Experience

It has been a while since I have blogged not because I have not wanted too but because I am not sure what to write.

Our lull ended near the end of June and we are back on the schedule of 20+ shifts a month. It is tough. We are like single parents working a full time job. Compounding this challenge are the cases we face in the hospital. I haven’t the experience for it. I need somebody beside me.

24 year-old male presents with progressive paralysis x 4 days. At presentation he is barely able to move his left arm and leg. Diagnosis: suspected Guillain-Barré Syndrome. Treatment required, IVIG –we don’t have it. We tell him he is sick and that there is not much we can do beyond just supportive care. We explain to him, he may or may not get better. Two days later he dies after we coded him for 30 minutes.

IMG_11092 year-old presents with malaria and anemia. During rounds he goes into respiratory arrest. We bagged him for 30 minutes and decide to place him on BIAP, hoping he will survive. He survives the night. Follow up exam show fluid in the lung. Chest tube placed drains copious amounts of pus. He is alive today on antibiotics and eating up a storm.

19 year old males comes in because of loss of consciousness x 5 days. When it started he was treated at another clinic with a plethora of medications. We suspect meningitis based on a lumbar puncture and start rocephin and dexamethasone. The following day he is like a new man; however, this was not to last. After completing 10 days of IV antibiotics he is no better than when he came. We are at a loss for his actual diagnosis, but we cannot do anything more for him. We have sent him home to die.

26 year old females present with difficult breathing x 3 days. Work up shows concern for a right lower lobe mass. There is not much we can do for her. I explain to the family that she is very sick and that she may die. I tell them she needs more than what we can provide here. They tell us they cannot afford to go anywhere else. We treat with all that we have – antibiotics, steroids, broncodilators, oxygen, and place her in the ICU. The first and second nights were rough, she became sicker, developing subcutaneous emphysema (air leak in the tissue). But then she started to turn the corner. Five days ago she was discharged from the hospital. Boy were we wrong on that one. Thank you Lord.

On and on it goes . . . the successes put you on a high. The failures put you on a low.

Experience is a funny thing. If you have it, a patient benefits. If you do not have it, the patient does not benefit from it. But you have to go through it to know it. Somebody has to be the “first/test case.” I wish there was another way. I wish experience could be simply observed and taught. I think that is what systems, protocols, and stories are for.

The Bible is just that –it is the story of Christ. It tells us through stories, illustrations, and parables on how we are too live our lives. No, it is not going to be all roses all of the time, maybe even none of the times, but there is hope in the end. And in that we must believe, because if life is just now and for the moment, the stories and struggles over here are depressing. But if there is truth in the Bible, and there is, then the stories and struggles over here are joyful. They are stories –through action and prayer –of love, hope, compassion as we at HBB reach out to the sick and the dying in times of need to show, if only for a second, to a stranger, they are loved and God cares.

God I ask for your strength and your wisdom in interacting, treating and ministering to the patients here in Togo. I pray my inexperience will not be there burden. I also pray for the future Lord, that if it is your desire for us to remain in the field you will open the doors. Amen.”

God Bless.

See our updated pictures and prayer requests

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Bread Alone

IMG_0908He came in very thin and looking very weak and several months younger than he actually was.  He had a rash over his whole body. After a few moments of questioning “mom” a very different life-picture emerged. The real mother had abandoned the baby shortly after birth because she was upset with the two other wives that the husband had. This was actually the sister of the husband who had been looking after the baby. She was single and unmarried and so didn’t have breast milk and the family couldn’t afford to buy powdered milk/formula and so they had been boiling biscuits in water and then feeding the baby the boiled concoction since birth.

I happened to be spending some extra time with the pediatrician when this little guy came in. My first reaction was shock at the situation and then anger and confusion at the family situation not fully understanding the cultural dynamics and saga that had taken place here. The diagnosis was actually relatively simple: severe malnutrition with kwashiorkor (swelling in the feet) along with a skin infection.

