Palm Sunday Miracles

Sunday, April 1, 2012

It’s hard to believe it’s APRIL already and Palm Sunday too!!

Lent flew by so quickly. At first I was disappointed to miss Easter at home (especially since it is my all time favorite holiday) but after today, I am actually ver excited.

We got to church early this morning to find several small children with palm leaves twisted and braded into all sorts of decorative shapes. Our friend, Henry, came up to us also with a decorative palm leaf.

“Today is Palm Sunday,” he states very matter-of-factly.  “We know,” we told him. “Then where are your palms??” he looks confused. I explained our traditions and he smiled indicating his understanding. He tells us to wait in the front of the church entrance.

In the mean time, some woman comes up to us and begins blabbing something about a “walka” and the palm leaves. The she begins singing a song. She is trying to teach us the words unsuccessfully. Them I realize that she is trying to explain to us that there is a procession through town with the palm leaves.

Henry returns with three beautifully folded palm leaves for us and confirms the lady’s story. The priest soon follows so I walk up and introduce myself. He explained to me that the church in Kamakwie (St. Peter’s) is actually a chapel so they don’t have a permanent priest. Instead, the priests from the surrounding four parishes rotate through each Sunday taking turns.

After his quick explanation he gathers everyone around and we follow him through the neighborhoods and houses until we reach the other side of town and the main street through the market. He lines everyone up two by two and the cross bearer leads us through the busy 9am market with the priest at the back of the procession.

We sing and chant a bunch of Krio songs while waving our palm branches all the way back to the chapel. It was such an amazing experience! I was so absolutely glad that I got to participate. I cannot wait for Easter.

This evening Steph and I went in for surgery on a lady with an acute abdomen. She had severe epigastric pain and hadn’t had a bowel movement in three days. When we opened up her belly yellow pus and fluid spilled out everywhere.

We started suctioning immediately. Dr. Tom pulled out her small bowel. It was covered in a thick fibrin material that looked like the thickest snot I had ever seen. The entire bowel was covered. We start pulling it off as we run the bowel from her abdomen looking for any perforations or holes from the Salmonella typhi that she contracted from the dirty water she uses to cook with.

The bowel ends as we pull through the first part of her duodenum where it attaches to her stomach. Still no holes had been found. All this fluid had to be leaking from somewhere. We continue searching. Her liver and gallbladder are both covered in the fibrin “snot”. As we make it to the stomach, the nurse points something out- a hole the size of my index finger.

Dr. Tom begins to suture it closed. With five stitches and much maneuvering of the abdomen, the perforation was resealed.

I was amazed at the fact that we had just spent over two hours repairing a hole that in the US could have been fixed with a little electricity, a scope and a couple of staples. I guess the important thing is…

The outcome is the same.

Our friend, Henry, outside of St. Peter's chapel in Kamakwie.

Praying over the patient before we opened up her abdomen.

The Swamp

Saturday, March 31, 2012

Today was a great day. Rounds in the hospital went much more smoothly. We spent the second half of the day going into the market and making the tailor busy until Wednesday. We came back for supper and Stephanie and I walked down to the swamp behind our house. I love going down there. It is so lush and green and beautiful. It reminds me of the jungle in Belize. It makes me wonder what Africa is like in the rainy season. 

But for now, during the end of the dry season, the swamp is the only thing left with water and people scavenge to get what they need. People go there to bathe and do laundry and to tend their crops. They also go to fetch water to drink and cook with. (Or if you are like the children that we were with, why fetch it when you can just scoop it up and drink the dirty bath water right there??)

This sometimes presents a problem since the water if often contaminated. Dr. Karen says that cases of typhoid (from Salmonella enterica (typhi), a bacterium that grows in contaminated water) are increased in the spring months at the end of the dry season because water is so hard to find. It's hard to believe that something that provides so much life can also cause so much harm.

After dinner we enjoyed a nice game of “Apples to Apples” with Jacob and Samuel and even though it is very much an American game, they did really well. It was a lot of fun and a great way to end an amazing day.

 

African Beauty Pageant

Friday, March 30, 2012

EVENING 

After such an emotional day, we decided it best to take our new friend, Jacob, up on his offer to escort us to a “beauty contest” at the local community center. Intrigued by what an African beauty contest would consist of, we were rather excited at both the opportunity to get away from the hospital and to join in on a local social function. Jacob picked us up and we walked to town through the darkness of the night.

I could tell instantly that tonight was a special occasion. We could hear the music at the edge of the hospital campus. As we got closer I could see that there were people everywhere outside the community center.  Already I was confused about exactly what type of “beauty contest” this would be. We paid the small entry fee and enter through the front door…

There are people EVERYWHERE- crammed wall to wall- literally on top of one of another. Guys are holding girls on their shoulders and backs; people are standing on benches and chairs; small children are weaving in between people’s legs- all trying to shove as close to the front of the stage as possible. We try to push in and sneak a view, but the crowd is too dense. The wall of people will not budge.

It’s hot everywhere in Sierra Leone, but when you pack the entire village of Kamakwie into one windowless concrete building, even on a cool night, the heat becomes unbearable. The smells were so strong as people crammed in so tight, dripping with sweat.

We slid past a few people and Jacob leads us to the front. My body is being pushed and shoved in every direction possible. I’m stepped on and tossed around like a rag doll. I’m being squeezed so tightly in the crowd that at times I can’t even see the other white people in front of and behind me. I don’t think Las Vegas was even this crowded on New Year’s Eve!

Finally we reach the stage. Jacob passes a bench over the top of the crowd to a man on stage and they pull us up onto the stage. I was very hesitant, not wanting to draw any more attention to myself than my white skin already had. They insist until finally we are all on stage.  There is a guy dancing in the center and I begin to realize that we are now sitting with the judges at the edge of the stage. 

I look around the dimly lit building at the crowd around us. Finally I feel like I can breathe again (somewhat)... But only minimally- the stage is high and all of the generator-powered lights are centered around us. The air is so thick and hot that I can barely inhale. I can feel the weight of the humid air lying heavy on my chest and the pressure is beginning to get to me.

The guy continues to dance, mimicking Michael Jackson’s signature moves across the stage. I look out at the crowd and realize it is now a solid wall of people- there is no way out. The song ends and the dancer stops. People toss money onto the stage in support of his dance moves, but as he exits the stage they become unruly. People are getting trampled. There are several “security guards” in fort of the stage and as I look down, they are hitting people, punching and shoving to try to contain the crowd. A small boy has made it to the front and I notice as people begin to push backwards to avoid the guards that he becomes engulfed in the mass of people. All I can see are the extremities of people flailing around behind one another.

