I can feel my heart start to beat a little faster in anticipation. My mouth starts to water and I hope I don't drool. The suspense is killing me! Every time I see someone with some kind of rag draped over a body part or waddling in like a sore cowboy after a long ride wearing nothing but a wrap draped around the waist, I can't help but wonder, what gross thing am I going to get to cut open or take out next?
Friday, it's an eight-year-old boy from Kélo. The father brings him in his arms. The right leg is draped in an army green rag that was probably a shirt at one point. The air gets a little thicker and I'm glad for my cold that dampens the odors. I quickly pull out the strip of paper to cover the exam table. The rag is hanging wet and limp. As soon as the boy is put down I regret having brought him into my office as the paper is starting to soak up whatever foul liquid is oozing from whatever it is under that "bandage." I hurriedly pick him back up myself and take him outside to the gurney where I gingerly lift up the cloth to reveal...
Saturday night, it's a quiet shake from my wife. Sarah's on night duty and I am feeling drugged from fatigue. The last two weeks we've been doing 2-3 surgeries a day and it's taking it out of me. She's saying something about a teenager who has no lung sounds on one side. I seriously can't wake up. I'm trying but it's like I took a sleeping pill. I mumble something about sticking a needle in over the rib and seeing if there's liquid or air making the lung collapse. I tell her if there's air to come get me, if liquid than I'll see him in the morning. I wake up early Sunday morning wondering what I'll find as I walk over to the hospital in the coolness and stillness of an early African morning...
Monday, two guys waddle into my office wearing only skirts. They've both come from far away. I can hardly contain my excitement as I ask them to lie down on the exam table and fumble with the knot attaching the cloth skirt to their waist. As I slowly un-wrap it to look I find just what I was expecting...
Tuesday, I operate on a woman who'd come in the Thursday before. She had a cloth wrapped around her mid-abdomen. She'd been sick for a month with pus draining from a small hole (fistula) in her belly button. As I am poised with my scalpel after the pre-op prayer, I wonder what I'll find inside. I quickly slice down from her belly button to her pelvis. To my surprise, I find...
Wednesday, Sarah comes running up to me with an amazed grin on her face. "James, you have to see this guy's arm. It's three times the usual size." I walk into the clinic and see an elderly man with whitening hair and beard on his rugged face lying moaning on a stretcher on the floor. His left arm is wrapped in a rag that at one time ages ago was probably white. From finger tips to mid upper arm I can see nothing. The upper arm to the shoulder is swollen to three times the size of the other arm. As I grab some gloves and bend over to unwrap it and take a look I have a feeling I might find... sure enough, as I snap off the gloves and order him to surgery...
One of the glorious benefits of working in a bush hospital is the phenomenon of pus surprise. No matter how often I see it. No matter how often I suspect it. No matter how often I have to really search for it... I always find it. Seek and ye shall find is my motto for tropical pus explorers. It is usually deeper than you think... but it's always there. But why this rush when I suspect it or the anticipation when I suspect it's there hidden under some rag? Maybe I'm weird, but few things bring instant gratification like liberating some imprisoned pus.
The boy's leg is a fungating, purulent mass surrounding his entire lower leg with the exception of his foot which is swollen and edematous. I take him to surgery, wrap a blood pressure cuff around his upper thigh and slice down to his tibia. I then cut up his tibia taking off his patellar tendon from the bone. That opens up his knee joint where I cut through the ligaments and menisci exposing his patellar space. There is barely a drop of blood anywhere thanks to the tourniquet. I divide and tie his vessels and cut through his sciatic nerve. I then slice down leaving some muscle for the flap. Israel lifts off the leg under the drape while I attach the patellar tendon to the posterior cruciate ligament. I then suture the flap closed and put a dressing and ace wrap on. While I didn't get to directly liberate pus, I did get to cut it off.
Three days later he's already up on crutches moving around on his own. Sarah has been giving him books to read and crayons to draw and he is quite smart and a talented artist. He talks almost nonstop without fear. The only time he expressed any reserve was after I took the dressing off and was going to replace the bandage. In a tiny, timid voice he begged "please, not too tight, it hurts."
As I enter the OR, Sarah has already prepared the young man for his chest tube. I infiltrate around the ribs between his nipple and his armpit. I slice down to muscle and then poke up and over the rib with a curved clamp. I feel the pop. I see the stream of liquid pus squirt up. Most severely, I am almost floored by the pungent force of the odor that escapes with the pus geyser. I smell plenty of body fluids and odors in my work but this one I can barely take. It's not that I feel nauseated, I just feel like I really don't want to breathe that one more second. I try to hold my breath as I grab the large bore chest tube with the clamp and push it in over the rib and into the pleural space. I then attach the drainage chamber and suture the tube in place. The damage has been done, though, and I think I have never attached and wrapped a chest tube in place faster in my life before bursting out for a breath of fresh air. The block isn't the same for days, despite our best efforts at deodorizing.
Tuesday, I operate on the two skirt-wearing gentlemen. Out of the first, I take a newborn-baby-sized hydrocele with his testicule and cord ensemble. It's the only way for a man to really experience the joys of childbirth as we push the hydrocele out of the incision into the air I almost expect to hear a baby's cry. The joy is about the same for either. The second, I cut into his scrotum, expecting the same pleasurable result only to realize it's actually an extremely large hernia. Changing strategy mid-operation, I open up his inguinal canal but with the size of the defect and sac I'm obligated to take out his testicule and cord as well. Well, it's almost as good as pus!
Unfortunately, as I follow the fistula down from the woman's umbilicus I find it leads to the bladder which is filled with friable tumor which I scrape out as much as I can. I know that this is a very advanced cancer that I can do nothing about so I'm forced to close up and give the family the bad news. Sometimes the surprise is a bad surprise...especially when there's something besides pus. If you find pus, you can usually do something about it. If you find cancer...
I lift off the rags from the man's arm. The whole arm is three times the usual size. The skin on the back of his hand is like the bladder from a basketball that is half-filled with water. It pokes in and bounces out as if there's nothing but liquid inside. His skin is peeling off in many places and in others is like wet cornmeal that crumbles off when rubbed. He has blisters in spots and holes leaking pus in a few spots. We inject Diazepam and Ketamine to put him under and I incise down the back of his wrist. Yellow and red liquid seeps out. I extend the incision towards his shoulder with scissors. The skin is thin and like rubber with nothing attached underneath all the way to the elbow. There is just a little yellow jello like substance that melts away with pressure like a jellyfish caught on the beach on a hot summer day. I find what used to be muscle or fat but is now just a fibrous mass the consistency of sponge cake which dissolves into pus when my fingers dig into it searching for the limits of the infection. I pull up mats of this spongy pus leaving anatomy I haven't seen since cadaver lab in Gross Anatomy my first year of med school. All the superficial veins are intact and thrombosed. A fine net of superficial nerves remains draped over the veins. All the tendons and aponeuroses are exposed on the back of the hand leaving skin covering the fingers like an inverted weight lifter's glove. When I finish debriding the wound it extends from the base of the fingers to above the elbow and half way around the circumference of the arm on both sides. The other side of the arm, while swollen, doesn't appear to be necrotic or pus-filled.
We wrap up the arm in diluted bleach soaked lap sponges and wrap it tightly with an ACE wrap before letting off the blood pressure cuff tourniquet. There is some brisk bleeding near the elbow that I compress while sending Siméon to get a sand bag. A family member soon comes with a piece of cloth filled with a few kilos of sand that I place over the bleeding part to compress it and we take him out to his bed.
I'll never forget the pleasant sensation of feeling my fingers dig into that mass of necrotic fat and muscle squeezing out the pus along the length of the man's arm. To get all that nastiness out is a source of great satisfaction. I pray that with dressing changes and powerful antibiotics we'll be able to save his arm by liberating his pus surprise!
James
Friday, December 29, 2006
Darkness II
One minute I'm eating my Danish tuna pasta salad garnished with circles of fresh green pepper and the next I can't even see my hand in front of my face. Then, silence abruptly descends as the motor driving the generator is shut off. With the increasing silence, the sounds of mourning increases as well. The wails and shrieks and moans that have become all too common and yet still cut deep into my psyche with their piercing hopelessness come from directly behind our house.
It must be our neighbors. It must be the family of Allawaye, the father of "Naked Boy" and "One Armed Boy", our little neighbors with self-explanatory names (although "Naked Boy" has recently transformed himself into "T-shirt and Sometimes Pants Boy"). Allawaye's third wife's little one-year-old was recently hospitalized for meningitis and treated with a full course of IV Chloramphenicol. At discharge, the fontanel was normal, there was no fever, and the child was breastfeeding and otherwise acting cured. Three days later, the child came back seizing and with a tense fontanel. The H. flu bacteria infecting his little cerebral spinal fluid was resistant. We had no other good alternative but did what we could.
Last night, David came to talk to me.
"Allawaye's wife came to the gate with the child insisting on going home. I told them to wait until morning."
This morning, I enter the peds ward and see Allawaye with two of his wives including the mother of the child with meningitis. The mother looks down the whole time and has a scowl on her face. The baby is breastfeeding... an improvement from two days ago when I was forced to put in a feeding tube. The fontanel has become less tense. I start to explain to Allawaye that while the baby is still sick and could die, there are some positive signs. Just then the other wife pipes up with a low, vicious voice and an evil glare. The nurse translates her Nangjere. She insists on going home. The child isn't better. Our treatments haven't worked. It's time to consult the witchdoctor.
I make her leave and continue to explain to Allawaye why I think the child should stay in the hospital. He seems to understand and agrees to finish treatment. The mother of the child continues to act like we're trying to torture her child by asking him to stay.
I offer to pray for the child and they accept. I'm desperate for God to prove that it's not some witchcraft that is making the child sick (although, I guess one could say all sickness originates with our enemy, the devil). I ask that God continue to heal the child. We've done our best but with the limit in our arsenal of antibiotics we need a miracle.
Now, in the crying, wailing, and yelling coming from next door I'm afraid God has once again not intervened.
Siméon told me this evening another related tall tale.
On Friday, a boy from lie presents with a leg wound "treated" for 18 days at the Kélo Hospital. All I see is a fungating mass encompassing his entire lower leg between the knee and ankle. The foot is swollen and the eight-year-old is in obvious pain. We take him immediately to surgery.
His leg is doubled up in contractures from weeks of not moving so I prop up the leg with rolled up towels after giving him his spinal anesthetic. He is naturally afraid, but curious at the same time. I feel his eyes on my every movement. I put on my sterile gloves and attach sterile towels around the legs, leaving just the knee exposed. I'm about ready to start, but then Israel asks if I'm going to let the boy watch. I look over and see him still staring at me in wonder tinged with anxiety.
I ask for a sterile drape as well so that the surgical site can be hidden from the boy's view. Israel pumps up the blood pressure cuff around his thigh to 260 and then I pray before starting. I imagine in my head the two flaps I want to create and then slice down to bone across the anterior tibia. I retract up the skin flap with forceps and slice up the bone cutting off the patellar tendon from its attachment. I then enter the knee joint and cut across the menisci and the ligaments. There is no blood thanks to the tourniquet. The only things holding the leg on now are the popliteal blood vessels, the sciatic nerve and the posterior muscles. I dissect a little around the vessels and clamp and tie them off before cutting them loose along with the nerve. I then slice inferiorly to leave a muscle flap and have Israel pull off the leg from under the drape. He tosses it in the trash as I sew up the two flaps and wrap an Ace bandage around the wound.
As I'm about to leave the OR after the boy has been taken out and we've cleaned up, I pause over the trash can. It's in the middle of the floor filled with plastic IV bottles, tubing, tape, gauze, plastic drapes and an upside down, normal looking foot sticking straight out like someone has been dumped in there upside down. I'm reminded of Samedi's tale during the time of Dr. Kip when they did a ton of amputations and dumped the body parts in a pit behind the hospital. One day, after a rain, a woman came running into the compound screaming that someone had drowned in the now water-filled pit. All she saw was a foot sticking out and was sure there had to be a body attached somewhere in the water. I get the same feeling now as I stare down at the bottom of the boy's foot so recently attached to a living body.
Now, for the tale: apparently, Siméon had to listen to this boy talk and talk all day long the following day. He wouldn't keep quiet and told Siméon how his leg got infected. His dad sent his mom away shortly after he was born and married another woman. According to the boy, the woman is a sorceress who transforms herself into a cat. A few months ago, she had it out for the boy so she became a cat and bit his leg which subsequently got "poisoned" and that's why it didn't heal and had to be cut off. It was natural since it had been cursed by his witch stepmom.
The problem is, these stories are not uncommon. Most people's idea of cause of disease here is that it's witchcraft and someone has "poisoned" them or cast a spell on them or performed some sorcery against them. Therefore, usually some sort of "traditional" treatment has been tried before they are brought to the hospital in the throes of death. Then, the hospital is blamed when the patient dies.
As I sit in the darkness listening to my neighbors trying to appease the spirit of the departed child, dead from meningitis, I feel frustrated and hopeless. How can one fight against not only the forces of physical disease in a resource poor setting, but against the forces of ignorance and the forces of darkness? It seems sometimes that they want the person to die to prove that they were right that it was some witchcraft and that our medicines are useless. I've seen people go out of their way to discourage a patient and tell them they're going to die and after I've spent so much time trying to get them to be encouraging and hopeful, when the person finally does die, largely in part to the psychological attacks of their family, they go out of their way to say "I told you so. I knew they would die, but you kept insisting they had a chance. See, I was right and you were wrong." Nothing that I've experienced here comes close to that for discouraging.
After lighting a kerosene lamp to bring a little light to the darkness of my room, I pull out my Bible. Finally, I find what I'm looking for, but in a surprising place: right after the most famous verse in the Bible, John 3:16. "This is the verdict: Light has come into the world, but men loved darkness instead of light because their deeds were evil." John 3:19.
Yes, I can understand a little God's dilemma. He can't "mess with free will" (as he says in the movie "Bruce Almighty"). In other words, Satan has an advantage: he can use fear, force, superstition, manipulation, coercion, brutality, etc. God can't. And because I've aligned myself on God's side, I can't use those things either. As much as I'd like to take some parents by the neck and shake them until they realize they need to bring their kids to the hospital when they first become sick rather then when they're on death's door, I can't. I have to try to persuade them. But, I've found it amazingly true that men (and women) really do love the darkness rather than the light... and it's so frustrating realizing there's nothing one can do about it except continue to fight, even if it seems like a losing battle, to continue to fight, because who knows, maybe one or two will see the light and come out of the darkness...
James
It must be our neighbors. It must be the family of Allawaye, the father of "Naked Boy" and "One Armed Boy", our little neighbors with self-explanatory names (although "Naked Boy" has recently transformed himself into "T-shirt and Sometimes Pants Boy"). Allawaye's third wife's little one-year-old was recently hospitalized for meningitis and treated with a full course of IV Chloramphenicol. At discharge, the fontanel was normal, there was no fever, and the child was breastfeeding and otherwise acting cured. Three days later, the child came back seizing and with a tense fontanel. The H. flu bacteria infecting his little cerebral spinal fluid was resistant. We had no other good alternative but did what we could.
Last night, David came to talk to me.
"Allawaye's wife came to the gate with the child insisting on going home. I told them to wait until morning."
This morning, I enter the peds ward and see Allawaye with two of his wives including the mother of the child with meningitis. The mother looks down the whole time and has a scowl on her face. The baby is breastfeeding... an improvement from two days ago when I was forced to put in a feeding tube. The fontanel has become less tense. I start to explain to Allawaye that while the baby is still sick and could die, there are some positive signs. Just then the other wife pipes up with a low, vicious voice and an evil glare. The nurse translates her Nangjere. She insists on going home. The child isn't better. Our treatments haven't worked. It's time to consult the witchdoctor.
I make her leave and continue to explain to Allawaye why I think the child should stay in the hospital. He seems to understand and agrees to finish treatment. The mother of the child continues to act like we're trying to torture her child by asking him to stay.
I offer to pray for the child and they accept. I'm desperate for God to prove that it's not some witchcraft that is making the child sick (although, I guess one could say all sickness originates with our enemy, the devil). I ask that God continue to heal the child. We've done our best but with the limit in our arsenal of antibiotics we need a miracle.
Now, in the crying, wailing, and yelling coming from next door I'm afraid God has once again not intervened.
Siméon told me this evening another related tall tale.
On Friday, a boy from lie presents with a leg wound "treated" for 18 days at the Kélo Hospital. All I see is a fungating mass encompassing his entire lower leg between the knee and ankle. The foot is swollen and the eight-year-old is in obvious pain. We take him immediately to surgery.
His leg is doubled up in contractures from weeks of not moving so I prop up the leg with rolled up towels after giving him his spinal anesthetic. He is naturally afraid, but curious at the same time. I feel his eyes on my every movement. I put on my sterile gloves and attach sterile towels around the legs, leaving just the knee exposed. I'm about ready to start, but then Israel asks if I'm going to let the boy watch. I look over and see him still staring at me in wonder tinged with anxiety.
I ask for a sterile drape as well so that the surgical site can be hidden from the boy's view. Israel pumps up the blood pressure cuff around his thigh to 260 and then I pray before starting. I imagine in my head the two flaps I want to create and then slice down to bone across the anterior tibia. I retract up the skin flap with forceps and slice up the bone cutting off the patellar tendon from its attachment. I then enter the knee joint and cut across the menisci and the ligaments. There is no blood thanks to the tourniquet. The only things holding the leg on now are the popliteal blood vessels, the sciatic nerve and the posterior muscles. I dissect a little around the vessels and clamp and tie them off before cutting them loose along with the nerve. I then slice inferiorly to leave a muscle flap and have Israel pull off the leg from under the drape. He tosses it in the trash as I sew up the two flaps and wrap an Ace bandage around the wound.
