Sunday, June 22, 2014

June greetings from Nyankunde

June 22, 2014
Pregnancy Progresses

June is coming to a close and I am one month closer to giving birth, now 32weeks gestation.  With each passing day the baby seems to be getting bigger and stronger and making its’ presence known.  It’s amazing the little things you can know about a baby before birth, like their sensitivity to noise.  I spend my mornings rounding on kids in the hospital and any time a child cries, the little one in my womb turns and kicks.  It seems more aware of its’ surroundings.  When I am quiet, the baby is the most active…but on busy days the womb is quieter. 
Do you see the hand?

I am thankful for this pregnancy period and the time to prepare for this major life change.  This past week I painted the nursery on my day off…not sure if this is nesting behavior or not.  We have the benefit of having inherited many baby items.  Decorating the nursery will take some creativity.  We were able to bring many baby items with us to Congo 2 years ago such as a stroller, crib, changing table, rocking chair, mobile, clothing/bedding, etc.  At the time it seemed like advance planning, but now I am very thankful to have these items.  We are having a mahogany cradle made by a charming gentleman in our village named Machine.  Warren and I have been thinking about how fun it would be to design and make wooden toys…so stay tuned for this possible side hobby.

I find myself wondering more and more what this little one will be like, look like, etc.  I am looking forward to the coming chapter of motherhood and less clinical duties. 

Clinical Challenges
Speaking of clinical duties/challenges, these past few weeks I have been caring for two children with
A special patient following treatment for a jaw tumor
varied degrees of right heart failure from malformed heart valves.  Patients that would normally be referred to a specialist in the US and require expensive tests (cardiac catheterization, MRIs, echos) simply walk in the door here.  They usually come with incomplete records, an obscure history, and a complete ignorance of what medications they have been on….a table rasa.  Over the past 1.5years, I find myself doing cardiac echos on a weekly basis and slowly but surely improving my skills at performing and interpreting this test. 

Two weeks ago, a young girl came in with a large heart, dizziness, and shortness of breath.  I immediately did an echocardiogram, confirmed that she was in cardiac tamponade and needed a drain to be placed immediately to drain this fluid.  Her heart anatomy was so distorted that I could barely find her left ventricle.  She had such a large fluid accumulation around her heart (a pericardial effusion) that it was causing severe cardiac dysfunction.  With Warren’s help, I placed my first pericardial drain.  Her breathing improved immediately and she felt better.  Over the last 2 weeks we have been trying to better characterize her valve problem and manage her heart failure.  Our hospital is the closest referral center from their home 150km away, so it looks like I will be her long-standing “fill-in cardiologist.”  At what point do I send her home, knowing the risks of this fluid accumulating around her heart again?    What guidance for home do I give? I can confidently say is that she cannot carry 25L jerry cans of water on her head anymore!  I can also give practical dietary advice for avoiding anemia and to come to a hospital not a health center when she is sick with fever.  This is just a sample of one of the complex patients I am faced with everyday. 

A quick story from our malnutrition program here at Nyankunde.  About 2.5months ago a mother and
The twins, their mother and grandmother
her twins were evacuated from their home by our Samaritan’s Purse team in a state of severe malnutrition.  The mother was so weak that she had to be carried to the road.  They have been recovering in the hospital for the last few months, the babies steadily gaining weight and learning how to eat solid foods.  The mother now has the strength to work again and the courage to try again.  It is difficult to understand how someone can become so severely malnourished, but we are grateful that they are recovering.  The real work begins now as they return home to farm the fields and rebuild their lives.  It is very difficult for women to make it in this culture without a male head of household.  It seems that so much of the poverty we see is related to the lack of social support in the nuclear family.  Pray for this family as they return to their home.
Nurse Bora, twins and their family, and Rachel a maternal/child health expert with Samaritan's Purse

The nutritional program continues to expand.  We have an average of 16-20 patients at any given
Our stock of F100 and F75
time.  Just keeping up with the hours of food preparation and distribution is a full-time job.  I am realizing what a unique opportunity it is to build a rapport with these mothers and minister to their spiritual needs.

Prayer Requests
1)   Strength and rest for this last trimester of pregnancy. 
2)   For renewal in the church and family, for men to rise up as leaders of their households.
3)   For Lindsey as she wants to minister to the spiritual needs of mothers and children in the malnutrition program.  The needs are endless, but God can provide for their needs and we are part of that.
4)   It is mango season here in Congo, please pray for less injuries and an awareness of the dangers of tree climbing.

