‘Wilson’ came to clinic carried in by his brother. Our triage doctor said to me that he has seen a lot of bad things, but this kid looked really bad. He weighed 6.7 kg (about 14 lbs) and was nine years old. Yes, that is what you read, NINE. He was literally skin and bones, except for his severely distended abdomen.
The chief reason for his family bringing him to clinic was that over the last few days he had developed a ‘mass in his stomach’ and was seemingly more sick than usual. Of course the concern was cancer, but the time course for cancer was not consistent with what we were seeing and there could be many other causes…many that are more treatable in Honduras!
A brief evaluation revealed he had much stool in his large intestines which we took care of…no need for further description on that. But even after cleaning him out of his backed-up stool, I realized he still had a mass that was dull as I tapped on it. As I put the ultrasound on him it became clear that he was full of urine. So with some difficulty I catheterized him and voila, 650 ml of urine. Now for an adult a full and uncomfortable bladder is around 350 ml…so imagine now that this is a child that weighs 14 pounds. After all of this, his abdomen matched the rest of his body and he felt better, but he was still in fragile condition considering his severe malnutrition.
Due to his severe chronic malnutrition and increased infection risk, I admitted him to the hospital. He was in fact so lacking in muscle mass that I could not inject him with antibiotics. I had to wait to get an IV. I have never seen a human that so much lacked muscle mass except the tiniest premature baby. I then called our pediatrician, Judy, and asked her what could be done. You see his condition is chronic and we don’t want him exposed to all the types of bacteria that reside in a hospital. She and I came up with a plan to transfer him over to the children’s center and start feeding him high calorie shakes. He came back the following week having gained one kilogram (2.2 pounds). The road to recovery for him will be long as this didn’t happen over night, but we were happy to see such rapid improvement in his immediate health. We have now put in place a long-term plan for Wilson, monitoring him closely and trying to help ensure access to high-calorie foods for him.
Food scarcity is still a problem for many here, as was the case for Wilson. You see his father died about 2 years ago and things got difficult for the family, so there wasn’t always enough food to go around. These stories are always complicated. Poverty is not a crime unless you and I don’t do something about it. Thankfully in this case, we were able to play a very small role in relieving the symptoms of poverty for one small boy.
A BIRTH STORY
“Then they journeyed from Bethel; and when they were still some distance from Ephrath, Rachel was in childbirth, and she had hard labor. When she was in her hard labor, the midwife said to her, ‘Do not be afraid; for now you will have another son.’ As her soul was departing, for she was dying, she named him Ben-Oni, but his father called him Benjamin. So Rachel died…” Genesis 15:16-19
Every missionary doctor develops a quiver full of harrowing birth stories. Shoot, every obstetrician does no matter where they practice medicine! So before I let you know one of mine, you may or may not have noticed that Benjamin’s birth described above in Genesis was a breech delivery…butt/legs first. This would be the only way that the midwife could have already known that Rachel was delivering a boy before the birth was complete. What I find interesting and sad here is that the mother died. Often it is the baby who suffers from the head getting stuck during the breech delivery and the mom is usually spared. But likely Rachel died of a hemorrhage. That is just speculation however.
Thankfully, most of you women reading this delivered your babies with modern obstetric capabilities within reach, including ultrasound, and quick access to anesthesia in the event of an emergency situation. Likewise, we are thankful to say we can help moms deliver safely here at Loma De Luz. This however does not guarantee that nothing scary ever happens.
Now imagine that your best and most adept colleague is on call doing OB and you are dozing off to sleep for the night. You have called him countless times in a pinch, he has taught you how to perform cesarean sections, he can do anesthesia, and he is a walking encyclopedia of medical knowledge. This doctor is the head of obstetrics. He is truly an amazing man. And even with all of the emergency situations here you have yet to see him lose his cool.
Then the middle of the night call comes…code blue, parto (Labor and Delivery), meaning all doctors were needed at the hospital ASAP. As I ran around getting shorts on and looking for the key to the 4-wheeler, I remembered that it was HE, our most trusted physician, who was on at the hospital. He was the one calling the code blue. But what could I possibly do to help him? Nevertheless, I drove to the end of my driveway and another staff member was already coming down the hill towards the hospital. I waited for him to pass me and we all arrived to the delivery room together.
SHOULDER DYSTOCIA! The baby’s head had delivered but the shoulders were stuck and she was blue. The primary doctor called the dystocia about 2 minutes into the time it started, so by the time the rest of us all arrived we were a good 7 minutes into this, with baby deprived of oxygen. Even though he is the most capable doctor among us, he did the first thing you do in this situation…he called for help.
He who never sweats (I always do) was very sweaty and he said “I can’t get this baby out. I have tried everything.” Other colleagues were flexing mom’s legs, pushing down over the shoulder. My gloves went on, we discussed options, and he had called for ketamine which is the anesthesia needed to do an emergency C-section. Not knowing what to do, I decided to stick my hand in and try and push the anterior shoulder out of under the symphysis pubis, the bone above the birth canal. All I remember is feeling a pop, seeing the shoulder, pulling the baby out, and saying thank you Jesus! We rushed her to the warmer and resuscitated her. She lived! Her arm was injured but she went home two days later, healthy and ALIVE.
There was a team of us in there and by God’s grace and by us functioning as a body, that baby and mom did well. 1 Corinthians 12 details the necessity for all different parts of the body to function well together, acknowledging the need for different parts. “Now if the foot should say, ‘Because I am not a hand, I do not belong to the body,’ it would not for that reason stop being part of the body. And if the ear should say ‘Because I am not an eye, I do not belong to the body,’ it would not for that reason stop being part of the body. If the whole body were an eye, where would the sense of hearing be? But in fact God has placed the parts in the body, every one of them, just as he wanted them to be. If they were all one part, where would the body be? As it is, there are many parts, but one body.”
I didn’t think I could play a meaningful role in the birth of this baby, given that the most revered doctor among us couldn’t seem to safely birth the baby. But I showed up anyway, and ended up playing a pivotal role. Thankfully most of our deliveries here are much less dramatic, but the drama of this birth taught me an important lesson in functioning as a unified body. I may not be the most skilled doctor among us in every aspect of medicine, but I am needed.