17.9.14

My Medi-Vac Story

By Jess Cropsey

Last Friday was one of the craziest days of my life.  My back had completely gone out almost 2 weeks before and I was bed-ridden for a few days.  After some time, I was able to start walking again with the help of crutches and even for a day or two without any crutches at all.  By Tuesday, the nerve pain in my left leg was so severe that I was only able to lie face-down on my bed.  Any movement at all was excrutiatingly painful.  I know many people have stories of back pain like this, but I was feeling particularly sorry for myself — I was in the middle of nowhere in Africa with no access to medical care for this problem and the in-laws were leaving the next day.  How long was this going to last?  I was completely helpless and my husband and teammates were having to take on watching my kids, preparing meals, changing diapers, teaching, etc.  After several days of lying face-down in bed (with several pity parties in the mix) and exploring various options, we decided to pursue medical assistance in Nairobi.  We had met with a neurosurgeon there several months ago when I was having more moderate pain and he came highly recommended.  We consulted our neurosurgeon friend in the States and then decided to take the surgical plunge.  

We contacted the insurance company to make the necessary arrangements and they organized an air ambulance evacuation.  What?!  A whole airplane just for me?  I’m thinking this seems way over-the-top, but I also know that I would never have been able to sit on the commercial flight from Bujumbura to Nairobi unless I was under the influence of some serious medication.  So, Friday morning, John laid down the seats in the back of our Toyota ProBox, put in a mattress and I made the tortuous 30-meter journey from my bed to the back of the car and once again resumed my face-down posture.  After a 2-1/2 hour drive down the windy mountain road, we arrived at the Bujumbura airport and John worked his magic on how to get us back to the airplane.  After discussions with several security officials who incredulously peered into the back of the car at this crazy white lady, we were escorted onto the tarmac via the car and I hobbled into the airplane that had a stretcher where I could lay down.  John enjoyed the snacks and drinks provided by the healthcare professional while I tried to ignore his munching so that I could be ready for surgery that day.  

Upon arrival in Nairobi, we were transported in a brand-new, first-class (as far as I could tell) ambulance that whisked us away to Nairobi Hospital.  They even used the siren to get through the horrendous traffic.  We had already contacted the neurosurgeon to let him know we were on our way.  We settled into a nice bay in the ER, where we waited for almost 9 hours to sort out insurance approval.  We met with the neurosurgeon late that night and I wolfed down my first meal of the day after discovering that surgery wouldn’t be happening right away.  Around midnight, I was admitted and once again struggled to move from one bed to the next with the Kenyan nurses continually saying, “Sorry, sorry!”  

The next morning, I was taken for an MRI and scheduled for surgery later in the afternoon.  The MRI showed a ruptured disc in the L5-S1 portion of my spine and this was what caused the nerve pain and numbness in my leg.  The plan was to perform a micro-discectomy.  

I’m not much of a trooper when it comes to pain, so I was pretty eager to get this taken care of even though I am terrified of all things medical done to my person (I even despise IVs) and having surgery in Africa has always been one of my greatest fears.  When the time came to be wheeled away, it all started to sink in.  John kissed me good-bye after looking at the scans with the surgeon.  I started to cry as the nurse wheeled me down the ramp into a basement hallway area that smelled like a swimming pool.  Being in a foreign country, with foreign doctors, in a foreign hospital, and completely unable to move made me feel incredibly vulnerable.  At least they spoke English!  So I prayed fervently that God would help me be brave, that I would see my husband & kids again, and that I would be able to move my legs & toes when I woke up from surgery.  Once I was wheeled into the OR with a single table in the middle of the gigantic cave-like room (that did have some modern equipment in it, thank the Lord!), I was only awake for a few minutes before the anesthesia kicked in.  I have never been so thankful to go to sleep.  

I woke up in a total fog, observing from the clock that it was 4 hours later than when I left for surgery.  What did that mean?  Did things go poorly?  Check — yes, I could wiggle my toes.  Thank God!  The doctor asked how my pain was and I said my back hurt.  She must have given me more juice because I went back to sleep.  

