Jarretts Ministry

April 29, 2001

Dear Friends and Family,

Thanks for your prayers and recent letters. We are doing well and the patients whom I’ve shared with you recently have all made remarkable recoveries, some of which I will detail. I continually feel like I’m being stretched medically and spiritually. This term, more than ever before, I have been asking the medical team of doctors and nurses to pray in a circle around patients who have difficult problems, often ones that seem hopeless to me. The results have been remarkable not only in terms of recovery from the medical problem, but also in stretching the faith of those of us who have participated in the public invocation of God’s help. God wants us to ask Him for His help with our problems. In doing so in an open manner, He is given the glory when the results can be attributed to nothing else but His intervention. A good example of this would be Lilly’s remarkable recovery.

Malaria Challenges

Lilly is only 18 and unmarried; she had recently become pregnant and gone away from her family at 4 months into the pregnancy to stay with friends. Several of their children had become sick with malaria, and soon Lilly began to have the symptoms. Only after she lay down with abdominal pains and delivered a small, dead baby did they realize she was pregnant. She then began bleeding rather profusely. Her friends brought her to Tenwek Hospital.

When Lilly first arrived, her blood pressure was dangerously low. The doctors in Casualty Room began IV fluids, and one of the interns did a quick suction curettage to remove the remaining placenta from the womb. Lilly was admitted to the ICU for further management by the obstetric team. Initially, we were concerned about her kidney function; but as she slipped into a coma, we were baffled as to the cause. We had little history to go on at that point, but when the malaria screen came back with “Many Parasites” we realized she had a serious case of cerebral malaria. [In cerebral malaria, the parasites have clogged up the small blood vessels that carry oxygen to the brain causing impaired mental function]. I began her on intravenous quinine therapy every 8 hours. Quinine is so toxic that its use was discontinued in the 1950’s. However, malaria caused by the Falciparum strain of Plasmodium prevalent in this area [transmitted by the anopheles mosquito] has become resistant to less toxic drugs, so quinine is once again the drug of choice for severe malaria. [You can tell if patients are taking their quinine by asking them if their ears are ringing – if they say “no” then they're not taking their medicine properly.] Another side effect is a dramatic lowering of the blood sugar which can be fatal if uncorrected. We always give it in an intravenous sugar solution.

Instead of improving, Lilly’s condition worsened. She no longer responded to our voices but only to a painful stimulus such as rubbing the sternum [breastbone]. She began having seizures and a posturing of her body where her neck was rigid and arched backwards. We did a spinal tap which was normal, thereby ruling out meningitis. Her blood sugar was normal although her kidney function wasn’t good. After 24 hours of quinine, we expected more improvement. What could be the problem? Had we given her some medicine that her body couldn’t eliminate? Did she have some serious bacterial infection from the uterus or other source? After eliminating or covering all possibilities, we were up against the proverbial wall. We could only pray and ask for God’s intervention.

A few hours later, the friend who had brought Lilly in came to see her. It was our first interview with someone who could talk to us [even if it was in a foreign language]. She told us about the malaria in her own family and that she had sent word to Lilly’s relatives concerning the seriousness of her illness. I asked her of Lilly’s spiritual condition. She said that Lilly sometimes attended church, but beyond that she was uncertain of her salvation. We told her of our fear for Lilly’s life and of our turning over all hope for her recovery to God. I checked back every few hours for a change in Lilly’s condition, but nothing seemed to be different. Finally, I left at 5PM wondering whether she would be alive in the morning.

The next morning the first stop on the trip to the top of the hill was in ICU. Lilly remained in the bed where she had been the evening before. Her mouth was still open and her lips parched. But her eyes seemed to respond to our presence, and she moaned at the mention of her name. Could it be she was coming out of the coma? We wrote orders to have her turned regularly to avoid pressure sores. We checked all the laboratory tests that were available. Some tests such as electrolytes [sodium, potassium, and chloride] couldn’t be run because of lack of supplies in the lab. As the day progressed, she was becoming more and more responsive. I ordered a transfusion since her red blood cell count had dropped even further due to the continued destruction by the malaria parasite. The malaria count was still “positive moderate”. We couldn’t believe the response to quinine was so slow but decided we were on the right track and decided against a change in diagnosis and treatment.

The following day, Lilly was awake! She was thirsty and dry but able to express herself. Her fever had dissipated, she no longer had seizures, and her kidney function was improving. She showed evidence of bleeding in the intestinal tract which is another side effect of severe malaria. We decided that by the end of the day, she could leave the ICU. This morning on rounds she was sleepy but has continued to improve so that I no longer fear for her life. We are very thankful to God for her recovery. After 25 years of delivering babies for healthy women on the north side of Indianapolis, this brush with the death angel was too close for comfort.

Other Patient Updates

I was pleasantly surprised with the recovery of the HIV positive patient, Joyce, who had developed necrotizing fasciaitis. She is one of the few patients with this condition who recovered, and God’s intervention on her behalf is obvious. She also had the Pneumocystis Carinii Pneumonia [PCP] which is typical of AIDS patients in addition to the fungus in the mouth. Her wound is healing well, and we will look for an opportunity to close it. She is a recent convert to Christianity after a promiscuous early life.

I had mentioned another patient [Joan, age 18], a “schoolgirl”, who was recovering from an induced illegal abortion. Her kidneys had shut down from the shock of blood loss. [She is one of three patients we have had in the past two weeks with induced abortion]. Her kidney function continued a downward spiral, reaching a creatinine level of 6.5. [Normal is .7 to 1.2 – consider dialysis above 7]. She broke out with cold sores all over her mouth [herpes labialis] and nose. We began to consider transfer to Nairobi for dialysis, but the nurse who assists us on the female surgical ward thought we should order an HIV test first. Tragically, the test was positive. Joan’s kidney function has reversed, and her creatinine is now 3.0, so she won’t need dialysis. But she probably won’t live long in this country with no drugs to fight HIV. She has recommitted her life to Christ.

