Window

The thunder rolls. A cool breeze bursts through the window ruffling the papers on the table. I'm sitting, staring out my window at life in Bere as the sun goes down behind the house. The red sunset reflects off the mango tree leaves poking up like heads of broccoli above the pale tan of the mud brick walls of my neighbors lots. The thatch roofs of the huts add no color but rather texture and ruggedness. A gentle rain sprinkles down. The sky is a steel grey.

People pass by on the path that runs 20 feet from where I sit behind mosquito screen and iron bars. Finally, a little rest from a long 24 hours of hospital work.

It started yesterday evening after the lights came on with a simple testicular abscess that we drained in the OR by removing his testicle. Afterwards, I was reminded how often unusual things come in pairs.

The nurse calls me to see an old man with urinary retention who had gone to a health center where they tried to insert a catheter into his bladder but came up with blood instead and couldn't get it in. They referred him to us. I see him now with a huge round mass in his lower abdomen: a distended bladder holding a liter or two of pee. I try half-heartedly for a few minutes knowing that a false track has probably been created leaving me with no option except to drain his bladder through his abdominal wall.

Then, I remember an instrument I saw among the bag of weird, mostly useless instruments brought by one of our volunteers. I hurry home and come back with an instrument looking like a torture device from the dark ages. It's a metal tube with a tee at the end and perpindicular to the tee a spout curving out. on top is a round top on a piston connected to a four-sided razor sharp spearhead poking out the opposite end.

I inject some local anesthetic above the pubic bone of the old gentleman, make a small skin incision and then poke and twist the torture device straight in until I feel a "pop". I pull back the piston and bloody, foul-smelling urine jets out the spout all over the bed and partly in the basin we'd arranged for it to go in. I then slide a rubber tube down the spout into the bladder and pull the torture device out. I tie the tube in place and attach it to a drain bag and send him to the ward after examining his prostate with a gloved (duh) finger and confirming that it's monstrously enlarged.

Outside my window, a fat lady mosey's on by pushing a push cart. Chickens peck the ground looking for insects while trying to escape the amorous advances of a strutting, cocky rooster.


Last night at 11pm, the twin of old man with the large prostate and urinary retention comes in. Same story, went to health center, tried to put in catheter, got blood, sent to the hospital. This time I'm ready and quickly repeat the same suprapubic insertion of the drainage tube under local anesthetic with the severe-looking trocar.

The rain continues to fall outside as a woman walks her friend out the gate of her courtyard half way down her path to the main path. As the saying goes here in Tchad, if I accompany you out then my blessing goes with you. She stops and shakes hands and her tall lanky friend saunters away down the path glancing casually around and greeting the two boys bringing the cows back in from grazing. A sharp smack with a long stick ensures that the cows keep up a healthy trot and stay in line.


The morning brings a pair of hernias. Not too unusual except that both have associated hydroceles. We do them with the generator running, but since it's kind of a mutant, handicapped generator, it can only do a few things at a time so we operate without lights (except for sunlight through the opaque glass brick "windows") so we can run the a/c and keep from dying from heat stroke and falling into an open groin wound.

In between cases, a 10 year old boy comes in after being attacked by a bull on the outside of his upper arm. A superficial 10cm U-shaped wound looks like it was cut with a knife or razor blade. How he avoided massive injury with those big horns I'll never know. I suture him up under general anesthesia and then do the second hernia/hydrocele combo.

A few hours later, another 10 year old boy comes in with a wound to his armpit from another bull's horn. This one is also superficial having missed his blood vessels and lungs. Those bulls need to practice their goring, they're attempts are pathetic. I let Simeon suture this one up while I grab a bite to eat.

A large woman waddles by outside my house as I sit and take in the calm evening scene around my house. On her head are carefully balance an enormous pile of bound reeds. I'll never cease to be amazed...where this path joins the main road in front of the hospital a group of about six kids hops, skips and talks animatedly to each other as they head away from me. A tiny girl in a tattered pink dress does semi-cartwheels, her bare feet flailing in the air before tumbling over on her back.


As I'm about to go home a little after 3pm, one of the nurses comes to see me to say that one of the kids on pediatrics is pooping blood. I go over to see one of the kids we'd treated for meningitis and malaria as well as giving a blood transfusion for anemia. She was doing better this morning according to the family and had finished the treatment. She always looked a little drowsy to me, but I guess I just chocked it up to being worn out from all that's happened. For some reason, it did strike me, though, especially looking back.

She is 4 months old, very cute, and with devoted parents.

She is resting face down on her moms lap, her butt cheeks in the air, her legs hanging down and dark red, partially coagulated blood coming out of her anus. I've never seen what I'd learned about in medical school as red currant jelly stool but this looks like it. I refresh my mind with a quick look up in my ER book and am convinced it's what's called intusseception (when the small intestine gets swallowed up by the large instestine creating obstruction).

We take her to the OR. She looks so tiny on that large table. She only weighs a little over 10 lbs (5 kg). Abel finds an IV, Simeon administers the anesthetic and after prayer I open up the thin skin of her belly with much trepidation.

Some red inflammatory fluid bubbles out along with most of her small instestines. I search for where her small intestine joins her large bowel and don't find what I expect. Instead, I find a deep red, almost black gangrenous appendix that fortunately hasn't ruptured. I perform an appendectomy and close her tummy up.

