I didn't realize it was urgent till I burst through the door into labor and delivery.
I knew the woman in labor had a fetus in the breech position with one foot wanting to come out first. I'd told the midwife to alert me when she was completely dilated so I could assist the delivery.
Sarah came and told me that the woman was about to deliver so I wandered back over to the hospital.
When I opened the door, I sized up the situation instantly and sprang into action.
I saw a woman lying on metal table with her legs spread apart and coming out of her was an abdomen with two legs attached, flopping down onto the bed. No arms or head was visible. My first thought was gloves but as I reached for the ones I'd washed and hung to dry earlier I realized they were still too moist to get on quickly so I dove in with my bare hands.
When the baby comes out feet first it's very important that she deliver quickly because if not the umbilical cord coming out of the abdomen will be compressed by the fetal head blocking off the blood circulation and its crucial supply of oxygen to the baby.
I had no time to lose since who knows how many minutes had flown by with the head stuck before I arrived.
I reached inside to try and free up the first arm. It wouldn't budge. I twisted the baby around so the other arm was on top. This time I was able to hook it with my index finger and drag it down and out. I turned the baby over again and freed up the other arm. Then I stuck my finger in the baby's mouth and pulled his chin down to his chest all the while pulling with my other hand firmly grasping the baby's feet between my fingers.
The head popped out and the baby flopped to the table. No tone. No cry. No breathing. Grayish blue color.
I quickly clamped and cut the cord and moved the limp mass over to the reanimation table. I started rapidly pressing the chest with one had while I quickly grabbed the bulb suction with the other and tried to clear his airway. He had a faint, slow heartbeat. For those of you who know, APGAR at one minute was one.
I kept doing chest compressions while the midwife dried, stimulated and sucked the gunk out of his nostrils.
After what seemed like hours, but was really minutes the heartbeat started to pick up. He grimaced a little and seemed like he wanted to cough.
We continued our efforts.
Slowly but surely he started to pink up and his heartrate became normal. Still pretty floppy and no breathing.
Don't stop now.
Finally, his legs and arms started to curl up. He was getting some muscle tone and his body was now pink.
At last, after I turned him over and gave him a good whack on the back he started screaming like a banshee.
Amazingly enough, APGAR at 5 minutes was nine! He was discharged home in good condition two days later.
Thursday, December 18, 2008
Wednesday, December 17, 2008
Miracles
Miracles start with small things and are often small themselves and go
unrecognized unless we have eyes to see and ears to hear.
I almost forgot to bring my pillow. Sarah held it out to me at the last
minute as I rushed out the door, hopped in the back of the van and took a
nap all the way to Kelo where we dropped off Andre and his adopted daughter.
They got on public transport for Lere while Levi and I went to the TEAM
mission station there in Kelo to find some Arabic new testaments. The rep
for the Gideons wasn't there but promised to meet me at noon at the Kelo
hospital.
I foolishly thought I'd be done in Moundou before then.
We arrive in Moundou and go directly to the construction site. Frederic,
the boss, isn't there. I call him and while waiting check out the progress.
The bricked up windows have been reopened letting in a ton of light. The
back two rooms have been converted into one large room with three huge
windows and a double door from the outside and a small door into the
hallway. This will be the operating room. The slab for the veranda has
been re poured, the trusses have been repaired, the roof replaced and the new
ceiling mostly done.
I go back outside and see Anatole, our head lab tech. Two days ago I received a message that his son had meningitis here in Moundou.
"Anatole, bonjour, ca va? I tried to call you but I couldn't get through."
"Yeah, my phone was stolen at the hospital."
"I wanted to contact you to have you bring your son back to Bere, how did you find me here?"
"I just happened to see the van drive by and followed it here."
Anatole then goes on to explain how his son was treated (or mal-treated) first at the health center with once a day IM Quinine and Penicilline and then referred to the only hospital here in Moundou, Chad's second largest city. No lab tests were done to confirm or deny meningitis or cerebral malaria but treatment was started. The antibiotic wasn't available and had to be purchased on the black market for 5 times the going price. Nurses came by once a day only for injections and once, the nurse came to give a shot with an empty seringe and didn't notice until Anatole pointed out he'd just injected air into his son's thigh! In a week at the hospital, he saw a doctor once. He finally decided last night to just take him home where at
least he himself could make sure the meds were given when they were supposed to!
