The Road to Gimbie Letters

06/02/01

Dear Family and Friends,

Sorry you haven't heard from us in a while. Things have been very busy. Dr. Rose has been on furlough and I have been wearing more than my own hat.

We had one of those nights last night. We had two women in labor that came in at the same time. One of them, sadly, had a dead baby and it took some time for her to deliver. In fact, we delivered her at about 1 a.m. this morning, by using a vacuum extraction delivery, basically sucking the kid out by the head. I felt sad to see her face as we pulled out the baby she had worked so hard to push out and she turned away so that she would not have to see the dead child. The cord had been around the neck and the arm had been up around the neck also, making it a very difficult delivery. The baby had been dead since the day before, most likely and was dead when she came in.

The other woman had a much brighter story. The mom came in and I checked the baby and the heart rate was okay, but when we broke her bag of water, the baby had passed stool in it already. This is a bad sign and can mean baby is in distress. We got things ready for a c-section and during this time the heart rate of the baby began to go down. When the surgeon got the baby out, there was an immediate, lusty, loud cry. It made it all worth while.

Speaking of the surgeon, we have a surgeon that we got temporarily from Addis Ababa. We have been keeping him pretty busy, as you will see.

Besides these two patients, we had another sad-story patient. I had seen a woman in clinic with coughing out blood. She was holding a three-month-old baby and she looked like she might have TB. I checked her sputum and there was no TB in it, so I started her on antibiotics. She had some vomiting also and I had checked a pregnancy test since there had been no menstrual period. The pregnancy test was positive. She was shocked and very upset, since she had six other kids at home. She said they could not afford another baby. She asked me to do an abortion. Abortions are illegal in Ethiopia. I told her that, and the fact that we are a Christian institution and are in the business of saving lives. She went away sad, but the sad part is yet to come. She came in about five hours later, about 5 p.m. last night. She was in shock. She just said that she had been vomiting on the way home. I then saw blood on her clothes. I asked her if she had an illegal abortion and she denied it. I checked her vagina and there was some tissue coming out of the cervix. I checked her abdomen and it was very tender. I called the surgeon, since some illegal abortions go on and they don't know what they are doing and can sometimes make a hole in the uterus. He was concerned, too, especially since she was in shock. We brought her to the OB ward and tried to check what was happening. When we looked with a speculum, we could see some of the tissue coming out of her cervix. We then looked more carefully and discovered that it was intestine! Someone had illegally done an abortion, had poked a hole in the uterus and then with a clamp had pulled down and out some intestine. That is not the worst part. We rushed her to surgery after that and the surgeon discovered that not just a bit of intestine had been pulled out. At least 12 feet of small intestine had been pulled out by the person doing the abortion and she only had about 3 inches of ileum and 9 inches of jejunum left. Those are parts of the small intestine. That amount of small intestine is not compatible with living. This poor lady may survive the surgery, but she is going to die of malnutrition, leaving behind a three-month-old baby. She was still denying the illegal abortion. How very sad.

At the same time that this woman came into the hospital in shock, another woman came in with shock. She had delivered a baby at home six weeks before and had bled for nearly a month. A pharmacist had seen her and given her an injection of something. She then stopped bleeding for a while and then began bleeding very heavily the day she came in. She came in and was barely conscious. When I checked her, I found most of the placenta still in the cervix, keeping the cervix half open. After removing the placenta, she did well. She is very anemic, but feeling a lot better this morning. At the same time as all these obstetric or gynecologic cases, another man came in who had been in a fight. Someone had thrown a rock and it had hit his leg. It shattered both of the bones in his shin (tibia and fibula) and one of the bones had poked through the skin. I then stretched out his leg and got the bones in the best position I could and then splinted the leg. We don't have any casting material, so we will use the splint for now. He really needs surgery, but cannot go to a place that does surgery, so we will just leave him splinted and hope. He is doing a lot better today also.

Besides those cases, we got a couple of other cases in last night. One of them was an AIDS patient with fever and headache and it looks as though he has a brain infection with a parasite called toxoplasmosis. He was doing a bit better today, but recovery is going to be tough. Another case that came in at this time was a woman with abdominal pain. I still don't know what is wrong with her, but she seems to be feeling better. Probably too many worms. Finally, one last patient came in with weakness and fever. He is a TB patient, 18 years old, and probably has AIDS. I haven't found out what is wrong with him either. That may take a few days to discover.

All of these folks seemed to have come together, but it all got sorted out and 2 a.m. we had all of them taken care of. Unfortunately, a boy came in at 3 a.m., but was not too sick and the nurse gave him some pain medicine and didn't wake me up. I am glad, too, because I would probably have been pretty fuzzy at 3.

Besides the busy night last night, we had another mass casualty day last week. A truck with eight people in it rolled over when it slipped off the road. It is beginning to rain on a regular basis now and some people don't slow down. Well, we heard them coming. A passing bus stopped and picked up all eight casualties and brought them in. You could hear the screaming and wailing as the bus came up to the hospital. Two of the men had skull fractures. One woman had her legs badly crushed. The surgeon had to amputate one of them and splint the other. Another young man had a hip fracture and deep abrasions of his hip. Another old man had lots of cuts on his head and had a femur fracture. One woman had a fracture of her arm and her jaw was broken in several places and hanging loose. One boy had rib fractures and the driver broke his nose and was bleeding from it. One young lady actually only had abrasions of her ankle and a sprained back, but she was making all the screaming noise. She made more noise than all the rest of the patients put together. She seemed to be enjoying the attention that it gave her from all the young men.

Well, after doing lots of sewing and bandaging, we finally got them all taken care of. I can happily tell you that they are all better. One of the guys with a skull fracture actually had a seizure just before I started to sew all the cuts up on his head. It is good he didn't do it while I was sewing. Anyway, he can sit up and talk and even eat now. This tells me that the recovery was an answer to prayer, since he was pretty banged up. The nice thing about these mass casualties, if there is a bright side, is that they all did okay and it was due to the work of the Lord and the hard work of our staff. We had our pharmacy people bandaging wounds and our lab people starting IV's. We just prayed about it and did our best and everyone pitched in and the patients were blessed because of their work and the blessings of God.

At the same time as all the above patients came in, a young girl, aged 16, came in with abdominal pain. As a routine, I asked her when her last menstrual period was and she said that she never had one in her life. I then checked her and couldn't see a vagina. Her hymen was completely covered. She had not been able to pass urine or stool. When the surgeon opened up the hymen, out came nearly a liter of blood and then gas came out of the rectum and the urine started flowing. What a relief. She had been having menstrual periods inside and it had been building up for years. After surgery, the only thing she wanted to know about was if she was still a virgin and if her husband would notice. I am told that even given these circumstances, a man would not marry her if her hymen was not intact. Fortunately, we had a very sensitive surgeon, aware of these facts, and so he had only made a 1 cm hole in the hymen to let the blood out but to make it as if she is a virgin. Once she found this out, she was very grateful. It taught me that there are still a lot of things to learn about this culture.

Well, I have run out of time, there are other cases where God has blessed us, such as the man who I call "donkey man" because he came in after being kicked in the abdomen by a donkey and ended up with a perforated intestine. He is doing well now.

Take care and God bless. Thank you for your prayers. God has really blessed.

Sincerely in Christ,

Nick, Phosfe, Christopher and Ian Walters