"Each of you should use whatever gift you have received to serve others, as faithful stewards of God’s grace in its various forms. If anyone speaks, they should do so as one who speaks the very words of God. If anyone serves, they should do so with the strength God provides, so that in all things God may be praised through Jesus Christ. To him be the glory and the power for ever and ever. Amen."
1 Peter 4:10-11 (NIV)

Saturday, April 13- Monday, April 15: Travel and arrival at New Day Orphanage

**This is the first of day-by-day recap blog posts about PPIHN's Spring 2019 trip to Zambia. Each trip I do these day-by-day posts to give an in depth look at what PPIHN is all about--to see what amazing things God is doing through this ministry, to describe what we as team members cannot in just a conversation with you and to be accountable to those who donate to make these trips happen. 

This trip we saw 49 prosthetic patients, 5 orthotic patients and 25 ocular prosthetic patients---all in 12 working days. Our prayer is that all the people we were able to help saw the love of Christ through our work, our words and our actions. 

We are absolutely amazed at how much PPIHN has accomplished in just 8 trips to Zambia! This isn't "how much John, Chris and I have accomplished"....this is how amazing it is to look at what God has done to establish ongoing prosthetic care in rural Zambia through the monetary provisions to make each trip happen, through the donations enough to build a clinic, through the continual addition of new team members to go, through the addition of a paid Zambian team member who is being trained for sustainable and continual care, and through the continual growth of people who know, care for and pray for Prosthetic Promises. It's all of us together---the body of Christ---who make up the wonderful ministry called Prosthetic Promises. 

Saturday, April 13th three of the PPIHN team members left out from DFW airport for Prosthetic Promises' 8th trip to Zambia to provide prosthetic, orthotic and ocular prosthetic services. Team members included John Brinkley (ocularist), Katie Brinkley (prosthetist/orthotist) and Whitney Vandiver (volunteer going to assist the team). With less than usual checked baggage, we only had 11 checked bags this trip which all made it to Livingstone. 

(L to R): John, Whitney and Katie

Our journey was from DFW to London to Johannesburg to Livingstone, arriving on Monday afternoon in Livingstone where another team member, Protashow, (with Gaye who is a long term volunteer at New Day) picked us up and then a 3 hour ride to New Day Orphanage. We arrived after dark so we dropped off our trunks of supplies at the clinic and had a late dinner at the guesthouse before heading to bed as soon as we could since we would be getting an early start on Tuesday with seeing patients. 

We were supposed to meet up with another team member, Carolin Alius, who is from Germany, in Johannesburg but her flight from London to Johannesburg was delayed almost 3 hours so she missed the connection. Caro had to stay overnight in Johannesburg and fly to Livingstone on Tuesday, where Wes from New Day would pick her up from the airport. Caro worked with us during our April 2018 trip, so we were so excited to be able to see her again and work together!

Next post: Tuesday, April 16th: Macha area patients

Tuesday, April 16: Macha area patients

Tuesday morning started early with our team (minus Caro since she would be arriving late Tuesday) leaving New Day on the bus to head to Macha to meet patients at the radio station for screenings.  We always do the trips set up in the same manner with patient evaluations at Macha first, then patients from Choma the next day, fabrication in the middle of the trip and then patient fittings at the end. 

Protashow coordinates ahead of our trip to have an announcement on the radio for a few weeks about what services we provide, and he also communicates with the Disabilities Office in Choma for them to contact patients that they know need prosthetic and ocular prosthetic services. 

The Macha radio station is currently closed, so that radio station did not announce about our trip, but a station from Choma did instead, instructing patients to meet at the Macha radio station on Tuesday or the Disabilities Office in Choma on Wednesday. 

The wonderful Whitney on our (very bumpy dirt road) ride to Macha. Whitney and I have been friends since childhood, so it was really special to me to be able to share the experience of this trip to Zambia with her.

The New Day bus at the radio station.

We had 3 prosthetic patients and 2 ocular patients meet us at the Macha radio station and then picked up several other people as we drove back to the clinic. There were also people at the clinic when we arrived. In all, we 23 patients on Tuesday---7 ocular patients for John and 16 patients for prosthetics or orthotics. 

