Pharmacokinetics of sertraline in relation togenetic polymorphism of CYP2C19 Objective: Our objective was to evaluate the relationship between the disposition of sertraline and the pres- ence of the CYP2C19 gene and to define the contribution of cytochrome P450 2C19 (CYP2C19) to ser- traline N -demethylation. Methods: A single oral 100-mg dose of sertraline was administered to 6
Mikecurry.orgOur Church at Rock Creek team consisted of seven people who had never visited Africa before. Three of us were nurses, two pastors and two who were willing to assist in any way God arranged. We were working with an existing ministry, called Light Ministries, and partnered with a team from Bellevue Baptist Church (who had previously worked with the children and teachers in the areas we were scheduled to visit). Although Light Ministries has developed several feeding stations and two orphanages, there had not been any medical mission efforts prior to our group. We received medications from Kingsway Charities, and medical supplies from CrossLink and Caring Partners International. We were definitely going in “blind.” Where did you work? Describe the conditions geographically, politically, and economically.
God sent us to Kakamega and Nairobi, Kenya. Nairobi is the capital city of Kenya and home to somewhere between 1.5 and 5 million people. Populations are hard to accurately count in Nairobi because most of the people live in “slums” and do not participate in any census counts. Although estimated to be much smaller, the area of Kakamega is thought to be home to over 2 million people, many who are homeless children. Both cities sit nearly on the equator, so despite the fact that we were there in February, it was hot, with temperatures during the daytime of nearly 105 degrees Fahrenheit. All of Kenya was experiencing one of their two annual “dry” seasons, so the areas were dry and dusty. On the last day we were in Kenya it rained very heavily, and the locals explained that it was the beginning of their “rainy” season. The political environment was one of relative stability, since the elections of 2008. The country of Kenya is currently governed by both a President and a Prime Minister, and according to most of the local Kenyans that we met, the government is very corrupt. There are very few, if any governmental resources available to the Kenyan people. Poverty is rampant. There is no water supply, nor is there sewage treatment. Most Kenyans battle living conditions that are unfathomable in the United States. Education is only available to those who are able to pay for it. Food resources are best described as scarce, and food that is available often has little or no nutritional value. Obtaining water safe for drinking is often a task that requires mothers and children to walk up to ten miles in each direction…often barefoot or in shoes that do not fit properly. Many of the children we saw were homeless orphans, whose only source of nutrition and education was provided by the volunteers serving at the feeding stations established by Light Ministries. Our team held four medical clinics during our time in Kenya. We could have held forty more, but our time was also spent worshiping in Kenyan churches, sharing the love of Jesus in open-air evangelisms, participating in a pastor’s conference (held to refresh over 40 pastors of Kenyan churches and their families), traveling on difficult roads, and one morning of witnessing God’s beautiful creations seen only on an African safari. Our clinics were held in open pavilions with little to no access to clean water. We focused primarily on serving the children who were fortunate enough to be sponsored and have access to the feeding stations….we passed by thousands more who were not. We also provided medical care to the volunteer staff members of the feeding stations and their immediate families. We did hold a clinic open to the community that surrounded one of the feeding stations and were stunned by the difference that the nutrition provided by the feeding stations makes in the overall health of the children in that area. We also saw adults from the community, many of which suffered with ailments and diseases far beyond the scope of our clinics. We also held a clinic for the 40+ pastors and their families who were attending the pastors’ conference-their medical needs were nearly as great as those of the homeless orphans we cared for, and many of them were attempting to hold feeding stations for the homeless orphans in the areas of their churches, spread all over Kenya. What type of medical conditions did you treat? Were the medicines and supplies you
received appropriate to treat these conditions?
Regardless of the location of our clinics, the medical needs we witnessed were great. Most of the children had never been seen by any medical professional for anything. Every person we came into contact with was battling gastrointestinal parasites due to a lack of clean water. When asked what hurt, most children would rub their swollen bellies first. Nearly every one we saw was afflicted with some stage of malaria. There were fungal skin infections on nearly every child. Scabies was frequently observed. Often times the children had skin abscesses due to bacterial infections that were the result of scratching the itchy fungal or parasitic skin ailments. Most of the children suffered with various upper respiratory infections and ear infections were very common. Many of the children and adults that we served mentioned that their eyes hurt and had symptoms ranging from those related to living in dusty, dry areas, to chronic infections that were stealing their vision. We saw individuals with obvious signs of tuberculosis and typhoid. Many of the infants were very poorly nourished due to the lack of nutrition that their breast-feeding mothers received. Most of the people we saw were profoundly anemic. Signs of chronic hepatitis were obvious in many of the adults that we served. It is estimated that nearly one-third to one-half of the orphaned children we saw were also afflicted with HIV or AIDS. It would not have been possible to offer relief of any of these symptoms to the > 1800 people that we ministered to, had it not been for the medications resources and supplies we received from donors. While we are aware that we left many, MANY medical conditions untouched by Western medicine, we were able to share the love of Jesus to all of the people that we did offer some symptomatic relief to. Those that we were able to reach through our clinic efforts were so very appreciative of any relief we could provide, and were very aware that is was all because of the love of Jesus. How did the medical supplies enable you to share the Gospel?
