Samaritans Purse-World Medical Missions

This last year World Medical Missions, a branch of Samaritan's Purse helped us logistically as our sending organization.

Take a look at the website. I highly encourage you to view some of their video clips.  It will help paint a picture of what it is like serving overseas, the world-wide needs people have for health care and hearing the gospel.

Here is a piece on the post-residency program which is available to residents willing to commit to two years of service.  We worked with a number of families serving through this program:

http://www.samaritanspurse.org/medical/post-residency-program/


About Samaritan's Purse:
The story of the Good Samaritan (Luke 10:30-37) gives a clear picture of God's desire for us to help those in desperate need wherever we find them. After describing how the Samaritan rescued a hurting man whom others had passed by, Jesus told His hearers, "Go and do likewise."

For over 40 years, Samaritan's Purse has done our utmost to follow Christ's command by going to the aid of the world's poor, sick, and suffering. We are an effective means of reaching hurting people in countries around the world with food, medicine, and other assistance in the Name of Jesus Christ. This, in turn, earns us a hearing for the Gospel, the Good News of eternal life through Jesus Christ.


Mission Statement:
Samaritan's Purse is a nondenominational evangelical Christian organization providing spiritual and physical aid to hurting people around the world. Since 1970, Samaritan's Purse has helped meet needs of people who are victims of war, poverty, natural disasters, disease, and famine with the purpose of sharing God's love through His Son, Jesus Christ.

Karanda Mission Hospital

Leaving town you pass a number of police checkpoints.  When they learn where you are traveling their eyes brighten and they wave you through.  As the vehicle picks up speed it is necessary to shout during conversation to overcome the loud rattles of the aging Land Cruiser.  You elect to roll down the windows and let a smile or nod suffice.  The broken fuel gauge reads empty, but it looks like the rear tank is full.  Pyramid stacks of just picked produce are selling for a dollar along the road.   It is surprising how in short time the arm out the window is starting to redden like one of the roadside tomatoes in the African sun. 

Every so often your knuckles whiten as an oncoming lorry takes more than its fair share of the black tar.  Soon however the tall golden swaying grass charms you into a relaxed state.  Breathing in the warm air, licking the dust off your teeth, taking in those uniquely African smells, you remind yourself to savor these moments.   Everything here seems to focus on the moment.  The past is often too painful to think about.  Nobody knows what tomorrow will bring.  The focus is on where you are and whom you are with at that moment.  It’s a welcome adjustment.

Three hours later, signaling a turn the vehicle leaves the hot tar, heading north on the rough gravel road.  A young family is walking with a sick child towards the hospital.  Stopping you allow them to cram in back with the supplies.  “Matebos Chiremba.”  Thank you doctor.   After 30 minutes of pounding the Cruiser climbs steeply out of the riverbed, around a sharp turn and suddenly the Karanda Mission Hospital sign confirms that we’ve arrived safely. 

Outside Karanda Mission Hospital gate

Karanda Mission Hospital is one of the most respected hospitals in Zimbabwe.  Patients travel from all over Zimbabwe and neighboring countries to receive care.  It was started by TEAM about 50 years ago and is located in a rural area about 250 kms northeast of Harare, the capital city of Zimbabwe.  Karanda is a 150-bed hospital with an outpatient department that sees 150 - 300 patients per day depending on the season.  They perform 100-120 deliveries a month with about 10% of those being by Caesarean Section.  They have a very busy Antenatal Clinic, Immunization and Well Baby Clinic.  Dr. Dan Stephens, a general surgeon who has worked at Karanda for over 20 years, has recently been joined by Dr. Paul Thistle, an Ob/Gyn surgeon, who has practiced in Zimbabwe for almost 20 years.  Together they provide care in nearly every surgical discipline. 

TEAM Zimbabwe

Karanda has long had a strong educational presence in Zimbabwe hosting medical students for clinical rotations and running a Nursing School with 30+ students enrolled in a 3-year training program. 

Dr. Dan Stephen’s father, Dr. Roland Stephens, is a general surgeon who directed Karanda for much of its history up until his retirement this January.  Previously, he had been doing most of the orthpaedic surgery work.  This is now Dr. Dan Stephens’ responsibility.  Originally we had hoped to spend all of our time in Zimbabwe working at Karanda doing orthopaedics.  Due to licensing logistics, which turned out to be a blessing, plans changed and we spent much of our time working in Harare.  We were still able to make it out to Karanda for multiple orthopaedic surgical visits.  During these visits Dr. Stephens quickly became adept at using the SIGN nail system to treat long bone fractures of impoverished patients with difficult injuries.  This implant system, which is free to patients, is generously donated through the support of Dr. Patrick Ebeling and Dr. Justin Esterberg.