The patient who came in catatonic [mute and unresponsive] and later suicidal at 19 weeks gestation has had a remarkable recovery. Within three days of starting Paxil [similar to Prozac], she began smiling, talking, and eating. I’ve never seen such a rapid reversal of severe depression! Thanks for your prayers! The drug is supposed to take weeks to work, but she was discharged to the care of her sister-in-law who never left her side during her nearly two-week stay. Family loyalties are often strong here.

Christine, the 23-year-old who had a stroke while losing her baby due to toxemia, has complete recovery of arm and hand strength. She was discharged yesterday and is very grateful to God for her recovery.

The young patient with a placenta previa at 23 weeks, Decla, is still here with us; but her family is coming tomorrow to decide where she will stay for the rest of the pregnancy. I hope she can stay close by the hospital for her sake.

Nights on Call Can Be Interesting

The phones keep going out without warning. Today I was awakened at 7AM after a short night of sleep by a security guard pounding on the door. They needed me to do a Cesarean section on a 15-year-old whose baby weighed over 9 pounds. It is so rare to see such a large baby here. Most are less than seven pounds. While I was waiting to do the delivery, I noticed some skull x-rays on the viewbox in the operating theatre. There was a large arrowhead superimposed on both views of the head, so I correctly guessed that the surgeons had also had a busy night. From the angles of the arrow, I guessed that it had entered the nose and come out the cheek. When I went to the ICU after surgery to take my patient there, I saw the man with the facial bandages to prove my diagnosis correct. He was fortunate to have both eyes undamaged. I didn’t hear the story of how he came to receive these injuries. I would surmise either foul play or an overly aggressive attempt at sinus drainage.

And Now a Word from Russ White

I have taken the liberty of copying some of Russ’s latest newsletter. He often has good stories which illustrate God’s love and healing touch. I know many of you have expressed appreciation of his notes.

He writes, “A seven-year-old girl named Cherono presented to Tenwek several months ago with a large tumor growing out of her forehead. It seemed very likely to be a brain tumor. She is one of the few patients who we sent into Nairobi for a CT scan. Her local church (where I preach regularly) raised funds for the CT scan. The results also seemed to indicate a brain tumor. We operated on her in January. After many hours, we were able to fully remove the tumor which seemed to extend from the skull, and not the brain. Cherono did very well, and is a beautiful little girl. Her mother is a single woman whose husband left her. She is really trying to raise Cherono to love Jesus. Cherono is one of the most pleasant patients I have had the privilege to care for.

The second is a 21-year-old woman named Cherotich. She came to me about six weeks ago with a history of having fallen out of a second floor window three years previously. She was completely paralyzed below the waist for two full years, and then began to develop some slight strength in her legs. She was eventually able to hobble around a bit on crutches. Also, she was constantly bothered by a complete inability to control her urinary bladder. I was actually amazed to hear her story–i.e. that she began to recover after two years of paralysis. She had been to doctors in Nairobi who told her to bring 500,000 shillings (about $7,000) and they would see what they could do. Needless to say, this was well beyond the means of her family. Her X-rays showed a fracture of her first lumbar vertebra with bone fragments compressing the spinal cord. After consulting by email with several colleagues in America, I decided to go ahead and operate on her back. I have never done this type of surgery, but there was no one else willing to help. She and her family understood that this was not my area of expertise, but trusted God to direct. We operated four weeks ago, removing the bone fragments from the spinal canal, and supporting the spine with several pieces of one of her ribs. I sent her home wearing a plaster brace, which I plan to leave on for eight weeks. I just saw her in clinic this week and was thrilled to see her walking reasonably well with a cane. She reported that the strength in her legs is improving daily, and that she now is able to completely control her bladder. This was really more than I had expected!! She and her family are praising God for his healing, and I am certainly joining her. I continue to be amazed how God can use very weak, imperfect vessels to bring about His healing!!”

Closing Words

Thanks so much for standing behind us as we work in God’s service at Tenwek. The workload is heavy, but He is able to sustain us each day. Your prayers for strength and wisdom are appreciated.

In the Name of Jesus,

Paul, for all the Jarretts in Kenya

April 22, 2001

Another Visit to a Kenyan Church

Dear Family and Friends

We were honored to be able to visit another church in the Tenwek area. This church is about 6 km from Tenwek up the forest road toward Mugagno. Joel, one of the security guards whom we see daily around the compound, pastors the church. He had been assistant pastor for 10 years and now has been the pastor for 3 years. For a long time, he had been inviting us to his church. “You are highly welcome.” is his best sentence in English.

Joel’s eldest son, Charles Mutai, was to escort us to the church that the Dickson family had visited two weeks ago. They had walked and then rode back in a vehicle; but today we had a car available, so Charles came to our house about 10 AM. It was a bright sunny day typical of most days in Kenya.

The church was just off the road and we were able to pull right into the churchyard after Charles removed a rail gate fence It sat on a plot of ground looking out over the hillsides now being cultivated after destruction of the rain forest a generation ago. The hills are lush with corn [maize], tea, and the other crops grown on the small farms. The abundant rainfall of recent months has completely disguised the effects of the three-year drought which has affected the areas surrounding Tenwek.

The church was a building of fairly new construction typical of the churches being built by the Africa Gospel Church with the assistance of World Gospel Mission. The 9-ft. high walls are made of stone blocks cut from the local hillsides. Each block is chipped by hand to its rectangular configuration and is about 12”x12”x16” in size. Then they are mortared together. Beneath the walls was a foundation of the same stones laid out in a trench which was dug out by hand. This church is larger than most in the area. The dimensions appeared to be about 30-ft. in width and 70-ft. in length. The floor was still under construction in the front ¼ of the building so it was easy to see the method of construction that had been used. The ground was dug out of the hillside and flattened out. Then large irregular stones were brought in for the fill much like we would construct a gravel driveway in the States. Then smaller crushed stone was added which undoubtedly was some of the chipping from the stone wall shaping. A very fine powdered rock was the topmost layer leaving a very dry, solid floor in the building.

