Monday, April 16, 2018

ICU rounds with Warren

So, who wants to go on rounds with me?  Don’t worry, we won’t see all the patients, just some of the ones in the ICU. This will give you a little taste of the challenges we face here.

Bed 1 was a disaster. She was a 22 year old girl who came to us after having been operated three times.  It was not clear what they did, but she had stool pouring out of her abdominal incision. I’ve operated on her twice. She had a hole in the duodenum, the jejunum and the cecum. Despite having close the holes, she continued to leak. At a certain point of malnutrition, the body simply do not have the ability to heal.  We explained the situation to her mother, who was hoping for a miracle. There seems to be no other family around and I wondered how the mother would manage when she died. It takes some time to starve to death. One morning I came and found her bed empty. I didn’t need to ask what happened. 

Bed 2 is a man who is paralyzed. I can’t remember if it was a fall or a mine cave-in. He has no feeling or movement below the rib cage. We try to turn him from side to side, but he is already getting bedsores. 

Bed 3 is a motorcycle taxi man who encountered armed assailants.  He said that they emptied a whole clip at him, but managed to only hit his shirt. He then scuffled with one man trying to grab the weapon, but he managed to get shot at point blank range in the thigh.  The bullet shattered his proximal femur but spared the major blood vessels and nerves. We had just enough bone left to put an external fixator on him.  I think it will eventually heal, but it will be a long time. These armed attacks are getting more frequent and alarming. It was a pretty riveting story and he had us entranced. Better than a movie, we all agreed. 

Bed 4 is a young girl who was a motorcycle passenger. It sound like they got clipped by truck. The driver was ok, but she has an open fracture of the tibia/fibula, a complex fracture of the femur and a gaping open wound which goes into the knee. She also happens to be pregnant. So far the fetus seems to be doing ok. 

Bed 6 is an old man who was hit by a motorcycle. He has a open fracture of the tibia and a smashed jaw. He has been confused since the accident. We don’t know if it’s from a head injury or (more likely) from alcohol withdrawal. 

Bed 7 was a moto vs. moto.  He managed to smash in his face. I did my best to elevate the bridge of the nose. This was a disturbing procedure. I pulled his nose out, far enough to make him Congolese, but stopped before if gave him a European nose. I’m not sure what to do about the potato chip fragments of his forehead and frontal sinus. It’s fortunate he did not give himself a frontal lobotomy. 

Bed 8 is another disaster. She was operated on at another facility, where they managed to cut both her ureters.  She came here after two weeks on not passing urine. Her abdomen was full of urine. I operated today and all I could manage to do was to put tubes in he ureters. If she survives I will have to figure out what to do next.  The problem around here seems to be related to too many people doing surgery in poor conditions. This simply should not have happened, and it should have been recognized long before. 

Bed 9 is an army officer who was shot. He came in with a gangrenous foot and there was nothing to do but remove the leg.  He was heading down the road of sepsis, but I think he will make it. 

Bed 10 is an older lady with a thyroid cancer. She had tolerated this slowly growing mass for years before coming in.  It finally reached the point where she couldn’t breath. It was a difficult case and I managed to peel her thyroid gland off of her trachea. It was a palliative operation, at best. If she can breath and eat, I will consider it a success. 

In the hallway is a 15 year old boy who was sucking on the end of a pen.  Somehow he managed to aspirate the little plastic plug of the pen down his trachea. These are really tough cases.  I have a flexible scope that is small enough to get down the trachea. I have a few precious instruments that I can use to snag a foreign body, like throwing a lasso around the neck of a cow.  Manipulating the scope is like trying to control a piece of cooked spaghetti. After a nerve-wracking hour of trying to fish it out, I finally got a snare to slip around it, tightened up and pulled it out.  I am pretty sure that we are the only hospital in eastern Congo that could perform this procedure. The plastic piece was deep in his airway, blocking his right lung. If we hadn’t gotten it out, he probably would have died.  What a stupid think to die from!  Could you ever imagine that sucking on a pen could be lethal?  

