Stories from Thursday…

Thursday… We saw 42 new patients and 63 inpatients and gave away about 50 suckers to smiling kids. From what portrays a pretty typical day, some stories follow:

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Alice, a stoic 28y/o woman, arrived “pregnant” for eight months (no menstruation). She had been concerned that she had not seen growth in her abdomen, but began bleeding the previous day and decided to travel 3½ hr to be seen.  Her urine pregnancy test was positive and, on ultrasound, we found, instead of a pregnancy, a uterine tumor, often referred to as a “molar pregnancy”, which grows aggressively and causes secretion of the pregnancy hormone, bHCG.  If the tumor is not removed, it can cause severe hemorrhaging and become cancerous.  She also looked quite pale, so we checked her hemoglobin, which came back 2.4 (normal 12).  She said she’d had “some” vaginal bleeding, yet she had lost 80% of her blood!  We had a MAF flight lined up for the next day for other surgery patients and told her she needed blood immediately and surgery in coming days to remove the tumor. 

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We typed Alice’s blood and she was O(-), a rather rare type here. We typed her mother, who had brought her in, the two of them on a motorbike with a hired driver for 5hr, and we were glad when she tested the same. We explained the situation and that her daughter needed a little of her mom’s blood to survive until surgery and that the two of them needed to fly to Lubango the next day for surgical removal of the cause of the bleeding. Alice’s 55 y/o mom refused to give blood! I kindly explained again the reason and we compared her daughter’s paper-white nail beds to her healthy pink beds, we showed her the ultrasound again, and drew pictures – refusal; then I tried to persuade her in stronger terms – refusal; then I became quite angry. After more than a few years living in various cultures, I understand cultural nuances and the difficulty for those uneducated in understanding health issues, but I told her I refused to watch this woman die with her mother by her side. She wouldn’t budge. I looked at our list of workers and their blood types and we had no one who could donate to her.

Alice survived the night and the flight to Lubango (with her mom), with three others needing surgery, where our colleagues at CEML will be strapped to find several O(-) donors prior to Alice’s surgery.

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Angelina arrived during the night with her nursing newborn, in severe respiratory distress and breathing at a rate of 60 breaths/minute, drooling and sitting up because she couldn’t breathe lying down. Her family communicated that she had a cough and fever for over a week, which had begun after suffering from a large dental abscess the week prior, and she had worsened in the past few days, struggling to breathe. Her lungs were “crackly” on both right and left via the stethoscope, she could only grunt answers and her oxygen level was 62% (normal > 93%). Ultrasound revealed free fluid in both chest cavities and, when draining the side with the most fluid, we pulled out about 500ml of thick, chunky, milky pus. She improved a little and was worse again the next day. We aspirated both chest cavities and she improved a little, but was still quite hypoxic and breathing fast, but said she was better. The next day she was worse.

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Over the coming days, Angelina endured painful drainage of both her chest cavities with large IV catheters (10g), a tube in her chest for almost a week, 24/7 oxygen, very little sleep, and she never really improved for long from her bilateral empyema, pus in her chest cavity, a complication of untreated pneumonia, which is a common cause of death in underserved areas. She had essentially developed a large abscess in both chest cavities from festering, untreated wounds in her lungs (pneumonia), the likely cause – breathing in the bacteria from her dental infection. After draining pus multiple times with the IV catheters, I put a urinary catheter under her arm and into her chest, because we don’t have chest tubes, hoping the increased diameter of the tube, a bit thicker than a pencil, would help facilitate drainage. Everything we tried, including this catheter, became plugged because of the thickness of the pus and its associated debris. We flushed her cavities around collapsed lungs with saline multiple times to try to thin the fluid and accommodate drainage, to no avail. She continued to produce large amounts of pus. We needed to get her stable enough to transport her for surgery and it never happened. She and her family demonstrated severe trust in our care and, in the end, we couldn’t help her and she died on this Thursday after one of our further attempts to drain her chest.

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There are few people whose lives I admire more than that of Mother Teresa, and her simple philosophy centered not around successful treatment of illness, though this was always sought but, rather, around serving those suffering with dignity and honor. Seeking to similarly honor Angelina and her family in death, our ambulance transported her body and her mourning family four hours over dirt to their village.

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An 8y/o boy arrived with severely bowed legs (photo), likely from a vitamin deficiency, causing soft bone growth called “Rickets”. We can correct the vitamin deficiency, but he will likely never walk normally and without pain. Several other children arrived severely malnourished who needed IV hydration, followed by calories and protein. They will survive and return to the same environment that caused the problem in the first place. Two other children arrived with severe malnutrition and dehydration and didn’t survive their first night with us. We will see much similar malnutrition in coming months, as last year the region suffered a drought which killed many animals and destroyed virtually everyone’s crops. The stored corn from last year’s harvest before the drought is now gone for most, and few people have seed left to plant this year.

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A young man brought in his severely malnourished 2y/o and I told him she needed about 2-3 weeks of recuperation and nutrition at our hospital to recover. He sheepishly said they had no food or money to buy food. I asked him to find out the local cost of two weeks of food for him and his wife and child, in addition to what we would give the child, and let me know. He came back in the afternoon and said that 500kz would likely be enough for them, if they rationed. I knew the local price and his price of a kg of ground corn was accurate. This beautiful man then, quite humbly, asked if he could borrow 500kz, promising to repay me when he could. This is less than one US dollar and would have minimally fed them, perhaps for a few days. I gave him 1000kz and told him to let me know if he needed more. They were all literally starving at home and the first to suffer was the child…

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Two kids came to our simple bush hospital with their educated father from a large city, about 7hr away (!), one 22 and the other 14 years old. They’d both suffered from crises of chest pain over many years and we tested them for Sickle Cell Anemia and both tested positive.  The rest of the world has medication and bone marrow transplants that would allow them both to survive this disease and live full lives, but these cannot be found in Angola.  I gave the father the name of the meds for him to seek in the cities and I will try to bring some back from the states, but I delivered the devastating news to them, that they were born with a disease almost universally fatal in Angola (about half die in their first year), and from which they would suffer horribly from further pain crises.  We prayed together and asked our Father for help that we could not provide. 

