Hip-Hippo-Rah!

Gracie turns 1!  Well, almost...

We were in South Carolina for a dear friend's wedding this past weekend, so we went ahead and celebrated Little Miss Gracie's first birthday.  What a fun party!


The theme:  Hippos.

As we discussed possible party themes, safari and jungle animals kept coming to mind since we recently returned from Africa.  While in Koutiala we learned that Mali means "Hippo."  So, a safari themed hippo party it was!

Nana and Papa worked hard to make this day extra special:

   
A friendly hippo and tall giraffe along with a tree full of monkeys greeted guests as they arrived.



Gracie and her cousin Dylan enjoyed their safari hats...



as well as the inflatables.



We all sang happy birthday...



while Gracie watched.



She wasn't sure about the cake.



She played with the icing but never really tasted the yummy carrot cake (we figured since it is one of our favorites she would like it too).



She did like the chocolate covered banana pops that Nanny made!  They were hit with all the guests.

Many friends and family came to this special event.



Aunt Susan and Uncle David helped Gracie play with bubbles.

Gracie monkey-ed around with Aunt Beth & Uncle Ralph (aka: Nana 2 & Papa 2).

Mary & Martha snuck in a few hugs, too!


Gracie enjoyed playing with the wrapping paper while we helped her open her gifts.



We have several new books to read, new outfits to wear,

                                                   new toys to play with,











and a new bookbag to keep our things together!



What an amazing year it has been!  We are so thankful that God blessed us with this sweet little girl.



It has been quite a while since our last post -- we have been busy working in the hospital, traveling to SC weddings, listing our house, and trying to keep up with our mobile little girl.



Gracie is crawling, cruising, standing ... we await some first steps and walking soon!

Excitedly entering year two,

DD&G

Dernier Jour

Today was our last day at the hospital.  Our weeks here flew by so quickly.  It is surprising how familiar the layout of buildings and rooms feels when just 4 weeks ago it all seemed a maze of activity.

Now, I look at Salle 1 (Room 1) and images of the many children who have stayed in the pediatric "ICU" come to mind.  It is considered the ICU because it is the room closest (literally adjacent) to the nurses' station.  The sickest patients stay here so they can receive quick attention if they begin to decline.

As my gaze continues around the quad which forms the inpatient pediatric unit, I remember the patients and families who have lived in these rooms, hoping and praying for healing.  We took time yesterday and today to visit each Salle and give a small gift to every patient.  For the older kids we gave toy cars or stuffed animals and for the younger kids (especially the babies) we gave clothing (mostly items Gracie has out grown which we brought along for this specific purpose).  Our words were few as we handed these items to either the child or the child's mother:  Alla ka du biya (God bless you).

      

In the midst of our goodbyes to patients and hospital staff, we continued to work.  More interesting cases present on a daily basis.  We have seen a couple of toddlers come in unable to swallow after ingesting lye (which is caustic to the esophagus and can cause scarring).  In both cases we were able to dilate the esophagus and the children began drinking again.  A young boy came in with intusseption (intestines "telescope" inside itself) -- the classic sausage shaped mass in the abdomen was readily apparent on exam.  Dean assisted Dan with surgery; a segment of dead bowel had to be removed and then the healthy sections of bowel were rejoined (right hemicolectomy with illeocolic anastomosis).

There are more stories to tell.  Each involves a precious child, designed by God.  We hope to share more of these with you upon our return.

Today was also Gracie's last day with Marte, the nanny who has kept her every morning (and many afternoons) while Dean and I worked at the hospital.  Gracie enjoyed her time with this sweet Christian young woman.  We were very thankful to have her help.

A couple days ago we toured a place nearby where they make mud-cloth.  This is a traditional method of using mud to dye cloth -- you can see an couple examples of the patterns they make.  Sometimes they use stensils to create repetitive designs.

Our departure is bittersweet.  We have come to love the people here, and we truly enjoy working at the hospital.  God has confirmed that He has designed us for practicing medicine in an international setting. We look forward to God showing us the specifics of with whom and where over the next months.  Thank you for joining us on our journey.  Your prayers and support are greatly appreciated.

