Tout le monde,
As I sit here finishing off my nutritious, delicious evening meal of Southwestern barbecue goulash with Paul I think back to one word to describe N'Djaména (besides Sodom, Gomorrah, Babylon, frustrating, filthy, dangerous, corrupt, etc) it's BUREAUCRATIC. (Actually the goulash is just corn, old rice and burnt lentils...hence the "Southwestern" flavor).
So I'm in N'Djaména. I'm waiting as usual. All I want is some fabric to have some extra surgical gowns and drapes made. I've come to the "Grand Marché" (Great Market) where one can buy everything from dried beans to pharmaceuticals to door locks to plastic pitchers to dried flowers for making "Jus d'Osais" to axes to radios to turbans to cloth to shoes to...I've come here to the fabric section and they've run off somewhere. A boy passes wearing the long flowing Muslim robes with a small bowl balanced perfectly on his head. I'm sitting with Bichara who has his legs crossed contemplating the passersby. He orders a glass of red tea from a turbaned vendor and then buys one for me as well. As I try to balance to glass in my hand without burning myself with the tea-heated-glass a pair of Arab women with brightly colored wraps and shawls pass by giggling in Arabic which Bichara translates as "So, Nasara [whitie], you drink tea, too?" Hee-hee-hee. Several Arabs across the street start the ritual washing for prayer. The prayer mats are rolled out and taking a small plastic pitcher they carefully wash first the hands and forearms then the face and lastly the feet and ankles moving them onto the mat when finished. All is done with a fluidity and grace that comes from doing this five times a day for the last who knows how many years. It is a communal event as an old man will be joined by a merchant who'll be joined by a passing youth. They will stand together facing east. They will bow together. They will pray together...shoulder by shoulder. Finally, the man comes back with the thick green cloth I've been looking for and we move on...
I'm just trying to make photocopies. The place said only 30 Francs per copie so I couldn't pass it up. I sit on thinly covered pole chairs...not comfortable. The generator has been fired up for me. I'm trying to copy 200 "Dossiers" or medical charts so we can document things at the hospital. That took forever yesterday with me finally coming back this morning only to find it still not done. I then gave them a Nangdjere (Béré's local language) song book so we can turn our church service into a local language speaking church rather than a foreign French/whitey church. I gave it to them at 8am and it's 10am and still not done. So I wait...at least they call me by name now...Oh, here comes Bonaparte...what's he doing here? He just seems to be everywhere. He's going to help us lay the foundation for the staff housing we'll be building in June with the help of a group from the states...he seems to show up everywhere...I greet him and continue waiting...
I'm in the bureau of the State Police. I came here yesterday to have a paper signed authorizing Paul to film us in Béré. It was already signed by two other offices. This is the last signature. I was told to come back at 0930AM today...then noon. It's now 2pm. The office is sparse with three desks. Behind one works the secretary, a wiry man with a little gray and purposeful movements who is always coming and going, bringing and taking papers...I'm not sure if he really does anything with them. It's hot but a little breeze comes in the doorway right where I'm sitting next to a large woman reading the Bible in French. She's in Genesis and says she's going to read through it all when I ask her if it's interesting what she's reading. The other desk has another large woman behind it reading some other book. I make small talk. They don't seem to mind their reading being interrupted. The man comes back and says he can't find my paper amongst the visa requests. I say that's because it's a request for authorization to film. He says "Oh that shouldn't have taken any time at all...I thought it was a visa request." He comes back in two minutes with the paper signed and puts the all important "cachet" on it and I'm outta there...
Ah yeah, the omnipotent "cachet" or rubber stamp. One cannot survive here in Tchad without it. I'm just beginning to discover it's secret powers. Paul and I went to register him with the National Security Office. He filled out a small form and we wait. Then the guy starts to ask me some questions. He seems suspicious. What is he doing here? Where will he stay? Who's responsible? Give me the address. I write down my name and the PO box of the hospital. He still has a scowl of disapproval on his face. Then, thinking quickly I reach for my secret weapon. To the untrained eye it is simply a piece of wood with some carved rubber pasted on the end. To the one who has wisdom...it is power. I place the rubber stamp in the ink and stamp it down forcefully on the paper in purple ink. The man's face lights up. He smiles approvingly and shows me a stack of similar papers all with a variety of stamped ink. He returns in 1.5 minutes with the document approved having placed his own stamp in Paul's passport...he is now legally in Tchad!
