Dear Family and Friends:

It seems that we have a clear answer today that I am not supposed to take this trip to Alaska. As the World Medical Mission team explored all options particularly at a meeting at the Christian Medical Dental Association for the past several days, there are two major obstacles with my going rather than only one insurmountable obstacle: short-term malpractice insurance and medical licensure.

Even though the setting is much like a third-world environment, Alaska is still the United States with medical malpractice risks as well as intra-state differences in medical licensure both requiring a lengthy and costly application process and insurance protection. These problems may exist going to foreign countries as well, but generally the hurdles are low and easily cleared.

While it is disappointing not to go on this trip with my grandson [and collect the last 50th to my list of visited states], perhaps we can plan a mission trip together next year. God’s not allowing this incredible coincidence to work out was surprising, but He will use it somehow to His glory according to His purpose; God is never taken by surprise.

Thank you for praying!
Serving Jesus with you but not in Alaska at this time,

Paul, for the Jarretts

Dear Friends and Family:

I have been delinquent in sharing updates after our return from Kenya. Finally, I have some things to share and request your prayers. Thank you for your ongoing prayer and support. The urgent request is for me to find some malpractice insurance quickly. Please click on the link to read more….

Rachel and I have returned to our Zionsville house with the idea that we need to really get the house ready for the spring real estate surge in order to sell it after listing it on the market unsuccessfully for two years. We decided to lower the price another 12% to a total of 20% from where we began in 2010. We just were not getting anyone to look at the house –only a handful of people after the initial agreement that fell through before we had even listed it.

We were greeted with a very early spring allowing a lot of outside work to get it into immaculate [as ever it has been] condition and work on the inside as well. Truthfully, the inside looked better than we had left in September. We have “house guests”, John and Patti Sharer, who returned a year ago from five years of ministry in Ukraine, part of which was with Mission to Ukraine on whose board I serve. Their needing a place to stay and longer term job situations, the arrangement has worked beautifully to our mutual advantage. Patti does some cooking and John has done a lot of maintenance and has helped me a great deal. Rachel enjoys their company too.

With the good weather, I have repaired railings, cleaned and watersealed the front and back decks, mulched flower beds so that the landscaping looks great, painted where needed [still in progress], killed weeds everywhere they were trying to take over, and mowed nearly twice a week – 3-5 hours each time.

We have the inside looking good and I’m working on the garage now. We had a showing last week with good ratings on the exterior and the inside rated as clean and kept up nicely. All of this amounts to no offers at this point. The house is twenty years old and we get “dinged” on carpets, wall covering, and appliances needing modernized. What we’re really talking is different tastes and expectations compared with newer homes and under appreciation of the beauty and isolation of the surroundings.

I know the Lord will bring the right buyer when it is His timing, but to me it feels like we really need to get this part of our lives behind us. My father needs more assistance as he approaches 94 this summer and has decided to give up driving. I will make more 70-mile roundtrips to Anderson than in the past. I took title of his car this week and need to move out one or two of my older, well-maintained but not show-room condition cars. This is a prayer item as well as selling the house soon!

Many ask about my missionary trip schedule. I had nothing concrete other than a vague discussion of returning to Tenwek for two months August and September – the housing and family situations being too uncertain to make definite plans.
I was happy to hear that one of my grandsons, Tyler Jarrett (15), of the South Carolina Jon Jarrett family is going to Alaska on a mission trip for three weeks in June. He is volunteering with a ministry called Missionary Aviation Repair Center which flies missionaries throughout Alaska, Yukon, and eastern Russia. He is to go the first week to Tanalian Bible Camp in Port Alsworth, Alaska to serve as a cook for the Teen Camp. The next week he would serve in Soldotna, AK replacing flooring and painting walls in public areas of the operations center. Both areas are very remote with access only by airplane.

Last week, Samaritan’s Purse called me about serving as a volunteer doctor at a camp in Alaska; another doctor had cancelled his plans, and SP needed help on short notice. As I listened, I was interested and thought it sounded a lot like what Tyler was going to do. It is the same camp at the same time! I thought that was more than a coincidence. They had no idea that Tyler was involved with this trip.

For me it meant cancelling a week of vacation, but Alaska is a place I have always wanted to visit. Now here was an opportunity to serve with my grandson who has always wanted to come with me on a mission trip; I would be going with him!

It seemed if the Lord had worked out this wild coincidence, which isn’t a kosher word, according to one Bible teacher, then it seemed His intention was for me to go. Then the big MI words popped up. This is still the USA even though it is like a third world in terms of the infrastructure and the way that the served teenagers [largely Native Americans] live – rarely leaving their small, isolated villages. But Alaska isn’t covered by my Malpractice Insurance that I have for my volunteer work with clinics in Indianapolis.

Samaritan’s Purse coordinators and I have found no viable way to get insurance for me to work there. One company would combine it with the Indiana coverage if I bought it, but the cost is astronomical relevant to one week’s work at the camp – roughly $20,000 over the next six years and probably more. The Indiana insurance has been covered by another ministry which no longer can find coverage here and hopes to go to a government pool program starting in July. I may be out of that ministry, too, if they aren’t successful.

Two other companies, one of which supposedly issues short-term MI policies, and the other full-time insurance [and with whom I was covered with for 27 years without a lawsuit] does not return responses to my inquiries. If the Lord does not provide an answer to this need, it seems I won’t be able to respond to this request. Would you pray this weekend that God will answer with the way forward if it is, indeed, His plan? I think that SP will have to keep looking and find another doctor if the Lord has someone else in mind.

If I go, my dates will run from approximately June 1 – 22. Perhaps the house will sell while I am gone – like the water that doesn’t boil if you watch it too closely.

Other family updates:
Amy Jarrett was home in April for thee weeks in Indiana with a side trip to Colorado to see our family members there. She has returned for the last term of the school year at Rift Valley Academy in Kijabe, Kenya. Her second year begins in August. She is doing very well.

Laura and Keisuke Noguchi are looking forward to a May 10 day for their four-month-old son, Yoshiki, to have the first surgical procedure to repair his cleft lip and palate. He and Laura will be in the hospital for a week. Her blog: http://keisukelaura.blogspot.jp/

Susie and Chris Gordon, along with three-month old Mara Elise, will move back to Indianapolis June 15 in preparation for Chris’s anesthesia residency. They have had a good intern year in Cincinnati.

Debbye and Aaron Biermann’s third son, Declan Patrick, is one month old and doing very well.

Related to these prayer requests are three unspoken requests leading up to October of this year. You can guess, but you probably won’t be right. Generally, I don’t like to give unspoken requests, but God does know what they are; I talk to Him about them daily. Also, I have not received payment from the insurance company for my hospitalization in Nairobi before Christmas. We are past the date they promised an answer, so I may need to ring them up. My ministry expenses for the past six months from my World Medical Mission account were reimbursed with donations from supporters; thank you, Lord!

