Sunday, November 24, 2013

Leavin.....on a jet plane!

October 13th.  That’s the last day that I wrote a blog. Oops!  I have several of them mostly written in my head (the witch doctor that was dancing outside my house in an effort to find the thief who stole my neighbor’s things…..the day I had three deliveries in a day and may have finally overcome my reflexive urge to vomit from nervousness every time a laboring woman comes in, etc). But it’s old news now, so I’ll just have to leave those blogs to your imagination (and please imagine them to be the perfect balance of information, hilarity and emotion.

It’s 4am now and jet lag has me wide awake write a blog about the most recent exciting event in my life.  My trip home!! In order to tell it well, I have to go back a bit to explain my travelling buddies.  One of the reasons I was so frantic in my last blog to get everything legally squared away for Marie was because I knew I would need those documents to get a visa for her to go home at my usual time in November.  I figured that if I got legal custody, they would have to give me a visa for her right?  Um….wrong.  I spoke with a friend of mine who was in a similar situation.  She and her husband had obtained legal custody of a 10 year old Sierra Leonean boy who was sick. They had exhausted all the medical options in Sierra Leone so wanted to take him to the US for medical treatment. We all know that when trying to get a visa for someone, the object is to try and prove that they will come back to Sierra Leone when they’re supposed to.  Unfortunately, because such a high percentage of Sierra Leoneans DON’T come back when they’re supposed to, it’s VERY difficult to get an American visa.  My friend explained that even though they had legal custody of this little boy, the consulate was still VERY concerned that he would run away (he’d been living on the street in Salone) from them while he was in America and wouldn’t come back.  So they POURED over her documents and ended up saying something to the effect of “Ok, I’ll give you this visa, but don’t bring this boy back again and don’t bring me any more children!”  Yikes!!! 

For this reason, even after I got Marie’s legal custody papers, I was still nervous about getting her visa and was mentally preparing myself to spend my first Christmas in Salone.  Since Marie is only five and never lived on the street, I was hoping they wouldn’t think she’d run away. However my friend advised me that I had to prove I would come back with her.  I brought all the documents I could think of and just started praying!  The day of the visa interview we went in and I had a very pleasant interview experience.  There are two people that conduct the interviews (Americans) and the woman I got asked me quite a few questions, but they all seemed perfectly legitimate to me and in the end gave me a 2 year, multi-entry visa for Marie.  Woo hoo!!!  America here we come!!!

Ok, now about my second travel companion.  Oh boy.  Peter is a friend of mine and we’ve been…eh hem….talking? dating? Spending a lot of time together? for the last year or so.  My parents have met him, but we decided it would be fun for him to get to come to America with me over the holidays to spend some more time with my family and experience my culture.  To be honest, I was a little excited for him to experience what it’s like to be in a culture that’s so foreign from your own with different languages, different way of doing things, different way of thinking about things, etc.  He’s always so sympathetic when I’m feeling homesick or on the days that I “feel like I’m taking crazy pills” because everything is just SO different, but until you experience that kid of “fish out of water” experience, it’s hard to explain.  At one point he asked me how many black people there are in my town and I explained I live in a small town that isn’t very racially diverse.  However, I assured him, that I highly doubted the kids would yell “BLACK!! BLACK!!!” like they yell “WHITE WHITE” at me in Sierra Leone when I’m walking down the street.  So it wouldn’t be exactly the same……

We had a little trouble getting Marie’s application completed online so Peter’s interview was first. We took everything we could think of to prove that he would come back when he was supposed to.  It still didn't even take them five minutes to deny him a visa. Bummer. 

A friend of mine suggested that we call the American ambassador to see if he would have any sway.  As the day for the interview approached, my dad tried to call the ambassador a few times but could never get through. Then I found out that his term was over and the new one hadn’t arrived yet.  Bummer!!  Our ace in the hole plan was foiled!! 

To be honest, I was a little annoyed. Not at anyone in particular, but I was 100% sure that Peter would be denied and really didn’t want to make the 7 hour trip over a horrible road just to sit at the embassy for 4 hours and be told that once again, he couldn’t have a visa.  If we applied for a visa again, we were supposed to come with new information that would prove he was going to come back. But we'd given them everything we could think of the first time. Peter did end up getting a letter from a veterinarian telling them how many cows, sheep and goats he had……but somehow I didn’t think that would make a big difference. 

Miracle of all miracles happened though, on the interview day!  The woman that interviewed him was the same woman who had interviewed Marie and I and she recognized the name of our NGO.  She ended up calling me to the counter to ask about the nature of our relationship and the purpose of his visit. I just told her the truth.  And she gave us the visa.  We. Were. Shocked.  We both just stood there staring at her and she started laughing.  That was NOT what we were expecting!

I was so exited to go, but was also nervous!  I'd never traveled with non-citizens before and was afraid I hadn't done something correct, or wouldn't have the right documents. I was especially concerned about Marie because I did NOT want to go to prison for child-trafficking!  

The first two officials we spoke with at the airport asked if we had documents for Marie and when I said yes, they said "ok" without asking to see them. Finally someone from immigration asked to see my documents and although I was nervous, he said it looked good.  Yeah!! Safe!!!!

We went through security and as they were checking our bags a police officer came up to us and asked about Marie. I knew that the police don’t really have much to do with immigration so I explained that I had just shown my papers to the immigration man. He told us he wanted to see us after we were done.  Oh great.   After we were done he came over to us and asked to see Marie's custody papers.  I pulled them out and he started pouring over them.  At one point he looked at the document that had Marie’s parents’ thumb prints as signatures and said, “Well these people aren’t educated. You could just tell them this says anything and they would sign it.”  Um….it’s true. But that’s not what I did!! See the magistrate’s stamp and signature!!?!?  Then he pointed out a word that said “recomendating” and said, “Um, I don’t think this is the right word is it? Shouldn’t it be recommending?”  I said, well yes, that’s not the right word, but I didn’t type it up.  AND SEE HOW THE MAGISTRATE SIGNED IT!?!??!!  (At this point I was getting a little frustrated).  He said, “If this was a real court document, I don’t think there would be these mistakes..........  Oh man. I started praying!!  I also pulled out the pictures I had of Marie when I first met her and she was near death with malnutrition.  I showed them to him and he immediately changed his tune.  “This was her? What happened? Was she in a fire?” (She has wounds all over her body in the picture). Peter jumped in and started explaining that she’d been in the hospital 3 times for malnutrition and was near death before she came to live with me.  The police officer said, “Well, God decided that she shouldn’t die. Thank you for taking care and helping her.”  Thank you Lord!!!

We made it out of the airport and were ready to go!! The trip was pretty uneventful….albeit long!  I had shown Peter where we had to fly on a map before we left, but you really can’t have a concept of how long it will take until you do it. Marie did awesome!!  I was SO thankful for the little personal TV’s because she was fascinated!  The hardest part was making sure she didn’t kick they guy next to her while she was sleeping. Peter and I learned after that to put her in between us! 
Food and TV on a plane. Could life get better?

First Starbucks!
Marie getting prepared to step off the moving sidewalk
My favorite moment was when we went on the moving sidewalk things and the escalator.  Marie LOVED them but every time we got close to the end she would start saying “oh! Oh! Oh! Oh!”  Our flight from Brussels to Chicago was delayed so we were cutting it pretty close to catch our flight to Portland. Unfortunately that was the time we had to go through customs and security and seemed to have our bags checked a million times.  As Peter took our laptops out of the bag AGAIN he said, “You really have to have patience if you want to travel to this country!!   So true! 
After about 30 hours of travelling we made it to Portland and were greeted by some familiar faces. I am SO excited to be home and get to share this with Marie and Peter!  :)
Wonderful reception at the airport

Sunday, October 13, 2013

I'm Legal!!

Marie came to live with me in January.  I inquired about the custody process with the Child and Social Welfare office in Makeni, which is a 4-5 hour drive from my village.  It was quite the process as I had to first get her birth certificate, her passport, bring both her parents for an interview, etc.  I started in March because I know how slow the government can be here, and wanted to have PLENTY of time to get everything in place before I hoped to travel home with her in November.  In March I was granted custody for six months as a preliminary step before beginning the adoption process.  I was assured MANY times that this was all the documentation I needed in order to travel with her. I even went to the American embassy to make sure I had the right documents.

