screening

I am experiencing a rite of passage at the moment. Travelers diarrhea. Not really very fun but I am surprised it took three weeks before deciding to overtake my body. So my weekend plans got cancelled and instead I am sitting on my bed drifting in and out of sleep and wiping the fever sweat from my body. Being sick always refreshes my compassion for my patients.

Yesterday I participated in an orthopedic screening. Becoming a Mercy Ships patient is a bit of a process. First, general public screenings are held and potential patients are given a yellow card with a date to come to the port for a secondary screening. Community physicians and Mercy Ships crew can also hand out yellow cards. Patients arrived on the prescribed day and have a nursing history and physical exam performed. They then sit and wait in the outdoor tent to be seen by the surgeon. Some sat in the African heat for nine hours with small children. The surgeon will decide if we can help them. If we can, they are given a green card with a date for surgery.

We saw about 70 patients and were only able to schedule 12 for surgery. Many of these patients have injuries that are so old, they are beyond repair. It’s very sad to watch someone’s hope of physical restoration wither and die.

Many children came to the screening and I felt at home. I love taking care of the VVF women but children will always be my favorite. They had club feet, miss-healed broken arms, and strange burn-like skin deformities. There were a series of questions I’d ask the family via the translator. I always asked “do you smoke” and it would make the parent’s laugh. One 2 year old girl got really scared and started freaking out when I tried to take her blood pressure. We were stationed in the back room of a tent which was crowded and dark. And I am a weird white person trying to touch her. I would have been scared too.

We took little Janet outside and finished her vital signs there. I distracted her with stickers. She did much better. She had acted just like my 2 year old patients back home.

Around 10:30 two women approached our tent. One a full figured women wearing a beautiful orange and blue dress, the other a delicate withered frame which had a large piece of green fabric wrapped around her head. She held a piece of the cloth in front of her face so that she remained completely veiled. Only her exposed eyes were visible and they were glistening with shame and embarrassment. Her posture was cowered over. I lead them to the back room of the tent.

Once we were out of the general publics sight she unveiled her face. You could see her nerves and feeling of exposure. A dense pink tumor about the size of a softball was protruding from her left jaw. It was the width of her face and carried a foul stench. The left shoulder of her white t-shirt was covered in puss-like drainage.

Pictures of these tumors look horrific. But meeting her I didn’t see the tumor.

I saw a woman.

A woman who was in pain. A woman who weighed only 95 pounds because she could barely eat. A woman who covered her head so that people wouldn’t stare as she walked by. A woman who laughed at me when I asked if she could be pregnant (she was almost 60). A woman who was never touched.

As we went through the screening questions she became a bit more relaxed. I tried to touch her hand as much as possible. But this was not a maxillo-facial screening. We were looking for orthopedic patients. A surgeon who could help her won’t be here until September.
Her vitals signs were notably off, so I grabbed Ance, a lovely Dutch woman who is in charge ( I forget what her official title is). She has been with Mercy Ships for 6.5 years and has seen these tumors before.

Ance assessed the tumor. It had only been growing for a year. Not a good sign. Because we don’t have a maxillo-facial surgeon here at the moment there was not very much we could do. We gave here malaria medication and Tylenol for the pain. And a yellow card to come back in September.

The woman wearing the red and orange dress was the daughter. The woman with the tumor was her mother. They came from an IDP camp. IDP stands for internally displaced person which Wikipedia defines as, “someone who has been forced to leave their home for reasons such as religious or political persecution, war or natural disaster, but has not crossed an international border.” These camps are over crowded and dirty (if interested, you can read more about IDP camps at the end). They had traveled five hours to get here. Now they’d travel five hours back. In disappointment.

Only the daughter spoke English so Ance began to tell her our plan. Her face became painted with distress and tears filled her eyes. The mother could not understand the words being said but sensed they were not receiving good news. Her tired eyes made an unsuccessful attempt to withhold tears. I moved my chair closer to her and grabbed her hand. I began to rub her emaciated back feeling every bony prominence of her spine.

Honestly, her heart rate was 145. She weighed 95 pounds. I wouldn’t even want to know what her hemoglobin was. She might not make it until September. I wanted to make the most of this small window to show her God’s love.

Once the daughter regained her composure she translated our plan to her mother. They would come back in September. Four nurse’s gathered around and we prayed for her before she left.
Ance and I gave her a ride to a local market where they would catch a cab to go home. Before leaving the tent she carefully re-wrapped her head and covered her tumor. We had to walk down the port and past several groups of people. I put my arm around her shoulder. In return, she placed her arm around my waist. We walked together. Past the people. I think that meant something to her.

I hope she comes back in September. And we can help her.

From Wikipedia
“Internally Displaced Persons (IDPs) are people forced to flee their homes but who, unlike refugees, remain within their country's borders. There are as many IDPs in Africa as in the rest of the world put together: around half of a global total of 24 million, though exact figures are hard to establish. While the case of IDPs in large camps such as those in Darfur, western Sudan, are relatively well-reported, little attention is paid to those IDPs who escape conflict or political violence by fleeing to larger towns and cities. There they are faced with a grim prospect of survival in an unfamiliar and threatening environment with little or no support from the government for their immediate needs or to allow them to return to their homes when the situation allows it. As one IDP woman still living in Luanda five years after the end of the conflict explained to delegates of the UK based advocacy organization IDP Action [2]:
“I’m from Huambo, we came here because of the war, we’d like to go back but there is nothing there, we lost our families, all our houses and possessions. If there were no mines and houses and services I’d go back. Or if I was given the materials I’d rebuild my own house, but we have nothing. I live here with my seven children, my children go hungry because there is no food, we need to buy water is we want to drink and wash, because we have no access to water, sometimes people give us some water. We don’t have money for food or clothes or anything”.
This woman lives, with 330 other families – a total of 1558 people – in a camp 105 meters by 65 meters in size, smaller than a soccer field. There is no running water in the camp and only two toilets, sanitary conditions which encourage the spread of disease. The one school classroom acts as the mortuary because of lack of space. Lack of income and livelihood forces many women and girls as young as 13 into prostitution.”