What are you drinking?

How many times a day do you go to the sink, turn on the cold water, and drink, not thinking if it is safe water or not.  Safe drinking water is not something that is readily available in many parts of the world.  

Everyday at the hospital I see kids and adults that are sick because of bacteria and virus contaminated water.  Only a few in this part of Tanzania have safe clean water.  Others rely on buying water that they have been told is clean.  Others just use what they can get.  Even though most know to boil water, they don't because of the cost of firewood or charcoal.  So we continue to treat all sorts of water borne diseases.

But good news!  Don Reed, a missionary with Open Door Enterprises (http://www.everypeople.org/Every_People_%5Bopen_door_enterprises%5D/Water.html)  and his team of well drillers will begin drilling a well for us at the hospital on Monday (12th March).  When they walk away, we will have clean water piped in to the surgical area and for the maternity ward.  We will have one or two large storage tanks and a pump that fills the tanks at 25 gallons a minute.  

Asking that you pray with us for safety as they drill, that the new compressor system will give them even more power to drill, and that they will find great water.  Don told me yesterday that he thinks they will need to drill to about 170 feet.

We are so thankful for Don and Sarah and their commitment to see Tanzanians have safe clean water.  Provided our internet works, I'll post pictures on Monday as the work commences.  

Just remember us the next time you take a deep swig of cool refreshing water…

Daily by His grace.

Larry and Sally

Lots of opinions

Ever talked with a group of doctors and got more opinions than the number of docs? This week I feel so blessed to be part of a group of over 235 medical missionaries from all over the continent of Africa and 105 visiting teaching doctors and staff from the USA/Canada. I have gotten lots of opinions on various "problem cases" that i have been facing at our hospital.

The meeting is the 32nd CMDA gathering. It provides me with a source of CME (continuing medical education) credits which I need to maintain my Tanzanian and American medical licenses. But even more than the great teaching is the opportunity to fellowship with other medical missionaries and talk about various challenges that we face. We are blessed too to have a visiting pastor speaker for our morning chapel service. It is so awesome to sing praises to God together with 340+ health care professionals. It is humbling.

Sally and I are here together as CMDA has a spouse program as well. She has been blessed to be together with 40 other spouses.

We are so thankful for the support we have from our organization to attend this meeting every two years. Well, another lecture is beginning so I better go.

Daily by his grace...

Ultrasound Training in Kigoma

So, what are the odds of an American specialist radiologist giving up 10 days of practice and family to come to the 'far West' of Tanzania to teach ultrasound?  Not likely...but hey, you don't know how God works.  In August, I put a request in through Baptist Medical Dental Fellowship (www.bmdf.org) for help in teaching us how to use our 1997 ultrasound machine.  That month, it just so happened that Dr. Justin was attending a medical missions meeting in Texas (he's from Mississippi) and heard of our request.  He notified BMDF of his desire to talk with us.  We began emailing and he and his family decided that his coming to Kigoma Tanzania was part of their ministry. 

January 23rd he arrived in Kigoma (5 flights from home) and began teaching.  For 5 days he did as many kinds of ultrasound studies as possible on a variety of patients (kids, teens, middle aged, elderly, pregnant, etc.)  In the months leading up to his arrival we had prepared a list of patients needing an ultrasound scan done by him, and also as a way to check my scanning abilities and interpretation.  We have a very busy Out Patient Department (OPD) and so had plenty of other patients to ultrasound.  It was days of hard work as the machine at the government referral hospital is broken and patients were coming for scans.


 Our machine is old but still works.  Justin showed us how to use it to the best of it's capabilities, and our various abilities.  I had been self-teaching for several months and had learned some, but having Justin with us was amazing!  He's a great teacher, very patient, and loves to serve God through his skills and compassionate care for the sick.