I look behind us at the stairs we climbed to enter the stage. They are covered with spectators. One guy tries to get down and punches are thrown. A small fight breaks out, but quickly the boys are separated and everyone calms down. I realize that we have no way to exit except down those same stairs. My heart begins to pound a little faster.

A new dancer has begun. She has on a short ruffled skirt. As she begins to dance she throws around the ruffles of her short skirt and the crowd becomes even more excited. I will not argue her talents, but I quickly realize that this is not the type of beauty pageant that any of us thought we would be attending. As the comfort level rapidly declined with the addition of this new dancer, we all decided that we desperately needed to make a get away before things got even more out of control.

With a nod of agreement we all begin our descent back into the crowd. Slowly but surely we push our way through, manipulating our bodies and stretching our extremities until finally we reach the other side. Already the air seems so much cooler. We hang out in the back of the crowd for a few minutes before deciding to go back outside. The night air never felt so good on my warm skin.

We laughed and carried on with our friends outside the community center. They made fun of us for needing bug spray as we questioned them intensely on the events of the pageant. We soon decide to leave the community center and begin our walk back through the town to the hospital. The walk was long, the night dark but the conversation light.

It was a good ending to a bad day and we made friends that we will remember forever.

Before falling to sleep, I thank God for finally allowing this day to end.

The girls with Jacob and Samuel

Phillip with the boys

A great group

 

Conundrum

Friday, March 30, 2012 

AFTERNOON

We sit for lunch and bless the food only to have Dr. Karen explain some very bad news to us. She told us that the reason she and Dr. Tom had been absent from the hospital all morning was because they had been praying over some issues that had recently arisen with the leaders of the Wesleyan Church in SL. She proceeds to tell us that she and Dr. Tom have a serious decision to make and they may not be able to return to work in Kamakwie next year. The day went from bad to worse. We were all very upset about the news. It was very discouraging for both myself and Phillip, especially after being here and seeing all the good work that has come from their sacrifice and labors.

We all decided that after lunch it was best if we stayed away from the hospital for a while until clinic.

The remainder of lunch went by in the usual fashion, but everything seemed to pass in slow motion with so much uncertainty in the air now. It was hard to see the children who come after school, but I forced a smile as we played on the porch.

 

The rest of us went to clinic while Ali stayed in the OB ward with the women. We saw four cases of assault- one a small boy who’d been beaten by his mother with a board. For the second time that day, my heart broke. I reached my arm around his bruised back and gently hugged him. I don’t think that I let go of him until his escort from the Health Poverty Action (HPA) domestic abuse agency took him away again. I don’t know the exact process yet, but we have several HPA cases each week so I’m interested to find out more. Dr. Tom even introduced me to one of the guys that works there, so Jenny and I hope to go one day next week to talk to them.

After clinic, Dr. Tom informed Steph and I that the labs were back (after three days of waiting) for a patient of ours in the women’s ward. She was very thin and complained of a new cough that had been present for a couple of months. We found out after her first few days of admission that she was HIV+. Her labs now showed she was positive for Tuberculosis. Dr. Tom asked that we get her started on treatment and moved to a private room for isolation purposes as soon as possible, so we left to go talk to her nurse.

She informed us that there is only one nurse for the whole hospital that takes care of all the tuberculosis medications. We leave to go track him down, but only learn that he is in Freetown for a meeting all week and will not be back until Monday. Someone told us to go find another tech in the lab, but when we got there we were notified that the entire staff is in an emergency meeting that was called in the chapel to discuss the Asher’s leaving.

We got to the chapel just as they are adjourning the meeting. We found the lab technician, but he sent us to find the outpatient nurse. Once we found him, he told us that the Tuberculosis nurse is in Freetown to get more medications and that all our isolation rooms are full. He told us that we would have to discharge the lady since we wouldn’t have treatment for her until Monday. He seemed quite perturbed and when I questioned him further he explained that he felt she’d wasted a lot of our time by not telling us she was HIV + when she was admitted. I learned that the HIV counselor told him that the lady had received treatment in Freetown prior to her admission here. 

I had to stop for a moment and ponder what would motivate a person to do such things. I wondered if she knew how many people she’d exposed to her respiratory illness because of our lack of insight. It frustrated me to think about how much more quickly we could have had a diagnosis if we’d only known to go in that direction from the beginning. We wasted critical time chasing many other diagnoses without knowing that important piece of information…

According to the nurse, this is a common occurrence. HIV patients are often ostracized completely due to a lack of understanding and education on how the disease is transferred.  He says the patients often times have a hard time finding people to take care of them, even among their own family members. This patient, in particular, had specifically requested we not tell her mother who’d been diligently caring for her progressively weakening young daughter, unknowingly exposing herself to both diseases in the process.

After much discussion we leave. It was a conundrum for me. I was angry that she’d deceived us for so long, but I didn’t want to send her home to die, however I knew there was nothing I could do to help her here and she’d only continue to endanger the rest of the patients by staying. I reluctantly write the discharge orders and give the ward nurse the instructions.

Carry On

A little apology in advance...this has been the hardest entry for me to type so far. It was such an emotionally challenging day and as hard as I tried, I felt as if I could never portray how draining it was- there are just not enough adjectives in the English language. But to sum it up, I will leave you with this before you begin to read:

There has never been a time in my life where I have experienced every imaginable human emotion all in one day...

Grief, despair, hopelessness, regret, doubt, anger, denial, joy, love- you name, it was all there and hopefully you can sense that here.

Friday, March 30, 2012

Today felt like it should have been filmed as an episode of the TV show “24” because it was hands down the longest 24 hours of my life and I thought it may never end…

MORNING

The morning started with a nice breakfast but was foreshadowed somewhat by the fact that we all missed chapel.

Stephanie and I decided to tackle the women’s ward while Jenny went with Phillip to see the patients on the ped’s ward. When we arrived to see the women patients, there were no charts ready for half our patients and the ones we did have, didn’t have labs or meds done. There were several new patients who didn’t even speak Krio so it was difficult to obtain any history of their illness. (One patient was admitted for altered mental status. She was very disoriented and spoke only in her tribal language so it was impossible to obtain any information.) Two of our patients were still waiting for procedures for the third day in a row and three patients were not allowed to leave because they still owed money.