I have had small improvements every day post-surgery.  Each of these gave me hope that some day I might actually feel normal again.  Words of encouragement from many friends & family members were a huge boost as were the many prayers that were lifted up on my behalf all over the world.  I am happy to report that I am able to walk and sit in moderation.  Please pray that the remaining numbness in my left leg & foot would completely resolve.  I was discharged from the hospital today (Wednesday), have a final follow-up visit with the doctor on Thursday, and then travel home to Burundi on Friday.  

I AM SO THANKFUL…For good health insurance and the access that we have to quality medical care, even if it isn’t immediate access.  My Burundian friends would never have been able to get the care that I received.  But as I sit here in this modern hospital, getting vital signs checked regularly, with access to MRIs, medications, and doctors with specialty training, I know that this is what we are praying for and working towards in Burundi for the future.  

I AM SO THANKFUL…For my awesome teammates in Burundi who have cared for our kids while we’ve been away.  For my mom who is coming back to Burundi to stay for several weeks while I recuperate.  For John who has patiently cared for me and been my medical advocate.  For my kids who have taken care of me and who have been so brave while Mommy & Daddy have been away.  For the team of doctors and nurses at Nairobi Hospital who have provided excellent care.  For a wonderful bed on the ward that has a big window with a nice view.  For the visitors (several missionary friends from our Kenya days) who have come with food and flowers.  For Java House strawberry milkshakes.  For a God who is faithful and loves me with an incomprehensible love and who I can have complete faith in whether or not I regain the same physical strength that I had before. 

I’ll leave you with a verse that a dear friend shared with me:

Psalm 94:17-19
If the Lord had not been my help, my soul would have soon lived in the land of silence.  When I thought, ‘My foot slips’, your steadfast love, O LORD, held me up.  When the cares of my heart are many, your consolations cheer my soul.

8.9.14

Imvunja

by Rachel

There is about one textbook in the whole world for learning Kirundi.  Maybe there's more, but only one I've ever seen.  It was written by Betty Ellen Cox, a missionary who actually used to live at Kibuye years ago (her house is still here).  I remember flipping through the manuscript and dismissing it as "irrelevant" (before I arrived at Kibuye).  The lessons featured vocabulary that I was not at all interested in learning, and, I was convinced, would never need to be able to say.  Why would I want to know the phrase for "the woman is hoeing" (Umugore ararima)?  Or the word for a jigger (imvunja)?  I mean, what is that, even?

Ah, the folly of my pride and ignorance.  What I apparently didn't understand was that Betty WAS giving the most appropriate vocabulary for our daily lives at Kibuye.  Every last person around here hoes. And carries hoes on their heads.  And builds our houses with hoes.  Jiggers?  Well.  Let's just say they have been the secret scourge of the McCropder team here in the past 2-3 months.  I mean, we're not talking ebola or HIV or even African sleeping sickness or Lyme disease, but jiggers are pretty gross and painful.  They are little tiny black insects that burrow into your feet and lay little egg sacks inside.  I know, gross.  Don't keep reading if you're not interested.  A few people got them while we were in Banga, but since the start of the dry season around May, every last one of us has become "infested."

It goes something like this.  We examine our feet and find what looks like a blackhead zit or a small blister with a black center.  They usually show up next to the toenails but sometimes on the heels.  I'm not sure what would happen if we didn't ever remove them.  Don't want to find out.  If the jigger is discovered in a kid's foot, the next step involves wailing and gnashing of teeth, bribery and cajoling.  You can remove a jigger with tweezers or toenail clippers and a lot of squeezing, like popping a giant zit.  The next step (again for the kids) involved finding colorful bandaids, suckers, or other treats.  Then resolving to wear shoes and socks for the rest of your life.  Until the next one shows up…  In the end, I am super grateful that we don't have more dangerous wildlife around us.  No poisonous snakes (or even regular ones that we've seen), no scorpions or tarantulas or stray/rabid dogs.  Jiggers might be a bit irritating, but certainly not dangerous.  Even so, here's to hoping the rainy season brings a reprieve from our little black "friends."