We had 5 days together starting with morning coffee, a quick check on the ward before heading to chapel, staff meeting and then a FULL day of ultrasound.  The first three days Justin spent teaching our other staff.  The last two days I did 'immersion' training. Justin had me doing scans with various probes, checking my techniques, correcting bad habits, and helping me to properly interpret what I was seeing.  I have to say it was challenging but fun!  Having this capability really helps us as we have very limited laboratory capabilities right now to help in diagnosis.  Of course, 75-80% of a diagnosis comes from the history, and then more from the physical examination of the patient, and then finally lab and X-ray and other tests help to confirm the diagnosis. 


Besides teaching ultrasound, Justin also shared a bit of his personal life story as to why he had come to Kigoma, his love for God and his desire to follow the example of Jesus Christ in preaching and healing.  I had the opportunity to be his Swahili translator when he spoke in chapel, a first for me.  The staff appreciated his teaching, and especially his story of why he came and how he loves God.


I'm excited to continue to learn more of ultrasound.  I will be doing a one day ultrasound training course this next week as part of the Christian Medical Dental Assocation meeting here in Kenya. I am searching out options to do more training when we are back in the USA later this year. One deficiency of our machine is that we don't have a probe to do cardiac ultrasound.  I am trying to find one through sources in the USA so we can have the capability to do cardiac ultrasound as there is a lot of heart disease in our Area.  Hopefully one day we'll have a newer ultrasound machine but for now, we use what we have. 


Sally and I are so thankful that Dr. Justin could come and help.  We are excited about future collaboration.  Thank you Dr. Justin!


Daily by His grace...

Hit the ground running...

Got back from our whirlwind trip to Michigan, very happy to have seen our family and help out with the care of our parents, and already are going full speed.  Apparently in the month of December, many people in the community have decided that our hospital provides better care than the regional referral hospital and our numbers have sky rocketed. 

From Jan 1st through the 9th we provided care for over 800 outpatients and numerous inpatients.  Mondays have gone from 80-90 patients in OPD to 130-150.  Not to brag but I've treated 420 patients in OPD over the past 9 days.  Part of the increase in patients is because it is malaria season here.  Every day we admit children with high temperatures (often over 103F) because of serious malaria infections.  Almost all families have insecticide treated mosquito bed nets but still kids get bit in the evening before sleeping and so problems of malaria continue.

I thank God that our good reputation continues to grow in the community. We hope sometime this year to reopen the maternity ward to provide even more services to the community.

Sally and I are excited that next week Dr. Justin will arrive from Mississippi.  He will be teaching many of us ultrasound skills and doing as many scans as I can convince him to do with us.  We are so grateful for his willingness to come and help us as it is a big cost in many ways to him and his family.  We have numerous patients booked for scans.  In addition to myself there are 4 other doctors who will be trained and at least one nurse.  Five days of intense teaching will give us a taste of U/S scanning and hopefully will improve greatly my self-taught skills.  We are using an old machine but it is working for now.  We hope someday to get a newer one that will allow us to do cardiac scans as well.  If you happen to know someone with a spare U/S machine to donate to the hospital let me know.

The other thing I am excited about it to have gotten a really cool teaching set of MP3 files from cardiologist, Dr. Michael Barrett.  He graciously gave us permission through the American College of Cardiology to have these training files that teach about heart sounds.  The files called HeartSongs 3 are his brainchild (www.cardiosource.org).  He has a passion for teaching and has helped countless students, interns, and residents to gain the skillls necessary to recognize various normal and abnormal heart sounds.  When I was back in the USA I picked up two MP3 players and now our doctors are listening to the files to improve their skills.  Thank you again Dr. Barrett! 

