Friday, September 27, 2019

Coping with loss, living with hope.

We gain lots of things coming here, including the experience of loss. Eliel, just days before his 6th birthday, had fallen in love with his sweet Bunny. He tenderly cared for him, hunted for green leaves even in dry season, and would share stories and draw pictures of his friend every day. Suddenly Bunny took ill, and in a matter of hours we watched Bunny die, helpless and disbelieving. After local fashion, we buried him on the same day, surrounded by friends, there to help carry Elie's grief. It's been several weeks now, and Eliel still talks about Bunny, his memories. Death, very real to us, continues to be ever present. But today, as I sit here listening to the deafening pounding of first rains and the shouts of joyful children, I'm hopeful. We are thirsty: He is the Living Water.

Our neighbors and neighborhood.

 Gentlemen waiting outside their brother's room on men's ward. We love meeting our neighbors!
Sunset at Rio Kukala (our local creek). 

Friday, September 06, 2019

Biology, bigotry and the blood of Jesus.

 Last week we walked to church through the woods, passing a small cemetery covered by the graves of all the new borns who die at our hospital… and lastnight I wrote a review for a government epidemiologist of the 7 maternal deaths the hospital had in the first 6 months of the calendar year.When asked what our “numbers” for neonatal mortality, I reply grimly “I don’t know, a couple a week, I’ll have to go count.” Daniel is at the hospital right now preparing for a cesarian delivery and rationing out our magnesium sulfate to another eclamptic lady, this one just arrived from an outside hospital and has been seizing for 3 days.

Home deliveries gone awry, septic infants, premature babies, anemic, febrile, infected. Mothers seizing from eclampsia or malaria, febrile from disseminated TB or schistosomiasis, hemorrhaging from placenta previa or abruption, septic from their uterine rupture or concomitant typhoid perforation… this happens all the time. 

But it's not all heavy. We have fun moments where our odd homeschooling strategies and patient care sometimes work out well together! Let me tell you about one such case: 

Last week Monday I was carrying for a lady with a septic abortion who was anemic, with a Hgb < 4. We treated the infection, removed the retained placenta… but she still needed blood. I left family with the task of finding someone to donate blood, and went home, praying. Tuesday morning is a school day for me (meaning I magically become a kindergarten and 2nd grade teacher) but at breakfast I got the distressing news that the young woman, whose family is from “the bush,” only had elderly ladies with her and were unable to donate. So after our math assignment, I told the kids we were doing our science experiment early. We we walked over together (along with our dear friend Luis, who does school with us) to “Hemoterapia” (our “Blood Therapy” ward) where I donated blood. We then walked over together to maternity… everyone taking turns carrying the bag of fresh warm blood. The boys were interested; Naomi, seriously worried. “Are you going to die? How can Philadelphia blood mix with Kalukembe blood? Are you strong enough right now?” She scowled watching the blood being given to our young lady, worried for a bit, that this life-giving blood was going to take my life. But in the end I laughed, picked her up, and we skipped out of maternity together. On our walk home we all had a sweet talk about biology (how amazing our bodies are!), bigotry (how we are all the same inside), and the blood of Jesus.

And guess what? Just like that she got better! I showed the kids her smiling face on the day of discharge and we all celebrated, even Naomi. This week we also re-double our efforts to prevent maternal and infant mortality. We restarted our ultrasound outreach (funded by Hope for our Sisters), where we invite ladies to come for a free prenatal ultrasound (usually costs a day laborer a week’s wage). It is sweet to give surprise notices of twins… but it is also a time to counsel risks. In three days we did 47 ultrasounds… a small step, but worth celebrating too. 

II Corinthians 5:14-15

For Christ’s love compels us, because we are convinced that one died for all, and therefore all died. And he died for all, that those who live should no longer live for themselves but for him who died for them and was raised again.

Wednesday, September 04, 2019

Scenario 1

Update from Kalukembe! We have been here for a month and a half; Priscila continues with multiple tasks including homeschooling, caring for guests, caring for patients including reinitiating care for women with vesicovaginal fistulae, thinking up new ideas for projects for the family and hospital and home. I continue in my moral support with occasional skeptical commentary. 

Imagine this coming out of the liquid that bathes your brain and spinal cord. I can't. The 9 year-old boy that I drew this fluid out of had been sick for roughly a month, getting various treatments, including an assortment of antibiotics (though none likely were properly prescribed or taken), traditional medicines and then in the last week, his condition worsened. Pus drained out of his ear, he mounted persistent high fevers, and his neck grew stiff. His father took him to the municipal hospital across town but they told him they could do nothing and sent the boy to us. That day when his father brought the boy to our hospital, he no longer could talk and could only moan, eyes wandering in separate directions. His father was clearly concerned, but it was already too late for us to save the child. Even with the right antibiotics, antimalarials and judicious IV fluids--for a malaria rapid test positive, smear negative result (and this LP test was just done out of curiosity how the lab would interpret the liquid), the boy died 2 days later in our ICU.
The story's like this boy's played out for at least 6 other babies and children this past week. . . treatments at home or in some nurse's clinic that don't show improvement and then the parents bring their child unconscious to our hospital. After expending their time, money and efforts elsewhere, I feel heartbroken to see the children succumb to intervenable and preventable diseases.
Government officials recently visited our hospital to look through the charts of malaria deaths recorded here year-to-date (almost 90). Apparently, only 2 deaths were recorded due to malaria last year--clearly something off with our statistics. It overall seemed to be a good learning experience, for the hospital to be reminded to maintain better records of what happened to patients and improve diagnostic clarity. We all have much to learn in caring for our sick. I should be the first to admit I miss the mark to be compassionate and competent with each and every patient. I pray God will give me and my colleagues the desire for whole healing of our patients and families. It's for His goodness sake we seek healing.