Jarretts Ministry

Please respond to jarretts@tenwek.com

Jarrett’s Prayer Letter
Volume 6, Number 4
February 22, 2005

Dear Friends and Family:
We have a rather urgent prayer request for a good friend, Mr. U, as I will call him. It would seem that his life is in real danger which I will explain shortly. Our family is doing well following a nice trip to Nairobi for groceries and eating out at restaurants, something we can’t do here at Tenwek. Our patients are doing well, so we appreciate your prayers and recognize the significance of them.
How Much Do You Love Your Brother?
Mr. U came to Kenya about 5 years ago as a political refugee from another African country when the political parties switched [in virtually every country in Africa this has historically been a violent process – the elections two years ago in Kenya being a major exception to the rule]. He lost everything he owned in his home country and began anew in Kenya, albeit at a significant disadvantage. The Lord has provided for his large family in great ways; his situation here has been livable if not comfortable.
About three weeks ago, his brother who is about 20 years his junior, returned to his native country on business. The apolitical brother was comfortably established in Europe and had no reason to believe that he had political enemies at home except for the fact that his last name is the same as Mr. U. Upon arrival in his home country, he was immediately arrested, beaten, and thrown into prison.
John 15:13 Greater love has no one than this: that he lay down his life for his friends. NIV
Mr. U’s response to this has been to immediately plan a return to his home country to try and obtain his brother’s release, if necessary, by exchanging places with him. Certainly this is a very high risk move – one that could lead to his own imprisonment or even death, with no guarantee of helping his brother.
Romans 5:7-8
Very rarely will anyone die for a righteous man, though for a good man someone might possibly dare to die. But God demonstrates his own love for us in this: While we were still sinners, Christ died for us.
NIV
Please pray for Mr. U. He leaves our area tomorrow and flies out on Thursday directly to his home country. We must anticipate that he will be immediately arrested, but only God knows what plans are in store and how He will use this situation for any good. An obvious good outcome would be for him to secure his brother’s release and have them both leave the country after settling with the government. But Mr. U seems to have no high expectations of such an outcome. He is saying “Goodbye” to people here. Please pray that God would keep Mr. U very close to Himself and give him peace and protection, help him to be a witness wherever he goes, and give him the words to say before the government.
Luke 21:12-16 “But before all this, they will lay hands on you and persecute you. They will deliver you to synagogues and prisons, and you will be brought before kings and governors, and all on account of my name. This will result in your being witnesses to them. But make up your mind not to worry beforehand how you will defend yourselves. For I will give you words and wisdom that none of your adversaries will be able to resist or contradict. NIV
Please pray that God will preserve his life.
Dan 6:16 So the king gave the order, and they brought Daniel and threw him into the lions’ den. The king said to Daniel, “May your God, whom you serve continually, rescue you!” NIV
Please pray for the hearts of the government officials to be turned favorably to Mr. U and his brother.
Proverbs 21:1 The king’s heart is in the hand of the LORD;
He directs it like a watercourse wherever He pleases. NIV
Thank you so much for your prayers. It is difficult to see friends in such circumstances. It is our job to “hold the ropes” as he is lowered into the lion’s den. Please pray for the wife and children of this man; the children are good friends of our daughters as well.

Updates on Patients
Jacklynn, our patient with the abdominal pregnancy responded favorably to the new antibiotic, and her fever went away. We sent her home on Monday. Caroline, the patient with a double uterus and placenta previa has been stable. She has had no further bleeding, no signs of infection, and no further drop in her blood count.
Please pray for a situation involving a young girl, Chepkoech, who had an illegal abortion in Silobwet. She developed infection afterward, but responded to antibiotics. She has also responded to the ministry of the chaplains. There is a real need to find this abortionist who is risking the lives of young women without their parent’s consent. This individual seems to have medial training unlike many of the “traditional healers”. Please pray that the police will be diligent in their investigation, and that the truth will be revealed.
Please continue to remember Mrs. P and her daughter, Y. There has been no resolution of the situation concerning the wayward husband.
Marty’s response to James
I had recently requested your prayers for Marty as she responded to a man, James, who seemed spiritually open. I thought her letter to him was so well done that you might appreciate reading it. I typed the letter as follows, and I attached a separate file containing the Bible references, since I wasn’t sure that James had easy access to a modern translation. I could easily forward the Bible references to anyone who would desire them. Please continue to pray for James as he should have received the letter today; we’ve heard no response as yet.
James, I am thankful for your wife’s good outcomes (miraculous, I would say) after battling two serious health problems. Sometimes we take the precious gift of good health for granted. Every day of life is a gift from God. I am also thankful that your wife’s special art talent is being recognized and enjoyed by many people. God is faithful to provide for our needs, and it is a blessing to see how He has allowed your wife’s talents to be used for some of that provision. One of our seven daughters has a God-given talent for drawing people. She also enjoys ceramics. Debbye is an art education major and hopes to one day have a studio of her own and give art lessons to children.
James, you are right to think I might understand something about trials, victories, priorities, peace rather than worry, joy, sorrow, power of prayer, and most of all, the need for my Lord and Savior, Jesus Christ. However my understanding comes only from what God has given me through His Word, the Bible. During the last thirty years of my life, God has been a very present help, constant guide, and loving Father for me. The chapters in my life He has written for me include many joys, sorrows, trials, and victories. Ten children, several miscarriages, thirteen grandchildren, two house fires caused by arsonists (our home was completely destroyed the second time), loss of a dearly loved brother in an automobile accident, leaving behind my very close-knit family six months each year to join my husband in Kenya for the ministry to which God directed us, and my husband giving up his medical practice of 25 years along with all financial security in order to obey God’s call to the mission field – these are all part of God’s special plans for my life to help me glorify Him and enjoy Him forever which is His purpose for my being on earth and then with Him for eternity. Each of these events has been an opportunity for God to meet my needs, deepen my love for Him, and enable my faith to grow as I put my trust in His absolute sovereignty and faithfulness. I mentioned 30 years ago because that was the time in my life that I saw the need for Jesus as my Savior to forgive my sins and as my Lord to take control of my life. God’s tender way of opening my eyes and heart to Him is very special to me, but I won’t go into that story now. I will just say that when my dearest friend shared the good news of Jesus Christ with me, I knew I wanted to give my Creator the control of my life.
