Malaria and Leprosy

Not every day do you get to care for people with these two conditions, and I would beg your prayers for healing for these two patients.

The first lady is the same lady from previous posts who had the thyroidectomy - my "not a witch, not a wizard" lady. She's got malaria really, really badly right now. We had a couple of interesting shifts with her as she cycled through the stages of malaria- peaking in some horrible moments of fever (106.5!!!) hypertension, tachycardia, full body rigor, incoherence. So our medical crew quickly pulls out all the available "welcome to tropical medicine" books onboard and pour through them rapidly to figure this one out. Oh the joys of pouring in fun drugs into somebody without the backup safety of IV pumps - yup, we're calculating gravity drip rates! (My nursing friends are cringing right now.) Any drug that comes with the warning "infuse with caution, patient should be on telemetry as Quinine bolus infusion can cause QT prolongation and develop into Torsades de Pointe"- should start by being on a pump! (that's a lethal, shockable rhythm, by the way.) And then teaching your fellow crewmates what QT prolongation looks like so they can spot it during the night. We all know what to do with the torsades- yell for help!  The conversations get interesting at that point. One of the docs onboard posed the question - "so do you have any diazepam or dilantin should she seize during the night?" Supplies are always interesting onboard and you're never quite sure what you have. Although our pharmacy is literally the best stocked in Sierra Leone- one tiny room.

Another chap came to us having just gotten over his leprosy, but I can truly say i'd never seen what that can do to a person before. Yes, the missing digits, shrivelled hands and feet, but this poor fella also has a terrible pressure ulcer on the side of his left foot from having spent months in a bed and nobody turning him. His foot also then curled inwards, so now he walks on that side of his foot - so we got him a pair of crutches and he gets around not walking on that wound, but man! Talk about eye-opening! He's also tested negative for the leprosy since, for which I was glad 'cause or else we wouldn't have been able to bring him onboard - no way to isolate as effectively as needed. We do have two isolation rooms that are currently in use. He's actually here for hernia surgery, and we're treating his wound, and he's getting a cataract operation afterwards. I think he's done quite well by us! :-) 

  Now, I've been a nurse for 9 years now and have seen quite a bit, but this one was completely new. You kind of lean on your expertise to deal with current situations (experience) and I had zero point of reference on leprosy. And this is completely wicked but all I could think of was leprosy in the Bible and wondered if I should stand around the bed yelling "unclean! unclean!" and wow, I can't believe I just admitted that and I'm giggling as I'm writing it, but it is what crossed my mind :-) (and no, I wouldn't do it!! :-)

and I can't get away

"You hem me in - behind and before;
  you have laid your hand upon me.
Such knowledge is too wonderful for me,
  too lofty for me to attain.

Where can I go from your Spirit?
  Where can I flee from your presence?
If I go up to the heavens, you are there;
  if I make my bed in the depths, you are there.
If I rise on the wings of the dawn,
  if I settle on the far side of the sea,
even there your hand will guide me,
  your right hand will hold me fast."

Psalm 139:7-10, italics mine.

I've found Paradise, it's called Bureh Beach

Swaying palm trees, cute little kids running around, crashing waves, lagoons, rivers, falling coconuts, canoes, playing in the waves with friends. Lovely!

This little girl ran after us yelling "Pady, Pady, popo me!" "friend, friend put me on your back!"

Andrew and Juan with the local kids.

Ironic, I'd say. Down with Man U. Long live Chelsea! Brendon, this one's for you!

Taxi driver with good taste.

Not a witch, not a wizard

   Our lady that I wrote about in my last post, the lady who had her thyroidectomy (ok, huge lump on her throat removed), yesterday the doc was doing rounds and she took our hands, and through a translator and with the biggest grin on her face she said, "At home they called me a witch, they called me a wizard, they said I was cursed and called me all sorts of hurtful names. Now I go back and I am beautiful. You have taken me from shame and disgrace to joy and God will bless you."

   Next lady, who also had a lipoma on her arm (huge, random growth) that we removed, went through the same routine. Both of them speak Temne, but you understand their smiles. "I am no longer called witch, I am no longer wizard."

  Tell me that's not worth coming here for. To God be the glory. There are few surpassed joys that I've had than yesterday being able to look at these ladies and tell them that God has not forgotten them.

Lumps, Bumps and a legitimate Lord

I have been remiss in writing! I must say that inspiration had flagged a bit and couldn't think of putting into words some of the stuff that I've seen, but you're just gonna have to put up with my fumbling through this one.

Ten years ago there was a bloody civil war that swept through Sierra Leone where rebel soldiers literally cut a swath through the countryside, chopping hands, arms or limbs off to induce terror or for the sheer heck of it, murdering, raping, you name it. The diamond fields were used to fund most of the munitions (watch Blood Diamond for a point of reference). The history is seared into the memories of the people here, where those who could escaped into Freetown that was largely spared from active turmoil. Millions of people poured into a city with the infrastructure designed for a couple hundred thousand. (Thus the mess outside.)

