We are 10 km from Yaound�. We left Bere Friday morning. It is Tuesday noon. I'm exhausted...which may explain what happens next. We pull up to yet another military check point.
Sarah and I are in the back seat of a Toyota minibus modified to hold 20 passengers. That means we are crammed five across on barely padded benches with not nearly enough space for my knees to fit even if I sit up straight (which is impossible due to the low ceiling). I therefore have spent the last 8 hours with my knees and legs twisted into positions I had previously thought impossible for me. I'm thinking of quitting medicine and joining the circus as Flexible Man. Despite closing the windows, everyone is lightly dusted in fine red dust highlighting eyebrows and almost shaved heads in a rich earth tone.
Since entering southern Cameroun it seems we've been stopped every 15 minutes by the military. My hand reaches automatically for our passports velcroed safely in a side pants pocket. Sure enough, a soldier swaggers up with a lazy "bonjour" slipping out of his mouth as he asks for ID papers. I present them. He scans them quickly and hands them back. At least I have nothing to hide like the last time I came up from Yaound� when I had an expired visa. I twist around a little to relieve my numb right leg when another soldier sidles up and asks for our passports. I inform him politely that we've already been checked. He takes them, anyway. After a cursory glance, he asks for our yellow vaccination cards.
I hand him mine. Sarah has left hers in Bere. I explain that it's not needed except at international borders and we've already been checked. He says that this is the border of Yaound� so we need them. This is an old Camerounian trick I've seen before. They want money to let us pass. He saunters off with our passports across the road to his buddies sitting under a tree. I am livid and so tired my normally weak inhibitions are completely obliterated. I shove open the window, crawl out, and march angrily across the street. We are in the middle of nowhere and they all have guns and are wearing military fatigues. What I do next isn't well thought out.
I storm up to the one holding the passports and start yelling at him in French explaining why it's so stupid and unnecessary to be always bothering people and trying to extort money. One of them says that I should start by greeting them or saying "bonjour". I snap out a sarcastic "bonjooouuuur" and continue my tirade. Pastor Job and the guys from the North Cameroun Mission who've been traveling with us come up and intervene. Miraculously, they let us go without any more fuss. I am wasted now not only physically but emotionally. As I crawl back into the minivan I start to have brief flashbacks of events on this trip up to this point.
Sarah, Nellie, and I are sitting on a sandy beach by the Chari River. This is the border between Bongor, Chad and Yagoua, Cameroun. There is no bridge. There are 10 or so dugout canoes pulled up on the beach with some Chadians idling around waiting to transport customers. They offered to take us across for 1000 francs each. We refuse. To cross the river in Lai--which is twice as far across--costs 250 francs. We take our backpacks off, set them on the sand and sit down to chat. It is noon. We know we need to cross but we don't want to be just give in to their exploitation of foreigners. We periodically bargain with them till the price comes down to 500 francs per person.
Sarah is hard core and says "no." We continue to sit looking at the invitingly cool water rippling past as we swelter in the midday sun. Sarah suggests swimming to amuse ourselves. Then it hits me!
"Why don't you two swim across and I'll take the bags, pay the 500 francs, and transport them across?"
They like it and start taking off their shoes and walking towards the water.
The unexpected happens! The Chadian we'd been bargaining with gets a frightened look on his face and yells not to cross that he'll take us for 250 francs each! Sarah replies that they really want to swim but he's adamant saying the current is strong, there are hippos, you are girls who don't know how to swim, etc.
Slowly it dawns on me, in Chadian culture, if something happened to one of the girls crossing, they would be responsible and they couldn't live with that. They were suddenly obliged to take us across, even if for free! We pay up and cross, feeling the cool water refresh us temporarily as we drag our hands the few hundred meters to the opposite bank.
Immediately, guys on motorcycles pull up yelling for our business. It is 7 km to Yagoua and I've been told the price for a "clando-man" is 500 francs. I waltz up to the first one and say, "Yagoua, cinq-cent francs". He agrees but then his boss runs up and says "750 francs." He refuses to give in. Sarah, as tough as ever, says "Well, we'll just walk then", grabs her backpack and starts around the corner to the immigration "office".
The "office" is in an old, abandoned carcass of a steel motor home with rickety wooden steps. Out back is a shelter made of sticks stuck in the ground with woven straw mats laid on top to provide shade.
"Al-salaam alekum," I greet as I duck into the door at the top of the stairs.
"Wa alekum al-salaam" is the reply of the camo-wearing immigration officer. I present our three passports and he signs them quickly with plenty of rubber stamps making our passports very "official" looking.
Meanwhile, Sarah has been reasoning with the "clando-men" who've followed us. They argue that gas prices have gone up (an old excuse, nothing new here). Sarah just picks up her pack and takes a few steps down the road before they laughingly call out after her "�a va, 500 francs". Sarah's a very tough customer.
The wind whips into my face, stinging my eyes and causing tears to leave a streak back across my cheeks. It's nice and cool and free-feeling to be bouncing up and down on the sandy roads riding casually on the back of the "moto". We pull quickly into town and board the first of many buses.
Several hours, much reading, quite a few frozen yogurt baggies, and we are nearing Maroua. The man next to me heard me speaking English to Sarah and asked me where we were going in broken English. I told him the Koza Adventist Hospital. It is nearing sundown, Friday evening and we hope against hope to make the last bus to Mokolo where we can catch more "motos" to Koza. He suggests getting of the bus before Maroua as the road to Mokolo shoots off there. He says we may get lucky and catch a bus there.
Suddenly, after miles of no crossroads, a road veers off to the left. My friend points. We look for a bus and see nothing until we are past the turn off when we see a tiny minivan. He motions something to me. I don't understand. He yells and the bus screeches to a halt on the side of the road. We explain and the driver grudgingly sends his assistant to the top of the bus to take our luggage down. Meanwhile, I've sent Sarah back the 100 meters to the crossroads to make sure they don't leave.
We snag our bags off the asphalt as the bus scurries away and run awkwardly back to Sarah with our backpacks swaying back and forth. They have plenty of room and leave 30 seconds after we are on board! Nous avons la chance!
Sarah and Nellie are crammed in the back next to a Camerounian girl with an MP3 player! All the people on the bus are constantly checking their cell phones and commenting on whether or not the network is present! All the while, we pass small mud brick huts, herds of goats, and kids dressed in rags waving cheerfully as we chug by spewing out rich, black diesel smoke from our tailpipe.
Shortly after dark, we enter a darkly lit, smoky little town called Mokolo. The streets are rocky and steep, built on the side of a mountain shooting out of the surrounding desert. Small shops selling a little bit of everything are harshly lit with bare fluorescent bulbs. The bus stops on the steep part of a hill and once again we are surrounded by the "clando-men".
One of them says "Docteur, we haven't seen you in a while but we've been waiting for you." Since I've never been there before I can only assume they are confusing my army style buzzed blond hair, lanky frame, and clean-shaven face for Dr. Greg Shank's thick, dark curly hair, broad shoulders, and black goateed face. After all, according to them, all white people look the same (every time we watch a movie with the Chadians they think I am the main star...�a c'est toi, James, n'est-ce pas?).
The night is cool, the stars are out, the air is dry and dusty as only can be found in a desert night, and the road is windy, rocky, and steep. Once again I am hanging on the back of a small motorcycle and I have an hour to just let my weary, wandering thoughts focus on the simple beauty and joy of being in that moment...for an hour!
Arriving in Koza, I find Greg and Audrey in surgery. A young man was stabbed by his brother multiple times. He then showed up--after half an hour in a pushcart over mountain trails--with his intestines hanging out his side, one lung collapsed, and profusely bleeding wounds down to bone on his right arm and left posterior shoulder. When we get to the OR, Greg has the belly open, has sewn up the diaphragm and is controlling the bleeding on his liver wound. A blood transfusion is up and running and I ask how I can help. I change into scrubs, put on sterile gloves, and start cleaning out and suturing his shoulder and arm wounds. A piece of skin the size of a small plate has been sliced back off his arm and has rolled up into a scrunchy little mess at the medial border of the wound. I slowly stretch it back out and over the wound after washing out and closing the muscles. I leave the lower part open to drain and an hour later we both unscrub with the boy still alive. He has a urinary catheter sticking out of his chest (improvised by Greg since no chest tubes were available), a massive bandage on his abdomen and side, and two loosely wrapped dressings on his arm and shoulder.
We all head home (except Greg who has a few rounds he wants to make) to a never-better-tasting supper of cold beans and rice. I sleep till the next afternoon when we catch the "motos" to Mokolo, the bus to Maroua and sleep that night at the Catholic mission before catching the 7 am bus to N'Gaoundere.
On that bus we meet up with Job and Wangkel from the Chad Mission and the 3 administrators from Northern Cameroun Mission. 4pm finds us in N'Gaoundere where we hit town for some fried egg sandwiches in a hole-in-the-wall place showing English League soccer and serving the best papaya drinks ever. 6pm and we are on the train for Yaounde.
I stretch out on the bunk and strip down to my shorts in anticipation of a nice long sleep overnight with the cool air rushing in as we descend on Yaounde. An hour and a half later we still haven't moved until a man tells us that the cargo train ahead of us has derailed and the train won't be leaving tonight. The president of N. Cam. Mission calls and arranges for us to sleep with the vice-president of the court of appeal! She's a strong Christian and opens up her house to us.
The next day, after avocado sandwiches, we head out to the market to search for French Christian music. The head of a local Christian radio station had come over that morning and takes us to a small boutique blaring loud Christian Nigerian praise from some huge old, speakers with the bass totally shot.
We are supposed to catch the noon bus for Yaound� but our host says not to worry as she knows the owner and has told him to wait for us as long as it takes. Here in Africa, it's all about who you know!
11 hours and two buses later we find ourselves in Bertoua. We pull off the main route, around a corner, and into a small, poorly-lit courtyard with several other buses. A guy comes running up yelling "Yaound�! Yaound�" and tells us to put our bags over on a bus right next to ours. It's a tiny mini-bus. We unload and quickly reload our packs. The first bus drives off and soon we look around to find the place empty except for us and a few other passengers. We've been abandoned.
I sit on a bench. Then I get hungry. I walk out with Sarah to the street. We sit on a crude wooden bench in front of a table covered with different feast-preparing items. In one corner is a pile of French bread. Scattered across the table are piles of avocados, old tin plates, a cup full of random silverware, a cardboard egg crate half full of brown eggs, and a spatula. Underneath and behind is a metal can with some coals in it and a frying pan sizzling over it with the fresh smell of "fried" wafting across the cool night air.
Sarah has just bought some freshly baked French baguettes from a bakery that happens to be just at the back of the bus stop and we order egg and avocado sandwiches. Nothing has ever hit the spot like those sandwiches. The smell of charcoal mixed with muddy, African street odor and the sounds of frying, scraping, shuffling, distant shouting and the occasional roaring of a passing diesel cannot be described, only experienced.
My belly full, I pry open the window of one of the abandoned buses, crawl through and stretch out on a seat until Sarah wakes me at 2:30 am to cram into the back of a tiny minibus and bounce around over unpaved, red-dust covered mountain roads until 10:00 the next morning when we find ourselves 10 km from Yaounde at the last of many police check points...
Friday, December 30, 2005
Sunday, November 27, 2005
Thanksgiving in Bere
Gobble gobble,
I am alone. The last Thursday in November and I am alone. Sarah left Tuesday to stay in an Arab village for a few days.
She made friends with a tiny Arab girl whose mother was hospitalized, pregnant, and with malaria. They are cattle herder nomads. Another member of their clan was diagnosed with AIDS and tuberculosis and had just finished his first two months of treatment in the hospital. He came in with draining tuberculous lymph nodes on his neck and was all skin and bones with no hair. Although a strong Muslim he insisted on joining us for "prayer" several evenings and was interested very much in the one true God who also loved him. So, Mahamat (as he is called), came to escort Sarah to his "village". I was to be without a wife for at least 3-4 days. She wasn't sure when she'd be back.
One of my biggest fears about being married was how I was going to sleep with someone else in the bed with me. About the only time in my life I'd ever shared a bed with someone was during family vacations when I was a child. My twin brother, David, and I had to often sleep in the same double bed and we spent most of the nights fighting for covers or sleeping fitfully in the cold. As a result, I was convinced I could never sleep well with someone else always wanting the blankets or kicking me or rolling over on me or pushing me to the edge of the bed. But, now I find that I have a hard time sleeping without Sarah there.
So I toss and turn all night and find myself awake and alone at 6:30 am on the last Thursday of November. The phone rings.
"Hallo"
"Oui, bonjour, c'est André, �a va?"
"Oui, �a va..."
"Vous allez f�ter ce soir?"
And it all comes back to me, today is Thanksgiving. André had also left me alone on Wednesday to take care of some money issues with the PASS project and for some reason calls me to ask me if we're celebrating this evening.
I'd forgotten. Now I feel even more alone as my family is so far away and one should be with one's family on Thanksgiving.
I go next door and ask Nellie and Rebecca if they would like to fix a dinner and invite the hospital staff to dine with us for Thanksgiving. They agree. We ask Salomon to buy three chickens and I go to the hospital.
It's André who's supposed to read the daily Bible chapter for staff worship. I take his place. At the end, as is our custom, we ask for prayer requests. I take the opportunity to thank God for Thanksgiving and to invite them all to have dinner with us at 5 pm. I say I'll talk more about it later, but they're all invited. As we discuss the cases from the evening, Thanksgiving slips my mind.
The day is thankfully slow. I had planned to do an open reduction and internal fixation of a mandible fracture but the girl never shows up. She had been hit with a stick in the jaw by her husband. By the time she went to the hospital in Lai, was referred to us, was sent by us to Kélo for an xray, returned the one day I was sick and so went to the traditional healer, came back with the xrays but not the patient, and finally returned...three weeks have passed. I hope she'll show up tomorrow.
Other than that, it's a routine day of rounds, clinic and minor procedures. I'm actually able to leave at 3 pm as scheduled. Nellie, Rebecca and I start to prepare Thanksgiving dinner.
I boil water and dump in half a can of mashed potato flakes...voila! an essential Thanksgiving dish! The gravy is made my Rebecca who unfortunately has no other oil but the local peanut brand...it tastes like peanut butter. We have a can and a half of green beans, a can of cranberry sauce, two cans of baked beans, Rebecca makes stuffing from Salomon's bread, Salomon boils the chickens in tomato sauce to be served over rice and we are set.
I set out the plastic chairs that came in the container out in the courtyard along with our two locally made couches. The sun is going down turning everything a glowing orange. Samedi is the first to arrive and the only one on time. Soon after Pierre and David show up. Then a cry arises from the street. I look up.
"Sarah! Sarah! Sarah!" The kids are screaming.
Next thing I know around the corner of the hospital comes a wild haired red head bouncing on a fine Arab stallion with dust on her face pierced by the widest smile imaginable. Behind her comes a robed and turbaned Arab on a donkey with a sheep tied behind his saddle. My joy is complete. I didn't expect her till tomorrow. As she swings down from the saddle I stride over to meet her and sweep her up in my arms. I can tell the trip has been good for her. She looks dirty but refreshed.
As the sun goes down most of the staff have arrived. Samedi and Anatole have been regaling us with stories from the hospital's past and all the missionaries of B�r� past. Degaulle insists on singing one of the only two songs he knows in English: "She'll be comin' 'round da mountain when she comes..." At least he thinks he's speaking English. I join in.
Everyone chows down and the food disappears fast. Even the team on duty breaks away for a few minutes to partake. The two Arabs accompanying Sarah (Mahamat and his father), also join in.
At the end, everyone goes around saying what they're thankful for. As usual, Degaulle flies off on a tangent and we all try to gently (and finally, roughly) to bring him back to the point. Anatole surprises me by being so thankful that God brought him to B�r� because his life has been saved and so much bettered by having been here. I am shocked as all he usually does is complain about things. Even Mahamat is thankful that his sickness brought him to B�r� where his "eyes were opened" and his body was cured. I, of course, am thankful that in the last year God found me a hot Danish nurse for a wife...even way out in Tchad.
Lazare says something bizarre, as usual, but says it with such enthusiasm and obvious joy that everyone bursts out in applause at the end. Finally, they all leave except Lona's two sons, Fambé and Henri, who spontaneously help bring in the two couches even though they are only 3 and 5 years old respectively.
While the generator is still on I show Sarah half of the best Thanksgiving movie ever, "Planes, Trains and Automobiles". Then the generator cuts off and we go back to our rooms in darkness.
All day I'd been trying to call my family to wish them a Happy Thanksgiving but the satellite phone wasn't connecting. Finally, late that night I get through just as they are finishing eating waiting for the apple pie to come out of the oven. Grandpa, Grandma, Aunt Jeannette, Mom, Dad, and Chelsey are all there. While I'm jealous of the apple pie and the family being together, I have to admit my Thanksgiving has been hard to beat!
I am alone. The last Thursday in November and I am alone. Sarah left Tuesday to stay in an Arab village for a few days.
She made friends with a tiny Arab girl whose mother was hospitalized, pregnant, and with malaria. They are cattle herder nomads. Another member of their clan was diagnosed with AIDS and tuberculosis and had just finished his first two months of treatment in the hospital. He came in with draining tuberculous lymph nodes on his neck and was all skin and bones with no hair. Although a strong Muslim he insisted on joining us for "prayer" several evenings and was interested very much in the one true God who also loved him. So, Mahamat (as he is called), came to escort Sarah to his "village". I was to be without a wife for at least 3-4 days. She wasn't sure when she'd be back.
One of my biggest fears about being married was how I was going to sleep with someone else in the bed with me. About the only time in my life I'd ever shared a bed with someone was during family vacations when I was a child. My twin brother, David, and I had to often sleep in the same double bed and we spent most of the nights fighting for covers or sleeping fitfully in the cold. As a result, I was convinced I could never sleep well with someone else always wanting the blankets or kicking me or rolling over on me or pushing me to the edge of the bed. But, now I find that I have a hard time sleeping without Sarah there.
So I toss and turn all night and find myself awake and alone at 6:30 am on the last Thursday of November. The phone rings.
"Hallo"
"Oui, bonjour, c'est André, �a va?"
"Oui, �a va..."
"Vous allez f�ter ce soir?"
And it all comes back to me, today is Thanksgiving. André had also left me alone on Wednesday to take care of some money issues with the PASS project and for some reason calls me to ask me if we're celebrating this evening.
I'd forgotten. Now I feel even more alone as my family is so far away and one should be with one's family on Thanksgiving.
