Gone

Youlou's gone. Sunday morning. Barely responsive. Tubes sticking out everywhere. No family. Brother arrives. Call from Moundou. Cousin's a doctor. Knows him well. Has treated for years. Yes, HIV+, he knows. Evacuate. Ambulance arrives. Put Youlou on a stretcher. Out the door. In the Land Cruiser. Anatole and Augustin accompany. Gone.

The baby's gone. Bottle feeding. Changing poopy rags. Burping. Soothing. Sweet. Calm. Sunday evening. Mother's still denying. Local chief comes. Doesn't recognize. Operated patient does. My mother's relative. She's coming. Washes. Feeds. Mom sitting up. Drinks. New wrap. Uncle will come. 50 kilometers away. One more evening. Crying. Washing. Preparing milk. Sucking bottle. Morning. Knock, knock. This is the uncle. Over to Augustin's. Baby brought out. Sit in chairs. Recount stories. Mom AWOL. Family unaware. Went to market. Never came back. Gone.

Baby in box. Take out. Give to uncle. Merci beaucoup. Gone.

Monday afternoon. Woman in labor. Not progressing. Husband demands surgery. We stall. No progress. To the OR. Prep and scrub. Fat baby. Cries. Uterus closed easily. No complications. Back to ward. Wash hands. Go home. Evening. Oscar comes. Knock, knock. Breathing gone.

Rush. Run. Don't look panicked. Pupils dilated. Inner eyelids pale. No blood. No pulse. Occasional gasp. Chest compressions. Oscar take over! Call Delfine! Get a gurney! Run to OR. Scramble for Adrenaline. Nursing student! Draw up adrenaline. Broke and spilled. Take another. Broke again. Another. Finally. IV push. Heart beat. A little pulse. Push on chest. Air moves in. And out. Dump on stretcher. Run to OR. Open fridge. Take blood. O negative. Cold. Run it in. More adrenaline. Delfine! Another IV! Call lab. Blood type. Anatole comes. Blood sugar. Normal. Breathing on own. Heart beat. 140 per minute. No blood pressure. Oxygen sats normal. More blood. Hydrocortisone. Stop adrenaline drip. IV fluids. No urine output. One hour. Breathing well. Out to ward. Stress gone.

Move to bed. Woman speaks. Wants to sit up. Turn around. Crank handle. Raise head. Breathing bad. No pulse. No heartbeat. Adrenaline twice. Gone.

Tuesday morning. Call from Moundou. Youlou. Getting better. Coma gone.

Tuesday evening. Ring, ring. Anatole. 6:30pm. Youlou dead. Gone.

Knock, knock. Anatole. Samedi. Come in. Sit down. Have some tea. Almost seven years. Hundreds of deaths. Samedi, over 30 years. Anatole over 25 years. Cholera. Liquid diarrhea. Up to knees. Wear boots. 1996 epidemic. Family won't help. 24 perfusions. Doxycycline. Doctors without borders. Money. In other's hands. Gone. Only Samedi and Anatole. Bury the dead. Stuff cotton in nose, mouth, anus. Even at night. Family doesn't help. Only Samedi and Anatole. 24 hours a day. Three months. Never got sick. Many others gone.

Measles epidemic. 1987. Samedi. Four children. Measles. Family emphatic. Don't treat. Samedi ignores. Penicillin for each. Eye drops. Citrus. All live. Many patients. Hospital full. Father of four. Loses two today. Loses two tomorrow. All gone.

1983. Black September. Curfew. Anatole and friend. Thrown in jail. Come out. Beat or killed. Three days. Finally released. Village of Bere. Hospital empty. Village gone. Samedi in one house. Anatole in another. No electricity. By themselves. Protecting. Watching. Guarding. Anatole gone. Samedi 24 hours a day. One week. No one else. Next week. Anatole alone. Doctor taken hostage. Samedi captured. Night. African bush. Military. We'll kill. Who's that? We're with you. Who's that? Nurse. Samedi? Let him go. Samedi runs. Gone.

