Snake Bites In Mukinge, Zambia.

Sub Saharan Africa has some of the most venomous snakes in the world. Even before we left for our recent medical mission in Mukinge, Zambia, we were warned about the snakes there. We had to beon the look out for snakes  during the seven minutes walk from our residence to the hospital through the grassy fields and the dusty street. As part of the streets had no street light and as elecricity failure was a regular happening there, we always had to carry a flash light with us. From the British heritage, the Zambians continue to call the flash light "torch light". Fortunately for us we did not see any live snakes on our way. Our missionary friend had a couple of these unwelcome visitors which ended up getting killed.

(This seven years old boy was bitten by snake on his right index finger)

I had several victims of snake bite in the hospital during our stay in Mukinge. Surprisingly all of them were boys between the ages of seven and ten and all the bites were on their fingers, that too on the right hand. Thank god, all of them survived. These children are brought to teh hospital typically with markedly swollen hand and blisters around the finger with the bite marks. Usually they will have multiple scratch marks around their arm and forearm with some dried poultice stuck on all over the skin. It is customary for the Zambians to go to their Native Doctors first and try the natural treatment with herbs before coming to the hospital. Of the intense inflammation the patient has is partly from the infected scratches on the arm. Eventhough there were not much systemic envenomation, the local tissue reaction and sloughing had resulted in loss of the finger in one child I treated there.

Before putting the child to sleep in the operstion theatre, our anasthetist asked him if he did put his hand in the hole. he said, 'yes'. Then she recounted her experience with another boy the week before I came to Mukinge. He explained to her taht he was very hungry and was on the look out for mice.He went and put his hand in the hole and was stung by something which he thought was a mouse. He was elated and put the hand back in to grab it and got bitten again. There was no mouse, it was a snake that bit him twice.

Now that explains why all the victims of snake bite were young boys and all of them were bitten on the fingers of their dominent hand!

Outside My "Comfort Zone"

A view of Mukinge Mission Hospital, Mukinge,Zambia.

 It was with much apprehension that my wife, a retired pediatrician and I, a retired general surgeon, went to Mukinge for a four weeks of medical mission there. Very limited resources, limited staffing and many limitations made it tough to diagnose and treat all those who came to Mukinge with various medical needs. For me dealing with issues outside “my comfort zone” was a serious concern. I had to deal with a lot of simple fractures and dislocations. Though outside my “comfort zone”, I could manage them.

(a severely malnourished girl in the Pediatrics ward)

 This was a different story. A seventeen years old young man was brought to the hospital with a trans condylar fracture of his right femur. the distal fragment was much displaced and the swollen knee was in 90 degree flexion. instances like these always calls for consulting the Great Physician and that is exactly what I did. With the patient under general anesthesia, I attempted to reduce the fracture and placed the lower limb in a long leg cast with knee in almost full extension. I was pleasantly surprised at the alignment of fragments I saw in the post reduction x ray.

A thirty years old male was brought to the hospital in shock and a lot of pain after falling off from the bicycle, hitting his anterior chest and abdomen on the ground. He had much tender abdomen and very tender right anterior chest. Ultra sound scanning of the abdomen showed free fluid in the belly. He was kept under close observation with the provisional diagnosis of liver laceration and internal bleeding. He required a unit of blood transfusion, but recovered very well without need for surgery. After being discharged from the hospital, he returned to the surgery clinic for follow up, very happy and thankful. Jokingly I told him that now he should give back that unit of blood to the blood bank. I think he took it as a serious challenge and said that he will!





















This was not the first time that I was Doing abdominal hysterectomy for large uterine fibroids ; the last one was in 1982 ! Another lady with a complex mass in her right lower abdomen turned out to have an old ectopic pregnancy producing a right tubo ovarian mass and that too needed surgery.

 When we realize our limitations and are aware of our limited resources, Great Physician with His limitless resources will be there to help; if only you ask.

