Wild, Wild... South?

The white pick-up truck blasted its horn with annoying persistence as it sped up to the clinic doors. Urgent voices shouted instructions as a handful of soldiers waved their AK-47s about like sticks.

Another emergency, Lord? Really...? How many this time?

I wearily slipped on gloves as I watched the cargo being unloaded. Our staff had to fight to carry the broken soldier in our front door; each one held a limb.

It took four strong men to lift him; their hurried instructions and shuffled steps left a steady trail of blood as they went.

Once on the bed, everyone seemed intent on getting to him at once. Five of them attempted to cut off his shirt while two others turned in circles. Getting close enough to help was next to impossible.

Fortunately Dennis arrived quickly... and then Tom, so I stepped aside and let them do their thing.

In the next room, I found another soldier who had not been assisted yet; so I got to work. He’d been shot in the neck; and though he was in obvious pain, he was stable. Remarkably, the bullet had missed his carotid... and his spine. 

But as I worked to start an IV and get his vitals, crowds of looky-lous screamed through the window demanding to know details. I could not hear myself think.

Why, Lord? Why must these strangers harass us while we work?

I asked them to leave but they refused. Over and over, I told them I could not work with them yelling like this, but it made no difference.

Meanwhile, more gun shot wounds filtered in, and I turned to help them.

One man had a compound fracture and was losing a lot of blood. Another had his foot filleted open, exposing tendons and nerves. The last to arrive, stumbled in on his own. In obvious shock, he barely made it to the bed before he collapsed. His shoulder had been grazed by a bullet, leaving a gaping wound.

Five soldiers. Five gun shot wounds.

We had to lock and bar the clinic front door to keep people from walking in, but even that didn't keep them all out. And although the clinic gate was locked as well, people climbed over it, insisting they had the right to bother us. It was a constant battle to keep them away.

Thankfully, all the soldiers survived. Three were transported to Wau for surgery, but the other two were stable enough to stay.

When I asked what the fighting was all about, they explained there had been more cattle raiding. The soldiers had gone to protect them and a shoot-out ensued.

Honestly with all these cattle raids, I’m reminded of the wild, wild, West. But instead of saloons we’ve got tukels; and instead of cowboys, we've got soldiers.

Please pray for them to heal quickly, and for the cattle raiding to stop. Also pray for the staff here (me in particular). I can’t speak for the rest of them... but I am tired of trying to save lives while simultaneously shooing away demanding crowds.

Tired. Disgusted. And dangerously close to burned out.

There. I said it.

Please pray as the Lord leads. Thanks.

Lost and Found.

So yesterday after all our patients were stable, the commissioner and a few of his friends came to help identify the injured. Those who could not talk (unconscious, or dying), had been identified by other travel companions, except for one.

He had sustained neurological problems after a concussion; and although he was conscious, he could not speak. So our compound manager spent the afternoon allowing small groups of spectators to filter in, to see if anyone could identify him.

I watched the eager rubber-neckers come, click their tongues in empathy, talk over him with hushed excitement, then grow bored and move on.

Then a few minutes later, a new crowd would come, and it would start all over again.

Gawking. Clicking. Whispering. Bored.

Dozens came and went, but no one identified him. Eventually, the spectators grew tired and hungry and made their way home.

Our John Doe stayed on the back porch until this morning when a couple came by asking to see him. When they realized he was their missing son and that he was alive, they exploded in joyful thanks.

The father was some high-ranking military man. He had been informed his son was dead and had come to collect the body. But when he and his wife could not find it among the rest of the cadavers, they decided to stop by our clinic --just in case.

“What if... what if he was still alive?” they wondered.

When they realized he was in fact alive, they were thrilled! He was disoriented and suffering from partial paralysis, but he was alive!

They decided to take him back to Wau where he could get more specialized care. What a blessing!

Please continue to pray for these hurting families. Thanks.

Emergency.

Last Monday night a semi (yes, a semi!) drove up with patients in it. Thirteen to be exact.

Thirteen bleeding, broken, and seriously hurting men.

They said they had been racing down the road at top speeds when a front tire blew, sending them rolling.

And rolling. And rolling.

The worst case was a man with a dislocated jaw; all of his front teeth were gone, and he was having trouble breathing. Once stabilized, we transported him and a few others with worrisome head injuries and broken bones to Wau.

