March 3

We are all here, with our luggage. Tired but doing well. Please send a note down the chain and let everyone know we are all fine.

    We arrived and right after lunch immediately went to visit the Mother Teresa’s  HIV orphanage and clinic. Already Africa is pulling at out heart strings.

Lori A. Spies

Africa 2010 March 8 (or by the Ethiopian Calendar 29/6/2002)
  In Addis we toured Mother Theresa’s HIV orphanage and saw a home and treatment for children who might not have anywhere else to be cared for. We spent time at ALERT an internationally recognized treatment and training center for Leprosy, TB and HIV. It is in a building that was constructed in the 1930’s. It seems that additions are added rather than new things built. It creates an interesting hodge podge of old and new in the same area. Always there is dust and construction about. The most exciting part for me about the ALERT was the orthotics department where new limbs are constructed. A process of plaster casting and then a hard plastic that is cured in kiln type oven over the casting. A soft liner is made since leprosy causes a loss of sensation and the people would not be able to feel if a place was rubbing too hard. A shoe as close to normal shoe is added in hopes of enabling someone who has lost a leg to have a more normal life. Rubber from old tires were used to make soles of shoes and sandals.

   Serial casting is done on hands that no longer work to put the fingers in a position of funtionality. The patients return every day to have a new cast placed until slowly the hand is able to be used in a closer to normal way. I am struck by how it is not only treatment that restores quality to life.
   At the CURE hospital A Christian outreach in several countries, we saw how cleft palates and club feet are treated. In some parts of Ethiopia children born with a cleft lip are left to die because the survival rate is so very low and the disorder is a source of shame for the parents. At CURE surgeries are done but also information is disseminated to spread the word of this amazing place and these gifted surgeons, nurses and yes- even a Nurse Practitioner. Here at this wonderful charity hospital is one of two plastic surgeons in the country.
    This year again we learned of the life restoring work done by the Fistula Hospital. Woman from all over Ethiopia come to this hospital to have surgical repair of fistulas that develop after days and days in labor. 2-8 days spent in labor. A tragic condition that leads to the woman being outcast from their homes. At this wonderful place woman are embraced and repaired and educated.  We visited with the remarkable woman who is about to graduate her first class of midwives. Her goal is to have woman able to provide early intervention and referral to prevent these tragic fistulas from forming.  God is doing amazing work in all of these places.
   Langano is as beautiful as I recalled. Birds of the most amazing hues are visible in every tree. A troop of baboons is visible from the window where I am sitting. The waves lapping at the shore are a wonderful background noise as we go to sleep each night. I have seen warthogs and green vervet monkeys in the compound. I love this place.
   Saturday we took a drive to Tufa a remote village on the other side of the lake, to do a community assessment. Our missionary hosts are exploring an outreach to the area and wanted our help gathering information on nutrition and health in the area. As we left the compound a donkey had fallen over with a heavy stick load and blocked the road. Our translators and evangelist jumped out to upright the beast and help the woman getting her wares to market. This was such a funny Ethiopian happening…travel is differnt here. The drive was…exciting… unexpectedly heavy rains created large puddles or perhaps small lakes on the road in dozens of areas. Luckily African vehicles are equipped with a snorkel that kicks in to prevent the engine from getting waterlogged and stopping. Goats and donkeys frequently blocked are crossing of the road.

   We provided care to many sick people. Malaria and worms, Respiratory infections and malnutrition…We gathered data and spent time with 243 patients. The evangelist made meaningful contacts with the village elders. The students began the process of learning to conduct a clinic under a tree. We were stretched in many ways.

   We are humbled by the great outreach of Baylor grads Kim Scheel and Allyson Smith. Many have been led to Christ by this mission outpost. My students have already had a rich learning experience in Ethiopia and I am convicted the Lord has much more to show all of us.
   I ask for you continued prayers for health and safety, for our wisdom in treating challenging patients in challenging conditions. For confidence as we learn new things. Most of all we pray that our actions will glorify God.