Antoine, our church contact in Moundou shows up and we go to see the "Chef de Quartier" to find out about purchasing 1 or 2 of the empty lots next to our project. We bounce over the dirt streets of this industrial capital of Chad and turn down a small side street before pulling up in front of a brick wall.
Attached to the wall is a small lean two with low ceiling made of brick and tin roofing. I stoop through the narrow door into a dark room filled with old men. The dim light comes through cracks in the bricks and ceiling and through the door illuminating several low wood slat chairs and a rickety hand made coffee table with various documents spread across the top. The chief is a wizened man in his late 60's or 70's with short white curly hair, a traditional long pocketed shirt and trousers and a leg wrapped in an elastic bandage.
We are motioned to some of the low chairs, only a few inches off the ground. I find myself basically squatting with the slats digging into my bony butt. Antoine starts speaking in Ngambai. I catch a few words like "doctor" "hospital" "magistrate" etc. and after much dialogue Antoine gives me the resume that he knows the original owner of one lot and he'll ask who he sold it to so we can see if we can buy it and that the owner of the second property is an old magistrate who is too old and tired to build and has told the Chief to contact him if he finds a worthy buyer. He is very content that we're building a health institution in his neighborhood and will do all he can to help.
"It seems your sick," I speak to the chief in French, pointing to his leg. "Mind if I take a look?"
He motions for a young man outside who comes in and between the two of us we lift up and unwrap his leg revealing a bunch of crumbled up dry leaves wrapped around a single swollen ankle and foot in the traditional manner. The other leg isn't swollen at all so I suspect early elephantiasis and prescribe him medicines for filarial worms and tell him to elevate his leg at night.
Just then, the pudgy old man to his right starts hacking up a lung. He's been coughing for a while so I prescribe him two antibiotics and an inhaler to open up his airways.
They are very happy and the chief steps outside with us to wish us well and tell Antoine to check back tomorrow about the properties.
After a few other errands, we stop at one of this metropolis's two gas stations. A couple of Arabs are lounging on chairs between the three antique pumps in the sandy courtyard. They slowly rise up as we place our three gas cans open in front of them and unlock the gas tank. We place our airplane fuel filter in the opening as they "warm up" the pump. It slowly whirs into action and after a few minutes they start pumping. The gas spews out in spurts and little bursts of air spraying the gasoline into our tank. After 18 L (4 1/2 gallons) it stops running.
"Sorry, that's the last of it. We should have some more tomorrow!"
We drive off to the second and last gas station. As we pull up the two guys sitting out front just look at us when we ask if they have gas and shake their fingers "no".
We pick up Anatole and his son and lay him in the back, conviently there is a slightly used pillow waiting for him to rest his head on.
We arrive in Kelo without incident. The Post is closed. We go to the hospital. It's 2pm and Mathias, my contact for the Arab Bibles has gone home. We get his number from the nurse on night duty and he tells us to meet him at the Pili-Pili Hotel.
After picking him up and going back to the hospital to get the Bibles we return him directly to his house in the "suburbs". As we head back towards the main robe a tall, athletic man comes running after us in a green Arab robe barely covering his basketball shorts. He waves his hands and yells after us.
"You have a ton of packages at the Post Office. You need to pick them up tomorrow."
"We're heading back to Bere now and it's not easy to come. Can't you open up the office and let us take them with us now?"
"Ok. Ca va."
He hops in and we pick up 25 packages, most for the student missionaries but one from the AMALF in France containing 150 vials of Ceftriaxone, the exact medicine we need (and just ran out of) in order to treat Anatole's son's partially and poorly treated meningitis.
As I pray with Anatole later, after arriving in Bere I am convinced that God will heal his son since he went to some much effort in so many small ways to bring us in contact and get us the exact medicines we need. Seemingly insignificant details when seen alone, but miracles none the less.
unrecognized unless we have eyes to see and ears to hear.
