I’ve never been so glad to see puss in my life. One of our friends recently brought her toddler to see us. The little girl, Chantal, had a firm mass on her neck, extending from the right side of her chin, to her right ear. The mass seemed to be originating from the mandible and was non-tender. Though she had a URI the week before and had been running fevers ever since, the mass did not seem to be an abscessed lymph node. We feared that Chantal had the most common type of childhood cancer here in Cameroon, Burkett’s Lymphoma. Though curable with chemotherapy, treatment would be impossible in the bush, and treatment in a hospital would be a logistical nightmare and quite traumatic for both child and mother. Non-compliance was probable, and without treatment, she would certainly die.
In desperation, we gave her some antibiotics and told the mother to continue hot soaks, hoping that we were wrong and it was, quite simply, an abscess. Two days later she came back, and we still had no answers, though we were happy to see that there was no detectable growth in the mass. Some further research revealed that Chantal did not fit the normal age parameters for Burkett’s Lymphoma, but we could not dismiss the possibility.
Once more she came back and we saw that the mass was coming to a fluctuant point that was now tender and reddened. With hope renewed, we performed an I&D. What a relief it was to see puss draining from this toddler’s neck. Unfortunately, after a painful procedure like that, it will be a long time before she ever trusts us again.
Sunday, September 20, 2009
Out of Options
How I would love to have an x-ray right now. Several days ago a small patient was brought to us. We were told that this 6 or 7 year old girl had been running and fell, injuring her right leg. Her name is Libala Justine.
It was dark out, we had no good place to examine her, and she was very scared and unable to tell us where she was hurting or how she was hurt. It seemed that even the smallest movement caused her more pain. Her left shoulder was painful, with a small deformity and some neurological deficit in the arm, suggesting either a dislocation or a break of the proximal humorous, but she was using her arm in spite of the pain. Her back was also injured; the left thoracic region of the ribcage was quite painful and swollen with sharp corners to the ribs on one side. She also had abrasions on her back that looked to be a few days old. But when we examined her back, the part she complained the most about was lower, just to the left of the sacrum. We were told that this is where the traditional healer removed some stones from her body. There was no evidence of abrasion and only one superficial cut, so these stones were obviously spiritual in nature and believed to be the cause of the illness. The most difficult of her injuries to localize was the one that concerned her father the most. He told us that her right upper leg was injured from the fall. We immediately suspected a femur fracture, but there was no deformity and no shortening of the bone. We moved up to the pelvis, thinking that the injury must be more proximal, but without x-ray, we were not able to find the source of her pain. Out of options for the night, we put her in a sling to stabilize her shoulder and told her father to keep her in bed.
The next morning she came back, the sling so pulled out of place that it was doing more harm than good, and her father was urging her to walk to the examination table. Our examination, this time in the light of day, just confirmed the previous night’s conclusion that we really needed an x-ray, but one was not available except in the provincial capital, and even with an x-ray, proper treatment would not be available. The best thing for her injuries was bedrest, pain medication and a lot of prayers.
We talked at length with the father, who’s story had changed from the night before, though he insisted that her injuries were from a simple fall. The injuries did not tell the same story. Libala’s behavior was equally confusing. Though our examination caused her pain, she reached out to us, the strangers, for comfort and support. When sitting up and laying down were too painful, she leaned against my chest and held tightly to my arms. Frequently I have the desire to take a patient home with me. The suspicious nature of Libala’s injuries and her need for physical affection and support made it that much harder to send her home to her own family that day. In the western world, she would have been removed from her parent’s custody, if not for the injuries themselves, then for medical neglect. In fact, as a health care provider, I could face serous consequences for not intervening on he child’s behalf. but life is different here. There is no child protective services agency. Justice, when served, is sought within the community. Children, though loved, do not have rights. This culture, when viewed from a western perspective, seems backward and just plain wrong, but with some insight and experience, one begins to understand that things are, of necessity, much different here. Qualities that are of great value in this culture are disregarded in ours and things that we hold dear are of little importance here. I was taught in missionary training that when adjusting to a new culture it is important to remember that the practices of others are not necessarily right, not necessarily wrong, but just different. Value judgments should be withheld until the culture is better understood. Though Libala must be cared for to our best ability, imposing my western ways will only make problems worse. Finding the balance is the challenge.
Last night I read the tenth chapter of Christy, by Catherine Marshal. Christy, a rookie teacher in the rural Appalachians was having trouble with some of the difficult things that she had seen since moving to this un-developed area. She considered the people backward, uneducated, violent and crude and had witnessed the consequences of ancient beliefs in the death of an infant and the neglect of a mentally ill child. She saw it as the responsibility of the mission and of the doctor to ignite change, and she wondered why nothing was being done. Christy made quite a few value judgments, but the doctor set her straight. The mountain people of Appalachia could not change quickly. There were too many beliefs and superstitions in the way. The life they lived was the only life they knew, and it was difficult to let go of it. Change had to come slowly, gradually, in its own way. And those who were to set about initiating that change had to first understand the culture and the root of the problems before uprooting everything.
In my present situation, I feel that we are out of options, but I am wrong. Soon, the Baka will understand the Gospel of Hope. Soon they will be given a different perspective, new motivation to improve their lives and their communities. When that time comes, change will happen for the better.
It was dark out, we had no good place to examine her, and she was very scared and unable to tell us where she was hurting or how she was hurt. It seemed that even the smallest movement caused her more pain. Her left shoulder was painful, with a small deformity and some neurological deficit in the arm, suggesting either a dislocation or a break of the proximal humorous, but she was using her arm in spite of the pain. Her back was also injured; the left thoracic region of the ribcage was quite painful and swollen with sharp corners to the ribs on one side. She also had abrasions on her back that looked to be a few days old. But when we examined her back, the part she complained the most about was lower, just to the left of the sacrum. We were told that this is where the traditional healer removed some stones from her body. There was no evidence of abrasion and only one superficial cut, so these stones were obviously spiritual in nature and believed to be the cause of the illness. The most difficult of her injuries to localize was the one that concerned her father the most. He told us that her right upper leg was injured from the fall. We immediately suspected a femur fracture, but there was no deformity and no shortening of the bone. We moved up to the pelvis, thinking that the injury must be more proximal, but without x-ray, we were not able to find the source of her pain. Out of options for the night, we put her in a sling to stabilize her shoulder and told her father to keep her in bed.
The next morning she came back, the sling so pulled out of place that it was doing more harm than good, and her father was urging her to walk to the examination table. Our examination, this time in the light of day, just confirmed the previous night’s conclusion that we really needed an x-ray, but one was not available except in the provincial capital, and even with an x-ray, proper treatment would not be available. The best thing for her injuries was bedrest, pain medication and a lot of prayers.
We talked at length with the father, who’s story had changed from the night before, though he insisted that her injuries were from a simple fall. The injuries did not tell the same story. Libala’s behavior was equally confusing. Though our examination caused her pain, she reached out to us, the strangers, for comfort and support. When sitting up and laying down were too painful, she leaned against my chest and held tightly to my arms. Frequently I have the desire to take a patient home with me. The suspicious nature of Libala’s injuries and her need for physical affection and support made it that much harder to send her home to her own family that day. In the western world, she would have been removed from her parent’s custody, if not for the injuries themselves, then for medical neglect. In fact, as a health care provider, I could face serous consequences for not intervening on he child’s behalf. but life is different here. There is no child protective services agency. Justice, when served, is sought within the community. Children, though loved, do not have rights. This culture, when viewed from a western perspective, seems backward and just plain wrong, but with some insight and experience, one begins to understand that things are, of necessity, much different here. Qualities that are of great value in this culture are disregarded in ours and things that we hold dear are of little importance here. I was taught in missionary training that when adjusting to a new culture it is important to remember that the practices of others are not necessarily right, not necessarily wrong, but just different. Value judgments should be withheld until the culture is better understood. Though Libala must be cared for to our best ability, imposing my western ways will only make problems worse. Finding the balance is the challenge.