Mweetwa met us at the radio station. Here I'm examining his prosthesis to assess what needs repair. He has been a patient coming for quite some time now to see us. He speaks English, so we have a much easier time communicating. 

One of John's long time patients, Nico, also met us at the radio station to come for a check up.

Akim and Blessford are brothers who we have been seeing since 2017. Akim's prosthosis (combination orthosis and prosthesis to provide support for his right leg deformity and make the right side the correct height) needed repair with a new foot and straps. Blessford's above knee prosthesis needed a new foot, and the prosthesis needed to be lengthened since he has grown. We can definitely tell these little boys are active with their prostheses by how worn out the prosthetic feet were.

A young boy who came to the radio station for screening for a prosthetic eye.

We also stopped by the Macha hospital to see if Dr. Samuel was at the eye clinic. He is an ophthalmologist missionary who John coordinates with for ocular prosthetic patients. 

 By the time we got back to the clinic, the bus was full with the people from the radio station and people we picked up along the way who were waiting at different areas. There were also people waiting on the porch already, so we had quite a full waiting area! Before starting to see patients, I had a translator go around the porch with me checking to make sure I had everyone on my list who needed to be seen.

Protashow and I looking through the list of people to see to determine how we would split up patients. I started with casting all the new patients while he did repairs, asking for help or double checking things with me when he needed, then I helped him finish up repairs. Protashow is doing great with increasing his knowledge and skill set with prosthetics! It was awesome to see him seeing patients independently this trip.

 Chabelo is 1 year old and has clubfoot. He is unable to walk but can stand on his right leg while being supported. Our option to help him walk due to his left leg deformity is to make a bent knee prosthesis, which will allow him to kneel into a custom support over his thigh and lower leg that has a prosthetic foot attached underneath. We had made one of these types of prostheses for another pediatric patient a few years ago, Rhoda, and have made her another one for her since she's grown. So, we know this will be a great option for Chabelo. We hope one day he will be able to have an elective amputation to give him a more functional opportunity with a standard prosthesis.

Clyness was casted for a right knee disarticulation prosthesis. After seeing her in September where her leg was infected, we gave her family money to get her to a doctor to consider a revision amputation to address the chronic infected wound. To make a long story short, after many conversations and connections she was able to be seen at Beit Cure Hospital in Lusaka for a revision amputation to a knee disarticulation. Her surgery site was healed, and she was cleared by the doctor for prosthetic fitting just prior to our arrival this trip. It was great to see her smiling for the first time! We are so thankful that her family trusted us and took her to Lusaka for the revision amputation. 

Alvera was casted for a right below knee prosthesis. Her amputation was in 2018 due to diabetes. 

 Marytah was casted for a left below knee prosthesis. Her amputation was in May 2018 due to diabetes. 

Interestingly (at least to us orthotic/prosthetic nerds) we have seen an increase in incidence of amputations due to diabetes since we have been coming to Zambia since 2012. (Diabetes is the #1 cause of amputation in the United States). 

We also saw a young boy with a left knee genuvalgum deformity (knocked-knee). His right leg is also 1/2" too short, which could be a contributing factor for his deformity. A lift was put in his right shoe to make him more balanced, but his family was advised to have him see an orthopedic doctor for further evaluation of the left knee deformity. This was another example of someone coming expectantly to see us and us having to tell them there is nothing we can do. It's always so sad to have this conversation, and I'm always amazed at how gracious and thankful the people are for us to just evaluate and talk with them even though we are unable to help them. 

Before and after(below) photo of a patient of John's who came for a check up.

 Whitney took this amazing picture of the absolutely stunning tree by our clinic.  This is the beautiful view we get to see from the clinic everyday during our trips. 

We finished out the extremely busy Tuesday with Caro arriving! She got to New Day and came up to the clinic just about the time we were finishing seeing patients. Tuesday was an awesome day seeing some familiar faces of returning patients for check ups and new patients as well. 

Next post: Wednesday, April 17: Choma area patients 

Wednesday, April 17: Choma area patients

Wednesday started early with John and I leaving with Protashow to go to Choma about 7:30am. Caro and Whitney stayed at New Day to get the clinic set up and organized a bit more for us to see patients and start on filling the casts that were taken on Tuesday  with plaster to get the process of fabrication started. This also allowed for someone to be available at the clinic before we returned in case anyone came directly to the clinic to be seen. 

