Village News

Our Angels of Mercy Past and Present – Nursing in Kwai River Christian Hospital

I’m told that the very beginnings of medical care in the Sangkhlaburi area started with nurses. And even after the doctors came, there have been times when there were no doctors in Kwai River Clinic/Hospital. But our nurses have been there throughout our hospital’s history…. with the baton passed from one generation to the next.

The Changing Face of KRCH

 

by Dr. Phil McDaniel

 

Construction progressing on the “new” Kwai River Christian Hospital in Huay Malai, approximately 1983-1985. These photos were taken from the water tower of the mission compound.

 

“What if we built something ‘bambooish’ to start with?” I remember Dr. Lois Visscher saying something like this around 1982 during one of our discussions about the uncertain future of the Kwai River Christian Hospital.

The Electrical Generating Authority of Thailand was in the process of constructing a dam that would result in flooding of the valley of the Khwae Noi River (often called the Kwai River in English). Detailed surveying by EGAT had shown that the Kwai River Christian Hospital at its original site would be flooded out along with several villages. Time was running out for us. The reservoir would start filling in June, 1984. We had to decide whether to rebuild or close down.

 

 

Map of the Sangkhlaburi and Thongphaphum areas of western Thailand depicting roughly the area flooded by the reservoir that backed up behind the Vajiralongkorn Dam, also known as the Khao Laem Dam. The note at the bottom of the page about travel times by car or boat was true in 1984 but no longer apply. There is now a paved road all the way from south of the dam to the new town of Sangklaburi. That distance can be covered in about an hour.

 

 

 

 

 

By “bambooish”, Dr. Visscher meant a structure that used inexpensive, locally available building materials such as bamboo. Dr. Visscher had been a missionary in India for about 40 years before she aged out according to the rules of her mission board. She then came to help at the Kwai River Christian Hospital! She was used to economizing from her days in India.

But why rebuild the Kwai River Christian Hospital with cheap materials? It’s because some were asking, “Why rebuild the Kwai River Christian Hospital at all?” The KRCH had been in operation since 1963 (and had operated as a small clinic in a wooden shed for a year or two before that). In those twenty years of operation, the hospital had served thousands of patients, but there had been frequent problems staffing the hospital, especially with doctors and nurses. Twice the hospital had closed for lack of staff. Some said, “Maybe it would be better to just close the hospital, and eliminate these headaches!”

Another force dampening enthusiasm for building a new hospital, robust from end to end, was uncertainty as to whether the villagers would actually move to the relocation sites assigned to them: “What if the hospital moves to its assigned relocation site but the villagers don’t move to theirs? The hospital might end up serving a very sparse population.”

The Electrical Generating Authority of Thailand did provide some compensation for villagers and institutions. However, the compensation for the hospital was not sufficient to rebuild the hospital with all new robust materials from one end to the other. We decided to build one end of the hospital robust and the other end “bambooish”, with the intent of gradually upgrading the cheaply built end if the hospital was well utilized. The service and support area of the hospital (operating room, delivery room, x-ray, pharmacy, and central supply) was built robustly. This allowed medicines and equipment to be stored in locked rooms.  The inpatient and outpatient areas of the hospital had a concrete floor but woven bamboo walls.

 

Ben and Doris Dickerson
Ben and Doris Dickerson, long time missionaries among the Karen people, were assigned to the Kwai River Christian Mission, arriving in June, 1982. Ben was put in charge of moving the Kwai River Christian Mission, including the hospital. He was assisted by Jit Yawan. Doris was assigned to the evangelism department of the Kwai River Christian Mission.

 

 

Woven bamboo walls divided examining rooms in the outpatient department.

 

 

 

 

 

 

 

 

 

 

The “new” hospital in Huay Malai turned out to be well utilized, serving two refugee camps along the Thai-Myanmar border as well as the villages near Huay Malai, the new town of Sangklaburi and points beyond. The “bambooish” end of the hospital was upgraded by degrees, until it began to look like a real hospital. At no time did patient care cease. It was available either at the old site or the new and for a brief time at both. To bring this about was a bit of a challenge as a major amount of construction material was being salvaged from the old hospital to use in the construction of the new. After the carpenters removed the roofing and support structures from half of the hospital at the old site, there was nothing to keep the rain from falling into the unroofed hallway and making its way to the part of the hospital which still had a roof. We had to chisel a small diversion channel so that the rainwater would run out the side of the hospital rather than continuing into the pharmacy and x-ray area.