DD&G

P.S.  An unexpected power outage prevented us from posting this Friday post until Saturday morning.  Ah, but God is gracious and the power did return in time for fans to help us sleep!

Take a look

Tonight we thought we would share some photos.   Hope you enjoy!

Sunday afternoon we took a walk with Brian (school teacher) and his son (Caleb).  This picture depicts the general landscape here rather well -- dust, dry, hot with a few splashes of green and shade.

We stumbled upon as swimming hole (more like big mud puddle) where local boys were cooling off.  A few of the boys showed off by doing back flips into the water.  Looks like fun!

Dean saw this little boy walking along yesterday.  Can you tell what he was carrying?  Nope, not a little lamb...a little goat head with goat feet!  Eeekkk!

Here is the "cloth" from Journee de La Femme -- guess it is actually green, purple and cream.  We saw more ladies wearing the cloth today (March 9th) than yesterday, not sure why.

Set of premature twins who have been "growing" at the hospital since we arrived last month.  Currently the are up to just over 1800 grams.  They need to be over 2000 grams before they will be discharged home.  Yesterday, however, they graduated out of the incubator they had been sharing since birth and moved into the bed with their mom.  Aren't they cute?

Amanda has been reading daily with Fatumata (girl diagnosed with diabetes).  It's interesting since Amanda doesn't know Bambara and the little girl doesn't know English.  Mainly they are working on recognizing letters and learning the sound each letter makes.

Here is the book they are using to guide their studies.

Today, Gracie and I watched while they practiced the letters "b" and "a."  As you can tell Gracie was quite interested in this game ... and "babababa" is definitely a word she likes to say!

Seytou (young girl with severe burn) standing outside the pediatrics building looking out onto the courtyard.  The iron work on the windows is quite pretty.  There is no glass, just open air.  Some windows have crosses worked into the design.

Seytou had her skin graft done today.  Please pray that the graft will take.

Gracie captures another heart!

With Love from Mali,

DD&G

La Femme

Wow, are we really 2 days in to our last week at the hospital here in Koutiala, Mali???  That's hard for us to believe.

Today is National (actually, I think it is International) Women's Day -- "Journée de la femme" as they say here in Mali.  Special cloth is made to commemorate important days -- people will have outfits made out of the same cloth and wear it as a sign of solidarity.  And "Journée de la femme" made the cut with it's own special purple and yellow cloth displaying the logo of a woman and child and March 8, 2011.

So, happy day to all you "Femmes" out there!



Gracie and I sitting in the lady's section at church Sunday.



Ladies waiting for clinic visits at the hospital.


We saw another sad (although very interesting) case today in clinic.  A little girl (10 years old or so) returned with her family.  We saw her about 3 weeks ago for right arm weakness and a mass around her right shoulder blade.  She went home with ibuprofen and instructions to return in 1 week.  It was only after numerous phone calls (yes, many folks here have cell phones -- or at least friends/family with one) that she finally returned to clinic 3 weeks later.

They said she got “better” with the ibuprofen so they didn’t come back.  What our exam showed though was no where near better -- unfortunately it was quite worse.  She can no longer move her legs, she cannot stand.  In fact she can only sit upright if she props herself up using her left arm.  Her right arm remains weak.  The “swelling” around her right shoulder blade did seem better -- but now she has a fullness in the front of her neck on the right side.

After seeing her on the first visit, we put our heads together trying to figure out what was causing her symptoms.  We were suspicious for a brachial plexis (bundle of nerves that innervate the arm/hand) tumor or rhabdomysarcoma (muscle tumor).  We were eager to see her in follow-up (which is why we kept calling and asking for them to return) -- but today it was very sad to see how much worse her condition has become.



Most likely it is some sort of aggressive cancer.  What type?  How we wish we knew.  Without imaging it is nearly impossible to determine the source of her “mass” and evaluate her spinal cord.  Her symptoms suggest that her spinal cord is being compressed.  This makes us suspicious that she has a tumor originating from a nerve (or nerve sheath).  Our initial concern for an aggressive rhabdomyosarcoma also remains a possibility.