Funeral. Youlou. Tomorrow. Let's go. Ok. Good night. Walk to gate. Laugh. Why are we alive? My brother dead. Same car. I'm alive. Anatole and Samedi. Alive. Back to house. Stars. Cloudless sky. No moon. Tears flow. Sobs wrack. So many...gone.

Unwanted

It's the barking that first wakes me up. Of course, I'd just fallen asleep. Is Caramel just barking at shadows or is there a nurse at the door. Then I hear the sound that has replaced the fear-provoking sound of my residency pager: the gentle "tap, tap, tap" of a finger on a sheet metal door.

I roll out of bed trying not to disturb Sarah (as if she could sleep through the racket), pull on some scrub pants and head out to the porch. A headlamp outside the scree confirms my suspicions: they want me at the hospital.

It's Oscar, one of our new nurses. He did several nursing school rotations at our hospital and was always one of the sharpest students. The problem is that he still looks like a student, a junior high student. It doesn't help that his one lazy eye always makes you wonder if he's really looking at you or not.

"We just got a case referred from the health center," Oscar begins holding out a small piece of paper with some scribbling and the ink from a rubber stamp marking it as official. "Femme psychose." I have to have him repeat it and then finally look at the paper where I recognize that the patient is referred for being a "female psychosis."

"She's nine month's pregnant and is crazy," Oscar continues. "She won't let any of us examine her. The baby's head is half way out but she just writhes and shrieks and doesn't push."

"Ok, ok, I'm coming." I go back inside, pull on a dirty scrub shirt, grab my flashlight and keys and walk back out under the full moon.

As I enter labor and delivery, I see a crowd of nurses and nursing students standing around laughing and joking just beyond the curtain that separates our one delivery bed from the three postpartum beds. The woman is quite large, looks young and has a blank stare on her face as she gazes at the wall, her back arched behind her and her obviously pregnant belly shoved out proudly in front.

I send everyone else out except Delfine, the nurse responsible for labor and delivery this evening. I go over to the side of the bed where the young woman is staring.

"Lapia." I greet her. She rambles something off in Nangjere that I don't understand.

"Bebe gei age." I tell her the baby wants to come out.

"Bebe kang ddi." She denies that there is a baby. I decide not to provoke her. I'm not sure what to do. If I even try to come close to touch her she screams, tenses up and pulls away.

"I have to poop!" The girl continues in Nangjere.

"Ok, go ahead," I place a bed pan under her. "Do it in here."

She pushes it away indifferently. I put some gloves on, still uncertain as to how to proceed. I can't really knock her out because the baby's respiration will be depressed. Yet at the same time, I'm worried that the baby's oxygen is being compromised by his not coming out fast enough. What to do?

Every time the woman has contractions she stretches out her legs, squeezes her buttocks and arches her back: not the classic pushing technique I remember from medical school. Amazingly, after a couple more contractions she actually pushes the head all the way out. Even more remarkable, she turns on her back, spreads her legs and allows me to grab the head and pull the baby out. He is curled up, great tone and starts to scream immediately. I clamp and cut the cord and give the baby to Delfine. Fortunately, the mother is still being slightly accommodating and the placenta delivers almost immediately. Plus she has no tears and her uterus is well contracted with no bleeding so we don't have to touch the mom and freak her out.

As I turn back to the baby, Delfine is finishing tying off the cord. We dry him off as best we can and wrap him in the only thing the mother has available: her head scarf. I go to present him to his mom and she turns away, again denying that she has a child. Now what? I call in Anatole who happens to be there with one of our staff members who is sick. He tries to talk to her in Nangjere and Ngambai but just gets nonsense replies. Still, none of her family has shown up, which is unusual in Africa. I pick up the baby in my arms and go to see Augustin, our administrator. He calls up the health center that referred her. As he talks to them, one of his family, a young teenage girl has taken the newborn from me and is cooing and giggling at him in the chair across the room.

"The woman you referred has delivered, but no family has shown up and she doesn't want the baby. What's the story?"

Apparently, she came from a village down the road called Dabegue. She just showed up and was so uncooperative that the nurse at the health center put her on his motorcycle and dumped her at the hospital. That's all they know. And no one has shown up for her there either. One of the other nurses on duty, Seraphim, is from Dabegue. I take the child back and go to see him in the pediatric ward.

