Just a quick note to say that we are back in the good ole USA! Only a few events occurred between my last email and this one. We had no problems with travel - The Lord took good care of us and returned safely.
Overall the trip was one of rest, focus on God, a time to make connections for our church to return to Bolivia for a pastor's conference this summer, and of evangelism to locals, patients, and doctors; a humbling (in the sense of not being used much medically) trip, and one that we gained experience (which i heard defined as "something you get when things don't go as planned") in another culture and rely upon The Lord to do what He has planned. We appreciate all of your prayers and support, and look fwd to answering some of your emails and calls. For me a verse that has been in my head for days is "God opposes the proud, but gives grace to the humble." - as God is continually breaking down my pride.
On the way home we were able to visit the historical Macchu Piccu (one of the last cities of the Incas high in the Andes mountains). The mountains in Bolivia and Peru are beautiful - jungle like terrain with dense undergrowth in Peru, leading up to snow caps in the highest mountains.
To get to the site, the only access is a winding train through the mountains. This provided for a God-sent interaction with a fellow we met, who sat directly across from me on the train. Kristen and i were both able to tell him about the greatest man in history, who came into this world to save the lost. He already had lots of ?s ready to be asked - as it seems back home he had no one to ask. We began by simply letting him know why we went to Bolivia - to share the gospel with the people there. To let them know our stories of how He has worked in our lives -e.g. - that He opened my eyes to show me that i was living my life in rebellion to a holy and just God who has given me everything (life, breath...) and that i have broken his commandments, and the Bible clearly shows the penalty for that is death, an eternal separation in Hell apart from God - which, of course, is all bad news. But, John 3:16 let s me know that He loved us so much, He came down here, to take the penalty for me - to die for me - and that i have eternal life by believing upon His work - not my good deeds, but trusting that He died for me, and that His work on the cross is all i need to enter heaven (there is nothing i can do to earn such a gift - only He can merit it)... anyway, He asked lots of typical ?s - like what about al the other religions, and do we believe they are the same or not - well, we just answered with scripture (it doesn't matter what i think, it matters what God says) - "I am the way, the truth, and the life. No one comes to the Father apart from me?" - words of Jesus in John 14:6. I believe it was a divine interaction that God used to speak into this man's life - that was one of the highlights of our return trip.
If you ever plan to visit Macchu Piccu in Peru - book it early!!!! That was another lesson learned.
Sunday, May 4, 2008
Machu Picchu!
Matt and I had a great time at Machu Picchu..it was beautiful! We also had an awesome conversation with a Canadian about Christ on the four hour train ride.
Our whirl wind tour...La Paz, Bolivia to Cuzco,Peru to Machu Piccu to Lima, Peru!
see pics at
www.snapfish.com
user: sorensenk@uthscsa.edu
password: india
Our whirl wind tour...La Paz, Bolivia to Cuzco,Peru to Machu Piccu to Lima, Peru!
see pics at
www.snapfish.com
user: sorensenk@uthscsa.edu
password: india
Wednesday, April 23, 2008
Bolivia!
Dear Family and Friends,
I hope you all had a good week. Sorry for the delayed email, the internet doesn´t always work (nor the water or electricity, but our needs are well cared for).
Last week we worked at the hospital most mornings with various doctors. One morning Matt shared his testimony and I translated and we both drew out the gospel and interacted with the patients in the waiting room. God was good to open many opportunities after morning rounds this week to share our testimony and the gospel with the patients here. Many of them know Christ and are living for Him, but there are also many who do not Him and who are trusting in their good works to get them into heaven instead of trusting in the fact that Christ did everything through his death and resurrection so we could spend eternity with Him.
On Thursday, we went with a local physician into the mountains to provide medical treatment to the children at a school in Mal Pasos, which means ´´bad paths´´ which is ironic because we off roaded for over an hour up the mountain along the dirt trail to the village which is at an altitude 15,000 ft! We were definitely out of breath after hiking to the school where we provided medical treatment for the children and people in the village. Most of the people live in very small stone homes (literally a village made out of stones, like Bedrock on the Flinstones), speak Cetchua, and have a stream as their only source of water. Matt and I really enjoy doing medical missions in this enviornment so we were very excited. First we educated the Children about the importance of sanitation, washing their hands, using boiled water, and then we shared the gospel with them. After, we split up into teams, saw a lot of patients with diarrhea, and Matt was able to use his manipulation skills on a woman´s sacrum. It was a bit disorganized but we enjoyed serving the children in the mountains, which were beautiful. The school was very grateful and invited us back.
We have also been going to various orphanages in town. There are an overwhelming number of orphans. At one place we held babies and played with the children to show the love Christ has for His children.This orphanage was started by a very young Christian woman from the U.S who has served there for over 4 years. I really enjoyed carrying around one little baby who was wearing a cute Pooh blanket.
