Alili

"So, how did you get shot?" I asked the 12 year-old boy in front of me.  I had heard what had happened, but I wanted to get his account.  Here is the story he told me.  His family had lived in a village called Niania.  At about three in the morning, they were awakened by people shouting and gunfire.  His father went to the door and was shot and killed.  His mother was also killed.  I didn't ask too many questions.  Sometimes you don't want to hear all the details.  It was unclear who the attackers were.  12 year old Alili tried to hide but he was struck by a stray bullet which passed through the shoulder.  He fled into the bush, bleeding and terrified.  He stayed hidden for a week.  He ate cassava and raw sweet potatoes which he found in the fields.  His arm became gangrenous.  I can only imagine the horror and terror that he lived through.

An uncle did not find Alili's body in the village and he went searching.  He finally found him and brought home home.  More than a week later he finally received medical care and underwent a "guillotine" amputation (exactly what is sounds like) at the level of the shoulder.  Some time later he was sent to Nyankunde for management of the dead scapula which was protruding from the wound.  

It was a close brush with death, but an even closer one was ahead.  I saw him in the ward and we scheduled him for a revision of the amputation.  It seemed like a relatively simple matter of removing the dead scapula bone and closing the wound.  Well the operation got delayed a bit.   It seemed like there was always something more urgent.  Several days went by.  Near the end of the week, I decided that we had put him off long enough, he smelled bad enough and we needed to operate that day.  I sent for the patient and was surprised to hear that he had been transferred to the ICU.  

As it turns out, that morning he had started having difficulty breathing.  He was transferred to the  ICU and put on oxygen, but he deteriorated rapidly.  By the time I saw him he was in severe respiratory distress.  Something seemed to be compressing his trachea.  To make a long story short, the bullet and the subsequent infection had caused the superior lobe of the lung to die and the infection had entered the neck and was compressing the trachea.  I opted for an emergency tracheostomy, and with a bit of luck I found the trachea, pushed way over.  I didn't have an appropriate tube, so I put an ordinary endotracheal tube in.  We were able to ventilate the patient, sighs of relief all around, but in performing the tracheostomy, I had stirred up some pretty major bleeding.  Not exactly "audible bleeding" but close.  I ended up ripping off the clavicle to ligate the subclavian vessels.  I was tying off bleeding arteries without actually knowing what they were.  

The patient had entered the OR in a state of severe anemia and he went into shock.  There was no blood pressure or pulse.  There was only one family member with Alili and he had an incompatible blood type.  I asked the blood type...B+. Oh well, time for me to give again.  I asked for an empty blood bag and poked the huge needle into that little scar in my left antecubital fossa.  I've stuck it so many times that I have no nerves working in that area and I feel no pain, just the slight queasiness of sticking a needle into my own body and watching the blood flow.  I had just stuck myself and was sitting down, when Ayiko, the head anesthetist told me not to bother.  It wasn't worth wasting my blood.  He's usually pretty optimistic, and usually pretty accurate.  I decided that I'd come that far, I might as well continue.  

As soon as I'd filled up the bag, I pulled the needle out of my arm.  There was only a tiny IV in his hand.  We needed something bigger.  I got the ultrasound machine, located his jugular vein and stuck a 16 gauge IV in.  Unfortunately the puncture site in my arm had not yet clotted and I was dripping blood all over the table and floor.  One of the other doctors grabbed a gauze and held pressure on my arm until I had fixed the IV in place.  We poured the blood in.  I squeezed the bag and got it in in a couple of minutes.  Alili came back to life.  There's no other way to put it.  He started breathing again, his pulse came back, and he opened his eyes.  

Since that day, he's actually done quite well.  We got the tracheostomy tube out after a day or so.  We took him back to the OR to remove the scapula and pull the wound together.  He looks a bit funny, but he is doing well.  After all he's been through, I've kind of concluded that he is a tough kid.  He is still missing a good portion of one lung and he still has a large infected wound, but he's alive.

Anyway, I don't have any real conclusions to make.  It was a case that moved me.  This kid has suffered more than I can imagine.  He has been so close to death, but he seems ok.  He smiles, he laughs, he's really a pretty cute kid.  This can only be the grace of God.  For me it is a reminder to go all out, to not give up easily.  We've had a lot of disappointments in the surgical department, a lot of death.  Still, there are those cases which make me believe that it is possible to make a difference.  

