MISSION: RESOURCES you'll be glad you knew about

Below I have provided some valuable resources that I found both prior, during, and after my recent trip to Uganda. If something like this is in your future, then I think you will find some helpful information here. Most of this is available FREE by clicking the links I have provided.

MISSION VIDEO
At the 2007 Missionary Medicine Seminar, Dr. Bob Cropsey, a missionary surgeon from Togo, presented an excellent 3 minute video of quotes from missionaries, theologians, and others that lays the foundation for why Christians should be serving in medical missions. Watch this and be encouraged about your missionary endeavor.

Quotes from missionaries and about missions abound on the web. Great for donation letters, thank you cards, and mission presentations. Here are a few:MISSION QUOTES #1,MISSION QUOTES #2,MISSION QUOTES #3,MISSION QUOTES #4

HANDBOOK FOR SHORT TERM MEDICAL MISSIONARIES
If you pick up one thing to read prior to going on a medical missionary trip, PICK UP THIS. This is hands down the most helpful and practical work written on medical missions. Bruce and Mickey Steffes have left no topic unexplored in this tremendous guidebook. Reading this before my recent trip to Uganda saved me a lot of headaches and prepared me for the trip in innumerable ways. Can't recommend this enough....GET THIS! READ THIS!

MISSIONARY MEDICINE SEMINAR

Recognizing the need for Third World-oriented Continuing Medical Education (CME), Samaritan's Purse / World Medical Missions, Inc. created the Missionary Medicine Seminar in 1996 with the intent to prepare physicians, dentists, nurses, and other allied healthcare professionals for volunteer service at missionary hospitals around the world. Each seminar is designed to equip course participants with the essential knowledge necessary to appropriately manage common disease processes and injuries, even if this means crossing medical disciplines. Emphasis is placed on the practical aspects of diagnosis and treatment using limited resources. The Missionary Medicine Seminar takes place each October as part of the Prescription for Renewal conference at the Billy Graham Training Center at the Cove in Asheville, North Carolina. Focusing on medical diagnosis and treatment, this site is a wealth of information for medical professionals going abraod. You can download notes, powerpoint presentations, and audio from previous seminars starting in 1997.

UGANDA INFO FROM CENTER FOR DISEASE CONTROL

Visit here early on to find out everything you will need to know regarding travel notices, safety and security, things to keep in mind when preparing for travel, diseases and vaccinations, tips on staying healthy while in the country, things to keep in mind when returning home, etc. An invaluable resource not to be missed!

UGANDA INFO FROM US STATE DEPARTMENT

Consular information sheet from the US State Department. Focused from the perspective of an American traveling abroad, this site provides information on entry/exit requirements, safety and security, crime prevention, embassy information, etc.

OPPORTUNISTIC INFECTIONS TRAINING MANUAL

This ~170 page manual is a comprehensive guide on HIV/AIDS and associated opportunistic infections (OIs). Obtained from the Joint Clinical Research Center in Uganda, this training manual is very comprehensive in scope with detailed information on the diagnosis and treatment of OIs.

CDC YELLOW BOOK

The increase in global travel makes us ever more mindful of the importance of staying healthy while traveling. CDC Health Information for International Travel (the Yellow Book) was developed to provide up-to-date and comprehensive information on immunization requirements and health recommendations to protect and promote the health of international travelers. The Yellow Book is published every two years by CDC as a reference for those who advise international travelers of health risks. The Yellow Book is written primarily for health care providers, although others might find it useful. At this site there is a searchable directory and all chapters can be downloaded.

HESPERIAN FOUNDATION

The Hesperian Foundation is a non-profit publisher of books and newsletters for community-based health care. Our first book, Where There Is No Doctor, is considered to be one of the most accessible and widely used community health books in the world. Simply written and heavily illustrated, Hesperian books are designed so that people with little formal education can understand, apply and share health information. Developed collaboratively with health workers and community members from around the world, our books and newsletters address the underlying social, political, and economic causes of poor health and suggest ways groups can organize to improve health conditions in their communities. In addition, Hesperian relies on a multi-faceted distribution strategy to ensure our materials reach those who need them most. Downloadable books include:
A Community Guide to Environmental Health, Where There Is No Doctor, Where Women Have No Doctor, A Book for Midwives, A Health Handbook for Women with Disabilities, HIV Health and Your Community, Helping Children Who Are Blind, A Worker's Guide to Health and Safety, Cholera Prevention Fact Sheet, Sanitation and Cleanliness for a Healthy Environment, Water for life, Safe Handling of Health Care Waste, Women's Health Exchange, Global Health Watch 2005-2006, Global Health Watch 2, Where There Is No Dentist

BRADT TRAVEL GUIDE - UGANDA

As well as giving a wealth of practical information, this guide details every aspect of Uganda’s tourist infrastructure, from national parks and gorilla reserves to Lake Victoria and the Ssese Islands, making it an essential, up-to-date guide for any visitor to the region. Mostly geared for the tourist, but this book includes a large introductory section with a wealth of information on Uganda's culture, history, politics, and wildlife.

OXFORD FIELD GUIDE TO TROPICAL MEDICINE

Delivering the facts to your fingertips, the “Oxford Handbook of Tropical Medicine” provides an accessible and comprehensive, signs-and-symptoms-based source of information on medical problems commonly seen in the tropics. A handy guide which can fit in the coat pocket and be used easily at the bedside, it has been designed to be as practical as possible with illustrations of blood films and stool smears, which are useful for diagnosis, as well as clinical features, diagnosis, and management. Medical conditions are ordered by system except for the five major tropical conditions--malaria, HIV/STIs, tuberculosis, diarrhoeal diseases, and acute respiratory infections--and fevers. In this new edition the sections on malaria, cardiology, chest medicine, gastroenterology, mental health and dermatology have undergone major revision, and there is new material on altitude sickness, heat stroke, avian flu and fuller poisoning. There is a greater emphasis on pediatric medicine and public health throughout, and new illustrations and photographs have been included to aid with diagnosis. Small enough to throw in your rucksack, this unique handbook is the ultimate quick reference guide for all those working in the tropics.

INFECTIOUS AND TROPICAL DISEASE - A HANDBOOK FOR PRIMARY CARE

This practical reference provides a single, concise source of current information on the diseases and conditions common among immigrants, refugees, travelers, and persons in contact with these populations in the developed world. An easy-to-use format makes this reference ideal for primary care and other providers in a variety of clinical settings. It also features content on agents that may be used as biological warfare. * Diseases and conditions are arranged in alphabetical order for quick reference. * Concise discussions of 93 infectious diseases and conditions of immigrants, refugees, travelers, and those in contact with these populations * The ability to search by either signs and symptoms, geographic area, or diseases and disorders. * A discussion on emerging infectious diseases and why they are an important health issue. * An overview of the physical diagnosis of these diseases. * Approaches to diagnosing newly arrived immigrants and refugees. * Strategies for pre-travel counseling and immunizations. * Information on primary geographic distribution, agent and vector, incubation, clinical findings and treatment, signs and symptoms, complications, common laboratory findings, diagnosis, differential diagnosis, treatment, prevention, and reporting.

UGANDA MAP by NELLES

Folded road and travel map in color. Traces six different kinds of highways and roads, shows road numbers and railway lines. Places of interest are marked directly on the map: airports, archeological sites, lodges and campsites. beaches and water recreation areas, as well as national parks. Exquisitely subtle relief shading makes this map resemble an aerial photo. Includes a city plan of central Kampala that includes markets, shopping centers, places to stay, embassies, places to worship and important buildings. I purchased mine in the airport in Entebbe for $12, but you can purchase online before you go for cheaper. Great for following along as you travel about the country.