And…we were shorthanded so we were splitting one nurse between women’s and ped’s ward (about 50 patients). So there was no sign of any progress in the near future. Stephanie and I finished rounding on what we could do at about 10am. Dr. Tom was still nowhere to be found so we leave to go check on Jenny and Phillip in the ped’s ward. They are also finishing up.

We go to see their last patient with them when suddenly a crowd of about 4-5 people coming through the door dragging the limp body of a small boy about 8 years old. They tried to get him to walk, but he kept falling. Finally they get him to a bed. Jenny and Phillip rush over to start examining him. The mother of the child is standing at the bed observing when all of a sudden she drops to the floor and begins to wail. The child lay with his head thrown back- nares and mouth wide- struggling to breath. Quickly Jenny begins to read his admission note from the outpatient nurse that shows that he was given albuterol and steroids for wheezing and a cough. They begin the exam while the family watches. Stephanie and I go to the mother and escort her and the newly forming group of spectators from the bedside, trying to get the mother to calm down so they can finish the exam.

Just as we get a few feet away, I turn to see the two brothers start to cry and wail. I can see Jenny’s face. The kid stopped breathing with Phillip’s stethoscope on his chest. It was hardly noticeable, yet his family knew instantly. After looking at each other for a second that seemed like an eternity Jenny and Phillip start CPR as Stephanie and I move the relatives out of the way. Jenny screams to me, “I need something to help this kid breath!” I sprint down the breezeway- not knowing what I’m looking for, not even knowing what options or resources I have available for this type of situation. I stop in the OB ward and grab Emily, the nurse practitioner who knows the hospital much better than myself. “Quick, we need help. This kid stopped breathing in peds,” I quickly spurt out all in one breath.

We race back to peds. "There's an oxygen tank and a mask in the OR, if we can get him there," Emily informs me calmly. When we enter the room, Jenny and Phillip are still compressing his chest but he he's not breathing on his own. I stare at him as they stop briefly to check him. "He has a pulse!" I scream and point to his arm. He is lying with his arms above his head and in the glare of the light against his dark skin, I can see the thrill of a pulse over his brachial artery.

"Let's take him," Emily gives the command and it slowly registers that this is not a normal occurrence in SL. There was no doubt or discussion for us as to whether we should try life saving measures, but in Kamakwie you have to question everything especially since there is no way to continue care if life does resume. There are no respirators, cardiac monitors, intensive care units, etc. It was something I was not used to and very uncomfortable having to think about in such a quick manner.

We move the child to the OR, his limp body in Phillip and Jenny’s arms. I watch as if in slow motion as they rush him down the breezeway past his still wailing family. We hook up the portable oxygen to the battery source in the OR (it isn’t charged) and start manually pushing oxygen into his small lungs with a bag. We watch his chest slowly rise and fall with each pump of the bag. I can feel the blood rush every time Jenny pumps on his chest. I check for a pulse while they're bagging and realize it’s weak at best and is slowly diminishing. She stops and it becomes weaker and weaker until I can no longer feel it. He has no spontaneous respirations. 

His lifeless body lays there stretched out on the table, the oxygen still blowing through his nose but without his chest moving. We turn it off.

Finally with blank expressions on our faces, we’re forced to look at one another and deal with the truth that none of us wanted to admit: There was nothing more we could do. We weren’t changing the outcome. We had to stop. Jenny leaves the room in silent tears and Emily follows to go talk to the family. Phillip, Stephanie and I stand in silence, staring at the young boy. The frustrations of the day slowly fill my mind.

As hard as I try, I can’t hold back the tears.

Anger consumes me:

“This should not be happening. We should not be here. HE should not be here. This never would’ve happened if things were more organized and systematic.” I try to blame the nursing staff. “This never would’ve happened if we’d had more help. We shouldn’t have to be handling this on our own. We’re just students!” I had to blame someone or something. I was so angry. We did everything we could, exactly the way we were supposed to, exactly the way we’d been trained, but still we fell short. “How could this happen? This can’t be real. He’ll wake up soon. He’ll breath again.” The denial quickly crept in.

I look back at him and the reality sets in. I feel his leg. It's already growing cold.

We exit the room still in silence. Finally Dr. Tom shows up and we spend the next several minutes recapping the order of events of the morning that seemed to have lasted forever. Without any good explanation, reason, or cause for a normal, healthy appearing young boy to stop breathing we turn back to our other patients and continue working as if nothing ever happened. As if we hadn’t just walked past his crying, weeping, wailing family staring at us for answers- their tear filled eyes pleading for some explanation. As if this was some switch that we were supposed to be able to just turn off and walk away. As if I’m not supposed to question every single step of what happened to this child over and over again in my head- feeling the heavy guilt of every action.

I go back to work plagued by the longing eyes of that family- comforted only by the peaceful look on the child’s face as he silently rested. I wondered how much strife this family had faced before- how many times they had undergone this unnecessary pain. Or was this pain less than those they’d faced before? I wondered if it ever got any easier for them. I struggle to just make it through the rest of the morning, but somehow by the grace of God we carry on…

Life in the Bush House

Thursday, March 29, 2012

Jenny, Steph, and Ali got here yesterday evening so we are now all settled into our new bunks in the appropriately named “Bush House”, as it sits at the back edge of the property in “the bush”.

After dinner we came back to the house to settle in for the night. We noticed before dinner, however that the water wasn’t working properly for the showers. Everything else was fine, but we’d just flushed a toilet so we thought it was related to that and decided just to give it more time. So tonight when Ali went to take her shower, the water still wasn’t working. We had been using water in all the other rooms so we decided to again wait to see if time made any difference.

We sat around chatting while waitng on the water to miraculously start working when all of a sudden we hear this loud beeping sound as if from a smoke detector. We search around and decide it is coming from the battery that runs all the lights in the house. We quickly turn it off as Jenny runs to get the flashlights. Steph and I are now sitting in the dark living room for about 2 minutes while I call Dr. Tom to see if he can help. Just as he answers the phone, something in the dining room makes a loud scurrying noise right behind me. Steph and I both scream and run to the other end of the hall as I try to calm down enough to apologize to Dr. Tom and convince him that we are not crazy. He explains that there are screeching owls that live in our ceiling, that our battery is dying and that our water tank is drained and he will have to come turn on a valve to pump water into it in the morning since it’s already so late.