 John and Protashow walking up to the Disabilities Office in Choma. We coordinate with the Disabilities Office in Choma each trip for them to help make contact with patients who would benefit from the services we provide.

 There were a ton of people waiting around the Disabilities Office to be seen for screening.

John talking with Ruth and a patient he was screening. Ruth and Hildah work at the Disabilities Office and help coordinate patients for us to see during our trips. They have been great to get to know a little better as we see them each time, and working with the Disabilities Office has been a fantastic partnership. 

 Seeing patients in the small Disabilities Office can sometimes get a little chaotic, but I'm always amazed how people will be waiting when we arrive, for who knows how long, and wait their turn to be seen one at a time for evaluation.

Also while we were at the Disabilities Office, a few people from a local radio station in Choma came to interview us about the work we do. I was still screening patients, so John did the interview and told them about Prosthetic Promises, what we do, how often we come, and our partnering with the Disabilities Office to get patients taken care of. 

We ended up with so many patients who needed to be seen for either a new device or check up, that we made the decision to split them into two groups, because A) there was simply not enough room on the bus to bring everyone back to the clinic who needed to be seen and B) there was not enough team members (and energy level) to see that many people in one day. We had all new eye patients, all new patients for prosthetics and some who needed repair to come on the bus to the clinic on Wednesday. We had to tell 12 other people needing prosthetic repairs and 3 eye patients needing check-up and polishing to come the next Friday, when the new people would come back for fitting. 

We had a full waiting area when we got back to the clinic!

 Cooking lunch for the patients. We always hire these ladies to cook on the days we have patients waiting at the clinic, since they have to wait most of the day while everyone is seen until the bus takes them back to either Macha or Choma. 

Everyone getting served lunch. 

Felix came with his mother for check up. He was fit with a modified walking boot (you can see in the right bottom corner of the picture) to take pressure off his heel where an open wound was in September. Felix had a severe burn that caused amputation of the front of his foot, and he has had continued chronic wound issues. His mother said the wound healed up but then opened again recently. Since his wound is not healed, we cannot make him a prosthesis. We advised them to see a wound care or burn specialist if possible. We got their contact info and have since made contact with Beit Cure Hospital in Lusaka to inquire whether they can help Felix. They have a burn specialists coming to their hospital soon, so Protashow has passed along the information to Felix's mother to have her call them to set up an appointment. Please join us in prayer for Felix as they pursue care at Beit Cure. 

Casting Mutukwa for his first below knee prosthesis.

Caro seeing a patient for repair to his existing prosthesis.

 Casting Steward for an above knee prosthesis. He is 13 years old, so he will be needing more frequent new prostheses as he grows. 

John evaluating a patient for an ocular prosthesis. 

Rhoda came with her father for check up on her bent knee prosthesis for her clubfoot. The bent knee prosthesis still fits, it just needed to be lengthened since she has grown. We first saw Rhoda in 2016, and she was very shy and solemn. Now, she's all smiles around us. We love that!

John evaluating Oswell for a ocular prosthesis. He lost his eye due to a work accident.

This is Emmanuel. He has lower extremity tone due to a neurological issue, which his mother did not know exactly what his diagnosis was. We fit him with a pair of pediatric AFOs (ankle-foot-orthoses) that we had brought. These were modified to fit him and provide neutral positioning of his ankles and feet. Through a translator, we discussed how to put the braces on, a wearing schedule to gradually increase how much he is wearing them and some stretches that his mother can do for his ankles and feet. This is another case where we can provide some treatment of symptoms (ie: braces for lower extremity tone) but we know that he's not getting the overall diagnosis care like he would receive back home. 

John has made this lady an ocular prosthesis in the past, so she came for a check up. Here he's fitting this patient's prosthetic eye after her check-up and cleaning of the ocular prosthesis. 

Wednesday was another packed day with seeing patients all day. There were 30 patients total who were seen on Wednesday---20 prosthetic and orthotic patients, and 10 ocular patients. Though we had more patients on Wednesday vs Tuesday, it went much faster with having Caro there to see patients as well. Caro and Protashow saw patients for repairs while I started with the new patients needing to be casted. After I finished the castings, I helped with repairs as well. 

