Lazy Days of Summer

Nyankunde Hospital

Nyankunde airstrip

July 2015

Greetings family and friends!  We just returned from some much needed time to relax in Uganda.  The DRC and Uganda are neighboring countries but are different in many ways.  The roads in eastern DRC are for the most part rugged and the most common vehicle one meets on the road is a motorcycle or an overloaded truck.  We passed several overturned, overloaded semi trucks.  In DRC woman carry mostly everything on their heads, however in Uganda weight is often carried on the back.  Attire is different too.  Clothing is very colorful and patterned in Congo, whereas in Uganda the colors and styles are more neutral and western.  Congolese eat lots of foo-foo (ground cassava) and dried fish whereas Ugandans eat lots of chapatis and bananas.

Vacation in Uganda

Murchison Falls National Park is a national park situated right on the Nile River with lots of wildlife to

behold.  Going on safari with a baby is interesting to say the least.  Emmanuel wanted to hold the steering wheel and stand up to see out of the windows the whole time.  He was not able to see the elephants and giraffe in the distance like we were, but spotted an antelope up close.  I think he thought it was a big goat.  We slept in a safari tent, enjoyed great food while watching the monkeys play in the trees and hippos surface on the water.  Emmanuel enjoyed swimming for the first time (in a pool, not the Nile).  He liked getting his face wet and drinking the water, as well as floating on his back.  It will be fun teaching him how to swim.  For me just being outside and seeing wildlife was so relaxing.  Uganda is a great place to go on safari.

Next onto Kampala for some supplies shopping and good food.  We were able to meet up with a couple of Warren’s old friends and have fellowship together.  In some ways all big cities are alike, lots of people, traffic, and noise.  It was so convenient to walk into a store and buy many things all in one place.  What might take a day of searching around multiple shops here in DRC, we were able to do in just a couple of hours.  I was encouraged by our visit to Ambrosoli International Church.  I told Warren that hearing the message on Sunday morning was the most important reason we were in Kampala.  The pastor started out by asking when the last time was that we had had a serious discussion or thought about heaven.  Our lives on earth account for such a small percentage of God’s plans for us, so how is it that we never talk or think about eternity?  This is a very poignant question.  He went to challenge us to keep our perspective on eternity and not get lost in our daily trials.  He posed the question, if you catch a fish and take a photo to show it off will people appreciate its’ magnitude?  Probably not.  But if you take a picture of the same fish relative to your body, will people then appreciate its’ size?  Definitely.  Just as it is difficult to appreciate the size of a fish alone, our lives in isolation don’t make a lot of sense.  We may find ourselves discouraged by daily frustrations and fail to see the larger picture.  If however we see our lives relative to eternity as God has made us to live with him, our lives make a lot more sense.   He does not want us to lose heart by our daily experiences and troubles, but to be renewed on the inside in our relationship and knowledge of Jesus Christ.  It is this relationship with Christ that we need to cling to in this life.  Our lives do matter for eternity so we must fix our eyes as Corinthians says on “not what is seen, but on what is unseen.”    We must not lose heart and lose this perspective.   

2 Corinthians 4:6; 16-18

For God, who said, “Let light shine out of darkness,” made his light shine in our hearts to give us the light of the knowledge of the glory of God in the face of Christ…Therefore we do not lose heart.  Though outwardly we are wasting away, yet inwardly we are being renewed day by day.  For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all.  So we fix our eyes not on what is seen, but on what is unseen.  For what is seen is temporary, but what is unseen is eternal. 

An Interesting Anecdote

Today the local radio station announcer came to our house to talk to Warren.  He and Warren are good friends and help each other out from time-to-time.  Warren advertised a reward for anyone who could help him capture a swarm of bees.  For days we had people stopping in with a bee sighting.  Next we announced our escaped goat and sure enough we were able to recover him.  So tonight our friend came by to see if Warren could help him find “hidden treasure”.  He had been told that a certain rocky hillside contained treasure and wondered if Warren had any “machines” that might help him.  I had to smile because my husband does know a lot about a variety of things AND has plenty of “machines.”  Therefore he was a reasonable consult for such an endeavor.  Life is always interesting here.

