Sunday, October 29, 2017

"Love, love, love that's what it's all about." Children's Hospital Ministry

October 2017
Walking again

Once again I am amazed to see children learn to stand and walk after debilitating illnesses!  It seems  Our hospital is gaining a reputation for being a place where children walk again, recovering from chronic illnesses such as TB, malnutrition, meningitis, etc.  I give thanks back to God for His faithfulness to us.  I give thanks to Him for all I have learned in the last five years caring for a vulnerable population.  This week I give thanks for Debra’s (name change) recovery from osteomyelitis caused by tuberculosis.  She was in so much pain only two months ago, such that I could barely examine her painful legs.  She required anesthesia for pain control.  Her hip is permanently dislocated, but she is able to stand.  She will likely form a false hip joint and walk soon.
Debra
like every month I have a story to tell, of how God heals.

I want to give a few stories to illustrate how medicine looks different here in Congo compared to the USA.  I frequently have these kinds of conversations and today it hit me that others might be interested as well.

Sickle Cell, the “banana cell” disease
I sat down to counsel the family of a short 4-year old girl with the new diagnosis of sickle cell anemia.  The father came from home to give blood and talk with us about her medical problem.  I drew an orange and said, “This illustrates what a normal red blood cell looks like.”  Then I drew a banana and said, “This is what Furaha’s red blood cells look like.”  I proceeded to draw one orange and nine bananas to represent 90% sickled cells.  I said when the majority of her cells change to the shape of a banana she needs a transfusion

The family asked, “Will changing her diet improve her health?”  I said eating lots of green vegetables and beans will help her to make new red blood cells.  But I said food will not cure her.  She was born with “banana shaped cells” just as she was born with brown eyes and food won’t change that.

Then the family asked, “How do we prevent having another child with this disease?”  I told them that you can’t prevent it if both of you carry the possibility to give it to your children.  A nurse asked, “Should they use contraception?”  To this I said, that is up to them as there is a chance that they will have a child without sickle cell anemia.  There is also a 75% chance that they won’t have a child with the disease.

Then they asked, “Did her brother die of the same problem.”  I replied, “Probably, yes.”

Then we talked about the three things the family could do to prevent future hospitalizations.  First, there is eating three times a day, a diet rich in iron and taking daily iron supplements.  Second there is preventing infection (thus hospitalizations) with monthly antibiotic injections of benzylpenicillin and vaccines.  Lastly I advised her to prevent dehydration with lots of water everyday.  I advised them to come to the hospital at the first sign of fever and/or anemia, with a potential blood donor.

The family nodded understanding and motivation to care for their little girl.  I did not draw any genetic diagrams or give any complication teaching, but nonetheless the message seemed to translate well.

Recurrent fetal deaths
Next I saw a 20year old woman with her husband and father (!).  She had had three full-term babies that died shortly after delivery, after seemingly uncomplicated pregnancies.  I asked lots of questions from her prenatal care, size of the deceased babies, menstrual cycle, etc.  In the end I was left with the unsatisfying advice to do blood testing for common diseases like hepatitis, syphilis, HIV, blood type to see if we could identify a chronic medical problem.  If there is not a chronic problem we were left with the likelihood of a genetic problem linking these deaths.  I wondered about the presence of her father, but she really wanted his support and presence.  I am reminded on a daily basis to ask questions, not judge people/situations, and to ask how I can best support them.  I see some really challenging social situations (sometimes infuriating), but I have learned to step back and ask how can I communicate the love of God to this person. 
An All-Star Grandmother
The last story of the day happened on rounds.  I love this particular grandmother, all of 5 feet tall, ripped arms, bare feet, always with a big smile on her face and a word of “thanks.”  I knew she had a story.  Well today she told the whole room her life story.  She left a militia occupied area in the forest where she lost everything, moving with her grandchildren to live in the nearby community called Irumu.  It is a sad, yet hopeful story.  You can tell by looking at her that she is hard worker.  I asked what she was currently planting and she named every possible vegetable imaginable!!!  I told her that I needed to visit her home and fields to learn from her.  She replied that she needed to do this to feed and support her family (so encouraging!).  I told her that there was a special reward in heaven for grandmothers like her.  Then she told me how much the older girl struggled with losing her leg in a below the knee amputation.  During a recent hospitalization, her father came for a visit.  It seems that he has left the family and the girl asked him why he left.  He didn’t have an answer.  A tear welled up in her eyes as the story was being told.  My heart was moved.  I was reminded yet again that God is our Father, who looks out for us when our earthly fathers are not.  I told her how much God the Father loved and treasured her and saw her struggles. 
All-Star Grandmother front and center (green headscarf)

