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.

Yeye Update

Find and update on Yeye here.

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.

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.

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.