Jarretts Ministry

Jarrett’s Prayer Letter
Volume 5, Number 8
March 28, 2004

Dear Friends and Family;
Thanks again for your prayers. We are doing well and continuing to spend a lot of time and energy working on the materials for the WGM retreat next weekend. I’ve used up a bottle of ink refill for the printer\copier for all the materials that Marty and the girls have put together. And Gretchen Dickson has been busy with the sewing machine getting some crafts put together.

Thanks for your prayers for Julie Six, our pregnant missionary who was due next week. We are happy to report that she has safely delivered her little girl, Haven Acacia, who was born on Thursday at Tenwek Hospital. I had been “on call” for the past several weeks, as we anticipated an early delivery. The timing worked out well with missionary nurses available this week to do private duty care, whereas next week would have found them all in Nairobi for the retreat. And I was available despite having three major surgeries and two minors that day. We utilized the private room on the maternity ward for the delivery, which worked out very well. Of course, it was more expensive than a regular room, and the total hospital bill for Julie’s labor and delivery was $38.00; fortunately, they had 80% insurance coverage which reduced the out of pocket cost to $7.50. Naturally, that didn’t include the birth certificate which was an additional 50 Shillings [$0.67]. By comparison, Julie’s sister-in-law recently had a hospital bill of $12,000 for a normal delivery in an Indianapolis hospital. Perhaps we should offer a package deal for Americans to come here for delivery.

With the Dicksons here for two weeks, we have tried to do some orphan visitation. After our visit to Umoja, we visited Alice’s orphanage near Bomet. We have mentioned in the past that one of our staff, who is a clerk in the business office, is supporting 15 orphans in addition to her three children. She is also expecting a child in June. We had never visited the facility before, although we’ve had some of the children in our home. We rode with Alice in our vehicle out to the Bomet Airstrip which is next to the orphanage.

The airstrip serves small aircraft usually from Missionary Aviation Fellowship [MAF] which brings some of the visitors to Tenwek. I had only been out there once before to greet some visitors a few years ago. The road to the airstrip has deteriorated quite a bit, and to reach Alice’s house, we opened a gate and drove down the runway about 2\3 of the way where the house adjoining the runway was separated only by a barbed wire fence. Cows and goats roamed the runway; they double as the grounds crew by keeping the grass from growing up too high. However, they don’t repair the chuckholes on the runway, which are getting too big for the smaller planes to land.

We greeted the 7 orphans who were there that day. The others are in boarding school, but will return this week when school is dismissed for a month. She has constructed a “strip motel” of rooms and a separate cooking shed. A garden has been plowed up and awaits planting. While Alice lives and works at the hospital, two of her single sisters are staying with the children. One has a child herself, and the other one is recovering from some mental illness which caused her to lose her job at a local health center. She isn’t violent but seems quiet and withdrawn. The sister, Joanna, greeted us, but didn’t make much conversation. She did shoo the cows out who followed us into the compound when we neglected to close the gate. She seems to be doing pretty well considering that a few months ago she was found lying in a river under a bridge after being missing for several days.

We sized up the children for clothes and played soccer with them. After our visit, we prayed for the children and promised to return soon. As it turns out, we were able to go out a day later along with Betty Feltner and our girls who didn’t make the first trip. We took soccer balls for the local schools where the orphans attend. We also met the assistant chief of the district who was paying a courtesy call. He had high praise for Alice’s work with the orphans. He arranged to take a ball to the school near the airport the following day and sent us pictures of the children receiving the ball. The children and school teachers are always very appreciative; the balls are given in the name of Jesus. We will take the children some clothes later today.

We also made a trip on foot from the Tenwek area to visit a family where 8 children were being raised by grandparents and the older siblings according to the report given to David Kilel. Alicia, Gretchen, Joanna, and Olivia went with David and me. This was a pretty easy walk about a mile along one of the dirt roads until we got to the house where we had to climb a fence to get into the yard. We were greeted by two young men about 20 years old and a girl about 19 with a 1-year-old child. These were two of the older siblings and a male cousin. Soon three girls appeared about 7-10 years old. Three other children are in the upper grades of primary school and weren’t there this afternoon. We were asked to sit on some benches inside the traditional mud home. Apparently they had just coated the floor with a fresh layer of cow manure because the aroma hadn’t dissipated yet. Soon we were joined by two elderly men [above 70] and an older woman. I recognized her as Elizabeth, our “vegetable lady”.

I hadn’t seen Elizabeth for a week or more; they explained that she had been sick. The older men were her husband and his brother who lives nearby. They explained how the daughter-in-law had died 7 years ago and finally the son died two years ago. Elizabeth sells vegetables around the Tenwek compound to try to support the family. She normally comes to our house every day with pineapples, tomatoes, potatoes, carrots, and other things that she can grow. Actually, the pineapples are grown nearer to Lake Victoria, but a truck brings them into our area. She buys some and then resells them for a few shillings profit. A pineapple costs 35 Shillings or about $0.45. Now is a lean time for crops as the gardens are just beginning to produce. Most of the maize is not ready. We weren’t offered any chai [tea] during our visit which lead me to believe that they didn’t have any right now. They thanked us profusely for our visit. The men said that we are the first white people who have ever entered their home. We will send some clothing for the children this week. I gave them about 200 Shillings for some food.

Pastor Kilel shared that a new orphanage is being started not far from Umoja orphanage. This time the land will be owned by the church from the beginning of the project. The church choir has purchased the land and has seen the vision for supporting needy children. We look forward to working with this group as things develop. So, even if Umoja doesn’t work out for our expanded participation, perhaps it will live true to its name of Umoja [number one] if the model can be copied elsewhere.