My recovery from the stroke, if not the reimbursement, has been all but forgotten by me. Other than some words getting stuck on their way to my tongue, I truly don’t even think about it other than to take my preventative medicines at night. Thank you, Lord, and thank you all for your prayers.

Please continue to remember the ministry of Tenwek Hospital – we need some additional OB help this summer beginning in June. The orphans are doing very well and our support for spring has been met. I would appreciate wisdom on how best to direct further support of the orphans and widows. God has been very gracious this year in response to our prayers for support. Thank you, Lord. Terrorists continue to pose threats in Nairobi. Please remember this as well.

Serving Jesus with you,
Paul, for the Jarretts

Dear Friends and Family:
Just a quick note to say that Rachel and I made it home safely with good flights and pretty good rest all things considered. We enjoyed our time with Amy and worried some family, as unbeknownst to us there had been a terrorist attack in Kenya which made the news; we were only informed of that today.

The grenade attack on a crowd at a bus stop was south and east of Nairobi, the opposite side of where we were, although not that far from the airport. It is apparently retribution from Kenya’s army pursuing Al Qaeda associates in Somalia. Many people were killed and hurt.

The other big news in Kenya is a nurses’ union strike that actually began a week before we left. Unlike the doctor’s strike two months ago, this one paralyzed the government hospitals immediately; we felt the impact at Tenwek with a big influx of patients forcing us to cancel elective scheduled surgeries to focus on all the emergency and urgent cases. The strike is in its 11th day. As before, many people die needlessly and suffer significantly during these closures. In response to this strike, the government fired 25,000 nurses and asked retired nurses to come back to work. It seems unlikely that this is a feasible strategy. Please pray for this situation.

Amy will come back to Indiana for a three-week visit with family in two weeks. Debbye Biermann is waiting for her third child to come any time. Already he has forced a dress rehearsal of their labor back-up plan, but he seemed less interested in being born as it was initially thought. The waiting continues.

We appreciate your prayers and support very much. Thanks for serving with us.
In Christ,
Paul, for the Jarretts

Dear Family and Friends:
We are nearly packed for leaving today. Some bags are coming home, others going into storage here for a future trip, God willing. Today we will go as far as Amy’s apartment at Kijabe\Rift Valley Academy. Our flight leaves Kenya Saturday 10:55 pm [almost 3 pm Indy time].

We are scheduled to arrive in Indy at 6:30 pm Sunday night. We’re praying for good flights and connections. We go through Amsterdam and Detroit. Please pray for safe travels and rest on the plane.

We have had a very good term here despite the challenges with health. We’re thankful for God’s enablement and His provision for our orphans. I’ve had many good meetings with Pastor Kilel and our orphanage directors.

Thank you for praying for Erin who has recovered from her amoeba; I misunderstood her name as Aline who is another missionary here with virtually the same last name. God knows who His children are and always cares for them.

Praising and serving Jesus with you,

Paul, for the Jarretts

Dear Friends and Family:

Thank you for your prayers for our family. I can happily report the safe arrival of Mara Elise Gordon to Susanna and Chris Gordon. She is a beautiful addition to the family for which we are grateful. I have some orphan updates and prayer requests to pass along. Please click on the link to read more….

My grandchildren census is at 26 with the safe arrival last week of Mara in Cincinnati on Feb. 18. This one should move back to Indianapolis in mid June, but I think it likely that a visit to see her will be an early trip on our schedule after arrival. The “old” newest grandbaby in Japan is doing very well with good growth and behavior being reported by her proud parents. Both are appearing regularly on my Facebook account.The next anticipated arrival is penciled in at the end of March, a third son for Debbye and Aaron.

Rachel and I leave Kenya two weeks from tonight. We are trying to tie up loose ends and get a few things accomplished we had deferred to this time. Tomorrow, after our regular church, I will probably visit a local church in Bomet that a friend has been asking me to attend with him. Next Sunday we are invited to attend a different local church with our househelper, Janet. Rachel says we’re invited to another home for lunch next Saturday with our previous long-term househelper and his family. The pre-departure rush seems to occur each year. I think I still have the energy.

One of those things deferred and accomplished this morning was a visit to the Kitoben Vision orphanage where we had a great time. Rachel and I took a young medical couple from Duke University, Stephen, MD — Internal Medicine and Erin, RN. Also we took a young Kenyan man 20, Gilbert, whose parents work here; and our driver, Donald, whom I like to take as he always contributes a lot.

As we prepared to load, one of the Tenwek visitors gave me an assignment. Mark and his wife, [look older than me] who are here doing water projects with schools had planned to go to this home too but has run out of time before they leave. He had the name and phone numbers of the director, Alice [and her husband, Samuel Langat], and their contact in the States, Drs. Tom and Anne Kettler, of Kansas City, who are my friends and the major supporter of the Kitoben Vision Childeren’s Home. Alice was interested in a well [borehole] with which type of projects Mark is involved.

He wanted me to look at the place where they were buying land suitable for a borehole, see if they had the deed yet [they don't], and give Alice the requirements of the hydrological study and registration with the Bomet County Council. He showed me the costs of a borehole project in Eldoret a European group had put in. The cost of it was a pretty good estimate of what a borehole would cost here — 1.6 million KSh [$20,000]. Mark repeated his mantra, “Water is not free”; even a borehole requires someone to maintain it, power must be used to bring it up — diesel or electric usually, and then the water must be transported.

He also gave me a picture of a water kiosk at a place near the Bomet airstrip called Itembe. I told Donald I wanted to see this before we arrived at the home and measure the distance there. At Itembe a project had been set up from a borehole with a water line to other kiosks. Unbeknownst to us, at the head of the road to the airstrip, a kiosk now exists. As we drove along the highway towards the airstrip away from Bomet, Donald suddenly pulled off the road and hailed a grandmother with some children — I thought perhaps a relative. No, she climbed in as he brought her with us to show us the project kiosk; she was on the committee — how he knew her by sight, I don’t know, but Donald knows a lot of things and people around the area. He himself has a private water project in Silobwet, so I also learned he knows water development.

When we turned off the highway on the airstrip turnoff, we pulled up to the next intersection of the road that parallels the road and there was a kiosk for the Itembe water project — it is 0.7 kilometer [0.42 miles] from the home. The lady gave Donald the details of the operation. The water is turned on and off remotely and a pipe brings it to the kiosk. Someone works in the little permanent shed during hours of operation and has a handle to turn on and off the faucet in front of the building. People come up with their containers and pay 5 KSh {\=} for 20 liters [$0.06 per 5 gallons US]. Lots of bystanders came up and joined the conversation as I looked around. No water was running at the moment.