I almost forgot to bring my pillow. Sarah held it out to me at the last
minute as I rushed out the door, hopped in the back of the van and took a
nap all the way to Kelo where we dropped off Andre and his adopted daughter.
They got on public transport for Lere while Levi and I went to the TEAM
mission station there in Kelo to find some Arabic new testaments. The rep
for the Gideons wasn't there but promised to meet me at noon at the Kelo
hospital.
I foolishly thought I'd be done in Moundou before then.
We arrive in Moundou and go directly to the construction site. Frederic,
the boss, isn't there. I call him and while waiting check out the progress.
The bricked up windows have been reopened letting in a ton of light. The
back two rooms have been converted into one large room with three huge
windows and a double door from the outside and a small door into the
hallway. This will be the operating room. The slab for the veranda has
been re poured, the trusses have been repaired, the roof replaced and the new
ceiling mostly done.
I go back outside and see Anatole, our head lab tech. Two days ago I received a message that his son had meningitis here in Moundou.
"Anatole, bonjour, ca va? I tried to call you but I couldn't get through."
"Yeah, my phone was stolen at the hospital."
"I wanted to contact you to have you bring your son back to Bere, how did you find me here?"
"I just happened to see the van drive by and followed it here."
Anatole then goes on to explain how his son was treated (or mal-treated) first at the health center with once a day IM Quinine and Penicilline and then referred to the only hospital here in Moundou, Chad's second largest city. No lab tests were done to confirm or deny meningitis or cerebral malaria but treatment was started. The antibiotic wasn't available and had to be purchased on the black market for 5 times the going price. Nurses came by once a day only for injections and once, the nurse came to give a shot with an empty seringe and didn't notice until Anatole pointed out he'd just injected air into his son's thigh! In a week at the hospital, he saw a doctor once. He finally decided last night to just take him home where at
least he himself could make sure the meds were given when they were supposed to!
Antoine, our church contact in Moundou shows up and we go to see the "Chef de Quartier" to find out about purchasing 1 or 2 of the empty lots next to our project. We bounce over the dirt streets of this industrial capital of Chad and turn down a small side street before pulling up in front of a brick wall.
Attached to the wall is a small lean two with low ceiling made of brick and tin roofing. I stoop through the narrow door into a dark room filled with old men. The dim light comes through cracks in the bricks and ceiling and through the door illuminating several low wood slat chairs and a rickety hand made coffee table with various documents spread across the top. The chief is a wizened man in his late 60's or 70's with short white curly hair, a traditional long pocketed shirt and trousers and a leg wrapped in an elastic bandage.
We are motioned to some of the low chairs, only a few inches off the ground. I find myself basically squatting with the slats digging into my bony butt. Antoine starts speaking in Ngambai. I catch a few words like "doctor" "hospital" "magistrate" etc. and after much dialogue Antoine gives me the resume that he knows the original owner of one lot and he'll ask who he sold it to so we can see if we can buy it and that the owner of the second property is an old magistrate who is too old and tired to build and has told the Chief to contact him if he finds a worthy buyer. He is very content that we're building a health institution in his neighborhood and will do all he can to help.
"It seems your sick," I speak to the chief in French, pointing to his leg. "Mind if I take a look?"
He motions for a young man outside who comes in and between the two of us we lift up and unwrap his leg revealing a bunch of crumbled up dry leaves wrapped around a single swollen ankle and foot in the traditional manner. The other leg isn't swollen at all so I suspect early elephantiasis and prescribe him medicines for filarial worms and tell him to elevate his leg at night.
Just then, the pudgy old man to his right starts hacking up a lung. He's been coughing for a while so I prescribe him two antibiotics and an inhaler to open up his airways.
They are very happy and the chief steps outside with us to wish us well and tell Antoine to check back tomorrow about the properties.
After a few other errands, we stop at one of this metropolis's two gas stations. A couple of Arabs are lounging on chairs between the three antique pumps in the sandy courtyard. They slowly rise up as we place our three gas cans open in front of them and unlock the gas tank. We place our airplane fuel filter in the opening as they "warm up" the pump. It slowly whirs into action and after a few minutes they start pumping. The gas spews out in spurts and little bursts of air spraying the gasoline into our tank. After 18 L (4 1/2 gallons) it stops running.
