March update from Dan Nesselroade

March 23, 2006

I don’t believe it has rained here since October, and hot season came in with a vengeance this week. The one thing falling from the sky out here is babies. We are averaging nearly 5 a day at the hospital. If only they came in one at a time, weekdays between 8 and 5. :)

We have seen an enormous amount of abnormal deliveries recently. Breeches, arm presentations, face presentations, prolapsed umbilical cords, ecclampsia, placental abruptions, cervical lacerations, placenta accreta, molar pregnancies, ectopic pregnancies, abdominal pregnancy, shoulder dystocias, transverse lies, twins, fetal distress, forceps galore and on and on. Our case load from the past few weeks reads like the table of contents for a textbook of obstetric emergencies. Through it all we continue to see amazing things, most notably God’s kindness intervening to save our collective bacon, routinely. There is nothing quite so humbling as watching God leap into the middle of a disaster in progress, and provide you with a good outcome, directly on the heels of your missed diagnosis. (ah…..your Great Commission dollars hard at work) It leaves you kind of bewildered. Who is like our God?

Marcy’s parents visited us for the entire month of January. It was so fun to operate together again with her father. We laughed and laughed the whole time. I marvel at God’s kindness to us.

Ami

There is a large, painted sign on the wall in our recovery room. Its message is written in Bambara, the dominant language here. It reads: HEALTH IS FOUND IN JESUS. Under that sign, for weeks on end, lay a pathetically sick 17 year old new mother, literally ravaged by typhoid fever. We expected her to die so many times that I quit counting. Her premature baby lay in a bassinet next to her bed. In spite of its tiny birth weight, it was thriving and growing, receiving infant formula dripped in through a tube in its nose every couple of hours by nurse after nurse, shift after shift, for weeks on end. Its mother, however, was its antithesis. I have never seen anyone run continuous fevers above 103 degrees like that, literally day after day for weeks solid, without succumbing. On occasion, she would push to 104 and 105 degrees. Two times she became so overwhelmingly infected that her blood lost its ability to clot. She would vomit blood, bleed uncontrollably from her nose and pass large amounts of fresh blood from her anus, at times, simultaneously. She received 13 transfusions and probably consumed one third of the entire hospital’s supply of potent intravenous antibiotics during her 7 week hospitalization. She prayed to receive Jesus early in the illness, in a window of relative lucidity. It became quite clear that while yes, she was overtly physically ill, she was as well exceedingly spiritually ill. Now in America it is medically quite vogue to talk about “holistic care”, caring simultaneously for the body, mind and spirit of the patient. But, as best I know, none of our Malienne nurses have ever attended a workshop on any such thing. Neither would they know to define the term, as such. But what I saw them provide was the most dramatic example of compassionate holistic care that I have ever seen, or ever really imagined. God moved on a couple of their hearts and they began to really pray for this girl. They infected the others. It became a common sight to find the nurses gathered around her bed singing hymns at the change of shift. I would come in, in the middle of the night, and find a nurse at her bedside reading scriptures to her. At times they fought for her. Real spiritual combat. Their worldview leaves them perfectly unencumbered to be able to do such things. No need to follow formulas, they simply know the power of Jesus’ blood over evil spirits. Nothing theoretical whatsoever. “Love thy neighbor” means that you understand and use this authority when it is needed. Yet again, I found myself thinking- who is the missionary here? And who is supposed to be teaching medicine to whom?

Last week she went home smiling and free and healed. Do I think that the antibiotics and the blood helped her? Of course I do. But they aren’t what set her free. HEALTH IS FOUND IN JESUS.

A Painful Loss

Yesterday we operated on a girl with an abdominal pregnancy. It is a type of ectopic pregnancy, so it is outside the uterus, but the pregnancy continues to develop, usually implanted on the rectum or the intestines. They are extremely rare, and I had never seen one. The baby was alive and near the fifth month of gestation, so that the gestational sac was about the size of a volley ball and filling the pelvis, behind the uterus. Unfortunately, the placenta had begun to separate and she began to bleed catastrophically into her abdomen. By the time we got to the OR, her pulse was already 160 and she was hypotensive and had bled several units of blood into her belly. You cant take the placenta out because you cant get the bleeding stopped if you do. We couldn’t get the bleeding stopped even leaving it in place. She received a total of 9 units of blood. (we have no blood bank, so this was just 9 willing people who gave a unit of whole blood on the spot) We worked for 5 hours and ended up packing her pelvis as tightly as possible with compresses and closing her abdomen, hoping she would clot off and we could go back in 36 hours or so and take the packs out. I’ve just never seen anything like it. We transferred her to the recovery room and she was laying in the same bed, under the same sign. HEALTH IS FOUND IN JESUS. Last night around 10:30 she died. She was 20 years old. I cried and cried. Perhaps the most discouraging thing about prayer is when God doesn’t do what we want him to do. I imagine he feels the same way about us.

Prayer

Please continue to pray for us. Pray for the missionaries and the Malienne staff as well. We are all tired and kind of beat up. The work increases faster than we can respond to it, so we chase along behind and get discouraged. Pray for the patients here. Pray that God would open hearts and minds to his grace and forgiveness. HEALTH IS FOUND IN JESUS.

May the peace of God keep you.

Dan, Marcy, Emma, Ellie and Maggie