Bongor

I sit by the side of the road. Around me in all directions stretches the African plain. It's vast, flat expanse allows one to see miles in every direction broken only by the occasional tree and smoke from a cooking fire. Ahead and behind the single lane road stretches into infinity, swallowed up in the haze of the Harmatan winds off the Sahara.

My neck is burned, my hands are caked with grease, and the smell of diesel clings to my plain, tan-colored Arabic robes. My mouth is parched, my lips are cracked, my nose is filled with thick, black tinged snot, and my eyes are dry.

I lean against the hood of the truck as a small crowd of kids on foot and adults on bikes alternately stares and whispers among themselves in Arabic and a variety of local languages.

Sarah has left to fill our water bottles in the little cluster of huts off to the left. It is 3pm. We left B�r� at 7:30am and Bongor at 11am. Bongor is 24km, one toll booth, and a long day filled with experiences away...

....Coming out of Bongor I start to notice a problem with power and acceleration. As we approach the toll booth outside of town, the car stalls as I clutch and brake, I pop the clutch and the truck roars to life only to die again as I try to juggle braking, hitting the gas and pulling the emergency brake to stop and pay our toll. We try in vain to start it. Finally, the toll guys give us a push through the gate and we try to start it that way, but nothing.

With my wrenches in hand, I open the hood and remove the diesel return valve bolt from the injection pump. It is filthy. I ask some of the bystanding gawkers if they have any kerosene. One guy with a shortened upper arm brings me a plastic capfull. I clean out the tiny filter with the kerosene, a match, and blowing with my own mouth. I replace the part and the car starts right up.

I'm feeling really good about myself until 5km later when the pickup finds its closest point to our destination for the day. The time is 11am. We pull up under a tiny tree providing the only shade around. A few meters ahead a "road" turns off to a school built out of woven mats. The kids are outside playing some game. A medium-sized man with a rare Tchadian paunch sidles up, his hands deep in the pockets of his pants pulled up to his belly button with a tight white tank top tucked in.

He says we need a mechanic. A classic Tchadian introduction of stating the obvious. At the same moment, he yells to a passing motorcycle driven by a blue-robed Arab with curly, nappy hair and a short moustache. He immediately starts messing around with the engine by taking off the fuel filter and hand fuel pump. He says the problem is with the hand pump. I think it's maybe the filter, which looks a little crushed.

He calls someone in town and I climb on behind. We tear off down the tarmac, the wind stinging my eyes. The thought crosses my head that if the tire blows out, or we hit a goat or something that I'm dead. I grasp a 5 liter bottle in one hand and the old filter with hand pump attached in the other. I promptly upend the filter spilling diesel all over my lap. The unchanging African plain whirs by in a blur as my eyes sting and tear from the wind and dust.

We arrive in Bongor at a little shop with different sizes and shapes of glass bottles filled with a variety of fuels out front. Inside are an assortment of car parts old, new, and used piled haphazardly on shelves and all over the floor. We buy a new filter and a new pump which is obviously a cheap imitation. We haggle out the prices and I'm not satisfied but am desperate and know I will never get the same price as a local because of my skin color. A variety of "Al salaam alekums" and "al hamdullilahs" float around as I wait for our motorcycle friend to fill up the bike for our return trip.

The return is the same except I am doubly weighted down with filters and pumps, and the 5 liter jug is now full of gasoline.

The truck has been pushed down next to the school and Sarah is playing jumping games with the now out-of-school kids. We have now been reinforced with 3 more Arabs who all seem to know a little about engines but not much. They alternately open and close things pumping furiously and often on the new hand pump. Eventually, with a push we get the car started and our "friend" drives off down a dusty side road.

A half an hour later, Sarah and I are beginning to wonder if our truck has been hijacked to help out in the coup-d'�tat effort going on in parts of Tchad and whether we'll ever see it again. One of the other Arabs comes back on his motorcycle and takes us 100 meters up the paved road where the truck has stalled again.