5.9.14

COTW: Buying Time

(from Eric)

Claudette was first admitted to the hospital 6 weeks after having a baby, just after the cut-off of getting "free" care from the government.  She had swollen legs and a blood pressure through the roof.  Her eyes were blurry.  She is 23 years old.  Her baby (as would be normal here) stayed with her, but (as would not be normal here) she was otherwise quite alone.  I believe she has a husband, but I never saw him.  We started her on some medicines, hoping that this was a weird late manifestation of a pregnancy complication, and that she would get better soon.

She felt better a few days later, and we discharged her.  She hung around, waiting for her family to show up and pay her hospital bill.  They didn't.  About a week later, still waiting, she got sick again, not having bought her outpatient pills either.  Blood pressure still high, this time with fluid in her lungs, making her breathing very difficult.  We admitted her back into the hospital and started her back on treatment.  We checked her kidney function, and found that she didn't really have any (in American units, a Creatinine of about 22, but in our units >1500, which makes it sounds even worse).  At this point her prognosis is getting worse.  The baby is still her only companion.  We don't have a hospital cafeteria (yet) and the other patients' families were helping her to find some food.

Somewhat against expectations, we pull her out of her crisis, tried to control her blood pressure a bit better, to protect what little kidney function is left.  Finally, she is stable, and we discharge her again from the hospital.

She waits some more.  No one comes.

On the day that we admitted her to the hospital for the 3rd time (due to another downturn in absence of appropriate support), a family member shows up.  They want to go home.  I don't blame them, but now is not the moment.  I know her prognosis is poor.  I know we can't change that.  I want her and her baby home, too, but I think if we wait a day or two, we can get her a longer stay at home before she gets home.

We're buying time.  Often, that's exactly what we're doing.  It's the reality of medicine in a mortal world.  Even if you "save a life" of an otherwise young healthy person, you're really "buying time", just more of it.

In a sense, that's what we all want.  More time.

For Claudette, for her baby, there's not that much we could do to buy her much time.  She needed dialysis weeks ago.  She needed intensive monitoring of her blood pressure and her electrolytes.  And she didn't get that.  But hopefully she got some time.  

And maybe we would all do well (since we are all in the same scenario after all) to shift our focus from the amount of time to the type of time, the quality of the time.  Time for Claudette to be at home.  Time for her to share in family meals.  Time with her baby.  Time for her baby to get week-by-week a little older, in hopes of doing better when Claudette is no longer there.

After a couple more days and a couple more discussions with Claudette and her lone family member, we sent her home, paying for her hospital stay from the Needy Patient Fund.  The fact that I haven't seen her now in a few weeks is potentially a good sign, but not necessarily.  But my time spent with her is, at least, a good reminder.  The importance of the time we have.  The importance of how we spend this time.  May it be well-spent.

20.8.14

Ballet in Burundi

by Jess Cropsey

As a parent, it’s easy to question yourself when it comes to your kids.  It’s one thing to decide that God has called me to move to Africa.  It’s another thing to make that decision for my children, knowing that doing so sends their life in a very different trajectory and also exposes them to additional risks (health, safety, etc.).  I have come to a place where I can trust God with those things (most of the time!) and am confident that this is where He wants our family to be for this season of our lives.  And, yes, my children have lots of wonderful opportunities that other kids don’t have, but part of me still wants them to have the best of both worlds -- piano lessons, sports clubs, dance classes, swimming lessons, church youth group, etc.  We do what we can in those departments, but our human resources just aren’t the same.  Me functioning as the art teacher for over half the year is a perfect example of this!  So, it brings me great joy when visitors come with a vision to minister to us and our children.  In the last few months, we’ve had some special visitors here who have done just that.  While most of them had medical spouses serving at the hospital, they shared their talents with those of us on the home front.  

Last Thursday was the first day of ballet class for the little girls.  Julie Banks (who, along with her physician husband, served with us in Kenya for 5 months) is here for two weeks and graciously brought leotards and tights for our little princesses.  The girls have been thrilled to learn some ballet moves from their beautiful and talented teacher and can’t wait until 3:00 every day!  