 

 

 

The changing face of KRCH, Huay Malai

 

 

Over the years it has become more and more difficult to meet the building codes of the Ministry of Public Heath at the Huay Malai facility. The parts of the Huay Malai structure that were salvaged from the original (1963) building are now 55 years old. Construction is already underway for relocating the hospital once again.  With financial assistance from Overbrook Hospital in Chiang Rai, USAID, and Church World Service, this new building will be up to date and ample in size. The building is going up in Sangklaburi Christian Center in the town of Sangklaburi, the transportation hub for the district of Sangklaburi.

 

Artists conception, new KRCH
Second relocation: the next big move (still pending at the time of this post). Artist’s conception of the new Kwai River Christian Hospital building due to be completed in late 2019 or early 2020.

 

 

Over the years a great deal of time, effort and money has gone into building, relocating, upgrading and remodeling. When the new building (at Sangklaburi Christian Center) is complete, the Kwai River Christian Hospital will be able to move into the largest and best equipped facility in its history. However, the most important asset of the hospital will still be its staff. My hope and prayer is that the doctors, nurses, aids, pharmacists, cashiers, and cleaners will always feel genuine compassion for the sick and suffering and that “Caring for the weakest on behalf of God Almighty” may be a daily practice, not just a motto.

 

 

 

Back to VOLUNTEERS FROM THE PAST

Making Do

by Dr. Phil McDaniel

From the 1960s through the 1980s the hospital was still quite remote. Budget was tight. Much of the equipment had been donated and was quite old. To keep expenses low we made do with the materials and equipment we had.

With no regular electricity available during the day, we had to either start a “back-up” generator to provide power for, say, surgery or x-rays, or we had to schedule procedures for a time in the night when we expected that there would be electricity.

 

This 15 kVA 2-cylinder diesel generator was run from dusk to about 10 PM each night in the mid 1980s to supply the mission compound with power the first part of each night. Outside of these regular hours, it was used for urgent electric power needs at the hospital such as x-rays or surgery. After the arrival of government power in the late 1980s, it became a backup generator used during the frequent power outages.

 

 

Nurse Eiam providing the air pressure required for a nebulizer treatment for an asthma patient, using a bicycle pump.

 

 

Another asthma patient getting a nebulizer treatment powered by air pressure from a bicycle pump.

 

 

This man had been gored in the chest by a wild ox and had a collapsed lung on the right with some bloody fluid in his chest. I put in a chest tube to drain the fluid and help re-expand the lung. The only suction machine we had at the time was this hand-operated vacuum cylinder. It was not very efficient. Staff were encouraged to stop and give a few pulls on the vacuum pump each time they passed by the room. The patient made a gradual recovery. In fact, he is the happy fellow returning home by boat with his family in my “Boats, Carts and Elephants” post.

 

 

This spotlight, powered by a motorcycle battery, was primarily used by the night watchmen for the hospital and mission compound. It was also useful by day to search for termite entry points. When the electricity went off in the middle of an operation, it came in very handy as an emergency light source.

 

 

In the 60’s and 70’s there was no electric cast saw. Casts had to be removed by small crescent-shaped hand saws. This was a tedious task assigned, in this case, to the hospital gardener. Sometimes it was assigned to a friend or relative of the patient or even the patient himself!

 

Back to VOLUNTEERS FROM THE PAST

Boats, Carts and Elephants

By Dr. Phil McDaniel

In the early days of the hospital, patients came and went using multiple means of transportation. The method used in a given case depended upon distance to travel, the season, the patient’s resources, what types of vehicles could get through, and how ill the patient was.

Boat, patient, hammock, old hospital site
At the original hospital site [now under water due to a hydroelectric project], patients were sometimes brought by boat. See boat in foreground, patient in a hammock suspended from a bamboo pole in the background. (early 1980’s)
This patient [the man behind the mahout] arrived at the hospital on elephant back. As I recall, his reason for coming to the hospital was giddiness. Given that elephants lurch and sway when they walk, this was a curious choice for means of transportation.

Oxcart pulling up to the front of the hospital (probably in the late 1980’s or early 1990’s).
Patient suspended from a bamboo pole approaching the rear entrance of the “new” hospital in Huey Malai. [This picture, taken by my dad, Dr. Ed McDaniel, during one of his volunteer stints, was actually staged following the recovery of the patient!] Note that the patient is suspended from the pole by sarongs, the same type of garment worn by the bearers of the pole. Patients who arrived at the hospital this way were usually in bad shape: incapacitated by a land mine injury, a gunshot wound, a stroke, cerebral malaria, cholera, or snake bite. (mid 1980s, rainy season; hospital staff houses in the background)
Two patients slung from hammocks in the back of a pickup truck. (probably late 1980’s or early 1990’s)
Patients often come and go from the hospital in taxi-buses: pickup trucks with two long benches in the back. (1990’s)
These passengers boarded this “long tail” boat at the boat landing in front of the doctor’s house at the original hospital site. It was taking the mobile clinic team to one of the villages it regularly visited and was also returning a patient and his family to their home. (early 1980’s)
Many patients came to the hospital on motorcycles: usually just 1-3 per motorcycle, but sometimes more! Hopefully this family has now heard about family planning. (early 1980’s)
Patient and family heading home after hospital discharge (early 1980’s).
Patient, improved, returning home with family (early 1980’s).