I go next door and ask Nellie and Rebecca if they would like to fix a dinner and invite the hospital staff to dine with us for Thanksgiving. They agree. We ask Salomon to buy three chickens and I go to the hospital.
It's André who's supposed to read the daily Bible chapter for staff worship. I take his place. At the end, as is our custom, we ask for prayer requests. I take the opportunity to thank God for Thanksgiving and to invite them all to have dinner with us at 5 pm. I say I'll talk more about it later, but they're all invited. As we discuss the cases from the evening, Thanksgiving slips my mind.
The day is thankfully slow. I had planned to do an open reduction and internal fixation of a mandible fracture but the girl never shows up. She had been hit with a stick in the jaw by her husband. By the time she went to the hospital in Lai, was referred to us, was sent by us to Kélo for an xray, returned the one day I was sick and so went to the traditional healer, came back with the xrays but not the patient, and finally returned...three weeks have passed. I hope she'll show up tomorrow.
Other than that, it's a routine day of rounds, clinic and minor procedures. I'm actually able to leave at 3 pm as scheduled. Nellie, Rebecca and I start to prepare Thanksgiving dinner.
I boil water and dump in half a can of mashed potato flakes...voila! an essential Thanksgiving dish! The gravy is made my Rebecca who unfortunately has no other oil but the local peanut brand...it tastes like peanut butter. We have a can and a half of green beans, a can of cranberry sauce, two cans of baked beans, Rebecca makes stuffing from Salomon's bread, Salomon boils the chickens in tomato sauce to be served over rice and we are set.
I set out the plastic chairs that came in the container out in the courtyard along with our two locally made couches. The sun is going down turning everything a glowing orange. Samedi is the first to arrive and the only one on time. Soon after Pierre and David show up. Then a cry arises from the street. I look up.
"Sarah! Sarah! Sarah!" The kids are screaming.
Next thing I know around the corner of the hospital comes a wild haired red head bouncing on a fine Arab stallion with dust on her face pierced by the widest smile imaginable. Behind her comes a robed and turbaned Arab on a donkey with a sheep tied behind his saddle. My joy is complete. I didn't expect her till tomorrow. As she swings down from the saddle I stride over to meet her and sweep her up in my arms. I can tell the trip has been good for her. She looks dirty but refreshed.
As the sun goes down most of the staff have arrived. Samedi and Anatole have been regaling us with stories from the hospital's past and all the missionaries of B�r� past. Degaulle insists on singing one of the only two songs he knows in English: "She'll be comin' 'round da mountain when she comes..." At least he thinks he's speaking English. I join in.
Everyone chows down and the food disappears fast. Even the team on duty breaks away for a few minutes to partake. The two Arabs accompanying Sarah (Mahamat and his father), also join in.
At the end, everyone goes around saying what they're thankful for. As usual, Degaulle flies off on a tangent and we all try to gently (and finally, roughly) to bring him back to the point. Anatole surprises me by being so thankful that God brought him to B�r� because his life has been saved and so much bettered by having been here. I am shocked as all he usually does is complain about things. Even Mahamat is thankful that his sickness brought him to B�r� where his "eyes were opened" and his body was cured. I, of course, am thankful that in the last year God found me a hot Danish nurse for a wife...even way out in Tchad.
Lazare says something bizarre, as usual, but says it with such enthusiasm and obvious joy that everyone bursts out in applause at the end. Finally, they all leave except Lona's two sons, Fambé and Henri, who spontaneously help bring in the two couches even though they are only 3 and 5 years old respectively.
While the generator is still on I show Sarah half of the best Thanksgiving movie ever, "Planes, Trains and Automobiles". Then the generator cuts off and we go back to our rooms in darkness.
All day I'd been trying to call my family to wish them a Happy Thanksgiving but the satellite phone wasn't connecting. Finally, late that night I get through just as they are finishing eating waiting for the apple pie to come out of the oven. Grandpa, Grandma, Aunt Jeannette, Mom, Dad, and Chelsey are all there. While I'm jealous of the apple pie and the family being together, I have to admit my Thanksgiving has been hard to beat!
Thursday, November 17, 2005
N'Djamena police chase
It was during my first month in Chad. I was stuck in N'Djam�na, trying to get a long term visa without knowing French, without knowing which offices to go to, without knowing whose signatures and stamps to get (and in which order!), and especially without knowing my way around.....
.....For almost two weeks I have just waited. A pastor and his wife have taken me into their home, assuming that it would only be a few days before I can go out to B�r� hospital and finally start learning the languages and to work. But my tourist visa only lasts for one month. A government official has promised to help me, but then an important journey came up and he had to leave.
Concerning the language, I do wonder what in the world I was thinking (or rather, not thinking) in going to a place by myself, where I don't know the languages or anybody. But in His mercy, God has come to my rescue: The pastor and his wife are from Brazil and speak Portuguese. Not that I do, but it somewhat reminds me of Spanish that I learned a bit of while 6 months in Peru, two years earlier. So they speak Portuguese to me, and I answer in Spanish. And dread the day I will end up in B�r�, with only French, Arabic and the local dialect to choose from.
Each day I go with the pastor's wife to the school where she is teaching. I sit 5 hours in the nearby church and read and go back home with her afterwards. I go to bed early, and am woken up every morning at 4 am by the minaret nearby loudly praising Allah and inviting to Morning Prayer. I find it hard to want to praise anybody, brutally being wakened up like that at the only time of day when it's actually cool enough to get some rest!
At last the government official is back. He has something for me to do while still waiting for the visa: there's a clinic near the main market and the big mosque. There is a dentist, and I can go help him pull teeth. The first day the pastor's wife shows me which minivan to squeeze into, and where to get off. She explains to me how to get back, too. So instead of going with her in the mornings, I now go to the clinic. I bring my dictionary and spend most of the time trying to learn more French.
The dentist has a cup that the patients sip from in between his twisting and pulling their teeth. Blood runs off its sides, along with saliva and rotten stumps of teeth. I hardly believe my own eyes when the first patient is done and another quickly takes his place in the chair. And sips from the same cup, not noticing it's only half full (since it has not been changed out or even emptied or cleaned after the first patient.) I am so perplexed and lacking words (of course), I mostly just feel like pointing to the bloody, slimy cup and screaming!!
The dentist likes to talk. Especially about the terrible situation his country is in, with both tuberculosis and AIDS all over. While he talks, I come up with something to say. Somehow I get the words together and ask: "What would happen, if a patient with, for example, AIDS or tuberculosis comes in here, drinks from the cup and bleeds on it, and then right after that someone else comes in and drinks from the bloody cup again?" He answers right away that it would not be good. Next day he has bought a couple of new cups that once in a while get dipped in a bucket with soap water.
The government official arrives at the clinic to tell me he needs two pass port photos from me, and then the visa can be issued. Thrilled, I ask the dentist where to get photos taken. He explains which minivan to get on, and when I see a certain shop on my right hand, then to ask to be dropped off. I go to the big public bus stop, near the main mosque. I get in, and as usual we have to wait to go till the bus is full. Because of the heat, the side door is still open, and I sit right next to it to get most possible of a possible breeze. Someone has opened the back door to load stuff, when suddenly the driver jumps in behind the wheel and takes off! While pressing the horn and pushing the speeder he gets everyone to jump to the side and other vehicles to leave him space on the road. The back door is still open, and I hold on to the frame of the car to not fall out the open side door! "Geez", I think," that's so rare to see anyone here in a hurry!" I want to close the door, but the driver does not slow down over the uneven and bumpy road, so I can't let go of my grip. I get a feeling he's not just in a hurry. I look back and see a jeep filled with armed military in the back, trying hard to catch up with us!
Turning to the front window, I see how the driver takes a narrow street to the left. I'm sure the chase will soon be over, because the street is packed with people selling their vegetables, chickens or other goods at both sides of the street, and I can't believe the driver will run over someone on purpose. Well, he doesn't, but people have to jump for their lives! Women with heavy baskets on their heads throw everything to jump to security; others push people in front of them to not get run over. The driver turns another corner without looking to his sides, speeds up, and tries another little ally. I try to figure out how to fold my arms around my head, so when we do drive into another vehicle I won't break my neck! But we are all bouncing around inside the car and have to hold on to whatever is closest.
Finally the driver ends up in a big area with other minibuses, and before the bus has come to stop he's out and running towards a market set up of several tents. Everybody else gets out of the minibus as fast as possible and are soon scattered. I guess this ride was for free! But I find myself in this unknown market, surrounded by Arabic speaking businessmen and heavily veiled women that all look down and hurry in whatever direction they are headed. I look around. I don't even know the name of the place I was going, just to get off when I see a certain shop on the right. I have lost all sense of direction, and nobody understands anything I say. Not that I actually try to get the attention of the Arab men, who, in my experience, could easily misunderstand my "interest" in them.
I have looked around for a while. I see people get into smaller taxies, and I recognize a lady who was also in the minibus. I get in the same taxi. I don't even ask where we are going. After all, how can this turn out to be a greater adventure than the previous?
Sarah
.....For almost two weeks I have just waited. A pastor and his wife have taken me into their home, assuming that it would only be a few days before I can go out to B�r� hospital and finally start learning the languages and to work. But my tourist visa only lasts for one month. A government official has promised to help me, but then an important journey came up and he had to leave.
Concerning the language, I do wonder what in the world I was thinking (or rather, not thinking) in going to a place by myself, where I don't know the languages or anybody. But in His mercy, God has come to my rescue: The pastor and his wife are from Brazil and speak Portuguese. Not that I do, but it somewhat reminds me of Spanish that I learned a bit of while 6 months in Peru, two years earlier. So they speak Portuguese to me, and I answer in Spanish. And dread the day I will end up in B�r�, with only French, Arabic and the local dialect to choose from.
Each day I go with the pastor's wife to the school where she is teaching. I sit 5 hours in the nearby church and read and go back home with her afterwards. I go to bed early, and am woken up every morning at 4 am by the minaret nearby loudly praising Allah and inviting to Morning Prayer. I find it hard to want to praise anybody, brutally being wakened up like that at the only time of day when it's actually cool enough to get some rest!
At last the government official is back. He has something for me to do while still waiting for the visa: there's a clinic near the main market and the big mosque. There is a dentist, and I can go help him pull teeth. The first day the pastor's wife shows me which minivan to squeeze into, and where to get off. She explains to me how to get back, too. So instead of going with her in the mornings, I now go to the clinic. I bring my dictionary and spend most of the time trying to learn more French.
The dentist has a cup that the patients sip from in between his twisting and pulling their teeth. Blood runs off its sides, along with saliva and rotten stumps of teeth. I hardly believe my own eyes when the first patient is done and another quickly takes his place in the chair. And sips from the same cup, not noticing it's only half full (since it has not been changed out or even emptied or cleaned after the first patient.) I am so perplexed and lacking words (of course), I mostly just feel like pointing to the bloody, slimy cup and screaming!!
The dentist likes to talk. Especially about the terrible situation his country is in, with both tuberculosis and AIDS all over. While he talks, I come up with something to say. Somehow I get the words together and ask: "What would happen, if a patient with, for example, AIDS or tuberculosis comes in here, drinks from the cup and bleeds on it, and then right after that someone else comes in and drinks from the bloody cup again?" He answers right away that it would not be good. Next day he has bought a couple of new cups that once in a while get dipped in a bucket with soap water.
The government official arrives at the clinic to tell me he needs two pass port photos from me, and then the visa can be issued. Thrilled, I ask the dentist where to get photos taken. He explains which minivan to get on, and when I see a certain shop on my right hand, then to ask to be dropped off. I go to the big public bus stop, near the main mosque. I get in, and as usual we have to wait to go till the bus is full. Because of the heat, the side door is still open, and I sit right next to it to get most possible of a possible breeze. Someone has opened the back door to load stuff, when suddenly the driver jumps in behind the wheel and takes off! While pressing the horn and pushing the speeder he gets everyone to jump to the side and other vehicles to leave him space on the road. The back door is still open, and I hold on to the frame of the car to not fall out the open side door! "Geez", I think," that's so rare to see anyone here in a hurry!" I want to close the door, but the driver does not slow down over the uneven and bumpy road, so I can't let go of my grip. I get a feeling he's not just in a hurry. I look back and see a jeep filled with armed military in the back, trying hard to catch up with us!
Turning to the front window, I see how the driver takes a narrow street to the left. I'm sure the chase will soon be over, because the street is packed with people selling their vegetables, chickens or other goods at both sides of the street, and I can't believe the driver will run over someone on purpose. Well, he doesn't, but people have to jump for their lives! Women with heavy baskets on their heads throw everything to jump to security; others push people in front of them to not get run over. The driver turns another corner without looking to his sides, speeds up, and tries another little ally. I try to figure out how to fold my arms around my head, so when we do drive into another vehicle I won't break my neck! But we are all bouncing around inside the car and have to hold on to whatever is closest.
Finally the driver ends up in a big area with other minibuses, and before the bus has come to stop he's out and running towards a market set up of several tents. Everybody else gets out of the minibus as fast as possible and are soon scattered. I guess this ride was for free! But I find myself in this unknown market, surrounded by Arabic speaking businessmen and heavily veiled women that all look down and hurry in whatever direction they are headed. I look around. I don't even know the name of the place I was going, just to get off when I see a certain shop on the right. I have lost all sense of direction, and nobody understands anything I say. Not that I actually try to get the attention of the Arab men, who, in my experience, could easily misunderstand my "interest" in them.
I have looked around for a while. I see people get into smaller taxies, and I recognize a lady who was also in the minibus. I get in the same taxi. I don't even ask where we are going. After all, how can this turn out to be a greater adventure than the previous?
Sarah
Wednesday, November 2, 2005
Miscellaneous experiences...
Friends,
Random experiences:
1. The baby has one normal leg. He is two days old brought in by his arab nomad parents. The second leg is cut off halfway up the shin with something like a floppy foot with toes with no bones. Oh, he also doesn't have an anus which is why he was brought in. We take him to the OR, an IV started by Samedi sticking out from his good foot. Sarah administers the Ketamine anesthetic and the baby sleeps. I know I will have to do one of two things--one easy and the other hard. The most difficult will be to open his stomach, find his colon, cut a hole in it, attach it to his abdominal wall and let him poop out of there until his is old enough to try and create an anus for him. The easiest is what I try first. I heard about this a few weeks ago when I was with my surgeon friend, Greg Shank, at Koza Hospital in northern Cameroon. I grab a needle and a syringe and I poke it into his butt skin where his anus should be. I aspirate and fortunately, about 2cm in I hit meconium (baby's first poop). I leave the needle in to guide me and slice through his skin. I grab a clamp and dissect down until I pop into his rectum where black meconium and brown, stinky, regular poop pours out. I leave a piece of rubber catheter in and he wakes up to a new experience...defecation!
2. Angeline is well known at the hospital. She came in last year with osteomyelitis and ended up having to have the middle part of her left tibia taken out and her wound dressed with diluted Chlorox in order to get rid of the infection. Of course, that took months. We saw her grow up (and fatten up) before our eyes. She was always wary of us, though, and would often cry just seeing Sarah or I. Unfortunately, her bone never reformed and she was left with a floppy left lower leg that was left in a cast. When my orthopedic surgeon friend, Troy Dickson, was here we tried to contact her to come and have some sort of transplant procedure. We couldn't find her, however, so Troy told me what to do and left. Now she is before me.
Her leg is still floppy but the joints are also still moving normally and the fibula is intact. She is fat and healthy and yes looks at me with suspicion. I decide that her only chance of walking again is to do what Troy suggested and I've read about but never seen: a fibula transplant.
Sarah puts Angeline to sleep. Both legs have been scrubbed and now prepped with Betadine. My heart is in my throat. I know I'm in way over my head. I scrub and drape. I grab the scalpel and cut into the lateral side of her good leg and down to her fibula. I'd measured the defect on xray to be 7cm. I separated the middle part of the fibula from its attachments to the tibia and then with a tiny, Swiss Army Knike-like saw I cut out her tiny, chicken bone-like fibula. I put it in a dish of saline, close the defect in layers, staple her skin shut and cover it with a sterile dressing.
I go to the other side of the table and cut into her old scar and down to the two stubs of bone. I clean them up by munching on the ends of them with an instrument called a Rongeur, pull out some of the spongy bone from the knee end of the tibia, pull out the fibula and find it too short.
I split it in half and jam it into the two ends of tibia and surround the three fracture sites with pieces of spongy tibia. I close the fascia over the graft and staple the skin shut. I put on a dressing and a fiberglass cast with her leg in as close to normal position as I can guess without access to intraoperative x-ray.
I take off my gloves and gown, Angeline wakes up and my heart finally descends to its normal place in my chest. It was thanks to last year's SM, Jennie Norton, that her surgery is paid for but it will be only through supernatural intervention that it will actually heal and allow her to walk.
3. The baby has what sounds like asthma on listening with the stethescope, but as Dr. Ken points out, the baby's only one month old so it's probably bronchiolitis. In either case the only thing to do is treat with nebulized albuterol and oxygen. We have albuterol but no oxygen...wait, didn't we get one in the container? We search in our storehouse and find the oxygen extractor which we've never tried. Micky, the visiting ER nurse, is administering the neb. The lights are on because the sun has just gone down and our 2 hours of programmed electricity is just beginning so we find a transformer and plug in the O2 extractor. It works and the baby seems to be doing well on it as we watch its oxygen saturation rise (on the O2 sat machine given us 3 years ago by Erling Oksenholt the night I visited him in Oregon on the spur of the moment before going to Chad to visit for the second time on a trip that lasted only 2 days and didn't include a visit to B�r�). It started at 85% and is now up to 93-95%.
I'm called to see a 12-year-old boy with a swollen stomach and no stool or gas for a day. He needs a laparotomy. We go to the OR. His thin body is in contrast to his firm, bloated belly. Sarah finds an IV fast and gives him his Ketamine. I scrub and drape and quickly cut him open from sternum to pelvis around his belly button as his intestines pop out and spill across the abdomen. I don't see anything obvious at first but there are red patches all over the intestines with little darker areas. Something is weird. I think maybe Typhoid fever at first at the point of perforating.
Then, as I run the intestines I discover that part of it has twisted on itself. I untwist it and quickly the dark areas become normal covered except for those patches that look almost dead. I know I can't leave them.
I put on bowel clamps, clamp and cut through the mesentery on the bad looking section and once all the blood vessels are tied off I cut the dead intestine out and then suture the two cut ends back together in two layers of running sutures. I release the clamps, there is no leakage. I leave in a drain and close the fascia with sutures and the skin with staples.