As I'm about to leave the OR after the boy has been taken out and we've cleaned up, I pause over the trash can. It's in the middle of the floor filled with plastic IV bottles, tubing, tape, gauze, plastic drapes and an upside down, normal looking foot sticking straight out like someone has been dumped in there upside down. I'm reminded of Samedi's tale during the time of Dr. Kip when they did a ton of amputations and dumped the body parts in a pit behind the hospital. One day, after a rain, a woman came running into the compound screaming that someone had drowned in the now water-filled pit. All she saw was a foot sticking out and was sure there had to be a body attached somewhere in the water. I get the same feeling now as I stare down at the bottom of the boy's foot so recently attached to a living body.
Now, for the tale: apparently, Siméon had to listen to this boy talk and talk all day long the following day. He wouldn't keep quiet and told Siméon how his leg got infected. His dad sent his mom away shortly after he was born and married another woman. According to the boy, the woman is a sorceress who transforms herself into a cat. A few months ago, she had it out for the boy so she became a cat and bit his leg which subsequently got "poisoned" and that's why it didn't heal and had to be cut off. It was natural since it had been cursed by his witch stepmom.
The problem is, these stories are not uncommon. Most people's idea of cause of disease here is that it's witchcraft and someone has "poisoned" them or cast a spell on them or performed some sorcery against them. Therefore, usually some sort of "traditional" treatment has been tried before they are brought to the hospital in the throes of death. Then, the hospital is blamed when the patient dies.
As I sit in the darkness listening to my neighbors trying to appease the spirit of the departed child, dead from meningitis, I feel frustrated and hopeless. How can one fight against not only the forces of physical disease in a resource poor setting, but against the forces of ignorance and the forces of darkness? It seems sometimes that they want the person to die to prove that they were right that it was some witchcraft and that our medicines are useless. I've seen people go out of their way to discourage a patient and tell them they're going to die and after I've spent so much time trying to get them to be encouraging and hopeful, when the person finally does die, largely in part to the psychological attacks of their family, they go out of their way to say "I told you so. I knew they would die, but you kept insisting they had a chance. See, I was right and you were wrong." Nothing that I've experienced here comes close to that for discouraging.
After lighting a kerosene lamp to bring a little light to the darkness of my room, I pull out my Bible. Finally, I find what I'm looking for, but in a surprising place: right after the most famous verse in the Bible, John 3:16. "This is the verdict: Light has come into the world, but men loved darkness instead of light because their deeds were evil." John 3:19.
Yes, I can understand a little God's dilemma. He can't "mess with free will" (as he says in the movie "Bruce Almighty"). In other words, Satan has an advantage: he can use fear, force, superstition, manipulation, coercion, brutality, etc. God can't. And because I've aligned myself on God's side, I can't use those things either. As much as I'd like to take some parents by the neck and shake them until they realize they need to bring their kids to the hospital when they first become sick rather then when they're on death's door, I can't. I have to try to persuade them. But, I've found it amazingly true that men (and women) really do love the darkness rather than the light... and it's so frustrating realizing there's nothing one can do about it except continue to fight, even if it seems like a losing battle, to continue to fight, because who knows, maybe one or two will see the light and come out of the darkness...
James
Thursday, December 28, 2006
Darkness
One minute I'm eating my Danish tuna pasta salad garnished with circles of fresh green pepper and the next I can't even see my hand in front of my face. Then, silence abruptly descends as the motor driving the generator is shut off. With the increasing silence, the sounds of mourning increases as well. The wails and shrieks and moans that have become all to common and yet still cut deep into my psyche with its piercing hopelessness come from directly behind our house.
It must be our neighbors. It must be the family of Allawaye, the father of "Naked Boy" and "One Armed Boy", our little neighbors with self-explanatory names (although "Naked Boy" has recently transformed himself into "T-shirt and Sometimes Pants Boy"). Allawaye's third wife's little one year old was recently hospitalized for meningitis and treated with a full course of IV Chloramphenicol. At discharge, the fontanel was normal, there was no fever and the child was breastfeeding and otherwise acting cured. Three days later, the child comes back seizing and with a tense fontanel. The H. flu bacteria infecting his little cerebral spinal fluid was resistant. We had no good other alternative but did what we could.
Last night, David comes to talk to me.
"Allawaye's wife came to the gate with the child insisting on going home. I told them to wait until morning."
This morning, I enter the peds ward and see Allawaye with two of his wives including the mother of the child with meningitis. The mother looks down the whole time and has a scowl on her face. The baby is breastfeeding...an improvement from two days ago when I was forced to put in a feeding tube. The fontanel has become less tense. I start to explain to Allawaye that while the baby is still sick and could die, there are some positive signs. Just then the other wife pipes up with a low, vicious voice and an evil glare. The nurse translates her Nangjere. She insists on going home. The child isn't better. Our treatments haven't worked. It's time to consult the witchdoctor.
I make her leave and continue to explain to Allawaye why I think the child should stay in the hospital. He seems to understand and agrees to finish treatment. The mother of the child continues to act like we're trying to torture her child by asking him to stay. I offer to pray for the child and they accept. I'm desperate for God to prove that it's not some witchcraft that is making the child sick (although, I guess one could say all sickness originates with our enemy, the devil). I ask that he continue to heal the child. We've done our best but with the limit in our arsenal of antibiotics we need a miracle.
Now, in the crying, wailing and yelling coming from next door I'm afraid God has once again not intervened.
Siméon told me this evening another, related tall tale.
Friday, a boy from lie presents with a leg wound "treated" for 18 days at the Kélo Hospital. All I see is a fungating mass encompassing his entire lower leg between the knee and ankle. The foot is swollen and the eight year old is in obvious pain. We take him immediately to surgery.
His leg is doubled up in contractures from weeks of not moving so I prop up the leg with rolled up towels after giving him his spinal anesthetic. He is naturally afraid and curious at the same time. I feel his eyes on my every movement. I put on my sterile gloves and attach sterile towels around the legs leaving just the knee exposed. I'm about ready to start, but then Israel asks if I’m going to let the boy watch. I look over and see him still staring at me in wonder tinged with anxiety.
I ask for a sterile drape as well so that the surgical site can be hidden from the boy's view. Israel pumps up the blood pressure cuff around his thigh to 260 and then I pray before starting. I imagine in my head the two flaps I want to create and then slice down to bone across the anterior tibia. I retract up the skin flap with forceps and slice up the bone cutting off the patellar tendon from its attachment. I then enter the knee joint and cut across the menisci and the ligaments. There is no blood thanks to the tourniquet. The only things holding the leg on now are the popliteal blood vessels, the sciatic nerve and the posterior muscles. I dissect a little around the vessels and clamp and tie them off before cutting them loose along with the nerve. I then slice inferiorly to leave a muscle flap and have Israel pull off the leg from under the drape. He tosses it in the trash as I sew up the two flaps and wrap an Ace bandage around the wound.
As I'm about to leave the OR after the boy has been taken out and we've cleaned up, I pause over the trash can. It's in the middle of the floor filled with plastic IV bottles, tubing, tape, gauze, plastic drapes and an upside down, normal looking foot sticking straight out like someone has
been dumped in their upside down. I'm reminded of Samedi's tale during the time of Dr. Kip when they did a ton of amputations and dumped the body parts in a pit behind the hospital. One day, after a rain, a woman came running into the compound screaming that someone had derowned in the now water-filled pit. All she saw was a foot sticking out and was sure there had to be a body attached somewhere in the water. I get the same feeling now as I stare down at the bottom of the boy's foot so recently attached to a living body.
Now, for the tale: apparently, Siméon had to listen to this boy talk and talk all day long the following day. He wouldn't keep quiet and told Siméon how his leg got infected. His dad sent his mom away shortly after he was born and married another woman. According to the boy, the
woman is a sorceress who transforms herself into a cat. A few months ago, she had it out for the boy so she became a cat and bit his leg which subsequently got "poisoned" and that's why it didn't heal and had to be cut off. It was natural since it had been cursed by his witch stepmom. The problem is, these stories are not uncommon. Most people's idea of cause of disease here is that it's witchcraft and someone has "poisoned" them or cast a spell on them or performed some sorcery against them. Therefore, usually some sort of "traditional" treatment has been tried before they are brought to the hospital in the throes of death. Then, the hospital is blamed when the patient dies.
As I sit in the darkness listening to my neighbors trying to appease the spirit of the departed child, dead from meningitis, I feel frustrated and hopeless. How can one fight against not only the forces of physical disease in a resource poor setting, but against the forces of ignorance and the forces of darkness? It seems sometimes that they want the person to die to prove that they were right that it was some witchcraft and that our medicines are useless. I've seen people go out of their way to discourage a patient and tell them they're going to die and after I've spent so much time trying to get them to be encouraging and hopeful, when the person finally does die, largely in part to the psychological attacks of their family, they go out of their way to say "I told you so. I knew they would die, but you kept insisting they had a chance. See, I was right and you were wrong." Nothing that I've experienced here comes close to that for discouraging.
After lighting a kerosene lamp to bring a little light to the darkness of my room I pull out my Bible. Finally, I find what I'm looking for, but in a surprising place: right after the most famous verse in the Bible, John 3:16. "This is the verdict: Light has come into the world, but men loved darkness instead of light because their deeds were evil." John 3:19.
Yes, I can understand a little God's dilemma. He can't "mess with free will" (as he says in the movie "Bruce Almighty"). In other words, Satan has an advantage: he can use fear, force, superstition, manipulation, coercion, brutality, etc. God can't. And because I've aligned myself on God's side, I can't use those things either. As much as I'd like to take some parents by the neck and shake them until they realize they need to bring their kids to the hospital when they first become sick rather then when they're on death's door, I can't. I have to try and persuade them. But, I've found it amazingly true: men (and women) really do love the darkness rather than the light...and it's so frustrating realizing there's nothing one can do about it except continue to fight, even if it seems like a losing battle, to continue to fight, because who knows, maybe one or two will see the light and come out of the darkness...
James
It must be our neighbors. It must be the family of Allawaye, the father of "Naked Boy" and "One Armed Boy", our little neighbors with self-explanatory names (although "Naked Boy" has recently transformed himself into "T-shirt and Sometimes Pants Boy"). Allawaye's third wife's little one year old was recently hospitalized for meningitis and treated with a full course of IV Chloramphenicol. At discharge, the fontanel was normal, there was no fever and the child was breastfeeding and otherwise acting cured. Three days later, the child comes back seizing and with a tense fontanel. The H. flu bacteria infecting his little cerebral spinal fluid was resistant. We had no good other alternative but did what we could.
Last night, David comes to talk to me.
"Allawaye's wife came to the gate with the child insisting on going home. I told them to wait until morning."
This morning, I enter the peds ward and see Allawaye with two of his wives including the mother of the child with meningitis. The mother looks down the whole time and has a scowl on her face. The baby is breastfeeding...an improvement from two days ago when I was forced to put in a feeding tube. The fontanel has become less tense. I start to explain to Allawaye that while the baby is still sick and could die, there are some positive signs. Just then the other wife pipes up with a low, vicious voice and an evil glare. The nurse translates her Nangjere. She insists on going home. The child isn't better. Our treatments haven't worked. It's time to consult the witchdoctor.
I make her leave and continue to explain to Allawaye why I think the child should stay in the hospital. He seems to understand and agrees to finish treatment. The mother of the child continues to act like we're trying to torture her child by asking him to stay. I offer to pray for the child and they accept. I'm desperate for God to prove that it's not some witchcraft that is making the child sick (although, I guess one could say all sickness originates with our enemy, the devil). I ask that he continue to heal the child. We've done our best but with the limit in our arsenal of antibiotics we need a miracle.
Now, in the crying, wailing and yelling coming from next door I'm afraid God has once again not intervened.
Siméon told me this evening another, related tall tale.
Friday, a boy from lie presents with a leg wound "treated" for 18 days at the Kélo Hospital. All I see is a fungating mass encompassing his entire lower leg between the knee and ankle. The foot is swollen and the eight year old is in obvious pain. We take him immediately to surgery.
His leg is doubled up in contractures from weeks of not moving so I prop up the leg with rolled up towels after giving him his spinal anesthetic. He is naturally afraid and curious at the same time. I feel his eyes on my every movement. I put on my sterile gloves and attach sterile towels around the legs leaving just the knee exposed. I'm about ready to start, but then Israel asks if I’m going to let the boy watch. I look over and see him still staring at me in wonder tinged with anxiety.
I ask for a sterile drape as well so that the surgical site can be hidden from the boy's view. Israel pumps up the blood pressure cuff around his thigh to 260 and then I pray before starting. I imagine in my head the two flaps I want to create and then slice down to bone across the anterior tibia. I retract up the skin flap with forceps and slice up the bone cutting off the patellar tendon from its attachment. I then enter the knee joint and cut across the menisci and the ligaments. There is no blood thanks to the tourniquet. The only things holding the leg on now are the popliteal blood vessels, the sciatic nerve and the posterior muscles. I dissect a little around the vessels and clamp and tie them off before cutting them loose along with the nerve. I then slice inferiorly to leave a muscle flap and have Israel pull off the leg from under the drape. He tosses it in the trash as I sew up the two flaps and wrap an Ace bandage around the wound.
As I'm about to leave the OR after the boy has been taken out and we've cleaned up, I pause over the trash can. It's in the middle of the floor filled with plastic IV bottles, tubing, tape, gauze, plastic drapes and an upside down, normal looking foot sticking straight out like someone has
been dumped in their upside down. I'm reminded of Samedi's tale during the time of Dr. Kip when they did a ton of amputations and dumped the body parts in a pit behind the hospital. One day, after a rain, a woman came running into the compound screaming that someone had derowned in the now water-filled pit. All she saw was a foot sticking out and was sure there had to be a body attached somewhere in the water. I get the same feeling now as I stare down at the bottom of the boy's foot so recently attached to a living body.
Now, for the tale: apparently, Siméon had to listen to this boy talk and talk all day long the following day. He wouldn't keep quiet and told Siméon how his leg got infected. His dad sent his mom away shortly after he was born and married another woman. According to the boy, the
woman is a sorceress who transforms herself into a cat. A few months ago, she had it out for the boy so she became a cat and bit his leg which subsequently got "poisoned" and that's why it didn't heal and had to be cut off. It was natural since it had been cursed by his witch stepmom. The problem is, these stories are not uncommon. Most people's idea of cause of disease here is that it's witchcraft and someone has "poisoned" them or cast a spell on them or performed some sorcery against them. Therefore, usually some sort of "traditional" treatment has been tried before they are brought to the hospital in the throes of death. Then, the hospital is blamed when the patient dies.
As I sit in the darkness listening to my neighbors trying to appease the spirit of the departed child, dead from meningitis, I feel frustrated and hopeless. How can one fight against not only the forces of physical disease in a resource poor setting, but against the forces of ignorance and the forces of darkness? It seems sometimes that they want the person to die to prove that they were right that it was some witchcraft and that our medicines are useless. I've seen people go out of their way to discourage a patient and tell them they're going to die and after I've spent so much time trying to get them to be encouraging and hopeful, when the person finally does die, largely in part to the psychological attacks of their family, they go out of their way to say "I told you so. I knew they would die, but you kept insisting they had a chance. See, I was right and you were wrong." Nothing that I've experienced here comes close to that for discouraging.
After lighting a kerosene lamp to bring a little light to the darkness of my room I pull out my Bible. Finally, I find what I'm looking for, but in a surprising place: right after the most famous verse in the Bible, John 3:16. "This is the verdict: Light has come into the world, but men loved darkness instead of light because their deeds were evil." John 3:19.
Yes, I can understand a little God's dilemma. He can't "mess with free will" (as he says in the movie "Bruce Almighty"). In other words, Satan has an advantage: he can use fear, force, superstition, manipulation, coercion, brutality, etc. God can't. And because I've aligned myself on God's side, I can't use those things either. As much as I'd like to take some parents by the neck and shake them until they realize they need to bring their kids to the hospital when they first become sick rather then when they're on death's door, I can't. I have to try and persuade them. But, I've found it amazingly true: men (and women) really do love the darkness rather than the light...and it's so frustrating realizing there's nothing one can do about it except continue to fight, even if it seems like a losing battle, to continue to fight, because who knows, maybe one or two will see the light and come out of the darkness...
James
Der
I'm walking back from the hospital. I've just finished late Sunday morning rounds and plan on doing some emails or computer work. I see André standing by the gate. I waltz up and ask him what's going on. He's dressed in a light blue and white full jogging suit like he's about to head out
to warm up for some match.
"We're going to Der to visit Daniel. We haven't seen him in awhile and we heard he was deathly sick. Pierre, David and I are going as soon as David gets here."
Daniel is one of the teachers at our school. I instantly am impressed I should go. The words of my late brother, David, come to mind: "do what's important, not what's urgent." I decide this is important.
I put on my swimming suit and a t-shirt and grab the keys for the truck.
Pierre, André, Doumpa and David pile in and we head across Béré till we find a narrow, sandy track out of town heading more or less west. We go until we hit water.
"It only gets worse," remarks David, "We'll be up to our knees at least. Everything is flooded this year." There's no room to turn around but I try anyway and immediately get stuck in the thick mud of the adjacent rice field. The guys easily push me out but I decide I'll just have to back out when we get back. Little did I know how hard that would prove to be. We tumble out and I lock up.
The day is beautiful. The sky is blue like a Pacific atoll on a calm day. Billowy white clouds add character making the sky seem infinite, yet so close. The sun brings out the warm greens of the vast fields of tall, orderly rice waving in the gentle breeze in neat, but not perfect rows. The
water is warm under my feet and the sandy bottom almost makes me believe I could be near the ocean and that I should hear the crash of waves at any time.