"Sorry, that's the last of it. We should have some more tomorrow!"
We drive off to the second and last gas station. As we pull up the two guys sitting out front just look at us when we ask if they have gas and shake their fingers "no".
We pick up Anatole and his son and lay him in the back, conviently there is a slightly used pillow waiting for him to rest his head on.
We arrive in Kelo without incident. The Post is closed. We go to the hospital. It's 2pm and Mathias, my contact for the Arab Bibles has gone home. We get his number from the nurse on night duty and he tells us to meet him at the Pili-Pili Hotel.
After picking him up and going back to the hospital to get the Bibles we return him directly to his house in the "suburbs". As we head back towards the main robe a tall, athletic man comes running after us in a green Arab robe barely covering his basketball shorts. He waves his hands and yells after us.
"You have a ton of packages at the Post Office. You need to pick them up tomorrow."
"We're heading back to Bere now and it's not easy to come. Can't you open up the office and let us take them with us now?"
"Ok. Ca va."
He hops in and we pick up 25 packages, most for the student missionaries but one from the AMALF in France containing 150 vials of Ceftriaxone, the exact medicine we need (and just ran out of) in order to treat Anatole's son's partially and poorly treated meningitis.
As I pray with Anatole later, after arriving in Bere I am convinced that God will heal his son since he went to some much effort in so many small ways to bring us in contact and get us the exact medicines we need. Seemingly insignificant details when seen alone, but miracles none the less.
Thursday, December 11, 2008
Blue baby
Dr. Jacques knocks on the door.
"I just assited an uncomplicated vaginal delivery, but the baby is having espiratory distress. The nares are flaring, the intercostal muscles are retracting and he's just having a hard time. I tried aspirating to see if he had any mucus but it seems his nose is blocked...it's like there's just no connection to the throat."
In my mind I'm thinking, "yeah, right, he must just not know how to stick a tube down a baby's nose..." but my better judgement says I should just go and look.
I enter the dimly lit corridor and push open the labor and delivery room door into a brightly lit, but small chamber. A quick glance takes in a young woman lying comfortably on the bed, not much blood around, and breathing and glancing around normally. She's fine.
I turn to the baby reanimation table and see a chubby, bluish gray baby with a disproportionately tiny head (normal newborns heads are huge compared to their bodies) lying staring up and grunting but not really breathing.
I grab him around the chest, flip him over on my hand and slap him hard on his back. He starts to cry vigourously. I think that must be it. They just are afraid of these supposedly fragile little beings and don't stimulate them enough.
I flip him back over on his back on the green, brightly patterned cloth underneath him and reach for the aspirator. A tiny tube goes into a small canister with a slightly larger tube coming out the same top. I slip the bigger end in my mouth ready to suck and slide the smaller tube into the baby's nose. It only goes in 1-2cm and is stuck. I wiggle it around and then try the other nostril. Still no passage. I stick my finger into the newborn's mouth straight back into his throat. He starts to gag as I feel around and confirm, there's no opening between his nostrils and his airway.
Now, here's the problem. Instinctively, a newborn is an obligatory nose breather. This allows him to nurse and breath at the same time, two very important things God makes sure they now how to do instinctively because there's just no spare time to have to learn it in. He only breaths through his mouth if he cries.
We can't just make him cry all the time, he just won't do it. He cries a little and starts to pink up and then goes back to sucking in impotently on his blocked up nostrils.
What to do? I think quickly and go to the OR to find some probes and see if there isn't some passage back there after all that's just blocked up.
The probes go nowhere. I've brought the hemorroidectomy kit as that's the only one I know of with probes.
I call the father in and explain the situation.
"He can't breath through his mouth because it's against his instinct and he can't live without breathing and we can try to poke a hole through but he could bleed a lot and die or we could damage some important things, but the bottom line is he won't live if we do nothing. What do you think?"
"Do what you have to, it's in God's hands."
