2 Kings 5

Tuesday, September 17

I have focused over the last few days on  specifically taking captive my anxious thoughts and actively evaluating them against what I know to be true.  This is one of those things that sounds so easy but is really hard to practice. It is much easier to be caught up in the whirlwind of insecurity and doubt as your heart rate and blood pressure soars.  There is so much to stress and worry about and yet the point of my being here is completely lost if that is where I spend my time. I will chose to be present in the moment, do the best I can with the issues at hand, and trust God with the rest.

We had our typical Tuesday morning meeting on the ward.  The singing is always so wonderful and I wish I could record it to share but it would simply not be appropriate.  It is true worship. Sam had the devotional today and spoke out of 2 Kings 5. I immediately felt God’s special hand in it as this was the Bible Story that prompted me to ask Jesus to be my Savior as a little girl.  He spoke about how even a captive doing her duties brought healing physically and spiritually to her master and his house. He spoke that as we at the hospital go about our duties we are able to accomplish the same things.  It felt like reassurement especially for me.  

We also talked about nursing responsibilities at the meeting with Sam and the nursing supervisor openly directing the students to have specific patients, follow them, and be present and active on roundS. It really seemed to have a good impact and today with rounding we were not having to search for translation help. A few of the nursing students also asked great questions and seemed very interested in learning.

The little one with heart failure looks better in some ways as a lot of her edema is gone with the use of diuretics over the past few days.  However, now her frail cachectic frame is revealed. I teared up as she stood for her chest X-ray today, so pitiful. He mom and dad are diligent by her bedside.  Her sweet father stroking her hand and giving her sips of juice. I asked Sam if he thought the patents fully understood the terrible prognosis this girl has. This led to a discussion about cultural practices here. When patients are given terrible news of terminal illness and pending death they seem to calmly respond with “yes doctor” or “thank you”.  Evidently tears are saved for after death and by showing emotion before it is almost as if you are asking for it. Additionally, you see large numbers of people here with patients. Both sides of the family are expected to be present to support the patient. In fact, if a person is missing and the patient dies that family member is likely to be blamed for the death.  All of that helped me understand a little better what I see and I love that the Malawians were open to share.

One of our puffy kids was dramatically worse today.  His kidney function and urine output are terrible and the edema is worse.  I contacted our ambassador at KCH the hospital in Lilongwe and they accepted him for a nephrology evaluation.  Additionally, the baby with the distended abdomen had worsened overnight and still has not stooled which signals an obstruction or Hirschsprung’s disease.  I referred him to KCH as well. We were happy to have the two at the same time so they could share the ambulance and the cost. Transport seemed to take forever to arrange.  Finally, it was revealed that the bill was the problem again and an organization that usually helps with the cost was just not returning the call. So, I just went to the business office and paid the tab and the ambulance was quickly loaded.  

I think I have talked about the ambulance transport before.  However, it is always fun to watch as parents, grandparents, patients, pots/pans, firewood, etc. are loaded in the back. I watched and took a few pictures.  

After the ambulance left, we were fully into lunch time. Lisa and Rinske had put in my taco order and I sat in the grass and waited with them.  Amelia came by with the kids and we caught up a little. Her state respresentatives and congressmen have responded to their calls and emails and they have submitted forms that allow them to make request on their behalf.  So hopefully, with their help they can move along their adoption process. She has been here for about 3 months and her kids have some medical issues that need to be addressed in the US. We are praying that the consular will come on Wednesday to complete the necessary interviews.  

Taco Tuesday did not disappoint again.  It was a long wait today but when you are talking with friends under a shade tree it is okay.  It was a very hot day today. First time I have really just felt hot and sweaty through the day.  As I am typing there is a cool breeze blowing and it is comfortable but I think summer is on its way.  

The afternoon was good in that we were able to review patients’ progress through the morning, adjust medicines and check doses.  We did find one that we thought the clinical officer had seen but she had not. We were able to discharge them home with their asthma inhaler attached to a cut off water bottle to act as the aero chamber.  You do what you can!

We had one admission with bronchiolitis vs. pneumonia.  We only do chest X-rays if we absolutely need to because of the cost and that makes diagnosis sometimes a little tricky.  Marleen and I ended the day on time with a little time for discussion and talking through a few conditions and treatment ideas with the medical students.  I felt really good about the day. Kids are still very sick but today all got good treatment, appropriate attention, and have a good plan for care going forward.  I also went a full day without having to ask Catherine any questions which is a great bonus!!

I am looking forward to an evening of tacos, reading, and an early bedtime.