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‘Art disturbs, science reassures’. -Georges Braque

Dr. Mary Vanderkooi is graciously allowing me to illustrate the 7th edition of her book, Village Medical Manual: a layman’s guide to health care in developing countries (vol. 2). The past couple of months I have been working both diligently and lackadaisically on drawing diseases that range from being known worldwide, making my stomach turn and skin crawl, to a large number that the United States has not seen or heard of in years. Three cheers to the individuals that dedicated their lives to eradicating and controlling a large number of diseases so we would not have to see our loved ones suffer.

I was introduced to this book through the Medical Missions Intensive (MMI) class I took to help prepare myself for working over seas. The class was taught by my current ‘co-workers’, Dr. Mary and Sophie, at Equip International in North Carolina. The education gained from those two weeks fits in the category of one of the things money is worth being spent on in this world.

The book was written to allow non-medical people living and serving in the rural, underdeveloped areas of the world to provide medical care when it’s needed. I didn’t fully understand the depth of need for this sort of reference and education until I started working in Ethiopia and saw both the lack of medical care, and access to this care for so many people.

I think we would all agree that a non-medical person isn’t ideal, but when you’re the only person within 50 miles that is educated enough to make a medical decision it weighs heavily on you. Having a resource like this book is a beautiful hope for helping save lives.

I knew from taking the class and studying her book that Dr. Mary was a brilliant woman, and after working with her for a year that truth has been solidified in my mind. Her knowledge and understanding of tropical diseases is phenomenal and her desire to pass on the knowledge has not only allowed me to work under her, but has also produced this book, giving hope to so many individuals that are serving the destitute in remote areas.

I feel more than blessed to be able to take part in something that has the power to heal and save. It’s amazing to be able to use a gift God has given me to help people around the world regardless of where I am. It is my prayer that this book and the illustrations would give confidence to those delivering medical care and bring healing to the sick.

To conclude, I’d like to give another three cheers (plus a trophy) to the brave souls working in these areas and doing things they never dreamt they would have to do. May God bless you ten-fold for your dedication to the sacred lives of those in all tongues, tribes and nations.

Scabies

Mongolian Spot

Syringe

Abdominal Divisions

Live Fluke Snail Host

Impetigo

Tape Worm

Rickets

Primary Syphilis

Yaws

Pellagra

Vitiligo

Chalk Art

The other day was far too nice to sit inside, so we took our art to the streets…

Emanuel

 

Mitten drawing her car

 

John drawing his car (semi-disappointed that the red chalk was yellow inside)

 

Berket and the sun that very shines

 

Emanuel branching away from the car to make the longest line ever

 

Chalk Face

 

Yabsera and the smiley face

Story Time

Two days ago I was on my motorcycle, riding to town and a little girl came running up alongside me as I was driving and put a small bird on my forearm. He had a string tied around his little leg and the poor chap looked right up at me and gave me the sad eyes.

He didn’t move or try to fly away at all. The little girl said, ”hamsa birr,” which means 50 birr. She wanted me to buy him for 50 birr. I said no way and then looked down at the precious little guy again. I felt so bad for him and knew something wasn’t right since he was just sitting there so calm and collected.

I am fairly opposed to having birds as pets (as a child I was told that their feathers alone held massive amounts of worms and diseases, so I can only image what a whole bird had to offer) and certainly was not going to give this small child 50 birr for a wild bird.

My heart grew pretty soft as it sat on my arm so I stopped my bike, looked at the bird and made a decision. I told the girl I would give her 10 birr to let the bird go free. She agreed and started to untie the shackles from his foot. She couldn’t get it off, so she just threw the bird in to the bushes. I was a bit startled and looked over to see the bird, still in chains, sitting on a bush and breathing really hard.

I knew if I left him there she would just take him back and do who knows what with him, so I grabbed him, took off his chains and drove him to the hospital compound. He stayed on my arm for a good hour or more and with the help of some friends and google, we decided that he was probably a yellow bellied chat.

I did like how cuddly he was, but I also knew that I did not want to take him home. I took him outside and found a very nice avocado tree and set him on the branch. I put a bit of cracker next to him for good measure and walked away.