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Five adults and two kids arrived from great distances on the same day, wasted to skin and bones and very ill with TB.  Though they waited far too long to arrive, because they sought help here, they will likely survive, though two have heart failure because of the duration of their illness and their recovery is less certain.

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Three months ago, a young woman innocently stuck her thumb with a thorn, sought treatment from the local shaman when it became swollen and painful, was treated with “all-natural” herbs and roots, and her thumb has become necrotic and she will lose it. 

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A 64y/o man hadn’t urinated for three days and arrived in severe distress. I once traveled in an MAF plane for four hours from Ft Lauderdale to Haiti and forgot to urinate before the flight. I can’t describe the distress I endured for the last two hours of that flight. Two hours! He had kidney failure from the blockage caused by his prostate and we tried and could not insert a urinary catheter to relieve him of his urinary retention. Because it was the end of the day, we drained his bladder with a needle and he experienced severe and immediate relief. The next day, after all of us slept well, we put a large catheter into his bladder through his abdomen, which will drain his bladder the rest of his life, if his kidneys rebound from their insult.

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A rail-thin, 30y/o woman arrived in liver failure and in shock from dehydration, as she had been vomiting for days.  She has AIDS, liver failure from Hepatitis B and a belly full of likely two gallons of free fluid, TB, and kidney failure.  Like most of those we see in Cavango, she did nothing to cause her suffering from these diseases, other than choose a challenging birth location.  She has been with us for two weeks, and has been tricky to treat, but we spent over an hour with her this day, draining her chest (also full of fluid) and abdomen while giving her IV fluids because of her severe dehydration, which will cause the liquid we have drained to re-accumulate…

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A two month old arrived with her grandmother, severely swollen, but nursing. Her grandmother told us that her daughter, the baby’s mother, died during her home delivery and she had been nursing the baby since (she also had a newborn). She said the baby had a febrile illness about a month ago and then developed severe edema. It is likely that the child suffered kidney damage from malaria during her first month of life and we will try to “nurse” her kidneys back to health. Kids’ kidneys usually respond well to treatment in similar situations. Home maternal deaths are common in under-developed, low-resource cultures because, although most deliveries occur safely, as they have historically before the modern, hospital-delivery era, there is obviously no help for the inevitable, occasional complications. So many of these deaths can be prevented by delivery in the hands of one with experience and up to date medical knowledge…

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A woman arrived in the middle of the night by motorbike yesterday, after she experienced severe hemorrhaging following a home delivery of a healthy baby boy.  The cause of her hemorrhage was simply a uterus which had difficulty squeezing closed and a single medication resolved the issue.  She went home today.  Many die without seeking the help this wise woman’s family sought last night, and she would also have died with a couple more hours of blood loss. 

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In the middle of the day, because we had two patients needing oxygen from our electric oxygen concentrators from the US, we fired up a beautiful, brand new generator, which arrived on one of our recent shipping containers, generously purchased and donated by dear friends and, because of the many people waiting, I asked one of our older and experienced leaders to fill the tank with diesel fuel, after showing him the tank. He readily agreed and ran out the door toward the generator, glad to be of help with the new generator.  As I was doing my next consultation, I had an intersecting thought that we had better use a screen filter for the diesel, because our fuel cans often produce flakes and debris in the fuel, and I left in the middle of the exam to tell him.  I found him near the generator, opening a gallon jug of motor oil that he was about to put in the fuel tank.  I stopped him and showed him the diesel can and how to filter it.  I returned to work with my stomach around my ankles, and thanked my Father for “intersecting thoughts”…

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A 14y/o boy returned from Lubango with a diagnosis of lymphoma causing a large facial tumor and, the same day, a 12y/o boy arrived with his abdomen full of tumors, likely from the same lymphoma, called Burkitt Lymphoma.  It is quite common in Sub-Saharan Africa and quite readily treated in the rest of the world, but a death sentence here.  A generous donation of a single chemotherapy agent from a physician in Canada gives them some hope, and they will both receive this (minimal) treatment in coming months.  I’m seeking counsel from physician friends in the US as to how best to treat them, as oncology is not where my experience lies.  Please pray for these kids and for five others who arrived with the same illness over just the past month!

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Peter wrote years ago, after living with Jesus for three years, denying Him and hiding in fear, witnessing Him alive after His crucifixion, and before he died a horrific death for telling people that Jesus was alive, loved them and called them to live closely with Him, “Do not be surprised at the fiery ordeal that has come on you to test you, as though something strange were happening to you, but rejoice inasmuch as you participate in the sufferings of Christ, so that you may be overjoyed when his glory is revealed.”

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Days like this one are difficult for me but much more so for those I treat, and I so look forward to the coming day when Jesus’ glory is revealed and the above stories will be told no longer.

Until then…

Those who support this work are Mother Teresa and Jesus’ hands in serving these beautiful people… those who recover and those who don’t… with dignity and honor…

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