motorcycles, actually- each one loaded 
with 3 people.  I was focused on another patient at the moment, and except 
for a fleeting thought of "oh no, this is something bad", I didn't think 
much of the group  until it was time for me to examine them and see what 
the problem was. They were ushered into the room, and as we began hearing 
the stories and I started pulling back kanga's and removing the coverings, 
my stomach dropped as I realized the extent of the burns we were dealing 
with.  The story went that the mother was carrying her child on her back 
when she "fell" into the fire.  What the truth is, we don't actually know, 
but I do know that either she was extremely drunk when it happened, or else 
she was kicked, to be as severely burned as she was.  It was agonizing.  It 
had been 2 days since the accident, and other then a little local "dawa" 
(medicine), absolutely nothing had been done for them.
    I bandaged the child first.  Little Miriam was small for her four 
years, and very cooperative, something I've not found much of in my young 
patients.  Her entire back and bottom, and mostly down the back of her legs 
was burned, as well as her one arm, and spots on both ankles.  I was able 
to get her well coated in B&W salve, and bandaged decently.
    Then I turned to her mother, and as the layers of kanga's came off, I 
realized we were dealing with an extremely severe case, and I estimated 
skin surface to be at least 50% burned.  I quickly saw that it was more 
then I could handle.  Maybe, if she would've come to me right away, I 
would've been able to heal her off with the B&W, but the delay in coming 
for help had set her back so far.  Her one arm was burned the entire 
circumference, thus was cutting off circulation to her hand, which was 
already double the size of her other one.  Infection was setting in, and I 
realized that if she didn't get help soon, she would be loosing that arm, 
as well as possibly her life.  I bandaged her as best I could, and gave 
clear, non-questionable commands to get her to town as soon as possible, 
then took a deep breath, and cried as I watched her get back on the 
motorcycle on which she had come.  Her seat was completely burned, and the 
thought of her riding that cycle was more then I could handle, but I had no 
better option to give her. 
    I've been bandaging Miriam for a week now, and am very pleased with her 
progress.  When we asked about her mom today, the ladies simply said she's 
still alive and good.  What that means, I don't know.  I only pray that 
she'll pull through.

This past Saturday was a very stretching day for me.  My first patient was 
a young, timid Sukuma woman, accompanied by 2 big men (the Sukuma are a big 
people!).  I first confirmed the miscarriage they feared had happened 3 
weeks ago, then moved on to the most important subject of her continued 
bleeding. Once again, I realized I was dealing with a case that was beyond 
my capacity to handle in my simple little clinic, and gave them 
instructions to get her out to a bigger hospital with more advanced 
equipment.  I felt so bad to be the bearer of bad news, and desperately 
wished I could help them more, as I felt I hadn't done anything.  But upon 
releasing her, the men (her husband and father), both couldn't thank me 
enough.  The father actually gave us an extra 1000 tsh on top of our normal 
500 tsh fee, "just to get chai and maandazi for all we did".  I was touched 
by their gratefulness and the obvious care they took over the dear girl. 
 Love and care to other human beings is something not seen very often in 
this culture, and it gave my heart a much needed boost to observe people 
actually caring for another person. 
     The morning passed with several other more routine patients, as well 
as some down time to study Swahili, then Trudy and I locked the clinic and 
headed to Zeiset's for lunch. I wasn't even done eating my rice and fish 
stew when a motorcycle showed up at the door with another pregnant woman in 
trouble.  I quickly finished my food and hiked the 10 minutes to the other 
side of the village where my clinic is now located.  Examination and 
questioning showed us that she had a hard fall the night before during a 
fight, and was in a fair amount of pain.  I used my doppler to find a 
heartbeat- which, PTL, was strong and healthy!  It took a lot of 
questioning until I finally realized that it was not labor pain she was 
feeling (she still had several months to go before her due date), but 
muscle pain from the fall, but I decided I wanted to observe her for at 
least an hour to be sure.  I got her comfortable on my clinic bed, sent the 
two men who accompanied her to kill some time, and settled in beside her to 
watch. She fell asleep immediately, poor woman, and slept hard the entire 
hour away, awakening feeling a lot better.  I prayed for wisdom as I 
watched her sleep, and when she awoke, decided to just strongly enforce a 
lot of rest with her feet up, as well as an immediate trip to a larger 
hospital should she begin labor pains.  Once again, I was showered with 
thanks for everything I had done, and once again I felt like it wasn't 
much, and I wished I could do more.  One of the other girls reminded me 
that in this culture where people aren't valued, showing some compassion 
and giving time can go a long way in making people feel loved and cared 
for.  I was thankful for that reminder, as I constantly am wondering how I 
can show love when I can't even speak much of the language yet.

Today I dealt with my first malnourished baby- 3 months and 4 1/2 pounds. 
 He made me so sad.  I worked with his mother for several hours, attempting 
to teach her how very important it is make him eat even when he's weak and 
falls asleep easily, (because she had milk, and he was still able to suck), 
and eat often, It's a desperate feeling to try so hard to get a naive 
mother to realize how important it is, especially when the life of her baby 
was laying very close to the edge. 

My mornings are spent actively involved in the clinic, and I'm often 
mentally and emotionally weary once the morning is over, but I love 
dropping in at Joyce's to greet her and squeeze baby Beatrix... or in at 
Mama Wini's to give little Silivana a hug.  I love "my" babies, and won't 
miss a chance to squeeze them, and to greet their sweet mama's.  I love to 
throw the mat out in the shade of my bedroom house and "study Swahili" 
there, but more then happy to be interrupted by the school students walking 
by on their way to and from the river with water, or any other neighbors 
who happen by. (Unless, of course, it's an annoying man, then I'm all too 
pleased once he's on his way.)  I blunder around with my limited Swahili, 
understanding much more then I can begin to form into words myself.  I love 
throwing the mat out in Tim and Sheryl's courtyard after dark and 
journaling by the light of the candle and the current full moon.  Until the 
journaling is discarded in favor of a heart to heart chat with fellow 
laborer's- don't ask how late Teresa and I were out there the other 
night!:)  So yes, I feel overwhelmed on a regular basis, but I also find so 
much joy and fulfillment in my life that the good times tend to outweigh 
the bad.  
Pray for me as I relate to the many people that fill my life- whether it be 
my patients, the neighbors, the young people, the countless children, or my 
fellow missionary team.  God is refining me greatly and I'm finding some 
rough edges that I didn't realize were there, and while I'm thankful for 
that, it's not exactly easy.  I need wisdom and patience beyond my human 
capacity, and am so VERY grateful to serve a God who never changes, even 
when life seems to change daily. 
God bless you today!
Kim

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