May 22, 2016
We hope all of you are enjoying the springtime. May is such a lovely time of new birth…the flowers, fruit trees, baby birds and the animals. The Karnes’ are no exception. On May 6th we welcomed our newest grandchild, Kallie Jill Karnes into the family. Kallie is David and Betsy’s third child and rounds off our biological grandchildren to ten!
Since coming to Ethiopia the national maternal mortality rate has been remarkably reduced, in fact cut in half. But the sad fact is that even now throughout this country one mother dies every hour somewhere due to complications from giving birth. Motherhood is serious business here.
You may remember in a former newsletter I talked about our frustration because we do not have enough blood for our patients. It has not changed much. Our blood shortage had a sad outcome two weeks ago when we lost a mother to postpartum hemorrhage. Our medical director, Dr. Sok, has tirelessly and fearlessly worked to get us more blood from the government. This week, due to her heroic efforts and making the tough decision to put the hospital on bypass, meaning we could receive no new patients, we finally received an additional 40 units from Addis Ababa, the capital. This will only last a very short time, maybe a week, but the govt. has reassured us that things will get better. I am grateful that we received that blood because we have already used it on several patients and it saved the life of another mother earlier this week who has received five units of blood so far.
Another maternal killer here is pregnancy induced hypertension and its associated complications and sequelae. Last night at 10:30 PM I was called to the emergency room to see a comatose women who had delivered one-week prior at another hospital. She had been induced for severe preeclampsia and her baby died after two days of life. She had hemorrhaged and had received one unit of blood at that hospital. They were out of blood so they referred her to the Black Lion Hospital in Addis Ababa, which is the largest teaching hospital in the country. The family felt that she was not improving so they took her home. She became unconscious 24 hours before I saw her. When I arrived in the ER her family were all huddled around her. Her pupils were dilated and only responded very minimally. She was totally unresponsive. An ultrasound of her liver revealed that it had liquefied and become necrotic. Her hemoglobin was 5 and her platelets were very low. I explained to the family that she was critically ill and was in liver failure, kidney failure and severely anemic and unless God did a miracle she probably would not survive. I told them we would admit her to our ICU and give her supportive care to see if her body could recover but from my experience in my past I was very doubtful. The family decided to take her home and I told them that that was not a bad choice.
The word has gotten out that we have blood at our hospital and we have been receiving many patients from other hospitals because they believe we have blood. We lost another patient two weeks ago when the referring hospital, thinking that we had blood, sent us a critically ill patient in urgent need of a transfusion. But the word on the street was wrong…we had no blood.
One of my saddest cases happened last month. I admitted a critically ill patient at 17 weeks gestation. She had severe hypertension with blood pressures ranging well over the 180/120 range. We kept her in the hospital and watched her carefully. Unfortunately her condition deteriorated to the point that she was going to die if she was not delivered. For the first time in my medical career of over 36 years I had to terminate a pregnancy to save the life of the mother. She was 23 weeks plus 5 days. After the procedure the mother continued to spiral down and her kidneys failed. We sent her to a larger hospital three hours away in hopes that they would perform dialysis. I do not know the outcome.
I am very grateful that Dr. Nate Ross, an OB/GYN from Alabama, and his wife Sheryl are spending this month helping us out. He went with me to the ER last night after which he went to the OR to perform a C-section on another patient who had been referred to us with preeclampsia and in need of blood.
We have had some wonderful success stories as well with the delivery of one mother six weeks early who also had preeclampsia but has gone home with a live baby. Dr. Ross has been a Godsend to us. We also have a new GP, named Dr. Sifora. She has spent the past month with me in OB and has been a wonderful asset to me. She is a recent graduate of medical school in the Philippines and would like to become an OB/GYN in the future. Dr. Sheryl Ross has her PhD in leadership and has been giving leadership training to our nursing, administration and chaplain staff. Because they are here it has made it possible for us to take some time off. We hope to go to Gondor to see our Ethiopian son who is in the university there and on to Axum where we will check on another university student.
Allison speaking: Having a little extra coverage in April by Dr. Bierte from Norway, made it possible for us to take a trip to South Africa to see our kids. Miriam and Chris have bought their first home, an older house with a very substantial yard and lots of possibilities. I think Miriam had been thinking before we got there about all the jobs she was going to assign us. But we like to keep busy. Mark helped Chris with clearing the yard and also hung two tree swings from a massive mulberry tree. I sanded and painted a large jungle gym and also painted 108 French door windows:) The grocery store is always one of our highlights because there are so many foods in the store that we do not get in Ethiopia. It’s easy to want to buy everything in sight. One day I overheard our six-year-old grandson, Mark say to his sister in his cute South African accent, “I love to go to the grocery with Grandpa. He buys us everything we want!” It was pretty true, Diet Coke, chocolate candy, potato chips, yogurt, apples, broasted chicken, cheese, crackers, ice cream, etc. One interesting side note to our trip to South Africa was that we were invited to do a short television interview on the morning news show. Our connection was Miriam who happens to train the news anchor.
