The Hard Goodbye

Sorry for the not so joyful posts lately, but here is yet another one.  For the 5^th and final week of our trip, Julie’s family was in town and we all had to head to Lusaka for the week.  That meant saying our goodbyes in Zimba this past Monday.  Here is an excerpt from my journal that I wrote about the day we left…

Day 29:  Monday 22/7/13

Today is the day I had been dreading since Julie’s family arrived last Thursday.  I did not want to leave.  To say goodbye was not an option for me.  I was not ready – by a long shot.  I would have never imagined that a small town in the middle of Africa could capture my heart like it has. 

• I will miss waking up to the loud trucks and the roosters in the mornings.
• I will miss saying good morning to Gertrude while she is cooking breakfast.
• I will miss having my quiet time in that corner chair with God, my Bible, and some worship music in the mornings.
• I will miss chapel in the mornings and hearing those sweet, sweet African voices.
• I will miss Charity and Purity’s high-fives every morning (and every time we met after a short break).
• I will miss rounding with Joan and those incredibly special teaching moments that we had often.
• I will miss attempting to handle those male and female ward patients – trying not to kill them.
• I will miss those days in OPD where it is so busy that you are trying and trying to see the patients, but you can’t even tell that you have made the slightest dent.
• I will miss discussing those difficult patients with Dan and/or Joan.
• I will miss the walks to and from the hospital.
• I will miss the sunsets.
• I will miss Jock, the dog, greeting us every time we were in the compound.
• I will miss the kids:  Choolwe, Sharon, Caleb, Jeremiah, Faith, and the others.
• I will miss Gertrude’s wonderful dinners.
• I will miss having dinner with Dan and Joan – especially the days when Dan just talked and talked – they were rare, but too funny when they did happen!
• I will miss Joan sharing her heart with us – from her frustrations to her testimony.  She is such an amazing woman of God and has been through so much.  I pray that she has the strength to continue on.
• I will miss movie nights (especially with the popcorn), even if we never made it through an entire movie without falling asleep.
• I will miss Dan and Joan.
• I will miss Gertrude.
• I will miss Ruth and Keiko.
• I will miss Jesse and Selinda.
• I will miss my patients.
• I will miss Joan’s reaction when she does not approve of something her patient is doing, “Badala (or mama) pepe!” 

Most of all, I will miss seeing God in just about every situation I was in – from the joyful, the sorrowful, the painful, the scary, and even those times when life was just average.  I never want to lose that focus.  I pray that I don’t.

I never wanted to leave Zimba, but I pray that I can return very soon.  My heart has remained in that place.  Thank you all so much for praying for this journey.  I heard from several people before I left that this trip will be nothing but fantastic.  That it has.  I will return back to the States physically, but emotionally, I will still be in Zimba.  I will have to relearn how to survive in American culture, but one thing that I do not want to do is continue back into the norm of life there – I never want this experience to leave me.

(I apologize in advance for this picture.  I was a complete basket case the day that we left.  None of us thought to get a group photo before our last day…)

 

Given

Disclaimer:  For those of you who are reading my blog for only the happy times in Zimba, you might want to skip this blog.  For those who know that times are not always happy-go-lucky in Africa, I commend you… read on.

 

So last week I was in Male Ward rounding on my patients.  On Monday, I had maybe 7 or 8 patients.  One of them was Given.  Given is a 28 year old HIV and TB positive patient.  He was admitted at the beginning of July for potential cryptococcal meningitis.  For those who aren’t medical, that is a type of fungal meningitis.  This particular fungus is more common for HIV patients to get, and can be deadly. 

He started treatment for this meningitis and a response to the antibiotics seemed to be lagging a bit.  We were wondering why.  We knew, obviously, he was immunocompromised, but we were also wondering if something else was going on:  particularly a TB treatment failure. 

