It's hard to get out of my warm bed. The nights have been actually cool here lately and getting out on the cool cement floor is all the more difficult. I finally make a break for the bathroom and am thankful for one of the few luxuries we have here...hot showers. I dress in scrubs and head to the kitchen on the other side of the duplex for breakfast. Nathan gives me a chunk of eggs well cooked on account of their sketchy appearance on being cracked open. I also fry up some of Salomon's now stale bread dipped in eggs and cinnamon to form a sort of French Toast. The final element is the big bowl of local Arab milk turned into yogurt overnight mixed with fresh limes, bananas and sugar. The breakfast of champions and definitely not a "petit déjeuner"!
I walk over in the early morning haze to our temporary waiting room under the mango tree. Behind me is the skeleton of our clinic with it's roof and ceiling completely removed and all furniture and equipment moved to the main hospital ward. Pierre reads from Psalms, we pray, Samedi gives his report from "Garde" duty and we pray again. It's 8am and the day is about to begin.
I enter my temporary office, the midwife's office, and am bombarded by a foul smell that has been growing. We put out poison for the mice a few nights ago and everyone tells me they've all died in my office. I tell Ferdinand to pull of the two boards covering a pile of wires in the corner as that appears to be their nest. I grab my army shoulder bag that serves as my doctor bag and then am accosted by Koumabas for supplies from the main pharmacy. After giving him the syringes, needles and meds he needs I check in on Ferdinand who has discovered one dried, splayed out mouse high up in the wires and a fresh kill down below along with tons of plastic, papers and a former nurses surgical cap that the mice have used for their nest.
I head out to the wards. I see Anatole's child first whose mom prefers to be hospitalized on the porch instead of inside. They are all spread out on a variety of mats and Arabic rugs. The kid has malaria and still has a very rapid heartbeat but otherwise appears to be doing somewhat better despite vomiting a couple times. I go inside.
The unlighted wards are perpetually dim and filled with shadows. I visit Pediatrics first. One adolescent with cerebral malaria and possibly syphilis is ready to go home. A nomadic Fulabi child with malaria is also ready to be discharged. The little 6 year old with meningitis and resultant right sided paralysis has woken out of his coma today and started to eat a little soup. The young boy with the osteomyelitis of his femur from a long standing thigh abscess gets his Ketamine and dressing change with a diluted blend of Clorox. Little Angeline who has been with us for over 4 months with osteomyelitis of her tibia necessitating removal of part of the bone has finally closed her wound. I have the mom buy a roll of fiberglass casting so I can replace her windowed leg cast that has been supported for months with two sticks.
I move on to the adults. The first patient is a sad case of teenage pregnancy. She labored for 4 days at home before going to the health center where they let her labor one day more before referring her to the hospital. Instead of coming to the hospital she continued to labor 4 more days at home until she delivered a dead baby while shredding her cervix and bladder. When she finally came to the hospital 2 weeks after being referred she had a raging infection with dead tissue hanging out and a 10 cm tear in her bladder. Her infection has now been treated and we've tried two repairs on her bladder with restoration of almost completely normal anatomy. Unfortunately, there is still a little leak (vesicovaginal fistula) meaning she has no control over urination. Our other local doctor has been trained in repair of these types of fistulas and if he's ever around we'll see if he can help her.
The second patient is an adult with malaria ready to go home. Next up is a woman with a huge jaw abscess from neglected dental caries. She's doing better after 3 extractions and antibiotics. I move onto an elderly gentleman with a huge inoperable bladder tumor who we are providing palliative care to. Another woman with Malaria and some strange shoulder pain is fine except for the hypersensitive painful, unswollen shoulder that just won't get better no matter what treatment we try. Following is a man admitted last night with ascites and lower extremity edema. Questioning reveals a heavy drinking past so I assume it's cirrhosis and plan a paracentesis later to draw off a bunch of the fluid in his belly.
I head back to the office, stop to change a dressing on a man who'd passed under my knife for a finger amputation a couple weeks ago. Then I see Angeline and her mom who've paid for the new cast. I pull out the newly donated cast saw, hook up to the lab's small generator and tear through the old fiberglass. Jennie and Nathan then help me rub off the thickened old skin over her leg and wash her down. The leg kind of flops for lack of a completely formed new tibia. I then wrap her leg in cotton and apply the fiberglass cast from thigh to foot. She only cries a few times and then with sniffles gives me our traditional 5 or ten high fives.
Back to my now clean smelling, mice-free office for clinic. It's 10am. Five of my nine patients are HIV positive. Two of the girls are relatives of one of my patients who just died on Monday. All three have AIDS. The one who died was one who had the resources to buy anti-retrovirals and took it for 3 months without any improvement...in fact she steadily got worse. One of the girls I see today, Honorine, on the other hand, started ARVs at the same time and has been healthy since gaining over 14 lbs. It's good to see all of them as they are the patients I see often enough to actually have formed relationships with them. Honorine just finished her last ARV pill and doesn't have money to buy more. She is an orphan and has some property in Kélo left her by her mom. It will be sold the 20th...too late to buy the ARVs as even a day or two of missed treatment can allow the HIV to become resistant. I lend her the money and she takes off immediately for Kélo. It is her life.
I finish clinic at about 1:30pm and head to do the paracentesis on the man with the ascites. I stick a large needle and catheter in the left lower quadrant of his belly and the anticipated straw colored fluid flows out. I send some to the lab and let 4 liters drain off. As the fluid goes down I examine his belly and am surprised to find his liver quite enlarged rather than the shrunken one that one usually finds in cirrhosis. Also, the consistency of his abdominal wall is thickened and doughy. Instantly, another possible diagnosis enters my head...abdominal tuberculosis. If this is the case it is good for him as we can treat that while the end stage of cirrhosis has no cure and is universally fatal in less than a year. I put him on a two week trial of anti-tuberculosis meds just as Dimanche, the Garde, comes up to tell me there are two patients just arrived referred from the hospital in Kélo. Apparently their generator is broken.
I go to see the first at about 2:30pm. A young man who shows the wear and tear of a hard life is lying temporarily on one of the delivery beds. His hair is wild and sticking straight up like Buckwheat's. He has a deep old scar on his left forearm and various smaller scars scattered across his torso. According to the story he was gored by a bull yesterday evening at 5pm. His intestines popped out and he went to the hospital where they covered the intestines with betadine soaked gauze and gave him antibiotics and pain meds. He was then told to come to Béré. I look at his belly. It is soft with good bowel sounds. He has bowel function intact (he farts). I take off the dressing and see a 10cm portion of irritated small bowl already starting to adhere to the skin. I give him Valium and try to reduce it at bedside. He doesn't tolerate. We rush him to the OR where I inject Ketamine, prep and scrub and push the intestines back in. Clear, serosanguinous fluid comes out of the belly. By the angle of the wound it appears that he was gored almost parallel with the abdominal wall and it is unlikely that the intestines have been punctured. I leave a drain inside, close the fascia and leave the skin open with our famous diluted Clorox dressings. Interestingly, I didn't need the generator...
I go to see the next patient. It is 4pm. She is a young girl at 7 months of her first pregnancy. She has been bleeding for a day and has abdominal pain. I check for the fetal heartbeat; it is absent. There is minimal amount of bleeding and she is stable. I order IV fluids and plan surgery for 6:30pm when our generator comes on. I go home. I haven't eaten yet since breakfast.
I eat heartily of Salomon's excellent vegetable sauce over rice and relax of an hour and a half by watching "Step Into Liquid", a great surfing movie, on the computer.
At 6:30pm on the dot the generator comes on and I rush over where Samedi has already brought the patient to the OR and is getting her set up. We put in a urinary catheter, I give her a spinal anesthetic, we prep the abdomen, scrub, drape and then pause for prayer before cutting through the lower abdominal skin straight down to fascia. In less than 5 minutes the baby is out...premature and unfortunately dead. We find she has had a placental abruption where the placenta separates from the uterus before the baby is born. We close quickly and by 7:30pm I am back home and ready for seconds on Salomon's sauce.
