Our Mission to Africa: A Long Week--And No Green Mamba Anti-venom!

I want to say this week was fabulous; this week just flew by; I want to say I’ve been spiritually uplifted, that I’ve been rejuvenated, and that I’m itching to get started on the coming week.

The truth is, that I’m emotionally spent. I’m physically drained—I’m tired and I’m on a spiritual low. In short, I gots me a BAD ATTITUDE! Sister Fife says it’s got to change. I’m looking forward to that.

Today marks the end of a very long week, and I’m very happy to see it go. We spent endless hours at the office on the phone only to come home each night to spend more endless hours on the phone! There is a lot of serious illness here in Africa; lots of stuff going on. Some things are exciting, some sad, but most are just routine. We are very much looking forward to the return of the missionaries to the MTC (that seems to be our boost) and having the Temple open again.

I will mention a couple of things in this entry, mostly for myself, just so I can have them recorded. Forgive my ramblings, but these are things I don’t want to forget. This week, I was asked to get involved in a couple of area welfare matters. Sometimes these can to be very sad, sometimes uplifting, and again, sometimes just mundane.

I was asked to get involved with a very sick young woman (26 years old whom Michelle and I actually met a couple of weeks ago down in Cape Coast). She took ill a couple of days before we saw her and was being treated in the hospital for what her husband assumed was malaria. (It turns out that half of all hospitalizations are a result of malaria.) Her condition deteriorated quite suddenly and unexpectedly last Friday morning—she essentially lapsed into a coma. Her physician said that she needed to be transferred here to Accra, which has a large tertiary hospital.

Her husband, Stephan, was beside himself because of her condition and because of the fact that hospital fees needed to be paid in advance before any transfer would take place. In her case, a fee of GCD 1000 (about $800) would need to be paid or she couldn't come. This was Friday night. He had nowhere to turn, so asked the church for assistance. That’s when I was called to "figure out" what was going on and make recommendations.

I spent most of the night on the phone trying to piece the puzzle together. The physicians initially refused to talk to me because I was an American doctor, and it was none of my affair. The nurses were belligerent. The family was beside themselves with worry and fright. Financial assistance could not be approved without approval from the area presidency, and this required the report that I was supposed to write. Meanwhile, the husband kept calling me with reports—she is having a seizure and nobody will do anything about it; she is bleeding from her nose and mouth and nobody will do anything about it...on and on, every half hour through the night. I would call and demand to talk to the head nurse or to have the physician’s phone number, but was hung up on many, many times through the night. Well, after many hours of calls, and many prayers, the physician actually called me about 10:00 on Saturday.

The story I received was that she presented to the health clinic in her village initially with a blood pressure of over 260 systolic and that is why she was hospitalized. She had been in the hospital for almost 2 weeks and had only two sets of labs drawn and somewhere along the line had managed to receive four units of blood. She did have a CT scan which showed an "enlarged kidney". Anyway with the few pieces of information we had, it was obviously that she was having severe kidney failure (I think probably from polycystic kidneys) and had developed uremic encephalopathy (the toxins in her blood were too high for normal brain function) and her condition was rapidly deteriorating; she needed dialysis.

This country has 20 million people and 3 dialysis machines! In the city of Minot alone we have 20,000 people and 20 dialysis machines.

I asked how bad it was, and he told me he wasn’t sure. I asked how her creatinine was, and he had to go find it--6.9. I told him that in fact that was very bad. What was so astonishing to me, was that this lab value was four days old...and that no labs had been done since. Hence the reason she was unconscious and not doing well. Un-Freaking-Believable! The way it works in most of these hospitals is this: if a lab test, a medication, an x-ray or scan is ordered, the family immediately gets a bill that they must go and pay. Once the bill is paid in full, and the receipt is in hand, then you can go to the pharmacy and pick up the medication or to the blood bank and pick up the blood etc. If you can't pay, you don't get the service--no exceptions.

The physician then told me they planned to transfer her Monday morning. MONDAY MORNING--are you kidding me? I immediately called the mission President and the welfare specialist and told them that she would soon die if not transferred, and my report would soon be coming. The funds were released and plans were made--but still for Monday morning.

Later that night, plans had in fact changed. Her condition “deteriorated” (how much worse can it get?) to the point that they felt it necessary that she come immediately. They first tried to put her in a private car, but the husband insisted on the ambulance (and this happened), but she was taken off her oxygen and not monitored. She left at 6:00 pm and didn't arrive here until 2:00 am. (The husband called me every half hour along the trip for updates, but could never tell me about her condition.) Once they finally arrived, the husband reported that the doctor came in, put his stethoscope on her chest and told the family that it was too late. I figure she died sometime shortly after leaving Cape Coast.

