Reflections on Pediatrics

A post from Marc:

I have just come to the end of 2 months of taking care of pediatric patients here at Galmi. I have posted very little in my time here about the medical care that I’ve been doing. These 2 months have been very difficult for me both professionally and personally. I have wrestled with a lot of different emotions and have had a hard time wanting to write much about what has been going on. I have never seen so many sick and dying patients in my life. I regularly feel inadequate to care for the patients that I see in the clinic and hospital. 

Day after day children are brought to Galmi from great distances by parents who are looking for answers to their medical problems. And many times I look at their sick children and have no answers to give. I don’t know why they are so sick, why that mass is growing or what it is, how to cure their seizures, or paralysis, or respiratory distress… 

Almost every day I admit a child who is critically ill. I look them over carefully, ask questions, do an exam, think through the list of possible diagnoses, think about the labs and imaging studies I would like to order. But because of the limitations of our hospital, or the parents’ resources, I usually cannot get all the labs and x-rays that I would like and that would be readily available in the Unites States. Or, I think about the specialists that I would like to consult: a pediatric cardiologist, or nephrologist, or pulmonologist, or neurologist. But there are none. The patient is stuck with me. So I make by best educated guess. I start medications, give IV fluids, pray…  

Often I think about these children during the night. Did I make the right diagnosis? Did I choose the right medications? Sometimes I go back to the hospital late at night to check on them. I pray some more. I look at Eli and Hailey and think about what these parents must be going through. I remember when Eli spent 3 days in the hospital. He wasn’t nearly this sick, and I was a wreck as I worried about him and grieved for him. What are these parents thinking as they see their children in such distress? 

Almost every morning when I get to the hospital to see the kids I admitted the day before, I find an empty bed. A child and mother are gone. I try to think positive, “Did they change beds? Are they getting an x-ray? Is the mother away buying food for the day?” But then reality sets in. I walk to the nurses’ station and pick up the black book that sits on the corner of the desk. I look for the bed number and the child’s name and my name as the admitting doctor. My heart sinks. The patient died during the night. 

Then the thoughts come, “What happened? Did I get the diagnosis wrong? The medications wrong? Not enough IV fluids? Too much IV fluids? Should I have given a blood transfusion? Not given a transfusion? Was the child too sick to save? Would they have survived in the U.S.?” I often talk to Ruth, a physician from Northern Ireland and my partner on pediatrics. We round together in the hospital and see patients together in the clinic. “Did I do the right thing?”,  I ask. “What could I have done differently? What can I change next time? Should that child have survived?” 

And then often she tells me her story. She lost a patient, too. We listen to each other and try to convince ourselves that we did our best.

The first 6 weeks were very hard. I felt depressed at times and wondered if I should even be here. "Am I cut out for this? Have I been trained well enough to take care of these people? Am I making a contribution?" But thankfully, I feel like the darkness has lifted. I am finding joy in my job again. I've learned a lot, and I think I provide better care now than when I first arrived. But I also think I am learning to handle the stress and the loss and the grief a little better. I can focus more on some of the good outcomes - the children who are still in their beds when I arrive in the morning. The patients who came in dehydrated, and febrile, and sick and who go home well. The smiling kids and moms that I see in clinic who are thriving. The patients in the malnutrition unit who are gaining weight and get to go home much healthier than when they first arrived. And I think about the spiritual implications of our work. Hundreds of patients a day come to the hospital and hear about God's love for them.They find compassion and a healing touch. They learn about a God who loves them so much that he sent his Son into the world to die for them. And they see people who were sent by that same God to care for them and heal them.

And so, at last, after nearly 10 weeks, I feel that I am finally settling in. I am making a positive contribution here. My presence matters. I feel satisfaction in my job. I have joy in the Lord. I am glad we have come. I feel back to myself. And so now I am ready to tell you about a day in the life of pediatrics...

I usually arrive to hospital around 8 am and enjoy a good laugh with the nurses as I try to greet them in Hausa. Most of them speak Hausa and French, but not English, so I am happy to find Tchissou or Mammane, my wonderful translators who are my mouth and ears in the hospital. I gather my charts and meet up with a nurse and with Ruth to start morning rounds. 

A nurse, Ruth, me and Tchissou 

We usually have 6 to 12 kids in the hospital each day. A pediatrician who worked previously at Galmi painted several large pictures depicting the story of Noah’s Ark. They hang on the walls above the children’s beds. Each morning as we do rounds a local evangelist and a missionary come by to talk about Jesus or tell a story from the Bible and to pray for the patients.

A missionary and evangelist doing morning rounds

This was a two week old who recovered from sepsis. This was the mother's 11th child. Five of her children have already died.

A 7 week old with gastroenteritis

A 10 month old recovering from malaria

A 1 month old with malaria and dysentery. This mother was mixing formula with contaminated water because she didn't have enough milk for her twins.