NEWS: University bible fellowship takes health to Lyantonde

Sunday, 22nd February, 2009 NEW VISION

Doctors prepare to offer treatment to the residents of Lyantonde

By Stephen Senkaaba

NUWAMANYA Tessa a resident of Lyantonde, has a child sick of malaria. She is also ill and yet for the last five days, they have failed to obtain treatment.

This soon changed when a team of doctors from the University Bible Fellowship (UBF) visited Lyantonde district. UBF is an evangelistic organisation focused on social development through preaching and reaching out to disadvantaged communities.

The visit organised in collaboration with Bethesda Mission Clinic, a Makerere-based mission health unit, is part of UBF’s annual Medical Mission outreach.

The Project was launched in the district three years ago. Between January 26 and 28, a team of 21 medical personnel including physicians, general surgeons, paediatricians, orthopedic surgeons, oncologists family doctors and dentists visited the district.

Part of the team comprised of medical personnel from the US, Germany and Korea’s Kwangju province.

The team included a senior consultant paediatrician, an intensive care unit nurse and an internal medicine specialist from the USA, a paediatrician, a chest physician, oncologists, anesthesiologist, pharmacist from Uganda and other specialists from Germany.

Working hand in hand with a local organisation, Integrated Community Development, the doctors offered treatment and medical advice to hundreds of patients and performed numerous surgical operations.

In the paediatric clinic, doctors carried out monitoring and evaluation of malnourished infants, vitamin A supplementation and deworming.

As the doctors attended to patients in Lyantonde hospital, some members of the medical team visited villages. They visited vulnerable HIV orphaned households and set up a clinic at Kitazigolokolwa village. David Gumisiriza, the village chairman said “We are thankful that the help rendered has gone beyond the three-day medical assistance.”

With a population of 74,000 people, the district has one hospital and 22 health care units, 12 of which are private clinics.

According to Dr Katumba Ssentongo, the district health officer, the hospital also serves the areas of Kooki, Kakyera, Kyazanga, Nyabushozi, Kiruhura, Rwemiyaga, among others.

With an annual budget of sh437m, the district cannot sufficiently meet its health care targets which is estimated at twice as much as the funds they have received.

The district faces an acute shortage of staff. “We have a third of the workforce needed. Out of 363 health workers we need, we have 122,” says Dr. Katumba.

He said the district has only four doctors out of the required nine, four registered nurses out of the required 40, four registered midwives out of the required 12 and nine clinical officers.

The district lacks Xray, CT scan and ultrasound machines. Compounded by the devastating effects of HIV/AIDS, the community in Lyantonde faces an acute problem of poverty.

Whereas 11% of the population is orphans, 65% of whom lost their parents to HIV/AIDS, 36% of these orphans are living under the care of their elderly grandparents.

Even when extended families try to care for AIDS orphans, many are unable to cope financially. The majority of the orphans are forced to fend for themselves.

Young girls bear much of the domestic responsibilities, including caring for their younger siblings.

Such conditions have led to a desperate cry for help among the local people.
“We are overwhelmed,” the Lyantonde LC chairman, Nayebare Kyamuzigita says. Every day we receive two to three accident cases and yet we do not have the necessary facilities.

Despite the challenging circumstances, the doctors reported a positive response. “Most operations were successful, said Dr. Specky Mbula from Mulago. She said: “The service was friendly, quick and timely.”

Dr. Hannah Kim was very excited at the opportunity of being one of the volunteers this year. “I was happy to be part of this team but I saw there are too many patients. I noticed that even with limited drugs, there can still be a difference,” she said.

Karen Bahirwe a 25-year-old mother was very thankful after receiving medication for both herself and her son. She confessed however that even though the treatment was good and timely, it was not sustainable.

Dr. Maria Keller, a dentist from Germany, said there was no time to educate the people about oral hygiene because the patients were too many.

Dr. Titus Keller from UBF Germany, observed that more needs to be done to create awareness and educate the residents about basic health issues.

Dr. Samuel Zun from Cincinnati, USA, called for Government support. “More collaboration with the community groups and medical doctors will all be needed if the objective of reaching rural communities is to be achieved,” he said.

MEDICAL: MALARIA - a crash course in transmission, diagnosis, and treatment on the mission field

MALARIA - A CRASH COURSE

Since malaria and its complications were probably the most prevalent medical condition that we saw in Kiburara and a condition that future trips to this area of the world will not doubt encounter, I thought that it would be appropriate to post a "crash course" on malaria here for reference. I wish that I would have read all of this prior to the mission trip as it would have helped tremendously as those suffereing from this disease came for treatment. Most of the information presented here has been excerpted from the CDC website or Wikipedia. I have concentrated on posting information here that is relevant to sub-Sahran Africa and medical missions. This is very long! but I wanted to post everything that I felt relevant

OUTLINE OF POST

What is Malaria?.....How is it Transmitted?.....Where does Malaria Occur?.....Symptoms and Presentation.....Uncomplicated Malaria.....Severe Malaria.....Malaria Relapses.....Other Manifestations of Malaria.....How Malaria Affects People's Health.....Clinical Diagnosis....."Presumptive Treatment".....Microscopic Dignosis.....Social and Economic Toll.....Our Treatment of Malaria in Kiburara 2009.

_________________________________

What is Malaria?

Malaria is a serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans. People who get malaria are typically very sick with high fevers, shaking chills, and flu-like illness. Four kinds of malaria parasites can infect humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. Infection with P. falciparum, if not promptly treated, may lead to death. Although malaria can be a deadly disease, illness and death from malaria can usually be prevented.

Malaria is one of the most severe public health problems worldwide. It is a leading cause of death and disease in many developing countries, where young children and pregnant women are the groups most affected. The World Health Organization estimates that each year 300-500 million cases of malaria occur and more than 1 million people die of malaria, especially in developing countries. Most deaths occur in young children. About 60% of the cases of malaria worldwide and more than 80% of the malaria deaths worldwide occur in Africa south of the Sahara. In Africa, a child dies from malaria every 30 seconds. Because malaria causes so much illness and death, the disease is a great drain on many national economies. Since many countries with malaria are already among the poorer nations, the disease maintains a vicious cycle of disease and poverty.

_________________________________

How is malaria transmitted?


Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito's saliva and are injected into the person being bitten.


Because the malaria parasite is found in red blood cells of an infected person, malaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her unborn infant before or during delivery ("congenital" malaria). Malaria is not spread from person to person like a cold or the flu, and it cannot be sexually transmitted. You cannot get malaria from casual contact with malaria-infected people, such as sitting next to someone who has malaria.

For most people, symptoms begin 10 days to 4 weeks after infection, although a person may feel ill as early as 7 days or as late as 1 year later. Two kinds of malaria, P. vivax and P. ovale, can occur again (relapsing malaria). In P. vivax and P. ovale infections, some parasites can remain dormant in the liver for several months up to about 4 years after a person is bitten by an infected mosquito. When these parasites come out of hibernation and begin invading red blood cells ("relapse"), the person will become sick.


Plasmodium falciparum causes severe and life-threatening malaria; this parasite is very common in many countries in Africa south of the Sahara desert. People who are heavily exposed to the bites of mosquitoes infected with P. falciparum are most at risk of dying from malaria. People who have little or no immunity to malaria, such as young children and pregnant women; or travelers coming from areas with no malaria, are more likely to become very sick and die. Poor people living in rural areas who lack knowledge, money, or access to health care are at greater risk for this disease. As a result of all these factors, an estimated 90% of deaths due to malaria occur in Africa south of the Sahara; most of these deaths occur in children under 5 years of age.

