Sweet People

I can't believe that we are 1/2 way through the week already!  The days just keep checking on by! I keep reminding myself to enjoy and be present in each moment, because the time goes by so quickly.  Here is a little update on a few patients: There is a 17 year old girl here (she has been here as long as we have... she has sickle cell trait, and has extreme pain in her knee and hip... we are worried that she may have osteomyelitis, or arthritis... if that is the case... it is really sad... because she is so young... and that is usually a pretty degenerative and progressive disease for younger people... pray for her... her name is Natasha. Dr.Fuka did an ultrasound on her and thought it looked like arthritis...

Then I went around with Ginny to pray with the patients... I like doing that... since Ginny can talk to them in French/some Lingala I feel like more of a connection is made on a different level. There is a new little girl who was admitted yesterday who has severe malnutrition. She is 2 years old (looks like she is 1 years old) and her name is Virginia (pronounced Ver-geen-ee). She is so tiny... and so weak... hopefully she follows through with the treatment... usually the first week is the hardest because they don't like the formula they have to drink... until they have had it daily for about 7 days... then the children love it.  There are 4 little ones with malnutrition right now... so so sad... the usually what happens is that the mother gets pregnant before her youngest current child is weaned from the breast... then the child doesn't get proper nutrition... This little kids sometimes look like old people... they are so frail, they bald, they don't play at all... pray for these sweet little babies!

Later in the afternoon Olivia came from her house (3 mile bike ride) to help translate for me. We saw Virginia (the middle aged woman with burns on her leg). We did passive range of motion, and then I got her to stand, then we got her to walk about 30 feet! She is much stronger than she thinks she is... it is difficult however because the more she moves... the more her wounds bleed... and the more she is exposed to potential infection.. but the less she moves the more chance for contractures in her legs (not being able to move). Also, she is not getting enough nutrition... on the burn unit at home we pump the people up with calories because the body uses up so many calories to heal... here she is per scribed to eat at least 1 egg a day... for protein... that is not nearly enough... but there isn't enough money for her to buy more than that on top of the other food (which isn't much). Either way... she is working hard for me... even though I have to tease, and barter with her to be as active as I would like her to be! She has a great sense of humor... which is lost if you can't communicate fully... so I am thankful for Olivia!

Then Olivia went with me to see a woman in the post-partum ward who had had a baby a week ago... the woman was in labor for days... (her pelvis was too small to allow the baby to pass through the birth canal), and the baby died during the process, other people were pushing on her stomach to get the baby out... the baby finally came out... but the woman had a fistula (not exactly sure what that is), but it left her with "dead weight" legs. She can walk, but not well... and she has severe pain in her pelvis (no doubt!) Women here (especially in remote areas) are viewed as "weak" if they have to have a c-section... so they aren't taken to the hospital... they labor for days... the baby dies... and often the mother does too... unfortunately this situation is not uncommon here either... at least the woman is doing well... and her function in her legs will gradually come back... So I did some range of motion activities with here and talked about pain control, and walking safely.

We had a new member at our English class this week!  Mary Rose (a nurse here at the hospital who comes to English class) brought Paya on her bicycle!  It was the cutest thing!  He is the younger of the set of twins who are here being treated for malnutrition.  Thankfully he has completed his treatment and is doing fairly well now, but his brother, Kumo, is still on the malnutrition treatment schedule, and he has malaria. Side note: Paya means "second" and Kumo means "first" in Lingala... so the twins names are literally... Second, and First. :) This evening we made oatmeal raisin cookies and Ciska (the cook who cooks here for lunch each day) made bread... so we had fresh bread, cheese, and pineapple for dinner... and cookies for dessert while we played cards! We didn't finish the game because we got tired... :)

I'll have to tell you more about my Monday evening too... Sarah (who I haven't written about yet) took me with her on a walk through the village to see on of her friends who is home bound with club feet. It was amazing... to walk through the village and truly see how the people live. It is a gift to be able to experience such a different reality.