I thanked him for the explanation and hung up the phone relaying the news. Jenny walks me to my room with the flashlight and just as she exits the door I hear someone whisper through my window…”hello?” I let out a very high-pitched squeal as Dr. Tom again says “hello?” Jenny and Steph come running back in, hearing nothing but the squeal. “Dr. Tom?” I ask. “I decided just to fix your tank now,” he explains through my dark window.

We invite him inside and he agrees to come look at our battery situation as well. We bring out our flashlights and walk over to the closet; still hesitant from the loud clanking sound we’d heard earlier in the dining room. Just as we lean in to watch what buttons he’s pushing and what plugs go where, a flyswatter that had been hanging on the wall falls and brushes against Jenny’s arm. She screams and jumps scaring all of us and again we are left trying to explain our sanity… I’m not sure of our success.

The “Bush House” can be a scary place after dark.

Possessed

Wednesday, March 28, 2012

Last night Phillip got called back to the OR for a c-section. Apparently Dr. Tom had to call him three times to wake him up. I felt bad but I guess Dr. Tom could tell by how I fell asleep on Judy’s couch after dinner that I was very tired. They told me that they were in surgery until 3:30am. I did not even hear the generator turn on.

Needless to say, it was a slow day because of it. I’m happy to say that everyone in the women’s ward is doing well under my watch this week. I did have a strange case come in on Monday. She’d had an exploratory laprotomy (open abdominal surgery) for primary infertility at the beginning of the month and she presented to the hospital at post-operative day #20 with restlessness, insomnia, headache and altered mental status. When I went to see her she was moaning and flailing around with a blank stare in her eyes, but complaining of nothing more than a headache. I prescribed her medications for pain and something to help her sleep while I waited on her laboratory studies. When I went back to check on her yesterday I was informed that she began having seizures during the night. On exam, she was not actively seizing, but she was foaming at the mouth and very incoherent. Her speech was muffled and broken and she could not maintain eye contact. Her eyes kept rolling back in her head and then she’d open them wide and stare into space. It was very bizarre bit she did have a pain response to flexion of her neck so I started her on antibiotics for encephalitis (a brain infection that could be caused from malaria or some other type of infection).

As I was leaving her room, I passed Pastor Jarr on the way out. I said hello and she greeted me as she entered to see the lady.

I found out from Judy today that Pastor Jarr spent some time with the lady praying for healing. Apparently it worked, because today when I went to check on her eshe was sitting up and talking- completely oriented! She knew her name and where she was and could answer any question I asked.

As Judy informed me, Pastor Jarr seemed to think that the lady had been cursed and was possessed by an evil spirit. When I told Emily this story today, she agreed saying that there is definitely an evil presence here and that many of the people greatly fear it. I’m not sure what I believe in this specific case, but I don’t think that just a few doses of an antibiotic can heal someone that quickly. I also think that you can’t believe in the presence of the Holy Spirit if you don’t believe in the presence of evil. I also think that if you believe in anything enough, then it does become real to you.

Either way I’m just grateful she is on the road to healing now, whether it be physical or spiritual.

White Girl in the OR

Tuesday, March 27, 2012

Every day I see things that amaze me more than the last. Today was my first day to go into the OR to actually perform a procedure and I realized first hand the shortage of materials and limitations to what we can offer. It was quite surprising yet still very fulfilling.

A 14 yo girl came hobbling in on one leg. They got her onto an OR table and called Dr. Tom. I’m sitting on the couch not even changed from work yet when I hear through the window “Angela?”

At first it startled me a little. I still haven’t completely gotten used to the open slatted windows yet. “Yes?” I reply, recognizing Dr. Tom’s voice. “There is a new case in the OR. A girl came in from a motorbike accident with a laceration on her leg. I want you and Phillip to repair it.” We quickly gather our things and head down to the hospital to meet him.

When I walked in, there was a very frightened girl atop the table. My attention immediately turned to her leg. There was an open wound starting from behind her left knee and making a jagged turn down the inside of her leg. Impressively, she was crying on a little. The wound was covered in dirt and debris and the edges of her skin were torn very unevenly.

We quickly get to work. Dr. Tom leaves to go get supplies and the nurse starts to work on her IV. Soon she is sleeping peacefully as if she didn’t even know how badly her leg was injured and how lucky she was that she could still walk. WE irrigated the wound and dug out dirt and debris for over an hour until finally Dr. Tom brought in suture. Phillip started suturing on her left side. The needle was not a cutting edge needle (the kind you typically use at home) so it was VERY difficult to penetrate the skin. The wound edges barely matched up as they were and there were several time that Phillip had to pull so hard on her skin to get the needle through that I was most certain he would tear the skin more. But, thankfully, he did not. After several sutures on the top of the knee he rolled her leg outwards so that I could try to suture the inside of her leg. It was getting dark and we have no electricity. My eyes were beginning to hurt from all the straining. The dark blue suture was nearly impossible to see against her dark skin. Finally Dr. Tom agreed that we needed the lights to continue further.

I look over at Phillip and he has been concentrating so hard in the hot stuffy room that he hasn’t even realized that there is sweat dripping down his nose. I quickly motion for the nurse to get a napkin. He wipes Phillip’s head and face just before the sweat drips into the wound. My scrubs are soaked and I feel faint so we take a short break while we wait for the generator.

Eventually it cuts on and Dr. Tom returns. While we were waiting I noticed that the wound started bleeding again. I turn to Dr. Tom and ask if we have any gauze to dry the area for better viewing. “We don’t have any,” he replies. So, without gauze or a clear picture of what we had already sutured and what exactly was left, we continued on in perseverance.

After over 24 wide spaced sutures (we had to conserve) and 2 hours of working on a wound that should have taken less than one hour anywhere else, I again look at Dr. Tom and ask, “Do we have anything to clean her with before we bandage her leg?” “No,” he says “but here, try this.” He hands me a large paper like material that is normally used as a drape to cover areas where you aren’t working to keep them clean. I glance at her leg, now covered with dried blood and sitting in a pool of blood/iodine/sterile water mix that was also slowly dripping onto the floor. Reluctantly I scrubbed her legs with the tough scratchy paper until I got it a little cleaner…not clean by any means.

As she was becoming aroused, we began to pick up the drapes and instruments. I asked if I could bandage her leg (still bleeding somewhat) and was handed a roll of Kurlex- a loosely woven stretchy gauze type material that normally is used to only hold a bandage in place. It is non-absorbent, but it’s all we have. I know she will bleed through it in a matter of minutes but I wrap her up and send her back to the ward where she will stay for a long recovery. I hope she knows how lucky she is to have her leg and most especially to still have full function of her leg. I’m certain she will have much suffering during her stay at KWH but I’m also very hopeful she will walk again with no complications. I praise God for that.

