Friday, March 24, 2006
I'm Not Afraid: the story of Samedi & the Bere Adventist Hospital
Samedi is a nurse who started out as a janitor at a small bush hospital in rural Chad and after working 28 years there has so much ... all » experience that during the years when there was no doctor at the hospital was able to save many lives by doing emergency surgeries in addition to all his other duties.
Thursday, February 23, 2006
Miracle?
I'm drained. Another day. Up early. Drink a liter of water. Read the Bible on the throne. Eat breakfast. Go to staff worship. Sing something in Nangjere. Read some obscure Old Testament passage. Listen to how many patients got admitted with malaria last night. Hear how many kids died of malaria last night. Pray. Grab stethescope, clipboard, and pen. Walk to the wards. Notice how much plastic, bloody cotton, and trash is lying around. Look at the dirty walls and floors. Watch them bring out the filthy round cart. Walk around. Look and see how many meds haven't been given. Yell a little. Listen to some hearts and lungs to make it look like I'm doing something. Write prescriptions. Send people home. Send people to the lab. Change dirty dressings. Smell many things I'd rather not describe. Repeat same thing in Pediatrics. Yell at mothers and fathers for not buying the necessary meds to treat their kids. Yell at them again for not giving the meds or giving them wrong. Get "fives" from chronic, cute kids who'll probably be handicapped for life because the best place they can come is here and here's not good enough. Hear about a premature baby referred for warming lights. Smirk bitterly as I remember warmers without probes to make them work and lack of electricity besides. Promise to come see baby after rounds. Finish rounds. Go see baby sitting on front steps of clinic. Notice sun shining on tiny 7 month premie who is blue. Watch and see no breathing. Tell mom boy is dead. For some reason, listen to heart with stethescope. Hear heart beat. Lackadaisically pick up baby and walk over to gurney. Put baby on gurney in sun. Call for bag-valve-mask to breath for baby. Start breathing for baby. Ignore soon gathering crowd of locals. Too tired to care. Continue breathing. Baby starts to turn pink and grimace. Baby starts to move legs and arms. Listen to heart. Beating stronger. Keep breathing. Getting warm. Murmurs ripple through crowd. Sweat drips onto baby. Baby opens eyes. Stop breathing for baby. Baby breathes with difficulty on own. Continue to help from time to time. Send for mom. Give pink, squirming, breathing baby into mom's arms. Tell her to sit in sun. Feel heart pounding. Warm, feel-good feeling. Go back to grind. Miracle? Two hours later, nurse tells me...baby...is...DEAD...
Friday, February 10, 2006
The Balance of Life and Death in Chad
by JAMES APPEL
The sun beats fiercely from the brilliant blue sky as we make our way along the well-worn path toward the river. The path disappears into a flooded rice field. Removing our sandals, we wade into the warm water.
Occasionally we pass locals and greet them with a friendly "lapia." When we arrive at the river, the half-naked children quickly leave their fishing spears to watch the foreigners swim.
The sun sets as we make our way back across the rice paddies, tired but refreshed. A little recreation helps us focus on the difficult tasks we face working in the mission hospital in Bere, Chad.
One morning a baby is brought in with a severe infection in her lower abdomen and legs. Antibiotics fight the infection, and I remove large patches of dead black skin to save the child's life. Later that day, Sarah, one of our mission nurses, reports that the baby is unconscious. I rush to her and find she is not breathing. Desperately I perform CPR, but it is too late; the child is dead. Sarah is devastated, thinking that somehow the child's death is her fault. But I blame myself. If I had checked on her more often, maybe I could have saved her. We see death all the time, but this child's death troubles me deeply.
A young woman comes in with abdominal pain. The nurse suggests a urinary tract infection; I suspect appendicitis. She says she is not pregnant, but I wonder. A pelvic exam suggests an infection of the uterus or fallopian tubes. I wish I had an ultrasound that could identify the source of infection. I put her on antibiotics.
That evening the staff wants to go to the river. I do too. But I stay behind to check on the woman. She is worse. I ask more questions and search the medical books. A urine test reveals she is pregnant. If it is an ectopic (out of uterus) pregnancy, only surgery will save her life. But if I am wrong, she has undergone major surgery for nothing. I pray, then I decide to operate. I find a swollen mass that is about to rupture. I thank God for revealing her problem, even without proper equipment.
What if I'd gone to the river instead of staying with this woman? How does one find balance in a world so overwhelmed with the never-ending needs of a place like Bere?
Your weekly Sabbath School mission offerings make ministry such as that at the outpost hospital in Bere, Chad, possible.
From: http://www.ssnet.org/qrtrly/eng/06a/less06.html
The sun beats fiercely from the brilliant blue sky as we make our way along the well-worn path toward the river. The path disappears into a flooded rice field. Removing our sandals, we wade into the warm water.
Occasionally we pass locals and greet them with a friendly "lapia." When we arrive at the river, the half-naked children quickly leave their fishing spears to watch the foreigners swim.
The sun sets as we make our way back across the rice paddies, tired but refreshed. A little recreation helps us focus on the difficult tasks we face working in the mission hospital in Bere, Chad.
One morning a baby is brought in with a severe infection in her lower abdomen and legs. Antibiotics fight the infection, and I remove large patches of dead black skin to save the child's life. Later that day, Sarah, one of our mission nurses, reports that the baby is unconscious. I rush to her and find she is not breathing. Desperately I perform CPR, but it is too late; the child is dead. Sarah is devastated, thinking that somehow the child's death is her fault. But I blame myself. If I had checked on her more often, maybe I could have saved her. We see death all the time, but this child's death troubles me deeply.
A young woman comes in with abdominal pain. The nurse suggests a urinary tract infection; I suspect appendicitis. She says she is not pregnant, but I wonder. A pelvic exam suggests an infection of the uterus or fallopian tubes. I wish I had an ultrasound that could identify the source of infection. I put her on antibiotics.
That evening the staff wants to go to the river. I do too. But I stay behind to check on the woman. She is worse. I ask more questions and search the medical books. A urine test reveals she is pregnant. If it is an ectopic (out of uterus) pregnancy, only surgery will save her life. But if I am wrong, she has undergone major surgery for nothing. I pray, then I decide to operate. I find a swollen mass that is about to rupture. I thank God for revealing her problem, even without proper equipment.
What if I'd gone to the river instead of staying with this woman? How does one find balance in a world so overwhelmed with the never-ending needs of a place like Bere?
Your weekly Sabbath School mission offerings make ministry such as that at the outpost hospital in Bere, Chad, possible.
From: http://www.ssnet.org/qrtrly/eng/06a/less06.html
Tuesday, February 7, 2006
National Strike, Surgery Crazy, & River Surf
I am fatigued. The weekend has brought a brief respite. For only the second time in 2 weeks I have had a day without a surgery. All the government health care workers have been on strike for over a month. Even the General Hospital in the capital of N'Djam�na is closed. Here in B�r�, the nurses assigned by the government to our hospital have only worked 6 weeks since June 2005 leaving us more understaffed than usual. Since mid-December the surrounding hospitals have been closed, and for the last two weeks all the health centers have shut down, too, leaving us as the only hospital in 5 counties, and me the only doctor for a population of approximately 1/2 million people.
Our hospital is overflowing. We have moved into the partially completed new church in order to free up the old church for a tuberculosis ward, as we had almost 20 patients crammed into a ward made for 8. We have no beds, despite a fast discharge rate. And we have been operating like crazy.
The following statistics will give tangible proof of the marked increase in work at the B�r� Adventist Hospital:
2005:
Consultations: 1510 (125.8/month)
Hospitalizations: 1095 (91.25/month)
Deaths: 95 (7.9/month)
(42 Malaria, 25 malaria/anemia combo)
Deliveries: 107 (8.9/month)
Surgeries: 168 (14/month)
Hernias: 35 (2.9/month)
C-sections: 31
Laparotomy: 17
Hydroceles: 12
Tubal ligation: 11
Miscellaneous: 62
Lab tests: 2798
HIV tests: 334 (73 positive)
TB sputum smears: 188 (57 positive, 11 deaths)
Blood transfusions: 99 (almost all had hemoglobin <5) 75% lived
January, 2006:
Consultations: 216
Hospitalizations: 164
Deaths: 15
Deliveries: 8
Surgeries: 37
Hernias: 20
Hydroceles: 4
Oophorectomies: 3
Fibroadenomas: 2
Hysterectomy: 1
Ectopic pregnancy: 1
Bone graft: 1
Open fracture: 1
Leg amputation: 1
C-section: 1
Misc: 2
And in the first 5 days of February (in fact in the first 3): 10 surgeries
As I sink back into the all too comfortable couch I feel the soreness of my shoulders and arms and I think back...