After supper, at 8pm the lights go off. I gather with Nathan, Jennie, and Becky out on the porch under another fantastic, pitch black, star filled Tchadian sky. We pray and I feel a peace pour over me that cannot be described. Strangely enough, I am completely content. I go to sleep almost immediately afterwards...
James
Saturday, December 11, 2004
Friday, November 26, 2004
Chills
I close my office door. I feel cold and tired. My muscles and joints ache. I put my Old Navy sweatshirt on over my scrubs. I lie down on the exam table. It's not even my office. I'm in the Prenatal care office temporarily as the main building gets renovated. I'm sure it's just exhaustion. I don't really feel sick. It feels so good to lie down. Since Sarah left three days ago my life has been crazy again.
I drove her to the N'Djamena airport in our pickup. We walked across the courtyard and into the waiting area past huddled groups of Tchadians, many wearing the traditional robes and round hats or turbans. Sarah packs lightly so I had her backpack on and she had just a tiny carry on bag. Acting like we knew what we were doing we walked past the guards through the cage like entrance to the check in room. I held her hand. We loaded her bag onto the belt and I hugged her good bye. Apparently, people were watching in wonder to see someone actually show affection because when I let her go where only ticketed passengers can go a woman came up and told me to go with her. She said we could go up to the observatory to watch the plane come in. The woman checked her passport and then we walked up the steps to a huge glass window with open slats letting the cool N'Djaména night air blow in. We stood there laughing and talking watching a plane come in (not many come into N'Djaména). Finally, I knew I had to say goodbye. I felt weird, surreal. It hadn't sunk in that she was leaving and that I wouldn't see her again until a week before we got married. I had the strange sensation of wondering if I even knew this beautiful girl with wild red hair beside me and would I feel even weirder after a month apart. Then I walked down the stairs, past the passport checkpoints, out the guarded cage-like entrance and into the eerily dimly lit yellow N'Djaména night. Across the pavement, into the car, zombie like thinking how normal this all seemed and yet within a few hours one could be in Europe in a different universe.
Rahama knocks on the door and opens it. "Docteur, pardonnez-moi, mais il y a d'un urgence." And three sweaty, out-of-breath men come in carrying an elderly woman who's moaning but not responsive. Probably malaria. I examine her and order some tests and treatments and send her to the ward. I really start to feel chills. I head to the lab and have Matthieu poke my finger for a Goutte Epaisse (malaria smear). Then I go back and lie down, slipping quickly into that nebulous zone not awake, not asleep, not thinking, not dreaming just there kind of aware but not aware.
I arrive back at SIL, the Bible translator's compound in N'Djaména, and shoot the breeze with Nathan until well after midnight. At 6:30am I'm awake again with the truck ready to go. We'd spent all day yesterday getting it fixed after running around, buying and replacing several parts. Now I go pick up Joy and Michelle from Pasteur Job's house. They've come visiting from the Adventist Hospital in Koze, North Cameroun. They are student missionary nurses. All we had to do is go to the Camerounian embassy to renew their Camerounian visas. Simple right? Wait, I'm forgetting we're in French Africa. We're told that even though they have 45 day valid Tchadian visas they need to go buy Visa de Court Sejour (3 months) before the ambassador can give them new Camerounian visas. A technicality but we run back and forth all over N'Djamena several times before it's resolved. I'm driving as we've left the chauffeur in Béré due to lack of space in the car.
Finally, at 10:45 we leave N'Djaména. We race through the pothole filled roads to Guelengdeng dodging them mostly but feeling the severe jolt when we come on one suddenly. No flat tires this time, though, not like the trip to N'Djaména. Suddenly, in Guelengdeng the truck stalls when I brake and put in the clutch. The same problem we'd supposedly fixed in N'Djaména. Now, leaving Guelengdeng we also start to lose power. I'm not sure we'll make it to Bongor but I find that by pumping the gas pedal I'm able to keep a little power and the pickup limps in. We stop right where we normally eat chicken, drink pineapple milkshakes and buy soap. As soon as I open the hood, a group crowds around quickly hoping to benefit from "Nasara." Everyone's a mechanic, several are drunk and I don't trust any. All I need is to change to fuel filter I think. We have an extra with us. I ask for a number 12 wrench. They give me one that is worn and when I say it doesn't work they try to show me that I'm just stupid Nasara who needs their expert help by grabbing it and almost stripping the nut before I can wrestle it away from them. I spot a public transport van just ahead and go ask for a real wrench which I get and soon have the filter off. Then someone comes with a tire chain welded to a pipe which grips the filter allowing me to unscrew the head. Then, I hear my name (although they've all been calling me "Docteur" from the beginning, I guess I've been there enough times now), Docteur James and I recognize the mechanic/chauffeur from the health district of Béré. Just happens to have stopped there on his way to N'Djaména so he makes a few adjustments to the idle and we are on our way. Not before pipe/bike chain man demands to be paid. I give him 500 francs. He refuses saying he'll take nothing rather than that small amount. I say fine. I'm going. The passengers with us, the chaplain's daughter, adds 500 making it a 1000 francs ($2). He still refuses. They say I should give him more. I tell him I just spent time with the second best mechanic in N'Djaména who charges 4000 francs/hour and since he wants more than 1000 francs for 15 minutes he must think he's a better mechanic. He continues to refuse. I get in the car. His friend takes the 1000 francs. I say it's not for you. My tchadian passengers say that's the way it works in Africa. The "mechanic" tries to make me feel guilty by coming up to wish me "bon voyage" even though I'm robbing him because he's a good person (according to him). I say, "Ça va" and start up the car. Finally, he realizes he isn't going to get more so his attitude changes, he takes the 1000 francs, smiles, shakes my hand and wishes me a real "bon voyage" now. Having visited with 6 different mechanics here in Tchad in the span of 2 weeks with 2 different cars has kind of made me a "local" as far as knowing what's appropriate payment for services.
We arrive in Béré at 6pm.
I'm really starting to feel the chills. I have goose bumps all over and my hair is standing on end. My teeth are chattering and my legs shivering. I go to the house and climb in my zero degree down sleeping bag still chattering. The muscle aches are severe now and my head is pounding. I drift into a troubled snooze.
At 8:30pm I'm sitting on the porch ready for our evening prayer time with the missionaries. As a good missionary I've only waited 11 months to start having regular prayer with the other missionaries! I finish my opening prayer and am interrupted by Anatole. A case of intestinal obstruction. After struggling to place a nasogastric tube I go to place the urinary catheter in the patient before surgery. It gets blocked. Bloody tip. Try again. Finally, after 4 different types of catheters and no success we decide to just start the surgery. It's about 10pm. I scrub, Samedi preps with Betadine, and we gown and drape. After a prayer by Anatole, I grab the scalpel and slice quickly from sternum to pubis. Going through skin and subcutaneous fat I hit the fascia and slice through. The pressure inside the belly bulges out as I dissect carefully into the peritoneal cavity and then with my fingers protecting cut rapidly through the rest of the fascia till his belly is laid open from top to bottom. Black, foul-smelling small intestine pours out along with thick, dark red fluid. The Sigmoid colon is hugely dilated with the necrotic small intestine wrapped around it's base. I try to reduce the colon through the trap unsuccessfully. I poke a hole in the bowel wall letting out the gas and some nasty fluid then pull tight the purse string suture to close the hole and reduce the sigmoid freeing it. It is inflamed but still viable. The small intestine is dead just up to about 6-8 cm from the Cecum and halfway back to the duodenum. I clamp the bowel, poke/clamp/cut/tie across the blood supply to the dead part and heave it off onto the floor. Then I suture the two cut ends of good intestine back together in two layers. Then it's irrigation with cold fluids (I know they‚re supposed to be warm but how in the middle of the night in an emergency with no reliable source of power?) and suck out all the nastiness. I leave in two drains and stuff the colon and intestines back into their rightful place. I then close him up. By the end I can barely stand. I feel drained. It's 1am. Walking back I feel chills and have to warm up under the shower for half an hour before being able to sleep.