Last night I read the tenth chapter of Christy, by Catherine Marshal. Christy, a rookie teacher in the rural Appalachians was having trouble with some of the difficult things that she had seen since moving to this un-developed area. She considered the people backward, uneducated, violent and crude and had witnessed the consequences of ancient beliefs in the death of an infant and the neglect of a mentally ill child. She saw it as the responsibility of the mission and of the doctor to ignite change, and she wondered why nothing was being done. Christy made quite a few value judgments, but the doctor set her straight. The mountain people of Appalachia could not change quickly. There were too many beliefs and superstitions in the way. The life they lived was the only life they knew, and it was difficult to let go of it. Change had to come slowly, gradually, in its own way. And those who were to set about initiating that change had to first understand the culture and the root of the problems before uprooting everything.
In my present situation, I feel that we are out of options, but I am wrong. Soon, the Baka will understand the Gospel of Hope. Soon they will be given a different perspective, new motivation to improve their lives and their communities. When that time comes, change will happen for the better.
Wednesday, September 2, 2009
The End of a Long Fight
While I was spending some unplanned time in the capital city, I received word that Yeye died. I’m not surprised, but it is hard to accept all the same. We’ve been caring for Yeye for the last three months. At her older brother’s request, we went to pick her up from her father’s encampment, and brought her to her brother’s encampment, just a short walk from my home. From the reports of her failing health, I expected to find a very ill child, bedbound and breathing her last breath. What I found when we showed up was a skeleton of a child, still able to walk, in spite of her severely compromised state. A quick physical exam confirmed our suspicions of tuberculosis. We expected that she would die within the week. She survived the week, though her condition was still very fragile. Each time we walked down the dirt road to see her, my ears were tuned, wondering if I would hear the sounds of the death wail as the family mourned the loss of her life. We started her on TB medications, which she could not tolerate at first, and I wondered again if she had any chance of living at all. After a short break for the sake of her weak stomach, we started the TB medications again, in addition to multiple other drugs to lessen her symptoms and improve her breathing.
A month went by, and I was amazed that her lungs, full of fluid, worked well enough to keep her alive. I was even more amazed that her greatly compromised heart continued to beat, though it was doing more than double the work it was meant to do. Her family, though they have very limited resources, cared for her the best they could.
Another month went by, and though we had seen slight improvement, Yeye declined once more as she fought the cold virus that was making its rounds in the encampment. We thought that this must surely be the end. Yet she survived even this setback.
Two weeks ago, Yeye’s brother came to tell me that she was hurting. I went to see her and found that her little heart had finally had enough. She had developed congestive heart failure. I gave her a shot of lasix to make her more comfortable and prayed that God would do his will in her life and in the lives of her loved ones. The next morning she looked much more comfortable, but she required a shot again that evening.
That night I was robbed and the decision was made to go stay with some other missionaries. On the way out, we stopped to check on Yeye. I told her where I was going and that I would be back soon. Though I didn’t expect that she would still be living when I got back, I wondered if God would choose to continue to extend her life, against the odds. He chose, instead, to allow her to die. I don’t quite understand His timing. He preserved her life for 3 months, but she didn’t live to fully understand the Gospel and its saving message. I know that God loves Yeye much more than I ever could and that He desired that she would become His child. I know that He knows best and that He does what is best for us. And I know that He is sovereign over every situation, even life and death. I don’t have to understand. I just have to trust Him and keep doing what He called me to do.
Please pray for Yeye’s family. Pray that they would see how God miraculously preserved her life during those 3 months. Pray that they would begin to truly understand God’s saving grace through the blood of His son Jesus.
Monday, July 27, 2009
The Sunday that wasn’t “a Day of Rest”
Yesterday we woke up expecting a nice relaxing Sunday with an intimate church service, an afternoon nap and perhaps a walk in the rainforest. Our expectations were never realized. I slept in a bit, and after feeding the two inside cats, stepped outside to re-hang some laundry that didn’t dry the day before. I found the outside cat, Mixie, lying at the door, panting. Thinking that she is expecting kittens soon, I assumed she was about to give birth to a litter. Upon closer examination, I discovered that she had been injured by a wild animal, her injuries including a badly broken leg. So, church was postponed in order to look up feline pain medication dosages. But while in the process of researching pain medication, we had a knock on the door…
Sufayo was patiently waiting to speak with us. My heart quickened, thinking that he may be bringing bad news about his sister Yeye, who has TB (more about her later). He must have sensed my anxiety, because he had a really hard time stating his business. When he finally found his tongue, he told us that a woman had come to have her arm bandaged. We discovered that this was the same woman that we had seen a couple times about 2 weeks ago. She had come to us with a badly infected cut on her upper arm. It was already sutured, and she was taking antibiotics, but it was infected all the same. Yesterday, I was glad to see that the swelling had gone down and that our patient was much more comfortable. Since she doesn’t speak French or Baka, but only her tribal language and some Pidgin, we instructed her, in very simple English, how to wash the wound today and told her to come back tomorrow for a dressing change. I hope she understood.
Before she left, our neighbor, Angula came to tell us that his wife had an eye infection. We reminded him that we don’t do medicine on Sundays and told him to wait until our church service was over.
We gave Mixie some aspirin and went back to our little church service. We sang some songs and were in the middle of prayer requests when we heard a knock on the door…
It was Sufayo again, this time with a whole entourage of white people! You have to realize at this point that in our corner of the jungle, one rarely sees white people (except when looking in the mirror of course), so a group of 7-8 white faces was a bit of a surprise. They were French students, in Cameroon to help at a hospital and had come to greet us and see what it was that we were doing among the Baka. They got a brief explanation of our ministry and armed with the knowledge that we were in the middle of a church service, were on their way. It was already half past noon when we finally got the sermon tape going, which was entitled, “Being Willing to be Used by God.” Appropriate. It was a long sermon, so it was 2 pm by the time church was over.
Angula showed up at Reda’s door just after I left, so she was left to tend to the eye infection. She took the opportunity to also check in on a young girl with pneumonia who is visiting from another camp. She and her family have been staying with our next door neighbor for the past 3 days in order to get treatment for her illness. Lendo and Sanda, our neighbors have been very gracious to house the visitors in their 120 square foot “house” in addition to their own grandchildren.
After a quick lunch, we all came together again to tend to the injured kitty. I tried to keep her comfortable and still while Reda tended to her wounds. The boys stood by and helped by holding flailing paws and finding the needed bandages and tape. We got her cleaned up, wounds dressed, and a splint placed on the injured leg. Mixie was a good sport about it all, only trying to give me a few warning bites in the midst of all the painful meowing.
By this time, the afternoon was nearly over. We are blessed with a satellite internet connection, but it is not always reliable and we’ve learned that weekend afternoons are the best time to hook up with the rest of the world. Not wanting to miss that opportunity, we sat down to collect and send emails. I was deep into composing my emails when we realized that darkness would be falling soon and we had not yet visited our young TB patient.