I pull out the bag from the back of the truck and unzip it. Inside I pull out two halves of a bright blue epoxy surfboard. I place the carbon fiber tube in the center for strength and cinch the two halves together with the patented Pope Bisect integrated screw mechanisms. The board is already waxed and I head down the beach to the water. A gorgeous red-head (my wife) is waiting on the bank with her somewhat scrawny pony. There is the definite smell of a cattle crossing and the edges are muddied by numerous hoof prints. I wade out into the foot deep water and shove my board ahead of me as I jump on, bend my back up, and feel that oh so nostalgic feeling of hands dipping in and out gliding my stick effortlessly upstream. I hear Sarah mount the horse and begin chasing me, water splashing furiously in the horse's wake. Yeah, there's nothing even remotely resembling a wave but somehow that motion up and down, pull and drip forward is comforting and relaxing. A great blue heron flaps up suddenly and awkwardly across my path as numerous other birds twitter and flit around the steep clay banks. I cannot completely relax as, while I'm almost positive there are none here, I still keep an eye out for hippos and crocs. I finish my upstream paddle and gently coast back down with a leisurely stroke now and then. Near the put in point I call to Sarah and suddenly paddle furiously, put my hands on the board and in one motion push off, slide my feet up and am standing... surfing? Not quite but as the board shoots out from under me and off to the side and I tumble in I raise my arms in exultation as Sarah giggles helplessly...well, life is good!
James
Our hospital is overflowing. We have moved into the partially completed new church in order to free up the old church for a tuberculosis ward, as we had almost 20 patients crammed into a ward made for 8. We have no beds, despite a fast discharge rate. And we have been operating like crazy.
The following statistics will give tangible proof of the marked increase in work at the B�r� Adventist Hospital:
2005:
Consultations: 1510 (125.8/month)
Hospitalizations: 1095 (91.25/month)
Deaths: 95 (7.9/month)
(42 Malaria, 25 malaria/anemia combo)
Deliveries: 107 (8.9/month)
Surgeries: 168 (14/month)
Hernias: 35 (2.9/month)
C-sections: 31
Laparotomy: 17
Hydroceles: 12
Tubal ligation: 11
Miscellaneous: 62
Lab tests: 2798
HIV tests: 334 (73 positive)
TB sputum smears: 188 (57 positive, 11 deaths)
Blood transfusions: 99 (almost all had hemoglobin <5) 75% lived
January, 2006:
Consultations: 216
Hospitalizations: 164
Deaths: 15
Deliveries: 8
Surgeries: 37
Hernias: 20
Hydroceles: 4
Oophorectomies: 3
Fibroadenomas: 2
Hysterectomy: 1
Ectopic pregnancy: 1
Bone graft: 1
Open fracture: 1
Leg amputation: 1
C-section: 1
Misc: 2
And in the first 5 days of February (in fact in the first 3): 10 surgeries
As I sink back into the all too comfortable couch I feel the soreness of my shoulders and arms and I think back...
I pull out the bag from the back of the truck and unzip it. Inside I pull out two halves of a bright blue epoxy surfboard. I place the carbon fiber tube in the center for strength and cinch the two halves together with the patented Pope Bisect integrated screw mechanisms. The board is already waxed and I head down the beach to the water. A gorgeous red-head (my wife) is waiting on the bank with her somewhat scrawny pony. There is the definite smell of a cattle crossing and the edges are muddied by numerous hoof prints. I wade out into the foot deep water and shove my board ahead of me as I jump on, bend my back up, and feel that oh so nostalgic feeling of hands dipping in and out gliding my stick effortlessly upstream. I hear Sarah mount the horse and begin chasing me, water splashing furiously in the horse's wake. Yeah, there's nothing even remotely resembling a wave but somehow that motion up and down, pull and drip forward is comforting and relaxing. A great blue heron flaps up suddenly and awkwardly across my path as numerous other birds twitter and flit around the steep clay banks. I cannot completely relax as, while I'm almost positive there are none here, I still keep an eye out for hippos and crocs. I finish my upstream paddle and gently coast back down with a leisurely stroke now and then. Near the put in point I call to Sarah and suddenly paddle furiously, put my hands on the board and in one motion push off, slide my feet up and am standing... surfing? Not quite but as the board shoots out from under me and off to the side and I tumble in I raise my arms in exultation as Sarah giggles helplessly...well, life is good!
James
Sunday, January 29, 2006
Bongor
I sit by the side of the road. Around me in all directions stretches the African plain. It's vast, flat expanse allows one to see miles in every direction broken only by the occasional tree and smoke from a cooking fire. Ahead and behind the single lane road stretches into infinity, swallowed up in the haze of the Harmatan winds off the Sahara.
My neck is burned, my hands are caked with grease, and the smell of diesel clings to my plain, tan-colored Arabic robes. My mouth is parched, my lips are cracked, my nose is filled with thick, black tinged snot, and my eyes are dry.
I lean against the hood of the truck as a small crowd of kids on foot and adults on bikes alternately stares and whispers among themselves in Arabic and a variety of local languages.
Sarah has left to fill our water bottles in the little cluster of huts off to the left. It is 3pm. We left B�r� at 7:30am and Bongor at 11am. Bongor is 24km, one toll booth, and a long day filled with experiences away...
....Coming out of Bongor I start to notice a problem with power and acceleration. As we approach the toll booth outside of town, the car stalls as I clutch and brake, I pop the clutch and the truck roars to life only to die again as I try to juggle braking, hitting the gas and pulling the emergency brake to stop and pay our toll. We try in vain to start it. Finally, the toll guys give us a push through the gate and we try to start it that way, but nothing.
With my wrenches in hand, I open the hood and remove the diesel return valve bolt from the injection pump. It is filthy. I ask some of the bystanding gawkers if they have any kerosene. One guy with a shortened upper arm brings me a plastic capfull. I clean out the tiny filter with the kerosene, a match, and blowing with my own mouth. I replace the part and the car starts right up.
I'm feeling really good about myself until 5km later when the pickup finds its closest point to our destination for the day. The time is 11am. We pull up under a tiny tree providing the only shade around. A few meters ahead a "road" turns off to a school built out of woven mats. The kids are outside playing some game. A medium-sized man with a rare Tchadian paunch sidles up, his hands deep in the pockets of his pants pulled up to his belly button with a tight white tank top tucked in.
He says we need a mechanic. A classic Tchadian introduction of stating the obvious. At the same moment, he yells to a passing motorcycle driven by a blue-robed Arab with curly, nappy hair and a short moustache. He immediately starts messing around with the engine by taking off the fuel filter and hand fuel pump. He says the problem is with the hand pump. I think it's maybe the filter, which looks a little crushed.
He calls someone in town and I climb on behind. We tear off down the tarmac, the wind stinging my eyes. The thought crosses my head that if the tire blows out, or we hit a goat or something that I'm dead. I grasp a 5 liter bottle in one hand and the old filter with hand pump attached in the other. I promptly upend the filter spilling diesel all over my lap. The unchanging African plain whirs by in a blur as my eyes sting and tear from the wind and dust.
We arrive in Bongor at a little shop with different sizes and shapes of glass bottles filled with a variety of fuels out front. Inside are an assortment of car parts old, new, and used piled haphazardly on shelves and all over the floor. We buy a new filter and a new pump which is obviously a cheap imitation. We haggle out the prices and I'm not satisfied but am desperate and know I will never get the same price as a local because of my skin color. A variety of "Al salaam alekums" and "al hamdullilahs" float around as I wait for our motorcycle friend to fill up the bike for our return trip.
The return is the same except I am doubly weighted down with filters and pumps, and the 5 liter jug is now full of gasoline.
The truck has been pushed down next to the school and Sarah is playing jumping games with the now out-of-school kids. We have now been reinforced with 3 more Arabs who all seem to know a little about engines but not much. They alternately open and close things pumping furiously and often on the new hand pump. Eventually, with a push we get the car started and our "friend" drives off down a dusty side road.
