So much happens here that it is almost paralyzing to consider what to share on blogs. And, I’ve been a pretty lousy ‘blogger’… But I’m trying to get back in the game, so I was trying to figure out what to write. Last night my wife was sifting through the photo album of my iPod, alternately smiling at family pictures and cringing at various medical photos. So I figured, ‘hey, that could work for a blog.” I decided to give a brief tour through a missionary surgeon’s iPod photo album.

This was shortly after our arrival in Ethiopia after our trip to the United States. We stayed at the guesthouse at Myungsung Christian Medical Center (MCM) where PAACS is expanding this year. This photo is with Chi and Sandy Chung. The Chung’s moved to Ethiopia this July and Chi will be involved with setting up the PAACS program at MCM. They are a great couple and we’re really blessed to be working with them. This photo was taken in the cafeteria just after breakfast. I am very thankful for our relationship with MCM.

On the way out of Addis, heading down to Soddo. In this country, drivers are held responsible if people hop onto the back of a vehicle and fall off. So this is one way to keep the riffraff off your rig. If you can’t make it out, those are very uninviting thorn bushes lashed onto the back of a truck.

The kids in the back of the truck on our way down to Soddo. At this point, they’re seasoned travellers.

This is the leg of a five-year-old boy who was run over by a car. He is missing a segment of bone and the foot was no longer viable. We amputated it to save his life. He also had a head injury that became complicated with meningitis. This was the first time I have ever seen this complication. We took a cerebrospinal fluid sample via a lumbar tap that basically looked like pus. Over the ensuing weeks, he made some improvements and we eventually got him over the meningitis. But he just wasn’t bouncing back from the head injury. We sent him home with his family a few days ago. I don’t think he is going to do well.

This is an eighteen-year-old woman who came to our clinic with a burn contracture  from when she was a toddler. Way beyond my pay grade. We occasionally have plastic surgeons visit the hospital, so we gave her the operating room’s phone number to call in every month or so and check about the availability of a plastic surgeon. There are many things I just can’t do yet.

This is the chest x-ray of a two-week-old boy who came to the hospital with a myelomeningocele. This is a developmental abnormality where the spine doesn’t form properly and leaves the spinal cord in danger and often damaged. We were considering an attempt to repair it. There are plenty of problems with that, including the development of hydrocephalus from a usually associated abnormality at the base of the skull. But he had some problems with his oxygenation and the chest x-ray showed an abnormal heart. We referred the family to Addis Ababa for an echocardiogram and further work up. I don’t know if they will be able to do it. This problem may just be too much for our resources here.

Dave Hardin has been visiting with us for the last month. Dave will be moving to Ethiopia early 2013 with his family and we will be partners here. Dave and I trained together in general surgery at Baylor in Dallas. This was the first operation he tackled here in Soddo. This is a weird cystic mass in a man’s neck, hanging out from under his mandible. (The chin is in the upper right corner of the photo.) After some post-operative emailing to smarter people than us, we think it is a huge ranula, basically a blown-out submandibular gland from a blocked salivary duct. We were able to remove the portion extending into the neck. But there was a large component up in the floor of the mouth, between the tongue and the mandible. From inside, we could feel where the gingiva on the inside of the mouth met the back molars of his lower jaw. Only the lining of his mouth separated his mouth from the wound. We decided to stop before doing harm and left a drain and emailed for help. We sent him home and we’ll pray for the best. If it recurs, we’ll tackle it from inside the mouth next time.

This is the uterus of a woman with molar pregnancy. Medical sorts will appreciate the typical “grape-like” appearance. Mark Karnes is one of our obstetrician-gynecologists here at Soddo. I love him dearly. The man is passionate about women’s girl parts. Every time he plops one into a steel pan, he calls us in to check it out. He has operated on several women with molar pregnancies in the last few weeks. By the way, it isn’t a normal pregnancy and won’t ever result in a baby. It can sometimes be treated medically but many of the women who come to our hospital are so advanced that surgery is the only option. Again, I am very thankful for Mark’s work here.

Last week Becca took the kids to Addis for a home schooling conference. While she was gone, Dave and I lived the bachelor life here in Soddo. As two bachelor surgeons, we pretty much just operated and played card games. On the one time when I decided to do some dishes, I pulled back a pan to notice this big fella in the sink. Becca is not a fan of spiders and I was happy to discover this while she was away. The second picture is after I judo chopped it with a Pampered Chef rubber spatula.