I go back to check on the one month old. I see a dead bat in the trash can by the door. The nurses look up mischievously. The baby is stable but still wheezing. Apparently, a bat entered the room, hit the fan, and landed directly on the baby's face, dead as a doornail! The baby lives through the night and the next day and the next and goes home the third day.
The boy recovers normally and by the 5th day post op is eating, walking, pooping, and passing gas. He goes home, comes back 3 days later to have his staples out and looks fine.
4. The baby is one month old and has a circular wound around the back of its head. Over the course of the next few days of antibiotics and dressing changes the whole part of his scalp that is inside the circle comes off leaving his skull exposed in the center. We continue antibiotics, he nurses normally and to all other appearances is totally healthy. We do dressings with diluted Chlorox and his wound starts to turn beefy red. He is still hospitalized.
5. A 1 1/2-year-old comes in. She'd been seen by me in April 2004 when she was a few months old and had an abscess on her left arm incised. Apparently she did well and I never saw her again until today. Now she has a bone sticking out of her forearm. It is jagged and rotten. Her hand and arm move and function normally. A centimeter from the bone is another wound draining pus. The radius and ulna appear intact but there's this third bone sticking out. It seems her bone got infected last year but since she's so young and otherwise healthy a new bone formed pushing the infected part out until it came out the skin. Sarah gives her an IM shot of Ketamine and I grab the bone with a clamp and pull out a 3 cm long piece! That's it. She comes back two days later and the two wounds are all but closed and her hand and arm continue to function normally...
6. Today, a woman comes in with a change in bowel habits and a big hard mass right under her sternum that is pulsating. I can only think of very bad things that I couldn't do anything about like cancers and aneurysms and such. I say she should go to N'Djam�na. The husband says he doesn't have the money. I say maybe and x-ray would help, but our machine is down one week after our friends from Florida got it up and running. Finally, I say we can try and ultrasound but I don't think I'll be able to see much.
I pull out the portable, laptop-sized ultrasound just donated by GE and brought by the Florida team. It runs on batteries, so I can use it without the generator. I turn it on, put in her name and place the probe over the mass. To my pleasant surprise, it appears that it is in her liver and that it is either a cyst or an abscess. After looking in some books I am convinced that it is an amebic liver abscess so I hospitalize her and put her on Metronidazole. I will be able to check on her in a few days again and see if it's going down in size. If not I can use the ultrasound to help me put a needle in it! Technology comes to B�r�! Above all, I thank God that He made me think to use the ultrasound. Sometimes, I am so used to hopeless situations that it's hard to get used to having more options around now.
James
Random experiences:
1. The baby has one normal leg. He is two days old brought in by his arab nomad parents. The second leg is cut off halfway up the shin with something like a floppy foot with toes with no bones. Oh, he also doesn't have an anus which is why he was brought in. We take him to the OR, an IV started by Samedi sticking out from his good foot. Sarah administers the Ketamine anesthetic and the baby sleeps. I know I will have to do one of two things--one easy and the other hard. The most difficult will be to open his stomach, find his colon, cut a hole in it, attach it to his abdominal wall and let him poop out of there until his is old enough to try and create an anus for him. The easiest is what I try first. I heard about this a few weeks ago when I was with my surgeon friend, Greg Shank, at Koza Hospital in northern Cameroon. I grab a needle and a syringe and I poke it into his butt skin where his anus should be. I aspirate and fortunately, about 2cm in I hit meconium (baby's first poop). I leave the needle in to guide me and slice through his skin. I grab a clamp and dissect down until I pop into his rectum where black meconium and brown, stinky, regular poop pours out. I leave a piece of rubber catheter in and he wakes up to a new experience...defecation!
2. Angeline is well known at the hospital. She came in last year with osteomyelitis and ended up having to have the middle part of her left tibia taken out and her wound dressed with diluted Chlorox in order to get rid of the infection. Of course, that took months. We saw her grow up (and fatten up) before our eyes. She was always wary of us, though, and would often cry just seeing Sarah or I. Unfortunately, her bone never reformed and she was left with a floppy left lower leg that was left in a cast. When my orthopedic surgeon friend, Troy Dickson, was here we tried to contact her to come and have some sort of transplant procedure. We couldn't find her, however, so Troy told me what to do and left. Now she is before me.
Her leg is still floppy but the joints are also still moving normally and the fibula is intact. She is fat and healthy and yes looks at me with suspicion. I decide that her only chance of walking again is to do what Troy suggested and I've read about but never seen: a fibula transplant.
Sarah puts Angeline to sleep. Both legs have been scrubbed and now prepped with Betadine. My heart is in my throat. I know I'm in way over my head. I scrub and drape. I grab the scalpel and cut into the lateral side of her good leg and down to her fibula. I'd measured the defect on xray to be 7cm. I separated the middle part of the fibula from its attachments to the tibia and then with a tiny, Swiss Army Knike-like saw I cut out her tiny, chicken bone-like fibula. I put it in a dish of saline, close the defect in layers, staple her skin shut and cover it with a sterile dressing.
I go to the other side of the table and cut into her old scar and down to the two stubs of bone. I clean them up by munching on the ends of them with an instrument called a Rongeur, pull out some of the spongy bone from the knee end of the tibia, pull out the fibula and find it too short.
I split it in half and jam it into the two ends of tibia and surround the three fracture sites with pieces of spongy tibia. I close the fascia over the graft and staple the skin shut. I put on a dressing and a fiberglass cast with her leg in as close to normal position as I can guess without access to intraoperative x-ray.
I take off my gloves and gown, Angeline wakes up and my heart finally descends to its normal place in my chest. It was thanks to last year's SM, Jennie Norton, that her surgery is paid for but it will be only through supernatural intervention that it will actually heal and allow her to walk.
3. The baby has what sounds like asthma on listening with the stethescope, but as Dr. Ken points out, the baby's only one month old so it's probably bronchiolitis. In either case the only thing to do is treat with nebulized albuterol and oxygen. We have albuterol but no oxygen...wait, didn't we get one in the container? We search in our storehouse and find the oxygen extractor which we've never tried. Micky, the visiting ER nurse, is administering the neb. The lights are on because the sun has just gone down and our 2 hours of programmed electricity is just beginning so we find a transformer and plug in the O2 extractor. It works and the baby seems to be doing well on it as we watch its oxygen saturation rise (on the O2 sat machine given us 3 years ago by Erling Oksenholt the night I visited him in Oregon on the spur of the moment before going to Chad to visit for the second time on a trip that lasted only 2 days and didn't include a visit to B�r�). It started at 85% and is now up to 93-95%.
I'm called to see a 12-year-old boy with a swollen stomach and no stool or gas for a day. He needs a laparotomy. We go to the OR. His thin body is in contrast to his firm, bloated belly. Sarah finds an IV fast and gives him his Ketamine. I scrub and drape and quickly cut him open from sternum to pelvis around his belly button as his intestines pop out and spill across the abdomen. I don't see anything obvious at first but there are red patches all over the intestines with little darker areas. Something is weird. I think maybe Typhoid fever at first at the point of perforating.
Then, as I run the intestines I discover that part of it has twisted on itself. I untwist it and quickly the dark areas become normal covered except for those patches that look almost dead. I know I can't leave them.
I put on bowel clamps, clamp and cut through the mesentery on the bad looking section and once all the blood vessels are tied off I cut the dead intestine out and then suture the two cut ends back together in two layers of running sutures. I release the clamps, there is no leakage. I leave in a drain and close the fascia with sutures and the skin with staples.
I go back to check on the one month old. I see a dead bat in the trash can by the door. The nurses look up mischievously. The baby is stable but still wheezing. Apparently, a bat entered the room, hit the fan, and landed directly on the baby's face, dead as a doornail! The baby lives through the night and the next day and the next and goes home the third day.
The boy recovers normally and by the 5th day post op is eating, walking, pooping, and passing gas. He goes home, comes back 3 days later to have his staples out and looks fine.
4. The baby is one month old and has a circular wound around the back of its head. Over the course of the next few days of antibiotics and dressing changes the whole part of his scalp that is inside the circle comes off leaving his skull exposed in the center. We continue antibiotics, he nurses normally and to all other appearances is totally healthy. We do dressings with diluted Chlorox and his wound starts to turn beefy red. He is still hospitalized.
5. A 1 1/2-year-old comes in. She'd been seen by me in April 2004 when she was a few months old and had an abscess on her left arm incised. Apparently she did well and I never saw her again until today. Now she has a bone sticking out of her forearm. It is jagged and rotten. Her hand and arm move and function normally. A centimeter from the bone is another wound draining pus. The radius and ulna appear intact but there's this third bone sticking out. It seems her bone got infected last year but since she's so young and otherwise healthy a new bone formed pushing the infected part out until it came out the skin. Sarah gives her an IM shot of Ketamine and I grab the bone with a clamp and pull out a 3 cm long piece! That's it. She comes back two days later and the two wounds are all but closed and her hand and arm continue to function normally...
6. Today, a woman comes in with a change in bowel habits and a big hard mass right under her sternum that is pulsating. I can only think of very bad things that I couldn't do anything about like cancers and aneurysms and such. I say she should go to N'Djam�na. The husband says he doesn't have the money. I say maybe and x-ray would help, but our machine is down one week after our friends from Florida got it up and running. Finally, I say we can try and ultrasound but I don't think I'll be able to see much.
I pull out the portable, laptop-sized ultrasound just donated by GE and brought by the Florida team. It runs on batteries, so I can use it without the generator. I turn it on, put in her name and place the probe over the mass. To my pleasant surprise, it appears that it is in her liver and that it is either a cyst or an abscess. After looking in some books I am convinced that it is an amebic liver abscess so I hospitalize her and put her on Metronidazole. I will be able to check on her in a few days again and see if it's going down in size. If not I can use the ultrasound to help me put a needle in it! Technology comes to B�r�! Above all, I thank God that He made me think to use the ultrasound. Sometimes, I am so used to hopeless situations that it's hard to get used to having more options around now.
James
Monday, October 24, 2005
Frogs, Mud, and Barges
Hallo,
I step outside. The buzzing hits my ears. A million insects like microscopic cockroaches fall as if they were small kamikaze pilots trying to demolish the big toads hopping gingerly away from my feet. Unfortunately, they mostly hit my back and neck. I walk out into a foggy, full-moonlit night. The drums pound in the background. A chant wafts on the air softly numbing the senses like the unceasing pounding of the ocean on the shore.
My chest burns as my lungs suck in the hot, searing air. It is Saturday and everyone has left church on march to the river for a baptism. The young guys have taken up my challenge. I began to walk fast and they soon felt I couldn't keep it up. They said, aren't you taking the car. I said of course not. I haven't exercised in weeks. I change from my Arab robes into some long shorts and a plain white t-shirt with sandals.
We pass the mud puddle in front of the hospital's main gate. The ducks waddle off quacking and swaying as if drunk. We round the corner at a fast pace. I am surrounded by young guys ranging in age from 6 years to late teens. We pass through the remnants of a millet field which, like a ghost town, has just a few reminders of the past prosperity left standing. Past the night watchmen's hut and through a few more mud puddles we hit the main "road."
Red clay stretching off into the African plain surrounded by yellow tipped rice in paddies as far as the eye can see. A few boys fish with homemade sticks and twine in the standing water that houses the rice. The red road is pocked with massive mudholes and deep grooves from the large transporters. We are still keeping up a brisk pace and already I'm wishing I'd brought water as the sun bakes my head making even sweating to keep cool seem almost like spitting in the wind.
A small Peugot truck is stuck between a rice paddy and the road where it tried to skirt a mud puddle. The mud is over the tires and into the chassis. I call the boys over, take off my sandals and step into the muck as I begin to discuss a plan of action with the turbaned driver. The back of the truck is piled with four barrels of diesel and a ton of miscellaneous sacks and plastic containers. I call all the boys over as they pass.
We attach a rope to the back and some pull while others lift and push on the side facing the rice paddy. I look over and see a well dressed man hit some slick clay and fall on his back off the bike like a Three Stooges movie. He's ok but getting the truck out has been put on hold as everyone stops to have a belly rolling laugh as his expense. Soon, we are to follow as the rope breaks and our boys end up also on their butts.
We change strategies and unload all the bags, plastic containers, and one barrel. Then with coordinated heaves and ho's and many manly grunts, and with much soiling of clothes, the truck backs out of the hole and back on the "road." With many "Que Dieu vous guide" following us we take off again with mud between our toes.
I suddenly feel very energized and I take off running at a determined pace. The boys gladly fall in line bragging of how they'll run me off the road and how they could run all the way to Kelo if they had to. Unfortunately, I don't last long but end up having to slow to a fast walk which fortunately opens up the time to many questions. Most of them are to be baptized today and they pound me with questions about Sorcery and Ogres and stuff that is a part of their everyday lives and how that relates now to believing and serving one God. They are smart and with such stimulating and intelligent conversation we arrive quickly at the river where I dive in, barely missing the fishing net.
I baptize for the first time and couldn't imagine a better place or way: a muddy river, after pulling a truck out of the mud, in shorts and a plain t-shirt with guys I've just been running and having deep spiritual conversations with...it's my first time and I wouldn't trade it for anything.
The drums pound, the long metal cylinder is pounded and clanged, the rattles are in full roll, and the chanting brings each person into and out of the water where we wait waist deep. Laughs and swaying and dancing abounds. People drink water straight from the river from one plastic water bottle that one person has thought to bring. Pierre fetches the water, wading out with his shirt off showing off his ample gut rolling over his trousers.
It's probably one of the best days I've ever had...
James
I step outside. The buzzing hits my ears. A million insects like microscopic cockroaches fall as if they were small kamikaze pilots trying to demolish the big toads hopping gingerly away from my feet. Unfortunately, they mostly hit my back and neck. I walk out into a foggy, full-moonlit night. The drums pound in the background. A chant wafts on the air softly numbing the senses like the unceasing pounding of the ocean on the shore.
My chest burns as my lungs suck in the hot, searing air. It is Saturday and everyone has left church on march to the river for a baptism. The young guys have taken up my challenge. I began to walk fast and they soon felt I couldn't keep it up. They said, aren't you taking the car. I said of course not. I haven't exercised in weeks. I change from my Arab robes into some long shorts and a plain white t-shirt with sandals.
We pass the mud puddle in front of the hospital's main gate. The ducks waddle off quacking and swaying as if drunk. We round the corner at a fast pace. I am surrounded by young guys ranging in age from 6 years to late teens. We pass through the remnants of a millet field which, like a ghost town, has just a few reminders of the past prosperity left standing. Past the night watchmen's hut and through a few more mud puddles we hit the main "road."
Red clay stretching off into the African plain surrounded by yellow tipped rice in paddies as far as the eye can see. A few boys fish with homemade sticks and twine in the standing water that houses the rice. The red road is pocked with massive mudholes and deep grooves from the large transporters. We are still keeping up a brisk pace and already I'm wishing I'd brought water as the sun bakes my head making even sweating to keep cool seem almost like spitting in the wind.
A small Peugot truck is stuck between a rice paddy and the road where it tried to skirt a mud puddle. The mud is over the tires and into the chassis. I call the boys over, take off my sandals and step into the muck as I begin to discuss a plan of action with the turbaned driver. The back of the truck is piled with four barrels of diesel and a ton of miscellaneous sacks and plastic containers. I call all the boys over as they pass.
We attach a rope to the back and some pull while others lift and push on the side facing the rice paddy. I look over and see a well dressed man hit some slick clay and fall on his back off the bike like a Three Stooges movie. He's ok but getting the truck out has been put on hold as everyone stops to have a belly rolling laugh as his expense. Soon, we are to follow as the rope breaks and our boys end up also on their butts.
We change strategies and unload all the bags, plastic containers, and one barrel. Then with coordinated heaves and ho's and many manly grunts, and with much soiling of clothes, the truck backs out of the hole and back on the "road." With many "Que Dieu vous guide" following us we take off again with mud between our toes.
I suddenly feel very energized and I take off running at a determined pace. The boys gladly fall in line bragging of how they'll run me off the road and how they could run all the way to Kelo if they had to. Unfortunately, I don't last long but end up having to slow to a fast walk which fortunately opens up the time to many questions. Most of them are to be baptized today and they pound me with questions about Sorcery and Ogres and stuff that is a part of their everyday lives and how that relates now to believing and serving one God. They are smart and with such stimulating and intelligent conversation we arrive quickly at the river where I dive in, barely missing the fishing net.
I baptize for the first time and couldn't imagine a better place or way: a muddy river, after pulling a truck out of the mud, in shorts and a plain t-shirt with guys I've just been running and having deep spiritual conversations with...it's my first time and I wouldn't trade it for anything.
The drums pound, the long metal cylinder is pounded and clanged, the rattles are in full roll, and the chanting brings each person into and out of the water where we wait waist deep. Laughs and swaying and dancing abounds. People drink water straight from the river from one plastic water bottle that one person has thought to bring. Pierre fetches the water, wading out with his shirt off showing off his ample gut rolling over his trousers.
It's probably one of the best days I've ever had...
James
Friday, October 21, 2005
Border Crossings
Hello,
It wasn't as early as I expected and it lasted longer than I wanted.
Sarah and I jump into our pickup, a Toyota Hilux. The truck is typically Tchadian in that it looks much older than it actually is. Inside it may only be a little over two years old but you'd never guess it by the dents, scratches, cracked windshield, broken mirror, twisted bumper, bent tailgate, and grill literally hanging on by a thread (or wire).
My dad and two other "nasara" climb in the back and we pull out of TEAM with a rattle, squeak and roll complimented by a grinding at the level of the right front tire and a stuttering turn of the steering wheel.
Bumping along the dirt road we find the round-about and hit pavement which turns out to be about as jarring and filled with potholes as the dirt part. Turning left at the French Embassy we pass the typical N'Djam�na midday scene: Turbaned men struggling with overloaded pushcarts carrying anything from plastic jugs of water or fuel to 10 meter long metal poles to dirty arabic rugs going to the river to be cleaned; a horde of bicycles weaving in and out usually with something on the back whether another person or a bundle or a live goat tied up waiting its fate at the market; people walking anywhere and everywhere--mostly uniformed students, fatigue-wearing soldiers with guns, robed and turbaned Arabs, and ragged kids and common laborers; Muslim philosophers sitting under trees and outside shops trying to conserve energy during their Ramadan fast; women selling anything and everything from pineapples, watermelons, and bananas to cell phones and cigarettes.
