I am emotional (A rant)

Staying dry while it rains!

I am emotional.  I cry a lot more in silence these days.  I have been here before.  It comes when re-reading a blog, reflecting on a comment and or seeing a sick patient.  It comes out of the blue, a 180 degree turn of emotions.  I fight it, swear, ask for strength and it is gone, as quick as it comes.

But it comes.  And when it comes I wish I was home in a different setting, a different hospital, a different life.  When it comes, I am mad at the place, the patient, God and the world.  I cannot believe we have not learned from our past.  A 100 years ago, maternal mortality/morbidity in US was six persons per 1000.  Then we learned how to wash our hands and the mortality/morbidity fell.  Then we discovered antibiotics and it fell even more.  Then we developed ventilators and then it fell again.  Today it is 0.1 person per 1000.  This place seems like a different world.  It has not benefited from the advances of mankind.

And then the emotion goes and I realize the opportunity I am in.  My training in the US was composed of diagnosis and treating disease processes in infancy.  Many times during my training, I wondered about the futility of what we are doing and or the medications we are prescribing.  Treatment was a memory process.  In Africa it is not.  Here you see the end result of untreated/unvaccinated hepatitis and tetanus, malaria, hypertension, congestive heart failure, rheumatic heart disease, pancreatitis, etc.  Here you learn to appreciate the well patient checks, vaccinations, and abnormal lab values.  You learn to appreciate the diseases you treat because you not only see the end results, and many times too late; but you get to see the medication and treatment process work.

But this is not the first time I have been emotional.  As a young engineer I worked for a small company for 6 years and I was emotional.  During my time there the company went through it all –downsizing, bankruptcy, start up, environmental issues, health and safety issues, etc.  Shortly after I was hired I realized the trouble the company was in and I made a choice to stay, to learn, to make the best of it.  It was an interesting 6 years.  I learned a lot.  I often said my 6 years of experience there was like 12 years in a normal company.

But there is a price when you become emotional.  Something has to give.  When I left that company, I quit.  I walked away.  I wanted no more.  I took time off, went to France and Switzerland, lived with my brother and finished my MBA.  And when I thought I was ready for work again, I looked for a job and went through some interviews.  Everything looked different.  Prior to taking my first engineering job, I saw work as an opportunity to prove yourself, to gain wealth, to become famous within a circle.  Now all I heard was a sales pitch, a presentation without substance, passion, or ideals.  It was then I thought, maybe I should change careers.  And now I am here, 9 years later, the same position, the same struggles.  Ironic.  Who would have guessed?

It gets to me that we struggle with the basics, that we cannot create a solid society, a sustainable society.  Why are there hungry people?  Why are there people dying of curable diseases?  Why are we complacent?  Why do we treat people different based on relationships, position, status, color?  It gets to me when I know we could be that much better and yet, it seems, we choose not to.  The problem is not me.  The problem is not you.  The problem is us.  The problem is sin!  We choose this.   We promote this.  A case in point.

A 28 year old mother of three, 17 weeks pregnant is in decompensated liver failure secondary to Hepatitis B.  She has a small liver and lots of fluid in her belly.  Her problem started mid-November.  She has been tapped four times, by an outside clinic, for ascites over a two weeks period.  We saw her for the first time a few days ago.  On Monday we hope to run a few more test to see the degree of liver failure.  If her 6 month survival is low, we cannot do anything for her.  However, if she is still alive in 10 weeks-time we will do all we can for her unborn child who will most likely grow up without knowing mom.  If her 6 to 12 months survival is good we will be challenged with our next obstacle, to find 12 plus months of medication and hope she responds.

But this is not the point.  The point is hepatitis B is a treatable disease.  Yes not everyone responds to the treatment, but it is a treatable disease.  What one needs is access to medical care and to medicine.  We choose not to provide that access.  Not only that, an immunization exists for Hepatitis B.  In the states it is a standard part of newborn care since 1991, here it became the standard in 2007.  Some would argue well we have it now.  Not good enough.  Not good enough for her kids and her unborn child.  We have failed her.  We have failed her children.  How can you not become emotional?!  How can you not take a moment to pray, to ask for a miracle, to ask for a better place?!

^“The greater my wisdom, the greater my grief. To increase knowledge only increases sorrow.”  Ecclesiastes 1:18.

God Bless

UPDATE (a bit technical for the doctors that may be reading this blog)

We have run additional test on the lady in question and have calculated a MELD score of 13, which in her case is good news.  Having stated all this, her only abnormal findings are an INR of 1.5, T.Bili of 1.5, Hep B positive, ascites and platelets of 115.  With these findings we are questioning if hepatitis B is the actual cause of her liver failure and or are we missing something.  We have presumptuously treated her for schistosomiasis.  We have redone her echo to verify a small liver with irregular boarders and a heart that is contracting well, and we have tapped her and are presently in the process of ruling out TB.  We are now in search of a Lab in Lome that can verify additional hepatitis B markers that would include viral load.  This could confirm our diagnosis and give us a basis to verify if and when we treat her, if the treatment is working.  From there, our challenge with her will be treatment, which at this time we are estimating will cost about 1500.00 US dollars (wage range for an unskilled worker to a doctor is 70 to 450 US dollars a month).  A quick thank you to the doctor at Tri State for the curb side consult.