Warning: The following blog post contains graphic pictures that may be disturbing to some, and is likely to cause tears, and is also an unashamed plea for money.
One of the things they taught us in medical school and residency was to be somewhat disimpassioned. Don’t get too caught up with your patients, don’t get too personal, don’t empathize too much. I know that sounds heartless, but to do our job effectively, especially in surgery, we can’t identify too closely with our patients. If we did we would never be able to do our job. If we thought too much about the suffering of our patients it could easily get overwhelming and one loses ones objectivity, and then judgment is sacrificed and finally good patient care. That is why we are not supposed to treat family and close friends. That, and because they ALWAYS have the worst complications.
Here in Tchad it would be really easy to get overwhelmed by the suffering we see around us everyday, all day. It isn’t that there isn’t suffering in the developed world, or really wild bizarre pathology, it’s just that it isn’t normal to see it every day, all day. For instance today I had a lady with a huge, I mean huge, breast cancer, the whole lateral aspect of her breast is one big fungating, ulcerated mass. There is no way to get flaps to cover the defect if it is removed, she has an abdominal mass as well, probably a metastasis, and of course lymph nodes under her arm as well. Her hemoglobin is four. I can not remove this mass with killing her because she will bleed to death on the table. Friday I did a upper leg amputation for a young man who, a month ago, was in an accident and broke the end of his thigh bone (femur). The end of the bone came out through the skin behind his knee, taking with it the nerves and major blood supply to his lower leg and foot. So he has foot drop now. He also had 2 inches of dried rotten femur sticking out of the back of his knee, and a small opening on the front of his leg that literally squirted a fountain of pus 2 inches high each time we moved his leg. Thankfully I was able to convince his father that the leg was not worth saving, so we did an amputation and left the leg open.
One evening last week the nurse comes to my door just as we were sitting down to dinner.
“Docteur, a patient is here with a dental abscess he has had for the last two weeks. He is in a lot of pain.”
“Ok, I will come after dinner.”
He had been sick for two weeks, how urgent could this be? So after a nice leisurely dinner I strolled over to the hospital. “OK, Rafine, where is the malade (read “patient”)?
“Oh, he died 5 minutes after I came to get you.”
HE DIED? What kind of dental abscess is that? Not one I want for sure. And this is just the last few days, pretty much every day has its own little surprise in store for me. Oh, I forgot about the guy with the hernia with quite literally half of his small intestine in his scrotum, been that way for a long time. And although this was the largest one so far, the hernias here are ginormous. I can’t imagine having that volleyball between my legs all the time. (For those pictures, visit the surgical pictures page, if you dare, followed by a deep guttural Vincent Price type laugh.)
But twice since I have been here I have been pushed to the edge. Two times I had to blink back the tears and try really hard not to think too much about what it is like for these patients. Both times were for little kids with Burkitt’s Lymphoma. I included pictures so you can share my pain and more importantly their pain. But I have to tell you, pictures do not come close to doing this disease justice. It is horrifically dreadful.Burkitt’s Lymphoma is a type of lymphoma (cancer of the lymph system) that is endemic in high malaria areas. It manifests itself usually as a swelling in the face, and if untreated can cause gross malformation of the face and jaw and swelling around the eye. There can also be abdominal tumors. Usually these are in preschool age kids, little ones who can’t understand what is happening to them. They have a hard time eating and drinking because their jaws and mouth don’t work right. They can’t see out of one or both eyes, they constantly drool, they cry, the swelling is uncomfortable at best, painful at worst. They are sickening to look at, partly because of the grotesque deformity, and mostly because the suffering hits you right in the mouth. But, and this is a big but, it is amazingly treatable, with single agent chemotherapy. Cyclophosphamide works wonders in these kids. It cures over half of them. They get a dose every three weeks until the tumor is clinically gone, then one final dose. The first kid I treated came back for his second dose. He looked normal. The next two, were the two worst ones I have seen. They haven’t come back yet, and they may not, they may not survive, or maybe their parents don’t have the money to pay for treatment, who knows. But it is their only hope, and only help.
Now for big but number two. There is no cyclophosphamide in Tchad. In fact as far as I know, there are only two places in Tchad that kids can get treatment for Burkitts, Bere and Moundou, the two Adventist hospitals. And we have it only because we purchase it in the US and we or our volunteers bring it with us. The stuff, as you can imagine, is not cheap, over $100USD a gram. We usually treat the kids with between one and two grams depending on their weight. Since the medication is donated, we can’t charge for it, which is just as well since no one could afford it anyway.
I have one gram of cyclophosphamide left, Bekki is going to try to get more while she is in the US and bring it back with her. If your heart has been touched and you want to help financially please send your tax deductible contribution to The Clarkston SDA Church, PO Box 548, Asotin, WA 99402. Put on your check that it is for the Africa Mission Fund, for Burkitts Kids. And if you send me an e-mail, or a comment on the blog site that you have donated for a Burkitts Kid, I will do my best to send you a before and after picture of a kid you helped save. Thank you on behalf of all our Burkitts Kids.
For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital, where we initially were to be. Soon there will be a new video about Moundou. There is also the Surgical Pictures Page, but be forewarned, it has some very graphic pictures, so if you don’t like blood and guts, stay away from that page. You will also find links to other missionary blogs such as Olen and Danae Netteburg, Jaime and Tammy Parker and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us. For our Francophone friends there is a French translation of our blog that you can find at http://gardnersenafrique.wordpress.com.
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