Jarretts Ministry

August 22, 2003

Dear Friends and Family:

There have been dramatic changes occur in the last 24 hours which have completely changed my plans for the fall. Even typing this letter is difficult, as I will explain. I would appreciate your prayers for the days and weeks ahead.

In the twinkling of an eye

Yesterday morning, as I was preparing the car for the long trip to South Carolina, I had an accident that suddenly changed everything. I caught the middle finger of my left hand in the moving fan belt of the engine. In less than a second the last inch of the finger was suddenly dangling by a narrow flap of skin and subcutaneous tissue.

I said a quick prayer, shut off the engine, and went inside to find help. Alicia was up and about, but Laura and Rachel were still asleep. Everyone else was gone. I held the base of the finger tightly to stop the bleeding and Alicia found some bandages to wrap around it. I decided to call the Hand Center rather than going to the Emergency Room, since I knew a hand surgeon would be required to reattach things if it were possible to save the end of the finger. They were just opening for the morning, so they told me to come on in.

Alicia awakened Laura and Rachel, and we prayed together as we do before any journey or with any bad news. Alicia drove me down to the Hand Center where one of the doctors in training was to make the initial assessment. I told Alicia to go on to work, as I knew it would take all morning to deal with this mess.

The young doctor was just starting his hand fellowship, but he had just finished an orthopedic surgery residency. He looked at the finger, tested it for sensation [there was very little feeling in the tip] and put a digital block in [a local anesthetic for just the injured finger]. He remarked that the color was good and even though it appeared that both arteries were severed, blood flow was still getting through the attachment of tissue. The wound was dirty with grease, but he was hopeful of saving it. They prepared an operating room and only a minor delay was encountered in getting approval from the insurance company.

As we began preparation for surgery, I asked if we might pray before we began like we do at Tenwek. The team willingly agreed. [What choice did they have?] I prayed for God’s guidance for the surgeons and nurses and thanked Him for His presence with us. One of our former patients was a nurse who was assigned to start an IV for antibiotics. She was kind and remarked on the reversal of our roles in each other’s lives. She said that I had helped her through some crisis times in the past. I didn’t remember any details, but I was thankful for God’s sending of her for comfort and encouragement.

The surgery took about 90 minutes, I think; I didn’t bring my watch. The surgeon found both ends of the nerve and reattached it. He is doubtful that complete sensation will return because of my age. One of the more crass surgeons passed through the OR as they were working and remarked “What kind of a bomb went off in that hand?” I recognized his voice from working with him in the past, as one of the nurses shut him off by saying, “This is Dr. Paul Jarrett.” He then came around the drape shield and greeted me.

The surgeons reattached the finger by drilling a K-wire through the tip of the finger into the bone, through the joint, and into the next bone to anchor it. This will keep it immobilized for the next six to eight weeks. They then repaired the skin and the nail bed. The doctor indicated that the nail will grow out abnormally at first, but may eventually be normal [after six months]. He indicated the tendon on one side wasn’t cut where there was a separate laceration, but it was exposed and needs to be watched for an infection that could leave the whole finger stiff.

My prayer is that no infection will occur and that the finger will be functional in the future. Obviously, this is a significant injury for a surgeon, as I tie knots with this finger and do lots of other things with it as I am being reminded moment by moment [Like hitting the “e” key on the keyboard].

I will not be able to go to South Carolina with the family. I’m supposed to have a dressing change in four days and watch for any complications. Susanna will be staying at home this week anyway, but I’m encouraging the others to enjoy the vacation without me.

I doubt that I will be able to go to Ukraine as scheduled on September 2nd. I will wait until I’ve seen the doctor to say for sure, but the sutures are to be removed that day. Maybe I’ll be able to go a little later; only God knows for sure. I wouldn’t be operating there, but the little wire protruding out the end of the finger may prove too limiting.

I can’t plan on going to Tenwek or covering another doctor’s practice for the month of November. I’m hopeful that it will be clear enough that I can return to Kenya in January.

The only things that are certain are that God loves me, has been present with me, and will guide us for the future. Already, questions have been answered, but not in a way that I would have chosen.

News from Tenwek

I haven’t been able to get any report of news of our orphans and the new orphanage as my e-mails go unanswered to Tenwek. I will give you an update through the words of fellow missionary Russ White written August 20, 2003.

The surgical schedule continues at a hectic pace. Over recent months, we have adjusted our operating room staff schedules to allow us to have more available hours each day to working the operating rooms. We have certainly more than filled up the additional hours!

