It feels good to be on the road again. I never thought that a trip to N'Djamena would be something to look forward to, especially without my own car. However, after practically never leaving the hospital in the month I've been back in Tchad, it's good to be going anywhere.
Besides, it's a relatively cool morning, the desert is starting to be transformed into the green, African Sahel and I'm on the back of a moto with the wind blasting my face bringing tears to my eyes. The humid, fragrant smell of freshly rained on earth and grass rushes into my brain bringing back memories of calmer times.
Sarah and I are accompanying our Swiss volunteer, Esther, to the airport and then hope to bring back enough medicines and supplies to make it through the rainy season when the road to Bere gets really bad. Esther was the first to be off, followed by Sarah. They are no where in sight.
The overcast sky starts to lift as a few rays of sun pierce the clouds. The red clay road already has a few mudholes that the moto taxi man zigzags through like a professional slalom skier. It seems that my driver is a little more aggressive than most but I notice that we seem to be accelerating even more than usual. We skirt the potholes and dodge the goats, chickens, bikes, kids and women carrying goods to market on their heads. Our speed steadily increases.
I'm trying not to worry or think about what will happen to my helmetless head if we slip in the slimy clay or hit a hole or something worse. We go faster and faster. I notice the taxi man fiddling with a cable coming out of the handlebar. It hits me: the accelerator is stuck. He wiggles, pushes, twists and turns the cable as our velocity steadily increases. I now truly feel like I'm in the Olympic downhill as we caroum at ever increasing angles in our now deadly slalom course.
At about the same moment as I ask myself why he doesn't just turn the engine off I see him reach for the ignition. My gase follows his hand to where the key should be, but isn't. Apparently, the bouncing of the dirt road has shook the key out of the ignition and it is flapping in the breeze attached to the handlebar by a cell phone SIM card and a small wire.
We aren't slowing down.
All my hopes rest on the coordination of this stranger as the key places keep away from his desperately grasping fingers. Finally, he has it. Now, as he continues his slalom moves with one hand, he plays target practice with his other trying to fit the key into the jiggling, wiggling, shaking ignition.
The key enters, and is quickly turned to off. The moto slowly decreases it's velocity as we cruise around the mudholes and finally come to rest, like Noah's ark after the flood, on the side of the road.
My taxi man apparently is also a "mechanic". He pulls off a makeshift, crudely welded tool, uses his hand as a hammer and hits the tool against the cover of where the accelerator cable enters the engine until it slowly unscrews. He fiddles with the cable that had some gunk in it keeping it from releasing. When he's satisfied it's back to "normal" we get back on and continue on our way.
Now, I'm starting to feel the uncomfortableness of wearing a heavy backpack that is forced up onto my shoulder blades by Esther's hard suitcase that has been strapped vertically on the back of the moto with some strips of old innertube.
About 8 km from Kelo, 35 km from Bere, the back wheel starts to make some serious grinding noises. We stop again. The bearing is shot. So, we get back on and start to move forward at about 10km/hour. It feels and sounds as if the wheel could fall off at any time.
3 km from Kelo, we run out of gas. Coincidentally it seems, at the same time I notice that all the clouds have disappeared, the sun has moved higher in the sky, the humidity has increased and I'm starting to seriously sweat.
Even before we start to push the moto the last three kilometers to Kelo.
Despite the weight of the moto and the grinding of the back wheel, we still manage to pass a lot of people on foot. My hands grip the top of the suitcase and my thighs start to burn. As the women whisper and giggle to see a tall, skinny white dude passing them pushing a moto (they are easily entertained), I start to wonder if my out of shape body will make it the three kilometers.
Miraculously, 45 minutes (it seemed like hours) later we arrive on the outskirts of Kelo.
My guy calls another moto taxi over and he says he'll take my across town for 500 FCFA. I laugh and tell him I didn't just arrive here yesterday. I'd already agreed to pay 3000 francs to go to the bus station (such as it is) and if my moto can't make it then it's up to my taxi man to arrange other transport. The crowd that has gathered (as it usually does around unusual and interesting things like a white person) laughs in approval and the two taxi men smile begrudgingly and work it out amongst themselves.
Finally, I arrive at Kelo, 43 painful kilometers later, and just the beginning of my journey to the grand capital of Tchad.
Wednesday, June 27, 2007
Sunday, June 10, 2007
Sight to the Blind
The wizened little arab grandpa has already been in the hospital for awhile. He arrived at the end of my vacation and was operated on for a hydrocele then rehospitalized for a urinary infection with urinary retention. He has come back now after being sent home with urinary retention again. I found he had an enlarged prostate and scheduled him for surgery tomorrow.
I approach his bed in the semidarkness of an overcast day. There are no lights without the generator. At his side is another old arab with a gap toothed smile revealing teeth pointing in all four directions of the compass and then some. Another elderly, robed muslim hangs out quietly in the corner next to a middle aged woman ("middle-aged" through a tough life rather then by length of years) wearing a brightly colored green dress with poofy sleeves and a shawl draped lazily over her head covering the small leather fetish pouches dangling haphazardly from a thick leather cord around her neck. She is breast feeding the child cradled absentmindedly in her right arm.
"Al salaam alekum" I start the long greeting process.
When we have finished they tell me that suddenly, last night, he became totally blind and has been vomiting since yesterday despite his intravenous malaria treatment. I examine him and he is completely blind.
I can think of no medical explanation for it but plenty of spiritual ones.
"Ibliss or one of his angels has blinded him." I explain that only through praying to Allah, the one true God can he be healed.
They all nod expectantly and gather around with hands outstretched, palms up expecting the baraka of Allah. I pray in the same way with my arms and hands in the appropriate position.
As I finish they all smile and demonstrate a faith I can only marvel in. They have complete confidence now that Allah's will will be done.
None of us are surprised the next morning to come and find his vision completely restored. They all just smile, hold their hands out while looking up and saying "Praise be to Allah."
I approach his bed in the semidarkness of an overcast day. There are no lights without the generator. At his side is another old arab with a gap toothed smile revealing teeth pointing in all four directions of the compass and then some. Another elderly, robed muslim hangs out quietly in the corner next to a middle aged woman ("middle-aged" through a tough life rather then by length of years) wearing a brightly colored green dress with poofy sleeves and a shawl draped lazily over her head covering the small leather fetish pouches dangling haphazardly from a thick leather cord around her neck. She is breast feeding the child cradled absentmindedly in her right arm.
"Al salaam alekum" I start the long greeting process.
When we have finished they tell me that suddenly, last night, he became totally blind and has been vomiting since yesterday despite his intravenous malaria treatment. I examine him and he is completely blind.
I can think of no medical explanation for it but plenty of spiritual ones.
"Ibliss or one of his angels has blinded him." I explain that only through praying to Allah, the one true God can he be healed.
They all nod expectantly and gather around with hands outstretched, palms up expecting the baraka of Allah. I pray in the same way with my arms and hands in the appropriate position.
As I finish they all smile and demonstrate a faith I can only marvel in. They have complete confidence now that Allah's will will be done.
None of us are surprised the next morning to come and find his vision completely restored. They all just smile, hold their hands out while looking up and saying "Praise be to Allah."
Sunday, May 27, 2007
Crash
The hot air blasts up to smack me in the face like a Danish sauna as I step out the door onto the runway in N'Djaména. Two months have flown by as Sarah and I trekked across Europe from Paris to Denmark to Portugal and then all across the US from California to Florida to Tennessee. We're back in Tchad, refreshed and not quite prepared for the crushing news soon to be unleashed upon us.
We clear customs without any difficulty, Job and Aime are waiting outside to take us to the mission house at AIM. We stop on the porch to chat and Sarah asks when Israel, Paul and Dr. Bond will be up with the truck so we can take the road to Bere.