Coming back from South Africa presented a few challenges with WRAPS. Inge, my partner, had to go back home to Norway for some family problems. The local transformer went out so we were without electricity at our factory. The only way to keep sewing was to move all five girls into Inge’s house. The power just came back on after two months and we will move back up to our factory next week. On the positive side, because the girls were sewing next door, I was able to do some work with the gardeners at the hospital. It’s Spring time here also and we do all of our landscaping projects in May. We had our last school outreach at another Soddo rural school with Wraps. I felt like it was our best outreach so far. Each time we go out to the schools we learn from our past experiences and seem to get a little better organized.
Mark’s clinic is very close to completion. We are putting in the sinks and hanging the cupboards this week. The tiled floor is in and most of the painting is completed.
Thank you all for your prayers for our work, your prayers for our health and well-being and your sacrificial donations to our work. We cannot do this without you.
Mark and Allison
Dear Friends and Family,
The ward is full to overflowing. The four bed wards now have six beds and the hallways have become a patient ward. We are anxious for the new clinic to be finished so that we can add seven beds to the OB ward. Yesterday I called Allison to see if she could locate the new iron beds that were made by the welder. They are not totally finished but I was desperate for more beds. I have seven major surgeries scheduled for today and I’m sure we will be interrupted for emergencies. Usually during this time of year we are checking the standings of our favorite college basketball teams and hoping they can make it past the initial first round. But this year my March Madness is a little different. I call it Soddo March Madness.
In February Mark attended the annual meeting of the Ethiopian Society of Obstetricians and Gynecologists. They met at the Hilton in Addis Ababa. Mark is the only foreign member of the academy. Can you find him?
We don’t talk much about malaria. Because Soddo is at such a high altitude we do not need to take malaria prophylaxis. Even though great strides have been made with treated mosquito nets and sanitation, malaria still rears its ugly head in parts of the country.
The baby’s name is Meherit which means mercy. Her mother came to us from the rural area suffering from cerebral malaria. At the time of admission she was incoherent. It quickly became obvious that Meherit was in trouble. We did an emergency CS and amazingly the baby survived. She required oxygen for several days. Her aunt came in to care for her. Unfortunately, the malaria took its toll on her mother and she was unable to recover. She died without ever seeing her daughter. Just before Meherit was born we had another patient who had typhoid fever and delivered at home four days earlier. She was also acutely ill and died of a ruptured bowel with overwhelming sepsis. Her baby was also cared for by family members in our OB ward. Both of these patients were cared for with our maternal benevolent fund.
On a more positive note, a woman came from a health center after being fully dilated for four hours. They had allowed her to labor even though she had a previous classical caesarian section. This means that instead of the incision being horizontal on the uterus, it was vertical, which puts the patient at much greater risk for uterine rupture. This is only the second case that I have seen where the uterus has ruptured and the baby survived. Her little girl was out of the uterus but the umbilical cord was still attached and there was just a thin layer of peritoneum near the patient’s bladder that had not given way which allowed the baby to survive. It truly was a miracle. Today I advised the parents that they should name their daughter Tamarat which means miracle, for it truly was a miracle that this baby survived. I also stressed to them that she must NOT go into labor if she has a subsequent pregnancy and that we would deliver her baby three weeks early.
I have also stayed busy doing a lot of prolapse cases. Uterine prolapse is a significant problem in this country. I am doing around four cases per week. All of these are funded by the Canadian Foundation, “Mother’s With a Heart for Ethiopia.”
In February Dean and Colleen Wolf paid us a visit. Dean is a contractor and he came out to do work on the OB ward. We remodeled two private bathrooms in the ward during his 3-week visit. It was eye popping for Dean. A simple 5-hour ceramic tile job in the U.S. turned into a five-day job here! By the time he left though the bathrooms were looking much improved. Thanks so much to this sacrificing couple! (Colleen hates her picture being published so I didn’t include one:) This past weekend we joined the Charlottesville Community Church in the lakeside town of Hwassa where we had a missionary staff retreat. It was restful and enlightening.
A great big heart felt thank you to the North Muskegon High School Interact Class that raised over $4000.00 for the hospital. Under the direction of Mr. John Slocum, a teacher and long time friend, they poured their hearts into a fundraiser for us. We are humbled and blessed to have you part of our team. This money will be used for the remodeling of the OB ward and the furnishings in the new clinic.
(The North Muskegon Interact Class sent T-shirts to our OB staff. Here we are posing outside of the OB ward. We made a short video for the fundraising event, ending with the chorus, “Go Norse!”)
