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!

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 moms......in 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!!

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.”

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."???

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!!!! :)

To Pee or Not to Pee. Wait....are missionaries allowed to say "pee?"

 I need to start this blog by warning you that I might overshare.  I’m sorry. It can’t be helped. The fact of the matter is that my sister has historically served as my social filter and she’s thousands of miles away and couldn’t be reached by phone in time for me to post this.  And I feel that in order for you to sense the urgency of this situation, you have to know some things about me. 

So here we go.  Last week my friend Peter asked me to do him a favor.  His church was holding a crusade in a small village and they needed help transporting their speakers, keyboard, sound system, etc to the village. (You know, everything that is a must at a crusade here….)  Since Peter has been SUPER helpful in the whole process with Marie, I was happy to be able to help.  Also, I’ve never really been to a crusade here so I was interested to see what it was going to be like. 

The crusade was to start on a Thursday and go through Sunday so on Thursday morning we loaded up my car and headed out. Of course part of my “load” was a giant banner on the front of my car announcing the crusade.  First time to travel with a banner so….I can mark that one off my bucket list now.  We headed out and after 30 minutes reached the river that we had to cross with the super sketchy ferry.  When we got there, we saw that the ferry was on the other side of the river. And it was in pieces.  We asked how long it was going to take to make the repairs and got some vague answers. We decided to wait a little and see.  After about an hour we saw the ferry cross over to our side and got all excited.  After waiting for 2 ½ hours we hunted down the man in charge and tried to get a final answer.  Was it going to be repaired today?  “No way.”  Huh. That would have been nice to know a couple hours ago.  Oh Salone.

So we headed back the way we came in order to go around to some other ferry.  Fortunately, it was on one of the worst roads I’d ever been on so….that made it easier.  After a couple hours of going around we met the other ferry. Unfortunately it’s the end of dry season, so the river was very low.  They couldn’t just pull the ferry across using a rope like they usually do, but instead had have five guys jump in the water and literally push the ferry around a sand bar to meet up with the rope on the other side where it was deeper.  When it came to negotiating a price, the men wanted Le50,000 (about $12).  It seemed reasonable to me, but the pastor who was with us was outraged!  When Peter started negotiating and they agreed on Le25,000 (about $6) she said that he was acting like a white man.  She had only wanted to pay Le20,000 and thought that he gave up too easily.  I was on the “white man’s” side though and agreed that sitting and arguing for 10 min. over $1.25 didn’t seem like the best use of our time. Especially since Peter was the one paying for it. J

The "ferry" under repairs.  Unfortunately it pretty much looked the same when the repairs were finished.....

Our initial plan was for Peter and I to go and drop the crusaders off at the site and then return the same day.  It didn’t take long after crossing the ferry to realize that that wasn’t going to happen.  The road was just awful and I don’t like traveling at night. As much as I love my car, it’s having some starting problems and sometimes doesn’t like to restart if I happen to accidentally kill it.  Those factors combined with the fact that we went hours without seeing another person and we had no cell phone coverage made me think that an attempt to return that night probably wasn’t the wisest decision.  When contemplating a decision I often think “What will people say at my funeral if I die doing this thing? Will they say, ‘We’re sad that Emily’s gone, but she sure was an idiot to do that thing……”’  I decided that traveling in the remote bush at night and being eaten by some jungle animal or inadvertently stumbling into some secret society business might earn me the title “Dead because she’s an idiot.”  So I began to mentally prepare myself for sleeping in the village.

I’ve done this a few times.  And it takes a little mental preparation.  Sure, I don’t always have running water and sometimes my solar is low so we sit in the dark.  But I’m comfortable where I live.  Spending the night in a strange place with people I don’t know who have different customs from me pushes me outside my comfort zone.  (And I was praising God that I’d left Marie with my two roommates!!)

One of the benefits of the horrible road was that I got to practice using my low gear.  Did you know that when you put it into low gear it doesn’t mean that you have to keep it in first gear?  I didn’t know that. I know that now. The small overheating problem that resulted from my previous ignorance gave us a few minutes of much needed rest.  Everyone in the car headed off to their respective areas of bush to “ease themselves” (the polite way of saying they needed to pee).  And this is where my oversharing begins.

