Dernier Jour

Today was our last day at the hospital.  Our weeks here flew by so quickly.  It is surprising how familiar the layout of buildings and rooms feels when just 4 weeks ago it all seemed a maze of activity.

Now, I look at Salle 1 (Room 1) and images of the many children who have stayed in the pediatric "ICU" come to mind.  It is considered the ICU because it is the room closest (literally adjacent) to the nurses' station.  The sickest patients stay here so they can receive quick attention if they begin to decline.

As my gaze continues around the quad which forms the inpatient pediatric unit, I remember the patients and families who have lived in these rooms, hoping and praying for healing.  We took time yesterday and today to visit each Salle and give a small gift to every patient.  For the older kids we gave toy cars or stuffed animals and for the younger kids (especially the babies) we gave clothing (mostly items Gracie has out grown which we brought along for this specific purpose).  Our words were few as we handed these items to either the child or the child's mother:  Alla ka du biya (God bless you).

      

In the midst of our goodbyes to patients and hospital staff, we continued to work.  More interesting cases present on a daily basis.  We have seen a couple of toddlers come in unable to swallow after ingesting lye (which is caustic to the esophagus and can cause scarring).  In both cases we were able to dilate the esophagus and the children began drinking again.  A young boy came in with intusseption (intestines "telescope" inside itself) -- the classic sausage shaped mass in the abdomen was readily apparent on exam.  Dean assisted Dan with surgery; a segment of dead bowel had to be removed and then the healthy sections of bowel were rejoined (right hemicolectomy with illeocolic anastomosis).

There are more stories to tell.  Each involves a precious child, designed by God.  We hope to share more of these with you upon our return.

Today was also Gracie's last day with Marte, the nanny who has kept her every morning (and many afternoons) while Dean and I worked at the hospital.  Gracie enjoyed her time with this sweet Christian young woman.  We were very thankful to have her help.

A couple days ago we toured a place nearby where they make mud-cloth.  This is a traditional method of using mud to dye cloth -- you can see an couple examples of the patterns they make.  Sometimes they use stensils to create repetitive designs.

Our departure is bittersweet.  We have come to love the people here, and we truly enjoy working at the hospital.  God has confirmed that He has designed us for practicing medicine in an international setting. We look forward to God showing us the specifics of with whom and where over the next months.  Thank you for joining us on our journey.  Your prayers and support are greatly appreciated.

DD&G

P.S.  An unexpected power outage prevented us from posting this Friday post until Saturday morning.  Ah, but God is gracious and the power did return in time for fans to help us sleep!

Take a look

Tonight we thought we would share some photos.   Hope you enjoy!

Sunday afternoon we took a walk with Brian (school teacher) and his son (Caleb).  This picture depicts the general landscape here rather well -- dust, dry, hot with a few splashes of green and shade.

We stumbled upon as swimming hole (more like big mud puddle) where local boys were cooling off.  A few of the boys showed off by doing back flips into the water.  Looks like fun!

Dean saw this little boy walking along yesterday.  Can you tell what he was carrying?  Nope, not a little lamb...a little goat head with goat feet!  Eeekkk!

Here is the "cloth" from Journee de La Femme -- guess it is actually green, purple and cream.  We saw more ladies wearing the cloth today (March 9th) than yesterday, not sure why.

Set of premature twins who have been "growing" at the hospital since we arrived last month.  Currently the are up to just over 1800 grams.  They need to be over 2000 grams before they will be discharged home.  Yesterday, however, they graduated out of the incubator they had been sharing since birth and moved into the bed with their mom.  Aren't they cute?

Amanda has been reading daily with Fatumata (girl diagnosed with diabetes).  It's interesting since Amanda doesn't know Bambara and the little girl doesn't know English.  Mainly they are working on recognizing letters and learning the sound each letter makes.

Here is the book they are using to guide their studies.

Today, Gracie and I watched while they practiced the letters "b" and "a."  As you can tell Gracie was quite interested in this game ... and "babababa" is definitely a word she likes to say!

Seytou (young girl with severe burn) standing outside the pediatrics building looking out onto the courtyard.  The iron work on the windows is quite pretty.  There is no glass, just open air.  Some windows have crosses worked into the design.

Seytou had her skin graft done today.  Please pray that the graft will take.

Gracie captures another heart!

With Love from Mali,

DD&G

La Femme

Wow, are we really 2 days in to our last week at the hospital here in Koutiala, Mali???  That's hard for us to believe.

Today is National (actually, I think it is International) Women's Day -- "Journée de la femme" as they say here in Mali.  Special cloth is made to commemorate important days -- people will have outfits made out of the same cloth and wear it as a sign of solidarity.  And "Journée de la femme" made the cut with it's own special purple and yellow cloth displaying the logo of a woman and child and March 8, 2011.