 K.E and Leya Mathew

Experienc in Mukinge Mission Hospital, Zambia

Sunrise in Mukinge

Hospital Courtyard

Recent Medical Mission trip to Zambia was an experience that will stay in our memory for a very long time.This was the first time taht my wife and I were visiting Zambia. Our previous stay in Tanzania many years ago and the tree short medical mission trips taht we made to Kenya in the past three years had given us an idea about the African continent and the many challenges theyface there especially in the field of medical care.World Medical Mission, the medical wing of Samaritan's Purse was doing all the ground work in sending us to Mukinge . Zambia.  Mission Hospital in Mukinge has been in operation for over fifty years. Presently a two hundred bed facility, this hospital is owned by the Evangelical Church of Zambia (EZC) sopported by financial grant from the government of zambia. Mukinge is in the North West region of Zambia in the Kesampe district. This poor region that is away from the more developed regions like Lusaka and the copper belt area depends solely on this hospital for any specialised medical care. Unfortunately this facility too is very limited in resources and man power. Their small medical staff has one surgeon from Newzealand, three general practitioners from the USA, a young Zambian physician, another Zambian LMD and another Zambian Clinical officer. It is amazing to watch these hard working people respond to all sorts of medical and surgical emergencies. A twenty four hour emergency room and a busy labor and delivery department and the neonatal unit are all well managed by these men and women who are self trained in multitasking and wearing more than one hat a time! Dr. David Friend, the surgeon from Newzealand was away on a three month sabbatical o his home country. Apparently this was the first time in his six years stay there that he was taking a break, that too forced on him by the missionary friends ta Mukinge. I was there to cover for Dr . Friend for one month and Leya, my wife accompanied me to work in Pediatrics. We both were blessed by the love, support and hospitality of the missionaries at Mukinge.

Library in the Doctors Lounge nearby the painting "Chief of our medical staff"
(We used both books and the consultant while at Mukinge)

From the very first day at the hospital, we both felt that we were needed there. Though we felt apprehensive at times about the lack of many supportive diagnostic and treatment modalities that we came to think were basic, soon we had to change our thinking. We had to repeatedly tell ourselves that we were in Mukinge and we have to do the best with what we have. Laborotory could do a hgb/hct at any time. They would do a full blood count during day time. Urine dip stick and gram stain as well as malaria smears were done in the lab. they may even do a Total bilirubin and alk phsphatase but no electrolytes or any enzyme assays. Blood bank would draw blood and cross match on demand. There was no pathologist, radiologist or anesthesiologist. Two CRNAs there were able to run the anesthesia department by sharing calls. While outside the theatre one was working as the nursing superintant while the other functioned as the Chief Executive officer.

Dr.Daren and Elise Tompkins

Dr. Stephen and Amy Snell

Even the regular nursing staff in the operating theatre knew how to mutitask. One evening I had a patient with perforative peritonitis who needed emergency laparotomy. When I went to the ward to see the patient, Sister Ruth from the theatre was the nurse in charge of taht ward. She was taking care of all the patients in the male ward. When I went to the theatre, sister Ruth was there in the operating room with the patient. She was the scrubb nurse, circulating nurse as well as the recovery room nurse for that day. She already had borowed somebody from some where to take care of the male ward while she was in surgery! Talk about limited resources and multi tasking. It made me think of the "surgery team " that would come when I would call for an emergency like this in the USA! what a contrast. CRNA managed the anesthesia while multi tasking as the circulating nurse and Sister Ruth assisted me while being the sole scrub nurse. Patient had a perforated duodenal ulcer with lot of spillage in the belley. Thank god, he did well.

Dr. Darrin Tompkins with his family

Dr. Leya Mathew with Amy Snell

Elise Tompkins was presented with a prayer shawl that Leya made for her

Burns are too many. This boy had skin graft on abdomen and both thighs

A young girl with two fingers fused together.

