Thursday, November 5, 2015

Surviving a Medical Nightmare in Mozambique

Almost two decades ago Victor noticed a little girl at church who prayed in a way that was mature and profound beyond her years. He talked to her parents and told them that if she ever wanted to get into the ministry when she got older, he could help her go to Bible school.

I met Marta during her last year in Bible school when I first visited Mozambique in 2007.  A few months later she had graduated and joined the staff at the orphanage. Over the next few years I came to love Marta, and she has been a good and easy friend ever since. Marta loves God, loves people, is always smiling or laughing, and is kind and gentle with the kids. She serves them meals, leads Bible study, mentors the girls, serves in the church, and has an open house where any kid can hang out. In Mozambique it is a compliment to call someone “simple” because it means they are not complicated, high maintenance or needy. Marta is “simple” in all the best ways.

For years we had been praying for another couple on staff. It is valuable to have staff members who are in all stages of life since older and younger people have different things to offer the kids. Most of our staff are young people in their 20’s with great energy and enthusiasm, but not yet in a position to model how to interact in a marriage or as a parent or person who has weathered years of life experience. As we prayed for a couple, we imagined older people - but soon a young man came onto our staff who had also grown up in the same church and had known Marta since they were children.

Silmone and Marta were a perfect match. Silmone is patient, humble, gentle, kind, dedicated, responsible, and exceptionally trustworthy. Just like Marta, he is usually smiling and extremely pleasant to be around. Soon Marta and Silmone were married and living in a little round house about ten feet from ours in the middle of the orphanage. Every evening they would sit side by side in the front doorway of their house…smiling, relaxed, and watching the kids play soccer. Younger children would always come and sit with them and it made everyone feel safe and secure and “normal” and happy to have them there like that.

One day about two years before Marta was married, she experienced a pain in her stomach so agonizing that she collapsed onto the ground and had to be rushed to the hospital. Mozambique has some hard-working, dedicated, and intelligent doctors who have saved countless lives. But this country has an insane patient to doctor (or even nurse) ratio, and even the best private clinics (not to mention public hospitals) lack well-trained personnel, technology, critical equipment, and even the most basic things like soap, toilet paper, and latex gloves. Because of this, you often feel that entering a hospital is more dangerous to your health than whatever problem you have that might kill you.

At the hospital they suspected that Marta had an intestinal obstruction and needed surgery to clear the block. Needing a surgery with the current hospital conditions is terrifying, and there is often little hope that a person will survive. No matter how urgent the situation is, the hospital will not begin the operation until you bring a friend to donate blood, which is how they maintain any blood supply. Daniel, a young man on our staff who had grown up in the orphanage, rushed to the hospital and donated his blood so that they could operate on Marta in time. The whole orphanage prayed that she would not die in surgery. God answered the prayers of His children and Marta survived. But the surgery had been botched, and as she was traumatized and forced to return to the hospital again and again, the problem became worse and worse.

A few months later when Victor and I were in the U.S., Marta again collapsed to the ground in agonizing pain. A Brazilian missionary friend rushed her to the hospital. According to a Public Radio International article from April of this year, there are only about 20 practicing surgeons in Mozambique, which has a population of almost 26 million people. In order to be one of the people seen by a surgeon you will need to pay a huge bribe or have a strong and aggressive advocate with the hand of God on your side. Our Brazilian missionary friend advocated, and Marta got and survived a second surgery. This time the doctor told Marta that if this were to happen again they would not be able to fix it a third time, and she would die. They told her that she could never get pregnant because this issue would kill her if she did.

Two years ago Marta did get pregnant. Everyone was excited, but in the back of our minds we remembered what the doctor had warned. We all prayed that Marta would be able to have the baby without anything going wrong with this sensitive medical condition.

But when Marta was six months pregnant, our worst fears happened and she again collapsed in agonizing pain due to the same intestinal issue. She was rushed to the hospital and everyone prayed again.

At first the hospital acted like Marta’s situation was a hopeless case and there was no movement toward helping her. The hospital is overcrowded with people who all have emergencies, and no one will be seen unless someone takes extraordinary action. Most Mozambicans have grown up in a system where self-advocacy is not really possible, so sometimes the only people with the guts to demand what they need are people who have had experience outside the country. Because of all the opportunities Victor has had in the U.S., he is able to see things differently, and God has been able to use him to advocate for those we serve in our ministry. This was one of the best cases of that.

While Silmone and others tried to keep Marta alert and in good spirits, Victor walked through the halls of the hospital searching for a doctor. He heard that there was actually a surgeon from North Korea (yes, North) at the hospital. Victor knows a few Korean words because of family and friends from Korea. The surgeon was shocked and thrilled when he heard his own language come out of the mouth of a Mozambican, something that had never happened before. This started a friendship with the surgeon, and he agreed to operate on Marta, even though it wasn’t a case that would have been chosen. 