Back to VOLUNTEERS FROM THE PAST

Volunteers from the Past

Click here for a “snapshot” of our past on:  

BOATS, CARTS AND ELEPHANTS

MAKING DO

THE CHANGING FACE OF KRCH

THE PEOPLE WE SERVE

by Dr. Phil McDaniel

Volunteers from many countries have donated their time and talents to further the work of the Kwai River Christian Hospital and benefit the community. They have generally paid their own way to get to the Kwai River Christian Hospital and paid for their own room and board while there. Some volunteers have been repeaters, giving of their time and talents again and again. A few volunteers are pictured below. I hope to add more photos as they get digitized.

 

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Bruce Mills trying to keep his boots dry by pole vaulting across the stream. Bruce came with Phil Blackman and son Andrew Blackman to put in a gravity-fed water system for the Village of Yakadee.

 

 

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Phil Blackman and Bruce Mills. When I asked Phil whether he thought he could improve the function of our rickety old operating table [this table swayed a bit from side to side and also slowly sank under the weight of the patient during operations], he said, “Not a problem. It works just like a piece of farm machinery!” At that time Phil Blackman was managing a farm owned by a specialist surgeon in Australia and Bruce Mills was running a sheep ranch.

 

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Bruce, Phil, and Gideon give the operating table a test ride after their overhaul job done in the hospital’s back yard.

 

 

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Dr. Ed McDaniel covered the KRCH many times. The first time was in the early 1960s when he covered the hospital for a week or two for Dr. Doug Corpron. At that time, son Philip was still in high school. In this photo, probably from the late 1980’s, Dr. Ed is examining a patient recovering from a coma. Patient is lying on a mattress on the floor. I think this is because the beds were all full. However it also could have been a precaution against falling out of bed due to a seizure or disorientation.

 

 

Dr. and Mrs. Curry (Frank and Beryl), July, 2004, Washington State, USA
Dr. and Mrs. Curry (Frank and Beryl) in Washington State, USA, where Phil McDaniel went to visit them in July, 2004. Frank and Phil’s dad, Dr. Ed McDaniel, together covered the KRCH for about one year (1987/1988) while Phil was on furlough in the USA. Frank and my dad both turned 70 in 1987. Their birthdays were just four days apart. They referred to themselves as “the two old men manning the fort”.

 

 

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Dr. Keith Dahlberg and nurse Satja, round on a patient in the big ward. Dr. Dahlberg took turns with Dr. Bina Sawyer and Dr. Ed McDaniel to cover the hospital part of the time during the two year gap between Dr. John Freeman and Dr. Phil McDaniel. In later years, Dr. Keith returned from the States 2-3 times to cover the KRCH so Dr. Phil could go to a conference or go on vacation. Dr. Keith has been listed in some accounts of the hospital’s history as one of the former directors. However, he was never officially the hospital director at KRCH. He was director at Maesariang Christian Hospital.

 

 

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Dr. Akira Koga from Japan [back row, center, flanked by Dr. Phil McDaniel and nurse Ebra Sanba] with cataract patients in the mid 1980’s. Dr. Koga came twice, sending expensive donated equipment ahead of his first visit.

 

 

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Dr. Koga testing visual acuity of a patient following cataract surgery.

 

 

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Improved vision following cataract surgery. Note that this was in the mid 1980s. We were still using an old method involving removal of the entire lens (intracapsular cataract extraction) and no placement of an artificial intraocular lens. This was in the days when post cataract surgery patients had to wear thick glasses.

 

 

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The staff called visiting dentist, Dr. Phil Horton, “Dr. Phil Tooth” to distinguish him from Dr. Phil McDaniel.

 

 

Phil Horton working with kids crowded around
Dr. Phil Horton works on a student while curious schoolmates look on.

 

 

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Dentist Phil Horton with translator and assistant Kalay (left) and gardener-turned-denture-maker Moung Oo (right).

 

 

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Dr. Mathew Clark came for a volunteer stint in the 1980’s. Here he is aspirating a liver abscess. We located this clinically [no ultrasound or CT scan at KRCH in those days!]. Patient felt much improved after aspiration.

 

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Forest Daugherty, family practice doctor from Columbus, Ohio made two trips to KRCH with his wife, Marsha. Their enthusiasm was infections.

