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!!