Job has seemed strangely distant all evening and now his face exudes his anguish as he tells us the story that he didn't want to dump on us our first night back but now has to.
"The truck won't be coming for you...you see, there's been an accident..."
I don't hear the rest of the story till the next evening when I find myself sitting next to Sarah on a mat outside of the hospital ward in Pala where Pierre, Noel and many family members have come to grieve, console and encourage our administrator, Andre, who lies inside still a little wobbly, with bandages on his right temple and ear. Next to him is his mother-in-law and our former accountants daughter...the only survivors.
As I sit next to Job, Pierre and Noel the pieces of the story that Job only new part of that first night in N'Djamena begin to unravel themselves.
Last Saturday (before our arrival in Tchad), Sarah and I were chatting with some friends from Africa in the comfort of my cousin's house in Chattanooga, Tennessee, USA. Meanwhile, in Béré, Noel, André and the rest were preparing to leave church when a raging man broke in violently and tried to attack our chaplain. Before he could reach Noel, he was restrained and Noel was quickly ushered into a back room. The man was identified as the son of one of our janitors and was finally convinced to return home. Noel continued on to the hospital to see the patients and was followed by this man. When it was seen that he was heading for the hospital, the gatekeeper quickly locked the gate and Noel hid inside. The man jumped the fence, now armed with a knife. As he ran around hunting for Noel, the hospitalized patients' caregivers fought him off with sticks, brooms, and anything else they could get their hands on to keep him away from Noel. Finally, Andre was able to contact the gendarmes who came and subdued him, but not before he had stabbed and destroyed one of the two air conditioners in the operating rooms (the only two on campus and necessary for surgery in this hot climate). The man was taken to prison where he struggled so hard he managed to break one of their doors before finally being locked up.
That same day, it is discovered that our Accountant, Ganota, who we'd just fired for embezzeling, has managed to sneak into the garage and steal five bicycles, several large cooking pots and a generator. Somehow, he'd broken in the back door and little by little been carrying things off. We onlyfound out because these items were left by patients as collatoral for their hospital debts and one came back to reclaim his bike only to find it wasn't there. Andre and Pierre were able to go to the market and find that that very day Ganota had packed all the stuff up to ship to his home town of Lere and they were able to recover all the lost items. A warrant was immediately put out on Ganota who managed to slip through the fingers of the gendarmes. Ganota's wife immediately began to pack up to return to Lere herself to be with her relatives.
Monday, Sarah and I headed back down to Florida with my parents and my sister Chelsey. The van is pulling a U-Haul trailer with my sisters' college stuff to take back home. 20 minutes out of Chattanooga, Chelsey hears a noise from the back tire. We stop and don't see anything. When it continues, we are forced to find a mechanic who takes the whole wheel off and declares there is nothing wrong. We continue on our way, but with eyes and ears peeled, our nerves sharpened.
A woman passes us in a car waving her hands and pointing at the trailer, indicating there's something wrong. Dad hesitates. We've had one false warning already. Chelsey looks back and says the trailer's wheel is wobbling. I tell Dad to pull over at once, it won't hurt to look. We slow down quickly and move over through traffic to the side of the road. Not a moment to soon we find out as we examine the trailer. The bearing has completely disintegrated and the axel has pulled out almost completely from the wheel leaving just a centimeter of axel holding the wheel on. When the police arrive, we are unable to move more than 50 feet down the side of the road at a crawl pace before having to stop because the wheel is falling off. We got of the road not a second too soon. As the officer explains, if the wheel had fallen off, the trailer would've fishtailed causing it to flip taking the van with it. At 75 mph and a crowded interstate it would've been a lot of funerals to attend.
Meanwhile, back in Bere, Andre has agreed to give Ganota's wife a lift to the nearby town of Kelo where she has arranged for some relatives to send her some money. Arriving in Kelo, she finds that Ganota has proceeded her and somehow, despite Andre's advance warning to the relatives, managed to con the money from them. Right before leaving Béré, André asked his niece to accompany him with his two year old son so he wouldn't have to return from Kelo alone. His mother-in-law and Ganota's daughter are also in the truck. André decides he can't abandon Ganota's wife who, with all her belongings, doesn't have enough money to take public transport all the way to Lere. Andre decides to drive them all to Pala, half-way to Lere.
On the outskirts of Pala is a notorious stretch of road where in the last year, unbeknowst to Andre, five vehicules have crashed. The dirt road, through a series of natural events such as wind, rain, composition of the road, gravity and incline has collaborated together to make a "washboard" road. If one goes too slow or too fast, there is no problem. But when onegoes average speed, say 35-45 mph (50-60 km/h), the tires hit the tiny ridges at just the right velocity to skip across them causing one to lose traction and experience what drivers from rainy and icy countries know as "hydroplaining".
As Andre hits the stretch of road, suddenly, without warning the car starts to slide and he loses control. Instinctively, he tries to brake resulting in locked wheels which, according to police reports, skid 31 meters veering to the right off the road. When he hits the ditch at the side, the car turns on it's right side just in time to collide with all it's forward momentum into a hugh tree trunk. The roof takes the brunt of the force and is smashed to within inches of the bottom of the back seats, tearing the metal supports on both sides of the windshield off. Andre slams forward bending the steering wheel 45 degrees with his chest and taking the windshield on the head. He is knocked unconscious. His mother-in-law in the front seat suffers a similar fate. In the back seat, Andre's niece and his son are killed instantly. Ganota's wife manages to open her eyes and say a few words to those who quickly pulled everyone from the car before dying. Ganota's daughter miraculously survives even though being in the completely compressed back seat. She has minimal lacerations on her scalp and some bumps and bruises.
The car is virtually unrecognizable despite having no damage to either tires, wheels, chassis or motor. However, the extensive damage to the cabin is sobering as one realizes that no one should have survived that accident.
After hearing the news from Job that first night in N'Djaména sleep comes difficultly. I toss and turn only to wake up early. We are forced to take public transport. Job accompanies us. We arrive at the chaotic Dembe market and find a mini-van filled with people with a loaded rack apparently ready to leave. Blessing our good fortune we pay up and sit down to wait for the "one other passenger" that they need in order to leave. After 15 minutes, the people start to get out of the van until it is empty. Then, they start to unload some suspicously light sacks until there is virtually nothing on top. We have been duped and are forced to wait an hour and a half until they really find enough passengers. By this time, it's already after 2pm and we have a long journey ahead of us.
On the way down, Sarah and I are crammed in the very back seat. My seat has no back, only the rear window to rest my head against. We share the seat with a Chadian woman and her shy child who plays incessently with a noise-making toy cell-phone. Sarah tries to discourage him by poking him every time the cell phone makes a sound. It doesn't work.
In front of us, as the journey progresses, I watch unfold one of the most unusual and astounding things I have seen in my three plus years in Chad: plublic affection between a man and wife. I am mesmerized by their intimacy. They actually seem to enjoy each others company leaning their heads in closely to share secrets. Her arm rests lovingly on his shoulder. He casually loops his arm around hers. As night approaches, their heads lean in and touch as they alternately rest and share intimate moments in their own little world. She has the traditional muslim head covering and he, while not dressed in Arabic robes, is obviously a firm believer as he steps out to pray with the others as the van takes breaks at all the appropriate prayer times.
In order to appreciate the magnitude of this, one has to have lived in Africa and seen the total separation of the sexes. Men and women eat apart, socialize only with their own gender and come together only in private for making children. One may see gruff soldiers walking down the street hand in hand all the time but rarely will one see a girl and boy or man and woman making even this most minimal of public gestures of affection. One time, before a trip that Sarah was making, as I was huggingher good bye I saw that Pierre and his wife had arrived. Pierre was going to accompany Sarah, so to tease him I told him, "Pierré, this is how we say 'au revoir' in my culture." He replied that it was a good custom and he was willing to try it. As he moved toward his wife, she began to laugh nervously and quickly got up and moved rapidly out of reach. Pierré would have to wait for another day to try that new cultural experience!
