Friday, August 5, 2011

August 3

Well, our time here is coming to an end here in the next week. I have a little heaviness in my heart as I think of leaving Njinikom.  In this little walk-a-bout section of St. Martin de Porres hospital, I felt as if we have been enclosed in the womb of Christ. This is not to suggest a gender assignment to God, but only to depict the kind of peacefulness, security, warmth, and holiness that a womb symbolizes, and I have felt while here in this little area of Africa.  I do not have a car, and therefore cannot zip around and go many places, and haven’t really had the urge. There are few cars or motorbikes around, and so there is no “traffic”. Most walk every where they need to go, and always greet each other with a “Good morning” or “Good afternoon”.  I have attended daily mass in the morning with a chapel full of devoted Sisters and felt their love of Christ. I am surrounded by these same Sisters throughout the day as nurses in the hospital, midwives, nurse anesthetists, another working with the animals, and various other jobs that they do.  I have cooked more than I have in the last 3 years, and eaten all three meals each day, sitting at the table with my son. We have had tea together in the evenings with our wonderful short-term partner, Dr. Tim and played epic games of scrabble, uno, or rumy. I have shared knowledge and conversation with doctors, HIV counselors, and nurses that are full of faith and dedicated to the care of their patients.  

It has been a spiritually blessed experience that has encompassed medicine, our faith, and family.  And over time, there has been less and less awareness of the material things and comforts that were initially missing. Thank you God, thank you Mission Doctors, thank you Sr. Xaveria, and thank you all for your prayers and support.
Today, Milan and I were in his classroom and teaching the <, >, and = symbols with positive and negative numbers. They love to compete with each other and so we had a Team A and Team B, and the latter team won by one point!  

They had an extra long recess today, despite the rain, and you can see that Milan had fun teaching them some games on the merry-go-round!  He is also mastering the tire-rolling with a "y" shaped stick.  Says he'd like to bring this game to the States!!

August 1

Milan and his student
This week I will be spending the days with Milan and his classroom. It was strange but exciting to see him sitting at the teacher’s desk, looking through the lesson plans for the day. Today they learned, and I reviewed ‘coordinates’ and graphing them on a grid.  By the end of class, they had a pretty good handle. Milan reviewed the quadrants of a grid with them and later reviewed their multiplication tables using the game “travel” that he has played in his own school in Johnstown, Pennsylvania.  And of course, there was freeze tag and ‘futbol’ (soccer) for break time. These kids play in flip-flops and barefoot, and they play hard. It’s weird to be playing amidst goats, but they are all around, and usually scatter out of the way when they come running.  One black goat in particular would butt his horns at us when we got too close, so when the ball rolled near him, it took some distraction and quick maneuvering to get it back!
After school today, we agreed to videotape a group of youth that had recorded a song in a studio in Yaounde, and now wanted to record a video for it. They had arrangements with another gentleman to record them, but it fell through… so, they saw me with my camera and made the request. There were about 8-10 youth in the 7 video clips that we recorded. It was actually an R&B song and they sounded pretty nice. Especially the part in the song that says something along the lines of “You’re the only sugar in my tea…” I wish them well on their musical endeavors!! 

And wouldn’t you guess, on the way home, in Njinikom, Africa, we watched four young gentlemen as they played foosball on an outside table. It was pretty rickety, but it seemed to be able to withstand the brutal goals that they were getting on each other.

Wednesday, August 3, 2011

July 30

The Sisters were having a novena for their foundress, Maria Hueber, who founded the missionary group called the Tertiary Sisters of St. Francis. She was from Austria. It was a beautiful prayer time with singing and a small historical lesson on the life of Maria Hueber. The order is now teaching, nursing, working with the elderly, delivering babies as midwives, instructing choirs, ministering in prisons, and working with the handicapped, as just a few examples of their ministry, in 3 continents thus far: Germany, Africa, and Bolivia.

Two of the missionary doctors, Tim and Jim, shared a piece of their long-term mission training course, and it is a reflection that I hope to keep in the front of my mind and heart. When you go on a mission, you may not ever know why or for what purpose that you have been called there.  You may be somewhere for three years, that has one special moment for which you were there, and you’ll never know what that moment or encounter is. This, I suppose, is the mystery of God. This mystery and trust in Him, requires us to be open and always emanating Him in all that we do, and with all whom we encounter.  This is of course, much easier to say than do at times, but the reflection offers a gentle, constant reminder that God requests your kindness, fidelity, patience, and compassion towards others in the simplest of circumstances.

July 29

Learned more Kom today: “Tu Chikaju” means “Goodnight”.  And in Pigeon, it’s very hard to actually quantify amounts, so if you need to know if they are eating well, you ask “Do you chop small or chop plenty?” (Chop = Eat).
Nester, the NP to be
This evening I had the pleasure of sharing tea with a compound nurse that works at the hospital. These are the nurses that handle all the after hour admissions. They write orders, medications, fluids, and even blood. They are quite smart and know when to call the docs if someone is really sick. Well, there is one gentleman that I just learned will be leaving to Mbingo to complete a Nurse Practitioner course!! You can imagine how delighted I was for him!! We had tea and he asked me about the coursework and my experience. I’m not sure how similar our courses will be, but I offered what I could and shared his excitement. I gave him a couple books that I had brought with me, to prepare for the course. I am eager to see how this will benefit the hospital here!

