Building Update from Bob Braafhart:

• Started construction on one of the porches of the existing maternity building to enclose an area to house about 10 extra beds. With the present rate of over 130 deliveries a month(doesn't include sick patients), only 13 beds in the maternity ward has proven to be not enough. There should be beds in there by the end of the month. Please pray for a timely completion to this project.
• We are currently working through the plans for the new women's medical building. It will cover the square meters about the size of a football field. We are working through the floor plan to get it down to the budgeted size and to be sure that what gets built is useful for the needs in this culture. Please pray for wisdom and unity as we work our way through these plans.
• We are in great need to solve a rain problem before the rainy season starts in a little over a month. After the Pediatric building was built and the first rain came we found that the building wasn't adequitly protected. The rain came in with such force that it flooded rooms through closed windows and large entry door opening. We would like to extend the roof off the east side to help with the rain, take some of the direct sun off the patients' room and supply a place to park staff vehicles out of the scorching sun. Please pray for the funds to do this. It is estimated to cost $8,000
  

Triplets

This last month brought the arrival of the first set of triplets delivered at the Koutiala Women & Childrens Hospital. They were between appox 3, 4 and 5 pounds. Within an hour after their arrival twins were born bringing the total births for that day to 8. Please pray for Dr. Dan Nesselroade and the staff as they are on call 24/7 with little to no relief in sight.

Women and children are alive today that otherwise would not be because of the ministry here. Hundreds of patients have heard the message of the freedom available with faith in Jesus Christ with a few making a descions to follow. Seeing and hearing this makes our cups overflow. There is bound to be struggles and obstacles where Satan's territory is being assalted. How we deal with those also testifies to our lives and faith in Christ.

Thank You for being a part of God's work here in Koutiala!

March update from Dan Nesselroade

March 23, 2006

I don’t believe it has rained here since October, and hot season came in with a vengeance this week. The one thing falling from the sky out here is babies. We are averaging nearly 5 a day at the hospital. If only they came in one at a time, weekdays between 8 and 5. :)

We have seen an enormous amount of abnormal deliveries recently. Breeches, arm presentations, face presentations, prolapsed umbilical cords, ecclampsia, placental abruptions, cervical lacerations, placenta accreta, molar pregnancies, ectopic pregnancies, abdominal pregnancy, shoulder dystocias, transverse lies, twins, fetal distress, forceps galore and on and on. Our case load from the past few weeks reads like the table of contents for a textbook of obstetric emergencies. Through it all we continue to see amazing things, most notably God’s kindness intervening to save our collective bacon, routinely. There is nothing quite so humbling as watching God leap into the middle of a disaster in progress, and provide you with a good outcome, directly on the heels of your missed diagnosis. (ah…..your Great Commission dollars hard at work) It leaves you kind of bewildered. Who is like our God?

Marcy’s parents visited us for the entire month of January. It was so fun to operate together again with her father. We laughed and laughed the whole time. I marvel at God’s kindness to us.

Ami

There is a large, painted sign on the wall in our recovery room. Its message is written in Bambara, the dominant language here. It reads: HEALTH IS FOUND IN JESUS. Under that sign, for weeks on end, lay a pathetically sick 17 year old new mother, literally ravaged by typhoid fever. We expected her to die so many times that I quit counting. Her premature baby lay in a bassinet next to her bed. In spite of its tiny birth weight, it was thriving and growing, receiving infant formula dripped in through a tube in its nose every couple of hours by nurse after nurse, shift after shift, for weeks on end. Its mother, however, was its antithesis. I have never seen anyone run continuous fevers above 103 degrees like that, literally day after day for weeks solid, without succumbing. On occasion, she would push to 104 and 105 degrees. Two times she became so overwhelmingly infected that her blood lost its ability to clot. She would vomit blood, bleed uncontrollably from her nose and pass large amounts of fresh blood from her anus, at times, simultaneously. She received 13 transfusions and probably consumed one third of the entire hospital’s supply of potent intravenous antibiotics during her 7 week hospitalization. She prayed to receive Jesus early in the illness, in a window of relative lucidity. It became quite clear that while yes, she was overtly physically ill, she was as well exceedingly spiritually ill. Now in America it is medically quite vogue to talk about “holistic care”, caring simultaneously for the body, mind and spirit of the patient. But, as best I know, none of our Malienne nurses have ever attended a workshop on any such thing. Neither would they know to define the term, as such. But what I saw them provide was the most dramatic example of compassionate holistic care that I have ever seen, or ever really imagined. God moved on a couple of their hearts and they began to really pray for this girl. They infected the others. It became a common sight to find the nurses gathered around her bed singing hymns at the change of shift. I would come in, in the middle of the night, and find a nurse at her bedside reading scriptures to her. At times they fought for her. Real spiritual combat. Their worldview leaves them perfectly unencumbered to be able to do such things. No need to follow formulas, they simply know the power of Jesus’ blood over evil spirits. Nothing theoretical whatsoever. “Love thy neighbor” means that you understand and use this authority when it is needed. Yet again, I found myself thinking- who is the missionary here? And who is supposed to be teaching medicine to whom?

