We just returned from another trip to Nyankunde. We were going to spend two weeks there, but we ended up spending three. The time went by in a whirlwind. Maybe it’s a simplistic way of looking at life, but I think that the more that time flies, the better time I am having.
It was a privilege to have a protégé. I was accompanied by a surgical resident. He had grown up in Congo and his program had given him the opportunity to do a short stint abroad. It was fun to watch him confront the diversity of cases that Congo will throw at you. We saw a fair amount of general surgery, but also a smattering of ortho, urology, pediatric surgery, obstetrics, etc. We had some pretty tough cases.
We did the first case right after arriving. I thought we were just going to the hospital to greet the staff, but as soon as I opened the door, I smelled an all-too familiar odor that told me we had work to do. It was the smell of rotting human flesh and I followed it down the hallway to a room where a young man lay with a very swollen leg. It was cold and pulseless and there were black patches of skin at the upper thigh. There was a sensation of gas bubbles as I pushed on his abdomen and chest. His urine in the drainage bag was the color of strong black coffee. Anyone with any medical knowledge understands that this is a very dire situation. It meant necrotizing fasciitis, “flesh-eating bacteria” if you need a more dramatic version.
Perhaps the medical story makes a little sense, but the social history made none. The story I got was that this young man was a member of the local militia. He had taken it upon himself to punish a local “sorcerer” and had beaten him. This seems to be one of the practices of the local movement, but he had apparently not obtained the proper permission for this action. As a result, the young man was apprehended and beaten severely. These beatings are no joke. This man received 250 blows, so I was told. It’s some pretty medieval stuff. His leg started to swell and he was seen by a traditional healer, who performed hundreds of tiny cuts on the skin. By the time he reached the hospital he was very sick and on the day we arrived he had progressed rapidly to the state already described. It seems a bit ridiculous to recount such a bizarre story. Do such things really happen in 2022? In Congo they do.
Without going into all the gory details, we immediately performed a very high amputation at the level of the hip joint. Over the next several days we performed progressively more radical operation to remove dead tissue, but he died several days later. It was sad, but certainly not unexpected.
There were other tragic cases. I recall the young lady who presented the a bowel obstruction and a perforation of the intestine. Throughout the entire operation she had no measurable blood pressure and we operated essentially without anesthesia. Again, it was not a surprise when she died shortly after. We saw several mismanaged orthopedic surgical cases and struggled to do what we could with the few resources we had. We saw kids with advanced tumors and struggled to explain to mothers that we had little to offer, but the truth and a prayer. We treated kids with severe infections of the joints and the bones. We saw a series of young men who had been shot. Two of them died. Treating gunshot wounds sounds like very dramatic work, but in real life it is pretty monotonous. We took off fingers, an arm, cleaned up wounds, put on external fixators and put in chest drains. We had a lot of challenging cases and we worked long hours to get through them.
In addition to the broken bodies, I found myself working on broken equipment and systems. The solar power in several areas had problems. We were able to get a donation of several solar batteries for the maternity ward, and we took the “best” of the bad batteries and distributed them around several other systems. This is the stuff that someone else should be doing, but for whatever reason, I seem to the be the man who can troubleshoot these systems, and get something to work. Most surgeons probably do not have to fix the oxygen concentrator before they can give general anesthesia for a complicated case, but that’s what I end up doing. In the end I used a small wooden plug to patch up a leak so that I could do an operation. This is all kind of fun on one level, but also infuriating. It’s impossible to do surgery if things don’t work. On the technical side the hospital is really suffering. The generator sounds rough and needs some TLC. The oxygen concentrator needs a better solution that a wooden plug. The solar energy system needs to have the right inverters in place so that our huge solar array and batteries (installed but never hooked up 😢) can be used. The panels and batteries have been sitting there for three years, but for lack of technical support have yet to produce one electron of useable energy. In the meantime we provide poor care for lack of power and we lose patients for lack of oxygen. I do what I can, struggling between cases to sort things out, but I am what they call a “bricolleur,” trying my best to Macgyver a solution with duct tape and a bent paperclip.
On the security side things are better. Though there have been alarming incidents, people seem more willing to talk and work through problems. In the past there was a lot of fear. Now there is an element of hope and a new-found determination to work things out. I am trying in my own imperfect way to be a voice for peace. I was in a very interesting meeting, involving certain community leaders, the church, hospital administration and representatives from the local militia. Though positive in many ways, I noted nearly every participant do three things. First of all they gave me a history lesson of the wrongs done to their community, but never the wrongs done by their community. Secondly they reasserted that their own tribe was known for inclusiveness, but neglected to acknowledge the obvious fact that outsiders did not feel welcome. Thirdly they decried the ineffectiveness and corruption of their own government and that of the Congolese Army, yet indicated that they were waiting for them to take effective action. I pointed out these observations and succeeding in touching a nerve here and here. I believe I’ve been here long enough, and treated enough patients on all sides to have the right to speak my mind.
We enjoyed being at Nyankunde so much. It was so peaceful and so calm. We enjoyed taking walks and climbed the ridge to our “Hill Hut”. It was fun to catch up with friends. For all the challenges it is such a wonderful place. Emmanuel loved playing with his friends, climbing trees and building forts.
For our part, we are looking to come back in early March and stay at Nyankunde. We will again be the only expatriates, but that’s ok. Perhaps our presence will give others the courage to return. You might ask, “Is it safe?” This is a hard question to answer. We feel that it is safe enough, as safe as things can be in this chaotic country. We are doing things that will help us to feel safer. We will continue to monitor the situation and adjust our plans accordingly. We believe that God is still at work in this community and we believe that the hospital has the potential to be a powerful voice for peace and for the Gospel of Jesus. We don’t want to just wait until things improve, we want to be part of that process.
Please pray for us as we return to Nyankunde. Pray for that delicate balance of wisdom and courage. Pray for us to experience and to exude the perfect peace that comes only from God. Pray for balance as we manage needs at the hospital, in the community and in the home. Pray for Emmanuel as we continue to home school him. Thanks for your support and your encouragement.
Warren, for all of us.
