Saturday, May 28, 2016

MPEC

MPEC (pronounced "empeck") is an acronym that I've come to know and fear.  It stands for "Meilleur prise en charge" (better care).  This is the most common reason for transfer to Nyankunde from another hospital.  What MPEC means is basically that the referring physicians have no idea what to do, that they've performed a number of detrimental operations and that they're afraid that the patient will die on them.  This week I've dealt with a number of MPEC cases.  A note to the squeamish; each of these cases involves stool leaking.  An alternative for you would be to skip the text and look at some of these nice, happy pictures.  

The first is a young healthy man who was shot.  The bullet went in one hip and out the other buttock.  It shattered his hip and blew a hole in his rectum.  This is a devastating injury and generally requires diversion (creation of a colostomy) to prevent further contamination.  This was not done and they patient underwent a "non-therapeutic" abdominal operation.  He came to us a week later.  We did a colostomy and drained the wounds.  We eventually ended up doing a very high amputation of the left leg.  He is septic, anemic and malnourished.  It's a bad combination.  He smells like rotting flesh.  We're doing the best we can, but I doubt he will survive.  

Patient two is a lady who underwent a c-section.  Unfortunately they left a surgical sponge in her.  A week later they figured it out and reoperated on her.  It's a bit unclear how, but they left her with three or four holes in her bowels.  She was sent here for MPEC.  We have operated on her once, but she's still leaking stool from the wound.  Her intestines are all stuck together, and the more you try to free things up, the more they tear.  

Another patient we treated this week had been operated on three times for an intestinal perforation from Typhoid fever.  We've operated on him twice, finally doing a diverting ileostomy.  I am not optimistic for his survival. 

The other patient came in today, a week after being shot in the abdomen.  He was operated on in another hospital, but they failed to find the hole in his intestines.  He is now (guess what?) leaking stool out the bullet hole.  

These cases are so frustrating.  They illustrate the desperate situation of surgical care in Eastern Congo.  The problem is not the lack of surgical care, but simply poor care.  I can't really blame these folks.  They are inadequately trained, they work in facilities with poor anesthesia and lighting.  They do the best they can, but it's not enough.  After a couple of unsuccessful operations, they transfer them here.  MPEC.  It's discouraging to have to deal with the complications of others.  It's painful when they die.  I wish they got here a bit faster.  They have usually been deteriorating for a week or so before they arrive here.  My hope is that our doctors in training will pick up the skills necessary to avoid some of these complications.  That is also a challenge.  I get these trainees for two months.  It's not enough time.  

Lindsey has spent her days doing battle with malaria.  It's now the rainy season and malaria stalks these kids like a lion.  A healthy child can deteriorate and die with shocking speed.  I believe they have around 70 kids in the hospital now, and many of them have malaria.  Hardly a day goes by when she doesn't lose one.  The deaths are mainly due to cerebral malaria with severe anemia.  She deals with these tragic cases, them comes home and hugs Emmanuel with a strange intensity.  We struggle with giving him malaria prophylaxis, but come hell or high-water she manages to disguise the bitter taste of Mefloquine and get it down.  They say that deaths from malaria are decreasing.  We're still waiting for that magical anti-malarial vaccine.  Bill and Melinda have poured plenty of money into it...  In the meantime we continue to treat and transfuse.  We continue to see those sad little bundles carried out of the hospital by wailing moms.  This kind of stuff takes a toll on you.

 

Our life, however, isn't all death and disasters.  The climate is pleasant and the landscape is incredibly green.  We've had some of the most amazing sunsets ever.  We take a walk in the evenings and the clouds are magnificent. I've been working on various projects. My latest one has been to make a trailer out of an old Land Rover chassis that I found hidden in tall grass. It's a bit funny looking, but it's going to be great.  I can at least tow it behind the tractor and takes the kids on a hayride. This week I actually took a day off from medical work to concentrate on some administrative challenges and technical problems. A day with no surgery!  It was kind of nice. The highlight of our days is simply watching Emmanuel grow. He is starting to talk a bit. He knows a lot of words and it is a relief to actually be able to communicate a bit. All parents think this, but he is such a pleasant, fun little guy!  It is amazing to think that God gave us such a gift. 

Thanks to those who have prayed for us and supported us in various ways.  Without your help we couldn't be here.  Please do pray for this desperate country. 

Warren Cooper

3 comments:

  1. Enjoyed your newsletter as we worked in Congo at Ibambi. God bless you in your work and praying you will not become discouraged. Jacobsons are our good friends from Nebobongo days.

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  2. Praying for you , that you get abundently, blessed by all that you do for these people.

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  3. I'm inspired and encouraged by your updates. Thank you for continuing to share glimpses of your lives. Sola Deo Gloria! Rachel Gerner

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