Wednesday, April 27, 2011

A Different Way to Spend Easter

All seven churches in Tansen came together for the Easter service this year.  There were about 500 people worshiping together.  In past years, they have done marches around the town, demonstrating Christian unity and they have passed out tracts and Bibles.  The churches decided this year to give a different kind of gift to Tansen.  We split up into groups of ten or so, and went to different parts of town to collect up trash from the roads.  The idea of using trash cans hasn’t really caught on here yet, so in our two hours of trash collecting, our small group filled a few 50-gallon bags.  All together, they needed a tractor trailer to haul away all of the trash collected by Christians that day.  So many people asked us what we were doing.  We said we were giving them an Easter gift by cleaning up in front of their houses and stores.  They agreed that it looked much nicer after we had finished.  We even convinced two children to join us in our efforts.  I pray that such children will be the future leaders in Nepal.  Our circuit ended at the bus park where there was no small amount of trash.  We told people that this was a group effort of all of the Christians in Tansen.  We serve because our LORD served.  Some people were appalled that doctors would collect trash.  But then again, the Creator of the universe made things from wood, fed hungry people, talked to women, made mud with his spit for a blind man’s eyes, and held children.  We are compelled to be like our Master.

For the medically inclined, here are some of the challenging diagnoses of the week:  young adult with high fevers on and off for a year, with no response to antibiotics nor anti-malarial medicine, and no other abnormalities can be found (except for an increased white blood cell count and the fevers are now daily), tuberculosis with treatment interruption at six weeks (the patient was so thin, I asked what they were feeding him; they answered: rice and lentils and Red Bull; oh my!), Kala Azar, opacity on chest x-ray that I could not discern, ascites of unknown etiology, and then too many people killing themselves through addiction to alcohol.

On a high note, there was a premature baby that I cared for last week, for whom we had to stop the resuscitation efforts.  When I came home and shared the story with Ana, she immediately put out a request for prayer.  Well, I went to see that little one today.  She is breathing on her own.  She is off of oxygen.  She is through her jaundice.  She is nursing.  And she has now surpassed her birth weight of 1900 grams.  The parents are so happy.  They still haven’t named her yet.  They want to wait to see if she is really going to survive.  This is a miracle.  Our God continues to perform miracles.  Thanks be to Him!


Monday, April 18, 2011


This morning I came out of my slump.  You know whenever you step out of your comfort zone, to do hard things, you are bound to go through what I am calling a slump.  To me, a slump includes things like doubt, sadness, apprehension, disappointment, feelings of inadequacy, fear, confusion, or some other “difficult” feeling that persists for a while.  I have noticed that every single one of us who serves at this mission station goes through times of slump.  For me, returning to inpatient care has accentuated my “difficult” feelings.  Yesterday, I was the senior doctor for pediatrics; my colleagues: an intern and a brand new resident.  Did I mention that I lack training in this specialty?  The day was extremely difficult.  It started at 7:30 am with the 8-month-old in the ER with septic shock.  Then we began rounds.  One of our patients was two-days old, having been born six weeks before her due date.  Again, I sensed my lack of experience and training.  At 10 am, we were called back to the ER to resuscitate the septic child who had stopped breathing.  It seemed that we had resuscitated him successfully and he was prepared for transfer to the ward.  We returned to rounding on the inpatients and finished at noon.  We were on our way to the outpatient clinic to see the 60 patients who were awaiting our arrival, and we were called to the operating room.

Here is the highlight of the day.  The patient: a woman who had lost her first four babies (either in utero when they were full-term, or at the time of delivery).  She was having a c-section while this baby was still alive; I prayed that she would receive her first live, healthy child.  We were there to care for the baby in any way that he might need.  THANK YOU GOD…this little guy (whom they had estimated to be four pounds, by ultrasound) came out crying and weighing at least six pounds by my estimation.  All I had to do was dry him and examine him.  He looked perfect.  I was so happy…I wanted to kiss the adorable little guy!  To avoid being misinterpreted as eating her child, I settled for big smiles and telling the mom that she had a beautiful, healthy baby boy.

Unfortunately, during this c-section, we were called again to the ward; the 8-month-old had a respiratory arrest again, and this time he died.  I made it in time only to say to the mom that I was so sorry.  One-o-clock: finally on our way to clinic.  There were some of the usual diagnoses that we see in pediatrics (pneumonia, ear infections, etc.) but there was also the five-year-old who weighed barely more than twenty pounds.  Her TB is now cured; why isn’t this child growing?  After some help from a Nepali speaker, this is what I discovered: the mom is made to work all day long, by the husband who beats her if she doesn’t obey.  While she is out in the fields, there is nobody home with this five-year-old and she goes all day without eating.  She is simply not being fed…and she shrinks away.  I feel that old pain in my heart again. 

We did our best to see the 60 patients in 3 hours; that’s how much time we had before we were called to the maternity ward for the 2-day-old.  She had stopped breathing.  We breathed for her, with a hand-held resuscitation bag, off and on, for three and a half hours.  Unfortunately, not one of the doctors on duty yesterday knew how to use the ventilator, which this baby might have most benefitted from.  I spent a few hours that evening consulting with other doctors to see if we could find someone to be responsible for the ventilator for the night so that she might make it to morning when we could investigate the potential causes of her apnea (the cessation of breathing).  In the end, I had to release the nurses to tend to the other patients and we stopped our resuscitation efforts.  Ouch.  Are there any pediatricians out there who can come to Nepal to help the generalists like me?