We questioned his family about how often he is taking his continuation phase TB meds.  His mom, at this time, states that when he is not feeling well, she gets scared and does not give him his meds.  She could not tell us how many days that he has gone without his medication for TB.  We look at his DOTS card (Patients with TB have to have somebody directly observe them taking their medicine and document it on a card.  In the States, nurses usually handle this.  In Africa, the family handles it.).  His DOTS card is barely filled out. 

We order a chest x-ray.  This x-ray looks hideous.  Bad infiltrate in his left upper lobe of his lung.  We start him on 2 more antibiotics for a possible pneumonia.  We are still not positive as to whether this is a TB treatment failure or just a bad pneumonia.  So now, he is on 4 antibiotics, plus his HIV and TB meds.  Nine very potent meds. 

All this time, he is not taking food or liquids by mouth very well and vomiting often.  Antiemetics are not helping.  So we give him liter after liter of dextrose, normal saline, lactated ringers, you name it.  Hypotensive and tachycardic the entire time, but surprisingly, a decent urine output. 

He had his up and down moments over the course of the next couple of days.  Friday afternoon I go and check on him after I finish in OPD.  He had taken a minor downfall.  Not improving and not responding to commands or his name.  We discover that his lungs are beginning to fill with fluid.  In the meantime, his respiration rate is around 35 breaths per minute (normal is between 12-20).  Still hypotensive and tachycardic.  This is not looking good.

Saturday he was pretty much the same.  Only a little less tachypnea.  We maintain his current regimen and continue to pray.

Monday, I transitioned out of the Male Ward and into OPD for the week.  Before I began in OPD, I wanted to check on Given.  When we walked in, we saw him sitting up, bright-eyed and bushy-tailed.  It was incredible!  We could not believe it!  He was responsive, alert and oriented x 3.  His speech was still a little slurred, however.  Later that day, it occurred to me in the back of my mind… what if this is just a peak before the fall.  I was hoping not… we would have to see what the next couple of days hold.

Tuesday was a little more difficult for Given.  He became agitated throughout the day, and acted like he didn’t feel as well.  His belly was fairly hard and distended.  An abdominal film was ordered.  Dilated loops of small bowel… Bowel obstruction.  Enemas were tried, but ultimately, the only treatment was surgery.  The closest place the surgery could be done is in Livingstone.  He was not stable enough to be transferred to Livingstone… in the flatbed of a truck.   Prayers going up cause I didn’t know what was going to happen…

Wednesday:  Julie peeks through the window outside of Given’s bed.  She sees the blue privacy curtains.  She peeks in through the Male Ward door… privacy curtains and what appears to be a covering over his head.  She said, “This doesn’t look good.”  My mind goes blank.  It takes me several seconds before I can make myself enter the ward to make reality what is already in the back of my head.  I finally walk in and see the blue privacy curtains for myself.  I walk around to the other side of the curtains and find Given’s great-grandfather trying to close his mouth.  At that time, Given’s sweet mother, Edith, falls onto the empty bed herself and buries her head between her knees.  It happened.  Given died. 

I immediately sit down beside Mrs. Edith and put my arm around her.  (I find it very hard in these situations to find the words to say, so most of the time I just set quiet and was there with her.)  Charity, my awesome interpreter, begins talking to Mrs. Edith about various things, one being the funeral arrangements.  She is so good.  She has the biggest heart ever.  Given’s family lives an hour outside of Kalomo, a city about an hour away from Zimba.  They had no way to get his body home, so Charity offered up some options for a funeral service here in Zimba.  She has a heart of gold!

Throughout this entire morning of pain and suffering, as I reflect back, I can definitely see God’s strength at work in me.  Late last week, I was practically a wreck knowing what was likely going to happen soon with Given.  After his body was rolled out of the ward, I was practically a wreck and very close to just losing it at the nurses station.  But during that time while I was with Mrs. Edith, sitting with her and comforting her, I had an incredible amount of peace and stability.  I can only thank God for that one! 