After we visited the home for awhile, I discussed the topic with Samuel and then Alice. Samuel says that they buy 80 liters [4 containers, 20\=] and hire a motorcycle for 10-15\= to bring it to the home. [their donkey was stolen; water transportation is a major use for a donkey] They actually began using the water from the kiosk in January when their water tanks from the rain water collected from the roof and gutter system ran out in dry season.

Apparently there is some consideration at the Itembe project to bring the water line closer to the home and a college also abutting the airstrip. According to Donald, the water would be metered locally where you could take whatever you need and pay as you go from the meter. The lady from the highway closer to Bomet says that the project near them is separate from Itembe and plans extending a line in the direction of the home as well, but that is future. [I thanked her and gave her 100 \= for her time and walking back home.]

Alice had the vision that perhaps if they had their own borehole, they would have their own water [albeit with a distance away] and they could sell to the neighbors. I really questioned if the seasonal water need would be the best use of such a $20,000 expense and if any profits would be realized after expense of maintenance and power [the electric power has arrived -- the power lines go across their back property line.]

I explained that people in the US usually didn’t put in a well themselves and maintain it if they lived within reach of a water company line. [It might sound cheaper than paying a bill until you pay $2,000 for a new pump after a lightening strike or paying a company to clean it periodically or test the water.]

The power lines that go overhead nearby can be harnessed to provide light for the home which currently uses a diesel generator when funds are available. Here, I heard the same cost as we encountered at both Bosto and Umoja for connecting – 35,000\= [~$475.] After that and any local wiring costs, there is a regular monthly bill depending on usage.

Alice now has 80 children under her care. She and her husband both live there now with their three youngest daughters, Dorcas, Zipporah, and Sandra. The older four children live there when not in school as do most of the orphan boarding school students three months each year.

This Saturday morning, about 30 children were around as most were at day school or boarding school. Both Alice’s sisters were there. Sharon is the matron living with the girls in their dorm, and Joyce helps with cooking; she struggles with mental illness but gave me a hug and big smile – she looked very nice and seemed completely appropriate.

Some young men were working there – Cheruiyot has been there for quite awhile, and an accountant, Bernard, was there working with them for a few days – he was helping one of the high school graduates in accounting school.

The home looked very nice with fresh paint, more sidewalks than in the past [very helpful in rainy season], working gutters, a newer permanent water tank as well as some KenTanks [black plastic]. Since I was last there, a semi-permanent girls’ dormitory and remodeling of the boys’ dorm had been added. The cotton soil here does not readily allow construction of permanent stone buildings without very deep foundations. Wooden and iron buildings with concrete floors will last a long time but not a lifetime.

The children were all dressed well and looked healthy. Most were new to me and the older ones I knew best were away in school although a few I could recognize. They greeted us with some songs and told us their names and grades.

After handshakes, we greeted them with short speeches and encouragement from God’s word. The Bemms gave me two soccer balls to present to them; they were gratefully received. We also borrowed some hula hoops and jump ropes from Bemms so that the visitors and the children could play.

Their garden is pretty dry right now. The Napier grass for the cows and goats isn’t growing very much, so the animals have been moved to the other side of the river from Tenwek over seven miles away. The chicken project here, unlike at Umoja, never took off with neither someone or place to market the eggs nor the home withstanding the expenses of raising and feeding the chickens while laying. It definitely takes the right situation for this project to be successful as it has been at Umoja Children’s Home.

Alice gave me some updates on the oldest children whom I know. Peninah, whom I visited at school two years ago, had always been a favorite. Two years ago when I saw her, she had filled out from her skinny childhood frame to an 18-year-old woman. Now she is married with a child and living in Nairobi with her husband, a teacher. She hopes to continue her education when possible. Her situation made me very happy. It is very rewarding to have participated and to have watched an abandoned 10-year-old girl [along with her younger sisters] grow up to complete her high school education, marry a responsible man who values her, begin raising her own child, and, most importantly, continue to love the Lord. Those who prayed for and supported these children over the years must be thanked and encouraged. Thank you!

Other children are continuing in college and university; obviously, this is very expensive and Alice gives thanks to the Lord who has provided the fees year after year [not through our Hope Ministries]. One of the two Mercys of the generation with Peninah is living at home with her old grandmother whom she can help until she has the opportunity to further her post-graduate training after high school. Her sisters and brothers are still in the orphan home and boarding school, but Alice and her sponsors felt this to be the best situation for Mercy – giving back to those who helped you and perhaps witnessing to relatives are part of the reason.

Over the years, Alice and Samuel have treated these orphans as they did their own children, trying to obtain the best education and advantages for them. They must be commended. From the very first children Alice took home from Tenwek who were abandoned at the hospital by relatives, they have continued to take in children. Although Alice continues to work in Tenwek’s office where patients pay their bills, most of the children she is now raising have been brought to her by grandparents in the community who no longer can care for them.

Somehow, Alice has continued working on a theological degree in Nairobi; I’m not sure how much more time she needs to complete her degree, but she perseveres. Living at the home is certainly a harder place to live and commute from [over 5 miles] than Tenwek Hospital staff housing; yet this is where she wants to be – taking care of the children. Last year she lost her mother who had assisted her for several years.

Earlier this week, I met with Pastor David Kilel and our three directors. We had two major purposes – to appoint the directors of the three children’s homes, Umoja, Kenduiwo, and Bosto also as directors of our AGC Tenwek Area Education Fund and as signatories — as well as letting them talk about some of their concerns.

When we set up the fund many years ago, there were three other AGC pastors besides David Kilel as directors. To avoid any difficulties with too much control over the fund by one person, three signatories were required including one major one like David or the pastor of the big church down the hill, Ruben Koech. The other two pastors have since retired and whose absence is creating some current difficulty with finding signatories.

The first issue was handled easily enough as they were willing to be signatories and members of the steering committee. The second was helpful in having them bring up some issues at the homes.

They had some concerns about continuation. They wanted me to set up someone who would continue if I were unable to do so; someone just like me was their preference. I was thankful for their vote of confidence in my ability even if not in my ability to continue forever. But they are right. They also didn’t mention Pastor Kilel who actually retires next year, and he is very much the main person on this end keeping things together. For the most part, the former directors were “yes” men for decisions and with whom I rarely talked. Granted, it was important for the AGC [the large denomination Africa Gospel Church] to have these individuals associated with the whole project.