I checked for him the next day and he was no where to be found. I like to think he regained himself physically and mentally, found his family and flew off in to the morning sunrise.

Here are some pictures of the little gem I named Jail Bait:

Jail Bait

 

 

Just taking a 'lil nap

 

Hanging out in the tree with his cracker

Kutua

Chickens: Round 1

As most of you many know, my gardener, Zinabu, built a chicken coop for us some months ago. Through the basic setbacks of Ethiopian living, we ended up waiting quite a while before getting everything together to be truly prepared chicken owners.

About a month ago we decided the time was right and went to a barn to pick out five beautiful chickens that would benefit our bellies along with combating the rampant protein deficiency among our patients at clinic.

It was quite the process of getting the chicken feed, food and water containers, saw dust for the floor and the chickens packed in to a tiny bajaj and taken all the way to our home. Along the way two chickens escaped, one got terrible diarrhea and a good part of the sawdust flew up in a tornado style funnel, covering the bajaj and us. Lots of laughter and screams filled the air as we found our way across the bumpy path to our home.

We finally got the chickens (two white and three brown) settled in their new home and ready to lay some delicious eggs. We went about our daily living and came back later that night to host supper for some friends.

Around 9pm, following a delicious supper, we were all sitting around playing cards and enjoying the cool of the night. All of a sudden we heard some serious racket outside and paused for a moment. Silence followed, so we continued on with our game. About five minutes later, we hear a loud, rapid knock on our window and I quickly hurry outside.

I opened the door to see my guard motioning me over to the coop, flashing the light at chicken run, and shouting, ‘it was like a small tiger.’ I peered in to the coop to find feathers everywhere, the two white chickens scurrying around and all three brown chickens lying dead on the ground.

I couldn’t believe my eyes. I’m not sure if it was merely coincidence or a racial attack, but all of the brown chickens, which, of course, are the ones that lay the most and best eggs (according to the chicken dealer) were attacked and killed in a rather ferocious way. After much research and conversations, we decided that the small tiger was most likely a civet cat and he got in via one of the twelve entry points we found on the coop.

We have, since then, restructured the coop, patched the holes and every night, lock the chickens in the inner room to spare their precious little lives. We were a little nervous that the remaining chickens were not going to lay eggs for a while, but to our surprise, the next day we had two beautiful eggs.

Since then, we have named one of the survivors Tyson (both a fighter and a productive enterprise) and the other we just call Stupid because she gets stuck in tiny boxes and can’t get out. She can’t help it.

First set of 5 (some are hiding)

Chickens: Round 2

About three weeks following the massacre, we decided to replenish our tiny chicken colony and try once again. We purchased another white one, a brown one and a small mix baby. Turns out they don’t like each other and have become cannibals. According to ‘Chickens In Your Backyard,’ if there are too many chickens in one pen they will start pecking each other to death and one of our chickens has been pecked to the point of bleeding. The only solution is to give a chicken away, so we gave the one that is bleeding with no butt feathers to Daweet, the boy taking care of our other chickens. He was so happy he strutted home with chicken under his arm before his workday was even finished. Daweet is a 13 yr old, very hard working boy that is supporting his sister and grandmother, so the addition of eggs to their diets will benefit them tremendously.

Although it has been quite the beginning process, the chickens are doing well and are a huge joy to all of our workers and us. We have (hopefully) worked out a majority of the kinks and if all goes well we will be getting around 24 eggs a week, which will go to help our patients.

Each clinic day we bring about two dozen eggs and hand them out to the pregnant mothers, children that are clearly malnourished and sick, wound patients and the elderly that are without access to protein on a daily basis. They get protein about twice a year, maybe a little more if they are lucky.

The most common diets in this community are Ethiopian sweet potatoes (they look like our sweet potatoes, but are white inside and contain no vitamins or nutrients whatsoever), corn, false banana (looks like a banana plant, but they eat the root and plant itself, which contains 100% starch), occasional lentils and beans, bananas, very occasional mango, avocado, papaya, and anything else green, leafy or full of nutrients. The access to meat of any kind is almost non-existent and comes mainly around holidays.

