Sunday, October 19, 2014

An update from Nick

Considering that we are half way through our time here in Galmi, I (Nick) wanted to give a quick update from my perspective as Michaela has been doing much of the writing for our blog. I wanted to share a story and give a synopsis of my usual days. We have been really challenged as a family and I have been challenged personally as a husband, father, and physician here. Everything is different. Raising children and connecting with Michaela have had to take on a completely new appearance. I had never seen a case of malaria, typhoid, or severe “kwashiorkor” malnutrition before coming here and these are the “bread and butter” diseases here. I can think of one or two children that died on our pediatrics service in Wichita with our most intensive care. Here with the medicine that we are able to provide, children come in gasping for what seems to be their last breath and miraculously most of them get better. Death is a very harsh reality here that I have not seen the likes of before – nearly every day there is at least one of the patients that I had some role in their care that dies.

One of the things that we are learning that bridges the gap for us and we have had to rely on heavily is listening to the Spirit. Our sense of this need has been heightened with everything that has been new, different, and difficult. Though, truly living in the Spirit is and was a huge need we had even before we came to a new land. We actually had a chance to share some of our thoughts at last week’s church service here on the compound. The missionaries take turns leading the service each week, including the short termers. It was a great chance to think back and reflect on the time we have spent here as well as what comes next for us here as well as in our future. Below I mention one of the stories that I thought a lot about while preparing what we shared.

My usual day starts at about 8 am, rounding on the admitted patients in the hospital. There are 5 wards that are divided up between the children, men, women, isolation, and “intensive care” units. I have been rounding on about 20-25 patients a day and here this takes only about 2 hours! I then get a morning break from 10-10:30 and then have clinic for either adults or children. The clinics are always overflowing with people who come from hours away to get care. When I ask people why they come, they say it is the best care in the region and they trust the care and medicines that they get here. I generally get a lunch break from 1-3 pm and finish clinic at about 6:30 pm. I am on call about every 3rd or 4th day and in the evenings of my call I also usually take any of the C-sections that come in.
The compound we live on is directly connected to the hospital and the main road runs straight to our house. One of my favorite parts of the day is finishing exhausted from a full day at the hospital and beginning to walk down the road to find Charlie tootling towards me as fast as he can or Moriah running and yelling “daddy, daddy!” as they see me on my way.

I often have patients that I admit at the end of the day that I have to wonder if they will be alive in the morning. One of those patients was a little 3 year old girl (same age as Moriah) named Aliyah. She came to the clinic and had malaria with a superimposed pneumonia. She had a hematocrit (blood level) of 8 when normal is in the mid 30s from the breakdown of her blood cells by her malaria infection. I was unable to awaken her and she was limp with her eyes rolled back in her head. Her oxygen saturation which should be more than 90% was in the 60s and 70s. We do not have ventilators here but in the intensive care unit called the “uche” here we do have oxygen concentrators that can deliver up to 6 Liters of oxygen by a nasal cannula.

I ran her up to the uche and got oxygen on her, started her on antibiotics and antimalarials, and got her mother to get a family member to donate blood for her – the lab here has a blood bank that is a huge benefit to treatment but in order to get blood you have to have someone give a unit first. In the US she would be on a ventilator, seeing every intensivist in the hospital, getting 30 lab tests a day, and vital signs every 10 minutes. She would have tubes sticking out of every opening measuring everything that is measurable. Here she got transfused blood, 3 lab tests, antibiotics, and a little bit of oxygen. She laid on a bed with 2 other babies also needing oxygen – no such thing as single rooms, or often single beds for that matter!

This is the reality of most of my days, and many of my patients… And remember this is what the people here know to be the best care available, and truthfully I take pride in the care that we are able to give even with little resources!

Not being able to be a micromanager of care, monitor levels hourly, and give advanced treatment can be a really frustrating thing to a physician who knows what is available in other places. But it leaves much more recognition for me to be aware of the need for the Lord through his Spirit to intervene in and through us. When I would usually ask for more tests or a consult, I am left with prayer and asking the Spirit “what does this patient need that You can show me or You can do?” I am also reminded that it should not be my last resort, but rather my first.