Fun Fact #8: There are highways here in Impfondo... but not like the highways we are used to driving on... I like to call them ant highways.  We have all seen a trail of ants before... you know on a picnic, or in the summer if you leave something out on the counter overnight.  Here there are HIGHWAYS and intersections, and off /on ramps... it is incredible! They follow the same paths along the walls in our house (and in the hospital buildings too!). The intersections are fascinating to watch... they are seriously like round-a-bouts... where about four highways intersect together; you would think that would be traffic jams, but everyone seems to know exactly where to go!  Maybe we should have ants teach drivers ed...

Time

** I uploaded more pictures so scroll down to see them!!**

Monday: It is interesting here because life is simpler... I don't have to think about driving, schedules, appointments... but at the same time... it is more complicated because "normal" is so different.  I am reminded more and more that it is not my time during the day... it's God's time.  After morning report I usually write a list of things I would like to accomplish for the day, and I think... "how am I going to do this... with out a translator, without this evaluation tool, etc." But at the end of the day... I look at my list... and it is complete!  It doesn't just happen without effort on my part (although that would be nice at times!) but there is reward in committing my attitude to be positive, to be open, to be flexible, to be willing to adapt, to listen to the urgings of the holy spirit as the day develops.  This environment really makes it clear... it's not my time... it's God's... and I find true freedom in that and I pray to take that continual recognition home!

So today, my friend Mr. Perrone the 71 year old gentleman, who came in last Thursday 3 days post having a stroke leaving the left side of his body immobile, went "home" today.  We worked on range of motion exercises together for his shoulder, elbow, wrist, hand, hip, knee, and foot.  It was very encouraging because today I observed him complete his exercises independently, eat independently, and transfer with good body awareness... he even took a few steps using a walker!  His left arm function has increased significantly which is encouraging!  Function is livelihood here... his effort is great... and because of that I am sure he will continue to progress in is functional ability, and adaptability to the permanent loss of function.

He has no family nearby (remember it took him 3 days to get to the hospital!), and there is a family friend who accompanied him to the hospital and his taking care of him... but the family friend must return to work or he will lose his job... so it was decided that Mr.Perrone was doing well with his rehab and understood what should be done to continue progressing when he returned home.  I would have liked to work with him a little longer, but things are different here!  

This man also reminds me that our human emotions are the same no matter what language we speak, or what country we are from... he told me that it is difficult to accept this change in his body... I can't imagine... he is a very fit 71 year old man! I hope you can see his muscles in the picture I hope to post!  Continue to think of him as he makes the long journey home, and the changes that he will have to adjust to upon returning to "normal" life at home.

Fun Fact #7: I help Ginny teach an English class on Monday and Thursdays... today we talked about the weather.  It is funny to talk about weather with a group of people who really only experience HOT and HUMID and sometimes rainy weather... we talked about snow... I drew a picture on the chalk board... and they all said..."It....is...star...outsieed..too-dee."  They thought my picture was of stars... explaining snow is fun!  So I drew a picture of a snowman... Then they got it!  

End of the Week

Thursday night a baby was born, and Sean being on-call he was called for the delivery.  He called the head maternity nurse since he hasn't seen a delivery completed here. So he observed (from 11:40 pm-3:40 am) so he was tired yesterday!

The day began with the morning meeting - Monday through Friday the day begins at 7:00 am in the administration building: all the hospital workers and staff are there (grounds keepers, guards, maintenance, nurses, techs. There we sing praise songs (in French) and then read about a chapter in the Bible (in French... good thing I have my English Bible) 

After the Bible lesson, morning report begins (the time where the night nurses give updates on the patients). After morning report rounds usually begin (Formal rounds are on Monday, Wednesday, Friday, but Sean rounds on his own on Tuesday and Thursday).  So we did formal rounds... it is good to see all the patients and talk about what is to be done that day.

