Thursday, February 23, 2006

Miracle?

I'm drained. Another day. Up early. Drink a liter of water. Read the Bible on the throne. Eat breakfast. Go to staff worship. Sing something in Nangjere. Read some obscure Old Testament passage. Listen to how many patients got admitted with malaria last night. Hear how many kids died of malaria last night. Pray. Grab stethescope, clipboard, and pen. Walk to the wards. Notice how much plastic, bloody cotton, and trash is lying around. Look at the dirty walls and floors. Watch them bring out the filthy round cart. Walk around. Look and see how many meds haven't been given. Yell a little. Listen to some hearts and lungs to make it look like I'm doing something. Write prescriptions. Send people home. Send people to the lab. Change dirty dressings. Smell many things I'd rather not describe. Repeat same thing in Pediatrics. Yell at mothers and fathers for not buying the necessary meds to treat their kids. Yell at them again for not giving the meds or giving them wrong. Get "fives" from chronic, cute kids who'll probably be handicapped for life because the best place they can come is here and here's not good enough. Hear about a premature baby referred for warming lights. Smirk bitterly as I remember warmers without probes to make them work and lack of electricity besides. Promise to come see baby after rounds. Finish rounds. Go see baby sitting on front steps of clinic. Notice sun shining on tiny 7 month premie who is blue. Watch and see no breathing. Tell mom boy is dead. For some reason, listen to heart with stethescope. Hear heart beat. Lackadaisically pick up baby and walk over to gurney. Put baby on gurney in sun. Call for bag-valve-mask to breath for baby. Start breathing for baby. Ignore soon gathering crowd of locals. Too tired to care. Continue breathing. Baby starts to turn pink and grimace. Baby starts to move legs and arms. Listen to heart. Beating stronger. Keep breathing. Getting warm. Murmurs ripple through crowd. Sweat drips onto baby. Baby opens eyes. Stop breathing for baby. Baby breathes with difficulty on own. Continue to help from time to time. Send for mom. Give pink, squirming, breathing baby into mom's arms. Tell her to sit in sun. Feel heart pounding. Warm, feel-good feeling. Go back to grind. Miracle? Two hours later, nurse tells me...baby...is...DEAD...

Friday, February 10, 2006

The Balance of Life and Death in Chad

by JAMES APPEL

The sun beats fiercely from the brilliant blue sky as we make our way along the well-worn path toward the river. The path disappears into a flooded rice field. Removing our sandals, we wade into the warm water.

Occasionally we pass locals and greet them with a friendly "lapia." When we arrive at the river, the half-naked children quickly leave their fishing spears to watch the foreigners swim.

The sun sets as we make our way back across the rice paddies, tired but refreshed. A little recreation helps us focus on the difficult tasks we face working in the mission hospital in Bere, Chad.

One morning a baby is brought in with a severe infection in her lower abdomen and legs. Antibiotics fight the infection, and I remove large patches of dead black skin to save the child's life. Later that day, Sarah, one of our mission nurses, reports that the baby is unconscious. I rush to her and find she is not breathing. Desperately I perform CPR, but it is too late; the child is dead. Sarah is devastated, thinking that somehow the child's death is her fault. But I blame myself. If I had checked on her more often, maybe I could have saved her. We see death all the time, but this child's death troubles me deeply.

A young woman comes in with abdominal pain. The nurse suggests a urinary tract infection; I suspect appendicitis. She says she is not pregnant, but I wonder. A pelvic exam suggests an infection of the uterus or fallopian tubes. I wish I had an ultrasound that could identify the source of infection. I put her on antibiotics.

That evening the staff wants to go to the river. I do too. But I stay behind to check on the woman. She is worse. I ask more questions and search the medical books. A urine test reveals she is pregnant. If it is an ectopic (out of uterus) pregnancy, only surgery will save her life. But if I am wrong, she has undergone major surgery for nothing. I pray, then I decide to operate. I find a swollen mass that is about to rupture. I thank God for revealing her problem, even without proper equipment.

