Greetings from Nyankunde:

A lot has happened since I last wrote, from my arrival in the DRC and becoming the head of Obstetrics and Gynecology -- I’m the only Ob/Gyn in this part of Congo -- to having an emergency appendectomy (I’m recovering) and trying to find funding for the last bit of a very large project (it involves toilets, but more on that later). It’s definitely been interesting so far, and now that I’ve been here just over two months, I’d like to fill you in on my day-to-day life.

Maternity ward with a new roof

New rooms being built inside the maternity ward.

The intern I'm helping to train.

I usually wake up between 5:30 and 6:00 a.m., and part of my breakfast routine is to sweep the house because, no matter what, the reddish dirt always seems to be tracked inside. Along with the rest of the hospital staff, at 7:30 a.m. I head to the morning meeting where we spend about half an hour sharing what’s been going on and then listening to someone teach from the Bible. It’s a moment for people to reflect and remember why we do the work that we do: to give medical care in the name of Jesus. It’s an encouraging way to kick off the day, but the trick right now is to be sure I sit next to someone who translates from Swahili into French. After that are hospital rounds: I start in the intensive care unit, move to the surgical ward, and then take care of the maternity ward. There are typically 4-7 surgical patients and 15-30 obstetrical patients and their babies.

After hospital rounds, the day begins to vary; sometimes I go directly to surgery, and other days I go to the outpatient area and do mostly consults. On Tuesday and Saturdays I try to make it to the Ob clinic where all the pregnant ladies come for education and routine prenatal care. Most of these women are from the area, but it often means they walk anywhere from 1-6 miles to get to the clinic. I’m often still in the maternity ward when they do their education, so I’m not sure what exactly they’re being taught, and the clinical part is limited. We measure their bellies, listen to the baby’s heartbeat, ask if they have had any problems, but because government funding has run out and most of these women are extremely poor, we aren’t able to conduct routine blood tests, and we only have one of the vaccinations. I’m hoping this will change, but in a country where most people struggle daily, how does one determine what’s the most important?

One of my most difficult cases right now is a woman who has been here almost as long as I have. She had c-section because her uterus had broken open during labor, and during recovery she developed an infection in the uterus and abdomen. We gave her antibiotics, but she wasn’t getting better, so we did a second surgery to remove the uterus and to leave a drain in place. She never seemed to improve, and despite receiving several blood transfusions, her blood count was always low. 

She didn’t have anyone at the hospital with her, so on top of it all, she wasn’t eating well. And then she started to develop a cough. We found out her husband was receiving treatment for tuberculosis, so we started her on treatment as well, but she’s since developed another infection and is now leaking urine from her vagina. It’s been a month since her surgery, her family has abandoned her, and we’re trying to determine the best care for her. A woman at the hospital cooks her food for her, but she still doesn’t really eat. She has significant anemia on top of the tuberculosis, and, to boot, the hospital has just exhausted its supply of IV antibiotics. If anyone has any suggestions on what to do for a malnourished, anemic, tuberculosis patient with an active pelvic infection and a vesico-vaginal fistula, I’m open to ideas!

Most of my cases, though, are fairly straightforward, so with a translator, it only takes a couple hours to see the majority of the moms and infants. Most days I get done around 5:00 p.m. and then head home for dinner. I haven’t really established a routine yet, but if I’m eating alone, I usually make rice, a green leafy vegetable called Muchicha, and maybe some fish. I’ve never been a great cook, and to prepare things here often takes a lot more time, so I just hired someone to cook for me. Today is day number 3, so we’ll see how things go.

Home for me is one side of a duplex. I have a guest room, a kitchen, a bathroom, and several standard American conveniences like a stove, fridge, and sometimes even hot water. And, funny enough, all my cupboards, closets, chairs and tables are made out of mahogany. In the US this would never be possible, but mahogany happens to be one of the local trees. I also have solar electricity and running water, which I’ve started to filter. It comes from a natural spring in the hills just behind the hospital and has been tested to be pure, but after getting sick, I’ve become more cautious, maybe overly cautious. All in all, it’s a really great place, and my neighbors are a nice family with two children: Patrick is an internist-pediatrician, Anna is a nurse practitioner, Luke is 3 years old, and Miriam is 9 months old.

It’s been good to have close neighbors who are medically trained because health for me has been somewhat of a challenge since I arrived. It started with an allergic reaction to mango skins, which was then followed by a bout of scabies, a fungal infection on my arms, something called Nairobi eye, amoebic dysentery, and, finally, a perforated appendix (which we initially thought was typhoid fever). I’m being initiated into the world of tropical medicine with firsthand experience, and for someone that was never really ill growing up, this has been difficult, but I’ve received solid care and am regaining my strength.

It’s also been good to be in an environment where everyone has been very welcoming and friendly. They have looked out for me during the last several weeks when I’ve been ill, and before that they helped me figure out the lay of the land, prices, and cultural differences. They’ve forgiven me my cultural ignorance, helped me figure out the best way to do things, given me counsel on how to handle certain demands from people, and how to understand people different from myself. 