Brief summary of the good news (gospel) of Jesus: God Himself coming to earth as the Son, Jesus, to live on earth as man (but still fully God), to show us how to live and the way to the Father, to shed His blood on the cross in payment for our sins, to be raised from the dead by God’s power (which is the same power made available to us when we are surrendered to Him), to go back to Heaven to prepare an eternal home for those who believe in Him, and finally – God’s Spirit (the Holy Spirit) to live within the believer’s heart to guide, instruct, comfort, encourage, convict, and correct moment by moment while I live on earth – awaiting my eternal home.
Please allow me to share this good news through God’s own Words. Romans 3:23-26; Romans 6:23; John 3:16; Romans 10:9-11; Ephesians 2:4-10; 2 Corinthians 5:14-15, 17-20; John 14:1-4,16-18,26-27; Ephesians 1:13-14; 2 Corinthians 5:1-8; 1John 5:1-13. Read all of the gospel of John and Philippians 2:5-11 to get a deeper grasp of just who this Jesus is and the relationship that He wants to have with you.
I share with you my testimony of receiving Jesus Christ as my Lord and Savior so that you might have a deeper understanding of all the things God is doing and allowing in your life to draw you closer to Him. Christianity is not a religion (man’s attempt to please a holy God), but it is a personal relationship with Jesus Christ, God’s Son (God’s provision to redeem His created beings so that they may become His children). Jesus is the bridge between sinful man and the holy God. It is the personal love relationship with Jesus that gives me hope, joy, and purpose in life and a promise of eternity with Him.
All the issues that you mention in your E-mail – trials, victories, priorities, peace rather than worry, existence of an Almighty God, who knows and controls everything, and the power of prayer – begin to have meaning through instruction of the Holy Spirit as you read God’s Word: His truths become real and the motivation and lifeline for your journey on earth. About 20 years ago, God opened my heart to a deeper meaning of faith – taking God at His Word – trusting His Character, believing His promises – not looking at circumstances for my joy and peace. (Luke 7:7-9)
God’s Word has become a treasure for me. Read all of Psalm 119 and get a sense of the infinite value of His Word. God’s Word has meaning for everything in our lives. It is our “instruction manual”, so to speak, to take us through life’s journey on into eternity.
I want to share with you God’s words concerning the various topics you talked about in your note. When you said that you realized that there is a “man upstairs”, I thought immediately of Romans 1:18-25. You are speaking of the Holy God – our creator, who places in each one of us a desire to know Him. You certainly live in a place of magnificent beauty which speaks of His awesome power in all He created. All of Psalm 139 tells us how intimately God knows us and cares for each of us which is so evident in Jeremiah 29:1-13 and Isaiah 49:16. The Lord was gracious to bring His promise in Jeremiah to me right before our house burned down. He is always faithful to meet our needs – even as we endure trials, He is carrying us through with His love and mercy. Reading God’s Word daily has become so important to me, as it is in His Word that I can begin to understand and appreciate His never changing character – His awesome attributes, infinite excellence, and majestic worthiness to be praised. I especially love the Psalms to help me really know and appreciate Him. All of Psalm 103 is a partial summary of God’s character. Through the years, two of His perfect character traits that minister to me the most are His sovereignty and faithfulness. Lamentations 3:21-25 has become one of my favorite passages of scripture – one that I claim almost daily for my walk with God.
As I mentioned earlier, God also has a very definite purpose for our lives which should influence our priorities. His purpose is that we glorify Him and enjoy Him forever. 1 Corinthians 6:20; 1 Corinthians 10:31; Matthew 5:16; 1 Peter 4:8-11; James 1:16-18; Psalm 63: 1-5
In response to God’s purpose for my life, I need to seek and obey His word concerning:
My priorities: Those are stated clearly in Matthew 22: 37-40.
My personal relationship with Christ: Philippians 3:7-14; Matthew 6:19-21, 25-34; Matthew 7:24-27; Hebrews 11:24-26; James 4:13-17.
My commitment to my marriage: Ephesians 5:22-33
My responsibility to employer and assigned tasks: 1 Thessalonians 4: 9-12.
My service to God through church ministries and community involvement: Colossians 3:17; James 1:27; Matthew 28:18-20; 2 Corinthians 8:3-5; Hebrews 10:23-25.
God promises to direct my steps if I choose to put my trust in Him and seek to follow His leading. Psalms 32:8; Colossians 2:5; Proverbs 3:5-6. Furthermore, I am taught and encouraged about true success according to God’s standards in Joshua 1:8-9.
Through a study of God’s character and recalling past experiences of seeing God’s faithfulness at work in my life, I can choose to trust Him with the trials and victories that come my way. The Bible has much to say about trials (strengthening of my faith) personally seeing the Lords faithful provision during those times constantly challenges me to keep my eyes on Him. James 1:2-15; 2 Corinthians 4:6-18; 1 Peter 4:12-14; Romans 5:1-5.
Because the Lord has repeatedly proved to me His sovereignty in all things, I can choose to rest in Him each moment.
When I am resting and trusting in God’s total control, I can experience peace rather than worry. Matthew 6:25-34; Isaiah 26:3-4; John 14:27; John 16:33; Philippians 4:6-9.
The passage in Philippians brings us to the importance and power of prayer. As a believer in Christ and a child of God [through the blood of Christ], I know I can come confidently to the throne of God – certainly not because of any worthiness on my part but because of what Christ has done for me. Hebrews 4:14-16. Of course, the initial prayer God is longing to hear from every person is the prayer of repentance and realization of his need for Jesus as Lord and Savior. After that prayer of turning to God, He is always available to listen and answer according to His perfect will. Jeremiah 33:3 [God's phone number (>:] invites us to “call on me and I will answer you”. We are to pray about everything 1Thessalonians 5:16-18. Because we come in Jesus name, and ask desiring His will, God hears and answers according to His perfect purposes. John 14:12-14; 1John 5:14-15.
