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
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