Monday, November 26, 2012

Things I Think are Funny

Someone noted that my blog was depressing, so here are some things that I think are funny in Cameroon. Maybe they will cheer you up. Sometimes people don't understand my humor, but I think I it usually quite good.  

If you've ever seen a newborn baby under the blue lights in the US, it's just a bit pitiful. But here, its much more pitiful. Poor thing is closed up in a wooden box with blue bili lights shining down, eyes blindfolded by a bandana type cloth to protect them from the light. For some reason, it is always funny to me though - looks like a tiny abduction victim. Its probably not funny to you, but maybe.

This one is what "you're having twins" indicates in Cameroon. One on each arm while you ride the motorcycle. 

This one came on a bad day. Everything seemed to be a struggle. I had to do a procedure in the OR. As I bent down to take the broken bed apart, I saw this sign mounted on the underside of the OR table. I thought, "well, I guess this is encouraging on a bad day, at least the table won't blow up". 

The female bathroom sign is normal, a little girl in a triangle type dress. And then you see the male sign. I mean, I never thought the normal, general sign was flattering to the male figure, until I saw this one. Wierd. Where in the world did they get this? Oh yeah,  Africa. 

The flash distorted the photo a bit, but this is a box of tea in the store. There's tea for everything, sex, fat, etc. But this is my favorite. "The de la defication" - Defecation tea (for those who speak country - tea to help you poop). Note the cool picture with the woman reading on the toilet. 

This one isn't really funny, its kind of gross. What's for dinner? Fish heads. I didn't eat these.

Now, this one seems funny to me every time I come to town. It never gets old for me. The sign below says "At your own risk WILD DOGS". If you don't get why this one is funny, I can't help. 

Wednesday, November 21, 2012

Hope in Despair

Two children died coming into this world before, and now the next was at stake. The 20 year old couple had lost too many for so few years. In fact, they only had losses, no living children. They were offered a C-section, as the child was breech, but declined. Labor ensued. Hope mixed with pain, the intensity of which worsened after the water broke and trickled onto the floor. The young man was obviously concerned as he watched his wife. Awkward and young, he didn’t know what to do or say, but he kept coming to check on her. She called to him as she began to push, and obediently, he came. The nurse told him that he could rub her back to help with the pain. Massage isn’t really practiced here, but he tried to do what he imagined she was telling him to. The child came, a bit closer, and closer. But the pushing continued. Joy came closer with each millimeter of progress. No electronic monitors available, so the nurse listened every few minutes.

Oh I love that sound of the fetal heartbeat. That rhythm brings a slight nod of my head and pulse of my fingers that ensures me that everything is okay. I miss the continuous rhythm of electronic monitoring, the transmitted beats written on the page, and delighting my ears. Fetal monitoring in the developed world comforts me, but here, there is no fetal monitor. Only an occasional, momentary check to make sure the heartbeat is still there. No soothing, continuous “da-dum, da-dum” to nod my head with.

And then the nurse went to check again, and it was gone. She could hear nothing but the swish of the maternal pulse. Had the child shifted, or was it there, but hard to hear? I imagined hearing some faint sound, but I could tell it was only an imagination of my mind. I called ultrasound to come. But with no ultrasound immediately available on maternity, there was nothing to do but wait for them to bring the machine. The worst thing would be to do emergent surgery on an already deceased baby. That would bring higher risk to mother, but no reward in a child. So we waited, and anxiously searched for the heartbeat with the fetoscope until the ultrasound finally came. It confirmed there was no heartbeat.

Our hearts sunk, as now there was only one course of action. She couldn’t push anymore, and the fit was tight through those young bones. Terrible, terrible delivery it was. Intentional, forceful removal of the fragile infant’s body is one hardest things for an obstetrician to feel beneath our hands. It brings me a wave of nausea to have to deliver intentional harm like that. We, who love to bring life, also have the job when outcomes are at their worst. And this was certainly worst. All of the prior impending joy was lost as we struggled to complete this delivery.