My six months custody was supposed to end mid-November so they told me I needed an extension so my custody wouldn’t finish while I was in the States. The two men at the office assured me that it was a simple matter of getting the magistrate to sign a form.  Simple. Ha. During the last month I’ve made three trips down to Makeni to try and get this precious signature. First, the magistrate was out of town. Then they had changed magistrates, so the new one hadn’t started coming to court yet.  Last week was the third time we’d went down. We tried to call the men to tell them we were coming, but neither were answering their phones. 

When we arrived, we found out why. One of the men was in jail, and the other was nowhere to be found.  Apparently some motorbikes were missing and they were locking up all the suspects.  I couldn't believe it!  The men’s boss, who we’d never met before was at the office. When we explained why we were there, he told us that he had to sign off on all such cases and had never heard of our case.  When I showed him our paperwork he looked at the signatures and said that the man who was locked up had signed his name, but had used the boss’s stamp. So it was a forgery.  He said that anyone who wants to take a kiddo out of the country has to be referred directly to Freetown.  No one had ever told us that. I was devastated.  My interview for Marie’s visa is next week.  And the last eight months of work for all the custody stuff had all been for nothing.  I broke down in the office. 

We went to the man’s house who wasn’t in jail to see if we could talk to him,  but he was MIA.  So what the heck do we do now?  After talking with the bossman for a couple of hours he finally agreed to write a letter for us to the Freetown office.  I wanted to go down to Freetown on Monday, but wouldn’t you know malaria struck again and I didn’t think I’d be able to drive that far.  So Tuesday morning I woke up bright and early to head to Freetown. 

Several months ago Marie’s mom and dad started having some marital problems so she went to stay in Freetown with her brother. Her father decided it was time to reconcile, so I picked him up on the way down so he could go see her family in Freetown. (Dropping him off is worth a whole blog in itself as I found myself in one of the most uncomfortable positions I've ever been in.  And that's saying something!)

Wednesday morning I headed to the office. My dad is coming early Tuesday morning and Marie’s visa interview is for the day after he leaves. This meant that I had four days to get this paper done. Four days. Dealing with the government.  Impossible.

I went to the office and they told me that sure enough, the paperwork I had wouldn’t get me anywhere. Except maybe Pademba Road (the prison) for child trafficking.  NOT where I wanted to go.  They told me what I needed and praise Jesus I had everything I needed INCLUDING both of her parents in Freetown. What are the odds???????

After two VERY long days of waiting at the office, I emerged last night at about 6pm with my official, court mandated custody paper and a letter from social services saying that I was permitted to travel with Marie.  And the only money I had to give was the “fee” for the magistrates signature. I wasn’t sure if it was a bribe or not.  I’ve always had a strict no bribing policy so I wasn’t sure what to do.  I talked with some other people who had gone through the same thing and hadn’t paid any money either, except this magistrate “fee.” Apparently there’s not a way to get around it.  So I paid it. For better or worse…..God judge me as You will.  All in all I couldn’t BELIEVE that everything had gone that well….that fast, without greasing the palms of everyone involved.  They really really really tried hard for me!!

My precious document!!
As I was driving home last night, I started thinking about the last week. When I arrived in Makeni and found the man I’d been dealing with in jail, I was devastated. Surely this meant I wouldn’t be going home!  As I thought about it though, I realized that if they hadn’t gone to jail, their boss probably wouldn’t have shown up.  (Their boss is the regional supervisor so travels a lot and has never been there when I’ve been there).  If their boss hadn’t shown up, I never would have known that I had the wrong paperwork. I would have gone to the interview and been told to go take a hike. I had this mental image of me sitting in the office crying, thinking all was lost when God was there saying, “Emily….this is for the best! I know it doesn’t seem like it right now, but wait and see!” I don’t like to get all philosophical….because I’m just not that good at it. But it really made me think about all the other times in my life that things seemed lost, doomed, destroyed.  And I cry and fuss and grumble (sometimes the things really are HARD!!)  But Emily (sometimes if I use my name when I talk to myself it makes me pay better attention to myself)….don’t you think that God is still saying, “Emily…this is for the best! I know it doesn’t seem like it right now, but wait and see!” 

Things worked out really well this time.  And by “really well” I mean that they ended how I wanted them too. And I’m SO SO SO thankful for that.  There are other things in my life that I’m still “waiting to see” how they’re going to end up for my good.  But I’m thankful for this little reminder that THEY WILL!!  Even if I don’t see how until I’m in heaven.  Thank you, Lord Jesus, SO much for your faithfulness! 

Thursday, October 3, 2013

Final Musa Update

Musa died early Sunday morning. For the last two weeks, he hasn’t been doing well. He got another kidney infection, was in a lot of pain (suspected a sickle cell crisis which is often precipitated by infection) and wasn’t peeing, no matter how much medicine I gave him. I kept offering to have him admitted to the hospital because they would be able to manage his pain easier and he would be closely monitored. But he kept putting me off and settled for my daily visits to give him pain medicine injections and IV Lasix (to try  and make him urinate).

I had to go to Makeni on Tuesday for some custody stuff for Marie and ended up being delayed there until Friday. I called to check on him on Wed. and he didn’t sound great. I encouraged him to go to the hospital but when I called the next morning his mom told me that he was afraid to go if I wasn’t there. I pushed it and he started feeling badly enough that he finally agreed.

I got back Friday afternoon and immediately went to see him. He didn’t look well.  The next day was Saturday and I had to work. It was initially slow so I got to spend some time with him.  He wanted to go outside so we spread a mat for him and he and I went to sit outside so he could feel the sun on his face.  He was having a lot of trouble breathing but he started talking about Job (from the Bible).  We’d done a study about Job and his suffering and the following Sunday he’d gone to church with my friend Peter and they also preached about Job. I guess it stuck.  He said that Job suffered a lot but didn’t understand why.  He said he also didn’t understand why he had to suffer so much, but that he was trusting that God had a reason.  Somehow.  He then started quoting the twenty-third psalm.  As I write this I’m realizing that this was the last conversation I had with him.

Shortly after this I got a critical patient and was busy doing an emergency c-section.  Musa started seizing. He would seize and then go into his post ictal state (kind of unconscious---like a deep sleep). He would then wake up for a few hours but would seize again. His seizures were violent and at one point he broke off two of his teeth.  His faithful brother held the guard in his mouth for hours so he wouldn’t chomp down on his tongue.

After he seized he would wake up enough to make eye contact and I knew he saw me because he would do this little eyebrow raise that we always did to each other.  That night I went home for a couple hours but went back around 10pm. I wasn’t sure if he would die that night, but I knew I had to be there if he was going to.  At around 11:30 I laid down on one of the extra beds and dozed on and off until 1am. I heard his breathing change and sure enough, he’d started seizing again. After this one he never regained consciousness. 

It was painful to watch.  I honestly don’t know how his mother did it.  I was begging God to be merciful and take him home quickly.  His mother would leave periodically and his brother sent me out to encourage her if she was crying. At 1:30 I told her that he was sleeping. It was hard to watch him struggle for each breath like he was, but he wasn’t feeling pain. He wasn’t suffering. Shortly after that she took some of her things and went back to the house. I think she knew he was going soon. Sure enough, at 1:45am his breathing started to ease and he died.

At 2:30am I went back to my house to try and sleep. Musa’s family called me at 5am just to check on me and see if I’d stopped crying. I couldn’t believe that in the midst of their grief they were calling to see if I was ok.  Later that morning, around 8 I was getting ready to go down and check in at the hospital (I was supposed to work that day) when the family called to tell me they were waiting for me to do the burial preparations. Wait. What?!?! I have no idea what the appropriate stuff to do for a burial is. Why do they need me? I called my friend Peter and we went down to see the family.