Finally, I want to share with you about one young boy that I admitted today.  At 4-1/2 he began to have problems breathing in December.  He hasn't been able to play with other kids his age because of fatigue and breathlessness.  He got treated for malaria because of a fever but still hadn't gotten better.  His mom brought him to the hospital today.  He was breating at a rate of 70/min.  His heart was racing at 100.  Yet he was smiling.  One of the other doctors had examined him and asked me to see him too.  We discovered he had a very loud heart murmer and early signs of pulmonary edema (water on the lungs).  We checked his oxygen saturation and it was only 33% (normal >95%).  We admitted him and got him on oxygen that is provided by a machine called an oxygen concentrator.  It takes room air oxygen and concentrates to a higher percentage.  After some medications and the oxygen his saturation had risen to 65%.  By the time I left the ward his breathing rate had slowed down a bit, and his saturation was now 80%.  The challenge now is to get him stablized and then find a way for he and his mom to travel to another hospital for echocardiography (heart ultrasound) and most likely surgery.  Just to share with you what the social challenges are here, the mom has one other child.  The dad is studying in a city about two days away and they don't have the money to take the child to the other hospital.  We will begin tomorrow to encourage them to hold a family meeting so they can determine the way to get the funds to take him to the referral hospital.  The extended family will be asked to contribute. It is the way that things are done here.  I would ask you to pray for this little boy (Kambugwe) and his family. 

Will write more and post some pictures once Dr. Justin arrives and the fun begins.  Meanwhile, I would ask you to pray for all of us at the hospital as we continue to provide compassionate quality care for very needy and sick people. 

Daily by the grace of God...

Back to Michigan for a White Christmas

Sunday Sally and I begin our flights (5) to reach Detroit.  It was not on our 'radar' of plans to do this but because of changes in the health of our parents, and our responsibility to honor our parents, we felt it was wise and prudent to make this trip.  

This past week Sally's mom (Gloria) was hospitalized after experiencing a stroke.  She is currently in rehab and doing well.  We thank God it was not a massive debilitating one, but a stroke is a stroke.  In fact, in the medical field, we call them 'brain attacks' as it is like a heart attack in that there is tissue damage and it is serious.  We are so thankful for the excellent care she has gotten and that she is doing better.

Last month my dad (Leo) had hip replacement surgery.  After some complications post-operative, he is doing remarkably well in rehab and hopefully will be coming home soon.  Home now for mom and dad is their apartment in Charlotte, Michigan.  They moved there this year as they were closer to my sister and brother-n-law who are their main support system as well as closer to their doctors.  Dad has been in and out of rehab the past couple of years.  Mom is doing well, but hey, she isn't a young puppy anymore (Sorry mom).  Both of them have regular doctors appointments and need help with things.

So this is our time to physically be there and help them.  We know it will also provide some 'relief' to family members that are the primary helpers of our parents.  We are so thankful for them!  When we stepped out in faith 16 years ago to serve in medical missions in Africa we knew that it would mean leaving many things and persons behind.  Being 8,000+ miles away from our family has been one of the continuing 'challenges' of our journey in following Jesus Christ.  We aren't there to help out when there are small problems or big ones.  It is not easy, but we still believe that God has a plan for us to continue to serve in His kingdom work here in Kigoma, Tanzania.  (I treated 182 patients in out patient department this week, not counting daily hospital rounds)

Obviously, in addition to helping with our parents we will get to see family again, especially our kids!!!  Yeah for Adam, Megan, and Kelly!  Sally hasn't seen Adam since May 2010 (I got to see him in July 2010.)  Haven't seen Megan since summer of 2010.  Kelly since August of this year.  Needless to say we are excited and our kids are too.  It will be a crazy schedule but we know that this is the right time to do this.

We would ask that you remember us in your prayers.  International travel is long; jet lag is no fun at all (we are 8 hours earlier than EDT); not excited for cold weather; will need wisdom on how to divide our time; and good health.  Mostly we want to be there to serve our parents with love and compassion as they have cared for us as all these years.  They are amazing people and we love Mom Jessup and Mom and Dad Pepper so much!

Finally in closing, in this Christmas season, we are so thankful for the support system we have as 'Watumwe' (Kiswahili for 'sent ones' or 'slaves.'  We love being 'slaves' for Jesus!).  Our sending agency (IMB Connect) has a wonderful way of supporting us. Southern Baptist Churches all over the USA voluntarily send funds to support all of us 'Watumwe.'  This month will mark the annual Lottie Moon Christmas Offering where we see the majority of our support come from Southern Baptist churches all over America.  Next years IMB budget is $324 million.  It is huge.  The majority of it will come from this special offering. We continue to be amazed by the sacrificial giving.  May you be blessed.