Small fish and tad poles swim in schools around our legs and through the rice fields. Tiny, delicate dragonflies with fluorescent green heads and fluorescent blue tails flit across the surface of the water covered trail as larger, uglier dragonflies ply the air between the heads of rice. Dark, bug-like animals scoot with coordinated flaps of their legs across the sandy bottom...dragonfly larvae according to David.
Sparrow-sized, pudgy, bright red or yellow "millet eaters" chirp and dart from patches of scrub bushes on slightly elevated "islands" in between the flooded fields. The sand gives way to a black silt. The clay makes turns our march into a slick situation. I almost fall several times. We head out into the rice fields where at least walking on the grasses makes it less likely we'll slip.
The water gets deeper. I'm wading up to my thighs. The path/river takes a bend around an "island" and I finally see the village poking their thatch roofed heads above the tall heads of millet and between the mango trees. Smoke rises from several cooking fires. I reach a dry path and put my shoes back on.
David, Doumpa and I wait up for Andre and Pierre and then we march through the village till we find Daniel's house at the other side. It has been blown down in the last rain. When it rains it pours! We finally catch up with him at this mother-in-law's.
Apparently, he became dizzy and weak while out working in the fields. Then he couldn't move his legs and arms because they just cramped up. He thought he was going to die. All his family and friends came by but refused to pray for him because he's been going to the Adventist Church. "Pronounce the name of the Evangelical Church of Chad or we won't pray for you," they said. So he did. He was very confused though, wondering why Christians wouldn't pray for other
Christians just because they were from a different denomination. I wondered the same thing out loud to him.
After all, at the Adventist Hospital we pray for all our patients whether Adventist, Evangelical, Muslim, Animist, Atheist, Pagan, whatever. His two daughters are sick now, too. So we convince him to come back with us. I put the four year old on my shoulders and wade back through the water until it gets shallower and shallower and arrives back at the truck. We've gone two
kilometers each way through the flooding.
After waiting again for Andre and Pierre we start backing up. There is no problem until we almost get to the dry sand when suddenly the engine revs and the car slows down as the
right front sinks.
I get out to look and see that apparently the hard sand is only about a foot thick under which is a liquid soup of muddy sand. We work for an hour or so without even the slightest movement of the truck. I call Rich Hoyt again to see if he can pull me out. I can't get a hold of him. I try Sarah, nothing. Andre finally calls Enock, the guy who's building our staff housing who agrees to go search for Rich. David heads off on foot since it's getting dark and he needs to start the generator at the hospital and start his shift as night watchman. We are about to head off on foot
ourselves when we see and hear a motorcycle followed by a Land Cruiser. They've come!
Rich comes to check things out on foot and then returns to the Land Cruiser to turn it around and back up to pull us out. He ignores the rule he'd taught me last time he pulled me out and backs into a field to turn around. Now he's stuck too!
Enock heads off to the Evangelical Church of Chad of Béré #7 to round up manpower. We wait around getting eaten alive by mosquitoes the size of small vultures. It's night and the beauty of the day has fast faded. I’m starting to get frustrated. Then, I remember that I felt impressed to come, that this was important and that I have a choice as to my reaction to a situation. Instead of getting mad, Rich and I go apart and talk. Apparently, he's had a horrible weekend and this just tops it off. But, he's amazingly upbeat. I am able to unburden some of my hard times from the past week and I realize that this bad situation has given us both a chance to debrief that we
wouldn't of had otherwise. We pray together and then the crowd arrives.
With the arms, legs and backs of 21 people, the Land Cruiser is fairly easily pushed back onto the road. Rich doesn't want to risk getting closer to us to pull us out so he goes to where the road is solid. Then, with a lot more effort but no less enthusiasm, the 21 lift the back of the truck out of the holes onto more solid ground and then push the truck out of it's front tire pits as I gun the engine for all it's worth in low four-wheel drive reverse! I get about 100 feet when the left side of the truck sinks again into the mush. This time the 21 man force just pushes the truck to the right out of the hole and I wind the engine out until I’m on solid ground! What a great feeling! (although, I don't think I want to drive again for awhile...at least until the rainy season is over!)
James
to warm up for some match.
"We're going to Der to visit Daniel. We haven't seen him in awhile and we heard he was deathly sick. Pierre, David and I are going as soon as David gets here."
Daniel is one of the teachers at our school. I instantly am impressed I should go. The words of my late brother, David, come to mind: "do what's important, not what's urgent." I decide this is important.
I put on my swimming suit and a t-shirt and grab the keys for the truck.
Pierre, André, Doumpa and David pile in and we head across Béré till we find a narrow, sandy track out of town heading more or less west. We go until we hit water.
"It only gets worse," remarks David, "We'll be up to our knees at least. Everything is flooded this year." There's no room to turn around but I try anyway and immediately get stuck in the thick mud of the adjacent rice field. The guys easily push me out but I decide I'll just have to back out when we get back. Little did I know how hard that would prove to be. We tumble out and I lock up.
The day is beautiful. The sky is blue like a Pacific atoll on a calm day. Billowy white clouds add character making the sky seem infinite, yet so close. The sun brings out the warm greens of the vast fields of tall, orderly rice waving in the gentle breeze in neat, but not perfect rows. The
water is warm under my feet and the sandy bottom almost makes me believe I could be near the ocean and that I should hear the crash of waves at any time.
Small fish and tad poles swim in schools around our legs and through the rice fields. Tiny, delicate dragonflies with fluorescent green heads and fluorescent blue tails flit across the surface of the water covered trail as larger, uglier dragonflies ply the air between the heads of rice. Dark, bug-like animals scoot with coordinated flaps of their legs across the sandy bottom...dragonfly larvae according to David.
Sparrow-sized, pudgy, bright red or yellow "millet eaters" chirp and dart from patches of scrub bushes on slightly elevated "islands" in between the flooded fields. The sand gives way to a black silt. The clay makes turns our march into a slick situation. I almost fall several times. We head out into the rice fields where at least walking on the grasses makes it less likely we'll slip.
The water gets deeper. I'm wading up to my thighs. The path/river takes a bend around an "island" and I finally see the village poking their thatch roofed heads above the tall heads of millet and between the mango trees. Smoke rises from several cooking fires. I reach a dry path and put my shoes back on.
David, Doumpa and I wait up for Andre and Pierre and then we march through the village till we find Daniel's house at the other side. It has been blown down in the last rain. When it rains it pours! We finally catch up with him at this mother-in-law's.
Apparently, he became dizzy and weak while out working in the fields. Then he couldn't move his legs and arms because they just cramped up. He thought he was going to die. All his family and friends came by but refused to pray for him because he's been going to the Adventist Church. "Pronounce the name of the Evangelical Church of Chad or we won't pray for you," they said. So he did. He was very confused though, wondering why Christians wouldn't pray for other
Christians just because they were from a different denomination. I wondered the same thing out loud to him.
After all, at the Adventist Hospital we pray for all our patients whether Adventist, Evangelical, Muslim, Animist, Atheist, Pagan, whatever. His two daughters are sick now, too. So we convince him to come back with us. I put the four year old on my shoulders and wade back through the water until it gets shallower and shallower and arrives back at the truck. We've gone two
kilometers each way through the flooding.
After waiting again for Andre and Pierre we start backing up. There is no problem until we almost get to the dry sand when suddenly the engine revs and the car slows down as the
right front sinks.
I get out to look and see that apparently the hard sand is only about a foot thick under which is a liquid soup of muddy sand. We work for an hour or so without even the slightest movement of the truck. I call Rich Hoyt again to see if he can pull me out. I can't get a hold of him. I try Sarah, nothing. Andre finally calls Enock, the guy who's building our staff housing who agrees to go search for Rich. David heads off on foot since it's getting dark and he needs to start the generator at the hospital and start his shift as night watchman. We are about to head off on foot
ourselves when we see and hear a motorcycle followed by a Land Cruiser. They've come!
Rich comes to check things out on foot and then returns to the Land Cruiser to turn it around and back up to pull us out. He ignores the rule he'd taught me last time he pulled me out and backs into a field to turn around. Now he's stuck too!
Enock heads off to the Evangelical Church of Chad of Béré #7 to round up manpower. We wait around getting eaten alive by mosquitoes the size of small vultures. It's night and the beauty of the day has fast faded. I’m starting to get frustrated. Then, I remember that I felt impressed to come, that this was important and that I have a choice as to my reaction to a situation. Instead of getting mad, Rich and I go apart and talk. Apparently, he's had a horrible weekend and this just tops it off. But, he's amazingly upbeat. I am able to unburden some of my hard times from the past week and I realize that this bad situation has given us both a chance to debrief that we
wouldn't of had otherwise. We pray together and then the crowd arrives.
With the arms, legs and backs of 21 people, the Land Cruiser is fairly easily pushed back onto the road. Rich doesn't want to risk getting closer to us to pull us out so he goes to where the road is solid. Then, with a lot more effort but no less enthusiasm, the 21 lift the back of the truck out of the holes onto more solid ground and then push the truck out of it's front tire pits as I gun the engine for all it's worth in low four-wheel drive reverse! I get about 100 feet when the left side of the truck sinks again into the mush. This time the 21 man force just pushes the truck to the right out of the hole and I wind the engine out until I’m on solid ground! What a great feeling! (although, I don't think I want to drive again for awhile...at least until the rainy season is over!)
James
Ramadan
My horse seems very tired. I have such a love-hate relationship with him. One day he seems like he's the best horse around and the next, I wonder if I shouldn't sell him. Ever since Sarah's horse chased him around until he tried to jump over a six-foot fence and dislocated his knee and broke part of his pelvis, he just hasn't been the same. Now that they're both castrated, they get along fine...but the damage is done.
Sarah and Israel are far ahead. They are both riding bareback on Sarah's horse who has boundless energy. My horse can't even walk right. Every once in a while, when I get too far behind, I make him trot to catch up but it's like pulling teeth. Sarah's horse has to be held back to keep from galloping the whole time and mine won't even do a slow trot.
But the day is beautiful and we are headed out to an Arab village to celebrate the end of Ramadan, the Muslim month-long fast. The sun is out, the sky is a deep bleu with billowy white clouds, and there is a cool breeze. Our sandy path takes us through endless fields of meter high waving deep green rice divided by rows of tall grasses swaying in the wind. There is still water on much of the path but the water table is descending rapidly as the rains have mostly come to an end.
The horses eat like pigs and are constantly turning their heads to the sides to sweep, gather and tear of luscious heads of rice. They are in perpetual search of food and never cease to eat even at night. Eat like a pig? Forget it...eat like a horse is the true saying to describe a glutton!
We pass through the Nangjere section of Kouloum Goumdah accompanied by the usual cries of "Nassara lalé, nassara lalé" wrung from the throats of a thousand kids. Soon we exit the Nangjere part and enter open fields. The arab village is not really a village but rather a few small huts scattered around a huge central cattle enclosure. The Nangjere are cultivators and the Arabs are herdsmen. The cows are all out to pasture now. We wind through some huts
until Ahmat comes running to meet us.
The staccato, ritualistic Arabic greetings commence.
"Al salaam alekum"
"Wa alekum al salaam"
"Kikef?"
"Afe tayybin"
"Afe, bet afe?"
"Al hamdullilah"
"Machallah"
"Kullo afe"
"Kullo, machallah"
"Al hamdullilah!"
Ahmat leads us through the village to his small mud brick hut. The "fancy" mud brick hut is where is mom lives while to the side is a rounded hut made in the style of a tent with wood bent over in curves covered by cow skins with a low, three-foot high door in one side. Inside is a bed made of curved, twisted sticks with a cotton mattress covered by layers of ornate Arabic rugs. The dirt floor is meticulously swept and to the side there are piles and piles of cheap, metal pots with brightly painted designs wrapped around the top. Outside is a half fence of "sekos", woven reed mats, with a large wooden mortar and pestle for pounding millet into flour. A long, pointed Arab knife in a leather sheath hangs inside the door by an equally covered long machete.
Ahmat takes us to a shelter outside the door of his mom's hut. Four large, twisted branches have been stuck in the ground with cross pieces covered with mats making a three walled enclosed resting spot. On the ground are woven reed mats covered with Arabic rugs. We are invited in as the round of Arabic greetings repeats itself with Ahmat's wife and mother.
As we lounge on the mats, Ahmat's wife brings us tea and some "Beignets", or flour donuts cooked in peanut oil. Our day is spent like this, greeting people who come to welcome us, drinking tea from time to time, eating small things here and there (millet paste, rice with a tiny bit of meat sauce, etc.)
Sarah goes into Ahmat's mom's hut and Israel and I stay outside. The chief of the village comes and we get into a conversation with a visiting Arab who'd been treated at our hospital about why Muslims shouldn't drink alcohol and why he should quit if he wants to be a good Muslim. I ask him if he can imagine standing before Allah on judgment day with a glass of "Argyle" (millet wine) in his hand. He looks horrified and then laughs as it sinks in.
At 3pm we head over to the cattle enclosure where they have cleared off some brush to make a place for the horse races. Of course, Sarah is hyped up to enter. We are some of the first to arrive but there are already 3-4 Arabs with their horses all decked out in brightly colored ribbons around the neck and along the sides. The horses are prancing as they are whipped with short pieces of rope. They all have metal bits in their mouths and are in constant motion as their rides try to control them.
I can imagine their thoughts as they see Sarah ride up, a woman on an old castrated horse with only a rope around it's nose and no fancy accoutrements. The son of Abdoulaye, an elder in the village who had been treated for weeks in the hospital for an abscess on his hand, offers to race Sarah to start of the ceremonies.
Sarah pulls up next to him and they take off together in a slow walk to the end of the cleared off patch. There is quite a contrast. Sarah's horse is calm and easily controlled while the son of Abdoulaye his constantly tugging at the reins and whipping his horse to keep him in line. The horse is bursting with energy and there is no doubt that he will win.
Finally, they are just specks on the horizon about 300 meters away. Suddenly, they both jerk their horses around and they take off at a tremendous gallop. They are moving so fast that they rapidly regain size in a blur of legs and frothing mouths. The son of Abdoulaye is standing up in the stirrups not moving at all but seeming to glide towards us as his horse releases all his pent up energy.
Sarah has a white veil tied as a scarf around the top of her head that is streaming behind her along with her long curly red hair. The speed of the horses is actually frightening as they quickly approach without slowing down in the slightest. Finally, they both tug back and reluctantly,
fighting all the way the horses are brought to a halt as the crowd scatters wondering if they might get trampled. And, to the embarrassment of all, except me and Israel, Sarah has
won!
The races continue until sundown interrupted from time to time by herds of cattle coming in for the night. Crowds of little boys wearing new Arabic robes and crowds of girls wearing new dresses and veils play to the sides. Fires are started in the cattle pen to ward of insects. Sarah races a few more times and then we go back to Ahmat's.
Ahmat requested that we bring the Jesus film with us. He'd seen part of it once when he came to visit. He is HIV-positive and was treated for two months in the hospital for TB and continues to come to visit from time to time as he made a lot of friends. It was he who helped us get the horses. So when Sarah showed him part of the Jesus film in Arabic he was very impressed and came three mornings in a row before the feast of the end of Ramadan to remind us to bring the film.
So, we set up a sheet over the side of the shelter, hook up the generator to the projector and show the Jesus film in Arabic. Most of them don’t understand standard Arabic and their reactions are kind of funny. When they see donkeys, goats, cows, horses, etc. the kids get so excited and shout out the names. When they see some apples, they shout out "Mangos!" When they see old white people it seems to be the most hilarious thing they've ever seen...white people look so funny to them.
At the end, I ask Ahmat if he understood since they speak Tchadian Arabic and the movie was in Saudi Arabian Arabic. Ahmat says he understood everything and now he knows that "Issa" is the "grand marabout", or traditional healer. So, as I lie under the stars that night before falling asleep I wonder how much did he get out of it? Only Allah knows.
James
Sarah and Israel are far ahead. They are both riding bareback on Sarah's horse who has boundless energy. My horse can't even walk right. Every once in a while, when I get too far behind, I make him trot to catch up but it's like pulling teeth. Sarah's horse has to be held back to keep from galloping the whole time and mine won't even do a slow trot.
But the day is beautiful and we are headed out to an Arab village to celebrate the end of Ramadan, the Muslim month-long fast. The sun is out, the sky is a deep bleu with billowy white clouds, and there is a cool breeze. Our sandy path takes us through endless fields of meter high waving deep green rice divided by rows of tall grasses swaying in the wind. There is still water on much of the path but the water table is descending rapidly as the rains have mostly come to an end.
The horses eat like pigs and are constantly turning their heads to the sides to sweep, gather and tear of luscious heads of rice. They are in perpetual search of food and never cease to eat even at night. Eat like a pig? Forget it...eat like a horse is the true saying to describe a glutton!
We pass through the Nangjere section of Kouloum Goumdah accompanied by the usual cries of "Nassara lalé, nassara lalé" wrung from the throats of a thousand kids. Soon we exit the Nangjere part and enter open fields. The arab village is not really a village but rather a few small huts scattered around a huge central cattle enclosure. The Nangjere are cultivators and the Arabs are herdsmen. The cows are all out to pasture now. We wind through some huts
until Ahmat comes running to meet us.
The staccato, ritualistic Arabic greetings commence.
"Al salaam alekum"
"Wa alekum al salaam"
"Kikef?"
"Afe tayybin"
"Afe, bet afe?"
"Al hamdullilah"
"Machallah"
"Kullo afe"
"Kullo, machallah"
"Al hamdullilah!"
