I’m sorry there’s nothing we can do

It’s strange to be in a position to say those words, but that’s exactly where we’ve ended up as missionaries to a remote, rural people group. It doesn’t feel good to say that, and it also doesn’t feel honest.
It’s prompted some reflection on what those words actually mean as I work through the guilt of saying it quite often.

On Tuesday we had a visitor from another of the Kovol villages, about a 2 hour hike away. In Kovol style, we hung out all morning (it was the morning of making mamuni), hours passing until there was zero activity for at least 10 minutes before bringing up the fact that they’d hiked over for a specific purpose.

Someone in their village was sick. There was a man who had been sick for a while and who had an immensely swollen stomach. His stomach was often swollen larger than a woman 9 months pregnant and they were really worried about him because he had a bad cough. Someone in the village had died in the last week from similar symptoms and they were afraid for him.

In our team meeting that evening we started thinking of what we could do. In just over a week our neighbours in the Pal tribe were due a helicopter flight and the schedule said the back flight was empty. Could we pull together a medevac to get the guy to hospital? Could we arrange it with the community in time? (they need to pay 1/4 of the flight costs and also be ready to support the guy in town as he gets treatment). Would the hospital treat him during the State of emergency (due to Covid). Are we even allowed to fly national passengers since the normal flight rules aren’t in operation (again Covid state of emergency).
We wound ourselves up in details, ifs and buts, unknowns and guesses – but there was no progress.

Finally, we decided that a medevac was not likely possible, but we’d investigate it with NTM aviation, and we needed to go see the man ASAP. We had been planning an overnight in the village next week anyway, so it seemed a good time to just bring it forward.

ASAP turned out to be Thursday as on Wednesday I had to hike with some guys to a mountain ridge where we could shout a message over to the other village. We’ve been warned multiple times to not turn up anywhere unannounced as people could well be away in their gardens. So we had to wait a day to send a message (the Kovol people yodel, it’s awesome!).

Next day then we’re hiking over prepared to stay the night. Upon arriving in the village the guy isn’t even there; he’s gone to his garden! We went over thinking he was urgently sick! That’s why we don’t arrange helicopter medevacs without assessing the patient ourselves!
So we hung out and showed off our pictures from making the mamuni, practising the verbs, making small talk etc etc.

Eventually the guy arrives and we can assess him. He’s not currently sick, vital signs were all good and he looked well. He does have something going on though. If he works too hard his stomach swells up, apparently pushing his spleen out so it can be seen under his skin. Along with this goes dizziness, shortness of breath and black stools sometimes with diarrhea.

Here is where we feel far, far out of our depth. Going on what we know we’re guessing maybe a side affect of repeated malaria infections has caused liver damage? Or maybe it’s internal bleeding? Or maybe it’s cancer?
We know enough to tell him that the black stool means blood is getting in somehow, and that’s bad. (Possibly very bad – but we don’t know!).

And here’s where we say “Sorry, there’s nothing we can do”.
On the one hand its absolutely true – we have no idea what it could be, how to diagnose it or how to treat it.
I feel bad though because technically there is something we can do, we can use our resources (money and helicopter) to get him to town. If we had those symptoms we’d have been flown out long ago.
There’s nothing we can do extends to much, much smaller things too. While there I saw a little girl with sores on her arms and legs the size of a 1p piece. They needed washing with soap and covering – but that’s not something we’re going to do.

We know that as soon as we start giving out or applying plasters (band aids) we’ll be inundated with requests. This week alone I’ve seen 4 people with oozing sores and boils that need covering (not to mention the many I’ve just not noticed).
I’m sorry, there’s nothing we can do.

It’s uncomfortable, it feels wrong.
On the other hand there are traditional ways sores can be covered. There are medicinal plants and bush band aids that can be made from materials here. If the little girl’s parents aren’t covering her sores when they could, should we step in to do it for them? Tough questions.

A mental breakthrough I made pondering all this was to imagine myself hearing those words. If I went to a hospital in the UK and heard the words “I’m sorry there’s nothing we can do” I’d probably accept it. As I thought some more I also realised that if a hospital told me “there’s nothing we can do” what they really mean is “while there might be something we could do, our hands are tied”. I’m sure if the hospital dropped every other case and focussed all their staff and budget on my case something could happen; but there are other patients to consider, other responsibilities to fulfil.

When we say “there’s nothing we can do” we mean it along those lines. Yes we could charter a helicopter flight to get this guy to town, but we can’t charter a helicopter flight for every person in Kovol when they get sick. We might have the resources for one, but we don’t have the resources for 1,000 and so we can’t open that door. (our policy is that the most we’ll do is redirect an existing helicopter flight that has empty space – this makes charging 1/4 of the cost to the community feasible).

We told the community in this case that the guy needs to go to the hospital. Our job we told them is to check our medical books to see if we can find something that would help him, if there is we’ll let him know. Their job is to decide as a community if they’ll send the guy to hospital or not – if they do they should let us know and we’ll see if there’s anyway we can support this community effort (a referral letter, calling the hospital, providing painkillers for the journey etc.).

One more crisis muddled through. In this case we don’t know the guy; it was the first time we’d seen him. We’re not looking forward to a crisis involving the people we’re growing to know and love.