The medical supplies provided an opportunity to share the Gospel with every individual we saw. With each encounter, each nurse would introduce herself, explain that “Jesus sent us there to try to help you feel better and be sure that you know that He loves you very much.” We would then offer to pray with them and were sure to remind them that there are people in the U.S. that love them because Jesus loves all of us the same. Whether a nurse was seeing a three year old orphan, a seventy year old blind, homeless man, or a 25 year old pastor along with his wife and two children, our messages were the same. Often we were only able to clean a cut, provide a dose of Albendazole, rinse a dry eye, offer a dose of Tylenol or Motrin for a pain related to a much more severe condition, or offer reassurance…but we did it with love in our hearts, and those who we cared for recognized that love as the love of Jesus. How would you describe the spiritual condition of those you served?
Overall the spiritual condition of the Kenyan people we served was amazing. When asked, one fifteen year-old orphaned boy replied, “We have Jesus, what is there not to be happy about?” In an area of the world where most Americans would shed tears for all of the lack of material possessions and comforts we witnessed, many of the Kenyans we met depend on God for EVERY thing in their lives. Their daily reliance on God for the most basic of provisions seems to lead to a spiritual strength rarely seen in our culture. Most all of the children we served had heard the Gospel before, because Light Ministries has always made feeding their spiritual souls as big of a priority as feeding their physical bodies. Even still, there were adults (and a few children) we served seemed slightly skeptical or uneasy with our reasons for loving them and the concept of Jesus loving all of us equally. Even so, they seemed very appreciative of the medical relief that we offered and seemed surprised that we would travel so far to share it with them. The members of our team continue to pray for these individuals that they would come to develop a meaningful relationship with Jesus Christ as a result of witnessing His love through our team. Share compelling stories where you saw the evidence of physical healing and spiritual hope
being provided through your mission.
“I was amazed at how many people our team was able to reach out to. The medical team did a phenomenal job of combining a personal touch with the determination to care for as many people as possible. I have taken medical teams before but have never witnessed as big an impact as I did on this trip. The first day of the medical clinic was at the Light Feeding Station in Kakamega. The team was able to see and medicate all of the children as well as the staff prior to lunch. We then asked Rebekah, the head of the Feeding Station, to go out into the surrounding community and invite the "neighbors" to receive free medical care. When we returned from lunch the crowd was already there waiting on us. Once again, the team poured their hearts into this with the result that another +/- 100 people were seen in the afternoon. It was during the afternoon that a mother brought in an infant with +105 degree fever. The baby was lethargic and droopy, the skin seemed clammy. Our medical team immediately jumped into action and brought the fever down. One of the nurses suggested that the child might have died without the treatment received. The fact is, were it now for how proficient the team was in the morning, we would not have opened the clinic to the community in the afternoon. So thankful for the talents and giftings God anointed this medical team with.”-Mike Grober, Missions Pastor “A memory that will always stay with me. At the community med clinic we did @ Bread of Life feeding station, a 12 (or so) year old boy approached me, in obvious pain. He was sheltering his eyes from the sun & squinting. When I finally understood (through our translator) what he was telling me, he relayed a very sad story. He had been abused & beaten by a guardian, about 3 years before, to the point that he was almost blind. His eyes were severely bloodshot & obviously infected. On top of the lack of clear vision, due to the prior injury, this poor child was in excruciating pain from an eye infection, which magnified his discomfort. I flushed his eyes out with saline & applied antibiotic eye drops. Then I prayed over him & told him I would continue to pray for him daily. He smiled at me & melted my heart. When his friend helped lead him away, I walked into the sewing room, where we had set up our clinic & cried like a baby. His name was Zacharius & I will never forget him.”- Dani Strickland, RN “Before going on the trip we were thinking we would not give injections because HIV/AIDS is so prevalent there and this was the first time our church was visiting Kenya…we thought we‟d just see how it was this time around. However, several Rocephin antibiotic injections were available and were donated to us. So, we decided God must have a use for these injections in Kenya, so we took them with us. Two patients who received these injections really stand out in my mind. One was an 18-month old baby girl. Her mother told me she had been sweating, coughing and had a runny nose. The baby was very lethargic. I took her temperature and it was 105.1! We gave her infant Tylenol, an intramuscular injection of Rocephin, and wrapped an instant ice pack in a towel and placed it on her abdomen. Within 1 hour, she already looked less lethargic and her temperature was falling! Another patient, a boy, approximately 3 years old had several abscesses on his head…some standing about an inch off of his skull. An adult worker at a feeding station was carrying the boy around and brought him to me. The abscesses were very painful and he was screaming and crying. We decided to give him a Rocephin injection. About an hour later, the little boy was running around laughing and playing! That was an amazing sight to see and I praised God at that moment for the healing he‟d provided to that child.”- Crystal Davis, RN “The night the medical team did the clinic for the pastors and their wives was amazing! So many were so scared about what might be wrong with them. I saw a woman who was so worried because she had not felt any movement from her unborn child. Using sugar under the mother‟s tongue, the nurse was able to stimulate the baby to move. What joy for this woman! Every person who came to the clinics was shown tender love and concern. I believe every person left knowing that Jesus had touched them through the hands of the medical team.”- Gail Marts Tell us about the experiences of others in your group. How did you see God at work? How
did God work through you?