We arrive late in Kelo and have to wait another hour for the bus to Pala. We finally leave a little after 10pm only to be stopped by the gendarmes at the exit of the village. The barrier is down and they say that no one can travel after 10pm so we might as well just settle down and sleep till morning. The driver turns off the van and everyone sits there stunned. I feel a little nervous, but decide I should try something.
I cautiously approach the machine gun toting soldiers in the dark and greet them. I introduce myself as the doctor from the Béré hospital just down the road. I explain the situation with Andre and the accident and how I'd like to see him tonight so I can return to Bere in the morning. Otherwise, I point out, the hospital will be without a doctor. Oh, and I heard there's a national strike going on and the Kelo hospital is closed. Wouldn't that be tragic if one of your relatives got sick, decided to go the the only hospital around that's open (in Béré) and find that there wasn't a doctor there? I wonder if there's anyway they can help us. They tell me to come over and sit on the bench with them. I get up from where I'd been squatting on the ground in front of them and sit down. They call up their superior and explain the situation. After a few minutes, they call over the driver and tell him to get his passengers in and get on the road. We make it to Pala a little after midnight where, after my enlightening conversation with Pierre, Job and Noel I find myself lying on a woven mat on the ground with the mosquitos buzzing around and no lights on in the entire hospital thinking that only 36 hours ago I was in Paris.
C'est la vie au Tchad!
James
We clear customs without any difficulty, Job and Aime are waiting outside to take us to the mission house at AIM. We stop on the porch to chat and Sarah asks when Israel, Paul and Dr. Bond will be up with the truck so we can take the road to Bere.
Job has seemed strangely distant all evening and now his face exudes his anguish as he tells us the story that he didn't want to dump on us our first night back but now has to.
"The truck won't be coming for you...you see, there's been an accident..."
I don't hear the rest of the story till the next evening when I find myself sitting next to Sarah on a mat outside of the hospital ward in Pala where Pierre, Noel and many family members have come to grieve, console and encourage our administrator, Andre, who lies inside still a little wobbly, with bandages on his right temple and ear. Next to him is his mother-in-law and our former accountants daughter...the only survivors.
As I sit next to Job, Pierre and Noel the pieces of the story that Job only new part of that first night in N'Djamena begin to unravel themselves.
Last Saturday (before our arrival in Tchad), Sarah and I were chatting with some friends from Africa in the comfort of my cousin's house in Chattanooga, Tennessee, USA. Meanwhile, in Béré, Noel, André and the rest were preparing to leave church when a raging man broke in violently and tried to attack our chaplain. Before he could reach Noel, he was restrained and Noel was quickly ushered into a back room. The man was identified as the son of one of our janitors and was finally convinced to return home. Noel continued on to the hospital to see the patients and was followed by this man. When it was seen that he was heading for the hospital, the gatekeeper quickly locked the gate and Noel hid inside. The man jumped the fence, now armed with a knife. As he ran around hunting for Noel, the hospitalized patients' caregivers fought him off with sticks, brooms, and anything else they could get their hands on to keep him away from Noel. Finally, Andre was able to contact the gendarmes who came and subdued him, but not before he had stabbed and destroyed one of the two air conditioners in the operating rooms (the only two on campus and necessary for surgery in this hot climate). The man was taken to prison where he struggled so hard he managed to break one of their doors before finally being locked up.
That same day, it is discovered that our Accountant, Ganota, who we'd just fired for embezzeling, has managed to sneak into the garage and steal five bicycles, several large cooking pots and a generator. Somehow, he'd broken in the back door and little by little been carrying things off. We onlyfound out because these items were left by patients as collatoral for their hospital debts and one came back to reclaim his bike only to find it wasn't there. Andre and Pierre were able to go to the market and find that that very day Ganota had packed all the stuff up to ship to his home town of Lere and they were able to recover all the lost items. A warrant was immediately put out on Ganota who managed to slip through the fingers of the gendarmes. Ganota's wife immediately began to pack up to return to Lere herself to be with her relatives.
Monday, Sarah and I headed back down to Florida with my parents and my sister Chelsey. The van is pulling a U-Haul trailer with my sisters' college stuff to take back home. 20 minutes out of Chattanooga, Chelsey hears a noise from the back tire. We stop and don't see anything. When it continues, we are forced to find a mechanic who takes the whole wheel off and declares there is nothing wrong. We continue on our way, but with eyes and ears peeled, our nerves sharpened.
A woman passes us in a car waving her hands and pointing at the trailer, indicating there's something wrong. Dad hesitates. We've had one false warning already. Chelsey looks back and says the trailer's wheel is wobbling. I tell Dad to pull over at once, it won't hurt to look. We slow down quickly and move over through traffic to the side of the road. Not a moment to soon we find out as we examine the trailer. The bearing has completely disintegrated and the axel has pulled out almost completely from the wheel leaving just a centimeter of axel holding the wheel on. When the police arrive, we are unable to move more than 50 feet down the side of the road at a crawl pace before having to stop because the wheel is falling off. We got of the road not a second too soon. As the officer explains, if the wheel had fallen off, the trailer would've fishtailed causing it to flip taking the van with it. At 75 mph and a crowded interstate it would've been a lot of funerals to attend.
Meanwhile, back in Bere, Andre has agreed to give Ganota's wife a lift to the nearby town of Kelo where she has arranged for some relatives to send her some money. Arriving in Kelo, she finds that Ganota has proceeded her and somehow, despite Andre's advance warning to the relatives, managed to con the money from them. Right before leaving Béré, André asked his niece to accompany him with his two year old son so he wouldn't have to return from Kelo alone. His mother-in-law and Ganota's daughter are also in the truck. André decides he can't abandon Ganota's wife who, with all her belongings, doesn't have enough money to take public transport all the way to Lere. Andre decides to drive them all to Pala, half-way to Lere.
On the outskirts of Pala is a notorious stretch of road where in the last year, unbeknowst to Andre, five vehicules have crashed. The dirt road, through a series of natural events such as wind, rain, composition of the road, gravity and incline has collaborated together to make a "washboard" road. If one goes too slow or too fast, there is no problem. But when onegoes average speed, say 35-45 mph (50-60 km/h), the tires hit the tiny ridges at just the right velocity to skip across them causing one to lose traction and experience what drivers from rainy and icy countries know as "hydroplaining".
As Andre hits the stretch of road, suddenly, without warning the car starts to slide and he loses control. Instinctively, he tries to brake resulting in locked wheels which, according to police reports, skid 31 meters veering to the right off the road. When he hits the ditch at the side, the car turns on it's right side just in time to collide with all it's forward momentum into a hugh tree trunk. The roof takes the brunt of the force and is smashed to within inches of the bottom of the back seats, tearing the metal supports on both sides of the windshield off. Andre slams forward bending the steering wheel 45 degrees with his chest and taking the windshield on the head. He is knocked unconscious. His mother-in-law in the front seat suffers a similar fate. In the back seat, Andre's niece and his son are killed instantly. Ganota's wife manages to open her eyes and say a few words to those who quickly pulled everyone from the car before dying. Ganota's daughter miraculously survives even though being in the completely compressed back seat. She has minimal lacerations on her scalp and some bumps and bruises.
The car is virtually unrecognizable despite having no damage to either tires, wheels, chassis or motor. However, the extensive damage to the cabin is sobering as one realizes that no one should have survived that accident.