Our Baby is Growing Up

Our little baby is officially crawling and walking with assistance.  We alternate adjectives between busy,

active, and trouble!  Our house has undergone a progressive childproofing.  Warren removed the handles on the lower cupboards in the kitchen.  The bird cage as been elevated.  Electrical cords are concealed.  Our kerosene refrigerator has tape blocking the flame adjusting knob.  He opens every door and cupboard just because he can.  He loves to play outside with his puppy and goat.  My handy husband welded him a swing out of rebar today.  He is making so many sounds and waving “hi” and “bye.”  He loves people and often extends his hands to everyone.  As you can imagine everyone loves

this.  I can’t make a trip to the local market without multiple people asking me about Emmanuel or being called “Mama Emmanuel.”  In this culture you are who you are because of your relationships to others.  Warren and I hope that we will be able to handle him once he starts walking! 

Thanks again for your interest in our lives.  Pray that we would be encouraged in our daily work and have more opportunities to share the hope we have in Christ.

Blessings,
Lindsey, Warren and Emmanuel

The 4 M's

These days we've seen a lot of trauma at the hospital. As a young surgeon, trauma seems really exciting.  As you get older, it just seems annoying.  It is so stupid, so avoidable, but it takes so much effort to treat. In the setting of trauma, I have four enemies. 

The first is the motorcycle. There is a Chinese-made motorcycle called the "Senkhe" (or some variant). A Senkhe can be purchased for about 500$. They drive these motorcycles like madmen. Scarcely a day goes by when I don't see several two or three Senkhe victims. Mastaki is a 15 year old who was on a motorcycle with two buddies. He has a skull fracture with a major leak of cerebrospinal fluid from his nose. He has a fracture of the humerus, which required a plate and screws, and a fracture of the radius which we treated with a cast. He has now awakened from a coma, but I suspect he has a major contusion of the frontal lobe of his brain. He knows who he is, and where he is, but he has a serious brain injury. He sounds pretty bad off, until you learn that both of his friends on the motorcycle died. I could tell you many stories of patients who have horrible orthopedic injuries. As a motorcycle rider, these injuries do give me cause to ponder.  I have a Honda, however, so I should be ok. 

The second enemy is (predictably) the machine gun. The fact of the matter is that Eastern Congo is a violent place, and my old friend the AK-47 is alive and well. In the area east of here there has been fighting between the Congolese army, the UN "Peacekeepers" and a rebel group known as the FRPI. This is, of course, the Force for Patriotic Resistance in Ituri.  This conflict has been heating up as of late, and we've received some horrible injuries. One man had his jaw shattered. Several young combatants were shot through various limbs. Beside the conflict victims, we have the civilians who are injured by bandits, or from stray bullets. I have a 10 year old girl and a 60 year old women who were shot. In this business, one learns to hate guns. Still, in this line of work, they do offer some job security.  

The third is the gold mine. As it turns out, there is a lot of gold in this area. I wish there was no gold here. The lure of easy money drives families apart and results in a lot of vices. It also entices able-bodies young men to dig down and tunnel, like rats into the depths of the earth. These tunnels cave in, killing many and resulting in terrible injuries. At the present time we have five patients who are paralyzed, and two who have severe pelvic fractures. One man had a stone fall on him, rupturing his urinary bladder. On a good day, these miners will show up at the local store to buy beer and cigarettes. They weigh out the gold on little scales. A matchstick's weight of gold is worth about three dollars. Some people are making a killing on gold. Not these guys. They're just getting killed. 

The fourth enemy, particularly in this season, is the mango. So far I've only seen a couple of kids with broken bones. This is because the season is in full swing and the mangoes are dropping like manna from heaven. It gets dangerous later on the season as those ripe mangoes are high up in the tree. Mango trees are notoriously weak. Some days it seems like there are as many kids dropping out of the trees as mangoes. Every year I see a few that die. I like a good mango as much as the next guy, but I haven't yet tasted one I was willing to die for. 