Each of the homes has significant bills at Tenwek for the children in their care; we haven’t paid for them, and the homes certainly don’t have money. In the past, we’ve had some assistance from the “Tenwek needy patients’ fund” which missionaries and hospital administration committee members oversee. We need to apply to them as we don’t have funds to pay them without additional donations. I think it’s over $3,000 total. At this point, the children aren’t often turned away but the caretakers usually get comments from those in registration regarding their balance. I will talk with Amy Bemm who has been on the committee. Please pray for God to give us wisdom and favor in this situation.

Each home has a handful of HIV+ children who must be taken to the hospital for regular check-ups as well as occasional illnesses at the home for which there are no designated funds. Transportation costs are significant particularly for the two distant homes – Umoja, the closest one, has a vehicle, Bosto’s vehicle is personally owned, and Kenduiwo must always hire. It seems like each needs a regular budget for transportation. There is always concern among donors in Africa about giving funds directly and funds not being utilized for a designated purpose, but these pastors have been our directors for over 7 years. They give their heart and souls to the children day and night. Is this a time to have a fund? – Pastor Kilel always stresses their need for accountability in all situations. I am proposing giving each home 5,000\= [~$70] as a trial. Please pray for the provision for this amount from our donors.

A situation came up with a high school girl who requested school fees to resume school as a Form 3 [Junior in High School]. Two years ago, she left Umoja and lived with a grandmother in Londiani, a long distance away. She was enrolled at Aisaik Secondary School which is near Umoja. She got pregnant and had the baby which the grandmother is taking care of at home. Should we resume sponsorship? — which we hadn’t done the past year or two – so far, I have no positive answer to that one from God. We agreed to pray about it, but I have not been led to pick her up again as she has been taken out of our care and supervision and gotten herself into big trouble. There are others who have behaved themselves whom we can’t yet pick up for lack of funds.

Future plans for the children must be discussed as well. Not only additional polytechnic training but also university training may be considered as it has not been in the past, although funds for even one student are prohibitive. Where these children will go after finishing high school is a concern for the directors. Will you pray for the committee for wisdom? Please continue to pray for God to provide funds for caring for these children whom we see as potential leaders in their generation.

One other prayer request is for our director at Umoja Children’s Home, Joseph Chepkwony. His oldest son, Bernard, age 23 was injured in an accident when he was riding as a passenger on a motorcycle which collided at an intersection with another motorcycle. They brought him to Tenwek where he was admitted in a coma to the ICU with a serious head injury, but he died shortly afterward. Please pray for comfort for this family as well as the children at Umoja where he has helped the past nine years.

Thank you for your prayers and assistance with the orphan programs. If I had known all the issues involved with caring for more than 150 children, I’m not sure I would have signed on, but the children are growing as the directors, Bemms, and I have as well – along with the other missionaries who participate in various ways. No one person can do anything, but God has brought together a team of His people who have made a difference in the lives of many people who are learning of the love of our Heavenly Father.

Serving Jesus with you,

Paul, for the Jarretts in Kenya

Dear Friends and Family:

I am happy to give updates on God’s answers to prayers regarding our orphan program and my visit with the doctors in Nairobi. Rachel and I will return in 4 weeks; we still have some adventures ahead and wait to see all that He plans. Please click on the link to continue.

My day trip to Nairobi went very well; thank you for praying. The doctor said the esophageal cardiac ultrasound test on my heart was perfectly fine. Because of the stroke, they wanted to see that there wasn’t a hole between the two upper chambers [right and left atrium] where a clot could have slipped through.

When a hole is present, it is usually called a patent foramen ovale [literal: open round window], a necessary component of fetal circulation that closes minutes after birth to changeover to adult circulation — a miracle of God’s creation, in fact, or after millions of years of evolution, if one denies the role of a Creator.

I did not have any residual opening which is as it should be. They conclude the stroke happened because a small vessel in my brain closed itself off due to age rather than an embolus [traveling clot] from somewhere else. Their prescriptions of a statin drug and anti-platelet drug should help prevent other small vessels from closing themselves off and causing other strokes. They agreed I did not need medication to lower my blood pressure and placed no restrictions on me [other than some weight loss and diet changes].

Thank you for praying for our meeting with the surgeons; it was helpful in solving some issues and providing us a second day in the operating room on Thursday in addition to Tuesday. The increase in our caseload had become difficult to manage with the previously available space. We have had two obstetricians sequentially visit for two weeks apiece which has given a week’s time off-duty to Carrie Huber, my colleague in OB. We will pick up the extra day in surgery very soon.

We’ve been very busy even with the extra help. Last Tuesday after I did an exploratory surgery for a large pelvic mass that looked more like a lymphoma which we biopsied, we heard that a patient from Longisa District Hospital was on her way with a ruptured uterus – they called to let us know because they didn’t have a surgeon available but sent some labs with her along with an IV line.

I was in main operating room and Karen Zeinert, the OB from Michigan, was in the Maternity operating room [theatre]. She had just taken in an emergency cesarean for a footling breech. We kept my operating room open and the patient from Longisa rolled in very soon. The OR team got her prepped and anesthetized; we had one unit of B negative blood to give her. After that O negative would be next choice. B negative is very rare here.

I scrubbed in with the new Family Practice resident and the new surgery resident [probably less experienced than the FP at this point] and we opened up the mother after they put her asleep. [I did remember to have them ask her if she knew Jesus which she answered affirmatively – she was able to answer, but obviously getting close to passing out.] We opened her abdomen and found lots of blood in her abdomen – probably 3,000 ccs; we just scooped out all the blood clots along with the placenta and the large baby boy – very freshly stillborn with a good color to make us think that maybe he had just died and could be resuscitated– but they couldn’t.

Looking at the mess of her torn uterus and active bleeding, I thought the fastest thing to get her bleeding under control was just to clamp the big arteries and to start sewing the uterus back as quickly as possible while catching the arterial bleeders as we went. The alternative was a hysterectomy with a lot more blood loss which this mother couldn’t stand. Liz, the surgical resident, sewed on one side while I sewed up the right side which was torn down deeper into the cervix and the support ligament. Surprisingly, we got everything stopped pretty quickly; the anesthetist was giving her lots of fluids including the first unit of blood. He says her blood pressure stayed above 90 mmHg the whole time.

At the end of an hour’s surgery the bleeding had stopped, the uterus was at least put together, and we had tied her tubes; her uterus couldn’t contain another future pregnancy safely without rupturing again early in pregnancy even without labor. She stayed in the ICU for a night for monitoring but went home to her family on the fourth day after surgery.

Through last week we had received sufficient donations for starting our previously sponsored orphans in school along with the eight freshmen class children from Umoja and Kenduiwo Children’s Homes. The students must be enrolled by tomorrow. Pastor Killel and the directors from the homes have been purchasing things like dictionaries, other books, notebooks, mattresses, and soap and other hygiene needs that would enable a young man or woman at age 15 to live at school away from home for three months at a time.