Ahmat leads us through the village to his small mud brick hut. The "fancy" mud brick hut is where is mom lives while to the side is a rounded hut made in the style of a tent with wood bent over in curves covered by cow skins with a low, three-foot high door in one side. Inside is a bed made of curved, twisted sticks with a cotton mattress covered by layers of ornate Arabic rugs. The dirt floor is meticulously swept and to the side there are piles and piles of cheap, metal pots with brightly painted designs wrapped around the top. Outside is a half fence of "sekos", woven reed mats, with a large wooden mortar and pestle for pounding millet into flour. A long, pointed Arab knife in a leather sheath hangs inside the door by an equally covered long machete.
Ahmat takes us to a shelter outside the door of his mom's hut. Four large, twisted branches have been stuck in the ground with cross pieces covered with mats making a three walled enclosed resting spot. On the ground are woven reed mats covered with Arabic rugs. We are invited in as the round of Arabic greetings repeats itself with Ahmat's wife and mother.
As we lounge on the mats, Ahmat's wife brings us tea and some "Beignets", or flour donuts cooked in peanut oil. Our day is spent like this, greeting people who come to welcome us, drinking tea from time to time, eating small things here and there (millet paste, rice with a tiny bit of meat sauce, etc.)
Sarah goes into Ahmat's mom's hut and Israel and I stay outside. The chief of the village comes and we get into a conversation with a visiting Arab who'd been treated at our hospital about why Muslims shouldn't drink alcohol and why he should quit if he wants to be a good Muslim. I ask him if he can imagine standing before Allah on judgment day with a glass of "Argyle" (millet wine) in his hand. He looks horrified and then laughs as it sinks in.
At 3pm we head over to the cattle enclosure where they have cleared off some brush to make a place for the horse races. Of course, Sarah is hyped up to enter. We are some of the first to arrive but there are already 3-4 Arabs with their horses all decked out in brightly colored ribbons around the neck and along the sides. The horses are prancing as they are whipped with short pieces of rope. They all have metal bits in their mouths and are in constant motion as their rides try to control them.
I can imagine their thoughts as they see Sarah ride up, a woman on an old castrated horse with only a rope around it's nose and no fancy accoutrements. The son of Abdoulaye, an elder in the village who had been treated for weeks in the hospital for an abscess on his hand, offers to race Sarah to start of the ceremonies.
Sarah pulls up next to him and they take off together in a slow walk to the end of the cleared off patch. There is quite a contrast. Sarah's horse is calm and easily controlled while the son of Abdoulaye his constantly tugging at the reins and whipping his horse to keep him in line. The horse is bursting with energy and there is no doubt that he will win.
Finally, they are just specks on the horizon about 300 meters away. Suddenly, they both jerk their horses around and they take off at a tremendous gallop. They are moving so fast that they rapidly regain size in a blur of legs and frothing mouths. The son of Abdoulaye is standing up in the stirrups not moving at all but seeming to glide towards us as his horse releases all his pent up energy.
Sarah has a white veil tied as a scarf around the top of her head that is streaming behind her along with her long curly red hair. The speed of the horses is actually frightening as they quickly approach without slowing down in the slightest. Finally, they both tug back and reluctantly,
fighting all the way the horses are brought to a halt as the crowd scatters wondering if they might get trampled. And, to the embarrassment of all, except me and Israel, Sarah has
won!
The races continue until sundown interrupted from time to time by herds of cattle coming in for the night. Crowds of little boys wearing new Arabic robes and crowds of girls wearing new dresses and veils play to the sides. Fires are started in the cattle pen to ward of insects. Sarah races a few more times and then we go back to Ahmat's.
Ahmat requested that we bring the Jesus film with us. He'd seen part of it once when he came to visit. He is HIV-positive and was treated for two months in the hospital for TB and continues to come to visit from time to time as he made a lot of friends. It was he who helped us get the horses. So when Sarah showed him part of the Jesus film in Arabic he was very impressed and came three mornings in a row before the feast of the end of Ramadan to remind us to bring the film.
So, we set up a sheet over the side of the shelter, hook up the generator to the projector and show the Jesus film in Arabic. Most of them don’t understand standard Arabic and their reactions are kind of funny. When they see donkeys, goats, cows, horses, etc. the kids get so excited and shout out the names. When they see some apples, they shout out "Mangos!" When they see old white people it seems to be the most hilarious thing they've ever seen...white people look so funny to them.
At the end, I ask Ahmat if he understood since they speak Tchadian Arabic and the movie was in Saudi Arabian Arabic. Ahmat says he understood everything and now he knows that "Issa" is the "grand marabout", or traditional healer. So, as I lie under the stars that night before falling asleep I wonder how much did he get out of it? Only Allah knows.
James
Thursday, December 7, 2006
A Photo Tour from the Bere Bunch 2006
Loading up truck in NdJ upon arrival. Where do all 6 of us sit , James???
View of country side on way to Bere’ – not much to see – Tchad is FLAT and Dry
Our home – Bere’ Adventist Hospital Dorm – for the next 10 days.
Bere’ Village Homes
Our work begins – new home for James and Sarah with guest quarters attached
View inside when we arrived – rather rough. We hired local muscle to help – they did good.
Jamie - installing plumbing
Tasks – Rick mixing concrete
Peter doing electrical work – where are the inspectors? – Oh, Peter is an inspector back home!
Kelli’s ultrasound student.
View inside new home when we finished
Most of us slept in mosquito-proof (hopefully) tents on the porch or in the yard.
Friday night on the front porch – ‘Jammin’ with James and Jamie
Everyone joins the Jam session – Sarah with many friends
Our work is done. Headed back to NdJ and home – but first – where’s the bridge – a barge?
Everyone gets thirsty in Tchad – even the truck
A warm sunset to reflect the warm hearts we have for Bere’
View of country side on way to Bere’ – not much to see – Tchad is FLAT and Dry
Our home – Bere’ Adventist Hospital Dorm – for the next 10 days.
Bere’ Village Homes
Our work begins – new home for James and Sarah with guest quarters attached
View inside when we arrived – rather rough. We hired local muscle to help – they did good.
Jamie - installing plumbing
Tasks – Rick mixing concrete
Peter doing electrical work – where are the inspectors? – Oh, Peter is an inspector back home!
Kelli’s ultrasound student.
View inside new home when we finished
Most of us slept in mosquito-proof (hopefully) tents on the porch or in the yard.
Friday night on the front porch – ‘Jammin’ with James and Jamie
Everyone joins the Jam session – Sarah with many friends
Our work is done. Headed back to NdJ and home – but first – where’s the bridge – a barge?
Everyone gets thirsty in Tchad – even the truck
A warm sunset to reflect the warm hearts we have for Bere’
Wednesday, December 6, 2006
We’re back home - -
In fact we’ve been home for a few days now. All of us struggling with getting our body clocks back to match our local time zones. But let us back up a little.
After 9 days of very hard work, we were able to hang up the shovels, put down the saws, pack away the tools and get ready for Sabbath – our second Sabbath in Bere’. The Lord knew what he was doing when he asked us to rest one day out of seven. Six days of labor had made all of us very tired. Along with missing our families, we were ready to come home.
Unfortunately, we were missing one thing – a method to get back to the airport. James had gone to NdJ for meetings, and on the return, the truck had some mechanical difficulties which forced James to remain in NdJ an additional day for repairs. So instead of James returning to Bere’ on Friday afternoon, he left NdJ Sabbath morning. He was able to stop along the way at one of our churches and attended SS and Church.
This was a miracle provided by God because when he stopped, he noticed a leak in the radiator of the truck. Upon further inspection, a large hole had formed and was expelling water and stream at a goodly rate.
James was able to jam a piece of rubber into the hole, but that was only a temporary fix. Every few miles he would have to stop, find a source of water (well, ditch, what ever), fill his drinking bottle and pour it into the radiator. The rubber plug was getting looser, so James and the other rider in the truck began chewing all the gum they could find and then jam that into the hole.
Well, a trip that should take between 7 and 8 hours actually took close to 15 hours. There were 6 very happy people to welcome James back to Bere’ – until we discovered why he was so late.
Upon further inspection, it was determined that the radiator would not survive a return to NdJ in its present shape, so a search was commenced to find suitable radiator fixit ‘stuff’. Yes – we were not in a position to be selective – anything that might hold was considered. But once again, the Lord provided for our needs – at the time of our need.
All of us had been in the closet looking for things all week long and none of us spotted the ‘radiator gunk’. This is a special sealant designed specifically for leady radiators. Was it there all week? We don’t know. Was it there when we needed it most – absolutely!
Jamie – our resident truck repair man to go along with his electrical and plumbing skills once again rose to the occasion. He mixed up the compound and in a matter of minutes had plugged the leak. We let it sit overnight and upon complete inspection in the morning found that for the most part the leak had stopped. But would it stand under pressure of a 200 mile drive in the heat and rough roads? Well, the Lord does not take a person so far and then drop him - - neither did He provide for us the radiator gunk only for it not to work. Oh, we took extra water with us in the truck, and we did add about 2 liters half way to NdJ, but we made it to the airport in good shape.
We even were able to get past the highway guards who gave us such a hard time the week before. This time, we learned that a little sugar goes a long way. It turns out the guards had a healthy sweet tooth and offerings of candy, gum and other such items was all that was needed for quick passage through the checkpoints.
In NdJ we went directly to TEAM for a quick shower and on to the airport because we had been informed that the rebels from the East where on the outskirts of NdJ. You know how news travels and how bad news usually gets blown all out of proportion. Well, that was the case here, but we did not know for sure and were not in a position to question conventional wisdom – so all 6 of us took our last Chadian shower in record time – and were off to the airport to wait out the ‘rebel attack’ and be in position to board the first plane out of NdJ.
We were able to spend quality time – 9 hours worth - in an airport with no place to eat, one bathroom without the necessary paper products for either end of the body, hard chairs, no air conditioning, and people going to and fro speaking a language we did not understand. But once again, the Lord provided us with a safe refuge and at 11:55pm (on time) our Air Bus 320 lifted off the runway and we were away from suspected danger and one our way home.
An overnight flight to Paris brought us to the City of Light in the Dark at 6am. And Paris was still foggy and rainy – just as we had left it the week before. We did find a place to purchase some snacks for breakfast. We ate as we discussed our week’s adventure. Each of us took time to record our impressions on Video that will become part of the official record of Bere Team’s adventures in Tchad.
Peter departed before the rest of us as he went a different way back to Seattle. We boarded our plane at the appropriate time and then we waited and waited for it seemed that not only was our truck from Bere’ to NdJ in need of repair but so was our plane from Paris to New York.
After a 45 minute wait we were once again airborne ‘over the pond’ to our home – the USA.
Due to our delay in Paris, we missed our last connection to Orlando. You see, the Lord had us wait at the airport in NdJ, so we would be in good practice to wait at JFK. We experienced another long wait – this time roughly 7 hours (but with all the pleasures of ‘home’ such as clean bathrooms, air conditioning, food, English speaking people. Our 8:30pm flight was full, but we all made it back to Orlando by 11pm and were finally in familiar surroundings and the loving arms of family.
Have we recovered - for the most part yes. Have our body clocks returned to be in sync with the local time – for the most part yes. Did any of us catch Malaria – not that we know of for we faithfully took our medicines while there and then gladly accepted the final treatment that James prescribed for us.
Are we ready to go back to Bere’? Not at this moment, but give us a few weeks or a month or two and then ask us again.
God was, is and is always good. He took care of our needs - - not necessarily our wants (we wanted ice cubes in Bere’, but they did not materialize). But through His blessing, we were able to accomplish pretty much everything we had hoped to and for all we know, the things that did not get finished – well, they were not in God’s plan to begin with.
So family and friends, thank-you for supporting us on our mission. Thank-you for understanding why we did call home more often. Thank-you for accepting that we wanted to go to bed early when we got home and seemed to get up way before the time we should. And thank-you the most for loving us, for caring about us and for keeping us in your prayers.
So long for now.
May God Bless us all.
The Bere Bunch 2006
After 9 days of very hard work, we were able to hang up the shovels, put down the saws, pack away the tools and get ready for Sabbath – our second Sabbath in Bere’. The Lord knew what he was doing when he asked us to rest one day out of seven. Six days of labor had made all of us very tired. Along with missing our families, we were ready to come home.
Unfortunately, we were missing one thing – a method to get back to the airport. James had gone to NdJ for meetings, and on the return, the truck had some mechanical difficulties which forced James to remain in NdJ an additional day for repairs. So instead of James returning to Bere’ on Friday afternoon, he left NdJ Sabbath morning. He was able to stop along the way at one of our churches and attended SS and Church.
This was a miracle provided by God because when he stopped, he noticed a leak in the radiator of the truck. Upon further inspection, a large hole had formed and was expelling water and stream at a goodly rate.
James was able to jam a piece of rubber into the hole, but that was only a temporary fix. Every few miles he would have to stop, find a source of water (well, ditch, what ever), fill his drinking bottle and pour it into the radiator. The rubber plug was getting looser, so James and the other rider in the truck began chewing all the gum they could find and then jam that into the hole.
Well, a trip that should take between 7 and 8 hours actually took close to 15 hours. There were 6 very happy people to welcome James back to Bere’ – until we discovered why he was so late.
Upon further inspection, it was determined that the radiator would not survive a return to NdJ in its present shape, so a search was commenced to find suitable radiator fixit ‘stuff’. Yes – we were not in a position to be selective – anything that might hold was considered. But once again, the Lord provided for our needs – at the time of our need.
All of us had been in the closet looking for things all week long and none of us spotted the ‘radiator gunk’. This is a special sealant designed specifically for leady radiators. Was it there all week? We don’t know. Was it there when we needed it most – absolutely!
Jamie – our resident truck repair man to go along with his electrical and plumbing skills once again rose to the occasion. He mixed up the compound and in a matter of minutes had plugged the leak. We let it sit overnight and upon complete inspection in the morning found that for the most part the leak had stopped. But would it stand under pressure of a 200 mile drive in the heat and rough roads? Well, the Lord does not take a person so far and then drop him - - neither did He provide for us the radiator gunk only for it not to work. Oh, we took extra water with us in the truck, and we did add about 2 liters half way to NdJ, but we made it to the airport in good shape.
We even were able to get past the highway guards who gave us such a hard time the week before. This time, we learned that a little sugar goes a long way. It turns out the guards had a healthy sweet tooth and offerings of candy, gum and other such items was all that was needed for quick passage through the checkpoints.
In NdJ we went directly to TEAM for a quick shower and on to the airport because we had been informed that the rebels from the East where on the outskirts of NdJ. You know how news travels and how bad news usually gets blown all out of proportion. Well, that was the case here, but we did not know for sure and were not in a position to question conventional wisdom – so all 6 of us took our last Chadian shower in record time – and were off to the airport to wait out the ‘rebel attack’ and be in position to board the first plane out of NdJ.
We were able to spend quality time – 9 hours worth - in an airport with no place to eat, one bathroom without the necessary paper products for either end of the body, hard chairs, no air conditioning, and people going to and fro speaking a language we did not understand. But once again, the Lord provided us with a safe refuge and at 11:55pm (on time) our Air Bus 320 lifted off the runway and we were away from suspected danger and one our way home.
An overnight flight to Paris brought us to the City of Light in the Dark at 6am. And Paris was still foggy and rainy – just as we had left it the week before. We did find a place to purchase some snacks for breakfast. We ate as we discussed our week’s adventure. Each of us took time to record our impressions on Video that will become part of the official record of Bere Team’s adventures in Tchad.
Peter departed before the rest of us as he went a different way back to Seattle. We boarded our plane at the appropriate time and then we waited and waited for it seemed that not only was our truck from Bere’ to NdJ in need of repair but so was our plane from Paris to New York.
After a 45 minute wait we were once again airborne ‘over the pond’ to our home – the USA.
Due to our delay in Paris, we missed our last connection to Orlando. You see, the Lord had us wait at the airport in NdJ, so we would be in good practice to wait at JFK. We experienced another long wait – this time roughly 7 hours (but with all the pleasures of ‘home’ such as clean bathrooms, air conditioning, food, English speaking people. Our 8:30pm flight was full, but we all made it back to Orlando by 11pm and were finally in familiar surroundings and the loving arms of family.
Have we recovered - for the most part yes. Have our body clocks returned to be in sync with the local time – for the most part yes. Did any of us catch Malaria – not that we know of for we faithfully took our medicines while there and then gladly accepted the final treatment that James prescribed for us.
Are we ready to go back to Bere’? Not at this moment, but give us a few weeks or a month or two and then ask us again.
God was, is and is always good. He took care of our needs - - not necessarily our wants (we wanted ice cubes in Bere’, but they did not materialize). But through His blessing, we were able to accomplish pretty much everything we had hoped to and for all we know, the things that did not get finished – well, they were not in God’s plan to begin with.
So family and friends, thank-you for supporting us on our mission. Thank-you for understanding why we did call home more often. Thank-you for accepting that we wanted to go to bed early when we got home and seemed to get up way before the time we should. And thank-you the most for loving us, for caring about us and for keeping us in your prayers.
So long for now.
May God Bless us all.
The Bere Bunch 2006
Friday, November 24, 2006
Happy Thanksgiving in Bere
Thursday, November 23, 2006
Hello Everyone!!! Happy Thanksgiving to all our Families!!!
We are all missing our families today very much! Philip has something special to be thankful for. His wife went for and ultrasound while he was here and he just found out they are having a girl. Yeah, Peter!! They have a 2 year old already!!
Rick will be a grandpa for the first time any day now. So we are thankful for that.
We are especially thankful for you, our families. Being in a place like this reminds us of how much we have and how much God has blessed us with.
Today was a usual work day for us since we have so much to do before we leave. The hospital never sleeps and we have a house to build. Graham and Steve made a lot of headway today. They have taken the basic structure of the cabinets that were up and framed them and finished the edges. Basically all that is left is the counter tops and the sink.