Long story short, there is little to no protein in their diet, which is needed for many body functions and is especially important in wound healing, baby production and strengthened immune systems. There are other things we do along with handing out eggs that increase the health of these patients, but it is a simple addition that is of little trouble to us and vital importance to them.

Along with benefiting these patients, we have found the chickens to bring great joy to our hearts. They are truly interesting to watch and, at times, very hilarious in their stupidity. I take great joy in letting them out of their cage to roam the yard in the evening while I enjoy a cup of tea. The other day we were standing outside and Daweet came to us and said, ‘I really love chickens.’ We all agreed.

It is funny to catch yourself, after a few too many minutes, just standing by the coop, watching and laughing at the chickens. I have also seen all of our workers doing the same thing and love the fact that such crazy things can bring so much joy and blessing to so many people. Good job, little chickens, good job!

New Brown-town lovin' the compost

Plucker...she moved out.

Daweet and the conjo mix baby.

Infestations

Lice: plural of louse

Louse: 1. a small wingless insect that lives as a parasite on humans and other animals. There are sucking lice, for example head and body lice, and biting lice, for example, bird lice. 2. An offensive term that deliberately insults somebody’s behavior and attitude toward others (informal insult). Ha.

 

Now that we know what lice are, I want to take you to a little place in the world called rural Ethiopia and explain how much damage these little parasites can do when untreated for indefinite amounts of time.

In my last six months of working in Ethiopia I have come to understand that lice is a just a normal part of life that has little to no consequence to most people. I know my American-ness causes me to freak out at the thought of a diagnosis of a lice infestation on my head, let alone live with it for years, but come on….after seeing what I’m about to show you, one would think they would see the reproductions and at least attempt to rid themselves and their families of this destructive little blood sucker. Wrong. This unfortunately does not happen, so I have been left to deal with treatment of patients with a ridiculously long history of this condition, more often than not. I am working on educating for the purpose of prevention, but most people just aren’t lucky enough to bypass these little pests no matter how hard they try.

I have moved mainly to education of treatment and the importance of coming to clinic when it is a ‘small problem’ instead of waiting until it is a ‘big problem.’ I will be honest and say that nothing is more frustrating than a parent who lives very close to the clinic will not bring their child until their illness has become so bad the kid can barely deal with day to day living.

Case and point, a few weeks ago a small boy, around 8 yrs or so came in to the clinic with his mother. You could literally smell the kid inside the building when he was standing outside. He had his hood pulled up; covering his head but you could see a serious wound on the left side of his face.

I had to go through the line of patients already waiting before I saw him, so I had plenty of time to really appreciate the smell radiating from his head. Once I got to him, I said ‘bessa,’ which is a command form of ‘show.’ He uncovered his head to reveal something I could have never dreamt to see. I will see if I can explain this fully…

The entire top of his scalp (extending down toward the back of his neck) and a section on the left side of his face was a rough, scabbed, whitish yellow color that almost looked like his flesh was rotting off and little tufts of hair were holding things in place. I was at a loss in that very moment so I started with the basic history from his mother via a translator.

After a semi-short discussion I can to find out that he had lice, his head started to get small sores on them, but they really weren’t too bad so the mother decided not to bring him in. I will go back just a bit and talk about lice and what happens with infestations over time. In this area, there is a huge lice, malnutrition, and general hygiene problem. The lice bite the head so much that it becomes abscessed and full of open wounds. With a poor immune system and a lack of cleanliness, the problem is exacerbated and huge infected wounds result.

I asked the mother when this problem began and she said one year ago. I became slightly frustrated by my perception of the lack of compassion and action this mother had in regards to her small child and went in to a small lecture on the importance of bringing your child when the problem is small because now the problem is so big that it will take a long time to get better, there will be scaring and probably a significant amount of pain the child will have to go through.

She quickly responded, ‘I did not bring him because I was sick,’ and I just left it at that because I decided I truly did not know the situation, I would give her the benefit of the doubt, and I had already lectured her. I then moved on to deciding how to treat the child’s head at this very moment. I knew I would have to debride his scalp in a big way, but at that very moment in time I started with the basics of washing with soap and water.