I’d only been part of one burial here before.  This was a lot different because, as I came to realize after spending about 10 minutes in the house, instead of being the one to sympathize with the loss of the family, everyone was treating me as if I was one of the family that lost a child as well.  After the greeting formalities we all gathered in a circle and the Imam (who was also Musa’s grandfather) explained that they didn’t want to proceed in the burial plans without my approval and wanted to know if there were any special prayers or anything that I would want to do.  It was sweet that they wanted to show me that kind of respect, but I was quick to assure them that whatever they wanted to do, I was fine with.  I explained that I believed that because Musa had trusted Christ for his salvation, he was already in heaven and that my prayers were for those of us left behind who were in pain because of his absence. 

We stayed at the house for a few hours while they built a little house outside to wash the body. As they took his body out of the room to wash it, everyone stood up. I assumed it was out of respect, which it was. But Peter also explained that some people believe that if you don’t stand up when the body passes by, that you’ll be the next one to die.  Yikes.  

Periodically a new woman would come to the house and would start wailing.  People would allow her to cry for awhile and then would say “That’s enough. That’s enough.”  As we were all sitting around we started talking about Musa and sharing things about him that were nice, or made us laugh.  Some things are the same in any culture.

The burial was scheduled for 12 noon. We all met back at their house and they had a little service where they talked about Musa and his family. Then we headed for the burial site. Peter and I went ahead on his motorbike and watched as they carried the body towards us.  As they were coming, I realized that there were no women among them.  Islamic funerals don’t allow women to go to the burial site, so I stayed put and Peter joined the men to go to bury him. 

Afterwards we went back to the house where they women had been cooking up a storm and all sat around and ate rice.  We hung out for awhile and then I went back to my house to take a nice, long nap.  I’ve been spending a lot of time with Musa’s family this week. His father arrived the day after they buried him and they’re planning to do another memorial service in November. Yesterday the entire family came up to my house to “greet” me.  They just wanted to tell me that even though Musa’s gone now, they don’t want the relationship to end. At first, I thought they were talking about money, but Peter clarified and Musa’s mom said, “No, no! We’re not talking about money. I just want to be coming to greet you and I want you to be coming to greet me.”  It’s amazing to me how grief can bring people together.  My prayer is that I’ll continue to be able to love this family and that they will see Jesus!! 

Monday, September 16, 2013

To Live and Die

It was quiet in the OB ward yesterday. We only had two patients and they had both been in the ward for over a week.  At 2:45 pm a woman walked in with her husband. I’ll be honest and say that my first reaction was “Darnit! I’ve been sitting here doing nothing for seven hours and NOW you want to come in….when I’m supposed to go home in 15 minutes!?!?!” I know right? Bad Emily! 

I asked what was going on and the husband told me that her belly had started hurting yesterday morning. She was five months pregnant.  They must have met the lab man on their way in because they came in with completed labs.  I glanced down and immediately saw that her hemoglobin was low enough to probably need blood, and also, she was HIV positive. They  had gone ahead and checked her husband….he was negative.  I know that Africa is known for its high rates of HIV, but it’s still pretty low in Sierra Leone. Last time I checked it was about 3%, as opposed to 25% in some African countries. I don't think she knew. 

I sent her back to the labor room to be checked while I quickly got some basic information from her husband. When I went into the labor room, it was pretty apparent that this wasn’t just ligament pain, heartburn or some other benign pain in pregnancy. She was contracting. Hard. I checked her vital signs which were fine. She measured at about 21 weeks, but was probably a little farther, as the measurement isn’t as accurate after labor begins. Next, fetal heart tones. I searched and searched. She told me she’d felt the baby move that day, so I kept looking. Finally I found them. 150 beats per minute. Perfect.  I was just about to perform the vaginal exam to see how far dilated she was when she told us (I had a midwife student with me….who ironically enough I’m sure has WAY more OB experience than me! Have I mentioned that OB IS NOT MY THING!??!!)  Anyway, I always get a little nervous when someone says they have to have a bowel movement because the sensation to push the baby out is so similar. We got the bedpan for her and she urinated. We started helping her back to bed when she said she wasn’t finished yet. As she sat back down, it happened. She delivered her baby boy into the bedpan. We maneuvered to get her back into the bed to deliver the placenta.

As I cut the cord and wrapped the baby in a blanket, I asked if she wanted to see him. She did. I asked if she wanted to hold him, but she declined. So I held him close as he took his first and final little breaths. As I was holding him, I took a few minutes to inspect him.  He was perfect. Perfect little hands, little toes, little nose. He was beautiful. He was just too small.

I went to tell the husband that she’d given birth but the baby hadn’t made it. He was visibly upset. This was her fourth pregnancy but her husband said it had been a long time since her last pregnancy. I suspected that her previous children were with someone else and this was the first one for the two of them.

After the delivery I debated about where to put her. Our ward is divided into two sections with one section for deliveries and the other section for women with other pregnancy related problems. We usually try to put the women that lost their babies in the non-delivery section so they don’t have to be surrounded by happy women with their babies.  But the other section was empty and the last time I’d tried to put a patient over there by herself for that reason, she’d asked why she'd had to be over by herself and asked if she could come join everyone else.  Knowing this woman's HIV status made me ESPECIALLY sensitive to her feeling like an outcast. So I made up her bed with the other two patients.  Her husband requested to go home, but she needed blood and even more importantly, she needed to talk to our HIV counselor.  So I asked them to wait. 

This morning I came down to the ward and saw that one of our staff members had delivered a bouncing baby boy overnight. This was a big deal!  She had a five year old little boy that died about 10 years ago. Since that time she hadn't been able to get pregnant.  Infertility is extremely painful in any culture. Here, if a woman is unable to give birth her husband will often leave her to go find someone who will "give birth for him" and she is often labeled a "witch."  My friend and her husband have desperately been hoping and praying for another baby. And it finally happened!  We are all thrilled!!

The visitors have been streaming in all morning. Literally. A constant stream all morning. They're laughing, eating, singing and dancing.  I want to jump in and dance with them! (But I will never do that. My sisters wedding video is humiliating evidence that I should never. ever. dance. Ever.)  As happy as I am for my friend, every time a new batch of visitors walk in, my eyes glance over to this other patient who delivered her premature baby yesterday.  Her baby died yesterday and tomorrow she will meet with our HIV counselor and find out news that will change her life forever. Sometimes it just amazes me the way that joy and pain can be tied so closely together!  

Monday, September 9, 2013

Musa Update IV

Yesterday marked one week being back in our village with Musa.  The journey to get here was not without its drama. The morning I was to take Musa from the hospital, I was talking with a nurse who informed me that Musa is a sickle cell patient.  (This is a disease that isn’t uncommon here but we hadn’t tested for it at my hospital.) I panicked. As sad as I was to take Musa home to most likely die, I’d come to terms with it and was ready to move ahead with a plan. This new information threw everything off.  Would the treatment change? Was there more we could do now? If so, how was I going to pay for it? While I was thrilled at the thought that we might be able to turn things around, my plans were all of the sudden thrown off and once again I felt like I had no idea what to do.
I waited around to speak with his doctor.  He confirmed that yes, he did have sickle cell disease. (This is a  genetic disease in where many of your red blood cells are in the shape of a half-moon instead of circles. This makes the blood unable to flow fluidly and often gets “stopped up” at the corners.)  However, he was still in need of dialysis. This new information helps us understand why he might have gone into renal failure in the first place. (I went home and was researching sickle cell on the internet and read that the most common cause for death among these patients is organ failure, particularly kidney failure). However, because his kidneys were already so damaged and were failing, our treatment course couldn’t change.  He still needed dialysis which meant that we were still taking him home.

The night before we were to take him home, I tested positive for malaria. I was a little relieved!! I’d been having symptoms for a couple of days but when I initially tested, it was negative.  When the symptoms returned, I thought that my alleged hypochondria was in overdrive and my coping mechanisms were just shot.  So when my weakness, nausea, fever and chills were explained with one little line on a malaria test, I felt glad that I hadn’t completely lost my mind. But now I was in a quandary. I hadn’t had this particular strain of malaria yet. And this was the bad one. The one that kills the white people. My co-workers that had had this one had been hospitalized, delirious and in need of IV fluids.  Apparently the symptoms are worst in the 12-24 hours after starting treatment. If I started treatment that night, I would be feeling bad right about the time I was beginning a day long drive up country with a carload of people and one sick kid.  I contemplated delaying my treatment and just risking it for a little while until I got home, but…..the nurse in me wouldn’t let me do that. This particular strain makes me afraid. I would say that anyone who was contemplating that was an idiot.  So I couldn’t do it. After a lot of deliberation, we decided that Musa could go and stay with his uncle for one night and then hopefully the next day I would feel well enough to travel.

