Fever of unknown origin

Fever of unknown origin! For those of you who are medical you have an idea of what I am talking about. For the rest of you, this simply means a fever without an obvious source. For example a child with a fever, who has no obvious pneumonia, ear infection, sinus infection, or infected throat. In the United States we generally assume this is some sort of viral syndrome and the child will most likely improve over the course of 5-7 days with minimal treatment. In Africa, fever of unknown origin (FUO), especially in kids is much more daunting. With illnesses such as malaria, meningitis, and tuberculosis much more prevalent, and many parasitic infections present that are uncommon to us the differential diagnosis is much more challenging. Add to that, the fact that many children remain unvaccinated this creates quite a melting pot of infectious disease possibilities.
For this reason, one of my biggest fears when deciding to travel with small kids to Africa was the fever of unknown origin. Shea and I both knew this was a very real possibility, but still hoped this was a bridge we would not have to cross.
Unfortunately this last week we experienced FUO x2. First Gracie then Beau became ill with unexplained high fevers. After ruling out the most common things we decided (with the help of Todd Stephens who luckily was here) that they both should be treated for malaria. We have since treated them with 3 day courses of coartem, and after several sleepless nights they are both recovering well, and doing fine.
It was not an easy time, as you can imagine. I asked myself many times while holding Gracie why we were here. I thought to myself on more then one occasion about going home while praying that Beau would stop shaking and crying with fever. Looking into Shea's tearful eyes and not having any good answers was a terribly helpless feeling. It was quite a challenge, but I could feel the Lords presence as family back home kept us in close prayers, and our friends Paul and April were a constant encouragement and comfort to us on those wakeful nights. In the midst of it all it seemed very difficult. In reality many of you are going through, or have gone through many more difficult things. Even now as you are reading this many of you are struggling with loss of loved ones, abuse, broken relationships, job loss, financial crisis, poor health, and much more.
Fever of unknown origin in African is much like suffering that occurs in life. We do not usually know why it happens, or even how to make it stop. In the midst of the pain there are rarely answers or solutions to the problems at hand. All we can really do is keep going(or in medicine treating, often with multiple medications), and pray a lot. It is this dependence on God that makes the experience worth it. In the end the pain is always worth the growth (easy to say when your not in the midst!!). James says in James 1:2-4 “Consider it pure joy my brothers, when you face trials of many kinds, because you know the testing of your faith develops perseverance. Perseverance must finish its work so that you may be mature and complete, not lacking anything.” Or in 1 Peter 1:6-7, Peter says “though now for a little while you may have had to suffer grief in all kinds of trials. These have come so that your faith-of greater worth then gold, which perishes even though refined by fire-may be proved genuine and may result in praise, glory and honor when Jesus Christ is revealed.”
The good news is trials/suffering like FUO usually resolve. Whether it takes 4-5 days( like it did with our kids), or many years (like the struggles I know some of you are facing today). In the end your pain is well worth the faith you gain through your perseverance. And your months or years worth of suffering will seem like a mere drop in the bucket compared to the inexpressible joy you will have for eternity with our Creator. Anyway, just another valuable lesson I've learned from our time here in Zimbabwe!
Well to change gears, aside from our little battle with illness things are continuing to go well here in Zimbabwe. We just had a visit from Dr Leu, and Dr Stephens. They were here for about 4 days, but added so much in there brief time here(actually....they literally brought a lot of stuff....most importantly a kiddy pool for the kids). But no, we really enjoyed rounding, clinic, and even operating with them. They were just very encouraging, and helped a lot with some of the work load.
We also made our first trip back to Harare to reload on groceries. It was really nice to get a break from the hospital, and mainly just driving in a car for a change(its amazing how much you miss the freedom to drive when you haven't done it for a while). Paul and I got to take turns driving a 1990s Toyota Land Rover through the bush in Zimbabwe and in Harare. It was awesome just to have the freedom and it was just a ton of fun to drive(especially the dirt roads). Don't worry April and Shea kept a close eye on us making sure we kept in the left lane(yeah.....they drive backwards here), and watched with great care as we made our very strange wide right turns. The whole driving on the wrong side of the road (well, I guess it depends who you ask), takes some getting used to, but by the end of the weekend I think we had it figured out. It was a lot of fun, and we do have an interesting driving in Zimbabwe story, but I think it will be more fun if we tell it in person.
The medicine here continues to be both challenging and fascinating. I know Paul has shared with you recently one of our sad C-section stories. (By the way if you haven't checked out Paul and Aprils blog, you should do so at mcquilleninternational.blogspot.com . Paul is a gifted writer, much more eloquent then I, and he gives much better play by play as he usually updates his blog twice weekly.....oh yeah and did I mention he also takes great pictures). Sorry for the commercial interruption...back to my thought. Anyway, we have had several very tough C-sections as moms often labor for 2-3 days at home, before they finally get to us. This makes the procedure very difficult since often the babies head is deep within the pelvis, and the babies are often near dead by the time they arrive. On the flipside, we have also had some really great outcomes were babies that should not have survived lived, and this has been very encouraging. We had one little 28 week baby deliver vaginally through a placenta previa (this is when the placenta covers some or all of the cervix...so not something you want to deliver through.) Anyway the mother went into preterm labor and we were giving her steroids to help mature the babies lung before Csection. Unfortunately she delivered precipitously before a Csection could be done. Amazingly the baby has done wonderful. Usually babies less then 34 weeks do not survive here, but obviously God is in control, and we are all excited to see this little one still kicking and crying.
Well I think I've gone well over my 1000 word limit(sorry not hard to do when I get rambling). I have so many more stories to share, but I'll have to save them for another time. Anyway all 4 of us our doing great. I think Gracie will be crawling soon. Beau is starting to talk a lot more and he is just a blast to be around(if we could just get him potty trained we'd really be ecstatic). He will be turning 2 in about a week, and I think he is already pumped for his cake and ice cream. Shea is doing a great job balancing home and work.....she really loves getting a chance to work in the hospital and is doing a great job.
We miss everyone a lot, and love getting all of your emails. So please keep them coming.(and pictures are great as well). We hope to hear from you all soon.
To His Glory
John, Shea, Beau and Gracie