I don’t like death.  Death is one of the things that really causes emotions to really spring forth in me… even if I don’t know that person very well.  I feel for the family that is hurting.  Strength is not really something that I consider myself having when dealing with death.  God is the true source of all our strength!  I am now beginning to realize how close God feels to us while here in Zimba.  I love it!  I am seeing God in many situations that I encounter at the hospital… in the hurt and the rejoicing.  I long for that to follow me back to the States. 

It is crazy to think that we only have 2 more days in the hospital before we prepare to leave (we will spend our last week in Lusaka, about 6 hours away from Zimba).  We have already been here for a month… it feels like 2 weeks maybe!  Time has really flown by.  I’m not sure how much I like it flying by so fast… maybe that is God telling me I need to come back soon…

Busily Fantastic

Sorry for the delay in posting an update!  I know some of you have probably been wondering how things are going.  I have been adjusting well and finally starting to settle in to life here in Zimba.  The days are long and busy, but fantastic!  I am still learning so much, especially from Dr. Joan.  I am strongly considering taking her back to the States with me! :) 

Last week I was working in OPD (the out-patient department/clinic) Wednesday through Friday.  Monday and Tuesday last week were holidays in Zambia.  My time in OPD was very busy!  I saw around 17 patients per day, and didn’t feel like I was even making a dent.  This was OPD yesterday. (It looked like this last Wednesday as well.)  Most of the time, there was another provider there besides me, but there were times when I was by myself. 

One of my goals during my time here was to take time and pray with each of my patients, particularly times when I am in OPD.  The first day I was in clinic I achieved this.  It was hard for the first patient, but then it got easier throughout the day.  Due to the insane busyness in OPD lately, I have not gotten a chance to pray with them.  I want to badly, but I also know that there are hundreds of patients waiting to be seen and I have already taken at least 10 minutes just trying to figure out what is wrong with them.  I’m not exactly sure what to do in this situation… Prayer request:  reassurance in knowing that prayer is better than any medicine that can be provided, and that it is more important than any number of patients I feel I can see in a day.

This weekend we went to Chobe, Botswana on a safari!  When in Africa, one must go on a safari at some point.  We left for Livingstone Friday afternoon and stayed at a place called Jollyboys Friday night… lets just say that was one very interesting night filled with very little sleep!  (At Jollyboys, most people stay in large rooms filled with at least 10 strangers… who enjoy their alcohol).  It was all good though, and an experience nonetheless! Lol 

The safari was a 2-part experience.  The morning was spent on a boat riding down the Chobe River in Botswana.  Prior to Saturday, I honestly couldn’t remember the last time I was on a boat… it felt nice to be out on the water!  We saw several elephants, hippos, impala, crocodiles, and lots of birds.  The afternoon was spent riding through the wildlife park.  This is where we saw a ton of animals!  Some up close and personal!  We saw 2 female lions and several giraffes along this ride.  It was a glorious day spent with lots of animals!

Today after I did rounds in the male ward we headed off for outreach in a nearby town.  To me, outreach in Africa takes on a whole new meaning.  I love that thought!  The outreach had 4 parts.  The first was general health counseling lead by Mrs. Chebwa, the most joyful woman I think I have ever met!  Next were child immunizations, family planning, and antenatal care.  I worked with Mrs. Chebwa in antenatal care.  I have always had an interest in this area, so it was good to help manage these particular patients at this wonderful point in their life!

After all the patients were seen (about 3.5 hours), we packed up to head back to Zimba.  We were beginning to load the Range Rover, but the other door needed to be opened.  I opened the other door and began to climb in… what I encountered next was very unexpected.  I was half in the vehicle when I saw a chicken sitting in the seat next to the door staring me in the face…  So totally random and hilarious!  I still don’t know why or how that chicken managed to get in the back seat of the vehicle!  Definitely a highlight of my day!  The chicken rode with us all the way back to Zimba (after being moved to under the seat) and didn’t even make a peep!  :)  This is our new friend…