We met on Thursday at David’s office discussing how much more expensive the items along with the cost of tuition have become since last year – about 20%. We knew about the tuition, but we had underestimated all the extra costs. We were short nearly $500 overall. I went to the bank machine to get 40,000 KSh which amounted to $482 in USD. A donation had just arrived this week to cover the amount.

On Friday, we found three more of our orphans had been accepted by local principals having missed the original “draft” which is pretty descriptive of how the scholars are accepted into various schools in the area based on their national examination. We did not know these undrafted three were qualified and weren’t alerted by one of our directors. We did not have any more money meaning they would have to stay out of school for an entire year. What should we do?

I thought of Hezekiah and spread out the lists of the name of the students and their bills; David Killel and I prayed over them and asked God what we should do. It then occurred to me to write some guests visiting in Nairobi who were coming tomorrow to visit the orphans; that in itself is unusual – we don’t get a lot of visitors other than for medical work. I had been in contact with them although hadn’t actually met them yet. I wrote to them of the unexpected specific need of the children whom they planned to visit.

It seemed that God knew ahead of this situation and the visitors had been given some money from their friends to use in their ministry to the orphans – just enough to cover the expenses for the year for the three students and their incidental expenses. Did God want us to realize our need and want us to ask Him making our will in line with His will?

That was the theme of the message of our pastor, Elijah Bii, at Tenwek this morning. His text on prayer was from 1 Samuel chapters 1-2, the story of Hanna. The story tells how she was barren and persecuted by her co-wife – certainly a familiar story here around Tenwek. Undoubtedly, she prayed for a long, long time. It was when her will came in line with God’s will that He answered her prayer. 1 Sam 1:11 And she made a vow, saying, “O LORD Almighty, if you will only look upon your servant’s misery and remember me, and not forget your servant but give her a son, then I will give him to the LORD for all the days of his life, and no razor will ever be used on his head.” NIV. She became the mother of Samuel, the judge of Israel whom God desired – the one who later anointed David.

So it happened that our prayer had come in line with God’s plans. How much less would we have appreciated the money if we had not seen our need and prayed for it? It was God’s timing that made us recognize our need, our requirement to pray, and then give Him praise and glory when He answered – this time nearly immediately. Thank you, Lord, not only for your provision but also for Your teaching us.

Last week a friend sent me an excerpt from a devotional from an author named Young that I enjoyed. I was reminded again of it today.

“I am with you and for you. You face nothing alone-nothing! When you
feel anxious, know that you are focusing on the visible world and
leaving Me out of the picture. The remedy is simple: Fix your eyes not
on what is seen but on what is unseen. Verbalize your trust in Me, the
Living One who sees you always. I will get you safely through this day
and all your days. But you can find me only in the present. Each day
is a precious gift from My Father. How ridiculous to grasp for future
gifts when today’s is set before you! Receive today’s gift gratefully,
unwrapping it tenderly and delving into the depths. As you savor this
gift, you will find me. Romans 8:31; 2Corintians 4:18; Genesis
16:13-14

Please continue to pray for us in the months ahead as we will again need God’s timely provision to pay the next installment of tuition for our 50+ students in April. Rachel is staying a week at Rift Valley Academy with Amy. Pray for her time there and her trip back next Sunday. Please pray for Susanna’s delivery with her first child, Mara. She is due today in Cincinnati. Laura is at home with Yoshiki James Noguchi, who is gaining weight rapidly.

Thank you so much for your participation in our ministry in so many ways – primarily in prayer. I thank God for you.

In Christ,
Paul, for the Jarretts in Kenya

Dear Friends and Family:

I appreciate your prayers very much. I want to update you first on my recovery from the stroke on Dec. 22, 2011. Laura has given birth to her first son who is also on our prayer list at this time. Please click on the link to read the entire message….

God has blessed me richly in many ways. As mentioned three weeks ago, I returned to work with no obvious deficits that would interfere with my work in surgery or at the hospital. The medical staff did not place me on night call to allow me to get extra rest which turned out to be a wise decision. I became progressively fatigued over the first two weeks of January with very little energy during the day.

I required a lot of extra rest, but also found that I was short of breath when climbing the hill to which I was acclimated after 4 months here. I checked my pulse and found it was around 100. I had a nurse check my blood pressure and found it was only 105\66; my normal BP has been 130\85 under normal circumstances.

It made sense to me that the small dose of blood pressure medicine was causing more than a 20 point drop making me somewhat hypotensive. I stopped the medication the next morning and found I was up 10 points. By the next morning, I was back to normal, and so was my energy. The doctors here agreed with holding the medicine until I visit the prescribing doctor in Nairobi on Feb. 2 this week for my scheduled appointment.

I still find that I need a full night’s sleep to have normal energy. This past Monday, I hadn’t slept so much on Saturday night and was very tired after the clinic day. When I came home at the end of the day, a new visitor came by and almost whispered to me for thirty minutes wanting to tell her life story and why she needed some money for school fees. I knew I needed a nap and was able to send her away with a promise to pray about her situation and make a decision soon.

I told Rachel I was going to lie down for a nap before dinner and then slept hard for an hour. She “called the cops” on me when she was worried. She had two surgeons and a family practice doctor come by to see me that evening. I was able to convince them I really was okay but had needed a nap; Mike Chupp could tell that I was not in the same situation as a month ago and let me pass. I had to show Rachel my pulse rate daily for the next five days before she really believed me.

I think the reason I lost sleep Sunday morning waking up at 4 am was probably related to the second anniversary of Marty’s passing that day. I knew all of us were thinking of Marty that day. I decided to write our children which I will share with you at this time.

Dear Children:

It will come as no surprise to any of you that today marks the second anniversary of your precious mother’s graduation to Heaven. I expect a wide range of emotions is represented throughout our family and perhaps within each individual as well. Playing the Chris Tomlin song, I Will Rise, no doubt will start the water works for most of us.

However, I didn’t play that song yet, nor did they ambush me by playing it at church today as occasionally happens. I woke up early this morning with thoughts about Marty; thankfulness dominates all other feelings today.

I could make a long list of things for which I am thankful, but I will only mention a few. Marty led me to the Lord – lovingly with perseverance. Without her preaching God’s Word with her words and life where would I be? Maybe I would be still lost, stumbling around in sin – only God knows. My salvation should be at the top of the list of eternal things.

You children and grandchildren have eternal life because of Jesus Christ, but Marty’s willingness to be His handmaiden and allow Him with thankfulness and without reluctance to put you in her womb must be acknowledged with great gratitude. How many men at this stage of his life can say he has this many descendants not just living but walking with the Lord with the help of the godly woman God gave him?