Merry Christmas!

Larry and Sally

Update

The past couple of weeks have flown by.  Seems that work at the hospital keeps on growing, with more and more outpatients coming.  Last Monday, myself and another doctor saw over 100 patients.  We are thankful that people are regaining confidence in the quality of the hospital services.  As what seems to be the usual, there are encouraging days and 'challenging' ones.

Thankful my Kiswahili continues to improve.  I still get a problem at times with complicated histories of patients.  Sometimes you ask 'what is the problem today' and they begin with their history of 5 years ago... I have to read just about every evening on some aspect of medicine that either I learned a long time ago, or have never treated.  Am thankful for special gift money that helps me to keep a medical program called UpToDate on my computer.  Has the most up to date information on a wide variety of things in medicine. It's equivalent to having probably 10-15 text books.  (by the way, inspite of how we doctors act at times, we really don't know it all!).

Anyway, this past week was one of treating and counseling.  I try hard to give education to patients on the ward whenever we do rounds.  Together with the nurses we teach about general hygeine, especially about safe drinking water, and malaria avoidance.  More about water later.  But this week was a bit different as I was doing counseling with a married couple about infertility, then with a young man who had a bad case of shingles on his face and had just been tested and discovered he has the HIV virus.  Another young married man about 'family issues' and counseling a young wife about why it was that I couldn't lie and fill out a form incorrectly for her as she was pregnant with another persons child.  Yeah, all that in Kiswahili.  I pray that what I heard and what I said was correct. 

Unfortunately, once again it was a week with death.  A one year old boy died on the ward, after 4 days of treatment.  I can still see his sweet little face as he looked at me while I was examining him.  Some of the children cry as they are used to getting immunizations and so think I am going to give them one.  Others cry because I am white (and I suppose some cuz I'm ugly).  But this little boy looked right into my eyes as if he could see right through to my soul and was saying 'help me!'  We did all that we could but yet early the next morning he died.  And then two days later I had to tell a 20 year old married lady that her 6 month old baby had died inside her.  Don't know the cause of either deaths.  Was able to pray with them.

I hope that it isn't depressing to read this, but I just want to share with you what the reality is.  Life is hard here for Tanzanians.  Disease is everywhere, and because of poverty and other causes, many are late to reach the hospital for service, others go to traditional healers first, then when all seems hopeless, they come to us.  That is the reality.  But we do treat a lot of patients that get better and go home, Praise God!

Oh yeah, water.  The hospital was blessed to receive 4 of the 8 water filters from
Baptist Global Response (http://www.baptistglobalresponse.com/blog/?cat=120).  These filters are made in Kenya and work great to provide safe drinking water.  We put two on the ward, one in Maternal Child Health Clinic, and one in Pharmacy.  So thankful for clean, safe, drinking water.


OK, so today (Sunday) we went to Kibirizi Baptist Church.  Took us 45 minutes to find the place (it's 10 min from our house).  There are NO signs anywhere, and people gladly helped us to find three other types of churches, before someone finally said, "go back to the market, turn left and climb the hill. Ask there, they will explain."  Finally we came across a lady who told a youth (yes, she told him to 'get in their truck and show us') who showed us the way there.  We had a great time of worship with the believers at Kibirizi Baptist Church.  After the service we had a 'family' meal all together.  This church and Kalalangabo Baptist get together the first Sunday of the month, then after the service have a meal.  We had ugali (cooked white corn meal), beans, and dagaa (like smelt).  They are a major source of protein in the diet here.  Caught at night out on lake Tanganyika and then sun dried.  Before eating they are soaked in water and then fried in oil with some tomatoes, onions and salt. I really liked them.  This weekend we'll get some when the boats come in in the morning and then fry them like smelt...my mouth is already watering.

Daily by His grace...

A week about death

Seems that some weeks are better than others.  You've been there I'm certain.  This past week has been emotionally challenging.  Seems to be a lot about death. Thinking about it, seeing it, seeing the effects of it, not liking it.

