The Latest from Bob the Builder

The Warehouse
While we were in the States, Craig Hanscome did a great job of keeping the warehouse project moving. Between running out of cement and figuring what to do with the rain water until the systems to handle it are in place, he was able to oversee the finishing of the walls inside and out. Plus much more.
Ever since our arrival we have been working on the steel trusses for the roof and how we will get them up. You can see in the photo that we have been able to get the first 2 up. The biggest job is always establishing the technique. Once that is established my very capable crew here takes off and does the same thing over and over again. Yes, I have to keep track of the quality but they do a great job of that also.
We have 3 teams coming to help with installing the 300—6 meter sheets of roofing and the 6,000 bolts to hold it all on. Please Pray for their safe travel and their safety in working with sharp steel during a rather warm time of the year. The teams that are coming in the next 2 months and their dates are as follows:
Christ Community Church, Omaha Nebraska October 6-17
Shawnee Alliance, Lima Ohio. October 20-31
First Alliance Church, New Castle Pennsylvania November 4-14

The Morgue
I arrived to work in the usual way this day. On my little Yamaha scooter like I do most every day. And on most days many of our workers are already getting things ready for the days projects. They may be watering new bricks or cement that was just poured the day before. There are always many tools and supplies to prepare for the day’s projects.

Here in Mali it is good to get going a little early to get a jump on the heat. There are 4 seasons in Mali, they consist of warm and dry, really hot & dry, hot & wet then there is really hot & dry. I know I said that before but it is sooo hot during that season that is worth repeating!! But today was different and I wasn’t exactly sure why. Everyone was just standing around my shop and not really appearing to be doing anything. This was puzzling but with a scan of the area it was evident that we had visitors this morning and it didn’t take long to figure out why.

There was a Muslim van backed up to the warehouse project which, at this time, had some walls up on one end. They were using the privacy of the space between the rear wall of the property and the warehouse wall as an area to wash and prepare a woman’s body for burial. It was what you would expect around a construction sight, scaffolding, bricks, steel, etc, and none of it in an orderly manner. It was a mess! But there they were! Carefully preparing the body of their loved one who would most likely be buried the next day or even the same day.

As soon as the realization of the situation sank in I did the only thing I could. Expressed sympathy to the family and then cried. I seem to do that a lot here. Tears come easier all the time for some reason. And so does the phase “But for the grace of God, there go I”. While traveling down the road I see village after village and wonder, “Do they know?” ‘Who will tell them?”. Who will tell them that Christ came and died for us and rose from the dead to pay the price for me, you and them. Not only that life eternal is ours and theirs but life in abundance here on earth also simply through faith in Jesus Christ our Lord and Savior. The peace that surpasses all understanding!! We don’t have to kill anyone or sacrifice anything on an alter to obtain a place in heaven. It is already there, in a better state that we can imagine.

So we are building a morgue!! The phrase I have heard time and time again is “They don’t care about what you know until they know that you care”. So we are trying to help bring some dignity into an already difficult situation. All of these side projects cost money and detract from the main building projects but they are needed none the less. Please pray for the finishing of this building and also the funds to help pay for it. Pray also that those who pass will ask questions as to why and that we would again have an opportunity to share Christ’s Love.
Please pray also for the evangelization of Mali.

HELP!!
I need older style waterbed thermostats to build baby warmers for premature babies. If you have one stored some where, please contact me. bbraafhart@gmail..com

Neonatal Care in Mali from Dr. Brett

In Mali, where 1 out of every 4 kids dies before age 5, the first month of life is definitely the most critical time. A quarter of all the kids who die in the first 5 years die in the first month of life. Neonatal infections, respiratory problems, and prematurity are the main culprits. Babies get infected more often here because the pregnant women are not followed as closely as in the states. Often women come to our hospital after having been in labor with their water broken for 3 days leading to neonatal infections. Also, as in the states, but much more often here, the babies are frequently under extreme stress in the womb which leads to the passing and aspiration of their own stool (meconium) leading to extreme breathing problems. And, of course, just like all over the world, prematurity is a big problem. In WestAfrica 15.4% of babies are <2500g>

Thankfully, the cost isn't much for the families since most of our main equipment is donated. We just have to charge enough to cover our staff's salary, electricity and medicines. So we charge $2 a day for the first 2 weeks and then $1 for each day thereafter. At first I insisted on using the US NICU rate of $10,000 per day, but we eventually worked down to this price. :)

