Sunday, June 10, 2018

A week in the life of...May 2018 DRC

So, I typed this up some time ago and haven't looked back through it.  I remember it sounding a little like complaining, but I'll let you read through some of my thoughts dealing with a somewhat challenging week, but it's not uncommon.

I don't have photos, again, phone was taken with all the photos on it for this last month.  So, I'm working on getting some more for this month's update.


A week in the life of Michelle Doran

So, I’m an Ob/Gyn living in eastern DRC.  I speak decent Congolese French and am learning Swahili.  I’ve been at Nyankunde hospital for the last 3 years and have had some very interesting experiences.  Some weeks are calmer than others, but I’m going to tell you a little bit about last week.

Malaria, it’s now the 3rd or 4th time that I’ve had it. I woke up in the middle of the night with chills-teeth chattering, searching my house for a second blanket—followed by sweating and fevers.  I throw off all the covers and have to change my clothes because they are soaking wet.  I know I have malaria, but it’s the middle of the night and all the tests are negative.  So the next morning I go see my next-door neighbor Anna.  We eventually find a rapid test for malaria, but after poking my fingers 5 times with no blood coming out and only part of the kit, we make the trek down to the health center.  Fortunately it’s in a car, even though I could do without all the bumps.  The test is negative there as well, but I start the treatment anyways. I make it through the day, but it’s not pleasant.  I feel like I’m in a mini-labor having stomach cramps.  But, 12 hours after accidentally taking a double dose of the medicine, I feel much better.

The next day I am outside my house after spending almost a complete week in bed.  And, 2 days later I am back at work...consults, rounds and a C-section.  The following 2 days I had every intention on returning home early, but I ended up rounding early, having a surgery lasting longer than expected, having an emergency surgery and then had to deal with the aftereffects of a mom dying from anemia.

That was a tough moment.  We have moms who die here 3 or 4 times a year.  It’s a lot better than some other places I’ve been, but it was hard.  She died because she had a bad reaction to a blood transfusion where her lungs filled up with fluid.  What made it worse was that her almost full term baby wasn’t taken out by c-section when they realized that she had died.  There have been 3 maternal deaths this year all from problems with transfusions or bleeding.

With each one we sit down and go through what we could’ve done differently.  So much...a delay in diagnosis, no ultrasound was done to confirm the age of the baby, a transfusion was given but the patient was followed well and there was no post-mortem c-section to save the baby.  So, we crammed 20 people into my 10’x10’ office and discussed this until people started blaming each other for what went wrong.  That’s when I just lost it.  I don’t cry often, but it’s just awful to have something like this happen and then everyone try to blame someone else for what went wrong.  In the end, the responsibility lies with me to teach, to train, to help people understand what to do better next time.  And, helping people understand the importance of taking responsibility for their mistakes in order to improve.

Well, because of this 2 hour meeting, I had to cancel a surgery and then try to deal with all the different pregnancy complications that come with malaria season...anemia, blood transfusions, low amniotic fluid levels, fetal distress, etc.  It was turning into a long day.  We had over 30 patients in the department with their babies with some of the beds having 2 people in it.  The lab wasn’t getting out results.  And, we had 2 emergency c-sections and a D&C on a lady who was bleeding significantly.

This, of course, was the day that I got back the money I was asked to exchange in the US.  I was asked to take a large sum of money back to the US to change the money into new bills.  In the DRC, if a bill is older than 2008, has even the tiniest tear or doesn’t look pretty enough, it won’t be accepted, not even by the bank.  So, I took the money with me when I left in May 2017, I gave it to someone in Samaritan’s Purse, they sent it back to the DRC where is preceeded to sit in someone’s office drawer.  The person who brought it back no longer worked for SP, so it took 4 months to track down the person and figure out where the money was at.

Finally, after all of this, the envelope with the new money arrived when I was working.  I was so happy, so I put it in my pocket.  Well, I didn’t keep close enough track because I eventually took off my jacket in one of our working areas and it, my phone and my house keys in the only jacket I’ve worn for the last 2 years.  It was devestating.  Losing someone’s money after all that time and energy and knowing that I’d have to pay it back out of money of my own.  Not cool, especially because it’s really hard to get money in the DRC.