When the dust settled, bruised and bloodied men were strewn about everywhere on make-shift beds. Some snored loudly; others moaned for water.

It was intense.

Afterward, Dennis commented that this was the worst car accident we’d had to deal with to date.

That was true, until today.

Today as church ended, a few government officials asked to use our cars and ambulance. There had been an accident. They needed our help.

The reports said there were lots of injured, so some of the medical staff went to help. But it took over an hour for the first patients to trickle in.

The first batch had two expectant mothers, a three-year-old boy, and a semi-conscious man.

One of the mothers had bitten three-quarters of her tongue off and had a large gash on her forehead, exposing her skull. When she woke up in the clinic, disoriented and scared, she thrashed in confusion.

I asked for her name but she couldn’t speak; her bloody grunts were unintelligible. We tried to guess what she was saying, but gave up, figuring it’d come out in time.

When I asked how many months pregnant she was, her eyes flashed with the unspoken question, “Is my baby alright?” Immediately she started gesticulating wildly, then held up 6 fingers.

“You’re six months pregnant?” I asked to confirm.
She nodded slowly.
“Can you feel your baby moving?” I continued.
She grunted no, adding a slight hand shrug for emphasis.

She was the right size for six months. The baby could be easily palpated; but I couldn’t find the heart-tones.

Each time I asked her anything about the accident, she would shake her head in confusion. Finally it occurred to me that she’d missed it all. Only later, once her tongue was reattached did she explain: “I don’t know if my belly was hit. The first thing I remember was waking up here.”

The other pregnant woman didn’t wake up for over an hour. She was in shock, and needed massive fluids to stabilize her blood pressure. But once she came around, I was happy to inform her her baby was alive. Fortunately, she only sustained a small gash on her thigh.

The young boy had no visible wounds and appeared stable. He had suffered a blow to the head and we were watching him closely. But as the second wave of injured were carried in, we needed his bed and moved him outside for observation.

The next batch had a hip fracture which needed to be braced, two or three semi-conscious men with only minor injuries, and two severe cases.

The first case was a man in obvious shock. He labored for every breath, fluttering in and out of consciousness. Starting an IV on him was next to impossible, since he fought me every inch of the way. I had to stick him 5 times before I got it in. Dr. Mike suspected massive internal bleeding.

The other case had massive head injuries and needed intubation. We don’t have any laryngoscopes, so we made due with half a speculum. Dr. Mike got the tube in without much trouble and together we bagged him until his breathing stabilized.

The third batch of patients came back with our missing medical staff (which was half of us), and we were able to start move IVs, get more medicines, and stabilize a few more patients.

Our guard did a fairly good job at keeping the looky-loos out of the compound. But he didn’t stop them all. I constantly had to chase away random gawkers, even walking some of them out of the compound myself.

I felt like a broken record asking them repeatedly to leave. But if I didn’t they would literally stand between the doctors and the patients, trying to get the best view. What a nightmare!

We started prepping to send the worst cases to Wau once stable. The broken femur and the internal bleeding were high priority. They also insisted the young boy go, even though he looked fine. Dr. Tom kept saying, “I just don’t feel good about keeping him here.”

But as we waited for the patients to be loaded into the ambulance, he died suddenly, surprising us all. He just stopped breathing.

Around the same time, the man Dr. Mike had intubated also died. His injuries were just too severe.

Only then did I have time to ask what happened.

I was told that two SUVs, carrying about a dozen passengers each, had a head-on collision when one SUV inexplicably swerved into the wrong lane. They were both moving at high speeds; the impact was catastrophic.

Fourteen people died on the scene --five of which were trapped inside the wreckage. 

Those that were not brought to us were taken to the hospital in Rumbek. We lost two within an hour. That gives us an estimated total of 16 dead, and another 15-20 wounded.

I don’t know how many were sent to Rumbek. But honestly, I’m surprised there were only two vehicles involved. How did so many people fit in just two SUVs?

I’m proud of how well the staff worked together, but I’m sad at how many we lost. Please pray for these families. Pray as the Lord leads. Thanks.

Post Script: After the ambulance dropped off the first batch in Wau, they came back for two more. The pregnant woman with the missing heart tones went back because that’s where she’s from. And one more of the ‘less injured’ developed signs of possible internal bleeding. So we sent him as well.

Updates: Triplets, Clubbing, Car Accident...