Right now, I'm sitting in the airport in Entebbe, Uganda.  In a couple of hours, I will get on a plane and return to the US.  It is a focused trip.  I am bringing back some endoscopic equipment that needs to be repaired.  I'm hoping to learn how to do service and repair of this equipment.  I'm not looking forward to going back alone, and I already miss Lindsey and Emmanuel.  I'll be back in Uganda in about ten days and then we will spend a couple of days together in Uganda before returning to Congo.  

Pray for us as we give our blood, sweat and tears.  Pray for Alili, that God will comfort him and give him the strength to go forward.  

Warren

Father's Day & Recent Novelties

June 17, 2016

Happy Father's Day to all of you dads (spiritual and otherwise)!!!  I am grateful for my father and the husband the Lord has given me.  Emmanuel absolutely adores his father.  I come home so many days to see them rising the tractor together, playing in the woodshop, watering the garden, or playing with the dog.  He hears his motorcycle coming home from the hospital and he says, "Daddy!"  I enjoy hearing them sing and talk together.  What a great calling it is to raise children who know Jesus.  "The father of the righteous will greatly rejoice; he who fathers a wise son will be glad in him"  Proverbs 23:24.

This last month has some random novelty worth mentioning.

 

We ate our first wild guinea fowl!  It was quite good.  Our night watchman trapped it for us.  They are beautiful birds and like to pillage peanut fields.  

Last week one of our teammates had a really severe reaction to malaria, what looked like anaphylaxis.  He is finally feeling better and we are so grateful.  I am learning that malaria can present itself in almost any way!

We praise God for our first case of successful pediatric resuscitation after circulatory/ respiratory arrest.  It has been a rocky road of recovery for this baby, but we are so grateful for his life.  We still don't know exactly what happened.  I do know, however, that we are seeing some very strange presentations of cerebral malaria as well as handicaps afterwards. 

We set up our first above ground pool in the yard and had a first swim this past Sunday.  The crazy part is that

our newly renovated water system can support having a pool (at least in the wet season).  Emmanuel had such a fun time!  He likes being able to touch the ground and float around.  We look forward to some fun times with kids having the opportunity to swim.  I remember how many fond memories I have as a child swimming and I want the same for Emmanuel.

These have been difficult days in the hospital with so many complicated cases.  People come for care so late and often as a last resort after they have been to traditional healers or been operated on by an unqualified person.  We struggle to know how to handle the needs.  Some people live and others die.  It is hard to know how hard to try...and when it is ok to say "stop."  Both Warren and I struggle to experience joy in the daily experience as we slog through it all.  I need to remember and claim the promises of God.  It is a deliberate choice to give thanks and rejoice for He is always good.  We need to remember continually that the "Joy of the Lord is my strength," not in a trite spiritual sense but in a deep, gut-wrenching battle sense.  

I have been learning about "Joy" and the need to claim it.  Everythings can literally be falling apart around you and you can still claim joy in God's presence.  I am learning that rejoicing is a choice and direction of our hearts.  There is always something to rejoice in.  Even simply that we walk with The Lord, that we can talk to Him, that He accepts us, and forgives us.  Joy is also incomplete in this life and will be made perfect in eternity when we walk firsthand with God.  

Do you ever feel like you are from another planet?  Some days I feel this way.  Leaving my house in the morning

is life stepping out of a spaceship on foreign terrtain.  Other days I feel very much at home out of my element.  Some days it just seems that the educational and cultural barriers are too hard.  At times I forget these differences and speak with ease in my funny Swahili.  Often I laugh and cry with my patients.  Occasionally I can be speaking the same language as a family, yet it still seems that people are tuned into a different frequency.  I have felt special bonds to many of my patients and families...yet other times I feel estranged from their beliefs and worldview.

I suppose all of this comes with cross-cultural living.  We are different and we come from a different language and culture.  We have the unique challenge and honor of being moulded by a different culture.  I can accept that there will always be things that I do not understand, or, as Warren so often says that I will never understand the whole truth around something.  I will always be a bit of an alien.  But I do hope to come closer to understanding where people are coming from and to communicate effectively.  People across all cultures need to be understood and loved.  I can get my mind and heart around this.  I can speak the language of love.