We continue to see many challenging patients at the hospital. This week we had several more mothers with malaria who were quite sick. There seems to be somewhat of an epidemic of this awful disease again. Some of the mothers had already delivered and came in very anemic. Mothers are susceptible to the disease for about six weeks after birth until their immune system recovers. At one point, the hospital blood bank refrigerator was down to only 3 pints of blood remaining. These very sick patients are a big drain on our resources particularly if their relatives don’t come to donate blood. We send the survivors home with instruction to purchase a mosquito net on their way home.

One woman came in who was coughing quite a bit and was also anemic. She was found to be HIV positive which makes her susceptible to many other diseases as well. The intern’s initial diagnosis was pneumonia, but she didn’t really look acutely ill like someone with pneumonia is likely to be. And she didn’t improve with the usual pneumonia treatment. We went back and reviewed the admission chest x-ray and found that it looked very much like tuberculosis. The patient had been collecting sputum specimens for us, as that is the only way to make the diagnosis with certainty. We placed her in an isolation room, although she’d already been in a six-bed room for several days. Sure enough, the laboratory reported that she had the tuberculosis germ in the first specimen she submitted. She was begun immediately on the appropriate treatment which is a combination of three drugs. The government of Kenya supplies these drugs at no cost to the patient which is indeed fortunate. Patients must take the drugs for an entire year to be cured. The newborn baby also needs to be on one drug because of his exposure.

Tuberculosis is still a major killer worldwide despite available drugs. The AIDS epidemic has contributed to this by lowering a patient’s resistance to the TB infection that lays dormant in the body of the person due to earlier exposure. As the immune system fails, the TB activates and becomes contagious to others. Fortunately, it’s not as contagious as the common cold, but it commonly spreads to others in the family and sometimes to health care workers. Treatment programs help to cure those who are diagnosed, but many others go untreated for long periods of time.

This patient and now her husband also will need treatment for HIV. He was also newly diagnosed as HIV positive after his wife was found to have the virus. Much has been in the news about cheaper antiretroviral drugs [ARV] being made available in Africa. There are several organizations helping with these distribution and surveillance programs. Walter Reed Hospital is sponsoring one program in which we are participating. This will provide drugs at reduced cost, but it still beyond the reach of many Kenyans. Samaritan’s Purse is making the drug available at no cost to mothers in the first year after birth, although I don’t know full details of this program. When the patient and her husband return next month to the TB clinic for follow-up, they will meet with the ARV team to begin this program which can greatly extend the live of an AIDS patient or an HIV + patient whose immune system has deteriorated but not to the extent to be classified as AIDS. AIDS is the end-stage of the spectrum of disease caused by infection with the HIV virus.

We had another woman come in with Sheehan’s syndrome, which is death of the pituitary gland following a hemorrhage at delivery. All three patients we have seen in the past year have been Maasai women who came in with the strange collection of systems from total endocrine gland failure. Like the others, our current patient had general weakness with progressive confusion. She had sought treatment elsewhere, but finally was brought to Tenwek Hospital. The intern saw her and began blood transfusions, but missed the diagnosis until a serum sodium level came back at 104. This should be 140, but the absence of the adrenal gland hormone makes the body lose the sodium that normally would be conserved. The adrenal gland is fine, but it doesn’t function without instruction from the pituitary [master] gland. A sodium level this low isn’t compatible with continued life.

When I reviewed the patient, I found that she had produced no milk, which is also dependant on the pituitary gland. The nurses noted that the elderly grandmother was nursing the baby and feeding with a cup as well. All the staff had difficulty talking with the patient and her family as they were speaking only Maasai language without understanding of English or Swahili. The patient was nearly unconscious when I saw her on Friday morning. I consulted with the medicine team and we began a somewhat heroic resuscitation effort with massive amounts of IV fluids containing sodium, intravenous hydrocortisone, and a central IV line to start a dopamine drip in order to restore blood pressure. Her response was fairly dramatic as she woke up and was able to communicate again. I asked the chaplain Helen Tangus if there was a Maasai speaker around. She informed me that one of the interns, Rezon, is a Maasai.

Rezon is the only intern that I haven’t really worked with yet. She has been on Medicine and Pediatrics, but not OB. She broke her ankle and missed several weeks at the start of her surgery rotation. Now she is hobbling around on crutches on the ward, but hasn’t been able to get back into surgery. I asked her if she would share the gospel with this patient while there was a window of communication time. Rezon hadn’t had this opportunity in the past, but she found out that the patient and her grandmother were both Christians. She shared with them how sick the patient was, and the patient reported to her that she was at peace as she faced death. Rezon then prayed with her, which was her first time to pray with someone else in Maasai. I’m not sure when Rezon became a Christian, but she has been in school settings where she would be speaking mainly English and Swahili for about 10 years. The patient soon slipped back into her coma and died the same evening. I was thankful for the opportunity that we had to confirm the patient’s salvation and for the growth experience for Rezon.

We admitted yet another patient with choriocarcinoma this week. Winny had been to a Kericho hospital with heavy bleeding for two months following a miscarriage. They had transfused her with multiple units of blood but a gynecologist wasn’t available to make the diagnosis. Finally, the patient had requested transfer to Tenwek. The doctors had felt that this was a case of advanced cervical cancer, but the positive pregnancy test and the large tumor growing out of the vagina was typical for choriocarcinoma. I started Winny on Methotrexate, the chemotherapy agent of choice, and it was interesting to watch the tumor begin to turn dark as it was dying during the course of the week. Despite the rather grim appearance of the tumor, Winny actually has a chance to make it if she continues treatment.

Both Gladys and Kirangare returned this week for treatment. Gladys had a level of about 9,300 on her quantitative HCG last week. This tells me that she’ll need therapy for a while longer; we’ll check it again in two weeks to see that she is responding, and, if it isn’t lower, start another agent. Eventually the level has to go to zero. I’m hopeful that the hospital can continue to find the drug from the supplier. They normally only order 200 tablets at a time, and we’re using 150 tablets every two weeks for these three patients. And the supplier doesn’t keep large quantities in stock either, since there is quite a bit of expense involved. Would you please pray for an uninterrupted supply of this life-saving medicine?

