Well hello all! Time for another mass email update from this corner of the earth. I feel as if I have adjusted well to the pace of life and am really enjoying what the days bring. I absolutely love the medical work…there is lots to know…but I am enjoying the challenge. The Portuguese language is coming along….I find my Spanish helps my comprehension quite …but it will be a bit longer before I am engaging in sensible two way conversation.
I thought I would write a bit about my time at one of the clinics. So much happens in a day here, I thought I’d try and run you through a typical day! For those of you who don’t have time to read – that’s o.k – it’s gotten to be a long email. In short – I am doing very well – there are challenges but God is ever so present – and I am so gratefully to be here.
Those of you who have the time – heave-ho – let’s go…..
5:50am – Rise and shine!
6:00am – Exercise club! …word got out that I liked to workout and soon I found myself developing exercise programs for everyone and their dog! It’s been a great test – did I learn something in University?!
7:00am – Breakfast with Steve (Dr. Foster), Peggy (his lovely wife) and Pam (another Pre-med student and a wonderful new friend!). We always have a great devotional and then spend a good amount of time in prayer. This time is so important for us – it keeps us grounded.
8:45am – Jump in the truck and Head to Rio de Hulia (RDH). Currently, I spend two days a week at RDH– a little clinic about an hour drive outside of Lubango (the city I am living in). The distance is only 37 km but the conditions of the roads rarely allow for travel over 60km. It’s quite a bumpy ride (understatement – we joke we get a good back massage everyday) – it’s often smoother to drive in the ditch. Dr. Foster drives a huge ¾ tonne truck – my little Honda civic wouldn’t survive these roads!
9:45ish - We pull up to RDH to find at least 50 people gathered outside. The RDH clinic was started by the church in the late 60s as a mission outreach to the surrounding tribal people. A couple of dogs wander over to us. Anyone who has traveled to a third world country knows the tragic condition of these dogs– they are desperately hungry- their filthy, dry coat hangs off their frame –you can see far too many bones. It’s hard to walk past them – knowing you don’t even want to touch them. It sickens me to know they are only on the fringe of a much greater tragedy.
We weave are way through the people – a few smiles here and there but most are tired – an emptiness and despairs looks back at you -they have been waiting for long hours - even days to see the doctor. So we get straight to work. Dr. Foster not only does surgeries but also a large amount of general patient consultations. You have to be a jack of all trades in this country!
The consult room itself is about 2m by 3m – grey walls, once white, close in a dirty cement floor. A bare bulb stung from the hallway is awkwardly wired to the wall – fortunately the window provides light as we rarely get electricity. An old, dingy plastic wash basin sits on the floor in the corner – we’ll all wash our hands numerous times in this water -there’s no running water here – that’s for sure. The sheet covering the examination bed is still the one from last week – probably over 50 people have been examined on this sheet - to the eye it looks relatively clean – who knows what a microscope would see! A nurse brings in a stack of patient records – there are always way more than we can see in a day. Dr. Foster sifts through them and tries to pull the ‘most desperate’ from the already really desperate.
We first see an old lady with small burns on her hands. She has lost feeling in her hands and has been burnt while cooking. It turns out she has leprosy. Dr. Foster prescribes some medication and gives some good advice to the women and her accompanying daughter. Because she has lost sensitivity to heat, pressure etc. -for the rest of her life she will have to be very careful not to further damage herself. Dr. Foster is really great at interacting with the patients – he takes a generous amount of time with each patient and really seeks to incorporate the ‘bigger life picture’ into things.
Next, in comes a young girl – she is quite weak – complaining of being tired – we check under her eyelids – she looks quite anemic. She like many others has malaria. A case that really gets me today is a women who comes in looking very pregnant. She comes in complaining she has been pregnant for 2 years now. Now, we all know the 9 month pregnancy duration don’t we? Something’s fishy? We examine her and find an empty uterus– but she is swollen right up. Steve questions her quite intently to find out if she has been seeing the local witchdoctor – something very common around here. Many patients will see traditional healers far long before they come to this clinic. I’m blown away everyday by the devastating effects of these witchdoctors. Sadly, many people are poisoned or die from these extreme practices. On this women she has about 100 little knicks – which have formed scars in a concentric pattern around her belly – this is some sort of bleeding technique these witchdoctors practice. So how is she so swollen? She took a series of potent drinks ‘to make her pregnant’ – and ‘my goodness’ did she get pregnant with something! She is lucky to be alive – her abdominal cavity is filled with fluid- she has hepatitis and is in a state of toxic shock.
Dr. Foster says it is a huge uphill battle trying to get people to stay away from these witchdoctors – there is years of culture twisted up in these practices. Furthermore, the natives have been so hurt by the white people –why should they trust them? I have seen and heard story after story about these ‘traditional healers’.
The consultations are my favorite so far. I love interacting with patients and the diagnostic process – gathering the clues –putting the puzzle together to figure out what’s wrong.
11:30ish roles around and the anesthetist lets us know he is ready – so we make our way to the operating room. Today we have 13 operations. We save the more complex and ‘messy’ ones for the end of the day. We start with a couple gastroscopies (inserting a scope down through the mouth to view the stomach and duodenum) and then a couple of cystoscopies (checking out the bladder). We will finish our day with a toe amputation – that’s the plan anyways.