Today I had a good one. I suppose it fits under the "motorcycle" category, but perhaps I could make an additional category called "moo". It is a guy in his 30's, who seems intelligent enough. He got up early in the morning and headed out on his Senkhe. Either his headlight was not working, or it malfunctioned, and he found himself in a large herd of cattle which was on the road. He managed to crash into a large cow and basically impaled himself on its horn. Now that I write this, it seems implausible, but that was his story. The horn entered his chest, barely missing his heart. He presented with what we call an "open pneumothorax" or, more colorfully, a "sucking chest wound."  This is a hole in the chest wall. If it is large enough, the air will preferentially go through the chest wall, rather than through the airway. I found him breathing with some difficulty. Nobody seemed to know what to do.  Lesson of the day: if there is a hole in the chest wall, try to seal it with something. The general dictum is that you put a piece of plastic over the hole and tape it on three sides. That permits air to leave the chest cavity, but not to enter it. When we got him a bit stabilized, we brought him to the OR. He had a gaping hole, through which the heart and right lung were visible. The horn had passed to the side of his heart, but had torn through the internal mammary artery, which runs down the inside of the chest well. After we ligated the bleeding artery, fixed the hole and gave him some blood, he felt much better. I've replayed the scene in my mind a couple of times, and it still seems bizarre.  Is it really possible to drive a motorcycle with no headlight and impale yourself on the horn of a cow?  It seems that it is. 

So, those are my major challenges: motorcycles, machine guns, mines and mangoes. My real challenge is to share the love of God to people who are suffering here.  Many of them, one must concede, are suffering because of stupid things.  I continue to work closely with the trainees that pass under my tutelage. Teaching Congolese doctors is the only way I can hope to have a greater impact on healthcare in this area. It is challenging, infuriating, frustrating, maddening, but never boring. 

Two days ago we had another motorcycle incident. There were three big guys on a Senkhe. This blows my mind.  The story is stil hazy, but the crashed into a bus (or vise versa). One had an open fracture of the tibia and severed his patellar tendon. One had a femur fracture, which we treated by placement of a steel rod with interlocking screws. The last had a dislocated hip and a fractured pelvis.

It's time for us to get out of Nyankunde for a bit. We've been here for six months without a break and it's time for a change of scenery. We are going to take a little road trip to Uganda. We'll see some animals, eat at a restaurant, do a little shopping. Most importantly, we will be spared from patient care for a bit. We love our job, really we do, but it takes a toll and sometimes we just need to get away!

Warren

Back from Nepal

I’ve been back in DRC for almost a week.  I spent a couple of week in Nepal, assisting with the earthquake relief effort.  It was a good experience.  Nepal is a fascinating, bewildering, bizarre experience, even without an eartquake.  The earthquake has devastated this poor country and it was my privilege to go and try to help. 

Preparing for surgery

I would like to make a couple of observations.  Firstly, the “news” does not present an accurate picture.  I before arriving in Kathmandu, I had read about the situation.  It sounded like the city of Kathmandu had been flattened, the hospitals completely overwhelmed and the infrastructure totally destroyed.  This was not the case.  I landed in the airport with the other medical teams and the search and rescue squads.  There were cracks here and there, but things were functioning ok.  I was met outside of the airport by a van from the hotel.  On the trip to the hotel I looked for signs of destruction but I didn’t see much.  There were houses here and there which were damaged.  Some of the buildings looked a little crooked, but in Kathmandu a lot of things look crooked.  Most of the destroyed structures were older building make out of brick.  The more modern buildings seemed ok.  I’m not trying to make light of the situation; what happened was terrible.  Don’t believe the news, however.  The stories always make the situation sound worse and more dramatic than the reality.  A dramatic story captivates us, it grabs our attention.  It sells newspapers (do they still exist?).  Anyway, I think it is helpful to view the news as a product and not a completely accurate reflection of the situation.

