Wednesday, March 25, 2015

Momma Back to Work

March 2015

Back to Work

This Momma is back to work!  It feels good, even refreshing, to be working again, speaking Swahili, and using my medical knowledge.  I feel renewed to try new things and have had some time to think about improvements to the pediatrics service.

Some weeks the diversity of the practice of medicine here astounds me.  As a pediatrician you manage things that children would see specialists for in the US.  I use my clinical knowledge much more than any lab test….but isn’t that how it should be? Last week I diagnosed a 3month-old baby with congenital syphilis.  I see contagious diseases like tuberculosis, meningitis, and whooping cough, even diphtheria regularly.  There are always cases of malaria, intestinal parasites, schistosomiasis, pneumonias, osteomyelitis, and new cases of HIV.  I take pictures of unusual rashes.  I am not sure why children get pancreatitis here and are left with pseudocysts.  I follow our kids in the malnutrition program very closely as their conditions can change rapidly.  Most days I go home with several clinical questions to look up.  My question of the day is, how does one diagnoses tubercular osteomyelitis (infection of the bone) in this setting?  It is not as simple as obtaining a specimen for pathology, rather a clinical decision.  Medicine is humbling and often rewarding.

I recently started two children with HIV on anti-retroviral (ARVs) medications, a first for Nyankunde Hospital.  We seem to be doing HIV counseling on a weekly basis of late.  It is my hope that we can get these children feeling better, gaining weight, and resolve of their infections with the help of ARVs.  It is an unfortunate reality and one I hope we can improve with public health measures over time, such as prenatal testing.

Being a mom is making me more sensitive to hospitalized babies and the worries of parents.  This last week Emmanuel has been fighting a viral infection with fevers making him feel miserable.  I have been giving him plenty of warm baths, Tylenol, and lots of love.  Parents everywhere want their children to feel well, eat and sleep and not suffer from fever.  I am constantly reminded to care for others with the same compassion I would want someone to show my son.

Emmanuel loves his new nanny Maziga and really looks for her to feed him in the morning.  I taught   I realized when I went to explain that a baby monitor was like a kind of telephone…that maybe I had given her information overload.  She seems very comfortable in our home and enjoys singing and playing with our little boy in her language.  This means so much to me.  There are so many things that transcend culture and love for children is one of them.  It is fun to see Emmanuel’s face light up when I get home.  Most days I work about 5hours, allowing me to follow the inpatient pediatrics service and see a few consults.
her how to light a gas stove, to sterilize dishes and bottles, to make baby food, how to use safety devices such as seatbelts, etc.

Rainy Season Begins
Wet season is starting here in Congo.  We woke up last week to the sound of thunder and the sudden crack of a cedar tree branch falling on the road just outside.  It took the better part of three days for our garden staff to cut the branches and store the wood.  It gave us pause to consider how powerful the wind can be!  Wind seems immaterial, but can cause major alterations in the natural landscape!  It is interesting that Scripture talks about the Holy Spirit coming with the sound of a mighty wind, without shape or form, but in power.  Just as quickly as the wind comes, it also goes away.  Like the wind the Holy Spirit has incredible power to change both us and those around us.  In an instant God can show up and transform things drastically.  I love that God is totally in control of our lives and the physical world.  Storms are a reminder of God’s sovereignty. 

Looking at the Malnutrition Program
Many people have shown interest in our ongoing work and support of the hospital malnutrition  For those of you who have supported this work, “THANK YOU SO MUCH!”  This past year we have seen >50% increase in the number of admissions (about 150 in 2014), an older population of children being served, yet still a high mortality rate (12%).  Samaritan’s Purse has been able to refer many children to our hospital for care and follow-up with families in their homes.  I know that many children’s lives have been saved on re-admissions.  I am thankful to have had this partnership.  We have a long ways to go!
Inpatient Nutrition Program

Some children come in critically ill, many irreversibly.  Malnourishment affects children’s abilities to respond to vaccines and many get diseases they should have immunity against.  I struggle to read about the “anti-vaccine revolution” in the United States when I see the realities of these diseases in the vulnerable population here.  There is so much meningitis here that leads to hydrocephalous.  It is sad.  We have less meningitis in the US due to the H. flu and Pneumovax vaccines.  An outbreak of measles would be fatal to so many in this at-risk malnourished population.  Diphtheria is such a scary disease.  One case of tetanus is one case too many.  I couldn’t imagine living here without my child having the basic vaccines, as the exposures are great.      

We are trying to improve the supplemental nutrition received by our children after discharge from the  Children receive a ration of corn and soy flour on a weekly basis.  People will often walk many kilometers for this small ration.  It is our hope to keep these children out of the hospital and to be able to identify those who are sickest and re-hospitalize them. 

It feels like an uphill climb as we seek to improve the overall nutritional status of this at-risk population.  I am reminded that even as we climb this cliff, there is respite on small ledges.  The poor will always be among us, but it really is a testimony to Jesus as we care for the poorest of the poor.  We hope that families are receiving spiritual nourishment and hope to continue.  I know that the causes of malnutrition are deep and are rooted in the breakdown of the family.  We serve a population affected by displacement by war and insecurity, where many fathers are non-existent and women raise their children with the help of their extended families.  Without a head of household to prepare the fields for planting and to assist in harvest, many families fall onto hard times.  We want people to feel supported and cared for by their hospital family. 