A hundred backward glances over the days to follow. Wishing for more resources outside, more wisdom inside. Every morning I rounded on the woman. My uncomfortable eyes meeting with hers, another reminder to me of the failures that can occur with our best skill and intention. I knew it was not truly my fault, but there was a constant twinge of guilt. I fought against the thoughts that came –“I am the one who is supposed to be able to help”, “I’m supposed to give them a live baby when the past ones all died in the village”, “They’ve come to the hospital because I am a specialist here”. I could think of nothing else I could have done or offered though. The course was reasonable right up until the difficult delivery. If I knew the future, knew the outcome, we could have changed the course. But only God can know these things. I pray for wisdom to choose smooth paths, compassion to walk patients through rough ones.

In spite of circumstance, the young woman and her husband were continually gracious and appreciative. Was it their humble state in life, filled with poverty and loss, that left them numb?  Had it not sunk in? Was this culturally appropriate external action, while brokenness or anger lay concealed inside?

My greatest hope was that it was something more. I hoped that God had given peace, surpassing circumstance. He speaks of it as a “peace that passes understanding”. It is what lets the soul rest in Him, while storms rage all around. It is not ignorance, or numbness, or a false mask of joy. It knows great pain, acknowledges brokenness, it feels disappointment – but it knows the gentle and comforting hands of the Father hold them in the midst of it all. We come to know this peace most often when we find ourselves beyond our limits, during times when life gives us more than we can bear. It is then that self-sufficiency is lost, and we recognize our need for God’s sufficiency. And thankfully, when we realize our need, He comes to fill it. We have mountaintop experiences with God dotted throughout life, but these experiences in the darkness and hopelessness of the depths are where we come to know and trust Him most. I hope and pray that this young couple has found Him as a comforting guide to walk them through these hard times. 

A Greater Love

The woman was quite upset when I told her about the cancer. The most outward display of emotion I have seen here with delivery of such news. Obviously afraid, she begged me not to leave her. Clinging tightly to my hand, she didn’t even give me the option to leave. She was overwhelmed by confusion, fear, vulnerability, and despair. One moment of bad news brought out every insecurity. I prayed with her, but she was too overwhelmed by her emotions to find comfort there. She called her husband on the phone and spoke to him with a scared, cracking voice. He was her husband of many years, and she begged him to come to the hospital, with deep hope that he would somehow make it better. She yearned for his presence. I had to go on with my work for the day, so I gently freed my hand from her firm grasp. I ensured her that I would return to discuss the cancer with her husband when he arrived. It took hours for him to get there, all the while her fears and needs grew deeper. When he came, he made me even ashamed. I tried to break the news to him gently, since I saw that his wife was banking so much on him. I imagined that his deep love for her would make the news hard to hear. But he never seemed to care about her. His only questions, deeply concerned as he asked them, were about how to protect himself from getting cancer. He understood that it was associated with sex. He understood that it had been working in her for years. And so, logically, he knew that he must have been exposed. Was he at risk? Did he need vaccines, or testing, or screening??? He was willing to do anything to make sure it wasn’t eating him up inside too. But it didn’t bother him at all that he had likely given the infection to her, or that his wife’s burden was far too heavy for her to bear. She bent her shoulders forward sitting in that ward full of women, broken by the despair of disease and the lack of concern from those she loved. I wondered if she was as ashamed of him as I was. I felt sorry for her. She was not a love, or partner, but only a risk to him. However, he had been everything to her.

It reminded me of how much we need to know the love of God. It is a love that does not fail, better than the best any person on earth could provide. There is no one who can fill every need you have except Him. To place our every hope, our every dream, our everything, on another, only gives them a heavier load than they can carry. No one can fill us up except the One who is meant to “fill all in all”. He can always be trusted, he always cares, and he never leaves His people. I wish that lady knew that there was a far surpassing Love available. She was made for more than her miserable husband could provide. 

Thursday, November 15, 2012

Fundraising, ugh

I am not much of a fundraiser. People always ask me what I need. I usually tell them that I have enough to eat and a house to stay in, but that I treasure their prayers most. And all that is true. However, there are many other expenses along the way. I will say that what I, and people like me around the world, am doing is really important. As we work to provide medical care and teach others to do the same, we are able to alleviate disease not only in the here and now, but with fingers reaching into more distant areas and even future generations. As we recognize and minister to the needs of peoples’ hearts in the name of Christ, we are able to bring healing that far outlasts the ever present weaknesses of these temporary bodies. So, I’m not going to try to give you an exhaustive list of why you should give. I do believe it enriches one’s life as they learn generosity toward others. If you and your family do decide to ever support me financially, I am truly thankful. I really do appreciate every person who gives, every person who prays, and even every person who just cares. Thanks to those of you who do.

