Sunday, April 15, 2018

Busy week, Workshop, Birthday, Harare surgery team here and Tyler leaves!






This past week was busy here as we tried to finish off our month end reports and see our patients.  It was a busy week with many patients and Tyler, our medical student helped with 4 C/Sections in less than 16 hours!  He was happy!

On Thursday and Friday a Health team came to conduct a workshop here to teach us how we are going to be reimbursed for the amount of work we do in the future.  Since we see a lot of patients we do hope to benefit from this program and we hope it brings us funding for the hospital that we have not had for 2 years and 7 months. 

As we were involved with this training we all had to go in and out to see our patients and keep the hospital moving at the same time, so we were going early and coming home late to get both done.
We celebrated Dr. Isala, our Medical Superintendent’s, birthday with a cake during lunch at the meeting.  Everyone got a bite of cake to celebrate.  He has been with us 4 years this week too.
On Friday night I hosted a dinner for the team that came and my visitors—so there were 13 of us for dinner. 

Friday night to Saturday morning kept me going to my door all night.  At 2 am the driver came to take 2 of the team members to Karoi and pick up our surgeon and Anesthesiologist from Harare who left Harare at 2 a.m. to meet him in Karoi at 4 a.m. so they could come on for a day of surgery here.

Then at 3:30 a.m. another driver came to get a car to transfer a patient to Karoi who had been bitten by a hemotoxic snake and was bleeding internally and had a platelet of 35!
By 5 a.m. the team who presented the conferences left so I got up to see them off and just decided to stay up and get coffee and muffins ready for the surgery team before they started a long day of surgery!

By 6:15 a.m. the surgery team was here and ready to go but they had to wait 30 minutes as our team did a C/Section—the second one that night!  Then they started their work!

They had 12 people on their list and 3 hysterectomies.  They worked hard and Tyler got to assist and hold instruments and put some stitches in so he was very happy.  They all broke for breakfast at 1 p.m. and then came to my house when finished at 5 p.m. and had dinner.  They left at 6 p.m. to return home to Harare and Tyler went with them as he is off to spend a couple days in Harare with a urologist seeing patients and then going to Victoria Falls for a few days before leaving next Sunday.

Last night I went to bed at 8:30 p.m. exhausted and woke up at 6:30 a.m.!  Started my 4 loads of laundry to get all the linen used by the visitors cleaned before the next lot and got 2 done before the electricity went off at 10 a.m.! What a week!

 Teaching at the workshop

 Staff who attended

 Mrs. Isala lighting the birthday cake for her husband

 Dr. Isala blowing out the candles


 Saying goodbye to Tyler at devotions

 Tyler helping Harare surgeon and our doctors


Tyler doing some suturing with Dr. Isala

Sunday, April 8, 2018

Retirement lunch, Happy Easter and lots of visitors

On the 29th of  March we had a retirement lunch for all our staff at the hospital to honor 2 staff who were retiring at the end of March.

Mr. Wise Makaza, our driver for 12 years and Mrs. Patricia Tapfuma, a Nurse Aide for 28 years and work in the Pharmacy retired.  We had a wonderful lunch and Major and his family sang and we gave them each 100 broiler chickens with fencing and chicken food to get them started in raising chickens to sell.  We also gave them $100 each in cash for their service to us.

On Friday the 30th through Monday the 2nd we had a 4 day Easter holiday here.  Many of our churches had Easter meetings from Friday night through Sunday morning so it was quiet here with most people away.  I had to stay and be on call for anesthesia.  We did 2 C/Sections, but both during the day--so I got off easy!

On the 1st of April,  Dr. Chiura, my urologist from Harare, came out with 2 residents to see some patients and be here for lunch.  We set up for him to come again later in the week for some surgeries.

That evening Tyler Sheetz arrived who is a final year medical student at Ohio State to be with us for a month.  He gets back just in time to graduates and starts a urology residency at Ohio State in July.

On Tuesday 6 people from our Research team from Stanford and Harare arrived to stay until Saturday morning.  We also had a busy week covering 3 outreach sites and our support group at Chidamoyo on Saturday to draw Viral Loads for our research project.