We put the internet time on hold and made the short trek to see Yeye, Sufayo’s 12 year old sister, who is fighting tuberculosis. Yeye has been teetering between life and death for the last 2 ½ months while we have attempted to treat her disease with medications and lots of prayer. We were pleased that, though her condition has been getting steadily worse for the last week, she seemed to have improved ever so slightly yesterday. In addition to our patient and her family, there were also two women at Yeye’s home, strangers visiting from another part of Cameroon. One of the women, attempting to be helpful, I think, spent our entire visit instructing us on how to take care of our patient. We were happy to be able to communicate with the family in Baka, a language the women could not understand or easily interrupt.
Then it was back home to finish up the emails and start on dinner. I was cutting up some potatoes when Noah came to my window to say that a woman had been bitten by a snake…
I found the elderly woman outside, sweating profusely and quite scared. Her foot was already swelling, but she was alert and showing no signs of shock. We did our best to stop the spread of venom by using a constricting elastic bandage and electric shock, but, as we have no antivenin, that was about all we could do. For a couple of hours we monitored her pain level and vital signs, all the while concerned about her bleeding gums, which, we feared, could be a sign that the venom had reached her blood stream. There was no place for her to stay in Lendo and Sanda’s already maxed out house, so we made a place for her and a family member to sleep on our teammate’s vacant front porch.
By this time it was 10:30 pm, and neither Reda nor I had eaten dinner. I was feeling the effects of low blood sugar, so I abandoned the planned scalloped potatoes and invited Reda over for some left-over beef stroganoff. We read about snake bites in a tropical medicine book and discussed our planned action. I slipped off to bed while Reda stopped checked on our patient one more time and gave the family some nighttime instructions.
And so ends the Sunday that was not a day of rest…
Our snake bite victim survived the night, and still looked quite strong this morning, but her granddaughter, who has pneumonia, is not getting better. We were able to find a ride to the nearest hospital for both of them with our friend, Pierre, who stopped in this morning before driving to town.
Sufayo was patiently waiting to speak with us. My heart quickened, thinking that he may be bringing bad news about his sister Yeye, who has TB (more about her later). He must have sensed my anxiety, because he had a really hard time stating his business. When he finally found his tongue, he told us that a woman had come to have her arm bandaged. We discovered that this was the same woman that we had seen a couple times about 2 weeks ago. She had come to us with a badly infected cut on her upper arm. It was already sutured, and she was taking antibiotics, but it was infected all the same. Yesterday, I was glad to see that the swelling had gone down and that our patient was much more comfortable. Since she doesn’t speak French or Baka, but only her tribal language and some Pidgin, we instructed her, in very simple English, how to wash the wound today and told her to come back tomorrow for a dressing change. I hope she understood.
Before she left, our neighbor, Angula came to tell us that his wife had an eye infection. We reminded him that we don’t do medicine on Sundays and told him to wait until our church service was over.
We gave Mixie some aspirin and went back to our little church service. We sang some songs and were in the middle of prayer requests when we heard a knock on the door…
It was Sufayo again, this time with a whole entourage of white people! You have to realize at this point that in our corner of the jungle, one rarely sees white people (except when looking in the mirror of course), so a group of 7-8 white faces was a bit of a surprise. They were French students, in Cameroon to help at a hospital and had come to greet us and see what it was that we were doing among the Baka. They got a brief explanation of our ministry and armed with the knowledge that we were in the middle of a church service, were on their way. It was already half past noon when we finally got the sermon tape going, which was entitled, “Being Willing to be Used by God.” Appropriate. It was a long sermon, so it was 2 pm by the time church was over.
Angula showed up at Reda’s door just after I left, so she was left to tend to the eye infection. She took the opportunity to also check in on a young girl with pneumonia who is visiting from another camp. She and her family have been staying with our next door neighbor for the past 3 days in order to get treatment for her illness. Lendo and Sanda, our neighbors have been very gracious to house the visitors in their 120 square foot “house” in addition to their own grandchildren.
After a quick lunch, we all came together again to tend to the injured kitty. I tried to keep her comfortable and still while Reda tended to her wounds. The boys stood by and helped by holding flailing paws and finding the needed bandages and tape. We got her cleaned up, wounds dressed, and a splint placed on the injured leg. Mixie was a good sport about it all, only trying to give me a few warning bites in the midst of all the painful meowing.
By this time, the afternoon was nearly over. We are blessed with a satellite internet connection, but it is not always reliable and we’ve learned that weekend afternoons are the best time to hook up with the rest of the world. Not wanting to miss that opportunity, we sat down to collect and send emails. I was deep into composing my emails when we realized that darkness would be falling soon and we had not yet visited our young TB patient.
We put the internet time on hold and made the short trek to see Yeye, Sufayo’s 12 year old sister, who is fighting tuberculosis. Yeye has been teetering between life and death for the last 2 ½ months while we have attempted to treat her disease with medications and lots of prayer. We were pleased that, though her condition has been getting steadily worse for the last week, she seemed to have improved ever so slightly yesterday. In addition to our patient and her family, there were also two women at Yeye’s home, strangers visiting from another part of Cameroon. One of the women, attempting to be helpful, I think, spent our entire visit instructing us on how to take care of our patient. We were happy to be able to communicate with the family in Baka, a language the women could not understand or easily interrupt.
Then it was back home to finish up the emails and start on dinner. I was cutting up some potatoes when Noah came to my window to say that a woman had been bitten by a snake…
I found the elderly woman outside, sweating profusely and quite scared. Her foot was already swelling, but she was alert and showing no signs of shock. We did our best to stop the spread of venom by using a constricting elastic bandage and electric shock, but, as we have no antivenin, that was about all we could do. For a couple of hours we monitored her pain level and vital signs, all the while concerned about her bleeding gums, which, we feared, could be a sign that the venom had reached her blood stream. There was no place for her to stay in Lendo and Sanda’s already maxed out house, so we made a place for her and a family member to sleep on our teammate’s vacant front porch.
By this time it was 10:30 pm, and neither Reda nor I had eaten dinner. I was feeling the effects of low blood sugar, so I abandoned the planned scalloped potatoes and invited Reda over for some left-over beef stroganoff. We read about snake bites in a tropical medicine book and discussed our planned action. I slipped off to bed while Reda stopped checked on our patient one more time and gave the family some nighttime instructions.
And so ends the Sunday that was not a day of rest…
Our snake bite victim survived the night, and still looked quite strong this morning, but her granddaughter, who has pneumonia, is not getting better. We were able to find a ride to the nearest hospital for both of them with our friend, Pierre, who stopped in this morning before driving to town.
Wednesday, July 22, 2009
Friday, July 17, 2009
The Miracle of Birth
Early this week, our neighbor, Ngono, came to us to say that she was having labor pains. We listened to the baby's heartbeat, confirmed that she was having significant contractions, and told her to call us when things progressed a little more. We don't usually deliver babies out here, since Baka babies are usually delivered at home without any complications, but we had good reason to be present at this birth. Ngono's birth history leaves a lot to be desired. Her first delivery was a C-section. We don't know the reason. Her second delivery was stillborn. Again, we don't know why. So, with limited resources and no facilities, we did not want to gamble with this one. Any physician in the States would have scheduled a c-section for this delivery, but we don't have that option, and the only facility equipped to handle a c-section is without a doctor right now. So, we prayed, a lot!