So picture the problem outside our door. Or, rather off our dock :-) Still no infrastructure, i.e., some rather dilapidated, overrun hospitals that won't touch you if you don't have money and can't pay up front, but your arm has just been shattered because it was fired upon on close range. Or you have any of the many diseases that plague any other place in the world with nowhere to take the problem to. Then this enormous white ship sails up one day, and announcements go out over the radio that this miracle ship can fix your legs, or your baby's cleft palate, or your facial deformity.

The thing that is just so deceptive about the evil one... grrr. I could just spit. If you have a physical deformity, here it is a sign that you are cursed and are evil. Therefore, babies with cleft lips are thrown out to die or cleft palates, if you have a goiter (lack of iodine in your diet so your thyroid, a gland on the front of your neck, gets enlarged to the size of a mango). Many, many a patient comes to the ship - mothers who have been thrown out of their families and divorced because they had a baby with a cleft lip/palate. The mom wouldn't abandon the "demon child" and been pitched out.

 People with lipomas are marked as cursed as well. If you have this odd growth on the side of your face or arm are ostrasized universally, thrown out of their families, if you own a shop to make a living, people will not buy from you for fear of being cursed as well. You can imagine how belief like this take root in a society where there is no medical resource and no idea how these odd lumps and bumps spread or occur, so it's just very sad and all these beliefs are perpetrated. The most wretched I still believe is the myth that sex with a virgin will cure your AIDS/HIV, so rape of babies in South Africa is a big problem. Grrrrr. But that's South Africa and I'd better not ever write about it - I'd never shut up. But I digress...

   So I had the honor of taking care of three such special patients this week that come to mind. One is a lovely lady, she speaks only Temne so there was a major communication barrier. I have a working defensible understanding of Krio and can sometimes make myself to be understood, but Temne sounds like Klingon to me and no such luck there. (Although we do come in peace :-)  heehee....
But I digress..

   This lady has a goiter, lump the size of a large mango on the front of her neck. We had to check preoperatively to see if she was pregnant (standard procedure for women between certain ages) but she told us flat out - no contact with a man since her husband left her because of this deforming lump on her throat. A few hours later she's back on the ward, flat neck, small dressing on her throat. Awesome! and thanks to Dr. Blair's fabulous hemi-thyroidectomy technique, she'll probably go home and be able to be with her children again. We hear this happens a lot - so they go back and can reintegrate into society, and have a story to tell.

Another gentleman about 40 years of age was sitting on his bed doing bead work, using his toes to secure one end of the thread and threading it in complicated little patterns with shiny beads, and I wondered what was up with his arm because it was curled right under him, deformed as if he was born with it or had had polio - so I just asked. He raised his shirt sleeve and proceeded to pull his bone around from where it should have been in a stationary position. When I asked what happened, I was told flat out the rebels shot it at close range, shattering the bone and since there was nowhere to go with the problem it just healed in place. He was lucky to survive really, and you can imagine the suffering the poor man went through in the healing process. Now, this was ten years ago - you can imagine how long you suffer with these injuries.

Another kid we took care of this week had an eye in not so good a shape. You could see it was shut and a bit shrivelled, and he is blind through it, but causing him intense pain. He is 21 and I read on his H&P exactly what happened. When the rebels came through his village, he was running through the forest to escape and a stick pierced him in the eye. He's been in pain every day since. Until yesterday, when Lord Ian McColl (yes, he's an English lord, how cool is that?) fixed it for him. The eye had to go of course, but he replaced it with this thingie (ok, can you tell I don't do eyes) that looks like a plastic eye sheath, which Lord Ian said will hold the shape of the eye socket in place, and then when he returns from England in a few month's time he can replace it with a glass eye. Cool, huh? So this poor kid who'se been in pain since he was 10 years old gets to go home today.

Now isn't that just lovely?

Sal y Amor / Salt & Love

  I'm submitting for your enjoyment the movie some friends and I made this past week to submit it to the Africa Mercy International Film Festival. We won the award for best drama :-) It had to have 5 people or less, a bottle cap, and the phrase "It's a trap!"

I'm not sure what program it will play with, let me know if it does or doesn't play. (I can post but not view video onboard. )

I don't know if the subtitles are on or not, go with it.... it's in italian and spanish :-)

Further quirks and vagaries of patient education

  The m/v Africa Mercy has day volunteers who staff our units as translators, help clean the wards and when time allows, patient education on varoius topics such as handwashing, teeth brushing, malaria prevention, breaking the cycle of food contamination, etc. They have applied for the position through their local churches and come with recommendations from their pastors and are generally a blessing and a a bit of a stress to work with for reasons of various cultural differences.

   So I came across a day volunteer who had taken the good initiative to grab the patient teaching folders that hang on the walls of the ward, and he was teaching on diarrhea. Good for him, showing this self-motivation. This was a  ward of about 10 post-operative (male) hernia patients who seemed to be attentively listening and commenting at appropriate intervals; the teaching was in Krio, so there I had a bit of an idea as to what was going on, but not much.

   I went about my business to return to 10 glazed-over expressions and patients in various states of unconsciousness - so I peeked at the day worker's papers to see what topic he had decided to cover next: breastfeeding! Somehow he thought it necessary to teach 10 men about how to breast feed and when to introduce food to "your tiny new baby"?!?!?!  Going through the motions of breastfeeding and all :-)

   What a laugh :-)