The complicating matter in this situation was how to treat –it needed to be done very carefully! If we fed him too fast he could die. Fifty percent of deaths in children in Africa between 6 months and 5 years is related to malnutrition and complicated by infection that can cause a quick spiral downward. Effects of the malnutrition affect everything in the body from brain development to kidney function (not being able to excrete sodium well or excess fluid) to poor intestinal digestion and absorption, electrolyte imbalances, decreased immune system, and more. The first step in this situation was to initially stabilize him the first few days with IV fluids, antibiotics, and then gradually adding in milk and then possibly other food sources.

The big question was if his little body would be able to handle it or had it gone too far in damages? One of the first things we needed to do was to warm him up –his body temperature was registering at 34-35˚C –this was because he literally had no fat insulation and a large body surface area with very little weight. After ordering labs, our next responsibility was to determine what type of fluid and how much should we give him, and what electrolytes (Potassium, Magnesium, etc.) did we need to get him and when. Then using a special formula put out by WHO (World Health Organization) we started him on some slow oral feedings with plans to transition him to formula sometime over the next few days depending on how he tolerated it all.

Initially things were concerning, his skin began to peal all over his body, and the edema was getting worse, now extending up his lower legs, into his upper legs, and into his lower abdomen. His aunt was very concerned the first few days that he was actually getting worse. It is in this time that we had done everything we could –followed all the known directions that we could down to the smallest calculation of electrolytes and such –and now just step back, pray and allow the body to heal and praying that it wasn’t too late and that God would allow this little guy to survive.

Each day we had a chance to interact with the surrogate mother and to pray with her for the health and healing of this little one. Then all of a sudden one day there was a sudden and dramatic change that seemed to turn the corner for this little guy –his swelling was all of a sudden gone, he was taking in good amounts of formula and he started interacting and playing a little! It is not every child that comes in that we pray with that survives, and I often wonder what is it about one child that God calls home versus another that he allows to stay on this earth longer?

Now the big question is to what kind of a life will this little guy go home to? The family had initially come in because of some workers from an community outreach group, YWAM, had encouraged them to come –so we are hoping that YWAM will continue to have interaction with them and support this little boy and family during the next few months as he grows –there is no governmental system to follow-them once they leave our care. But we also hope and pray there will be a true change in the life of this family as a result of the interactions that they had here at HBB –that is his only hope.

After fasting forty days and forty nights, he was hungry. The tempter came to him and said, “If you are the Son of God, tell these stones to become bread.” Jesus answered, “It is written: ‘Man shall not live on bread alone, but on every word that comes from the mouth of God.’” Matthew 4:2-4

See our updated pictures and prayer requests.

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The Lull

It has been a strange 8 weeks.  It has caught me off guard.  I am not sure how to interpret it all, nor am I sure how to write about it.  I feel like up until now we have been traveling at 100 miles an hour, and then all of a sudden we stopped.

It is strange, with this change of pace I have had to re-learn how to take time for myself – to read, to exercise, to study.  It has been a welcomed change but also concerning.  I was near my end.

Noah loved the water!

Noah loved the water!

The start of the change was abrupt and planned.  Short term help was coming and we were given 10 days of vacation starting March 15.  We left the compound tired but happy.  We traveled to Ghana for the 10 days spending time hiking, sleeping, eating, and exploring Accra and the Gold coast learning about the slave trade.  We return to the compound on the 23rd having had a good time but also a bit anxious on what was waiting for us.

What was waiting for us turned out to be more doctors.  Surprising what a few more doctors can do!  It’s like night and day.  We have been running anywhere from 8 to 11 doctors for the last 8 weeks.  This is up from 5 doctors during our first 9 months.  Oh the difference it makes!

