A Night on Call!

I had just fallen asleep, when I awoke to the ringing of the phone with a maternity nurse on the other end. She just called to inform me that a patient arrived who had delivered at home, and continued to have significant bleeding. I was tired as it had been a long weekend on call, and I was hoping for a good night of rest before the start of the week. Half asleep I reached for my scrubs and bag of random medical supplies and stumbled to the door to assess the situation. As I walked to the front gates of the hospital I noticed an anxious man standing next to a small cart with two large oxen attached to the front. This was an ox cart which was a common mode of transportation for many of the Shona people. I could only assume this was the husband of the lady I was about examine.

I proceeded to the maternity ward where I saw an elderly lady holding a small newborn right outside the delivery room. She was friendly, but nervous, and I also assumed she was the mother of the women I came to see. I arrived at the bedside to find and HIV positive mother who was completely pale, and barely responsive. I came to find out that she delivered at home which was 20km away. Evidently only a part of the placenta was delivered, and she had spent the next several hours with significant bleeding. They all loaded in the ox cart and initially drove 5km to a local clinic only to find no one available, and then turned and drove another 25 km to our hospital. All the while our young mother continued to bleed. As I examined her I knew  she needed several (3-4) units of blood. Unfortunately we had no blood in the hospital to give her. I asked one of our midwives how much she was still bleeding, and her response was "She has stopped...I do not think she has any blood left to bleed". Sadly, this was not much of an overstatement. The only option was to perform a D&C to remove the rest of the placenta and hope she would stop the bleeding, and we could keep her alive through the night.

We took her back to the theatre (operating room), and gave her some sedation. With some difficulty I was able to manually remove most of the placenta. Her placenta was firmly affixed to the uterus (placenta accreta). This made it quite difficult to remove. After removing most of it, I then used a curettage to remove the rest. Her bleeding slowly stopped, but the battle for her life will continue on through the night.

For now the night appears to be over. The rest of the hospital is quiet, and I'll try to get some sleep. This may be difficult, because I don't know if she will make it through the night. I know the best medicine I can give her at this point is prayer. I know our prayers have the power to move mountains (Mark 11:23-24). I'm also thankful Christ has removed the fear of death, and with him safe place to seek shelter (Prov. 18:10).

Happy Birthday Sekuru!

Happy 81st Birthday Dr.Roland Stephens! Or as he is affectionately known "Sekuru", which means grandfather in Shona. We just celebrated Sekuru's 81st birthday on January 24th. Roland Stephens is still working hard here at Karanda, and shows no signs of slowing up! He operates 8-10 hours a day, takes call with frequent C-sections in the middle of the night, and still runs 3 miles three times a week.

I guess 81 candles was just too much!

Sekuru has been the stabilizing force at Karanda for the last 40-50 years. After finishing his surgery residency in the early 60s he and his wife Kathy, and there 4 boys came to a very small bush hospital in eastern Rhodesia called Karanda. They both felt called from the Lord to spend there career serving others on the mission field. Its was at Karanda where Sekuru operated quite faithfully for many years. In the late 1970s as the civil war erupted in Rhodesia, violence threatened Karanda Hospital. In those days they would frequently hear mortar rounds right outside the gates. Sekuru had no intention of leaving, and he continued to operate through the violence for many months. He felt that was where God wanted him, and that God would continue to protect him. As the war escalated, and violence near Karanda continued to worsen the "powers that be" finally were able to persuade Roland Stephens and his family to leave. In 1979 Roland Stephens and his family were flown out of the war zone, and shortly thereafter Karanda hospital closed.

A rare smile by Sekuru Stephens

In the years that followed Dr Stephens and his family continued to follow the Lords calling on his life, and spent most of the next several years working in other bush hospitals all over africa. His heart however, was always at Karanda. Karanda had since reopened in the country that was now called Zimbabwe.  In the early 1990's Roland Stephens returned to Karanda to work with his son, Dan, who followed in his fathers footsteps as a missionary surgeon. Here at Karanda, Roland continues to work quite tirelessly at one of the busiest hospitals in the country. He still performs 5-15 surgical cases a day, rounds on multiple wards, and has been on call as the only physician for several months straight over the last year.

Beau, Gracie and the Reimer kids patiently waiting for some cake!