There is a long term need for mission hospitals that I would like for you to pray about. In discussion with a doctor from Kijabe Hospital and our own doctors, we noted that the future in sustaining high quality medical care for the poor will be with national specialists in each of the four major disciplines [OB, Surgery, Medicine, and Pediatrics]. The hospitals don’t have the funds out of current revenue for either capital projects or for hiring this level of specialists. From the earlier discussion of the revenue generated from a normal delivery, I think that you can see that it is hard to sustain the 500 employees here with patient revenues, let alone expand the quality of the staff. Perhaps the answer is an endowment fund that would pay salaries for the specialist staff. It seems that some help from the “outside” will always be needed.

This week was the first conference to be held in the new Community Health Training Center, which was officially opened three weeks ago. Our girls and the Dicksons provided worship music for the opening session for the Christian Blind Mission organization’s retreat. Marty led a devotional for them as well. Betty Feltner has made a wonderful contribution to this facility in training the staff in hotel management from the ground up. Betty had heard God’s call last year to come to Tenwek. She thought that she would be working with orphans, but God wanted her to work in Community Health. Despite the lack of background in this field, God utilized her skills as a “people trainer” to organize many facets of the Community Health ministry, including this new training center. So, if God is prompting you to serve Him somewhere out of your comfort zone in some ministry, just say “yes”.

We’ve had several inquiries into donations for the Education fund in the past two weeks for which we’re thankful. Please continue to pray that God will raise up the funds for this project. Information about the project is on the website, so I won’t repeat it in this letter.

Please pray for the WGM field retreat beginning on Friday of this week. Marty, Alicia, Betty, and the girls will be running the children’s program. We will be there until Tuesday, and perhaps Alicia and Betty will need to stay longer to renew their visas. Marty and another girl may stay in Nairobi with them until Thursday to get this accomplished. We’re hopeful that they won’t need to stay the extra time. Please pray for the Dicksons as they leave on Wednesday the 31st. They will spend 2 weeks vacationing in England on the way back home. Please pray for safe travel for all the missionaries for the retreat and for the hospital ministry in their absence.

Please pray for the work of the new church in the Raiya section of Bomet. The church was begun last June with the evangelistic service with Dr. Russ White. You may remember the story of how people were converted at the initial service while they were lying drunk in their homes listening to the service over the loudspeakers. Many of the people in this area are continually drunk, getting sober only long enough to find something else to drink. The church has been growing steadily with many new converts despite its location in an illegal alcohol brewing area that supplies “moonshine” to a wide area of Kenya. New converts are threatened and abused by the recalcitrant population. They are now raising funds for a permanent building.

Our suitcase has never appeared that was lost in the Chicago airport when the Dicksons came. It was supposed to be sent here last Sunday, but as of Thursday, there was no trace of it at Nairobi. Would you please pray that the suitcase will be delivered to us soon?

Thanks so much for your prayers on our behalf. We know that without prayer, we will accomplish very little, if anything. The amount of work that is needed here is immense, but our God is bigger.

If you have a break between games of March madness, drop us a note.
Serving Jesus with you,

Paul for the Jarretts at Tenwek

Jarrett’s Prayer Letter
Volume 5, Number 7
March 18, 2004

Dear Friends and Family:

Thanks for your prayers for our family and guests. Gretchen and Joanna Dickson arrived yesterday without major difficulty. They brought our remaining suitcases save for one bag that is lagging behind somewhere between Indianapolis and Nairobi. We turned in the claim and anticipate that it will appear one day soon. It contains primarily clothing for orphans.

We are now getting rain most days, and we have had hydroelectric power for 24 hours a day for the past week. The generators are sitting idle, and we appreciate the peace and quiet. Our generator worked very well, and we anticipate that it will be a blessing in the future as well.

The work at the hospital has been busy. I have been blessed to have an OBGYN resident, Dr. Brian Myers, with me for the past month. I’ll be very sorry to see him go this weekend. We are praying that he and his wife, Jane, will be able to return as long term missionaries after completion of his residency in 2005. The workload with two staff level doctors has been much more reasonable, although someone’s principle would state that the work will expand to fill the available time. It would be nice to do more preventative care than is currently possible.

The matatu crisis would seem to be waning judging from the size of our clinics the past two weeks, although many people are still experiencing hardship throughout the country. Two patients that I operated on last night were delayed very long in getting here during labor, but it’s difficult to say whether transportation was the sole factor.

One young mother had been pushing for seven hours at home within a few miles of the hospital when she finally arrived at the hospital about midnight. The baby was too big for her and was seriously impacted into the birth canal. I judged the situation inappropriate for any type of forceps. Historically she would have been a candidate for a symphysiotomy. This relatively simple operation was done for a long obstructed labor in preference over a cesarean section. The doctor would cut the ligaments that bind the pubic bones together in front; this immobile joint is accessible without entering the abdominal cavity. The release effect causes the pelvic bones to separate widely and the baby is delivered vaginally. The pelvis would then be immobilized with a wrap-around belt until it healed. The patients who didn’t heal well, however, gave the operation a bad name, and it has largely been abandoned. The problem remains how to get the baby out of the pelvis in this situation. I made the incision in the normal place for a c-section, and found not the head, but the neck and shoulders. Pulling it out wasn’t the remedy, as this would have hurt the baby. An assistant had to force the head back up from below until I could reach around it. Based on the fetal monitor record, I knew the baby was probably asphyxiated, which, in fact, she proved to be. Three doctors worked several hours on her, but she died without ever breathing on her own. My hope is for the mother not to lose tissue between the bladder and vagina due to the prolonged pressure. This is the usual mechanism of injury for many women who develop what is known as a vesico-vaginal fistula, which renders them totally incontinent of urine unless an operation can fix things later – not a simple task. We avoided any tearing of the uterus in this c-section; Chepngetich will be fortunate indeed if she escapes without a serious wound infection.

