Saturday, May 21, 2016

Weekend call...

Quite a weekend…. I’d arrived late Wednesday night, spent the day Thursday organizing and distributing the meds and supplies I’d brought with me. Friday I met with the medical staff and with our SIM Liberia Director.  Saturday morning I took over as the on-call physician at ELWA Hospital, covering our 50 bed facility for the weekend. One of my local colleagues helped me with rounds on Saturday.  And then, about 11:30 AM, it all started….

Amelia (not her real name) is a 32 year old mother of 3 who had not been to ELWA before. She came from 25 minutes down the road—the rural area between Monrovia and the airport. She told us she’d never had a day of formal education. She was 9 months pregnant, and had severe abdominal pain starting around 10:00 in the morning. There were no fetal heart tones, and she had significant vaginal bleeding. The abdomen was so tender that it was difficult to really get a good exam.  I talked with Amelia, her sister, and an Aunt who had helped get her to the hospital. I told them she’d need an urgent operation, as it looked like the placenta had separated from the uterus and we needed to get the baby out and get the bleeding controlled, though it looked like the baby had already died in her abdomen. 

After the surgical team made their preparations, I scrubbed in and got ready to start the case. I’d been hoping for an easy first weekend—maybe a c-section or two, but let them be healthy ones with good babies. Not this time. As we entered the abdomen, we encountered copious clots and blood—I reached my hand in through the incision and explored, and realized this was not an abruption, but a uterine rupture—the baby had been expelled through a tear in the lower uterine segment, along with the placenta. We extracted the stillborn baby and the placenta and brought the uterus into view—there was a stellate rupture extending in 3 different directions. With some skillful help from Gideon, the assistant, we pieced the uterus back together and repaired it in 2 layers. After a transfusion, Amelia’s BP stabilized and she was able to go on the postpartum ward.

Sunday morning I was awakened at 5:30 by a call from the ER—a pregnant woman had come in, short of breath, with O2 saturation of 57%. When I arrived, she looked like she might give up the ghost at any moment. Her heart was massively enlarged, she was in pulmonary edema, and she was full term. I silently prayed for her as we gave her oxygen, lasix, hydralazine, and IV digoxin. Miraculously, she gradually stabilized, and later in the day delivered a full term baby girl who unfortunately appeared to have brain damage from her prolonged hypoxia. 

Add to that a couple other challenges—a vacuum extraction on a woman whose baby had apgars of 5, 5, and 7; and a c-section on a patient attempting a trial of labor after prior cesarean. 

All these women survived, and two of the four had good neonatal outcomes. If these women had been pregnant just 18 to 22 months ago, during the worst Ebola epidemic the world has ever seen, it’s quite likely that all 4 of them would have died or had even more complicated deliveries, due to the closure of most health facilities here. Timely, skilled maternity care is a lifeline in a place like Liberia—a very fragile lifeline. One of our priorities is to extend that lifeline to as many women as possible, as well as training local midwives and physicians in quality emergency obstetric care. I’m so grateful to practice as part of teams, both here in Liberia and in Worcester, that make women’s health and maternity care such a priority!  

Friday, April 08, 2016

The answer to his own prayer request

One of the first people patients meet when they check into the clinic at ELWA hospital is William Pewee. He receives their clinic card with a warm greeting and a smile, then hands them their medical record before they join the line to see a provider. If they have a question, he will help, because he wants people to feel cared for when they come to ELWA.  In fact, before he was employed in the records room, Pewee was a volunteer  who led devotions and prayed with patients on the wards.

