Hydrocephalus, Prayer, and Saving Babies

Saturday night when I was on call last weekend I had just finished my fourth C-section in 24 hrs and was sitting at the dining room table thinking about sleep when I was called by a nurse from the "ICU" (a 4-bed section in the female ward) to come see a patient who had arrived after ingesting an unknown poison. I arrived to find three male nurses trying to manage an agitated, combative man who would yell and thrash wildly whenever they approached. They succeeded in holding him down long enough for a injection, however, and the second medicine we tried sedated him rapidly.

While we were dealing with him a nurse from the Peds ward appeared beside me and said, "Doctor, we received a baby who just arrived from Harare, and the condition of the baby is not good." I told her I would be right there, but a few minutes later she was back, asking me to come right away. I arrived in the Peds ward to find a 7 month old baby girl with hydrocephalus (very enlarged head because cerebrospinal fluid - CSF can't drain properly).

She would take a gasping breath about every 20 seconds with nothing in between. She had a strong heartbeat, but I knew with her breathing pattern she probably wouldn't make it through the night. She had had a VP shunt placed in April (a tube that drains fluid from the brain into the abdomen), but it was obviously not functioning as her anterior fontanelle (soft spot) on the front of her head was bulging with excess fluid, compressing her brain and now affecting her respiratory center.

Expecting her to quit breathing any minute, I called Dr. Stephens for advice. He recommended I insert a needle in the anterior fontanelle and drain off 150 milliliters of CSF. I inserted the needle and started draining fluid, but after only 5 mL it stopped flowing. I asked the nurse for another needle and tried again, but once again it stopped flowing after after only a small amount of fluid had come out. The fontanelle wad obviously still bulging with fluid, but something was not right.

I decided to go to the theatre (O.R.) and look for a bigger syringe, and I needed a minute to think about why my attempts weren't working. As I turned on lights and rummaged through drawers I mumbled inside my head something like, "God, this baby's about to die, so if you want her to live you had better do something for her because I don't know what to do." At that moment a knew thought popped into my head. Maybe the needle was clotting off with blood or clogging as it entered the skin, sonwhat about trying a needle with an introducer (a shaft inserted in the hollow part of the needle that is removed after the needle is in place). I grabbed a spinal needle, and as I walked back to the Peds ward I smiled because I knew I had found the answer. I inserted the needle and CSF flowed beautifully.

As I removed syringe after syringe of fluid, the fontanelle became flatter and she began to take more frequent breaths. After I had removed 120 mL's of fluid I could get no more out, and the baby girl was taking more regular, even breaths. I bandaged her head, ordered some antibiotics, and left. I was somewhat uncertain how she would do overnight, but yet confident that God had answered my spur of the moment prayer. She was so close to death, yet God brought her to me, and the moment I acknowledged my need for his help, he gave the needed wisdom and her condition reversed.

As I left the ward, I heard wailing coming from near the female ward, and found that a patient there had just passed away. I realized again that God is sovereign over the days of each of our lives, just as his word says. The next morning she was doing well, and has since had the needed surgery to correct her condition for the time being. God's ways are not always ours, but for His own glory he chose to spare the life of this young child that night.


Below are a few pictures of other children who have also been admitted with hydrocephalus and received shunts placed surgically to drain fluid from their brains.

Strange Swellings

Karanda is known for doing a great deal of surgery, and people arrive with all kinds of surgical needs. The picture below looks a little like a pregnant abdomen ready for a C-section.






It is actually a person's back, and below is a lipoma (benign fatty tumor) that I removed last week.






This patient has a recurrence of a malignant tumor, but returned seeking surgical help. I assisted Dr. Stephens in removing the cancerous portion last week.





Below are a few other patients with what we call "strange swellings" who present to the hospital seeking help. I praise God that Karanda is here and is able to aid in relieving the suffering and disfigurement experienced by these patients.

Clayton Mufambi

Almost two weeks ago, Clayton Mufambi arrived at Karanda with a huge, unsightly, foul-smelling tumor growing from his face and neck, seeking treatment. He was admitted and I assisted Dr. Stephens in removing the tumor from his face that weighed in at more than eight pounds.