God is so good. The morning after my mom announced to the world via Facebook that I was sick I got on in the morning and started crying at all of the people praying for and encouraging me. And praise God I didn’t get that sick! In fact it was my “best” case of malaria so far!!  So thank you thank you thank you!

The morning we were to travel I left the house at 8am.  We reached our village at 8pm. It was a grueling day. Between the traffic, bad road, potty stops for Musa and Marie and rest stops when Musa just couldn’t take the bumps anymore, it took us FOREVER to get home. But we did.  Musa looked awful. It took a lot out of him and he was exhausted.

I didn’t know what to expect when we got home. I’ve never done this whole “waiting to die” thing with a patient at home, so I really had no idea how long it would take.  My friend Peter and I have gone to see him every day since we arrived. For the first three or four days, he looked really rough. At one point he was so discouraged he said he’d rather die that continue to be sick like this. That was heartbreaking.  But then about three days ago, he seemed to turn a corner! He called me one evening crying in pain so I bought a medication to inject for the pain and went to give it to him. The next day when I went to see him, I was amazed at the difference! His breathing was better, he wasn’t in the pain anymore, and he said he felt stronger. He has gradually improved a little each day. 

Before Musa was sick Peter and I were doing a Bible Study at my house with him and a couple other people every Thursday evening. Last night we took the Bible Study to his house. I strayed from our previous topics and talked about suffering. I’d been thinking about it a lot lately. As I was preparing for the study I was overwhelmed by the hope that I truly do have because of Jesus. I know that my suffering is so small compared Musa’s and millions of other people all over the world. But I’m so thankful that to whatever degree I suffer, I have hope now, and I have hope for my future.

Thank you all so much for the encouragement that you’ve been to me during this time. You have NO idea how much it’s meant!!  I don’t know what the future holds for Musa…..but I’m praying that we will both learn to cling to the Hope that we have. 

Marie and I hanging out with Musa at his house

Tuesday, September 3, 2013

Musa Update III

It’s very odd being on the other side of the ICU doors.  It’s especially odd being on the other side of a Sierra Leonean ICU.  The ICU here is set up quite differently from ours in America. Instead of rooms, it’s one giant room divided by curtains.  It’s not as visitor friendly, as they do not allow chairs next to the beds. I’ve taken it as a personal challenge and tried all different means to challenge my stamina. Leaning, crouching, squatting, etc.  I tried to just sit down on the ground but that caused a general uproar so I had to stand up again. 

I didn’t know this before, but when you have a patient in the ICU, your life revolves around the little numbers posted on the “visiting hours” sign.  You wait all day in the waiting room for the intermittent hours you’re permitted to go inside. (Keep in mind, this is here. I don’t remember us being as strict in the US).  Because you’re spending so much time in the waiting room, you develop a strange close relationship with perfect strangers whose only commonality is that you all have a loved one sick enough to be on the other side of those doors.  A tentative first hello quickly develops into shared stories, encouragement, laughter and tears.  Musa was initially admitted with five other ICU patients. In the days since his admission, several of them have transferred into the wards.  But their family members still come to visit us. It’s very strange. But really nice. 

After Musa’s first few days in the ICU, his condition really seemed to stabilize.  Two nights after we arrived, I went home and promptly had a breakdown with some friends. He just can’t keep on like this! He can’t keep breathing like this!!  When I’d left the hospital he’d been talking, but not really making sense.  I expected his death in the next day or two, and was just praying that I would be there when it happened.  I had considered sleeping in my car that night but had an important e-mail that had to be sent out so I headed back through the three hours of traffic to get home.

The next morning when I arrived at the hospital, I was expecting the worst but was pleasantly surprised to see that Musa was doing better! His breathing looked better! He was definitely still struggling, but it was a pretty remarkable turnaround from the previous evening.  Shortly after I arrived they whisked him away to do his ultrasound.

Musa’s kidneys are failing. We suspected that this is what was happening when we were at my hospital, but didn’t have the lab results to confirm it.  They did labs here the first night we arrived and confirmed what we’d suspected.  His kidneys were failing. But why????  I waited around until the afternoon to speak with the doctor about the ultrasound results. I suspected that the cyst had returned and was somehow impeding his kidney function.  I was wrong. In fact, it was a large kidney stone that the radiologist suspected was contributing to his kidney failure. 

As the doctor passed by in the afternoon, I stopped him to discuss the results.  I needed to know what our options were. Musa has failing kidneys and a large kidney stone.  So what do we do?  Unfortunately, not a lot.  In America, when someone has a large kidney stone that won’t pass on its own, there are several different non-invasive things we can do to bust up the kidney stone so it can pass.  Here, they do surgery. But no surgeon would touch Musa with his compromised respiratory status and failing kidneys.  So we just have to play the “wait and see” game.  Will Musa’s kidneys be able to recover on their own?   The doctor explained to Musa’s parents and I that he wasn’t without hope, but that Musa was indeed, very sick.

The next few days were a whirlwind of monotony.  Leave the house in the morning, go pick up Musa’s parents, sit in 2-3 hours of traffic before arriving at the hospital.  But medicine, pay for tests, spend time with Musa. Leave hospital at 6-7pm to sit in traffic for another 3 hours before returning home.  Next day? Repeat.

On Sunday morning, I sought out one of Musa’s doctors.  They had repeated Musa’s kidney function tests, and although he looked better clinically, his lab tests showed that his kidneys were worsening. He needed dialysis.  Unfortunately there is one dialysis machine in this country.  It was donated to the government hospital in Freetown, but up to this time has never been used. Dialysis, the option needed to save Musa, was really not an option.   

I didn’t know what to do.  The medicines we'd tried and the treatments up till now were not working. And I was out of money. (Please do not read this as a plea for help. I already did that and people have been MORE than generous. Thank you!!)  I had tallied the amount of money I’d spent in 4 days at this hospital, and it was more than what Marie and I live on in a month. Every morning they brought out a list of medicines that we needed to buy as well as the bill for any tests they had done.  I just couldn’t keep this up. Especially since we knew he wasn’t getting better. I was honest with the doctor. I told her that I was out of money and that I couldn’t afford to keep Musa at this hospital. We discussed transferring him to the government hospital or taking him home.  She told me she wanted to talk to her boss (the doctor that I really like) the next day.

After this discussion I went out to my car to call my dad.  He’s my go-to man when I have no idea what to do.  The pressure that I felt was beyond anything I think I’ve ever felt before. I love this kid. I’ve been “taking care” of him for months. His whole family is looking to me to see what to do.  I felt like I failed him. I called my Dad and explained the situation to him. Because of his medical background, he quickly understood that I really didn’t have many options.  After we discussed things for a while, my dad said something that I will probably never forget. He said, “Maybe your role in Musa’s life now is to teach him how to die.”  I lost it. How could I do that???  “Emily, Musa is a believer.  He has hope!  We’re out of medical options.  But God is still God.  We have hope that God can do a miracle and heal Musa like He did countless times in the Bible. But if He chooses not to, Musa has hope that when he dies he will spend eternity in heaven with His Savior, where there is no sickness, no pain, and no tears.  Paul said that for him to live is Christ, and to die is gain and that we do not grieve as those who have no hope.”  He was right. I knew it.  I stayed in my car for a little while to collect myself and went out to talk with his family. 

As we were leaving the hospital that evening , I broached the subject with his family.  I explained what the lab tests showed and that Musa really needed surgery to remove the kidney stone. But he needed dialysis in order to get well enough for the surgery.  And that we couldn’t do it. And that I was out of money. I suggested that we transfer him to the government hospital because I still felt like I had to keep trying something.  But Musa’s mom wanted to take him home.  And pray.  I had no logical reason to argue.

