Saturday, July 11, 2009

"I am the vine, you are the branches"

Yesterday was my day at Evangel hospital. I guess I should give some background about why I went. Another intern here, Mark, has been interning with me at Back2Back but has been spending the last couple weeks in Evangel watching and occasionally helping as he is in his second year of medical school. For half of my undergrad, I pursued nursing and was close to having all my prerequisites done when my heart tugged for social work (short version of the story). After I finish my social work degree next May, I'm still interested in possibly doing the accelerated nursing program at community college mainly for the ability to take that into any city or country. So Mark asked if I would be able to tag along too for the day, and next thing I know I'm leaving at 7am for a full day at the hospital.

I had toured Evangel a week or so ago very briefly, so I was already slightly familiar with Evangel. We began in the doctor/resident meeting (as they start with every single morning). There are a couple actual doctors but most of them are all residents and chief residents (residents that opted for an extra year, very respectable position). It’s basically an update on the new patients that came in since the last day as well as any mortalities that happened overnight. A good portion of the patients are drawn from RTA’s or road transportation accidents. Since everyone pretty much rides motorcycles everywhere (they are taxis), there are TONS of motorcycle accidents. Lots of broken leg bones from RTA's. Other new patients included those with ovarian problems, cerebral malaria… to mention a few. A couple babies died last night--one of heart failure and another resulting in poorly developed lungs. Today I learned that Nigeria has the highest infant mortality rate (1 in 7 die) and highest maternal mortality (1 in 10 pregnant women die) rate in the world. That’s incredible for me to fathom, as I flashback to my Intro to Soc. class where we were handed packets with information on every single country in the world and their mortality rates, economic status, industrialization, etc. So in the meeting I listened to all 20 or so in the room talk about each case. One woman in particular they spent about 20 minutes brainstorming how in the world she has an ovary in the wrong place in her body. It was really neat for me to see the teamwork and deep patient interest in the hospital.

The first part of the day we went into the neonatal intensive care unit (NICU) where four teeny, tiny 3-lb. babies were—each in their own little fish tank-sized incubator with oxygen and IVs. I’ve never seen babies that small before up close, it left me awestruck seeing their short, quick little breaths. It truly is amazing that God is able to sustain such tiny and intricate babies. And it’s equally incredible that they have the ability to be our size one day.

Next we followed a few doctors/residents on their rounds. We went into the maternity ward, where most of the five women who had just been in labor the day before, now had five very healthy babies. "You are welcome" is the resounding phrase heard in the room, encouraging us to enter. One of the residents handed me a bundle just under a day old—sooo precious and amazing. I told all of the women that their babies were very beautiful and it was apparent they were very proud of their babies. The mother to baby bond is so beautiful. I think I’m much more appreciative of the victory that both mother and child are living and healthy. I'm left in awe of the fact that women here go through so much pain in birthing, the aftermath of birthing, and knowingly chance the alarming mortality rate for the sake of life.

There are mostly wards containing 15 or so patients per room at Evangel, and there are a few private and semi-private rooms but are more costly. One patient in a private room we visited was an older woman who had been having chronic diarrhea. Nigeria also has a super low life expectancy, so the fact that she looked well over 80 was in itself amazing. She evidently has cancer in multiple places (can’t remember which) and her family has chosen not to tell her so that she may die in less fear and worry. I hear that it's a common and respectable thing to do to protect the emotional wellness of the elder.

The woman in the next private room I heard had a hysterectomy (I did not go in) and had her uterus was lying in a bedpan beside her—yep, serious. Unfortunately, it is not uncommon for “phantom surgeries” to occur where a woman goes to a hospital and is told that she has received a surgery, but instead the doctors just make an incision and stitch it back up and tell them that it’s taken care of. So the uterus in the bedpan is pretty much proof that the operation happened. The woman is also HIV+ so it’s strange to me that her bloody uterus would be just lying next to her in her room.

In one larger room, we visited a couple women whose C-sections were stitched up a day prior. Both women lost their babies during labor but still needed to stay for rountine check-up on the healing. Keep in mind that all wound cleaning, wiping, etc. is done without any anesthetic so a lot of screams and mourns are heard all the while.

An OB/GYN doctor that is here from Fort Collins, Colorado, super sweet guy… walked Mark and I to a ministry called Faith Alive a few blocks over. Faith Alive is a hospital, laboratory, school, and counseling center for HIV+/AIDS victims. Once we arrived we met a few others from their group (all from Colorado) then followed a Nigerian counselor, Simon, to his office for an opportunity to sit-in on any HIV therapy sessions. I was super excited about potential counseling and therapy for the sake of great social work experience, especially because I have been interested in HIV/AIDS awareness since I was a kid.

Simon's open hours are from 9am-4pm and yesterday he had 3 patients… all day. So the odds were stacked up against us at the start. A husband and wife came briefly, they had been both living with HIV for three years and had to come in for a routine CD4 count (amount of T-cells your body still has). Another man also came in for a CD4 count a bit later. He is a first year medical student and just found out that he is HIV+. He comes from a reputable family and travelled 8 hours to Faith Alive just to avoid anyone finding out about it. In order for patients to start counseling at Faith Alive, they have to confide in someone, either a close friend or family, that they are HIV+. So he won’t start until he decides to tell someone. He is afraid that because of his family’s status and the stigma of HIV/AIDS that he will be shunned from his family. Simon said that they have seen over 5,000 patients living with HIV since the start of Faith Alive. The time spent there mainly included Simon answering my million questions about the entire counseling process and their resources provided. He also let me read through the educational information they use to train their staff on HIV/AIDS. The myths about HIV/AIDS are absolutely crazy--it’s not uncommon for many villages to believe that the way to cure the disease is to sleep with a virgin.