A special visitor to our home, Ed Densham

From Warren

Yes, pregnancy has been hard on me too.  The mood swings, the cravings, the fatigue and general irritability!  I've experienced it all.  I've been eating plenty of cookies in order to sympathize with the weight gain.  In a short while it will all be over and life will be back to normal again!  At least this is what I tell myself.  I suspect the reality will be somewhat different.  Fortunately for me the gender roles here in Congo are strict and well-defined.  The woman is pretty much expected to do all the work.  

Things are going well.  I continue to struggle with my series of surgical nightmares, but I promised myself I wouldn't mention any gory details.  Besides that I keep myself busy gardening, riding my motorcycle, running, and playing an addictive game on the Ipad called "Threes".  Let the reader beware, do NOT under ANY circumstances download this game.  Your life productivity will take a serious hit.  

Thanks for your interest and your prayers.  We appreciate it!

My little friend helped me to write this post!

Sunday, June 1, 2014

May Growing Pains

May 30, 2014
29weeks pregnant!

Greetings and blessings from DR Congo this beautiful month of May!  I have entitled this month's post "May Growing Pains" as I am now entering my third trimester and feeling quite pregnant.  We just celebrated our 4th year wedding anniversary and wonder at how quickly time passes.  Here we are about to become parents! 
Two in a Greek bathtub
Post-Resident Cohort 2013-2014

Returning to the Field
Warren and I returned from Greece about two weeks ago and are back at the hospital.  We had a wonderful time re-connecting with colleagues and friends at the Christian Medical and Dental Conference.  It is fun to see my post-resident friends...all of us glad to be away from the field for a while and some of us trying to put on some needed weight (those living in Niger, not to name any names).

Our friends from Minnesota, Dr. Ron and Colleen .Johanssen

Re-adjustment is an interesting process.  Somehow one sees with fresh eyes the challenges/difficulties and joys.  I returned to a pediatric ward of about 70 patients, compared to about 45 when we departed.  There were many (18 to be precise) new patients in the malnutrition program and several diagnostic dilemmas.  The nurses have been working overtime to meet the increasing needs and the children were struggling to receive regular feedings.  I came one evening to see the number of patients and families sleeping on the floor and found both wards jammed full.  This is not really new, just increased from the past.  I have a couple of patients with advanced stages of HIV and families in various stages of acceptance/denial.  There were a couple of days when the poverty simply overwhelmed me, and I had to step back for perspective.  Being a doctor requires that you come very close to those who are suffering, but this requires a certain wisdom.  We need the wisdom to not take these burdens on ourselves, rather to give these burdens back to God.    

“Come to me, all you who are weary and heavy burdened, and I will give you rest.  Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls.  For my yoke is easy and my burden is light.”  Matthew 11:29-30

I think I memorized this passage as a child, but I did not really understand what a burden was at this age.  I am struck by the command to “come” to Him and “take” his yoke.  It does not say…”come to me if you will,” but rather you “come.”  We are promised rest, or perhaps peace of mind, even joy, in the middle of it all..

Once again, I am also struck by how communal our lives are here, in contrast to the independent
Juicing passionfruit on Sunday.  This represents 50cents worth of passion fruit!
lifestyle we get so used to in the United States.  I have really come to appreciate the help of our guys who help us with the garden and running of our household.  Laundry and cooking takes a fair amount of time and I do a lot of it in addition to my hospital work.  Going to the market and gardening also take time, as does procuring supplies.  Our workers are blessed in return with consistent employment and a way to support their families.  As this pregnancy progresses I am learning more and more to ask for help with things.

We find ourselves in a season of waiting for this baby to arrive and me entering the third trimester.  I am so thankful for a relatively uncomplicated pregnancy and the recent time we had in Europe.  I can say that this baby is very healthy and has had very normal organ development including heart, kidneys, liver, brain, etc.  It has been such a neat experience to watch development in real-time on ultrasound.  The baby was so active during our travels…especially with loud noises of planes on the tarmac and airplane turbulence.  The baby seemed to go right to sleep anytime I went swimming.  I now look pregnant and everyone asks about my health.  You have to really look pregnant before Congolese people will ask about the baby. 