If anyone does need my information for my Samaritan's Purse account, it is:

World Medical Mission
Christy Lee, Acct #004394
PO Box 3000
Boone, NC 29607

or online

Wednesday, November 14, 2012

Not this one!

I’ve written in brief about my cervical cancer patients previously. The problem with cervical cancer is that usually by the time you have any symptoms, it has gone to far to be able to offer any good treatment. In the states, pap smears are  so engrained and routine, we often catch the cancer early. Here, they always come in advanced. I diagnose it as they walk in the door. The smell of rotting flesh has no obvious source as they walk in, so that tells me exactly where the source is. I don’t even shy away anymore from the smell, don’t grimace during the exam. That seems degrading to someone who you are about to give very bad news to. The exam is the same, black and gray flesh where pink should be, overtakingly malodorous discharge pouring out, and dull eyes peering over the pelvic bones wondering what I am seeing down there. I finish, and cover their legs again. I keep them lying flat to help taper the trickle of bleeding that ensues after the most gentle exam I can perform. And I draw my chair up beside them to talk face to face. I tell them that the cancer is too big, and that I have no way to cure it. No one has any way to cure it. I have some “special x-rays” (an old cobalt radiation machine) available 6 hours away, but it won’t cure the cancer. It can help with the pain or the bleeding, but that is all. But she can’t afford it anyways. It may as well not exist as a false hope in her world. I tell her that no matter what we do, this cancer is eventually going to take her life. I answer any questions, and then I ask if I can pray with her. I pray to a God who can be trusted in the best of circumstance, and the worst of circumstance. She usually cries a little. I tear up too, but have it under control by the time she opens her eyes at the finish of the prayer. Then I send her to the chaplaincy to continue her counseling (they also do much of the psychology here), and palliative care, who will supply her morphine until she dies.

But not this week. Yesterday someone came in with the biopsy results, “invasive cancer” it read. She had been screened at an outside screening progam. She didn’t smell bad. And the cervix was still visible. In fact, the area was small. I knew it was small enough. Small enough to give another talk, instead of the usual one. I finished the exam, all of it was clear otherwise. I cursed the cancer to myself, “you can’t have this one”.

But that isn’t the really amazing part. In just a few hours I knew that walking into my clinic would be the doctor from Canada with whom I will learn for the next week. I know of no one else who has done so many cancer surgeries here. Next week, we are doing cervical cancer surgery together so that I can learn the procedure better. I assisted on a few in residency, but not enough to feel like my patients would really get the best surgery if I tried to do it alone. But he has done this many times. And he has travelled the country over the past days, from one screening center to the next, rounding up only the handful of women who are eligible for surgery amongst the swarms of inoperable. Only a few drops of hope in the midst of a sea of despair, but a few beautiful drops.

This lady was the only one from our hospital region who qualified for the surgery. She came in randomly on that day. This doctor came randomly on that day too. Apparently, others have been waiting on him for months. And now, she is to meet us next week for surgery. Seemingly random events, but actually very amazing. Why do so many die, and yet the paths have come together so well for her? I don’t know. But still, I pray to a God who can be trusted in every circumstance. And I pray that the hope I have seen in her will be lived out in life instead of death this time. That her children will get to keep her. And she will die at some ripe old age, filled up with days. But more, that she will understand, at least as I see it, that there is some divine hand working for her good. And that her life lived will be lived for His glory.