So, happy day to all you "Femmes" out there!



Gracie and I sitting in the lady's section at church Sunday.



Ladies waiting for clinic visits at the hospital.


We saw another sad (although very interesting) case today in clinic.  A little girl (10 years old or so) returned with her family.  We saw her about 3 weeks ago for right arm weakness and a mass around her right shoulder blade.  She went home with ibuprofen and instructions to return in 1 week.  It was only after numerous phone calls (yes, many folks here have cell phones -- or at least friends/family with one) that she finally returned to clinic 3 weeks later.

They said she got “better” with the ibuprofen so they didn’t come back.  What our exam showed though was no where near better -- unfortunately it was quite worse.  She can no longer move her legs, she cannot stand.  In fact she can only sit upright if she props herself up using her left arm.  Her right arm remains weak.  The “swelling” around her right shoulder blade did seem better -- but now she has a fullness in the front of her neck on the right side.

After seeing her on the first visit, we put our heads together trying to figure out what was causing her symptoms.  We were suspicious for a brachial plexis (bundle of nerves that innervate the arm/hand) tumor or rhabdomysarcoma (muscle tumor).  We were eager to see her in follow-up (which is why we kept calling and asking for them to return) -- but today it was very sad to see how much worse her condition has become.



Most likely it is some sort of aggressive cancer.  What type?  How we wish we knew.  Without imaging it is nearly impossible to determine the source of her “mass” and evaluate her spinal cord.  Her symptoms suggest that her spinal cord is being compressed.  This makes us suspicious that she has a tumor originating from a nerve (or nerve sheath).  Our initial concern for an aggressive rhabdomyosarcoma also remains a possibility.

So what is the plan?  Well, we are going to start empiric chemotherapy to see if she has any improvement in her symptoms.  Also, in an effort to make a definitive diagnosis, Dean and Jason took her to the Bloc (OR) and did a muscle biopsy from the right shoulder (thickest area of the "swelling").  During surgery things looked normal (at least to the naked eye) -- but they didn’t want to probe too far into this area and definitely didn’t want to venture into the neck (other area of “swelling”) with no one of more surgical expertise present and no image or idea of what was beneath.  Dean and I will take the muscle sample back to the U.S. where a pathologist will look to see if there are any abnormal cells present.

And we will pray.  Pray for God’s healing and His comfort, for guidance and discernment.

Please pray along with us for Sanata and her family during this time of uncertainty.

DD&G

Balance

Hot, hot, hot!

Whew...what a day!  Temperatures will surely surpass one hundred degrees today, and the Kubacz family will certainly spend the afternoon escaping to the shade and refreshing water of the pool.  We are blessed (maybe even slightly spoiled) indeed!

After a brief mid-morning stroll through the market, Gracie is napping -- recharging before her next adventure.  She always draws a crowd, which really shouldn't be a surprise for a white skinned, blonde headed baby carried by her father (not mother) on his front (not back) using a Baby Bjorn carrier (not cloth wrap) in rural West Africa.

 




Earlier this morning, Dean helped Jason (the other pediatrician here -- he works part time at the hospital and spends the rest of his time learning the Bambara language) with hospital rounds while I kept Gracie at the mission.  We don’t have Marte (our borrowed nanny) on the weekends, making it difficult for both of us to work.  The kids at the hospital seem to be doing fairly well.  Amanda (a pre-med college student who has been staying at the guest house with us) has been teaching Fatumata, the diabetic teenager, to read Bambara, so she accompanied Dean to the hospital today.  Fatumata and her mother both seem interested in learning to read; progress is slow going, but we pray the Lord will bless this effort.

It is very exciting to watch children get better!  Yesterday, we visited with Setou (the 10 year old girl who was burned) while she had her dressing changed.  She continues to progress well; God’s design amazes us daily as we watch bodies heal.  Here are a few “before and after” shots of patient’s wounds:



This lady has bad leg ulcer -- maybe a tropical ulcer or maybe pyoderma gangrenosum.  She has been getting regular wound care with good results.  Hopefully she can have a skin graft done soon.

But as with most things in life: where there are “ups,” there are also “downs.”  Sad stories are numerous on the hospital wards -- not all of our patients get better.  Many mornings on rounds, my eyes linger on an empty bed that had been occupied the day before.  Despite antibiotic treatment, children die.  Newborns succumb to septicemia (wide spread infection); young children succumb to meningitis (infection of the central nervous system) and typhoid (infection which can cause the intestines to perforate); children and adults alike suffer and eventually pass away due to cancer.  Death is an ever-present reality.

