Read on at your own risk. This blog contains NO pictures and in my mind they can make the blog--as a simple picture can often portray events better than most words. I write these experiences today for my own benefit, a substitute for my journal. To be honest, this is about all that’s getting recorded as I have found myself lacking in the diligence it takes to keep up with a journal. Realizing that this is somewhat of a public medium (we are blogging for the benefit of our children), I will try to be somewhat sensitive as the events involved are rather personal in the lives of a few very honorable and good missionaries.
This last week has been one of curious circumstances—one right after the other. At times I have never felt so stressed, and at times never so relieved. Some circumstances left me wondering if we would ever see this thing through to resolution. Looking back over these last several days, I see clearly the hand of the Lord working in ways that were at the time were quite mysterious to me. Now I see that many of these circumstances were answers to my desperate prayers—though not the answers I was expecting. We started this last week on our knees pleading for the Lords help and guidance and now are on our knees expressing gratitude for the abundance of blessings of which we have been the recipients.
Oh, to be a missionary in this great work! It’s a gratifying, yet very humbling experience.
In my life I have been witness to much disease and affliction. I have seen people struggle with the devastating effects of cancer, diabetes, heart disease, depression and all sorts of infections—from everyday coughs and colds to most recently the tragic world-wide malaria epidemic. I think I’ve never seen anything as sad and debilitating as schizophrenia. This disease is almost entirely a disease that affects men (very few women are ever affected). This rarely manifests itself before the age of 19. That means that our young Elders are prime targets, and with so many thousands of young men in the mission field, we are bound to be seeing at least a few cases here and there. Here in the Africa West Area, we have about 900 elders, so it’s no surprise that we will see a case or two. This is what we have been dealing with this last week.
Let me see if I can simplify. Someone with Schizophrenia is prone to having psychotic episodes. This means that the mind is not functioning properly and not able to separate reality from ‘imagination’ for lack of a better word. They may be delusional—hearing voices that are not there or seeing things that are not there. The neurochemical connections in the brain may not be all there—so when someone is hungry for example they may feel hungry, but not understand that the physical act of eating is what needs to be done to satisfy the hunger. So when they sit down in front of a meal they may start twitching or bobbing or standing up and sitting down instead of picking up the fork and using it to put food in their mouth. I can only imagine how this must feel. It can be dangerous for the person and for those around during a psychotic episode.
So we have an Elder who became psychotic earlier this year. He had to be hospitalized for his safety. Without going in to too much detail, he was found naked in the streets yelling at cars—a very dangerous and frightening experience I am sure for this elder, for his companions, and I’m of course for those driving the cars. We are so fortunate to live in times where medications are available, and anti-psychotic medications can be very effective at keeping these psychotic episodes at bay. These medications however are not without side effects—they can cause horrible constipation and can cause the muscles to do weird things like twitching etc. So for this reason, our young elder stopped his medication two weeks ago. Upon learning of this, he was given the choice to stay on his medication or go home—and home was the choice. Hence, arrangement were made to leave on Tuesday.
For safety I advised a couple of things. First he was to be in the company of 4 other missionaries at all times, and second an escort was needed to see him safely home. That is when I started preparations to fly with him.
Things proceded without incident, although I had been increasingly anxious by Saturday. Michelle and I, after pondering and prayer, felt the need to be close so we made arrangements to drive down to the mission home (Cape Coast), and be on hand just in case. We took off Sunday morning thinking we would have a pleasant stay and that we were just being overly cautious. The Elders went to church as a group and the mission president had to travel for a stake conference. This is when our first trial (and really our first blessing) came.
An hour after leaving, I received a desperate call from the zone leader. They were in the middle of a psychotic break. Our Elder had lost touch. He was walking around in small circles—backwards, and bobbing up and down. “What shall we do? President Shulz is presently speaking in stake conference and asked us to call you.” I told them to stay with him and keep him and anyone around him safe, and that we would need to take him to the hospital for medication. We were still some 2 hours away, and becoming more anxious by the minute. I received updates every few minutes from our elders who handled things very admirably.