Lance (R), fearless leader of medical team

The country of Nepal was certainly inundated with foreign medical teams.  Did they have needs for supplies and assistance?  Certainly, but they didn’t need all the doctors who showed up.  As a matter of fact, the Ministry of Health had a big job trying to coordinate and direct the foreign medical teams.  The military was quite effective in evacuating wounded patients to hospitals in Kathmandu.  These hospitals were quite adamant about not needing the assistance of foreign doctors.  Was there pride involved?  Was there a degree of posturing?  I believe there was.  Were there patients whose care was delayed due to inadequacies of the medical system?  Certainly.  Nevertheless, I confess that I was impressed by the general competence and efficiency of the Nepali medical system.  Many of the foreign medical teams ended up in more remote areas, vying to stake their claim and struggling to find something useful to do.  There are huge medical needs in Nepal and there is much that needs to be done to rebuild the health sector, especially in outlying rural areas.  There are incredibly remote areas which are cut off and need basic medical care. 

A typical scene of destruction

Anandaban OR

Did they need me there?  Not really.  It’s hard to say this, but I did not feel especially useful.  I mostly worked at Anandaban Hospital.  This is a smallish hospital on the outskirts of Kathmandu.  It functions as a center for the care for patients with leprosy, but they also do a fair amount of orthopedic surgery.  Obviously the leprosy work was on hold for the two weeks following the earthquake.  There was a steady, but not overwhelming caseload of orthopedic cases.  The cases were what you would generally expect in an earthquake: crush wounds, lacertations, open and closed fractures.  Most of the injuries involved the lower extremities.  We put a lot of bits of metal to fix broken bones.  It was actually a good learning experience for me, as I was able to work with some very competent orthopedic surgeons.  I learned a lot, and this felt like a real luxury.  In Congo I am forced to muddle through on my own, with inadequate materials.  In Nepal I worked with three orthopedic surgeons.  We had access to decent materials, we had good x-rays, a c-arm, good anesthesia, adequate supplies, etc.  I didn’t quite succeed in saving the world, but I learned a lot, and I enjoyed my time.  In these situations, you really don’t know what you’re going to find until you get there.

Dr. Tul, an old friend from Tansen

As always, the stories are heartbreaking.  I spoke with people who had lost half of their family in a matter of seconds.  They lost lifestock and posessions.  I spoke to one man who was in his late 90’s.  He had survived the last big earthquake in Nepal, the one in 1934.  In this earthquake he lost his wife, a son and two grandchildren.  He lost his buffalo and several goats.  I think that it is a privilege to offer help to people who have suffered so much.  When you multiply this level of several of suffering by the number of people who were affected it can be truly overwhelming.  The wonderful thing about medicine is that you have the ability to provide tangible physical care to individual people.  One woman with a fractured femur is a drop in the bucket in one sense, but in another it is the most important thing.  We put a rod in that broken bone.  It helped her pain and it got her up walking and back home to what remained of her family.   

Parked in the wrong place!

Dr.s McClusky and Tul

Nepal will continue to have overwhelming needs.  They need food, clean water, adequate sanitation and shelter.  This need for shelter will become even more pressing as the monsoon approaches.  It was my privilege to work with the Samaritan’s Purse team and I was impressed to see the level of competence and compassion that they manifested.  It was also great to see the commitment to sharing the gospel and working alongside the local Church in a culturally appropriate manner.  In a disaster situation, people need physical help, but I believe that even in this situation, people have a spiritual need.  They have questions, doubts and fears.  They need prayer, kindness and the good news.  It makes me proud to see that Samaritan’s Purse acknowledges these spiritual needs, even in the acute disaster situation. 

I’m back at Nyankunde, and truth be told, I’m far busier here.  Today we had a conference (topic: sickle cell disease), operated on a ectopic pregnancy, a prostatectomy, removed a fish bone from the esophagus of a lady (that was my most challenging case), chiseled away the outer part of the skull on a girl with a huge scalp wound, did three c-sections, an umbilical hernia on a child, several major debridements,  and treated a soldier who had been shot through the femur.  There may have been a couple of other case I forgot about.  We saw a bunch of outpatients as well.  This is my ongoing chronic disaster situation.  It may not be in the news, there may not be relief organizations rushing to help, money pouring in…but it keeps me busy.