"Seraphim, there's this crazy woman from Dabegue who just delivered, is all alone and doesn't want her baby. I'm trying to figure out what to do with the baby. Would you mind coming and seeing if you know her?"

He agrees and we set off across the darkened campus to the Maternity ward. The woman is still staring off into space. Seraphim goes around and gets a good look at her.

"Nope, I don't know her." I try again to present the mother her baby but she turns away in indifference.

So I take the baby home. I walk into the bedroom and place the bundle by Sarah.

"Hey, look what I brought you." She half opens her eyes and in the light of the flashlight takes in the baby.

"You're kidding! What's going on?" I explain the story but tell her to go back to sleep, I'll take care of it.

I leave the package on the bed and go over to Tammy and Jamie's.

"Hey, do you guys have a bottle and some infant formula? I just brought home a baby that a mentally challenged woman doesn't want . Since she has no family with her I figured I'd keep him tonight and see what we can figure out in the morning."

Jamie comes out and chats while Tammy scurries around in the kitchen and finally comes out with a bottle and matching nipple.

"Do you have any formula as well?"

"Actually I do. I'm helping feed that orphan baby across the street and they're coming tomorrow to get the can but I guess you can use some tonight."

"Ok, thanks." I go home and put some water on the stove to heat up. I fix some formula and put the rest in a plastic storage bin, mix in some colder water until it's just right and try and wash the newborn nastiness off the little guy. I give him some formula (he doesn't want much) and then wrap him in a blanket and pack him in a cardboard box on the couch.

As I lie in bed again trying to go back to sleep only one thought enters my head: "now what?"

Tobacco

"Docteur, mind if I interrupt?" Desiré pokes his head into the OR. Actually, I do mind because I'm trying to take out a large cecal mass that is hovering right on top of the major artery going down to the right leg while Sarah is trying to keep the patient alive with an Adrenaline drip.

"Yeah, go ahead," I say as I briefly look up before getting back to careful dissection. All I hear is mumbling, something about a boy and a horse and falling and a clavicle. Must be a clavicle fracture, not urgent.

"Ok, I'll come and see him later." I keep working and eventually am able to get out most of the mass and reattach the patient's small intestine to his large bowel. However, his heart rate and blood pressure keep tanking without the Adrenaline so we find a good rate for the drip, send up a quick prayer and release him out to the wards for lack of an ICU.

I've forgotten about the boy who fell off the horse until Desiré spots me from far away as I try to escape back home and calls me back to the ER.

I leave the darkness of the overcast sky to enter the even deeper obscurity of the ER who's light isn't working. I see a pre-teen boy, well formed and conscious sitting up on a dilapidated bed. He has a 5 cm open wound below his clavicle that is filled with nasty green clumps of grass or something. It's then I get the real story. He was riding from the fields with his throwing knife, fell off and stabbed himself in the upper chest. Well at least he seems to still be breathing. I go to my office and bring back my stethescope. Breath sounds seem to be equal bilaterally and he is in no respiratory distress. The wound looks deep, but maybe it didn't make it to his lungs. We take him to the OR for exploration.

After starting an IV, giving antibiotics and a sedative, I examine the wound. I pull out the clumps of dark green crushed leaves mixed with blood and dirt.


"What is this, some kind of traditional medicine?" I ask Samedi. He goes out and inquires of the family and then comes back into the OR chuckling.

"Doc, it's tobacco leaves."

I'm stunned. Tobacco? What will I see next? I try to wash it all out. The wound is deep but slanted up so it goes almost to the clavicle but not straight in thus avoiding the lung. If it would've gone any deeper it may have his the subclavian artery or vein and he'd be dead.

I leave a drain deep and close the muscle and fascia leaving the skin open with a diluted bleached soaked dressing.

I go to check on the previous patient. We have nursing students currently so I'd assigned one to take vitals every 10 minutes (exceptional for here). It's actually been done and the patient has maintained a normal heart rate and blood pressure. The IV bag is almost empty so I mix up another 500ml with 2 mg of Adrenaline and get it running at about the same rate by eyeballing it.