During the break, our Elder confronted a man on the street and took his meat away and threw it to the dogs. This didn’t go well. The elders were able to calm down the man and give him money to buy more meat. They had to use all four of them to restrain this poor elder and get him into the truck—which they did with much discretion. I gave them instructions to head to the ER, to get help and sedation. At this point the elders were committed to physical restraint. They did well. I worried about safety for all of the Elders involved. They just sandwiched him between to big elders in the back seat—they had his hands, and then two elders in the front seat each had a foot. It worked really well. He would struggle for a few minutes and then relax for a few minutes and this cycle continued.
We just couldn’t drive fast enough.
Of course this was Sunday afternoon, and things aren’t running as usual. We had MAJOR problems at the hospital, for when our young elders arrived at the ER, they were turned away. The doctor “didn’t want that sort of problem today” so they just refused to see him. Meanwhile the Elders were stuck restraining a psychotic elder in the truck. They were sent directly to the psychiatric hospital (about 30 min drive), once there however, they were “closed for the weekend” and also refused to help and were sent back to the regional hospital. At that time Michelle and I were still an hour away.
I had the Zone leader go into the ER, find the physician and stand in front of him until he would talk to me on the phone, which he did. He was anxious just to be done with us, but I explained our situation to him and he said they had run out of anti-psychotic medications, so he would not help. I asked him to just sedate the missionary for us, so that we could handle him at home. He promised he would, but as soon as he was off the phone with me, he kicked the Elders out of the hospital and again refused to help. Still close to an hour away from the hospital, I instructed the elders just to keep him restrained until we arrived. They did fine, but could tell they were obviously a little weary. I tried to get some oral antipsychotic in him—the elders had his home medication, but he was in no state to follow any kind of directions. At one point I had them crush a pill in a bit of Fanta and try to get him to drink. He took a swallow and that was it.
We arrived at the ER to find all of the Elders in good spirits—still sandwiching him in the back seat. They were parked outside of the ER. The three of us went in to get help (sister Fife, myself, and the zone leader). I can’t believe the trouble we had. NO ONE WOULD HELP US. Even at the government hospitals, they treat who they want, and the rest can fend for themselves.
Michelle stayed in the ER with the head nurse who was sympathetic to our cause and actually was trying to help by making some phone calls. I went in search of someone from administration who may help. At one point, the ER doctor agreed to give us sedative, syringes and needles as long as we would “go away and not come back”. Taking this as a small victory, we thought that we would take what we could get and were set to set up shop at the mission home. By this time however, the chief of medicine at the hospital got word of the ruckus we were making and was on his way. We stayed until his arrival. He was kind and helpful. He just made a couple of what appeared to be heated phone calls and had arrangements for a psychiatrist to see us back at the psychiatric hospital. So back we went.
Once at the psychiatric hospital, we waited (still restraining our missionary) for about an hour for the psychiatrist. He was somewhat helpful. Typically, a patient would be placed in the hospital, where he could be monitored etc, but because there were no extra nurses available, this did not happen. We did get him sedated (20 mg of valium and a huge dose of antipsychotic). I was afraid he wouldn’t wake up for days. Anyway, we took him home overnight, with plans to return to the hospital the next day for follow-up.
We had a graet evening with the five elders involved (the 2 AP’s, the two zone leaders, and his companion), as well as President and Sister Shulz, and sister Fife and I.. We taught them a lot about schizophrenia—this was their first encounter. These Elders decided that they would keep these events quiet (out of respect for our sick elder so that it wouldn’t be tossed around as gossip throughout the missionaries in the mission.). I can’t say enough good things about these Elders. I figure they kept him forcibly restrained for about 6 hours in total—not once murmuring and all the while watching over him carefully so he wouldn’t hurt himself. I think we all grew up a little last Sunday.
Thankfully our night was uneventful. We monitored the missionary through the night, and by the next morning he was awake enough to dress, eat and get back to the hospital, where he was able to take oral medications—we loaded him with uncomfortably big doses of medication, and planned a weak of close monitoring in the mission home. So our plans to take him home to Ethiopia were postponed until he was somewhat more stable.