With the extra help I was able to spend 4 weeks working solely with the surgeons.  Yes, I was on call every 3rd night but it was different.  Prior to these 4 weeks, when I was on call, I was making the decisions.  Now I was nothing more than a resident, a lackey, working under two other doctors.  The responsibility was not mine!  It was nice for a multiple of reasons.  First, I got to see and be a part of a lot –para-cardiocentesis, inguinal hernia repair, exploratory laparotomy, bowel resection, below the elbow arm amputation, sign nail, casting, fracture reduction, biopsy, mastectomy, central line, cardiac window, supra pubic cath placement, prostectomy, anal fistula / fissure repair, myelomeningocele repair, etc.  Second, I was not responsible for all the decisions being made.  Third, I learned a lot and because of it, I have become a better doctor.  Now, if I could only get five more months like that.

Since the beginning of May, and because of the short termers, our call schedule has changed.  We are now each now doing call – OB and Medicine – only every 4th night giving us a total of 15 on call shifts a month, in addition to regular hours, and not the 20 to 30 we were doing before.  Topping this off are Dr. B and Dr. C, two family doctors who also do OB.  There seems like nothing the 4 of us will not hesitate to tackle and/or discuss – tetanus, Potts disease, breech delivery, oligohydramnios, polymyositis, TB, etc.  It is refreshing and fun.

PETReaching beyond this, we have started to reach out to the community in the first of what we hope are many projects.  We have arranged to get 5 PET – personal energized transportation – vehicles from the US to Togo.  A hospital pastor has identified 5 persons suffering from debility who require “all-terrain” wheelchairs to get around.  We are hoping the vehicles will be here by the end of June to distribute them during the months of July and August.  If the PET wheel chairs turn out to be sturdy and practical in the Togo environment, we are hoping to import more.

IMG_0921The timing of the lull is interesting as we are considering and praying about our future.  If it was a matter of interesting work, it would be a no brainer, we are staying.  But there are more factors than that such as sustainability.  To stay would mean a commitment of not merely two years, but a place to build a home, a base, a future.  Anyone can work hard for 6 months to a year, but what about 5 years? 10 years?  Without the lull I would call the schedule unsustainable.  With the lull I would call it sustainable.  The challenge becomes now to determine what is normal, the first 9 months or the last 8 weeks?  Looking to the future, I am afraid that it is former.  I am afraid the lull is going to end sometime near the end of June.  Please continue to pray for us for God’s very clear direction in our lives and that we would find his strength during the tough times.

God Bless

Please also see our updated prayer requests and soon-to-be updated pictures.

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Happy Easter – 2014 Spring Newsletter

Fun!

Fun!

Our Spring news letter is now posted!  Go to our website under “newsletter” tab or click here.   Hope and pray that you have a blessed Easter.

Please also see our updated prayer requests as we head into this new year and be looking for new pictures to be coming soon!

God bless

Fred, Lydia and Noah

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Eighteen and Dead, the Argument for Christ

100_1843She was carried in complaining of vaginal bleeding for nine months.  Her history was classic: positive pregnancy test in March, miscarriage in April, D&C (an operation to clear out the uterus) done in April, June and again in September secondary to continued vaginal bleeding.  Now it was January and she was still bleeding.  The conclusion (confirmed with ultrasound, a quantitative ß-HCG and chest x-ray) . . . she had choriocarcinoma with metastasis –this is a cancer in the uterus that if caught in the right time can be treated with chemotherapy.  The looming questions were: did we need to do a hysterectomy?  (This is a hard decision for anyone, let alone in an 18 year old, especially when out here being able to have and bear children is very important.)  Did we have enough of the medication to adequately treat her cancer without compromising other patients currently being treated for Burkitt’s lymphoma?  Would she follow-through on her treatments and labs that needed to be done?  Should we treat her?  The family’s question, “How can we afford any of this??”  Theirs was a daily struggle of food, not one of the future.

In it simplest form poverty is defined as lack of income to live.  In its broader form, poverty is defined not only by a level of income but access to a minimum level of resource –health care, education, etc..  Anyway you look at it this family was poor.  