By uterine size, we thought Ngono was ready to deliver a month ago, and she thought she had seen some amniotic fluid at that time too, but she was only having light contractions, and the head was still very high. It would have been nice to test for amniotic fluid, but we don't have the ability out here. So, we kept an eye on her, and both mom and baby continued to do well.
Fast forward one month. Ngono leaned back against the chest of another Baka woman who supported her during each contraction. Reda and I sat with her on a double sized mattress in a room barely big enough to hold the bed. The floor was dirt and the walls were also dirt, plastered with cement. Though Ngono and her mother-in-law did their best to keep the place as clean and tidy as possible, mice peeked in at us every once in a while, and the presence of insects was evident.
Late in the afternoon, about 24 hours after Ngono began labor, birth was eminent. We waited for one little rim of cervix to slip out of the way. Attending the birth were Ngono's mother-in-law, Reda, myself, 4-5 other Baka ladies, and one small child. Needless to say, the room, only big enough to squeeze in a double-sized mattress, was crowded. Most of us piled on the bed.
Ngono insisted that she needed to use the bathroom. No amount of telling her that she was experiencing pressure from the baby's head was going to convince her. So, we provided her with a old milk can beside the bed... She squatted, buttocks pressed against the bed, knees against the wall. After a few minutes of pushing, against our pleadings, we succeeded in dragging her back onto the bed, and there was the baby's head, fully crowned. A quick moment of perineal massage. The head was delivered, the shoulders quickly followed. The apgar score would not have been good. Peripheral cyanosis, eyes bulging, no spontaneous breathing, very little response to stimulation and flaccid limbs, but his heart was beating strong. After a few tense minutes of suctioning and stimulation, we got a weak cry. Some more stimulation and his tone began to improve. I heard one of the ladies remark how white his feet were and then I heard someone say that it was a boy. By the time the umbilical cord was cut, we were confident that he was sufficiently resuscitated. A healthy little boy, a safe delivery. Thank you Lord!
The little guy, still unnamed, is 3 days old now, and I can hear him crying next door. I heard yesterday that he and his mom will be departing for her parent's village as soon as his umbilical cord falls off. Apparently she only stayed here to deliver the baby. Her husband has been gone for the last several months. It was his child from another wife who died on my front porch shortly after my arrival. It is rumored that he has sent word to Ngono to go back to her parents, because he has found yet another wife. I like Ngono. She is a hard worker, smiles and laughs a lot, and is patient with my attempts to learn her language. It will be sad to see her go.
But I praise God for the miracle of a safe delivery, against the odds, of a healthy baby boy.
Sunday, July 5, 2009
Ndae
Ndae died a couple days ago. Medically it doesn’t make sense. She shouldn’t have died. People don't die of leprosy. Her body was strong, but it just couldn’t take the last assault of infection. Spiritually it makes even less sense. Everyone is convinced it was sorcery, and after the death of 3 young women and a child, I am not surprised, and I, too, wonder if sorcery is to blame, but I can’t help thinking that this would have been the perfect opportunity for a miracle. I guess it is good that I am not God. He knows infinitely better than I do, and I cannot understand His ways. He is good, and I can be assured that He sees the suffering of our dear neighbors, even way out here in the jungle, and that He loves them much more than I do.
Wednesday, July 1, 2009
Utter Frustration
I guess anyone who works in medicine has times of utter frustration, but I am really feeling it right now. Out in our corner of the rainforest, the phrase life and death takes on new meaning. It is very common for someone to be healthy and happy one day and near death the next. In the last month, we have seen three deaths in the camp and many serious sicknesses.
Ndae is one of our patients who is seriously ill. She has leprosy and has been taking the treatment for a little over a month. Part of the risk of treatment is that one’s body may begin to react to the destruction of bacteria. That is what has happened with Ndae, and the reaction is severe. She developed painful swellings in her joints and mucous membranes. We treated her with steroids only to find out a few days later that her throat hurt so bad that she stopped eating and taking her meds. We saw first hand what the textbooks talk about when they say not to abruptly discontinue high dose steroids. Ndae became swollen all over her body, her skin thickened and began to flake off, and her eyes, which were not affected by the reaction at first, became grossly swollen and inflamed. The most frustrating part is that we had informed her of the risks of discontinuing the medication. Today Ndae’s swelling had decreased, after introducing steroid treatment again, but she developed some more complications. Her eyes, already inflamed, have now become infected. She will likely loose her sight. She has aspirated fluid into her lungs and is now fighting pneumonia. And due to the high dose steroids, she has developed psychosis.
To make matters even worse, there are stories of sorcery floating around the camp. We are doing all we can for her medically, but that is clearly not enough. We need a miracle.
Ndae is one of our patients who is seriously ill. She has leprosy and has been taking the treatment for a little over a month. Part of the risk of treatment is that one’s body may begin to react to the destruction of bacteria. That is what has happened with Ndae, and the reaction is severe. She developed painful swellings in her joints and mucous membranes. We treated her with steroids only to find out a few days later that her throat hurt so bad that she stopped eating and taking her meds. We saw first hand what the textbooks talk about when they say not to abruptly discontinue high dose steroids. Ndae became swollen all over her body, her skin thickened and began to flake off, and her eyes, which were not affected by the reaction at first, became grossly swollen and inflamed. The most frustrating part is that we had informed her of the risks of discontinuing the medication. Today Ndae’s swelling had decreased, after introducing steroid treatment again, but she developed some more complications. Her eyes, already inflamed, have now become infected. She will likely loose her sight. She has aspirated fluid into her lungs and is now fighting pneumonia. And due to the high dose steroids, she has developed psychosis.
To make matters even worse, there are stories of sorcery floating around the camp. We are doing all we can for her medically, but that is clearly not enough. We need a miracle.
Thursday, June 25, 2009
One Great Physician
There are more developments on the medical front out here. Yeye continues to fight TB with only minimal improvement, but we are pleased that God has allowed her to live this long. Pray that the medications would help her fight this sickness and that she would come to saving knowledge of our Lord.
We are also mourning our second death in the camp in the last month attributed to AIDS. Kosene was only sick for a few months, but she declined quite quickly. When presented with the Gospel on her deathbed on two separate occasions, Kosene refused. Our hearts grieve. She leaves behind two young boys, Angu and Ambili. The other young mother who died a couple weeks ago left behind a one year old daughter who is also fighting for life. Her name is Adja Noelle. We do not know if she has also contracted AIDS or if she is simply suffering from malnutrition due to her mother’s illness. Pray that her young body would gain strength and that those who are caring for her would be attentive to her needs.
Jeelo is also in need of healing and encouragement. She has been fighting a constant onslaught of illness for a few months now and is now battling a gastric ulcer and irritable bowel syndrome. She is very discouraged. Today she came to us asking her to take her to the hospital. She is convinced that she had a miscarriage and that her symptoms are complications. We ruled out the possibility of miscarriage once more and got her started on drug therapy for her abdominal symptoms.
With these recent deaths and illnesses, there is suspicion in the camp that someone is practicing sorcery against all the young women. While we don’t discredit the possibility, we know that the recent rash of sickness and death among young women can also be explained medically and that God is sovereign over spiritual powers and over medical conditions. One young woman, Ndae, who started treatment for leprosy about a month ago, is experiencing a painful leprosy reaction. She is quite discouraged and depressed and is convinced that sorcery has been practiced against her. Pray for wisdom in how to interact with her and how to treat her symptoms, and pray that God’s power would be demonstrated in her life, bringing her to knowledge of the Great Physician.