What if I'd gone to the river instead of staying with this woman? How does one find balance in a world so overwhelmed with the never-ending needs of a place like Bere?

Your weekly Sabbath School mission offerings make ministry such as that at the outpost hospital in Bere, Chad, possible.

From: http://www.ssnet.org/qrtrly/eng/06a/less06.html

Tuesday, February 7, 2006

National Strike, Surgery Crazy, & River Surf

I am fatigued. The weekend has brought a brief respite. For only the second time in 2 weeks I have had a day without a surgery. All the government health care workers have been on strike for over a month. Even the General Hospital in the capital of N'Djam�na is closed. Here in B�r�, the nurses assigned by the government to our hospital have only worked 6 weeks since June 2005 leaving us more understaffed than usual. Since mid-December the surrounding hospitals have been closed, and for the last two weeks all the health centers have shut down, too, leaving us as the only hospital in 5 counties, and me the only doctor for a population of approximately 1/2 million people.

Our hospital is overflowing. We have moved into the partially completed new church in order to free up the old church for a tuberculosis ward, as we had almost 20 patients crammed into a ward made for 8. We have no beds, despite a fast discharge rate. And we have been operating like crazy.

The following statistics will give tangible proof of the marked increase in work at the B�r� Adventist Hospital:
2005:
Consultations: 1510 (125.8/month)
Hospitalizations: 1095 (91.25/month)
Deaths: 95 (7.9/month)
(42 Malaria, 25 malaria/anemia combo)
Deliveries: 107 (8.9/month)
Surgeries: 168 (14/month)

Hernias: 35 (2.9/month)
C-sections: 31
Laparotomy: 17
Hydroceles: 12
Tubal ligation: 11
Miscellaneous: 62

Lab tests: 2798
HIV tests: 334 (73 positive)
TB sputum smears: 188 (57 positive, 11 deaths)
Blood transfusions: 99 (almost all had hemoglobin <5) 75% lived

January, 2006:
Consultations: 216
Hospitalizations: 164
Deaths: 15
Deliveries: 8
Surgeries: 37

Hernias: 20
Hydroceles: 4
Oophorectomies: 3
Fibroadenomas: 2
Hysterectomy: 1
Ectopic pregnancy: 1
Bone graft: 1
Open fracture: 1
Leg amputation: 1
C-section: 1
Misc: 2

And in the first 5 days of February (in fact in the first 3): 10 surgeries

As I sink back into the all too comfortable couch I feel the soreness of my shoulders and arms and I think back...

I pull out the bag from the back of the truck and unzip it. Inside I pull out two halves of a bright blue epoxy surfboard. I place the carbon fiber tube in the center for strength and cinch the two halves together with the patented Pope Bisect integrated screw mechanisms. The board is already waxed and I head down the beach to the water. A gorgeous red-head (my wife) is waiting on the bank with her somewhat scrawny pony. There is the definite smell of a cattle crossing and the edges are muddied by numerous hoof prints. I wade out into the foot deep water and shove my board ahead of me as I jump on, bend my back up, and feel that oh so nostalgic feeling of hands dipping in and out gliding my stick effortlessly upstream. I hear Sarah mount the horse and begin chasing me, water splashing furiously in the horse's wake. Yeah, there's nothing even remotely resembling a wave but somehow that motion up and down, pull and drip forward is comforting and relaxing. A great blue heron flaps up suddenly and awkwardly across my path as numerous other birds twitter and flit around the steep clay banks. I cannot completely relax as, while I'm almost positive there are none here, I still keep an eye out for hippos and crocs. I finish my upstream paddle and gently coast back down with a leisurely stroke now and then. Near the put in point I call to Sarah and suddenly paddle furiously, put my hands on the board and in one motion push off, slide my feet up and am standing... surfing? Not quite but as the board shoots out from under me and off to the side and I tumble in I raise my arms in exultation as Sarah giggles helplessly...well, life is good!

James