Shammah - 'The Lord is Present' (A General Medical Update)

Firstly, we hope you had a blessed Easter. Thank God for Jesus - his Grace permits us to live with the freedom we now have!

Wow.....when I said I wanted to get stuck in with raw nursing, God seriously heard me! It is an honour to be working in a medical clinic where Jesus is central to the care we deliver. Where you can pray with patients bringing them hope (instead of in the UK worrying about being taken to a tribunal). Working at Shammah Health Center has been a rollercoaster of emotions, but lives are being transformed.

I think it is important to introduce you to the team at Shammah Health Center before I continue:

- Josh: Executive Director (Nurse) = Josh has a lot of A+E experience and is good at being objective in shocking/emergency situations.

- Nadine: Medical Director (Nurse) = Nadine vibrantly teaches and delivers excellent healthcare, in an environment where resources are often limited.

- Zenon: Doctor = He is so humble and knowledgeable and likes to discuss complex cases with Nadine and I before deciding on a plan of action.

- Everest: Nurse = The most gentle hearted nurse I believe I have ever met, who is also a pastor. He takes patient histories and leads prayers with patients who would like to be prayed for.

- Matabishi: Lab Technician = He is great, a real lively character with an awesome passion to learn English with 'Force'. Matabishi screens blood, urine and faeces for infection and is always keen to show us what he finds. Malaria under a microscope is fascinating! You often hear Matabishi before you see him.....he has a very infectious laugh.

- Vumilia: Head Cleaner = She is in charge of sterilising medical equipment, washing linen, cleaning beds and floors. Vumilia is also knowledgeable in pre and post natal care so will be involved in this process, when we have our first delivery at the clinic. Vumilia has a beautiful voice and often sings at the end of the day when she is cleaning.

- Salvatore: Cleaner = Salvatore helps Vumilia with all of the cleaning duties. He is a very genuine guy with a heart to serve. We sometimes bring chocolate spread to work as a treat for the staff and Salvatore nearly finished the whole pot to himself the first time. Bless him - he had never had it before.

- Grace: Head of Reception/Triage = Grace is one of the first faces people see at the clinic. She makes sure patients are seen in order of entry and prioritises emergencies. Grace has the best smile and is amazing at translating English to Kirundi and visa versa. She is a good friend of Andy and I.

- Mamert: The Clinic Welcomer/Guard = Mamert is a man of few words, but he is very thoughtful and kind. He is the first face patients see and he is great at communicating any concerns he may have to the rest of the team when first encountering patients.

- Hannah (Me): Paediatric Nurse = I assist Nadine with nursing jobs, ie: wound dressings, IV, IM, SC and oral drug administration, vital sign observations, health promotion, running pharmacy, etc. In complex Paediatric cases I offer my advice to help plan their care.

- Andy: Development Coordinator = He has become known as Gitega's handy man, if it's broken he fixes it. He has kitted the Shammah Health Center truck with blue lights and sirens courtesy of SV lights (UK) and is heading up the Malnutrition Project next to the clinic, whereby making healthy food produce a sustainable business to generate income that can benefit the running of Shammah.

Every morning we meet at 07:30am for devotion, where a different member of the team reads from the Bible and explains what they have interpreted from the passage. We then discuss it and pray for our day ahead. We generally work until 5:30pm 5 days a week, but have had a few crazy shifts lasting up to 14 hours!

EMMANUEL

Okay now you have met the team, I would like to start by telling you about a man called Emmanuel. He is a fairly young Burundian who first presented at Shammah with symptoms of Malaria. When Matabishi tested his blood it was confirmed that he had the disease, so he was prescribed quinine as treatment. He returned to the clinic still unwell 1-2 weeks later so was retested for Malaria and found to still be positive. We were concerned he may have a resistant form of Malaria and we could only offer another prescription of quinine, so in addition to this Nadine, Vumilia and I prayed that Jesus would heal him completely. When he returned - you guessed it, he was malaria negative and appeared so well! Praise Jesus!

SANDRINE

Sandrine is the next amazing story we would like to share. Sandrine is a 5 year old girl who came into the clinic with severe pneumonia and appeared to be septic with a really high temperature. She was struggling to maintain her oxygen saturation level and her respiration rate and heart rate were extremely high, meaning she may de-compensate and stop breathing all together at any moment. She was given oxygen and high dose IV antibiotics along with IV Fluids, because she was dehydrated. It was then a waiting game, where other than oxygen therapy, fluids and managing her fever with paracetamol it was up to Sandrine to fight. I would like to stress that this little girl was in respiratory failure and in the UK would have been on a ventilator. However, there are no ventilators in Burundi at all. 