The next morning Musa’s doctor arrived and when I asked how he was doing, he said, “Well not as good as you! I hear you want to take him home.”  I asked him to go see Musa and then come chat with me when he was done.  As I was waiting for him, I started crying. He was going to try to convince me to stay. I know medical people. It’s not easy for us to give up. I had all this pressure to make a decision regarding the life of this boy, and I was petrified I was going to make the wrong one. 

As soon as the doctor came into the room I started explaining my reasoning for wanting to take him home. Of course I started crying and of course he immediately started begging me to stop doing. (They HATE crying women here!)  I explained my understanding of the lab results and his prognosis. I explained that I was out of money.  He sat and listened to me, and then basically repeated what I’d told him.  Musa’s prognosis just wasn’t good.  There was nothing more we could really do.  Then he said something that I was so thankful for. He said that if he was the patient and this was his prognosis, his mother would want to take him home too. Then he asked what he could do to help.

Lord thank you!! I know it was silly, but that confirmation was such an encouragement when I was feeling utterly alone in this decision. I knew in my head that it wasn’t true, but I felt like I was abandoning Musa and letting money rule my decisions.  This doctor was a godsend to remind me it wasn’t so.  This was Monday morning. I had a meeting in Freetown on Wednesday morning so I really didn’t think I could go up to my village and back before that time. It’s rainy season right now, and that road is brutal.  I had initially wanted to transfer him to the government hospital for a few days until we could go up, but then another family member approached me about just transferring him to the ward for a few days. This would be a much less expensive daily rate and would allow his mom to stay with him.  When the doctor asked what he could do to help, I offered this option.  They didn’t technically have to do it. Musa was still sick enough to need the ICU so I didn’t know if he would agree. He went to speak to management and when he came back told me that they’d agreed to let Musa stay in the ICU so he would still get the attention of the ICU, but only charge me the price of staying in the ward.  Once again, thank you Lord!!

The plan is to take him home tomorrow. And apart from a miracle from Jesus, Musa will most likely die.  This is going to be hard. Lord give me strength!!


Saturday, August 24, 2013

Musa Update II

It is with a heavy heart that I write this blog.  The irony of the situation I’m in is not lost on me.  My last blog post was about my little friend Musa.  You can read about his story here and here.  I was boasting about how well he was doing!  Unfortunately, Musa has taken a turn for the worse. Literally one or two days after I posted that blog, his illness returned.  Or some kind of illness returned.
He was over at my house one evening and started complaining of left sided pain.  I didn’t take it too seriously because people here tend to complain about aches and pains quite frequently.  However when he mentioned his pain again the next day, along with another symptom that he wasn’t “peeing freely,” he caught my attention.  I asked him some questions and tapped on his kidneys to see if he was in pain.  When I touched him, he jumped back and gave me a look like “why in the world would you want to do that to me?!?!!?”  Yup, definitely painful.  I looked at his face and noticed that his face looked a little puffy as well.

It was obvious that Musa had a kidney infection.  This is pretty uncommon in young men, but I began the treatment and he seemed to improve.  But then he got worse again.  He said he was having trouble urinating so we inserted a catheter to drain some urine.  Pus was noted in the urine.  We encouraged him to drink plenty of fluids.  These symptoms went on for about two weeks. I discussed this case with the doctor we have here and we started a couple other medicines to try and treat any other possible causes of an obstruction that was causing his inability to freely urinate.
I discussed his condition with the surgeon who did his initial surgery as well as with our doctor here.  It seemed that we had done everything we could for him and needed to take him to Freetown to obtain some more studies. Unfortunately in the last six months or so our ultrasound machine has broken, our xray maching is broken, and we no longer have the capacity to check necessary lab tests.  The decision to take Musa to Freetown for further studies was unanimous.  When I told Musa, he started crying. This poor boy has been through so much, for so many years and this was very discouraging news for him.  I left him Saturday afternoon at the hospital with a nurse who was going to reinsert his foley catheter to drain some urine.

Sunday morning I was working in the OB ward when Musa’s mother came to get me. She said that Musa was just lying down, wasn’t talking, and was chewing on his tongue.  I figured that he was just discouraged about the news I’d given him yesterday and told his mother that as soon as my friend Peter (also a friend of Musa’s) and I got back from church we would go talk with him.  She said it couldn’t wait and asked me to come see him now.  So I went.  When I arrived at the house, Musa was laying on the floor in severe respiratory distress. His face was twice as swollen as it had been the previous afternoon. No!!

I asked if there was a motorbike that would be able to take him to the hospital, as there was no way he could walk. They went to arrange one and I set off at a trot to be able to meet them at the hospital.  They beat me there and as soon as I walked into the hospital the nurses started saying “Emily! Your friend Musa has returned!” (Everyone in the hospital knows him). 

When I listened to his lungs, I heard quite a bit of fluid in his lungs.  I inserted a foley catheter (they were unsuccessful the previous afternoon) and gave him some medicine to try to drain some of the fluid off his lungs.  40mg of Lasix….no urine output.  I gave him another 20mg.  Nothing.  I gave him another 20mg and he finally started putting out some urine.  This was a hefty dose of Lasix we had to give him in order to get some urine. It appeared that for some reason, his kidneys weren’t working.  Had his cyst returned and was somehow interrupting his kidney function? Was it truly kidney failure?  We had no way of knowing. As I mentioned above……everything is broken. 

I called the doctor and he met me at the hospital.  We continued the treatment, but neither of us had a good feeling about him.  We were flying blind, and even if we weren’t, we had such limited capabilities.  Frustrating.

That night I decided to sleep at the hospital.  I’ve been with this kiddo for so long.  I was in the OR with him during both surgeries, visited him at least once a day every day he was in the hospital and after he was discharged he made it a habit to come to my house every day.  If he was going to die tonight, I wanted to be with him to the end. 

Praise the Lord for some good friends who kept Marie for me that night.  It was a long one. His breathing was so labored and every time he stirred in the night I awakened to see what was going on.  His mother tried to go home to rest but returned a short time later stating she just couldn’t stay away from him.  One of the sweetest things of that night was watching Musa’s older brother. He didn’t sleep a wink. Anytime I looked up he was doing something to help his brother. Adjusting the sheet, fixing the oxygen cannula, helping him to the bathroom or applying Vaseline to his dry lips.  It was precious. At 5:30 I got up to go home to shower before a meeting I had at 8.  He asked where I was going and I explained but asked if he wanted me to stay.  He said, "Yes. Stay." So I stayed. Thirty minutes later he awoke suddenly and started asking, "where's Emily? Where's Emily?"  "Look me! Look me!," I said. 

Later that morning the doctor and I discussed our options.  He was sick.  Really sick. And that was our problem.  We knew that there wasn’t much we could do for him here. But could they do anything for him in Freetown?  If he truly was in kidney failure, do they have a dialysis machine? If it was the cyst that was somehow impeding his kidney function, could they do anything for it? He certainly wasn’t a candidate for surgery!  And the biggest question of all. Would he even survive the journey?  Do I take this kid and his mother away from their only support system if he’s just going to die anyway?  Ugh!  Decisions, decisions.  We finally decided that if he was the same or improved the next day, we would take him to Freetown. If he was worse, we would keep him here and let him pass away near his family.
That night I decided to sleep in my house. I didn’t think I’d be able to make the 7 hour drive on two nights of no sleep, so with strict instructions to call me if his condition changed at all, I went to my house. The next morning I was pleased to see that his condition looked slightly improved. We decided to go. I already had my bags packed so I took care of a few remaining things and we loaded him up into the car.

The journey down was brutal for him. I don’t know if I’ve discussed the condition of the road to my village before, but it’s one of the worst roads in the country. And it’s rainy season, which always makes the roads worse. Although I went much slower than usual, I still had to stop several times just to give him a break from the jostling. When he told us that he had to have a bowel movement, I thought the strain of getting him in and out of the car might be the end of him. He just had no reserve for his respiratory effort. 

We reached Waterloo where the rest of my NGO lives. We had arranged that I would drop Marie off so she could get to bed. I met them at the turnoff for the house and passed Marie off. As I went to get back into my car, one of my co-workers told me her husband was going to come with me. I started crying. I know they were concerned with my safety, traveling at night like I was doing. But they also didn’t want me to have to do this by myself.  I am SO blessed with the team I have here. I can’t even express it.