Mostly I’m happy to be back home with my family.  I missed Lindsey and Emmanuel.  I love it all: our evening walk, my struggle to feed an active little boy, our evening winding-down rituals.  I love to see the new things he is doing, to feel his little tooth which is coming in.  All these things are valuable to me.  Yesterday was our 5 year anniversary, and our first as a family.   It gives me pause to consider the incredible blessings of this life.  I have a beautiful wife who loves me despite all the ways I drive her crazy, we have a child who is an incredible gift and a joy to us.  We have work that is challenging and meaningful.  We feel that God has called us to be here in this time. 

Thanks so much to everyone who has supported us and prayed for us.  I was especially touched by so many who prayed for us during the time we were apart.   You are an integral part of our ministry here and we can’t thank you enough.

Warren

Happy Boy

My coffee plantation- expecting a bumper crop!

Nyankunde from a drone

Circumstances force us to spend some time apart...

April 27, 2015

From Warren

 I am writing this from Entebbe airport, in Uganda. On Saturday I received an email asking whether or not I would be willing and available to travel to Nepal to assist with the earthquake relief efforts. Now, here I am, waiting for a flight which will take me to Doha tonight and then to Kathmandu tomorrow. 

I have been in Kathmandu a number of times and it is disturbing to see the images of devastation. Having seen the aftermath of the earthquakes in Pakistan and Haiti, I have an idea of what to expect, but there is really no way to prepare yourself. 

I have no idea where I will be working, or precisely what I will be doing. I only wish to help in whatever way I can. 

Please pray for me as I continue my journey and start working. Pray for Lindsey and Emmanuel as they stay behind at Nyankunde. There was a time when I would be very excited about such an opportunity, but I have to confess that I would rather stay at home with my family, carrying out the demanding work at Nyankunde Hospital. There are times, however, when I am needed elsewhere, and this is one of those times. 

The rest is from Lindsey

April 25, 2015

For the first time this week we were able to see our village from the air!  We welcomed a communications team from Samaritan's Purse (SP) who did some interviews and videoing of active SP projects in the area.  They took aerial shots with a drone which attracted all the neighborhood children.  Emmanuel was fascinated to watch its' flashing lights go higher and higher and finally pass out of sight.  He seemed a bit more intimidated as the drone descended coming towards him.  It is the first time I remember seeing him "cling" to me in fear.  We were happy to share our lives a bit with the communications team and pray that they will find  a story to tell here.

I have been archiving topics in my mind to blog about this past week, some medical and others non-medical.  The first is that of fuel economy.

On Fuel Economy

Did you ever stop to think about the cost to bake bread versus make chapatis/tortillas?  What goes into it?  An oven is an unusual resource here and something most people don't have.  Ovens are costly to run whether by gas, charcoal, or wood.  Imagine if everything you cooked depended on your ability to find enough wood to cook with, not just for fun like a bonfire, but seriously cooking every meal this way?  Would you burn all your wood to bake bread?  What if you had to hike up and down a steep hill to harvest this wood everyday?  I can tell you that I would probably not cook more than once/day and I would not be baking bread very often!

 It is much less expensive to use a burner to prepare a flat bread like chapatis.  This is much of the world's bread, probably for all these reasons.  People here choose the type of bean they prepare based on fuel economy (what cooks fastest).  By the way, white beans cook the fastest).  I now think about the cost of the foods I am preparing, but I am able to afford to operate an oven and a gas stove.  I have enjoyed reading the introduction of the cookbook "More with Less" that discusses the responsible use of food resources.  I recommend it as a great take-off point for cooking from scratch.