Matthieu comes to tell me my Malaria smear is positive for Falciparum (the worst kind). I take 5 Mefloquines and go back to the warmth of my sleeping bag.
Yesterday was no better. I come in to a hospital filled to the gills, mostly with nomadic arabs. I clear the place out by sending many home (as they should've been days ago). Then there's a girl with a post partum infection. She'd been to the Health Center on the 10th after 5 days of labor and was referred to the hospital. She shows up here two weeks later after delivering a dead baby at home with pus dripping out from down below. I take her to surgery, give her a spinal anesthetic and then try to clean up the damage. There is dead tissue in side that is easily pulled out. I then notice what looks like the inside of her bladder and I can‚t identify the cervix. It turns out her bladder has about an 8cm tear in it into the anterior vagina and her cervix was so shredded I can't even really find the opening into the uterus. I finally find it but it's at a weird angle, impossible to do a D&C. I have the mom by a urinary catheter and a suture and I proceed to repair her bladder injury. It seems to be working so far. Pray is all I can say.
That evening we celebrated Thanksgiving with mashed potatoes and gravy and Fri-chik Nathan got in a package from his mom. I just wasn't that hungry. I went to sleep early.
After worship today, I'd told the staff we would like them to celebrate Thanksgiving with us today even though it's a day late. After taking my Mefloquine and sleeping a few hours the chills and fever have worn off so I weakly join them in the courtyard under the trees where we have three coffee tables full of boiled chicken and rice. This is the first meal as a hospital staff together. I explain the rules and we all say what we're thankful for and then "Papa" Sam (Samedi) prays and we dig in and enjoy an hour of pleasant conversation. Everyone totally loved it. We finish and I head back to bed to sleep off my malaria and hope for no more terrible bouts of severe chills.
This evening I'm lying on the couch listening to Avalon's "We Are the Reason" and "Adonai" and I get chills for a different reason and I start to cry (I don't know if it's just the Mefloquine making me emotionally labile or not--I don't care). It's tears of joy though and overwhelming thanks to "my Adonai" who has brought me here to Béré.
Malaria's giving me a headache and a few chills now--gotta go.
James
I drove her to the N'Djamena airport in our pickup. We walked across the courtyard and into the waiting area past huddled groups of Tchadians, many wearing the traditional robes and round hats or turbans. Sarah packs lightly so I had her backpack on and she had just a tiny carry on bag. Acting like we knew what we were doing we walked past the guards through the cage like entrance to the check in room. I held her hand. We loaded her bag onto the belt and I hugged her good bye. Apparently, people were watching in wonder to see someone actually show affection because when I let her go where only ticketed passengers can go a woman came up and told me to go with her. She said we could go up to the observatory to watch the plane come in. The woman checked her passport and then we walked up the steps to a huge glass window with open slats letting the cool N'Djaména night air blow in. We stood there laughing and talking watching a plane come in (not many come into N'Djaména). Finally, I knew I had to say goodbye. I felt weird, surreal. It hadn't sunk in that she was leaving and that I wouldn't see her again until a week before we got married. I had the strange sensation of wondering if I even knew this beautiful girl with wild red hair beside me and would I feel even weirder after a month apart. Then I walked down the stairs, past the passport checkpoints, out the guarded cage-like entrance and into the eerily dimly lit yellow N'Djaména night. Across the pavement, into the car, zombie like thinking how normal this all seemed and yet within a few hours one could be in Europe in a different universe.
Rahama knocks on the door and opens it. "Docteur, pardonnez-moi, mais il y a d'un urgence." And three sweaty, out-of-breath men come in carrying an elderly woman who's moaning but not responsive. Probably malaria. I examine her and order some tests and treatments and send her to the ward. I really start to feel chills. I head to the lab and have Matthieu poke my finger for a Goutte Epaisse (malaria smear). Then I go back and lie down, slipping quickly into that nebulous zone not awake, not asleep, not thinking, not dreaming just there kind of aware but not aware.
I arrive back at SIL, the Bible translator's compound in N'Djaména, and shoot the breeze with Nathan until well after midnight. At 6:30am I'm awake again with the truck ready to go. We'd spent all day yesterday getting it fixed after running around, buying and replacing several parts. Now I go pick up Joy and Michelle from Pasteur Job's house. They've come visiting from the Adventist Hospital in Koze, North Cameroun. They are student missionary nurses. All we had to do is go to the Camerounian embassy to renew their Camerounian visas. Simple right? Wait, I'm forgetting we're in French Africa. We're told that even though they have 45 day valid Tchadian visas they need to go buy Visa de Court Sejour (3 months) before the ambassador can give them new Camerounian visas. A technicality but we run back and forth all over N'Djamena several times before it's resolved. I'm driving as we've left the chauffeur in Béré due to lack of space in the car.
Finally, at 10:45 we leave N'Djaména. We race through the pothole filled roads to Guelengdeng dodging them mostly but feeling the severe jolt when we come on one suddenly. No flat tires this time, though, not like the trip to N'Djaména. Suddenly, in Guelengdeng the truck stalls when I brake and put in the clutch. The same problem we'd supposedly fixed in N'Djaména. Now, leaving Guelengdeng we also start to lose power. I'm not sure we'll make it to Bongor but I find that by pumping the gas pedal I'm able to keep a little power and the pickup limps in. We stop right where we normally eat chicken, drink pineapple milkshakes and buy soap. As soon as I open the hood, a group crowds around quickly hoping to benefit from "Nasara." Everyone's a mechanic, several are drunk and I don't trust any. All I need is to change to fuel filter I think. We have an extra with us. I ask for a number 12 wrench. They give me one that is worn and when I say it doesn't work they try to show me that I'm just stupid Nasara who needs their expert help by grabbing it and almost stripping the nut before I can wrestle it away from them. I spot a public transport van just ahead and go ask for a real wrench which I get and soon have the filter off. Then someone comes with a tire chain welded to a pipe which grips the filter allowing me to unscrew the head. Then, I hear my name (although they've all been calling me "Docteur" from the beginning, I guess I've been there enough times now), Docteur James and I recognize the mechanic/chauffeur from the health district of Béré. Just happens to have stopped there on his way to N'Djaména so he makes a few adjustments to the idle and we are on our way. Not before pipe/bike chain man demands to be paid. I give him 500 francs. He refuses saying he'll take nothing rather than that small amount. I say fine. I'm going. The passengers with us, the chaplain's daughter, adds 500 making it a 1000 francs ($2). He still refuses. They say I should give him more. I tell him I just spent time with the second best mechanic in N'Djaména who charges 4000 francs/hour and since he wants more than 1000 francs for 15 minutes he must think he's a better mechanic. He continues to refuse. I get in the car. His friend takes the 1000 francs. I say it's not for you. My tchadian passengers say that's the way it works in Africa. The "mechanic" tries to make me feel guilty by coming up to wish me "bon voyage" even though I'm robbing him because he's a good person (according to him). I say, "Ça va" and start up the car. Finally, he realizes he isn't going to get more so his attitude changes, he takes the 1000 francs, smiles, shakes my hand and wishes me a real "bon voyage" now. Having visited with 6 different mechanics here in Tchad in the span of 2 weeks with 2 different cars has kind of made me a "local" as far as knowing what's appropriate payment for services.
We arrive in Béré at 6pm.
I'm really starting to feel the chills. I have goose bumps all over and my hair is standing on end. My teeth are chattering and my legs shivering. I go to the house and climb in my zero degree down sleeping bag still chattering. The muscle aches are severe now and my head is pounding. I drift into a troubled snooze.
