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.
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.


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