They bring in the mobile bed and begin to roll her from the room. I offer to hold the door for them and after such a long period of time in the hot, stuffy, sweat-box of a room, when the hot night air hits my face I let out a big sigh. “Ahhhh, AIR!!!” I yell and they laugh at me. Silly white girl…

Whatever You Do For the Least of These

Monday, March 26, 2012  Day 17

“For I was hungry and you gave me food…”             Matthew 25:35

I have so many many thoughts racing through my mind right now that I feel like I should’ve been jotting things down all day.

This morning was a normal hospital day, except that before we stared rounding we said goodbye to a very tearful Lorena. She and Dr. Karen left for Freetown today to pick up Jenny, Steph and Ali, and even though it was sad to say goodbye, I’m still very excited to see the girls!

Today we decided to switch things up a bit so Phillip covered the ped’s ward and I took the women’s. I am happy to report that the lady who received Phillip’s blood donation was stable and doing very well. I sent a lady with ascites for her second paracentesis- I’m unsure if it will really help with anything other than making her symptoms more bearable, but we have no treatment for hepatitis so I have to continue with what we can do. The surgical patient that I spoke of earlier from Freetown that has the open wound in her pelvis is worsening. I do not think her strength will last much longer, but her daughter seems to be very hopeful.

On the ped’s ward, all my patients from the weekend are still stable! Thank goodness. Phillip did get a new patient who was temporarily placed in a private room in the back of the ward. When we entered the room, I noticed a small radio propped up on the edge of the bed. Over the noisy cries that are the peds ward, I could hear the voice of Josh Groban singing “You raise me up”. I sat on the edge of the bed and held out my arm towards the small 6 year old. Most of the time, they don’t shake my hand, but instead stare at my strange white skin or scream out in tears because the last “white” stuck them with a needle. To my great surprise the child sprang up and wrapped her tiny arms around my waist in a big hug! It absolutely made the rest of my hospital work totally worth it!

Before leaving the wards for lunch, I decided to make a stop to check in on the Alpha children. The last time I was there, a proud “Mami”came rushing up to me showing me her “pitkins”. There were two older children, each of who were holding an infant- a tiny set of twins!! They were absolutely adorable. Both were being treated for malnourishment, but it was obvious one was flourishing more than the other (which I’m told is also typical of twins here.) As we were visiting with Tira yesterday, she made mention of a cousin of hers who had twins in the alpha ward. She said she went to visit them, but that one of the twins had died. I thought it must have been a mistake. She couldn’t have been talking of the same set of twins. I’d just seen them. I didn’t want to believe it, so to be certain I decided to check for myself.

I greet the nurse. “Where are the twins?” I ask. She looks at me and points to a child alone in a bed. “Here is the one. WE lost the other on Saturday,” she responds. My heart dropped. I must have heard wrong. It cannot be. I look over at the Mami and with only the look in her eyes, I could tell it was true. I recalled the wailing Saturday night. My heart broke. I watched the woman as she collected her things. The second twin was now strong enough to go home, she had just been waiting on her sister to get well enough to join her. The whole atmosphere of the ward seemed to have transformed. On previous visits the mothers were very happy- all smiling and showing their pitkins as if saying, “Look at mine! Look at mine!” But not today. Today things were much darker.

I wished them well and then walked away to go eat my lunch while I tried to forget about the news.

I have a group of about 4-5 girls that have learned my lunch routine. Every day for the last week or so, they have visited me. They come to Bud and Judy’s front porch and climb on the bench to press their faces to the screen window as the stretch their necks to see if anyone is inside. We can hear their whispers followed by snickering giggles. Eventually a “helloooo” and “where is An-gel-a?” I go outside “Where is Phil-lip?” they ask. “Phil-lip is sleeping,” I tell them. They giggle and think it is funny that he and Bud nap on the couches during the hot day. Soon the questions begin and they either decided to count my freckles or plant my hair. They are amazed with our hair and it sometimes becomes a game to them to just pat my head. My watch beeps and they ask what time it is. “2:00, “ I tell them “Time to go to work. We will meet tomorrow.” “Tomorrow!” they respond as they run down the hill.

I join Dr. Tom in clinic while Phillip goes to teach the nursing students about genetics and when he is done, we switch. The students seem so eager to learn and to my surprise they actually understood the blood groups by the time I left. I think they really loved the clay models. We ended up making a game of it- one person was the donor, one the recipient and each had to express their “antigen” while a third “antibody” person decided whether the recipient could accept the donation. I was a lot of fun. I may have enjoyed it more than them in fact!!

After dinner tonight, we went for our usual slow stroll back to Bud and Judy’s. We were sitting in the living room in silence each engulfed in our own work. In the distance I hear the leaves rustle and then the scattering of little feet followed by an “An-gel-a”. I close my laptop and walk to the door. “Where is Phil-lip?” The familiar voices always ask. “He’s scared of the dark, “ I reply. As usual they snicker and I can hear Phillip laughing through the window as well. “We have come to see if you have for us any mango? We have no chop (dinner). Do you have for us a mango?”

I’m silenced. I can’t get the words to come out. Finally I stutter, “I have no mango.” They ask again. My heart sinks into my stomach, but I literally have nothing to give them. I look back at the door half expecting Judy or Phillip or Bud to come running out to help me whisk the children in the house so that we can properly feed them, but I am left with nothing- no words and a dumb look on my face. My jaw won’t move. I can’t even find words to tell them I’m sorry. Finally, I again disappointedly say, “I have no mango.” The tears are building up and I find it hard to swallow, but the children just flash a big bright smile and say, “Okay we see you tomorrow,” and again off they go- as if nothing ever happened. As if they were just so used to going to bed hungry. That thought made me even sadder.

My heart is still breaking. All I can think of is the scripture that keeps repeating in my head:

“Whatever you do for the least of these, you have done for me…”           

Sleep will not come easy tonight.