Jesus Himself gave us the perfect model for bringing our praises and requests before our Heavenly Father. [Matthew 6:7-13]
Well, James, this has definitely been a very long response to your E-mail. (>: You had no idea why you shared your trials with me, and, believe me, I had no idea what, if any, response, I needed to make. I believe God prompted you to share so freely. As always, I took it to the Lord and sought His direction for any letter that I should write. This response is the result of His leading. Of course, most of the content needed to be from His Word – the only source of truth. I also have been blessed with a multitude of personal experiences which have allowed me to see God’s Hand at work in my life. Over and over, He proves to me His love, His holiness, His faithfulness, His sovereignty, and His almighty power.
As a popular Christian song says, “Because He lives, I can face tomorrow.” My joy, hope, and strength are found in Jesus. Psalm 27:1, Psalm 46:1-3; Isaiah 40:28-31; Psalm 16:11; Psalm 43:3-4; Habakkuk 3:17-19; Nehemiah 8:10, Psalm 39:7; Psalm 71:5-8; Hebrews 6:17-19; Ephesians 1:17-21; Romans 15:13
“Untroubled trust” – a deep knowing of Jesus and taking Him at His Word – this faith in Him is the thing God is looking for in my relationship with Him. Hebrews 11:6.
My prayer for you, James, is found in Ephesians 3:14-21. May God bless you as you seek to trust and obey Him.
Joy in Jesus,
Marty Jarrett

Thank you for praying for all these concerns. We serve a great, loving God who is listening to each of you.
Paul, for the Jarretts back at Tenwek

Jarrett’s Prayer Letter
Volume 6, Number 3
February 12, 2005

Dear Friends and Family:

Thank you for your prayers regarding the young man, Geoffrey. As Marty and I both prayed about it, we were led to support him in entering high school. Proverbs 19:17 particularly came alive to me. “He who is gracious to a poor man lends to the LORD, and He will repay him for his good deed.” NASB After reaching that decision, one family wrote back that they would like to underwrite Geoffrey’s support for all four years of secondary school. A few days later, another family also expressed interest. Now our family can help some other people here with serious problems.
I initially planned on taking Geoffrey to St. Michael’s school on Monday when I had a day off following weekend call; however, I couldn’t find him around the compound. When I did find him on Tuesday, I had to delay taking him until the end of the week. Wednesday is always too busy to be away from the hospital because it is GYN clinic day. I told him to come on Thursday, and I’d see how that day would be for getting away for two hours. But the big emergency surgery of the week was Thursday morning, and I needed to stay at the hospital all day to follow the patient in ICU. So, I again rescheduled for Friday morning.
The day was quiet as far as workload, so I slipped away at 11AM and drove Geoffrey into Bomet. St. Michael’s school was all the way through town and another kilometer south of town. It was a one way distance of 9 kilometers [5.5 miles] that Geoffrey will walk to school in the morning and return again in the evening. That was about the same distance that I traveled to school when I was in Jr Hi and High school, but I rode a bus or later drove. I think I may have ridden my bicycle once for fun, but it wasn’t enough fun to do it again. At least there isn’t snow to walk through in Kenya, although it occasionally will be raining pretty hard during his “commute”.
We pulled up to the gate of St. Michael’s school, a collection of one-story buildings with a hedge around the perimeter. Our view of the gate was partially obscured by the hedge. I thought the guard would open the gate, but soon he came out and said “just wait”. When I didn’t park the car outside the gate as he was attempting to communicate, he motioned for me to move the car back. As we got out of the car, I then could see that they were actually installing the gate. It wouldn’t be ready for a few more days, so it was good that we didn’t “just wait”. We could see the male students milling around while the girls were playing volleyball in one corner of the grounds.
Geoffrey and I walked around the edge of the quadrangle of buildings [minus one side] and found the Headmaster’s office. We were welcomed inside, and I told him who I was and that I wanted to enroll Geoffrey. He asked to see Geoffrey’s examination scores from the final exam from Standard 8 [eighth grade]. He said that it was sufficiently high and welcomed Geoffrey. I paid the 7,800 Shillings [about $100] for the first term. The headmaster promised to give me updates on Geoffrey’s work each term. The fee for the remining two trimesters would total another 7,800 KSh. He explained that this is a day school as opposed to a boarding school, although they hoped to build some dormitories this year for boarders. Lunch is provided for the students.
I had brought a soccer ball with me to present to the school as well. I then gave the Headmaster the ball and watched his eyes light up. I started to explain about the ball, but he said to wait a minute. He called the head teacher in to the office to hear the story. It seems the teacher had just been in the office presenting the problem to the Headmaster that they didn’t have enough balls for the school. The volleyball that I had seen outside was the only one. That’s why the boys were just milling around. So, I explained that the ball was a gift from our Awana kids at Castleview Baptist Church in Indianapolis. They were both very pleased and excited about God’s provision. So the name of Jesus was praised once again for a soccer ball.
There are many young orphans and children of widows who have the potential to go to school but are unable to do so because of the costs involved. Two or three hundred dollars is beyond the reach of these unfortunates. Anyone who is interested in assisting a student can contribute to the Tenwek Area Education Fund by sending a check to the Christian Foundation of Indiana.
Orphanage Ministry
Today we visited the Umoja Children’s Home. Accompanying me were Marty, Rachel, Alyssa Pfister, and Marita Bishop, the wife of a visiting physician from Snohomish, WA. The orphanage is aptly named, because Umoja means First and it is the first of the four orphanages in the area. The project was the vision of Juliana Too, an older Kipsigis mother who herself had been an orphan at an early age. She gave the land to her son, Joseph, to start the orphanage project. We have been assisting them over the past three years when we first heard of their vision.
Fourteen children are living at Umoja. There are two matrons living with them and a local elderly man is the night watchman. When we first arrived, only 2 children were present. We asked where the children were, and Juliana told us that the matron had taken them to the river for water.