Last month I operated on two children on the same day with nearly identical tumors. Both children had Wilm’s tumors, which is a childhood cancer of the kidney. The tumors were nearly identical in weight (about 3 ½ pounds). However, in the younger child who was 10 months old, this constituted 25% of his body weight. The older child was 8 years old, and so the tumor was relatively smaller. Our anesthetists were afraid to put the younger child to sleep, since his breathing was so severely affected by this large mass in the abdomen. However, both cases went well, and we were able to get these large tumors out without major complications. The younger child’s breathing was markedly improved immediately post-op. The older child was out of bed and playing within several days. He was thrilled that he could once again run and play without the difficulty caused him by the tumor growing inside. In both cases, addition of chemotherapy post-operatively will significantly improve the chance for long-term survival. We find that if we refer these children to the national hospitals in Nairobi for follow-up care, they usually do not get the appropriate treatment. One of our regular visiting doctors at Tenwek has been able to arrange to get the drugs needed for chemotherapy sent to us, and so this month we will begin a six-month course of chemotherapy for each child. We have never undertaken this level of advanced chemotherapy here at Tenwek. Pray that all will go well, and that these two little boys will have a chance at a long life! [These are the children I referred to in our last letter – Paul.]

Another of the many unusual cases I have seen recently involved Henry Arap Serem. He is a 50-year-old man who came in last month with a terrible infection involving his face and head. When I first saw him, I thought for sure that he must have some type of cancer which was destroying the side of the his face. There was a great deal of tissue destruction on the right side of his face, extending into his scalp and behind his right ear. The smell was something to experience! In fact, one of our career missionary doctors who was working in the outpatient department that day found the experience of examining Henry to be downright nauseating! I assumed that we would not be able to do anything for Henry in a curative fashion, but obviously had to try to do something to clean up the situation. I had to admit Henry to one of our private rooms, simply because the smell was too bad to be admitted to the general ward. In attempting to describe Henry’s condition to each other, our hospital staff referred to him as “the man with the stinky head!” This was eventually shortened to “the stinky man”.

I took Henry to surgery and found that there was, in fact, no cancer present. Rather, Henry had a profound infection of all the skin and soft tissues of the right side of his face and head. All the tissue down to the bone was badly infected, and much of it was dead. This is akin to what some have described as an infection with “flesh-eating bacteria”. I had to remove most of the soft tissue from his scalp and face. The infection was extending all the way to the midline of the back of his head, and was into the eyelids and extending to the bridge of his nose in the front. The third time I took him to the operating room (after about 3 days) for further cleaning and removal of dead tissue I discovered that the infection was now extending nearly all the way around his head. Further, it had extended deep into the neck and chest, involving all the muscles around the spine to a level about ½ of the way down his back. I had asked a visiting ear, nose, and throat doctor to assist me in this operation. He was as amazed as I was at the extent of the infection. It became apparent to both of us that the only way to cure Henry would be to amputate from about the level of the mid-chest on up!! Obviously, this was not an option! So, for the first time in my life when dealing with a soft-tissue infection, I decided that Henry could not be cured. The smell was still pretty bad, so I put him back in the private room and asked the nurses to change dressings daily in an attempt to keep him clean and to give him enough morphine to prevent serious pain. I talked to Henry myself, and also had the chaplains talk to him to explain that his condition was beyond cure, and that the infection would continue—he would likely become comatose within the next several days. Henry asked Jesus into his life and seemed to understand that there was nothing more we could do.

I was away from Tenwek for the next several days, so that I did not see Henry. When making rounds upon my return, I asked if Henry had passed away yet. The nurse smiled and said, “Henry is doing much better—in fact the stinky man is no longer stinky!” I really couldn’t believe it, and had to see for myself. When I walked into the room, I could tell that the nurse was telling me the truth. The infection seemed to have been arrested and was much improved, and the terrible smell was gone! Henry was sitting in bed smiling at me telling me that Jesus was healing him. It has taken several more operations to clean away all the dead tissue, but the infection was completely stopped. Several weeks ago, we did skin grafting and plastic surgical flaps to cover most of the defects in his face and scalp and Henry looks quite presentable! He will be going home soon to tell his village that God healed him when the doctors said he could not be healed! With our staff, I thank God that “the stinky man is no longer stinky!” His face looks much better than when he arrived, but more importantly, his heart has been made clean by our Lord!

RESEARCH

I am continuing in the research work into the very common problem of esophageal cancer. We continue to have referrals from all around Kenya and neighboring countries. Currently, I see 2-3 new cases every day. I finally have received clearance from the Kenyan government to begin a new research project comparing several different treatment plans in managing this disease. We are also continuing in our village screening program, in which we try to find these cancers at a very early stage when there is a meaningful chance of cure. Through our work, we have discovered that at least 2% of the general population of adults has a pre-cancerous growth present in their esophagus. We are continuing to try to have an impact on this very serious, common problem