What A Weekend

Sunday morning, March 25, 2012  Day 16

Last night I was awoken three times. Once at 4am by the wails of a woman from the hospital. I could hear her screams piercing the silence of the still night like glass shattering from a brick. I drifted back off to sleep listening to her cry. Again, at 5am the Muslim chants began. I rolled over slightly trying to ignore them and pretend they didn’t exist. Although I love how faithful and devout the chanting its, I was determined not to let it ruin my sleep. A second scream broke out through the early morning again at 6am. I awoke and listened for a while. Was I dreaming? No, the chants were still there too. The wailing continued. Was it the same woman? Was it more family just now finding out? Did a different patient expire? It’s hard to sleep with so many thoughts running through my mind. The remainder of my sleep was restless at best. I sincerely hope and pray that Phillip’s blood donation was not in vain.

Sunday night, March 25, 2012 Day 16

What a way to spend a weekend! It absolutely did NOT last long enough! I guess with working half the day on Saturday, I feel like we try to cram a whole weekend in on Sunday. Which, by the way, is a pretty impressive feat considering we attend two church services and a typical African service last at least 2 hours.

There is a medical student that is visiting Kamakwie from San Francisco. Her father was from here so she still has a lot of family in Kamakwie. Dr. Asher even knows some of her relatives, so she attended rounds with us in the hospital on Friday. We recognized her with her brother this morning in church where they invited us to their aunt’s home for a family lunch with traditional African food. So…we actually had lunch with the Ashers’ around noon and then a “mid-afternoon snack” around 2pm. It was very interesting too because they served kasava leaves (a spinach type vegetable served over rice), which we’ve had before with the Ashers and Bud and Judy’s, but this time it was very different. I was informed that it’s always the same ingredients, which I’ve learned is most often the case with any meal. (Dr. Tom even tells a story of how he once got in trouble with the cook for suggesting she put fish in a dish that is traditionally cooked with chicken.) But some how, each person manages to make it taste a little differently. The food here is amazing though.

We spent a couple of hours conversing with Tira and her brother and meeting their family. She has an uncle who is in the government in SL. He was very instrumental in getting the Catholic church in Kamakwie (which I’m told is a fairly new development), and his dad (Tira’s grandfather) actually donated the land for the Catholic school! Her uncle was very nice and spoke very good English. He even taught us a few Krio phrases! He also invited us to go and visit him when we go to Freetown.

Our afternoon gathering ended with a rendezvous with Lorena and Meredith for a trip to visit our friend Mansu, the tailor. Yesterday I dropped off 2 lapas (precut yards of fabric)- one for me a dress and one for Phillip a shirt. I actually got a dress and a skirt out of the fabric, and Phillip’s shirt looks great on him. He looks like he’s ready for the beach- a natural tourist! I think he will definitely be able to wear it back home. Once Meredith and Lorena had collected their items, we began the walk back.

Along the way, a couple of the children called me by my name!! It’s very exciting because I usually get called “white”, “white woman”, or “Lorena”. As Tira explained to me, the children don’t see enough white people here to learn how to distinguish between our facial features- and I thought I was having the reverse problem, turns out I’m not the only one!!

Upon returning home, we cleaned up and had an African dinner at Judy’s house- Jalif Rice- my favorite so far! It’s a stew of chopped onions cooked in a tomato sauce with other spices and served over rice. (Like everything else African!)The onions make it taste sweet so it is very good!

After dinner Meredith stopped by on her walk home and we sat on the porch with she and Judy making red blood cells out of clay until dark. Tomorrow Phillip and I are speaking to the nursing students. He is going to talk about genetics and I am going to teach them about ABO blood groups and donor compatibility. I really hope it goes well and I don’t confuse them more! We will see how much of a language barrier there is! We’re both really excited to have this opportunity. It makes me realize how much I’ve missed teaching. I guess I get it honestly.

Dr. Tom informed us earlier that Philip’s patient was still stable after receiving her transfusion, so I’m still not sure what the wailing was about. Tomorrow I will have to go and check on my malaria patient. Hopefully he is doing better after his transfusion too, but I still want to check him for Sickle Cell Disease even though Dr. Tom says it’s not as prevalent here. We’ll have to wait and find out…

The Ultimate Sacrifice

Saturday, March 24, 2012  Day 15

Another Saturday spent in the hot SL sunshine!

We arose early and made rounds after breakfast. Earlier in the week there were 3 patients that Phillip had been monitoring for an acute abdomen. Two of the cases went to surgery with which he assisted. The third patient he continued to monitor throughout the day on Wednesday and Thursday until she began to show signs of improvement at which time he called off surgery.

We did not round yesterday since we spent the day in Medina, so when we came into the hospital door this morning, we were met by the nursing staff who informed us that this non-surgical patient had expired.

I will never forget the look of shock, disbelief, and immediate guilt on Phillip’s face. “What happened? I don’t understand. She was getting better,” he mumbled quietly to me. I knew it wasn’t something he was going to let go of easily whether he admitted it or not. Dr. Asher and I both reassured him that there was nothing that could have been done but as I walked over to the peds ward I heard the wailing begin in the breeze way. I peered out the window feeling guilty for watching but too intrigued to turn away and not knowing any other way to show respect.

I saw her daughter drop to the ground shaking profusely on the hard concrete- her body limp as if she had lost all control of function. The pain was paralyzing for her. I continued to watch as family members came to comfort her and help her up from the ground.

I watched until a woman speaking something to me in Krio interrupted me. I recognized her as Foday’s mother, the child from one of Phillip’s surgeries. She came to inform me that her son was able to go to the bathroom- a great feat for a post-operative patient who’d just had an open abdominal surgery for a perforated bowel because of typhoid.

“We done send de sample,” she tells me. I look over to the child and notice he has a tube in his nose. Apparently he’d had some trouble through the night. Dr. Tom instructs me to keep careful watch for signs of improvement so that we can try to take the tube out as soon as possible. So after lunch I made a short trip down to see the tailor in the afternoon heat so that I could go check on Foday. He was doing well with no vomiting so I tell the nurse that she can remove it. “Ok but I have a new malaria patient with a hemoglobin of 2.3 and I have to start the IV for a transfusion so you’ll have to do it yourself,” she says a bit flustered as she runs past me with a bag of blood in hand.

“Great, “ I think. “ I don’t even know where to start. Hopefully I can just pull…”

I instruct the child on what I’m doing and he thankfully agrees. I tug firmly and gently and slowly it is freed. “Whew!” I hope he didn’t know I was just as scared as he was.

I leave to go check on the malaria patient and as I walk in the door I recognize the limp pale child. I ask for his chart. He had been admitted only 10 days prior for the same condition. His hair had not even grown back from where they shaved his head for his last transfusion. I have never seen a dark child so pale.

