Wednesday, January 22, 2014

Dim Hope

She had been only on the earliest brink of the changes to womanhood. She had never even seen her menstrual flow, but the boy in the village wanted to have sex, so she agreed. He pushed his frame onto her childlike bony frame. That is what had started all the pains. Months later, at twelve years old she lay pushing in the darkness for days. Finally, after the seemingly endless labor, the family made it down the lengthy footpaths out of the bush to a distant health clinic. A clinician with minimal training cut open her belly and released the dead baby from the tiny pelvis which had become its prison. Her family’s dread turned to a bit of hope that maybe the girl would live.

And live she did. But life became much more complicated. Just after the surgery, urine and stool both leaked though the incision on her abdomen. Foul odor and discolored drainage from the urine-feces mix stained clothes day after day. She was sent back to her village, where it continued for a full year. Then, finally the wound on her belly healed, the dirty leaking through the incision stopped. Her bowel movements returned to normal. But the urine did not. Now, she began urinating constantly through the vagina. Whatever injury to the urinary tract that had been, managed to find a different method of exit. Still, it was better than the prior, at least the stool had stopped. Years went on, time continued. For seven years she stayed in the village, smelling of urine, and dripping all around.

Finally, she came to the hospital. I wish I could say that all got better, and she left with a smile. But that isn’t the way it went. Some initial blood work showed that she had HIV. Further tests and examination revealed that it wasn’t a new, mild case, but full-out AIDS. Her health was terrible. In a few moments, her world had once again worsened tremendously. She thought her world had fallen apart long ago, but now even the intact threads seemed to be shredding.

I got some initial tests for the urine problem. It was still her heaviest burden - the plague that she felt the most, and the trail of urine that others could see and judge. The HIV at least was not known as soon as she entered a room. She hoped for a cure for the chronic leak. I examined inside her pelvis, noting that its full development had been stunted by the pregnancy, now many years ago. My finger felt bones like that of a normal ten year old girl. She could barely endure the pain of the exam.

We sat down to talk, not of immediate satisfaction, but a lengthy process. First, she needed months on medications to fight the newly diagnosed virus that was ravaging her body. The chance of healing would be low if we decided to operate before her overall health was improved. However, even getting the medications was not an easy task to manage, since the closest place to obtain the necessary medications is a two day walk from her village. But determined, she agreed to make the journey monthly for the drugs. Then, we needed more imaging studies of the urinary tract to make sure we knew exactly where the defect was that was causing the urine loss. These costs were beyond her means, but thankfully the missionary who had brought her to the hospital agreed to help cover the hospital’s costs. Lastly, she had to understand that the repair would be difficult, and depending on what we found when all of the information was put together, I may need to wait for a specialist to come with more expertise than I have. She understood. Resolution to her condition wasn’t a magic tablet that could affect a quick fix, but it was a glimmer of hope.

But a glimmer is important when the rest of the world is caving in so awfully dark. In the midst of pain, filth, rejection, scars, odors, drips, disease, despair – a glimmer starts to grow. And maybe one day it will burst into flame with some beautiful light. Life has been too hard. At least now there is a little, tiny ray of light peaking through that days may get better, and wrongs may be right. Maybe one day she will shine like “a city on a hill”, or a “lamp on a lamp stand”, giving light even for others to see. But for now it is only the smallest little speck, the tiniest little ray buried inside her. I hope that her soul will begin to find rest and comfort as we begin to care for her body. I hope that her burdens are a bit lighter, as she begins to know that others do care and want to help. For now, it is our job to bring our lights to her, to bring hope into her darkness. It has been too hard for too long. 


Like the dust filling the air this dry season, troubles and difficulties hover in this place. Almost  every breath breathes them in, breathes them out. You think that maybe the dust has settled, but then a passerby or a rolling tire comes and poofs it back up to fill the air. Even when you haven’t noticed it as much, its still there. You go to blow your nose and there’s half dust, half snot. Just like even the decent days are filled with struggle mixed in, constant dirt in what otherwise could be a nice scene.

Effort has been significant, difference made has been minimal. I will qualify “minimal” by saying that for individuals served by the physician- patient relationship, lives have been changed, spirits lifted, maybe even hearts opened. But in the systemic plagues that define medicine in the developing world, little to no change. Pages could be written about culture, or departmental issues, or education, or mission hospitals, or accountability, or sustainability, but the words would only describe, they couldn’t in themselves actually bring resolution. I have spoken them over and over, and am weary of speaking to issues beyond my strength to change. I have fought hard, a good fight with worthy goals, but winning is not possible. My encouragement is that disappointment now is often looked back on with gratitude for what we have learned in the process.