I had the boy lean his head out the window in the building and I began to pour water over his head. The instant I started very lightly rubbing his head, copious amounts of puss began pouring out from under the layer of ‘co-sha-sha’ (garbage/dirt) playing the role of his scalp. I had him close his eyes right away and attempted to manually ‘express’ a majority of the puss out.

Along with the puss, small chucks of this ‘covering’ came off as well, exposing raw, pink flesh. This is, in one sense, good because there was healthy tissue below the bad, but in this environment, having that much exposed open flesh is asking for big trouble. I knew he needed all the bad ‘covering’ removed and I also knew it would cause quite a bit of pain (especially on the side of his face) and he would most likely need to be put under and then debrided.

I sent him home on Metronidazole (for the stinky infection), ointment for his head and instructions for washing once a day until the next time at clinic. We told the mother not to allow him to eat anything the morning of the ‘surgery’ because we would be giving him a medicine that would ‘put him to sleep’ and if he eats anything it could ‘cause him to die.’ Mary explained that this was the only way she can get them to understand the importance of not eating if they will be put to sleep.

Well, the next clinic day the child came with a belly full of food (this happens all the time) and so my next option was to soak the kids head for a while in hopes of softening the tissue and start cutting away the bad parts until the pain was too much to bear. It actually turned out quite well and the boy barely felt pain and I was able to remove quite a bit of the problem areas.

The smell was still potent at times and the pockets full of puss were quite revolting to say the least. I did not have the time to get everything, so we put ointment on his head, covered it with a clean baby hat and sent him off with hopes and prayers that he would not become more infected. He came back each clinic day and I removed more and more of the tissue. He is one of the bravest little kids I’ve seen and he sits so patiently as I remove his scalp. It breaks my heart when tears finally fall down his cheeks, so that is when I have to stop.

He has quite a bit of scaring at this point, but hopefully his hair will grow back to some extent, but most importantly, I hope he heals completely and does not have to deal with anything like this again.

I cannot tell you the amount of little kids that come in with this same problem, although this is, by far, the worst I have seen. I am working to educate the patient’s and their families on how to deal with lice and the problems it produces. I never liked lice, but these situations make me despise it to my core.

Here are pictures of the little gem and me removing his scalp…

 

Side View

 

First Debridement

 

Debridement/Scarring

Blessed is he whose help is the God of Jacob, whose hope is in the Lord his God, who made heaven and earth, the sea, and all that is in them, who keeps faith forever; who executes justice for the oppressed, who gives food to the hungry. The Lord sets the prisoners free; The Lord opens the eyes of the blind.

I have no idea what it means to be physically blind nor can I fathom what it would be like to see the beauties of this world and then lose that privilege as infection takes over my eyes.

There is a prevalent disease here called Trichiasis, which is and eye infection transmitted by flies that attacks the eyes, causing scar tissue to build up and contract the eyelid, resulting in the eyelashes growing back toward the eye, scratching the cornea or conjunctiva and causing blindness. Surgery is needed to provide longer lasting treatment that will prevent further scratching and resolve some of the symptoms. It is not a permanent cure because there is still the possibility for the eye to become infected again, but it is the best option for the people in the rural settings with limited access to medical care.

There are many patients that have come to clinic seeking this surgery (Dr. Mary used to perform these surgeries on a regular basis for the community) and we asked them to come back in three months because I was in the process of learning how to suture correctly. Dr. Mary taught me the ins and outs of suturing an eyelid, which is, in and of it self, a scary thought, let alone the act of actually doing it.

One patient returned promptly at the three-month mark and she was my first trial at being a semi-surgeon. I say semi-surgeon because Mary did a majority of the surgery and I got the privilege of placing the sutures in the second eye. It was an exhilarating experience that I will not forget and, with all hopes, will do many more times if the other patients return.

