If there is one word that can describe the amount of work that has to be done here it is overwhelming. I keep being amazed by the sheer number of people that we see daily in the outpatient department, the several operations we perform, and the number of deliveries that are done daily. Even with four physicians working this week, we seem to go at breakneck speed just to get through the number of patients. I guess it has made me appreciate all the more the all sufficiency of Christ and how He gives the strength necessary to complete the work.
Unfortunately our second day at Makunda was filled with much death. The reality of death is something that is ever present here because there are many diseases for which, no matter how good our therapy, there is little hope of the patient surviving. One of the patients who had been here for thirteen days suffering from tetanus died around 2 AM because of respiratory failure. We had managed to keep his seizures and constant muscle contractures under control for several days with barbiturates but apparently that wasn’t enough and he passed away. He had been isolated in a room that was completely dark because patients with tetanus will go into spasm if there are any loud noises or bright lights. It was tragic because it was so easily preventable since a tetanus vaccine is available here but still many people never get it because of a lack of health literacy. He was only in his twenties and it all started because he had a small cut on his leg.
The second death happened around nine in the morning. It was a lady Christo had helped to admit the day before with Dr. Ancily who had suffered a massive stroke. She was the patient that had presented unconscious with a dense right sided hemiplegia. Our guess was that her stroke was due to some type of massive intracranial bleed and thus the mass effect on her brain stem must have cause her death. The other two deaths today were two fetuses that died. One was a lady in her twenties who came in with thirty days of vaginal bleeding. She was about three months pregnant when the bleeding started but did not seek treatment until she was so weak that her family finally brought her in. When we checked her hemoglobin initially it was 4 (normal is around 12-15) and her blood pressure was 80/40. She was the palest person I had ever seen. We did a dilatation and curettage to remove the infected products of conception and stop the bleeding. She was also able to find someone who matched her blood type and thus we were able to give her one unit of blood. We don’t have a blood bank available at the hospital and thus we rely on patients to find a compatible relative/friend to provide the blood immediately before transfusion. We have the ability to check the blood for blood borne illnesses but because of the difficulty in finding donors, it is hard to get more than one or two units of blood per patient. The fourth death was a lady that had an intrauterine demise at around 5 months of pregnancy. We delivered the stillborn baby and on examination it appeared as though the baby had been dead for several days before the mom had come in. Frequently many women who had retained dead fetuses died from infection because they had no access to healthcare prior to Makunda coming into existence. Even though it was tragic that these two babies had died it was good to see that their moms did not die along with them.
On the second day Christo observed and then assisted on a couple of operations after our outpatients were seen. The first operation of the evening was a lady with two large 5 cm bladder stones. I had seen kidney stones before but this was the first bladder stone I had seen and they were huge. The looked like two large eggs that were crowding out most of the bladder. Because the stones had been present for such a long time and due to the subsequent chronic inflammation it also appeared that a tumor had formed in the bladder and thus we took biopsy specimens and sent them to a bigger hospital to have them read to help us decide how to proceed in the future. The second operation was a C-section that I got to assist Dr. Ancily with. The mom came in with arrest of labor due to cephalopelvic disproportion. Getting into the uterus was fairly easy but extracting the baby was not. Because of how long the mom had been in labor, there was significant molding of the fetal head as it engaged the pelvic inlet. Thus we ended up using forceps with the C-section to pull out the head and finally get the baby out. Mom and baby both did well. Because it had been a long day, I decided to go home around 7:30 PM while Dr. Ancily and Dr. Rockfuii performed another C-section that evening that got finished around 10 PM…another long day.
After finishing at the hospital, Jonathan, the hospital administrator and his wife Lydia invited us to their home for dinner. It was wonderful to get to know them and their heart for missions and commitment to the work at Makunda was readily visible. Jonathan has worked at Makunda for about six years as the hospital administrator and he married Lydia about 2 ½ years ago. They have a one year old baby, Kenneth. Both of them are from the state of Tamil Nadu and since college had felt a deep burden to reach India for Christ through mission work. We found a little bit more about what had happened to Jonathan a couple of weeks ago when he was assaulted by some villagers. The land that the hospital is on was granted to them by the government many years ago because they took care of leprosy patients. Over time, the land owned by the hospital has been illegally encroached upon by villagers. Most recently, there was a dilapidated structure located on the edge of the property that was illegal constructed. Jonathan and some of the other workers here had gone to remove that structure after getting the proper legal paperwork and because the person that claimed to own that land was not happy about it, he and some other villagers beat up Jonathan and the other workers and cut his arm with a knife. Thankfully even though Jonathan had several bruises and the cut on his arm, he recovered quickly and the villagers have left him alone since then.
