Two AM, and I am pulled toward consciousness by a muffled "1, 2, 3," followed by the rachety hum of the generator. An X-ray. I slide out of my sleeping bag and into the action of the makeshift living-room-turned-emergency-department.
This is the Jungle School of Medicine Kawthoolei at its finest. We may be in the middle of the jungle in the middle of the night, but we're certainly not at a loss. I say "we." I am here as an observer. I have come to see this remarkable thing - a school of medicine tucked into an obscure valley in Karen State, training medics to serve a people in desperate need of good medical care. This is good work. For a week, I've looked over shoulders and walked the rhythm of life here, and I am impressed with what I've seen. Then the plan was for my group to leave the school early this morning and hike all day to reach another village. Sometimes plans change.
The generator groans as the X-ray takes another image. Our patient is a stoic young man who I am told was shot in a hunting accident a few hours ago. He smiles, Mercutio-like, and says his Good Mornings. The wounds are small, but they promise to be enough. Bits of the bullet managed to pierce his abdomen and his chest cavity. He is in enormous abdominal pain, and he's starting to have trouble breathing. His X-ray shows a hemothorax. It's only a matter of time before he'll drown in his own blood. Unless we do something. So much for being an observer.
Dr. Mitch sends the nurse-midwife and me to the Inpatient Department so we can start antibiotics and set everything up for a chest tube insertion. My mind flashes back five years to when I was a nursing student and saw this procedure performed on a little girl. I try to remember details. What did they use? How did it work? I poke around in the mercifully well-labeled supply room and pull out bits and pieces - things Dr. Mitch mentioned or that occur to me as potentially useful: a pleuravac, chest tube and scalpel, sterile gloves, gauze and betadine, tegaderm. The other nurse and I put the pleuravac together like a piece of do-it-yourself furniture, reading the instructions (once we locate the bit in English) and following them step by step. Then we hook the thing up to a car battery that had been charged during the day by solar power. It works. Score.
Minutes later, we're all standing around the patient, as ready as we know how to be. We pray. We methodically talk through what we're about to do. And away we go. There I am, still in my pajamas, serving up the sterile field with lidocaine and instruments and suture. Headlamps focus on the operation site. A gush of blood issues from the pleural cavity as the scalpel does its work. Tubes, ties, suction, and soon the internal blood reservoir is draining into the pleuravac. Gauze and tape, and we're done. Placement confirmed, patient stable.
We don't have the facilities to address the man's acute abdomen, so we know we need to send him to a hospital at least a day's walk away. An extremely fit Free Burma Ranger team is available minutes later, ready and willing to carry the guy where he needs to go. We set up a small substitute drain connection with a one-way valve and send him on his way. It is probably the most miserable journey of his life, but he is alive to take it.
A week later, I find out that our patient is doing well. He made it to the hospital, they took care of him in ICU for a few days, and he is on the road to recovery. The doctors there are impressed with the care he got before he arrived. So am I.
It's amazing, really. Generator, solar power, X-ray, chest tube equipment, a medical team, a transport team - everything and everyone necessary to save this man's life, strategically placed in the outback of southeast Asia. And all of it is part of a bigger picture - a vision to multiply this ability through education. And that vision is part of something bigger yet - a mission to bring help, hope, and love to those who suffer here. The big stuff isn't just talk or wishful thinking; it is manifest in this man's story, and in the stories of so many others. I am giddy with praise for it. Truly, our God is great and is doing marvelous things.