After much prayer, the Rock Creek team hauled 350 lbs. (seven 50# lbs bags- 1 for each person on our team) of medical supplies, to Kenya. Although we had been prepared for the possibility of customs agents in Kenya confiscating or holding our supplies upon arrival in country, we prayed feverously that God would intervene & intervene He did!! All of our supplies, luggage, etc. made it through customs without a hitch! Praise God for his incredible provision!! He obviously wanted the supplies there! “I have never witnessed miracles like I saw there. Our medical supplies never seemed to diminish. We were able to examine around 800 patients and pass out 1500 de-worming pills! Almost every child we saw there had a cough and runny nose. A lot of decongestants and cough medicine was donated to us, so we were able to treat all of those children. They were not like most American children I have met…they did not whine about having to take the medicine. They just opened up, took it, smiled, and walked away! So appreciative! This was my first mission trip. It was an extremely humbling experience. Although I saw poverty like I have never seen before, I also saw happiness that I have never seen before. They have very few, if any, material possessions and they draw on the Holy Spirit for all they need. I also remember that while we were packing our supplies in preparation for Kenya, I noticed some ABD pads had been donated to us…at the time I wondered what they‟d be used for. One lady I examined complained of pretty bad menstrual cramps. I got creative and gave her a few of the ABD pads along with some gallon-size Ziploc bags. She told me she had access to hot water, so I told her to wet the ABD pads with the hot water, put them in the bags, and then place them over the area where she was cramping. I was also able to give her a few ibuprofen tablets. As a woman I understand how miserable menstrual cramping can make you, so I was so thankful God provided a way for her to get some relief! It was so wonderful being God‟s hands and feet in Kenya and I cannot wait to go back! The Kenyan people have nothing and are so amazingly appreciative of anything you can provide to them or teach them. We were so grateful that so many medical supplies and medications were donated to us and we were able to take them to this needy country. I have shared these stories, and many more, with many people since I‟ve been back home. Because of these accounts, two women are visiting my church with me and several have made donations to the people of Kenya! Praise God!”-Crystal Davis, RN “I have led somewhere around 50 short-term mission trips. A number of these have been medical in nature. The joys of witnessing medical professionals pour themselves sacrificially into the lives of people who often have never seen a doctor is beyond words! This trip was no different. However, the magnitude of the impact far exceeded any previous medical trip I have been on. I would take this team anywhere at the drop of a hat. They worked well together, complemented each other in a divinely orchestrated way, and fit right into the primitive conditions they were placed in. For me, watching God work through them and seeing the hope in the eyes of those they cared for, were priceless. If I had done nothing other than watch them the whole trip, my time in Kenya would have been well worth it. So thankful that we had the meds to care for over 1800 patients. There is no way we could have afforded the 7 duffle bags of meds we were given.”-Mike Grober, Missions Pastor “ As a Pastor in the USA my primary responsibility on our recent mission trip to Kenya was to speak to a group of about thirty pastors who had come from all across Kenya for their annual Pastor‟s Conference. Many of these pastors along with their wives and children traveled for two days in order to attend with many actually arriving at the „hotel‟ where we stayed via bicycle taxi (a bicycle with a seat on the back). My primary objective in addition to some equipping messages was to encourage these pastors in their work. Their tasks are enormous and they serve in the face of incredibly difficult situations which often causes discouragement. I sought to interact personally with a number of the pastors, especially those more fluent in English. Their stories were compelling. In addition to myself and our Mission Pastor there were seven others from our church (The Church at Rock Creek) who were part of our mission team including three nurses. They made up the first ever medical team that had visited the feeding stations, schools, and orphanages in the area where we served. As I interacted with the pastors they expressed great interest in the medical team and what they had to offer. Kenya is a country infested with sickness and terminal diseases. This situation is compounded by the lack of adequate medical personnel and facilities. Time and time again the pastors expressed hope that they along with their families might be able to be treated by the medical team. So, late one evening around 10:30 the medical team was made available to the pastors and their families. The nurses worked till after midnight treating the various ailments of the pastors along with their wives and children. I have never seen a more appreciative group. It may seem to be a crude illustration, but perhaps the best analogy of that evening was the relief our team was able to provide one of the pastors suffering from severe constipation. I think living in the environment of sickness and death puts a lot of pressure on these