I have a problem.  I have dubbed my problem “shy bladder syndrome.”  I don’t know if it’s an actual condition, but if there was a medicine for it, I’d take it!!  My problem is just like it sounds.  When there are other people around me, I often just….can’t go!!  It’s really odd!! And it doesn’t happen all the time.  It sneaks up on me!  One of the biggest problems it’s caused me has been with the mandatory drug testing I have to do when I get a new nursing job.  Just knowing that there’s someone on the other side of the door waiting for me to pee makes my bladder clam up and I can’t go!  One time I spent almost 3 hours at the drug testing place, with 4 or 5 false attempts and I don’t even know how many liters of fluid before I could go.  I had to get to the point where I was literally seconds away from….embarrassing myself…before my bladder could overcome the shyness and I could give them the sample they need!  Annoying!  And a little bit awkward!

Well let me tell you. Africa is not a great place for people with shy bladders!!  As I headed off to my tree, I tried to talk to myself…and my bladder.  It’s ok bladder!  Don’t punk out on me now!! It’s a long way to the village!!  My pep talk seemed to help because I went…..but then all of the sudden I just stopped!  And that was it.  I tried to relax, envision myself in a plush bathroom in the States…..nothing.  My bladder was rebelling!  And I still had to go.  It was a long, bumpy road to the village!

We arrived to the villa I realized just how remote we were. We were only 7 miles from Guinea.  They used Guinean currency.  They only used Guinean Sim cards in their phones.  We were in the sticks!! 

The first thing I did was ask where I could go use the rest room. I saw what looked like one of the typical bathrooms here but wasn’t sure…and you don’t want to just go peeing somewhere you shouldn’t. I asked the pastor and she told me to come with her.  As we approached the little bathroom hut, we both went in and she plunked down and started going.  I tried. Not happening.  I told her really awkwardly about my shy bladder problem and she looked at me like I had horns on my head but went outside to wait for me.  I tried again.  No luck.  When she asked me if I’d gone when we went outside….I lied. I’m a missionary and I lied right to her face and said, “Yup! No problem!”  Blast! I still have to go!

The host pastor works for the military so we were staying at the immigration outpost. I was sharing a bed with the pastor.  Everyone went to take their stuff to our lodging place (of course Peter and I had nothing because we weren’t planning on staying) and freshened up before the crusade began that night.  When we reached the site for the crusade it was in full swing with the singing and dancing.  As we started looking for a place to perch, I realized that Peter was leading me up to the stage.  Negative. Negatory. Absolutely not.  For the first six months I was here I would get sick to my stomach every time I went to church because I felt so out of place.  And that was when I was down in the congregation with everyone else!  The thought of going up on stage during the service and having everyone watch how much I don’t know the songs, how I can’t dance to save my life, etc.  sounded like my worst nightmare.  Peter looked a little confused at my reluctance to go onstage but we stayed on the ground. Until they called his name.  Good! Go up on the stage! Secretly I was glad because now I knew where the bathroom was and I wanted to sneak off and try to finally empty this stupid shy bladder of mine!  But then they called my name too.  D.A.N.G.I.T.  I knew it would be more awkward to refuse to go up….so up we went. 

After 20 min. or so of singing I couldn’t take it anymore. I just kept thinking about that bathroom….all alone, in the dark.  Perfect for my shy bladder!  So I told Peter I’d be right back and headed off the stage.  After I got a little ways away from the stage I turned my flashlight off.  It’s hard to go anywhere alone when you’re the white girl and the last thing I needed right now was some kids to attach themselves to me and spoil my plan for privacy!  So I stumbled along in the dark….and totally biffed it. I mean I fell hard! And I must have fallen on a rock or something because it hurt!  Darnit!  Fortunately, because I didn’t have my flashlight on nobody saw me.  I scrambled up and renewed my mission of the bathroom.  I made it there in one piece.  But my bladder hates me.  I don’t know if it was the fall or all the pressure there was to make use of this one precious opportunity….but the suspense was too much and my bladder didn’t cooperate.  After waiting just long enough to keep Peter from sending out a search party for me, I reluctantly headed back…with my full bladder.  And my new bloody knee.