There were many questions that we struggled with.  Why was this caught so late?  We are doctors tasked with the diagnosis and the treatment of medical/surgical conditions.  We did not receive training with respect to choosing who should have a chance at life and who should not.  We do not want that responsibility, and yet here it is.  God, if it is you will, please take this burden from us and if it is not, please give us the wisdom to know how to minister to this young girl and her family.

After talking with the hospital pastors we decided, anonymously, to use some of the money received by our supports to pay for her present and future medical bills –she would need weekly chemotherapy with additional lab tests –and also to help her family with transportation and food costs.  In starting her treatment, we decided to wait on the hysterectomy in hopes that the chemotherapy may save the uterus.

When she didn’t come back in the next week for her second chemo treatment, we were wondering what happened.  We finally got a hold of someone in her family and found out she had been bleeding heavily again and was very weak.  We told the family they had to bring her in.  This time the decision was made that she needed to have a hysterectomy, or she might not make it.  It was during this hospitalization that she made the decision to surrender her life to Christ!

The decision to accept Christ is fantastic for multiple reasons.  In this case, it was a reflection of how God had been working in her life, and the time spent with the patient, in an hour of need, to not only tell her that she mattered and was loved, but also to show her.  This is the argument for Christ –his example.   This young girl heard and was shown the message of Christ because of the pastors and staff at HBB.  They, the pastors and the staff, are here because of ABWE & Samaritans Purse.  ABWE & SP are here because of Christians who listen to God’s leading and thus give selflessly.  Christians are here because of Christ and his example.  Where is the equivalence in today’s society?  His example transcends cultures, laws, regulations and systems.

Hard decisions then needed to be made for when did we need to restart the chemo after the surgery.  The plan was made for two weeks afterwards.  She never made it for her third round of chemo.  She came back in about a week and a half later with an infection and died about three days later.  This was a hard loss for the family and for us.  Was this a life that was lost?  No.  Yes, she died but she now has life after death with God –no more sorrows, no more tears, praising God, and surrounded by his love!

Thank you for helping this girl to find love and salvation through Christ Jesus in this dark world.  Please keep praying for the family that in the midst of their hurt and grief that the love that was shown to them and their daughter while she was at HBB will also allow them to follow their daughter in her spiritual decision.

Thank you again so much for listening to God’s calling in your life to give and pray and thus helping to make an eternal difference!

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Clothes Pins and a Tour

We love our little guy and he continues to keep us entertained as he finds new ways to make us laugh!

Take a mini-tour with us through the hospital to get a feel for the  hospital, staff and patients (2 parts) -though realize I’m not a professional videographer so apologize for all the shaking!

 

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“Biannual Report”

100_1729 100_1776We are at the half way mark, month 15 of 30.  What a trip it has been so far.  So many stories and experiences.  We would like to give you an update of where we are and where we are going.

ABWE / HBB / The Hospital of Hope

ABWE, the organization that runs HBB in Tsiko Togo, and where we are currently located, is on track to open a new hospital in the Northern Part of Togo called Hospital of Hope.  Opening date is January 2015.  We are hoping to make a trip there sometime in February/March of 2015 to visit the hospital and site.

Prayer Support

We are not sure of the exact numbers of people who are praying for us, but we know there are a number of you who do and we are very thankful for your prayers.  We do feel “watched over and cared for” – especially on those really busy nights when things feel “out of control” and one can lean on the arms of our Heavenly Father and know that there are people who are at that moment lifting you and your family up to Him.  We could not be here without your prayers.  We also very much appreciate your words and thoughts of encouragement that you share with us through responses to our blogs and emails.

The Blog

The blog continues to be a joy/therapeutic to write.  We have 132 subscribers to our site and an average daily viewership of 25.  Our blogs are a reflection of our experiences/feeling as they happen.  Our goal is to relate our experiences as best as we can to you, so that you may share in the ups and downs of missionary life and know how to pray for both the Togolese and us.

If you have any questions, suggestions about a blog or would like to know about something specific please, feel free to write us.

