A Miraculous Recovery & Pictures from Everyday Life

May 3, 2020

Kid in the bucket!

A Miraculous Recovery

Yesterday I saw a woman in the clinic named Dora.  She had a terrible dental infection that she had been hoping would get better. It did not and by the time she came she had a large abscess under the chin.  It was pushing up her tongue and she was very ill.  We did an emergency drainage of the abscess and she seemed to be much better.  

I was called to the hospital several hours later to see her.  She had been having more and more difficulty breathing.  I think that she may have had bleeding into the abscess cavity and her tongue was obstructing her airway.  We had an inexperienced doctor on call who did not appreciate the extent of her symptoms. By the time I arrived, she had stopped breathing and her pupils were dilated.  This is a sign of profound anoxic brain injury. We rushed her into the OR hallway and I went to the supply room.  In front of me I found a cricothyroidostomy kit.  It was 4 years expired, but I had been keeping it around just in case.  There was no need for anesthesia as the patient was virtually dead.  I got the tube in her trachea and we began ventilating her.  Her oxygen saturation came up with ventilation but she was making no spontaneous respirations.  After bagging her for an hour or so, I was about to give up.  I remembered that we had received two old ventilators on a container from WMM.  I hooked her up to one of them and it worked fine.  It was an old and very basic ventilator, but it did the trick.  

At midnight, the power went out and the ventilator stopped. The nurses bagged her for a while and then she started breathing spontaneously. This was about 6 hours after she stopped breathing.  I had fully expected her to die, but she basically woke up, started breathing  and responded appropriately. 

This morning, I found her breathing on her own, communicating and asking for food and water.  I had utterly given up hope, but here she was alive and neurologically intact.  She may have lost a few brain cells, but she seems ok.  

The airway kit and the ventilator were both gifts from Samaritan's Purse, stored on a shelf. They were procured, packed and shipped by people who care.  The ventilator was checked out by the biomed team. Even the OR is here because of Samaritan’s Purse. 

This morning Dora and her husband are praising God for his mercy.  Her four children will hear the story of how her life was spared.  She is by no means out of the woods, but she has come back to life.  In the days to come we will continue to speak with her and her family about God's goodness.  

 Few Photographs of Life

We want to share a few photographs depicting life in Congo.  This is an agricultural society.  People's ability to provide for their families depends on what they are able to grow with their own two hands.  Here are some photos showing a traditional wheelbarrow, hoe, and a mix of soybeans/corn going to the mill.  We mill our own soybeans and corn to make nutritional porridge for our outpatient malnutrition programs.

Corn and soy mix prior to milling

There is nothing quite like freshly ground peanut butter!  It is a process to harvest, shell, decorticate, and roast peanuts.  Then you pass it through this mill to make peanut butter...or you grind it by hand.  The natural oils are pressed out of the nut giving the peanut butter a very smooth texture.  There is no need to add sugar or any preservatives!

We have been growing Arabica coffee for a few years now and have had several harvests.  The berries turn pinkish/red on the vine indicating that it is time to pick them.  Then you float the berries in water to determine which ones are good and which ones are not.  Then either you can de-pulp them by hand or run them through a manual mill like this one.  Next you are left with the bean covered in parchment to be dried in the sun and then stored.  The parchment protects the bean until it is ready to be removed and beans roasted.

There is not a Home Depot around the corner to purchase tree and shrub seedlings.  We start our trees from grafts.  This takes a bit of time.  Here is a pomegranate tree which was started from a graft years ago.  Now it is producing beautiful fruit!

This is a vanilla vine growing up a tree seedling.  We planted 4 vanilla vines within 2 meters (social distancing) of each other.  This is the way it is done in the forest.  Eventually, the vines will cover the trees and cross-pollinate one to another.  It takes years to harvest vanilla pods and at least initially cross-pollination is done by hand.  I have no idea what this involves, but it is fun to learn these things!

Vanilla vine

The rainy season has begun!  Rain is a blessing and waters the plants to provide food we desperately need.  It is my prayer that we will feel more connected to creation as we tend and water the fields and animals around us.  

Psalm 104:13-15 says, "You send rain on the mountains from your heavenly home, and you fill the earth with the fruit of your labor.  You cause grass to grow for the livestock and plants for people to use.  You allow them to produce food from the earth-wine to make them glad, olive oil to soothe their skin, and bread to give them strength."  

