Hello dear family and friends,
It has been almost 12 days since I left for Zambia. It feels like I just arrived but that somehow I have had a lifetime of experiences since arriving. The people of Zambia have the most beautiful smiles, laughter and voices. Some member s of the choir often practice next door and the sound is so amazing. I was privileged to hear about 2 hours worth of beautiful performances over Easter weekend. The children are often terrified of me at first. Many of them have never seen a ‘ghost’ before. J After a few days they often warm up and I get the most wonderful hugs and smiles and high fives(I’m teaching them this fun new greeting). The families are so grateful for anything you can do to help their child. They clap in greeting to one another here and this custom warms my heart when I am the recipient. Little children knock at my door any time I am home, often just to smile and talk whether or not they understand my language. The people are so peaceful. Violent crimes simply do not happen where I am at. It is strangely and wonderfully refreshing as there is less crime here than in the neighborhood around KU!
On the trying side of things, the limitations of the available medical care here are staggering. I have never experienced so much loss of life that should never occur. My heart has been broken at least a hundred times already, watching mothers and fathers helpless to provide the most basic provisions for their children. I am responsible for 3 wards: general/icu pediatrics(35-50 pts), the pediatric malnutrition ward (currently only about 15 pts, but commonly up to 30-40) and the special care nursery or NICU as we call it (currently 10-15 pts). We also see anyone from the outpatient clinic that the medical officer there is uncertain about.
There has been a sudden upswing in Malaria cases since I arrived. We are routinely having at least 4 or 5 children per day who arrived seizing or in a comatose state. Some days it is many more than that. I have run more codes, performed more lumbar punctures and seen more children die since my arrival than in all of medical school and residency combined. On Easter, we lost 5 children in one day. The resources are so limited. Do to financial limitations, the hospital is woefully short of supplies, medicines and lab tests. (warning: medical lingo in this paragraph!) I cannot even obtain electrolyte levels or cultures. There are no ventilators and only 3 O2 condensers for the entire hospital. A condenser provides approx 70% oxygen and max 5 liters of pressure (not much for the non-medical). There are no monitors of any sort, it is all clinical. I have approximately 5 antibiotics including chloramphenicol which is banned in the U.S. I had to intubate a newborn on Sunday using a laryngoscope with no light and an ET tube but no stylette so I used a flashlight and prayed really hard. We do LPs with 21G needles so if the patient has increased ICP, the fluid often shoots halfway across the room (or all down your clothing) initially. We were out of IV tubing the first week so no one could receive any fluids or infusions. We have tubing now, but have to calculate how many drops per minute the fluid should drip in at and adjust it by hand. Meds don’t come in the right concentration, so we get to mix them, often while a child is coding. There is no availability to perform functional echos or cardiac surgery so we’ve had to send babies home to die. We’ve done multiple IOs, I had to do a needle decompression of a pneumothorax based on clinical findings with no CXR (ours is now broken).
We’ve had alligator attacks, snake bites, horrific auto/trailer accidents, more broken femurs(thigh) than I can count. I’ve also diagnosed liver abscesses, schistosomiasis, pericardial effusions, TB of every organ, malaria, epilepsy, HIV, rheumatic fever, osteomyelitis, etc. I currently have a 30 wk premie in an incubator made from wood and light bulbs on a CPAP created with an O2 condenser and a cup of water. We have multiple 32 weekers surviving on room air and breast-feeding from birth, several home births who bring in the baby 3 days later. In our malnutrition ward, I have one child so malnourished that he weighed 5 kg at 3 yrs of age and another who is so edematous from lack of protein that his skin has been split open all over his body. The stories could go on forever.
I am staying directly across from the front door of the hospital. Customarily, when a patient dies, the entire family comes to the bedside wailing loudly. It is the most gut-wrenching sound I have ever heard. They then accompany the body to the morgue and leave through the front of the hospital where they continue their weeping for a few minutes longer. I am awakened multiple times a night by this sound. I think the chill of it may never leave me.
Daily God reveals more and more of my own selfishness and pride. It is painful in this place to realize how small we truly are. I pray that I never stop trying to care for each child as I would my own, but I also know that my own knowledge and skill will never be enough without His grace and mercy. In the states, there are many diseases we cannot cure, but we never have to leave the bedside of a critical child without a monitor to warn us if something is going wrong. I have never had to run 3 codes simultaneously without even a nurse in each room. I have never had to step over the patients on the floor because we were out of beds. I am working as hard as I can, but I cannot be enough. God has promised that when we are at the end of ourselves, He WILL be enough and He has been faithful through every moment.
I have no doubt that He has sent me here for such a time as this. Please pray for wisdom, strength and a willingness to let God continue to mold me no matter how painful the experiences are. My ‘scripture of the day’ this morning was “He who began a good work in you will carry it on until completion on the day of Christ Jesus”. It was comforting to me to know that God is consistently working on us and also that he does not expect the work to be complete yet. He simply expects that when He reveals an area of weakness that we submit that area to Him. How humbling that with all the suffering here, he is constantly comforting me.
I promise the next email will be full of more fun and happy details. I appreciate the prayers more than you can know. Please also pray for health for all the staff here as well. My supervising doctor is quite fatigued. I broke my toe pretty nastily last week and seem to have some sort of respiratory thing going on at the moment and am losing my voice. Your prayers have obviously sustained an amazing amount of energy and pep for me, it is definitely beyond human, as everyone attests! J I love you all and look forward to sharing more of the joys and happiness of Zambia in my next email.
All my love,
Amber
The server can't handle pictures but I will keep trying!
