Wednesday, April 27, 2011

Photos of HELP! (Hôpital Evangelique Le Pionnier)

So I realized I haven't posted many photos of what things look like here. I finally took the time to post some photos here. Hope you all enjoy! It gives a little idea of what things are like. There are more photos I can post, but perhaps another day.
The toiletes-they build pit toiletes because the
patients didn't know how to use the flushing toilets.

The clothesline...I believe also a fruit tree.

Some of the kids of patients/visiters sitting in the shade.
Note the Colt's fan!

The courtyard of the BiBi Star.
One of the few restaurants in town.

Christine with one of the burn patients from the boat that exploded.
She was cooking on a kerosene cooker, with some tanks of gas nearby. The gas exploded, her cooker exploded, and she was severely burned.
She's made quite a bit of progress, but still has more to go before returning to her home in Central African Republic.

Hippotherapy with a boy who lost the lower part of his leg due to gangrene.
He has a ways to go, but we may be able to make a prosthesis for him out of
bamboo, plaster, and saw dust...

The daughter of one of our nurses trying to play frisbee.

Tortillas, Jempy (like Nutella), and Diet Coke. Such a treat!!

Our team on rounds. Karen was the chosen scribe because her
handwriting was most legible. 

Ginny (Chaplain) and Kyria (Physical therapist).
Also aunt and niece.

Me with Emma, one of the nurses. She keeps trying to teach me Lingala.
I'm a little slow at it. And a visual, not auditory, learner.
Appollinaire (one of the nurses) and I outside Salle de Consultation,
with a patient standing at the door to Salle de Triage

Me inside one of the containers here that we use for storage.
The right side is in the process of being sorted, the left side already sorted.

The building with the mural is the chapel.
It's a mural of the story of the men lowering the paraplegic through the roof to see Jesus.
It's the symbol for our hospital.

Me in surgery. I had just repaired a cervical and vaginal tear after a "normal vaginal delivery." 

Buildings from left to right-Pediatrie,
Medicine Men, Medicine Women's wards

Left-Post-Partum and "NICU"; Right, Maternity

One of the vehicles we use for transportation. I haven't learned to drive it yet.

"The Bloc"-Surgery (we have three operating rooms, two we really use, the third is mostly storage)

Me checking out one of the pediatric patients here...

Looking down from Surgery Men towards Surgery Mixed.
The folks at the end of the sidewalk are patients and visiters.

Looking from the back side of chapel (on left). The building on the right has
the Lab, Pharmacy, Radiology, "ER", triage, and "ICU".

A better photo of the mural on the chapel wall.

Donkey-he does our hippotherapy with some of the patients.
I've seen quite a change in the demeanor of the patients after getting to
sit on his back or ride on him. He likes to bray glad he's here and
not at the mission!!! =)

Standing outside Surgery Women and looking at the backside of
Medicine wards. The tent is no longer used for anything but trapping
heat, which it does very well.

Patients and families sitting around making meals, eating, etc.
There are several places set up as shelters for families to make food
for the patients, as well as a place to wash clothes and clothes lines,
though the trees and grass work well for drying clothes too. There are several
places where the patients can obtain clean water as well.

Sunday, April 24, 2011

Jungle Walk

One of our guides-Albert

Claire and Karen leading the way through the forrest

Can't go over it, can't go under it, gotta go through it...

Our two guides picking some leaves to sell in the market-it's the thinner vine leaves they are picking.

Cutting the vine to get the water out
Me drinking some of the water
Christine hanging from the vine-the guide pulled himself up the vine to her left-about the height of the top of the photo.
Yesterday I had the opportunity to go on a jungle walk with several other missionaries and two pygmies as our guides. It was fantastic. The forrest was much cooler under the canopy of tree limbs than out in the open sun. We are fortunate to have gone at the beginning of rainy season, as there were several areas we used as paths that will be under several feet of water come end of rainy season. Our guides stopped at various points along the way to show or talk about certain plants. For example, there is one plant they will eat the leaves if they have a stomachache. Another that is good for getting rid of worms (but only eat a little bit because it's very strong!) There were several they use for poison on their arrow tips when hunting animals or fish. There is one that you can crush up and throw into water and it will kill all the fish within seconds. Then you can scoop them up with your net, and have them to eat or sell. There was a type of vine that grows there that when you cut it open, there is water inside you can drink! It tasted pretty good! Our guides also demonstrated calls for attracting crocodiles, monkeys, and antelope. All of these they kill to eat or take to market. We didn't see any of these animals after they called for them; it was too late in the morning and we weren't deep enough in the forrest. On our way back we passed this fantastic vine and some of us couldn't resist swinging on it. Christine was able to pull herself up to a seated position on the vine! We thought we were doing pretty good until one of our guides jumped on and pulled himself up the vine  several feet above our heads, with just his hands!
Karen between two termite mounds