Dr Stephens doesn't do all of this for accolades, notoriety, or fame. In fact, if he knew I was writing about him he would probably just crack a small smile, shake his head, grunt, and walk the other direction. Sekuru Stephens does this because he loves the Lord. He felt a calling on himself at an early age, and has never looked backed. At an age when most 81 year old surgeons would be counting there retirement saving, playing 4-7 rounds of golf a week, or worse yet, sitting in a nursing home with a diaper and some milk, Sekuru Stephens keeps working..day after day...after day. He has no plans to slow down either. As long as God gives him the strength to get out of bed, a brain that works, and the ability to pick up a scalpel, you can be sure Sekuru will keep going. He is a tremendous example to me, and should be to all of us. The most important thing to realize though, is he doesn't do it for himself nor for you or I. He does it to bring Glory to our Lord!

Physical Therapy in Zimbabwe

    Beau and I walked down to the rehab room, Beau was very excited that we could bring some braces for other children that needed them too!  He ran into the room and handed one to Ms. Oshe, she is the rehabilitation therapist here a Karanda Hospital.  We refer many things to her from post operative rehab to congenital problems.  She does geriatrics, orthopedics, and pediatrics. We had the opportunity to bring new supplies to Ms. Oshe. The supplies were donated by Team Rehab's physical therapist Lisa Krieg. 

     Now how we came to now 'Miss Lisa', as Beau refers to her is an interesting story.  Of course, our insurance company has it's "in network" physical therapists. I heard about Team Rehab when we moved to New Hampton from one of the local physical therapy aides .  I called our insurance company to see if they were in our "network" and I was told that they were.  That same day, Lisa had an opening due to a cancellation, so I drove Beau to Decorah.  Beau immediately bonded with her and after some conversation, we found out that Lisa had grown up in Nigeria, as a missionary child.  We had a lot of good conversations about serving in Africa.  Lisa even tried to arrange her and her husband to come on this trip with us to Karanda, but do to the many details that needed to be worked out in order for them to leave their business, they were not able to accompany us this time.  Lisa did send us with many orthotics and two pair of pediatric crutches.

As it turns out, Team Rehab, is not in our network. If it wasn't for that first lady who told me that it was, I wouldn't have had the opportunity to meet Lisa or have their supplies donated here at Karanda.  It is  awesome to look back over the past 2 years and see how God used Beau's stroke to work for the good.  I am sure God will continue to use Beau to help us grow, learn, and even reach more people for Christ. 

The Epperlys 

No Power, No Water, No Problem!!

A little bedtime reading!

We just finished a 5 day stretch without power. It is something we became quite accustomed to last year. This year we were hoping for a little more power consistency. Unfortunately, the only thing that has been consistent is the lack of power. Water has also been a bit of a problem. The water pumps have been dry by 11 am since we've been here. It really hasn't been that difficult though. We've learned to take showers early and save the water for dishes later in the day. (We haven't had to use cloth diapers yet either...that's been awesome). We have a generator on the compound that comes on several hours a day to help with some daily tasks, and gives us a chance to check emails. We also have a gas stove for which we do most of our cooking, and plenty of good flash lights. (We've even had to pull out the headlights again for Csections) I find it interesting how quickly our perspective can change, and how quickly things that seem necessary, just become luxury.
I was just reading in Psalms 63: 1-8 the other day. As always, I was struck by David's reliance on the Lord. He says: " My soul thirsts for you, my body longs for you in a dry and weary land where there is no water" The Lord was his ultimate source of power, strength and protection. Being here really puts that passage into perspective. To often while living in comfort and luxury in the US my eyes are taken off the Lord. I instead  turn toward my own strength, and ability to provide for myself and family. Thankfully, being here has really reset my mind and heart to a complete and utter dependence on our Lord. I hope this way of thinking can persist and I continue to say as David says: "My soul clings to you; your right hand upholds me".

Back in Zimbabwe

We made it! Our trip to Zimbabwe took about 3 days. We had a few unexpected delays, and challenges but overall went as smooth as we could have asked for. Its good to be back in Zimbabwe! Its been really nice coming back to a familiar place.

