March 2015
Back to Work
This Momma is back to work!
It feels good, even refreshing, to be working again, speaking Swahili,
and using my medical knowledge. I feel
renewed to try new things and have had some time to think about improvements to
the pediatrics service.
Some weeks the diversity of the practice of medicine here
astounds me. As a pediatrician you
manage things that children would see specialists for in the US. I use my clinical knowledge much more than
any lab test….but isn’t that how it should be? Last week I diagnosed a
3month-old baby with congenital syphilis.
I see contagious diseases like tuberculosis, meningitis, and whooping
cough, even diphtheria regularly. There
are always cases of malaria, intestinal parasites, schistosomiasis, pneumonias,
osteomyelitis, and new cases of HIV. I
take pictures of unusual rashes. I am
not sure why children get pancreatitis here and are left with pseudocysts. I follow our kids in the malnutrition program
very closely as their conditions can change rapidly. Most days I go home with several clinical
questions to look up. My question of the
day is, how does one diagnoses tubercular osteomyelitis (infection of the bone)
in this setting? It is not as simple as
obtaining a specimen for pathology, rather a clinical decision. Medicine is humbling and often rewarding.
I recently started two children with HIV on anti-retroviral
(ARVs) medications, a first for Nyankunde Hospital. We seem to be doing HIV counseling on a
weekly basis of late. It is my hope that
we can get these children feeling better, gaining weight, and resolve of their
infections with the help of ARVs. It is
an unfortunate reality and one I hope we can improve with public health
measures over time, such as prenatal testing.
Being a mom is making me more sensitive to hospitalized
babies and the worries of parents. This
last week Emmanuel has been fighting a viral infection with fevers making him
feel miserable. I have been giving him
plenty of warm baths, Tylenol, and lots of love. Parents everywhere want their children to
feel well, eat and sleep and not suffer from fever. I am constantly reminded to care for others
with the same compassion I would want someone to show my son.
Emmanuel loves his new nanny Maziga and really looks for her
to feed him in the morning. I taught I realized when I went to explain that a baby
monitor was like a kind of telephone…that maybe I had given her information
overload. She seems very comfortable in
our home and enjoys singing and playing with our little boy in her
language. This means so much to me. There are so many things that transcend
culture and love for children is one of them.
It is fun to see Emmanuel’s face light up when I get home. Most days I work about 5hours, allowing me to
follow the inpatient pediatrics service and see a few consults.
Rainy Season Begins
Wet season is starting here in Congo. We woke up last week to the sound of thunder
and the sudden crack of a cedar tree branch falling on the road just
outside. It took the better part of
three days for our garden staff to cut the branches and store the wood. It gave us pause to consider how powerful the
wind can be! Wind seems immaterial, but
can cause major alterations in the natural landscape! It is interesting that Scripture talks about
the Holy Spirit coming with the sound of a mighty wind, without shape or form,
but in power. Just as quickly as the
wind comes, it also goes away. Like the
wind the Holy Spirit has incredible power to change both us and those around
us. In an instant God can show up and
transform things drastically. I love
that God is totally in control of our lives and the physical world. Storms are a reminder of God’s
sovereignty.
Looking at the
Malnutrition Program
Many people have shown interest in our ongoing work and
support of the hospital malnutrition For those of you who have supported this work,
“THANK YOU SO MUCH!” This past year we
have seen >50% increase in the number of admissions (about 150 in 2014), an
older population of children being served, yet still a high mortality rate (12%). Samaritan’s Purse has been able to refer many
children to our hospital for care and follow-up with families in their homes. I know that many children’s lives have been
saved on re-admissions. I am thankful to
have had this partnership. We have a
long ways to go!
 |
| Inpatient Nutrition Program |
Some children come in critically ill, many irreversibly. Malnourishment affects children’s abilities
to respond to vaccines and many get diseases they should have immunity
against. I struggle to read about the
“anti-vaccine revolution” in the United States when I see the realities of
these diseases in the vulnerable population here. There is so much meningitis here that leads
to hydrocephalous. It is sad. We have less meningitis in the US due to the
H. flu and Pneumovax vaccines. An
outbreak of measles would be fatal to so many in this at-risk malnourished
population. Diphtheria is such a scary
disease. One case of tetanus is one case
too many. I couldn’t imagine living here
without my child having the basic vaccines, as the exposures are great.
We are trying to improve the supplemental nutrition received
by our children after discharge from the Children receive a ration of corn and soy
flour on a weekly basis. People will
often walk many kilometers for this small ration. It is our hope to keep these children out of
the hospital and to be able to identify those who are sickest and
re-hospitalize them.
It feels like an uphill climb as we seek to improve the
overall nutritional status of this at-risk population. I am reminded that even as we climb this
cliff, there is respite on small ledges.
The poor will always be among us, but it really is a testimony to Jesus
as we care for the poorest of the poor.
We hope that families are receiving spiritual nourishment and hope to
continue. I know that the causes of
malnutrition are deep and are rooted in the breakdown of the family. We serve a population affected by
displacement by war and insecurity, where many fathers are non-existent and
women raise their children with the help of their extended families. Without a head of household to prepare the
fields for planting and to assist in harvest, many families fall onto hard
times. We want people to feel supported
and cared for by their hospital family.
The “Lent Project”
A great resource for Lent is an online devotional called the
“Lent Project” from Biola University. I
recommend checking it out. The webpage
is found at: ccca.biola.edu. I enjoy the
posts everyday, and really enjoyed a recent post about the women
disciples. Often we neglect to discuss
the many women who followed Jesus and showed him hospitality. Many of these women followed him to the cross
and cared for his physical needs both before and after death. I really like the meditation from March 15th:
A Day in the Life of Warren
around to
it.
