And this letter comes from Bangladesh. The crazy travel schedule continues….
I was met Sunday morning at the Dhaka international airport by Steve Kelley. They said they had come all the way to Dhaka to attend someone’s wedding the night before, but I know it was really because deep-down they were excited to see me and just couldn’t wait any longer. I can’t get them to admit that, but I truly know that has to be it. Delusion is such a comfortable state in which to live…. Still, I appreciated it – I don’t speak Bengali. Actually, it is amazing the number of languages I don’t speak. Sad, really.
We went to the Dhaka guesthouse from the airport and I tried to sleep a bit while Steve attended a business meeting with the engineering firm designing the new hospital. The last meeting with them had been disturbingly acrimonious but God stepped in this time. First of all, they wouldn’t see him until 11:00 but we had to leave for the airport at 11:30 to catch the plane to Cox’s Bazaar. That wasn’t enough time – so God delayed the plane’s departure until 2:30. Secondly, about 15 minutes into the meeting, there was a sudden change in attitude and they became very cooperative and helpful. Thanks be to God. We flew on a near empty plane (small to medium prop job and all ten of us passengers sitting in the back of the plane to balance the weight) for an hour and then drove north an hour up to the hospital in Malumghat.
It has been really good to be with Steve and Stephanie and their two children (Luke & Shannon) still on the field with them (the two older ones are students at University of Florida – Gainesville). They have been very welcoming and gracious. I enjoy Steve’s intellect, endless supply of stories and surgical skills.
It continues to amaze me at the volume of complex surgery that Steve does here. He, and his fifth-year PAACS resident John Tripura, do about 20 elective cases a week. Along with his many other responsibilities, that is enough to keep Steve very busy. He could do more of course and certainly the cases are here to be done, but one has to pace oneself differently in a marathon than one does in a sprint, something that some short-termers have trouble coming to grasp with. His oversight of the new hospital building project will make that work load worse and not better.
I was admittedly anxious about doing complex surgery again since it has been a while since I have done so regularly, but on the first case, Steve was kind enough to throw me into the deep end without a life vest. We have had some fascinating cases this week including two cases that were unique in my personal experience. One was a boy with imperforate anus. His rectum came to a blind pouch and had a colostomy placed shortly after birth. Normally, the dead-end pouches are not too deeply placed beneath the perineal skin but this one was actually a blind pouch ending in the abdominal cavity. I have not done one exactly like that (although I have done a reasonable number of the less complex procedures), but since I had to open the abdomen to revise the colostomy anyway (it had prolapsed – turned inside out), it was not difficult to free the rectal stump from the back of the bladder and bring it down. We reconstructed each layer and I was very pleased with the final result (and in my heart of hearts, thanked Dr. Alberto Pena for allowing me to observe him that time at Cincinnati Children’s Hospital). Unfortunately, many of these children don’t get great functional results because the rectum and surrounding tissues do not have normal innervations.
The next day, we had an 8 month old with massive swelling of his left buttock and entire leg down to the ankle. This is due to a congenital malformation of the lymphatic system and unfortunately, there is not a good answer to this, especially in this sort of rural culture where compression pumps, education and disability insurance are all lacking. We did an old almost abandoned procedure (the Charles procedure) where we harvested all the skin below the knee with a skin-graft machine (dermatome) and then all the skin and subcutaneous tissue is taken off right down to the muscle and muscle is skin-grafted directly. We only went from knee to foot at the present time but took off over 2 pounds of tissue (a lot for this little guy). He actually had a normal sized leg under there. That was another procedure that I haven’t done before (although the individual parts of it are certainly very familiar). I sure hope it heals satisfactorily but that is not a given because of the remaining lymphatic obstruction.
You see such advanced cancers here, too. One 37 year old woman we did Monday had a huge fungating cancer of the right breast. It was rotting and foul-smelling. The nodes in the axilla (arm-pit) were obviously full of cancer. We removed the breast and involved skin, but had to skin-graft the area of missing skin. You do the surgery in these cases not in hopes of cure, but for palliation – there are much better ways than to die with a rotting tumor on your chest, the smell of which makes you an outcast even from your own family. Chemotherapy is available here (unusually so, compared to Africa) but this is a bad tumor and it is not likely to respond well even if she can afford it. Wednesday, we also explored a 33 year old male for an unresectable stomach cancer (metastatic to nodes and much of the right lobe of the liver). All we could do for that extensive disease is to bypass the tumor so he could continue to eat until he meets his Maker. Chemotherapy is rarely efficacious for that tumor. I can only hope and pray that both will listen to and accept the Gospel while they are here.
There are even some routine cases – hernias, lots of skin grafts for burns and other injuries, placement and removal of orthopedic devices for fractures, fasciotomies for compartment syndrome and breast biopsies. There are well-trained orthopedic techs here so placement of pins, traction and simple reductions with casting are handled by them.
Thursday afternoon, I hopped on the back of Steve Kelley’s motorcycle and rode along with Luke Kelley (Steve’s son), John Tripura and the head of anesthesia off to the tribal lands in the hills. It gave me a view of Bangladesh that I hadn’t seen before. We had tea in the establishment of some patients of Steve’s and I met a young man who had been elephant stomped by a rogue bull a couple of years ago – he had nearly died but is now doing well with Steve’s help and God’s healing. He is the only known believer in that whole village. The tribal ministry is a passion of John’s and his tribe (the Tripuras), the third largest of the tribal peoples, is about 95% Christian. They have a real outreach to the other less-evangelized tribes.
Praise and Prayer Requests:
- Please pray for the wisdom I need here for the next two weeks.
- Pray for the work here – despite its age, it remains a spiritual battle on many fronts.
- Pray for Steve Kelley as he oversees the building of the hospital – there are so many steps still to go before the first spade is overturned. Pray for them as they plan on their furlough this summer.
- Two possible source of funding for PAACS have arisen in the past couple of days. Please pray for God’s desire to be done.
Yours, for the peoples of Africa – and Bangladesh,
Bruce for Micky and Sean