Financial Supporters

We presently have two sources of income, Samaritans Purse and you, and with our current monthly commitments we are at 100 plus percent of support to the end of our term.

Outside of that we have roughly 70 financial supporters, 18 monthly donors and 52 one time and or intermittent donors, who have given anywhere from 25 dollars to 6,000 dollars.  Our goal, which we have met, was to raise 1,200 US dollars a month.

Looking over our expense records, we spent about 6,000 US dollars a month while in Switzerland for the seven months and are presently spending about 3,200 US dollars a month while in Togo.  Our major expenses in Togo, not including rent are as such:

  • Student loan: 866/month
  • Groceries: 650/month
  • US taxes: 306/month
  • US medical License/organization fees: 250/month
  • Health Insurance: 240/month
  • Electricity: 200/month
  • House Help: 162/month
  • Internet: 70/month
  • Other (gifts, household consumables, printer paper/cartridges, transportation, etc): 456/month

Noah

Noah continues to grow and explore in all sorts of ways.  Most recently he was branded as the “escape artist.” This was because one day as we were working in the hospital, we heard a “Mama, Dada, Mama, Dada,” and turned around to find our son walking in the hospital door with Fred’s shirt and no one accompanying him!  He’d managed to get out of a locked door at our house without our househelp knowing and walk all the way into the hospital, about 400meters, all by himself!  He’d had a good number of people out looking for him that day!  The next day thankfully one of the missionary wives saw him headed toward the hospital again and was able to stop him and get him back home.  Since then we’ve had a lock put on the door high up and out-of-reach of young fingers!

Future

As we look to the future and where God would have us to be, we are uncertain.

In staying in the field long term, there are many challenges including Noah’s education, establishing a monthly salary, planning for retirement, and establishing a home as well as ministry.   We would go from part time missionaries financially supported by Samaritans Purse and you to full time missionaries supported only by you.  Our monthly expenses would likely double including new costs such as rent, hospital fees, retirement and ministry funds (supporting the hospital and local churches).

These have not been easy months for us –as many of you may know from reading our blogs, but God has been our continual support and He is working in our lives and the lives of our patients –though not always as fast and direct as we would wish for. But we are whole heartedly asking God for clarity on whether He would have us to stay on the mission field long term.

As we pray for God’s direction in our lives we would ask you to pray as well.  Pray with us that God would give us clear direction on where He would have us to be and then the faith to follow that wherever it may be.  And pray also for what role you, our supporter, would play going beyond June 2015 –as a continued and/or new prayer/financial supporter.

God Bless

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Feb 27, 2014

IMG_2208I am down.  I am struggling.  I called a friend, a teacher, a doctor who participated in my training.  We talked.

In the middle of January, I told my wife, we have been blessed / lucky so far, no major OB cases were we wonder “what if”.  Yes there have been a lot of difficult OB cases and yes, there have been a number of medical cases were we have wondered “what if” . . . a 28 year old mother of five admitted for sepsis secondary to provoked abortion dead 16 hours later.  I was with her for the last 5 and wondered out-loud what if.

It is surprising what a month will do.  I have now two cases related to OB and post-partum where I wonder “what if”.

Oh Lord, you know our situation, you know what I will face today, give me strength, give me wisdom to prevail.”

In my conversation with this friend I was reminded that I was a good doctor, a good person, here in Togo doing a service.  She told me to remember the success and the saves.  Interesting advice.

I do not remember the good times, the saves, or the success.  I, instead, remember the failures, the struggles, the defeats.  These struggles mark me with strong emotions, and it is these emotions that I remember.  It is these emotions that rule the day when I am down that make me question what I am doing.

