Sunday, December 9, 2012

Moussa


Moussa, 10 years old


I'm not sure why certain patients grab my heart and come to mean so much to me.  In 13 years as a pediatrician I've never had a patient affect me as much as Moussa did.  He came to us two years ago with a huge abdominal mass.  We diagnosed a probable Wilms Tumor, which is a type of kidney cancer.  His tumor was so large it wasn't difficult to see.  He had surgery immediately and his kidney with the tumor was removed.  He started chemotherapy at the same time and stayed at the hospital for several months.  The difference in his appearance was remarkable after his surgery.




After surgery







Moussa had a great response to his treatment and began to feel better immediately.  He became a constant presence in my office and around pediatrics.  Other than losing his hair he had very few side effects and quickly became my buddy.  Incredibly, he even gained weight while on chemo.  He chunked up nicely after having been sick for so long.












After several months of treatment, Moussa had no further evidence of his cancer and he was able to return to his village.  One of the unique things about Moussa is that he was illegitimate.  His mother had him out of wedlock, which creates great shame for the family.  She abandoned him and left him with his grandparents and she moved away.  She married a man who would not accept Moussa and so he only saw her a couple of times in his life.  He was cared for by his grandparents and great grandparents in their village.  His basic needs were met but he was never treated like a legitimate son of the family.  Despite this, he developed an amazing personality and had a wonderful little laugh.  He was such a delight and made me smile and laugh every day I was with him.  Of course there were times I wanted to wring his neck, but they were far and few between.

Road to Moussa's village
Saying goodbye
Moussa, his grandmother and great-grandmother
 Moussa's great-grandfather                                                                                                                                                                    
Moussa's home
               







Moussa was home for several months before he had a recurrence of his tumor.  I was contacted by the local nurse and I drove out to pick him up and bring him back to the hospital.  He'd lost a lot of weight and was having a lot of pain in his back and sides.  His tumor seemed small but was easy to feel on examination of his abdomen.

Outside my office window

My buddy was back but a lot skinnier



We started chemotherapy again and he once again responded well to treatment.  His tumor shrunk and he felt well. This was a really fun time with Moussa.  He was everywhere at the hospital.  He came to staff devotions every morning, hung out in my office, and basically supervised everything.  He'd let me know it if I was a few minutes late, who else was late, who didn't come to work that day, etc. 

Hanging out with nurse Kristen, one of my teammates









Playing doctor
He would tire out easily and fall asleep on the exam table
table in my office



After several more weeks of chemo it was time for his second operation.  The goal was to remove the new tumor.  I was able to assist in his surgery where we found that, although the tumor had shrunk, it was still very extensive.  There was no distinct tumor to remove and we had to close him up without removing anything.  The cancer had spread everywhere.  This meant that there was no other treatment left for him.  It was heartbreaking to know there was nothing else we could do for him and to know that the tumor would start growing again.  

After he had recovered from his operation, we once again returned him to his village.  It was hard saying goodbye to him this time because I knew he would soon begin to have pain from the cancer as it started to grow again.  We had nothing left to do for him but treat his pain.

About a month after I took him home I went to check on him and was saddened by the change in his appearance.  He'd begun to lose weight and have abdominal pain.  Despite this he was not ready to return to the hospital for hospice care.



One month after going home

Still with a smile despite feeling so bad

I left him again knowing I'd be back in a couple of weeks.  I left a lot of pain medicine for him that helped him rest.  He wasn't eating much at this point but was still getting around and happy to be home.

Two weeks later I was pretty amazed at the difference in him.  He'd lost more weight and the tumor in his abdomen was growing and giving him lots of pain.  This time we knew it was time to bring him back to the hospital so we could maximize his pain meds for his final few weeks of life.





Over the next couple of weeks he got weaker and weaker and spent a lot of time in my office with me.  He eventually got too weak to leave his bed so I'd stop by and see him throughout the day.  

In mid November I was scheduled to come home to the States for my home assignment.  About four days after my arrival I received an email from Sheri MacLean (my teammate who took over Moussa's care) letting me know that Moussa had died.  That was November 21.  I thought being thousands of miles away would make it easier to hear.  But it wasn't.  

Here's what Sheri wrote:

When I came in this morning he was already in agonal breathing so I knew it wouldn't be long. I sat with him for a long time. Though he was unconscious, when I said his name and told him I was there, he grunted. I really believe he knew I was there. I laid down on the floor beside him (as for the last few days the ground was his place of choice to lay) and gently rubbed his head. The poor thing had suffered so much and the end was in sight. As I mentioned before he had asked me to go to church. I wasn't able to fulfill that wish to my regret but as I was thinking of that this morning I started to sing some of the few songs I know in Bambara. His grandmother joined in and we serenaded him for the last 10 minutes of his life. The last song we sang right before he passed says,
 An taato file san fe,                                   We are going to heaven
 An ka so nyuman de be yen.                        Our beautiful home is there
 Matigi tarra an nye fe                                  God has gone before us. 
       An bee be taa sigi a fe.                               We all will go sit next to Him.

How fitting to sing this as he left this world and I believe he was welcomed into heaven by a great chorus. It is humbling to sit with someone, especially a child, as they leave this world. It was not a moment I will soon forget. As awful as it was, it was a privilege to get to be with him and his grandmother at such an intimate time.



Despite grieving for Moussa, I'm so grateful for having known him.  He brought me a lot of joy and made my job so much fun.  I'll miss him.  





Tuesday, April 19, 2011

Village Medical Outreach




In February a team from Christ Community Church in Omaha, Nebraska came out to help us with three days of medical outreach to two villages. We saw HUNDREDS of people. It was amazing and overwhelming. On one day we (five providers...three docs and two nurse practitioners) saw over 400 patients.