The case that really weighs on my heart today is of a young girl – 12 years old. She came in with a recto-vaginal fistula – a tear that that has caused her fecal waste to come through her vagina. In the bush these girls end up alienated from their tribes – abandoned and left to die. Imagining how horrible this could be – I wonder how she even got this fistula. Turns out it was the result of an obstructed labor – she had had a baby 5 months prior. Although things have improved - there are still stories from the bush of people that sit on the abdomen of the women in labor to assist the process (yes we are in the year 2005….I am still processing this one!). As you can imagine- the results for the women are painfully detrimental. Whether or not this girl experienced this is questionable, but the fact that she is twelve years old is enough to know she is not well equipped for labor. Holding her frail hand I was overwhelmed by the loss- the injustice done to this little girl – she was so tiny – just old enough to enter junior high back home – and yet, she a child had carried a child.
Our approach in assisting her physically will be two surgeries. The first a colostomy (pulling her lower colon out of her body through an incision in the stomach). This will allow for things to become ‘clean’ so we can examine how damaged she is. In a week’s time we will hopefully begin stitching her up. After the 30 minute operation I go get the rusty old stretcher and wheel her to the ‘post-op’ room. We hoist her onto the bed. A few of us gather around her and pray for her recovery. Emotionally and spiritually I can only imagine how tormented this girl must be.
The stench in the Post-Op room often makes my stomach knot. The mattresses are stained with urine, some have gaping holes in the middle- flies crawl all over the place, sending shivers up my spine. The conditions would shock anyone - it is pretty horrendous. I do my best to push past these things-a smile of a patient always makes these things fade away.
Looking for the beauty in this place can be challenging at times. Because the hospital obviously lacks resource and personnel – it requires the families to take care of the patients. Of course this means the quality of post-op care varies immensely – but I do see a lot of goodness though this. Most families travel for miles (sometimes hundreds of miles) so they camp out for their duration –which can mean weeks. Most bring as much food as they can because there is certainly no cafeteria! Fortunately, some entrepreneurial vendors trek to the clinic to sell grains, vegetables and the odd chickens (and yes they’re live!) for those who have to endure a long unexpected stay. I can often hear the hustle and bustle of meal times outside – the chicken resisting it’s fate – the crackling of the fire – the hungry children crying. All part of the sights and sounds from the OR. Additionally, there is minimal house keeping at the clinic – the families must provide the blankets and bed sheets. Those fortunate enough, get there sheets laundered in the stream outback. And you got the idea….no gift shop either!
Appalled you might be – no sheets – no nurse attendant – no meals on trays – no clean bathroom - no running water (don’t even think about a TV!)- but amidst the depravity there is hope here. Most often I see a unified effort of the family to care for their sick one. Ten people will easily show up for the grandmother’s operation. Grandchildren will tend to their grandparents for days on end. Love and compassion for one another – these are things no monetary amount could ever provide. So I cling to hope here -for without love we are nothing.
5:00ish -We start a external fixation operation on a femur. A 39 yr old man was in a car accident last year and shattered his femur. The government hospital put a pin 15 cm to long in his leg and it is poking out his hip. Dr. Foster is distraught – ‘this is the kind of treatment that passes as medicine in this country –it is so wrong’! We remove the pin and start over.
6:45ish – We start on our last operation – the toe amputation. A 22 year old girl has somehow managed to have her big toe mangled. It is literally on top of her foot sticking up at a 90 degree angle – crazy – I’ll have to show you pictures. We can’t save her toe as most of the tissue is dead. Maybe in the 1st world a ‘prosthetic toe’ could be used – but unfortunately here that option is not possible.
So it’s nearing 7:30pm – I usually get pretty giddy by this time (A sure sign I am over tired!). We stroll on out of the OR, past the front of the clinic. Under the overhang at least 20 people are camped out on the cement pad for the night. They wait in hopes of seeing the ‘doc’ tomorrow. It will likely be three days until we are back. Think about this the next time you have to wait more than 30 minutes to see your doctor!
7:45ish -We jump in the truck and head home – I still can’t believe this was all in one day. Crazy?!
8:45pm Have dinner.
9:00pm Debrief with Pam– pull out the books – go over surgeries for the next day – look up anything we didn’t completely understand today. Brush up on some Portuguese –can’t ever get enough of that!
10:30ish – hit the sack!
So that’s a day in the life of Ang right now. Not everyday is like this. Although, next week we are heading to Kalekembe – a mission hospital 6 hours in to the bush. Dr. Foster likes to do major operations at Kalekembe as there are more staff that can assist us. From what I hear it is going to be a very intense week – we will likely do over 65 surgeries and see at least a 100 patients in 5 days. Apparently we will start really early and go to 10pm each night. Our living conditions will be quite primitive – no running water- no flush toilets, etc. …should be an adventure….
Well this has been one long email –if you have made it to this point – I hope this finds you well! Thanks again for all your prayers and encouraging words. I am ever so grateful for your support.
Blessings,
ang
This is me and Pam with a little hydrocephalus baby we operated on!