We looked around the property. There are two large water tanks that were donated by an international charity, but the only source of water for the tanks is rainwater that is collected off the roof. The tanks are nearly dry, since it hasn’t rained in two weeks. Behind the tanks, the clotheslines were full with the school uniforms that the children wear to school each day, but Saturday is wash day. Their blankets were also washed and hanging over the fence. The corn in the field was grown up only about a foot high awaiting the rain. Three cows roamed about the pasture which was adequately fenced to protect the corn. The chicken coops were filled with about 30 chickens. Joseph told me there are now enough eggs for the children to have eggs on Saturday and Monday. The rest of the time they have ugale [corn meal mush], rice, and beans. This is pretty typical for Kenyans. Often they have the flat bread, chapatis, as well. Very rarely would they have any meat. The buildings were well maintained. The dormitories were neat with 3 or 4 bunk beds in a room. The extra clean clothing was kept in cardboard boxes in the corner of the room. They still didn’t have individual lockers or boxes to keep their few belongings. Marty has a burden to locate a appropriate box for each child to use.
Soon, the children arrived. There are six boys and eight girls ranging from age 5 to 12. Each was carrying a gallon of water he had carried from the river. Each one greeted us and posed for pictures with us. Then we were invited to the office, while the children sang songs in the dining area next to the office.
We were welcomed by Samuel, one of the members of the 14 member committee that oversees Umoja. He was a member of the local Catholic Church, while other committee members are from the Africa Gospel Churches in the area. We were pleased to see the local churches working together to support the project which remains privately owned by Joseph as far as a title deed to the property.
We have supported this project in the past few years with gifts of money from our prayer partners for construction, clothing, medicines, and school fees. One little boy is HIV positive, and we helped make the arrangements for his care at Tenwek. He is now receiving anti-retroviral drugs [ARVs] which are specifically used for AIDS patients to fight the virus and improve their immune systems. He wasn’t coughing anymore and looked quite a bit better than he had in September. ARVs are now more widely available through outside donations, but there are still difficulties in administering such distribution programs. This boy, Kiplangat, is brought to Tenwek monthly by the director for his tests and drugs, which has involved a small co-pay.
We sat in the director’s office for nearly an hour, hearing and giving speeches [which are translated back and forth], signing the guest book, and drinking chai [tea with milk and sugar]. We were pleased to see that hundreds of people from the local community had visited in the past year. There was also an article from a Nairobi paper with a picture of Juliana. The story told of the work of this children’s home. Perhaps seeds are being planted that will grow into additional similar projects in the future. Local churches and neighbors are bringing some milk and food for the children. This is an answer to our prayers for local people to respond to God’s word concerning the care of orphans.
Currently, the children need shoes and clothing which we will try to take when Alicia and Susanna visit us in March. They will be bringing suitcases filled with these items. Other basic needs include charcoal for cooking as well as food and salaries for the matrons. The head matron has not been given her salary for 7 months. Joseph and the committee would like to have a pump and water line run from a water source to keep the tanks full during the dry season. They say that this would benefit the local community as well. Such a project would cost about $6,000 in USD.
After sitting in the director’s office, we joined the children. They sang several songs for us and introduced themselves. They exhibited beautiful smiles as they sang “Jesus is Near to me”. Most quoted a Bible verse in Kipsigis, although two did so in English; and several said that they loved Jesus. We gave each child a toothbrush and toothpaste. Marty gave instructions how to use the brushes. It was great fun watching them practice. Also we gave each a pencil and a small toy. We had some hackysacks to leave with them. I’m afraid my demonstration was not too impressive, but they will have fun tossing the balls back and forth. It is our desire to share Christ’s love with these children. As we left, Marty passed out “hugs” which surprised the shy children but thrilled most of them.
AHospital Story with a Twist
The big “I’ve never seen that before” case of the week was a case of an abdominal pregnancy, the rarest of all the described cases of ectopic [outside the uterus] pregnancies. Actually, I’ve seen advanced abdominal pregnancies twice before, and that’s where a remarkable coincidence occurs that I will explain later.
Normally, a pregnancy begins when an egg is fertilized in the Fallopian tube. Sperm are swept up the Fallopian tube to meet the egg; but remarkably, after fertilization takes place, the current created by the beating of microscopic hairs [cilia] is reversed and the egg is swept down into the uterus to implant into the prepared lining and begin the growth process that we recognize as a pregnancy. If the tube is damaged from a prior infection or disease process such as endometriosis or even prior surgery, the fertilized egg may implant into the tube and create a tubal pregnancy. This is dangerous because the thin-walled Fallopian tube will eventually rupture when the pregnancy grows too big, usually within a month or two. Last week we described an ectopic pregnancy that had grown in the middle of the uterine wall where it normally doesn’t have access.
An abdominal pregnancy occurs where the fertilized egg is dropped out of the tube and implants on some other structure such as the colon or outside of the uterus. It might occur where the fallopian tube is stuck to some other structure and the pregnancy eats through the tube into the thick walled structure on the other side. Then it can continue to grow until some other catastrophe occurs. These pregnancies have occasionally gone 9 months or beyond, but if the condition isn’t recognized, the baby eventually dies since it has no access to the birth canal to get out. An abdominal incision is needed to get the baby out. The problem then facing the surgeon is getting the placenta [afterbirth] out. Normally it detaches easily from the lining of the uterus and is expelled after the birth of the baby. But if the pregnancy isn’t in the uterus, there is no detachable plane that allows the placenta to be removed. The placenta must be left in place to slowly disintegrate. Mothers often die later because of infection or bowel obstruction since the placenta is often deeply attached to the bowel. Attempting to remove the placenta from non-removable organs usually results in an immediately fatal hemorrhage.
The second case that I saw of an abdominal pregnancy was my final year in residency. I referred to Patty’s case in the first letter written this term as an example of when I had to leave packing behind and re-operate a few days later. We left the placenta inside in that case and Patty had drainage from her incision for over a year afterwards, but survived to live a normal life.