At 5 AM before the sun was up this past March, Dr. Akimu Mageza, an orthopaedic resident working in Harare, joined me on a trip out to Karanda.  That day we were able to treat 4 patients with SIGN nails and another patient who had suffered a hip fracture.  Dr. Mageza was thrilled to experience the mission hospital setting and amazed by what is being accomplished there with limited resources.  We are currently working on a collaboration that would have the orthopaedic residents visiting Karanda regularly to treat patients with Dr. Stephens in the rural setting.

Some of the Karanda team, including Dr. Christopher Kidwell, our physiotherapist, Charity, and theatre nurse, Prosper, came to Parirenyatwa Hospital in Harare to learn the Ponsetti method of treating babies born with clubfoot.  This method uses 6 weeks of serial casting and a tenotomy followed by bracing to correct clubfoot in children.  This is a life changing treatment that is now offered at Karanda Hospital in collaboration with our good friends in the physio department at Parirenyatwa Hospital.

Peter working with Zimbabwean ortho resident

.At the end of March, I was joined by my good friend, Dr. Peter Sanders.  We again visited Karanda where the team was able to attend to many orthopaedic patients.  Dr. Sanders led some very practical lectures on orthopaedics and shared a wonderful devotion with the nursing team.  I would like to thank the Stryker team in Minneapolis, Minnesota, which sent orthopaedic hardware with Dr. Sanders to care for the poor.  The equipment has been put to immediate use!  Stryker has been very generous to our efforts in Nepal in Zimbabwe.I just got word from the surgeons in Nepal that donated Stryker drill kits worth well over $50,000 had arrived  – just as the old equipment gave out!  God’s timing is perfect.  

We ask for your prayers for the Karanda Mission.  I recently received this communication from, Jon Christiansen, a missionary at Karanda:
“Not normally being an alarmist, I find myself alarmed.  This past year was one that presented the Karanda with inadequate rain.  Looking back, the Lord prompted me to pursue the drilling of one more borehole to supply water at Karanda.  Well over two months ago we began to see our other wells dry up.  To date, the only well that is producing a little water is the new one that we just put in place.  This water is all that we are now having available to supply the hospital and residential area of the facility.  The surrounding village pumps are going dry as well, putting more pressure on the Karanda system.  Our newest well is now going into “dry run”.  We are running out of water.  We are asking you folk to pray about this.  We need an immediate solution from our Lord – He can open the flood-gates.”

Elephants enjoying a part of Zim spared by drought

Salt and Light

 After leaving Tansen Mission Hospital we took a holiday in South Africa.  We spent Christmas in Cape Town, which is absolutely beautiful.  Table Top Mountain, penguins at the beach, wine country, pristine coastline, a safari, and many hours splashing in the waves were the highlights.

We arrived in Harare, Zimbabwe, Jan 11, 2013 fully rested and ready to get to work.  Our original plan was to head straight out to Karanda Mission Hospital in the bush where Ryan had previously spent 6 months in 2006.  However, our plans have changed as the Medical Council here granted Ryan’s medical license contingent on spending 3 months working in Harare.  At first we were quite disappointed with this news.  However, we have again been shown that the Lord’s plans are better than our own.  Ryan has been working at the two main trauma and teaching hospitals in the country that provide care for the poor, Harare Hospital and Parirenyatwa Hospital.  A good friend and Karanda missionary, Jon Christiansen, dropped me off at Parirenyatwa Hospital the first day, knowing that we had wanted to be serving at the mission hospital.  He offered up a prayer that I hope would resonate with you wherever you are working.  He prayed that even though I was working at this government institution and not the “mission” that I could be “salt and light to the people you encounter wherever you are.”  This has been an encouragement to me and I pray that it would be for you as well.

