MERRY CHRISTMAS - Sunsets over Applesbosch skies-South Africa 2010

THE LORD IS GOD AND HE HAS MADE HIS LIGHT SHINE UPON US!
Psalm 118: 27


Sunset after heavy thunder and lightening storms



 

First sunset upon my arrival Sept 21st to Appelsbosch Campus
South Africa

 

Sunsets at our Appelsbosch Campus in South Africa



MERRY CHRISTMAS to all and a HAPPY NEW YEAR for 2011!

As we celebrate this special season, the birth of our Lord Jesus Christ, may HIS JOY be with you!

LUKE 2:8-14:

⁸ And there were shepherds living out in the fields nearby, keeping watch over their flocks at night. ⁹ An angel of the Lord appeared to them, and the glory of the Lord shone around them, and they were terrified. ¹⁰ But the angel said to them,  “DO NOT BE AFRAID.  I BRING YOU GOOD NEWS THAT WILL CAUSE GREAT JOY FOR ALL THE PEOPLE.”.  ¹¹ Today in the town of David A SAVIOR HAS BEEN BORN TO YOU; HE IS THE MESSIAH, THE LORD. ¹² This will be a sign to you: You will find a baby wrapped in cloths and lying in a manger.”13 Suddenly, the angle was joined by a vast host of others-armies of heaven-praising God and saying, 14 “Glory to God in highest heaven, and peace on earth to those with whom God is pleased.”

With much thanks and blessings to each and everyone.

Debra

Mental Health Program-SA (2)

THE MENTAL HEALTH PROGRAM SOUTH AFRICA-Sept-Oct 2010

Church Leader play therapy
The Mental Health Program was limited in South Africa, not only in numbers but also in scope since we only had two months to offer training. However, during that time we provided training in five regions and to over 120 church leaders, primarily men since they are being trained as caregivers, from a variety of denominations. In addition, we traveled to Swaziland and Mozambique to connect with church leaders for future training. With only a few exceptions, the program participants were of Zulu heritage, affording us an opportunity to gain better understanding of
not only life as it is in contemporary South Africa, but also a taste of the history of the Zulu nation. Our hearts were touched as we heard stories of the pain of apartheid and the separation that still exists on some levels. Yet, the participants were people of tremendous forgiveness and hope.

Thuli’s family
THULI: Of the many amazing experiences of the South African field service there are two that I will never forget. The first is of a woman named Thuli who asked if she could work for me. She told me her husband died one year previously, and she had 6 children. It struck me that this woman in tattered clothes and swollen feet did not ask for money; she asked for work. My desire was to connect her with the church leaders, but she was hesitant. “God doesn’t answer my prayers”, she said softly. I asked for her phone number, and gave her 10 Rand, which is about $1.50. Her face lit up, and she said, “Oh thank you, thank you. Now I can buy bread for my family!” This, too touched me, and I asked if I could hug her. When I did, she sobbed in my arms. At that point I gave her more money for groceries, and asked if I could pray for her. She said, “Please pray for me, and pray for me tonight . . .by name, please pray for me tonight. I just wanted to die. And please have the pastors pray for me. Will you come to my house to bless us?” I told this story to the church leaders, and we followed Thuli’s story for the next two weeks of training. My team and I went to Thuli’s house, and prayed for each family member. What moved us the most was that the love demonstrated among these two sisters and the 3 children at home had more value than much food and many possessions. They truly understood love, but didn’t realize the treasure they have. Thuli asked that I share her story and family picture so that others would also pray for them.

Fire of God and the Cross
The second story occurred on our last day of training in Newcastle. There had been a storm that morning, and part of my closing ceremony was to have the participants take their sin, their unforgiveness, or their pain to the cross. Commenting that I needed to find a dry spot to put the box since I am not Elijah, I set the box where I thought it had the best chance of not getting wet. I lit the first match, and a slip of paper caught on fire, but died out immediately. The flame on the second match blew out before it reached the papers. This was not unusual for me. But what followed was unusual. I said, “Breath of Heaven, we need you.” Immediately the papers burst into flame, and the entire box burned to the ground. The participants did not realize what had happened. This fire was not lit by human hands! And as you see in the picture, the cross, where Jesus took all our pain,
appeared in the fire. Glory be to God!
(by Lyn Westman –Mental Health Program Administrator)