There were four openings for windows along each side of the church with no frames as of yet. The openings are 4-ft. by 5-ft. and a poured concrete arch complete the top of the window. Two large doors on either side were located at the front of the church and one large door on the back wall was the main entrance. The roof construction is unique to buildings developed by the World Gospel Mission engineers. There are trusses of rebar welded together on site. Each truss is about 12 foot in length and is comprised of three steel rods spaced about 8 inches apart which are then welded with a curved reinforcing rod snaking back and forth between two of the rods on each leg of the long triangular column. As each side is thus reinforced, the column is joined to its mate from the opposite wall and welded together with the rods interlacing. The ends of the trusses are mortared onto the top of the wall and a steel cable spans the width of the building from the base of each truss for relief of the down and out force created by the truss. The effect is of a high arched ceiling with good visibility from the back of the room since the steel cables do not obstruct vision in any way. Then on top of the trusses are fastened wooden rafters running lengthwise to the building and large sheets of corrugated aluminum roofing fastened down to the rafters. This creates a very dry, sturdy roof albeit somewhat noisy when it rains. This roof was put on by Tammie King’s work team from Community Church of Greenwood.

The seating in the church was primitive to say the least. It was basically a lattice of boards and stones thrown together temporarily until the building is finished. I’m sure that finished benches or chairs would disappear unless the church doors and windows were secured. In fact, I rather suspect that the boards were removed after the church service to prevent theft. On each stone block which was left over from the wall construction, a 4”x4” beam ran lengthwise and then crosspieces of 2”x5” rough sawn boards were placed across for seats. On either side of a center aisle there were about 8 rows of seats, each large enough for 8 to 10 people to sit on. As we were among the first to arrive, we took seats at the front just behind the “podium”. The speaker’s podium looked like a hitching post – a flat board on two 4-ft. posts.

As people began to gather, the women and children sat one side of the church, and the men sat behind us. Eventually all available “seating” was taken. I soon began to covet the 2”x8” boards on the opposite side of the aisle. Sitting on a 2”x5” rough board 15” above the ground with no backrest or padding is not conducive to falling asleep during church so I suppose there are some advantages to this arrangement. There is no electricity in the building, so all light along with a nice breeze came in through the large open windows. I only noticed a matatu go by twice during the service.

While we waited for the crowd to come, the only woman present moved to our side of the church with her three small children. She began the singing which would be characterized as antiphonal if I know my musical terms correctly. She would start a verse which would be echoed by the men. Most songs today were in Kipsigis, although I heard a few Swahili songs that were familiar. Familiar words like Jehovah, Hallelujah, and Amen are heard in the songs. Almost all are accompanied by hand clapping or a drum. Her precocious 18-month-old son was the only charismatic in the crowd as he spoke in an unintelligible tongue throughout most of the early part of the service. He was nattily attired in a purple hooded sweater with a tassel on the top, green Bermuda shorts, thigh-high yellow and red argyle socks, and black tennis shoes. During the singing he went to the front of the church, clapped his hands, and marched around. Then he went back and forth from his seat to the rockpile in the front of the church methodically transferring the rocks back to his seat for the remainder of the service.

Soon a slender woman about 30 years of age came to the front of the church and led songs and scriptures. She seemed to be a deaconess. She wore a pink and blue flowered long skirt, a transparent tan blouse over a T-shirt with red lettering, a white cardigan sweater, black shoes with no laces, and an attractive headscarf. [Color coordination is not a big thing here so it's safe to let me go out of the house without Marty's supervision.] In fact, all the women wore headscarves. This is a far cry from the traditional dress worn 70 years ago before the arrival of the missionaries. Then the women wore only leather skirts around the waist and a leather poncho on the top.

Next, the pastor greeted everyone as is customary. I noted that Joel was wearing his Sunday-best shirt. Unfortunately it’s also his Monday-best, Tuesday-best, and any other day of the week shirt. We gave him another shirt before we left in September, but he probably gave it away since he already had a shirt. We were the only guests today so we were highly welcomed and greeted. The Dicksons’ visit was remembered and greetings were to be sent to them through us. After a scripture reading which neatly dovetailed with my planned but unannounced message, it was time for testimonies. A song was begun and someone came to the front and gave a testimony of being saved by God’s grace. This went on for some time with different individuals of all ages coming forward. One twelve-year-old boy came forward and gave a scripture. An older [50-something] woman came up. She was one of the few women in the church who had the detached loop of earlobe dangling two inches beneath the rest of the ear. This custom of ear lobe stretching is dying out among the younger generation and certainly among the church members. Some men come to Tenwek requesting plastic surgery to have the earlobes reattached which is done with modest success.

Then the pastor made some announcements that were translated into English for our benefit. They were planning to send someone to Tenwek Church for training in Sunday school teaching as they were concerned about consistently good teaching for the young people. A report was given about a camp they had sponsored, and then a woman gave a report of a youth meeting that had been held. Each person who came up to give an announcement took time to greet everyone and give a testimony of being saved. “Testifying” and camp meetings seem to be common in the Wesleyan Methodist tradition as far as I have read, and these practices have carried over into the African Gospel Church.

An offering was then collected. The pastor had a zipper pouch briefcase that was held on the hitching post up front. People came up and dropped in their offerings. A 10-lb. bag of potatoes and a small sack of tomatoes and eggs were brought forward, but most of the donations today were cash. Later the food donations were given to us as a gift.

Then our family was introduced and asked to come forward. It was a welcome relief to stand up after over an hour of trying to avoid splinters. I brought greetings from the Dicksons, our family, and Castleview Baptist Church, all of whom were greeted in return. Marty read a scripture and brought greetings. Debbye, Becki, Amy, and Laura then sang a song that was received with appreciation.

