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

Thursday, May 19, 2016

Mangoes in May

May 16, 2016

I love the month of May.  I love flowers blooming, trees budding, celebration of Mother’s Day, mangoes in abundance, memories of our wedding day.  Everything is quite green here at Nyankunde!  Sunsets are stunning through the rainy season cloud formations.  I am reminded again that we live in the beautiful place and of the many things God has blessed us with.
Celebrated our 6th wedding anniversary this May

Malaria Season & An Unusual Case
Malaria season has completely EXPLODED!  Our pediatric service has over 70 patients at the moment.  It is a challenge to see every child every day.  Most of the children are recovering nicely, but some are not and it is really necessary to see even the straightforward cases.  I am thankful for the help of Dr. Patrick LaRochelle who is a med/peds doctor who is helping with the increased patient load.  He was looking to be more involved in pediatrics and now he has his wish! 

I continue to be amazed at the interesting cases and complicated pathology we see everyday.  I am caring for a young boy with a complicated heart condition called Ebstein’s anomaly (malformed tricuspid valve) that results in very small ventricles.Over time children experience profound symptoms of heart failure.  This young boy also happens to have signs of abdominal tuberculosis with a huge abdomen such that he looks 9-months pregnant.  On admission he was having a lot of abdominal pain and difficulty eating.  He essentially was not able to walk due to his large abdomen.  Now he is able to eat, is gaining weight, and is not having abdominal pain.  We are really hoping for good recovery and for him to return home soon.  He will have to live with his symptoms of heart failure, given the risks of cardiac surgery which are far too great.  Pray for his recovery.


Running on Solar Electricity
In rainy season we test our solar system capacity to the limit.  We are at the limit!  Warren is quite adept at finding solutions to our power shortages.  I appreciate how handy he is and am learning a lot myself.  Our home shares electricity with the guesthouse next door and facilitates a VSAT for three households so it really is important that we have consistent power.  The hospital recently installed 20 new solar batteries, gifted by a church in Switzerland.  This should significantly improve our power problems.  In the US most of us simply switch on the light switch and don’t give a thought to how many watts we are using.  A few years ago Warren was shocked at how many Christmas lights I had installed on our Christmas tree (exceeding 1200 watts).  It was the equivalent of running a high-powered mixer for hours.  In Congo we use low wattage bulbs and try to conserve appliance use as much as possible (..I still have low wattage Christmas tree).

Emmanuel Minute
Emmanuel continues to advance in his language skills.  I think he understands much more than he speaks in English, French, and Swahili.  Now when we look at books he points out the sun, moon, bears, bunnies, water, twiga (giraffe), tembo (elephant), simba (lion), babies, mommas, daddies, fish.  It is quite entertaining.  We sing a lot of songs to learn words.  It will be really interesting which language he masters first and then how he will choose to use the other languages surrounding him.  We are really enjoying this chapter of parenting.  I will keep working on “I love you Momma.”

I am often reminded that every day is a gift.  Sometimes simply preparing food for the evening and taking care of Emmanuel can be time consuming.  It can feel like  a stretch to get everything done and the laundry put away.  Yet despite the busy work, having a child forces you to take a step back and smell the roses.  Some days Emmanuel literally pulls up my meticulously planted herbs to smell them.  I can’t get too upset with him when I see his cute grin.  I love that he is discovering his world, even my herbs!

Projects & Ministry Support
We have a lot of projects going on around the house and guesthouse.  We are completing a foundation behind our house to be used as a play area and gazebo.  We plan to plant additional fruit trees and flowers in the surrounding lawn.  We are planning to design a nice outdoor wooden table with stools.  One of Warren’s gifts is adapting his environment for greater functionality.  I love this and am a direct beneficiary. 

If you would like to be a ministry partner, we would love to hear from you.  We anticipate some significant costs to replace a set of solar batteries in addition to a recently repaired water line to the   These are all necessary maintenance costs to continue living here.  We are hoping to raise funds to buy a vehicle over the course of 2016.  We continue to pray about these things and let our support base know.  You can contact us at: warrenandlindsey@gmail.com or through Christian Health Service Corps at:  http://www.healthservicecorps.org/moto/dr-warren-and-dr-lindsey-cooper-

Blessings and love,

Lindsey (Warren & Emmanuel)
Bridges are a huge problem, trucks actually go through!
Emmanuel with Lukas Folmer