March: A Month of Firsts

March 18, 2012

Greetings from DR Congo.  Our hearts go out to one of the post-resident families, the Kelleys, whose youngest child went to heaven this past week due to a brain tumor.  Many people all over the world have heard their story and the way that they are trusting in the sovereignty of God over her life.  As I cried over the loss of a child here a nurse reminded me that "we are all voyagers in this life" and that our real home is to come.  Very true, still it is really hard to say goodbye.  

This week I am surpassing the longest period of time I have ever spent overseas at once.  Feels great.  We are thankful for health and the comfortable home we now live in.  One of the big events since my last posting is Warren’s installation of an outdoor bathtub overlooking the garden.  It is magnificent!  On a hot day (like today), one can simply fill it with cold water and bask in the sun.  Or an evening after a long hike, one can have a warm bath at sunset.  We are also happy to announce that our first garden has been planted.  We anticipate a grand harvest of corn, melons, tomatoes, peppers, lettuce, chard, peas, okra, etc in only a few months.  Tonight I planted a humble herb garden on the terrace outside the kitchen.  Stay tuned for photo postings of our garden as it grows.

The outdoor bathtub overlooking the garden

Lindsey's herb garden

Our garden

The theme so far in March has been “Lots of Firsts.”  

…the ICU

For the last three weeks we have been using the intensive care unit for post-operative care and closer monitoring of hospitalized patients.  All in all it has been working fairly well, although the idea of giving a medication (such as an anti-hypertensive medication) and watching the response is fairly new.  Often it is simply assumed that an intervention will work, but I believe our way of practicing is changing.  It is really helpful to observe patients you are more concerned about.  It’s funny….a clean, bright, new environment is not always what our patients want. One of our long-term patients who sustained gunshot wounds to the legs resulting in bilateral amputations, actually requested a private room in one of the old, rundown buildings.  We were all a little surprised, but quickly agreed.  Just because it is a nice environment for us to work in does not mean that our patients feel most at home in this environment.  I have been working with the nursing staff a lot regarding patient care and assessment; they are eager learners.

A little entertainment in his spare time

Warren and his patient

…on surgery

There are lots of firsts in this department.  The first-ever laproscopic surgery was done at Nyankunde last week.  In addition we are starting to get orthopedic referrals appropriate for the SIGN nail program.  SIGN is a program for low cost internal fixation of broken extremities.  We have had a series of difficult cases these last few weeks such as a young boy who sustained a gunshot wound to the head leaving his brain literally “hanging out” of the dura.  His brain is now “covered” and his wounds are healing and he remains surprisingly happy through it all.

Our first laparoscopic surgery

Our new anesthesia machine/monitors

…on anesthesia

Two anesthesia machines arrived two weeks ago and we have been using them daily.  The nursing staff has really learned quickly and is doing a fabulous job.  I have helped out with a few pediatric cases requiring general anesthesia and paralysis which has been fun.

…on malnutrition

Malnutrition is a big issues in this part of Congo.  I am told that malnutrition was much worse in the returnees after the war.  Being unable to farm a plot of land or lacking the support of a husband raises the incidence of childhood malnutrition tremendously.  I am seeing pellagra (vitamin B3 deficiency), rickets, zinc deficiency, and even what I believe to be scurvy (vitamin C deficiency).   I  have even seen a toddler with right heart failure from malnourishment.  I never learned about heart failure from energy deficit in medical school!  Children with malnutrition simply look too tired to eat.  It takes too much energy to play, or even to sit up.  In South Sudan I saw a young girl squat because it took too much energy to stand. I am trying to learn as much as I can to recognize these cases of malnutrition….and to see the signs of chronic anemia during regular admissions for as a sign of inadequate nutrition.  Pray for us, as we do not have the supplemental milk (F75 and F100) that we are accustomed to giving these children.  It was pillaged in unrest this late fall and there is not yet a good supply in this region.  We are grinding corn and soja and making high calorie porridge for the moment. 

…on pediatrics

I am making and treating many medical conditions that I have never seen in the States.  I am learning how to do echocardiograms...as we had a run of children with rheumatic heart disease.  I diagnosed a young girl with HIV and complications therein a couple of weeks ago.  Common things are common.  Malaria, bronchiolitis, pneumonia, viral gastroenteritis, malnutrition, amoeba, and of course sickle cell anemia-these are the most common diagnoses here.  Then there are rarer cases of diphtheria, hepatitis A, ocular changes (chorioretinitis) from toxoplasmosis, intussusception, and meningitis. 

…prayer requests

1) Praise for God’s faithfulness to Nyankunde Hospital over the years and the dedication of the staff to provide quality care, despite shortages of resources.  We have been able to provide much needed spiritual care and counsel to patients.  We are thankful for the many new procedures and endoscopy now available in this part of the country.  It is exciting to be part of these changes.