Finally it was time for me to speak. The text of my sermon was Ephesians Chapters 1:1 through 2:10. I would speak a sentence in English and the assistant pastor would translate it into Kipsigis. I’m not sure how faithful the translation was. I noted later as I read a passage in English and he read it from the Kipsigis Bible that he was getting lost on occasions and reading from the end of chapter 2 instead of chapter 1. In any event the audience was attentive and responsive. I tried to hurry as I watched the progression of the pained looks on the faces of Marty and the girls as we passed the two-hour mark in the service. I tried to incorporate some of the ideas I had heard used at the funeral last month with the contrast of serving God or serving the Devil. I won’t say it was all fire and brimstone, but the lake of fire did receive more than passing attention. However, the real thrust of the message was the secure position we as believers have in the Lord Jesus Christ and the fact that each of us was created with specific work to do. Ephesians 2:10 For we are God’s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do. (NIV)

We then presented the church with some Bibles donated by a children’s Sunday school class at Castleview, some pictures, and some gospel tracts in Swahili donated by one of the Bible societies in the States. The service was then dismissed after we were thanked, and greetings were once again sent back to our home church. You are all invited to Kenya. And you are all highly welcome!

After shaking hands outside with many of the congregation, we piled into the Land Cruiser with all the pastoral staff and headed up the road about a kilometer for dinner at Pastor Joel’s house. On the way we picked up several children and a wife so we were packed like sardines by the time we got up the road. But it was fun since it was only for 3 minutes. We then headed down a lane between fenced-in pastures and fields. There was no road base here, just ruts where occasional vehicles dare to venture. Over the hills, around corners and rocks, around scrubby trees for at least a kilometer, we finally arrived at Pastor Joel’s house. The skies were quite threatening by now so we knew we’d need the 4-wheel drive before the day was over.

As we walked up to the house, I noticed an older man sitting down in a mud-hole washing himself and his clothes. Apparently this was a bit of a natural spring even on top of the mountain, although there was no stream running out of it. It may have been just a cistern. The old man put on his jacket and came over to greet us. This was Pastor Joel’s father who isn’t a Christian and doesn’t attend church. He has the detached earlobes characteristic of his generation. He greeted us cordially and shared some jokes in Swahili in relation to the size of our family. He has two wives and Joel is the oldest son of the first wife. Both families live on the compound of houses on the top of the hill that looks out on a beautiful panorama of the surrounding farms and hills. Joel has 5 children ranging in age from about 10-18. His brother and sister-in-law live on the family land as well.

We were all escorted into his house that was constructed of mud on a board frame. The roof was corrugated aluminum. The two-room house had a sitting room and a bedroom. Locks were apparent on the doors, and the two small 18-inch square window openings had bars and shutters rather than glass. The floor was of such a hard packed mud that I wasn’t sure at first if it was plastered or even concrete. The interior walls were made from the same mud and were gently sculpted where they joined the floors. No corners or angles for dust bunnies here. Two small tables and an armoire along with some benches completed the living room furniture. All were hand crafted from solid wood. Two crocheted table clothes of orange and green yarn covered the two tables where we were served. The walls were decorated with pages from Newsweek, advertisements for office furniture, and calendars. Strung from a lattice of string that connected the rafters above were pages of used school test booklets with holes cut in the pages and scalloping the borders. The effect was not unpleasant, however, as it concealed the view of the darkened rafters above. There was no electricity on the premises.

As no other women were dining with us, I’m certain that Marty and the girls were afforded special honor by being served with the men. We were first given a basin and some soap to use and water was poured out of a pitcher onto our hands. We went ahead and accepted this hospitality despite having discretely used our antibacterial hand lotion immediately beforehand. Even Rachel offered no protest at washing her hands twice as she might normally have done.

After all the customary welcomes and greetings, we were then served rice, beans, cabbage, and an unidentified chunky-style meat with broth. Probably Cabrerra, but we didn’t ask. The tableware was enamelware of recent vintage and a spoon. Thankfully, all the family ate modest portions without complaint, and I actually enjoyed mine. I’m afraid I’m becoming more and more African with the passage of time. I’ve got all the handshaking down pat. We were then served Chai which most of the girls still dislike. Milk, tea, and a supersaturated amount of sugar is actually very good. We still have yet to be offered Moresik [fermented milk in charcoal]. No disappointment, that.

It then began a downpour which made conversation somewhat difficult. Life in the United States was discussed which is a great curiosity for Kenyans. Differences in government, customs, education, farming, marriage, etc. are all topics I can now expound on. Pictures of Joel’s family were shared, and Marty was prepared with her brag book as well. It was remarkable that the pictures of Joel from 1999 onward were in his familiar shirt. Since it still looks very nice, it must be of an indestructible material unknown in the West! We then had some greetings, testimonies of family members, songs [an encore for our girls was requested], and then we all expressed thanks to our host and hostess with a brief speech. We gave some gifts to the family as we were leaving. Joel asked that we come next door before we left to pray for the newborn niece, Cherono Sharon. [Girl born when the goats were coming home.] We climbed through a split rail fence, artfully dodged some cow-patties, and entered a smaller house next door. Marty trailed behind, and I later learned that she had been practicing doing the splits in the wet mud and grass. It’s hard to take her anywhere!

Our afternoon was shortened by the necessity of the pastors returning to church for a special prayer meeting. So after only six hours of Kenyan culture immersion, we called it a day. We all piled in the car for the now slippery return to the main road. Piece of Cake! After negotiating the road to Masai Mara in this vehicle, I feel like I’m ready for anything! I did give one cow quite a fright, and I gave the Kenyan pastors a laugh at the end of the drive when I told them that I was thinking of applying for a driver’s permit.

Well, the medical students have arrived for the Sunday evening songfest so I’ll close this adventure story. No blood or gore today. I can’t risk losing any of my readership, that is if I still have any. I’m still not convinced that my recent letters are not just circling somewhere in cyberspace. Maybe someday we’ll receive an outside e-mail and confirm my suspicions.

Remember that you, too, have been given specific work to do for God’s Kingdom. Serving Him in Africa with your support,

Paul for the African Jarretts

April 21, 2001

Dear Friends and Family:

I have numbered each prayer letter this term for easy reference. If you notice a “skip” in the sequence, it may be because the formerly reliable mode of e-mail has failed to bring you our latest missive. If that is the case, we would be happy to send you a back copy as that should be easy to do. “Should be” perhaps should be in quotation marks as nothing seems to work easily with our e-mail nowadays. Letter number 11 was forwarded to some people a grand total of seven times. Letter number 12 may or may not have made it out of Africa with two different attempts over the last two weeks. I have never received a response to it except from our local Tenwek family.