Enjoying the outdoors!

We have enjoyed this last week even more as we have began to

appreciate being able to get out into nature. Zimbabwe is very

beautiful and the people here are so kind. We thank you for

all of your prayers, as God has kept our family from any sickness

thus far.

Surgery Day

Well I'm kind of new at this whole blogging thing. This is really my first pure blog. I usually just prefer email, but this seems to be the new trendy thing to do so I guess I'll give it a chance. I guess the way this works is you just start writing whats on my mind....well if I did that you would all be bored, because right now all I'm thinking is Taco Bell, Taco Bell, Taco Bell. Sorry I guess I'm a little hungry and I miss my old favorite fast food back in the states. Anyway back to my point. I think blogging is kind of like journal except everyone can read it. Thats kind of strange, but Oh well I'll give it a shot. I was going to sleep since our internet was down t0night, but happened to check before bed, and I guess its working again. Shea just went to sleep, and both the kids are down for the night(well at least beau, Gracie still likes to wake up on some occasion) Anyway, today was a great day at Karanda Hospital in Zimbabwe. MWF our my work days, and on TTH Shea works and I stay at home with the kids. Well Wen. just happen to be surgery days, so today after rounds, I got to spend all day in the theatre. It was wonderful! There is just something satisfying about reparing something thats broken. Well.............I guess I didnt really repair a whole lot today. We really just took a lot of things out. Namely testicles and prostates. It sounds a bit harsh but they are both actually quite fun to do, and you dont need to be a brain surgeon to do it. We did fix a few things though. A few broken bones, small intestine that was seperated, hernias, a clubbed foot, and a kids brain that wasnt draing fluid that way it should....just to name a few. So it was a great day at work!!! We then spent the evening on a 3 mile walk with the kids. We discovered how beautiful Zimbabwe really is. We havent ventured to far from the hospital until now, but it was breathtaking to see the rolling hills, farms and forests. Its also quite fun to see all the people walking with us on the dirt roads. Cars are quite a luxury that we have really gotten used to. But most people around here 3-7 KM every day just going to work, school, or down to the river to get water.
After the walk we all enjoyed a nice dinner, and sat inside and listened to the thunderous rain as it poured over our roof. It is such a wonderful sound, as the people here have been quite concerned over the drought which has hit them right in the middle of the farming season. So tonight is an answered prayer.
Well I guess that is the quick summation of my day. I can honestly say that we are really starting to enjoy our lives here at Karanda. There is still daily struggles and obstacles, but struggles will arise whereever you might live. In the end the Lord is in control, and you have to lay your head on your pillow at night giving all your concerns and worries to him. I'm so thankful that we serve a loving God, and so thankful that he loves Shea and my kids more then I ever could. I gladly give him the reigns!!!