The kids have both adjusted to jet lag quite well. Gracie was sick for the first week of our trip, but is now back to normal and full of smiles again! Oh yeah, and back to annoying her brother again! She also found Beau and Abbie's old chairs from last year and realized that she is now big enough to use them. Also, dad thought it would be a good idea to give her a little play-do while I was cleaning up. I had no idea she would put it in her hair, nose, ears, and of course belly button.

Beau is doing well too! He's back to chasing bugs and lizards and anything that moves. He's also enjoying playing soccer with some of the other local kids in the area. Oh yeah and he still loves climbing on the jungle gym out back!

My favorite quote of Beau's so far happened on the night we spent in Ethiopia. After trying for about an hour to get him to sleep. He said: "Dad, why is the sun broken?" I said: "What do you mean? He replied: "Well I don't think its night night time right now, but its still dark?"



Looks like Beau has a cold!



Shea and I have jumped back into work at the hospital. As always its quite busy. Between the wards, operating room, delivery room,  and outpatient clinic.....there is always something going on. We've both enjoyed being able to get right back into the swing without the steep learning curve as last year. We've already seen a lot interesting pathology, strange diseases, and several tragic stories...including snake bites, a crocodile attack, and a surprise twin c-section. The medicine is always a lot of fun, but its really just a tool to allow us into the lives of these wonderful people. I think the best part for both of us is getting to rekindle many of the relationships of the last year.  

We have already seen God work tremendously in allowing us to get our visas.  When we arrived in the country, we had a temporary work visa that was valid through Jan 27th, 2011.  We tried to get a 30 day visitor visa when we arrived at the airport, but they wouldn't allow it. They told us to go to immigration.  At immigration, they started a "file" on it, and told us to return in a few days.  Our hospital is located 3 hrs from immigration, so another missionary that lives in Harare went to follow up on it for us.  He just emailed us and notified us that they extended our visa for 60 more days, for free.  Awesome!  This was more than we expected, as we were planning on have to take a couple thousand dollar trip out of the country to be allowed to get a second 30 day visa.  Praise God!  It has all been taken care of and we do not have to pay another dollar.

Many of you have contacted us by email and have told us that you are praying for us.  Thank you so much.  Our health has been great and as long as the Internet allows we will continue to keep you updated on the things God is doing here.

The Epperlys

The Excitement of the Peds Ward!

The last several weeks have flown by. We are down to our last week here at Karanda. I can't believe 5 months have actually gone this fast. We've had our moments here, and there's been times I thought the end would never arrive. But as I sit here with a week left to go Shea and I both feel so lucky to have had this experience, and the thought of leaving is bittersweet. Many of our local friendships have blossomed, although saying goodbye won't be quite as difficult since we've decided to return in January. We are excited about the ministry opportunities here, and glad we can be a part of the ministry here in the near future. Its been great having Rhonda around, and we have all benefited from her marvelous cooking (especially our waist lines).

The last several weeks have been great for Shea and I as we have been in charge of the Pediatric ward. Its been quite an experience. We have really enjoyed working with the children. It has been both heartbreaking and heartwarming. Its painful to see these innocent little kids stricken with such devastating diseases, yet encouraging to see kids at the brink of death return to life with proper medical and/or surgical treatment. The ward has also been a wonderful place for evangelism as many of the families are eager to hear about the gospel, and have been very receptive to His calling!

The Pediatric ward has been so busy that it is often quite stressful trying to make rounds and keep all of the patients straight. The other day we had 32 patients in the ward. The capacity is actually 24.....but here in Zimbabwe we really don't have to worry about petty things like “fire marshals” and “regulations”. I've been told by several nurses that the previous high was 30 patients, so you can imagine it was quite a zoo. The actual room the ward is located in is about the size of an average 2 car garage. So you can imagine trying to fit 32 sick gets, there moms/family, IV poles, oxygen tanks, and what little staff we have was quite a challenge. We still have sick kids sleeping under the beds of other sick kids trying to make enough room for everyone.

We've had an incredible array of pathology the last several weeks. We've been stumped on many patients, but we have enjoyed the challenge of figuring out the correct diagnosis, and delivering the best medical and surgical treatment possible. We've seen patients with diagnosis ranging from measles, tetanus, meningitis, cerebral malaria, a necrotic thigh and tuberculosis to pneumonia, neonatal fever, burns, traumatic amputation (her dad was chopping wood and slipped), femur fractures and clubbed feet.