So what is the plan?  Well, we are going to start empiric chemotherapy to see if she has any improvement in her symptoms.  Also, in an effort to make a definitive diagnosis, Dean and Jason took her to the Bloc (OR) and did a muscle biopsy from the right shoulder (thickest area of the "swelling").  During surgery things looked normal (at least to the naked eye) -- but they didn’t want to probe too far into this area and definitely didn’t want to venture into the neck (other area of “swelling”) with no one of more surgical expertise present and no image or idea of what was beneath.  Dean and I will take the muscle sample back to the U.S. where a pathologist will look to see if there are any abnormal cells present.

And we will pray.  Pray for God’s healing and His comfort, for guidance and discernment.

Please pray along with us for Sanata and her family during this time of uncertainty.

DD&G

Balance

Hot, hot, hot!

Whew...what a day!  Temperatures will surely surpass one hundred degrees today, and the Kubacz family will certainly spend the afternoon escaping to the shade and refreshing water of the pool.  We are blessed (maybe even slightly spoiled) indeed!

After a brief mid-morning stroll through the market, Gracie is napping -- recharging before her next adventure.  She always draws a crowd, which really shouldn't be a surprise for a white skinned, blonde headed baby carried by her father (not mother) on his front (not back) using a Baby Bjorn carrier (not cloth wrap) in rural West Africa.

 




Earlier this morning, Dean helped Jason (the other pediatrician here -- he works part time at the hospital and spends the rest of his time learning the Bambara language) with hospital rounds while I kept Gracie at the mission.  We don’t have Marte (our borrowed nanny) on the weekends, making it difficult for both of us to work.  The kids at the hospital seem to be doing fairly well.  Amanda (a pre-med college student who has been staying at the guest house with us) has been teaching Fatumata, the diabetic teenager, to read Bambara, so she accompanied Dean to the hospital today.  Fatumata and her mother both seem interested in learning to read; progress is slow going, but we pray the Lord will bless this effort.

It is very exciting to watch children get better!  Yesterday, we visited with Setou (the 10 year old girl who was burned) while she had her dressing changed.  She continues to progress well; God’s design amazes us daily as we watch bodies heal.  Here are a few “before and after” shots of patient’s wounds:



This lady has bad leg ulcer -- maybe a tropical ulcer or maybe pyoderma gangrenosum.  She has been getting regular wound care with good results.  Hopefully she can have a skin graft done soon.

But as with most things in life: where there are “ups,” there are also “downs.”  Sad stories are numerous on the hospital wards -- not all of our patients get better.  Many mornings on rounds, my eyes linger on an empty bed that had been occupied the day before.  Despite antibiotic treatment, children die.  Newborns succumb to septicemia (wide spread infection); young children succumb to meningitis (infection of the central nervous system) and typhoid (infection which can cause the intestines to perforate); children and adults alike suffer and eventually pass away due to cancer.  Death is an ever-present reality.

Little Allou still struggles as he fights leukemia.  Despite completion of the first two phases of chemotherapy, he is not improving.  His little body has not responded as we hoped.  Currently his mouth is covered with sores.  He struggles to drink his milk.  His sullen face pulls at our hearts.  As medical providers, we are faced with difficult decisions, and in Allou’s case it has not been easy to do what we know is best -- stop chemo and transition to comfort cares.  His prognosis is grim despite medical treatment efforts.  His family desires to take him home where he can spend his last days.  It is hard to see him go.  Sheri, who overseas the daily cares for the cancer patients, has grown particularly close to this little one.  Friday she and her boys brought Allou special, farewell gifts and presented them to him and his family.  Sheri also took Allou for a ride around the hospital grounds on a golf cart -- he loves to “drive.”  Please pray for this sweet child as he continues to live out each day he is given.  Pray for comfort, for peace -- for him, for his family, for Sheri and the staff here who has grown to love this precious child.

Perhaps, I should have reversed the stories in the post, ending on happier thoughts.  All of these events are reality here in Mali, as else where in the world.  And the “happy” and “sad” are not always balanced.  Some days patients improve in ways we didn’t imagine; some days death seizes patients we didn’t expect.  Ah, but there is hope.  For everyday, God provides.  His grace is renewed each morning, and His grace is enough.

Leaning on Him,
DD&G