I drove us the hour and a halfish to get to the hospital. When we got there they brought a stretcher and took him straight to the ICU. I met with the doctor and explained the whole complicated situation, beginning from the first surgery.  Families aren’t allowed to stay with the patients in the ICU so after we said goodnight, I took his mom and dad to their family’s house and I went home.
We came here on Tuesday. Today is Friday.  The doctors and staff here have been wonderful.  They are hopeful, but realistic.  This is the best hospital in the country, but there are still limitations. I talked with his doctor about intubating him (putting a tube down his throat to breathe for him) but they don’t have the lab tests available to make sure the settings are correct. We talked about dialysis (putting him on a machine that will essentially do his kidneys job for him) but the doctor said that the one and only dialysis machine that was donated to Sierra Leone is at the government hospital and until now has never been used.  So we were left with managing him as best we can with medicines. And prayer. Lots of prayer.

Yesterday Musa looked bad. When I left him at about 7pm his breathing was worse, his heart rate was up, and he was confused. All very bad signs.  I went home and had a breakdown with my friends.  I figured he’d probably die today or tomorrow.  You just can’t keep breathing as hard as he is without tiring out.  Every day I’m sitting in 5-6 hours of traffic to travel to and from the hospital, but I just can’t stop.  I need to be with him until the end.

As I walked into the hospital today I got the same sinking feeling I always do.  Just wondering what I’m going to find.  Today however, I was encouraged!!  His heart rate was down, his breathing was easier, and he was fully conscious.  Thank you Lord!!  I know he is still critically ill.  I’m afraid to become hopeful, but I can’t help it.  Yesterday I was mentally arranging how I would get his body back to the village.  Today I dare to hope that he might go back to the village alive!  One of the saddest things about yesterday was that he still has such a strong will to live!  He told me to please tell the doctors that he is seriously sick. He asked me if we were going to do an operation on him to make him better. He told me he was tired of being sick and really wanted to go back to the village with a “well body.”  It was heartbreaking. 

So we wait.  Once again I am SO incredibly thankful for my teammates. I honestly don’t know what I would do without them. I’ve been leaving the house at 8am every morning and returning around 10pm.  These would obviously be very long days at the hospital for Marie, so my friend Robin has graciously agreed to watch her for me.  What a relief to be able to leave her with people that she loves and love her so much and not have to worry about her.  It makes my load so much lighter!!

Several of you have asked me to mention any extra financial needs I may have.  This is one. Like I said before, this is the best hospital in the country, but that means it’s expensive.  Since he’s in the ICU, it’s costing a couple hundred dollars every day. I know it’s minute compared to hospital costs in America, but this is hungry season so the requests to me for help have been plentiful.  To be honest, I’m tapped.  If you’re interested in helping, just let me know. Thank you, thank you, thank you!!

Please pray. I know that God is the giver and sustainer of life so I’m trusting that His hand is in this.  Please pray for healing, and also that Musa would be encouraged.  No matter what the outcome is, my desire is that Musa will draw near to Jesus and that He will be glorified in this situation. THANK YOU!

Friday, August 9, 2013

Musa Update

I realized today that I never gave an update on the kid “Musa” that we did an operation on a couple of months ago.  Allow me to do so now.  You can read about the first half of the story here.  Musa finished the surgery and did pretty well. He was in a lot of pain but gradually started getting better. After a week or so he was ready to be discharged. He asked if he could take me to his house when he went home, so I followed he, his mom and his brother home.  I got a lot of “Musa, look your wife has come!” comments as we were walking. (Keep in mind, he’s about 14). 
Musa and I after his first discharge

We got to his house and the Imam (Islamic leader) for the community came out to greet me.  I sat down with the family and exchanged pleasantries for awhile.  As I was preparing to leave they dropped the bomb that they wanted to “give me Musa.”  Wait. What? Even though I’ve lived here for a while, I’m still not always up on what these things mean. Pay his school fees? Give him a place to sleep? Not sure.  So I do what I usually do in those awkward situations. Chuckle like they’re joking, say “oooohhhh Thank You…” like I thought they were kidding and slyly get up and walk away.  It’s an art form…. In awkwardness.  I’ve learned to embrace it.

The next night I got a call from one of the nursing assistants down at the hospital. Apparently he had seen Musa at his house and he’d taken a turn for the worse.  The family wanted to take him somewhere to get some medicine but the nursing assistant told them they should talk to me first.  I asked if he looked sick enough to be admitted and he said he’d be fine overnight. I told him to tell Musa to come to the hospital in the morning and I’d see him.

When I got to the hospital the next morning they had already re-admitted him. His abdomen was swelling again and he just didn’t look good. We started him on a week of antibiotics (virtually unheard of here as they are so expensive) and decided to wait and see.

After about a week he just wasn’t getting better. Or he’d get better, but then worse again, back and forth.  Finally we decided that we just had to take him back to surgery to find out what was going on. I was afraid. He was so weak and had lost so much weight, I was afraid he wouldn’t survive the surgery. But we just didn’t have another choice.

The next day I went down to the OR for the surgery. When they opened him up they found two things. One, the cyst that was his original problem, had started to grow back. He also had a big ole’ bowel obstruction (the poop got all stopped up and wouldn’t come out).  We had a different surgeon this time and he could see why the cyst came back and proceeded to fix it. He also fixed the bowel obstruction. Praise the Lord there was no dead bowel!!  (PS it was the first time I’d watched one of those repaired and it was gross!!!  I thought there would be a more high tech way to fix it but nope. Stick a hole in the bowel, squeeze out the poop that’s stopped it up….sew up the hole.  Gross).

This time after surgery, Musa did great!! I did have to run intervention one night when his mom called me in utter frustration because Musa was refusing to take it easy in his bed.  (This was the first day after surgery).  She was beside herself.  In his defense he'd felt bad for SO long and was just tired of laying in bed.  I went down to the hospital and had a little chat with them both and they became friends again.  Teenagers and their every culture. :)

Musa came over for science class one day.  We made....a green volcano.  Use what you have :)
His body still had zero fat on it, but over the last couple of months he’s really gotten stronger.  Since he had to drop out of school due to his illness he doesn’t have a lot to do during the day so he comes around my house a lot. He and Marie have developed quite a friendship with her idolizing everything he does and he graciously tolerating all her questions and bossiness. My favorite part is that during this whole thing, Musa developed a great interest in the Bible and in Jesus.  To be honest, I’m always a little hesitant when this happens in these kinds of circumstances because I don’t know if it’s genuine or if they’re just trying to please the person that helped him. I’ve explained to him many times that whether or not he chooses to follow Jesus will in no way affect our relationship, but he persisted that he was interested.  So my friend Peter and I have started meeting with him every Thursday night to begin talking about what it looks like to follow Jesus. I remembered last week how much I love teaching.  I don’t know how good I am at it, but talking to other people about how awesome Jesus is reminds me of all the reasons I love him. Win win!!

Thursday, July 25, 2013

African ICU

Yesterday was one of those days that I think might be imprinted in my mind forever.  I went down to the pediatric ward in the morning to round on the kiddos.  Rounds were pretty benign (which means I didn’t stumble upon a kid that was barely breathing and end up spending an hour literally running (always gets a “heeeeeeeeey….look at the white lady run!) up and down the hospital trying to save them.  The kids were all stable.  I wasn’t sure what to do about two of the kids so I went and talked to the new doc (he’s awesome!) about them.  He said he’d go take a look at them and I headed up to the house.

A couple hours later I was doing some homeschooling with Marie (which no doubt meant that I was inwardly beating my head against the wall while outwardly calmly pointing out ONCE AGAIN the difference between a straight and curved line) when the doctors wife came up to ask me something. She told me that they were bagging a kid (“bagging”= placing a mask over the kid’s face that’s attached to a bag of air that you squeeze to breath for the kid when they can’t breathe on their own) and wanted me to teach the family how to do it so they could all rotate.