Last week she went home smiling and free and healed. Do I think that the antibiotics and the blood helped her? Of course I do. But they aren’t what set her free. HEALTH IS FOUND IN JESUS.

A Painful Loss

Yesterday we operated on a girl with an abdominal pregnancy. It is a type of ectopic pregnancy, so it is outside the uterus, but the pregnancy continues to develop, usually implanted on the rectum or the intestines. They are extremely rare, and I had never seen one. The baby was alive and near the fifth month of gestation, so that the gestational sac was about the size of a volley ball and filling the pelvis, behind the uterus. Unfortunately, the placenta had begun to separate and she began to bleed catastrophically into her abdomen. By the time we got to the OR, her pulse was already 160 and she was hypotensive and had bled several units of blood into her belly. You cant take the placenta out because you cant get the bleeding stopped if you do. We couldn’t get the bleeding stopped even leaving it in place. She received a total of 9 units of blood. (we have no blood bank, so this was just 9 willing people who gave a unit of whole blood on the spot) We worked for 5 hours and ended up packing her pelvis as tightly as possible with compresses and closing her abdomen, hoping she would clot off and we could go back in 36 hours or so and take the packs out. I’ve just never seen anything like it. We transferred her to the recovery room and she was laying in the same bed, under the same sign. HEALTH IS FOUND IN JESUS. Last night around 10:30 she died. She was 20 years old. I cried and cried. Perhaps the most discouraging thing about prayer is when God doesn’t do what we want him to do. I imagine he feels the same way about us.

Prayer

Please continue to pray for us. Pray for the missionaries and the Malienne staff as well. We are all tired and kind of beat up. The work increases faster than we can respond to it, so we chase along behind and get discouraged. Pray for the patients here. Pray that God would open hearts and minds to his grace and forgiveness. HEALTH IS FOUND IN JESUS.

May the peace of God keep you.

Dan, Marcy, Emma, Ellie and Maggie

A Little Look At Life in Mali: Going to Church

by Jessica Schaeffer

"I consider everything a loss because of the surpassing worth of knowing Christ Jesus my Lord." Philippians 3:8a

I just got home from church, where the pastor spoke on the verse above. It is still very difficult to understand the sermon in Bambara, but I was grateful for this reminder from Paul to keep pressing on to know Christ more and to help others know Him too. As usual, my church was packed out for the almost 2 and a half hour service. There was a little "traffic jam" of bikes, motos and people trying to get out of the church courtyard after the service. To my best estimate, there are nearly 500 people (including children) who come each Sunday. Small children sit on the lap of an older sibling or mother, and bigger children sit quietly on mats on the floor at the front of the church for the first half of the service, and then they divide into 3 or 4 classes for Sunday School. Two ushers help find space to squeeze another person into the church…often people who sit on the end of the bench are half on the bench and half off. The worship is lively with a few people playing drums and an instrument with a large gourd and beads. Most people have the songs memorized, but a few people (including the worship leaders and myself!) bring songbooks. Although most songs we sing seem to be tunes and words that originate in Africa, there are a few with tunes taken from English hymns or choruses. The song we sing while the offering is taken every Sunday is to the tune of "Auld Lang Syne". Women sit on one side of the church, men on the other side. After the service is over, people exit pretty quickly and to their visiting outside the church courtyard on the dusty road. I am the only white person who attends the church since my missionary colleagues attend the other 3 Alliance churches in Koutiala.