We are also mourning our second death in the camp in the last month attributed to AIDS. Kosene was only sick for a few months, but she declined quite quickly. When presented with the Gospel on her deathbed on two separate occasions, Kosene refused. Our hearts grieve. She leaves behind two young boys, Angu and Ambili. The other young mother who died a couple weeks ago left behind a one year old daughter who is also fighting for life. Her name is Adja Noelle. We do not know if she has also contracted AIDS or if she is simply suffering from malnutrition due to her mother’s illness. Pray that her young body would gain strength and that those who are caring for her would be attentive to her needs.
Jeelo is also in need of healing and encouragement. She has been fighting a constant onslaught of illness for a few months now and is now battling a gastric ulcer and irritable bowel syndrome. She is very discouraged. Today she came to us asking her to take her to the hospital. She is convinced that she had a miscarriage and that her symptoms are complications. We ruled out the possibility of miscarriage once more and got her started on drug therapy for her abdominal symptoms.
With these recent deaths and illnesses, there is suspicion in the camp that someone is practicing sorcery against all the young women. While we don’t discredit the possibility, we know that the recent rash of sickness and death among young women can also be explained medically and that God is sovereign over spiritual powers and over medical conditions. One young woman, Ndae, who started treatment for leprosy about a month ago, is experiencing a painful leprosy reaction. She is quite discouraged and depressed and is convinced that sorcery has been practiced against her. Pray for wisdom in how to interact with her and how to treat her symptoms, and pray that God’s power would be demonstrated in her life, bringing her to knowledge of the Great Physician.
Sunday, June 21, 2009
Kosene
For the last several months, we have been watching the very fast decline of a young woman in the camp. Kosene is the mother of two young boys and is not currently married. Through the course of her sickness over the last few months, she developed a very severe throat infection, lost a ton of weight, and lost a 5-6 month pregnancy. My heart breaks to say that she is likely dying from AIDS and has very little time left. Yesterday, I went to her bedside to deliver some pain medication, because that is all we can do right now. No, that is not all we can do. As a missionary nurse, though most of my time is spent tending to medical needs, my primary objective is to spread the Gospel of Christ. My teammates demonstrated how to do that with love and concern at Kosene's bedside the day before yesterday. The story of that interaction, with its heartache is here.
Saturday, June 6, 2009
AIDS takes its toll
This morning we received word that Mbele, the woman who likely had AIDS, died. She had been at Grand Pol to visit the traditional healer for a few weeks and came back yesterday. We don’t know how her baby is. If she has gotten some nutrition, she may still be living, but now the question is who will care for her and does she also have AIDS. Yesterday, we saw Mbele’s sister, Jeelo. She had some vague complaints that were hopefully related only to a viral syndrome and we gave her a refill on iron supplements. She says she is faithfully taking the papaya leaf tea that we suggested for malaria prophylaxis. I really hope that works for her. I also saw her visit my teammate’s house and come away with a small jar of white powder. I found out later that it was milk powder. I wonder if she bought it for her niece who she will most likely be caring for now.
Sunday, May 31, 2009
TB meds
We’ve been treating superinfection and trying to improve Yeye’s nutritional and hydrational status for nearly 3 weeks now, and we are finally confident enough to start the TB meds again. A few days ago, the first day of TB meds, I walked over to her home in the morning to deliver some Salbutamol. I was surprised to see her respirations in the 40’s and her heart rate in the 130’s (instead of the usual 60’s and 160’s respectively). She was sitting in her little house with the rest of the family, waiting for the morning meal to be ready, and she looked so much more comfortable, so much more relaxed. I could hear a normal inspiratory and expiratory phase, and she had less stridor than usual. I even heard some air moving in the upper right lobe. She had no fever, and she even denied belly pain. Wow!
I wondered, ‘is this what she normally looks like in the mornings or have we finally turned a corner?’ Regardless of the reason, I was grateful to see such a significant difference in her condition. I walked home thanking God! Unfortunately, my colleague didn’t get to see this improvement, as Yeye was back to normal by late afternoon when we made our daily visit. I have to assume that she experiences daily cycles, better in the mornings, and worse in the evenings and nights. Yesterday, we found a streak of black traditional medicine on her back. Her grandmother said that she started having difficulty breathing the night before, so she made medicine for her. It is hard to imagine that she could have had much more difficulty breathing than she normally has. She also had a decreased heart rate (with a possible extra heart sound?) and slightly increased respiratory rate. Is she starting to decompensate? Her lungs are so full anyway that we wouldn’t know if there was extra fluid there. However, she was fidgeting with her hands and feet, so we concluded that if she has enough energy to fidget, she must be doing better, and not worse.
Lord, Yeye does not yet know you. Please show your grace by healing her, body and soul.
I wondered, ‘is this what she normally looks like in the mornings or have we finally turned a corner?’ Regardless of the reason, I was grateful to see such a significant difference in her condition. I walked home thanking God! Unfortunately, my colleague didn’t get to see this improvement, as Yeye was back to normal by late afternoon when we made our daily visit. I have to assume that she experiences daily cycles, better in the mornings, and worse in the evenings and nights. Yesterday, we found a streak of black traditional medicine on her back. Her grandmother said that she started having difficulty breathing the night before, so she made medicine for her. It is hard to imagine that she could have had much more difficulty breathing than she normally has. She also had a decreased heart rate (with a possible extra heart sound?) and slightly increased respiratory rate. Is she starting to decompensate? Her lungs are so full anyway that we wouldn’t know if there was extra fluid there. However, she was fidgeting with her hands and feet, so we concluded that if she has enough energy to fidget, she must be doing better, and not worse.
Lord, Yeye does not yet know you. Please show your grace by healing her, body and soul.
Wednesday, May 27, 2009
Taking Inventory
The serious medical cases continue to pile up in our neck of the woods. It is not uncommon to have very serious medical cases here, but we have definitely had more than our share lately.
Today we received word that Kosene lost her baby. She was about 6 months pregnant and has been fighting a very serious throat infection for the last month. The last time she came here, at the end of last week, she was looking quite thin and was having difficulty breathing due to the swelling in her throat. We worried for her life and that she would loose the pregnancy. After receiving sketchy details about the delivery last night and Kosene’s general condition, we decided it would be best for us to go to the camp to do a good assessment. We found her in her house, very thin, looking miserable, but our worst fears were not realized as she was sitting up and conscious. She was bleeding a lot, her pulse was up and blood pressure down, and she had a boggy uterus. We gave a pitocin injection and some teaching about uterine massage to help with the bleeding and we added another antibiotic to help with the obvious additional infection that resulted in the loss of the baby.
While examining Kosene, Jelo came to tell us that she was not feeling well. Last month, we took Jelo to the local hospital with headache, fever, severe abdominal pain and a strange mass in her left abdomen. After some lab tests and some nearly non-existent overnight care, we decided to take her home, convinced that she did not have a raging infection. The mass ended up being a very large and misshapen spleen, and her malaria symptoms and abdominal pain responded, very slowly, to quinine. Her spleen reduced in size some, and she was on the road to recovery. Today, she is complaining of headache, fever, and some abdominal pain. We are treating her for malaria again, but the real question is how do we prevent malaria and subsequent spleenic attacks in the future?