             Life Outside The Hospital With The Missionaries in Mukinge, Zambia.

"Dinner is ready"

Entertaining a few friends at our home in Mukinge

Leya enjoyed cooking and serving.

Mango trees in bloom

Pool being filled and getting ready for summer

Two views of our house- the pool house.

Avacado

Mango tree in bloom

Sun rise in Mukinge

Trees across the hospital in bloom.

How Much Do You Care?

                           HOW MUCH DO YOU CARE?





Even stones have got stories to tell. In the book of Joshua there is a reference to twelve stones that were picked by the Hebrew people from the bottom of river Jordan and set up on its bank on their long journey from the slavery in Egypt to the freedom in the land of Canan. In Joshua 4:6-7 (NIV) it says:
 "In the future, when your children ask you, ‘What do these stones mean?’ [7] tell them that the flow of the Jordan was cut off before the ark of the covenant of the Lord. When it crossed the Jordan, the waters of the Jordan were cut off. These stones are to be a memorial to the people of Israel forever.”

It was customary for the Old Testament patriarchs to set up stones in places where they had visions or contacts with the angels of God. At times they set the stones up as a memorial, at other times as a monument and at times as a witness and reminder of the greatness and mercies of The Lord to the coming generations.

This is the first time for my wife Leya and I to be in Zambia for a short medical mission under World Medical Mission. We had been to Kenya on three different occasions and every time it turned out to be a fulfilling and rewarding experience. Mukinge Mission Hospital in the Kesampe district of Zrambia is about one hour and thirty minutes away by mission flight from Lusaka. This hospital caters to the medical needs of a large area of the country. With the limited resources and the meager manpower, they have been doing an excellent job for the past several decades. Several voluntary missionaries from Europe and USA diligently serve here. Presently they have two  missionary doctors from the US, one on long term and another on two year commitment . A general surgeon from Newzealand has been serving at Mukinge hospital for the past six years without taking a break! He is the only surgeon in this area! A young Zambian doctor has recently joined the medical staff. A CMO and another LMD also are on the staff to complete the medical staff roaster. As Dr. David Friend, the surgeon was forced to take a three months sabbatical and to go home, WWM was looking for surgery coverage for these three months. Paul Osteen from Houston, Tx agreed to serve for June and July and I signed up for the month of August at Mukinge. New borns and children are all being cared for by the members of this wonderful medical team. They were excited to know that my pediatrician wife also will be accompanying me and is willing to serve during the same period. We sure did have some apprehension and concerns while considering this mission trip. Being in retirement for two years and staying away from the hospitals for this long period was one reason for concern. Health issues that goes with age was another. Safety issues in Africa was yet another. It was just recently only our daughter and her young family had to cancel their plans to serve and return home from Tanzania      due to safety issues there.

Dr. Paul Osteen was the first name that came to mind for us to talk about these and other issues. His input was of  immense help in making up our mind for the mission trip to Mukinge Hospital, Zambia. Paul was another God sent person in our life in retirement. On the very first trip to Tenwek Hospital, Kenya, my bag with every last piece of my clothing for our stay there did not arrive at Nairobi in the same flight with us. We were told that the bag will be sent to the hospital the next day. Paul who s already serving at Tenwek and who knew very well that " the next day" for the Kenyan Airlines people could be after several "next days" decided to present me with two plastic bags, one with a pair of sneakers and the other with all the essential clothes for me to survive and work for the next few days! He was there to guide me and help me through the routines in the department of surgery as well. I was quite apprehensive about the cases that are out of my "comfort zone" and sure enough they had many. Head trauma was very common in that referral hospital where neuro surgery was handled by the surgeon on call. Pediatric and neonatal surgery too was another major field where I felt uncomfortable. In most mission hospitals, the physician will have to do the best he/ she can, as there was no other option! Paul was there to guide me through my initial cases.