I think the most beautiful part of the whole story was the woman receiving the surgery. We had her lay down on a flat, hard bench where she held completely still for the entire procedure (which lasted a good hour if not more) and once it was complete, she sat up, praising the name of the Lord. There was never one flinch, complaint or question, but a spirit full trust, peace, and praise to God for blessing her with this surgery.

It will take a few weeks to heal and I am super curious to see how she is doing, but it is a true miracle that we are blessed with the ability, wisdom and expertise to provide someone with restored sight. It is amazing to see a small piece of heaven here on earth!

I want to share these pictures with you and I know some look pretty barbaric so if you are faint of heart, please scroll carefully. I hope you are able to see the beauty in this story of restoration and healing.

Placing the sutures.

 

 

 

Post op eye ointment application

 

 

 

 

Post op

Post op Trichiasis Surgery

 

 

Egexiabher yestelen amesegenalu (Thank you, Praise the Lord)

Faith, Hope and Love.

The other day I was blessed to take part in something that brought tears to my eyes, deep thoughts to my mind and joy to my heart. A beautiful woman from South Africa, ‘Sue’, is running an orphanage here in Soddo and she got called out on an emergency to rescue an abandoned baby. I happened to be with her at that time, so I joined her in going to a vacant field in an area called Ottona.

When we arrived there was nothing less than a mob of people surrounding the area and joining us on the short trek to where the baby was laying. We walked up a hill and over to a spot of bushes and saw a woman standing next to a little bundle of white cloth. This was the woman that had found the baby naked, lying in the bushes and called the police, who then called the orphanage. The woman was walking through the field and came upon the baby boy and wrapped him in her shawl. The baby had been lying there all night long and it was a true miracle that he had survived the night (the temperature around here has been getting down in to the low 50’s with raging winds).

The baby’s temperature was way too low, so we hurried to the local hospital where the doctor’s did a quick exam to find the baby doing well, but very cold. We then rushed the baby to Sue’s house where we warmed him by swaddling him and giving him a bath. He began to get color in his skin, started crying for the first time and had a bowel movement. That may seem too much information and a little grotesque, but it is a beautiful sign of a healthy baby. I couldn’t help but start crying at the sound of his precious little voice. He was then dried off, and Sue did something that I’m sure she does for all her babies, but it was a thing I had never seen before. She took some oil, anointed the baby’s head and said the most beautiful prayer for the life of this child.

I wish I had memorized the prayer so I could recite it for you, but I will give you the general idea. She spoke about how we are all created in the image of God and that this baby has a beautiful purpose in life. He had been spared a life of sorrow and will now be blessed with a life of love and affection from a family that has been praying and longing for him for many years now. She spoke a beautiful blessing over the baby and he was then sent back to the hospital to learn how to take a bottle. The baby is now thriving and in the process of being adopted out to a family who is anxiously anticipating his arrival.

My eyes welled up with tears once again as I took part in something that had began as an injustice to an innocent child and ended in a miraculous story of healing and survival. I still do not fully understand why someone would leave a baby out to die, but I know that there is more to the story that I cannot fathom due to my life of an American where I rarely need to focus on my physiological needs, and instead strive toward becoming who I’ve longed to be (thank you, Maslow). I don’t know what it’s like to not be able to feed my child, or to see all my other children die because I have to feed my new baby instead. I don’t know what it looks like to have absolutely nowhere to turn when I can’t provide for my child or to have nowhere to take him after he is born. I don’t know what it is like to question if its better for him to die at night or die by the hand of my husband who comes home drunk every night with threatening words and actions.

I don’t know what the story is behind this child, but I know that he was spared death and has the opportunity to live life to the full from here on out. I wish that were the case for all the abandoned children of the world and not just this child. I wish there were never a time that a child would be left for the hostilities of nature to take his last breath. I am so thankful for a God of love and for the comfort of His words in 1 Corinthians 13:12-13:

For now we see in a mirror dimly, but then face to face. Now I know in part; then I shall know fully, even as I have been fully known. So now faith, hope and love abide, these three; but the greatest of these is love.

God, give us the grace to love with a burning passion, fill us with hope for better things to come and have the faith make a change in this world.  Amen.