I’ve just been informed by WordPress that this is my 400th brevity-challenged update / blog post since our family began our cross-cultural trek and I began writing about our “adventures” in 2005. It’s been quite a journey… Thank you for joining us along the way!

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Some complicated cases for a bush hospital…

Alice (a-lee-seh), a young, new mother arrived by motorbike in the middle of the night with her newborn after several days of sounding like she was breathing through a small straw. One could hear her sucking air and wheezing well before entering her room. She had a persistent look of panic, couldn’t lie down, held her chin high in the “sniffing position”, hadn’t slept for days, had severe throat pain, fever and only a thready, barely perceptible pulse. She could still eat and drink, though with quick, small bites and swallows while trying to breathe.

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We diagnosed Alice with a rare, severe infection of her trachea and larynx, which caused swelling, extreme narrowing of her vocal cord area and airway beyond (normally about the size of one’s little finger), and a hoarse, almost inaudible voice. This is similar to epiglottitis or supraglottitis, an infection of the area above the larynx, which we encounter somewhat regularly and which will not permit the person to swallow, even their own saliva. Her oxygen levels were quite low, as we could also hear an obvious pneumonia in one lung.  She also had renal failure, likely from a combination of infection and shock from extreme dehydration. With IV hydration, strong anti-inflammatory medication and high dose antibiotics, we were also able to provide epinephrine nebulizer treatments and concentrated oxygen, neither of which are available for hundreds of square miles and neither of which were available here just a few months ago (solar and generator energy are sure nice).

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Alice’s month-old baby hadn’t nursed since her illness began two weeks ago (mom “had no milk”), and had been “fed” only diluted corn drink.  He was severely malnourished.

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Our nurses worked around the clock with Alice, giving this young mom everything our little hospital had to give. Every day we arrived surprised to still hear her wheezy, sucking, stridorous breathing as we approached her room. After about four days of this ridiculously torturous existence (and no sleep), she noted a small improvement subjectively and this gave us, and her, some hope.  After two more days, she was breathing normally and walking, though still too hoarse to speak. She slept and slept… Today, after a week of treatment, her voice is almost normal, she has no difficulty breathing (or stridor) and she is pain-free.

The baby devoured our infant formula for three days until the rehydrated Alice’s milk returned, after which he nursed hungrily. This baby will live and will know his mom!

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A 48y/o woman, Teresa (Teh-ray-zah), arrived after a month of a rapidly growing mass in her anterior neck, followed by severe difficulty breathing, though not from compression of the mass. She had all the signs of severe heart failure and the resulting pulmonary edema (wet lungs) but her echocardiogram revealed a normally functioning heart (!). Her neck mass was a severely enlarged thyroid gland, which was over-producing thyroid hormone (hyperthyroid), causing “high-output” heart failure. Her oxygen level was below 60%, she had almost no blood pressure and, on top of all of this, she was quite pale so we checked her blood count (hemoglobin) and it was less than 4 (normal > 12). She was certainly not going to survive.

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We threw at her every medication we had for heart failure, also giving her fluid, three blood transfusions over three days and removing fluid with diuretics.  She received high concentration oxygen and other medications to minimize the effects of her raging thyroid gland (called “Thyroid Storm”). She was another pleasant surprise every morning when we saw that she had survived the night. After almost five days (!), she began to improve and today (after ten days) she left her bed and walked outside!

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When I arrived a couple days ago, I was confronted by her family, which consisted of her two beautiful brothers-in-law, who had transported Teresa to us on a motorbike over dirt for several hours and stayed with her through it all. Teresa’s 30y/o son had arrived from another part of the country and informed us that they would pay for no further treatment and that he was taking his obviously cursed mother to the witch doctor for healing. I asked Teresa if this was true.  Shoulder shrug.  She obviously had no say in the matter.  This young man had witnessed nothing of the past week (death to life) and had not seen his mother for almost a year.  The only thing he could not deny was her obvious neck mass, which to him meant “spiritual attack”. 

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He heard a rather passionate explanation of all that had occurred over the past several days as the nurses and brothers-in-law chimed in.  I told him that further treatment for his mom now meant likely survival and that departure meant certain death. She is still receiving maximum-dose diuretics and oxygen for her heart failure and still “wet lungs” and we have medication arriving on the next MAF plane that will kill the production of thyroid hormone. Trying to explain this to a completely uneducated bush man, through a translator, was an exercise in frustration.

But he relented and this is two days later and Teresa is still with us and still improving.  I haven’t seen the son again.

