Tuesday, February 16, 2016

Arrival

(Written 7/2/16…there is internet but it’s slow and I’ve not had much time to connect between visiting and working)

Changes
I’ve been away for as long as I was here. So much has changed, yet almost nothing has changed. I’ve changed in many ways-physically, emotionally, spiritually) and people here have changed in similar ways. The climate and the culture are still the same, which doesn’t surprise me. Things still run on “African Time” (what we time oriented people would call “late”). This can range from the expected time of arrival to an event to how long it takes to run errands. I have to remind myself when I make a “to do” list that I should keep it very short, and be happy if I get just one thing on it done each day, because errands and other tasks just take longer here. 
The last 2-3 hours of my flight from Paris to Brazzaville seemed to take FOR-E-VER. I was so eager to see my Congolese family that I could no longer rest. We finally landed in Brazzaville. All the sights and sounds of the airport were so familiar, except for the nurses handing out health questionnaires (a result of the recent Ebola epidemic, but the screening is now rather lax). The heat and humidity of the immigration area closed in on us as we joined the line to have our yellow cards checked and passports stamped. Once through, we waited with all the others for our luggage. This takes some time as though there are fully functioning belts that look quite nice and remain in working condition, the luggage is unloaded from the plane into large carts and then pushed/pulled by airport personnel to the airport, then manually unloaded. 
As we left the baggage area to proceed through customs, I dreaded taking off our 8 pieces of luggage and passing them through the x-ray scanner (a procedure I’ve found to be hit or miss-sometimes requested, sometimes not). This time, a somewhat familiar face greeted me and read my letter of invitation. He was familiar with Impfondo as his brother works at our hospital. I know his brother well, he works in the workshop, with the chaplains, and has made multiple dresses for me in the past. He resembled his brother very much! He let us through without requiring they go through the x-ray machine. 
Finally, I saw them-my “other” family-Yvonne, Octavie, and Guylvi. They had been waiting for about an hour and half by the time we got everything and saw them. Oh, it was so wonderful to see them! I had tears in my eyes! We chatted a bit and then soon were off to Hotel Bravo together, where we got to visit a bit more before they had to take off. We had some time together on Sunday, but still not as much as I would like. I will have more time to visit with Guylvi and his parents as he is coming back to Impfondo on our flight. I realized after we left that I did not get a picture of all of us together. I am sad for that. 

Saturday, October 17, 2015

Myths about missionaries

There are some commonly held beliefs about missionaries that I've noticed both before, during, and after living overseas. Some are true, some are not. I''d like to dispell some commonly held beliefs...

1. Missionaries are spiritual giants.
While we may feel called to go overseas, it doesn't mean the calling is any more meaningful than being called to work in the US, or wherever you currently call home. It also doesn't mean our theology is perfect. Often, it isn't, and we can learn alot about God from those around us, regardless of what culture we are in, if only we'd open our eyes. 

2. Missionaries have it all together.
This, in fact, is one of the biggest myths out there. Sure, it takes a lot to give up your home and familiar surroundings and go overseas. But we all have baggage, including missionaries, and it doesn't stay at the airport when you leave. Often, living overseas can exaggerate or worsen whatever baggage you have...but I think God often uses that as a way of calling attention to those sharp edges we have that He'd like to smooth over. Often, it seems God calls the most stubborn to be missionaries because there are things He knows you have to be taken out of your comfort zone in order for you to see all your glaring faults, so he can prune those unhealthy parts of you so you can grow back healthier and stronger. 

3. Working overseas is glamorous.
Sure, those of us who have worked overseas have our stories..."one time someone brought me a boa constrictor in a jerry can and wanted to sell it to me as a pet"..."I was once monkey-slapped by my neighbors pet monkey"..."we went on a jungle walk and ate fresh cacao fruit".
These stories seem great, but it's just a small part of life overseas. It's still life, just not in one's home culture. There are still ups and downs, joys and pains. Sometimes, the pains seem to come more frequently than the joys. There is conflict, more often with other missionaries than with the nationals you live among. This conflict can seriously impact the ministry you are trying to build. There are cultural misunderstandings, which at times can lead to broken relationships with those among whom you are trying to build relationships. 
If you're a medical missionary, there is much sickness and death, frustration at diseases that could be treated easily in your passport culture (where you were born and raised) but are not so easily treated in your host culture. This could be due to late presentation (coming in for care too late in the disease process to be able to treat), lack of resources/equipment to treat the disease, or lack of financial ability to pay for the needed treatment. 
There are joys as well, such as a malnourished child being nursed back to health-watching the fog in their eyes lift as their body gets proper nutrition, and then seeing them continue to do well after hospital discharge. Or the woman you admitted whom you thought would die over the weekend, and miraculously not only survives to hospital discharge, but thrives afterwards from accepting Christ as her Lord and Savior. Or the joy of seeing 1.4 kg preemie gaining weight, and discharged to home and doing well in follow-up...if only it was easier to remember the joyous occasions rather than the sad ones! 