Blessings and love,

Lindsey and Warren Cooper

A traditional hoe

A critical time

WARNING!  This blog will contain nothing about the Coronavirus. I know that in these times, there can be no other topic of concern or information which more important,  but I am going to take the bold step of actually talking about something else.  Feel free to stop reading now. 

What I would like to mention first is that our little village of Nyankunde is in a state of conflict. I won’t say the word “war”,  but the security situation is at a low point. There have been rumblings for several months. The local tribe here is Bira.  For reasons that we do not fully comprehend, a local Bira militia has been formed.  Their purpose was ostensibly to protect the local population, but whenever you mix tribal issues and bands of enthusiastic armed youth, things are liable to go astray. Go astray, they did.  There have been a number of “incidents” over the preceding months.  There were some attacks of people in the community. There were a number of murders which took place. It was difficult to get an accurate account of what was going on and why. It was hard, and still is, to understand whether this movement was supported by the local population or not.  

Anyway, things came to a head last night.  The militia had openly come into Nyankunde town for the first time, brandishing arms.  There was some incident regarding a shopkeeper who was accused by the Congolese army of supplying the militia.  The army moved in, and last night, we heard shooting in town. One Congolese soldier was seriously injured and several bodies were found around the town this morning. 

They called me to the hospital last night to see the injured soldier.  He had a thoracoabdominal wound appeared to have injured his lung and liver.  He was in shock from bleeding into his abdomen. Everyone was convinced that he had been shot. The patient himself asserted this.  There was an entrance wound, but no exit wound.  Trauma surgery is pretty simple stuff.  The question is, “where did the bullet pass and what did it injure en route.”  I got an X-ray and discovered a bullet in the left lower quadrant.  This meant that the bullet had passed all the way thought the abdomen, from side to side and top to bottom.  There was a potential for devastating injury and we took him immediately to the operating room. I opened him up and discovered that there was a wound to the diaphragm and the right lobe of the liver, which was bleeding, ...but nothing else.  I just could not figure out how the bullet ended up where it was, without injuring something else.  After some head-scratching, I ended up packing around the liver to control the bleeding, and closed.  After closing, it hit me that this was not a gunshot wounds all, but a stab wound.  The knife had cut cleanly into the diaphragm and liver.  The bullet I discovered on X-ray, had been there for years, and he had forgotten about it.  This morning he admitted that there had been a lot going on, and that yes, it might be possible that he was stabbed instead of shot.  He needs more blood, but seems to be doing fine, for now.  

Excuse the medical diversion. Our peaceful little town is now in a state of fear and confusion.  The majority of the population left. The Congolese army is firmly established in town.  The militia have reported pulled back, but it is uncertain whether or not they will attack again.  We do not know what the future holds.  For the moment we do not feel personally threatened. I feel that my presence here is needed at the hospital and it is my desire to continue to demonstrate that I wish to stay.  There is always a tendency for all expatriates to run away in time of need.  This obviously is a decision which must be carefully weighed.  There is a time when non-essential personnel should be evacuated. We are discussing what we should do as a family.  It is hard to contemplate evacuation in a time when the world seems be a on lock-down and any other place may be scarier or more dangerous.  

On a less dramatic note, I have been waging another war, against dust.  We have been embroiled in a project to redo the floors in the OR/ICU in terrazzo.  Our floors had deteriorated to a point where we could not properly clean them.  We got some funding and we have had them redone in terrazzo.  This is a durable and beautiful option, though very expensive.  It involves pouring a mixture of cement and small stones.  When it hardens the surface is ground down, leaving a beautiful surface with small colored stones.  The process of grinding down the floor puts out a fine dust powder which is EVERYWHERE!  I’ve spent the last week cleaning every surface, every window, every piece of equipment and moving them back into the rooms.  It has been an massive job and it has nearly done me in.  We are finally nearing the end, and we actually operated in the our “new” OR on the stabbed patient who though he was shot, see above. 