Several weeks ago, Rachel's brother (starting a graduate degree in music therapy) and sister-in-law Heidi supplemented our weekly music class.  


In April, Hannah Willis came prepared with several fantastic art lessons for our kids -- a major improvement from the instruction they were receiving from me!  A young teen, Nina, also put together some VBS material for our kids during her 3-week stay with us.  Around that same time, a couple came along with their grand-daughter and blessed the entire team with a generous 2-day get-away at a nice resort in Bujumbura.  It was the first time our entire team had been together outside of Kibuye since our arrival and the kids absolutely loved time at the beach, pool, and playground.

Visitors who intentionally seek out time with our kids (in conversation, playing games, etc.) are also a tremendous gift, especially since our kids have limited access to adults who speak their heart language.  These visitors are often remembered and talked about for many months afterwards.        

Thank you, visitors, for sharing your time & talents and blessing us and our children!  

15.8.14

Ebola Update

We've recently received an influx of visitors from the US, which has been fun.  Over a group discussion one night, we realized what a big deal ebola has been in the US news.  Really, it hasn't been something we've been thinking about every day here in Burundi, but have gotten a number of questions from friends and supporters, so we thought we'd send out an update.

1.  Is there ebola in Burundi?
No.  Absolutely not.  There has never been a confirmed case of ebola in this country, including previous outbreaks.  In fact, to the best of my knowledge, ebola in this current outbreak has not left West Africa.

2.  Is ebola likely to spread to Burundi?
No.  Being one of the poorest countries in the world has its advantages.  People don't have money to travel, and people from other countries often don't travel here.  There is far more travel between West Africa and the US than there is between West Africa and Burundi.  Think of it like we're in El Salvador and you're in the US.  Same continent, but very far removed.  

3.  Are you planning to go to Liberia to work?
No.  Although we applaud the doctors and nurses who have volunteered to provide much needed treatment and care to West Africa, we have no plans to leave Burundi.  We feel like our work is here.

4.  Will you stay in Burundi if ebola comes?
Difficult to say.  We'll cross that bridge if we come to it.  Here's a great article talking about the decision to go or stay in times of difficulty.

5.  How is Kent doing?
As far as we know, Kent is expected to make a full recovery.  Samaritan's Purse has released a statement saying as such.  Thanks for your prayers.  We are in full support of what Kent chose to do and are glad that we can continue to count him as one of our colleagues.

6.  If you're interested in what it's like to live through an ebola outbreak, our regional field leaders, Scott and Jennifer Myhre, were living in Bundibugyo, Uganda during the 2007 outbreak (Bundi is one of the oldest Serge Africa sites).  Their kids were evacuated, but Scott and Jennifer stayed.  She's a great blogger.  If you go to their website paradoxuganda.blogspot.com, choose 2007 on the right side link and start in December for a ton of articles and posts.

Thanks for all your prayers and support.  Please keep praying for the thousands of African lives being affected by ebola. We'll let you know if anything changes, but for now, everything here is "sawa sawa."

11.8.14

Happy Anniversary!

by Rachel

Arrival at Kibuye, Nov 2014
August 6th marked our one year anniversary in Burundi.  It seems very surreal for most of us, unable to believe that we’ve been here a year (and some days unable to believe it hasn’t been longer!).  One of the reasons that it’s hard to believe is that there have been so many transitions this last year.  Arrival in August, three months in Banga, move to Kibuye in November, start at the hospital in January, McLaughlins moved into their house in May, etc.  It’s amazing how much has been done when we reflect on it, which is good because in the midst of day to day living we tend to focus more on what still needs to be done.  We are so incredibly grateful for everyone who has supported us.  It is because of your help that we have been able to move “full steam ahead” for so long now.  And it has been amazing to see so many dreams and plans and goals finally come to fruition this year.

Since our arrival in August, all of the adults spent at least three months learning Kirundi.  This means various things for various people, but we can at least all share greetings and communicate on a basic level with our neighbors in certain contexts.  Listening to the “muzungu” speak Kirundi never fails to bring a smile from the locals, sometimes even applause.