After hearing the news from Job that first night in N'Djaména sleep comes difficultly. I toss and turn only to wake up early. We are forced to take public transport. Job accompanies us. We arrive at the chaotic Dembe market and find a mini-van filled with people with a loaded rack apparently ready to leave. Blessing our good fortune we pay up and sit down to wait for the "one other passenger" that they need in order to leave. After 15 minutes, the people start to get out of the van until it is empty. Then, they start to unload some suspicously light sacks until there is virtually nothing on top. We have been duped and are forced to wait an hour and a half until they really find enough passengers. By this time, it's already after 2pm and we have a long journey ahead of us.
On the way down, Sarah and I are crammed in the very back seat. My seat has no back, only the rear window to rest my head against. We share the seat with a Chadian woman and her shy child who plays incessently with a noise-making toy cell-phone. Sarah tries to discourage him by poking him every time the cell phone makes a sound. It doesn't work.
In front of us, as the journey progresses, I watch unfold one of the most unusual and astounding things I have seen in my three plus years in Chad: plublic affection between a man and wife. I am mesmerized by their intimacy. They actually seem to enjoy each others company leaning their heads in closely to share secrets. Her arm rests lovingly on his shoulder. He casually loops his arm around hers. As night approaches, their heads lean in and touch as they alternately rest and share intimate moments in their own little world. She has the traditional muslim head covering and he, while not dressed in Arabic robes, is obviously a firm believer as he steps out to pray with the others as the van takes breaks at all the appropriate prayer times.
In order to appreciate the magnitude of this, one has to have lived in Africa and seen the total separation of the sexes. Men and women eat apart, socialize only with their own gender and come together only in private for making children. One may see gruff soldiers walking down the street hand in hand all the time but rarely will one see a girl and boy or man and woman making even this most minimal of public gestures of affection. One time, before a trip that Sarah was making, as I was huggingher good bye I saw that Pierre and his wife had arrived. Pierre was going to accompany Sarah, so to tease him I told him, "Pierré, this is how we say 'au revoir' in my culture." He replied that it was a good custom and he was willing to try it. As he moved toward his wife, she began to laugh nervously and quickly got up and moved rapidly out of reach. Pierré would have to wait for another day to try that new cultural experience!
We arrive late in Kelo and have to wait another hour for the bus to Pala. We finally leave a little after 10pm only to be stopped by the gendarmes at the exit of the village. The barrier is down and they say that no one can travel after 10pm so we might as well just settle down and sleep till morning. The driver turns off the van and everyone sits there stunned. I feel a little nervous, but decide I should try something.
I cautiously approach the machine gun toting soldiers in the dark and greet them. I introduce myself as the doctor from the Béré hospital just down the road. I explain the situation with Andre and the accident and how I'd like to see him tonight so I can return to Bere in the morning. Otherwise, I point out, the hospital will be without a doctor. Oh, and I heard there's a national strike going on and the Kelo hospital is closed. Wouldn't that be tragic if one of your relatives got sick, decided to go the the only hospital around that's open (in Béré) and find that there wasn't a doctor there? I wonder if there's anyway they can help us. They tell me to come over and sit on the bench with them. I get up from where I'd been squatting on the ground in front of them and sit down. They call up their superior and explain the situation. After a few minutes, they call over the driver and tell him to get his passengers in and get on the road. We make it to Pala a little after midnight where, after my enlightening conversation with Pierre, Job and Noel I find myself lying on a woven mat on the ground with the mosquitos buzzing around and no lights on in the entire hospital thinking that only 36 hours ago I was in Paris.
C'est la vie au Tchad!
James
Monday, March 19, 2007
Adventist Mission
I'm sitting in the dark. The generator has just wound to a halt. A kerosene lamp gives it's warm but not far-reaching light to an otherwise shadow filled room. Sarah has gone to N'Djamena to take our Danish medical student, Trine, to the airport for her return to Denmark. It's just me and the guys. I'm sitting at the table in front of the lamp. The cat is playing with my foot as if it was a dead rat. Israel is lying on the couch on the right and Paul is sitting on the couch to the left.
As with most conversations between guys the topic swiftly turns to...missions. What would you talk about? Gosh! Israel is a nurse from Puerto Rico recently graduated from Southern Adventist University. He is fluent in English and Spanish and already speaks French quite well after only two months. He has taken night shifts where he is the only nurse in the hospital and post-call still comes into help in surgery. He's what you might call a missionary stud.
Not to be left behind is Paul. A Nigerian trained at the Ile-Ife Adventist Hospital he has had the highest level of nursing training, speaks fluent English, Hausa and Yoruba and has also learned enough French to be very dangerous. Despite not being Adventist and having most of his classmates tell him not to come to some God-forsaken place like Tchad, he has dedicated a year of his life to help his Chadian brothers.
Both have fearlessly followed Sarah's lead and learned to ride horses the hard way...both having fallen off at full gallop, not much the worse for wear.
So, I’m talking about the good and bad of Adventist missions. I mention that one of the positive things is the fact that my school loans are being repaid in exchange for six years of service allowing me to head out immediately after residency. However, the weakness is that our church only does that for doctors and dentists, not for nurses, PTs, Physician's Assistants, midwifes, etc. Israel states that if he could have his loans from nursing school paid off he'd gladly spend at least four years in the mission field. How hard could that be? Does the General Conference have to do it or couldn't we just ask the local churches to remember they are part of a worldwide movement, the body of Christ, each one interdependent on each other, those who have been entrusted with resources using them to help those who have not?
When an Adventist wants to be a missionary the Church tells him we have a budget here and there and in that small place where no one has been in a long time. Where do you want to go? Instead of asking the person, where do you feel God is calling you? We say where do we have a budget for a missionary. Instead of asking, where do we need someone? We ask if you have any other financial obligations. Instead of feeling called to life work among a certain people un-reached by the news about God and who he is, we jump around from place with a budget to another place with a budget every six years never bothering to learn to communicate with the locals in their own language, "because I'm just going to leave anyway, why waste the effort?"
If someone does decide to accept a "call" to where there is a missionary budget there is no contact with any local churches for the spiritual support and encouragement that is so desperately needed when one is so far removed from everything familiar and comforting. That responsibility is left to some people at a high level of administration who may have never seen you and may not even really know your name, where you are, what the conditions are like, and for sure haven't ever visited "sur le terrain" (on site). This robs both the missionary and the members of the local church who then never have contact with the outside world leaving their world small and inward focused on their own needs easily forgetting those "far away."
Paul brings up the problem in Ile-Ife. He literally begs me if there is anything that can be done to bring in specialist physicians, especially surgeons. They desperately need a general surgeon or an orthopedist or a traumatologist as they see so many motor vehicle accidents with mass casualties needing surgical intervention. They also need a neurosurgeon for the same reason, lots of head trauma. If only someone could come and teach their physicians and help them take care of the overwhelming load. Since when does the Third World not really need our help anyway?
Somehow I think we have that idea...they have their own doctors, their own nurses, their own etc...let them suffer on their own. But since when are we called to ignore suffering? Most of their doctors are in the cities making the "big bucks" too. Who's willing to go out to the small villages and towns? So even in Nigeria, where things are a lot more developed than Tchad, Paul is pleading, "Come help us!"
What is the ratio of patients to doctors in the US? Is it better than 140,000 to one? Here in Béré, our hospital serves a population of 142,000 in our district plus the thousands who come to us from the outside districts. I’m the only physician. Does that seem normal to you? How can anyone say we don't need another doctor here at the Béré Adventist Hospital? But I can guarantee you the General Conference of SDAs will never allocate another physician budget here...in fact, they are cutting back the number of missionary budgets because people aren't giving to the missionary fund anymore. And why should they? Does anyone in the church even know the names of the missionaries that are out there much less where they are? Only a andful of close friends and family.