Some E-mail Rules

Since the rules seem to be changing, I thought I would review the most recent terms of engagement. We love to hear from you! Please write often. We currently are requested not to send or be sent pictures as they clog up the system so that no mail can get through. If sending a reply to us, please do not send the text back of what we had sent you. One of these prayer letters is about 35 K and a quick response is ten times smaller if it doesn’t contain my writing. It is also much more likely to get through the poor phone lines without disrupting the connection.

Our server in Nairobi has only been keeping the e-mails that you send us for 48 hours. If our Tenwek server fails to make a connection with Nairobi for over 2 days, you will likely receive a notice that your message was undeliverable. It may say something about permanent fatal errors. This does not refer to our health. We are all well. We do not plan on changing our e-mail address or server at this time. [There are currently no other options anyway, but this could change in the future as Internet service is contemplated.] If we change our address at any time, we will send notification. [You might extend us the same courtesy if you wish to remain on our list, as the Internet providers usually don't forward letters when you change addresses.] At least the US Postal Service will still do this much for six months. Our e-mail address remains: jarretts@maf.or.ke

Please don’t send “online” greeting cards. We are not “online” and can’t view a card. If it’s just the thought that counts, then go ahead and send one. When forwarding us a letter or joke from a friend of a friend of a friend, please just “cut and paste” the text, as the “wrapping” attached to each forward takes up much valuable space.

The problem we have here seems to be caused by the static on our phone lines. It’s always been bad, but it now seems worse. Electronic data transmission [faxes and e-mails] is much more sensitive to static than regular voice communication so that the connection is often broken during transmission of a letter. The system won’t send just part of a letter, so the next time it connects it must start over again. An e-mail of 5 to 30 K stands a decent chance, but a picture of 800 K or more doesn’t have a prayer and neither does anything in line behind it. It just keeps plugging away until the whole queue is purged from the server’s system after 48 hours.

Someone is thinking about calling the Kenya phone system about the problem with the lines, but the person in charge of that is also responsible for thinking about repairing the hydroelectric which isn’t working right either. And there are probably other things to think about. Hence we’re still on generator much of the time despite an abundance of water in the river. Well, that’s more than you ever wanted to know about our e-mail, but I had the whole thing in my system, and I couldn’t download just part of it.

Gradual Transformation

Romans 12:1-2 says: Therefore, I urge you, brothers, in view of God’s mercy, to offer your bodies as living sacrifices, holy and pleasing to God– this is your spiritual act of worship. Do not conform any longer to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is– his good, pleasing and perfect will. (NIV)

We are observing many transformations at the hospital and in our own lives as we seek to renew our minds. Our lives don’t seem to resemble so much what they used to be, and perhaps not yet so much as what they will become. Becoming more and more like Jesus Christ would seem to mean that we will appear less and less like what we once were.

It is hard to believe it has been just over a year since I gave up my practice in Indianapolis in order to come to Kenya. That time of my life seems very distant, not just in time, but in the pattern of thinking. As I have come to rely increasingly more on God for our provision and direction each day, more of the self-sufficiency that characterized my earlier life melts away. I very much enjoyed my 27 years of medical practice and had many ministry opportunities during that time, but it now seems that in some respects it was only preparation for the ministry and practice that I now have.

The end of this term in Kenya seems to be rapidly approaching as we will leave here the 24th of June. I wonder what it will be like to be home during the six-month furlough. If it is anything like the three months we were home at the end of 2000, it will be a whirlwind of activity — travel, visiting with friends and family, and planning for our return in January 2002. Plans are still incomplete for a trip to Nigeria for training in fistula repair. The Russ White and Phil Renfroe families also return in June and are no doubt going through similar transition anxieties. Please pray for God’s direction for this time for all three families.

Hospital Changes

Another gradual transformation that is a change for the better has occurred in the Maternity Ward. We formerly observed sudden stillbirths in our high-risk obstetric patients with alarming frequency. This is changing. When I returned in January 2001, I brought back 3 fetal monitors that were donated by St. Vincent’s Hospital in Indianapolis. Our home church, Castleview Baptist, donated the money for transducers and papers to make the units usable.

The arrival of the monitors did not signal immediate change. First, wooden boxes had to be built to house and protect them. Then a nurse had to think to use the monitor that was in the box to check on a baby. The whole concept of electronic fetal monitoring had to be introduced.

Next, there were lectures to be given on high-risk pregnancies. Then there were lectures on how to use and interpret fetal monitors. Finally, it was a matter of personally putting the monitor on an individual patient and teaching anyone who walked by what the monitor was indicating. Gradually the nurses, interns, and other attending doctors began to utilize the monitors without my direction.

We are nearing our goal of recording a monitor strip of each patient on admission to the hospital and are monitoring many outpatients weekly from the Maternal Child Health [MCH] clinics. We have identified several babies “on the brink” in time to intervene and save lives. The high-risk nature of our patients demands this to be a regular and important part of our effort.

The value of having the monitors can be illustrated by a case we had last week. Alice was in labor at term with her fifth pregnancy. She had a cesarean section with her last delivery because of hypertension problems, but this time her blood pressure was normal. Brian Myers, a senior medical student from Memphis, was hovering over her like a mother hen and had the fetal monitor attached. Suddenly the fetal heart rate plummeted and the patient broke out in a cold sweat. There was no visible bleeding or significant increase of pain. I heard my page as I walked up the hill from lunch. When I arrived, the baby’s heart rate had been down to 60 [normal is 120-160] for 5 minutes. Brian thought the baby was not as low in the birth canal as it had been. These findings had to be interpreted as impending uterine rupture. Since both operating rooms were in use, we hurried into our own operating theatre which is not as well-equipped for a quick general anesthesia [putting the patient to sleep]. The second and only choice was a quick spinal block as there wasn’t enough local anesthetic available in the room. We knew this could drop Alice’s blood pressure if she was bleeding internally, but the alternatives included a dead baby. We made the incision a few minutes later and found the baby completely out of the uterus and floating in the abdomen. The lifeline [placenta] was also detached. The nurses and family practice doctor were able to resuscitate the baby. The uterus had split along the side completely away from the old c-section scar, but we were able to repair it instead of doing a risky hysterectomy [removal of the uterus]. What a reward it was to see Alice nursing her baby a few days later! Thank you, St. Vincent’s and Castleview. Thanks also to Jenny Currie, the U.S. Surgical suture representative, who donated a large quantity of suture samples which were put to good use that day.