Paul Osteen , a board certified General surgeon with vascular surgery training had been in private practice in Arkansas when his father John Osteen passed away. Paul gave up his practice and moved to Houston, Tx to help his younger brother to take care of their dad's church. They sure did take care of that church in Houston which received the abundant blessings from The Lord and grew in to the present Lake Wood church in down town Houston at the former Astro stadium attracting tens of thousands of believers for very service and Joel's television ministry and written messages reaching millions around the world. Paul is an associate pastor at the Lake wood church where he directs the missions. He continues to spend six months every year helping surgeons at mission hospitals in Africa, Haiti, South America and Central America. His wife Jennifer and their children have accompanied Paul in most of his mission fields.  My wife and I had the privilege to get to know this man of God and his beautiful family at Tenwek Hospital, Kenya. Paul is an unassuming, soft spoken person and wears a constant smile on his face. He is an accomplished surgeon who taught himself to become the special surgeon for African mission fields. He is a great bible teacher too who preaches through his actions and uses words when necessary. It was by Divine  providence that Paul happened to be there at Tenwek hospital all the three times we were there. Our second term in Kenya was for two months and that was a very rewarding and fulfilling experience. Paul has a special gift of finding the needy and taking care of the one in most need in a discrete way. Many are the patients who received financial help from Paul without much publicity or fanfare. His mission is always one on one. Counseling and praying with the one in distress is a special gift for this servant of God. The third time that I was at Tenwek for a two weeks mission tour, I got sick the very day I reached there. I could do very little work and I became a burden than a help for Paul whom I came there to help by sharing surgery calls. He was very understanding, considerate and helpful to me. He took my calls and helped me at the time of my illness. His final diagnosis on my condition was that I was suffering from separation anxiety, as this time for the first time ever, I travelled alone. And the prescription, " never travel abroad without  your wife Leya with you."

Paul is a hard working man who is not afraid of challenges at the same time he is such a humble person who will always make others feel more important than himself. No wonder he has a huge number of good friends all across the globe!


At Mukinge we were following the Osteens who just left after serving for two months. We were staying in the same house that the Osteens stayed. Paul had made a special  request for the housing authorities to allot the same house for us. This was a house the Osteens had invested a lot of their personal funds for renovation . They decided to stock the food pantry and the closets with most of the things we would ever need for our short stay there. The whole house was re painted and new curtains were installed. New bath towels and sheets were placed . Thanks to the Osteens; such a luxury in a remote part of Zambia for a mission house! Paul had already bragged to the other missionaries in the campus about the cooking skills of Leya. He also mentioned about our health concerns and our age concerns too. It sure made a difference. They seemed to know a lot about us before we arrived and they sure treated us well.

                                        (This stone was placed there so that we, while walking 
                                        at night won't stumble and fall hitting that metal hook)

You may be wondering why I started this article writing about those stones from the bottom of River Jordan mentioned in the book of Joshua. We too are seeing a set of stones near to our housing at Mukinge. One large stone and two smaller ones as markers on our path to to hospital. These stones were placed there by Paul for a special purpose we were told. The largest stone is close to a hook over the metal lid covering a large manhole and the other stones mark the shallow ditches and dips in the path that is covered with grass. Paul set them there that we, his friends will not stumble and fall when we make our way to hospital and back especially at night. To us this is the ultimate in caring for the well being of your friends.

                          (fire place was stocked with firewood that were handpicked by the Osteens from the fields)

There is a fireplace in the house where we were staying. Before leaving the house, Osteens made sure that there was enough fire wood stocked inside the fireplace for the Mathews to use. This obviously is not the firewood that we are used to buying in the stores they are hand picked from the field and it makes it double special. They walked that extra mile to make sure that every need of their friends was addressed and attended to. What an example of true friendship!

For us the stones on our daily path to the Mukinge Hospital represent the love and care from true friends . They cared enough to think of the safety and convenience in detail and did something about it.

 How far do you and I go in caring for our friends?