I won’t go into more details about the man with the pancreatic pseudocyst, the three old men with prostrate problems, the four paralyzed men, the 5 year old girl with a broken neck or all the other fractures.  

Most of my work is a result of what humans do to themselves or others.  Without motorcycles, mines and machine guns, I’d have very little to do.  On one level I think I shouldn’t complain. Human error means job-security for me.  On the other hand it gets tiring to see the same injuries over and over again.  I find that my level of compassion gets exhausted and all I have left is the sense of profound annoyance and the sheer will that it takes to cobble together some solution to fix what is broken. 

There are bright spots.  Despite the annoyance, it was a tremendous feeling of accomplishment to fish out that little plastic plug.  It is encouraging to see my Congolese colleagues performing procedures that they had not previously mastered. I do still enjoy operating, but it is even more gratifying when I can walk into the room and Charles or Faustin tell me they can handle it.  There are rewards when a patient smiles for the first time, a mother expresses gratitude or a patient who was smashed up walks out of the hospital.  This past week an old man stopped me as I was rushing to finish rounds.  He told me I had operated on him a couple of months ago.  I could not for the life of me remember the case, but he was thankful and proudly presented me with a sack of peanuts, 4 eggs and a live chicken. Despite everything, at that moment, it all seemed worth it, and I felt the assurance that I truly have the best job in the world. 

Please pray for:

  1. Security in this difficult part of the world
  2. Patience as we train Congolese doctors
  3. Comfort and peace for patients who suffer more than we could imagine 
  4. Wisdom as we strive to be good parents and role models for our son Emmanuel
  5. Grace as we deal with various challenges in the missionary community. 


Monday, April 9, 2018

A beautiful night

April 9, 2018
Any guesses on how this was taken?

It was a beautiful night.  The sky was clear and the colors vibrant, especially green.  The guinea fowl were running, and I was too.  Narrow footpaths, muddy from a morning’s rain shower.  I followed wet tracks from a recent vehicle.  Some days the scenery is enough to distract me from the pain and breathlessness of of running.  I bought eggs on my way back and thought better of continuing to run.  What happens to eggs in the shell when you run with them?  I wasn’t willing to find out. I did a double-take as I crossed the road for the final ascent.   A Congolese man dressed in a red suit jacked, bright turquoise pants, and a yellow tie raced by on a motorcycle. He was wearing ALL the emboldened colors of the Congolese flag, no shame.  I wondered where he was coming from and where was he going.  I greeted friends on my way up the hill, turning to view the sunset, and stumbled home.  I spoke Swahili naturally and didn’t wonder if they understood me.  It felt good.

I have developed different routines living in central Africa.   I really need to be outside when the sun is setting.  I am not sure why, but I gravitate outside at sunset.  Somehow it marks the passage of time.  Birds also mark the passage of time.  I know exactly what time it is because particular birds sing and our parrot starts imitating EVERYTHING he hears!  It is literally a cacophony of sound around 4pm.

After dinner tonight we sat outside to enjoy the stars.  I smiled as Warren was explaining to Emmanuel how God loves us so much and gives us things to enjoy like “chickens, parrots, cats, dudus (bugs)….”  Emmanuel piped in about spiders.  It is fun to hear his ideas and participation in conversations.

Malaria season is upon us as the rains begin.  It is always a wild ride as we enter into May-August!  I was enjoying the peace and calm of this past month and ease back into clinical work again.  I think we are crash landing again.

I would ask you to pray for a very special girl with advancing kidney disease.  I found her in the ICU this morning having seizures and struggling to breathe.  After about an hour of stabilizing her blood pressure and seizures with about 6 drugs, I was able to walk away from her bedside.  Then about two hours later she woke up and asked for her “muzungu doctor” white doctor.  She was concerned about evil spirits.  She was in a deep sleep when I came to her bedside, but she seemed to acknowledge my presence.  I am looking forward to talking with her again and pray that she can turn a corner and we can figure out where the seizures are coming from.