pastors who not only have the responsibility of looking after their churches and members of their community but their own family as well. The tension such an environment creates can be incredibly binding and painful. The very fact that a medical team from the USA was there to offer medical treatment to these pastors and their families was like an oasis in the middle of their desert and it released a lot of anxiety and stress they live with daily. RELIEF.that was what the medical team offered these pastors if even for a short while. They were renewed and given fresh hope. These pastors who are themselves so worn down from being the primary caregivers in their community finally had a chance to be care receivers as our medical team treated them. Our church has invested in the future of this area by sponsoring a feeding station and having a water well drilled at the orphanage. Future plans call for a medical clinic to be built on the grounds of one of the schools and feeding stations. This will be a huge enticement for future medical teams to travel to Kenya and help the people there. Our church is committed to an on- going ministry in this area including medical missions. Thanks for your gracious generosity in providing medical supplies for our recently completed trip. I assure you they not only were put to good use but they blazed a trail for future missions of mercy.”- Greg Kirksey, Teaching Pastor “I believe that our team is eternally bound together. Everyone worked together and cared for one another's needs. Everyone did what was necessary to accomplish each task. Each person had the full trust of the others on the team. God enabled all of us to do what we could never do alone. God alone is responsible for anything and everything that was done to help others. Over and over again God took what was available (medical supplies, energy, time, talents) and made it more than enough to meet the needs of the moment.”- Gail Marts A final example of God’s AMAZING hand on our recent efforts in Kenya: Before we ever left the U. S., one of the main things we knew we would be facing & wanted to
impact, was the epidemic of gastrointestinal parasites due to the lack of clean water supply in
this area. Thus, we knew in advance that we would strive to provide de-worming meds to as
many citizens as possible. We transported with us, 1,500 doses of Albendazole - a single dose,
chewable pill that provides protection from intestinal parasites (worms) for 6 months. Along the
way, during our clinics & travels, we passed out 1,300 doses of the medication, reserving 200
doses for the last day in country, when we were told we would be visiting a feeding station in an
area of Nairobi called the Mathare Slum. We were initially advised that there were 150 children
there at a feeding station to which we would be providing Albendazole. Once we arrived at
Mathare, we were given a walking tour of the area, from the local pastor; jumping ditches of raw
sewage & visiting tin wall, dirt floor "classrooms" at this feeding station that was the poorest of
poor. Upon completion of the area tour, 4 of us split up the Albendazole (the 200 doses we
had) into rubber glove "cups" (rubber gloves with the fingers tied together). We realized, after all
we had seen, that there were many, MANY more than the original 150 people we had been told
we would be treating. After dividing up the pills, we held hands & prayed over the doses,
pleading with God to not make us decide who "deserved" the short supply that we had- & asking
for his provision to administer de-wormer to everyone there that needed it. We again made our
way to each & every child, volunteer teacher, kitchen help & additional person we came in
contact with in the slum that day & none of our gloves ever went empty!
Not only had God provided doses to everyone that needed it…as we poured our gloves back
into the pill bottle after administration, we discovered that we ended up with about half of a
bottle (250 pills!!) LEFT!!
All of us wept & praised God because we knew that there was NO "logical" explanation for the miracle we had just witnessed. Afterward, the Bishop's wife that was with us, we asked just how many children were there. She told us she estimated there were about 700. So, not only does God hear our prayers, but he provides exactly what His children need, exactly when they need it. What an incredible blessing it was to be able to witness this modern day "fish and loaves" miracle firsthand. God bless you all and thank you for letting us share what God has done in the lives of our team, as well as the lives of the amazing people God introduced to us in Kenya. There are no sufficient words to thank the donors for the supplies that made this medical trip possible. Not only were we able to provide physical healing in some cases, but through the Great Healer we were also able to tend to spiritual and emotional needs. God used our willing hands & feet, and the medical supplies and medications from generous donors like you to allow our brothers and sisters in Kenya to experience relief from pain & illness, but more importantly, God's grace in a whole new dimension. Respectfully submitted, In Jesus Christ alone!
Aberfan and Merthyr Vale Youth and Community Project Adult Community Learning & Library Services, Healthy Living Creative, Bridgend County Borough Council Barnardo's Cymru Neath Port Talbot Partnership Page 1 of 13 Blaenau Gwent County Borough Council - Regeneration Department Training Centre Bridgend and District Citizens Advice Bureau Bridgend Association of Volunt