In Christ,
Lori A. Spies

Africa 2010 March 10
      Greetings from Ethiopia. The team continues to work alongside our missionary and Ethiopian colleagues to provide care to the people in the area.
      Each morning we have buna (Coffee) on the screened in porch of the house where we are staying. The mornings here are cool and the
afternoons are quite warm and sunny. We have a beautiful view of Lake
Langano and it is truly a blessing to have this peaceful place to
reflect on the work we do for long hours in the community and the
clinic. The porch functions as a place for us to provide continuing
education for our nursing colleagues. After our long clinic days we
provide tea and snacks and a short talk. It has been fun for all of us
to share knowledge with each other and the porch makes for a relaxed
time with our Ethiopian colleagues. In the evening the team gathers and we discuss the day’s events. Each night a student shares a devotional and we lift up our prayer concerns and pray together. We are lucky to have solar lights in our rooms. We also occasionally have e-mail access in the office.
     Today was prenatal day and in addition to the usual patients with
Malaria, intestinal parasites and wound infections we saw around 100
pregnant woman. It is a busy day at the clinic. Every woman is treated
to prevent Malaria and vaccinated for tetanus. The prenatal vitamins we brought from home are a much needed treatment for the huge amount of anemia we find. The students were able to perform leopolds maneuvers to determine if the baby was breach and assess the fetal heart tones on dozens of woman. Woman that are found to be breach are encouraged to return to the clinic to give birth unlike the 95% of woman in Ethiopia who give birth at home, most without a trained attendant. It is a rich learning experience for the team and an important outreach to the community.�
      While the patients wait to be seen we conduct community education. This morning the topic was washing faces. We often teach about hand washing, but in this Trachoma endemic area keeping children’s faces clean can prevent this blinding disorder. The student taught in English, Kim Translated into Amharic and the clinic worker translated into Oromo.
  It can be complicated to accomplish the most simple thing on the mission field. But it is worth the effort.
     Yesterday was the “Nutrition day”. All the children who fall below the 75% on heights/weights and mid-upper arm circumference qualify for an enriched peanut butter supplement. The Plumpynut does an amazing job of providing calorie and nutrient dense food that the children love. It comes in foil packets and is very popular. One boy cried when he learned he had gained enough weight that he no longer qualified to receive his weekly case of plumpynut packets.  It is a great program and very successful in tending to the widespread malnutrition during this time of famine.
March 11
    Today is vaccination day and the day we are doing check-ups on
children from the local school in addition to all of the regular clinic patients. The children have a variety of conditions such as Malaria,Shigella and as always in the people we are seeing many are malnourished or marginally nourished. Yet children are children and they are filled with joy and interest in all that we are doing. One student is out in the community with a missionary nurse teaching about the importance of latrines, face and hand hygiene and food preparation. This afternoon a postpartum and newborn check up is planned for the wife of one of our very helpful mission interpreters in the family tukul.
     The students are an impressive group, after long days in the clinic after our continuing education, team debriefing and team prayer time they are studying and reviewing tropical disease presentation and
treatment. This in addition to the months of prep work and biweekly
tropical disease teaching for the trip has created a very well prepared team. What a pleasure to work with them, what a blessing they are for the people we serve and work with. I am also humbled by the work our missionary hosts do day in and day out to minister the physical,
educational and spiritual needs of the Oromo people. 