We hoped also to see Jelo’s sister Mbele and her one-year-old daughter at the camp. Mbele is dying of AIDS. We first saw her in January, when she was too week to get out of bed and so very thin. When we saw her a couple of weeks ago, she quite pale and weak, but improved. Her baby, however, was no longer the healthy kid that we saw in January. She was pale and lethargic and her skin hung loosely on her thin frame. She was obviously malnourished and dehydrated, and she may have AIDS too. Her mother is simply too ill to provide her with good breastmilk. We did our best to perk her up with some sugar water and provided some high protein food for the baby and nutrition education for her ill mother. Today Jelo told us that the mother and daughter had traveled to a nearby village, most likely to seek help from a medicine man.
And Yeye continues to beat the odds and is still living, over two weeks since we first brought her back from her father’s other encampment. Her fevers are less frequent, her breath sounds are slightly improved, and the swelling in her hands and feet are completely gone. We know her nutritional and hydration status, though still not ideal, are greatly improved. But her breathing and heart rate continue to be dangerously high and her reserves are very low. The lack of hope in her face may very well be an indicator of her prognosis, but I keep praying that God would allow her to become His child before He takes her. After 2 weeks on amoxicillin, it is time to try the TB meds again. Will her already sore belly be able to handle the medications this time? With our limited resources, what can we do for Yeye, for Kosene, for Jelo, and for Mbele and her baby? Sometimes it seems like we are not doing much, but what we do, we do so that the Baka will hear of the Love of God.
Today we received word that Kosene lost her baby. She was about 6 months pregnant and has been fighting a very serious throat infection for the last month. The last time she came here, at the end of last week, she was looking quite thin and was having difficulty breathing due to the swelling in her throat. We worried for her life and that she would loose the pregnancy. After receiving sketchy details about the delivery last night and Kosene’s general condition, we decided it would be best for us to go to the camp to do a good assessment. We found her in her house, very thin, looking miserable, but our worst fears were not realized as she was sitting up and conscious. She was bleeding a lot, her pulse was up and blood pressure down, and she had a boggy uterus. We gave a pitocin injection and some teaching about uterine massage to help with the bleeding and we added another antibiotic to help with the obvious additional infection that resulted in the loss of the baby.
While examining Kosene, Jelo came to tell us that she was not feeling well. Last month, we took Jelo to the local hospital with headache, fever, severe abdominal pain and a strange mass in her left abdomen. After some lab tests and some nearly non-existent overnight care, we decided to take her home, convinced that she did not have a raging infection. The mass ended up being a very large and misshapen spleen, and her malaria symptoms and abdominal pain responded, very slowly, to quinine. Her spleen reduced in size some, and she was on the road to recovery. Today, she is complaining of headache, fever, and some abdominal pain. We are treating her for malaria again, but the real question is how do we prevent malaria and subsequent spleenic attacks in the future?
We hoped also to see Jelo’s sister Mbele and her one-year-old daughter at the camp. Mbele is dying of AIDS. We first saw her in January, when she was too week to get out of bed and so very thin. When we saw her a couple of weeks ago, she quite pale and weak, but improved. Her baby, however, was no longer the healthy kid that we saw in January. She was pale and lethargic and her skin hung loosely on her thin frame. She was obviously malnourished and dehydrated, and she may have AIDS too. Her mother is simply too ill to provide her with good breastmilk. We did our best to perk her up with some sugar water and provided some high protein food for the baby and nutrition education for her ill mother. Today Jelo told us that the mother and daughter had traveled to a nearby village, most likely to seek help from a medicine man.
And Yeye continues to beat the odds and is still living, over two weeks since we first brought her back from her father’s other encampment. Her fevers are less frequent, her breath sounds are slightly improved, and the swelling in her hands and feet are completely gone. We know her nutritional and hydration status, though still not ideal, are greatly improved. But her breathing and heart rate continue to be dangerously high and her reserves are very low. The lack of hope in her face may very well be an indicator of her prognosis, but I keep praying that God would allow her to become His child before He takes her. After 2 weeks on amoxicillin, it is time to try the TB meds again. Will her already sore belly be able to handle the medications this time? With our limited resources, what can we do for Yeye, for Kosene, for Jelo, and for Mbele and her baby? Sometimes it seems like we are not doing much, but what we do, we do so that the Baka will hear of the Love of God.
Wednesday, May 20, 2009
Yeye Update
Nine days after picking Yeye up from her father’s village, she is still hanging on. A couple days ago, she had some improvement in her respirations and heart rate, but she was suffering from nausea, vomiting, and abdominal pain, most likely from the TB meds that we had just started. Then 24 hours later, her respirations and heart rate were back up again. Yesterday, I thought I saw a slight improvement. The vomiting has stopped, though the abdominal pain is still present, her heart has slowed a little, and she looked a little more comfortable. Her hands, which have been swollen since we first saw her 9 days ago, were back to normal and the swelling in her legs and feet was slightly better. She is still moving hardly any air, but the stridor was diminished considerably yesterday. I wonder what she thinks when she hears us arrive. Does she dread taking the medication again? Does she wonder why we are so focused on what the stethoscope tells us? Up until she began with the abdominal pain, she was denying any pain. Is she telling the truth, or is she denying pain because she fears receiving yet another traditional treatment?
And I wonder what we can do for her spiritually. I simply do not have the language ability yet to minister to her spiritual needs. A teammate came with me yesterday and was able to pray for Yeye. Lord, continue to guide us in this process.
Each day, we make the 1 kilometer walk down to the little encampment where Yeye is staying. As rainy season has started, the red-clay roads are quite muddy in spots and there is one place where we leave the road to take a little foot-path for a few feet. There is a wall of green bush and trees on either side of the road, and as we approach the encampment the sound of pigs gets louder. Every once in a while we have to dodge a motorcycle or a truck piled high with plantains or wood, and often the driver stares as he goes by (it’s not very common to see white people walking along a remote rainforest road). From the moment I begin the daily trek my mind begins to turn to what I will find when I get there. My ear is always tuned, even when I am at home, to hear any sound that is out of the normal. A couple days ago, some of our neighbors came home, singing loudly. My heart quickened for a moment, thinking that I was hearing the mournful sounds of the death wail. And as I walk to Yeye’s house I listen, wondering if the wailing will begin as I approach. But she made it through, not just the first 24 hours, but nearly a week and a half. Praise God.
And I wonder what we can do for her spiritually. I simply do not have the language ability yet to minister to her spiritual needs. A teammate came with me yesterday and was able to pray for Yeye. Lord, continue to guide us in this process.
Each day, we make the 1 kilometer walk down to the little encampment where Yeye is staying. As rainy season has started, the red-clay roads are quite muddy in spots and there is one place where we leave the road to take a little foot-path for a few feet. There is a wall of green bush and trees on either side of the road, and as we approach the encampment the sound of pigs gets louder. Every once in a while we have to dodge a motorcycle or a truck piled high with plantains or wood, and often the driver stares as he goes by (it’s not very common to see white people walking along a remote rainforest road). From the moment I begin the daily trek my mind begins to turn to what I will find when I get there. My ear is always tuned, even when I am at home, to hear any sound that is out of the normal. A couple days ago, some of our neighbors came home, singing loudly. My heart quickened for a moment, thinking that I was hearing the mournful sounds of the death wail. And as I walk to Yeye’s house I listen, wondering if the wailing will begin as I approach. But she made it through, not just the first 24 hours, but nearly a week and a half. Praise God.