So I kept busy going out to the clinics and drawing blood and cooking for 8 people and all with no electricity!  Our electricity went out on the 30th and finally came back a week later on Friday night!  It's always a challenge keeping food cold, water cold to drink and food hot--all with no electricity.  Thank goodness for gas stoves!

Tyler kept busy helping us draw bloods and doing 2 C/Sections this week during the night!  

Dr. Chiura came back on Friday with a resident from Harare and saw patients but then left after lunch as no one qualified for surgery.  We are starting him a list to come back for.

Our kids who are under 12 showed up for their support group and medicine on Saturday morning and Tyler drew the 42 blood draws we had.  We came home exhausted to rest in the afternoon!  Then our electricity went out again all Saturday afternoon but came back about 6 p.m. so we were very happy!  Or freezers are frozen again!


 Mrs. Tapfuma and Mr. Makaza at their lunch

 Mrs. Tapfuma

 Mr. Makaza

Major and family singing

 Tyler drawing blood from kids at Chiroti

Group being drawn at Nhari by Kathy


 Kathy drawing at Chedope

 Tyler watching a surgery

Research group with Tyler and me

Sunday, March 25, 2018

Unpacking cintainer, interviewing a new doctor

It has been busy this week unpacking the container that arrived recently.  We have been unloading it a truck load at a time and bringing it up to the hospital to unload.  Carolyn Mereki has been helping to unload and sort and then she delivers it to the different departments.

We are really happy with a lot of good supplies that we are unpacking to use at the hospital.

We are putting the barrels and boxes in the hallway outside my office and opening them when we have time.  It is always fun to see what we get!

On Friday this week we traveled to Kadoma (1 hour south of Harare), about 4 1/2 hour drive for us.  We met up with Mashoko administration to interview 6 people for jobs at Chidamoyo and Mashoko as doctors.  We have tentatively made decisions, but have another 2 people to interview--so please pray with us that we choose the right doctor.

The doctor strike continues since 1 March.  No settlement and government hospitals only doing emergencies so we can't really refer other patients either.  The doctors here make a basic salary of  $389  a month.  Also they want  equipment and medicines available in the hospitals they work in.  We hope this is settled soon.

 Unpacking the container

 Waiting to be unpacked

 Carolyn sorting things from container



Dr. Moyo and Major from Chidamoyo at the Interviews

Saturday, March 10, 2018

New Baby, ART outreach clinics


This week was a busy week back after a week being gone in Harare.  It’s also the end of the month so we are doing end of month reports in between seeing patients and doing procedures!  No visitors here to help me get the paper work done!

The doctors in the country went on strike on 1-March-18.  Since we are a mission hospital we don’t go on strike and so we have seen an increase in patients who are being turned away at hospitals through out the country.  We had to transfer a patient yesterday and Major went to our local district hospital and it took him over an hour for someone to take the patient and then others were asking him to take them to Chidamoyo since they had been admitted for days and no doctor had seen them!  The hospitals are in chaos as only the Administration is working and trying to keep things going.  They are supposed to attend to emergencies, but not sure what they call emergencies since some of the people who came here were very sick.

We were happy to hear that Dr. Kajese (who used to work here) and his wife No had a C/Section for their second child on Sunday the 4th of March and welcomed a new baby girl—Zoe.  She was a bit early but is doing well after being readmitted and discharged again.  Big sister Alexis is welcoming her too.  Congratulations to them.  We hope to see him here as part of the surgery team that comes to do our elective surgeries in the next month.

This week we went out to 2 outreach clinics, Batanai and Zvarai to draw blood on or our research kids and some adults who needed their Viral Loads done.  We ran Batanai results and all the kids are doing well—no one failing—so we are so happy with that!  We think most of our kids are doing better and we hope for better results over the year they are being studied.

I enjoy going out (except for the terrible dirt roads) and being with our kids and adults on ART.  So many of these patients are personally started on ART and it is so great to see them growing up and doing well and the adults doing so well.  It gives us encouragement to keep working hard to eliminate this disease!