�
March 12, 2010
    Yesterday we learned that the mother of a guard at the mission
compound had died.  We were able to attend the funeral with our
missionary hosts. The tradition here is that you join the family at
their home, sitting in areas under trees and in tents that are used
specifically for funerals.  All of the neighbors and friends and sit and talk quietly. As family members arrive you here the weeping and wailing as they approach. It is a gut wrenching sound of grief. While we were at the family home with scores of others Kim was asked to give a Christian witness on what death mean to Christians. It was an amazing cultural opportunity. Like all of the woman present we wore scarves to cover our hair.  We were provided seats of honor as foreign visitors and fed great coffee with a touch of salt as is the local custom. Additionally we were provided a food called gunfo served from a container decorated elaborately with shells. Gunfo was described as “like spicy grits with rancid butter”.  I have found the Ethiopian people to be extraordinarily generous and hospitable. Which in the case of gunfo means if you ate it too rapidly your plate was filled again. Our goal was to be culturally appropriate eating some in a fashion of appreciation but not too rapidly.
   Today is Friday and another prenatal day and regular clinic. One
student is out in the community helping Laura one of the missionaries
conduct a survey of health in the homes. This is a great opportunity to provide teaching about hygiene, mosquito net use, water… it is
especially beneficial as the student is working on her capstone project to provide education for nurse practitioners who hope to work
internationally and provide community education.
   It has been a week of great learning and culturally enriching. We
have seen many things rarely seen in the US. We have helped identify
children suffering from severe malnutrition. We were able to get 44 teen girls immunized for tetanus at the local school, a demographic that is key to preventing neonatal tetanus. We have provided 100’s with prenatal assessment and education. Learned how malaria is diagnosed, how anemia is assessed, what a child with intestinal worms looks like. The trip so far has allowed us a powerful sampling of what the provision of health care in an environment of scarcity looks like. It has been a wonderfully rich experience.
    Thank you for your prayers and support. We are healthy and happy,
although a little tired. It is a blessing to be here we are all grateful
that Baylor University Louise Herrington School of Nursing has a vision
for mission and blessed by all of the gifts and prayers and support that
enables this incredible learning and service opportunity to be possible.
Blessings to each of you,
Lori March 16, 2010

   Today was a tough day. The reality of injustice in the world and the unneeded suffering was made real to all of us on the team and at the clinic today. Our morning began slowly as the long hours, hot climate and challenging work makes us all long for extra sleep.

   The clinic day started as usual with a bible reading and time of prayer with the clinic staff. First the scripture is read in Amharic and then, because we are there it is read in English. I had just made clinic assignments and the team was setting up for school physicals, nutrition and regular clinic duty when our plans abruptly changed.

    A mother with twin 10 day old babies came into the clinic. The woman stated the baby had not eaten in two days. On first glance the student recognized a gravely ill child. The child was ashen in color and hardly breathing. It was obvious that the child was not going to survive. What a hard thing to know. We are accustomed in the United States that all acute illness calls for herculean effort even when the end result is unchanged. The clinic became chaotic for a while as it was determined the other twin was also very ill. A thoughtful intervention by one of the team allowed the mother and dying baby a room to themselves. Rapid intervention by the clinic staff and our pediatric pro team member had the twin receiving treatment quickly, and returned to Mom for feeding and care. I don’t think I can say how each of the team member’s hearts broke as we saw the pain on the Mother’s face that one twin had died. Her grief seemed almost unbearable.

     The team prayed together for this woman and we were also able to have the local evangelist meet with her and pray with her. It is surely our Lord and Savior who is best able to provide her comfort.

     Tonight before we returned to where we sleep we checked on the baby and Mom. We gave the final dose of medicine to both Mom who had Malaria and the baby. It was encouraging to see the mother feeding the baby and smiling down at the sweet infant in her arms. Such a hard time. So many of the people we see have lost a child or multiple children. The reality of life in environments of poverty is gut wrenching and cruel. I am grateful that many of my students and the missionaries we work with have dedicated there lives to alleviating some of this suffering.

     A custom in some parts of Ethiopia is adding butter and salt to coffee. The pharmacy tech at the clinic comes from one of those areas and when she learned we were interested in trying this coffee she invited us to her home.

    This was an amazing experience; we arrived to her two small rooms at the back of the clinic and she was dressed in traditional clothing from her region of the country. She had prepared the typical foods served with coffee. Kolo – a roasted barley with peanuts, sweet popcorn and dabo kolo a sweet small pretzel. The coffee was like none I had ever tasted and it was delicious ( a couple of us thought so anyway). It was strong dark Ethiopian coffee with butter in which garlic had been sautéed added as it was brewed in the traditional coffee pot over a fire. Such a different flavor, like a rich broth rather than what we think of as coffee in the US. I asked for the technique and hope to make some when we are back in the states.