I grab a Kelly clamp and probe downward in the right nostril to where the palatte seems thinnest between the nose and mouth. I poke through. I then do the same on the other side. However, he still can't breath because the mucosa of the mouth just falls back in place. We need something to keep it open. I grab the aspirator and cut off a piece of the bigger tubing. I reach the clamp through into the mouth, grasp the tube and pull it out through the nose. The first time it pops all the way out. I then attach another clamp onto the mouth and and pull it through again, this time the clamp prevents it from coming all the way out. I repeat it for the other
nostril.
I suck up some blood out of the nose and mouth and down the tubes using what's left of the newborn aspirator. He's still struggling but I can hear and feel air coming out the two tubes.
I then insert a feeding tube in the mouth and the mother starts squeezing out breastmild which we feed the baby through the tube with a syringe.
He's already pinking up, only his hands and feet stay blueish gray.
Yep, he's in God's hands all right.
"I just assited an uncomplicated vaginal delivery, but the baby is having espiratory distress. The nares are flaring, the intercostal muscles are retracting and he's just having a hard time. I tried aspirating to see if he had any mucus but it seems his nose is blocked...it's like there's just no connection to the throat."
In my mind I'm thinking, "yeah, right, he must just not know how to stick a tube down a baby's nose..." but my better judgement says I should just go and look.
I enter the dimly lit corridor and push open the labor and delivery room door into a brightly lit, but small chamber. A quick glance takes in a young woman lying comfortably on the bed, not much blood around, and breathing and glancing around normally. She's fine.
I turn to the baby reanimation table and see a chubby, bluish gray baby with a disproportionately tiny head (normal newborns heads are huge compared to their bodies) lying staring up and grunting but not really breathing.
I grab him around the chest, flip him over on my hand and slap him hard on his back. He starts to cry vigourously. I think that must be it. They just are afraid of these supposedly fragile little beings and don't stimulate them enough.
I flip him back over on his back on the green, brightly patterned cloth underneath him and reach for the aspirator. A tiny tube goes into a small canister with a slightly larger tube coming out the same top. I slip the bigger end in my mouth ready to suck and slide the smaller tube into the baby's nose. It only goes in 1-2cm and is stuck. I wiggle it around and then try the other nostril. Still no passage. I stick my finger into the newborn's mouth straight back into his throat. He starts to gag as I feel around and confirm, there's no opening between his nostrils and his airway.
Now, here's the problem. Instinctively, a newborn is an obligatory nose breather. This allows him to nurse and breath at the same time, two very important things God makes sure they now how to do instinctively because there's just no spare time to have to learn it in. He only breaths through his mouth if he cries.
We can't just make him cry all the time, he just won't do it. He cries a little and starts to pink up and then goes back to sucking in impotently on his blocked up nostrils.
What to do? I think quickly and go to the OR to find some probes and see if there isn't some passage back there after all that's just blocked up.
The probes go nowhere. I've brought the hemorroidectomy kit as that's the only one I know of with probes.
I call the father in and explain the situation.
"He can't breath through his mouth because it's against his instinct and he can't live without breathing and we can try to poke a hole through but he could bleed a lot and die or we could damage some important things, but the bottom line is he won't live if we do nothing. What do you think?"
"Do what you have to, it's in God's hands."
I grab a Kelly clamp and probe downward in the right nostril to where the palatte seems thinnest between the nose and mouth. I poke through. I then do the same on the other side. However, he still can't breath because the mucosa of the mouth just falls back in place. We need something to keep it open. I grab the aspirator and cut off a piece of the bigger tubing. I reach the clamp through into the mouth, grasp the tube and pull it out through the nose. The first time it pops all the way out. I then attach another clamp onto the mouth and and pull it through again, this time the clamp prevents it from coming all the way out. I repeat it for the other
nostril.
I suck up some blood out of the nose and mouth and down the tubes using what's left of the newborn aspirator. He's still struggling but I can hear and feel air coming out the two tubes.
I then insert a feeding tube in the mouth and the mother starts squeezing out breastmild which we feed the baby through the tube with a syringe.
He's already pinking up, only his hands and feet stay blueish gray.
Yep, he's in God's hands all right.
Ma Joie
At the last minute, I decide to go. I hardly got any sleep last night and woke up at 3am before falling back asleep until the alarm sounds at 4:30am.
