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.
Subscribe to:
Posts (Atom)