Thursday, June 7, 2012

The Rest of the Story

This week I had a reminder of an experience from the early weeks of our time in PNG. It seemed like a good story to make into a blog post. So I sat down to write it. The further I went in writing, the more I had the feeling that I had written it before, maybe shortly after it happened. In those days we used an email list to share information about our ministry. That was before blogs and Facebook, believe it or not!

Kamda and Yamul with Lori's little brother








So I stopped and looked back through some files that I haven't accessed for years, and there it was. Interestingly, I had included many of the same peripheral information then as I was including in the new version. There were a few facts that were told differently than I now remember them. The earlier version is more likely to be right. The "reminder" alluded to above was a conversation with Kamda and Yamul, the parents who adopted the baby in the story. My old version was closer to what they told me than were my later recollections.

As I read the old story, I realized that I probably couldn't tell it any better now than I did then. Let me just paste old version with just a little editing, and then I'll tell you the "rest of the story".

We called her Susie.  Her "real" name was Winda, but many PNG people have several names, and change them at different times and for different reasons.

On the maternity ward I don't often have a chance to get to know the patients well.  Even here with our high infant mortality rates, most women come in labor and leave a few days later with their healthy child, and do not require much attention from the doctor.  Not so with Susie.  She came to Nazarene Hospital initially from her home in the Jimi Valley because her abdomen was swollen to a much greater size than could be explained by her 7 months of pregnancy.  When I first saw her, I allowed myself a brief hope that maybe she was carrying twins or triplets.  But as soon as I examined her I knew it was something far worse.  Her huge abdomen was filled, not with a term-pregnant uterus, but with fluid.  There is a short list of possible reasons for this condition, and none of them are good. 

There is a medical superstition about things coming in threes, and this was following that tradition.  When she came in last November, she was the third similar case I'd seen within a few weeks.  The first had delivered successfully, had come back a few times after that, and then had been lost to follow-up, presumably because of death.  The second delivered, then was quickly taken home by her family to die.  In reality, she probably died shortly before or while being carried out by her relatives.  I don't know anything about either baby.

It was with a true heaviness of heart that I confirmed the diagnosis with ultrasound; normal-sized uterus with a vigorous-looking, thirty-week fetus, a huge sea of watery fluid and a small, shrunken liver.  Cirrhosis, probably caused by a hepatitis B infection.  What, I wondered, would be this child's future?  If we could delay delivery for a few weeks, she would have a fighting chance.  But then what?  Motherless children in PNG are usually cared for by relatives, or by their father's new wife.  Often they are loved and well cared for, but not always.  There are always problems with what to feed them.  Many have a relative who still has breast milk, and who is willing to nurse them, but not all.

So I admitted Susie to our maternity ward, and she was there long enough to get to know her well.  At first she was fearful of everything.  She was physically very small (as are many people from the Jimi), and came from a very remote place, the village of Kwipun.  She had had little or no contact with modern technology (even the paltry bit that we have) or with expatriates.  But it didn't take long for her to realize that she need only expect to be treated with kindness.  Then her natural sunny disposition became evident.  There are many Jimi people who work here at Kudjip station, and they quickly rallied around to make her feel welcome and safe.

At first she showed signs of premature labor, so we gave medicines to stop that, and medicines to try to prepare the infant should we fail in our efforts to delay delivery.  If we could just buy a few weeks' time, the baby would be mature enough to make it in the "outside" world.  After nearly a month in the hospital, Susie went into labor, and delivered a beautiful baby girl.

We didn't know whether to measure Susie's expected life-span in weeks or months or years, but we optimistically performed a tubal ligation on her, in case she recovered and lived long enough to get pregnant again.  We needn't have worried.  We discharged her at first to stay with relatives who live nearby, but after her follow-up visit, she went home to the Jimi.  I know the doctors who work at the small health center near her home, and I sent a note to them along with her, and instructed her to follow up with them as needed.  Then she was gone from my life.  I thought of her from time to time, and wondered what might have become of her and her baby.  I thought that maybe some day I would have a chance to ask the doctors from the health center if they had had any contact with her.  But that was all.