It was such a difficult day.  I came home and had a long talk with Dave.  I realized that without him, to talk to after such days, I might not be able to do this mission work; it might break my heart.  So, I thanked God for my husband.  We talked again this morning and something suddenly became so clear to me, that I came out of my slump.  We lack skilled personnel here, and I myself lack knowledge and experience that I wish I had.  Still, I keep going to work, with a learning attitude, hoping to keep becoming a better clinician.  I find it hard and humbling.  But, this morning I realized that I do have three things, and these three things will last forever: FAITH, HOPE and LOVE.  These I have in abundance.  These I can freely give.  And I do.  I demonstrated love to every patient that I saw yesterday, as best I could.  I hope that they saw and felt it.

Faith, hope and love abide, and the greatest of these is love.

Thank you for being somebody who loves us enough to follow along in our journey,

Wednesday, April 6, 2011

Heartache again…please soothe the pain, LORD.

This is what I can focus on…praying for comfort for those who suffer.  You know, for some reason (not well understood by me), I was made as a person who feels so much, so deeply.  This personality struggles to live so close to so much suffering.  And yet, I wonder about Christ.  He submitted himself to the center of the suffering, and some Scriptures convince me that he felt the experience deeply.  Just this morning I read, “You know the generous grace of our Lord Jesus Christ.  Though he was rich, yet for your sakes he became poor, so that by his poverty he could make you rich,” from II Corinthians.  And we know that he wept in the midst of the experience.
So, this is all leads up to a difficult case that I recently saw on Pediatrics.  I only learned some of the details later, but here it is.  This family waited 10 years to have a child.  Finally, he came; yes, it was a boy…what a precious reward according to this South Asian culture.  There is even a saying here, “If it’s late, it will be a boy,” meaning something like, “After the long wait, the reward will be great.”  So, their boy reaches 10-months of age.  He is pudgy and seemingly thriving.  But one day he gets a fever and a cough.  They wait a few days, get some medicines from the local medical hall, and wait again.  Finally, they decide that their precious son is not going to get well at home.  They find transportation to the mission hospital and arrive at our emergency room.  The child has a rapid respiratory rate, taking a breath more often than every second.  The fever is high and the lungs sound like it’s a case of pneumonia. Oxygen is given, an intravenous line is started, and antibiotics are begun.  Then the parents are told that the child will need to stay in the hospital for a little while; they can bring him to the ward.  This is where I meet the child.  But at the meeting, the child is not conscious.  Why is this child unconscious?  Nobody seems to be aware of exactly when he lost consciousness.  A quick check of oxygen level and blood sugar eliminate two possible causes.  The child’s temperature is noted to be 105 degrees.  We work at cooling this kid with medications and external cooling.  He isn’t waking, and his pupil reactions aren’t quite normal.  A head CT is not an option; that can only be found a one-hour car ride away.  We change medications, thinking that the infection may really be in the central nervous system (perhaps meningitis?).  It would be good to take some fluid from the spinal column to evaluate for this, but suddenly we notice one hand twitching…then the other…eventually all four limbs.  Now we have seizure activity, and it is not appearing to be simply related to fever.  We begin anti-seizure medications.  The response is for a brief period of time, but again the seizure activity begins.  After five doses and medication adjustments, the seizure activity is under control.  The fever subsides, the breathing gets easier (with good oxygenation), but still the child does not awaken.  Our next problem is the failure of the IV, and multiple attempts to replace it on this plump kid fail.  He needs that IV.  He has a brief awakening (I am told after I get back from a weekend away).  He is sent to the operating room where he will have a “cut-down” procedure to secure a good intravenous line.  During the preparation for the procedure, he has a respiratory-cardiac arrest.  CPR is performed.  He dies.  So many questions unanswered…was it encephalitis?  It was certainly incredible pain for the family.  And the cycle of suffering continues.  We pray for COMFORT for this family in their loss.  Oh Lord, I pray that they experienced LOVE at our hospital.

Above I mentioned the medical halls where the family got some medicine.  This is a predicament here.  Western medicine has definitely arrived.  Medicine can be found around every corner.  But training in the administration of such things is clearly lacking.  So often, patients arrive at the hospital having already tried a large variety of medicines from the medical hall, not necessarily in the proper doses and quite often mixed in combinations that are certainly ineffective, probably dangerous and occasionally downright harmful.  Dave, the anthropologist, thinks that medical halls may be replacing the witch doctors.  Their efficacy may not be much different.
Just recently, Dave reminded us all of a surgeon who worked in Tansen last year.  Just before she left she shared a story with us.  She had a young patient with cancer, and many were praying for the girl during her hospital stay.  The surgeon’s prayer had been that God would show His strength to this Hindu family through a miraculous healing.  The girl died.  The family went home.  The surgeon felt sadness.  Then just before her departure, she discovered that the family had turned to the God who is LOVE.  She was shocked.  Their response was that the LOVE they experienced at the hospital was something entirely different than anything they had experienced before.  It was their pathway to God.  PRAISE HIM…He always knows what He is doing.
Trust Him, Kimberly, trust Him…even in the pain.
Thanks for listening.