A half an hour later, Sarah and I are beginning to wonder if our truck has been hijacked to help out in the coup-d'�tat effort going on in parts of Tchad and whether we'll ever see it again. One of the other Arabs comes back on his motorcycle and takes us 100 meters up the paved road where the truck has stalled again.
Finally, at 3pm they leave for Bongor to find a mechanic and I find myself leaning against the hood waiting for Sarah to come back with water. All I can think about are the watermelons in Guelengdeng just 45 km up the road where we were planning to stop for refreshment. They are the best in the world, especially on a dry, hot, dusty Tchadian day.
I glance up and see four round green objects sitting on my side of the road just 50 feet ahead. I ask the locals hanging around what they are and to my unbelieving ears hear the word "watermelon"! I immediately buy two, borrow the ever-present, razor-sharp Arab knife from a boy standing by and slice into and devour one of the sweetest, crispest watermelons I've ever eaten!
As the juice runs down my face and chin and drops on my diesel stained robes, Sarah comes back to partake in the feast.
She then says she saw some horses back in the small village and wants to go back see if they'll let her ride them.
She arrives at the edge of the village where a marriage is being celebrated with the traditional spontaneous horse races up and down the dusty path in front of the wedding site. The men are hesitant to let a mere woman get on a horse as they are sure she will fall off and kill herself on their "wild" stallions.
As she mounts expertly and then challenges them to a race, they all smile condescendingly and the women turn to smile and cheer. They've never been given the privilege of riding and so are all on Sarah's side.
It is Sarah against two Arab men. Sarah's horse has obvious Arabian blood in it, is pale white with delicate feet and with Sarah mounting up like a jockey on the short stirrups she beats them hands down, not once but twice. As she rides up to where I am waiting there is a wildness and gleam in her eyes that reminds me again of what an amazing thing it was to have met and married a girl like her in a place like this.
The mechanic comes and promptly breaks the diesel intake valve. I had been warning them all day not to touch that as I'd broken that same part last year and knew how fragile it was. He leaves, promising to send a tow truck.
I'm frustrated and mad by now. I go to talk to his associate who's stayed behind and tell him we'll just stay here in the bush tonight and they can bring us the part in the morning and put it on and we'll go from there.
He cancels the tow-truck and it's not until the darkness descends that I regret my decision. The associate says he'll flag down a car that'll pull us into Bongor for at most 5000 francs. The next truck is a tiny Peugeot piled so high with baggage and people prickling out from on top of the cargo that the bumper is almost touching the ground. They stop and the turbaned chauffeur offers to tow us for 25,000 francs. After negotiation we get it down to 10,000 francs but in my state of mind I'm so angry with the whole situation that I refuse.
I continue to regret my decisions until a tiny, old toyota car pulls up equally weighted down. A tall, commanding Arab with a goatee pulls out and finally talks sense into me that we need to go to Bongor for our own safety. He says his car is too weak to pull us, though. As I discuss with the mechanic's associate, the commanding Arab comes back and says he can't leave us stranded like that and will pull us for the same price, 10,000 francs that we refused the other truck. I accept.
We attach a cord to our bumper and to the other car with about 10 feet in between. He says that when we see his left uncovered brake light go on we should stop, as the other lights don't work. We limp into Bongor and are deposited next to the fluorescently lighted grilled chicken restaurants. Our tow man comes back to tell us he's called the chief mechanic to come meet us here himself. We pay him and he leaves.
We wait. Our tall Arab comes back to say the chief mechanic is sick but he will pull us to the garage where these other guys can help us. It is the main garage in Bongor, run by the "chinois".
I'm not reassured as a wobbly gate made of tin roofing is slid to the side revealing what looks more like a junkyard than a garage. Another dude pulls up on a moto and they replace the broken part, fiddle with some things, start up the car, and take it out for a test run. It does great!...until they return and it loses power. They say they'll come back tomorrow at 5:30am. It's now 8:30pm.
I call Pastor Job in N'Djam�na and get the local pastors phone number to see if we can stay with him. I get no reply from the local pastor but I do get his name and know he lives somewhere near the Mayor's office. The mechanic on the moto takes us to the Mayor's. We ask around and finally a group of muslims lounging on some mats under a tree point us up the road to the Adventist church.
All is dark as we pull up behind the church. We call out "Al salaam alekum" and a groggy Pastor Issa emerges in shorts and a unbuttoned jacket to welcome us. He then wakes up his kids and moves them out of their mud hut so Sarah and I can sleep there. We stay up another half hour eating cold chicken and bread Sarah had bought on arrival in Bongor and hearing stories of how our hospital came into existence and the adventures of early missionaries like Armin Krakolinig, who built our hospital and most of the Adventist churches in Tchad including this one next door here in Bongor.
Sarah and I finally crash on a thin foam pad surrounded by piles of cassette tapes, simple notebooks, and clothes hanging on a string over the bed. With no mosquito net we sleep fitfully as the malaria vectors buzz our ears all night. At 6 a.m. I am up and have to pee but can't find a latrine. We walk back to the garage with Pastor Issa as our guide.
The mechanics are already at work. We sit around eating peanut oil-flavored beans Sarah has bought just outside, and wait as they clean the fuel tank and putter around adjusting and cleaning the injectors and the rest of the diesel circulation system. The "chinois" has arrived, the "Chef de Garage" and he helps fine tune things. While waiting for some new, clean diesel to arrive I strike up a conversation with the "chinois".
Then, he is about to send off someone to the pharmacy to buy him some meds. I tell him to wait as I'm a doctor, maybe I can find out what's really wrong and get him a better prescription. He gives me the classic joint pains, headache, and intermittent fevers of Malaria. I prescribe some good anti-malarials and the guys finally finish.
We head out for the last test run. I'm in the back of the pickup with one of the mechanics while the other one drives with Sarah inside. We accelerate well and fly out of Bongor back towards K�lo. About 10 km en route I sit up a little and the wind catches my glasses sending them tumbling onto the road. I bang frantically on the roof for the driver to stop. Eventually, he does and we spend the next 45 minutes walking up and down the road looking desperately for my glasses and asking everyone we pass if they've seen them. As we were leaving B�r� I remember thinking maybe I should put my contacts in my toiletries bag but decided against it since the trip was so short.
We are about to give up when a bike that had passed us a few minutes ago returns with my smashed and twisted glasses. One lens is gone but the left is still there and with a little bending I make them fit my face. We are on the road again. The car runs fine, it stalls a few times but easily starts back up. After Guelengdeng I have Sarah take over as I'm getting a headache driving with only one lens in my glasses and keeping my right eye shut.
As I enter our room in N'Djam�na at 4:30 p.m. that night my first thought is to take a shower and wash the last two days off of me. As I open my toiletries bag I find my contacts and solution somehow there. I laugh and call Sarah and we rejoice together to have the privilege of living, working, and surviving in a place like Tchad.
My neck is burned, my hands are caked with grease, and the smell of diesel clings to my plain, tan-colored Arabic robes. My mouth is parched, my lips are cracked, my nose is filled with thick, black tinged snot, and my eyes are dry.
I lean against the hood of the truck as a small crowd of kids on foot and adults on bikes alternately stares and whispers among themselves in Arabic and a variety of local languages.
Sarah has left to fill our water bottles in the little cluster of huts off to the left. It is 3pm. We left B�r� at 7:30am and Bongor at 11am. Bongor is 24km, one toll booth, and a long day filled with experiences away...
....Coming out of Bongor I start to notice a problem with power and acceleration. As we approach the toll booth outside of town, the car stalls as I clutch and brake, I pop the clutch and the truck roars to life only to die again as I try to juggle braking, hitting the gas and pulling the emergency brake to stop and pay our toll. We try in vain to start it. Finally, the toll guys give us a push through the gate and we try to start it that way, but nothing.
With my wrenches in hand, I open the hood and remove the diesel return valve bolt from the injection pump. It is filthy. I ask some of the bystanding gawkers if they have any kerosene. One guy with a shortened upper arm brings me a plastic capfull. I clean out the tiny filter with the kerosene, a match, and blowing with my own mouth. I replace the part and the car starts right up.
I'm feeling really good about myself until 5km later when the pickup finds its closest point to our destination for the day. The time is 11am. We pull up under a tiny tree providing the only shade around. A few meters ahead a "road" turns off to a school built out of woven mats. The kids are outside playing some game. A medium-sized man with a rare Tchadian paunch sidles up, his hands deep in the pockets of his pants pulled up to his belly button with a tight white tank top tucked in.