Rick says that they have had the best day as far as floor pouring goes. 17 110lb bags of cement was the previous record for the day. Today they topped that at 25. All the floors are almost poured. They will finish tomorrow and then all that will be left will be the porches. They also hot tested the house and there is power. Yeah!!! We are accomplishing things by leaps and bounds in these last days.
Peter has finished attaching all the compression lugs to the battery cables. This is hard and tedious work. It has taken him the past two days to attach the compression lugs with a crimper. Tonight he is going to go rewire the electrical panels to accommodate the new system. Then all we have to do is wait for the batteries. James left for N'Djamena yesterday. He had a meeting today and hopefully will pick up the batteries while he is there, if they are there. Pray they are.
Jamie has been busy too. He ran the main electrical wire over to the house and built the electrical panel, then helped to test the system. Then he spent the rest of the day helping Peter and doing Sudoku. (I have him hooked.) Sorry Tammy, I think you will have to buy him a couple of puzzle books when he gets home.
I spent the day doing ultrasounds and teaching Milka, the midwife, the ultrasound machine. My French is getting better and better. I can now communicate most of what I want to say to her in French, the only language she understands. We scanned 9 pregnant patients and one Pelvic ultrasound from 9:30 to 1:30. I was worn out. It is tiring teaching and scanning in that short period of time.
I then came back to the house and had lunch. I had a short 10 minute rest and then I had to start thanksgiving dinner. They caught the rooster and killed it this morning. Guess what they grilled for thanksgiving dinner. I didn't have any, Veggie that I am. They said it was good. Oh well, guess I'll miss out. We had mashed potatoes and gravy, cornbread stuffing (homemade), veggie chicken (or as my husband would call it, feet (fake meat combined) chicken), cranberry sauce, fried eggplant that Solomon the cook made this morning, Pumpkin Pie with whipped cream!!, and brownies. Yummy!! But it all isn't the same without our families. You are sorely missed and we will be happy to see you and talk to you again when we get home.
We miss you. All our love.
Kelli, Graham, Rick, Jamie, Peter and Steve.
Hello Everyone!!! Happy Thanksgiving to all our Families!!!
We are all missing our families today very much! Philip has something special to be thankful for. His wife went for and ultrasound while he was here and he just found out they are having a girl. Yeah, Peter!! They have a 2 year old already!!
Rick will be a grandpa for the first time any day now. So we are thankful for that.
We are especially thankful for you, our families. Being in a place like this reminds us of how much we have and how much God has blessed us with.
Today was a usual work day for us since we have so much to do before we leave. The hospital never sleeps and we have a house to build. Graham and Steve made a lot of headway today. They have taken the basic structure of the cabinets that were up and framed them and finished the edges. Basically all that is left is the counter tops and the sink.
Rick says that they have had the best day as far as floor pouring goes. 17 110lb bags of cement was the previous record for the day. Today they topped that at 25. All the floors are almost poured. They will finish tomorrow and then all that will be left will be the porches. They also hot tested the house and there is power. Yeah!!! We are accomplishing things by leaps and bounds in these last days.
Peter has finished attaching all the compression lugs to the battery cables. This is hard and tedious work. It has taken him the past two days to attach the compression lugs with a crimper. Tonight he is going to go rewire the electrical panels to accommodate the new system. Then all we have to do is wait for the batteries. James left for N'Djamena yesterday. He had a meeting today and hopefully will pick up the batteries while he is there, if they are there. Pray they are.
Jamie has been busy too. He ran the main electrical wire over to the house and built the electrical panel, then helped to test the system. Then he spent the rest of the day helping Peter and doing Sudoku. (I have him hooked.) Sorry Tammy, I think you will have to buy him a couple of puzzle books when he gets home.
I spent the day doing ultrasounds and teaching Milka, the midwife, the ultrasound machine. My French is getting better and better. I can now communicate most of what I want to say to her in French, the only language she understands. We scanned 9 pregnant patients and one Pelvic ultrasound from 9:30 to 1:30. I was worn out. It is tiring teaching and scanning in that short period of time.
I then came back to the house and had lunch. I had a short 10 minute rest and then I had to start thanksgiving dinner. They caught the rooster and killed it this morning. Guess what they grilled for thanksgiving dinner. I didn't have any, Veggie that I am. They said it was good. Oh well, guess I'll miss out. We had mashed potatoes and gravy, cornbread stuffing (homemade), veggie chicken (or as my husband would call it, feet (fake meat combined) chicken), cranberry sauce, fried eggplant that Solomon the cook made this morning, Pumpkin Pie with whipped cream!!, and brownies. Yummy!! But it all isn't the same without our families. You are sorely missed and we will be happy to see you and talk to you again when we get home.
We miss you. All our love.
Kelli, Graham, Rick, Jamie, Peter and Steve.
Tuesday, November 21, 2006
Friday at Bere
Tuesday, November 21, 2006
Graham and Steve have partnered on all the cabinet work. They made 540 feet of lumber that Rick brought from Kelo this morning for the cabinets. They planed and stripped and ripped using the Béré table saw - which was invented by Graham for such a place as this. They got the linen cabinet done in the master bath.
Jamie and Rick pulled the wire to all the outlets and switches and Jamie set the toilets in the bathrooms. In addition, we got the master bedroom floor poured and finished.
Jamie became a truck repairman by fixing the turn signals and changed the oil in the truck. In this process he found a rag wrapped around the fan blade - blade is taken loosely because two of it's 6 blades were missing.
Peter mounted the 4 invertors in the control room for the solar system. He also stuck his head inside an autoclave - fortunately it was not on because it burned up a few months ago. The supplied part was incorrect, so they will have to default to the smaller unit.
Peter also experienced his first OR contribution - by assisting James in a cyst removal procedure. He now qualities as an OR nurse. OH - - all by flashlight as the generator was not running. Hopefully after we leave, flashlights will become a thing of the past.
As part of our Solar System installation, Graham and Peter converted previously mentioned Béré Table Saw into the One and only Béré Wire Cutting Saw - - since Peter has to cut 48 pieces of 20 inch - this wire size is similar in thickness to a sharpie. It would have been a tough job by hand.
On the medical front - - yesterday the lady who came in pregnant with her baby outside her uterus, came back today - this time with money to cover her costs for surgery. It was a mess and she is touch and go at the moment.
Kelli assisted with a prostatectomy. There Béré' heat had a negative effect and Kelli needed some fresh air. It can happen to the best of us.
Around 6am, Rick and Steve - were deep in dreamland when James walks by dragging a pig behind him. Actually, it was a piglette - maybe weighing 20 pounds. This peg had been terrorizing the grounds for a number of days. Our fearless Resident Physician Surgeon and now Pig Catcher cornered the critter and with one swoop of his large hand had pig in paw.
This pig gave his all - in that he became lunch for a number of the patients.
We all hope that the rooster witnessed the mornings events - and took good notes so to avoid any our guest at Thanksgiving.
In closing we are one week into our stay at Béré'. The next 3 work days will most likely stretch into work evenings as well if we can construct temporary lightly.
Thanks for you all being there to read this - we miss you much.
The Béré Bunch
Graham and Steve have partnered on all the cabinet work. They made 540 feet of lumber that Rick brought from Kelo this morning for the cabinets. They planed and stripped and ripped using the Béré table saw - which was invented by Graham for such a place as this. They got the linen cabinet done in the master bath.
Jamie and Rick pulled the wire to all the outlets and switches and Jamie set the toilets in the bathrooms. In addition, we got the master bedroom floor poured and finished.
Jamie became a truck repairman by fixing the turn signals and changed the oil in the truck. In this process he found a rag wrapped around the fan blade - blade is taken loosely because two of it's 6 blades were missing.
Peter mounted the 4 invertors in the control room for the solar system. He also stuck his head inside an autoclave - fortunately it was not on because it burned up a few months ago. The supplied part was incorrect, so they will have to default to the smaller unit.
Peter also experienced his first OR contribution - by assisting James in a cyst removal procedure. He now qualities as an OR nurse. OH - - all by flashlight as the generator was not running. Hopefully after we leave, flashlights will become a thing of the past.
As part of our Solar System installation, Graham and Peter converted previously mentioned Béré Table Saw into the One and only Béré Wire Cutting Saw - - since Peter has to cut 48 pieces of 20 inch - this wire size is similar in thickness to a sharpie. It would have been a tough job by hand.
On the medical front - - yesterday the lady who came in pregnant with her baby outside her uterus, came back today - this time with money to cover her costs for surgery. It was a mess and she is touch and go at the moment.
Kelli assisted with a prostatectomy. There Béré' heat had a negative effect and Kelli needed some fresh air. It can happen to the best of us.
Around 6am, Rick and Steve - were deep in dreamland when James walks by dragging a pig behind him. Actually, it was a piglette - maybe weighing 20 pounds. This peg had been terrorizing the grounds for a number of days. Our fearless Resident Physician Surgeon and now Pig Catcher cornered the critter and with one swoop of his large hand had pig in paw.
This pig gave his all - in that he became lunch for a number of the patients.
We all hope that the rooster witnessed the mornings events - and took good notes so to avoid any our guest at Thanksgiving.
In closing we are one week into our stay at Béré'. The next 3 work days will most likely stretch into work evenings as well if we can construct temporary lightly.
Thanks for you all being there to read this - we miss you much.
The Béré Bunch
Monday in Bere
Monday, November 20, 2006
We got a lot accomplished today on the house. All of the floors are poured except for the master bedroom and the great room/living room. Graham and Steve worked all day and got all the base cabinets and pantry cabinets in. Tomorrow they will work on the top cabinets and the counters.
The steel window guards arrived today. That was a surprise. We continue to attract a crowd outside the fence while we work on the house. It grows and grows with each day. Everyone wants to see the Nasara (white people) work.
We had a lot of issues today with the ultrasound. Today was supposed to be the first day of free obstetric ultrasound. James had advertised this by word of mouth and on the local radio station. We had 6 patients today. Most of the ultrasounds were normal. Although, after my first two ultrasounds, the battery went dead on the ultrasound machine. We discussed the fact that we might be able to turn the big generator on, but James didn't want to do that. It uses too much gas. So we got one of the small generators, a 2 stroke POS generator Tiger generator (as said by Peter)(I write this info for my hubby), and a voltage regulator and we blew the power supply. Luckily we had another power supply. We then connected it to the other small generator, a portable 4 Stroke gasoline, 14 HP 7000 watt Generac (again for my hubby) that had been leaking gas and Peter rigged it up temporarily to work. It worked until the generator ran out of gas. I then had enough battery to do the last patient.
We all came back to the house for a meal of Solomon's Eggplant Parmesan. Solomon is the cook that James and Sarah hire. He works from seven in the morning until four in the afternoon. He is a big help while I am helping out at the hospital. In the middle of lunch, James came to get me. He had a woman with a mass in her lower abdomen. She was having heavy bleeding and was extremely tender. She said she wasn't pregnant, but James suspected she was and asked me to confirm it by ultrasound. He considered an ectopic pregnancy, but said her belly was probably too big for that. I went over and Peter tried another rigging of the generator. It didn't work, so Jamie went to find gas for the generator we had it hooked up to before. When it was up and running, I began to scan. It was hard to make heads or tails of what I was seeing at first. But after scanning for a few minutes, I determined that it was a ruptured ectopic pregnancy (a pregnancy in her fallopian tube that had gotten big enough to rupture the tube). She was bleeding internally. There was blood all in her pelvis.
James went to talk to the family. They decided that they didn't want the surgery and none of James' pleading could change their mind. They didn't want to pay for the surgery. So they took her and left. Talk about frustrating. What do you do when a patient's family takes her away from a surgery that would save her life? This woman will die without the surgery. What it comes down to is the family would rather pay for her funeral (about $200 American dollars) than pay for her surgery ($28 American dollars). So we had to let her go knowing tomorrow she would be dead. How do you fight that? Please pray for these people.
Kelli
We got a lot accomplished today on the house. All of the floors are poured except for the master bedroom and the great room/living room. Graham and Steve worked all day and got all the base cabinets and pantry cabinets in. Tomorrow they will work on the top cabinets and the counters.
The steel window guards arrived today. That was a surprise. We continue to attract a crowd outside the fence while we work on the house. It grows and grows with each day. Everyone wants to see the Nasara (white people) work.
We had a lot of issues today with the ultrasound. Today was supposed to be the first day of free obstetric ultrasound. James had advertised this by word of mouth and on the local radio station. We had 6 patients today. Most of the ultrasounds were normal. Although, after my first two ultrasounds, the battery went dead on the ultrasound machine. We discussed the fact that we might be able to turn the big generator on, but James didn't want to do that. It uses too much gas. So we got one of the small generators, a 2 stroke POS generator Tiger generator (as said by Peter)(I write this info for my hubby), and a voltage regulator and we blew the power supply. Luckily we had another power supply. We then connected it to the other small generator, a portable 4 Stroke gasoline, 14 HP 7000 watt Generac (again for my hubby) that had been leaking gas and Peter rigged it up temporarily to work. It worked until the generator ran out of gas. I then had enough battery to do the last patient.
We all came back to the house for a meal of Solomon's Eggplant Parmesan. Solomon is the cook that James and Sarah hire. He works from seven in the morning until four in the afternoon. He is a big help while I am helping out at the hospital. In the middle of lunch, James came to get me. He had a woman with a mass in her lower abdomen. She was having heavy bleeding and was extremely tender. She said she wasn't pregnant, but James suspected she was and asked me to confirm it by ultrasound. He considered an ectopic pregnancy, but said her belly was probably too big for that. I went over and Peter tried another rigging of the generator. It didn't work, so Jamie went to find gas for the generator we had it hooked up to before. When it was up and running, I began to scan. It was hard to make heads or tails of what I was seeing at first. But after scanning for a few minutes, I determined that it was a ruptured ectopic pregnancy (a pregnancy in her fallopian tube that had gotten big enough to rupture the tube). She was bleeding internally. There was blood all in her pelvis.
James went to talk to the family. They decided that they didn't want the surgery and none of James' pleading could change their mind. They didn't want to pay for the surgery. So they took her and left. Talk about frustrating. What do you do when a patient's family takes her away from a surgery that would save her life? This woman will die without the surgery. What it comes down to is the family would rather pay for her funeral (about $200 American dollars) than pay for her surgery ($28 American dollars). So we had to let her go knowing tomorrow she would be dead. How do you fight that? Please pray for these people.
Kelli
Saturday, November 18, 2006
Sabbath in Bere
Saturday, November 18, 2006 - Sabbath
Today we had church with the locals of Béré. The church is fairly new and is located just outside of the walls of the hospital in a bare field of sorts. It is a mud brick structure with a tin roof and a green door. We walked the short distance and went inside. The children were singing. Little did we know that they were practicing for us. They put on special music for us later in the church service. Peter preached with James translating in French and another church member translating from French into Nangere (the local language). The people then sang special music for us in their own dialect and then the children sang. I think the others would agree with me that we all enjoyed the singing immensely, even though we couldn't understand a word. We also sang for them.
After the sermon, they all voted that they wanted Peter to stay. He commented that seeing all the beautiful children made him miss his and he didn't think that he could stay. Their response was that he could just bring them here. Rachel, how do you feel about that?
We went to the Logone River today. On the way we saw this woman struggling with a load and her baby. We stopped and gave her a ride. We must have gone at least 2 or 3 miles more before she asked us to stop and she was coming from Béré, so when we picked her up she had probably already walked a few miles. She was very greatful and said Merci, Merci several times before we pulled off. She will have a story to tell around the fire in her village tonight.
I got some surprises for Tyler, some of them courtesy of Paul, one of the other missionaries here. Jamie, Rick and Paul went out onto this sand bar where they saw and found a lot of things. We didn't see any Hippos or wildlife, except birds and the local's animals. We did see the locals traversing the river in their dugout type of canoes. They would take loads of people, animals and even motorcycles across the river in their long canoes. It was very interesting.
On the way back we stopped and got some great pictures of the sunset. It was beautiful.
We are watching one of the movies we brought for James and Sarah and will possibly have popcorn later.
I will write more tomorrow.
Kelli
Today we had church with the locals of Béré. The church is fairly new and is located just outside of the walls of the hospital in a bare field of sorts. It is a mud brick structure with a tin roof and a green door. We walked the short distance and went inside. The children were singing. Little did we know that they were practicing for us. They put on special music for us later in the church service. Peter preached with James translating in French and another church member translating from French into Nangere (the local language). The people then sang special music for us in their own dialect and then the children sang. I think the others would agree with me that we all enjoyed the singing immensely, even though we couldn't understand a word. We also sang for them.
After the sermon, they all voted that they wanted Peter to stay. He commented that seeing all the beautiful children made him miss his and he didn't think that he could stay. Their response was that he could just bring them here. Rachel, how do you feel about that?
We went to the Logone River today. On the way we saw this woman struggling with a load and her baby. We stopped and gave her a ride. We must have gone at least 2 or 3 miles more before she asked us to stop and she was coming from Béré, so when we picked her up she had probably already walked a few miles. She was very greatful and said Merci, Merci several times before we pulled off. She will have a story to tell around the fire in her village tonight.
I got some surprises for Tyler, some of them courtesy of Paul, one of the other missionaries here. Jamie, Rick and Paul went out onto this sand bar where they saw and found a lot of things. We didn't see any Hippos or wildlife, except birds and the local's animals. We did see the locals traversing the river in their dugout type of canoes. They would take loads of people, animals and even motorcycles across the river in their long canoes. It was very interesting.
On the way back we stopped and got some great pictures of the sunset. It was beautiful.
We are watching one of the movies we brought for James and Sarah and will possibly have popcorn later.