Now you’ll see the incredible circumstances arranged by God. Please bear with the story to its end to see the hand of God at work. The first case of an abdominal pregnancy that I saw was during my freshman of medical school. It was 2 or 3 days before our wedding on Dec.23, 1966. I was at home in Anderson getting ready for the big day when my father said that I should come to the hospital where he worked to see a case of abdominal pregnancy, which I might never see again. This patient of Dr. Donaldson had previously had a hysterectomy with preservation of the uterine cervix. An x-ray had shown the baby growing inside the abdomen. The cervix had become reattached to the Fallopian tube allowing the pregnancy to occur without benefit of a uterus. Doing the surgery that day with Dr. Donaldson was a young general surgeon, Dr. Robert McCurdy. He later became a friend and colleague of mine when I covered my father’s practice in Anderson for six months in 1973. Fast forward now to January 28, 2005 in Kenya. Jacklynn, a mother of seven children, is 17-weeks pregnant with her eighth child. She is carrying a 5 gallon drum of water on her back when she slips on the wet ground. She falls flat on her stomach with the heavy load on her back. She immediately begins having abdominal pain. Nevertheless, there’s work to be done, so she goes on carrying the water and caring for her family. Over the next several days, Jacklynn finds that she has no appetite, and she is only able to drink liquids. Soon she begins to run a fever. By the 8th of February, her situation is becoming desperate. The pain is severe, and the fever is raging. She convinces her husband that she needs to go to the hospital. She walks to Longisa District Hospital. The doctor that sees her wants to do an ultrasound examination, but none is available in the whole district except at Tenwek Hospital. The next day, Jacklynn and her husband catch a matatu to Bomet and then switch to another car going to Tenwek. They come to the ultrasound room with their referral slip. The ultrasound technician, Solomon [aptly named], realizes that something very unusual is going on with Jacklynn and sees immediately that he shouldn’t simply give the report back to the patient to take back to the doctor at Longisa. He knows that they are not equipped to deal with what he is seeing on ultrasound. Jacklynn, who is in severe pain, and her husband, agree to be seen in the emergency department at Tenwek.
Late on Wednesday afternoon, I am called to see Jacklynn. Her abdomen is greatly distended and feels fairly tense. The shape is wrong for pregnancy since most of the bulge is in the center of the abdomen and not correspondingly enlarged on the sides. I take her back to ultrasound and have to agree with Solomon that an abdominal pregnancy is a possibility. [So is a ruptured uterus of nearly two weeks duration.] The ultrasound shows an empty uterus low in the abdomen and a dead baby high in the abdomen surrounded by lots and lots of fluid that is free in the abdomen. Amazingly, Jacklynn has a normal blood pressure and doesn’t look extremely pale. She has a fever and an odor that suggests serious infection. I request that blood be cross matched, three antibiotics be started, and preparations be made for surgery first thing in the morning.
On Thursday morning, I come up to the hospital a bit early to see if everything is ready. No O positive blood is available today, and Jacklynn has a Hemoglobin of only 6.7 mg%. Normal is 12 to 14. I go down the list of units of blood in the bank and find two units of O positive that are assigned to a patient of mine that had surgery two days previous and won’t be necessary for her care. I asked that they be cross matched for Jacklynn. Since this will take an hour, I called for the mother with twins to be brought for her scheduled c-section. Sarafina, the medical intern, and I do that case in the maternity operating room. Then I find that one of the two units matches Jacklynn and we can proceed with her surgery. But first, a sudden emergency D & C needs to be done since the mother is in shock while experiencing a miscarriage. Dr. John Mbogo, the new OBGYN consultant, does that procedure.
Then John Mbogo and I scrub together for Jacklynn’s surgery. We make a midline incision in the lower abdomen and drain out about 3 pints of blood and fluid. It fills a basin quickly. Everything is sort of stuck together as we explore gently to see what we can do. I’m very hesitant to tug and pull on things for fear of a torrential hemorrhage. I find the uterus down in the lower abdomen, but it isn’t ruptured as I expected. No, the placenta is growing out of the top of the uterus and is completely, firmly attached to the outside surface. The abdominal fat pad called the omentum is also attached, and maybe the colon [large bowel] as well. I make the incision higher above the belly button and find the dead baby along with a huge abscess out of which drains foul smelling pus. I feel like the characters in the Southwest Airlines advertisements “Want to get away?”. As I probe the depth of the abscess cavity, the first fresh bleeding begins. Everything we’ve seen so far has been old blood, accumulated over the past two weeks. Now the lonely feeling begins. What in the world do we do next? It’s hard to tell abscess wall from placenta from bowel from who knows what else [liver or spleen?]. What’s beneath what we’re seeing? How can we stop the bleeding that we’ve already started? For the third time since I’ve been here, I can foresee the patient dying on the operating table. Twice before, the patient has survived. Will Jacklynn survive this?
John Mbogo hasn’t seen a case like this before, so I know that I need more help. Normally, I can call Russ White or Mike Chupp for help. Russ has just left for Thailand for nearly a month. Mike has left to teach a class in Nairobi. Fortunately, World Medical Mission has arranged for a retired, visiting surgeon to be here this month. Dr. Robert McCurdy from Alexandria, Indiana is here and available. I know that he’s done this kind of case before – I’ve seen him do it! [Remember, he was the doctor I watched operate on a patient with the same condition 38 years ago.]
Bob graciously scrubs in to assist. He makes the large incision even larger until we can find the location of all the vital organs that I’ve just worried about. They seem to be safe. We tie off some vessels from the ovaries and attempt to tie off the uterine arteries with a blind stitch on either side of the uterus even though the tissues are inflamed and distorted from the infection. We strip away the abscess cavity and it becomes clear that the placenta isn’t attached to anything vital other than the uterus, which can be removed without long term consequences. We tie off the troublesome omentum where it is attached. Then Bob attacks the uterus with a technique quite unlike my normal gynecologic approach. No meticulous dissection of the supplying vessels. Just tie a large knot around a section of the outside of the uterus and cut. Control the back bleeding with a free hand and use the assistant to tie the knots. Definitely more of a team approach than what I use as the only surgically trained individual when I do a case. Speed is of the essence now. We’ve got to chop down to the uterine vessels before we lose what little blood Jacklynn has left. Two IV lines are pouring in IV fluids along with the only unit of blood that is available. The second unit was inexplicably incompatible. Finally, we’ve got both uterine arteries controlled. The bleeding has stopped. The placenta is out. All that remains is stripping away the rest of the abscess and some more irrigation of the tissues to clean out residual debris. Bob closes the abdominal wall with the reinforcement of large retaining sutures that will help the abdomen stay together if the main repair fails. Jacklynn is carted off to ICU.