I searched every department twice, but wasn’t able to find anything. So, after a pretty awful day, I went home, had dinner and went to bed.  I had hoped that my jacket and my phone would turn up, but it didn’t.  Everyone was really concerned at the hospital, but I had to accept that I wasn’t getting anything back.  I think worse than the money was that all my information was on my phone.  It has a code, but it takes forever to download apps on a phone.  And, a week later, I’ve not been able to replace the SIM card because the person at the 5’x5’ phone “store” can’t figure out how to register a SIM card with an existing number.

Well, the week continued.  The next day was just as busy.  It was better because I had moved past my stuff getting stolen and could focus on life again.  We did surgery, we helped people and we worked until late in the day to get everything done.  It was great to work with Dr. Deborah and the resident was finally getting the picture that if he rounds early in the morning, then he gets to operate.

So, I got up the next day to go down to our weekly doctor’s meeting.  It lasts about 2 hours and includes a devotional, praying, talking about difficult cases and education.  There are so many things going on at the hospital that we didn’t have time to have the educational portion….water not running at the hospital, the 5 or 6 deaths at the hospital because of late care or anemia, not having a blood bank, how to improve things at the hospital without having the resources to do so.  And, a discussion about a difficult case at the maternity.

There was a woman who came to have an operation from a town far south of us.  When she came she had a catheter in her bladder and a note saying she had a mass in her pelvis.  Well, she had some problems with parasites in her intestines, some weird polyps coming out of her uterus and belly pain.  I opted to treat her medically.  A few days later one of her relatives found me walking down the road and says that the patient actually went to the hospital in Beni (the town south) because she was unconscious and not making any urine.  Well, I tucked that information away to talk to the patient the next day. Well, that’s when I got sick and the patient had to wait.  When I finally got back, we then had the meeting about the maternal death.  Then she had a reaction to her transfusion.  Finally, almost 3 weeks after she arrived, we decided to operate on this pelvic mass the next day.

Well, after rounding and seeing a few patients, I decided I should probably catch up on the 30 emails I’ve ignored over the last week.  So, I walked down the hill towards MAF (the pilots and airstrip).  I go down there because they’re kind enough to let us use their really good internet.  So, I grab a key to an empty house and sit on the floor in order to respond to the wide variety of emails in French and English.  4 hours later, I decide that I can’t do any more, so I head back up the hill about a ¾ mile home.  I’ve figured out what I’m going to do for vacation, I try to see what’s going on with the travel plans for the visitors, I e-mail about getting a health evaluation for myself, I start working on the contract between Serge (my organization) and CME (the hospital) in French, I check to make sure no one’s used my credit card information from stealing my phone, which I assume they figured out the code because they called one of the doctors, and I replied to multiple personal emails.  I can’t quite remember what I did once I got home, but I think it involved making dinner, working in the garden, trying to clean up my desk which is a disaster and then getting to bed.  And, trying to reply to all the emails I got in return to the ones I sent out earlier in the day.

Well, Friday was looking up.  I’d caught up on a lot of correspondence and we were finally going to operate on this lady who had been waiting for 3 weeks.

I looked through the clear window of the OR door.  They were just putting in the medication into her back (spinal).  I walked towards the changing area when one of the interns found me and said there was an emergency in the operating room.  I was there less than 30 seconds ago, what could be the problem? I walked back the way I’d come and see multiple people standing around the OR table with the patient laying on the bed which was tilted at 30 degrees.  The new anesthesiologist in running around at the head of the bed looking for something.  So, I ask what’s going on as I examine the patient.  She stopped breathing and her heart wasn’t beating.

It was one of those moments that I was glad I’m bossy and that I’ve dealt with a lot of emergencies before.  So, I tell them to put the bed flat and started pressing on her chest to circulate blood while bossing around all the people that had no idea how to resuscitate a person.  Put a tube down her throat to breath for her.  Try to get a bigger IV.  Go get Dr. Patrick to help.  Look for the medication called epinephrine.  Give her 1mg. Go get more IV fluids.  No, you have to empty the air out of the IV line. Change positions with me.  You have to press harder than that for compressions.  What’s her pulse? Is she breathing? Thanks Patrick for getting the defibrilator.  What’s her heart rhythm.  Stop touching the patient.  She has a heart rate again. Doesn’t look good.  Keep giving fluids. Stop compressions.  Is she breathing on her own now?  Leave the tube in place until she can pull it out on her own.  She’s having an MI (myocardial infarction/heart attack).  Keep the oxygen going...etc. Then I had to run, down to the health center and back to get aspirin because there wasn’t any at the hospital. And, the patient could never figure out that she was supposed to chew it instead of swallowing it. But, she lived, and I was convinced that I wasn’t going to do surgery on her.  The poor lady waited 3 weeks for a surgery she will never get.  Thankfully, her family understood. Disaster averted.