Sad news on the patient who came on Thursday night (the 19 year old girl in sever pain after the D and C at another clinic). She passed away in the night. She was septic and wouldn't have survived surgery. We heard wailing around 9:00 pm and hoped that a baby was being born, but it was the girls family mourning her death. It isn

't fair, but at least she was brought to a place wher

e people were praying for her, and where she could be made a little more comfortable

In the afternoon I was called to the BLOC (where the OR is) to the recovery room to do the dressing change of little Eda (the 5 year old little girl with hand burns).  "E-boyee! E-boyee!" (I refuse! I refuse!) The left hand looked better, but the right still has some eschar (dead skin) that is difficult to debried off without a whirlpool, certain topical, and more pain medication! I tried to describe a whirlpool bath... but the message didn't get across... I'll have to get someone to translate for me on Monday!

She isn't using her her hands much... but the edema (swelling) looks better.  It is difficult to promote hand use here with here: 1. because she isn't on any pain medication, so she doesn't want to move at all, and 2. because there is no such thing as a burn unit... infection and bacteria are everywhere... so the more stuff she touches the higher risk of infection. Her range of motion looks good with her dressings off though... I just wish I had some splinting material to make some palmar extension splints.  (Thanks Laura and Susan for showing me that... that was the last splint I made on my burn rotation!) Who knows... if she needs it maybe I'll jimmy rig some splint with the Velcro and fishing line I brought.  They keep asking me what I think about the 2 burn patients here... YIKES!  I have been doing more reading... I don't want to say the wrong thing! 

Enoch (the little boy in traction) is still enjoying his balloon... he likes to hit it hard and let it bounce back and hit his mommy.  Little boys are so funny.  He said something funny to his mom yesterday... and she told us during rounds.... "Tell those Chinese to get me out of this thing!"  So he thinks Sean and I are Chinese!  We all got a great laugh out of that. 

The Stroke patient who was admitted, I saw him as well. Oliva (my Lingala translator, Dr. Harvey's daughter) came and helped me out.  He is 71 years old and I believed suffered a right CVA, leaving his left side somewhat paralyzed. He has decent function in his hand, but no wrist, elbow, or shoulder voluntary movement.  We went through some passive range of motion exercises, together, and we talked about working on dressing, and transferring (from bed to chair, from sit-to lay).  There was another man with him, who was not very helpful... he was basically repeating everything I was saying, only in a forceful tone.  My patient said that the other man was hurting his feelings... and he was frustrated that this happened to him... it is not easy getting older on whatever Continent you live on! 

Sean and I rode our bikes to a nearby (1 1/2 miles away) pharmacy to buy some medicine for the 6 month old boy named Prince with meningitis.  It is awesome to ride our bikes through the village... children saying "hello!" or "mundella!" (white person).  We can see the Congo River right off the road... it is dry season now so it is fairly low, but there are still plenty of people in carved out wooden canoes. Just across the river is the rain forest of the DRC. 

Why the Pharmacy visit? Well, here if the hospital doesn't have the drug in stock, they write a "prescription" for the drug, and then the family has to go out of the hospital grounds to a pharmacy in town to buy the medicine, and bring it back to the hospital to be given to the patient.  This little guys' father is not around, and his mother doesn't have any money, if he doesn't get this medicine, his status will get much worse... so for about $12 American dollars, we can get him through the weekend. 

In the evening we made pizza for a "kid party" we had last night.  The Harvey kids: Olivia, Claire, Isabelle, Noah, and 2 of their missionary kid friends who are staying with them came over for pizza, cookies, and a movie.  We had a good time.  We baked the pizza's and the cookies in an outdoor oven (we'll have to show you a picture!) It was all delicious... we are not going hungry here!  

We watch "Night at the Museum." Sean had to leave us for a bit because a new patient came in... a woman in her 20's with abdominal pain.  He and the nurses got her stable, consulted Dr.Fuka (surgeon) and decided she wouldn't need surgery yet.   Thankfully Sean wasn't woken in the night and got a full nights sleep! 