Finally, at 3pm they leave for Bongor to find a mechanic and I find myself leaning against the hood waiting for Sarah to come back with water. All I can think about are the watermelons in Guelengdeng just 45 km up the road where we were planning to stop for refreshment. They are the best in the world, especially on a dry, hot, dusty Tchadian day.

I glance up and see four round green objects sitting on my side of the road just 50 feet ahead. I ask the locals hanging around what they are and to my unbelieving ears hear the word "watermelon"! I immediately buy two, borrow the ever-present, razor-sharp Arab knife from a boy standing by and slice into and devour one of the sweetest, crispest watermelons I've ever eaten!

As the juice runs down my face and chin and drops on my diesel stained robes, Sarah comes back to partake in the feast.

She then says she saw some horses back in the small village and wants to go back see if they'll let her ride them.

She arrives at the edge of the village where a marriage is being celebrated with the traditional spontaneous horse races up and down the dusty path in front of the wedding site. The men are hesitant to let a mere woman get on a horse as they are sure she will fall off and kill herself on their "wild" stallions.

As she mounts expertly and then challenges them to a race, they all smile condescendingly and the women turn to smile and cheer. They've never been given the privilege of riding and so are all on Sarah's side.

It is Sarah against two Arab men. Sarah's horse has obvious Arabian blood in it, is pale white with delicate feet and with Sarah mounting up like a jockey on the short stirrups she beats them hands down, not once but twice. As she rides up to where I am waiting there is a wildness and gleam in her eyes that reminds me again of what an amazing thing it was to have met and married a girl like her in a place like this.

The mechanic comes and promptly breaks the diesel intake valve. I had been warning them all day not to touch that as I'd broken that same part last year and knew how fragile it was. He leaves, promising to send a tow truck.

I'm frustrated and mad by now. I go to talk to his associate who's stayed behind and tell him we'll just stay here in the bush tonight and they can bring us the part in the morning and put it on and we'll go from there.

He cancels the tow-truck and it's not until the darkness descends that I regret my decision. The associate says he'll flag down a car that'll pull us into Bongor for at most 5000 francs. The next truck is a tiny Peugeot piled so high with baggage and people prickling out from on top of the cargo that the bumper is almost touching the ground. They stop and the turbaned chauffeur offers to tow us for 25,000 francs. After negotiation we get it down to 10,000 francs but in my state of mind I'm so angry with the whole situation that I refuse.

I continue to regret my decisions until a tiny, old toyota car pulls up equally weighted down. A tall, commanding Arab with a goatee pulls out and finally talks sense into me that we need to go to Bongor for our own safety. He says his car is too weak to pull us, though. As I discuss with the mechanic's associate, the commanding Arab comes back and says he can't leave us stranded like that and will pull us for the same price, 10,000 francs that we refused the other truck. I accept.

We attach a cord to our bumper and to the other car with about 10 feet in between. He says that when we see his left uncovered brake light go on we should stop, as the other lights don't work. We limp into Bongor and are deposited next to the fluorescently lighted grilled chicken restaurants. Our tow man comes back to tell us he's called the chief mechanic to come meet us here himself. We pay him and he leaves.

We wait. Our tall Arab comes back to say the chief mechanic is sick but he will pull us to the garage where these other guys can help us. It is the main garage in Bongor, run by the "chinois".

I'm not reassured as a wobbly gate made of tin roofing is slid to the side revealing what looks more like a junkyard than a garage. Another dude pulls up on a moto and they replace the broken part, fiddle with some things, start up the car, and take it out for a test run. It does great!...until they return and it loses power. They say they'll come back tomorrow at 5:30am. It's now 8:30pm.

I call Pastor Job in N'Djam�na and get the local pastors phone number to see if we can stay with him. I get no reply from the local pastor but I do get his name and know he lives somewhere near the Mayor's office. The mechanic on the moto takes us to the Mayor's. We ask around and finally a group of muslims lounging on some mats under a tree point us up the road to the Adventist church.

