Mbingo Baptist Hospital: view from Mbingo Hill

Sunday, June 30, 2013

Special Need: the shortcomings of human interventions

Meet Chrystabelle. She is a beautiful 13-yo female who presented to MBH two weeks ago. She has the unfortunate reality of living with congestive heart failure, a disease that typically effects the elderly, but that she developed as a young girl, likely secondary to rheumatic heart disease. She now also has kidney failure and is dependent on peritoneal dialysis to filter the body's waste products. It is because of her kidney failure that she showed up to Mbingo.


Chrystabelle was slated to undergo a valve replacement for her heart this June at a nearby, Italian-run, cardiac hospital - Shisong. However, before she could go for her evaluation, she began to have difficulty urinating and by the time she presented to us had been unable to produce any urine for 3 days. She was in renal failure (BUN 280 and Cr 10) when she arrived. We quickly placed her on peritoneal dialysis - which is a new therapy here at MBH that allows us to do the work of the kidneys in an acute setting, allowing the kidneys time to recover from the immediate insult - and began to filter out the waste products from her body. The difficulty in this setting is that her heart with its failure, feels that the body has too much fluid in it - it can't effectively pump against the pressure. The kidneys, on the other hand, feel that there is too little fluid in the body because the heart is failing to pump the blood forward. So, we are stuck either helping the heart and damaging the kidneys, or helping the kidneys and damaging the heart. This is quite a conundrum.

Betrand & Ivor.
Betrand is Chrystabelle's neighbor in the dialysis ward, and
Ivor is one of our newly trained PD Nurses

Medically speaking, what she needs is a heart valve transplant to allow for improved cardiac function, and then a chance at restoring her kidneys to health. This is where Shisong Hospital comes in. However, Chrystabelle's story becomes more bleak. A cardiac surgery at Shisong will likely cost the family approximately $5000, which is roughly the equivalent of 5 years of salary (a typical laborer makes $50-100 per month). This seems cost-prohibitive, and for many it is. However, as families by and large do not have medical insurance in Cameroon, they tend to unite together in emergent situations and provide for one another. It is miraculous to see how families join together to provide when need arises. This, however, is where Chrystabelle's story again becomes more desperate.

Chrystabelle is one of four siblings. Her father passed away about 4-months ago, and as per local custom, her only surviving paternal uncle, Valentine, has become the sole provider for Chrystabelle and her siblings, in addition to his own wife and children. Valentine is a kind and gentle man who loves the Lord, but this is quite a new burden to suddenly take on - four new children, and one who has medical needs that cost more than you can earn in 5 years of work. Because of the cost, many families would simply choose to take the child home - not only is the chance of survival low, but paying for the surgery would preclude their ability to care for the rest of the family. This is quite the dilemma for the family.

This is also quite the dilemma for the physician. What is my aim in serving Chrystabelle. In medical school and residency we learn to advocate on behalf of the patient. When does advocating for the patient at the expense of the family become inappropriate. Our resources are such that the daily decision of whether or not to send a child home from the hospital has ramifications not only for that immediate patient, but for the ability of the caretaker who is with the child to provide for the other five siblings that are at home without a parent and without any means of earning an income. Justice and mercy and love seem to take on a new meaning in these shades of grey.

During medical school and residency, my aim was always to "heal" the patient. Working here I am daily reminded that I cannot heal the patient. In fact, God's purpose for me is not to necessarily heal anybody. Rather, I am called to provide compassionate care to my patients in a way that shares God's incredible love, and to let God do the healing. Sometimes knowing how that plays out is easy. Other times, it is not.

In this instance, Lindsay and I have felt called to help Chrystabelle in any way we can. Specifically, we want to continue her on dialysis until August when the next Italian cardiac surgeon is coming to Shisong, and to help the family pay for her valve replacement at that time. We aim to raise $5000 to offer Chrystabelle the best chance she has at a healthy life, a new heart so to speak, and in the process, to show God's incredible mercy and compassion for those in need. If you would like to partner with us in this endeavor, please make a donation to our Samaritan's Purse Project Account, and we will use the funds accordingly.

We serve an almighty God who is able to do immeasurably more than we can imagine. We are eager to see how His love is poured out on Chrystabelle and how His perfect plan is brought to fruition. Thank you for prayerfully considering making a donation on her behalf.

With love and broken hearts,

JR & Lindsay

Work is tough. God is the perfect provider, and He provides rest for the weary.
I am blessed to be able to find rest in enjoying His creation.

1 comment:

  1. Hi, my name is Esther Carey and I'm interning with the Samaritan's Purse communications team. I've enjoyed reading about your ministry from your blog! If you would be interested in writing a guest post for the Samaritan's Purse blog, we would love to have you do that! Please contact the blog editor, Chelsea Pardue, at cpardue@samaritan.org for more information. Thanks!