Persons most vulnerable are those with no or little protective immunity against the disease. In areas with high transmission (such as Africa south of the Sahara), the most vulnerable groups are: young children, who have not yet developed immunity to malaria; pregnant women, whose immunity is decreased by pregnancy, especially during the first and second pregnancies; and travelers or migrants coming from areas with little or no malaria transmission, who lack immunity.

________________________________

Where does malaria occur?

Malaria typically is found in warmer regions of the world -- in tropical and subtropical countries. Higher temperatures allow the Anopheles mosquito to thrive. Malaria parasites, which grow and develop inside the mosquito, need warmth to complete their growth before they are mature enough to be transmitted to humans.


Malaria occurs in over 100 countries and territories. More than 40% of the world's population is at risk. Large areas of Central and South America, Hispaniola (the Caribbean island that is divided between Haiti and the Dominican Republic), Africa, South Asia, Southeast Asia, the Middle East, and Oceania are considered malaria-risk areas. Travelers to sub-Saharan Africa have the greatest risk of both getting malaria and dying from their infection. However, all travelers to countries with malaria risk may get this potentially deadly disease.

In Africa south of the Sahara, the principal malaria mosquito, Anopheles gambiae, transmits malaria very efficiently. The type of malaria parasite most often found, Plasmodium falciparum, causes severe, potentially fatal disease. Lack of resources and political instability can prevent the building of solid malaria control programs. In addition, malaria parasites are increasingly resistant to antimalarial drugs, presenting one more barrier to malaria control in that continent.

_________________________________

Symptoms and Presentation

Following the infective bite by the Anopheles mosquito (the "incubation period") goes by before the first symptoms appear. The incubation period in most cases varies from 7 to 30 days. The shorter periods are observed most frequently with P. falciparum and the longer ones with P. malariae.

Antimalarial drugs taken for prophylaxis by travelers can delay the appearance of malaria symptoms by weeks or months, long after the traveler has left the malaria-endemic area. (This can happen particularly with P. vivax and P. ovale, both of which can produce dormant liver stage parasites; the liver stages may reactivate and cause disease months after the infective mosquito bite.)

Such long delays between exposure and development of symptoms can result in misdiagnosis or delayed diagnosis because of reduced clinical suspicion by the health-care provider. Returned travelers should always remind their health-care providers of any travel in malaria-risk areas during the past 12 months.

________________________________

Uncomplicated Malaria

The classical (but rarely observed) malaria attack lasts 6-10 hours. It consists of:

1) a cold stage (sensation of cold, shivering) .....2) a hot stage (fever, headaches, vomiting; seizures in young children).....3) a sweating stage (sweats, return to normal temperature, tiredness)

Classically (but infrequently observed) the attacks occur every second day with the "tertian" parasites (P. falciparum, P. vivax, and P. ovale) and every third day with the "quartan" parasite (P. malariae).

More commonly, the patient presents with a combination of the following symptoms:

Fever.....Chills.....Sweats.....Headaches.....Nausea and vomiting.....Body aches.....General malaise

In countries where cases of malaria are infrequent, these symptoms may be attributed to influenza, a cold, or other common infections, especially if malaria is not suspected. Conversely, in countries where malaria is frequent, residents often recognize the symptoms as malaria and treat themselves without seeking diagnostic confirmation ("presumptive treatment").

Physical findings may include:

Elevated temperature.....Perspiration.....Weakness.....Enlarged spleen.

In P. falciparum malaria, additional findings may include:

Mild jaundice.....Enlargement of the liver.....Increased respiratory rate.

Diagnosis of malaria depends on the demonstration of parasites on a blood smear examined under a microscope. In P. falciparum malaria, additional laboratory findings may include mild anemia, mild decrease in blood platelets (thrombocytopenia), elevation of bilirubin, elevation of aminotransferases, albuminuria, and the presence of abnormal bodies in the urine (urinary "casts").

_________________________________

Severe Malaria

Severe malaria occurs when P. falciparum infections are complicated by serious organ failures or abnormalities in the patient's blood or metabolism.

The manifestations of severe malaria include:

Cerebral malaria, with abnormal behavior, impairment of consciousness, seizures, coma, or other neurologic abnormalities.....Severe anemia due to hemolysis (destruction of the red blood cells).....Hemoglobinuria (hemoglobin in the urine) due to hemolysis.....Pulmonary edema (fluid buildup in the lungs) or acute respiratory distress syndrome (ARDS), which may occur even after the parasite counts have decreased in response to treatment.....Abnormalities in blood coagulation and thrombocytopenia (decrease in blood platelets).....Cardiovascular collapse and shock

Other manifestations that should raise concern are:

Acute kidney failure.....Hyperparasitemia, where more than 5% of the red blood cells are infected by malaria parasites.....Metabolic acidosis (excessive acidity in the blood and tissue fluids), often in association with hypoglycemia.....Hypoglycemia (low blood glucose).

Severe malaria occurs most often in persons who have no immunity to malaria or whose immunity has decreased. These include all residents of areas with low or no malaria transmission, and young children and pregnant women in areas with high transmission.
In all areas, severe malaria is a medical emergency and should be treated urgently and aggressively.

_________________________________

Malaria Relapses

In P. vivax and P. ovale infections, patients having recovered from the first episode of illness may suffer several additional attacks ("relapses") after months or even years without symptoms. Relapses occur because P. vivax and P. ovale have dormant liver stage parasites that may reactivate. Treatment to reduce the chance of such relapses is available and should follow treatment of the first attack.

________________________________

Other Manifestations of Malaria

Neurologic defects may occasionally persist following cerebral malaria, especially in children. Such defects include troubles with movements (ataxia), palsies, speech difficulties, deafness, and blindness. Recurrent infections with P. falciparum may result in severe anemia. This occurs especially in young children in tropical Africa with frequent infections that are inadequately treated.

Malaria during pregnancy (especially P. falciparum) may cause severe disease in the mother, and may lead to premature delivery or delivery of a low-birth-weight baby. On rare occasions, P. vivax malaria can cause rupture of the spleen or acute respiratory distress syndrome (ARDS).
Nephrotic syndrome (a chronic, severe kidney disease) can result from chronic or repeated infections with P. malariae. Hyperreactive malarial splenomegaly (also called "tropical splenomegaly syndrome") occurs infrequently and is attributed to an abnormal immune response to repeated malarial infections. The disease is marked by a very enlarged spleen and liver, abnormal immunologic findings, anemia, and a susceptibility to other infections (such as skin or respiratory infections)

_________________________________

How Malaria Affects People's Health

Malaria can affect a person's health in various ways. People who have developed protective immunity (through past infections, as is the case with most adults in high transmission areas) may be infected but not made ill by the parasites they carry. In most cases, malaria causes fever, chills, headache, muscle ache, vomiting, malaise and other flu-like symptoms, which can be very incapacitating.

Some persons infected with Plasmodium falciparum can develop complications such as brain disease (cerebral malaria), severe anemia, and kidney failure. These severe forms occur more frequently in people with little protective immunity, and can result in death or life-long neurologic impairment.

People subjected to frequent malaria infections (such as young children and pregnant women in high transmission areas) can develop anemia due to frequent destruction of the red blood cells by the malaria parasites. Severely anemic patients might receive blood transfusions which, in developing countries, can expose them to HIV and other bloodborne diseases.

Babies born to women who had malaria during their pregnancy are more often born with a low birth weight or prematurely, which decreases their chances of survival during early life
In developing countries, the harmful effects of malaria may combine with those of other highly prevalent diseases and conditions, such as malnutrition, HIV/AIDS, and anemia of all causes. Such combinations can have severe results, especially if they occur repeatedly.