I weave in and out of the myriad bicycles, motorcycles, pedestrians, yellow Peugeot taxis and pickups trying to avoid the potholes as well. With a sharp eye, a lack of road markings and police and a heavy hand on the horn I find myself on both sides of the road and sometimes "off road". I pass the US embassy and then one of only a few actual gas stations (the rest of the fuel is sold on the side of the road in various glass bottles). Next comes the Catholic school where I am slowed down temporarily by the glut of school kids with their light blue and maroon uniforms and all their various forms of transport causing a mild traffic jam.
I hit the Chagoua round-about with it's gas station, entry-only bridge across the Chari River, and its bread, fruit and boiled egg vendors. On the other side of the round-about is a small mini-bus stop and then a stretch of firewood vendors with their bundles of sticks brought down-river in wooden log canoes. We finally get to the main bridge and cross the rain-engorged river.
Descending to the other bank I see the police. My first reaction is to keep going but unfortunately one catches my eye and waves me over. I should've kept going.
The policeman sidles up with a mocking look on his face. I know what's going to happen. I rebel. I'm tired of being seen as a source of easy bribe money just because I have a white face.
"Why are you bothering us?" I ask him, "I know what's going on..."
He asks for the cars papers and of course finds out that we haven't paid some tax and haven't had our annual vehicle inspection. Maybe he's right, the chauffeur normally is supposed to take care of all that. But I see all kinds of vehicles passing us in obvious street-unworthiness that aren't pulled over because they prefer to get bribes from foreigners.
I argue some more using all the tricks I think I've learned only to realize that it's hopeless. He threatens to impound the vehicle. I know that even if he doesn't have the right to do that he can do it.
I try to get the car's registration back. I know that if he has the papers he will use that as more leverage to get more bribes. Finally, I ask how much of a "fine" I should pay. He says 6000 francs (about $12). Not nearly as much as I feared, maybe showing no fear did some good. I pay it and we continue on our way as I boil inside at the corruption here and the feelings of helplessness. Unfortunately, it's only the beginning of the bureaucracy.
I turn left and then instead of going straight down the road to B�r� I hang a quick right towards the Cameroun border. Here the typical N'Djam�na scene is repeated with the addition of many handicapped Tchadians in their motorized or hand-pedaled three-wheelers carrying sacks of sugar from Kousseri (Cameroun) to N'Djam�na. Each day they are allowed to bring in one sack duty-free which allows them to sell and make a profit and have a livelihood...of course, with a little "soap money" placed in the appropriate hands they can bring in more than one sack.
I approach the red and white striped heavy duty metal pole that serves as a customs gate. It is slowly raised in front of me and we pass underneath. I pull to the side of the road right before the single lane bridge across the Chari leading to Kousseri. As I step out of the air-conditioned interior I am blasted by the dry heat that defines life in N'Djam�na. The sweat forms almost instantly on my forehead and I can feel it already dripping down my back and legs.
I walk down the dusty slope to the small cluster of dirt yellow block buildings with the red, yellow and blue striped Tchadian flag in front and Emigration-Immigration printed in black over the door. There is the usual small crowd inside consisting mostly of merchants coming and going from Cameroun and Nigeria. There is also one "nasara". The room is dark and consists of a high counter on the right behind which stand three officials and on the left a single wooden bench. The back of the room has a partly open door leading into an even darker room with a desk piled high with papers and documents. The counter has some scattered forms, a circular metal ringed rubber stamp stand with its variety of well-worn wooden stamps and some stains and a few pens.
I have all the passports from our truck and I start to fill out the forms. Pastor Job comes in a few minutes later with the passports for the rest of the group who've just arrived. We are 17 in all. Job and I furiously fill out the forms but they want basically all the passport and visa info for each one. One of the officials, a woman, starts to help out but, since she doesn't read English, requires frequent translation help. Slowly, another official starts to hand copy all the information into a thick bloc-note book. The sweat has now drenched me. The air is suffocating. I see Mickey out the door talking with some other foreigners.
Finally, all is copied. The official calls in an Arab courier, puts all the passports in a paper folder and the courier walks out the door with our documents. I sit down to wait. Sarah walks in and we chit-chat. Time passes. Finally, the man comes back with the stamped passports. Now they need to be signed at yet another office. Job hands the officials 3000 francs "for their trouble." We exit and enter the office just to the right.
A Muslim man is lying down on a bench. He gets up when we walk in a sits down behind a desk. As he signs all the passports I fill out a tiny slip of paper with the trucks info that I am to hand to someone right before crossing the bridge. I take the signed passports and am about to leave when he looks at Job and says "Kikef?" which means literally "What's up?" in English but really means "What, no bribe?". Job hands him 1000 francs with which he is not to happy but Job walks out the door laughing and shaking his head. I follow.
I think we're done. Wrong again. Job leads us across a small ditch and into yet another office. Fortunately, it's one of Job's "acquaintances" and he signs all the stamps yet again and no money is necessary. Finally, we finish. Sarah and I jump into the truck and crank on the a/c. We wait in the line with the group of motorcycles, bicycles and pedestrians waiting to cross. Finally, when the green signal comes, we approach a little straw shack providing shade to some other officials who are in the process of interrogating the driver of another car. Sarah calls him over, gives him our little slip of paper and we move another 10 meters where we stop to pay the 1500 francs toll to cross the bridge. Another officer asks for our passports, leafs through them rapidly, and wants to know if we are with the mini-van that just passed with Pastor Job inside. We say yes, which is apparently the right thing to say as he waves us on.
We cross the narrow bridge and almost repeat the same process except that this time it's only one office and we don't have to wait for him to copy it all into his book, he just takes the info, stamps (and signs) the passports and we are at last, 2 1/2 hours later, inside Cameroun on our way to the National Park of Waza where after all that trouble we see 3 giraffes, 5 foxes, 10 gazelles, 3 antelopes and a bunch of birds...but hey, we only had one evening and one morning of safari...then, after a short detour to Mora to drop off some supplies for the Adventist Hospital of Koza, we return to the border for more laughs, kicks, and giggles...
James
It wasn't as early as I expected and it lasted longer than I wanted.
Sarah and I jump into our pickup, a Toyota Hilux. The truck is typically Tchadian in that it looks much older than it actually is. Inside it may only be a little over two years old but you'd never guess it by the dents, scratches, cracked windshield, broken mirror, twisted bumper, bent tailgate, and grill literally hanging on by a thread (or wire).
My dad and two other "nasara" climb in the back and we pull out of TEAM with a rattle, squeak and roll complimented by a grinding at the level of the right front tire and a stuttering turn of the steering wheel.
Bumping along the dirt road we find the round-about and hit pavement which turns out to be about as jarring and filled with potholes as the dirt part. Turning left at the French Embassy we pass the typical N'Djam�na midday scene: Turbaned men struggling with overloaded pushcarts carrying anything from plastic jugs of water or fuel to 10 meter long metal poles to dirty arabic rugs going to the river to be cleaned; a horde of bicycles weaving in and out usually with something on the back whether another person or a bundle or a live goat tied up waiting its fate at the market; people walking anywhere and everywhere--mostly uniformed students, fatigue-wearing soldiers with guns, robed and turbaned Arabs, and ragged kids and common laborers; Muslim philosophers sitting under trees and outside shops trying to conserve energy during their Ramadan fast; women selling anything and everything from pineapples, watermelons, and bananas to cell phones and cigarettes.
I weave in and out of the myriad bicycles, motorcycles, pedestrians, yellow Peugeot taxis and pickups trying to avoid the potholes as well. With a sharp eye, a lack of road markings and police and a heavy hand on the horn I find myself on both sides of the road and sometimes "off road". I pass the US embassy and then one of only a few actual gas stations (the rest of the fuel is sold on the side of the road in various glass bottles). Next comes the Catholic school where I am slowed down temporarily by the glut of school kids with their light blue and maroon uniforms and all their various forms of transport causing a mild traffic jam.
I hit the Chagoua round-about with it's gas station, entry-only bridge across the Chari River, and its bread, fruit and boiled egg vendors. On the other side of the round-about is a small mini-bus stop and then a stretch of firewood vendors with their bundles of sticks brought down-river in wooden log canoes. We finally get to the main bridge and cross the rain-engorged river.
Descending to the other bank I see the police. My first reaction is to keep going but unfortunately one catches my eye and waves me over. I should've kept going.
The policeman sidles up with a mocking look on his face. I know what's going to happen. I rebel. I'm tired of being seen as a source of easy bribe money just because I have a white face.
"Why are you bothering us?" I ask him, "I know what's going on..."
He asks for the cars papers and of course finds out that we haven't paid some tax and haven't had our annual vehicle inspection. Maybe he's right, the chauffeur normally is supposed to take care of all that. But I see all kinds of vehicles passing us in obvious street-unworthiness that aren't pulled over because they prefer to get bribes from foreigners.
I argue some more using all the tricks I think I've learned only to realize that it's hopeless. He threatens to impound the vehicle. I know that even if he doesn't have the right to do that he can do it.
I try to get the car's registration back. I know that if he has the papers he will use that as more leverage to get more bribes. Finally, I ask how much of a "fine" I should pay. He says 6000 francs (about $12). Not nearly as much as I feared, maybe showing no fear did some good. I pay it and we continue on our way as I boil inside at the corruption here and the feelings of helplessness. Unfortunately, it's only the beginning of the bureaucracy.
I turn left and then instead of going straight down the road to B�r� I hang a quick right towards the Cameroun border. Here the typical N'Djam�na scene is repeated with the addition of many handicapped Tchadians in their motorized or hand-pedaled three-wheelers carrying sacks of sugar from Kousseri (Cameroun) to N'Djam�na. Each day they are allowed to bring in one sack duty-free which allows them to sell and make a profit and have a livelihood...of course, with a little "soap money" placed in the appropriate hands they can bring in more than one sack.
I approach the red and white striped heavy duty metal pole that serves as a customs gate. It is slowly raised in front of me and we pass underneath. I pull to the side of the road right before the single lane bridge across the Chari leading to Kousseri. As I step out of the air-conditioned interior I am blasted by the dry heat that defines life in N'Djam�na. The sweat forms almost instantly on my forehead and I can feel it already dripping down my back and legs.
I walk down the dusty slope to the small cluster of dirt yellow block buildings with the red, yellow and blue striped Tchadian flag in front and Emigration-Immigration printed in black over the door. There is the usual small crowd inside consisting mostly of merchants coming and going from Cameroun and Nigeria. There is also one "nasara". The room is dark and consists of a high counter on the right behind which stand three officials and on the left a single wooden bench. The back of the room has a partly open door leading into an even darker room with a desk piled high with papers and documents. The counter has some scattered forms, a circular metal ringed rubber stamp stand with its variety of well-worn wooden stamps and some stains and a few pens.
I have all the passports from our truck and I start to fill out the forms. Pastor Job comes in a few minutes later with the passports for the rest of the group who've just arrived. We are 17 in all. Job and I furiously fill out the forms but they want basically all the passport and visa info for each one. One of the officials, a woman, starts to help out but, since she doesn't read English, requires frequent translation help. Slowly, another official starts to hand copy all the information into a thick bloc-note book. The sweat has now drenched me. The air is suffocating. I see Mickey out the door talking with some other foreigners.
Finally, all is copied. The official calls in an Arab courier, puts all the passports in a paper folder and the courier walks out the door with our documents. I sit down to wait. Sarah walks in and we chit-chat. Time passes. Finally, the man comes back with the stamped passports. Now they need to be signed at yet another office. Job hands the officials 3000 francs "for their trouble." We exit and enter the office just to the right.
A Muslim man is lying down on a bench. He gets up when we walk in a sits down behind a desk. As he signs all the passports I fill out a tiny slip of paper with the trucks info that I am to hand to someone right before crossing the bridge. I take the signed passports and am about to leave when he looks at Job and says "Kikef?" which means literally "What's up?" in English but really means "What, no bribe?". Job hands him 1000 francs with which he is not to happy but Job walks out the door laughing and shaking his head. I follow.
I think we're done. Wrong again. Job leads us across a small ditch and into yet another office. Fortunately, it's one of Job's "acquaintances" and he signs all the stamps yet again and no money is necessary. Finally, we finish. Sarah and I jump into the truck and crank on the a/c. We wait in the line with the group of motorcycles, bicycles and pedestrians waiting to cross. Finally, when the green signal comes, we approach a little straw shack providing shade to some other officials who are in the process of interrogating the driver of another car. Sarah calls him over, gives him our little slip of paper and we move another 10 meters where we stop to pay the 1500 francs toll to cross the bridge. Another officer asks for our passports, leafs through them rapidly, and wants to know if we are with the mini-van that just passed with Pastor Job inside. We say yes, which is apparently the right thing to say as he waves us on.
We cross the narrow bridge and almost repeat the same process except that this time it's only one office and we don't have to wait for him to copy it all into his book, he just takes the info, stamps (and signs) the passports and we are at last, 2 1/2 hours later, inside Cameroun on our way to the National Park of Waza where after all that trouble we see 3 giraffes, 5 foxes, 10 gazelles, 3 antelopes and a bunch of birds...but hey, we only had one evening and one morning of safari...then, after a short detour to Mora to drop off some supplies for the Adventist Hospital of Koza, we return to the border for more laughs, kicks, and giggles...
James
Thursday, October 20, 2005
An Africian Experience
A small group from Markham Woods Church went to Bere Adventist Hospital in Tchad a central African country. We know this country here in America as Chad. Our destination is a remote hospital. There were 14 of us going on this adventure. We were nurses, a doctor, a carpenter, construction contractors, accountant, computer engineer, and others. The primary purpose of our trip was to do maintenance on the buildings, deliver medical equipment and provide in-service training to the staff.
Sunday, September 11, 2005
Navigating the mind
I lie on the couch. My arms stick to my bare chest. My eyelids are so heavy I can't keep them open. Hens cluck outside, their chicks tweeting alongside. Andr� shouts something in Moundan, which sounds like Chinese badly spoken. In the distance, thunder threatens to disrupt the heavy heat that hangs in the air like a cobweb stretching desperately to ensnare its next victim. The taste of M & M's rests in my mouth like a sticky, sweet film of scum on top of a stagnant pool where mosquitoes breed ready to spread their deadly curse of malaria across our small village.
Thoughts flit through my head hoping not to be caught by anything that might make my consciousness stay awake.
I glide through the wards in my mind as in a misty cave lit dimly by torchlight. There to the left is a smiling face of a well-looking woman with a cast on her right leg. She smiles, holds out her hand and says, "lapia". Three small children play some game with a plastic bag at her bedside.
To the right, Lona leads me to the new arrival. An elderly woman betraying her age by her silver hair rather than by her skin and body lies stretched on her back. I examine her abdomen and write prescriptions in her little health record which is carved out of a school notebook and called a carnet.
I enter the next room barely noticing the cracked blue dingy paint and ceiling panels hanging like moss from an ancient cave. Under a white mosquito net sits the Business Manager of the Mayor's office. His knee wound has become infected post-op leaking out pasty remnants of his gout deposits like toothpaste gone really, really bad. I unwrap and change the dressing.
I proceed to the next mosquito net cocoon hiding not a butterfly but a man lucky to be alive, yet very much so despite lying in his own stool which is leaking out of a poorly done colostomy on his left abdominal wall. Five days ago I was intimately acquainted with his abdominal contents from midnight until 6:00 am as I first unwrapped, then removed his dead sigmoid colon which had twisted on itself in a bizarre act of suicide called a volvulus. He is eating, has no pain, wound is clean, drains removed yesterday and colostomy functioning despite being done wrong (as learned by post op reading on the subject).
I move to the outside door passing our tall, thin friend with a left leg that I was sure he would lose when he first arrived. His thigh wound is still rather large but beefy red with no swelling or signs of infection. Of course, after two months at home and only our pitiful attempts at physical therapy, he is a long ways from bending his knee normally. But he has his leg...
I walk under the porch and across a surprisingly clear walkway lacking the normal proliferation of mats and bright colored Arabic rugs. I enter the dungeon of pediatrics.
Darkness and the smell of urine and old pus assault my senses. The smells soon disappear in the amazing adaptability of the body and the darkness by simply opening the sheet metal shutters. A row of red beds stretches in what seems like infinity interrupted by a smattering of mosquito nets and tubing hanging haphazardly from a varied assortment of poles, sticks and protuberances. I feel I should have a treasure map in my hand, a hat on my head, a whip by my side and a wry smile playing about my lips if I intend to navigate well this ancient tomb.
I notice that the second bed to the left has a new child. The one who'd occupied that bed the previous five days sticks out in my mind. A tiny 8-month-old with the typical fever, diarrhea, vomiting and anemia was admitted, diagnosed with malaria and severe anemia, and treated with IV Quinine and a blood transfusion. But despite all that, this tiny thing continued to hang on the edge of eternity. Each day brought no improvement. Her Arab father continually sought what to do and was quick to buy the necessary treatments. His love was contagious.
But the diarrhea continued. The refusal to breastfeed was discouraging. The fast heart rate and breathing was ominous. Finally, two days ago I noticed a change, but not the one I was expecting or hoping for. I noticed a small piece of white paper or animal hide folded many times and tied to her wrist. Then, I took note of the heavy bundle of leather pouches tied around her neck. I spoke to the father.
"Are you a Muslim?"
"Yes."
"Do you believe in the one true God?"
"Yes."
"Do you believe He is all powerful?"
"Yes."
"Then why do you put your confidence in these fetishes to save your child's life? If it is Allah's will she will die, if it is Allah's will she will live but you may give credit to the fetishes rather than Allah if she does. Why not take them off and put your trust in the all-powerful one God?"
"Doctor, you are right."
I pray with them. I walk away. I come back the next day and the child is well. The child has no pouches or things tied around her. They go home that same day.
I continue on pediatrics and remember what happened two weeks ago at the end of the cavern. A mother lying on the floor begins to writhe and twist and moan. I feel instantly this is something supernatural. Through a nursing student as translator we pray for her. She calms down. We speak with her.
She used to know God. Then, a catastrophe struck. She lost her husband and faith at the same time. She visited a witch doctor. The "seizures" started. We pray for her again, assuring her that our God is all powerful and she can be free. She is calm. Her child is still sick, though.
The next day, she is gone along with her child.