Blessings,

Lindsey

MPEC

MPEC (pronounced "empeck") is an acronym that I've come to know and fear.  It stands for "Meilleur prise en charge" (better care).  This is the most common reason for transfer to Nyankunde from another hospital.  What MPEC means is basically that the referring physicians have no idea what to do, that they've performed a number of detrimental operations and that they're afraid that the patient will die on them.  This week I've dealt with a number of MPEC cases.  A note to the squeamish; each of these cases involves stool leaking.  An alternative for you would be to skip the text and look at some of these nice, happy pictures.  

The first is a young healthy man who was shot.  The bullet went in one hip and out the other buttock.  It shattered his hip and blew a hole in his rectum.  This is a devastating injury and generally requires diversion (creation of a colostomy) to prevent further contamination.  This was not done and they patient underwent a "non-therapeutic" abdominal operation.  He came to us a week later.  We did a colostomy and drained the wounds.  We eventually ended up doing a very high amputation of the left leg.  He is septic, anemic and malnourished.  It's a bad combination.  He smells like rotting flesh.  We're doing the best we can, but I doubt he will survive.  

Patient two is a lady who underwent a c-section.  Unfortunately they left a surgical sponge in her.  A week later they figured it out and reoperated on her.  It's a bit unclear how, but they left her with three or four holes in her bowels.  She was sent here for MPEC.  We have operated on her once, but she's still leaking stool from the wound.  Her intestines are all stuck together, and the more you try to free things up, the more they tear.  

Another patient we treated this week had been operated on three times for an intestinal perforation from Typhoid fever.  We've operated on him twice, finally doing a diverting ileostomy.  I am not optimistic for his survival. 

The other patient came in today, a week after being shot in the abdomen.  He was operated on in another hospital, but they failed to find the hole in his intestines.  He is now (guess what?) leaking stool out the bullet hole.  

These cases are so frustrating.  They illustrate the desperate situation of surgical care in Eastern Congo.  The problem is not the lack of surgical care, but simply poor care.  I can't really blame these folks.  They are inadequately trained, they work in facilities with poor anesthesia and lighting.  They do the best they can, but it's not enough.  After a couple of unsuccessful operations, they transfer them here.  MPEC.  It's discouraging to have to deal with the complications of others.  It's painful when they die.  I wish they got here a bit faster.  They have usually been deteriorating for a week or so before they arrive here.  My hope is that our doctors in training will pick up the skills necessary to avoid some of these complications.  That is also a challenge.  I get these trainees for two months.  It's not enough time.  

Lindsey has spent her days doing battle with malaria.  It's now the rainy season and malaria stalks these kids like a lion.  A healthy child can deteriorate and die with shocking speed.  I believe they have around 70 kids in the hospital now, and many of them have malaria.  Hardly a day goes by when she doesn't lose one.  The deaths are mainly due to cerebral malaria with severe anemia.  She deals with these tragic cases, them comes home and hugs Emmanuel with a strange intensity.  We struggle with giving him malaria prophylaxis, but come hell or high-water she manages to disguise the bitter taste of Mefloquine and get it down.  They say that deaths from malaria are decreasing.  We're still waiting for that magical anti-malarial vaccine.  Bill and Melinda have poured plenty of money into it...  In the meantime we continue to treat and transfuse.  We continue to see those sad little bundles carried out of the hospital by wailing moms.  This kind of stuff takes a toll on you.

 

Our life, however, isn't all death and disasters.  The climate is pleasant and the landscape is incredibly green.  We've had some of the most amazing sunsets ever.  We take a walk in the evenings and the clouds are magnificent. I've been working on various projects. My latest one has been to make a trailer out of an old Land Rover chassis that I found hidden in tall grass. It's a bit funny looking, but it's going to be great.  I can at least tow it behind the tractor and takes the kids on a hayride. This week I actually took a day off from medical work to concentrate on some administrative challenges and technical problems. A day with no surgery!  It was kind of nice. The highlight of our days is simply watching Emmanuel grow. He is starting to talk a bit. He knows a lot of words and it is a relief to actually be able to communicate a bit. All parents think this, but he is such a pleasant, fun little guy!  It is amazing to think that God gave us such a gift. 

Thanks to those who have prayed for us and supported us in various ways.  Without your help we couldn't be here.  Please do pray for this desperate country. 