How many would willingly leave parent, home, and children to go with her husband to the end of the earth and lead people of another culture to her Savior? I am thankful that she spent so much time in prayer to hear God’s voice that orphan children needed parental love and help.

Yet I must not end the list without her example of her love for Jesus and His Word which she instilled in each of your lives as well as her encouragement to me to learn more and more of Him each day. I can’t begrudge our Lord having taken her to sit at the feet of His throne where she was prepared to be. I can only praise Him with thankfulness for the time I was given with Marty. We were all prepared by her to walk on our own feet alongside our loving Lord Jesus.

Love to each of you, Dad

Two days prior to this, Laura gave birth by Cesarean to Yoshiki James Noguchi in Japan. His name, Yoshiki, when written in Kanji, means “Joy in Christ.” He has a special challenge in his young life, a cleft palate and lip, which will require surgeries beginning in three to five months.

Laura and Keisuke are coping very well with the adjustments recognizing that this has been no surprise to God and that He intends for them to be a witness throughout the process. A special encouragement has been that the government insurance covers everything including dental treatments in the future.

Our orphan ministry continues to go very well. God has blessed us with sufficient funds for the existing enrolled students as well as the four beginning freshmen students at Umoja and four at Kenduiwo. Thank you, Lord. Please pray that throughout the coming months, He will provide an equal amount of support divided equally in April and August. We had asked for guidance on how many we could start; we interpreted His provision of the needed amount for all eight students. God is good, all the time.

I am excited to report that we have started a cervical cancer screening clinic this month at Tenwek and some of the outlying clinics. Each Friday, I have been called to examine patients identified by a trained nurse who sees potential pre-cancerous conditions. Instead of seeing patients who have inoperable cancer, for the first time, I am seeing either immediately pre-cancerous or early stage conditions which can be treated effectively.

Seeing more cases requiring hysterectomies will add some extra patients on our already full schedule. We are meeting with the surgery department on Tuesday where we hope to agree on another day in the week where we can schedule cases. At this point, we only have one dedicated day in the five major operating rooms; trying to squeeze cases into our own operating room in Maternity is difficult to schedule with all our cesareans and other minor cases with a somewhat unpredictable availability of an anesthetist whom we share with the eye surgeons in their suite. Please pray for a reasonable plan to come from this meeting.

Please pray for a patient I will call Dorcas. She came to us a week ago with a “bad obstetrical history.” Sometimes this means one or no living children out of four or five pregnancies. Dorcas had her first two children born alive and survive, but then she lost the next at 34 weeks. The next 7 were stillborn at 26 weeks – once a year for the past 8 years.

This time she came to the clinic at 30 weeks with the baby still alive. We had an ultrasound performed in November which confirmed the date, but the baby was so tiny inside her womb now. The baby measured more like 25 weeks or a pound with a few ounces – not much growth in nearly 3 months. We used our only working fetal monitor and saw that the baby’s heart rate showed normal variability, a good sign, until a little Braxton-Hicks contraction occurred which immediately sent the heart rate down below 80 for a minute following. Obviously, this baby had no reserve for labor.

We discussed the situation with the pediatrician. He felt that the baby wouldn’t survive for very long in the nursery below 31 weeks; before this age in our set-up, most die from either lung immaturity or bowel death [necrotizing enterocolitis]. If we could watch it closely until the first of next week, the chance might be better with the corticosteroid injections we were giving to the mother. [We had been out for a few days, as the pharmacy hadn’t found a source in the country to restock – first time I had ever seen that medication run out.]

We did daily fetal monitor assessments showing the baby’s condition was unchanged. He was moving regularly. The mother was told she would need a cesarean for the earliest sign of labor or change in her situation; she had to come immediately to the labor room from her bed in the ward. I talked with the nurse in-charge to alert every nurse on duty that a prompt response was absolutely necessary.

Yesterday afternoon, the fetal monitor once again showed the baby’s condition was satisfactory with a “reactive non-stress test.” Four hours later, the mother came to the labor room saying she had a strong contraction. The team was alerted immediately, but the nurse had trouble finding the heartbeat. Dr. Bryan Myers, visiting here for two weeks, came up immediately as they prepared for a cesarean. It seemed like the baby’s heart was only twitching on the ultrasound. The immediate cesarean was fast but not enough to save the baby despite the pediatrician’s best efforts at resuscitation. Bryan said the placenta was only tiny and may have separated at the edge.

Please pray for us and Dorcas as we advise her for the future. We can say with certainty that she has much treasure in Heaven, but her body does not seem to have the ability to nourish a baby large enough to reach maturity or even given a chance under the best circumstances available here.

Please pray for my doctor’s visit on Thursday, Feb 2. I plan to stay overnight in Nairobi, do some grocery shopping, and come back Friday morning. I had hoped that my paperwork would be processed to combine this trip to the government building to get a long-term work permit and a re-entry visa for future trips. But it doesn’t seem it will be ready in time. Does God plan for me to return later in the year or at any time in the future? Please pray for this answer as well.

We have only six weeks before Rachel and I leave Kenya on March 10. There are many questions for our immediate future. Our house has been for sale nearly two years this spring. Is this God’s season for us to sell the house? If not, will we be able to refinance the mortgage which will expire this year? Where would He have us live? Will the volunteer medical clinics in downtown Indianapolis find malpractice coverage for me and other retired doctors? Does God have other medical trips planned for me? These are questions I am praying for answers.

Susanna’s baby is due in the next few weeks; Debbye is due at the end of March. Please pray for safe arrivals for these two grandchildren as well as Yoshiki’s continued growth required for his surgery. Rachel’s ministry has been very effective with her helps ministry. Please pray that we will finish well here at Tenwek over the next six weeks.

I did finish my project of editing the Watchman Nee book, The Normal Christian Life, for my family. Several were encouraged by it. I encourage anyone to read that important book if he hasn’t done so. Nee’s knowledge and radical “big picture” thinking is not sufficiently appreciated in today’s church.

This very helpful book is regarded a Christian classic. Nee To-sheng [Watchman Nee] lived in China from 1903-1972. Much of the independent home church movement in China today has its roots in his teaching and leadership. Arrested on false charges by the communist government in 1952, he remained imprisoned until his death.
This book is based on his lectures in Europe in 1938-39 as recorded in transcriptions and private notebooks. It represents his personal understanding of the Christian life towards the end of the first twenty years of his pastoral ministry service. Although it may seem so, it is not a systematic treatise on Christian doctrine. He did not edit this book or the notes himself. First published in 1957, the edition I have read and reviewed is a revision from 1961 published in paperback by Tyndale in the US in 1977.