Top 10

Hello Everyone!!
Well it has been several weeks now and we and the McQuillens are finally getting settled in. My mom recently made it back to Wichita. We loved having her here why we got settled in, and she added so much to our trip. She also was able to work some in the school and with the HIV orphans.
It hasn’t been an easy trip as many of you know. It has been more taxing then Shea and I’s Kenyan trip 4 years ago. I think the 2 kids under 2 may have something to do with that. But we are starting to get accustomed to the lack of electricity and water much of the time. We are also getting used to cooking food from scratch, and planning meals well in advance.
We have asked ourselves many times over the last several weeks why we are here, but we both know this is where God wants us. He always provides us with just what we need (often not much more), and we have become quite thankful for little things. Like a nice cold shower at the end of the day to cool us off, a drink of cold clean water, and a nice freshly prepared chicken with all of the fixin’s. We’ve enjoyed sitting around our dark, hot room at night as Paul reads us stories from Wendell Berry’s: That Distant Land by flashlight. Or our morning devotionals as the Shona sing in accapella with their heavenly voices.
The medicine has also become more enjoyable. It is quite different then back home, and we realize more every day how lucky we are to have all of our resources we do in the US. Paul, Shea and I have been busy in the hospital wards, operating room, and clinic/triage rooms. We have performed C-sections, many other surgeries, and have seen many unusual illnesses. I look forward to sharing with you, some of the more interesting medical cases in the future
The poverty here is amazing and I am continuously reminded of the abundance we have, even here at Karanda. We actually have a freezer full of meat and water that runs most of the time…so we really can’t complain.
Beau and Gracie our adapting very well. It took about 7-10 days for them to get over jet lag, but they are now doing great. Beau spends most of his day running around with only a diaper(cloth of course), shoes and his brace. I think he would explore the whole country side if we'd let him. He's walking and running better all the time. I think the heat bothers us alot more then it does them. Gracie just rolled over several days ago, and she is smiling and chating with anyone that will listen (but of course her brother is always quick to steal back the attention).
I just thank all of you for your continued prayers, and ask that you keep them coming, as we probably have many challenges ahead of us. Up until now, no one has been really sick. We keep the kids under bed nets at night. And we all are faithfully taking are prophylaxis to keep them from getting malaria, as the malaria season is in full swing. Just continue praying that no major illness attack our family, and that the political climate here in Zimbabwe remain stable.
Before I go, I wanted to leave with you all with a top 10 list of things to remember when traveling with small children to Africa. These are just some of our funny memories, and lessons we learned the hard way through our first several weeks of traveling together with the McQuillens. Unfortunately for us there is actually more then 10……Oh well.
Anyway, I hope you all enjoy!!!!

Top 10 things to remember when traveling with small children to or in Africa!!! (No particular order)
1) Do not vomit more then 10 times on South African Air or the pilot will ask you to deboard the plane in Senegal (a muslim developing country) to receive proper(yeah right) medical care. (Unfortunately this happened to my mom)
2) Make sure your travel agent gives you more then 2 hours between connecting flights before you 18 hour flight, or you might find yourself sprinting in the airport, with a screaming 2 year old, a backpack, 2 over the shoulder carryons, and a roll behind carryon with a car seat strapped to it. (it wasn’t a good way to start the 18 hour flightJJ)
3) Make sure you never bring car seats, you will just end up carrying them through every airport on your back and never get to use them, as no vehicles actually have seat belts here in Africa.(I just wanted to burn those things)
4) Don’t bring a backpack that you hope your toddler can carry, as you will just end up carrying your toddler and his backpack, and all the toys that keep falling out of the pouches.
5) Make sure your travel agent checks all your bag through from your original destination to your final destination or in your short 2 hour layover you will be forced to carry all 15 checked bags, 14 carry-ons, 2 strollers(one we never got), and 2 car seats(remember we had 5 adults and 3 kids, but my poor mom couldnt carry much with her bad back) from the baggage claim back up to the check in desk. Then rewrap all of your bags with seran wrap, and duck tape(to keep people in South Africa from stealing your stuff), and start sprinting to catch your flight(see #2)
6) Don’t start using cloth diapers for the first time when you don’t have power or water…I think this one speaks for itself.
7) Don’t expect just because you tell your kids “night night” that they will just go to bed and stay in bed after traveling for 29 hours half-way across the world. Or any night for the next week!
8) Don’t go to Africa and live 3 hours from the nearest grocery store. Or as you’ll find out your chicken/meat will go bad, unless you adapt your deep freeze. You’ll be forced to fill old containers with water to make blocks of ice, wrap your food in paper, and put sleeping bags and blankets around your deep freeze….since the power may go out for days at a time.(remember no going back to town for 1 month…..maybe we should have thought harder about this whole trip JJ)
9) Don’t expect that you and your son will get a seat in the vehicle that takes you across Zimbabwe when your driving 3 hours on hot, pot hole filled roads. You’ll probably just end up in the back of the truck wedged between the luggage. You could always tell your son that this is an African Disney ride that lasts 3 hours…..Man we’re lucky!!!!
10) Unless your crazy (like literally taking antipsychotic medicine) don’t travel with small to kids to Africa!!!!(That’s the moral of the story)

