From Nick's perspective

Nick’s on call today. But right now, he’s up at the hospital giving blood. He got called in a few hours ago for an admission. He ended up having five patients come in. One of them was a kid who died from anemia waiting for blood. His hematocrit was 5 - probably means a hemoglobin of around 1. Normal hemoglobin is somewhere about 12-17. In the United States we usually give a blood transfusion once it gets down to 7. Death and suffering is so commonplace here. We usually end up talking about his day by focusing on what he’s learning or something new he was able to do with ultrasound. Here’s a few snippets he wrote in an email about life at the hospital. The email was to the director of the fellowship and the other fellows going abroad in January so it's pretty technical.

"They were really hurting for help when we got here and were really glad to have us. In looking back they were really gracious to let us have a couple days and the weekend to catch up before really getting thrown in. There is one pediatrician and one med/peds post residency fellow who had been the only medical doctors here for basically 2 months while one family was on furlogh. They were getting burned out seeing every kid and adult in both the outpatient and inpatient areas. 

I started out for the first week in the PMI which is their outpatient ward for kids <5 yrs. It is lots of empiric treatment of disease which has been a little difficult for me as we really rely on history and have very few definitive diagnostic studies. Labs we can get: CBC, HCT, ALT/AST, Na, K, Cr, CO2, urine dip, urine micro, thick smear (no thin smears), peripheral smear (for sickle cells and once they saw filaria!), sputums for TB, and HIV 1/2. They do stool exams but I think they are few and far between and there are no cultures done and little to no gram stains of anything. They have medical screeners that treat basic medical problems that are straight forward and then send everyone that is sick or complicated to us. Probably 60% of what we are seeing now is malaria in kids and it isn't even malaria season yet!! There are also lots of superficial skin infections with bullous impetigo, sickle cell crises, pneumonias, diarrhea/dysentery, dehydration (that gets really severe), and really crazy malnutrition. Any people that we admit from the clinic or while on call we take care of until we discharge them, which usually means rounding on 6-12 patients in the AM.

Cerebral malaria and seizures here are a conundrum. IV/IM diazepam and oral phenobarb are the only seizure meds that we have available currently. I had a kid seize for almost 24 hrs straight and couldn't get them to abort even with huge doses of diazepam and trying to give phenobarb by NG. It was the most frustrating thing that I have encountered here and I think took me from the "everything is interesting and fun" to "this sucks" pretty quickly. It was a good spot to be in to have to rely on the Lord and for Him to be sufficient for both me and the child.  If you have any extra IV anti-convulsants around in the US, send them this way as malaria season is coming...

The second week I moved to the OPD (adults and kids >5 yrs) and Parker moved to the PMI. The OPD is ultrasound heaven. I have loved learning and have really improved my skills in the one week I have been here. I have diagnosed with ultrasound: pneumonias, pneumothorax, pleural effusions, constrictive TB pericarditis, CHF, metastatic liver masses, perforated typhoid, gangrenous large bowel, bowel obstructions with perforation, ascites and liver failure, intussecption, splenomegaly, ovarian cysts, neurogenic bladder, hydronephrosis, BPH, Bladder masses, extremity abscesses, and probably more. I really love it and have enjoyed being able to have more of a definitive diagnosis for things in the OPD that I can diagnose with ultrasound. I have been surprised by the variety that we see there from hypertension and diabetes (?), filariasis, lots of TB, lots of typhoid, lots of malaria, some HIV, skin infections, one case of cutaneous leishmaniasis, asthma (that has nearly no treatment options here), etc. The x-rays I have seen here have been like none other too!! 

We have not got into the OB side of things yet but probably will soon now that we are getting more comfortable with the Med/Peds part."

Let's go fly a kite

Nick got to use his father’s day present tonight. If you know Nick well, you know he’s in to weird things. So it makes sense that he wanted an air foil kite. For those of you like me who don’t know anything about kites, that means it has two strings to hold on to so your kite can do fancy tricks and stuff. We went out on the air strip before sunset to test the kite in the mild breezes we were getting. Nick went first and was quite impressive. He passed the handles off to me, and it took me all of about 3 seconds to crash it into a tree over the fence line. We realized we had an onlooker who ran over to help untangle the kite from her side of the fence. The air strip is between the compound to the south and millet fields to the north.