Again, thank you for your prayers and support. We give God all praise.
Serving Jesus with you,

Paul and Rachel in Kenya

Dear Friends and Family:

Thank you for your prayers. I want to share some stories from last week, an update on Joan, and the passing of my mentor and friend, Dr. Robert Livingstone Foster. I continue to gain strength; today I did three emergency major surgeries while others were working in our scheduled clinic which lasted past 7pm tonight. Please click on the link…

Joan greeted me with a smile this morning and thanked everyone for their prayers. She nursed her baby and walked in the hallway with no evidence that she was different than any other mother recovering from a cesarean. Thank you, Lord.

Last week was very busy causing Pastor David Kilel and I to postpone our visit out into the community each day until Friday. I want to thank God for providing enough fees to start our children this week. David was very busy buying items to send the children on to school while waiting for the wire transfer to pay the schools their funds. Please pray that God will provide the remainder of the funds within a short time for the forty plus students. In addition, we will soon learn how many of our orphans will have qualified on the exam to start Form 1 [freshman year] at the end of the month. I expect about ten children to pass the exam.

Funds for sending orphans to school and orphanage support can be sent to Hope Ministries, Inc., 9902 East 200 South, Zionsville, IN 46077. Mark the donation for Tenwek orphans. A receipt for tax credit will be issued. All funds are passed directly to orphan support in the Tenwek area as administration and expenses are covered by a donor.

I began Friday morning by confessing to the morning report group of medical staff and interns of my conviction of our need to be more active in being certain that our sicker patients need to hear about Jesus. This was prompted by the death of a mother on early Thursday am; on Wednesday morning she had experienced the worst outside delivery I had ever seen.

Since the dead baby’s delivery had already been finished by our nurse, I worked off and on all day stabilizing her pulse and blood pressure believing all of her injuries were external and all blood loss had stabilized; it was late in the afternoon before we realized she also had internal injuries including her bladder torn open as well as the uterus ruptured. She was taken to surgery and several surgeons worked on her, but unlike Joan’s situation, she did not survive three hours after the surgery. I could have talked with her through a translator when she was conscious. I just didn’t realize she was in such peril. Sometimes we don’t realize a person has no more chances to hear the gospel; I don’t know what her spiritual status was when she died.

I got more chances with other patients Thursday night and Joan Friday night with emergency hysterectomies after deliveries as well as an ectopic [tubal] pregnancy on Friday who had lost 6 pints of blood.

We’ve had a patient in an intensive unit with a very unusual condition of ovarian hyperstimulation apparently spontaneously from her first pregnancy at age 18. The ovaries blew up with multiple follicles from the ovulation that gave rise to the pregnancy; instead of having at most one or two follicles the size of a marble, she had hundreds of hen’s eggs size in both ovaries. Her ovaries actually pushed up under her liver with a tremendous amount of fluid in her abdomen [ascites] and lungs [pleural effusion]. This usually happens in infertility cases with too much drug stimulation to cause too many follicles.

She has a live 9-week baby and needs to lie very quietly and definitely not be operated upon which would probably cause her to lose one or both ovaries. Left alone with minimal support, everything should regress. She looked better after four days. I had one case of these many years ago to a much smaller size using the fertility pill, Clomid, which I’ve used in thousands of patients.

On Friday evening, David and finally had a chance to go out for the first time. There was a poor mother named Rebekah who wanted to see me; I guess after a number of years of my working with Pastor Kilel and actually visiting out in the poor areas with him, my name is known some places – not sure how it happens. Anyway, we went down a road towards Ndaraweta off the road just north of Silibwet towards Litein. I have a fairly good sense of direction and remembered going down this road to see a widowed grandmother with 13 kids probably the very first time I went out with David in 2001. I remember most of her adult children were dead with HIV. I asked about it as we went by the place, and he said we’d stop on the way back.

We stopped outside a boarded up duka [store or shop] with some sheep tied up in front. David said it was the place, although it didn’t look like a house. Behind it attached were some storage sheds where the family was living. Rebekah looked to be in her latter forties. Her countenance was very sad, and the story she told was completely believable. She introduced me to her 28-year-old daughter, the oldest; there were three mid to young teenagers belonging to this single mother’s kids and some smaller ones from whom I’m not certain. Other members weren’t home yet. In a 7 ft by 5 ft room made of rough wooden boards turned black by cooking fires over years, we sat on very small stools on a dirt floor. Cardboard paper helped block some of the wind which wasn’t blowing this night. The other room where they cooked and slept was maybe half again as big. The door we walked in was about 2.5 feet in width, which I stepped in sideways. This looked more like an animal shed.

The family’s belongings were meager. From the only shelf I was shown some legal papers requesting assistance from various government agencies, a Kalingen [Kipsigis] bible David Kilel gave Rebekah in 1983, and some five or six family pictures in a plastic bag for protection. They paid 600 Kenya Shillings a month to stay in this shed [about $7.00] but the owner wants them to leave so he can use his shed for his business. They try to eke out a living by working day labor in neighbors’ gardens, picking tea, and sometimes begging. Rebekah’s husband chased out all the family in 1999; this is the fourth place they have lived in the area. They have no other income other than charity. The alcoholic father gave them nothing after sending them away.

The second born, a 25-year-old son, died two weeks ago; this was the first thing Rebekah told us — obviously a very sad situation. He had delivered a seizure disorder and drowned when he was washing his face at the river falling in when had a seizure. Another boy is in secondary school having received some support but has none for this year. Another daughter wanted to go to school but couldn’t. They had no food in the house the past five days. Their local church couldn’t help them right now since they were constructing a large church building within a block of their shack.

David and I prayed for all of these issues before we left. I had brought 500 KSh before leaving the house knowing there would be a need; it might provide some food for perhaps a week at most. But they were encouraged and appreciative. It seemed like a drop in the proverbial bucket.

We stopped at the other house for a very quick stop. There was a 20-something girl named Janet who had contacted David. Only the roof of the house was visible from the road, but down a steep hill I recognized the house because we first came to a large corn crib before seeing the house. That’s where we stopped and David showed me that Janet and her children were living in the corn crib. I remembered 11 years ago giving the occupants some large paper disposable surgical drapes from my shipment to block out the wind. Some family members were still living in the corn crib.

Janet came up to us and shook our hands. She told me she had been to my house. I vaguely remember some of the family had visited us at Tenwek after my visit there to the grandmother with 13 kids. Janet was probably a teenager then. Her mother had chased her away. I presume she is a single mother – a very rough life in this society where there is no welfare safety net or such things as aid to dependent children or food supplements.