Sunday we drove to Kigali, Rwanda in order to take Kelly to the airport.  We thank God she is back safely in Michigan.  As we drove into and around Rwanda, I was continually reminded of the horrible genocide that occurred there in 1994.  800,000 to 1,000,000 people murdered in about 8 months.  As I saw youth walking the streets of Kigali, I thought about how they have grown up under the shadow of a horrific time in Rwanda.  I saw old people and wondered how all the deaths that they saw affected them.  I thought about the fact that most likely there were people still mourning while those who committed untold atrocities walked the streets.  We drove past a memorial for some of those brutally murdered.  All that, along with saying goodbyes to Kelly was draining.

Tuesday, Sally and I returned to Kigoma safely.  Praise God!  It is always a blessing to have traveled in E. Africa for 22 hours on the roads without an 'event.'  As I passed the road that goes to our hospital I thought about the 45 year old mom/grandmother that I had admitted to the ward right before we left for Rwanda.  She came complaining of headache and arm weakness with a blood pressure of 300/180 mmHg.  I am not kidding.  On Wednesday I saw her on the ward.  She was recovering from a stroke, but doing well.  The plan was for discharge.  I went to OPD to see patients.  After a while I got summoned to the ward to help.  I was informed that just after seeing her grandchild from across the ward and waving to her, she suddenly collapsed and stopped breathing.  CPR was attempted but from the signs it was clear she had most likely  suffered a sudden bleed into her brain.  The family went from planning her return home to planning her burial.  We were all shocked and saddened.  I had seen and and been touched by death once again.

Thursday morning upon reaching the hospital for our morning worship time, I learned that one of our Baptist pastors, Pastor Timothy Mbiha, had died.  He was about 50 years old.  I had yet to meet him.  At his funeral, I heard some of his life story.  He heard the good news of the gospel of Jesus Christ in 1980 and decided then and there to receive by faith, the free gift of salvation.  He began serving as an evangelist while getting bible training.  I'm sorry that I do not know his complete history, but I can say that I heard testimony after testimony about his life of serving Christ, preaching the truth of the gospel, of befriending many people and sharing Christ with them.  Many shared about his life of serving his people as pastor of Mwasenga Baptist Church.  He has left behind 8 children and his wife.  We continue to pray for them.

I estimate that over 400 people attended the funeral and burial.  People representing several denominations of churches as well as several Muslims attended.  The gospel was clearly proclaimed at his funeral.  At the end of the funeral service, after all had passed by to pay their last respects, something happened that I didn't expect.   Apparently, as is the custom, the men stood in two columns stretching from the door of the church to the grave.  His coffin was passed out through the door of the church and then was handled/passed by each of about 100 of us men until it reached the grave side. Once again I had seen and 'handled' death.  His body/coffin was then carefully placed on the ground and again the gospel was preached.  It was a humbling experience.  

But what was clearly different from Rwanda and the death of that dear mother/grandmother, was that in the death of Pastor Timothy was the hope of the resurrection.  The promise of Jesus Christ that by faith we receive forgiveness of the penalty of our sins, that we are born again, a new creation, empowered to live a Christ-like life through the indwelling Holy Spirit.  And then, when 'God calls us' as was preached, we leave this temporary life on earth and continue to live eternally in the presence of Jesus Christ.  That is the hope we have.  That is the truth of the Holy Scriptures.  We have a sure hope, and that is the person of Jesus Christ.

I have to say that this week of 'death' has not been what I expected or hoped for or prayed about.  But I know that God has allowed us to pass through the events of this week for a reason that He knows.  In this week of thinking about, seeing death, seeing the effect of death on families, I am thankful that I have a living Lord and Savior that conquered sin and death through his sinless life, sacrificial substitutionary death on the cross, and amazing resurrection!  

Let me close with the words of the chorus from the song "Because He lives."

Because He lives, I can face tomorrow, Because He lives, all fear is gone.

Because I know he holds the future,   And life is worth the living, just because He lives!

Continuing to serve, daily by His grace…