Car Accident:
Kuac, the boy run over by a truck, had to wait almost 24 hours in Wau before he got surgery. But he eventually got it. Thank you so much for praying!

His family is running out of money, though. Please pray they obtain the funds needed to get the rest of the surgery he might need. The man who hit him will be held liable, of course. It’s just an issue of liquid cash. The hospital charges for each item used (i.e. gauze, gloves, IV fluids). They have to pay up front.

Clubbing:
Baby Tong, the boy born with severe clubbing, is doing well. His parents brought him in for a check-up today. He’s breastfeeding well, and his joints are more limber.

After several recommendations, I researched Arthrogryposis, a rare congenital condition that displays these symptoms. No one is sure how this condition develops. Nevertheless, I believe he has it.

If he has it, there is a 50/50 risk he’ll die within the first year of life (assuming he has one type of the condition). But it’s equally possible he’ll live a long, albeit disabled, life. There is no way of knowing for sure how severe it will turn out to be.

Please pray for his family to know how to care for him properly and that he’d one day have use of his hands and feet. If you are interested in learning more about this condition, I recommend this website. 

Triplets:
The triplets are alive! Can I get a hallelujah?

Yar, their mother, came in because Ngor has a cold and needed medicine. I took the opportunity to check them all out. Each has gained weight since I saw them last, but they are not growing as would be expected for their ages.

Yar told me they eat only twice a day. She gives them cow's milk, even though she still has breast milk. Once again, I did a long teaching on what should be done to help them gain weight. But I don’t think she listened. She’s hard to read. I’m not sure what to think.

Anyway... please keep praying for them. Their names are Ngor, Chan and Adit. Thanks.

Preterm:
Since I haven’t seen our preterm baby for a check-up this week, I’m starting to think she may have died. She was just so small.

However, I reserve the right to be wrong. Perhaps she’s doing so well that her mom doesn’t think it’s necessary to come back for a check-up. Perhaps.

Pray as the Lord leads. Thanks.

Car Accident.

Kuac is in bad shape.

About an hour ago, his ten year old body was struck by a speeding truck, then dragged 40 feet before stopping.

His chin and lower teeth are all but missing; his chest is rubbed three layers raw; and yet he's conscious.

There is a hole from his left molars through his cheek, ending at a stub that used to be an ear.

And both ankles are broken.

Although he's only ten... and in a lot of pain... he still took the time to thank us for saving his life. I mean, come on!

This kid is strong. Remarkably strong.

His family is gathering money for an immediate transport; the police are filling out accidents report forms; and the looky-loos have all come to gawk.

Now that his ankles are braced and his wounds are cleaned, we watch his tiny chest bounce up and down as he breathes, waiting for his transport to Wau.

Like I said... he's in bad shape.

But by God's grace he'll live. Please pray that he does. Thanks.

Hit and Run

The patient being carried by his family.

The other night just as I was cleaning up after a birth, two honking cars showed up at the gate.

After they rushed in clamoring and banging walls, they unloaded their cargo on our bed. A hit and run victim roughly 40 years old and very drunk lay curled up on his side.

Unconscious and bleeding, he didn’t make a sound as his friend moved his fractured leg around like a puppet on a string.

It flopped awkwardly to one side --the two pieces were severed beneath the skin. But most of the bleeding was coming from his head via a star-shaped gash.

Not skilled in emergency medicine, I started an IV and waited for Dr. Tom to arrive.

Tom worked hard to get the leg braced and the patient eventually woke up. I got to suture his head (which was totally cool and nothing like perineal tissue!) and we kept him over night.

It took his family a day or so to rally up enough money to get him to Wau for surgery, but they eventually did so; and he left on a bus this afternoon.

Please pray for him to get the pins in place and heal properly so he can walk again. I’d hate to see them amputate....

Bullet Explosion!

Late one afternoon, as the clinic was closing down for the day, a boy walked up with his hand wrapped in a bloody towel. He and his parents had traveled from a far village by car. Normally, it would have taken a day to walk the distance, but this time, they drove. They explained his hand was all cut up after a ‘bullet explosion’. (Huh?)

Unwrapping his hand, we all cringed to see the mutilated fingers hanging limp and dead. The story fell together piece by piece as we prepared to suture. As a goat herder, he stumbled upon a bullet while wandering the fields and picked it up. Curious as any nine year old boy would be, he decided to see what would happen if he beat it with a stick. I am not sure how long he hit it, but eventually it exploded, taking several fingers with it. There was even charred residue glued to his skin. It was bad. Fortunately, by the time he reached us most of the bleeding had stopped.