I will write more tomorrow.
Kelli
Friday, November 17, 2006
Friday at Bere
Friday, November 17, 2006
We started out the morning with seven men we hired locally. Steve, Graham and Jamie got the mixer running and we set about pouring concrete. While Jamie was putting in the underground plumbing in kitchen, we had the men mix the concrete and pour the first bedroom. They finished the concrete in that bedroom and they started in the kitchen.
The way the men work is from seven until 12, take a 2 hour lunch break and then they come back and work from 2 - 4 p.m. So that being the case, they got all the concrete in the kitchen but left before the concrete was finished. It was wet, I had to go over to the house and finish the concrete in the dark.
The method for mixing the concrete: The men bring in 100 lb cement bag to the mixer and then we mix the rock, sand and water with the cement. We use wheelbarrows to get the concrete into the building.
- Rick
I spent the day working in the kitchen with Solomon and then went into town with him to get some cloth from Market for a native dress. The children started to gather at the edge of town and followed me all over the market. The children are all so curious and wonderful with beautiful infectious grins, you can't help but smile back.
- Kelli
One day morphs into the next here. Time zips by so quickly it's hard to keep track anymore. By the time I realized it was Friday, the day was almost over. I'm certainly put outside of my comfort zone here on a daily basis. It was amusing to have an audience of three to four people when I did a simple rewire in the morning. Later, I tried my hand at "masonry," using only bricks and basic mud to make a fire pit/incinerator. We'll see on Sunday if it works or not.
God is blessing us greatly here. We are finding many things in place that will make the solar installation easier; things that no one could have planned. There's just too much to tell in a couple of paragraphs, but suffice it to say that it's amazing to see God working every day. I can't wait to see what he has planned next!
-Peter
We started out the morning with seven men we hired locally. Steve, Graham and Jamie got the mixer running and we set about pouring concrete. While Jamie was putting in the underground plumbing in kitchen, we had the men mix the concrete and pour the first bedroom. They finished the concrete in that bedroom and they started in the kitchen.
The way the men work is from seven until 12, take a 2 hour lunch break and then they come back and work from 2 - 4 p.m. So that being the case, they got all the concrete in the kitchen but left before the concrete was finished. It was wet, I had to go over to the house and finish the concrete in the dark.
The method for mixing the concrete: The men bring in 100 lb cement bag to the mixer and then we mix the rock, sand and water with the cement. We use wheelbarrows to get the concrete into the building.
- Rick
I spent the day working in the kitchen with Solomon and then went into town with him to get some cloth from Market for a native dress. The children started to gather at the edge of town and followed me all over the market. The children are all so curious and wonderful with beautiful infectious grins, you can't help but smile back.
- Kelli
One day morphs into the next here. Time zips by so quickly it's hard to keep track anymore. By the time I realized it was Friday, the day was almost over. I'm certainly put outside of my comfort zone here on a daily basis. It was amusing to have an audience of three to four people when I did a simple rewire in the morning. Later, I tried my hand at "masonry," using only bricks and basic mud to make a fire pit/incinerator. We'll see on Sunday if it works or not.
God is blessing us greatly here. We are finding many things in place that will make the solar installation easier; things that no one could have planned. There's just too much to tell in a couple of paragraphs, but suffice it to say that it's amazing to see God working every day. I can't wait to see what he has planned next!
-Peter
Thursday in Chad
Thursday, November 16, 2006
This is a general email that we are sending to all our family and friends. I guess there were some people who were confused as to why they were receiving an email from me. I am acting as the official writer of the happenings here and we just wanted our families to know what is going on.
Last night was not as cool as the night before. It's funny that all the days start running together already. Time goes by so fast here. Yesterday a few of the guys went into Kelo to try and get some supplies they would need for the house. They were unsuccessful, so today Jamie and Rick went into Kelo and have just gotten back. They had success. They were able to get pipe for the new house. They had some interesting experiences on the way back. There is a river crossing just outside of the hospital that you have to cross. A truck had gotten stuck on the barge, which is just a platform and ramp made out of loosely put together wood strips (I honestly don't know how it holds anything). Jamie and Rick helped them push the truck out of the way so they could get by. They said they got stuck on the river crossing twice.
I got to help James a lot today in surgery. I even assisted in a hernia repair. That was so much fun. I actually did about 4 ultrasounds today. They are going to advertise by word of mouth and local radio that I am here and they will offer free prenatal ultrasounds next month. They are hoping this will encourage the people to get prenatal care.
We have been having great meals here. Solomon is a great cook. Today we had wheat gluten that he made, breaded and fried. Rice with a gravy containing okra. I don't usually like okra but it was yummy. He also makes good bread.
Peter, Graham and Steve got the other generator running today too. They have been doing a lot of evaluating today as well to see what needs to be done. A funny thing happened today. Peter and Steve were in the surgical ward looking in the x-ray room and asking James what things he wanted to get rid of and then we left them to do some surgery in the other room. After Peter and Steve left, they thought the place was empty and locked us in. The door is locked by a padlock from the outside. After banging on the door a few times, someone came and let us out. We had a good laugh about it.
Kelli
This is a general email that we are sending to all our family and friends. I guess there were some people who were confused as to why they were receiving an email from me. I am acting as the official writer of the happenings here and we just wanted our families to know what is going on.
Last night was not as cool as the night before. It's funny that all the days start running together already. Time goes by so fast here. Yesterday a few of the guys went into Kelo to try and get some supplies they would need for the house. They were unsuccessful, so today Jamie and Rick went into Kelo and have just gotten back. They had success. They were able to get pipe for the new house. They had some interesting experiences on the way back. There is a river crossing just outside of the hospital that you have to cross. A truck had gotten stuck on the barge, which is just a platform and ramp made out of loosely put together wood strips (I honestly don't know how it holds anything). Jamie and Rick helped them push the truck out of the way so they could get by. They said they got stuck on the river crossing twice.
I got to help James a lot today in surgery. I even assisted in a hernia repair. That was so much fun. I actually did about 4 ultrasounds today. They are going to advertise by word of mouth and local radio that I am here and they will offer free prenatal ultrasounds next month. They are hoping this will encourage the people to get prenatal care.
We have been having great meals here. Solomon is a great cook. Today we had wheat gluten that he made, breaded and fried. Rice with a gravy containing okra. I don't usually like okra but it was yummy. He also makes good bread.
Peter, Graham and Steve got the other generator running today too. They have been doing a lot of evaluating today as well to see what needs to be done. A funny thing happened today. Peter and Steve were in the surgical ward looking in the x-ray room and asking James what things he wanted to get rid of and then we left them to do some surgery in the other room. After Peter and Steve left, they thought the place was empty and locked us in. The door is locked by a padlock from the outside. After banging on the door a few times, someone came and let us out. We had a good laugh about it.
Kelli
Wednesday, November 15, 2006
We are here.
November 15, 2006, Wednesday
We are finally here and everyone is safe and well. We spent our 9 hour layover in Paris in the airport. We opted not to go into town due to inclement weather and the time it took to get through customs each time. We were disappointed, but this wasn't the purpose of the trip anyway, just a luxury. Jamie came down with the flu on his way here. He wasn't feeling well in Atlanta when we picked him up. We doctored him up with some Airborne and he is feeling well now.
We met Peter in Paris and in that long wait, we all got to know each other well. We arrived in N'Djamena at 4:55 our time Tuesday morning. There is a 6 hour time difference between here and the east coast. It was a miracle that I prayed for when we got all of our luggage and got through customs o.k. We then went to T.E.A.M. which is a hostile for missionaries. I showered and the others freshened up. Jamie, Peter and I took a little nap while the others went and got us registered with the police. After a few hassles with the police, being stopped and having to pay them off we were on our way to Béré. It was nicely paved most of the way. Pedestrians and animals here do not have the right of way. You just honk and keep going. If they don't get out of the way. Oh well.
We arrived here last night at 6:00 p.m., Béré time. We were exhausted. We pitched our tents outside and crashed. It has been an eventful day today. I have scanned three people already, two pregnant women and one man. The first pregnant women they thought she had twins. They were going to do surgery on her and tie her tubes, but when I scanned her, she was measuring only 35 weeks and had 25cm of amniotic fluid (a lot). Due to the babies age, James opted to wait a couple weeks on the surgery. The gentleman I scanned had appendicitis and will be operated on this afternoon. The other woman, a policeman's wife who was with her and had his gun, was unsure if she was still pregnant. I confirmed that she was 12 weeks along. They were both very happy.
Graham, Steve, Jamie, Peter and Rick have been evaluating the new building to see what supplies we will need to get from Kelo. They will go there today and get those so they can get started tomorrow.
I will write more tomorrow. All our love to our families and friends.
Kelli
We are finally here and everyone is safe and well. We spent our 9 hour layover in Paris in the airport. We opted not to go into town due to inclement weather and the time it took to get through customs each time. We were disappointed, but this wasn't the purpose of the trip anyway, just a luxury. Jamie came down with the flu on his way here. He wasn't feeling well in Atlanta when we picked him up. We doctored him up with some Airborne and he is feeling well now.
We met Peter in Paris and in that long wait, we all got to know each other well. We arrived in N'Djamena at 4:55 our time Tuesday morning. There is a 6 hour time difference between here and the east coast. It was a miracle that I prayed for when we got all of our luggage and got through customs o.k. We then went to T.E.A.M. which is a hostile for missionaries. I showered and the others freshened up. Jamie, Peter and I took a little nap while the others went and got us registered with the police. After a few hassles with the police, being stopped and having to pay them off we were on our way to Béré. It was nicely paved most of the way. Pedestrians and animals here do not have the right of way. You just honk and keep going. If they don't get out of the way. Oh well.
We arrived here last night at 6:00 p.m., Béré time. We were exhausted. We pitched our tents outside and crashed. It has been an eventful day today. I have scanned three people already, two pregnant women and one man. The first pregnant women they thought she had twins. They were going to do surgery on her and tie her tubes, but when I scanned her, she was measuring only 35 weeks and had 25cm of amniotic fluid (a lot). Due to the babies age, James opted to wait a couple weeks on the surgery. The gentleman I scanned had appendicitis and will be operated on this afternoon. The other woman, a policeman's wife who was with her and had his gun, was unsure if she was still pregnant. I confirmed that she was 12 weeks along. They were both very happy.
Graham, Steve, Jamie, Peter and Rick have been evaluating the new building to see what supplies we will need to get from Kelo. They will go there today and get those so they can get started tomorrow.
I will write more tomorrow. All our love to our families and friends.
Kelli
Sunday, November 12, 2006
Prolog - Mission Trip to Bere 2006
November 12, 2006
Well, I can't believe it is here already. We leave today. We met yesterday after church and divided up all our items to make sure all of our suitcases were under the 70 lb mark. We have 9 or 10 plus our carry on items, 2 per person.
This is a little scary for me, since I haven't been this far away from home before. It will be a long plane flight. Everyone else has made this trip before or at least one like it.
It will be challenging but also a blessing. I am learning a little French so I can attempt to communicate while we are gone.
We leave today at 5:45 EST and fly to Atlanta. We won't leave Atlanta till 11:00 pm. From there we fly overnight to Paris, France. We will have a 9 hour layover in Paris and plan to take a tour. Yeah!! From there we fly overnight to N'Djamina, Chad (or Tchad). We then freshen up at TEAM (a hotel for missionaries that come through). Do some shopping in the local market and then take the 6-8 hour drive (depending on the roads), Steve said 6 hours to Bere, where the hospital is.
Long trip with two nights on planes. I am sure we will be exhausted. I will try to email everyone just as soon as we get there to let everyone know we are safe and well.
Bonjour,
Kelli
Well, I can't believe it is here already. We leave today. We met yesterday after church and divided up all our items to make sure all of our suitcases were under the 70 lb mark. We have 9 or 10 plus our carry on items, 2 per person.
This is a little scary for me, since I haven't been this far away from home before. It will be a long plane flight. Everyone else has made this trip before or at least one like it.
It will be challenging but also a blessing. I am learning a little French so I can attempt to communicate while we are gone.
We leave today at 5:45 EST and fly to Atlanta. We won't leave Atlanta till 11:00 pm. From there we fly overnight to Paris, France. We will have a 9 hour layover in Paris and plan to take a tour. Yeah!! From there we fly overnight to N'Djamina, Chad (or Tchad). We then freshen up at TEAM (a hotel for missionaries that come through). Do some shopping in the local market and then take the 6-8 hour drive (depending on the roads), Steve said 6 hours to Bere, where the hospital is.
Long trip with two nights on planes. I am sure we will be exhausted. I will try to email everyone just as soon as we get there to let everyone know we are safe and well.
Bonjour,
Kelli
Monday, August 28, 2006
Malaria Nightmare . . .
Salut!
I'm standing awash in pools of blood and amniotic fluid. I've just slashed down deep through skin, fat, and fascia then ripped through muscle and peritoneum to find the bulging uterus. I then cut through well perfused muscle causing arteries to spurt blood into the wound as a gush of amniotic fluid thickly stained with meconium (baby poop) pours onto the operating field. I then reach a hand down into the swirling pool of red mixed with split pea soup green to find a grossly distorted baby's head too big for his mom's pelvis and pull it up and out. I clamp and cut the cord as the blood and gunk continues to pool and splurt all around. I then reach in and rip out the placenta which is in and of itself not a pretty sight, much less when covered with meconium.
It's at this point that I get nauseated. One would think that what I'm in the midst of doing would be enough to nauseate anyone. But this is different. It's sudden. A clamminess; a churning of the stomach; a feeling of light headedness; aching muscles and joints; a splitting headache; sweat dripping despite the air conditioned chilliness of the OR. This can only be...Malaria.
Somehow I find the strength to clamp the bleeders on the uterus, suture it closed and close the skin. I feel ready to collapse at any point. I quickly help clean up the patient as the feeling of needing to vomit increases. My head is going to explode. How do you describe it unless you've experienced it? A clamminess inside. Something that reaches to the depths of who you are and strangles you. We move the patient out to the wards and clean up the OR. I walk back in a haze. One step at a time. You can do it, James. You're almost home. It's 3am.
At home I open a packet of Artesunate and swallow six pills. I chase it with 800mg of Ibuprofen, a promethazine and a gram of Tylenol and then collapse. My body is racked with chills as a cold sweat breaks out all over. I pile on the blankets and crash into a deep sleep.
At 6AM I am awakened by Hortence. Another woman who is having trouble delivering. Using the force of my will only I pull my self from my Malaria/Promethazine fog, slip on my scrubs and head groggily up to the hospital. This woman has great contractions but a huge baby. The head of the baby is very molded and high up in the pelvis. I give her a few chances to push to see if she can make the head come down. In between encouraging and waiting I literally almost fall asleep on my feet. I feel I have nothing to give. Please, God, don't let her need a c-section.
Finally, I face the inevitable, the baby won't come out. But then,
something slips out of my sluggish mind...symphysiotomy. Of course, it's only her third pregnancy and we don't want to condemn her to repeat c-sections every delivery for the next 5-7 times she'll be pregnant. I force myself to walk to the OR and get the syphysiotomy box. I still feel like passing out or just lying down somewhere. It is sheer will-power that keeps me going.
I arrive back to the delivery room. I shave her pubic area, inject lidocaine, prep with betadine, drape with sterile towels, put on sterile gloves, grab the scalpel and cut straight down to her pubic symphysis. I can feel and almost hear as the scalpel cuts through cartilage. My fingers are inside moving the foley catheter filled urethra to the side so it can't get damaged. I feel that it's mostly cut. I stick my finger in and feel a nice gap. I tell Hortence and Moise to pull the legs apart and down to the side. Suddenly, there is a crack and her pelvis opens up. I quickly suture up the wound and almost immediately the baby's head drops down and appears. I suction the nose and mouth and pull the shoulders and legs out. The huge 4.2kg baby starts yelling immediately as I clamp and cut the cord. My adrenaline wears off and my aching body returns racked with chills.
I go home and crash. I sleep for 24 straight hours almost without moving. Every part of me feels like it's been punched and pounded. I feel I can't sink in deep enough into the mattress. I alternate between soaking the sheets with foul smelling sweat to being so cold that even wool socks, a sweatshirt, three blankets and a sheet aren't enough to keep me warm as I huddle in the fetal position. I try to drink but everything has a metallic, bitter taste. I'm dead to the world. I wake up briefly to realize it's night, the generator's on and my wife is standing over me asking me if there's anything she can do for me. I just fall straight back into my self-induced coma after taking my second dose of Artesunate and wait for the morning to come...
James
I'm standing awash in pools of blood and amniotic fluid. I've just slashed down deep through skin, fat, and fascia then ripped through muscle and peritoneum to find the bulging uterus. I then cut through well perfused muscle causing arteries to spurt blood into the wound as a gush of amniotic fluid thickly stained with meconium (baby poop) pours onto the operating field. I then reach a hand down into the swirling pool of red mixed with split pea soup green to find a grossly distorted baby's head too big for his mom's pelvis and pull it up and out. I clamp and cut the cord as the blood and gunk continues to pool and splurt all around. I then reach in and rip out the placenta which is in and of itself not a pretty sight, much less when covered with meconium.
It's at this point that I get nauseated. One would think that what I'm in the midst of doing would be enough to nauseate anyone. But this is different. It's sudden. A clamminess; a churning of the stomach; a feeling of light headedness; aching muscles and joints; a splitting headache; sweat dripping despite the air conditioned chilliness of the OR. This can only be...Malaria.
Somehow I find the strength to clamp the bleeders on the uterus, suture it closed and close the skin. I feel ready to collapse at any point. I quickly help clean up the patient as the feeling of needing to vomit increases. My head is going to explode. How do you describe it unless you've experienced it? A clamminess inside. Something that reaches to the depths of who you are and strangles you. We move the patient out to the wards and clean up the OR. I walk back in a haze. One step at a time. You can do it, James. You're almost home. It's 3am.
