by Fenton and Pat Rees
It’s always good to BYOD, as in “Bring Your Own Doctor!”
Sometimes wearing sandals has a downside--like you get a sand flea (a/k/a jigger) under a toe nail. These were originally native to Central America but were spread to Africa and other places by early explorers and traders. No permanent damage, so it’s all good. And this is NOTHING to compared to some of the stuff that Pat sees at the hospital, as described below.
I’ve been on a bit of a “crusade” to try and get all electrical outlets properly grounded--so appliances with metal outsides (fridge, washing machine, medical machines) are safe to touch even if there is an electrical fault inside. Sometimes it seems a little bit like the anecdotal story about a man throwing starfish back into the water when the beach is littered with thousands of them. Even though it won’t help them all, it will help some. I was going through the latest house to be built (for a second ophthalmologist), and was fascinated to see that almost every outlet had a cell phone plugged into it, belonging to the masons, carpenters etc., working on the house. No more than five percent of the people in Burundi live in a house with electricity, but many have cell phones (go figure). As soon as workers arrive on site, they plug in their cell phones.
And now some words from Pat:
I have been uncharacteristically "quiet" on the email / Facebook front since I have been here in Kibuye. That is really a huge reflection on how difficult it has been to work here. I actually didn't think I was going to make it past the first 2 weeks when there were so many cases (especially the orthopedics) that I didn't know for sure how to handle. When I had worked here before, it was simply a small "bush hospital". Now that they have specialists in eye surgery, internal medicine, OB-gynecology, and pediatrics, the number of patients visiting the hospital is huge! Also, it is now a "referral center" which means other hospitals send their most difficult (sickest) patients here. The weekends can be especially hard, as their doctors may be going out of town, so they transfer many patients here for care. Also, just like in the USA, people tend to drink alcohol more on the weekends, and this results in many more injuries during Friday through Monday morning time frame. All my email efforts had previously been directed to asking questions of the surgeon who normally works here and is on furlough in the USA right now. I am still emailing him frequent questions, but I have a better understanding of how to care for some of the unique East Africa illnesses.
I have seen so many times over these last seven weeks where the Lord's hand has reached down and touched a patient. There are cases that my best surgical efforts and our best patient care could not explain how they have recovered from their illnesses.
Jerome is such a case. He is twenty-nine years old and was drinking before he rode his bicycle home. When he lost control of his bike, he fell in such a way that the handlebar tore the flesh from the right half of his chest, and broke apart several of the ribs from the sternum (breastbone). He was at another hospital for two days, and they transferred him to our hospital on a Friday evening. When I looked at his chest and watched the lung moving back and forth in the bottom of the wound, measured his oxygen saturation which was in the mid eighties(it should be above ninety-five percent) and saw how fast he was trying to breathe---he couldn't even speak--I knew he was in big trouble. Here we don't have anesthesiologists skilled at putting a tube in patients lungs and breathing for them. We also don't have any machines that would breathe for the patient after surgery. Even finding a chest tube set up to re-inflate this man's lung was going to be an effort. As we went to the operating room at almost 9 PM, I was praying that he would live through the case. I had already spoken to his petite wife, who had an infant child strapped to her back, and explained he might not survive the procedure.
Jerome's oxygen saturations only got worse as we gave him a little sedation, and anesthesia tried hard to get his saturations above seventy-five percent. It was like the patient could no longer mount the effort to breathe once he had some sedation. I was praying as I tried to find some muscle from the surrounding ribs to close over the gaping wound. I was able to eventually close the skin and put a chest tube in him, but not before we had the power go out (as it does normally about 10 PM). I was back to working with a small headlight while we had to wait the ten minutes for the local "electrician" to turn on the generator. I didn't expect Jerome to be alive the next morning, and told his wife this news. Much to my surprise, the next morning his oxygen saturations were ninety-five percent! He had lots more pain from my closing his ribs, but was alive. Over the next five days, he continued to do better and better, and was discharged home with a very thankful wife. Both the medical students and I were amazed, and told him over and over, that his recovery was not us, but obviously a work from God, as his chest and lung damage usually doesn't recover so rapidly or so well. He left saying he knew that God has spared his life and healed his body.
One of my biggest difficulties here was learning how to handle the disease called osteomyelitis. We have minimal of this disease in the USA and it usually comes in people with diabetes and chronic foot wounds. Here, it is an acute onset illness in the young children, especially those who are malnourished. There was one week where I had 5 admissions of these poor little kids, with huge draining pockets of pus on their thigh or legs, that is draining from a massively infected bone. Sometimes, I have had to go and drill holes in the bones to allow the pus to drain. Always, the wounds take weeks and weeks to heal with daily dressing changes. Sometimes, the bones are so weakened by the massive amount of infection, they actually break. One of my saddest cases was five year old David. His parents brought him from Tanzania for care. He had a high fever, his entire left hip, thigh and leg that were very swollen, and so painful. An x-ray showed that his hip was broken, his thigh bone infected, but his leg was not infected. I drained his pockets of pus, but a metal pin across his leg bone to allow me to put him in traction to try to bring his hip into right alignment, and put him on antibiotics. We also started him on something called Busoma. This is a grain porridge that was invented by one of the early surgeons here in Burundi, Dr. Frank Ogden, who lives in Everett now. Ogden figured out what products could be grown locally, developed a "plant" to roast and mix the grains, and when added with sugar and oil, becomes a high protein and high calorie supplement for the starving children.
Over the last five weeks, we have been feeding David as much Busoma as we can get in him. We have tended his wounds, watched his traction, and treated the malaria he has had twice. I have watched his traction set up and frequently would feel his hip area to see if things were "healing" and the pain decreasing. It was with great joy, that we were able to take David off of traction on Thursday and see that he could bend his hip without pain! What a miracle that he has healed that bone in the face of malnutrition and other illnesses. One thing remained and that is to remove the metal pin used to hold his leg in traction. Unfortunately, David's family could no longer afford the money to give David sedative medication to remove the pin. For the want of about four dollars, David endured the orthopoedic technician taking the drill and reversing the pin's course through his bone. The next day, when I found what had happened, it was a tearful little boy who indeed said his pain was only at the site of his pin removal. Sadly, it looks like he may also have developed a small infection in this site as well as having suffered the pain of the procedure. The choice of David's parents: between food for their child and having him suffer pain was difficult for them. (It is intolerable for me and I have started a fund to pay for sedation for any child with this problem. Care to add your coffee money to the fund?) I am continuing to pray that David's wounds heal and that he gains strength as he begins to walk on crutches on his weakened leg.
Fenton here again. Like I said before, my little toe deal was a complete “nothing burger” compared to the above.
Well that’s about all for now, Keep Praying,