A 1 year old with vomiting and dehydration

After hospital rounds we make our way over to the pediatric clinic, or PMI (French acronym for Protection of Mothers and Infants) as it is known here. The building is also called Gidan Yara (“House of Children” in Hausa). 

Rufai, a local health worker, in front of Gidan Yara

Mothers and children in the waiting room

Abdu and Rufai - local health workers - screen all of the pediatric patients. They treat malaria, dehydration, pneumonia and many other illnesses. If they feel a child is too sick for them, they get referred to one of the doctors. They also manage the malnutrition unit and administer vaccines in local villages. I love these guys. We have become good friends.

Seeing patients in the clinic with Tasala - another wonderful translator

At 10 o’clock I head home for the morning break to visit Stephanie and the kids. I go back to the clinic at around 10:45. At some point in the morning, we usually visit the malnutrition unit to check on the patients there. We look at their growth charts to make sure they are gaining weight and see anyone the health workers have concerns about.

If someone looks sick we bring them to the outpatient department for a closer look and decide if they need to be admitted to the hospital.

A malnourished girl who was readmitted for refusal to eat. After a few days with a feeding tube she is now doing well and was sent back to the CREN this week.

At 1 o'clock we break for lunch. I get to spend 2 hours at home before going back to work from 3 until 6 to take care of little ones like this!

After the last clinic patient is seen, I usually go briefly to the hospital to check on lab work and any children I am worried about that I admitted earlier in the day.

11 month old with severe pneumonia

Then home at last (if I'm not on call!) to enjoy some family time after a day filled with blessings and joy, heartache and pain, life and death. I'm glad we are here. I think these little ones are, too.

Recent Happenings

I have some pumpkin bread in the oven and the kids are well into their nap so I thought I would update you a bit on what has been going on lately....

This was dinner by candle and headlamp light the other night during a power outage. Eli loves getting to wear that thing!

Eli is beginning to learn some Hausa phrases. The other day some men were working on our air cooler and Eli greeted them with a "Sannu," "Ina kwana" which means "Greetings," "How was your night?" which is a typical greeting to someone in the morning hours. This was completely unprompted by me since I was in the kitchen pouring some cereal for the kids. Eli just greeted him through our screen door. The shop worker got such a kick out of this! Eli also tried to greet our house worker one day with a "Sannu" "Baba ganouj." For those of you who have never eaten baba ganouj (which was us about a month ago), it is a Mediterranean appetizer dip made from eggplants. I had made this the day prior and Marc and I were trying to teach Eli how to say it since it is a funny word. He obviously assumed we were teaching him some more Hausa though. :) Eli has also finally learned his colors. We have been working on this for nearly six months. He could always group colors together but could not name them until just a few weeks ago. He also really loves counting things right now. He recently showed us that he has picked up counting to ten in Spanish from watching Dora the Explorer.

Marc is transitioning some into adult medicine this month and is working with one of the physicians here who does all of the HIV care. He really enjoys watching how this doctor incorporates medicine and faith together as he daily share stories from the Bible with each of his patients on morning rounds. This week they saw a man who, on ultrasound, was found to have a large mass in his liver and lung which is presumed to be a cancer. There is really nothing that can done for a patient like this in a country where the resources are so limited. This man was told he did not have much longer to live and was sent home after meeting with the evangelist. These situations play out literally hour by hour for Marc as he sees people that he can unfortunately not make well. Jesus is really the only one who can bring hope and healing into situations as difficult as these. Marc has been encouraged to watch the evangelists who work in the hospital each day sharing the Good News with these patients and their families.

Hailey is lots of fun these days. She is really cuddly and loves to give hugs and kisses to us and Eli. She has learned all the features of the face and loves to poke and prod on my face while she names each one. Every time she gets to "nose," she feels the need to stick her finger all the way in my nostril while saying "Nnnoooossseee." I try to stop her before she does it (it hurts!), but she thinks it is quite funny and often catches me by surprise. :) She must be getting taller now because when she leans all the way forward in the baby swing, she can drag her feet. She also thinks this is really funny though it makes pushing her quite a challenge. Now that I think about it, she thinks a lot of things are funny lately that I don't think are quite as funny. :) She has this mischievous look that she gives me when she knows she is doing something that she shouldn't. I remember Eli had the same look at this age. Nonetheless, she is a gem and we adore her.

                                                Eli reminding Hailey he is still taller than she is

As you can tell by yesterday's post, I have really been enjoying the time during the day that I have to cook. It is so fun for me and certainly the way I decompress any stress. My dad told me recently on skype that I looked like I had lost some weight so I went ahead and ate FIVE of the chocolate chip cookies I made the other night. They tasted really good and he had me convinced I needed to put back on a few pounds. :) We are starting the Beth Moore "James: Mercy Triumphs" video series with some of the ladies here this weekend. It is going to be great. I was so encouraged after doing the first week of lessons and watching this first video.