On the homefront we have offered shelter to two large extended Congolese families in our guesthouse.  This is a record for the number of people we have lodged.  We have 21 people in a 3 bedroom house!  There is plenty of room for cooking outdoors and a bit of a yard which is helpful for the kids to play.  Many Congolese families have sought shelter in other villages, but since the hospital side of the village is more peaceful, we are lodging these people here.

So that’s the news from Nyankunde.  It is disturbing and unsettling. All over the world, we are coming to terms with the reality that this world can be a scary place, and none of us can think that we are somehow “safe” in the bubble we have created. Here, in our troubled little village, as you are wherever you may be, we assert that we are in God’s hands and we can rest in that calm assurance of his peace.  

We appreciate your prayers and support.

Warren, for the Coopers

Riding the epidemic wave AGAIN

March 24, 2020

A funny sight... chickens perching on the parrot perch in the house.  They came in through the aviary window.

Riding the Wave

I have pinched myself a few times this last week as we read the news of the Coronavirus pandemic striking the world by storm.  I keep hoping that I will wake up.  Is this really happening?  How is it possible that countries have closed their borders and people are repatriating home? It seemed at first like a disease that was only affecting China, and now the whole world is trembling.  Even the Congolese border is now closed, as are many borders around us.. It feels like the world is riding some giant wave of unknown magnitude, with so many unknowns.  The lives of so many people has changed overnight and we are scrambling to make our own medical masks!  Even our jobs and livelihoods look less certain these days.  These are crazy times. 

This new pandemic has given me pause to look back on the last 1.5years.  We have been living through an Ebola epidemic here in DRC for the last 1.5years.  This epidemic has drastically changed our lives and caused us to mitigate risk.  I (Lindsey) chose not to provide patient care so as to reduce the risk of exposure of our son.  We were vaccinated against this terrible disease.   We don’t shake hands.  I still haven’t shaken hands with anyone for 8months since coming back.  We don’t touch patients with ungloved hands anymore.  Sometimes we have had to delay life-saving care due to the need to test patients.  We have practiced social distancing and avoided large markets and public areas for weeks on end.  We spend more time at home and less time traveling.  Our daily lives have changed in significant ways.  Ebola is not a forgiving disease-it is a deadly one if not detected and treated early.  We have learned that vaccines and novel therapies are game changers for the prevention and treatment of Ebola.  At long last, Ebola appears to be coming to a close.  In just 2 more weeks with no further cases and they can declare the epidemic is over. It has been a long haul to get to this point and we are so grateful!

Some of the same principals we have learned from living through an Ebola epidemic may apply to treating coronavirus.  Even some of the drug therapies may be similar.  Let’s hope that we can properly put on/take personal protective equipment, wear N95 masks, dispose of waste properly, self-quarantine, wash our hands in bleach multiple times a day, and identify patients with this disease early.  I am thankful in a strange way for everything we have learned.  Probably the most aggressive thing we can do is test/isolate/trace and isolate contacts. We need to equip health care workers to do their jobs safely to protect their lives and the lives of others.  Hospitals need to treat only essential conditions to avoid exposing people to the virus.  Health care providers need to cohort care to limit exposures.  We need to educate the general population from ALL angles on why it is important to limit contacts.  People need to limit their movement and interactions and consider the essentials of life.  On a community level in Africa this does not mean staying in one’s often very small house 24/7, but avoiding large groups.  Here we need to consider things like food security and the possibility that goods could become scarce.  For this reason we are planting more of the fields around us and considering how we can anticipate the needs of others.  

Now life is back to basics. Many parents need to school their kids and find new activities together.  This brings challenges, but also rewards.  We are forced to slow down our frenetic life….unless of course you are in healthcare.  If you are working in healthcare your life just got infinitely more complicated and risky and may separate you from family temporarily.  We need to pray for those in health care and public service who care for others.  We need courage for the tasks ahead of us.  We need a way to surrender our worries to God, lest they overwhelm us. He is faithful and He hears our prayers and I believe we will see His intervention.

Let’s take care of our mental health-getting outside to appreciate nature.  Let’s get enough  physical exercise.  Let’s check-in with the needs of others, help a neighbor.  If possible, let’s limit our news intake as hard as that is.