I return to the present. I find my way through the maze of sick children and return home. I pass through whirlwind of email trying to get students ready to enter nursing school, sending the chauffeur to get IV fluids at Lai across the barge-less and bridge-less swollen Logone River, going to church, getting called out to see a woman with a likely kidney infection and going home to find some peace with George MacDonald's "The Princess and Curdie" and M & M's leads me to an exhausted flop on the couch where I drift back into an endless cycle of thoughts buzzing through my head like mosquitoes in search of Malaria-free victims to infect...
Thoughts flit through my head hoping not to be caught by anything that might make my consciousness stay awake.
I glide through the wards in my mind as in a misty cave lit dimly by torchlight. There to the left is a smiling face of a well-looking woman with a cast on her right leg. She smiles, holds out her hand and says, "lapia". Three small children play some game with a plastic bag at her bedside.
To the right, Lona leads me to the new arrival. An elderly woman betraying her age by her silver hair rather than by her skin and body lies stretched on her back. I examine her abdomen and write prescriptions in her little health record which is carved out of a school notebook and called a carnet.
I enter the next room barely noticing the cracked blue dingy paint and ceiling panels hanging like moss from an ancient cave. Under a white mosquito net sits the Business Manager of the Mayor's office. His knee wound has become infected post-op leaking out pasty remnants of his gout deposits like toothpaste gone really, really bad. I unwrap and change the dressing.
I proceed to the next mosquito net cocoon hiding not a butterfly but a man lucky to be alive, yet very much so despite lying in his own stool which is leaking out of a poorly done colostomy on his left abdominal wall. Five days ago I was intimately acquainted with his abdominal contents from midnight until 6:00 am as I first unwrapped, then removed his dead sigmoid colon which had twisted on itself in a bizarre act of suicide called a volvulus. He is eating, has no pain, wound is clean, drains removed yesterday and colostomy functioning despite being done wrong (as learned by post op reading on the subject).
I move to the outside door passing our tall, thin friend with a left leg that I was sure he would lose when he first arrived. His thigh wound is still rather large but beefy red with no swelling or signs of infection. Of course, after two months at home and only our pitiful attempts at physical therapy, he is a long ways from bending his knee normally. But he has his leg...
I walk under the porch and across a surprisingly clear walkway lacking the normal proliferation of mats and bright colored Arabic rugs. I enter the dungeon of pediatrics.
Darkness and the smell of urine and old pus assault my senses. The smells soon disappear in the amazing adaptability of the body and the darkness by simply opening the sheet metal shutters. A row of red beds stretches in what seems like infinity interrupted by a smattering of mosquito nets and tubing hanging haphazardly from a varied assortment of poles, sticks and protuberances. I feel I should have a treasure map in my hand, a hat on my head, a whip by my side and a wry smile playing about my lips if I intend to navigate well this ancient tomb.
I notice that the second bed to the left has a new child. The one who'd occupied that bed the previous five days sticks out in my mind. A tiny 8-month-old with the typical fever, diarrhea, vomiting and anemia was admitted, diagnosed with malaria and severe anemia, and treated with IV Quinine and a blood transfusion. But despite all that, this tiny thing continued to hang on the edge of eternity. Each day brought no improvement. Her Arab father continually sought what to do and was quick to buy the necessary treatments. His love was contagious.
But the diarrhea continued. The refusal to breastfeed was discouraging. The fast heart rate and breathing was ominous. Finally, two days ago I noticed a change, but not the one I was expecting or hoping for. I noticed a small piece of white paper or animal hide folded many times and tied to her wrist. Then, I took note of the heavy bundle of leather pouches tied around her neck. I spoke to the father.
"Are you a Muslim?"
"Yes."
"Do you believe in the one true God?"
"Yes."
"Do you believe He is all powerful?"
"Yes."
"Then why do you put your confidence in these fetishes to save your child's life? If it is Allah's will she will die, if it is Allah's will she will live but you may give credit to the fetishes rather than Allah if she does. Why not take them off and put your trust in the all-powerful one God?"
"Doctor, you are right."
I pray with them. I walk away. I come back the next day and the child is well. The child has no pouches or things tied around her. They go home that same day.
I continue on pediatrics and remember what happened two weeks ago at the end of the cavern. A mother lying on the floor begins to writhe and twist and moan. I feel instantly this is something supernatural. Through a nursing student as translator we pray for her. She calms down. We speak with her.
She used to know God. Then, a catastrophe struck. She lost her husband and faith at the same time. She visited a witch doctor. The "seizures" started. We pray for her again, assuring her that our God is all powerful and she can be free. She is calm. Her child is still sick, though.
The next day, she is gone along with her child.
I return to the present. I find my way through the maze of sick children and return home. I pass through whirlwind of email trying to get students ready to enter nursing school, sending the chauffeur to get IV fluids at Lai across the barge-less and bridge-less swollen Logone River, going to church, getting called out to see a woman with a likely kidney infection and going home to find some peace with George MacDonald's "The Princess and Curdie" and M & M's leads me to an exhausted flop on the couch where I drift back into an endless cycle of thoughts buzzing through my head like mosquitoes in search of Malaria-free victims to infect...
Sunday, September 4, 2005
Speaking in Tongues the hard way...
Tout le monde,
Speaking in tongues would come in real handy right now. Apparently, in early post-Jesus days, His disciples were given the instantaneous ability to speak fluently languages they'd never known before. Here we just struggle along hoping to understand a few words of what's said around us.
Chad has 130 languages and dialects and two official languages: French and Chadian Arabic.
Before coming, I felt if I could just learn French I'd be fine. Who wants to learn some obscure language anyway? Wrong...
Most of our staff speak a minimum of 5 languages including French, Arabic and a smattering of local languages. The dialects heard commonly if not daily at the hospital are Nangjere, Moundan, Foulb� and Ngambai.
Without Rahama I'm lost. I call a patient in. It's a Fulani woman. She is dressed in bright colored frilly blouse and wide skirt. She has dreads, a nose ring, and multiple leather pouch fetishes hanging around her neck. She carries a baby strapped on her back with another bright cloth that completely clashes but somehow seems right. Her husband is wearing a tattered light blue arabic robe with a white turban wrapped amply around his neck. I begin.
"Al salaam alekum"
"Wa alekum al-salaam"
"Inti af�?"
And then she spouts off in Foulb�. Her husband translates into Chadian Arabic, Rahama translates into French and hopefully I understand. Rahama has a gift of translation because she's done it long enough that she knows what I want and so if the person doesn't answer the question right instead of just translating she'll continue to clarify with the person till the answer comes to the question asked. With other translators it often turns into a long, painfully slow process of back and forth translation.
I go on rounds. I've heard certain things translated enough that I have picked up some key Nangjer� phrases. I approach a one and a half year old with Malaria. I ask the mom...
"Ba ma balou ga?" (Has he vomited, upchucked, heaved, honked, ralphed, lost his lunch, tossed his cookies, puked, blown chunks, or spewed?)
"Balou di" (None of the above)
"Ba ma sua kouba?" (Does he breastfeed?)
She responds with a nod and a click in the throat.
"Ka kang" (Any more IV fluids left?)
"Kang di" (There's nothing)
"Xalas, ma ere 'ya ba" (He's done with his treatment, he's discharged)
But then grandma comes in and starts to greet me in the long drawn out African style and all I can do is smile and say "lapia" over and over without understanding a thing.
Gueltir knocks on the door. He's arrived to give me my first official Nangjer� lesson. We open the songbook. I can sing a ton of songs but not understand a word. I think it's time to change. We start with the blessing at the front. It's only 4 short lines, but one hour later we have exhausted ourselves trying to help me understand it. The problem is that Nangjer� is so simple and grammatically different from English or French that they are used to translating the meaning of phrases but not words so I never really know what a word means. I made him tell me even if it didn't make "sense" or wasn't good English (our exchange is that Gueltir gets to practice his English). Our other hang-up today is that kà, ka, ka' and 'ka all have different pronunciations and meanings (at least he says they sound different...it's all one and the same to me).
Sarah and I learn languages differently. She learns by ear. She listens, hears, talks and learns...the way we all learn our first language when we are kids...but she may not be able to tell you why a certain thing is said a certain way...just like not everyone who speaks English can teach it. She has an amazing gift and already speaks Danish, English, German, Spanish and French fluently as well as a little Croation, Hebrew, Chadian Arabic and Nangjer�.
I, on the other hand, need books. I need to understand the structure and grammar, the why. That's why Nangjer� is so difficult. There are no books and no dictionary.
With Chadian Arabic I'm having more success. I've bought a book of grammar, a dialogue book and a dictionary. Three nights ago I found myself in the throes of exhilarated language study the kind of which I hadn't enjoyed since my three months in France at the language institute of Collonges.
I had looked up a word in the dictionary. That had it in several phrases. I saw another word I'd wanted to know the meaning of. I looked that up which sent me off to find out the meaning of two other words...etc, etc. I stayed up late with just a candle feeling the thrill of search and discovery. That's why that ending is there. That's what that phrase is they say all the time..."Marra wahid" means completely or till the end...ah ha! Yeah, it's sounds geeky, but when you love languages...
So, I'm starting to feel better. Maybe this speaking in tongues will come even if it is the hard way.
I'm back at work rounding on peds again. I'm feeling pretty cocky after my night with the Chadian Arabic dictionary and my first Nangjer� lesson with Gueltir. I approach the first patient.
"Ba ma balou ga?" Blank stare. Ok, no Nangjer�.
"Hu gai giddif?" Arabic maybe? Blank stare...
"Docteur," a nursing student ventures, "She only speaks Ngambai..."
I give up...
James
Speaking in tongues would come in real handy right now. Apparently, in early post-Jesus days, His disciples were given the instantaneous ability to speak fluently languages they'd never known before. Here we just struggle along hoping to understand a few words of what's said around us.
Chad has 130 languages and dialects and two official languages: French and Chadian Arabic.
Before coming, I felt if I could just learn French I'd be fine. Who wants to learn some obscure language anyway? Wrong...
Most of our staff speak a minimum of 5 languages including French, Arabic and a smattering of local languages. The dialects heard commonly if not daily at the hospital are Nangjere, Moundan, Foulb� and Ngambai.
Without Rahama I'm lost. I call a patient in. It's a Fulani woman. She is dressed in bright colored frilly blouse and wide skirt. She has dreads, a nose ring, and multiple leather pouch fetishes hanging around her neck. She carries a baby strapped on her back with another bright cloth that completely clashes but somehow seems right. Her husband is wearing a tattered light blue arabic robe with a white turban wrapped amply around his neck. I begin.
"Al salaam alekum"
"Wa alekum al-salaam"
"Inti af�?"
And then she spouts off in Foulb�. Her husband translates into Chadian Arabic, Rahama translates into French and hopefully I understand. Rahama has a gift of translation because she's done it long enough that she knows what I want and so if the person doesn't answer the question right instead of just translating she'll continue to clarify with the person till the answer comes to the question asked. With other translators it often turns into a long, painfully slow process of back and forth translation.
I go on rounds. I've heard certain things translated enough that I have picked up some key Nangjer� phrases. I approach a one and a half year old with Malaria. I ask the mom...
"Ba ma balou ga?" (Has he vomited, upchucked, heaved, honked, ralphed, lost his lunch, tossed his cookies, puked, blown chunks, or spewed?)
"Balou di" (None of the above)
"Ba ma sua kouba?" (Does he breastfeed?)
She responds with a nod and a click in the throat.
"Ka kang" (Any more IV fluids left?)
"Kang di" (There's nothing)
"Xalas, ma ere 'ya ba" (He's done with his treatment, he's discharged)
But then grandma comes in and starts to greet me in the long drawn out African style and all I can do is smile and say "lapia" over and over without understanding a thing.
Gueltir knocks on the door. He's arrived to give me my first official Nangjer� lesson. We open the songbook. I can sing a ton of songs but not understand a word. I think it's time to change. We start with the blessing at the front. It's only 4 short lines, but one hour later we have exhausted ourselves trying to help me understand it. The problem is that Nangjer� is so simple and grammatically different from English or French that they are used to translating the meaning of phrases but not words so I never really know what a word means. I made him tell me even if it didn't make "sense" or wasn't good English (our exchange is that Gueltir gets to practice his English). Our other hang-up today is that kà, ka, ka' and 'ka all have different pronunciations and meanings (at least he says they sound different...it's all one and the same to me).
Sarah and I learn languages differently. She learns by ear. She listens, hears, talks and learns...the way we all learn our first language when we are kids...but she may not be able to tell you why a certain thing is said a certain way...just like not everyone who speaks English can teach it. She has an amazing gift and already speaks Danish, English, German, Spanish and French fluently as well as a little Croation, Hebrew, Chadian Arabic and Nangjer�.
I, on the other hand, need books. I need to understand the structure and grammar, the why. That's why Nangjer� is so difficult. There are no books and no dictionary.
With Chadian Arabic I'm having more success. I've bought a book of grammar, a dialogue book and a dictionary. Three nights ago I found myself in the throes of exhilarated language study the kind of which I hadn't enjoyed since my three months in France at the language institute of Collonges.
I had looked up a word in the dictionary. That had it in several phrases. I saw another word I'd wanted to know the meaning of. I looked that up which sent me off to find out the meaning of two other words...etc, etc. I stayed up late with just a candle feeling the thrill of search and discovery. That's why that ending is there. That's what that phrase is they say all the time..."Marra wahid" means completely or till the end...ah ha! Yeah, it's sounds geeky, but when you love languages...
So, I'm starting to feel better. Maybe this speaking in tongues will come even if it is the hard way.
I'm back at work rounding on peds again. I'm feeling pretty cocky after my night with the Chadian Arabic dictionary and my first Nangjer� lesson with Gueltir. I approach the first patient.
"Ba ma balou ga?" Blank stare. Ok, no Nangjer�.
"Hu gai giddif?" Arabic maybe? Blank stare...
"Docteur," a nursing student ventures, "She only speaks Ngambai..."
I give up...
James
Friday, August 19, 2005
Numb
I stare blankly at the small hand and arm. I sit on a stool in front of a delivery bed. My hands hang at my side. My whole body feels heavy. My eyes would close if they could to banish the sight forever from my consciousness. Before me, on the floor sits a large, green plastic basin. In the basin are some bloody pieces of gauze, a few blood clots and disembodied arm and hand. The arm is perfect. The nails, the tiny fingers, the palm creases, the forearm and elbow are all perfect...except for being a deep purple and totally detached at the upper arm. There is no accompanying body. I sit here numb in front of its mother waiting for the rest of "it" to come out. My mind drifts as the minutes drag by...
I am pulled to the door by a rattling banging of fist on metal. My wife, Sarah, has left for N'Djaména. The monsoon rains pound the tin roof mercilessly. David, the night watchman, stands outside all but swallowed up in a bright yellow rain slicker.
"Bon soir, David."
He doesn't reply, just reaches solemnly into his jacket and pulls out a worn half of a paper notebook we call a "carnet" or portable medical record.
I read inside. Young woman. First pregnancy. Dates unknown. Bleeding since 4pm, 2 hours ago. Cervix dilated at 3-4cm. IV started with normal saline. Refer to Doctor.
I give the carnet back to David. "J'arrive."
I pull on my scrubs. So much for a quiet, rainy evening reading in my favorite chair. I go next door and quickly down some cold spaghetti and eggplant sauce and tell the medical students, Carol and Sara, what's going on.
I slip on my sandals, pull my hooded sweatshirt low and step into the downpour. The ground has disappeared. I slosh through water up to my ankles following the moonlight splayed across a million tiny circles splashing on the surface. It is a lovely dream about to become a nightmare.
I reach the shelter of the overhang beside the operating room and enter the hospital ward turning right into labor and delivery. The first surprise is that I see Rahama there. I think how nice of her to come help at night. She never does that. David, the nurse, is with a small frightened girl. She is completely naked her legs sprawled at weird angles on the table. Pools of blood stretch along each side of the bed. Clots with a few pieces of gauze are on top in between her legs. She writhes but doesn't really speak.
I ask how far along she is. Rahama replies that she's about 4 months. I then realize that this is Rahama's daughter. David is just finishing putting in the IV. The IV fluids drip in. I ask for gloves. Normally there are always gloves in L&D. There are none. I inexplicably start to become very nasty. I start to talk coldly to Rahama and David asking how come there are no gloves when I left a ton before I went on vacation. I tell them cruelly how they always just use stuff up. I feel very out of control and realize it but somehow don't care. I am bothered, frustrated, and in over my head.
David rushes off to the Garde room and brings me some gloves. I try to examine inside the girl. She won't move into the right position. She doesn't understand French. Then, she doesn't seem to understand the translation. She fights, squirms and I can't even begin to examine her. I start to yell how we're trying to help you but we need some cooperation. Rahama starts to yell at her, too. Nothing. We struggle. Rahama starts to slap her. Finally, I can examine her. There are clots but no real active bleeding. Must be an incomplete abortion.
I run out to get the instruments to do a curettage under spinal anesthesia. The rain intensifies. I give David a urinary catheter to put in her. He can't get it in. I try to help without gloves getting blood all over my hand. I call for gloves. There are none. There is no gauze. I wash my hands off. David continues to struggle with the catheter. I start to rain down deprecations on the entire lack of adequate staff and materials and how can we work under these conditions. David has no luck. Carol brings me some gloves. I finally get the catheter in. The girl has continued to struggle and get hit in the face by Rahama.
She is turned on her side and the spinal needle doesn't want to go in. The puncture starts to bleed. We have no gauze. Sara runs to surgery. I wait, seething. I wipe off the blood and am able to get the anesthesia in at last. The girl quickly relaxes and actually falls asleep during the rest of the procedure...exhausted.
I am able to examine her easily now and after dilating the cervix discover that the fetus is more like 7 months than 4. I can't do a D&C. We listen for fetal heart tones. There are none. On exam it feels like a breech presentation. I try to deliver the first leg and after pulling it out, find it's really the arm. Now I'm stuck. This position will never allow the dead fetus to come out. I don't want to do a c-section since the baby's already dead. I try to push the arm back in. The humerus cracks, but it goes in. I try to turn the infant inside. No luck. I feel sick at the thought that enters my head. I might have to pull it out piece by piece. I reach inside...
The arm is out again. It is a deep bluish purple and perfect. I grab some scissors and cut through the skin. Three cuts and I'm through. I drop the arm and I gaze in a weird slow motion sequence as it slowly spins through the air to bounce in the bottom of the basin splashing up a few drops of dark blood. I reach inside and able to pull the head down which has been doubled almost completely backwards over its little back. What now? The cervix is still only 5cm dilated...I place my hand on her uterus through the abdominal wall and feel only rare uterine contractions. I stop, dejected, and stare blankly at the small, detached arm and hand in the green basin on the floor in the pool of blood, clots and gauze...
