Western
Jurisdiction
United Methodist Volunteers
In Mission
By Robert Bradley, M.D.
Where: Mulungwishi Methodist Seminary, Democratic Republic of Congo. Five hours over a dusty, pot-holed road from the city of Lubumbashi near the border of Zambia.
Who: An UMVIM mission team of seventeen medical personnel from Colorado, Washington, Idaho and California
What: A dose of Congolese reality.
When: May 30, 2005
After our brief welcome last night, work began in earnest when Jean, a nurse and the clinic’s supervisor, took Kathy Raven, M.D. and me on rounds in the infirmary. The aging white and blue concrete building consisted of a small pharmacy and five patient rooms, each containing two thin bare mattresses atop dilapidated gurneys. The rooms had open, though barred, unscreened windows. The cement floors were cleaned daily, but an itinerant mouse scurrying across the floor must have found crumbs somewhere.
On this first day of real work we visited several patients. The first was an elderly malnourished man with cough and rales. Gentamycin and Chloramphenicol battled his yellow fever. Next, we looked in on a five week old baby with purulent lesions covering the scalp. The prescription was IM Rocephin along with daily scrubbing. Our final patient was a young woman with an apparent septic abortion. We treated her with Rocephin and attempted a one finger uterine curettage.
After our dispensary rounds Kathy and I parted to begin clinic. I served as a consultant physician working with Jean, the male nurse clinician. Mama Mutumbo, a Methodist pastor fluent in French, Swahili and English served as my interpreter. My first patient on this trip to this disease-ridden third world country was a seminary professor looking for reading glasses. Reading glasses? I had traveled to sub-Saharan Africa to help people with serious illnesses and he only needed readers! Fortunately, the team had brought 140 pairs of donated reading glasses. They were all much appreciated.
Several patients later I had my first taste of the sad reality of Congolese village life. A young mother of ten children brought her five month old boy into clinic. The infant looked quite ill, with grunting respirations. He was fussy, irritable and very pale. Jean immediately diagnosed malaria with severe anemia. One of the few lab kits available at the clinic was a hemoglobin test, which yielded a result of 1.5 grams for this child. In thirty years of family practice, I have never seen a hemoglobin register this low. Within an hour, Ferdinand, our lab tech, inserted a needle into the child’s external jugular vein to transfuse a half pint of blood donated minutes before by one of our waiting patients. This efficiency both impressed and worried me. Unfortunately, in spite of our efforts, the child died two hours later. We could do nothing more to save this life.
My reaction to this poor child’s death was one of surprise and dismay. In my world of sophisticated western medicine, childhood death is a rare occurrence. Children simply do not visit my office and die three hours later. Yet, in this Congolese clinic childhood deaths happen almost daily.
My second day in clinic was nearly as jolting. A father arrived, explaining that his four year old son had "diarrhea and swelling" which had started a week prior. Jean’s experience with similarly malnourished children told him this man’s story simply was not true. "He is a liar!," said Jean, who could see that the child had suffered for some time.. Indeed, with protruding ribs, swollen abdomen, edematous feet and extensive purpura, this child had Kwashiorkor – protein calorie malnutrition. The boy had evidently been fed nothing more than bukari, a totally carbohydrate root staple, along with contaminated stream water. This young boy died five days later. I had never seen a child die from malnutrition, another harsh dose of Congolese reality.
I later consulted with Lorene Persons, a long time United Methodist missionary who runs a weekly nutrition program offering soy products and eggs to children and babies. In spite of feeding programs and nursing care, nutritional neglect takes a toll.
Fortunately, no more children died on my two week watch at the clinic. The remainder of my varied experience was challenging and rewarding. Being exposed daily to cases of malaria, parasitic infections and tuberculosis, I learned at least as much as I taught.
Just a week after returning to Colorado I read an article in Family Practice News which put my Congo experience into perspective. During the years 2000 - 2003 there were 10.6 million annual deaths worldwide in children younger than five years. The major causes were pneumonia (19%), diarrhea (18%), neo-natal pneumonia / sepsis (10%), pre-term delivery (10%), malaria (8%), and asphyxia at birth (8%). Four communicable disease categories accounted for more than half of all child deaths. Notably, 94% of the global deaths from malaria occurred in Africa alone. A Congolese child is 30 times more likely to die than an American child, and one in five Congolese children dies before the age of five. Under-nutrition is an underlying cause of 53% of all childhood deaths.
I appreciated reading Dr. Roger Boe’s article in the summer, 2005, issue of "The Knock" about how communities can improve poor neonatal outcomes in developing countries. I am reminded of the value of Lori Persons’ nutrition program at Mulungwishi. Imagine how many deaths could be prevented if children were better nourished! I’m proud of the monetary donation our mission team was able to leave with Lori so she could maintain and develop her program.
What else might our team have left behind that could have a lasting positive effect on the health of the Congolese people?. We didn’t solve all of the problems presented to us in clinic. Children will still die daily. That was a dose of Congolese reality for me. I was gratified, though, by the comments of the local people regarding the care and concern displayed by every member of our team. Maybe that was the reality we brought to the Congolese.
Just the fact that we were there and that we cared will make a difference we cannot measure in the lives of those we served.