2) Feeding program for malnourished children-We are using alternatives for our refeeding program-that of corn and soja.  This orients families to a home regimen, but I am not sure it is the best for severely malnourished children who need energy dense food.

3) A hospital demonstration garden-We would love to see this created to benefit malnourished children and families in need.  There is such a need in this area to teach farming practices and cultivation of particular foods.  There is a Samaritan’s Purse team here doing agricultural projects for the next 1-2years and this may be a real possibility.

4) Financial stability of this Nyankunde Hospital-This truly is a Congolese mission hospital serving a very poor population in the name of Jesus.  Our staff is Congolese, many of whom returned after the war to rebuild their lives and at great sacrifice to themselves.  Our staff is not fully paid due to financial difficulties of the hospital and this is a hardship.  We are hoping that the expanding surgical program will improve the financial status of the hospital.  Warren has had many ideas in this realm.  This is a critical time for the hospital to strategize on how to really make this hospital self-sustaining. 

5) Medications for the patients-We are out of many medications/antibiotics and many other drugs.  I have carried an independent supply of Ceftriaxone in my bag now for the past two weeks.  Pray for wise logistics and the ability to get needed medications.

6) Language learning-We are working and communicating in French on a daily basis.  We are taking Swahili lessons together weekly.  I am often able to understand the general context of medical Swahili…so it is coming along.

Thanks for your friendship and support.  It is an honor to be serving here. 

Blessings,

Lindsey and Warren (and Josh too)

Evening game of croquet with Soborabo

Group Photo

SIGN nail

Today was kind of a momentous day in the OR.  We did our first SIGN nail procedure!  This is a technique of fixing a fractured bone by passing a metal nail down the center of bone and then putting screws through the bone and the nail.  It was the culmination of a very long process. 

Generally, with a new procedure, you try to pick an easy one.  This one was far from easy.  In fact, an experienced orthopedic surgeon told me that it probably wouldn’t be possible.  It is a woman who had fractured her tibia a year ago.  It did not heal.  The pieces of the bone were separated from each other and it simply would never have healed. 

It wasn’t an easy operation.  I had actually been up most of the night vomiting and felt pretty weak.  The first couple of instrument sets that we opened up did not pass the sterilization test and had to be rejected.  (Had they not been sterilized for the proper time?  Were the tests themselves bad?)  Anyway, we eventually got the ends of the bone mobilized and succeeded in passing the nail down the bone.  I’m not sure if the bone will actually heal or not, but I believe that this procedure will offer her the best possible chance.  Maybe it’s good to start out with a tough one.  They will all seem easy after this one!  I believe that this operation is not available anywhere in this part of the country and once the word gets out, we will probably be inundated with fractures.   There are many people in this country who suffer from mistreated orthopedic injuries.   

We’ve had some pretty tough cases here.  There have been a few victories, but also a lot of heartbreak.  It is hard when you do everything you possibly can, but the patient dies.  It’s even harder when a patient dies because of an operation that you did.  There are a few of these that I could tell you about, but it is too hard to relive them.  I have a medical student who is spending a few months “shadowing” me.  After a run of pretty hard deaths, I turned to him and asked him, “Do you really want to do this?  There are easier ways to make a living!”  I think he was a little taken aback.  Later he came back and told me that he had thought a lot about what I had said.  He said that if he could think of anything else to do with his life, he would, but that it kind of felt like a calling. 

Otherwise we are doing well.  We have settled into our home.  We are learning a bit about life in community.  At the present time there is only one guest (the aforementioned medical student) but for the past couple of weeks we have had seven people in the house.  This is a lot of fun, but also stressful in ways that I had never imagined.  There are times when I just want to walk around in my underwear, and that’s simply not possible.  It does feel like a ministry of sorts.

Every day has its new challenges here.  Tomorrow my challenge is removing the kidney from a young man who suffers from a huge renal tumor.  That and dealing with the many unexpected patients who will walk through the door needing help.  My challenge is to deal with their problem in the best way I can, but also to show them compassion.

For the moment, all is quiet.  It is a wonderfully cool night and the evening is full of the noise of crickets and frogs.  I am feeling much better, and that gives me a much better outlook on life.  At these moments it feel like an incredible blessing to simply be here and to be part of the work that God is doing here.

Warren   

"Wow, I really live here now."

