Merci

Like I’ve said before, I’m not that good with names.  However, It’s the tough cases, the ones that die or the ones that come close to dying, that you remember better than the others.  And thus, you learn the individual’s name.

Merci first came to me in full blown labor.  She was well over 50 kg (over 110 pounds) at that point.  A typical story.  She had labored a long time at home.  Her baby was dead already.  Thankfully she was fully dilated.  

I brought her to the operating room for a forceps extraction of the baby.  I put in a foley catheter to empty her bladder and then applied the forcep blades on the head of her already dead baby.  Carlie, a nurse who has now been here several months, was new to africa at the time, but was helping us that particular evening.  I remember feeling bad for Carlie because it was a particular horrid delivery to get the fetus delivered.  Finally, however, I was able to deliver the baby.  

After her delivery, I attempted to move the foley a little, but it was not placed properly.  The balloon had been blown up in her urethra (causing her urethra to be dilated).  So after finding the right path of the urethra, I planned to leave the foley in for a week.  

Merci recovered after all of this.  We took her foley out, and she urinated normally.  Just to be sure her urethra was functioning normally, I instructed for her to come back in a week.  

She did not come back, however.  She lives about 30 km’s away, and road conditions were not optimal.

She went to a health center to look at her stitches I had put in.  She also had started to leak urine.  They weren’t familiar with different types of urinary leakage.  She was having trouble urinating because of her dilated urethra, so her bladder became full, and then would leak from time to time because of the fullness.  This is called overflow incontinence.  Since she was complaining of leaking urine, they referred her to the fistula hospital a long, long ways away.  She of course did not go.  

She stayed at home with her husband.  I’m not sure how it all started, but what eventually occurred was nothing short of neglect!  Maybe the urinary leakage caused the husband to think she was now worthless.  Maybe it would have happened anyways.    Maybe he is like other men who think because her baby died with the delivery, she is not a good woman.  Maybe her husband is just a selfish pig.  

Men always eat first here.  It’s polite.  It’s the culture.  Women and children eat last.  The children, who should get the best nutrition as they have the least defense, always get what’s leftover.  Always the non-nutritious rice, never the sauce that might have a little nutrition in it.  

But a urine smelling, dead-baby mama?  What does she deserve?  From the way the story panned out, he obviously thought she deserved nothing.  

After a while she just lay in her cold, dark hut....starving.  He refused to give her anything.  She may have felt a little sick and not wanted to eat at first, and this continued with him not feeding her.  Maybe she was depressed from losing her full term baby.  That would be normal.  But to leave her in a cold, dark hut with nothing to eat? Excuse me, but that is neglect! 

Almost 2 months later, her mother took her in.  She stayed with her mother for a week and then they came back to us.  

Merci!  She wasn’t even recognizable anymore.  She was only 33 kg (73 pounds)!  She had lost so much weight!  She was a starving skeleton.  I was sooooooo angry at them for letting her get like this.  She didn’t even speak a common language, so we had to get another patient to translate the whole story.  There’s nothing much to say, except it was neglect.  You get tired of getting angry over and over again here.  But this just makes you furious!  

Even more than the anger, were the thoughts like....”Was this my fault?”  “If I would have put in the foley correctly, maybe she wouldn’t have had overflow incontinence, and maybe her husband would have continued to love her without her smelling like urine.”  In reality, I know it was not my fault, but when I take on a patient...to do surgery or help with a delivery, they then become mine.  If they don’t recover, then it is my fault.  I want to help be in control of their recovery.  And now I want to beat her husband’s face in the dirt. 

How do we fight the war against hate?  The war against inequality?  It is so great here.  We cannot fight it with anger.  Not with violence.  We are all children of God.  Why can’t the men see here that women are also daughters of God?  Jesus loved each person equally.  He didn’t treat men better than women.  He healed women and men.  Why is there such a stark contrast with how women and men are treated here?  Even within the church?  Last year Tchad was ranked as the worst country in the WORLD for women to live.  It didn’t get that rank just by talking.  Women are treated BADLY here.  It’s okay to beat a woman here....so long as there is no blood.  It’s okay to withhold food from your wife or wives here.  Hey, the husband is the one that earned the money.  His wife is his possession, he can do with her as he pleases.  As a woman here, you cannot tell your husband (and probably any man) no if he wants to have sex.  Everything is permissible.  And, men usually have 2 or 4 wives here, so he can have sex every single night of the week or twice a night.  Everything is about pleasing the man here.  Never about pleasing a woman.  

So, to all of you who think that women’s rights are awful in the states...Please reconsider, and also be happy for what you have.  I have heard that women’s equality is big time talk for the upcoming elections.  I am still thankful to be an American citizen and have rights.  If I had to personally deal with these dumb laws and rules here, I’m certain I would be killed already... or I would be the president.  

Merci came back to us in her emaciated state.  She could not walk.  She could not eat.  She could barely speak.  She had awful diarrhea, and she was lying in it.  I thought for sure she was going to die within a few days.  She looked like a corpse that breathed and had a heartbeat.  

But she lived.  God showed us another miracle here.  We treated her for everything we could think of.  I left her foley in for a long time.  

Julie, our nutritionist from the states, immensely helped to save her life in those first few days.  She started out with a milk/sugar/oil mixture and gave it to her every 2 hours.  If we could only trust our nurses in the night to give it, Julie could have stayed at home and gotten some sleep.  But we don’t trust our nurses in the night, and thus, Julie came in several nights in a row to give Merci the much needed nutrient rich, yet gentle mixture every 2 hours.  

After several nights of this, we felt it was wiser to transfer Merci to Wendy’s Mother and Child Nutrition Place (still un-named).  Olen and I loaded Merci, her mother, and her first child, into the 4Runner and headed down to Bendele.  She still was unable to walk, and had to be propped up in the backseat by her mother.  The road was filled with huge craters of mud puddles.  Merci got a little car sick and vomited in the car.  It landed mostly in her lap.  Okay, maybe a little on Olen’s back.  But that was nothing compared to the diarrhea. 

Wendy's girls at Bendele nursed her back to heath, slowly by slowly.  Bronwyn, Athens, Carlie, and Wendy.  Day and night.  At one point she got an NG tube because she couldn’t eat or keep the food down.  Then they figured out that Merci liked bananas.  When she was strong enough to eat bananas, they would bribe her to eat the other nutritious mixtures by giving her bananas.  

She had to be hospitalized one more time with IV quinine for malaria.  Afterwards, we transferred her back to Wendy’s.  Slowly by slowly she started walking.  

Danae, Merci and Bronwyn

Finally, we took out her foley and she could urinate normally again.  

Last week she was discharged home.  Well, not home, home.  Not home to her husband.  Home to her mother’s home.  At least that is what they say.  She was over 40 kg (88 pounds).  There’s only so much you can do here.  You do what you can, and you ask your friends to pray.  

Please pray for Merci.  She’s been through so much and I pray that God will continue to make her stronger.  Pray that she comes back for follow up also.  

PS.  I am not a man-hater.  I love my husband, and I am so very greatful that he views me as an equal child of God.  I just loathe social injustice, to men, women, and children.