While we are improving outcomes, the quality and quantity of referrals is increasing. A referral from the local district hospital used to be a long-neglected disaster. Now these referrals are more timely allowing us to intervene in time to save the mother and to save the baby as well. There are still many outlying clinics and hospitals that are not equipped to deal with problems in labor; the long delays in referral to Tenwek have resulted in the formerly observed bad outcomes. For example, just this week we received a young mother who had been pushing for over 12 hours in a futile attempt to deliver her firstborn. It was fairly easy to deliver the baby with the vacuum cup, but the baby was so sick from infection and inhalation of meconium [his own bowel movement] that he died within a day. We’re hopeful that by leaving a catheter in the mother’s bladder for two weeks that her vaginal wall will not slough away from the resultant pressure destruction.

We continue to be limited by the insufficiently equipped newborn nursery to enable the sickest premature babies to survive. This is not a true Neonatal Intensive Care Unit as we do not have the ability to use ventilators to support breathing for the very young. Because of the mothers’ illnesses, we have had to deliver viable babies between 29 – 32 weeks gestation [38 -- 40 is full term] only to have them succumb to their prematurity. In the US, babies born at 27 weeks have a 95% survival rate. These limitations are primarily from equipment and medication, although such a unit requires many highly trained personnel as well.

More AIDS Woes

We now have a rapid diagnostic test available for the determination of HIV status [whether or not someone is infected with the AIDS virus]. Since we are offering a drug to a mother at the time of delivery [Nevaripine] to prevent transmission to the baby, more people are being tested. Consent for testing is more likely to be given here than in the West because there is preventative help available for a baby; there is not as much of a threat perceived from society if one is found to be infected. Someday we may have some statistics to report ourselves, but the incidence of HIV positive women in the Tenwek area is not believed to be as high as in Nairobi and Nakuru [15% and 25%].

Squeamish Avoid this Paragraph – Censored by Marty

Yesterday we operated on Joyce, a 40-year-old mother who reported to the hospital with severe lower abdominal pain. She appeared somewhat wasted and her tongue was coated with a fungus [oral thrush] which is a fairly common characteristic of advanced HIV. She had an abscess draining from the left labia, but the redness, pain, and swelling extended over the pubic area into the abdominal wall. This was an unusual finding as the natural barrier of the groin ligaments limits the spread of a vulvar infection. I had never seen a patient with necrotizing fasciaitis, but this looked like my first encounter with this nasty disease. It is characterized by destruction of the underlying fascia [gristle] layer by aggressive bacteria. Wide exposure and removal of the infected tissue is necessary to prevent the spread of the infection, but the immunity system compromise of a patient with AIDS makes it a tough fight. The visit with the chaplain today will probably be of more benefit than the surgery was yesterday. As always, your prayers would be appreciated.

Squeamish Rejoin Us Here

Another woman has been ill for several months and is 23 weeks pregnant. She is bleeding a little and the ultrasound indicates the placenta previa condition exists. [Where the placenta covers the opening of the womb and causes massive hemorrhage on occasions.] Her HIV test is negative, but we’re unsure as to why she has lost so much weight. She lives many miles from the hospital where there is no transportation or phones. Staying at the hospital is her best chance to survive, but getting the family and patient to accept this option is another matter. It’s beyond the means of most patients to afford long term hospitalization, even at $7.00 a day. Often there are no easy answers to the problems we encounter.

Another mother came in at 19 weeks pregnant and was severely withdrawn. She was mute and unresponsive much of the time. She didn’t respond to treatment for cerebral malaria which she didn’t have — even though that was the most likely bet. She proved to be HIV negative which was our second guess. Her spinal tap was negative ruling out meningitis, our third choice. We are left with severe depression for a diagnosis which appeared much more likely after she tried to strangle herself with her bed linens. Quick intervention from other patients proved once again that there is an advantage to open wards. [Other patients often serve as interpreters, prayer intercessors, and nursing assistants.] The training that I received at Central State Mental Hospital 33 years ago is once again being utilized. Some of the drugs we use here are the same ones I used for patients then. Hopefully, we won’t have to revive my electroshock skills.

We have had three more patients with eclampsia [convulsions from high blood pressure in pregnancy]. Christine, a 24-year-old mother, whose baby died from prematurity, has had a stroke affecting her left side. However, she seems to be making some recovery thankfully. She is a Christian. Cherono, a 16 year old, developed pneumonia after her seizures and her kidneys nearly shut down; but she is now recovering also. We praise God that she has prayed to receive Christ as her savior.

We continue to order blood transfusions at record rates. We’ve still had many patients sick with malaria. Several patients have bled heavily after delivery and after miscarriages. Criminal induced abortions are still being seen. One young woman is in the ICU tonight with kidney failure after her massive hemorrhage. Another just delivered her 30-week baby prematurely after someone had inserted IV tubing into her cervix to induce abortion. It seems I’m on a first name basis with most of the blood bank technicians.

Despite all the challenges, failures, discouragements, and heavy work load, I couldn’t be happier with the work here. Training of the interns and nurses appears to offer long term benefits that will accrue long after our departure. And the changed lives of people who have received Jesus while at the hospital will have far-reaching ripple effects in the future.

Personal Security Issues

One of the young single Kenyan doctors, Emily, was attacked in her home here on the compound. She awakened to find a man in her room with a knife at her throat. He was after money and her car. Fortunately, she had a visitor staying with her in the next room who heard her scream and came to assist her. The intruder, who was obviously a local from his native language, fled into the night with only a little money. It took over an hour for the security guards to round up a “posse” so it was too late to apprehend the perpetrator.