Although the clinic is not open at night at present due to staffing, Josh made an executive decision to work through the night to save Sandrine's life and then get her to Kibuye Hospital (a hospital Shammah is linked to) the next day, if she stabilised. It was touch and go overnight and the family were fully aware that at any moment Sandrine may die due to pure exhaustion. She was incoherent, unaware of her surroundings and thrashing about the bed that night. Her blood pressure dropped......but she kept taking breaths. By morning when we arrived at the clinic we were apprehensive about what we would find, but figured no news is good news. We walked into the clinic to see Josh tired but relieved and Sadrine asleep and stable. That morning she woke and said 'Jambo' = 'Hello' to staff and appeared to be aware of where she was. She only improved further by the afternoon, so along with a baby who had come in with pneumonia that day too she was transferred to Kibuye Hospital by Josh and Andy. We have been informed since that both are doing well and continue to recover.

DEBORAH

The third and fourth stories I have to tell our very dear to my heart. Some of you who are following us on Facebook may have seen talk of a 5 month old baby dying and then coming back to life. I swear to you this is not a dramatisation of the event it is 100% true. It was nearing the end of the day on Tuesday 15th April 2014, when a young woman ran as fast as she could into Shammah Health Center, with her baby girl limp in her arms. My first thoughts were epilepsy or choking. I took the child from the woman's arms, who I now know to be Deborah and walked briskly with Nadine to one of the hospitalisation rooms, where I lay her down. At this point it became clear that her airway was obstructed and her mother confirmed that she had been eating an orange segment, when a pip must have got stuck in Deborah's throat. Realising what had happened she came as fast as she could to the clinic. At this point Nadine and I started administering back blows and small chest thrusts to try and dislodge the pip, but we were having no luck and Deborah was becoming exhausted, gasping for air, but having little success oxygenating herself. We tried suctioning her and administering some breaths using an ill fitting bag, valve, mask set (ambu-bag), but Deborah lost consciousness and stopped breathing. This beautiful black baby lay limp in front of us, eyes closed, tongue almost white and body grey in colour. We had no oxygen at the clinic because the tanks were being refilled. In my head I knew she was gone, but in my heart I was not ready to accept it, so I cried out, 'COME ON, JESUS!" - I remembered what one of our leaders (Matt Gutteridge) at Woodlands Church, Bristol said, 'When you make an act of faith, you put God in a position where he has to be present!' 

I turned to Nadine and said 'The ambu-bag is not working, I know I shouldn't but I'm going to do this....' Then I proceeded to give direct mouth to mouth/nose breaths - initially 5 and then 2 to every 15 chest compressions. Nadine took over chest compressions and together we worked to try and bring Deborah back. It felt like an eternity (2 mins) with no response, then slowly but surely her eyes started to open and she began to cough and burp. All of a sudden the pip was visible at the front of her mouth. Nadine effectively finger swept the pip out. Deborah was with us, but her breathing remained shallow and slow, so I continued to administer every other breath by mouth to nose contact. After 10 minutes Deborah's normal colouring had returned and the most amazing bit was that there were no obvious signs of brain damage. She was looking around and gripped Andy's fingers, all great signs. Her mother had resided her first and only child would die, so when we brought her into the room, she was scared to come close initially, because she could not believe her daughter was alive and well. The whole Team at Shammah had been praying during the event and were so relieved at this outcome. Zenon was in awe of God, as were we all! He said, 'This baby was with Jesus, and now she is here, I can not believe it!' - he went on to say 'Does this baby have a name, because if not she should be named Hannah after you!' I was so blessed by this and expressed my gracefulness but said she already had a strong Biblical name. Everest offered to pray for the family and they joyfully accepted, bowing as they prayed, in amazement at what God had made happen. It was so special for me to be able to use all of my training as a Paediatric Nurse for the glory of God's name. Just before leaving, Deborah was able to breastfeed without any difficulty. We gave her medication to treat any pain post resuscitation, as well as antibiotics to prophylactically treat any aspiration related chest infection. 

The mother strapped Deborah to her back, this beautiful little girl was a normal colour and alert, looking at us......away they walked with their family. I shout, 'BYE, HALLELUJAH!' and in a beautiful chorus they replied with 'HALLELUJAH!' and beaming smiles. Wow, what a day! In the week leading up to Easter, it made me so aware of what Jesus did for me and how he is not just a life changer, but a life saver. I am excited for Deborah, because I am sure he brought her back because she has a great destiny! Nadine has the pip in a little pot on her office table, as a reminder that anything is possible with God at the Center! (Those of you who have nursed with me and know me well, will be glad to know giving direct breaths to a snotty nose has helped me overcome my fear of bogeys :) ).