We send David, the night watchman, to find Anatole to get Oxytocin from the lab fridge. The girl still sleeps. Rahama sits quietly. She looks at me and says, "I don't know what I'm going to do. The expense for all this falls on me and I don't know what I'll do..." Rahama always lives in debt, barely scraping by, getting advances on her salary to try and feed her husband, kids and relatives who depend on her. With the famine, the increased prices and her own crops from last year being burned up, she lives in constant anxiety about how to make ends meet. This is the straw that may break the proverbial camel's back. I sense her desperation.
The oxytocin arrives. The girl awakes. She is shivering only covered by a thin sheet. I grab my sweatshirt and lay it on her. Rahama tries to protest saying it'll get all bloody. I say not to worry about it. The girl snuggles under and goes back to sleep. I stay for 45 minutes with my hand on the uterus monitoring the contractions and adjusting the oxytocin till she has regular contractions and I'm sure she won't have tetany that could lead to a rupture of her uterus. Rahama has washed the instruments. The blood still lies pooled on the floor and table but has started to dry. Rahama says she'll monitor her closely now to make sure the contractions don't get out of hand. I head back home. The rain has stopped. My feet have been pickled in my soggy shoes. The puddles are still there. My forearm and hands are cramping from reaching trying to pull and tug and turn a dead baby...my mind has effectively walled it off so that I'm still in dream land as I slosh home, wash up and crash into an empty bed with a feeling of emptiness so complete that I can't even think of anything to worry about but fall into a deep, troubled sleep...
I am pulled to the door by a rattling banging of fist on metal. My wife, Sarah, has left for N'Djaména. The monsoon rains pound the tin roof mercilessly. David, the night watchman, stands outside all but swallowed up in a bright yellow rain slicker.
"Bon soir, David."
He doesn't reply, just reaches solemnly into his jacket and pulls out a worn half of a paper notebook we call a "carnet" or portable medical record.
I read inside. Young woman. First pregnancy. Dates unknown. Bleeding since 4pm, 2 hours ago. Cervix dilated at 3-4cm. IV started with normal saline. Refer to Doctor.
I give the carnet back to David. "J'arrive."
I pull on my scrubs. So much for a quiet, rainy evening reading in my favorite chair. I go next door and quickly down some cold spaghetti and eggplant sauce and tell the medical students, Carol and Sara, what's going on.
I slip on my sandals, pull my hooded sweatshirt low and step into the downpour. The ground has disappeared. I slosh through water up to my ankles following the moonlight splayed across a million tiny circles splashing on the surface. It is a lovely dream about to become a nightmare.
I reach the shelter of the overhang beside the operating room and enter the hospital ward turning right into labor and delivery. The first surprise is that I see Rahama there. I think how nice of her to come help at night. She never does that. David, the nurse, is with a small frightened girl. She is completely naked her legs sprawled at weird angles on the table. Pools of blood stretch along each side of the bed. Clots with a few pieces of gauze are on top in between her legs. She writhes but doesn't really speak.
I ask how far along she is. Rahama replies that she's about 4 months. I then realize that this is Rahama's daughter. David is just finishing putting in the IV. The IV fluids drip in. I ask for gloves. Normally there are always gloves in L&D. There are none. I inexplicably start to become very nasty. I start to talk coldly to Rahama and David asking how come there are no gloves when I left a ton before I went on vacation. I tell them cruelly how they always just use stuff up. I feel very out of control and realize it but somehow don't care. I am bothered, frustrated, and in over my head.
David rushes off to the Garde room and brings me some gloves. I try to examine inside the girl. She won't move into the right position. She doesn't understand French. Then, she doesn't seem to understand the translation. She fights, squirms and I can't even begin to examine her. I start to yell how we're trying to help you but we need some cooperation. Rahama starts to yell at her, too. Nothing. We struggle. Rahama starts to slap her. Finally, I can examine her. There are clots but no real active bleeding. Must be an incomplete abortion.
I run out to get the instruments to do a curettage under spinal anesthesia. The rain intensifies. I give David a urinary catheter to put in her. He can't get it in. I try to help without gloves getting blood all over my hand. I call for gloves. There are none. There is no gauze. I wash my hands off. David continues to struggle with the catheter. I start to rain down deprecations on the entire lack of adequate staff and materials and how can we work under these conditions. David has no luck. Carol brings me some gloves. I finally get the catheter in. The girl has continued to struggle and get hit in the face by Rahama.
She is turned on her side and the spinal needle doesn't want to go in. The puncture starts to bleed. We have no gauze. Sara runs to surgery. I wait, seething. I wipe off the blood and am able to get the anesthesia in at last. The girl quickly relaxes and actually falls asleep during the rest of the procedure...exhausted.
I am able to examine her easily now and after dilating the cervix discover that the fetus is more like 7 months than 4. I can't do a D&C. We listen for fetal heart tones. There are none. On exam it feels like a breech presentation. I try to deliver the first leg and after pulling it out, find it's really the arm. Now I'm stuck. This position will never allow the dead fetus to come out. I don't want to do a c-section since the baby's already dead. I try to push the arm back in. The humerus cracks, but it goes in. I try to turn the infant inside. No luck. I feel sick at the thought that enters my head. I might have to pull it out piece by piece. I reach inside...
The arm is out again. It is a deep bluish purple and perfect. I grab some scissors and cut through the skin. Three cuts and I'm through. I drop the arm and I gaze in a weird slow motion sequence as it slowly spins through the air to bounce in the bottom of the basin splashing up a few drops of dark blood. I reach inside and able to pull the head down which has been doubled almost completely backwards over its little back. What now? The cervix is still only 5cm dilated...I place my hand on her uterus through the abdominal wall and feel only rare uterine contractions. I stop, dejected, and stare blankly at the small, detached arm and hand in the green basin on the floor in the pool of blood, clots and gauze...
We send David, the night watchman, to find Anatole to get Oxytocin from the lab fridge. The girl still sleeps. Rahama sits quietly. She looks at me and says, "I don't know what I'm going to do. The expense for all this falls on me and I don't know what I'll do..." Rahama always lives in debt, barely scraping by, getting advances on her salary to try and feed her husband, kids and relatives who depend on her. With the famine, the increased prices and her own crops from last year being burned up, she lives in constant anxiety about how to make ends meet. This is the straw that may break the proverbial camel's back. I sense her desperation.
The oxytocin arrives. The girl awakes. She is shivering only covered by a thin sheet. I grab my sweatshirt and lay it on her. Rahama tries to protest saying it'll get all bloody. I say not to worry about it. The girl snuggles under and goes back to sleep. I stay for 45 minutes with my hand on the uterus monitoring the contractions and adjusting the oxytocin till she has regular contractions and I'm sure she won't have tetany that could lead to a rupture of her uterus. Rahama has washed the instruments. The blood still lies pooled on the floor and table but has started to dry. Rahama says she'll monitor her closely now to make sure the contractions don't get out of hand. I head back home. The rain has stopped. My feet have been pickled in my soggy shoes. The puddles are still there. My forearm and hands are cramping from reaching trying to pull and tug and turn a dead baby...my mind has effectively walled it off so that I'm still in dream land as I slosh home, wash up and crash into an empty bed with a feeling of emptiness so complete that I can't even think of anything to worry about but fall into a deep, troubled sleep...
Saturday, August 13, 2005
All things new...
Everyone,
I was on my way. A strange mixture of emotions coursed through me...fear, excitement, anxiety, courage, hope, wonder, tentativeness, anticipation...I was back on the road to B�r�.
Arriving in N'Djam�na I had been struck by a profound sense of change in the air. Not just because of the time change, the culture change, the first world to third world change--no, things really were happening in Tchad's capital. We entered the airport and found everything under construction. The days were cool and rainy. Everything was green, transformed by the wet season. We'd left a desert, we found an oasis. Even the trash and smells seemed content to be temporarily hidden behind the new life bursting all around.
Sarah and I arrived with a colleague of mine from medical school, Troy Dickson, and his wife, Kim. I met Pastor Job and was thrilled with his warm, prodigal-son embrace. We registered Troy and Kim with the national security and went to the Grand Mosque to change money.
As we circled the one way street counterclockwise around the center of Islam in N'Djam�na we looked for our friend. Sure enough, he emerged from the crowd of white robed, white capped African Arabs reclining on mats in front of an empty store front.
"Al-salaam alekum."
"Wa alekum al-salaam. How are you my friend? Come, lets have some Cokes together."
We--Bichara, Job, and I--closed and locked the truck, then marched off behind our regular black market dealer. We removed our shoes, crossed the mats between the still reclining Muslims and into the empty cement room behind. We reclined on our mats as another robed Arab brought us our sodas. I carefully sipped mine and we made small talk about my trip and what was happening in N'Djam�na and Tchad in general. Apparently the roads are getting paved, the president was sick in France but is back now, and business is improving slowly.
After 15 minutes or so, I remark that I have some money to change. I ask what the going price is. I say I'd heard we were up to 530 francs per dollar. Job quickly pipes up with, "560 per dollar". Our friend immediately agrees to 530. Thus begins the bargaining. Finally, we seem at an impasse at 540. We aren't satisfied. I pull out the calculator and do some quick figures.
"Mon ami, you will make 400,000 francs (~$800) on this deal at 540 per dollar. You will admit that is a lot. If you give it to us at 550 you will still make 200,000 francs. Not bad for a few minutes work?"
He smiles broadly and nods while motioning with his hand to give him the dollars. We count it all out, I put the francs in a brown paper bag and stuff it to the bottom of my backpack. We rise to leave.
"Au revoir..." he waves.
"Agodt afe" I reply and we're off directly to the bank to deposit it. The black market has saved us approximately $2000 that would've been lost in the bank and we've established a valuable relationship.
After picking up twin medical students, Carol and Sara that night we are off to B�r� the next morning. Prior to departure, we arrange Job's plane ticket to Kenya and the finances for the start of his master's in International Development which will start the end of August.
In those brief days in N'Djaména I have heard many rumors that have plagued my mind leading to my anxious anticipation to get to Béré.
We enter Kélo by the southern roundabout instead of through the back way through the market. The landscape has been incredible: luscious green plains, full rivers, millet, rice, corn and other crops pushing to the sky which is deep blue with puffy white clouds. The only thing missing is herds of antelope, zebras, giraffes and elephants. We leave the pavement in K�lo plunging into red mud with numerous puddles spray painting the truck with a slimy coat. The roundabout takes us by the K�lo Hospital. The rumors are true: it is closed. Not a living thing can be seen.
The government health care workers are on strike. They haven't been paid in 5 months. The two hospitals closest to Béré--Kélo and Lai--are closed. Our staff is at half strength with only three nurses and one lab tech. We have gone back to Tchadian civil war era times with the three stalwart "pillars"--Anatole, Samedi, Lona--holding down the fort as they have over the years.
However, even with this grim news, a sense of excitement continues to build as we approach Béré. I recognize everything, yet it's all changed. I've never experienced this drastic change since I missed the slow transformation of the rains and have left the extreme of 130 degree weather and brown, dead landscapes for an instantaneous, 2 month change to lush tropical with 70-80 degree weather. I am excitedly filling in Troy, Kim, Sara and Carol on this and that memory associated with this and that. I am coming home.
We stop 8 km from Béré to see the hippos. We climb out and down to the edge of the river. Not 100 yards away are 7-8 large hippos showing off with grunts, gap-toothed yawns and impressive lunges out of the water. Slowly, some local passersby stop to see the strangers. We chat easily about the rains, the crops, the meanness of the hippo in general and about Marty, the fisherman bit by one of these same hippos over a year ago. Apparently, they all know him and are eager to report on his continued good health.
We hit the road, cross the river on the barge, and slosh through the muddy roads till we see the "Welcome to Béré" sign with the hospital's water tower visible over the mango trees in the distance. An indescribable feeling moves through my body, a combination of chills, warmth and the strange desire to cry and run and laugh at the same time.
As we pull in we see some of the staff in front of the church on benches. Friday evening worship is in full swing. They wave furiously and get up hurriedly to meet us in front of the house. André's grin stretches from ear to ear as he emerges from behind a large, 40 foot blue container sitting on our front lawn. He is shaking his head in joy as he embraces me with the biggest bear hug ever. In fact he can't stop laughing and hugging me. The others crowd around shaking hands, smiling, asking a million questions a minute. Bichara tries to stoically take charge of unloading our bags as there is general pandemonium. I glance over at the hospital and see two beautiful outdoor bathrooms for the patients and staff, a new walkway between Pediatrics and the rest of the hospital so we don't have to walk in the mud anymore.
André manages to get in a few words. "We weren't sure if we'd be able to finish the roofs or not...the container...what a challenge...God held back the rains as we struggled to unload all day...just after reloading it poured down...the strike...Lona, Anatole, Samedi, David...working hard...we've been blessed with the new government nurse, Josu�....you can't believe what a leader he is..." And on and on he goes.
I verify later, the roofs on the hospital ward, labor and delivery and operating room have all been repaired. My heart is filled with joy. Everyone has pulled through in my absence without a doctor, half-staffed and yet they have managed to not only not go backwards but have made a huge push forwards. Andr� sits me down two days later and explains all the important decisions, resolution of staff conflicts and other administrative things he's done and my heart swells with thankfulness.
Yes, God's hand is definitely in this place...I am relieved to see how little they really need me, yet how much they really want me...we're back, ready or not...
James
I was on my way. A strange mixture of emotions coursed through me...fear, excitement, anxiety, courage, hope, wonder, tentativeness, anticipation...I was back on the road to B�r�.
Arriving in N'Djam�na I had been struck by a profound sense of change in the air. Not just because of the time change, the culture change, the first world to third world change--no, things really were happening in Tchad's capital. We entered the airport and found everything under construction. The days were cool and rainy. Everything was green, transformed by the wet season. We'd left a desert, we found an oasis. Even the trash and smells seemed content to be temporarily hidden behind the new life bursting all around.
Sarah and I arrived with a colleague of mine from medical school, Troy Dickson, and his wife, Kim. I met Pastor Job and was thrilled with his warm, prodigal-son embrace. We registered Troy and Kim with the national security and went to the Grand Mosque to change money.
As we circled the one way street counterclockwise around the center of Islam in N'Djam�na we looked for our friend. Sure enough, he emerged from the crowd of white robed, white capped African Arabs reclining on mats in front of an empty store front.
"Al-salaam alekum."
"Wa alekum al-salaam. How are you my friend? Come, lets have some Cokes together."
We--Bichara, Job, and I--closed and locked the truck, then marched off behind our regular black market dealer. We removed our shoes, crossed the mats between the still reclining Muslims and into the empty cement room behind. We reclined on our mats as another robed Arab brought us our sodas. I carefully sipped mine and we made small talk about my trip and what was happening in N'Djam�na and Tchad in general. Apparently the roads are getting paved, the president was sick in France but is back now, and business is improving slowly.
After 15 minutes or so, I remark that I have some money to change. I ask what the going price is. I say I'd heard we were up to 530 francs per dollar. Job quickly pipes up with, "560 per dollar". Our friend immediately agrees to 530. Thus begins the bargaining. Finally, we seem at an impasse at 540. We aren't satisfied. I pull out the calculator and do some quick figures.
"Mon ami, you will make 400,000 francs (~$800) on this deal at 540 per dollar. You will admit that is a lot. If you give it to us at 550 you will still make 200,000 francs. Not bad for a few minutes work?"
He smiles broadly and nods while motioning with his hand to give him the dollars. We count it all out, I put the francs in a brown paper bag and stuff it to the bottom of my backpack. We rise to leave.
"Au revoir..." he waves.
"Agodt afe" I reply and we're off directly to the bank to deposit it. The black market has saved us approximately $2000 that would've been lost in the bank and we've established a valuable relationship.
After picking up twin medical students, Carol and Sara that night we are off to B�r� the next morning. Prior to departure, we arrange Job's plane ticket to Kenya and the finances for the start of his master's in International Development which will start the end of August.
In those brief days in N'Djaména I have heard many rumors that have plagued my mind leading to my anxious anticipation to get to Béré.
We enter Kélo by the southern roundabout instead of through the back way through the market. The landscape has been incredible: luscious green plains, full rivers, millet, rice, corn and other crops pushing to the sky which is deep blue with puffy white clouds. The only thing missing is herds of antelope, zebras, giraffes and elephants. We leave the pavement in K�lo plunging into red mud with numerous puddles spray painting the truck with a slimy coat. The roundabout takes us by the K�lo Hospital. The rumors are true: it is closed. Not a living thing can be seen.
The government health care workers are on strike. They haven't been paid in 5 months. The two hospitals closest to Béré--Kélo and Lai--are closed. Our staff is at half strength with only three nurses and one lab tech. We have gone back to Tchadian civil war era times with the three stalwart "pillars"--Anatole, Samedi, Lona--holding down the fort as they have over the years.
However, even with this grim news, a sense of excitement continues to build as we approach Béré. I recognize everything, yet it's all changed. I've never experienced this drastic change since I missed the slow transformation of the rains and have left the extreme of 130 degree weather and brown, dead landscapes for an instantaneous, 2 month change to lush tropical with 70-80 degree weather. I am excitedly filling in Troy, Kim, Sara and Carol on this and that memory associated with this and that. I am coming home.
We stop 8 km from Béré to see the hippos. We climb out and down to the edge of the river. Not 100 yards away are 7-8 large hippos showing off with grunts, gap-toothed yawns and impressive lunges out of the water. Slowly, some local passersby stop to see the strangers. We chat easily about the rains, the crops, the meanness of the hippo in general and about Marty, the fisherman bit by one of these same hippos over a year ago. Apparently, they all know him and are eager to report on his continued good health.
We hit the road, cross the river on the barge, and slosh through the muddy roads till we see the "Welcome to Béré" sign with the hospital's water tower visible over the mango trees in the distance. An indescribable feeling moves through my body, a combination of chills, warmth and the strange desire to cry and run and laugh at the same time.
As we pull in we see some of the staff in front of the church on benches. Friday evening worship is in full swing. They wave furiously and get up hurriedly to meet us in front of the house. André's grin stretches from ear to ear as he emerges from behind a large, 40 foot blue container sitting on our front lawn. He is shaking his head in joy as he embraces me with the biggest bear hug ever. In fact he can't stop laughing and hugging me. The others crowd around shaking hands, smiling, asking a million questions a minute. Bichara tries to stoically take charge of unloading our bags as there is general pandemonium. I glance over at the hospital and see two beautiful outdoor bathrooms for the patients and staff, a new walkway between Pediatrics and the rest of the hospital so we don't have to walk in the mud anymore.