All is dark as we pull up behind the church. We call out "Al salaam alekum" and a groggy Pastor Issa emerges in shorts and a unbuttoned jacket to welcome us. He then wakes up his kids and moves them out of their mud hut so Sarah and I can sleep there. We stay up another half hour eating cold chicken and bread Sarah had bought on arrival in Bongor and hearing stories of how our hospital came into existence and the adventures of early missionaries like Armin Krakolinig, who built our hospital and most of the Adventist churches in Tchad including this one next door here in Bongor.

Sarah and I finally crash on a thin foam pad surrounded by piles of cassette tapes, simple notebooks, and clothes hanging on a string over the bed. With no mosquito net we sleep fitfully as the malaria vectors buzz our ears all night. At 6 a.m. I am up and have to pee but can't find a latrine. We walk back to the garage with Pastor Issa as our guide.

The mechanics are already at work. We sit around eating peanut oil-flavored beans Sarah has bought just outside, and wait as they clean the fuel tank and putter around adjusting and cleaning the injectors and the rest of the diesel circulation system. The "chinois" has arrived, the "Chef de Garage" and he helps fine tune things. While waiting for some new, clean diesel to arrive I strike up a conversation with the "chinois".

Then, he is about to send off someone to the pharmacy to buy him some meds. I tell him to wait as I'm a doctor, maybe I can find out what's really wrong and get him a better prescription. He gives me the classic joint pains, headache, and intermittent fevers of Malaria. I prescribe some good anti-malarials and the guys finally finish.

We head out for the last test run. I'm in the back of the pickup with one of the mechanics while the other one drives with Sarah inside. We accelerate well and fly out of Bongor back towards K�lo. About 10 km en route I sit up a little and the wind catches my glasses sending them tumbling onto the road. I bang frantically on the roof for the driver to stop. Eventually, he does and we spend the next 45 minutes walking up and down the road looking desperately for my glasses and asking everyone we pass if they've seen them. As we were leaving B�r� I remember thinking maybe I should put my contacts in my toiletries bag but decided against it since the trip was so short.

We are about to give up when a bike that had passed us a few minutes ago returns with my smashed and twisted glasses. One lens is gone but the left is still there and with a little bending I make them fit my face. We are on the road again. The car runs fine, it stalls a few times but easily starts back up. After Guelengdeng I have Sarah take over as I'm getting a headache driving with only one lens in my glasses and keeping my right eye shut.

As I enter our room in N'Djam�na at 4:30 p.m. that night my first thought is to take a shower and wash the last two days off of me. As I open my toiletries bag I find my contacts and solution somehow there. I laugh and call Sarah and we rejoice together to have the privilege of living, working, and surviving in a place like Tchad.

Near death experiences...

I'm staring at the old bathroom tile. On its smooth surface sit four drops of blood in the form of a T. On each has been placed a drop of a different liquid: blue, yellow and two clear. In the dim, fluorescent light I search diligently for signs of agglutination. It is a matter of life or death.

It started with a call from the nurse...

"There's the doctor from Kélo who brought someone. He wants you to see them."

I walk quickly over from the house to the hospital. It is dusk and the shadows are gathering. I hear the roar as the generator begins its nightly two-hour vigil. The fluorescent lights fight flickeringly to overcome the resistance to their illumination. I round the corner of the OR and towards the yellow light of the one bed "ER".

The nurse on duty, Hortance, points me back outside where a father sits on a crude bench holding tightly to his 7 month old son while his wife sits at his side with fear, desperatation, and hopelessness in her eyes. Dr. Assane from Kélo is standing by in street clothes, a departure from his usual stylish sport coat and unbuttoned, tie-less dress shirt.

Assane quickly explains that he went to his home village to visit relatives and found this kid on death's door. Since our hospital is closer he brought them here.

Truly, the kid is not long for this world. His eyes are rolled back. His body is limp. His respirations come in gasps. I listen to his heart which is pounding furiously and desperately. I look at his eyelids...white as snow. Anemia. Severe malaria. Our bitter daily bread and butter.