At 8:30pm I'm sitting on the porch ready for our evening prayer time with the missionaries. As a good missionary I've only waited 11 months to start having regular prayer with the other missionaries! I finish my opening prayer and am interrupted by Anatole. A case of intestinal obstruction. After struggling to place a nasogastric tube I go to place the urinary catheter in the patient before surgery. It gets blocked. Bloody tip. Try again. Finally, after 4 different types of catheters and no success we decide to just start the surgery. It's about 10pm. I scrub, Samedi preps with Betadine, and we gown and drape. After a prayer by Anatole, I grab the scalpel and slice quickly from sternum to pubis. Going through skin and subcutaneous fat I hit the fascia and slice through. The pressure inside the belly bulges out as I dissect carefully into the peritoneal cavity and then with my fingers protecting cut rapidly through the rest of the fascia till his belly is laid open from top to bottom. Black, foul-smelling small intestine pours out along with thick, dark red fluid. The Sigmoid colon is hugely dilated with the necrotic small intestine wrapped around it's base. I try to reduce the colon through the trap unsuccessfully. I poke a hole in the bowel wall letting out the gas and some nasty fluid then pull tight the purse string suture to close the hole and reduce the sigmoid freeing it. It is inflamed but still viable. The small intestine is dead just up to about 6-8 cm from the Cecum and halfway back to the duodenum. I clamp the bowel, poke/clamp/cut/tie across the blood supply to the dead part and heave it off onto the floor. Then I suture the two cut ends of good intestine back together in two layers. Then it's irrigation with cold fluids (I know they‚re supposed to be warm but how in the middle of the night in an emergency with no reliable source of power?) and suck out all the nastiness. I leave in two drains and stuff the colon and intestines back into their rightful place. I then close him up. By the end I can barely stand. I feel drained. It's 1am. Walking back I feel chills and have to warm up under the shower for half an hour before being able to sleep.
Matthieu comes to tell me my Malaria smear is positive for Falciparum (the worst kind). I take 5 Mefloquines and go back to the warmth of my sleeping bag.
Yesterday was no better. I come in to a hospital filled to the gills, mostly with nomadic arabs. I clear the place out by sending many home (as they should've been days ago). Then there's a girl with a post partum infection. She'd been to the Health Center on the 10th after 5 days of labor and was referred to the hospital. She shows up here two weeks later after delivering a dead baby at home with pus dripping out from down below. I take her to surgery, give her a spinal anesthetic and then try to clean up the damage. There is dead tissue in side that is easily pulled out. I then notice what looks like the inside of her bladder and I can‚t identify the cervix. It turns out her bladder has about an 8cm tear in it into the anterior vagina and her cervix was so shredded I can't even really find the opening into the uterus. I finally find it but it's at a weird angle, impossible to do a D&C. I have the mom by a urinary catheter and a suture and I proceed to repair her bladder injury. It seems to be working so far. Pray is all I can say.
That evening we celebrated Thanksgiving with mashed potatoes and gravy and Fri-chik Nathan got in a package from his mom. I just wasn't that hungry. I went to sleep early.
After worship today, I'd told the staff we would like them to celebrate Thanksgiving with us today even though it's a day late. After taking my Mefloquine and sleeping a few hours the chills and fever have worn off so I weakly join them in the courtyard under the trees where we have three coffee tables full of boiled chicken and rice. This is the first meal as a hospital staff together. I explain the rules and we all say what we're thankful for and then "Papa" Sam (Samedi) prays and we dig in and enjoy an hour of pleasant conversation. Everyone totally loved it. We finish and I head back to bed to sleep off my malaria and hope for no more terrible bouts of severe chills.
This evening I'm lying on the couch listening to Avalon's "We Are the Reason" and "Adonai" and I get chills for a different reason and I start to cry (I don't know if it's just the Mefloquine making me emotionally labile or not--I don't care). It's tears of joy though and overwhelming thanks to "my Adonai" who has brought me here to Béré.
Malaria's giving me a headache and a few chills now--gotta go.
James
Tuesday, October 19, 2004
Footsteps right behind you
I walked swiftly down the path. Through the sunlight flickering off the rustling leaves of the guava trees I could see the kids slinking up. I felt the adrenaline surge. This was my time. The kids always stole our guavas. I knew how to stop them. All I had to do was catch one and beat him up like any good Nangjere man would do and the theft would stop. Unfortunately, for some reason beating up on small children has been something I‚ve never been able to do. Now, if it was the pigs that came scrounging for worms every morning. I could beat them up without a qualm. The only problem is they're too fast. You'd never think it to see them, but they're fast.
The kid in the tree saw me. Two things happened simultaneously: one, I kicked off my flip flops and began to lope towards the tree while, two, the boy almost fell out of the tree in his hurry to get down. His watchman took off and quickly veered left. I was hot on the tail of the second, the one who'd actually been in the tree.
A few days before I thought I'd found a solution. We watched from our screen window as a 12 or 13 year old took off one shoe, leaving the other shoe and both socks on, and climbed up the tree while his watchman stood casually by. Nathan went out the side door and ran up. Amazingly, for the first time ever, they didn't run. Everyone runs when Nasara comes anywhere close to where they are stealing guavas. They must've been new and didn't know the rules. So Nathan casually grabs his shoe. I follow close behind. I ask the boy how many guavas he's stolen. He looks confused. I explain that taking things that don't belong to you is called stealing. He nods and seems to understand. I notice two green guavas in his hand. I say, we'll keep your shoe here, you come back tomorrow to pay for the guavas and we'll give the shoe back.
He hangs around all afternoon with a small crowd of boys eager to see how the drama will unfold.
Nathan and I are on my side later that afternoon and see another boy up a tree. We pounce easily and take his hat. He follows us to the porch where we are soon surrounded by boys of all ages and a ritual dance of bargaining begins. He claims its not stealing. He claims it is only one guava and since when we caught him he dropped it to the ground he didn't really take it. I ask how much guavas go for. The boys say 10 francs (about 2 pennies). Finally, we bargain down to 5 francs and he pays for the two guavas of the other boy, they get their hat and shoe back respectively, and I explain how we don't like stealing so if they want our guavas all they have to do is ask for them.
This boy I'm chasing obviously hasn't been informed of that. He just knows someone is chasing him and he needs to get away. He's in too much of a hurry. I pace myself. I keep up with him easily with a measured stride. He cuts down a pit where mud bricks have been harvested and falls getting up in almost the same motion as I circle the rim. He ascends the other side with me know hotly on his heels. We enter an opening in a mud brick wall and circle around a hut into a courtyard. Â I can smell his fear. I know he's mine. He realizes he's in a dead end. He finds a narrow break behind a pile of reed mats. I cut him off. He stops behind the mats. Only the mats protects him from what he is sure is a severe beating. He begs for forgiveness then makes a break for it. I'm only a few feet behind. The pigs are his ruin.
You see, everywhere a small patch of water gathers, there the pigs will gather as well wallowing deep in with silly grins plastered on their snouts. When our outside faucet leaked last spring the melodious sounds of contentedly snorting pigs never ceased to freshen the airwaves as they kept it boggy. The pig's snuggling down keeps the wallow wet and slick even when all around has dried out.
Our friend met his wallow. With a look of surprise and terror he went down fast and hard skidding along the slime for a good 5 feet on his belly. I was on him in a second. I grabbed his wrist and pulled him up out of the bog. Come with me. He couldn't do anything but comply because of his fear even though I barely had his wrist with one hand. I had no idea what I was going to do with him but it had been good sport by the powers. He finally realized my weak grip and broke free only to trip and fall within 10 feet. By then the crowd has gathered and I explained again that while we don't like stealing we don't mind if they eat our guavas if they ask. I release him.