Thank God for the weekend.  Saturdays are half days.  So, I show up with the thought that maybe today will be a little different.  Well, I did end up going to the local, open-air market where I bought cabbage, beans, tomatoes, onions, and some other things, I got to finally talk to the lady to whom I’m giving money to help build her roof (her husband left her with 9 people to care for and she makes less than $100 a month), I help celebrate Luke’s (my 6 year-old neighbor) birthday, I went to the church to encourage people to donate blood for free for all the people dying and I paid back Katsiko the money that had been stolen from me.... This was intermixed in with 2 c-sections, rounds and a few consultations.  One of the c-section was on a lady who was newly diagnosed with HIV just before the c-section.

Sunday is my day off.  Well, it seems like it’s the day to get things done.  I woke up late with a sore throat.  It was raining for the 7th day in a row.  The solar electricity hasn’t been running well because there’s been no sun.  So I get up an switch on my fridge, which has been off all week because the solar batteries don’t last through the night.  I get dressed and I head to church.  I’m thankful I’m late because today the generator has gasoline and they are using the microphones and the amplification is highpitched with whining—a sound that only dogs should hear.

I sneak in the back and listen to what’s going on.  The lady behind me needs me to unzip her shirt in back so she can breast feed.  The new missionary family’s son keeps walking back towards me to smile and wave.  I can hear what the pastor is saying because there is a microphone and it ends up being a really good talk.  I think it’s the first time I take notes and actually have paper and pen with me.  Church ends and I walk through the mud in my flip-flops back home.  I need to find bananas so I can make banana muffins for breakfast throughout the week, but no-one’s been able to find them.  Well, I catch a ride with my neighbors who are heading down the hill so I can go to the market, but then I realize that the guy from MAF is heading up the hill to help me with some projects at home.  I jump out of the car and head back up the hill.

I finally got the door latch put on, the soap dish hung on the wall, the hinges on my cupboards tightened down.  I helped some, but I was working on making beans.  I had soaked them and cooked them and now I just had to heat them in oil with some spice.  I also was able to make passion fruit juice.  You cut them in half, dump them into a fine strainer, put water over top and grind the seeds against the strainer with a spoon to press the juice through. And, I worked on some other things in the kitchen while getting help with all those other projects.  So, after this I thought about sitting down.  Sunday is a day to rest, or so I’m told.

Well, that changed.  One of the nursing students that works in the yard told me that the youth meeting was at 2pm instead of 3pm.  Funny how they failed to mention the time change since I was the one talking.  So, since it was already 2:15pm, I thought I’d head back towards the church.  Well, I was the only one there even though I was late. Thankfully, people started showing up.

It was the first time I had talked with the youth group.  My voice was holding up, despite me sounding like a chain smoker (laryngitis).  And, we talked through the very taboo subject of sex.  There ended up being close to 100 people there.  And, there were people with some very specific and detailed questions.  But it was great because they were talking.  Somehow I got volunteered to talk about normal anatomy next month.

Heading home, I thought about the last week.  It was a tough week.  I don’t typically have things stolen, but the rest of it seems status quo.  I thanked God for my returning health, that the lady we tried to operate didn’t die, that I could converse in French, that I have the resources to repay that money that I had stolen, that it’s warm enough here that I don’t really need a coat, that I have friends who look out for me and I have a good home where I am safe.

It ended up being even better when I got home because I had bean burritos for dinner and I got to eat some cake and ice cream that someone had made for Luke’s birthday.  And, I got to see some missionaries that had spent a few years in Nyankunde but are now working in an even more rural hospital.

I went to bed wondering what the next day would  Well, it seems like maybe it will be a little less intense this week.