Children’s hospital ministry…it is about being the family of God to one another and loving unconditionally.  It is about encouraging the beautiful reflection of God in every person we touch.  It is about loving people into the Kingdom of God.

We had a wonderful visit from an older Swiss missionary Yvonne and her friend Mary this past week.

Over 30 years of faithful service to Congo!  She came to celebrate her 80th birthday.  It was truly an honor and inspiration to be together.


Blessings,

Lindsey 
Yvonne (center), Mary (right)

Monday, October 16, 2017

Great Visit!


It was a great pleasure for us to host some special visitors.  We had a great visit from Carl Reading and Tim and Nancy Dowdell.  Carl and Tim are radiologists and they did a lot of teaching during their time here.  Here at Nyankunde Hospital, we all have to read our own X-rays and do our own ultrasounds.  We do our best, but we are all limited to one degree or another.  During this time we organized the first annual (hopefully) Radiology Conference of Nyankunde Hospital. We invited doctors from some of the surrounding hospitals as well as physicians practicing here for an intensive training session in Ultrasound and X-ray.  What we discovered was…that we have a long way to go.  



Medical imaging in an interesting thing.  To the uninitiated, it probably seems like you get an exam such as an X-ray or a CT scan, and it simply shows you what is wrong.  Sort of, but you’ve got to SEE it.  You have to understand the anatomy and make the correlations between the unique individual, the organs, the disease and the pixels on the screen.  When Jesus healed the blind man, he saw people, but they looked like trees walking around.  That’s kind of where we are now.  How do we teach people how to see, how to interpret the images, make clinical correlations, and use them to improve medical care?  To some degree it takes place in a lecture, but it also takes place in a real-life clinical setting.  Tim and Carl did a great job bridging that gap between the theory and practice.  It was great to see some of our young doctors have that elusive “AHA moment” when they really got it.  In the past we could always blame our poor interpretation of X-rays on the poor quality of our films, but with digital X-ray, the quality of the image is superb and you have only yourself to blame. 



For some reason, our doctors seem to “get” ultrasound faster than they get X-ray interpretation.  I’m not sure why this is, but they start to interpret those grainy, floating dots on the screen and begin to master the views, identify organs and diseases.  We are all somewhere on that continuum, and the more we do ultrasound, the better we get.  20 years ago, I snuck into the ultrasound room of a hospital which I will not now name, opening up a textbook of ultrasound, turning on the machine (the size of a large kitchen stove) and hunting around for my pancreas.  I’ve come a long way, but there’s still a lot to learn and new horizons ahead.  I’m an ultrasound junkie, but this one technology has revolutionized the way that a clinician in a limited setting, can reliably “see” (actually “hear” is more correct) what is going in the human body.  The stethoscope is essentially a toilet paper roll that we press on the patient’s skin and hear the rumbling within.  Ultrasound is infinitely more useful to me.  A stethoscope looks good around your neck, but an ultrasound really gives you a window to the inside.  