He says we need a mechanic. A classic Tchadian introduction of stating the obvious. At the same moment, he yells to a passing motorcycle driven by a blue-robed Arab with curly, nappy hair and a short moustache. He immediately starts messing around with the engine by taking off the fuel filter and hand fuel pump. He says the problem is with the hand pump. I think it's maybe the filter, which looks a little crushed.
He calls someone in town and I climb on behind. We tear off down the tarmac, the wind stinging my eyes. The thought crosses my head that if the tire blows out, or we hit a goat or something that I'm dead. I grasp a 5 liter bottle in one hand and the old filter with hand pump attached in the other. I promptly upend the filter spilling diesel all over my lap. The unchanging African plain whirs by in a blur as my eyes sting and tear from the wind and dust.
We arrive in Bongor at a little shop with different sizes and shapes of glass bottles filled with a variety of fuels out front. Inside are an assortment of car parts old, new, and used piled haphazardly on shelves and all over the floor. We buy a new filter and a new pump which is obviously a cheap imitation. We haggle out the prices and I'm not satisfied but am desperate and know I will never get the same price as a local because of my skin color. A variety of "Al salaam alekums" and "al hamdullilahs" float around as I wait for our motorcycle friend to fill up the bike for our return trip.
The return is the same except I am doubly weighted down with filters and pumps, and the 5 liter jug is now full of gasoline.
The truck has been pushed down next to the school and Sarah is playing jumping games with the now out-of-school kids. We have now been reinforced with 3 more Arabs who all seem to know a little about engines but not much. They alternately open and close things pumping furiously and often on the new hand pump. Eventually, with a push we get the car started and our "friend" drives off down a dusty side road.
A half an hour later, Sarah and I are beginning to wonder if our truck has been hijacked to help out in the coup-d'�tat effort going on in parts of Tchad and whether we'll ever see it again. One of the other Arabs comes back on his motorcycle and takes us 100 meters up the paved road where the truck has stalled again.
Finally, at 3pm they leave for Bongor to find a mechanic and I find myself leaning against the hood waiting for Sarah to come back with water. All I can think about are the watermelons in Guelengdeng just 45 km up the road where we were planning to stop for refreshment. They are the best in the world, especially on a dry, hot, dusty Tchadian day.
I glance up and see four round green objects sitting on my side of the road just 50 feet ahead. I ask the locals hanging around what they are and to my unbelieving ears hear the word "watermelon"! I immediately buy two, borrow the ever-present, razor-sharp Arab knife from a boy standing by and slice into and devour one of the sweetest, crispest watermelons I've ever eaten!
As the juice runs down my face and chin and drops on my diesel stained robes, Sarah comes back to partake in the feast.
She then says she saw some horses back in the small village and wants to go back see if they'll let her ride them.
She arrives at the edge of the village where a marriage is being celebrated with the traditional spontaneous horse races up and down the dusty path in front of the wedding site. The men are hesitant to let a mere woman get on a horse as they are sure she will fall off and kill herself on their "wild" stallions.
As she mounts expertly and then challenges them to a race, they all smile condescendingly and the women turn to smile and cheer. They've never been given the privilege of riding and so are all on Sarah's side.
It is Sarah against two Arab men. Sarah's horse has obvious Arabian blood in it, is pale white with delicate feet and with Sarah mounting up like a jockey on the short stirrups she beats them hands down, not once but twice. As she rides up to where I am waiting there is a wildness and gleam in her eyes that reminds me again of what an amazing thing it was to have met and married a girl like her in a place like this.
The mechanic comes and promptly breaks the diesel intake valve. I had been warning them all day not to touch that as I'd broken that same part last year and knew how fragile it was. He leaves, promising to send a tow truck.
I'm frustrated and mad by now. I go to talk to his associate who's stayed behind and tell him we'll just stay here in the bush tonight and they can bring us the part in the morning and put it on and we'll go from there.
He cancels the tow-truck and it's not until the darkness descends that I regret my decision. The associate says he'll flag down a car that'll pull us into Bongor for at most 5000 francs. The next truck is a tiny Peugeot piled so high with baggage and people prickling out from on top of the cargo that the bumper is almost touching the ground. They stop and the turbaned chauffeur offers to tow us for 25,000 francs. After negotiation we get it down to 10,000 francs but in my state of mind I'm so angry with the whole situation that I refuse.
I continue to regret my decisions until a tiny, old toyota car pulls up equally weighted down. A tall, commanding Arab with a goatee pulls out and finally talks sense into me that we need to go to Bongor for our own safety. He says his car is too weak to pull us, though. As I discuss with the mechanic's associate, the commanding Arab comes back and says he can't leave us stranded like that and will pull us for the same price, 10,000 francs that we refused the other truck. I accept.
We attach a cord to our bumper and to the other car with about 10 feet in between. He says that when we see his left uncovered brake light go on we should stop, as the other lights don't work. We limp into Bongor and are deposited next to the fluorescently lighted grilled chicken restaurants. Our tow man comes back to tell us he's called the chief mechanic to come meet us here himself. We pay him and he leaves.
We wait. Our tall Arab comes back to say the chief mechanic is sick but he will pull us to the garage where these other guys can help us. It is the main garage in Bongor, run by the "chinois".
I'm not reassured as a wobbly gate made of tin roofing is slid to the side revealing what looks more like a junkyard than a garage. Another dude pulls up on a moto and they replace the broken part, fiddle with some things, start up the car, and take it out for a test run. It does great!...until they return and it loses power. They say they'll come back tomorrow at 5:30am. It's now 8:30pm.
I call Pastor Job in N'Djam�na and get the local pastors phone number to see if we can stay with him. I get no reply from the local pastor but I do get his name and know he lives somewhere near the Mayor's office. The mechanic on the moto takes us to the Mayor's. We ask around and finally a group of muslims lounging on some mats under a tree point us up the road to the Adventist church.
All is dark as we pull up behind the church. We call out "Al salaam alekum" and a groggy Pastor Issa emerges in shorts and a unbuttoned jacket to welcome us. He then wakes up his kids and moves them out of their mud hut so Sarah and I can sleep there. We stay up another half hour eating cold chicken and bread Sarah had bought on arrival in Bongor and hearing stories of how our hospital came into existence and the adventures of early missionaries like Armin Krakolinig, who built our hospital and most of the Adventist churches in Tchad including this one next door here in Bongor.
Sarah and I finally crash on a thin foam pad surrounded by piles of cassette tapes, simple notebooks, and clothes hanging on a string over the bed. With no mosquito net we sleep fitfully as the malaria vectors buzz our ears all night. At 6 a.m. I am up and have to pee but can't find a latrine. We walk back to the garage with Pastor Issa as our guide.
The mechanics are already at work. We sit around eating peanut oil-flavored beans Sarah has bought just outside, and wait as they clean the fuel tank and putter around adjusting and cleaning the injectors and the rest of the diesel circulation system. The "chinois" has arrived, the "Chef de Garage" and he helps fine tune things. While waiting for some new, clean diesel to arrive I strike up a conversation with the "chinois".
Then, he is about to send off someone to the pharmacy to buy him some meds. I tell him to wait as I'm a doctor, maybe I can find out what's really wrong and get him a better prescription. He gives me the classic joint pains, headache, and intermittent fevers of Malaria. I prescribe some good anti-malarials and the guys finally finish.
We head out for the last test run. I'm in the back of the pickup with one of the mechanics while the other one drives with Sarah inside. We accelerate well and fly out of Bongor back towards K�lo. About 10 km en route I sit up a little and the wind catches my glasses sending them tumbling onto the road. I bang frantically on the roof for the driver to stop. Eventually, he does and we spend the next 45 minutes walking up and down the road looking desperately for my glasses and asking everyone we pass if they've seen them. As we were leaving B�r� I remember thinking maybe I should put my contacts in my toiletries bag but decided against it since the trip was so short.
We are about to give up when a bike that had passed us a few minutes ago returns with my smashed and twisted glasses. One lens is gone but the left is still there and with a little bending I make them fit my face. We are on the road again. The car runs fine, it stalls a few times but easily starts back up. After Guelengdeng I have Sarah take over as I'm getting a headache driving with only one lens in my glasses and keeping my right eye shut.