Oh Lord, help me to glorify you.  Have mercy on those I see in your name.  Do not punish them for my compliancy, pride, sin”

It is tough.  In a full day at OB clinic I will see many patients.  Of the 25 plus patients I see, I only remember the two difficulty “what if” ones.  That fact that they continue to come to our clinic for follow up is a testimony to them, their strength of character.  I am not sure I would.  I would run.  Yes, I am the doctor and I am here.  But on days like this I am only there because the airport is 3 hours away, and outside of purchasing a ticket home, I am not sure what I would do.  Beside, my wife is post call, at home with Noah . . . I have no other options.

Thank you Lord for the Togolese people, there heart, their desire to know you and their example.  I am not worthy.”

After the first case, the surgeons, medical chief and I visited the patient.  Our object was simple, to give no excuse, simply to explain what happened.  During this process, the patient explained that she was a seamstress who makes clothes and understands from time to time things happen.  And when they happen, you correct them and move on.  She then went one to say she hoped that what had happened would not affect her relationship with us the doctors and the hospital staff!  She continues to come to our hospital, to our OB clinic, I have seen her two times.  Her husband has invited us to their baby dedication.

Thank you Lord for her, for her faith, for her example.  I pray that you will bless her life and that of her family.  What successes you have promised me, I pray you give to her.”

The second case is tougher.  I have no description, no details.  All I can say is she comes to our clinic for follow up.  We pray.

I am at your mercy Lord”.

Today, my wife is on OB call, she started in the morning and has yet to come home.  I start my OB call tomorrow.  Our OB deck is different than most.  We manage not only the mothers but the babies, with their complications, that are born either at our hospital or at an outside clinic.  We are blessed to have a post resident pediatrician guiding us in our decision making and handling some of the more difficult cases.  Presently we have quadruplets, weight between 1.29 kilos and 1.6 kilos, born at an outside clinic; we have one baby on day number fourteen of IV antibiotics for 2 positive blood cultures, we are waiting the third; we have a baby who is seizing regularly with fever and on scheduled phenobarb, we are not sure of the source of the fever.  Outside of that we are in the process of inducing a pregnant lady who is at 42 weeks gestation and the baby is no longer living –four days ago the baby was fine.  And we are watching a mom, 20 weeks gestational age with a 2 cm dilated cervix, in whom we have placed our first cerclage (a stich to try and keep the cervix closed) –we hope to stop an earlier delivery.

“Lord God, thank you very much for Dr. K and her patience and care for not only the patients but us (me and my wife) for taking the time to train us and to give us a new set of skills.  We pray for her and thank her for her time here at HBB and for her safe travels as she heads back to the states for a few months prior to heading to the Northern part of Togo to help start and run the Hospital of Hope.”

God Bless

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I am emotional (A rant)

Staying dry while it rains!

Staying dry while it rains!

I am emotional.  I cry a lot more in silence these days.  I have been here before.  It comes when re-reading a blog, reflecting on a comment and or seeing a sick patient.  It comes out of the blue, a 180 degree turn of emotions.  I fight it, swear, ask for strength and it is gone, as quick as it comes.

But it comes.  And when it comes I wish I was home in a different setting, a different hospital, a different life.  When it comes, I am mad at the place, the patient, God and the world.  I cannot believe we have not learned from our past.  A 100 years ago, maternal mortality/morbidity in US was six persons per 1000.  Then we learned how to wash our hands and the mortality/morbidity fell.  Then we discovered antibiotics and it fell even more.  Then we developed ventilators and then it fell again.  Today it is 0.1 person per 1000.  This place seems like a different world.  It has not benefited from the advances of mankind.

And then the emotion goes and I realize the opportunity I am in.  My training in the US was composed of diagnosis and treating disease processes in infancy.  Many times during my training, I wondered about the futility of what we are doing and or the medications we are prescribing.  Treatment was a memory process.  In Africa it is not.  Here you see the end result of untreated/unvaccinated hepatitis and tetanus, malaria, hypertension, congestive heart failure, rheumatic heart disease, pancreatitis, etc.  Here you learn to appreciate the well patient checks, vaccinations, and abnormal lab values.  You learn to appreciate the diseases you treat because you not only see the end results, and many times too late; but you get to see the medication and treatment process work.

