Friday, Gratitude, BnB…

Just another Friday. We arrived early to send off a 21 month/old baby with hydrocephalus to CEML via MAF. The baby lost the ability to use his left side about two months ago, after his parents said he had suffered from malaria. This is one cause of hydrocephaly in this region as the movement of fluid within the brain is impeded because of scarring from the parasite. They only came to Cavango because the baby hadn’t stopped crying for several days (and nights), likely from severe head pain. His head measured off the charts. I’m glad he was crying, as it motivated us to do a spinal tap and remove some fluid, to perhaps give him some temporary pain relief. He fell peacefully asleep immediately after. At CEML, our colleagues will be able insert a permanent drain in the ventricles of his brain, hopefully in time to preserve full brain function for this child.

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We then began rounding on our almost one hundred inpatients.  We had six critical patients, any of whom could have died during the night. We were thrilled to hear that they had all made it to morning, as we’ve seen eight patients die in the last ten days, none entirely expected.  We have three kids on our two oxygen concentrators, all with severe pneumonia and oxygen levels on arrival that wouldn’t support life for long.  One is a ten-day-old baby with oxygen levels in the 60s on room air (normal > 93%), pneumonia in both lungs (likely from a traumatic delivery at home), breathing almost 100x/minute and not able to nurse.  His mother is expressing milk and providing drops via a syringe, which the baby was able to swallow.  His oxygen level remained normal all night with the supplemental oxygen via the machine, he continued to swallow his mom’s milk through the night and actually began nursing this morning. 

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One of our three concentrators malfunctioned, so two other babies are sharing one oxygen concentrator, after we connected three lines to a “T”, normally used to divide propane gas lines. Both received enough oxygen to survive the night but remain critical as their blood oxygen levels drop significantly without the rigged supplemental oxygen lines, but both are awake, the three-year-old eating and drinking (and accepting a morning sucker) and the 10-month-old nursing. But all three continue to need the supplemental oxygen, which is concerning, because our little portable generator malfunctioned during the night and we are using a backup which is highly unreliable.

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We crossed the hall to see a 50y/o army colonel who arrived here by car from Luanda on Wednesday, the country’s capital, a two day drive (!). We saw him a month ago for severe heart failure, and he had such a remarkable recovery that the family brought soap and mops to give as gifts of gratitude (they also recognized a need for both at our hospital). You may not be aware, but virtually no one, anywhere in the world, returns to their doctor/hospital after recovery to say “Thank you”. But on arrival, this man’s heart was beating at 30x/minute, he had almost no blood pressure and he couldn’t stop vomiting during his whole trip to us. He vomited all day Wednesday, but is recovering well today, walking and eating, after we treated his symptoms and recognized and removed the offending agent, a medication that a cardiologist prescribed in Luanda, used commonly in the developed world 50yr ago and virtually never prescribed today (but errantly prescribed often in Angola). His primary complaint this morning was a sore leg!

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Our next patient was a 50y/o woman who arrived last week unable to walk for several weeks.  She had made no progress initially with our treatment for spinal TB and then on Wednesday contracted severe malaria, with rigors and vomiting.  She was in bad shape, as well as quite discouraged.  But we prayed with her, encouraged her, treated her aggressively and, as we entered her room today, we were greeted with the most animated smile!  She was almost giggling.  She said she slept all night, awoke and ate breakfast, had no fever and demonstrated almost complete use of both her legs, kicking both in the air repeatedly while laughing hysterically!  As we left the room, she jumped out of bed and gave me a huge hug.   I think that was a first!

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Our last critical patient was a teen girl who arrived several days ago having not tolerated liquids or solids for two weeks with severe abdominal pain. She had a very firm and distended abdomen, and free abdominal fluid on ultrasound, normally a result from perforation of an intestine. The question as to whether we needed to emergently transport her to surgeons revolved around the cause and where she might be post-perforation. We decided that we could watch her here and that she might survive without surgery (surgery involves a MAF flight and many financial resources that we don’t hesitate to use but they are limited and we want to reserve them for the worst), determining that the cause of her illness may be TB. We walked in today (after several days of treatment) and she immediately reached for a sucker with a smile, said she was hungry and that she had no pain.

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Three of the deaths this week had severe malaria and had lost ¾ of their blood to the parasite. One received blood and died. One did not receive blood because she looked like she may survive without, and died. Two children with the same blood loss, who we did not transfuse, went home. Another arrived and died within an hour with the same degree of anemia. We transfused a baby today who arrived with worse anemia (Hb 2, normal 12), who will now likely survive. I never saw Hemoglobin (Hb) numbers like these in the US (2-4) and it is always a challenge because we have such limited resources (typing kits, tests, blood bags, etc – all purchased and brought with us from the US). We saw dozens of “normal” malaria patients for every severe case.