NEW CHURCH GROWTH

Many of you prayed for me in June when I was speaking at the opening of a brand new church in a very difficult area near Tenwek. This area is called Raiya, and is the most common local place for brewing of illegal alcohol, prostitution, and crime. We set up a small tarp under which to speak. The people sat in the grass under trees and we had our first service. I had brought also a generator and sound equipment. We led people in music and shared the word of God. I spoke that morning on a comparison of cancer and sin. Many of the people are aware of my work with esophageal cancer research, and I found many appropriate analogies with sin. The service went well, and at the conclusion, many people came forward to kneel on the bare ground and pray. I discovered that these were Christians from a number of surrounding communities who had come to pray for this village. The first Sunday, there were 45 adults, and 42 children in attendance. The next Sunday, 60 adults and 55 children were there. Among the adults were six people who asked to speak during the service. They told that the previous Sunday they had been too drunk to attend the service. However, each of them had heard the message preached while lying drunk in their homes, and they had each asked Christ to forgive their sins and give them a new life. One of the men even had with him notes he had written on the previous Sunday’s sermon! Apparently he had felt he was too drunk to walk to the meeting area, but not too drunk to take notes on the sermon! This small gathering of believers has continued to grow each week, and they are now in the process of arranging to construct a roof under which to meet. They will simply put up rough timber posts and tin sheets for a roof so that the can sit out of the sun or rain. Continue to pray for the growing church in Raiya!

NEW SURGICAL BUILDING

We have nearly finished clearing the site for the construction of our new surgical building. We are waiting for final blueprints from the USA to begin the actual construction. We have an American builder here to help supervise the project. Ken and Joanne Duval arrived from Rhode Island at the very end of July. They are settled in and Ken is involved with preparing to build—we expect a groundbreaking within two weeks! We almost had to evacuate Joanne Duval shortly after arrival. She became quite ill within a week of arrival here at Tenwek. It turned out that she had been having frequent attacks of abdominal pain for several years while in the USA. However, soon after her arrival here, these attacks became continuous abdominal pain. We found that she was having an attack of full-blown pancreatitis due to a gallstone lodged in her pancreatic duct. This can be a very severe condition. In the USA, she would have undergone an emergency procedure called ERCP (endoscopic retrograde cholangeopancreatography—better to just call it ERCP!). This procedure is not done in Kenya. We had to decide whether to a) try to fly her out, b) do the procedure via open surgery, or c) attempt to do our own ERCP here with the limited tools we had. We decided on option c, and so we proceeded to do the very first ERCP and endoscopic sphincterotomy (opening of the pancreatic duct to remove the stones) performed in Kenya. I really do thank God that all went well and we were able to open the duct and remove the stones. Joanne is doing much better, and the pain has not recurred. Pray for the Duvals. Pray for Ken as he supervises our building project, and for Joanne that she would have continued good health!

Concluding Remarks

My scripture reading yesterday morning before I tried to amputate my finger was Job chapters 1-4. Already I had felt a little like Job. The house has been infested with fleas. One of our furnaces gave up the ghost and must be replaced at a large expense. The situation with employment was already mentioned. Even the cancellation of the Ukraine trip will result in a personal loss of money, since there is a fee associated with any ticket change. Oddly, I had called last week to the company recommended by Samaritan’s Purse for travel insurance and they failed to send me an application as they had promised. That insurance would have covered the loss had they done as their standard procedure would have dictated. The hospital lost my application; the malpractice carrier lost my application. My new computer suddenly quit working; I think the AC power adapter failed. Weird stuff!

But then, we’re used to weird things happening when we’re involved with ministry. There is always spiritual warfare going on around us. That’s why we are so eager to have your prayers. It’s the only weapon that we have besides the word of God to fight the unseen enemy.

Please pray for safety tonight as Peter Burke drives with Amy, Laura, Rachel, Alicia, and Stephanie Rawlins the 800 miles to South Carolina to join Marty, Debbye, Becki, and Beth. Also pray for their return trip next Saturday.

Well, I guess I’ll cut this letter short as well since I’m in that mode. Thanks so much for your prayers.

Resting in the love of Jesus,

Paul, the Jarrett left home in Indiana

August 12, 2003

Dear Friends and Family:

My late summer schedule is now formulated, and I wanted to let you know of the latest travel plans. We have been busy with house projects, visits to family, and some vacation activities.

Ukraine Trip

I will visit Ukraine on September 2 through the 17th. Once again I will be spending time at the Women’s Center where we minister to women in crisis pregnancies, crippled children, and orphans. There are other evangelistic outreaches associated with the center’s activities; I anticipate it will be a busy time. I have not worked in hospitals in past visits to Ukraine, although I’ve visited several. I will be making further assessment of the ministry there for future sending of other doctors through World Medical Mission.

I am not going with a group this year, although I will travel with Hubert and Sarah Harriman who are visiting another ministry in Kiev; Hubert is president of World Gospel Mission. It’s nice to travel with others when ministering in a foreign land. Please pray for our travel safety on those dates. Customs inspection on arrival is also an area where prayer is appreciated.