The typical day starts with doing an x-ray round with the orthopaedic residents at Parirenyatwa Hospital and then driving the Toyota Tazz across town to work at Harare Central Hospital.  It has been wonderful to work with these eager residents and get to know the handful of orthopaedic surgeons working in this country of 12 million people.  My first day rounding at Harare Hospital I met an 18-month-old girl named Angel.  Her mom is in South Africa and no one knows where Dad is.  She had been looked after by a nanny and was just brought to the hospital after neighbors were concerned.  She wasn’t able to walk or crawl and further examination showed she had been systematically abused and had a total of 9 fractures in every limb of her little body.  Nobody comes to visit her.  I have taken this little Angel under my wing and with traction, lots of prayers and time her fractures are healed.  Unfortunately, adoption is regarded as a last resort for placement here.  We are looking for a safe place for her.

Rounding at Harare Hospital these first days the situation seemed quite desperate.  The wards and clinics are full of patients that need an operation, but we are only able to accomplish 1-3 orthopaedic operations per day and 1PM is the witching hour when everything seems to come to a halt.  In a little over a month, reasons for the theatre being shut down have included: no power, no water, no steam for autoclave, no nursing staff, no anesthesia staff, the equipment wasn’t washed, the implants were lost, no gowns, no sheets, underpaid staff leaving early to moonlight in private clinics, continuing medical education, etc.  To hear a patient who has been on the ward for weeks weeping after spending the morning waiting in the OR hallway only to have their surgery cancelled again is difficult.  I have focused on the patients we can help and prayed about everything else.  Slowly, our team is starting to get more done.  These hospitals were in fact shut down just a few years ago as Zimbabwe hit bottom (hopefully) and at least now the doors are open and the lights on (sometimes).

Despite the difficulties, there is much to be encouraged by!  One of the most exciting blessings of this Harare detour is that SIGN (www.signfracturecare.org), described in a previous post, is providing intramedullary nail equipment to care for the desperately poor patients with fractures at both Harare Hospital and Parirenyatwa Hospital.  This wouldn’t have happened if I had been permitted to go to Karanda straight away.  Sponsorship of these programs is still needed if you are so moved.  One of the first patients we treated with the SIGN system in Zimbabwe was a woman who was 6 months pregnant and had been in a bad motor vehicle accident before Christmas in Zambia.  She fractured her femur, broke her tibia in two places, and had the skin peeled off the back of her calf.  She tried to get treatment in Zambia and couldn’t.  She rode a bus to Botswana looking for treatment and couldn’t find it.  Finally, 6 weeks after her injury she arrived in Zimbabwe very pregnant and with a very shattered limb which we were able to put back together with the SIGN system.  Without this donated implant her unborn baby would likely have been walking before she was! 

Recently we took a fly-fishing trip out to the Highlands near the Mozambique border with Dr. Prawius from the U.S. Embassy and Pastor John Bell.   We had first been introduced to Pastor Bell after his sermon on “Salt and Light.”  A week later we were sharing the poetry of the fly rod.  Not my first time out, I fished hard for two days and was empty-handed.  Andrea took a turn and landed a nice Rainbow Trout on her third cast!  Pastor Bell said God routes for the underdog.  I could only smile J

It felt good to smile, as there have been many tears at our house the past few weeks.  Our friend, Becca Sweeney (Koch), was called home to the Lord after battling leukemia, leaving behind a husband, two young children, and a legacy of love and grace.  This news came a few days on the heels of the passing of my grandfather, Harold Horazdovsky.  I last saw my Grandpa Harry in July and would have guessed he had many years left with us.  When my Grandma Sally passed just a couple months ago after a lifetime together my Grandpa told her, “Don’t get too far ahead of me.”  They are together again.  Being far away during these times has been hard. 

Harry and Sally

Kidwell's hours after the addition of their newest member

Win, Andrea, and I all piled in the front seat and drove an old Land Cruiser out to Karanda Hospital for the weekend Thursday night to treat some fracture patients.  The 2.5-hour trip took almost 5 hours due some of the wildest thunderstorms we have ever seen.  We saw a tree fly through the air and topple a power line.  White knuckled we drove in the dark on beat up roads submerged in water and through the river to reach Karanda safely.  That old Cruiser is now officially part of the family.  While we were at Karanda we got to see the mission family grow as well.  The Kidwell’s (www.kidwellsinafrica.blogspot.com) delivered their much anticipated little girl, Grace, faster than expected right on the living room floor, while their two young boys ate dinner and watched a movie with us.  No one can remember the last time a missionary had a baby at Karanda.  Perfect timing!

