The Tchadian sky stretches out expanding beyond what seems possible to give the effect of being in some circus mirror show where everything is distorted to become larger than life. It's a brilliant light clear blue sky except for one huge bank of stacked puffy white clouds on the horizon. We are escaping Bere and the hospital. Becky, our second redhead nurse leads the way down the small path away from the back of the compound. Nathan, our 6'7" student missionary, strides casually beside her. Wendi, the third redhead in the group walks behind me with Jennie, the second newly arrived volunteer nurse. Sarah, the first and final redhead, brings up the rear. The sun beats down fiercely as we enter the rice fields where the path disappears under water for long stretches at a time. The water is hot to our bare feet alternating between a fresh sandy and a sticky mud bottom. We occasionally pass locals on their way to or from who knows where carrying flip flops and wading purposefully through the water much as we are. Friendly "lapia's" are exchanged and repeated as befits local custom. Occasionally, a "lapia aye" or "lalay" will be thrown in for variety. Of course, Sarah has to always show off by actually carrying on brief conversations in Nangjere not just giving generic greetings. I found it's not really necessary as "lapia" repeated often back and forth seems to keep everyone content.
At the river finally we are surrounded as usual by half naked children with fishing spears or poles who are more than happy to leave what their doing to watch "nasara" swim. What could be more entertaining than watching weird looking strange white foreigners jumping, swimming, mud wrestling and tossing mud at them? Getting them to hum the tune of "Indiana Jones" is also a big hit.
Coming back the moon is reflecting perfectly off the still waters of the rice paddies as the sky is still pinked from the recently setting sun.
A few days later a baby comes in with a severe infection in her groin and legs and lower abdomen. Antibiotics help but then large black dead skin patches remain with yellow pus filled edges. They need to be debrided (taken off). I do. That afternoon Sarah comes to me to say she's unconscious. I come and find her recently dead. I desperately refuse to believe. She's pale. The bandages are red with blood. She's bled out and no one noticed. I do CPR furiously unable to let go and accept that I should have checked back on her several times before going home. I would've noticed. No one else did or seemed to be concerned about her at all. A waste. We have no post operative recovery room or any real post operative care. I see death all the time but this one gets to me. I should've checked more carefully to make sure all bleeding was stopped. Sarah is also devastated when I see her later. She feels it's her fault. I hug her and let her know it's not. I feel sick to my stomach.
Dimanche's sister comes in the next morning with abdominal pain. I first hear from the nurse that it's probably a urinary infection. I go to see her and I at first think it's appendicitis. She gives a good story and has peritoneal signs consistent with appendicitis. I decide I should do a pelvic exam first. Then I think it's probably an infection of the uterus or tubes. The pain has switched sides to the left. Then, her story changes too. I wish I had an ultrasound or other tests. I check a blood count which is normal. I put her on antibiotics and continue my work. I don't feel quite comfortable with the diagnosis. After work, the gang wants to go to the river. Right before leaving I decide to check on the patient again. She's worse. I look some stuff up in books and ask some more questions. I wish I had an ultrasound again. After reading I remember I should have checked to see if she was pregnant even if she hasn't missed a period. Matthieu comes in from home to do the test but says it probably won't work because it's not a morning urine sample. We do it anyway. The faintest of lines appears telling us it's positive. I feel relief. God has helped us come to the probable diagnosis even with our lack of equipment--ectopic pregnancy (out of the uterus). I know I need to operate but I'm always more nervous when it's a friend or a relative someone I work with everyday in this case. What if I'm wrong and I operate for nothing and something goes wrong? I'd operated a woman a few months ago who I'd thought had an ectopic pregancy and it turned out to be a simple pelvic infection treatable with antibiotics. Was I making the same mistake? I open up her belly in a low pelvic (Pfannensteil) incision and dark blood comes out of the abdomen. Sure enough there's a swollen mass in the left Eustachian tube. It was about to rupture. Despite some delays due to lack of equipment and my not having anyone to consult eventually with the help of books God led me to do the right thing in time to save her. What if I'd just gone to the river like I really wanted to? It's so hard to find that balance between doing what's right and needs to be done and not getting so overwhelmed and sucked in that you lose yourself and who you are in the incredible, never ending needs of a place like Béré.
Today, I'm finishing up lunch and look out the window at our guava trees. I see three kids staring up. There must be another kid up them again stealing our guavas. If they'd just ask I'd give it to them but kids here have no sense of right and wrong or respect for what belongs to others (like privacy for example). It's not their fault. They have no boundaries. They are outside naked and barefoot with other kids with no regular meals, often dependent on what they find in order to be able to eat. Then at night they can be out until 2-3 in the morning dancing and singing and pounding on drums without any set bedtime. I'm talking about 3 and 4 and 5 year olds as well as the pre-teens and teens. So they get the idea they shouldn't be doing something but not because it's wrong; because they might get beat if they're caught.
So I sneak out the front door to the edge of the house. The three kids are absorbed in whatever's happening in the branches above them. I start running. About 15 feet away they see me and start to run. I arrive at the tree and look up. Sure enough, a kid is caught there. She's about 8-9 years old dressed in a rag wrapped around her waist with bare feet and chest. I look at her with an expressionless face. Then I feel a shock course through me as she lets out a blood curdling yell that doesn't stop as her eyes go wild with fear and she's starts swaying on the branch while holding on tightly above her. I tell her to come down in a flat voice. I feel cut to the quick by her unreasonable fear. She starts to come down howls filling the air.
Other kids start gathering and laughing hysterically at her cries and fear and that she'll probably get the beating of her life now from the terrible "nasara." A couple adults who appear to be relatives approach. She comes down and when I reach to help her down she goes ballistic hanging onto the tree for all she's worth while her screams make my blood go cold. I pull her off the tree and let her down to the ground. She collapses and tries to wriggle away. I grab her wrist gently but firmly. She has wrapped herself around the legs of one of her relatives. Â I pull her free and if possible her cries intensify. I have a sick pit in my stomach half-loving and half-loathing the fear I cause in her. I explain to her relatives that this is our property and that taking stuff from someone else's property is called stealing. They agree. The surrounding kids continue to chortle gleefully at the young girl's distress.
The relatives start to yell viciously at the poor girl. I interrupt to continue trying to explain reasonably why she shouldn't be in our tree. I ask what they will do about it. The young man says they'll discipline her. I let her go as the giggles from the kids continue. The young man picks up a switch as she takes off. I turn away hoping that they won't beat her if I'm not there--that they would only do it because they think I want it and that when I leave they'll all just laugh but somehow I just think the whole situation was sick. If the kids would just ask for the guavas I'd give them to them. But their parents have never taught them how to behave so they have no clue. They learn from their fellow children and that is the basis for the society and social structure and attitudes that leads them later in life to prefer to let their kid die than pay $5 for a complete treatment.
I return home subdued--life is hard here in so many ways.
James
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