The “Lent Project”

A great resource for Lent is an online devotional called the “Lent Project” from Biola University.  I recommend checking it out.  The webpage is found at:  I enjoy the posts everyday, and really enjoyed a recent post about the women disciples.  Often we neglect to discuss the many women who followed Jesus and showed him hospitality.  Many of these women followed him to the cross and cared for his physical needs both before and after death.  I really like the meditation from March 15th:

A Day in the Life of Warren

So...what did you do today?

Today, I got up to discover that the power was out last night. We have the luxury of fairly consistent solar power, but the rainy season has begun and the sun has not been making an appearance. No photons in, no electrons out. That is the economics of solar power.

I did a little tour of the gardens. The tomatoes have been planted. If we can keep the goats out we might have a chance. The cucumbers are coming along. The cabbages are failing miserably.  My coffee plantation (23 bushes) shows promise. They are flowering and looking healthy. Not sure we will ever get consumable coffee, but these little projects keep me from being bored.

Feed the dog, put out the cat before Lindsey gets up. We aren't "cat-people" and Lindsey is allergic, but without a cat we have mice.  Then it's time to get Emmanuel up and dressed. He is a happy guy in the morning and it lights up my day to see him smile and laugh. Lindsey gets up and we share coffee and a time of reading and prayer before we leave. By this time Maziga has arrived. This is Emmanuel's nanny.  He is always excited to see her.

I arrive at the hospital to be confronted by the director of the nursing school who is wondering if I might have forgotten that I had committed to give a lecture to the nursing students about endoscopy. Oops!  It might have slipped my mind. Luckily, I am able to give this lecture with no preparation. Despite my lack of preparedness, it went fairly well.

I was hoping to round today, but never quite got  Fortunately I have a pretty good team covering surgery and they can let me know if there are any critical cases. I stop in the ICU to see a few cases and then I go to the OR. The first case is a boy with osteomyelitis (a chronic infection of the bone). He needs an operation called a "sequestectomy". I scrub in for the critical part, and then see a few outpatients. This is how my days go. I run back and forth between the OR and my office. I am always in a hurry, always two steps behind.
around to it.

I see a boy with a painful hip, probably TB. I see a man with a rectal cancer. He needs a big operation. I see a child with a big abdominal tumor. I was supposed to operate on him a month ago, but he disappeared. The tumor is, predictably, larger. It is unlikely that we will be able to cure him with surgery, but we need to at least try.

I run back to the operating room. I amputate a person's hand. It was turning black, possibly a complication of a treatment at another hospital. My Congolese colleagues are doing a hernia in the other room. The clock on the wall has stopped, but I know that time is ticking away. No lunch, but I am revived by a cup of black coffee and some "glucose biscuits".

I see more patients. Several of them have advanced cancers. Two of the liver and one poor skeletal woman with cervical cancer. It has already spread. I am sick of cancer, sick of telling people that they are going to die. I try to explain things simply and clearly. We talk about spiritual matters, end-of-life stuff. It is always a tough conversation. Strangely enough, people always thank me for being honest with them. Thanks for what?  They news that you are going to die?  Death is no stranger here and people accept it. Maybe they just don't get it. We pray together and they leave.

I run to the ICU to see a boy whose head was hit by a falling tree branch. I operated on him yesterday to remove a blood clot which was compressing his brain. He is still in a coma. Will he make it?  Hard to say. I see a lady whom I operated on yesterday. She was an obstetrical disaster. She had a vesicovaginal fistula and a rectovaginal fistula. I operated on her to repair her colostomy and to deal with the urine leak. It was a tough operation. She is in pain, but there seems to be no leak for the moment.

I run back to the OR to stick a drain in a man with a chronic infection of the kidney. He has seen all the traditional healers, and his flank is marred by the tiny cuts that they make. I tell the OR staff that I do the same thing. I just make a deeper cut. He will need this kidney removed, but for the moment I need to drain the half-liter of pus that is trapped in his kidney.

More outpatients.  A kid with hydrocephalus. He needs surgery but I am all out of the tubes that we use to shunt he fluid from the brain to the abdomen. It seems like every patient is a disaster of one sort or another. Where are the nice simple cases?  I try to stop between cases to do a little teaching with the junior resident.

I leave without seeing all the cases. Some of them can wait. The work is never done, and at some point I just have to go home.

I rush home to write a few emails. I am way behind. People who sit at their computers sometimes don't understand the delay, but I'm kind of busy during the day.

I have a little time with Emmanuel. We take a family walk. The soccer game is finishing up and there is chaos on the road. Everyone stops to marvel at a chubby, white baby with deep blue eyes. He is a mystery and a source of much discussion.

The evening passes peacefully. Dinner with a friend, dishes, some bonding time with the dog. There are a few calls to make. Then it's time for bed.

Lindsey kept asking me if I was ok. I am ok, I think. It's just that we see a lot of misery. It takes a toll. It weighs upon the soul. Still, I can't think of anything that I would rather be doing. I guess that is something like job satisfaction. I never come home wondering what I'm doing with my life.

Our Prayer Requests

1) Pray for Warren as he is dealing with some really difficult orthopedics and general surgical cases.  The work weighs on the soul.  Today he told four patients that they had terminal, inoperable cancer.

2) Pray for the upcoming arrival of the post-residents, the Dr. Patrick & Anna LaRochelle and their family and Dr. Michelle Doran.  Pray also for the work being done to rehabilitate a duplex for their arrival.

3) Pray that we would be able to identify another source of therapeutic milk for our nutrition program.  We anticipate the supply to run out by September.

4) Pray for the fields to produce a great harvest to feed the local population.

5) Pray that the Lord would be glorified in our work and give us strength, hope, and daily bread.

Blessings to all of you,

Lindsey, Warren, and Emmanuel