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.
Sunday, May 31, 2009
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.
Subscribe to:
Posts (Atom)