Being left with nothing else to rely on except the Spirit that lives in us is actually a wonderful place to be. In John 7:37b-39 Jesus said: “If anyone thirsts, let him come to me and drink. Whoever believes in me, as the Scripture has said, ‘Out of his heart will flow rivers of living water.’” Through belief in Jesus we are filled ourselves with living water (the Spirit) and have the ability to spill over onto others.

So I came back the next morning and was with one of the translators. We came to the uche and I saw Aliyah. I was surprised she was alive, but she did not look good and was still limp and not responding. I watched for 3-4 minutes for any evidence of breathing and there was none. I pulled out my stethoscope and put it on her chest. Her heart was beating about 70 times per minute which is too slow for a 3 year old. I looked at the translator and said I think she is going to die. He agreed.

Usually there is little benefit to “bagging” a patient here with a mask as we are unable to ventilate them for long periods of time, but I thought we might as well try. I bagged her giving supplemental breaths for 5-6 minutes and then watched again for what seemed like an eternity for signs of breathing. The mother (who likely can’t read or tell time and has no idea how old she is or when her children’s birth dates are) was looking at me bewildered but there was a sense that she knew that it was not going to end well. I told the translator that there were no more medical treatments that we could do for the patient and that she was going to die. People experience so much pain and difficulty here that they don’t cry and generally don’t mourn outwardly. The mother had some tears in her eyes and was clearly preparing herself for the worst.

The mothers here all carry their babies on their backs as Michaela has talked about and shown pictures of in the previous blogs. All babies get carried out of the hospital on their mother’s back, regardless of whether they are alive or dead. This has been one of the most emotionally difficult things for me to watch in the hospital – a mother pick up her limp, deceased child and place him or her on her back, tie them on with a piece of cloth and leave the hospital to return to their village with a dead child. Only then to be greeted by a life of other sick and malnourished children, back breaking work, and no hope that comes from the creator and sustainer of life.

The translator, who doesn’t know the Lord personally yet, said why don’t you pray. Of course! It's sad that I have to be reminded again of the living water in me that my translator had seen at work and knew had power. I prayed for her to be healed and if she was not, that her mother would be comforted and through this time their family would come to know the Lord. And I left her there, not breathing at all.

The Lord does some pretty awesome things here, but this was the most awesome I have seen. I came back the next morning and she was awake, sitting in bed breathing on her own. The mother was ecstatic showing me how she was alive and breathing. I asked her through my translator if she remembered what happened and she retold the story. I told her I was thankful to God, that my medicines were not the thing that healed her and that the God who heals wanted her daughter to live and be healed physically, but more importantly to give them a new heart and a new Spirit. She listened eagerly with a smile from ear to ear. Every time I came back into the ward she greeted me with a raised fist above her head (reserved for those who hold authority) and a smile.

Here is a picture of Aliyah and her mother.  

One of the wives of the surgeons here who Michaela has written about before went up to see them in the hospital and took a picture book to explain the gospel to them in Hausa because she could not read. I discharged the little girl alive and much improved soon thereafter.

In Ezekiel 36 God says that the “nations will know that I am the Lord” and the means for accomplishing this is that he gives those who follow him heart transplants, replacing our heart of stone with a heart of flesh, and also giving us His Spirit inside us to be life to us. Seeing the nations come to know God is why we are here doing this fellowship and training for the future. It is so wonderful to be filled with His Spirit! Oh, that we would abide in him more fully and have a more complete union with him. He does awesome things and is at work in us.

4 comments:

  1. So encouraged by your reliance on the lord who is the great healer. Such a good place to be in and I am giving God glory for the way you are able to see first handed the workings of the king of kings and lots of lords!!

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  2. Wow. This has encouraged my heart in many ways. Thank you for sharing what God is doing among you in Galmi. Praise God for Aicha and her family- May they be blessed and welcomed warmly into our eternal family.

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  3. Wow, so encouraged by your willingness to step forward in your obedience to Him!! We're impressed by the level of openness and vulnerability in your blog, too. Honestly, just can't wait til the day when we get to hug you in person again. All praise and glory to HIM. Love you.

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  4. That same God is at work here, oh that I had a translator to remind me of His power and faithfullness. Wichita needs prayer and I charge you as one entrusted with the gospel to let every medical encounter I try and share with you in the years to come be met with your challenge that I pray! some men trust in CatScans some men in hematocrits but we will trust in the name YHWH.

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