As I enter our room in N'Djam�na at 4:30 p.m. that night my first thought is to take a shower and wash the last two days off of me. As I open my toiletries bag I find my contacts and solution somehow there. I laugh and call Sarah and we rejoice together to have the privilege of living, working, and surviving in a place like Tchad.
Saturday, January 14, 2006
Near death experiences...
I'm staring at the old bathroom tile. On its smooth surface sit four drops of blood in the form of a T. On each has been placed a drop of a different liquid: blue, yellow and two clear. In the dim, fluorescent light I search diligently for signs of agglutination. It is a matter of life or death.
It started with a call from the nurse...
"There's the doctor from Kélo who brought someone. He wants you to see them."
I walk quickly over from the house to the hospital. It is dusk and the shadows are gathering. I hear the roar as the generator begins its nightly two-hour vigil. The fluorescent lights fight flickeringly to overcome the resistance to their illumination. I round the corner of the OR and towards the yellow light of the one bed "ER".
The nurse on duty, Hortance, points me back outside where a father sits on a crude bench holding tightly to his 7 month old son while his wife sits at his side with fear, desperatation, and hopelessness in her eyes. Dr. Assane from Kélo is standing by in street clothes, a departure from his usual stylish sport coat and unbuttoned, tie-less dress shirt.
Assane quickly explains that he went to his home village to visit relatives and found this kid on death's door. Since our hospital is closer he brought them here.
Truly, the kid is not long for this world. His eyes are rolled back. His body is limp. His respirations come in gasps. I listen to his heart which is pounding furiously and desperately. I look at his eyelids...white as snow. Anemia. Severe malaria. Our bitter daily bread and butter.
In 2005 we saw 67 patients, over 90% of whom were kids 2 years and under, die of malaria. Of those 67, 25 died of severe anemia requiring blood transfusions (hemoglobins less than 5). As depressing as that is, in all we transfused 99 patients meaning despite the desperate condition of the patient which pushed us to transfuse (using whole blood donated from a family member), we were able to save 75% who would've surely died otherwise.
This baby has the look of not even making it long enough to test his blood much less transfuse. The father gazes at me, pleading in his eyes. I tell the night watchman to go get Anatole, our lab tech.
Meanwhile, I ask Hortance to try and find an IV on the child so we can be ready if and when the blood arrives. The father places the limp child on the exam table. His head flops to one side as he continues to stare up, uncomprehending. His arms and legs are like jelly.
Anatole is not at home and he hasn't left his key. I sit there helpless watching Hortance search in vain for a vein on this tiny baby who has lost probably at least 3/4 of his red blood cells to the Plasmodium parasites. I could probably do the blood typing, I've seen Anatole do it countless times. If only I had the key, as all the equipment is safely locked in the lab.
Adam, our newest student missionary, is standing by, so I ask him to go get the bag-valve-mask so we can at least help this tired baby breathe. He returns and I place the mask over the baby's nose and mouth and start pumping in air with every effort he makes. His mom starts crying behind me.
Hortance has used up two IVs already when Anatole's son arrives with the lab key. I pass the bag-valve-mask to Adam and hurry to the lab. I open the door, flip on the light, open the armoire, find the fridge key, and pull out four bottles with droppers: A, B, AB and D. I grab two bathroom tiles, two lancets, some cotton, some alcohol prep pads, and rush back to the baby.
I prick the baby's middle finger and squeeze out a drop of blood in four different spots on the tile. Three across for A, B, and AB and one underneath B for D. I drop one blue drop for A, one yellow drop for B and one clear drop for AB and a different clear drop for D. I use the bottom of the vials to mix the drops in with the blood (since I'd forgotten to bring mixers from the lab). I start rotating the tile so the liquid will move allowing me to see if small clots form (agglutination). After two minutes nothing has formed in A, B or AB but there are agglutinations in D. Baby's blood is O positive. I prick mom's finger and repeat the process. She is O positive as well. I hope I've done it right as a mistake could cause a life threatening reaction, but desperate times call for desperate measures.
We are also out of rapid HIV tests. The only test we have takes 45 minutes to an hour. I look over at the dad. He's holding the baby as Hortance has given up trying to find an IV. He is trying to close the eyes, saying that the baby is about to die. The mom is sobbing. I make a quick decision.
One of our government lab techs, Matthieu, has just showed up. He's on strike, but I ask him a favor. He agrees and takes the mom off to draw her blood for the blood transfusion. I take the child back to the exam table. I need an IV.
Sarah has arrived and she brings me a larger IV and a 2 mL syringe. I feel the baby's femoral pulse and stick the needle in to the inside of the pulse where I know the vein should be. I pull back on the syringe looking for that quick fill of dark blood indicating I'm in the vein. I search and search. Finally, on pulling out I hit a small flash. I try to advance and it goes in. I pull out the needle and see a little blood in the catheter.
Matthieu has just arrived with the blood. Adam continues to help the baby breathe. I attach the bag of blood and it drips slowly in. I breathe a sigh of relief.
After a couple minutes, Sarah points to the groin and asks if it isn't swelling. Sure enough, the IV isn't in the vein and the blood has been going in under the skin only. I ask for another IV and try the other vein. This time I find the vein easily and with the big flash I know I'm in. I attach the blood again and open it up to go in fast.
We watch a miracle take place before our eyes. First, the floppy baby's legs start to curl up. Then, he stretches his arms straight over his head as if he were Lance Armstrong celebrating yet another Tour de France win. Then he pees straight up in the air, a glorious clear fountain telling us his internal organs are waking up now too. Then, his blank stare transforms into an intelligent sparkle as he looks around at the world he thought he'd left.
Three days, one more transfusion, 8 IV infusions of quinine, and one unbelieving family later, the little boy goes home...
It started with a call from the nurse...
"There's the doctor from Kélo who brought someone. He wants you to see them."
I walk quickly over from the house to the hospital. It is dusk and the shadows are gathering. I hear the roar as the generator begins its nightly two-hour vigil. The fluorescent lights fight flickeringly to overcome the resistance to their illumination. I round the corner of the OR and towards the yellow light of the one bed "ER".
The nurse on duty, Hortance, points me back outside where a father sits on a crude bench holding tightly to his 7 month old son while his wife sits at his side with fear, desperatation, and hopelessness in her eyes. Dr. Assane from Kélo is standing by in street clothes, a departure from his usual stylish sport coat and unbuttoned, tie-less dress shirt.
Assane quickly explains that he went to his home village to visit relatives and found this kid on death's door. Since our hospital is closer he brought them here.
Truly, the kid is not long for this world. His eyes are rolled back. His body is limp. His respirations come in gasps. I listen to his heart which is pounding furiously and desperately. I look at his eyelids...white as snow. Anemia. Severe malaria. Our bitter daily bread and butter.
In 2005 we saw 67 patients, over 90% of whom were kids 2 years and under, die of malaria. Of those 67, 25 died of severe anemia requiring blood transfusions (hemoglobins less than 5). As depressing as that is, in all we transfused 99 patients meaning despite the desperate condition of the patient which pushed us to transfuse (using whole blood donated from a family member), we were able to save 75% who would've surely died otherwise.
This baby has the look of not even making it long enough to test his blood much less transfuse. The father gazes at me, pleading in his eyes. I tell the night watchman to go get Anatole, our lab tech.
Meanwhile, I ask Hortance to try and find an IV on the child so we can be ready if and when the blood arrives. The father places the limp child on the exam table. His head flops to one side as he continues to stare up, uncomprehending. His arms and legs are like jelly.
Anatole is not at home and he hasn't left his key. I sit there helpless watching Hortance search in vain for a vein on this tiny baby who has lost probably at least 3/4 of his red blood cells to the Plasmodium parasites. I could probably do the blood typing, I've seen Anatole do it countless times. If only I had the key, as all the equipment is safely locked in the lab.
Adam, our newest student missionary, is standing by, so I ask him to go get the bag-valve-mask so we can at least help this tired baby breathe. He returns and I place the mask over the baby's nose and mouth and start pumping in air with every effort he makes. His mom starts crying behind me.
Hortance has used up two IVs already when Anatole's son arrives with the lab key. I pass the bag-valve-mask to Adam and hurry to the lab. I open the door, flip on the light, open the armoire, find the fridge key, and pull out four bottles with droppers: A, B, AB and D. I grab two bathroom tiles, two lancets, some cotton, some alcohol prep pads, and rush back to the baby.
