Sunday, 2 June 2013

Masanga- Fallen mangoes and tears

Day 9's first memory was the sound of rain pounding heavily upon the tin roof, occasionally accompanied by the thundering of a mango hitting the roof, loud enough to make me jump out of my skin.
I checked on Steph after breakfast, by which point she was awake but feeling worse than yesterday, hardly able to sit up without holding on and feeling the earth spin around her. While she sat up, with her eyes closed to try to keep from feeling nauseous, she ate a fried egg for breakfast and we discussed the possibilities for the days to come. Should we wait for her to get better before we leave Masanga or could she tolerate traveling for minimum 8 hours upright in a car?
By the time I walked down to the hospital in the rain, rounds were almost finished so I discussed Steph's case with our doctor friends and then headed back to take her some meds and do a quick pack up of our things to move rooms later that day. The thing about having a sick friend is that there's only so much you can do and then there's nothing. They feel bad that they can't do anything and you feel bad that you can't help them feel better and that's where you are both stuck. So I lay on the bed beside her, her sick of laying down but unable to get up and me, wanting to lay down because I'm tired of constant activity and the constant heightened emotion.
After a review by the doctors and not much else discussed except the possible diagnosis of labyrinthitis and that there's nothing to do about it, I headed back to the hospital.
The path on the walk down to the hospital was littered with ripe mangoes, dropped off the trees after the heavy rain.

The hospital was quiet too, with rain pouring down intermittently. Patients were mostly staying indoors and out of the wet. There were hardly any admissions as the rain keeps the patients from traveling.
I did see some very nasty wounds though. I looked at a wound on a man’s foot. He is one of many patients who have had leprosy and now have terrible ulcers. This man had had an ulcer on his foot now for 7 years. The wound had a terrible odour and after the gauze came away we could see why. His foot bones were completely exposed. You could see at least 4 bones staring back at you, not covered by anything. There were no tendons, no muscles, no skin, just dead bone. The patient actually had no feeling in his foot from just above his ankle to his toe. Next week they will amputate below the knee. There are many wounds here that I have seen like this to varying degrees.
I also helped plaster cast a man’s leg who had been hobbling around on this badly damaged leg after an accident two weeks ago, using a thick stick as a crutch. He had a complete fracture of his tibia and fibula. The poor man could feel the bones grating together as he moved around and as we put the cast on, you could clearly see the leg bend and move where it should have been solid and straight. After the cast was set and he’d rested from the pain, he had a smile of relief plastered on his face. Every time I walked back into emergency where he was resting and we caught each other's eye, a giant smile spread across his face.
We casted another kid’s leg for a fractured femur and then I walked back to the hostel to check on Steph and move into our new quarters for the next two nights.
Once I was back at the hostel for an unknown reason, frustration peaked and overflowed inside of me. I closed myself off, turned the music on and dowsed myself in cold water, washing the sweat of the past day down the drain. As I sat down, refreshed and clean, the unshed tears of the past week reached my eyelids, but somehow still didn't fall.

We ended the day with dinner, a nice group of friends, candle light chats and precious pieces of dark chocolate. I thought that that would be it for the night and I would fall asleep, but as I settled in, hearing the sounds through my open windows of the outdoor wildlife, as though they were in my very room (perhaps some were) I couldn't sleep, as words and thoughts poured through my mind, eager to reach through my fingertips to paper and the cry in my heart became desperate to feel something other than just numb. And then in the pitch darkness they came and trickled down my cheeks and into my ears. But not nearly enough for the emotion dammed up, for the sorrow of lives lost, the sadness of disease and the hurt and pain of sickness. Not one heart can carry such a burden. So in the warm glow of candle light I gave it back to Him. Him who holds all things and keeps all things together. He will carry my burden.
Day 10 was the final day for me working in Masanga. I left Steph sleeping off her sickness, praying that she was improving and not getting worse and I headed down to the hospital.
Every day on the walk down to the hospital I meet people on their way to pump water at the well near the hostel. The children always stop and say, What is your name? To which I would also stop and tell them and ask theirs in return. Occasionally I would see the same child again but not very often. Most often the women and children walking past had buckets full of water on their heads or mangoes that they had collected from the ground.

After the morning meeting, I rounded with  Dr David and the students in emergency, then ducked into the paediatric ward to say hello to my pikins (Krio for children) and then I wandered into maternity and ended up finishing the round with them and finding fetal heart beats with the doppler and feeling for the baby positions.

Back up in emergency there were some new paediatric admissions with malaria. These kids come in very sick with haemoglobins of 50-60 (5.0-6.0 for those in the US), blood glucose levels between 0.9-5.0mmol/l ( 16.2-90mg/dl), most often fevers up to 39.0 C (102.2 F), tachypneoic and tachycardic and sometimes seizing. After now seeing many, many of these cases I know what to do and how to help and better assess and look after the patient. Today was another day of practicing what I'd learned because in the later afternoon these admissions started pouring in and before I knew it every bed and more were filled with children ranging from 5 months - 3 years old, all positive for malaria, all with burning fevers, lethargic, pale and barely crying when poked with needles.
After getting things under control, blood transfusions running, fluid boluses, IV lines inserted, NG tubes placed, my friend Dave and I walked out after 6pm. Sadly that was the end of my days working in Masanga hospital. I’m sad because I have truly come to love it here. Although I don't know in which capacity I might work here for a longer period of time, I loved the friends I made in the patients, nursing staff, doctors and students and I will truly miss them. Perhaps there is a seed planted here for the future. I will let in sit in good soil and see what comes. For now though, there is still plenty to wrap my mind around in all the things that went on while I have walked my flip-flopped feet around this hospital.

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