Another orphanage that we went to had 70 boys only. The orphanage is run by Bolivian Christians who are mainly supported by American donations. The boys all attend school, help with the chores, and are well organized. I was impressed as to how well behaved the boys were. Matt really enjoyed playing soccer with them with the Andes in the background! THis is a great organization as they bring up these abused and neglected children by helping them through their traumatic past and teaching them about their heavenly Father who will never desert or mistreat them. Thus, most are believers and desire to serve God in missions someday! Please pray that God would continue to provide for these orphans and that they would understand that they have a heavenly Father who loves them very much! Matt 19´13,14.
¨Kid Washing¨
This was started by a local Christian Bolivian man who felt God leading hime to provide baths for the children who live on the streets. We washed over 40 kids. God has totallly provided all the funds and volunteers both American and Bolivian, for him to set up a tent with small baths for the children. Every Saturday he brings a huge generator to warn the water and set up a tent with 3 small baths. The children are bathed with soap and water individually in the tubs by the women, given clean clothes, have their hair styled, and given bread and mild. It is an awesome display of the body of Christ serving the poor. I helped to bath the children while singing Jesus songs to them in Spanish and Matt was vital in sharing the gospel with the mothers and using his strength to carry and pour out the water.
CIC church,
We were able to worship this past sunday with many of the local missionaries and a great growing church that is a mix of both Bolivians and missionaries. The church is an oasis for local and short term missionaries. They have a vision to equip other local pastors by having confereces at the church ' to basically provide some formal bible training and fellowship as most of the pastors here have no formal bible-seminary training and little or no accountability or fellowship. As this is also a passion of our pastor in harlingen, we feel we have made many contacts for our home church to return and continue such ministries. It is unfortunate that many of the local chrisitians have do not reach out a lot to their fellow bolivians. This is due to their culture, which doesn´t reach out much, but who are more focused on making a living, providing food, and helping their own family. However, CIC has begun taking locals out to minister into the jungle areas and they are loving it, catching the vision to serve. They are doing a great job supporting the goal most ministries have, which is to get the local christians to reach out locally.
I think God is bringing us back to the basics, God is teaching us to be patient in the midst of a different culture. To rest and to listen to His voice, something I feel we take little time for in America. To love the Lord our God and to love others Matt 22 37 40 and John 13 34 35, those being the greatest commandment according to Jesus, as they sum up the rest. Not an easy task, but somewhat simplifies life. We often forget that loving the Lord means sitting quietly and patiently at his feet, another not so easy task for our driven culture!
Feel free to share what is going on in your lives, we love to hear from you! We will be returning home in a few days - sunday afternoon. Thank you for all of your emails and prayers, we really appreaciate the body of Christ - what an awsome family!
Matt and Kristen
I hope you all had a good week. Sorry for the delayed email, the internet doesn´t always work (nor the water or electricity, but our needs are well cared for).
Last week we worked at the hospital most mornings with various doctors. One morning Matt shared his testimony and I translated and we both drew out the gospel and interacted with the patients in the waiting room. God was good to open many opportunities after morning rounds this week to share our testimony and the gospel with the patients here. Many of them know Christ and are living for Him, but there are also many who do not Him and who are trusting in their good works to get them into heaven instead of trusting in the fact that Christ did everything through his death and resurrection so we could spend eternity with Him.
On Thursday, we went with a local physician into the mountains to provide medical treatment to the children at a school in Mal Pasos, which means ´´bad paths´´ which is ironic because we off roaded for over an hour up the mountain along the dirt trail to the village which is at an altitude 15,000 ft! We were definitely out of breath after hiking to the school where we provided medical treatment for the children and people in the village. Most of the people live in very small stone homes (literally a village made out of stones, like Bedrock on the Flinstones), speak Cetchua, and have a stream as their only source of water. Matt and I really enjoy doing medical missions in this enviornment so we were very excited. First we educated the Children about the importance of sanitation, washing their hands, using boiled water, and then we shared the gospel with them. After, we split up into teams, saw a lot of patients with diarrhea, and Matt was able to use his manipulation skills on a woman´s sacrum. It was a bit disorganized but we enjoyed serving the children in the mountains, which were beautiful. The school was very grateful and invited us back.
We have also been going to various orphanages in town. There are an overwhelming number of orphans. At one place we held babies and played with the children to show the love Christ has for His children.This orphanage was started by a very young Christian woman from the U.S who has served there for over 4 years. I really enjoyed carrying around one little baby who was wearing a cute Pooh blanket.