July 26, More Good News

There was a young lady who came in about a month ago unable to walk. The history was that she had the herpes zoster virus on her back and she needed something for the pain. A street chemist gave her 3 injections in each of her upper, anterior thighs (1 near or on each femoral nerve?). She presented to us with zoster pain and inability to walk, urinary retention, and b/l leg pains. They had no idea what the solution is the syringe was. So over the course of these weeks, she is now walking, albeit with a walker. Her strength is improving, although her gait and leg movement is still a bit uncoordinated. The biggest problem we had was her urinary retention. We checked her urine and treated her for a UTI. She had the catheter removed twice with no luck, these were the days that I walked into the women’s ward and she had no smile for us. We tried to get a medication called Bethanacol to help the bladder, but no one could find it in the pharmacies. It was a struggle. As I was reading up on this issue, I found that constipation was also a factor. We added mineral oil to the regimen, ibuprofen for any swelling, and prayed. Two days ago, after teaching her to press on her bladder downward when trying to void, the foley came out.  The next morning she was smiling!  It was a relief… She had some dysuria and we treated her empirically with Cipro, but we are waiting on a possible urine culture. Yesterday morning I knelt at her bed and we both thanked God for His divine intervention. (Update: cx came back Ecoli, not susceptible to Cipro, so changed her to gatifloxacin. She has been discharged, but some patients remain for many days until they are able to settle their bill. They are not charged for the days after official discharge. Usually the family at home is trying to gather monies together to pay the bill).
Another younger lady came in with headache x 1week, diplopia, papilledema, and nausea. No fever. We started her on steroid and antibiotic treatment but we weren’t sure if there was a meningitis brewing or space occupying lesion. After a couple of days, she was better and we backed off on the treatment. Then she developed a fever, severe headache, and vomiting. She also had a swollen forearm and hardened vein near the IV site. So, her serum toxoplasmosis was negative, but we couldn’t tap her (because of the risk in the case of a lesion), to check for Cryptococcus. Or could the fever be from the infected IV site. So we placed her back on ceftriaxone, increased the steroids again, and added an antifungal. The next morning she was walking around with only a small headache. Thanks God. But we still aren’t sure what is going on in her.

Our young boy with the Sickle Cell Crisis is finally healing well. We were afraid that he may have been developing acute chest syndrome, but he seems to be improving. In the beginning, this young boy was contorted in so many different, awkward positions trying to alleviate his pain; icteric with an enlarged liver and spleen; had a pneumonia; and hematuria. Yesterday he was sitting up smiling, moving without grimacing…usually a good sign. They use Pentazocine (Talwin) here, and it seemed to help. I hope that he continues to improve.

Just as an FYI: For our diabetics, we have Insultard (longacting), Mixtard (similar to 70/30), and Atrapid (regular). For oral agents we have Metformin and Glibencamide, and they also have some sort of traditional herbal drink that helps with glucose control.

This week Milan made his first futbol goal and apparently it was pretty epic. First it was kicked up, next he headed it up, and last he kicked it in. He was pretty pleased with himself as was I. The score was still 6 to 4, them, but a great game nonetheless when he comes home fully covered in dirt and mud.  He has given the yo-yos a rest for now and is still passionately trying to master pen-spinning. I don’t know how he manipulates each joint of his fingers to swing the pen around the way he does, but he’s improving every day. That is one thing with Milan… if he wants to learn something, he is relentless…practices with passion.  Yesterday for an afternoon snack he had a “mealy cob” and ground nuts. Essentially this is like corn on the cob, but the corn here is different. It is not like our corn in the States, and that’s all I can say. It’s good corn, we like it, but just thicker and hardier I think. And ground nuts are peanuts. They grow underground, hence “ground” nuts.  As for me, I’m doing fine. Love it here. How could I not… there are goats all over the place!

Yesterday we met two Lay Mission Helpers who are just beginning while a 3-year mission, teaching secondary school in Kumbo. They were very kind and extremely excited for this adventure in following God’s will. The younger lady will be teaching English and computers while Frank will be teaching English as well as assisting with animal husbandry. I am anxious to read their blogs and hear of their experiences. Frank and I were able to speak to each other in our native languages (Polish and Slovak). That was an unexpected and welcomed surprise!

With the return of Jim there is sometimes not enough space for all of us in the office, so for a few of these latter days, I have gone exploring other aspects of the hospital.  Yesterday was the operating room. Sister Martha, who is also a nurse anesthetist, was my guide for the day.  Dr. Lazarre (an orthopedic surgeon) was the operating. There were a total of about 5 scrub nurses or nurse assistants in the room. They do not use the term “OR techs”. They use Halothane as their gas and have fentanyl, morphine, diazepam, propofol, thiopental, and a few vials of etomidate, as well as doing spinals. They pray together before each surgery and have a preprinted anesthesia/OR record sheet similar to what we have in the States.  The cases for the day were a reconstruction of a varus deformity at the proximal end of the left tibia/fibula; a left hernia; an infected wound debridement; and an open exploration of an acute abdomen r/o obstruction, which ended up being a small intestine volvulus.