________________________________

Clinical Diagnosis

Malaria must be recognized promptly in order to treat the patient in time and to prevent further spread of infection in the community. Malaria can be suspected based on the patient's symptoms and the physical findings at examination. However, for a definitive diagnosis to be made, laboratory tests must demonstrate the malaria parasites or their components.

Diagnosis of malaria can be difficult. In some areas, malaria transmission is so intense that a large proportion of the population is infected but not made ill by the parasites. Such carriers have developed just enough immunity to protect them from malarial illness but not from malarial infection. In that situation, finding malaria parasites in an ill person does not necessarily mean that the illness is caused by the parasites.

In many malaria-endemic countries, lack of resources is a major barrier to reliable and timely diagnosis. Health personnel are undertrained, underequipped and underpaid. They often face excessive patient loads, and must divide their attention between malaria and other equally severe infectious diseases such as pneumonia, diarrhea, tuberculosis and HIV/AIDS.

Clinical diagnosis is based on the patient's symptoms and on physical findings at examination.
The first symptoms of malaria (most often fever, chills, sweats, headaches, muscle pains, nausea and vomiting) are often not specific and are also found in other diseases (such as the "flu" and common viral infections). Likewise, the physical findings are often not specific (elevated temperature, perspiration, tiredness).

In severe malaria (caused by Plasmodium falciparum), clinical findings (confusion, coma, neurologic focal signs, severe anemia, respiratory difficulties) are more striking and may increase the suspicion index for malaria. Thus, in most cases the early clinical findings in malaria are not typical and need to be confirmed by a laboratory test

________________________________

"Presumptive Treatment"

In highly endemic areas (particularly in Africa), the great prevalence of asymptomatic infections and lack of resources (such as microscopes and trained microscopists) have led peripheral health facilities to use "presumptive treatment". Patients who suffer from a fever that does not have any obvious cause are presumed to have malaria and are treated for that disease, based only on clinical suspicion, and without the benefit of laboratory confirmation. This practice is dictated by practical considerations and allows the treatment of a potentially fatal disease. But it also leads frequently to incorrect diagnoses and unnecessary use of antimalarial drugs. This results in additional expenses and increases the risk of selecting for drug-resistant parasites.

_________________________________

Microscopic Diagnosis

Malaria parasites can be identified by examining under the microscope a drop of the patient's blood, spread out as a "blood smear" on a microscope slide. Prior to examination, the specimen is stained (most often with the Giemsa stain) to give to the parasites a distinctive appearance. This technique remains the gold standard for laboratory confirmation of malaria. However, it depends on the quality of the reagents, of the microscope, and on the experience of the laboratorian. Alternate methods for laboratory diagnosis include exist (such as molecular diagnosis through PCR) but these tests are expensive and requires a specialized laboratory generally not available in a field clinic.


________________________________


Social and Economic Toll

Malaria imposes substantial costs to both individuals and governments. Costs to individuals and their families include: purchase of drugs for treating malaria at home; expenses for travel to, and treatment at, dispensaries and clinics; lost days of work; absence from school; expenses for preventive measures; expenses for burial in case of deaths.

Costs to governments include: maintenance of health facilities; purchase of drugs and supplies; public health interventions against malaria, such as insecticide spraying or distribution of insecticide-treated bed nets; lost days of work with resulting loss of income; and lost opportunities for joint economic ventures and tourism.

Such costs can add substantially to the economic burden of malaria on endemic countries and impede their economic growth. It has been estimated in a retrospective analysis that economic growth per year of countries with intensive malaria was 1.3% lower than that of countries without malaria.

*************************************************************************

Our Treatment Plan in Kiburara, Uganda 2009

Many people when coming to our clinic in Kiburara would list "malaria" as one of their chief complaints. It took a little experience to realize that "malaria" did not always mean they had or sufffered from the disease that was explained above. Sometimes a complaint of "malaria" meant that they had a fever - either recently or sometime in the past.

The patients that presented with current complications from malaria were obvious to identify. Most of these were very small children or infants that had a history of 2-3 days of nausea, vomiting, and fever. These children looked very ill and medical immediate medical treatment was imperative.

Our medicine of choice for treatment was Coartem - the commercial name of artemether–lumefantrine, a drug combination effective in treating malaria

It was added to the WHO essential drug list showing a success rate above 95%. To help fight malaria mostly in Third-World countries, the WHO and Novartis concluded an agreement to help manufacture and sell the drug at lower costs in countries where the average income rarely exceeds two dollars a day. An audit found that Novartis lost 80 cents for every dose sold. The expected number of orders for 2006 was 100 million, but due to local difficulties, namely the lack of a proper health infrastructure in Third World countries, the number of doses actually sold will be far less than that. A dose of Coartem now costs 55 cents for a child up to age 3. Even so, Uganda has had its share of difficulty precuring and manufacturing enough of this medicine for it population (see here)

DOSAGE:

A standard three days treatment schedule with a total of 6 doses is recommended as follows for adults and children >35kg: four tablets as a single dose at the time of initial diagnosis, again four tablets after eight hours and then four tablets twice daily (morning and evening) on each of the following two days (total comprises 24 tablets).

For infants and children weighing 5 to less than 35 kg, a six-dose regimen is recommended with 1 to 3 tablets per dose, depending on bodyweight. With very small children the tablet should be crushed before giving it to the child.The dose should be taken with high fat food or drinks such as milk. In Kiburara, we had plenty of packaged milk (unrefrigerated type) available for administration. Patients should be encouraged to resume normal eating as soon as food can be tolerated since this improves absorption of artemether and lumefantrine. In the event of vomiting within 1 hour of administration a repeat dose should be taken. Note that patients with acute malaria are frequently averse to food.

Two associated clinical manifestations of malaria required treatment often prior to administration of Coartem.

DEHYDRATION:

In cases where there was a stated history of mild nausea, oral rehydration therapy was attempted. The parent, generally the mother, was encouraged to either breast feed infants or in the case of older children encourage oral rehydration generally through a syringe. For the future a solution like Pedialyte or similar would be very helpful here. The children were then monitored for fluid tolerance. If oral feedings were tolerated, then Coartem was administered as directed.

If there was a stated history of severe vomiting and poor food tolerance, we would provide fluid rescisitation for dehydration. In this case our protocol was to provide boluses of 10-20 mL/kg of 0.9% NaCl solution. For infants we often provided this through slow IV push, otherwise a IV drip was established.

NAUSEA and VOMITING:

It was frequently the case that children entering the clinic were unable to tolerate food for a significant period of time. In addition to fluid resuscitation to reverse dehydration, it was imperative that we administer a fact-acting antiemetic so that the required doses of Coartem could be administered.

We found that oral Zofran worked remarkably well for this. Crushing the tablet and mixing it with bananas was well tolerated in most children.

Children were given orally disintegrating ondansetron tablets according to the guidelines: 2 mg for children 8-15 kg, 4 mg for children 15-30 kg, and 8 mg for children over 30 kg. Occasionally 1mg was given to children <8kg.>

Fluid rescusitation and administration of Zofran was successful in allowing us to provide the required Coartem oral regimen for treatment. After a short stay in our treatment room, children were recovered well enough to return to the community. Parents were sent home with the remaining required doses of Coartem and an antipyretic for fever - in our case Panadol (paracetamol).