Monday, May 11, 2009
Yeye
After a bit of a reprieve from critical medical cases, we heard from Sufayo last night that his little sister was dying in a village about 15 kilometers from here. Sufayo had told me about Yeye before, that she had a cough, that she was really weak, and that she was loosing weight. At that time he was going to his father’s village to see her, and remembering that his mother died of tuberculosis, I recommended that he take her to a clinic to get her tested for TB. He wasn’t able to take her to a clinic at that time and since then, her condition has gotten even worse. The word that Sufayo received was that Yeye had become very weak and even thinner, that she was swelling in her hands, feet and face, and that she was not able to walk.
When my teammate was asked to go to the other village to pick Yeye up and bring her here, I asked to go along. Thinking that she would be in no shape to travel even the 15 kilometers or so by car, I brought some medications along, to make her more comfortable if we decided to let her die there.
To my surprise, Yeye was standing outside the house when we arrived. She was quite thin and pale, struggling for every breath, and swelling in her hands and feet, but she was not knocking at death’s door today. For a 12 year-old, she is quite small, about the height of an average 8 year old around here, and weighs only 19 kilograms. She has pronounced stridor throughout the lung fields and air movement only in the left upper lung. She did not seem feverish, but after I gave her some paracetamol and rehydration fluid, she began sweating profusely. I am honestly surprised that she is able to walk! Her younger siblings, who also came back with us are also ill, and I wonder if they all have TB. From a public health standpoint, it seems impossible that anyone in that house could have avoided getting TB. They have a tiny little mud-stick house with poor ventilation and only two small beds for the entire family.
We hope to get Yeye enrolled in the tuberculosis program here, but her prognosis is quite grave. Last night and this morning I prayed that she might live. On the way to the village to pick her up, I prayed for God’s guidance and that I might be able to show His love. On the way back, I praised God that she was strong enough to ride in the car. As my coworker said, “humanly speaking, she will not make it, but God can do miracles.” So, at this point, what we do medically may or may not make a difference. Lord, please communicate love through our actions.
When my teammate was asked to go to the other village to pick Yeye up and bring her here, I asked to go along. Thinking that she would be in no shape to travel even the 15 kilometers or so by car, I brought some medications along, to make her more comfortable if we decided to let her die there.
To my surprise, Yeye was standing outside the house when we arrived. She was quite thin and pale, struggling for every breath, and swelling in her hands and feet, but she was not knocking at death’s door today. For a 12 year-old, she is quite small, about the height of an average 8 year old around here, and weighs only 19 kilograms. She has pronounced stridor throughout the lung fields and air movement only in the left upper lung. She did not seem feverish, but after I gave her some paracetamol and rehydration fluid, she began sweating profusely. I am honestly surprised that she is able to walk! Her younger siblings, who also came back with us are also ill, and I wonder if they all have TB. From a public health standpoint, it seems impossible that anyone in that house could have avoided getting TB. They have a tiny little mud-stick house with poor ventilation and only two small beds for the entire family.
We hope to get Yeye enrolled in the tuberculosis program here, but her prognosis is quite grave. Last night and this morning I prayed that she might live. On the way to the village to pick her up, I prayed for God’s guidance and that I might be able to show His love. On the way back, I praised God that she was strong enough to ride in the car. As my coworker said, “humanly speaking, she will not make it, but God can do miracles.” So, at this point, what we do medically may or may not make a difference. Lord, please communicate love through our actions.
Sunday, May 3, 2009
Yaws
After last weekend’s fight for life, it was refreshing to have a relaxing day yesterday, just a few kids with some of the normal stuff, for here anyway.
Two of the more remarkable cases that we saw today were the brothers with Yaws. The older one has a large ulcer on his knee and other smaller sores on his feet. The younger one has sores all over his feet and on his hands. They both have a very high pain tolerance. It is amazing that they are able to walk with their wounds, and they don't even wince when we wash, treat and bandage them. The medical texts will tell you this is a rare disease only seen in some pygmy populations. Well, it is seen here in the Baka pygmy population. Yaws is a skin infection that causes a large ulcer called a mother yaw and progresses with several smaller lesions appearing later. Oral penicillin treats it, and, believe it or not, soap and water prevents it, 100%.
It's still hard for me to understand how a kid can grow up without being washed, at least once a week, especially in a place like this, where kids get so dirty. But water is at least a walk away, and soap costs money and seems unnecessary to some. After a recent trip where I stayed in a Baka camp for a few days, I better understand that water is a valuable commodity, not to be wasted, but I still value cleanliness. And there is more than just soap and water at play here. These kids just lost their elderly father and their mother seems to play the part of victim, powerless to make any improvements in life.
I hope that as we care for these two kids, the whole family begins understand that we love them. I hope that our love clearly reflects the love of Christ.
Two of the more remarkable cases that we saw today were the brothers with Yaws. The older one has a large ulcer on his knee and other smaller sores on his feet. The younger one has sores all over his feet and on his hands. They both have a very high pain tolerance. It is amazing that they are able to walk with their wounds, and they don't even wince when we wash, treat and bandage them. The medical texts will tell you this is a rare disease only seen in some pygmy populations. Well, it is seen here in the Baka pygmy population. Yaws is a skin infection that causes a large ulcer called a mother yaw and progresses with several smaller lesions appearing later. Oral penicillin treats it, and, believe it or not, soap and water prevents it, 100%.
It's still hard for me to understand how a kid can grow up without being washed, at least once a week, especially in a place like this, where kids get so dirty. But water is at least a walk away, and soap costs money and seems unnecessary to some. After a recent trip where I stayed in a Baka camp for a few days, I better understand that water is a valuable commodity, not to be wasted, but I still value cleanliness. And there is more than just soap and water at play here. These kids just lost their elderly father and their mother seems to play the part of victim, powerless to make any improvements in life.
I hope that as we care for these two kids, the whole family begins understand that we love them. I hope that our love clearly reflects the love of Christ.
Friday, May 1, 2009
Thankful
This morning I found myself thanking God for two very normal things; kids that hug and kids that play.
Brianna, my teammates' daughter offered me a sweet soft embrace this morning, and in the midst of that embrace I realized that I needed a loving touch from a child that was not fighting for life or suffering pain. As nurses we know that sick children need to have some positive, loving touch to counter all the painful, clinical touch that they get. Well I learned today that this nurse needs to give some positive, loving touch to healthy kids in order to balance out the clinical touch that she has to give to those who are suffering.
And just a few moments ago I heard a group of young Baka boys calling to each other from up in their playground of tree branches. Their voices were free of worries for the moment; they were simply enjoying some play time. After having listened so carefully, so attentively to the breath of a sick child, hoping to hear her call out to her mama or even gather up enough strength to cough, I was glad to hear the clear, pure voices of children at play.
Some other observations:
Treating a child in a hospital bed is very different from treating a child on your front porch, both logistically and emotionally.
Acting as a change agent among a group of people without hope is an impossible situation.
Instilling hope into a group of people who see death so often, who are oppressed and who experience suffering daily is impossible without Jesus.
Introducing Jesus to people can sometimes be a very slow and frustrating process and can only take place by carefully listening to and obeying the Holy Spirit.
Brianna, my teammates' daughter offered me a sweet soft embrace this morning, and in the midst of that embrace I realized that I needed a loving touch from a child that was not fighting for life or suffering pain. As nurses we know that sick children need to have some positive, loving touch to counter all the painful, clinical touch that they get. Well I learned today that this nurse needs to give some positive, loving touch to healthy kids in order to balance out the clinical touch that she has to give to those who are suffering.