WRAPS Update: This week WRAPS went out to a rural school to teach and give out our product. Funded by a grant from the Canadian foundation, “Mother’s With A Heart for Ethiopia, we packed 5th, 6th, 7th and 8th grade girls into a small library over two days sharing our product, feminine hygiene and encouraging the girls to stay in school. I asked each class of girls, before I began to speak, what they had done that morning. The school started at 12:30 PM. I asked them if they had access to water. They all nodded their heads in unison. I asked if it was far. They said, “No, it is not far. Just 15 minutes walk. Before school that day the girls had gone to the stream to fetch water. They had chopped firewood for their mothers, taken care of the small children and helped their mother prepare food. More than half of the 8th grade girls did not come to school the day that we were there. When they finish 8th grade at this rural school their only option is to go to Soddo, a 15 minute drive, where they can begin 9th grade. I asked them, “Will you go to Soddo to school?” They said, “Yes.” I asked them if they would live in Soddo or take a taxi?” They said, “No, it is not far. We will walk to school. It is just a 30 minute walk.” That being said, you have to really want to succeed in school to make it out of the 8th grade. I have no illusions that Wraps is going to change the world. We are doing our best to solve one sliver in the layers and layers of issues that crush a girl’s educational goals. Each kit costs $7.00. We gave away these kits. If you feel the urge to help us out, you can give to our project at Globaloutreach.org. Hit the donate button and click our name and account #3020 and specify for WRAPS. 100% of your donation will go to WRAPS. Thanks so much.
Thank you for your prayers, faithful contributions and your outpouring of love. There are days when we wonder if we can keep up the pace. The nights when Mark doesn’t return from clinic until 9:00 at night and then has six major surgeries the next day, we question whether we can keep going. Your prayers sustain us. If you know of an OB/GYN that would like to come and help us out, please drop us a line.
For the kingdom,
Mark and AllisonM
Mark has been exceptionally busy this last week. He has had two women with ruptured uteruses and dead babies due to prolonged labors at home, several sad cases of advanced breast cancer, tuberculosis, and many high risk deliveries. He is also preparing a chapel sermon on prayer. Wow…the timing for that sermon is perfect. As you know, we have been coveting your prayers for Dr. Gray. We thank you for your encouraging emails. We know you are behind us and that helps us to keep going. As I said, this has been a difficult week. Today, because Mark is so busy, I’m writing the newsletter to tell you about one of his heartbreaking cases.
Allison speaking: My heart is breaking. Today Mark delivered twin baby boys from the young mother who is paralyzed from the chest down. We had hoped that she could make it another week or two but she went into labor this morning. Why is my heart breaking this time? We see so much tragedy here one might think that we become immune to poverty, sickness and injustice. And sometimes it seems that we do. But God has a way of breaking our hearts and remolding them, creating a vulnerability that can be painful yet healing. This patient, named Tamanyn, which means honest, came to the hospital approximately 5 weeks ago. She had experienced severe back pain in her upper spine and then lost all feeling and movement from the chest down. But getting to our hospital isn’t quite as easy as driving across town on a fast interstate highway. She had to be carried from her tiny thatched house, into the village and down the rocky mountainside to the small town where they took a crowded taxi 250 Kms. to our hospital.
Now backspace one week. Sara, the chaplain, and I went to visit Tamanyn last Thursday. Because she is a country girl from a distant tribe, she only speaks her native language. But even though she could not speak Amharic, her beautiful smile spoke volumes. Her husband translated as we told her that we wanted to spend some time praying for her healing and for the babies. We made her comfortable (she needs help just turning over or moving in her bed) and then anointed her with oil and began to pray. I wish I could say there was a miraculous healing but there wasn’t.
On Tuesday Tamanyn went into spontaneous labor and delivered the twins by Cesarean section. In the states when our babies are born we have baby showers and baby gifts. It is not uncommon for our beloved children to have enough newborn clothes to never wear an outfit twice. Tamanyn and her husband are desperately poor. They are being sustained by our maternal benevolent fund. These perfect twin boys had absolutely nothing to wear. Not a diaper, not a shirt, not a blanket. Nothing!
When Mark told me the babies had been delivered I went into town to purchase some clothing for them. My Muslim student, Semira and I went to several shops looking for anything that would fit newborn twins. The pickings were slim. We bought four outfits, some rubber pants, baby lotion and soap. When I got home we packed a box with the new clothes, two baby blue blankets from Muskegon High School and two little baby blue hats knitted by one of our supporters. We also tucked in some cookies, oranges and juice boxes and headed up to ICU. Every bed was full so the ward was teaming with visitors. There are no walls or drapes in ICU. All patients, male, female, babies and children are in one large room. Our patient was in the last bed. She was lying flat on her back, still sleepy from her general anesthetic. Her husband stood quietly by the bed. She smiled when she saw me. I bent down and kissed her softly on the forehead. “They are beautiful,” I told her. I walked around the bed to the bassinet where the little boys lay completely naked under the faded surgical drapes. They were sound asleep, facing each other, oblivious to the cruel world that awaited them. I gently peeled back the drapes from their faces so I could have a look at these sweet babies. “They look like you,” I said to the husband. He smiled. They asked me to pray. I choked back the tears as the reality of their future slammed into me. She is a paralyzed country woman, uneducated, with twin boys to raise. It’s one thing to use a wheelchair on the sidewalks at Soddo Christian Hospital. It is quite another thing, however, to negotiate rocky mountain trails, uneven dirt floors and grass paths.
Today the gardeners and I took a donated wheel chair out of one of our hospital storage containers and brought it to Tamenyn and her husband. It is sitting in the corner of her room, a stark reminder of her paralysis. We continue to pray for complete healing. Yesterday Mark started her on high doses of steroids. He had to wait until the babies were born to begin this treatment. He is also treating her for tuberculosis. We will wait and see and hope…but in the meantime, please join us as we continue to pray that she will walk again.