NEWS: Polio case reported in Amuru district

Tuesday, 24th February, 2009 from NEW VISION

A child is being treated for polio in Amuru district 12 years since the last case was reported in Uganda. No case had been reported in the country since 1996 and in 2006, the WHO declared Uganda free of Polio. A country is declared polio-free if no case of the disease is found for 10 years. But a sample from a 16-month-old baby boy admitted to Lacor Hospital with weakness in the limbs, has tested positive for the polio virus. The child is said to have been living in Awer camp for the internally displaced persons and he was first treated for malaria. Samples from two other suspected cases in the camp have been taken for testing at the Centres for Disease Control in Entebbe. Doctors in Amuru said the patients present with acute flaccid paralysis, which is the weakness of limbs. The district health officer, Dr. Patrick Odong, yesterday said the preliminary results from the sample tested positive. He said the sample had been sent to South Africa for confirmatory tests. A team from the Ministry of Health is expected in Amuru today to carry out verification and collect more samples, he said. The assistant commissioner for epidemic surveillance, Dr. Issa Makumbi and Dr. Possy Mugyenyi of the Uganda National Expanded Programme on Immunisation said the preliminary tests had showed positive results. Makumbi said he had sent a team to the district to check on the situation. Due to the global sensitivity to polio, the health ministry reported constant surveillance. “We don’t want any chances of polio re-entry into the country. We are concerned that the disease may spread from our neighbours,” Monica Musenero, the principle epidemiologist, said. Last year, the ministry and the WHO issued a polio alert and launched an immunisation programme after cases were reported in the neighbouring DR Congo. The districts that were feared to be under threat were Kanungu, Kisoro, Rukungiri, Kabale and Kasese. Others were Bundibugyo, Ntungamo, Mbarara and Bushenyi. This was because of their closeness to the Congo border and the fact that Congolese were fleeing into Uganda, escaping the armed conflict back home. The health ministry and the WHO launched a polio immunisation campaign in Kanungu last year, which targeted children below five years in the nine districts bordering Congo. In the first week of February, about 1.4 million children in 23 districts were immunised against polio. The two-day sub-national immunisation targeted children below five years. “Our target was to reach 80% of the children in the 25 risky districts. So far, we have immunised 1.4 million children, which is 90% coverage,” said Mugyenyi.

2009 TRIP: Thanks to you, David! (our fun, fearless, and faith-filled leader!)

Dear Kiburara Medical Team,

I trust you have been able to unwind from the long trip, spent unhurried time with family and friends, and told stories of God's grace, goodness, and activity in the little village of Kiburara.... What a mission we had! As I have reflected back on the time in Uganda, I can't stop thanking God for His grace and mercy upon us. Isn't God good??

On behalf of Doug and the whole office team here at Covenant Mercies, I would like to express our heartfelt gratitude to you all for stepping out in faith with us to serve the community of Kiburara. Your humble attitudes, servant spirit, compassionate care, enthusiasm, joy, and professionalism spoke volumes to the people of Kiburara of your love for and faith in the Lord we serve. I'm sure many years from now there will be individuals in this community that will still be reminiscing about the life changing experience they had because of their encounter with this team! So thank you for allowing the Lord to use you in this way for His glory.

Let me encourage all of us to pray for Pastor Moses and the church in Kiburara. It is unmistakable (as you can all testify) that God is positioning this church for greater influence in that part of the country. What a priviledge to be part of God's activity in this remote part of the world! Thank you for encouraging the congregation in their walk with the Lord on that memorable Sunday morning, and for your support as they begin on building a permanent church structure. We will endeavor to keep you posted on any new developments. And for those of you who are keeping your bags unpacked, you can be sure we will be doing this again soon:-)

Once again, please accept our thanks to you all for being part of this mission, and for your desire to serve the people of Uganda. You are a great team..., and will be in my prayers often.

" God is not unjust; he will not forget your work and the love you have shown him as you have helped his people and continue to help them." Hebrews 6v10

Best regards,

David Mayinja
Covenant Mercies, Inc.
610.361.0606 ext. 113
http://www.covenantmercies.org/

"On the one hand, we are called to play the Good Samaritan on life's roadside, but that will be only an initial act. One day we must come to see that the whole Jericho Road must be transformed so that men and women will not be constantly beaten and robbed as they make their journey on life's highway. True compassion is more than flinging a coin to a beggar. It comes to see that an edifice which produces beggars needs restructuring." MLK

DEVOTIONAL: Redeeming the time

Only one life, 'twill soon be past,
only what's done for Christ will last.
And when I am dying, how happy I'll be,
if the lamp of my life has been burned out for Thee.

Today in church, I thought of our recent medical mission to Uganda and the wonderful group of folks that I had the opportunity to share this experience with. We are currently in a series from the book of Ephesians. For the past 3 weeks or so we have been fleshing out this tremendous passage:

Look carefully then how you walk, not as unwise but as wise, making the best use of the time, because the days are evil. Therefore do not be foolish, but understand what the will of the Lord is. (Eph 5:15-17)

I for one realize, although perhaps not as often as I should, that we have a very finite time on this earth. The Bible would liken it to a "vapor" or a flower whose beauty is fading with the inevitable passage of time. This Scripture and the Bible as a whole would encourage us not to walk foolishly or unwisely. We are to be very intentional and careful about how we walk and how we spend our time. We are encouraged to make the absolute best use of time that we can while we have time at all.

As I was showing the pictures from the trip to Kiburara, Uganda in the service this morning, my heart was taken back to that small town, to the faces we met, to the mud-walled church with the tin roof, and to a people that God loves and Christ died for. I could not help feeling that those 2 weeks were a most effective use of time as we walked out the meaning of compassion and the gospel in a tangible way. My heart is somewhat knit with those people and the call of missions abroad. Though it was difficult to leave my family, I would go again tomorrow if it could be so.

Some of Jesus' last words to His disciples and indeed to us as well were, "Go therefore and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, teaching them to observe all that I have commanded you." (Mat 28:19-20) In this familiar passage, Jesus tells us specifically how to make the most effective use of the time we have. It's about going to the nations. It's about seeing the power of God as He saves people. It's about baptizing new converts. It's about sharing the gospel through the word of God.

While my suitcase may still be somewhat packed in the corner of my bedroom, awaiting the next plane and opportunity to go abroad, the need for the gospel in my own neighborhood is still an ever present reality. We are not to leave the message of salvation for another nation. If I look around, and I don't have to hard, there is a "nation" of folks around me that are in need of the very same gospel...of the very same message that saves....of the very same Christ.

So let's make the most effective use of every second, minute and hour that we have.. Let us "preach the word in season and out of season" (2Tim 4:2)...or in another nation and in our own neighborhoods.

Let us redeem the time we have.


"When I stand at the Judgment Seat of Christ.
And He shows His plan for me,
The plan of my life as it might have been,
Had He had His way, and I see
How I blocked Him here, and checked Him there,
And I would not yield my will,
Will there be grief in my Savior's eyes,
Grief though He loves me still?
Would He have me rich and I stand there poor,
Stripped of all but His grace,
While memory runs like a hunted thing,
Down the paths I cannot retrace.
Lord, of the years that are left to me,
I give them to Thy hand.
Take me and break me and mold me,
To the pattern that Thou hast planned!"

NEWS: Uganda to make anti-malaria drugs

A lot of the sickness we saw on our last mission trip was due to malaria. Prior to our arrival we ran into dififculty getting enough Coartem for treatment due to the limited supply in the country. The following article is from the Ugandan newspapaer NEW VISION addresses the ongoing problem.