The four oldest kids have completed a year of school in the newly formed Kibuye Hope Academy.

An emergency room, eye unit, and neonatology (NICU) unit have all been created.  I think Alyssa, John, and Carlan would say there is a lot more development that needs to be done in each of these units, but they are functional, where there was nothing before.

Four houses (McLaughlin, Cropsey, Fader, Pfister) have been started and are in various stages of completion.  The McLaughlins have already moved in and the Cropseys will hopefully be moved into their home within a month.  Alyssa and the Faders hope to be in their homes by Christmas.  “Container plex” has also been built.

There is running water in the hospital.




We have had a part in educating over 70 medical students, developing and presenting over 30 lectures in French.

The operating room, under Jason’s direction, has close to tripled the amount of surgeries since last year.  And we are eagerly awaiting a US anesthesiologist who will help provide further education for our staff.

Our sending agency (which has also undergone a name change this year) has approved two new families to join us in our work here, which total 4 adults and eight kids!

Countless relationships have been formed with local pastors, nurses, doctors, community workers, etc.  

There are many more things to list, but in truth, it is not our work but God’s, and we are blessed to be a part of it.  We pray that we have been and will be faithful stewards of the gifts given to us.  And we look forward to many more “happy anniversaries” to come!
Kids enjoying our celebratory "crepe anniversary party"

The team in July, 2014


6.8.14

COTW: Maternal Mortality

by Rachel

A woman died on my service Thursday.  Now, people die every day around the world, and of course people die every day in Burundi.  Even more so in the hospital.  But this was a woman I had fought for.  Was fighting for.  A defeat in many senses of the word, which is always hard.  

She had come to a health center, in labor with her 5th baby.  You would think that birth becomes routine, especially after four normal deliveries.  But this time, something went wrong.  Instead of the baby’s head coming out first, an arm slipped into the birth canal and the baby turned sideways.  She was transferred to Kibuye Hope and my colleague did a C-section to deliver the baby.  It was a little bloodier than some, but went well overall...until they finished the surgery and pulled off the drapes to discover that she was lying on the table in an ever expanding pool of blood.  I was called in to assess the situation.   By then there was blood everywhere.  We did a hysterectomy and I removed her uterus as quickly as I could, although I left her cervix behind (a common variant of the hysterectomy often used after a C-section because it’s quicker and easier).  The bleeding seemed to stop, and we wheeled her back to maternity.  I have no idea how much blood she had lost by this point, but I do know she was in desperate need of a transfusion.  Our blood bank was empty (again).  Our neighboring hospital in Gitega, 30 min away, sent one unit by ambulance.  I returned to her bedside an hour after the hysterectomy, and the blood had just arrived.  She was still unconscious and now having gasping respirations.  And unfortunately, she was now in another giant puddle of blood.  We rushed her back to the operating room and I discovered that, perhaps all along, the cause of her profuse hemorrhage had been a large tear on the inside of her cervix, perhaps due to the baby’s arm, maybe due to the delivery.  I repaired it.  The unit of blood was emptied into her veins.  There was no more blood to give.  She died less than 30 minutes later.

Burundi has one of the highest maternal mortality rates in the world.  Almost one in every 100 deliveries ends in the death of the mother.  So, if a woman has on average 5 children, she stands a 5% lifetime chance of dying during or immediately after one of her pregnancies.  Incredible.  Incredibly sad and tragic.  Most of those deaths are due to hemorrhage, infection, or obstructed labor without access to a C-section or other proper care.  I don’t even know how many of these deliveries ends in the death of the baby, but it’s also quite high.  This particular case hits harder because she came to us.  She was in the best place possible.  She had a US-trained OB-GYN caring for her.  And we failed her.  Maybe that’s not true, but it feels like it to me.  