The nurse wiped the scalp clean as she began looking for venous access. She slowly advanced the needle, but with no success. I convince her to try for the arm, so she hands me the needle. I stick once. The sweat is just rolling down my back now. Missed. The child barely squirms or flinches. I try again…nothing. The nurse tries once more for scalp access. Finally- a flash of blood! But still no drip yet. We tried to adjust the needle with no success. A second nurse is called in and eventually after sticking almost every vein in the child’s body we get access and the transfusion was started.

After all the drama, I decided to rest until after dinner when Dr. Tom got called in to check on an employee who’d passed out. Phillip and I both go with him, and as we are finishing up, the nurse comes over to inform us that there’s a victim of a dog bite in the peds ward that we need to see. We walk over only to find out that there are actually two victims- the child and the father who tried to save the child. I let Philip and Dr. Tom talk to them while I go over to check on the malaria patient from earlier. He was still very pale and lethargic but I am hopeful that he will recover.

We leave the ward only to again be stopped. A lady on the women’s ward with a history of vomiting blood is now passing blood in her stool. Phillip goes to check on the woman since he’d seen her earlier in the day. Her hemoglobin is 5.0 and she is very sick. Dr. Tom, realizing that our blood stores are low and that there is no family here in the middle of the night to donate for her, quickly volunteers to donate. Phillip without hesitation piped up and refused. He decided that it was easier for him to give and to save Dr. Tom’s donation for a time when there was no one else available. I was floored. How is this even okay? For a moment I thought they were joking, but then I realized there was no laughter, no smile, and no other donor. After a few minutes, the idea settled in and I realized once again I’m in Africa. Phillip graciously walked to the lab with Dr. Tom to get typed for his donation while the woman lay sleeping, too ill to even know what a sacrifice he was making. I was amazed. What a great way to end the day.

The Potter and The Clay

Friday  March 23, 2012  Day 14

Today we held clinic in Medina for about 5 hours. Phillip and I acted as the doctors with Dr. Tom running between the two of us as a translator of sorts while overseeing our work. It was CRAZY, but even more so exciting to be calling all the shots. At the same time though, it was very nerve racking and frustrating because the translators were so few and I didn’t want to miss anything. It wasn’t until after about the 5^th or 6^th patient, that I had to remind myself again T.I.A. !! Anything is better than nothing and nothing is EVERYWHERE.

One lady came in with “the boil” that “hot her leg and make it warm”. When I raised her skirt she had an abscess the size of a baseball that was necrotic and smelly. I told her to “wait small” while I went to ask Dr. Tom if we had any wound care supplies. He looked at me with a puzzled face that told me he clearly did not know. “Let me go check to see what we brought,” he replied. Soon enough he came back with a Ziploc bag full of 4x4 gauze and a roll of Kurlex with some tape and scissors. “Here you go,” he said “Do what you can.” 

For a moment I panicked. “No gloves?!” I thought. I’m sorry but this is not something that I will EVER be able to chalk up to T.I.A.! Again I tell the lady to “wait small” while I leave her to go search for gloves. I ask a couple of the nurses with no success. Finally I interrupt Phillip’s room to scavenge. In the corner, in front of an open window sat a dust-covered box of size large latex gloves. Thank goodness! I snatched up a pair and shook them off. As I placed them on my hands, I brushed them across my scrubs and noticed the dirt that they left behind. All I could think was “it can’t be worse than the dirt that’s under my fingernails”...

So now, on top of being limited on knowledge and supplies, the nurse asks if he can watch so he will know what to do next time. Seriously?! I am hardly qualified to be doing wound care myself much less instructing someone else on what to do! The thought that my actions could shape the type of care that many others receive from this nurse long after I’m gone crossed my mind briefly and then again I was reminded T.I.A., you take what you can get…and right now it was me, a dirty pair of gloves and a bag of 4x4’s or the mud encrusted leaves that the “country doctor” had put over her leg. I decided I would prefer the dirty gloves with clean gauze and inexperienced hands too.

It is so easy for me to get caught up in the every day responsibilities of my job that after a while I begin to feel responsible for the bad and want to take the glory for the good. More often than not though; it’s the responsibility issue that troubles me the most. I feel the weight of having to “save every life” or make every person better. We struggle a lot with it in the peds ward when at least a handful of kids every week don’t go home or it’s “just another day” when 2-3 infants expire. It’s not a mentality that I’m used to and it’s not one that I like to accept, but again I have to learn to be satisfied with knowing that it is beyond my control and just as it is for all other things, it’s better left to God.

I don’t know how that lady will come through with her leg ulcer, but I am certain that the road of healing will be long and painful and I suppose it may never have even begun if she hadn’t shown up today. I refuse to take glory for any outcome, though, because I know that my actions were not my own but were guided by someone much more powerful than myself. I pray that God guide all those in the clinics here who will continue to heal once we have left and most especially for all who use healthcare as a ministry of healing- that they may always remember that they are merely an instrument of His will.

"And now, O Lord, you are our Father, yet truly, we are clay. And you are our Maker, and we are all the works of your hands."

Isaiah 64:8

Home in Africa

 Thursday, March 22, 2012  Day

It’s funny how quickly I’m already learning to adapt to things. Every day when I go to write the date here, I have to think really hard in trying to remember how NOT to write in the British format of day/month/year the way we do for work. I was actually thinking about that earlier. I was beginning to miss home a little and then my train of thought led me to how different and weird things will be after we return. I’m wondering if it will take me less time to forget about Africa than it did to get accustomed to it? I hope not…

I’m so glad that our stay is a full eight weeks. I feel like I am just now starting to catch the hang of things. I can’t imagine if it were half way over already. And to think that two weeks ago when we got here, I was worried that eight weeks may be too long!! It’s starting to feel a little like home already- which was also a strange thought for me, because I realized today that we spent the last few weeks trying to make Point Pleasant feel like home. Than I stopped to ponder the reasoning behind it…what was the point? It dawned on me: I will never be going back to Point Pleasant. No, I realize that and I suppose the reason I did not let that stop me is because I don’t really have anywhere else to make feel like home, so why not here?

I guess that person that said; “home is where the heart is” really knew what they were talking about all along, because my heart is here. I guess I never put much thought into that statement either because I always looked at it the other way around and like every good pessimist/optimist argument there’s always two sides.