Friday, 20th February, 2009

The Ministry of Health has worked out emergency supplies of the frontline anti-malarial drug, Coartem, to end a shortage that hit Uganda after Global Fund money was withheld. The commissioner for health services planning, Dr. Francis Runumi, said the ministry had contracted Quality Chemicals, a Kampala-based pharmaceutical company, to produce Coartem. Previously, the drug was imported using Global Fund donations. However, following suspension of the Global Fund grants over accountability queries, Coartem ran out at the end of 2008. On Thursday, Runumi said following a presidential directive, the finance ministry had allocated sh60b for the drug and they were procuring Ugandan-made Coartem. “We are very proud to be self sustaining. We are making so much that we cannot even consume it all. The capacity is for the region,” said Runumi. He was speaking during a dialogue with British and Ugandan parliamentarians at Kabira Country Club. Runumi was responding to queries raised by Kinkizi West MP Chris Baryomunsi on the drug stock-outs countrywide. Baryomunsi expressed fear that lives could have been lost countrywide due to a Coartem shortage towards the end of 2008. “It’s just that we are not so technical to ascertain whether deaths have risen as a result, but it’s a very big problem. People are dying,” he noted.

DEVOTIONAL: "So what did God show you?" (part 1) - the faithfullness of giving

As I sit here and write out thank you cards to all those who contributed to my trip to Uganda, I am reminded of a question that I have been asked repeatedly since I returned and will no doubt be asked again. Though it has come in many forms, the general question asked is..."so what did God show you while you were away?". I was asked this the other day as I sat down with pastor for breakfast. I am not sure exactly why but I find myself stumbling over the answer. I find it hard to put into words exactly what it is that God has shown me.

Perhaps it is because the general nature of the question seems to hint at a single comprehensive answer. And I don't feel that a single answer can be given. For me, I feel that the things that God desires to show me and work in my heart are still to come in the months ahead as I continue to reflect and pray for Kiburara and the work of God there.

One lesson I learned though, actually took place before I left the US. I have never been good at asking for donations. As a kid, I dreaded the inevitable yearly 4H cookie sale or the school magazine sales. I intended to pay for the trip to Uganda myself in order to avoid asking for donations. This was in part to avoid the awkwardness of asking people for money, but if I am to be honest, it had also to do with my lack of faith.

Originally the trip to Uganda was scheduled to take place last fall. I remember talking about it with my pastor who was very supportive but recognized that at the same time we were going to be providing for someone in the church to go to Pastor's College so church finances were going to be a little stretched. I was excited to tell him later that the trip had been rescheduled for February. But then the US economy tanked and I realized that I would be asking for donations right around the holidays. Rather than see this as an opportunity for God to provide in seemingly insurmountable circumstances, I found myself lamenting about how the money could possibly come in time. I hear our Savior's words, "Oh you of little faith!".

Then at the end of December, I received a most encouraging email from Bethany Walton, a friend from a former church. Bethany is currently in another part of Africa, Mozambique, where she is living for a year. She is caring for the needs and education of a group of orphans through Yoido Mission. She sent a tremendously encouraging story about her fundraising efforts:

I have recently been reminded myself of God’s faithfulness to meet needs when I stepped out in faith to give. It is my pleasure to share the story with you . . . Some of you know that Pastor Kawende, the director/founder of the mission I am going to serve, recently became very ill and was hospitalized for several weeks. During that time, I received countless phone calls from his concerned wife, Sifa as she battled with her husband’s health and the responsibilities of running the center alone. One night I Sifa called saying that they urgently needed to perform an operation that would cost $1,000 dollars but had no way to pay. It was not an easy thing for me to step out in faith and say I would pay for the operation. I had been working to save that money for several months and had some medical bills myself I knew I would soon need to pay (I broke my tooth and when I was 11. Figures that just weeks before I move to Africa they would say I need a root canal done on it!). “God, will you come through for me if I take care of your servants?” I received no immediate answer but knew from Proverbs that He cares for those that give to the poor and takes great delight in His children trusting Him. What else could I do? The money was sent: $1,000 for the operation and $45 for the wire transfer. Several days later I was worshiping in my small group and opened up my Bible to turn to Luke. I don’t generally read where I open but I felt prompted to look down. The page was on Zephaniah 3 and verses18-20 were highlighted. Now honestly, I couldn’t tell you one verse that is in Zephaniah though I thought the “quiet you with His love” passage was in there somewhere. This wasn’t that. I read it quietly, “At that time I will gather you; at that time I will bring you home. I will give you honor and praise among all the peoples of the earth when I restore your fortunes before your very eyes.” The words were like a promise to my heart. God would restore. Within 30 minutes the leader of my small group stopped everything to say they would be spending the rest of the time “honoring” me in sort of a farewell (I had no idea they had planned this). They had made a DVD with pictures from the year, had all written letters and made a beautiful scrapbook for me to take to Africa (I have AMAZING friends). Then came the clincher, “We took a collection for you.” The amount? $1,040! Keep in mind that they knew nothing about the money I had wired and are all in college or recent graduates, living on “dreams and spaghetti-o’s.” The next day as I looked down at the scrapbook I noticed a Bible reference one of my friends had written at the bottom of her letter, “Zeph 3:18-20.” “Oh, I thought that was the ‘quiet you with his love’ verse,” she said. Nope. God is so good.

Wow! I was reminded through Bethany's s story that God is not hindered by holidays or encumbered by economic collapse. This was a turning point in my attitude and although at the point that I received this email I had only raised a fraction of the needed money, I knew that God would provide. And provide He did. I was humbled by the way my friends and family stepped out in faith to give to this cause. Some donations were given faithfully with tremendous financial sacrifice.

One of the things that God showed me during this time was a simple truth: To avoid asking for donations is to deny others the opportunity to serve the Lord in the cause of overseas missions. I had someone in my church tell me that I had the opportunity as a nurse to do something that others in the church could not do. That by giving to my cause, I was allowing others to feel a part of what I was doing and to do something tangible with the desire to contribute to missions.

This was made apparent one night at work. A nurse assistant that I work with pulled me aside as she was leaving. She took a $50 bill out of her wallet and handed it to me. She told me that she doesn't attend church regularly but she gives money every once in a while to a TV ministry.

"I give my money to them, but I don't really know where it goes", she said. "At least if I give money to you, then you can come back and tell me how my money was used."

I realized that a lot of people feel this way. I mean, don't you?

On that note...I must get back to writing my thank you cards.

(...oh yeah, of course God provided all the money I needed to raise and I learned alot about faith in the process)

2009 TRIP: Presenting about our trip ... a daunting task indeed

How do you share with others all that we experienced with Uganda? In a way of course you can't. There was too much we saw, touched, and experienced to put it into words. I feel like I will be telling stories for many months, perhaps years, to come about that special week in Kiburara, February 2009.

Tomorrow, however, I have to try to put something together for a church presentation. No doubt you will have to also. I tried to capture as much as I could in pictures (about 950!!) and in my journal. I am so glad that I did. My approach tomorrow will be to share some faces and stories through about 10% of the pictures. You all will be on my mind as I do so and there will no doubt be stories about some of you to tell (...don't worry, I will stick to only the encouraging, non-embarassing type stories!).

Below I have linked a small portion of my slideshow. I did so hoping that maybe it would come in helpful as you put together something for your church. (You might find the title page especially helpful....I am getting a lot of mileage from that picture of Jeff!)

GRACE COMMUNITY SLIDE SHOW

To God be the Glory!!

2009 TRIP: Building the church - one brick at a time

I received this email the other day from Pastor Moses at the Kiburara Gospel Centre Church:

Hi Brethren,

Your precious contribution has so far done this. Here is the attachment of church pictures. Please pray with us and find an opportunity to invest in His kingdom as we serve in His will.God bless you all.