I leave him in God's hands.

The next morning he's talking and asking to have some water to drink.

Lies

The knock on the door is all too familiar. The case is not. A well built young man in his mid twenties lies on the ER bed with his legs curled up in obvious pain. He as all the symptoms of acute appendicitis. What is unusual is that he's only been sick for three days and the excruciating pain localizing to his right lower quadrant started at 4:00 am this morning. It's just a little after 6:00 am on a Sunday. He actually came in to the hospital almost right away. He didn't wait!

I open him up with a McBurney incision and find an appendix with the last two centimeters flaming red but non-perforated. I think this is probably the first non-perforated appendicitis I've operated on in 7 years here in Chad. Unlike the others, he should have an uncomplicated recovery and go home in a couple days. As I close up the skin incision I notice through the glass block windows of the OR that outside has turned dark and I can hear the rain pounding on the tin roof. This year, the rain started early and has been consistent and heavy. I head outside to do rounds as the cool wind and rain forces everyone under shelter.

The surgery ward is saturated with complicated wounds and post-op cases or patients who've come from far away and with the rains having destroyed all roads into Bere, it is unthinkable to send them home and have them come back in a week for suture removal. We'll just have to keep them until they can go home definitively.

On the medicine ward I find a not too uncommon sight. An elderly woman is sitting on the hospital bed with an IV hanging off her arm attached to an empty bag of IV fluids that once had Quinine in it. On the floor next to her bed is a half folded mat with a baby asleep on it surrounded by two young women and a young man eating a traditional meal. They break off a piece of millet paste and dip it into the slimy, green leafy sauce using two fingers and the thumb of the right hand. The man gets up when we approach while the women continue dipping and eating.

"Ca va?"

"Oui, ca va."

"Do you know the hospital rules?"

"Yes."

"Ok, how many family members can stay with the patient?"

"Two."

"How many of you are there?"

"Two."

"Do I look stupid? I can count. How many of you are there?"

"Three but one of them is outside."

"Where are we, inside or outside?"

"Inside."

"Do I look stupid? Where is the woman, inside or outside?"

"Inside, but she just arrived this morning."

"Really? Who let her in?" I go to the door and call the gatekeeper who is standing in the rain swallowed up in his army green poncho.

"Jean-Jacques, did you let this person in this morning?"

"No, she must have been in here already."

I turn to the family member and ask him, "When did she come?"

"Ask her."

Seraphim, one of our nurses' aides asks the woman in Nangjere when she got here.

"Nanga," she replies and even I understand that doesn't mean today, that means yesterday.

"My friend," I ask the man. "How many more lies are you going to tell today that are so easy to verify as false? Are you going to tell us you're the president of Chad? Or maybe Barack Obama?"

But I can tell by the look on his face that my attempt at humor has escaped him.

I finish rounds just in time to be called to labor and delivery where a woman has been in prolonged labor at the health center and was referred since 2 am. She arrives at 10am. I examine her and find that the baby is trying to come out face first and it just isn't working. We do a see section and pull out what looks like a little alien with his eyes bugging out, forehead swollen and molded by the pelvis and his face edematous and red. But he does start crying and moving with some vigorous efforts at reanimation by Sarah and Anatole and looks like he'll be fine. I wonder how long it'll take him before the culture teaches him that lying is ok as long as it's used to give excuses for not doing what you should be doing and to protect yourself from something that might turn out to be shameful.

But for right now, he's just like any other newborn, he just wants oxygen followed by a good breast feeding.

Crutch

I sigh. I can't help it. I've seen too much. Too many children die, too often. And this is just another sad case. The nurse hands me the carnet. A seven year old who was amputated here in May during my vacation. Now he's back with tumors everywhere according to the nurses' initial evaluation. Diagnosis: metastases. I motion for the nurse to bring in the child. He practically skips into the room, if one can skip on crutches. He's almost bouncy until he looks up at me and then turns his head down and slightly to the left as he shyly looks back up with a small grin revealing two missing front teeth. He is way too cute to be dying.