Little Allou still struggles as he fights leukemia.  Despite completion of the first two phases of chemotherapy, he is not improving.  His little body has not responded as we hoped.  Currently his mouth is covered with sores.  He struggles to drink his milk.  His sullen face pulls at our hearts.  As medical providers, we are faced with difficult decisions, and in Allou’s case it has not been easy to do what we know is best -- stop chemo and transition to comfort cares.  His prognosis is grim despite medical treatment efforts.  His family desires to take him home where he can spend his last days.  It is hard to see him go.  Sheri, who overseas the daily cares for the cancer patients, has grown particularly close to this little one.  Friday she and her boys brought Allou special, farewell gifts and presented them to him and his family.  Sheri also took Allou for a ride around the hospital grounds on a golf cart -- he loves to “drive.”  Please pray for this sweet child as he continues to live out each day he is given.  Pray for comfort, for peace -- for him, for his family, for Sheri and the staff here who has grown to love this precious child.

Perhaps, I should have reversed the stories in the post, ending on happier thoughts.  All of these events are reality here in Mali, as else where in the world.  And the “happy” and “sad” are not always balanced.  Some days patients improve in ways we didn’t imagine; some days death seizes patients we didn’t expect.  Ah, but there is hope.  For everyday, God provides.  His grace is renewed each morning, and His grace is enough.

Leaning on Him,
DD&G

Gracie Grace

Tonight we will focus on little Miss Gracie.  

            

Gracie has truly been a trooper these past 5 weeks.  God has blessed us with a happy girl who lights up our world with her smiles and giggles.  She is also quite the hit with Malians -- guys and gals of all ages just can't resist stopping to shake her hand or pat her head or even hold her.  We all love to see her smile.

Gracie's latest trick is "clicking" her tongue against the roof of her mouth -- quite amusing and much preferred to the spitting and food blowing last week.  Over the last couple weeks her interest in and taste for solid food has taken off.  Today she saw a banana and was not content until it was peeled so she could gnaw away, mushy bite by mushy bite.  Other favorites solids are toast and fruit melt-away bits which she proudly "fist"-feeds to herself.

 

Gracie loves to swim.  Today she realized that when mom and dad go underwater they don't actually disappear.  At first she remains a bit skeptical, staring at the spot we were last seen but as we swim towards her she looks down, sees a familiar head beneath the surface and starts kicking her feet and flapping her arms with glee.  She likes to "pat pat" Daddy on the head until he surfaces again, but for Mommy she likes to "pull pull" her out of the water by her hair -- yikes!

Gracie is willing to adopt any form of transportation that will get her where she wants to go.  In the hospital, she revs the engine as she rides the fire truck down the halls.  

And out on the streets, she hitches a donkey cart ride and races her daddy to the pool.

All in a day's play for our little Gracie girl!

DD&G

P.S.  Here is a picture of the Malian meal we had at Batima's house -- yum, yum!

 

If you can read this...

then you are blessed!

No, not because you are reading words from us, but because you CAN read!

On Tuesday, a teenaged girl was brought in by her extended family (she has been living with them).  They said that she had "pain in her feet".  When asked if the pain kept her from sleeping, they said that she got up every hour to pee and that was what kept her from sleeping.  It turns out, the thing that finally prompted them to seek care was that she was crying out that she wanted her mother.  A dipstick test of her urine made our suspicions for diabetes even higher, and a blood test confirmed it.

The happy news is that she is reunited with her mother at the hospital.  The sad news is that treatment of type I diabetes in Mali is an incredible challenge.  Most kids probably don't get appropriate treatment before they die (this is the first case that Dr. MacLean has seen in his 3 years here).  Cost, access to medicines, access to medical care, etc. are all major obstacles.  But to top it off, this young lady cannot read.  And neither can many (if not most) Malian women.  Education is expensive, and for girls it is not a priority.  And the empowerment of women has a long, long way to go.

So, here is a young woman.  She lives away from her own mother.  She has just been diagnosed (by God's grace and His provision of the medical care at this hospital) with a life-threatening, life-changing, lifelong illness.   Diabetes is often difficult to treat under ideal conditions.  And she lives in a country where few things are ideal (by our standards, at least).

We pray that God will show Himself and His love while she is at the hospital.  We pray that she will see Jesus in the actions of the people here.  We know that she will hear His story from the films that play each day and from the spiritual counselors.   Please pray along with us.

 Tomorrow... she starts to learn how to read.

Read more here later-
DD&G

Marching on...

Well March is here!  How have 2 weeks past since our last post?  Things have been busy here and we continue to enjoy our time in Mali.

Last week Dean participated in village outreach with a group of hospital staff and a short term medical team from Omaha, NE.

Dianna and Gracie stayed in Koutiala since the village trips were all day affairs and "napping" options were limited.  At the hospital we continue to see interesting cases.

I think we've mentioned our burn patient before...a ten year old girl who fell into the cooking fire.  She has been in the hospital for a couple of weeks.  She has done better than we anticipated -- her face, chest and left hand are healing very well and will not require grafting.  Her right hand and arm were burned more severely and still require frequent wound care -- she will need grafting to that area.