    In the midst of the Ebola crisis, Pewee shared a request at the monthly ELWA prayer meeting for the patients in the Ebola Treatment Unit, that someone would encourage them in the Lord. For obvious reasons, volunteers could not enter the unit to lead devotions. That night, he dreamed that a man in a white gown came to him saying “we are coming for you, so get ready,” meaning that he might die, but he argued and wrestled against him.  He had recently read the story of King Hezekiah, and he told the man he was a preacher and wanted more time like Hezekiah was given.
    The next morning as he got ready for work, he felt the chills of a fever. Although he did not think he had been exposed to Ebola, he knew he should be careful. When he arrived at the hospital, Dr. Fankhauser saw his bloodshot eyes and put him in the “suspected cases” ward of the Ebola unit. 
    The Ebola test was positive, but his case was not typical. Although he experienced bleeding from his nose and ears--one of the scarier symptoms--it subsided after a few days. In the end, his sickness was very mild and he never even had the diarrhea that weakens most patients.
    After just four days in the ETU, Pewee felt better. But he realized that his prayer request was very relevant, because dozens of people were dying around him.  People were truly afraid, especially at night when so many seemed to pass away. So he became the answer to his own prayer request and “opened a revival,” as he puts it.  Late every night, after the last medications were administered, the patients who were strong enough gathered to read the Bible and sing and pray.
    While he was recovering, he met a familiar face.  A surgeon and former medical director of ELWA Hospital, Dr. John Dada, was admitted to the ETU. Dr. Brown asked Pewee to look after him, and call whenever there was a concern. But sadly, even as he seemed to be improving, the beloved doctor suddenly died.  Losing Dr. Dada hit the ELWA staff very hard.
    SIM recognized that many people would be affected by the traumas they faced in those months.  They organized a program to train local facilitators of “Trauma Healing Groups” who would learn about the emotional impact of trauma and the road to healing.  Eighty facilitators were trained in July 2015. There is such a demand for these groups among those who have been touched by the Ebola crisis and other past traumas in Liberia that more facilitators will be trained in May.
    Pewee participated in the first trauma healing workshop.  Although he was able to reach out to others in the middle of his own Ebola experience, he said the program helped him to understand and cope with his own lingering emotions: "it helped me come down," he says. Losing patients he prayed with, watching the body bags leave the ETU was a painful experience that has stayed with him.   

William Pewee’s job at ELWA may seem like a small one, pulling and replacing files all day. But for him, it is a way to show the love of Jesus to someone who may be having a difficult day. He is one of the wonderful staff that we get to work with at ELWA--so many of them have a story to tell of God’s faithfulness. 

And I’m excited to share that it is going to be my new assignment with SIM-Liberia to tell these stories. I am now the Communications officer for our field, a job that I began during my trip in February.  I’ll be doing my best to fill the role from the U.S. with occasional trips to Liberia as our family situation allows.  I hope that you will be encouraged to hear more about the way God has been working in Liberia through these stories.

Praise God for the power of the Resurrection in our lives and in our world!

Debbie 

Wednesday, September 02, 2015

Thank God for Life

 

 
 In Liberia when you greet people, “How are you?” they often respond, “Thank God for life.”  I’ve always appreciated that answer—it says so much:  God is in control, God has given me life, this day is a gift from Him and I want it to honor Him.  That answer is even more real to me now.  
     September 1 was the one year anniversary of Rick’s diagnosis of Ebola virus disease.  It is hard to believe that life is so normal now, considering the possibilities that this day held for us a year ago.  While Rick waited for the result of his test, and began to feel the effects of the virus taking hold, he felt the strong arms of his heavenly Father holding him close.  For my part, I took long walks and shed many tears, trying to imagine life without Rick, but completely sure in my heart that God would carry me through.
     As the news broke, we were caught up in a tidal wave of evacuation plans and media attention, and held afloat by the prayers and acts of kindness of our family, friends and community.  We have often said that for a few days, Rick was probably the most prayed for individual on the planet.  There are no words that could ever express our gratitude for the way our family was loved through our crisis, so we wish to just say thank you and God bless you.
     We admit that the story of the Ebola epidemic reveals many uncomfortable realities of our world today, including apathy towards the crisis from the developed world in the early months and the social inequalities exemplified by the evacuation and treatment of the Americans who contracted the disease. But there were no guarantees because our times are in God’s hands.  By His mercy and thanks to the amazing professionals at the Nebraska Biocontainment Unit, Rick recovered fully. We trust that in some way, God has used him in the battle against Ebola in West Africa, which is hopefully in its last days.  Although Liberia has been Ebola free for much of the last 5 months, Sierra Leone and Guinea are still reporting a few cases each week. But now there is promise that a vaccine could finally bring this epidemic to an end, and prevent future ones.
      However, that vaccine will not prevent a crisis like this from happening when a new disease or virus emerges to sweep through West Africa or another region. Strengthening the healthcare systems in countries like Liberia is the real “vaccine” that will prevent a future crisis.
     This week, SIM has invited missionary and West African healthcare leaders to meet in Ghana for a conversation about how the mission and its partners can help strengthen healthcare resources in the region. Rick couldn’t be there, but you know his heart is with them.  Please pray along with us for these Christian leaders who desire to change the realities that caused African families to lose their husbands, fathers, wives, mothers, brothers, sisters, and children in the last year and a half.