We set up shop in a school and saw patients all together in one room. Privacy laws in Mali aren't quite the same as in the States.






In one village we had no school house so we did clinic under a tree.






At the end of the day families packed up in their kids and headed home. Who needs a four wheel drive when you can have a donkey cart. These are everywhere and you actually have to be careful not to run into them. They roll up and down the highway (I use the term loosely) along with the cars and trucks.











Sunday, February 13, 2011

Kamabougou Trip



On February 1, 2011 a team from Grace Point Church in Bentonville, AR came to Mali to work and serve in the village of Kamabougou. GPC has been sending teams to this village for four years and has developed a great relationship with the local church. Mike MacDaniel is the pastor of GPC and a friend of mine from Bentonville. He led the team of seven from the States and met me in Bamako where we bought supplies and medicines for our week in Kamabougou. We had a great week. Here are some of the photos of our week.



The team from Grace Point Church.


We drove about five hours from Bamako to get to Kamabougou. Most of the road was dirt but still passable by van this time of year.

The building on the left is where we kept our belongings and where some slept. The building on the right is the kitchen. In between is a grass roof shelter to give us shade in the heat of the day.
This was home-sweet-home for the week we spent in Kamabougou. Every morning we'd meet as a team, pray, and plan the day. This pic is taken with my back to the two buildings in the previous pic. The building in this photo is the Kamabougou church. Several of us slept in there at night to try to escape the dust and wind.










These are pics of some of the children in Kamabougou. They were at our campsite every morning and stayed all day. They were tons of fun.






Joshua and Nonjohn were two of our English/Bambara translators. We had two lady translators too, Mastan and Montané. We couldn't have done this week without them. Very few people out in the village speak French either so they were indispensable to us.






Clinic in the church



Three days of clinic where we treated illnesses, did wound care and screened children for malnutrition. We weighed babies from a hanging scale made to hang from a tree limb. We used a rafter in the church. We had a dental clinic going on at the same time and over 40 teeth were pulled in three days.






Dancing during the worship service each night. Drums and singing rang through the whole village. We then had a time of story telling from the Bible. This is an oral culture and storying is one of the best ways to present the gospel.





Umaro(yellow shirt) and Brama were my buddies all week. Brama had a severe infection in his right leg about a year ago which caused it to stop growing as quickly as his left leg. So he has about a 4cm leg length discrepancy that causes him to use a stick as a crutch. We're going to try to get a shoe made with a 4cm sole. Hopefully it will allow him to walk normally.





Village elder with a huge goiter. Probably iodine deficiency.


The village chief. When we arrived we had to present ourselves to him, exchange greetings (which took thirty minutes), and ask permission to have clinic in his village. He gave his permission gladly. On the last day we went back to say our formal farewells. The elderly are highly valued and respected in Mali. He laughed and smiled constantly.

Sunday, November 7, 2010

The Good and the Bad



Yesterday was a really important day for Koutiala Women and Children's Hospital. The new buildings were dedicated in an all day event that included music, food, speeches, and tours of the new buildings. There were some very distinguished guests who attended, including the Minister of Health of Mali, a representative from the American ambassador to Mali, along with local and regional police officials and army officials. There were several hundred people in attendance who were seated under open-air tents in the space between the current women's building and the new buildings. There was a 50 person choir who sang songs and danced to African drums and kept the place energized. The entire hospital staff participated and everyone was dressed in their best, most colorful African clothing.






The event couldn't officially start until the most important person had arrived. In this case it was the Minister of Health. The local schools were called upon to have their students line the street from town to the hospital. When his caravan of SUVs and Mercedes arrived, the students cheered. The hospital staff, American and Malian, lined up to receive him and shake hands with him. It was really quite a sight. Once he arrived, the speeches began.


Isaiah (pediatric staff) and his little girl







After the speeches our hospital director and medical director gave the Minist
er of Health and the American embassy official a tour of the hospital. Dozens of ladies from a c
ouple of local churches spent two days preparing the meal of rice, vegetables and meat. We sat in groups of four and five throughout the hospital and ate our meal. Meals in Mali are generally shared from a common large bowl. This was no exception. I'm getting better at eating with
my hands. That means I'm not dropping half of my rice on the ground as I'm trying to get it to my mouth. I ate with some of the pediatric staff and enjoyed the time with them.






Around four in the afternoon the officials and Health Minister left. It was a good day of celebration and everyone was excited and proud that our little hospital was given such a nice dedication. For a Christian hospital in a predominately Muslim country to receive recognition like this can only be a good thing. I'm thankful that we have favor in the eyes of the government of Mali. I pray that will continue for many years to come.



Staff dressed up for the event
Staff members little boy.


In my last blog post I included a picture of Miriam, the little girl with TB who seemed to be getting better after three months in the hospital. Sadly, Miriam's condition took a turn for the worse about two weeks ago. She developed some severe breathing difficulty one afternoon and we did all we could to help. We gave more oxygen, more medicines, but nothing helped. Miriam did not make it and we were all very saddened by her death. We're not certain what made her suddenly deteriorate. The hospital staff had grown to care for her over the months she was here. They took it very hard. Miriam's mother, a Christian, thanked our nursing director, Jessica, for all that had been done for Miriam during her months at the hospital.

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Miriam


I haven't experienced the death of a patient in a very long time. Miriam was one of four deaths we had in two weeks. In private practice in the States we have very few patients die. The ones that do are most often in a children's ICU at a children's hospital being cared for by specialists. We are the specialists here. Kind of scary and exciting at the same time. Please pray that God would give us wisdom beyond our training and education as we care for these sick kids.