Now for Abomosu. Abomosu is a fairly large sized village. There are a few branches of the church around that area as well. In that district, there are 10 missionaries and one senior missionary couple. Two weeks ago, they flooded—and they flooded bad.

This is the only way to get to Abomosu

The village elders (70 years old or more) could never remember waters like this. Needless to say the whole district became an island. Isolated. Cut off on all four sides by rivers now a mile wide. No one knows how to swim, they had 4 people drown the first day. One young mother was found after two days in a tree with a baby strapped to her back. She spent the time fighting off the snakes and scorpions that were vying for a spot on the tree. We have been in touch daily if not more often with Elder Dalton who is the district leader.

There are huge problems that come with the rising waters. First is the fact that there is now real sewer system and most people just use the ground, hence the water is foul, contaminated and likely to cause major health problems in the days and weeks to come. My biggest fear is a Cholera outbreak. We managed to get water filters to the missionaries along with some medications and supplies. They are set for now. In Sunday school, the topic has been cleaning hands, cleaning water, cleaning food, and just overall sanitation.

Life at home in Abomosu
Thanks Elder Dalton for the Photos

They have done a great job and are frantically teaching whoever will listen how to avoid becoming sick. Michelle and I will go to Abomosu as soon as the roads become passable. For now, they are doing well. The missionaries are trying their best to stay clean, but they need to wade through the water to get to the farms for food. We pray daily for their safety.

Another problem with the flooding (besides the fact that it has wiped out the entire village's food supply and farms (the yam and cassava crops were decimated), is the snakes and scorpions. They have been coming up and into the yards by the dozens. The missionaries are good at identifying the cobras and have also been staying clear of the scorpions. They have not been as careful with the cute little green snakes however. I sent them updates on the poisonous snakes and scorpions and some are very deadly—including the cute little green mambas and the green scorpions. I sent pictures of a green mamba, and since then they have been much more careful around even the cute little green ones. With all of the snakes and scorpions that were trying to find dry places, I wanted to get antivenin (anti-venom) for green mambas, green scorpions, and cobras to the health clinic, as the closest hospital is two hours away (and that is when there is not a mile of water on the highway). After a day and a half, we gave up. These supplies are very limited here and carefully guarded by the ministry of health. Only the regional hospitals are allowed to have these. (The green mamba bite can be deadly within a half hour, and they would have at least a 3-5 hour trip.) Hence, our Elders now are on careful guard as they walk around these villages. As of now, we have a stalk of medications and can treat typhoid, malaria, and cholera for at least the 10 missionaries. I don’t know what we will do if the villagers become sick. We hope for the best.

One blessing that we count on is that we get to come back to our nice little flat each night—it’s a little slice of home.

Ruth's fruit stand just down from our flat

One other little welfare matter that I am working on this week is for this little girl who is about as cute as a bugs ear. She is so beautiful. She needs surgery for a tumor behind her right eye. She lives in Enugu (The northern part of Nigeria). We are on a fact finding mission—again in hopes of getting some funds released for her needed surgery. So far, things look very positive. We remain optimistic. I think she has a neuroblastoma (nerve cell tumor), and with treatment has a pretty good chance of survival.

Our scheduled trip to Nigeria has been postponed for now. The area presidency is out of the country and all travel is essentially on hold until further notice. We hope to get into Nigeria this fall, but we were told that we needed to arrange to visit all four missions in one trip rather than trying to make 4 small quick trips.

The calls keep coming. One Elder this week was in surgery for appendicitis. Another we are dealing with chronic headaches, many with stomach issues. I think our malaria count this week has improved—I am only aware of 3 cases, and one is not responding—I suspect Typhoid. Several Elders from Accra have been in with ingrown nails. I wound up removing one nail entirely. I have been trying to avoid this when possible as I am worried about infection. I gave one sister an occipital nerve block yesterday. Another was in with uncontrolled asthma. One of the workers that is down here repairing Moroni on the temple came down with malaria and responded nicely to treatment. Lots and lots of other little tiny things.

We went out to dinner to celebrate Sister Woods 82^nd birthday. She and her husband are here now serving a mission in the temple. This is their 6^th or 7^th mission. They are awesome. This was the highlight of our week.

Even the temple workers have had a rough week. We’ve had fun watching out our office window this last week as they have labored diligently erecting scaffolding on the temple in order to replace the statue of the angel Moroni. (The scaffolding does not come in chunks, it comes one pole at a time, hense it was a big process.) We even watched them uncrate, and take the new angel up to the first level. After all that work, everyone came away quite disappointed, because the boom that was brought in is not big enough to hold up the angel and it was bending too far to lift the statue up and out. I am curious to see how this gets resolved.