But this is not the first time I have been emotional.  As a young engineer I worked for a small company for 6 years and I was emotional.  During my time there the company went through it all –downsizing, bankruptcy, start up, environmental issues, health and safety issues, etc.  Shortly after I was hired I realized the trouble the company was in and I made a choice to stay, to learn, to make the best of it.  It was an interesting 6 years.  I learned a lot.  I often said my 6 years of experience there was like 12 years in a normal company.

But there is a price when you become emotional.  Something has to give.  When I left that company, I quit.  I walked away.  I wanted no more.  I took time off, went to France and Switzerland, lived with my brother and finished my MBA.  And when I thought I was ready for work again, I looked for a job and went through some interviews.  Everything looked different.  Prior to taking my first engineering job, I saw work as an opportunity to prove yourself, to gain wealth, to become famous within a circle.  Now all I heard was a sales pitch, a presentation without substance, passion, or ideals.  It was then I thought, maybe I should change careers.  And now I am here, 9 years later, the same position, the same struggles.  Ironic.  Who would have guessed?

It gets to me that we struggle with the basics, that we cannot create a solid society, a sustainable society.  Why are there hungry people?  Why are there people dying of curable diseases?  Why are we complacent?  Why do we treat people different based on relationships, position, status, color?  It gets to me when I know we could be that much better and yet, it seems, we choose not to.  The problem is not me.  The problem is not you.  The problem is us.  The problem is sin!  We choose this.   We promote this.  A case in point.

A 28 year old mother of three, 17 weeks pregnant is in decompensated liver failure secondary to Hepatitis B.  She has a small liver and lots of fluid in her belly.  Her problem started mid-November.  She has been tapped four times, by an outside clinic, for ascites over a two weeks period.  We saw her for the first time a few days ago.  On Monday we hope to run a few more test to see the degree of liver failure.  If her 6 month survival is low, we cannot do anything for her.  However, if she is still alive in 10 weeks-time we will do all we can for her unborn child who will most likely grow up without knowing mom.  If her 6 to 12 months survival is good we will be challenged with our next obstacle, to find 12 plus months of medication and hope she responds.

But this is not the point.  The point is hepatitis B is a treatable disease.  Yes not everyone responds to the treatment, but it is a treatable disease.  What one needs is access to medical care and to medicine.  We choose not to provide that access.  Not only that, an immunization exists for Hepatitis B.  In the states it is a standard part of newborn care since 1991, here it became the standard in 2007.  Some would argue well we have it now.  Not good enough.  Not good enough for her kids and her unborn child.  We have failed her.  We have failed her children.  How can you not become emotional?!  How can you not take a moment to pray, to ask for a miracle, to ask for a better place?!

The greater my wisdom, the greater my grief. To increase knowledge only increases sorrow.”  Ecclesiastes 1:18.

God Bless

UPDATE (a bit technical for the doctors that may be reading this blog)

We have run additional test on the lady in question and have calculated a MELD score of 13, which in her case is good news.  Having stated all this, her only abnormal findings are an INR of 1.5, T.Bili of 1.5, Hep B positive, ascites and platelets of 115.  With these findings we are questioning if hepatitis B is the actual cause of her liver failure and or are we missing something.  We have presumptuously treated her for schistosomiasis.  We have redone her echo to verify a small liver with irregular boarders and a heart that is contracting well, and we have tapped her and are presently in the process of ruling out TB.  We are now in search of a Lab in Lome that can verify additional hepatitis B markers that would include viral load.  This could confirm our diagnosis and give us a basis to verify if and when we treat her, if the treatment is working.  From there, our challenge with her will be treatment, which at this time we are estimating will cost about 1500.00 US dollars (wage range for an unskilled worker to a doctor is 70 to 450 US dollars a month).  A quick thank you to the doctor at Tri State for the curb side consult.

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“Doctor!”