Mark and Allison
Dear Friends and Family,
Here is hoping that all is well with you. My beautiful wife is back home with me in Soddo. Hooray! It is marvelous having her here, unfortunately she contacted a cold in the USA and has been quite sick this entire week. Harry and Donna Brown are here, arriving a couple of days before Alice. Harry recently retired from teaching computer technology and television at Muskegon Community College. With his expertise he was able to help me purchase some important equipment for our ultrasound while in Addis Abba. He also is working on filming a documentary on Soddo Christian Hospital. In addition to the Browns, Nardos and Azariyas (two teenage children from our Addis Abba Ethiopian family) returned to Soddo with us to spend a few weeks of their summer holiday in Soddo.
I want to give you an update on Tesfenesh. Tomorrow she will have been here three weeks and is still very critical. Two weeks ago when I wrote to you about her I mentioned how attentive to her her husband had been. Well, I was mistaken. It is her young brother who has been by her bedside day after day. Her husband has stayed at home stating that he does not have enough money for transport to the hospital.
Seven days after her operation her skin incision broke open spilling a large amount of pus. At that time her temperature came down and she was able to take a few steps. We were very encouraged and hopeful for her. Now, after an additional week, her fascial incision has come apart. In fact, her fascia (the fibrous connective tissue that keeps the internal organs inside the abdomen) totally disintegrated. When taking off her dressing, her rectus muscles are visible and today I can see straight through to her uterus and intestines. There is nothing between her internal organs and the dressings that we change every three hours. She is too ill to take back to surgery and there is no tissue that we can put together over her internal organs. We will have to wait until her body produces a protective lining and covers them on its own. Months later, if she pulls through, we will take her back to surgery and repair her hernia. Yesterday she received another unit of blood. She is extremely anemic and has a high fever. Her Foley catheter is still in place draining most of her urine, but today she started leaking urine from her vagina for the first time, indicative of the formation of the dreaded vesicovaginal fistula. She does have muscle control over her legs but has no control of her bowels and soils her bed often. Please continue to pray for her.
This past week we have been very busy with many deliveries and surgeries. I rounded on 18 patients yesterday. We have had two sets of twins in the past 24 hours and many other challanging cases. One 22 year old woman died of metastatic cervical cancer this week, but we were, however, able to operate on a 25 year old with ovarian cancer and are hopeful that she will survive.
Please continue to pray for Tefenesh and that God will give us wisdom in knowing how best to care for her and the other patients that he sends our way. Thank you for you generous donations to our maternity benevolent fund. Her entire care is being underwritten by that fund. Thanks also for your words of encouragement. They mean so much to us.
Greetings from Soddo. This week has been very different for me. A lot of my energy has been focused on one patient who I will talk about later. Also, Alice and I celebrated our 37th wedding anniversary June 8th, but on separate continents. This was a for for us. Usually we spend a couple of days going to a bed and breakfast along Michigan’s beautiful west coast. Alice spent the day returning home to MI from Waco, TX where she had been with David, Betsy and Jack David. I really missed her but was grateful that she could be with our kids and new grandson. It was a blessing that she was there because Betsy became very ill with gallbladder stones and spent four days in the hospital undergoing two surgical procedures. While Betsy was in the hospital, Alice took care of Jack David who is now two months old. Betsy is now recovering nicely and Alice has re turned to Michigan.
Monday afternoon upon returning to the hospital from lunch, I was informedl that a patient had just been admitted to our “ICU” with a ruptured uterus. I went there immediately and found a young 15-17 year old girl (no one knows how old they are here), who was exhausted and frightened. Her abdomen was distended and rock hard and looked similar to a two humped camel’s back. There was no heart beat because her little boy had died at least two days earlier. She hasd been in labor several days and had ‘pushingn down pain’ for three days. . She was feverish and her baby’s face was presenting at her vaginal opening. His nose and dmouith couild be seen there, which is termed a face presentation. She was septic, meaning that she had a life threatening infection. We immediately took her to surgery and opened her abdonmen. Upon opening it, we were met with a foul stench that filled the room. .It was one of the most difficult cases I have ever encountered. The head was entrakpped within the p elvis making the baby very hard to deliver. The baby’s skin had already begun to slough off and as we attempted to deliver him it partrially peeled off in our hands. Finally, afater muich stgruiiggle and maneuvering, we were able to extract him fromhis hyoung mother. He was placed in a cardboard box on the operating room floor. Next we had the task odf piecing together her sheredded uterus. Since she had been in labor for such a long time the lower uterine segment was str etched out paper thin and torn. It was like trying to sew butter or Jellow together. The Ethiopian surgeons automaticallyt perform hysterectomies on any patient with a uterine rupture but I have found that the patients do better if we can save their uterus if possible. Hers was extremely challenging for several reasons: she kept losing a lot of blood, her uterus would not clampdown, and she was severely infected. Her postoperative course has been very rocky and she is acutely illto th is day and still may not survive. She has a high fever and labored breathing. Her lungs sound terrible alnd we are afraid she may be developing a pulmonary embolism. We cannot give her Heparin because, No. 1, we do not have enough of the medication, and No. 2, we have no way to test her clotting lev els. We have started her on Aspiri,k our only available treatment. She has received blood tranbsusions from three relatives, Dr. Michele, our visiting resident from Muskegon and myself. Her legs are swollen and ulcerated. They look similar to an elephants. She has no bowel congtrol and is unable to walk due to nerve damage from the baby being trapped in the pelvis for such a long time. Her Foley catheter will be in place for several weeks (if she survives) due to the fact she has no bladder control. Hopefully, she will not develop a vesicle-vaginal fistula. Her husband has been very supportive. Please joinus in saying a prayer for her. Her name is Tesfenesh, which means hopeful. In the future, hoopefully I can share somen of our other patient’s stories but hers is the most pressing at this time. Thank you for your prayers and encouraging words.