So, what can be done? Mass changes. We need to create either a mission focused church again (the reason for the church structure to begin with was to better organize outreach/mission activities...not maintain existing structures and institutions)...but that's not likely. The church is too weighed down with top-heavy administrative loads to change. So, I propose a separate, yet affiliated mission organization whose only task is to coordinate and arrange support--financial and spiritual.
For example, start with medical missions. As a physician, I could work two months out of the year in the US and make around $16-20,000 depending on where and how much I worked. Working for a locums company specializing in placement of physicians in temporary positions I would have travel, car and lodging taken care of for those two months. Air travel to and from Tchad would be $2000 (x2 for me and Sarah) = $4000. Say we live pretty frugally but want to travel some the third month to visit relatives and sponsoring churches so we spend $3000 for those three months. That leaves us with $7-11,000 (depending on original sum). Emergency evacuation through South Africa can be purchased for $2000/person/year leaving us with $3000. Local health insurance bought through the Central African Union (I don't know the actual price but I'll guess) $1000/person/year leaving us with $1000. We can easily live off the local salary of $500/month that we are receiving currently from the Union so that would be $4500/year (for 9 months in Tchad). Therefore, Sarah only needs to work as a nurse enough to make $3500. An easy task with traveling nurse in the US or if we took our month vacation in Denmark (at least a vacation for me...she'd take the two months in the US as vacation) she could work in Denmark or Norway and easily make $8-9,000. Essentially, we could be self supporting by working 2-3 months abroad and spending 9 months at home in Tchad. Any excess expenses we could ask our sponsoring churches to help us cover keeping them involved financially as well as morally and spiritually (they could also help out
with hospital needs, etc.)
This would free up medical personnel from all fields (nurses, PTs, Pas, RNPs, Midwives, OTs, lab techs, etc.) to become missionaries where they would feel called and where their was a need without depending on someone "higher up" to create a budget there. The main thing many of them, especially the young ones like Israel would need would be loan repayment. If that could be raised by the local churches and then paid off each year based on years served according to a contract established between the churches and the missionary, that would free up many promising missionaries to go where they feel called.
Does it seem normal that a whole country like Tchad has only two Adventist missionaries, my wife and I? We should have a whole team here to meet the overwhelming needs and to support and encourage each other. There are so many amazing things that I'm getting to experience professionally and spiritually that others should have the chance to share but our current system blocks that on anything more than a one year volunteer scale. How much more could we be experiencing if we were a team and not just a burned out overworked doctor-nurse team trying desperately to salvage what lives we can from the teeming masses of under-treated people so desperate to find healing that they'll come from miles and miles around to our pathetic hospital just because it's so much better than they can find where they are.
Am I just venting or does somebody out there hear me?!
James Appel
Medical Director
Béré Adventist Hospital
BP 52 Kélo
Tchad
00-235-645-5188
As with most conversations between guys the topic swiftly turns to...missions. What would you talk about? Gosh! Israel is a nurse from Puerto Rico recently graduated from Southern Adventist University. He is fluent in English and Spanish and already speaks French quite well after only two months. He has taken night shifts where he is the only nurse in the hospital and post-call still comes into help in surgery. He's what you might call a missionary stud.
Not to be left behind is Paul. A Nigerian trained at the Ile-Ife Adventist Hospital he has had the highest level of nursing training, speaks fluent English, Hausa and Yoruba and has also learned enough French to be very dangerous. Despite not being Adventist and having most of his classmates tell him not to come to some God-forsaken place like Tchad, he has dedicated a year of his life to help his Chadian brothers.
Both have fearlessly followed Sarah's lead and learned to ride horses the hard way...both having fallen off at full gallop, not much the worse for wear.
So, I’m talking about the good and bad of Adventist missions. I mention that one of the positive things is the fact that my school loans are being repaid in exchange for six years of service allowing me to head out immediately after residency. However, the weakness is that our church only does that for doctors and dentists, not for nurses, PTs, Physician's Assistants, midwifes, etc. Israel states that if he could have his loans from nursing school paid off he'd gladly spend at least four years in the mission field. How hard could that be? Does the General Conference have to do it or couldn't we just ask the local churches to remember they are part of a worldwide movement, the body of Christ, each one interdependent on each other, those who have been entrusted with resources using them to help those who have not?
When an Adventist wants to be a missionary the Church tells him we have a budget here and there and in that small place where no one has been in a long time. Where do you want to go? Instead of asking the person, where do you feel God is calling you? We say where do we have a budget for a missionary. Instead of asking, where do we need someone? We ask if you have any other financial obligations. Instead of feeling called to life work among a certain people un-reached by the news about God and who he is, we jump around from place with a budget to another place with a budget every six years never bothering to learn to communicate with the locals in their own language, "because I'm just going to leave anyway, why waste the effort?"
If someone does decide to accept a "call" to where there is a missionary budget there is no contact with any local churches for the spiritual support and encouragement that is so desperately needed when one is so far removed from everything familiar and comforting. That responsibility is left to some people at a high level of administration who may have never seen you and may not even really know your name, where you are, what the conditions are like, and for sure haven't ever visited "sur le terrain" (on site). This robs both the missionary and the members of the local church who then never have contact with the outside world leaving their world small and inward focused on their own needs easily forgetting those "far away."
Paul brings up the problem in Ile-Ife. He literally begs me if there is anything that can be done to bring in specialist physicians, especially surgeons. They desperately need a general surgeon or an orthopedist or a traumatologist as they see so many motor vehicle accidents with mass casualties needing surgical intervention. They also need a neurosurgeon for the same reason, lots of head trauma. If only someone could come and teach their physicians and help them take care of the overwhelming load. Since when does the Third World not really need our help anyway?
Somehow I think we have that idea...they have their own doctors, their own nurses, their own etc...let them suffer on their own. But since when are we called to ignore suffering? Most of their doctors are in the cities making the "big bucks" too. Who's willing to go out to the small villages and towns? So even in Nigeria, where things are a lot more developed than Tchad, Paul is pleading, "Come help us!"
What is the ratio of patients to doctors in the US? Is it better than 140,000 to one? Here in Béré, our hospital serves a population of 142,000 in our district plus the thousands who come to us from the outside districts. I’m the only physician. Does that seem normal to you? How can anyone say we don't need another doctor here at the Béré Adventist Hospital? But I can guarantee you the General Conference of SDAs will never allocate another physician budget here...in fact, they are cutting back the number of missionary budgets because people aren't giving to the missionary fund anymore. And why should they? Does anyone in the church even know the names of the missionaries that are out there much less where they are? Only a andful of close friends and family.
So, what can be done? Mass changes. We need to create either a mission focused church again (the reason for the church structure to begin with was to better organize outreach/mission activities...not maintain existing structures and institutions)...but that's not likely. The church is too weighed down with top-heavy administrative loads to change. So, I propose a separate, yet affiliated mission organization whose only task is to coordinate and arrange support--financial and spiritual.
For example, start with medical missions. As a physician, I could work two months out of the year in the US and make around $16-20,000 depending on where and how much I worked. Working for a locums company specializing in placement of physicians in temporary positions I would have travel, car and lodging taken care of for those two months. Air travel to and from Tchad would be $2000 (x2 for me and Sarah) = $4000. Say we live pretty frugally but want to travel some the third month to visit relatives and sponsoring churches so we spend $3000 for those three months. That leaves us with $7-11,000 (depending on original sum). Emergency evacuation through South Africa can be purchased for $2000/person/year leaving us with $3000. Local health insurance bought through the Central African Union (I don't know the actual price but I'll guess) $1000/person/year leaving us with $1000. We can easily live off the local salary of $500/month that we are receiving currently from the Union so that would be $4500/year (for 9 months in Tchad). Therefore, Sarah only needs to work as a nurse enough to make $3500. An easy task with traveling nurse in the US or if we took our month vacation in Denmark (at least a vacation for me...she'd take the two months in the US as vacation) she could work in Denmark or Norway and easily make $8-9,000. Essentially, we could be self supporting by working 2-3 months abroad and spending 9 months at home in Tchad. Any excess expenses we could ask our sponsoring churches to help us cover keeping them involved financially as well as morally and spiritually (they could also help out
with hospital needs, etc.)
