Goodbye Beautiful Boy 7/28/2014

From 7/28/2014

  Guedna died last night. In our minds, we knew it would happen. In our hearts, we kept believing he would recover. He didn't. 

  A woman from the village walked to our home to deliver the news. Kim was sobbing. This was her baby. The one who needed the most attention.  Guedna, 2 years old,  was so sick. His mother, Julienne, wanted the best for him and she did everything right: medicines, nutrition program, follow up consults. A recent widow, she was willing to do anything to raise money to support her four children. 

 Upon notice, we immediately packed our bag with some tea leaves, sugar, and beans. Taking a gift is customary when attending a grieving family as it  helps feed the masses who are gathering. 

  We drove the motorcycle to their home while Papa, a local resident teenager who we often call upon for Nangjere translation, readily volunteered to accompany us. He was relegated to Grace's bike without complaint. 

  Just off a dirt path, we arrived to find a sea of people. The men were sitting on rickety, wooden benches at the front edge of the yard.  The women, sitting hip to hip, were huddled together on mats spread around the area near the fire and home.  Others were preparing food, tending the fire or serving guests. There wasn't much chatter, just the heart wrenching sounds of mothers grieving together. Kim sat, cried and prayed with Guedna's mom. Someone brought Papa and me a bench to sit upon  in the same manner as the other men.

Each time a new mother arrived to pay respects, they would approach the mat and remove their sandals  before greeting Julienne. Most would wail with her in loud guttural cries. This cycle continued with each new visitor until you are eventually shifted off the mat onto another or make your exit with handshakes for everyone as you did when you arrived.  

It was tragic and sweet at the same time. I watched one of the prettiest sunsets tonight as I sat outside, under a tree next to a mud brick shack  while listening to women crying together in grief.

  These people have very few personal possessions. Their clothes are often threadbare. Every meal,  usually lacking in sufficient quantity and quality, takes hours of preparation and work.  It's a hard life here. Yet in that moment, as I sat with them in the setting sun, I could feel the richness in their lives.  They have a loving community of neighbors, friends & family. 

  Another baby died in Chad today but deaths are not just statistics. Guedna was a son, a grandson and a brother. He was loved. And now he is surely missed. 

-Mason

Thankful 7/20/2014

Sometimes we complain about things we don't have or "miss having." Honestly, we do without a lot of things now. But today,  we had another very humbling reality check & reminder of how much we do have. 

I used my phone to take this photo from our front porch when I noticed village kids reaching through the fence. They had extended a long stick into the compost pile for the compound and were trying to drag out decaying food scraps to eat. It felt like someone punched me in the gut. My trash is someone's treasure.  I pray that I will be a better neighbor to those more in need than I can even imagine. 

Just breathe momma 7/18/2014

  77% is not what I wanted to see when I placed the pulse oximeter on her hand. We were in the OR to do an urgent C-Section. 

  This a.m. one of our OB patients was looking a bit puny when we did rounds. She was pre eclamptic & her body was swollen everywhere with edema but they were delaying the baby's delivery until it was old enough to survive. Her breathing took some effort but it wasnt terrible. Still, she was looking worse so we decided she needs to deliver today- this mom is hypertensive & fluid is accumulating in her lungs.  To be safer, her surgery was scheduled for 2pm since she ate breakfast. 

 When I arrived to preop later that day, the patient was already in the OR. I could hear her wet cough through the walls. She was struggling to find a comfortable position to breathe: on her side, on her hands & knees. She kept rolling & twisting despite 2 nurses trying to pin her down so she wouldn't fall off of the OR bed. She looked bad.  What a downward turn in just a few hours. I had them sit her up with legs straddling each side of the bed. Now she can breathe a bit easier as we finalize the plan. 

  77% oxygen saturation. For you it would probably be 97-100%.  Her cells are starving without enough oxygen and she is virtually drowning in her own fluid. In the US, I would probably intubate her so I could manage her safer. Without a ventilator, things would only worsen here in Chad...& I may never get her extubated. I chose a spinal anesthetic after quickly debating the pros & cons. I do a quick mental check: IV/monitors/turn on oxygen concentrator/ equipment ready for "plan B".  Lets go. 

  This momma is so swollen that I couldn't feel any landmarks on her back. As I pressed the skin on her back to feel her spinous process, my fingers sunk in and left a 1/2" crater. I buried the spinal needle all the way and had to push even deeper to find her spinal fluid.  Mom started twisting & moving again just as I was about to inject the medication so I shouted to her & the nurses: S'il vous plaît! Ne bougez pas! 

I was already sweating & the thought of failing on this spinal was not helpful.   Thankfully it went in easily & we laid her down to do the C-section. 