MENTAL HEALTH TRAINING: South Africa Sept-Oct 2010

“This helped me to understand people's problems, but first it helped me to understand myself,” said Beatrice Nhleko, speaking of the Mental Health Training Seminar led by Dr. Lyn Westman, Mercy Ships Mental Health Program Administrator. Mercy Ships partnered with the KwaZulu Regional Christian Council to offer 45 hours of training in basic counselling skills and mental health assessment to help pastors assess the problems of their parishioners. Beatrice, a pastor and hospital chaplain from the far north village of Ubombo (close South Africa's border with Swaziland) attended the week-long seminar in Pietermaritzburg recently with 31 other northern area pastors.

In the far north region, people commonly ask their pastors' help with all their problems – partly because they trust them, but also because they lack funds to seek help from health care professionals. Many people are victims of human rights abuses caused by a lack of understanding of mental problems.

The Mental Health Training Seminar offered a better understanding of the symptoms that separate physical, emotional and spiritual problems. Dealing with people holistically provides a better appraisal. Beatrice noted, “This was an eye-opener! Sometimes the problems we deal with are only medical, and we are casting out the devil when the devil is not there. Sometimes we don't need to pray and overload God when we can refer the problem to a professional and then pray.”

Beatrice founded a non-governmental community health organization to assist the terminally ill, orphans, and others with social and health problems. She has recruited ten volunteers to work with her to get government funding and access to government grants by documenting community members with personal information, such as birth certificates, which are required for such funding. In addition to the valuable training Beatrice received, the seminar began the process of networking with pastors to work toward mutual goals.

Beatrice admitted she would love more training of this kind, adding, “Sometimes we think we know something, but we don't. Sometimes, we think people are stubborn, when it's us who are stubborn.”

Pharla Gumede is a pastor from the Assembly of God church in a small village near Sondwanaby in northern Zululand. He has lectured on theology at Parousia Bible College for the past three years. In addition, once a week he makes a seven-hour visit to a nearby prison where he teaches a course in theology and prays with 73 inmates there. He says he must teach about forgiveness before he can begin the theology lessons. The prison students get assignments and take tests just as college students do .When they complete the course, he gives them diplomas and documents their study for credit. Two of his prison graduates are now pastors of large churches.

According to Pastor Gumede, “God can heal psychologically, mentally and socially… but it will start with their heart. First they must change their mind before their spirit can be changed. Then they can accept Jesus. They must then apologize to their victims and ask for forgiveness, even if they are in jail for life.”

He has found this training seminar extremely helpful for dealing with members of his congregation and the prisoners – especially in dealing with trauma and conflict. He is hopeful that additional training will be offered in the future.

Newcastle, SA Church leaders at Mental Health Workshop

Pastor Mezrom Mbonambi, who leads a congregation in the northern village of Kosibay, heads a team of volunteers that go into schools to teach students the importance of education and sexual purity. He said. “I've been longing to have this information for so long, and I see no reason why we shouldn't take this training to our team.”

He cited a case he had dealt with during the previous month – a young girl who was thought to be possessed or mentally ill. He observed, “Now I recognize that this girl was molested. If I had known then what this workshop taught me, I would have recognized it right away.”

Pastor Mbonambi said that the pastors had been looking at all problems as spiritual problems. Now he knows that all problems are not spiritual problems. “Dr. Lyn has helped us to see the signs leading to social and mental problems. Now we can look to the symptoms and address them accordingly, with the help of the Holy Spirit,” he remarked.

He is aware that more people will be coming to the pastors for help, and they must be equipped to handle the problems. Their mission now is to share their new knowledge with others inside their churches. He is very grateful to Mercy Ships and Dr. Westman for the training.

Over the next few weeks, Dr. Westman will conduct this seminar in several more locations in South Africa, thus enlarging the network of trained mental health counsellors.