Until Lorrie arrived on A Ward.  Lorrie had pneumonia, but not a severe case, as far as severe pneumonias go here.  She is a chubby, bright, happy healthy baby girl of about 8 months.  She seemed secure and happy.  She has evidently had some contact with BUWGs (Big Ugly White Guys) as she didn't seem too afraid of me.  She would even smile for me when I saw her on rounds.  Her mother was attentive and competent, answering my questions clearly as she sat nursing her baby.

It was only after she had been in the hospital for a few days that one of our nurse's aids who is from the Jimi, slipped up beside me while I was seeing Lorrie.  "Do you remember the patient Susie who was on bed B-5 last November?  She had bad liver disease."  I had to think for a moment before the memories of Susie's hospitalization came flooding back.   Yes, of course I remember her.  "This is the baby that she carried here; she died just two or three weeks later.  This mother has adopted the baby.  She has never carried a child, but she has breast milk for the baby." 

"Yes," added one of our nurses, "she took some Metamide, and now she has plenty of milk for the baby."  "Plenty?" I asked incredulously.  "Plenty?"

"Yes, plenty," said the mom, as well as several others more or less at once. "Plenty!" 

Lorrie is clearly well-nourished.  She hasn't had formula.  Baby formula is very expensive here.  It would take more than most families' entire income to supply a baby with formula if they have to buy it at the drug store.  We give some away as we are able.  People feed babies the milk that is available here, sometimes watered down.  Sometimes they feed them Milo, which is a chocolate powder that you can add to milk to make a tasty beverage that is popular here.  More often people have to mix it with water to feed the baby.  Milo in water has little or no nutritional value.  But it is all some babies get.  Even worse, many families use unsafe water sources, either out of ignorance or necessity.  We give either or both of two medicines to adopting moms that can sometimes stimulate some milk production, but this is usually not very successful, especially if they have not had a baby recently.

But here was this miracle right before my eyes.  Lorrie's dad is Kamda, a cousin of Susie's.  He teaches at Melanesia Nazarene Bible College, and directs the Extension Bible College program for pastors who cannot attend school full-time.  He and his wife Yamul had not been able to birth children, but now they are the obviously-proud parents of Lorrie.  As an adoptive father, I could relate to their happiness.

Romans 8:28 reads, "And we know that God causes everything to work together for the good of those who love God and are called according to his purpose for them. (Holy Bible : New Living Translation. 1997 (Ro 8:28). Wheaton, Ill.: Tyndale House.)  I have to admit that I struggle with the application of that verse many times.  Did God allow Susie to die, just so that Kamda and Yamul could have a baby?  No, I don't think so.  But in a world where sin and evil still exist, God takes terrible circumstances and brings good out of them for His glory.

So, that's the story I told in February, 2005. Since then, Kamda has become the District Superintendent of the Bromley District of the Church of the Nazarene, which includes the Jimi Valley. To be honest, I had failed to make the connection between Kamda, the new DS of the Bromley District, and the couple of the story above. But this past Wednesday evening I had the chance to visit with him and his wife Yamul, and they reminded me. They mentioned that their daughter Lorie was a baby that I had helped to bring into the world. With a few reminders, the story came back to me.

Lorie is now a happy healthy 9 year old, and is in grade 3. Kamda and Yamul have now adopted 5 children. She has successfully breast-fed all of them. As I was visiting with them a 4 year old was sleeping contentedly on his dad's lap.

Most of the patients I take care of come into my life for a short time. For many, they come for a relatively-minor problem, and there really isn't much of a story. For those that I've been more deeply-involved with, they may come back, but many times see a different doctor. Or they come for a new problem, and don't realize that I don't remember the earlier events, or they assume that I wouldn't be interested in being reminded. So there often isn't any "rest of the story". But I love it when there is!
AB

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