A visiting doctor

Just before the DRC/Ugandan borders closed, we were able to welcome a visiting surgeon

Dr. Peter Stafford who was traveling from Togo.  He and his family are trying to discern where they should serve as medical missionaries. There were a fair amount of obstacles affecting his trip: obtaining a “letter of invitation” with signatures from mayors/chiefs/important people in our province, a temporarily lost passport, a wife approaching her due date, the on-going Ebola epidemic, and then now the coronavirus epidemic.  Somehow it worked out and he was able to get back to Togo two days early!  We had a good time together and hopefully helped him to understand a bit more about Nyankunde Hospital, its’ history and vision for the work here.

Planting

We are getting ready to plant our fields as the rainy season begins.  Warren loves driving

Dr. Peter Stafford with our family

around the tractor and Emmanuel loves to ride along.  We are hoping to plant peanuts, soy, and corn in a couple of fields around us.  I really am thankful that our vegetable garden is starting to produce okra, onions, tomatoes, squash, and beans among other things.  Our gardener has been working hard to get things re-established since we were in the USA much of last year.  I always gain greater respect for how the Congolese

Tractor shenanigans

live off the land around us. How would we all do if we had to grow almost verything we eat?  That is how people live in this part of the world.  

A few special patients

I have a lot of special patients.  One in particular is a little girl with a protein losing kidney disease (a nephrotic syndrome).  It can be a very serious problem to treat and cause a reduction in kidney function. She has been dependent on steroids which have not really controlled her disease.  We needed to try something else.  We have had a small surplus of a immunosuppressant drug called tacrolimus which was about to expire.  Well she has been on that drug for the last month or so and seems to have better control of her disease.  In the USA, this little girl would have had a kidney biopsy and countless tests to better define her disease.  I would love to do that!  We don’t have a pathology department and it is really challenging to send biopsies out. So we treat her disease using clinical measures and she is getting better!  It is so rewarding to see her improving and getting off steroids.

One of our nutrition kids is almost 3years old and only weighs 6kg.  As a point of reference,

Mixing a corn/soy blend for our outpatient porridge

this is usually the weight of a 6mo baby.  She simply isn’t growing and is cradled in her mother’s arms most days.  She has never walked or crawled.  She simply hasn’t gained weight since birth.  The mother has been displaced from a few communities over time and her father is no longer alive.  She does not have an immunodeficiency like HIV/AIDS.  She does not appear to have cancer or a heart condition.  She does not have a thyroid deficiency.  It is more likely that she could have tuberculosis which is effecting her weight gain.  Many of the nutrition kids get better with just a little support and then there are others which confound us.  We will keep working with this little girl whose Swahili name means “Looking for peace.”

I would like to close with a song called “It is Well With My Soul” written by Horatio Spafford

In 1873.  It is a well-known hymn,a favorite of my grandmother.  It is about our hearts being at peace because of the work of Christ on the cross for our sin.  We can have a deep peace even when we go through great hardships.  A little background on the hymn’s author:  Horatio was a devout Christian and successful lawyer in the Chicago area.  He was married with 4 daughters and 1 son.  He was doing well, yet his faith did not spare him from adversity.  His son tragically died and then he lost property in the Chicago fires.  Then he sent his wife and children on a boat trip to Europe in the wake of this turmoil at home.  The ship was shipwrecked and all 4 of his daughters died.  He wrote this song when he was passing over the ocean to meet his wife, an ocean that had claimed the lives of his daughters so tragically.

When peace like a river, attendeth my way,
When sorrows like sea billows roll
Whatever my lot, thou hast taught me to say
It is well, it is well, with my soul

It is well
With my soul
It is well, it is well with my soul

Though Satan should buffet, though trials should come,
Let this blest assurance control,
That Christ has regarded my helpless estate,
And hath shed His own blood for my soul

It is well (it is well)
With my soul (with my soul)
It is well, it is well with my soul

My sin, oh, the bliss of this glorious thought
My sin, not in part but the whole,
Is nailed to the cross, and I bear it no more,
Praise the Lord, praise the Lord, o my soul

It is well (it is well)
With my soul (with my soul)
It is well, it is well with my soul

Weathering the pandemic storm from DRC.  Let’s encourage each other while today is today.