But there was one major problem - there was no anesthesiologist available, and by now it was late at night. Victor found people in the hospital who knew where the anesthesiologist lived, drove to his house, and knocked on the door. At first the exhausted anesthesiologist refused to come out, but finally Victor convinced him, and he got in the car and drove back to the hospital with Victor. But there were no anesthesia drugs in the hospital. The anesthesiologist gave Victor the name of the drugs needed. Victor drove around the city looking for any open pharmacy, but there were none of the needed drugs. He asked a technician in the hospital if there was any way to find the drugs in the city and was told that important and hard-to-get drugs are often hidden, locked away, and guarded by hospital staff, even in their own homes. He eventually located a person hiding the right drugs and convinced him to release what was needed for the surgery. Victor also located an OBGYN who he also convinced to be in on the operation in case there was any chance that the mother and baby could both survive. 

After Victor’s night of driving around and personally picking up the staff needed to perform the surgery and the drugs and medical supplies required for it to take place, it was finally time to operate. Everyone was prepared for the worst and mostly just focused on Marta’s life being saved. So we were all shocked and overjoyed when we found out that she AND the baby were both still alive after the surgery. The North Korean surgeon had saved Marta’s life by giving her a colostomy. 

In the hospital you have to bring food, water, blankets, soap, toilet paper, and sometimes even pain killers; and you have to make sure that your loved one is getting cared for or it may not happen. The nurses were neglecting Marta and refusing to change her colostomy bags or treat her. When the surgeon found out about it he started doing it himself and was checking on her every few hours, caring for her, and reporting concerns and progress to Silmone.

When Marta had recovered enough to return to her house in the orphanage she was still in pretty bad shape and struggled to get used to the colostomy. The surgeon came to the orphanage every other day and personally checked on her and cared for her. We were all blown away by the way he went so far above and beyond what he was called to do. The surgeon found out that our MAF missionary friend Jill had been giving our kids taekwondo lessons and wanted to see what they had learned. He did a taekwondo demonstration for the kids, and we were all impressed and intimidated by his intensity and strength! There are a lot of great details that we can’t share in a blog, but this surgeon was kind of like the Good Samaritan, to say the least.

When it was time for Marta to have the baby everyone was praying for another miracle, knowing how scary and fragile Marta’s health was. The North Korean surgeon and the Mozambican OBGYN and their team were prepared, and God protected Marta again as they helped her deliver a healthy baby boy through cesarean section, despite the complications of the colostomy. Everyone watched her care for her son while handling her medical condition with grace and courage. And Courage is the name Marta and Silmone gave to their new baby.

Initially the surgeon planned to reverse the colostomy six months after the delivery. But as time passed it appeared that a reversal would be too risky. On several occasions Marta has run out of bags and we have scrambled to find friends who could bring them from outside the country, just in time. The month long electricity crisis and water shortage during the floods at the beginning of the year were especially hard on Marta in her condition. Silmone has been the most amazing husband, father, and caregiver through it all and has set an incredible example to everyone who knows him. 

One day Silmone went to the hospital to talk to the surgeon and couldn’t find him. Silmone found another doctor from the same country and he told Silmone that the surgeon had been reassigned, was already gone, and would never be back. Silmone tried not to panic. We already knew that this surgeon was the only practicing doctor in our region who knew how to do this type of operation. He was also the only person who truly knew what was going on medically with Marta. There was no way to reach him, and there were no records telling what had happened or what had been done with Marta.

We started looking for a doctor who would take a case like this. We talked to medical people who told us that this was an extremely complicated situation, and even in the U.S. it would be hard to find a doctor who would attempt a colostomy reversal on a patient who had no medical records without first cutting in to see what was going on. Even then, many experienced surgeons would probably refuse to do this operation. But the idea that Marta would have to continue living with a colostomy in a place like Mozambique where you can never count on having consistent electricity, water, the right type of food, or control over how sanitary your living conditions are was unimaginable.

In South Africa you can get health care comparable to the U.S., and at a much lower cost. We started asking all our friends with connections to South Africa to help us find a doctor there who could look at Marta’s case. We planned to fundraise to send her to South Africa and pay for a surgery once we found a doctor who could look at her. But we could not find one doctor who we could go to. We kept praying that God would provide a doctor and funding to pay for the trip and medical costs.

This summer Victor was planning to do a youth conference in Malawi, and he asked Silmone and a friend who speaks Chichewa, the local language, to go there to set things up a few months in advance. They stayed with one of Victor’s old friends, Pastor Haswell. When Silmone told Pastor Haswell about Marta’s situation, Pastor Haswell told him that he had a relative who had had an operation like that at a hospital nearby and he would try to find him.

Malawi is a small country surrounded by Mozambique on three sides with friendly people facing the same challenges that Mozambicans face, in and out of the hospital. We never dreamed that we would find a solution to Marta’s condition in Malawi. But suddenly out of nowhere we had Pastor Haswell, who was able to track down the Malawian doctor and his team. He shared Marta’s story, and the doctors agreed to set a date to operate on her.