Carl Reading brought me a new tool which I ordered and am excited about.  It is a wireless portable ultrasound probe which connects via WiFi to any smartphone or tablet.  It is made by a Chinese company and I bought it on EBay using PayPal!  What a brave new world!  I felt like I was taking a step into the unknown…but the darn thing actually works!  I can carry it in my pocket, connect it to my IPhone and use it on rounds to make a diagnosis.  Any “Trekkies” out there?  Remember Dr. McCoy and the “Tricorder”?  It’s here, and I bought one from China!  OK, call me an “early adapter” but I can put it in my pocket, take it anywhere.  I can save images, clips and send them to a real expert, like Carl.   The image quality is not exactly top-of-the-line, but it is decent and usable.  With each generation it will get better and better.  My prediction is that within a few years, every clinician will have one of these in pocket, and that we’ll finally ditch that stethoscope.  But…I digress.

If only i had a wireless probe and an iPhone!


It was a great visit.  Sometimes visitors come and one wonders what lasting impact they had.  I feel like we made real progress.  We got the good out of them and managed to keep showing them patients until the moment they got on the plane to leave.  Nancy was also a great help and encouragement. She helped take care of Emmanuel, taught some English lessons and generally filled in where she was needed.  Many thanks to Carl and the Dowdell’s!   Maybe we can pencil you in for the second annual radiology conference.  


Meanwhile…between cases, I continue my quest for new projects and hobbies.  We are now harvesting the coffee and I’ve got the roasting process down to a science.  I have installed a few more bee hives and we had a meager, but tasty harvest of African Killer Bee Honey.  We are planning to plant some Cacao trees soon.  I purchased 10 kilos of beans and as a little experiment, we made chocolate!  Surprisingly, this is not as complicated a process as you might imagine.  It involved roasting the beans, shelling and preparing the “nibs”, mixing with sugar, then grinding the mixture in a hand-crank grinder.  For the first couple of passes, you get a granular product, but after the 5th or 6th pass through the grinder, it is honest-to-goodness chocolate!  OK, it’s a bit on the grainy side, but it tastes good, and it’s real chocolate!  How did I learn to do this, you might ask?  Same way I learn anything…YouTube!  Other hobbies include (in no particular order); blacksmithing, composting, goat-tending, fixing the solar power system at the hospital, harvesting the peanuts, motorcycle maintenance, disciplining a strong-willed toddler, chicken-keeping (we’re up to 3 eggs on a good day) and the ever-popular servicing of a Romanian-made tractor.  Anyone with a Romanian tractor has a project for life. Oh, and today we got a cute little baby African Gray parrot.  We are now accepting name-suggestions.  



Well, I’ve babbled on more than I planned.  Life is full of joys and challenges.  The hospital keeps me busy, mostly with motorcycle-related trauma.  Every day brings a couple of disasters.  We continue to invest in the lives of our Congolese training doctors.  We are coming to the end of a Bible-study on the life of Joseph and it has been a challenge for all of us to life lives of integrity, and follow God both in good times and hard times.  



Thanks so much for your prayers and support.  We are part of a team and it is humbling to see how many people have given generously to the work of the hospital.  We are planning to leave Congo at the end of November.  We will be in the US for a couple of months.  I have a recertification exam in Surgery that I need to take and we need to catch up with friends and family.  While we are back, we hope to see YOU!


Warren for the Coopers




Saturday, September 30, 2017

Baby Grace

September 30, 2017
Baby Grace


I am writing to ask for prayer for an abandoned baby, her mother, and father.

On Thursday morning my nanny told me, “I heard a baby crying on my way home from my field last night.  I found a baby girl in the tall grasses all alone next to her placenta.”  What???  Did I understand her French correctly?  Yes I had.  I was speechless.  I haven't seen this before.

My nanny immediately informed the chief of our village and the local health center whom then took responsibility for the situation and hospitalized the baby for care.  Since then our maternity nurses have been caring for her needs and affectionately call her “Grace.”