About Sex

People are always talking about sex. I’m an ob/gyn doctor, so my job is highly dependent on sex. I have to talk about it all the time. I really do enjoy educating young people about it. I always like to discuss what sex was meant for. I mean, the world is full of answers and tips, but mostly it offers a bunch of lies. Sex, as portrayed by the world around us, seems so glamorous, but really it is a far less amazing thing that it was meant to be. It was meant to be great. But the twisted nature of it leaves it beautiful on the outside, but rotten on the inside. Distortion of it seems to span the globe, like an unacknowledged plague. Very literally bringing problems which, when combined, are like a plague. I see it here so much. The effects of the twisted, adulterated version are seen in the patients lined up for clinic. Sex was designed by God to be enjoyable, and there isn’t anything wrong with it – that is unless somebody uses it incorrectly. But when used in different ways than God originally planned, mercy, does it go bad.
-She comes to sit in my office at the age of 39 and have a conversation about how her cervical cancer (the only known sexually transmitted cancer) is inoperable. Then we will talk about what “inoperable” means. It means that this is what is going to take her life. Tears fill her eyes as she asks me what she will do with the children she is raising. How will they make it without her?
-She comes to the office and talk about how she’s been trying to have children for 12 years. She has had medications, and surgery, and healing prayer services, and witchcraft. But the baby won’t come. And I’ll tell her how the tubes are scarred. She wonders why. I respond it is from a sexual infection, often many years ago. Most of the time, she didn’t even know that it was waging war inside of her, but it irreversibly damaged her tubes. Now the egg cannot make it into the place where it should sit in the uterus.
-Or she comes in with an ectopic pregnancy. I open her belly to save her life. It’s tensely filled with blood. We are giving IV fluids, but her heart has a hard time keeping up with the active loss. That scarred tube caught the pregnancy, and it grew inside there until finally the tube could stretch no more. It ruptured open, began spewing blood, and  is now endangering the mother’s life. The next morning, I tell her that we had to take out the fallopian tube. She wants to know what made the scars. I have the STD talk again.
-Or, she really hasn’t done anything. But her husband is with 3 other women. She lives in fear of HIV. But there’s nothing she can do. Why not leave? Well, because the poverty around her is swallowing her up. She doesn’t have any way to make enough to support herself and her kids. He beats her. And she doesn’t get to choose whether she will have sex since she has little power as a woman.
-Or,  one of the prostitutes who usually don’t make it to my office. She wishes she could have a better life, but can’t get out. Her family needs money. Everybody needs money. There’s no other work. So, she decides to just try to be careful. But its only gonna make $2 with a condom, and $10 without one. I mean, $10 could really help…
-And I could list a thousand others with other sexually related problems, but I'll spare you.

And you read about them and think that they are people a world away. And yes, they are. Fewer resources, less opportunity. But many of the problems are still the same in my hometown and in this new town. Sexuality is idolized all over the world it seems. Perverted, and with the safety of the protective walls of marriage taken away, it leaves physical scars, emotional scars. It was meant to be unifying between two people, freeing them to a level of vulnerability within commitment that was unparalleled. It doesn’t make marriage perfect, or easy. But it is a symbol of the commitment within relationship. How far less it is to settle for a few moments of pleasure, when so much greater was the original offer. And how devastating to find that the easier road had so many unrecognized, painful consequences. God offers more to His people. He demands more from them. And His ways are infinitely better than this world can offer. We need to work to redeem the generations coming up. They are taught by the world that sex is ultimate. But Christ is ultimate. And thankfully, He has made a wonderful place for sex, but it is not going to satisfy outside of His intention for it. 

Wednesday, November 7, 2012

Guava Mania

It was a good day at work, topped off by finishing up with patients a bit early. One of the short term volunteers had asked me to take her riding horses, so I gave her a call and said to get ready. But, why perform one task when you could multi-task. I had been wanting to go find the guava grove so I could pick fruit and make juice from it. So, that's where we headed. The people in the village laughed at me on the way up. I had my market/farming basket on my back as I rode. They think it is very funny when I use mine, though theirs all are exactly the same. Everyone along the way stated, "You are going to farm", somewhat as a question, partly a joke.

We arrived at the hill where scattered trees hold green and yellow guavas. You could see the trees shaking as we bent their boughs to lean in and grab ahold of the ripe fruit. Little by little the basket on my back filled almost to the top. Satisfied, we headed back to the horses. I tilted my body a bit to lift up to the saddle, finding a showering of guavas from my basket hitting me on the head and then rolling on the ground. Stopped to pick those up, then tried again to mount the horse a smarter way. Finally we were off. This time the people along the road didn't make fun, they all said, "You have gotten oranges!" (they couldn't tell what fruit they were, only that they were piled high in that basket, and they did look a bit like the yellow oranges they have here). I was proud of our load. It must have been 40 or 50 pounds on my back, with the little straps of my basket digging in to the crevice they had made in my shoulders. But I was thankful to not be walking while carrying the burden, at least the horse was doing most of the work.

