Speechless

August 23: God does many things that I don’t understand. Yesterday, we wrote, very excited, eagerly anticipating God’s miraculous hand at work in young Chrystabelle’s life - her surgery for a new heart valve had finally been scheduled. Today, after her story had pulled at many or our hearts, and after raising greater than $10,000 to support her in this journey, Chrystabelle quietly slipped away post-operatively, leaving her uncle Valentine speechless, Lindsay and I in shock, and her medical team in despair.

God chose to take her from this world and to bring her home. I suppose I ought to be joyfully celebrating her final reunion with her Lord and Savior, and yet here I am, speechless, confounded, and wondering “why God, did you place her burden on my heart, only to take her away just as everything was coming together?” I am speechless.

I don’t know why God chose to prick my heart with Chrystabelle’s story, or why for that matter, we shared her story and raised funding to support her if this was the end result. Praise God, that when our knowledge fails, when our hearts can handle no more, and when our endurance gives way, God remains steadfast, sovereign, and true.

God tells us in Isaiah 57:1-2 “the righteous perish, and no one takes it to heart; the devout are taken away, and no one understands that the righteous are taken away to be spared from evil. Those who walk uprightly enter into peace; they find rest as they lie in death.”

August 24: I spoke with Valentine again today. I tried to express our sincere condolences, but fumbled for the right words. He told me, “Doctor, God is in control. It will be all right.” We will be attending Christabelle’s funeral on Monday. We praise God for letting us know Christabelle, being encouraged by her bravery and her steady faith, and we thank God that she is finally home.

Please pray for Valentine and Christabelle’s family. They are trusting in God’s provision and plan, but there is pain in the loss.

God uses situations like these to teach us something. I am sure I still have much to learn. However, one thing that is very clear is that you are all amazingly generous, Godly people who without hesitation raised money for a girl you didn’t know to give her a new chance at life. Thank you for offering of yourselves and freely giving to offer Christabelle hope. Praise God for each and every one of you, and praise God that our true hope is in the Lord.

Much love and many blessings,

JR & Lindsay

Chrystabelle Update: God is Bigger

"On Christ the solid rock I stand, all other ground is sinking sand. All other ground is sinking sand."

Tomorrow, Friday, the 23rd of August, Chrystabelle is going to surgery at 8am for her mitral valve replacement surgery. I just got off the phone withe Valentine, her uncle, who called me to let me know of the newly formed schedule.

Chrystabelle left Mbingo on the 13th of August and made the difficult trip to Shisong Cardiac Center by multiple taxis with her uncle. When they arrived, Valentine called me to let me know that all had gone smoothly. The staff at Shisong also called to inform us that she had arrived and was being set up for her cardiac and anesthetic reviews and to continue her peritoneal dialysis. The following morning, shy and soft spoken Chrystabelle called me at 6:45 am to wish me a good morning and to tell me that she was "doing fine."

 August 13 - ready to travel to Shisong

We have been waiting anxiously for word on her upcoming surgery, and just this evening learned that she is scheduled for tomorrow morning. We had hoped to give you earlier notice, but we are just pleased that she is finally on the schedule.

Tomorrow is a big day for Chrystabelle. We are praying for a miracle - a healthy heart.

"And my God will supply every need of yours according to His riches in glory in Christ Jesus." 
- Philippians 4:19

When we wrote in June about Chrystabelle, we had hoped to raise perhaps half of the money needed to support her for her surgery. Within one month, God had touched the hearts of many people, and abundantly provided the financial means for her to receive coverage for her entire surgery. God is still working miracles in the lives of His children, and it is awesome to be in the middle of Chrystabelle's miracle. Thank you for taking part in her story.

"Let the children come to me; do not hinder them, for to such belongs the kingdom of God." 
- Mark 10:14

Before Chrystabelle left for Shisong, I had the chance to sit down and talk with her in more depth about Christ's love for her. She is a believer like her Uncle Valentine, and although scared about her upcoming surgery, she is at peace. She trusts in God's perfect provision. We were able to provide her with a new Bible before she left, and Valentine told me this evening, that reading the Scriptures has been a great source of joy and encouragement for them both.