I check on Jacklynn throughout the day. Her blood pressure has never dropped to the point of instability at any time. Urine is appearing continually in the catheter bag, meaning that her kidneys are working fine. And she is waking up and asking for something to drink! The blood bank finds another unit of blood which we begin right after surgery. After that unit is in, the hemoglobin is over 7. We’re ahead of where we started! Jacklynn remains stable throughout the night and by Friday morning, she is ready to leave the ICU. She is very thankful for all the care she has received. She is grateful to God and to Tenwek. “Asante, Asante.” Thank you, thank you. Asante sana. Thank you very much. I’m sure she would thank World Medical Mission and all of you who pray for us as well.
So we say, Asenteni sana. Thank all of you very much. We are here serving the people of Kenya only in the power of God as mediated through your prayers. So let us continue to partner together in the work until Jesus returns. Please pray for our trip to Nairobi next Friday through Sunday. Please pray for rain for the local farmers.

Paul, for the Jarretts at Tenwek

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.

Jarrett’s Prayer Letter
Volume 6, Number 2
February 5, 2005

Send replies to Jarretts@tenwek.com
Two new photos are posted on our website.

Dear Friends and Family:

We’ve been here for nearly a month now, so I would like to update you on some of our activities and prayer needs. Our patient, Regina, whom I earlier wrote about, is nearly ready for discharge from the hospital. We’ve removed all the tubes and drains, and she has maintained good spirits throughout her stay, but she is glad to be going home. We haven’t heard the pathology report yet, which might show us the need to go back in for more surgery if a malignancy is found.
Thanks for praying for my sermon last Sunday. I finally settled on a message from Chapter 1 of Habakkuk borrowed heavily from a Martyn Lloyd-Jones book, From Fear to Faith. Several people said that they were encouraged by the message. The main theme of the message was God’s control of history, and how He is working to bring together His kingdom before the return of Jesus Christ to the earth. God is still on the throne; He is in control, despite all the apparent chaos in the world. And Christians shouldn’t be discouraged by current events, but should be about their business of serving God in the work that He has called them to. Another theme was how God reveals His will to believers and ways in which he commonly answers our prayers. If anyone is struggling with these issues, I’d be happy to forward a copy of the message to him.
Orphanage Ministry
We’ve visited both Kitoben Vision and Kenduiywa orphanages. We’re pleased with how well the children are doing, and I’ll give you an update on each project. Kitoben Vision is the private orphanage by the Bomet airstrip managed by Alice Langat, a clerk in the business office at Tenwek. She has received some support for the children from some of our prayer support team and is very grateful for your prayers and assistance. There are about 17 children there now, and the numbers go up to nearly 25 during the month when the schools are not in session [April, August, and December]. The children appear healthy and happy. Six siblings have a genetic bleeding disorder, but they have not had major problems.
We took with us two medical students, Cyrene Wright of Chicago and Alyssa Pfister of Nashville, TN, as well as the missionary school teacher, Kimberly veenKandt and a short term volunteer with Community Health, Jan Jackson, of Zionsville, IN with us for the visit. We presented the children with pencils, toothbrushes, hackysacks, and some other toys. We were pleased to see that the children all had shoes and school uniforms which donors had earlier provided. Before they had come to the orphanage, the children who had been staying with guardians would have lost these items, as the guardians were taking the items and selling them.
Alice still hopes to purchase adjacent acreage for pasture and garden space. The mentally ill sister who helps with cooking has been doing well. It seems to be a satisfactory arrangement for this individual to both heal and serve others at the same time. Please continue to pray for these children and their care givers.
When I last visited the Kenduiywa orphanage, it was in August and they had just had their official dedication. They opened shortly afterwards and now have 15 children living at the home with a matron, a woman from the local church. There are many things that excite me about this facility. I mentioned earlier how the leadership from the local church had taken the initiative to begin the project without waiting for outside assistance. I had brought some money to finish the construction. They recently held a fundraiser for ongoing expenses that was very helpful to them. This local church doesn’t have a church building to meet in, but they decided that God was calling them to build the orphanage first. Virtually every other local church makes the building of the church building as their first priority; people are always asking for donations for assistance in completing these buildings.
Another exciting thing connected with this facility is the presence of Jaclyn, an orphan who is also a new high school graduate whom we assisted through the Tenwek Area Education Fund channeled through the Christian Foundation of Indiana. Jaclyn wanted to give back to others in thankfulness for the help that she received, so she is assisting the matron as an unpaid volunteer. Recently, one of the children was at Tenwek for abdominal surgery. When the child returned, he still was sick, so Jaclyn stayed with him continually. One night, he cried throughout the night with pain, so Jaclyn carried him a mile down the road to David Koech’s house. David, a local school headmaster, is one of the directors of the orphanage. He made arrangements to bring him to Tenwek where the boy needed a second surgery. Jaclyn stayed with him as a mother would do and comforted him during his hospitalization.
Yesterday, David Kilel, Laura, Rachel, and I went out to the Kenduiywa home along with Cyrene [pronounced Serena] Wright to visit the orphans. Cyrene is working with me on the OB service. We stopped first in Silobwet to pick up Jaclyn and an orphan whom she had taken the six miles into town. We waited a few minutes while he finished his haircut. We then bounced along the rocky, hilly road to the orphanage in our Pajero. What a blessing this 1991 vehicle continues to be to our family! God had laid it on the heart of some friends to give us the vehicle when we weren’t really sure if we needed one. But God knew that He wanted us involved with orphans, and a personal 4-wheel drive car is really the only way to get around most of these places.