We were thankful that despite her family’s urgings to leave Tenwek, Emily has decided to stay and work in her ministry here. In fact, she senses the Lord’s clear leading to stay in spite of these trials. She has moved up closer to the hospital where there are more people around the compound. She had been living in the lonely “river apartments” where we stayed in 1999 during our one-month visit.

Twice John Mbogo has awakened to someone trying to break into his family’s house; he has been living just up the hill off the compound. The man was shouting and making all kinds of racket in his attempt to get into the house. Apparently the criminals here have not watched enough television to perfect their criminal techniques.

Preaching the Gospel

Tomorrow I will preach at a local church where one of the security guards, Joel, is the regular pastor. Today, God has laid on my heart a sermon message from Ephesians Chapters 1 and 2. I will preach through an interpreter. It is exciting to do things that I’m completely unqualified for by training and natural ability and just let God do the work. To Him be the Glory! Keep praying for all of us including the Tenwek staff!

Serving Jesus with you,

Paul, for all the Jarretts in Kenya

Dear Friends and Family:

Thanks for your prayers and encouragement. We are all well and suffering only from slow e-mail. Lots of interesting cases have been seen at the hospital, but I’ll detail some of those at another time. My father and Marty’s mother are greatly improved the last we heard 5 days ago. The Dicksons have had a wonderful two weeks of ministry with us and are heading home. Please pray for their safe travel. They were a blessing and encouragement to many of the missionary families and national staff.

Okay, So Don’t Have a Cow, Already

The use of medical terminology with non-medical people can cause problems in communication in any language. Recently we had a patient who vividly illustrated this observation. As I was standing at the nurses’ station in the labor room, a patient was wheeled past us into the Delivery Room for emergency admission. The report accompanying her stated that she was having bleeding after a home delivery.

She had begun vomiting on arrival at the hospital but, since no emesis basin had been provided her, she was wearing most of her lunch. She was riding in one of our rickety wheelchairs that has no metal foot rests so it was necessary for her to place her muddy, bare feet on the cloth straps that have been tied in place as a substitute. As we approached from behind, we could see fluid dripping from all points of the wheelchair and a little vapor cloud rising above her. She resembled a broken down vehicle with an overheated radiator.

Prior to transferring her to the table for examination the nurses began to clean her up and make their initial assessments. I asked the nurses to inquire as to whether she had delivered the placenta, as retention of the afterbirth would be a leading cause of bleeding after a delivery. A nurse dutifully translated into the Kipsigis language the question that I had proposed. The patient then looked very puzzled and finally answered something in a quiet manner sending the nurses into gales of laughter. I could not endure not knowing what in the world was so funny, so I asked, “What is going on?”

The nurse then explained that the Kipsigis word for “placenta” is the same as the word for “cow”. So the nurse had asked the patient if she had delivered a cow, and the patient had answered that she had indeed not delivered a cow, but a baby that was in the hallway outside with the grandmother. Eventually, close inspection revealed a laceration to be the cause of the bleeding. This can happen in a normal delivery as well as with an alien birth, but the baby crying outside validated the mother’s assertion.

What’s in a Name

I am very pleased to have John Mbogo here after a long delay in the timing of his arrival. He is the OB-GYN resident who will spend his second year of training at Tenwek before returning to Nairobi for his final year. John is a Senior Medical Officer in his mid 40’s and has been at Tenwek since 1994 after retirement from private practice in Kericho. He has been doing much of the gynecology at Tenwek for many years before returning for formal specialty training. John is from the Luo tribe but has spent some time working with Masai people as well as the local Kipsigis. Each morning we make rounds on all the patients on the OB-GYN service. It is very educational for me to have someone with John’s experience alongside, although I am supposed to be his teacher.

One morning I observed him laughing with a Masai patient. He had asked the mother what her baby’s name was, and she had responded with the Masai word for “girl”. He explained that the Masai don’t name their children at birth, but the hospital requires that a child have a name for the purpose of assigning a registration number. Consequently, the mother usually calls it “boy” or “girl”. Sometimes they display a little more whimsy and give the name of a tree or animal. Some people just will not bend to convention, and the Masai people are certainly unconventional.

The Kipsigis people, however, are so conventional with their naming of their children that it has created chaos in the medical record system. At birth a child is named according to the time of day, whether it is raining, or in relation to other unusual circumstances surrounding the birth. All boys are given a name beginning with “Kip” and girls with “Chep”. A child born at a certain time of night would be named Kipkemoi or Chepkemoi depending if it were a boy or a girl. A boy or girl born when the cows begin to come home between 3 and 5 PM would be Kiprono or Cheprono. A boy might also have a nickname of Kiprob because it was raining when he was born. Many of our c-section babies are Kipchirchir meaning boy born as an emergency. Pretty simple so far.

Children are often given a Christian name as well, so there are many Biblical names such as Ezekial, Elijah, Elizabeth, and Mary. On the other hand, an English name such as Geoffrey, Bernard, Agnes, or Alice may be given. The name situation is then stable until puberty when the child is given his “Arap” or “son of” name. This name is derived from his father’s childhood name by which he is then known for the rest of his life. For example, if his father’s name at birth was Kiplangat and his own name was Charles Kiprono, after circumcision he would be known as Charles Arap Langat. “Arap” is not used except as a formal title. As his siblings come of age they might be named Beatrice Langat, Wesley Langat, etc. However, one child might be given the father’s nickname of Kiprob and be known as Leonard Arap Rob, and he could be Charles Langat’s brother.

We therefore have thousands of people whose last name might be Langat, Koech, Mutai, Bett, or Rono and whose only relationship is that there fathers were born at the same time of day [or they might be brothers]. We often call a patient into the clinic from the waiting room by her name on the registration card and have more than one patient respond. It’s then necessary to decide which patient belongs to the card we have selected. The entire family is registered under the husband’s name or sometimes under the girl’s father’s name.