Wednesday, April 20, 2011

Physics & Arts and Crafts

Among the first week or two I was here, Stephen (another physician here) told me "being a medical missionary is not so much what you learned in medical school or residency as it is about Physics and Arts and Crafts."
You know what I've found? He's right.
  • Want to do a lumbar puncture? Ask for the LP tray. Go ahead, we'll get a chuckle out of it. Now go find a 21 G needle, a syringe, sterile gloves, betadine, and some gauze. If it's an adult, we do have spinal needles.
  • Want to do a thoracentesis or paracentesis? Go find a 16 G IV needle, IV tubing, and a foley bag. And a syringe if you want labs. No pigtail catheter, no vacu-tainer. If the effusion or ascites is big enough, it actually drains pretty fast.
  • Want to do surgery? Has it been sunny? Is there enough solar power for the whole surgery? Do you need a generator for more power? Who do you call to turn it on and how long will it take for him to get here? Do you need the generator that supplies 110V or 220V power?  Which oxygen concentrator goes with which power supply? If the fuse blows, how do you reset it? 
Stephen explained all these things to me when I first got here. Being as physics was my least favorite course in college, all I can remember of the electrical information is this:
"Blah blah blah...flux capacitor...blah blah blah...80 mph...blah blah blah...time travel...blah blah blah...Delorian."

Perhaps I should take a refresher course before the next time I'm on call...

Thursday, April 7, 2011

I like geckos, just not in my kitchen sink

Yesterday (Wednesday) I finished call. It was a tiring week, with many difficult cases. After completing rounds monday, Joe (the director) complemented me on my work, especially since there were quite a few patients with strange diagnoses admitted while I was on call. It was nice to hear, and helped me to feel better, though I know I still have a lot to learn. After my last post, there were still more difficult cases who came in over the weekend, Monday, and Tuesday. There was an infant born Sunday with Meconium Aspiration Syndrome, which is where the infant has swallowed some of his poop before he is born, and then gets into his lungs, where it causes inflammation. Normally when a kid is born with known meconium in the fluid, we try to suction below the vocal cords to help prevent/reduce the risk of this problem. However, things are not set up for that here. Initially he did well after birth, for about an hour, and then he started having trouble breathing. By the time I got called and arrived, the infant was breathing agonally, about 10 times/minute (50 is normal for an infant). His oxygen concentration was around 27% (normal above 95%), and his heart rate was too slow, at about 90 (normally 120-160). As I and Karen, the med/peds resident, resuscitated the baby, I prayed “Oh Lord, please don’t let this infant die. I can’t take it right now. I can’t handle it if he dies. Please let him live, and be a witness for you.” It may have been a bit of a selfish prayer for my own feelings, but it was also for the infant, the mother, and the family. We resuscitated him for at least an hour as he gradually increased his oxygen concentration to about 50-60%. He was cold when we first started, so after getting the oxygen concentrator going, we had mom hold him skin to skin to warm him while Karen got the incubator ready. By the time we put him in there, he was breathing more regularly though his breaths were still a little shallow. As his temperature normalized he improved more, but still needed quite a bit of oxygen. We took turns during the night checking on him about every hour, because we knew there is not enough nursing staff to pay that much attention to the baby. The family was also involved, making sure that if he pulled the nasal cannula away from his nose, to put it back in right away. That was wonderful to see, because sometimes they distance themselves from an infant if they fear he/she might not live. During one of my checks, I let the papa hold the infant for a few minutes. What a beautiful sight! Taking him gently in his arms, looking the infant over, with such love and care! The next morning he was still alive, with an oxygen saturation as high as 82% at times. As of yesterday, he was continuing to improve, no longer needing the incubator, and breastfeeding well. He still needs a lot of oxygen, but it helped to switch to an adult size nasal cannula to give a little more positive airway pressure (it helps open the lungs a little more). We actually started to wean the oxygen a little because he was up to 92%! Praise the Lord! 
Thank you all for all your prayers and words of encouragement. They have been a blessing to me and truly helped!!! Though I am far away from you in distance, it made me feel close in spirit. 
I want to close this post with a few prayer requests. 
  1. Continued prayer for several very sick patients in the hospital, including the infant mentioned above. There is also a little girl who has had inflammation around the brain for what sounds like three weeks according to the family. She received one dose of antibiotics three weeks ago, then the family went to some traditional healers, and brought her here Tuesday. I’m not sure what her brain function will be if she does recover from the infection, so be praying for that as well. 
  2. Be praying for the tractor to get here from Brazzaville. There are several logistical challenges, including finances for getting the tractor here. It is needed to start one of the generators at the hospital, as all our electricity is either by generator or solar. The current tractor has to be chained to a large truck and drug around the hospital grounds until it starts, and then the generator can be started. 
  3. Praise God for bringing a physical therapist and Physical Medicine and Rehabilitation physician here at the same time! They are working well together to help some of our patients with limb amputations, hemiparesis from strokes, and one child with traumatic brain injury after a tree fell on his head. They may even be able to work with our workshop here to fashion a prosthesis for the boy who had his leg taken off below the knee due to a bad infection! I’m hoping we can learn how to do some of these things so we can continue to help others after they have left