Blessing #1. The first psychotic break. The blessing here is that he had a psychotic break while here. It doesn’t seem like much of a blessing, but I know it was one of the biggest blessings of this whole mess. Can you imagine what kinds of trouble we could have been in had he had his psychotic brake while flying in the air—a nightmare. I am sick just thinking about it. I sure we would have had to force an emergency landing somewhere like Chad where we would have had all sorts of trouble. Given all of the stresses of flying, and looking back at his unstable state, there is no doubt in my mind that this would have happened. Even with all of the stress of the episode, I count this truly as a huge blessing.
The blessings and trials didn’t stop coming. No it couldn’t be that easy. The week was relatively uneventful. The medication seemed to be working well, and we felt we were OK to be in the air on Friday, so plans were made. We left him at the mission home under close supervision for a couple of days, and went back Thursday morning to pick him up, and start the journey home.
Around noon on Thursday, sister Fife and I set off---first stop Accra. We had a room available at the MTC where we could be next to him. Then leave the following morning for the airport. The stresses of travel took its toll however, and by the time we reached our office another break was under way.
Blessing #2. The second psychotic break. During the week, managed to order some IM medicate and IM valium to keep with me in case we ever encountered something like this in the future. When we stopped at the office—I was surprised to find the vials were already here and waiting for me at the front desk. So up in the office, I managed to get another 10 mg of valium in him and 25 mg of medicate, and he finally settled down enough to get back in the car and let us get him to the MTC. It’s really a miracle that the medication was there and just waiting at the perfect time—I wasn’t expecting it for another couple of weeks which is typical here in Ghana. I would not have sedated him the second time, had he not had another break—so the whole series of events of this second brake made it possible for us to fly uneventfully on Friday. He made it the whole way without falling asleep. We almost lost consciousness climbing the stairs, but made it to the bed, where he was 'out' for the remainder of the night. Again another blessing as the effects of the injection, combined with the oral pills I was giving him, kept us through the rest of the next day. He was awake enough to maneuver through the airport, but sedate enough not to cause any trouble.
Once in Ethiopia (Addis Ababa), the plan was to turn him over to the district president and his councilor, and they would take him north to meet his father, but they were not comfortable on their own, so we made plans for another journey inland—the 10 hour drive inland. His father is a farmer and we wanted him safely home on the farm with no stressors. We felt this would be the safest place for him.
This elder did pretty well. He took his medications when I asked. He followed directions clearly and did well. In fact at one point I was feeling kind of bad, because he looked so good and the district president I’m sure was thinking that we were just being overly cautious and maybe just “dumping” this missionary in his lap without reason.
Blessing #3. The third break. Once in Bahir Adar, we met his father (after 4 very long days of travel). His father was very kind, and I think understood all of our instruction. I was afraid he wouldn’t understand the gravity of the situation until it was too late, so it came as almost a relief that we had a small break down Sunday morning just before they got on the bus to go back to the farm. It wasn’t much (thankfully), his muscles just “froze up” and he stopped walking mid stride and couldn’t move for a minute or so, and then started his walking in backwards circles. My thoughts at the time were—oh great we got him this far only to have him break down here where there is no help anywhere. Anyway I got him to take two pills (a miracle in itself) and he settled back down after a few minutes and was able to get on the bus after a tearful goodbye—tears of joy and sadness for me. The point is, that his father got to see an episode, and I was able to talk him through what to do etc. On the farm if this happens, they can just keep him safe and let him be until he is settled enough to take his pills, which seem effective enough to stop them. Now his father sees how important it is to be diligent with the medication.
Now that is three huge and very timely psychotic breaks, and three very huge and timely blessings in disguise. I have looked back over the week and can identify at least a handful of other small miracles that happened just at the right time that made our trip, and his safety possible. How blessed we have been. Through trials we grow and learn.
I have a much greater appreciation for the Lords hand in the work we are doing. I have a much greater understanding of how to care for sick missionaries and where the “threshold” is between keeping a missionary in the field, and getting them safely home. I am truly blessed and thankful for the trials of this last couple of weeks, but if its all the same, would just assume not have to endure them again.
…Staying safe in Africa
Elder Fife
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