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
Monday, August 28, 2006
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
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