This is Hailey's favorite spot in the kitchen. She has learned if she positions herself between me and the cabinet and says "bite" enough times that I will continually feed her as I cook.

The weather in Galmi is getting hotter I assume (but we have no thermostat to know what the high is each day). However, it doesn't really feel much different from a few weeks ago. It is a dry heat so you really don't sweat that much. It has been nice having a working air cooler for the past few nights and the kids sleep much better during their naps when I turn it on. April and May will still be the hottest so we have a ways to go before we can say we have "conquered" the desert heat. :) We had several power outages last week (as you can tell in the first picture) but not very many so far this week. We feel like we have all (kids included!) adjusted very well over the past few months. This is such a testament to both of us of God's grace because there are some major differences in our day to day lives.

Well, that is a quick update but the bread is now cooling on the racks and the kids are awake and crawling all over me wanting to play. Have a great day!

Changing it Up

Do you ever feel like you cook the same meals over and over? I feel that way alot but never want to gamble on a new recipe that might flop. I took some time before we left for Africa and did some recipe searching on allrecipes.com. This is my favorite website for recipes because the comments help me to cook it right the first time and know if there are any adjustments that should be made to improve it. We are also limited here by what produce is currently in season and available, and this has forced me to branch out a bit. I decided to link you all up to some of the new things we have tried since we have been here. I only put up the recipes that we liked and that we will eat again. I would suggest reading some of the popular comments on each recipe. I changed up each of these recipes a tad (or sometimes a lot!) and really rely on those comments to make any needed changes. I hope you can snag a new recipe or two for your collection. :)

Shepherd's Pie
Morning Glory Muffins
Banana Chocolate Chip Muffins
Banana Crumb Muffins
Peppy's Pita Bread (I also use these to make some really yummy Pita chips)
Virginia's Tuna Salad (I really changed this one: added 1 Tbs. parmesan, 1 tsp. dill weed (instead of the relish), 1/2 tsp. lemon juice, 1/2 Tbs. dried parsley, 2 boiled eggs and less tuna, no celery)
Meghan's granola (I made lots of changes on this one based on what we have here but this was the base recipe)
Cabbage Sloppy Joes (I needed to find a good use for some extra cabbage that we had and found this tasty recipe. One of the wives here gave me a "40 min. hamburger buns" recipe that is easy and GREAT.)
Italian Bread Bowls
Balsamic Dressing
Fried Rice (I left out the shrimp, ham, celery, and peas because we don't have them but it was still quite tasty)
Black Beans and Rice (thanks to everyone who recently sent more black beans! We all love those and can't get them here in Niger.)
Lentil Tacos (we LOVED these and Marc couldn't believe that they were vegetarian)
Mexican Rice
Chocolate Chip Cookies
Eggplant Supper Soup (I used 1/2 lb. of ground beef which seemed plenty and 6 fresh tomatoes with 2 tsp. of Italian seasoning)
Tuna Noodle Casserole (I used macaroni noodles and made our own condensed mushroom soup)
Pumpkin Bread (I'm making this one in the next day or two but it looks tasty so I included it! I'm planning on doing half oil and half applesauce and using 1/2 brown sugar mixed with the white)

Can I just say how amazing it is to have Eli (our picky eater) gobble up nearly everything I make now??? Eli would never have eaten anything on this list above before (except for the chocolate chip cookies), but he loved each of these dishes and usually asks for seconds. There are fewer snack food options here so he is usually more eager to eat at meal time and he learned very quickly that if he didn't eat what was served he would be hungry. :)

It just doesn't get much better than enjoying some homemade salsa....

and Coca Cola! This is one drink you can find most anywhere in the world. :)

Happy cooking!

Mail Has Arrived!

We received our first package from my mom on February 11th (which was shipped on January 19th) and were in eager anticipation of some other packages that we knew were in transit. Someone brought our mail to us on Monday and there were five packages! Thanks to all our family who helped to restock our food supply. You all did great! Eli and Hailey loved seeing what was in each box and finding the little treats that were for them. The fruit snacks, gummy bears, teddy grahams, and cheerios were a big hit with the two little ones. Thank you for loving us so well. Here are the highlights in pictures.

Opening our first package that arrived back in February...

Round two of packages arrived on March 5th...

Marc's mom sent some caramel corn for his birthday when she mailed this package on January 19th. We were shocked to find that it still tasted fresh when it arrived seven weeks later!

(We opened the boxes right before bed which is why their toothbrushes made it in most of the pictures.)

 Memaw sent me some pecans from the trees in her yard which I loved, but the kids were more interested in the gummy bears. :)

Grandma and Grandpa Carrigan sent us some goodies from Peoria!

This was such a great day. It is a real treat to receive some mail... and even better when it is mostly edible! Ha! I have a couple half-done posts that I hope to finish out in the next day or two to update you a little better on our recent happenings. Have a great Wednesday!