I go later to the Central Referral Hospital for the country. I'm dressed in cargo pants, a t-shirt and tennis with uncombed scraggly hair. I say I'm the Medical Director of the Béré Hospital...for some reason the guard says he doesn't believe me...where are my credentials. I start to panic. I don't have any. They've all believed me before because I'm white. I need to see the director of Women's Health there. Then, I remember my secret weapon. I pull out my "cachet" and present it reverently to the guard. He nods knowingly for me to enter. Once again, rescued by the power of the "cachet"!
It's so good to be back in Béré. The first day back I released 13 people from the hospital. They were all complaining about having no space and patients sleeping on the floor but there were patients who hadn't been seen in almost a week and had been ready to leave for several days. Saturday, I cleaned house some more. Unfortunately, the baby I'd operated on just before leaving for N'Djaména had died. The boy with the skull injury though was awake and eating. He won't see out of his right eye though and he has lid lag. I casted his tibia/fibula fracture and sent him to another hospital for an xray. Things were smoothing out...until the "Sunday of Pregnancies from Hell"...
I rounded and did clinic while Dr. Claver did a C-section. No big deal. Then about midday three women came in to labor at once. One was tiny with a huge baby that then didn't progress. I did a symphysiotomy so her pelvis would open up and she still took forever to deliver and required an episiotomie as well. Then the baby wasn't breathing and was floppy. We mouth to mouth suctioned with a tube and I took a bag-valve-mask and tried breathing. THe heartbeat was slow. Sarah was listening and air wasn't going in. I adjusted and finally air started going in. The baby was limp and blue. Then the heartbeat picked up. Then the baby opened it's eyes with a look like a deer in headlights and coughed a few times. Some of the ever-present onlookers murmered "its a miracle." I had to agree. The baby is still alive today. I then went and had supper and was talking with Sarah outside in the early evening when the "Gard" came to tell me about a woman who'd just arrived with the baby's arm sticking out. Things were looking up though because the baby kept waving it's hand to let us know he was still hanging in there! At 9pm I was called to see her. At 1030pm we'd finished mopping up the mess from the c-section and the woman was already in recovery with a healthy baby girl. I really prayed for that one though because first of all the baby just didn't want to come out of the uterus and secondly I nicked the uterine artery with a suture needle and it bled like stink. I just pressed on it with gauze and tried to calm my panic. I asked for a suture hoping my voice wouldn't crack and was able to control it without much blood loss. Whewwww...I then returned to see the last woman in labor who had also not progressed despite adequate contractions. The woman and baby were big, but the pelvis was small...time for another symphysiotomie. After the procedure she pushed twice and the baby was screaming almost before it hit the mattress and the cord was clamped. By then it was midnight and I didn't even want to deal with the woman who'd just come in with a retained placenta after a home delivery. Fortunately, I didn't have to since I didn't find out about it till the next day! Oh, yeah, today, the next day. I woman comes in by oxcart from one of the outlying health clinics for a breech presentation (butt first instead of head). Another C-section, which fortunately went smoothly with another screaming, healthy kid.
Today, the men from Lai came who'd offered to give us another estimate on a wall to enclose the hospital. The pigs just keep getting more numerous and fearless and the hospital is a zoo. I spoke with the Architect of the government project that we have partnered with as well as the engineer in charge of the implementation. They had planned to give us $60,000 for a wall but not until the second phase which would be at some unknown time after the first phase which will start in September and include a new operating block. I felt we couldn't wait and had seen a beautiful fence around the Catholic school here made of 3 feet of brick with a cement and rebar header imbedded with another 3 feet of heavy chain link fencing on top. It was strong, durable, funcitional and yet open and not prison or concentration-camp like since you could see through and know what was happening inside. And, most importantly it was much cheaper. So these 2 guys from Lai gave me an estimate today of $26,000. Still way too expensive but I think we can negotiate as the Catholic Sisters got a much better deal. I think if we had $18-20,000 we could enclose the hospital, keep out the animals and extra people, keep in the patients, start to really clean things up and provide a hospitable environment as well as move forward with other projects such as providing mattresses and mosquito nets. Without a wall those things just walk away. Then, the government has said they will use the $60,000 to build us a new hospital ward which we also desperately need. I think it could really work out for the best if we can somehow raise the money for the wall.
Your encouraging letters mean more than I can say to each personally. They keep me going knowing I'm not alone out here but that there are people all over the world praying for us here at the little lost hospital of Béré.
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