Pastor Moses Nkwatsibwe,

Kiburara Gospel Centre,

Box 384,Ibanda,uganda.

The faithful brothers and sisters of the Kiburara Gospel Centre have far outgrown the mud walls and tin roof that houses them every Sunday. As such they are seeking to build a new and larger church believing that by God's grace He will continue to grow His church in Kiburara. And I have no doubt that He will. I had heard from someone on the team that approximately 4 years ago, Pastor Moses went door to door sharing the love of Christ and the spreading the knowledge of the gospel. For months he did not see any growth. But God is faithful to build His church and when we visited, the walls were practically bursting with folks that had come out on Sunday to hear the gospel being preached. Speakers had to be placed outside to minister to the crowds that had gathered outside the doors.

The foundation for the new church had been dug adjacent to the current building. The money for this had been acquired during a Covenant Life group trip last year. I talked to Pastor Moses about the cost of building his new church. He told me that it would cost 80,000,000 Uganda shillings (at that point ~$40,000). He told me that they have no building fund that they are keeping nor do they have a plan to raise X amount of money before continuing the building. No, the building plan for the Kiburara Gospel Centre is simple: raise money than use it immediately to build.

On our recent trip to Kiburara, we were able to raise ~$1200 to help in Pastor Moses's efforts to build a new church. His email showed what he has done with the money. The trenches that had been dug around the field are now being filled one brick at a time. What a tremendous picture of God at work in Kiburara. He is building His church there one brick at a time and one person at a time. As the mortar combines the mud bicks into a foundation for a new building, the town is alive with "living stones" that shine the knowledge of the glory of God.

As you come to him, a living stone rejected by men but in the sight of God chosen and precious, you yourselves like living stones are being built up as a spiritual house, to be a holy priesthood, to offer spiritual sacrifices acceptable to God through Jesus Christ. (1Pe 2:4-5)

2009 TRIP: Hmmm... were we duped at the Equator?

(This is on the lighter side side of things...something to ponder)

Before we talk about water flow down the drain at the Equator, perhaps we might want to research a little (and dust off those old Physics books)......

Alright so I was going through my pictures today and remembered that I had taken video footage on my digital camera at the Equator. We all remember the dramatic demonstration of water spiraling clockwise down the drain north of the equatorial line, spiraling counterclockwise down the drain south of the equatorial line and not spiraling at all directly on the Equator. Now I remember hearing about this as a grade school student, but I have to admit that I never believed it. I thought it to be an urban legend or myth. I even lived in the southern hemisphere for a year, but never actually tested it out myself. Needless to say I was quite impressed by the demonstration. You can find the same demonstration from the same guy on YouTube from September 2007.

I decided to do some on line research on the Coriolis effect so I could explain the phenomenon to people who ask "why is that so". And especially because I rub shoulders with a lot of science-types who are just as skeptical as I was about this. My first stop was Wikipedia. I don't remember that much physics to understand all this! I then found some information on Snopes which linked me to a site called Bad Coriolis.

The general consensus from these sites is that we were duped! They accuse us of falling victim to a gullible Equatorial tourist trap. Basically (I will leave the details for you to read), although the Coriolis effect is a real phenomenon (hurricanes spin clockwise in the northern hemisphere and counterclockwise in the southern hemisphere), it is a tremendously weak force on a minute scale. It is only perceptible over a very large scale and over a long period of time (ie. cyclonic revolutions of a hurricane). It cannot not be perceived on a roadside demonstration. Water down a drain is subject to so many variables, minute imperfections in the shape of the funnel for example, that more then compensate for the weak Coriolis force. The idea of water swirling a certain direction as you flush your toilet is due to the direction of the jets that force water into the bowl. Basically whatever direction the water starts swirling, it will continue in that direction no matter where in time and space you are located.

So did that guy at the Equator fool us? If he did, and from the science it seems like a real possibility, how he did it is a mystery to me. I have watched these videos to try and figure it out, but there is nothing overt that I find.

What do you think?

2009 TRIP: The orphans of Kiburara

This video was taken outside the Kiburara Gospel Centre church. It shows the orphan children currently sponsored through Covenant Mercies. To find out more about sponsoring children in Uganda, please visit http://www.covenantmercies.org/

2009 TRIP: A makeshift crutch and a smile

"Patrick, we have an urgent case that needs to be seen!", John said he stepped into the treatment room. "There is a girl with some kind of leg infection." I had been rearranging the treatment room when John approached me, preparing it for whatever would come through the door.

I wandered through Marliee's office and out into the bright sunlight. The crowd still huddled under the tent where many of them had been since early that morning. We were now on our 3rd full day of clinic in Kiburara. We had seen the crowds grow steadily each day. On our first day, there were few people hudlled under the tent especially compared to today.

Earlier in the week I had been talking with Harriet, a local nurse who had been a tremendous help to us - understanding the culture, language, disease processes, and treatment options in a way we "mzungos" never could. She related to me that on the day of out arrival at the clinic, there was an idea floating around town that kept a lot of people away until later. Most people knew that the clinic was held at the Covenant Mercies site and that it was associated with Pastor Moses Nkwatsibwe and the Kiburara Gospel Centre church in town. Because of this it had been reported around town that the clinic was only available to those who "were saved by Jesus and immersed in much water" - an ovious reference to baptism. After our first day of treating patients, it became rapidly clear that we were there to treat whoever needed care as we were able. From the size of the crowd today there was no problem correcting the initial misconception in the villagers minds.

John ushered me up the stairs and under the tent where people waiting patiently to be teated. Immediately 2 men in the front row, one of whom was her father, lifted up a teenage girl with a severely swollen left leg. They made no attempt to let her walk and it was unclear to me if she could at all. They rushed her down the stairs and to the triage area in such a rush that I was unsure if they knew that I was there to help. After some intial vitals and information, Marilee, one of the physician assistants, took her to her office for evaluation.

It was an apparent case of mild lymphatic filiarisis. This condition is a parasitic and infectious tropical disease caused by a nematode worm. In its more severe form, it can cause what is commonly know as elephantitis —thickening of the skin and underlying tissues—which was the first disease discovered to be transmitted by a mosquito bite. Elephantiasis results when the parasites lodge in the lymphatic system affecting proper drainage of lymph fluid.

It was obvious that this sweet girl had severe difficulty walking. She was escorted to the treatment room where we soaked her leg in some warm water. Her family was given a combination of effective anti-worm treatment that included, albendazole, ivermectin and doxycycline. Marilee than asked if we had any crutches. I wandered around asking anyone if they knew if there were crutches available. There were none.

I decided at this point that I was going to wander outside the complex and see if we could make a cane from a tree somewhere. One of our faithful young interpreters, Justine, escorted me out the side gait past the crowd of people waiting to get in. Behind the complex and down the hill there were 2 men cooking around a makeshift fire. They looked up when they saw us coming and began to speak in a local dialect. It was clear that they were not fluent in English. Justine stated that they were explaining to me that they were preparing lunch for us. From the smiles on their faces, it was clear that preparing our lunch was something that they were very proud and joyful to do.

Justine had explained to them that there was a girl at the clinic that needed a cane. With a quickness and determination I had not seen before, one of the men grabbed a machete and immediately chopped down a branch from the nearby bush. He then proceeded to chop away the leaves and smooth it out. From his quickness and skill, it was apparent that he had done this before. He gave the cane to me with a big smile. He was beaming.

We walked back to the clinic with our cane. I dried off the young girl's leg and presented her with the cane that was made in her honor. She smiled a joyful, thankful smile and she could now walk better. Her father shook my hand emotionally and they walked out of the treatment room together - her father feeling the need to carry her no longer.