"Sarah, I think I'm not going to N'Djamena. What am I really going to do there anyway? I'll just stay."
Sarah get's up and get's ready. I still don't hear Levi, the driver, so at 5 till 5am I get up and drive the car over to the hospital. I flip on the lights in the men's ward.
"Hey, you two, get up. We're leaving at five, remember? You're supposed to be ready!"
Our two friends, Mahamat and Lamglé, slowly raise up wiping their eyes. Their "garde-malades" start pulling down the mosquito nets and taking off the sheets carefully from under their right legs, twin-casted from groin to ankle.
I'd just performed the second surgery on each of them for non-union and mal-union femur fractures. They are relatives and both were in motorcycle accidents. I tried doing an open reduction and traction for each of them first but it didn't work. I just operated again a week ago and put in plates and screws with a cast. Now, I wanted to take them to N'Djamena for an xray since ours hasn't been working for years. Besides, they lived there and this way they can convalesce at home.
I'm now awake, and since Levi still isn't here I quickly pack, grab some cold Zachée pizza from the fridge and a week old bottle of vanilla protein drink for the road and we're off.
The headlights actually make driving on the rain scourged roads easier as the shadows light up where the holes are. Dawn breaks and a cool desert morning rushes in the open windows.
I startle a brightly colored bird with several shades of brilliant blue and a super-long tail. Unfortunately, it isn't fast enough and gets taken out in mid flight by the left side of the minibuses grill going out with a quick crunch.
A short time later, after missing countless sheep, goats, horses, cattle and camels I come across an Arab donkey caravan on a one way bridge and as I've almost come to a complete stop one of those dumb asses turns into the car with a piece of wood strapped to it's side and a crinkle of glass tells me my left headlight is no more.
Moving on, two little baby goats, one black and one white with black spots streak suddenly across the highway with just enough space in them for simultaneously sickening crunches under each front wheel. A quick glance in the rearview mirror shows the white one motionless but the black one struggling with it's head and front legs while it's back legs lie stuck to the asphalt.
Rounding the corner into N'Djamena over the bridge we strain to catch a glimpse of the hippos in the river but to no avail.
We drop off Mahamat and Lamglé at the National Reference Hospital in the midst of a chaotic ER filled with bodys in various stages of casting, wrapping, dressing and IV'ing.
Sarah and I bounce around N'Djamena in the minibus over near the airport towards the National Tuberculosis Program buildings. We enter our order for TB meds and are told to go wait in the pharmacy.
A small, lean, lighter skinned Chadian with a six-o'clock shadow beard and a bright smile waves us into his office and orders a young boy to bring "Chai" while he fills our order.
His French isn't that great and when we speak a few words of Arabic he lights up and speaks clearly and slowly so we can understand, peppering his talk with the occasional French or English word.
Apparently, he did all his studies here in Arabic, which is possible, but unusual, even getting his "bac" in Arabic (the French equivalent of a high school diploma). He then studied three years of nursing and three years of pharmacy in Syria.
He mentions that Christians and Muslims are very similar. We nod in agreement. He talks about not drinking alcohol and eating pork. I mention how we don't smoke as well.
I say the most important thing in life is to make it to paradise and he agrees with multiple "inshallahs" (God willing).
We start talking about the holy books and that there is the Tawrat (Torah), the Injil (the Gospel) and the Koran. They all are God's way of communicating with Man.
I mention that the true religion is the religion of Ibrahim (Abraham) he nods.
He asks if we are married. We nod and Sarah points out that Adoum (Adam) had only Hawa (Eve) and not Maryam, Khadidja, etc. as well. He laughs and says that in Islam it is permitted to have 4 wives, but only under special circumstances.
I agree saying that yes in countries hit hard by war, like Chad where women outnumber men, I can understand that, but it's an exception and I laughingly say that there is enough trouble with one woman, why add more? He stretches out his hand to be slapped and grasped in the Chadian way of sharing a joke and laughs along with me.
He agrees, which is why he also only has one wife, besides, life is difficult and who can afford more than one wife anyway?
He then asks if we have any children. We say not yet, and he replies that Allah will give us some, inshallah.
He then calls the boy back and tells him to pour us some more tea as we continue some small talk.