This week we had Agnes and Isabel from BRTI labs.  Agnes was here to look at our results so far and verify and she left on Friday.  Isabel is here for 2 weeks to help run the samples from our research in the laboratory.  They enjoyed going out into “the bush” with us to our ART clinics this week and we put them to work! 

This weekend am trying to catch up on our statistics.  As you can tell I am procrastinating by doing everything else on my list first!! 

Baby Zoe Kajese



 Agness and Isabel at Batanai 


Our group at Zvarai




Sunday, March 4, 2018

Digital X-ray Signing ceremony





On Friday the 2nd of March we went to Harare to hold a signing ceremony with the Japanese embassy.  Last year they approached us and asked if we would like to apply for a Digital X-ray machine and processor under a Grassroots Human Security program they run in Zimbabwe.
We were so excited and spent 4 months going through the application process including them coming to assess the need here at the hospital.  We were so happy to hear a few weeks ago that they had chosen us and approved this here in Zimbabwe and Japan.  This is something we have been praying about for a year.

This machine will mean our X-ray that now costs $20 for one will cost pennies!  No more buying film, fixer and developer and having to transport it from Harare to here.  This will be a massive savings for our hospital. 

We will also be able to take more than 1 view whereas before the patient could not afford to do this at $20 a film.  Now we can take more angles which  makes it easier for us to diagnose our patients.

We had a signing ceremony on Friday at Zimbabwe Christian College.  I represented the hospital and signed for us with the Ambassador from Japan, Mr. Toshiyuki  Iwado.  He and I both gave a short speech and then signed the official documents.

 Fuji then gave a presentation on the machine and then we had tea afterwards for the 30-people attended.  We were happy that our Provincial Medical Director office and our District office came to represent Ministry of Health and us.  The press and TV were there too, so we hope it brings good publicity for the embassy and the help they have been to us.

We will now start to remodel our old X-ray room and order the machine.  When it is all installed and ready to go we will have another ceremony here with the Ambassador.  We hope that will be soon!

Yesterday (Saturday)  morning we opened the container that arrived last week and got a load of boxes taken to the hospital to go through.  Then it started to pour rain, so we cut it short.  I need my team of people that were here in January to go through the boxes in the hallway!  Cathy and Holly, you better come back soon! Ha!


Signing ceremony with the Japanese Ambassador next to me


 Major was the MC for the event

Signing the agreement


Handing over the documents with the Ambassador


Opening the new container that arrived






Sunday, February 25, 2018

Research Project


That last two weeks have been busy at the hospital treating patients and going out for outreach to draw blood on our kids in our research project.  Many of you have asked about the research and so I am going to give you a short summary that was written by one of the researchers:

Community Based Antiretroviral Therapy (CBART) Project

At

 Chidamoyo Christian Hospital- Hurungwe District, Mashonaland West Province



Implemented by Biomedical Research and Training Institute (BRTI)



February 2018-January 2020



-------------------------------------------------------------------------------------------------------------------------

The Biomedical Research and Training Institute (BRTI) is a not-for-profit making research and training institution founded in 1995 to promote the health and quality of life of the peoples of Africa through research and training in the field of biomedicine. Zimbabwe, like other Member States of Southern Africa Development Community (SADC), adopted the 2013 WHO HIV treatment guidelines, which include HIV viral load (VL) monitoring for people receiving antiretroviral therapy (ART). VL indicate how well a person is responding to the HIV medicine (ART). However, Zimbabwe only has viral load monitoring equipment at provincial hospitals yet would like to ensure that 90% of all people on ART to have the HIV medicines suppress the HIV to undetectable levels in their blood. Studies that have been conducted in the region as well as in the country have shown that maintaining undetectable viral load among adolescents is more difficult than in other age groups. It is against this background that BRTI health research scientists, Dr Junior Mutsvangwa, Dr Shungu Munyati and Dr Justen Manasa with assistance from Prof David Katzenstein, applied for and received funding from Gilead – an American pharmaceutical company, to conduct a research project whose aim is to reduce virologic failure rates among children and adolescents who are on antiretroviral therapy (ART).



