Today I cried.

Today started out like every other day at the hospital. Priscilla and I woke up at 6am, got ready, and left for morning devotions at 6:45. After morning devotions, meetings, and rounds with Dr. Wegner, we headed to the “Emergency Room” where we were assigned to work all week. The day started out slowly, there were not very many new patients and no one was in or even near critical condition; mostly just recovery stuff, dehydration, or nausea. We were working with two Congolese nurses, Hird and Isabelle, as well as two American nurses—Sarah and Millie. Millie has been in Impfondo since March and has pretty much remade/taken over the Emergency Room. Many of the Congolese nurses actually know very little about health, most know only how to take vitals and how to give shots. Very few actually know when or why you should give fluids or a medication to a patient. So over the past few months Millie has been a superwoman to this hospital. She has organized, and saved the ER.

So today, since it was a slow day and the ER was well staffed, Millie left the ER for about 30 minutes to help with some more administration stuff. During that time Sarah taught Priscilla and I all about IVs. She taught us how they work, when we use them, how we use them, how to place one, how to flush liquids through them and much more. However, during this time that we were being taught, a small boy came to the hospital in critical condition. His vitals were taken and he was placed on a bed by one of the Congolese nurses and little was done after that. None of the American nurses were informed of the boy’s condition as he slipped from a fully conscious and crying state, to an unresponsive eyes-rolled-back comatose state (all in about 20 minutes). When we finished learning about IVs and went on rounds through the ER, we found the boy in a coma and all the other nurses in the office. He was hardly breathing, and we struggled to find a pulse. I was told to listen for the boy’s heartbeat with my stethoscope to make sure it was still beating.  It was still beating, but he was barely breathing. So while it was still beating I took over the breathing for him and used an air bag to pump air into his lungs while Priscilla ran to find a doctor. Sarah took his blood glucose (sugar) and found that it was around 15 (normal is about 70, anything below 50 is low). So Sarah shot a 50% dextrose (sugar) solution into his preexisting IV (from a hospital he had previously been at). No response. That is when Millie walked in.

Millie felt for a pulse and there was none. So she started CPR and I forced air into the boy’s lungs. Another Congolese nurse gave the boy epinephrine to increase/start the boy’s heart rate. Nothing happened. After a few more minutes or compressions, air, and fluids, everything stopped. The boy was not coming back, nothing more could be done.

This is the first death I have witnessed in the medical field. I was there, hands-on, and this poor young boy died. A doctor was never found, one was in surgery, one was busy, and the other wasn’t at the hospital at all. This child died because he was ignored.

Today I also learned that there is a significant cultural difference when it comes to how one cares for someone critically sick in Congo verse America. In the America, we are told to not think about the cost of medical attention, we are to think only of the sick individual’s well being. However, in Congo the Congolese nurses and the family of a patient must think for the patient at one small part of a family. At Pioneer Christian Hospital, when a patient needs a drug, a shot, a syringe, or anything, a family member of the patient must go to the pharmacy on the hospital ground and buy everything right then and there. If the patient needs it, you buy it. If you don’t have the money for it, you can get it, but the patient is not allowed to leave the hospital until his or her bills are paid for. The hospital ground literally turns into a campsite for the family until they pay their bills. There are cooking sites (fire-pits) and tents for the families to sleep in.

So sometimes an entire month’s salary is spent on the medical bills for a patient. It is hard, sad, but it is how things are. If one family member is sick, it hurts the entire family. For example, sometimes the family will decide to skip meals to save their loved one.

So culturally speaking, live is valued, but in the Congolese culture—where every cent is precious—death is sad but often easier on a family. So today when this boy died primarily because he was not treated by the Congolese nurses, it wasn’t because the nurses were lazy, it was because they knew it was very unlikely he was going to live and they wanted to save his family from the severe debt that providing seemingly unbeneficial treatment could cause. I see their reasoning now, but I’m still not sure I agree with it. Priscilla and I both were quite shocked after the death and cried a little, the other nurses did as well and were very supportive.

The rest of the day was kind of a blur. I took vitals, gave a man a shot, and helped with IVs. The rest of the night was pretty calm and we kind of just ate a lot and relaxed after a long and stressful day. Going to bed now, goodnight!