Sunday, April 26, 2015

Circumstances force us to spend some time apart...

April 27, 2015

From Warren

 I am writing this from Entebbe airport, in Uganda. On Saturday I received an email asking whether or not I would be willing and available to travel to Nepal to assist with the earthquake relief efforts. Now, here I am, waiting for a flight which will take me to Doha tonight and then to Kathmandu tomorrow. 

I have been in Kathmandu a number of times and it is disturbing to see the images of devastation. Having seen the aftermath of the earthquakes in Pakistan and Haiti, I have an idea of what to expect, but there is really no way to prepare yourself. 

I have no idea where I will be working, or precisely what I will be doing. I only wish to help in whatever way I can. 

Please pray for me as I continue my journey and start working. Pray for Lindsey and Emmanuel as they stay behind at Nyankunde. There was a time when I would be very excited about such an opportunity, but I have to confess that I would rather stay at home with my family, carrying out the demanding work at Nyankunde Hospital. There are times, however, when I am needed elsewhere, and this is one of those times. 

The rest is from Lindsey

April 25, 2015








For the first time this week we were able to see our village from the air!  We welcomed a communications team from Samaritan's Purse (SP) who did some interviews and videoing of active SP projects in the area.  They took aerial shots with a drone which attracted all the neighborhood children.  Emmanuel was fascinated to watch its' flashing lights go higher and higher and finally pass out of sight.  He seemed a bit more intimidated as the drone descended coming towards him.  It is the first time I remember seeing him "cling" to me in fear.  We were happy to share our lives a bit with the communications team and pray that they will find  a story to tell here.

I have been archiving topics in my mind to blog about this past week, some medical and others non-medical.  The first is that of fuel economy.

On Fuel Economy

Did you ever stop to think about the cost to bake bread versus make chapatis/tortillas?  What goes into it?  An oven is an unusual resource here and something most people don't have.  Ovens are costly to run whether by gas, charcoal, or wood.  Imagine if everything you cooked depended on your ability to find enough wood to cook with, not just for fun like a bonfire, but seriously cooking every meal this way?  Would you burn all your wood to bake bread?  What if you had to hike up and down a steep hill to harvest this wood everyday?  I can tell you that I would probably not cook more than once/day and I would not be baking bread very often!

 It is much less expensive to use a burner to prepare a flat bread like chapatis.  This is much of the world's bread, probably for all these reasons.  People here choose the type of bean they prepare based on fuel economy (what cooks fastest).  By the way, white beans cook the fastest).  I now think about the cost of the foods I am preparing, but I am able to afford to operate an oven and a gas stove.  I have enjoyed reading the introduction of the cookbook "More with Less" that discusses the responsible use of food resources.  I recommend it as a great take-off point for cooking from scratch.

On Contagious Diseases

This week I have helped to care for a boy with probably Hepatitis A and a malnourished child with likely pertussis.  I am exposed to a host of diseases daily.  I am grateful to have some level of immunity for most of these diseases.  I do my best to wash my hands and even change my clothing when I come home to care for Emmanuel. I believe in vaccinating children and I really want my little boy to be healthy.  I struggle to understand the vaccine debacle in the United States.  It seems like a "luxury" almost to choose to vaccinate or not vaccinate.  This can't be a positive thing in the bigger social picture for those at higher risk among us.  

A Typical Day for Lindsey

My day started getting Emmanuel ready for the day and giving instructions for vegetable preparation to one of our workers.  I then made my way down to the hospital.  On any given day there are on average 30-50 pediatric patients that I am responsible for.

I first visit a sweet 1year old boy in the ER who is dying from AIDS, so beautifully cared for by his mother for the past two months.  It is heartbreaking to see that no matter what we do, anti-retrovirals, antibiotics, therapeutic milk, etc he just was too sick to come back.  I organize a care conference to talk about his condition and recommend the family to return home.  We pray together and the mother shares some deep concerns on her heart.  I have never seen such devotion by a parent in the hospital.  I am grateful for the time they have had and the healing they have experienced as a family.

My next patient is an 8mo with tetanus.  The nurses rightfully noticed that the child had less "contractions" in the calm of the night.  I talk the family into a feeding tube and know the child will lose vascular access soon.

A few other kids with malaria and the like and I am off the the regular pediatric wards.  I pass by hoards of people and children sitting and talking outside the pediatrics ward.  Many onlookers are eating morning beans and rice.

Where is our 1year old with miliary tuberculosis and complications of pneumonia?  It seems the mother has left the hospital to care for her other children as the father, a military man, is called out to the field.  I inform the health center so that they can search for her.

I see a 9year old girl with a nephrotic syndrome, still in need of high dose steroids and not tolerating an outpatient drug taper.  I don't think her kidney function is completely normally so I limit her water intake, place her on diuretics and steroids, and tell her to keep her urine over 24hours.  The lab tells me they can do a creatinine so this is helpful.

I see the other children with malnutrition...one little boy has been waiting >1 week for a transfusion with a hemoglobin of 5 (normal >12).  He looks so unwell with his big belly (ascites) and swollen extremities.  I can't wait anymore and make plans to donate blood later in the afternoon.

I see another 1year old with his first sickle cell crisis and meet with the family about how to best care for him.  We try to explain the genetics of this disease and write a prescription for long-acting monthly penicillin.  We discuss how to avoid anemia (not contract malaria and parasite) and which foods are high in iron content.

There are two children with hydrocephalous, one also has spina bifida with a spinal fluid leak from the back mass.  We discuss how surgery is a major stress to the body and how the child needs better nutrition and to be cleared of his current infection.

I make a trip to the health center to discuss two tuberculosis patients and their outpatient follow-up and to report the case of tetanus.

Then I go back to the ER to discharge a patient and I see a new mother who just gave birth with likely severe eclampsia.  She is unable to see anything and is very confused.  It is 1pm and it is time for me to get back to take care of Emmanuel.  The patient with an abdominal tumor will have to wait until tomorrow.

Three hours later I am back to give blood and look at the peripheral blood smear of a patient with suspected lymphoma.  I think I can confirm the presence of lymphoblasts.  The family will go home on palliative care as chemotherapy and advanced diagnostics are not available.  I will have that discussion tomorrow.

This is a typical day.  I am a western pediatrician working on the equator in a country where people are surviving day by day and wanting the best for their children.  As a mother now I feel things more deeply.

Pray for:

1) The injured and missing in Nepal following the recent earthquake.  Pray for Warren's safe journey to Kathmandu and that he would be a blessing and help to many in his care.  Pray for Emmanuel and I in Warren's absence as we continue on here in Congo.  He will be in Nepal for 3 weeks.

2) Pray for the ministry of Nyankunde Hospital, that we would declare the Gospel boldly as we should.


Love and blessings,


Lindsey, Warren, and Emmanuel
Never too young to start!