After awkwardly swaying and clapping my way through the crusade, it was over. Everyone was loading up the sound equipment so I took a look at my knee. I was dabbing it with a Kleenex when Peter and the pastor saw what I’d done.  I was reprimanded for not telling them earlier.  Those of you who know me well know that me falling down is not an unusual occurrence and therefore no reason for a lot of hoopla.  There was a time in the not so distant past where if I went a week without falling I would congratulate myself.  But they were all concerned.  And insisted they wanted to “Spray it.”  What do you mean “spray it?” Spray it with what?  Perfume. That’s what. They wanted to spray my open wound with perfume. Apparently this is the standard practice when there are no other first aid supplies around. I tried to use my six years of higher education in the medical field and nine years of nursing experience to convince them I could wait until we got back and clean it with soap and water….but to no avail.   They kept insisting I should spray it.  But I too was adamant.  I’ll just wait. 

When we arrived back at our lodging place I was at the car cleaning my wound when the pastor came up and asked to see it. I was happy to show her my nice clean, non-sprayed wound  but when I did she SNEAK SPRAYED me!!  She seriously pulled out the perfume and started squirting it on my knee.  I screamed!  (Not that I’m dramatic or anything…)  What the heck just happened?!?!  That hurt!!!!  She tried to keep doing it but I started running away.  “See?” she said. “Isn’t that better?”  Better! Well, it hurts more and smells better so….ok, that’s better.  Sneaky spraying pastor!!

After our long day I was glad to head to bed.  But I still had to go!  While everyone else was getting changed I snuck out to the back.  I found a nice private area but this time was surrounded by cows.  They were watching me. I told them to stop, but they wouldn’t cooperate.  And neither would my bladder. It let me go a little bit, but then it rebelled, I still had to go. Frustrating!!!! 

As I was getting ready for bed I had a dilemma.  I wear contacts.  The last time I’d slept with my contacts in I hadn’t been able to drive home because my eyes were so sensitive to the light. I knew that I HAD to be able to drive home the next day, so I had to figure out something to do with my contacts.  The problem was that I didn’t have any contact solution.  And I can’t use water on my contacts.  But I can use my spit.  So ensued the conversation with my roommates about what exactly contacts were and why exactly I was spitting into a cup and putting said contacts into a cup.  I grossed myself out….I can only imagine what they thought of me. 

I made another attempt to go outside and relieve myself, but the pastor caught me. “Are you going to the bathroom? I’ll go with you.”  Great.  When we got to the side of the house she copped a squat, pointed next to her and said, “Pee here!”  I mentioned my shy bladder again and moved a little farther away from her.  No use.  When we got back into the room she told me that if I needed to go to the bathroom during the night I needed to wake her up.  Awesome.  I understood her reasoning.  We’re in a strange place with lots of soldiers around etc. But I knew I was going to have to disobey.  At this point it was nearly midnight.  I lay down and tried to sleep….I was exhausted from the travelling.  But there was no way.  I had to go too badly! It was painful to lie down because of the pressure it put on my stupid shy bladder!  But I had to wait the pastor out. I knew if I made my move too quickly, before she was really asleep, then I would lose my window and I’d have a urinating buddy. So I waited. And I waited.  After about an hour and a half I felt her breathing was deep enough that she had to be asleep.  So I quietly and very sneakily got up and started praying. Please Lord!! I have to go!! Please!!!  I’m not going to sleep tonight!! Is it possible for bladders to explode!?!?!? (Name that movie). 

And Jesus loves me.  At 1:30 in the morning, after 12 hours of really needing to “ease myself” with the cows as my witnesses, my bladder finally cooperated.  I thought I might cry in relief.  I snuck back into the room and was asleep in 3-5 seconds.  The next day Peter and I headed home and I got to use my very own bathroom.....with success on the first try.  

Oh the Familiar Feeling...