Since then he has remained at Karanda while he waits for a skin graft to cover the area of his face and neck once occupied by the tumor. For the last few weeks I’ve seen him every morning on wards, where he greets me with a smile and friendly words.

Recently I sat down with him one afternoon because God had been impressing upon me a desire to find out more about him. He told me he grew up in a rural area but spent time with children of a white family, from whom he learned to speak English well. He has a wife and six children, and grows tobacco on a two-acre farm. At one point he had joined a Seventh Day Adventist church, but was forced to leave because he continued to grow tobacco on his farm. Tobacco is the only “cash-crop” grown in his area of the country. He says he would be given fertilizer in exchange if he grew corn, but if he wants to sell a crop that someone in his area will buy, the only current option is tobacco. As we talked he asked, “If I continue to grow tobacco, will God still be with me?”

The tumor on his face had been growing for about 3 years, and he finally went to a hospital in Harare hoping for a surgeon to remove it. He told me that many surgeons come to the large public hospital where he waited, but unfortunately would do the operation at their own private surgery centers where they charged a large fee. One day someone told him, “You’re wasting your time waiting here for surgery. You should go to Karanda.” Therefore he got on a bus and rode 2 ½ - 3 hours into the bush to Karanda Mission Hospital, hoping for someone to do an operation. He says that when he arrived, he was so weak that he was sure he was near death. He credits God working through Karanda and the operation he received for saving his life, and is now longing to return home. He said local people believe that God is present at Karanda, and that if it were to close, God would also leave.

As we talked, I gained insight into his understanding of God and the world, which helped me understand more of the world of the patients I treat everyday at Karanda. From the teaching at the SDA church, he understands the biblical account of the life, death, and resurrection of Jesus Christ, and says he has believed in him for salvation. Even though he has heard stories from the Bible, he was full of questions about heaven. “Will there be fields where we can work, and mombe (cattle)?” “Where will this place be? On earth, or in space, or somewhere else?”

We continued talking back and forth, and at one point he said with sincerity, “You say in heaven there will be no more sickness or pain. I know God has blessed the Israelites, but he has not blessed the Africans. In heaven, when God is handing out food, for example 2 kgs to one and 2 kgs to another, will he give 10 kgs to the Israelites and only a few grams to us Africans?”  

I shared the best I could about God’s love for all people in Christ, and how the Bible tells us that in Christ, God no longer makes distinctions between Jew and Gentile, slave and free, rich and poor, male and female, or even black and white. It was the “right answer,” yet I could see that every experience in his life has taught him that he is on the bottom rung of the ladder of this world.

As we finished talking, he told me about how he feels like he has two hearts; one that wants to follow God, and one that does what he knows is not right. He shared how his family and friends at home ask him to make sacrifices to traditional African gods, but he believes there is only one true God, and he is not sure if he is strong enough to say no once he returns home.

As an American, the thought of making an animal sacrifice to the gods of my ancestors is not a serious temptation. But what is he really doing? He is giving up something of value in the hope of gaining better crops, better health, and a better life, without acknowledging the One True Giver of all good things.  Working hard to succeed is a noble endeavor, but how often is my heart divided, being pulled to sacrifice time, energy, money, and relationships to the gods of financial security, successful career, or a comfortable life without acknowledging God and asking whether the path I am on leads to him or down the wide road that will prove to be empty and filled with despair when I reach the end?

 

We talked some more and I prayed with him before I left. I plan to give him a Shona Bible before he leaves, and mark some scripture verses to help him stand strong as he returns to his village and faces the pressure to return to the worship of the other gods of his traditional ancestral African beliefs.

On Call

This was my first weekend on call at Karanda. My first call came at 1 am Fri. night/Sat. morning for an urgent C-section. I had to concentrate a
little harder simce I has been a few months, but everything turned out well. As I was walking out the door to go home a nurse said, "we'll take the next patient back now..." I finally walked out of the hospital at 5 am and the sky was already turning pink on the horizon.

Saturday evening brought another C-section double-header, making 4 in 24 hrs. Sunday morning as I was finishing rounds just before church I saw a scrub tech walk out of the maternity ward and asked what she was up to.
Her: "C-section"
Me: "When?"
Her: "Now"
I missed church but I could hear a little bit of the beautiful Shona singing as I waited for patient #5 to be ready.