Another orphanage that we went to had 70 boys only. The orphanage is run by Bolivian Christians who are mainly supported by American donations. The boys all attend school, help with the chores, and are well organized. I was impressed as to how well behaved the boys were. Matt really enjoyed playing soccer with them with the Andes in the background! THis is a great organization as they bring up these abused and neglected children by helping them through their traumatic past and teaching them about their heavenly Father who will never desert or mistreat them. Thus, most are believers and desire to serve God in missions someday! Please pray that God would continue to provide for these orphans and that they would understand that they have a heavenly Father who loves them very much! Matt 19´13,14.
¨Kid Washing¨
This was started by a local Christian Bolivian man who felt God leading hime to provide baths for the children who live on the streets. We washed over 40 kids. God has totallly provided all the funds and volunteers both American and Bolivian, for him to set up a tent with small baths for the children. Every Saturday he brings a huge generator to warn the water and set up a tent with 3 small baths. The children are bathed with soap and water individually in the tubs by the women, given clean clothes, have their hair styled, and given bread and mild. It is an awesome display of the body of Christ serving the poor. I helped to bath the children while singing Jesus songs to them in Spanish and Matt was vital in sharing the gospel with the mothers and using his strength to carry and pour out the water.
CIC church,
We were able to worship this past sunday with many of the local missionaries and a great growing church that is a mix of both Bolivians and missionaries. The church is an oasis for local and short term missionaries. They have a vision to equip other local pastors by having confereces at the church ' to basically provide some formal bible training and fellowship as most of the pastors here have no formal bible-seminary training and little or no accountability or fellowship. As this is also a passion of our pastor in harlingen, we feel we have made many contacts for our home church to return and continue such ministries. It is unfortunate that many of the local chrisitians have do not reach out a lot to their fellow bolivians. This is due to their culture, which doesn´t reach out much, but who are more focused on making a living, providing food, and helping their own family. However, CIC has begun taking locals out to minister into the jungle areas and they are loving it, catching the vision to serve. They are doing a great job supporting the goal most ministries have, which is to get the local christians to reach out locally.
I think God is bringing us back to the basics, God is teaching us to be patient in the midst of a different culture. To rest and to listen to His voice, something I feel we take little time for in America. To love the Lord our God and to love others Matt 22 37 40 and John 13 34 35, those being the greatest commandment according to Jesus, as they sum up the rest. Not an easy task, but somewhat simplifies life. We often forget that loving the Lord means sitting quietly and patiently at his feet, another not so easy task for our driven culture!
Feel free to share what is going on in your lives, we love to hear from you! We will be returning home in a few days - sunday afternoon. Thank you for all of your emails and prayers, we really appreaciate the body of Christ - what an awsome family!
Matt and Kristen
Monday, April 14, 2008
Bolivia!
greetings friends,
Here is are some emails from Matt and I!
thank you for your prayers. we really appreciate them.
Bolivia is a very beautiful country with the Andes mountains and temperate climate. The city we are in, Cochabamba, is basically an eternal spring weather in my book. It is currently Fall here as we are below the equator, but the weather and flowers are springish. most days start cool - around 60, and increase to about the upper 80s. The altitude is over 8000 ft, so the sun is very bright when out. The city basically sits in a valley surrounded by green, grass covered mountains, with a few rugged peaks containing snow filled crags. Behind the hospital is a strong display of the green mountain and spring flowers on our grounds.
Many of the indiginous rural peoples grow flowers to take into town and sell. It isn´t unusual to see a field full of Iris´s or other multicolored flowers. The women typically are the ones who tend to the field. Men also work sometime, but usually only for the harder manual labor such as plowing or moving the cattle. yes, many have diary cattle for milk and plowing, but only a couple. Some cannot afford that luxury. Homes in these rural areas are on mountainsides (not steep), built out of concrete, brick and wood. Some older buildings are built of mud/clay bricks - i will try to show some pictures once i return. Do to working outside contantly under the bright sun, the `people age quickly, and apparently get skin cancers frequently, although i have yet to see any. The indiginious peoples are short, with typical wear that i will post once at home. Most seem very calm, with friendly demeanors. Of course, within the busy city itself, there are those who are less warm, but for the most part everyone keeps to themselves. The city is much like Mexico, but somewhat cleaner and better observance of some (not all) traffic laws. Each city has a center, which consists of what we would call a city square, with many benches and green grass and trees to provide shade. People congregate around these areas, including many street vendors with local foods, as well as typical items needed within the home, plus bootleg CDs and DVDs - again, much like a mexican market.