Yesterday I was working in the OB ward. It was quiet so I was reading a book when I watched some people carry a woman down the hall on a stretcher.  It was Saturday which meant it was a half day and since it was almost noon, I figured that the outpatient department had closed a little early and they were bringing the woman to our “ER” when the outpatient department is closed. It’s a very sophisticated ER……a green bench in the hallway outside the nurse’s station.  I turned my attention back to my book. Until I heard….”Emily!  It’s a pregnant woman!”  Commence stomach dropping and palms sweating. 

She was able to get up from the stretcher pretty easily, which was comforting to me.  As I led her back to the labor room I asked her how many times she’d been pregnant and if she’d ever had a c-section. She said this was her fifth pregnancy and she’d never had a c-section.  (Small “darnit” in my head.  If she’d had a c-section before it would be a simple matter of calling the OR staff and doing another one).  This meant I was going to have to think and try and problem solve.  Double darnit!

We got to the labor room and I started doing the check in things like vitals, listening to the fetal heart tones, etc.  Everything looked ok. The baby’s heart rate was strong.  Ok, so why was this woman here? She said that she’d been in labor since yesterday (which is always a slight help…..but lots of women like to fudge a little on the time because they don’t want to get yelled at for staying in the house so long).  The information that it does give me, is that she’s been in labor longer than usual and it’s been so long that the traditional birth attendant or whoever was trying to help her deliver, became concerned and sent her here.

So why isn’t she delivering?  It’s her fifth pregnancy. By now it should be like a slip n’ slide and the kid should just shoot out of there right?  I did a vaginal exam and she was fully dilated. The head was the presenting part, but it was still a little high.  Her bladder looked a little distended so the first thing I did was put a foley catheter in to drain the urine.  Ok, she didn’t produce a lot so that probably wasn’t what was holding things up.  Next option.  Five pregnancies.  I’ve learned in the past that sometimes these women who have delivered quite a few times (especially if they do it in a short time) will have uteruses that just get tired.  So I started an IV with some oxytocin to see if that could get things moving a bit.  After I started the IV I decided to check things down there again.  Although the woman had said that her water had come out, as I was feeling around, I thought things felt a little too squishy and that her membranes were still intact. Since we don’t have any of the fancy tools to break someone’s water, I pinched and used my fingernail until I could finally make a little hole.  Sure enough, more water came out. 

And then things moved fast! In the next five minutes I saw the head had moved down quickly!  But wait, what was that squishy thing? Was that the cord?  Did the cord come down with the head???  I’ve had that happen before and the baby died when it did, so I’m always afraid of that happening!!  I listened to the baby’s heart rate again and it was much slower.  Shoot. It’s a half day. Who else is around?  I ran down to the outpatient department to see if there was anyone there. Fortunately, my friend who frequently saves my butt was there, even though it was his day off.  I told him what I suspected and he and I ran back down to the OB.  I saw the anesthesiologist from the OR team so I asked him not to leave yet, as we might have a c-section to do.  As I entered the OB ward again I saw one of the midwives who has been doing this whole baby borning thing forever!  As we all headed into the labor room I remarked to my friend…..”See how much Jesus loves me?!?!   I was all by myself and now look at all the help I have!”  J  My friend did a vaginal exam and said that he didn’t feel any cord.  Good!!  (And bad, as I once again proved that I didn’t really know what I was doing!)  Two pushes later the head was out. The cord was wrapped around the baby’s head so I clamped it and cut it. One more push and a bouncing baby boy was born.  8 pounds!! I told them that was an American sized baby!! 

The placenta was delivered just fine and mom had no complications.  I was talking with my friend later about prolapsed or presenting cord (when the cord comes down in front of or in conjunction with the presenting part, thus putting pressure on the cord and essentially cutting off the blood supply and oxygen to the baby).  He gave me some tips on things you can do if you have that problem. In the States they will immediately go for a c-section but here, it takes an hour to get everyone into the OR so the outcomes are also not great.  But praise God this woman delivered just fine!! I think it was probably the combination of a tired uterus and intact membranes that slowed things down. I was a little bummed at the end because if I hadn’t suspected the cord issue, I totally would have delivered her by myself!!!  But I thank God that even though I had to eat some humble pie, the woman and baby did fine and I got to learn some more.