As I hand her back to her parents, tubes coming out from all over, I can't help but hope that one day soon, she too will be attempting cartwheels down the streets of Bere...

Flashlights

I find myself bumping along the supposedly paved streets of N'Djamena in a Hilux pickup so thrashed that you wouldn't believe it could still be running unless you've lived in Chad and seen the miraculously still running majority of Chadian vehicules limping along the highways and byways of the African plain. Sitting next to me is Enock, a squat, heavily muscled slowly turning to fat nursing student flashing a toothy grin complete with gold glint.

Whatever the case, he has been reminded of an unbelievable story that he now shares with me.

Several years ago, his son became deathly ill with severe abdominal pain. He was rushed to the health center who appropriately referred him to the National Reference Hospital in the capital, N'Djamena. They were fortunately living there at the time and were able to get him there quickly.

It was the middle of the night.

Trying to manoeuvre through the crazy ER with people piled all over the place already cost him some "tea" and "soap" money but finally he was seen by a doctor who confirmed the diagnosis: acute appendicitis.

He was scheduled for surgery that very night.

As Enock and his wife huddled together praying, the surgery team wheeled their son away through the swinging doors on a gurney. All they could do was sit and wait...

Until a half hour later, when all the lights went out.

Of course, there was instant confusion and they heard an orderly fumbling through the halls and bursting through the doors of the operating room. In a frantic rush he bumped into Enock.

"Are you the father of the boy with appendicitis?" He demanded.

"Yes, what's going on?"

"We're in the middle of the case, your son's belly is open and we have no light."

"Yeah, I noticed...what..."

"Hurry out to the market and buy some flashlights...HURRY!"

Enock rushed out, down the stairs, out the door of the hospital, hailed a motorcycle taxi, raced to the market, luckily found someone open, bought two flashlights and hurried back.

The surgeons then continued their life saving procedure and a week later Enock's son was home safe and sound.


Only in Chad.

Kids

The dust kicks up a small puff of powder with each tread of my foot. The clear blue, cloudless sky leaves no hint of the massive showers soon to hit. Travis, Justin and I are hoofin' it to the river while Sarah and Chelsey ride on Bob and Pepper, our two horses. It has been exceptionally hot this year reaching into the 130's Fahrenheit and even higher in the A/C-less furnace we used to call our operating room. As the sun bakes my brain I try to desperately keep it alive with frequent sips from my camelback. After about 45 minutes we are in a groove but suddenly feel a cool gust. I look up and notice that out of nowhere behind us is now this gray, hazy area in the sky blotting out the trees and dusty terrain to the northeast.

Plip-plop. The first drops plump into the parched soil of the path. Soon we are almost shivering as a cold rain pelts us just as we arrive at the river with the pack of local boys we've picked up like groupies at a rock concert. We are famous. After all, we are "Nasara" the most interesting thing to happen in these parts in a long while for sure.

The river actually feels warm after the cold rain. The clean sandy bottom is just a couple feet under the surface and I have to lie down completely to get covered. I drift along with the surprisingly fast current till I hit a slightly deeper section. I grab a breath and dive. As all other sounds mute instantly I am made keenly aware of the gnashing of teeth sound of fish feeding and the soothing melody of raindrops on water. I wish I could stay under forever.

As I come up, I spot our groupies who have stripped down to their birthday suits and are splashing around in the shallow end. I decide to have some fun. I jump up and crash through the water chasing them as they flee in all directions, terrified of the white beast from the deep. For me it's just a game so I'm shocked when I actually catch one and he's crying and screaming his brains out with a petrified look on his deer in the headlights stare.

I grab him, throw him over my shoulder and run back to the river where I toss him in. He comes up unsure and when he realizes I'm not going to torture or eat him he hesitantly starts to smile as his comrades in arms hoot and holler from the shore.


Several minutes later, I repeat the same thing, sure this time they'll realize it's all just a game. I chase down the chaplain's son, a boy well known to me who seems to like me and has never been afraid of me before...until now. As I pound my barefeet up the bank and through the ruts leading down to the river I find myself gaining on him easily. Just as I'm about to catch him, he rounds a small bush and does a face plant as his feet slip on the wet clay. Before I can laugh I follow him in a crash landing slide into home reaching out at the last minute to tag the plate by grabbing his leg.

As I stand up I am shocked to hear him shrieking in terror. "Je ne veux pas!!! Je ne veus pas!!! I don't want to..." I'm shocked. I try to calm him down. I definitely let go of him and try to tell him I'm not going to do anything and to stop screaming. He completely ignores me. Anyone within a mile must be sure that someone is torturing and killing something as he squeals like a stuck pig.

He is clutching desperately to a clump of grass as I back away. He won't let go even as I return to the river to wash off.

It's another brutal reminder of the differences in culture as I can only reason that here boys aren't used to rough-housing or playing with adults. In fact, about the only contact they have with an adult is if he is going to beat them or punish them in some way. So even though I've never given him a reason not to trust me and he just saw that I was just playing with his friend, he was sure something horrible was about to happen to him.

I weep for the kids of this country who are so often abandoned and neglected and left to fend for themselves even for the food they eat and grow up learning not to trust and that fear is the only way to interact with others.