Between chasing them from our guava trees, playing basketball on our leaning tower of hoop and playing guitar and drums on the porch, we have gained quite a following among the local kids who never cease to tirelessly yell out "jay-mmm-suh, jay-mmm-suh, lalé, lapia, lalé" as they wave joyously anytime we pass or hang out. They are dirty, naked, barefoot, ragged, cheery, playful, mischievous, tireless, incorrigible and about the cutest to be found anywhere.
Since that day, one tiny little 6 year old boy never fails to come up every day and with a big grin ask in broken French, "Je mange les guyabes??" We of course say, "Oui, eat all you want"
James
The kid in the tree saw me. Two things happened simultaneously: one, I kicked off my flip flops and began to lope towards the tree while, two, the boy almost fell out of the tree in his hurry to get down. His watchman took off and quickly veered left. I was hot on the tail of the second, the one who'd actually been in the tree.
A few days before I thought I'd found a solution. We watched from our screen window as a 12 or 13 year old took off one shoe, leaving the other shoe and both socks on, and climbed up the tree while his watchman stood casually by. Nathan went out the side door and ran up. Amazingly, for the first time ever, they didn't run. Everyone runs when Nasara comes anywhere close to where they are stealing guavas. They must've been new and didn't know the rules. So Nathan casually grabs his shoe. I follow close behind. I ask the boy how many guavas he's stolen. He looks confused. I explain that taking things that don't belong to you is called stealing. He nods and seems to understand. I notice two green guavas in his hand. I say, we'll keep your shoe here, you come back tomorrow to pay for the guavas and we'll give the shoe back.
He hangs around all afternoon with a small crowd of boys eager to see how the drama will unfold.
Nathan and I are on my side later that afternoon and see another boy up a tree. We pounce easily and take his hat. He follows us to the porch where we are soon surrounded by boys of all ages and a ritual dance of bargaining begins. He claims its not stealing. He claims it is only one guava and since when we caught him he dropped it to the ground he didn't really take it. I ask how much guavas go for. The boys say 10 francs (about 2 pennies). Finally, we bargain down to 5 francs and he pays for the two guavas of the other boy, they get their hat and shoe back respectively, and I explain how we don't like stealing so if they want our guavas all they have to do is ask for them.
This boy I'm chasing obviously hasn't been informed of that. He just knows someone is chasing him and he needs to get away. He's in too much of a hurry. I pace myself. I keep up with him easily with a measured stride. He cuts down a pit where mud bricks have been harvested and falls getting up in almost the same motion as I circle the rim. He ascends the other side with me know hotly on his heels. We enter an opening in a mud brick wall and circle around a hut into a courtyard. Â I can smell his fear. I know he's mine. He realizes he's in a dead end. He finds a narrow break behind a pile of reed mats. I cut him off. He stops behind the mats. Only the mats protects him from what he is sure is a severe beating. He begs for forgiveness then makes a break for it. I'm only a few feet behind. The pigs are his ruin.
You see, everywhere a small patch of water gathers, there the pigs will gather as well wallowing deep in with silly grins plastered on their snouts. When our outside faucet leaked last spring the melodious sounds of contentedly snorting pigs never ceased to freshen the airwaves as they kept it boggy. The pig's snuggling down keeps the wallow wet and slick even when all around has dried out.
Our friend met his wallow. With a look of surprise and terror he went down fast and hard skidding along the slime for a good 5 feet on his belly. I was on him in a second. I grabbed his wrist and pulled him up out of the bog. Come with me. He couldn't do anything but comply because of his fear even though I barely had his wrist with one hand. I had no idea what I was going to do with him but it had been good sport by the powers. He finally realized my weak grip and broke free only to trip and fall within 10 feet. By then the crowd has gathered and I explained again that while we don't like stealing we don't mind if they eat our guavas if they ask. I release him.
Between chasing them from our guava trees, playing basketball on our leaning tower of hoop and playing guitar and drums on the porch, we have gained quite a following among the local kids who never cease to tirelessly yell out "jay-mmm-suh, jay-mmm-suh, lalé, lapia, lalé" as they wave joyously anytime we pass or hang out. They are dirty, naked, barefoot, ragged, cheery, playful, mischievous, tireless, incorrigible and about the cutest to be found anywhere.
Since that day, one tiny little 6 year old boy never fails to come up every day and with a big grin ask in broken French, "Je mange les guyabes??" We of course say, "Oui, eat all you want"
James
Calloused Hearts or Just Feet?
The sunset that evening sank into the dusty earth as if in a trance. Just a yellow orb leaving only a tiny trail of pink...it was like a sticky yellow ball flung onto a wall of light blue and slowly sliding into the night with no dying breath or comment. How jipped I felt!
In the early hours before dawn of that same day, Sarah, another nurse, and I had lost a small baby boy to death. His small body was already too weak to live when the parents had finally brought him to the hospital as a last resort. His small round belly had the markings of local healing. That is, he had scars on either side of his stomach where the parents had tried to bleed the evil out. It hadn't helped.
His bone thin extremities barely moved, and his eyes stared up at me in an empty gaze. I lead his parents down the dark hospital hallway, holding his infusion of quinine and glucose high as if it would light my step. I remember thinking I should put him in a bed where the least amount of kids had died. Maybe that would help. It hadn't.
Some people have made light of death of small children at Béré Hospital. It makes continuing with life easier if they laugh about it- saying the parents have eight other kids to worry about. They'll just have another kid to make up for that one. Some have even gone so far as to say that the villagers don't feel much human pain or loss. How unfair that is!
It you could only see the way a worried grandmother looked over her small granddaughter. I watched the shriveled brown fingers of the grandmother's hand gently caress the baby's forehead. Then the grandmother hunched forward as if in extreme pain. I thought she was going to let out a wail for a second, but she just put her head in her hands silently. And people have suggested they don't feel pain?
It is true that most of the dark eyed women here are forced into marriage at an absurd early age. Even before their breasts are fully developed, they are soon sagging after only five years. They are uneducated about sanitation and mud-hut keeping, and trained to cower beneath their old decrepit husbands who already have four other wives.
However, I believe their hearts are calloused (if I should apply such a term) out of necessity of survival...like their mud-soiled feet, yet their motherhood (or fatherhood) seems to bring about a softening of that guarded heart. I guess I can explain it as the kind of life that keeps their feet tough and their brown faces smiling.
Today, for example, I observed an old man squish his face like a contorted raisin with whiskers, (he had extreme pain from his toe amputation,) then in the next second, he stuck out his hand grinning from ear to ear to greet me. Amazing!
I think maybe they have naturally discovered this Buddha thought that "the secret of health for both mind and body is not to mourn for the past, not to worry about the future, or not to anticipate troubles, but to live in the present moment wisely and earnestly." Or perhaps Buddha arrived at such a conclusion from watching civilizations similar to Béré?
With their loads piled high on their heads, (the women anyway), and life shooting out of every sandy crevice throughout the village, the people keep laughing. No time is spent on burial...for life is alive and kicking around the corner. It is not their heartlessness or lack of pain that keeps them going each day. It is wisdom!
Becky Jarnes
In the early hours before dawn of that same day, Sarah, another nurse, and I had lost a small baby boy to death. His small body was already too weak to live when the parents had finally brought him to the hospital as a last resort. His small round belly had the markings of local healing. That is, he had scars on either side of his stomach where the parents had tried to bleed the evil out. It hadn't helped.
His bone thin extremities barely moved, and his eyes stared up at me in an empty gaze. I lead his parents down the dark hospital hallway, holding his infusion of quinine and glucose high as if it would light my step. I remember thinking I should put him in a bed where the least amount of kids had died. Maybe that would help. It hadn't.
Some people have made light of death of small children at Béré Hospital. It makes continuing with life easier if they laugh about it- saying the parents have eight other kids to worry about. They'll just have another kid to make up for that one. Some have even gone so far as to say that the villagers don't feel much human pain or loss. How unfair that is!
