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.
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