Ok here is a few others that didn’t make the top 10 list, but still good:
-Don’t just let your kid start playing with strange bugs
-Don’t just give your kid a bunch of milk that was sitting in the fridge for who knows how long(no matter how bad he wants it)….or you might just end up with projectile vomiting all over your room, and no water or power to clean up with…that room still stinks!!
-Make sure your travel agent books your wife and 2 kids in the same row on your 18 hour flight, and not 3 rows back.(starting to notice a travel agent theme here) Its very important to double team the kids whenever possible on a long flight.
-Don’t sit behind someone on your 18 hour transatlantic flight that doesn’t like kids, or your kid may end up kicking his seat the whole, and this kind of makes life miserable for you.
-Don’t bring more carry-ons/kids then both of you can bring on to the plane at one time, the airline industry really doesn’t take kindly to people going back and forth off the plane just to get more stuff.
-Don’t assume that just because you sleep under a mosquito net that you’ll be free from getting mosquito bites, that is unless you checked under your nets for mosquitos first. Otherwise you just trapped them all in with you for a nice full night of feasting on your blood, and trying to give you malaria.
-Don’t assume that just because you checked your brand new $500 stroller at the gate in Washington DC that it will be waiting for you when you land in Johannesburg. (I mean where could it go, it was supposed to go right on the plane with us……Wishful thinking, maybe someday it will turn up)

OK….OK I think that’s enough for now, but stay tuned I’m sure this list will continue to grow before its all said and done. The Lord really has blessed us, and we are very thankful to be getting settled in. We thank you for your prayers.

We have arrived in Zim

Our family has safely made it to Zimbabwe or Zim, as people here refer to it. We have just about finished with the sleepless nights of jet lag, which is extremely hard on children- I have learned. We spent the first 4-5 days in the capital, Harare and now have arrived at Karanda. John is at his first day of work today. I think he has spent most of the in the operating room or theatre (as it is called here).

Moving into the guesthouse there are a few things that we have had to get use to-- we are now using cloth diapers, which is a adjustment....Beau has wet through quite a number of pants, but I think we've figure out how to do them correctly now. We are becoming aware that electricity comes and goes as the wind...it can make getting our chores done a little tricky. Another new thing is filtering our drinking water, which at times does run out...that is why we have a very large trash can of water sitting outside our back door. The guesthouse that we are staying in is just beautiful though and we have really appreciated the fans in it, as it about 95 degrees out.

Fran, John's mom, came with us and will be leaving next week. She has been such a help and has been able to work at the school and is working with HIV orphans as I write this.
We want to thank all of you for your prayers. God has already been teaching us about relying on Him and I'm sure He is going to teach us even more about patience, compassion, and love. We are going to be serving the Shona people and are excited to meet them, please pray for those patients that we will encounter as well as the hospital staff. A verse that I have been reading because it's posted next to our diaper changing station is: Romans 12:12 Be joyful in hope, patient in affliction, faithful in prayer.
Hopefully I'll get to update again soon.

tropical medicine

First official Epperly family blog! I'm just sitting in the tropical medicine lecture listening to a talk on neurology in the tropics. Shea is 32 weeks pregnancy and is in Tucson with Beau. This is all I'm going to write about now. Stay tuned for more later. (I've gotta seen if this actually works). I dont really trust technology!