André manages to get in a few words. "We weren't sure if we'd be able to finish the roofs or not...the container...what a challenge...God held back the rains as we struggled to unload all day...just after reloading it poured down...the strike...Lona, Anatole, Samedi, David...working hard...we've been blessed with the new government nurse, Josu�....you can't believe what a leader he is..." And on and on he goes.
I verify later, the roofs on the hospital ward, labor and delivery and operating room have all been repaired. My heart is filled with joy. Everyone has pulled through in my absence without a doctor, half-staffed and yet they have managed to not only not go backwards but have made a huge push forwards. Andr� sits me down two days later and explains all the important decisions, resolution of staff conflicts and other administrative things he's done and my heart swells with thankfulness.
Yes, God's hand is definitely in this place...I am relieved to see how little they really need me, yet how much they really want me...we're back, ready or not...
James
Monday, May 30, 2005
A walk with Gueltir...
Bonjour,
Gueltir sets a brisk pace. We're walking side by side down the dusty streets of Béré. There are no street signs, no pavement, no sidewalks, no traffic lights, no signs, no evidence that we are in the 21st century. We walk past mud brick huts with people in front lying under mango trees on woven reed mats, pounding millet in crude wooden mortar-and-pestles, carrying big bundles of firewood on their heads, cooking over open fires, and a host of other activities that could place us anywhere from after the Flood to the present. In essence, Béré has managed to capture timelessness...at least until a motorcycle drives by or a man crosses the path with his world-band radio blaring.
We are headed to visit one of the junior high schools in Béré. There are two mixed junior highs, a Catholic girls only junior high and one full-fledged high school bursting at the seams with 1500 students meeting in crude mud buildings or in "hangars" constructed of woven reed walls and roof supported by crooked sticks stuck in the ground. The one we are going to visit is a private one built in 2001 which Gueltir says has been all but abandoned as the owner is occupied with other things in N'Djaména. Besides, for the moment, all the teachers are on strike everywhere except at Gueltir's school. None have been paid for three months. Fortunately, with some help from the US, our teachers are paid every month...a rare thing in Tchad.
We arrive at the Junior High. It's pathetic. The three mud brick buildings surround a courtyard with an open, empty well in the center. To the left and to the right, the buildings have three rooms each, side by side. Straight ahead is the administration building with two rooms. The doors are made from thin wood frames with green painted corrugated roofing nailed on. They hang haphazardly, "locked" precariously with tiny padlocks that come apart when unlocked. Inside, the uneven dirt floors support some rickety benches and tables leaning crazily at all different angles because of the floor. Most have been eaten by termites. Two walls have windows. The side facing the courtyard has windows made of the same material as the doors and they can be opened. The opposite side is made of mud bricks crisscrossed to leave openings in between for air circulation. The roofs are corrugated tin balanced on twisted sticks tied to the bricks with metal bands. One wall is painted black to serve as a chalkboard.
The ad building has one desk, a small bookshelf with a couple of empty chalk boxes on it, a locked trunk and a locked cabinet. A small chair leans precariously against the wall. I tell Gueltir I'm amazed at the conditions. He wonders what I mean saying this is great compared to how he learned sitting under mango trees and temporary shelters. In fact, on the way here, we passed a school and a church that were made entirely of mats. How can the Tchadians hope to become more educated when they have to learn without books, without good facilities and often without teachers (who are on strike half the year it seems)?
We finish and head across town, through the market as it closes up, and on to the house of one of the local "house doctors". He welcomes us into his courtyard, brings out chairs, and invites us to sit. One by one the members of the household come to greet us. The women bow to the ground and extend their hand to shake with the other hand supporting it at the elbow in a sign of deep respect. Our friend's wife brings us a metal bowl of water and a table is called for. We begin to discuss the local gossip. It appears everything is known about everyone. He wonders why I didn't leave to go to Koumra this morning with André. He thought I'd left. I just found out about it last night and decided it was too late to go. Apparently, he knew I was supposed to go before I did. We move on to the raising of ducks, how to plant fruit trees with bull horns buried beside, when the rain will come and a variety of other topics.
The pastor of the Evangelical Church #2 joins us. He is Dimanche's dad (Dimanche is one of our nurses provided by the state). We pass to another round of greetings and acknowledgements.
Finally, I get around to the purpose of our visit. I tactfully mention that we are all here for the health of the community and that one thing I've noticed is that kids often get referred late for treatment of malaria. In fact, we just finished rescuing a small, one-year-old girl that had been treated by him for several days before coming to the hospital. I say that it's something in general we see that kids just don't do well with malaria unless they're hospitalized. He seems to understand. In fact, he seems happy at the exchange. I don't bother to mention that I think he has no right to be treating patients at all since he is not trained except in basic CPR and first aid. He's still going to continue to treat patients at his home. In fact, in the middle of the conversation, someone comes up and greets him as "doctor." All we can do is try and help him to not hurt people.
It's getting dark. We bid goodbye. Our friend accompanies Gueltir and I just till the main road. Without a guide, I'd be lost in the maze of paths and huts. He promises to come see me soon at the hospital. Gueltir and I head home. We pass an outdoor cabaret. The warm rumble of muffled conversation floats over the air along with the smell of local brew. Surrounding the cabaret are the small time vendors. Each has a small table with a kerosene lamp, small plastic sacs of tea and sugar and detergent and oil along with cigarettes, small crackers and various other items. Over head is a mat supported on four sticks poked into the ground. Business is booming. We continue on through the dark streets bereft of any artificial light until we see the fluorescent glow of the hospital through the trees and we know we are home.
James
Gueltir sets a brisk pace. We're walking side by side down the dusty streets of Béré. There are no street signs, no pavement, no sidewalks, no traffic lights, no signs, no evidence that we are in the 21st century. We walk past mud brick huts with people in front lying under mango trees on woven reed mats, pounding millet in crude wooden mortar-and-pestles, carrying big bundles of firewood on their heads, cooking over open fires, and a host of other activities that could place us anywhere from after the Flood to the present. In essence, Béré has managed to capture timelessness...at least until a motorcycle drives by or a man crosses the path with his world-band radio blaring.
We are headed to visit one of the junior high schools in Béré. There are two mixed junior highs, a Catholic girls only junior high and one full-fledged high school bursting at the seams with 1500 students meeting in crude mud buildings or in "hangars" constructed of woven reed walls and roof supported by crooked sticks stuck in the ground. The one we are going to visit is a private one built in 2001 which Gueltir says has been all but abandoned as the owner is occupied with other things in N'Djaména. Besides, for the moment, all the teachers are on strike everywhere except at Gueltir's school. None have been paid for three months. Fortunately, with some help from the US, our teachers are paid every month...a rare thing in Tchad.
We arrive at the Junior High. It's pathetic. The three mud brick buildings surround a courtyard with an open, empty well in the center. To the left and to the right, the buildings have three rooms each, side by side. Straight ahead is the administration building with two rooms. The doors are made from thin wood frames with green painted corrugated roofing nailed on. They hang haphazardly, "locked" precariously with tiny padlocks that come apart when unlocked. Inside, the uneven dirt floors support some rickety benches and tables leaning crazily at all different angles because of the floor. Most have been eaten by termites. Two walls have windows. The side facing the courtyard has windows made of the same material as the doors and they can be opened. The opposite side is made of mud bricks crisscrossed to leave openings in between for air circulation. The roofs are corrugated tin balanced on twisted sticks tied to the bricks with metal bands. One wall is painted black to serve as a chalkboard.
The ad building has one desk, a small bookshelf with a couple of empty chalk boxes on it, a locked trunk and a locked cabinet. A small chair leans precariously against the wall. I tell Gueltir I'm amazed at the conditions. He wonders what I mean saying this is great compared to how he learned sitting under mango trees and temporary shelters. In fact, on the way here, we passed a school and a church that were made entirely of mats. How can the Tchadians hope to become more educated when they have to learn without books, without good facilities and often without teachers (who are on strike half the year it seems)?
We finish and head across town, through the market as it closes up, and on to the house of one of the local "house doctors". He welcomes us into his courtyard, brings out chairs, and invites us to sit. One by one the members of the household come to greet us. The women bow to the ground and extend their hand to shake with the other hand supporting it at the elbow in a sign of deep respect. Our friend's wife brings us a metal bowl of water and a table is called for. We begin to discuss the local gossip. It appears everything is known about everyone. He wonders why I didn't leave to go to Koumra this morning with André. He thought I'd left. I just found out about it last night and decided it was too late to go. Apparently, he knew I was supposed to go before I did. We move on to the raising of ducks, how to plant fruit trees with bull horns buried beside, when the rain will come and a variety of other topics.
The pastor of the Evangelical Church #2 joins us. He is Dimanche's dad (Dimanche is one of our nurses provided by the state). We pass to another round of greetings and acknowledgements.
Finally, I get around to the purpose of our visit. I tactfully mention that we are all here for the health of the community and that one thing I've noticed is that kids often get referred late for treatment of malaria. In fact, we just finished rescuing a small, one-year-old girl that had been treated by him for several days before coming to the hospital. I say that it's something in general we see that kids just don't do well with malaria unless they're hospitalized. He seems to understand. In fact, he seems happy at the exchange. I don't bother to mention that I think he has no right to be treating patients at all since he is not trained except in basic CPR and first aid. He's still going to continue to treat patients at his home. In fact, in the middle of the conversation, someone comes up and greets him as "doctor." All we can do is try and help him to not hurt people.
It's getting dark. We bid goodbye. Our friend accompanies Gueltir and I just till the main road. Without a guide, I'd be lost in the maze of paths and huts. He promises to come see me soon at the hospital. Gueltir and I head home. We pass an outdoor cabaret. The warm rumble of muffled conversation floats over the air along with the smell of local brew. Surrounding the cabaret are the small time vendors. Each has a small table with a kerosene lamp, small plastic sacs of tea and sugar and detergent and oil along with cigarettes, small crackers and various other items. Over head is a mat supported on four sticks poked into the ground. Business is booming. We continue on through the dark streets bereft of any artificial light until we see the fluorescent glow of the hospital through the trees and we know we are home.
James
Monday, May 23, 2005
From Sarah
I'm sitting in our living room with Djongjabe, the 5 year-old daughter of Pierre, the cassier. She's enjoying herself with paper and crayons. Last year she lived with me for almost two months. It all began when she would come and sit by me in church. Her family felt sorry for me that I slept alone (in this culture, being alone = by yourself is the worst possible thing that can happen to you.) They suggested "lending" me their daughter for company and help. I loved the idea. And apparently, so did Djongjabe! We would eat together, do the dishes together, shower together and she would sleep next to me. In the morning I would send her out the door to go to preschool, and she would come back late afternoon. We didn't speak the same language but got along just fine. I dare say she understood my Danish pretty well, and I usually figured out what she meant when she spoke her native language, which is Mundange. Besides, tickling never needed translation.
This idyllic evening makes me think of some of the extremes I have experimented here at the hospital. I have been in several situations, where if I had known about them, I probably would not have wanted to come. I have certainly done things I would NEVER have thought I would....
It was during one of my night shifts. A shift that begins at 2PM when everybody leaves and only the guard nurse is left to take care of all hospitalized patients, what comes in the ER and any deliveries.
A woman comes in for her delivery. She's alone. The husband is nowhere to be found, and for some reason she has no sister, mother, aunt cousin or neighbor with her. I recognize her - her little son was treated for tuberculosis some months earlier. I examine her. She still has a little ways to go. I check on the other hospitalized patients in between. Early morning comes and I expect the woman to deliver anytime soon. She's dilated and has a few good contractions. The head is right there.
After morning worship I give report about the night's events and hand over the woman to Rahama who is experienced in delivering babies. I go back to house and hope the goats and children will be quiet and keep away from my windows so I can get some rest.
I'm getting relaxed and ready to doze off, when the watch man calls me from outside the window "Sarah, you have to come up to the hospital. They have an emergency and need you to take care of the delivery". The delivery? That should have been over long ago? It's almost noon?! I worry if there had been any signs of complications I missed out on during the night?
On my way to the hospital I pass a group of people who have found a shady spot to sell their matches, spices and little plastic bags with sugar and salt. "Lapia" I say, knowing how not greeting people almost is taken as an insult. A teenage girl rises to follow me. She asks where I'm going, although everybody knows I mostly just walk the path between the house and the hospital. Often when I have bought something with her, she has kept the change and only by insisting and getting the help of onlooker have I got back the money she owed me. My thoughts are with the woman who has not yet delivered. What can be wrong? I'm no midwife! Just a plain RN.
Arriving at the hospital, I notice all the people gathered outside the OR. Some emergency has happened and someone is being operated. The other nurses are in there.
I arrive at the door to the delivery room. I notice the teenage girl is still behind me as I open the door. I turn and tell her to stay outside. I walk in to find the woman in great pain and to older women from the church are by her side. The husband has not showed up, neither have any relatives or friends. My mind is racing as I examine her again. Why hasn't she delivered yet? The contractions are good, there seem to be space enough for the baby to come out.... I get distracted by the sound of the door slamming. The teenage girl walks in. I widen my eyes in surprise and tell her this is not an entertainment show and she has to leave. I return to the woman. I wish I had someone to ask for help. Are there even sterile instruments around? Did anyone survey her or was she left alone when I went home?
As I turn to see if I have what I need nearby, I see the teenage girl, who has now found a comfortable place to sit down and watch! As I feel the stress of being thrown into a situation outside my competence, being tired and feeling alone, I raise my voice to make it even more clear to this girl that I meant what I said. I mobilized all my patience and explain again why she is not allowed to watch. I even tell her "PLEASE, go outside!" I know I can't concentrate on this delivery while she is sitting there.
She tilts her head, smiles subtly and says: "What if it doesn't PLEASES me to go outside?"
I'm beyond amazed! I need to get this girl out! I know I can't get violent...I look down on my gloved hand, covered with bloody vaginal secretion from examining the woman. I look sternly at the girl and walk towards her with my hand raised. As I get to her, she looks at me like she couldn't care less. I wipe my hand off on her cheek and neck, amazed at my self and she hadn't already left!!! She widens her eyes, turns and leaves. As I turn to the woman my eyes meet the two older women. They smile knowingly and nod. I think "WHAT did I just do???"
We tell the woman to PUSH and get this over with. The two older women have done this so many times before. They scold and slap her (why didn't I think of that...) and she starts to push better. Shortly after, a healthy baby comes out, I tie the cord and dry him off, extremely relieved. Everything goes well, the placenta comes out, the uterus goes hard and small, all bleeding stops.
The two women from church promise to look after the mom, and help her breastfeed. I walk to the OR. The head nurse has come out. I drag him aside and say I have something to confess. Somehow I'm sure they will not have anything to do with a nurse who smears bloody vaginal secretions over people. After telling him about the incident, he laughs hard and says "You did the right thing - she had it coming!" I can't believe my own ears.
After getting some sleep, I laugh too. And think of how much I'm learning about myself in this place, being driven beyond anything I've ever been before. Of course I have never had to things like this before, in Denmark I've never had strangers refuse to leave the delivery room.
Here, one has to be creative...
Sarah
This idyllic evening makes me think of some of the extremes I have experimented here at the hospital. I have been in several situations, where if I had known about them, I probably would not have wanted to come. I have certainly done things I would NEVER have thought I would....
It was during one of my night shifts. A shift that begins at 2PM when everybody leaves and only the guard nurse is left to take care of all hospitalized patients, what comes in the ER and any deliveries.
A woman comes in for her delivery. She's alone. The husband is nowhere to be found, and for some reason she has no sister, mother, aunt cousin or neighbor with her. I recognize her - her little son was treated for tuberculosis some months earlier. I examine her. She still has a little ways to go. I check on the other hospitalized patients in between. Early morning comes and I expect the woman to deliver anytime soon. She's dilated and has a few good contractions. The head is right there.
After morning worship I give report about the night's events and hand over the woman to Rahama who is experienced in delivering babies. I go back to house and hope the goats and children will be quiet and keep away from my windows so I can get some rest.
I'm getting relaxed and ready to doze off, when the watch man calls me from outside the window "Sarah, you have to come up to the hospital. They have an emergency and need you to take care of the delivery". The delivery? That should have been over long ago? It's almost noon?! I worry if there had been any signs of complications I missed out on during the night?
On my way to the hospital I pass a group of people who have found a shady spot to sell their matches, spices and little plastic bags with sugar and salt. "Lapia" I say, knowing how not greeting people almost is taken as an insult. A teenage girl rises to follow me. She asks where I'm going, although everybody knows I mostly just walk the path between the house and the hospital. Often when I have bought something with her, she has kept the change and only by insisting and getting the help of onlooker have I got back the money she owed me. My thoughts are with the woman who has not yet delivered. What can be wrong? I'm no midwife! Just a plain RN.
Arriving at the hospital, I notice all the people gathered outside the OR. Some emergency has happened and someone is being operated. The other nurses are in there.
I arrive at the door to the delivery room. I notice the teenage girl is still behind me as I open the door. I turn and tell her to stay outside. I walk in to find the woman in great pain and to older women from the church are by her side. The husband has not showed up, neither have any relatives or friends. My mind is racing as I examine her again. Why hasn't she delivered yet? The contractions are good, there seem to be space enough for the baby to come out.... I get distracted by the sound of the door slamming. The teenage girl walks in. I widen my eyes in surprise and tell her this is not an entertainment show and she has to leave. I return to the woman. I wish I had someone to ask for help. Are there even sterile instruments around? Did anyone survey her or was she left alone when I went home?
As I turn to see if I have what I need nearby, I see the teenage girl, who has now found a comfortable place to sit down and watch! As I feel the stress of being thrown into a situation outside my competence, being tired and feeling alone, I raise my voice to make it even more clear to this girl that I meant what I said. I mobilized all my patience and explain again why she is not allowed to watch. I even tell her "PLEASE, go outside!" I know I can't concentrate on this delivery while she is sitting there.
She tilts her head, smiles subtly and says: "What if it doesn't PLEASES me to go outside?"
I'm beyond amazed! I need to get this girl out! I know I can't get violent...I look down on my gloved hand, covered with bloody vaginal secretion from examining the woman. I look sternly at the girl and walk towards her with my hand raised. As I get to her, she looks at me like she couldn't care less. I wipe my hand off on her cheek and neck, amazed at my self and she hadn't already left!!! She widens her eyes, turns and leaves. As I turn to the woman my eyes meet the two older women. They smile knowingly and nod. I think "WHAT did I just do???"