It you could only see the way a worried grandmother looked over her small granddaughter. I watched the shriveled brown fingers of the grandmother's hand gently caress the baby's forehead. Then the grandmother hunched forward as if in extreme pain. I thought she was going to let out a wail for a second, but she just put her head in her hands silently. And people have suggested they don't feel pain?
It is true that most of the dark eyed women here are forced into marriage at an absurd early age. Even before their breasts are fully developed, they are soon sagging after only five years. They are uneducated about sanitation and mud-hut keeping, and trained to cower beneath their old decrepit husbands who already have four other wives.
However, I believe their hearts are calloused (if I should apply such a term) out of necessity of survival...like their mud-soiled feet, yet their motherhood (or fatherhood) seems to bring about a softening of that guarded heart. I guess I can explain it as the kind of life that keeps their feet tough and their brown faces smiling.
Today, for example, I observed an old man squish his face like a contorted raisin with whiskers, (he had extreme pain from his toe amputation,) then in the next second, he stuck out his hand grinning from ear to ear to greet me. Amazing!
I think maybe they have naturally discovered this Buddha thought that "the secret of health for both mind and body is not to mourn for the past, not to worry about the future, or not to anticipate troubles, but to live in the present moment wisely and earnestly." Or perhaps Buddha arrived at such a conclusion from watching civilizations similar to Béré?
With their loads piled high on their heads, (the women anyway), and life shooting out of every sandy crevice throughout the village, the people keep laughing. No time is spent on burial...for life is alive and kicking around the corner. It is not their heartlessness or lack of pain that keeps them going each day. It is wisdom!
Becky Jarnes
Saturday, October 9, 2004
Moonlight and Guavas
The Tchadian sky stretches out expanding beyond what seems possible to give the effect of being in some circus mirror show where everything is distorted to become larger than life. It's a brilliant light clear blue sky except for one huge bank of stacked puffy white clouds on the horizon. We are escaping Bere and the hospital. Becky, our second redhead nurse leads the way down the small path away from the back of the compound. Nathan, our 6'7" student missionary, strides casually beside her. Wendi, the third redhead in the group walks behind me with Jennie, the second newly arrived volunteer nurse. Sarah, the first and final redhead, brings up the rear. The sun beats down fiercely as we enter the rice fields where the path disappears under water for long stretches at a time. The water is hot to our bare feet alternating between a fresh sandy and a sticky mud bottom. We occasionally pass locals on their way to or from who knows where carrying flip flops and wading purposefully through the water much as we are. Friendly "lapia's" are exchanged and repeated as befits local custom. Occasionally, a "lapia aye" or "lalay" will be thrown in for variety. Of course, Sarah has to always show off by actually carrying on brief conversations in Nangjere not just giving generic greetings. I found it's not really necessary as "lapia" repeated often back and forth seems to keep everyone content.
At the river finally we are surrounded as usual by half naked children with fishing spears or poles who are more than happy to leave what their doing to watch "nasara" swim. What could be more entertaining than watching weird looking strange white foreigners jumping, swimming, mud wrestling and tossing mud at them? Getting them to hum the tune of "Indiana Jones" is also a big hit.
Coming back the moon is reflecting perfectly off the still waters of the rice paddies as the sky is still pinked from the recently setting sun.
A few days later a baby comes in with a severe infection in her groin and legs and lower abdomen. Antibiotics help but then large black dead skin patches remain with yellow pus filled edges. They need to be debrided (taken off). I do. That afternoon Sarah comes to me to say she's unconscious. I come and find her recently dead. I desperately refuse to believe. She's pale. The bandages are red with blood. She's bled out and no one noticed. I do CPR furiously unable to let go and accept that I should have checked back on her several times before going home. I would've noticed. No one else did or seemed to be concerned about her at all. A waste. We have no post operative recovery room or any real post operative care. I see death all the time but this one gets to me. I should've checked more carefully to make sure all bleeding was stopped. Sarah is also devastated when I see her later. She feels it's her fault. I hug her and let her know it's not. I feel sick to my stomach.
Dimanche's sister comes in the next morning with abdominal pain. I first hear from the nurse that it's probably a urinary infection. I go to see her and I at first think it's appendicitis. She gives a good story and has peritoneal signs consistent with appendicitis. I decide I should do a pelvic exam first. Then I think it's probably an infection of the uterus or tubes. The pain has switched sides to the left. Then, her story changes too. I wish I had an ultrasound or other tests. I check a blood count which is normal. I put her on antibiotics and continue my work. I don't feel quite comfortable with the diagnosis. After work, the gang wants to go to the river. Right before leaving I decide to check on the patient again. She's worse. I look some stuff up in books and ask some more questions. I wish I had an ultrasound again. After reading I remember I should have checked to see if she was pregnant even if she hasn't missed a period. Matthieu comes in from home to do the test but says it probably won't work because it's not a morning urine sample. We do it anyway. The faintest of lines appears telling us it's positive. I feel relief. God has helped us come to the probable diagnosis even with our lack of equipment--ectopic pregnancy (out of the uterus). I know I need to operate but I'm always more nervous when it's a friend or a relative someone I work with everyday in this case. What if I'm wrong and I operate for nothing and something goes wrong? I'd operated a woman a few months ago who I'd thought had an ectopic pregancy and it turned out to be a simple pelvic infection treatable with antibiotics. Was I making the same mistake? I open up her belly in a low pelvic (Pfannensteil) incision and dark blood comes out of the abdomen. Sure enough there's a swollen mass in the left Eustachian tube. It was about to rupture. Despite some delays due to lack of equipment and my not having anyone to consult eventually with the help of books God led me to do the right thing in time to save her. What if I'd just gone to the river like I really wanted to? It's so hard to find that balance between doing what's right and needs to be done and not getting so overwhelmed and sucked in that you lose yourself and who you are in the incredible, never ending needs of a place like Béré.
Today, I'm finishing up lunch and look out the window at our guava trees. I see three kids staring up. There must be another kid up them again stealing our guavas. If they'd just ask I'd give it to them but kids here have no sense of right and wrong or respect for what belongs to others (like privacy for example). It's not their fault. They have no boundaries. They are outside naked and barefoot with other kids with no regular meals, often dependent on what they find in order to be able to eat. Then at night they can be out until 2-3 in the morning dancing and singing and pounding on drums without any set bedtime. I'm talking about 3 and 4 and 5 year olds as well as the pre-teens and teens. So they get the idea they shouldn't be doing something but not because it's wrong; because they might get beat if they're caught.
So I sneak out the front door to the edge of the house. The three kids are absorbed in whatever's happening in the branches above them. I start running. About 15 feet away they see me and start to run. I arrive at the tree and look up. Sure enough, a kid is caught there. She's about 8-9 years old dressed in a rag wrapped around her waist with bare feet and chest. I look at her with an expressionless face. Then I feel a shock course through me as she lets out a blood curdling yell that doesn't stop as her eyes go wild with fear and she's starts swaying on the branch while holding on tightly above her. I tell her to come down in a flat voice. I feel cut to the quick by her unreasonable fear. She starts to come down howls filling the air.
Other kids start gathering and laughing hysterically at her cries and fear and that she'll probably get the beating of her life now from the terrible "nasara." A couple adults who appear to be relatives approach. She comes down and when I reach to help her down she goes ballistic hanging onto the tree for all she's worth while her screams make my blood go cold. I pull her off the tree and let her down to the ground. She collapses and tries to wriggle away. I grab her wrist gently but firmly. She has wrapped herself around the legs of one of her relatives. Â I pull her free and if possible her cries intensify. I have a sick pit in my stomach half-loving and half-loathing the fear I cause in her. I explain to her relatives that this is our property and that taking stuff from someone else's property is called stealing. They agree. The surrounding kids continue to chortle gleefully at the young girl's distress.