The second patient came in very shortly afterwards from a district hospital. She had been 9 cm dilated for 30 hours according to the records. I have no idea why it took so long for her to be referred. Three or four hours would have been plenty. However, her baby looked good on the monitor, and her cesarean delivery produced a very healthy looking boy. He wasn’t stuck quite so deeply, so I’m more hopeful for this mother and baby.

I went back home at 3:30 AM, but at 5:30, the nurse called me back up for another cesarean where the umbilical cord was falling down in front of the presenting part of the baby, which seemed to be in a breech position. The mom had just arrived from home. We ran the Chinese fire drill which looks a lot like an old Keystone Cops movie — people running everywhere, throwing out bundles of instruments, searching for supplies, getting the patient into position [first into knees and chest down, then flipping at the last moment], and finally a crash general anesthetic while the patient was being washed [prepped]. We even had waited a few minutes in the hallway outside surgery while the keys were found, but they still got the mother to sleep pretty quickly. I delivered the healthy boy, and then found a surprise twin brother stowed away. This mom was the one beaming most brightly this morning when the sun finally came up. I was thankful to turn the reins over to Brian this morning, as there were three more c-sections lined up.

I had two mothers die in the ICU this past weekend from cerebral malaria at about 30 week’s gestation. Both came in comatose with a heavy parasite load in the blood. The second mother’s baby was still alive, and she began to wake up a bit; but both ended up vomiting and aspirating [inhaling] the stomach contents into their lungs which is often fatal. The intern tried to save the live baby after the mother died, but it was in vain. Both mothers were Christians with several children at home. The chaplain and I tried to console the disconsolate husband of the first woman. The second died in the middle of the night without family around.

The surgeons were busy this week with numerous fractures; people falling out of trees and being run over by tractors were commonplace. The woman who was run over by a hippopotamus on his way back to the river was the recipient of some unusual fractures and lacerations, but she lived to tell the tale. The hippopotamus kills more people in Africa than any other animal with the exception of man. A senior citizen came in holding her intestines in a kanga [large, multi-purpose scarf]; she had been gored by a cow while walking along the road. I always give the long-horned bovines a wide berth.

Yesterday, I observed one of those strange scenes at the hospital that rivet my attention occasionally. I observed a large 24-passenger mini-bus matatu parked outside the morgue. It’s not unusual to see a pick-up truck being loaded with a coffin, but this looked a bit strange. The bus was full of passengers, but men were loading a coffin into the bus right along with the other passengers. “How many people can a matatu hold?” The answer is “one more”. Well, in this case, it was a different answer. They tried to maneuver the coffin down the center aisle once they negotiated the door. I half expected to see people scrambling out the windows, but most looked non-plussed. Finally, they gave up on this approach. Men scrambled up on the roof rack and passed the pine box up top without divesting it of its contents. They then hammered the lid down with more nails and strapped it down with ropes for the 3-hour journey back to Kisumu [according to the route destination printed on the side]. Thus another scene from National Lampoon’s Vacation movie was reenacted before my eyes — where Aunt Edna is strapped to the roof of the car after her untimely death on the journey to WallyWorld. This is right after the car repair scene described in the last letter. Does life imitate art, or is it the other way round? Some would take exception to my describing that particular movie as art, but it’s one of my favorites.

Alicia Bechtle recently wrote a letter to her supporters describing the family’s recent adventures, and I thought I would include it as part of this letter to the wider group.

Dear Friends…

Hi there!! I’m so sorry you haven’t heard from me in awhile…..life has been so crazy the last few weeks with all our fun company that I haven’t had time to process things enough to write about them… =) But here I am now….excited to tell you about what’s been going on here!

Pat and Lisa: Pat and Lisa Jarrett and their oldest three children came to visit us for two weeks! What a fun adventure it was… =) Elissa (age 11) loved the bumpy roads and came ever so excited for me to highlight her hair and give her a pedicure.. =) Nathan (age 9) was always up for playing any kind of sport we could think of with the other missionary kids, turned out to be a good little bargainer with the Kenyans who were selling things, and was so sweet with the Kenyan kids, even though he couldn’t usually understand what they were saying! Katie (age 7) learned a few kipsigis and swahili words immediately and was never afraid to shout them out at the appropriate moments! She loved giving out candy and smiles to the neighboring children and orphans, and almost got adopted by an older kipsigis mamma who really liked her… =)

Pat and Lisa seemed to greatly enjoy getting to do things out of their normal, busy routines…..Pat did some woodworking projects–built a very nice screened in porch for us to enjoy–mosquito free!! (usually…=) , and Lisa–even though about 5 months pregnant did great keeping up with everybody—even hiked for 2 hours with us up and down a nearby mountain! What fun.

A few of our other adventures with Pat and Lisa and company… =) include the following: a visit to the premie baby ward to give clothes to the mammas, the experience of Kenyan soda and mandazis (like doughnuts) at the hospital restaurant, a trip to the elementary school to make “wordless book” bracelets (and present the Gospel) with the first grade Kenyan class, several trips to the school to play soccer with the kids… =), a very fun 3-day safari where we saw more animals on one trip than I think I’ve ever seen on safari before!! (this was the kids’ most favorite thing.. =), several visits to the pediatric ward to sing and give out coloring pages and candy to the kids, and a fun endurance hike up nearby Mt. Motigo. Around the edges of these activities, we had lots of memory-making time just enjoying each other, playing games, playing sports, catching chameleons (much to the kids’ delight!), and having fun watching the kids and Pat and Lisa get acquainted with Kenya!