So aside from my daily routines, the medical emergencies, and the compassion and care of my colleagues and neighbors, my thoughts have been occupied by a big, exciting project: A little boy raised over $60,000 to completely remodel the maternity ward. From what I’ve heard secondhand, this boy received a magazine from the organization that I work for -- Samaritan’s Purse -- and in the magazine you can buy certain things like goats or chickens or other items that can be donated to someone in a different country. And at the back of this particular magazine there was a section that said you could build a hospital for $60,000, so he decided that was what he was going to do.

He started making and selling cakes through social media until he raised the money, and he did it fairly quickly. I think the people at Samaritan’s Purse were a little surprised when he called to say he wanted to build a hospital and had the money to do it. In reality, it takes more money than this to build a hospital, so they decided that it would be best used to rehabilitate the maternity ward here in Nyankunde.

Built in the 1960s, the building was beginning to fall apart: the roof was leaking, the ceiling starting to rot, there was only electricity in the delivery room at night, there were only two sinks in the entire building, and there was a lot of unusable space because of layout. In order to start the project, the entire maternity department has been moved into a different building, and now that demolition is over, they’re in the process of rebuilding: the new roof is almost finished, they’ve bricked in an office for me, and they’ve separated the delivery room from the operating room. When it’s complete, there will be solar electricity, better access to running water, and more space for patients.

It’s going to be a much better place for my patients and a better place to work, but one thing that wasn’t really budgeted for in this whole endeavor was the bathroom. Unlike the U.S., all bathroom facilities here are outside of the ward. There are two toilets and two showers for up to 40 patients and the family members that stay to take care of them. We’ve talked at length about moving the facilities to just outside the wall at the back of the building and enlarging them, but the estimated cost is about $5,200.

There’s not a lot of glory in toilets, but there will be a lot of grateful women who will use them if we can fund them. Any contribution, no matter the amount, will bring us a step closer to our goal, so if you’d allow me, I’d like to ask you to consider giving towards this specific project. We could even put your name above one of the toilet stalls! If you have any questions, you can always email me, but if you’re able to contribute financially, I’ve included instructions for donations at the end of this letter as well as our budget for the project itself.

As always, please stay in touch. I’m thankful for your notes, your prayers, and your general concern for the things that I’m doing here. I really enjoy what I’m doing, and I’m thankful for the opportunity to be able to do it. It’s only possible because of your support and encouragement, so thank you.

Michelle

Pray requests:

1.     Wisdom in knowing how to best treat patients with the limited resources, especially in the maternity ward.

2.     The maternity ward project.

3.     That I would continue to build relationships with people here, and we would be mutually helpful.

4.     Health.

Financial giving:

You can send checks with my account number on it (#004864) to:

Samaritan’s Purse

P.O. Box 3000

Boone, NC  28607

You’re also able to give online by searching my last name (Doran) at http://www.samaritanspurse.org/medical/wmm-doctors/

Project Budget

II	TOILETS
1	Roof
	Wood (15x5)		pce	6.5	0	CME contribution
	Wood (7x7)	27	pce	3.2	86.4	CME contribution
	Clou de 12cm	10	kg	2	20
	Sheets 26G	18	pce	18	324
	Sheet nail	3	kg	2.5	7.5
	Wood (19X3)	7	pce	10	70	CME contribution
	Subtotal				507.9
2	Walls
	Brick		pce	0.085	0
	ciment	15	sac	17	255
	sand	3	benne	70	210
	Subtotal				465
3	Plastering Walls
	Cement	16	sac	17	272
	sand	2	benne	70	140
	Subtotal				412
4	Floor
	fer à beton(iron) 12mm	16	pce	12	192
	Binding wire	1	ff	40	40
	Gravers	5	benne	100	500
	sand	3	benne	70	210
	ciment	29	sac	17	493
	Subtotal				1435
5	Carpentry
	Door	8	pce	70	560
	Window	9	pce	10	90
	Subtotal				650	CME contribution
6	Painting
	Oil based paint	20	litre	5	100
	Accessories (brush)	2	pce	2	4
	Accessories (rolling brush)	2	pce	5	10
	Subtotal				114
7	Fosse
	Creusage	1	somme	200	200
	brick		pce	0.085	0
	sand	2	benne	70	140
	Gravers	1	benne	100	100
	ciment	18	sac	17	306
	Subtotal				746
8	plomberie
	Toilet bassin	4	pce	60	240
	crepines	4	pce	5	20
	Tiles	56	boite	15	840
	Lavabo	1	pce	100	100
	Accesoires	1	ff	200	200
	Subtotal				1400
9	Demolition	1	ff	70	70
	TOTAL 2				5800
	Main d'oeuvre25%				1450
	TOTAL LATRINE				$  7,249.88
					$  2,126.10	$ from Previous Contract
					$  5,123.78	Total Money to be Raised
					806.4	CME Contribution	661