PS. After writing this I went to the hospital and Tesfenesh is doing some better. We are “hopeful” for her recover!
Today we are celebrating life and the resurrection of our Lord. Happy Easter everyone. This week we have experienced the depths of despair and the heights of joy.
- Our fourth maternal death: On Friday Stephanie was working at the government hospital when a young teenage mother came in in an almost comatose state. She had been in labor for four days and her baby was dead but undelivered. She was brought in by her brother because her husband had abandoned her during the pregnancy. Both she and her brother were orphans themselves. He had less than three dollars to his name and did not have the necessary money for her medications. The government hospital refused to provide any care for her until he could bring a paper from his local government substantiating his financial situation. This, of course, would take too long. Stephanie made arrangements to bring her to Soddo Christian Hospital because we have, at least, a benevolent fund which takes care of these patients during these circumstances. Many of you have given to this fund making this a possibility. Stephanie called me saying she was bringing the patient over and was going to have to perform a destructive delivery. After this gruesome procedure she was examined and it was thought that her uterus had ruptured. In actuality, her uterus was like a stretched out balloon and had no contractility to it. In an attempt to save her life, she was taken immediately to surgery, while three visitors, two medical students from England and Kim Hardy from Grand Haven donated their A+ blood. At the time of surgery her stretched out uterus would not contract and was necrotic from severe infection and prolonged labor. We performed a hysterectomy removing her necrotic foul smelling uterus. The blood loss and the infection were too overwhelming for her little body and she died a few hours later in our ICU. This death could have been prevented had she not waited so long to seek medical attention…but the reality of her death is that her extreme poverty contributed to her ultimately death. For more on Meskeram’s story please see Dr. Stephanie Hail’s blog site at: www.drhail.wordpress.com
- Ovarian Tumor: Earlier this week we operated on a patient with a massive ovarian tumor larger than a basketball. The outcome was postive and the patient recovered and did very well. She had lived carrying this tumor inside her for seven years. You can see pictures of this tumor at our blog site at www.soddospecialdelivery.org. Go to the gallery at the top of the page and click on it.
- Kim Hardy: We are very happy to have Kim Hardy, ultrasound and X-ray educator from Grand Haven, MI staying with us for five weeks. Kim has been patiently instructing me and my midwives and nurses in ultrasonography. She is also working with the techs in the X-ray department helping them improve their imaging in both X-ray and ultrasound and in orthopedics working with Dr. Anderson in performing nerve blocks. Yesterday she went out to a rural clinic with Dr. Mary Vanderkooi. Not only did she bring her teaching skills to Soddo but also carried a suitcase full of suture and other much appreciated items including colorful hats for our OR staff that had been made by our OR staff back in Muskegon. Alice is thrilled to have a bottle of Oxyclean to clean my dirty white coats!
- Teaching: Alice loves her new job teaching English at the private high school near the hospital. She goes Monday through Wednesday from 3:30-5:00 P.M. helping 10th grade students to prepare for the important national examination they will take in June. This test determines whether these students will continue on to the 11th grade and possibly university. If they fail the test their formal high school education will be over and they can move on to either vocational schools or choose to quit. Alice stated, “I really become alive in this classroom.” She is continuing her work at our small school on the hospital compound as well as overseeing our hospital gardeners.
