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…