And just a few moments ago I heard a group of young Baka boys calling to each other from up in their playground of tree branches. Their voices were free of worries for the moment; they were simply enjoying some play time. After having listened so carefully, so attentively to the breath of a sick child, hoping to hear her call out to her mama or even gather up enough strength to cough, I was glad to hear the clear, pure voices of children at play.
Some other observations:
Treating a child in a hospital bed is very different from treating a child on your front porch, both logistically and emotionally.
Acting as a change agent among a group of people without hope is an impossible situation.
Instilling hope into a group of people who see death so often, who are oppressed and who experience suffering daily is impossible without Jesus.
Introducing Jesus to people can sometimes be a very slow and frustrating process and can only take place by carefully listening to and obeying the Holy Spirit.
Monday, April 27, 2009
Sweet baby Lorel
Saturday night, April 25, 2009
Today our normal Saturday clinic hours turned into a fight for the life of a toddler named Lorel. It was obvious that she was very sick, but we were unsure why. Reda had seen her Thursday and had already treated her with antibiotics for a respiratory infection and covered her with quinine so as not to miss malaria. But today she was lying in her mother’s arms, pale, lethargic, dehydrated, hot with fever and trembling. It was the trembling that scared us the most. Though she had a fever, it was not high enough to give her seizure activity. We were looking at meningitis or cerebral malaria. Since we don’t have fancy diagnostic tests or a laboratory, we were forced to treat based on symptoms alone. Not that it is a problem; we still would have given quinine and amoxicillin.
If you have ever started an IV on a very ill child, you will have no problem understanding just how difficult it was to get a line in and just how disappointed we were when that line stopped flowing and we had to get another in.
So tonight I have several people sleeping on my front porch including a little girl hanging on, ever so loosely to life.
She has not been the only one. In the last week we have also had a 3 month old with very severe pneumonia and a young mother with high fever, headache and a painful mass in her belly. I am relieved to know that it is an unusually busy week, and that these kind of cases don’t usually come quite this often.
Lord, give Reda and me the wisdom and good judgment to make the right choices with this sweet little child and with all the other patients that come our way.
Monday morning, April 27, 2009
Our sweet little Lorel has survived her second night in our front porch PICU. Her mom has been with her the whole time, providing the best care she knows how to provide. She’s had a constant flow of visitors, and some family members have even taken up residence in a little mongulu (leaf hut) that we had made for demonstration and hadn’t been intended to actually house people. I am glad to see our little community here showing their love by bringing food to Lorel’s mom, doing some menial tasks like washing linens, and taking turns sitting with her.
On the clinical side of things, her status is still very critical. After her first night here, she showed a little more strength, but her breathing and heart rate were still far to fast and her hydration level was far below ideal. As we had lost all IV access, we had to figure out how to hydrate her and administer medication. IV’s were nearly impossible to start and almost as difficult to keep patent, and we were not to comfortable starting an IO, given the inability to keep the environment perfectly clean. We were encouraged that she seemed more alert, occasionally murmuring “mama” and reaching for her mother, but she was still not taking enough orally. So we settled for IM administration of antibiotics, rectal administration of quinine and fluid replacement by NG tube. After inserting the NG tube, it became clear that she had aspirated during the process. Our little semi-conscious patient has become a little more comatose again and is struggling for every breath. However, her hydration level has improved, and she has been free of fever and seizures for over 24 hours.
Last night was still very touch and go, as she was working so hard just to get oxygen, but I was happy to see her looking more relaxed this morning even though she doesn’t have much fight in her. Her mom is sitting up with her, offering breastmilk when she will take it and stating that she still has a strong suck. She only tolerates nursing for very short periods of time.
We’ve had 24 hours of rain and dreary weather, but this morning it is sunny and warm, lifting our spirits a little. We are praying for some improvement today.
Monday afternoon, April 27, 2009
With sadness in my heart, I report that baby Lorel lost her fight for life a couple of hours ago. She went peacefully. She stopped making urine and then slipped into a non-responsive state, and then she simply stopped breathing. The family expressed thier grief loudly and are in obvious pain, but her suffering is over.
Today our normal Saturday clinic hours turned into a fight for the life of a toddler named Lorel. It was obvious that she was very sick, but we were unsure why. Reda had seen her Thursday and had already treated her with antibiotics for a respiratory infection and covered her with quinine so as not to miss malaria. But today she was lying in her mother’s arms, pale, lethargic, dehydrated, hot with fever and trembling. It was the trembling that scared us the most. Though she had a fever, it was not high enough to give her seizure activity. We were looking at meningitis or cerebral malaria. Since we don’t have fancy diagnostic tests or a laboratory, we were forced to treat based on symptoms alone. Not that it is a problem; we still would have given quinine and amoxicillin.
If you have ever started an IV on a very ill child, you will have no problem understanding just how difficult it was to get a line in and just how disappointed we were when that line stopped flowing and we had to get another in.
So tonight I have several people sleeping on my front porch including a little girl hanging on, ever so loosely to life.
She has not been the only one. In the last week we have also had a 3 month old with very severe pneumonia and a young mother with high fever, headache and a painful mass in her belly. I am relieved to know that it is an unusually busy week, and that these kind of cases don’t usually come quite this often.
Lord, give Reda and me the wisdom and good judgment to make the right choices with this sweet little child and with all the other patients that come our way.
Monday morning, April 27, 2009
Our sweet little Lorel has survived her second night in our front porch PICU. Her mom has been with her the whole time, providing the best care she knows how to provide. She’s had a constant flow of visitors, and some family members have even taken up residence in a little mongulu (leaf hut) that we had made for demonstration and hadn’t been intended to actually house people. I am glad to see our little community here showing their love by bringing food to Lorel’s mom, doing some menial tasks like washing linens, and taking turns sitting with her.
On the clinical side of things, her status is still very critical. After her first night here, she showed a little more strength, but her breathing and heart rate were still far to fast and her hydration level was far below ideal. As we had lost all IV access, we had to figure out how to hydrate her and administer medication. IV’s were nearly impossible to start and almost as difficult to keep patent, and we were not to comfortable starting an IO, given the inability to keep the environment perfectly clean. We were encouraged that she seemed more alert, occasionally murmuring “mama” and reaching for her mother, but she was still not taking enough orally. So we settled for IM administration of antibiotics, rectal administration of quinine and fluid replacement by NG tube. After inserting the NG tube, it became clear that she had aspirated during the process. Our little semi-conscious patient has become a little more comatose again and is struggling for every breath. However, her hydration level has improved, and she has been free of fever and seizures for over 24 hours.
Last night was still very touch and go, as she was working so hard just to get oxygen, but I was happy to see her looking more relaxed this morning even though she doesn’t have much fight in her. Her mom is sitting up with her, offering breastmilk when she will take it and stating that she still has a strong suck. She only tolerates nursing for very short periods of time.
We’ve had 24 hours of rain and dreary weather, but this morning it is sunny and warm, lifting our spirits a little. We are praying for some improvement today.
Monday afternoon, April 27, 2009
With sadness in my heart, I report that baby Lorel lost her fight for life a couple of hours ago. She went peacefully. She stopped making urine and then slipped into a non-responsive state, and then she simply stopped breathing. The family expressed thier grief loudly and are in obvious pain, but her suffering is over.
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