To continue from my last blog
reflecting on God’s goodness and His role as the Great Physician, I will start
by talking about a young woman whom I will call AZ. She came in to BMC back in
November last year with a history of fevers, cough, and weight loss for the
past few months, as well as lumps on her neck. She was very thin and had diffuse
neck lymphadenopathy (enlarged lymph nodes) with some of them with open wounds
that were draining some pus (a classic appearance of lymphadenitis due to
tuberculosis- also known as scrofula). Her sputum was checked for AFB
(acid-fast bacilli- to test for tuberculosis), and it came back positive, so we
initiated TB treatment. A few days later, I was on-call for the hospital and
was called in the middle of the night to come see AZ because she was having
extreme difficulty in breathing. She could not lie down and was sitting on a
chair next to her bed with her forehead resting on the bed, breathing very
fast, lungs were not clear, and her legs were now very swollen. I gave her some
diuretics (medicines that cause someone to urinate more in order to get fluid
off of the lungs and help with leg swelling), and then I did an ultrasound on
her heart later that morning. The ultrasound showed a very large, thick
pericardial effusion (fluid around the heart), and her heart was just waving
back and forth in the fluid (for medical people- this motion would have caused
something called electrical alternans on EKG if we had had that available, and
it is a sign of cardiac tamponade- too much pressure on the heart from the
fluid surrounding it, and it causes the heart to not pump the blood adequately;
it requires emergent drainage of the fluid- a pericardiocentesis). So later
that morning, Dr. Haun (another missionary here) and I drained some of the
fluid from around her heart- approximately 1 liter of lightly bloody fluid was
removed! By the next morning, AZ was walking around the hospital, breathing
much better; and by three to four days later, her leg swelling was gone and she
was able to lie down to sleep at night. Praise the Lord for such a miraculous
recovery! I later had the opportunity to sit down with AZ to pray with her and
tell her a story about the ultimate Heart Specialist- Jesus. Please pray that
AZ would come to know the peace and comfort that comes with having a
relationship with Jesus Christ.
Another woman, whom I will call
Bima, came into BMC a few years ago with difficult to control diabetes. She was
treated for a while with oral medications to try to control her blood sugar,
but eventually she had to be switched to insulin. In our setting here in Northern
Ghana, being on insulin is not an easy task for the average person because most
people do not have refrigerators to make the insulin last, do not have access
to a glucometer for checking their blood sugars, and have no good way of
administering the insulin because of not living close to a health facility and
feeling nervous about doing it themselves. Bima actually moved from her village
to Nalerigu so that she could come to BMC every morning and every evening to
have her blood sugar checked and insulin given. Most patients are unable to
make this sacrifice. She was very thin, and during one of her admissions for
hyperglycemia (high blood sugar), she began spiking some fevers and reported
having a cough for the past couple weeks. We tested her for TB and it came back
positive. We treated her for pulmonary tuberculosis- aka TB of the lungs- and
by the end of her 6 months of treatment, she had gained a significant amount of
weight- now up to a normal weight- and had her diabetes under much better
control. I still see her fairly often in the hospital coming in to get her
morning insulin injection. The drastic change in her appearance from before and
after TB treatment reminds me of what Paul says about the change in a person
who accepts Christ as their Lord and Savior in 2 Corinthians 5:17 “Therefore,
if anyone is in Christ, he is a new creation; the old has gone, the new has
come!”
I am realizing that many of my
memorable patients had tuberculosis. This next story also fits that same theme.
A few years ago, there was an ill-appearing 7 year-old girl, whom I will call
Mary, who came in with a few day history of a swollen right thigh and fever.
She was admitted and treated with antibiotics, but her condition was not
improving. Her knee was becoming stiff, so we took some fluid out of her knee
joint (which ended up being pus) and placed a drain in her knee. A few days
later, she also had an abscess in her thigh which we drained. Not long after
that, she began having difficulty breathing, so a chest X-ray was done.
It showed that her heart was enlarged and she
had a pneumothorax (air inside the chest but outside the lung). I did an
ultrasound on her heart to see the cause of the heart enlargement, and it
showed a pericardial effusion (fluid around the heart that isn’t supposed to be
there) as well as heart failure (the heart was not pumping well). I also placed
a chest tube for the pneumothorax. Over the next several days, Mary was placed
on several antibiotics to cover almost any bacteria possible, but she continued
to spike high fevers and not improve much. She did not have much cough and did
not have sputum, so we were unable to test for pulmonary TB. After much thought
and prayer, I finally decided to start her on anti-tuberculosis treatment to
treat suspected TB pericarditis (infection of the sac around the heart) and TB
osteomyelitis (infection of the bone). Oftentimes in children, particularly in
our setting where specialized TB tests are not available, a diagnosis of TB
(more commonly extrapulmonary-TB outside the lung-in children) is confirmed
after the patient responds favorably to empiric TB treatment. After a few weeks
of anti-tuberculosis treatment, Mary began to improve dramatically and her
fevers disappeared. She had always looked so tired, sick, and unhappy during
the first several weeks in the hospital. Now she was a happy, playful little
girl with a big smile (along with her mother).
Lastly, I would like to share a
story about God’s protection and healing for a group of gunshot victims- this
one is not related to tuberculosis. Back in December of last year, I was
on-call and doing my night rounds in the hospital when one of the nurses asked
me if I had heard about what happened at an area about 2 hours from BMC. I had
not heard anything, so we sat down and he showed me some texts and WhatsApp
messages that he had received from a friend in that area describing an attack, where
several masked men on motos carrying semi-automatic guns opened fire on innocent
people in the market. There were 11 casualties, 4 of which had died right away,
and the other 7 were supposedly en route to BMC. I called Dr. Haun, the general
surgeon, to give her a heads-up, and about 30 minutes to 1 hour later, I
received the first phone call from theatre: there were 4 patients with gunshot
wounds to the abdomen. Dr. Haun, myself, and a couple of the volunteers went
right away to the hospital and started triaging the patients. There were 3
adults and one child; 3 of the 4 victims were eviscerated (intestines were
hanging outside the body); two of the patients were in shock and very anemic
(low blood count); there was only one anesthetist and one general surgeon. Dr.
Haun operated on the patients all throughout the night while I stayed up
managing the IV fluids, blood transfusions, and urine output of the other
patients that were waiting for surgery, while periodically giving updates to Dr.
Haun in the operating room. A few hours after the first 4 patients had arrived,
another 3 arrived: one with a femur (or thigh bone) fracture, one with a
tibia/fibula (the two bones in the lower leg) fracture, and one with a gunshot
wound in the buttock with the bullet lodged in the scrotum. I splinted the
first two and put them on traction, then transferred them the next day to see
an orthopedic surgeon. The third one recovered without any procedures needed.
By God’s grace, all 7 of the gunshot victims that arrived at BMC survived.