Next post: Thursday, April 18- Friday, April 19: Fabrication begins and a few more patients!

Thursday, April 18- Friday, April 19: Fabrication begins and a few more patients!

Thursday began our fabrication of all the prostheses and ocular prostheses. We also had 3 patients come to the clinic---2 prosthetic patients and 1 ocular patient. And several volunteers and staff from New Day came up to the clinic to help organize and clean around the clinic. So nice to have the extra help! And so fun to have all the people at work around the clinic...it was quite the buzz of activity. 

 Modifying a plaster model for a below knee prosthesis. 

 Caro smoothing the edge of foam used to make a cushion inner portion for a below knee prosthetic socket, called a Pelite liner (for the U.S. team member) or Soft socket (for the German team member) 😄 . She's a rock star at making these! So incredibly thankful for her expertise in fabrication!

 John working the fabrication process of the custom ocular prostheses. 

Gluing the edges of the cushioned soft socket before forming it to the mold of the patient's leg.

The next step for the soft socket is to heat the material and form it around the model of the patient's leg. 

 Here I'm smoothing the mold of Chabelo's leg for the bent knee prosthesis. 

 Protashow was our cast filling extraordinaire. The casts of the patient's legs are filled with plaster and a pipe set up in the plaster as it hardens to hold the mold in the vise as we work on modifying it. 

Here I'm giving Protashow instructions on modifying a below knee prosthesis. Protashow and I got to spend time on instructing on the modification aspect of prosthetics this trip. Each trip we make, we get to spend more time teaching him all aspects of prosthetic patient care and fabrication of the devices. I also took him a laptop with a ton of instruction material---notes, powerpoints and videos---for him to be able to self study.

 Lindsey and Chipo organized all the prosthetic socks in the storage room for us. So very helpful to have these separated by sizing! The prosthetic socks are necessary for patients to have to add over their leg if the prosthesis is fitting too loose. We give each patient who is fit with a prosthesis several socks in the different thicknesses to ensure they can keep the prosthesis fitting properly. We will definitely have to take socks with us for our next trip since we are so low on stock of these. 

Caro fabricating a shoe lift onto a tennis shoe for a patient who was evaluated at the Disabilities Office in Choma. She has a leg length discrepancy and only needs a shoe lift. I measured how much she needs for a lift while evaluating her at the Disabilities Office, so she would only need to come once to the clinic at fitting the following week. 

Walk to the clinic on Friday morning. 

 This is a great example of everyone at work (and Whitney behind the camera). We're continuing to get the plaster models ready for the next stage of fabrication, which is lamination.

 John had a new patient on Friday for a prosthetic eye. 

 Here he's evaluating the young boy for a custom ocular prosthesis.

Working in the clinic. If you follow this blog for each trip, you can tell how the organization of our work space has improved! First trip in 2012 was on a front porch at New Day, then in the partially finished guesthouse (the Ark), then a few years in the garage at New Day and then we moved into the newly built (and not totally finished) clinic in 2016, and have been getting more and more organized and efficient each trip since. What wonderful provision God has blessed PPIHN with in this amazing clinic. It's home to our teams during our trips and being used between our trips for a multi-function clinic, just like we had hoped. 

 John polishing an ocular prosthesis.

 Here is Mimi checking out her new prosthetic eye. She was brought to our clinic by Judi and Jack, who are missionaries in Mkushi (about 400 miles from the clinic). Judi and Jack are friends with Wes and Laurie from New Day. Judi had messaged me ahead of our trip about Mimi and Hardwell (a prosthetic patient) when she found out from Wes and Laurie that we would be coming and what we do. They brought Mimi and her mother along with Hardwell all the way to our clinic for them to be seen. After fitting of Mimi's prosthetic eye on Friday, the two of them left to head back home in Mkushi. Jack and Judi continued staying in the area with Hardwell who would be fit the next week with his prosthesis. 

Friday was the completion of week 1 of our trip, though we work through the weekends too. We were planning to work on fabrication more on Saturday and then decide if we could take Sunday afternoon for rest depending on how far along we felt we were. 

Next post: Saturday, April 20- Sunday, April 21: A familiar face, a new patient and Easter!