Win riding shotgun

Love this truck

Ta Ta Tansen

Almost 5 months in Nepal has quickly come and went.  We just finished eating at the Lazy Gringo in Kathmandu.  We have come full circle, as this is the first place we ate upon arriving in Nepal.  Lots of dal bhat (rice and lentils) bookended with chimichangas.  The bags are ready and we soon board a plane for Africa.  The Lord has blessed our family with health, safety, good friends, and plenty of work to do during our time at Tansen.

 

Andrea found herself busy at the hospital 3 half days per week working with the children.  This included playing with children, working with pastoral care, and providing distraction during painful procedures.  While at Tansen, Andrea taught 3 classes on child friendly approaches to the pediatric patient, including lecturing to an auditorium of over 80 nursing students.  Teaming up with Pernilla Ardeby, a pediatric nurse from Sweden, Andrea wrote a chapter on emotional support and distraction for the pediatric patient.  This is soon to be published and adopted nation wide for the pediatric nursing curriculum. 

    

It has been a productive time in terms of orthopaedics.  In 4 months at Tansen Mission Hospital I have operated on over 250 patients.  We worked 6 days a week at the hospital, Sunday-Friday.  I had clinic 1-2 days per week where with a single resident we would see 60-100 patients per day.  The efficiency and hard work of the clinic and operating theatre staff make this possible.  About half of the operated patients were pediatric.  73 of the patients operated were pediatric patients with elbow fractures of every kind.  12 patients got 13 intramedullary SIGN nails for femur and tibia fractures.  After assisting a number of cesarean sections, 8 patients had orthopaedic C-sections for fetal distress and breech presentation, as this is part of surgical call.   Dr. Dipak and Dr. Tul were able to take some well-deserved breaks.

SIGN Nail

Open fractures treated with provisional external-fixation, now for SIGN nail

Being here for some months has allowed me to see many of our follow-ups.  In an earlier blog post I mentioned a horrible accident involving a bus going over a cliff in which many people were killed and 17 badly injured patients were brought to our hospital over 30 minutes.  With the treacherous roads This is not an uncommon event here and the Tansen triage ran smoothly as usual.  One of the patients had a bad pelvic fracture.  After consulting and crafting an operative plan with Dr. Peter Cole we operated on this mans pelvis including placing percutaneous sacroiliac screws which had not been done at Tansen before.  At 10 weeks from surgery he is in no pain, happy, and ready to get back to work so he can support his family. 

                       

I owe a huge thanks to Dr. Dipak Maharjan, Dr. Tul Bdr Pun, and the lovely patients of Nepal for giving me a fellowship of orthopaedics in the tropical developing setting.  They gave me experienced instruction on how to address tuberculosis of the spine, hip, knee, and ankle.  They also helped me diagnose and treat pyomyositis, acute and chronic pediatric osteomyelitis the likes of which I have never seen.   Dr. Anod’s surgical approach to pediatric supracondylar elbow fractures I will always take with me.

The moments that will be forever with us stem from sharing Christ’s love with our Nepali friends and patients.  Through our daily work, devotions, and worship we have had much treasured fellowship.

  

Cooking with small spoon at ortho Christmas party

 Despite it being December in the mountains and not having heat our family is feeling warm.  We had a wonderful visit from Andrea’s mom, Diane, and Uncle Gary.  They brought us a new drill!  Instead of snow there are poinsettia trees.  The past weeks have been filled with Advent and Christmas celebrations with the Nepali and mission community.  Our Tansen Men’s Barbershop Choir performed White Christmas and Silent Night at a couple of them.  We are blessed to have been a part of and supported by the Tansen community.  It has been home to us and we are sad to go.

Poinsettia

Mom and Uncle Gary playing with Tansen patients

Beginning of 10 hour bus ride to Kathmandu.  No whahka whahka yet (vomit).

We have been blessed by the safe arrival of the SIGN nail sets sponsored by Dr. Ebeling and Dr. Esterberg which will be the first program in Zimbabwe.  Please see our earlier post on SIGN nail if interested (www.signfracturecare.org).  This equipment was shipped by Orphan Grain Train on a large shipping container which made the 4 month journey from Nebraska to Karanda.  Currently having some difficulty with the Zimbabwe medical license, but trust that all will work out as it is meant to.  

Merry Christmas and Happy Holidays!

Andrea, Ryan, & Winslow Horazdovsky