I grieve for her baby, born alive but who stands a high chance of dying in the next few months because there is no mother to give milk, to provide care.  I grieve for the husband and four other children who have lost a mother and wife.  I grieve for a country that doesn’t have the basic infrastructure to provide life saving blood (On a side note, reading US literature on postpartum hemorrhage/PPH, the protocol states that as soon as you diagnose PPH, order SIX UNITS OF BLOOD from the blood bank.  I doubt there are six units available within a 2 hour drive of here).  And although it seems selfish, I grieve for myself.  The “What if” game is a hard one to play, especially as a physician.  If only I had managed her differently, perhaps one unit of blood would have been enough.  I know that the outcome probably would have been the same, and on most levels I feel like I did everything I could.  But it’s hard on these days, to be a stranger in a strange land, to feel like I’ve given up quite a bit of normal life to be here for just such a time as this, and to feel a woman slip through my fingers.

Many times people read our blogs and ask, what can I do about this problem?  It’s a tough question to answer.  I do have some thoughts.

1.  Raise awareness.  Every day, the number of women who die in childbirth is equivalent to a 747 jet crashing into the ocean.  It’s awful.  There are organizations that seek to fight this.  You can start here.  I can’t speak to the specific ethical issues of every organization involved, but it’s a good place to start.

2.  Give blood.  Women’s lives are saved every day in the US because of the selfless gift of blood donation.  If not for that, the mortality rate after US deliveries would probably be quite a bit harder.

3.  Be grateful.  Sometimes I hear Americans in support of home birth use the argument “A hundred years ago, everyone gave birth at home.”  Yeah, and a lot more women died.  I’m not saying that home birth is the wrong choice for some people.  But be grateful for the medical resources that save lives every day.  Be grateful for your access to them in case of an emergency, no matter what.

4.  Pray. Pray for justice and healing and a world where things like this no longer happen.  Where every woman has access to a safe and healthy delivery, where women don’t have to be afraid of losing their life every time they get pregnant.  

27.7.14

Please Pray

This is a simple post.  Dr. Kent Brantly is a post-resident working at ELWA hospital in Liberia, who has been caring for patients in the Ebola outbreak there.  He has now contracted the disease itself.  Very serious and very difficult to pull through.  His wife and two children have been evacuated out of country.

We met their family in Greece this last year.  We were very interested to hear his news, since he is part of the same program we did in Kenya, and the Cropseys were our delegated to look at his hospital in 2010 as a long-term home for us before we decided on Burundi.

Please pray for Dr. Brantly and his family, and the over 1000 confirmed cases of Ebola in this outbreak.  Here is the CNN link.

24.7.14

Forgetting English, Part II

(from Eric)

In case you are wondering if the phénomène that we wrote about last year is still valid, I give you this update:

No one told me that the road to fluency in a foreign language would include a kind of nether-land where you are fluent in no language at all.  Fluency, as I have learned in this process is way more of a continuum than I had ever imagined.  Even among native speakers, there is a spectrum of fluency.  

And regarding English, I'm not so much where I once was on that spectrum.

And by the way, these teammates of mine are no help.  Exemple:  I could easily be sitting with them some evening and say something like: "Did you have a good voyage?  I was wondering if you would rest in Bujumbura another day."  Some of you probably think that sentence sounds a bit weird for normal conversation.  "Voyage"?  Was he getting on board a ship to pass through the Strait of Magellan (which I recently learned is called the détroit de Magellan)?  Was he packing a covered wagon to move to Oregon?  Why did he need to "rest"?  Is Buja a good place to rest (Answer: not really)?  No actually, voyage just means "trip" and rester means "to stay".  But here's the thing.  No one in the room thought that was at all awkward, thus we may be doing it dozens of times a day without knowing it.

(By the way, Agatha Christie is constantly using her Belgian super-sleuth Hercule Poirot to make these kind of jokes out of his bad English.  I notice them now, and find them really funny, even though I'm quite afraid I'll stop noticing them soon.)

Typing is another thing.  I had never given much thought to keyboards in foreign languages, but French having many accents or other slightly altered letters (é ù ô ç ï...), I made a decision to start using the French keyboard setting when I was typing French.  Seen here, it is the "AZERTY" keyboard as opposed to the Anglo "QWERTY" keyboard.
 