Sarah mentions that we have several Korans at home.
He asks if they're in English or what language.
We say Arabic, English and French. He nods approvingly.
We finish our tea, he helps us haul out the TB meds to our van and we shake hands promising to see each other another day, inshallah.
I somehow have no doubt that I will see him again, whether on earth or not, certainly in paradise.
Sarah and I are off. We run some other errands before being called back to pick up Mahamat and Lamglé. We wander through several dirt road detours through the "suburbs" of N'Djamena (mud brick houses slightly more spread apart than in the "Grande ville") until we come to a mud plastered three roomed house with a ramshackle covered dirt "porch" which Mahamat claims as his. He apologizes saying a huge wind knocked half his wall down last May.
After helping them out onto crutches and onto a mat in the shade we are invited to sit with them. A metal bowl of water is placed before us. I try to ignore the floating things as I bring it slowly to my parched lips. A young boy is sent off for some Cokes and Grapefruit "Top". We then have some rice "boule" with some green leaf and dried fish sauce. I must be starving because as I dig into the sticky rice paste and dip it into the spicy sauce, I actually can't eat it fast enough. It just seems to hit the spot.
We then head off back to the "big city" and stop at Ma Joie's house. Ma Joie is the 8 year old girl, also a relative of Mahamat and Lamglé who also had a right femur fracture that also wasn't healed properly that we also opened and reduced and put in traction. The only difference is that she healed after two months and has been home for over a month already.
We enter a low, dank mud entrance down an open alley past some couches in various stages of fabrication until we turn into an open courtyard. There our shy, cute little friend limps towards us on one crutch. Apparently, she doesn't need it but her grandfather insisted she use it in front of us in case we expected it. We greet all 14 members of the extended family and Ma Joie makes my day by lighting up with a crooked tooth grin when I lay out my hand palm up so she can give me "five". She slaps it hard and soon all the other kids are lining up! Right before we leave, she runs off and brings us each a black plastic bag with some brightly colored African cloth as a present.
She is not only Ma Joie but Notre Joie (our joy)...
"Sarah, I think I'm not going to N'Djamena. What am I really going to do there anyway? I'll just stay."
Sarah get's up and get's ready. I still don't hear Levi, the driver, so at 5 till 5am I get up and drive the car over to the hospital. I flip on the lights in the men's ward.
"Hey, you two, get up. We're leaving at five, remember? You're supposed to be ready!"
Our two friends, Mahamat and Lamglé, slowly raise up wiping their eyes. Their "garde-malades" start pulling down the mosquito nets and taking off the sheets carefully from under their right legs, twin-casted from groin to ankle.
I'd just performed the second surgery on each of them for non-union and mal-union femur fractures. They are relatives and both were in motorcycle accidents. I tried doing an open reduction and traction for each of them first but it didn't work. I just operated again a week ago and put in plates and screws with a cast. Now, I wanted to take them to N'Djamena for an xray since ours hasn't been working for years. Besides, they lived there and this way they can convalesce at home.
I'm now awake, and since Levi still isn't here I quickly pack, grab some cold Zachée pizza from the fridge and a week old bottle of vanilla protein drink for the road and we're off.
The headlights actually make driving on the rain scourged roads easier as the shadows light up where the holes are. Dawn breaks and a cool desert morning rushes in the open windows.
I startle a brightly colored bird with several shades of brilliant blue and a super-long tail. Unfortunately, it isn't fast enough and gets taken out in mid flight by the left side of the minibuses grill going out with a quick crunch.
A short time later, after missing countless sheep, goats, horses, cattle and camels I come across an Arab donkey caravan on a one way bridge and as I've almost come to a complete stop one of those dumb asses turns into the car with a piece of wood strapped to it's side and a crinkle of glass tells me my left headlight is no more.
Moving on, two little baby goats, one black and one white with black spots streak suddenly across the highway with just enough space in them for simultaneously sickening crunches under each front wheel. A quick glance in the rearview mirror shows the white one motionless but the black one struggling with it's head and front legs while it's back legs lie stuck to the asphalt.
Rounding the corner into N'Djamena over the bridge we strain to catch a glimpse of the hippos in the river but to no avail.