Sunday, April 3, 2011

A difficult day

   It is with a sad heart that I write this. It's been a tiring week of call, and it's just the first of many. Women delivering on the floor, a 10 year old weighing 11 kg (25 lbs) died, three cesarean sections, all of which left me soaked to the bone with sweat (I literally had sweat drip off my fingers when I took my gloves off afterwards, one of those sections was for a placenta previa. The infant was alive when she came in, but by the time we got to our "STAT" cesarean 2 hours or so later, the infant was dead. 
   Last night a woman who had been here for mastitis, and was getting better, had a seizure with a fever to 39C (102F). After 30 minutes of seizing, we finally got them to stop. We gave her antibiotics and anti-malarial medications. She was non-responsive last night, but it was soon after she had received diazepam. This am she was still non-responsive (not a good sign). Then, I was in the middle of seeing a man who came in with tetanus when all of a sudden the family of the patient behind me started wailing. I turned and realized the patient was dying. I started chest compressions after I didn't feel a pulse. The nurse kicked the family members out of the room, but I could still hear them wailing outside. I asked for the nurses to get an ambu bag, adrenaline and atropine. He fumbled to find the correct size of bag for an adult patient. I asked another nurse to do chest compressions while I found the ambu bag and drew up adrenaline and atropine. I gave them to the patient, but without results. I took over chest compressions again, but every time I stopped, there was no heartbeat. 

Finally I called it-she is dead.

   I don't know how to write how I feel. Numb would be one word I could use. Also sad, frustrated, and a little angry. Why did this woman die? What caused her seizure? She had no previous signs of sepsis. No fever, no blood pressure problems. Was it malaria meningitis? Shigella? Staphlococcus or Streptococcus? Septic emboli? Or something unrelated? I'll never know. I keep wondering if there is something I could have done differently. Something I missed. If we had better diagnostic tests, would it have changed anything? 

   Now the family will have to buy formula to feed the one month old infant, who is still at his birth weight. It's $8 for each small can of formula powder. Will he suffer from malnutrtion because of his mother's death? Can the papa afford to continue with the formula? Will he switch to the powdered whole milk, which is cheaper but does not have as many calories? Will he get ill since he didn't feed from the time his mother had a seizure until just 30 minutes ago? (A total of about 14 hours). 

   I stood out in the pouring rain and cried. I only wished it was raining harder, with a force to match my feelings. The family wailing filled my ears. I wanted to wail with them. Wanting to cry out-why God? Why? I don't understand. I'll never understand. I know ultimately He is in control. He is just, and right, and good. Evil and sadness and death are not in this world because of him, but because of the Evil One. I know these things in my head, and mostly feel them in my heart. The knowledge helps, but it doesn't make the hurt go away.