This poor guy was operated on in a very rural hospital for an unknown bowel problem. From the description, I think it was a sigmoid volvulus where part of the colon twists on itself, obstructing it and sometimes killing it. It seems some sort of bowel resection was done but then he leaked several days later where the bowel was sewn back together. Unfortunately the surgeon decided to try to sew it again. This time it leaked and the abdomen was, as we say, hostile. He was transferred here. We have basically just been doing wound care and pounding calories into him. By God’s grace, he is improving and the wound is getting under control. It is a fairly well controlled fistula now, and it does seem colonic. So, it should eventually coalesce into a colostomy, of sorts. We are trying to get him stronger. He is currently on our benevolent fund because they have no money. Our deal is this: if he gets up and walks each day and eats all of his food, we’ll keep him here until the wound is manageable enough to go home. He’s keeping his end of the bargain. God willing, we will try to operate and repair the fistula in about a year. No quick solution for this one.

This is wispy thin little old lady with full-blown AIDS who came in with a necrotizing infection of her legs. When we were debriding the dead stuff off, I was able to literally pinch her skin off with my fingers. That’s not normal. Between her immunosuppression and malnutrition, even her normal tissues are weak. I think I could tear her normal skin with my bare hands. Again, we applied a lot of wound care and aggressive eating. (They never eat that aggressively, though. But we keep pestering every day.) We finally got the wounds ready for skin grafting, but I was really worried about our ability to take her skin… it just seemed so weak and thin. Sure enough, it didn’t go well. When we skin graft, we use a machine that takes a sheet of partial thickness skin, leaving the dermis in place. We put the top layer that we removed onto a wound and it heals. And the bottom layer, that we didn’t remove, also heals. Well, her skin was so thin; it was just going right into the fat below the skin. I couldn’t it to work. So, we improvised. We took a full thickness strip of skin off the side of her leg and sewed the defect shut. We then meshed that piece of skin like we would a split thickness graft and put it on the wound. It actually worked pretty well. This photo was taken four days later when we took the dressing off. Helpful little tidbit to have in the repertoire.

This woman came to our clinic with an incarcerated epigastric hernia. This is a hole in the abdominal wall between her belly button and the bottom of her chest. We offered surgery but she left to talk with her family about funding for the operation. In the meantime, the bowel that was stuck in the hernia died and began leaking intestinal content into her abdominal wall. It eroded through the skin and was a horrible mess when she returned. Thankfully, though, it was localized to her abdominal wall and did not contaminate her abdominal cavity. We were able to resect the involved bowel and put her abdominal wall back together. She did well and went home with wound care.

But it’s not all gruesome and scary. While walking home one day last week, I saw my son, Nathan, building a small city in the sand (dirt) box at the campus’ new playground. It’s so awesome to come home to a beautiful, loving wife and two great kids.

Well, there is just one problem with sharing a photo album. It only conveys things that photos are good to convey. Life and surgery in Ethiopia are gifts and I am very thankful for them. But the greatest reason for our being here is the gospel of Jesus. In Him our lives have been forever changed and we joyfully give ourselves to Him and His kingdom. What I can’t illustrate well with pictures is how God is showing His love and how He is graciously letting us come along and watch. Let me just share a brief excerpt from a prayer letter:

“We have also seen many patients respond to the gospel. I had the great privilege of watching God use my friend Dave Hardin to draw two men to Himself. It was an especial blessing to Dave who has been praying that God would such use him. One morning we were rounding with the residents and finished in the surgery ward. We had a couple of patients in the medical ward and we headed over. I took one of the guys and went to see a difficult patient in relative privacy (financial situation). When we had finished, we met up with the rest of the team in a three-bed room where I found Dave sitting on the bed next to young man whose gallbladder Dave had removed a few days prior. They were just finishing sharing the good news of Jesus with him and he expressed faith and desired to pray. We all prayed with him and my heart was rejoicing. But God wasn’t done. After the prayer, Dave stood and we all started to leave the room. But there was a medicine patient one bed over who called out to stop us. He said he wanted to trust in Jesus too and wanted us to pray with him as well! We joyfully complied and the residents shared further with as well. And he also confessed faith in the saving work of Jesus. It’s pretty amazing how God kindly uses us to accomplish His work.”

I thank God for His goodness and faithfulness. And I thank Him for loving me and including me and my family in His work.

Paul

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