The foods here are varied. We have eaten both chicken and beef dishes, usually with rice or potatoes. Saturday we had some Saltenas, which are like a beef soup enclosed within a sweet bread, that was very tasty. Interestingly, their ¨picante¨foods are actually quite mild. I guess they don´t have the jalapenos we often see in >Tex-Mex. There are also many local fruits grown in this climate - some of which no one can explain due there originality. Just like many other countries, they like to fry bananas. Apparently we are going to eat some yucca and llama tonight?! They also have a burger king and pizzeria downtown if we need american foods. However, the city of cochabamba is actually about 45 min away. We ride in small vans, that resemble the old VW van for all of you hippy type, in which we pack about 15 into what should probably be about a 8 person vehicle, and, if you are over 5´5¨, there is no leg room. It is very cheap - costing about 20-25 cents to ride about 20 kilometers. This transportation style is giving us a loook at what it is like to live in a big city. Most people do not own cars. Most of the food costs about a 1/4-1/3 of the cost of USA.
The hospital - well, Kristen mentioned a bit of it below. They really do not have much patient volume, which is quite surprising. I can explain more of that later. Essentially, the hospital is out of the city a bit, and not as well known as needed. Many of the patients are from the Adventist University right around the corner, and so far seem to know the Lord. There is an on fire charismatic chaplain who preaches interactively with the waiting patients each am, and seems to do a great job. The doctors here who are Christians seem to leave sharing the gospel to him. I have been able to see some cases here, including typhoid, some lab pathology showing malaria, TB, cryptosprodiosis, trichomonas, and some typical problems such as abscesses, osteomyelitis, COPD, ruptured appedix, cholecystitis, and multiple ortho injuries, including 2 clavicle fractures from apparently the most dangerous activity in Bolivia - futbol (Soccer)! Don´t worry mom and dad, i haven´t played... yet. Unfortunately, i have no crazy medical stories to tell due to low number of patients. Will continue to keep you updated as able. >Thank you again for your prayers.
We are doing well. This has been a bit of a different experience than we thought it would be. God is good and we´re trying to just trust Him. We don´t have much access or time to do internet so I´m sorry for the short message.
I am a bit trapped at the hospital and our house because it isn´t safe to go out alone. So I go wherever Matt goes which is a blessing to have him here. God is giving me a rest from running and more rest in general which is a blessing.
I shared my testimony in Spanish to the patients waiting in the waiting room the other day and I gave a presentation on the Chagas disease. We´ve gotten to share our faith with the patients and with some of the Bolivians in the street. We have also seen some cool surgeries. The other day we went to an orphanage to share Christ with the kids and play with them.
The other girls that are volunteering here (they are 4th year med students) are really sweet. Our house hosts (Iris and Thomas) live at the guest house with us, cook some of our meals, and are very kind. Their little girl is also adorable.
We are trying to make connections with the different churches and missionaries here because our pastor in Harlingen is coming to Bolivia in August to do a pastors conference. They supported us quite a bit which was a huge blessing.
Bolivia is beautiful with all the all the Mts. but is a very poor country. The hospital is a bit lacking in patients and we are observers which is pretty frustrating (esp for Matt). Also, few of the Drs. speak English so I´m translating as best as I can.
I am enjoying the beauty and rest, speaking Spanish, and spending lots of time with Matt.
Please pray that God would show us our purpose here, open doors to share our faith, joy in the midst of frustration, and that our relationship would continue to grow.
We got to see the Christ on the hill (which is larger than the one in Rio de Janiero!)and also watch a Bolivian soccer game which was very cool.
Hope all is well with you all! I love you all lots. Email me prayer requests!
Matt and Kristen
Here is are some emails from Matt and I!
thank you for your prayers. we really appreciate them.
Bolivia is a very beautiful country with the Andes mountains and temperate climate. The city we are in, Cochabamba, is basically an eternal spring weather in my book. It is currently Fall here as we are below the equator, but the weather and flowers are springish. most days start cool - around 60, and increase to about the upper 80s. The altitude is over 8000 ft, so the sun is very bright when out. The city basically sits in a valley surrounded by green, grass covered mountains, with a few rugged peaks containing snow filled crags. Behind the hospital is a strong display of the green mountain and spring flowers on our grounds.
Many of the indiginous rural peoples grow flowers to take into town and sell. It isn´t unusual to see a field full of Iris´s or other multicolored flowers. The women typically are the ones who tend to the field. Men also work sometime, but usually only for the harder manual labor such as plowing or moving the cattle. yes, many have diary cattle for milk and plowing, but only a couple. Some cannot afford that luxury. Homes in these rural areas are on mountainsides (not steep), built out of concrete, brick and wood. Some older buildings are built of mud/clay bricks - i will try to show some pictures once i return. Do to working outside contantly under the bright sun, the `people age quickly, and apparently get skin cancers frequently, although i have yet to see any. The indiginious peoples are short, with typical wear that i will post once at home. Most seem very calm, with friendly demeanors. Of course, within the busy city itself, there are those who are less warm, but for the most part everyone keeps to themselves. The city is much like Mexico, but somewhat cleaner and better observance of some (not all) traffic laws. Each city has a center, which consists of what we would call a city square, with many benches and green grass and trees to provide shade. People congregate around these areas, including many street vendors with local foods, as well as typical items needed within the home, plus bootleg CDs and DVDs - again, much like a mexican market.