  The surgery was textbook. No problems, limited bleeding, mom looked a bit better while breathing oxygen. Unfortunately the baby was pretty floppy at delivery. Stimulate. Suction. Stimulate. He needs to be ventilated by hand. We have all the right face masks & Ambu bags for adults, children, & newborns... But only one oxygen concentrator. So who gets our only source of oxygen? The mom drowning in her own fluids or dusky newborn needing help to jump start his life? The baby wins this one-- we ventilated him for just a few minutes and then eventually returned the oxygen to the mom. I simultaneously gave mom oxytocin to contract her uterus, checked on baby, gave repeated doses of lasix to help mom eliminate excess fluid & breathe easier, irrigated the wound for the surgeons, back to check baby again. Oh, and there was a film crew here recording everything for a project back in the U.S. 

No pressure!

 Thankfully there was a beautiful ending to this chapter of the story. I whispered into moms ear: C'est un garçon et il est fort. She gave a weak smile and closed her eyes again.     

  Mom isn't necessarily "safe" after surgery but her oxygen levels were 90% before returning to the maternity ward. We can ALL breathe a little easier now. 

 

-Mason

Africa Meds 7/15/2014

Our medicine cabinet hosts the typical array of cold medicines, band aids, ointments and pain relievers but we also have a bag I have labeled "Africa meds." This bag contains a variety of of foreign treatments for malaria, worms, typhoid and other parasites; even as medical providers, these were all new to us. Though all common here, they are used quite frequently and written as standing orders for children admitted to the hospital. Today, Mason and I administered my first familiar medication Cytotoxan, though it has been over 14 years for me and 16 for Mason since either of us had used a chemotherapy drug. 

Our morning was filled with ethical and moral discussions for the use of this drug on our specific patient. He is  very malnourished 2 year old who has been treated for every typical infection and illness and almost every drug our pharmacy shelves. Despite months of treatments, examinations and receiving nutritional supplementation, he remains a very sick and malnourished child. Upon yet another consult and blood test, our mission physicians have narrowed the suspects down to lymphoma or TB; neither which has a good prognosis for this child. With limited diagnostic equipment and tests, treatment here in many cases is a diagnostic tool. After much discussion, it was decided Cytotoxan was the best course of treatment.

Yet Mason and I walked away conflicted with ethical dilemmas: lack of protocol, lack of medications to treat side effects, lack of educated provider, and immunosuppressing a child in a remote disease and dirt laden hospital. This treatment will surely kill this weak, weak child. Our only impetus; if we do nothing, he will also surely die. 

So yesterday afternoon, after an early morning call to one of my besties on the stateside who I knew wouldn't mind, pleading for help locating a protocol as we were unable to download anything ourselves, we began IV administration without a pump of a chemotherapy drug to our patient laying a on shared mat in the Chadian worm filled and bacteria infested dirt. Modern medicine doesn't look the same in third world country. In a few short weeks, Mason has functioned as a pediatrician, oncologist and oh yeah an anesthetist.

P.S Thank you Kleins for your expedient and informative emails

 

Momma's perfect baby boy 7/14/2014

I was going to include a photo in my post because I couldn't stop thinking about this baby. I didn't include it because he died today. Its the kind of thing that creeps into my thoughts long after seeing it.  The photo is what you look like at 14 weeks. Alive & moving. Perfect little boy.  Of course a 14week old fetus cant survive. So this  baby boy died while we saved mom. 

We were in the OR caring for a young mom hemorrhaging with an ectopic pregnancy. She didn't "look" too bad but her hemoglobin was only 3.  Mom survived the surgery (thanks to Danae Netteburg our awesome OB doc). Unfortunately another child died in Chad today. This time it was unavoidable but the sadness is the same.  We saved a man with a ruptured intestine from typhoid, a man with an eroded gastric ulcer, and another OB mom in the night bleeding to death. We win some and we lose some. It is a bit like the US, but our losses come more often. I played competitive baseball most of my youth. We won most of the time except for the year my team went 1 and 17. We won one game and lost 17 games. That was a character building year. Im going to bed tonight praying that tomorrow we win another game. I'm not wanting anymore character right now. 

-Mason

Skin and Bones 7/9/2014

Skin and Bones

Many times during my life I've been described as "nothing but skin and bones." And, I know at times it was meant as a compliment but also most saying I was too skinny.  In fact, our whole family is on the lean side; anyone familiar with Mason knows he is barely able to maintain weight. Yet even at my thinnest, I have never been close to the literal vision of "skin and bones." Since working with malnourished children, I am now quite familiar with the true description of those words.

Three weeks ago, I received a quick turn-over of the Nutrition Program, which was started and has been managed for many years by a Mission Momma & nurse, who has now relocated to Indonesia. I have taken over management of the program during the summer before a new and scheduled director (and I am sure somewhat more prepared than I) takes over in September. Currently, I see the mothers and their malnourished children, once per week on an outpatient basis. Essentially, running a clinic for the day. I assess their weight and general appearance and take a brief history of intake/output and general health from the mother, any illness or fever.