Fun Fact #6: There are little conversations that happen in the blue house: I think there are bats, lizzards, and mice that live in the walls and ceiling of the house. Every now and then you here a "thump, tap, thump, tap, thump, tap" that sounds like a lizzard crawling on the ceiling (the first night we were here, I thought it was someone climbing on the roof!)  Another sound are mouse arguments... a high pitched "squable, squable, sweek, seek, heck, keck, keck" replied by another "squable, squable, sweek, sweek, heck, keck, keck!"  And at night time, you can hear the bats wake up and "swooop" out of the hole in the overhang of the roof.  (the first night I thought this sound was someone breaking in the house!)  

So needless to say... lots of sounds... but we are more comfortable with them now! 

Busy Day

Thursday Rounds: It was a very busy day today... I went on rounds with Sean this morning... it was fun, we saw every patient in the hospital (23 right now). Not all needed much attention other than just to be "checked" up on on. There were 4 nurses walking around with us... they are all so very helpful. Julian (a big guy, who also helps out in the OR) speaks English pretty well, so between Sean's French, and mixing in some English, we get the job done. I am sure it will gradually get better.
After we finished rounding I went with Julian to take Mama Virginia (ver-gin-ee) to the OR to have her dressings changed. Mama Virginia is the woman who was burned before Christmas while lighting her oil lamp and it caught her skirt on fire. So I saw her wounds open today... YIKES! The entire back side of her right leg is raw from her mid-calf to her mid-buttocks. I took some pictures. She was in such pain as they were debreeding her wounds... I held her hand, hummed, and patted her back... She did very well... I can't imagine... the only pain medication she is on is Ibprofen. At home we give morphine, or dilodid which is much stronger.

After her, we changed the dressings of a little girl (about 5 years old) named Eda. She has bilateral hand burns on the palms of her hands. They are pretty deep on the "meat" part of her palms below her thumbs. I did her dressing yesterday... I wish I could have again today, but instead I just helped hold her down... poor thing... again... I don't think she had ANY pain meds before the change. And the whole time she was crying "e-boyee...e-boyee" which in Lingala means "I refuse! I refuse!" Afterwards she still let me play with her and tickle her... so I think we are still friends despite her efforts to kick us as we were doing the dressing change! Such a strong little girl... and such a strong mommy who was with her the whole time.

Then I found Sean walking to the isolation room where a pediatric patient (a 6 month old little boy named Prince) is with Meningitis. They started an IV on him so they only had to administer the drugs he needs once a day opposed to giving him a shot 2 times a day. Much less pain and hassle for everyone! So as they started the line I was distracting him with an orange balloon... talking to him and "occupying" him... I am an occupational therapist I guess! :) I find it interesting because the mothers at time do not seem to be interested in what is going on, but as soon as I put my hand on her leg, shook my head, and smiled, she smiled back. That is what makes me wish I could have a full conversation... but I am learning new ways of conversing... which sometimes can be more challanging and out of our comfort zones through body language, it is more vunerable than just words.

We then had lunch - fish, rice, papaya, fried plantanes, and cabbage salad. After lunch I took a little rest and then headed out to the pediatric ward to see my little friend Enoch, the 2 1/2 year old who's leg is in traction. I took some pictures of it today... hopefully I can upload soon! It's quite the contraption. I went by myself... I figured tying a balloon with fishing line above his bed was self explanitory! He LOVED it! Hopefully he continues to like it. I thought I could gradually add somemore things, and teach mom some more games since he has only been in it for a week, and he still has 2 more weeks to go! (turns out he is in traction for a total of 4 weeks, then a cast after that.... I was afraid it was traction for 6 weeks... thank goodness it's not!)  It was fun to play with him though... I think he is getting more used to me.... he really loved the balloon... at first it was scarry (I don't know if he knew what it was)... but once he saw it "bounce" when he hit it... oh man... it was the BEST! :)
Before leaving the pediatric ward I tried out my newest Lingala phrase... Tikay la malamu (may you stay well). It is basically a nice thing to stay when you say goodbye. They all were impressed and laughed in praise at my efforts. It feels good to make connections, even if they are small. :)

