Couscous and Goat

The couscous steamed in the belly of the goat is quite tasty if a little undercooked. I spoon another mouthful garnished with a piece of flesh ripped off the greasy leg bone on my plate.

How else would one welcome someone as important as the Minister of Health.

That morning started off with trying to desperately tear myself out of bed. Between 80 plus surgeries this month including 24 in a five day stretch last week and working on stripping out the inside of the ambulance that had been used as a storage shed for any spare part containing massive amounts of old oil, I'm needless to say, exhausted.

Sarah has warmed up the Danish cauliflour gravy over yesterday's mashed potatoes and "Ocean Platter". Our nurse, Job, exhorts us in morning worship from Acts 13 and we talk about quinine drips for kids in staff meeting.

It's during this encounter that someone calls to say that the Minister of Health will be driving through Bere at 11:00am or so and could we please all be there.

Sure, no problem, is that 11 o'clock African time?

I spend some time with Andre and Noel discussing the spiritual battle facing us and how we can help each other to keep from being taken out by our enemy.

As I head to the OR for the first case, Sarah corners me as I pass the door to the temporary ER (the old one is having it's roof replaced).

"Could you come see this patient? He has peritonitis."

Unfortunately, she's right. Pain for a week, severe since this morning. Vomiting, jumps and grimaces when I tap on his belly. Tender inside when I do a rectal exam.

His wife pays for the surgery and we wheel him in. The 20 year old woman born without a vagina, the old man with the hernia and the even older man who can't pee because of his huge prostate will have to wait.

Within 20 minutes of diagnosis, my knife is slicing through skin, muscle, fat, blood vessels, fascia and peritoneum to let out a bubbly gush of slimy green fluid over some angry, blotched loops of small intestine.

I enlarge the incision to the sternum with scissors and after sucking up all the goo I find the small hole in his stomach letting it all out.

Perforated peptic ulcer.

I put in some silk sutures along the perforation but don't tie them. Then I drag in a piece of omentum and tie it over the hole with the sutures.

Lots of irrigating and sucking and washing and rinsing and aspirating later I close up.

It's only 11:00. Since it's African time, maybe I have time for a prostate before going to meet the Minister.

Abel and Simeon, a viciously efficient OR team have the patient out, the OR cleaned and prepared and the grandpa sitting on the table ready for his spinal anesthetic almost before I turn around.

As soon as the lidocaine is in his spinal canal we lay him down, lower the head of the table, strap him in for the ride, prep his belly and groin with Betadine and I scrub with our Danish medical student, Camila.

After Abel's prayer I cut down horizontally to the bladder and incise it vertically letting out a stream of blood tinged urine. Camile grabs suction while I enlarge the bladder incision. Simeon pulls out the foley catheter while I stick my finger in to feel the mass of prostate bulging into the bladder.

I insert my index finger into the prostate where the urine should normally go out and with the pressure of the finger tip start to shell out the prostate. I sweep around. My fingers start to cramp from the pressure and awkward position as my body twists and contorts over the patient trying to get my finger in deep enough to go all the way around.

It pops out and I fish it out of the bladder. Simoen inserts the large 3 way foley catheter that I guide through the crater left where the prostate should be. Camile aspirtates the blood that wells up while Simeon inserts 30cc into the ballon to tamponade off the bleeding.

I suture the bladder, fascia and skin and Simeon has the bladder irrigation running as blood tinged flood flows out into the urine bag.

12:34 and I might have time to catch the Minister of Health.

Sonya and I walk over to the District Medical Office where a large (for Tchad) convoy of 6 or 7 cars is parked along main street in the red dirt of Bere.

A group of raggedy Red Cross volunteers with various qualities of red cross painted shirts collects outside the offices while out back under the mango tree the big boys gather.

I pass the camouflage-wearing, turban-toting soldier with his AK47, go through the chainlink and sit on the edge of a chair next to my wife. In the low slung, neon green, fake velvet chair of honor is a simply dressed, tall, sun-glass-wearing Tchadian I assume is the Minister of Health.

A camera man makes sure to video the proceedings as two woman come in bearing the two couscous stuffed goats on platters, anatomy complete minus the heads.

A greasy, finger stuffing, soda popping 15 minutes later the Minister gets up for his speech.

"We have been touring the country to get a better idea of the conditions that you, our frontline health care workers, work under. We've been all over the south-central region for a week seeing hospitals from Doba to Koumra to Sarh to Lai and now Bere."

"There are less than 400 physicians in all of Tchad, less than 4000 nurses and less than 200 midwives. This is why Tchad has some of the worst maternal child statistics in the world."

With that and many other encouraging words, they take their leave. They are in a hurry since word has come this morning that the united rebel forces are already in Ati vowing to make N'djamena and overthrow the President.

No one is worried too much yet because the European Union special forces have started arriving since yesterday and the rebels aren't strong enough. At least no one is fleeing N'Djamena yet for the bush which everyone takes as a good sign.

So I return to round on the hospitalized patients, schedule another hernia and a vaginal hysterectomy for prolapsed uterus coming completely out hte vagina, draw out cloudy spinal fluid on an infant already struggling with malaria and severe anemia (hemoglobin of 4.6) and head home.

Even after the couscous and goat I still crave some of my wife's Danish home-cookin'...

GROSS PICTURE OF THE DAY