The foods here are varied. We have eaten both chicken and beef dishes, usually with rice or potatoes. Saturday we had some Saltenas, which are like a beef soup enclosed within a sweet bread, that was very tasty. Interestingly, their ¨picante¨foods are actually quite mild. I guess they don´t have the jalapenos we often see in >Tex-Mex. There are also many local fruits grown in this climate - some of which no one can explain due there originality. Just like many other countries, they like to fry bananas. Apparently we are going to eat some yucca and llama tonight?! They also have a burger king and pizzeria downtown if we need american foods. However, the city of cochabamba is actually about 45 min away. We ride in small vans, that resemble the old VW van for all of you hippy type, in which we pack about 15 into what should probably be about a 8 person vehicle, and, if you are over 5´5¨, there is no leg room. It is very cheap - costing about 20-25 cents to ride about 20 kilometers. This transportation style is giving us a loook at what it is like to live in a big city. Most people do not own cars. Most of the food costs about a 1/4-1/3 of the cost of USA.
The hospital - well, Kristen mentioned a bit of it below. They really do not have much patient volume, which is quite surprising. I can explain more of that later. Essentially, the hospital is out of the city a bit, and not as well known as needed. Many of the patients are from the Adventist University right around the corner, and so far seem to know the Lord. There is an on fire charismatic chaplain who preaches interactively with the waiting patients each am, and seems to do a great job. The doctors here who are Christians seem to leave sharing the gospel to him. I have been able to see some cases here, including typhoid, some lab pathology showing malaria, TB, cryptosprodiosis, trichomonas, and some typical problems such as abscesses, osteomyelitis, COPD, ruptured appedix, cholecystitis, and multiple ortho injuries, including 2 clavicle fractures from apparently the most dangerous activity in Bolivia - futbol (Soccer)! Don´t worry mom and dad, i haven´t played... yet. Unfortunately, i have no crazy medical stories to tell due to low number of patients. Will continue to keep you updated as able. >Thank you again for your prayers.
We are doing well. This has been a bit of a different experience than we thought it would be. God is good and we´re trying to just trust Him. We don´t have much access or time to do internet so I´m sorry for the short message.
I am a bit trapped at the hospital and our house because it isn´t safe to go out alone. So I go wherever Matt goes which is a blessing to have him here. God is giving me a rest from running and more rest in general which is a blessing.
I shared my testimony in Spanish to the patients waiting in the waiting room the other day and I gave a presentation on the Chagas disease. We´ve gotten to share our faith with the patients and with some of the Bolivians in the street. We have also seen some cool surgeries. The other day we went to an orphanage to share Christ with the kids and play with them.
The other girls that are volunteering here (they are 4th year med students) are really sweet. Our house hosts (Iris and Thomas) live at the guest house with us, cook some of our meals, and are very kind. Their little girl is also adorable.
We are trying to make connections with the different churches and missionaries here because our pastor in Harlingen is coming to Bolivia in August to do a pastors conference. They supported us quite a bit which was a huge blessing.
Bolivia is beautiful with all the all the Mts. but is a very poor country. The hospital is a bit lacking in patients and we are observers which is pretty frustrating (esp for Matt). Also, few of the Drs. speak English so I´m translating as best as I can.
I am enjoying the beauty and rest, speaking Spanish, and spending lots of time with Matt.
Please pray that God would show us our purpose here, open doors to share our faith, joy in the midst of frustration, and that our relationship would continue to grow.
We got to see the Christ on the hill (which is larger than the one in Rio de Janiero!)and also watch a Bolivian soccer game which was very cool.
Hope all is well with you all! I love you all lots. Email me prayer requests!
Matt and Kristen
Friday, February 15, 2008
Leprosy info.
Leprosy: (Hansen’s disease).
Leprosy is a chronic inflammatory disease caused by Mycobacterium leprae infecting macrophages and peripheral nerve Schwann cells.
It’s presentation and progress are determined by the patient’s cell mediated immune response to the mycobacterium. Most people (~95% develop an effective immune response to clear the M.leprae. The minority that cannot mount this immune response develop clinical leprosy.
Clinical Features of leprosy:
Classification Spectrum of Immune response Skin Lesion Nerve Involvement
Indeterminate Solitary hypo pigmented 2-5 cm lesion. Centre may show sensory loss. May become TT like. None clinically detectable.
Tuberculoid
(TT)
paucibacillary Strong but ineffective immune response to the bacteria which damages peripheral nerves and skin Lesions with well defined borders and sensory loss.