It's not terribly different, but different enough (which seems to always be the heart of the problem), and in preparing lots of French lectures, I've gotten as comfortable with the French keyboard as I am with the English keyboard.  The problem is that I have achieved this in part by becoming less comfortable with the English keyboard.  Seriously, even as I type this, I haven't been this bad at typing since my sophomore high school typing class.  Punctuation is right out.

As mentioned before, this remains mostly funny, and just a little bit tragic.  Some days, after arduously persevering in French all day long with students, I'll come home, my mind wistfully full of the unconscious ease of communicating with another native English speaker, eager for the sanctuary of my own home where I can simply talk with Rachel, focusing only on what we are saying, and not on how we say it.  Then, by the second sentence some French word slips past my lips.  Dommage.

(PS.  Writing the word "dommage." (meaning here "shame") took no fewer than 5 typing attempts, especially to find the M and the period.  I finally decided to change back to the English keyboard, only to find that I was already using the English keyboard.  Which explained a lot...)

22.7.14

COTW: Arm Paralysis

(from Eric)

3 weeks ago, I was covering Urgences (i.e. the ER) in Carlan’s absence, and the nurse showed me a new case.  He is a 60 year old man, very polite despite his problems, laying flat on his back, with arm paralysis, specifically bilateral shoulder and elbow paralysis, though he could still shake my hand weakly.  He said it had been there for a few weeks, and he had gotten some injections at another hospital that had helped, but now it recurred (which I doubted then, and I still doubt now).  

I examined him and found more or less what he said:  flaccid paralysis in the shoulders and elbows of both arms, no spinal deformity, but an odd bulging of his lumbar spine, which he said was painful, though he didn’t complain of leg problems, just general weakness.

I was wishing for an MRI, so I could look at his spinal cord, and wondering what on earth we could do to diagnose or treat this guy.  His lumbar spine bulge could have been TB of the spine, but it didn’t explain his arm symptoms, since a spine problem there would only affect his legs and bowel and bladder function.

So I ordered an xray of his cervical spine and another of his lumbar spine, and sent him off to our temporary xray tech: Jason.

Several weeks ago, we inaugurated our digital xray system here at Kibuye.  It seems out of place, in our otherwise very basic hospital, but Jason prioritized it on the grounds that it will save the hospital money, improve record keeping, and hopefully improve the quality of our films.

Digital X-ray at Kibuye
But the only guy in the department that could work a computer was getting married and was gone for a few weeks, so Jason became the xray tech, and so he took the films of my patient.  I didn’t really expect to find much, since only the bones are visible, and I though the heart of the problem was in the spinal cord.

Mais voilà!  However, we found that our gentleman had compression fractures in both his cervical and lumbar spine, at levels which could certainly explain his systems.  He was placed on some steroids, while we pondered what to do.

What caused this problem?  He’s not a really old guy, with no other evidence of osteoporosis.  It doesn’t look characteristic of multiple myeloma.  TB of the spine?  In two locations?  I’ve never seen that.  We checked his HIV status, and I emailed two Tenwek friends with more experience than me, and they both responded in the same fashion:  They have never seen TB of the spine in multiple locations separated by such a great distance.

So what is it?  Probably cancer.  Metastatic from somewhere.  Where?  Does it even matter?  We certainly can’t treat it at this advanced stage.

He stayed on our service for 2 1/2 weeks, each day polite and gentle, even when he lost his ability to shake hands.  Several times, he quietly suggested that we change his medicine, because the present one wasn’t helping.  We again explained that, unfortunately, there are not any other ones to give him.  His wife stayed with him, and continued to meet me with a smile each day.

Monday, we sat down and talked more in depth.  We explained that we have nothing further to offer, and that he could go home if the family could find a way to transport him.  They said OK, and took the information in the typically stoic way of people who have never expected their lives to be free of such tragedies.  We prayed together.  They thanked us.  We expressed our regrets that we couldn’t do more.  

And now he is home.  And we continue to pray for him.