Chrystabelle & Valentine

"As for me, I will call upon God; and the Lord shall save me. Evening and morning, and at noon, will I pray, and cry aloud: and He shall hear my voice."
- Psalm 55:16-17

We trust in God's unfailing love, His perfect provision, and His sovereign plan. Please join us in praying for Chrystabelle, for her surgery, for her recovery, and for her continued walk with the Lord. Thank you for partnering with us and with Chrystabelle in this journey of faith.

We love you all and cherish your prayers and support.
Blessings,

JR, Lindsay, and Cathen

Lindsay, Chrystabelle, & JR

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

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.

Another Day at the Office

Today was just another day. It started a littler earlier than usual (3:30 am), and it hasn't technically ended yet, but it has overall been pretty "routine." Here is what a routine day at Mbingo Baptist Hospital entails:

Chapel begins promptly at 6:40am. Chapel includes most of the staff from the overnight shift as well as the incoming shift of hospital workers - probably close to 500 people. Then we have morning report from 7:00-8:00am. On Tuesdays we actually have the resident Bible Study, and Thursdays we have the joint surgery/medicine Tumor Board case presentations. From 8:00-9:30am we attend clinic and then start ward rounds at 9:30am.

This morning in clinic before going to rounds I saw 5-6 patients. If anyone thinks that he didn't go into outpatient pediatrics because it was too boring, perhaps he is simply practicing in the wrong location. I saw a 6-mo with a patent ductus arteriosus (PDA) coming for a scheduled closure with our visiting pediatric surgeon, a 4-yo with a badly dislocated right hip and inability to walk (see picture below), a 12-yo male that we are managing for his seizures, and a 16-yo M (who was admitted) with likely glomerulonephritis and acute renal failure (Cr 10.0, BUN > 250, hypertensive at 190/110, and 3+ protein and RBCs in the urine).

The ward was where things finally began to get a little more interesting... Here is a rundown of what we currently have on the pediatrics ward:

• 2 patients with malaria, one simple, the other complicated (hemoglobin < 5, unresponsive, and requiring emergent resuscitation on rounds)
• 15-yo M with suspected leukemia. Pathology results pending.
• 7-yo F with a distal radius fracture an superinfection
• 12-yo M with suspected Guillain-Barre Syndrome (AIDP) - bilateral lower extremity paralysis and loss of reflexes
• 3 children admitted with severe malnutrition and edema
• 2 burn patients
• 9-yo M with typhoid fever
• 7-mo F with hydrocephalus and meningitis 
• 13-yo M with recent admission for hypertensive crisis (BP 200/110 and vomiting), now with right-lung white out and ultrasound showing a large retrocardiac mass (see picture below)
• 2-week M with tracheo-esophageal fistula and severe malnutrition, s/p GT placement - scheduled for surgery later this week
• 14-yo F with left heart failure (likely rheumatic heart disease), now presenting with acute renal failure (suspected glomerulonephritis) and initiating peritoneal dialysis (PD) 
• 12-yo M with a likely primary bone tumor and abdominal metastases who has a acute abdomen with a left lower quadrant volvulus.

I spent a good portion of the day working to resuscitate our severe malaria case (transfusing blood, positive pressure ventilation, drawing blood, etc), and then was visiting with the surgeons regarding a number of our cases. We had our afternoon rounds at 4:00pm after the afternoon lecture. 

Praise God that we have a neonatologist and a NICU nurse, Margaret and Pat, visiting us right now. They managed the preemies and the other babies on the maternity ward today, while I continued on the peds ward, in clinic, and then later seeing consult patients. Typically the work is split between myself and either Lindsay or Angela. But the Barriers are home expecting their second child, and Lindsay is in Yaounde picking up her cousin, Greer, who is coming to help watch Cathen, allowing both of us to attend work at the same time. It will be a blessing to have them both here tomorrow afternoon.