DEVOTIONAL: Investing to Please the Lord

Here is a look back at a small devotional I sent out before our trip. Let us revisit it now and I think you will see its relevance to our trip and where we go with our lives now:

Ephesians 5:8-10
(8) for at one time you were darkness, but now you are light in the Lord. Walk as children of light
(9) (for the fruit of light is found in all that is good and right and true),
(10) and try to discern what is pleasing to the Lord.

I was struck by the last part in which Paul admonishes us to "discern what is pleasing to the Lord." To discern takes effort and thought and prayer and ultimately knowledge of God's word - His primary means of revealing His will. Paul reminds us that once we were in darkness, unable to please God (see chapter 2), but now since we have the light of the knowledge of the glory of God in the face of Christ (2 Cornithians 4:6) we have a reflected light that not only shines outward through our words, actions, and deeds but also inwards to illuminate our hearts to God's will. There is an urgency to this as Paul reveals later:

Ephesians 5:15-16
(15) Look carefully then how you walk, not as unwise but as wise,
(16) making the best use of the time, because the days are evil.

Paul realizes (as we all do every day as we get older) that we have a very limited time on this earth. That we live in a world that does not in totality reflect God's glory and thus, has real trials, struggles, and challenges. We therefore need to take every advantage of opportunties to serve and advance Christ's purposes in the world. Another reason that we should carefully discern what is "pleasing to the Lord." James mentions something that we can invest in that pleases the Lord. A loving task that should make us all feel in the center of God's will:

James 1:27
(27) Religion that is pure and undefiled before God, the Father, is this: to visit orphans and widows in their affliction, and to keep oneself unstained from the world.

Let us pray for Covenant Mercies, their opportunity to walk out this part of God's word in this time, and our role in coming alongside them. Be encouraged that what we have done in Uganda is "pleasing to the Lord". His revealed Word tells us so.

For the gospel and the glory of God!

DEVOTIONAL: "So, why are you going to Africa?"

I originally sent this out to everyone in the team before we left. I would like to remember these thoughts so I posted it here so that it doesn't get lost in my flood of miscellaneous emails.


"So, Patrick, why are you going to Africa?"...It is a question that I have been asked a lot by friends, family, coworkers. It is an expected question and one that seems to be easy to answer. But as I reflect on this tonight, I am wondering if I have really answered the question accurately ... and more importantly, in a God glorifying way..... when I have been asked. My answers to this question have varied on who I am talking to. I tend to give more "spiritual" answers to my church family (..."to share to love of Christ", "to put hands and feet to the gospel", etc) and more "clinical" answers to my coworkers and friends (..."to set up a medical cinic", "to provide medical and dental care to orphans and their caregivers", etc). But it hit me tonight during my family devotions, that I am missing the big, over-arching, God-exalting reason that is foundation for it all.

When I am home in the evenings, (a rarity it seems for a 3-11 shift worker....I am sure that some can relate) I enjoy reading out of a wonderful book by Starr Meade, "Training Hearts and Teaching Minds" for night time devotions with the kids. With the Westminster Shorter Catechism as its background, this book asks one of the catechism questions and then takes a week of walking through the Scriptures to answer it and refect upon its application. Tonight as I opened it up for my kids, (Jeremy 12, Zachary, 8 and Lydia, 3), we landed upon the question "What are the decrees of God?" and the Scripture readings focused on the point that, all of creation is to give glory to God. The last Scripture that we looked at was Psalm 96. And there it was. I had to stop and simply reflect on the words staring up at me.

(Psalms 96:1) Oh sing to the LORD a new song; sing to the LORD, all the earth!
(Psalms 96:2) Sing to the LORD, bless his name; tell of his salvation from day to day.
(Psalms 96:3) Declare his glory among the nations, his marvelous works among all the peoples!
(Psalms 96:4) For great is the LORD, and greatly to be praised; he is to be feared above all gods.
(Psalms 96:5) For all the gods of the peoples are worthless idols, but the LORD made the heavens.
(Psalms 96:6) Splendor and majesty are before him; strength and beauty are in his sanctuary.
(Psalms 96:7) Ascribe to the LORD, O families of the peoples, ascribe to the LORD glory and strength!
(Psalms 96:8) Ascribe to the LORD the glory due his name; bring an offering, and come into his courts!
(Psalms 96:9) Worship the LORD in the splendor of holiness; tremble before him, all the earth!
(Psalms 96:10) Say among the nations, "The LORD reigns! Yes, the world is established; it shall never be moved; he will judge the peoples with equity."
(Psalms 96:11) Let the heavens be glad, and let the earth rejoice; let the sea roar, and all that fills it;
(Psalms 96:12) let the field exult, and everything in it! Then shall all the trees of the forest sing for joy
(Psalms 96:13) before the LORD, for he comes, for he comes to judge the earth. He will judge the world in righteousness, and the peoples in his faithfulness.

This Psalm I am sure is familiar to a lot of you, especially if you are a missions oriented person as this psalm of praise has as its emphasis, world missions. It makes the bold declaration that one day the message of God's mercy will be known the world over ("among the nations"). That God's marvelous works and the splendor of salvation will be "among all peoples". How will this occur?....Notice the repetition of action verbs in the verses. We are to "sing"...we are to "bless"...we are to "tell"...we are to "declare"... we are to "ascribe"... we are to "worship"...we are to "say". We are to shine the light of God's salvation, marvelous works, splendor, majesty, strength, righteousness, and faithfullness among the nations of the earth. In summary, we are to reflect and reveal the GLORY OF GOD.

(Psalms 96:3) Declare his glory among the nations, his marvelous works among all the peoples!

Does this mean evangelism? Yes. By God's grace I pray that there will be opportunities to walk someone through the richness of the gospel. Let us all pray and equip ourselves for that opportunity. But the compassionate medical care that we will be providing, certainly is evangelism as well and a way to "ascribe to the LORD glory and strength" and "ascribe to the LORD the glory due his name."

In Matthew 5, Jesus commanded that we "let [our] light shine before others, so that they may see [our] good works". Just previous to this he said that we "are the light of the world" and "a city on a hill" - as such we have a light that is not meant to be hidden but put up on a stand to be displayed to all. Now I certainly do not see myself as a light for the world and as glorious as a city displayed upon a hill. And on my own with my own resources...I most certainy am not. I do not have inherent light, but as a sinner saved by grace we have a reflective light- the light of the knowledge of the glory of God in the face of Christ:

(2 Corinthians 4:6) For God, who said, "Let light shine out of darkness," has shone in our hearts to give the light of the knowledge of the glory of God in the face of Jesus Christ.

We have the knowledge of God's salvation and glory to be shared among the nations. It is a treasure for sure in a jar of clay, but our good deeds ... which specifically, is our compassionate medical care to orphans and their caregivers, will show the world the glory of God and that this "surpassing power belongs to God and not to us" (2 Cor 4:7). This is why Jesus stated in the conclusion of His thought in Matt 5:16 that we are to let our light shine before men, not for our own accolades or praise or feelings of worth or desire to do a mission - "thing", but to let others see our good works and "give glory to your Father who is in heaven". It is all about God ... it is all about good deeds that lead others to ponder, reflect, consider, and bow their knee to a glorious God.

I thank God that He reminded me of this tonight as I was going through devotions with my kids. I am thankful that tomorrow as I go to work and am asked once again, "Patrick, why are you going to Uganda?", that I can give them the accurate, God - exalting reason. I will say, "I am going because God's word states.....

Declare his glory among the nations, his marvelous works among all the peoples!" (Psalms 96:3)

For the gospel and the glory of God!