Saturday, March 30, 2013

Three months in

The last couple of weeks has felt like a perpetual roller coaster.  We have had so many difficult cases.  There have been many deaths.  This kind of comes with the territory and the job, but it is still hard.  I keep asking myself whether I should have done something differently.  There are cases which just tear at your heartstrings.  You try and try and try.  They look like they might possibly make it, but at a certain point people just lose hope and dwindle away.  Somewhere along the way there is an invisible line, I think.  The art of medicine consists of doing everything you can before that line is crossed.  After the line, I think it is simply to help people die well.  I'm not sure I know how to do either of these things well.  

These disappointments are offset by the happy cases.  One of them is a 12 year old boy named Bulo, who took a bullet in the head.  He  lost a good chunk of his skull and he came to Nyankunde after more than a month in another hospital  He had a large amount of brain that was exposed, and pushed out like a hideous mushroom.  To make a long story short, we have nearly succeeded in closing his scalp and getting the brain back inside.  This kid is so incredibly brave that it makes me want to cry.  He is never without a smile.  He is learning how to make the left side of his body function again, and this is hard work.  When I think of the suffering he has undergone, I find it hard to comprehend how he could be so funny, so courageous and so positive.  The human spirit has a capacity for hope that is simply unfathomable.  Either that, or the bullet destroyed the negativity center of his brain.  

We alternate between these happy results and the many crushing defeats.  I think that in the end, the only way to make sense of it all is to believe that God has a mysterious plan and to count ourselves fortunate to be part of it.  We have to be willing to do everything we can possibly do, but then step back and let events take their course.  Medicine is a funny thing.  We seem to believe that our job is to never let anyone die.  The human mortality rate, last time I checked was somewhere around 100%.  Anyway, it certainly passes the time and staves off the boredom.  

In our spare time we have been developing a farm.  It was a garden, but I think we're a bit past that.  Actually what we've been doing is paying some workers to dig the soil and plant things.  Still, it is really cool to see these little plants push up through the soils and push towards heaven.  It is satisfying to imagine the bountiful harvest we will reap.  This is one of the great blessings of living in a place like this.  We are going to eat food which grows out of our own ground.  So far we have planted spinach, eggplant, beets, carrots, corn, watermelon, squash, lettuce, okra, cabbage, peanuts, corn, etc.  I really don't like half of these things, but I am looking forward to eating them.  Every morning I look at the little shoots and marvel at the progress.  

This next week we are going to take a little trip to Uganda.  We've been here for three months and we haven't had a day off.  I think it will be good to get a little change of scenery.  We are planning to visit Murchison falls, then drive to Kampala and then Jinja.  This is going to be a real adventure.  Travel by road in Africa can be a little tricky.  Anyway. we are looking forward to it.  

Thanks so much for your support, your love and your prayers.  We feel so blessed to be here, to work alongside the Congolese and to show love to people who have suffered so much.  It feels like a calling, and it makes all the stuff seem like it is worth it.

Warren (for both of us)

Tuesday, March 19, 2013

March: A Month of Firsts



March 18, 2012


Greetings from DR Congo.  Our hearts go out to one of the post-resident families, the Kelleys, whose youngest child went to heaven this past week due to a brain tumor.  Many people all over the world have heard their story and the way that they are trusting in the sovereignty of God over her life.  As I cried over the loss of a child here a nurse reminded me that "we are all voyagers in this life" and that our real home is to come.  Very true, still it is really hard to say goodbye.  

This week I am surpassing the longest period of time I have ever spent overseas at once.  Feels great.  We are thankful for health and the comfortable home we now live in.  One of the big events since my last posting is Warren’s installation of an outdoor bathtub overlooking the garden.  It is magnificent!  On a hot day (like today), one can simply fill it with cold water and bask in the sun.  Or an evening after a long hike, one can have a warm bath at sunset.  We are also happy to announce that our first garden has been planted.  We anticipate a grand harvest of corn, melons, tomatoes, peppers, lettuce, chard, peas, okra, etc in only a few months.  Tonight I planted a humble herb garden on the terrace outside the kitchen.  Stay tuned for photo postings of our garden as it grows.

The outdoor bathtub overlooking the garden

Lindsey's herb garden

Our garden


The theme so far in March has been “Lots of Firsts.”  

…the ICU
For the last three weeks we have been using the intensive care unit for post-operative care and closer monitoring of hospitalized patients.  All in all it has been working fairly well, although the idea of giving a medication (such as an anti-hypertensive medication) and watching the response is fairly new.  Often it is simply assumed that an intervention will work, but I believe our way of practicing is changing.  It is really helpful to observe patients you are more concerned about.  It’s funny….a clean, bright, new environment is not always what our patients want. One of our long-term patients who sustained gunshot wounds to the legs resulting in bilateral amputations, actually requested a private room in one of the old, rundown buildings.  We were all a little surprised, but quickly agreed.  Just because it is a nice environment for us to work in does not mean that our patients feel most at home in this environment.  I have been working with the nursing staff a lot regarding patient care and assessment; they are eager learners.

