Medical evacuation, part 2

By Alyssa 

In the last few years of team life, we have experienced several "all hands on deck" crises - such as the flash flood at the waterfall in 2016 and the failed coup d'état in 2015. These events definitely bring us together as a team in ways beyond what we experience through day-to-day life and work together. We regularly reference those intense bonding times and they go down in team history to be retold again and again. Well, we recently added another crisis to the team lore with our second medical evacuation (for the first one, read here.)

Similar to family life, each of us has team "roles" in addition to our hospital, school, and community work - tasks such as facilitating the weekly market order or the vehicle upkeep. One of my roles is to be team doctor. Usually that means handing out Zofran for stomach bugs, answering questions about malaria prophylaxis, or maybe putting steri-strips on a wound.

Cleaning and steri-stripping a minor wound for Abi

But last month our team dealt with an unexpected medical crisis for a visiting American boy that went way beyond minor! Cole was visiting with his family so his father, a surgeon, could help cover the surgery service for Jason. One day after running Cole complained of leg pain. As he was a healthy, active 12 year old, we didn't worry too much about it, but the visiting orthopedic doctor did check him out during lunch. The next day his leg was still hurting and he had developed a low grade fever, so we brought him up to the hospital for x-rays and lab tests. The x-rays were normal but the labs showed signs of infection and inflammation, so we started antibiotics. The leg still looked normal with no visible wound, swelling, or redness. The following day, however, he developed swelling in the leg and an ultrasound revealed a deep fluid collection near the bone. He definitely needed to have it drained in the operating room. We looked into sending him to Kenya for the operation, but it would be at least 24 hours before there was an available flight, and almost all the orthopedic surgeons we knew in Kenya were at a medical conference in Greece. We had a visiting American orthopedic surgeon at Kibuye, and he and Cole's father, also a surgeon, decided it was better to operate right away. Thankfully the surgery went well and the surgeons found and drained the infection near Cole's fibula. We now had a diagnosis: acute osteomyelitis (infection of the bone.) We hoped Cole would begin to recover with continued IV antibiotics.

Pre-op on left, post-op on right

The next morning, Cole was sitting on the couch reading a book when I came to check on him and give him his antibiotics. I listened to his lungs and noticed crackles in the left base that weren't there before. Then we checked his oxygen level and discovered it was lower than it should have been. And then he had another fever and significant tachycardia (fast heart rate), too. These were all concerning symptoms and meant without a doubt that we needed to get Cole to a hospital with an available intensive care unit ASAP! We were concerned the leg infection was now in his bloodstream and he could develop septic shock as a result.

This is the moment when the team mobilized into high gear like a well oiled machine. We were few in number as most of the doctors were at the medical conference in Greece, but everyone remaining dropped everything and came running to do the work of many more people. These are the folks you want by your side in a crisis! As Cole's dad spent hours on the phone with the med-evac company, the Serge Kibuye team packed up all the suitcases for the family of 7, looked at flights and arranged guesthouses for the mom and other four children in Kenya, drove cars (including a makeshift ambulance for Cole, his dad, and me) to Bujumbura, made lunch and fed all the kids, facilitated quick goodbyes, texted our Kenya connections to receive the family in Nairobi, connected with Kenyan doctors/hospitals, and of course monitored and cared for Cole. He got worse with a medication reaction just before we got into the vehicles to head for Bujumbura but thankfully responded to a breathing treatment.

Susan driving our "ambulance." A definite answer to prayer is that Cole actually started feeling better, and his oxygen levels increased as we drove down the hill towards the airport. The lower altitude and the vancomycin helped, but mostly people were praying around the world! Thank you! 

We waited for the airplane with our Serge teammate and peds ER doc Randy Bond, and thankfully Cole remained stable in the interim. Again Serge teammates served the family by caring for Cole's siblings and mother until their flight the next morning.

Cole and his father flying to Nairobi

Driving right onto the runway in our "ambulance" with our special patient 

As we drove back to Kibuye the next day and recovered from the chaos of the previous few days, Cole and his family's journey continued in Nairobi. He went back to the operating room multiple times and was finally stable enough to fly back to America where he was immediately hospitalized in Michigan for a few more days. And two and a half weeks after the ordeal began, he finally went home (though he will continue treatment for several more weeks from home.)

Cole thanking the Kibuye kids for their Get Well cards. Even the kids prayed for Cole and cared for him!

Thinking of Cole on Good Friday brought new meaning to Isaiah 53:4 where we learn that Jesus carried our pain and suffering. And that hope encourages me as I think of the pain and suffering my Burundian patients face as well. We all wait for the day when all things will be made new and there will be no more sickness or suffering or pain. In the meantime, I'm thankful to be waiting with my amazing friends and teammates!