I heave him up onto the exam table and first teach him how to give me five. At first he is reluctant. After all, he's been taught to shake people's hand and slapping is kind of a bad thing. But after some encouragement, he gets into it and really lays it on as his face lights up. I lie him down and pull down his shorts. His left testicle is swollen, looks like a hydrocele. His right leg is amputated above the knee and the wound has scarred down well. However, the leg above the amputation is swollen and the groin is filled with large, mobile masses. His lower abdomen also has numerous palpable masses swelling out his stomach.

My face falls. I'm about to turn to the father shaking my head to tell him there's nothing we can do but I decide to do something desperate and hope for a miracle. We do actually have one chemotherapy agent: cyclophosphamide which we use to treat Burkitt's lymphoma. Burkitt's is very common here and very treatable with a few doses of Cyclophosphamide spread out in cycles of three weeks. It usually presents with a large mass in the upper or lower jaw but can present elsewhere. After one dose, the mass usually shrinks remarkably and after 2-3 doses it is usually visually gone. Even though I'm almost positive this is not Burkitt's I figure it won't hurt to try.

The boy is hospitalized and the first perfusion given. I see him the next morning and his abdominal masses have all but disappeared and the groin masses have shrunk remarkably. He went home 5 days later much improved. Yesterday he came back and got his second dose. This afternoon I saw him and can hardly feel any mass in his groin. All the other masses have completely disappeared. I don't know what it was and I'm pretty sure our treatment shouldn't have worked. But all I really care about is that this really cute boy is getting better against all odds.

Fuel

I'm looking for fuel. Not just any fuel, that I could find anywhere. All along Moundou's one paved road are small rickety wooden tables stacked with old whisky, gin and wine bottles filled with various colors of gasoline and diesel. No, I'm looking for Moundou's one working gas station: such as it is. It hardly stands out. Two bright new fuel pumps stand just outside one of the hundreds of other brick stores with rusting sheet iron doors opening onto dark painted wooden counters in front of an endless supply of haphazard new and used parts and products. There are also two old pumps with glass tubes and a hand pump that fills up the tubes which are then emptied of their specific quantity of fuel out a second hose. It's hard to recognize until you're almost past it and there is barely room for a care to get off the pavement and onto the dirt as motorcycles, bicycles and pedestrians weave in and out in a weird rhythm interrupted by the occasional black exhaust spewing battered diesel truck.



Today, I can't seem to find it. I'm driving slow, peering out the window of the Hiace mini-bus when I spot the two old pumps but no new ones! Just past the pumps on a stool is my friend, Mahamat, wearing a Chadian National Football team jersey. He waves to me and I screech to a halt and back up.

"As salaam aleikum!" I greet Mahamat.

"Wa aleikum as-salaam," he replies and then adds. "You're looking a little lost, what's up?"

"Yeah, I was looking for your gas pumps, but they're gone!"

"We just moved across town last week. I'm here just to orient my clients. Do you need gas?"

"Yes, I was looking for you, but you found me instead!"

"Come, I'll take you to my new place." With that, Mahamat hops into the passenger side and we do a u-turn and head back towards the surgery center.

Mahamat is plump with a ready grin and is a huge football fan. Apparently, in the day, he was quite the player as well and still gets out occasionally.

"How long have you been in the new place?"

"Just a week, God has blessed us. I came from N'Djamena a few years ago, and didn't know what I would do, but here I am."

"Yes, with God's help you have succeeded. He meant for you to come here."

"It's true. Our business will continue to grow, inshallah."

I turn and smile. "Yes, we must always say that, if God wills. We don't know what will happen even tomorrow."

Mahamat grins as he chews on his tooth cleaning stick trying to keep his mind off food until Ramadan ends at sundown. "So many people want to plan out their whole lives, but it's only the right now that God has given us."

"Yes, you're right."

"I thought I saw you yesterday evening." Mahamat changes the subject slightly.

"Yes," I reply. "I came into town with my wife looking for something to eat. We found some great beans and rice after sundown. I prefer simple things, the things that God has made rather than things from a can or box."