Patch is dry (loss of sweating) and hairless. May have one peripheral nerve affected. Occasionally presents as a mono-neuropathy.
Borderline Tuberculoid
(BT) Varying immunity and bacterial loads. Irregular plaques with raised edges and sensory loss.
Satellite lesions at the edges. Asymmetrical peripheral nerve involvement.
Borderline
(BB) Varying immunity and bacterial loads Many lesions with punched out edges. Satellites are common. Widespread nerve enlargement. Sensory and motor loss.
Borderline Lepromatous
(BL) Varying immunity and bacterial loads Many lesions with diffuse borders and variable anesthesia. Widespread nerve enlargement. Sensory and motor loss.
Lepromatous
(LL)
multibacillary Cellular anergy towards M.leprae with abundant bacillary multiplication. Numerous nodular skin lesions in a symmetrical distribution. Lesions are not dry or anesthetic. There are often thickened shiny earlobes, loss of eyebrows, and skin thickening. Widespread nerve enlargement. Sensory and motor loss.
Presentation:
1. Skin lesions
2. Nerve Damage: Weakness and Numbness occurs in the peripheral nerve trunks. Great auricular nerve, ulnar nerve (elbow), radial cutaneous nerve (wrist), median nerve (wrist), lateral popliteal nerve (neck of the fibula), and posterior tibial nerve (medial malleolus) lead to regional sensory and motor loss. Small dermal nerves are also involved producing patches of anesthesia in TT/BT lesions and glove and stocking sensory loss in LL patients.
3. A burn or ulcer in an anesthetic hand or foot
4. Borderline patients: nerve pain, sudden palsy, multiple new skin lesions, pain in the eye, or systemic febrile illness.
5. Ulceration and digit loss is due to secondary damage in neuropathic hands and feet.
Transmission:
Untreated patients discharge bacilli from he nose.
Infection- M.leprae invades via the nasal mucosa with hematogenous spread to skin and nerve. Leprosy bacilli can survive for several days in the environment.
People in contact with people have a greater but still small chance of becoming infected.
Incubation period is 2-5 yrs. For TT and 8-12 yrs for LL cases.
Diagnosis:
1. Macular hypo pigmented, hypo aesthetic lesion skin lesions.
2. Nerve enlargement
3. Positive skin smear for Acid Fast Bacilli
*Test Skin lesions for sensation.
*Palpate peripheral nerves to assess enlargement and tenderness.
*Assess nerve function b testing the small muscles’ power and sensation in hands and feet.
*Check eye function- Visual acuity, corneal sensation, and eyelid closure.
* Serology is not helpful.
Management:
1.Chemotherapy to treat the infection:
Leprosy Type Drug: Monthly Supervised Drug: Daily self administered Treatment Duration
Paucubacillary (2-5 skin lesions) Rifampicin 600mg Dapsone 100mg 6 months
Multibacillary (>5 lesions) Rifampicin 600mg Clofazimine 50 mg 12 months
Clofazimine 300mg Dapsone 100mg
2. Educate the patient: Patients are non-infectious within 72 hours and can lead a normal life. No limitations on touch. This is not a punishment from God. Deformities are not a result of the disease but due to the patients lack of sensation and harm without knowing it.
3.Prevent disability: Monitor sensation and muscle power in pts. Hand, feet, and yes as part of routine follow up so that new nerve damage is detected early. Treat any new damage with Prednisolone 40 mg daily, reducing by 5mg/day each month. Protect hands and feet!!
4. Support the patient socially and psychologically.
Leprosy is a chronic inflammatory disease caused by Mycobacterium leprae infecting macrophages and peripheral nerve Schwann cells.
It’s presentation and progress are determined by the patient’s cell mediated immune response to the mycobacterium. Most people (~95% develop an effective immune response to clear the M.leprae. The minority that cannot mount this immune response develop clinical leprosy.
Clinical Features of leprosy:
Classification Spectrum of Immune response Skin Lesion Nerve Involvement
Indeterminate Solitary hypo pigmented 2-5 cm lesion. Centre may show sensory loss. May become TT like. None clinically detectable.
Tuberculoid
(TT)
paucibacillary Strong but ineffective immune response to the bacteria which damages peripheral nerves and skin Lesions with well defined borders and sensory loss.
Patch is dry (loss of sweating) and hairless. May have one peripheral nerve affected. Occasionally presents as a mono-neuropathy.
Borderline Tuberculoid
(BT) Varying immunity and bacterial loads. Irregular plaques with raised edges and sensory loss.
Satellite lesions at the edges. Asymmetrical peripheral nerve involvement.
Borderline
(BB) Varying immunity and bacterial loads Many lesions with punched out edges. Satellites are common. Widespread nerve enlargement. Sensory and motor loss.