Bringing Hope and Healing…

PO Box 2020, Lindale, Texas, .75771-2020, USA / www.mercyships.org Photos: Debra Bell, John Rolland / Story: Elaine Winn

Acute Presentation of Noma: from Diagnosis to Surgical reconstruction (Togo, West Africa)

¹Boys A, ¹Murugiah M, ¹van Gijn D, ²Raw J, ¹Hughes F

¹Kingʼs College Hospital, London

²University College, London

Photos: Debra Bell and Liz Cantu

INTRODUCTION
Scar evolution and secondary complications Noma, or Cancrum Oris, is a multifactorial destructive and disfiguring condition occurring within a background of malnutrition and immunosuppression. The World Health Organisation reported a total incidence of of 770,000 in 1997. The mortality rate is 95%. Disease progression consists of three overlapping stages; severe malnutrition, a preceding severe illness and colonisation with specific invasive and destructive microbes such as Fusobacterium necrophorum and Prevotella intermedia.

CASE REPORT
The authors present a case of a severely malnourished six year old female with extensive buccal soft tissue necrosis and bony destruction of the right maxilla and zygoma. Initial treatment consisted of parenteral nutrition, intravenous antibiotics and sequential surgical wound debridement under ketamine sedation. Tissue viability, ocular protection and masticatory exercises were commenced and pursued over a ten month period. Optimal nutrition and immune status were achieved prior to reconstructive surgery. The conditions
required for noma to occur dictate that the patient is usually from a remote, and impoverished area, without access to healthcare. Therefore, the majority of surviving cases present to the reconstructive surgeon at a clinically advanced stage. The case here described offers a novel insight into the full progression of the disease - from the acute presentation through to surgical reconstruction allowing consideration of holistic treatment planning, including the prevention of frequently encountered secondary complications of ectropion, corneal abrasion and ankylosis.

Fig 1. Acute infection Day 4

Fig 2. Following initial debridement

Fig 3. 6 months post debridement

Fig 4. 10 months post debridement



SCAR EVOLUTION and SECONDARY COMPLICATIONS
Once the infective process has ʻburnt outʼ, or been arrested with antibiotics, scar evolution begins. Over time (6-12months) impressive scar contracture can occur reducing the defect size considerably. However, this comes at an expense; distorting surrounding tissues, most often at effecting the lower lid. Significant ectropion can occur, leading to corneal abrasions and ultimately blindness. Muscle fibrosis and contracture can result in trismus and ankylosis. It is for this reason that presentation at the acute stage can allow early intervention to reduce secondary complications.

Fig 1. Incision and inversion of scar

Fig 2.Temporalis flap raised

Fig 3. Inversion of flap

Fig 4. Split thickness skin graft (unmeshed)

SURGICAL RECONSTRUCTION

The patient in this report underwent a single stage temporalis flap with split thickness skin graft. The patient was fibre-optically nasally intubated, due to reduced mouth opening. No debridement was needed due to waiting ten months. The marginal scar was incised and inverted for use as oral lining. A hemi-coronal incision was made, a flap was raised via elevation of temporalis fascia and temporalis muscle including a 15 mm margin of deep temporalis fascia on the superior edge of the muscle. The temporalis muscle was inverted and
passed into the oral cavity where it was sutured into position over the inverted normal scar to form a buccal lining.

The inverted noma scar covered about 50% of the oral surface of the cheek whilst the muscle flap covered deep to the inverted scar as well as the space between the edges of the inverted scar tissue. An unmeshed split thickness skin graft from the left thigh was applied to the facial surface of the temporalis muscle flap. Vicryl was used to secure the skin graft to skin surrounding the muscle flap. Jelonet, saline soaked gauze and sponge covering was secured over the graft. Right lateral tarsorraphy was carried out using prolene with silastic tubing bolster. A Wolfe graft and naso-gastric feeding were applied for 7 days.

Fig 1. Two weeks post-operatively

Fig 2. Four weeks post-operatively

Fig 3. Five weeks post-operatively

Fig 4. Four months post-operative

DISCUSSION

It is rare for a noma patient to present to a medical centre in the acute stage of infection, rarer still is on hand surgical expertise to advise on early management. The case presented therefore offers a unique view into the disease process. Although early advice and input from specialists do not alter the timing of reconstructive surgery, it is beneficial on a number of
levels. Survival can be ensured with resuscitation and staged debridement. Optimisation of the patient for surgery with minimisation of secondary complications are the key benefits to early specialty input. Observing the scar progression and anticipating secondary complications allowed optimal surgical planning and minimised morbidity to the eye and
temporomandibular joint.

(For patient story during her surgical and recovery time on the Africa Mercy, refere to my archive: Aicha-Love in Action, June 1, 2010)

Correspondence email: abigailboys@googlemail.com

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