Friday, February 28, 2014

Big changes and Grace

Time is flying by.  I can't remember the last time I updated this blog. Seems like it is my turn (Warren).

So, what's new?  A whole lot!  The big news is that (drumroll please....) we're having a baby!  Even as I write these words, it seems surrealistic. Lindsey is due in August. What a mysterious process!  We have been following the progress with ultrasound and it is so amazing to watch this new life progress from tiny blob to a little creature with hands and feet!  Who knows how this happens, how the cells migrate, the organs develop, and the fantastic architecture of a human being develops?  Anyway, there are lots of changes ahead for both of us and we look forward to this grand new adventure. Lindsey is well into her second trimester and is developing a little bump.  She is starting to feel something like butterfly wings moving inside.  God has been so good to us and we have both been in excellent health. I had a little touch of morning sickness, but I'm ok now!

On a slightly similar note, we took the plunge and got a new puppy in Kampala.  It is a sister of our late beloved dog Peterson. Same mother and father. Her name is Rosie. I was going to go with something more ferocious, but Lindsey vetoed all my suggestions. Even at 2 months, you can see the instinct to guard her territory.  I think she will be a great family dog. We drove all the way back from Kampala with her. She even drove for a bit. 

We've had the luxury of having two other doctors here. Kimiko Sugimoto is a surgeon who actually grew up in Congo. She has been here for a month and has been a great help. We also have Laura Foudy, a family practitioner who has an interest in surgery. Having this help has allowed me to work on some other projects. This includes things like constructing a charcoal oven, planting trees, watering the garden, responding to some neglected email.  We were able to travel to Beni, and spend a couple of days working at the hospital there. 

We had a great time in Uganda. We spent several days at Mulago Hospital, observing cardiac echo for congenital heart disease. This was a chance to get some experience.  It was interesting to see how things work in large hospital in the big city. It made me so thankful for our situation in Nyankunde. Maybe we cannot do open-heart surgery, but I feel like we are doing what we can to help. Plus, Nyankunde is just so much more pleasant than Kampala. 

We spent a couple of days in Kampala, taking care of things. I had to go the US embassy to get my passport renewed.  We bought a lot of groceries. We also bought a lawn mower and a washing machine.  A lawn mower sounds like a luxury, but I really want our garden-keeper to focus on the garden.  It takes him about three days to cut the grass with a slasher. Now I can do it in 40 minutes, and it's therapeutic for me. 

None of this was especially relaxing, so we drove to Jinja and spent two days there. It was wonderful to just relax on the shores of the Nile, watch the birds, enjoy some nice food and appreciate how calm and peaceful our life is (but not for long). It wasn't exactly the "babymoon" but it is important for us to just escape the medical world for a bit. 

 We are well into our second year at Nyankunde. We really feel like we are home here. We feel like we are becoming part of the society here. We still have our share of cultural challenges, but we are making progress. The hospital has come a long way in this short time. This morning we had our weekly doctors' meeting. I looked around at the mix of foreign and national doctors, united in their desire to serve God by caring for the sick and suffering. I was so proud to be part of the process of medical education. I have been thrilled to see the ways that the hospital has progressed. I am excited to see these Congolese doctors advance in their care of complicated patients. Ten years ago this hospital was reduced to ruins. Today it is a beacon of care and training. Only God could do this, and it has been wonderful to be a part of it. We don't know if it will be possible to continue on with our present organization, but we feel like we have been called here and we are committed to this project. Lot of questions need to be answered and I'd be lying if I said I didn't have some anxiety, but we sincerely believe that God can work out all the details. 

Every day has it's share of little miracles, and we need to remind ourselves of that. One recent one was a 14 year old girl named Neema.  This word means "Grace" in Swahili.  She had stepped on a dirty tin can and cut her foot. She did the rounds of various care-givers and received the usual inadequate treatment. By the time we saw her she had a swollen right leg and she was in excruciating pain.  When I saw the patient, I did an ultrasound and discovered that she had a blood clot that was blocking her femoral vein. We started a heparin drip, but her condition was deteriorating rapidly. The next morning she was hypoxic and had a feeling of impending doom. This is a bad sign. We surmised that a part of the blood clot had broken off and traveled to her lungs; a pulmonary embolus. She was also having high fevers. What to do?  I found myself looking a girl who looked like she was about to die. I made the decision to amputate the leg. This is not the usual treatment of a blood clot, but I had the feeling that something else was going on in that leg. Few of you have had to amputate the leg of a 14 year old girl. It's a tough decision, especially when the leg itself doesn't look so bad.  It was just swollen. I was prepared for a tough conversation with the family.  Thankfully they realized the gravity of the situation and consented immediately. We took her to the OR and performed a very high amputation in order to stay above the clot. 

As I was closing the muscle, I asked Lindsey to open the vein and see what was there. She discovered that there was not only a huge blood clot, but that the femoral vein itself was full of pus. This pus had showered into her blood stream causing the sepsis.  The next couple of days were a bit rocky, but the fevers immediately resolved.  In another day she was off of oxygen and after about 10 days, she went home...minus one leg, but alive and healthy. 

There are lots of moving parts in a story like this one. First of all, how crazy to nearly die from stepping on a tin can!  A 14 year old girl usually does not get a blood clot.  Generally a high amputation is not the treatment of a clot, but there is absolutely no doubt in my mind that she would have died if we had not intervened as we did.  Without an ICU and a proper OR, we could have not have cared for this patient.  Without an ultrasound machine, we would have never even had made the diagnosis.  There were so many levels at which the story comes together, but I believe that every turn, God's grace was present.  "Neema".  Maybe this makes me a bad scientist, but when I look at the work we did and the people we treat, what I see is Grace, over and over again.  God heals people, but he lets us be a part of it, and it's exciting stuff.  

So, now we have a little girl with one leg.  The stump is probably too short to even fit her with a prosthetic limb.  She is maimed for life.  It is horrible and tragic, but it is also something of a miracle.  This is the paradox of the work we do.  I also know that God's grace will continue to work in her life.  

Thanks so much for being interested and for being a part of the work at Nyankunde. 

Warren (for the three of us...four if you count the dog)


  1. Ah! you guys are so awesome. Congrats on baby Cooper and Rosie Cooper! Both are in the most excellent of hands. Continuing to pray for your ministry and work and really enjoy keeping up with you! Thanks for sacrificing!

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    1. It is nice to read your news letter :) I miss you so much S2