Borderline Lepromatous
(BL) Varying immunity and bacterial loads Many lesions with diffuse borders and variable anesthesia. Widespread nerve enlargement. Sensory and motor loss.
Lepromatous
(LL)
multibacillary Cellular anergy towards M.leprae with abundant bacillary multiplication. Numerous nodular skin lesions in a symmetrical distribution. Lesions are not dry or anesthetic. There are often thickened shiny earlobes, loss of eyebrows, and skin thickening. Widespread nerve enlargement. Sensory and motor loss.
Presentation:
1. Skin lesions
2. Nerve Damage: Weakness and Numbness occurs in the peripheral nerve trunks. Great auricular nerve, ulnar nerve (elbow), radial cutaneous nerve (wrist), median nerve (wrist), lateral popliteal nerve (neck of the fibula), and posterior tibial nerve (medial malleolus) lead to regional sensory and motor loss. Small dermal nerves are also involved producing patches of anesthesia in TT/BT lesions and glove and stocking sensory loss in LL patients.
3. A burn or ulcer in an anesthetic hand or foot
4. Borderline patients: nerve pain, sudden palsy, multiple new skin lesions, pain in the eye, or systemic febrile illness.
5. Ulceration and digit loss is due to secondary damage in neuropathic hands and feet.
Transmission:
Untreated patients discharge bacilli from he nose.
Infection- M.leprae invades via the nasal mucosa with hematogenous spread to skin and nerve. Leprosy bacilli can survive for several days in the environment.
People in contact with people have a greater but still small chance of becoming infected.
Incubation period is 2-5 yrs. For TT and 8-12 yrs for LL cases.
Diagnosis:
1. Macular hypo pigmented, hypo aesthetic lesion skin lesions.
2. Nerve enlargement
3. Positive skin smear for Acid Fast Bacilli
*Test Skin lesions for sensation.
*Palpate peripheral nerves to assess enlargement and tenderness.
*Assess nerve function b testing the small muscles’ power and sensation in hands and feet.
*Check eye function- Visual acuity, corneal sensation, and eyelid closure.
* Serology is not helpful.
Management:
1.Chemotherapy to treat the infection:
Leprosy Type Drug: Monthly Supervised Drug: Daily self administered Treatment Duration
Paucubacillary (2-5 skin lesions) Rifampicin 600mg Dapsone 100mg 6 months
Multibacillary (>5 lesions) Rifampicin 600mg Clofazimine 50 mg 12 months
Clofazimine 300mg Dapsone 100mg
2. Educate the patient: Patients are non-infectious within 72 hours and can lead a normal life. No limitations on touch. This is not a punishment from God. Deformities are not a result of the disease but due to the patients lack of sensation and harm without knowing it.
3.Prevent disability: Monitor sensation and muscle power in pts. Hand, feet, and yes as part of routine follow up so that new nerve damage is detected early. Treat any new damage with Prednisolone 40 mg daily, reducing by 5mg/day each month. Protect hands and feet!!
4. Support the patient socially and psychologically.
Tuesday, February 12, 2008
PICS
Hey Everyone!
I'm back safely and have uploaded pics
www.snapfish.com
email: sorensenk@uthscsa.edu
password: india
I hope you all enjoy!
My last week was a bit of a crazy "whirl wind" tour of India. New Delhi, Jaipur and Agra and I started last week on Inpatient with the Christian Family Practice Residency in Harlingen. (I get to work with Matt close by again which I really enjoy!) It was a hard transition back and I was very tired but it is such a blessing to be so welcomed by my friends here and to be encouraged again in my faith.
I will be posting an essay on leprosy soon for those of you who are interested. God bless! Thank you all again so much for your prayers! It's great to be back safe and sound.
I'm back safely and have uploaded pics
www.snapfish.com
email: sorensenk@uthscsa.edu
password: india
I hope you all enjoy!
My last week was a bit of a crazy "whirl wind" tour of India. New Delhi, Jaipur and Agra and I started last week on Inpatient with the Christian Family Practice Residency in Harlingen. (I get to work with Matt close by again which I really enjoy!) It was a hard transition back and I was very tired but it is such a blessing to be so welcomed by my friends here and to be encouraged again in my faith.
I will be posting an essay on leprosy soon for those of you who are interested. God bless! Thank you all again so much for your prayers! It's great to be back safe and sound.
Tuesday, January 29, 2008
Week 3 / 4
I had the most wonderful last week! I went with Doctors on Tues. and Nurses on Wed. to do rounds in the villages (home visits and setting up clinics in the villages)! I loved doing medicine outside, in the beauty of nature, in people's homes, and in the quiet and peace of the villages...it's hard to explain, but I could see myself doing that!