Triplets!: We have a wonderful househelper named Richard who is invaluable in helping with all the bleaching of fruits and veggies, filtering of water, and preparing of food that is necessary here. He has 6 kids, and his wife was pregnant with twins (we thought!)…..Two weeks ago we got the call that his wife Mary had just delivered triplets!!!! A boy and two girls…. =) They were each about 4 pounds…so good size babies. Needless to say, Richard’s life has gotten more complicated!! The babies have been in the hospital until yesterday so they could get bigger. One big concern was how Richard and Mary would be able to pay the hospital bill…..we’ve been praying lots though….God has provided through various people that He prompted to help them…and we were able to take the final payment up to the hospital for them today!! Now the babies are at home….they’re keeping Mary very busy….but it sounds like things are going well…Please join us in praying for them though. The babies names are Becky, Susanna, and Patrick. =)

Teen Bible Study: Amy, Laura, Olivia, and I have gotten to have a teen Bible Study at our house on Wednesday nights for the past month….and it’s been so neat! There are about 4 other teens here right now….and it’s done a lot to draw us together around spiritual things, as well as things like sports and just the “community” feel of intertwining lives so close together.

More babies!: Laura and I went on another trip with community health this Tuesday to help with a clinic in a nearby community. Once again, lots of mammas and babies showed up to get their vaccinations, check-ups, and tips for living more healthily out in the bush. =) Laura and I got to weigh babies (and some pregnant mammas too) the whole time!! They were adorable. I must say their scales are much different than baby scales in the States….the babies here are wrapped up in a big cloth with a knot tied at the top (you know the stork with the bundle of baby hanging from it’s beak? That’s about right!) and then hung from a hook at the base of the scale that’s suspended from a rafter by a rope—kind of scary to just watch them hanging there—I always stuck my hands underneath just in case! What fun it was though, to feel their fuzzy little heads and look at their beautiful faces as we weighed them. These trips always make me feel like I’ve experienced the Kenyan community a little more….and I like that. =)

To the orphanage!: Today a group of us went with missionary nurse Aunt Robyn to a nearby orphanage to feed the 18 orphans that she has taken under wing there. The orphans have a visiting day once a month, so Aunt Robyn always cooks a meal to take to the children…along with lots of love, greetings, and hugs! The kids were precious….one girl was missing parts of both legs and both arms, but was the most joyful, heart-capturing young girl… =) She was full of smiles and seemed so happy to see us as she scooted quite skillfully along the floor. The orphans all have lots of needs and come from pretty rough situations….but they all seemed so well cared for by the kind ladies who run the orphanage. They even sang us a song and quoted Scripture they had learned. =) We had fun giving them little bags of candy and toys, because they were so excited to get them!

Saloon… =): I’m still having fun traipsing around the compound with my haircutting bag and bucket of nail stuff to do people’s hair and nails—maybe I’m getting big muscles by now!! I doubt it though… =) It’s much easier to have a traveling salon (or “saloon” as Kenyans call it) here than it is in the States because I can just walk from house to house! God keeps sending me a steady stream of people who either need a haircut, want highlights or think it sounds fun to get a manicure or pedicure….so it keeps me busy around the edges of the other activities of life happening here. I so enjoy getting to do these things for people….and it sure gives me chances to build relationships and stay connected with everyone here on the compound! I must admit it’s one of my favorite things.

Camera troubles…: Last time I wrote I asked you to pray that my digital camera would be able to get fixed so I could keep sending pictures. Thanks for your prayers…and keep praying! I was able to send it home to my parents with Pat and Lisa and my dad found a shop to take it to….the shop is looking for the right parts but are having trouble finding them, so who knows? I know the Lord does though…and that He cares about even these little things….so please keep praying with me that the parts can be found and that it can be somehow fixed to send with Olivia’s mom and sister who are leaving Monday to fly here to Kenya. =) I’ll let you know what happens! [Ed: it didn't get repaired in time to make it.]

Upcoming events: The annual missions retreat here is coming up again in a few weeks, and we are in charge of the children’s program again this year! The main challenge is that we have to make up the curriculum—-a lot of work, but it always ends up being a very rewarding time with the kids! Pray for God to help us know what’s most important to teach….and for the kids to be receptive. The dates of retreat are April 2-6.

Also, as I mentioned above, Olivia’s mom and sister—Gretchen and Joanna Dickson–are coming to visit us for two weeks and then fly with Olivia back to the States (along with a side family trip to London). Olivia’s been with us here since January, so we’re going to really miss her! She visited Kenya several years ago with her family….and since then always felt the call to come back….she saved her money, and the Lord worked it out for her to come this term for 3 months to join in on the ministry, and it’s so fun to have her as another “little sister”… =) Seems God is letting me collect sisters…another one of my favorite things. I’m so enjoying the time with Amy, Laura, and Rachel too—hard to believe it’s almost time for Amy and Laura to graduate and that it’s their last term for awhile. They are a lot of my purpose while here in Kenya too, so I’m interested to see what God has in mind next for me…..whatever it is, I’m sure it will be good.

“Inside” lessons… =): God’s been busy not only on the outside activities, but also the inner “heart” lessons too… =) I feel like the biggest thing He’s teaching me right now is to not dwell on the things that aren’t true or happening at this moment that it seems I’m always imagining. I can tend to be a such a “what if”, worrier-type person, and it’s been really getting me down lately. God’s been showing me, though, how much that habit takes away from giving my best energy and focus of mind on what really matters. Philippians 4:8 says it well…
“Finally, brethren,
whatever is true,
whatever is honorable,
whatever is right,
whatever is pure,
whatever is lovely,
whatever is of good report,
if there is any excellence
and anything worthy of praise,
let your mind dwell on these things.”