Faith Alive’s primary mission is to promote healthy and productive living while having the disease. They discourage finding the source of the disease as all it usually accomplishes is blame shifting, many times blaming the wrong individuals or circumstances. Instead, they promote healthy diets, counseling for coming to terms with the disease, and a variety of vocational training to allow them to be productive members of society (cosmetology, computers, seamstressing, etc.). So after Mark and I had been sitting with Simon for over an hour we decided to head back to Evangel as no patients were coming in for therapy.

We changed into scrubs and went right into surgery. (The operation room is about three feet to the right after walking in the front door, it is literally possible for anyone to enter.) I think my “picture of the day” was probably the first thing that my eyes saw after entering the OR. A 14-year old girl was lying on a table, wide awake, and looking around while a resident and nurse held up her stub of a left leg and were in the middle of suturing the amputated leg—she was under an epidural anesthesia. They were suturing her up and all I wanted to do was hold her hand, but I wasn’t sure if I could touch her, so I instead pulled off my mask and shot her a smile. She returned with a slight grin.

We then went into the room over—there are three connected operating rooms total—where we observed a VVF (vaginal vasicular fistula). The VVF procedure is super common here for one reason or another. The vagina is torn, so the woman had no control of when she urinates as the tear was right before the sphincter (muscle to regulate urine control). It’s just a random drip of urine that comes out through the vagina. (As you can imagine that can cause a lot of problems, in addition to the cultural stigma of always smelling like urine.) I watched with a few other nursing students, as two doctors cut and prodded with many sharp tools—I’ll spare details. Just know that neither I nor Mark, who is in his 2nd year of medical school, could really identify much because it was such a mess. That operation took probably about 3 hours. All the while, the woman was completely awake but under an epidural anesthesia.

I learned that Friday at Evangel is the day for swapping out bandages from wounds/surgeries. Patients grit their teeth and let out agonizing screams as the residents wipe away at their healing sores. The craziest wound I saw was of a man that was robbed and his assailants had shot him with a shotgun through his thigh. It barely missed the fibula bone so he pretty much has a giant hole going through the lower of the thigh. The body is absolutely amazing in regards to how quickly it begins healing itself. The middle part of his leg was already healing quite rapidly and the hole had turned into two potholes instead.

Another surgery we watched was the removal of a lipoma (fatty tumor) just bigger than a half dollar above the patient’s eyebrow. He was given a local anesthetic, but was of course awake during the entire thing. The entire time I was praying that the man did not understand English because of the conversation that the residents were having among us and each other. “Do it how?” “Like that?” “Oops, sorry” At one point they asked Mark if he wanted to try suturing his wound closed after the lipoma was removed. “Do you want to try?” “Uh, no, I’d rather not.” “You’re right, you should probably practice on an arm or leg or something before practicing on the head.” At first glance it would appear that the surgery was reckless and archaic, but I am understanding that trial and error is moreso the approach to medicinal learning in a third-world country rather the luxury of extensive training with cadavers in the States. The guy took the entire operation like a champ, though you could definitely tell when the anesthesia was wearing off.

One thing that really took me by surprise was the fact that many of the patients that were going to have surgery next were wheeled into the big surgery room and could witness all of the surgeries from wherever they were sitting or lying. I don't know about you, but I think I would start wheeling myself out of there just out of the anxiety of the anticipation. All of the operations are super cheap though compared to the States… I asked a doctor how much a leg amputation would be and he pulled out his materials and procedure cost list and told me 3,000 Naira which is equal to about $20 right now. Keep in mind they have no social security, insurance, etc. A colonoscopy was about $15/$20. When I told the doctor how much it would be in the States without health insurance he said, “Well, you Americans can afford that price.”

We spent most of the day in surgery, then saw about a dozen women in labor rooms. Unfortunately, I didn’t get to see any births. But I did get to see a few sonograms in action: one of a healthy baby, one of a not-so-healthy baby, and one of an empty uterus. I think that covers most of the day. I wanted this to be a thorough update so you could somewhat have an idea of what this day was for me. But unfortunately this has been a very surface levely type of blog entry.

What I realized from the day and what I hope you can realize from reading this is that amidst the tough and seemingly unfair circumstances endured for medical treatment in most parts of the country, God has not lost control and still receives glory in every outcome, whether successful or unsuccessful. It is our job to be good stewards of the time, money, gifts, and relationships that He has given us--that's where the good is found, in our infinite opportunities to be vessels for God's glory.


Anonymous said...

Sara! im super jealous of this whole post but it sounds like it was a great day. So proud of you going tooo!! Ill be praying for you and the new team this week! i hope it goes so great!

your favoroite,


Anonymous said...

Wow. I can't believe you got to see all of this stuff!! I'm praying that God will make clear to you the desires of your heart so that you can do what you need to do to be best equipped to serve Him!

P.S. We got to see the guys from Rayitos de Luz... but, they won't be there much longer. I'll fill you in next time.