Curiosity got the best of her and she soon hopped over the fence to get a closer view. Nick insisted she get her hands on the strings for at least a bit. We also had a security guard who paused on his rounding duties to watch the beautiful kite and snap some pictures with his phone. We exchanged Hausa greetings. It was fun family time as well as a way to connect with a couple locals. 

Times like this I really miss my Thailand experience. I lived with a family and was immersed in the culture all the time. I had no need to find a way to practice language or connect with local people. I was surrounded by a foreign language and local people were the only ones around me. This immersion is the kind of missionary experience Nick and I have envisioned when we’ve talked and thought about missions. Don’t get me wrong. Life on the compound is nice in a lot of ways. And rural Thailand is more advanced than rural sub-saharan Africa. We have reliable running water in our sink: locals haul large plastic drums to and from a fill station.  We have sufficient electricity for lighting a 3-bedroom house, a full size refridgerator/freezer, computers, a microwave, a toaster oven, etc: locals who can afford it have electricity for a few lightbulbs and maybe a television and small refridgerator. We have a nice sewage and garbage burning system, enough said. We have all of our fancy bulk food items without constantly feeling the need to give them away to people who have little and buy food one meal at a time.

We also have a lady who sells delicious fresh fruit on the compound a couple times a week. If people buy too much to carry home, she kindly sends her daughter with them. Her daughter helped me carry a few things home. I asked her name, and she asked me mine and my kids’ names (usually I have them with me). When we got inside she was disappointed they were sleeping. A couple hours later, she came back with a peeled orange to share with the kids. She wanted to play with them. While we waited for them to wake up, she helped me finish the cooking and baking I was doing to get ahead. She washed all the muffin tins and every pot I had used. She was very sweet and so excited to play with Charlie when he woke up. 

It was a strange mix of feelings I had with her in the house. I was excited to have someone in the kitchen forcing me to scramble for the few Hausa words I knew and to quickly learn new ones. But I was embarrassed at all the food in our refrigerator and pantry. She probably thought I was baking for the masses because I made a couple dozen muffins. Most people in a culture of poverty are used to having enough to get by. They don’t think about buying in bulk or making a large batch and saving some. Even though it’s cheaper in the long run, it requires an investment, which they often don’t have. If they do have enough, they usually don’t buy in bulk anyways because everyone expects them to share. I saw this with Prang in Thailand. She would try to buy bulk items she and her kids used everyday. But whenever she would have a large case of, say, boxed milk, her nieces and nephews would grab some because the understanding was people ate what was available. If they didn’t have much, they went a little hungry. If they had more than enough, they shared. I hid my precious food items in a suitcase in my room so they didn’t disappear so quickly… which left me with a rotting mouse in my bag after a couple months. Sadly, I had to stop hoarding :(

Having the sweet girl around challenged my thinking. The idea of "incarnational living" is great and so important. How can we be like Paul in 1 Corinthians who became all things to all people, so that by all means he might save some? And of course like Jesus, who was himself God but took on flesh? How do we live among the people we are serving when we will never be just like our local neighbors? After seeing pictures of Nick's long hair, Nick's translator asked him why he cut it short. "Because I didn't want to stand out anymore than I already do," was his response. "But we know you're different than us. You're never going to be like us even if you cut your hair short," the translator replied. I think we can navigate how to do some things differently because they're cultural or helpful - like buying bulk cases of green beans because we can only get them in the capital and we really like them... or making large batches of muffins to save - without constantly feeling guilty about our plenty when others are in want.

Our Via Christi fellowship group discussed principles of giving and dealing with asking in cultures of poverty. We need to carefully consider our lifestyles in light of Jesus' clear teachings on generosity and money (give to everyone who begs from you, if someone takes your tunic give him your cloak too, don't store up treasures on earth but treasures in heaven). We also need to be careful not to make ourselves into "the God who provides" and not to rob people of the dignity of earning their own fair living, subtley telling them "you don't have what it takes to provide for a family."* Paul learned to be content living in plenty and in want. Did that mean when he had plenty everyone else did too so he didn't have anything to feel guilty about? Or that he gave it away until he had the same as everyone else? I don't know. But all this thinking about heavy stuff is clogging my brain. Kite flying was fun :)

*These ideas are core principles in the book When Helping Hurts by Steve Corbett and Brian Fikkert.