It was even worse in the old days! At one time, women were not permitted to speak their husband’s name, so the wife would register under a fictitious name to avoid saying her husband’s name. Then when she returned, she couldn’t remember the name she had used; consequently her card couldn’t be found. It is no wonder that often we do not have an old chart when we’re seeing a patient in the clinic. Sometimes when patients are scheduled for surgery, the doctors hide the clinic chart so it will be available when the patient comes in for admission. However, if the patient comes in before that time the chart, of course, can’t be found. It might sound like a system badly in need of computerization; however, the recent power system crashes that we have experienced resulted in the loss of many current charges from patient’s accounts which are computerized. This and the tremendous cost involved have dampened the enthusiasm of the electronic advocates.

Sound the Retreat

Our five days at field retreat were quite enjoyable. This was a gathering of over 70 World Gospel Mission missionaries from Kenya, Burundi, and Uganda along with their youth and children. It was held at the Brackenhurst Center north of Nairobi. This is a lovely facility run by the Southern Baptists. Our family provided care and training for the children ages 13 and under. Each of the girls and Marty took a group of 3 to 6 children and gave age-appropriate instruction consistent with the retreat’s theme of “Restoring your passion for Jesus”. I was given the responsibility of “sergeant at arms” and sometime story reader.

World Gospel Mission is headquartered in Marion, Indiana, but is international in its membership representation. It was originally the outreach of the National Holiness Association but has been known by its present name for many years. WGM originally founded Tenwek Hospital but has long since turned over administration to the national church, the Africa Gospel Church, which it founded. Even though our family has come out with World Medical Mission [Samaritan's Purse], we have been made to feel most welcome and appreciated from our first association with the WGM extended family. We now have friends who are missionaries from such foreign lands as Japan, India, England, and Kentucky.

A special highlight of the retreat was a retirement ceremony for five missionaries each of whom reviewed his call to the mission field. God’s faithfulness in each of their lives over the years was a recurring theme. Likewise encouraging was a video produced by WGM featuring an interview with Bob Smith, a missionary who came out in the 1930’s. He told stories of the early days at Tenwek when he and his wife, Catherine, and their two small children were the lone missionaries with the exception of an occasional nurse.

Bob related the story of a time that Catherine became seriously ill with fever that didn’t respond to the quinine they had for malaria. They sent to Kericho for a mission doctor to come see her. During rainy season, it was nearly impossible to get here over the mud roads. It took over twelve hours for him to arrive; part of the time it was necessary to pull the car with 12 oxen to get it through the mud bogs. [And we complain about a few potholes and speedbumps for the 70-minute drive].

By the time he arrived, it was apparent that Catherine was terminally ill with meningitis. Her neck was stiff and her teeth were clinched so that Bob could only feed her liquids between the gaps in her teeth. She was flat in bed and unable to move. The doctor, who was a close friend, could only offer the grim pronouncement of her hopeless prognosis and bid her goodbye. He had no medicine that would help. He spent the night and left the next day, declaring that she would be dead in another day. Catherine, too, knew that the end was near. All they could do was pray.

It was a Sunday morning back home in Indiana where their good friend, Dr. Tom Hermiz, Sr. was preaching. Suddenly, he got a word from the Lord that he needed to pray for Catherine. He stopped the sermon and announced to the congregation that they needed to pray for Catherine, which they did until they received assurance of an answer to their prayers. Meanwhile back in Kenya, Bob Smith was out in the yard feeding supper to the children. Suddenly, Catherine walked up behind him and offered to take over the feeding duties. He was flabbergasted to see her up and about. He told her she needed to be in bed, but she responded that the Lord had healed her; if he didn’t need her help, she would sit down and write a letter to her mother detailing her recovery which she then proceeded to do. She had actually seen the Lord Jesus in the room with her, and He had passed His hands over her; the fever and stiffness had left immediately.

Letters in those days took 36 days to pass back to the States. Apparently, her letter and Tom Hermiz’s letter of inquiry as to these events from the opposite shore arrived at their destinations the same day. [And we complain when our e-mail is down for 5 days.] But time and distance do not limit God’s Holy Spirit.

I could recount other similar stories of God’s prompting of His people to pray for missionaries who were in danger. I have heard enough to believe without hesitation the validity of the stories. My friend, Dr. Robert Foster, tells a similar story of his grandson’s awakening in the middle of the night in the USA acutely aware of the peril of his grandparents who were in South Africa. His prayers with his mother resulted in Dr. and Mrs. Foster’s miraculous deliverance from an assailant.

Prayer Warriors Working with the King of Kings

Prayer is the most important weapon in the Christian’s armament. If you are ever prompted to pray for us or any other missionary, please take the time to do so. God is as much a God of miracles today as in the time of Christ. He is the same yesterday, today, and tomorrow. And He moves in response to the prayers of His people. I don’t know all the reasons why He has chosen to work in this way, but I know that He has and does. One reason He works in response to our public prayers is so that He may be glorified among men and may draw them to Him.

We are here in Kenya at His direction and for His glory. We see many people being drawn to Him at the hospital and through the work of the churches. Our encouragement to you is to seek Him with all your heart and to find how you are to serve Him. It may not be in Africa or anywhere other than right where you are right now, but there is no doubt that He has work for you to be doing as well as for missionaries on a foreign field in order to further His Kingdom.

If you have never received Jesus as your Lord and Savior, it is really as simple as confessing: that He is Lord; that you are a sinner [All have sinned and fall short of the glory of God] hopelessly helpless in reaching God through your own efforts and works [good things that you do]; repenting of your sin [make a deliberate decision to change]; and asking Jesus to come in to your life and make you the person who He wants you to be. Jesus died on the cross as the perfect substitute sacrifice to pay for and remove the penalty for our sins. In becoming a Christian, there isn’t a promise of an easy life, wealth, or health. There is a promise of intimate fellowship with the Creator of the Universe who made you specifically for this relationship. [He says He will never leave us or forsake us, just as He never left the side of Catherine Smith or Bob Foster] I would encourage you to read the book of John [found near the front of the New Testament] this Easter season. Before you read it, ask God to reveal Himself, the living Word, to you. He will never turn away someone who is coming to Him, no matter what he has done or been in the past. Jesus paid the price for the sins of the whole world and rose victorious from the grave. That’s the hope of eternal life that we celebrate at Easter.

Rejoicing this Easter with you, Paul for all the Jarretts in Kenya