We drop off Mahamat and Lamglé at the National Reference Hospital in the midst of a chaotic ER filled with bodys in various stages of casting, wrapping, dressing and IV'ing.
Sarah and I bounce around N'Djamena in the minibus over near the airport towards the National Tuberculosis Program buildings. We enter our order for TB meds and are told to go wait in the pharmacy.
A small, lean, lighter skinned Chadian with a six-o'clock shadow beard and a bright smile waves us into his office and orders a young boy to bring "Chai" while he fills our order.
His French isn't that great and when we speak a few words of Arabic he lights up and speaks clearly and slowly so we can understand, peppering his talk with the occasional French or English word.
Apparently, he did all his studies here in Arabic, which is possible, but unusual, even getting his "bac" in Arabic (the French equivalent of a high school diploma). He then studied three years of nursing and three years of pharmacy in Syria.
He mentions that Christians and Muslims are very similar. We nod in agreement. He talks about not drinking alcohol and eating pork. I mention how we don't smoke as well.
I say the most important thing in life is to make it to paradise and he agrees with multiple "inshallahs" (God willing).
We start talking about the holy books and that there is the Tawrat (Torah), the Injil (the Gospel) and the Koran. They all are God's way of communicating with Man.
I mention that the true religion is the religion of Ibrahim (Abraham) he nods.
He asks if we are married. We nod and Sarah points out that Adoum (Adam) had only Hawa (Eve) and not Maryam, Khadidja, etc. as well. He laughs and says that in Islam it is permitted to have 4 wives, but only under special circumstances.
I agree saying that yes in countries hit hard by war, like Chad where women outnumber men, I can understand that, but it's an exception and I laughingly say that there is enough trouble with one woman, why add more? He stretches out his hand to be slapped and grasped in the Chadian way of sharing a joke and laughs along with me.
He agrees, which is why he also only has one wife, besides, life is difficult and who can afford more than one wife anyway?
He then asks if we have any children. We say not yet, and he replies that Allah will give us some, inshallah.
He then calls the boy back and tells him to pour us some more tea as we continue some small talk.
Sarah mentions that we have several Korans at home.
He asks if they're in English or what language.
We say Arabic, English and French. He nods approvingly.
We finish our tea, he helps us haul out the TB meds to our van and we shake hands promising to see each other another day, inshallah.
I somehow have no doubt that I will see him again, whether on earth or not, certainly in paradise.
Sarah and I are off. We run some other errands before being called back to pick up Mahamat and Lamglé. We wander through several dirt road detours through the "suburbs" of N'Djamena (mud brick houses slightly more spread apart than in the "Grande ville") until we come to a mud plastered three roomed house with a ramshackle covered dirt "porch" which Mahamat claims as his. He apologizes saying a huge wind knocked half his wall down last May.
After helping them out onto crutches and onto a mat in the shade we are invited to sit with them. A metal bowl of water is placed before us. I try to ignore the floating things as I bring it slowly to my parched lips. A young boy is sent off for some Cokes and Grapefruit "Top". We then have some rice "boule" with some green leaf and dried fish sauce. I must be starving because as I dig into the sticky rice paste and dip it into the spicy sauce, I actually can't eat it fast enough. It just seems to hit the spot.
We then head off back to the "big city" and stop at Ma Joie's house. Ma Joie is the 8 year old girl, also a relative of Mahamat and Lamglé who also had a right femur fracture that also wasn't healed properly that we also opened and reduced and put in traction. The only difference is that she healed after two months and has been home for over a month already.
We enter a low, dank mud entrance down an open alley past some couches in various stages of fabrication until we turn into an open courtyard. There our shy, cute little friend limps towards us on one crutch. Apparently, she doesn't need it but her grandfather insisted she use it in front of us in case we expected it. We greet all 14 members of the extended family and Ma Joie makes my day by lighting up with a crooked tooth grin when I lay out my hand palm up so she can give me "five". She slaps it hard and soon all the other kids are lining up! Right before we leave, she runs off and brings us each a black plastic bag with some brightly colored African cloth as a present.
She is not only Ma Joie but Notre Joie (our joy)...
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