Later that afternoon, while Milan was playing cards with the kids in the wards, I went to take a walk with Sr. Hilda on her afternoon rounds to feed the animals. First stop was to see if the dogs’ food was prepared. They eat “fufu”, which is ground corn meal.  Next onto the chickens. Sr. Hilda had such a sharp eye for the one chicken who was limping. It was so slight initially, but she picked up on it right away. She opened the cage a bit more so it was easier for the chicken to reach the feed.  And then came the cows, all 61 of them.  It was wet outside, so it was “slushy”, but I followed her in my sandals as she walked with her lovely knee-high rubber boots.  We checked on the baby calves, which were a bit timid, and the older calves which nudged me hard with their heads to get me to rub them!  Next we went out into the big field, up on the hilltop, to inspect the rest of the herd and make sure that none of them were acting strange, limping, crying, or lost.  She calls them by name: Benjamin, Toffee, Epiphany, and Bamenda are just a few that I remember. And even these big cows came to nudge you to pet them. Some would get jealous if you were petting another one for too long and ignoring them. I was rubbing the heads and necks of 3 at one time. Again she had this meticulous eye, checking over the whole herd. I think that Benjamin was missing, so she went to look for him while I headed back to find my Milan for dinner.

Friday, July 29, 2011

July 25, What happened?

In the hospital, a young 2 ½ y/o boy had come in with sepsis. The story was that he had a swollen right leg and a blister on his right medial foot that the grandmother had tried to drain a week ago. He now had a taut, swollen right thigh, moist cough, and very distended abdomen with a heart rate of 144 and pox of 75%.  I wasn’t sure that he was going to make it through the night. His lungs were coarse and there is only one oxygen concentrator for all of the medical wards, which works when there is electricity, which is sporadic at night. His right upper arm was slightly swollen; we couldn’t feel any abscesses in his swollen thigh; his abdomen was distended and he hadn’t passed stools for the past week; he also had an altered level of consciousness in which he would not focus his vision on you or anything, just kind of stared off into space, and had a sardonic-like smile.  Over the next few days, with antibiotic therapy, nursing care, and a lot of prayers, he is getting better. The swelling in his arm has dissipated, his cough is less (pox 93%), his belly has softened after enemas and paraffin tx, and the swelling of his thigh has reduced enough to reveal multiple abscesses. Probably for an incision and drainage soon. Thank you for your prayers.
Just a little FYI: The language they speak here are Pigeon, Kom, and English. Pigeon has many English words in it with different organization of expressions. For example: If you’d like for the patient to sit on the examining table, the term is, “Climb for bed”. If you’d like for them to lay down for an abdominal examination, you say, “Sleep for bed”.  Have you lost any weight is “Is your body small for skin?” If you’d like them to take deep breaths, you say “Breathe deep.”  Diarrhea is “posh”, vomit is vomit, cough is cough. Tuberculosis is “Strong cough”. Fever is fever, or “Is your skin for hot?” Pain is “hot”. For example, when checking for dysuria - “Is it hot when de piss?”  And by the way, just when you think you have the pronunciation down right, you’ll say it in your best American Pigeon, and they still won’t understand you. Our translator still has to sometimes repeat exactly what we’ve said, but with familiar accent and then they understand.

In Kom, it is a little more foreign. “Lay down” is “Ninyi”. “Sit up” is “Lolli”. “Deep breathe” is “Z’usa”.  “Say ahhh” is “Zese ahhh”.  “Where is the pain?” is “Fos ia de hot?”.  “Goodmorning” is “Tulima,” the response is “Aye, Wulime”. Or, “How did you sleep?” is “Aye wachima junga?” and the response is “Aye, machime”, which means you slept fine. And I always sleep fine because if I didn’t sleep fine then that would lead to a whole explanation that I am nowhere near translating!! “I’m sorry” is “Asha.”

This morning, a young lady came in comatose, pupils fixed and dilated, no doll’s eyes. The story was that she was fine yesterday, had some had not been ill, no history of headache. Last night she had some problems sleeping (unclear why) and this morning she awoke and told her mother that her head hurt, and collapsed.  They tried to give her some traditional medicine to wake her, but it did not help and so they brought her to us.  We placed an NG, oral suction, and placed her in what they call “cardiac position” (HOB elevated).  Within a couple of hours, she passed. SAH? Ruptured aneurysm? I suppose we’ll never know. God rest her soul and be with her family…

Today Milan felt the pain of teaching. The usual instructor that teaches grammer and reading was not there as he had a funeral, so Milan taught math (division of fractions) for 4 periods today and was exhausted. The children seem to be catching on to the concepts, but it has taken time. And of course on their break, Milan plays a mean game of futbol with them.  He says that they are really good, especially one young boy is superfast.