- Easter: Easter is a big holiday in Ethiopia and Soddo in particular. I asked our Amharic language teacher, Paulus, how the Christians here celebrate Easter. He said that a good majority of Christians spend all day Good Friday in fasting and prayer at their various churches for about 12 hours. On Saturday night they gather at their individual congregations at 8:00 P.M. for an all night praise/prayer service. At 4:00 A.M. Easter morning many of the churches gather at one place for further singing and praying until dawn at which time they return to their various churches and have services until about 11:00 A.M. Afterwards they return home for a special holiday meal. All of the homes are decorated with grass for the traditional coffee ceremony and many of the bajoj’s (mini taxis) are decorated with palm branches. Paulus asked me how the ferengis (foreigners) celebrate Easter. I was too embarrassed to mention the Easter bunny, colored eggs, chocolate candy and fancy new Easter garments. Our Easter this year was very different. For the first time we experienced a Seder meal. A Seder meal is a meal designed by Messianic Jews celebrating the traditional Passover meal but also tying the scriptures to Jesus, the Messiah. We celebrated this on Friday night sitting on blankets and pillows in our lapa (traditional thatched house) with all the missionaries. Earlier that morning Alice and I had the privilege of praying and worshipping with our Ethiopian brothers and sisters in church. One of the hospital workers helped translate for us. Our friends, Elizabeth and Peter came from Addis to spend the weekend with us. Early this Easter morning we woke up at 3:30 A.M. and walked a short distance to a local church where we worshipped with about 150 young people gathered outside in the church courtyard. A large bonfire was blazing and a live band played praise music as the kids worshipped, singing and dancing. It could have almost been an American youth group except that the girls danced with the girls and the boys danced with the boys! At dawn, while walking home, it was thrilling to hear the echos of worship coming from all quarters of the town as people lifted their voices in praise to the ressurrected Jesus. Later this morning we worshipped with our Soddo Hospital missionaries singing many traditional Easter songs followed by a delicious brunch in the lapa. Alice made her traditional hot cross buns. Later today we visited with friends and then I was called back to the hospital to take care of a woman who was hemorraging internally due to a ruptured tubal pregnancy.
- Thank you for your continuous prayers. We covet them. Love, Mark and Allison
What a week we have had! This week started last Sunday when we met Oom Bole (pronounced Um Boley), a 103 year old soldier and servant of Jesus. We felt so humbled to be in his presence, a great man of God. Please read Alice’s blog below to learn more about him.
We had our third maternal death this week. A young mother, 8 months pregnant, came in with convulsions in the night and died of cerebral malaria. On Friday I operated on a young woman with a large abdominal mass and was saddened to find that she had extensive metastatic ovarian cancer. She has five children, the youngest being three years of age. Her tumor was so extensive it could not be removed without killing her in a very short time. After closing her abdomen, we went out to tell her husband and he just cried and asked us to pray for him and his wife. We did. I sent her back to her village yesterday and prayed again with both of them. She looked at her her crying husband and said softly, “Don’t cry.” This truly has broken my heart.
Early one morning I was called to see a patient with a “ruptured uterus.” Upon arriving in the ward I was surprised to find that there was still a fetal heart beat. She had been in hard labor at least 36 hours previously at a rural health center. Her uterus actually had not ruptured but the baby’s head was impacted in her vagina sideways and could not be born. This was one of the most difficult Cesarean sections I have ever performed. I really did not believe the baby was going to make it. Her uterus was so contracted and the baby impacted within the vagina making delivery even by Cesarean section extremely treacherous. Baby was born lifeless but after fifteen minutes of resuscitation the baby started crying. He is now eating well but is jaundiced and is not able to move his right arm. His mother is leaking urine continuously and has developed a vesico-vaginal fistula. Both, however, are alive. She has a good possibility of being cured in the future.
The highlight of the week was when a Muslim couple in their mid forties came in for their six week check-up after she had had her ovaries removed as well as her uterus for ovarian tumors and pelvic adhesions. We thought that she most likely had cancer but the path report came back from Addis revealing no identifiable cancer present. The couple, as well as myself, were very relieved. They were so grateful and said that they had been to many hospitals and no one had helped them. My midwife, Addis, told them that we were here because of Christ and asked them if they knew about Jesus. They said that they had heard of him but like Mohammad knew he was now dead. But she went on to tell them that, no, he was not dead but alive and had risen from the dead and was the reason that she had hope for the future and eternal life. She shared her own testimony how Jesus had helped her and given her hope. My patient’s husband said, “We want this kind of hope.” Addis told them that they could have this hope by believing in Jesus Christ and putting their faith in Him. They said they wanted to do this and then he spontaneously got on his knees and prayed, lifting his hands towards heaven and receiving Christ. Their joy was palpable! Addis said that she had a book for them with the words of Jesus. She asked if they would read it and he said yes. She gave him an Amharic Bible. She also shared with him the importance of finding a church where he could hear the words of hope on a regular basis and meet with other Christians. He stated that there was a church near his home and they would attend. This couple seemed sincere and were thrilled to meet our Savior.
As you see, living here brings sorrow and gladness. We have had many healthy babies to be born and now to have new babes in Christ…what a blessing!
You have agonized with us over the saga of Dr. Stephanie’s license medical license. You are aware that she would only be given a license if she worked at the government hospital here for one year under the supervision of an Ethiopian gynecologist. We met with him last Monday and she started working there the next day. He is very happy to have her to share in the work load. We still do not know what this will mean for us at Soddo Christian Hospital, whether she will be able to work any of her time here. This has been an adjustment for both of us. Stephanie will be a blessing wherever she works. Thank you for continuing to pray for us and for your words of encouragement. God bless you. Mark
March 28, 2011
God’s grace has been much more tangible to us since coming to Ethiopia. It was never more apparent, however, than on Wednesday of last week when our grandson was born. Jack David Karnes entered the world at 5:55 A.M. in Waco, Texas weighing 8 lbs. 10 ozs.! He was 21 inches long. David and Betsy are the very proud parents. Jack David is the first male Karnes of his generation. Even though we are bursting with pride his birth didn’t come without some frustrations and tears on our end.