Philippians 3:8a in Bambara: "Tinyé la, ne bé fén bée jate bóné ye nin nafaba kosón, Yesu Krisita ne Matigi dónniya kóni."

Our Friend Ami

by Betsy Bohuslavsky

Hello again from Koutiala where the work goes on night and day at the hospital for Women and Children. Thankfully we serve a God who never sleeps! He has shown His faithfulness and mercy amongst our patients in special ways this past month. One patient, Ami, delivered her baby at our hospital late January, then became ill just after with high fevers and dangerously low blood counts. We began treating her with antibiotics and blood transfusions but the severity of her illness didn't improve much. One evening she prayed with some staff and put her faith in Jesus. The next day something happened we don't see or talk much about in the U.S. She began acting and talking weird and the Malians, including our pastor, quickly recognized that she was suffering from demon possession. It's a very "spirit" world here in Africa and the Christians don't doubt it's reality and really wield the weapon of prayer and praise in the all-powerful one our Savior and Lord, Jesus. It was a beautiful thing to see pastor Enoch sitting at her bedside all day praying over her and one of our nurses Germaine hardly left her bedside that night singing praise songs over her. Whenever the demon spoke through Ami they told it to leave in Jesus name. I know this story sounds so unusual and hard to imagine for us "Westerners." I sensed my own inadequacies in dealing with such an obvious spiritual battle. I was thankful the Lord put me with a team of Malians and other missionaries to learn from in this situation. As for Ami, she seemed to be herself after a day of praying, but still very physically ill. Last Saturday morning her abdomen and assessment showed alarming signs of needing surgery. We took her to the "bloc" and after opening her abdomen we were relieved she didn't need any bowel resection but parts of her bowel were completely inflamed and hot. That, along with all her other symptoms confirmed in Dan's mind from what he learned in tropical medicine training that she definitely had Typhoid Fever. We continued with the treatment for the disease and praying for her healing. This past week she's required constant nursing care and hasn't been able to eat anything except a little "clears." We've given her a total of about 11 blood transfusions the past 3 weeks and her blood counts seem to finally be stabilizing. Probably the most encouraging sign the last couple days has been that her temperature has returned to normal a few times. Many times despite giving Tylenol her fever would reach 105 degrees. Even though we are seeing encouraging signs we ask you to pray with us for her healing and strength to return.

A team just arrived this weekend to come work at the hospital and relieve us medical missionaries so we can gather as a whole missionary team to have our annual Prayer Conference. We leave Wed this week and I'm looking forward to the time learning from God's word together and praying for Mali. Pray for the team as they work at the hospital and for our Prayer Conference to be a renewing time for all the missionaries.

We have three new nurses, one who is a new employee and the other two who are nursing students doing clinicals with us. We have a program designed for how we want their time to look with us. The hard part is always having enough qualified experienced nurses around to oversee them. Pray for us as we manage a lot of new nurses and try to teach them things. Many times I get stuck with my few Bambara words and don't know how to teach them clearly.

Our first two fistula repair patients are doing o.k. They still have their catheters in. One came back after her catheter got blocked at home and she was leaking urine again. The problem seems to be temporarily fixed with a new catheter but we are unsure how well both the ladies will heal completely. Pray for wisdom whether more surgery is needed in the future and healing.

Pray for our care of preemie and sick babies and their mothers. These little ones need lots of TLC and Gail has been very busy taking care of newborns lately and managing their care.

Thank you for your partnership and prayers!