At home I open a packet of Artesunate and swallow six pills. I chase it with 800mg of Ibuprofen, a promethazine and a gram of Tylenol and then collapse. My body is racked with chills as a cold sweat breaks out all over. I pile on the blankets and crash into a deep sleep.
At 6AM I am awakened by Hortence. Another woman who is having trouble delivering. Using the force of my will only I pull my self from my Malaria/Promethazine fog, slip on my scrubs and head groggily up to the hospital. This woman has great contractions but a huge baby. The head of the baby is very molded and high up in the pelvis. I give her a few chances to push to see if she can make the head come down. In between encouraging and waiting I literally almost fall asleep on my feet. I feel I have nothing to give. Please, God, don't let her need a c-section.
Finally, I face the inevitable, the baby won't come out. But then,
something slips out of my sluggish mind...symphysiotomy. Of course, it's only her third pregnancy and we don't want to condemn her to repeat c-sections every delivery for the next 5-7 times she'll be pregnant. I force myself to walk to the OR and get the syphysiotomy box. I still feel like passing out or just lying down somewhere. It is sheer will-power that keeps me going.
I arrive back to the delivery room. I shave her pubic area, inject lidocaine, prep with betadine, drape with sterile towels, put on sterile gloves, grab the scalpel and cut straight down to her pubic symphysis. I can feel and almost hear as the scalpel cuts through cartilage. My fingers are inside moving the foley catheter filled urethra to the side so it can't get damaged. I feel that it's mostly cut. I stick my finger in and feel a nice gap. I tell Hortence and Moise to pull the legs apart and down to the side. Suddenly, there is a crack and her pelvis opens up. I quickly suture up the wound and almost immediately the baby's head drops down and appears. I suction the nose and mouth and pull the shoulders and legs out. The huge 4.2kg baby starts yelling immediately as I clamp and cut the cord. My adrenaline wears off and my aching body returns racked with chills.
I go home and crash. I sleep for 24 straight hours almost without moving. Every part of me feels like it's been punched and pounded. I feel I can't sink in deep enough into the mattress. I alternate between soaking the sheets with foul smelling sweat to being so cold that even wool socks, a sweatshirt, three blankets and a sheet aren't enough to keep me warm as I huddle in the fetal position. I try to drink but everything has a metallic, bitter taste. I'm dead to the world. I wake up briefly to realize it's night, the generator's on and my wife is standing over me asking me if there's anything she can do for me. I just fall straight back into my self-induced coma after taking my second dose of Artesunate and wait for the morning to come...
James
Sunday, August 13, 2006
Resurrection? . . .
I take the well-worn path between the house and the hospital. The rains have turned the desert in to a jungle barely kept at bay by the piggish, constant munching of two half-starved horses. Hortence has called me to look at a child with a hemoglobin of 5 (normal 13-15) to see if he needs a blood transfusion. I savor the cool air, slight breeze and overcast sky. Maybe it'll rain. I walk down the verandah of the OR and towards the Nurse's station.
A few minutes later we are in the dimly lit cave that is Pediatrics. The tin roof windows are mostly closed to keep out the "cold" leaving the entire ward lost in the shadows of late afternoon. After verifying that the 5-year-old is stable enough not to need a risky blood transfusion I walk back down the rows and stop to look at the "miracle" baby. She is, amazingly, still alive. Her chubby body lies flaccid on the mattress, her breathing shallow but not too fast. Her eyes are rolled back and she is unconscious. Her body is hot to the touch. I grab a thermometer and insert it in the baby's anus. 38 degrees Celsius: a high fever consistent with her cerebral malaria. I prescribe an injection to lower the fever and walk back to the nurse's station with the father of the child in tow.
As the father of the child pays for the medicine I can tell he is tired and discouraged.
"It's a miracle she's still alive." I say.
"Yeah, but it's all a waste..." the dad replies leaving unsaid the obvious fact that he's sure she'll die.
As I look at the tears that well uncontrollably in his eyes the whole story of her resurrection passes quickly through my head as told to me by Sarah:
"I was just making normal rounds on Pediatrics when I saw that little baby Koussekoura's IV wasn't working. They hadn't been able to find an IV in her anywhere except her external jugular. There she was, semi-conscious, with this big taped IV and tubing coming out the left side of her neck. Israel and Pernilla tried to help me get it working. We tried everything: injecting a syringe of Glucose solution, wrapping the IV tubing around our fingers to press the fluid through the catheter, inserting needles in the IV bottle to let out the air, everything. This was only her 2nd day of treatment for cerebral malaria and she needed that IV!
"Just then, I noticed that she was breathing faster. Then her hands curled up into fists, her eyes rolled back in her head and her body stiffened as she had a generalized seizure. The mom and great aunt were standing by. Before I could do anything, she stopped breathing. Israel, Pernilla and I all searched for a pulse and couldn't find one; neck, wrist, groin, chest, nothing. The women starting crying softly as the mom came to close the eyes and arrange the limbs. The baby was completely limp. The great aunt went to look for a cloth to wrap the body in. We started to comfort them.
"Several minutes passed when, suddenly, the baby gave a small gasp for air, then another. Shocked I checked for a pulse and found a slow one. I started doing external cardiac massage until the heart beat became faster. She was still unconscious but now definitely alive! Then she started seizing again and I had to give her three doses of Valium before they calmed down. She was then breathing short and fast with big pauses. I thought there was no way she'd live through the night."
It is now a day later and little, chubby Koussekoura is still alive, but the dad is convinced she won't last. It is still sketchy but something in me rises up and forces its way out.
"No, it's not a waste!" I cry, "She's alive. Our only responsibility is to do what we can while we can. Our money won't last. One day it's going to burn. But what we do with our money lasts. One day, whether she lives or dies right now, one day you'll see her again. God will reward you because you have given from your heart. You sacrificed to buy the medicines to treat your baby even though you thought she would die. Whether she lives or dies is now in God's hands because you've done all you could. That's all that's required. But if you didn't do all you could, then you would be responsible. Courage! You're doing the right thing!"
As the dad walks back to his comatose daughter and I walk back to my house I look up at the stars that have now come out and pray that God will reward that dad's love and sacrifice. I feel an unexpected warmth and peace as I walk the familiar path home.
James
P.S. As of the writing of this email, little Koussekoura is alive but still in a coma.
A few minutes later we are in the dimly lit cave that is Pediatrics. The tin roof windows are mostly closed to keep out the "cold" leaving the entire ward lost in the shadows of late afternoon. After verifying that the 5-year-old is stable enough not to need a risky blood transfusion I walk back down the rows and stop to look at the "miracle" baby. She is, amazingly, still alive. Her chubby body lies flaccid on the mattress, her breathing shallow but not too fast. Her eyes are rolled back and she is unconscious. Her body is hot to the touch. I grab a thermometer and insert it in the baby's anus. 38 degrees Celsius: a high fever consistent with her cerebral malaria. I prescribe an injection to lower the fever and walk back to the nurse's station with the father of the child in tow.
As the father of the child pays for the medicine I can tell he is tired and discouraged.
"It's a miracle she's still alive." I say.
"Yeah, but it's all a waste..." the dad replies leaving unsaid the obvious fact that he's sure she'll die.
As I look at the tears that well uncontrollably in his eyes the whole story of her resurrection passes quickly through my head as told to me by Sarah:
"I was just making normal rounds on Pediatrics when I saw that little baby Koussekoura's IV wasn't working. They hadn't been able to find an IV in her anywhere except her external jugular. There she was, semi-conscious, with this big taped IV and tubing coming out the left side of her neck. Israel and Pernilla tried to help me get it working. We tried everything: injecting a syringe of Glucose solution, wrapping the IV tubing around our fingers to press the fluid through the catheter, inserting needles in the IV bottle to let out the air, everything. This was only her 2nd day of treatment for cerebral malaria and she needed that IV!
"Just then, I noticed that she was breathing faster. Then her hands curled up into fists, her eyes rolled back in her head and her body stiffened as she had a generalized seizure. The mom and great aunt were standing by. Before I could do anything, she stopped breathing. Israel, Pernilla and I all searched for a pulse and couldn't find one; neck, wrist, groin, chest, nothing. The women starting crying softly as the mom came to close the eyes and arrange the limbs. The baby was completely limp. The great aunt went to look for a cloth to wrap the body in. We started to comfort them.
"Several minutes passed when, suddenly, the baby gave a small gasp for air, then another. Shocked I checked for a pulse and found a slow one. I started doing external cardiac massage until the heart beat became faster. She was still unconscious but now definitely alive! Then she started seizing again and I had to give her three doses of Valium before they calmed down. She was then breathing short and fast with big pauses. I thought there was no way she'd live through the night."
It is now a day later and little, chubby Koussekoura is still alive, but the dad is convinced she won't last. It is still sketchy but something in me rises up and forces its way out.
"No, it's not a waste!" I cry, "She's alive. Our only responsibility is to do what we can while we can. Our money won't last. One day it's going to burn. But what we do with our money lasts. One day, whether she lives or dies right now, one day you'll see her again. God will reward you because you have given from your heart. You sacrificed to buy the medicines to treat your baby even though you thought she would die. Whether she lives or dies is now in God's hands because you've done all you could. That's all that's required. But if you didn't do all you could, then you would be responsible. Courage! You're doing the right thing!"
As the dad walks back to his comatose daughter and I walk back to my house I look up at the stars that have now come out and pray that God will reward that dad's love and sacrifice. I feel an unexpected warmth and peace as I walk the familiar path home.
James
P.S. As of the writing of this email, little Koussekoura is alive but still in a coma.
Wednesday, August 9, 2006
River Stories From Africa
I feel the stress flow off me as the wind blows in the open truck door. I'm on my way to the river. I hear the singing coming from the back as the young guys express their joy in the moment. The road is red and dusty and the green is starting to push up through the perpetual brown of Béré. The wind is warm but cooling as it dries the sweat off my face.
We pass a small village where women are selling peanuts, donuts and grilled meat. The smell of smoke and cooking flesh wafts its pleasant odor across my nostrils. I wave to the kids who jump up to chase after us waving and yelling "Lapia, Lapia". We round a corner as the road narrows and pass some nomad women in brightly colored clothes draped over their heads and bodies swaying gently on their donkeys' backs. A little ways ahead a small boy with a huge turban and a stick watches his cattle amble across the road. I honk my horn and a few cows turn to stare blankly at the truck while a few others start to lope across a little faster. I slow down and slowly weave my way through the bovine maze.
A few meters farther and I see the sign announcing the end of the road with an arrow pointing out the detour to the left that takes one to the barge. I go straight and pull up just to the edge of the cement where the bridge used to be.
There are backhoes and graders parked on the other side watching in silent contemplation their destructive handy work. All the trees have been mowed down leaving a naked, scarred earth with deep ruts and grooves from their relentless march across. All this is supposed to somehow help them rebuild the bridge. On the other side, cars and mini-vans are parked as people unload their merchandise to cross in tiny, hand hewn dugout canoes. Today is Saturday, Market Day and with the barge under repairs there is no other way across.
I get out, take off my shirt and glasses, tie the car key to my swimming shorts and climb down the rough volcanic stone to the water's edge. Daniel and Ferdinand follow me while the others head downstream to a safer crossing.
In between the two buttresses of the ancient bridge the water way is forcibly narrowed creating whitewater and rapids from its strong current. As I step in I feel the tug and lean back to keep from being swept away. I feel the sharp pumice stones encrusted with shards of oyster shells cutting into my feet. I move slowly downstream until it gets deep enough to let go and ride the rapids.
The current whips me around to the left as the whitecaps slap my face. I am borne to the left hand bank which is a clay cliff 20 feet tall with roots from bushes hanging over the top. One tree has fallen in head first leaning it's trunk against the bank. I twist around, give a few quick strokes with my hands and feet and grab onto the tree. I pull myself around and up, using it as a ladder to get to the top of the cliff. The wet clay slips between my toes as I try to get a grip on the bank. I make it to the top where a small crowd as gathered to watch the "entertainment". I look down and see that Daniel and Ferdinand have entered the current and are approaching the tree swiftly. They rapidly follow me up.
I look down river and see the others crossing: Koumakoi, Doumpa and Felix. I also see that Sarah has just arrived on horseback her curly red hair blowing wildly in the wind as she effortlessly trots up and wipes the sweat from her forehead before smiling and giving me an enthusiastic wave. She brings the horse slowly down to the river to drink and then takes him for a swim.
Koumakoi joins us and looking down at Sarah tells me that she needs to be careful or her horse will turn into a hippo. I laugh, thinking he's joking, but one look at his face tells me that he believes it.
We decide to jump off three by three. Doumpa, Ferdinand and I are the first to jump. I step back and then take a few quick steps forward and launch myself out as far as I can wildly flailing my arms and legs to amuse the crowd with the silliness of "Nasara". I plunge in and feel it all the way to the tips of my sinuses as they get their cleansing purge. I touch the sandy bottom and kick my way to the surface taking in a big gulp of refreshing air as I wipe my eyes and nose and leisurely paddle to the bank.
I see Ferdinand has reached the bank too and forgetting about Doumpa I look up to watch the others jump. They are a little hesitant and I start to egg them on. Suddenly, I hear Ferdinand behind me:
"Where's Doumpa?"
I turn and look just in time to see a pair of hands break the surface about 5 feet from Ferdinand and about 15 feet from me. The hands then sink back beneath the surface. As thoughts race through my brain of how I'm going to explain the drowning of his son to our lab tech, Anatole, I push off and quickly swim to where I saw the hands. Ferdinand reaches the spot first and does a surface dive straight down. I arrive just to feel a head and arms being pushed up. I grab Doumpa as he sputters and coughs for air and I pull him to the bank. Ferdinand follows. Instead of the expected fear and sympathy, everyone, including Doumpa, starts laughing. Maybe I'm the only one who realizes how close we came to death in those swift, muddy waters.
A few weeks later, Sarah and I decide to go to the river again and this time she accompanies me in the truck. Israel, our latest nurse volunteer, follows me into the current while Sarah and the Danish medical student, Pernilla, head upstream to get in out of view of the stares of the ever present crowd.
Since the water has risen about 5 feet, Israel and I are able to enter at the top of the rapids and enjoy the whole ride although the slaps from the waves are harsher this time and I'm a little out of breath when I get to the calmer water. We climb and jump just like last time and then circle around with the current as it circles the deep pit at the center of the river. It's perfect since we would be unable to swim upstream if it didn't reverse itself and bring us easily and quickly back to the rapids. We make the circuit several times then watch from the cliff as Sarah and Pernilla also navigate the whitewater.
Sarah and Pernilla then go to rest in the shallows by the opposite bank near where it rises up to the bulwark of the old bridge. There is some calm water there with some old tree branches sticking up. We pass by several times without incident on our way back to the rapids.
When Israel and I get tired of swimming we start chasing kids who have gathered to watch. Many of them are laughing but some are truly terrified and when we actually catch one I'm afraid he'll faint from terror as his eyes are wide and he screams bloody murder while shaking his hands and shouting "Ai, Ai, Ai, baaaaooooooooo!"
Finally, we are tired and I go upstream to get Sarah and Pernilla's clothes. As I return, an excited Isreal runs up to me and says "look, a hippo!" I look downstream just in time to see some huge nostrils break the surface.
"He was hiding down by the bank in the branches, right where we swam past all those times! Then he finally came up and then headed downstream. We were this close, man!"
Suddenly, a cry goes up from the onlookers. Sarah and Pernilla are still in the water by the rapids. I yell at them to come look. They get out quickly and also see the massive hippo waddle out of the water, up the bank and into the bush.
The locals start running after him with sticks and huge rocks that they throw at him. We jump into the truck and give chase. I veer down a small path only to have the kids on top yell for me to go back, go back! I slam it into reverse and squeal back onto the main road.
"Forward, forward!" They scream. I hit the gas and we follow the crowd. I stop and climb out onto the roof. I see the hippo just 30 feet away crashing through the bushes with the others still in hot pursuit. We follow the chase for about 15 minutes before they finally get too far away.
That night, as I'm explaining to Koumakoi and the others he lets me know that those hippos that come out of the water are really men that take on the form of the hippo. Apparently, hippos are not really animals, they're men or horses that have been transformed. Me, I'm just glad that he didn't take a bite out of me and that I'm home in one piece!
James
We pass a small village where women are selling peanuts, donuts and grilled meat. The smell of smoke and cooking flesh wafts its pleasant odor across my nostrils. I wave to the kids who jump up to chase after us waving and yelling "Lapia, Lapia". We round a corner as the road narrows and pass some nomad women in brightly colored clothes draped over their heads and bodies swaying gently on their donkeys' backs. A little ways ahead a small boy with a huge turban and a stick watches his cattle amble across the road. I honk my horn and a few cows turn to stare blankly at the truck while a few others start to lope across a little faster. I slow down and slowly weave my way through the bovine maze.
A few meters farther and I see the sign announcing the end of the road with an arrow pointing out the detour to the left that takes one to the barge. I go straight and pull up just to the edge of the cement where the bridge used to be.
There are backhoes and graders parked on the other side watching in silent contemplation their destructive handy work. All the trees have been mowed down leaving a naked, scarred earth with deep ruts and grooves from their relentless march across. All this is supposed to somehow help them rebuild the bridge. On the other side, cars and mini-vans are parked as people unload their merchandise to cross in tiny, hand hewn dugout canoes. Today is Saturday, Market Day and with the barge under repairs there is no other way across.