Mahamat looks at me in surprise. "You are a true believer, that's for sure." He laughs and keeps chewing on his stick as we pull up to his new gas station.

Tire

I walk over to the mini-bus, my muscles aching and my back burned. I've just been out in the hot sun all putting in the plumbing for our house at the new surgery center in Moundou so the builder can pour the floor and keep things moving. I glance at the rear tire and see it's gone mostly flat. It's had a slow leak for a while, but this is going flat quicker than normal. Sarah and I hop in, I start her up and we pull out onto Moundou's one paved road.

In the round about ahead is the statue of an African woman next to a large, homemade water jar reaching out half a calabash of water to us thirsting passersby. Just past the effigy I spot a yellow tank with a motor and old belt on top. A tire repair shop. I screech to a halt and look down the dirt embankment to a teetering brick wall where someone has stretched out a ragged tarp between a tipped up push cart steadied with palm fronds and an old metal sign. The tarp is attached to it's supports with old inner tube that allows it to toss and turn at the whim of the wind offering varying degrees of shade.

Under the tarp a man is stretched out asleep on a board balanced precariously on each end by two old tires.

"Hey, anyone working today or are you closed?" I shout out in French in the man's general direction. He sits up and smiles and walks up to us.

"My back tire is low and needs to be repaired," I say to the man as I step out of the van and around to the back passenger side. He nods and mumbles.

"TWENTY THOUSAND? Are you crazy?" I respond incredulously.

The man smiles and laughs. "No, no! TWO thousand, not twenty." He walks over towards his homemade tools scattered all over the ground. "Twenty thousand, that's practically the price of a new tire. No, I would never say that."

I agree with a nod and a grin and the man gets to work jacking up the van to take off the tire.

"Mind if I sit in your shade?" I ask. He tells me to go right ahead and then when he sees Sarah still sitting in the van, he motions that she should join me, which she does.

We both quietly read until I see he has the tire off the rim. I get slowly to my feet and saunter on over where the man shows me a nail poking through the rubber.

"That's what made the tire go down quick, put there must be another hole somewhere because it has had a slow leak for awhile."

"Sure, no problem."

I go back and resume reading my friend Franklin Cobos' book about his experiences in Chad in 2008 called "It Could Be Worse." Little do I know how pertinent his title will seem in retrospect.

The man calls me over and points out a piece of bailing wire that he also found in the tire. He patches both with old pieces of inner tube and glue. I figure he's about done, but return to my reading anyway. After 20 more minutes I see him still struggling to inflate the tubeless tire. I see him walk away across the paved road and return 5 minutes later with a back of flour. I stop reading and watch closely. He puts it in a bowl and deftly mixes in a little water till he's created a very sticky dough. Then he smears it around the edge of the tire. I get up and stand nearby watching in typical Chadian fashion. As he tries to inflate the tire with the air hose the dough puffs out in a couple places like a kid trying to make bubbles with chewing gum.

"I need more flour." The man states matter-of-factly and takes off again soon returning with double the amount of flour. He repeats the procedure until practically the whole tire is white with dough. I wonder if it sits enough on the hot Chadian pavement if it'll turn into bread and stop up the holes. It still doesn't inflate after multiple trials interspersed with reapplication of the dough.

"I'll go see a brother who can help." With that he takes off with the tire back towards where we came from, rolling the white doughy mass in front of him until he's out of sight. I go back to my book. Finally, he comes back and shows me an inflated tire with pieces of plastic jutting out around the edges in between the lumps of dough. It seems to be holding air, though, so I nod my approval and he remounts the tire.

"Four thousand francs." He demands.

"Whoa, buddy, we agreed on two thousand, here take it."

"NO! I fixed two holes, two thousand per hole!"

"The extra work wasn't patching the hole, it was taking the tire off and trying to re-inflate it! That's not my problem that you didn't know what you were doing and had to take it elsewhere!"

I hold out the two thousand franc note. He looks at it in scorn. "Either four thousand or you keep your money!"