I prick the baby's middle finger and squeeze out a drop of blood in four different spots on the tile. Three across for A, B, and AB and one underneath B for D. I drop one blue drop for A, one yellow drop for B and one clear drop for AB and a different clear drop for D. I use the bottom of the vials to mix the drops in with the blood (since I'd forgotten to bring mixers from the lab). I start rotating the tile so the liquid will move allowing me to see if small clots form (agglutination). After two minutes nothing has formed in A, B or AB but there are agglutinations in D. Baby's blood is O positive. I prick mom's finger and repeat the process. She is O positive as well. I hope I've done it right as a mistake could cause a life threatening reaction, but desperate times call for desperate measures.
We are also out of rapid HIV tests. The only test we have takes 45 minutes to an hour. I look over at the dad. He's holding the baby as Hortance has given up trying to find an IV. He is trying to close the eyes, saying that the baby is about to die. The mom is sobbing. I make a quick decision.
One of our government lab techs, Matthieu, has just showed up. He's on strike, but I ask him a favor. He agrees and takes the mom off to draw her blood for the blood transfusion. I take the child back to the exam table. I need an IV.
Sarah has arrived and she brings me a larger IV and a 2 mL syringe. I feel the baby's femoral pulse and stick the needle in to the inside of the pulse where I know the vein should be. I pull back on the syringe looking for that quick fill of dark blood indicating I'm in the vein. I search and search. Finally, on pulling out I hit a small flash. I try to advance and it goes in. I pull out the needle and see a little blood in the catheter.
Matthieu has just arrived with the blood. Adam continues to help the baby breathe. I attach the bag of blood and it drips slowly in. I breathe a sigh of relief.
After a couple minutes, Sarah points to the groin and asks if it isn't swelling. Sure enough, the IV isn't in the vein and the blood has been going in under the skin only. I ask for another IV and try the other vein. This time I find the vein easily and with the big flash I know I'm in. I attach the blood again and open it up to go in fast.
We watch a miracle take place before our eyes. First, the floppy baby's legs start to curl up. Then, he stretches his arms straight over his head as if he were Lance Armstrong celebrating yet another Tour de France win. Then he pees straight up in the air, a glorious clear fountain telling us his internal organs are waking up now too. Then, his blank stare transforms into an intelligent sparkle as he looks around at the world he thought he'd left.
Three days, one more transfusion, 8 IV infusions of quinine, and one unbelieving family later, the little boy goes home...
Friday, December 30, 2005
Never travel from Bere to Yaounde
We are 10 km from Yaound�. We left Bere Friday morning. It is Tuesday noon. I'm exhausted...which may explain what happens next. We pull up to yet another military check point.
Sarah and I are in the back seat of a Toyota minibus modified to hold 20 passengers. That means we are crammed five across on barely padded benches with not nearly enough space for my knees to fit even if I sit up straight (which is impossible due to the low ceiling). I therefore have spent the last 8 hours with my knees and legs twisted into positions I had previously thought impossible for me. I'm thinking of quitting medicine and joining the circus as Flexible Man. Despite closing the windows, everyone is lightly dusted in fine red dust highlighting eyebrows and almost shaved heads in a rich earth tone.
Since entering southern Cameroun it seems we've been stopped every 15 minutes by the military. My hand reaches automatically for our passports velcroed safely in a side pants pocket. Sure enough, a soldier swaggers up with a lazy "bonjour" slipping out of his mouth as he asks for ID papers. I present them. He scans them quickly and hands them back. At least I have nothing to hide like the last time I came up from Yaound� when I had an expired visa. I twist around a little to relieve my numb right leg when another soldier sidles up and asks for our passports. I inform him politely that we've already been checked. He takes them, anyway. After a cursory glance, he asks for our yellow vaccination cards.
I hand him mine. Sarah has left hers in Bere. I explain that it's not needed except at international borders and we've already been checked. He says that this is the border of Yaound� so we need them. This is an old Camerounian trick I've seen before. They want money to let us pass. He saunters off with our passports across the road to his buddies sitting under a tree. I am livid and so tired my normally weak inhibitions are completely obliterated. I shove open the window, crawl out, and march angrily across the street. We are in the middle of nowhere and they all have guns and are wearing military fatigues. What I do next isn't well thought out.
I storm up to the one holding the passports and start yelling at him in French explaining why it's so stupid and unnecessary to be always bothering people and trying to extort money. One of them says that I should start by greeting them or saying "bonjour". I snap out a sarcastic "bonjooouuuur" and continue my tirade. Pastor Job and the guys from the North Cameroun Mission who've been traveling with us come up and intervene. Miraculously, they let us go without any more fuss. I am wasted now not only physically but emotionally. As I crawl back into the minivan I start to have brief flashbacks of events on this trip up to this point.
Sarah, Nellie, and I are sitting on a sandy beach by the Chari River. This is the border between Bongor, Chad and Yagoua, Cameroun. There is no bridge. There are 10 or so dugout canoes pulled up on the beach with some Chadians idling around waiting to transport customers. They offered to take us across for 1000 francs each. We refuse. To cross the river in Lai--which is twice as far across--costs 250 francs. We take our backpacks off, set them on the sand and sit down to chat. It is noon. We know we need to cross but we don't want to be just give in to their exploitation of foreigners. We periodically bargain with them till the price comes down to 500 francs per person.
Sarah is hard core and says "no." We continue to sit looking at the invitingly cool water rippling past as we swelter in the midday sun. Sarah suggests swimming to amuse ourselves. Then it hits me!
"Why don't you two swim across and I'll take the bags, pay the 500 francs, and transport them across?"
They like it and start taking off their shoes and walking towards the water.
The unexpected happens! The Chadian we'd been bargaining with gets a frightened look on his face and yells not to cross that he'll take us for 250 francs each! Sarah replies that they really want to swim but he's adamant saying the current is strong, there are hippos, you are girls who don't know how to swim, etc.
Slowly it dawns on me, in Chadian culture, if something happened to one of the girls crossing, they would be responsible and they couldn't live with that. They were suddenly obliged to take us across, even if for free! We pay up and cross, feeling the cool water refresh us temporarily as we drag our hands the few hundred meters to the opposite bank.
Immediately, guys on motorcycles pull up yelling for our business. It is 7 km to Yagoua and I've been told the price for a "clando-man" is 500 francs. I waltz up to the first one and say, "Yagoua, cinq-cent francs". He agrees but then his boss runs up and says "750 francs." He refuses to give in. Sarah, as tough as ever, says "Well, we'll just walk then", grabs her backpack and starts around the corner to the immigration "office".
The "office" is in an old, abandoned carcass of a steel motor home with rickety wooden steps. Out back is a shelter made of sticks stuck in the ground with woven straw mats laid on top to provide shade.
"Al-salaam alekum," I greet as I duck into the door at the top of the stairs.
"Wa alekum al-salaam" is the reply of the camo-wearing immigration officer. I present our three passports and he signs them quickly with plenty of rubber stamps making our passports very "official" looking.
Meanwhile, Sarah has been reasoning with the "clando-men" who've followed us. They argue that gas prices have gone up (an old excuse, nothing new here). Sarah just picks up her pack and takes a few steps down the road before they laughingly call out after her "�a va, 500 francs". Sarah's a very tough customer.
The wind whips into my face, stinging my eyes and causing tears to leave a streak back across my cheeks. It's nice and cool and free-feeling to be bouncing up and down on the sandy roads riding casually on the back of the "moto". We pull quickly into town and board the first of many buses.
Several hours, much reading, quite a few frozen yogurt baggies, and we are nearing Maroua. The man next to me heard me speaking English to Sarah and asked me where we were going in broken English. I told him the Koza Adventist Hospital. It is nearing sundown, Friday evening and we hope against hope to make the last bus to Mokolo where we can catch more "motos" to Koza. He suggests getting of the bus before Maroua as the road to Mokolo shoots off there. He says we may get lucky and catch a bus there.
Suddenly, after miles of no crossroads, a road veers off to the left. My friend points. We look for a bus and see nothing until we are past the turn off when we see a tiny minivan. He motions something to me. I don't understand. He yells and the bus screeches to a halt on the side of the road. We explain and the driver grudgingly sends his assistant to the top of the bus to take our luggage down. Meanwhile, I've sent Sarah back the 100 meters to the crossroads to make sure they don't leave.