The project is being conducted at Chidamoyo Hospital in Hurungwe District of Mashonaland West Province and is divided into two broad components: (i) laboratory and (ii) ethnography. The first component (laboratory) seeks to monitor virological failure, drug resistance and toxicity on the target population using mobile health technologies. The second component (ethnography) hopes to find out community factors that help or hinder treatment adherence. After seeking clearance from the Medical Research Council of Zimbabwe (MRCZ) BRTI investigators have started working with both Chidamoyo Hospital and Chinhoyi Provincial Laboratories. Highlights of the project interventions include the following activities:



a)     digital data collection and near point of care Viral Load monitoring

b)    lower cost test for HIV drug resistance (genotyping) for individuals with persistently high Viral Load



Project Benefits to the community

i.     The project avails HIV diagnostics that capture electronic records of laboratory tests, and provides mobile collection of patient information, enable electronic tracking of blood samples, linkage to care, treatment(s) and viral load differentiated care. These interventions take advantage of the unique functionality of mobile and wireless devices. Data is captured on Tablets or smart-phones at the point of care in dispersed rural communities and can use compressed 3G cell phone connections to relay and update patient data. Real time acquisition of patient data, rapid transmission of aggregated/summary data to district and provincial level managers of ART programs, will be achieved despite limited broadband capability at the point of care. This facilitates near real-time data collection to provide feedback and digital records to the pharmacy, laboratory and clinical services to achieve and maintain virologic suppression by assessment of VL differentiated care and switching to more effective regimens in a community setting – drug resistance or drug toxicity is detected and managed earlier.



ii.         Chidamoyo Hospital is one of the few health facilities in the country which offers Community based ART – a situation where a health facility reaches out to the community with HIV testing and treatment facilities.  This approach reduces stigma and discrimination among people living with HIV. As the adolescents and children are enrolled and take part in the project, there is peer to peer support to adhere to ART. The project activities also strengthen and ensure family and community support for people infected and affected by HIV.

Sustainability

Modern biomedical research, training, public health institutions and health service providers are increasingly using digital communication and new on-line and digital tools to address the HIV and TB epidemics. These new methods to monitor responses to ART will enhance the effectiveness of community-based adherence interventions and appropriate treatment switches to maintain virologic suppression.     



As the project is implemented, there will be capacity building of staff and facilities at Chidamoyo and the Provincial Hospitals and these skills and equipment will remain in the province after the life span of the project.



The ethnography component of the project involves interaction with Village Health Workers and community leaders (political, religious and traditional leaders) who will always be part of the community and will continue the supportive role long after the project.

Hope this explains what we are doing and the work we are in now is visiting our 8 outreach clinis to draw blood on or 21’s and under kids.  We think this will be a big help in treating or kids, kids in Zimbabwe and throughout the world.  We have already drawn 135 kids and hope to have 600+ kids on the program.

On Friday morning we were happy to see a container that had been sent at the end of October from CA arrive.  We are so happy and can't wait to have the time to unload it.  This really helps our patients to get a lot of their supplies free.  We are so thankful for our many people who help collect things and take them to Gene and Sue Beckstead and for their great help in collecting and sorting everything and putting it in the container and getting it sent.  Thank you to all of you!

Packing up to go to ART outreach


 Drawing blood at Magororo

 Magororo Outreach

 Testing Urine with Lab Assistant from BRTI Labs

Drawing blood at Magororo

 Outreach at Nyamutora

 Kids getting their meds after their blood drawn at Nyamutora

 Nyamutora Outreach Clinic


 Container arrives



Thursday, February 15, 2018

More visitors and lots to do!