In 2005 we saw 67 patients, over 90% of whom were kids 2 years and under, die of malaria. Of those 67, 25 died of severe anemia requiring blood transfusions (hemoglobins less than 5). As depressing as that is, in all we transfused 99 patients meaning despite the desperate condition of the patient which pushed us to transfuse (using whole blood donated from a family member), we were able to save 75% who would've surely died otherwise.

This baby has the look of not even making it long enough to test his blood much less transfuse. The father gazes at me, pleading in his eyes. I tell the night watchman to go get Anatole, our lab tech.

Meanwhile, I ask Hortance to try and find an IV on the child so we can be ready if and when the blood arrives. The father places the limp child on the exam table. His head flops to one side as he continues to stare up, uncomprehending. His arms and legs are like jelly.

Anatole is not at home and he hasn't left his key. I sit there helpless watching Hortance search in vain for a vein on this tiny baby who has lost probably at least 3/4 of his red blood cells to the Plasmodium parasites. I could probably do the blood typing, I've seen Anatole do it countless times. If only I had the key, as all the equipment is safely locked in the lab.

Adam, our newest student missionary, is standing by, so I ask him to go get the bag-valve-mask so we can at least help this tired baby breathe. He returns and I place the mask over the baby's nose and mouth and start pumping in air with every effort he makes. His mom starts crying behind me.

Hortance has used up two IVs already when Anatole's son arrives with the lab key. I pass the bag-valve-mask to Adam and hurry to the lab. I open the door, flip on the light, open the armoire, find the fridge key, and pull out four bottles with droppers: A, B, AB and D. I grab two bathroom tiles, two lancets, some cotton, some alcohol prep pads, and rush back to the baby.

I prick the baby's middle finger and squeeze out a drop of blood in four different spots on the tile. Three across for A, B, and AB and one underneath B for D. I drop one blue drop for A, one yellow drop for B and one clear drop for AB and a different clear drop for D. I use the bottom of the vials to mix the drops in with the blood (since I'd forgotten to bring mixers from the lab). I start rotating the tile so the liquid will move allowing me to see if small clots form (agglutination). After two minutes nothing has formed in A, B or AB but there are agglutinations in D. Baby's blood is O positive. I prick mom's finger and repeat the process. She is O positive as well. I hope I've done it right as a mistake could cause a life threatening reaction, but desperate times call for desperate measures.

We are also out of rapid HIV tests. The only test we have takes 45 minutes to an hour. I look over at the dad. He's holding the baby as Hortance has given up trying to find an IV. He is trying to close the eyes, saying that the baby is about to die. The mom is sobbing. I make a quick decision.

One of our government lab techs, Matthieu, has just showed up. He's on strike, but I ask him a favor. He agrees and takes the mom off to draw her blood for the blood transfusion. I take the child back to the exam table. I need an IV.

Sarah has arrived and she brings me a larger IV and a 2 mL syringe. I feel the baby's femoral pulse and stick the needle in to the inside of the pulse where I know the vein should be. I pull back on the syringe looking for that quick fill of dark blood indicating I'm in the vein. I search and search. Finally, on pulling out I hit a small flash. I try to advance and it goes in. I pull out the needle and see a little blood in the catheter.

Matthieu has just arrived with the blood. Adam continues to help the baby breathe. I attach the bag of blood and it drips slowly in. I breathe a sigh of relief.

After a couple minutes, Sarah points to the groin and asks if it isn't swelling. Sure enough, the IV isn't in the vein and the blood has been going in under the skin only. I ask for another IV and try the other vein. This time I find the vein easily and with the big flash I know I'm in. I attach the blood again and open it up to go in fast.

We watch a miracle take place before our eyes. First, the floppy baby's legs start to curl up. Then, he stretches his arms straight over his head as if he were Lance Armstrong celebrating yet another Tour de France win. Then he pees straight up in the air, a glorious clear fountain telling us his internal organs are waking up now too. Then, his blank stare transforms into an intelligent sparkle as he looks around at the world he thought he'd left.

Three days, one more transfusion, 8 IV infusions of quinine, and one unbelieving family later, the little boy goes home...