Character Influencing Work

Oh Africa…
I’ve had several experiences recently that have really showed me how poverty and the difficult climate shapes the African mindset.

I’m in the hospital treating a man with florid heart failure. I don’t have a probe to adequately ultrasound his heart. I can’t measure creatinine, so I don’t know when I’m pushing his kidneys too hard with Lasix. He’s been deteriorating over the past 2 days and I’ve been warning the family that things are worsening. More and more family arrive as the end draws near and every day I’m seeing new faces. I get called to the ward because he is having agonal gasps. I give medicines to keep him comfortable and I call for a man in the family. One of the newer faces shows up and says “I’m the small Pekin.” I tell him that his father is dying imminently. 20 minutes later he dies. I call the family and witness their pain. This is the second patient I’ve lost in the span of 4 hours and I sit in the ward quietly weeping while the nurses prepare the body for the morgue. The family packs up their stuff.

Less than an hour later I get called the ward to check on the patient across the way. He says, “I can see that you really care for your patients and I appreciate that.” And oh, by the way, can I have the bed that is now vacant? He can see the shock on my face as the bed is hardly cool and hasn’t been cleaned yet. He quickly clarifies, ‘That bed is under the one working fan in the room.’ It’s heart breaking to me that death is so frequent and our wards are so under furnished that patients are asking for transfers less than an hour after their neighbor dies.

Later, the accounts office comes to find me so I can do the death certificate. There’s lots of shouting going on from the family. I ignore it, as I don’t really like being around when people are talking money. But even 30 minutes after I finish the paperwork, the shouting is still going on. I go to see what is causing people to be so vexed (as they say). After asking 3 people who are all shouting, I find out that the family’s fan has been stolen. The ‘small Pekin’ wasn’t part of the family at all. He was just hanging around to steal stuff. He came to me as family, kept a sober face when I told him of his “father’s” impending death. All for one standing fan.

This story is just crazy to me: A long con, through a tragic death, to steal during a time of crisis. And while I will always feel shock, I had an opportunity to watch a man work about a week later. We hiked up a local mountain and met a man making gravel. And by ‘make gravel’ I mean that he chisels off big pieces of rock, then smashes them with a hammer into smaller pieces of rock. He told me it would take 3-4 days to finish smashing the big rock pile. It was impressive how much he's worn down the metal on his hammer. Plus, he holds the victim rock with his flip flop foot before he smashes it. I wouldn't have 10 toes if I had his job. It really take some strong character to work when your alternatives are to smash rocks for almost no pay or to steal while people are mourning…

I still live in awe of these hard working people who are scrounging a life from nothing. But I’m going to be asking more questions of the families in the future.

Christina

I want to tell you about my patient Christina. She came to the hospital over a month ago barely conscious, incoherent, in respiratory distress. Her blood sugar was 600. She had diabetic ketoacidosis: DKA.  It is cases like this when I remind myself I worked urgent care for a reason in the States! This patient would have ended up in the ER, then admitted to the ICU with a battery of labs performed, her electrolytes closely monitored and an insulin drip started. Well, now I am a hospitalist who relies heavily on UpToDate without access to electrolyte monitoring or insulin drips. We managed to get her blood sugar back to a more manageable range with only fast acting insulin injections and IV fluids. She improved. She left the hospital on the only oral medications we have for diabetes. She needed insulin, but she does not have electricity, therefore no refrigerator, so she would be unable to keep the medicine from spoiling. 

Patients here are surprisingly good at keeping their follow up appointments. When I saw her again in my wonderfully air conditioned office at 75F, her blood sugar was still too high and I discussed how I could only increase her oral medications so much and that she really needs insulin. We talked about far-fetched ideas like her coming to the hospital every morning for an insulin injection. Instead, she decided she would work on lifestyle. 

Next time I saw her she had bought a long sleeve shirt on the way to the clinic because the AC in my office was too cold. Since her last visit she felt like a virus was coming on and she blamed by AC. The cold causing illness myths are everywhere! About diabetes, she had lost some weight, had been exercising daily, and eating healthy foods. Her fasting blood sugars were within normal range! I was ecstatic. This is a lofty feat for an American who has ample access to places to exercise safely and a wide variety of foods. Here in Africa, the roads are dangerous to walk on due to traffic and the vegetables in the market are limited and expensive for locals. This is a HUGE achievement. She is going to school to be a seamstress so she can have a business, save up money, and hopefully get a visa to visit her two sisters that immigrated to the US. 

She let me take a picture with her. She’s the first patient I’ve connected with in this way and it was truly encouraging. Sometimes I feel like I’ve moved all the way out here just to spend all my time figuring out how to eat and survive, read UpToDate, struggle with hospital finances and politics when supposedly we came to do ministry. I’m not sure when we will start to feel like we are actually doing ministry, but this patient certainly ministered to me.  She didn’t pray with me or preach to me but my heart felt lighter after my visit with her. I think God can use interactions that don’t fit the cookie-cutter “ministry” to glorify Himself and to bless those around us. I’m looking forward to seeing Christina again, and I’ll be sure to turn my AC off when she comes.