Lindsey Cooper

Bob the parrot who likes to socialize (eat) with us in the morning

Saying "goodbye" for now to some of our friends in  Kenya

Coming Back

February 19, 2020

Coming Back

Jacob our new puppy

Did you ever take a long pause from something, then return to it to find it was like you never left? I have experienced that this week after returning to consulting patients after an 18mo hiatus.  It is as if I closed one computer app and started another, to find it like I left it.  Even some of the patients/parents are the same.  The same challenges are these of providing medical care in a poor area, the same joys also.  It feels like a favorite pair of old shoes.  As I have often said the nutrition kids are like an extension of my family and they consider me a bit like a mother.  It really is a special relationship.  

It feels good to be back. I think most of you know that our family was in the USA for an extended period in 2019.  Since returning to Congo in August 2019 I have had very limited patient contact due to the possible risk of exposure to Ebola.  The risk was real, even this fall as our hospital received patients with Ebola and triaged many others for testing.  I have been teaching at the nursing school, preparing sessions with our young physicians, as well as taking on various projects like a children’s garden for hospitalized children.  I did homeschooling for our son Emmanuel as well.  THANKFULLY, for the last 1.5months there have been no new Ebola cases in Ituri Province which has opened the door for me to start providing patient care again. 

In a way, I am thankful for the time away from patient care because it has opened my eyes to other ministry opportunities and relationships.  A pediatric garden, a farming project, etc… I have been able to play a role in the rehabilitation of the hospital chapel and the installation of a memorial in photographs inside.  It is so important to consider the past in the present and honor those who have preceded us.  One sees things with new eyes after being away for a while.  It is easier to try new things.  

A Pediatric Play Garden

This week a project two years in the making is coming to fruition.  Our pediatric play garden

The beginnings

is going up!  It is very exciting to see something happen that has required a lot of planning/ordering/begging for material and funding.  It was designed for children who are hospitalized for long periods of time, especially for children in the nutrition program.  It is an essential part of the healing process to have a place to play and explore the world again.  The children have been sitting on the wall alongside the garden, looking longingly at the slide and swings.  In another two weeks they will be playing inside the garden.  I hope that it will be a pretty place and one that people want to visit and contributes to the healing process.

A couple of pediatric patients

We are currently caring for a little girl who was attacked by bees last weekend and had an anaphylactic reaction.  I am reminded that we need to always look in every orifice.  Everyday she sneezed out another bee!  Today we gave her anesthesia and pulled more bees out of her ears. She is fortunate to have survived.

There is another little girl with chronic kidney disease, a sort of nephrotic syndrome that doesn’t respond to normal treatment.  These are the conditions that you see a specialist for and probably have a renal biopsy to better define the disease.  We are limited here in our ability to analyze a kidney biopsy, so we are left with clinical management and observation.  It can seem limiting at times, but I can honestly say that it probably makes us better clinicians to make decisions in the absence  of all of these things.  For now we changes doses of steroids and we observe.

Then there is a 11mo baby with growth retardation and the beginning signs of malnutrition.  I remember the mother with short stature from previous hospitalizations with other children.  She confirmed that she had 4 girls that all died, seemingly from malnutrition.  The family is living in the village of Sezabo which has suffered from insecurity these previous days.  Life can not be easy.  Most people in the area walk to Sezabo to farm in the fields and then return to their respective villages.  We want to do everything we can to discover why this baby is suffering from malnutrition: immune status, hypothyroidism, etc so that it doesn't happen again.

The last interesting case is a young girl with an abscess between her liver and rib cage.  Very unusual location and we still don’t know why it is there.  Warren says that pain is often pus that needs to be drained.  It is very true.

On the homefront:  Jacob, the new puppy

Jacob is his name.  He is a native breed of the Congo, one of the top African breeds of dogs, the basenji.  He gains about 1lb a week so far!  I had forgotten how much puppies bite!  But he is really cute, smart, and has a nice disposition.  We hope that Emmanuel will learn responsibility in caring for his needs.  Right now we are trying to teach Emmanuel how to not overly excite the dog and be his master. We have struggled to keep dogs healthy in this environment and we are really hoping that a native breed will have a stronger immune system.

Thanks for your interest in our lives.  Pray for our little hospital in our little corner of the world, unknown to many.  Pray that the Lord might be honored in our work and ministry.

Lindsey

Fun with missionary kids

Valentines Day picnic

The slick back look

Upside down heart for Valentines Day