With God’s help, I’m making a conscious effort to not dwell on what hasn’t happened yet or always be bracing myself in nervousness for how things are going to turn out…..but rather just focus on and deal with what is true and real right now this moment…..and leave all the rest to the Lord. He’s promised to give me grace to deal with things as they come, but not before! It’s sort of hard to put into words, but it’s been so exciting to have a freer mind to “be all there” in what God puts before me to do every day. Please pray that I will stay soft and keep moving forward with the Lord in these things. It makes such a difference to not have my mind so occupied with things that are His responsibility…not mine!…but takes constant watchfulness to break old habits like this….a power greater than me is definitely needed. =)

Well, this letter has gotten rather long….so I better wrap it up for now! Thanks for “listening”…..and for all your interest and love. I’d love to hear what’s happening with any of you that have a moment to write…. =)….and thank you so much for the emails you’ve sent—they always are such a bright spot!!

For Jesus, and in His Name…..and with much love for you!!
Alicia

Paul writing again. Would you pray for my upcoming return to Indiana at the end of May? I don’t know at this time what I will be doing, as I’m still waiting for specific direction from God. I signed up with a locum tenens agency which could send me anywhere in the US temporarily [if the situation was right], but I’ve heard nothing from them. I would desire to go to Ukraine sometime this year. I plan on avoiding advanced auto mechanical operations. My greatest desire is to be where God wants me to be.

Please pray for the Umoja orphanage. We visited there tonight with the Dicksons. The children are happy and well-fed, but no funds have been found to pay the staff which has worked many months without pay. Please pray for God’s will in this situation to be done. We plan on visiting several more orphans this weekend.

Please keep our choriocarcinoma patients in prayer. Gladys came in for her visit yesterday, and the hospital hadn’t found any chemotherapy [Methotrexate] in time for her visit. I was pretty bummed out, but this may have been of the Lord. I ordered a quantitative HCG [blood test] which will be back next week. If it’s low enough, I might not need to give more chemo. The drugs came in today, so it’s available if I need it. Kirangare went home feeling very well and is due back in a week. The patient who had surgery scheduled last week for this same cancer failed to come in. I fear for her life if she doesn’t come very soon. We plan chemotherapy for another patient with ovarian cancer, and we’re trying to trace another patient whose D & C revealed endometrial cancer at age 34. That’s not supposed to happen at such an early age, but things happen here that aren’t supposed to happen. That’s why we’re here trying to help and spreading the love of Jesus in the process.

Thanks for serving Jesus with us in prayer.

Paul, for the Jarretts and Dicksons in Africa

Jarrett’s Prayer Letter
Volume 5, Number 6
March 8, 2004

Dear Friends and Family:

I wanted to write an “official” prayer letter to update all of you. Those of you who have E-mail have received several requests in the last few weeks, but you “snail-mail” friends may think that we’ve fallen in a hole somewhere. Well, we’ve driven through a few holes recently, but we’ve always emerged on the other side. We’ve just been too busy with our family visit to take time to write more than those urgent requests.

Our visit with our family was as wonderful as it was brief. Two weeks just wasn’t long enough with precious grandchildren and children, but it will have to do until our return home later this spring. We had time to visit orphans, schools, and the pediatric ward as well as paying a visit to the lions, cheetahs, and all the herd animals down on the Masai Mara last weekend. We drove the family into Nairobi on Friday for their flight home, but before they left, we took them shopping in the shanty complex where we have a Bible distribution ministry. The family had a great time bargaining for souvenirs and visiting with our friends in the market. I had an hour just to sit with some of the Christian storekeepers and encourage them. Pat and Lisa arrived home safely in Noblesville on Saturday evening.

Our son, Patrick, helped make two construction projects successful. We installed a generator which is running when the power is shut off from the hospital. This allows us to run the refrigerator, freezer, and lighting in the house [including the computer]. This should help our food to keep better than it has for the past two months with power rationing in full force here at the station. The rains are due soon, which should alleviate the crisis, but until that time, we are getting used to the hum of the generator in our garage; the neighbors across the yard also have one running. [Keeping up with the Jarretts is the closest thing to the Joneses that we have here.] Pat also screened in a porch landing which allows us to open up the house in the evening without letting all the mosquitoes in for dinner. Laura and Amy are their preferred menu items, although they’ll bite any of us given the chance.

Our previous letters have detailed some of our difficulties in keeping our 1991 Pajero in top running order. This trip to Nairobi was also used to attempt to upgrade the vehicle. The speedometer/odometer quit working two weeks ago, which is how we keep track of the car expenses with World Gospel Mission, so that needed fixed ASAP. Also, the front shock absorbers we put on here in Bomet didn’t seem heavy duty enough, as the car soon began to bottom out on the numerous chuckholes. And the steering seemed to bind a bit at the extremity of the turning radius, so I wanted to check that. And the rear tires were wearing out quickly, so new ones were needed pretty soon.

Saturday morning, I headed for one of the car repair shops that I would need to visit — Rob’s Suspension Magic, which sells heavy duty shocks. I got the rears done last year, but the front ones were still serviceable at that time. I got there at the opening of the doors just before 9 AM and they began the installation procedure. I took a book with me. They took two hours to do the shocks, and then they checked the steering and alignment. They advised that the car was quite a bit higher on one side which would adversely affect the new shocks and advised adjusting the torsion bar. That should take only 45 minutes. Two and ½ hours later, I left the shop with only one of my items accomplished. I was told of another place down the road, MPPS, where they might fix the odometer cable. MPPS checked it out and said a new cable was needed, but all parts stores were now closed. I’d need to come back for the cable repair. I stopped at the tire store next door and got two new tires. The job that should take 40 minutes by their estimate also took two hours. It was now 4PM. I still had another errand to do before returning to the guest house to pick up Marty for our planned half day of shopping and Bible distribution. Somehow, this didn’t seem to fit into the remaining available time.