I get out, take off my shirt and glasses, tie the car key to my swimming shorts and climb down the rough volcanic stone to the water's edge. Daniel and Ferdinand follow me while the others head downstream to a safer crossing.
In between the two buttresses of the ancient bridge the water way is forcibly narrowed creating whitewater and rapids from its strong current. As I step in I feel the tug and lean back to keep from being swept away. I feel the sharp pumice stones encrusted with shards of oyster shells cutting into my feet. I move slowly downstream until it gets deep enough to let go and ride the rapids.
The current whips me around to the left as the whitecaps slap my face. I am borne to the left hand bank which is a clay cliff 20 feet tall with roots from bushes hanging over the top. One tree has fallen in head first leaning it's trunk against the bank. I twist around, give a few quick strokes with my hands and feet and grab onto the tree. I pull myself around and up, using it as a ladder to get to the top of the cliff. The wet clay slips between my toes as I try to get a grip on the bank. I make it to the top where a small crowd as gathered to watch the "entertainment". I look down and see that Daniel and Ferdinand have entered the current and are approaching the tree swiftly. They rapidly follow me up.
I look down river and see the others crossing: Koumakoi, Doumpa and Felix. I also see that Sarah has just arrived on horseback her curly red hair blowing wildly in the wind as she effortlessly trots up and wipes the sweat from her forehead before smiling and giving me an enthusiastic wave. She brings the horse slowly down to the river to drink and then takes him for a swim.
Koumakoi joins us and looking down at Sarah tells me that she needs to be careful or her horse will turn into a hippo. I laugh, thinking he's joking, but one look at his face tells me that he believes it.
We decide to jump off three by three. Doumpa, Ferdinand and I are the first to jump. I step back and then take a few quick steps forward and launch myself out as far as I can wildly flailing my arms and legs to amuse the crowd with the silliness of "Nasara". I plunge in and feel it all the way to the tips of my sinuses as they get their cleansing purge. I touch the sandy bottom and kick my way to the surface taking in a big gulp of refreshing air as I wipe my eyes and nose and leisurely paddle to the bank.
I see Ferdinand has reached the bank too and forgetting about Doumpa I look up to watch the others jump. They are a little hesitant and I start to egg them on. Suddenly, I hear Ferdinand behind me:
"Where's Doumpa?"
I turn and look just in time to see a pair of hands break the surface about 5 feet from Ferdinand and about 15 feet from me. The hands then sink back beneath the surface. As thoughts race through my brain of how I'm going to explain the drowning of his son to our lab tech, Anatole, I push off and quickly swim to where I saw the hands. Ferdinand reaches the spot first and does a surface dive straight down. I arrive just to feel a head and arms being pushed up. I grab Doumpa as he sputters and coughs for air and I pull him to the bank. Ferdinand follows. Instead of the expected fear and sympathy, everyone, including Doumpa, starts laughing. Maybe I'm the only one who realizes how close we came to death in those swift, muddy waters.
A few weeks later, Sarah and I decide to go to the river again and this time she accompanies me in the truck. Israel, our latest nurse volunteer, follows me into the current while Sarah and the Danish medical student, Pernilla, head upstream to get in out of view of the stares of the ever present crowd.
Since the water has risen about 5 feet, Israel and I are able to enter at the top of the rapids and enjoy the whole ride although the slaps from the waves are harsher this time and I'm a little out of breath when I get to the calmer water. We climb and jump just like last time and then circle around with the current as it circles the deep pit at the center of the river. It's perfect since we would be unable to swim upstream if it didn't reverse itself and bring us easily and quickly back to the rapids. We make the circuit several times then watch from the cliff as Sarah and Pernilla also navigate the whitewater.
Sarah and Pernilla then go to rest in the shallows by the opposite bank near where it rises up to the bulwark of the old bridge. There is some calm water there with some old tree branches sticking up. We pass by several times without incident on our way back to the rapids.
When Israel and I get tired of swimming we start chasing kids who have gathered to watch. Many of them are laughing but some are truly terrified and when we actually catch one I'm afraid he'll faint from terror as his eyes are wide and he screams bloody murder while shaking his hands and shouting "Ai, Ai, Ai, baaaaooooooooo!"
Finally, we are tired and I go upstream to get Sarah and Pernilla's clothes. As I return, an excited Isreal runs up to me and says "look, a hippo!" I look downstream just in time to see some huge nostrils break the surface.
"He was hiding down by the bank in the branches, right where we swam past all those times! Then he finally came up and then headed downstream. We were this close, man!"
Suddenly, a cry goes up from the onlookers. Sarah and Pernilla are still in the water by the rapids. I yell at them to come look. They get out quickly and also see the massive hippo waddle out of the water, up the bank and into the bush.
The locals start running after him with sticks and huge rocks that they throw at him. We jump into the truck and give chase. I veer down a small path only to have the kids on top yell for me to go back, go back! I slam it into reverse and squeal back onto the main road.
"Forward, forward!" They scream. I hit the gas and we follow the crowd. I stop and climb out onto the roof. I see the hippo just 30 feet away crashing through the bushes with the others still in hot pursuit. We follow the chase for about 15 minutes before they finally get too far away.
That night, as I'm explaining to Koumakoi and the others he lets me know that those hippos that come out of the water are really men that take on the form of the hippo. Apparently, hippos are not really animals, they're men or horses that have been transformed. Me, I'm just glad that he didn't take a bite out of me and that I'm home in one piece!
James
Africa Projects Update
Salut à tout le monde!
I'd like to give a quick update to everyone on the different projects that have been accomplished this last year at the Béré Adventist Hospital as well as projects already started or about to start. Many of you have given anonymously and generously in many ways.
Thank you.
1. Nursing student, Augustin, sent for his first year of nursing school at the evangelical hospital of Bebelem. Costs: $600 tuition, $50/month living expenses, $60 moving allowance, total $1260/year.
2. Nursing student, Enoch, sent to a private nursing school in N'Djamena. Costs: $500 tuition, $50/month room and board, total $1100/year.
3. Medical student, Odei, starting 5th (of 7) year. Costs: living allowance (tuition paid by the state) $50/month, total $600/year.
4. Medical Equipment Repair technician student, Anatole, sent for 1st two months of 2 month per year for 4 year program at Valley View University in Ghana. Costs: tuition free, room and board $400, travel & visas $900.
5. Medical Equipment Repair technician and theology student, Evariste, in same program as Anatole (see #4): Costs: tuition free for Medical Equipment Technician program, room and board $400, tuition + room & board per semester for Theology $1260 (paid by me the last year and a half).
6. Master's in International Development program for our administrator, Andre. Three year program of one month per year in Kenya. He will leave for the first session on August 25. Costs: tuition $2000/year, passport $170, visa (to be obtained in airport, cost unknown but estimated at $20-50), room & board $18/day for 25 days, travel (unknown but estimated at $1200 to $1600 to and from Nairobi). estimated max total costs: $4160/year.
7. Staff housing at the hospital: foundation, walls, roof and plastering $24,000. Plumbing, ceilings, painting, electricity and slab to be done by team from Florida. Costs as yet unknown.
8. Midwife student, Hortance, to start this September in N'Djamena. Since she has her nurses aide degree and has already worked over a year at the hospital she can enter in as a second year student and finish in two years. Costs: Tuition $500/year, living expenses $50/month, total per year
$1100.
9. Nursing student, Samedi, to start this September in N'Djamena at the same school as Enoch (see #2). Samedi has worked 30 years at the Béré Hospital starting out as a janitor and being trained on site without formal education until he has become our finest nurse and in charge of the operating theater. He's the one who does emergency surgery during my absence and did over 70 surgeries without complications during my vacation in March and April. We feel it is high time to get him some formal education. Costs: tuition $500/year, living expenses $100/month, total per year $1700.
Again, we thank you for your encouraging words that you never cease to send, as well as your generosity in allowing us to build for the future so the Béré Adventist Hospital can continue to function in this neglected and abandoned corner of the world to bring hope and healing to those who are so often discouraged and minimized.
Merci beaucoup! Shukran katir! Merci beja!
James & Sarah
I'd like to give a quick update to everyone on the different projects that have been accomplished this last year at the Béré Adventist Hospital as well as projects already started or about to start. Many of you have given anonymously and generously in many ways.
Thank you.
1. Nursing student, Augustin, sent for his first year of nursing school at the evangelical hospital of Bebelem. Costs: $600 tuition, $50/month living expenses, $60 moving allowance, total $1260/year.
2. Nursing student, Enoch, sent to a private nursing school in N'Djamena. Costs: $500 tuition, $50/month room and board, total $1100/year.
3. Medical student, Odei, starting 5th (of 7) year. Costs: living allowance (tuition paid by the state) $50/month, total $600/year.
4. Medical Equipment Repair technician student, Anatole, sent for 1st two months of 2 month per year for 4 year program at Valley View University in Ghana. Costs: tuition free, room and board $400, travel & visas $900.
5. Medical Equipment Repair technician and theology student, Evariste, in same program as Anatole (see #4): Costs: tuition free for Medical Equipment Technician program, room and board $400, tuition + room & board per semester for Theology $1260 (paid by me the last year and a half).
6. Master's in International Development program for our administrator, Andre. Three year program of one month per year in Kenya. He will leave for the first session on August 25. Costs: tuition $2000/year, passport $170, visa (to be obtained in airport, cost unknown but estimated at $20-50), room & board $18/day for 25 days, travel (unknown but estimated at $1200 to $1600 to and from Nairobi). estimated max total costs: $4160/year.
7. Staff housing at the hospital: foundation, walls, roof and plastering $24,000. Plumbing, ceilings, painting, electricity and slab to be done by team from Florida. Costs as yet unknown.
8. Midwife student, Hortance, to start this September in N'Djamena. Since she has her nurses aide degree and has already worked over a year at the hospital she can enter in as a second year student and finish in two years. Costs: Tuition $500/year, living expenses $50/month, total per year
$1100.
9. Nursing student, Samedi, to start this September in N'Djamena at the same school as Enoch (see #2). Samedi has worked 30 years at the Béré Hospital starting out as a janitor and being trained on site without formal education until he has become our finest nurse and in charge of the operating theater. He's the one who does emergency surgery during my absence and did over 70 surgeries without complications during my vacation in March and April. We feel it is high time to get him some formal education. Costs: tuition $500/year, living expenses $100/month, total per year $1700.
Again, we thank you for your encouraging words that you never cease to send, as well as your generosity in allowing us to build for the future so the Béré Adventist Hospital can continue to function in this neglected and abandoned corner of the world to bring hope and healing to those who are so often discouraged and minimized.
Merci beaucoup! Shukran katir! Merci beja!
James & Sarah
Wednesday, July 19, 2006
Mourning From Africa . . .
Bon soir,
A cool east wind has chilled me to the bone. I've just finished praying with Sarah and for the first time in a long time settle down to sleep without earplugs. As I snuggle next to the warmth of my wife I drift off to the chirping of the myriad Béré night insects. All things slowly fade off into dreamland. But, just before starting the night visions, I am reluctantly tugged back to reality by a soft tap, tap, tap on the door.
"Médecin?"
I groggily reply "Oui?"
"C'est David, one of the patients just died. The family traded a bicycle in to get their ox cart out of hawk so they can take the body back to their village but I can't get the combination lock on the gate to open. I called Boniface and he can't get it open either."
As I zoom back out of the tunnel of the subconscious I hear fading in the wails, groans and shrieks of a Nangjere mourning ritual. I pull up the mosquito net and grab my flashlight.
"J'arrive," I mumble as I search for some pants and a ragged t-shirt. I pull my clothes on, punch open the metal door, slip on some flip flops by the slim light of my torch and pad reluctantly after David towards the hospital.
Aaaaaaaahhhhhh! Ohhh, ohhhh, ohhhhhhh! Aye yi yi yi yi yi yi! The ghoulish sounds of the dead man's family waft across the campus as if straight out of nightmare. Am I really awake? I follow David to the gate where the eerie, flickering glow of a kerosene lamp dimly lights up the shadows of peoples arms waving and dim forms moving back and forth and rocking up and down.
I shine the flashlight on the lock. Three turns to the right, stop at 30. Turn back left past 30 and stop at 20. Back to the right till 02 and tug! The padlock falls open. I remove the chain as David and Boniface both click their approval in the background followed by a few "ça, ça, ça's" and "kai, kai, kai's". David opens the gate and two shadowy forms silently slip in past us.
I look outside to where the dancing orange flame lights up a series of rolled up mats, three bicycles tightly in a row, a couple of bundles wrapped up in cloth and tied at the top, and a group of what appears to by women as judged by the shadows from their head and body wraps. One woman with a bundle, probably a baby, strapped to her back is waving back and forth with arms flailing the air as she marches five steps forward, turns and five steps back in a never ending dance of death.
The others are kneeling or sitting in a tight bunch with various head bobs and arm movements rhythmically accompanying the chants, wails, moans and groans in a macabre symphony of fear.
A man walks up with an agonizing yell tearing from his throat as he beats his breast. Dogs bark in chorus in the background as a cat yelps in a discordant cacophony straight from hell.
I find anger and pity and sorrow welling within me. It's so unnecessary and disheartening. The sorrow is not real. These same people left their relative sick for a week without treatment followed by three days in a coma before coming to the hospital. To pay $20 for his treatment is all but impossible. Yet, now, they will spend hundreds of dollars on entertaining and feeding the relatives and friends who will come to pay their condolences. Everyone will gather and make a lot of noise to "prove" how sorrowful they are and to make sure that his spirit doesn't come back to haunt them because they weren't sad enough at his passing.
It makes me sick to sense all the fear of death and spirits and hauntings that I hear in their crys. To see and know the ignorance that keeps them captive breaks my heart. I know the one who has promised to "free those who all their lives were held in slavery by their fear of death" (Heb 2:15). But it seems so overwhelming to fight against so much superstition and tradition and fear.
I show Boniface and David how to work the lock as the two men who'd entered re-emerge out of the darkness pulling the ox cart past us and out the gate. We put the chain back around as the two watchmen click and mutter their excitement at learning how the combination works. I walk back through the tall grass towards my bed as the chilling sounds of the Nangjere fade again into the background soon to be lost to the darkness of the African bush as it swallows up it's children once again in its bottomless pit of despair.
James
A cool east wind has chilled me to the bone. I've just finished praying with Sarah and for the first time in a long time settle down to sleep without earplugs. As I snuggle next to the warmth of my wife I drift off to the chirping of the myriad Béré night insects. All things slowly fade off into dreamland. But, just before starting the night visions, I am reluctantly tugged back to reality by a soft tap, tap, tap on the door.
"Médecin?"
I groggily reply "Oui?"
"C'est David, one of the patients just died. The family traded a bicycle in to get their ox cart out of hawk so they can take the body back to their village but I can't get the combination lock on the gate to open. I called Boniface and he can't get it open either."
As I zoom back out of the tunnel of the subconscious I hear fading in the wails, groans and shrieks of a Nangjere mourning ritual. I pull up the mosquito net and grab my flashlight.
"J'arrive," I mumble as I search for some pants and a ragged t-shirt. I pull my clothes on, punch open the metal door, slip on some flip flops by the slim light of my torch and pad reluctantly after David towards the hospital.
Aaaaaaaahhhhhh! Ohhh, ohhhh, ohhhhhhh! Aye yi yi yi yi yi yi! The ghoulish sounds of the dead man's family waft across the campus as if straight out of nightmare. Am I really awake? I follow David to the gate where the eerie, flickering glow of a kerosene lamp dimly lights up the shadows of peoples arms waving and dim forms moving back and forth and rocking up and down.
I shine the flashlight on the lock. Three turns to the right, stop at 30. Turn back left past 30 and stop at 20. Back to the right till 02 and tug! The padlock falls open. I remove the chain as David and Boniface both click their approval in the background followed by a few "ça, ça, ça's" and "kai, kai, kai's". David opens the gate and two shadowy forms silently slip in past us.
I look outside to where the dancing orange flame lights up a series of rolled up mats, three bicycles tightly in a row, a couple of bundles wrapped up in cloth and tied at the top, and a group of what appears to by women as judged by the shadows from their head and body wraps. One woman with a bundle, probably a baby, strapped to her back is waving back and forth with arms flailing the air as she marches five steps forward, turns and five steps back in a never ending dance of death.
The others are kneeling or sitting in a tight bunch with various head bobs and arm movements rhythmically accompanying the chants, wails, moans and groans in a macabre symphony of fear.
A man walks up with an agonizing yell tearing from his throat as he beats his breast. Dogs bark in chorus in the background as a cat yelps in a discordant cacophony straight from hell.
I find anger and pity and sorrow welling within me. It's so unnecessary and disheartening. The sorrow is not real. These same people left their relative sick for a week without treatment followed by three days in a coma before coming to the hospital. To pay $20 for his treatment is all but impossible. Yet, now, they will spend hundreds of dollars on entertaining and feeding the relatives and friends who will come to pay their condolences. Everyone will gather and make a lot of noise to "prove" how sorrowful they are and to make sure that his spirit doesn't come back to haunt them because they weren't sad enough at his passing.
It makes me sick to sense all the fear of death and spirits and hauntings that I hear in their crys. To see and know the ignorance that keeps them captive breaks my heart. I know the one who has promised to "free those who all their lives were held in slavery by their fear of death" (Heb 2:15). But it seems so overwhelming to fight against so much superstition and tradition and fear.
I show Boniface and David how to work the lock as the two men who'd entered re-emerge out of the darkness pulling the ox cart past us and out the gate. We put the chain back around as the two watchmen click and mutter their excitement at learning how the combination works. I walk back through the tall grass towards my bed as the chilling sounds of the Nangjere fade again into the background soon to be lost to the darkness of the African bush as it swallows up it's children once again in its bottomless pit of despair.
James
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