Or I thought he was doing most of the work. But then after I got home I realized that a good portion of it was yet to come. I brought out my biggest pots and boiled the water, sliced the fruit, and waited. Then to the sieve, squashing the pulp through to keep the seeds out. Over and over again. So many guavas, so many twists of the wrist. On and on, until finally it was done. It had been dark for hours, and now, late in the night, it was time to clean up. A little while longer and I got to fall asleep, satisfied somehow by harvesting and preparing. And in the morning, how lovely to wake up and get a big glass of fresh guava juice! Mmmm, mmmm, mmmm. It was so worth all that effort.

 Only a few of the many guavas beside my market basket

Cook em up, squash em up.

Tuesday, November 6, 2012

Pigeon GYN

No, I have not begun performing aviary medicine. Pigeon english is the language that they speak here. You'd never know there was any english in it, except for when they really slow it down for you. Even then, many of the words aren't in any dictionary. So, gynecology can be a bit interesting. Here are some of the daily phrases we say. Some are only my version of pigeon, but the patients understand what I am asking or saying, so it works. Some are what my nurse translate when I ask the question.

To the one who comes for infertility, but is 46 years old:
"Yo ovary done grow old"

To the couple after I've explained the most fertile time of the month to concieve, who are now finished consulting: 
"Now yu and yo man go make pikin"

The explanation of a hysterectomy (pikin=child/children):
"We gon move yo house fo pikin"

Do you have abnormal vaginal discharge?:
"Yu done got bad water from de woman skin"

Have you been to the witch doctor/traditional healer?:
"Yo done drink country mercy?"

Have you had a period/menses?:
"Ya done see ya time fine? It de come fine?"

Have all of your prior deliveries been vaginal, or any c-sections (pikin=child/children)?:
"All yo pikin dun come tru de woman skin?"

Have you ever had a miscarriage?
"Some belly be dun spoiled?"

Have you ever had a D&C?:
"De be done wash yo belly?"

We need to do a semen analysis (pickin=child/children): 
"We be check yo man pikin water"

The ovary:
"Dat place where de egg done come from"

The cervix: 
"Dat door fo house for pikin"

You have male factor infertility, the semen analysis is abnormal:
"If dem sperms no swim, ya no get pikin"

How many wives does your husband have? (husband=master/owner - hey, I didn't come up with it):
Un a de how many fo yo masseh?

Is the relationship monogomous?:
Yo masseh got noder woman fo outside?


I prepared for a c-section today. Standing, looking at the pile of green rain boots that are shared by all the staff, I cringed. I hate to put my foot down in that deep dark hole. Once I found an old, dirty sock inside. Today I found an old rag. I told the OR staff member standing in the room, "Judy, I hate to put these boots on, I imagine there are critters inside". I turned away to go in my plain shoes, but she stopped me. She said I had to wear them, that she didn't want me to get blood all on my feet, and that I knew c-sections always had plenty of blood dripping down. So, I grabbed them up and put them on. It seemed the responsible course. Those oversized boots clunked off my heels as I walked into the OR.

The case went fine, baby out, uterus back together, beginning to close the skin... and ouch! I jumped as behind  my right knee stung. I looked beneath the drape of my sterile gown to see a gigantic cockroach on my pant leg. Uggghhh! I broke sterile technique, jerked my foot out of that gross boot, and knocked the roach of my leg. It was Charleston sized, big enough to eat my toe if it wanted. Oh it was disgusting. I kicked the other boot off, considering that maybe he had a brother or cousin hiding out in there, leaving me in my socks to finish surgery.

As he ran for the door, my outburst demanded someone follow him for the kill. You can't let him get away with assaulting me like that. The circulating nurse went after him. And sure enough, when I came out after the case was safely completed, there he was flipped on his back, injured, but with legs still wiggling in the air. I left him to die a painful death. My compassion doesn't extend to roaches.

I can manage with limited suture choice, or bendable needles made in China, or power outages in the middle of a case. But I don't do cockroaches. Not on me. Who knew roaches could bite, or sting, or whatever it did to me. If my right leg gets infected and I die off over here, you'll know what started it all. Nasty little thing! I am still feeling crawly all over. I keep trying to brush away non-existent bugs as the sensations tickle my skin every few minutes.