We picked up David Koech at his school and arrived at the orphanage about 4 o’clock. Eight of the children were there including the boy who had been sick. We met the matron, Helen, who also teaches some of the younger children who are too young for primary school. She explained that some of the children were still at school and others went about a half mile straight downhill to the river to get water. As we were talking in the yard, David told me to step aside for the donkey. I usually don’t pay much attention to the animals around us as they usually stand around and don’t come near me. But I was on this fully loaded donkey’s path to the kitchen where she would be relieved of the two five-gallon cans of water from her back. I stepped aside as she made a beeline for the cooking shed, where she promptly laid down to await the unloading process. [I'm not sure which is more amazing, the donkeys or the women who load them. At 3 pm right before we came, I had examined a woman who had ruptured her membranes at 19 weeks gestation while lifting a 190 lb. bag of corn onto a donkey. The baby's cord had then fallen out which caused his death.]
We were given a brief tour of the five rooms at the orphanage and then served chai [tea] and chapattis [pancakes]. We weren’t hungry, and we had a full dinner waiting for us at home, but we were obligated to take a few. Everyone gave speeches, and then all 15 of the orphans came in, the rest having arrived from school. Cyrene presented them with toys [stuffed animals, Barbie dolls, yo-yo's – all rejects from a Chicago charity which had been unable to find children who wanted them. We gave them pencils, toothbrushes, and the three hackysacks which Laura impressively juggled for them. At least, I was impressed, since I never learned to juggle anything. She learned the trick on her Japan trip.
The children had been unhealthy when they first came. But four months of good nutrition had made quite a difference. They still need some school uniforms, but are otherwise well clothed. They have blankets for their beds, which are very much needed on the top of this windy hill. The temporary buildings are made of wood slats, and the cracks do allow the cold into the rooms which are unheated. Even though we're near the equator, at 7000 feet above sea level, it is cold on top of these hills. Please check out the picture of these orphans on our website. You can see the high hills around the area. Pictured are several orphans with David Koech, Helen [the matron], and Jaclyn who is holding her Bible which she was carrying with her when we picked her up in Silobwet.
The other picture shows the children sitting in the dining/multipurpose room where we gave them their presents. Cyrene gave them a little talk about dreaming big because we serve a big God. She has derived this message from growing up poor in inner city Chicago. She is now a senior medical student and will graduate in June. She wants to take an OBGYN residency at Cook County in Chicago. She raised money for her trip by standing outside Wal-Mart soliciting donations while telling people of her dream to come to Africa to work for this elective two-month rotation.
The dream for Kenduiywa is to build a permanent stone dormitory. I think it is good that they have begun small, because it has taken time for the vision to take hold in people’s minds. At first the local people didn’t want the orphans around as orphans are viewed as outcasts by many in this society. They didn’t understand the concept of caring for them in a designated place. More often, they’re taken in by relatives, often as second class children. Now the local people are bringing corn and beans to feed them. One of the male teachers at David Koech’s school comes in the evening to give further instruction since many are behind in school. While we were there, the watchmen brought in a big bag of corn on a donkey that a church several miles away had donated. I read the guest book. Many people have stopped to visit since the facility opened. Several neighbors stopped in while we were there. The vision to care for orphans is catching on!
Hospital Work
Work at the hospital has been busy as usual. I haven’t reaped the benefit of extra help yet. The recent graduate of the OB program was traveling and then recovering from a back injury most of the time since I came. We’ve worked together only three days so far. The second year OB resident won’t get to come until March, if then. I have appreciated having both a medical officer intern and clinical officer intern with me as well as Cyrene and a junior medical officer staff member, Kays Muruka on the rotation. It is wonderful to have the extra help, although it increases the teaching responsibilities. But that’s part of the reason that I’m here as well, so I welcome that opportunity to have an impact on the lives of these young people in training. Their abilities vary quite a bit and that is part of the challenge – to make sure that they meet the national standards of competence when they finish the rotation. The MO intern is Sarafina, the first Turkana intern whom the hospital has had. The Turkana people live in the desert northern areas of Kenya. She is a very sweet girl who trained at Moi University in Eldoret. The CO intern is Charles, a Kipsigis who trained in Tanzania. I also had a CO student from that school, Shadrach, with us for the past two weeks.
The unusual hospital case of the week (not on our service) was an 8-year-old child who was attacked by a hyena. Sarafina got to take care of him when he came in. The x-ray showed the femur bone broken completely through by the bite. The hyena dragged him off a ways before men were able to rescue him. Three men were also bitten before killing the hyena. This aggressive behavior is very suspicious of rabies for which Sarafina treated the boy as well as getting him to surgery for the leg wound. We hope that the men who went to Narok district hospital instead of Tenwek for their more minor wounds were treated for rabies as well, or their scratches may prove fatal.
The following story will be most appreciated by medical readers. It gets a bit graphic and very technical, so squeamish people may want to fast forward.
My “I’ve never seen that before” case this week was Margaret, a 45-year-old woman who came in with complaints of bleeding and abdominal pain. She hadn’t had a menstrual period for an entire year, but she had a positive pregnancy test. There was an irregular shaped mass in her abdomen coming up to her belly button from the pelvis. An ultrasound is usually helpful in sorting out such a case, but it just made us more confused. The uterus wasn’t in the pelvis – it was pushed up high on the left side of the abdomen. There was a large mass deep in the right side of the pelvis that looked like an old pregnancy of about 14-15 weeks size, but there was no baby inside and the amniotic sac [if it was an amniotic sac] was very small. The pregnancy wasn’t in the uterus, but it also seemed to be connected to the uterine cavity at about the middle of the uterus—not a place where it could be in the tube or ovary. I had trouble coming up with a good diagnosis. Both trophoplastic disease [placenta cancer] and an old uterine rupture came to mind, but neither seemed to fit exactly. There was a small amount of blood free in the abdominal cavity, so we knew this was an operative case. We prepared two units of blood to give if needed.