In August Marta, Silmone and Courage traveled to Malawi for the colostomy reversal. We discovered that a surgeon from Britain was traveling around Africa with a surgeon from Sudan, working with local African doctors in different places, and this was the team that would operate on Marta. They would do the surgery free of charge. The doctors did not know if they would be able to reverse the colostomy. Without medical records they were dependent on oral history from non-medical people, from Portuguese to English with no translator who could speak both languages. They would have to cut in and see what was going on and then determine if it would be safe to attempt a reversal or not.

We all waited and prayed that they would be able to perform the operation and that it would work. We knew from other medical professionals how dangerous the whole thing was and were preparing to trust God with whatever outcome He would give us.

The day of the big reversal operation finally came, and Marta was in surgery for many hours as everyone waited to hear what they would find and if they would even attempt to do it. Finally the doctor came out and gave the good news that they had found it would be possible and had performed a colostomy reversal. Everyone was overjoyed! It seemed the operation had been a success, but we would still have to wait to see if it would take. 

Pastor Haswell and his wife Josephine and their children graciously hosted Marta and her family for over two months during this time. After initially being released from the hospital there were many ups and downs, and Marta even had to return to the hospital for a second surgery.

Silmone, Pastor Haswell, Josephine, Marta, and Courage in Malawi.

As we waited to see if Marta would become stable and be released to return to Mozambique, we considered how we would get her and her family back home. To get from Nampula to Malawi is either extremely hard on the body (and mental health and emotions) or extremely expensive. If you don’t have a car that can handle a trip on unpredictable roads that could be broken, impassible, or covered by a river, you have to take the 9-15 hour train ride from hell, public transportation in overcrowded chapas (small passenger vans) with no shock absorption, and then ride on the back of a bike being peddled by a teenager half your weight up and down a mile’s worth of dusty hills before getting the next all-day chapa. Taking a commercial flight would cost over $500 per person and would drop you at an airport 336 kilometers away. Long distances in bumpy, crowded vehicles were not really an option for Marta at this point, as we didn’t want to damage the delicate operation she was freshly recovering from. 

We are good friends with the MAF families based in Nampula. MAF is Mission Aviation Fellowship - missionary pilots who fly in and out of the most remote locations on earth, transporting missionaries and health workers in and out of places that are difficult or impossible to reach by land, responding to emergencies, and doing tons of other stuff that would never happen without them. In 2009 an MAF pilot rescued us from Cuamba, where there was no doctor, when Victor got extremely ill with blood poisoning. We called MAF and they said they would be able to pick up Marta and Silmone in Malawi! The small MAF plane was able to land on a tiny runway near the hospital, where no commercial plane could ever go.

A few days ago Marta was given the all clear and released to return to Mozambique. The MAF plane picked up her family and flew them back to Nampula where the whole orphanage had been eagerly awaiting their return! 

At the airport in Malawi with MAF Pilot Dave LePoidevin. 
(That's the control tower behind them!)

Getting on the MAF plane.

Marta, Silmone and Courage on their way home.

Arriving at the Nampula airport.

I know I have not been able to convey the true drama, emotion, and miraculous works of God that we have witnessed through Marta and all the people God has used to get her through this. I just hope you can get a glimpse of the way God cares for His people in Mozambique where the challenges can sometimes look so insurmountable.

Thank you so much all who have kept Marta in your prayers. Please continue to pray for her and her family as they serve our children, church, and community. Marta and Silmone are such a blessing to us and we are so grateful for their strong faith, gentle presence and hard work. 

Thank you all who have cared for Marta and the rest of us through all of this. Thank you to the doctors and other medical staff in the hospitals in Nampula and Malawi. A special thank you to the surgeon from North Korea who worked tirelessly for the good of his patient with such dignity and honor in the midst of the most challenging conditions a surgeon could face. Thank you for your creativity and high quality of work in order to save two lives under the most dire circumstances. And to the doctors from Malawi, Sudan, and Britain who were willing to take a patient from another country, perform a surgery other doctors would not do, and see her through with proper care until the end. Thank you to Pastor Haswell and Josephine Banda and family for your great kindness and hospitality for such a long time. By serving this family you are serving all the children and families that they serve. And thank you to MAF in Nampula for providing us and so many others with such a tremendous service when no other way really exists. We are repeatedly amazed at the way God works and we are so thankful for being a part of all of this. 


Anonymous said...

Thank you all for allowing us to be part of your lives. This story touched my heart. We serve God who calls each star by name. How even more so he knows each one of us intimately. We truly do have a father in Heaven who adopted each one of us.

Janet Frasier said...

You expressed it quite well!! Thank you for sharing this remarkable story. It is eye-opening in so many ways. And miraculous how the aspects of your life came together to help Marta connect with that surgeon! Just amazing!! (Janet Frasier)

Corredores do Reino em Moçambique said...

Muito linda a história da Marta! Que o Senhor continue abençoando essa terra e esse povo com mais profissionais de saúde engajados e mais saúde!

Jen said...

Ohhh this is so beautiful! thanks for sharing, God is so good! Love you and your sweet family.. and "simple" is my favorite, too. Praying for you all!