My heart breaks to think of this little one being left all alone.  My heart aches for the mother to realize the treasure she left behind.  I can’t understand the desperation it would take to leave a newborn like that.  Did the mother hope that the child would be found?

In the United States there is a way a woman can anonymously give up her child and know that it will be given a home.  No questions asked.  In Congo, this social support does not exist. 

Join me in praying for Baby Grace and her parents.  Pray for the very best home for this little one.  There are efforts being made to find the mother.  Pray for a change of heart of the mother.  Pray for the father also.

She is a cutie.



Monday, September 4, 2017

Trip to Uganda for Supplies (and a safari story)

September 3, 2017 

Thank you to so many who have generously given to the needs of Nyankunde Hospital!  We have be blessed and humbled to see the interest and concern of others, some of whom we have never met but feel connected to the work in eastern Congo.  From the depths of our hearts, THANK YOU!!!  

We currently sit in Kampala, Uganda, awaiting an autoclave to clear customs!  We have visited medical warehouses and pharmaceutical companies, looked for various office supplies and are
preparing to travel by road back to Congo this next week.  We have been able to purchase some new vital sign monitors, sat monitors, surgical instruments, surgical supplies, a new autoclave, suction pumps, an infusion pump, and various medications.  It has been a been frustrating to wait and wait, but really nice to have down time together as a family.  

We pet a few days exploring western Uganda on safari with our friends the O'Brien family.  We had a lovely time together!  Emmanuel's favorite animal was probably the elephant and the crocodile.  There is something surreal about seeing elephants walking along the plain while eating breakfast.  It was a special time however both Warren was recovering from malaria and in Emmanuel's case probably typhoid fever.  At one point early in our vacation I had two febrile, miserable boys away from home....it did not feel like a vacation!  Emmanuel's appetite has returned and he is putting on weight again.  These are all the potential complications of living overseas.  I am thankful for my medical knowledge and experience to know what to do in these situations-it would be overwhelming otherwise.  It is not like getting sick in America!  

Partway through our vacation Warren had the opportunity to recover a digital X-ray plate in Iraq!  He came to me saying this was an answer to prayer, as the plate was no longer in use in Iraq and our exact imaging system.  Indeed.  So within 48hours he was on a plane to Iraq, on the ground for 36hours to assemble things, and then back to Uganda for the remainder of our time in Kampala.  Recovering from malaria, off to Iraq, then back to Uganda.  Such a blessing to have been given this piece of equipment!

One of the highlights of the time in western Uganda was chimp trekking.  I wish I could adequately describe the experience, as it was unreal. At one point we were following a troop of about 30 chimps and we were a equivalent number of humans.  They just started jumping out of trees all around us and screaming and it wasn't clear what was going on.  It was a little overwhelming.  The alpha male was arriving and all the male grunting was an acknowledgement of his superiority.  It seemed that the females were present, but not central to these troop interactions.  They often had their young somewhat to the periphery.  It really felt like we were in the chimpanzee's home and I wondered it they wanted us there.  This particular group was used to humans and there was no problem with our presence...yet I could truly understand that these could be aggressive animals.  Our ranger was telling us about the social structure of this group. led by the alpha male Totti and how he had become the leader of the tribe.  Just as he is explaining this, up comes Totti with the previous clan leader Machezi.  He started walking directly towards our group where I am standing at the periphery.  Then Totti gets about 6 feet away and turns walking directly up to me, full speed ahead.  The ranger is behind me and says "Stand still.  He will find his way."  My heart accelerated (and probably skipped a few beats) and I had to turn my body 180 degrees to let him pass by.  The ranger let out a chuckle and said that he was exerting his "dominance."  In the past he used to be fairly cheeky, and had been known to take people's shoes and generally be mischievous.  Well, I almost danced with this chimpanzee!  Still processing through that.  I have it all on film which is the crazy part....I didn't imagine any of it.  Later in the day the O'Briens went trekking and followed the same troup of chimpanzees.  Their guide had heard about this close encounter and wanted my friends to get close too.  They were able to do some amazing filming of Totti.  He was quite photogenic and seemed to like all the attention.  In the orientation we were told to keep a 15 foot distance from the chimps and to back up if approached.  This is all fine and good until the chimp walks right up to you.  It happens pretty fast.  He broke the rules!  