After seeing off most of the US visitors on Sunday the 28th of January, I returned home to Chidamoyo to welcome on Tuesday our research team from Harare.  Nine people arrived and stayed through Friday morning.  We had David from Stanford, CA and Dr. Anat from Tel Aviv, Israel and then 7 people from BRTI Laboratories in Harare that are helping us with the research.
Our research proposal is to study our 21 and unders on ART medication for AIDS.  We went on our first run at Chiroti outreach center on Thursday the 1st of February and drew 22 kids.  We worked out a lot of kinks in what we have to do—get consents signed, draw blood and do urines on all kids and give them their medications.  It was a cloudy day and started to rain in a very holy roofed shed.  Dr. Anat was holding an umbrella over me while I drew meds for a while!  Quite exciting.
The team left Friday morning and left Happiness from BRTI to work with our lab to do the tests on the bloods.  She stayed until the next Tuesday.
Two college graduates who arrived on the 17th of January, Claire and Erin from Illinois via University of Kentucky continue to work at the hospital and help in the research project.  They were very helpful and most excited to do anything.  We kept them busy even helping with our celebration and then at the hospital.  Claire wants become a Physician Assistant and Erin a Medical Social Worker.  They both will start Graduate school this next year.
They left for 5 days in Vic Falls before leaving on the 14th of February to go home after a month with us.  We miss them. 
On Monday a team of 6 Ohio State Medical students who are doing a month in Harare came to be with us for a “bush experience” for a week.  We had Sola, Martins, Tanve, Kenneth, Van, and Chris.  We kept them busy helping the doctor, making rounds, helping in surgery and with different procedures.  They did everything from Lumbar Punctures, to Incision and Drainage and VIAC (visual inspection of cervix), to examining outpatients.  They seemed to really enjoy their time and did some hiking around to see the area.  They left on Sunday afternoon and I was suddenly all by myself!!
We have had amazing rains in February compared to our drought in January.  It was hot and dry during most of January and for our celebration and travels afterwards.  However, on January 31 through the 13th of February it rained everyday and hard!  Of course, our electricity went off on the 31st and only came back on the 14th!!  We did enjoy seeing crops come back to life in most areas and also be a lot cooler for us.  It still continues to be a bit cloudy and a few drops on and off, with more rain forecast every day.  People are happy!
We have been excited by some great progress our hospital has seen in helping us to provide quality medical care for our patients.  In mid-January we were one of 25 hospitals in the country to be chosen to get 4 Samba machines that measure viral loads.  This has been so helpful in getting quick results to know if our patients are failing their ART drugs. The tests takes 90 minutes.   We are also using them to test our research bloods.  We are very grateful we were chosen for this project and know this will help our patients in the long run.
We also received word this week that a grant that we applied for from the Japanese embassy was approved and they are spending almost $100,000 to get a digital X-ray machine.  No more buying films, fixer, developers and envelopes.  What a cost saving this will be to our patients and us!  Now we can take several views too without wasting films and money.  We will have a signing ceremony with the Embassy in Harare on May 9th and then we can start the project.  We are so excited!
Through our research project we also have been able to get a new centrifuge, a new fridge/freezer for the lab and a file cabinet as well as lab help to get the samples run quickly and efficiently.  We are thankful for that.
After no electricity for 12 days we finally got it back on Wednesday night in time for our Bible Study.  We had all been going to bed early because of no electricity, now we stay up to get some things done!
Michael Mereki returned to school in South Africa on Sunday.  He finishes his degree in November.  His sister Carolyn is waiting for her visa to join him in school any day.
After so many visitors and so much to do it has been nice to relax and catch up on some work at home and the hospital. 

 Erin and Claire saying goodbye after devotions with Major

 Erin and Claire with Kathy

 Caroline from Harare explaining the research project

 Team from BRTI labs with Dr. Anat and Dr. Katzinstein

Drawing bloods at Chiroti with umbrella helping us

 Kenneth examining a patient

 Tanve doing a lumbar puncture

 Sola examining a patient

 Tanve with a Pediatric patient

 Kenneth and Tanve checking urines on our research kids

Martin drawing blood on a research kid

 Van drawing blood on research kid

 The OSU Medical students with Kathy as they left Sunday

 The new Samba Viral Load machines


The staff and students from OSU and Claire and Erin