David Kilel, the Tenwek staff pastor, has a difficult job because many destitute people in the community and orphans come to his office. He is pastor to our 500+ employees, but his long standing in the community and church makes him recognizable everywhere and sought out. We have provided a very small benevolence fund through Hope Ministries which has given him some way to assist a little in emergency situations. As with our visit, prayer and a small amount of money is a tremendous encouragement.

A person often feels so desperate that one may try to take his or her life, but intervention and pointing people to our Heavenly Father through Jesus Christ, his Son, sometimes saves people at their lowest point. Rebekah gave her testimony when Jesus saved her back in 1983; she was thinking of killing herself before she met David Kilel who helped her give her life to Jesus.

Despite the prosperity gospel preaching, Christian people often remain in a hand to mouth existence. Our loving God provides their needs although sometimes He is expecting His church to be His hands and feet. He isn’t always asking for large, permanent buildings although there is nothing inherently wrong with a church building. But those members living in the shadow of the church must also be considered and assisted in times of emergencies.

Robert Livingstone Foster, 1924-2012

Dr. Bob Foster preached God’s word and trusted God in so many ways that influenced my life more than any living person; in my estimation, he is in the highest tier with Hudson Taylor and George Mueller of generations before him. Because our family had ten children, no mission organization encouraged us to serve overseas as a family – except for Bob and Belva Foster who had raised seven children on the mission fields of Zambia and Angola. He constantly challenged and encouraged Marty and me. He and Belva, who survives him, were personal friends for twenty years. I have served God as an overseas missionary off and on for the past 17 years because of Bob Foster’s impact on my life. When I get to Heaven, I will listen for his booming laugh; he won’t be hard to find.

Samaritan’s Purse did a video with him 9 months ago; his voice was a little weaker at that time, but, at 87, his mind was sharp telling his some of his stories. You can listen to the interview on the following link:

http://www.youtube.com/watch?v=B1W1u2S9b3I)

Testimonials to Bob Foster can be read at:

http://drbobfoster.blogspot.com/

Your partnership in our ministry is so greatly appreciated. Your prayers enable us more than you will ever know. Thank you so much.

Serving Jesus with you,

Paul, for the Jarretts

Personal support for our ministry can be sent to World Medical Mission, which can be found on https://www.samaritanspurse.org/index.php/giving/wmm_doctors/ and find my name or contact World Medical Mission for my account #2355

Dear Praying Friends:

Thank you so much for your prayers. Joan seems to be out of danger but not without the efforts of many people and God’s intervention. Details will follow how God intervened through his people…

Carrie Huber stayed up all night checking on Joan’s progress after calling me after 2am; she consulted with Matilda, our Internal Medicine colleague, as well. All decided the next step was finding fresh blood. Our hospital staff members who had not donated within a fairly short time period began to arrive at the blood bank. Since only one technician is typically on call during the wee hours of the night, another person must have come in from off duty to process drawing the blood, testing for infections as required, and cross matching against Joan’s blood. Only O positive patients could be used – about 40% of the population.

As the blood became ready, one pint at a time was taken to ICU and given to Joan. By 7am, five fresh units of blood had been given. More blood was being processed, but Joan continued to bleed actively, despite being awake with good blood pressure restored. After having removed the packing Carrie decided it was now time to go back for inspection. She called me up to help her with the surgery and a surgery consultant was making rounds nearby if he were needed.

As we opened the old incision, we looked closely at everything after removing a large amount of clotted blood. I clamped many small vessels which were bleeding, particularly on the lower uterus segment below the closure of the upper segment after the removal of the uterine fundus. I recommended we remove the cervix and the lower portion of the uterus and Carrie agreed. From that point forward, we progressively got control of the bleeding. After removing the entire lower uterus, we had complete hemostasis [lack of active bleeding]; we irrigated all debris with saline and closed the incision – a little more than two and a half hour procedure.

Joan was stable throughout the procedure today, unlike the night before. We thought we had accounted for 3 more pints of blood loss, and those units were replaced with additional fresh blood. We counted 11 pints of blood transfused, a total exchange of Joan’s own blood.

Jennifer stayed with her sister in theatre and ICU all night long; she is one of our surgical technicians whom I have known since my first visit here in 1999. I remembered being impressed with her when she was a patient attendant, a lower position than her current job, because she had refused marriage proposals in order to be the provider for her younger siblings after her father had died. Joan is her older sister with six children. She is very thankful to God and everyone for their role in saving the life of her sister.

Complications can always occur in the post-operative time period, but we are very optimistic that she will go home with her baby hopefully next week. Thank you for your role in saving Joan’s life by “holding the ropes.”

Serving Jesus with you,
Paul, at Tenwek

Dear Praying Friends and Family:
Please pray for God to spare the life of Joan, a sister of one of our staff members who has continued to bleed after an emergency hysterectomy after an emergency cesarean. Her blood pressure is 50 over 30 with pressure packing placed as a last resort. She needs more fresh blood.

Joan’s sixth delivery was complicated by a breech presentation, so a cesarean seemed to be the best choice for safety delivery of her baby. The baby is doing very well in our nursery. Bleeding began after the cesarean and Dr. Carrie Huber was called up from home to assist the capable Kenyan staff doctor who did the cesarean section.

One problem we face here is our dependancy on blood bank with no extra clotting factors which are lost on the shelf without isolating platelets which must be kept frozen. When a patient has a major hemorrhage, she has used up her own platelets, a major component of blood coagulation. In this state, bleeding often continues on cut surfaces normally from small vessels rather than the big arteries which have been tied off. I’m simplifying the coagulation process by referring only to platelets, because there are many other factors found only in fresh blood in our setting.

Our only recourse in this situation is to get fresh blood from donors and give it as soon as possible. Pressure packing may help when all arteries have been tied off, but we can only pray for God to help from that point on; so we ask you to join us in prayer.

Also pray for Carrie. She is carrying a very heavy load with my not helping on night call after my stroke. I have worked a full load in the last three days and have felt tired in the evenings. I wouldn’t have been much help tonight after all surgery has been done anyway. My blood is on thinners that wouldn’t help even as a donor. This is the third night where we have had major obstetrical trauma requring Carrie to do a hysterectomy; the first two nights were referred in from long distances away with a ruptured uterus and a dead baby. Tonight was our own case. The first patient died in the intensive care unit with no more blood available of compatible type. The second case should survive. Joan’s situation is very critical.

Please pray that Carrie won’t be discouraged and worn out with night after night of hard cases. She did rest during the day both Thursday and Friday while I covered I hope this letter makes sense because it’s 3 am here and Carrie called to run the situation by me and ask for prayer.

We appreciate your standing with us in prayer.
Serving Jesus with you,

Paul in Kenya for our staff and patients.

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