Prayer Request

3 weeks ago Holli found a breast mass. She consulted a general surgeon who suspected a cyst but recommended further screening if it persisted after a couple of weeks. We traveled to Blantyre this week where a diagnostic mammogram and ultrasound revealed a solid mass requiring biopsy.

Holli will return to the US on Tuesday March 2nd. Her appointment at Wake Forest/Baptist Hospital will be on Friday March 5th. Ashley will accompany her to the US and I will drop work back to mornings only to be with Chad and Wes after school.

Please pray for safety as she and Ashley travel. Please pray for a benign biopsy result.

James

Mphonde Medical Outreach

Children lining up outside Calvary Chapel Malawi

church plant building, Mphonde

Mphonde is a small village about an hour drive outside Lilongwe. It was chosen as medical outreach site as Calvary Chapel Malawi has a church plant established there. It is also one of the sites selected by Water Missions International and the Foster Friess Foundation for its water purification and safe sewage initiative and community development. It is a village of about 1000 and along with 10 other surrounding villages comprises an isolated community. Children have to walk for several kilometers, including crossing a small river, to get to school. There is no access to medical services, clean water, electricity or even village market.

Timothy, a youth worker with Calvary Chapel, Malawi helped with organization and triage of patients.

Clinic was set up inside the church building. Patients lined up outside and then rotated through the building. Tom, a pastor with Calvary Chapel, Malawi shared scripture and the Gospel with patients while they waited.

Many of these villagers had never been to any sort of clinic and didn't quite know what to expect.

We held a general clinic. We treated infectious diseases included diagnosing new cases of HIV and TB. These patients were referred to the nearest government office for CD4 testing and ARV/TB treatment. We cleaned and bandaged wounds, treated hypertension, dewormed and treated Schistosomiasis. We treated close to 300 patients and have plans for monthly followup starting this February.

A team of 4 American nurses accompanied us on the trip. They preserved all day despite sapping heat, over-crowding and seemingly unlimited number of patients. I think our next clinic will be outside under a tree!

Toward the end the clinic I went out around the village. These girls were coming up from the small river. They were a bit scared at first. I don't know what was in the small plastic bottle.

At the bottom of the hill is small river. It was way down as it was the end of dry season. Many of our patients had acquired schistosomiasis from this water. It was also their source of drinking water. The oxen for this ox cart had broken free leaving the owners trying to free it from the stones in the river bed. I helped them pull it out and walked back to clinic while the owners reattached the oxen. About 30 minutes later a mother frantically ran up to the clinic carrying her 3 year old girl. The ox cart wheel had run over her right thigh and broke her right femur. As we were close to leaving we loaded mom and child into our car and brought them back to ABC. Because the xray demonstrated a compound fracture and surgery was not available, she had to be placed in a traction cast for 6 weeks at the central hospital. The moral of the lesson is leave the ox cart in the river!

Ruth's Shawl Medical Outreach

Ruth's Shawl is a widow and orphan community organized by Calvary Chapel, Malawi, located on the outskirts of Lilongwe. The community is composed of 19 widows and about 70 orphans. Information about Ruth's Shawl can be found online at: www.ruthsshawl.org.

Patients were already lining up when we arrived. Our clinic was held in a widow's house. We held a general medicine clinic.

I noticed this little girl on the way into the clinic. She has a huge hemangioma on her neck and face. As long as it does not compromise her ability to breath and eat it should eventually regress and go away late childhood. If it progresses will need to have a tracheostomy and feeding tube placed. The workers at Ruth's Shawl are monitoring her progress.

A nurse is bandaging a sprained knee of one of the widows.

One of the orphans waiting while his grandmother was treated.

This girl had a open wound on her toe.

The orphans enjoyed looking at themselves in the chrome of our car.

Kids were taught choruses and played games outside while we worked inside.

Some of the orphans posed for a group picture with one of the nurses before we left.

This was my favorite medical outreach clinics so far. We plan on going back every month to follow up on chronic diseases and screen for malnutrition. Many of the women and children meet criteria for malnutrition and will benefit from a high calorie and protein supplement made from peanuts and soybeans.

A look around ABC Community Clinic

This blog is a description of the ABC Community Clinic and Inpatient Ward. Most days start about 745 with devotions and prayer. Then I round on inpatients at the ward. After that outpatient clinic starts at 830 and goes until 1230pm, then restarts at 2pm until 430 pm. I then do afternoon rounds at the ward and then call it a day! As I am the only full time doctor at ABC currently, things can get really busy.

the inpatient ward

The inpatient ward has capacity for about 18 but generally we have about 4 patients at a time. Admissions primarily have malaria or other infectious disease requiring IV hydration and antibiotics. We have also admitted premature babies for phototherapy and failure to thrive. Many admissions also have complications from HIV.

the new ambulance

ABC Community Clinic was donated the funds for the new ambulance by a patients family as a way of saying "thank you" to Dr. John Jones for his care of their sick mother while he served here last year. The stretcher just fits in the back!

Danford

Part of what I enjoy about working at ABC is the Malawian nationals that I work with. Danford, pictured above, started out at as a house helper at ABC as a teenager. One of the ABC missionary staff realized his potential and sent him to school. He completed his education and is now on the clinical officers (equivalent of US physician assistant) at the clinic. He oversees the HIV/AIDS work done at the clinic including collection of CD4 counts and followup as well as keeping up with National Aids Commission guidelines on HIV management. He is a true joy to work with and has a heart for the people of Malawi.

Olita

Olita, a nurse at the nurse's desk in the inpatient ward. Olita used to be an operating room nurse at the central hospital. She has been key in renovating our OR for upcoming surgery. Unfortunately nurses here seem to have as much paperwork as nurses in the US.

A little boy with malaria getting an "drip" with IV Quinine. He was better (conscious, eating) the next morning and went home. I am amazed at how children with malaria recover so quickly with malaria if given the medications quickly. Unfortunately we have about several children each month who don't make it because of delay of seeking treatment .

Loveness and Judith

Loveness (r) and Judith (l) are two other nurses. They are waiting for patients at the nurse triage desk. Patients get a blood pressure and weight and are triaged to the lab for malaria screening if they are febrile even before I see them.

Rashid

Rashid is another of the clinical officers that I work with. As you can see he has a contagious smile. He is also exceptionally smart and amazing at putting IVs into dehydrated little babies. I have learned so much from the clinical officers. Patients want to come see me because I am western trained and have an MD behind my name, but the ABC clinical officers are extremely knowledgable, excellent clinicians and have a lot more experience with tropical diseases than I do. I dont think I would be able to practice here without them.

James

James is the senior lab technician. Here he is looking at slide for malaria parasites. Our lab can screen for most infectious diseases, run complete cell counts and serum chemistries as well liver function, cholesterol, check for tumor markers as well as urinalysis and stool studies.

This is one of two pharmacies at the clinic. Its well stocked with a representative of most class of drug. I brought a good number of medicines with us from the US just to find them in the clinic pharmacy as well.

my exam room

Patients wait in an adjacent waiting room until its their turn. Unlike the US where clinicians rotate between patient room, here patients move from room to room and the clinician stays in one room. So after I see a patient I will send them to a different location for a procedure, lab or xray.

my office

Its full of supplies and medicines that have been donated from visiting medical teams. Medicines and supplies that have been donated cannot be allocated a charge or fee so I have kept them separate from the clinic's supply. We are in the process of setting up community health (village) outreach clinics in three rural sites in cooperation with other mission and developmental NGOs here in Malawi. These supplies will be used for those clinic and evangelism outreach projects.