I think the honeymoon is over

They say there are 4 stages to culture adjustment – the honeymoon stage, the hostility stage, the humor stage and the home stage.

It was 2 am and my question was simple, “Why did you come to the hospital today?”  I already knew his response as I had seen him about 10 days ago.  This was a young man who suffered a shock from an electrical outlet and was knocked unconscious for about 15 minutes.  The electricity had entered his left index finger, leaving a large hole and had exited his right chest area just below his nipple leaving a mark.  At the time, we watched him for 12 hours and sent him home with antibiotics and the message that he would most likely will lose his finger.  He was told to follow up in surgery clinic within the week for possible amputation of his index finger.  It was now 10 days out since he had been discharge, he had missed his appointment with the surgery days ago, he was in pain and it was 2 am, my opening question was a mere formality.  I did not wait for him to answer.  I let into him.  “What did we tell you to do when you left the hospital?”  “Why did you miss your appointment?”  “This is not right.”  I did not give him more time.  I was irritated.  I was busy.  It was 2 am.  I am not his father.

They say the second stage – the hostility stage – is characterized by frustration, anger, anxiety and sometime depression

In covering the OB deck, I was managing the labor of a first time mom that was progressing slowly.  Depending on the criteria one follows, one could’ve justified a c-section.  However, the baby’s heart tones were looking good, so we had time.  “Welcome to labor” was my attitude.  However I found myself explaining to the patient and family multiple times that although I could do a c-section, c-sections are not without their risks.  And this being Africa, those risks are compounded by availability to medical care.  Many of these patients live far from the hospital.  Doing a c-section is not only costly, but puts mom at a future risk of uterine rupture in the absence of access to medical care.  In the three months we have been here so far, we have seen 2 of them.  The baby died in each case.  The moms required a c-hysterectomy, but survived.  This process is not only devastating secondary to the loss of the baby, but secondary to the loss of ability to have more children.  Here in Togo a women’s identity is tied to her ability to have children.  Taking out a uterus, even in justifiable situations is not an easy decision.  The care of this mom in particular, took a lot of effort.  The good news is she delivered the following shift successfully.  When I heard this, I could not refrain from visiting her in recovering and asking her, with a smile, if she still wanted me to cut

The frustration

Frustrations come from a few sources.  First of all, we can only do so much here at HBB.  Our care is limited by available resources and the financial ability of patients to pay.  Patients who are in life threatening conditions are treated and then asked to pay a fee.  Patients who are not in life threatening conditions are asked to pay a fee first, and then are treated.  Second, we are the first and only stop for many patients.  It is hard to see somebody die who could have, in another life . . . another place, lived.  Third we have American expectation, right or wrong, in an African setting.  We are learning to think American with African expectations.  Deciding not to treat and accepting death is Ok.  Fourth, we are treating things we would not normally be responsible for in the USA.  Although this is exciting and something that interests us, we feel many times inadequate and wonder/question the contribution we are making.  We are thankful for our state-side colleagues who taking our calls and emails.  Fifth, it is hard to be on call for 24 hours and then be responsible for your son the following day while your partner works.  At times we are too tired to interact with him . . . we feel that he is getting the short end of the stick sometimes.

A Clarification

We are doing well.  We are working lots and learning how to adjust.  Based on comments and personal emails we have receive on past blogs, we are left with the impression that you, our friends and supporters, believe we are struggling.  It is tough here, but we are doing well.  Our blogs are a reflection of our experiences, thoughts, questions at a particular moment in time.  We hope, pray and ask for patience as well as wisdom and endurance for ourselves as we go through this culture adjustment.

“We now have this light shining in our hearts, but we ourselves are like fragile clay jars containing this great treasure.  This makes it clear that our great power is from God, not from ourselves.  We are pressed on every side by troubles, but we are not crushed.  We are perplexed, but not driven to despair.  We are hunted down, but never abandoned by God.  We get knocked down, but we are not destroyed.  Through suffering our bodies continue to share in the death of Jesus so that the life of Jesus may also be seen in our bodies.” 2 Corinthians 4:7-10

God Bless