Other than obtaining equipment here in Kampala we have had time to do household shopping, and spend time together as a family.  We celebrated Emmanuel's third birthday with cake and ice cream in the company of friends.  Warren and I went out for a date which we have done only a handful of times overseas.  Emmanuel has loved swimming in pools and is getting more and more confident.  I did absolutely no cooking for two weeks!  I can't remember the last time this happened.  Now I consider a vacation, not having to cook and having uninterrupted time together.  It is pretty incredible and a bit overwhelming to shop in Kampala.  I can only handle so much shopping in a day...it is sensory overload and I just want to find a quiet corner of the store.  We are missing the village life we are accustomed to...all fresh fruits, vegetables, meats, fresh milk, nothing processed.

I have changed in the last 5 years we have been in Congo.  I wonder what it will be like to visit the US again in only 3months.  We are looking forward to many things, namely reconnecting with friends and family.  Although I love NYC, I think that might be too much for me these days.





Monday, August 14, 2017

Learning from a little girl

August 14, 2017
Jenina in August 2017


Some of you have followed the story of my 5-year old patient Jenina, a little girl with nephrotic syndrome (protein losing urinary disease) who has been in the hospital since January.  Young Jenina went home today!  She is such a special little girl with a beautiful voice and faith in Jesus.  She loves to braid hair and dress up.  It took her about 5minutes to prepare herself to take this picture.  In Swahili she sang to me this past week, “He gives and takes away.  May the name of the Lord be praised.  He is good.” 

I asked the family if I could share her story.    The family was willing to stay in the hospital (even 6 months) if it meant another chance at life.  We tried multiple drugs, including tuberculosis therapy and a kind of chemotherapy.  We did everything short of a renal biopsy as pathology is just not available in this part of the world.  I will probably never know exactly what kind of kidney disease she has, but as is so often in this part of the world, you try various things and you watch closely.  The immunosuppressive medication called tacrolimus traveled around the world from India, to the US, to Congo to help control her disease.  It seems to have helped.  We finally got her dose of steroids down to a manageable level and will come back to see me in a month.  It is a small victory.  Is she cured of her disease?  Not yet, but it is manageable.  I want her to have the best quality of life possible.  May the name of the Lord be praised.
Jenna in January 2017
They agreed that this would be good.  The family thought Jenina was not going to survive as her body was so swollen and she had no energy.

This little girl touched my life and taught me several things. 

-She reminded me the importance of love in medicine.
-She reminded me to be patient when looking for the best therapy and to not give up.
-She taught me to push the limits of what is possible medically, even out here in Congo.
-She reminded me that children experience the love of God very tangibly and this is often how they come to know Jesus.
-She reminded me how important it is to give thanks to God in all things and to share our stories with others.

Our family is leaving tomorrow with our friends for a little safari vacation in western Uganda.  We have been looking forward to this time all summer.  Unfortunately, both Warren and Emmanuel came down with malaria this past weekend so we have been recovering.  I need a break from clinical medicine and to think about other things for a while.  It is really important to get a break.  We will also be acquiring some medical supplies and equipment for the hospital during our time in Uganda. 

THANK YOU so much to all of you who have responded so generously to the work of Nyankunde Hospital during this time of crisis.  God has used you to bless us and remind us of His faithfulness.  We will keep you updated on what we have been able to accomplish.  Keep praying for our hospital and ministry. 

Many blessings,

Lindsey (for the Coopers)

Warren roasting coffee on his forge



Catching butterflies


Lots of hospital projects...a walkway through the rain



Love his curls!