Warren Cooper

Mangoes in May

May 16, 2016

I love the month of May.  I love flowers blooming, trees budding, celebration of Mother’s Day, mangoes in abundance, memories of our wedding day.  Everything is quite green here at Nyankunde!  Sunsets are stunning through the rainy season cloud formations.  I am reminded again that we live in the beautiful place and of the many things God has blessed us with.

Celebrated our 6th wedding anniversary this May

Malaria Season & An Unusual Case

Malaria season has completely EXPLODED!  Our pediatric service has over 70 patients at the moment.  It is a challenge to see every child every day.  Most of the children are recovering nicely, but some are not and it is really necessary to see even the straightforward cases.  I am thankful for the help of Dr. Patrick LaRochelle who is a med/peds doctor who is helping with the increased patient load.  He was looking to be more involved in pediatrics and now he has his wish! 

I continue to be amazed at the interesting cases and complicated pathology we see everyday.  I am caring for a young boy with a complicated heart condition called Ebstein’s anomaly (malformed tricuspid valve) that results in very small ventricles.Over time children experience profound symptoms of heart failure.  This young boy also happens to have signs of abdominal tuberculosis with a huge abdomen such that he looks 9-months pregnant.  On admission he was having a lot of abdominal pain and difficulty eating.  He essentially was not able to walk due to his large abdomen.  Now he is able to eat, is gaining weight, and is not having abdominal pain.  We are really hoping for good recovery and for him to return home soon.  He will have to live with his symptoms of heart failure, given the risks of cardiac surgery which are far too great.  Pray for his recovery.

Running on Solar Electricity

In rainy season we test our solar system capacity to the limit.  We are at the limit!  Warren is quite adept at finding solutions to our power shortages.  I appreciate how handy he is and am learning a lot myself.  Our home shares electricity with the guesthouse next door and facilitates a VSAT for three households so it really is important that we have consistent power.  The hospital recently installed 20 new solar batteries, gifted by a church in Switzerland.  This should significantly improve our power problems.  In the US most of us simply switch on the light switch and don’t give a thought to how many watts we are using.  A few years ago Warren was shocked at how many Christmas lights I had installed on our Christmas tree (exceeding 1200 watts).  It was the equivalent of running a high-powered mixer for hours.  In Congo we use low wattage bulbs and try to conserve appliance use as much as possible (..I still have low wattage Christmas tree).

Emmanuel Minute

Emmanuel continues to advance in his language skills.  I think he understands much more than he speaks in English, French, and Swahili.  Now when we look at books he points out the sun, moon, bears, bunnies, water, twiga (giraffe), tembo (elephant), simba (lion), babies, mommas, daddies, fish.  It is quite entertaining.  We sing a lot of songs to learn words.  It will be really interesting which language he masters first and then how he will choose to use the other languages surrounding him.  We are really enjoying this chapter of parenting.  I will keep working on “I love you Momma.”

I am often reminded that every day is a gift.  Sometimes simply preparing food for the evening and taking care of Emmanuel can be time consuming.  It can feel like  a stretch to get everything done and the laundry put away.  Yet despite the busy work, having a child forces you to take a step back and smell the roses.  Some days Emmanuel literally pulls up my meticulously planted herbs to smell them.  I can’t get too upset with him when I see his cute grin.  I love that he is discovering his world, even my herbs!

Projects & Ministry Support

We have a lot of projects going on around the house and guesthouse.  We are completing a foundation behind our house to be used as a play area and gazebo.  We plan to plant additional fruit trees and flowers in the surrounding lawn.  We are planning to design a nice outdoor wooden table with stools.  One of Warren’s gifts is adapting his environment for greater functionality.  I love this and am a direct beneficiary. 

If you would like to be a ministry partner, we would love to hear from you.  We anticipate some significant costs to replace a set of solar batteries in addition to a recently repaired water line to the   These are all necessary maintenance costs to continue living here.  We are hoping to raise funds to buy a vehicle over the course of 2016.  We continue to pray about these things and let our support base know.  You can contact us at: warrenandlindsey@gmail.com or through Christian Health Service Corps at:  http://www.healthservicecorps.org/moto/dr-warren-and-dr-lindsey-cooper-

Blessings and love,

Lindsey (Warren & Emmanuel)

Bridges are a huge problem, trucks actually go through!

Emmanuel with Lukas Folmer