Yesterday, with the help of several members of the Public Health team and my girls, we saw 17 children from the age of 2 months to 2 years. And yes, most of them aptly fit the description "skin and bones." A new child for the program weighed in at 4.5kg at 10 months old. As I placed him on the scale, I could feel every curve and angle of the bottom of his pelvic bones; the weight upon my hands was light but the burden upon my heart quite heavy. Any child accepted into the Nutrition program to receive supplemental formula must fall within 3 standard deviations below the median for height/weight according to a WHO table. It was obvious upon first glance that he would indeed fall well below the 3rd. Thankfully, the mother breastfeeds and combined with education classes, nutritional supplements and a round of meds to treat malaria and worms, he has a good chance of recovery.  Additionally, he received vitamin A and a B12 shot. I sent him to the pediatric ward to receive his injection because after 12 years of motherhood and away from nursing, I wasn't about to jump back in with an IM injection for a child without muscle tissue.

The morning wasn't entirely discouraging, there are 3 children who are very close to goal weight and will very soon graduate from the program. Even more encouraging, 4 mother's walked over 20km to attend classes and receive formula.  In a culture where the life of infants and young children is not highly valued but seen as more transient, finding mothers committed to their child's health is uplifting. The care for these kiddos is definitely a roller coaster of emotions. The gravity of malnutrition is a tough sight yet I still spent much of the morning laughing and the mom's too. Mostly at my attempts in learning the language, they love me trying to roll these foreign sounds over my tongue. A good laugh is also had when I mix up moms and kids, they are all still new to me. And of course, it is always comical trying to express wit across cultural and language barriers.

Our time here has been short but our experiences thus far have been extraordinary. We have quickly learned willing hands can do much more work than you may expect, even smaller ones like my girl's who have been side by side with me as we learn to serve the women and children here. Overall, despite the difficult circumstances we see, it is very rewarding.

7/4/14

Independence

Today is the 4th of July. I (somewhat) explained in French to some people today what this day means to Americans & how we would celebrate. 

  In Bere, Chad we didn't barbecue or watch fireworks but we did gather together with a nice potluck meal complete with  homemade ice cream, red, white, & streamers, and cake. We also celebrated a 3yr birthday for our good little friend Zane.  So we celebrated the birth of a nation & the birth of a boy. 

  It made me think of the founders of our country: the rich and the poor who risked everything for the greater good. They abandoned comfort and security 

for the dream of better things to come. 

  Personal sacrifice & the belief that change can occur & things will get better if we work together... It was true then in America & it's true today across the globe.  Have fun today with friends & family. God bless America and each of us. 

 Mason, Kim, Grace & Emmie

whyweshouldgo.blogspot.com

 

Tough day 7/1/14

Spoiler Alert: very rough day today. 

  We have many successes here and more lives are saved because of the work being done each day.  But the deaths are surreal & painful in ways we don't experience each day in the U. S.  so I find I write about suffering to unload my emotions & to report how hard life is for others in this world. Count your blessings & hug your children tonight. 

  When I arrived this morning to set up the OR & arrange the surgery schedule there was a young girl already on the OR table.  She's maybe 16yrs old & pregnant & her baby is definitely dead. The mom may have a ruptured uterus (labored for days--not at our hospital). A forceps delivery of a dead baby is really tough to watch. The scent of death filled the OR immediately & left a permanent scar on my heart. I felt sick with grief. Frequent death is still new to me. They closed up mom with no rupture but things just seemed "off" with large belly & pain after delivery but she was stable & not bleeding. 

  An hour or so later we were called to the OB ward to see her again. She looked bad-- like sepsis creeping up. We hand carried her to the OR just a 100 feet away. Definitely septic. Ketamine anesthesia. Not bleeding, normal hemoglobin, but laparotomy found lots of fluid, swollen bowels, no perforation but her tissues look bad. Did I mention we could not obtain her blood pressure for probably 5 minutes? We were pretty sure she would die in the OR. I found some Levophed in the drawer (one of only 2 bottles in the country), mixed my own drip and titrated the medication with no pump, just a roller clamp. 

I kept her in the OR for hours as our mini-ICU. We cancelled elective surgeries & I stayed with her all day until I was called out to see a child gasping for breath in pediatrics. Actually he was laying on a mat by the fence outside-- kind of near pediatrics. He was maybe 8 yrs old & struggling for breath. I had them carry him to preop so I could give oxygen, medications, &monitor him. He struggled for breath as we treated him for maybe 20 minutes, working through treatment algorithms & working out why he was so ill. I held his hand & stood beside him the entire time. For a few minutes he looked like he was slightly improving. That sweet boy died literally right in my arms. One moment struggling & in the blink of an eye he was still & silent. I was shocked by the speed that death occurred & I saw it coming. His eyes & face changed & he was gone. As I confirmed with my stethoscope what I already knew, I felt the now familiar sensation of my tears rolling. We called in his mother & grieved with her, choking back my own sobs that tried to break through. It honestly tore my heart apart. 

  We ended the day with another C-section--but with a happy ending. Strong baby boy & healthy mom. We debriefed a bit afterward to help the team cope with the boys death just an hour earlier, I cleaned up & walked home.  It's 530pm & I haven't had anything to eat or drink since 7 am. I stripped off my scrubs, stepped into the shower, & cried again. 

This is "slow season" in Chad. 

 -Mason

P.S. I really, truly love it here.