REGIS

The fourth story is about a 4 year old boy called Regis. Since being in Burundi and working at the clinic, he is the most neglected/malnourished child I have encountered. He had come to the clinic due to an abscess in his right cheek, bigger than a tennis ball. This infection is most likely due to poor oral hygiene and the fact that his teeth were black and falling out. His skin was breaking down because he is lacking vital nutrients, he was below a healthy weight for his build and had scabies on his buttocks and thighs. He had a dangerously high temperature, so it was decided that Zenon, Nadine and I would do a minor surgical procedure to drain the abscess of pus. We considered using lidocaine as local anaesthetic, but the abscess was too big for it to work effectively, so as awful as this sounds, we had to restrain him for the procedure. He was sooo brave! He cried and fought, but I believe he understood we wanted to help him. Zenon used a sterile blade to make an incision and once he hit the abscess, pus poured out (approx. 30-50mls), it smelt of faeces, which explains just how nasty the infection was. Zenon packed the cheek with betadine soaked absorbent rope and then dressed it.

Prior to the procedure we gave IV Ceftriaxone to treat the infection and post the procedure we gave pain relief for comfort. This is the first child I have just wanted to scoop up in my arms and take home, largely because of how he was post procedure. After we had finished I picked Regis up and took him in my arms, where he then cuddled in and fell asleep due to fatigue. What struck me was that a 4 year old child in the UK, after what I'd been a part of, would have hit me before letting me touch them, but this child was obviously so deprived of affection he took it from the person who gave it, despite what I'd done. His mother did not seem to understand the gravity of the situation, because we had explained he would need further treatment at Kibuye Hospital and gave them the necessary medication for overnight, telling them to come back by 07:30am the next day. Josh needed to transport Anesie (previous blog) to Kibuye for a surgical review at this time so it was not negotiable. They did not return until approx. 10.00.....by then the transport had gone. It was decided by Josh that they would have to go to Gitega Hospital for what should be, free treatment, as Regis is under 5 years old. This was because his mother had said she would bring money to pay her debt from the day before, but did not. She had not taken an opportunity offered to her child in the morning and so I am unable to tell you how Regis' story ends or if his mother took him to get further care. All I can say is that when he left us that day he had been given some more antibiotics for free and his temperature was normal; he appeared more comfortable. Regis often plays on my mind - in the UK the outcome would have been so different. Please pray he is well and that his mother is attending to his needs.

FINALLY......

Two brief overviews of other people who are being helped by the clinic are Claude, a young man who was attacked with a machete in his back by a thief and had a botch suture job done, that resulted in the wound reopening. He comes regularly for dressing changes and is on antibiotic treatment. Then there was a baby (Olivera) on Monday 7th April, with malaria and queried meningitis, who had a bulging fontanelle. Olivera went away with oral treatment for both conditions because the mother was refusing to go to hospital and Olivera had pulled his cannula out half way through his IV malaria treatment with us and was impossible to recannulate. The mother believed the government funded hospital would charge her, when she should not be charged because her child is below 5 years of age and she had no money. We had seen how Gitega Hospital could be, so wanted to ensure some treatment had been given. This was before we had Ceftriaxone (IM). Olivera's mother was supposed to bring him back two days later for a review, but never did. We were worried he may have died. Just yesterday, a relative came to pay the debt for Olivera's care and reported that he is very much alive and well now. This news made my day!

A day at the clinic is never boring. There are times where we laugh, cry and reflect with patients, but most of all we aim to show them the love of Jesus in everything we do. The Burundian people are very humbling in their demeanour. I feel honoured to be serving them and to be working at a private clinic that provides an excellent standard of care for a low price. In addition to this Josh and Nadine have set up a debt scheme, where people who can not afford to pay on the day of their care can come back and pay at a later date. People are so grateful for this and approx. 70% of those with a debt have come back and paid it. Those who wish to pay for their debt, but have no work are able to work with Andy on the malnutrition project, hoeing the land. They are so happy to be able to pay their way. There has been an elderly woman and a woman with a baby strapped to her back and a toddler at her side who have opted to do this. I am blown away by how strong and uncomplaining the typical Burundian woman is.

I apologise for the length of my blogs, but there is just so much I want to share. We hope you are well and would like to say a special thank you those of you who have donated towards Anesie's care, we are on our way to the target! If you have not done so yet, and would like to it is not too late. Send us an email on Andy's account at: andy_faulkner@hotmail.com

May God truly bless you for reading this,

Love Hannah (& Andy) xxx

P.s: Andy had severe food poisoning last week, but has made a full recovery now. I nursed him at home and I am very excited to say I got my first cannula in and it was on my husband!