Ok. Pause. What? They’re bagging a kid?  I didn’t think we did that here? The ICU nurse inside of me got really excited. When I moved here one of the most difficult things to get used to medically (don’t get me started on the food, bugs, larger gross animals, shirtless women, etc) was that we don’t do any “heroic measures.” That means when a person stops breathing, we just let them go.  (We do make exceptions for newborns who need a little help to get used to living outside the womb). This flies in the face of all I’ve been taught as an ICU/ER nurse.  When people are dead, we do our darndest to reach out there and snatch them back. 

I digress. I went down to the Peds ward to see what was going on. When I walked into the ward I saw that not only were they bagging the girl, but the doc had intubated her. This means that she had a tube down her throat into her lungs which allows the air to easily pass through.  She was about 12 years old and had been bitten by a snake approximately 30 minutes before coming to the hospital. When she came in she was crying and upset but then started vomiting, seizing and eventually stopped breathing. Hence the intubation. 

I showed several family members how to bag and went to find a suction machine to try and suck some of the junk out of her lungs.  I proceeded to accidentally fry our suction machine when I plugged it into a 220 socket. I’ve been here for 2 ½ years. I still do that. Darnit. I started heading back to the house to e-mail my dad and ask for one on the container that’s coming when I noticed a little bit of commotion in the peds ward. I turned around and went back. (Incidentally, praise the LORD we had several other suction machines in storage….so I was able to sleep that night).

When I got there, the doctor and his sister (a nurse that just got here and is visiting for a couple weeks) were at the bedside of the little girl.  He explained that in the bagging, we’d essentially collapsed a lung. (Air was on the outside of the lung and was pushing against the lung, not allowing it to expand).  He said that this is inevitable with this kind of bagging which is why we always put patients on ventilators that regulate the pressure that’s used to push the air into the lungs. When I’d left the girls oxygen saturation had been 99% (we want it over 90%). Now it was 50%.  He proceeded to stick a needle into her chest, letting the air out and allowing the lung to inflate again. The dilemma was what to do next. We needed a one way valve so the air could come out but not go in. He said, “well, in the books they do this…” and proceeded to take a rubber glove, cut off the tip of a finger and put a slit in the end. Then he taped the tip of the glove to the end of the needle.  It’s a valiant effort….but not a long term solution. She needed a chest tube.  This is a tube that’s inserted into the chest to allow the lung to continue to inflate and deflate. So how do we make a chest tube here?

The next hour was spent trying to find supplies to see if it would even be possible.  And if not, how can we jimmyrig something so it would work.  We found a contraption called a “pleuraVac” which is what we use in the ICU for our chest tubes.  But as we’re talking this all out and the doc is making sketches of exactly how we could make this work, we’re overcome with our limitations. I don’t know how many times the words, “if we were in America…..” were said. 
The fact was, even if we could get this to work, the chance of this little girl surviving was very slim.  We needed 24 hour electricity in order for the chest tube to even work.  Our solar usually goes off around 11pm at night. There’s no way the patients family could afford to pay to run the generator all night and the hospital doesn’t even have enough money to run it for 2 hours a night to give the staff homes a little electricity in the evenings.  Things are VERY tight right now.  He said that she would need the chest tube for at least 3 days. Then there was the issue of the ventilator. We don’t have one. Someone would need to bag for 24 hours. And the same thing would happen again. The air would start going into the wrong places and she’d blow up like a balloon….and then die.  There just wasn’t anything we could do.  Which as health care providers is VERY frustrating!!!  As we hashed it out between ourselves we realized there was just no way this was going to work.  So I prepared to do something that I haven’t done in years.  Withdraw life support. Only this time it wasn’t on an 87 year old man who’d coded in the nursing home, it was on a 12 year old girl who was helping her family on the farm and was in the wrong place at the wrong time and got bit by a stupid snake.

We went back to the ward and asked to see the girls mom and dad.  When we were told that the mother had left, the doc asked them to go get her. In that moment I realized that I’ve been here for awhile.  I put myself in this doc’s place (newly arrived) and of COURSE you have the parents come. They’ll sit with their child and say goodbye while she goes.  That’s what we do.  In America. Not here. Here, the parents usually leave when it looks like the child is going to die. They can’t bear to watch.  (Incidentally I was talking about this with my friend Peter (Sierra Leonean) and he was equally horrified by our culture’s need to be present as I was at the parent’s absence here. “How could you sit there and just watch your child die?!?!!) 

So I knew that asking for the parents and waiting until they got back was not going to work.  We had asked for the parents, but the family brought us the grandfather. They said he was the “strongest one.”  The doctor proceeded to explain everything. He explained what we’d done, what our goal had been in intubating her to begin with (see if we could breathe for her long enough for the paralyzing poison to wear off) but that we’d reached a point where we just couldn’t do anything else. And we were suggesting removing the tube….which meant that the child would die.
The grandfather agreed.  We removed the tube.  She had absolutely no respiratory effort of her own. And we sat there and held her hand, touched her foot and cried with her mother….wherever she was, as her child slipped away. 

Later that night I went down to the doctor’s house to see how he was doing. Both he and his sister had taken off (totally know that feeling when you just have to get away).  I started talking with his wife about what happened that day and she asked me how I do it. How do I stay here and keep working with no supplies, so much death, etc. She’d asked me that before so I’d been dwelling on it for a little while. I think the answer is probably different for everyone, but mine is pretty simple.  Number one, I STILL get frustrated with the death, the lack of supplies, etc.  It’s a DAILY struggle.  Number two, I think some of it is just time. It’s a BIG jump to go from working in a country with some of the best medical care in the world to working in a place that has one doctor for how many tens of thousands of patients.  A BIG jump.  But this is my reality. And at some point you have to start accepting your reality or go crazy. I’ve been here for almost three years. They just got here. They didn’t see me when I first arrived!! J

But I think the biggest thing the enables me to stay here is that medicine is not my end goal. If it was, I absolutely would go crazy.  When I saw that little girl intubated yesterday, the ICU nurse in me got really excited.  We were going to get to radically try to save a life. But in the end, we failed. As we were sitting there holding her hand while she passed away, her grandfather had tears in his eyes but looked repeatedly at the doctor and said, “You tried. You really tried.”  And we did. We did everything in our power to save the little girl but in the end it wasn’t enough. And while I get SO frustrated and tired of death, I know that while we couldn’t save her, yesterday we showed her family that their child was important. We loved them by loving their child.  I can’t save everyone. I believe that ultimately, God is the giver of life. So I’ll work as hard as I can for them but whether or not I can save them, I will love them. And someday when I stand before God, I think He’ll say it was enough. “His grace is sufficient for me.”

Wednesday, July 10, 2013

A time to live.....a time to die....

Death is something I deal with on a weekly, if not daily and sometimes hourly basis.  For that reason I was surprised to realize yesterday that in my two and a half years here, I have never been to a funeral.  I’ve pronounced plenty of people dead, I’ve used my car as a hearse many times, but have yet to observe the whole thing. Until yesterday.

Two nights ago my friend Peter called me to tell me that one of his employees had lost his mother. It was unexpected because the woman had been pretty healthy and suddenly keeled over and was dead.  She had been visiting her family in this village so they needed to get her body back to her own village and I volunteered The Colonel (my car).  They decided to wait to take the body until the next morning. 

The next morning Peter and I took the body, along with as many other people that could cram into my car to a village about 7 miles away.  The women in the back periodically started wailing and singing woeful songs.  After a few miles Peter told me to start blowing my horn continuously every time we reached a village.  Not liking to draw attention to myself I asked why and he explained that this way people would know they were coming with the body and would come for the funeral.  “How do they know who the body is? How do they know what village we’re going to?” “They just know. People have told them.”  The information that is passed to people in the middle of nowhere still amazes me.

We arrived to an assembled crowd in the village, all wailing. I wish I could convey the sound of this wailing through a blog.  I’ve heard it countless times, but it never fails to take my heart and give it a good twist!  I started tearing up.  Death is just so hard!!

 They took the body into a house. When I asked Peter what they were doing, he said that they were washing the body and dressing her in a white dress that had been made that morning by the tailor. She would then be wrapped in the same white material, with her hands and feet tied together.  The wailing continued to come from the house.  While we were waiting someone started beating a drum signifying that the woman had been related to the chief.  A small boy started beating on a tire rim that was strung between two trees, the signal to begin coming to the church. 