We've had at least 5-7 patients with hydrocephalus some who have received new VP shunts and others that have had VP shunt malfunctions and/or infections. We had one young boy who was evidently playing with a hand grenade and it went off. It took off a good portion of his right hand. (Don't ask me how he got a hold of a hand grenade....I've asked several family members and no one seems to know). We had another young boy who had 2 large tumor growing out of his back and buttock. We removed them both and are waiting for pathology results as well as his skin graft to take.

We had another young boy who was presumed to be bitten by a cobra (never a good thing). He was starting to improve and his family wanted him discharged even though we felt he would be better suited to stay another day or two. We obliged, but unfortunately the boy and about 18 or 19 others were involved in a mass trauma when a large flat bed truck carrying 12-15 people collided with another small truck about one half mile down the road from Karanda. The irony of the situation was that most of the people in the truck had just been discharged from the hospital and were leaving to go home. The trucks hit head on, as they came around a tight corner probably only going about 30-40 km/hr. The impact was still great enough that it sent most of the passengers through the air, and some ended up with significant fractures. All that to say the boy with the snakebite did fine, aside from a couple of lacerations and bruises. We did get our wish and got to keep him in the hospital another night.(I guess they should have listened to us in the first place). Also, Shea got quite the surprise when 20 injured people from that wreck showed up at the OPD right before her lunch break. That's a whole other story, I'll save that one for later.

Anyway back to the Peds ward. We've also had 5-6 patients with severe malnutrition and all are currently on our high protein feeding program. One such patient also had something called a Noma. A Noma is an ulcer on your face that usually eats through your skin and tissue until your teeth and gums are exposed from the outside. This typically occurs in severe malnutrition. This particular patient is a 9 year old boy named David who came in weighing 10 kgs (22 lbs). David was completely emaciated when he arrived. He was also unable to walk and HIV positive. Both of his parents have passed away from HIV and he is now being raised by his grandpa. His grandpa is very attentive and never leaves his side (I think David is his only family). David initially couldn't even turn to look at me during rounds. Now with several weeks of proper nutrition (aside from the occasional lolli-pop I sneak him) and treatment he actually smiles during rounds and has become quite interactive. He goes outside with his grandpa and its just wonderful to see him happy. According to our scales he now weights 15 kgs (its quite a jump, not sure I always trust our scales here, but I'm just encouraged he continues to improve). So with the Lords help David will continue to improve, and with proper HIV treatment and education he may still have many good years of life ahead of him.

So as you can see the Peds ward has been very challenging, but also quite rewarding. The rest of our time has been spent in the maternity ward doing C sections (Shea and I actually got to do a twin C section together...it was great), in OPD seeing patients, in the theater operating on an array of pathology, and at home chasing kids, and changing diapers (although a few less since Beau is starting to use the toilet alot more). Overall things are great, and were excited for one more good week of work here at Karanda. We really look forward to see all of our friends and families real soon. God Bless!

The Perfect Mothers Day Get-Away!

Happy Mothers day to my beautiful wife Shea, my wonderful mom Fran, and my arizona mom Rhonda. I'm a lucky man to have those wonderful women in my life! Yesterday Shea and I tackled “pulpit rock”. Climbing as always been one of Shea's favorite things to do. So for a pre-mothers day celebration what better then a good climb. After Paul and I finished rounding on the hospital, seeing patients in the outpatient clinic, and doing a quick C-section Shea and I headed to climb the massive rock formation.(Its so nice to have a Grammy here for babysitting, and a little break from the kids is always appreciated). It sits about 15-20 kilometer's from Karanda, but most of it is bush roads so it takes about 30-40 minutes to get to the spot where we will begin our approach hike. Legend has it that hundreds of years ago pulpit rock was inhabited by the Zulu tribe. After conquering territories in what is now Southern Zimbabwe and South Africa they left there massive rock for a time. According to the legend they returned some years later with hundreds or thousands (depends on whose telling the story) of Zulu warriors to move the rock to there new territory in the south. Now if you were to see this massive 640 meter high rock structure up close you would find it hard to believe, but you know me.....I'm always up for a good legend! (Elvis still lives...right?)

