Luke 7:22 "... the lame walk..."

Paralysis was the admitting diagnosis. "Can you review the child? Could he have polio?" Just six days before admission 3 year old Tamandani and his mother had been in Mozambique attending his father's funeral. His father had had a brief, febrile illness, with body pains, headache, gastrointestinal bleeding, prostration and death. Now less than a week later he was ill too. He lay on the exam table without moving his arms or legs, unable to hold up his trunk or head. Olive, the head nurse, coaxed him to take her cell phone in his left hand and after some time he passed it to his right. When supported under the arms, with his head held upright, he was able to bear some weight, even making a clumsy, "dough-boy" step forward desperately trying to escape my grip to reach his mother.  Pushing on the bottom of his foot back toward his body brought out clonus, a repetitive downward flapping movement of the foot. Additionally he had hyperactive knee reflexes and his cheeks appeared swollen. These were signs not of a flaccid paralysis like polio but a spastic paraparesis. Spastic paralysis has a wide differential; TB, HIV, lymphoma, herpes, cryptococcus, B12 deficiency. Transverse myelitis, inflammation of the spinal cord, can be due to a variety of causes including schistosomiasis, typhoid, and Burkett's lymphoma.

His mother reported he had not urinated all day and would not eat or drink. So a catheter was placed to drain obstructed urine. The parasite schistosomiasis was not found in the urine, the abdominal ultrasound , CXR and spine films were normal and an HIV test was negative.  

In my reading I discovered that typhoid can cause parotitis (swelling of the parotid glands in the cheeks) just like mumps. Typhoid fever occurs when food or water contaminated with feces is ingested. The World Health Organization estimates there are 20 million infections and over 200,000 deaths each year from typhoid. Humans are the only known reservoir.

Treatment included antibiotics, prayer and physical therapy. After a week he was able to hold up his head.  Mulungu akumuchilitsa ("God is healing him") I encouraged the mother. A few days later Tamandani was sitting up on his own, then standing up and 2 weeks after admission he was able to walk slowly, holding on to one of his mother's hands.  
In John 14: 12 Jesus told his disciples "I tell you the truth anyone  who has faith in me will do what I have been doing. He will do even greater things than these..." What a blessing to be the hands and feet of Jesus, a pencil in God's hand as Mother Teresa would have said, through the ministry of healing and pointing people toward God.  Thank you for praying for me during my time in Malawi!

Mark 16:18 "...they will place their hands on sick people and they will get well. "

Resurrections Still Happen

Today is Ash Wednesday, the beginning of Lent. It's a time of preparation before Easter when out of love for the world, God sacrificed His son Jesus who took the punishment for all our sins, died on a cross so that we would not perish but instead be given eternal life. Three days later on Easter, He was resurrected from the dead. In the Bible, we read about a number of others who were also raised from the dead (unlike Jesus all of them eventually died a second final death). Remember Elijah raising the son of the widow at Zarephath (I Kings 17:22), Elisha raising the Shunammite's son (2 Kings 4:34), Jesus raising Lazarus, Jairus' daughter and the only son of the widow of Nain (Luke 7:15). And who can forget Paul raising the sleepy teen Eutychus (Acts 20:9-10) who fell out the window and died during a long sermon?

I don't tend to think about the possibility of someone being raised from the dead or a resurrection happening these days. Yet just as Elisha "prayed to the Lord...got on the bed and lay upon the boy, mouth to mouth, eyes to eyes, hands to hands.... and the boy's body grew warm" God raised a young girl from the dead while I was at Nkhoma. As it is written in Hebrews 11:35, "Women received back their dead, raised to life again."

She arrived on the ward from the outpatient department, without a pulse or respirations. We immediately started CPR, gave a bolus of fluids, glucose and epinephrine. Blood had been ordered but had not arrived. No one knew when she had stopped breathing or how long she had been without oxygen. The anxious mother stood nearby watching as we ran for equipment, felt for a pulse, gave chest compressions, felt for a pulse and gave breathes to the child with an ambu bag trying to assure oxygenation.  After about thirty minutes Dr Sohil, a volunteer 3rd year pediatric resident from California said he felt a pulse. Although I had been praying continuously and asking for a miracle, I was surprised. Yet the heart rate registered over 230 on the oxygen saturation monitor.  Still I thought her long term survival was unlikely. There were no ventilators and if she failed to breathe for herself there was no hope. We had endotracheal tubes but with only two nurses and 60-80 patients it would have to be family bagging so we never intubated anyone. But then she began to take breathes and eventually we stopped assisting altogether. A day or two later on rounds, I told the nurse to tell her mother she could move to another section of the ward away from the oxygen concentrators since her daughter no longer required oxygen. I recalled her arrival on the ward and said to the nurse and resident, "You know this was a resurrection. She was dead. No heart beat and no respirations for at least thirty minutes. But, God has something planned for her life. Every one of her days was written in his book before there was even one, and it was not time for her to die that day." The nurse stopped and said we have to give this testimony to her mother and translated my words into Chichewa. "We need to give thanks and praise to God for what He has done."