Saturday, July 18, 2015

Community Health Survey

Last Saturday afternoon was bright and sunny after a rainy morning. Because I had the day free, I had contacted a few friends to let them know I might be visiting. First I walked up Rock Hill across the main road from ELWA, to visit old family friends Tom and Bindu. It’s always so wonderful to get off the compound into the community, to greet people as they’re sitting on their porches or working in their gardens. I was encouraged to see that the city had run water pipes up to the top of Rock Hill and now residents can fill 2 buckets of water for 5 Liberian Dollars (about 6 cents US) at any of several stations like this one: 
 
 
This setup solves a major problem for the community. In the past, during dry season, people would have to walk 15 minutes to get to reliable wells where they could draw water. The money goes to pay the city water bill.   
   My visit to Tom and Bindu was a house call of sorts—Tom’s foot was hurting and he was having difficulty getting around.  So I did an exam and recommended some treatment that would help him recover. I enjoyed some nice sweet potato greens, rice, and fresh mangoes and bananas that Bindu had fixed, and caught up with everyone in the family.  
   Getting out in the community is more than just a chance to see old friends and greet people. It helps me to understand the context which has such an impact on peoples’ health. As I walked up the hill, I noticed a lot of big holes full of water in yards and near the road. Many of the residents of Rock Hill make a living by breaking up the rock (with hammers) around their houses into gravel for road and construction projects. The holes are left behind after they have dug out the rock. During rainy season, these holes fill with water and become a drowning risk for toddlers and kids who wander away from their caretakers and fall into them unobserved. Bindu told me that each year there are incidents of drowning in the community.  What a heartbreak it is for those families when a tragedy like that could be prevented.
   On Sunday morning I was on duty at the hospital. An elderly man who had died at home during the night was brought in the back seat of a car. The family needed a certificate from the hospital stating that he had not died from Ebola, so that they could take the body to a funeral home.  The man had not been ill, and there were no signs to suggest Ebola. As I was filling out the paperwork, I overheard some of the family members saying that others in the home were not feeling well. When I inquired about it, I found out that all the others who had slept in the house were dizzy or disoriented. I asked about generators and learned the family had been running a small generator in a utility room inside the house. I immediately asked the family to have the others who weren’t feeling well brought to the hospital, and we treated 3 of them with oxygen for carbon monoxide poisoning. This is another common safety issue that occurs in Liberia: there is no utility power for most Liberians, so they purchase a small generator to provide household power.  The generators are not always vented properly and cannot be left outside for security reasons.  There isn’t a system of enforcing building codes for most residences, and people don’t always understand the safety precautions they must take with a generator. 
   I don’t want to give the impression that people are simply careless with these matters – the truth is that safety costs something.  You have the rock available to help provide income but then what do you fill the hole with?  You can’t use the money to build a safety fence-- you need it for important things like school tuition. You find a way to buy a little generator and a liter or two of fuel for each day so you can have lights, but you can’t afford to build a proper exhaust system. And the generator will be stolen if you run it outdoors (or it might be raining). We don’t realize that safety is a benefit of affluence.
   In spite of that reality, I feel compelled to try to raise awareness when I see things like the water-filled rock holes and carbon monoxide poisoning.  ELWA Radio airs a program called “Appointment with the Doctor” which is a forum for educating listeners about health issues.   Yesterday I recorded a radio program about these two community safety matters. I am praying that our listeners will be able to share information and ideas with their neighbors and help communities in our area become safer! 

Tuesday, June 30, 2015

Some Family News

     We have not shared any family news in long time, and a lot has been happening, so I’m going to use this update to catch you up.
     We had two graduations in May. Caleb graduated from high school.  He will be attending Lesley University in Cambridge, MA next year, where he is signed up to study Illustration.  We feel that Lesley is a great fit for him, and hope he will thrive and grow there as he discovers his talents and interests.  He is going to be working at Worcester Art Museum this summer as an assistant teacher for their children’s classes.
     Jared also completed his program in Heating, Ventilation, Air Conditioning and Refrigeration (HVAC-R). He really toughed it out over the winter, traveling every day to Boston on the commuter rail. He is applying for entry level jobs in his field, which is always a tricky process. 
     Max has been living at home since Rick’s illness, and just got a job as a restaurant server. It has been good to have him on hand, especially when Rick is away. 
     Our family has talked and dreamed of visiting Europe for many years (it was always so close, as we traveled through on the way to Liberia) and the timing seemed just right this year to make it happen.  We spent about two weeks in central Italy and France at the beginning of June, just ahead of the crowds and the heat. We saw the sights and the museums until our legs felt like rubber, but we feel like we made the most of it.
   Probably the most powerful day of the trip was the day we spent touring Utah and Omaha beaches in Normandy and visiting the American cemetery. Our guide told stories that made us think “God was there.” 
     Rick left on June 29 for Liberia, and will be there through most of July.  The SIM Liberia team is slowly transitioning back to normal operations.  Our new country director, David Writebol, returned in June along with his wife Nancy (the Ebola survivor) to take up his new position.  The other missionaries are also getting back.  Dr. Fankhauser and his family have been there for several months already. They all recently enjoyed a visit from Dr. Kent Brantly and his family.  In addition, work has resumed on the new ELWA hospital complex.