Caring for these neonates has been really enjoyable, but it can be pretty difficult as I face challenges here that I never did in the US. Besides adjusting to the obvious differences in technology and staff knowledge level, I have faced challenges such as having to swat flies from inside preemies' incubators, learning how to explain to illiterate moms how to give medicines at home (19% of Malians are literate, but those are mainly men), as well as asking myself…When a newborn has a temperature of 102 but the room is 110 is that a good thing or a bad thing? Does that mean he is doing a pretty good job keeping his body cool, or that he might die soon from a serious bacterial infection and needs emergent antibiotics? Some days our post-partum room feels like a car turned off in the summer with the windows rolled up. I tried using this analogy with our staff but since none of them have cars, they didn't really get it. :)

Latest from Jessica Shaeffer

Dear Friends,

Whenever I am in town, whether buying fruits and vegetables, looking for fabric for a new dress, or making photocopies, I hear the same thing. "You work at the Hospital for Women and Children, right? You really do a good job there. We want you to treat men too, the whole family!" J One person emphasized how our hospital takes patients seriously and cares about them. In other clinics or hospitals, he explained, patients aren't "taken into account", and doctors and nurses often take some of the patients' medicines for themselves. The honesty and kindness shown at our hospital are making a difference, and we have seen patients come from countless cities and villages (including the capital city 5 hours away) for medical help.

Although I hear regular positive feedback, there is some opposition in town too. A few weeks ago, in a mosque near the hospital, the imam (Muslim teacher) spoke before the Friday prayers telling the people to stop taking their women to our hospital because we would force them to become Christians. Those present openly disagreed with the imam, telling him that they have found that we give good and loving care at the hospital. After expressing their disagreement, they left. Many seeds are being planted through our ministry at the hospital. Pray that these seeds will grow and bear fruit.

Today I went to visit Adam, the young woman who was so ill with typhoid and perforated bowel in January and February. She had 3 surgeries during her hospital stay, but has been home for nearly 2 months now. She told me to thank everyone who prayed for her during her illness. She said that she and her husband are seriously considering following the "Jesus way".

In February I completed my last language test, and hope to finish my final language requirements in the next few months. I come home from my 10-12 hour shifts at the hospital pretty exhausted after speaking 2 foreign languages all day, especially with current daily temperatures of 100-110 degrees. In the next few months I will be taking on the role of supervisor of hospitalized nursing care. This will include training and teaching new nurses and nurses aids, writing protocols to improve organization and consistency of nursing care, problem solving, etc!

We've had some difficult cases this past month, and it has been discouraging to lose 3 women. One pregnant woman was brought in from the village because she was in a coma. We treated her for 10 days, but she showed little improvement. Early last week it became clear that she had only hours left, and the baby was in distress. The family agreed for us to do a c-section, which Dr. Dan did at the bedside. The baby was 8 weeks premature, but is growing and doing well. Another young woman, age 18, came in a week after delivering a stillborn from a village 65 kilometers away. She looked like she was still pregnant as her abdomen was ballooned up. She was quickly taken to the OR, where 1 to 2 liters of pus was removed from her abdomen, and a hysterectomy was done. She had retained placenta that had eaten through her uterus, the upper half of which was dead. I spent the following 8 hours at her bedside until she died that evening. We did everything possible we could for her medically that day, and several staff members and our chaplain spent many hours praying at her bedside. The response of the family was very typical. They received the news with stone faces saying "It was Allah's will". I know many of you also read about this young woman in Dr. Dan Nesselroade's last update…if you haven't and you want to hear more, I can forward it to you. The third woman came in with eclampsia, having seizures and blood pressure through the roof (200/120). She died on the operating table, and a few days later her premature baby also died.

Fatigue and discouragement have almost overtaken me a few times this month, but I have been frequently reminded of God's faithfulness: He never fails. He is with me. He is at work here. As I mentioned earlier, people here tell me that the name of the hospital is spreading around Mali. May Jesus' name also be spread throughout Mali. Thank you for the ways you partner with the ministry here through your prayers, your gifts, and your encouragement.