No Medical Work in the US

So far everything has fallen through in my attempt to do any medical practice while on home assignment. It may be that God is just closing doors on working here for the present time. If it were only one door that closed, it would be less clear but many doors seem closed. Perhaps the answer is “wait” rather than “no”, but there are no “yes” answers at this time.

The major issue seems to be malpractice insurance. A doctor can’t practice in a hospital without it, and the companies who write insurance aren’t particularly interested in limited part-time policies. A part-time, year-round policy is available at 6/7 of the cost of full time coverage. Since OBGYN doctors pay the highest premium of all doctors, this is prohibitive. For the uninitiated, while Indiana has one of the lowest rates in the nation, the premium is still > $33,000 per year. Chicago obstetricians are being asked to pay $170,000 for this next year. There are many areas in this country without doctors practicing in some specialties simply due to liability issues.

Although I have written the company requesting coverage for two weeks here and two weeks there for covering another doctor’s practice, I haven’t been able to get an answer since the company “lost” my file. It took three weeks to find out that I need to file a new application. A hospital also “lost” my request for privileges and asked me to re-file. Even teaching residents in the St. Vincent clinic seems impossible at present. The door is wide open, however, for me to return to teaching at the local public schools this fall. That may be what I’ll be doing with available days.

So far the days that are available seem few and far between. I’ve been visiting my father and taking him to medical appointments. I’ve been painting and refinishing the front and back porches – there are still many days of work left to go on these projects. At the end of August, we will take a vacation to South Carolina to catch the end of daughter Beth’s baseball season in Savannah; and we’ll visit the beach at Hilton Head where we have held a lot of family get togethers in the past.

Amy, Laura, Rachel, and I went to Maranatha Bible and Missionary Conference in Muskegon, Michigan at the end of July. We were able to see lots of old friends as well as enjoy a week of challenging messages from Erwin Lutzer and Dr. Bob Foster; the latter played a large role in our decision to become missionaries. And we spent a lot of time with 7 of our grandchildren who also went for the week.

Marty has spent a lot of time going through her mother’s personal effects. Her mother died last May; our leaving for Kenya a few months later delayed the sorting process until now. She is greatly enjoying the time with her children and grandchildren.

This past weekend we went to Lexington, KY to see Beth’s team play on Sunday night. We also got to visit with Dr. Carol Spears for a short time. She is doing well and God continues to minister to her. She will tape a national radio interview for Moody Radio to be broadcast one evening in late August. If I get a head’s up on the time, I’ll try to send it out to you. Please be praying for her during this time.

We participated in our home church’s missions emphasis week in July. I lectured at the University of West Virginia at the beginning of July. We will attend Prescription for Renewal in early October. There is a medical missions conference in Louisville in early November if I’m available to attend. We’ll participate as cooks in our church’s youth retreat in Kentucky in late October. So there are many opportunities to promote missions while I’m not participating directly.

Dr. Russ White recently operated on two children with a Wilm’s tumor. These tumors are fairly common malignant tumors of early childhood and are even curable with surgery and chemotherapy. The only problem in Kenya, of course, is the lack of follow-up treatment with either radiation or chemotherapy after surgery. He requested that we try to find some of this expensive medicine to send back for these children; their ages are one and four respectively. Please pray for these children.

St. Vincent Hospital has generously donated the medication. Dr. Hal Vick, OBGYN, has agreed to serve as a courier for me to take the medicines [which need to be kept refrigerated] with him when he leaves on Friday, August 15. Please pray that he will have no difficulty with travel and that his month at Tenwek will go well.

I’ve also been rounding up suture and other medical supplies to take back to Kenya with me in January. Tracking down and rounding up these medications and supplies is a time-consuming activity, so perhaps it’s best if I’m not involved with medical practice. Whatever the Lord has for me, I’m content with it. I have had peace about not having a “real job”.

We appreciate your prayers as we continue serving God with you during our “home assignment.” We hope to send a check to Tenwek for the orphans’ school fund to cover September tuition in the next few weeks. I will repeat the address for this fund at the bottom of the letter. At the present time it appears that our return to Tenwek will be in January.

There is one other exciting “bit of news” in our family. Our daughter Becki has recently become engaged to Peter Burke of Indianapolis. They both have more education ahead of them, but they are currently thinking about a December 2004 wedding. I am watching Father of the Bride 1 and 2 in preparation for the event.

Serving Jesus with you,

Paul for the Jarretts in Indiana

AGC Tenwek Area Education Fund [sending orphans to school] contributions: Checks payable to and send to: Christian Foundation of Indiana, 8445 Keystone Crossing Blvd, Suite 200, Indianapolis, IN 46240. Indicate for Tenwek on a separate piece of paper.