As the team and staff at ELWA come back together, please pray for them. As we learned after our evacuations from Liberia due to civil conflict, you don’t just pick up where you left off.  Things happened in the interim that might have changed everything. It takes grace and patience and understanding to put the organization back together.  

Also, please continue to pray for EBOLA TO END in West Africa. It was just about a year ago that the first Ebola cases came to ELWA Hospital. Sadly, after over a month of zero cases, at least one death due to Ebola was reported in Liberia this week. Twenty to thirty cases continue to be reported every week in Sierra Leone and Guinea.  The ongoing situation is no longer in the news, but efforts to contain and end this epidemic continue to require attention and resources in the region.

Thanks for your ongoing support and prayers for us, our family and the ministry in Liberia.
For the Kingdom, Rick and Debbie

Friday, May 08, 2015

A Good Read

I just finished reading this lovely little book, the personal story of Louise Troh, who invited her long lost love Eric Duncan to come to the United States to build a future together, only to lose him to Ebola disease within a month of his arrival.  I loved it. And I hated it.  You will get to know a true Liberian woman if you read this book. She is an iconic Liberian "mother" but she is also honest about ways in which she has not been perfect.  On the other hand, her story reveals to us how our media-saturated culture of outrage has dehumanized those who get caught up in a situation like hers -- spewing vitriole and hostility, spreading gossip and outright lies, making them victims of our fears.  It's shameful.  It also raises uncomfortable questions about the royal treatment that the other (dare I say, white and/or American) patients, including Rick, were given compared to the abusive scorn directed at Ms. Troh, Mr. Duncan and their families.  These are questions that we all need to confront, confessing that injustices exist. I'm so sad that she lost a chance at love because he did not get the level of treatment that was made available to us.

A shining light in the midst of this story was the loving care of the Wilshire church for Louise and her family.  It was an example of the way the body of Christ is supposed to be. Her own courage to rise above the hurt and wait on God for justice and provision is a testimony of her trust in God, though some might accuse her of being too passive. I would maintain she could not have chosen a more powerful way to speak against injustice and prejudice than to tell her story in her own voice (with the help of a journalist who seemed to understand and respect her)  without polishing her words to sound like a civil rights activist.  Reading her story, I shared her pain and her anger-- I experienced her journey as a war refugee, and a struggling and misunderstood immigrant, and matriarch of a close-knit family building a life as new American citizens. Perhaps if more of us knew people like Louise Troh personally, or even through a book like this, we'd see more progress in dealing with the injustices that continue to exist in our society.

http://www.amazon.com/My-Spirit-Took-You-In/dp/1602862893/ref=pd_rhf_gw_p_img_1
Look for my review. 

Monday, May 04, 2015

An unexpected opportunity



There is something wonderful about the look on the face of a young, enthusiastic physician as they learn something new. 

I’ve gotten to see that look a couple of times during this visit to Liberia. We have three new Liberian physicians working with us who have just completed their internships and are presently in a six month emergency obstetric and surgical skills training program. We call them our post-interns. They will spend three months with us and three more at another hospital. Then they will be deployed to a rural hospital post for a two year term of service.  This system is part of the tuition-free medical education program in Liberia.
 
A couple days ago I led a mini-training session about the management of bleeding after childbirth; this coming Tuesday I’ll be teaching them again on the use of insulin in diabetic emergencies.  Today they were getting some words of wisdom from our Medical Director Dr. Jerry Brown before starting rounds. 

If you know me, you know that training doctors is my passion. While much of what we do and know is contained in books and articles, there is a lot of personal experience and nuance that gets passed on from doctor to doctor, during rounds, “curbside” consultations, and case discussions. I am again moved and stimulated to continue to pray and trust God to help us establish a Family Medicine residency program here at ELWA.