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Two heart failure patients arrived on the same day. Each almost comatose and couldn’t breathe because of their severely weakened heart muscle and they each also had collapsed lungs because of so much fluid accumulating between their lung and chest wall. Their blood oxygen levels were below 80% (normal > 93%), despite panting at more than a breath/second. Both received aggressive medical treatment, chest drainage and high concentration oxygen. One survived and thrived, the other died after two days…

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A 50y/o man also arrived severely short of breath, with persistent chest pain and hadn’t been able to lie down for days. He also had large fluid collections in both chest cavities, preventing his lungs from expanding. We immediately drained more than a liter of fluid from each chest cavity and he slept soundly (lying down) for twelve hours. He is now walking, eating and sleeping well.

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Two teens and one adult arrived with peritonitis from Typhoid. Based on their story and our initial exam, on arrival they all appeared to need urgent surgery in order to survive, but by day three or four they were all improved and likely will overcome this deadly disease without looking up at bright lights and a masked surgeon.

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A teen girl arrived with severe diarrhea and vomiting for a week.  She hadn’t urinated for days, we couldn’t feel a peripheral pulse and her kidneys looked quite damaged on ultrasound (from severe dehydration).  It took several days of IV hydration and antibiotics, but she will likely pull through.

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We delivered a healthy baby boy (no drama) and I gave the mom and baby a ride to the village one day after postpartum treatment of the mom’s malaria.  I asked them where they were from and they pointed in the direction over the river.  I asked if it was far and the mom replied that it was “not far”, just one full day’s walk. 

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A fifty year old man arrived yesterday afternoon in a coma and I told the family to take him to the ED (Banco Urgencia). They came back a few minutes later and told me that no one was there. I went and did all of the vital signs, checked glucose levels and obtained a positive malaria test. The nurse returned “from lunch” at home (!) and took over his care. Can you imagine how many times this man has had malaria in his life and he still suffered a case so severe that it put him in a coma? I tell our patients and workers all the time that one never knows if he/she received one bite of a malaria-carrying mosquito or ten and, with each scenario, the outcome will likely differ. He woke up today and will survive.

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Thirty-five year old Eliseo (E-lee-zeh-oo), arrived with a heart barely squeezing and completely incompetent heart valves, likely secondary to previously untreated strep throat.  He barely survived three days of oxygen therapy and aggressive medication but I saw him out slowly wandering the campus at 5:30a this morning with no difficulty breathing!

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Jesus (Jeh-zoos) said to several people, “Your faith has made you well”.  How significant is faith in health and healing, in sickness and hardship?  How do our who/what-do-I-trust choices affect our health and the events around us?  I’ve long believed that faith (trust) is a uniquely human characteristic, given us by our Creator, that we apply daily in virtually all of our endeavors/choices.  We place our faith (trust) in our senses, people, our memory, our upbringing, our education, written/spoken messages, our experiences, our world view, our perception of God and how He intervenes in our lives…

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Faith is a much maligned, misunderstood and misused concept today, both among people who consider themselves Jesus-followers those who don’t.  It is thought of as a force, a confidence, a belief…  I think if we would substitute the word “trust” for the word “faith” in our Father’s letters to us, we would have a better understanding of what our Father meant by “faith”.

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Teresa’s son highlights the importance of where/how we place our God-given faith.  He must decide in whom to place his trust as he makes his life choices (or those for his mom).  Does he believe the story of what happened the previous week?  Does he believe the words of his family, the doctor, the nurses, or his “instincts”, etc  What/whom does he believe about the cause of the illness which would, of course, influence his response?

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All the other patients are the same.  When someone arrives ill and goes home well, they must decide why.  When they need help facing illness or a broken tooth, lack of rain, a relational rejection/offense; when they experience a special sunrise or encounter something else of wondrous beauty, or when they consider their political alliance, where they place their trust likely will influence their response and the outcome, both within them and around them.  This is, of course my view, which is in stark contrast to the common cultural perspective of those in Cavango which would more reflect a belief that nothing we do or believe will affect the influence of the unseen spiritual forces, which control all outcomes… and the best we can do is bear well whatever is “thrown at us”.

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With this man’s mom, was her improvement because of an accurate diagnosis and treatment, properly aligned stars, prayer, good fortune, chemical reactions, spirits, a miracle (pretty close), etc?  Was God involved?  How/where?  Who/what caused the illness and who/what cured the same? 

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I think Jesus’ statements about faith and healing were far more complex than simply “believing”, or even “believing in Him” (though this can be one of many factors) and have much more to do with wisdom in our choices of how and, in whom, we place our trust…