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We were then told that a teen boy with a strange neck swelling, who had been improving – eating, drinking and breathing better than at his arrival several days ago, had died in his bed during the morning, after eating breakfast and walking to his bed without difficulty.  It was an all-too-common surprise for us, and I sure wish I had sent him to our colleagues in Lubango for a tracheostomy, but I hadn’t because of his apparent improvement.

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A young woman broke into tears, as did her mother, when we told her she has been prescribed medication errantly for two years.  She likely has leprosy and has been mistreated.  We will turn her around.

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A man returned by car from five hours away. He arrived a couple months ago with fulminant gout and kidney failure. He almost died several times while with us, couldn’t eat, leave his bed or walk and his whole body was grossly swollen. He needed two joints painfully drained of pus and delicate treatment for his renal failure (caused likely by the same agent that causes gout – uric acid). Gout used to be called the malady of kings, because only kings could consume a diet which would elevate blood uric acid levels. Now gout is a common illness throughout the developed world (where everyone eats as only kings once ate). He responded remarkably to our treatment and went home after about a month. We sure get acquainted with some people while they’re here and grow quite fond of them. He returned all smiles, walking with little pain and no swelling, blabbering his gratitude for five minutes (another one!) while we all celebrated with him. His was the second car parked at our hospital! We need to think about a parking lot!

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Eduardo and I, along with our local colleague, Florindo, saw the other inpatients and about thirty new arrivals and called it a day. Eduardo and I went home to share a beer and some Brazilian sausage and debrief when, halfway through our “meal”, one of our nurses arrived on motorbike to excitedly tell us that only a part of a baby had delivered breech in maternity (they couldn’t deliver the head). She had arrived earlier today with severe malaria, not in labor, and only 2cm dilated when we left! We immediately returned to a just-delivered, unresponsive, apneic (not breathing), chubby, flaccid, blue baby. Our nurse had begun chest compressions (which was great to see) and I felt an erratic, slow heartbeat (bradycardia) but there were no spontaneous breaths. The room was full of people willing to help and everyone pitched in. One of our cleaning crew ladies assisted Eduardo and me (she was great) while others helped our nurse with Mom. A few minutes of beer-breath-mouth-to-face resuscitation and chest compressions and the baby began breathing on his own. Today, the baby was nursing hungrily and crying for a cerveja! The lousy placenta/meconium smell/taste in my facial hair that soap won’t remove for a few days is well worth it!

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We had a three-day visit from a beautiful Canadian surgeon, Sandy Yeh, who was able to do eight surgeries at low cost for these rural folks.  She is a joy, has been to Cavango many times and we hope to see her again with her soon-to-be-husband in the near future.

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Our visiting Internal Medicine Specialist, Stephen McNulty, became severely ill for several days and MAF flew him to Lubango to be urgently flown to South Africa for tertiary care.  It was such a delight to have such a passionate learner and caring physician join us for about a month and we were sorry that his trip was cut short in such a way.  I’m sure he will be a huge blessing to many as he begins his practice in Barberton, OH in coming weeks.  He has faced some severe, chronic illnesses in his life and, because of his many times “on the other side of the stethoscope”, he will be a true servant in his role as a healthCARE professional.  We sure hope for him a speedy recovery to full health so that he can give his life away serving those with great needs.

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Please know that these stories are recorded with gratitude for those of you who support our work in Cavango, which Eduardo and I have nicknamed the BnB – Battle in the Buraco – an English and Portuguese language mix meaning “Battle in ‘The Hole’”. The daily grind is sober, severe, exhausting, overwhelming, emotionally violating, sometimes rewarding, but always worth every ounce of effort to care for those our Father created in love and arranged to be lovingly served at our BnB – both those who survive their illness and those who don’t…

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We thank you for not allowing us to battle alone but, rather, choosing to join us in so many sacrificial ways from the other side of the world…

Estamos juntos!

3 comments

  1. Hi Tim,

    You guys amaze me with the things you are able to accomplish with your limited supplies and primitive conditions. Praying God will bless you in a special way as you serve in this setting.

    Beverly

  2. Praying for you, Eduardo, staff and all these patients you mention and their families today… my heart is full of gladness for your willingness to lay down your lives in this way and for the ways God works through your faithfulness. I am praying now also for God to bring you workmates to help bear these burdens. can I share this blog post with some trained doctor friends of mine?

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