Living the Call Together,
Jessica

The Latest from Dr. Dan

Thursday a girl was brought in critically ill from a village 65 kilometers away. She had delivered there 7 days prior and the placenta had to be manually extracted afterwards by the maternity nurse, as she had protracted bleeding. She was 18 years old. It was her second pregnancy, but she had no children, as both prior babies had been dead at birth. On presentation, her abdomen was ballooned up as though she was still 9 months pregnant. Her fever was 103.5 and her heart was racing at 170 beats per minute. She was extremely anemic with a hematocrit of 14% (about one third of a tank) Everyone scrambled to find blood as we prepped the operating room. People like this are so outrageously sick that you marvel at the fortitude of their bodies. How can someone really sustain such an insult? We poured in IV fluid, antibiotics and blood and opened her abdomen to be greeted with 1-2 liters of eye-watering anaerobic pus. The best I can tell, she had an unusual problem called placenta percreta. The placenta had perforated through the uterus almost like a cancer. How she could have this and still have managed to live even a few hours after delivery without bleeding to death straightaway, I cannot explain. Now 7 days later, what remained of the placenta was dead, as well as the upper half of her uterus. We did a hysterectomy and tried to clean things up. She seemed to stabilize a little bit initially, but over the ensuing 8 hours, she spiraled steadily downwards and expired. To respond well medically to a case of this magnitude takes a Herculean effort from everyone involved. Lab, anesthesia, nurses, surgeons, everyone drops what they are doing and invests 110%. And when it is not enough, it can be rather demoralizing. 18 year old girls just aren’t supposed to die as a complication of childbirth.
When I informed the family, their response was typical. They received the news with absolute stone faces. “It is Allah’s will” they said- which is nice from the point of view of never having to worry about being accused of causing a bad outcome, but it never sits right. There is a smothering fatalism out here that has incredible numbing power. It is a philosophical anesthetic that allows people to deal with tragedy after tragedy, but on the other hand, exempts any and everyone from any personal responsibility, because, “hey, whatever happens was God’s will.” I found myself thinking, but wouldn’t God have wanted you to bring her in for treatment before 7 entire days had transpired? The tension between Divine Sovereignty and human responsibility wanders like a fault line, dissecting all of life. Both here, and everywhere, I suppose.
We rolled her body into the next building to wait for morning when the rest of the family would come to wash and bury her. I rode home wrestling for the thousandth time with the problem of evil. Things are so stark out here. One is constantly reminded that our time on this earth is but a few years.
155 babies were delivered at the hospital in the month of March. There are lots of preemies and 4 sets of twins in the house right now. It is amazing to see little two pound babies make it when you consider how little technology we have to offer.
We have had several visiting medical teams in the past 6 months. Each team leaves us stronger than we were before, as we are slowly expanding our competence and confidence. It is great fun to see the progress. 2008 looks to finish strong as we are nearing completion of a large storage building and preparing to start construction of the new maternity complex.
Thank you for your faithful prayer and support of us. It is your kindness in giving to the Great Commission Fund that allows us to stay out here.

The Latest from Bob the Builder

Columns Up

As the temperature goes up here in Mali so does the new warehouse for the hospital. The Warehouse is 71 meters long and 15 meters wide. We poured 60 columns and have brought in over 100 trucks of dirt. Granted the trucks aren’t as big as you would see in the States but it is still a substantial amount of dirt. We go from no fill on one corner to 1 meter in a few places. The place where we are building is suitable for little else but is a great sight for a warehouse. It will be close to the pediatric and maternity buildings which will help for stocking those buildings with supplies. There will be a room set aside for an x-ray machine and 5 offices to be used for administration for a few years. Then they could be transformed into any number of uses that best suit the hospital’s needs at that time. Please pray that we would find an x-ray machine to come out in this summer’s container. We are focusing on digital to get away from developing solutions because of the high heat situation here The columns were wrapped with cement paper to help hold in the humidity and were soaked down a couple times a day. This time of year when the humidity is below 10%, it is important for the strength of the cement to take this extra step.

The Malian group that we have building this building is from Koutiala and is learning much in this process. This is an important step in the building process here. Not only for the fact of teaching and expanding the local labors’ skills but it also helps with local public relations that we help employ local people and keep funds here in Koutiala. It cost no more except for time and effort. But the return from this investment will be considerable. I have been blessed to be able to work with these guys. Please pray for Momine, the mason in charge, as he is Muslim. Pray that our time together would be more than just teaching temporary skills but be of eternal value to him and those under him who don’t know Christ.

Please pray also for the project that it would continue to move forward at a good rate and that we would be able to get a roof, windows and doors on before we go on home assignment the end of April. Please pray for wisdom as I am far out of my abilities. I love what I am doing and truly enjoy seeing God at work in our daily activities.

Bed from and for Mali

After much work with a local metal fabricator and much input by the medical staff here we have a bed that is especially suited for the patient’s needs here. Everything for this bed is purchased & built here in Koutiala. “Appropriate Technology”.
-Removable canopy for mosquito net support.
-hooks for IV solution bags.
-Place to mount urine bag
-removable divider for either side of bed to protect babies from falling off, they sleep in bed with Mom. (cultural)
-standardized dimensions so all accessories are interchangeable.
-place under bed for storage of personal items.
We do have some regular medical beds for patients when needed. Please offer praise for this success and pray for future design opportunities

Thank You for being a part of this project!!!