Once again I am amazed to see children learn to stand and walk after debilitating illnesses! It seems our hospital is gaining a reputation for being a place where children walk again, recovering from chronic illnesses such as TB, malnutrition, meningitis, etc. I give thanks back to God for His faithfulness to us. I give thanks to Him for all I have learned in the last five years caring for a vulnerable population. This week I give thanks for Debra’s (name change) recovery from osteomyelitis caused by tuberculosis. She was in so much pain only two months ago, such that I could barely examine her painful legs. She required anesthesia for pain control. Her hip is permanently dislocated, but she is able to stand. She will likely form a false hip joint and walk soon.
I want to give a few stories to illustrate how medicine looks different here in Congo compared to the USA. I frequently have these kinds of conversations and today it hit me that others might be interested as well.
Sickle Cell, the “banana cell” disease
I sat down to counsel the family of a short 4-year old girl with the new diagnosis of sickle cell anemia. The father came from home to give blood and talk with us about her medical problem. I drew an orange and said, “This illustrates what a normal red blood cell looks like.” Then I drew a banana and said, “This is what Furaha’s red blood cells look like.” I proceeded to draw one orange and nine bananas to represent 90% sickled cells. I said when the majority of her cells change to the shape of a banana she needs a transfusion
The family asked, “Will changing her diet improve her health?” I said eating lots of green vegetables and beans will help her to make new red blood cells. But I said food will not cure her. She was born with “banana shaped cells” just as she was born with brown eyes and food won’t change that.
Then the family asked, “How do we prevent having another child with this disease?” I told them that you can’t prevent it if both of you carry the possibility to give it to your children. A nurse asked, “Should they use contraception?” To this I said, that is up to them as there is a chance that they will have a child without sickle cell anemia. There is also a 75% chance that they won’t have a child with the disease.
Then they asked, “Did her brother die of the same problem.” I replied, “Probably, yes.”
Then we talked about the three things the family could do to prevent future hospitalizations. First, there is eating three times a day, a diet rich in iron and taking daily iron supplements. Second there is preventing infection (thus hospitalizations) with monthly antibiotic injections of benzylpenicillin and vaccines. Lastly I advised her to prevent dehydration with lots of water everyday. I advised them to come to the hospital at the first sign of fever and/or anemia, with a potential blood donor.
The family nodded understanding and motivation to care for their little girl. I did not draw any genetic diagrams or give any complication teaching, but nonetheless the message seemed to translate well.
Recurrent fetal deaths
Next I saw a 20year old woman with her husband and father (!). She had had three full-term babies that died shortly after delivery, after seemingly uncomplicated pregnancies. I asked lots of questions from her prenatal care, size of the deceased babies, menstrual cycle, etc. In the end I was left with the unsatisfying advice to do blood testing for common diseases like hepatitis, syphilis, HIV, blood type to see if we could identify a chronic medical problem. If there is not a chronic problem we were left with the likelihood of a genetic problem linking these deaths. I wondered about the presence of her father, but she really wanted his support and presence. I am reminded on a daily basis to ask questions, not judge people/situations, and to ask how I can best support them. I see some really challenging social situations (sometimes infuriating), but I have learned to step back and ask how can I communicate the love of God to this person.
We had a wonderful visit from an older Swiss missionary Yvonne and her friend Mary this past week.
Over 30 years of faithful service to Congo! She came to celebrate her 80th birthday. It was truly an honor and inspiration to be together.