A Day in the Life of Warren
So...what did you do today?
Today, I got up to discover that the power was out last night. We
have the luxury of fairly consistent solar power, but the rainy season has
begun and the sun has not been making an appearance. No photons in, no
electrons out. That is the economics of solar power.
I did a little tour of the gardens. The tomatoes have been
planted. If we can keep the goats out we might have a chance. The cucumbers are
coming along. The cabbages are failing miserably. My coffee plantation (23 bushes) shows
promise. They are flowering and looking healthy. Not sure we will ever get
consumable coffee, but these little projects keep me from being bored.
Feed the dog, put out the cat before Lindsey gets up. We aren't
"cat-people" and Lindsey is allergic, but without a cat we have
mice. Then it's time to get Emmanuel up
and dressed. He is a happy guy in the morning and it lights up my day to see
him smile and laugh. Lindsey gets up and we share coffee and a time of reading
and prayer before we leave. By this time Maziga has arrived. This is Emmanuel's
nanny. He is always excited to see her.
I arrive at the hospital to be confronted by the director of the
nursing school who is wondering if I might have forgotten that I had committed
to give a lecture to the nursing students about endoscopy. Oops! It might have slipped my mind. Luckily, I am
able to give this lecture with no preparation. Despite my lack of preparedness,
it went fairly well.
I was hoping to round today, but never quite got Fortunately I have a pretty good
team covering surgery and they can let me know if there are any critical cases. I
stop in the ICU to see a few cases and then I go to the OR. The first case is a
boy with osteomyelitis (a chronic infection of the bone). He needs an operation
called a "sequestectomy". I scrub in for the critical part, and then
see a few outpatients. This is how my days go. I run back and forth between the
OR and my office. I am always in a hurry, always two steps behind.
I see a boy with a painful hip, probably TB. I see a man with a
rectal cancer. He needs a big operation. I see a child with a big abdominal
tumor. I was supposed to operate on him a month ago, but he disappeared. The
tumor is, predictably, larger. It is unlikely that we will be able to cure him
with surgery, but we need to at least try.
I run back to the operating room. I amputate a person's hand. It
was turning black, possibly a complication of a treatment at another hospital.
My Congolese colleagues are doing a hernia in the other room. The clock on the
wall has stopped, but I know that time is ticking away. No lunch, but I am
revived by a cup of black coffee and some "glucose biscuits".
I see more patients. Several of them have advanced cancers. Two
of the liver and one poor skeletal woman with cervical cancer. It has already
spread. I am sick of cancer, sick of telling people that they are going to die.
I try to explain things simply and clearly. We talk about spiritual matters,
end-of-life stuff. It is always a tough conversation. Strangely enough, people
always thank me for being honest with them. Thanks for what? They news that you are going to die? Death is no stranger here and people accept
it. Maybe they just don't get it. We pray together and they leave.
I run to the ICU to see a boy whose head was hit by a falling
tree branch. I operated on him yesterday to remove a blood clot which was
compressing his brain. He is still in a coma. Will he make it? Hard to say. I see a lady whom I operated on
yesterday. She was an obstetrical disaster. She had a vesicovaginal fistula and
a rectovaginal fistula. I operated on her to repair her colostomy and to deal
with the urine leak. It was a tough operation. She is in pain, but there seems
to be no leak for the moment.
I run back to the OR to stick a drain in a man with a chronic
infection of the kidney. He has seen all the traditional healers, and his flank
is marred by the tiny cuts that they make. I tell the OR staff that I do the
same thing. I just make a deeper cut. He will need this kidney removed, but for
the moment I need to drain the half-liter of pus that is trapped in his kidney.
More outpatients. A kid
with hydrocephalus. He needs surgery but I am all out of the tubes that we use
to shunt he fluid from the brain to the abdomen. It seems like every patient is
a disaster of one sort or another. Where are the nice simple cases? I try to stop between cases to do a little
teaching with the junior resident.
I leave without seeing all the cases. Some of them can wait. The
work is never done, and at some point I just have to go home.
I rush home to write a few emails. I am way behind. People who
sit at their computers sometimes don't understand the delay, but I'm kind of
busy during the day.
I have a little time with Emmanuel. We take a family walk. The
soccer game is finishing up and there is chaos on the road. Everyone stops to
marvel at a chubby, white baby with deep blue eyes. He is a mystery and a
source of much discussion.
The evening passes peacefully. Dinner with a friend, dishes, some
bonding time with the dog. There are a few calls to make. Then it's time for
bed.
Lindsey kept asking me if I was ok. I am ok, I think. It's just
that we see a lot of misery. It takes a toll. It weighs upon the soul. Still, I
can't think of anything that I would rather be doing. I guess that is something
like job satisfaction. I never come home wondering what I'm doing with my life.
Our Prayer Requests
1) Pray for Warren as he is dealing with some really difficult orthopedics and general surgical cases. The work weighs on the soul. Today he told four patients that they had terminal, inoperable cancer.
2) Pray for the upcoming arrival of the post-residents, the Dr. Patrick & Anna LaRochelle and their family and Dr. Michelle Doran. Pray also for the work being done to rehabilitate a duplex for their arrival.
3) Pray that we would be able to identify another source of therapeutic milk for our nutrition program. We anticipate the supply to run out by September.
4) Pray for the fields to produce a great harvest to feed the local population.
5) Pray that the Lord would be glorified in our work and give us strength, hope, and daily bread.
Blessings to all of you,
Lindsey, Warren, and Emmanuel
No comments:
Post a Comment