After going back to the blue house for some water... Sean came to find me and said Dr. Joe had a patient for me... an older man who had a stroke 3 days ago leaving his left side flaccid (floppy/ paralyzed). So since I am here Dr. Joe admitted him... otherwise they would just send him home. So I will be working with him for a week on transfers, and using his left hand and leg as an assist for functional activities like dressing, eating, toileting ect. It'll be interesting! Oh... and it took him 3 days to get to the hospital... can you imagine... 3 days to get to an emergency room?

Shortly after that, some people brought a 19 year old girl named Josephine, to the ER in a wheel barrow (a normal form of transporting patients to the hospital here). She had been ill since new years day, went to a clinic a few days ago, thought she was pregnant, took a pregnancy test, it was negative, but they still did a DNC (cleaning out her uterus), and maybe poked through something they shouldn't have because, Sean, Dr. Joe, and Dr. Fuka, determined that she is septic and basically came alert with a lot of pain, and now is somewhat comatose... pray for her... hopefully she makes it.

Dr. Joe was telling us that this is unfortunately not that uncommon... someone goes to a "church" or a government run clinic and they "treat" the patients, and as soon as the patient turns for the worse (basically is dying) they refer the patient to the Pioneer Christian Hospital (this hospital), or they call it the "American" hospital even though the majority of people here running it are Congolese, and Canadian. :) So sad... she is too young... but it happens a lot.

Tonight is Sean's first night of being on-call... he will be all this week until next Thursday night. YIKES! We'll see what happens... so he is the first one to be called if a doctor is needed. I am proud of him... he is doing very well.

Well... I guess that is enough for now... it is amazing how tired we get! Sean is asleep on the love-seat right now... so I guess it is time for bed!

The Hospital Grounds

Since we have been here for over a week now... I guess it would be good to describe the hospital grounds so you can get a picture of what it is like... Hopefully pictures can be loaded soon so you can see it!

If you read from our second post about the hospital grounds here is a further description. The hospital was originally designed to be a communist youth camp. So all the buildings and the wall surrounding the grounds were pre-existing, but were rehabilitated to suit the needs of a hospital in Congo.There are several different buildings. Each department is in its own separate building that serves as that area of medicines “ward” (Medicine female, medicine male, peds, maternity, surgical female, surgical male, Emergency, post-partum). Each building has about 6 or 7 beds, electricity, cable's installed high on the walls so IV's and mosquito nets can be hung, and a wash bin with soap on a rope to wash your hands. (little different than at home!)

The operating room (OR) is also in a separate building and has 3 operating suites. There is also a building with a lab, pharmacy, and xray (not currently working), an administrative building and a chapel. The property is beautiful. The buildings are well spread out with grass, flowers and trees between (as well as many lizards, geckos, birds and donkeys). There is also a soccer field!

During the day as we walk around you see patients and their families outside under the trees, washing clothes, sleeping in the shade, making food by fire (they make their own food here, there is no such thing as "hospital" food).  There are often children running around following their mothers or older siblings carrying and playing whatever they can get their hands on... sticks, avocado nuts, bottle caps, expired batteries, water bottles... they are so precious... I

 think they are more used to us walking around, because now when I say Mbote (hello in Lingala) and hold out my hand, most of the little ones shake my hand back... before they would just stare at the Mundella (White person).  
There are two doctors regularly here. Dr. Joe Harvey is an American physician trained in family medicine and Dr. Fuka is from the Democratic Republic of Congo and is trained in general surgery.