We snag our bags off the asphalt as the bus scurries away and run awkwardly back to Sarah with our backpacks swaying back and forth. They have plenty of room and leave 30 seconds after we are on board! Nous avons la chance!
Sarah and Nellie are crammed in the back next to a Camerounian girl with an MP3 player! All the people on the bus are constantly checking their cell phones and commenting on whether or not the network is present! All the while, we pass small mud brick huts, herds of goats, and kids dressed in rags waving cheerfully as we chug by spewing out rich, black diesel smoke from our tailpipe.
Shortly after dark, we enter a darkly lit, smoky little town called Mokolo. The streets are rocky and steep, built on the side of a mountain shooting out of the surrounding desert. Small shops selling a little bit of everything are harshly lit with bare fluorescent bulbs. The bus stops on the steep part of a hill and once again we are surrounded by the "clando-men".
One of them says "Docteur, we haven't seen you in a while but we've been waiting for you." Since I've never been there before I can only assume they are confusing my army style buzzed blond hair, lanky frame, and clean-shaven face for Dr. Greg Shank's thick, dark curly hair, broad shoulders, and black goateed face. After all, according to them, all white people look the same (every time we watch a movie with the Chadians they think I am the main star...�a c'est toi, James, n'est-ce pas?).
The night is cool, the stars are out, the air is dry and dusty as only can be found in a desert night, and the road is windy, rocky, and steep. Once again I am hanging on the back of a small motorcycle and I have an hour to just let my weary, wandering thoughts focus on the simple beauty and joy of being in that moment...for an hour!
Arriving in Koza, I find Greg and Audrey in surgery. A young man was stabbed by his brother multiple times. He then showed up--after half an hour in a pushcart over mountain trails--with his intestines hanging out his side, one lung collapsed, and profusely bleeding wounds down to bone on his right arm and left posterior shoulder. When we get to the OR, Greg has the belly open, has sewn up the diaphragm and is controlling the bleeding on his liver wound. A blood transfusion is up and running and I ask how I can help. I change into scrubs, put on sterile gloves, and start cleaning out and suturing his shoulder and arm wounds. A piece of skin the size of a small plate has been sliced back off his arm and has rolled up into a scrunchy little mess at the medial border of the wound. I slowly stretch it back out and over the wound after washing out and closing the muscles. I leave the lower part open to drain and an hour later we both unscrub with the boy still alive. He has a urinary catheter sticking out of his chest (improvised by Greg since no chest tubes were available), a massive bandage on his abdomen and side, and two loosely wrapped dressings on his arm and shoulder.
We all head home (except Greg who has a few rounds he wants to make) to a never-better-tasting supper of cold beans and rice. I sleep till the next afternoon when we catch the "motos" to Mokolo, the bus to Maroua and sleep that night at the Catholic mission before catching the 7 am bus to N'Gaoundere.
On that bus we meet up with Job and Wangkel from the Chad Mission and the 3 administrators from Northern Cameroun Mission. 4pm finds us in N'Gaoundere where we hit town for some fried egg sandwiches in a hole-in-the-wall place showing English League soccer and serving the best papaya drinks ever. 6pm and we are on the train for Yaounde.
I stretch out on the bunk and strip down to my shorts in anticipation of a nice long sleep overnight with the cool air rushing in as we descend on Yaounde. An hour and a half later we still haven't moved until a man tells us that the cargo train ahead of us has derailed and the train won't be leaving tonight. The president of N. Cam. Mission calls and arranges for us to sleep with the vice-president of the court of appeal! She's a strong Christian and opens up her house to us.
The next day, after avocado sandwiches, we head out to the market to search for French Christian music. The head of a local Christian radio station had come over that morning and takes us to a small boutique blaring loud Christian Nigerian praise from some huge old, speakers with the bass totally shot.
We are supposed to catch the noon bus for Yaound� but our host says not to worry as she knows the owner and has told him to wait for us as long as it takes. Here in Africa, it's all about who you know!
11 hours and two buses later we find ourselves in Bertoua. We pull off the main route, around a corner, and into a small, poorly-lit courtyard with several other buses. A guy comes running up yelling "Yaound�! Yaound�" and tells us to put our bags over on a bus right next to ours. It's a tiny mini-bus. We unload and quickly reload our packs. The first bus drives off and soon we look around to find the place empty except for us and a few other passengers. We've been abandoned.
I sit on a bench. Then I get hungry. I walk out with Sarah to the street. We sit on a crude wooden bench in front of a table covered with different feast-preparing items. In one corner is a pile of French bread. Scattered across the table are piles of avocados, old tin plates, a cup full of random silverware, a cardboard egg crate half full of brown eggs, and a spatula. Underneath and behind is a metal can with some coals in it and a frying pan sizzling over it with the fresh smell of "fried" wafting across the cool night air.
Sarah has just bought some freshly baked French baguettes from a bakery that happens to be just at the back of the bus stop and we order egg and avocado sandwiches. Nothing has ever hit the spot like those sandwiches. The smell of charcoal mixed with muddy, African street odor and the sounds of frying, scraping, shuffling, distant shouting and the occasional roaring of a passing diesel cannot be described, only experienced.
My belly full, I pry open the window of one of the abandoned buses, crawl through and stretch out on a seat until Sarah wakes me at 2:30 am to cram into the back of a tiny minibus and bounce around over unpaved, red-dust covered mountain roads until 10:00 the next morning when we find ourselves 10 km from Yaounde at the last of many police check points...
Sarah and I are in the back seat of a Toyota minibus modified to hold 20 passengers. That means we are crammed five across on barely padded benches with not nearly enough space for my knees to fit even if I sit up straight (which is impossible due to the low ceiling). I therefore have spent the last 8 hours with my knees and legs twisted into positions I had previously thought impossible for me. I'm thinking of quitting medicine and joining the circus as Flexible Man. Despite closing the windows, everyone is lightly dusted in fine red dust highlighting eyebrows and almost shaved heads in a rich earth tone.
Since entering southern Cameroun it seems we've been stopped every 15 minutes by the military. My hand reaches automatically for our passports velcroed safely in a side pants pocket. Sure enough, a soldier swaggers up with a lazy "bonjour" slipping out of his mouth as he asks for ID papers. I present them. He scans them quickly and hands them back. At least I have nothing to hide like the last time I came up from Yaound� when I had an expired visa. I twist around a little to relieve my numb right leg when another soldier sidles up and asks for our passports. I inform him politely that we've already been checked. He takes them, anyway. After a cursory glance, he asks for our yellow vaccination cards.
I hand him mine. Sarah has left hers in Bere. I explain that it's not needed except at international borders and we've already been checked. He says that this is the border of Yaound� so we need them. This is an old Camerounian trick I've seen before. They want money to let us pass. He saunters off with our passports across the road to his buddies sitting under a tree. I am livid and so tired my normally weak inhibitions are completely obliterated. I shove open the window, crawl out, and march angrily across the street. We are in the middle of nowhere and they all have guns and are wearing military fatigues. What I do next isn't well thought out.
I storm up to the one holding the passports and start yelling at him in French explaining why it's so stupid and unnecessary to be always bothering people and trying to extort money. One of them says that I should start by greeting them or saying "bonjour". I snap out a sarcastic "bonjooouuuur" and continue my tirade. Pastor Job and the guys from the North Cameroun Mission who've been traveling with us come up and intervene. Miraculously, they let us go without any more fuss. I am wasted now not only physically but emotionally. As I crawl back into the minivan I start to have brief flashbacks of events on this trip up to this point.
Sarah, Nellie, and I are sitting on a sandy beach by the Chari River. This is the border between Bongor, Chad and Yagoua, Cameroun. There is no bridge. There are 10 or so dugout canoes pulled up on the beach with some Chadians idling around waiting to transport customers. They offered to take us across for 1000 francs each. We refuse. To cross the river in Lai--which is twice as far across--costs 250 francs. We take our backpacks off, set them on the sand and sit down to chat. It is noon. We know we need to cross but we don't want to be just give in to their exploitation of foreigners. We periodically bargain with them till the price comes down to 500 francs per person.
Sarah is hard core and says "no." We continue to sit looking at the invitingly cool water rippling past as we swelter in the midday sun. Sarah suggests swimming to amuse ourselves. Then it hits me!