Anyway, today we were charged with getting to the top of the great rock, and enjoying one of eastern Zimbabwe's finest views. Shea and I along with Dr Stephens (who lead the climb), and our friends Nicci and Anna decided today was the day for the ascent to the top. Luckily, I can tell you there were no thrilling/death defying stories comparable to my climbing mishap in 2004. No major falls or seizures or helicopter rides to trauma centers (not that there are life flights or trauma centers anywhere within hundreds of kilometers). The outcome of this climb was much better. Although there were several moments when I wondered why we were doing this without better equipment the climb went relatively smooth.

It was interesting this was the first time Shea and I climbed together since before we had kids. In the past we have climbed some pretty “hairy” things, and probably taken some unnecessary chances. But now with kids back home waiting for us to return, the idea of taking needless risk, for risk sake seemed a bit less appealing. With those reservations in mind, we still were excited to have a couple of “kid free” hours outdoors, and looked forward to climbing again.

This climb was a bit unconventional. Shea and I are used to climbing shoes, a good rope, a harnesses, and some solid carabiners. (Not to mention a good belay device). Today we just had our tennis shoes, and Dan's old rope that he says he brought "only if the women need it" (Hey what about me, its not like I have the best Life insurance policy here). So that being said he planned that we would free climb the face of this pulpit rock. Well I guess we'd have to see about that.

So we drove our car as far as we could through the windy and rocky dirt roads. We stopped about 1 mile from the base of the rock. We hiked the last mile and enjoyed the scenery as we saw several villages scattered about between the road and pulpit rock. We got to the base of the rock and began our ascent to the top. The majority of the climb was steep, but didn't require any climbing. We just leaned up hill and maneuvered between stones, boulders, trees, and loose dirt, and used all 4's as needed. The last several hundred feet was a 4 sided cliff face without any significant switch backs. This was where it got a bit tricky. Dr Stephens, had done this climb multiple times in the past, and he was used to taking climbers of all skill level up to the top. There were two very difficult spots in the climb, the first at the very beginning and the last at the end. We all went up about half-way on the first part of the climb without any rope. But as the winds picked up and began to howl, we felt a little more comfortable at least having a rope in our hands in case a slippage were to occur. (Wasn't going to be a gentle fall to the bottom). Dan reluctantly agreed, and climbed up ahead and attached his unconventional rope to the base of a tree at the top of the first pitch. We all used this to aid in our climb to the top of the first part of the climb. As I said before it was awesome to be climbing with my wife again, and the risk of death is always a bit of a thrill, but the thought of Beau and Gracie without parents was a bit sobering. So we kept that in mind with every firm grip of a hand-hold, and securely placed foot-hold.

After finishing the first part, we gently maneuvered around a narrow switch-back and came to the base of the last part of the climb. Unfortunately, Dr Stephens left our only rope anchored back at the tree at the other part of the climb. So to enjoy our conquest at the top and the breath-taking views we had to free climb the rest. This last part was bit shorter then the first, and fortunately the rock formation formed a bit of a crack and we were able to snake/wedge ourselves against it. We would have much preferred to have a rope at this point, but aside from a loose rock encountered by Shea's right foot (took away our breath for a second), we all got to the top quite safely.

The view at the top of pulpit rock was magnificent! There were breath-taking views from all 4-sides and the beauty of Zimbabwe was so evident on the summit. What a powerful God we serve! The top of the rock was probably big enough to fit two moderate sized homes, and it even overlooked onto the Mozambique valley which lay about 20 kilometers to the east. We stayed at the top for about 30-45 minutes, but then envisioned Rhonda at home with a hungry Gracie (she still doesn't like to take milk from a bottle), and decided to head back down.

Going down brought a few hair-raising moments, but we made it down with all limbs intact and no major injuries. It was another wonderful adventure for Shea and I, and we were so lucky to have Rhonda here so we could share it together. I can't imagine raising kids with anyone other than my wonderful wife.The patience and love she displays on a daily basis to our kids never ceases to amaze me. Raising these first two kids has been so much fun, and really pretty easy I'm already looking forward to another. Although, I think  we may still have to talk more about that one. :) Happy Mothers Day Shea and Mom!