First Fistula Repair Surgery

by Betsy Bohuslavsky

During my first few months in Mali, I read the book The Hospital By The River by Catherine Hamlin. The book is about a hospital in Ethiopia called the Addis Ababa Fistula Hospital which does surgery helping women whom from long, obstructed labor suffer complicated fistulas that cause them to constantly leak urine or stool. I was so inspired by the book and the life changing work the Lord has done through them for women in Ethiopia. I wondered if that was something women in Mali suffer from and if our hospital here would one day be helping ladies with those types of fistulas.

This week Dan performed his first fistula repair with success so far at post-op day 2. The patient is a young girl, about 18 years old. We actually had the blessing of doing many surgeries this week with the help of a visiting medical team from Omaha, NE and Dan's father-in-law, Dr. Dave Billings. This particular surgery though was something new for all of us (it's not common in the US). We are praying for healing and a successful recovery for this young girl. She has to stay on bedrest for two weeks and the nurses have to watch her urinary catheter closely so that it doesn't get blocked. Please pray with us for her healing and for the Lord to speak to her and her family caregivers during the next few weeks in the hospital.

Our Little Fulani Baby

(His incubator days)

(Ready to go home)

An answer to prayer is named “Baby Christophe”. He was born about 6 weeks premature at the hospital on November 18^th. He required antibiotics, oxygen, an incubator, tube feedings, and a lot of TLC for 2 months. His weight at one time dropped to just over 1000 grams (2.5 pounds). Today he is 2,000 grams, drinking from the bottle, and planning to go home with his mom in the next few days! Because normally babies are not named until they have been home for 1 week, our Pediatric Nurse Practitioner, Gail Warner, named him Christophe because she was praying that his healing would be a Christmas present. Well, it came as a New Year’s gift. But we praise God and give Him the glory for this miracle! We also praise God that while this Fulani mother was with us at the hospital, she heard clear presentations of the Gospel. (The Fulani are a people group who care for cattle. They also have very limited access to the Gospel.) She understands that the credit for healing her baby belongs to God.

We praise Him for this miracle!

Visiting Surgeon Does Cleft Repairs

We had the pleasure of hosting Drs. Tim and Hyuen Bartholomew, missionaries headed to work at the Hope Clinic in Guinea, West Africa. Tim performed three cleft repairs on three children whose families asked missionaries about treatment possibilities several months ago. The results look remarkable and the chance to do something special for these children and their families was an opportunity from God. May He receive the glory!

Missionary Jeff Amstutz also scrubbed in for a change from his administrative duties. All three kids were brought to the OR, placed with IVs, put under anesthesia and intubated and sedated throughout the entire procedure which ran from 2-4 hrs total with recovery time. The hospital hopes to host Tim again in a year or so as we expect more cases to be coming asking about treatment.

Update from Dan Nesselroade

December 6th, 2006

This is the coldest time of year in Mali. The temperature drops down into the high 60’s at night and it seems funny but we are all wearing jackets and sweatshirts in the morning. I am sitting here in our living room with a cup of coffee and if I didn’t look out the window, I could imagine it was autumn and I was back in Ohio. The rains stopped here about two months ago and we won’t be expecting anymore until next June. It is dry and dusty, but COOL and for that we are very thankful. I hope this letter finds you all in peace.

The hospital is beginning to take on a life of its own. We are doing about 100 deliveries a month now and seeing 50-80 patients in consultation each day. We are doing about 20 surgical cases a month as well. God has blessed us with a wonderful team of Malian and expatriate doctors and nurses. It has been a great joy to watch how we are walking forward together, taking small steps each month, learning and improving our efficiency and our level of care. I am so proud of our little team.

Medical practice here is challenging. There is an enormous amount of infectious disease. Fortunately, most Malian women are as tough as nails. Their resilience in the face of malaria, often profound anemia, and frequent poor nutrition is shocking. Their emotional fortitude in the face of all too frequent infant death is equally amazing.