The relatives start to yell viciously at the poor girl. I interrupt to continue trying to explain reasonably why she shouldn't be in our tree. I ask what they will do about it. The young man says they'll discipline her. I let her go as the giggles from the kids continue. The young man picks up a switch as she takes off. I turn away hoping that they won't beat her if I'm not there--that they would only do it because they think I want it and that when I leave they'll all just laugh but somehow I just think the whole situation was sick. If the kids would just ask for the guavas I'd give them to them. But their parents have never taught them how to behave so they have no clue. They learn from their fellow children and that is the basis for the society and social structure and attitudes that leads them later in life to prefer to let their kid die than pay $5 for a complete treatment.
I return home subdued--life is hard here in so many ways.
James
At the river finally we are surrounded as usual by half naked children with fishing spears or poles who are more than happy to leave what their doing to watch "nasara" swim. What could be more entertaining than watching weird looking strange white foreigners jumping, swimming, mud wrestling and tossing mud at them? Getting them to hum the tune of "Indiana Jones" is also a big hit.
Coming back the moon is reflecting perfectly off the still waters of the rice paddies as the sky is still pinked from the recently setting sun.
A few days later a baby comes in with a severe infection in her groin and legs and lower abdomen. Antibiotics help but then large black dead skin patches remain with yellow pus filled edges. They need to be debrided (taken off). I do. That afternoon Sarah comes to me to say she's unconscious. I come and find her recently dead. I desperately refuse to believe. She's pale. The bandages are red with blood. She's bled out and no one noticed. I do CPR furiously unable to let go and accept that I should have checked back on her several times before going home. I would've noticed. No one else did or seemed to be concerned about her at all. A waste. We have no post operative recovery room or any real post operative care. I see death all the time but this one gets to me. I should've checked more carefully to make sure all bleeding was stopped. Sarah is also devastated when I see her later. She feels it's her fault. I hug her and let her know it's not. I feel sick to my stomach.
Dimanche's sister comes in the next morning with abdominal pain. I first hear from the nurse that it's probably a urinary infection. I go to see her and I at first think it's appendicitis. She gives a good story and has peritoneal signs consistent with appendicitis. I decide I should do a pelvic exam first. Then I think it's probably an infection of the uterus or tubes. The pain has switched sides to the left. Then, her story changes too. I wish I had an ultrasound or other tests. I check a blood count which is normal. I put her on antibiotics and continue my work. I don't feel quite comfortable with the diagnosis. After work, the gang wants to go to the river. Right before leaving I decide to check on the patient again. She's worse. I look some stuff up in books and ask some more questions. I wish I had an ultrasound again. After reading I remember I should have checked to see if she was pregnant even if she hasn't missed a period. Matthieu comes in from home to do the test but says it probably won't work because it's not a morning urine sample. We do it anyway. The faintest of lines appears telling us it's positive. I feel relief. God has helped us come to the probable diagnosis even with our lack of equipment--ectopic pregnancy (out of the uterus). I know I need to operate but I'm always more nervous when it's a friend or a relative someone I work with everyday in this case. What if I'm wrong and I operate for nothing and something goes wrong? I'd operated a woman a few months ago who I'd thought had an ectopic pregancy and it turned out to be a simple pelvic infection treatable with antibiotics. Was I making the same mistake? I open up her belly in a low pelvic (Pfannensteil) incision and dark blood comes out of the abdomen. Sure enough there's a swollen mass in the left Eustachian tube. It was about to rupture. Despite some delays due to lack of equipment and my not having anyone to consult eventually with the help of books God led me to do the right thing in time to save her. What if I'd just gone to the river like I really wanted to? It's so hard to find that balance between doing what's right and needs to be done and not getting so overwhelmed and sucked in that you lose yourself and who you are in the incredible, never ending needs of a place like Béré.
Today, I'm finishing up lunch and look out the window at our guava trees. I see three kids staring up. There must be another kid up them again stealing our guavas. If they'd just ask I'd give it to them but kids here have no sense of right and wrong or respect for what belongs to others (like privacy for example). It's not their fault. They have no boundaries. They are outside naked and barefoot with other kids with no regular meals, often dependent on what they find in order to be able to eat. Then at night they can be out until 2-3 in the morning dancing and singing and pounding on drums without any set bedtime. I'm talking about 3 and 4 and 5 year olds as well as the pre-teens and teens. So they get the idea they shouldn't be doing something but not because it's wrong; because they might get beat if they're caught.
So I sneak out the front door to the edge of the house. The three kids are absorbed in whatever's happening in the branches above them. I start running. About 15 feet away they see me and start to run. I arrive at the tree and look up. Sure enough, a kid is caught there. She's about 8-9 years old dressed in a rag wrapped around her waist with bare feet and chest. I look at her with an expressionless face. Then I feel a shock course through me as she lets out a blood curdling yell that doesn't stop as her eyes go wild with fear and she's starts swaying on the branch while holding on tightly above her. I tell her to come down in a flat voice. I feel cut to the quick by her unreasonable fear. She starts to come down howls filling the air.
Other kids start gathering and laughing hysterically at her cries and fear and that she'll probably get the beating of her life now from the terrible "nasara." A couple adults who appear to be relatives approach. She comes down and when I reach to help her down she goes ballistic hanging onto the tree for all she's worth while her screams make my blood go cold. I pull her off the tree and let her down to the ground. She collapses and tries to wriggle away. I grab her wrist gently but firmly. She has wrapped herself around the legs of one of her relatives. Â I pull her free and if possible her cries intensify. I have a sick pit in my stomach half-loving and half-loathing the fear I cause in her. I explain to her relatives that this is our property and that taking stuff from someone else's property is called stealing. They agree. The surrounding kids continue to chortle gleefully at the young girl's distress.
The relatives start to yell viciously at the poor girl. I interrupt to continue trying to explain reasonably why she shouldn't be in our tree. I ask what they will do about it. The young man says they'll discipline her. I let her go as the giggles from the kids continue. The young man picks up a switch as she takes off. I turn away hoping that they won't beat her if I'm not there--that they would only do it because they think I want it and that when I leave they'll all just laugh but somehow I just think the whole situation was sick. If the kids would just ask for the guavas I'd give them to them. But their parents have never taught them how to behave so they have no clue. They learn from their fellow children and that is the basis for the society and social structure and attitudes that leads them later in life to prefer to let their kid die than pay $5 for a complete treatment.
I return home subdued--life is hard here in so many ways.
James
Friday, October 1, 2004
Nose Peanuts
Warning: no bloody, gory or otherwise crazy-nuts stories available at this time.
So I'm hauling sand what was left after construction of the wall. I decided to landscape a little around the house which is really ridiculous because now there's this one tiny patch of niceness replete with cactus, volcanic rock and a brick piece border on one corner of a tin roof house with peeling paint, cracked windows and moth eaten rafters harboring bats and rats. So anyway, the boys start gathering as they usually do anytime "Nasara" starts doing anything. Soon they have insisted on grabbing the shovels and hauling the sand in the wheel barrows as well--but you already know the story--this is really a tale about a boy--Fambe (think Thumper and Bambi crossed and you have an idea of the pronunciation). He starts dancing on the sand pile. He's only three, runs around naked most of the time and dances as if he was born to it. He's Lona's second youngest son. He loves to stare at "Nasara" with a blank look on his face. He won't smile, talk or do anything accept come up to you in church and want to sit on your lap until he rips your Arab robes. Then he'll run off to sweep up peanut shells off the floor. Occasionally, you'll be walking to work in the early morning fog and you'll see someone sitting in the dirt waving with a huge grin saying "lalé, lalé" but other than that it's all just serious, expressionless staring. I'm not sure if Fambe still likes me now after I circumcised him and he then got infected because, well he runs around naked and rolls in the dirt at every opportunity. Not to mention that he was quite proud of his new look and would show off to anyone. Oh, and there was the time I was tossing the football and accidently pegged him right on the head causing him to tumble off the porch railing he was perched on 4 feet to the ground. I got there quickly to find him screaming like a hyena with blood pouring off a tiny slit in his scalp. Lona just laughed and shook his head when I told him. As mentioned, Fambe has natural rhythm and likes to take one of my small drums, lay it between his legs as he sprawls on the ground and pound it--sometimes in rhythm with what we are playing.