February 16, 2013

Greetings from Nyankunde, DRC!  As I passed through the hospital tonight shaking the hands of elderly men and saying goodbye to one of my new teenage moms, I had a moment of realization that “wow, I really live here now.”  This feeling continued as I passed into the pediatric ward where one of our nurses was lighting his nighttime lantern and preparing evening medications.  I went to visit a little girl named Furaha (which means “joy” in Swahili) who I recently diagnosed with acute rheumatic fever.  This little girl had swelling from her head to her toes, a roaring heart murmur, severe arthritic pain, and a strong history of fevers.  She was sitting over her metal bowl of fish and plantains, as happy as could be.  She was much happier to be examined by me while eating her plantain and frankly ignored me.  I asked her mother how the day went.  She reported that she had been playing outside and had not been severely short of breath.  Her neighbor was surprisingly happy to see me, a little boy with congestive heart failure-also appearing to be due to acute rheumatic fever.  He happily reported that he had not been eating ANYTHING with salt in it (as advised)!  For the first time in many days, he appeared to be feeling better and have more energy…not needing his wheelchair anymore.  That was very rewarding from a kid who could barely walk across the room only 5 days ago!  There is a surprising amount of cardiac disease out here.  Cardiac problems are exaggerated by anemia caused by malaria.

My kids with various stages of rheumatic heart disease

My teenage mom with her baby Furaha

It is a bit like my eyes are being opened just a little bit more every day that I am here.  I see lots of malnutrition and am starting to understand the complicated cultural dynamics/food security issues behind this.  It seems that children are much less likely to be malnourished in homes where the father provides for the family.  A woman may be in better health if her husband is home and she is not the sole provider for the children.  It is really important to understand the social support network of families…what food is available, who cooks at home, etc.  Eggs seem like the perfect source of protein to me, but unfortunately men are ones who eat all the eggs around here.  I am hoping this is up for discussion.  On the whole, families seem to really want their children to thrive and welcome suggestions.  Food is a very common topic of conversation around here.

My patient with Pellagra (Vitamin B3 deficiency)

Another picture of her

This past month I was very thankful that one of my teenage moms finally accepted her premature baby and was able to see them home from the hospital.  I found myself very frustrated as the mother pulled out nasogastric tubes and didn’t follow our advice.  It is really hard to watch a baby lose weight, knowing exactly what needs to happen when it isn’t happening.  God began to show me that this was a young mom who really needed to be supported and didn’t have it.  The father of the baby was a soldier and had left the mother.  The mother was also probably shunned by her family.  We worked on building rapport and encouraging the things she was doing well, instead of focusing on immature behavior.  The core issue was that she had not really accepted this child as her own.  The hospital director’s wife sat down with her and reinforced that every child is a gift from God and needs to be embraced.  She also said that there is no guarantee that God will grant her the ability to have another child, and that she needs to be responsible with what she has been given.  This was very powerful coming from another Congolese woman.  This resonated with the mother and with me.  The BONUS is that she has come to see me for weight checks and encouragement for the past two weeks.

We have been blessed to have the Barton family (and friends) with us these past two weeks.  This is Dr. Barton and his daughter Anna’s second trip to DRC.  Anna has been taking French lessons with her friend Kristina who came along.  Ian is our representative Canadian who has become quite well known in town for his beard.  We have been trying lots of new recipes from the “More With Less” cookbook by our wonderful cook Sarah.  Yesterday we tried Moussaka and coconut rice, which has quickly become a favorite!  Today I drove to the market with them to do some shopping for material to take home..we blend in quite well as you can imagine.  Dr. Andrew Barton has been training the OR staff in regional and general anesthesia.  I have learned a lot and only hope I can get the ventilators functioning when they arrive!  We are thankful they could join us.  

Ian selling beans in the market

Nyankunde market

This week I saw the Biblical account (Matthew 8: 1-4) of healing of the man with leprosy with new eyes.  There are many places in Scripture where Jesus asks those who have witnessed miracles, not to tell anyone, and the man with leprosy is no exception.  Jesus tells him specifically to present himself to the priest and offer the gift commanded by Moses as a testimony to them.  I love how Jesus means this to be a witness to God the Father to the Jewish people.  Jesus was also wanted this man to re-integrate back into society and tell others what Jesus had done for him.  I am amazed at the wisdom in this.  I am sure Jesus did not want to be known for the miracles themselves, but for changed lives.  As I think about applying this to my own life, I ask myself what do I say when I witness healing.  Do I think, “What a great decision I made to treat this or that…or “He was healed because of this or that antibiotic.”  My first response is to ascribe healing to science.  But I need to take these opportunities to give thanks and glory to God.  I know there is much commentary when I step away from a bedside…this might be related to what I am wearing, my mispronunciations of Swahili, dietary instructions given, or what a child’s weight was.  It is my hope that when I leave a bedside that people will say, “Look what God has done!”  Personally, I am learning how to give God the glory for healings and ask more about people’s needs.

Warren and I are doing well and taking one day at a time, to rely on God for our daily needs.  There are numerous challenges, but so many blessings.  We are becoming rich in relationships.

 Thanks for  your friendship and involvement in our lives!

Love,

Lindsey (for us)