Our lives in the village are full and fulfilling.  We are thankful to be able to share this cross-cultural  life with a growing little boy. It is amazing to hear him speak French and even some Swahili and negotiate Congolese social norms!  The local preschool has been a great way to make friends and integrate. 

Continue to pray for the refugee situation in the Bunia area.  It appears to be slowing down and people are returning to their villages.  We have heard about the growing problems with malnutrition among children in the refugee camp.   It feels like a very fluid situation from a political and security standpoint in this part of the country.  Yet we feel safe and called to continue in our daily hospital work.

Pray for us as we continue to minister to needy people with the incarnate message of the Gospel.

Pray for us as we raise our little boy and teach him that God loves us.

Pray for necessary fundraising for our nutrition programs.  We would like to branch out into more agricultural programming as well.

For the Coopers,

Easter Sunday Missionary Kid Stealth Egg Hunt

Slip and Slide!

Making rice crispy egg nests
Sunrise service

Sunday, March 18, 2018

Back to Nyankunde Life Again

March 18, 2018
Waiting to cross the Semliki River from Uganda to DRC

Refugee camp in Bunia with >100,000 people
We are back in Eastern Congo from our three month home leave.  We had quite the eventful trip back to Congo from Switzerland, totally 5 days, 4missed flights, 4 countries, layovers, Turkish baths….finally arriving to the Semliki River where we crossed into DRC where we collapsed under a tree awaiting our final flight into our village.  Warren said this was a great adventure, whereas I might have said a major inconvenience.  Anytime we had to transfer flights we missed our connection due to bad weather in Europe.  All in all we were taken care of, beds to sleep in, and the means to travel.  It is good to be back and in some ways feels like we never left.

For those of you following the news there have been recent problems in our Ituri Province resulting in many refugees pouring into the city of Bunia and over the border into western Uganda.  Villages have been burned and populations have fled certain areas.  There is a lot of confusion about why this is happening, ethnic and otherwise.  I will refer you to some recent new articles from the New York Times showing these areas:

We visited a camp for internally displaced people in Bunia which contained >100,000 people, from these areas mentioned.  Food has been scarce and our MAF teammates have been helping with food provisions.  Have you ever cooked for thousands of people on charcoal?  We visited the camp briefly and were met with a lot of blank looks and people standing around, some with tarps about a tent-like structure others with only the skeleton of a structure.  It is not an easy situation and we pray that things stabilize soon without any further destruction.  We feel safe where we are currently and are staying informed about security of the area on a daily basis. 

Perhaps due to all of this our hospital census has been extremely low.  I think the pediatric service has about 10 patients!  I suppose this gives me time to do administrative and home-related things, Swahili learning.  This may be a first! 

Emmanuel has enjoyed being in his home again, sleeping in his bed, holding his parrot, going to school, being with his nanny Maziga who he affectionately calls “ My Ziga” and playing with his friends.Yesterday we had fun on the slip and slide with our friends from Isiro.  Emmanuel advanced in his English during our time in the US and is not speaking a lot of French, but this will come back in no time.  We struggled with routines and discipline with all our traveling and changes, but things seem to be settling down again. 
Emmanuel and Miriam

Slip and Slide time

Rainy season has started and everything is becoming green again!  This is my favorite season of the year…it is just so beautiful! 

Back to cooking from scratch, pasteurizing milk, roasting coffee and peanuts, walking to the hospital, sandals, lots of bugs, and hills to sweat going up.  I have started running again which is always very humbling.  Life is beautiful in its simplicity, but other things are more complicated like official documents, official mail, planting a garden by hand, etc…I am very thankful for all the everyday help we have with cooking/shopping/cleaning.  It makes it possible for us to work here and minister to others.

We just wanted to keep you posted on our whereabouts and let you know that we are doing fine.  Keep us and the people of Eastern Congo in your prayers.  Pray for security and that the current conflicts will stop.  Pray for our hospital to have a strong witness for Jesus in this needy place.

Lindsey for the Coopers