Last Tuesday a lady presented for consultation being buoyed up by a family member under each arm. They were from an outlying village. She had delivered a premature infant there, 6 days earlier. The infant died at birth, but the placenta never came out. Now, 6 days later, she was massively infected, febrile to 103 F, her pulse was 150 beats/minute, and still bleeding with a hematocrit of 11% ( that is about one fourth of the normal amount of blood cells for an adult) I really couldn’t believe she was even alive. While we were scrambling to get blood for her and to get the operating room ready, a second lady came in pouring blood in active labor with a baby already dead that was positioned sideways in the uterus. Her placenta had prematurely begun to separate from the uterine wall and was causing the hemorrhage, but the baby was locked in her pelvis, unable to descend because of its transverse lie. Her hematocrit was only 14% (equivalent to a hemoglobin of 3.6) and she was actively bleeding all over the delivery room floor. We decided to take her back first, as we only have one operating room. I have never been so proud of our staff. Everyone mobilized. Those who weren’t in the OR helping were over in the lab giving blood or trying to find suitable donors. We don’t have a blood bank, so when transfusions are necessary, we type the family (and our staff) and whoever matches gives a unit on the spot. We do a crossmatch, a rapid HIV test, a hepatitis B test and then just transfuse the whole blood. We really needed an absolute minimum of 4 units for these two ladies. Somehow, they found them and we got two units of blood while we were still in the OR. The surgery went well. 5 days later, she was weak, but walking and eating again.

Then we went back to the OR with the first lady who had the retained placenta for 6 days. She got two units of whole blood on the OR table and we started a curettage to remove the retained dead placenta. Unfortunately, when the uterus is that infected, it doesn’t respond well to medications that would normally help it to contract down and slow the bleeding. We watched the two units of blood that we were running into her arm come pouring back out her uterus when we started the curettage. It gives you the unsettling feeling that you are just sort of changing the oil. Ultimately, we got the placenta out in pieces, but we couldn’t get her to stop bleeding and just ended up packing her uterus full of meters and meters of sterile gauze. Thankfully the pressure from all of the gauze pushing on the walls of the uterus was enough to get the bleeding stopped. She stabilized over the night and we were able to pull all the gauze out the next day without incident. It seems to me that both of these ladies should have died. Often, I feel as though God intervenes here to protect his own reputation because his name is on the sign out front.

Everyday is certainly not as exciting as Tuesday, and all of the outcomes are not always good, but we do see the need to be here and thank God that he is blessing us and inching us forward, though often it seems, in spite of ourselves.

For the many who were praying for the arrival of the hospital shipping container, (the one that left this summer from Ohio- the train that was carrying the container derailed in the desert in Senegal) THANK YOU! We were all delighted when it arrived the week before last moderately disheveled, but 90% intact. No major piece of hospital equipment was irreparably damaged. The container itself was hammered and irrecoverable- so we see God’s hand in protecting all of that stuff!

-Dan Nesselroade

Hospital Life and Babies

Hospital life

The Koutiala Hospital for Women and Children keeps on going! It is
exciting to look at the progress we have made. The first month of
opening, we had about 20 patients a day in clinic and 2 or 3 deliveries
a week. Now, we see 60- 75 patients in clinic each day and do an
average of 3 deliveries a day! We did 3 surgeries yesterday and one
today! If you look too closely at the hospital, it's easy to get
discouraged and see all the faults, but if you stand back and see where
God has brought us, my only appropriate response is to praise Him for
what he has done!

Babies

Newborn care is one thing we have been focusing on lately here at the
hospital. It is an area of care that is very new to many of our staff.
It is also an area where we have seen God's incredible grace! Gail
Warner, Pediatric Nurse Practitioner, works hard educating staff, doing
neonatal resuscitation at birth, and checking babies before they go
home. Since opening, we have delivered about 300 babies and only 2
have died! We cannot claim any of this success as our own human
effort. It is often in spite of our efforts that babies have lived.
It is common to see mothers who have had 8, 9, 10 pregnancies and only
3 or 4 (or less) living children. This culture doesn't have all the
"touchy feely" stuff that we have in the states to cope with infant
death. The women are incredibly strong, but they do grieve deeply when
their babies die. I pray that not only can we comfort them, but also
show them the way to Jesus Christ, the Ultimate Comforter.

by Carey Schlieker

New: Koutiala Hospital blog

Come back soon to read how things at the Hospital are going...