After thirty minutes or so, the women came out of the house with some male pallbearers carrying the body.  They made a procession into the church where we had the service.  There were no children present.  They don’t come to funerals.  The pastor briefly spoke about the woman and her faithfulness to the church and then spent 20 minutes or so challenging the congregation to begin financially preparing for their own funerals so they would have nice ones.  No comment. 

The pastor did preach a nice message to we who were left about our life being a vapor and encouraging us to make the most of it.  We sang several mournful songs and the mood was sober.  After the service was over we took up the rear of the procession as they took the body to the cemetery, singing the whole way. 

Cemeteries.  I love cemeteries ( I know, I'm kind of odd) at home but when I came here I noticed that I saw very few.  I think I’ve seen two.  So where do they bury their dead?  I’ll tell you. In the middle of the bush.  We went down a path to the “cemetery” which I definitely wouldn’t have known was there.  It felt like something in a novel....from a hundred years ago. The trees were hung low.  People were gathered around a 4 foot hole that was clearly a grave, and the body was placed beside it.  As I looked around, I noticed mounds of dirt near the grave.  One had the mark of a wooden cross. The other had no marking.  When I asked Peter where the other graves were, he explained that they were all around us, but were in various stages of being reabsorbed into the ground.  No markings. 

The pastor shared a few words and then opened it up if someone else wanted to share.  After the sharing, the singing started again and the body was lowered into the grave. At this point there was some confusion about who was supposed to lower the body into the grave. Some said that women had to lower a woman down, but others said it didn’t matter. A man beside me muttered “Those Limbas. They have too many traditions!” (Limba is one of the tribes here).  Since three men had already descended into the grave, they let it slide and moved on. The pastor remarked that the younger generation was so bold, but the older people were still afraid to touch a dead body.

After the body was laid into the grave (no casket….just the covered body), her oldest son (Peter’s employee) took a small amount of dirt and threw it into the grave.  Then the men took large sticks, some looked like small trees, and put it over the grave.  They covered the opening completely. Then everyone started taking branches and leaves and putting them over the sticks.  Peter explained that they wanted to make sure that the dirt wouldn’t be directly on top of the body.  Then, as the sticks start to decay they will fall into the hole and all will be absorbed into the earth.  After they packed the dirt on top, we began the procession back to the town.

When we arrived, there were many people assembled under a tarp.  Peter explained that they were deciding when they would do the next gathering.  Because we don’t have refrigeration here, funerals must happen quickly to prevent well….you know. For that reason, they often have another time of remembering for the deceased either 3, 7 or 40 days from the funeral.  The family originally decided on 40 days until someone reminded them that that would be right after Ramadan and they would be spending a lot of money during Ramadan. Would they have money for the funeral then?  See, as I learned….funerals here are a big deal!  If a funeral isn’t done correctly, people will talk!   As the eldest son, Peter’s employee was responsible for paying for most of the people to get to the village and was expected to feed them as well. He said that in big towns some people rely on funerals for their daily bread. They will listen for the sound of a funeral and go there for the food, occasionally hitting up more than one in a day!

As Peter and I were waiting for the meeting to finish, a woman passed by and said, “Thank God that woman gave birth to Idrissa (Peter’s employee). If it wasn’t for him they would have had nothing!!”  I asked Peter why people wouldn’t just be able to understand that they were poor and didn’t have money to feed all these people but he said that if they didn’t have the money they would need to borrow it in order not to bring shame upon the family.  Yikes!!  That's a lot of pressure in your time of grief!

When the meeting was over we crammed about 15 women into my car and headed back.  Not to waste a trip, I loaded up 20 bags of charcoal on the top of my car for another friend of mine. When we stopped to pick up the charcoal I realized that one of the women we had with us was…..rather intoxicated.  The other women said that she had been drinking most of the time during the funeral.  Well, they took to goading her and she didn’t love it. She got so mad that she started yelling and saying she wanted us to just leave her there, and she was going to walk. When Peter told her he couldn’t do that and shut the door, she started cursing us and telling us she was going to take Peter to the chief.  The women kept goading her and she ended up slapping a bunch of them.  They started agreeing, saying we should just drop her on the road! J  We made it back without further incident and I was glad I got to help out a friend and witness my first Sierra Leonean funeral.  I wonder if things here will ever start to feel "normal."???

Tuesday, July 2, 2013

An EYE for an EYE

Well, it’s been a little quiet on the blog front this month. Part of that is because I haven’t been able to see. Literally.  Several weeks ago I went to bed….like I do every night.  When I woke up I could feel that my left eye felt dry and was a little sensitive to the light. This isn’t the first time this has happened so I didn’t think much of it and headed off to work.  As the day progressed, my eye started getting worse and worse.  It didn’t help that that day, of all days, when I was now struggling to keep my eye open due to the light sensitivity that I had the worst. Labor. Patient. Ever. 

Now I’ve never been in labor.  So there’s no way that I can fully empathize with the pain that you ladies are going through. And Sierra Leonean pregnant women, I’m with you! When you’re crying in pain and the men around you tell you you just have to “bear” the pain, I want to slug them right along with you. But this particular woman took the cake for most dramatic labor to date.  At one point I walked in the labor room and she was STANDING on the labor bed (which is much higher than a normal bed AND HAS WHEELS!! Even if they’re locked, they still move a little).  Up to that point I’d been the picture of compassion and patience  so I think it startled her when I very sternly and loudly said: YOU SIT DOWN RIGHT NOW!!  She was on her best behavior. For about three minutes.  Then
it was back to screaming, pulling IV’s out, etc. 

And my eye! My stupid eye was getting worse and worse.  I was working a double shift that day and by the time the OR team got there for this patients c-section (she wouldn’t stop pushing so everything got really swollen and the baby started getting in trouble) I could barely see.  One of my beloved friends who’s always looking out for me called the night shift nurse to come early and as soon as I caught the baby, I went home. 
Attractive.....I know
The next morning I woke up and couldn’t open my eye. Thank you Jesus we have a new doctor that had arrived the week before and as soon as he saw me he said that I had an ulcer on my cornea.  When we were discussing treatment options, he told me that if I was in his ER in the States, he would send me straight to an ophthalmologist.  Well, not so much an option here.  He started me on some antibiotic ointment and we decided we’d watch it.  One of the kickers was that my friend was getting married in a few days and I REALLY wanted to be there for it! Since I didn’t know any ophthalmologists in Freetown, I decided to just stay in my village and see. My mom wasn’t thrilled about that. :) 

I was putting the ointment in for a day or so and went to see the doctor’s wife to talk about a little bridal shindig for my friend.  The doctor happened to be there and when he saw my eye he was….concerned. Apparently it looked way worse. I couldn’t really tell because I literally couldn’t open the eye, which made it really hard to open my other eye so had basically sat on my couch for the last day, listening to movies.  When he asked me to count his fingers, I couldn’t. I could see his hand waving, but my vision was bad enough that I couldn’t distinguish how many fingers he was holding up. Shoot. I’d thought it was because of the ointment I was putting in, but apparently not.  Now it seemed like it might be a little more serious. 

Fortunately I have some great friends and a great God!  My in country director e-mailed an ophthalmologist that used to work here but has since returned to the UK.  He ended up calling me that night and after discussing everything with him put me on an antibiotic regimen of eye drops every 30 minutes for 2 days.  Then I decreased it a little bit. He also gave me the name of an ophthalmologist from the States who was working in Freetown!!  I did the drops as prescribed, got to see my friend get married, and then headed down to Freetown to see the eye guy. 

When I saw him that morning, he said that I was pretty lucky. Apparently these things can ulcerate and perforate the eye (put a hole in it) within 48 hours. Ummm….scary.  He said that it had headed that way, but that it was starting to heal.  Unfortunately it’s going to take months to fully heal and he said I may never get all of my vision back.  Right now my vision in my left eye is about what it is when I’m not wearing my glasses.  But I’m SO thankful for how things turned out!! It’s been several weeks now and my eye still bothers me, especially in the bright sun, but it could have been so much worse!!  And I was so blessed to have my awesome roommate Valentina who was there to take care of Marie when I was sitting on the couch like a lump for several days.  Vale, you're awesome....and missed!!!! :)