 

 

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Marsha Daugherty accompanied her husband, Dr. Forest Daugherty on two volunteer trips to KRCH. While Forest saw patients, Marsha led a charge to dust and wash glass louvers as well as scrub walls and clean shelves. When Forest was not examining patients, he and Marsha worked together to sand and varnish some of the woodwork in staff housing.

 

 

Mr. and Mrs. Don Cross, November 18, 1995
Don (electrician) and Jeanette Cross from Western Australia. Don came to KRCH two or three times. He did extensive wiring jobs and over-saw the installation of a hospital-wide suction system.

 

 

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Dr. Jim Smith, ear, nose and throat specialist from Oregon, USA, evaluates a patient with a large goiter (enlarged thyroid gland). We later removed this under local anesthesia.

 

 

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Dr. Smith made a side trip to KRCH following a medical conference in Malaysia, which we had both attended. Here Dr. Smith is operating to remove the large goiter pictured above (Phil assisting).

 

 

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Dr. Steve Parker came to KRCH for an elective rotation as a medical student. Later he returned as a resident and still later, while he was an attending physician at Oregon Health and Sciences University. The white streaks on his face are from the application of a cooling slurry of water and mentholated powder. This was applied by someone on the hospital staff as a gesture of goodwill and compassion during one of the hottest days of the hot season. In his hands Steve is holding a generous helping of mangoes and sticky rice.

 

 

Dr. Veeraphan evaluating a patient at KRCH
Dr. Veeraphan evaluating a possible candidate for eye surgery at KRCH

 

 

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Dr. Veeraphan working on an eye patient in the operating room at the Kwai River Christian Hospital. Most of his visits were in the 1990’s. He performed extracapsular cataract extractions with intraocular lens placement.

 

 

Dr. Veeraphan and team
Dr. Veeraphan, eye surgeon, and his team came every three months for several years. The vehicle they used was donated by CBM.

 

 

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This man had particularly dense cataracts. His grandson (center) had been his guide, leading him around with a stick. After cataract surgery he was able to walk independently. He was pleased with that and also very pleased that he was now able to see his grandson for the first time!

 

 

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Cataract patient being led by grandson before his cataract surgery. The look of anxiety on his face was soon to be replaced with a big smile!

 

 

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Dr. Phil McDaniel consults with Dr. Doug Walsh (left) and Dr. Scott Miller (both connected with AFRIMS) on the day of the official opening of the AFRIMS-KRCH Clinical Research Building

 

 

 

 

Flooded! Showers of Blessings…

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9:34 AM Friday 20th 2018

Friday the 20th started with an innocent pitter-patter of raindrops, as almost every morning does during the rainy season. By late morning it was clear the drainage ditch bringing water under the road in front of the hospital was in trouble. It had been about 5 years since the last flash flood had swamped the hospital, but immediately, the hospital staff went into high-gear to move all the equipment and medications to the higher ground of the inpatient annex and above the level of the flood waters. The Saha Christian School next-door closed classes early, and sent us their older students to help sandbag off and seal the front and rear entrances to the building. Unfortunately while they were battling at those fronts, the floodwaters came up rising up through the sewers and the toilets.

The little army of volunteers barricaded the CT room with plastic liners and sandbags, and scooped with anything that could hold water,  while water pumps were set up. After a couple hours of valiantly battling the rising tide of murky water, it began to recede towards the OR and labour and delivery rooms, where the waters were deepest.

By the end of the day, with much sweat and elbow-grease, we had mopped up the outpatient area, the ER and OR. The CT room only had 2 cm of water sneak in, and after a quick check, we left the CT room sandbagged overnight for safekeeping.

Nearly everything is functional again, except a non-portable x-ray machine, and we are waiting for the electronics for the server portion of the CT machine to dry out a bit more before the technicians inspect it and we risk turning the power back on.

Our rainy season lasts until the end of October, so we are praying that this does not happen again. We will be ready though, and it was such a blessing to see everyone working together in the smelly water to get the hospital cleaned up and running again!

Prayers Are Needed

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Join us to give thanks to God for the provision of light enough for each step on the journey, as well as the camaraderie and gracious assistance of many who have helped to lighten the load of the full-time team serving at KRCH.

Please do pray along with us to use our resources wisely to serve the community entrusted to us, and those who have trusted us for their care.

Uphold the leadership team and the hospital board of directors, as we build up the team  and begin building the physical structure of the new Kwai River Christian Hospital in Sangkhlaburi Christian Center.

Pray for healing and wholeness for the physical, emotional and spiritual health of our staff, especially for some who have gone through loss and sorrow. May our Lord be their comfort and source of strength.

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Helping Hands

A huge thank you to the many people who have played an important part in helping our patients and equipping and encouraging our staff.