For now, there are hard, jagged days that I wonder multiple times “how much longer?” Where I check the calendar on the phone attached to my hip to see if the time is drawing near. The constancy of the struggle turns my gaze away from the here and now to something that may someday be. To faces that I love, people that I miss, the gentle blanket of familiarity. For those moments the wonder is gone for distant places and things, and returns to the place where my roots hold fast. The romance in my imagination returns to home. Beauty, and warmth, and acceptance, snuggled alongside those I love most, tucked in between mountains and streams, familiar places, delightful people. And when I think of it, I remember that there is an even better home waiting, an eternal home. One filled with ultimate purpose and pleasure and love. A home where He is. A home that I am one day meant for.

Home. There is no comfort in that word, no heart connection for millions who roam the earth. I do not speak of here in Cameroon specifically, not for the moment. But in nations not too far to the north or east or west or south, and then further countries spotted all over the globe, they are there wandering, wallowing in despair. Daily struggles for survival and basic necessities are considered normal for many. Hopelessness sets in, trying to overtake any other emotion. Children dying untimely deaths, men and women with no semblance of honor left, disease, war, and decay ruining what could be a beautiful world. Yet there are those with a glimpse of hope, not for here and now, but for somewhere and forever. They stop in the midst of the struggle to imagine what it will be like “in a little while”. They long for a better world. The desperate spirit inside calls out to the God above, yearning to be freed from all the horrors that have come to make up life. Longing for the time to come.  

And yet, amazement will always be ignited within me when I recall the reality of the God who hears. I can’t understand even the worst days that come and go in my own life. How much less the much worse horrors in the most desperate of places. I can’t give you the right answer for why bad things exist, sometimes even thrive. But God does hear and is at work from the broken-hearted wealthy, residing in penthouses, to the hungry refugee within the barbed-wire encircled camp. And the rest of those who read this, who are somewhere in between.

I lie down sometimes in my bed at the end of a disheartening day, and in the darkness remember that on the wall just above my head is written “I will both lie down and sleep in peace, for You, O Lord, make me to dwell in safety”. I am reminded of His presence. Even when the night comes on thick in its darkness I can take cover, give a little grin and think “in a little while”. Better things are yet to come. 

Sunday, January 5, 2014

Born Broken

“Some people are born with these kinds of problems…”, that is how the explanation started. I had the luxury of reviewing the patient’s booklet the day before, and realized that her problem was genetic. However, it is the sort of problem that doesn’t display itself until puberty. All the other girls had started to wear bras, grown mature patterns of hair, filled out their curves. But she didn’t. In the states, the parents would have brought her in at 13 or 14, realizing that something was wrong. But not here. Here, she presents in her mid-twenties with the chest of a child, no hair under her arms (or anywhere else that may signal maturity), never having seen a cyclic pattern declaring womanhood, dark eyes filled with insecurity and disgrace.

It is a rare problem, where the initial genetic material is wrong. People presenting like this can either have female or male genetic makeup, but they look, and have always thought, that they were a girl. We don’t have the tools to properly work up the genetics. Recommendations are out the window for proper care. I told her of the possibility of surgery, to reduce the risk of a rare type cancer that can sometimes come with this disorder. She didn’t want that. I counseled her on her options for making her develop breasts. Her head shook quickly, confirming her desires. She longed for woman-breasts instead of the little child chest she had worn all her life. This was the most outward, obvious sign that she was not like the other girls. She wanted some hope that she could fit in, and this was the way that had filled her dreams. She didn’t even try to hide her excitement, when she realized that the option was available. I told her that it is a process, not a quick fix. Hope of normalcy sustained the possibility, even if it were going to take a long while.

Next was the hardest part. It is a subject that none of us would want to broach. The uncomfortable nature even made me squirm. I began gently by telling her that she had great worth as a person. That God made her and thought she was valuable. But then came the sad reality. That is God’s way, but not the way of the visible world around her. Her culture gives no value to a woman who cannot bear children. Over and over I see women set aside by their husbands because they are infertile. Three husbands later, they are often still coming in looking for something that may help, some magic chance to have a baby.  This girl didn’t stand a chance. I told her that because the probability for a husband was low, she should really try to stay in school and get a good education so that she could learn to support herself. She had thought of this already, and told me that she was working hard to finish her education. The cultural truths were hard and mean and ugly. She might be good enough to be used or enjoyed by a man, but she would likely never be able to depend on any commitment from one. She would never be accepted as a wife, and would certainly never be accepted by any in-laws. But in the midst of such bitter reality, the eternal truth was sweet, that she was valuable as a human being, and strongly loved by the God who made her.

Sometimes we see that life is just not kind. It is sharp and harsh. Our struggles are each different. Some can be seen from the outside, like this patients. Others lie hidden from the watchful eyes, deep in the broken parts within. But they all still bring pain. Being a Christian doesn’t make life a constant spring bouquet of fragrant pleasures. It doesn’t make every sadness better, every wrong right, at least not for now. But no matter what the road brings, or how defective we feel as we walk down it, there is a deep, abiding pleasure when we stop for a moment and remember that even in our brokenness and incompleteness, we are highly valued and deeply loved.