This would free up medical personnel from all fields (nurses, PTs, Pas, RNPs, Midwives, OTs, lab techs, etc.) to become missionaries where they would feel called and where their was a need without depending on someone "higher up" to create a budget there. The main thing many of them, especially the young ones like Israel would need would be loan repayment. If that could be raised by the local churches and then paid off each year based on years served according to a contract established between the churches and the missionary, that would free up many promising missionaries to go where they feel called.
Does it seem normal that a whole country like Tchad has only two Adventist missionaries, my wife and I? We should have a whole team here to meet the overwhelming needs and to support and encourage each other. There are so many amazing things that I'm getting to experience professionally and spiritually that others should have the chance to share but our current system blocks that on anything more than a one year volunteer scale. How much more could we be experiencing if we were a team and not just a burned out overworked doctor-nurse team trying desperately to salvage what lives we can from the teeming masses of under-treated people so desperate to find healing that they'll come from miles and miles around to our pathetic hospital just because it's so much better than they can find where they are.
Am I just venting or does somebody out there hear me?!
James Appel
Medical Director
Béré Adventist Hospital
BP 52 Kélo
Tchad
00-235-645-5188
Sunday, March 18, 2007
Gwame
I strip down to my underwear, half-walk, half run down the sandy slope and plunge into the coolness of the river. The hot season is upon us and nothing is cool here except the river. The harmatan winds blow hot dust and wind off the Sarah leaving the Sun a well defined, somewhat darkened orb in a murky sky.
Sarah, Israel and I have brought our two volunteer resident physicians, Aimee and Jennifer out here on horseback. Everyone is hot, dusty and sweaty but I'm the only one to take the plunge. I feel invigoratedand take long crawl strokes upstream. However, due to the force of the current and my long unused swimming muscles my progress is slow and my fatigue comes onfast. Every once in a while I lift the head up for along look ahead…you never know if their might be hippos! I pull out of the water and dry off with my shirt and pull on my pants. Sarah and Israel have disappeared with mine and Sarah's horses. The girls inform me that the horses ran off and they went to chase them. They soon come back. I grab the single rope attached to the nose bridle, place my left foot in the stirrup and swing up. My butt is already sore from being to long out of the saddle. We start off in a slow trot. The girls are behind Sarah and Israel and are bouncingup and down like jackhammers. That's gotta hurt!
They can't really gallop so I spur my horse, Bob, onahead. The wind whips through my hair as I fly overthe dusty trails passed the burned fields awaiting thenext rainy season to be transformed. There is one field that is surrounded by a two foot high thorn fence and dirt retaining wall where someone is desperately and pathetically trying to grow something (looks like weeds, maybe it's their local smoke). A pack of women with huge metal basins covered with brightly colored cloth perched on their heads block my path. I pull in the rein (singular) tightly and Bob slows down as they also realize that a horse is upon them and quickly move to the sides. I wave and shout"Lapia" and continue on.
I turn around and gallop into the Harmatan winds until I rejoin the others and we slowly walk back. At thef irst house on the outskirts of the village Sarah stops to ask if they have any chickens for our going away party for our volunteers tomorrow. They have none. Just then I see Gwame run up. A cute 4-5 year old hehas old shorts, a torn shirt and a huge grin as he stops near my horse with arm outstretched to give me"five". After I slap his hand his tongue pokes out in concentration and he rears back his palm to smack mine with all his little might.
Hard to believe that less than a year ago he was acripple with nothing but a lifetime of suffering ahead of him.
In August, thanks to my old (yes, old) friend Troy Dickson and his wife he was sent to Kenya to the Cure Hospital for a life-changing operation. He had what is called "wind swept knees" meaning that both knees were displaced laterally as if a strong wind was blowing them to the side making it almost impossiblefor him to walk. In fact, when Troy and I first saw him he was also malnourished and covered with scabies from head to toe. Being an indentical twin made it even sadder as by looking at his brother we could see what he should be.
Now, radiating joy and health he begs me to lift him up for a horse ride as I have the habit of doing whenever I pass. I reach down and grab him under the armpit and swing up his little body onto the horse. His straightened legs easily fall on either side of the horses shoulder and off we go. We take off in a trot with the other kids following screaming at the top of their lungs and a permanent grin on Gwame's face threatening to split his ears in two. When wecome back and chase the other kids all the way into the courtyard of the house he giggles and chuckles with a contagious hilarity that makes us all feel like nothing could touch us in this moment. We are as free as free can be. Free to rejoice in a miracle, in a transformed life, in the moment.
James
Sarah, Israel and I have brought our two volunteer resident physicians, Aimee and Jennifer out here on horseback. Everyone is hot, dusty and sweaty but I'm the only one to take the plunge. I feel invigoratedand take long crawl strokes upstream. However, due to the force of the current and my long unused swimming muscles my progress is slow and my fatigue comes onfast. Every once in a while I lift the head up for along look ahead…you never know if their might be hippos! I pull out of the water and dry off with my shirt and pull on my pants. Sarah and Israel have disappeared with mine and Sarah's horses. The girls inform me that the horses ran off and they went to chase them. They soon come back. I grab the single rope attached to the nose bridle, place my left foot in the stirrup and swing up. My butt is already sore from being to long out of the saddle. We start off in a slow trot. The girls are behind Sarah and Israel and are bouncingup and down like jackhammers. That's gotta hurt!
They can't really gallop so I spur my horse, Bob, onahead. The wind whips through my hair as I fly overthe dusty trails passed the burned fields awaiting thenext rainy season to be transformed. There is one field that is surrounded by a two foot high thorn fence and dirt retaining wall where someone is desperately and pathetically trying to grow something (looks like weeds, maybe it's their local smoke). A pack of women with huge metal basins covered with brightly colored cloth perched on their heads block my path. I pull in the rein (singular) tightly and Bob slows down as they also realize that a horse is upon them and quickly move to the sides. I wave and shout"Lapia" and continue on.
I turn around and gallop into the Harmatan winds until I rejoin the others and we slowly walk back. At thef irst house on the outskirts of the village Sarah stops to ask if they have any chickens for our going away party for our volunteers tomorrow. They have none. Just then I see Gwame run up. A cute 4-5 year old hehas old shorts, a torn shirt and a huge grin as he stops near my horse with arm outstretched to give me"five". After I slap his hand his tongue pokes out in concentration and he rears back his palm to smack mine with all his little might.
Hard to believe that less than a year ago he was acripple with nothing but a lifetime of suffering ahead of him.
In August, thanks to my old (yes, old) friend Troy Dickson and his wife he was sent to Kenya to the Cure Hospital for a life-changing operation. He had what is called "wind swept knees" meaning that both knees were displaced laterally as if a strong wind was blowing them to the side making it almost impossiblefor him to walk. In fact, when Troy and I first saw him he was also malnourished and covered with scabies from head to toe. Being an indentical twin made it even sadder as by looking at his brother we could see what he should be.
Now, radiating joy and health he begs me to lift him up for a horse ride as I have the habit of doing whenever I pass. I reach down and grab him under the armpit and swing up his little body onto the horse. His straightened legs easily fall on either side of the horses shoulder and off we go. We take off in a trot with the other kids following screaming at the top of their lungs and a permanent grin on Gwame's face threatening to split his ears in two. When wecome back and chase the other kids all the way into the courtyard of the house he giggles and chuckles with a contagious hilarity that makes us all feel like nothing could touch us in this moment. We are as free as free can be. Free to rejoice in a miracle, in a transformed life, in the moment.