Mark makes an attempt every week to try and take off Wednesdays. So far, this has never actually happened, but this week it looked like a good possibility. We went to bed Tuesday night knowing that Betsy was having regular contractions and that she had visited her doctor that morning and was dilated to three. We told them to call us when they got to the hospital. About four in the morning the land-line phone rang in the living room and Mark leaped out of bed to answer it. No one was on the line. Suspecting that it might be the kids trying to reach us, we went online and logged into Skype. If you are not familiar with Skype, it is a free program that allows you to chat face to face with your contacts or just chat like a telephone conversation. We are able to talk with all of our children by using Skype. In fact, Skype is the only way we have to telephone the states. Like you, we have become very dependent on our Internet working. But unlike you, this is virtually our ONLY way to communicate overseas. We do have cell phones and a land line but they are VERY expensive to use and would only be used in an emergency. We called David and sure enough it was him trying to call and let us know that they were at the hospital.
About the same time Soddo hospital called and Mark had to leave to do a cesarean section. I went back to bed but couldn’t fall asleep. I began to pray earnestly for Betsy and our grandson. God gave me such a beautiful picture as I prayed. He showed me that He had His hand on our grandson enclosing Betsy’s abdomen and then a picture emerged of His great wings extending around David, Betsy, and her mother, Jill. The feathers on the wings were so vivid, each one detailed with such pinpoint accuracy. I was surprised by this realistic picture but the Lord reassured me of His deep love for my children and that He was in control. In the morning, during my quiet time, my scheduled reading (I’m reading the Bible through again) was Psalm 91. One verse leaped out: “He will shield you with His wings. He will shelter you with his feathers. His faithful promises are your armor and protection.” Psalm 91:4 I did not know then that that vision and verse would sustain me throughout the long day.
We were able to chat again on Skype in the morning and she was dilated to 6. I went to the school to teach my scheduled lesson but took the computer with me for I had prepared a lesson on crocodiles and I needed my pictures of our weekend trip to share with my class. I kept the internet on, however. Mark stayed at home. When I returned from school around 11 he was pacing. Oh how hard it is to be an OB/GYN when your children are delivering and you cannot manage the case! We got back on Skype and Betsy was dilated to 8! He began to fret, just a little. “What station was she, why hadn’t she progressed faster?” It’s just so hard to micromanage an OB patient from 10,000 miles away. Just as we tried to Skype back with those questions, the Internet went out. We tried again and again, but it would not connect. All of our plans to be with our kids when our grandson was delivered fell apart. These simple words cannot adequately convey our frustration. The Internet stayed down for 6 hours! Mark left for a planned hospital meeting and during that time David called on the land-line with the news. We told him that our Internet was down and he said he figured as much. Four long hours after that it finally came back on and we were able to see our family.
This was the first time since coming to Ethiopia that I felt we had really sacrificed something to be here. We wanted so much to be part of the delivery experience and see little Jack enter the world. But God, in His goodness and knowledge, knew beforehand that it would not happen. I am so thankful for the picture He gave me during prayer that our children were in His loving arms. It was the Lord’s loving grace that sustained us during those long tedious hours when there was virtually nothing we could do. Living in Ethiopia, where events can spiral out of control very rapidly, has definitely allowed us to feel the grace of God on our lives in a much more realistic and tangible way. Even though we grieved because we could not be there for Jack David’s birth, the reassurance of God’s love and tenderness in our life was a lovely lesson to learn.
This past week has been the week of the preemies. We have had five. The three smallest of these weighed in at 1.1 kg., 1.3 kg., and 1.7 kg., respectively. With these very small babies come some big challenges to keep them alive. There are multiple reasons for this. The first is that their skin is so thin that they lose heat quickly and cannot maintain their own body temperature. Secondly, they have not acquired the suck reflex so cannot eat from their mother’s breast or bottle. Also their lungs are immature requiring oxygen. They are also more susceptible to infection.
I have been so grateful that Stephanie has been here. She has really taken on the challenge of caring for these little ones. Since we do not have a functioning incubator, we converted one of our patient’s rooms into a preemie nursery. Here we have radiant heaters to keep the room warm. We keep the doors and windows closed so it is quite toasty inside. When the babies get cool their oxygen levels go down and then they start having seizures. Also these little ones have tiny veins that require IV fluids at very slow rates. Initially we did not have any NG tubes that were small enough for them but by scrounging around the supply room we were able to find some expired ones which are working quite well.
Speaking of Stephanie, we spoke too prematurely about her license. We had been told that it would be issued next month. Well, that has changed. The powers to be have now stated that she has to work at the government hospital here in Soddo for one year before they will grant her an Ethiopian license. She will have to work under a young Ethiopian gynecologist who also recently finished his residency. Words cannot express how disappointed we are with this decision. On the positive side we are happy that at least she can work in Soddo and not in Addis but we really do not know how this will all play out. We are awaiting the official letter with the government’s directives concerning this issue and then will meet with the doctor at the other hospital to finalize details. Until then she can continue working with me at SCH. We have to trust God in this matter but would really appreciate your continued prayers regarding this and for Stephanie.