Most of the children that we see are really quite sick, and the pathology is astounding. However, what is truly amazing is how God takes scenarios that seem completely helpless and brings healing to many of these kids. Please pray that we would have wisdom in treating these children, that we would be compassionate and caring in our words and actions, and that we would not let our work become simply "routine." Please also pray for safe travels for Lindsay and Greer tomorrow as they drive up to Mbingo, and pray for the Barriers while they are home waiting for the new little one to come.

We miss you all, and thank you for your support and prayers. 

Blessings,

JR

Right hip dislocation

Right-sided pneumonia and pleural effusion and retrocardiac mass

Cathen. She is dressing herself these days... Rain boots, fortunately, are always appropriate here.

Catching up from the past few months...

Wow! Mbingo Baptist Hospital is a busy place and there has been a lot of new and exciting activity underway since last we posted on the blog. Highlights of the past couple months include the following:

Hospital and Training Related

• The CIMS (Christian Internal Medicine Specialization) Clinic Building is expanding to a second floor and getting a new roof.
• The Outpatient Chemotherapy room is open and functioning.

Construction on the CIMS building

• We are unveiling a new teaching model for the residency program this week. We have been utilizing a standard Morning Report, case-based presentation system in addition to didactic lectures provided by the residents and the staff. We are rolling out new Problem-Based Learning cases to more effectively engage the trainees and to make the learning group-based. We are excited to see if it takes in our setting.
•  After meeting in Bamenda with the CBC Health Board and discussing the progress of our own Maternity Ward and Nursery, we have started a 2-week trainer courses for advanced skills in neonatal nursing for practitioners that work at other CBC health centers and hospitals.
• Infant mortality is still very high in Cameroon, and this program has grown from the desire and hope that with even basic level training, we can greatly improve neonatal outcomes.
• We were blessed with having a friend and former colleague of Angela’s, Leigh Greer, who is a neonatal nurse at Vanderbilt, come and work with our staff and help design some basic nursing guidelines. Through that, some of our MBH staff have already informally undergone training; and we have now developed a curriculum and are implementing the course with our first participants from other healthcare facilities.
• The rough drafts of our Pediatric Basics and Neonatal Basics (two evidence-based, protocol-driven manuals designed to standardize patient care within the CBC) booklets have been completed and are being reviewed for final edits and hopeful printing here in Cameroon. This has been a collaborative effort between us and friends and colleagues from home. Holly Frost, who trained with us in Denver, played an integral role in bringing the Neonatal Basics booklet to fruition. 

Part of this month's Peds Team

• The hospital has a new website, and a new Facebook page. Dennis Palmer and Chuck Barrier have put a great deal of effort into revitalizing MBH’s presence on the web, and it is looking really nice. Take a look at it if you have a moment.
• http://www.mbingo.org
• search for "Mbingo Baptist Hospital" on Facebook
• The Facebook page is linked to both the Barrier's blog and to our blog
• If you use Facebook, please "Like" the MBH Facebook page

Personal Notes

• We have had a number of pediatric residents rotating here at MBH over the past few months (Michaela, Courtney & Caitlin [med-peds], Holly, and Melinda & Katelyn). This has allowed us to finalize the rough drafts of the guidelines mentioned above, but more importantly, it was such and enriching and blessed time to have new friends here to share with and to pass along the vision of the hospital. Each one of them has been a tremendous help and brought new energy and ideas to the program. Thank you so very much for your time and dedication.
• We made a quick getaway to the beach at Kribi with Chuck, Angela, Isaac, and Christy last month. It was a blast, and a much needed break from work. 

Isaac and Cathen enjoying the waves

• Please continue to pray for safety, pray for wisdom and discernment in seeing God’s path for teaching and growth of the hospital, and for effective and cooperative work with our national colleagues.

We are so blessed by our family and friends back home. We miss all of you and wish we were together, and we thank you for your continued support and encouragement. God Bless!