Luke 7:22 "... the dead are raised and the good news is preached to the poor."

"She was just too little"

I was called to the maternity ward to help assess and manage an infant delivered at 28 weeks by dates after premature rupture of membranes. The mother had had some abdominal pains earlier in the week and had been hospitalized for possible preterm labor. Everything had been done that could be done to prevent delivery and to prepare for it at the same time; antibiotics for possible urinary tract infection even though the urinalysis was normal, steroids to try to mature the babies lungs and drugs to attempt to stop contractions. The parents had been waiting, hoping and praying for a child for eight years and the mother was now 38 years old. Mercy Oduyoye, Bridget Ben-Naimah  and other African women theologians have described reproduction from the traditional African perspective as a woman's religious duty and the most important factor governing marriages. They report African woman are disempowered and shamed by childlessness even in the church community. One of the students from Ohio doing a rotation asked me if people think about children the way we do. It is clear by the names given to children, they are desired and cherished; patients with names in Chichewa meaning Accomplishment, Remembrance, We are thankful, Love, Faith, Gift, and Fruition were all on the ward this month.

I saw the breath go out of this medically educated mother when I told her the baby weighed just 720gms. We spoke of the next 24 hours as the most critical for her baby's survival. Being able to breathe alone would be the telling factor. I tried to instill hope even when I had none. It was less than an hour after birth when the baby began to have episodes of apnea (failing to breathe) and bradycardia (low heart rate) with concomitant drops in oxygenation. Apnea and bradycardia are seen in nearly 100% of babies born under 1000gms.  In Neonatal ICU's  in the US we have surfactant and ventilators to help premature lungs and children survive. We did not have a catheter, an endotracheal tube or even a nasogastric tube small enough to use in this infant. Through a miniscule butterfly IV introduced into a vein barely visible through the translucent skin, we gave antibiotics and dextrose.

When the baby failed to breathe we began giving extra breathes with an ambu bag. The oxygen saturation continued to fall slowly and inexorably. Despite drugs to stimulate the heart, respiratory distress persisted and progressed. In a final effort to try anything that might help I called the lab to come and assess for anemia and then contacted the missionary surgeon with O- blood to give 15ml (3 teaspoons) of blood in the unlikely event that this would improve the course of events. Shortly before her death,her mother began asking questions every mother asks, "Was there anything I did to cause this? Was there anything I could have done to prevent this?" When a child is sick mothers the world over blame themselves wondering if there was anything done or not done that led to their child's illness. I have done it myself. At a deeper often unspoken level in Africa people often wonder if there is a curse or an evil force conjured by someone to cause illness and death. Five hours after her birth this beloved and cherished child died. "I am so sorry. She was just too little."

In the late afternoon, when the relatives had gathered, a group of 30 women proceeded in single file out from the hospital gate carrying a small bundle. The mother and father were not among the group which included women friends, staff, patients and myself. Three different women took turns carrying the baby, wrapped in a pink blanket, in their arms. A cloth which covered their chests was tied at the back hiding their precious bundle. Twice on the journey the group stopped while the baby was taken and placed in another's arms, retying the cloth. Each of the three women bore the burden of their friend's child a relatively short distance on the way to the forest but there was solidarity in the act - a sharing of the loss. It was getting toward dusk, the breeze was picking up and the clouds in the sky were changing to pinks and oranges. There was a good chance of rain and only one of us had an umbrella. We marched on across the field, across the road, through the school yard and into the graveyard. Without a word women broke away from the line and began picking up large rocks from the sides of the path. I moved into the grass and found two sizeable moss covered rocks. Rocks in hand we proceeded on past fresh graves strewn with withered and faded flowers into the quiet of the surrounding forest. We followed a narrow dirt path further into the forest till the group stopped by a large tree. After some discussion one of the women began digging with a khasu, a wooden handled hoe whose blade can be turned and used as an axe or a shovel. Women took turns beating the earth and shoveling it aside. Each worked digging the grave deeper and deeper while others stood in a semicircle watching. When one woman paused another would take the handle and begin again pounding the earth with renewed vigor. The vigorous hammering seemed cathartic. Eventually the depth of the grave reached mid-thigh. Still the beating and shoveling continued until everyone was satisfied it was deep enough so that this tiny infant would not become prey for the wild dogs. Finally a woman on her knees in the soft earth at the edge of the grave shoveled out the last bit of earth and all were satisfied. As we stood in the darkening forest watching the proceedings, the laughter of children playing in a field nearby moved through the trees and we could feel the coming of rain. Nearby saplings were quickly hacked down and leaves stripped off the branches, creating a bed of leaves on which to place the infant. Then the patter of rain drops began as if the Lord himself were weeping and the infant was gently lowered into the grave and covered with white plastic. Sticks were positioned lengthwise over the body followed by a layer of rocks and dirt. The remaining dirt was mounded up a foot high above the level of the ground and rocks arranged on top. A simple prayer was said and we slowly filed back out of the forest past many, many, many other small unmarked mounds.

Psalm 139 "....All the days ordained for me were written in your book before one of them came to be..."