We did a lot of antenatal exams and I of course enjoyed to be able to feel the women's belly and listen to the baby's heart beat. There was also a lot of health maintenance (HTN, diabetes, COPD, asthma etc.), making sure people are taking their meds., referrals to the hospital, and follow ups from the hospital. We saw some cool things like chicguru dz.(I spelled that wrong), rheumatic heart dz., mumps, and well baby exams (getting to hold the babies was awesome).
CMC/CHAD has spent 26+ yrs. mapping out all the villages around this area and serving them and referring them to the community hospital (CHAD). They also tell all the women to go there to have their babies where they also perform the C-Sections, tubals, and other surgeries.
There was a undergrad who went with me on Tues. from Virginia and she was very cool. She was taking a yr. off to work on the Mercy ships, come here, and then go to Uganda! How awesome! I still would love to do the Mercy ships. Then today there was a med. student who's going into Family Med. from Denver with me and we had so much in common...Jesus, ministry, traveling, sports etc. It was a blessing to have fellowship. The Docs and nurses have been so friendly and during our lunch break the Indian Docs and nurses all sang Indian songs and worship songs! Too cool. =)
I went swimming in a nice pool that is just around the corner from the campus...an oasis for the foreigners & the missionary families.
I've been super tired. My days are long but so good. I just love doing medicine outside and in homes!
My last day was at the Leprosy hospital which I will have to blog about later because there is so much I learned.
We've been traveling and touring like crazy since Friday with early and late hours on trains, planes, and auto rickshaws! We've been to Chennai, Delhi, Jaipur, and now Agra! Crazy with very little sleep.
I have lots of stories that I look forward to sharing. Please keep praying for protection b/c we had a very scary experience in Delhi.
Scott wasn't traveling with us yet, and I am so glad he is now b/c touring with just girls is unsafe.
I am exhausted but am glad to be seeing the sights.
I saw the Taj Mahal today and it was incredible!!
I also road and elephant today..haha!
I want to come back and see the beautiful places in India (ie the Himalayas and Kerla)!
God is teaching me through Matt 8-10 recently. Will have to share more later.
So much overwhelming poverty here (sheep without a shepherd).
Please pray for continued safety as we travel. I will blog more later in the week and upload more pics!
More Verses:
Matt 6:25-7:12
Ps. 107:9b,14,16,18-22
rom 8:28, 1peter 1:3-5
We did a lot of antenatal exams and I of course enjoyed to be able to feel the women's belly and listen to the baby's heart beat. There was also a lot of health maintenance (HTN, diabetes, COPD, asthma etc.), making sure people are taking their meds., referrals to the hospital, and follow ups from the hospital. We saw some cool things like chicguru dz.(I spelled that wrong), rheumatic heart dz., mumps, and well baby exams (getting to hold the babies was awesome).
CMC/CHAD has spent 26+ yrs. mapping out all the villages around this area and serving them and referring them to the community hospital (CHAD). They also tell all the women to go there to have their babies where they also perform the C-Sections, tubals, and other surgeries.
There was a undergrad who went with me on Tues. from Virginia and she was very cool. She was taking a yr. off to work on the Mercy ships, come here, and then go to Uganda! How awesome! I still would love to do the Mercy ships. Then today there was a med. student who's going into Family Med. from Denver with me and we had so much in common...Jesus, ministry, traveling, sports etc. It was a blessing to have fellowship. The Docs and nurses have been so friendly and during our lunch break the Indian Docs and nurses all sang Indian songs and worship songs! Too cool. =)
I went swimming in a nice pool that is just around the corner from the campus...an oasis for the foreigners & the missionary families.
I've been super tired. My days are long but so good. I just love doing medicine outside and in homes!
My last day was at the Leprosy hospital which I will have to blog about later because there is so much I learned.
We've been traveling and touring like crazy since Friday with early and late hours on trains, planes, and auto rickshaws! We've been to Chennai, Delhi, Jaipur, and now Agra! Crazy with very little sleep.
I have lots of stories that I look forward to sharing. Please keep praying for protection b/c we had a very scary experience in Delhi.
Scott wasn't traveling with us yet, and I am so glad he is now b/c touring with just girls is unsafe.
I am exhausted but am glad to be seeing the sights.
I saw the Taj Mahal today and it was incredible!!
I also road and elephant today..haha!
I want to come back and see the beautiful places in India (ie the Himalayas and Kerla)!
God is teaching me through Matt 8-10 recently. Will have to share more later.
So much overwhelming poverty here (sheep without a shepherd).
Please pray for continued safety as we travel. I will blog more later in the week and upload more pics!
More Verses:
Matt 6:25-7:12
Ps. 107:9b,14,16,18-22
rom 8:28, 1peter 1:3-5
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