A little entertainment in his spare time
Warren and his patient


…on surgery
There are lots of firsts in this department.  The first-ever laproscopic surgery was done at Nyankunde last week.  In addition we are starting to get orthopedic referrals appropriate for the SIGN nail program.  SIGN is a program for low cost internal fixation of broken extremities.  We have had a series of difficult cases these last few weeks such as a young boy who sustained a gunshot wound to the head leaving his brain literally “hanging out” of the dura.  His brain is now “covered” and his wounds are healing and he remains surprisingly happy through it all.

Our first laparoscopic surgery


Our new anesthesia machine/monitors
…on anesthesia
Two anesthesia machines arrived two weeks ago and we have been using them daily.  The nursing staff has really learned quickly and is doing a fabulous job.  I have helped out with a few pediatric cases requiring general anesthesia and paralysis which has been fun.

…on malnutrition
Malnutrition is a big issues in this part of Congo.  I am told that malnutrition was much worse in the returnees after the war.  Being unable to farm a plot of land or lacking the support of a husband raises the incidence of childhood malnutrition tremendously.  I am seeing pellagra (vitamin B3 deficiency), rickets, zinc deficiency, and even what I believe to be scurvy (vitamin C deficiency).   I  have even seen a toddler with right heart failure from malnourishment.  I never learned about heart failure from energy deficit in medical school!  Children with malnutrition simply look too tired to eat.  It takes too much energy to play, or even to sit up.  In South Sudan I saw a young girl squat because it took too much energy to stand. I am trying to learn as much as I can to recognize these cases of malnutrition….and to see the signs of chronic anemia during regular admissions for as a sign of inadequate nutrition.  Pray for us, as we do not have the supplemental milk (F75 and F100) that we are accustomed to giving these children.  It was pillaged in unrest this late fall and there is not yet a good supply in this region.  We are grinding corn and soja and making high calorie porridge for the moment. 

…on pediatrics
I am making and treating many medical conditions that I have never seen in the States.  I am learning how to do echocardiograms...as we had a run of children with rheumatic heart disease.  I diagnosed a young girl with HIV and complications therein a couple of weeks ago.  Common things are common.  Malaria, bronchiolitis, pneumonia, viral gastroenteritis, malnutrition, amoeba, and of course sickle cell anemia-these are the most common diagnoses here.  Then there are rarer cases of diphtheria, hepatitis A, ocular changes (chorioretinitis) from toxoplasmosis, intussusception, and meningitis. 

…prayer requests
1) Praise for God’s faithfulness to Nyankunde Hospital over the years and the dedication of the staff to provide quality care, despite shortages of resources.  We have been able to provide much needed spiritual care and counsel to patients.  We are thankful for the many new procedures and endoscopy now available in this part of the country.  It is exciting to be part of these changes.

2) Feeding program for malnourished children-We are using alternatives for our refeeding program-that of corn and soja.  This orients families to a home regimen, but I am not sure it is the best for severely malnourished children who need energy dense food.

3) A hospital demonstration garden-We would love to see this created to benefit malnourished children and families in need.  There is such a need in this area to teach farming practices and cultivation of particular foods.  There is a Samaritan’s Purse team here doing agricultural projects for the next 1-2years and this may be a real possibility.

4) Financial stability of this Nyankunde Hospital-This truly is a Congolese mission hospital serving a very poor population in the name of Jesus.  Our staff is Congolese, many of whom returned after the war to rebuild their lives and at great sacrifice to themselves.  Our staff is not fully paid due to financial difficulties of the hospital and this is a hardship.  We are hoping that the expanding surgical program will improve the financial status of the hospital.  Warren has had many ideas in this realm.  This is a critical time for the hospital to strategize on how to really make this hospital self-sustaining. 

5) Medications for the patients-We are out of many medications/antibiotics and many other drugs.  I have carried an independent supply of Ceftriaxone in my bag now for the past two weeks.  Pray for wise logistics and the ability to get needed medications.

6) Language learning-We are working and communicating in French on a daily basis.  We are taking Swahili lessons together weekly.  I am often able to understand the general context of medical Swahili…so it is coming along.


Thanks for your friendship and support.  It is an honor to be serving here. 


Blessings,

Lindsey and Warren (and Josh too)





Evening game of croquet with Soborabo