I always used to translate that to mean that your home will always hold a special place in you heart and no matter where you physically go, a piece of your heart will always be there. Now as every other outlook I have on life is being challenged in some way, I realize that even my interpretation of meaningless sayings has become more insightful. But, yes, I have found that throughout this year, no matter where I have gone I have tried to put my heart and soul into every place I work, house I live in, life I touch. Therefore where my heart is found there also will be my home and until May 2nd, my home is Africa and I will continue to make the most of it. 

Comfortable

Wednesday, March 21, 2012  Day12

So is the life in Africa that I had to miss a day of writing for fear that I had malaria…

Last week Dr. Karen returned from Freetown with a nasty illness. It was significant enough that she was given a full course of IV fluids, phenergan and malaria treatment. Then on Sunday when we were in the tiny smothering hot church house, Dr. Tom had to excuse himself because of nausea and vomiting. He has not been feeling well since either. So yesterday of course my stomach began to cramp. We were working an eye clinic in Gbendembu and it was so unbearably hot that I could not eat lunch. After we packed everything up and headed out, my achy nauseated stomach had to endure the 2.5h drive down the unpaved, red dirt, washed out Kamakwie Road. To my recollection, I have not properly attempted to describe the conditions of the road and that is primarily because it is just that…INDESCRIBABLE!

But I shall indeed try. It is, if I recall correctly 50 miles of the most rugged terrain that you could ever imagine that a normal car could pass through. It is torturous and eroded- worse than any logging road I have ever seen in the piney woods of Northwest Louisiana! One would think almost that it had been cleared using an army tank or a herd of elephants. There are holes big enough for the truck to fit inside, better referred to as “craters” than potholes. It makes you wonder how Mother Nature could be so cruel to one piece of land, but then again I suppose there is reason in all God’s doing. Anyhow, I digress.

My point in stating all this is that the road alone is enough to make you sick, even if you don’t start out with a belly ache.

By the time we reached Kamakwie, I was really not feeling so great. I tried to not let on at first, thinking it would get better or go away after I ate. I forced down some supper, but things only got worse. Then my head began to feel hot. I went to bed at 8pm with a fever, two ibuprofen, a stomachache, and a prayer for anything but malaria.

I awoke this morning feeling very weak, but the general condition has improved throughout the day. (I’m quite sure now that it is NOT malaria, despite the close call.) So much so that I was able to join the other girls here on my afternoon off to get our hair “planted” as they say. I spent about 40minutes this afternoon with my head and neck being contorted in all different directions by tow of the local girls until finally I am able to say that I am currently sporting a hairstyle unlike any other I’ve ever had. There are more than a dozen braids twisting and twining across the curvature of my scalp until finally they all conjoin into one large gathering in the back center of my head. Each braid sticks through individually, resembling somewhat; I’m sure, the head of Medusa. It is very original and though I can hardly stand the sight of it, the people here really seem to enjoy it. I’m sure on some level they find it amusing and ridiculous, but all the little girls come to us saying how much they like “our style”. It is very entertaining for me as well. If for no other reason than just to watch their expressive responses.

Phillip and I had a very long talk with Bud and Judy tonight about family, growing older and again in general. It’s very interesting too because I am certain their children are all very much older than either of us, each having families of their own; so it is always nice to get their input on raising a family and the differences and changes they have seen with their children and grandchildren. It just makes you stop and think about things a little, especially when you are so far removed from family and everything you once found comfortable.

I’ve learned…NOTHING is comfortable in Africa.

But it is always nice to know that someone else has been in your shoes before… and they’re still walking.

Nothing is Everywhere

Monday, March 19, 2012  Day 10

A little over a week ago I had just returned from one of the richest areas in DC when Phillip’s dad called me about graduation plans for when we return in May. We spent a few moments discussing some details and I could tell there was something unsettling about his voice. He brought up out traveling and asked if I was prepared. I responded with a nervous, “I hope so.”

Then he said something to me. Something that didn’t really mean much to me at that time and something that I have not thought much of since…until now that is.

He said, “It will change your life forever.”

I pulled out my camera tonight to try and pick out a photo to email to my sister. I went trough some of the ones I took from last week and as I did I recalled some of my initial thoughts as I was taking the photos…It amazed me! I was astonished at how quickly my perception of things has changed in just one week!

When we arrived, I was uneasy about so many many things:

1.     The lack of modesty- most women and children go naked here

2.     The lack of medical resources- the hospital is very primal and basic is an overestimate. “Improvise” is often the word of the day.

3.     The housing conditions- most houses have unlevel foundations with cracks in the walls and scraps of tin on the roof.

4.     No electricity- no one has it but some still find ways to maintain luxuries without it.

5.     Lack of transportation- No one has a car, few have motorbikes and every road is LONG and HARD

Those are just a few of the things, I could go on to include water, food, clothes, sanitation- all of the basic necessities useful for sustaining life.

Today, we have walked past those places I took photos of last week at least a dozen times. I do not notice the naked children on the porches anymore because they at least have a porch to stand on, or the cracks in the walls because at least they have walls and don’t live in a hut. I don’t notice the washed out roads that we walk because at least it means they are well worn between neighbors’ homes.  The medical supplies we use are often second hand or not used for the intended purpose, but at least they have a way to make things work when needed.

I began to realize today that my outlook on things had COMPLETELY turned around. His words came back to me, “It will change your life forever”. My chin almost hit the ground. I never realized before how true that statement would be.

When I first heard it I thought, “Yeah, I hope you’re right. I hope I become more grateful for the things I have. I hope it changes the way I practice medicine and the decisions I make in my career. I hope it brings me closer to God. I hope it transforms my relationship with Him. I hope it changes my relationship with Phillip. I hope it makes us appreciate one another more.”

I never really thought about how any of those things would quite transpire. I never dreamed that I would be staring myself in the face screaming, “you fool!”  I never realized that by asking for my relationship with my Savior to be transformed, that I would have His face revealed to me in so many ways. Nor did I realize that I would be the one doing all the transforming!

I’ve never been much of an optimist and don’t think that I don’t still have my moments, but I believe that to place yourself among disparity in the heart of hopelessness, you have to find something to believe in. Without much else to go on besides faith, you grow increasingly dependent upon it, and again you begin to notice that you are grateful for all that you have (and not in that superficial American way of stating it but not FEELING it) because on that same level you are forced to SEE that you could have NOTHING.

Nothing is easy to find here. Just look around…it’s everywhere.

P.S. I am anticipating the discharge of my patient with the febrile seizures tomorrow. He is doing great!!