Fambe's brother Henri on the other hand just stands around looking at you with the cheesiest grin all the time. I've never seen a kid so happy and with a bigger smile. Even when he was deadly sick with Malaria his smile never diminished--his eyes just looked a little droopy.
A boy with a huge Burkitt's Lymphoma on his right cheek (bigger than two huge grapefruits) who I've searched to world over to find treatment for comes into see me when I say I've found it. I first saw him walking down the street to market months ago and stopped the car to yell at him to come see me which he always has done everytime I've called for him. Now when I have the meds finally I set up an appointment to start chemo and he never shows up. I see him by the basketball court we've rigged up in a field the other day and he says he's coming tomorrow then never shows up. I don't get it--maybe he's afraid of getting his hopes up or what--I often can't figure out how people think here.
So, finally--nose peanuts. Never say never. You can teach an old dog new tricks. I never cease to be amazed. Sarah calls me to come see a baby with a peanut stuck up it's nose. I hurry over and see the baby comfortably in mom's arms. I walk down the hall to my office and gather my arsenal: Otoscope, nasal speculum, forceps, clamps, spray anesthetic. I'm armed to the teeth. I walk back balancing all my goodies in both hands. I turn the corner and see a strange man bending over the child. One of the other patients' fathers. I don't get it until I hear loud sucking noises. I'm frozen. He then lifts his lips off the baby's nostrils and there is the slimy peanut sitting right there. He nimbly picks it off and tosses it aside. I'm flabbergasted feeling a little foolish with my "modern" medecine. I tell Sarah to give them their money back and return home laughing and shaking my head. It's brilliant!
James
So I'm hauling sand what was left after construction of the wall. I decided to landscape a little around the house which is really ridiculous because now there's this one tiny patch of niceness replete with cactus, volcanic rock and a brick piece border on one corner of a tin roof house with peeling paint, cracked windows and moth eaten rafters harboring bats and rats. So anyway, the boys start gathering as they usually do anytime "Nasara" starts doing anything. Soon they have insisted on grabbing the shovels and hauling the sand in the wheel barrows as well--but you already know the story--this is really a tale about a boy--Fambe (think Thumper and Bambi crossed and you have an idea of the pronunciation). He starts dancing on the sand pile. He's only three, runs around naked most of the time and dances as if he was born to it. He's Lona's second youngest son. He loves to stare at "Nasara" with a blank look on his face. He won't smile, talk or do anything accept come up to you in church and want to sit on your lap until he rips your Arab robes. Then he'll run off to sweep up peanut shells off the floor. Occasionally, you'll be walking to work in the early morning fog and you'll see someone sitting in the dirt waving with a huge grin saying "lalé, lalé" but other than that it's all just serious, expressionless staring. I'm not sure if Fambe still likes me now after I circumcised him and he then got infected because, well he runs around naked and rolls in the dirt at every opportunity. Not to mention that he was quite proud of his new look and would show off to anyone. Oh, and there was the time I was tossing the football and accidently pegged him right on the head causing him to tumble off the porch railing he was perched on 4 feet to the ground. I got there quickly to find him screaming like a hyena with blood pouring off a tiny slit in his scalp. Lona just laughed and shook his head when I told him. As mentioned, Fambe has natural rhythm and likes to take one of my small drums, lay it between his legs as he sprawls on the ground and pound it--sometimes in rhythm with what we are playing.
Fambe's brother Henri on the other hand just stands around looking at you with the cheesiest grin all the time. I've never seen a kid so happy and with a bigger smile. Even when he was deadly sick with Malaria his smile never diminished--his eyes just looked a little droopy.
A boy with a huge Burkitt's Lymphoma on his right cheek (bigger than two huge grapefruits) who I've searched to world over to find treatment for comes into see me when I say I've found it. I first saw him walking down the street to market months ago and stopped the car to yell at him to come see me which he always has done everytime I've called for him. Now when I have the meds finally I set up an appointment to start chemo and he never shows up. I see him by the basketball court we've rigged up in a field the other day and he says he's coming tomorrow then never shows up. I don't get it--maybe he's afraid of getting his hopes up or what--I often can't figure out how people think here.
So, finally--nose peanuts. Never say never. You can teach an old dog new tricks. I never cease to be amazed. Sarah calls me to come see a baby with a peanut stuck up it's nose. I hurry over and see the baby comfortably in mom's arms. I walk down the hall to my office and gather my arsenal: Otoscope, nasal speculum, forceps, clamps, spray anesthetic. I'm armed to the teeth. I walk back balancing all my goodies in both hands. I turn the corner and see a strange man bending over the child. One of the other patients' fathers. I don't get it until I hear loud sucking noises. I'm frozen. He then lifts his lips off the baby's nostrils and there is the slimy peanut sitting right there. He nimbly picks it off and tosses it aside. I'm flabbergasted feeling a little foolish with my "modern" medecine. I tell Sarah to give them their money back and return home laughing and shaking my head. It's brilliant!
James
Monday, May 17, 2004
AIDS in Bere
As most people realize, AIDS is a huge problem in Africa. At first I didn't think it was that big a problem here but as it turns out that's just because people don't want to know, don't get tested, and if they are seropositive everyone hushes it up because to them its a death sentence and the health care workers feel like there's nothing to do either.
I felt the same way at first because all I saw were advanced cases who ended up dying.
Now I've started to identify and work with a group who I've tested because of various risk factors or exam findings (or often when they come with a kid at the end stage then I identify the parent as HIV +) This group is healthy and I've discovered that there are things we can do.
1. We can educate to prevent transmission (fidelity, if there are several wives and some are negatif...condoms, etc)
2. We can treat pregnant mothers to prevent transmission to the newborn (if we have the medicines which we hope to soon...transmission can also be reduced by elective c-section) We are trying to start a program to test pregnant women for HIV (very rarely done here)
3. We can see them at regularly scheduled monthly visits for routine physical exams and lab tests to identify and treat infections early
4. We can identify and treat Tuberculosis or give primary prevention with Isoniazid
5. We can provide emotional and psychological support...especially if they end up abandoned by their families (as unfortunately happens only too often)
And, if we can identify a group that is trustworthy and comes to regularly scheduled visits and is reliable we could hopefully start some of them on Anti-retroviral therapy (anti-HIV meds) if we could find some donors or if the government comes around to decreasing the cost.
We have somehow found a little hope on this dark continent that is at the point of an epidemic. Pray for us and if you can in anyway give us other suggestions or help in any way...
I felt the same way at first because all I saw were advanced cases who ended up dying.
Now I've started to identify and work with a group who I've tested because of various risk factors or exam findings (or often when they come with a kid at the end stage then I identify the parent as HIV +) This group is healthy and I've discovered that there are things we can do.
1. We can educate to prevent transmission (fidelity, if there are several wives and some are negatif...condoms, etc)
2. We can treat pregnant mothers to prevent transmission to the newborn (if we have the medicines which we hope to soon...transmission can also be reduced by elective c-section) We are trying to start a program to test pregnant women for HIV (very rarely done here)
3. We can see them at regularly scheduled monthly visits for routine physical exams and lab tests to identify and treat infections early
4. We can identify and treat Tuberculosis or give primary prevention with Isoniazid
5. We can provide emotional and psychological support...especially if they end up abandoned by their families (as unfortunately happens only too often)
And, if we can identify a group that is trustworthy and comes to regularly scheduled visits and is reliable we could hopefully start some of them on Anti-retroviral therapy (anti-HIV meds) if we could find some donors or if the government comes around to decreasing the cost.
We have somehow found a little hope on this dark continent that is at the point of an epidemic. Pray for us and if you can in anyway give us other suggestions or help in any way...
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