Who says Africa can’t break your heart a second time?

Today was my third day at Evangel Hospital and it felt good to know the residents and interns a little. Today I got to truly be their attending staff. The morning started with two scheduled repeat C/S and I felt right at home in that role. I talked through the procedure with the first year resident and then he performed his 5th C/S under my tutelage and it went well. He told me he suffered from a lack of confidence and I reassured him that it was an appropriate feeling at this stage of his training and experience. We reviewed how to do an op note and he seemed to enjoy the experience. I also staffed another C/S which the third year resident did with a medical student from Switzerland who had been there for three months. We reviewed the in house patients and all was well. I left my comfort zone at the women’s ward and headed to the main operating room. Today was “fistula day” in the O.R. V.V.F. means vesicle vaginal fistula which may mean nothing to you. When a young women (a girl actually) who is barely through puberty becomes pregnant and tries to deliver a baby when your pelvic bones have not fully developed, the baby gets stuck in the birth canal, The baby eventually dies in labor and is stuck in the pelvis. The head puts pressure on the bladder or rectum or both. This pressure causes the blood supply to these organs to be cut off and the tissue dies and creates a connection between the bladder and the vagina or the rectum and the vagina or both. Eventually the baby passes or is removed by C/S but the young women now leaks urine or stool or both out of the vagina. Due to hygiene she becomes unable to live in her home or village and is often divorced by her husband. It is a medical condition with devastating social ramifications. Evangel Hospital has an extensive program for these women. The have a residence for them which then gives them access to counseling, job training, and medical and surgical care. The women may live there for months. Having a series of surgeries and counseling. Their families may visit but it creates a new community for these women and offers them hope and eventually their life back. I got to see two operations by a very competent Nigerian surgeon who was a family practice resident at the hospital who was trained to perform the repairs. He was patient in explaining the procedures and demonstrated some aspects of the surgery for me. The patients were young women and it seemed so unfair that medical care could not be available for these young women to prevent this tragedy.

As I left the O.R. I heard a child moaning softly and uttering a muffled cry. There on the gurney was a chubby one year old boy. Yesterday he was playing around the cooking fire and there was a pot of boiling water over the fire. He pulled the pot over and the boiling water inflicted scalding burns over his face chest and upper arms. He was whimpering as they applied cream to his burns where the skin had already peeled off. His eyes were blistered shut and he was trembling with pain. There is no burn unit, no peds I.C.U., and limited treatment options. There he was, alone with the nurse changing the dressings. I know the surgeon there is very good and he will do all he can to help this boy but it was overwhelming to see a baby in pain and not imagine his future. At the same time, a ten year old boy was brought to Faith Alive clinic after a motorcycle accident. He had an area of swelling on his head and was having seizures. He had “road rash” on his head and seemed to not be able to move his right side. The parents were desperate and brought him in to the emergency clinic. They gave him Valium to stop the seizures and told the parents he needed a hospital and told them to go to the teaching hospital. The parents left to find a car to drive him to the next facility. There is no ambulance service or EMT’s – just frantic parents and a hired car. It was too much to process. I shut down. I did my 4 P.M. resident lecture on postpartum hemorrhage and caught the bus back to the guest house. The house was dark (no electricity) and so I climbed to the gazebo where I had greeted the sunrise full of promise that morning. I gazed out toward the hills and over the trees. The breeze greeted me. I sat quietly and tried to make sense of a seemingly senseless world. Why did these things happen to children? How could the world let this continue? Did no one care? No easy answer came. My heart ached. I pray to God I will never forget and I vow to somehow make a difference.

I’m alone now. I am typing in the dark by my “doggy” night light. The electricity is still off as is the water. Annoyances that somehow seemed significant a couple of days ago don’t any longer. The day is ended and I will sleep. As I drift off I will pray for the children of the world and turn them over to the One who never sleeps but holds His creation in his hand and speaks love into the heart of every forgotten and broken child.

Larry Kieft

Larry with children at Gindiri

Larry with children at Gindiri

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