James
Panic
I wake up in a panic...did I ever really sleep? I'm not sure. Yet, I'm not really awake either. I'm in that gray zone between...the netherworld. I reel the desperation rising within me. Images of the day'ssurgeries well up as well as a nebulous, all-pervadingfear that gnaws deep down...a fear put into wordsearlier in the day by Dr. Warren.
"James, I don't know how you're going to be able to handle it when I'm gone. It's just too much."
A retired surgeon, Warren arrived at the end of January to much anticipation on my part. I was surethat I would have a break and be able to catch up onso much other stuff I'd let slip by in January. I had reached the breaking point with our 71 surgeries in the first month of 2007, but now, with the arrival of a real surgeon, I was sure that things were on the upswing. Maybe I'd have time for a little exercise. Shoot some hoops, go to the river for a swim, ride the horses, jog a little, you know, some leisurely activities having nothing to do with the hospital.
I even hoped that while I was at work I'd have a chance to relax, really follow the inpatients well, have some in depth outpatient visits. You know, be areal, thorough doctor for once, not just someone scrambling around to try and do the minimum possible to save as many of the masses that came from all overthe country to the one hospital still functioning and still affordable.
I was wrong...dead wrong.
Warren arrived on Sunday. On Monday, he did two hernias, a hysterectomie, and a nephrectomie. I saw 50 inpatients and 28 outpatients, and did 6 ultrasounds. Then, we all got called in at midnight for a perforated duodenal ulcer that needed to be intubated and resuscitated in a difficult anesthesiacase. While Warren operated I was bagging him and telling Paul what drugs to give to keep the man alive.We managed to save his live for a few days before he succumbed. Who knows exactly what since we have noelectrolyte or chemistry panels in our lab and nointensive care.
Then, things started to get really bad.
First, the big autoclave has been out for monthswaiting for parts. Then, within the week prior to Warren's arrival, both small autoclaves got fried. Then, the generator went out leaving us without wateror power. We had a small generator given us by the Shanks in Koza, Cameroun that at least allowed us alittle light, suction and a monitor in the OR. However, Warren, at the age of 74, was forced to workwithout air conditioning in the ever-increasing Chadian hot season.
And work he did. In three weeks, counting today, he's done 55 surgeries, many of them complicated like the man with a redundant small bowel cyst and many hysterectomies and some osteomyelitis. Of course, there's always the tons of hernias and hydroceles aswell as a c-section with 8 liters of ascites and anovarian cyst the size of a soccer ball.
The lab then ran out of power. We hooked everything up in reverse (since the small generator is 110V and the hospital is wired for 220V) so the lab battery could charge and than they could run things off the inverter. I thought we had it all set up but they managed to fry a microscope bulb and the hematocrit machine leaving us without the ability to even check the hemoglobin. Now, we rely entirely on the color of the conjunctiva to decide if a person needs to be transfused. Modern day medicine at it's best.
We adapted. We borrowed a 220V generator from the District to pump water every few days and continued to operate with the small 110V one. I continued to see about twice as many outpatients as normal as well as the increased number of inpatients due to the increase in frequentation and the increase in surgical cases. We borrowed a stand up autoclave (a glorified pressurecooker) that takes 6 hours to sterilize with either apetrol or propane stove stuck underneath trying toheat it up...we have no adequate heating source.
Not to mention that our accountant is not working as we're giving him time off to try and find money to payoff the $1200 he stole from the hospital. Not to mention the fact that Andre's been in N'Djamena formost of the month trying to get medicines from the central pharmacy as we run out of even basic thingslike Bactrim and Flagyl. We haven't had a new urine collection bag in months. We've been re-washing oldones and using feeding tube bags. So, all the administrative decisions have been falling back on meas well.
And, all the nurses are working themselves to the bone at the same time. What would we do without our two student missionary nurses, Paul and Israel? What about our half deaf new nurse, Abel, who's not above getting down and dirty to assist on surgeries, cleanup the blood and guts, wash the instruments, and staytill sundown almost every day except Saturday? Whatabout the two new government nurses just assigned?
God always gives us just enough to get by.
But, now, today, with the bloody c-section for uterinerupture leading to a hysterectomy with four blood transfusions and difficulty controlling the bleeding rolling around in my head after a "relaxed" Sunday spending over six hours in the OR (we had a case ofosteomyelitis of the tibia as well as an incarcerated hernia that came in during the c-section), now, when I don't eat from a few hash browns for breakfast until some cold pasta late in the evening, now, as the panic sets in as Warren's departure approaches...How will I handle it? And more importantly, what will happen to the hospital and health care in the region when Sarah and I go on vacation March 11...and both Paul and Israel leave?
And more importantly, how will my body handle this stress if I can't even sleep but spend my nights tossing and turning or begging God with racking sobs to intervene? It's been too much for too long and it's just getting heavier...Is God not listening or is someone else out there who He's calling to come help not listening? All I know is that I'm not going to last much longer with out some kind of intervention.
Is there anybody out there?
James
"James, I don't know how you're going to be able to handle it when I'm gone. It's just too much."
A retired surgeon, Warren arrived at the end of January to much anticipation on my part. I was surethat I would have a break and be able to catch up onso much other stuff I'd let slip by in January. I had reached the breaking point with our 71 surgeries in the first month of 2007, but now, with the arrival of a real surgeon, I was sure that things were on the upswing. Maybe I'd have time for a little exercise. Shoot some hoops, go to the river for a swim, ride the horses, jog a little, you know, some leisurely activities having nothing to do with the hospital.
I even hoped that while I was at work I'd have a chance to relax, really follow the inpatients well, have some in depth outpatient visits. You know, be areal, thorough doctor for once, not just someone scrambling around to try and do the minimum possible to save as many of the masses that came from all overthe country to the one hospital still functioning and still affordable.
I was wrong...dead wrong.
Warren arrived on Sunday. On Monday, he did two hernias, a hysterectomie, and a nephrectomie. I saw 50 inpatients and 28 outpatients, and did 6 ultrasounds. Then, we all got called in at midnight for a perforated duodenal ulcer that needed to be intubated and resuscitated in a difficult anesthesiacase. While Warren operated I was bagging him and telling Paul what drugs to give to keep the man alive.We managed to save his live for a few days before he succumbed. Who knows exactly what since we have noelectrolyte or chemistry panels in our lab and nointensive care.
Then, things started to get really bad.
First, the big autoclave has been out for monthswaiting for parts. Then, within the week prior to Warren's arrival, both small autoclaves got fried. Then, the generator went out leaving us without wateror power. We had a small generator given us by the Shanks in Koza, Cameroun that at least allowed us alittle light, suction and a monitor in the OR. However, Warren, at the age of 74, was forced to workwithout air conditioning in the ever-increasing Chadian hot season.
And work he did. In three weeks, counting today, he's done 55 surgeries, many of them complicated like the man with a redundant small bowel cyst and many hysterectomies and some osteomyelitis. Of course, there's always the tons of hernias and hydroceles aswell as a c-section with 8 liters of ascites and anovarian cyst the size of a soccer ball.
The lab then ran out of power. We hooked everything up in reverse (since the small generator is 110V and the hospital is wired for 220V) so the lab battery could charge and than they could run things off the inverter. I thought we had it all set up but they managed to fry a microscope bulb and the hematocrit machine leaving us without the ability to even check the hemoglobin. Now, we rely entirely on the color of the conjunctiva to decide if a person needs to be transfused. Modern day medicine at it's best.