"Take it!" I try to give it to him, when he refuses I put it in his cardboard box and go around to the driver's side. The man comes to the passenger side and reaches across Sarah and grabs a hack saw sitting on the console between the seats. Sarah grabs the hacksaw as well and almost falls out of the car wrestling with the man until he wrenches it from her grasp. Meanwhile, I've quickly gone back around and take the saw back, twisting it out of his hands.

"Now you're going to steal something or what!?" I motion for some people across the street to come over as witnesses and intermediaries. I motion Sarah to get back in the van and try to close the door behind her. He pushes his butt in the way. I push him out and close the door but he reopens it and wedges himself in there again. I push him out again with a hip thrust and this time lock the door and manage to close it while boxing the man out as I lift the handle on the door so it stays locked.

Meanwhile, a small crowd has gathered and the man starts shouting out in Arabic about not having eaten anything all day because it's Ramadan, the Muslim fast. I switch over to Arabic and shout out a few things about that he'd agreed to two thousand and then tries to change his mind and steal our saw and molest my woman. The man just keeps repeating the same things over and over even as other Chadians try to reason with him and motion me to just go. So I get in, hope desperately the van will start (which it does) and take off without a look back, hoping desperately that the plastic and dough holds up at least till I get out of view.

WELL

I finish as quickly as I can at the hospital. Lightening rounds and a couple of simple operations and I find myself heading towards where my heart has been all morning. I open the back gate and step into the bush. Grass is starting to push it's way up through sand transforming this desert into it's annual reawakening an African savannah. This year the rains have started early and have been regular. No one is talking about famine this time. I walk across the field towards the church and pass a couple of sticks stuck in the ground that serve as goal posts for the afternoon soccer matches between the neighborhood kids.

In the distance, I spot Jamie amongst a crowd of African children surrounding a small metal brace towering out of the masses. The slow chug and then roar of a pull started diesel motor breaks the silence as I see a motor slowly rising along the supports towards the top. As I draw near I see a metal pipe attached to the bottom of the motor and some huge plastic tubes coming off the bottom running to another small motor that has just been started as well. Coming out of this motor is an even larger, green hose going into a pit filled with muddy water which is starting to disappear as the metal pipe starts turning, the motor is lowered and sand filled muddy water pours out from under the apparatus, down a channel, into a small pit for collecting the larger debris and then through another canal into the big water pit.

A well is being drilled before my very eyes!

As the motor gets to the bottom of the rig, it is shut off. The pipe is loosened from the motor and then locked in a brace that will keep it from slipping forever into the bottom of the water reservoir. The motor is then restarted and hand cranked up enough to screw in another pipe and continue the process of up and down, up and down with the drill bit getting progressively further towards a clean water source. I take off my scrub shirt, roll up my scrub pants, take off my sandals and jump into the muddy fray.

Suddenly, one kid yells to another kid to start the water pump. We haven't attached the other pipe yet and a powerful jet of clay filled water spurts out on Jamie, Doulgue and I covering us from head to toe in mud. Everyone starts laughing while we silently plot our revenge.

Finally, the well is 85 feet deep. We slowly and excruciatingly reverse the process to remove the pipes one by one. Finally, the drill bit is out. We bring in the large plastic pipe that will be the well casing. It is bright blue and the first one to go down as little slits all along it to let water, but not soil in. We have to modify the end so it will go in easier by cutting out triangular wedges with a hacksaw and heating up the plastic with a propane stove so we can bend the end closed. We then lower it into the pit and hold on while another one screws into the end. None of them want to screw in until we realize we have to grease it well for it to work as the plastic just grips itself.

We have 3-4 ten foot lengths in when we discover that the threads are bad. Now we have to try and pull it back out to unscrew that last one. It's difficult as the muddy water in the hole wants to suck it in and now the pipe is covered in clay and quite slippery. We finally wedge it with a large adjustable wrench and a plethora of hands but it feels like it'll slip away at any second. We manage to finally unscrew the old one and screw on a new one and slowly lower it back until we have 8 sections in for a total of 80 feet.

It's revenge time. The first boy sees me coming and backs away laughing...right into the arms of Doulgue. We haul him over and baptize him in the sump pit as a fitting celebration of the arrival of clean water for our elementary school and junior high. We go home sunburned, tired and very satisfied.