I went to an office in Nairobi for the payment of a deposit on a trip at the end of April. They had closed early, so another errand was shot down. I hurried to the guesthouse and picked up Marty. We had an hour and a half left before the storekeepers left where we were taking our Bibles. The grocery shopping would be postponed to Sunday morning. While driving down the road to the Sarit Centre, I hit a medium size chuckhole [by Kenya Standards]; this one would be grounds for road closure in the States. I heard a loud CLANK, but saw no parts of the vehicle on the road in the rear view mirror. Then it began a SCRONK, SCRONK sound as I turned the wheel slightly. Clank and Scronk spelled trouble to me, so I wondered where to go next with all repair shops closed until Monday morning. I was entering a roundabout intersecting with the main highway with its usual heavy traffic. On the other side was our destination and two service stations. I prayed quickly for help. I started into the roundabout, but a bus forced me to go left up the highway. I now had to just turn off the road into a roadside area which fronted some apartments and contained a number of kiosk shacks [dukas] and cars, but little else. I wondered how the Lord was going to get us out of this jam.

I had no sooner gotten out of the car to look under it than I was assisted by two Kenyans in coveralls. They immediately crawled under the car and said that the torsion bar had come apart. They could fix it if I had a jack. I was skeptical, but I got the jack out and stood in the late afternoon shade with Marty as our grimy angels got busy. They jacked up the car with the jack and some rocks. They said a washer had fallen off, and they needed to fashion one out of 2-inch square steel plate by cutting a hole in the center of it. They just happened to have their welding tanks 30 feet from where we had pulled in. Two additional angels appeared with borrowed wrenches and hammers. They cranked and adjusted the height of the vehicle using a stick from a nearby tree as a gauge. It was almost possible to stand by as a detached observer and watch the Lord’s work. But I knew that I had to pay these angels in few minutes. The scene from National Lampoon’s Vacation movie came to mind where Clark W. Griswold [Chevy Chase] asks the redneck mechanics how much the emergency repairs would cost. Their answer had been “How much have you got?” The price was ALL of what he had. I knew there was no Better Business Bureau to appeal to here either.

They soon pronounced the Pajero ready to roll. I began the negotiations with the questions, “Who’s the boss here?” and then “What’s a fair price for the work?” He replied “How about 3,500 Shillings [$47]?” Well, that’s 7 times what I paid in Narok two weeks ago, so I told him that was too much, even though $47 wasn’t bad by US standards. I told him about the work for 500 Shillings. He said, “what about 2,500 Shillings?” I countered with 1000. He must have figured by now that I had a 1000 Shilling note and a 500 Shilling note, so he said “how about 1500 Shillings”. I pulled out the two notes from my pocket which made it obvious that was all I had. [My other money (15,000 Shillings) was in my money belt, but I keep a small amount in the pocket for a robber or for easy access without undressing]. So everyone was happy, even though I was $20 poorer than I would have been if Rob’s Magic had fixed things correctly four hours ago. Apparently, Rob had temporarily lost his magic touch.

We hurried over to the dukas and still had time to pass out the 30 Bibles in the remaining twilight before we were due back at the guesthouse for dinner. Once again we had the privilege of passing out your donated Bibles and receiving thanks on your behalf. Please pray that God’s word will have an eternal impact on these precious people. Many are nominal Christians, and some are seekers. Some are more mature believers who are happy to have a Bible with a concordance or commentary.

On Sunday morning, we did our grocery shopping, ate lunch, and headed back to Tenwek with passengers, Dr. Brian Myers, and his wife, Jane, who had just arrived that morning at the airport. The car was working well until it started raining at Narok. The windshield wipers seemed to be too tired to work. They gave a twitch of an effort, but that was all they could muster. It was too difficult to see out the windshield, so I got out and encouraged the wipers with a little power boost with my hand. They were out of reach of a swift kick. However, that was all the encouragement that they needed, and they soon were working at normal speed all the way home. This car just needs a little coaxing and cajoling now and then. I’m not sure, but Pajero may be Japanese for “mule”.

Last Tuesday we received a 25-year-old Maasai mother, Kirangare at the hospital. She has two small children at home. She came in with severe anemia from bleeding from choriocarcinoma, the rare, malignant cancer that started from a pregnancy which she miscarried in December. There was one metastasis in the vaginal wall [secondary location from spread of the cancer] that gave away the diagnosis to anyone who has seen this awful disease before. I knew from my previous experiences here that her only hope was to remove the uterus and the metastasis as soon as possible and then begin chemotherapy. She and her husband are both Christians, which is unusual in the Maasai community.

Her story illustrates some of the challenges that we face here. The intern who admitted the patient missed the diagnosis, but still prepared the patient by giving her a unit of blood. I had a good hunch of the diagnosis just by his description of his examination when he presented the case on Wednesday morning. The husband also knew the opinion of cancer by a doctor at the first hospital, but the wife didn’t know; she’s the only one the intern talked to on admission. Patients are not always informed of their diagnosis by attending doctors, but sometimes authoritative family members are. Patients and their families aren’t always assertive enough to give you information if you’ve failed to ask the right question.

She is blood type A negative which makes it hard to find suitable units of blood. I wanted to get her ready for surgery sometime on Thursday, but knew it would take a lot of riding herd on the situation for that to take place. I talked with the blood bank technician and found that a unit of A negative and a unit of O negative were available, but that was all in the bank at that time. I knew she would need those two units to have a safe blood level to operate. She had already received one unit. But we might not have one unit in reserve as is customary for this operation until more blood was donated on Thursday. It would be a tight schedule, and we needed some help from the Lord [as we always do, but frequently lose sight of]. I ordered that the two units be given on Wednesday night. We decided to start Thursday morning with a scheduled cesarean section and do Kirangere’s hysterectomy later in the day.

I came to the hospital at 7:30 Thursday morning and found that only one unit had been given. The floor nurse independently decided that one unit would be given and one held in reserve for surgery since that is customary. I checked with the lab three times to find the result of her hemoglobin after the transfusion. The blood was just being drawn the first time that I checked. The second trip revealed the blood was there, but the machine was broken down that would analyze the result. The third trip found that the hemoglobin was only 7.5 – too low to start surgery, just as I expected. I went to the blood bank to check on available units. There was one more new unit, but it was assigned to an orthopedic patient that had already had surgery during the night. I ordered the remaining unit to be started immediately [now it was 9AM]. I had Brian Myers do the Cesarean. I went to the orthopedic unit to check on the patient’s condition with his nurse. She thought he wouldn’t need the unit of blood and paged the orthopedic doctor for a release, which they granted. I now had my reserve unit.