On Contagious Diseases

This week I have helped to care for a boy with probably Hepatitis A and a malnourished child with likely pertussis.  I am exposed to a host of diseases daily.  I am grateful to have some level of immunity for most of these diseases.  I do my best to wash my hands and even change my clothing when I come home to care for Emmanuel. I believe in vaccinating children and I really want my little boy to be healthy.  I struggle to understand the vaccine debacle in the United States.  It seems like a "luxury" almost to choose to vaccinate or not vaccinate.  This can't be a positive thing in the bigger social picture for those at higher risk among us.  

A Typical Day for Lindsey

My day started getting Emmanuel ready for the day and giving instructions for vegetable preparation to one of our workers.  I then made my way down to the hospital.  On any given day there are on average 30-50 pediatric patients that I am responsible for.

I first visit a sweet 1year old boy in the ER who is dying from AIDS, so beautifully cared for by his mother for the past two months.  It is heartbreaking to see that no matter what we do, anti-retrovirals, antibiotics, therapeutic milk, etc he just was too sick to come back.  I organize a care conference to talk about his condition and recommend the family to return home.  We pray together and the mother shares some deep concerns on her heart.  I have never seen such devotion by a parent in the hospital.  I am grateful for the time they have had and the healing they have experienced as a family.

My next patient is an 8mo with tetanus.  The nurses rightfully noticed that the child had less "contractions" in the calm of the night.  I talk the family into a feeding tube and know the child will lose vascular access soon.

A few other kids with malaria and the like and I am off the the regular pediatric wards.  I pass by hoards of people and children sitting and talking outside the pediatrics ward.  Many onlookers are eating morning beans and rice.

Where is our 1year old with miliary tuberculosis and complications of pneumonia?  It seems the mother has left the hospital to care for her other children as the father, a military man, is called out to the field.  I inform the health center so that they can search for her.

I see a 9year old girl with a nephrotic syndrome, still in need of high dose steroids and not tolerating an outpatient drug taper.  I don't think her kidney function is completely normally so I limit her water intake, place her on diuretics and steroids, and tell her to keep her urine over 24hours.  The lab tells me they can do a creatinine so this is helpful.

I see the other children with malnutrition...one little boy has been waiting >1 week for a transfusion with a hemoglobin of 5 (normal >12).  He looks so unwell with his big belly (ascites) and swollen extremities.  I can't wait anymore and make plans to donate blood later in the afternoon.

I see another 1year old with his first sickle cell crisis and meet with the family about how to best care for him.  We try to explain the genetics of this disease and write a prescription for long-acting monthly penicillin.  We discuss how to avoid anemia (not contract malaria and parasite) and which foods are high in iron content.

There are two children with hydrocephalous, one also has spina bifida with a spinal fluid leak from the back mass.  We discuss how surgery is a major stress to the body and how the child needs better nutrition and to be cleared of his current infection.

I make a trip to the health center to discuss two tuberculosis patients and their outpatient follow-up and to report the case of tetanus.

Then I go back to the ER to discharge a patient and I see a new mother who just gave birth with likely severe eclampsia.  She is unable to see anything and is very confused.  It is 1pm and it is time for me to get back to take care of Emmanuel.  The patient with an abdominal tumor will have to wait until tomorrow.

Three hours later I am back to give blood and look at the peripheral blood smear of a patient with suspected lymphoma.  I think I can confirm the presence of lymphoblasts.  The family will go home on palliative care as chemotherapy and advanced diagnostics are not available.  I will have that discussion tomorrow.

This is a typical day.  I am a western pediatrician working on the equator in a country where people are surviving day by day and wanting the best for their children.  As a mother now I feel things more deeply.

Pray for:

1) The injured and missing in Nepal following the recent earthquake.  Pray for Warren's safe journey to Kathmandu and that he would be a blessing and help to many in his care.  Pray for Emmanuel and I in Warren's absence as we continue on here in Congo.  He will be in Nepal for 3 weeks.

2) Pray for the ministry of Nyankunde Hospital, that we would declare the Gospel boldly as we should.


Love and blessings,


Lindsey, Warren, and Emmanuel

Never too young to start!