"Why don't you two swim across and I'll take the bags, pay the 500 francs, and transport them across?"
They like it and start taking off their shoes and walking towards the water.
The unexpected happens! The Chadian we'd been bargaining with gets a frightened look on his face and yells not to cross that he'll take us for 250 francs each! Sarah replies that they really want to swim but he's adamant saying the current is strong, there are hippos, you are girls who don't know how to swim, etc.
Slowly it dawns on me, in Chadian culture, if something happened to one of the girls crossing, they would be responsible and they couldn't live with that. They were suddenly obliged to take us across, even if for free! We pay up and cross, feeling the cool water refresh us temporarily as we drag our hands the few hundred meters to the opposite bank.
Immediately, guys on motorcycles pull up yelling for our business. It is 7 km to Yagoua and I've been told the price for a "clando-man" is 500 francs. I waltz up to the first one and say, "Yagoua, cinq-cent francs". He agrees but then his boss runs up and says "750 francs." He refuses to give in. Sarah, as tough as ever, says "Well, we'll just walk then", grabs her backpack and starts around the corner to the immigration "office".
The "office" is in an old, abandoned carcass of a steel motor home with rickety wooden steps. Out back is a shelter made of sticks stuck in the ground with woven straw mats laid on top to provide shade.
"Al-salaam alekum," I greet as I duck into the door at the top of the stairs.
"Wa alekum al-salaam" is the reply of the camo-wearing immigration officer. I present our three passports and he signs them quickly with plenty of rubber stamps making our passports very "official" looking.
Meanwhile, Sarah has been reasoning with the "clando-men" who've followed us. They argue that gas prices have gone up (an old excuse, nothing new here). Sarah just picks up her pack and takes a few steps down the road before they laughingly call out after her "�a va, 500 francs". Sarah's a very tough customer.
The wind whips into my face, stinging my eyes and causing tears to leave a streak back across my cheeks. It's nice and cool and free-feeling to be bouncing up and down on the sandy roads riding casually on the back of the "moto". We pull quickly into town and board the first of many buses.
Several hours, much reading, quite a few frozen yogurt baggies, and we are nearing Maroua. The man next to me heard me speaking English to Sarah and asked me where we were going in broken English. I told him the Koza Adventist Hospital. It is nearing sundown, Friday evening and we hope against hope to make the last bus to Mokolo where we can catch more "motos" to Koza. He suggests getting of the bus before Maroua as the road to Mokolo shoots off there. He says we may get lucky and catch a bus there.
Suddenly, after miles of no crossroads, a road veers off to the left. My friend points. We look for a bus and see nothing until we are past the turn off when we see a tiny minivan. He motions something to me. I don't understand. He yells and the bus screeches to a halt on the side of the road. We explain and the driver grudgingly sends his assistant to the top of the bus to take our luggage down. Meanwhile, I've sent Sarah back the 100 meters to the crossroads to make sure they don't leave.
We snag our bags off the asphalt as the bus scurries away and run awkwardly back to Sarah with our backpacks swaying back and forth. They have plenty of room and leave 30 seconds after we are on board! Nous avons la chance!
Sarah and Nellie are crammed in the back next to a Camerounian girl with an MP3 player! All the people on the bus are constantly checking their cell phones and commenting on whether or not the network is present! All the while, we pass small mud brick huts, herds of goats, and kids dressed in rags waving cheerfully as we chug by spewing out rich, black diesel smoke from our tailpipe.
Shortly after dark, we enter a darkly lit, smoky little town called Mokolo. The streets are rocky and steep, built on the side of a mountain shooting out of the surrounding desert. Small shops selling a little bit of everything are harshly lit with bare fluorescent bulbs. The bus stops on the steep part of a hill and once again we are surrounded by the "clando-men".
One of them says "Docteur, we haven't seen you in a while but we've been waiting for you." Since I've never been there before I can only assume they are confusing my army style buzzed blond hair, lanky frame, and clean-shaven face for Dr. Greg Shank's thick, dark curly hair, broad shoulders, and black goateed face. After all, according to them, all white people look the same (every time we watch a movie with the Chadians they think I am the main star...�a c'est toi, James, n'est-ce pas?).
The night is cool, the stars are out, the air is dry and dusty as only can be found in a desert night, and the road is windy, rocky, and steep. Once again I am hanging on the back of a small motorcycle and I have an hour to just let my weary, wandering thoughts focus on the simple beauty and joy of being in that moment...for an hour!
Arriving in Koza, I find Greg and Audrey in surgery. A young man was stabbed by his brother multiple times. He then showed up--after half an hour in a pushcart over mountain trails--with his intestines hanging out his side, one lung collapsed, and profusely bleeding wounds down to bone on his right arm and left posterior shoulder. When we get to the OR, Greg has the belly open, has sewn up the diaphragm and is controlling the bleeding on his liver wound. A blood transfusion is up and running and I ask how I can help. I change into scrubs, put on sterile gloves, and start cleaning out and suturing his shoulder and arm wounds. A piece of skin the size of a small plate has been sliced back off his arm and has rolled up into a scrunchy little mess at the medial border of the wound. I slowly stretch it back out and over the wound after washing out and closing the muscles. I leave the lower part open to drain and an hour later we both unscrub with the boy still alive. He has a urinary catheter sticking out of his chest (improvised by Greg since no chest tubes were available), a massive bandage on his abdomen and side, and two loosely wrapped dressings on his arm and shoulder.
We all head home (except Greg who has a few rounds he wants to make) to a never-better-tasting supper of cold beans and rice. I sleep till the next afternoon when we catch the "motos" to Mokolo, the bus to Maroua and sleep that night at the Catholic mission before catching the 7 am bus to N'Gaoundere.
On that bus we meet up with Job and Wangkel from the Chad Mission and the 3 administrators from Northern Cameroun Mission. 4pm finds us in N'Gaoundere where we hit town for some fried egg sandwiches in a hole-in-the-wall place showing English League soccer and serving the best papaya drinks ever. 6pm and we are on the train for Yaounde.
I stretch out on the bunk and strip down to my shorts in anticipation of a nice long sleep overnight with the cool air rushing in as we descend on Yaounde. An hour and a half later we still haven't moved until a man tells us that the cargo train ahead of us has derailed and the train won't be leaving tonight. The president of N. Cam. Mission calls and arranges for us to sleep with the vice-president of the court of appeal! She's a strong Christian and opens up her house to us.
The next day, after avocado sandwiches, we head out to the market to search for French Christian music. The head of a local Christian radio station had come over that morning and takes us to a small boutique blaring loud Christian Nigerian praise from some huge old, speakers with the bass totally shot.
We are supposed to catch the noon bus for Yaound� but our host says not to worry as she knows the owner and has told him to wait for us as long as it takes. Here in Africa, it's all about who you know!
11 hours and two buses later we find ourselves in Bertoua. We pull off the main route, around a corner, and into a small, poorly-lit courtyard with several other buses. A guy comes running up yelling "Yaound�! Yaound�" and tells us to put our bags over on a bus right next to ours. It's a tiny mini-bus. We unload and quickly reload our packs. The first bus drives off and soon we look around to find the place empty except for us and a few other passengers. We've been abandoned.
I sit on a bench. Then I get hungry. I walk out with Sarah to the street. We sit on a crude wooden bench in front of a table covered with different feast-preparing items. In one corner is a pile of French bread. Scattered across the table are piles of avocados, old tin plates, a cup full of random silverware, a cardboard egg crate half full of brown eggs, and a spatula. Underneath and behind is a metal can with some coals in it and a frying pan sizzling over it with the fresh smell of "fried" wafting across the cool night air.
Sarah has just bought some freshly baked French baguettes from a bakery that happens to be just at the back of the bus stop and we order egg and avocado sandwiches. Nothing has ever hit the spot like those sandwiches. The smell of charcoal mixed with muddy, African street odor and the sounds of frying, scraping, shuffling, distant shouting and the occasional roaring of a passing diesel cannot be described, only experienced.
My belly full, I pry open the window of one of the abandoned buses, crawl through and stretch out on a seat until Sarah wakes me at 2:30 am to cram into the back of a tiny minibus and bounce around over unpaved, red-dust covered mountain roads until 10:00 the next morning when we find ourselves 10 km from Yaounde at the last of many police check points...
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