Once his hand was properly numb, Dennis (our clinical officer) removed a finger which barely hung by sinew and muscle. He left the main bone sticking out, saying it would die and eventually fall off. The other fingers were then stitched and wrapped tightly in gauze.

As he sutured, the boy’s mother, kept peeking at the carnage and mourning her son’s pain. She was a wreck. In fact, the boy kept comforting her: “Don’t worry mom, it doesn’t hurt at all. I promise.” It was really quite sweet.

I asked him if he was ever going to play with bullets again, and he shook his head emphatically. This lesson was costly but effective. I told him to tell his friends to stay away from bullets too, and reminded him that he was fortunate he only lost a few fingers. The realization of this truth stopped us all up short, and together we thanked God it was not worse.

Today, he came in for wound dressings. I’m happy to report that it is healing nicely. Pray for a full recovery. Perhaps one day, he’ll warn his son the dangers of playing with bullets... I hope so. 

For those who are squeamish, I am putting the pictures after the story. I don’t want to spoil anyones breakfast (Achem... I mean yours Robin! ha ha!).

Two Broken Legs and a Baby.

Last night I was called to the clinic to help with an emergency. Two women were in critical condition after being hit by a truck. To get to them, I had to walk through a dozen somber looking men gathered on the clinic porch. They pressed in to see but our staff barricaded the doors; the doctors needed space to work.

My patient was named Adong. She looked to be in her twenties and had a severe fracture of her left femur; it lay unnaturally swollen and twisted. When I lifted it back in place, I could see where her bones were no longer connected. It was a clean break -- No doubt a painful one.

While irrigating a deep gash on her foot and removing mud and sand from various wounds, I was able to piece together her story. She and her sister-wife, were walking alongside a road when a land cruiser hit them, sending them flying. The driver stopped, abandoned the vehicle and ran for his life. They knew both the driver and the vehicle well. There was no doubt who was responsible. 

Only then did she ask me if her baby was okay. What? She’s pregnant? I made her repeat herself. She explained she was five months along.
-- “My stomach hurts a lot. Is my baby okay?” She groaned in delirium as I palpated her belly.  “It hurts everywhere.” I could feel the well formed baby beneath her skin, perhaps she was more than five months.
-- “Can you feel your baby moving?” I asked. But she seemed not to hear... or understand. Instead she repeated how she was in pain and wanted to turn on her side.
-- “Your leg can’t be moved right now. Why do you want to turn?”
-- “I have to turn because my baby is uncomfortable in this position. I have to lie on my side.”
-- “Please don’t move. I’ll check on your baby. Just don’t move.”

Adong with Dr. Tom

As I got the doppler and ultrasound gel, I couldn’t help but wonder if we’d have a third victim on our hands. Relief rushed through me when I immediately found a solid heartbeat.
-- “Adong, your baby is fine.” I reassured her. “He’s fine. Meth Apoul. He’s doing well. ”

The room sighed in relief with me... but she moaned. The pain was intense. I took her hand and prayed. I couldn’t thank Him enough that they were all alive. It could have been much worse. I then went to pray with Amer, her sister-wife in the next room. Amer sustained a fractured right leg and several facial lacerations. She was stable and despite the blinding pain, would live.

The crowds continued to come and go. Among those pressing to get into the clinic were newspaper reporters and police investigators. Everything had to be documented. The man who hit them was a foreigner, an Ugandan. He worked for a Christian relief organization. Worse still, he attends our church and once worked with our ministry. We know him well.

As the reality of this news became clear, each face grew heavy in question marks and concern. Would their family retaliate? Would he be killed? Would he flee to Uganda? How will any good come of this? Answers would come in time. So we turned in for the night.

Amer after being stabilized.

This morning’s light brought more officials, commissioners and looky-loos. It took some time for the women to be moved to our vehicle. But by mid-morning all was arranged and they left for Wau.

I also learned that the driver was arrested (mostly for his protection) and is now being held in custody. Since no one died, his life is not in jeopardy but he will have to pay several fines. 

Please pray with me Romans 8:28 for our Ugandan brother. Pray for wisdom, peace, protection and grace. Pray for these women and their families; healing, life, forgiveness and mercy. May this little baby grow healthy and strong. Amen.