I went to the gynecology [female surgical] ward to see whether the blood transfusion had been started as ordered. It wasn’t. I asked the nurse where the blood was for the patient. She pulled back the sheets to show me that the blood was being warmed by placing it against the patient under the sheets. It was still pretty cold, but the nurse got the blood-giving set out to start the transfusion. I checked with surgery, and they said that they thought a room would be available in an hour. I checked back at 11 AM and they said they’d sent for the patient. I went to the ward, but the patient was still in her bed with no one moving towards getting her to the operating theatre. I asked the nurse to take the patient to theatre even though she hadn’t heard the call. We started the case by 11:45; it went extremely well with minimal blood loss. The remaining unit of blood could likely be used for someone else when we longer needed it for insurance against an unexpected hemorrhage. Kirangere’s done well after surgery, and we gave her the first dose of Methotrexate today. She will need treatment for five days every two weeks until the pregnancy test is finally negative indicating that all cancer cells are gone.

I saw Gladys back for a visit last Wednesday [my other current patient with choriocarcinoma]; she still has a positive pregnancy test nearly two months after her initial surgery, but there is no visible tumor. Continue to pray for her as well. The pharmacy told me this morning that they only have enough of the Methotrexate to complete Kirangere’s current course [using the injectable form of the drug]. The tablets used for outpatient treatment are now on back order. A break in therapy can be fatal for both patients. Please pray that additional supplies will be found in time for future therapy by Wednesday the 17th. I have another patient, Cherono, age 21, who has a hydatidiform mole, the more benign sister to choriocarcinoma. She’ll have surgery tomorrow morning. Another 42-year-old patient will have a hysterectomy on Thursday for one of these two conditions – I’m not sure yet which it is. Either or both might need the Methotrexate as well.

In a previous letter I had mentioned that only one patient whom I’ve treated previously for choriocarcinoma had survived. I was surprised to see one of the patients back in clinic recently whom I had given up for dead. Picoty had only one round of chemotherapy and never came back. I was pleasantly surprised to see her in follow up from a recent pregnancy which she delivered at term. Unfortunately, she had lost that baby from an unrelated problem, but she’s alive and will not have problems due to the cancer in the future.

Unless I’ve mentioned their deaths, all the other patients for whom I’ve requested prayer have gone home including Eunice, the mother with a stroke and bad high blood pressure complicating eclampsia. We would appreciate your continued prayer for the hospital’s financial situation. Patient visits are still below normal with the continuing matatu [public transportation] crisis. Fewer vehicles are running, and the cost has increased; this is a double whammy for our poor patients. Although we noted many more matatus in Nairobi, it is still difficult for people to get to work there and some children can’t go to school. It’s impossible to get a driver’s license currently with the backlog of matatu drivers seeking their registration papers. One missionary had been standing in line for two days without success to get a vehicle registration. And we [me included] complain about the BMV in Indiana when we have to wait an hour.

Marty asked for prayer as she and the girls prepare their materials for the children’s program to present at the WGM annual field retreat near Nairobi April 2-5. It is a big responsibility for each of them; they are putting together the curriculum from available materials. I am not planning on attending the retreat, unless it is for a portion on the weekend. They may stay over the 6th and 7th to get visa extensions for Betty Feltner and Alicia, although arrangements for this would need to be pulled together.

Laura has appreciated your notes of encouragement as she prepares for her mission trip to Japan in June 2004. Please continue to pray for her preparation and financial provision.

Our daughter, Susanna, has recently become engaged to Chris Gordon. They are currently discussing a wedding date in July 2005. Please pray for their planning and for Chris’s schooling. He is a pre-med student at Purdue.

We would appreciate your prayers for protection from minor physical illness. Several of us have had illnesses in the past few weeks which drain our energy.

An update on my finger: I trimmed the new fingernail for the first time this week. It’s continuing to do very well without complaining.

We would appreciate your continued prayers for the orphan ministry. The Umoja orphanage is finding it difficult to get enough food for the orphans without the support of the local church. Joseph, the director, is discouraged; pray that he will understand God’s will and direction. The children are happy and recovering their health. They no longer show the signs of malnourishment that were present in September. Joseph told us that only one of the 11 children has tested positive for HIV. Likewise, our friend Alice continually needs support for the orphans that she is caring for.

The orphan education fund also needs additional contributions to meet the current term’s expenses. 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. Gretchen Dickson will bring a check when she comes on March 17.

I will be preaching on April 18 at a local national church and May 2 at Tenwek. There are invitations to preach at other churches on other available dates yet to be worked out. Please pray for God to give me the messages that He wants given for these occasions. I also have a medical lecture to give to the nursing staff on March 15.

Please pray for Julie Six, a WGM missionary volunteer, who will give birth to her first child sometime in the next month at Tenwek. I am planning on staying close at hand until the baby arrives. Faith Shingledecker, one of our missionary staff, is recuperating nicely from colon cancer surgery here two weeks ago. Joanne Duval has left to return to the States for breast cancer treatment. She is in good spirits. God has provided her family a place to live and doctors to care for her. Her husband, Ken, hopes to return to Tenwek in a few months to continue supervision of the new operating theatre building construction. Both Faith and Joanne thank you for your prayers.

We appreciate so much your standing with us in prayer. It is easy to get discouraged if we look at the waves around us, but we’ll not sink if we keep our focus on Jesus, the author and finisher of our faith. We see His hand on our lives at every turn [and in each chuckhole].

Serving Jesus with you,

Paul, for the Jarretts remaining in Kenya