We tell the woman to PUSH and get this over with. The two older women have done this so many times before. They scold and slap her (why didn't I think of that...) and she starts to push better. Shortly after, a healthy baby comes out, I tie the cord and dry him off, extremely relieved. Everything goes well, the placenta comes out, the uterus goes hard and small, all bleeding stops.
The two women from church promise to look after the mom, and help her breastfeed. I walk to the OR. The head nurse has come out. I drag him aside and say I have something to confess. Somehow I'm sure they will not have anything to do with a nurse who smears bloody vaginal secretions over people. After telling him about the incident, he laughs hard and says "You did the right thing - she had it coming!" I can't believe my own ears.
After getting some sleep, I laugh too. And think of how much I'm learning about myself in this place, being driven beyond anything I've ever been before. Of course I have never had to things like this before, in Denmark I've never had strangers refuse to leave the delivery room.
Here, one has to be creative...
Sarah
Thursday, May 5, 2005
A tale
I feel lost in a story that seems to fly by. It's moving, intense, captivating, exhausting...and each page is turned so fast I can only catch enough glimpses to get the general idea of the what's going on...yet, each page once turned is permanently turned...you can't go back.
A woman in labor for 2 days. Seen last night by a retired health care worker. Sent to us this morning. Her baby's too big. The head is all molded and almost sticking out...but it's just skin on his head that has been squeezed out...the skull won't fit through.
I have been called from my egg and rice breakfast. I run to the OR. I grab a syringe, anesthetic, an instrument box, a scalpel, a urinary catheter and some gauze and gloves. I rush back. I shave, prep, and slice down to her pubic bone. I start to cut through the cartilage. The scalpel breaks inside. I can't find it. I yell for a flashlight and another scalpel. I mop up the blood with the gauze. I call for Lona and Rachel. They each grab a leg. I cut deeper, going by feel. I tell Lona and Rachel to pull her legs apart. I hear a crack and feel her pelvis widen at the front.
The baby slides out in a slippery bath of brownish green fluid. He's huge, has a slow heartbeat and a little muscle tone. He never breaths. Despite CPR and resuscitation for 10 minutes he never cries. He's dead.
Meanwhile Lona has delivered the placenta and casually says she's bleeding. As I'm pressing the baby's chest between my fingers and two thumbs to pump his blood I look and see that Lona has draped a gauze over the perineum which is soaked with strings of coagulated blood dripping down into the green basin as the entire area is bright red. I leave the baby. I pull off the gauze...the entire birth canal is filled with blood and a piece of tissue hanging out. I yell for more gauze...they run to get it. I cram gauze inside and pull them out so I can see what's going on. Nathan holds a flashlight over my shoulder.
It appears the cervix has completely torn itself off circumferentially and is literally hanging by a thread. I clamp the base. Then, I soak up the blood in the wound where I cut her pelvis and with the flashlight try to find the piece of broken off scalpel. No where to be seen. I fish around with a needle driver and bang against something. I dab up blood and look again. I see it and pull it out. Then I wash out and suture up. I then suture up a tear around her urethra and a small posterior perineal tear. I cut off the dangling strip of cervix, take off the clamps, see there's no bleeding and an hour and a half after starting head off for rounds.
What part do I have to play? Why am I even in this story called H�pital Adventiste de Béré? My character being in the tale, much less one of the protagonists, is as odd as Crush the turtle showing up in Blair Witch Project. I get this feeling sometimes of the other players whispering behind their backs, when they think I'm not looking, asking how did he get a part? And, doesn't he realize that his lines are totally out of place and poorly acted?
I'm called over to the TB ward. Someone's not doing well. I see one of our long-timers is in bad shape. He'd come from Kelo...had started to improve and put on weight. He has a congenitally deformed left arm where the hand faces the wrong way and the whole thing is too short. Yesterday, his cousin told me he had a fever...probably malaria. Sure enough the smear is positive. I write for Quinine and Fandsidar and forget about it.
Now, he's death warmed over. He's unconscious, gray, has a slow heart beat, his cheeks are sunken and his breathing is more like an occasional deep sigh out of reflex rather than a serious effort at obtaining oxygen. I expect him to die in front of me. I sit there and stare at him for ten minutes. If I'd only gone to see him yesterday maybe I'd have seen he was bad and been more aggressive with treatment. It's so easy to ignore the TB patients...there just there taking pills. I'm so busy, maybe I'll see them tomorrow...at least once a week...or now and then...
A little girl, also hospitalized with TB, is sitting at the foot of the bed weeping. She is the cutest, cheeriest, most helpful girl. She always yells, "James-uh", and waves as she passes by carrying laundry or water on her head. She's helped us this week trim the mango trees wanting to saw as much as she can even if it doesn't really do much. Now, as easily as she laughs, she cries for someone she wouldn't know except for their common disease...I feel useless...I want to cry too...I want to run home and hide...I want to be a little kid again...but I just stand and stare and then walk lamely off with a blank expression...
Yet, somehow, it works. Beyond all rational thought, the play goes on...the plot thickens...the suspense builds...the rivals grow to respect each other...love is found in the most unexpected of places...laughter pops up randomly...joy is found...
I see all three "James-uhs" today. I've had three kids born here since I've been here who are named for me. The first one is the Chaplain's grandson. He's also been treated for Malaria a couple times and just wandered in with his mom looking healthy. James-uh 2 was brought in when 3 days old with a strangulated umbilical hernia that we operated on urgently. He recovered, then developed a wound infection and came in daily for a while for antibiotic shots and dressing changes. He sees me today as one of the sutures has poked through the skin and is sticking out. He is a round, chubby, dark baby with a serious afro going on and a vigorous cry and kick as I cut the suture and pull it out.
James-uh 3 is weak and malnourished. He is the surviving twin of Yvonne, born of c-section to an HIV+ mom. David, his bro, died last week. He manages to barely hang on. We tried him on formula to protect him from mommy's HIV and almost killed him with the diarrhea and lactose-intolerance. He's somehow toughing it out and I see him stretch out his puny arms for mom's breast as I change her dressing. She pulls him close and he sucks vigorously as if his life depended on it...and it does...
Then, despite the time in the desert, thirsty, hot, baked, dried out, tongue sticking to the roof of the mouth, hot, unbearable...despite it coming to an end with refreshing rain and cool winds and pleasant evenings...the sleeplessness continues. The thoughts ramble. The feeling of hopelessness for change enters. The spirit isn't even willing and the flesh is very weak.
A well-groomed, stocky man walks into my office with jeans, a tucked-in flannel and alligator skin boots. He presents his dossier. He is the referring doctor for a patient I've just seen. I was surprised to get an official looking letter with a reference from a traditional healer that morning. He'd tried to treat her pelvic pain for 3 days without success and so now was referring to the hospital. How cool, I'd thought.
Now he's presenting me papers telling how he's met with other traditional healers from Benin and other African countries for an exchange of ideas and how they're researching traditional pharmaceuticals. I'm impressed. I ask him how he was trained. That's when things suddenly turned bizarre.
I notice he's holding a carved horn as if it was a newborn baby...tenderly and pressed against his chest. He calmly tells me that he was drowned as a child, 5 spirits entered him and revived him, and they now tell him which plants to use for which problems. I don't know what to say. We continue otherwise to chat as colleagues. I tell him we've found Shistosomes in his patient's urine and have prescribed treatment. He is gracious, polite, refined and the last way I'd expected to see my first witch doctor.
This is just the latest to confirm my suspicions of the heaviness of spiritual forces here. A few weeks ago, after morning report we somehow got on the topic and all the staff started recounting tales of the supernatural.
Rahama told of taking her husband into the bush to see a healer. He boiled water, made him stand in the vapor and then threw something at his eyes. Animal bones immediately flew out of her husband's eyes and fell to the ground. She was shocked but had presence of mind to gather them up. She showed them to me the next day.
Samedi once saw two men who came by to show their powers. One took a sharp bush knife, suddenly turned, and whacked off the head of his companion. They all saw it fall to the ground. Then he picked it up and set it back on his friend's shoulders and he started talking and moving normally.
Andr� has seen people put curses on things that if you touch them you become frozen in place till the person comes back and sees it was you who was going to steal it. The others all confirmed that this is common.
Someone told the tale of our swimming hole by the bridge where Sarah and I like to jump off the cliffs. Apparently, a healthy young man was accused of adultery and was forced to swim across...which he did fine. But on swimming back he suddenly cried, lifted his arms out, and disappeared under the surface never to be seen again.
Then, there are the simple things like, when Pastor Job from N'Djam�na was here and said he's never heard goats and animals make so much noise or be so bothersome. He said they must be possessed. I'd thought the same thing but was afraid of sounding silly or paranoid if I mentioned it. Why else would they poop on our porch exclusively, pee right out side our windows, bleat uncontrollably for no reason just as we fall asleep and basically do as much as possible to assure we get no rest.
Spiritual forces are palpable here. I believe that God will protect me...but how to battle for the others? I've seen many patients I'm convinced should've lived except there was always some "sorcellerie" going on, or as the patients say, "he's been poisoned" meaning had a spell cast on him. What can I do? I feel helpless and inadequate...
I wonder like Sam Gamgee as he wanders the wilds near Mordor if they will write about me in the tales or am I way too insignificant...do I have an important part to play in this cosmic story? Will I have made a difference when the credits roll?
Somehow, I know that in the end, as I sit around the campfires of heaven, I will have stories to tell. People will say, tell me more about Samedi, and Lona, and Anatole and especially, about Sarah...did you really?...Are you serious?...No way!...That's what keeps me going...even though, or especially because, a place like this is beyond my wildest nightmares...it begins to take on a mythic quality. I feel detached at times, looking at myself, wondering if this is reality or just another movie, a story, a tale, something someone made up...and just maybe Someone did and the ending will be beyond my fondest dreams...
To be continued...
James
A woman in labor for 2 days. Seen last night by a retired health care worker. Sent to us this morning. Her baby's too big. The head is all molded and almost sticking out...but it's just skin on his head that has been squeezed out...the skull won't fit through.
I have been called from my egg and rice breakfast. I run to the OR. I grab a syringe, anesthetic, an instrument box, a scalpel, a urinary catheter and some gauze and gloves. I rush back. I shave, prep, and slice down to her pubic bone. I start to cut through the cartilage. The scalpel breaks inside. I can't find it. I yell for a flashlight and another scalpel. I mop up the blood with the gauze. I call for Lona and Rachel. They each grab a leg. I cut deeper, going by feel. I tell Lona and Rachel to pull her legs apart. I hear a crack and feel her pelvis widen at the front.
The baby slides out in a slippery bath of brownish green fluid. He's huge, has a slow heartbeat and a little muscle tone. He never breaths. Despite CPR and resuscitation for 10 minutes he never cries. He's dead.
Meanwhile Lona has delivered the placenta and casually says she's bleeding. As I'm pressing the baby's chest between my fingers and two thumbs to pump his blood I look and see that Lona has draped a gauze over the perineum which is soaked with strings of coagulated blood dripping down into the green basin as the entire area is bright red. I leave the baby. I pull off the gauze...the entire birth canal is filled with blood and a piece of tissue hanging out. I yell for more gauze...they run to get it. I cram gauze inside and pull them out so I can see what's going on. Nathan holds a flashlight over my shoulder.
It appears the cervix has completely torn itself off circumferentially and is literally hanging by a thread. I clamp the base. Then, I soak up the blood in the wound where I cut her pelvis and with the flashlight try to find the piece of broken off scalpel. No where to be seen. I fish around with a needle driver and bang against something. I dab up blood and look again. I see it and pull it out. Then I wash out and suture up. I then suture up a tear around her urethra and a small posterior perineal tear. I cut off the dangling strip of cervix, take off the clamps, see there's no bleeding and an hour and a half after starting head off for rounds.
What part do I have to play? Why am I even in this story called H�pital Adventiste de Béré? My character being in the tale, much less one of the protagonists, is as odd as Crush the turtle showing up in Blair Witch Project. I get this feeling sometimes of the other players whispering behind their backs, when they think I'm not looking, asking how did he get a part? And, doesn't he realize that his lines are totally out of place and poorly acted?
I'm called over to the TB ward. Someone's not doing well. I see one of our long-timers is in bad shape. He'd come from Kelo...had started to improve and put on weight. He has a congenitally deformed left arm where the hand faces the wrong way and the whole thing is too short. Yesterday, his cousin told me he had a fever...probably malaria. Sure enough the smear is positive. I write for Quinine and Fandsidar and forget about it.
Now, he's death warmed over. He's unconscious, gray, has a slow heart beat, his cheeks are sunken and his breathing is more like an occasional deep sigh out of reflex rather than a serious effort at obtaining oxygen. I expect him to die in front of me. I sit there and stare at him for ten minutes. If I'd only gone to see him yesterday maybe I'd have seen he was bad and been more aggressive with treatment. It's so easy to ignore the TB patients...there just there taking pills. I'm so busy, maybe I'll see them tomorrow...at least once a week...or now and then...
A little girl, also hospitalized with TB, is sitting at the foot of the bed weeping. She is the cutest, cheeriest, most helpful girl. She always yells, "James-uh", and waves as she passes by carrying laundry or water on her head. She's helped us this week trim the mango trees wanting to saw as much as she can even if it doesn't really do much. Now, as easily as she laughs, she cries for someone she wouldn't know except for their common disease...I feel useless...I want to cry too...I want to run home and hide...I want to be a little kid again...but I just stand and stare and then walk lamely off with a blank expression...
Yet, somehow, it works. Beyond all rational thought, the play goes on...the plot thickens...the suspense builds...the rivals grow to respect each other...love is found in the most unexpected of places...laughter pops up randomly...joy is found...
I see all three "James-uhs" today. I've had three kids born here since I've been here who are named for me. The first one is the Chaplain's grandson. He's also been treated for Malaria a couple times and just wandered in with his mom looking healthy. James-uh 2 was brought in when 3 days old with a strangulated umbilical hernia that we operated on urgently. He recovered, then developed a wound infection and came in daily for a while for antibiotic shots and dressing changes. He sees me today as one of the sutures has poked through the skin and is sticking out. He is a round, chubby, dark baby with a serious afro going on and a vigorous cry and kick as I cut the suture and pull it out.
James-uh 3 is weak and malnourished. He is the surviving twin of Yvonne, born of c-section to an HIV+ mom. David, his bro, died last week. He manages to barely hang on. We tried him on formula to protect him from mommy's HIV and almost killed him with the diarrhea and lactose-intolerance. He's somehow toughing it out and I see him stretch out his puny arms for mom's breast as I change her dressing. She pulls him close and he sucks vigorously as if his life depended on it...and it does...
Then, despite the time in the desert, thirsty, hot, baked, dried out, tongue sticking to the roof of the mouth, hot, unbearable...despite it coming to an end with refreshing rain and cool winds and pleasant evenings...the sleeplessness continues. The thoughts ramble. The feeling of hopelessness for change enters. The spirit isn't even willing and the flesh is very weak.
A well-groomed, stocky man walks into my office with jeans, a tucked-in flannel and alligator skin boots. He presents his dossier. He is the referring doctor for a patient I've just seen. I was surprised to get an official looking letter with a reference from a traditional healer that morning. He'd tried to treat her pelvic pain for 3 days without success and so now was referring to the hospital. How cool, I'd thought.
Now he's presenting me papers telling how he's met with other traditional healers from Benin and other African countries for an exchange of ideas and how they're researching traditional pharmaceuticals. I'm impressed. I ask him how he was trained. That's when things suddenly turned bizarre.
I notice he's holding a carved horn as if it was a newborn baby...tenderly and pressed against his chest. He calmly tells me that he was drowned as a child, 5 spirits entered him and revived him, and they now tell him which plants to use for which problems. I don't know what to say. We continue otherwise to chat as colleagues. I tell him we've found Shistosomes in his patient's urine and have prescribed treatment. He is gracious, polite, refined and the last way I'd expected to see my first witch doctor.
This is just the latest to confirm my suspicions of the heaviness of spiritual forces here. A few weeks ago, after morning report we somehow got on the topic and all the staff started recounting tales of the supernatural.
Rahama told of taking her husband into the bush to see a healer. He boiled water, made him stand in the vapor and then threw something at his eyes. Animal bones immediately flew out of her husband's eyes and fell to the ground. She was shocked but had presence of mind to gather them up. She showed them to me the next day.
Samedi once saw two men who came by to show their powers. One took a sharp bush knife, suddenly turned, and whacked off the head of his companion. They all saw it fall to the ground. Then he picked it up and set it back on his friend's shoulders and he started talking and moving normally.
Andr� has seen people put curses on things that if you touch them you become frozen in place till the person comes back and sees it was you who was going to steal it. The others all confirmed that this is common.
Someone told the tale of our swimming hole by the bridge where Sarah and I like to jump off the cliffs. Apparently, a healthy young man was accused of adultery and was forced to swim across...which he did fine. But on swimming back he suddenly cried, lifted his arms out, and disappeared under the surface never to be seen again.
Then, there are the simple things like, when Pastor Job from N'Djam�na was here and said he's never heard goats and animals make so much noise or be so bothersome. He said they must be possessed. I'd thought the same thing but was afraid of sounding silly or paranoid if I mentioned it. Why else would they poop on our porch exclusively, pee right out side our windows, bleat uncontrollably for no reason just as we fall asleep and basically do as much as possible to assure we get no rest.
Spiritual forces are palpable here. I believe that God will protect me...but how to battle for the others? I've seen many patients I'm convinced should've lived except there was always some "sorcellerie" going on, or as the patients say, "he's been poisoned" meaning had a spell cast on him. What can I do? I feel helpless and inadequate...
I wonder like Sam Gamgee as he wanders the wilds near Mordor if they will write about me in the tales or am I way too insignificant...do I have an important part to play in this cosmic story? Will I have made a difference when the credits roll?
Somehow, I know that in the end, as I sit around the campfires of heaven, I will have stories to tell. People will say, tell me more about Samedi, and Lona, and Anatole and especially, about Sarah...did you really?...Are you serious?...No way!...That's what keeps me going...even though, or especially because, a place like this is beyond my wildest nightmares...it begins to take on a mythic quality. I feel detached at times, looking at myself, wondering if this is reality or just another movie, a story, a tale, something someone made up...and just maybe Someone did and the ending will be beyond my fondest dreams...
To be continued...
James
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