The pre-operative hemoglobin was low, so we began one unit of blood as we started surgery. Even the opening incision was strange in this case. There was blood under the muscle layer before entering the inner peritoneal cavity. That meant she had been bleeding into tissue planes underneath the surface lining [retro-peritioneal], rather than freely into the abdomen. After we opened the abdomen completely, I still wasn’t sure what was wrong. The uterus was enlarged and pushed up by this large mass in the right broad ligament [the usually thin support ligament under another supportive ligament called the round ligament which in this case ran over the top of the mass. The tube and ovary on the right were pushed up out of the way as well, but didn't seem to be involved; if this was an ectopic pregnancy, it didn't start in the tube where it usually does. What in the world was going on? We had started the case with prayer as usual, but I stopped and prayed for wisdom on how to proceed.
I started a hysterectomy on the left side of the uterus. Normally, I may lose about 5 ounces of blood on a routine hysterectomy. I thought if I could get three of the four main arteries tied off, then I would have a decent chance of getting the mass and uterus out without much blood loss, but that strategy seemed to be flawed as heavy bleeding immediately began from the left side of the uterus [we're talking a fountain that sprayed up into my face and up to the overhead lights] Even after the two left side arteries were clamped and tied, the bleeding was still far too heavy. I stopped to clean off my glasses so that I could see. I tied off the artery coming into the right ovary with no effect on the bleeding whatsoever. Packing was slowing, but not controlling the bleeding. We were down about 2 pints of blood. The last artery was under this huge grapefruit sized mass.
I recalled that the mass seemed to connect with the interior of the uterus. I normally wouldn’t even see inside the uterus in a routine hysterectomy until I had removed the uterus completely and then checked it as a pathology specimen off of the operating table after finishing the surgery. This really didn’t look like a cancer, so it must be somehow a rupture of the uterus. I made a classical [high vertical] c-section type of incision into the bleeding uterus after I had pushed the bladder down out of the way. I could then see a small part of the pregnancy coming out of the right wall of the uterus. I grabbed the part of the mass that I could see and pulled it up. I then just pushed my finger and then my hand into the hole it had come out of and grabbed the grapefruit-size pregnancy mass and pulled it out. I shoved a pack back down in and then clamped and cut the torn uterine wall on either side. Then I found the right uterine artery pumping away and clamped it. Suddenly the case was under complete control.
I pulled out my pack and saw that there was no bleeding in the broad ligament. I could see the right ureter completely exposed but lying uninjured at the bottom of the ligament. It was a simple matter of cutting off the top of the uterus as in a uterine rupture case. I opened the mass up to see that it was an old pregnancy with a complete amniotic sac but no baby inside, just like the sonar suggested. But where had this pregnancy originated? It clearly hadn’t started in the uterus, and it hadn’t started in the tube. It wasn’t in a blind horn of a double uterus. It wasn’t in the tubal portion of the uterus. It had to have started in the middle of the side wall of the uterus. The only way that I can think that it could have gotten there in the first place was to have implanted into a section of the uterine wall affected by an unusual condition called adenomyosis, where a network of endometrial glands work their way into the wall of the uterus. Usually this condition is recognized because of bad menstrual cramps. It is more common in women in their 40’s than in the decades preceding this. I couldn’t find this condition mentioned in my obstetrics textbook, but I think it’s the only logical explanation for such a late presentation of an ectopic pregnancy that finally ruptured back through the uterine wall as well as into the broad ligament instead of into the peritoneal cavity.
The good news in this case is not only that Margaret survived the surgery, but she prayed to receive Christ with one of our chaplains after her surgery. So she not only gave birth to a year-old pregnancy with no baby, she received a new birth in Christ as well.
Prayer Concerns
Please continue to pray for Mrs. P, whom I mentioned in the last letter. Her situation seems most desperate as her husband has now found another woman, a widow with 5 children that he wants to marry. He sent one of the widow’s sons over to Mrs. P’s house to stay and get some things from the house and garden. He’s taken all the money from the farm, which he wants to sell out from under Mrs. P, Y, and the 2 sons who live there. His mind seems to be very warped. It’s difficult to know how to pray in such a situation, other than for God’s will to be done and for His protection over Mrs. P and her family. Laws that protect people in such situations either don’t exist or aren’t enforced here.
We would appreciate your prayers for wisdom of how to help the young man, Geoffrey, whom we have known for better and worse for six years. He needs school fees to start high school but doesn’t really qualify for the Tenwek Education fund since he has a single mother who is living. At least there are more than 50 actual orphans ahead of him on the waiting list. Geoffrey’s behavior has been very good for the past two years, and he has done well in primary school. We hate to see him idle in the area around where there are such temptations that can easily corrupt a young man. It would cost about $300 to send him to school for this year.
Please pray for the Tenwek Area Education Fund to be built up enough to support the many needy children in school or vocational training. The pastors’ committee is meeting this coming week, but it seems to be inclined to hold the number of children enrolled at about 56. Since some have graduated, more will be accepted, but many will be left out.
Personal Ministries
Marty and Rachel are volunteering at Community Health each week counting and packaging medicines to be taken to villages. Laura continues to volunteer in the physical therapy clinic and do much babysitting to help missionary families. She will also be a teacher for the older children at the World Gospel Mission retreat in Mombassa in April.
Marty doesn’t have the responsibility of guest house hostess this year. She has been leading a Bible study for two young house helper women and has started an accountability group for missionary wives that has been very meaningful to her. She’s also had more time for personal Bible study this term. Of course, she has the responsibility of caring for me and hosting meals for visiting staff.
We have been doing a study as a family on godliness. 1 Timothy 4:8 reminds us of the importance of training for godliness (part of this training involves studying God’s word, trusting, and obeying Him.) 1 Tim 4:8 For physical training is of some value, but godliness has value for all things, holding promise for both the present life and the life to come. NIV
Thank you for your prayers and support. We feel very blessed to have the opportunity of serving the Lord with you here at Tenwek.
Paul, for the Jarretts in Kenya