We find ourselves so blessed with beautiful baby clothing inherited from our friends the Millers, much more than we could ever use ourselves.  Friends and family sent some really nice gifts to us while we were in Greece.  There is very little that we need.  We plan to have a bassinet, highchair, and rocking chair made out of local hardwood (probably mahogany) to add to our growing nursery.  We plan to have the baby here at Nyankunde with all the monitoring at our house, God willing.  I will have a Congolese midwife and my nursing friend Heather help me with labor.  We are trusting God with a safe delivery and entrance into the world.  We still can’t quite imagine ourselves as parents, but are really looking forward to the next chapter of raising a family together.  I am thankful for this period of waiting in wonder, as I know that God is transforming me into the mother I need to be. 

I am taking one day off per week to relax and prepare for the baby.  This entails some gardening, cooking, organizing, and catching up on correspondence.  I am trying to end my workdays by 2pm and eat regular meals.  It is a necessary discipline to slow down when you are pregnant.  I am not quite sure how my pregnant colleagues in residency managed this work/life balance.  My job can be emotionally taxing, so I am trying to do the necessary things and listen to my body.

Our future
Many of you know this, but we are planning to stay here at Nyankunde for another term beyond our initial 2-year commitment.  It is hard to believe it has already been 1.5years!  We are really hoping to have another surgeon here full-time and work towards becoming a surgical training site.  So many Congolese leave DRC for their surgical training, many from this area!  It would be wonderful to be able to train them close to their homes and keep them working in this needy part of the country.  We also have become quite a referral center for orthopedic trauma….we can always use a good orthopedic surgeon.  It’s the orthopedic cases that bring Warren home wiped out.

We are expecting two Samaritan’s Purse post-residents this upcoming year, an ob-gyn and internal medicine/pediatrics doctor and his family.  We look forward to our kids knowing each other and being playmates. 

We continue to appreciate your financial and prayerful support of our ministry here and for following our story.

Fragility of Life (by Warren)

To say that life is fragile is a cliche. Here in Congo, it is a cold, hard truth. Lately I've struggled to care for people whose lives have been overturned in a second.

They are mostly the victims of motorcycle accidents.  There is a certain country, whose name shall not be mentioned, which has flooded the market with cheap motorcycles.  People, mostly young males, ride these things very fast.  When they crash, as they frequently do, the aftermath is horrible.  I've had a run of fractures that I am struggling to deal with.  We have the ability to do internal fixation, but these are often very difficult cases.  It takes a toll on me and I find myself returning home exhausted.  Many of them have open fractures with horrible wounds.  Dealing within these injuries taxes us to the extreme.  They then have agonizingly long hospital stays and frequently can't/won't pay their bill.  It is interesting that they can often afford to buy a motorcycle, but can't afford to pay for repairing the damages. 

'Tis the season to fall out of mango trees.  Yes, folks, it's just beginning.  Right now the mangoes are low and easy to reach. With time, the better ones will be higher and higher.  At the end of the season it almost seems like more people than mangoes are falling from the trees.  The last one was a 12 year old kid who was high up in the tree.  He was throwing the mangoes down, but then he realized that other kids were taking the mangoes on the he ground.  He tried to come down quickly, which he did!  9.8 m/sec2.  He had a horrible fracture of his elbow, which required surgery.  We will have more and more of these injuries, and certainly some deaths as the season progresses. 

Other injuries are just too bizarre to imagine. We have a 7 year old boy who was playing football (soccer to most of you) and hit his head on the goalpost. There happened to be a nail sticking out of goalpost which poked through his skull into the brain.  He was initially conscious but over the course of a couple of days he lost consciousness and stopped moving one side of his body.  I took him to the OR and managed to drill a hole in his head (with absolutely none of the right instruments). I opened the dura mater, the covering of the brain and found a big collection of blood and pus. I drained it, and he seems to be doing better, but time will tell.  

Anyway, this is my life.  Sometimes it seems frustrating to spend so much time treating things that just seem stupid.  They could have been so easily avoided!  Still, this is the nature of human kind. We are prone to doing stupid things.  This means job security for me!

It also makes me think about the nature of our lives.  How frail we are!  We can make one wrong decision and everything can change!  

Our prayer requests for June:
1) Thanksgiving for an amazing pregnancy.  Strength and endurance for the third trimester and a healthy baby that stays head-down.
2) Our work with many new medical trainees rotating through Centre Medical Evangelique Nyankunde.
3) Wisdom and compassion for the many challenging medical cases we are faced with daily.
4) A full-term nutritionist for the malnutrition program to help with therapeutic milk distribution.  Wisdom as we seek to help the poorest of the poor in our area, empowering them to improve their lives.

Love and blessings,

Lindsey and Warren

I believe I can fly!