100_1445It had been a relatively challenging night.  I hadn’t gotten home till about 11pm and one of the patients I’d been managing overnight was laying heavy on my mind.  I wanted to go over early to see her and check on how things were doing.  As I was getting close to the hospital I noticed a man and woman supporting between them a younger looking woman who looked like she was struggling to walk.  I wondered who she was and what her story was as she looked vaguely familiar.  As I walked into the hospital they came in a different door and she collapsed on the floor, I quickly realized she was pregnant –we moved her to a bed and rolled her to maternity.  She was confused and groaning.  She looked full term.  Suddenly I realized why she looked familiar –she was one of our patients that we have been following in the Obstetrics clinic.  When we got her back to maternity we were unable to find fetal heart tones.  I was in the process of ultrasound machine out when I heard the nurse call, “Doctor!” I looked over and the patient had quit breathing.  I went over and assessed for pulse and was unable to find any, so we started CPR and in the meantime I am calling out for different things that we need.  My husband comes and as we get a pattern going, I try to find out any history from the mother of the patient of what has happened.  What I find out in total later is that the night before she had complained of some back pain that sharply ran down both of her legs that had continued till this morning when they had been able to bring her in.  The last time she had felt the baby move was from the night before when the pain had started.  “We need to save her!” is the thought running through my head, “God please help!”   After 45 minutes of coding her, we make some “last-ditch” efforts and then we finally call it.  My heart is breaking . . . she was 14 years old and we lost both her and the baby.  I went into the bathroom and cried.  I could only pray that somehow through our monthly/weekly interactions with this young mother-to-be that she had somehow come to know our Lord and Savior.  The sun was shining, but it felt very overcast to me that day.  Are we really making a difference?

“People are like grass; their beauty is like a flower in the field.  The grass withers and the flower fades.
But the word of the Lord remains forever.” 1Peter1:24

It was a different day –New Year’s Eve and I was on call.  The day had been steady, nothing too heavy, just continuous.   We had a full OB floor and two in labor.  One had been in earlier that morning –this was her 5th pregnancy and her second set of twins –all still living!  We’d actually sent her “home” that morning as she had showed no cervical change over 12 hours and her contractions seemed to be lightening up.  We told her to stay close by the hospital, though.  I had been able to go home around midnight and had been asleep for about three hours when I got a phone call, “Doctor, the twins are back and ready to deliver!” She’d walked in just 5 minutes prior and was complete!  I quickly rushed over to the hospital to watch as the first baby delivered –the baby is crying and doing very well.  I stepped in and worked to find the fetal heart tones of the second.  I reapply gel to the probe, move, wait, listen and am unable to find heart tones. I quickly move to get the ultrasound to find heart tones and position of the second baby.  This has been the most trepidatious part for me in the past watching and waiting and knowing when to intervene.  I turn on ultrasound machine but it’s not working!  I quickly unplug and move the cord to another outlet.  I plug it in again and flip the switch . . . ok, it’s still not working!  “Doctor!” –the head was crowning!  “Thank you, Lord!”  The second baby came out just as handsome as the first –two beautiful baby boys!  I cried.  It was a wonderful way to start a new year!  I hope and pray that we make a difference and not just in prolonging lives or helping to bring in new life.

“For everything there is a season, and a time for every matter under heaven:  a time to be born, and a time to die; a time to plant, and a time to pluck up what is planted; a time to kill, and a time to heal; a time to break down, and a time to build up; a time to weep, and a time to laugh; a time to mourn, and a time to dance; a time to cast away stones, and a time to gather stones together; a time to embrace, and a time to refrain from embracing; a time to seek, and a time to lose; a time to keep, and a time to cast away; a time to tear, and a time to sew; a time to keep silence, and a time to speak;  a time to love, and a time to hate; a time for war, and a time for peace.”  Ecclesiastes 3:1-8

Whatever your season of life, we pray that God would bless you and be with you and draw you close to Him in this new year.

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