On another note, the DeBrabers left Soddo today for Addis and then in a couple of days they will return to Michigan. They have been such a blessing here and have accomplished a lot in their short sojourn. Will has done some interesting cases and Agnes managed to trip on some construction material and break her hand! Duane put on a nice fiberglass cast for her today to travel home in. On Friday after surgery we left for a one night trip to Arba Minch, a town three hours away where there are two beautiful large lakes full of crocodiles. We stayed at lodge overlooking the Rift Valley and could see the lakes in the distance with the trees canopied below. On Sat. morning after breakfast we were met by several families of baboons rambling around our lodge. Later we took a boat ride on one of the lakes and saw about a hundred crocodiles sunning themselves on the shore and swimming around our boat. The largest crocodiles in the world are in the lakes in Arba Minch. We also saw many hippos and beautiful birds. We just enjoyed seeing the beauty of God’s creation with the mountains silhouetted against the calm untouched waters.
Our mini vacation didn’t last long. Within one hour of returning to Soddo on Saturday night I was back at the hospital delivering our ‘last’ preemie. The baby’s mother had severe preeclampsia and her first baby was born stillborn at 34 weeks. We believe this baby is about 33 weeks but is very small due to growth restriction.
Duane and Jackie Anderson have arrived back from the states. Hooray! It is great having them here as well as the Arselands who returned last night with an ICU nurse from Norway who will be with us for 6 weeks. Duane is our orthopedic surgeon and he brought us more surgical tools to be used in OB and GYN surgery. We now have enough instruments to have three D & C sets ready to go. Also it will be easier and safer to perform hysterectomies more efficiently. Asle and Kari Arseland share our duplex with us and he is our anesthesiologist. Thank you for your continued prayers and words of encouragement. Allison’s blog follows and tells the story of one of our very sick mothers.
Here’s the latest news:
Well believe it or not there were no major catastrophes this week. The maternity ward has been pretty slow and the surgical cases have all gone well. We are praising God for this. This has given us more time to do other things like meeting with the hospital administrator and nursing director to talk about how we can make improvements regarding patient care at the hospital. We also have been working on various protocols for our patient care.
One problem here is the need to have ‘focused nursing care.’ That means one nurse is responsible for a particular number of patients. This is a foreign concept. Here, all of the patients on the wards are cared for by all of the nurses, i.e., one nurse may take vital signs while another nurse checks to see if the patient has taken their medications. No nurse has his/her own patients. Here, when we write orders for our patients to receive medications the patient’s family heads to the pharmacy to buy the medicine and brings it back to the room where it is kept by the bedside. This includes IV bags and tubing, injectables,etc. The family is responsible for giving the patient the drugs. Crazy isn’t it? So when an IV dose of medication is needed sometimes the nurses will ask the family if they have the meds and then she will administer it.
When I come into the ward and ask who is responsible for my patient I’m often met with a blank stare because all of the patients are generally taken care of by all the nurses. This is how many times big things are missed like vital signs, meds, etc. because no one individual is responsible for a particular patient. Patients have been admitted on the pediatric ward and the nurses did not even realize they were there.
Sadly this happened yesterday. There are several orphanages here in Soddo and Stephanie Bowers manages one for babies and small children who are adoptable. A ‘caretaker’ dropped off a severely malnourished little girl at her orphanage to be cared for. This child had obviously been neglected and was near death suffering from kwashiorkor. Her body was markedly swollen from the lack of protein and she was in kidney failure. Her story goes something like this: her father had died and her mother had left her behind with friends and family to go looking for work in a town three hours away. Those ‘caring’ for her essentially did nothing for her. In the U.S. these people would have been arrested for child abuse and neglect. They had dropped her off at the orphanage so that they would not be accused of murdering her when she died at their home. After being dropped off Stephanie brought the girl to the hospital on Friday. The outpatient Dr. wrote orders for her and she was admitted to the pediatric ward. Her ‘caretaker’ came along with her to care for her but soon left the child alone. None of the Drs. orders had been carried out by the nurses and the child expired Sunday morning. She had not been fed, no IV’s had been started. No one bothered to notify Stephanie that the ‘caretaker’ had left so consequently Stephanie did not know to call another worker to come to the hospital. This little 4 1/2 year old girl died alone not being fed or held. No one was taking responsibility for her care. This is a significant problem and makes one wonder if it is cultural. Did they think that the child was going to die so why bother?
Saying all of this, we do have caring nurses here who want to give good care. It is just a matter of mentoring them and teaching them how to be more responsible and showing them how they can be more efficient in giving good care and taking ownership of their patients.
Our responsibility here is more than just patient care. We have to educate and love, educate and direct, educate and serve, and educate and mentor our physicians in training as well as our nurses.
Good News!!! Today we have heard the first positive news about Stephanie’s license. We have heard from the Ministry of Health that they will be granting her license next month! This has given us tremendous joy. God DOES answer prayers. Thank you so much for your continued prayers regarding this matter. Stephanie is not celebrating until she gets the license in her hands but we are thrilled. Thanks also for your words of encouragement. We look forward to your short notes of encouragement that help sustain us.
Allison’s blog follows.