Saturday afternoon brought a 9 yo girl after a "road traffic accident." Her left upper arm was broken, with much of the skin gone and bone exposed through torn muscle. I called Dr. Stephens who does the Ortho surgery here, and helped him put in a pin to hold the bone together and then close up the torn tissue.

Being on call here gives an experience like no other, as we are small town ER and major referral center combined into one. I'm thankful for the competent African nursing staff here who are extremely helpful and make things run smoothly despite the occasional chaos and limited resources.

I did have another interesting case while on call this weekend, but I'll write about that later. It's a story that needs it's own page.

Land Cruising

I've always thought driving a land cruiser through a river sounded fun. To leave the hospital to go to Harare this past weekend, we had to drive through a river that crosses the road just below the hospital. During the rainy season everyone drives around the river which is an extra 30 minutes longer, but why not save time by driving through a river when you can?



We packed up the land cruiser and headed off to Harare on the left side of the road with me behind the steering wheel on the right. For the first few miles I repeated "left side of the road" out loud to remind myself I wasn't crazy. Driving on the left in the city traffic brought more excitement, but thankfully all went well. I may have grown too comfortable, because on the way home I got a speeding ticket. Twenty dollars later though we were on the road again. We had just reached our last major turnoff on the way home when we recognized a nursing student among a small crowd of people waiting for rides by the roadside. Hitchhiking is a common way to travel here. We pulled over to see if she wanted a ride. She said "yes, but..." looking at the four other people with her and then at our vehicle already full with 3 adults (we had Corrie, a short-term teacher with us) a baby, and a month's worth of food piled in the back. Five minutes later we had crammed in three midwifery students and two nursing students, Lisa and Jude BOTH sitting in his car seat and Corrie laying on top of the food and bags in the back.

We were glad there were no more police checkpoints. If we had left the ladies, they likely would have been dropped off by someone else at the last major road 4 miles before the hospital unless they were lucky enough to get picked up someone else headed to the hospital, which is rare late on a Sunday afternoon, especially since the weekly Sunday afternoon Karanda soccer game was away that week. Needless to say, we were glad we could give them a lift. Everyone but Jude was also sore and "squished" by the time we finally reached the hospital, but thankful that God brought us safely back home.

Chiremba Rick

"Chiremba" (doctor) Rick Moberly finished the fellowship last year, and after volunteering again at Karanda the last month, just left for home last Friday.




We had great times at the hospital, and as you can see here, wandering around "Karanda Town." Rick learned quite a bit of Shona last year, and did a great job of making patients feel at ease.


Just before he went crazy with the balloon animals, he introduced us to the Dokwane Eating House, the (only) local restaurant where you can enjoy sadza, greens, and meat of some kind, usually beef. Sadza is the staple of the diet here- sort of like a mashed potato paste but made from ground corn. If the right person makes it, it can be really good.
Rick is about to start a new practice in New Hampton, Iowa with several other Via Christi graduates. We'll miss you Rick. Fambai Zvakanaka (go well).

Zoster

This patient is recovering from herpes zoster, commonly known as "Shingles" of his left hand, arm, and chest. He has HIV, making him more likely to manifest this disease and to have a more severe case. It is caused by the reactivation of the virus that causes chickenpox, and usually happens at mid-adulthood or later. These kinds of "opportunistic" illnesses are seen everyday in the clinic due to the large number of patients with poorly-controlled HIV who are more susceptible to diseases that cause problems either rarely or not at all in healthy individuals. Great strides have been made toward the prevention, treatment, and de-stigmatization of HIV in Zimbabwe, but there is still a long way to go.

We are enjoying the Shona people and culture of this part of Zimbabwe. Most people I meet each day are quick to give a smile and a greeting in Shona. My favorite word so far is "Zvakanaka," pronounced similar to "Shhh" but with a "Zhhh" sound, and a "Spanish" A (zzzhaw) and it means "Ok," "Alright," or "It's all good." To really say it correctly you need to whistle through your teeth as you say the first syllable. I hope this finds you all Zvakanaka today.