We adapted. We borrowed a 220V generator from the District to pump water every few days and continued to operate with the small 110V one. I continued to see about twice as many outpatients as normal as well as the increased number of inpatients due to the increase in frequentation and the increase in surgical cases. We borrowed a stand up autoclave (a glorified pressurecooker) that takes 6 hours to sterilize with either apetrol or propane stove stuck underneath trying toheat it up...we have no adequate heating source.
Not to mention that our accountant is not working as we're giving him time off to try and find money to payoff the $1200 he stole from the hospital. Not to mention the fact that Andre's been in N'Djamena formost of the month trying to get medicines from the central pharmacy as we run out of even basic thingslike Bactrim and Flagyl. We haven't had a new urine collection bag in months. We've been re-washing oldones and using feeding tube bags. So, all the administrative decisions have been falling back on meas well.
And, all the nurses are working themselves to the bone at the same time. What would we do without our two student missionary nurses, Paul and Israel? What about our half deaf new nurse, Abel, who's not above getting down and dirty to assist on surgeries, cleanup the blood and guts, wash the instruments, and staytill sundown almost every day except Saturday? Whatabout the two new government nurses just assigned?
God always gives us just enough to get by.
But, now, today, with the bloody c-section for uterinerupture leading to a hysterectomy with four blood transfusions and difficulty controlling the bleeding rolling around in my head after a "relaxed" Sunday spending over six hours in the OR (we had a case ofosteomyelitis of the tibia as well as an incarcerated hernia that came in during the c-section), now, when I don't eat from a few hash browns for breakfast until some cold pasta late in the evening, now, as the panic sets in as Warren's departure approaches...How will I handle it? And more importantly, what will happen to the hospital and health care in the region when Sarah and I go on vacation March 11...and both Paul and Israel leave?
And more importantly, how will my body handle this stress if I can't even sleep but spend my nights tossing and turning or begging God with racking sobs to intervene? It's been too much for too long and it's just getting heavier...Is God not listening or is someone else out there who He's calling to come help not listening? All I know is that I'm not going to last much longer with out some kind of intervention.
Is there anybody out there?
James
mangos and urinary retention
Her face was so swollen it was all but unrecognizable. Her right eye was completely shut. Blood caked in streaks and dotted lines ran from her lower lip, down her chin around a large gash under her chin across her neck and spattered her shirt with dark maroon patches like a painted mustang. Out of her left ear and nose dribbled an oily, blood tinged liquid. Patches of bloody cotton stuffed haphazardly into her left ear attempted to control to flow.
She was awake, alert and not afraid despite her small size for her 8 years.
Her father had brought her all the way from Kelo on a motorcycle after she fell from a mango tree that afternoon.
It was Sunday night after a long, busy day at the hospital.
She opened her mouth to reveal a cut inside along the gums leading to a visible mandible fracture. Most of the teeth on the right had been knocked out except one molar on the top, a split molar on the bottom and 4 of her front teeth.
All caused by an addiction to mangos...what can I say, I'm guilty myself.
As I have them prepare for immediate surgery, Lona and Rahama, the nurses on duty, ask me to see an old man who can't pee. Lona tried to pass a foley catheter but was unable to get it into the bladder.
I walk into labor & delivery where they've placed him and see a sobering sight.
A wizened, almost blind man in his 70's is squatting on one of the delivery beds with a wrap half covering his manhood. His chest is bare, sunken and twisted. His scrawny arms still reveal what was once a wiry, tough man.
Blood is smeared all over the table, the wrap, and the man's groin, several clots drip blood from his urethra.
His bladder is swollen halfway to his belly button. I stick a gloved finger up his rectum and confirm a grossly enlarged prostate. He begs to be taken home so he can die. I explain that we will operate on him first thing in the morning, that he won't die. He refuses. We leave the sons to reason with him while Israel, Paul, Sarah and I take the small girl to the OR.
Sarah gives her general anesthesia and I first attempt to wire her jaw. I take a steel suture pass it around the base of her only two molars on the right (the side of the fractures). I twist them together leaving a tail that I then twist together with the molar's twin to bring the jaw together in a functional position. I repeat the process with the front teeth. It's sketchy but is sort of working.
I then open up our internal, maxillo-facial fixation tray and enlarge the wound between her lower lip and chin to expose the fracture. I drill four small holes through a small compression plate, measure the depth of the holes, select the appropriate sized screws and carefully screw them in with a hand screwdriver. Just like I learned in carpentry class (and in the Ventura County Medical Center OR)!
We wash out the wounds well and then I close a couple and Israel closes the rest. She also has a probable basilar skull fracture causing the cerebrospinal fluid to come out her nose and ears. I put her on a strong antibiotic for a week. A few days later the swelling is almost gone and her pain is controlled with ibuprofen and tylenol. After a week of IV antibiotics the leaking has stopped and she goes home.
Meanwhile, I come out of the OR to find that the man with the enlarged prostate is at the gate and would've been home already if the night watchman hadn't blocked his leaving.
As I walk up under the starry Chadian sky a huge part of me wants to just yell at him for being so stupid and let him go home to die. He refuses to wait for the morning saying he'll die before then.
The air is cool and I am tired. It's 11pm already. But, an unfortunately rare thought enters my
head...what if it was my dad? My grandpa? Me? What would I want done?
I offer to operate right now. After much discussion and suspicious glances thrown my way by the old man, his sons convince him.
We carry him to the OR, prep him and give him a spinal anesthetic. I scrub my already well scrubbed hands. I'm almost in a dream, a moment frozen in time as my hands go through the automatic ritual of nails, fingers, hands, wrists to the elbows that has been drilled in me. It's a comforting and important ritual.
I open the OR door with my back, dripping elbows out and hands up. I grab a towel, dry my hands slowly and methodically and drop the towel on the floor. I grab the gown, shake it out and slide my hands through. I'm in another world. I put on my sterile gloves and then Israel and I place the sterile towels around the lower abdomen of the man and then lay on the drape.
After prayer, I take the scalpel and slice horizontally through the skin right above the syphysis pubis...the same as for a c-section. I cut down to the fascia and just through to the muscle on either side of the mid-line. I take the scissors, spread them under the fascia to detach the muscles and cut to the edges of the skin incision both ways. I grab the fascia with clamps, lift up and with my fingers and scissors take the muscles off first superiorly and then inferiorly. I split the muscles with a clamp, insert my fingers and pull the muscles apart. Israel inserts retractors and I open the bladder with the scalpel in a vertical incision. Israel uses the suction tubing to sop up the fountain of urine that pours out. I extend the incision with the scissors.
Israel sucks out all the urine and then pulls the wound open with the retractors. I find the posterior part of the prostate and make a nick with the scalpel. Then we pull out all clamps and retractors and I stick my finger into the bladder, find the small incision and push into the mucosa around the prostate and then sweep around the prostate, shelling it out. Blood pours into the bladder as I lift out the trophy.
Paul inserts a small urethral dilater from below, I attach a heavy suture to the dilator, and Paul pulls it out the urethra. He then ties the suture to a large foley catheter which is then guided into the bladder around the false track. Paul inserts 30ml of water and yanks the foley down into the hole that used to have the prostate.
Israel and I close the bladder, fascia and skin while Paul attaches the irrigation tubing to the three way foley catheter as bloody fluids start coming out into the urine bag.
The next day, our man, who I find out lives in our same neighborhood, is pleasantly surprised to find himself still alive. He's even more surprised to find out a week later that he is going home in very good condition with normal urine function...the only draw back is that he has to suffer through a large indwelling catheter for another week. He smiles, grabs my hand with both his and repeats over and over "Lapia, merci beja, lapia, lapia, lapia..."
( P.S. for other similar email stories look to bereadventisthospital.blogspot.com )
James
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