Saturday, May 24, 2014

Interesting cases part one

For those of you a bit queasy, this post is not for you. This is for those either a)medical or b)interested in medical stories.




This is a photo depicting the leg of a young girl, I believe she is 11 years old. The probe is in her femoral vein, if I remember correctly. She presented with a swollen, painful right calf. Two weeks prior she had cut her foot on a piece of a tin can. The cut on her foot had healed, and did not look infected. We did an ultrasound to look for DVT, but unfortunately did not look high enough in her leg (only looked from about the calf down, since that is where the swelling was). The next day she was admitted to the ICU with tachycardia, hypoxia, and right heart strain. She also developed high fevers. We did a more thorough ultrasound and found a large thrombus in her femoral vein. With all her signs and symptoms, we suspected a septic thrombus. We put her on heparin, but without thrombolytics, there wasn't much else we could do except amputate the leg above the thrombus. We did an amputation of her right leg, and this photo shows the amputated portion. When we cut into the vein, there was pus that came out. She improved dramatically in the days following the amputation. Clearly the surgery saved her life. She did fairly well emotionally too. Her father has some form of deformity in his legs (I can't recall what), so the idea of a person walking with crutches for their whole life wasn't foreign to her or her family. I think this helped her to cope, and had it not been the case, I'm not sure her parents would have agreed to the surgery. Dr Lindsey is looking to see if it will be possible to obtain a prosthesis for her.


This next photo is the leg of a sweet little girl who fell at least a year prior, and sustained an open tibial fracture. Obviously it wasn't well reduced (often a result of traditional treatment), and resulted in part of the tibia sticking out of the leg. We gave her anesthesia and pulled out the dead bone you see here, then put her in a cast to stabilize the leg as the remaining healthy bone heals in. I suspect her fibula will tibialize to support her weight. 


This little boy presented with abdominal pain, fever, and a distended abdomen. While the first concern from the history was for peritonitis, further physical exam and ultrasound confirmed a large abscess between his abdominal muscles and skin, which extended down into his scrotum. It required a very large incision to drain. This photo is after several dressing changes, when it was starting to heal. Soon after, we were able to close the skin secondarily, and he was able to go home.


This young lady, in her mid 20's, sustained this ankle fracture in a motorcycle accident.  (Which is where most of our Ortho cases come from.) She presented several months after the accident. This was beyond our ability to treat, as ankle/foot fracture of this nature are a challenge even to orthopods and podiatrists. When we told her we wouldn't operate, she fell to the ground, crying and pleading that we would do something for her. Then we called in her mother to console her, and when we informed her the same news we told her daughter, she also fell to the floor and did the same. They weren't without hope, as there is a doctor in a nearby town who was willing to operate, but they were hoping they would have something done at Nyankunde.



I came in one morning to see two of the Congolese doctors attempting a D&C for a retained placenta. They were using ultrasound guidance, and found the placenta seemed to be oddly placed...very superior in the fundus, and no plane of separation. This is because she had placenta increta, where the placenta has grown into not just the endometrium, but the myometrium (uterine wall) as well. Thankfully it wasn't through the serosa (which would make it placenta percreta), as that is more difficult to treat. Kimiko and I are doing a hysterectomy in this photo.
This young 40 something year old presented with early satiety and an abdominal mass. She was also anemic and appeared mildly malnourished. The mass you see in her abdomen is her spleen. The following photo is her spleen after we removed it. I believe it weighed at least 5 lbs! It was heavy, at any rate! It's not often we do a splenectomy for splenomegaly, but in her case, it was definitely warranted.





This x-ray is from a young man who presented with shortness of breath. Diagnosis? 
He felt much better after we placed a chest tube. 


This 30-something year old man came in with a leg mass that he had for at least 2 years. It has progressively increased in size. We offered to do surgery to remove the mass (it appeared well-circumscribed, no boney involvement) but he never returned for surgery. I'm not sure if he was still looking for money to have the surgery done or he decided to go elsehwere.