We live in the “blue house,” Which is a blue house on the edge of the hospital grounds. It’s great, we have a room with a mosquito net (we sleep under it every night), a kitchen, bathroom, dining room, and sitting area. Suzy who lives at the blue house as well has her own bed and

 bathroom. At night time the Internet works especially well since no one else is using it! It’s a great place to stay… it also makes it easy to access the hospital since we are just a 2 minute walk away from the OR or the wards! We hope to upload some pictures because they will obviously tell the story much better than we can.  

Fun Fact #5: We have some functional art hanging in our house... it is an entire "stalk" of bananas (around 50 bananas)  hanging on a bungee cord from the ceiling. Jean-Pierre cut them down from a banana tree here on the grounds, they were green at the time, but now the bottom ones are beginning yellow... we had a few tonight for dinner... they were delicious! So sweet! So not only do the banana's taste good... they also look cool hanging in the dining room!

Awake for Surgery

Yesterday I took some pictures and observed an abdominal surgery on a young woman with abdominal pain. Sean assisted Dr. Fuka throughout the surgery. I love that I find it fascinating, I truly appreciate the skills and knowledge that each individual has… it was amazing to see her appendix removed by Sean and Dr.Fuka! They also drained a cyst on one of her ovaries.

 When I first arrived they had already begun the surgery. As I was taking pictures I couldn’t see the patients face… and then I saw her hand move and gesture towards one of the OR nurses… “Yikes!” I thought, "she's not all they way asleep"… then the nurse asked me to come over there… the patient wanted her picture taken. So it was a little weird taking the picture of a ½ smiling patient while her intestines were being inspected of any abnormalities! They used spinal anesthesia (like we use in a C-section).

I did like that she was awake… because even though we couldn’t REALLY talk to each other because of the language barrier, between the nurses who know some English, and my limited Lingala, I got to know her a little. I held her hand for a while… and she kept asking, “finished?”… She was sweet… Mary Rose the OR nurse asked her if she was a Christian… she said she was Muslim. Either way I still prayed for her as I held her hand… that her heart would be touched by God through all the hands touching her at that moment. It is such an honor to be here, and to be here with Sean.

Hopefully we can upload some more pictures soon... the internet hasn't loaded them recently.  We'll keep trying!

Cool Breeze

Thank you for sending the COOL BREEZE our way!  On Saturday night the sky was teasing us with lightning and thunder... would rain come? After running over to the administration building with Suzy to turn off the Internet (it got hit by lightning last year and it took  about 4 months to fix) we had dinner at Ginny and Jean-Pierre's house on the other side of the compound.  

We enjoyed fresh baked bread from the outdoor stove, fried plantains, fresh spinach from their garden, and homemade pineapple jam, and cheese. We played quite the game of "wizard" and then Indian (2 new card games we have learned... very fun!)  We headed home, and hit the sack starting to feel a slight breeze coming through our mosquito net... would there be rain?

And the RAIN CAME pouring down around 4:00 am... it was fantastic... I love to sleep to thunderstorms... The cool air stayed all through Sunday allowing us to enjoy a nice walk around the grounds (we estimate it is at least a 1/2 mile to walk the perimeter), play some Uno, read up on some info on patients, and take a truck ride 3 miles to the Harvey's house for signing and pop corn... ALL WITHOUT BREAKING MUCH OF A SWEAT!  

Even though we expect it to be very hot every day... it was nice to have a day with a nice breeze, so thank you for sending it our way!

Fun Fact #4: I have observed on numerous occasions the art of nose picking at home: you know, someone who is sitting in the car behind you at the stoplight thinking "no one can see me," as they continue to dig for gold, and yet... you say... "ha ha... oh yes I can!"  Well, I have noticed here that nose picking is something to be shared with others, not in secrecy.  While on rounds some patients and family members of patent's have displayed their skills, and they are very thorough... I am sure you are all very glad I "picked" that to share with you!