   We leave tomorrow for Addis and then on to Sierra Leone.  We have exciting work planned in Sierra Leone. We will provide health care in an orphanage, we will set up a community clinic working with our missionary colleague who is a dentist. I know several students are looking forward to learning a bit about dentistry in the mission field. We hope to visit with the Nursing and Midwifery board, visit hospitals and provide some continueing education. It will be a full time.

     We are not looking forward to the travel….we will leave Langano for a multiple hour drive and then we will have a five hour flight and then an eight hour flight. We are starting the trek tired and a few of the team members have been a bit under the weather.  Prayers for traveling mercies would be appreciated. In Freetown we will be joined by three additional team members who will have made the equally as long journey from Dallas. It will be great to have the whole team together. I am glad our first day in Sierra Leone is a day planned for rest.

   I look forward to all we will see and do in West Africa, but I will miss the wonderful people we have been able to work with in Ethiopia. God has blessed our time here in many ways.

God is Good,

Lori A. Spies

Hello from Sierra Leone, 3/25
    I hope you are all doing well. We have had many wonderful experiences in Sierra Leone. We have been graciously cared for by Gabe and Sada Herrera. Our accommodations are comfortable the food good and the conversation enriching and engaging.
   Our first clinical day found us setting up a clinic in the rural village Rokon.  We were greeted with speeches by the chief and village leaders and entertained by a chorus of uniformed school children. Gabe – a dentist – provided dental care and we provided health care. We worked with dedicated people who translated English to Krio and Krio to Timni. It is at times a tedious process to get a health care history. But all involved had on their hearts how desperately the people needed Christian love and quality health care. The community had some of the greatest need of any I have ever seen. We saw 5 cases of lymphatic filiarisis, several cases of what was almost certainly TB – (cavernous breath sounds, weight loss, longstanding cough, hemoptysis), pneumonia, dehydration my first Africa case of neurofibromatosis, a severe case of tuberculosis of the spinal column, probable leishmaniasis and of course the ubiquitous Malaria and malnutrition. We were able to provide evaluation, treatment and working with a local minister provide pastoral care to more than a hundred.
    Tuesday the FNP students provided check ups for 70 orphans. The director of the orphanage was an impressive woman who during the war took the children in her care to Guinea to keep them from harms way.  She is now in parliament and working for the benefit of many. It was a highlight of the trip for me to watch each of my students working with the children providing not only expert physical care and medication but just as important taking the time to teach health promotion and pray with each child. It truly is a blessing to watch the Baylor students minister in such beautiful ways.
   The midwifery students put on a well received workshop for midwives. Each midwife in attendance received a gift. Teaching was hands on with songs and activities to encourage engagement, comprehension and learning. Sierra Leone has the highest maternal mortality rate in the world. The best way to improve this horrific state is to provide education and information to those who are providing the care of woman.

 A huge problem in Sierra Leone and across the continent is the traditional birth attendant who practices far beyond her level of skills and knowledge. I am still aghast that the TBA can by pitocin over the counter and uses it for delivery in the villages leading to devastating sequelae. It is a challenging problem to educate community level workers

The last two days have been challenging and rewarding clinical days. We have been working at the UMC hospital and eye hospital. The students partnered with a physician and assisted in the provision of care to both out and in patients. This is a Christian hospital and it was easy to spot the difference in care from government hospitals. The floors were clean and the staff was smiling. The students saw many sad cases and complicated cases of Malaria, Typhoid and strangely for Africa several cases of Appendicitis. Several students opted to observe eye surgery and a few rotated to the lab.

  Sierra Leone has provided a wonderful opportunity to contrast the cultures of Ethiopia. I am surprised by the myriad of differences. Yet the need across Africa is dire and while their are regional variation in the specific diseases all is compounded by malnutrition, lack of clean water, lack of health care access and lack of education. It is good to be a part of the solution.

   It has been wonderful to see how much benefit will be gained from the comprehensive vision GCPN has for the Hope Center. It has been an honor to work alongside Gabe and Sada for this time and I hope we can return and expand our work in years to come. It is humbling to work with people with such commitment and compassion. I am certain that many in Sierra Leone will be blessed by their work. I look forward to seeing what Baylor LHSON work with them will bring forth for the Kingdom.
Thank you,
Lori Spies