Watching this silent, scared little girl heal has been a joy.  Today she smiled while posing for a picture.  What a gem she is.  We pray that she will understand the message of the videos played in the waiting area at the hospital, that her heart will open to He who also bears scars on His hands, scars that give life and hope.

Malnutrition is prevalent here.  The hospital has plumpy nut (a high calorie, high protein, ready to eat food supplement) which is given to children with severe malnutrition.  This little girl needed hospital admission for severe malnutrition and anemia.  One morning she was crying and her mom had stepped out of the room, so I comforted her while we waited for her mom to return.  I don't know many Bambara or French phrases, but thankfully a smile and soothing touch are understood by all.



Last week a young boy came in complaining of belly pain and swelling.  Family reported that he had a bike accident -- he fell forward on the handlebars (we envision the front wheel turn sideways and the round end of the handle stuck straight into his upper abdomen just below his ribs).  On exam we could still make out the handlebar mark over his epigastrum (stomach area).  On ultrasound we found a 8x12 cm cystic mass just to the left of his liver.  After observing him, reading up on blunt trauma to the belly, and long discussion between the physicians here, we suspected pancreatic trauma with psuedocyst formation and took him to the OR for evacuation of the fluid/debris and drain placement.  Dean scrubbed in on the surgery along with Dan (the OB-Gyn who is here full time).  The boy tolerated the surgery well -- about 400mL of fluid and clot came out at surgery and he continues to drain fluid from the drain.  Thankfully the drain output decreases daily.  A feeding tube was placed during surgery -- it goes from his stomach to his small intestine -- this allows the food to bypass his pancreas.  Here is a picture of him with the tube feeding system.



This little boy (below) came in for routine immunizations but his skin caught our eye.  We think it is neurofibromatosis type 1 (his mom says he dad's skin looks similar) -- also can be called "cafe au lait" spots.  As you can tell by his smile he was a happy fella, spots and all!



Outside of the hospital, we have enjoyed getting to know the folks here who work in the hospital and at the mission.  The pool on the mission compound is very nice and has brought lots of laughs and splashes out of Miss Gracie!

Last night we had dinner at the home of a long-term missionary here (she's been in Mali over 20 years).  She is from Germany, so Dianna enjoyed conversing with her in German for a bit.

After dinner we tasted the fruit from a cashew tree.  The fruit is a mixture of sweet and tart (similar to kiwi).  In the picture you can see the fruit's red skin with yellowish flesh.  The green "bean" on the plate is the hull in which the cashew nut is found.  The nut has to be processed in a special way before eating, so we (yes, even Dean) passed on trying to dig the nut out of the hull.



Gracie found some dolls she really liked.  I think she is most intrigued by the dolls' hair.



A couple weekends ago, we had a Malian meal prepared at the home of Batima, the guest house worker.  His family made a traditional Malian wedding feast for us (our family along with several of the missionaries and several volunteers from Florida who spent a couple weeks here).  Dean gives a good description of the typical Malian festive meal (see below).  Gracie had fun playing with Batima's granddaughter.



Here's what Dean had to say about the village trips (pictures at the bottom):

A group from the hospital (as well as a group from Nebraska), took several trips to a nearby (1.5 hours away) village last week.  We had a clinic for women and children the first day and added men the second day.  Many of the people had similar complaints (that were not life-threatening) and they were happy to get vitamins and de-wormer (and to be entertained by the show that came to town).  But there were a few fairly sick people who we treated there or recommended that they come to the hospital.  On the third day there were a few children so ill that the team transported them back to the hospital.

After the clinic we ate a Malian meal (not a typical meal, but more of a meal for weddings or other celebrations).  This consists of rice or noodles in a large bowl with meat and a few vegetables on top.   The meat is sheep, goat, or beef and the organs are and the vegetables are cabbage and something like an eggplant.  You sit in a circle around the bowl with others of your gender and dig in!  No utensils.  You imagine a pie-shaped wedge in front of you and you try to eat from your area.  The meat is sometimes subtly batted toward the honored person(s) (guests) but if you wait long enough, someone will eat it.  I ate goat stomach for the first time.

The most exciting part was to watch the film and hear the preaching in the evening.  The videos were made in West Africa with West African “actors” and are in French.  Some of the people in the village speak French, but others only Bambara.  So, someone translated into Bambara via microphone.   Microphone and video were powered by generator - no electricity out there.  And so many stars in the sky!!  There has been outreach to the village but no clinics before.  There is no church, yet, but there are some Christians.  It is exciting to watch people hear and see the truth!!

We hope to post more regularly over the next week since the internet is back up and running at the guesthouse.  We shall see...

Marching on,
DD&G